On your patient schedule see a diagnosis of plagiocephaly on your patient schedule and
are able to explain the etiology of this head growth disturbance is to the parents of this
4-month-old : - Your child's head appears flat. This form of craniostenosis can result
from premature fusion of lambdoidal or coronal skull sutures and is often only cosmetic
and can be treated with a special helmet
During a 1-week-old male well child check the head circumference is 3 S.D. (standard
deviations) below the predicted mean. What risk factors increases the risk of this
finding? - Prenatal Zika virus exposure
You are seeing a 6-month-old today for follow-up after a febrile seizure yesterday. On
exam you expect to find: - Posterior Fontanel Closed
You are examining a 22-month-old today for follow-up after a with a new sudden onset
of jerking movements while febrile earlier today. Which of the following is not typical of
this type seizure? - Seizure lasting more than 15 minutes
A15-year-old with a diagnosis of epilepsy had a seizure in your office lasting 12 minutes
requiring rectal diazepam (Valium). He is stable in a postictal state. His parents express
concern as his last seizure was 2 years ago and he wanted to be weaned off his
phenytoin (Dilantin).Which of the following may have contributed to this seizure? -
Experimentation with alcohol lowers seziure threshold.
Grow spurt may decreased kg/mg dosage.
Adolescent may be non-compliant with regimen.
What question in an adolescent's history is the MOST important to ask concerning new
onset of headaches? - History of headache most severe when arising from sleep.
A 17-year-old arrives for evaluation of a headache. He states it is worse in the morning
and does not respond to ibuprofen. His caffeine intake has not changed, he has no
known head trauma. On exam you note he is slow to respond to questions and your
fundoscopic exam the optic disc borders are blurred (papilledema). You explain your
next action - He exhibits a focal neurological sign, order a CT.
A 17-year-old gymnast presents following her competition with a resolving headache
rated 3/10, after her spotter missed her and she fell 4 feet and struck her head.
Although she did not lose consciousness and seems fine now, her parents are
concerned because she does not remember how she got off the gym floor. Which of the
following would NOT be indicated. - Order of a CT of the head.
, Yes indicated: bedrest, accetaminophen, teach warning signs of head injury, return to
school, No contact sports.
An 11-year-old male presents with a history head trauma resulting from a "hard hit"
while playing football 2 days ago. His GCS score is 14. Despite 20/15 vision recorded 3
months ago during his sports physical he states he has blurred vision and is unable to
read fine print, otherwise his neuro exam is normal. What is your best plan of care? -
Focal neurological sign, order a CT.
You are examining a 4-month-old with a fever who suddenly stares blankly and her
limbs start twitching. You time the episode which lasts 3 minutes. What are next steps?
- Lie child on their side at time of event, administer antipyretic.
Your are treating a 16-year-old female with chronic headaches. Effective management
of headache in an adolescent patient includes which of the following - Appropriate
medication/pain relieving intervention, explanation of likely cause and course of HA,
elimination of HA triggers.
Your 12-year-old male patient has a history of cord compression and anoxia at birth
presents with spasticity and partial paralysis. His likely diagnosis is: - Cerebral palsy
A 3 year-old-female presents with loss of the use of her left arm since her forcep
delivery birth. Which of the following is her most likely diagnosis? - Brachial plexus palsy
9-year-old Sarah presents with her normal-height parents who are concerned about her
short stature. Physical exam is unremarkable except for height and weight are in the 3rd
percentile, you note she is Tanner Stage 1, her endocrine work-up is normal except for
a delayed bone age (8 years). The treatment for Sarah's suspected diagnosis -
Reassurance, observation with anticipated growth acceleration.
16-year-old Michael presents with his 60-year-old father with a concern about delayed
puberty, physical exam is remarkable for scant body hair, tall stature, mild
gynecomastia and hypogonadism. The treatment for Michael's suspected diagnosis is: -
Referal for likely Klinefelter syndrome and consideration for testosterone therapy.
15-year-old Dana presents with her 60-year-old mother w a concern about delayed
puberty with amenorrhea, physical exam is remarkable noting short stature, low set ears
and hair line, cubitus valgus and web necked. The treatment for Dana's suspected
diagnosis is: - Endocrine referral for likely Turner's syndrome and consideration of
estrogen, progesterone and growth hormone.
A 4-year-old girl presents with her mother with concerned about her breast
development. Her family history is negative for endocrine disorders. Physical exam is
unremarkable except for stage 1 breast development, no pubic with no signs of axillary
or pubic hair . Her height and weight are above the 95th percentile. Which of the
following BEST describes this child's physical findings? - Premature thelarche
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