ER
A DOL 5 term infant presents to the ED with seizures. The seizure started in the right arm and then progressed to GTCs and lasted 5 minutes. The baby has also had a temperature of 39°C at home. POC glucose is 120 mg/dL. After seizure control, what is the next priority in management of this patient?
Ampicillin, Gentamicin and Acyclovir. Admission to NICU. D10 1/4NS at TFL 120. NPO. EEG with Neuro consult. BMP, CBC, culture, LP
You are called to the NICU to evaluate an otherwise healthy 2-day-old neonate who has not yet passed meconium. He developed significant abdominal distention and just had an episode of green vomiting 3 minutes ago. On physical exam rectal tone is tight and the rectal ampulla is found to be empty. What is the most likely diagnosis?
Hirschspung's disease
What is the best method to diagnose developmental dysplasia of the hip in an infant?
Physical examination at birth and repeated at each well visit until the child is walking
A mother brings her 16-day-old boy to your office because she is concerned about a rash on her baby’s eyebrows. She first noticed it yesterday and it seems slightly worse today, which concerned her and her mother-in-law. She tried bathing the baby but that did not help. Her son does not seem bothered by the rash. He was a full-term vaginal delivery weighing 7 pounds 4 ounces and was observed for 48 hours in the hospital after delivery due to inadequately treated group B strep colonization in the mother but discharged without concerns. He is exclusively formula-fed. What treatment would you recommend?
seborrheic dermatitis requires no treatment
Scabies is treated with what medication?
permethrin (Elimite)
A 15 yo teenager comes in to the ED with c/o vaginal itching and a foul-smelling vaginal discharge. What is the most likely parasitic infection she could have and how would you treat it?
A 33-week gestation male was born 2 weeks ago to a G3P3 mother who had a SVD. He is being ventilated with high pressures for respiratory distress syndrome. On physical examination his breath sounds are symmetric and he has a grade III/VI systolic heart murmur. What is the next step in this patient's care?
Echocardiogram
A mother brings her previously healthy 6-year-old son to your office for evaluation of limping. He has been complaining of left leg and knee pain over the past week. His past medical history is non-contributory and his mother reports no recent trauma or known tick exposure. On physical exam he is afebrile with mild tenderness over the right knee without effusion, edema, misalignment or weakness of the lower extremities. There are petechiae over his chest and neck, and hepatomegaly is not on the abdominal exam
ALL
An 11 y/o girl presents with arthralgias x 2 days. She states that about two weeks ago, she had a sore throat, fever of 102.0, and a generalized rash which resolved spontaneously. On physical exam, you note a new onset heart murmur. Laboratory testing reveals elevated ESR and ASO titers. ANA and RF are negative. What is the most likely diagnosis?
Rheumatic Fever
A previously healthy 3-year-old male presents to your primary care clinic with acute onset of generalized petechiae. He is otherwise well and review of symptoms is negative for weight loss, fatigue, recurrent fevers, and change in activity. On physical examination, the patient is a well-appearing toddler in no apparent distress with generalized petechiae. The remainder of his examination is normal. There is no history of a preceding viral illness. He does not take any medications. Family history of bleeding disorders is noncontributory. CBC is significant for severe thrombocytopenia with platelets of 12,000. WBC and hemoglobin are normal. Which of the following is the most likely diagnosis in this patient?
ITP
A 5 month old is brought in for an episode of choking and turning purple in the face. Mother reports that the episode occurred 30 minutes after a feed. The patient was not responsive and required rescue breaths and father did CPR for 30 seconds. On exam, the patient is very well appearing and smiling and babbling. What is your disposition for this patient?
observation
During a routine health assessment, a review of growth charts for a 6-month-old shows consistent growth in the 50th percentile for height and weight. There is no history of medical problems. The parents are healthy and the pregnancy and delivery were uneventful. On physical examination, a grade III/VI harsh, pansystolic murmur is heard over the left sternal border without radiation; heart rate is 70 bpm.
