First Aid for the USMLE Step 2 CS

Section 3. Minicases

Child With Red Eye

No child will be present; only the parent will relate the story, either in person or by telephone.

Key History

Onset, location, duration, affecting one or both eyes; eye discharge, itching, pain, photophobia, tearing; associated symptoms (constitutional, dermatologic, GI, cardiac, pulmonary, renal, pelvic, rheumatologic); exacerbating and alleviating factors; medications; sick contacts, day care, immunizations; history of similar symptoms.

Key Physical Exam

Vital signs; HEENT exam.

Presentation

Differential

Workup

■ 3 yo F presents with a 3-day history of “pink eye.” It began in the right eye but now involves both eyes. She has mucoid discharge, itching, and difficulty opening her eyes in the morning. Her mother had the flu last week. She has a history of asthma and atopic dermatitis.

Bacterial conjunctivitis

Viral conjunctivitis

Keratitis

Seasonal allergies

Uveitis

Physical exam

Ophthalmoscopic eye

exam

CBC

Electrolytes

Discharge cultures

Slit lamp exam

 

Child With Short Stature

No child will be present; only the parent will relate the story, either in person or by telephone.

Key History

Associated symptoms (constitutional, GI, cardiac, pulmonary, renal, pelvic, endocrine); medications; prenatal and birth history, growth history; past medical history; family history; cognitive abilities, school performance.

CHILD WITH SHORT STATURE (cant'd)

Key Physical Exam

Vital signs; height, weight; HEENT, heart, lung, abdominal, and neurologic exams.

Presentation

Differential

Workup

■ 14 yo M presents with short stature and lack of sexual development. His birth weight and length were normal, but he is the shortest child in his class. His father and uncles had the same problem when they were young, but they are now of normal stature.

Constitutional short stature

Growth hormone (GH) deficiency

Hypothyroidism

Chronic renal

insufficiency

Genetic causes

Cystic fibrosis

Physical exam

CBC

Electrolytes

GH stimulation test

IGF-1, IGFBP-3 levels

TSH, FT4

XR—hand

U/S—renal and cardiac

Sweat chloride testing

BUN/Cr

Karyotype

 

Behavioral Problems In Childhood

No child will be present; only the parent will relate the story, either in person or by telephone.

Key History

Onset, severity, duration, triggers; physical violence or use of weapons; substance use, developmental history, changes in environment or school performance; change in personality, anhedonia.

Key Physical Exam

Vital signs; neurologic exam.

Presentation

Differential

Workup

■ 9 yo M presents with a 2-year history of angry outbursts both in school and at home. His mother complains that he runs around “as if driven by a motor.” His teacher reports that he cannot sit still in class, regularly interrupts his classmates, and has trouble making friends.

Attention-deficit hyperactivity disorder (ADHD)

Oppositional defiant disorder

Manic episode

Conduct disorder

Hyperthyroidism

Physical exam

Mental status exam

TSH, FT4

EEG

BEHAVIORAL PROBLEMS IN CHILDHOOD (cant'd)

Presentation

Differential

Workup

■ 12 yo F presents with a 2-month history of fighting in school, truancy, and breaking curfew. Her parents recently divorced, and she just started school in a new district. Before her parents divorced, she was an average student with no behavioral problems.

Adjustment disorder

Substance intoxication,

abuse, or dependence

Manic episode

Oppositional defiant

disorder

Conduct disorder

Physical exam

Mental status exam Urine toxicology

■ 15 yo M presents with a 1-year history of failing grades, school absenteeism, and legal problems, including shoplifting. His parents report that he spends most of his time alone in his room, adding that when he does go out, it is with a new set of friends.

Substance abuse

Conduct disorder

Oppositional defiant disorder

Adjustment disorder

Urine toxicology

Mental status exam Physical exam

■ 5 yo M presents with a 6-month history of temper tantrums that last 5-10 minutes and immediately follow a disappointment or a discipline. He has no trouble sleeping, has had no change in appetite, and does not display these behaviors when he is at day care.

Age-appropriate behavior

ADHD

Oppositional defiant disorder

Physical exam

Mental status exam



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