Peds NBME Form 1
16 yo boy - painless lump in R.breast
Tanner stage 4
1 cm, smooth, firm mass under R.nipple
no lymphadenopathy
most likely dx?
Correct Answer:
physiological pubertal development
11 yo - 14 day hx of fever, HA, and yellow-green nasal discharge; nocturnal
cough
FHx: sister has cold
PE: post pharyngeal wall erythematous and covered w/ thin gray mucus
most likely dx?
Correct Answer:
sinusitis
*purulent nasal discharge*
> 10 days - presume bacterial infection
tx: amox-clav
5 yo boy - 2 day hx of fever, persistent cough, and abd pain
breath sounds dec at R.lung base
PE: abd diffuse tenderness
,CXR: R.lower lobe density
most likely dx?
Correct Answer:
bacterial PNA
*classic PNA: fever, productive cough, and consolidation on CXR*
MC: S.pneumo followed by Haemophilus and Moraxella
in kids > 5 yrs - atypical pathogens
neonates: E.coli, GBS, Chlamydia
3 yo boy - rapid breathing for 1 hr
can't catch his breath
PE: lungs clear; slight hyper resonance on R.side of chest; dec breath sounds
on R; no infiltrates/effusions
oxygen via nasal cannula
next step in mgnt?
Correct Answer:
bronchoscopy
best 1st test in evaluating aspiration
also a way to obtain a proper culture specimen
kid may have aspirated a foreign body - rigid bronchoscopy can visualize and
remove the object
3 yo girl - syncopal episode followed by generalized tonic-clonic movements
lasting 30 seconds
2 minutes after episode - alert
another episode: 3-4 rhythmic jerks of R.upper ext
ECG: P waves at 80/min w/ no QRS complexes - NSR resumes in 20 seconds
, most likely dx?
Correct Answer:
Adams-Stokes attack
sudden collapse into unconsciousness due to disorder of heart rhythm -
slow/absent pulse resulting in syncope w/ or w/o convulsions
normal heartbeat from upper chambers to lower chambers is interrupted
2 yo boy - 5 day hx of fever
PE: systolic murmur at L.lower sternal border; spleen palpable
along w/ echo, what other studies do you want to order to confirm the dx?
Correct Answer:
serial blood cultures
pt most likely has infective endocarditis
TTE - id valvular abnormality
TEE - id vegetation (best test)
2 yo boy - severe resp distress
5 day hx of fever and cough
maternal drug use
PMHx: FTT, frequent thrush, and recurrent diarrhea
O2sat - 82%
PE: tachypnea, grunting, nasal flaring; diffuse crackles; hepatosplenomegaly
CXR: interstitial infiltrates
next step in dx?
Correct Answer:
silver stain of bronchoalveolar fluid
16 yo boy - painless lump in R.breast
Tanner stage 4
1 cm, smooth, firm mass under R.nipple
no lymphadenopathy
most likely dx?
Correct Answer:
physiological pubertal development
11 yo - 14 day hx of fever, HA, and yellow-green nasal discharge; nocturnal
cough
FHx: sister has cold
PE: post pharyngeal wall erythematous and covered w/ thin gray mucus
most likely dx?
Correct Answer:
sinusitis
*purulent nasal discharge*
> 10 days - presume bacterial infection
tx: amox-clav
5 yo boy - 2 day hx of fever, persistent cough, and abd pain
breath sounds dec at R.lung base
PE: abd diffuse tenderness
,CXR: R.lower lobe density
most likely dx?
Correct Answer:
bacterial PNA
*classic PNA: fever, productive cough, and consolidation on CXR*
MC: S.pneumo followed by Haemophilus and Moraxella
in kids > 5 yrs - atypical pathogens
neonates: E.coli, GBS, Chlamydia
3 yo boy - rapid breathing for 1 hr
can't catch his breath
PE: lungs clear; slight hyper resonance on R.side of chest; dec breath sounds
on R; no infiltrates/effusions
oxygen via nasal cannula
next step in mgnt?
Correct Answer:
bronchoscopy
best 1st test in evaluating aspiration
also a way to obtain a proper culture specimen
kid may have aspirated a foreign body - rigid bronchoscopy can visualize and
remove the object
3 yo girl - syncopal episode followed by generalized tonic-clonic movements
lasting 30 seconds
2 minutes after episode - alert
another episode: 3-4 rhythmic jerks of R.upper ext
ECG: P waves at 80/min w/ no QRS complexes - NSR resumes in 20 seconds
, most likely dx?
Correct Answer:
Adams-Stokes attack
sudden collapse into unconsciousness due to disorder of heart rhythm -
slow/absent pulse resulting in syncope w/ or w/o convulsions
normal heartbeat from upper chambers to lower chambers is interrupted
2 yo boy - 5 day hx of fever
PE: systolic murmur at L.lower sternal border; spleen palpable
along w/ echo, what other studies do you want to order to confirm the dx?
Correct Answer:
serial blood cultures
pt most likely has infective endocarditis
TTE - id valvular abnormality
TEE - id vegetation (best test)
2 yo boy - severe resp distress
5 day hx of fever and cough
maternal drug use
PMHx: FTT, frequent thrush, and recurrent diarrhea
O2sat - 82%
PE: tachypnea, grunting, nasal flaring; diffuse crackles; hepatosplenomegaly
CXR: interstitial infiltrates
next step in dx?
Correct Answer:
silver stain of bronchoalveolar fluid
