A 4-year-old presents with a dry scaling rash which recurs intermittently. The family history is positive for asthma, allergy, and eczema.
Treatment of eczema includes which of the following?
Correct Answer D: Moisturizing skin and anti-inflammatory creams are the mainstay of treatment to minimize the drying and itching, which cause the rash.
A. Bathing dries the skin and worsens eczema.
B. Allergy tests correlate poorly with eczema and allergy shots have not been proven in the treatment of eczema.
C. This type of dietary restriction is not helpful and may result in nutritional deficiencies.
E. Oral steroids will clear the rash, but the result is only temporary, and long-term use would risk steroid dependency and immune suppression.
A 7-year-old girl remains hospitalized following surgical removal of a craniopharyngioma. On post-operative day one, she begins to have an increased volume of urine output.
Which of the following would you also anticipate if no action is taken?
Correct Answer E:
All of the above abnormalities are associated with diabetes insipidus (DI), which may occur post-operatively during surgery involving the pituitary stalk. In DI, there is an absence of anti-diuretic hormone from the posterior pituitary gland, and therefore there is an inability to concentrate the urine. Excess free water is lost, causing a dilute high-volume urine output and subsequent hemoconcentration and hypernatremia.
Note: Hemoconcentration - decrease of the fluid content of the blood, with increased concentration of formed elements (increase in both hemoglobin and hematocrit levels).
A 3-year-old child is seen in the emergency department with a recent history of eating a fast food hamburger. The child has bloody diarrhea. Laboratory evaluation reveals:
Management of this patient should include all of the following, except:
The child has what appears to be consistent with hemolytic uremic syndrome due to uncooked or infected beef. The patient is in acute renal failure with an elevated creatinine and potassium. Fluids should be given very cautiously due to the inability of the kidneys to remove excess fluid, leading to pulmonary edema (choice E).
A. Patients with acute renal failure may have multiple EKG abnormalities, including T-wave elevations, loss of P-waves, a widened QRS, and S-T depression.
B. Intensive monitoring is recommended until potassium levels are in a safe range.
C. Calcium gluconate is used to help stabilize the cardiac cell membrane.
D. Insulin and glucose drive potassium into the cells, decreasing serum levels.
A 6-year-old male presents with a 3-week history of leg pain which has increasingly worsened. He has spiking fevers at night, but no rashes. He now awakens at night crying with pain, and his mother is worried that he is fatigued and pale. Blood counts reveal a hemoglobin of 104 g/L, platelet count of 85 x 10^9/L, and WBC is 28 x 10^9/L, with 80% lymphocytes and 10% blast forms. A diagnosis of leukemia is made. Further testing is consistent with L2 morphology and is PAS negative.
Favourable prognostic factors for this disease include all of the following, except:
Correct Answer D:
Acute lymphocytic leukemia (ALL) is the most common form of childhood malignancy. The age of the child is important in evaluating the prognosis in a specific case and is an important factor in choosing the appropriate chemotherapeutic regimen. Children less than 2 years of age or greater than 10 years of age are at much higher risk than children between the ages of 2 and 10. This child’s age of 6 years places him in a favorable prognostic category.
Good prognostic factors:
A 6-year-old boy is seen in the office for a well visit. During the exam, strabismus is noted. You are concerned that he may be at risk for amblyopia. Of the following, which is a true statement concerning amblyopia?
Correct Answer A:
Successful treatment depends on early recognition and referral for occlusion therapy.
B. It is important to monitor the amount of television exposure but this alone is not a root cause of amblyopia.
C. Although recent reports show there may be some small benefit even from late treatment, corrective therapy is most successful prior to 8 years of age.
D. Treatment of amblyopia may include occlusion of the “good eye”, forcing the child to use the “bad” or lazy eye.
E. Some of the known risk factors for amblyopia include strabismus, myopia, muscle weakness, cataract.
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