PEDIATRIC VACCINATIONS

QUESTION # 01

Vaccine that contains components of the organism is:

A. Tetanus

B. Diptheria

C. Acellular pertussis

D. Hepatitis B vaccine

E. Subunit influenza vaccine

QUESTION # 02

Vaccine that needs least number of booster doses is:

A. MMR

B. Hepatitis B

C. DTaP

D. Hib

E. IPV

QUESTION # 03

The contraindication to give DTaP vaccine is:

A. Family history seizures

B. Cerebral palsy

C. Family history SIDS

D. Family history of an adverse events after DTP or DTaP administration.

E. Encephalopathy within 7 days of administration of previous dose of DTP or DTaP.

QUESTION # 04

The following conditions are not contraindications to DTaP vaccinations except:

A. Temperature of less than 40.5°C, fussiness or mild drowsiness after a previous dose of DTP or DTaP.

B. Well-controlled convulsion

C. Developmental delay

D. Progressive encephalopathy

E. Family history of SIDS

QUESTION # 05

A child has meningococcal meningitis. 

Prophylaxis should not be given to the following category:

A. All medical personnel in that unit.

B. Household members.

C. Daycare and nursery school contacts.

D. Persons who had contact with patient’s oral secretions during the 7 days before the onset of illness.

E. Physician who intubated the child.

QUESTION # 06

A child has meningococcal meningitis. One of the sibling developed fever without UPPER RESPIRATORY TRACT INFECTION symptoms. 

The following statement is true about management of the sibling:

A. Sibling should receive acetaminophen therapy for fever.

B. Reassurance.

C. Sibling should be evaluated in the clinic next day.

D. Sibling should receive ibuprofen therapy for fever.

E. Meningococcal meningitis should be ruled out.

QUESTION # 07

The following statement is not true about the prophylaxis of meningococcal disease:

A. Penicillin therapy eradicates nasopharyngeal carrier.

B. Ciprofloxacin (500 mg orally as a single dose) can be used in person 18 years of age or older.

C. Ceftriaxone (125 mg in a single dose IM for children less than 12 years of age and 250 mg in a single dose IM for adolescents 12 years or older) can be used.

D. Rifampin (10 mg/kg orally every 12 hours for a total of four doses, maximum dose 600 mg and 5 mg/kg/dose for infants less than 1 month of age) is used.

E. Hospitalized patients should be isolated for droplet precautions for 24 hours after the onset of therapy.

QUESTION # 08

The following is a live virus vaccine:

A. Mumps

B. DTP

C. Pneumococcal

D. Hepatitis

E. Meningococcal

ANSWERS ON MONDAY DATED 31/12/2018

PEDIATRICS MCQS: TUBERCULOSIS

QUESTION # 01

If a mother is PPD positive and has a negative chest x-ray, the newborn infant should be:

A. Separated from the mother

B. Given INH prophylaxis

C. Evaluated with a chest radiography

D. Evaluated with a PPD testing

E. With the mother

QUESTION # 02

A mother has an active pulmonary tuberculosis. 

All of the following statements are true about management of the newborn except:

A. The newborn should receive INH therapy.

B. The newborn should be isolated from the mother regardless of her symptoms during INH therapy.

C. The newborn should be isolated from the mother if she has drug-resistant tuberculosis, she is noncompliance, and she is ill enough to require hospitalization.

D. The newborn should receive INH therapy until the mother’s sputum cultures are negative for at least 3 months.

E. The newborn should receive a Mantoux tuberculin skin test after 3 months of age. If positive, INH should be continued for a total duration of 9-12 months.

QUESTION # 03

The preferred therapy for a pregnant woman with an active pulmonary tuberculosis is a combination of:

A. INH, pyrazinamide, and rifampin

B. INH, ethionamide, and ethambutol

C. Rifampin, ethambutol, and ethionamide

D. INH, rifampin, and ethambutol

E. Streptomycin, INH, and rifampin

QUESTION # 04

The following CSF findings are appropriate for patients with a tuberculous meningitis:

a) Leukocyte counts are 2000, mostly polymorphs, glucose is 8 mg/dL, and protein is 350 mg/dL.

b) Leukocyte counts are 200, mostly lymphocytes, glucose is 50 mg/dL, and protein is 60 mg/dL.

c) Leukocyte counts are 350, mostly monocytes, glucose is 40 mg/dL, and protein is 70 mg/dL.

d) Leukocyte counts are 4,500, mostly lymphocytes, glucose is 30 mg/dL, and protein is 100 mg/dL.

e) Leukocyte counts are 400, mostly lymphocytes, glucose is 35 mg/dL, and protein is 3,900 mg/dL.

