Pediatrics 401371.A 3-year-old African American boy with a history of sickle-cell dis-
ease presents to the ED after he developed a low-grade fever, runny nose,
and an erythematous discoloration of both cheeks. His vital signs are heart
rate (HR) 110 beats per minute, respiratory rate (RR) of 24 breaths per
minute, and pulse oximetry of 98% on room air. The patient looks well and
is in no acute distress. You note a macular lesion in both cheeks. The rash
is not pruritic and there is no associated cellulitis or suppuration. What is
the most serious complication to consider in this patient?
a. Osteomyelitis
b. Viral encephalitis
c. Pneumonia
d. Aplastic anemia
e. Meningitis
372.A 9-month-old boy is brought to the ED with a 2-day history of fever,
vomiting, and fussiness. The patient has had multiple episodes of emesis
that follow intense periods of fussiness after which the patient seems to relax
and go to sleep. He has had no fever or diarrhea. In between these episodes,
he has slightly decreased energy but otherwise seems well. Oral intake is
decreased and urine output has been decreased since the day of presenta-
tion. Which of the following statements is true regarding this condition?
a. The majority present with vomiting, colicky abdominal pain, and currant jelly
stools.
b. Air enema is the therapeutic intervention of choice.
c. Plain films of the abdomen can usually confirm the diagnosis.
d. Surgical intervention is often indicated.
e. Most of these have a “lead point” as the underlying pathologic cause.
373.A 7-year-old girl with sickle-cell disease and a previous history of
admissions for acute painful crises presents with a 1-day history of fever
and cough. She is tachypneic on presentation with a temperature of 102°F.
Auscultation of the chest reveals rales on the right. A chest radiograph con-
firms the diagnosis of pneumonia. After initial treatment with antibiotics
and intravenous (IV) fluids, patients with this condition are most at risk for
developing what complication?
a. Acute chest syndrome
b. Sepsis as a result of the relative immunodeficiency of patients with sickle-cell
disease
c. Empyema
d. Stroke
e. Congestive heart failure because of the anemia coupled with infection