Peds Practice Cases
4-day-old baby boy born at home presents for evaluation of vomiting and abdominal distention. Physical examination is notable for distended abdomen and expulsion of air on rectal exam. Mom reports the child is constipated and has not had a bowel movement yet. What's most likely dx and which test is required to confirm diagnosis?
Hirschprung Dz Rectal Bx
6-year-old boy presents to the Emergency Department with periorbital swelling. His mother notes that for the past three days the periorbital swelling would appear in the morning and gradually decrease throughout the day. The boy also presents with loss of appetite, abdominal pain, and loose bowel movements. The physical examination reveals an fussy child with blood pressure of 100/70 mmHg and temperature of 37oC. He has periorbital edema, anicteric sclerae, pink palpebral conjunctiva, clear breath sounds, a nontender abdomen, no bipedal edema, and capillary return less than 2 seconds. Urinalysis is positive for 3+ proteinuria and red blood cell count of 10 cells/hpf. Serum cholesterol and triglyceride levels are elevated with serum albumin less than 2.5 g/dL. What is the initial drug of choice for the most likely diagnosis?
(most likely dx is nephrotic syndrome) Prednisone
Upon stroking of the lateral aspect of the sole from the heel to the ball of the foot, the great toe dorsiflexes and the other toes fan. This is a positive what sign?
Babinski (normal in pts < 2 y/o)
Breast milk jaundice
-Unconjugated hyperbilirubinemia caused by a molecule in breast milk that increases enterohepatic recirculation of bilirubin. -Presents after the first 3-5 days of life and peaks about 2 weeks after birth.
Rule of 5s for neonatal conjunctivitis
0-5 days old: N. gonorrhoea 5 days to 5 wks: C. trachomatis 5 wks to 5 yrs: Strep or H. Flu
After what timeframe should an infant return to birthwt?
2 weeks
A 2-week-old, ex-34 week male infant presents with fever and abdominal distension. The patient has decreased bowel sounds and bloody stool in his diaper. What test should be obtained to make the diagnosis?
Abd Xray
A 7-year-old boy presents with his mom because his teacher says he "zones out" all day at school. His mom denies hyperactivity or destructive, disobedient actions but says he often "stares off" during meals for a few seconds. An EEG shows a generalized 3-Hz spike and wave pattern. What's most likely dx and first-line tx for this boy?
Absence (petit mal) seizure Ethosuximide
Mother brings her previously healthy 6 y/o son to clinic because he's been limping and c/o left leg and knee pain for the past week. Mom denies any recent trauma and his PMH is unremarkable. PE reveals T: 100 (O) w/o LE edema, misalignment or weakness. Pt has TTP over R knee, hepatosplenomegaly & petechiae on chest & cheeks. What's most likely dx and next best step in his evaluation?
Acute Lymphoblastic Leukemia (ALL) CBC w/diff.
6-year-old boy is brought to the emergency room by his mother because he has been complaining of severe abdominal pain that started yesterday. He has refused to eat for the past couple of days and has vomited once since arrival to the emergency room. He has not had a bowel movement for the past 3 days. On physical exam he appears to be in moderate distress. His abdomen is soft but is exquisitely tender in the right lower quadrant on palpation. Rebound tenderness is absent. Rectal exam reveals stool in the rectal vault. Vital signs are T 101.3°F, HR 119, BP 100/68, and oxygen sat 98% on room air. What's most likely dx and which of the following is the most appropriate diagnostic study?
Acute appendicitis Abd U/S
A father brings his 2-week-old to the ED after a gagging episode at home where the infant "turned blue." The newborn had been sleeping in his father's arms when he started choking, turned blue, and went limp. The father turned the baby over, did five back blows, and performed CPR for two minutes until the newborn started crying and his color returned to normal. The father does not report any recent illnesses. On exam, the newborn appears sleepy but is easily arousable. V/S: HR 152 bpm, RR 30, T 37.6°C, SpO2 99% RA. PE is unremarkable. What's the best next step in management?
