PAEA Pediatrics EOR Topics- Questions
and Answers| Latest Update
PAEA Pediatrics EOR Exam Topic List Quiz - used PPP, previous study guides,
and Current Diagnosis and Tx: Pediatrics, 23rd edition
a patient w/ growth hormone deficiency will likely have what other characteristics? tx for GHD?
s/sx: truncal adiposity, immature face, episodes of hypoglycemia, other pituitary hormone
issues (thyroid)
tx: must be cleared w/ MRI of hypothalamus/pituitary first then can start on recombinant GH
short stature, lateral thinning of eyebrows, constipation, cold temperature intolerance,
bradycardia, thick tongue, large fontanels, poor muscle tone, hoarseness, umbilical hernia,
jaundice, and intellectual retardation are all signs of congenital hypothyroidism- if left
untreated will have severe intellectual/developmental deficiencies - so TSH checked as a
newborn and especially when there is jaundice
Dx? goiter, inc TSH, low FT4, short stature, hair/skin changes, mental sluggishness,
constipation, cold intolerance; tx? dx: chronic lymphocytic thyroiditis (hashimotos
thyroiditis) is MC cause of hypothyroidism in children (will have + thyroid antibodies)
tx: *levothyroxine (T4)*
acute/suppurative vs subacute/nonsuppurative thyroiditis have what etiologies? -acute:
bacterial (enlarged tender thyroid, sore throat, fever) tx is abx (d/t group A streptococci,
pneumococci, Staphylococcus aureus, and anaerobes)
,-subacute aka *de Quervain thyroiditis*: viral (enlarged painful thyroid, sore throat, fever but
onset is more gradual than acute thyroiditis) tx is supportive (d/t mumps, influenza, echovirus,
coxsackievirus, Epstein-Barr virus, or adenovirus)
Dx? nervousness, emotional lability, hyperactivity, fatigue, tremor, palpitations, excessive
appetite, weight loss, increased perspiration, and heat intolerance, goiter, exophthalmos,
tachycardia, widened pulse pressure, systolic hypertension, weakness, and smooth, moist, warm
skin; labs show? tx? dx: hyperthyroidism (MC Grave's dz- Ab to TSH receptor)
labs: dec TSH, inc FT4/T3, + TSH receptor-binding antibodies (TRaB)
tx: 1st line- *methimazole* (takes a few weeks to produce results so give a *B-blocker* like
atenolol/propranolol for immediate effects (HTN/tachycardia)), 2nd line *propylthiouracil
(PTU)* bc can cause severe hepatotoxicity; if refractory can do *radioactive iodine ablation* or
*surgical resection*
a patient with hypercalcemia may exhibit the following characteristics: abdominal pain, polyuria,
polydipsia, hypertension, failure to thrive, renal stones, intractable peptic ulcer, constipation,
bone pain or pathologic fractures, impaired concentration, altered mental status, mood swings,
and coma; *what would be your DDx?* DDx:
1. *hyperparathyroidism* (rare- d/t parathyroid adenoma- cut it out or give calcitriol, or CKD tx
w/ furosemide)
2. *familial benign hypercalcemia* (d/t excessive reabsorpion of Ca by kidneys from parathyroid
receptor dysfxn- no tx needed usually)
3. *hypervitaminosis D* (too much oral vitD so dec it)
4. *idiopathic hypercalcemia of infancy (williams syndrome)*- rare, tx is restriction of dietary
Ca and vitD
,obesity in children is defined as >____ percentile for age and gender; what screening tests should
be done for these patients? tx? >95th percentile
-tests: lipid panel, AST/ALT, fasting glucose
-r/o endocrinologic, neurologic, or genetic cause if otherwise healthy and has no delay in growth
or sexual maturation
-tx: behavioral therapy and modifications in diet and physical activity
Dx? abdominal pain, n/v, somnolence, polyuria, polydipsia, polyphagia, fruity breath; workup?
