Pediatrics & Child health

@Pediatrics1s

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Channel's geo and language

World, English

Pediatrics & Child health

30 Apr 2023, 18:53

Educational objective: Acute spinal cord compression can present with loss of motor and sensory function, loss of rectal tone, and urinary retention. Management includes emergency surgical consultation, neuroimaging, and possibly intravenous glucocorticoids.

41.7k 0 11 2

Pediatrics & Child health

30 Apr 2023, 08:53

Which of the following is the best next step in management of this patient?

Poll

A. CT scan of the head without contrast
B. Lumbar puncture
C. Nerve conduction studies
D. Thoracolumbar brace
E . Urgent neurosurgical evaluation

1249 votes

36.2k 0 14

Pediatrics & Child health

30 Apr 2023, 08:52

64-year-old man is brought to the emergency department due to sudden onset of painless lower extremity weakness. He was swimming in a pool when he suddenly felt his legs become weak and had to struggle to exit the pool. The patient has had no loss of consciousness or visual or speech problems, but he is unable to pass urine. He also has had back pain for the last 2 months. Medical history is significant for type 2 diabetes mellitus, hypertension, and osteoarthritis. Physical examination shows significant motor weakness in both legs and numbness from the umbilicus to the soles of the feet He has no sensation in the perinea! area. Rectal tone is absent A urinary catheter is placed, and 800 ml of urine is collected.

30.1k 0 18 1

Pediatrics & Child health

29 Apr 2023, 18:51

Educational objective: Spinal epidural abscess, a bacterial infection of the epidural space, typically arises in the setting of bacteremia from intravenous drug use or distant infection. Manifestations include fever, malaise, focal back pain, and progressive neurologic findings (eg, sensory, motor, reflex deficits).

24.4k 0 4

Pediatrics & Child health

29 Apr 2023, 08:51

Which of the fotlowinq is the most likely cause of this patient's weakness?

Poll

A. Bacterial invasion of the epidural space
B. Immune-mediated peripheral nerve injury
C. Segmental spinal cord inflammation
D. Spondylosis-associated cord compression
E. Viral infection of the motor neurons

752 votes

24.1k 0 12 2

Pediatrics & Child health

29 Apr 2023, 08:50

A 29-year-old man comes to the emergency department due to lower extremity weakness. The patient has not been feeling well over the past several days and has had worsening back pain. When he woke up this morning, he noticed weakness in both legs and had to have a friend help him walk to the car. The patient has a history of HIV, which was acquired via shared needles, but does not take antiretroviral therapy consistently. The patient still uses injection drugs occasionally but no longer shares needles. Temperature is 38 C (100.4 F), blood pressure is 116168 mm Hg, and pulse is 98/min. The lungs are clear on auscultation, and heart sounds are normal with no murmurs. Abdominal examination shows a distended bladder. The back is tender to palpation over the lower thoracic region. Neurological examination reveals 315 bilateral lower extremity muscle strength with upgoing bilateral plantar reflexes. Skin examination shows scattered folliculitis and no lower extremity edema.

21.5k 0 12

Pediatrics & Child health

28 Apr 2023, 18:50

Educational objective: Neoplastic epidural spinal cord compression presents with worsening focal back pain, bilateral lower-extremity weakness, sensory loss, and gait ataxia. Bowel/bladder disturbances are late findings.In the acute phase of spinal cord injury, patients can develop spinal shock with absence of reflexes and flaccid paraplegia as a result.

21.7k 0 3

Pediatrics & Child health

28 Apr 2023, 18:49

Which of the following is most likely responsible for this patient's clinical presentation?

Poll

A. Brainstem ischemic stroke
B. Diabetic polyneuropathy
C. Guillan-Barre syndrome
D. Normal-pressure hydrocephalus
E. Spinal cord compression
F. Spinal cord infarction

