Pediatric Emergencies

4-week-old male infant BIB mother after abrupt onset of vomiting. Yesterday child was well appearing with no active issues; this morning child appeared fussy with significant crying; now the child appears quite ill. Bilious vomiting started approximately 2 hours ago. Physical examination reveals that patient is grunting and presents with dry mucous membranes. The patient’s abdomen is diffusely tender, mildly distended, and tympanic. Blood streaked stool is noted on rectal exam. An obstruction series shows dilated loops of small bowel overlying the liver with paucity of air distally. Vitals signs reveal:

99.2 degress F -- 80/50 mmHg -- 160 /min -- 40 /min -- 99% RA

The most likely diagnosis is:

• appendicitis

• duodenal atresia

• intussusception

• malrotation and midgut volvulus

2-week-old full term male infant (no birth/ delivery complications) BIB parents reporting difficulty breathing during feeding. This is the first episode of any difficulty experienced during feedings as there were no issues surrounding feeds prior to yesterday. Examination reveals a non-cyanotic, tachypneic infant. You note on your cardiac exam, the heart rate is approximately 140 per minute and you hear a widely-radiating systolic murmur with interscapular radiation. Further examination reveals a decreased pulse amplitude and duration bilaterally in lower extremities. CXR= cardiomegaly + pulmonary congestion. Vital signs reveal:

99.2 degrees F -- 100/55 mmHg -- 180 /min -- 75 /min -- 93% RA

The child’s most likely diagnosis is:

• atrial septal defect

• coarctation of the aorta

• patent ductus arteriosus

• hypoplastic left ventricle

8 month-old male BIB parents who are concerned about his abdominal pain x 6 hours. The parents describe the child’s pain as intermittent with episodes lasting between 15-20 minutes during which the patient is crying inconsolably, fussy and irritable. During each episode, he is described to be in significant pain and is progressively worsening in frequency and duration. He also had vomiting x 1 associated with these painful episodes. Abdominal exam = a sausage-shaped mass in RUQ with absence of bowel sounds in RLQ. Hemoccult test is (+). The child has an unremarkable birth history. Vaccinations are up-to-date. Vital signs reveal:

99.2 degrees F -- 95/60 mm/Hg -- 160 /min -- 35 /min -- 99% RA

Which of the following statements is most accurate?

• air enema is an effective diagnostic and therapeutic intervention

• recurrence after successful reduction is rare

• the preferred method for definitive treatment is surgical reduction

• the most characteristic presentation is a pale and lethargic infant

A 2 year old male with a history of asthma presents with worsening dyspnea at rest, dry cough, and increased use of his albuterol (Proventil®) inhaler over the last 2 days. On exam the child appears in mild respiratory distress with mild retractions. Heart is regular with a regular rate. Lungs have diffuse expiratory wheezes with no rhonchi or rales appreciated. Vital signs are as follows:

98.9 degrees F -- 112 -- 30 -- 116/56 -- 94% room air

In regards to his treatment, which of the following is true?

• addition of iprateropium bromide to first 2-3 doses of albuterol has been associated with decreased need for hospitalization

• administration of systemic steroids has been shown to increase need for hospitalization

• albuterol via nebulization is superior to albuterol via metered dose inhaler

• five day course of prednisone is superior to dexamethasone

A mother presents with her 6 year old complaining of a rash. The rash is symmetric with circumferential erythema and central clearing. There are many lesions on both arms without any mucosal involvement. The child complains of itching, but no pain. Mom denies any recent illness, fevers, or new soaps, lotions or exposures. Which of the following is true?

• Treatment only requires antihistamines and cool compresses in most cases

• This rash requires treatment with systemic steroids as well as antihistamines

• This rash is generally secondary to active bacterial infection and may indicated severe multi organ dysfunction

• This rash is often associated with tick borne vector and is common in the northeastern United states in the summer months

Empiric antibiotics for treatment of acute bacterial meningitis in 0-4 weeks age group are:

• Ampicillin plus gentamicin or cefotaxime

• Cefotaxime

• Cefotaxime or ceftriaxone plus vancomycin

• Ampicillin plus cefotaxime or ceftriaxone or vancomycin

False-positive Hemoccult results may occur with consumption of which of the following?

• Bismuth

• Iodine

• Iron

• Spinach

Clinical features of which pediatric orthopedic condition include bone fragility, ligament laxity, defective dentinogenesis, short stature, scoliosis, middle ear deafness, blue sclera and tympanic membranes, and misshapen skull?

• Congenital dislocation of the hip

• Ewing's sarcoma

• Osgood-Schlatter disease

• Osteogenic imperfecta

Which fastidious organism that colonizes the respiratory and oropharyngeal tracts in children has been implicated as a common cause of osteoarticular infections in young children aged 6 months to 4 years old?

• Haemophilus influenzae

• Kingella kingae

• Streptococcus pneumoniae

• Staphylococcus aureus

2-year-old male presents with parents after brief episode of shaking. Parents describe a sudden onset of shaking all throughout the body x 5-10 minutes about 1/2 hour ago. Parents deny any prior episodes of shaking remotely or in the child’s medical history. The child is reported to be a full-term delivery and is up-to-date on vaccinations and without any other medical history. The child recently enrolled in day-care. Vitals signs reveal: 102.8 degrees F -- 105/65 mmHg -- 160 /min -- 39 /min -- 98% RA

Which of the following statements is most accurate regarding the patient’s presentation / diagnosis?

• focal post-ictal neurological deficits are frequently present with presenting condition

• the presenting condition is associated with increased risk of epilepsy

• recurrence of the presenting condition after the first episode is rare

• family history of similar seizures is uncommon