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CMS III - PEDS Test #2 - Comprehensive Review
Winter Semester 2011
347
Medical
Graduate
04/18/2011

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Cards

Term
What scabicides SHOULD be used in children?
Definition
Permethrin 5% cream (Elimite)
Term
What scabicides SHOULD NOT be used in children? Why?
Definition
Lindane (Kwell) - may be associated with neurotoxicity
Term
What condition has associated findings of Keobner Phenomenon and Auspitz sign?
Definition
Psoriasis
Term
What clinical sign is described as a removal of a small scale on the lesion causes bleeding?
Definition
Auspitz Sign
Term
What is the Hallmark sign of Psoriasis?
Definition
Auspitz Sign
Term
What clinical sign is described as lesions induced in areas of local trauma?
Definition
Koebner
Term
Where are the common areas of the body affected by Psoriasis?
Definition
Extensor surface of the extremities, scalp and butt (esp found on knees and elbows)
Term
What skin condition is described as red, well demarcated plaques with dry, thick silvery scales?
Definition
Psoriasis
Term
What psoriasis occurs after an infection with strep pharyngitis?
Definition
Guttate Psoriasis
Term
Which condition found in infants (aged 1 - 6 months) is described as red, itchy papules and plaques that ooze or crust and are found on the cheeks, forehead scalp, trunk and extensor surfaces? How long does it last?
Definition
Atopic Dermatitis (Eczema); Lasts 2 - 3 years
Term
What condition is found in children aged 4 - 10 yrs and is described as dry, papular, intensely pruritic circumscribed scaly patches that are found on the wrist, ankles, antecubital and popliteal fossae (MOSTLY FLEXURAL surfaces)?
Definition
Atopic Dermatitis (Eczema)
Term
What is a big difference between atopic dermatitis and Psoriasis?
Definition
With the exception of infants, atopic dermatitis is found on the FLEXOR surfaces, while psoriasis is found on the EXTENSOR surfaces
Term
Where on the body is atopic dermatitis commonly found in children (4 - 10 y/o)?
Definition
FLEXOR Surfaces
Wrists, ankles, antecubital and popliteal fossa
Term
Where on the body is atopic dermatitis commonly found in infants (1 - 6 mo old)?
Definition
Cheeks, forehead, scalp, trunk and extensor surfaces
Term
Where on the body is atopic dermatitis commonly found in adults (12 and older)?
Definition
FLEXOR areas of arms, neck, legs, dorsum of hands/feet - btwn fingers and toes
Term
What dermatologic condition is described as an acute hypersensitivity syndrome that is triggered by drugs, viruses, bacteria, foods, and immunizations?
Definition
Erythema Multiformes
Term
What is the MCC of Erythema Multiformes in Children?
Definition
Infection
Term
If a pt presents with recurrent Erythema Multiformes rash, what should you suspect?
Definition
HSV infection
Term
What rash is described as symmetrical and has target shaped lesions?
Definition
Erythema Multiformes
Term
Where is E. Multiformes rash generally located?
Definition
Extensor surfaces of arms and legs
Term
How long does E multiformes rash generally last?
Definition
1 - 3 weeks (self-limiting)
Term
What additional symptoms may accompany an E multiformes rash?
Definition
low-grade fever, malaise, myalagias
Term
Is E. multiformes found on the mucous membranes?
Definition
Usually SPARES the mucous membranes
Term
Children comes to your clinic with a low grade fever, is very tired and lethargic and complains of being achy all over. You notice red dusky macules or wheals on the pts elbows and knees. What should you suspect?
Definition
E. multiformes rash due to an infection
Term
What condition seen in pts 3 - 12 mos old, described as dirty brown scales on flanks, elbows and shoulders and sparing the face and flexural areas?
Definition
X-linked Ichythoses
Term
What condition that appears in the 1st month of life with the first sign being a colloidian membrane, that then develops into a thick growth gray sheet-like scales with raised edges on the face, trunk, extremities and flexural surfaces?
Definition
Lamellar Ichytheoses
Term
What Ichytheoses has a characteristic colloidian membrane present at birth?
Definition
Lamellar Icthythoses
Term
What condition is described as thick warty scales and intermittent blistering that occurs on the flexure surfaces?
Definition
Epidermolytic Hyperkeratosis Ichythoses
Term
If a pt has widespread blisters what conditions may this suggest?
Definition
herpes simplex or epidermolysis bullosa
Term
What does AD spare?
Definition
Moist and Intereginous areas
Term
What is the major difference between contact dermatitis and atopic dermatitis?
Definition
With contact dermatitis there will be a hx of contact relating to the distribution
Term
Which condition has discreteness of lesions and distribution in a "christmas tree" or "fir tree" distribution that can be either hyper or hypo pigmented?
Definition
Pityriasis Rosea
Term
What condition is described as central clearing with active red border of red papules, vesicles and pustules?
Definition
Tinea Corporis
Term
Which condition is described as FLAT Topped pruritic polygonal violaceous papules and plaques?
Definition
Lichen Planus
Term
Which type of Lichen planus is described as fine lacy pattern?
Definition
Wickham's striae
Term
What skin condition starts on the dorsal surface of the extremities and can display keoberization at sites of prior trauma and is polygonal violaceous flat-topped papules and plaques?
Definition
Lichen Planus
Term
What condition is described as flat topped papules that are abrupt, linear or swirled and show lines of Blaschko (skin lines) and are found mostly on the extremities, neck, upper back? What is the cure?
Definition
Lichen Stiatus; resolves spontaneously in 1 - 2 yrs
Term
What is the difference btwn Lichen Planus and Lichen Striatus based on where it is located?
Definition
Lichen planus is found on dorsal surfaces of extremities, wile Lichen striatus is found on the extreemities, but also the neck and back
Term
What is the difference between the appearance of Lichen Planus versus Lichen Striatus?
Definition
Planus is violaceous and are PRURITIC
Striatus has lines of Blaschko (skin lines),
Term
What findings are characteristic of a viral infection of Herpes and Varicella?
Definition
Multinucleated Giant Cells on Tzank Smear
Term
What condition is characterized by a plane cleavage high in the epidermis that develop thin walled bullae and has a pos Nickolsky sign?
Definition
Scalded Skin Syndrome
Term
If an infant pt has slippage of the top layers of skin when rubbed, what sign is this and what condition does this indicate?
