Jeopardy - Peds

Rashes are the worst

100

1 week old M born 36weeks is coming in for a sick visit as mother states he looks more yellow. No history of previous sibling having this happen or family history of being yellow. What is the treatment? 

Neonatal Jaundice - Physiologic most of the time 

Use BiliTool! 

Treatment: Phototherapy 

200

7 yr old F hx of poor weight gain, iron deficiency and chronic diarrhea referred to GI clinic. on exam, is small for stated age, has a rash like below. Family hx: positive for Hashimotos in mother. What is the treatment for this patient? 

Celiac Disease 

Autoimmune mediated intolerance to gliadin

Diagnostics: labwork IgA anti-tissue transglutaminase, anti-endomysial antibiotics, can do IgA levels to make sure they're not IgA deficient 

Gold standard: Biopsy of duodenum and/or proximal jejunum showing villous atrophy 

Tx: gluten free diet 

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)

400

5 yr old unvaccinated child started having fever, feeling fatigue and then 1-2 days later started with a rash, on his trunk which is now all over his body below. You also find out his mother is currently pregnant. What are your next steps  

Varicella - chicken pox

Dew on a rose petal 

Different stages of healing 

Contagious! Airborne and contact 

If mom does NOT have immunity, could pass it on to her fetus as a TORCH infection. Would need VZIG - up to 4 days after exposure 

500

Treatment including Mechanism of Action and if not treated, complications of the following rash with some rhinorrhea that a 9 yr old presented to your office with was in Pennsylvania with his dad this past weekend:

Erythema Migrans (bulls eye rash) - Lyme Disease (caused by Borrelia burgdorferi)

Doxycycline (put sun block on when going outside)/Amoxil 

Complications: Bells Palsy

Migratory arthritis 

Heart Block 

Encephalopathy 

“Previous concerns about tooth staining in children aged <8 years stem from older tetracycline-class drugs that bind more readily to calcium than newer members of the drug class, such as doxycycline"

Pediatric Emergencies

100

1 year old M getting usual screening lab work done at pediatricians office. 

Hbg 6.4 MCV 70, RDW high, Reticulocyte count high 

Upon further questioning, patient drinks 36oz of milk a day. 

What is going on?

iron deficiency anemia due to excess milk consumption

Ca prevents Iron absorption 

Limit to 24oz a day 

Can also supplement with oral iron 2-3 mg/kg/day. studies show every other day good absorption. 

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

300

11 yr old F presenting with rapid shallow breathing, vomiting, abdominal pain, as per mother, has been tired for the past couple days, has been drinking water a lot more than usual and has lost some weight in the past several months. On exam, cap refill is 3-4 secs, What do you anticipate laboratory findings to be in this patient and what is the initial treatment? 

Diabetic Ketoacidosis (DKA)

+ Ketones uirne, POC >500, high anion gap metabolic acidosis, Hyperkalemia 

Treatment: IV bolus fluids 1st! IV insulin, 2-bag system +K in fluids 

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 

500

What is the treatment of a 12 yr old M born in rural Turkey, moved to the US last year, has been having epigastric pain described as burning, worse at night with some weight loss, with dark stools. Food makes it better.

Treatment: Triple Therapy: Amoxil, Clarithromycin and PPI - can quadruple therapy if concerned about resistance 

H pylori (Gram negative, catalase and urease POS) 

Can use Urea Breath Test/Fecal antigen test for probable diagnosis BUT EGD with biopsy, would show gastritis and/or PUD especially around duodenum, correct staining shows you h pylori bacteria, esp with someone with weight loss (concern for MALToma) and dark stools (concern for UGI) 

Developmental Milestones

100

draws a person with at least 3 body parts, hops on 1 foot, can draw a cross, speaks in words that are 100% understandable to strangers

4 years

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 

300

Waves bye bye, calls parent mama + dada, pulling to stand, walks if holding onto something, can briefly stand independently for seconds without, can hold something small with just thumb and first finger. 

