Name: ______________________________
Pediatric Emergency Medicine Board Review
Resuscitation
Sept 20, 2012
1. A 4-kg infant presents to the emergency department with sinus
bradycardia. The airway has been secured with endotracheal intubation
and there has been adequate ventilation and oxygenation. Atropine is
given as part of the resuscitation. Which of the following is the correct
dose?
A.
B.
C.
D.
E.
Atropine 0.02 mg IV
Atropine 0.08 mg IV
Atropine 0.1 mg IV
Atropine 0.2 mg IV
Atropine 1 mg IV
2. An unresponsive child is carried into the emergency department by a
frantic mother. When placed on cardiac monitoring, the following rhythm
strip appears.
Which of the following is the most appropriate management for this child?
A. Intubate the trachea, obtain IO access, administer lidocaine 1 mg/kg
B. Start bag-valve-mask ventilation, start chest compressions, administer
epinephrine 0.1 ml/kg of 1:10,000
C. Start bag-valve-mask ventilation, start chest compressions, defebrillate at
2 Joules/kg
D. Intubate the trachea, start chest compressions, administer epinephrine
0.01mg/kg of 1:10,000
E. Start bag-valve-mask ventilation, obtain IO access, cardiovert at 0.5
joules/kg
3. A child is brought into the emergency department by paramedics
complaining of palpitations. The cardiac monitor strip is shown.
Patient is maintaining the airway with good ventilation and oxygenation.
The patient has pulses and has maintained adequate perfusion. Which of
the following should be administered next?
A.
B.
C.
D.
E.
Amiodarone
Lidocaine
Cardiac compressions
Defebrillation
Cardioversion
4. You are the medical coach at a karate match with 13-year old boys. A
contender is hit in the chest and collapses seconds later. The boy has no
pulse and is unresponsive. Which of the following rhythms would be
expected?
A.
B.
C.
D.
E.
Pulseless ventricular tachycardia
Ventricular fibrillation
Atrial fibrillation
Aystole
Pulseless electrical activity
5. Which of the following best describes a child in compensated hypovolemic
shock?
A.
B.
C.
D.
E.
Weak pulses, somnolent mental status, and bradycardia
Cool extremities, tachycardic and crying
Confused, tachycardic, and mottled extremities with acrocyanosis
Obtunded, prolonged capillary refill time, bradycardia
Prolonged capillary refill time, seizing, and asystole
6. A previously healthy child has been successful intubated with an
endotracheal tube for airway protection after being involved in a motor
vehicle accident. Immediately after intubation, the oxygen saturations are
normal and the patient is having good chest rise. You are called
immediately back to the bedside for decreased oxygen saturations and
worsening central cyanosis. Which of the following is the next best step in
management of this patient?
A. Remove the endotracheal tube and perform bag-valve-mask ventilations
B. Increase the ventilator peak inspiratory pressures to overcome resistance
of pulmonary contusions
C. Auscultate breath sounds and perform needle thoracostomy if breath
sounds are unequal
D. Suction the endotracheal tube and administer an Albuterol med neb
treatment
E. Perform a needle cricothyrotomy
7. In monitoring the response to fluid resuscitation in a child presenting with
shock, which of the following is correct?
A.
B.
C.
D.
Blood pressure is the most sensitive indicator of shock
Urinary output is a straightforward, readily available monitor of fluid status
A central line should be established as part of the initial resuscitation
For children over 1 year of age, urinary output should be maintained at 3
ml/kg/day
E. Fluid overload is rarely a problem with pediatric trauma patients
8. A child is brought into the emergency department after a submersion
injury. He was intubated with an endotracheal tube in the field by
paramedics and was reported to be bradycardic with pulses during
transport. Upon arrival, there is no pulse palpated and cardiac monitors
were placed and the rhythm strip is shown:
Chest compressions are started. Which of the following is the next best
course of action?
A.
B.
C.
D.
E.
Defibrillate 2 joules/kg
Cardiovert 0.5 joules/kg
Epinephrine 0.01 mg/kg of 1:10,000
Epinephrine 0.01 mg/kg of 1:1000
Atropine 0.02 mg/kg
9. A child is involved in a motor vehicle accident and presents with pulseless
electrical activity. Which of the following is a possible etiology for his
dysrhythmia?
A.
B.
C.
D.
E.
Hyperthermia
Hyponatremia
Tension pneumothorax
Myocardial contusion
Pulmonary contusion
10. A 17-year old G1P0, 40-week gravid teenager comes to the emergency
department in active labor. Meconium stained fluid is present as the
mother delivers the infant. Infant is limp, mottled, and making no
respiratory effort. Which of the following is the best plan of management.
A.
B.
C.
D.
E.
Dry, clean and stimulate. Suction mouth and nares
Suction mouth and nares. Administer BVM
Direct laryngoscopy of the cords. Endotracheal intubation and suctioning
Suction mouth and nares. Direct laryngoscopy of the cords
Dry, clean, and stimulate. Endoracheal intubation if no respiratory effort
11. Immediately after delivery, a neonate is noted to have respiratory distress
and cyanosis despite initial resuscitation efforts. The abdomen is noted to
be scaphoid and bag-valve-mask ventilations worsen the respiratory
distress. You obtain a chest radiograph.
Which of the following is the next step in management?
A.
B.
C.
D.
E.
Echocardiogram and prostaglandin
Lumbar puncture and broad-spectrum antibiotics
Endotracheal intubation and nasogastric tube
Chest thoracostomy and broad spectrum antibiotics
Digital rectal exam and pediatric surgery consult
12. A 5-year old child is brought into the emergency department when he was
noted to be “acting funny” after playing in the barn on his grandfather’s
farm. The patient is vomiting and having diarrhea. He is anxious,
wheezing, and having respiratory distress. You suspect organophosphate
poisoning. Which of the following is the best therapeutic endpoint for
administering the antidote?
A.
B.
C.
D.
E.
Continue until the heart rate normalizes for age
Continue until muscle fatigue has resolved
Continue until wheezing and respiratory distress resolve
Continue until altered mental status returns to normal
Continue until resolution of vomiting, diarrhea, and diaphoresis
13. Which of the following signs or symptoms distinguishes a
sympathomimetic from an anticholinergic toxidrome?
A.
B.
C.
D.
E.
diaphoresis
hypertension
tachycardia
mydriasis
hyperthermia
14. Which of the following is described as a unique characteristic of MDMA
(Ecstasy) toxicity?
A.
B.
C.
D.
E.
mydriasis
persistent neurologic damage
perceptual distortion
bruxism
flatulence
15. Which of the following statements regarding N-acetylcysteine (NAC)
therapy for acetaminophen ingestion is correct?
A. Higher doses of NAC are required if charcoal has been administered
B. Higher doses of NAC are required if initiating more than 12 hours after
acetaminophen ingestion
C. NAC prevents hepatic injury by inhibiting glucuronide conjugation
D. Administration of NAC is beneficial even after hepatotoxicity has occurred
E. Administration of NAC is contraindicated in pregnancy
Answer D. Most acetaminophen ingestion undergoes hepatic glucuronide and
sulfate conjugation to form inactive, nontoxic metabolites. A small portion is
converted by the cytochromeP-450 to form the hepatotoxic metabolite NAPQI. In
large ingestions, the glucuronide system is overloaded and more of the
hepatotoxic metabolite is formed. NAC is 100% effective after 8 hours of
ingestion. NAC also acts as a non-specific antioxidant which may explain why it
helps even after fulminant liver failure. NAC should be separated from charcoal
administration by 1-2 hours but the doses of NAC given far exceed those actually
needed to detoxify. NAC is safe in pregnancy.