Definition
Nickolsky's Sign; Scalded Skin Syndrome
Term
What pathogen is responsible for scalded skin syndrome?
Definition
S Aureus
Term
How is scalded skin syndrome diagnosed?
Definition
nose or conjunctival swab with positive results for S Aureus
Term
What pathogen causes blistering distal dactylitis?
Definition
S. aureus (esp common in children with Atopic Derm) or Grp A hemolytic Strep
Term
What is the condition described as a blister on the anterior volar fat pad of the distal phalynx? What other condition in childhood is it commonly found with?
Definition
Blistering Distal Dactylitis; AD
Term
What disorder is described as beginning with flu-like symptoms, followed by a painful purple rash that spreads and blisters and eventually causes the top layer of skin to die and shed? What is the common cause of this condition?
Definition
SJS; hypersensitivity rxtn to meds
Term
What is the severe form of Erythema Multiformes called?
Definition
Steven Johnson's Syndrome
Term
What is SJS most commonly caused by?
Definition
A hypersensitivity to meds
Term
Does E. multiformes affect the palms or feet?
Definition
YES
Term
What heart condition is characterized by sub-q nodules over bony prominences?
Definition
Rheumatic Heart Dz
Term
What are heart condition is characterized by nontender, macular lesions most commonly involving the palms and soles? What are these lesions called?
Definition
Bacterial Endocarditis; Janeway Lesions
Term
What heart condition is characterized by small, tender nodules that develop on the finger or toe pads ? What are these lesions called?
Definition
Infective Endocarditis; Osler Nodes
Term
What heart condition is characterized by narrow, red to reddish-brown lines of blood beneath the nails? What are these lesions called?
Definition
Acute Bacterial Endocarditis; Splinter Hemorrhages
Term
Which congenital heart abnormalities are Acyanotic? (6)
Definition
ASD
VSD
PDA
PS
AS
Coarctation of the Aorta
Term
Which congenital heart abnormalities are Cyanotic? (6)
Definition
Tetralogy of Fallot
Tricuspid Atresia
Transposition of Great Vessels
Truncus Arteriosus
Total Anomalous Pulmonary Venous Connection
Hypoplastic Left Heart Syndrome
Term
Which congenital heart condition is characterized by CXR findings of cardiomegaly, and increased pulmonary artery vasculature?
Definition
Atrial Septal Defect; Truncus Arteriosis
Term
Which congenital heart condition is characterized by CXR findings of increased pulmonary artery vasculature and increased pulmonary vein size?
Definition
Patent Ductus Arteriosus
Term
Which congenital heart condition is characterized by CXR findings of cardiomegaly, Left atrial enlargement, and increased pulmonary vasculature?
Definition
Ventricular Septal Defect
Term
Which congenital heart condition is characterized by CXR findings of normal heart size, and post-stenotic dilation of pulmonary artery?
Definition
Pulmonic Stenosis
Term
Which congenital heart condition is characterized by CXR findings of normal pulmonary vasculature, rib-notching post coarctation dilation and cardiomegaly?
Definition
Coarctation of the Aorta
Term
Which congenital heart condition is characterized by CXR findings of a usually normal heart?
Definition
Aortic Stenosis
Term
Which congenital heart condition is characterized by CXR findings of a boot-shaped heart, normal heart size and decreased pulmonary vascular markings?
Definition
Tetralogy of Fallot
Term
Which congenital heart condition is characterized by CXR findings of a boot-shaped heart with a concave border, a normal heart size and decreased pulmonary vasculature?
Definition
Tricuspid Atresia
Term
Which congenital heart condition is characterized by CXR findings of Cardiomegaly and an egg-on-a-string appearance, increased pulmonary vasculature and narrowed mediastinum?
Definition
Transposition of Great Arteries
Term
What other heart defect MUST you have if you have transposition of the great arteries?
Definition
ASD, PDA or VSD
Term
What is the difference in appearance of ASD and Truncus Arteriosis?
Definition
both have cardiomegaly and increased pulmonary vasculature, but Truncus Arteriosis commonly presents with VSD (which would have left atrial enlargement as well)
Term
Which congenital heart condition is characterized by CXR findings of cardiomegaly with snowman appearance and increased pulmonary vasculature?
Definition
Total Anomalous Pulmonary Venous Connection
Term
Which congenital heart condition is characterized by CXR findings of enlarged heart with increased Pulmonary Vascular Markings and Pulmonary Vascular congestion?
Definition
Hypoplastic Left Heart Syndrome
Term
What congenital heart condition has a soft systolic ejection murmur heard at the ULSB, and a low-pitched mid-diastolic rumbling murmur heard at the LLSB?
Definition
ASD
Term
What congenital heart condition is MC?
Definition
VSD
Term
What congenital heart condition has a loud, harsh pansystolic murmur that is loudest at the LSB?
Definition
VSD
Term
What is the MC heart valve abnormality?
Definition
Mitral Valve Prolapse
Term
What congenital heart condition has a murmur described as a mid-systolic click, followed by a late systolic murmur?
Definition
Mitral Valve Prolapse
Term
What is the prophylaxis treatment given to prevent bacterial endocarditis?
Definition
Amoxicillin 50mg/kg one hour before procedure
Term
What conditions are a HIGH risk for bacterial endocarditis developing and are therefore given a prophylaxis?
Definition
Prosthetic Cardiac Valves
Previous Bacterial Endocarditis
Complex Cyanotic Congenital HD
Surgically constructed systemic pulmonary shunts and conduits
Term
What conditions are a MODERATE risk for bacterial endocarditis developing and are therefore given a prophylaxis?
Definition
Most other congenital abnormalities
Acquired Valvular dysfunction
Hypertrophic Cardiomyopathy
MVP w/valvular regurgitation or thickened leaflets
Term
What complication of uncorrected congenital heart anomalies produces a L to R shunt reversal?
Definition
Eisenmenger's Syndrome
Term
What are the MC cardiac anomalies that Eisenmenger's syndrome develops in?
Definition
VSD
ASD
TA
TOGA
Term
What is the treatment for PDA?
Definition
Ibuprofen/Indomethacin (causes closure, most effective in premies not full-term), ligation
Term
What is the treatment for Ventral Septal Defect?
Definition
Watch and Wait, most close on there own
Surgery indicated if large defect or HF by 2 months
Term
What is the tx for mild pulmonic stenosis?
