Pediatrics By Lesson–(EXTRA) General+Emergency+Dermatology

A 7-year-old boy was brought to the emergency room unconscious after being in a motor vehicle accident. He wasn’t wearing a seat belt. Examination reveals an occipital hematoma on the head, and a right arm and calf deformity.

Which of the following is the most appropriate next step?

A 2-year-old boy is brought unconscious to the emergency room after drowning in a pool. An airway was established and positive pressure ventilation was given through a bag and mask, with supplemental oxygen. Examination is significant for a very weak and slow pulse, and the cardiac monitor picture is attached.

Which of the following is the most appropriate next step?

A 5-year-old boy is brought to the ER following a motor vehicle accident. On arrival he seems in pain but fully conscious. Vital signs – pulse 55/min, room air saturation 98%, blood pressure 140/90 mmHg. Neurological examination is normal. In light of the above, which of the following is the most important test?

While eating at a restaurant you are called to treat a 5-year-old boy that is suffocating while eating. You note that the child is conscious, coughing, and suffocating.

Which of the following is the most correct order of actions?

A 3-year-old male is evaluated in the emergency department after ingesting several antihypertensive tablets he found on table at home. On initial examination, the child is somnolent, with bradycardia and hypotension.
What is the most appropriate antidote for this condition?

An 8-year-old female presents with severe bilateral headache. The headache is associated with nausea and photosensitivity. The patient’s mother reports that the episodes often occur after nights of poor sleep. There is no history of vomiting or awakening due to pain.
What is the recommended initial treatment in this case?

A 2-year-old male is brought to the ER after being found with an open bottle of toilet cleaner. The parents note that he has vomited several times since the incident, and he is complaining of abdominal pain and burning in the mouth. Upon physical examination, he exhibits drooling and tachypnea.

What is the most recommended immediate treatment in this case?

A 9-year-old boy was stung by a bee and arrives at the emergency department with widespread redness on the surface of the skin, itching, and general weakness. On admission: pulse 190, blood pressure 60/40 mmHg, 40 breaths per minute, saturation 90%, capillary refill of 1 second.

What will be the immediate next step in the treatment?

A 4-year-old male hospitalized in the pediatrics suddenly loses consciousness and stops breathing. What is the size of the tube that you will request to insert into the child during CPR (tube diameter without balloon)?

You hear shouting at the beach and see a gathering of people. When you approach them, you see a child of about 5 years old lying on the sand, fully wet, unresponsive, and not breathing. You are the only qualified medical specialist around. What is the first immediate action required for you to take?

A 7-year-old was brought into the ER in a stupor. Not talking. Opens eyes in response to pain stimulation and reaches out towards pain area; what is the child’s GCS (Glasgow coma scale) score?

Which of the following is an indication for treatment with an intraosseous infusion?

A 6-year-old boy, bitten on the arm by a dog. Examination one hour after the event: surface wound that is not large, with irregular margins and no signs of infection. Normal vaccination history, the dog is inoculated and is supervised by its owners. What is the most important initial step when treating a bite wound?

A two-month-old girl, unconscious. In her examination, she is limp, pale, pulse 58 beats per minute and superficial breaths. The team initiates an Ambu mask ventilation with oxygen, but the heart rate is not increasing.

What is the next step in case management?

A 3-year-old girl, burnt by boiling water. In her examination, red skin with blisters in the forearm. The girl is aIert, no other signs of distress. The burn is spread over less than 5% of the body area. What is the most correct recommendation for further case management at this stage?

A full-term female newborn, stopped breathing after her birth, loses tonus and has cyanosis. Examination – no respiration and no response to stimuli, pulse 70 beats per minute. What is the next step in case management?

5 years of age, ate peanuts for the first time in his life. Arrived for examination due to generalized redness on the skin, itching and general weakness. Upon admission, pulse 190, BP 60/40 mmHg, 40 breaths per minute, saturation 90%, capillary refill time – 1 second.

What will be the next stage in his treatment?

A 13-year-old boy had a loss of consciousness episode during a football game.
Workup included the attached ECG strip, after which beta blocker treatment was initiated.

A few months later he has had an additional episode of loss of consciousness.
Which of the following is the most appropriate treatment?

A 17-year-old who is followed up by a cardiologist due aortic root dilatation, presents with sudden respiratory distress and left chest pain. He has no fever or additional complaints. Examination reveals he is 180 cm high and weighs 63 Kg. Blood pressure is 120/75, room air saturation is 91%, 105 beats/min, and respiratory rate of 20/min. Heart sounds are normal, his

chest is symmetrical, with slightly reduced breath sounds on the left. Chest X-ray is below.

Which of the following treatments, in addition to supplementary oxygen, is most appropriate for this patient?

A 16-year-old boy with a history of asthma, presents with acute chest pain after basketball training. Examination reveals a hemodynamically and respiratory stable teenager, with normal oxygen saturation in room air, and decreased breath sounds on the right. Chest x-ray is attached.

Which of the following is the most appropriate next step?

 A 1-week-old newborn’s examination reveals the skin finding in the photo.

Follow-up shows growth of the lesion. The rest of the examination is unremarkable, and there are no additional lesions.
Which of the following is the most recommended treatment?

On examination after birth, a skin lesion was noted on a week-old infant’s hand (image attached). During a follow-up examination, growth of the lesion was documented. Apart from this finding, the physical examination was normal, with no additional lesions.

What is the recommended management of the case?

