Case presentation A 7-year-old male with a medical history of asthma presents with 7 days of cough and “not feeling well.” Four days ago, the patient developed fever to 103 degrees Fahrenheit. He was seen at his primary care provider 2 days ago and started on azithromycin, but he has not been eating or drinking well for the past several days and has had decreased urine…
Case presentation A 16-year-old female presents with a history of severe headaches, nausea, and vomiting for the past 3 weeks. She was seen at an urgent care facility where she was diagnosed with sinusitis and was given prescriptions for odansetron, prednisone, and amoxicillin. After several days of these medications, she did not experience any relief, so she was seen by her primary care provider. She was…
Case presentation A 7-month-old baby presents with left infraorbital swelling and erythema for the past 2 days, which has progressed rapidly. There has been a fever of 101.5 degrees Fahrenheit for the past 24 hours. He has not had cough, congestion, vomiting, or diarrhea. Four days ago, the child was playing with his older sibling, who, during the course of play, threw a small toy car…
Case presentation A 10-year-old male presents with left eye edema and pain for the past 2–3 days. The child reports mild congestion for the past week but there has been no fever, vomiting, cough, vision changes, eye discharge, or trauma. He states that it is difficult for him to completely open the eye because of the swelling. When he does, he complains of generalized eye pain.…
Case presentation A 13-year-old male presents with acute onset of mental status changes. He was found in his room, lying facedown. Emergency medical services was called. On their arrival, the patient was conversing but appeared sleepy; he was responsive to questions but confused. He was attempting to speak but was able to manage only a few words. Once in the Emergency Department, the patient was able…
Case presentation A 2-year-old child presents with difficulty ambulating for the past 24 hours. His parents state that the child has had fever, cough, and congestion for the past 5 days. He was seen twice by his primary care provider and diagnosed with a viral upper respiratory infection. A chest x-ray 1 day ago was interpreted as consistent with a viral process. The parents tell you…
Case presentation A 20-month-old patient presents with decreased activity, including eating and drinking, over the past 2 days. He is currently completing a second course of oral antibiotics for acute otitis media and 1 week ago completed a 10-day course of cefdinir. He was especially sleepy today, per the parents, who decided to bring him to his primary care physician for evaluation. He was also found…
Case presentation A 17-year-old male presents with right-sided facial numbness and extremity weakness that has been intermittent for the past 1 month. Several hours ago, the patient noted he had difficulty ambulating when rising out of bed due to the weakness, causing him to fall. He was able to prevent injury by steadying himself on a chair. He went back to lie down and then called…
Case presentation A 4-year-old female presents with the parents noting that the child has been “not walking right” and “wobbly” for the past 3 weeks. She sustained a head injury 1 month prior to her current presentation but there was no reported loss of consciousness at that time and the fall was off a chair, onto a hardwood floor, less than 2 feet. At the time,…
Case presentation A 6-year-old male with no significant medical history presents with headaches for the past 2 weeks. The headache is described as diffuse and, while occurring throughout the day, seems to be worse at night, at times waking him from sleep. He has also had daily first morning nonbilious, nonbloody emesis for the past week. There is no complaint of abdominal pain and there has…
Case presentation An 83-day-old female, with a history of congenital hydrocephalus and chronic subdural fluid collections, presents with a 1-week history of increasing fussiness and decreasing oral intake. She has a ventriculoperitoneal (VP) shunt that was placed soon after birth; there has been no revision of the shunt since placement. The mother reports to you that there has been no fever, vomiting, diarrhea, or rash, and…
Case presentation An 11-year-old female presents with severe right-sided abdominal pain that began 5 days ago. The patient reports that she was in her usual state of good health until she experienced the pain, which initially seemed generalized, intermittent, and achy but has become more constant, sharp, and now is located primarily in the right lower quadrant. She developed a fever to 102 degrees Fahrenheit 2…
Case presentation A 14-month-old female is referred from her primary care pediatrician for increasing abdominal girth and an abdominal mass. For the past month, the child’s abdomen has been increasing in size, as noted by her parents. There has been no associated fever, vomiting, diarrhea, trauma, back pain, urinary complaints, difficulty breathing, or cough. She is otherwise behaving at her baseline. Physical examination reveals a well-appearing…
Case presentation An 11-year-old male presents with acute onset of left-sided lower abdominal pain and left-sided flank pain, which began 1–2 hours prior to presentation. The patient was not engaged in any particular activity; he states that he was “just relaxing” when the pain began. He denies trauma. There has been no fever, back pain, dysuria, hematuria, testicular pain/swelling, or other abdominal pain. While he has…
Case presentation A 13-year-old female presents with acute onset of right lower quadrant pain for the past 4 hours. She states that she has been in her usual, normal state of health and was “just walking down the street” when she experienced the pain, which was accompanied by nausea and she has had three episodes of nonbilious/nonbloody emesis. She states that after the emesis, she feels…
Case presentation A 4-month-old male presents with bilateral scrotal swelling. Per the mother, this has been present since 1 month of age but has worsened over the past week and she has noted that the right side of the scrotum appears darker than normal. The mother also states that there has been mild congestion and cough for the past week and today the child developed a…
Case presentation A 15-year-old male presents with left scrotal pain and swelling for the past 5 hours. He states that he was jumping on a trampoline just prior to presentation and afterward, he experienced his symptoms. He denies genital trauma. He has not had fever, back pain, dysuria, hematuria, penile discharge, abdominal pain, or vomiting. He denies being sexually active. Physical examination reveals a well-appearing pleasant…
Case presentation A 3-week-old male presents with nonbilious, nonbloody emesis for the past 1.5 weeks. Initially there were two to three episodes per day, occasionally with feeding, but this has increased to emesis with every feed. The parents report that the emesis is “forceful” and afterward the child appears to want to eat again. He has had decreased urine output over the past 24 hours. There…
Case presentation A 4-year-old male presents to the emergency department after his parents witnessed the ingestion of a coin. His mother states that he grabbed one out of her purse that was lying on the ground nearby. The patient is resting comfortably in the room, in no acute distress. His lungs are clear to auscultation, there is no stridor, and he is managing his secretions. His…
Case presentation A 14-year-old male is brought to the emergency department with severe diffuse abdominal pain. He has had multiple episodes of nonbloody but bilious emesis accompanying the pain. There has been no fever, diarrhea, or trauma. There are no sick contacts or travel. He has had decreased oral intake of both solids and fluids due to nausea over the past 5 days. Notably, his weight…