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4560 Pediatrics

A 5-year-old girl without past history of UTI is in the hospital on antibiotics for E coli pyelonephritis. She is still febrile after 4 days of appropriate antibiotics. A renal ultrasound revealed no abscess, but a focal enlargement of one of the lobes of the right kidney. CT scan of the abdomen reveals a wedge-shaped area in the right kidney distinct from the normal tissue with minimal contrast enhancement. Appropriate management of this patient includes which of the following interventions?

AProlonged antibiotic therapy
BRoutine treatment with 10 to 14 days of antibiotics for pyelonephritis
CSurgical consultation
DDimercaptosuccinicacid (DMSA) scan
Pediatrics
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4561 Pediatrics

A 6-year-old boy is often teased at school because he has stooled in his underwear almost daily for the last 3 months. He was toilet trained at 2 years of age without difficulty, but over the last 2 years he has developed ongoing constipation. His family is frustrated because they cannot believe him when he says, “I didn’t know I had to go.” He is otherwise normal; school is going well, and his home life is stable. His only significant finding on examination is stool in the rectal vault. The plain radiograph of his abdomen is shown. Initial management of this problem should include which of the following?

ABarium enema and rectal biopsy
BFamily counseling
CTime-out when he stools in his underwear
DClear fecal impaction and short-term stool softener use
Pediatrics
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