A 4-year-old female has been discovered to have congenital hearing loss. Her mother is an 18-year-old migrant farm worker who is currently at 8 weeks gestation with her second pregnancy. The mother has been found to have cervical dysplasia on her current Papanicolaou (Pap) smear and has also tested positive for Chlamydia.
The most likely cause of this child’s hearing loss is:
Correct Answer E:
Cytomegalovirus (CMV) is the leading infectious cause of congenital sensorineural deafness and occurs in up to 2.2% of newborns. It is the leading cause of congenital hearing loss. The virus is transmitted by contact with infected blood, urine, or saliva, or by sexual contact. Risk factors for CMV include low socioeconomic status, birth outside North America, first pregnancy prior to age 15, a history of cervical dysplasia, and a history of sexually transmitted diseases. Infection can be primary or a reactivation of a previous infection. While the greatest risk of infection is during the third trimester, those occurring in the first trimester are the most dangerous to the fetus.
Which of the following is not true of congenital cytomegalovirus (CMV) infection?
Correct Answer D:
Hearing loss (choice D) is the most common sequela of congenital CMV infections and should be screened for as soon as the diagnosis is entertained.
A. Acute fulminant CMV infections in the neonate present with multiorgan involvement. CMV affects the liver presenting with elevated direct bilirubin and transaminases. It also causes hepatosplenomegaly with petechiae related to abnormal spleen sequestration and thrombocytopenia.
B. Periventricular calcifications are a classic finding on head ultrasound or CT of the head with congenital CMV infections, but calcifications may occur anywhere in the brain.
C. Mental retardation is common and related to both microcephaly, central nervous system calcifications, and neurologic dysfunction from primary CMV infection.
E. Microcephaly is not specific for congenital CMV infections but may be seen in up to 15% of patients.
A 12-year-old male middle-school wrestler comes to your office complaining of a recurrent painful rash on his arm. There appear to be several dry vesicles.
The most likely diagnosis is which of the following?
Correct Answer C:
The most common infection transmitted person-to-person in wrestlers is herpes gladiatorum (choice C) caused by the herpes simplex virus.
→ Molluscum contagiosum (choice A) causes keratinized plugs.
→ Human papillomavirus (choice B) causes warts.
→ Tinea corporis (choice D) is ringworm, which is manifested by round to oval raised areas with central clearing.
→ Mat burn (choice E) is an abrasion.
A 16-year-old male is brought to your office by his mother for “stomachaches”. On review of systems, he also complains of headaches, occasional bedwetting, and trouble sleeping. His examination is within normal limits. His mother says that he is often in the nurse’s office at school, and doesn’t seem to have any friends. After some questions from you, he admits to being called names and teased at school.
Which one of the following would be most appropriate?
Childhood bullying has potentially serious implications for bullies and their targets. The target children are typically quiet and sensitive, and may be perceived to be weak and different. Children who say they are being bullied must be believed and reassured that they have done the right thing in acknowledging the problem. Parents should be advised to discuss the situation with school personnel.
Bullying is extremely difficult to resolve. Confronting bullies and expecting victims to conform are not successful approaches. The presenting symptoms are not temporary, and in fact can progress to serious issues such as suicide, substance abuse, and victim-to-bully transformation. These are not signs or symptoms of thyroid disease.
The Olweus Bullying Program developed in Norway is a well documented, effective program for reducing bullying among elementary and junior-high-school students by altering social norms and by changing school responses to bullying incidents, including efforts to protect and support victims. Students who have been bullied regularly are most likely to carry weapons to school, be in frequent fights, and eventually be injured.
A 2-year-old white female is brought to your office by her parents, who are concerned about the child’s “flat feet”. On evaluation, the child’s feet are flat with weight-bearing, but with toe standing and with sitting the arch appears.
What would you do next?
Correct Answer A:
Flexible flat feet as described are not pathologic unless painful, which is uncommon. Flexibility of the flat foot is determined by appearance of an arch when the feet are not bearing weight. No treatment is indicated for painless flexible flatfoot. Spontaneous correction is usually expected within 1 year of walking.
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