Pediatrics By Lesson– Cardio+ENT+Metabolic+ophthalmology+Vaccination

A 16-year-old boy presents with 2 weeks of chest pain, lateral to the lower sternal border. The pain is worsened by movement and position changing, and not accompanied by shortness of breath or affected by strain.

Which of the following is a possible treatment for his condition?

A 3-month-old baby presents with severe restlessness with no additional symptoms. Examination reveals an afebrile infant, with normal oxygen saturation in room air, heart rate of 240/min, blood pressure of 80/40. The rest of the physical examination is normal.

Which of the following will contribute the most to diagnosis?

A 2-hour-old newborn is evaluated for central cyanosis. Oxygen saturation in room air is 60%, heart rate is 160 per minute, breath sounds are good and equal, and there is no murmur. Hyperoxia test revealed low PaO2.

Which of the following describes the next step in this newborn’s care?

A 12-year-old boy presents with fatigue and malaise that have recently become worse, followed by dyspnea.

His mother reports episodes of cyanosis following light physical activity. He has been followed up by a cardiologist due to a VSD until 2 years of age, and the follow up was discontinued since they moved. Chest X-ray demonstrates an enlarged heart

silhouette, and enlargement of the pulmonary artery.

Which of the following is the most appropriate treatment for this patient?

A 3-months-old infant presents with stridor, episodes of spitting up and vomiting, with arching of the back and neck. The mother reports the stridor is improved while arching. Thickening of the feeds was unhelpful.

Which of the following tests is most appropriate for the most likely diagnosis?

A 6-year-old girl with a history of Fontan operation presents with episodes of tachycardia and separate episodes of presyncope with dizziness and weakness.

Which of the following is the most appropriate treatment?

Which of the following is an absolute contraindication for physical activity?

An 18-month-old infant presents with fever, malaise, dyspnea, tachycardia, and hypotension.
Examination reveals a heart murmur with gallop heart rate. Echocardiography demonstrates
reduced ventricular function, dilated ventricles, and mitral insufficiency. Blood work includes increased troponin and PBNP levels.
Which of the following is the most common etiology?

A 13-year-old boy had a loss of consciousness episode during a football game.
Workup included the attached ECG strip, after which beta blocker treatment was initiated.

A few months later he has had an additional episode of loss of consciousness.
Which of the following is the most appropriate treatment?

A 2-day-old newborn in the nursery presents with cyanosis, room air oxygen saturation of 70%, and auscultation reveals a single second heart sound (S2), with no murmurs.

Which of the following is the most likely diagnosis?

A 4-year-old male presents two weeks after a viral upper respiratory tract infection. On examination, he was afebrile, respiratory rate of 40 breaths/min, an irregular heartbeat with gallop rhythm, systolic murmur (2/6) at the heart apex, and hepatomegaly in the abdominal examination. Apart from that, the examination was unremarkable.
What is the most likely diagnosis?

In which of the following diagnoses can the phenomenon presented in the picture be observed?

A 16-year-old male has blood pressure of 160/70 in the right arm. The following measurements were obtained from a cardiac catheterization:

Based on these data, what is the structural cardiac defect in this teenager?

A 13-year-old boy is hospitalized due to prolonged fever, weakness, and myalgia. The physical examination reveals a new murmur on auscultation to the heart and an enlarged spleen is palpated. Later, lesions appeared as seen in the attached images. Blood cultures positive.

What is the common pathogen that causes this condition?

A 15-year-old girl suffering from Turner syndrome with bicuspid aortic valve complains of pain after exertion in both legs. Chest x-ray and ECG demonstrate signs consistent with left ventricular hypertrophy. Femoral pulse is not palpable.
Which of the following signs would most likely support the etiology for her condition?

During the examination of a one-month-old infant, a murmur was heard. Blood oxygen saturation at rest is around 80% in room air, without improvement after oxygen administration.

Which of the following etiologies could explain his condition?

