Pediatrics is easy

Pediatrics is easy Pediatric education and books

05/12/2025

1. Children commonly develop respiratory failure prior to cardiac arrest. Early intervention, before cardiac arrest, offers the best chance for a successful outcome.

03/12/2025

Early food introduction and prevalence of food allergy (October 2025)

Observational studies and clinical trials over the past 25 years, and an evolving understanding of oral tolerance, led to guidelines promoting early allergen introduction for infants to prevent food allergy. Whether these guidelines have impacted allergy prevalence is unclear. A regional birth cohort study found decreasing rates of clinician-diagnosed peanut allergy or any immunoglobulin E-mediated food allergy (IgE-FA) in children 0 to 3 years of age, from before and after early food allergen introduction guidelines were published, and then after peanut-specific guidance was revised (0.79 to 0.53 to 0.45 percent for peanut allergy and 1.46 to 1.02 to 0.93 percent for any IgE-FA, respectively) [24]. There are reasons to be cautious about attributing these observed decreases to the infant feeding guidelines since this study has several methodologic limitations, and other data have shown slow adoption of these guidelines. However, the results align with the benefits observed in studies of early introduction of food allergens.

25/11/2025

A term neonate is admitted to the neonatal intensive care unit for respiratory distress after a precipitous delivery complicated by the presence of meconium.

His birth weight is 2 kg.

His respiratory distress resolved with oxygen delivered via high-flow nasal cannula.

He has been bottle feeding as desired.

On day 3, just prior to feeding, the baby is jittery.

A bedside glucose is measured at 42 mg/dL (2.33 mmol/L).

The tremors abate
when he is fed; however, follow-up point-of-care glucose values range from 39 to 53 mg/dL (2.16–2.94 mmol/L).

The neonate is placed on intravenous fluids containing dextrose.

Of the following, the next BEST step in this neonate’s evaluation is to

A. conduct a diagnostic fasting study

B. order brain magnetic resonance imaging

C. perform genetic testing for Beckwith-Weidemann syndrome

D. perform glucose testing after administration of uncooked cornstarch

16/11/2025

A newborn is being monitored in the neonatal intensive care unit due to a prenatal diagnosis of tetralogy of
Fallot.

On day 5 after birth, the baby develops generalized seizures.

Treatment for the seizures is provided.
Laboratory results are shown:

Laboratory Test Result
Calcium 5 mg/dL (1.25 mmol/L) (reference range, 8.8-10.7 mg/dL)

Magnesium 2 mg/dL (reference range, 1.6-2.5 mg/dL)

Phosphorus (reference range, 3.8-6.7 mg/dL) 9 mg/dL

Intact parathyroid hormone 22 pg/mL (22 ng/L) (reference range, 12-65 pg/mL)

25-hydroxyvitamin D 28 ng/mL (69.89 nmol/L) (reference range, 30-50 ng/mL)

1,25-dihydroxyvitamin D 78 pg/mL (187.2 pmo/L) (reference range, 24-86 pg/mL)

Glucose 102 mg/dL (5.66 mmol/L)

Of the following, the BEST next treatment for this infant is administration of

A. calcium and calcitriol

B. dextrose and growth hormone

C. hydrocortisone and fludrocortisone

D. sevelamer and vitamin D3

11/11/2025

Nice to remember
Malignancy is the most common cause of superior vena cava syndrome
The malignant causes are the (terrible 5Ts)
1- T- cell NHL
2- T-cell ALL
3- thymoma
4- thyroid cancer
5- teratoma malignant

09/11/2025

A 5-year-old child is evaluated in the emergency department for vomiting for the past 2 days.

Three days ago, she developed a cough and fever of 39° C.

When she is febrile, there is associated diffuse abdominal pain and headache, which improve when she is given ibuprofen or acetaminophen.

Over the past 24 hours she has voided twice.

She has not had any diarrhea.

On physical examination, the girl has a heart rate of 140 beats/min, respiratory rate of 28 breaths/min, blood pressure of 95/62 mm Hg, and oxygen saturation of 93% in room air.

She appears fatigued but responds appropriately to questions.

Her mucous membranes appear slightly dry.

There are focal crackles heard in the right lower lung field, a normal cardiac rhythm with no murmur, and a soft non-tender abdomen with no guarding, rebound, organomegaly, or mass.

Her extremities are cool with a capillary refill time of 3 seconds.

The remainder of her examination findings are normal.

Of the following, the degree of this child’s dehydration is

A. no dehydration

B. mild dehydration

C. moderate dehydration

D. severe dehydration

04/11/2025

A 10-year-old boy is brought to the emergency department for 2 days of fatigue.

He has no history of
diarrhea, nausea, vomiting, abdominal pain, headache, confusion, fever, cough, or loss of appetite. He has a history of generalized seizures, which are well-controlled with carbamazepine.

His heart rate is 82 beats/min, respiratory rate is 14 breaths/min, and blood pressure is 106/62 mm Hg.

He is alert and interactive.

On physical examination, his mucous membranes are moist, and capillary refill time is less than 3 seconds.

He has no neurological deficit, and the remainder of his examination findings are normal.