Admit for further w/u
Mom brings her 11 month old daughter to clinic bc of a persistent facial rash. The child is restless at night and scratches in her sleep. She is otherwise healthy. PE reveals a well-appearing, healthy white female w/dry, red scaly areas on the cheeks, chin and around the mouth. Diaper area is spared. Areas on cheek have a plaque-like, weepy appearance. Remainder of PE is unremarkable. What's most likely dx and next step in management of this infant?
Atopic dermatitis *ask about fam hx of asthma, allergic rhinitis! get more thorough hx to eval rash duration & exacerbating factors
4-month-old infant is brought to the clinic by his mother with complaints of a cough x 3 weeks. Initially, symptoms included running nose, sneezing and an irritating cough. Over the past week the cough has changed to persistent staccato, paroxysmal forceful coughs ending with a loud inspiration. WBC is 20,0000/mcl w/ 72% lymphocytes. What's your suspected dx and drug of choice for managing this patient?
Azithromycin Pertussis (whooping cough)
3-year-old boy presents in severe respiratory distress. His mother informs you that he has been ill for the last 5 days, initially with a low-grade fever and "barky cough." He was seen at an urgent care facility 4 days ago and given a "breathing treatment" and discharged on steroids. He has become progressively worse despite compliance with the steroid regimen, which prompted his mother to call an ambulance this morning. He is otherwise healthy and up-to-date on his immunizations. On examination, the child is toxic in appearance and febrile. His oropharynx is clear. You hear both inspiratory and expiratory stridor. What is the most likely diagnosis and management indicated for this pt?
Bacterial Tracheitis (barky cough, URI sx, "toxic appearing" child) Bronchoscopy, secure airway! IV ABX IVF
What diagnosis is considered in a child with similar symptoms to croup who appears systemically ill?
Bacterial tracheitis
A 12-year-old boy presents to the emergency department with recurrent headaches. The headaches have been present for the past four weeks and are increasing in intensity. They are worse in the morning and when lying flat, and are associated with vomiting but no nausea. For the past few days, he has complained of blurry vision. His initial exam is notable for altered mental status, extensor posturing, and papilledema. What are his most likely vital sign abnormalities?
Bradycardic (40 bpm) Hypotensive (BP 155/65) irregular respirations (All sx assoc. w/ Increased ICP)
A 2-year-old presents with sudden onset of cough and stridor. On examination the child is afebrile and appears nontoxic with a respiratory rate of 42 breaths per minute. What is the next step in the evaluation of this patient?
CXR (evaluate for foreign bodies)
Household contacts of a patient with bacterial meningitis are best treated with which of the following? A. Amoxicillin (Amoxil) B. Ciprofloxin (Cipro) C. Tetracycline (Sumycin) D. Vancomycin (Vancocin)
Cipro
A 15-year-old girl presents to urgent care with a nonproductive cough and low-grade fever that developed insidiously over the previous week. Physical exam reveals diffuse rales on pulmonary auscultation, and chest X-ray shows diffuse non-focal infiltrates. What's most likely dx and what are 2 extrapulmonary manifestations that come from this dz?
Comm. acquired PNA hemolysis and CNS involvement are possible manifestations
A 3-year-old boy is brought to the urgent care clinic by his mother. She tells you he has had a fever and cough for the past 2 days. His temperature is 38.6°C (101.5°F) and his respiratory rate is 35/min. Auscultation of the lungs reveals inspiratory stridor with a prolonged inspiratory phase. A chest X-ray shows subglottic narrowing. Which of the following is most likely the best treatment for this child's condition?
Corticosteroids (pt presenting w/croup)
An 18-month-old boy is brought in by his parents for shortness of breath. The parents woke to him coughing a low-pitched cough. They also noted other noises when he was breathing in that resolved upon walking outside. The patient is frequently coughing but has no abnormal sounds on auscultation of the neck or lungs. What is the most likely dx and most appropriate treatment?
