A 8-year-old boy appears in the ER with history of URI (upper respiratory infection) for the last 5 days. He received acetaminophen for fever up to 103°F. He does not want to eat. His activities are decreased significantly. For the last 12 hours, his fever went up to 104°F despite acetaminophen therapy. He vomited yellowish material twice. He is irritable, lethargic, and complains of back pain. He denies sore throat and pain in ears. He denies any history of trauma. He is not allergic to any medication. Past medical history is unremarkable.
Vital signs: Temperature 105°F (40.5°C),
heart rate 120 per minute (normal 70 – 110),
respiratory rate 20 per minute (normal 17 – 23),
blood pressure 100/60 (50th percentile).
QUESTIONS:
1. Physical examination reveals:
A. Pharyngeal exudate
B. Redness in tympanic membranes
C. Rales in right lung
D. Nuchal rigidity
E. Abdominal tenderness
2. Investigation which leads to definitive diagnosis:
A. Audiometry
B. Abdominal X-ray
C. Pharyngeal culture
D. Sputum culture
E. CSF
3. Test results reveal:
A. Conductive hearing loss
B. Dilated small intestine
C. Group A Streptococci
D. S. aureus
E. CSF: Gram stain positive for Gram positive cocci and culture positive for S. pneumoniae
4. The next step in management:
A. Intravenous antibiotics
B. Surgical consult
C. Oral antibiotics
D. Intravenous hydration
E. Bronchodilator therapy
5. The child is kept NPO (nothing per mouth). IV fluid should be given:
A. Two times of maintenance
B. One and half times of maintenance
C. One time maintenance
D. One half to two thirds of maintenance
E. One fourth of maintenance
CHECK ANSWERS on Tuesday 6/8/2019
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