sunny2
Forum Elite
Topics: 51
Posts: 385
|
The mother of a beautiful 3 year old child with fair skin and blue eyes calls because her child's temperature is 104.
past medical history is not known as the mother has memory problem after a recent accident of her Ford Mustang with harley davidson , the wind shield crashed and she had head injuries . She remembers that this child is recently adopted from Romania, the mother is concerned about preventing febrile seizures as she remembers that she has lost another child from her previous marriage with Jonathen because of similar situation of high temperature and seizures.
Which of the following could you tell her addressing her concern?
1.give acetaminophen right away
2.give ibuprogen right away
3.give aspirin right away
4.give diazepam right away
5.as long as child is not drowsy after a seizure,he will be fine
6.his teperature is 104, don't worry he is not at great risk
7.with 104 as temperature he is at increased risk of having a seizure
8.dont worry everythingh would be fine, relax, take it easy
9.immerse him in cold water
10.give him some coke and place him in front of the AC for 15 min.
11.place ice cubes in his mouth
Edited by sunny2 on 08/21/06 - 01:55 PM. Reason: a hint
|
| frank100
Forum Guru
Topics: 48
Posts: 586
|
Iīm goin to be simple: (1) is my answer.
ok, he is fair skinned and blue eyed, but whatīs wrong with it, he is european. I wonīt accept phenylketonuria, related to something super ultra high tech related to something even more high tech....that will end up being the the first step to the answer...
here: this is still considered moderate fever (for a child), so Aceptaminophen is the best next step, the antipyretics will decrese fever by one or 2 degrees, if it doesnīt then sponge is a good option.
he is adopted, so his brother isnīt genetically related to him. I shuldnīt spect same diseases.
|
| drk1980
Forum Guru
Topics: 147
Posts: 1,038
|
sunny2 wrote:
The mother of a 3 year old child calls because her child's temperature is 104.
past medical history is not known ...the mother is concerned about preventing febrile seizures...Which of the following could you tell her addressing her concern?
I presume the above is all tht is relevant to extract info for an ans?
1.give acetaminophen right away
sunny2, ur qs are a riot! ...keep 'em coming ;o)
|
| study_ing
Forum Fanatic
Topics: 180
Posts: 2,511
|
but duz that address her concern here? the pt shud be told something abt febrile seizures and their relationship with temperature...or am i overthinking??
___________________
If you yourself are at peace, then there is at least some peace in the world.
|
| sunny2
Forum Elite
Topics: 51
Posts: 385
|
study_ing ...pick a choice...the best guess.....as if you don't have more then 40 seconds for this question, then see if spontaneity worked or not ! 
|
| sunny2
Forum Elite
Topics: 51
Posts: 385
|
Acetaminophen is NOT the right answer -- it is a fine adjuvant and may make the child comfartable, but it does not prevent febrile seizures
|
| juanma0
Forum Senior
Topics: 10
Posts: 146
|
I pick 7. The question is about the motherīs concern not the treatment and at that temp he IS AT RISK. No other answer adressess this.
|
| sunny2
Forum Elite
Topics: 51
Posts: 385
|
Juanma0, this is not the correct answer. 7 is wrong !
|
| juanma0
Forum Senior
Topics: 10
Posts: 146
|
Ah Mittelshmerz!!! Then i go with 4. There are some studies that have proved beneficial effect of diazepam in preventing febrile seizures. Didnt go with this one first because it isntīt a routine reccomendation.
|
| sunny2
Forum Elite
Topics: 51
Posts: 385
|
4. is Incorrect.
juanma0, please don't get distracted ...earlier you were on the right track to answer this question correctly...as for Diazepam, do you think it's appropriate to ask or to expect a non medical personnel to give or have diazepam ...i mean just by talking on phone...!!
|
| cbenitesch
Forum Senior
Topics: 10
Posts: 141
|
Well, I think we have to solve this step by step. First, the cuestion is about momīs concern, so you can eliminate 1,2,3,4,9,10,11 as a way to treat the girl. Second, the girl has 104 F (40 C) she got fever!!! hehehe, well she lost another child because of the febrile seizure... but this girl is adopted!!! Third febrile seizure is a benign process, the girl is sleepy but antipiretic drugs donīt have any effect on prevente febrile seizure, so I think telling mamma "hey donīt worry take it easy, relax! sheīll be fine!". You are just answering momīs concern.
|
| sunny2
Forum Elite
Topics: 51
Posts: 385
|
OK, the answer is 6.
Explanation : Febrile seizures occur as the temperature is rising, therefore, now that the temperature is allready high, the child is not at as great a risk.
I have checked this concept and this is true, so may be it holds a clinical pearl to answer those iffy style questions in step-2....that is why i tried to bring this up.
