Pediatrics By Lesson– Hematology+Oncology+Neurology

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?

Complete blood count and blood smear of a 2.5-year-old toddler demonstrates the findings in the picture and table

Which of the following is the most likely cause of his disease?

A 4-year-old boy presents with petechia of the trunk and limbs. Examination does not reveal gingival bleeding, hepatosplenomegaly, or lymphadenopathy. Complete blood count is normal except for platelets of 25,000/mm3 (normal values 150-450,000). Peripheral blood smear revealed no blast cells.

Which of the following is the most recommended approach?

A 3-year-old male presents with fever, diarrhea, and vomiting for 5 days, accompanied by malaise

and abdominal pain. Examination reveals hypertension. Blood count and smear are below

Which of the following is the most appropriate treatment for the boy’s most

likely diagnosis?

A 1-year-old male is referred for anemia workup. Examination reveals pallor

of the skin and conjunctivas. Blood smear and laboratory results are below

Which of the following is the most likely diagnosis?

A 4-year-old boy with a history of many hospitalizations has a blood smear
which reveals Howell-Jolly bodies and the finding in the attached picture.

He is now admitted with suspected bacterial sepsis.
Which of the following is the most likely causative of his sepsis?

A 1-month-old infant is referred to the ER due to prolonged seizure. History is positive for significant
bleeding after the umbilical cord detachment. Normal pregnancy and normal home delivery. He is fed
with breast milk and formula and gains weight appropriately. Glucose is 60 mg/dl on glucometer.
Which of the following is the most appropriate treatment?

A 5-year-old male presents with findings as seen in the attached image. On examination, he is in good general condition, without active bleeding, hepatosplenomegaly, or lymphadenopathy. No fever or pains. His parents deny any history of epistaxis or oral bleeding. On the blood count: platelet level of 25,000, with all other blood counts normal. Peripheral blood smear does not show blasts.

What is the next step in treating this child?

A 15-month-old male underwent a routine blood count showing the following:

On examination, there is no dysmorphism or hepatosplenomegaly.
A peripheral blood smear was taken, results attached:

Which of the following scenarios could explain his condition?

A 10-year-old male presents to the clinic with fatigue, pallor, and recurrent epistaxis and gingival bleeding. In the background, there is a history of ongoing epiphora, recurrent pneumonia, and short stature. On examination, he is missing eyelashes, and the findings shown in the image are observed:
 
Results of the laboratory tests:

Which of the following is a characteristic complication of the child’s illness?

A six-month-old male is brought for examination due to paleness. According to the mother, he receives iron supplement therapy according to standard practice. The blood count test is as described in the table:

The measured values were demonstrated on 2 consecutive tests. What is the most likely diagnosis?

A 3-year-old male (as described in the image), has short stature for his age, referred for investigation due to incidental blood tests described in the table:

Several “café-au-lait” spots are observed on physical examination.

Which of the following findings are highly likely to be related to the child’s disease?

Below is the blood count of a healthy 1-year-old boy:

Which of the following is the most likely cause of anemia?

A 17-year-old male, vegan since birth, presents with chronic fatigue. Blood count reveals anemia with high MCV. Blood smear is below.

Which of the following symptoms is most likely in this boy?

A 1-year-old is referred for work up due to failure to thrive. History is positive for a few episods of infection, and multiple stools with steatorrhea. Laboratory tests are presented in the table.

Which of the following is the most appropriate treatment?

A 1.2-year-old female, vaccinated according to plan, was hospitalized due to fever and inability to move her right limb. Due to a suspected infectious process, began antibiotic treatment. Hemoglobin 7.2 g/dL in blood count on admission. Therefore, a direct blood smear was performed as described in the image.

Which of the following treatments would most likely be a part of the girl’s treatment?

As part of jaundice follow-up in a 9-week-old baby, a hemoglobin value of 10.5 g/dL is obtained. The mother is a vegetarian, the baby is breastfed and gaining weight, the physical examination is normal.

What is the most reasonable reason for this hemoglobin value?

For which of the following diseases bone marrow transplant is the standard treatment?