ANSWERS ON MONDAY 31/12/2018

PEDIATRIC MCQS: ABG INTERPRETATION

Study this arterial blood gas report of a 4-year-old child in the emergency unit with feeble peripheral pulses.

• pH :                 7.28
• PaCO2 :            32 mmHg
• PaO2 :              87 mmHg
• HCO3 :             12 mMol/L
• Base excess :    08 mMol/L

1. Give the complete ABG diagnosis and possible cause of the abnormality.

2. Name the most appropriate corrective measure for this child.

3. Calculate the predicted carbon dioxide level for this level of bicarbonate.

Answer on 18/12/2018

PEDIATRICS MCQS: PEDIATRIC NEUROLOGY

 PEDIATRIC NEUROLOGY



QUESTION # 01
Cyclic vomiting in children is a syndrome in which of the following groups?
A. Migraine with aura
B. Classic Migraine
C. Migraine without aura
D. Migraine equivalent
E. Epileptic syndrome

QUESTION # 02

A 10-year-old boy with a history of seizures and headache came to your office for an evaluation. You ordered a brain MRI, which is shown. The lesion shown in the MRI is resected and pathologic analysis is consistent with sub-ependymal giant cell astrocytoma.

What is the most likely diagnosis?

A. Tuberous sclerosis complex

B. Neurofibromatosis type 1 (NF1)

C. Neurofibromatosis type 2 (NF2)

D. Sturge-Weber syndrome

E. He probably does not have a neuro-cutaneous disorder; this tumor is most        often seen sporadically

Question # 03

The findings shown in the figures are consistent with which neuro-cutaneous syndrome?

Coronal T1-weighted pre-contrast MRI. 

What is your diagnosis?

A. Neuro-cutaneous melanosis

B. lncontinentia pigmenti

C. Hypomelanosis of Ito

D. Sturge-Weber syndrome

E. Epidermal nevus syndrome

QUESTION # 04

Physical complications of spina bifida include which of the following?

A. Allergy to latex

B. Leg weakness and paralysis

C. Club foot

D. (B) and (C)

E. (A) and (C)

QUESTION # 05

You are seeing a 3-year-old boy for his follow-up visit. He has a history of developmental delay and intellectual disability since early in life and has developed torticollis and spasticity in his limbs. He also has a history of seizures and aggressive behavior. He began biting himself to the point of bleeding and constantly self-inflicts injuries. He has had kidney stones and hyperuricemia.

Which of the following is not correct regarding this condition?

A. The genetic defect is in the gene HPRT1

B. It is autosomal recessive

C. Hypoxanthine guanine phosphoribosyltransferase is the deficient enzyme

D. It is caused by an enzymatic defect in the purine salvage pathway

E. Patients may have choreoathetotic movements

ANSWERS TOMORROW AT 10 AM.

PEDIATRIC MCQS: MISCELLANEOUS

QUESTION # 01

The preferred diagnostic study in patients with a sinus disease is:

A. AP x-ray of the sinuses
B. Lateral x-ray of the sinuses
C. PA x-ray of the sinuses
D. CT-scan of the sinuses
E. Ultrasonography of the sinuses

QUESTION # 02

A 5-month-old boy appears with respiratory distress for the last 24 hours. He had two episodes of pneumonia and four episodes of otitis media and six episodes of diarrhea. He is delayed for his growth and development. A physical examination reveals bilateral rales and right otitis media. 

