You Call The Shots
A 17yo M requires 15 sutures to repair a laceration after a fall. Prior to suturing, the wound required copious irrigation and debridement due to extensive contamination. He has received 5 doses of DTaP prior to 6yo and got Td at 11yo. What is the next step in management?
Give Tdap prior to discharge - should give if it's been > 5 years
(Tetanus Ig not indicated due to > 3 vaccines in the past)
A 13yo girl comes to the office with L knee pain. She is a star basketball player and noted worsening knee pain on her anterior knee over the course of the season. On exam, she has tenderness over the L tibial tubercle and pain on full extension of the knee.
Osgood Schlatter Disease
This resident's pet is named after cheese.
Who is Dalina?
(Gouda!)
In a child's speech development, which stage comes directly after cooing?
babbling
A mother of a healthy 6wk baby presents to clinic for concerns that her baby is 'pale.' Her pregnancy was uncomplicated. She is O negative. there was no significant jaundice after birth. She denies any blood in the stool, petechiae, or changes in urine. The baby is taking 2oz of iron-fortified formula every 3 hours. Mom remarks she was diagnosed with anemia due to heavy menses but denies any other family history of anemia. She convinces you to check a Hb, which is 10.5 with a normal MCV for age. What is the most likely diagnosis?
Physiologic Anemia
What is the oldest you can give the HiB vaccine in an immune competent child?
< or = 60mo (5yo)
An 11yo boy comes to clinic because his mother is concerned about his "knock knees" and significant right knee pain. She notes he was a very early walker but the deformity only started over the last year. On exam you see an obese AA boy with a R sided varus deformation of his knee.
Blount Disease
This resident's pet is employed at a rival hospital.
Who is Evan?
(Jax works at CHLA)
You ask a 3 year old child to build a tower of bricks. How many bricks would you expect the tower to be made from, assuming the child is developmentally normal?
> or = 6 blocks
A 9wk old Ex 30 week infant is noted to have tachycardia and increasing oxygen requirements. NICU course has only been complicated by the need for intubation x 3 days; he has been stable on 0.5L since. Maternal course was unremarkable. BW was 1250g. Physical exam reveals pallor. Hb is 7.0, and peripheral smear shows normochromic, normocytic anemia. What is the most likely diagnosis?
Anemia of prematurity
(EPO levels are low --> retics are low)
You are seeing a 12mo boy in your office for routine health maintenance. On review of his chart, you see he recieved his normal 6mo vaccines at his 6mo visit, then received an MMR vaccine at 7mo in anticipation of a trip to Nigeria between the ages of 8-10mo. When should he get his next MMR vaccine?
MMR today (any vaccines before age 12mo don't count toward the series)
A 14yo girl comes to the office with right elbow pain. She reports she is a softball pitcher and is right handed. On exam she has pain on full extension of her elbow and on wrist supination and extension.
Medial Epicondylitis (tennis or little league elbow)
This is the movie that Dr. Brandon Ng acted in as a child.
Aussie and Ted's Great Adventure
(Character name: Yi Chen)
When performing a developmental assessment on a baby, you notice that when picking him up, the head comes up in line with the trunk. Assuming the child is developmentally normal, what age is he most likely to be?
4 months
A 3yo girl comes into clinic with a chief complaint of "she seems pale - can you check her level?." Mom notes she has been well aside from a mild URI about a week ago. She has had no blood in her stool, petechiae or bruising. She eats iron-rich foods. CBC shows a normocytic anemia and iron studies are normal. There is an inappropriately low reticulocyte count for her level of anemia. What is the most likely diagnosis?
Transient Erythyroblastopenia of Childhood
A 13mo girl presents for a follow up visit 1 week after being hospitalized for Kawasaki disease, treated with high dose IVIG and ASA. She received her first dose of MMR vaccine 5d prior to hospitalization. When is her next MMR due?
Repeat dose in 11 months (then the normal vaccine at 4-6 years of age)
A 9-year-old boy presents to his pediatrician with a limp and hip pain. He denies any inciting trauma or event. On exam, he is noted to have atrophy in his upper thigh, asymmetry in leg lengths, and decreased range of motion in his left hip. Radiograph shows sclerosis in the femoral head. What is the most likely diagnosis?
Legg-Calve-Perthes disease
Name all current residents that did Sub-I's here.
Hannah
Evan
Torey
Aashna
At what age should a baby hold a convergent gaze on a dangling toy or bright object, moving their head and neck to follow it?
4 months
A 6yo boy presents to clinic with easy bruising and "little dots under his skin" of several weeks duration. On exam, he is 5th percentile for height and weight, and has abnormal thumbs (picture). You also note large hypergimented patches on his torso as well as petechaie. CBC shows Hb 8, MCV 110, Plt 90, WBC 2.7. What is the most likely diagnosis?
Fanconi Anemia
A 10yo boy comes to your office in the afternoon today. He was otherwise well and recieved a routine Tdap booster. Later that evening the mother calls you with concerns that the vaccine arm is swollen, indurated, and he is complaining of severe pain. What is the most likely diagnosis?
Arthus reaction
A 12yo boy comes to the office for worsening lateral thigh pain. His mom reports that several weeks ago he was accidentally kicked in the leg while playing football. They presented to the ED and XR showed no fracture. His pain got better but over the last two weeks it has gotten progressively worse. On exam, you note a large tender area along his lateral thigh with some underlying swelling.
Myositis Ossificans Traumatica
Chin
Schram
Douillard
Hawthorne
Do
Waldron
Shi
Druma
Marout
Shih
When assessing a 18-month child's development, you note that is able to walk unaided, use a spoon , uses multiple one and two-word labels when talking, but demands constant attention from his mother. What deficits, if any, exist (e.g fine motor, social, gross motor, normal)?
Developmentally normal
A 9mo girl presents with fatigue and decreased PO intake. On exam, you note a child with significant pallor, light-colored hair, and a triphalageal thumb. Her growth curve has shows stagnation of weight and linear height. CBC reveals macrocytic anemia and normal reticulocytes but no other cell line abnormality.
Diagnosis?
Diamond-Blackfan Anemia