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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor={{AZ}}
|QuestionAuthor= {{AZ}}
|Prompt=A 18-year-old African american male comes to the office for the evaluation of pain in his right hip that started 7 weeks ago. The pain has gradually progressed, and now it limits his daily activities. He has sickle cell disease and was hospitalized 4 months ago due to a painful crisis that was successfully treated with hydration, oxygen,  and  analgesics. His temperature is 37.4C (99F), blood pressure is 120/90 mmHg, pulse is 90/min, and respirations are 14/min. Physical examination reveals no local tenderness, but there is restriction of abduction and internal rotation of the hip. What is the most likely diagnosis?
|ExamType=USMLE Step 2 CK
|Explanation=.
|MainCategory=Pediatrics
 
|SubCategory=Head and Neck, Head and Neck, Respiratory
'''Educational Objective:'''
|MainCategory=Pediatrics
Avascualr necrosis should be considered in patients with multiple attacks of sickle cell crisis.
|SubCategory=Head and Neck, Head and Neck, Respiratory
|AnswerA=Femoral fracture
|MainCategory=Pediatrics
|AnswerAExp='''Incorrect'''-[[]]
|SubCategory=Head and Neck, Head and Neck, Respiratory
|AnswerB=Joint effusion from septic arthritis
|MainCategory=Pediatrics
|AnswerBExp='''Incorrect'''-[[]].
|MainCategory=Pediatrics
|AnswerC=Avascular necrosis
|SubCategory=Head and Neck, Head and Neck, Respiratory
|AnswerCExp='''Correct'''-[[]]
|MainCategory=Pediatrics
|AnswerDExp='''Incorrect'''-[[]].
|SubCategory=Head and Neck, Head and Neck, Respiratory
|AnswerE=Osteomyelitis caused by Staphylococcus
|MainCategory=Pediatrics
|AnswerEExp='''Incorrect'''-[[]]
|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?
|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
|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
|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.
|AnswerC=Endotracheal intubation with a set-up for tracheostomy
|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.
|AnswerD=Admit the patient and start broad spectrum antibiotics
|AnswerDExp='''Incorrect'''- Antibiotics administration are the second step after securing airways.
|AnswerE=Admit the patient and start nebulized racemic epinephrine
|AnswerEExp='''Incorrect'''- Nebulized racemic [[epinephrine]] is used in [[croup]] management not [[epiglottitis]]
|EducationalObjectives=[[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.
|References=First Aid, USMLE 2 CK
|RightAnswer=C
|RightAnswer=C
|WBRKeyword=Drug induced myopathy, Steroid induced myopathy
|WBRKeyword=Drug induced myopathy, Steroid induced myopathy
|Approved=No
|Approved=No
}}
}}

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.
References: First Aid, USMLE 2 CK]]

Approved Approved::No
Keyword WBRKeyword::Drug induced myopathy, WBRKeyword::Steroid induced myopathy
Linked Question Linked::
Order in Linked Questions LinkedOrder::
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