Beyond bruising
Upper extremity injuries
Mucous membranes
Lower extremity injuries
Pruritus
100
A 5-year-old unvaccinated girl presents with fever. She appears critically ill. She has the rash shown below.
What is the most important treatment?
Antibiotics. Ceftriaxone, Cefotaxime, Meropenem
100
14-year-old boy grabbed another player's football jersey during a game. What is injured?
Avulsion injury of FDP from insertion at base of distal phalanx.
100
A 17-month-old girl presents with 2 days of fever and rash. She is well-appearing with normal VS. What is the treatment for the rash?
Supportive care, hydration.
100
After joint relocation, what is needed next?
Vascular evaluation
100
An unvaccinated 2-year-old presents with fever and itchy rash. What type of infection control precautions are needed in their room?
Airborne, N95
200
A 6-year-old boy presents with rash to legs and arms. He is asymptomatic, well appearing, with normal vital signs. What is the most important lab test to obtain?
CBC (to hopefully confirm ITP and not malignancy)
200
4-year-old fell on playground and will not move her wrist/hand. What treatment is needed?
Velcro splint or volar slab splint
200
What is the best treatment option for this rash in a well-appearing, otherwise asymptomatic child?
Oral antibiotics. Cephalosporins, amoxicillin-clavulanate, dicloxacillin. In areas of high prevalence of MRSA clindamycin or doxycycline are the preferred treatments.
200
13-year-old presents with gradual onset knee pain over the past month. What treatment is needed?
NWB and likely surgery
200
A 7-year-old presents with a slightly itchy rash. No other symptoms. Is this rash contagious?
Yes, Poxvirus, a person can be infected more than once.
300
An 5-year-old boy presents with rash to the legs, joint pain and severe abdominal pain. What radiographic test should be performed?
US abdomen to look for intussusception
300
15-year-old hit in shoulder during hockey practice. What treatment is needed?
I-II: Sling
III: Geographical location dependent, but probably sling. Trial of sling for 4-6 weeks vs early operative repair
IV-VI: Surgery
300
A 4-year-old girl presents with 1 week of cough and fever. Nasal PCR is positive for mycoplasma. Today she developed a rash and mouth pain and stopped eating. What diagnosis should be considered?
SJS and
Mycoplasma-induced rash and mucositis (MIRM)
300
3-year-old fell off the slide and hurt her right leg. What treatment is needed for the injury below?
Walker boot vs cast (discuss with orthopedic surgery)
300
A healthy 4-year-old presents with slightly itchy rash. She is well appearing and otherwise asymptomatic. No rash to mucous membranes. What testing is needed?
None
400
A 10-year-old girl returns from camping with fever, headache and rash to wrists and ankles. She is unwell appearing and has signs of meningismus. LP is performed and vancomycin, ceftriaxone, acyclovir are started. What additional medication is needed?
Doxycycline
400
You are caring for a 5-year-old with a supracondylar fracture. The test below shows abnormal function on the right hand. What nerve is being tested?
Anterior interosseous nerve
400
A 6-year-old boy presents with sore throat, fever and rash. What is the treatment?
Antibiotics, amoxicillin
400
What injury is this knee XR indicative of?
Segond fracture highly associated with ACL and meniscal tears.
400
An entire family presents with a very itchy rash, no other symptoms. What is the treatment?
Permethrin cream, treat family members, wash clothes/linens in hot water
500
4-year-old presents with fever and rash. What treatment is needed?
Admission, IVF, antibiotics
cefazolin, nafcillin, and oxacillin
Vancomycin should be administered if MRSA is suspected.
Clindamycin administration may diminish bacterial toxin production; however, up to 50% of strains associated with SSSS have clindamycin resistance, rendering monotherapy with this medication inadvisable.
500
What findings on a pediatric elbow XR would make you concerned for a occult fracture?
•Anterior fat pad – ‘Sail sign’ – an enlarged sail shaped hypodensity should raise suspicion for a fracture
•Posterior fat pad – any hypodensity posterior to the humerus should raise suspicion for a fracture
•Radiocapitellar line – a line through the middle of the radius normally bisects the capitellum
• Anterior humeral line – a line along the anterior border of the humerus should bisect the middle 1/3rd of the capitellum
500
What is the treatment for this illness?
IVIG, ASA, supportive care
500
Which fracture below is most likely to be operative/unstable?
Webber B & C
500
6-month-old brought in for 1 month of itchy rash to face. What are some potential treatments?
Moisturizer within minutes of bath time. Can consider low-dose topical steroids in discussion with Dermatology and close follow up.