--- title: "Pediatrics Case: Child with Fever, Vomiting, Diarrhea & Abdominal Pain" description: "Pediatrics exam vignette: 3‑yr‑old with fever, vomiting, diarrhea, and abdominal pain — stepwise answer and high‑yield exam pearls." image: https://challengercme.com/hubfs/QUIZ%20TIME.png --- [![Med-Challenger-green-logo-1024x244](https://challengercme.com/hubfs/Med-Challenger-green-logo-1024x244.webp) ](https://challengercme.com/) - [SHOP EXAM PREP & CME ](https://challengercme.com/blog/a-3-year-old-girl-with-fever-vomiting-diarrhea-and-abdominal-pain-wakes-up-pale-and-lethargic#) ### [EMERGENCY MEDICINE](https://challengercme.com/emergency-medicine-exam-review-cme-course) [ABEM exam prep](https://challengercme.com/emergency-medicine-exam-review-cme-course), [MyEMCert](https://challengercme.com/emergency-medicine-myemcert-exam-review-course), etc. ### [FAMILY MEDICINE](https://challengercme.com/family-medicine-exam-review-cme-course) [ABFM exam prep](https://challengercme.com/family-medicine-exam-review-cme-course), [ABFM KSA](https://challengercme.com/family-medicine-moc-ksa-course), etc. ### [INTERNAL MEDICINE ABIM exam prep, MOC points, etc.](https://challengercme.com/internal-medicine-exam-review-cme-course) ### [OBGYN ABOG exam prep, CREOG, etc.](https://challengercme.com/obgyn-exam-review-cme-course) ### [PEDIATRICS ABP exam prep, MOCA-PEDS, etc.](https://challengercme.com/pediatric-medicine-exam-review-cme-course) ### [PEDIATRIC EM](https://challengercme.com/pediatric-emergency-medicine-3rd-edition) [ABP/ABEM exam prep Ed.3](https://challengercme.com/pediatric-emergency-medicine-3rd-edition), [Ed.2](https://challengercme.com/pediatric-emergency-medicine-pack2), etc. ### [SPECIAL PURPOSE / SPEX FSMB exam prep, etc.](https://challengercme.com/special-purpose-exam-review-spex-exam-preparation-course) ### [PHYSICIAN ASSISTANT](https://challengercme.com/physician-assistant-exam-review-cme-course) [PANCE / PANRE](https://challengercme.com/physician-assistant-exam-review-cme-course), [CAQ-EM](https://challengercme.com/pa-caq-em-review-course), etc ### [NURSE PRACTITIONER](https://challengercme.com/family-nurse-practitioner-exam-review-cme-course) [FNP](https://challengercme.com/family-nurse-practitioner-exam-review-cme-course), [ENP](https://challengercme.com/emergency-nurse-practitioner-exam-review-cne-course), [AGNP](https://challengercme.com/adult-gerontology-nurse-practitioner-exam-review-cne-course), [PNCB/CPNP](https://challengercme.com/pediatric-nurse-practitioner-exam-review-cne-course), etc. ### [NURSING / NCLEX NCLEX, CNE, etc.](https://challengercme.com/nursing-certification-nclex-exam-review-cne-courses) ### [STATE-REQUIRED CME / CE State CME requirements, etc.](https://challengercme.com/state-required-cme) ### [JOINT COMMISSION CME](https://challengercme.com/stroke-center-ce-review-course) [Stroke](https://challengercme.com/stroke-center-ce-review-course), [Cardiac](https://challengercme.com/cardiac-center-ce-review-course), [Trauma](https://challengercme.com/trauma-center-ce-review-course), [ALS](https://challengercme.com/advanced-life-support-and-resuscitation-center-ce-review-course), etc. ### [PROFESSIONALISM CME Professionalism review with CME](https://challengercme.com/professionalism-review-course) ### [DERMATOLOGY CME Dermatology review with CME](https://challengercme.com/dermatology-review-course) ### [USMLE STEP 2CK / STEP 3 USMLE exam prep, etc.](https://challengercme.com/usmle-certification-exam-review-clerkship-exams-shelf-exam-review) - [INSTITUTIONS ](https://challengercme.com/atlas-pro-inst) - [BLOG ](https://challengercme.com/blog) - [SUPPORT ](https://support.challengercme.com/knowledge) [SIGN IN ](https://fuse.challengercme.com/sign-in?redirectURL=%2Fuserdash) quick quiz # Pediatrics Case: Child with Fever, Vomiting, Diarrhea & Abdominal Pain Pediatrics exam vignette: 3‑yr‑old with fever, vomiting, diarrhea, and abdominal pain — stepwise answer and high‑yield exam pearls. [ Med-Challenger ](https://challengercme.com/blog/author/med-challenger) Feb 14, 2025 [Pediatric Medicine](https://challengercme.com/blog/tag/pediatric-medicine) [Personal Education](https://challengercme.com/blog/tag/personal-education) [Question of the Week](https://challengercme.com/blog/tag/question-of-the-week) [quick quiz](https://challengercme.com/blog/tag/quick-quiz) ### < [All Posts](https://challengercme.com/blog) ABP Exam Prep + CME Med-Challenger Pediatrics Pass-guaranteed ABP exam review with CME built-in. Try it for free. On sale now. 