All of the following findings are true for this patient except:

A. Total CBC lymphocyte counts are 1600/cmm.

B. Chest x-ray reveals bilateral infiltrates.

C. Blood culture is positive for Streptococcus pneumoniae.

D. Serum immunoglobulin levels are elevated.

E. Conductive hearing loss in the right ear.

QUESTION # 03

A full-term newborn appears with thick meconium stain. Her Apgar scores are 2 and 8 at 1 and 5 minutes respectively. The meconium is removed from the oropharynx. However, no meconium is visualized below the vocal cord. 

Most likely, this child will develop:

A. Meconium aspiration

B. Transient tachypnea of the newborn

C. Pneumothorax

D. Pneumomediastinum

E. No meconium aspiration

QUESTION # 04

The orchiopexy is performed for an undescended testis between:

A. 1-3 months of age

B. 3-6 months of age

C. 6-9 months of age

D. 9-15 months of age

E. 15-24 months of age

QUESTION # 05

A 9-year-old girls appears with fatigue, irritability, low-grade fever, arthralgia, abdominal pain, weight loss, and rash. A physical examination reveals erythema over the malar areas and bridge of the nose. She also has violaceous (heliotropic) discoloration of the upper eyelids and mild facial edema. 

All of the following laboratory findings are present in this patient except:

A. Coombs-positive anemia

B. Presence of antinuclear antibody

C. Absence of antibodies to DNA

D. Negative rheumatoid factor

E. Elevated serum creatine kinase

PEDIATRICS TOP-UPS

MANAGEMENT OF X-LINKED HYPOPHOSPHATEMIC RICKETS

A. Life-long therapy

1.        Phosphate (P04) solution 75 mg/kg/day 4-5 times a day (maximum 2 g) 15 ml = 10 mmol =300 mg

2.       Calcitriol 40 ng/kg OM X 3 months then 20 ng/kg (maximum 1 mcg) or Alfacalcidol 100 ng/kg OM X 3 months then 50 ng/kg (maximum 2 mcg)

B. Follow-up and Monitoring

1.        Six-weekly till biochemical parameters are stable (approximately 3 months) then 3-            monthly subsequently.

2.       Every visit:

a.       Parameters to be monitored:

·         Height (stadiometer)

·         Head circumference

·         Inter-condylar and inter-malleolar distances

·         Flaring of wrists, ankles, costochondral junction

·  Blood urea, creatinine, sodium, potassium, chloride, bicarbonate, calcium, phosphate, uric acid

         b.    Aim for:

·         Serum calcium >2.35 mmol/L

·         Serum phosphate >1 mmol/L

·         Serum alkaline phosphatase <500 U/L

·         Urinary calclum : creatinine <0.6

3.    Six-monthly:

•     iPTH (Aim for <10 pmol/L)

•   Urine oxalate : creatinine ratio (Aim for <0.268 mmol/mmol) If high refer to dietician

•     Renal ultrasound (for nephrocalcinosis)

0-     Normal

1 -    Faint hyperechogenic rim around medullary pyramids

2 -    More Intense rim with echoes faintly filling entire pyramid

3 -    Uniformly intense echoes throughout pyramids

4 -    Stone formation: solitary focus of echoes at the tip of the pyramid with              acoustic shadowing)

4.    Yearly:

•     Knee X-rays

•     Orthopedic review

•     Dental review

•  24 hour urinary protein excretion and creatinine clearance if there is nephrocalcinosis

•     Bone densitometry (also at diagnosis)

C. Screening of siblings: Initially at 3 months of age, then at 6 months of age

PEDIATRIC MCQS: PEDIATRIC MISCELLANEOUS

QUESTION # 01
A 3-year-old girl is seen in the emergency department 30 minutes after ingesting a large amount of her father's propranolol that was prescribed for the treatment of hypertension. You are working with a group of medical students who ask you what symptoms the patient may exhibit.

