In January, you see an 18-month-old boy in the middle of the night in the pediatric emergency department. The father relates that 1 hour ago his son started coughing. The father describes the cough as barking ("seal" like). The child has mild stridor at rest, but otherwise is not in respiratory distress. His RR is 45 breaths per minute. He has a temperature of 103.4°F . What is the most common etiology of this illness in children?
Answer(s): D
This case is a common presentation for viral croup, with the symptoms of a seal-barking cough, stridor, tachypnea, and fever in the winter. Pneumonia must also be considered with tachypnea, cough, and fever, but it is less likely to cause stridor and may not have the seal-bark type of cough. Sinusitis may cause cough and fever, but would be more likely to have a purulent nasal discharge and less likely to have the typical croupy cough. Bronchiolitis due to RSV is a common cause of wintertime cough and fever. It is less likely to have stridor and more likely to have wheezing. Children with epiglottitis are typically found in the "tripod position" and may be drooling. It is, fortunately, becoming rare with the widespread use of the H. influenzae vaccine. Parainfluenza types 1 and 2 account for 6070% of all viral croup. HIB was a common cause of epiglottitis, but is now rare because of widespread vaccinations. Influenza B and RSV can cause croup, but not as commonly as parainfluenza types 1 and 2. S. pneumoniae would be the most common bacterial cause of pneumonia or sinusitis. (American Academy of Pediatrics, 2003, pp. 454455) The steeple sign is subglottic narrowing of the trachea seen on an AP view of the trachea or a CXR. The trachea is seen to narrow, almost to a point, like the steeple of a church. Swollen adenoids are difficult to identify in lateral neck x-rays. The presence of swollen adenoids is unrelated to the airway narrowing seen in croup. The thumb sign is a swollen epiglottis seen with epiglottitis. Alobar pulmonary infiltrate may be seen with a typical bacterial pneumonia
In January, you see an 18-month-old boy in the middle of the night in the pediatric emergency department. The father relates that 1 hour ago his son started coughing. The father describes the cough as barking ("seal" like). The child has mild stridor at rest, but otherwise is not in respiratory distress. His RR is 45 breaths per minute. He has a temperature of 103.4°F .What is the most common x-ray finding in this illness?
Answer(s): E
Parents bring their 12-year-old son to your clinic for evaluation. The child states that he gets teased a lot in school because of his short stature. His weight and height are below the 10th percentile for his age. His parents are of average height. Following your physical examination, you determine that he has tanner stage 1 development and his bone age is that of a 9-year-old male. His examination is otherwise normal.What is the most likely diagnosis?
Answer(s): B
Short stature in an adolescent is a common reason for visiting the pediatrician or endocrinologist. Most short stature in adolescence is constitutional growth delay. These children will have normal growth velocity and delayed bone age. Growth is normal for the first 412 months, then decelerates to below the fifth percentile. These children will catch up to their peers in a slightly delayed fashion. Frequently, other family members have a history of short stature in childhood, delayed puberty, and eventual normal stature as adults. In contrast, children with familial short stature have a normal bone age and regular onset of puberty. These children will maintain their short stature as adults. Somatomedin-C (ILGF-1) is commonly used as a surrogate measure for the end-organ effect of the pulsatile GH release. In children with GH deficiency, the end-organ effect will be a low somatomedin- C level. An advanced bone age (advanced bone maturation) usually results in shorter final height. Chronic renal failure is a cause of growth delay, but not a common one
Parents bring their 12-year-old son to your clinic for evaluation. The child states that he gets teased a lot in school because of his short stature. His weight and height are below the 10th percentile for his age. His parents are of average height. Following your physical examination, you determine that he has tanner stage 1 development and his bone age is that of a 9-year-old male. His examination is otherwise normal.What is the most likely diagnosis?Which of the following is a true statement regarding the assessment of a child with short stature?
A mother brings her 15-year-old son in for a preparticipation sports physical examination. She feels that her son has not yet undergone pubertal changes and that makes her concerned.Which of the following is a true statement regarding puberty delay?
Answer(s): C
Pubarche in females is usually earlier than in males. Delayed puberty alone may be a pathologic condition; its presence in conjunction with short stature makes a pathologic state more likely. Males do, indeed, have adrenarche. Panhypopituitarism is a cause of puberty delay, but not a common one. Undiagnosed hypothyroidism can be a cause of pubertal delay, and thyroid function testing should be a part of the routine evaluation of this problem. The onset of puberty in males is usually signaled by an increase in testicular volume. This is commonly seen in conjunction with lengthening of the phallus and thinning of the scrotal skin. As a result of puberty, the other findings (deepening of the voice, increased muscle mass, and increased facial hair) may be seen, but the first of the listed findings to appear is increased testicular volume. In females, puberty is usually signaled by the enlargement of breast buds.
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