An 8-year-old boy arrives at the emergency department due to restlessness, hyperventilation, and loss of appetite which appeared several hours before his admission. On examination: pulse 280 per minute, temperature 37.3°C, BP 60/35 mmHg, 70 breaths per minute.

What is the most recommended treatment in this case?

A 5-day-old male, referred to the emergency room due to a seizure that stopped after the administration of Dormicum (Midazolam). On examination – no fever, alert, normotensive fontanel, cleft palate and small ears, systolic murmur on auscultation to the heart. On initial laboratory tests ionized calcium 0.6 (low). An echocardiogram demonstrated a Truncus Arteriosus type defect. Which test is highly likely to identify the underlying genetic disorder in the baby’s diagnosis?

A 7-year-old boy, normally healthy, underwent an ECG as part of screenings for a football team (attached).

What is the type of arrhythmia?

A 15-year-old boy is referred for evaluation due to a drop in his academic achievements and new complaints of anxiety and depression. Blood tests demonstrate increased levels of liver enzymes and hemolytic anemia. An eye examination revealed the attached finding (in the image).

What blood test finding is highly likely to support the diagnosis?

In which of the following conditions administration of 100% oxygen during an hyperoxic test will increase the saturation from 72% to 79%?

A 7-year-old deaf boy presents with several episodes of syncope during exertion. ECG is below.

Which of the following is the most appropriate treatment?

A term newborn exhibits profound cyanosis shortly after birth. Echocardiograph reveals the aorta attached to the right ventricle, and the pulmonary artery to the left ventricle.

Which of the following is the most appropriate initial treatment?

A 4-months-old baby presents with cyanosis and shortness of breath, alleviated in the knee to chest position. Chest X-ray recalls a boot shape heart silhouette (“Coeur en sabot”). ECG reveals a right axis and signs of right ventricular hypertrophy.

Which of the flowing is the most likely diagnosis?

A 1-year-old boy presents with weakness and apathy for an hour. On admission he is pale, grunting, and with a weak cry. His heart rate is 245 bpm, saturation is 97% with an oxygen mask. Capillary fill is 7 seconds and blood pressure is unmeasurable on several attempts.
A picture from the monitor is attached.

Which of the following is the next step in managing this patient?

A 15-year-old boy complains of pain and weakness in his legs after running. On cardiac examination, a systolic murmur is auscultated, radiating to the back, and weak femoral pulses are palpated. What additional symptom will most likely accompany his illness?

A 16-year-old male referred to the ER due to increase in temperature, cough, stabbing chest pain that are exacerbated during inspirium and relieved by sitting. On auscultation, distant heart sounds and pericardial friction rub heard. X-ray image below.

What is most likely to be found in an ECG in this case?

A 15-year-old boy complains of pain and weakness in his legs after running. During the cardiac examination, a short systolic murmur is heard at the border of the middle sternum and between the shoulder blades, and the chest X-ray demonstrates NOTCHING at the lower border of the ribs.

In accordance with these findings, what is the most likely finding that will accompany his complaints?

Male, 8 months of age, referred to the ER due to restlessness, tachypnea, and a decrease in appetite that appeared around a day before his admission. Upon examination, pulse of 280 per minute, temperature 37.3°C, BP 60/35 mmHg, 70 breaths per minute. An attempt to open a vein and provide an intraosseous infusion failed.

The following finding was observed on the monitor

What is the most appropriate treatment for his condition?

Male, 4 years of age, suffering from dyspnea after mild exertion that improves after squatting. Which of the following diagnoses is most likely in this case?

As part of a routine examination, in cardiac auscultation of a 4-month-old boy, a gentle 2/6 systolic murmur was heard, and widely split and fixed S2. Normal oxygen saturation. A chest X-ray demonstrated enlargement of the right atrium and ventricle.

What is the likely etiology?

An ECG was performed on a newborn with the attached results.

What anamnestic detail can explain the findings seen on the ECG?

A two-month-old male presented in the ER following a fever and a cough. On examination, he has a cleft palate. A chest x-ray demonstrated opacity at the base of the left lung and the absence of the thymus. Which of the following laboratory tests would advance the presumed diagnosis?

