brain power
In which of the following situations would an LP be most appropriate during the work up of a febrile seizure?
A child who had a single tonic-clonic 3-minute febrile seizure on Amoxicillin for AOM
Your sister, a flower farmer in rural TN, just moved into a 1948 “fixer upper house” to prepare for her new baby being born in February. After months of hard work, she and her husband finally finish the last final touches and are exhausted. At her next OB appointment, they note that her Hgb was low and reflex it with a PBS which shows basophilic stippling. What is the most likely cause of this patient’s anemia?
Lead poisoning
The MC infectious cause of death in children <5 years of age is _____. The MCC of this in children 3 weeks - 4 years is ____.
pneumonia, viral (RSV)
Coxsackievirus A16, enterovirus A71
treatment for an infection posterior to the orbital septum
Vancomycin + Ceftriaxone (or Cefotaxime) + Metronidazole until intracranial involvement excluded
A mother frantically brings her 4-month-old baby boy into the ED screaming that he’s having a seizure. Per mom, the child has been sick for the past couple of days after his big brother brought something home from daycare. When you examine the child, you see no current seizure activity. The mother describes the episode as “his whole body was shaking” and states it lasted for 3 or 4 minutes. She denies any previous history of neurological conditions and states this has never happened before. The child’s temperature was 100.8 F in triage. What is your next step in management of this child?
Acetaminophen, education for the parent, no indication for labs or imaging for simple febrile seizures.
A 16-year-old patient with a PMH of sickle cell anemia presents to the ED for a vaso-occulsive painful episode. He is currently afebrile with all vitals within normal limits apart from his 10/10 abdominal pain. He states that he was out in the sun for several hours the day before which he thinks triggered the event. He states he usually has success with Dilaudid for his pain episodes. His Hgb is at his baseline. What is the most appropriate acute management of this patient? Long term management?
IV fluids and Dilaudid (use individualized plan if available) for acute management. Hydroxyurea for long term management.
red flags for RSV
central cyanosis, RR > 70, decreased activity & auscultated movement, dry mucous membranes, hypoxemia, apnea
Ribivirus causes this disease
Rubella (German Measles)
treatment for OP periorbital cellulitis with skin trauma
Augmentin, cefpodoxime or cefdinir + Bactrim or Clindamycin
A 16-year-old female presents to the ED with c/o a HA, photosensitivity, and nausea following a high school women’s soccer game against Green Hope High School. The patient states that she was cleated in the head after a dirty tackle. Which of the following symptoms would warrant prompt neuroimaging?
Bruising behind the ear (Battle sign) – suggestive of a basilar fracture and should have prompt neuroimaging. Vomiting and brief/questionable LOC are “medium risk” and should warrant imaging if symptoms are not improving
You have a 4-year-old presenting to the PCP for a well child visit. The mother has no complaints, other than she feels like her child has been a bit more sedentary recently. She has been going to bed easily (which is not her norm), been less active on the playground, and has been requesting Pedialyte popsicles 2-3 times per day. The patient appears pale on examination but otherwise looks to be in good condition. You decide to order a CBC, which returns 2 days later with a Hgb of 10.4, MCV of 78%, Ferritin of 12, and slightly elevated TIBC. What is an important question to ask the mother regarding this child’s diagnosis?
What is the first line management for this child?
How much cow’s milk are you giving your child each day? (should be < 20 oz for children <5)
PO ferrous sulfate 3-6 mg/kg/day QD for 3-6 months, repeat CBC 4 week after treatment & parent education on dietary choices (milk avoidance, high iron foods)
treatment for a chronic PA infection in a 6 year old with PMH of cystic fibrosis..
speaking of CF what's the MC pathogen causing pulmonary infections in these individuals?
28 day course of inhaled Tobramycin, can be repeated if necessary
Staph aureus (MSSA) is most common 70.2%
MC pathogen that causes Roseola (6th disease)
HHV6B
treatment for severe otitis externa
Ciprofloxacin-hydrocortisone or Neomycin-polymyxin B-hydrocortisone + wick
A 5-month-old child is brought into their PCP with a CC of “growth delay”. The mother states that this is her second child, and she just doesn’t feel like she is developing as quickly as her first child. Her first child was born at 37 weeks, her second at 34 weeks gestation. Upon further questioning, you find out that she’s had a hard time holding her head up without support and has not learned to roll over onto her back. When you examine her, you note 3+ reflexes and increased muscular tone on the R side. What should be your next step in the management of this child?
MRI of the head (cerebral palsy)
A 3-year-old child presents with her parents to their PCP. They note that she’s been lethargic recently, hasn’t had her normal appetite, and that she’s had a fever for over a week now. Initially they thought she had some sort of viral infection, but mom is concerned that it has gone on for so long. On exam the girl has a bruise just under the R patella and a palpable spleen. You notice that several of her LN are enlarged but non-tender. You decide to send her to the ED for further workup, which reveals pancytopenia on CBC and >20% lymphoblasts on bone marrow biopsy. What is the most likely diagnosis?
If this patient presents 4 months later with an ANC <100 with a fever, what should your management be?
Acute Lymphoblastic Leukemia (ALL)
Fever in a neutropenic patient is a medical emergency – need a full sepsis workup & empiric IV antibiotics including coverage of PA
Parental treatment options for an acute exacerbation in a CF patient found to be PA
Pip/Tazo, Ceftazidime, Cefepime, Imipenem-cilastatin, Meropenem, OR Ticarcillin-Clavulanate PLUS Ciprofloxacin, Levofloxacin, Tobramycin, Amikacin, OR Colistin
Both rubeola & mumps are caused by a virus in the ___ family
Paramyxoviridae
treatment for someone with severe pharyngitis, fever, drooling, hot-potato voice, uvular deviation
Ampicillin-sulbactam (or Clindamycin) + Vancomycin if severe disease/refractory then 14 days of PO Augmentin or Clindamycin
You’re working in the NICU for the summer doing your rounds when you notice one of the babies has a heart rate in the 80s. When you examine the infant, you note bulging of the anterior fontanelle, prominent cephalic veins, & a large head circumference. What is the most common mechanism of the most likely diagnosis?
What is the preferred imaging modality for the evaluation of this child?
Obstruction of CSF (non-communicating)
Ultrasound - preferred for neonates/infants
A mother brings in her 8-year-old with a CC of “rash”. On examination, the patient has petechiae on the lower extremities and a couple bruises that the mom says he got while playing with the neighbors. His vitals are significant for a HR of 112 and a temperature of 100.7 F which the mom states she didn’t know he had. You do not appreciate any lymphadenopathy or organomegaly. After sending him to the ED, you follow up on his chart and note a CBC with a Hgb of 8.9, platelet count 97, and a WBC count of 4. What is considered the gold standard test for the most likely diagnosis?
Bone marrow biopsy with aspiration – hypocellular / fatty biopsy (Aplastic anemia)
IP treatment for a 4 year old with 101.8 F temp, diarrhea, tachypnea & poor feeding with a round infiltrate on CXR
How would treatment differ for OP?
Ampicillin or Pen G preferred, Cefotaxime and Ceftriaxone alternative options (uncomplicated bacterial PNA > 6 months)
Amoxicillin if no allergy, 3rd gen cephalosporin (Cefdinir) for mild PCN reactions, and Levofloxacin, Clindamycin or Linezolid for serious PCN allergies
this pathogen is responsible for the inflammatory response leading to Kawasaki disease
million dolla question...it's unknown :)
treatment for a fever + bulging, erythematous TM in a 3 year old with an PCN allergy that results in respiratory distress
Azithromycin, clarithromycin, or clindamycin