Pediatrics is easy

22/06/2026

A 13-month-old boy is seen in the pediatrician's office for yellowing of his eyes and poor appetite for the past
several days.

He was treated for an ear infection 4 weeks ago with amoxicillin (90 mg/kg/day) 2 times per day
for 7 days, and acetaminophen (15 mg/kg/dose) 4 times daily for 2 days.

His mother was diagnosed with
chronic hepatitis B during pregnancy.

He received hepatitis B immunoglobulin within 12 hours of delivery and the full hepatitis B immunization series (per Centers for Disease Control and Prevention guidelines).

Physical examination findings are remarkable only for mild scleral icterus.

Laboratory results are shown:

Aspartate aminotransferase 255 U/L

Alanine aminotransferase 384 U/L

Bilirubin, total 15.2 mg/dL (259.98 µmol/L)

Albumin 2.5 g/dL (25 g/L)
Hepatitis A IgM Nonreactive

Hepatitis B sAg Reactive
Hepatitis B sAb

14/06/2026

A 15-year-old girl is undergoing evaluation of neck enlargement first noted 3 months ago.

She has had no fever.
Her neck has not been painful or red.

She does not have any difficulty swallowing.

On physical examination, her thyroid gland is symmetrically enlarged without nodules and has a granular feel.

The remainder of her examination findings are normal.

Laboratory results are shown:
Laboratory Test Result
Thyroid-stimulating
hormone 1.25 µIU/mL (reference range 0.5-5 µIU/mL)

Free thyroxine 1.33 ng/dL (reference range, 0.7-1.6 ng/dL)

Thyroid peroxidase antibody >900 IU/mL (reference range 5 IU/mL (reference range

Whether you're a new resident mastering the basics, a busy practitioner seeking fast clinical answers, or a senior consultant staying ahead of the latest trends— we've got you covered.

09/06/2026

Proposed terminology change for polycystic o***y syndrome (May 2026)

Polycystic o***y syndrome (PCOS) is one of the most common endocrine/metabolic disorders of females and is associated with cardiometabolic risks, ovulatory and menstrual irregularity, subfertility and infertility, and clinically evident hyperandrogenism. There has been longstanding support for renaming the syndrome because "PCOS" does not reflect the most common clinical features of the syndrome. Pathological cysts are not a feature of the condition, and an inappropriate focus on ovarian imaging may delay diagnosis, particularly in adolescents. After a global consensus process, a consortium of experts proposed that the term Polyendocrine Metabolic Ovarian Syndrome (PMOS) replace PCOS as it better reflects the salient clinical features and underlying endocrine and metabolic pathophysiology [7]. Whether the new term will be widely adopted is uncertain at this time.

07/06/2026

An 8-year-old is seen in an urgent care center for 1 day of vomiting and diarrhea.

She has no significant past medical history.

She has not had fever, headache, abdominal pain, or blood in her stool.

She has been unable
to tolerate liquids at home and has urinated once in the past 24 hours.

The girl appears tired but is fully oriented.

Her heart rate is 120 beats/min, respiratory rate is 18 breaths/min, blood pressure is 96/60 mm Hg, and weight is 25 kg.

Her mucous membranes are dry, capillary refill time is 3 seconds, and abdomen is soft without focal tenderness or peritoneal signs.

The remainder of her examination findings are normal.

Laboratory results are shown:

Sodium 137 mEq/L (137 mmol/L)
Potassium 4.6 mEq/L (4.6 mmol/L)

Bicarbonate 20 mEq/L (20 mmol/L)
Chloride 110 mEq/L (110 mmol/L)

Urea nitrogen 10 mg/dL (3.57 mmol/L)
Creatinine 0.6 mg/dL (53.04 µmol/L)

Glucose 78 mg/dL (4.33 mmol/L)

Of the following, the BEST next step is

A. oral rehydration with a solution containing 20 g/L of glucose and 75 mEq/L of sodium

B. oral rehydration with a solution containing 250 g/L of glucose and 20 mEq/L of sodium

C. parenteral rehydration with a 200 mL bolus of lactated Ringer solution

D. parenteral rehydration with a 500 mL bolus of 0.9% sodium chloride solution

For more cases like this visit my website

Whether you're a new resident mastering the basics, a busy practitioner seeking fast clinical answers, or a senior consultant staying ahead of the latest trends— we've got you covered.