Croup Dexamethasone
A 12-month-old child with tetralogy of Fallot is most likely to have which of the following clinical features?
Cyanosis
5 y/o girl comes to clinic with her mom c/o fever, malaise and a cough for 2 days. Her PMH is significant for asthma and she has tried multiple OTC cold/allergy meds but her resp. sx have worsened over the past several months. PMH is also significant for rectal prolapse and sinusitis for the last 2 winters. Mom also tells you her daughter has always been "small for her age". After taking her vitals, you note she's at the 5th percentile for ht and wt. T: 101 RR: 32. Pt has scant purulent rhinorrhea bilaterally, wheezy breath sounds in all lung fields and diminished breath sounds on R side. You note digital clubbing but heart sounds and cap. refill are normal. What's the most likely dx and next best step in evaluating this pt?
Cystic fibrosis Perform sweat chloride test and obtain CXR
What 3 findings in a newborn are most consistent w/ breastfeeding jaundice?
Dark green stools 3 wet diapers in past 24 hrs wt loss of 11% from birthweight
What finding in the newborn is an indication of lactation failure jaundice?
Dark, sticky stools
22 month-old male infant presents with one day of barking cough preceded by three days of cold symptoms. On physical examination, axillary temperature is 100.4°F and he has no stridor at rest. Inspiratory stridor is evident when he becomes agitated during the exam. There are no signs of respiratory distress or cyanosis. What's most appropriate tx for this pt?
Dexamethasone PO
18-year-old female with diabetes presents to the emergency department with altered level of consciousness, deep breathing and fruity odor to her breath. What's suspected dx and which medication is indicated for this patient?
Diabetic Ketoacidosis Regular insulin
6-year-old male, a recent immigrant from Latin America, is brought to the emergency department with difficulty swallowing and breathing. On physical examination you note a gray-tan pseudomembrane in the back of the pharynx. There is also tender cervical lymphadenopathy. What's your suspected dx and which PE finding is most specific for dx in this patient?
Diphtheria Pseudo-membrane in pharynx (gray plaque that bleeds when scraped off pharynx)
19 y/o college student presents to university health center w/several days of fever, sore throat, malaise & a rash that developed today. She reports she first started to feel sick 10 days ago w/general malaise, HA & nausea. 4 days ago she developed a fever (103) that has persisted. She is drinking well but has solid-food dysphagia and worsening sore throat. She denies emesis, diarrhea or sick contacts. She takes a daily OCP and took 2 doses of ampicillin yesterday. Upon PE she is well-developed w/ a diffuse morbilliform rash. In no acute distress, she has mild supraorbital edema; bilaterally enlarged tonsils coated w/gray exudate; few petechiae on soft palate & uvula; bilateral posterior cervical LAD; palpable spleen 3 cm below costal margin. Labs show WBC of 17 w/50% lymphocytes and platelet count of 100,000. What's most likely dx, how will you quickly confirm dx and what management/plan is indicated for this pt?
Dx: Infectious Mono (EBV) Quick confirmation w/Monospot assay Supportive care; Avoid contact sports for 1-3 mos. while spleen is enlarged Acute illness lasts 2-4 wks (splenic rupture is a rare but possible complication)
ED calls you to tell you one of your pts is being evaluated for new-onset seizures. 2 y/o boy was in a good state of health until this AM when he c/o a HA and fell to the floor. Boy's mother reports seeing jerking of his arms/legs but PMH and fam hx is otherwise insignificant. When the ambulance arrived 5 min later, boy stopped jerking but was not arousable. His HR was 108, RR was 16, BP 90/60, T: 104 (O). Blood glucose was 135. By the time the child got to the ED he was awake and recognized his parents. PE in ED, CBC and UA were all normal. What's most likely dx and what do we tell his parents as far as management/what to expect if this happens again?
