{"id":1990,"date":"2017-11-22T08:26:07","date_gmt":"2017-11-22T13:26:07","guid":{"rendered":"https:\/\/www.roshreview.com\/?p=1990"},"modified":"2017-11-22T08:26:07","modified_gmt":"2017-11-22T13:26:07","slug":"ep-36-pediatrics-chlamydial-pneumonia-rubella-endotracheal-tube-size-child-abuse-hypoglycemia-shigella","status":"publish","type":"post","link":"https:\/\/www.roshreview.com\/blog\/ep-36-pediatrics-chlamydial-pneumonia-rubella-endotracheal-tube-size-child-abuse-hypoglycemia-shigella\/","title":{"rendered":"Podcast Ep 36: Pediatrics, Chlamydial Pneumonia, &amp; More"},"content":{"rendered":"\n<figure class=\"wp-block-audio\"><audio controls src=\"https:\/\/media.blubrry.com\/thereveal\/s\/media.blubrry.com\/roshcast\/s\/content.blubrry.com\/roshcast\/Ep_36_Roshcast_Emergency_Board_Review.mp3\"><\/audio><\/figure>\n\n\n\n<blockquote class=\"wp-block-quote is-layout-flow wp-block-quote-is-layout-flow\"><p>Do not go where the pay may lead, go instead where there is no path and leave a trail.<\/p><cite>-Ralph Waldo Emerson<\/cite><\/blockquote>\n\n\n\n<h6 class=\"wp-block-heading\">Welcome back to Roshcast Episode 36!&nbsp;This week we continue our collaboration with the <a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"http:\/\/emclerkship.com\/\" target=\"_blank\">EM Clerkship podcast<\/a>, focusing on pediatrics. Don\u2019t forget that we launched another trauma ring tone contest week, so listen up through Episode 38 to win a subscription to Rosh Review. For this week\u2019s rapid review, we will be covering a few pearls from Yehuda\u2019s most <a rel=\"noreferrer noopener\" aria-label=\"recent (opens in a new tab)\" href=\"https:\/\/www.roshreview.com\/blog\/rapid-review\/rapid-review-worms-cestodes\/\" target=\"_blank\">recent<\/a> <a rel=\"noreferrer noopener\" aria-label=\"posts (opens in a new tab)\" href=\"https:\/\/www.roshreview.com\/blog\/rapid-review\/rapid-review-red-eye\/\" target=\"_blank\">posts<\/a> on the <a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"https:\/\/www.roshreview.com\/blog\/\" target=\"_blank\">Rosh Review Blog<\/a>. Let\u2019s get started!<\/h6>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter\"><img loading=\"lazy\" decoding=\"async\" width=\"178\" height=\"66\" src=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/RapidReview_50.png\" alt=\"\" class=\"wp-image-1608\" \/><\/figure><\/div>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Cysticercosis<\/strong> is caused by <strong><em>Taenia solium<\/em><\/strong>,  a <strong>common tapeworm<\/strong>. It\u2019s <strong>transmitted<\/strong> via <strong>pork<\/strong>. Patients may present with <strong>seizures<\/strong> and <strong>CNS cysts<\/strong>.<\/li><li>Patients with <strong>acute angle-closure glaucoma<\/strong> classically present with <strong>severe eye pain<\/strong>, <strong>blurry vision<\/strong>, <strong>photophobia<\/strong>, and a <strong>dilated pupil<\/strong>. The <strong>intraocular pressure<\/strong> in this case would be <strong>elevated<\/strong>.<\/li><li><strong>Iritis<\/strong> presents with <strong>peri-limbic injection<\/strong>, a <strong>constricted pupil<\/strong>, <strong>pain<\/strong>, <strong>photophobia<\/strong>, and <strong>blurry vision<\/strong>. You would expect the intraocular pressure to be normal or even low.<\/li><\/ul>\n\n\n\n<p><strong>Now onto this week\u2019s podcast<\/strong><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p><strong>Question<\/strong><strong> 1<\/strong><\/p>\n\n\n\n<p>A 4-week-old boy presents with a 2-week history of increasing dyspnea, cough, and poor feeding. On examination you note conjunctivitis, and a chest examination reveals tachypnea and rales. A chest X-ray shows hyperinflation and diffuse interstitial infiltrates. Which of the following is the most likely etiologic agent?<\/p>\n\n\n\n<p><span>A.