Question 1

Case Study: Early Detection of a Congenital Heart Defect in an Infant

Accepted Answer

A 9-month-old infant presented to our pediatric clinic for the first time to establish care. The visit was otherwise routine, with no known past medical history reported by the family. However, during the physical examination, the infant was noted to be underweight for age, prompting closer evaluation.

On cardiac auscultation, an abnormal heart sound consistent with a pathologic murmur was appreciated. Given the infant’s poor weight gain and abnormal cardiac exam, there was immediate concern for an underlying structural heart condition. These findings were discussed with the family, who understandably expressed distress and concern upon hearing the recommendations for further evaluation.

The family was counseled thoroughly on the importance of prompt assessment and was urgently referred to Pediatric Cardiology. The infant was evaluated later that same week. Following the cardiology visit, the cardiologist contacted our office to report that the infant had a large ventricular septal defect (VSD) that would require open-heart surgical repair.

The diagnosis allowed for timely coordination of specialty care and surgical planning. The family later expressed deep gratitude for the careful examination, early recognition, and advocacy on behalf of their child, acknowledging that early detection played a critical role in the infant’s care and outcome.

This case underscores the importance of thorough physical examination, growth monitoring, and trusting clinical instincts, even during an initial visit, as well as the value of compassionate communication during emotionally difficult moments for families.

Question 2

Case Study: Severe Influenza Complications in an Adolescent Patient

Accepted Answer

A previously healthy adolescent was admitted to the Intensive Care Unit with severe complications related to influenza infection. The patient initially presented with flu-like symptoms that progressed rapidly, leading to respiratory distress and systemic involvement requiring critical care admission.

Despite aggressive management in the ICU—including advanced respiratory support, antiviral therapy, and multidisciplinary critical care—the patient’s condition continued to deteriorate. The clinical course was complicated by progressive organ dysfunction, consistent with known but rare severe complications of influenza in pediatric and adolescent populations.

Over the course of hospitalization, the patient experienced worsening respiratory failure and hemodynamic instability. Despite maximal medical intervention and exhaustive efforts by the ICU and consulting teams, the patient ultimately succumbed to complications of influenza.

This case highlights the potential severity of influenza infection, even in adolescents without significant underlying medical conditions. It underscores the importance of early recognition of worsening symptoms, timely escalation of care, and preventive measures such as annual influenza vaccination.

Question 3

Case Study: Severe RSV Infection in a 2-Year-Old Child

Accepted Answer

A 2-year-old female presented to the pediatric clinic for evaluation of acute respiratory symptoms. According to the caregiver, the child had several days of cough, nasal congestion, and worsening work of breathing. On arrival to the office, the patient appeared ill and in significant respiratory distress.

Physical examination revealed tachypnea, intercostal and subcostal retractions, nasal flaring, and decreased air movement, with audible wheezing. Pulse oximetry demonstrated hypoxemia, and the child was visibly fatigued. Given the severity of symptoms, point-of-care testing was performed and returned positive for Respiratory Syncytial Virus (RSV).

Due to concern for impending respiratory failure, emergency medical services (EMS) were activated immediately, and the patient was transported to the local children’s hospital for higher-level care. She was admitted for supportive management, including supplemental oxygen, frequent respiratory treatments, and close monitoring.

The patient remained hospitalized for three days, during which time her respiratory status gradually improved. The child was discharged home in stable condition with close pediatric follow-up and caregiver education on warning signs and supportive care.

Question 4

Case Study: Intraoral Lip Laceration in a 2-Year-Old Child

Accepted Answer

A 2-year-old female presented to urgent care after falling in the bathtub earlier that day. According to the caregiver, the child accidentally bit down on the inside of her lower lip during the fall. There was initial bleeding, which had since improved, prompting evaluation to assess the need for treatment.

On examination, the patient was alert and well-appearing. Oral examination revealed a small intraoral laceration to the inner aspect of the lower lip without active bleeding, significant swelling, or signs of infection. The wound edges were well-approximated, and there was no through-and-through injury or involvement of the outer lip.

Given the location and size of the laceration, no surgical repair was indicated. Intraoral lacerations of this nature commonly heal well on their own due to the mouth’s rich blood supply.

The family was counseled on supportive care, including offering soft, mushy foods, avoiding sharp or crunchy items, and maintaining good oral hygiene. Pain control with age-appropriate analgesics such as acetaminophen or ibuprofen was recommended as needed. The caregivers were also educated on signs of infection or complications, including increasing pain, swelling, fever, or persistent bleeding, and advised to seek follow-up care if these occurred.

This case highlights the importance of recognizing when conservative management is appropriate for minor oral injuries in young children and providing families with reassurance and clear guidance for home care.

Question 5

Case Study: Molluscum Contagiosum in a 1-Year-Old Child

Accepted Answer

A 1-year-old child presented to the pediatric clinic with multiple small, flesh-colored bumps on the trunk and upper extremities that had gradually increased in number over several weeks. The caregiver denied fever, pain, or systemic symptoms but expressed concern about spread and contagiousness.

On physical examination, the lesions were dome-shaped, smooth papules with central umbilication, consistent with a diagnosis of molluscum contagiosum, a common viral skin infection in young children caused by a poxvirus.

Molluscum contagiosum is highly contagious and spreads through direct skin-to-skin contact, contact with contaminated objects such as towels, clothing, toys, or bath sponges, and through autoinoculation when a child scratches or touches lesions and spreads the virus to other areas of the body. Young children are particularly susceptible due to close contact during play and immature immune systems.

The caregiver was counseled that molluscum contagiosum is a benign and self-limited condition. In healthy children, lesions typically resolve spontaneously within 6 to 18 months, though some cases may last longer. New lesions can continue to appear during this time as the virus spreads on the skin.
Treatment is often not required in young children unless lesions become irritated, infected, or cosmetically concerning. Preventive measures discussed included avoiding sharing towels or washcloths, keeping lesions covered when possible, trimming fingernails to reduce scratching, and practicing good hand hygiene.

The family was reassured that once the child’s immune system clears the virus, the lesions resolve without scarring in most cases. Education and reassurance were emphasized as key components of management

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