Nephro/Uro
A 7-year-old male presents to your clinic with his mother with a complaint of enuresis. Evidently, this child has never been completely continent at night, wetting his bed several times per week. This has become somewhat of a problem for him now that his friends are having sleepover birthday parties. Plus, his mother confides that she's tired of paying for pull-ups and cleaning sheets. His incontinence is monosymptomatic (meaning no overactive bladder symptoms or daytime wetting).
What percent of 7-year-old continue to have enuresis?
10%
Musical sounding that is a low frequency, vibratory, musical murmur best heard along the LMSB and LLSB. Usually a grade 1-2/6 in intensity.
Stills Murmur
A 4 y/o girl presents with a 4 day history of limp. She has not history of trauma. She had a viral URI about 1 week ago that resolved without consequence. She is currently afebrile and has no other symptoms. Exam is unremarkable with full ROM in all joints but a limp favoring the left leg. CBC with diff, ESR, and CRP are within normal limits. Radiographs are neg. What is the most likely cause?
Transient synovitis
A 15 y/o with sickle cell anemia presents to the ER with acute pain and swelling of the lower tibia. he is febrile and lethargic and reluctant to move the leg. CT scan shows cortical bone destruction. Which of the following abx regimens is indicated?
Ceftriaxone IV x 48 hrs; Cirpo IV x 6wks; Itraconazole PO x 6 mo; Tetracycline PO x 3 mo
Abx should cover S. aureus, Salmonella and other gram neg bacilli as these are most common. Cipro or vanc are the abx of choice for osteomyelitis in SCD.
Benjamin, a 4-month-old male, comes to your office for a well-baby check. His parents have no concerns. Development and feeding are progressing as expected. Looking at him, you think to yourself, "My gosh. Infants have such big heads relative to their bodies." On your examination, his head is >95th percentile, but his weight and height are still at the 50th percentile. His previous head circumferences have all been at the 50th percentile. He is a social infant but is having difficulty supporting his large head.
What is the imaging study LEAST likely to assist in the diagnosis of the macrocephaly?
Xray, CT scan, MRI, or US
Xray is not likely to aid in the diagnosis of macrocephaly.
US can be used when fontanelles are still open to assess fluid filled spaces
CT and MRI often used.
Differentiate nephritic and nephrotic syndrome.
Nephritic: hematuria and RBC casts in the urine, varying degrees of proteinuria (less severe then nephrotic syndrome)
Nephrotic: heavy proteinuria (>2g/day often >3.5 g/day)), low serum albumin (<3g/dL), hypercholesterolemia (>250 mg/dL)
A wide, fixed split s2 with a grade 2-3/6 Systolic murmur at the LUSB. May also hear a mid-diastolic rumble at the LLSB. And, if you know this murmur, 30-60% occur in which genetic syndrome?
ASD. Down Syndrome.
Abduction of the flexed hip of a 1 mo old elicits a "clunk." What test is the this and what does it assess?
Ortolani sign: developmental dysplasia of the hip
An 8 mo boy is brought to the rural health clinic by his mother. He was born at home and has not been seen by a pediatrician. the child is irritable, is not eating well, and easily fatigues. He appears jaundiced. Fingerstick hemoglobin is 7.2g/dL. Additional labs reveal an elevated retibulocyte count and a peripheral smear showing 20% nucleated RBCs and 10% sickled cells. What test would be most appropriate to order next to confirm the diagnosis?
Hemoglobin electrophoresis to look for Hgb S
A mother states that her 9 y/o child has abrupt episodes of diminished attention where he "disconnects" briefly from conversations yet has no awareness of these lapses. What EEG pattern would you expect to find in this child during typical attacks?
Spike and wave activity
What is the most common cause of chronic glomerulonephritis in children?
IgA Nephropathy
Grade 1-4/6 continuous machinery murmur that is loudest at the LUSB.
PDA
An 8 y/o female presents c/o a painful, stiff right knee for several days. She states she did have basketball practice the night before sx started but doesn't recall an injury or any trauma. She denies fever, wt loss, anorexia.
Exam reveals knee edema, erythema, limited ROM and diffuse tenderness to palpation. CBC, ESR, and xrays are normal. What disorder should you be suspicious of in this case?
Oligoarticular JIA
What is the most common childhood brain tumor?
Radiological studies are almost always obtained in the evaluation of suspected child abuse. However, the cause of fractures has a broader differential than abuse.
Which patient's injuries and/or radiological studies would be pathognomonic of abuse as far as fractures are concerned?
Fractures of multiple bones. Ribs, metaphyseal, scapular, and vertebral fractures. Spiral fractures in non-ambulatory children
What is the most common cause of primary nephrotic syndrome?
Idiopathic nephrotic syndrome with minimal change disease being the most common finding
2-3/6 systolic murmur heard at the LUSB with radiation into the left interscapular space often seen in Turner Syndrome. You also may want to look for this anatomic abnormality that sometimes goes with this abnormality.
Coarctation of the aorta. Bicuspid aortic valve.
A 5y/o presents with a fever of 104 F, bilateral conjunctivitis, dry, cracked lips, and cervical LAD.
What is the most important complication you need to monitor for in this patient?
Coronary artery aneurysm
Brain tumors can cause an increase in ICP. What are some main sx of increased ICP?
HA (worse in AM), vomiting (worse in AM and usually not preceded by nausea), lethargy, irritability
What is Wilson disease
Inborn error of copper metabolism causing deposition of copper in the liver, peripheral cornea, and CNS
What is the triad of HUS?
Hemolytic anemia, thrombocytopenia, and renal injury
An underdevelopment of the left side of the heart, resulting in hypoplastic left ventricle and aortic atresia.
Hypoplastic left heart syndrome
Describe each type of fracture in the Salter Harris Classification system
Type 1: fx through the growth plate
Type 2: fx through part of growth plate and metaphysis
Type 3: Fx through part of the growth plate and epiphysis
Type 4: Fx through everything
Type 5: crush injury to growth plate
This is associated with Reed-Sternberg cells
Hodgkin Lymphoma
A 4 y/o presents to ER c/o vomiting and confusion. The parents states she was diagnosed with influenza 3 days ago but is only doing supportive treatment. On exam, you find the child to be confused and irritable. The lungs are clear, heart sounds normal but you feel an enlarged liver on the abd exam. What should you be concerned about?
Reye syndrome