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.

Question 7

7.  Your patient is a 7 year old female brought in to see you for fatigue.  The patients CBC was normal.  Her thyroid labs were as follows:  T3 and T4 are elevated, and the TSH was low.  Which of the following is not one of the possible diagnoses?

A.  Graves Disease

B.  Subacute Thyroiditis

C.  Hashimoto's Thyroiditis

D.  McCune Albright Syndrome

Answer and Explanation 6

6.  Choice C is the correct answer.  The first urinary tract infection in a male and the second in the female needs to be referred to urology.  These can come from anatomical abnormalities such as ureteral reflux.  If the patient has been worked up for this already, both choices A and B are reasonable treatment plans.  This patient with a normal labs, and tolerating oral intake this patient in this age group can be discharged home and does not need to be admitted.

Question 6

6.  Your patient is a 18 month old male that presents with fever and vomiting.  His urinalysis is as follows WBC=25-50 RBC=0-2, Nitrite Positive. His CBC and electrolytes are normal.  His fever is down and he is eating and drinking normally.  This is his first documented UTI. Given the circumstances, what is the best management option.

A. Discharge the patient home with a script with Bactrim and Zofran

B.  Discharge the patient home with script for Macrobid and Zofran

C.  Refer the patient to Urology for a VCUG

D.  Admit the patient to the hospital