A 4-year-old female has had three urinary tract infections in the past 6 months. She complains of difficulty with urination and on examination is noted to have labial adhesions that have resulted in near closing of the introitus.
Which one of the following is the most appropriate management?
Correct Answer C:
The etiology of prepubertal labial adhesions is idiopathic. The adhesions may be partial or complete in some cases only a small pinhole orifice may be seen that allows urine to exit from the fused labia. This problem may be asymptomatic, but the patient may also have a pulling sensation, difficulty with voiding, recurrent urinary tract infections, or vaginitis. If there is enough labial fusion to interfere with urination, treatment should be undertaken. The use of topical estrogen cream twice daily at the point of the midline fusion will usually result in resolution of the problem.
A 3-year-old girl presents with a two month history of low-grade fever, cough, anorexia, and weight loss. A chest x-ray reveals a right-sided pleural effusion.
Which one of the following tests is most likely to confirm the diagnosis of tuberculosis if a previous culture result was negative?
Correct Answer B:
In patients with pleural effusion, the diagnosis of TB is made by detection of acid-fast bacilli by stain or by culture of mycobacteria in pleural fluid or pleural tissue (obtained by closed biopsy) or by the presence of caseating granulomas in histological sections.
A 10-year-old boy with cough, fever and night sweats has a positive skin test for tuberculosis. A chest x-ray reveals minimal hilar adenopathy and a small pulmonary infiltrate. Drug susceptibility studies are negative for drug resistance.
The current recommended treatment is:
Correct Answer B: All patients with new, previously untreated TB should receive a 2 month initial phase of treatment followed by a 4 or 7 month continuation phase. Initial-phase therapy is with a combination of antibiotics for the first 2 months which are isoniazid (INH), rifampin (RIF), and pyrazinamide (PZA).
Ethambutol (EMB) is added in the initial phase whenever there is any suspicion of initial drug resistance and while the results of drug susceptibility testing are pending (which is not the case in this scenario).
You suspect a neuroblastoma in a 4-year-old boy with headaches and hypertension. Which one of the following investigations provides a great advantage in confirming the diagnosis, as well as in following disease activity in the care of patients with secreting tumors?
Neuroblastoma is a cancer arising in the adrenal gland or less often from the extra-adrenal sympathetic chain, including the retroperitoneum, chest, and neck. Diagnosis is based on biopsy.
When sensitive assays are used, 90 to 95% of tumors produce sufficient catecholamines to increase urinary metabolites. This provides a great advantage in confirming the diagnosis of neuroblastoma, as well as in following disease activity in the care of patients with secreting tumors. The two enzymes primarily responsible for the catabolism of catecholamines are catechol-O-methyl transferase and monoamine oxidase. Dopa and dopamine are converted primarily to homovanillic acid, whereas norepinephrine and epinephrine are converted primarily to vanillylmandelic acid. Most laboratories involved in neuroblastoma diagnosis measure levels of both homovanillic acid and vanillylmandelic acid in the urine.
Because of the varied clinical presentation, neuroblastoma can be confused with other neoplasms as well as nonneoplastic conditions. Diagnosis of the 5 to 10% of tumors that do not produce catecholamines is particularly difficult, as is that of the 1 % or so in which the primary tumor is not obvious.
The conventional diagnostic imaging modalities include plain radiography, bone scintigraphy, CT, and MRI. The potential specificity and sensitivity of meta iodobenzylguanidine (MIBG) scintigraphy for evaluation of bone and soft-tissue involvement of neuroblastoma are attractive.
A 6-year-old child presents complaining of patchy hair loss on the back of the scalp. Examination reveals well-demarcated areas of erythema and scaling, and although there is still some hair in the area, it is noted that the hairs are extremely short and broken in appearance. See picture:
Which of the following is the patient most likely suffering from?
Tinea capitis is a dermatophyte infection of the scalp (scalp ringworm). Tinea capitis mainly affects children, is contagious, and can be epidemic. Tinea capitis causes the gradual appearance of round patches of dry scale and/or alopecia. T. tonsurans infection causes “black dot ringworm,” in which hair shafts break at the scalp surface; M. audouinii infection causes “gray patch ringworm,” in which hair shafts break above the surface, leaving short stubs. Tinea capitis less commonly manifests as diffuse scaling, like dandruff, or in a diffuse pustular pattern.
Dermatophyte infection occasionally leads to formation of a kerion, a large, boggy, inflammatory scalp mass caused by a severe inflammatory reaction to the dermatophyte. A kerion may have pustules and crusting and can be mistaken for an abscess. A kerion may result in scarring hair loss.
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