Enjoy !
|
| cbenitesch
Forum Senior
Topics: 10
Posts: 141
|
Hello sunny, this is kind of wired!. Theory says that the occurrence of a FS is when temp is over 38C but not when is rising, according to your information child can have a FS from 37,5C to 38,5C? mmm... may I have your bibliography to check?... actually Iīll check on UTD.
|
| GDS2008
Forum Elite
Topics: 9
Posts: 144
|
Sunny is right in the sense that febrile seizures are associted with the rapidity with which the temperature increases (i.e. it occurs when the body temperature is rising). However, it is incorrect to say that he is no longer at an increased risk just because the temperature has stabilized at 104. The next step in febrile seizures is always control the fever (acetaminophen in this case) and then r/o other potential causes. (like meningitis) or look for the source.
|
| sunny2
Forum Elite
Topics: 51
Posts: 385
|
I am sorry cbenitesch, I would differ on your comment "Theory says that the occurrence of a FS is when temp is over 38C but not when is rising", it is just the other way round..I have read this not just listned to someone but am not able to recall the journal, just googled and found this on the very first page i opened: , please note : I am not trying to force an openion, please follow what you read ...this is just a discussion...not a point to prove. I hope you understand and please let me know if you come across any information related to this
Thanks
http://en.wikipedia.org/wiki/Febrile_seizure
"A febrile seizure, also known as a fever fit or febrile convulsion is a generalized convulsion caused by elevated body temperature. They most commonly occur in children below the age of three years old and should not be diagnosed in children under the age of 6 months or over the age of 6 years. In many cases, the first sign of fever is the onset of the seizure. It has been theorized that the seizure is triggered by the rapidity of the rise in temperature, rather than the actual temperature reached"
|
| sunny2
Forum Elite
Topics: 51
Posts: 385
|
That is correct GDS2008, I agree.
But the point is she is calling on phone and I think there is a sort of panic situation because of a previous history, may be that's why The first step was to calm her down with the right information for her about her concern and then perhaps as 2nd step try to resolve the situation.
|
| frank100
Forum Guru
Topics: 48
Posts: 586
|
thank god you are not a USMLE question maker....sunny2.
|
| frank100
Forum Guru
Topics: 48
Posts: 586
|
I shouldnīt say that, but really not agree with your answer. but if I see this question on my test, Iīll choose your answer...(laughs)
|
| cbenitesch
Forum Senior
Topics: 10
Posts: 141
|
Hi again, Iīm sorry to push this way... but I think there are some mistakes, first google is not a good source for information, for example is kind of wired find a FS in child youger than 6months or older tha 4 or 5 y.o. and your wiki definition says 6y.o. I found some articles on ovid and they say that phatophysiology is not defined yet! we have some theories for example IL1 and HZV type 6 infection. Second the use of antipyretics is not recommended because febrile seizure is autolimited of course we have to find the source of infection if its the case. And the answer 6 having 40C of temp ???!!! come on! of course Iīll be desperated if my child get 40C !!!! I canīt tell the mom donīt worry she has 40C temp but sheīll be fine!
|
| cbenitesch
Forum Senior
Topics: 10
Posts: 141
|
Sorry... I forgot to add maybe a complete revision of FS:
http://www.ilae-epilepsy.org/ctf/febrile_convulsi...
|
| GDS2008
Forum Elite
Topics: 9
Posts: 144
|
cbenitesch -- there is no question to sunny's point regarding the pathophysiology of FS. it is verry well established that the rapid rise in body temperature somehow alters the neuronal excitability in the cerebral hemispheres which causes a seizure. (based on EEG recordings on animal models. U can find this by searching on the medline with keywords "febrile seizures" and "Review"). What is not known however, is the exact mechanism by whihc this occurs. There are theories regarding K+ channel instability but it is not for certain. So there is no doubt about that.....However, I agree with Sunny that it would be important to calm the mother down first but saying that there is no risk is wrong (there is a potential risk). Also, if we go through Nelson's essentials of pediatrics, it is clearly said that most authorities would first control the fever (obviously by giving anti-pyretics whihc of course would be acetaminophen) and then do a thorough examination to look for a casue. In most cases, it is due to an URT infection (viral) but if the need be the physician should be ready to perform an LP.
Thanks sunny for bringing up an improtant issue which is actually very high yield!
|
| sunny2
Forum Elite
Topics: 51
Posts: 385
|
frank100 and GDS2008, please see that it is not pressing on an answer and as I said earlier proving a point here.
The question was about a concept and if you look at it choice by choice you can easily eliminate all of them in lieu of what the question is asking you...to address her concern about feb. seizure.
of course he is at risk at 104 but he is not at "great risk"as the answer is pointing "increased /great" ...we have to watch these words like we watch "the likely,most likely,initial,best the most sensitive" sort of distracting words which completely changes the answer.
anyway, 
|
| cbenitesch
Forum Senior
Topics: 10
Posts: 141
|
Thanks guys! but have my doubts!
|
| frank100
Forum Guru
Topics: 48
Posts: 586
|
seriously speaking...you will never approach a phone call, where a mother is telling you her baby is 104!!! by saying "donīt worry he is not at great risk", unless you have a huge bank account to pay for lawsuits. you cannot tell if the fever is likely to go down or up only by history.
personally i will never say that to anyone in the world. the mother concer is not my concern righ now, because there is a child with high fever, and I donīt know whatīs causing it.
sunny2, maybe you tryed to make it as tricky as you can, but...
|
| GDS2008
Forum Elite
Topics: 9
Posts: 144
|
com on guys give him a break. He desings questions to convey concepts and most of his questions have ended up with pretty good discussions, clearing out mnay things for people on this forum. Thanks for that sunny and we will expect to to get more celebrity questions from you. Good luck every 1
|
|
| |
| | | | | | | | | | | | | | | | | | | | | | | | | |
