Tiêu đề Peds 12-2023 update 1.pdf ✅

SPOT LIGHT ON PEDIATRICS 2024 MCQS BOOK DR FADI QUTISHAT Pediatrics 12/2023 MCQs 1 st Edition • For internship doctors, residents and students in medical schools. • For preparation to internship exams, entrance exam for residency in JUH, Royal medical services and Ministry of health of Jordan. • More than 30 frequently tested facts • Past papers exam QUTISHAT FADI, MD 2023/2024
SPOT LIGHT ON PEDIATRICS 2024 MCQS BOOK DR FADI QUTISHAT Pediatrics 12/2023 1) A previously healthy 2-year-old girl child presented to the emergency room with history of generalized tonic-clonic seizure that has lasted aro 10 minutes. Her temperature was 40 Celsius and she had tonsillitis. The rest of the general and neurological exam were normal including meningeal signs. Parents mentioned that her sister had similar events when she was 1.5 years of age. All of the following are correct while counselling the family about her condition, EXCEPT: A. Risk of epilepsy is high in this child B. Seizures can recur at temperature as low as 38 Celsius C. During a seizure keep patient in lateral position D. If seizure persists for more than 5 minutes rectal valium is advised E. Antiepileptic treatment is not indicated Explanation SUMMARY AND RECOMMENDATIONS ●Description – Febrile seizures occur in children with fever, usually in the setting of systemic bacterial or viral infection. Affected patients are typically between the ages of six months and five years of age and do not have epilepsy, central nervous system infection or inflammation, or other triggers for seizures. ●Initial evaluation – The initial evaluation must distinguish febrile seizure from alternative and more serious etiologies such as central nervous system infection. In most cases, this can be accomplished with a thorough history and physical examination, as discussed in detail separately. ●Acute management – Fever should be treated symptomatically with antipyretics. •Seizure ended – The majority of febrile seizures have ended spontaneously by the time the child is first evaluated, and the child is rapidly returning to a normal baseline. In such cases, active treatment with benzodiazepines is not necessary. •Seizure prolonged or ongoing – In children with febrile seizures that continue for more than five minutes, we recommend treatment with intravenous (IV) benzodiazepines (diazepam 0.1 to 0.2 mg/kg or lorazepam 0.05 to 0.1 mg/kg) (Grade 1B). Buccal midazolam (0.2 mg/kg, maximum 10 mg) is an alternative when IV access is unavailable. Patients with continued seizures despite initial
SPOT LIGHT ON PEDIATRICS 2024 MCQS BOOK DR FADI QUTISHAT benzodiazepine administration (ie, febrile status epilepticus) should be treated promptly with additional antiseizure medications, as are other patients with status epilepticus. ●Disposition – Most children with simple febrile seizures do not require hospital admission and can be discharged safely to home once they have returned to a normal baseline and parents and caregivers have been educated about the risk of recurrent febrile seizures. Children with focal or prolonged seizures may require a more extended period of observation, particularly if there is delayed recovery to baseline or focal postictal weakness. ●Recurrent febrile seizures •Risk factors – Children with febrile seizures are at risk for recurrent febrile seizures, particularly if they have a young age of onset, a family history of febrile seizures, brief latency between onset of fever and seizures, and a relatively low fever. •Home benzodiazepines – In children with a history of prolonged febrile seizure, benzodiazepines (eg, diazepam rectal gel 0.5 mg/kg) can be administered at home by parents or caregivers if the seizure lasts longer than five minutes. •Limited role of antiseizure prophylaxis -For simple febrile seizures – We suggest not treating patients with simple febrile seizures with antiseizure medication therapy (Grade 2B). While antiseizure medications may decrease the risk of recurrent febrile seizures, the prevention of febrile seizures is generally not considered worth the potential adverse effects of treatment. The available evidence suggests that the use of chronic antiseizure medications does not reduce the risk of epilepsy. -For complex febrile seizures – The use of antiseizure medication prophylaxis in children with complex febrile seizures is individualized based upon underlying risk factors. ●Risk of epilepsy – Epilepsy occurs more frequently in children who have had febrile seizures than in the general population. In a normal child with a simple febrile seizure, the risk is only slightly above that of the general population. Children with complex febrile seizures, an abnormal developmental history, or a family history of epilepsy have an increased risk.
SPOT LIGHT ON PEDIATRICS 2024 MCQS BOOK DR FADI QUTISHAT Reference https://www.uptodate.com/contents/treatment-and- prognosisoffebrileseizurescsi=d9dfee0f-9dfa-4b70-9ba4- 9b55f1e43812&source=contentShare 2) An 8-year-old boy with positive family history suffering of repeated epistaxis. He denies any nasal mucosal trauma. Coagulation profile shows prolonged bleeding time, normal PT and prolonged PTT, slight decrease of platelet count. The most likely diagnosis is A. Idiopathic Thrombocytopenic Purpura (ITP) B. Thrombotic Thrombocytopenic Purpura (TTP) C. Hemophilia A D. Christmas disease (Hemophilia B) E. Von Willebrand disease (VWD) Explanation SUMMARY AND RECOMMENDATIONS SUMMARY OF VWD TYPES There are three major types of VWD ●Type 1 is due to a quantitative reduction in von Willebrand factor (VWF) protein (both concentration and activity are decreased). ●Type 2 is due to dysfunctional VWF. ●Type 3 is due to absent or severely reduced VWF (a severe quantitative reduction). Presentation – Bruising, mucocutaneous bleeding, heavy menstrual bleeding, and postpartum bleeding are common. Gastrointestinal bleeding is less common; gastrointestinal angiodysplasia may contribute. Joint and muscle bleeding are not typical but can be seen with types 2N and 3. Some individuals have a normal complete blood count (CBC); many have normal coagulation studies. Some have a prolonged activated partial thromboplastin time (aPTT) due to low factor VIII. Some have thrombocytopenia (type 2B) or microcytic anemia (from iron deficiency). VWF levels increase with aging, inflammation, and estrogen Evaluation – VWD should be considered in individuals with bleeding (especially mucocutaneous), positive family history, mild thrombocytopenia, unexplained prolonged aPTT, or apparent hemophilia A. Accurate bleeding history is essential; a bleeding assessment tool (BAT) provides an objective picture Diagnosis – Initial testing includes CBC, platelet count, and