Pediatrics

A 3-day-old term newborn becomes jaundiced; total bilirubin 18 mg/dL, direct 0.4 mg/dL; Coombs negative; hemoglobin normal; breastfeeding with suboptimal latch and 6 wet diapers/day.

A term infant at 1 hour develops grunting and tachypnea after C-section without labor; CXR shows prominent interstitial markings and fluid in fissures.

A 2-week-old with projectile non-bilious vomiting and hungry after emesis; olive-like mass in RUQ; metabolic alkalosis.

A 7-month-old with paroxysmal crying, drawing up legs, vomiting, and currant jelly stool; sausage-shaped mass in RLQ on exam.

A 5-week-old full-term infant has poor feeding, lethargy, hypotonia; labs: Na 128, K 6.5, hypoglycemia; ambiguous genitalia absent (male).

A 5-year-old with fever 6 days, bilateral non-purulent conjunctivitis, cracked lips, polymorph rash, edema of hands/feet, and cervical LAD.

A 15-month-old with acute stridor, barky cough, hoarseness; low-grade fever; steeple sign on X-ray.

A 2-year-old with sudden respiratory distress during eating peanuts; unilateral decreased breath sounds and hyperinflation on CXR.

A 10-year-old with hematuria and periorbital edema 2 weeks after impetigo; HTN; low C3 complement.

A 3-year-old with palpable purpura on legs, abdominal pain, arthralgia, hematuria.

A 4-year-old with fever, sore throat, sandpaper rash, strawberry tongue; rapid strep positive.

A 6-month-old with bronchiolitis (RSV) has increased work of breathing, diffuse wheeze, feeding difficulty; O₂ sat 89% on room air.

A 16-year-old obese boy with months of limping and knee pain; external rotation of foot; limited internal rotation of hip.

A 3-week-old infant with persistent jaundice; total bilirubin 9 mg/dL, direct 4.5 mg/dL; pale stools and dark urine; hepatomegaly.

A 6-month-old with failure to thrive, recurrent thrush, chronic diarrhea; lymphopenia; absent thymic shadow on CXR.

A 15-year-old girl with primary amenorrhea; normal breast development; scant pubic hair; blind-ending vagina; no uterus on US; karyotype 46,XY.

A 12-year-old boy with acute scrotal pain, high-riding testis with absent cremasteric reflex; pain not relieved by elevation.

A 7-year-old has perianal pruritus worse at night; mother notices worms on tape test.

A 14-year-old with easy bruising and epistaxis; normal PT/PTT; low platelet count after recent viral illness.

A 4-year-old with sudden petechiae, anemia, renal failure after bloody diarrhea; schistocytes, low platelets.

A 5-year-old pale, bone pain, hepatosplenomegaly; blasts on smear; thrombocytopenia; lymphadenopathy.

A 9-year-old with progressive ataxia, café-au-lait spots, telangiectasias on conjunctivae, recurrent sinopulmonary infections; elevated AFP.

A 6-year-old with nocturnal periumbilical pain relieved by defecation; alternating stool patterns; normal growth and exam.

A 2-month-old with poor feeding, prolonged jaundice, large fontanelle, macroglossia, hypotonia; newborn screen missed.

A 16-year-old boy with chest pain during exercise and syncope; harsh systolic murmur at LLSB that increases with Valsalva.

A 2-year-old with first febrile seizure (generalized <10 min), fully recovered; neuro exam normal.

A 9-year-old with polyuria, polydipsia, weight loss, abdominal pain; Kussmaul respirations; glucose 480 mg/dL; pH 7.10.

A 6-week-old infant with bilious vomiting and unstable vitals; abdominal distension; XR: double bubble with little distal gas; prenatal polyhydramnios.

A 5-year-old with fever, drooling, muffled voice, tripod posture; unvaccinated; lateral neck X-ray: thumbprint sign.

A 7-year-old boy with fever and migratory polyarthritis, new holosystolic murmur at apex; elevated ASO titer.