Dx: Simple Febrile seizure More seizures w/fever like this may occur but they should subside by the time he turns 5-6. He's had normal development thus far and will likely continue to do so. Educate parents on injury prevention during seizures, fever control
16 y/o presents to office c/o increased/heavy menstrual bleeding for the last 6 mos. She notes her cycles are regular, occur q29 days and last for 10 days. She reports going through 10-12 pads per day. Her LMP was 1 wk ago and she's c/o dizziness when she stands up. Pt denies concurrent vaginal d/c or abd pain. PMH and fam hx are insignificant for bleeding/clotting disorders. Menarche was at 12 y/o. reports she is not sexually active. PE is remarkable for mild resting tachy & orthostatic hypotension. Nail beds & conjunctiva are pale. Urine hCG is negative; hgB is 10. Most likely dx and management for this pt?
Dysfunctional Uterine Bleeding (DUB) (menorrhagia and iron def. anemia secondary to bleeding also) Tx w/iron supplement and monophasic low-dose OCP for 3-6 mos. F/u for HgB check in 6 wks **Iron supplement should be continued for 2 mos. once anemia has resolved
23-month-old M presents to the office with his father who reports the patient has had an acute onset of severe pharyngitis, fever of 103.5 degrees F and what sounds like harsh, high-pitched breath sounds. His dad states the child has started drooling and seems to be worsening. The child is not presently crying but has muffled voice sounds. The child has not been immunized due to religious reasons. What's your suspected dx and what is the most appropriate next step?
Epiglottitis Transfer pt to ER for intubation
You examine a two-day-old boy in the neonatal intensive care unit. On examination, you note that the neonate is small for gestational age, with microcephaly, enlarged liver, and petechiae. On complete blood count, you note thrombocytopenia. You suspect congenital cytomegalovirus infection. What's most appropriate therapy?
Ganciclovir
A 16-year-old girl is seen in clinic due to vaginal discharge. She complains of gray discharge with a fishy odor. She is sexually active for the past six months and has had one partner. She uses an intrauterine device for contraception. On physical exam you note gray vaginal discharge with a vaginal pH of 5. You then perform a wet mount which shows clue cells. What is the most likely etiologic agent and tx for this pt's likely condition?
Gardnerella vaginalis Metronidazole or clinda PO/intravaginally
A previously healthy 14-year-old boy presents to clinic with intermittent yellowing of the eyes. His mother is concerned because she notices this each time he has returned home from football practice this summer and wonders if he should quit the team. The boy experiences no symptoms during the episodes and was unaware of the yellowing of his eyes until his mother mentioned it. His exam is currently unremarkable. A liver panel is significant for an unconjugated bilirubin of 3 mg/dL. A CBC, peripheral smear, and reticulocyte count are unrevealing. The remainder of the panel is normal. What's your suspected dx and what is the next best step in management?
Gilbert syndrome (inherited disorder of bilirubin conjugation) Supportive care
A 22-year-old woman comes to the office because her urine is cola-colored and she has not urinated since yesterday morning. Her past medical history is significant for pharyngitis two weeks ago. Her mother and grandmother have type II diabetes. Her blood pressure is 146/92 mmHG. On physical examination, she has edema of her face and hands. What's most likely dx?
Glomerulonephritis (can occur 1-3 wks post strep infection)
MC etiology of otitis media?
H. flu (s. pneumo is also a big one)
6-year-old male presents with hemarthrosis of the left knee. Coag studies: PT 12.5s (normal 12-14 sec), INR 1.0, aPTT 58s (normal 18-28 sec), platelet 430,000/microliter (normal 150,000-450,000/microliter), and bleeding time 4m (normal 2-12m). What's the best treatment option for this patient and what's your suspected dx?
Hemophilia A Cryoprecipitate
A 7-year-old boy presents with five days of abdominal pain, arthralgias, and a rash of the lower extremities. Mild diffuse abdominal tenderness is noted on examination. The left knee and right ankle are swollen and tender without warmth or erythema. The rash consists of purple, non-blanching macules and papules of both legs and thighs. What's the most likely dx and which initial lab test is indicated?