12 months 

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

500

runs, kicks a ball, jumps with 2 feet off the ground, can point to two body parts, two words together "more milk", 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

Other, Misc

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 

200

Neonate born with this rash, what antibodies did mom have?

Anti-Ro + Anti- La from mom

DOES not mean baby has lupus

300

2 yr old with autism has a very limited diet (chicken nuggets no veggies, no fruits), presenting with refusing to walk, previously walked fine as per parents. On exam: gums are inflamed, petechia with strange hair appearance, normal DTRs and tone but is refusing to bear weight. What is the Treatment?

Scruvy 

Vit C supplementation, Vit C levels would be undetectable but takes weeks to come back. IF suspicious is high, start ascorbic acid.  

Imaging normal, labs show at times mild anemia.

400

12 month old presenting with R eye lid swelling, how do you differentiate pathology which then helps you decide treatment? 

Preseptal vs Septal Orbital Cellulitis

Tx: oral antibiotics (amox/clav) vs CT scan + IV Amp+Sulbact and potential drainage 

500

Inheritance pattern and major complication of a 2 year old child on exam, weakness of thighs, using arms to get up from ground, CK significantly elevated. 

 X linked due to frameshift deletion/nonsense mutation - genetic testing for diagnosis 

Dilated Cardiomyopathy 

Duchenne Muscular Dystrophy 

progressive myofiber damage, advances superiorly. "Gowers sign" 

"My child needs antibiotics/vax"

100

6 month old switched practices to this new pediatricians office, has not received any vaccines yet. Mom states he has a history of abdominal pain, bloody stool, took her to the ER and then helped her. What vaccines do you want to give them?

Hep B, HiB, PCV, IPV, Dtap 

NO ROTA - contraindicated due to intussusception history 

200

11 month old presented after injury on a rusty nail, previous vaccine history notes 1x dose of Dtap at age 4 months. What should this patient receive today in the ED after cleaning the dirty wound? 

incomplete immunization <3 doses of Dtap or Unknown - give Tetanus IVIG 

and Dtap vaccine 

300

5 yr old M presenting with very dark amber urine, swelling of his eyes and feet. 

His BP in the office is elevated for his height and weight. 

Upon further questioning he had a cold 3 weeks ago which urgent care gave him antibiotics for. 

What do you expect to find on labwork/histology?

Acute poststreptococcal glomerulonephritis 

2-4 weeks after strep pharyngitis or impetigo 

Type III hypertensivity reaction 

complement levels low, ALSO elevated. 

Histology: 

400

17 yr old F presenting with R sided abdominal pain and fever. HEADS exam: multiple sexual partners in the past year - did not use protection. Never been tested for STD 

ROS: +vaginal discharge 

PE: +cervical motion tenderness 

What is treatment? 

PID (pelvic inflammatory disease) polymicrobial but 50% of the time Chlamydia or Gonorrhea 

Outpatient: 

Ceftriaxone 500 mg IM in a single dose*

PLUS

Doxycycline 100 mg orally 2 times/day for 14 days

WITH

Metronidazole 500 mg orally 2 times/day for 14 days

inpatient treatment: 

Ceftriaxone 1 g IV every 24 hours

PLUS

Doxycycline 100 mg orally or IV every 12 hours

PLUS

Metronidazole 500 mg orally or IV every 12 hours

500

15 yr old M presenting with severe sore throat that started some days ago with tactile fever. Exam: anterior and posterior cervical lymphadenopathy with oropharynx exam below. State diagnostic tests that would support your diagnosis and treatment 

EBV (Mononucleosis) "kissing disease"

Diagnostic tests: monospot, EBV IgG and IgM, EBV Viral Capsid Antigen (VCA), you would also see atypical lymphocytes on a blood smear or differential 

Tx: supportive, avoid contact sports for 2 weeks