USMLE Forum Archives - USMLE Step 2 CK - Pediatrics
Pediatrics
Youngdoctor - 04-06-07 22:59
1)A 9-year-old boy presents with a 3-month history of multiple episodes of sudden awakening at night. His mother states that when he wakes up suddenly, he screams, "Go! Get away! Go!" and does not respond to the parents. His eyes are wide open, and he sweats heavily and looks scared. The parents have had to struggle to awaken him. After the episodes, he has no memory of what happened. Which of the following is the most likely diagnosis?
A. Confusional arousals
B. Night terrors
C. Nightmares
D. Obstructive sleep apnea
E. Panic disorder
2) 15-year-old girl presents with diplopia after prolonged reading and ptosis that worsens in the afternoon. On examination, she is noted to have bilateral ptosis, impaired extraocular muscle movements, facial weakness, and generalized hypotonia and weakness increasing with repetition. Which of the following is the best diagnostic test for this disorder?
A. CT of the brain
B. Electromyography
C. Lumbar puncture
D. Muscle biopsy
E. Nerve conduction velocity
3)A 2-year-old girl is brought to the clinic with headache, vomiting, and pallor. Her blood pressure is 130/80 mm Hg. On physical examination, she is noted to have aniridia and a large abdominal mass. Abdominal scanning reveals a poorly vascularized tumor in the upper pole of the right kidney. Which of the following is the most likely cause of this presentation?
A. Deletion of a gene on chromosome 11
B. Fragile X syndrome
C. Translocation of chromosome 9 and 21
D. Trisomy 13
E. Turner syndrome
4)A 14-year-old boy is brought to the emergency department because of soreness, and
weakness in his legs for the past day that has slowly spread from his calves to his thighs. He
now complains of weakness in his trunk and arms. On examination he appears tired and lays
on the examining table. His temperature is 37 C (98.6 F), pulse is 48/min, and respirations are
22/min. Both of his legs are diffusely tender. Deep tendon reflexes are absent in the lower
extremities, and sensation is greatly diminished. Which of the following studies is essential for
this patient's diagnosis?
A. Creatinine phosphokinase levels
B. Stool culture for Campylobacter jejuni
C. Motor nerve conduction test
D. Cerebrospinal fluid studies
E. Muscle biopsy
5)A 5-year-old boy is brought to his pediatrician's office after he falls from his bicycle and strikes his head against the sidewalk. There were no witnesses to this incident, which occurred 8 hours ago. The child is otherwise healthy, up-to-date on his immunizations, and not taking any medications. On physical examination, his vital signs are stable. He has a 5 × 4 cm abrasion on his forehead. He is alert and oriented to date, place and self. His motor and sensory examinations are normal and reflexes are normal. Which of the following constitutes reasonable management?
A. Admit overnight for observation
B. Instruct parents to observe neurological status for 24 hours
C. Obtain a head computerized tomography scan
D. Obtain a skull x-ray film and discharge if normal
E. Obtain a skull
Youngdoctor - 04-06-07 22:59
1)A 9-year-old boy presents with a 3-month history of multiple episodes of sudden awakening at night. His mother states that when he wakes up suddenly, he screams, "Go! Get away! Go!" and does not respond to the parents. His eyes are wide open, and he sweats heavily and looks scared. The parents have had to struggle to awaken him. After the episodes, he has no memory of what happened. Which of the following is the most likely diagnosis?
A. Confusional arousals
B. Night terrors
C. Nightmares
D. Obstructive sleep apnea
E. Panic disorder
2) 15-year-old girl presents with diplopia after prolonged reading and ptosis that worsens in the afternoon. On examination, she is noted to have bilateral ptosis, impaired extraocular muscle movements, facial weakness, and generalized hypotonia and weakness increasing with repetition. Which of the following is the best diagnostic test for this disorder?
