Pediatrics Case Studies

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Questions and Answers

What is a key criterion for diagnosing growing pains in a child?

The leg pain is unilateral.

The leg pain is bilateral. (correct)

The patient has a limp during the day.

The pain occurs during the day.

Which symptom does NOT support a diagnosis of growing pains?

Leg pain only at night.

Bilateral leg pain.

No limp during the day.

Symptoms present during the day. (correct)

What is the first-line treatment for juvenile rheumatoid arthritis?

Methotrexate

Ibuprofen (correct)

Prednisone

Acetaminophen

Which of the following is a common subtype of juvenile rheumatoid arthritis?

Polyarticular JRA (C) Signup and view all the answers

What condition is characterized by having no specific laboratory tests for diagnosis?

Juvenile rheumatoid arthritis (A) Signup and view all the answers

What risk is associated with early-onset pauciarticular JRA in young girls?

30% risk of chronic iridocyclitis (D) Signup and view all the answers

Which of the following symptoms is NOT associated with juvenile rheumatoid arthritis?

Persistent daytime pain (D) Signup and view all the answers

What is the significance of identifying a child with symptoms of arthritis beyond just a diagnosis of growing pains?

To exclude serious underlying conditions. (A) Signup and view all the answers

What is the recommended immediate noninvasive treatment for testicular torsion?

Manual detorsion (A) Signup and view all the answers

Which age group is most commonly affected by testicular torsion?

Men under 25 years old (D) Signup and view all the answers

What imaging technique is necessary when the diagnosis of testicular torsion remains unclear?

Doppler color flow ultrasound (C) Signup and view all the answers

What is the most likely cause of intussusception in a child older than 6 years?

Lymphoma (B) Signup and view all the answers

Which condition can be associated with intussusception in young children?

Meckel’s diverticulum (C) Signup and view all the answers

What is the most likely diagnosis for a 12-year-old boy experiencing bilateral leg pain only at night?

Growing pains (C) Signup and view all the answers

Which of the following is a supportive physical exam finding for testicular torsion?

Higher testicular lie (A) Signup and view all the answers

What is a common misconception about testicular torsion regarding its age prevalence?

It affects only prepubescent boys (D) Signup and view all the answers

What is recommended for children aged 2 months to 2 years with a documented first UTI?

Renal ultrasound and voiding cystourethrography (B) Signup and view all the answers

What should be added to the treatment plan if a child does not improve and their PEFR is between 50% and 80%?

Oral corticosteroid (D) Signup and view all the answers

In the context of acute rheumatic fever, which symptom is commonly associated with the illness?

Bilateral knee pain (C) Signup and view all the answers

What condition involves a complication of acute group A streptococcal pharyngitis?

Acute rheumatic fever (C) Signup and view all the answers

Which procedure is not routinely recommended for children with the first UTI after the age of 2?

Voiding cystourethrography (C) Signup and view all the answers

What does a significantly elevated sedimentation rate in a child suggest?

Infection or inflammatory disease (D) Signup and view all the answers

What sign may accompany carditis in patients with acute rheumatic fever?

Erythema marginatum rash (C) Signup and view all the answers

In a child with a urinary tract infection, when is a voiding cystourethrography indicated?

If high-grade vesicoureteral reflux is suspected (A) Signup and view all the answers

What is a major long-term consequence of rheumatic fever?

Rheumatic heart disease (C) Signup and view all the answers

At what age is slipped capital femoral epiphyses most commonly seen?

11 to 14 years (B) Signup and view all the answers

What abnormality is associated with Sydenham's chorea?

Involuntary movements (B) Signup and view all the answers

Which of the following could be a sign of serious illness in infants regarding bilirubin levels?

Bilirubin at >17 mg/dL (D) Signup and view all the answers

What is the typical management approach for hyperbilirubinemia in infants?

Phototherapy and exclusion of pathologic causes (A) Signup and view all the answers

What physical examination finding is associated with slipped capital femoral epiphyses?

