Peds question #8 (this question is tricky)! - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 3 Forum

USMLE Step 3 Forum USMLE Step 3 Discussion Forum: Let's talk about anything related to USMLE Step 3 exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 08-05-2013
XpaezX's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,216
Threads: 41
Thanked 1,327 Times in 711 Posts
Reputation: 1342
Listening Peds question #8 (this question is tricky)!

The father of a 1 week old infant comes to the office in panic. He has just noticed on his child a right anterior shoulder mass that seems tender. The father had some kind of childhood tumor and he fears the child may be suffering from the same. In reviewing the boy's discharge papers, you note that the child was a term, appropriate for gestational age vaginal delivery, with a weight of 3700 grams. Apgar scores were 9 at 1 and 5 minutes respectively. You examination is significant for a mass that measures 1.2 cms*.5 cms on the right clavicle, the mass does not move and does not cause any apparent discomfort on the child.
What is the next best step?
A; Reassurance and routine follow up.
B. MRI of the right clavicle.
C. Skin biopsy.
D. NSAIDs
E. Bone biopsy.
F. Referral to an orthopedic surgeon

After you pick your answer mention the most likely diagnosis.
Reply With Quote Quick reply to this message



  #2  
Old 08-05-2013
USMLE Forums Master
 
Steps History: ---
Posts: 530
Threads: 35
Thanked 291 Times in 207 Posts
Reputation: 301
Default

Quote:
Originally Posted by XpaezX View Post
The father of a 1 week old infant comes to the office in panic. He has just noticed on his child a right anterior shoulder mass that seems tender. The father had some kind of childhood tumor and he fears the child may be suffering from the same. In reviewing the boy's discharge papers, you note that the child was a term, appropriate for gestational age vaginal delivery, with a weight of 3700 grams. Apgar scores were 9 at 1 and 5 minutes respectively. You examination is significant for a mass that measures 1.2 cms*.5 cms on the right clavicle, the mass does not move and does not cause any apparent discomfort on the child.
What is the next best step?
A; Reassurance and routine follow up.
B. MRI of the right clavicle.
C. Skin biopsy.
D. NSAIDs
E. Bone biopsy.
F. Referral to an orthopedic surgeon

After you pick your answer mention the most likely diagnosis.
Bone callus after clavicle frx birth trauma. My answer is A.
__________________
Life is a sexually transmitted disease.
Reply With Quote Quick reply to this message
The above post was thanked by:
XpaezX (08-05-2013)
  #3  
Old 08-05-2013
Kais_MD's Avatar
USMLE Forums Veteran
 
Steps History: 1+CK+CS
Posts: 299
Threads: 26
Thanked 177 Times in 103 Posts
Reputation: 187
Default

I would say Reassure just because you dont wanna do anything invasive. I 'll be waiting for a full explanation as i don't want to take a shot at being wrong.
__________________
Always Remember (The Devil is in the Details) @_@
Reply With Quote Quick reply to this message
The above post was thanked by:
XpaezX (08-05-2013)
 
  #4  
Old 08-05-2013
Hitman's Avatar
USMLE Forums Master
 
Steps History: Not yet
Posts: 928
Threads: 17
Thanked 539 Times in 375 Posts
Reputation: 549
Default

Ans B , family h/o of tumor and normal for gestation age and weight . the probability of a clavicle fracture is low unless the delivery was complicated or the child was large or had a DM mother . i would go for a MRI rather than assuming it is clavicle fracture and keep the parents assured .
Reply With Quote Quick reply to this message
The above post was thanked by:
XpaezX (08-05-2013)
  #5  
Old 08-05-2013
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 791
Threads: 76
Thanked 673 Times in 317 Posts
Reputation: 691
Default

I think A is the right option.....

If i had to guess on the diagnosis, it would be either a clavicular fracture or hematoma due to some unnoticed birth injury,even though nothing is mentioned about the delivery....

I can hardly think of any bone tumor which arises so early in life, hence would not proceed with MRI.

Rest options are out of my thought process...
Reply With Quote Quick reply to this message
The above post was thanked by:
XpaezX (08-05-2013)
  #6  
Old 08-05-2013
XpaezX's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,216
Threads: 41
Thanked 1,327 Times in 711 Posts
Reputation: 1342
Default

Quote:
Originally Posted by anomali View Post
I think A is the right option.....

If i had to guess on the diagnosis, it would be either a clavicular fracture or hematoma due to some unnoticed birth injury,even though nothing is mentioned about the delivery....

I can hardly think of any bone tumor which arises so early in life, hence would not proceed with MRI.

Rest options are out of my thought process...
yup this is the correct answer.

There is no bone neoplasia to date that begins this young, remember Ewing sarcoma appears in patients from 10-20 years old. Familial Osteosarcoma is extremely rare and if it does happen is between 15 and 25 years old, specially in the bones of the Femur, Tibia and Humerus.. not in the clavicle (eventho it is remotely possible it can appear here as well)

This childīs weight is slightly above the upper limit of normal (which is 3500 grams) and eventho he is not macrosomic 50-60% of clavicular fractures happen in normal weight babies, the most common affected area is the mid third of the clavicle, these lesions heal extremely well in neonates, infants and kids. Next best step therefore would be reassurance and follow up
Reply With Quote Quick reply to this message
  #7  
Old 08-05-2013
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 515
Threads: 88
Thanked 508 Times in 232 Posts
Reputation: 518
Default

Bone callus after clavicle frx birth trauma. Answer is A.
Reply With Quote Quick reply to this message
The above post was thanked by:
XpaezX (08-05-2013)



Reply

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
Tricky but nice question... one_destiny USMLE Step 1 Forum 13 05-07-2015 05:36 PM
Blot Procedures Tricky Question Hope2Pass USMLE Step 1 Forum 12 12-22-2011 09:24 AM
Cardiovascular physiology - tricky question! bebix USMLE Step 1 Forum 16 08-01-2011 07:20 PM
Renal physiology - tricky question bebix USMLE Step 1 Forum 14 07-26-2011 04:51 AM
A little tricky question to solve.. dr.Hanief USMLE Step 1 Forum 7 07-02-2011 11:51 AM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)