Multiprofessional Critical Care Review: Pediatric 2024 (MCCRCP24ON)-MCCRCPeds_BoardReviewAnswers_Part5

MCCRCPeds_BoardReviewAnswers_Part5_2024

Pdf Summary

The document consists of multiple medical case studies and their corresponding rationale and references, focusing predominantly on pediatric intensive care scenarios. Each case presents a unique condition, followed by a discussion on differential diagnoses, recommended management strategies, and supportive evidence from medical literature.<br /><br />1. **Case 1**: A 10-year-old girl with a history of symptoms consistent with intermittent Maple Syrup Urine Disease (MSUD) is presented. Management should include glucose-free IV fluids with a methionine- and valine-free formula.<br /><br />2. **Case 2**: A 12-month-old boy is diagnosed with severe hyperammonemia, pointing to argininosuccinic aciduria, a urea cycle disorder. The differential includes organic acidemias and fatty acid oxidation defects.<br /><br />3. **Case 3**: A 5-year-old girl with a potential ventriculoperitoneal (VP) shunt malfunction requires transfer to a specialized facility for possible shunt revision due to slit ventricle syndrome (SVS).<br /><br />4. **Case 4**: A 12-year-old girl with severe influenza pneumonia and acute respiratory distress syndrome would most benefit from early enteral nutrition within 48 hours to improve survival chances.<br /><br />5. **Case 5**: An 8-year-old girl with multiple traumas and traumatic brain injury should begin enteral feedings promptly to aid in recovery.<br /><br />6. **Case 6**: A child presenting with symptoms of intestinal obstruction indicative of malrotation with midgut volvulus highlighted by imaging findings of a classic "double bubble" sign.<br /><br />7. **Case 7**: A 4-year-old lactose-intolerant child is best managed with a gastric feeding tube and milk protein-based formula, which is suitable despite lactose intolerance.<br /><br />8. **Case 8**: An ethical discussion on the resource allocation for pediatric intensive care in a developing nation, advocating for essential healthcare provisions rather than intensive care in regions with high child mortality rates.<br /><br />9. **Case 9**: A child with active sepsis is contraindicated for renal transplantation, underlining the necessity of resolving infections prior to such a procedure.<br /><br />10. **Case 10**: The use of opiates during the removal of life-sustaining support is ethical if intended to alleviate discomfort.<br /><br />11. **Case 11**: In cases of severe illness complicating chronic conditions, it is essential to provide detailed guidance and respect family decisions on resuscitation, ensuring they understand the full scope of care.<br /><br />12. **Case 12**: Hyperleukocytosis and leukostasis in a child with a high white cell count require urgent leukapheresis to prevent complications, but tumor lysis syndrome should be monitored and managed accordingly.<br /><br />13. **Case 13**: Hydroxyurea treatment in sickle cell disease increases Hemoglobin F, thus reducing disease severity.<br /><br />These cases collectively underscore the complexities in pediatric critical care, the necessity for prompt and accurate diagnosis, tailored management strategies, and ethical considerations in treatment planning.

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