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Nelson Pediatrics Review (MCQs) 19ed. Which statement about pediatric poisoning is NOT true? □Most bestthing.info Paediatrics. (Multiple Choice Questions). Q A 5 years old boy presents with joint swelling after minor trauma, mother gives history of prolonged bleeding from . Nelson Pediatrics Review bestthing.info Kaplan Step 2 Kaplan USMLE Ped 05 First Aid First Aid Full First Aid Flashcards Med-Ped Peds Ped PAEDIATRICS.
Gender of external genitalia of foetus becomes clearly distinguished by a 10 weeks b 16 weeks c 12 weeks d 20 weeks. A child can copy a circle first at a 2 years of age b one and half year c 4 years d 3 years.
Fetal Respiratory movements occur earliest at a 12 wks b 16 wks c 20 wks d 11 wks. Vocabulary of IViyear old child is a words b words c words d words. Order of development of secondary sexual characteristic in male a Testicular development — pubic hair — Axillary hair — beard b Pubic hair — testicular development — axillary hair — beard c Testicular development — beard — pubic hair — axillary hair d Axillary hair — beard — pubic hair — testicular development.
Which is incorrect about Thumb sucking a Can lead to malocclusion b is a source of pleasure c is a sign of insecurity d must be treated vigorously in the first year. IQ between indicates a Mild mental retardation b Moderate retardation c Severe retardation d Profound retardation.
Preference of use of one hand handedness is evident by a 6 months b 1 year c 2 years d 3 years. Neonatal period extends up to a 21 day s of life b 30 days of life c 28 days of life d 35 days of life.
First permanent tooth to erupt is a 1 st Premolar b 1 st Molar c 1st Incisor d 2nd premolar.
Medical Interview Questions
How many digits can a five year old child remember a 4 b 5 c 8 d The average B. Delayed speech in a 5 year old child with normal motor and adaptive development is most likely due to a Mental retardation b Cerebral palsy c Kernicterus d Deafness.
Anthropometric assessment which does not show much change in years a Mid arm circumference b Skin fold thickness c Chest circumference: Head circumference ratio d Height. A 5 year old child is assessed to have developmental age of one year.
His developmental quotient would be a b 80 c 60 d True breath holding attacks generally do not occur after a 1 year b 5 years c 2 years d 18 months. When a child is not able to perform the following motor functions such as skipping, walking on heels, hopping in place or going forwards in tandem gait, his motor development is considered to be below a 3 years b 4 years c 6 years d 7 years.
Birth weight of a child doubles at five months of age while the birth length doubles at the age of a 1 year b 2 years c 3 years d 4 years. Child is not expected to do at 40 weeks of life a Creeps crawl b Walks with one hand held c Sits up alone d Pulls to standing position. Breast feeding is recommended at least for a 4 months b 6 months c 9 months d 1 year. The most important factor to overcome protein energy malnutrition in children less than 3 years is. A 2 year old child has a weight of 6.
What is the grade ofmalnutrition in this child? Breast feeding is contraindicated if the mother is taking a Propranolol b Broad spectrum antibiotics c Sulfonyl ureas d Insulin. Fatty Acid necessary during 0to6 months of age is a Linolic acid b Linolenic acid c Arachidonic acid d Palmitic acid.
Initial treatment of caustic exposures includes thorough removal of the product from the skin or eye by flushing with water. Emesis and lavage are contraindicated. Activated charcoal should not be used because it does not bind these agents and can predispose the patient to vomiting and subsequent aspiration. Endoscopy should be performed within hr of ingestion in symptomatic patients or those in whom injury is suspected on the basis of history and known characteristics of the ingested product.
A 16 yr old, lb patient reports consuming mg capsules containing acetaminophen 1 hr ago.
The most appropriate approach to treatment is to: The antidote for acetaminophen poisoning is NAC, which works primarily via replenishing hepatic glutathione stores. NAC therapy is most effective when initiated within 8 hr of ingestion. However, there is no demonstrated benefit to giving NAC before the 4 hr postingestion mark. Thus, patients who present early after ingestion should have a 4-hr level drawn and decision to initiate NAC should be based on this level. A 2 yr old child presents in the emergency department after the reported ingestion of a mouthful of lamp oil.
The child reportedly vomited once at home. A chest film is read as normal. The most appropriate therapy for this child is to: Chest radiographs may initially be normal, but they often show abnormalities within 6 hr of exposure in patients who have aspirated.
A teenage girl presents in the emergency department with the story that she got upset with her boyfriend and swallowed a "handful of aspirin" about 4 hr previously.
One hour afterward, after she began vomiting, she confessed to her mother what she had done. On examination the patient has normal vital signs and is asymptomatic except for the complaint of nausea. A serum salicylate level is ordered, but the laboratory reports no salicylates in her blood. Given that patients might initially be asymptomatic and might not report acetaminophen as a co-ingestant, an acetaminophen level should be checked in all patients who present after an intentional exposure or ingestion.
