Baby Bugs
A 6-month-old has profuse watery diarrhea and vomiting in the winter months. Several children at daycare are sick. Labs show mild metabolic acidosis.
Rotavirus
A 6-year-old has a harsh holosystolic murmur at the left lower sternal border that does not change with position.
VSD
A 10-month-old boy has recurrent otitis media and sinus infections since infancy. He is growing normally. Physical exam reveals absent tonsils. CBC shows normal lymphocyte count.
XLA
A 3-day-old with jaundice has total bilirubin 14 mg/dL, direct bilirubin 0.3 mg/dL, feeding well.
reassurance and close f/u
**this is physiologic jaundice
A very premature infant with a history of prolonged mechanical ventilation and supplemental oxygen for neonatal respiratory distress continues to require oxygen beyond 28 days of life. The infant has tachypnea, increased work of breathing, and poor weight gain. Chest X-ray shows diffuse hazy opacities with areas of hyperinflation.
DX?
Bronchopulmonary dysplasia
A neonate presents at 2 weeks of life with poor feeding, lethargy, and seizures. CSF shows elevated protein and low glucose. Mom had flu-like illness during pregnancy.
A school-aged child has a fixed split S2 and a systolic ejection murmur at the left upper sternal border. She has frequent respiratory infections.
ASD
A 2-year-old has recurrent skin and lung infections. He has poor wound healing. Neutrophil count is normal. Nitroblue tetrazolium test is abnormal.
CGD
A 9-month-old has fever and irritability. Urinalysis shows leukocyte esterase and nitrites.
Start empiric antibiotics and send urine culture
A premature neonate who recently started enteral feeds develops abdominal distension, feeding intolerance, and bloody stools. The infant becomes lethargic and has temperature instability. Abdominal X-ray shows dilated bowel loops with pneumatosis intestinalis.
Diagnosis?
necrotizing enterocolitis
**most common cause of acute abdomen in premature infants
A 9-year-old has low-grade fever, headache, and dry cough for 5 days. Chest X-ray shows diffuse interstitial infiltrates. He has mild hemolytic anemia.
Mycoplasma pneumoniae
A 3-year-old has a systolic ejection murmur at the right upper sternal border with radiation to the neck. He has decreased exercise tolerance.
Aortic stenosis
An infant has persistent hypocalcemia, seizures, and recurrent viral infections. Cardiac exam reveals a conotruncal defect.
DiGeorge Syndrome
A 7-year-old presents with sore throat, fever, and cervical lymphadenopathy. Rapid strep test is negative.
Throat culture
A term newborn develops severe respiratory distress shortly after birth. Physical exam reveals decreased breath sounds on the left, scaphoid abdomen, and heart sounds displaced to the right. Chest X-ray shows bowel loops in the thoracic cavity with mediastinal shift.`
Congenital diaphragmatic hernia (Bochdalek)
A 7-year-old develops fever and cough followed by non-blanching petechiae and purpura. He becomes hypotensive and confused within hours.
Neisseria meningitidis
A child with Turner syndrome has a systolic murmur best heard at the right upper sternal border and diminished femoral pulses.
Coarctation of Aorta
A toddler has recurrent pneumonia and very high IgE levels. He has retained primary teeth and coarse facial features.
Job Syndrome (hyper IgE)
A toddler presents with vomiting and diarrhea for 3 days. Exam shows mild dehydration. Serum sodium is 128 mEq/L.
oral rehydration
**If signs of severe dehydration are present, give IV rehydration
A 10-year-old child presents with recurrent episodes of painful swelling of the hands and feet that develop gradually over several hours and resolve over 2–3 days. The swelling is non-pitting, non-erythematous, and not pruritic. There is no associated rash or urticaria.
Parents report multiple prior ED visits where the child was treated for an “allergic reaction” with antihistamines and steroids without improvement. The child also has a history of episodic severe abdominal pain with nausea and vomiting, with normal imaging and labs during previous evaluations.
There is no fever, no recent infection, and no clear trigger. Family history reveals a parent who had unexplained episodes of extremity swelling in adolescence.
diagnosis?
hereditary angioedema
A 12-year-old boy presents with fever and severe sore throat after human bite exposure. Exam shows a hand laceration over the MCP joint with swelling and erythema. Cultures grow a gram-negative rod that does not grow on MacConkey agar.
Eikenella corrodens
A neonate has cyanosis and a harsh systolic murmur at the left upper sternal border. Cyanosis worsens with crying.
TOF
A child presents with recurrent Neisseria infections. CH50 is undetectable, but immunoglobulin levels are normal.
Terminal complement deficiency
A newborn has cyanosis that does not improve with oxygen. Chest X-ray is normal.
Start prostaglandin E1 infusion (to keep PDA open)
** Don’t wait for echo
A newborn develops cyclic respiratory distress that worsens during feeding and improves when crying. Attempts to pass a nasogastric tube through the nares are unsuccessful. The infant has intermittent cyanosis without lung findings.
Choanal atresia