A 10-year-old boy develops an itchy, red rash on his legs after walking in the forest. He has had this before during the summer months. The rash is composed of blisters arranged in lines.
In this condition, which one of the following is true?
Correct Answer B:
Type IV reactions (delayed hypersensitivity) are T cell-mediated. These cells, sensitized after contact with a specific antigen, are activated by reexposure to the antigen; they damage tissue by direct toxic effects or through release of cytokines, which activate eosinophils, monocytes and macrophages, neutrophils, or killer cells depending on type.
Disorders involving type IV reactions include contact dermatitis (eg, poison ivy), hypersensitivity pneumonitis, allograft rejection, tuberculosis, and many forms of drug hypersensitivity.
A young couple bring their 30-month-old infant son to their pediatrician because he has not learned to speak, does not interact or play with other children, does not display eye contact and repeatedly flaps his hands. Physical examination is normal.
Which one of the following is the most likely diagnosis?
Correct Answer D:
Autism is a neurodevelopmental disorder characterized by impaired social interaction and communication, repetitive and stereotyped patterns of behavior, and uneven intellectual development often with mental retardation.
Symptoms begin in early childhood. The cause in most children is unknown, although evidence supports a genetic component; in some, autism may be caused by a medical condition. Diagnosis is based on developmental history and observation. Treatment consists of behavioral management and sometimes drug therapy.
For several months you have been evaluating a 2 1/2 year old male whose parents have numerous concerns. The patient has extreme difficulty mixing with other children, preferring to be alone. He is quite aloof around others, gesturing or pointing instead of using words. He also throws extreme tantrums for no apparent reason. The child does not respond to regular verbal cues and often simply ignores others when spoken to. His vocabulary is less than 10 words and he has never put two words together. Hearing screening tests and an EEG are normal.
Which one of the following is true regarding this patient’s disorder?
Autism is a pervasive condition affecting 7 out of 10,000 persons. Defined behaviorally as a syndrome consisting of abnormal development of social skills, sensorimotor deficits, and limitations in the use of interactive language, it is characterized by variable development, resulting in good skills in some areas and poor skills in others. No single cause has been linked to the development of autism. Studies have failed to show an association between any vaccine and the disorder. To date, no biologic markers are available to aid in the identification of patients with autism. Successful programs in the treatment of autism include behavioral modification strategies as well as programs emphasizing the development of social communication and early, active, and consistent family participation.
A mother brings to you her 5-year-old boy for short stature. Both parents have a history of short stature in childhood, but they are now of normal height. Features that qualify as main criteria for the diagnosis of constitutional growth delay include all of the following, except:
Correct Answer E:
This condition describes children who are small for their ages but who are growing at a normal rate. They usually have a delayed "bone age," which means that their skeletal maturation is younger than their age in years. (A child's bone age is measured by taking an X-ray of a child's hand and wrist and comparing it to standard X-ray findings seen in children of the same age.)
These children don't have any signs or symptoms of diseases that affect growth. They tend to reach puberty later than their peers do, with delay in the onset of sexual development and the pubertal growth spurt. But because they continue to grow until an older age, they tend to catch up to their peers when they reach adult height. One or both parents or other close relatives of these children often experienced a similar "late-bloomer" growth pattern.
Which of the following statements about a child with short stature is correct?
Correct Answer A:
Children with constitutional growth delay (CGD), the most common cause of short stature and pubertal delay, typically have retarded linear growth within the first 3 years of life. In this variant of normal growth, linear growth velocity and weight gain slows beginning as young as age 3-6 months, resulting in downward crossing of growth percentiles, which often continues until age 2-3 years. At that time, growth resumes at a normal rate, and these children grow either along the lower growth percentiles or beneath the curve but parallel to it for the remainder of the prepubertal years.
CGD is a global delay in development that affects every organ system. Delays in growth and sexual development are quantified by skeletal age, which is determined from bone age radiographic studies of the left hand and wrist. Growth and development are appropriate for an individual's biologic age (skeletal age) rather than for their chronologic age. Timing and tempo of growth and development are delayed in accordance with the biologic state of maturity.
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