Brain perfusion pressure generally equals: See Chapter 63, page Often, coma is seen immediately after the injury and is sustained. In some cases, such as with an epidural hematoma, a child may be alert at presentation but the condition may deteriorate after a period of hours. A similar picture can be seen in children with diffuse swelling, in whom a talk-and-die scenario has been described.
Clinicians also should not be lulled into underappreciating the potential for deterioration of a child with moderate TBI GCS score with a significant contusion, because progressive swelling can potentially lead to devastating complications. In the comatose child with severe TBI, the second key clinical manifestation is the development of intracranial hypertension. The development of brain swelling is progressive.
Need for ICP-directed therapy may persist for longer than a week. A few children have coma without increased ICP, resulting from axonal injury or brainstem injury. Children with moderate to severe traumatic brain injury require intracranial pressure monitoring and treatment in the critical care unit to prevent progressive swelling. If neuromuscular blockade is needed, it may be desirable to monitor the EEG continuously because status epilepticus can occur; this complication will not be recognized in a paralyzed patient and is associated with raised ICP and unfavorable outcome.
Other first-tier therapies include the osmolar agents mannitol and hypertonic saline given in response to ICP spikes. If ICP remains refractory to treatment, careful reassessment of the patient is needed to rule out unrecognized hypercarbia, hypoxemia, fever, hypotension, hypoglycemia, pain, and seizures.
Repeat imaging should be considered to rule out a surgical lesion. Guidelines-based second-tier therapies for refractory raised ICP are available, but evidence favoring a given second-tier therapy is limited. In some centers, decompressive craniectomy is used. Others use a pentobarbital infusion. Other second-tier therapies such as lumbar CSF drainage are options.
102 TOP Pediatrics Multiple Choice Questions and Answers _ All Medical Questions and Answers
See Figure ; also Chapter 63, page Which of the following statements regarding cooling treatment for perinatal hypoxic ischemic encephalopathy is not true? Exclusion criteria have included coagulopathy, bleeding, and hemodynamic instability.
According to the American Heart Association AHA guidelines predominantly for adults after a cardiac arrest when the initial event was associated with ventricular fibrillation , cooling should be initiated as soon as possible after return of spontaneous circulation but may be beneficial even if delayed hr ; it should be induced by means of surface cooling with cooling blankets; application of ice packs to the groin, axillae, and neck; use of wet towels; and fanning.
In perinatal asphyxia, cooling should be maintained for 72 hr. Shivering should be prevented with sedation and neuromuscular blockade.
Temperature should be continuously monitored. Hypothermia in children has been associated with an increased risk for neutropenia and sepsis. Therapy is adjusted for both symptoms and EEG evidence of seizures. As therapy escalates, continuous EEG monitoring should be considered to help titrate therapy.
For refractory status epilepticus, newer therapies include mapping of the seizure focus followed by neurosurgical resection, IV lidocaine, or levetiracetam. Ischemic strokes in children are generally not the result of atherosclerotic plaque migration, as they are in adults.
Instead, damage to the intima of cerebral arteries can form a thrombotic nidus. In sickle cell disease, chronic turbulent blood flow likely leads to vascular damage. In intracerebral hemorrhage, blood vessel wall integrity is compromised, leading to extravasation of blood into the parenchyma or dural spaces. The usual pathology in children with heart disease is embolism from diseased valves or intracardiac devices and right-to-left shunts that leads to cerebrovascular occlusion. The most effective strategy to minimize any ventilator complication is regular assessment of extubation readiness and liberation from mechanical ventilation as soon as clinically possible.
See Chapter 65, page The initial ventilator settings are determined by: Patients with severe forms of reactive airways disease e. Diseases associated with decreased time constants decreased static compliance, e. Diseases associated with prolonged time constants increased airway resistance, e. Per the IOM, high-quality health care by definition must be: The Six Dimensions of Quality are effectiveness, efficiency, equity, timeliness, patient safety, and patient-centered care.
The IOM emphasizes the concept that all Six Dimensions of Quality need to be met for the provision of high-quality health care. Health care that maximizes outcomes but is not efficient i. Health care that is highly efficient but limits access also is not high quality.
These concepts can be viewed as the overall value proposition—that is, the value created for a patient. Which of the following is a step in the rapid cycle of improvement PDSA? The PDSA cycle is typically aimed at testing small changes and then studying the results to plan and implement the next cycle of change i.
The PDSA cycle specifically requires that improvements be data driven. This is important because many clinicians attempt to make changes for improvement in their practice but do not emphasize the importance of data collection.
Organizations need to foster a culture of learning in which each individual will feel accountable for ensuring a safe and quality program, communication is open, and teamwork is valued. Reporting of errors should be valued, reports of adverse events should be handled confidentially, and those who report errors should be protected from discovery.
