Peds NBME Form 3 - Questions and Answers 18 month - 2 wks of URI PMHx: past 15 months - several episodes of AOM PE: L.TM bluish gray w/ visible
... [Show More] landmarks; air-fluid level present behind inf 1/2 of TM; minimal movement on pneumatic otoscopy; R.ext ear, ear canal, and TM gucci most likely dx? serous otitis media pt prone to this considering they have had multiple AOM in the past air-fluid level = serous tx: probably tympanoplasty 6 month boy - difficulty breathing for 2 hrs low-grade fever, nasal congestion, and runny nose for 2 days mild resp distress PE: gen harsh breath sounds; insp stridor most likely site of path? larynx kid most likely has croup aka laryngotracheobronchitis begins w/ viral URI prodrome > progresses to low-grade fever, mild dyspnea, insp stridor, hoarse voice, and barking cough AP neck x-ray: steeple sign dx: if improves w/ Epi tx: depends on severity of dz; mild - cool mist humidification; mod - O2, corticosteroids, nebulized racemic Epi; severe - admit and nebulized racemic Epi 4 month old seen in Jan - cough and poor feeding for 2 days urinating and making tears initially had fever RR: 56/min PE: pink TMs w/ good mobility; mild intercostal retractions; diffuse BL crackles/wheezes O2sat: 84% next step in mgnt? administration of oxygen babe prob has bronchiolitis presents in fall/winter - Jan MC cause: RSV - antigen testing pt presents w/ low-grade fever, rhinorrhea, cough, and apnea PE: tachypnea, wheezing, intercostal retractions, crackles, prolonged exp, and hyper resonance to percussion inc RR symptoms peak day 3-4 CXR: hyperinflation, interstitial infiltrates, and atelectasis tx: supportive; mild - fluids and nebulizers; inpts - contact isolation, hydration, and O2 RSV ppx: AB recommended in winter for high-risk pts (premie, chronic lung dz, or CHD) 4 yo girl - 6 hrs of fever, dec alertness, and rash over chest, arms, and legs pt obtunded RR: 30/min and shallow P: 120/min BP: 70/30 mmHg PE: purple macular rash over trunk and ext; face/ext edematous hospital administered: IV bolus of fluid and IV ceftriaxone and vanc started 15 minutes after admission: pt apneic > intubated and mech ventilation CMP: dec HCO3-; inc BUN urine output: 1.5 mL/kg/h ABG: dec pH 1 hr later, urine output: < 0.5 mL/kg/h CXR: hazy lung fields BL and cardiomegaly next step in mgnt? intravenous administration of dopamine girl is basically in shock (look at HoTN, rash, and edema) think of what is given during code SRT: fluids, antibiotics, and vasopressors 6 days post operation for truncus arteriosus defect 8 day old - jittery PE: micrognathia, hypertelorism Ca: 7 CXR: cardiomegaly w/o thymic shadow most likely dx? hypoparathyroidism babe probably has DiGeorge syndrome - so this presents at birth w/ the syndrome truncus arteriosus - asssociated w/ DiGeorge complication: hypoCa seizures from parathyroid hypoplasia CATCH22: cardiac anomalies, abnormal facies, thymic aplasia, cleft palate, hypoCa, 22q11 deletion features: short philtrum, hypertelorism, antimongoloid slant palpebral, mandibular hypoplasia, and low-set, notched ears inc risk of infection: viruses, fungi, and PCP PNA CXR: absent thymic shadow 3 yo boy - intermittent severe abd cramping over past 3 days no vomiting; passed 3 stools PE: abd soft w/ normal bowel sounds; no organomegaly/masses + occult blood in stool most likely dx? intussusception one part of bowel telescoping into another - will compromise blood supply abrupt onset of colicky abd pain pt: 3 months to 3 yrs knee-chest position for relief "sausage-shaped mass" in abd as vasc supply is compromised aka bowel begins to die > currant jelly diarrhea US - "target sign" air-contrast barium enema - for dx and tx 12 hour male - hasn't urinated since birth 36 wks gest APGAR: 7, 8 pregnancy: mom smoked 1/2 pack of cigs daily and occasional marijuana; drank 2 beers on wknds 1 oz of cow's milk-based formula w/o vomiting; 1 small meconium stool PE: lower abd distended w/ midline mass most likely dx? posterior urethral valves classic: newborn male w/ low/no urine output +/- palpable bladder 1st imaging: US catheterization to relieve pressure on bladder if you don't do this > hydronephrosis and renal dysfxn might be PMHx of oligohydramnios confirm: VCUG (to r/o reflux) tx: surgery 2 wk newborn - 2 days of excessive forceful vomiting after eating vomitus - not green or bloody breast feeding vigorously but fewer wet diapers than normal mildly dehydrated PE: soft abd; tolerates deep palpation of abd w/o crying next step in dx? ultrasonography of the abdomen probably pyloric stenosis baby 2-8 wks suddenly develops projectile vomiting after feeds PE: olive-shaped mass and visible peristaltic waves CMP: hypoCl-, hypoK, met alkalosis requires immediate IVF need to fix these first before surgery (pyloromyotomy) dx: US - "donut sign" [Show Less]