Society for Pediatric Pain Medicine
Better Care for Children in Pain

{“questions”:{“i2ecu”:{“id”:”i2ecu”,”mediaType”:”image”,”answerType”:”text”,”imageCredit”:””,”image”:””,”imageId”:””,”video”:””,”imagePlaceholder”:””,”imagePlaceholderId”:””,”title”:”A 12\u2011year\u2011old male with a known history of congenital methemoglobinemia presents for bilateral inferior alveolar nerve blocks to facilitate extraction of multiple impacted molars. He has no prior anesthetic history and is otherwise healthy. His preoperative hemoglobin is 14.6\u202fg\/dL, and his baseline methemoglobin level ranges from 2\u202f% to 14\u202f%. Which of the following is the most appropriate anesthetic management strategy for this patient?”,”desc”:””,”hint”:””,”answers”:{“a3w84”:{“id”:”a3w84″,”image”:””,”imageId”:””,”title”:”A.\tProceed with bilateral inferior alveolar nerve blocks using 4\u202f% prilocaine with epinephrine, without additional monitoring.”},”iphqx”:{“id”:”iphqx”,”image”:””,”imageId”:””,”title”:”B.\tAvoid all local anesthetics and use GA with volatile anesthetics.”},”eszcg”:{“id”:”eszcg”,”image”:””,”imageId”:””,”title”:”C.\tPerform the nerve blocks under ultrasound guidance using ropivacaine, implement continuous or serial methemoglobin monitoring, and have methylene blue immediately available.”,”isCorrect”:”1″},”p1pwb”:{“id”:”p1pwb”,”image”:””,”imageId”:””,”title”:”D.\tUse topical benzocaine spray to supplement a single-shot inferior alveolar block to minimize injection volume.”}}}},”results”:{“33uwr”:{“id”:”33uwr”,”title”:””,”image”:””,”imageId”:””,”min”:”0″,”max”:”1″,”desc”:””,”redirect_url”:”https:\/\/pedspainmedicine.org\/wp-content\/uploads\/2025\/06\/SPPM-QOM-June-2025.pdf”}}}

{“questions”:{“opejj”:{“id”:”opejj”,”mediaType”:”image”,”answerType”:”text”,”imageCredit”:””,”image”:””,”imageId”:””,”video”:””,”imagePlaceholder”:””,”imagePlaceholderId”:””,”title”:”A 7-year-old boy (24 kg) undergoes extensive bilateral lower-extremity orthopedic surgery. Epidural catheter placement under general anesthesia proves technically difficult, requiring several needle passes before a catheter is threaded. Twenty-four hours later he develops a bifrontal, throbbing headache with vomiting that is immediately relieved when supine and recurs on sitting or standing. Conservative therapy\u2014including IV fluids, oral caffeine citrate, acetaminophen, ketorolac, and continuation of the local anesthetic infusion through the catheter\u2014fails to provide durable relief. The parents are hesitant about further neuraxial procedures and ask whether any less-invasive options exist before proceeding to an epidural blood patch. \r\nWhich of the following interventions has documented success in children for aborting PDPH:\r\n”,”desc”:””,”hint”:””,”answers”:{“sa8iy”:{“id”:”sa8iy”,”image”:””,”imageId”:””,”title”:”A.\tBilateral greater-occipital-nerve blocks with 0.25 % bupivacaine”},”uvih7″:{“id”:”uvih7″,”image”:””,”imageId”:””,”title”:”B.\tIntravenous cosyntropin (synthetic ACTH) 1 \u00b5g kg\u207b\u00b9 infused over 5 min”},”so2f5″:{“id”:”so2f5″,”image”:””,”imageId”:””,”title”:”C.\tTrans-nasal sphenopalatine-ganglion (SPG) block using 4 % lidocaine-soaked applicator”,”isCorrect”:”1″},”5ihhg”:{“id”:”5ihhg”,”image”:””,”imageId”:””,”title”:”D.\tEpidural saline bolus via the existing catheter”}}}},”results”:{“ickbt”:{“id”:”ickbt”,”title”:””,”image”:””,”imageId”:””,”min”:”0″,”max”:”1″,”desc”:””,”redirect_url”:” https:\/\/pedspainmedicine.org\/wp-content\/uploads\/2025\/05\/SPPM-QOM-May-2025.pdf”}}}

