Tuesday Pediatric Cases 2018-2019

1. A 16-year-old girl took a bottle of acetaminophen to commit suicide. Her boyfriend just
separated their relationship. After thinking about this for 2 hours she called 911 and the
ambulance took her to your ED.
a) How frequently does this occur? Mo
b) What dose is toxic?
c) What is toxic compound
d) What is the treatment?
e) How does one decide to treat this girl?
f) What drug would you consider using?
g) What are the indications for liver transplant?

2. A 4-year-old child has the following, what could cause each of them?
a) Pinpoint pupils, coma, and respiratory depression
b) Sever metabolic acidosis, CNS depression, and blurred vision
c) Meiosis, salvation, diarrhea, bronchorrhea, and bradycardic
d) Fever, hyperpnoea, and metabolic acidosis
e) Delirium, combativeness, catatonia, miotic pupils and rotary nystagmus.
f) “Gray cyanosis” and “chocolate colored” blood
g) Body order
1) Garlic
2) Mothball
3) Rotten egg
4) Wintergreen
5) Bitter almond
6) Acetone

3. What anemias are microcytic, normocytic, and macrocytic?

4. A 15-month-old child comes to your office and has been doing well, the parents have no
complaints, but you notice the child looks pale:
a) What questions should you ask?
b) What tests should you do?
c) What do you need to do to interpret the tests?
d) After your initial tests, what is your differential diagnosis?
e) How would you treat this child?

5. You are called from the state lab that a child‘s newborn screen is positive for Sickle Cell
Anemia.
 a) What would you expect the hemoglobin level to be?
b) What test would you do next?
c) How is it inherited?
d) What would you do for this child now?
e) What are the complications? How are they treated?
f) If osteomyelitis develops, what are the most likely organisms?

6. A 37-week infant, Sunshine, appears yellow at 24 hours of life. The total bilirubin is 10 mg/dL.
What components of the history, physical exam, and lab data would be helpful in evaluating
this baby?

7. A child is born with Microcephaly.

a) What is Microcephaly?
b) Name the possible causes. (primary and secondary)

8. A newborn does not move his left arm.

a) What is the differential diagnosis?
b) What tests would you do?
c) If the test is abnormal what would you do?
d) If the test is normal what is the diagnosis? Prognosis? When would you refer them?

9. Seizures
a) What are seizures?
b) What is epilepsy?
c) Name some seizure types?
d) What is a febrile seizure and what are the 2 types?
e) What are absence seizures, what is the EEG abnormality, with what drug do you treat
them?
f) What are generalized seizure?
g) What is West Syndrome – Infantile Myoclonic Seizures?

10. A 15 y.o., Destiny, presents in labor to the ED. She claims to not have known she was
pregnant and has not received any prenatal care. She delivers a 4 lb 8 oz infant via spontaneous
vaginal delivery. The infant soon develops tachypnea.
a. How can you assess this infant’s gestational age?
b. What are the potential causes for this infant’s tachypnea?
11. Baby Virginia has an APGAR score of 5 at one minute and 9 at 5 minutes. What is the APGAR
score used for? What is the predictive value of the APGAR score? What is another source to
predict neurologic outcome of the infant?
12. A 15 y.o. female, Anna, is an honors students and dancer. She has also recently joined cross
country. Parents bring her in because they are concerned about her weight loss since cross
country season started. She has lost 15 pounds in 6 weeks. Her BMI is at the 4th percentile.
How would you evaluate this patient?
13. A 3-year-old boy, Freddie, is at the 95th percentile for weight and the 25th percentile for
height. Before his 24 month visit his weight was always at, or below, the 50th percentile. At his
30 month visit and today, it is at the 95th. Parents report that he is built like his father who is
“big-boned” and seem proud of his recent weight increase.
c. What history and PE information is important to obtain from the family? Dietary
history should assess food choices at meals and snacks, fluid types and amounts,
and portion sizes.

14. Max is a 17 y.o. male who presents with left testicular pain that started this morning. How
would you evaluate this patient?
15. A 6-week old afebrile infant, Petunia, presents to the ED after an episode of apnea. She was
full term and had an uncomplicated delivery. She does not attend daycare. She has had a mild
URI the past 2 weeks. Her mother has also had a URI with a prolonged cough recently. What is
your differential diagnosis? How would you evaluate and treat this patient?

16. 14 year-old Danny presents with fever and sore throat. On exam he has exudative tonsillitis.
He complains of fatigue and malaise. What is in your differential. What would be your approach
to evaluation and management?
17. A six year-old girl, Maddie, has urinary urgency and dysuria. No fevers. A clean catch
urinalysis is nitrite and leukocyte positive. How would you manage this child?
a. Would your management be different for a febrile 6-month old?
b. For a 16 year-old female?
c. For a male?
18. A four-year-old boy, Chen, is brought to the pediatrician because of “puffy eyes” and
sudden weight gain. What is your differential diagnosis and how would you evaluate this
patient?