Society for Pediatric Pain Medicine
Better Care for Children in Pain

{“questions”:{“0f30e”:{“id”:”0f30e”,”mediaType”:”image”,”answerType”:”text”,”imageCredit”:””,”image”:””,”imageId”:””,”video”:””,”imagePlaceholder”:””,”imagePlaceholderId”:””,”title”:”A 15-year-old, female, softball player presents for left knee ACL reconstruction with autograft, following a knee injury few weeks ago. The patient denies any numbness or weakness in her leg at this time, but active knee movement is limited by pain. Her past medical history and physical exam are otherwise unremarkable. Strength is perceived as 5\/5 in all muscles tested. Sensation was normal in the affected lower extremity. For pain management, left femoral nerve block is done with 0.2% ropivacaine (10 ml) under ultrasound guidance, and femoral catheter left in place, after anesthesia induction, prior to surgical incision. iPACK block is done at the end. GETA is otherwise uneventful and surgical tourniquet time is noted to be 92 minutes. In the recovery room, she is pain-free. She is discharged home with nerve catheter in place infusing 0.15% ropivacaine @8 ml\/hr with instructions for catheter care. She was followed by pain service while catheter is in place, and removal at home on postoperative day 3. Over this time there were no motor deficits reported. On routine post-surgical follow up 2 weeks after surgery in orthopedic clinic, she complains of persistent numbness in medial aspect of knee to foot. On exam, she also has weakness 3\/5 with knee extension and has been unable to participate in physical therapy. The orthopedic surgeon refers the patient to the anesthesiologist who performed the block for further assessment. After a thorough exam and discussion, referral to neurology is placed. Electromyography\/nerve conduction studies are conducted a week later which reveal neurapraxia. \r\n\r\nPlease select which of the following features will most help make the diagnosis of neurapraxia:”,”desc”:””,”hint”:””,”answers”:{“wzunp”:{“id”:”wzunp”,”image”:””,”imageId”:””,”title”:”A.\tNeurapraxia is associated with myelin damage to the peripheral nerve”,”isCorrect”:”1″},”r3ovl”:{“id”:”r3ovl”,”image”:””,”imageId”:””,”title”:”B.\tNerve conduction velocity testing reveals loss of conduction velocity and loss of continuity of axons”},”vjfyt”:{“id”:”vjfyt”,”image”:””,”imageId”:””,”title”:”C.\tEMG findings include fibrillations and loss of activation of larger motor unit potentials “},”xfdhu”:{“id”:”xfdhu”,”image”:””,”imageId”:””,”title”:”D.\tNeurapraxia is associated with a poor prognosis”}}}},”results”:{“irm93”:{“id”:”irm93″,”title”:””,”image”:””,”imageId”:””,”min”:”0″,”max”:”1″,”desc”:””,”redirect_url”:”https:\/\/pedspainmedicine.org\/wp-content\/uploads\/2023\/12\/SPPM-QOM-December-2023-REV.pdf”}}}

{“questions”:{“l9oig”:{“id”:”l9oig”,”mediaType”:”image”,”answerType”:”text”,”imageCredit”:””,”image”:””,”imageId”:””,”video”:””,”imagePlaceholder”:””,”imagePlaceholderId”:””,”title”:”A 3-month-old infant undergoes a Kasai procedure for biliary atresia. An epidural catheter was threaded from the caudal space to the thoracic level, and the position was confirmed by an epidurogram. On post-op day #1 the bedside nurse states that they do not think the epidural is working because the baby cries intermittently and sometimes appears uncomfortable. FLACC scores have been between 0-6. The baby has an NG tube in place, a right radial arterial line, and 2 peripheral IVs in the upper extremities. \r\n\r\nWhich of the following techniques is best for determining whether the epidural is functional or not?\r\n”,”desc”:””,”hint”:””,”answers”:{“8pq5v”:{“id”:”8pq5v”,”image”:””,”imageId”:””,”title”:”A. Confirm the position of the epidural with Ultrasound”},”ugy3t”:{“id”:”ugy3t”,”image”:””,”imageId”:””,”title”:”B. Use the Wong-Baker Faces Pain Scale in place of the FLACC”},”2lfyk”:{“id”:”2lfyk”,”image”:””,”imageId”:””,”title”:”C. Check dermatome levels by gently palpating along the chest and abdomen”,”isCorrect”:”1″},”10i1a”:{“id”:”10i1a”,”image”:””,”imageId”:””,”title”:”D. Stop the epidural and look for increased pain behavior”}}}},”results”:{“a5ls9”:{“id”:”a5ls9″,”title”:””,”image”:””,”imageId”:””,”min”:”0″,”max”:”1″,”desc”:””,”redirect_url”:”https:\/\/pedspainmedicine.org\/wp-content\/uploads\/2023\/11\/SPPM-QOM-November-2023-2.pdf”}}}