{“questions”:{“3dihz”:{“id”:”3dihz”,”mediaType”:”image”,”answerType”:”text”,”imageCredit”:””,”image”:””,”imageId”:””,”video”:””,”imagePlaceholder”:””,”imagePlaceholderId”:””,”title”:”A 16\u2010year\u2010old patient undergoing an open laparotomy had a T12 epidural placed under standard sterile technique. Because the \u201closs\u2010of\u2010resistance\u201d was not crisp and the resident expressed doubt about catheter placement. In addition to the usual epidural test dose of epinephrine, which of the following published methods can help confirm correct epidural catheter placement in pediatric patients? \r\n\r\nOptions: \r\nA. Epidural Pressure Waveform Analysis \r\nB. Electrical Stimulation (Tsui Test) \r\nC. Fluoroscopic Guidance with Contrast Injection (Epidurography) \r\nD. Ultrasound Confirmation \r\nE. pH Testing of Aspirated Fluid \r\nF. Combined Spinal-Epidural (CSE) Technique \r\n”,”desc”:””,”hint”:””,”answers”:{“lv6rz”:{“id”:”lv6rz”,”image”:””,”imageId”:””,”title”:”a.\tA, B, and C “},”ii3py”:{“id”:”ii3py”,”image”:””,”imageId”:””,”title”:”b.\tA, E, and F”},”1rn96″:{“id”:”1rn96″,”image”:””,”imageId”:””,”title”:”c.\tB, C, and D”,”isCorrect”:”1″},”4eyoh”:{“id”:”4eyoh”,”image”:””,”imageId”:””,”title”:”d.\tAll of the above”}}}},”results”:{“q7jnk”:{“id”:”q7jnk”,”title”:””,”image”:””,”imageId”:””,”min”:”0″,”max”:”1″,”desc”:””,”redirect_url”:”https:\/\/pedspainmedicine.org\/wp-content\/uploads\/2025\/04\/SPPM-QOM-April-2025.pdf”}}}

{“questions”:{“lo3qt”:{“id”:”lo3qt”,”mediaType”:”image”,”answerType”:”text”,”imageCredit”:””,”image”:””,”imageId”:””,”video”:””,”imagePlaceholder”:””,”imagePlaceholderId”:””,”title”:”Studies have shown that animal assisted therapy can be a beneficial part of multimodal management of many various symptoms, ranging from depression and anxiety to acute and chronic pain. Animal-assisted interventions (AAI) have been known to improve discomfort, stress, anxiety, and overall well-being in children and adults. In addition to subjective reports from patients, biomarkers have been used to investigate a positive response to AAI. All of the following objective measures have been utilized indicating a positive response to AAI except:”,”desc”:””,”hint”:””,”answers”:{“11jb5”:{“id”:”11jb5″,”image”:””,”imageId”:””,”title”:”A.\tdecreased respiratory rate, heart rate, and blood pressure”},”ghemf”:{“id”:”ghemf”,”image”:””,”imageId”:””,”title”:”B.\tincreased oxytocin, endorphins, and serotonin”},”k46xc”:{“id”:”k46xc”,”image”:””,”imageId”:””,”title”:”C.\tdecrease cortisol levels”},”07yjs”:{“id”:”07yjs”,”image”:””,”imageId”:””,”title”:”D.\tincrease salivary alpha-amylase”,”isCorrect”:”1″}}}},”results”:{“jimik”:{“id”:”jimik”,”title”:””,”image”:””,”imageId”:””,”min”:”0″,”max”:”1″,”desc”:””,”redirect_url”:”https:\/\/pedspainmedicine.org\/wp-content\/uploads\/2025\/03\/SPPM-QOM-March-2025.pdf”}}}

{“questions”:{“43c3d”:{“id”:”43c3d”,”mediaType”:”image”,”answerType”:”text”,”imageCredit”:””,”image”:””,”imageId”:””,”video”:””,”imagePlaceholder”:””,”imagePlaceholderId”:””,”title”:”An 8-year-old boy is brought to a local health post in rural Nepal by his parents with complaints of intense pain accompanied by swelling in his left wrist preceded by a fall on outstretched hand. The child is crying constantly and as per the Wong-Baker FACES Pain Rating Scale, he has a pain of \u201cHurts Worst\u201d. The wrist has a dinner fork like appearance. There are no imaging facilities in the health post and neither anesthesia consults or services. The nearest hospital is over eight hours drive away. Given the limited resources, what is the best pain management approach until he is transported to a higher center?”,”desc”:””,”hint”:””,”answers”:{“hmi4i”:{“id”:”hmi4i”,”image”:””,”imageId”:””,”title”:”A. Perform a closed reduction with hematoma block”},”hi4qo”:{“id”:”hi4qo”,”image”:””,”imageId”:””,”title”:”B. Perform a closed reduction with procedural sedation and analgesia”},”cxnk4″:{“id”:”cxnk4″,”image”:””,”imageId”:””,”title”:”C. Splint with available materials + NSAID”,”isCorrect”:”1″},”ch4kp”:{“id”:”ch4kp”,”image”:””,”imageId”:””,”title”:”D. Do nothing and just transport the patient “}}}},”results”:{“i66kd”:{“id”:”i66kd”,”title”:””,”image”:””,”imageId”:””,”min”:”0″,”max”:”1″,”desc”:””,”redirect_url”:” https:\/\/pedspainmedicine.org\/wp-content\/uploads\/2025\/02\/SPPM-QOM-February-2025.pdf”}}}