During a routine well-child examination a 10-year-old girl reports that she has occasional headache, “racing heart,” abdominal pain, and dizziness. Her mother states that she has witnessed one of the episodes, which occurred during an outing at the mall, and reported the child to be pale and to have sweating as well. Other than some hypertension, she has a normal physical examination. Evaluation of this child is most likely to result in which of the following diagnoses?
a. Hysterical fainting spells
c. Diabetes mellitus
e. Migraine headache
the answer is below…
The United States Medical Licensing Examination, or USMLE for short, is a three-part licensing examination that is required in order to receive a license to practice medicine within the United States.
The USMLE assesses a physician’s ability to apply knowledge, concepts, and principles, and to determine fundamental patient-centered skills that are important in health and disease and that constitute the basis of safe and effective patient care.Examination committees composed of medical educators and clinicians from across the United States and its territories prepare the examination materials each year.
This exam is designed by the Federation of State Medical Boards and the National Board of Medical Examiners to determine whether or not an individual understands and can apply the knowledge necessary to practice medicine safely and intelligently.
The USMLE is actually comprised of three different exams that are referred to as steps, which examine the individual’s knowledge of specific topics related to the field of medicine such as basic science, medical knowledge, medical skills, clinical science, and the application of all of these skills and areas of knowledge in the medical field.
All three steps of the USMLE include a series of computerized multiple-choice questions, but the format of the exam and the information covered in each multiple-choice section is different for each step of the USMLE. The USMLE Step II also has a clinical skills portion that examines an individual’s ability to work with real patients and the USMLE Step III has a computerized patient simulation portion in addition to the multiple-choice section of the exam. In order for an individual to receive a license to practice medicine, the individual must pass all three steps of the USMLE.
The correct answer is d; Pheochromocytoma.
The child in the question has all of the classic symptoms of childhood pheochromocytoma. In adults, the episodes of hypertension are more paroxysmal than in children, where the hypertension is more sustained. While it is an unusual diagnosis in children, pheochromocytoma must be considered in the evaluation of a patient with hypertension who has intermittent symptoms described. Pheochromocytoma can be associated with tuberous sclerosis, Sturge-Weber syndrome, ataxia-telangiectasia, and it can be inherited as an autosomal dominant trait. All of the other answers are possibilities in an adolescent-age child, but the concurrent finding of hypertension suggests an alternative diagnosis. Pregnancy would be unusual because of her age, but the diagnosis must be considered for practically all complaints in an adolescent of childbearing age. Migraine headache would be unlikely to produce the cardiac finding of “racing heart” reported in this child. Diabetes can produce a variety of findings, but important clues missing from this case include frequency of urination, weight loss, and other classically seen symptoms. Adolescent fainting spells (vasovagal reaction) are common, and many of the symptoms reported can occur during an episode. They commonly are seen during stressful situations, in groups of adolescents, or sometimes with minor symptoms; hypertension is not one of the features.