A 10-year-old boy is brought in with a chief complaint of multiple colds. On further questioning, you elicit a history of chronic, clear nasal discharge with no seasonal variation. Other symptoms include sneezing, itching of the nose and eyes, as well as tearing and occasional eye redness. Some relief is obtained with an over-the-counter cold medicine containing antihistamine and a decongestant. His history suggests which of the following?
Answer(s): E
The symptoms are suggestive of perennial allergic rhinitis. Causative agents are usually those to which the child is exposed year round, such as house dust, mold spores, or pet danders. Seasonal allergic rhinitis is attributable to sensitization to pollens of trees, grasses, and weeds. Nasal foreign bodies usually result in a foul smelling, unilateral purulent, and occasionally blood tinged, discharge. Recurrent infections may rarely be attributable to immunologic deficiencies. Recurrent pneumonias are the most common complaint.Rhinitis medicamentosa occurs secondary to excessive use of vasoconstrictor nose drops or sprays, resulting in rebound nasal obstruction. Sinusitis is suggested by a bilateral purulent nasal discharge, often accompanied by fever, cough, headache, and sometimes sinus tenderness.
A full-term newborn develops cyanosis a few hours after birth. Oxygen administration does not improve color or oxygen saturations. Which of the following is the most likely diagnosis?
Cyanosis in newborn infants is associated with major right-to-left shunts. Total anomalous pulmonary venous return results in a right-toleft shunting through an interatrial communication, usually a patent foramen ovale. Patent ductus arteriosus and atrial septal defect, when unaccompanied by other cardiovascular abnormalities, cause left-to-right shunts that do not produce cyanosis. Coarctation of the aorta does not typically cause symptoms in the newborn.Hypoplastic left heart presents with signs of failure in the newborn period.
A 4-year-old child was brought in for evaluation of sleep problems. He cried and screamed within an hour of falling asleep. He seemed disoriented and confused; he did not seem aware of his parents' presence. They were unable to arouse him to comfort him. This resolved spontaneously, and he had no recollection of the event the next morning. You informed the parents that he was most likely experiencing which of the following?
Answer(s): B
Parasomnias or disorders of arousal include nightmares, night terrors, sleepwalking (somnambulism), and sleep talking (somniloquy). This pattern suggests night terrors and is most common between ages 2 and 6 years. Nightmares occur at any age but peak between ages 3 and 5 years; they occur later in the night during rapid eye movement (REM) sleep. The child usually remembers the dream vividly, is upset on waking, but can be comforted by the parent. Sleepwalking occurs, as do night terrors, during non-REM sleep. It is most common between ages 4 and 8 years; safety of the child is the main concern. Sleep talking is not specific to any stage of sleep and may occur in association with nightmares and night terrors.Narcolepsy is a rare disorder characterized by excessive daytime sleepiness. Confirmation requires referral to a sleep laboratory
A 3-year-old boy was bitten while teasing a neighborhood cat. On examination, there are two puncture wounds on the right hand and some superficial scratch marks. There is erythema, warmth, and induration around the puncture sites. Which of the following organisms most likely caused the infection?
Answer(s): A
F. multicoda and S. aureus are organisms commonly associated with cat bites. The cat's sharp teeth and claws predispose the victim to puncture wounds. Wound infections are more common in cat bites than dog bites. E. corrodens, Peptostreptococcus species, and alpha Streptococci are more common with human bites. B. henselae causes cat-scratch disease, which presents with subacute lymphadenitis.
A5-week-old bottle-fed boy presents with persistent and worsening projectile vomiting, poor weight gain, and hypochloremic metabolic alkalosis. Of the following diagnostic modalities, which would most likely reveal the diagnosis?
The case presented is classic of pyloric stenosis. This results from hypertrophy and hyperplasia of smooth muscle in the stomach, causing a narrowed, even, obstructed outlet. Persistent projectile vomiting causes ongoing losses of calories and electrolytes, resulting in growth failure and hypochloremic metabolic alkalosis. Hyponatremia and hypokalemia may also be associated. Often, the diagnosis can be made by physical examination alone. However, if an olive-shaped mass is not palpated, an abdominal ultrasound may confirm the diagnosis
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