Transcript Pediatric Board Review

Pediatric Board Review
Mark Heller, MD
Department of Emergency Medicine
Mount Sinai School of Medicine
Question 1
An 8 year old male is brought into the ED by his mother.
Mom she has noticed that over the last month her son has
been limping. When asked why he is limping, the boy states
that he has a dull pain in his groin, L thigh, and L knee, that
gets worse when he is outside playing. On physical exam
there is limited abduction of hip & limited internal rotation in
both flexion & extension. The following X-ray is obtained:
Question 1
What is the most likely diagnosis?
a) Toxic Tenosynovitis
b) Turberculous arthritis
c) Slipped Capital Femoral Epiphysis
d) Legg-Calve-Perthes
e) Tumor
Q 1 Answer
What is the most likely diagnosis?
a) Toxic Tenosynovitis
b) Turberculous arthritis
c) Slipped Capital Femoral Epiphysis
d) Legg-Calve-Perthes
e) Tumor
MLH Q1
Legg-Calve-Perthes’ Disease
• Avascular necrosis of the proximal femoral head
• Femoral head collapses with potential for
subluxation
• Onset between 4 to 9
• 5 to 1 male to female ratio
• Presents with:
– Limp
– Chronic dull pain in groin, thigh, knee
– Pain worsens with activity
Legg-Calve-Perthes’ Disease
• 4 Stages
–
–
–
–
Widening of the cartilage space
Subchondral stress fracture of the femoral head
Increased femoral head opacification
Deformity of the femoral head
• Bone Scan and MRI are the best imaging
studies
• Ortho consult and admission for traction and
surgery
Question 2
Which of the following findings most strongly suggests that a
patient has chickenpox and not smallpox?
a)
b)
c)
d)
e)
Absence of pustules the proximal arms
Both crusts and papules are present on the right hand
Characteristic lesions are noted in the oropharynx
Greatest density of lesions is on the face and neck
Patient has fever, myalgias, malaise, and headache
Q 2 Answer
Which of the following findings most strongly suggests that a
patient has chickenpox and not smallpox?
a)
b)
c)
d)
e)
Absence of pustules the proximal arms
Both crusts and papules are present on the right hand
Characteristic lesions are noted in the oropharynx
Greatest density of lesions is on the face and neck
Patient has fever, myalgias, malaise, and headache
PEER VII Q56
Chickenpox
• Incidence of varicella declining secondary
to Immunizations
• More common in children <10 years old
• Highly contagious from prodrome until all
lesions are crusted over
• Rash starts as red macules on scalp or
trunk and within a day vesiculate
• Rash spreads outward
– Sparing palms and soles
Chickenpox
Chickenpox (continued)
• Multiple states of rash on same body part
• Low-grade fever, malaise, and headache
• Treatment is symptomatic
– Varicella-zoster immune globulin and
acyclovir for immunocompromised children
Smallpox
• Natural cases eradicated
• Virus only exist in two known laboratories in the
world
• Possible biological weapon
• Rash involves Palms and Soles
• Lesions appear in same stage
• Vaccine given within 3 days of exposure is
protective
• Exposed person quarantined for 18 days
• 30% mortality for unvaccinated persons
Smallpox vs. Chickenpox
Question 3
A 17 year old boy with Type I diabetes mellitus presents with
diabetic ketoacidosis. A venous blood gas analysis is
conducted, and the pH is 7.09. Treating this patient with
bicarbonate could result in which of the following
complications:
a)
b)
c)
d)
e)
CSF alkalosis
Hypokalemia
Hypotonicity
Increased work of breathing
Rightward shift of the oxyhemoglobin dissociation curve
Q 3 Answer
A 17 year old boy with Type I diabetes mellitus presents with
diabetic ketoacidosis. A venous blood gas analysis is
conducted, and the pH is 7.09. Treating this patient with
bicarbonate could result in which of the following
complications:
a)
b)
c)
d)
e)
CSF alkalosis
Hypokalemia
Hypotonicity
Increased work of breathing
Rightward shift of the oxyhemoglobin dissociation curve
PEER VII Q57
Pediatric Diabetic Ketoacidosis
• 27-40% of new-onset diabetics present in DKA
• DKA Definition
– Metabolic acidosis (pH < 7.25 or serum bicarb < 15 mEq/L)
– hyperglycemia (glucose > 300 mg/dL)
– Ketonemia
• DKA Presentation
–
–
–
–
–
–
Hyperventilation
Fruity breath odor
Abdominal Pain
Lethargy
Kussmaul’s respirations (Deep and Labored Breathing)
Decreased level of consciousness or coma
DKA (continued)
• Treatment
– Volume Replacement
• Calculate Total Fluid Deficit
• Normal Saline at 10 to 20 mL/kg over 1 to 2 hours
• After initial bolus replace remaining fluid deficit over 24 to 48
hours using 0.45% NS.
