Society for Pediatric Pain Medicine
Better Care for Children in Pain

{“questions”:{“aut5f”:{“id”:”aut5f”,”mediaType”:”image”,”answerType”:”text”,”imageCredit”:””,”image”:””,”imageId”:””,”video”:””,”imagePlaceholder”:””,”imagePlaceholderId”:””,”title”:”You are consulted for a 1-hr-old 34-week, 2 kg infant who was born to a GIP1 mother with a history of severe OI and chronic pain who has been taking methadone 15mg TID during the pregnancy. Mother is unavailable, but father is at bedside and reports mother has been slowly weaning her dose of methadone from a daily dose of 100 mg a day to limit fetal exposure. She has also received prn hydrocodone\/acetaminophen, for a recent fracture and has used 40mg hydrocodone in the last 48 hours. Father reports fetal ultrasounds showing limb length discrepancies and evidence of possible in-utero rib and limb fractures. \r\nNo x-rays have been done yet but are planned. Mother is planning to breast feed the infant and to continue taking methadone. The neonatology team is concerned about neonatal opioid withdrawal syndrome (NOWS) as well as pain management for possible fracture pain. \r\nIn addition to acetaminophen, documentation of withdrawal and pain scores, which of the following therapeutic approaches is the most appropriate in this patient? \r\n”,”desc”:””,”hint”:””,”answers”:{“55jo8”:{“id”:”55jo8″,”image”:””,”imageId”:””,”title”:”A. As needed PO or IV morphine every 2 hours”,”isCorrect”:”1″},”y1shk”:{“id”:”y1shk”,”image”:””,”imageId”:””,”title”:”B. Around the clock lorazepam for the first 48 hours and then a slow wean”},”rmy3z”:{“id”:”rmy3z”,”image”:””,”imageId”:””,”title”:”C. Eat, Sleep, Console with no additional opioids”},”5z6jq”:{“id”:”5z6jq”,”image”:””,”imageId”:””,”title”:”D. Start a dexmedetomidine infusion for 48 hours”}}}},”results”:{“5023u”:{“id”:”5023u”,”title”:””,”image”:””,”imageId”:””,”min”:”0″,”max”:”1″,”desc”:””,”redirect_url”:”https:\/\/pedspainmedicine.org\/wp-content\/uploads\/2024\/06\/SPPM-QOM-June-2024.pdf”}}}

{“questions”:{“c64yr”:{“id”:”c64yr”,”mediaType”:”image”,”answerType”:”text”,”imageCredit”:””,”image”:””,”imageId”:””,”video”:””,”imagePlaceholder”:””,”imagePlaceholderId”:””,”title”:”An 18-year-old female presents to your office with intermittent unilateral shooting pain localized to her left costal margin for the past 10 months. The pain is worse when laughing or twisting her torso. She occasionally feels a popping sensation associated with the pain. She is a gymnast who trains 20+ hours weekly, though does not endorse any inciting accident or activity causing the pain. On physical examination, you note that she is hypermobile in her shoulders with tenderness to palpation of her left costal margin. You send her for a dynamic ultrasound of her ribcage. \r\nWhich of the following is the most likely diagnosis: \r\n”,”desc”:””,”hint”:””,”answers”:{“epu3v”:{“id”:”epu3v”,”image”:””,”imageId”:””,”title”:”A)\tSlipping Rib Syndrome”,”isCorrect”:”1″},”v4sdo”:{“id”:”v4sdo”,”image”:””,”imageId”:””,”title”:”B)\tEhlers\u2019s Danlos Syndrome”},”6ogxl”:{“id”:”6ogxl”,”image”:””,”imageId”:””,”title”:”C)\tCostochondritis”},”znaev”:{“id”:”znaev”,”image”:””,”imageId”:””,”title”:”D)\tTietze Syndrome”}}}},”results”:{“j3hsy”:{“id”:”j3hsy”,”title”:””,”image”:””,”imageId”:””,”min”:”0″,”max”:”1″,”desc”:””,”redirect_url”:”https:\/\/pedspainmedicine.org\/wp-content\/uploads\/2024\/05\/SPPM-QOM-May-2024.pdf”}}}

