WBR1034

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Author [[PageAuthor::Ahmed Zaghw, M.D. [1]]]
Exam Type USMLE Step 2 CK
Main Category Pediatrics
Sub Category 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?
Answer A 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 lateral neck x-ray
Answer B Explanation 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 Endotracheal intubation with a set-up for tracheostomy
Answer C Explanation 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 Admit the patient and start broad spectrum antibiotics
Answer D Explanation Incorrect- Antibiotics administration are the second step after securing airways.
Answer E 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 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 No
Keyword Drug induced myopathy, Steroid induced myopathy
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