Henoch-Schnlein-Purpura (IgA Vasculitis) UA to evaluate for glomerulonephritis
An 18-year-old female presents to the office with fever, fatigue and sore throat. Physical examination reveals an erythematous pharynx, cervical lymphadenopathy and splenomegaly. CBC reveals an increased white blood cell count with atypical lymphocytes, normal hemoglobin and hematocrit and normal platelet count. What additional laboratory test will help you make the diagnosis in this patient?
Heterophile (Monospot) test
A 4-month-old baby presents to your office with symptoms of worsening constipation, poor feeding, listlessness, and generalized weakness for two weeks. Physical exam findings include temperature of 98.6°F, ptosis, poor head control and poor ability to suck. Which of the following is the most appropriate initial therapy?
Human-derived botulism immune globulin (dx here is botulism from constipation AND ptosis, facial, generalized weakness "floppy baby" sx)
A 23-year-old male presents with syncope. On physical examination you note a medium-pitched, mid-systolic murmur that decreases with squatting and increases with straining. What's the most likely dx?
Hypertrophic Cardiomyopathy
What GI disorder is associated w/ erythromycin use in neonates?
Hypertrophic pyloric stenosis
A 10-year-old boy presents to your office with complaints of fever, malaise, and facial swelling that began four days ago. He is not up-to-date on his immunizations. Physical examination reveals a temperature of 99.8°F and enlarged parotid glands. What's the most appropriate therapy?
Ibuprofen
7-year-old girl presents to urgent care complaining of vaginal irritation over the last several days. Mom noticed that the patient's vaginal area is abnormally red and irritated and that her underwear has been slightly damp. The patient denies bleeding, urinary complaints, or abdominal pain. On exam, the patient's vulva appears erythematous and a small amount of whitish discharge is present. There is no foul odor, bleeding, or abnormal lesions present. What's the most likely cause of the pt's presentation?
Irritant vulvovaginitis (MC cause of vulvar irritation in prepubertal girls)
A six-year-old girl is brought by her mother to the clinic due to fever and sore throat. The girl has had a fever for five days with a maximum temperature of 38.5°C that is minimally responsive to antipyretics. She is irritable with decreased appetite. On examination, there is bilateral bulbar injection, erythema of oral mucosa, enlarged anterior cervical nodes, and macular rash on trunk and extremities. What's the most likely diagnosis and tx for this pt?
Kawasaki disease IVIG ASA
4-year-old boy is brought to the ED by his parents because of severe abdominal pain and constipation for 2 days with no improvement. Prior to this episode, his mother states that he has become increasingly irritable and lethargic over the past 2 weeks to the point where he has stopped speaking. Review of the patient's medical history shows that he failed to meet developmental milestones over the past year. When asked about this, the parents mention that he has been having a hard time adjusting since they moved into an older home with many of the original fixtures 15 months before. Physical examination of the patient shows marked lethargy and is otherwise normal. What's most likely dx?
Lead poisoning (Level of <10 is positive)
7-year-old boy is brought in by his mother with concerns about limping for the past few days. He denies pain or recent injury. Physical examination reveals limited left hip motion and a limping gait. Hip radiographs reveal a hypointense subarticular line and a partial collapse of the femoral head. What's most likely diagnosis?
Legg-Calve Perthes Dz (consistent w/findings of AVN of hip)
Physiological Jaundice
MC type results from normal immaturity of conjugation enzymes, increased Hct, shortened RBC life span, increased enterohepatic circulation
A mother brings her 22-month-old child to the ED after noticing bloody bowel movements. The child has a normal birth history. Mom denies any pain associated with these episodes, but she states that the child has become increasingly pale with decreased energy. His vital signs include a blood pressure of 95/60 mm Hg, heart rate of 140 beats per minute, respiratory rate of 24 breaths per minute, and oxygen saturation of 98% on room air. Abdominal examination is unremarkable, but his stool is guaiac positive. What's most likely dx and what diagnostic tool is most likely to confirm the diagnosis?