Definition
Nothing
Term
What is the tx for mod to severe pulmonic stenosis?
Definition
balloon dilation via cath
Term
What is the treatment for aortic stenosis?
Definition
exercise restrictions (avoid contact sports)
balloon valvuloplasty in children
valve replacement in adults
Term
What is the treatment for tetralogy of fallot?
Definition
Blalock-Taussig Procedure
Term
What is the treatment for tricuspid atresia?
Definition
Blalock-Taussig shunt or prostaglandin
Term
What is the treatment for Transposition of great arteries?
Definition
emergency surgery if inadequate shunting = balloon atrial septostomy
Term
What is the treatment for truncus arteriosus?
Definition
digitalis/diuretics
Surgery - remove PA from TA, replace trunchal valve, close VSD if open
Term
What is the tx for hypoplastic L heart syndrome?
Definition
Prostaglandins (help dilate DA)
Diuretics
Surgery
Term
What is the MCC of acute bronchiolitis?
Definition
RSV
Term
What condition is described as an acute viral infection of the lower respiratory tract in infants and young children?
Definition
Acute Bronchiolitis
Term
What is the peak age of incidence of acute bronchiolitis?
Definition
< 6 mon
Term
Are most pneumonias viral or bacterial?
Definition
viral
Term
If a 3 mon old pt presents with wheezing, crackles, expiratory obstruction and respiratory distress, what condition do you suspect?
Definition
Acute Bronchiolitis most likely caused by RSV
Term
What is the tx for acute bronchiolitis? What do you avoid?
Definition
place in cool, humidified oxygen area
May use albuterol, epinephrine or ribavirin
Avoid sedatives (as they cause respiratory depression)
Term
Which type of pneumonia is most serious bacterial or viral?
Definition
bacterial
Term
What are the most likely organisms causing lower respiratory infections in neonates (0-1mon)?
Definition
E. Coli
Grp B Strep
Term
What are the most likely organisms causing lower respiratory infections in Infants (1-6 mon)?
Definition
Chlamydia trachomatis
RSV
Term
What are the most likely organisms causing lower respiratory infections in Children (6 mon - 5yr)?
Definition
RSV
Parainfluenza Virus
Term
What are the most likely organisms causing lower respiratory infections in Children (5 - 15yr)?
Definition
Mycoplasma Pneumonia
Influenza Virus Type A
Term
What are the most likely organisms causing lower respiratory infections in Young Adults (16 - 30 yrs)?
Definition
Mycoplasma pneumoniae
Strep pneumoniae
Term
What are the most likely organisms causing lower respiratory infections in Older Adults (>30y/o)?
Definition
Strep Pneumoniae
HiB
Term
If pt is asymptomatic but has a +PPD, what is your dx? What is the tx?
Definition
Latent TB
INH 300mg/d x 6-9 mo (Consider pyridoxine -B6, to prevent neuropathies)
Monitor LFTs every mon
Term
What med can cause orange tears or orange colored pee?
Definition
Rifampin
Term
What is the treatment for active TB in children?
Definition
INH and RIF for 9 mo
Term
Pt presents with persistent coughing, with phlegm at times, wheezing or SOB, excessive appetite but poor wt gain, greasy, bulky stools and very salty skin. What condition do you suspect?
Definition
CF
Term
What may be a clue on HEENT exam that the pt has cystic fibrosis?
Definition
nasal polyps
Term
If newborn is deemed failure to thrive and has a hx of meconium ileus and intestinal obstruction, what condition might you suspect?
Definition
CF
Term
What is the diagnostic test to confirm a dx of CF?
Definition
Sweat Chloride test
Term
On CXR there is hyperinflation of lungs, increased AP diameter on lateral view and scattered consolidation, what condition is consistent with these findings?
Definition
Acute Bronchiolitis
Term
On CXR of a child there is mediastinal adenopathy, segmental hyperinflation , alveolar consolidation, interstitial densities and a cavitation. What condition are you suspecting?
Definition
TB
Term
What is the gold standard for diagnosing TB?
Definition
CXR, PPD
Term
What is the gold standard fro diagnosing pertussis?
Definition
sputum culture
Term
What type of hypersensitivity reaction is asthma?
Definition
Type 1 - IgE mediated
Term
What condition is described as lower airway obstruction that is partially or fully reversible either spontaneously or with a bronchodilator or anti-inflammatory tx?
Definition
Asthma
Term
What condition is characterized by airway inflammation, bronchial hyperactivity, swelling, spasm or sputum production?
Definition
Asthma
Term
What happens to FVC, FEV1 and FEV1/FVC ratio with asthma?
Definition
FVC - Normal
FEV1 - decreased
FEV1/FVC ratio = <80%
Term
With a pulmonary function test what finding is suggestive of asthma?
Definition
increase in absolute FEV1 of >12% after bronchodilator
Term
What type of med is albuterol?
Definition
short acting B agonist
Term
When is albuterol used?
Definition
in all types of asthma
Term
When are long-acting B agonists used in asthma treatment?
Definition
optional in moderate persistant
Mostly used in severe pts
Term
What are long-acting B agonists used in conjunction with?
Definition
anti-inflammatory drugs (eg salmeterol)
Term
When does extrinsic (allergic) asthma onset?
Definition
childhood to adolescents
Term
Which type of asthma has characteristics including allergic shiners, hx of eczema, has predominant sx of a cough, is IgE associated and will have pos skin tests?
Definition
Extrinsic (allergic) Asthma
Term
What is the age of onset of intrinsic asthma?
Definition
>35y/o
Term
Which type of asthma has neg Fhx, no hx of childhood eczema, skin tests are neg, not IgE associated and has dyspnea with exercise?
Definition
Intrinsic Asthma
Term
Which type of asthma may be more chronic or severe, may require more extensive therapy and may become corticosteroid dependent?
Definition
Intrinsic Asthma
Term
At what stage of persistent asthma do exacerbations possibly affect activity?
Definition
Mild
Term
At what stage of persistent asthma do exacerbations limit activity?
Definition
Moderate
Term
At what stage of persistent asthma do exacerbations severely limit physical activity?
Definition
Severe asthma
Term
Which stage of asthma has FEV1 or PEF > 80% and PEF variability < 20%?
Definition
Mild Intermittent
Term
Which stage of asthma has FEV1 or PEF > 80% and PEF variability < 20% - 30%?
