Paediatric emergencies: acute chest syndrome: practice question

A Pediatrics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pediatrics · Paediatric emergencies: acute chest syndrome

Sample item

A 7-year-old with sickle cell anaemia admitted with a painful crisis develops fever, cough, chest pain and SpO2 of 88 percent on day 2. The chest radiograph shows a new right lower lobe infiltrate. Which management is most appropriate?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Oxygen, antibiotics with atypical cover, restricted fluids and transfusion if worsening

Acute chest syndrome is a new pulmonary infiltrate with fever or respiratory symptoms in sickle cell disease and is a leading cause of death. Management includes oxygen, antibiotics covering atypical organisms, careful analgesia and fluids to avoid pulmonary oedema, and simple or exchange transfusion for worsening hypoxia.

Option by option

  • A. Oxygen, antibiotics with atypical cover, restricted fluids and transfusion if worsening (correct)

    Correct. Oxygen, antibiotics with atypical cover, fluid restriction and transfusion for deterioration are standard care.

  • B. Intravenous corticosteroid pulses with observation and no antibiotics

    Corticosteroids are not routine and can provoke rebound pain, and antibiotics are needed.

  • C. Furosemide for presumed pulmonary oedema with oral antibiotics only

    Diuretics treat cardiac pulmonary oedema and are not the cause here, and oral antibiotics alone are inadequate.

  • D. Aggressive fluid boluses for the crisis with escalating opioid doses

    Aggressive fluids and heavy opioids risk pulmonary oedema and hypoventilation, which worsen the syndrome.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pediatrics question

What is the answer to this Pediatrics question?

The best answer is A, Oxygen, antibiotics with atypical cover, restricted fluids and transfusion if worsening. Acute chest syndrome is a new pulmonary infiltrate with fever or respiratory symptoms in sickle cell disease and is a leading cause of death.

Why is "Intravenous corticosteroid pulses with observation and no antibiotics" not the answer?

Corticosteroids are not routine and can provoke rebound pain, and antibiotics are needed.

Why is "Furosemide for presumed pulmonary oedema with oral antibiotics only" not the answer?

Diuretics treat cardiac pulmonary oedema and are not the cause here, and oral antibiotics alone are inadequate.

Why is "Aggressive fluid boluses for the crisis with escalating opioid doses" not the answer?

Aggressive fluids and heavy opioids risk pulmonary oedema and hypoventilation, which worsen the syndrome.

What concept does this question test?

It tests Paediatric emergencies: acute chest syndrome in Pediatrics. Management includes oxygen, antibiotics covering atypical organisms, careful analgesia and fluids to avoid pulmonary oedema, and simple or exchange transfusion for worsening hypoxia.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Paediatric emergencies: acute chest syndrome?

Memorise milestones and the vaccine schedule as tables and revise them often. Then use the flashcards and the other Pediatrics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.