Peds 6 Flashcards
S/s: chest pains, sharp onset without trigger, lasts for a minute or so, doesn’t happen everyday, gets worse with deep breath, no relieving factors, no associated symptoms.
Most likely cause/dx?
Precordial catch syndrome
John is a 17-year-old presenting today for a preparticipation physical exam. During the interview, he reports a low-grade fever, malaise, and headache for one week. In the past few days, his fever has gotten worse and he complains of a sore throat. He denies cough or chest pain. On physical examination, he is found to have a temperature of 101.3° F, and cervical lymphadenopathy and oropharyngeal erythema with exudate are noted. What dx do you suspect? Which test would you order?
Infectious mononucleosis
EBV serologies
A 17-year-old girl presents for a sports preparticipation physical. She reports that she occasionally gets short of breath and feels light-headed with exercise, and sometimes she experiences chest pain as well. She lost consciousness once last season during a playoff basketball game, but attributed it to feeling sick at the time. Her grandfather died suddenly at age 35 of unknown etiology. Which of the following is the most likely diagnosis?
A. Congenital heart block B. Hypertrophic cardiomyopathy C. Hypoglycemia D. Postural hypotension E. Ventricular septal defect
B. Hypertrophic cardiomyopathy
A 16-year-old boy presents to your office requesting clearance to play football. You begin by taking his medical history. He says that he feels very well, but admits that he recently experienced one episode of syncope that occurred when he trained really hard for football tryouts with his friends. He denies any shortness of breath, or chest pain currently. Family history is significant for an uncle who died of heat stroke at the age of 30 while playing basketball. Physical examination reveals no abnormalities. What is the next best step in management?
A. ECG now, and if normal, reassurance B. Medically clear him to play C. Observe and follow up in six months D. Referral to Cardiology E. Stress test
D. Referral to Cardiology
A 16-year-old previously healthy girl comes to the Pediatrics Urgent Care Clinic having “almost fainted” at soccer practice. She says that she had not eaten much earlier in the day and it was very hot and muggy outside. She felt light-headed and sick to her stomach. She denies losing consciousness and did not fall to the ground. She denies any chest pain. When you examine her, her eyes are sunken and he is tachycardic. What would be your next step in her management?
A. Administer fluids and fluids and recheck vital signs B. Blood glucose management C. Echocardiogram D. Electrocardiogram E. Stress test
A. Administer fluids and fluids and recheck vital signs
Claire is a 16-year-old girl who presents for birth control management. Her review of symptoms is unremarkable except for chest pain.Upon further questioning, she reveals the pains are intermittent, on and off for the past couple months. It is not associated with exertion, and is described as sharp, and well localized at the left sternal border. It is very brief, lasting only a few seconds, during which she says she sometimes notices it gets worse when she breathes in. She denies recent URI or viral illness. The family history is negative for early cardiac disease. Her vital signs and physical exam are normal. Which is the next best step in management?
A. Chest x-ray B. ECG C. Fast ultrasound of pericardial window D. Reassurance E. Referral to a cardiologist
D. Reassurance
The history and normal physical exam in this patient is most suggestive of precordial catch syndrome, the most common cause of chest pain in an adolescent. No further workup is needed.
What does the CRAFT screen for?
Substance abuse
What are 3 murmur characteristics that deserve further evaluation?
- Louder than grade III/IV
- Any diastolic murmur
- Any murmur that inc w/ standing or valsalva (suggestive of hypertrophic obstructive cardiomyopathy)
