WBR1034: Difference between revisions
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{{WBRQuestion | {{WBRQuestion | ||
|QuestionAuthor={{AZ}} | |QuestionAuthor= {{AZ}} | ||
|ExamType=USMLE Step 2 CK | |ExamType=USMLE Step 2 CK | ||
|SubCategory=Head and Neck | |MainCategory=Pediatrics | ||
|SubCategory=Head and Neck | |SubCategory=Head and Neck, Head and Neck, Respiratory | ||
|SubCategory=Head and Neck | |MainCategory=Pediatrics | ||
|SubCategory=Head and Neck | |SubCategory=Head and Neck, Head and Neck, Respiratory | ||
|SubCategory=Head and Neck | |MainCategory=Pediatrics | ||
|SubCategory=Head and Neck | |SubCategory=Head and Neck, Head and Neck, Respiratory | ||
|SubCategory=Head and Neck | |MainCategory=Pediatrics | ||
|SubCategory=Head and Neck | |MainCategory=Pediatrics | ||
|SubCategory=Head and Neck, Head and Neck, Respiratory | |||
|MainCategory=Pediatrics | |||
|SubCategory=Head and Neck, Head and Neck, Respiratory | |||
|MainCategory=Pediatrics | |||
|SubCategory=Head and Neck, Head and Neck, Respiratory | |||
|MainCategory=Pediatrics | |||
|SubCategory=Head and Neck, Head and Neck, Respiratory | |||
|MainCategory=Pediatrics | |||
|MainCategory=Pediatrics | |||
|SubCategory=Head and Neck, Head and Neck, Respiratory | |||
|Prompt=A previously healthy 3-year-old boy is brought to the emergency department (ED) due to stridor of sudden onset. Last night, he suddenly developed a high fever followed by breathing difficulty. His temperature is 40C (104 F), pulse is 130/min, and respiration rate is 40/min. In the ED, the child is toxic-appearing,sitting up, leaning forward and drooling. His lungs are clear, and oxygen saturation is 85% in room air. What is the most appropriate next step in management? | |Prompt=A previously healthy 3-year-old boy is brought to the emergency department (ED) due to stridor of sudden onset. Last night, he suddenly developed a high fever followed by breathing difficulty. His temperature is 40C (104 F), pulse is 130/min, and respiration rate is 40/min. In the ED, the child is toxic-appearing,sitting up, leaning forward and drooling. His lungs are clear, and oxygen saturation is 85% in room air. What is the most appropriate next step in management? | ||
|Explanation=[[Epiglottitis]] is common in a 3-7 year old child. The common initial presentation is toxic appearance (i.e. leaning forward, drooling), acute respiratory distress, [[stridor]] and high-grade fever. Tachycardia and tachypnea are also present. This is a pediatric emergency that necessitate an emergency endotracheal intubation. Preparation for possible tracheostomy is a standard, as the intubation in children could be difficult. | |Explanation=[[Epiglottitis]] is common in a 3-7 year old child. The common initial presentation is toxic appearance (i.e. leaning forward, drooling), acute respiratory distress, [[stridor]] and high-grade fever. Tachycardia and tachypnea are also present. This is a pediatric emergency that necessitate an emergency endotracheal intubation. Preparation for possible tracheostomy is a standard, as the intubation in children could be difficult. | ||
|AnswerA=Start intravenous methylprednisolone | |AnswerA=Start intravenous methylprednisolone | ||
|AnswerAExp='''Incorrect'''- [[Epiglottitis]] is a serious pediatric emergency as it may proceed to a sudden airway obstruction. Emergency endotracheal intubation is the first action to do. | |AnswerAExp='''Incorrect'''- [[Epiglottitis]] is a serious pediatric emergency as it may proceed to a sudden airway obstruction. Emergency endotracheal intubation is the first action to do. | ||
|AnswerB=lateral neck x-ray | |AnswerB=lateral neck x-ray | ||
|AnswerBExp='''Incorrect'''- Physician should not wait for the Xray films to diagnose or take action in epiglottitis. Typically lateral neck Xray shows; swollen epiglottis (thumb sign), thickened aryepiglottic folds, and obliteration of the vallecula. | |AnswerBExp='''Incorrect'''- Physician should not wait for the Xray films to diagnose or take action in epiglottitis. Typically lateral neck Xray shows; swollen epiglottis (thumb sign), thickened aryepiglottic folds, and obliteration of the vallecula. | ||
Latest revision as of 02:25, 28 October 2020
| Author | [[PageAuthor::Ahmed Zaghw, M.D. [1]]] |
|---|---|
| Exam Type | ExamType::USMLE Step 2 CK |
| Main Category | MainCategory::Pediatrics |
| Sub Category | SubCategory::Head and Neck, SubCategory::Head and Neck, SubCategory::Respiratory |
| Prompt | [[Prompt::A previously healthy 3-year-old boy is brought to the emergency department (ED) due to stridor of sudden onset. Last night, he suddenly developed a high fever followed by breathing difficulty. His temperature is 40C (104 F), pulse is 130/min, and respiration rate is 40/min. In the ED, the child is toxic-appearing,sitting up, leaning forward and drooling. His lungs are clear, and oxygen saturation is 85% in room air. What is the most appropriate next step in management?]] |
| Answer A | AnswerA::Start intravenous methylprednisolone |
| Answer A Explanation | [[AnswerAExp::Incorrect- Epiglottitis is a serious pediatric emergency as it may proceed to a sudden airway obstruction. Emergency endotracheal intubation is the first action to do.]] |
| Answer B | AnswerB::lateral neck x-ray |
| Answer B Explanation | AnswerBExp::'''Incorrect'''- Physician should not wait for the Xray films to diagnose or take action in epiglottitis. Typically lateral neck Xray shows; swollen epiglottis (thumb sign), thickened aryepiglottic folds, and obliteration of the vallecula. |
| Answer C | AnswerC::Endotracheal intubation with a set-up for tracheostomy |
| Answer C Explanation | AnswerCExp::'''Correct'''- This is a pediatric emergency that necessitate an emergency endotracheal intubation. Preparation for possible tracheostomy is a standard, as the intubation in children could be difficult. |
| Answer D | AnswerD::Admit the patient and start broad spectrum antibiotics |
| Answer D Explanation | AnswerDExp::'''Incorrect'''- Antibiotics administration are the second step after securing airways. |
| Answer E | AnswerE::Admit the patient and start nebulized racemic epinephrine |
| Answer E Explanation | [[AnswerEExp::Incorrect- Nebulized racemic epinephrine is used in croup management not epiglottitis]] |
| Right Answer | RightAnswer::C |
| Explanation | [[Explanation::Epiglottitis is common in a 3-7 year old child. The common initial presentation is toxic appearance (i.e. leaning forward, drooling), acute respiratory distress, stridor and high-grade fever. Tachycardia and tachypnea are also present. This is a pediatric emergency that necessitate an emergency endotracheal intubation. Preparation for possible tracheostomy is a standard, as the intubation in children could be difficult. Educational Objective: Epiglottitis is a serious pediatric emergency as it may proceed to a sudden airway obstruction. Emergency endotracheal intubation is the first action to do. Visualization of epiglottis should never be attempted. |
| Approved | Approved::No |
| Keyword | WBRKeyword::Drug induced myopathy, WBRKeyword::Steroid induced myopathy |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |