In normal female pubertal development, which of the following is true?
Correct Answer D:
The normal stages of female pubertal development in order are: thelarche (breast budding), adrenarche (pubic and axillary hair), peak height velocity, and menarche.
The age of pubertal change has been getting earlier, with breast development starting between the ages of 10 and 11 and menarche between the ages of 12 and 13. The mean interval from thelarche to menarche is 2.3 years, with a standard deviation of 1 year. If there is an absence of secondary sexual characteristics by age 14 with no menarche or normal secondary sexual characteristics but no menarche by 16, then the diagnostic workup of primary amenorrhea is necessary.
A. Thelarche is before adrenarche.
B. Menarche is the final event in the process.
C. Peak height velocity is about 1 year before the onset of menarche.
E. Often the first bleeding is not ovulatory.
A full-term infant presents to your office at 7 days of age with bilateral purulent conjunctive discharge, erythema and swelling at the medial aspect of the eyes.
Which one of the following is the most likely diagnosis?
Correct Answer E:
Neonatal conjunctivitis presents during the first month of life. It may be aseptic or septic. Aseptic neonatal conjunctivitis most often is a chemical conjunctivitis that is induced by silver nitrate solution, which is used for prophylaxis of infectious conjunctivitis. Chemical conjunctivitis is less common owing to the use of erythromycin ointment in place of silver nitrate solution for the prophylaxis of infectious conjunctivitis. Bacterial and viral infections are major causes of septic neonatal conjunctivitis, with Chlamydia being the most common infectious agent. Infants may acquire these infective agents as they pass through the birth canal during the birth process. Chlamydial ophthalmia usually occurs 5 to 14 days after birth. It may range from mild conjunctivitis with minimal mucopurulent discharge to severe eyelid edema with copious drainage and pseudomembrane formation. Follicles are not present in the conjunctiva, as they are in older children and adults. In chlamydial ophthalmia, systemic therapy is the treatment of choice, because at least 1⁄2 of affected neonates also have nasopharyngeal infection and some develop chlamydial pneumonia. Erythromycin 12.5 mg/kg po q 6 h for 2 weeks is recommended. Efficacy of this therapy is only 80%, so a 2nd treatment course may be needed.
→ Neisseria gonorrhoeae (choice A) is a gram-negative diplococcus and is potentially the most dangerous and virulent infectious cause of neonatal conjunctivitis. However, it's not the most common cause of neonatal conjunctivitis.
→ Herpes simplex virus (choice B) can cause neonatal keratoconjunctivitis, but it is rare and can be associated with a generalized herpes simplex infection.
→ The most commonly identified gram-positive organisms include Staphylococcus aureus (choice C), Streptococcus pneumoniae, Streptococcus viridans, and Staphylococcus epidermidis. These bacteria make up 30-50% of all cases of neonatal conjunctivitis.
→ Silver nitrate (choice D) is a surface-active chemical, facilitating agglutinate gonococci and inactivating them. Ironically, silver nitrate was later found to be toxic to the conjunctiva, potentially causing a sterile neonatal conjunctivitis (which less common than the infectious neonatal conjunctivitis).
A 5-year-old boy is found to have unusual cravings for dirt and ice. He has also been seen eating paint chips of the walls.
What is the most likely condition to be found in this child?
Correct Answer A:
Pica, is the term used to describe craving for and eating non-nutritious things such as dirt and ice.
Pica is often diagnosed in a hospital emergency room, when the child or adolescent develops symptoms of lead poisoning, bowel perforation, or other medical complications caused by the nonfood items that have been swallowed.
Most commonly, young children get lead poisoning from lead-based paint, which was used in many old homes. That's why kids who live in older homes are at a greater risk for lead poisoning. These children are found to have unsafe levels of lead in their blood, which can lead to a wide range of symptoms, from headaches and stomach pain to behavioral problems and anemia. Lead can also affect a child's developing brain.
A child who lives in an old building with his mother is found to have microcytic anemia. He also has symptoms of nausea, vomiting, anorexia and constipation, sleep disturbances, and irritability.
What is the most likely diagnosis?
Correct Answer C:
Lead paint was commonly used until 1960, used to some degree until the early 1970s, and mostly eliminated in 1978; thus, for a significant number of older housing units, leaded paint still poses some hazard. Lead poisoning is usually caused by direct ingestion of leaded paint chips (from cracked, peeling paint).
Lead poisoning is most often a chronic disorder and may not cause acute symptoms. With or without acute symptoms, poisoning eventually has irreversible effects (eg, cognitive deficits, peripheral neuropathy, progressive renal dysfunction).
Risk of cognitive deficits increases when the whole blood lead level is ≥ 10 µg/dL (≥ 0.48 mmol/L) for an extended period, although the cutoff may be even lower. Other symptoms (eg, abdominal cramping, constipation, tremors, mood changes) may occur if lead is > 50 µg/dL (> 2.4 mmol/L). Encephalopathy is likely if lead is > 100 µg/dL (> 4.8 mmol/L).
Lead poisoning will show a microcytic anemia with an MCV < 80.
A 3-year-old girl is brought to you because she has developed some concerning symptoms recently. They include anorexia, vomiting, abdominal pain and a wobbling gait. The family is poor and live in an old dilapidated building.
What is the likely lab finding on a complete blood count for this child?
Correct Answer B:
This child has symptoms that are consistent with lead poisoning. A child can present with symptoms of abdominal pain, vomiting, constipation, headache and decreased appetite. Some children can also present with neurologic symptoms such as tremor, confusion, seizures and ataxic gait. Lead poisoning causes a microcytic anemia, and the mean corpuscular value (MCV) would be less than 80.
Children who live in old homes or apartment buildings that have lead paint that is chipping or peeling off the walls are risk of developing lead poisoning. Especially, if they eat the paint chips that fall off the walls.
Treatment is with chelation with drugs such as succimer and dimercaprol, that bind the lead and eliminate it from the body. In addition, a lead abatement agency must be contacted to go and inspect the home.
Click to expand