• At glucose 300 – 250 mg/dL switch to 5% dextrose in 0.45%
NS
– Insulin Therapy
• Regular Insulin infusion of 0.1 U/kg/hr
• Increase to 0.2 U/kg/hr if no improvement after 2 hours
• No need for bolus
DKA (continued)
• Treatment
– Correction of Electrolyte Abnormalities
• Potassium is critical
• Add 30 to 40 mEq K to each litter of maintenance fluids
• Bicarbonate Therapy
– Not recommended
– May lead to
•
•
•
•
Hypokalemia
Cerebral Edema
Hypernatremia
Worsening tissue hypoxia
Question 4
A 20 year old woman presents with a painful right ear. She
has no history of ear problems but swims several times a
week. Examination reveals erythema of the external
auditory canal with some purulent discharge and a
perforation in the tympanic membrane. The treatment option
most likely to damage her ear is:
a)
b)
c)
d)
e)
Ciprofloxacin otic and hydrocortisone otic suspension
Hydrocortisone and acetic acid otic solution
Neomycin/polymyxn/hydrocortisone otic suspension
Ofloxacin otic solution
Penicillinase-resistant penicillin
Q 4 Answer
A 16 year old female presents with a painful right ear. She
has no history of ear problems but swims several times a
week. Examination reveals erythema of the external
auditory canal with some purulent discharge and a
perforation in the tympanic membrane. The treatment option
most likely to damage her ear is:
a)
b)
c)
d)
e)
Ciprofloxacin otic and hydrocortisone otic suspension
Hydrocortisone and acetic acid otic solution
Neomycin/polymyxn/hydrocortisone otic suspension
Ofloxacin otic solution
Penicillinase-resistant penicillin
PEER VII Q59
Otitis Externa
• Inflammatory process involving the auricle,
external auditory canal, and surface of the TM
• Caused by gram-negative eneric organisms,
Staph aureus, Pseudonomas, or fungi
• Peak age 9 to 19 years
• Erythema, edema of EAC, white exudate on
EAC and Tm
• Pain with motion of tragus or auricle
Otitis Externa (continued)
• Treatment
– Fluoroquinolone otic drops
– Oral antibiotics if auricular cellulitis is present
or TM is perforated (Quinolones,
Cephalosporins, or penicillinase-resistant pcn)
• Hydrocortisone and acetic acid otic
solution have a pH 3.0 which can be toxic
to the middle ear in perforations
Otitis Externa
Otitis Media
•
•
•
•
•
Infection of the middle ear
Infants and Young Children (peaks at 6 to 18 months)
25 to 30 million office visits per year
Strep pneumoniae most prevalent cause
Symptoms include fever, poor feeding, irritability,
vomiting, earache, otorrhea
• Signs include dull, bulging, immobile TM
– Light reflex is of no diagnostic value
• Treatment
– Amoxicillin 80 mg/kg/day PO divided q8 – q12 for 10 days (Highdose amox therapy)
Otitis Media
Otitis Media
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Question 5
A 2 year old girl is brought in by her parents for persistent
fever for the past 5 days. On examination, she has bright
red injected lips, pharyngeal erythema, cervical
lymphadenopathy, conjunctivitis, and a scarlatiniform rash.
