Pediatric Case Studies with MCQs,

Mr. ABC, a 12-year-old boy, presented with pain and weakness of legs for the last about one year. A practising child specialist diagnosed his problem as “growing pains”. Since then he received several tonics providing calcium, iron, and vitamins (including vitamin E) but nothing did him much good.

For the last month or so, his problem had become rather worse. Besides, weakness and pain, he also complained of breathlessness on running for a while. This was in contrast to his earlier stamina for long races.His dietetic intake was quite good. There was no loss of weight during the course of this ailment.

On examination, he was found to be a tall and fairly well nourished boy. The only relevant finding in the general physical examination was impalpable femorals while the brachial arteries were rather strong.

The heart size was normal but the apex was heaving. A systolic thrill was palpable in the suprasternal notch. There were also prominent arterial pulsations in the suprasternal notch and the carotid vessels. A loud ejection systolic murmur was heard, best over the interscapular area. Preceding it was a loud ejection click.

Questions:

1. What was the major diagnosis?

2. What do you expect to find in ECG?

3. What do you expect to find in X-ray chest?

4. What is the cause of systemic hypertension in this disease?

5. Describe briefly the course and complications of the disease.

6. The practising child specialist’s diagnosis of “growing pains” was sure wrong.      State what your concept of this vague entity is?

Answers: 17/8/2019

PEDIATRIC CASE STUDIES WITH MCQS

A 8-year-old boy appears in the ER with history of URI (upper respiratory infection) for the last 5 days. He received acetaminophen for fever up to 103°F. He does not want to eat. His activities are decreased significantly. For the last 12 hours, his fever went up to 104°F despite acetaminophen therapy. He vomited yellowish material twice. He is irritable, lethargic, and complains of back pain. He denies sore throat and pain in ears. He denies any history of trauma. He is not allergic to any medication. Past medical history is unremarkable.

Vital signs: Temperature 105°F (40.5°C),

heart rate 120 per minute (normal 70 – 110),

respiratory rate 20 per minute (normal 17 – 23),

blood pressure 100/60 (50th percentile).

QUESTIONS:

1. Physical examination reveals:

A. Pharyngeal exudate

B. Redness in tympanic membranes

C. Rales in right lung

D. Nuchal rigidity

E. Abdominal tenderness

2. Investigation which leads to definitive diagnosis:

A. Audiometry

B. Abdominal X-ray

C. Pharyngeal culture

D. Sputum culture

E. CSF

3. Test results reveal:

A. Conductive hearing loss

B. Dilated small intestine

C. Group A Streptococci

D. S. aureus

E. CSF: Gram stain positive for Gram positive cocci and culture positive for S. pneumoniae

4. The next step in management:

A. Intravenous antibiotics

B. Surgical consult

C. Oral antibiotics

D. Intravenous hydration

E. Bronchodilator therapy

5. The child is kept NPO (nothing per mouth). IV fluid should be given:

A. Two times of maintenance

B. One and half times of maintenance

C. One time maintenance

D. One half to two thirds of maintenance

E. One fourth of maintenance

CHECK ANSWERS on Tuesday 6/8/2019