Developing a culture of learning involves the compassionate and appropriate disclosure of system failures and medical errors to patients and families. Of the following, the most therapeutic approach is: To improve outcome, sequential excision and grafting of 3rd-degree and deep 2nd-degree burns is required in children with large burns.
Prompt excision with immediate wound closure is achieved with autografts, which are often meshed to increase the efficiency of coverings. See Chapter 68, page Which of the following regimens will provide the best pain management?
Opiate analgesia, prescribed in an adequate dose and timed to cover dressing changes, is essential to comfort management. Anxiolytic medication added to the analgesic is usually helpful and has more than a synergistic effect. Small 1st- and 2nd-degree burns of the hands, feet, face, perineum, and joint surfaces also require admission if close follow-up care is difficult to provide. Children who have been in enclosed-space fires and those who have face and neck burns should be hospitalized for at least 24 hr for observation for signs of central nervous system CNS effects of anoxia from carbon monoxide poisoning and pulmonary effects from smoke inhalation.
See Table , Chapter 68, page A burn wound characterized by the absence of painful sensation, bleeding, or capillary refilling is best classified as: The absence of painful sensation and capillary filling demonstrates the loss of nerve and capillary elements.
The wound cannot epithelialize and can heal only by wound contraction or skin grafting. Which of the following statements regarding predictive genetic testing is true? A major caution with predictive testing is that the presence of a gene mutation does not necessarily mean that the disease will develop.
Many of the disorders with age-dependent penetrance display incomplete penetrance. A person who inherits a mutation might never develop signs of the disorder.
In the USA, the Genetic Information Nondiscrimination Act of protects individuals from genetic discrimination at the hands of health insurers and employers but does not extend protection against discrimination from providers of life, disability, or long-term care insurance. See Chapter 72, page Genetic counseling is indicated in which of the following clinical scenarios? Which statement regarding treatment of genetic disorders is NOT true? The underlying defect itself is not altered by treatment.
Physiologic therapies are used in the treatment of inborn errors of metabolism. Physiologic treatments can be highly effective, but they usually need to be maintained for a lifetime because they do not affect the underlying genetic disorder.
Many of these treatments are most effective when begun early in life before irreversible damage has occurred. This is the rationale for comprehensive newborn screening for inborn errors of metabolism. Which statement regarding genetic disorders of metabolism is NOT true? This differentiates these infants from those who appear sick at birth due to birth trauma, intrauterine insults, chromosomal abnormalities, or other genetic diseases.
Severe forms of genetic disorders usually become clinically apparent in the newborn period or shortly thereafter. The majority of conditions are inherited as autosomal recessive traits. Most of the genetic metabolic conditions can be controlled successfully by some form of therapy, and a few can be potentially cured by the use of bone marrow or liver transplants. This underlines the importance of early diagnosis, which can be achieved through screening of all newborn infants.
A large number of genetic conditions can be identified by this method. See Chapter 78, page In the newborn period, the clinical findings are usually nonspecific and similar to those seen in infants with sepsis. A genetic disorder of metabolism should be considered in the differential diagnosis of a severely ill newborn infant, and special studies should be undertaken if the index of suspicion is high.
Signs and symptoms such as lethargy, poor feeding, convulsions, and vomiting may develop as early as a few hours after birth. See Chapter 78, page and Fig. Initial laboratory studies to investigate for metabolic disease in an ill infant should include: An elevated blood ammonia level is usually caused by defects of urea cycle enzymes. Infants with elevated blood ammonia levels from urea cycle defects commonly have normal serum pH and bicarbonate values; without measurement of the blood ammonia level their defect may remain undiagnosed and they may succumb to their disease.
Elevation of serum ammonia levels also is observed in some infants with certain organic acidemias. These infants are severely acidotic because of accumulation of organic acids in body fluids.
Essential MCQs in pediatrics by Zuhair almusawi.
When blood ammonia, pH, and bicarbonate values are normal, other aminoacidopathies e. A 2 day old boy manifests poor feeding, vomiting, and lethargy leading to coma. Laboratory data reveal respiratory alkalosis and hyperammonemia. The urine orotic acid level is also elevated. The most likely diagnosis is: In neonatal hyperammonemia, most of the symptoms are related to brain dysfunction due to the elevated ammonia.
The affected infant is normal at birth but becomes symptomatic within a few days of protein feeding. Refusal to eat, vomiting, tachypnea, and lethargy can quickly progress to a deep coma. Convulsions are common. See Figure for an algorithm to diagnose the cause of hyperammonemia. In the case of OTC deficiency, laboratory studies will not demonstrate acidosis. A marked increase in urinary orotic acid distinguishes OTC deficiency from other disorders.