Male, 8 months of age, currently diagnosed as suffering from anemia. His examination demonstrated evidence of microcephaly and microgenia, glaucoma, and a ventricular septal defect (VSD). Blood tests demonstrated the following results:

What is the reasonable treatment for the child’s condition?

A 9-year-old girl visits the doctor due to pallor, tiredness and glossitis. In anamnesis, she is on a vegetarian diet with limited food types. Blood tests: Hgb 9 mg/dL (normal over 11), MCV 115 fL (normal 80-90) Which nutritional component is most likely to be deficient in her diet?

A 7-year-old girl with iron deficit anemia started oral iron treatment with iron sulfate at a therapeutic dosage. 4 days later repeat blood tests were performed. What is the earliest lab sign that can be expected and indicate treatment efficacy?

A one year and two month-old girl, vaccinated according to age, hospitalized due to fever, dyspnea, reduced saturation and opacity in the chest X-ray.
Blood smear describes the findings in the image:

Blood tests: WBC 3 12,500/mm³ Neutrophils- 77% Hb- 6.5 g/dL Platelets 3 200,000/mm³
Which of the following combination of drugs is a part of the standard of care for girl’s acute diagnosis?

A 5-year-old boy visits the doctor due to fever for the past two weeks, tiredness, weakness and bleeding from gums. Examination: pale, cervical lymph nodes are enlarged, enlarged spleen and sensitivity in the long bones. Blood tests as described in the table Blood smear: normal and no blasts.

Which of the following tests will most likely promote you concerning the child’s disease?

A 4-year-old girl, healthy up until now, presented due to tiredness, pallor and bleeding from gums. In anamnesis: viral disease two weeks ago. Examination:
pale, fast pulse, spleen not palpated. Blood tests, as described in the table:

What is the most likely diagnosis?

A one-month-old male infant is brought to the emergency room due to a focal seizure. The pregnancy was normal, home birth. The baby is breastfed and gaining weight well. In the anamnesis: after circumcision, he was hospitalized for one day for observation due to bleeding. There is no evidence of diseases in the family.

What is the most likely cause of the baby’s illness?

A 13-year-old girl presents with a few months of intermittent fever, night sweats, weight loss, and night time itching. Examination is significant for hepatosplenomegaly and an enlarged right supraclavicular lymph node.

Which of the following is the first next diagnostic test?

A 2-year-old male presents with the finding in the photo below. Abdominal ultrasound reveals an abdominal mass.

Which of the following is the most typical for the toddler’s most likely diagnosis?

An 18-month-old infant is evaluated due to low-grade fever, vomiting, decreased appetite,

and weight loss. On examination – hepatomegaly.

Labs – normal liver function tests, anemia, and thrombocytosis.

Below is a photo of liver imaging.

Which of the following test will most likely advance the diagnosis?

A 2-month-old infant is examined due to an abnormal red reflex test at birth. The parents report he is developing well. His examination is attached in the photo

Which of the following may explain his finding?

A 14-year-old female presents with a two-month history of a cervical lymph node enlargement. She reports fatigue, slight weight loss, and night sweats. Treatment with antibiotics for 10 days did not improve the condition. On the physical examination, the lymph node is enlarged, hard, non-tender, and non-mobile. There is no redness or localized warmth. Laboratory findings include normal hemoglobin levels, mild leukocytosis, and elevated LDH levels.

What is the recommended next step in the investigation?

A 14-year-old boy, complaining of pain in his left knee for 3 weeks after an injury. X-ray demonstrated the attached finding.

What is the most likely diagnosis?

The toddler in the photo below has been born at term. He was diagnosed with VSD shortly after birth, and the defect was surgically treated. In addition, he has been diagnosed with congenital hypothyroidism by newborn screening , and is treated with L-thyroxin.

Which of the following has increased incidence in this boy’s condition?

A 7-months-old boy presents with restlessness, alternating fevers, and failure to gain weight over the last month. Examination is positive for an abdominal mass, and the finding in the photo below 

Which of the following is the most likely diagnosis?

