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  #1  
Old 06-19-2015
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Default Need help with these Peds clinical mastery form 1 q's

1) 12 month african baby girl with sickle cell has sudden high fever, irritability, tachypnea. eats regular diet. sometimes misses dosage of penicillin. fever, high pulse, high respirations. conjunctival pallor. systolic murmur at left sternal border. hematocrit 23%, leukocyte 23,000, platelet 250,000. what to do next?
a)oral penicillin
b) intravenous cefotaxime
c) intravenous corticosteroids
d) intravenous immune globulin
e) intravenous nafcillin
f) intravenous penicillin



2) 14 y/o girl had a 4 min generalized tonic clonic seizure occurred at a bar. pt arousable but confused. Fever of 102. most common organism?
arbovirus
borrelia burgdorferi
cytomegalovirus
enterovirus
herpes simplex virus
hiv
listeria monocytogenes
rickettsia rickettsii
toxoplasma gondii
varicella zoster virus








3) 5 yr old boy has painful limp for 3 weeks. unable to bear full weight on right and cries when stands on right foot. flexion and internal rotation of right hip is weakened. muscle strength 4/5 on abduction of right hip. X-rays of pelvis shows contracted dense right femoral capital epiphysis. left capital epiphysis normal. Whats wrong with this dude?
congenital hip dysplasia
diastematomyelia
femoral anteversion
fibular hemimelia
jumpers knee
legg calve perthes disease
metatarsus adductus
osgood schlatter disease
osteosarcoma
proximal focal femoral deficiency
septic arthritis of the hip
slipped capital femoral epiphysis
spondylolisthesis of l4 on l5
tibeal hemimelia






4)Newborn with irritability and difficult breathing has a 2 min. TC seizure. Mother had diabetes, no insulin therapy. Apgar scores fine. Exam shows decreased tone/lethargy. Pulse ox = 99%. Prolonged QT interval. Measured glucose, what other serum level do you want?

Bicarb
Bilirubin
Calcium
Mg
TSH
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  #2  
Old 06-19-2015
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Quote:
Originally Posted by ballers View Post
1) 12 month african baby girl with sickle cell has sudden high fever, irritability, tachypnea. eats regular diet. sometimes misses dosage of penicillin. fever, high pulse, high respirations. conjunctival pallor. systolic murmur at left sternal border. hematocrit 23%, leukocyte 23,000, platelet 250,000. what to do next?
a)oral penicillin
b) intravenous cefotaxime
c) intravenous corticosteroids
d) intravenous immune globulin
e) intravenous nafcillin
f) intravenous penicillin



2) 14 y/o girl had a 4 min generalized tonic clonic seizure occurred at a bar. pt arousable but confused. Fever of 102. most common organism?
arbovirus
borrelia burgdorferi
cytomegalovirus
enterovirus
herpes simplex virus
hiv
listeria monocytogenes
rickettsia rickettsii
toxoplasma gondii
varicella zoster virus








3) 5 yr old boy has painful limp for 3 weeks. unable to bear full weight on right and cries when stands on right foot. flexion and internal rotation of right hip is weakened. muscle strength 4/5 on abduction of right hip. X-rays of pelvis shows contracted dense right femoral capital epiphysis. left capital epiphysis normal. Whats wrong with this dude?
congenital hip dysplasia
diastematomyelia
femoral anteversion
fibular hemimelia
jumpers knee
legg calve perthes disease
metatarsus adductus
osgood schlatter disease
osteosarcoma
proximal focal femoral deficiency
septic arthritis of the hip
slipped capital femoral epiphysis
spondylolisthesis of l4 on l5
tibeal hemimelia






4)Newborn with irritability and difficult breathing has a 2 min. TC seizure. Mother had diabetes, no insulin therapy. Apgar scores fine. Exam shows decreased tone/lethargy. Pulse ox = 99%. Prolonged QT interval. Measured glucose, what other serum level do you want?

