A 12-year-old boy with a recent history of sinusitis and acute otitis media presented to the emergency department with 3 weeks of upper neck pain and generalized weakness. He also reported headaches and occasional diplopia and vomited twice the day before presentation. The patient was afebrile, with normal vital signs. On examination, he was listless and found to have a left-sided ear effusion,…

A 12-year-old girl presented to the emergency department with 1 week of monocular diplopia and crossed right eye. She reported new occipital headaches and neck pain during this time. She denied any eye pain, trauma, or other previous ocular pathology. Her history was otherwise negative for recent illness, incontinence, weakness, or vomiting. She had no personal or family history of neurologic…

A 4-day-old male neonate presented to the neonatology department with recurrent vomiting and jaundice since birth. The gestation and birth were normal. The baby looked well, was afebrile, and had a pulse rate of 135 beats/min, with a blood pressure of 61/31 mm Hg. Circulatory and pulmonary examination results were normal, and the abdomen was nontender, with bowel sounds. The WBC count was…

A 3-day-old male infant presented to the emergency department for emesis after every feeding. He was born at term without complications. Emesis was described as milk colored, nonforceful, and nonbilious. His mother reported multiple wet and dark stool diapers daily. Physical examination revealed weight loss of 185 g since birth, poor skin turgor sunken anterior fontanelles, and abdominal…

A full term, vaginal delivered, 7-day-old, male neonate presented to the emergency department (ED) with a 3-day history of a rash to the groin and abdomen (Figure). The mother denied history of sexual transmitted diseases, history of genital lesions, or antepartum antibiotic administration. The patient had no fever and was breastfeeding well, and the rash had not spread in 2 days. Vital signs…

A 12-week-old infant presented to the emergency department with 2 episodes of nonbilious, nonbloody vomiting after feeding. The parents reported that the child was born at full term, with normal eating and stool patterns since birth. On examination, the child was found to be afebrile and to have a soft, nontender, nondistended abdomen. Abdominal ultrasonography performed by the radiology…

An 18-year-old previously healthy man presented to the emergency department with 4 weeks of fatigue, a 20-pound weight loss, nonbloody, nonbilious vomiting, and a syncopal episode. He had no other significant symptoms. Vital signs were notable for a pulse rate of 78 beats/min and a blood pressure of 93/53 mm Hg. His physical examination result was unremarkable. Laboratory test results were…

A 16-year-old male adolescent with a history of short-chain acyl coenzyme A dehydrogenase deficiency and bicommissural aortic valve presented to the emergency department with 3 months of intermittent episodes of chest pain, emesis, and low-grade fevers. Physical examination demonstrated normal vital signs and unremarkable results aside from developmental delay. A chest radiograph demonstrated…

A 16-year-old male adolescent with no significant medical history presented with right shoulder pain and dysphagia after a football injury. He was tackled and landed on his right shoulder. On arrival, the patient was holding the right arm close to his body, with the elbow flexed at 90 degrees and the shoulder slightly internally rotated. There was tenderness over the entire right clavicle and…

A 13-year-old, developmentally appropriate, Tanner’s stage IV boy, with history of type 1 diabetes, presented to a tertiary care pediatric emergency department after development of dysuria, urgency, and frequency, with mild gross hematuria. He did not have any systemic symptoms such as fevers, chills, or rigors. He did not have flank pain.