Pediatrics By Lesson– Gastroenterology+Nephrology+Urology+Orthopedic

A 6-hour-old neonate presents with frothing from the mouth and nose, and difficulty in breathing during eating. On examination he is generally well, and cries without respiratory distress.

Which of the following is the next diagnostic test?

A 6-month-old infant is referred for work up of constipation and abdominal distention. The baby passed his first meconium at the age of 3 days, and has been padding stool every few days after insertion of a rectal thermometer. The imaging results are attached.

Which of the following test will contribute the most to diagnosis?

Blood work was obtained from a generally healthy 6-year-old boy, as per parental request.
Complete blood count was normal, and serum IgA anti TG2 was 100 units (normal value <15 units).
The boy does not have abdominal pain, and passes normal stool once a day. Family history is negative for celiac.

Which of the following describes the recommended approach?

A few hours old newborn presents with bilious vomiting. Pregnancy history includes polyhydramnios. Examination reveals a hypotonic newborn, with a soft and non-distended abdomen. Imaging is attached.

Which of the following is the most probable diagnosis?

A 3-week-old newborn was admitted due to jaundice. Laboratory results include total bilirubin of 12 mg/dl, and direct bilirubin 7.5 mg/dl (normal value <10% of total bilirubin).

Which of the following is the most probable diagnosis?

A 6-weeks-old male infant with a history of normal pregnancy and delivery, presents with vomiting after each meal, restlessness and failure to gain weight over the last few days. A photo of physical examination findings is below

Which of the following is the most appropriate treatment?

A 14-year-old girl with diagnosed asthma presents with episodes of dysphagia to solids for the last 5 months. Gastroscopy image is attached

Which of the following is the most appropriate treatment?

A 13-year-old boy has been hit by a ball during a soccer game, two days prior to his arrival. He has been complaining of epigastric pain since, fever, and vomiting. His examination is positive for significant abdominal epigastric tenderness.

Which of the following tests will most probably promote diagnosis?

A 10-year-old generally healthy girl presents with 6 months of dysphagia to liquids and solids, and episodes of vomiting of undigested food. Weight loss of 2 Kg. Physical examination is normal.

Which of the following is the most appropriate diagnostic test?

A 4-week-old infant is evaluated for projectile vomiting without bile content for the past 24 hours. The infant is in no distress, wants to eat, but vomits right after. He has passed a normal bowel movement about 4 hours prior to admission.
Abdominal ultrasound demonstrates the finding in the photo below.

Which of the following is the definitive treatment for the most likely diagnosis?

A 13-year-old male has been experiencing epigastric pain for several months, which worsens after eating. The symptoms are accompanied by nausea, and his stools are black. He reports medicinal treatment prior to the onset of symptoms.
What is the most likely cause of his condition?

A 2-year-old child is brought to the clinic with swelling around the eyelids. Laboratory tests reveal hypoalbuminemia with normal liver functions. Urine test shows no evidence of proteinuria.

What is the most likely diagnosis?

A 3-month-old male infant, with a history of normal pregnancy and birth, formula-fed, presents with frequent regurgitation, recurrent episodes of restlessness, and intermittently arches his upper body and tilts his head backward. The physical examination, including a neurological assessment, is unremarkable.

Which of the following treatments is suitable for his likely diagnosis?

Which of the following findings is more common in ulcerative colitis than in Crohn’s disease?

A premature neonate was born at week 29, now week 32. Fed with infant formula in amounts suitable for his weight. On examination he is panting and grunting, pale, and his abdomen is swollen and tender, bloody stools.

What is the next step in the management of this case?

A 4-month-old girl, until now has been exclusively breastfed, is brought for examination due to bloody stools. On examination – gaining weight well, vital, soft abdomen, no signs of anal fissure. Stool PCR negative for enteropathogens. The mother indicates that for the past few weeks, she has been fed infant formula.

What is the most recommended treatment in this case?

A 3-year-old boy arrives at the pediatric ER after swallowing a cleaning agent. In a sampling of the agent: pH = 14.

Which of the following is the most recommended as an initial treatment after the cleaning agent ingestion?

An infant aged one year and six months suffers from recurrent, projectile vomiting after each feeding, as well as a lack of weight gain. Abdominal US demonstrates evidence of considerable thickening of the pylorus.

Which finding in the blood tests is highly likely to support the diagnosis?