Definition
Mild Persistent Asthma
Term
Which stage of asthma has FEV1 or PEF 60% - 80% and PEF variability > 30%?
Definition
Moderate Persistent Asthma
Term
Which stage of asthma has FEV1 or PEF < 60% and PEF variability > 30%?
Definition
Severe Persistent Asthma
Term
What pathogen causes Hand, foot and Mouth disease?
Definition
Coxsackie Virus A16
Term
What is the pathogen causing herpangina?
Definition
Coxsackie virus
Term
Pt presents with conjunctivitis, pharyngeal MEMBRANE, "bullneck" and severe myocarditis, what condition do you suspect? What is the causative pathogen?
Definition
Diptheria; Corneybacteria Diptheria
Term
What is the routine dosage schedule to protect a child from Diptheria, Pertussis and Tetanus?
Definition
DTap @
- 2mon
- 4 mon
- 6 mon
- 15 - 18 mon
Term
If a pt has never received a vaccination against Tetanus, what is the schedule to catch-up?
Definition
First Dose
4 wks later Second Dose
6 - 12 mons later Third Dose
Booster dose q 10 yrs there after
Term
If a 8 year old pt has no record of Tetanus vaccinations, what is important to note about the first shot in their catch up series?
Definition
Since they are <10y/o you want to give them Tdap as their first shot in the series.
Term
What pathogen causes whooping cough?
Definition
Bordetella Pertussis
Term
3 y/o pt presents with a hx of a runny nose, sneezing, and a low-grade fever for the last 2 weeks. But now she is having coughing spells in which she turns purple to red at the end and she sometimes vomits after the spells. What condition do you suspect?
Definition
Whooping Cough (Pertussis)
Term
Which vaccinations are LIVE viruses?
Definition
MMR, Rotavirus, Varicella
Term
Can MMR be given to a pregnant women?
Definition
No
Term
What is the schedule for MMR?
Definition
1st = 12 - 15 mo
2nd = 4 - 6 y/o
Term
Can you give a pt MMR before they are 12mo old?
Definition
No it would be invalid
Term
When can the second dose of MMR be given?
Definition
given anytime 4 weeks after 1st dose
Term
What condition is described as an acute, contagious viral dz consisting of painful swelling of the salivary glands, MC the parotid glands and post-pubertal males may have accompanying orchitis?
Definition
Mumps
Term
What is the MC complication of Mumps in children?
Definition
Meningoencephalitis
Term
What is the minimum interval between each dose of Hib?
Definition
4 weeks
Term
When is a child 'too old' to receive a Hib vaccine?
Definition
59 mo
Term
What is the normal schedule for Hib vaccination?
Definition
1st = 2 mon
2nd = 4 mon
3rd = 6 mon
4th = 12 - 15 mon
Term
If a child is between the ages of 15 - 59 mon, and have not had their Hib vaccinations, how many doses do they need?
Definition
at least 1
Term
What does Hib protect against?
Definition
Haemophilus influenzae type B; Used to be the LEADING cause of bacterial meningitis in children < 5y/o prior to the vaccine, also causes pneumonia
Term
What are the 2 types of Pneumococcal Vaccines?
Definition
PPV and PCV
Term
Which pneumococcal vaccine is used for children? What ages?
Definition
PCV; 0 - 2y/o
Term
In what ages is the PPV vaccine not effective?
Definition
kids < 2y/o
Term
When is the PPV vaccine recommended for adults? When is it recommended for children?
Definition
Adults > 64y/o, HIV pts and immunocompromised adults
High-risk children > 2y.o (Asplenia, Sickle Cell dz)
Term
When is the normal PCV schedule?
Definition
1st = 2 mon
2nd = 4 mon
3rd = 6 mon
Booster = 12 - 15 mon
Term
What is pneumococcal vaccine used to prevent?
Definition
Used to prevent SEVERE pneumococcal pneumonia
Term
What does a newborn infant whose mother is Hep B pos need as a prophylaxis?
Definition
Hep B vaccine and HBIg
Term
What does a newborn infant whose mother is Hep B status is unknown need as a prophylaxis?
Definition
Hep B vaccine, test the mother and give HBIg within 7 days of delivery if mom is pos
Term
What does a PRE-TERM infant whose mother is Hep B status unknown need as a prophylaxis?
Definition
Hep B vaccine and HBIg
Term
What is the routine schedule for Hep B?
Definition
1st = Birth
2nd = 1 - 2 mon
3rd = 6 - 18 mon
Term
What is the Adolescent dosing for Hep B vaccination if the pt is between 11 and 15 and have never had a Hep B vaccination?
Definition
Use Recombivax give 1st dose then 2nd dose 4 - 6 mon later
Term
What is the minimum spacing of the Hep B vaccine?
Definition
1st and 2nd dose = 4 week in between
2nd and 3rd dose = 8 weeks in between (at least 16 weeks after 1st dose; infant MUST be at least 24y/o before giving 3rd dose)
Term
What is the adult schedule for hep B?
Definition
1st dose
2nd dose = 4 weeks later
3rd dose = 8 weeks later (at least 16 weeks between 1st and 3rd dose)
Term
What is IPV?
Definition
Polio vaccine
Term
Which pts are post-vaccination serologic testing recommended?
Definition
Infants born to HBsAG + women
Sex Partners of chronic HBV infection
Certain Healthcare personnel
Immunodeficient Persons
Hemodialysis Pts
Hemodialysis Pts
Term
If healthcare personnel is exposed to blood and possibly HBV, when should you get a titer?
Definition
1 - 2 months after 3 month shot series
Term
When is Hep A vaccination administered? What is the schedule?
Definition
Given between 12mon and 24 mon; given at least 6 mon apart
Term
Can Hep A vaccine be given to pts who have previously been infected with Hep A?
Definition
YES
Term
What is the MCC of nonspecific febrile illness with abrupt onset and no prodrome?
Definition
Enterovirus
Term
What is the leading cause of exanthems in children in summer and fall?
Definition
Enterovirus
Term
After one dose of IPV is there immunity? After 2 doses? After 3 doses?
Definition
Little Immunity after 1 dose
90% immunity after 2 doses
99% immunity after 3 doses
Term
What is the normal schedule for IPV?
Definition
1st = 2 mon
2nd = 4 mon
3rd = 6 - 18 mon
4th = 4 - 6 y/o
Term
What are the mandatory intervals between the IPV doses? How early can the 4th dose of IPV be given?
