WBR1034: Difference between revisions

Jump to navigation Jump to search
No edit summary
m (refreshing WBR questions)
 
(One intermediate revision by one other user not shown)
Line 1: Line 1:
{{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.
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::