See Figure in Chapter 79, page For most lysosomal storage disorders, carrier identification and prenatal diagnosis are available; a specific diagnosis is essential to permit genetic counseling.
Which of the following disorders is X-linked? See Chapter 80, page It most frequently presents in the first 6 mo of life with developmental delay followed by progressive psychomotor retardation and the onset of tonic-clonic seizures. A typical facies is characterized by low-set ears, frontal bossing, a depressed nasal bridge, and an abnormally long philtrum.
Hepatosplenomegaly and skeletal abnormalities similar to those of the mucopolysaccharidoses, including anterior beaking of the vertebrae, enlargement of the sella turcica, and thickening of the calvarium, are present.
A 4 mo old girl presents with developmental delay, an exaggerated startle response to loud noise, and macrocephaly. On physical examination, the child has decreased eye contact and a cherry-red spot in each retina. The clinical manifestations of Sandhoff disease are similar to those for Tay-Sachs disease. The diagnosis of infantile Tay- Sachs disease and Sandhoff disease is usually suspected in an infant with neurologic features and a cherry-red spot.
Affected infants usually develop normally until 4 to 5 mo of age when decreased eye contact and an exaggerated startle response to noise hyperacusis are noted.
Macrocephaly, not associated with hydrocephalus, may develop. In the 2nd yr of life, seizures develop that may be refractory to anticonvulsant therapy. Neurodegeneration is relentless, with death occurring by the age of 4 or 5 yr. A 15 yr old presents with chronic fatigue and severe bone pain of 1 year's duration. He has hepatosplenomegaly and a normal retinal examination. Laboratory studies reveal normocytic anemia and thrombocytopenia.
Radiographs of the distal femur reveal Erlenmeyer flask deformities. Clinical manifestations of type 1 Gaucher disease have a variable age at onset, from early childhood to late adulthood, with most symptomatic patients presenting by adolescence. At presentation, patients may have bruising from thrombocytopenia, chronic fatigue secondary to anemia, hepatomegaly with or without elevated liver function test results, splenomegaly, and bone pain.
Most patients develop radiologic evidence of skeletal involvement, including an Erlenmeyer flask deformity of the distal femur. A 14 mo old girl presents with irritability, poor walking, genu recurvatum, and hypotonia. Physical examination reveals absent deep tendon reflexes. Laboratory data reveal an increased cerebrospinal fluid protein level and decreased nerve conduction velocities. The clinical progression of the disease relates to the pathologic involvement of both central and peripheral nervous system, giving a mixture of upper and lower motor neuron and cognitive and psychiatric signs.
Deep tendon reflexes are diminished or absent. Gradual muscle wasting, weakness, and hypotonia become evident and lead to a debilitated state. As the disease progresses, nystagmus, myoclonic seizures, optic atrophy, and quadriparesis appear, with death in the 1st decade of life. On evaluation, decreased nerve conduction velocities, increased cerebrospinal fluid protein, metachromatic deposits in sampled segments of sural nerve, and metachromatic granules in urinary sediment are all suggestive of the disorder.
A 15 yr old Ashkenazi Jewish girl is seen because of chronic fatigue. On examination, she seems pale and thin and has a somewhat large abdomen. Her spleen is felt in the iliac fossa. She is mentally alert and has a history of normal development and normal school performance. Her blood cell count shows hemoglobin, 9. Gaucher disease should be considered in the differential diagnosis of patients with unexplained organomegaly, who bruise easily, have bone pain, or have a combination of these conditions.
Evaluation may show bruising from thrombocytopenia, chronic fatigue secondary to anemia, hepatomegaly with or without elevated liver function test results, splenomegaly, and bone pain. A 7 mo old boy has been healthy and developing normally since birth. Pleural effusion. The most likely diagnosis is: a. Tetralogy of Fallot b. Transposition of Great Vessels c. Truncus Arteriosus d. Tricuspid Atresia. A 2 year old infant is noted to have mild cyanosis who assumes a squatting position during long walking.A six week old infant cannot a Grasp dangling objects b Fix gaze c Lift and hold head d Turn head towards sound.
Which of the following is true regarding provision of assisted ventilation in the early moments of an emergency? It has no relevance or reliability in non-PICU patients, such as those receiving chemotherapy. Language delays may be the first indication that a child has mental retardation, has an autism spectrum disorder, or has been maltreated. Compounds with low viscosity, such as mineral spirits, naphtha, kerosene, gasoline, and lamp oil, spread rapidly across surfaces and cover large areas of the lungs when aspirated.
The child's mother telephones you for help. The affected infant is normal at birth but becomes symptomatic within a few days of protein feeding. Clinicians also should not be lulled into underappreciating the potential for deterioration of a child with moderate TBI GCS score with a significant contusion, because progressive swelling can potentially lead to devastating complications.
Immediate and aggressive intervention is necessary.
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