MCQS 241-243:A 4-month-old infant was taken to the pediatric casualty due to persistent vomitting

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Question:241
A 4-month-old infant was taken to the pediatric casualty due to persistent vomitting. On examination the child was noted to be irritable. In the history it was noted that the preparation of infant formula had been in a lead-soldered bowl bought by the father on a recent travel to the middle east. The lead levels in the venous blood were of 76 mug/dl (toxic level is less than 10 mug/dl) Treatment should include
a) ethanol
b) naloxone
c) physostigmine
d) atropine
e) methylene blue
f) diphenhydramine
g) calcium disodium ethylene diamine tetraacetic acid
h) deferoxamine mesylate
i) flumazenil
j) Folic acid

Question:242
A 16 year old girl complains of constant headache, general lethargy and left lower limb weakness. On inspection she is noted to be short for her age. On examination she is found to have bilateral temporal field deficits. Her GH, ACTH and TSH levels are low. Her plasma level of prolactin is increased. Radiographic examination shows retarded bone age. The most likely diagnosis is
a) constitutional delay
b) hypothyroidism
c) Hand-Schuller-Christian Disease
d) optic chiasm glioma
e) craniopharyngioma
f) ovarian dysgenesis
g) testicular dysgenesis
h) Kallmann's syndrome
i) congenital adrenal hyperplasia
j) anorexia nervosa
Question:243
An eight year old child developed a sore throat and headache. A throat swab was placed on a BAP plate with a bacitracin A disk. This showed colony growth with a zone of inhibition around the disk and Gram positive cocci in chains. The most appropriate treament would include
a) zidovudine (ZDV) plus lamivudine (3TC) plus IDV
b) intravenous trimethoprim/Sulfamethoxazole
c) combination of ticarcillin and gentamicin
d) 1-time dose of metronidazole
e) IM ceftriaxone plus doxycycline
f) ceftriaxone
g) combination of ceftriaxone and ampicillin
h) combination of ceftazidime and imipenem
i) single-dose benzathine penicillin G
j) do not administer antibiotics



Question:241
Correct Answer: G
Explanation:
Childhood lead poisoning is characteristically a disease that occurs between the second and third years of life, generally resulting from the child's ingestion of lead-based paint or dust. However, lead poisoning may also appear in the first year of life. Intense acute exposure to lead also results in symptomatic poisoning. The characteristic symptoms and signs of acute toxicity include abdominal colic, malaise, nausea, vomiting, constipation, fatigue, anemia, peripheral neuropathy, renal impairment, hepatic dysfunction, and alterations of the CNS. Lead poisoning in infancy may have unusual etiologies such as in utero transmission of lead by lead-poisoned women. Because sources of lead poisoning in infancy may be unusual, a detailed environmental investigation may be necessary to identify the exact source. Children exposed to lead in the first 2 years of life have a special vulnerability to the neurotoxicity of lead, with the risk of enduring developmental handicaps. The use of chelation in acute lead poisoning is guided by the patient's clinical status and blood lead levels. Any patient who is symptomatic with protracted GI problems or CNS toxicity from an acute lead exposure will require parenteral chelation therapy as an inpatient. Hospitalization and chelation is also indicated for any child with a blood lead level of greater than 69 mug/dl, regardless of whether the child is symptomatic. Patients admitted to the hospital should receive IV calcium disodium ethylene diamine tetraacetic acid (CaNa2 EDTA), the most efficient parenteral chelator of lead

Question:242
Correct Answer: E
Explanation:
Craniopharyngioma is the most common brain neoplasm of nonglial origin and the most common brain tumor associated with hypothalamic-pituitary dysfunction and sexual infantilism. Clinical manifestations include headache, visual disturbances, short stature, symptoms of diabetes insipidus, and weakness of one or more limbs. Physical findings include visual defects (including bilateral temporal field deficits), optic atrophy or papilledema, and signs of GH deficiency, delayed puberty, and hypothyroidism. Although only a few patients seek evaluation because of short stature, most are below the mean in height and height velocity at the time of diagnosis. Laboratory evaluation often indicates deficiencies in one or more pituitary hormones, including gonadotropins, GH, thyrotropin (thyroid-stimulating hormone [TSH]), corticotropin, and vasopressin (AVP). The plasma level of prolactin may be normal or increased. Radiographic examination often shows retarded bone age.
Question:243
Correct Answer: I
Explanation:
Colony growth with a zone of inhibition around the disk indicates a presumptive identification of Group A beta Strep. Gram staining produces Gram positive cocci in chains. These features are suggestive of beta-hemolytic streptococcal pharyngitis. Symptoms of acute pharyngitis most commonly are caused by viruses.However, in order to prevent rheumatic fever and its complications, group A beta-hemolytic streptococcal (GABHS) pharyngitis should be recognized and treated. For compliance reasons, single-dose benzathine penicillin G is recommended for GABHS pharyngitis or tonsillitis. The recommended dosage is 600,000 units intramuscularly for patients weighing 27 kg or less, and 1,200,000 units for patients weighing more than 27 kg. If oral penicillin must be used, twice-daily dosing has been found as effective as 4-time daily dosing (500 mg bid for 10 days). A full 10-day course is necessary for eradication


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