Laboratory results are shown:

Sodium 128 mEq/L (128.0 mmol/L)
Potassium 4 mEq/L (4.0 mmol/L)
Chloride 92 mEq/L (92.0 mmol/L)
Bicarbonate 24 mEq/L (24.0 mmol/L)

Urea nitrogen 8 mg/dL (2.86 mmol/L)
Creatinine 0.5 mg/dL (44.2 µmol/L)

Glucose 86 mg/dL (4.77 mmol/L)
Serum osmolality 266 mOsm/kg

Urine
Specific gravity 1.020
Leukocyte esterase Negative
Nitrite Negative
Blood Negative
Protein Negative
Urine osmolality 600 mOsm/kg
Urine sodium 60 mEq/L

Of the following, the BEST next step is to order
A. intranasal desmopressin

B. intravenous hypertonic saline

C. oral fluid restriction

D. oral sodium tablets

Common congenital heart disease Nice
23/10/2025

Common congenital heart disease
Nice

14/10/2025

A 10-year-old child is seen in the emergency department with nausea and vomiting.

His medical history is
only significant for asthma, which has been difficult to control during the last 6 months.

He has been hospitalized twice and required treatment with an oral glucocorticoid 4 times; the most recent course of glucocorticoids concluded 2 days ago.

The child’s vital signs include a temperature of 37.1 ℃, heart rate of
125 beats/min, and blood pressure of 82/50 mm Hg.

He appears tired, his mucous membranes are dry, and his capillary refill time is 3 seconds.

The remainder of his examination findings are normal.

Intravenous fluids
are administered after blood is drawn for laboratory testing.

Laboratory results are shown:

Sodium 131 mEq/L (131 mmol/L)
Potassium 4 mEq/L (4 mmol/L)
Chloride 98 mEq/L (98 mmol/L)

Urea nitrogen 25 mg/dL (8.92 mmol/L)
Creatinine 0.9 mg/dL (79.56 µmol/L)

Glucose 65 mg/dL (3.61 mmol/L)

Of the following, the BEST next step in management is to administer

A. inhaled albuterol

B. inhaled fluticasone

C. intravenous ceftriaxone

D. intravenous hydrocortisone

30/09/2025

A 5-year-old child is admitted to the hospital with a new diagnosis of type 1 diabetes mellitus.

She was brought to the emergency department with a 3-day history of increased thirst and bedwetting after having
been dry overnight for the past year.

Her hemoglobin A1c concentration at diagnosis was 8.2%, and her laboratory findings did not demonstrate diabetic ketoacidosis.

The family is concerned that she has had
unrecognized diabetes for a long time and wonder whether this could have been identified when the child
was last seen for a health supervision visit 2 months ago.

At that time, the child had no symptoms. The family also asks why their child has this condition when “no one else in the family has diabetes.”

Of the following, the BEST response to provide this family with respect to their concerns is

A. the child was likely born with a genetic predisposition to the condition and symptoms develop insidiously over time

B. the child is unlikely to develop other autoimmune conditions, because hers presents in isolation

C. the family has allowed the child to consume too much unprocessed sugar

D. universal screening for the condition is recommended for children at health supervision visits

17/09/2025

A 2-day-old term neonate is seen in the emergency department for decreased feeding and somnolence over
the last 6 hours.

The neonate’s prenatal history and postnatal course were unremarkable until this event.

Her temperature is 37.4 °C, heart rate is 170 beats/min, respiratory rate is 70 breaths/min, and blood pressure is
70/40 mm Hg.

Physical examination findings are significant for hypotonia.

Laboratory data are shown:

Glucose 40 mg/dL (2.22 mmol/L)

Creatinine 0.2 mg/dL (17.68 µmol/L)
Blood urea nitrogen 15 mg/dL (5.35 mmol/L)

Carbon dioxide 12 mEq/L (12.0 mmol/L)

Ammonia 210.08 µg/dL (150 µmol/L)

Anion gap 24 mEq/L (24.0 mmol/L)

Urine ketones Positive
Lactic acid 4.6 mmol/L

White blood cell count 5,000/µL (5.0 ×10 /L)
C-reactive protein 0.2 mg/dL (2.0 mg/L)

Of the following, the neonate’s MOST likely diagnosis is a disorder of

A. amino acid
metabolism

B. fatty acid metabolism

C. organic acid metabolism

D. the urea cycle

07/09/2025

A 10-month-old infant born at 32 weeks’ gestation is admitted to the pediatric intensive care unit due to
respiratory failure from influenza.

He was intubated in the emergency department for severe respiratory
distress, persistent desaturation and hypercapnia; he is being mechanically ventilated.

He was diagnosed
prenatally with congenital diaphragmatic hernia, which was repaired in the neonatal period.

The infant spent
8 months in the neonatal intensive care unit; he was mechanically ventilated for 3 months and successfully
weaned from supplemental oxygen at 6 months of age.

He has pulmonary hypertension and chronic lungdisease of infancy.

He was discharged home on albuterol, budesonide, sildenafil, chlorothiazide, ferrous sulfate and vitamin D.

He receives all enteral feeds by gastrostomy tube.

In the pediatric intensive care unit, the boy’s oxygen saturation is 85% on 90% FiO2 with moderate ventilator
settings.

He is mildly hypotensive despite intravenous fluid resuscitation.

On physical examination there are coarse lung sounds bilaterally with no wheezing and good overall chest rise with positive-pressure
ventilation.

The remainder of his examination findings are normal.

Chest radiography shows diffuse, bilateral
interstitial opacities with hyperinflation and proper position of the endotracheal tube.

A complete blood
count is remarkable only for mild leukocytosis; a complete metabolic panel is notable for a mildly decreased
serum bicarbonate and a low normal potassium.

An N-terminal pro b-type natriuretic peptide (NT-proBNP) level is 8,500 pg/mL.

Of the following, the BEST intervention to improve this infant’s oxygenation is to

A. administer a packed red blood cell transfusion

B. increase the inspired oxygen to 100%

C. increase the ventilator positive inspiratory pressure

D. initiate an additional pulmonary vasodilator

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