Quiz 4: 8 Year Old Well Check

Front 1

George is a 7-year-old boy frequently in trouble at school for being disruptive and inappropriately talkative in class, not following directions set by his teacher, and not working well with classmates during group activities. His mother relates that at home George is always on the go, sleeping only 6 to 7 hours a night. He does not follow her rules all the time either, including not doing his homework, and sometimes putting himself in danger by doing things she tells him not to do, such as running away unaccompanied. Which of the following is the most likely diagnosis?

Back 1

ADHD

Front 2

Jane is an 8-year-old girl who presents to your clinic for follow-up after being hospitalized for status asthmaticus. She has just completed a 10-day course of systemic steroids. Given her history of moderate persistent asthma, her outpatient regimen includes Advair, a combined steroid and bronchodilator. She was also diagnosed with ADHD one year ago and was started on Concerta, 18 gm PO once a day. Her BMI today is at the 83rd percentile for her age, and her blood pressure is at the 98th percentile for her age. What is the most likely cause of her stage I hypertension?

Back 2

Medications

Front 3

An 8-year-old boy is brought to clinic by his parents because they are concerned that he has not been doing his homework. His teacher recently called the parents to say that their son seems distracted in class, constantly interrupts other children when they are speaking, and is very fidgety. When you speak with the boy, he tells you that he did not know about the homework assignments and that he tries hard to pay attention in class. What is the next best step in management?

Back 3

Contact the teacher to find out more about his behavior. Find out more about the child's behavior at home

Front 4

An 8-year-old healthy obese African American male with no past medical history is found to have a blood pressure of 125/90 mmHg on all four extremities on routine evaluation during an office visit for well-child care. Review of symptoms is negative. A physical exam and screening bloodwork are performed. Both are normal, with the exception of his blood pressure and obesity. What is the most likely diagnosis?

Back 4

Primary hypertension

Front 5

Billy, a 7-year-old boy, presents to the clinic with complaints of headaches and episodes of feeling sweaty and flushed. He also reports that at times he feels as if his heart is racing. Billy was full term, had an uncomplicated birth, and has been otherwise healthy until now. On exam his BP is 120/80 mmHg and is the same in his upper and lower extremities. His weight and height are in the 50th percentile for his age. What is a likely cause of Billy’s hypertension?

Back 5

Catecholamine excess

Front 6

Symptoms of antisocial personality disorder

Back 6

• inability to conform to societal norms
  
• disregard rights of others
• often criminality
• impulsivity
• males > females
• only if older than 15

Front 7

somatoform disorder

Back 7

• reported physical symptoms
  
• drive is unconscious
  
• symptoms not intentionally produced or faked
  

Front 8

Conversion disorder

Back 8

More common in adolescents

sudden loss of sensory or motor functioning

Front 9

Factitious disorder

Back 9

Patient consciously creates physical symptoms

Front 10

Rhett's disorder

Back 10

• X-linked pervasive developmental disorder
  
• only in females
  
• affected males die in utero or at birth
  
• regression of language and development
  
• mental retardation
  
• ataxia
  
• hand wringing
  
• diagnoses 1-4 years
  

Front 11

Primary hyptersion

Back 11

• mild hypertension
  
• patient's age
  
• asymptomatic
  

Front 12

Renal artery stenosis

Back 12

• asymptomatic
  
• edema
  
• dyspnea
  
• htn
  
• abdominal bruits
  
• elevated serum angiotensin II and serum aldosterone
  

Front 13

Coarctation

Back 13

• Chest pain
  
• cold lower extremities
  
• dizziness
  
• syncope
  
• exercise intolerance
  
• FTT
  
• poor growth
  
• headache
  
• dyspnea
  
• pulses diminished distal to coarctation
  
• Turner's
  

Front 14

Pheochromocytoma

Back 14

• headache, diaphoresis, palpitations, tremor
  
• nausea. weakness, anxiety, nervousness, irritability
  
• weight loss, tachycardia
  
• htn, severely elevated
  
• elevated urinary VMA, urinary HVA, urinary metanephrines, and serum glucose
  
• assoc with endocrine neoplasia and Von-hippel-lindau disease
  

Front 15

Hyperthyroidism

Back 15

• heat intolerance
  
• frequent bowel movements
  
• increased appetite
  
• diaphoresis
  
• nervousness
  
• restlessness
  
• hair loss
  
• palpitations
  
• elevated T3, T4, serum glucose, high or low TSH
  

Front 16

Renal vascular disease

Back 16

predisposed by UA or UV lines as neonate