Story

A 6-month-old male came to the emergency room with a history of falling out of his mother's arms onto a bed. The infant cried and the mother placed him into the crib as it was time for his nap. About 1 hour later, the infant was crying, had vomitted and the mother felt he was lethargic. The radiologic evaluation showed frontal and interhemispheric acute subdural hematomas and the infant was transferred to a regional children's hospital for neurosurgical care. The past… Continue

He is an 8 years old boy. His mother brings him to emergency room with a 4 day history of cough, fever, decreased activity, vomiting, respiratory distress.

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Story

A 15-year-old female came to clinic for a round lesion on the anterolateral right neck that was slowly increasing in size over several months. She had squeezed it and a small amount of whitish, thick material had come out of it. She noted that there seemed to be a dark spot over the lesion's center. It was not painful or erythematous.

The pertinent physical exam showed a well-appearing female. The mass was ~12 mm wide and made the skin slightly elevated but appe

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Story

A 13-year-old female came to the emergency room with fever, headache and lethargy that were increasing over a few hours. On physical examination she was noted to have nuchal rigidity. A lumbar puncture was performed that showed white blood cell pleocytosis, increased protein and decreased glucose. She was given antibiotics, and was transferred to a regional children's hospital with a diagnosis of bacterial meningitis which the laboratory confirmed was cause… Continue

Story

A 15-year-old female came for a second opinion because of a 3 month history of abdominal pain described being in the upper half of the abdomen. The pain was described as crampy and would occur most days and also at night. She had 5-10 times/day stools that were described as loose without blood or mucous. Intermittently she had emesis. She was not able to participate in school or other activities because of the pain. She had a decreased appetite and had lost 3-5 pounds ov… Continue

She is a 10 year old girl who arrives walking to the emergency room with her mother. Mother tells her daughter is now four days complaining of headache, but in the last two days she has realized her daughter is decreasing her activity, and is a little bit sleepy, last night she vomited twice, and today she brings h

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Story

An 8-year-old female came to the emergency room with a new onset seizure. She was not able to speak and had movements of her left upper extremities. She was given lorazepam and taken by ambulance to the local emergency room where she had left sided weakness and some abnormal eye movements noted. She had a past medical history of Sturge-Weber Syndrome.

The pertinent physical exam showed a child who was tired but arousable. Her vital signs were normal

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she is a 3.6 kilograms, 4 months old baby. Her mother brings her to emergency room with an acute 1 day history consisting of vomiting, former clear and milk, but later bilious and brownish. abdominal distension, colicky pain, hiporexia, fever.

on examination she is dehydrated, her skin and mucous membranes with jaundice. Tense, tender, abdominal distension, tympanic, decreased bowel sounds, inguinal bilateral hernia, in the right side it appears not reducible.

labs: leucocytosis

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Story

A 10-year-old female came to the inpatient floor with suspected spontaneous bacterial peritonitis. She had steroid responsive nephrotic syndrome that was intermittent. Over the past 2-3 weeks she had been having more fatigue, shortness of breath and for the last 3 days has had periorbital edema with her urine being > 3+ on urine dipstick. She re-started her prednisone 3 days ago. She began having mild abdominal pain last evening and this morning it was increased and w… Continue