A. CT of the brain
B. Electromyography
C. Lumbar puncture
D. Muscle biopsy
E. Nerve conduction velocity
3)A 2-year-old girl is brought to the clinic with headache, vomiting, and pallor. Her blood pressure is 130/80 mm Hg. On physical examination, she is noted to have aniridia and a large abdominal mass. Abdominal scanning reveals a poorly vascularized tumor in the upper pole of the right kidney. Which of the following is the most likely cause of this presentation?
A. Deletion of a gene on chromosome 11
B. Fragile X syndrome
C. Translocation of chromosome 9 and 21
D. Trisomy 13
E. Turner syndrome
4)A 14-year-old boy is brought to the emergency department because of soreness, and
weakness in his legs for the past day that has slowly spread from his calves to his thighs. He
now complains of weakness in his trunk and arms. On examination he appears tired and lays
on the examining table. His temperature is 37 C (98.6 F), pulse is 48/min, and respirations are
22/min. Both of his legs are diffusely tender. Deep tendon reflexes are absent in the lower
extremities, and sensation is greatly diminished. Which of the following studies is essential for
this patient's diagnosis?
A. Creatinine phosphokinase levels
B. Stool culture for Campylobacter jejuni
C. Motor nerve conduction test
D. Cerebrospinal fluid studies
E. Muscle biopsy
5)A 5-year-old boy is brought to his pediatrician's office after he falls from his bicycle and strikes his head against the sidewalk. There were no witnesses to this incident, which occurred 8 hours ago. The child is otherwise healthy, up-to-date on his immunizations, and not taking any medications. On physical examination, his vital signs are stable. He has a 5 × 4 cm abrasion on his forehead. He is alert and oriented to date, place and self. His motor and sensory examinations are normal and reflexes are normal. Which of the following constitutes reasonable management?
A. Admit overnight for observation
B. Instruct parents to observe neurological status for 24 hours
C. Obtain a head computerized tomography scan
D. Obtain a skull x-ray film and discharge if normal
E. Obtain a skull
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#1
Re: Pediatrics jwang - 06-26-07 23:40 1 - night terrors
2 - electromyography.... i don't know waht nerve conduction velocity is. But I believe this patient has myasthenia gravis and to test it you would do a nerve stimulation test and test for fatigability. so whether the answer is B or E I am not sure
3 - deletion of gene of chrom 11. this patient has a wilms tumor and by process of elimination i choose a.
4 - i belive the kid has duchennes muscular dystrophy and you would measure the CK first since its non invasive and the next step would possibly be muscle biopsy?
5 - i think the best step is to instruct parents to observe for 24 hours. and you can allow the child to sleep just poke them at night and see if they respond the way they normally would. it has been 8 hours and the child seems fine. I guess legally you can just go ahead and get a CT of the head to rule out intracranial bleed.
#2
Re: Pediatrics nrp - 06-29-07 12:17 I agree with jwang except for the 4th question where it is a/c GBS. nd the investigation would be CSF examination where ull find albumino cytological dissociation
#3
nrp lakreol - 07-30-07 20:19 what do u mean by a/c , the increase in protiens in csf is MS right? :huh:
Ok young doc, what are the correct answers? :-)
#4
Re: Pediatrics bingousmle - 06-20-10 08:02 in first case night terrors since there is no memory for the event
second one is probably myasthenia but it is too early for this child - electromyography
third one is a wilms case - Deletion of a gene on chromosome 11
fourth one is GBS- so CSF studies
fifth- admit for overnight observation
#5
Re: Pediatrics babbu5508 - 06-20-10 13:41 C. Night terrors..eyes are wide open, and he sweats heavily and looks scared, no memory of events.
B. Electromyography..for myasthenia
A. Deletion of a gene on chromosome 11..phaeochromacytoma
#7
Re: Pediatrics babbu5508 - 12-05-10 05:05 After the episodes, he has no memory of what happened. Which of the following is the most likely diagnosis?
B. Night terrors
#8
Re: Pediatrics sudha2015 - 12-28-10 09:36 1 c
2 e
3 a I.E WILMS TUMOUR
4 c I.E G.B.SYNDROME
5 c We shd nt wait we shd go for ct scan of head
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