Pediatric Presentations

Question 0

What pathogen is associated with bronchiolitis?

Answer 0

RSV

Question 1

What pathogen is associated with croup?

Answer 1

Parainfluenza

Question 2

What pathogen is associated with exacerbations of asthma?

Answer 2

Rhinovirus

Question 3

Prodrome of cold, hoarseness and barking cough, minimal to severe inspiratory stridor, not toxic appearing, stridor best heard over neck with clear lung fields, low grade fever, Steeple sign (subglotting narrowing on CXR)

Answer 3

Croup (viral) (laryngotracheobronchitis)

Question 4

Prodrome of URI, hoarseness and barking, inspiratory stridor, toxic appearing, high grade fever, subglottic narrowing

Answer 4

Bacterial tracheitis (typically s. aureus)

Question 5

What pathogen is associated with pertussis?

Answer 5

Bordatella pertussis or bordatella parpapertussis

GNRs

Question 6

Coughing spells, post-tussive whooping, vomiting, no fever, elevated WBC, cough lasting more than 7-14 days

Answer 6

Pertussis

Question 7

Edema, increased mucus secretion and eventual necrosis of small airways, rhinitis, cough, *tachypnea, wheezing and crackles

Answer 7

Bronchiolitis

Question 8

Cough, grunting, chest pain, tachypnea, nasal flaring and retractions, cyanosis, dullness to percussion, decreased breath sounds, bronchial breath sounds, abrupt onset, high fever, toxic appearance

Answer 8

Bacterial pneumonia

Question 9

Prominent URI symptoms, low grade or absent fever, diffuse findings or wheezes on exam, possible diffuse infiltrates

Answer 9

Viral pneumonia

Question 10

Tachypnea, mild hypoxemia, lack of fever, wheezing, interstitial infiltrates

Answer 10

Atypical pneumonia - infancy (<3 mos)
Chlamydia trachomatis (also look for conjunctivitis at 10 days)

Question 11

Gradual onset, low grade fever, diffuse eam findings, diffuse infiltrates

Answer 11

Atypical pneumonia - older children (>5 yrs)

Mycoplasma

Question 12

How long can an abnormal appearance on CXR continue in bacterial pneumonia?

Answer 12

6 weeks

Question 13

When should CF be suspected in a child?

Answer 13

Recurrent episodes of cough, pneumonia, or sinusitis
Unexplained poor weight gain or FTT
Nasal polyps, rectal prolapse, hypochloremic alkalosis or FH of CF

Question 14

What tests can be used to diagnose CF?

Answer 14

Immunoreactive trypsinogen (IRT) - pancreatic enzymes elevated in CF, used in the newborn screen
Sweat chloride test - gold standard - >60 is positive
DNA analysis to identify CTFR mutations

Question 15

Bowlegs

Answer 15

Genu varum

Pathologic if asymmetric, unilateral, painful, or if progression different from expected

Question 16

Knock knees

Answer 16

Genu valgum

Question 17

Metatarsal bones of foot adducted

Answer 17

Metatarsus adductus

Question 18

What further work up is needed for metatarsus adductus?

Answer 18

Needs correction

Stretching exercise of foot straightens with gentle pressure, casting or bracing if rigid

Question 19

Medial malleolus is posterior to lateral malleolus

Answer 19

Tibial torsion - noticeable when child begins to walk

No treatment needed

Question 20

Twist in femur between hip and knee, kid sits in W position, kissing knees upon standing

Answer 20

Femoral anteversion or medial femoral torsion (MFT) - no treatment needed

Question 21

Pain and disuse of arm, no distress but arm guarding, slight flexion and pronation of elbow

Answer 21

Radial head subluxation = nursemaid s elbow
Treatment is manipulation back into place
Radiographs usually normal and not indicated unless history of fall and concern for fracture

Question 22

Pain and swelling around elbow, decreased range of motion, possible gross deformity

Answer 22

Supracondylar humerus fracture
Must ensure neurologic and vascular status of arm - if concerning it is a surgical emergency - lots of arteries and nerves run through

Question 23

Knee pain during puberty, gradual pain localized at tibial tuberous it’s, relieved by rest, worse with activity

Answer 23

Osgood-schlatter disease - rest, ice, NSAIDs, compression, stretching
Resolves after growth spurt

Question 24

What is often the cause of knee pain?

Answer 24

Pain referred from pathology at the hips

Question 25

What lab values suggest an infectious process?

Answer 25

WBC >12, ESR >20, CRP >1, fever >38

More than 2 of 4 positive

Question 26

9 month to 3 year old, refusal to bear weight, point tenderness over tibia

Answer 26

Toddlers fracture
Immobilize until healed
Initial radiographs often negative, follow up shows callus

Question 27

Hip pain, child up to 10 years (boys 4-8), confirmed hip effusion and exclusion of other conditions, negative hip tap

Answer 27

Transient synovitis

NSAIDs, resolves on its own

Question 28

Fever >38, cannot bear weight, ESR>40 in first hour, WBC>12

Answer 28

Septic arthritis - urgent need for surgical washout and antibiotics
Most commonly staph aureus
Group b strep in neonates

Question 29

4-8 year old boy, active with insidious onset of limp, possible pain, pain can be referred to thigh or knee, limited abduction and internal rotation at hip, smashed ice cream of femoral head

Answer 29

Legg-calve-perthes disease - mostly not weight bearing treatment

Question 30

Female, first born, breech, family history, galeazzi, Barlow test, ortolani test

Answer 30

DDH
Bracing or casting to hold in abduction, flexion, external rotation
Possible surgery
Radiographs useful only after 4-6 months of age

Question 31

Insidious or acute pain or limp, may be referred to thigh or knee, early pubertal age, obese, preferred position is foot externally rotated with flexion at the hip, limited internal rotation with pain, ice cream falling off cone

Answer 31

Slipped capital femoral epiphysis (SCFE) - surgical emergency - can stunt growth