{“questions”:{“71ld7”:{“id”:”71ld7″,”mediaType”:”image”,”answerType”:”text”,”imageCredit”:””,”image”:””,”imageId”:””,”video”:””,”imagePlaceholder”:””,”imagePlaceholderId”:””,”title”:”A 15-year-old previously healthy female was referred by dermatology for widespread itching refractory to multiple dermatologic treatments. Careful history suggested the itching sensations may have a neuropathic quality similar to paresthesias. As a pain physician comfortable with neuropathic medications, the referring physician would like you to consider a trial of gabapentin related to a possible small fiber neuropathy. On follow up, the patient reports >50% improvement in itching with low doses of gabapentin. As this is the first treatment to reduce symptoms, her mother would like to know why it helped when other treatments failed and whether she has a small fiber neuropathy. \r\n\r\nA lab evaluation was performed and was notable for a low vitamin B12 of 170 (normal 232-1245 pg\/mL). The patient denies other symptoms and there are no red flag symptoms for cancers, fatigue, or other chronic systemic diseases. The remainder of the small fiber neuropathy lab investigation is normal, including no signs of anemia, normal inflammatory levels, normal folic acid and other micronutrients, and normal thyroid studies. \r\n \r\nWhat is the next best step in management? \r\n”,”desc”:””,”hint”:””,”answers”:{“g51q0”:{“id”:”g51q0″,”image”:””,”imageId”:””,”title”:”A.\tGive intramuscular B12″},”o0lnp”:{“id”:”o0lnp”,”image”:””,”imageId”:””,”title”:”B.\tRefer to hematology\/oncology”},”ql9bt”:{“id”:”ql9bt”,”image”:””,”imageId”:””,”title”:”C.\tCheck homocysteine and methylmalonic acid levels”,”isCorrect”:”1″},”jfrfb”:{“id”:”jfrfb”,”image”:””,”imageId”:””,”title”:”D.\tCheck Intrinsic factor antibodies”}}}},”results”:{“8kqn6”:{“id”:”8kqn6″,”title”:””,”image”:””,”imageId”:””,”min”:”0″,”max”:”1″,”desc”:””,”redirect_url”:”https:\/\/pedspainmedicine.org\/wp-content\/uploads\/2024\/04\/SPPM-QOM-April-2024.pdf”}}}

{“questions”:{“wughy”:{“id”:”wughy”,”mediaType”:”image”,”answerType”:”text”,”imageCredit”:””,”image”:””,”imageId”:””,”video”:””,”imagePlaceholder”:””,”imagePlaceholderId”:””,”title”:”A 14-month-old male with medical history significant for sleep disordered breathing presents to the OR for circumcision. Previous analgesic plan included a caudal epidural block, however on physical exam there is concern for a sacral dimple. Which of the following alternate options would potentially convey the greatest benefit of achieving maximal analgesia?”,”desc”:””,”hint”:””,”answers”:{“qczuj”:{“id”:”qczuj”,”image”:””,”imageId”:””,”title”:”A. acetaminophen and ketorolac”},”qu23x”:{“id”:”qu23x”,”image”:””,”imageId”:””,”title”:”B. pudendal nerve block”,”isCorrect”:”1″},”v11h4″:{“id”:”v11h4″,”image”:””,”imageId”:””,”title”:”C. dorsal penile block”},”c4i3w”:{“id”:”c4i3w”,”image”:””,”imageId”:””,”title”:”D. ring block of the penis”}}}},”results”:{“wfejf”:{“id”:”wfejf”,”title”:””,”image”:””,”imageId”:””,”min”:”0″,”max”:”1″,”desc”:””,”redirect_url”:”https:\/\/pedspainmedicine.org\/wp-content\/uploads\/2024\/03\/SPPM-QOM-March-2024.pdf”}}}

{“questions”:{“rre6v”:{“id”:”rre6v”,”mediaType”:”image”,”answerType”:”text”,”imageCredit”:””,”image”:””,”imageId”:””,”video”:””,”imagePlaceholder”:””,”imagePlaceholderId”:””,”title”:”When discussing patients with Ehlers Danlos Syndrome (EDS), which of the following statements is FALSE?”,”desc”:””,”hint”:””,”answers”:{“cvwlg”:{“id”:”cvwlg”,”image”:””,”imageId”:””,”title”:”A. EDS patients have decreased efficacy to local anesthetic medications when local infiltration is performed”},”p8wsv”:{“id”:”p8wsv”,”image”:””,”imageId”:””,”title”:”B. Many patients with EDS also have concurrent chronic pain “},”96vy1”:{“id”:”96vy1″,”image”:””,”imageId”:””,”title”:”C. The response of larger peripheral nerve bundles to local anesthetic medications is similar to the response following local infiltration analgesia”,”isCorrect”:”1″},”rj04o”:{“id”:”rj04o”,”image”:””,”imageId”:””,”title”:”D. EDS is a hereditary disease that results in impaired connective tissue integrity”}}}},”results”:{“sux24”:{“id”:”sux24″,”title”:””,”image”:””,”imageId”:””,”min”:”0″,”max”:”1″,”desc”:””,”redirect_url”:”https:\/\/pedspainmedicine.org\/wp-content\/uploads\/2024\/02\/SPPM-QOM-February-2024.pdf”}}}