A negative medical exam neither confirms nor refutes the mother’s allegation. The mother should be encourage to report the matter to police, and if there are any concerns about the Mom’s ability to protect the child from her boyfriend you are required to inform Children’s Services. It is important to note that ninety-five percent of children who have been sexually abused have a normal genital exam.

A lumbar puncture (LP) is a procedure performed along with a blood C&S, urine C&S R&M, as well as a chest x-ray in the presence of respiratory symptoms and a stool C&S if GI symptoms are present. The purpose of the septic work-up is to determine the source of infection. An LP is performed to examine the CSF for meningitis. After the CSF is drawn by LP, tubes are sent for C&S, cell count, glucose and protein.

An infant with meningitis may present with a toxic appearance, fever, irritability and a bulging fontanelle. If this clinical picture is observed, an LP is warranted.

However, evidence of increased intracranial pressure, infections of the skin overlying the LP site and thrombocytopenia or coagulopathy are all contraindications to performing an LP.

Note: in a toxic infant, as above, antibiotics should be started immediately!

Hey Lauren, while I agree with you, I would add that the "correct answer" is also somewhat worrisome in that bulging fontanelle suggests increased intracranial pressure, and toxic appearance might suggest resuscitation or stabilization may be needed before proceeding to lumbar puncture

Gastroesophageal reflux disease is extremely common in infancy and may present with [non-bilious] vomiting after feeding, irritability, arching of the back and feeding problems. Further investigation may be required if the infant presents with failure to thrive, blood in the vomitus, recurrent cough, pneumonia or persistent symptoms. Management may include a trial of prevacid, frequent smaller feeds and positional changes.

Tanner staging is a sexual maturity rating used to describe male and female adolescent sexual maturation and growth. There are five stages in total.

STAGE 1
no sexual maturation
Female: no breast formation or pubic hair development
Male: no testes enlargement or pubic hair development

Stage 2:
Female: breast buds begin to form; sparse, fine, straight pubic hair develops on the labia
Male: testes enlarge, scrotal skin enlarges and reddens; sparse, straight pubic hair develops at the base of the penis

Stage 3:
Female: breast buds and areola enlarge; pubic hair thickens, coarsens and spreads
Male: penis increases in length; pubic hair thickens, coarsens and spreads

Stage 4:
Female: nipple and areola form a separate mound from the breast; pubic hair is coarser and does not cover the full adult area
Male: length and width of the penis increase; pubic hair is coarser and does not cover full adult area

Stage 5:
Female: areola rejoins the breast contour forming an adult breast in size and shape; pubic hair extends to medial thigh forming an inverted triangle
Male: penis reaches adult shape and size; pubic hair extends to medial thigh.

Treatment for HSP is generally supportive with analgesics for pain relief; HSP is most often self limited. NSAIDS are not recommended in patients with active GI bleeding. Corticosteroids may alleviate joint and abdominal pain but currently there is no strong evidence to support the routine use of corticosteroids to shorten the course of disease or to treat renal dysfunction. Immunosuppressive therapy may be indicated for severe renal disease.

The best method of diagnosing a urinary tract infection is obtaining both a urine culture and urinalysis. On urinalysis, findings of leukocyte esterase, nitrites and blood indicate a UTI. However, in infants with a UTI these finding may be absent. Since it requires several hours for bacteria to convert nitrates to nitrite in the bladder and since children empty their bladders quite frequently, nitrites may be negative on urinalysis in the presence of a UTI. Also since not all bacteria are able to convert nitrates to nitrite the urinalysis may be negative. When interpreting the results of the urine culture, attention must be paid to the method of collection. In practice, a bag urine (>10^8 CFU/L) or midstream catch (>10^5 CFU/L) is typically used to provide a positive result. However the gold standard is a bladder tap.
A voiding cystourethrogram is a radiologic evaluation for vesicoureteral reflux (VUR) or anatomic abnormalities which may predispose a child to recurrent UTIs leading to renal scarring. Radiologic evaluation (ultrasound and VCUG) is recommended for children less than two years old presenting with a fever and a UTI. Researchers consider a DMSA scan which shows evidence of pyelonephritis, as opposed to cystitis, the gold standard and this is becoming more commonly used in clinical practice.
*Thank you to Dr. Pinsk for help with this explanation

All of the above are potential complications of acute otitis media

Consider placing the correct answer at the bottom so as to indicate brain abscess and conductive hearing loss into "all of the above"?

