December Week 2

Peds in Review, Volume 31, Number 4, April 1, 2010, pages 135-144

1. As the Sick Resident in CYAS, you walk into room 22 and see a sweaty, pale, 5 year old girl on her mother’s lap. As her Mom describes the appearance of her digested Cheerios in great detail, you notice the girl shifts position every few minutes. When you ask her where her tummy hurts, she says “Everywhere” before she bursts into tears. Your physical exam yields no focal points of tenderness. Her pain is most likely:
A) Visceral pain.
B) Somatoparietal pain.
C) Functional pain.
D) Psycho-somatic pain.

2. You are the Gray intern on call at Georgetown and the SAR sends you down to the ER to evaluate a baby sent from the PMD. When you pull back the curtain, you see a 10 month old boy, sleeping calmly on the stretcher. His mother describes him screaming in pain “unpredictably” this morning, vomiting, not wanting to eat or drink, and overall just not seeming like himself. She hands you a print-out of the CBC drawn at the Dr. Balfour’s office that morning, and it shows a white count of 10,000, a hemoglobin of 11 g/dL, and a platelet count of 200,0000. You think you feel something on the right side of the baby’s abdomen, but he cries too much when you get too close to whatever it is. Opening the diaper, you see a blob of shiny, gelatinous blood. Who should you call next?
A) Dr. Volberg, for an ultrasound to rule-out intussuception, and possible air-contrast enema.
B) Dr. Chahine, for evaluation of suspected appendicitis
C) Dr. Rekhtman, for a colonoscopy to rule-out inflammatory bowel disease.
D) Dr. Morel, for a refresher on causes of infectious colitis