Answer and Explanation 15

15.  Choice D is the correct answer.  Cowden's Syndrome does not have Cafe Au Lait Spots.  It is multiple hamartomas syndrome.  Neurofibramatosis is the most common condition they are seen.  They are also seen with Fanconi Anemia and McCune Albright Syndrome.

Question 15

15.  Which of the following is not in the differential diagnosis of Cafe au Lait Spots?

A.  Neurofibramatosis

B.  Fanconi Anemia

C.  McCune Albright Syndrome

D.  Cowden's Syndrome

Answer and Explanation 14

14.  Choice D is the correct answer.  Chicken pox usually has a diffuse rash that covers the body and the head and neck in the 4 stages of development.  The four stages are papular, vesicular, ulcerated, and pre-erruptive stage.  Molluscum has more of a papular appearance and is not diffuse.  Scabies does not have a vesicular appearance and usually spares the head and neck.  While herpetic infections can cause erythema multiforme, they will have a bulls eye appearance.

Question 14

14.  Please identify the rash pictured below in the photograph?

A.  Erythema Multiforme

B.  Scabies

C.  Molluscum Contagiosum

D.  Chicken Pox

Answer and Explanation 13

13.  Choice A is the correct answer.  Neonatal fever and potential sepsis needs to be treated as a seconds to minutes emergency in the emergency room.  Patients in this age group can look perfectly fine and have sepsis or meningitis. This patients needs a spinal tap and the goal is to have all cultures collected and have ampicillin, gentamicin and acyclovir infusing in under an hour of arriving there.  Rocephin is not the best choice for antibiotic coverage in the neonatal period.  Also coverage agains herpes should be initiated too with a vaginal delivery.  There is literature to support covering with acyclovir in this situation.  Choice D needs to be done but is simply not aggressive enough in this situation.

Question 13

13.  A 2 day old female born via vaginal delivery to a group B strep negative mother presents to the emergency room with a fever 104 rectally, BP 92/43, RR 36, HR 189.  Preliminary assessment reveals the child to be non toxic appearing with no focus of infection.  There is no nuchal rigidity and there is no bulging or sunken fontanelle.  Which of the following is the best management option?

A.  Perform an immediate spinal tap and start IV ampicillin, gentamicin, and acyclovir

B.  Get a urinalysis, chest x ray, RSV and an influenza swab and give a shot of rocephin 50 mg/kg IM

C.  Get a urinalysis, chest x ray, RSV and an influenza swab and give a shot of rocephin 100 mg/kg IM

D.  Perform a CBC, BMP, Blood Culture, CRP, Urinalysis and a Chest X Ray and admit the child for observation

Answer and Explanation 12

12.  Choice C is the correct answer.  The patient has already received a toxic dose of lidocaine.  It is recommended that only 4.5 mg/kg be use of lidocaine without epinephrine and 7 mg/kg for lidocaine with epinephrine.  For a 70 kg individual this comes out to 28 mL for 1% 14 mL for 2% lidocaine without epinephrine.  So choice A is incorrect.  Children should not be sutured that do not have adequate anesthesia.  This just adds additional trauma to the situation.  This is not a situation for wounds to heal by secondary intention.  Therefore choice C taking the patient to the operating room for closure under general anesthesia is the best option.

Question 12

12.   Your patient is a 5 year old boy that comes in after a bicycle accident with extensive lacerations on his arms and legs.  There is a total of 44 cm of lacerations.  He weighs 30 kg.  You have used a total of 35 mL of 2% Lidocaine with out epinephrine.  He still seems to be feeling most of the laceration.  What is the best management plan based upon this scenario?

A.  Continue infiltrating with lidocaine until adequate anesthesia is obtained.

B.  Just suture the laceration.  Sometimes children are not reliable when it comes to assessing adequate anesthesia

C. Recommend the patients lacerations be closed in the operating room.

D.  Start the patient on ancef and just let the lacerations heel by secondary intention.

Answer and Explanation 11

11.  Choice B is the correct answer.  Patients with hypoplastic left heart syndrome have hypoplastic mitral and aortic valves. Their ascending aorta is usually small.  It is not unusual to see RVH on an EKG because of the hypoplastic left side of the heart.  In Total Anomalous Pulmonary Venous Connection the pulmonary vein connects into the right side of the heart as opposed to the left atrium.  In Truncus Arteriosis a single arterial trunk connects the pulmonary arteries, coronary arteries, and the aorta.  Tricuspid Atresia is when the tricuspid valve is under developed.

Question 11

11.  Your patient is a 9 year old boy who came in to your office to be evaluated for syncope that occurred during a soccer game.  He has noted some dizziness with activity and occasional chest pain.  EKG shows right ventricular hypertrophy but otherwise normal.  This patient will need an ECHO to rule out what condition before being cleared to return to sports/gym class?

A.  Total Anomalous Pulmonary Venous Connection

B.  Hypoplastic Left Heart Syndrome

C.  Truncus Arteriosis

D.  Tricuspid Atresia