A two-month-old male arrives for examination due to findings on his scalp (image attached). Attempting to peel off the scabs leads to pulling out the roots of the hair along with the scab. On physical examination, except for slight skin dryness and the findings on the scalp, the baby is alert, and relaxed, with no other findings.

What is the recommended treatment at this stage?

A two-week-old male is brought to the clinic due to a lesion on his shoulder (shown in the image).

The lesion was observed already after birth. Other than this finding, his examination is normal. What is the recommended treatment for this case?

A 9-months-old baby with atopic dermatitis develops the extensive rash demonstrated in the picture.

Which of the following is the most recommended treatment?

A child is diagnosed with atopic dermatitis. He is referred for examination due to the rash in the photos.

Which of the following is the most appropriate treatment?

A 6-year-old boy, who suffers from a recurrent itching rash in body folds areas since his first year of life (photo below). In addition, he experiences multiple episodes of nocturnal itching. In the past he had cow milk protein allergy.

Which of the following is the most appropriate treatment? 

A 5-year-old boy, generally healthy, arrived due to complaints of nocturnal enuresis, has never been weaned off diapers at nighttime. The mother reports that he tends to talk and walk in his sleep. Normal physical examination.

In addition to the urine osmolarity test, what other tests are recommended in order to advance the diagnosis?

Which of the following is a normal developmental test for a 3-months-old infant

A 15-year-old boy is referred for evaluation due to a drop in his academic achievements and new complaints of anxiety and depression. Blood tests demonstrate increased levels of liver enzymes and hemolytic anemia. An eye examination revealed the attached finding (in the image).

What blood test finding is highly likely to support the diagnosis?

A 3-year-old female, normally healthy, was discharged about 10 days ago from hospitalization due to pneumonia, treated with intravenous penicillin, referred due to edema and erythema of the hand in the infusion area, accompanied by fever up to 38.7°C, evidence of enlarged lymph nodes and joint pain. What is the best treatment in this case?

A 5-year-old boy, diagnosed on the autistic spectrum, was admitted due to decreased appetite, restlessness, and in recent days weakness in the lower limbs. Refuses to walk. On his examination, non-specific sensitivity over the lower extremities as well as the finding described in the image.

What is the most likely cause of the child’s complaints?

Which of the following findings is a contraindication to the administration of estrogen-containing pills?

A 4-month-old baby presents to the emergency room after getting hit by his 2-year-old brother. This is his 3rd time in the emergency room due to falls. Examination is significant for restlessness, chest tenderness on palpation, he doesn’t move his left leg. Laboratory results including a complete blood count, biochemistry and inflammatory markers is normal. X-ray is attached.

Which of the additional findings is likely to be present in this baby?

A 17-year-old male with bipolar disorder is referred to the emergency room with vomiting, nausea, confusion, and unstable gait. Vital signs include a temperature of 36oC, heart rate of 100/min, and saturation of 96% in room air. Examination is positive for resting tremor and myoclonus.

An overdose of which of the following drugs may cause these symptoms?

A 4-months-old infant is evaluated due to sleep apnea and severe constipation.

Blood gasses reveal CO2 accumulation during the night, with normal values during the day.

Which of the following diagnostic tests will facilitate the most likely diagnosis?

A 15-year-old boy complains of fatigue and a tendency to sleep during the day. His parents are worried of his deteriorating school performance over the last 3 months. He goes to sleep at midnight and wakes up at 7am, sleeps late on weekends, usually eats a snack an hour before he goes to sleep, and performs regular physical activity after school. He does not snore,

and does not wake up during his sleep. He is generally health with no regular medication, and has a normal physical examination with a BMI of 22.

Which of the following is the most appropriate recommendation?

A 16-year-old girl presents with irregular menstruation.
Examination reveals overweight and the findings in the attached photos.

Which of the following is the most appropriate first line treatment of her most likely disease?

A 7-year-old boy is evaluated due to two months of solid mass behind the left knee

that is more pronounced upon extension. On examination – the finding in the photo below.

Knee X-rays and labs – no abnormal finding.

Which of the following is the most appropriate treatment?

Which of the following is an etiology for early eruption of teeth in infants?

A 1-year-old infant who weighs 10 Kg is brought to the ER due to lack of appetite and vomiting. In the past two days he had fever and diarrhea and was treated with acetaminophen (Acamol) 250 mg X4/d.
labs – mild elevation of liver function tests.
Which of the following is the most appropriate next step?

Which of the following drug-to-side effect matches is most correct ?

A 17-year-old male, usually healthy, was transported to the emergency room by ambulance after experiencing a loss of consciousness. Upon examination in the ER, he appeared confused, lethargic, and disoriented to his surroundings. Blood test showed alcohol level of 240 mg/dl (high). Urine toxic screen is negative.

What is the probable cause of death in this case?

A 2-year-old male was brought to the ER after being found in a stupor at home. In the initial assessment in the emergency room – preserved airway, breathing about eight breaths per minute, irregular breathing, 100% saturation with oxygen, carotid pulse of 60 per minute, and blood pressure of 90/60. Constricted pupils, non-reactive to light. The parents report that he felt well during the day. Normal glucose finger stick test. What is the most appropriate treatment for this situation?

A two-month-old male, weight at birth 3500 grams, currently weighing 4700 grams. For the past three weeks, he has been suffering during the day from repeated episodes of crying that last about two hours. The baby is breastfed. Which of the following situations could be a complication for his condition?