Answer and Explanation 10

10.  Choice B is the correct answer.  Babies with meconium stained amniotic fluid should not be stimulated until their airway is visualized and cleared of meconium.  Stimulation before the airway is clear may lead to the child aspirating the meconium into their lungs.  Bag mask ventilation may force the meconium into the babies lungs.  High frequency Jet Ventilation is not indicated in this situation.

Question 10

10.  You are called to the delivery of a 40 week gestation male born via vaginal delivery.  The amniotic fluid is meconium stained.  Which of the following is the most important initial intervention?

A.  Dry the baby off, stimulate the baby, and monitor his oxygen saturations.  Give blow by if indicated.

B.  Try not to stimulate the baby, directly visualize the airway for any signs of meconium, aspirate the meconium if needed.

C.  Assist respirations with bag valve mask for 2 minutes.  Ensure the oxygen saturations are over 95%, then examine the airway for signs of meconium and aspirate if needed.

D. Place the baby on high frequency jet ventilation

Answer and Explanation 9

9.  Choice B is the correct answer.  These x rays are normal with normal growth plates.  This mechanism is typical for a radial head subluxation (nurse maid's elbow) and a reduction should be attempted. The patient should start moving it after that.  Whenever the patient has open growth plates a salter harris type 2 fracture is still within the differential.  The patient has no evidence of anterior or posterior fat pads.  There is no evidence of supracondylar fractures or osteomyelitis.

Question 9

9.  Your patient is a 2 year old female brought in by her mother not wanting to move her right arm.  Her mother states that she was holding her hand and she just dropped to the floor because she did not want to do what the mother wanted to do.  Below is her elbow x ray.  Base upon this information.  What is the most likely diagnosis?

A.  Supracondylar Fracture

B.  Radial Head Subluxation

C.  Occult radial head fracture

D.  Osteomyelitis

Answer and Explanation 8

8.   Choice D is the correct answer.  Wilms Tumor is the most common intra-renal malignant tumor in childhood.  Renal cel carcinoma is the most common renal cancer in adults.  Ewing sarcoma is a non osseous round cell tumor that is frequently spread a the time of diagnosis.   Langerhans Cell Histiocytosis is a group of diseases where there is infiltration of differentiated Langerhans cell histiocytes that can look like a malignancy.

Question 8

8.  Which of the following is the most common childhood renal malignancy?

A.  Renal Cell Carcinoma

B.  Ewing Sarcoma

C.  Langerhan's Cell Histiocytosis

D.  Wilms Tumor

Answer and Explanation 7

7.    Choice C is the correct answer.  Hashimoto's thyroiditis causes hypothyroidism.  Graves disease, subacute thyroiditis is a cause of hyperthyroidism. McCune Albright Syndrome is a rare cause of hyperthyroidism.