A 12-year-old presents with 3 weeks of abdominal pain, anorexia and weight loss of 2 kilos, accompanied by malaise and weakness for the last 2 months, with no additional gastrointestinal complaints. Physical examination is normal, laboratory results are presented in the table. Ultrasound revealed an unclear pelvic mass.

What is the immediate next step in managing this case?

A 2.2-year-old male was examined due to the finding described in the image (image no. 1).

As part of the investigation, a bone marrow smear examination was performed (image no. 2).

What is the combination of symptoms and signs that is likely to be found in the continued investigation of this case? (Please indicate the most accurate response.)

A 4-year-old boy is examined due to headaches for several weeks and vomiting in the mornings. Examination: imbalance, nystagmus and ataxia. Brain MRI shows a cystic finding in the cerebellum with a solid component showing enhancement after contrast agent injection.

What is the most likely diagnosis?

A 3-year-old boy arrives at the ER due to fever, tiredness and the finding seen in the picture, which appears in several places over his body. Physical examination: enlarged liver and spleen, pallor.
Blood test, as described in the table:

Lymphoblasts are seen in a blood smear What is the next step in the investigation of the case?

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 17-year-old girl has been having migraines for the last 2 years, and has been treated with acamol (acetaminophen). Lately she reports a significant increase in frequency of the migraines, with no change in their character. Neurological examination is normal.

Which of the following is the most recommended prophylactic drug at this point?

A 4-month-old infant presents with infantile spasm episodes, worsening over the last 4 weeks. Findings in physical examination are shown in the picture.

Which of the following is the most appropriate first line anti-epileptic drug?

A 6-year-old girl presents with a week of lower limbs weakness, numbness up to the navel level, with trouble in urinating and defecating. These complaints followed a febrile illness. CSF examination revealed a negative gram stain, and a slightly increased protein level.

Which of the following is the most appropriate treatment?

A 7-year-old girl’s parents and teachers report recent episodes of unawareness and stillness, occurring a few times a day and lasting 5-10 seconds. EEG is below.

Which of the following is the most likely diagnosis?

A 12-year-old boy presents with the physical findings in the photos below

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

A 10-year-old’s parents complain he daydreams and they have to repeat every order several times.

They report he is unorganized, forgets to do his homework, and has difficulties in school. His physical examination is normal.

Awake and sleep EEG are normal.

Which of the following is the next diagnostic test?

A 3-year-old boy presents with a first episode of a febrile seizure.

Which of the following is a criterion for defining the seizure as a complex febrile seizure?

A 4-year-old boy presents with proximal weakness over the last months. Examination is positive for calf
muscle hypertrophy and laboratory tests reveal elevated CPK.
Which of the following is the cardiac manifestation of the child’s most likely disease?

A 3-year-old girl is diagnosed with neurofibromas, skin hyperpigmented lesions, scoliosis, iris tumors,
and learning disabilities. Her brother who is 6-month-old has skin hyperpigmented lesions (more than 5) without any other signs. Genetic testing is positive for neurofibromatosis type 1 with the same NF1 gene mutation in both of them.
Which genetic principle is demonstrated is this case?

Which of the following is an indication for brain imaging for headaches in children?

A 10-year-old male presents with progressive muscle weakness that started about 5 days ago in the legs and continued to rise in the direction of the hands and the face. Around two weeks ago, he suffered from diarrhea, and since then has been complaining of increasing fatigue. The weakness progresses fast, and he struggles to hold objects in his hand and lift his legs from the bed. He is also complaining of dyspnea. On the examination, symmetrical weakness of the limbs, and weakened reflexes.

What is the most appropriate treatment in this case?

A 5-year-old female presents with a complaint of loss of visual acuity. On examination, findings seen on the attached image are noted. The child’s mother reports having similar findings.

What is the next step to be taken?

A 6-year-old female had fever and myalgia one week ago. She now presents with decreased level of consciousness, limb weakness, and gait instability. A brain MRI shows findings presented in the attached image.

What is the recommended treatment at this stage?