Definition
4 weeks; 4th dose can be given as early as 18 w/o
Term
When should Polio vaccination of adult be considered?
Definition
Only if adults are traveling to Polio endemic areas
Term
Pt presents with vesicular tender lesions varying in size from 3 - 7 mm occurring on tongue and dorsal surfaces of hands and feet. What condition do you suspect? What is it caused by?
Definition
Hand, foot and mouth dz; Cocksackie Virus A16
Term
What is the MC place that Herpangina sores are located?
Definition
Anterior Tonsillar Pillars
Term
Which condition is characterized by fever and vesicular lesions in the mouth surrounded by an erythematous ring that varies in size and is found on the anterior tonsillar pillars, soft palate, uvula, tonsils, posterior pharyngeal wall, and other surfaces in the mouth, child may also c/o HA, backache and vomiting?
Definition
Herpangina
Term
Which condition has a rash that is characterized by erythematous papules that develop into clear-filled vesicles, then lesions become umbilicated then become crusted and fall off (as a side note the rash is intensely pruritic?
Definition
Varicella
Term
Where does the Varicella rash begin?
Definition
face, trunk or scalp
Term
What condition is characterized by vesicular lesions in different stages of evolution in the same area?
Definition
Varicella
Term
What is the treatment for Varicella Zoster?
Definition
Acyclovir
Treat pruritis with calamine or oatmeal baths
Term
What bacteria are the MC pathogens for causing superinfections in Varicella Zoster?
Definition
Grp A Beta Hemolytic
Staph and Strep
Term
What is the schedule for the Varicella vaccination?
Definition
1st dose = 12 to 15 mon
2nd dose = 4 to 6 yrs
Term
Can the Varicella vaccine be given to pregnant women?
Definition
No
Term
What is Zostavax used to prevent? Who gets this vaccine?
Definition
Used for prevention or decreased severity of Varicella Zoster reactivation (Shingles); Given to pts >60y/o
Term
When is the highest incidence of RSV seen?
Definition
2 - 7 mo
Term
What is the schedule for rotavirus vaccine? What is the MOD?
Definition
1st = 2mon
2nd = 4 mon
3rd = 6mon
Oral Route
Term
What is the earliest age you can give the rotavirus vaccine? What is the latest age you can initiate the series? At what age is the child too old to receive the rotavirus vaccine?
Definition
Earliest = 6 wks
Latest Initiation of Series = 15 weeks
Oldest Age = 8 weeks
Term
What is the MC cause of diarrhea in children?
Definition
Rotavirus
Term
What is the MC type of Rotavirus?
Definition
Rotavirus A
Term
What is the tx for rotavirus?
Definition
HYDRATION
Managing symptoms (V/D and fever)
Term
In what ages can HPV vaccine be given? Can you give to pts within this age group who are already sexually active?
Definition
btwn ages 9 and 26; YES
Term
What is the general age that HPV is given?
Definition
11 - 12
Term
What is the general spacing schedule for HPV vaccination series? What is the MINIMUM intervals for this series?
Definition
0, 2m, 6m spacing
1st and 2nd = 4 weeks
2nd and 3rd = 12 wks
Between 1st and 3rd = Minimum 24 weeks
Term
In what ages is the Meningicoccal vaccine licensed for?
Definition
2 - 55 y/o
Term
When should the Meningicoccal vaccine be given to 2 - 10 y/o?
Definition
Child with Asplenia and complement def
Pts in outbreak zone or area where N. Meninigitidis is endemic
Term
What age is meningicoccal vaccine generally recommended for? How many doses should be given?
Definition
11 - 18 y/o; given 1 dose
Term
What med should be avoided in children with fever? Why?
Definition
ASA; b/c can cause Reye syndrome
Term
What is the general vaccine schedule for the flu vaccination?
Definition
6 mo old, then every year thereafter
Term
Who needs 2 doses of the flu vaccine?
Definition
Give 2 dose to first-time vaccines age 6mo-8yo (separated by 28 days)
Term
Which vaccines cannot be given to pts with egg allergies?
Definition
Varicella and Flu vaccines
Term
Who should not get LAIV?
Definition
Pregnant women
Pts with CV or Pulmonary Dz
Pts with CAD
Pts with asthma
Term
What component of the vaccines was the concern for causing autism?
Definition
thimerosal
Term
What virus may cause a BLANCHING, erythematous maculopapular generalized rash that may have accompanying sx of rhinitis, nonpurulent CONJUNCTIVITIS, PHARYNGITIS, and pre-auricular lymphadenopathy as well as low-grade fever and malaise?
Definition
Adenovirus
Term
What are forchheimer spots? What dz are they associated with? What day are they seen?
Definition
small reddish spots on the soft palate; Associated with Rubella; Day 1
Term
Which condition has an exanthem that begins on the face and SPREADS from Head to Rear (Cephalocaudally) an is described as discrete, pinkish red, fine maculopapular eruption?
Definition
Rubella (German Measles)
Term
What is the name of the pathognomic exanthem described as tiny bluish white dots surrounded by red halos that appear on the bucchal mucosa? What dz are they associated with?
Definition
Koplik Spots
Associated with Rubeola ("Ordinary Measles")
Term
Which type of measles exanthem spreads from the head to the tail (Cephalocaudally) and will eventually involve the palms and soles?
Definition
Rubeola
Term
Which type of measles can be transmitted to the baby in the womb?
Definition
Rubella (German Measles)
Term
In what time frame can the MMR vaccine be given to a pt who was exposed to Rubeola to prevent the illness?
Definition
w/in 72 hrs
Term
What is the pathogen responsible for Roseola Infantum? What age group of children does it affect?
Definition
HH6 (Human Herpes Virus 6); affects infants 6 - 36mon
Term
Which condition affecting infants begins with sx including an abrupt rise in temp, anorexia and irritability that is followed by an erythematous, maculopapular exanthem that BEGINS on the TRUNK and spread to the face, neck, and extremities?
Definition
Roseola Infantum
Term
What is the pathogen responsible for Erythema Infectiosum?
Definition
Parvovirus B19
Term
What condition begins with LARGE, bright red erythematous patches on both of the CHEEKS that are non-tender, macular and with circumscribed borders that fade and are followed by slightly raised LACY erythematous rash on the EXTENSOR surfaces of the extremities, then on the flexor surfaces, buttocks and trunk?
