14 y/o M with several months of recurrent bloating, stomach upset, occasional loose stools. Difficulty
gaining wt, short. Symptoms worse after crackers, cookies, and breads. No blood in stools. - Celiac
disease
Education for febrile seizures - Not actual seizure; best prevention is tylenol/ ibuprofen alternate
Q4hr; hydrate & rest; seek emergency care if seizure lasting longer than 5 minutes
10 y.o M with sudden scrotal pain upon awakening. severe N/V. Exam= tender, warm swollen L scrotum.
Cremasteric reflex negative and urine no findings. - Testicular torsion. Refer to ED
11 y/oM with sickle cell anemia woke up painful penile erection that wont go away. - Recommend
immediate referral to ED
12 month old with fever, suspected UTI, vomited 5x in last 7hours, last wet diaper ~6hrs ago. Prepare to -
arrange for child to be admitted to hospt
14 y/o M plays bball, complains of swelling and pain on bilat knees. Exam= tenderness over tibial
tuberosity bilat knees - Osgood-schlatter
+ post drawer sign in 10/yo soccer player? - instability of knee
17y/o M feeling something in L scrotum. Palpation is soft, movable, blood vessels that feels like 'bag of
worms' under scrotum skin. testicle not swollen or red. - Varicocele
, 4 weeks, forceful vomiting, wt down, seems hungry, sucks on bottle no problem. poss cause and
findings= - round olive like mass in RUQ
7 y/o M tells NP that teacher says he daydreams a lot, mom says he doesnt hear her/blanks out. -
Absence seizures
8 months with intermittent random episodes of vomiting, AB bloating, currant jelly stools, irritability
with poor appetite. growth/lethargic, sausage like mass on Right side - intusseception
8 y/o with DM1 seen for 3 day hx of urinary frequency and nocturia. UA is neg blood and nitrites, + large
amt of leukocytes and ketones. Trace protein. Best initial test - Urine culture/sensitivity
Appendicits - Constant periumbilical pain shifting to RLQ. Worsens over period of 4hrs. Pain
subsides as it migrates to RLQ and then worsens with movement, deep respir, and coughing.Pain/Fever
are late sign, leading to perforation. Vomiting. *Elevated WBC.
avoid this with celiac spruce - Avoid gluten (wheat, barley, rye)
+ obturator sign - acute appendicitis
Bactrim - treatment of choice for UTI in children
Beta thalassemia minor considered - microcytic anemia
child 2 months- 2 years with UTI, antibiotic therapy for - 7-14 days
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