{“questions”:{“a28mf”:{“id”:”a28mf”,”mediaType”:”image”,”answerType”:”text”,”imageCredit”:””,”image”:””,”imageId”:””,”video”:””,”imagePlaceholder”:””,”imagePlaceholderId”:””,”title”:”A 66 kg 15-year-old male with a history of sickle cell disease on methadone maintenance therapy for back pain and adolescent idiopathic scoliosis presents for posterior spinal fusion with combination general and regional anesthesia. Which of the following characteristics may increase the likelihood of developing chronic post-surgical pain (CPSP) in this child?”,”desc”:””,”hint”:””,”answers”:{“bb95y”:{“id”:”bb95y”,”image”:””,”imageId”:””,”title”:”A. Male patient”},”psi6h”:{“id”:”psi6h”,”image”:””,”imageId”:””,”title”:”B. History of pre-operative pain “,”isCorrect”:”1″},”ifyvu”:{“id”:”ifyvu”,”image”:””,”imageId”:””,”title”:”C. Undergoing orthopedic surgery versus thoracic surgery”},”3eex7″:{“id”:”3eex7″,”image”:””,”imageId”:””,”title”:”D. Use of a regional anesthetic technique”}}}},”results”:{“fcqpu”:{“id”:”fcqpu”,”title”:””,”image”:””,”imageId”:””,”min”:”0″,”max”:”1″,”desc”:””,”redirect_url”:”https:\/\/pedspainmedicine.org\/wp-content\/uploads\/2023\/10\/SPPM-QOM-October-2023-REV.pdf”}}}

{“questions”:{“649h0”:{“id”:”649h0″,”mediaType”:”image”,”answerType”:”text”,”imageCredit”:””,”image”:””,”imageId”:””,”video”:””,”imagePlaceholder”:””,”imagePlaceholderId”:””,”title”:”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. \r\nWhich of the following preventive and abortive treatment combinations should you consider for this adolescent?<\/strong>\r\n”,”desc”:””,”hint”:””,”answers”:{“dpn7k”:{“id”:”dpn7k”,”image”:””,”imageId”:””,”title”:”A.)\tOnabotulinumtoxinA injections and eletriptan”},”5mjj6″:{“id”:”5mjj6″,”image”:””,”imageId”:””,”title”:”B.)\tTopiramate and almotriptan”,”isCorrect”:”1″},”byz16″:{“id”:”byz16″,”image”:””,”imageId”:””,”title”:”C.)\tFremanezumab and sumatriptan”},”vob0m”:{“id”:”vob0m”,”image”:””,”imageId”:””,”title”:”D.)\tAmitriptyline and rizatriptan “}}}},”results”:{“48pnb”:{“id”:”48pnb”,”title”:””,”image”:””,”imageId”:””,”min”:”0″,”max”:”1″,”desc”:””,”redirect_url”:”https:\/\/pedspainmedicine.org\/wp-content\/uploads\/2023\/09\/SPPM-QOM-September-2023.pdf”}}}

{“questions”:{“vbo53”:{“id”:”vbo53″,”mediaType”:”image”,”answerType”:”text”,”imageCredit”:””,”image”:””,”imageId”:””,”video”:””,”imagePlaceholder”:””,”imagePlaceholderId”:””,”title”:”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? “,”desc”:””,”hint”:””,”answers”:{“epvwr”:{“id”:”epvwr”,”image”:””,”imageId”:””,”title”:”a) Standardized intraoperative PONV prophylaxis with at least 3 pharmacological agents”},”ocj5l”:{“id”:”ocj5l”,”image”:””,”imageId”:””,”title”:”b) Minimal intraoperative opioids, and postoperative patient-controlled analgesia (PCA) per standard protocol”},”rtfx8″:{“id”:”rtfx8″,”image”:””,”imageId”:””,”title”:”c) Total intravenous anesthesia (TIVA) to avoid use of sevoflurane\/desflurane”},”xoayt”:{“id”:”xoayt”,”image”:””,”imageId”:””,”title”:”d) Thoracic epidural analgesia “},”uts7n”:{“id”:”uts7n”,”image”:””,”imageId”:””,”title”:”e) Cryoanalgesia performed intraoperatively by surgical team”,”isCorrect”:”1″}}}},”results”:{“c94fp”:{“id”:”c94fp”,”title”:””,”image”:””,”imageId”:””,”min”:”0″,”max”:”1″,”desc”:””,”redirect_url”:”https:\/\/pedspainmedicine.org\/wp-content\/uploads\/2023\/08\/SPPM-QOM-August-2023-REV-JP-882023.pdf”}}}