Paediatrics videos & books

2022-08-30 11:14:46 77) A 14-year-old boy is brought to the emergency department for evaluation of fever and headache. The mother relates that her son has had a worsening headache for 5–6 days. She says that she took him to a walk-in clinic, and he was put on amoxicillin for… Open / Comment

2022-08-30 11:13:44 77) A 14-year-old boy is brought to the emergency department for evaluation of fever and headache. The mother relates that her son has had a worsening headache for 5–6 days. She says that she took him to a walk-in clinic, and he was put on amoxicillin for a sinus infection. His headaches have been getting worse and that he is now having fevers as high as 103.6°F. The mother says that he normally is very active and that he currently has a summer job at a local park clearing out underbrush. Since he has become ill, he has had such a decrease in energy that he cannot go to work. He has had a decrease in his appetite and has been sleeping more. He denies any sore throat, abdominal pain, chest pain, dysuria, vomiting, or diarrhea. On examination, he is an uncomfortable young man whose vital signs are: temp. 101.9°F, RR 26, HR 124, and BP 79/56. His head, ear, eye, nose, and throat examination reveals normal TMs, a mildly erythematous hypopharynx, and some shotty cervical lymphadenopathy. His lungs are clear. His cardiac examination is normal. His liver edge is palpable just below the right costal margin and is mildly tender. His spleen is not palpable. His skin examination is normal with the exception of scattered petechiae around his ankles and wrists. A CBC reveals WBC 13,000 with 65% segs and 22% lymphs, hematocrit of 35, and platelet count of 95,000. His electrolytes reveal a Na 125, K 5.1, Cl 102, and bicarbonate 21. His BUN and Cr are normal.
What is his most likely diagnosis? Open / Comment

2022-08-26 13:37:01 76) Explanation

Relative immaturity of the lacrimal drainage system can result in the accumulation of debris in the nasolacrimal duct. This will manifest as a swelling inferior to the middle canthus. Dermoid cysts in children are commonly found as a subcutaneous nodule on the lateral portion of the eyebrow. Mucoceles are usually found as fleshy papules on the inner portion of the lower lip. Frontal encephaloceles are midline in location. Open / Comment

2022-08-25 13:36:43 76) A 2-week-old infant is brought to the office for a check-up. The father relates that they have no concerns except that the baby seems to have tearing from his left eye. They also point out some swelling at the edge of his left eye. The infant is eating… Open / Comment

2022-08-25 13:35:15 76) A 2-week-old infant is brought to the office for a check-up. The father relates that they have no concerns except that the baby seems to have tearing from his left eye. They also point out some swelling at the edge of his left eye. The infant is eating, sleeping, stooling, and voiding well. On examination, you find a 1/2 × 1/2 cm firm nodule inferior to the medial canthus of the left eye. What does this most likely represent? Open / Comment

2022-08-22 18:40:03 75) Explanation

Febrile seizures are the most common cause of seizures in childhood. These are classically seen early in an illness and when there is a rapid rise in the child’s temperature. These seizures usually last less than 2–3 minutes (typical febrile seizures last no longer than 15 minutes) and have a very mild, short, postictal phase. Children who have seizures that are the result of bacterial meningitis will not subsequently be normal. For typical febrile seizures, in an otherwise healthy and well-appearing child, no evaluation (outside of treating any underlying cause of the fever) is warranted. Blood and urine cultures would not be necessary in evaluation of the seizures, but they may be warranted in evaluation of the fever. An EEG and head CT will nearly universally be normal and are unwarranted.
A single typical febrile seizure routinely does not require any anticonvulsant therapy. If the child has had multiple febrile seizures, or the seizures are not typical, anticonvulsant therapy may be entertained. Prophylactic anticonvulsant therapy is usually initiated after the third febrile seizure. Occasionally, children may have convulsions associated with fevers which do not fall into the typical features. Some criteria which would make a febrile seizure atypical would be prolonged duration (greater than 15 minutes) and a prolonged postictal state Open / Comment

2022-08-21 18:38:48 75) A 4-year-old child is seen in the emergency department after having a seizure at home. This is the first time that this has happened. The mother says that the child was sitting on the couch watching television when she suddenly became limp, started drooling… Open / Comment

2022-08-21 18:37:42 75) A 4-year-old child is seen in the emergency department after having a seizure at home. This is the first time that this has happened. The mother says that the child was sitting on the couch watching television when she suddenly became limp, started drooling, and having generalized tonic-clonic movements of her arms and legs. The mother relates that the child felt like she was “burning up” and that the tonic-clonic activity stopped after a few minutes. The mother says that the child is otherwise healthy, does not take any medicines, and has never been hospitalized. The child’s immunizations are up-todate, and she has no known drug allergies. On examination, the vital signs are temperature of 104°F, BP 97/49, HR 112, and RR 26.The child is sitting on the examination table playing with stickers and drawing. She has a mild amount of clear nasal congestion but her examination is otherwise normal. When asked, the child replies that she feels fine. What is the most likely diagnosis? Open / Comment

2022-06-23 18:04:01 The majority of otherwise healthy infants who get RSV infections will tolerate the course without complications. Some rare complications can occur in infants with risk factors, which include prematurity; cardiac or pulmonary disease or immune system dysfunction. Premature infants are at particular risk for apnea. It is prudent to observe premature infants for apnea in the first few days of their RSV infection. Afull sepsis workup would not be warranted in an otherwise well-appearing, afebrile, infant. RSV-IVIG is not indicated for acute management of RSV infections. Likewise, it is unwarranted to begin antimicrobial therapy without a clear indication. Open / Comment

2022-06-22 18:03:50 62) While working in the emergency department in the winter, you examine a 3-week-old female infant. The baby is accompanied by her mother and father. They report that the baby has been congested for the past 24 hours. The parents have been taking the infant’s… Open / Comment