Pedi

Question 1

A 3 yr old boy is brought for evaluation of recurrent bone fractures following minor injuries. He has speech delay n mild hearing loss. Hypermobility of his joints is noted. His height is at the 5th percentile.
Dx?

Answer 1

Osteogenesis imperfecta (type l collagen)- hearing loss is due to fracture of the ossicles 
Marfan also can present with hypermobile joints but pts r typically tall n not associated with recurrent fracture

Question 2

Children <18yrs
Arthritis in >=1 joint for >=6wks; fever for >=2wks temperatures spike once daily (often at night) and return to normal. A pink rash accompanied the fever n vanishes spontaneously.
HSM n LAP can b present
Anemia due to chronic inflammation, IDA
leukocytosis, thrombocytosis

Answer 2

Systemic juvenile idiopathic arthritis.

Question 3

A 16yr old girl came with knee pain. She has limp n swelling due to pain. Nontender pustules with a surrounding erythematous rim are seen on her palms. Joint aspiration- leukocyte of 30000, synovial fluid culture is negative
Dx?
Suggestive features?dx is made by?

Answer 3

Disseminated gonococcal infection.

• adolescent, monoarticular arthritis, pustules, synovial WBC count is usually <50000 compared to other causes of septic arthritis.
• Dx - culture of urine, urethral or cervical discharge, culture of blood n synovial fluid (less sensitive)

Question 4

Hx of monoarticular arthritis following months of migratory arthralgia and fatigue and a trip to Maine r concerning for ?

Answer 4

Lyme arthritis (borrelia burgdoferi)

Question 5

Greenstick fractures are?

Longterm complication?

Answer 5

Fracture involves only one side of the bony cortex rather than extending thru the width of the bone
- no longterm complication if treated appropriately

Question 6

A disease commonly presenting with lytic bone lesions and eczematous rash. Additional presenting signs include central diabetes insipidus, lymphadenopathy, HSM, cough( pulmonary nodules)

Answer 6

Langerhans cell histocytosis