Question
A previously well 5-year-old boy presents with recent onset of abdominal pain and diarrhea (that has contained blood on several occasions). A stool culture is subsequently positive for Shiga toxin–producing Escherichia coli O157:H7.

Explanation
- Most children with diarrhea caused by Shiga toxin–producing E. coli O157:H7 (STEC) should be treated only with fluid replacement and not an antimicrobial agent.
- Patients treated with an antimicrobial for STEC hemorrhagic colitis are at greater risk of developing hemolytic uremic syndrome (HUS)

Question
You are seeing a 14-year-old boy who is brought from a local swimming pool with neck pain after diving into the shallow end of the pool. He did not lose consciousness; however, he has complained of persistent neck pain and is refusing to turn his head due to pain. He is also complaining of weakness and tingling in his arms.

Explanation
🔹Spinal cord injuries are uncommon in children occurring most frequently in teenage males.
🔹Cer­vical spine injuries result from blunt trauma and may involve the bones, ligaments, blood vessels, peripheral nerves, or spinal cord.
🔹Cervical spine fracture is rare in children younger than 8 years.
🔹This age group is more likely to injure the upper cer­vical spine.
🔹Common mechanisms are motor vehicle crashes, diving, sports-related injuries, and violence.

Question
A 14-year-old adolescent girl is referred for evaluation of lower abdominal pain. She had menarche at 12 years of age. She initially had 1 period every 2 to 3 months, but for the past year she has had regular monthly periods accompanied by severe lower abdominal pain for the first 2 days that has had minimal response to ibuprofen. She misses 1 day of school monthly because of abdominal pain, nausea, and diarrhea. Her mother has a history of endometriosis. The girl has never been sexually active.

Explanation
🔹Primary dysmenorrhea is the most common cause of gynecologic-related abdominal pain in female adolescents.
🔹A urine pregnancy test should be done in any menstruating adolescent with pelvic pain or a premenstrual girl with a questionable history.
🔹Ovarian torsion and ectopic pregnancy are medical emergencies that must be ruled out in female adolescents with acute pelvic pain.

Question
A 12-month-old boy presents to your clinic for his health supervision visit. He is growing and developing normally. His diet consists of approximately 30 ounces of cow's milk daily, as well as mixed table foods. His heart rate is 122 beats per minute. Physical exam reveals gingival and conjunctival pallor and a grade 1/VI systolic ejection murmur heard over the left sternal border.

Explanation
🔹 This patient's age, history, and physi­ cal exam findings are most consistent with iron deficiency anemia(IDA)

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