WBR1034

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::