A 3-week-old breast fed newborn, born at term following a normal pregnancy and delivery presents with a few days of increasing vomiting, failure to gain weight and restlessness.

Below is an abdominal ultrasound

.

Which of the following are the most likely laboratory results?

An 18-months-old toddler presents with two days of fever, mild rhinorrhea, and vomiting that developed on the day of admission. The mother reports alternating episodes of restlessness, pain, apathy, and drowsiness. Examination reveals diffuse abdominal tenderness. Abdominal ultrasound is below.

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

Which of the following is considered a risk factor for perforation in childhood appendicitis?

A 7-months-old infant presents with high fever, watery diarrhea, some containing mucus and some blood, and decreased appetite. He is generally well on examination. Stool culture reveals salmonella.

Which of the following is the most appropriate treatment?

4-months-old generally well infant presents with bloody diarrhea. He has lately changed his diet from breast milk to cow milk base formula.

Which of the following cannot explain this symptom?

A 5-year-old boy is examined due to periumbilical abdominal pain over the last few months. The pain recurs during the day, lasts about 30 minutes, and resolves spontaneously. Physical examination and laboratory test including serum chemistry, blood count, and CRP are normal.

Which of the following is the most appropriate next step in management?

A 7-year-old healthy boy presents with upper abdominal pain over the last 2 months, and dysphagia for the last week. Family history is positive for a maternal uncle with atopic dermatitis which resolved after childhood.

Which of the following is the most likely diagnosis?

A 13-year-old girl is referred for work up due to fatigue, malaise, and elevated liver enzymes over the last 3 months. Examination is positive for a palpable, tender liver, 3cm below the rib cage. Laboratory results include total bilirubin 3.5, direct bilirubin 2, ALT 90, AST 80, GGT 25, ALKP 145, albumin 3.5, total protein 8.

Which of the following will most likely be found in this patient?

A 13-year-old female complaining of asthenia, tremors in her hands and a decline in academic achievements. Referred to an ophthalmologist. The test found the described finding (in the below image).

Which of the following findings would most likely support the diagnosis?

A 4-year-old male was referred for an examination due to rectal bleeding. No abdominal pain or diarrhea, no increase in temperature. No pain when passing stool. In blood count, hemoglobin levels are 8.0 g% (norm above 11.5). Which test would advance his likely diagnosis?

A 4-week-old male is referred to the emergency room due to repeated emesis after eating. Blood tests demonstrate evidence of hypochloremic metabolic alkalosis and indirect hyperbilirubinemia. Which of the following tests would significantly advance the diagnosis?

A 4-year-old male has been suffering for the last week from abdominal pain, loss of appetite, diarrhea, and emesis. On the last day, the parents have noticed periorbital edema. In a blood test, electrolyte levels are within the norm, and albumin levels are 2.6 g/dL (norm above 3.5). Urinalysis with no evidence of protein. What is the standard treatment in this case?

An 8-year-old male is complaining of dysphagia to solids and recurrent complaints of epigastric abdominal pain. The father suffers from atopic dermatitis. Blood tests: high levels of IgE and eosinophilia in blood count. Typical findings in gastroscopy. What is the initial treatment for the probable diagnosis?

A male, 5 years of age, was referred for clarification of repeated episodes of abdominal pain that resolved after about 48 hours of fasting. In the past, he was hospitalized twice for similar complaints. While hospitalized, the amylase values were around 800 (norm: <140). It should be noted that on tests taken between the events, amylase levels were normal.

Which of the following tests would significantly advance the child’s diagnosis?

A 13-month-old male, known to suffer from a progressive neurological disease, was taken in due to episodes of considerable restlessness, multiple incidents of reflux, short pauses in breathing, and recently a lack of weight gain. In the past, there were two hospitalizations due to pneumonia. An endoscopy revealed multiple eosinophils (up to 15 on HPF) in the distal esophagus.

What is the most optimal treatment in this case?

Male, 2 months old, normal development/ Birth weight of 3000 grams, now weighing 4200 grams. Examined due to repeated episodes of non-stop crying, lasting about 3 hours, at a frequency of about 3 days a week. Posseting observed once every few days in a small amount.

What is the reasonable treatment approach for this case?

A 7-year-old boy was referred for investigation: a noticeable slowing of his growth rate in the last two years. Blood tests demonstrated a microcytic anemia that did not improve after the iron therapy attempt. Further investigations including thyroid functions and IGF-1 levels were normal.

What is the most reasonable next step in advancing the diagnosis?

