Pediatric Quiz (June 2010)

Ocular toxocariasis is the most probable diagnosis in this case. The patient's symptoms of irritability, swelling of the left eye, and decreased appetite are consistent with ocular toxocariasis. The fact that the swelling is more prominent in the morning suggests that it may be due to an inflammatory response. Additionally, the presence of pet animals in the house increases the likelihood of exposure to Toxocara canis, the parasite responsible for ocular toxocariasis. Retinoblastoma, vitreous hemorrhage, and cataract are less likely based on the given clinical presentation.

A flexible flatfoot refers to a condition where the arch of the foot appears flattened when standing, but the arch can be restored when the foot is lifted off the ground. In this case, the pediatrician is not concerned because a flexible flatfoot is considered a normal variant and is usually painless. It does not cause any functional limitations or long-term problems.

A basilar fracture of the skull is likely to be seen on a CT scan in this scenario. The presence of blood behind the left tympanic membrane suggests a possible fracture in the area. This type of fracture occurs at the base of the skull and is commonly associated with head trauma. It is important to note that the boy in the scenario is alert and well oriented, indicating that there is no loss of consciousness or significant neurological deficit. This further supports the likelihood of a basilar fracture, as more severe injuries such as epidural or subdural hematomas would typically present with altered mental status.

Sutural separation refers to the widening or separation of the sutures in the skull. In a 1-year-old child with raised intracranial tension (ICT), sutural separation is the earliest change that can be observed. This is because the sutures in the skull are not fully fused at this age, and increased pressure within the skull can cause the sutures to separate. Other changes mentioned in the options, such as posterior clinoid erosion, erosion of sella, and silver beaten appearance on X-ray skull, may occur later in the course of raised ICT.

Central cyanosis with systolic murmur is seen in Transposition of the Great Arteries (TGA). TGA is a congenital heart defect where the positions of the pulmonary artery and the aorta are switched, causing oxygen-poor blood to be circulated throughout the body. This results in cyanosis, a bluish discoloration of the skin and mucous membranes due to low oxygen levels. The systolic murmur is caused by abnormal blood flow through the heart.

Hurler's Syndrome is a rare genetic disorder that affects multiple organs and tissues. It is characterized by various clinical features, including dolicocephalic head (abnormally long and narrow head shape), umbilical and inguinal hernia (protrusion of organs through the abdominal wall), and mental retardation. However, diaphragmatic hernia, which is a condition where there is a hole in the diaphragm allowing organs to move into the chest cavity, is not typically associated with Hurler's Syndrome.

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Aspiration pneumonia is a common complication of Dermatomyositis. This occurs when foreign material, such as food or saliva, is inhaled into the lungs, leading to inflammation and infection. In patients with Dermatomyositis, muscle weakness and difficulty swallowing can increase the risk of aspiration. Therefore, it is important to be aware of this potential complication and take necessary precautions to prevent it.

The statement "Special shoes, inserts and wedges help in creating arch in a child with flexible flat foot" is not true. Special shoes, inserts, and wedges may provide support and alleviate symptoms, but they do not create an arch in a child with flexible flat foot.

Bronchiolitis is a respiratory infection that primarily affects infants and young children. It is commonly caused by viruses, including Measles Virus, Adenovirus, Parainfluenza Virus, and Respiratory Syncytial Virus (RSV). Therefore, the correct answer is "Respiratory Syncytial Virus" because it is not a causative agent of bronchiolitis.