Peds NBME Form 2
4 month old
27 wks gest
hospitalization: sepsis and RDS - intubated and ventilated
O2 and diuretic therapy at home
PE: breath sounds dec BL; wheezing
cardiac exam: pronounced S2, precordial heave
abd exam: hepatomegaly
ECG: RAD, RVH
US: normal kidneys
cause of pt's HTN?
Correct Answer:
bronchopulmonary dysplasia
disruption of alveolization
if infant born < 32 wks and still needs O2 on day 28 - probably has BPD
due to damage from ventilation and long-term use of O2
6 month old - hemangioma on neck
was 0.5 cm - now 2 cm
raised, erythematous, blanches w/ pressure
next step in mgnt?
Correct Answer:
observation
strawberry hemangioma
,benign capillary hemangioma
appears first few wks of life
grows rapidly and regresses spontaneously by 5-8 yo
3 wk old - skin yellow
stools lighter in color
fed formula since birth
PE: jaundice
TsB - 14 w/ direct of 6
mechanism for infant's condition?
Correct Answer:
dec excretion of BR
believe that breast milk inhibits glucuronyl transferase (conjugation enzyme)
baby only eating formula - not inhibiting the enzyme > inc BR
asymptomatic 2 yo
2 month visit w/ grandpa - dx w/ active TB
PPD: 25 mm of induration at 72 hrs
CXR: normal
pt is administered what?
Correct Answer:
INH only
screen < 5 yo w/ PPD
screen > 5 yo w/ IFNy release assay
INH for latent
RIPE for active
, 5 month old - fever for 1 day
tugging at L.ear
nasal congestion - 4 days
fussy but consolable
PE: L.ear - bulging, diffusely erythematous TM; no movement on pneumatic
otoscope
most likely dx?
Correct Answer:
acute otitis media
this is literally the classic presentation
relief of pain w/ pulling pinna
loss of light reflex
MC bugs: S.pneumo, H.flu, M.catarrhalis
tx: amox; if recurs amox-clavulanate
re-recurs (3x/6 months or 4x/12 months): tympanoplasty (ear tubes)
11 yo - bloody urine w/ RBC casts
3 wks after tx of cellulitis
HTN, pedal edema
labs: inc antistreptolysin O titer, dec plasma C3
most likely outcome?
Correct Answer:
recovery w/o renal sequelae
acute poststrep glomerulonephritis
seen in kids 2-4 wks after GAS infection of pharynx/skin
4 month old
27 wks gest
hospitalization: sepsis and RDS - intubated and ventilated
O2 and diuretic therapy at home
PE: breath sounds dec BL; wheezing
cardiac exam: pronounced S2, precordial heave
abd exam: hepatomegaly
ECG: RAD, RVH
US: normal kidneys
cause of pt's HTN?
Correct Answer:
bronchopulmonary dysplasia
disruption of alveolization
if infant born < 32 wks and still needs O2 on day 28 - probably has BPD
due to damage from ventilation and long-term use of O2
6 month old - hemangioma on neck
was 0.5 cm - now 2 cm
raised, erythematous, blanches w/ pressure
next step in mgnt?
Correct Answer:
observation
strawberry hemangioma
,benign capillary hemangioma
appears first few wks of life
grows rapidly and regresses spontaneously by 5-8 yo
3 wk old - skin yellow
stools lighter in color
fed formula since birth
PE: jaundice
TsB - 14 w/ direct of 6
mechanism for infant's condition?
Correct Answer:
dec excretion of BR
believe that breast milk inhibits glucuronyl transferase (conjugation enzyme)
baby only eating formula - not inhibiting the enzyme > inc BR
asymptomatic 2 yo
2 month visit w/ grandpa - dx w/ active TB
PPD: 25 mm of induration at 72 hrs
CXR: normal
pt is administered what?
Correct Answer:
INH only
screen < 5 yo w/ PPD
screen > 5 yo w/ IFNy release assay
INH for latent
RIPE for active
, 5 month old - fever for 1 day
tugging at L.ear
nasal congestion - 4 days
fussy but consolable
PE: L.ear - bulging, diffusely erythematous TM; no movement on pneumatic
otoscope
most likely dx?
Correct Answer:
acute otitis media
this is literally the classic presentation
relief of pain w/ pulling pinna
loss of light reflex
MC bugs: S.pneumo, H.flu, M.catarrhalis
tx: amox; if recurs amox-clavulanate
re-recurs (3x/6 months or 4x/12 months): tympanoplasty (ear tubes)
11 yo - bloody urine w/ RBC casts
3 wks after tx of cellulitis
HTN, pedal edema
labs: inc antistreptolysin O titer, dec plasma C3
most likely outcome?
Correct Answer:
recovery w/o renal sequelae
acute poststrep glomerulonephritis
seen in kids 2-4 wks after GAS infection of pharynx/skin
