Answer and Explanation 20

20.  Choice C is the correct answer.  It is not unusual for patients with appendicitis to have white cells in there urine given the close proximity of the ureter to the appendix when it gets inflamed.  It is important to take this a little more series in male patients, especially those who are older.  It would be unusual to have WBC in the urine with mesenteric adenitis but possible.  Usually there is a preceding viral URI prior to the onset of abdominal pain.  Sending the child home on bactrim is not appropriate, he needs to be observed closely.

Question 20

20.    Your patient is a 7 year old male who presents to you with right lower quadrant pain and vomiting.  The patients vital signs are as follows:  Temp 99.1, Pulse- 94, RR-16, BP-92/50.  Labs are as follows WBC-11.4, Hgb 14.0, Hct-42.1, Platelets 145,000.  His urinalysis reveals WBC 2-4/hpf.  His abdominal exam reveals moderate tenderness in the RLQ.  Scrotal exam is normal.  Based upon this information, what is the best management option?

A.  Send the patient home with a script for bactrim for a UTI and follow the patient up in 5 days.

B.  Send the patient home, he likely has mesenteric adenitis since his abdominal exam is non surgical

C.  Order a CT scan of the abdomen and pelvis with IV and colonic contrast to rule out appendicitis.

D.  Instruct the patient on appropriate hygiene.  This is likely an issue with him wiping after defecating.

 

Answer and Explanation 19

19.  Choice B is the correct answer.  This patient has a surgical abdomen and has some unstable vital signs.  Manual reduction via barium enema is only indicated if the patient is stable without signs of peritonitis.   The patients heart rate is too high to blame just on pain an morphine and zofran are not going to improve the clinical picture.  Just admitting this patient for observation is not aggressive enough because this child needs attention immediately.

Question 19

19.  Your patient is a 3 year old female that presents to you with lower abdominal pain and vomiting.  Her vital signs are as follows pulse-190, BP-84/53, Temp-101.7 after fluid bolus and aggressive volume replacement.  Her CT scan shows an intussusception.  Her abdominal exam reveals some voluntary guarding and no bowel sounds.  Based upon this information, what is the best management option?

A.  Barium enema

B.  Surgical consult and recommend the patient be taken to the operating room for surgical reduction

C.  Give the patient some Morphine and Zofran, repeat vital signs and if normal attempt the barium enema.

D.  Admit for observation

Answer and Explanation 18

18.  Choice B is the correct answer.  The role of surfactant is to maintain the surface tension of the alveoli in the lungs.  Without surfactant the lungs become stiff and non compliant and increase the work of breathing.  Surfactant (Survanta) administered down the ET tube after birth to premature infants have been shown to have dramatic clinical outcomes and markedly decreases mortality.

Question 18

18.  Which of the following is accurate regarding the role of surfactant and its importance in premature infants?

A.  The lack of surfactant in premature infants increases the compliance of the lung and predisposes the infant to air trapping.

B. The lack of surfactant in premature infant decreases the compliance of the lung and predisposes the infant to an increase work of breathing.

C.  The lack of surfactant helps maintain surface tension of the alveoli in the lungs.

D.  There is little evidence that surfactant administration to a premature infant through an endotracheal tube to have improved clinical outcomes.

 

Answer and Explanation 17

17.  Choice B is the correct answer.  Turner's Syndrome is characterized by a missing second sex X chromosome.  These patients are always female and are infertile.  They have a short stature and are predisposed to congenital abnormalities.  They have an increased incidence of bicuspid aortic valves and coarctation of the aorta.  Children with Klinefelter's Syndrome have multiple X Chromosomes and one or more Y Chromosomes.  These patients are prepubertal boys and there is infertility from low testosterone and low sperm counts.  Trisomy 21 and Trisomy 18 is an extra chromosome on that particular chromosomal set.

Question 17

17.  Which of the following syndromes are characterized by a missing X chromosome, infertility, short stature, and increased incidence of bicuspid aortic valves and coarctation of the aorta?

A.  Klinefelter's Syndrome

B.  Turner's Syndrome

C.  Trisomy 18

D.  Trisomy 21

 

Answer and Explanation 16

16.  Choice B is the correct answer.  The most common organism causing epiglottis is haemophilus influenza.  Parainfluenza is the most common organism causing croup.  Mycoplasma and strep pneumonia are organisms that are frequent causes of pneumonia.

Questions 16

16.  What is the most common organism causing the pathology seen in the x ray below:

A.  Parainfluenza

B.  Haemophilus Influenza

C.  Mycoplasma

D.  Streptococcus Pneumonia