<em> Chlamydia trachomatis<\/em><\/span><\/p>\n\n\n\n<p><span>B. Parainfluenza virus<\/span><\/p>\n\n\n\n<p><span>C. Respiratory syncytial virus<\/span><\/p>\n\n\n\n<p><span>D.<em> Staphylococcus<\/em><\/span><span> species<\/span><\/p>\n\n\n\n<p><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Ep36-Chlamydia-Trachomatis.png\">Teaching Image<\/a><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p><strong>Question<\/strong><strong> 2<\/strong><\/p>\n\n\n\n<p>A 6-year-old immigrant boy from Bangladesh presents with fever and rash. The fever started three days ago followed by a rash which started on the head and spread to the rest of the body. Examination reveals a well-appearing child with a maculopapular rash and posterior cervical lymphadenopathy. Which of the following is the most likely causative organism for this disease?<\/p>\n\n\n\n<p><span>A. Measles virus<\/span><\/p>\n\n\n\n<p><span>B. Mumps virus<\/span><\/p>\n\n\n\n<p><span>C. Parvovirus B19<\/span><\/p>\n\n\n\n<p><span>D. Rubella virus<\/span><\/p>\n\n\n\n<p><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Ep36-Rubella.png\">Teaching Image<\/a><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p><strong>Question<\/strong><strong> 3<\/strong><\/p>\n\n\n\n<p>A 4-year-old boy presents with respiratory failure. Which of the following represents the correct endotracheal tube for this patient?<\/p>\n\n\n\n<p><span>A. 4.0 cuffed endotracheal tube<\/span><\/p>\n\n\n\n<p><span>B. 5.0 uncuffed endotracheal tube<\/span><\/p>\n\n\n\n<p><span>C. 5.5 cuffed endotracheal tube<\/span><\/p>\n\n\n\n<p><span>D. 6.0 cuffed endotracheal tube<\/span><\/p>\n\n\n\n<p><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Ep36-Cuffed-Uncuffed.png\">Teaching Image<\/a><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p><strong>Question<\/strong><strong> 4<\/strong><\/p>\n\n\n\n<p>Which of the following is the most common manifestation of abusive head trauma in infants?<\/p>\n\n\n\n<p><span>A. Epidural hematoma <\/span><\/p>\n\n\n\n<p><span>B. Retinal hemorrhage<\/span><\/p>\n\n\n\n<p><span>C. Subarachnoid hemorrhage<\/span><\/p>\n\n\n\n<p><span>D. Subdural hematoma<\/span><\/p>\n\n\n\n<p><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Ep36-Nonaccidental-Trauma.png\">Teaching Image<\/a><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p><span><strong>Question 5<\/strong><\/span><\/p>\n\n\n\n<p>Which of the following should be administered to a symptomatic 3-day-old infant with glucose of 25 mg\/dL?<\/p>\n\n\n\n<p><span>A. 1 mL\/kg of 50% dextrose (D50)<\/span><\/p>\n\n\n\n<p><span>B. 2 mL\/kg of 25% dextrose (D25)<\/span><\/p>\n\n\n\n<p><span>C. 5 mL\/kg of 10% dextrose (D10)<\/span><\/p>\n\n\n\n<p><span>D. Glucagon subcutaneously<\/span><\/p>\n\n\n\n<p><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Ep36-Pediatric-Dextrose-Hypoglycemia.png\">Teaching Image<\/a><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p><span><strong>Question 6<\/strong><\/span><\/p>\n\n\n\n<p>A healthy 6-year-old boy presents to the ED with bloody diarrhea. He was in his usual state of health until one week ago when loose, watery stools (up to 10 per day) were noted. He was seen by his pediatrician four days ago but has since developed increasing amounts of blood and pus in his stools along with a low-grade fever. Mom states there is no recent travel, antibiotic use, or known sick contacts. His vitals are heart rate 118 beats per minute, oxygen saturation 100% on room air, and rectal temperature of 38.3<strong>\u00b0<\/strong>C. Your physical exam reveals a mildly tender abdomen without localization, rebound, guarding, or peritoneal signs. You note grossly bloody stool on rectal exam. A brief discussion with his pediatrician confirms your suspicion of an invasive bacterial diarrhea; a stool culture was positive for <em>Shigella<\/em>. Which of the following statements is true regarding this condition?