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Pediatric Management and Diagnostic Dilemma Tool
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Dilemmas: The Art of Medicine

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Hot Seat: You’re as Cold as Ice

Case by: Masouma Mohamed, PGY4, Inova PEM fellowship HPI: 50 day old, ex FT, born to GBS negative mom, presents to the ER with low temperature. The child was doing well until 4 hours prior to presentation, when mom noticed that she felt cool to touch with forehead sweating. Mother checked a rectal temperature, and […]

Hot Seat #181: 5-year-old with difficulty walking.

HPI: 5-year-old female with a non-verbal autism presents to the ED due to progressive refusal to bear weight over the past month.     Patient was initially seen three weeks ago by her pediatrician for LLE pain. At that visit the CBC, CK, ESR, and CRP were all normal. She was incidentally found to have Vitamin […]

Hot Seat #162: A Patient with Inadequate Imaging

HPI: 16-year-old male with no pertinent past medical history presents for medical clearance with police.  Earlier today he was in a physical altercation and was subsequently arrested.  During the altercation, he notes that he was punched multiple times in the face, and ultimately thrown to the ground. He currently reports pain in his jaw and […]

Hot Seat #157: 10 day old with elbow swelling

CC: 10 day old girl with elbow swelling HPI: 10 day old ex FT girl presenting with left elbow swelling and decreased movement of left arm. Parents report that in the middle of the night, they noticed she was not moving her left arm the same way she was her right. Waking every 1-3 hours […]

Hot Seat #193: 6 yo female with SOB

Masouma Mohamed, PGY4, INOVA Children’s Hospital Fellowship HPI:  A 6-year-old female presents with difficulty breathing accompanied by her grandfather. For the past 3 days, she was not feeling well and was noted to be breathing quickly. No fever, vomiting, or diarrhea. She was seen by her PMD this week and started on Augmentin and cyproheptadine […]

Hot Seat #192: A Sore Throat Quandary

Case by Dr. Christina Rojas, MD HPI: 20 y/o female with a history of migraines presents with fever, sore throat, and headache for 1 day. No vomiting, diarrhea, cough, or shortness of breath. She has still been able to manage her secretions and drink liquids despite throat pain. Headache is nonfocal and feels similar to migraines […]

Hot Seat #191: A Pain in the Neck

Case by: Jessica Hippolyte, MD, MPH You are carrying THE phone when you get a call from EMS regarding destination decision. They are on scene with a 7 year-old who was a restrained backseat passenger who was involved in a front end MVC. Unclear speed of oncoming vehicle (patient’s vehicle was going ~15mph). Patient was […]

Hot Seat #190: Umbilical Uncertainty

HPI: 16-day-old ex-38 wk male who presents with erythema around the umbilicus. The umbilical stump fell off 1 day ago, and since last night parents have noticed redness along the umbilicus. This morning the erythema has worsened and child seems to be fussy upon touching the umbilicus. No drainage or pus from umbilicus. No fevers […]

Hot Seat #189: How fussy is too fussy?

HPI: 16moF otherwise healthy, presents with fever and fussiness. Has had 4 days of upper respiratory symptoms with decreasing PO over this same time. Yesterday she had vomiting, though the parents deny and blood or bile. Today has taken only minimal formula and has gone 12 hours without a wet diaper. Presents for further evaluation. […]