Pediatrics is easy, Cairo (2025)

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

01/09/2025

A 4-year-old child is transported to the emergency department because of confusion and vomiting.

He told his mother that he is having trouble with his vision.

He does not have neck pain, fever, ear ringing, chest pain,headache, or abdominal pain.

The boy was in his usual state of good health earlier in the day.

A few hours before his symptoms developed, he was playing in the garage with his sibling.

In the emergency department, his temperature is 37.2 °C, his heart rate is 115 beats/min, his respiratory rate is 42 breaths/min, his blood
pressure is 100/74 mm Hg, and his oxygen saturation is 100% in room air.

The child is sleepy but arouses to touch and responds to questions with a few words.

He moves all of his extremities symmetrically in response to pain.

Both pupils are 6 mm in size and sluggishly reactive.

Physical examination findings are otherwise
unremarkable.

Laboratory findings are shown:

Glucose 94 mg/dL (5.22 mmol/L)
Venous blood gas
pH 7.01
PaO 40 mm Hg
PaCO 20 mm Hg
Bicarbonate 6 mEq/L (6 mmol/L)

Oxygen saturation 100%

Sodium 136 mEq/L (136 mmol/L)
Potassium 3.4 mEq/L (3.4 mmol/L)
Chloride 103 mEq/L (103 mmol/L)
Ionized calcium 5.0 mg/dL (1.25 mmol/L)
Lactate 27.03 mg/dL (3 mmol/L)

Of the following, the BEST test to confirm this child’s most likely diagnosis is a serum

A. aspirin concentration

B. β-hydroxybutyrate concentration

C. methanol concentration

D. osmolar gap

24/08/2025

A 14-year-old football player is brought to the emergency department by ambulance after a helmet-to-helmet collision during a game.

The adolescent was struck on the side of his head by the other player’s forehead area.

He immediately fell to the ground and was slow to get up, but there was no reported loss of
consciousness.

Because he was dazed and slow in responding, he was taken out of the game and observed
by staff on the sideline.

After he vomited twice, an ambulance was called to take him to the hospital for further evaluation.

The adolescent arrives at the emergency department in cervical spine immobilization.

He has a temperature
of 36.8 °C, a heart rate of 75 beats/min, a respiratory rate of 16 breaths/min, a blood pressure of 122/78 mm
Hg, and an oxygen saturation of 99% in room air.

He is awake, alert, and interactive, and he has a Glasgow Coma Scale score of 14, with 1 point off for slowed speech in answering questions.

The boy vomits once in
the emergency department, but does not have a severe headache.

On physical examination, there is no scalp hematoma, but there is mild tenderness on palpation of the right
parietal area without any swelling, bogginess, or step-off.

The facial bones are intact, without swelling or pain.

His pupils are equal and reactive to light with full and painless extraocular motion.

There are clear and
intact tympanic membranes, a normal nasal septum, and no broken or displaced teeth.

With the head immobilized, the cervical collar is removed to facilitate neck examination, which reveals no tenderness or
step-off along the cervical spine.

The cardiac, lung, and abdominal examination findings are within normal limits.

The neurological examination findings include a continued Glascow coma score of 14, with intact cranial nerves, and equal and symmetric strength of all extremities.

Of the following, the BEST next step is

A. brain computed tomography if he vomits again

B. discharge home with immediate return for new symptoms

C. emergency department observation for several hours

D. urgent brain computed tomography

17/08/2025

A 2-month-old boy is seen in the office for a sick visit.

His mother is concerned that he is breathing fast and eating less.

Over the last few days, while breastfeeding, he has tired out sooner, breathed a little faster, and become sweaty.

He now seems to be breathing faster when he
is at rest and not eating.

He does not have rhinorrhea, cough, congestion, fevers, vomiting, diarrhea, or rash.

He is afebrile.

He has a heart rate of 158 beats/min, a blood pressure of 75/45 mm Hg, and a respiratory rate of 60 breaths/min.

He appears comfortable.

His oxygen saturation
is 95%.

His weight remains at the 50th percentile for age.

He has a regular heart rate and rhythm
with a normal S1 and physiologically split S2.

He has a grade 2/6 holosystolic murmur at the left lower sternal border.
He has good perfusion and normal pulses.

His liver edge is palpated 3 cm below the right costal margin.

Of the following, the BEST next step(s) in treatment is (are) to

A. admit the infant to the hospital for a septic evaluation

B. increase the infant’s caloric density of nutrition and refer him to a pediatric cardiologist

C. prescribe furosemide and refer the infant to a pediatric cardiologist

D. provide reassurance to the mother and follow up in 2 weeks for a weight check

13/08/2025

Early identification of biliary atresia in newborns (July 2025)

Early identification of biliary atresia (BA) improves outcomes, but most infants are identified only after becoming symptomatic. New guidance from the American Academy of Pediatrics describes early identification of BA at the initial primary care visit (at approximately two weeks of age) by measuring direct or conjugated bilirubin for any infant with jaundice. Direct or conjugated bilirubin ≥1 mg/dL in a neonate requires urgent referral to a specialist to evaluate for BA; smaller elevations or trends warrant close monitoring

11/08/2025

A 12-year-old is on a weekend hunting trip and falls from a 20-foot-high deer stand, striking his upper back
on tree roots.

