Pediatric Emergency Medicine

Chlamydia Cervicitis Diagnosis is made by nucleic acid amplification testing (NAAT) Most commonly caused by Chlamydia trachomatis Treatment is azithromycin Comments: Most commonly reported sexually transmitted disease in the United States Empirically treat for concomitant gonorrhea The United States Preventive Services Task Force recommends routine screening for sexually active women < 24 years of age, and in women > read more…

Hypercalcemia Patient will be complaining of bone pain (Bones), kidney stones (Stones), abdominal pain (Groans), lethargy, psychosis (Psychiatric overtones) Labs will show ↓ QT interval Most commonly caused by: Malignancy (most common inpatient cause) Primary hyperparathyroidism (most common outpatient cause) Treatment is IV fluids Sample question: A 67-year-old woman who was recently diagnosed with breast cancer presents read more…

Pertussis (Whooping Cough) Patient with a history of nasal congestion, cough, and low-grade fever “Rapid fire,” repetitive coughing followed by an inspiratory “whoop” and post-tussive emesis Most commonly caused by Bordetella pertussis Treatment is a macrolide – azithromycin Sample question:  A 2-year-old boy who is new to your practice is brought to the clinic because of coughing. For the past two weeks, he has had rhinorrhea read more…

Subdural Hematoma Patient will be elderly or alcoholic With a history of a fall or traumatic head injury Complaining of headache, mental status changes, seizures, or focal deficits Diagnosis is made by non-contrast CT, crescent-shaped hematoma Most commonly caused by rupture of the bridging veins Treatment is neurosurgical consultation Sample question: A 68-year-old man presents to the ED after a fall down 12 stairs. read more…

von Willebrand Disease Patient with a history of a parent with similar symptoms Mucosal hemorrhage or bleeding that is difficult to control Labs will show decreased factor VIII, prolonged bleeding time Treatment is desmopressin (DDAVP) Comments: Most common inherited bleeding disorder, autosomal dominant Sample question: A 9-year-old child is being evaluated for frequent epistaxis and easy bruising tendencies. Bleeding time is prolonged, PT, PTT, read more…

Hypothyroidism Patient will be complaining of generalized weakness, fatigue, facial swelling, constipation, cold intolerance, and weight gain PE will show periorbital edema, dry skin, and coarse brittle hair Labs will show high TSH and low free T4, antithyroid peroxidase, and antithyroglobulin autoantibodies Most commonly caused by Hashimoto’s thyroiditis Treatment is levothyroxine Comments: Takes about 6 weeks to see treatment effects. Monitor TSH Hashimoto’s: Risk factor for non-Hodgkin lymphoma Sample Question: A 55-year-old woman presents to your office with complaints of fatigue, read more…

Hyphema Patient with a history of blunt or penetrating trauma Complaining of blurry vision PE will show unequal pupils, injected conjunctiva/sclera and blood in anterior chamber Treatment is eye protection and rest with the head of the bed at 30-45 degrees all the times A 13-year-old boy is brought to the urgent care clinic by his mother. He read more…

Osgood-Schlatter Disease Example: A 12-year-old boy presents to his pediatrician’s office for right knee pain that started three months ago after starting basketball practices. On physical exam, the boy is tender to palpation over the anterior tibial tubercle. There is no erythema or warmth to the area. A lateral radiograph of the knee reveals elevation of read more…

Molluscum Contagiosum Patient will be a school-age child Presenting with “warts” PE will show multiple waxy, dome-shaped papules with umbilicated appearance Most commonly caused by poxvirus Treatment is self-limiting

Complex Regional Pain Syndrome Patient will have a history of previous extremity injury or fracture Complaining of light touch causing extreme pain and allodynia (pain felt from a nonpainful stimulus, such as clothes or bed sheets on the skin) Treatment is NSAIDs, gabapentin, sympathectomy

Bacterial Tracheitis Patient will be 3–5 years old High fever, barky cough, stridor Treat as airway emergency! Comments: Patient will look like croup but toxic appearing Sample Question: A 3-year-old boy presents in severe respiratory distress. His mother informs you that he has been ill for the last five days, initially with a low-grade fever and “barky cough.”  read more…

Absence Seizures Patient will be a 5–10 years old Sudden mental status alteration without motor activity or a blank stare EEG during an event would show symmetric 3 Hz spike and wave activity Treatment is ethosuximide Comments: There will be no aura or postictal state

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Causes: adhesions (pelvic surgery) > tumor > hernia (inguinal) Proximal: bilious vomiting  Distal: feculent vomiting High pitched bowel sounds X-ray: dilated bowel, air-fluid levels, “stack of coins” or “string of pearls” sign Modality of choice: CT NGT, surgery

Appendicitis Patient will be complaining of fever, pain that began periumbilical then moved to RLQ, nausea and anorexia PE will show Psoas sign (RLQ pain on extension of right hip), Obturator sign (RLQ pain on internal rotation of flexed right hip), Rovsing sign (right lower quadrant pain when the left lower quadrant is palpated) Diagnosis is made by ultrasound, CT Most commonly caused read more…

Today’s teaching image and Rapid Review covers cardiac tamponade. Pericardial Tamponade Patient will be complaining of dyspnea and chest pain PE will show muffled heart sounds, JVD and hypotension (Beck’s triad), pulsus paradoxus  ECG will show low voltage QRS, electrical alterans Echocardiography will show diastolic collapse of RV Treatment is pericardiocentesis For more teaching images, try read more…

Today’s teaching image and Rapid Review covers tinea versicolor. Tinea Versicolor Malassezia furfur Patches with altered pigmentation Torso Affected skin does not tan Selenium shampoo For more teaching images, try a free trial of our board review qbanks.

Today’s teaching image and Rapid Review covers basilar skull fracture. Basilar Skull Fracture Petrous portion of temporal bone fracture most common Battle’s sign, raccoon eyes, hemotympanum, CSF otorrhea/rhinorrhea CN VII, VIII entrapment CT For more teaching images, try a free trial of our board review qbanks.