Which of the following is an essential element in the therapy
of this child’s disease?
a)
b)
c)
d)
e)
Amoxicillin-clavulanate
Benzathine Penicillin
Droplet isolation precautions
Intravenous immune globulin
Plasma Exchange
Q 5 Answer
A 2 year old girl is brought in by her parents for persistent
fever for the past 5 days. On examination, she has bright
red injected lips, pharyngeal erythema, cervical
lymphadenopathy, conjunctivitis, and a scarlatiniform rash.
Which of the following is an essential element in the therapy
of this child’s disease?
a)
b)
c)
d)
e)
Amoxicillin-clavulanate
Benzathine Penicillin
Droplet isolation precautions
Intravenous immune globulin
Plasma Exchange
PEER VII Q61
Kawasaki Disease
• Clinical Findings
– Fever for at least 5 days
– Bilateral conjunctivitis
– Changes of the oral mucosa (erythematous lips, strawberry
tongue, erythematous oropharynx)
– Changes of the hands and feet (erythema, edema,
desquamation)
– Rash (scarlatiniform or morbilliform exanthem on trunk)
– Cervical Lymphadenopathy
• Peak incidence at 1 to 2 years
• Season distribution – winter/spring
• No clear agent identified
Kawasaki Disease
• Immune response during KD leads to systemic
vasculitis
• Treatment
– Single infusion of Intravenous Immune Globulin (2
g/kg IV over 8 to 12 hours)
– Aspirin 80 to 100 mg/kg/day in four divided doses
– ASA continued until afebrile, then reduced to 3 to 5
mg/kg daily for 6 to 8 weeks
• Untreated KD will cause coronary artery
aneurysm in 20 – 25% of patients
• Risk of aneurysm reduced to 3 – 4% with
treatment
Question 6
A 4 year old boy presents after sticking a fork into a home
electrical outlet with his right hand and getting shocked. His right
elbow was on the ground at the time. Although he cried initially,
he has remained asymptomatic. Physical examination reveals
two extremely small first-degree burns on his right hand and
elbow, a 12-lead EKG is normal. The most appropriate
disposition is:
a) Admit to a monitored bed for 24 hours
b) Admit to a non-monitored bed for serial peripheral vascular
examinations
c) Discharge home
d) Observe in the emergency department for 6 hours, if no dysrhythmias
occur, discharge home.
e) Perform echocardiography in the emergency department
Q 6 Answer
A 4 year old boy presents after sticking a fork into a home
electrical outlet with his right hand and getting shocked. His right
elbow was on the ground at the time. Although he cried initially,
he has remained asymptomatic. Physical examination reveals
two extremely small first-degree burns on his right hand and
elbow, a 12-lead EKG is normal. The most appropriate
disposition is:
a) Admit to a monitored bed for 24 hours
b) Admit to a non-monitored bed for serial peripheral vascular
examinations
c) Discharge home
d) Observe in the emergency department for 6 hours, if no dysrhythmias
occur, discharge home.
e) Perform echocardiography in the emergency department
PEER VII Q96
Electric Shock
• Three populations
– Toddlers – household electrical sockets and cords
– Teenagers – power lines
– Adults – work with electricity
•
•
•
•
Voltage gives idea of potential damage
Admit any electrical injury over 600 V
Household V ranges 110 to 220 V
Asymptomatic on presentation and have normal
EKG can be discharged home
Question 7
For young children with sickle cell disease, which of the
following tests is most useful in differentiating a splenic
sequestration crisis from an aplastic crisis?
a)
b)
c)
d)
e)
Erythrocyte Sedimentation Rate
Hemoglobin Level
Peripheral WBC Count
Platelet Count
Reticulocyte Count
Q 7 Answer
For young children with sickle cell disease, which of the
following tests is most useful in differentiating a splenic
sequestration crisis from an aplastic crisis?
