pediatrics cases

Question 1

fever hx ex

Answer 1

duration, severity/temp, rash, wheezing, cough, ear pulling/discharge, poor apetite, convulsions, lethargy, sleepiness, sick contacts / day care, immunizations (hflu b, n meningitis though this usu is more in adolescents)

ex: vitals, heent, neck (carotids, thyroid, lymph nodes), heart, lung, abdo, skin

Question 2

fever wu

Answer 2

PEx (includes pneumatic otoscopy for 3 or under or regular for older kids), cbc, euc, blood culture, lp (csf analysis), ua, urine culture, imaging (cxr, axr)

tympanocentesis culture, viral Ab/titers, throat swabs (strep culture), stool exam/culture

Question 3

fever ddx

Answer 3

otitis media (acute), uri, meningitis, pneumonia, pyelonephritis, gasteroenteritis (viral, bacterial, parasitic

neonatal sepsis (if fever, decreased intake/breastfeeding, lethargy, PROM/premie)

measules (viral exanthem), rubella, roseola, fifth’s dz/parvo, varicella, scarlet fever, meningitis if maculopapular rash, esp no MMR vaccine

Question 4

red eye hx ex

Answer 4

onset, whole eye or specific location / bilateral, duration. discharge (mucoid?), itching, pain, photophobia, tearing, alleviate/exacerbating,

allergic triad (asthma, atopic dermatitis), b sx (derm, gi, cardiac, pulm, renal, pelvic, rheum), meds, sick contacts/ day care, immuniz, Hx similar

Question 5

red eye wu

Answer 5

pex, opthal eye ex, cbc, euc, discharge culture, slit lamp

Question 6

red eye ddx

Answer 6

conjunctivitis (bacterial, viral), keratitis, seasonal allergies, uveitis

Question 7

shorty! hx ex

Answer 7

prenatal & birth hx, growth, development (sexual, otherwise), p med hx, family hx, cognitive abilities, school performance, assoc sx (constitutional, gi, cardiac, pulm, renal, pelvic, endo)

ex: vitals, height n weight, heent, heart, lung, abdo, neuro

Question 8

shorty wu

Answer 8

pex, cbc, euc, gh stimulation tst, igf-1, igfbp-3, tsh, t4, xr hand (osteogenesis and bone growth plates), renal and cardiac u/s, sweat chloride tests, bun/cr, karyotype

Question 9

shorty ddx

Answer 9

constitutional short stature, gh def, hypothyroid, chronic renal insuff, genetic ddx, cf (lung, pancreas Sx)

Question 10

gi hx

Answer 10

pain socrates & relation to meals, associated sx (B, ROS), changes in weight, skin rash, bloody/mucoid stools, change in stool color

exacer / alleviating factors, similar sx, hx abdo surgeries, meds, sick contacts, day care, immuniz

Question 11

gi ex

Answer 11

vitals, dehydration (skin turgor, low bp, high HR), heart, lungs, abdo, rectal, pelvic

Question 12

gi wu

Answer 12

pEx, cbc, euc, rectal, stool for occult blood, ua, u/s abdo, (ct abdo), u/s testicles, barium swallow/enema, contrast enema endoscopy, tsh/t4, serum lead level

ph probe, suction rectal biopsy, anorectal manometry, alt/alt/bili/alp, amylase, lipase

Answer 13

pyloric stenosis, partial duodenal atresia, gerd, gastroentero, hepatitis, uti, otitis media

Answer 14

hirschsprung’s, low-fiber diet, anal stenosis, hypothyroidism, lead poisoning

Question 15

sudden colicky abdo pain, n&v, 20 min apart, well between episodes, loose stools some hrs before pain, stools now bloody (red currant jelly)

Answer 15

intussusception, appendicitis, meckel’s diverticulum, volvulus, gastroentero, enterocolitis, blunt abdo trauma

Question 16

general/crampby abdo worse in morn, exacerbated by stress

Answer 16

somatoform disorder, malingering, ibs, lactose intolerance, child abuse

Question 17

persistent crying, susides after passing flatus etc

Answer 17

colic, formula allergy, gerd, lactose intolderance, strangulated hernia, testicular torsion, gastroentero