Of the following, the MOST likely symptom that would be seen is

A. Hyperglycemia

B. Hypertension

C. Seizures

D. Tachycardia

E. Tachypnea

ANSWER: TUESDAY 10 AM



QUESTION # 02
An 18-month-old boy is brought to your office because his parents are concerned about bowed legs. History reveals he was late in learning to walk independently (just starting at 15 months). Laboratory testing reveals the following:
• Alkaline phosphatase, 862 U/L; normal range, 150-420 U/L
• 25-hydroxyvitamin D, 31 ng/mL (77 nmol/L); normal range, 20-50 ng/mL (50 to 125 nmol/L)
• Parathyroid hormone, 15 pg/mL (15 ng/L); normal range, 10-65 pg/mL (10 to 65 ng/L)
• Serum calcium, 8.7 mg/dL (2.17 mmol/L)
• Serum phosphorus, 1.8 mg/dL (0.58 mmol/L).
A radiograph of the legs is shown below 

Of the following, the MOST likely diagnosis is
A. Fibrous dysplasia
B. Hypophosphatasia
C. Hypophosphatemic rickets
D. Osteogenesis imperfecta type I

E. Vitamin D deficiency rickets



ANSWER: TUESDAY 10 AM




QUESTION # 03
The newborn infant of a 28-year-old primigravida has severe respiratory distress and is noted to have pseudoepicanthus, flattened ears and nose, and bilateral club feet. There is no family history of renal failure. Abdominal ultrasonography reveals bilaterally enlarged echogenic kidneys with poor corticomedullary differentiation; there are no cysts or hydronephrosis. The liver, spleen, pancreas, and gall bladder are reported to be normal.

Of the following, the MOST likely cause of this neonate's condition is
A. Autosomal recessive polycystic kidney disease
B. Bilateral Wilms tumor
C. Multicystic dysplastic kidney
D. Nephronophthisis

E. Renal vein thrombosis


ANSWER: TUESDAY 10 AM


QUESTION # 04
A 5-year-old girl with classic 21-hydroxylase deficiency (congenital adrenal hyperplasia) develops gastroenteritis with fever (up to 38.9°C), vomiting, and diarrhea. Her regular medications include hydrocortisone and fludrocortisone. Upon presentation to the emergency department, she is tired-appearing and remains febrile. Her pulse rate is 162 beats/min, blood pressure is 62/40 mm Hg, and capillary refill is poor. Laboratory tests drawn in the emergency department are still pending, but fingerstick glucose level is 42 mg/dL (2.3 mmol/L). The patient is treated with a bolus of normal saline to restore circulatory support.
Of the following, the MOST important therapy to administer to this patient next is
A. Cortisone acetate intramuscularly and aldosterone intravenously
B. Cortisone acetate intramuscularly and dextrose intravenously
C. Dopamine and dextrose intravenously
D. Hydrocortisone hemisuccinate and aldosterone intravenously

E. Hydrocortisone hemisuccinate and dextrose intravenously


ANSWER: TUESDAY 10 AM


QUESTION # 05
A 13-year-old girl with systemic lupus erythematosus and lupus nephritis presents to your office for her REGULAR CHECK-UP. She has been doing very well and has not had any symptoms suggestive of active disease. Her current medications include prednisone, hydroxy-chloroquine, ranitidine, simvastatin, mycophenolate mofetil, enalapril, depot medroxyprogesterone, vitamin D with calcium, and a multivitamin. She asks you which of these medications are keeping her lupus disease under control.

Of the following, the response you are MOST likely to give is
A. Enalapril, hydroxychloroquine, mycophenolate mofetil, prednisone, and              simvastatin
B. Enalapril, hydroxychloroquine, mycophenolate mofetil, and prednisone
C. Hydroxychloroquine, mycophenolate mofetil, and prednisone
D. Hydroxychloroquine, mycophenolate mofetil, prednisone, and simvastatin

E. Mycophenolate mofetil, ranitidine, and prednisone


ANSWER: TUESDAY 10 AM

PEDIATRIC MCQS: PEDIATRIC NEUROLOGY

A 12-year-old boy came to the emergency department with progressive weakness for 10-h while he was seated in his classroom. He described it as a stinging sensation in his arms that progressed to numbness

and weakness to the level of his upper chest. He has not urinated for several hours and he wakes only with assistance. He has moderate hypertonia in his upper extremities and his lower extremities are flaccid.

Formal strength testing reveals (R/L): biceps 4/4, triceps 3/3, and wrist extension 4/4, with all other muscle groups tested being grade 0. He has a sensory level at T2, and deep tendon reflexes are absent throughout.

