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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor={{AZ}}
|QuestionAuthor={{AZ}}
|Prompt=A 18-year-old African american male comes to the office for the evaluation of pain in his right hip that started 7 weeks ago. The pain has gradually progressed, and now it limits his daily activities. He has sickle cell disease and was hospitalized 4 months ago due to a painful crisis that was successfully treated with hydration, oxygen,  and  analgesics. His temperature is 37.4C (99F), blood pressure is 120/90 mmHg, pulse is 90/min, and respirations are 14/min. Physical examination reveals no local tenderness, but there is restriction of abduction and internal rotation of the hip. What is the most likely diagnosis?
|ExamType=USMLE Step 2 CK
|Explanation=.
|MainCategory=Pediatrics
 
|SubCategory=Head and Neck, Pediatrics, Respiratory
'''Educational Objective:'''
|MainCategory=Pediatrics
Avascualr necrosis should be considered in patients with multiple attacks of sickle cell crisis.
|SubCategory=Head and Neck, Pediatrics, Respiratory
|AnswerA=Femoral fracture
|MainCategory=Pediatrics
|SubCategory=Head and Neck, Pediatrics, Respiratory
|MainCategory=Pediatrics
|MainCategory=Pediatrics
|SubCategory=Head and Neck, Pediatrics, Respiratory
|MainCategory=Pediatrics
|SubCategory=Head and Neck, Pediatrics, Respiratory
|MainCategory=Pediatrics
|SubCategory=Head and Neck, Pediatrics, Respiratory
|MainCategory=Pediatrics
|SubCategory=Head and Neck, Pediatrics, Respiratory
|MainCategory=Pediatrics
|MainCategory=Pediatrics
|SubCategory=Head and Neck, Pediatrics, 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='''Educational Objective:'''
Avascular necrosis should be considered in patients with multiple attacks of sickle cell crisis.
|AnswerA=Start intravenous methylprednisolone
|AnswerAExp='''Incorrect'''-[[]]
|AnswerAExp='''Incorrect'''-[[]]
|AnswerB=Joint effusion from septic arthritis
|AnswerB=lateral neck x-ray
|AnswerBExp='''Incorrect'''-[[]].
|AnswerBExp='''Incorrect'''-[[]].
|AnswerC=Avascular necrosis
|AnswerC=Endotracheal intubation with a set-up for tracheostomy
|AnswerCExp='''Correct'''-[[]]
|AnswerCExp='''Correct'''-[[]]
|AnswerD=Admit the patient and start broad spectrum antibiotics
|AnswerDExp='''Incorrect'''-[[]].
|AnswerDExp='''Incorrect'''-[[]].
|AnswerE=Osteomyelitis caused by Staphylococcus
|AnswerE=Admit the patient and start nebulized racemic epinephrine
|AnswerEExp='''Incorrect'''-[[]]
|AnswerEExp='''Incorrect'''-[[]]
|RightAnswer=C
|RightAnswer=C

Revision as of 01:00, 27 January 2014
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::Pediatrics, 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-[[]]]]
Answer B AnswerB::lateral neck x-ray
Answer B Explanation [[AnswerBExp::Incorrect-[[]].]]
Answer C AnswerC::Endotracheal intubation with a set-up for tracheostomy
Answer C Explanation [[AnswerCExp::Correct-[[]]]]
Answer D AnswerD::Admit the patient and start broad spectrum antibiotics
Answer D Explanation [[AnswerDExp::Incorrect-[[]].]]
Answer E AnswerE::Admit the patient and start nebulized racemic epinephrine
Answer E Explanation [[AnswerEExp::Incorrect-[[]]]]
Right Answer RightAnswer::C
Explanation [[Explanation::Educational Objective:

Avascular necrosis should be considered in patients with multiple attacks of sickle cell crisis.
Educational Objective:
References: ]]

Approved Approved::No
Keyword WBRKeyword::Drug induced myopathy, WBRKeyword::Steroid induced myopathy
Linked Question Linked::
Order in Linked Questions LinkedOrder::
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