Pediatrics By Lesson– Rheumatology+Endocrine

A 14-year-old girl presents with 6 weeks of fatigue, weight loss, painless oral ulcers, and recurrent episodes of high fever. In addition, she reports intermittent left wrist and right knee pain. Her examination is significant for the finding in the picture.

Laboratory results are presented in the table:  

Which of the following is characteristic of the most likely diagnosis?

A 17-year-old boy is undergoing workup for abdominal pain. Laboratory results reveal positive, low titer anti-nuclear antibodies (ANA).
After a week the patient is well with no abdominal pain.

Which of the following represents correctly the significance of the blood test result for this patient?

A 5-year-old boy presents with an afebrile limp starting the day before. His mother reports a febrile illness 10 days earlier. On examination – he bares weight with a limp in his right leg, with tenderness upon right hip joint rotation.

Laboratory results include normal CPK and no leukocytosis. Hip joint ultrasound demonstrates a small amount of clear fluid on the right, and synovial thickening.

Which of the following is the most appropriate treatment?

A 5-year-old boy is referred for workup of a fever up to 39 oC, for the last 2 weeks. The fever is accompanied by limping and pain in the legs. The photos below show the physical findings.

Which of the following is typical for his most likely diagnosis?

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?

18-month-old infant is evaluated due to fever for the past 6 days with erythema of the conjunctiva,

strawberry tongue, palmar edema, and lymphadenopathy. Labs- elevated CRP, anemia,

hypoalbuminemia. Echocardiography is normal. The patient is treated with IVIG.

Which of the following is a characteristic complication of the most likely diagnosis?

A 7-year-old boy is admitted due to fever of up to 39°C. The fever is daily for the past two weeks, mostly in the evenings (graph below).  On examination – hepatosplenomegaly and lymphadenopathy.
During fever spikes the following finding is noted that resolves when the fever normalizes.

Which of the following is the most appropriate treatment to his most likely diagnosis?

A 5-year-old male suffers from a fever of 39.5°C for the past 6 days, accompanied by enlarged lymph nodes, a maculopapular rash, eye discharge, and cracked lips. On examination, he is restless. Blood tests reveal elevated ESR and hypoalbuminemia.

What is the most correct treatment in this case?

An 8-year-old male has experienced fatigue and lower back pain following physical activity for the past year. Laboratory tests reveal normal levels of vitamin D, calcium, phosphorus, PTH and alkaline phosphatase. Bone density evaluation shows low bone mineral density. X-ray reveals a compression fracture of a lumbar vertebra.
What is the most likely diagnosis?

A 4-year-old boy is referred due to a fever that has lasted for about two weeks, with a temperature of around 39°C every day. During this period the child has been complaining of pain in the knees and hands, also the mother mentions a rash on the back (see in the image) that appears intermittently. On his examination, there is evidence of arthritis in the wrists as well as in the knees.

Which of the following clinical findings will most likely accompany his illness?

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 15-year-old male arrives due to a rash on his face for the past two months
accompanied by muscle pain muscle weakness, pain and swelling in his right knee. Blood test results are described in the table:

Based on these data, what is the most likely diagnosis for this young man?

An 8-year-old boy presents with recurrent (6 up until now) of fever, abdominal and chest pain. The photo below reveals the finding on examination

Which of the following is a risk factor for complication in this disease?

A 5-year-old girl presents with severe abdominal pain and green vomitus. Examination reveals swelling
 of the knees and the rash in the picture 

Which of the following is true regarding long term follow-up?

A 5-year-old presents with a new limp, with no fever. The mother reports a febrile illness 10 days ago. Examination reveals he carries weight but limps on the right leg, and tenderness on right hip rotation. Laboratory tests are within the normal range. Hip sonography demonstrated a small amount of clear fluid with thickening of the synovia on the right hip joint.

Which of the following is the most recommended treatment?

An 18-months-old boy presents with 5 days of fever up to 38.4°C, and two days of non-purulent conjunctivitis and right cervical swelling. Examination reveals a restless baby, heart rate is 165 bpm, a disseminated macular rash, enlarged right cervical lymph node, about 2 cm, and tenderness in the abdominal right upper quadrant. Laboratory tests are attached.

Which of the following is the most important diagnostic test?

A 10-year-old female, usually healthy, was examined due to acute pain in her right calf that presented several days after being injured in her leg while playing with a ball. She continued playing after her injury. On examination – there was significant tenderness and pallor in the limb. Afebrile, no right calf swelling, no signs of contusion, no localized warmth. In laboratory tests – normal count and inflammatory markers are within normal range. Normal X-ray of the limb.

What would be the best treatment in this case?

A 4-year-old male complaining of abdominal and joint pain. On examination, a raised rash is observed (see image below). The parents reported rhinorrhea a week before his presentation. What is the most likely diagnosis?