<\/p>\n\n\n\n<p>A.<strong>&nbsp;<\/strong>Antibiotics should be avoided because this is a severe case and the patient is at highest risk of developing hemolytic uremic syndrome<\/p>\n\n\n\n<p>B. Antidiarrheal agents (such as diphenoxylate and atropine) are indicated, given the frequency of loose stools<\/p>\n\n\n\n<p>C. Extraintestinal manifestations such as hallucinations, confusion, and seizures may occur<\/p>\n\n\n\n<p>D. Oral rehydration should be avoided; IV fluids should be initiated<\/p>\n\n\n\n<p><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Ep36-Shigellosis.png\">Teaching Image<\/a><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter\"><img loading=\"lazy\" decoding=\"async\" width=\"178\" height=\"66\" src=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/RapidReview_50.png\" alt=\"\" class=\"wp-image-1608\" \/><\/figure><\/div>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Chlaymdial pneumonia<\/strong> is often found in <strong>infants 3\u201316 weeks old<\/strong>. They usually present, <strong>non-toxic appearing<\/strong> and <strong>afebrile<\/strong>, but with <strong>tachypnea<\/strong> and a <strong>staccato cough<\/strong>, with or without rales. 50% also have <strong>conjunctivitis<\/strong>. Treat with <strong>azithromycin<\/strong>.<\/li><li><strong>Infants<\/strong> with <strong>parainfluenza<\/strong> virus typically present with <strong>coryza<\/strong>, a <strong>low-grade fever<\/strong> followed by a classic <strong>barking cough<\/strong> of croup.<\/li><li><strong>Infants<\/strong> with <strong>RSV<\/strong> present with <strong>lower respiratory tract infections<\/strong> like <strong>bronchiolitis<\/strong>.<\/li><li><strong>Measles<\/strong> presents with a <strong>fever followed by a rash<\/strong> and <strong>Koplik spots<\/strong>.<\/li><li><strong>Mumps<\/strong> is associated with an <strong>infectious parotitis<\/strong>.<\/li><li><strong>Infants<\/strong> with <strong>parvovirus B19<\/strong> often present with <strong>erythema infectiosum<\/strong> with the classic <strong>slapped cheek<\/strong> appearance.<\/li><li><strong>Rubella<\/strong>, also called <strong>German measles<\/strong>, often presents with a <strong>mild febrile illness<\/strong> with a <strong>diffuse maculopapular rash<\/strong>, <strong>generalized malaise<\/strong>, along with <strong>lymphadenopathy<\/strong>.<\/li><li>When choosing an <strong>endotracheal tube<\/strong> for children use the following formulas. For <strong>uncuffed tubes<\/strong>, take the <strong>age, divide it by 4, and add 4<\/strong>. For <strong>cuffed tubes<\/strong>, take the <strong>age, divide it by 4, and add 3.5<\/strong>.<\/li><li><strong>Retinal hemorrhages<\/strong> are the <strong>most common<\/strong> manifestation of <strong>abusive head trauma<\/strong> in <strong>infants<\/strong>.<\/li><li><strong>Posterior rib fractures<\/strong> <strong>without overlying bruises<\/strong>, <strong>metaphyseal fractures<\/strong>, <strong>sternal fractures<\/strong>, <strong>scapular fractures<\/strong>, and <strong>skull fractures<\/strong> should raise your suspicion for <strong>non-accidental trauma<\/strong>.<\/li><li>For <strong>hypoglycemic children<\/strong> <strong>less than one year of age<\/strong>, use <strong>D10 5\u201310 ml\/kg<\/strong>. For hypoglycemic children who are <strong>1 to 8 years old<\/strong>, use <strong>D25 2\u20134 ml\/kg<\/strong>. For hypoglycemic children <strong>over the age of 8<\/strong>, use <strong>D50 1\u20132 ml\/kg<\/strong>.<\/li><li><strong>Extraintestinal manifestations<\/strong> of <strong>Shigella<\/strong> include <strong>confusion<\/strong>, <strong>hallucinations<\/strong>, and <strong>seizures<\/strong>.