VSD
A 3 year old child is brought to the office by her parents for evaluation of an arm injury. They were playing in the backyard, and the child was being swung by her arms, when she suddenly stopped using her right arm. What is the most appropriate treatment for this condition?
supination of the forearm followed by flexion of the elbow
5 year old child presents with a 100.3F fever and a lacy red rash on both cheeks and on chest x 1 day. what is the most likely pathogen responsible for this possible infection?
Parvovirus B19
Treatment for PDA
Indomethacin and/or ligation
Which of the following burn injuries is most concerning for child abuse?
A.A 4 yo with a 2nd degree burn to his shoulder and upper chest after pulling hot tea off a counter
B.A 2 yo with a single irregular superficial 1st degree cigarette burn to the upper arm
C.An 8 month old with circumferential partial thickness burns to both feet and lower ankles sustained after climbing into the bathtub
D.A 9 yo with 1st and 2nd degree burns to his face after taking hot soup out of the microwave
C.....8 month old can't really crawl into bathtubs and then stand up
A 4-year-old child presents to the clinic with complaints of fever of 103oF, sneezing, coryza, and a harsh non-productive cough for the past two days. According to the chart his last visit to the office was his 1 year well baby evaluation. On physical exam there are no rashes. There is eyelid edema with light yellow exudate not bilaterally. On inspection of the buccal mucosa you note t white papules on an erythematous base
Rubeola
An 8 y/o boy presents to your pediatric office with a painless limp x 3 weeks. About a month ago he was complaining of knee pain, which his mother treated with acetaminophen. On examination, he demonstrates limited abduction and internal rotation of the left hip.
Legg-Calve-Perthes disease
An 11 month old female is brought to the office by her parents for evaluation of fever, congestion, and irritability x 3 days. Yesterday, the parents noted a pruritic, vesicular rash that started on the face and descended into the abdomen. What is the most likely diagnosis?
varicella
A 16-year-old female presents to your pediatric office complaining of intermittent, diffuse abdominal pain and bloating for the past 6 months. She reports bouts of up to 5-6 bowel movements per day. She describes her stool to be brown in color, loose and soft in consistency and often associated with mucus. She notes moderate relief of her symptoms after defecation. She denies fever, weight loss, pyrosis, nausea, vomiting, hematemesis, constipation, rectal bleeding or melena. Initial diagnostic studies include normal CBC, CMP, TSH, negative endomysial and transglutaminase antibodies and a negative hydrogen breath test. Which of the following is her most likely diagnosis?
IBS
A 13-year-old girl is seen in the pediatrician's office with her mother following a head injury 3 days prior. She initially had a headache when the injury occurred but it resolved and her energy level has returned to normal. She has now gone back to school but gets a headache about 20 minutes after she starts her first class of the morning. She does not get the headache if she takes acetaminophen before leaving for school. The headache recurs in the afternoon as she tries to do her homework. Her physical examination is normal. Her mother is concerned because school standardized testing is beginning in 48 hours and her daughter seems to be falling behind in her studies. Which of the following is the next best step in management?
Explain to the mother that the persistent headache is still secondary to the concussion and provide documentation to the school for the girl to have reduced assignments and defer the testing until she recovers.
A 12-hour-old infant who has been feeding poorly becomes tachypneic with grunting. Which of the following initial tests has the lowest diagnostic yield?
A Chest radiograph
B Complete blood count
C Urine culture
D Blood culture
E Glucose level
C. Urine cultures are not usually obtained in the workup of early onset sepsis. Urinary tract infections are rare in the first few days of life.
A salter-harris fracture that goes through the epiphysis and physis is what type?
III
A migrant worker from Mexico brings his daughter into your clinic c/o fever, rash, fatigue, vomiting and diarrhea. On exam, you notice a reddened area near the right temporal region and the right eyelid appears slightly swollen. You discover that they lived in a mud hut prior to emigrating to the U.S. What is the most likely parasitic infection this patient is experiencing?
Chagas
Which of the following is the first physical manifestation of normal puberty in girls?
Breast enlargement