Sickle cell ds
harry206 - 05-02-09 09:53 Bookmark and Share

A 30-month-old African American girl with sickle cell disease is brought to the emergency department because of a 1-day history of "fevers". She is generally healthy and has not had any serious complications from the sickle cell disease. The mother tells you that she is compliant in giving her daughter the prophylactic penicillin that has been prescribed. Her temperature is 39.1 C (102.4 F). Physical examination shows clear rhinorrhea, but is otherwise unremarkable. The most appropriate management of this child is to

A. admit her to the hospital for close observation


B. admit her to the hospital for hydration and antipyretics therapy


C. admit her to the hospital for intravenous antibiotics and hydration


D. increase the dose of the prophylactic penicillin


E. send a complete blood count and blood cultures and send her home with a follow up appointment in the clinic for the next day

Page 1
#1
Re: Sickle cell ds
bingousmle - 05-02-09 10:05

the episode is likely to precipitate sickle crisis hence admitting her and giving prophylactic antipyretics and hydration seems approprriate..

#2
Re: Sickle cell ds
sackatdoc - 05-02-09 10:23

this could be a autosplenectomised patient BUT as MENTIONED NO SERIOUS COMPLICATION, so taking penicillins can prevent many infections but definitely not all ---salmonella??? , so have to do blood cultures I GUESS

#3
Re: Sickle cell ds
InSitu - 05-02-09 11:19

B sounds the best answer. She is maybe Dehydrated so hospitalization and Hydration should be in the choice. That leaves only B or C. The fever seems viral so no need for antibiotics. Let wait and see. :)

#4
Re: Sickle cell ds
harry206 - 05-02-09 12:31

ANS: C

In a sickle cell patient with a fever, it is important that broad spectrum antibiotics are instituted as soon as possible to protect against septicemia from encapsulated organisms such as H. influenzae, Pneumococcus, and Neisseria.

Children with sickle cell disease are on prophylactic penicillin VK, but this is not sufficient for treating a possible life threatening illness

IV hydration and antipyretics are important adjuncts to treating a sickle cell patient with fever inpatient. However, this choice does not allow for antibiotics, which are necessary since she is at a high risk for septicemia.

#5
Re: Sickle cell ds
bingousmle - 05-02-09 13:27

ok.. so antibiotics are to be instituted for guarding against gram negative septicemia.. keep the good work up ...

#6
Re: Sickle cell ds
InSitu - 05-02-09 15:26

That is absolutely right. Overlooked the encapsulated bacteria...good question. Thanks

#7
Re: Sickle cell ds
meduploader - 05-03-09 11:51

C. admit her to the hospital for intravenous antibiotics and hydration

#8
Re: Sickle cell ds
conym5 - 07-12-09 11:03

CCC

#9
Re: Sickle cell ds
docraj - 07-13-09 13:42

This is fever with microangipathic hemolyisis. There is definately a clot. The antibiotics are definately a prophylactic measure. Remember that fever can also arise from a blood clot.

#10
Re: Sickle cell ds
mtniharika - 12-28-09 05:59

The most appropriate management of this child is to

C. admit her to the hospital for intravenous antibiotics and hydration


penicillin is not sufficientto preventsepticemia and hence IV antibiotics as inpatient is needed along with antipyretics...

#11
Re: Sickle cell ds
conym5 - 12-28-09 09:21

admit her to the hospital for intravenous antibiotics and hydration
Antibiotics.
pt;s with sickle cell anemia usually begin taking the antibiotic penicillin .Doing so helps prevent infections, such as pneumonia,

#12
Re: Sickle cell ds
nidayasir - 12-28-09 11:42

C admit her fr iv antibiotics n hydration as it wd help in rush of clot causing fever n antibiotics fr prevention of septicemia.

#13
Re: Sickle cell ds
babbu5508 - 02-24-11 14:54

A 30-month-old African American girl with sickle cell disease is brought to the emergency department because of a 1-day history of "fevers". She is generally healthy and has not had any serious complications from the sickle cell disease. The mother tells you that she is compliant in giving her daughter the prophylactic penicillin that has been prescribed. Her temperature is 39.1 C (102.4 F). Physical examination shows clear rhinorrhea, but is otherwise unremarkable. The most appropriate management of this child is to

C. admit her to the hospital for intravenous antibiotics and hydration

#14
Re: Sickle cell ds
sudha2015 - 02-28-11 08:28

A 30-month-old African American girl with sickle cell disease is brought to the emergency department because of a 1-day history of "fevers". She is generally healthy and has not had any serious complications from the sickle cell disease
C. admit her to the hospital for intravenous antibiotics and hydration

#15
Re: Sickle cell ds
babbu5508 - 02-28-11 10:35

The sites most often affected by the blocking or stacking action of sickled cells are found in the lungs, liver, bone, muscles, brain, spleen, penis, eyes, and kidneys.

#16
Re: Sickle cell ds
khanumi - 03-10-11 21:48

I agree it is C

#17
Re: Sickle cell ds
babbu5508 - 03-12-11 22:34

C. admit her to the hospital for intravenous antibiotics and hydration

#18
Re: Sickle cell ds
sudha2015 - 03-31-11 01:16

B. admit her to the hospital for hydration and antipyretics therapy

#19
Re: Sickle cell ds
babbu5508 - 03-31-11 11:50

c

Page 1



 

Copyright © 2014 Doctok.com All Rights Reserved | Terms and Conditions | Top