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An 8-year-old boy is brought in for evaluation by his parents, who are worried about his behavior in school. Recently, he has become increasingly upset about attending school. Whereas he had always enjoyed being read to as a small child, he has appeared easily frustrated when reading or being asked to write. During those times, he will often disrupt the class, and this has led to his parents being asked to remove him from the school. Which of the following additional diagnoses most likely would be present in this patient?
A 14-year-old boy is brought to the emergency department for evaluation of fever and headache. The mother relates that her son has had a worsening headache for 56 days. She says that she took him to a walk-in clinic, and he was put on amoxicillin for a sinus infection. His headaches have been getting worse and that he is now having fevers as high as 103.6°F. The mother says that he normally is very active and that he currently has a summer job at a local park clearing out underbrush. Since he has become ill, he has had such a decrease in energy that he cannot go to work. He has had a decrease in his appetite and has been sleeping more. He denies any sore throat, abdominal pain, chest pain, dysuria, vomiting, or diarrhea. On examination, he is an uncomfortable young man whose vital signs are: temp 101.9°F, RR 26, HR 124, and BP 79/56. is head, ear, eye, nose, and throat examination reveals normal TMs, a mildly erythematous hypopharynx, and some shotty cervical lymphadenopathy. His lungs are clear. His cardiac examination is normal. His liver edge is palpable just below the right costal margin and is mildly tender. His spleen is not palpable. His skin examination is normal with the exception of scattered petechiae around his ankles and wrists. A CBC reveals WBC 13,000 with 65% segs and 22% lymphs, hematocrit of 35, and platelet count of 95,000. His electrolytes reveal a Na 125, K 5.1, Cl 102, and bicarbonate 21. His BUN and Cr are normal. What is his most likely diagnosis?
A 3-month-old infant is brought to your office in the winter with a history of 1 day of vomiting, followed by 3 days of diarrhea. She has had six to eight stools per day, which are loose and foul smelling. On examination, she looks well. Which of the following viruses is the most likely cause of her illness?
A 13-year-old boy is brought into the emergency room with a laceration of his right arm. According to his parents, he received the injury when he fell on the ground while playing at the family farm about 1 hour ago. He has no known history of any medical problems. His parents say that they haven't brought him to the doctor in years. On questioning, they report that he only received one of his "baby shots" and they are not sure which one that was. On examination, he is healthy appearing. He is appropriately apprehensive but calm and consolable. His right arm has a 5 cm linear laceration with visible soil particles in and about the wound. The remainder of his examination is unremarkable. You carefully clean and irrigate the wound and then primarily repair the laceration with sutures. What immediate tetanus prophylaxis would be optimal in this case?
An 18-month-old boy is brought to the clinic for a checkup. As part of his routine care, a serum lead level is obtained. It is 25 g/mL. Which of the following is the most appropriate next step in his management?
A 6-year-old boy presents to the emergency department with a painful, markedly swollen elbow. While ice-skating, he fell with his arm outstretched. Radiographs of the elbow demonstrate a displaced, supracondylar fracture of the humerus. On examination, there is pain on passive flexion at the wrist and a decreased radial pulse, with diminished capillary refill in the hand. Which of the following is the most appropriate management of this injury?
In a 6-month-old previously healthy male infant, an abnormality is revealed during a routine diaper change, as illustrated in Figure. The parents have noted this finding on and off on several occasions over the last month. On each occasion, the child has been feeding well, and is content and playful. Which of the following is the most appropriate management at this time?
A 7-week-old, breast-fed, term infant presents with increasing jaundice, abdominal distention, and abnormal stools. Liver function tests demonstrate a conjugated hyperbilirubinemia, mildly elevated transaminases, and an elevated gamma-glutamyl transpeptidase. TORCH (congenital infection complex, including toxoplasmosis, rubella, cytomegalovirus, and hepatitis) serology and screening for inborn errors of metabolism are negative. As part of the diagnostic evaluation, the most sensitive imaging study in this clinical setting would be which of the following?
A 26-year-old divorced woman is brought into the emergency room after being found wandering the streets aimlessly. She is a relatively good historian but gives few spontaneous answers to questions. She describes a 1-year history of the belief that she is being followed by "agents" of the Vatican, who watch her closely to "see if I'm a good Catholic." While they monitor her, they also use radio signals to tell her she is a "whore" and a "slut." Due to these experiences, she has been unable to work. She is afraid to associate with others for fears of being "judged." She enies any medical problems and takes no medications. Her parents were divorced when she was an infant. She does not know anything about her father, but her mother has "manic-depression" and is taking lithium. Her MSE is notable for significant psychomotor slowing, paucity of speech, and a flat affect. Which of the above symptoms or signs is necessary in order to make a diagnosis of schizophrenia?
