A3-year-old boy suddenly begins choking and coughing while eating peanuts. On physical examination he is coughing frequently. He has inspiratory stridor and mild intercostal and suprasternal retractions.Initial management should include which of the following?
Answer(s): D
In the management of foreign body aspiration, it is generally felt that if the victim can speak, breathe, or cough, all interventions are unnecessary and potentially dangerous. When intervention is required, the first maneuver is a series of abdominal thrusts (for children >1 year of age) or back blows (for children 1 year of age or younger). When obstruction persists, foreign bodies sometimes can be removed from the oral cavity or pharynx if they can be seen, but blind finger sweeps of the hypopharynx are not recommended.Emergency tracheostomy, preferably performed by an experienced clinician, is employed only in cases of critical airway obstruction unrelieved by other maneuvers.
During a well-child visit, the grandmother of an 18-month-old patient is concerned because the child's feet turn inward. She first noticed this when her grandson began to walk. It does not seem to bother the child. On examining his gait, his knees point forward and his feet turn inward. Which of the following is the most likely cause of this condition?
Adducted great toe, metatarsus adductus, medial tibial torsion, and femoral anteversion can result in intoeing. In most cases, this is a benign condition that requires only observation. In this child, because the child's knees are straight, the rotational deformity is below this joint. In metatarsus adductus, the forefoot is adducted as compared to the hindfoot. Idiopathic avascular juvenile necrosis of the femoral head, or Legg- Calvé-Perthes disease, most commonly is seen in 4- to 8-year-old boys. Loss of hip medial rotation is an early sign.
A 13-year-old girl presents with parental concerns of poor posture. She has not had any back pain. On examination, she has unequal shoulder height, asymmetric flank creases, and a forward- bending test that shows rib asymmetry. The physical examination is otherwise normal. Which of the following is the most likely cause of her condition?
Answer(s): C
Idiopathic scoliosis is the most common back deformity in children. The incidence peaks in early adolescence and is much more common in girls. Screening for scoliosis should be part of every well check and sports physical in children at Tanner (IIV) stages. Congenital scoliosis is caused by failure of formation or fusion of the ossific nuclei of the vertebrae. It can present at any age, depending on the degree of curvature, and is much less common than idiopathic scoliosis. Patients with leg length inequality present with a limp. Patients with Scheuermann kyphosis usually present with back pain and have a sharp kyphotic angulation with forward bending. Postural roundback is an exaggerated kyphotic appearance often seen in adolescents.
After 10 days of nasal congestion and rhinorrhea, a 3-month-old infant develops a severe hacking cough during which he repeatedly turns dusky and appears to choke on or to vomit profuse thick, clear nasopharyngeal mucus. For 7 days, the coughing continues unabated. On physical examination, he is afebrile and his lungs are clear. His chest x-ray is normal. His WBC count is 24,000/mm3, with 15% polymorphonuclear cells, 82% lymphocytes, and 3% monocytes. Which of the following antibiotics should be used to treat this patient?
Whooping cough, or pertussis, tends to have a prolonged course, with a 2-week prodrome of undifferentiated upper respiratory infection followed by approximately 2 weeks of a paroxysmal, machine gun-like cough and nasopharyngeal mucus that is strangling, thick, and clear. The typical whoop, a stridorous inspiratory gasp at the end of each paroxysm, is often absent in infants younger than 6 months.Posttussive vomiting more likely will be found in this age group. The diagnosis should be suspected in children with a paroxysmal, harsh cough and absolute lymphocytosis. Specific inquiry into the history of a severe or long-lasting cough in adult caretakers should be sought. The diagnosis is made by culture of the organism (Bordetella pertussis) or by an immunofluorescent study of throat swab material. Erythromycin is the drug of choice. It has little effect on the illness course after paroxysms are established and is used primarily to limit spread of infection to others.
A 16-year-old girl presents with a history of primary amenorrhea. On examination, short stature and a short neck with a low posterior hairline are noted. Chromosomal analysis most likely would reveal which of the following?
Turner syndrome (usually 45,XO karyotype) occurs in 1 of 3000 live births. The hallmark of this genetic disease is gonadal dysgenesis. Although sexual maturation usually does not occur, a girl with Turner syndrome occasionally will have menstrual periods but rarely will be fertile. Treatment may include estrogen replacement or growth hormone usage. Psychosocial support is extremely important.
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