A previously healthy 7 y.o brought to peds b/c 1 week history of low grade fever and fatigue and a 3 day history of rash and moderate pain and swelling of ankles. Rash first appeared on ankles but has spread over his legs during the past 24 hrs. Tep 38.2. Exam shows palpable petechiae and confluent purpuric areas over lower extremities. Ankles are swollen and mildly tender.
A. ankylosing spondylitis
B. Behcet syndrome
D. henoch schonlein purpura
E. Juvenile rheumatoid arthiritis
G. Psoriatic arthiritis
H. Reactive arthritis
palpable petechiae/purpura in lower extremities = HSP. Edema is due to kidney involvement.
2yo has 2week history of irritability, poor appetite, occasional cough, and reluctance to walk. Has had 2kg weight loss since her last exam 6mo ago. No history of reuccrent respiratory illness, constipation, vomiting, or diarrhea. Appears uncomfortable and quiet. 7th%ile for height and 25%ile for weight. Temp = 100.2, Pulse: 140, RR: 24, and BP: 145/100. Bluish discoloration under both eyelids. Cardiac and abdominal exam normal. Labs:
Leukocyte: 8300 (Neu: 40%, Lymph: 55%)
Lateral x-ray of chest shows mass in posterior mediastnum. Diagnosis?
B. Congenital heart disease
F. Pulmonary Sequestration
Reluctance to walk (possible bone lesion), weight loss, poor appetite, etc over the course of 2 weeks makes me worried about malignancy. When I read bluish discoloration under eyelids, I think of neuroblastoma (case files says it's due to orbital involvement of the neuroblastoma).
A previously healthy 3 year old boy brought to doc b/c fever, sore throat, malaise, poor appetite for 2 days. He says that his throat feels scratchy. There has been no vomiting, diarrhea, rhinorrhea. Active and alert. Temp of 38.7. Exam shows no abnormalities of tympanic membrane or pharynx. Leukocyte count is 9500.
B. IV antibiotics
D. IM ceftriaxone
E. Oral antibiotics
F. Oral corticosteroid
G. Xray chest
There's no obvious indication that the kid has a bacterial infection that warrants treatment (purulent discharge, ear infection, pharyngeal exudate, etc). WBC is normal. At this point, just control the fever with tylenol.
Previously healthy 1 month old boy brought to ER 2 hrs after onset of bilious vomiting. Less active than usual and feeding poorly. Last bowel 1 day ago. Born at 38 weeks. Appears ill. Tep of 38, pulse 180, resp 60, BP 70/40. Abdomen firm and distended. bowel sounds decreased. normal rectal tone. small amt of stool in rectal vault. occult blood positive.
C. hypertrophic pyloric stenosis
E. midgut vovulus
I used process of elimination. Too young for intussusception. Pyloric stenosis causes nonbilious vomiting. Gastroenteritis unlikely to cause bilious vomiting. Hirschsprung unlikely given BM 1 day ago.
7 month old brought ot ER 35 min after seizure onset. Jerking mvts began in left arm the to right arm and both legs. Cyanotic. Temp 39.7, pulse 160, resp 30, BP 90/60. upward deviation of eyes. generalized rigidity and hyperextension of neck, back, all extremities. Clonic jerking mvts. oxigen administered. next step?
Stop the seizure
A 7 year old fainted while on field trip. Progressively lethargic over past winter, and complexion darkened. Her height and weight at 50th percentile. BP 80/40. Lab test?
A. plasma cortisol
B. serum glucose
C. serum gonadotropin
D. serum PTH
E. serum TSH
low BP and darkened complexion - think possible Addison disease