Which of the following patients is suspected of being immunodeficient?

The 4-year-old child in the picture is developmentally delayed. Examination reveals an early systolic ejection click, and he has

hypercalcemia, failure to thrive, and hypothyroidism.

Which of the following is the boys’ most probable heart defect?

A 5-months-old infant presents with respiratory distress especially during feeds, stridor, and dysphagia with arching of the back during swallowing. Echocardiography reveals right aortic arch.

Which of the following is the most appropriate treatment?

A 12-year-old boy who swims on the school’s team, complains of pain in his right ear for the last 2 days.
Examination reveals significant tenderness when the otoscope is inserted to the ear canal,
thick yellowish discharge, and an edematous and sensitive auditory canal.
Which of the following supports the most likely diagnosis?

A 12-year-old male, participates in the school swimming team, complains of pain in the right ear. On examination, there is a thick, rubbery, yellowish discharge, along with edema and tenderness of the ear canal.
Which of the following pieces of information best supports the diagnosis?

A 6-year-old male, healthy and vaccinated, presents to the clinic with a fever and sore throat. On physical examination, the following was found, as shown in the image.

What is the recommended management of the case?

An 18-month-old baby girl arrives at the pediatric ER due to a fever for 3 days accompanied by restlessness. Physical examination demonstrates the findings shown in the attached images.

Which of the following steps must be included in case management?

A newborn child suffers from respiratory distress that began immediately after birth.
An attempt to insert a nasogastric tube was unsuccessful.

Which of the following statements is correct regarding the presumed diagnosis?

Male, 13 years of age, arrives for an examination by a doctor due to earache that started two days ago, without a fever. He is a swimmer in the local city team. On the ear examination, there is noticeable tenderness in the movement of the auricle; the appearance of the auditory canal is as described in the attached image.

What is the recommended primary treatment in this case?

Which of the following pathogens is associated with congenital sensorineural hearing loss (congenital SNHL)?

A few-hour-old newborn presents with cyanosis and respiratory distress since birth, which improves while crying. An attempt to pass a nasogastric tube failed.
Which of the following is the most likely diagnosis?

A 30-month-old, healthy and vaccinated toddler, presents with high fever, torticollis, dysphagia and drooling. Other vital signs are normal.

Laboratory results reveal elevated inflammatory markers. Cervical CT is attached.

Which of the following is the most appropriate treatment?

Which of the following pathogens is associated with congenital sensoneuronal hearing loss?

A 2-year-old boy presents with speech difficulties. His history is positive for multiple ear infections.
Examination now reveals bilateral turbid ear drums, and middle ear effusion.
The boy is well, calm, and afebrile.

Which of the following is the most appropriate next step?

Maternal blood work of a term infant, born via a spontaneous vaginal delivery with a birth weight of 3100gr,
are presented in the table:

Which of the following is the most appropriate recommendation?

A 7-year-old male, partially vaccinated, was brought to the ER due to dysphagia, afebrile, odynophagia, and dysphonia. On examination, significant bilateral neck swelling and the findings are presented in the image (below) in the mouth and pharynx.

Which of the following vaccines could have prevented this disease?

A 2-year-old boy, of Jewish Ashkenazi descent, had developed well until 5 months of age, and then a developmental regression occurs, with an exaggerated startle reflex. In time deafness and blindness developed, as well as an inability to speak or walk. Examination reveals marked hypotonia, macrocephaly, and the retinal finding in the attached picture.

Which of the following is the most likely diagnosis?

A 1-month-old infant female is referred for workup of significant hypotonia, respiratory distress, and feeding difficulties. Laboratory results are positive for elevated CPK, and an echocardiogram reveals hypertrophic cardiomyopathy.

Which of the following is the most appropriate treatment for this disease?

A 6-year-old boy is admitted due to skin ecchymosis, anemia, thrombocytopenia, hepatosplenomegaly, and bone pain.

Which of the following is the most appropriate treatment ?