It's not her fault. The system automatically puts the answers in random order (which is better if you are going through the questions again a second time later down the road).

Phenylketonuria or PKU is a metabolic disease caused by a deficiency of phenylalanine hydroxylase which normally converts phenylalanine to tyrosine. In the absence of phenylalanine hydroxylase untreated patients develop hyperphenylalaninemia which leads to severe mental retardation, seizures, hyperactivity and skin hypopigmentation. The best treatment for this disease is limitation of dietary phenylalanine. Since phenylalanine is an essential amino acid for normal growth and development, phenylalanine is restricted but not completely eliminated from the diet. Patients who adhere to this diet from birth have a favourable outcome and generally lead a normal life. PKU is routinely screened for at birth and is an autosomal recessive trait.

Thanks.Awesome.

Wilson's disease is rare but fatal and is caused by a defect in copper metabolism leading to an accumulation of copper in the liver, basal ganglia and other tissues.

For more information of Wilson's disease please follow the link below
http://www.emedicine.com/ped/TOPIC2441.HTM

Pyloric stenosis is a gastric outlet obstruction due to hypertrophy of the circular muscles of the pylorus. It is most commonly seen in infants between birth and two months of age who present with progressive, projectile, non-bilious vomiting after feeds. Infants may show signs of dehydration and failure to thrive. On physical exam gastric peristaltic waves may be visible through the abdominal wall and on deep palpation of the right upper quadrant of the abdomen the pylorus may be felt as a firm, round, olive-sized mass, the so called "olive sign". A protuberant abdomen may be noted but is not always present. The best imaging modality is an abdominal ultrasound which shows a thickened pylorus and elongated pyloric canal. On KUB x-ray the stomach would appear distended. A "double bubble sign" is observed in patients with duodenal atresia not pyloric stenosis. Pyloric stenosis is treated surgically by a procedure called a pyloromyotomy in which a longitudinal incision is made through the musculature of the pylorus either laproscopically or as an open incision. After surgery, the outcome is excellent.

pyloric stenosis is more common in male....be aware!!!yahyahyah

If the clinical presentation is typical and an olive is felt, the diagnosis is confirmed and further imaging is not warranted.
Ultrasonography is the imaging modality of choice when evaluating a child for IHPS. It is both highly sensitive (90-99%) and specific (97-100%) in the hands of a qualified sonographer. The pylorus is viewed in longitudinal and transverse planes. The sonographic hallmark of IHPS is the thickened pyloric muscle.
Criteria for making the diagnosis include pyloric muscle thickness greater than 4 mm. The length of the pyloric canal is variable and may range from 14 mm to 20 mm. The pyloric diameter may range from 10-14 mm.

IHPS may be falsely diagnosed in infants who have pylorospasm. Ultrasonography also allows for observation of peristaltic activity, differentiating between pylorospasm and true IHPS.
Upper gastrointestinal imaging (UGI) can help to confirm the diagnosis of IHPS, but it is not routinely performed unless ultrasonography is nondiagnostic.
The "shoulder" sign is a collection of barium in the dilated prepyloric antrum and may be seen in the infant with IHPS. The "double track" sign, two thin tracks of barium compressed between thickened pyloric mucosa, once thought to be pathognomonic of IHPS, has recently been identified in multiple cases of sonographically confirmed pylorospasm.

http://www.emedicine.com/EMERG/topic397.htm#section~Workup