MRI of the spine shows an ill-defined intramedullary hyperintensity extending from C5 to T2 without significant cord expansion or enhancement. MRI of the head is normal. CSF studies are normal, and no oligoclonal bands are detected.

What is the most appropriate treatment at this time?

A. IVIG 0.5 g/kg I.V. daily × 4 days

B. Methylprednisolone 500 mg I.V.B.I.D × 5 days

C. Prednisone 40 mg P.O. daily with a slow taper

D. Cyclophosphamide 800 mg/m² I.V. every 4 weeks

E. Interferon-β − 1a 30 μg I.M. every week

CHECK RESULT ON MONDAY

PEDIATRICS FCPS TOACS STATION

1. Describe the pedigree.

2. What is the mode of inheritance?

3. Give 4 examples.

ANSWER: FRIDAY 30/11/2018 AT 10 AM

PEDIATRIC MCQS: PEDIATRIC ENDOCRINOLOGY

You found a newborn having low total thyroxine (T4) level on newborn screening. The level was drawn 24 hours after a term, healthy female neonate was born. Pregnancy was uncomplicated, and there was no maternal history of thyroid disease. Repeat testing in your office at 7 days after birth shows a thyroid-stimulating hormone level of 200 mIU/L and a low free thyroxine (FT4) level of 0.2 ng/dL (2.57 pmol/L) in this otherwise healthy girl. Her weight is 3 kg. Findings on physical examination are unremarkable.

Of the following, the BEST next step in the management of this patient is to

A. Begin treatment with levothyroxine (LT4)

B. Begin treatment with liothyronine (LT3)

C. Measure serum thyroglobulin level

D. Order a thyroid radionuclide uptake and scan

E. Order thyroid ultrasonography

ANSWER: WEDNESDAY 28/11/2018 AT 10 AM.

PEDIATRICS FCPS TOACS STATION

A 6-month-old infant presented with fever, anorexia, and marked irritability. The skin overlying the shin and mandible is neither warm nor discolored. There is no soft tissue swelling, and palpation reveals bony-hard thickening below the subcutaneous tissues, which are adherent to the underlying bone.

1. What are the x-ray findings in A and B?

2. What is the most likely diagnosis?

ANSWER: WEDNESDAY 28/11/2018

PEDIATRIC TOP-UPS: GENERAL

A patient with fever and focal seizure: herpes encephalitis. 

Please remember, varicella causes generalized seizure and SSPE (subacute sclerosing panencephalitis) causes symmetric seizure activities.

How to adjust the dose of valproic acid in a child with seizure: Troph serum level seven days after the starting dose. The beginning dose is 10 mg/kg/day, then increase the doses by 5 -10 mg/kg/week until the usual dose of 30 -40 mg/kg/day.

A patient appears with Kawasaki disease and abdominal pain: Hydrops of the gallbladder.

Evans syndrome: a combination of autoimmune hemolytic anemia with immune thrombocytopenic purpura. Patients may develop chronic disease like SLE and have poor prognosis.

Glycogen storage disease type Ib and neutropenia: severe hepatomegaly and growth retardation are present; a defective neutrophil mobility and neutropenia can cause recurrent b acterial infections.

TREATMENT: antibiotic; rhG -CSF correct neutropenia.

PEDIATRIC MCQS: PEDIATRICS NEUROLOGY

QUESTION 01:

The port wine stain characteristic of Sturge-Weber syndrome is most commonly found:

A. In an upper motor neuron seventh nerve pattern

B. In a lower motor neuron seventh nerve pattern

C. In the first division of the trigeminal nerve, bilaterally

D. In the first division of the trigeminal nerve, unilaterally

E. In the distribution of the greater occipital nerve

QUESTION 02:

2-day-old, former full-term neonate has seizures that are difficult to control. Her mother reports that in utero the baby had significantly more “hiccups” than her other children did. On examination, the infant is encephalopathic and hypotonic. Labor and delivery were uneventful and the infant had Apgar scores of 8 and 9. 

What test or intervention would be most useful in identifying the etiology for her seizures?

A. Brain MRI

B. EEG

C. Lumbar puncture

D. EMG

E. Response to therapeutic hypothermia

QUESTION 03:

Which cranial nerve is most likely to be affected by Lyme disease?

