A 13 year old girl with history of lethargy, joint pain and cough....

A 13 years old girl presented to accident and emergency department with a history of lethargy, joint pain and cough. Both of her parents are from Jamaica. Her problem started one month ago with an upper respiratory infection. She was seen by her family doctor and diagnosed to have a viral infection. She has a past history of skin rashes that was never seen by her family doctor.
On examination she has a palpable cervical lymph nodes of various sizes, a congested throat, generalized myalgia and a swollen ankle joint on the left side.
Her BP is 120/75 mmHg, HR 90 bmp, RR 22/min.
A urine test shows protein+ve with red cells.
other tests are as follows:
Hb = 9.7 g/dl
TLC = 4x10-9/l with neutrophils and lymphopenia.
Platelets =100x10-9/l
Retic count = 2.6%
CRP = 20

Questions:
1. Which three other investigations should be carried out?
2. What treatments should you prescribe?
3. What are three possible differential diagnosis?

Answers:

Regarding child's developmental milestones...

An infant can regard his parent’s face, follow to midline, lift his head from the examining table, smile spontaneously, and respond to a bell. He does not yet regard his own hand, follow past midline, nor lift his head to a 45° angle off the examining table.

Which of the following is the most likely age of the infant?
a. 1 month
b. 3 months
c. 6 months
d. 9 months
e. 12 months

Answer:

When calculating fluid requirements in children with burns...

When calculating fluid requirements in children with burns, which ONE of the following statements is correct?
A. 4 mL/kg × % of total body surface area affected should be given within the first 8 hours
B. 0.9% sodium chloride is the preferred intravenous fluid
C. Maintenance requirements are given in addition to resuscitation fluid
D. The volume of resuscitation fluid required is determined by the depth of the burn
E. Urine output is a poor way to monitor adequacy of fluid replacement

Answer:

Managing a Child With Fever & Sepsis

A 5-year-old boy presents with a 24-hour history of fever, reduced oral intake and progressive lethargy. He is previously well and fully immunized.

Initial assessment shows :

• Temperature 39.6°C, 
• HR 158/min, 
• RR 40/min,
• SaO2 95% (air),
•  BP 70/40, 
• central capillary refill time 4 seconds.

He is lethargic but opens his eyes in response to his mother’s voice. On examination, he has a
purpuric rash on his trunk, and there are no other specific abnormal findings. After two 20 mL/kg
boluses of normal saline, he remains clinically unchanged.

Which ONE of the following statements best describes the next treatment he should be given?
A. He should be given activated protein C
B. He should be given IV hydrocortisone
C. He should be given inotropes if central IV access has been obtained
D. He should be given inotropes through peripheral or central IV access
E. He should continue to be given boluses of normal saline until there is a clinical response

Answer:

Leak Around Endotracheal tube In A 6 year Old child

A six-year-old child is intubated with a size 4.5 mm ID endotracheal tube. Following intubation, there is a large leak of air around the tube, audible at the
mouth.
What is the most clinically significant effect of endotracheal intubation with a tube that is too small?
 Select ONE answer only:
A. Environmental pollution of anaesthetic gases
B. High gas flow consumption
C. Imprecise capnography
D. Increased risk of pulmonary aspiration
E. Unreliable ventilation and oxygenation

Answer:

Regarding “Pneumonia” Vaccine....

The parents of a 2-month-old male diagnosed with sickle cell disease want to know more about “pneumonia” vaccine. When discussing this vaccine with the parents, which of the following is true?

A. High-risk infants should receive the 23-valent pneumococcal vaccine.
B. Heptavalent pneumococcal vaccine alone is recommended for high-risk children older than age 2 years.

C. Children with sickle cell disease or asplenia who receive the pneumococcal vaccine still require antibiotic prophylaxis.
D. Pneumococcal vaccine is not recommended for healthy infants.
E. Pneumococcal vaccine may not be administered at the same time as MMR, varicella, or poliovirus vaccines.

Answer :

Treatment Of Otitis Media In Children

A 6-year-old girl presents with her first episode of otitis media. She has been treated with antibiotics on one prior occasion for a urinary tract infection. She has no known drug allergies. Which of the following is the most appropriate antibiotic to treat this patient?

A. Cefuroxime
B. Azithromycin
C. Amoxicillin
D. Cephalexin
E. Amoxicillin/clavulanic acid

 Answer :

Regarding Acute Sinusitis In Children

In treating acute sinusitis in children, which of the following sinuses is unlikely to be infected in a 6-year-old?
A) Frontal
B) Maxillary
C) Ethmoidal
D) Sphenoidal

Answer and Discussion

Cerebral Palsy

An 18 month old child attends the child development center for a thorough assessment with suspected diagnosis of cerebral palsy. Which of the following clinical features would be most likely to suggest an alternative diagnosis?
Select ONE answer Only

A. Dystonia
B. Family history of cerebral palsy
C. Hyperkinesia
D. Prematurity
E. Spasticity

Correct Answer is option B:  Family history of cerebral palsy

Cerebral Palsy:

Cerebral Palsy is a descriptive term which has been defined as a group of permanent disorders of movement and posture causing activity limitation that are attributed to non progressive disturbances that occurred in the developing fetal or infant brain.