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  #1  
Old 08-03-2013
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Star Peds question #4

A seven year-old boy arrives at the clinic with a chief complain of Fever for the last 48 hours+left facial swelling. His mother reports that 2 days ago the area surrounding his left eye was swollen and red, she also mentions the left eye looked like "it wanted to come out". He has a history of recurrent allergic rhinitis and also had an insect bite when he was at a basketball boot camp. Upon examination you notice the left eye looks swollen with proptosis, marked pain and limitation with movement, a mild hyperemic sclera and a normall fundus. The next best step in the management of this patient is?

A. Give oral NSAIDs and schedule and appointment for next week.
B. CBC, blood culture, IM ceftriaxone+Vancomycin and follow up the next day.
C. CBC, blood culture, IM ceftriaxone+Vancomycin, CT scan and follow up the next day.
D. Oral antibiotics for 21 days.
E. Admission to the hospital, IV antibiotics.
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  #2  
Old 08-03-2013
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Default

Here we go again with all of these eye questions lol just kiddin
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Old 08-03-2013
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Default orbital cellulitis

answer E....
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  #4  
Old 08-03-2013
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Remember to explain why you are picking a particular answer, that way everybody will learn.
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Old 08-03-2013
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ADmit and administer IV antibioitics. THe fact that there is pain on movement makes it an orbital cellullitis which is an emergency so whether its an adult or a child everyone has to be admited
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Old 08-04-2013
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Default Excellent!

Correct answer is E.
Orbital cellulitis is an infection and inflammation of the tissues around the orbit. While some cases arise from direct infection through trauma, most pediatric orbital cellulitis arise from direct extension like the paranasal sinuses (specially ethmoid sinuses... THIS IS a USMLE question). This infection is a life threatening entity and as such necessitates prompt hospital admision and IV antibiotics. Imaging is performed with a CT scan and MRI to determine the extent of the infection .

The other options are wrong because this child needs prompt admission, IM antibiotics or oral antibiotics mean you will lose your license and rot in hell
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