A 5-year-old girl is hospitalized with fever for the past two weeks, suspected systemic Juvenile idiopathic Arthritis. In the past two days her condition worsened, she appears sick, in her examination now, evidence of lymph nodes enlargement and also hepatosplenomegaly. The findings of the lab tests upon her hospitalization are described in Table 1.The findings of the lab tests taken upon the exacerbation of her condition are described in Table 2.

Which of the lab findings collected at the time of the exacerbation will support her likely diagnosis?

A 13-year-old girl complaining of intense pains in the left shin for the past 3 days. In anamnesis, about two weeks prior to her visit she injured her leg in a ballet lesson, and she continued dancing after the injury. Rules out systemic fever, notes sensation of paresthesia/tingling in the limb. Examination – significant tenderness over the left shin in mild touch, the limb is cold and pale. No limitation in joint movement. Lab tests are normal, including inflammatory indices, limb X-ray is normal.

Which of the following treatments is the most recommended based on the most likely diagnosis?

An 8-year-old boy presents to the emergency room with diabetic ketoacidosis and had been treated accordingly.
Two hours later the attached ECG was performed.

Which of the following is expected in this child’s blood work?

A 7-year-old boy presents with a few months of polyurea, polydipsia, failure to gain weigh, headaches, and vomiting. Laboratory results are presented in the table. After been given vasopressin (ADH) the urinary osmolarity increased and the blood osmolarity decreased.

Which of the following diseases can explain these findings?

A 15-year-old girl complains of nervousness, trouble sleeping, headaches, and deterioration in her school work.
Her examination reveals the findings in the picture.

Which of the following tests will assist her diagnosis?

A 10-day-old newborn presents with significant tremor in 4 limbs. He was born at 40 weeks of gestation, to a mother with gestational diabetes mellitus. Examination reveals a generally well, not dysmorphic newborn, with significant tremor and restlessness. Laboratory results are presented in the table.

Which of the following is the most likely diagnosis?

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 5-year-old female presents with a growth spurt, breast budding, and genital hair. Left hand X-ray revealed advanced bone age. LH levels after LHRH injection were increased. Brain MRI was normal.

Which of the following is the most appropriate treatment?

A 7-year-old boy presents with fatigue, excessive weight gain, and arrested growth over the last year. Examination reveals hypertension and purple striate over the abdomen and thighs. His serum glucose is increased.

Which of the following is the most appropriate diagnostic test?

In which of the following is the finding in the photo below most likely to be found?

Which of the following is an indication for growth hormone treatment?

A 2-month-old infant is evaluated for apathy and poor feeding. On examination – tachycardia and mild extremity tremor. Labs – glucose 35 mg/dl, urinary ketones negative.

Which of the following is the most likely diagnosis?

A 16-year-old girl presents with a few weeks of palpitations, heat intolerance, hyperhidrosis, tremor, increased appetite, and weight loss. Examination reveals heart rate of 140 bpm and a tender fulness on the anterior aspect of the neck.

Which of the following is a typical laboratory finding in her most likely disease?

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?

A 10-year-old male is referred for evaluation due to short stature. Since the age of two, his height has consistently been in the 5th percentile, while his weight is in the 20th percentile. The parents are in the 75th percentile for height. The father reported delayed shaving, starting at approximately 18 years of age. Upon primary investigation – X-ray of the hand shows a bone age consistent with 8 years. Extensive blood tests, including chemistry, complete blood count, celiac serology, and thyroid function, are all within normal ranges.

 What is the most likely diagnosis?

Which laboratory finding characteristic of hypocalcemia is typically observed in hypoparathyroidism?

The following image describes a 16-year-old girl with short stature, and complaints of hearing loss, who is under cardiac follow-up.

What is the most likely diagnosis?

You are examining a 4-month-old baby described in the image below.

Despite an abnormal result in the newborn screening, he did not receive appropriate treatment for his illness.

What additional finding would strengthen the probable diagnosis in this case?

A 16-year-old girl, who is overweight and has hirsutism, complains of irregular menstruation. Investigation that included prolactin levels, thyroid function, ACTH test, and urine collection for cortisol was normal.

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

A 13-year-old female has underlying celiac disease and hypothyroidism. Examined due to short stature. At examination: short and thick neck, distant nipples, and wide chest.

Which cardiac finding is most typical of the girl’s condition?

A 10-year-old boy is admitted to the emergency room due to sleepiness and vomiting since the day of his admission. On his examination, there are signs of dehydration and evidence of weight loss. The parents report that for several weeks, he has been drinking larger amounts than usual and urinating a lot.

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

Newborn screening of a week-old newborn revealed total T4<2 mcg/dl (normal value >10 mcg/dl). The parents are healthy and not related. Examination reveals an umbilical hernia, a large fontanelle, and no goiter.