Meckel diverticulum (painLESS rectal bleeding!) radionuclide scanning (technetium-99m pertechnetate scintiscan) aka Meckel scan
A four-year-old child presents to the emergency room with high fever, barking cough, stridor and moderate retractions at rest. Which stage of croup is this and what's the most appropriate treatment for this condition?
Moderate croup Nebulized racemic epi
An 8-year-old girl presents to the emergency department with a one-day history of rash. The rash is erythematous, macular, blanching, and covers her trunk and extremities. It is not painful or pruritic, and there are no vesicles, bullae or mucosal lesions noted. She has bilateral lymphadenopathy in the posterior cervical chains with splenomegaly on palpation of her abdomen. The rest of her physical exam is normal. Her pediatrician started an antibiotic last week for pharyngitis but she has not improved. What is the most likely etiology of her rash?
Mononucleosis
A 2-year-old boy presents to the ED with a painful swelling in his scrotum for the past four hours. His parents report a bulge in the groin area that comes and goes, but now is not going away. On exam, you note engorgement of the right scrotum. The child screams in pain when you try to touch the mass. What's the most appropriate next step in management?
Morphine sulfate (pt has incarcerated inguinal hernia which cannot be manually reduced)
A 15-year-old male was seen last week with complaints of sore throat, headache, and mild cough. A diagnosis of URI was made and supportive treatment was initiated. He returns today with complaints of worsening cough and increasing fatigue. At this time, chest x-ray reveals bilateral hilar infiltrates. A WBC count is normal and a cold hemagglutinin titer is elevated. most likely diagnosis is?
Mycoplasma PNA (insidious onset of sx, bilateral interstitial infiltrates, elevated cold hemaagluttinin titer)
Mom brings her son to clinic because she's concerned his face and chest are turning yellow. Her infant was born vaginally after uncomplicated term pregnancy. Fam hx is unremarkable. Outside of a large cephalohematoma, PE is unremarkable. He is breast-feeding well and shows no sign of illness. What's the most likely dx and next step in evaluating this pt?
Neonatal jaundice (Hyperbilirubinemia) Next step: get a serum or transcutaneous bilirubin level
Dad brings in his 3 y/o daughter and reports she's had less energy, loss of appetite, enlarging abd over past few wks. Intermittent emesis began yesterday. PE reveals pallor, proptosis, periorbital discoloration and large, irregular abd mass along her L flank that crosses the midline. VS and remainder of PE are normal. What's most likely dx and next step in evaluation?
Neuroblastoma (Ddx includes Wilms Tumor) Get CBC, CMP and refer for further lab testing & CT w/u to evaluate tumor
A 6-year-old girl presents with four days of lower abdominal pain. The patient complains of dysuria. On exam, the patient is afebrile and has mild tenderness to palpation in the suprapubic area. No costovertebral tenderness is elicited on exam. A clean-catch urine sample is sent for urinalysis. What's the most specific finding on the UA to confirm the diagnosis if UA is positive?
Nitrites
A 14-day-old neonate presents to clinic with bilateral eye discharge and conjunctival injection. What treatment is indicated?
Oral erythromycin
A 16-year-old girl presents to clinic with 3 weeks of worsening right knee pain. She attends dance class since age 5 and now dances 20 hours a week. She denies any inciting injury and continues to dance on the injured leg. On exam, she has pain at the inferior and medial pole of the right patella with no swelling or erythema of the knee. What's the most likely diagnosis?
