You are evaluating a 5-month-old with fever, tachypnea, and mild respiratory distress in the emergency department. You hear mild basilar rales. The child does not appear toxic.
Which one of the following tests would be most appropriate as an initial study?
Correct Answer D:
Pulse oximetry should be obtained on all paediatric patients with significant tachypnea, pallor, or respiratory distress. It has been found that CBCs, C-reactive protein levels, and erythrocyte sedimentation rates are not effective in differentiating between viral and bacterial pneumonia. Chest radiographs are also ineffective in distinguishing viral and bacterial pneumonia, and should be obtained in cases of ambiguous clinical findings, prolonged pneumonia, and pneumonia that is unresponsive to antibiotic therapy, as well as when there is the possibility of complications such as pleural effusions.
The most common cause of pneumonia in preschool-age (3 months - 4 years) children is:
Correct Answer E:
Viruses are the most common cause of pneumonia in preschool-aged children. Streptococcus pneumoniae is the most common bacterial pathogens.
A 10-year-old female presents to your office with a 4-day history of non-productive cough, low grade fever of 38.1°C (100.5°F), and now complains of a rash for one day. She has been taking an over-the-counter cough suppressant and Tylenol. She is otherwise healthy. On physical exam, she has a temperature of 37.7°C (99.9°F) and a respiratory rate of 20. Her lung exam reveals no rhonchi or wheezes. Her skin has several “target” lesions scattered on her trunk and upper arms. A chest x-ray reveals a fine interstitial pattern with normal cardiac silhouette.
She most likely is infected with what organism?
Correct Answer C:
This school-age child has an atypical pneumonia with erythema multiforme, which is consistent with mycoplasma pneumonia infections. Mycoplasma is the most common cause of atypical pneumonias in school-aged children.
A. Streptococcus pneumoniae is the most common cause of typical bacterial pneumonia in children. Patients usually are tachypneic and febrile with a consolidated lobar infiltrate on chest x-ray.
B. Chlamydia pneumoniae may cause interstitial, atypical pneumonias. Patients are usually afebrile. There is no associated with erythema multiforme. See Answer A.
D. Haemophilus influenzae is a cause of bacterial pneumonia in children, again with a consolidated lobar infiltrate.
E. Influenza A may cause a viral pneumonia with interstitial infiltrates, but patients typically have systemic symptoms such as fever, malaise, and myalgias.
A 5-year-old boy is brought to the ED with swollen eyelids, loss of appetite, nausea and vomiting. His blood pressure is high and urine tests show RBC casts.
Valuable treatment for his acute nephritic syndrome will include all of the following, except:
Glomerulonephritis generally presents as a set of findings that includes hematuria, edema, and often hypertension. It is caused by a number of disorders that are all characterized by glomerular injury accompanied by inflammation. In some cases, it may progress to renal failure. Treatment is mainly supportive, because there is no specific therapy for renal disease. When acute glomerulonephritis is associated with chronic infections, the underlying infections must be treated.
→ Nephritis treatment involves a diet that is low in protein and sodium (choice B), and may be necessary until kidney function recovers.
→ Diuretics (choice A) may be prescribed to help the kidneys excrete excess sodium and water and to treat high blood pressure.
→ Other agents useful in treating hypertension include calcium channel blockers (choice E) and nitroprusside and angiotensin converting enzyme inhibitors.
→ Most of acute glomerulonephritis patients have a recent streptococcal infection and are treat with penicillin (choice C), even though this antibiotic doesn't reduce the risks of glomerulonephritis development after 36 hours of clinical presentation, it is still useful to control symptoms of the throat and to prevent spread of infection to close contacts.
Glucocorticoids (choice D) are usually not indicated for acute glomerulonephritis and are only used in rare cases that develop into rapidly progressive glomerulonephritis. Therefore, glucocorticoids was the only treatment that is not generally indicated for patients with acute glomerulonephritis.
A 4-year-old girl is brought to you. She has developed knee pain. On exam the knees are swollen, warm and visible redness is noted. A lab workup shows the following:
What is the likely diagnosis?
Juvenile rheumatoid arthritis pain can develop in kids aged 1-16 years of age. Common presentations include swelling, red and warm joints. The knee and wrist joints are the most commonly affected.
Initial lab workup involves: CBC, ESR, RF and ANA. Treatment is with a combination of medication, physical therapy and exercise. Nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen are used most commonly.
Fanconi syndrome is a disorder in which the proximal renal tubules of the kidney do not properly reabsorb electrolytes and nutrients back into the body, but instead "spill" them in the urine. Symptoms include excessive drinking (polydipsia), excessive urination (polyuria) and glucose in the urine (glucosuria.) If Fanconi is left untreated, muscle wasting, acidosis and poor condition will also occur.
Abnormal labs values would not be present in growing pains and joint pain is not associated with iron deficiency anemia.
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