a)
b)
c)
d)
e)
Erythrocyte Sedimentation Rate
Hemoglobin Level
Peripheral WBC Count
Platelet Count
Reticulocyte Count
PEER VII Q146
Sickle Cell Disease
• Sickle Cell Emergencies
– Vaso-oclusive Crisis
– Hematologic Crisis
– Infections
• All SCD children with fever, pain, respiratory
distress or change in neurological function
require a thorough ED evaluation
• 8% of AA population are carriers
• 0.15% (1/500) are homozygous
• 20-30% of all deaths from SCD occur before 5
Sickle Cell Disease
Sickle Cell Disease (continued)
• Vaso-Oclusive Crisis
– Intravascular sickling
– Tissue ischemia and infarction
– ED Management
• Aggressive hydration
• Analgesics
– Acute Chest Syndrome
•
•
•
•
Pneumonia, Pulmonary Infarction, Pulmonary Emboli
CXR, CBC, Retic Count, Blood Cultures
IV hydration, Analgesic, Abx, Transfusion
All warrant hospital admission
Sickle Cell Disease (continued)
• Hematological Crisis
– Acute Sequestration Crisis
•
•
•
•
•
•
•
Spleen traps large portion of circulating blood
Hypotension, shock and death
Often preceded by viral infections (Parvovirus B19)
CBC shows profound anemia
Reticulocyte Counts are Elevated
Transfuse PRBC
Admission
Sickle Cell Disease (continued)
• Hematological Crisis
– Aplastic Episode
• Precipitated by Viral or Bacterial infections
• Present with gradual onset of pallor, dyspnea,
fatigue, and jaundice
• CBC shows low hematocrit (10% or lower)
• Reticulocyte Counts are Decreased
• Transfuse PRBC
• Admit
Sickle Cell Disease (continued)
• Infections
– SCD children are functionally asplenic
– Higher risk for bacterial infections, especially
encapsulated organisms
– Routine Haemophilus influenzae and pneumococcal
vaccinations
– Fevers are managed aggressively
– Treat with antibiotics covering Strep pneumoniae and
H. influenzae (eg, ceftriaxone)
– Low threshold for admission
Question 8
A 17 year old man presents with left eye irritation. He was
walking in a park and accidentally ran into a tree branch. He
believes the branch scratched his eye. Examination reveals
a corneal abrasion. The best treatment option is:
a) Erythromycin ophthalmic ointment, no patch.
b) Erythromycin ophthalmic ointment, patch
c) Homatropine, no patch
d) Homatropine, patch
e) Topical anesthetic
Q 8 Answer
A 17 year old man presents with left eye irritation. He was
walking in a park and accidentally ran into a tree branch. He
believes the branch scratched his eye. Examination reveals
a corneal abrasion. The best treatment option is:
a) Erythromycin ophthalmic ointment, no patch
b) Erythromycin ophthalmic ointment, patch
c) Homatropine, no patch
d) Homatropine, patch
e) Topical anesthetic
PEER VII Q 160
Corneal Abrasions
Corneal Abrasions
• Very Painful
• Fluorescein reveals dye update at abrasion site
• Treatment
– Topical Erythromycin, Tobramycin, or
Bacitracin/Polymyxin
– Tetanus updated
– Patching does not facilitate abrasion healing
– Topical anesthetics strictly contraindicated
• Cause corneal breakdown and ulceration
– Cycloplegic agents (homatropine) not recommended
• Recent studies show no benefit (Carley and Carley 2001)
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Question 9
A 13 year old boy presents with right hip discomfort that has
been getting worse for the past 2 to 3 weeks. He denies
trauma, fever, and recent illness. His mother says that
ibuprofen “helps a little.” Physical examination reveals an
obese adolescent boy. Active and passive motion of the left
hip elicit pain. Radiographs are obtained.