A 3-day-old male, has not had bowel movement yet. Was examined due to a swollen abdomen and vomiting.

The abdominal X-ray demonstrates the following finding:

What is the probable diagnosis for the baby?

Male, two months old, healthy so far, with a normal obstetric history. Referred for examination due to repeated episodes of restlessness, posseting mainly after eating, and short episodes of apnea.

Which of the following is a common clinical characteristic in the probable diagnosis of the baby?

A 13-year-old boy was referred to assessment due to significant slowing down of growth in the past year. He complains of intermittent abdominal pains, rules out diarrhea. Microcytic anemia in blood count. Physical examination – the finding described in the image.

Which of the following tests will support his likely diagnosis?

Attached are growth charts of a 3-year-old toddler, who has been suffering from abdominal pains accompanied by diarrhea, vomiting, poor eating and irritability (agitation episodes). Attached is the growth chart of the toddler before and after initiation of treatment for his likely disease (beginning of intervention is marked by a double arrow on the graph).

What treatment did the toddler probably receive?

Below are the results of a patient’s blood serology tests
Total ANTI-HBc – positive
Anti HBs – positive
HBV DNA – negative
HBsAG – negative
Which of the following definitions most accurately describes his condition?

A 10-year-old boy was hospitalized due to fever with several diarrhea episodes, the diarrhea is with blood. PCR contains evidence for Salmonella enterica (nontyphoidal). The baby is in good general condition, eats well, no signs of dehydration.
What is correct regarding the management of this case?

A 13-year-old girl has been complaining of abdominal pains for several months, which worsen after meals. In her examination, epigastric tenderness. Evidence of microcytic anemia in blood test. Which of the following is the likely pathogen causing her condition?

A 7-year-old boy presents with 2 days of hematuria, several weeks after having an episode of pharyngitis. His examination is significant for hypertension. Laboratory results include low serum C3, proteinuria, and microscopic examination of the urine revealed red blood cell casts.

Which of the following is the most appropriate treatment?

A 3-year-old boy presents with facial and limb edema. Urinalysis reveals significant proteinuria and blood work results are presented in the table.

Which of the following is a possible complicate his most likely disease?

A 15-year-old boy presents with a few months of deteriorating hearing. Hearing tests reveal bilateral sensoneuronal deficit.
The boy reports recurrent episodes of hematuria, and a maternal uncle with similar symptoms.
Which of the following is the most likely diagnosis?

A 7-year-old boy presents with hematuria, hypertension, and edema of the lower extremities. Urinalysis shows red

blood cells, proteinuria. Labs – mild normocytic anemia, low levels of C3.

Which of the following is the most appropriate treatment?

A 12-year-old girl presents with hypoalbuminemia, edema of the lower extremities, and elevated cholesterol

Which of the following is the most common etiology?

A 4-year-old male presents with a week-long history of fever and bloody diarrhea. Over the past day, he has become pale, weak, and lethargic. Laboratory tests reveal a clinical picture of acute kidney injury, anemia, and thrombocytopenia.

Which type of anemia is most consistent with his likely diagnosis?

Which of the following situations is an indication to perform a renal biopsy for a diagnosis of Post Streptococcal Glomerulonephritis?

A 7-year-old male, about one month ago completed treatment with steroids for nephrotic syndrome, which had fully resolved. He was hospitalized now due to a recurrent event of generalized edema, protein +3 in urine dipstick, a low blood albumin level, and hyperlipidemia.

What is the most appropriate management at this stage?

As part of routine tests for a healthy 15-year-old boy, protein +2 was found in repeated urine tests. On examination: Normal blood pressure and pulse, BMI in the 90th percentile, the rest of the physical examination is normal. Normal blood count, kidney functions and albumin within the norm.

Which of the following tests would most likely advance the diagnosis?

An 18-month-old baby is evaluated due to a lack of weight gain. He has had several past episodes of dehydration that required fluid infusion. Not taking any medications. The blood test he had is described in the table:

Considering the findings of the tests, which finding will strengthen the decision regarding the child’s diagnosis?

6-year-old boy presents with hematuria, low urine output, and hypertension.

C3 levels are low, and C4 levels are normal.

Which of the following is the most likely diagnosis?

A 2-months-old infant with failure to thrive is brought for a developmental assessment. Pregnancy was positive for polyhydramnios, and the parents are first degree cousins. Blood pressure is normal, and blood work is positive for metabolic alkalosis, hypokalemia, and hypochloremia. Urine analysis reveals hypercalciuria.

