Peds Cases

19 y/o has several days of fever, sore throat, and malaise along with new rash. Sore throat was 10 days ago and 4 days ago developed 103 degree fever. Took 2 doses of amoxicillin from previous illness. What was the diagnosis?

mono

what are the diagnostic tests for mono?

-CBC, CMP

-rapid monospot (heterophile Ab) & titers

-rapid strep & strep culture

-EBV IgM & IgG

what is the treatment for mono?

supportive, ibuprofen but no Tylenol

3 y/o brought to ED after seizure. No hx of epilepsy or seizures. After moving to different house, child became more irritable and has experienced abd pain, vomiting, constipation, body aches. No sick contacts. What was the diagnosis?

toxin exposure (Pb)

what are the diagnostic tests for toxin exposure?

-CBC, CMP

-EEG

-LP

-brain MRI

-Pb level

-tox screen

how can one get Pb poisoning?

houses built before 1978, food, toys, soil, water, vertical transmission in utero

what is the treatment for Pb poisoning?

chelation therapy with PO succimer if >45

4 y/o has sore throat and difficulty swallowing x 3 days. Irritable and does not want to move neck. Food and fluid decreased and she has vomited twice overnight, otherwise healthy and up to date on immunizations. Physical exam reveals fever, b/l tonsillar exudate, and erythematous posterior oropharynx with swelling of R posterior pharyngeal wall. What was the diagnosis?

retropharyngeal abscess

what are the diagnostic tests for retropharyngeal abscess?

-CBC, CMP

-CT of neck

-lat neck xray

-rapid mono & titers

-rapid strep & culture

what is the diagnostic test of choice for retropharyngeal abscess?

CT of neck

what is the treatment for retropharyngeal abscess?

empiric abx amp/sulbactam or clindamycin, surg if severe

8 y/o struggling in school, easily distracted and falling behind. He fidgets constantly and does not answer questions clearly. What was the diagnosis?

ADHD

what are diagnostic tests for ADHD?

-CBC, CMP

-TFT

-tox screen

-Pb level

-ADHD screening

what are the diagnostic results for ADHD?

6+ sxs on Conner's or Vanderbilt rating scales (or 5 if 17+)

what is the treatment for ADHD?

CBT & stimulants

what are non-stimulant options for ADHD?

-SNRI: atomoxetine, viloxazine

-appetite stim: cyproheptadine

-alpha 2 agonist: guanfacine, clonidine

-atypical antidepressant: bupropion

5 y/o has developed breast buds and pubic hair and increase in body odor. No menarche. Her height and weight are above the 95th percentile. What was the diagnosis?

central precocious puberty

what are the diagnostic tests for precocious puberty?

-CBC, CMP

-FSH/LH

-estrogen and progesterone

-cortisol

-pituitary MRI

-GH, IGF

-TFTs

-bone age x-ray

what are the diagnostic results for precocious puberty?

high LH, high estradiol, & older bone age

what is the treatment for precocious puberty?

GnRH agonists (leuprolide) until child reaches normal age of puberty

14 y/o presents with 3-day complaint of brown urine. Had 2-day fever and sore throat that improved spontaneously. Slightly puffy eyes that are attributed to late night studying. What was the diagnosis?

post-strep glomerulonephritis

what are the diagnostic tests for post-strep glomerulonephritis?

-CBC, CMP

-UA + culture

-ASO titer

-serum IgA

-C3 C4 complement

what are diagnostic results for post-strep glomerulonephritis?

documentation of recent GABHS infection, ASO titer, elevated BUN/Cr, & UA w/ hematuria or proteinuria

what is the treatment for post-strep glomerulonephritis?

-loop diuretics

-manage HTN w/ nifedipine or nicardipine

-abx if they still got strep

-referral to nephrology for renal biopsy

5 y/o has complaints of fever, malaise, and increased cough x 2 days. Hx of asthma for which she uses steroid inhaler daily and albuterol inhaler as needed. PMH of sinusitis in winter seasons, tried various OTC cold & allergy remedies but respiratory sxs have been worsening over past several months. Daily cough and expectorates blood-tinged mucus. What was the diagnosis?

CF

what are the diagnostic tests for CF?

-CBC, CMP

-chloride sweat test

-PFTs

-CXR

-ABGs

-sputum culture

what are signs of CF?

-recurrent resp infections

-meconium ileus

-pancreatic exocrine insufficiency

-FTT

what test should be performed after the newborn screening test for immunoreactive trypsinogen & sweat Cl test?

genetic test for CFTR mutation

what is the treatment for CF?

-airway clearance: bronchodilators, mucolytics

-aggressive abx: azithromycin

-new CFTR modulators: potentiatorys & correctors

-multidisciplinary care centers

2 month old presents to urgent care center for irritability x 7 days. Child cries constantly and cannot be consoled. No sick contacts. Mother reports child rolled off bed a week ago. PE had swelling over R anterior thigh. What was the diagnosis?

child abuse

what are diagnostic tests for child abuse?

skeletal survey & thorough PE (+ femur x-ray in this case)

what are suspicious areas of child abuse?

-abdomen

-face

-neck

-butt

-thighs

-inner arm