Peds 19 Flashcards
What is the mnemonic for differentials for a child presenting with altered mental status?
AEIOU-TIPS
A - alcohol/drugs, acidosis/alkalosis E - epilepsy I - infection O - overdose U - uremia
T - trauma
I - insulin (low CBG)
P - psychosis, poisoning
S - stroke, syncope, shock
You assess a child’s developmental milestones and determine he is on track. He is able to use 4-6 words consistently. He uses a spoon and cup, but spills occasionally. He is able to follow simple commands. He is able to stoop and recover. How old is he?
16 months old
Ian is a previously healthy, developmentally normal 16-month-old male who was observed to have a brief, self-limited generalized seizure and was subsequently unresponsive. There is a family history of febrile seizures and no history of trauma. On presentation he is responsive but irritable with significant fever.
What is the leading dx?
What tests would you order?
(simple) Febrile seizure
No tests needed at this time
What do you think might be some features of a complex febrile seizure?
- occurs 1+ in 24 hour period
- lasts > 15 minutes
- focal seizure
48 hours f/u for febrile seizure, you notice a blanching, non-pruritic, generalized maculopapular rash that developed this morning. He is currently afebrile, behaving normally, and is drinking well. What is the most likely dx?
Roseola infantum
This is a known association of febrile seizures.
A 16-month-old male is brought to the urgent care clinic by his father because of a seizure 30 minutes ago. The child dropped to the floor with loss of consciousness and had sporadic twitchy movements of his legs and arms that lasted for five minutes. He had URI symptoms for the past two days, with a fever to 39.4 C (103 F) today. He is previously healthy and had normal developmental screening at his last visit. Neither parent has a seizure disorder, but the child’s mother had a single seizure as a young girl after developing a high fever with a cold. Which of the following is the most likely diagnosis in this patient?
A. Absence seizure B. Complex febrile seizure C. Cyanotic breath-holding spell D. Epilepsy E. Simple febrile seizure
E. Simple febrile seizure
The father of a 15 year-old-girl calls the on-call provider with concerns of fever, headache and mental status changes over the past 12 hours. She has a fever of 39.4 C (103 F) and is acting dazed and difficult to arouse. On further questioning, the father states that she is breathing heavily, has decreased urine output, and decreased oral intake. He wants advice about whether she should be taken to the Emergency Department. Given the limited history, which of the following is highest on the differential?
A. Acute cystitis B. CNS tumor C. Diabetic ketoacidosis D. Hypoglycemia E. Meningitis
E. Meningitis
You see a 6-year-old male in the ED who presents with a history of a 10-second episode of jerking movements of his extremities with unresponsiveness, observed by both of his parents. His parents claim he has had abdominal pain and small quantities of bloody diarrhea for two days. The child has no significant past medical history, has taken no medications recently, has no pets, and has not traveled outside of California in the past year. He attends kindergarten. Which organism is the most likely cause of the child’s symptoms?
A. Clostridium difficile B. Enterotoxigenic E. coli (ETEC) C. Rotavirus D. Shigella sonnei E. Vibrio cholerae
D. Shigella sonnei -> shigellosis
Shigella sonnei causes bloody diarrhea and WBCs in the stool on Wright stain. Children infected with Shigella can suffer from seizures due to neurotoxin release.
A woman brings her 8-year-old son to the pediatrician after witnessing him stare blankly into the distance at dinner the previous week. He was unresponsive to her calling his name or any other stimuli, and it lasted for about 10 or 20 seconds. His teacher reports he does seem to daydream often in class but is able to keep up with schoolwork and excels in his studies. She doesn’t note him being disruptive or impulsive in class. His mother is concerned about these blank stares and unresponsive episodes. Which of the following is the most likely diagnosis?
A. Absence seizure B. Atonic seizure C. Complex partial seizure D. Generalized tonic-clonic seizur E. Simple partial seizure
A. Absence seizure
A 3-year-old boy presents to the ED 20 minutes after his parents witness an episode of convulsions at home. His parents report that Charlie was in his usual state of good health until three days ago when he developed fever, cough, and rhinorrhea. This evening they found him in bed with his eyes rolled upward, jerking all four of his extremities uncontrollably. He was unarousable from this state, which self-resolved after about two minutes. This has never happened before. Currently, Charlie is sleepy but arousable and complains of nausea. His vitals include T 103.2 F, P 112 bpm, BP 100/60 mmHg, RR 22 bpm, O2 sat 99% on room air. Aside from rhinorrhea and erythematous mucous membranes, the remainder of his physical exam is unremarkable. What is the next best step in management?
A. Abdominal ultrasound B. Administration of valproic acid C. EEG D. MRI brain E. Workup for source of fever
E. Workup for source of fever
A rash is noted to have a “slapped cheek” appearance and is reticular and lacy on the extremities. What is the most likely dx?
Fifth disease (erythema infectiosum) - caused by parvovirus B19
You note a light red sandpaper rash along with red lips and a strawberry tongue. What is the most likely dx?
Scarlet fever
On exam, you note a maculopapular rash and a fever. The child’s mom reports that in the last couple of days, he’s had a cough, coryza (stuffy nose?) and conjunctivitis, and Koplik spots on the buccal mucosa. What is the most likely dx?
Rubeola (measles)