Question 9
Question 9
What is the most likely diagnosis?
a) Femoral Neck Fracture
b) Legg-Calve-Perthes disease
c) Septic arthritis
d) Slipped capital femoral epiphysis
e) Transient synovitis
Q 9 Answer
A 13 year old boy presents with right hip discomfort that has been getting
worse for the past 2 to 3 weeks. He denies trauma, fever, and recent
illness. His mother says that ibuprofen “helps a little.” Physical
examination reveals an obese adolescent boy. Active and passive
motion of the left hip elicit pain. Radiographs are obtained. What is the
most likely diagnosis?
a) Femoral Neck Fracture
b) Legg-Calve-Perthes disease
c) Septic arthritis
d) Slipped capital femoral epiphysis
e) Transient synovitis
Slipped Capital Femoral Epiphysis
•
•
•
•
SCFE more common in boys
Peak from 10 to 15 years old
Present with pain in groin, thigh, or knee
Hip should not be forced through full range of
motions – may displace epiphysis further
• X-rays
– AP view shows medial slips
– Frog-leg view shows posterior slips
• Management is operative
Slipped Capital Femoral Epiphysis
Question 10
A 13 year old boy is brought in by his parents for sudden
onset of groin pain. On examination, the patient’s right testis
is swollen, tender, and slightly elevated in the scrotum.
Which of the following statements regarding this condition is
correct?
a)
b)
c)
d)
CT of the affected area is the imaging study of choice
Duplex utrasonography provides little data about testicular anatomy
Positive cremasteric reflex confirms the diagnosis
Relief of pain with elevation reliably differentiates this condition from
epididymitis
e) The “bell-clapper” deformity predisposes patients to this condition
Question 10
A 13 year old boy is brought in by his parents for sudden
onset of groin pain. On examination, the patient’s right testis
is swollen, tender, and slightly elevated in the scrotum.
Which of the following statements regarding this condition is
correct?
a)
b)
c)
d)
CT of the affected area is the imaging study of choice
Duplex utrasonography provides little data about testicular anatomy
Positive cremasteric reflex confirms the diagnosis
Relief of pain with elevation reliably differentiates this condition from
epididymitis
e) The “bell-clapper” deformity predisposes patients to this condition
PEER VII Q175
Testicular Torsion
Testicular Torsion
• Time is Testis
• Peak incidence at 13
• Pt presents with sudden and severe pain:
– Lower Abdomen
– Inguinal canal
– Testis
• Affected testis is elevated
• Cremasteric reflex is absent
• No relief of pain with elevation of testis (think
epididymitis)
• 96% salvage rate if detorsed in less than 4 hours
• 10% salvage rate if longer than 24 hours
Testicular Torsion (continued)
• Bell-Clapper Deformity
– Testis not fixed in place to
posterior scrotum
– Freely mobile
– Predisposes pt to testicular
torsion
Testicular Torsion (continued)
• Treatment
– Detorsion in ED
– Lateral-to-medial rotation of affected testis
– “Opening a Book”
• Urologic referral mandated
• Color Doppler to access blood flow
• Possible surgical exploration
Question 11
In the treatment of a 3 year old boy with a urinary tract
infection, which of the following additional signs is the
strongest indication for hospital admission?
a)
b)
c)
d)
e)
Localized myalgias
Maculopapular rash
Marked fever
Mucoid diarrhea
Persistent vomiting
Q 11 Answer
In the treatment of a 3 year old boy with a urinary tract
infection, which of the following additional signs is the
strongest indication for hospital admission?
a)
b)
c)
d)
e)
Localized myalgias
Maculopapular rash
Marked fever
Mucoid diarrhea
Persistent vomiting
PEER VII Q215
Pediatric UTI
• Clinic features vary by age
• Neonates
– Septic-like appearance
– Fever, Jaundice, Poor Feeding, Irritability , and
Lethargy
• Infants
– Gastrointestinal complaints
– Fever, Abdominal pain, Vomiting
• Older Children
– Urinary frequency, urgency, hesitancy, dysuria
– Fever, chills, back pain, vomiting, dehydration
Pediatric UTI (continued)
• Urine Culture is Gold Standard
• E. Coli accounts for vast majority
• Urine dip
– Leukocyte Esterase
– Urinary Nitrites
Pediatric UTI (continued)
• Treatment Depend on Age
• Infants < 3 months
– Hospitalized
– Intravenous antibiotics (ampicillin, cefotaxime,
Ceftriaxone)
• Older Infants and Children
– Single dose of ceftriaxone in ED and out patient oral
antibiotics (cephalexin, amoxicillin-clavulanate)
• Older infants and children with fever and UTI
complicated by vomiting, dehydration, sepsis,
inability to take oral antibiotics need to be
hospitalized for IV abx.
