View source for WBR1034

 {{WBRQuestion
|QuestionAuthor= {{AZ}}
|ExamType=USMLE Step 2 CK
|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
|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?
|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
|WBRKeyword=Drug induced myopathy, Steroid induced myopathy
|Approved=No
}}