tx? dx: DKA (type I DM)
workup: blood pH, glucose, electrolytes, UA (showing glu/ketones) & to dx T1DM: glucose
random >200, fasting ≥126, >200 after 2 hr 1.75mg/kg glucose load x 2 occasions)
tx:
1. fluid restoration: NS until restoration then NS + dextrose
2. IV insulin 0.05-0.1 U/kg/h
3. electrolyte replacement: Na and K are depleted (Na normalized w/ NS; K given as potassium
acetate/phosphate half/half if K is below 5mEq/L
4. correction of acidosis- achieved with fluid repletion and insulin
describe tx of T1DM 1. home blood glucose checks at least 4 times a day
2. a short acting insulin (for meal times): lispro (Humalog), aspart (NovoLog), or glulisine
(Apidra)
3. a long acting basal insulin: glargine (Lantus) or detemir (Levemir)
4. consider insulin pump if poor control
5. carried fast acting glucose in case of hypoglycemic episode
, 6. monitoring of comorbidities: nephropathy, retinopathy, hyperlipidemia, neuropathy, HTN
total daily dose:
prepubertal: 0.3-0.7 U/kg/d
pubertal/overweight: 1-1.5 U/kg/d
tx of T2DM in children is w/ exercise and diet control very helpful, metformin is first line
unless severe can add insulin
Dx: glucose random >200, fasting ≥126, >200 after 2 hr 1.75mg/kg glucose load x 2 occasions
a child with low H/H, low MCV, low reticulocytes should receive a trial of what therapy?
iron (ferrous sulfate)- if responsive to tx = *iron deficiency anemia*, if not investigate for
lead, thalassemia, and potential chronic dz (microcytic can be early sign)
macrocytic anemia in children is due to drug therapy (eg, anticonvulsants, anti-HIV
nucleoside analogues), Down syndrome, an elevated reticulocyte count (hemolytic anemias),
bone marrow failure syndromes (Fanconi anemia, Diamond-Blackfan anemia), liver disease, and
hypothyroidism
mostly NOT megaloblastic (d/t B12 or folic acid deficiency) but if they are can supplement with
both
*macrocytic not common in pediatrics*
and Answers| Latest Update
PAEA Pediatrics EOR Exam Topic List Quiz - used PPP, previous study guides,
and Current Diagnosis and Tx: Pediatrics, 23rd edition
a patient w/ growth hormone deficiency will likely have what other characteristics? tx for GHD?
s/sx: truncal adiposity, immature face, episodes of hypoglycemia, other pituitary hormone
issues (thyroid)
tx: must be cleared w/ MRI of hypothalamus/pituitary first then can start on recombinant GH
short stature, lateral thinning of eyebrows, constipation, cold temperature intolerance,
bradycardia, thick tongue, large fontanels, poor muscle tone, hoarseness, umbilical hernia,
jaundice, and intellectual retardation are all signs of congenital hypothyroidism- if left
untreated will have severe intellectual/developmental deficiencies - so TSH checked as a
newborn and especially when there is jaundice
Dx? goiter, inc TSH, low FT4, short stature, hair/skin changes, mental sluggishness,
constipation, cold intolerance; tx? dx: chronic lymphocytic thyroiditis (hashimotos
thyroiditis) is MC cause of hypothyroidism in children (will have + thyroid antibodies)
tx: *levothyroxine (T4)*
acute/suppurative vs subacute/nonsuppurative thyroiditis have what etiologies? -acute:
bacterial (enlarged tender thyroid, sore throat, fever) tx is abx (d/t group A streptococci,
pneumococci, Staphylococcus aureus, and anaerobes)
,-subacute aka *de Quervain thyroiditis*: viral (enlarged painful thyroid, sore throat, fever but
onset is more gradual than acute thyroiditis) tx is supportive (d/t mumps, influenza, echovirus,
coxsackievirus, Epstein-Barr virus, or adenovirus)
Dx? nervousness, emotional lability, hyperactivity, fatigue, tremor, palpitations, excessive
appetite, weight loss, increased perspiration, and heat intolerance, goiter, exophthalmos,
