Pediatric Commons

Story

A 4 month old male came to the emergency room with fever to 103° and cough for 48 hours. The coughing had been much worse over the past day but there was no apnea or cyanosis. The patient had not had anything to drink for the past 8 hours. The past medical history showed a full-term infant without neonatal problems. He was current on immunizations. The family history showed no pulmonary disease.

The pertinent physical exam revealed a tired…

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Story

A 2-week-old male came to clinic with his parents for his health supervision visit. He had surpassed his birth weight by 10%. The parents voiced usual concerns, but the father also asked about anything special he should do because he himself had chronic Hepatitis C. He was an older father and had contracted it through a blood transfusion during a surgery as a teenager. He only knew about it several years later when he was told he could not donate blood. He was being…

Story

A 5-year-old female was admitted to the inpatient service after a cuneiform to cuboid wedge surgery for recurrent talipes equinovarus on the left foot. The past medical history showed bilateral congenital clubfoot that was treated by the Ponseti method of serial casting and application of nightime foot orthosis for 2 years. Since that time the parents had noted an increase in left foot adduction and pain. The pertinent physical exam showed a healthy…

A mother brings her baby daughter to the emergency room for a fever, vomiting, watery stools with mucus, of three days' duration.

On initial examination She was noticed lower limbs deformity and mother reported that her baby was diagnosed with arthrogryposis.

Auxiliary examinations showed pyuria in urine but not in stools, and blood leukocytosis. She was started treatment with ceftriaxone. Subsequently, the orthopedic surgeon requested an x-ray of the hips and lower…

Story

A 6-month-old female came to clinic with mild fever, copious rhinitis and poor fluid intake for 48 hours. Children at her daycare had respiratory syncytial virus and her symptoms were getting worse over the past 8 hours with no fluid intake. The past medical history showed a healthy infant who had received influenza vaccine.

The pertinent physical exam showed a respiratory rate of 62, pulse of 119, temperature of 37.8° and an oxygen saturation of…

Story

A 4-year-old female came to the emergency room with fever and mild respiratory distress and cough. She had recently immigrated from Mexico. The past medical history was negative for surgeries and hospitalizations, and her immunizations were not current. The review of systems revealed that she had a poor appetite, poor growth, no sweats or actual weight loss. there was no hematemesis The social history showed that the family had been in several…

Story

While working on the general pediatric inpatient service, a pediatrician had 4 patients with similar stories. All were under 1 year of age and were admitted for respiratory distress, cough and dehydration due to respiratory syncytial virus. Each had a prolonged illness or needed readmission because each also had an underlying airway malacia that had been diagnosed by bronchoscopy - laryngomalacia, tracheomalacia, tracheobronchomalacia and bronchomalacia. The patient…

Story

A 2-year-old female came to clinic after 16 hours of severe right ear pain. She had fever to 38.5° and was being given ibuprofen. Previously she had rhinorrhea for 3 days but no cough. The past medical history showed an episode of otitis media 7 months previously. The review of systems was otherwise negative.

The pertinent physical exam showed a cranky female with normal vital signs and growth parameters in the 90-95% for age. HEENT…

Story

An emergency medicine physician called a regional children's hospital for consultation with a general pediatrician. His question was could a school age child who had elevated transaminase levels (2-3x normal), elevated bilirubin and mild clinical jaundice but no other clinical symptoms be infected by Epstein Barr Virus? The brief story was that the child had a fever for 2 days and the parent noted scleral icterus. There was no abdominal pain. The general…