Question of the Month Archives - Page 2 of 15 - Society for Pediatric Pain Medicine

Question of the Month – December 2024

A 2-year-old child who weighs 15 kg, undergoes laceration repair of the right index finger in the operating room. The resident does a digital nerve block using 2% lidocaine with epinephrine (1:100,000) and uses 1 ml/side. In the PACU, the anesthesiologists noticed the right index finger appeared pale and less perfused. Which of the following is the most likely cause of this finding?

A. Surgical injury to artery

B. Use of epinephrine in the block

C. Local Anesthesia Systemic Toxicity (LAST)

D. Hypothermia

Correct! Wrong!

Question of the Month - December 2024

Question of the Month – November 2024

A 30-week gestational age 1-day-old neonate with moderate neonatal opioid withdrawal syndrome (NOWS) is in the NICU showing signs of agitation, poor feeding, and sleep disturbances. The pain service is consulted for nonpharmacologic recommendations to help with her symptoms. According to available literature, which of the following techniques are recommended as first line therapy for the treatment of NOWS?

A. Start around the clock morphine

B. Prescribe as needed acetaminophen and avoid opioids

C. Use the eat, sleep, console approach

D. Provide acupressure/acupuncture prior to other therapy

E. Place a clonidine patch and recommend as needed morphine

Correct! Wrong!

Question of the Month - November 2024

Question of the Month – October 2024

A 16-year-old nulliparous female presents to the pain clinic for discussion of pain management options around placement of an intrauterine device (IUD) for contraception. She has seen the videos on TikTok(1) and is anxious about the potential discomfort during the procedure. She has no significant medical history and is not currently taking any medications. Vital signs are stable. Which of the following is the most effective analgesic technique for pain relief during the procedure?

A. No pain management required

B. Ibuprofen and acetaminophen

C. Paracervical block

D. Pre-procedure anxiolytic

Correct! Wrong!

Question of the Month - October 2024

Question of the Month – September 2024

A 17-year-old male with a history of degloving injury to his left lower extremity following a traumatic ATV accident who has undergone 3 separate reconstructive surgeries, complicated by ongoing burning pain to the left lateral leg/foot. He presents to your clinic for preoperative evaluation preceding his last and most involved surgery. In addition to his home regimen (acetaminophen, celecoxib, amitriptyline, pregabalin, and sometimes oxycodone), his previous perioperative analgesic regimen included sciatic nerve blocks with indwelling catheters, scheduled ketorolac, and oxycodone and IV hydromorphone as needed for breakthrough pain. Despite this, his acute-on-chronic pain has been difficult to treat post-operatively, interfering with his sleep and recovery.

You discuss the option of adding a ketamine infusion to his regimen but the patient is hesitant about receiving ketamine, citing its association with a highly-publicized death of a celebrity. He tearfully describes knowing friends who became mentally altered temporarily after taking ketamine tablets obtained online. You would like to educate your patient about ketamine use in treating pain.

Which of the following statements is TRUE?

A. Injectable ketamine is a treatment approved by the FDA for pain management.

B. Research indicates that ketamine is highly efficacious in treating non-neuropathic pain conditions including fibromyalgia, cancer pain, ischemic pain, and migraine headaches.

C. According to the 2018 ASRA guidelines, since ketamine is given at subanesthetic doses to treat chronic pain conditions, personnel in charge of its administration only require DEA licensure and ACLS training.

D. Ketamine is a non-addictive “street” drug popular for its euphoric and sensory-heightening properties.

E. Ketamine can be shipped to patients as oral and injectable forms when prescribed by a clinician with appropriate DEA prescribing privileges.

Correct! Wrong!

Question of the Month - September 2024

Question of the Month – August 2024

Emma, a 10-year-old girl, has been experiencing chronic musculoskeletal pain for the past six months. Her parents report that she often has difficulty falling asleep and wakes up frequently throughout the night. Despite trying various bedtime routines, Emma's sleep problems persist, and she frequently complains of feeling tired during the day. Her pediatrician has noted that Emma's pain seems to be worse on days following poor sleep, and her response to pain medication has been inconsistent. Given Emma's chronic pain condition and sleep disturbances, her pediatrician is considering different strategies to help improve her sleep quality and manage her pain more effectively.

Which of the following statements about the relationship between chronic pain and sleep disturbances in children is most accurate?

A) Just as acute pain influences sleep quality, chronic pain is also responsible for chronic sleep disorders in children.

B) Sleep mechanisms may adapt over time in children, hence chronic pain may not always be associated with sleep disturbances.

C) Behavioral interventions to modify sleep patterns have no significant impact on pain perception in children with chronic pain.

D) Deprivation of Rapid Eye Movement sleep does not influence pain perception in children.

E) Over-the-counter melatonin has been shown to be ineffective in regulating circadian rhythm and improving sleep quality in children with chronic pain.

Correct! Wrong!

Question of the Month - August 2024

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