Peds NBME Form 1 - Questions and Answers

Peds NBME Form 1 - Questions and Answers 14 yo girl w/ Down Hgb - 16.8 PE: mild-mod cyanosis; digital clubbing; S2 inc in intensity echo: large VSD, dilated main pulm artery cause of polycythemia? pulm artery HTN Down kids are at a higher risk of getting this - upper airway obstruction and congenital heart dz Down is associated w/ inc in anti-angiogenic factors > impairs fetal lung vessel growth > leading to pulm art HTN due to the L>R shunt and inc flow in the R.heart > pulmHTN occurs > eventually causes Eisenmenger's (R>L shunt) w/ body becoming cyanotic body tries to compensate for low oxygenation > makes more RBCs (causing polycythemia) 6 month old boy - 1 wk hx of episodes of unprovoked startle-like movements - sudden, quick flexion of heads, arms, and legs; cries during movements; occur in clusters PMHx: murmur FHx: dad - mental impairment PE: 3 areas of skin hypopigmentation CT of head: 4 periventricular nodules most likely dx? tuberous sclerosis hypopigmented spot (+ on Wood's lamp) = Ash leaf spot other skin findings: Shagreen patches (elevated fleshy collagen plaques); adenoma sebaceous (hyper plastic BVs) look for early onset seizures CT scan: tubers in brain 16 yo boy - painless lump in R.breast Tanner stage 4 1 cm, smooth, firm mass under R.nipple no lymphadenopathy most likely dx? 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? 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? 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? 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? 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? 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? silver stain of bronchoalveolar fluid kid most likely got HIV from mom - now predisposed to getting random funky infections homeboy probably has PCP ppx: TMP-SMX (dapsone if allergic) 2 day old - urinary dribbling and dec urine output term baby; normal delivery PE: 6 cm, round, midline, suprapubic pelvic mass CMP: dec HCO3- UA: trace protein most likely cause of oliguria? posterior urethral valves classic: newborn male presents w/ low/no urine output +/- palpable bladder PMHx: +/- oligohydramnios 1st imaging: US confirm dx: VCUG tx: catherization to relieve pressure on bladder; surgery 12 hr female - irritable, diff breathing, 2 min gen tonic-clonic seizure 36 wks gest by C-section for breech presentation maternal gestational diabetes - poorly controlled w/ diet PE: dec tone and lethargy ECG: prolonged QT interval in addition to measuring serum glucose conc, what else should you measure? Ca hyperCa - can shorten the QT interval hypoCa - can lengthen it hypoCa is common in gestational diabetes; results in irritability and dec myocardial contractility