PEM Source

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All posts with tag: "endocrine"

PEM Questions

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You are seeing an 18 month old with 3 days of cough and congestion and 4 hours of tachypnea. On exam, she has diffuse scattered wheezes and mild intercostal retractions. Her vital signs are: temperature of 38.6, HR 160, RR 40, and O2 sat 94% on room air. As part of her fever work-up her urine is dipped, and while there are no signs of UTI, she has glucosuria. Her serum glucose is 160, and her lytes are Na-138, K-4.2, Cl-110, CO2-17. 

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You are seeing a 6 year old girl who comes in for right leg pain after a ground level fall at the park. She is currently being worked up by her pediatrician for precocious puberty, including vaginal spotting and breast buds. On exam, her temp is 37.5, HR 90, RR 22, pulse ox 100% on room air. Her face appears asymmetric. Heart and lung exam is normal. Abdomen is soft, and you do not palpate any masses. Her right leg shows no swelling, obvious deformity, or neurovascular compromise, but she is tender to palpation along her anterior tibia. She has a large light brown irregularly shaped macule on her back. 

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You are seeing a 5 year old child with known adrenal insufficiency with fluid and pressor-resistant hypotension. You wish to give stress-dose steroids. 

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You are seeing a 13 year old boy with vague complaints of malaise, nausea, morning headaches, loss of appetite, and intermittent abdominal pain. When he first stands up, he feels dizzy. His exam is notable for tachycardia and hyperpigmentation of his gingiva, lips, knuckles, and palmar creases.

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A 14-month old boy presents with altered mental status. He has had 2 days of vomiting and diarrhea, but no fever. He weighs 10 kg. Bedside blood glucose measurement is 38 mg/dL. A 22 gauge peripheral IV is obtained in his right hand.

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What are pediatric emergency physicians seeing more of when COVID prevalence rises?

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Last week’s 10 day old patient presented with seizures and jitteriness due to hypocalcemia. In the ED, he has a peripheral 22 gauge IV placed. 

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You are seeing a 3yo girl brought in by ambulance after a new-onset seizure. The patient has no past medical history, but has been having an acute viral gastroenteritis for the last 24 hours, as have several family members. She has had decreased oral intake, vomited 3 times non-bloody non-bilious, and had 3 episodes of watery non-bloody diarrhea. She is afebrile. She went to bed at 9:30pm, sleeping next to her parent, and the parent was awakened by her having a generalized tonic-clonic seizure at 6am. Per EMS, seizure had resolved on their arrival but she was lethargic; point-of-care blood glucose was 40 mg/dL in the field, and she was given 5 mL/kg of D10W IV with patient becoming more alert. In the ED, her urine dip is positive for ketones.

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(Click the link to comment and to vote - voting not working through email, sorry!) You are caring for a 12 year old known diabetic who presents in diabetic ketoacidosis. Temperature is 37.5, HR 100, RR 24, BP 96/36, O2 sat 98% on room air. Labs show glucose 550, Na – 132, K – 2.8, pH 7.09. An initial bolus of normal saline 20 mL/kg has been given. [yop_poll id="162"]
(Click the link to comment and to vote - voting not working through email, sorry!) An 18 month old with history of pseudohypoaldosteronism presents with a K+ level of 9.0 and peaked T waves with mild QRS widening on the electrocardiogram, and blood pressure of 70/40. [yop_poll id="159"]
(Click the link to comment and to vote - voting not working through email, sorry!) You are seeing a 16 year old obese teen with no previous history of diabetes who presents with recent viral URI symptoms and increasing altered mental status over the last 8 hours. Her temperature is 37.9, heart rate 140, resp rate 22, and BP 90/35.  Blood glucose is 950, Na 130, K 3.4, and urine negative for ketones. The teen is confused and has a GCS of 13. [yop_poll id="66"]
(Click the link to comment and to vote - voting not working through email, sorry!) A previously healthy 5 year old boy with PMH of ADHD presents with 9 days of lethargy, fever, vomiting, diarrhea, and weight loss. He recently was diagnosed with strep pharyngitis and treated with amoxicillin for 3 days. His vital signs are: temp 39 C, HR 140, RR 24, BP 154/99, O2 sat 99% on room air. His exam is significant for agitation and restlessness, and tachycardia with bounding pulses and a hyperdynamic PMI. His mother feels that his anterior neck looks swollen. [yop_poll id="23"]
(Click the link to comment and to vote - voting not working through email, sorry!) You are seeing a 5 year old fully immunized patient with 2 weeks of new onset bedwetting, 3 days of cough and fever, and 2 days of increased work of breathing. Initial POC labs are significant for a blood sugar of 450 and a pH of 7.11, Na 130, K 3.4. You start a 20 cc/kg NS bolus and send a full set of labs. The patient is complaining of headache and is lethargic initially, becoming increasingly obtunded over the first half hour in the ED. [yop_poll id="22"]

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