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Read the focused answer and high‑yield exam pearls to test pediatric clinical reasoning. A 3-year-old girl presents to you with fever, vomiting, diarrhea, and abdominal pain that has lasted for 2 days. She wakes up one morning pale and lethargic. On examination, she is afebrile but weak and irritable. You decide to order laboratory studies. The results are as follows: White blood cell count: 19,400/μL Hemoglobin: 11 g/dL Platelet count: 60,000/μL Partial thromboplastin time: 37.7 seconds Prothrombin time: 13.3 seconds Urine blood: +1 Urine protein: +2 Creatinine: 1.5 mg/dL Blood smear: (+) schistocytes This girl is experiencing a condition that causes which of the following? - increased erythrocyte production - decreased erythrocyte destruction - increased erythrocyte destruction - decreased erythrocyte production The correct answer is: increased erythrocyte destruction   **Educational Objective:** Describe the effect on erythrocytes in hemolytic uremic syndrome. **Key Point:** Hemolytic uremic syndrome causes increased erythrocyte destruction. **Explanation:** In patients with hemolytic uremic syndrome (HUS) and diarrhea, endothelial cell damage occurs due to Shiga toxin or a Shiga-like verotoxin. Damage to the kidneys causes thrombosis and platelet aggregation with thrombocytopenia. Microangiopathic hemolytic anemia occurs due to the damage to erythrocytes that pass through. HUS consists of microangiopathic hemolytic anemia, low platelets, and renal insufficiency. When HUS is caused by *Escherichia coli* infection, these symptoms usually occur several days after gastroenteritis and may include bloody diarrhea. The course may be mild or severe. Severe complications include renal and heart failure. There may also be central nervous system involvement, including irritability and symptoms of encephalopathy. Disorders of the bone marrow, including malignancies, may affect erythrocyte production (an increase or decrease). Some anemias, such as anemia of chronic disease and Diamond-Blackfan anemia, cam cause impaired erythropoiesis and inadequate production of red blood cells. **References:** Scott JP. Platelet and blood vessel disorders. In: Kliegman RM, et al, eds. *Nelson Textbook of Pediatrics*. 20th ed., 2016:2400-2407. Van Why SK, Avner ED. 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All rights reserved [Privacy Policy](https://support.challengercme.com/knowledge/what-are-your-terms-of-service-privacy-policy-user-agreement) ```json { "@context" : "https://schema.org", "@id" : "https://challengercme.com/blog#webpage", "@type" : "WebPage", "description" : "The Challenger Medical Education Blog offers informative patient cases, medical certification exam preparation courses and board exam review tips.", "inLanguage" : "en", "isPartOf" : { "@type" : "WebSite", "name" : "Med-Challenger", "url" : "https://challengercme.com/" }, "mainEntityOfPage" : { "@id" : "https://challengercme.com/blog", "@type" : "WebPage" }, "name" : "Challenger Medical Education Blog", "primaryImageOfPage" : { "@type" : "ImageObject", "url" : "https://challengercme.com/hubfs/Webpage%20Featured%20Images/Medical%20Education%20Blog%20-%20Free%20CME%20resources%2c%20certification%20exam%20tips%2c%20clinical%20challenge%20questions%20and%20more.png" }, "publisher" : { "@type" : "Organization", "name" : "Challenger Corporation", "url" : "https://challengercme.com/" }, "url" : "https://challengercme.com/blog" } ``` ```json { "@context" : "https://schema.org", "@type" : "BlogPosting", "about" : [ "hemolytic uremic syndrome", "HUS", "microangiopathic hemolytic anemia", "thrombocytopenia", "renal insufficiency", "Shiga toxin", "Escherichia coli", "schistocytes", "pediatric clinical vignette", "exam preparation", "medical education", "continuing medical education" ], "articleSection" : "Pediatric Medicine", "author" : { "@type" : "Organization", "name" : "Challenger Corporation" }, "dateModified" : "2025-12-04T16:33:17.805Z", "datePublished" : "2025-02-14T15:42:31.000Z", "description" : "Pediatrics exam vignette: 3‑yr‑old with fever, vomiting, diarrhea, and abdominal pain — stepwise answer and high‑yield exam pearls.", "headline" : "Pediatrics Case: Child with Fever, Vomiting, Diarrhea & Abdominal Pain", "image" : [ { "@type" : "ImageObject", "description" : "Med-Challenger Medical Education, a Division of Challenger Corporation" }, { "@type" : "ImageObject", "description" : "Pediatric Medicine Exam Review course" } ], "inLanguage" : "en-US", "keywords" : [ "HUS", "hemolytic uremic syndrome", "microangiopathic hemolytic anemia", "thrombocytopenia", "renal insufficiency", "pediatrics exam vignette", "schistocytes", "Shiga toxin", "E. coli", "exam preparation", "Med-Challenger" ], "mainEntityOfPage" : { "@id" : "https://challengercme.com/blog/a-3-year-old-girl-with-fever-vomiting-diarrhea-and-abdominal-pain-wakes-up-pale-and-lethargic", "@type" : "WebPage" }, "publisher" : { "@type" : "Organization", "logo" : { "@type" : "ImageObject", "url" : "https://challengercme.com/logo.png" }, "name" : "Challenger Corporation" } } ``` ```json { "@context" : "https://schema.org", "@type" : "QAPage", "mainEntity" : { "@type" : "Question", "acceptedAnswer" : { "@type" : "Answer", "text" : "Increased erythrocyte destruction. The vignette is consistent with diarrhea-associated hemolytic uremic syndrome (HUS): endothelial injury from Shiga or Shiga-like toxin leads to microangiopathic hemolytic anemia (fragmented red cells/schistocytes), thrombocytopenia from platelet aggregation, and renal injury." }, "name" : "Effect on erythrocytes in hemolytic uremic syndrome (HUS)?", "text" : "A 3-year-old girl with fever, vomiting, diarrhea, and abdominal pain wakes up pale and lethargic. Labs: WBC 19,400/μL, Hgb 11 g/dL, platelets 60,000/μL, PTT 37.7 s, PT 13.3 s, urine blood +1, urine protein +2, creatinine 1.5 mg/dL, blood smear: schistocytes. This girl is experiencing a condition that causes which of the following? increased erythrocyte production; decreased erythrocyte destruction; increased erythrocyte destruction; decreased erythrocyte production." } } ``` ```json { "@context" : "https://schema.org", "@type" : "ItemList", "description" : "Exam-style review questions based on this article’s teaching points.", "itemListElement" : [ { "@type" : "ListItem", "item" : { "@type" : "Question", "acceptedAnswer" : { "@type" : "Answer", "text" : "Increased. HUS causes microangiopathic hemolytic anemia with RBC damage and schistocytes due to endothelial injury and microthrombi." }, "name" : "In HUS, is erythrocyte destruction increased or decreased?" }, "position" : 1 }, { "@type" : "ListItem", "item" : { "@type" : "Question", "acceptedAnswer" : { "@type" : "Answer", "text" : "Microangiopathic hemolytic anemia, thrombocytopenia (low platelets), and renal insufficiency — the classic HUS triad described in the article." }, "name" : "What triad defines hemolytic uremic syndrome?" }, "position" : 2 }, { "@type" : "ListItem", "item" : { "@type" : "Question", "acceptedAnswer" : { "@type" : "Answer", "text" : "Usually several days after gastroenteritis caused by E. coli that produces Shiga or Shiga-like toxin; symptoms may follow diarrheal illness and can include bloody diarrhea." }, "name" : "When does diarrhea-associated HUS typically occur relative to gastroenteritis with E. coli?" }, "position" : 3 } ], "name" : "Practice Questions", "numberOfItems" : 3 } ```