Peds NBME Form 2 - Questions and Answers

Peds NBME Form 2 - Questions and Answers 1 hr after delivery - newborn in resp distress 28 wks gest mom: prenatal care; intrapartum AB ppx APGAR: 8, 8 PE: grunting, nasal flaring, and intercostal retractions CXR: granular appearance of parenchyma w/ air bronchograms most likely dx? RDS of newborn path: surfactant def > atelectasis infant - premature, presents w/ grunting CXR: low long volumes (hypoextended), uniform granular pattern tx: surfactant and mech ventilation if severe VS TTN path: delayed clearance of fetal lung fluid seen in C-sections infant - near term w/ grunting and tachypnea CXR: hyperextended and "wet" appearing tx: O2 and CPAP/inbutation if needed 1 month old - 2 hrs after bilious vomiting less active than usual, fed poorly today last BM - 1 day ago 38 wks gest PE: firm/distended abd; dec bowel sounds rectal exam: normal tone; small amount of stool in rectal vault; + occult blood in stool most likely dx? midgut volvulus malrotation + acute twist = volvulus presents 1st month w/ bilious emesis, crampy abd pain, distention, and blood/mucus in stool abd X-ray: "bird-beak" upper GI - study of choice tx: NG tube (decompress), IVF; surgical repair if volvulus is gastric and surgery/endoscopy if intestinal 28 month old - crying, drooling, and holding an open container of drain cleaner resp distress PE: 2 1-2 cm erythematous blisters on lips and erythematous areas on tongue; stridor and subcostal/suprasternal retractions stabilize airway > then what? fiberoptic endoscopy most accurate way to dx upper GI dz would be able to see how far the damage goes for this kid - considering he probably ingested the drain cleaner 10 yo girl - gen tonic-clonic seizure 1 month hx of behavior disturbances 2 wk hx of fever, weakness, and painful swelling of L.knee CBC: dec Hgb (9), WBC (3800), platelet (65,000) + Coombs test UA: protein and microscopic blood most likely dx? SLE can present w/ SOAP BRAIN MD: serositis, oral ulcers, arthritis, photosensitivity, blood, renal, ANA +, immunologic (other AB), neurologic, malar rash, discoid rash confirm: + ANA; low C3, C4 levels + Coombs test - due to antibodies on RBCs 18 month boy - 4 hrs after onset of lethargy intermittent abd pain for last 24 hrs no vomiting/diarrhea PE: soft, nontender abd; mass palpated in RLQ; dec bowel sounds stool red; + occult blood abd X-ray: no air in asc/trans colon next step in dx? air-contrast enema homeboy probably has intussusception - bowel telescopes into adj segment; usually prox to ileocecal valve pt: 3 months - 3 yrs presents w/ abrupt-onset, colicky abd pain; kid flexes knees (to relieve pain); vomiting classic triad: abd pain, vomiting, bloody mucus in stool ("currant jelly stool" - late finding tho) PE: abd tenderness, + stool guaiac, palpable "sausage-shaped" RUQ abd mass abd x-rays: for complications US: "target sign" if high clinical suspicion - use air-contrast barium enema for dx and tx 7 yo girl - 7 days of bloody diarrhea fatigue for past 2 days PE: pallor, scleral icterus CBC: dec Hgb (6) and platelets; inc WBC and ret count most likely explanation? hemolytic-uremic syndrome HUS = anemia + worsening Cr (renal failure) + bloody diarrhea get serum shiga toxin assay and E.coli O157:H7 culture tx: supportive, dialysis, and plasma exchange newborn 42 wks gest fetal growth restriction - by 3rd trimester mom - no travel/ smoking/drinking/drug use no pets in household PE: hepatosplenomegaly; neuro exam gucci head X-ray: periventricular intracranial calcifications infectious agent responsible? CMV maternal: usually asymptomatic or mono-like illness neonatal: hearing loss, seizures, petechial rash, "blueberry muffin" rash, chorioretinitis, periventricular calcifications, jaundice, hepatosplenomegaly compared to toxo - calcifications scattered throughout cortex 7 month old - seizure began L.arm > R.arm > BL legs immunizations up2date cyanotic PE: upward deviation of eyes; gen rigidity; hyperext of neck, back, ext; clonic jerking movements in all ext O2 administered next step in mgnt is to administer? diazepam if seizure lasts > 5 minutes - abort it w/ benzo simple vs complex dx: EEG decide whether the pt needs anti-convulsant meds 3 yo boy - 4 days of lethargy and severe vomiting/diarrhea can't keep fluids down; no urine output for last 24 hrs 1 kg weight loss PE: sunken eyes, tacky oral mucosa, dry lips; no rash; lung clear; 1/6 midsystolic ejection murmur; hyperactive bowel sounds CMP: dec HCO3-; inc BUN, Cr UA: 1+ protein cause of pt's renal failure? impaired renal perfusion kid is severely dehydrated > kidneys not getting enough fluid to flush things out