Definition
Erythema Infectiosum (Fifth's Dz)
Term
What can be a complication of E Infectiosum in a pt with sickle cell dz?
Definition
May cause aplastic crisis
Term
What pathogen causes Mono?
Definition
EBV (Epstein-Barr Virus)
Term
Pt presents with on going fatigue for 1 week, low grade fever, lymphadenopathy and splenomegaly. What condition would you suspect? What test would confirm the dx?
Definition
Mono; positive Heterophile antibody response
Term
What HEENT finding is common (found in 50% of pts) in children who have MONO? What other HEENT sx are important to note?
Definition
Eyelid Edema; Tonsilar swelling, erythematous parynx that may have exudates
Term
What condition has characteristic small yellow oral ulcerations with red halos?
Definition
Herpetic Gingivostomatitis
Term
Is ocular herpes benign? Explain?
Definition
Ocular herpes may involve only the lids and periorbital skin but can spread to deeper structures, with devastating results.
Term
Which condition has a hallmark of dermatomal distribution of lesions?
Definition
Herpes Zoster
Term
What pathogen causes Lyme dz?
Definition
Borrelia burgdorferi
Term
What exanthem is common with Lyme dz?
Definition
Erythema migrans; large erythematous plaque which has central clearing
Term
What is the tx for Lyme dz in children < 8 y/o? What is the tx for children >8y/o?
Definition
amoxicillin or cefuroxime (Ceftin); Amoxicillin (for children > 8 )
Term
What pathogen causes Rocky Mtn Spotted Fever?
Definition
Rickettsia rickettsi
Term
Where does the rash associated with Rocky Mtn Spotted Fever Begin? What ocular findings accompany this rash?
Definition
Begins distally on the wrists, ankles, palms and soles ; conjunctival erythema and photophobia
Term
What is the treatment for Rocky Mtn Spotted Fever?
Definition
Doxycycline (Vibramycin) BID until 3 days after the fever subsides
Term
What pathogen causes folliculitis?
Definition
Staph
Term
What pathogen causes Impetigo?
Definition
strep, staph or both
Term
What condition has characteristic lesions described as "honey" colored crusts?
Definition
Impetigo
Term
What is the MCC of Ecthyma? Where is it most often found? How does it differ from Impetigo?
Definition
Grp A Beta Hemolytic Strep; Found in tropical areas; Lesions are more painful, crusts are harder, thicker and more adherent than Impetigo
Term
What is the cause of a Paronychia?
Definition
Staph/Strep from traumatized hangnail
Term
What is the causative pathogen of a Furucle?
Definition
Coag-Positive Staph
Term
What is the treatment for a furuncle?
Definition
Bactrim, Clinda, Rifampin
Term
What pathogen is responsible for cat-scratch fever?
Definition
Bartonella henselae
Term
What antibiotic is given to tx cat-scratch fever?
Definition
Azithromycin
Term
What are the MC pathogens of Osteomyelitis? What about in sickle cell pts? What about MC in puncture wounds of the foot?
Definition
S. aureus and B hemolytic Strep; In SC pt Salmonella is MC; In puncture wounds Pseudomonas
Term
What are the causes of septic arthritis in 90% of the cases? What is the tx for septic arthritis?
Definition
PNA or Meningitis; Tx is IV Antibiotic
Term
What is the leading cause of heart dz in children? What is the underlying cause?
Definition
Kawasaki's dz; AI disease
Term
Pt presents with persistent fever for five days at 104F, bright red cracked lips, red mucous membranes in mouth, extremely bloodshot eyes, red palms and soles of the feet that are swollen and tender, skin rash on the trunk of the body, peeling skin in the genital region, on the hands and feet, andswollen cervical lymphnode. What condition do you suspect? What is the tx?
Definition
Kawasaki's dz; IV gammaglobulin
Term
In what condition are purplish hyperpigmented plaques and nodules are characteristic?
Definition
Kaposi's Sarcoma
Term
In what condition is there a sandpaper-like tender exanthem and perioral fissures that are weeping?
Definition
Scarlet Fever
Term
When should the PPD test be read? What is a pos test in pts w/out risk factors? What is a pos test in members of high-incidence pop? What is a pos test in HIV pts?
Definition
48 - 72 hrs; 15mm; 10mm; 5mm
Term
What is the tx for Hiradenitis Suppurativa?
Definition
Bactrim
Term
What four criteria distinguish muscular dystophy from all other neuromuscular diseases?
Definition
1- Has a genetic basis
2- Primarily affects the muscles
3- Progressive worsening of sx
4 - Degeneration and death of muscle fibers occur at some stage
Term
What is the MC hereditary neuromuscular dz?
Definition
Duchenne muscular dystrophy
Term
What is the difference between Duchenne and Becker MD?
Definition
Becker is a milder and more protracted (lasts longer) course; learning disabilities are less frequent, can walk into late adolescence; death occurs in mid to late 20s
Term
What is Gower's sign? What is this a clinical sign of? When is this sign seen?
Definition
Getting up from the ground by widening legs and walking hands back towards them; Sign of MD; Seen at around age 3
Clinical sign of MD
Term
What type of gait is associated with MD? When is this seen?
Definition
Trendelenburg gait; seen at age 5 or 6
Term
By what age are the MD kids most likely confined to a wheel chair?
Definition
7 y/o or with lots of physical therapy, bracing and minor surgeries they may make it until 12y/o
Term
What is the generally age of death in Duchenne's MD?
Definition
18 y/o
Term
What lab test is significantly elevated in MD? What is the diagnostic test for MD?
Definition
Serum CK extremely elevated; Muscle biopsy is diagnostic
Term
Which type of MD is the 2nd MC?
Definition
Myotonic MD aka Steinert Dz
Term
Which type of MD is characterized by inverted V-shaped upper lip, thin cheeks, scalloped concave temporalis muscle (general facial wasting and hypotonia are early signs)?
Definition
Myotonic Muscular Dystrophy
Term
When do the initial signs and symptoms of Limb-girdle MD usually occur, distinguishing it from other forms?
Definition
Initially occur after middle or late childhood
Term
In what form of MD is cardiac and respiratory involvement significant as well as impaired intellect and seizure activity present?
Definition
Duchene and Becker MD
Term
Does Limb-girdle MD affect the cardiovascular system or the intellect?
