welcome

The Most Useful step 2 CS guide

ENTER

Tricky Pediatric Cases In USMLE step 2 CS

Here I am posting how to ask questions and points to cover on the tricky cases of pediatrics.Include all other questions of normal pediatric case also.

Picky Eater
So why do you think that your kid is picky eater? I mean
Does he have any specific preference to food?
Since when are you noticing this behavior?
Is it remaining same or getting worse?
What is your response to this? Have you ever punish / reward him?
How does it affecting your child’s life? Your life?
Have you taken any intervention for that? Like scheduling meal time?
Does he watch TV before/ during meal?
Does he take high calorie drinks like soda, juice in between the meal?
Do you have any other concern beside this?
Counselling
Well Mrs. …….., from the information I got from you, I feel that your son is probably going
through normal phase of behavior.
It is the common problem in this age group and it responds well to few behavior changes.
First of all, I suggest you to strictly follow meal schedule for your child.
I also recommend you not to give high calorie drinks in between the meals.
Do not watch tv before/during meal. Have a fun at meal time
Please never punish your child for his behavior. Do not force him to eat.
Regarding constipation, I would like to suggest taking high fiber diet.
However to confirm my diagnosis………
Causes
- low fiber diet
- hypothyroidism
- lead poisoning
- ADHD
- Oppositional defiant disorder
Investigations
- CBC, ESR
- T3, T4, TSH
- Blood lead level
- Blood calcium level
- Stool for ova and parasite

Temper tantrum
- How often does it occur?
- Can you tell me what happens at that time?Does he hold his breath? Does he harm himself during it? Does he pass out?- seizure
- does he harm himself?
- Do you know anything which may be responsible for this ? like fever? Pain? Missing meal?
Travel? New surrounding?
- Have you taken any intervention for that? – time out
- What is your response to tantrum?
- Are there any specific psychologic problems?
- Are the episodes starting or getting worse after age 4? -depression, autism,ADHD
- who lives with him at home in your absence?
Counseling
I advise you to keep his routine regular.
Please never punish your child for his behavior. It will definitely not work.
You should consider for TIME OUT.
Causes
-Normal growth and development
- ADHD
- Autism
-Depression
- Seizures, arrhythmia – passes out
Investigation
- CBC, ESR
- EEG,
- CT Brain
- MRI Brain
- echocardiography

Enuresis
- How often does it occur?
- Urine h/o - Frequency, urgency, color, blood, pain - Does he cry during urination? – UTI
-Bowel h/o - Frequency, consistency, color, blood, pain - Does he cry during Bow mov? - Consti
- Does he snore at night? – sleep apnea
- Does he have any stress? - secondary
- Does he have problem with walking? - secondary
- What is your response to it?
- Have you taken any intervention for that? – bed alarm
- Family h/o
Counseling
It is the common problem in this age group and it responds well to few behavior changes.
You should not give more fluid at bed time.
you should also take him for pee before going to bed.
Causes
-Primary nocturnal enuresis
-Secondary nocturnal enuresis
-UTI
-constipation
-Obstructive sleep apnea
Investigations
- P/R examination
- CBC, ESR
- UA
- USG kidney
- CT ABD

Consipation

No comments:

Post a Comment

Popular Posts