Which of the following is the most likely diagnosis?

Which of the following is an indication to begin dialysis in a 5-year-old boy with chronic renal failure?

A 16-year-old boy is referred for work-up of incidental proteinuria. Which of the following supports a diagnosis of orthostatic proteinuria?

Which of the following presents an indication for kidney biopsy in patients with nephrotic syndrome?

A 3-year-old presents with low grade-febrile fever, loss of appetite, abdominal pain, hypertension, and a suspected right abdominal mass. Blood work reveals thrombocytosis and a prolonged PTT.
Which of the following is the most likely diagnosis?

A 4-month-old male, healthy so far, arrives at the ER on a hot day, the parents describe a convulsion at home. On examination – the child is hypotonic. Body temperature 35°C. The parents reported that they gave him a large amount of water for fear of dehydration. What is the likely diagnosis?

Which of the following is the most common cause of chronic renal failure occurring over the age of 5?

A two-year-old female was brought to you for consultation due to the findings presented in the picture below.

What is the most common complication of a condition associated with this finding?

A 5-year-old boy is hospitalized due to a red/purplish rash that has been present for 3 days and does not go away upon pressure. He also has abdominal pains. His blood pressure, blood count, and chemistry are normal, and on urinalysis, there is evidence of 30 red blood cells in the microscope field of view. A week after the start of his complaints, all of them were resolved.

What will monitoring of this patient include according to his probable diagnosis?

A 4-year-old female, for several days, has been complaining of swelling around the eyes, and swelling in the sacrum area and the lower limbs. Laboratory tests – normal kidney functions, hypoalbuminemia (albumin <1.5) and hypercholesterolemia. A urine test demonstrated an increased protein-to-creatinine ratio.

What complication is typically observed in the diagnosis from which the girl is most likely suffering?

A one-year-old toddler with significant failure to thrive, suffers from recurring dehydration events characterized by a laboratory picture of metabolic alkalosis, hypochloremia and hypokalemia. What is the likely diagnosis of the toddler?

A 5-year-old girl arrives at the ER due to cola-colored dark urine and edemas in the lower extremities. Microscopic urinalysis shows erythrocyte casts. Lab tests as described in the table:

What is the most likely cause of the child’s condition?

A 4-year-old boy, pallor, weakness and tiredness appeared in the last 24 hours. About a week ago he had a febrile disease and bloody diarrhea. Lab tests as described in the table:

What is the most accurate definition of the anemia which the child has in his present disease?

A 6-year-old boy, normally healthy, was examined due to a rash in the shins and mainly in the area of the ankles and buttocks. The rash does not disappear when pressed and has a purplish color. Two days after the onset of the rash abdominal pain appeared. Blood pressure is normal, blood count is normal, chemistry panel is normal and on urinalysis, there is evidence of 30 red blood cells in the field of vision under the microscope. His complaints were resolved about a week later.

What would be the recommendation for the child at this stage?

A 3-year-old girl presents to the clinic with recurrent urinary tract infections and a single episode of pyelonephritis.
On voiding cystourethrogram (VCUG) the finding below is demonstrated.

Which of the following is the most appropriate treatment?

A 3-year-old boy presents with polydipsia and polyurea, with no glucosuria.
Blood osmolarity is increased and urine osmolarity is decreased.
Which of the following is the most likely diagnosis?

A 10-year-old girl has suffered a head injury in a motor vehicle accident 24 hours ago. Over the last 20 hours she has been experiencing polydipsia and polyuria. Laboratory results-

Which of the following is the most appropriate treatment of her most likely disease?

An 8-month-old female is hospitalized due to a urinary tract infection. At the age of 6 months, she was hospitalized due to pyelonephritis and was treated with antibiotics according to standard practice with a good response. After hospitalization, she underwent an ultrasound of the kidneys and urinary tract with no evidence of pathological findings.

What would be your recommendation for this baby at the end of the current treatment?

When examining a few-day-old newborn relaxed, the following finding (see image) is observed.

What is the standard treatment in this case?

A 5-year-old boy, generally healthy, arrived due to complaints of nocturnal enuresis, has never been weaned off diapers at nighttime. The mother reports that he tends to talk and walk in his sleep. Normal physical examination.

In addition to the urine osmolarity test, what other tests are recommended in order to advance the diagnosis?