Treatment & Management

Question 0

Work-up for FUO

Answer 0

Labs: CBC, esr, crp, LDH, Uric acid
Cultures: blood, urine
Chest X-ray
Other: HIV, ppd

Question 1

Musculoskeletal back pain

Answer 1

NSAIDs ( naproxen 500mg q12hrs prn pain)
Stretching exercises (use heating pad before stretching)
Physical therapy
F/u: 4-6 weeks, X-ray if not improved

Question 2

Work-up for syncope

Answer 2

Full neuro exam
Full cardiac exam (supine, squatting, sitting)
Orthostatic vitals
EKG
BMP
Consider: EEG, echo, MRI

Question 3

Management of excessive crying?

Answer 3

Excessive crying= greater than 1-2 hours and different in quality per caregivers

Stool for occult blood (poss intussusception)
Fluorescin testing of eyes (corneal abrasion)
UA and urine cx (UTI)
Pulse ox (cardiac causes sometimes increase irritability)
Electrolytes and blood glucose

Question 4

How do you manage a wards patient with a seizure on the floor

Answer 4

1. Go and assess patient (vitals, PE)
2. Airway, breathing, circulation (consider need for respiratory support, alternate airway)
3. Hx from who was in the room (ever had a seizure, is this typical for child’s seizure)
4. Consider need for labs, imaging
5. Meds to stop the seizure Ativan, diastat

Question 5

What is the treatment for croup? What’s the prognosis?

Answer 5

Treatment

• oral prednisone for 3 days
• nebulized racemic epi (but need to be observed for at least 2 hours for rebound stridor)
• can do nebulized budesonide (pulmicort) x1
• cool mist, humidified air

Prognosis

• fever may last 3-4 days
• cough, stridor tend to worse at night

Question 6

What are the indications for hospitalization in croup?

Answer 6

1. Significant stridor at rest
2. Child unable to eat
3. Parents unable to care at home

Question 7

Work-up for a dysmorphic child?

Answer 7

1. Karyotype (analyze chromosome)
2. Cytogenetics
3. FISH (good for detecting small chromosome abnormalities)
4. Serum AA, urine organic acids (eval for metabolic syndrome)
5. Imaging studies

Question 12

Management principles of DKA

Answer 12

1. Fluids (initial 10 ml/kg isotonic over 1 hour, then 1.5 mivf isotonic fluids, add dextrose when BG 250-300)
2. Insulin infusion 0.1 unit/hr
3. Q1 hour BG, ph and electrolytes for first 3-4 hours
4. Frequent Neuro checks for cerebral edema