Patellofemoral pain syndrome
18-year-old sexually active female was seen in the student health clinic 1 week ago for a sore throat. A streptococcal antigen test was positive, and she was given a prescription for oral penicillin. After 3 days, she stopped her medication because she felt better. She now presents with a severe sore throat. On physical examination, she has a temperature of 102.6° F (39.2° C), marked pharyngeal erythema, medial deviation of the soft palate on the left, tender left anterior cervical adenopathy, and a "hot potato" voice. The rest of her history and physical examination are unremarkable. What's most likely dx?
Peritonsillar abscess
A two-month-old male infant presents in August with a copious, bubbly, tenacious mucous discharge from his nose and mouth. He also has a repetitive paroxysmal cough terminated by an inspiratory "whoop" and followed by post-tussive emesis. The infant had upper respiratory symptoms for the past two weeks. His parents report a possible seizure before taking him to the emergency room. Other infants in his day care center have been diagnosed with respiratory infections associated with a "prolonged" cough. The infant is pale and cyanotic, tachypnic and bradycardiac as well as anxious looking. Physical examination of his chest is consistent with a lobar pneumonia. What's most likely dx?
Pertussis (Whooping cough)
Mom brings her 2 y/o daughter to clinic c/o perianal & perineal itching. Mom notes itching occurs more at night but denies fevers, diarrhea or emesis. her daughter goes to a "mother's day out" program 3 x per week but is otherwise w/mom. On PE, perineal area is red & irritated; anal sphincter tone is normal and there's no evidence of trauma. You note slight whitish vaginal d/c but diaper area is otherwise clean. Most likely dx? How do you confirm dx? Best management for this child's condition?
Pinworms (enterobius vermicularis) confirm w/cellophane tape to ID pinworm eggs tx w/mebendazole or albendazole & tx family
2-year-old previously healthy girl presents to the ED with complaints of 3 days of low-grade fever and congestion followed by noisy breathing and cough. Upon examination, you note a frequent barking cough, audible stridor at rest, and retractions. The child does not appear to be in any distress. Which of the following is the most appropriate next step in management?
Pt has moderate croup and should receive PO steroids and racemic epinephrine nebulizer and be observed in the ED for 3 hrs and discharged if symptoms abate
2-week old infant is brought to the office for a well child visit. The physical examination is completely normal except for a clunking sensation and feeling of movement when adducting the hip and applying posterior pressure. What's the most appropriate next step?
Refer to ortho for consultation (This pt likely has developmental dysplasia of the hip)
4-year-old boy presents with throat pain. Mom indicates that the pain started four days ago and has progressively worsened. The patient is refusing to eat or drink. His temperature is 38.3°C, HR 143 bpm, and oxygen saturation is 96% on room air. On exam, he has significant pain with extension of his neck. You note cervical lymphadenopathy, a muffled voice, and some drooling. What's suspected dx and what do you expect to see on Xray?
Retropharyngeal abscess widened retropharyngeal space twice the size of the vertebral body
Which of the following Rh genotypes in a mother and father would represent a risk for hemolytic disease of the newborn?
Rh - Mother Rh + Father
A 13-month-old boy is brought by his anxious parents to the clinic because of a rash. For the previous three days, he has been having high-grade fever that is lysed by ibuprofen. Then today, he became afebrile, and the mother noted the appearance of a rash on the neck and trunk. On physical examination, his temperature is 37.3ºC, heart rate is 104 beats per minute, respiratory rate is 25 cycles per minute. His skin examination reveals blanching maculopapular rash on the neck and trunk that has spread to the face and extremities. What's most likely dx?
Roseola
What is the most common sequelae of congenital CMV?
Sensorineural hearing loss.
A 4-year-old girl presents complaining of left knee pain. The patient was started on antibiotics one week ago for a simple ear infection. She now has a widespread morbilliform rash, urticaria, several swollen joints, and temperature of 102.74°F (39.3°C). What's the most likely diagnosis?
Serum sickness (type III hypersensitivity)
A 7-year-old boy with worsening scrotal pain for the past 3 days presents to your office. Upon examination, there is a swollen left hemiscrotum with overlying erythema. There is a dark blue dot present in upper pole of the left testicle. What's the most likely diagnosis?