Question 12
A 2 year old boy is brought to the emergency department by his parents
immediately after he was discovered “eating a few of his grandmother’s
pills.” The grandmother, who is visiting from out of town, keeps her pills
in an unlabeled, multi-compartment plastic container that organizes her
medications by the day of the week. The parents think the boy ingested
1 day’s worth of pills. He is asymptomatic. Which of the following is the
best next step?
a) Administer activated charcoal along with a flavoring agent
b) Feed the child syrup of ipecac to induce emesis
c) Have the child ingest sorbitol to induce osmotic catharsis
d) Initiate whole-bowel irrigation with polyethylene-glycol
e) Perform gastric lavage with room temperature isotonic saline
Q 12 Answer
A 2 year old boy is brought to the emergency department by his parents
immediately after he was discovered “eating a few of his grandmother’s
pills.” The grandmother, who is visiting from out of town, keeps her pills
in an unlabeled, multi-compartment plastic container that organizes her
medications by the day of the week. The parents think the boy ingested
1 day’s worth of pills. He is asymptomatic. Which of the following is the
best next step?
a) Administer activated charcoal along with a flavoring agent
b) Feed the child syrup of ipecac to induce emesis
c) Have the child ingest sorbitol to induce osmotic catharsis
d) Initiate whole-bowel irrigation with polyethylene-glycol
e) Perform gastric lavage with room temperature isotonic saline
PEER VII Q236
Unknown Ingestion
• Activated Charcoal reduces toxin
absorption by as much as 75% when
given within 1 hour
• Another option is to contact grandmother’s
pharmacy to identify medications and
develop a management plan. Only
effective if done rapidly.
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Question 13
A 10 month old boy is brought in by his parents after he turned blue at
home. The mother says he has been fussy recently, which she
presumed to be caused by teething. She has been treating him with an
over-the-counter topical teething gel. On examination, the boy has
marked cyanosis, including the perioral area and nail beds. Vital signs
reveal a mild degree of tachypnea and tachycardia. Room air oxygen
saturation is 88% and does not improve on high-flow oxygen. His lungs
are clear, work of breathing is normal, as are heart tones. Which of the
following treatments is most likely to be successful in treating this child’s
cyanosis?
a)
b)
c)
d)
e)
Botulinum antitoxin
Deferoxamine
Methylene blue
Prostaglandin E1
Sodium Bicarbonate
Question 13
A 10 month old boy is brought in by his parents after he turned blue at
home. The mother says he has been fussy recently, which she
presumed to be caused by teething. She has been treating him with an
over-the-counter topical teething gel. On examination, the boy has
marked cyanosis, including the perioral area and nail beds. Vital signs
reveal a mild degree of tachypnea and tachycardia. Room air oxygen
saturation is 88% and does not improve on high-flow oxygen. His lungs
are clear, work of breathing is normal, as are heart tones. Which of the
following treatments is most likely to be successful in treating this child’s
cyanosis?
a)
b)
c)
d)
e)
Botulinum antitoxin
Deferoxamine
Methylene blue
Prostaglandin E1
Sodium Bicarbonate
PEER VII Q245
Methemoglobinemia
• An oxidant stress from either a drug or chemical
eliminates methemoglobin, altering the structure
of hemoglobin, causing it to no longer carry
oxygen
• Medications
– Phenazopyridine
– Benzocaine (ingredient in common teething gels)
– Dapsone (HIV abx therapy)
• Clinical Features
– Pulse Ox 80-85% on and off supplemental oxygen
– “Chocolate brown” blood noted on blood draw
– Pt appears cyanotic
Methemoglobinemia (continued)
• Diagnosis
– Cyanosis unresponsive to oxygen
– ABG will have falsely normal oxygen saturation
– Definitive identification relies on Co-Oximetry
• Can differentiate oxyhemoglobin, deoxyhemoglobin,
carboxyhemoglobin, methemoglobin
• Co-Oximetry can be run on a venous blood sample
• Treatment
– Methylene Blue
– Effects seen within 20 minutes
Question 14
A pediatrician calls the emergency department and leaves the
following message with a nurse: “Private patient en route to ER
from home by car. Mother says child (male) is jerking and feels
hot. No meds, no PMHX. Suspect simple febrile seizure.”