A. Optic nerve

B. Oculomotor nerve

C. Trigeminal nerve

D. Facial nerve

E. Hypoglossal nerve

QUESTION 04:

A neonate is being loaded on phenobarbital for seizures. What is the most likely side effect the neonatology team should be prepared for?

A. Hyponatremia

B. Respiratory suppression

C. Anaphylaxis

D. Hypertension

E. Dystonic reaction

QUESTION 05:

What percentage of children with new-onset epilepsy  will eventually be able to discontinue medication and remain seizure-free?

A. 10%

B. 30%

C. 50%

D. 70%

E. 90%

ANSWER: MONDAY 10 AM.

PEDIATRICS SHOT: VIDEOS

WHAT TYPE OF SEIZURE THIS CHILD HAS?

PEDIATRICS PEARLS: NEONATOLOGY

1. 22-week-old female fetus appears with cystic hygroma.
Most likely diagnosis?

2. A 3.4 kg infant lost 200 gram s body weight in 3 days. Infant’s weight is 3.2 kg after 3 days. The infant is otherwise doing well.
Most likely cause?

3. How to examine muscle tone in newborn infants?

4. A newborn appears with broad toe or thumb.
Most likely diagnosis?


5. A newborn infant appears with hypoplastic nails, flattened nose, and hypertelorism. Mother was receiving anti-convulsant during pregnancy.
Name the anti-convulsant mother is taking?

ANSWER: SATURDAY 23/11/2018 10 am.

PEDIATRIC MCQS: PEDIATRIC HEPATOLOGY

A 13-year-old un-vaccinated CHILD brought by his parents approximately 3 weeks after exposure to hepatitis B from needle sharing with a known carrier. Following are the most likely laboratory findings indicating a hepatitis B infection if labs were taken the day of the visit:

A. HBV DNA negative, HBV core protein IgM negative, HBsAg negative

B. HBV DNA positive, HBV core protein IgM positive, HBsAg positive

C. HBV DNA positive, HBV core protein IgM positive, HBsAg negative

D. HBV DNA positive, HBV core protein IgM negative, HBsAg negative

E. HBV DNA positive, HBV core protein IgM negative, HBsAg positive

ANSWER: SATURDAY 23/11/2018 10 am.

PEDIATRIC MCQS: IMMUNODEFICIENCY

Of the following options, the best initial test for a workup for immunodeficiency is:

A. Serum levels of IgG, IgM, IgA, IgE

B. A complete blood count with differential

C. Peripheral T-cell phenotyping

D. Erythrocyte sedimentation rate

E. Post-immunization immunoglobulin levels

ANSWER: FRIDAY 23/11/2018 10 am. 

PEDIATRICS PEARLS: Dawn and Somogyi Phenomenons

Somogyi phenomenon, Dawn phenomenon, and Brittle diabetes:

Somogyi phenomenon: hypoglycemia precedes hyperglycemia. Hypoglycemia is due to insulin, while hyperglycemia is due to secretion of counter regulatory hormones. 

Hypoglycemia occurs in late night or early morning accompanied by sweating,

and terror. Within 4-5 hours, hyperglycemia, ketosis, glycosuria, and ketonuria develop.

Dawn phenomenon: Hyperglycemia in early morning (5-9 A.M.) without previous hypoglycemia. Blood sugar should be done at 3, 4, and 7 A.M .

Findings and management in Dawn phenomenon: 3 A.M. and 4 A.M. (Glucose level= 80 or above), 7 A.M. (Glucose level= 140 or above)= Increase intermediate acting insulin P.M. dose by 10-15%, or give PM injection 2-3 hours later.

Findings and management in Somogyi phenomenon: 3 and 4 A.M. (Glucose level= 60 or below), 7 A.M . (Glucose level= 140 or above)= Decrease intermediate insulin P.M . dose by 10 -15% or delay PM injection until 9 PM.

Brittle diabetes: blood glucose level fluctuates even with increase of insulin doses; often with recurrent DKA. They have normal insulin response in the hospital. Therefore, they have psycho-social or psychiatric problems including dysfunctional family and eating disorders. They need hospital admission, psycho-social or psychiatric evaluation.