Torsion of the appendix testis buzzwords are "dark blue dot" (MC cause of testicular pain in boys 2-10 y/o)
T/F: Seizures that develop during adolescence and adult life are predominantly due to tumor, trauma, drug use, or alcohol withdrawal.
True
T/F: The risk of developing coronary artery aneurysms in Kawasaki disease is greatest for children under 1 year of age.
True
2-month-old girl is found to have positive Barlow and Ortolani signs. Which of the follow is the most appropriate diagnostic study?
Ultrasound
A four-year-old boy presents to the emergency department for inability to walk. He has had two days of leg pain and has been irritable for the past day. The morning of presentation, he refused to get out of bed or bear weight. On his initial examination, he has 1/5 strength in his lower extremities, and 4/5 strength in his upper extremities. Patellar reflexes cannot be elicited. Which of the following is the most likely CSF finding?
WBC 2 Glucose 65 Protein 135
Peak incidence of SIDs occurs in newborns of what age?
b/t 2 and 4 mos.
13-year-old F presents to the office with right knee and thigh pain and the inability to bear weight since waking yesterday morning. The mother states the child had a fever of 100.9 degrees F this morning and continues to be non-weight bearing. Examination reveals a warm, erythematous, swollen knee. Which test would be most beneficial in the diagnosis and treatment of this patient?
culture of joint aspirate
A 20-year-old male presents with a mass in the groin. On examination with the patient standing, a mass is noted that extends into the scrotum. The patient denies any trauma. most likely dx is?
indirect inguinal hernia
4 year-old boy presents with pain and irritation of his left ear. Otoscopic examination reveals an insect in the left auditory canal. The tympanic membrane is not completely visualized. What's most appropriate management of this patient?
insert lidocaine solution w/suction or forceps removal
A 13-year-old boy with leukemia presents with epistaxis for two hours. The bleeding site appears to be from Kiesselbach's area. The most appropriate intervention is?
intranasal petroleum gauze
What is the "female athlete" triad?
low energy availability menstrual dysfunction low bone density
26-year-old female reports progressive distal to proximal spread of extremity weakness over the last 36 hours without fever, headache or syncope. Examination reveals symmetrical, paresis of the hands and feet with loss of the brachioradialis and Achilles reflexes. Biceps and knee reflexes are present but diminished. Sensory exam is normal. What are the most likely findings on cerebral spinal fluid (CSF) analysis?
normal glucose normal WBC elevated protein
what are 3 CIs to receiving MMR vaccine?
pregnancy immunocompromised advanced malignancy
A 2-year-old girl presents to the ED reluctant to move her left arm. The patient's father states that he had grabbed his daughter by her wrist to pull her up from the floor. On exam, there is no swelling or deformity. Which maneuver can be attempted to correct the injury?
simultaneous supination and elbow flexion
18-year-old male presents with pain in his wrist after he fell off of a moving motor cycle. Physical examination reveals tenderness in the anatomic snuffbox. No fracture is noted on plain radiography of the wrist. What's the recommended treatment for this patient?
thumb spica splint (scaphoid fx)
How is measles transmitted?
via person-person contact as well as airborne spread
A 22 year-old female presents to the emergency department with rapid heart rate. She appears thin and dehydrated. She denies that she is thin, stating "I am so fat that I can hardly stand myself! That is why I exercise every day." She runs twelve to fifteen miles a day, and on weekends also bicycles forty to fifty miles. Her LMP was six months ago. On exam, she is 5' 6" tall and weighs 98 pounds. Temp 98 degrees F, pulse 100, respirations 18, BP 98/60. EKG shows sinus tachycardia. Laboratory findings include Na 138 mEq/L, K 2.8 mEq/L, Cl 91 mEq/L, BUN 35 mg/dL, Creatinine 1.1 mg/dL. What's the next most appropriate treatment?
wt restoration and family therapy