Assuming that the pediatrician’s suspicion is correct, which of the
following most likely describes this patient and his emergency
department encounter?
a)
b)
c)
d)
e)
2 weeks old, afebrile and well appearing on arrival, had a generalized seizure
at home that lasted 10 minutes
4 months old, febrile on arrival, had a generalized seizure at home that lasted
10 minutes, urinary tract infection diagnosed by emergency physician
19 months old, febrile and well appearing on arrival, had a generalized seizure
at home that lasted 10 minutes
23 months old, well appearing on arrival, had two generalized seizures at
home that lasted 5 minutes each
9 years old, febrile and having generalized seizure on arrival, had twitching of
one hand at home that lasted 10 minutes.
Q 14 Answer
A pediatrician calls the emergency department and leaves the
following message with a nurse: “Private patient en route to ER
from home by car. Mother says child (male) is jerking and feels
hot. No meds, no PMHX. Suspect simple febrile seizure.”
Assuming that the pediatrician’s suspicion is correct, which of the
following most likely describes this patient and his emergency
department encounter?
a)
b)
c)
d)
e)
2 weeks old, afebrile and well appearing on arrival, had a generalized seizure
at home that lasted 10 minutes
4 months old, febrile on arrival, had a generalized seizure at home that lasted
10 minutes, urinary tract infection diagnosed by emergency physician
19 months old, febrile and well appearing on arrival, had a generalized seizure
at home that lasted 10 minutes
23 months old, well appearing on arrival, had two generalized seizures at
home that lasted 5 minutes each
9 years old, febrile and having generalized seizure on arrival, had twitching of
one hand at home that lasted 10 minutes.
PEER VII Q262
Febrile Seizure
• Generalized seizure lasting less than 15
minutes
• Children 6 months to 5 years old
• Occurs once in a 24-hour period
• No evidence of intracranial infection
• No evidence of neurological abnormalities
• Seizure caused by how fast the fever rises
rather than the temperature of the fever
Febrile Seizure
• No need for LP in children over 12 months
• No role for anti-seizure meds
• Treat fever with acetaminophen, ibuprofen,
and tepid water baths
• A simple febrile seizure does not
predispose the patient to epilepsy
Question 15
Which of the following best describes the cough associated
with pertussis in infants?
a)
b)
c)
d)
e)
Paroxysmal, staccato cough associated with posttussive emesis
Productive cough associated with fever and respiratory failure
Repetitive cough followed by a loud and distinct whooping sound
Seal-like barking cough associated with inspiratory stridor at rest
Weak cough with pooled secretions and very poor air exchange
Q 15 Answer
Which of the following best describes the cough associated
with pertussis in infants?
a)
b)
c)
d)
e)
Paroxysmal, staccato cough associated with posttussive emesis
Productive cough associated with fever and respiratory failure
Repetitive cough followed by a loud and distinct whooping sound
Seal-like barking cough associated with inspiratory stridor at rest
Weak cough with pooled secretions and very poor air exchange
PEER VII Q353
Pertussis “Whooping Cough”
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Caused by bacterium Bordetella pertussis
Infants unable to make whooping noise
DTaP vaccines
One of the leading causes of vaccine-preventable
deaths world-wide (300,000 deaths per year)
Staccato cough
Posttussive emesis
Diagnose with a single high antibody titer
Admission for infants
Supportive care
Antibiotics for adults
Cough in Children
• Pertussis
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Also known as “Whooping Cough”
Infants unable to make whooping noise
Caused by bacterium Bordetella pertussis
DTaP vaccines
Staccato cough
Posttussive emesis
Diagnose with a single high antibody titer
Admission for infants
Supportive care
Antibiotics for adults