Pediatric Emergency Medicine Question And Answers

A 3 year old boy is brought in. Height is in the 3rd percentile, weight in the first percentile. The patient has been treated for multiple sinus infections and pneumonia since birth and is noted to have loose, greasy, and mucousy stools. What is the best diagnostic study to confirm diagnosis? Ans ~ Sweat chloride test (cystic fibrosis) A 4 year old girl tires more quickly than others when playing. She is in the 10th percentile for height and 40th percentile for weight. BP is 132/82 in the right arm and 128/80 in the left. What is the most appropriate next step? Ans ~ Check BP in lower extremities (suspicious for coarctation) What are the top 3 most common diagnoses for forceful and repeated vomiting in newborns? Ans ~ Gastroesophageal reflux, pyloric stenosis, and intestinal obstruction A baby that has recurrent fussiness, irritability, and feeding aversion and frequently spitting up most likely has what? Ans ~ gastroesophageal reflux A mom is concerned that her baby is spitting up frequently after meals. However, the baby is otherwise healthy and does not appear to be in any distress. What should you tell the mom? Ans ~ This is normal, "happy spitter" A mom brings in her baby concerned that he is having bloody stools but appears otherwise healthy. Family history reveals that the mom is lactose intolerant. Baby is formula-fed. What is the best treatment for the baby's condition? Ans ~ Protein free formula (milk induced enteritis) A 6 month old boy presents with vomiting, poor oral intake, abdominal distention. was born at 33 weeks and had some respiratory problems as a neonate. Emesis is non-bilious and infant appears ill. What should you look for on physical exam? Ans ~ Inguinal hernia 6 month old presents with vomiting, poor oral intake, and has been intermittently fussy. Baby is otherwise healthy with no previous feeding intolerance. Mom says he has been passing reddish, thick mucous stool. On physical exam has a RUQ sausage-like mass. Most likely dx and best diagnostic test to confirm? Ans ~ Intussusception, abdominal x-ray What treatment is both diagnostic and therapeutic for intussusception? Ans ~ Barium / air contrast enema 6 month old with vomiting, poor oral intake, and abdominal distention. Mom says he has not been eating today and has been having green emesis. Has not had a wet diaper today. Baby looks very ill and abdomen is distended, tense, and tender. What should be your next step? Ans ~ Consult peds surgery for emergency surgery (volvulus) A 5 week old male is having projectile vomiting after feeds. Baby is immediately hungry afterwards. Was started on Prevacid a week ago for reflux but hasn't shown any improvement. What finding on ultrasound confirms diagnosis? Ans ~ Olive mass (pyloric stenosis) What is string sign diagnostic of? Ans ~ Pyloric stenosis 4 day old female presents with lethargy, abdominal distention, and emesis. Says she isn't eating as much or passing as much stool as her twin sister. You preform a rectal exam and the baby immediately passes a significant amount of stool. What is the diagnosis? Ans ~ Hirschsprung disease A 6 yo male presents to the pediatrician with abdominal pain and nausea. Started complaining yesterday after school and ate dinner but then woke up around midnight and vomited. Walks hunched over. History of occasional constipations. Abdominal exam is normal. What non-GI etiologies should you consider for abdominal pain and vomiting in children? Ans ~ Pharyngitis and UTI What is the diagnostic test of choice for appendicitis in pediatrics? Ans ~ Ultrasound What signs should you look for if you are concerned for emesis secondary to an intracranial mass? Ans ~ Triggering emesis with abrupt changes in position, headache, or focal neurologic deficit What are the most common causes of abdominal pain in adolescents? Ans ~ Gastroenteritis, appendicitis, inflammatory bowel disease, pregnancy, toxic ingestions What should you test for in all adolescent girls with abdominal pain? Ans ~ Pregnancy 8 year old girl has been vomiting for 3 weeks, has lost 6 pounds of weight, and has a fruity smell to breath. What diagnostic test is indicated? Ans ~ Check blood sugar what labs would you consider ordering to work-up prolonged vomiting in the pediatric population? Ans ~ CBC, electrolytes, BUN, lipase, LFT, urinalysis, stool studies A tense, bulging fontanelle in a neonate or young infant should raise suspicion for _________ Ans ~ Meningitis, hydrocephalus, NAT