Question of the Month Archives - Page 4 of 14 - Society for Pediatric Pain Medicine

Question of the Month – September 2023

A 16-year-old female with chronic migraine without aura comes to your clinic with her mother. She is having 2-3 migraines a week, but her mother notes she has milder headaches a couple of days a week as well. She is missing school frequently and has stopped participating in band. The patient has tried cyproheptadine and amitriptyline as preventive medications with naproxen as an abortive medication. She has not seen a decrease in the number of her monthly headaches, and the naproxen has been helpful, but it does not relieve the migraine. They received a few samples of rimegepant from their PCP, but their insurance company is not going to cover it. Despite her willingness to try off-label medications prior, now her mother is only interested in trying treatments that are FDA approved for pediatrics.

Which of the following preventive and abortive treatment combinations should you consider for this adolescent?

A.) OnabotulinumtoxinA injections and eletriptan

B.) Topiramate and almotriptan

C.) Fremanezumab and sumatriptan

D.) Amitriptyline and rizatriptan

Correct! Wrong!

Question of the Month - September 2023

Question of the Month – August 2023

A 16-year-old male athlete with pectus excavatum is scheduled in the OR for Nuss repair.1 He has previously had general anesthesia at the age of 14, with postoperative nausea and vomiting (PONV) secondary to anesthesia and also post-operative opioids (both intravenous and enteral). Family is requesting a modified anesthetic plan to address his PONV, while also being concerned of the severe pain associated with this procedure. Which plan would be most effective for this patient, to avoid PONV, manage pain efficiently and minimize hospital length of stay?

a) Standardized intraoperative PONV prophylaxis with at least 3 pharmacological agents

b) Minimal intraoperative opioids, and postoperative patient-controlled analgesia (PCA) per standard protocol

c) Total intravenous anesthesia (TIVA) to avoid use of sevoflurane/desflurane

d) Thoracic epidural analgesia

e) Cryoanalgesia performed intraoperatively by surgical team

Correct! Wrong!

Question of the Month - August 2023

Question of the Month – July 2023

A 16-year-old male basketball player arrives at the clinic with chronic bilateral lower leg pain. He reports a sharp cramping pain that begins while running and resolves 10-20 minutes after he stops exercising. He reports occasional paresthesias, and numbness to the extremity. He also reports mild swelling and tightness in both legs only during exercise. He denies any known trauma to the extremity. Physical exam is unremarkable.

What is the best initial treatment for the underlying cause of this patient’s condition?

A. Opioids

B. NSAIDS

C. Modifying/decreasing athletic activity

D. Popliteal nerve block

Correct! Wrong!

Question of the Month - July 2023

Question of the Month – June 2023

A 19 year male is on Medication Assisted Treatment (MAT) with Buprenorphine maintenance daily. His current dosage is 6 mg of buprenorphine daily. He is scheduled for a NUSS procedure. As his AYA (Adolescent and Young Adult) Pain Doctor what would you advise the patient about his Buprenorphine perioperatively?

A. It should be increased few days prior to the surgery

B. It should be continued during the perioperative period at the same dose.

C. It should be stopped 48 hrs prior to the surgery

D. It should be stopped 5 days prior to the surgery

Correct! Wrong!

Question of the Month - June 2023

Question of the Month – May 2023

A 14-year-old young woman with joint hypermobility presented with bilateral anterior knee pain. It started after a soccer tournament 3 years ago with initial presenting symptoms of knee pain and subjective swelling. She was initially treated with rest, modified weight bearing with crutches, knee brace and NSAIDs. The swelling improved, but the knee pain and kinesiophobia persisted. The pain significantly increases with any active or passive knee flexion. She maintains the knees in full extension the majority of time even when she sits.

Physical examinations are notable for mild bilateral patellar alta, mild lateral tilt of the patellae, internal rotation of the tibia, mild genu valgum, exquisite tender to palpation at the inferior patellar tendon, positive Hoffa’s fat pad impingement test.

Radiographic images were normal.

Which of the following syndromes is most suggested by the presentation outlined above?

A. Patellofemoral syndrome

B. Plica syndrome

C. Infrapatellar fat pad syndrome

D. Complex regional pain syndrome

Correct! Wrong!

Question of the Month - May 2023

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