Peds NBME Form 2 4 month old 27 wks gest hospitalization: sepsis and RDS - intubated and ventilated O2 and diuretic therapy at home PE: breath sounds dec BL; wheezing cardiac exam: pronounced S2, precordial heave abd exam: h epatomegaly ECG: RAD, RVH US: normal kidneys cause of pt's HTN? Correct Answer: bronchopulmonary dysplasia disruption of alveolization if infant born < 32 wks and still needs O2 on day 28 - probably has BPD due to damage from ventilation and long -term use of O2 6 month old - hemangioma on neck was 0.5 cm - now 2 cm raised, erythematous, blanches w/ pressure next step in mgnt? Correct Answer: observation strawberry hemangioma benign capillary hemangioma appears first few wks of life grows rapidly and regresses spontaneously by 5 -8 yo 3 wk old - skin yellow stools lighter in color fed formula since birth PE: jaundice TsB - 14 w/ direct of 6 mechanism for infant's condition? Correct Answer: dec excretion of BR believe that breast milk inhibits glucuronyl transferase (conjugation enzyme) baby only eating formula - not inhibiting the enzyme > inc BR asymptomatic 2 yo 2 month visit w/ grandpa - dx w/ active TB PPD: 25 mm of induration at 72 h rs CXR: normal pt is administered what? Correct Answer: INH only screen < 5 yo w/ PPD screen > 5 yo w/ IFNy release assay INH for latent RIPE for active 5 month old - fever for 1 day tugging at L.ear nasal congestion - 4 days fussy but consolable PE: L.ear - bulging, diffusely erythematous TM; no movement on pneumatic otoscope most likely dx? Correct Answer: acute otitis media this is literally the classic presentation relief of pain w/ pulling pinna loss of light reflex MC bugs: S.pneumo, H.flu, M.catarrhalis tx: amox; if recurs amox -clavulanate re-recurs (3x/6 months or 4x/12 months): tympanoplasty (ear tubes) 11 yo - bloody urine w/ RBC casts 3 wks after tx of cellulitis HTN, pedal edema labs: inc antistreptolysin O titer, dec plasma C3 most likely outcome? Correct Answer: recovery w/o renal sequelae acute poststrep glomerulonephritis seen in kids 2 -4 wks after GAS infection of pharynx/skin
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