Bicarb
Bilirubin
Calcium
Mg
TSH
1) give her cefotaxime as the patient misses doses regularly. ( an y fever should be treated promptly with flour or cephalosporins)

2)A? nothing else seems to fit

3)Legg calve is common at this age group

4) Check for calcium, as the infant is born to diabetic mother and generally has hypocalcemia also Qt is prolonged.
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ballers (06-20-2015)
  #3  
Old 06-20-2015
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Thank you. What about this one

11) 9 month boy sits with support, hits two blocks together, canít scribble, says mama dada but just not his parents. 50th percentile for length and weight.

Grossmotor development: delayed or normal?

Finemotor development: delayed or normal?

language development: delayed or normal?
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  #4  
Old 06-20-2015
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Quote:
Originally Posted by ballers View Post
Thank you. What about this one

11) 9 month boy sits with support, hits two blocks together, canít scribble, says mama dada but just not his parents. 50th percentile for length and weight.

Grossmotor development: delayed or normal?

Finemotor development: delayed or normal?

language development: delayed or normal?
He should be able to identify his parents, but, other than that everything is normal. So, i guess, it's all normal.
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  #5  
Old 06-22-2015
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Quote:
Originally Posted by doc007 View Post
He should be able to identify his parents, but, other than that everything is normal. So, i guess, it's all normal.
You sure it's all normal? Anyone else can confirm also?

Thanks!
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  #6  
Old 06-28-2015
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Quote:
Originally Posted by doc007 View Post
1) give her cefotaxime as the patient misses doses regularly. ( an y fever should be treated promptly with flour or cephalosporins)

2)A? nothing else seems to fit

3)Legg calve is common at this age group

4) Check for calcium, as the infant is born to diabetic mother and generally has hypocalcemia also Qt is prolonged.
----------------------------------------------------------------------------------------
I totally agree with your answers to Q1 and Q4.

For Q2 I believe it is HSV since it is more common. What I've learned from various questions is that if they not given you any clue go with the most common cause.

For Q3 I believe the answer is Slipped Capital Femoral Epiphysis as it can occur in the age group and x ray findings support it. It can't be Legg Calve since that AVN of femoral head.
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Old 06-29-2015
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Quote:
Originally Posted by drdminorc View Post
----------------------------------------------------------------------------------------
I totally agree with your answers to Q1 and Q4.

For Q2 I believe it is HSV since it is more common. What I've learned from various questions is that if they not given you any clue go with the most common cause.

For Q3 I believe the answer is Slipped Capital Femoral Epiphysis as it can occur in the age group and x ray findings support it. It can't be Legg Calve since that AVN of femoral head.
Yes, thank you for correcting me, I saw the confusion in question 2, missed that the first time, so you think that is the reason it is HSV?
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  #8  
Old 06-29-2015
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Fever plus seizure in a patient aged more than 6 means she is suffering form encephalitis. Although Varicella can too have similar symptoms, the most common organism is HSV. Reference MTB 2ck edition 2 pg 12

There is too little information to conclude its from an arbovirus. Please follow the link for symptoms caused by various arboviruses. Keep in mind most of are endemic to certain regions.
https://en.wikipedia.org/wiki/Arbovirus

Pt is not immunocompromised so no toxo or cmv
Pt is too old for Listeria
Pt has no features or typical rash for either borrelia burgdorferi or rickettsia rickettsii
No sexual history to suspect HIV
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  #9  
Old 10-04-2015
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Quote:
Originally Posted by drdminorc View Post
----------------------------------------------------------------------------------------
For Q3 I believe the answer is Slipped Capital Femoral Epiphysis as it can occur in the age group and x ray findings support it. It can't be Legg Calve since that AVN of femoral head.
I do not agree. The X ray findings, age group, gait pattern all point towards Legg Calve Perthes disease.
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  #10  
Old 10-04-2015
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Quote:
Originally Posted by Bohemian View Post
I do not agree. The X ray findings, age group, gait pattern all point towards Legg Calve Perthes disease.
I agree with you my friend ... and my apologies for the mistake ... Thank you for correcting me
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  #11  
Old 04-14-2016
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Default hi

did you find these answers yet?
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