There is immediate pain.

The child is placed on a backboard with a cervical collar and transported to the nearest pediatric trauma center.

He received 40 mL/kg of isotonic fluid during transport.

On arrival at the emergency department, the child’s temperature is 36 °C, heart rate is 52 beats/min, respiratory rate is 22 breaths/min, blood pressure is 80/40 mm Hg, and his oxygen saturation is 97% in room air.

His Glasgow Coma Scale score is 15.

Physical examination findings are remarkable for pain and swelling
at the midthoracic spine, lack of movement in both legs, and lack of sensation below the clavicles.

The remainder of the examination findings are within normal limits.

Brain and spine imaging is ordered.

Of the following, the MOST important next step in the child’s care is to

A. administer methylprednisolone via intravenous bolus

B. administer norepinephrine via intravenous drip

C. administer a 2L rapid bolus of lactated Ringer solution

D. transfuse 4 units of uncross-matched packed red blood cells

06/08/2025

Expanded approval for intranasal glucagon for hypoglycemia in young children with diabetes (April 2025)

The US Food and Drug Administration (FDA) has expanded regulatory approval for intranasal glucagon for the treatment of severe hypoglycemia in patients with type 1 and type 2 diabetes; while previously it was approved for those aged ≥4 years old, approval now includes those aged ≥1 year old. This expanded approval was based on a phase 1 single-arm study of seven patients age 1.8 to 4 years with type 1 diabetes. All patients experienced an increase in blood glucose ≥20 mg/dL from baseline within 30 minutes of administration of 3 mg of intranasal glucagon. No serious adverse events were reported, although several minor events occurred (eg, vomiting, epistaxis, nasal discomfort and eye irritation). Based on these data, we consider intranasal glucagon to be a safe and effective alternative to intramuscular glucagon for the treatment of severe hypoglycemia in patients with diabetes aged 1 year and older.

04/08/2025

A 10-month-old male infant is seen for follow-up.

He was diagnosed with bilateral acute otitis
media 3 days ago after developing fever and otalgia with abnormal tympanic membrane findings.

He was prescribed a 10-day course of high-dose amoxicillin and ibuprofen as needed.

He has received 6 doses of amoxicillin, but the fever persists despite administration of ibuprofen every 6 hours.

He has had a poor appetite and a few episodes of nonbloody, nonbilious emesis.

His parents have also noted that his eyes seem swollen and he is urinating less frequently.

His history includes a previous history of otitis media treated successfully with amoxicillin at 4 months of age.

He appears to be nontoxic and well hydrated.

His weight and length are in the 75th percentile, and his blood pressure is in the 87th percentile.

There is mild periorbital edema without conjunctival or scleral injection and no discharge.

Other significant findings include erythematous, opaque, and bulging tympanic membranes bilaterally.

The remainder of the
physical examination findings are within normal limits.

Laboratory findings reveal sterile pyuria,
proteinuria, hematuria, and elevated levels of blood urea nitrogen and creatinine.

Findings of a urine culture are negative.

Of the following, the BEST initial step in management is to

A. admit for intravenous fluid administration

B. admit for intravenous steroid administration

C. discontinue amoxicillin

D. discontinue ibuprofen

07/07/2025

A 3-year-old child is admitted to the hospital due to decreased appetite and weight loss. She has been afebrile, and has not had vomiting or diarrhea.

Her activity level has decreased over the past two weeks.

She had been healthy until 2 months ago, when she was hospitalized for 48 hours for a lower respiratory tract
infection with mild respiratory distress and poor fluid intake.

On physical examination, she has mild tachycardia, mild tachypnea, a normal blood pressure, and normal oxygen saturation in room air.

She has normal bilateral breath sounds, no wheezing, and no increased work of breathing.

There is a prominent S3 gallop, no cardiac murmur, no abdominal tenderness or distention,
and no splenomegaly.

The liver edge is palpable 3 cm below the right costal margin.

Peripheral pulses are 2+
and symmetric, and capillary refill time is 3 seconds.

Abdominal radiography is unremarkable. Her chest radiograph is shown (Figure 1). https://drive.google.com/file/d/1u0NKC82glqaprkOwRQtdVe4D5tf5NvqM/view?usp=drivesdk

Of the following, the MOST likely etiology for this child’s findings is

A. anterior mediastinal mass

B. dilated cardiomyopathy

C. large ventricular septal defect

D. primary pulmonary hypertension

28/06/2025

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Pediatrics is easy

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