Hip abduction and adduction pain (A) Signup and view all the answers

Which feature is NOT characteristic of Sydenham's chorea?

Prominent sensory loss (D) Signup and view all the answers

What is a common cause to suspect if slipped capital femoral epiphyses occurs before puberty?

Growth hormone deficiency (B) Signup and view all the answers

What is the primary treatment for tinea capitis in young children?

Oral antifungals (A) Signup and view all the answers

Which of the following statements about tinea capitis is true?

It usually causes lesions that are scaly and pruritic. (B) Signup and view all the answers

In a case of tinea capitis, what type of hair breaking is typically observed?

Hair shafts are broken at the scalp (D) Signup and view all the answers

What is a common symptom of the rash associated with erythema infectiosum?

Slapped-cheek appearance (D) Signup and view all the answers

What organism is most commonly responsible for tinea capitis?

Trichophyton (A) Signup and view all the answers

What complication can arise from untreated tinea capitis?

Increased susceptibility to other infections (D) Signup and view all the answers

Which characteristic is NOT associated with tinea capitis?

Rapid recovery without any treatment (A) Signup and view all the answers

What preventative measure should be taken for tinea capitis to reduce spread?

Daily use of selenium sulfide shampoo (B) Signup and view all the answers

What is the primary treatment approach for lower respiratory infections caused by RSV?

Supplemental oxygen and hydration (A) Signup and view all the answers

What symptom is least likely to be associated with an RSV infection in infants?

Rash (B) Signup and view all the answers

In which age group does RSV typically peak in incidence?

Infants aged 1 to 6 months (D) Signup and view all the answers

What should parents do if their child experiences a rash or mouth sore while on sulfonamide medication?

Discontinue the medication immediately (A) Signup and view all the answers

What is a characteristic radiographic finding in severe RSV infections?

Lung hyperexpansion (B) Signup and view all the answers

Which of the following organisms is most likely responsible for the symptoms described in the case of the 4-month-old infant?

RSV (Respiratory Syncytial Virus) (D) Signup and view all the answers

Which treatment option is no longer generally recommended for RSV infections except in severely immunocompromised patients?

Aerosolized ribavirin (C) Signup and view all the answers

What is the most common mode of transmission for RSV?