01/06/2026

A 4-year-old with short gut syndrome is seen in the complex care clinic for a follow-up visit.

He has been well
other than a viral upper respiratory illness 1 month ago.

He continues to receive both partial parenteral
nutrition and jejunostomy tube feeds.

He has several episodes of stool output per day.

He has not gained
any weight since his last comprehensive visit 6 months ago.

Results of his complete blood count are shown:

White blood cell count 3,500/µL (3.5 × 10 /L)
Neutrophils 30%
Lymphocytes 50%
Monocytes 12%
Eosinophils 8%

Platelet count 115 × 10 /µL (115 × 10 /L)

Hemoglobin 8.5g/dL (85 g/L)
MCV 100 fL
Absolute reticulocyte count 30× 10 /µL (30 × 10 /L)

A peripheral blood smear from this patient is shown https://drive.google.com/file/d/1BSTRDg_yFB_vomfIsLgtuidBZM2V7y3e/view?usp=drivesdk

Of the following, this child will benefit MOST from supplementation with

A. iron

B. vitamin B12

C. vitamin C

D. vitamin E

25/05/2026

A 14-year-old adolescent is undergoing evaluation for 4 days of bilateral hand pain, including pain in her
fingers when using her smartphone.

A week before this began, she had a self-limited illness with 2 days of low-grade fever and myalgias.

This week, she has had a rash on her face that is exacerbated by sun exposure
https://drive.google.com/file/d/1ut8trVxyNObnDJHgSlhJW5-zqAUGFUaP/view?usp=drivesdk

On physical examination, the adolescent has an erythematous confluent rash over her face and pain with movement of her metacarpophalangeal joints on both hands.

Laboratory values are shown:

Serum white blood cell count 9,000/μL (9.0 × 109/L)
Neutrophils 25%
Lymphocytes 45%
Monocytes 25%
Eosinophils 5%

Hemoglobin 9.0 g/dL (90 g/L)
Platelet count 280 × 103/μL (280 × 109/L)

Serum sodium 136 mEq/L (136 mmol/L)
Serum potassium 4.0 mEq/L (4.0 mmol/L)

Serum creatinine 0.5 mg/dL (44.20 µmol/L)

Aspartate aminotransferase 44 U/L
Alanine aminotransferase 32 U/L

High-sensitivity troponins

21/05/2026

Explanation of the previous post

19/05/2026

Why in vitamin K deficiency only the PT will be prolonged although vitamin is responsible for synthesizing factor 2 and 10 (common pathway), 7 (extrinsic pathway) and 9 (intrinsic pathway). ????

17/05/2026

A previously healthy 18-month-old child is seen in the office for vomiting and profuse watery diarrhea which
began 3 days ago.

The child has been having about 10 diarrheal stools daily, without blood or mucus.

He attends day care and 3 weeks ago returned from a family vacation trip to Puerto Rico, where he played with a
pet turtle.

His immunizations were delayed until 6 months of age during the COVID-19 pandemic.

On physical
examination, the boy’s temperature is 39.5 °C, heart rate is 120 beats/minute, respiratory rate is 40 breaths/min, and blood pressure is 92/62 mm Hg.

He has dry mucous membranes, decreased skin turgor, and a capillary refill time of 3 seconds.

His bowel sounds are hyperactive.

The remainder of his examination findings are normal.

Of the following, the MOST likely etiology of this child’s illness is

A. enterotoxigenic Escherichia

B. rotavirus

C. Salmonella

D. SARS-CoV-2