Pediatric Primary Care

Transient Tachypnea of the Newborn Patient will be a child shortly after birth Sudden onset of difficulty breathing PE will show tachypnea, nasal flaring, retractions, and hypoxia CXR will show parenchymal infiltrates and fluid in the pulmonary fissures Most commonly caused by residual pulmonary fluid Treatment is supportive, self-resolving within 72 hours Comments: Most common cause of neonatal respiratory distress Sample question: A full-term male infant read more…

Sample question: Which muscle is most commonly involved with rotator cuff injuries?

Coarctation of the Aorta PE will show higher blood pressure in the arms than in the legs EKG will show LVH CXR will show notching of ribs Diagnosis is made by echo Treatment is balloon angioplasty with stent placement or surgical correction Comments: associated with Turner syndrome Sample question: A 5-year-old girl with Turner syndrome is found to have systolic hypertension. Further examination read more…

Sample question: In children under 8 years of age, which of the following is the most common fracture involving the elbow?

Scabies Patient will be complaining of severe pruritus that is worse at night PE will show small papules, vesicles and burrows in the webbed spaces of the fingers and toes Diagnosis is made by microscopic visualization Most commonly caused by Sarcoptes scabiei hominis Treatment is permethrin 5% Sample question: A 15-year-old boy presents with an itchy rash on his hands and wrists. read more…

Pyloric Stenosis Patient will be 2–6 weeks old Non-bilious projectile vomiting after feeding and early satiety PE will show RUQ olive-like mass (hypertrophied pylorus) Labs will show hypochloremic hypokalemic metabolic alkalosis Diagnosis is made by ultrasound or UGI series (string sign) Treatment is surgical Sample question: A 3-week-old boy presents with two days of non-bilious projectile vomiting. Examination reveals a mass in the infant’s right upper quadrant. read more…

Wolff-Parkinson-White (WPW) Syndrome ECG will show short PR interval, delta wave, wide QRS Most commonly caused by an accessory pathway (bundle of Kent) connects atria to ventricles, bypassing AV node Definitive treatment is radiofrequency ablation Sample question: A 23-year-old previously healthy man presents to your clinic with complaints of chest discomfort, heart palpitations and decreased exercise tolerance. Physical exam read more…

Sample question: A 2-year-old boy is brought by his parents to the clinic because of opacity and hyperpigmentation of both eyes. His skin is noted to be dry and scaly, especially on the arms, legs, shoulders, and buttocks. He also gets sick frequently. Physical examination reveals an afebrile and weak-looking child. There is a note read more…

Rocky Mountain spotted fever (RMSF) Patient with a history of recently being in the woods hiking or camping Complaining of abrupt onset of severe headache, photophobia, vomiting, diarrhea, and myalgia PE will show maculopapular eruption on the palms and soles Most commonly caused by Rickettsia rickettsia Treatment is ALWAYS doxycycline, even in children Sample question: A 19-year-old woman presents with four days of read more…

Kawasaki Disease Patient is a child With a history of high fever for 5 days Conjunctivitis, rash, adenopathy, strawberry tongue, hand/feet edema, fever Treatment is IVIG + aspirin Comments: #1 cause of pediatric acquired heart disease, risk for coronary artery aneurysm Mnemonic: CRASH and burn: Conjunctivitis, Rash, Adenopathy, Strawberry tongue, Hand/feet edema, Fever Sample question: A 4-year-old girl is brought to read more…

Tetralogy of Fallot Patient with a history of episodes of cyanosis (tet spells) and squatting for relief PE will show pulmonic stenosis, right ventricular hypertrophy, overriding aorta, VSD CXR will show “boot-shaped” heart Comments: Most common cyanotic congenital heart disease Mnemonic: PROVe: Pulmonic stenosis, Right ventricular hypertrophy, Overriding aorta, VSD Sample question: A 1-year-old girl presents to the emergency room after her mother noticed that she became blue while crying. The patient subsequently read more…

Many of our savvy customers realize intuitively that there is a treasure trove of performance data accumulating in the background with each new question answered by each of our users (40,933,037 total questions answered, as of today).

Chlamydia Cervicitis Diagnosis is made by nucleic acid amplification testing (NAAT) Most commonly caused by Chlamydia trachomatis Treatment is azithromycin Comments: Most commonly reported sexually transmitted disease in the United States Empirically treat for concomitant gonorrhea The United States Preventive Services Task Force recommends routine screening for sexually active women < 24 years of age, and in women > read more…

Pertussis (Whooping Cough) Patient with a history of nasal congestion, cough, and low-grade fever “Rapid fire,” repetitive coughing followed by an inspiratory “whoop” and post-tussive emesis Most commonly caused by Bordetella pertussis Treatment is a macrolide – azithromycin Sample question:  A 2-year-old boy who is new to your practice is brought to the clinic because of coughing. For the past two weeks, he has had rhinorrhea read more…

Acanthosis Nigricans Patient will be obese or diabetic PE will show thickened, velvety, darkly pigmented plaques on the neck or axillae Comments: Screen for diabetes in those not yet diagnosed Sample question: A 19-year-old woman presents to her primary care provider’s office for a rash on the back of her neck that has grown and gotten darker over read more…

von Willebrand Disease Patient with a history of a parent with similar symptoms Mucosal hemorrhage or bleeding that is difficult to control Labs will show decreased factor VIII, prolonged bleeding time Treatment is desmopressin (DDAVP) Comments: Most common inherited bleeding disorder, autosomal dominant Sample question: A 9-year-old child is being evaluated for frequent epistaxis and easy bruising tendencies. Bleeding time is prolonged, PT, PTT, read more…

Hyphema Patient with a history of blunt or penetrating trauma Complaining of blurry vision PE will show unequal pupils, injected conjunctiva/sclera and blood in anterior chamber Treatment is eye protection and rest with the head of the bed at 30-45 degrees all the times A 13-year-old boy is brought to the urgent care clinic by his mother. He read more…