Thursday, 12 May 2016

Test Medicine Knowledge: Paediatrics

An 8-year-old boy with asthma is admitted to the hospital with shortness of breath. The mother tells you that he is usually well controlled with bronchodilator inhalers. However, for the past 2 days he has had rhinorrhea, a low-grade fever, and myalgias. She also reports that the child has a non-productive cough. Bronchodilators temporarily improved the child's breathing at home, but it once again worsened and they became worried. On admission, this child is given droplet precautions.

Nebulized bronchodilator treatments are initiated. Oxygen supplementation is given by nasal cannula and he is given aspirin for the relief of fever. For prophylaxis of influenza, an antiviral is administered because of a recent influenza outbreak in the community.

Of all of the therapies initiated in this patient, the one that is not indicated in this case is:
a. antiviral
b. aspirin
c. droplet precautions
d. nebulized bronchodilators
e. oxygen

Answer:  B (aspirin)
Although aspirin (choice B) is appropriate for the relief of fever, this patient is an 8-year-old child. The use of aspirin in a child with influenza is contraindicated, due to the association of aspirin usage in children with influenza and the development of Reye's syndrome. Reye's syndrome is more common with influenza B, but outbreaks have been found to be associated with influenza A. Hence, during an outbreak of influenza, aspirin is contraindicated in children with respiratory symptoms or fever.

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