Fomites and respiratory secretions (D) Signup and view all the answers

Study Notes

Case Studies in Pediatrics

Case 1: A 14-year-old boy presents with a mildly itchy rash spreading across his chest and back, following cleavage lines. The most likely diagnosis is Pityriasis rosea.
Case 1 Discussion: Pityriasis rosea typically affects children and young adults, beginning with a single herald patch followed by a diffuse papulosquamous rash. The rash often follows Langer's lines. Many other conditions can mimic pityriasis rosea, but secondary syphilis is a concern.
Case 2: A 5-year-old boy presents with scrotal pain and swelling of the left testicle. Appropriate management includes ultrasound evaluation with Doppler color flow.
Case 2 Discussion: Testicular torsion should be suspected in patients with acute scrotal pain and swelling. Prompt diagnosis is critical to preserve testicular viability.
Case 3: An 8-year-old with abdominal pain has intussusception. The most likely cause is a colon polyp.
Case 3 Discussion: Intussusception is the most frequent cause of intestinal obstruction in infants, often resulting from common causes for intussusception such as polyps, Meckel's diverticulum, and viral enteritis, but can also be caused by various other factors.
Case 4: A 12-year-old obese boy presents with nocturnal bilateral leg pain, without limping. The most likely diagnosis is "growing pains".
Case 4 Discussion: Growing pains are a self-limiting, benign condition characterized by bilateral leg pain, occurring only at night, without limping.
Case 5: A 12-year-old boy has joint swelling, fevers, and a rash. Laboratory results show anemia, leukocytosis, and thrombocytosis. Juvenile rheumatoid arthritis (JRA) is suspected. First-line treatment is Ibuprofen.
Case 5 Discussion: JRA is a diverse group of diseases; it is different from adult rheumatoid arthritis and requires distinguishing among subtypes (pauciarticular, polyarticular, and systemic). The first line treatments are typically NSAIDs like ibuprofen.
Case 6: An 8-year-old asthmatic with wheezing is given albuterol. Peak expiratory flow rate (PEFR) is 75%. The next appropriate step is to add an oral steroid.
Case 6 Discussion: Early treatment of asthma exacerbations is crucial for preventing progression. Short-acting beta2-agonists are first-line treatment, but additional measures such as oral corticosteroids may be needed for severe cases or persistent symptoms.
Case 7: An 18-month-old girl has a urinary tract infection (UTI). Appropriate treatment includes renal ultrasound and voiding cystourethrography (VCUG).
Case 7 Discussion: Practice guidelines typically recommend renal ultrasound to screen for anatomical abnormalities in children 2 to 2 years of age presenting with first UTI. VCUG is performed in cases of complex UTIs to confirm or eliminate the potential of anatomical problems or other conditions such as reflux, scarring, or obstruction.
Case 8: A 13-year-old girl has a sore throat, fevers, and bilateral knee pain. An elevated sedimentation rate is observed. The most likely diagnosis is acute rheumatic fever.
Case 8 Discussion: Acute rheumatic fever is a complication of group A streptococcal pharyngitis. It is characterized by arthritis, carditis, erythema marginatum, subcutaneous nodules and/or Sydenham's chorea.
Case 8 (additional): A child presents to the emergency room with abdominal pain. An abdominal series shows a "bird's beak" sign. The most likely diagnosis is intussusception.
Case 9: The condition of sigmoid volvulus is rare in children/adolescents, often diagnosed through barium enema. Usually presents with abdominal pain/distress, and often resolving spontaneously. It can become life threatening if not addressed promptly.
Case 10: A newborn presents with jaundice (bilirubin level of 18 mg/dL). Appropriate treatment is to begin phototherapy.
Case 10 Discussion: Hyperbilirubinemia is common in newborns but high levels warrant interventions; phototherapy is a standard treatment for jaundice in infants.
Case 11: A 12-year-old boy has progressive hip pain radiating to the thigh and knee. Pain is elicited with abduction and adduction, and radiographs show acetabular dysplasia. The most likely diagnosis is slipped capital femoral epiphysis.
Case 11 Discussion: Slipped capital femoral epiphysis (SCFE) is a condition where the ball portion of the femur (head) slides out of place from its socket, concerning commonly in adolescents especially those with obesity.
Case 12: A 4-year-old boy presents with patchy hair loss, scalp inflammation and scrapings showing hyphae. Treatment of choice is topical antifungals.
Case 12 Discussion: Tinea capitis, a fungal scalp infection, commonly presents with hair loss, inflammation and often indicated through microscopic examination of scrapings obtained from the affected area showing hyphae.
Case 13: Presenting with a slapped-cheek appearance, a low-grade fever and malaise is characteristic of erythema infectiosum (fifth disease).
Case 13 Discussion: Erythema infectiosum is a viral infection characterized by a distinct facial rash that resembles being slapped.
Case 14: A 3-year-old boy has recurrent ear infections. The appropriate management is to implement single dose prophylactic antibiotics nightly.
Case 14 Discussion: Recurrent otitis media may be treated effectively through a proactive approach, using prophylactic antibiotics to prevent further infections.
Case 15: With symptoms such as fever, runny nose, cough, and wheezing, a 4-month-old child is likely infected with RSV (Respiratory Syncytial Virus).
Case 15 Discussion: RSV is a common respiratory virus, especially in young children, that typically causes symptoms similar to the common cold but potentially worsening to pneumonia in severe cases.

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Description

Explore real-life pediatric cases that highlight common conditions such as pityriasis rosea, testicular torsion, and intussusception. Each case provides insights into symptoms, diagnosis, and management strategies essential for pediatric care. Test your knowledge and understanding of these key topics in pediatrics.