<\/li><li>For children concerning for <strong>shigellosis<\/strong>, <strong>treat supportively<\/strong> with <strong>PO fluids if tolerated<\/strong>. <strong>Antidiarrheal agents should be avoided<\/strong>. Depending on the situation, <strong>antibiotics may be needed<\/strong>.<\/li><\/ul>\n\n\n\n<p>That wraps up Episode 36.&nbsp;Don\u2019t forget to follow us on Twitter <a href=\"https:\/\/twitter.com\/roshcast?lang=en\">@Roshcast<\/a> and <a href=\"https:\/\/twitter.com\/roshreview?lang=en\">@RoshReview<\/a>. We can also be reached by email at <a href=\"mailto:roshcast@roshreview.com\">roshcast@roshreview.com<\/a> and are open to any feedback, corrections, or suggestions. You can help us pick questions by identifying ones you would like us to review. To do so, write \u201cRoshcast\u201d in the submit feedback box as you go through the question bank. And finally, if you have a minute, make sure to rate us and leave comments on <a href=\"https:\/\/itunes.apple.com\/us\/podcast\/roshcast\/id1156487141?mt=2\" target=\"_blank\" rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\">iTunes<\/a> to help spread the word about Roshcast.<\/p>\n\n\n\n<p>Until next time,<br>Jeff and Nachi<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Do not go where the pay may lead, go instead where there is no path and leave a trail. -Ralph Waldo Emerson Welcome back to Roshcast Episode 36!&nbsp;This week we continue our collaboration with the EM Clerkship podcast, focusing on pediatrics. Don\u2019t forget that we launched another trauma ring tone contest week, so listen up <a href=\"https:\/\/www.roshreview.com\/blog\/ep-36-pediatrics-chlamydial-pneumonia-rubella-endotracheal-tube-size-child-abuse-hypoglycemia-shigella\/\">read more&#8230;<\/a><\/p>\n","protected":false},"author":11,"featured_media":2068,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"inline_featured_image":false,"footnotes":""},"categories":[2025,1999],"tags":[2062,2070,2164,2212,2220,2267,2376,2400,2426,2430,2432,2451,2465,2479,2517,2599,2613,2631,2707,2723,2746,2842,2872,2873,2895,2901,2931,2992,2997,3011,3029,3070,3125,3161,3168,3225,3234,3238,3265,3281,3305,3341,3348,3440,3460,3494,3495,3507,3518,3530,3539,3540,3572,3579,3619,3620,3701],"coauthors":[],"class_list":["post-1990","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-emergency-medicine","category-podcast","tag-abusive-head-trauma","tag-acute-angle-closure-glaucoma","tag-antibiotics","tag-azithromycin","tag-barking-cough","tag-blurry-vision","tag-chlamydial-pneumonia","tag-cns-cyst","tag-confusion","tag-conjunctivitis","tag-constricted-pupil","tag-coryza","tag-cuffed-tube","tag-cysticercosis","tag-dilated-pupil","tag-endotracheal-tube","tag-erythema-infectiosum","tag-eye-pain","tag-german-measles","tag-glaucoma","tag-hallucination","tag-hypoglycemia","tag-infants","tag-infectious-diseases","tag-intraocular-pressure","tag-iritis","tag-koplik-spots","tag-lymphadenopathy","tag-malaise","tag-measles","tag-metaphyseal-fracture","tag-mumps","tag-non-accidental-trauma","tag-ophthalmology","tag-orthopedics","tag-parainfluenza","tag-parotitis","tag-parvovirus-b19","tag-pediatrics","tag-peri-limbic-injection","tag-photophobia","tag-pork","tag-posterior-rib-fracture","tag-rashes","tag-retinal-hemorrhages","tag-rsv","tag-rubella","tag-scapular-fracture","tag-seizure","tag-shigella","tag-skull-fracture","tag-slapped-cheek","tag-staccato-cough","tag-sternal-fracture","tag-taenia-solium","tag-tapeworm","tag-uncuffed-tube"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v21.7 (Yoast SEO v26.6) - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Podcast Ep 36: Pediatrics, Chlamydial Pneumonia &amp; More | RoshReview.com<\/title>\n<meta name=\"description\" content=\"Welcome to RoshCast (Ep. 36), the first question and answer style emergency medicine podcast. 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