A 2-week-old male presents to the ER with multiple episodes of vomiting, poor appetite, and weight loss since birth. On examination, he is pale, drowsy, and has hepatomegaly on abdominal palpation. Laboratory results show hypoglycemia, and the urine test is negative for ketones.
What is the most likely diagnosis?

An 8-year-old male with newly diagnosed adrenal insufficiency has been treated with medications for the past few months. In the past year, there has been a decline in his academic performance, including concentration difficulties and behavioral issues. As part of an evaluation for new-onset seizures, a brain MRI was performed, revealing widespread lesions in the white matter.

Which laboratory test is likely assist in determining the child’s diagnosis?

A 1-week-old male, born at home. Presents to the clinic with vomiting, hypotonia, generalized weakness, and refusal to eat since 2 days old. In the past day, he has shown poor suckling and reduced responsiveness to stimuli. The parents report his urine has a sweet odor.

Which test is likely to advance the diagnosis?

A 2-months-old infant has been somnolent for the last few hours, and has difficulty feeding. Examination reveals tachycardia, mild tremor of the legs, and hepatomegaly 3 cm below the rib cage. Serum glucose levels are 35 mg/dl, urine is positive for ketones, a serum lactate is increased.

Which of the following is the most likely diagnosis?

An 8-year-old male, for several months he has been treated with medications due to a new diagnosis of adrenal insufficiency. In the last year, his academic achievements have declined, and he has difficulty concentrating and has behavioral disorders. As part of an investigation after his first seizure, a brain MRI was performed, which demonstrated widespread lesions in the white matter. Which of the following laboratory tests would advance the diagnosis?

A 2-month-old male, his parents are first cousins, born weighing 2.8 kg, currently weighs 3.2 kg. Examined due to difficulty eating and breathing difficulties.
His examination demonstrated significant hypotonia.
In imaging, the following finding was demonstrated.

What is the treatment?

Male, 12 years of age, recently diagnosed with primary adrenal insufficiency and treated with a maintenance dose of steroids. Now, the school teacher reports a reduction in study achievements and behavioral changes and suspects Attention Deficit and Hyperactivity Disorder.

What is the next step in his assessment?

Female, 8 days old, was referred to the ER due to sleepiness and loss of appetite that has worsened in the past day.

Normal blood count. Ammonia level is 300 micromol/L (high), blood glucose – 30 mg/dL. Gases:

ph-7.05

HCO3- 11

Na- 135

K- 5

Cl- 98

What is the likely diagnosis?

A two-day-old baby is examined for poor appetite, sleepiness and apathy. Tests as described in the table. Urinalysis demonstrated elevated uric acid.

What is the most likely diagnosis?

An 11-year-old boy (image attached), known developmental delay. Physical examination: systolic heart murmur, hepatosplenomegaly, joint rigidity and short stature. Brain MRI found mild hydrocephalus. No corneal opacity.

There are several boys with a similar condition in the family. What is the most likely diagnosis?

A 16-year-old male complains of chronic tiredness and bone pains for about a year. Hepatosplenomegaly in physical examination. Normal eye examination.
Lab tests: normocytic anemia and thrombocytopenia.
X-rays of the distal femur as described in the image.

What is the most likely diagnosis?

A term 3600 g newborn is diagnosed with indirect hyperbilirubinemia at the age of 24 hours. Labs – total
bilirubin 25 mg/dl, direct bilirubin 1.3 mg/dl, no evidence of hemolysis. He is treated with phenobarbital
due to insufficient response to phototherapy and bilirubin levels decrease substantially.
Which of the following is the most likely diagnosis?

A 6-year-old male, usually healthy, under follow-up due to lack of eye contact in conversations, lack of social smiling, rarely speaking, poor language, rarely plays with his peers and prefers to watch screens. He has been referred due to sleep disorders.

Which of the following recommendations is the most likely in this situation?

A 7-year-old girl presents with the ocular finding in the attached picture.

She has no fever, blurred vision, or swelling around the eye.

Denies entry of foreign body or use of creams / makeup

Which of the following is the most recommended initial treatment?