A 4-month-old female presents to the emergency department following her first generalized seizure lasting approximately one minute. She has no prior neurological issues or family history of seizures. On examination of the child: her temperature is 39°C, she is fully conscious with a normotensive fontanelle, and the remainder of her examination is unremarkable.

What is the most appropriate next step in management?

A 3-year-old male toddler, normally healthy, is examined in the emergency room due to a generalized tonic-clonic seizure that lasted about ten minutes. During his examination, a temperature of 40°C was measured. The parents describe a similar incident approximately six months ago.

How can the seizure be defined?

At a summer camp in South Israel, 20 children developed watery diarrhea requiring medical treatment and fluid administration. Roast chicken was served in the camp dining room the day before. Three weeks later, one of the children was hospitalized with weakness in the legs. On neurological examination in the ER, patellar reflexes were absent.

Which of the following is the most likely cause of the outbreak?

A 6-year-old boy is getting up from the floor as seen in the images. Blood test demonstrates CPK levels of 25,000 IU/L
(normal below 160).

What is the most likely diagnosis?

A 10-year-old boy complains of weakness and back pain. On his examination – weakness in the lower extremities. After a few days, weakness also appeared in the upper limbs. On the physical examination, reflexes cannot be produced. The parents mention that about two weeks before the onset of the complaints, he suffered from diarrhea. A lumbar puncture was performed.

Which finding in the cerebrospinal fluid (CSF) will support the presumed diagnosis with the highest probability?

A 10-year-old boy presents with the findings in the image below. In addition, several Lisch nodules are observed in the eye examination.

Which of the following findings may most likely accompany his illness?

A 6-year-old boy presents with multiple short episodes of staring and detachment from his surrounding occurring at all hours of the day for the last few weeks. Hyperventilation worsens the episodes. EEG demonstrates general bursts of slow spikes and waves pattern.

Which of the following describes the appropriate treatment for this condition?

A 13-year-old complains of double vision and has been seen holding his eye open with his fingers to prevent it from intermittently closing. The symptoms are worse in the evenings. Recently he has been exhibiting difficulties in swallowing food.

Which of the following test will promote the diagnosis?

A 10-year-old boy’s examination reveals the findings in the photos

Which of the following is a complication of the boy’s disease?

Which of the following is characteristic of Horner’s syndrome?

A 6-months-old generally well infant presents with 2 weeks of episodes of “arm and head stretching”, more often around falling asleep and arousing. The episodes occur more often over the last week, and the parents report he stopped smiling and is less alert lately. EEG is attached.

Which of the following is the most likely diagnosis?

A 16-year-old boy presents with 4 months of leg pain, appearing mostly in the evenings before he goes to sleep, and at rest. The pain is relieved by moving the legs. Additionally, over the last few months his school work has deteriorated due to day time tiredness. Physical examination and laboratory tests are normal.

Which of the following is the most appropriate treatment?

Which of the following is a major risk factor for recurrent febrile seizures?

A 2-months-old baby, with parents who are first degree relatives, presents with weakness upon moving his limbs, and difficulty raising his head when in the prone position. Examination reveals an alert baby, which follows well with his eyes. No reflexes were obtained, there were tongue fasciculations, and the finding in the attached picture.

Which of the following is the most likely diagnosis?

A 15-year-old obese girl presents with afebrile headaches for the last 4 weeks. Ophthalmology reveals blurred borders of the optic disc; brain MRI was normal. Lumbar puncture revealed a high opening pressure.

Which of the following is a common complication of her diagnosis?

A 5-year-old male began walking at the age of 1.8 years; his parents report clumsy gait, difficulty going up and down stairs, and difficulty transitioning from sitting to standing. On physical examination – bilateral calf hypertrophy. In laboratory tests, CPK values around 3000 in several tests. Family history – brother with a similar history.

Which of the following findings is common in the toddler’s diagnosis?

The following finding (image below) is demonstrated in a few-hours-old newborn.

Which of the following actions could have prevented the phenomenon?

A 3-month-old male, hospitalized for investigation of suspected convulsions. On examination – findings are demonstrated in the image (below). Brain imaging (CT) showed subependymal nodules.

Which of the following findings is typical of the probable diagnosis in this case?