PEDIATRICS SHOTS: BIRTH MARK

BIRTH MARK

You are seeing an 8-month-old boy for the first time. His parents are concerned about a birth mark on his chest that has enlarged slowly over the past 5 to 6 months.

Of the following, the MOST appropriate management of this lesion is

A. Interferon-alfa

B. Intralesional corticosteroid

C. Observation

D. Pulsed dye laser

E. Systemic corticosteroid

ANSWER: FRIDAY 23/11/2018 AT 10 AM

PEDIATRICS TOP-UPS: INVESTIGATING HYPOCALCEMIA IN LEVELS

INVESTIGATING HYPOCALCEMIA IN LEVELS

LEVEL 1:

1. SERUM PHOSPHATE, SERUM ALKALINE PHOSPHATE
2. LIVER FUNCTION TESTS
3. RENAL FUNCTION TESTS (BLOOD UREA, SERUM CREATININE)
4. X-RAYS WRIST (RICKETS/ALBRIGHTS HEREDITARY OSTEODYSTROPHY)

LEVEL 2:

1. PTH LEVEL (RANGE 12-72 ng/ml) (HIGH PHOSPHATE AND NORMAL RENAL FUNCTIONS)
2. MAGNESIUM LEVEL ( NORMAL OR LOW PHOSPHATE LEVELS)
3. MALABSORPTION STUDIES (FECAL FATS, TTG ETC)
4. 1, 25 HYDROXY D3 (LOW IN VDDR 1, HIGH IN VDDR II)
5. IN NEONATES, MOTHER X-RAYS FOR OSTEOMALACIA AND HYPERPARATHYROIDISM.

PEDIATRIC PEARLS: SIDE EFFECTS OF PROSTAGLANDIN 1

Most common complication of prostaglandin 1: Apnea. 

Please remember, elevated prostaglandin levels can cause hypertrophic pyloric stenosis. For patients who develop apnea, endotracheal intubation is indicated.

A newborn received prostaglandin therapy for 5 days. The newborn developed non-bilious vomiting. Most likely diagnosis:

hypertrophic pyloric stenosis secondary to prostaglandin.

Management: Discontinue prostaglandin. 

The vomiting stops and pyloric stenosis resolves slowly with the discontinuation of medication. 

The child should be operated for the underlying cardiac condition.

PEDIATRIC MCQS: PEDIATRIC CARDIOLOGY

A 1-week-old infant presents to the emergency department with a 1-day history of poor feeding, pallor, diaphoresis, and increasing somnolence. She was born at term, and the delivery was uncomplicated. On physical examination, her heart rate is 180 beats/min, respiratory rate is 90 breaths/min, and blood pressure is 50/30 mm Hg. Her breath sounds are shallow, and cardiac evaluation reveals no murmurs but a gallop rhythm. Her liver is palpable at 3 cm below the costal margin. Her extremities are cool, pale, and mottled, and she has poor distal pulses. After you administer normal saline at 20 mL/kg, her heart rate is 194 beats/min.

Of the following, the MOST appropriate next step is

A. Adenosine infusion at 50 mcg/kg

B. Computed tomography scan of the head

C. Dopamine infusion at 10 mcg/kg per minute

D. Lumbar puncture followed by antibiotics

E. Normal saline infusion at 20 mL/kg

ANSWER ON THURSDAY AT 10 AM

PEDIATRIC TOP-UPS: CONGENITAL HYPOTHYROIDISM FOLLOW-UP

CONGENITAL HYPOTHYROIDISM FOLLOW-UP

DRUG USED:             THYROXIN

DOSE:                         10-15 MICROGRAM/KG/DAY OD

FOLLOW-UP:

GOAL:                         FREE T4 LEVEL 10-15 MICROGRAM/dL

                                     02 WEEKS AFTER START OF THERAPY

                                     02 MONTHLY FOR 01 YEAR

                                     03 MONTHLY FOR NEXT 02 YEARS

                                     YEARLY AFTER 03 YEAS

DEVELOPMENTAL ASSESSMENT, BONE AGE YEARLY