A father brings his 2 year old son to the ED. He reports that the boy spent several hours in the garage with him while he was repairing the car. On questioning, the father states that over the course of the afternoon, the child seemed more sleepier than usual, then became lethargic, vomited, and seemed like he was “drunk”. On the way to the hospital he began having seizures. In the ED, the boy was given a dose of lorazepam (Ativan) to stop the seizures and was endotracheally intubated because of respiratory depression. His initial laboratory results are: Sodium: 138 mEg/L Potassium: 4.9 mEq/L Chloride 100 mEq/L Bicarbonate 6 mEq/L Glucose 120 mg/dL BUN 10 mg/dL Calcium 5.5 mEq/L   Of the following, the MOST likely cause of this child’s clinical condition is ingestion of

A 15 year old male presents with severe scrotal pain which just started today. The most appropriate next step to his management would be:  

 A 3 year old, previously healthy, caucasian female presents to the ED and incidentally is found to have a blood pressure of 164/93 mm Hg. Upon further investigation of her history, the parents state that she has been increasingly irritable recently. On physical exam, she has 8 cafe au lait lesions measuring more than 3 cm x 2 cm. Of the following, which is the most likely etiology of her hypertension?

A 5-year-old female is very excited following a ride on the big Ferris Wheel. In the midst of her excitement, she suddenly loses consciousness and falls abruptly to the ground. Paramedics on the scene document pulseless ventricular tachycardia. The family history reveals a maternal uncle who died suddenly at 16 years of age. Following the PALS algorithm, what medication would the paramedics give during resuscitation?    

A mother brings her 6 year old son to the ED today. During the history taking, she states that his academic performance has declined during the last year. His teacher notices him “staring into space” frequently throughout the day. Sometimes, he seems “off in his own world.” He doesn’t answer questions often in class. You order an EEG that reveals a 3-Hz generalized spike-and-wave pattern that can be triggered by hyperventilation. What seizure type do you think this patient is likely to have?  

A 3 year old child presents with 24 hours of episodes of inconsolable crying. His parents state that his sleep/awake pattern is altered and he seems uncharacteristically “out of it” at times. Physical exam shows fluctuation in attention and being arousable, with diffuse hyperreflexia. Emergent head CT shows no abnormalities. Laboratory testing documents markedly elevated serum transaminases. Of the following, the MOST likely cause for the child’s mental status change is:  

A 12 year old, 50 kg male is admitted to the pediatric ward after being seen in the ED because he fell from a tree and sustained a depressed skull fracture. He has multiple bruises elsewhere but no other fractures on his trunk or extremities. Findings on a chest Xray and urinalysis are normal.He was placed on IV fluids (D5NS20K) at maintenance rate. However, 12 hours into his admission, the electrolyte values reveal hyponatremia:   Na = 127, K = 4.9, Cl =97, HCO3 = 22, BUN 9, Cr = 0.4 Hyponatremia is most likely a result of:   

A 4-day old female infant presents to your ED in cardiogenic shock. She is afebrile, pale and unresponsive. She is placed on oxygen without any change in her saturations. CXR shows altered pulmonary vasculature and cardiomegaly. What drug might you start initially?

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An 8 month old female fell from a top bunk (distance of 6 feet) approximately 30 minutes ago. She is brought to the ED via ambulance. While you are examining her she begins to vomiting. What is your next course of action?