Peds 25 Flashcards
An 18-year-old mother with her 3-month-old son arrives at urgent care clinic reporting “my baby stopped breathing!” She and her baby are rushed into a triage room, where her son is noted to be very lethargic with increased work of breathing. As vital signs are being obtained, the mother reports “my baby stopped breathing in the car coming here, and didn’t start again until I reached over and jostled his car seat!” Mom then shared that “my boyfriend said he rolled off the couch last night. Could it be related?” Mom also stated that her son hasn’t been as active as usual, and has been vomiting occasionally. Physical exam is notable for a respiratory rate of 70 breaths per minute with intercostal retractions and crackles in the right lower lung fields posteriorly. You admit this patient with the diagnosis of pneumonia for empiric antibiotics and support, pending additional evaluation. CXR subsequently demonstrates a RLL infiltrate and faint, vertical lines on several posterior ribs bilaterally. What is the best next step in management?
A. Anticipatory guidance about appropriate car seat usage B. Head ultrasound C. Obtain a PTH level D. Skeletal survey (more x-rays) E. Sweat chloride testing
D. Skeletal survey (more x-rays)
A 2-month-old infant is brought to the ED after his mother found him in his crib not breathing. She says he had no color and was still when she found him, but quickly regained his color. While you are examining him he starts having a tonic-clonic seizure and subsequently is found to have a temperature of 96 F, HR 200 bpm, and RR 18 bpm. On exam he cries intermittently, does not track you with his eyes, has a tense, full fontanelle, and decreased tone throughout. You also notice a healing bruise on his left arm. After assessing circulation, airway, and breathing you obtain IV access. What is the next step in your diagnostic workup?
A. Head CT
B. Lumbar puncture
C. Skeletal survey
D. Social work consult
A. Head CT
A 10-month-old infant is brought to the emergency department by his very concerned and frantic grandmother. Earlier that day, she retrieved the child from his mother’s new boyfriend, who had been watching him while his mother was at work. The grandmother makes it very clear she does not approve of this new boyfriend, and she is concerned that he is rough with her grandson. She demands that her grandson be worked up for injuries and that a restraining order be placed against the boyfriend. Which of the following finding does NOT indicate that a child is being physically abused?
A. A concaved, crescent-shaped mass on head CT B. A metaphyseal fracture of the wrist C. A spiral fracture of the tibia D. Retinal hemorrhages on fundoscopy E. Two posterior rib fractures
C. A spiral fracture of the tibia
A 5-month-old infant presents to urgent care with his mother who states that she witnessed her son stop breathing and turn blue for about 25 seconds. Upon physical stimulation by the mother, the patient began to breathe again. This is the first time she has ever witnessed this happening. The patient’s birth and past medical history are unremarkable. Physical exam is unremarkable, vital signs are stable and normal, and lab studies are all within normal limits. Which of the following is LEAST likely to be on the differential diagnosis as a cause for this infant’s BRUE (brief resolved unexplained event)?
A. Arrhythmia B. Congenital heart disease C. Gastroesophageal reflux D. Infection E. Seizures
B. Congenital heart disease
It is unlikely for a patient with congenital heart disease to first present with a BRUE. This patient has no past medical history and his birth history was unremarkable. Typically, a patient with undiagnosed congenital heart disease will suffer from acute decompensation within the first few weeks of life. These patients will also have growth problems, difficulty with feeding and a murmur is often appreciated on physical exam. Children with undiagnosed Tetralogy of Fallot may have intermittent episodes of cyanosis while blood supply is diverted from the pulmonary vasculature.
A young couple presents to the ED with their 2-month-old son reporting excessive sleepiness and difficulty arousing him after his nap. Per the parents, the PMH and prenatal course are unremarkable, except that the patient has always been very fussy and would often cry despite being held and cradled. He is cared for during the day by his babysitter. Today he had been in his usual state of fussiness when the babysitter arrived, and they returned to find him napping quietly in his cradle but could not arouse him from sleep when it came time for his feeds. He finally opened his eyes after several minutes of gentle nudging but seemed to quickly fall asleep again. On exam, the infant is afebrile with poor tone and is only mildly responsive to painful stimuli. Eye exam shows dilated pupils and an ophthalmology consult reveals extensive retinal hemorrhages in multiple layers across all four quadrants. What is the most likely diagnosis?
A. Bacterial meningitis B. Closed head injury C. Infant botulism D. Intoxication E. Metabolic disorder
B. Closed head injury
