Block 3 Week 4- Pediatrics

A 3-year-old male is brought to your office for a well child visit. The history indicates that the child has a vocabulary of about 100 single words and has not begun to speak in 2-word phrases. An ear examination is normal and the parents have no concerns regarding the child’s hearing. They report that the child is interacting with others normally. Which one of the following would you propose?

A previously healthy 5-year-old male is brought to your office because of painful swelling in his neck. His mother noted the swelling about 3 or 4 days ago and it has grown rapidly. This morning he was sent home from school with a temperature of 101.2°F. He has been eating well and has had no weight loss. They do not have a cat and he has not been around any cats. He is up to date on immunizations. He has a tender, erythematous, slightly fluctuant, enlarged lymph node in the left anterior cervical chain. He has no other enlarged lymph nodes and the examination is otherwise unremarkable. Which one of the following would be the most appropriate next step?

A mother brings in her 11-year-old daughter, stating that the child has not had a bowel movement in 5 days. Although she is very embarrassed to talk to you, the daughter confirms that this is the case, and that it has happened several times since she started middle school earlier this year, where the bathrooms are very unpleasant. Both the mother and the daughter state that this has not been a problem in the past. The mother reports that the daughter is otherwise healthy, takes no medications, and has no past surgical history. The patient has no discomfort with urination but does have some abdominal pain that has grown worse over the last day or so. She is not having any trouble breathing. She reports a decreased appetite over the last 3 days. The physical examination reveals normal vital signs, a normal BMI, and no abdominal distention or tenderness to palpation. Which one of the following would you advise at this point?

In a healthy full-term infant who is exclusively breastfed, iron supplementation should begin at what age in order to prevent iron deficiency anemia?

A 2-year-old male is brought to the emergency department by his frightened mother following the sudden onset of nasal stuffiness and a harsh, barking, nonproductive cough. The child does not appear significantly distressed. His temperature is 37.9°C (100.2°F) orally. Mild nasal flaring is present. The nasopharyngeal mucus appears mildly edematous and injected, and upper airway noises are heard, but good air movement is evident on auscultation of his chest. Which one of the following is the most appropriate treatment for this patient?

A 4-week-old white male is brought to your office with a 2-week history of increasing dyspnea, cough, and poor feeding. The child appears nontoxic and is afebrile. On examination you note conjunctivitis, and a chest examination reveals tachypnea and crackles. A chest film shows hyperinflation and diffuse interstitial infiltrates and a WBC count reveals eosinophilia. What is the most likely etiologic agent?

A 7-year-old boy presents with fever for 6 days. Examination reveals an uncomfortable child with erythema around the lips with cracking, bilateral conjunctivitis, a generalized rash and swelling of the hands. Labs show an elevated platelet count, CRP and ESR. Which therapy should be initiated?

Which of the following infants is at highest risk for developmental dysplasia of the hip?

A mother meets you in the emergency department with her 3-week-old infant. The infant was delivered at term, with an uneventful prenatal and postnatal course to this point. The mother reports that the infant stopped breathing for 20–25 seconds, and that his lips and tongue appeared bluish. There was no coughing, choking, or congestion, but the child seemed “limp.” The episode ended when the mother vigorously stimulated her child and he started crying. On examination, the child appears normal. Which one of the following would be most appropriate at this point?

In the United States, cow’s milk is not recommended for children until the age of