544 votes

22.2k 0 6

Pediatrics & Child health

28 Apr 2023, 08:48

A 64-year-old woman comes to the physician with a 10-day history of progressive difficulty walking and poor balance. Two days ago, she fell at home but did not sustain any injuries. Her chronic back pain is worse than usual and is especially bothersome at night She has no headaches, trauma, bowel or bladder incontinence, or loss of consciousness. The patient's past medical history is significant for type 2 diabetes mellitus, hypertension, transient ischemic attack, and breast cancer status post lumpectomy followed by chemoradiation 2 years ago. Her blood pressure is 162/78 mm Hg and pulse is 73fmin. Physical examination shows an unsteady gait, bilateral leg weakness, increased deep-tendon reflexes, and decreased pinprick sensation in both lower extremities up to the umbilicus. There is percussion tenderness over the lower thoracic spine. Digital rectal examination shows good sphincter tone. Mental status, memory, and cognition are intact

15.9k 0 7

Pediatrics & Child health

27 Apr 2023, 20:41

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8.6k 0 7

Pediatrics & Child health

27 Apr 2023, 18:48

Educational objective: Tetanus is a presynaptic neuromuscular junction disorder caused by the Clostridiwn tetani toxin, which blocks the release of the inhibitory neurotransmitters glycine and GABA across the synaptic cleft, leading to fever, painful muscle spasms, and trisrnus (lockjaw). only in those who are unvaccinated or incompletely immunized.

13.7k 0 6

Pediatrics & Child health

27 Apr 2023, 08:47

Which of the following is the most likely cause of this patient's current condition?

Poll

A. Immune-mediated peripheral nerve damage
B. Impairment of presynaptic acetylcholine release
C. Microbial invasion of the central nervous system
D. Sudden abstinence from an opiate drug
E. T-lymphocyte-mediated skeletal muscle injury
F. Toxin-mediated neurotransmission blockage

441 votes

17k 0 6

Pediatrics & Child health

27 Apr 2023, 08:45

A 38-year-old homeless man is brought to the emergency department due to severe muscle pain and stiffness. He arrived at a homeless shelter 2 days ago, and the manager says that he has been restless and irritable. The patient has a history of alcohol abuse and injection drug use. Temperature is 37.7 C (100 F), blood pressure is 150/90 mm Hg, and pulse is 102/min. Both pupils are normal, equal, and reactive to light There are marks on the patient's arms from previous injections as well as several abrasions and lacerations on the lower extremities. He is unable to open his mouth completely. Painful spasms of the neck muscles are triggered by physical stimuli.

12.1k 0 4

Pediatrics & Child health

26 Apr 2023, 18:45

Educational objective: Vascular dementia (VaD) is caused by large or small artery ischemia or infarction and presents with executive dysfunction and focal neurologic findings. Patients with suspected VaD should undergo neuroimaging to evaluate for cerebrovascular disease.

11.9k 0 3

Pediatrics & Child health

26 Apr 2023, 08:44

Which of the following is the most likely diagnosis in this patient?

Poll

A. Alzheimer disease
B. Dementia with Lewy bodies
C. Frontotemporal dementia
D. Parkinson disease dementia
E. Vascular dementia

462 votes

12.6k 0 2

Pediatrics & Child health

26 Apr 2023, 08:44

A 63-year-old woman is brought to the office due to a change in behavior over the past year. The patient was a highly successful CEO of a large company but had to step down 3 months ago due to poor performance. She once excelled in organization and strategic planning, but 9 months ago, she began to have significant difficulty planning important meetinqs. Now the patient is unable to shop and cook for herself. She has had recent bouts of sadness and urinary frequency. Medical history is significant for hypertension and type 2 diabetes mellitus. Temperature is 37 .1 C (98.8 F), blood pressure is 132/79 mm Hg, pulse is 76fmin, and respirations are 14fmin. The patient scores 23130 (normal: ~26) on the Montreal Cognitive Assessment. Gait is slow and unsteady. Extraocular movements are intact Reflexes are 3+ in the left upper extremity and 2+ on the right

12.5k 0 2

Pediatrics & Child health

25 Apr 2023, 18:43

Educational Objective: Torticollis is a common form of focal dystonia involving the sternocleidomastoid muscle. It can occur idiopathically but is very often medicationrelated. Discontinuation of the causative agent(s) may improve symptoms.

10.6k 0 2 1

Pediatrics & Child health

25 Apr 2023, 13:35

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Pediatrics & Child health

25 Apr 2023, 08:43

A 43-year-old man presents to your office complaining of periodic involuntary head turning and head fixation to the right side. Physical examination reveals a hypertrophied left sternocleidomastoid muscle. What is the most likely diagnosis?

Poll