Peds NBME Form 4 - Questions and Answers 13 yo boy no hx of serious illness past 2 yrs - brown urine when he has a cold; no dysuria or urinary urgency/in... [Show More] continence CMP: inc BUN; Cr and C3 WNL UA: blood 4+, protein 3+ most likely dx? IgA nephropathy classic: "cola-colored urine" along w/ cold recurrent painless gross hematuria + URI 4 yo boy - fatigue, dec appetite, and 2.3 kg weight loss over past 2 months P: 80/min when supine; 105/min when standing BP: 85/60 mmHg when supine; 75/45 mmHg when standing bG: 465 UA: 3+ ketones, 4+ glucose, 1-2 WBC next step in mgnt? administration of 0.9% saline, intravenously kid prob has T1DM you want to control his symptoms first before dx-ing him kid in DKA - you tx this w/ K, insulin, and fluid 18 yo man - nausea, fatigue, and periorbital swelling for 4 days (worse in mornings) PMHx: tonsillitis 2 wks ago - resolved w/ penicillin BP: 170/95 mmHg PE: periorbital edema BL and trace ankle edema CMP: inc BUN, Cr UA: 1+ protein, few WBC, many RBC, 1 RBC cast most likely dx? acute renal failure RBC casts = glomerulonephritis r/o nephrotic syndrome = >3.5g of protein/24 hr urine, edema, and HLD w/ UA spot test or 24 hr urine UA had few WBC and many RBC so could also be AIN (acute interstitial nephritis) caused by penicillin (also by TMP-SMX and cephalosporins) 9 month girl - concerned she isn't gaining enough weight breast-feeding 6x/day + baby food from spoon growth pattern consistent since birth
PE: gucci next step in mgnt? reassurance that this growth pattern is within normal limits homegirl has been in her percentiles for weight and length since birth healthy infants up to 1 yr require 120 kcal/kg/d > then 100 kcal/kg/d after FTT kids will require an additional 50-100% to catch up 4 yo boy - 1 wk of int fever last 3 days - dec activity and joint pain yesterday - red rash on chest daycare pale T: 101.1F P: 140/min RR: 24/min PE: petechial rash on chest; pale conjunctivae; diffuse adenopathy in cervical chain; 2/6 systolic murmur; spleen palpated; no redness/swelling of joints CBC: dec Hgb, platelets; inc WBC (50,000) most likely cause of anemia? acute lymphoblastic leukemia MC in male Caucasians bet 2-5 yo symptoms are abrupt in onset initially nonspecific (anorexia, fatigue) followed by bone pain w/ limp/refusal to bear weight, fever, bleeding, infection, pallor, anemia, ecchymoses, petechiae, and/or hepatosplenomegaly dx: lymphoblasts on bone marrow aspirate and blood smear tx: Ara-C or methotrexate (for CNS ppx), doxyrubicin, and cyclophosphamide f/u: tumor lysis syndrome (hyperK, hyperphosphatemia, hyperuricemia) 7 yo girl - 1 yr of progressive fatigue PMHx: JRA occasional fever and swelling/pain of knees during last month looks ill T: 102F P: 104/min RR: 20/min PE: pale conjunctivae; spleen palpated; R.knee warm, erythematous, and mildly swollen w/ limited ROM CBC: dec Hgb (9.5); MCV 75; inc WBC most likely cause of anemia? anemia of chronic disease she has JRA = chronic dz this type of anemia begins as normocytic but can turn into microcytic depending on the length of anemia when there's inflammation - body trying to prevent whatever it's fighting from getting its resources (like Fe) labs: inc ferritin, dec TIBC, low serum Fe tx: underlying dz - not possible w/ something AI so give EPO if Hgb > 8 (pt prob asym) so no tx needed 2 hrs after delivery - bG 25 poorly controlled maternal T1DM PE: plethora 90th perc for weight most likely primary mechanism of bG conc? increased insulin secretion baby presents w/ hypoglycemia (bG 25) common complication of maternal DM baby has had to secrete extra insulin due to its previous fetal environment now that it's in the "real world" - doesn't have to secrete as much but is still doing so > dec bG risk factors for hypoglycemia: LGA, SGA, IDM, IUGR symptoms: jitteriness, tremors, lethargy, poor feeding tx: 2mL/kg of D50W; if persistent - dextrose infusion (IV drip of D5 or D10) asym: feed and recheck 5 yo boy - 3 cm, red, circular lesion w/ clear center, lymphadenopathy, conjunctivitis, myalgia, and nausea SHx: 2 wks after camping in New England AB to Proteus vulgaris Ox-19 = neg most likely causal agent? spirochete dude prob has Lyme dz endemic areas in USA: NE seaboard (Maine to Maryland), MW, and West coast (North Cali) caused by Borrelia burgdorferi - which is a spirochete tx: amoxicillin for kids < 8 yo and pregnant women; usually doxycycline 8 yo - 3 days of fever, progressive cough, and sputum production PMHx: resp problems T: 99.5F P: 100/min RR: 32/min O2sat: 84% PE: clubbing, circumoral cyanosis, and hyperexpanded chest; diffuse rhonchi BL w/ end-exp wheezing CXR: hyperinflation, scattered atelectasis, and chronic interstitial changes most likely dx for cyanosis? cystic fibrosis majority present w/ FTT or chronic sinopulmonary dz recurrent pulm infections (S.aureus until 20 yo, Pseudomonas starting at 20 yo) w/ cyanosis, digital clubbing, chronic cough, dyspnea, bronchiectasis, hemoptysis, chronic sinusitis, rhonchi, rales, hyperresonance, and nasal polyposis others present w/ meconium ileum (bilious vomiting in newborn) - these are more prominent in infancy dx: genetic testing, sweat Cl test [Show Less]