A 6-year-old Caucasian female has breast enlargement (Tanner stage II) and coarse curly pubic hair. She is not yet menstruating. She is otherwise healthy and has normal growth parameters. There are no signs of virilization and her abdominal examination reveals no masses. Examination of the vaginal area shows signs of estrogenization. Which of the following is the most likely preliminary working diagnosis?
The patient is a 9-year-old girl brought into the urgent care clinic by both of her parents. Over the past 18 months, they have noticed emerging "habits" including repetitive squinting and grimacing, along with associated clearing of her throat and grunting noises. These behaviors occur almost every day and frequently occur together. She has gotten increasingly teased because of her peculiarities and her anxiety has only worsened her symptoms. She has no major illnesses and is not taking any medications. Her physical examination is within normal limits with the exception of the above stereotypes. Further history would most likely reveal which of the following comorbid diagnoses?
A 5-week-old infant presents with a 1-week history of progressive nonbilious emesis, associated with a 24-hour history of decreased urine output. The infant continues to be active and eager to feed. On examination, the infant has a sunken fontanelle and decreased skin turgor. The abdomen is scaphoid, and with a test feed, there is a visible peristaltic wave in the epigastrium. Which of the following is the most likely diagnosis?
A 10-month-old infant presents to the emergency department with a 24-hour history of low-grade fever and anorexia. The parents report several episodes in which the child has been suddenly inconsolable and crying, followed by periods of lethargy. He has had nonbilious vomiting and several loose stools. On examination, the infant is pale and mildly dehydrated. His abdomen is soft and nondistended, with fullness to palpation in the right upper quadrant. The child passed another stool in the emergency department Which of the following is the most appropriate next step in the diagnostic evaluation and management of this patient?
For each newborn with vomiting and illustrated radiographs, select the most likely diagnosis. Aneonate with bile-stained vomiting, abdominal distention, dilated loops of bowel on plain radiographs, and a small-caliber colon on contrast enema congenital hypertrophic pyloric stenosis annular pancreas duodenal atresia midgut volvulus intussusception imperforate anus
The patient is a 9-year-old girl brought into the urgent care clinic by both of her parents. Over the past 18 months, they have noticed emerging "habits" including repetitive squinting and grimacing, along with associated clearing of her throat and grunting noises. These behaviors occur almost every day and frequently occur together. She has gotten increasingly teased because of her peculiarities and her anxiety has only worsened her symptoms. She has no major illnesses and is not taking any medications. Her physical examination is within normal limits with the exception of the above stereotypes. Which of the following would be the most effective pharmacotherapy for her presenting illness?
A 3-year-old boy presents to the physician's office with an asymptomatic neck mass located in the midline, just below the level of the thyroid cartilage. The mass moves with deglutition and on protrusion of the tongue. For the above patient with a neck mass, select the most likely diagnosis. thyroid carcinoma cystic hygroma acute suppurative lymphadenitis thyroglossal duct cyst lipoma carotid artery aneurysm
A 5-week-old infant presents with a 1-week history of progressive nonbilious emesis, associated with a 24-hour history of decreased urine output. The infant continues to be active and eager to feed. On examination, the infant has a sunken fontanelle and decreased skin turgor. The abdomen is scaphoid, and with a test feed, there is a visible peristaltic wave in the epigastrium. Electrolytes and a urinalysis are evaluated. Which of the following laboratory findings are most likely to be seen in this patient?
An 18-month-old girl is brought to the physician's office for evaluation of left neck mass. Examination reveals a 2-cm soft, nontender, fluctuant mass in the left lateral neck. This is located at the anterior border of the sternomastoid, midway between the mastoid and clavicle. For the above patient with a neck mass, select the most likely diagnosis. thyroid carcinoma cystic hygroma acute suppurative lymphadenitis thyroglossal duct cyst lipoma carotid artery aneurysm
A 4-year-old previously healthy girl presents to the emergency department with a 24-hour history of rectal bleeding and dizziness. She has no other gastrointestinal symptoms. On examination, she appears pale. Her heart rate is 140 beats/min, and she has a 20 mmHg postural drop in systolic blood pressure. The child's abdomen is nondistended and nontender, and fresh blood and clots are in the rectal vault on rectal examination. Which of the following is the most appropriate diagnostic study to order for this patient?
During diagnostic evaluation, a 14-year-old girl with menorrhagia, frequent nosebleeds, and irondeficiency anemia is found to have a low platelet count with a normal coagulation profile. Bone marrow biopsy reveals abundant megakaryocytes. On abdominal examination, no organomegaly is noted. The patient has a satisfactory response to the initial therapeutic intervention, but over 612 months' time, the response is less dramatic and shorter in duration. There are signs and symptoms of increasing side effects from therapy. The next step in management should be to recommend which of the following?