Differential & Work-up: Pedia-Fever, Red Eye

Question 1

20-day old M presents with fever, decreased breastfeeding, and lethargy. He was born at 36 weeks as a result of premature rupture of membranes.

Answer 1

1. Neonatal sepsis
2. Meningitis
3. Pneumonia
4. Pyelonephritis

Question 2

WORK UP FOR:

1. Neonatal sepsis
2. Meningitis
3. Pneumonia
4. Pyelonephritis

Answer 2

1. CBC
2. Electrolytes
3. Blood culture
4. LP-CSF analysis
5. CXR
6. UA, urine culture

Question 3

3 yo M presents with a 2-day history of fever and pulling on his right ear. He is otherwise healthy, and his immunizations are up to date. His older sister recently had a cold. The child attends a daycare center.

Answer 3

1. Acute otitis media
2. URI
3. Meningitis
4. Pyelonephritis

Question 4

WORK UP FOR:

1. Acute otitis media
2. URI
3. Meningitis
4. Pyelonephritis

Answer 4

1. CBC, blood culture
2. LP-CSF analysis
3. UA, urine culture

Question 5

12 mo M presents with fever for the past 2 days accompanied by a maculopapular rash on his face and body. He has not yet received the MMR vaccine.

Answer 5

1. Measles (or other viral exanthem)
2. Rubella
3. Roseola
4. Fifth disease
5. Varicella
6. Scarlet fever
7. Meningitis

Question 6

WORK UP FOR:

1. Measles (or other viral exanthem)
2. Rubella
3. Roseola
4. Fifth disease
5. Varicella
6. Scarlet fever
7. Meningitis

Answer 6

1. CBC
2. Viral antibodies/titers
3. Throat swab for culture
4. LP-cerebrospinal fluid analysis

Question 7

4 yo M presents with diarrhea, vomiting, lethargy, weakness, and fever. The child attends a daycare center where several children have had similar symptoms.

Answer 7

1. Gastroenteritis (viral, bacterial, parasitic)
2. Food poisoning
3. UTI
4. URI
5. Intussusception
6. Volvulus

Question 8

WORK UP FOR:

1. Gastroenteritis (viral, bacterial, parasitic)
2. Food poisoning
3. UTI
4. URI
5. Intussusception
6. Volvulus

Answer 8

1. Stool exam and culture
2. CBC
3. Electrolytes
4. UA, urine culture
5. Abdominal x-ray

Question 9

3 yo F presents with a 3-day history of “pink eye”. It began in the right eye but now involves both eyes. She has mucoid discharge, itching, and difficulty opening her eyes in the morning. Her mother had the flu last week. She has a history of asthma and atopic dermatitis.

Answer 9

1. Bacterial conjunctivitis
2. Viral conjunctivitis
3. Allergic conjunctivitis
4. Keratitis
5. Uveitis
6. Orbital cellulitis
7. Preseptal cellulitis

Question 10

WORK UP FOR:

1. Bacterial conjunctivitis
2. Viral conjunctivitis
3. Allergic conjunctivitis
4. Keratitis
5. Uveitis
6. Orbital cellulitis
7. Preseptal cellulitis

Answer 10

1. Ophthalmoscopic eye exam
2. CBC
3. Electrolytes
4. Discharge cultures
5. Slit-lamp exam
6. CT-orbit