7-16 CorePendium Board Review

A 3-week-old infant is brought to the ED for persistent crying. The baby is afebrile, feeding well, and has normal vitals. Physical exam reveals tenderness when the right thigh is moved. There is no swelling or bruising. What is the most appropriate next step?

• Order hip ultrasound

• Reassure and discharge

• Obtain skeletal survey

• Administer oral acetaminophen and re-evaluate in 2 hours

A 2-month-old is brought in for inconsolable crying and intermittent leg stiffening. The infant is afebrile. Exam is normal. Abdominal ultrasound shows a target-like mass in the right lower quadrant. What is the next best step?

• Send stool for occult blood testing

• Emergent pediatric surgery consultation

• Order air contrast enema

• Start empiric antibiotics and admit for observation

In the evaluation of a crying infant, which of the following findings is most concerning for an urgent underlying pathology?

• Crying episodes clustered in the evening

• Calms with feeding or swaddling

• Persistent crying beyond 3 months of age

• Weak cry and poor suck reflex

In the evaluation of a crying infant, which historical feature is most concerning for an urgent underlying pathology?

• Crying worse in the evening

• Increased frequency of crying after feeding

• Change in pitch or tone of the cry

• Absence of crying during diaper changes

A 7-year-old boy presents with a limp and right hip pain for 2 days. He had a low-grade fever and upper respiratory illness last week. On exam, he holds his hip in slight flexion and abduction. Vitals: T 37.4°C. Labs: WBC 9,000/mm³, ESR 10, CRP 0.5. What is the most likely diagnosis?

• Septic arthritis

• Legg-Calvé-Perthes disease

• Transient synovitis

• Slipped capital femoral epiphysis (SCFE)

A 13-year-old obese male presents with chronic groin and knee pain. On exam, he has an antalgic gait and limited internal rotation of the left hip. What is the best diagnostic step?

• MRI of the pelvis

• Bilateral frog-leg lateral radiographs of the hips

• Bone scan of the lower extremities

• ESR and CRP

A 5-year-old presents with a new limp and intermittent refusal to bear weight. No trauma reported. Exam shows mild warmth and tenderness over the proximal tibia. Radiograph shows a lytic lesion with periosteal elevation. What is the next best step?

• NSAIDs and outpatient ortho referral

• Start empiric antibiotics for presumed osteomyelitis

• Orthopedic oncology consultation and MRI

• Joint aspiration and culture

A 10-year-old boy presents with fever, inability to walk, and severe left hip pain. He appears toxic. Labs: WBC 18,000/mm³, ESR 72, CRP 15. What is the most appropriate immediate step?

• MRI of the pelvis

• Empiric antibiotics and emergent orthopedic consultation

• Joint aspiration under ultrasound guidance

• NSAIDs and observe for improvement

A 6-day-old infant presents with poor feeding, lethargy, and hypothermia. Vitals: T 35.8°C, HR 180, RR 58. Capillary refill is 4 seconds. What is the most appropriate initial step?

• Administer ceftriaxone and acyclovir

• Give Tylenol and reattempt PO intake

• Begin broad-spectrum antibiotics and acyclovir after cultures

• Perform lumbar puncture immediately before starting IV fluids

A 3-day-old full-term infant presents with new-onset seizures and a bulging fontanelle. CT shows intraventricular hemorrhage. Which condition is most associated with this finding in a term neonate?

• Hypoxic-ischemic encephalopathy

• Vitamin K deficiency

• Germinal matrix hemorrhage

• Younger parents