Which of the following is the most likely cause of this condition?

A 7-year-old boy presents with one week of polydipsia, polyurea, nausea, and vomiting. Examination reveals a conscious boy, with mildly decreased turgor. His blood sugar is 900 mg/dl and his urine positive for ketones. Additional blood work is below.

Which of the following is true regarding the sodium level and the approach to this finding?

A 15-year-old girl presents with nervousness, trouble falling asleep, headaches, and deterioration of school work over the last months.

Examination reveals the findings in the picture.

Which of the following tests will promote diagnosis?

A 3-day-old newborn presents with apathy, vomiting, and reduced feeding.

Examination is positive for signs of dehydration, micropenis, and testicular hyperpigmentation.

Laboratory results reveal hyponatremia and hyperkalemia.

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

Which of the following is the most common cause of congenital hypothyroidism?

Which of the following is the first sign of puberty?

44- A 10-year-old boy presents with 2 months of weight loss and upper abdominal pain. He reports a feeling of abdominal fullness, melena, and multiple episodes of diarrhea. Gastroscopy revealed multiple ulcerative areas in the esophagus and stomach. Fasting gastrin levels are high.

Which of the following will most likely be part of the diagnosis?

Which of the following conditions will require treatment with progesterone-only birth control pills?

A 15-year-old male, usually healthy, with a normal BMI, complaining of sensitivity in the chest. In his examination, evidence of breast tissue was reported bilaterally. On examination – signs of sexual maturation are age-appropriate. What is the probable reason for this phenomenon?

A 10-day-old male was referred for investigation due to refusal to eat, multiple emesis events, and lack of weight gain. On examination – micropenis, no testicles palpated in the scrotum. Which of the following laboratory findings is typical of the presumed diagnosis of the baby?

A newborn screening test for a 5-day-old child reported low T4 levels in the presence of high TSH. Which of the following tests is the test of common choice to confirm the etiology of the child’s illness?

A 5-year-old male, since birth he has been treated with hydrocortisone due to adrenal insufficiency, well controlled. In the last day, he has been suffering from asthenia and a high systemic fever. A chest x-ray demonstrates evidence of lobar pneumonia. What will the instructions include regarding the regular treatment the child is taking?

Which of the following findings is a contraindication to the administration of estrogen-containing pills?

Male, 17 years of age, arrived for an investigation due to a delayed puberty. Upon examination, the testicles are small, sparse facial hair, height 180 cm, normal sense of smell. Upon laboratory investigation:
Gonadotropin levels: FSH 40 mIU (norm: FSH 1-8), LH level 20 mIU/ml (norm: LH 2-13). Testosterone level: 2 ng/ml (norm: 2.5-10).

What is the most likely diagnosis?

Male, 10 years of age, arrived to the clinic due to sleepiness, signs of dehydration, vomiting, and glucosuria. The parents report that for several weeks he has been drinking a lot and urinating a lot. He is complaining of fatigue and has lost weight.

Given the complaints, what will be observed in the laboratory tests?

Female, 6 days old, normal gestation and delivery. She was admitted to the ER by the parents due to impression of cyanosis in the legs, dyspnea, loss of appetite and low urine output. Upon examination – cyanosis in the lower body part, dyspnea, systolic murmur in the LSB, palpated femoral pulses are reduced bilaterally.

Which of the following syndromes is linked at a higher frequency to the described heart defect?

Which of the following combinations of lab findings is typical for adrenal failure
 (choose the most accurate answer)?

A 5-day-old newborn, referred to the ER after reporting an abnormal result of thyroid blood test as part of newborn screening. Repeat test in the ER resulted in the following values: TSH – 100ulm/ml (0.5-10) FT4 – 9pmol/l (12-26)

Which of the following causes is the most common for the newborn’s likely diagnosis?

A 7-year-old boy presented in due to high frequency of urination, accompanied by copious hydration, the mother notes he drinks about 3 liters a day. As part of investigation, the blood tests described in the table are collected:

Urine osmolarity increases and blood osmolarity decreases in reaction to vasopressin administration. What is the child’s likely diagnosis?

Which of the following is an etiology for early eruption of teeth in infants?

A 16-year-old girl presents with irregular menstruation.
Examination reveals overweight and the findings in the attached photos.

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

A 2-day-old small for gestational age newborn has the features demonstrated in the picture.
Prenatal ultrasound was not performed. Echocardiography reveals a bicuspid aortic valve.

Which of the following symptoms is common in the newborn’s most likely diagnosis?

 A 14-year-old boy presents with developmental delay and learning difficulties. Examination reveals elongated face, micropenis, and large testicles.

Which of the following is the most likely diagnosis?