EM COMAT questions with correct answers

A 25-day-old female is brought into the emergency department by her parents who report the neonate has been fussy and had a fever at home of 101.5°F (38.6°C). Her parents state that she has been having increased difficulty breathing but report that she has been feeding well. Vital signs reveal a temperature of 39.4ºC (103ºF), heart rate of 145/min, blood pressure of 75/35 mmHg, respirations of 38/min, and oxygen saturation of 94%. Physical exam reveals a well appearing child with an increased work of breathing, nasal flaring, and grunting. A plain film chest radiograph, complete blood count, and blood cultures have been obtained with results pending. What is the next best step in management? A. CT scan of the chest B. IM lorazepam C. IV ceftriaxone D. lumbar puncture E. stool ova and parasites CORRECT ANSWER The correct answer is: D A lumbar puncture, to obtain CSF for culture and cell count is indicated to determine the culprit for the neonates fever. Any child less than 30 days old presenting to the emergency department with a fever must have the full septic workup performed. A full septic workup includes a chest radiograph, blood cultures, complete blood count, lumbar puncture and urinalysis. The child's presenting symptoms would suggest pneumonia as the cause for the fever and difficulty breathing. As bacteremia and UTI may also be present a full workup still must be performed, even if the child is well appearing. Once older than 30 days a lumbar puncture is no longer indicated in well-appearing infants with a fever of unknown source as the risk for meningitis drops to ~1%. If the child has a clinically diagnosed bacterial infection (otitis media, pneumonia, cellulitis) this is considered a legitimate "source" for fe