424 Emergency Medicine
Pyloric stenosis typically presents between 3 to 6 weeks of life, but very
rarely after this time. It is most common in first-born males. If you were
looking for the finding of an olive on examination you will be disappointed
in the majority of cases. It can sometimes be felt in the operating room
under anesthesia.
(a)This is incorrect because the values are physiologically normal.
(c and e)These are incorrect because both the potassium and chloride are
elevated and this is not consistent with pyloric stenosis. (d)This is incor-
rect because the bicarbonate is low. Low bicarbonate can be a very late
finding in pyloric stenosis and is a sign of severe physiologic disturbance.
378.The answer is d. (Fleischer and Ludwig, pp 812-813, 857.)The
patient’s presentation is suspicious for chlamydial conjunctivitis.Even
without any respiratory symptoms at the time of presentation, a significant
percentage of these patients harbor the organism in their nasopharynx and
go on to develop chlamydial pneumonia at a later date. Therefore, treat-
ment for 14 to 21 days with oral erythromycin is appropriate. The classic
description of chlamydial pneumonia is a dry, staccato cough.
(c)It is incorrect because topical treatment alone is insufficient. (a and b)
These are incorrect because there is no systemic signs of illness. Nasolacrimal
duct stenosis (e)is common but does not typically present with conjunctivi-
tis. Rather, there is unilateral or bilateral discharge.
379.The answer is c.(Fleischer and Ludwig, p 635.)This patient had a
simple febrile seizure.Approximately 2% to 5% of children will experi-
ence a febrile seizure during their lifetimes. Febrile seizures occur between
the ages of 3 months to 5 years, are associated with fever, and are catego-
rized as either simple or complex. Simple febrile seizures are generalized
andlast less than 15 minutes.Complex febrile seizures are prolonged,
recur within 24 hours, or are focal. The approach to a patient with a febrile
seizure is, for all intents and purposes, identical to that of the same patient
who has not had a seizure, so long as the seizure has stopped by the time
you are evaluating the patient. If the seizure continues, attend to it as you
would any seizure with indicated medications and attention to ABCs. Once
the patient is stable, it is important to identify the source of the fever. This
female patient, having a temperature of 103°F for 2 days and having no
other source of infection mandates that her urine be checked to evaluate for
urinary tract infection (UTI).