Pediatric Primary Care Flashcards

A 4-year-old has had fever for 5 days with bilateral nonexudative conjunctivitis, strawberry tongue, cracked lips, and swollen hands and feet. What is the recommended treatment?

Answer: IV immunoglobulin plus aspirin

Kawasaki disease is treated with IVIG and aspirin, ideally within 10 days of fever onset, to reduce the risk of coronary artery aneurysms.

A 5-week-old boy has projectile nonbilious vomiting after every feed, and an olive-shaped mass is felt in the epigastrium. Which metabolic finding is most expected?

Answer: Hypochloremic, hypokalemic metabolic alkalosis

Persistent vomiting of gastric contents in pyloric stenosis causes loss of HCl, leading to hypochloremic, hypokalemic metabolic alkalosis.

Which missing milestone would be most concerning in a 9-month-old?

Answer: Sitting without support

Most infants sit without support by about 6 months, so not sitting at 9 months is a red flag, while the other skills come later.

A 2-year-old with no recent antibiotic use has acute otitis media along with purulent conjunctivitis. What is the most appropriate antibiotic?

Answer: Amoxicillin-clavulanate

Otitis-conjunctivitis syndrome suggests beta-lactamase-producing nontypeable H. influenzae, so amoxicillin-clavulanate is preferred.

A 6-year-old has bright red cheeks and a lacy, reticular rash on the arms after a mild viral illness. When can the child go back to school?

Answer: Right away, because the child is no longer contagious once the rash appears

In erythema infectiosum (parvovirus B19), children are contagious before the rash, so exclusion is not needed once the rash appears.

An obese 12-year-old boy has had a limp and vague knee pain for 3 weeks, with reduced internal rotation of the hip. What is the best next step?

Answer: Bilateral hip radiographs, AP and frog-leg lateral

Slipped capital femoral epiphysis often shows up as referred knee pain and is diagnosed with AP and frog-leg lateral views of both hips.

An 18-month-old has one generalized seizure lasting 3 minutes during a febrile illness and is back to baseline with a normal exam. What is the most appropriate management?

Answer: Reassurance, parent education, and treating the fever source

A simple febrile seizure needs no routine EEG, imaging, or anticonvulsants; management is education and evaluating the fever source.