A 3-year-old girl with fever, drooling, neck stiffness; lateral neck radiograph shows widened prevertebral space; CT: ring-enhancing collection.

A 4-month-old with cough, post-tussive emesis, paroxysms, and apnea; unimmunized; lymphocytosis.

A 12-year-old with morning headaches, vomiting, papilledema; MRI shows posterior fossa mass; unsteady gait.

A 5-year-old with edema, proteinuria 4+, hypoalbuminemia, hyperlipidemia; no hematuria; responds to steroids.

A 13-year-old with recurrent epistaxis, easy bruising; prolonged bleeding time; normal platelets/PT; PTT may be normal or slightly high.

A 2-year-old with refusal to bear weight, fever, ESR/CRP high; hip held flexed/abducted; US shows effusion.

A 6-year-old with recurrent sinopulmonary infections, situs inversus, and neonatal respiratory distress; infertility risk later.

A 9-month-old with iron-deficiency anemia risk (exclusive cow’s milk >24 oz/day); pallor; low MCV; high RDW.

A 6-year-old with fever and localized bone pain; refuses to bear weight; ESR high; MRI shows metaphyseal marrow edema; blood culture positive for MSSA.

A 15-year-old sexually active girl with lower abdominal pain, mucopurulent discharge, CMT; urine pregnancy negative.

A 10-hour-old term newborn becomes lethargic with temperature instability and respiratory distress after prolonged rupture of membranes (22 h) and maternal intrapartum fever.

A well-appearing 22-day-old infant has rectal temperature 38.4°C (101.1°F) at home and in the ED. Exam is nonfocal.

A 15-month-old with 39°C fever is tugging at the ear; exam shows bulging, erythematous tympanic membrane with loss of landmarks.

A 3-year-old with 10 days of AOM now has postauricular swelling, tenderness, erythema, and protruding auricle; fever persists.

A febrile 8-month-old girl has UTI confirmed by catheterized culture. Parents ask about imaging.

A 2-year-old boy with two febrile UTIs has grade IV vesicoureteral reflux on VCUG.

A 7-month-old boy has an undescended right testis not palpable in scrotum at 7 months corrected age.

A newborn boy has ventral meatus with chordee; parents request circumcision before discharge.

A 2-year-old suddenly refuses to use the left arm after being swung by the wrists; holds arm pronated, slightly flexed; no swelling/deformity.

A 24-month-old says only “mama/dada” and a few single words; does not follow 2-step commands; M-CHAT not yet done. Hearing history is notable for recurrent otitis media.

An 18-month-old does not point, has limited eye contact, and is not using single words; parents are concerned.

A 2-year-old living in a pre-1978 home presents with pica and microcytic anemia; capillary screen shows BLL 18 µg/dL.

A 4-year-old with sickle cell disease develops sudden pallor, tachycardia, and rapidly enlarging spleen; Hgb drops from 9 to 5 g/dL; retics high.

A 6-year-old boy with recurrent hemarthroses after minor trauma; maternal uncles affected. PTT prolonged, PT normal.

A 2-year-old unimmunized child has cough, coryza, conjunctivitis, Koplik spots, followed by cephalocaudal maculopapular rash and 40°C fever.

A 10-month-old had 3 days of 40°C fever; now fever resolves and a blanching maculopapular rash appears on trunk spreading to neck/face; child appears well.

A 7-year-old with hereditary spherocytosis develops pallor and fatigue after classmate’s “slapped-cheek” rash illness; labs show profound anemia with very low reticulocyte count.

A 10-day-old neonate has watery eye discharge that becomes mucopurulent with mild eyelid swelling; staccato cough develops at 6 weeks.

A 30-week preterm infant develops abdominal distension, bloody stools, and apnea on day 10; abdominal XR shows pneumatosis intestinalis.

A term newborn fails to pass meconium within 48 hours; abdomen distended; explosive stool after digital rectal exam; contrast enema suggests transition zone.