A 4-year-old boy returns for his second visit to the emergency room. Three days ago he was brought in with a 4-day history of fever up to 102°F. At that time, his physical examination was significant for injection of the oropharynx and an enlarged left anterior cervical lymph node. His left TM was nonbulging and nonerythematous. He was sent home on amoxicillin with a diagnosis of streptococcal pharyngitis. He returns today with a persistent fever, edema of both hands, bilateral conjunctivitis, and a polymorphous truncal rash.What is the treatment for this condition?
Answer(s): B
Kawasaki disease is the second most common systemic vasculitis in children. The diagnosis requires the presence of fever for at least 5 days and four of the five criteria: bilateral conjunctivitis (generally nonpurulent); oropharyngeal mucosal changes including pharyngeal injection, strawberry tongue, or injection or fissuring of the lips; nonfluctuant cervical lymphadenopathy, usually unilateral; polymorphous rash that is primarily truncal; and changes of the peripheral extremities, including edema or erythema of hands and feet, or desquamation of the finger/ toes, usually beginning periungally. The treatment of Kawasaki disease consists of high-dose aspirin and IVIG as a single dose infused over 12 hours. The role of corticosteroid as treatment is controversial. This therapy was abandoned after an initial report citing increased rates of coronary artery aneurysms. A few recent studies reveal successful treatment with methylprednisolone in children who failed therapy of IVIG, but it is not first line.
Parents bring their 6-year-old son to the emergency room following an acute onset of vomiting and combative behavior. The parents state that the child has recently had chickenpox. They have been giving him medication to reduce his fever, which has been as high as 102 F. Which medication is the likely cause of his current condition?
Historically, Reye's syndrome was a cause of hepatitis and encephalitis. It was seen in children with influenza or varicella who were given aspirin. Widespread knowledge of this issue, resulting in an almost complete cessation of the use of aspirin in children, has made Reye's syndrome a very rare occurrence.
Use of which medication can result in enamel staining of primary teeth?
Answer(s): E
Gray or brown teeth staining can be seen with the use of tetracycline in children who still have their primary teeth. Tetracyclines are usually safe as a single course in normal doses in younger children. The use of tetracyclines in children is typically safe after 8 years of age. Teeth staining can also be seen in the children of women who took tetracycline while pregnant.
A 10-year-old male has a history of seizures which are controlled with dilantin. The child also has asthma and often uses an albuterol inhaler. Which of the following asthma medications can lower the seizure threshold in children?
Answer(s): A
Theophylline, a methylxanthine, has an excitatory effect on the CNS. This serious side effect, in conjunction with its very narrow therapeutic window, has made theophylline use very uncommon. The use of any of the other medications listed would be recommended before consideration of the use of theophylline.
A 10-year-old boy presents to your clinic with right knee pain for 2 weeks. He is physically active at school and plays soccer and basketball. He describes pain in his knees when he runs or jumps. He denies any recent trauma. His physical examination is normal except for mild edema and tenderness over the right tibial tubercle. What is the most likely diagnosis?
Osgood-Schlatter disease is a repetitive stress injury to the inferior end of the patellar tendon at its insertion into the tibial tubercle. These patients are usually young, athletic males between the ages 10 and 15 years. The diagnosis is made when a young male presents with knee pain that increases with exercise without a history of trauma. Treatment consists of rest, activity restriction, and anti- inflammatory agents. Slipped capital femoral epiphysis occurs most commonly in African American obese adolescent males. It refers to a slipping of the epiphysis off the metaphysis. The "slipping" is caused by weakening of the perichondral ring of the growth plate, which allows the epiphysis and metaphysis to gradually or acutely displace from each other. This results in pain in the groin, thigh, or knee as well as a limp. Treatment is primarily operative internal fixation. Patellar tendonitis is caused by injury to the patellar tendon. Most of these patients have tenderness in the inferior portion of the patella and complain of chronic anterior knee pain. Iliotibial band friction syndrome causes lateral knee pain in runners.
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