In a brain ultrasound (US) of a premature baby born at week 32 weighing 1400 grams, the finding described in the image was observed.

Which of the following complications is common in the context of the presumed diagnosis?

A 4-year-old male, known history of upper respiratory tract diseases and recurrent pneumonia, referred due to ataxic gait that is worsening over time. On examination – findings as described in image.

Which of the following is the most recommended treatment?

A 10-day-old newborn female was born in a normal delivery, with a birth weight of 4.500 kg with the finding described in the image.

What would be the most appropriate treatment at this stage?

Which of the following patients suffers from a complex febrile seizure?

Which of the following is considered an indication to perform brain imaging for a child suffering from recurrent headaches?

Male, 5 months old. From the age of two months, a significant motor delay and hypotonia have been reported. Upon examination: significant Head Lag, he lies in a frog-leg position, tongue fasciculations, and absence of patellar reflexes. A molecular test indicates a homozygous pathogenic variant in the SMN1 gene.

Which anatomical part is most likely affected in this case?

A 14-year-old boy, has had recurring headaches for about a year. Pulsating pains, mostly bilateral, accompanied by nausea and photosensitivity. The episodes occur twice a weak, sometimes after stress at school or skipping a meal. Lately, the boy has been avoiding social activities, fearing an episode. The pediatrician is considering initiation of acute treatment during an episode. Which of the following medications is the most suitable?

A 10-month-old boy is referred for investigation due to recurring episodes of cramps in extremities. Congenital skin defects, attached in the following photo are seen in the examination. The EEG test is also attached

Which of the following diagnoses is the most likely?

A 15-year-old girl, has been complaining for two weeks of hand twitches in the morning hours, which make her drop things. EEG demonstrated 4-5 Hertz poly-spike and slow wave. What is the most likely diagnosis?

A 6-year-old girl is admitted to the ER due to reduced consciousness, bilateral weakness and ataxia, following a mild viral disease. Brain MRI showed the
findings in the image.

What is the most suitable treatment for her condition?

A 6-week-old boy, his parents are first cousins, was examined for congenital hypotonia. In his examination, alert and demonstrates gaze following, no reflexes, tongue fasciculations and in addition, a finding that appears in the attached image:

What is the baby’s likely diagnosis?

A 5-year-old boy with a history of seizures from infancy, developmental delay and hypotonia, referred to brain MRI. Examination demonstrated cortical tubers and subependymal subventricular lesions. What is the most likely diagnosis?

A 7-year-old boy comes in for consultation due to difficulty concentrating, hyperactivity and aggressive (impulsive) behavior at school and at home. The teacher reports difficulty sitting in one place, tendency to interrupt the lessons and difficulty completing assignments. The parents note that these behaviors are present since kindergarten.

What is the most likely diagnosis?

You are examining a newborn with the findings described in the image. Background: born to a mother who suffered from diabetes during pregnancy, with a birth weight of 5,200 kg, vaginal birth.

What is the most appropriate treatment for his condition?

A 16-year-old, generally healthy boy presents with fever, headaches, dyspnea, hemoptysis, malaise, and hematuria. Examination reveals he is pale, with respiratory rate of 24/min, bilateral lung rales with reduced breath sounds on the right, and sensitivity upon sinus percussion. No other abnormal findings.

Which of the following diagnostic tests will facilitate decisions regarding the most likely diagnosis?

A 14-year-old boy is evaluated due to hearing loss and myoclonic seizures appearing over the last 6 months. Up until then he was well, with normal development. His maternal aunt died of progressive dementia and ataxia at the age of 37. His maternal grandmother was diagnosed with diabetes and hearing loss and died at the age of 80 years. Examination reveals short stature, cachexia, ataxia and myoclonus. Laboratory results are significant for elevated serum and cerebrospinal fluid lactate. Which of the following genetic tests will be the most helpful with this patients’ diagnosis?

Which of the following is indicated in the routine workup of a child with a new diagnosis of autism spectrum disorder with no additional neurological or physical findings?

An infant’s neurological exam is positive for the finding in the photo

Which of the following is true?