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Pediatrics NBME form 4

Discussion in 'Shelf Exams' started by shortgymnast, Jun 2, 2016.

  1. shortgymnast

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    8 yo female with presents with 3 day productive cough (with sputum) and fever. normal exam at birth but h/o respiratory issues. T37.5, HR 100, RR32, pulse ox (room air) 84%. clubbing, cyanosis around mouth, diffuse rhonchi, expiratory wheeze. CXR: hyperinflation, chronic interstitial changes, atelectasis (scattered). diagnosis=??

    a asthma
    b BPD
    c CHD with R to L shunt
    d CF
    e HoCM
    F idiopathic pulm HTN
    g methemoglobinemia
    h PFO
    I persistent pulm HTN
    J pneumococcal PNA
    K RDS
     
  2. orthopod

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    @shortgymnast Thanks for the question. I would need the question written out a bit more like it was in the step to get a better idea of what they were asking. However, based on the h/o respiratory issues, low O2 saturation, clubbing, and pulmonary signs, I would guess the answer is Cystic Fibrosis.

    She could have had a fever due to an infection (remember pseudomonas!). The stem can push you away form CF as the patient had a normal exam at birth. If my memory serves me right, there aren't a ton of things that can cause clubbing in a child, but CF is one of them. In addition, atelectasis, hyperinflation, and interstitial changes point me towards CF.

    - Asthma is a possibility, although 'h/o respiratory issues' doesn't make me confident in that
    - BPD would have been known at birth
    - CHD wouldn't cause hyperinflation
    - HoCM wouldn't cause these s/s
    - idiopathic pulm HTN isn't usually seen in kids this young
    - methemoglobinemia doesn't fit
    - PFO wouldn't cause hyperinflation
    - persistent pulm HTN would have been known at birth
    - PNA is also a possibility, but I have no indication it's penumococcal, and it sounds more like in this case, it's a complication of an underlying disease.
     
  3. schistosoma_mansoni

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