Rashes are the worst
Pediatric Emergencies
Developmental Milestones
Other, Misc
"My child needs
antibiotics"
antibiotics"
100
Treatment for 2 month old with red rash on bilateral cheeks. Mom hx of asthma, dad with hx of food allergies.
Eczema: hydrocortisone ONLY 1% on face. Moisture two times a day (is MAIN stay treatment). Can do higher steroids to body
100
3 month old ex-36wk presenting with congestion, cough and increased work of breathing. Brother is also sick at home. You suction lots of mucus from nares. What is diagnosis and treatment?
Bronchiolitis
RSV (most common offender)
Tx: supportive, suctioning, NS nebs, oxygen therapy
100
Sings, acts, dances for you, uses, recognizes simple rhymes, tells a story with at least 2 events, counts to 10, hops on 1 foot, can draw a triangle
5 years
100
When do you turn the car seat from back facing to front facing?
2 years of age OR max weight or height as it states on the car seat - 45 lbs (which ever comes first)
State dependent
Booster til 8-12 years or until you reach height requirements
Then regular seat belt, should go over their shoulder and across their lap
100
10 month old with increased crying, unable to sleep and fever of 102F. Give diagnosis, most common pathogen and treatment.
R L
Otitis Media
Strep pneumo, Hib, Moraxella
Tx: Amoxicillin two times a day 10 days
200
It's summer time and a parents brings in their 15 month old who attends daycare with rash and refusing to eat, what is criteria for inpatient admission.
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HFM disease - often rash on buttocks as well. Criteria for admission: dehydration Tx: adequate pain control
200
2 year old who has history of peanut allergy, ate a cookie today given by sister 5 mins ago, now presenting with hives all over body, looks like he's having trouble breathing has swollen lips and vomited twice on the route here, what is your immediate treatment ?
Anaphylaxsis
IM Epi
Others: albuterol if wheezing, if rash, benadryl, if vomiting famotidine
200
Sits up with hands supporting her, laughs, squeals, likes to look in the mirror, puts things in her mouth, rolls tummy to back
6 months
200
Neonate born with this rash, what antibodies did mom have?
Anti-Ro + Anti- La
200
6 yr old with increased coughing, chest pain, fever for past 3 days of 103F, barely going down with tylenol/motrin. Pulse ox 88% on RA. CXR below. You decide to admit for oxygen therapy, what is your antibiotic of choice?
Lobar PNA, most common pathogen Strep Pneumo
Treatment: IV Ampicillin
Outpatient: Amoxil BID for 7 days
300
6 month presenting with itchy rash below, family members are also itching, what is treatment ?
Permethrin + WASH everything (If not washable, Dry-clean or seal items in a plastic bag for at least 72 hours to up one week)
300
2 year old presenting with URI sx for past 2 days, started having high pitched noise when breathing as per parents tonight, lungs reveal transmitted upper airway sounds. Looks like is having trouble breathing, what is the main stay treatment?
Croup caused by any URI (parainflu tested)
Dexamethasone
Rac Epi if respiratory distress
300
Waves bye bye, calls parent mama + dada, pulling to stand, walks if holding onto something, can hold something small with just thumb and first finger
12 months
300
A patient with blood smear as noted below is at risk for invasive infections from what kind of pathogen, what preventative measures do we take for this patient?
encapsulated organisms - due to auto splenectomy
Get Amoxil til age 5 + extra Meningococcal and Pneumococcal vaccines for immunocompromised
300
6 year old who was recently diagnosed with PNA (treated empirically with 7 days of amoxil), still presenting with strong cough and decreased energy. You get an xray that shows this. Why didn't the amoxil work?
Atypical PNA
Mycoplasma + Chlamydia
NO cell wall - can't treat with beta-lactams
Tx: Macrolids (inhibit 50S subunit Azithromycin)
400
5 yr old with hx of renal transplant presenting with sudden onset of fatigue, hemoglobin went from 9 to 6 and rash erupted as below. What is causing this?
Parovirus B19 - Slapped Cheek appearance
Viral Flu like symptoms preceding these symptoms. Causes bone marrow suppression, this child would need a pRBC transfusion
400
10 month ex-FT presenting with full body shaking episode and fever of 104F, what would prompt you to do more diagnostic tests and what would be the treatment?
Febrile seizures
Simple vs complex (requiring further work up)
Fever control
Benzos if >5 mins
400
Pointing to things they like, walks independently, can get up and down from a couch without help, scribbles, helps you dress him by pushing hand through sleeve and lifting foot, follows one step commands "give it to me", has 3 or more words besides mama dada, uses a spoon
18 months
400
12 year old with hx of moderate persistent asthma (2 PICU admissions, 1 intubation in past), atopic dermatitis and food allergies, presenting with chest tightness that worsened overnight. You listen his lungs and find increased expiratory phase, minimal air movement, patient is not speaking much, just nods yes and no. What is your immediate treatment?
Asthma Exacerbation
Tx: Duonebs x3, steroids (IV or oral)
Can also do:
Albuterol continuous
Magnesium IV
Terbutaline
Theophylline
Epi
BiPAP
Intubation - Ketamine
400
16 year old presenting with fever, altered mental status, "shaking episode" for 1 min prior to arrival. You do a CSF analysis which found this. Treatment and what do you need to monitor while on this medication?
CSF:
WBC > 10
Predominately lymphocytes
RBC > 50
Glucose normal
Protein elevated
High opening pressure
HSV meningoencephalititis
treatment: IV acyclovir q8h for 14-21 days
Need to monitor renal studies because can cause obstructive nephropathy, can also cause thrombophlebitis - patients get a PICC line
Repeat CSF to make sure of clearance
500
15 yr old presenting with chronic diarrhea, weight loss and rash on legs, what is the gold standard diagnostic test?
Colonoscopy with biopsy for IBD (Crohns or UC). Treatment: acute flare -> steroids
Maintenance -> Masalamine, Biologics (TNF alpha inhibitors - must do TB screening, HIV screening + hepatitis screening prior to starting)
500
9 year old newly diagnosed with leukemia (WBC on presentation 80,000 (nml 4-8k), just started chemotherapy started is now having seizures. Labs show: What is going on and what additional lab value would help you?
Ca of 6 (8-10 is normal)
Phos of 5 (nml 2-4)
K of 5.5 (3.5-4.5 nml)
Tumor Lysis Syndrome
Uric Acid
Tx: FLUIDS
Electrolyte corrections (except Ca)
XO inhibitors
500
runs, kicks a ball, can point to two body parts, two words together "more milk", nodding yes or blowing kisses, plays with more than 1 toy at a time, eats with spoon, walks few steps up stairs, looks at your face to see your reaction to a situation
2 year old
500
A baby is born, mother did not get any prenatal care, with a cleft lip, micrognathia, low set ears and cyanosis at birth, was taken to the NICU, they took a chest xray and started baby on oxygen.
What electrolyte abnormalities do you need to monitor for?
hypocalcemia
DiGeorge syndrome 22q11.2 microdeletion
Tetralogy of Fallot
500
3 year old fully vaccinated M, brought by parents as he is refusing to eat, has neck pain on extension, high fever for past 3 days and his voice is hoarse, you get a lateral xray which shows as below. You admit this patient, call ENT and start which antibiotic?
retropharyngeal abscess
Airway emergency!
Tx: IV ampicillin + sulbactam (Unasyn)