Definition
No
Term
Which form of dystrophy shows the earliest and most severe weakness of the face and shoulder girdle and has characteristics facial features including puckered lips, inability to close eyes when sleeping, and extraocular muscle weakness but generally spares the tongue?
Definition
Facioscapulohumeral Muscular Dystrophy (FSH)
Term
In which type of MD is scapular winging prominent, even in infancy?
Definition
Facioscapulohumeral Muscular Dystrophy (FSH)
Term
Which MD has severe findings at birth including thin muscle mass, contractures, diffuse hypotonia, poor head control, and hypoactive or absent tendon stretch reflexes?
Definition
Congenital Muscle Dystrophy
Term
What is the MC c/o Tuberous Sclerosis? 2nd MC complaint?
Definition
Seizures; Cutaneous Lesions
Term
Pt presents with a plaque of thickened skin with a cobblestone appearance on the dorsal aspect of the trunk. What is this called? What could this be a clinical sign of?
Definition
Shagreen Patch aka Ash leaf; Linked to Tuberous Sclerosis (one of the common cutaneous manifestations)
Term
Which condition is associated with six or more cafe-au-lait spots, axillary or inguinal freckling, lisch nodules (iris hamartomas), optic gliomas, neurofibromas and distinctive osseous lesions?
Definition
NF-1 aka vonRecklinghausen disease
Term
Which condition has characteristic findings including presenile lens opacities, impaired hearing or hearing loss, tinnitus, unsteadiness and facial weakness?
Definition
NF-2
Term
What is associated with a significant increase in the risk of CP in normal birth weight infants?
Definition
Intrauterine exposure to maternal infection
Term
Which disease has early signs including poor sucking/ feeding, decreased passive tone with brisk DTRs without concomitant weakness, and motor delays?
Definition
Cerebral Palsy
Term
What is the criteria of diagnosis of CP?
Definition
P = Posturing and abnl movements
O = Oropharyngeal problems
S = Strabismus
T = Tone (Increased or Decreased)
E = Evolutional responses
R = Reflexes Increased
Term
What is the MC type of CP?
Definition
Spastic - tense, contracted muscles
Term
Which condition is characterized by a port-wine stain on the face, located over the cutaneous distribution of the opthalmic division of the trigeminal nerve, a high incidence of mental retardation and ipsilateral leptomeningeal angiomatosis?
Definition
Sturge-Weber Syndrome
Term
Which type of seizures affect one area of the brain, in one hemisphere?
Definition
Partial (Focal) Seizures aka Jacksonian Seizures
Term
What is the difference btwn simple partial and complex partial seizures?
Definition
consciousness retained in simple partial seizures
Term
Which type of seizure affects both sides of the brain?
Definition
Generalized Seizures
Term
Which type of seizure is described as sudden loss of consciousnes lasting 10 seconds in which the pt may have rapid eye blinking and does not lose muscle tone?
Definition
Absence (Petit Mal) Seizures
Term
Which type of seizures are characterized by a sudden shock like contraction of a muscle?
Definition
Myoclonic generalized seizure
Term
Which type of seizure is characterized by increased tone or rigidity?
Definition
Tonic Seizure
Term
Which type of seizure consists of rhythmic muscle contraction and relaxation?
Definition
Clonic Seizures
Term
Which type of seizure may begin with a scream or “epileptic cry” f/b stiffening of limbs, a fall and cyanosis then after 60-90 secs, will begin an extremity jerk, then will have a postictal period (deep sleep)?
Definition
Tonic Clonic Seizure (Grand Mal)
Term
Which type of seizure is characterized by flaccidity or by lack of movement during a convulsion resulting in falls and injuries?
Definition
Atonic seizures (drop attacks)
Term
In which type of seizure is clothes picking common?
Definition
Complex Partial
Term
In which type of seizure in which the pt remains conscious and they have asynchromous clonic or tonic mvments that tend to involve the face, neck or extremities?
Definition
Simple Partial Seizure
Term
What can abrupt w/d of seizure meds lead to?
Definition
status epilepticus
Term
What condition is described as occurring in infants and is characterized by brief contractions of the neck, trunk and extremities (can be either flexion or extension)?
Definition
West Syndrome (Infantile Spasms)
Term
What syndrome is described as a life-long epileptic encephalopathy that manifests with atonic seizures, tonic seizures, and atypical absence seizures?
Definition
Lennox-Gastaut Syndrome
Term
What do infantile spasms often transform into?
Definition
Lennox-Gastaut Syndrome
Term
What differentiates Lennox-Gastaut Syndrome from benign absence epilepsy?
Definition
The slow spike and wave activity on the EEG
Term
What is the MC seizure d/o in childhood?
Definition
febrile seizures
Term
What are the MCC of febrile seizures?
Definition
Fever assoc w/Viral infections from URIs
Term
Tx for Absence Seizures?
Definition
Ethosuximide and Valproic Acid
Term
Tx for Myoclonic Epilepsy?
Definition
Valproate, lamotrigine, topiramate, or levetiracetam
Term
Tx for Generalized Tonic-Clonic Seizures?
Definition
DOC for epilepsy- Valproate
Phenytoin
Term
Tx for simple partial seizure?
Definition
Carbamazepine
Term
Tx of Complex partial seizures?
Definition
Valproate, Phenytoin, Carbamazapine
Term
Pt present with c/o of re-occurring HA lasting for apprximately 1 hr at a time. During HA pain is described as unilateral and throbbing. HA is associated with N/V, closing of the eyes and dark circles under the pts eyes. Before the HA the child is irritable and becomes withdrawn. What type of HA is your dx?
Definition
Migraine w/o Aura
Term
What is the MC type of aura accompanying migraine HA?
Definition
Visual Auras (ex - blurry vision, scotomata, scintillations, kaleidoscope patterns)
Term
Which type of migraine with aura has accompanying ataxia, tinnitus, hyperascusia, paresthesias and visual disturbances?
Definition
Basilar Type Migraines
Term
What are the OTC tx options for Migraines?
Definition
Acetaminophen (10 - 15 mg/kg/dose)
Ibuprofen (10mg/kg/dose)
Naproxen Sodium -Aleve (5 mg/kg)
Term
What are some prescription meds used to treat migraines in children?
Definition
Almotriptan
Sumatriptan
Zolmitriptan
Rizatriptan
Term
What is the prophylactic dose for bacterial endocarditis for a child? What if pt has PCN allergies?