tachycardia, widened pulse pressure, systolic hypertension, weakness, and smooth, moist, warm
skin; labs show? tx? dx: hyperthyroidism (MC Grave's dz- Ab to TSH receptor)
labs: dec TSH, inc FT4/T3, + TSH receptor-binding antibodies (TRaB)
tx: 1st line- *methimazole* (takes a few weeks to produce results so give a *B-blocker* like
atenolol/propranolol for immediate effects (HTN/tachycardia)), 2nd line *propylthiouracil
(PTU)* bc can cause severe hepatotoxicity; if refractory can do *radioactive iodine ablation* or
*surgical resection*
a patient with hypercalcemia may exhibit the following characteristics: abdominal pain, polyuria,
polydipsia, hypertension, failure to thrive, renal stones, intractable peptic ulcer, constipation,
bone pain or pathologic fractures, impaired concentration, altered mental status, mood swings,
and coma; *what would be your DDx?* DDx:
1. *hyperparathyroidism* (rare- d/t parathyroid adenoma- cut it out or give calcitriol, or CKD tx
w/ furosemide)
2. *familial benign hypercalcemia* (d/t excessive reabsorpion of Ca by kidneys from parathyroid
receptor dysfxn- no tx needed usually)
3. *hypervitaminosis D* (too much oral vitD so dec it)
4. *idiopathic hypercalcemia of infancy (williams syndrome)*- rare, tx is restriction of dietary
Ca and vitD
,obesity in children is defined as >____ percentile for age and gender; what screening tests should
be done for these patients? tx? >95th percentile
-tests: lipid panel, AST/ALT, fasting glucose
-r/o endocrinologic, neurologic, or genetic cause if otherwise healthy and has no delay in growth
or sexual maturation
-tx: behavioral therapy and modifications in diet and physical activity
Dx? abdominal pain, n/v, somnolence, polyuria, polydipsia, polyphagia, fruity breath; workup?
tx? dx: DKA (type I DM)
workup: blood pH, glucose, electrolytes, UA (showing glu/ketones) & to dx T1DM: glucose
random >200, fasting ≥126, >200 after 2 hr 1.75mg/kg glucose load x 2 occasions)
tx:
1. fluid restoration: NS until restoration then NS + dextrose
2. IV insulin 0.05-0.1 U/kg/h
3. electrolyte replacement: Na and K are depleted (Na normalized w/ NS; K given as potassium
acetate/phosphate half/half if K is below 5mEq/L
4. correction of acidosis- achieved with fluid repletion and insulin
describe tx of T1DM 1. home blood glucose checks at least 4 times a day
2. a short acting insulin (for meal times): lispro (Humalog), aspart (NovoLog), or glulisine
(Apidra)
3. a long acting basal insulin: glargine (Lantus) or detemir (Levemir)
4. consider insulin pump if poor control
5. carried fast acting glucose in case of hypoglycemic episode
, 6. monitoring of comorbidities: nephropathy, retinopathy, hyperlipidemia, neuropathy, HTN
total daily dose:
prepubertal: 0.3-0.7 U/kg/d
pubertal/overweight: 1-1.5 U/kg/d
tx of T2DM in children is w/ exercise and diet control very helpful, metformin is first line
unless severe can add insulin
Dx: glucose random >200, fasting ≥126, >200 after 2 hr 1.75mg/kg glucose load x 2 occasions
a child with low H/H, low MCV, low reticulocytes should receive a trial of what therapy?
iron (ferrous sulfate)- if responsive to tx = *iron deficiency anemia*, if not investigate for
lead, thalassemia, and potential chronic dz (microcytic can be early sign)
macrocytic anemia in children is due to drug therapy (eg, anticonvulsants, anti-HIV
nucleoside analogues), Down syndrome, an elevated reticulocyte count (hemolytic anemias),
bone marrow failure syndromes (Fanconi anemia, Diamond-Blackfan anemia), liver disease, and
hypothyroidism
mostly NOT megaloblastic (d/t B12 or folic acid deficiency) but if they are can supplement with
both
*macrocytic not common in pediatrics*
