A 4-year-old male presents with a 3-day history of sores on his right leg. The sores began as small red papules but have progressed in size and now are crusting and weeping. Otherwise he is in good health and is up to date with immunizations.
On examination he has three lesions on the right anterior lower leg that are 0.5-1.5 cm in diameter, with red bases and honey-colored crusts. There is no regional lymphangitis or lymphadenitis.
Which one of the following is the preferred first-line therapy?
Correct Answer D:
The lesions described are non-bullous impetigo, due to either Staphylococcus aureus or Streptococcus pyogenes. Topical antibiotics, such as mupirocin, but not compounds containing neomycin, are the preferred first-line therapy for impetigo involving a limited area.
→ Oral antibiotics are widely used, based on expert opinion and traditional practice, but are usually reserved for patients with more extensive impetigo or with systemic symptoms or signs. Penicillin V and hexachlorophene have both been shown to be no more effective than placebo.
→ Topical antibiotics have been shown to be as effective as erythromycin, which has a common adverse effect of nausea.
→ Topical disinfectants are not useful in the treatment of impetigo.
A mother is worried about her child, because of a family history of myopathy.
What is the most appropriate investigation to do first in the child?
Correct Answer A:
Myopathies refer to a class of degenerative skeletal muscle disease that is not caused by nerve dysfunction. Myopathies cause progressive weakness and wasting away of skeletal muscles. The causes for Myopathies vary. They could be hereditary, an inflammatory response, or the result of an endocrine disorder.
Creatine phosphokinase (CPK) is an enzyme found in skeletal muscle, cardiac muscle, and the brain. An initial step is to measure the level of this CPK enzyme with a simple blood test.
A 15-year-old girl who is at Tanner stage 3 is concerned because she has still not had her first menses. Patient denies abdominal pain or other concerning symptoms. Physical examination reveals no abnormalities.
The most appropriate management at this time is:
Tanner stages are as follows:
Female Breast:
Male and female pubic hair:
Since this patient is developing and has sexual characteristics, she may need to wait a little longer for menarche. This patient denies symptoms of abdominal pain which are often seen in cases of imperforate hymen and her physical examination reveals no abnormalities. Reassurance (choice D) is appropriate at this time. The average age for menarche is 12, but can vary between 9 and 16.
→ Pelvic ultrasound (choice A) could reveal abnormalities in anatomic structures of the pelvis but is not indicated at this point.
→ Chromosomal analysis (choice B) would be useful in a case that suggests Turner syndrome. This patient's physical examination reveals no abnormalities, which can be found in in Turner syndrome. Reassurance is appropriate at this point.
→ Progesterone withdrawal test (choice C) is useful in the work up of amenorrhea and can predictably induce bleeding if the circulating serum estradiol level is at least 50 pg/mL. This patient's is still 15 years old and is Tanner stage 3, reassurance is appropriate at this point.
→ Thyroid stimulating hormone (choice E) along with FSH, LH measurements are always first line testing in the work up of amenorrhea. In this patient, at this point, reassurance is appropriate.
During a sports physical examination, a 14-year-old boy expresses concern about his height. He was in the 15th percentile for height throughout childhood and now is just above the 10th percentile. His sexual maturation rating is Tanner stage 2 for both genitalia and pubic hair.
He should be told which of the following?
Tanner staging reveals information about pubertal development. Testicular enlargement is usually the first sign of pubertal development. Most boys reach adult height during the latter half of puberty (Tanner stage 4). Since this boy’s rating is Tanner stage 2, there is evidence that he will probably grow several more inches in height. Since this is the case, there is no indication that he is near his final height has a deficiency in growth hormone, should increase his daily caloric intake or that he will need testosterone injections.
A 14-year-old boy is concerned about his height. Physical examination reveals Tanner stage II pubic hair and genital development. Height and weight are at the 10th percentile for age.
Which of the following is the most accurate statement about his growth?
Correct Answer C:
The peak height velocity occurs at a mean of 13.5 years in boys and 11.5 years in girls. Since this boy is only in tanner stage II, he still has not reached the peak height yet. Most boys reach adult height during the latter half of puberty (Tanner stage 4).
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