Definition
Amoxicillin 50mg/kg; Clindamycin 20mg/kg
Term
What are the major criteria for the Jones criteria?
Definition
Polyarthritis
Carditis
Chorea (Syndenham Dz)
Erythema Marginatum
Subcutaneous Nodules
Term
What are the minor criteria for the Jones criteria?
Definition
Fever
Arthralgia
Previous Rheumatic fever
Elevated Acute Phase Reactants
Increased ESR or CRP
Leukocytosis
Prolonged P-R interval on EKG
Term
Which acquired heart condition is seldom seen in children?
Definition
Restrictive Cardiomyopathy
Term
What is the tx for Rheumatic heart dz?
Definition
Penicillin to eradicate B-hemolytic strep
Term
Tx for hypertrophic cardiomyopathy?
Definition
B-blocker, Ca-Channel blocker
Term
Tx for dilated cardiomyopathy?
Definition
Digoxin
Diuretics
Term
tx for restrictive cardiomyopathy?
Definition
Dopamine, Dobutamine, Digoxin
Term
tx for cardiac tamponade?
Definition
pericardiocentesis
Term
Which benign murmur is present in 3 - 6 y/o, occasionally is in infants and is heard at the LMSB or btw LLSB & apex?
Definition
Stills Murmur
Term
Which benign murmur is common in 8 - 14 y/o and is heard as a blowing murmur on the LUSB?
Definition
Pulmonary Ejection Murmur
Term
Which benign murmur is heard in premature and full-term infants and disappears at 3 - 6 mon and is heard at the LUSB, axilla and back?
Definition
Pulmonary flow murmur
Term
Which benign murmur is heard in 3 - 6y/o and is heard in the supra and infra clavicular regions?
Definition
Venous hum
Term
What benign murmur can be heard at any age and is located above the right clavicular region?
Definition
Carotid bruit
Term
What pathogen causes scarlet fever?
Definition
Grp A strep
Term
MC viral cause of pharyngitis?
Definition
Adenovirus
Term
What is the oppenheimer technique? How is it done?
Definition
A replacement technique for the babinski reflex as it gives a more interpretable response; running the thumb down the medial surface of the tibia
Term
What are the 2 types of retinal lesions seen in tuberous sclerosis?
Definition
Mulberry Tumor Nodular and Hamartomas (phakomas)
Term
What retinal lesion is described as astrocytoma of the retina on or about the optic nerve head? What condition is it associated with?
Definition
Mulberry Tumor Nodular; Assoc with tuberous sclerosis
Term
What type of retinal lesion is described as Round or oval gray-yellow glial flat patches found centrally or peripherally? What condition are they associated with?
Definition
Hamartomas; asoc with tuberous sclerosis
Term
What is the minimum w/u for a febrile seizure?
Definition
fasting glucose
calcium
magnesium
serum electrolyte levels
Term
Which type of cerebral palsy is described as Dysfunction of the LEs with normal or limited UE?
Definition
Spastic Diplegia
Term
Which type of cerebral palsy is described as Dysfunction of both the UEs and LEs?
Definition
Spastic Quadriplegia
Term
What type of CP is described as Upper extremities more greatly affected than LEs?
Definition
Hemiparesis
Term
Which type of CP is described as Involuntary mvmts noted after 1 year of age, Hypotonic and normoreflexive, and Delayed motor milestones?
Definition
Athetoid or Ataxic Cerebral Palsy
Term
Which type of CP is described as Severe motor and intellectual disability?
Definition
Hypotonic Cerebral Palsy
Term
What condition is described as a birth defect in which one or more of the vertebrae fail to form properly in the fetus during the first trimester of pregnancy?
Definition
Spina Bifida Occulta
Term
What is the MC type of spina bifida?
Definition
Spina bifida occulta
Term
Which type of spinda bifida is described as no sac or protrusion of spinal cord, Failure of one vertebra in the lower back to fuse properly and is associated with skin changes including dimple, hairy patch or birthmark?
Definition
Spina bifida occulta
Term
What is the MC type of overt spina bifida?
Definition
Meningocele
Term
What condition is described as spinal cord stays within spinal canal, but meningeal sac protrudes through the opening in the vertebrae but are nevertheless well covered by skin?
Definition
Meningocele
Term
What condition is described as the sac or cyst includes not just the coverings of the spinal cord but also the cord’s nerve roots, and often the cord itself, bulging out and often not covered by skin?
Definition
Myelomeningocele
Term
What is the MC cause of spina bifida?
Definition
lack of folic acid
Term
What is the DOC for treating bacterial pneumonia?
Definition
Azithromycin
Term
What is the MC presenting symptom of a pt with CF?
Definition
Acute or persistent respiratory symptoms
Term
How is Epidermolytic Hyperkeratosis treated?
Definition
keratolytics, lubricants, oral retinoids, & antibiotics for secondary infections
Term
What condition has thick warty scales with occasional blistering and skin lesions that are more prominent on the flexural surfaces?
Definition
Epidermolytic Hyperkeratosis
Term
Patient is highly involved in sports. He complains of itchiness and scaling of the feet. What is your diagnosis?
Definition
Juvenile Plantar Dermatosis-“Sweaty Sock Syndrome
Term
How do you treat lick licking Eczema?
Definition
Elidel and protopic ointment ( T-cell suppressor)
try to avoid steriods on facial skin because will cause hyper vascularization, striae, discoloration
Term
What is the MC irritant in contact dermatitis?
Definition
Nickle
Term
How do you treat irritant contact dermatitis?
Definition
topical steroids
Term
How do you treat tinea versicolor?
Definition
Topical antifungal or Oral Ketoconazole 1 time dose
Term
What is the MC pathogen of diaper dermatitis? What is the tx?
Definition
Candida; Tx is Nystatin cream
Term
What is the most common cause of recurrent E multiforme lesions in children and adults?
Definition
In children and adults recurrent EM is caused by Herpes Simplex Virus (HSV) infection
Term
Child complains of itchiness that worsens at night. The lesions are located in the intertriginous regions of the hands and feet. What is your dx and tx?
Definition
Scabies
Permethrin 5% cream (Elimite)
Term
Child presents with complaints of an itchy scalp and nits. Other children in the classroom have the same complaints.What is your diagnosis and treatment?
Definition
Head lice, Pediculicide (Permethric 1% or 5%)or Ovide
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