1. In a neonate requiring resuscitation, which one of the following steps is
appropriate if the heart rate continues to be less than 100 beats per minute (bpm)
after 30 seconds of effective positive pressure ventilation (PPV)?
A. Optimize PPV for another 30 seconds, and then reassess the heart rate.
B. Perform chest compressions with continued PPV for 45 to 60 seconds.
C. Administer epinephrine via umbilical venous catheter or endotracheal tube.
D. Administer sodium bicarbonate via umbilical venous catheter.
2. Which one of the following agents is recommended when the infant’s heart rate is
less than 60 bpm despite 30 seconds of adequate PPV and chest compressions?
A. Naloxone
B. Intravenous glucose infusion
C. Epinephrine
D. Sodium bicarbonate
3. Which of the following antibiotics is not an appropriate choice to treat
meningococcemia?
A. IV/IM Penicillin G
B. IV Azithromycin
C. IV Cefotaxime
D. IV Vancomycin
4. In a 9-year-old male diagnosed with symptomatic SVT, which is the most
appropriate first-line treatment?
A. Adenosine
B. Ice cubes in a bag applied to the face
C. Have child blow firmly through a straw
D. Synchronized DC cardioversion
5. An IV fluid bolus is contraindicated as the initial therapy offered to a pediatric
patient diagnosed with supraventricular tachycardia.
A. True
B. False
6. You decide to give adenosine to your patient for SVT. What is the appropriate
dosing regimen?
A. 0.1mg/kg followed by 0.2mg/kg if the first dose fails
B. 0.2mg/kg followed by 0.4mg/kg if the first dose fails
C. 0.5mg/kg followed by 1mg/kg if the first dose fails (up to 12mg/dose)
7. You decide that DC cardioversion is indicated for treatment of SVT in a child.
What is the appropriate starting dose of electricity to deliver?
A. 0.25 J/kg
B. 0.5 J/kg
C. 1 J/kg
D. 2 J/kg
8. A 5-year-old female presents to your aid station with a diffuse, purpuric rash.
She appears lethargic and is breathing shallowly 28 times per minute. Her blood
pressure is 70/50 and heart rate is 130. Her temperature is 103.4 F. She has a
capillary refill time of six seconds. What type of shock is she in?
A. Distributive
B. Cardiogenic
C. Neurogenic
D. Hypovolemic
9. You have just completed a successful newborn resuscitation that required
tracheal intubation, chest compressions, and ET tube delivery of epinephrine. Prior
to delivery there had been no maternal complications throughout the pregnancy nor
during delivery although the delivering physician had called a shoulder dystocia for
90 seconds. The infant is now awaiting transport to a higher-level hospital. What
post-resuscitation therapy should you begin?
A. IV fluid bolus
B. IV glucose infusion
C. IV naloxone
D. Packed red blood cells
10. For a 7-year-old patient who is found to be in respiratory failure with a pulse, at
what rate should you deliver rescue breaths?
A. 8 per minute
B. 12 per minute
C. 14 per minute
D. 20 per minute
11. A 4-year-old female who weighs 15kg has been admitted to your service after
three days of intractable vomiting and diarrhea. Initial blood pressure at
presentation was 70/40 with a heart rate of 130 beats per minute. After an initial IV
fluid bolus the patient was taken to the ward where a repeat blood pressure was
76/42 with a heart rate of 130. The next appropriate intervention is:
A.
B.
C.
D.
Nothing. She has been treated adequately.
Administer a 20cc/kg bolus
Administer a 10cc/kg bolus
Start maintenance fluids at 60cc/hour
12. Ratio of compressions for CPR in a 7-year-old for a two-person rescuer team
A. 15:2
B. 15:1
C. 30:2
D. 30:1
13. According to the PALS guidelines, the correct dose of epinephrine to administer
IV is:
A. 0.1mg/kg of 1:1000
B. 1mL/kg of 1:10,000
C. 0.1mL/kg of 1:10,000
D. 1mg/kg of 1:10,000
14. Contraindications for placement of an intraosseous line include all of the
following except:
A. Previous attempt on the same leg bone
B. Inferior vena caval injury
C. Fracture of the involved bone
D. Fever >= 102.5
15. Hypotension in a 6-year-old female is defined at a systolic blood pressure of:
A. 72 BPM
B. 76 BPM
C. 82 BPM
D. 86 BPM
16. You are called to a delivery suite to attend a delivery of an infant being born to a
G3P2 with an obstetric history of smoking and intrauterine growth restriction.
After spontaneous rupture of membranes a large amount of thick meconium was
noted in the bed. Fetal heart rate had been in the 60s in the four minutes prior to
delivery. The infant was delivered by vacuum-assistance and was pale, not
breathing spontaneously, and had poor muscle tone. Upon receiving the infant at
the warmer, the most appropriate first step is:
A. Stimulate by flicking the heels and drying aggressively
B. Administer positive-pressure ventilation
C. Intubate the infant for suction past the vocal cords
D. Start chest compressions at a rate of at least 100 compressions per minute
17. A 5-year-old patient presents to the emergency department with lethargy.
Initial vital signs are significant for a blood pressure of 90/50 and a heart rate of
170. He is breathing 28 times per minute. The child is alert but appears
uncomfortable and pale. Cardiac exam is significant for regular rhythm and no
murmurs. Lungs are clear bilaterally. The abdomen is softly distended and tender.
The most likely diagnosis is:
A. Re-entrant supraventricular tachycardia
B. Sinus tachycardia from hypovolemia
C. Ventricular tachycardia with a pulse
D. Cardiogenic shock
18. To measure pre-ductal pulse oximetry in a newborn, place the pulse-oximeter
on:
A. The left hand
B. The right hand
C. The left foot
D. Nowhere. You cannot measure pre-ductal pulse oximetry in a newborn.
19. 2-year-old child presents to the ER with dysphagia, noisy breathing, and
snoring-sounding respirations for the past thirty minutes after he was playing with
small toys at daycare. The child is afebrile and insists on sitting upright. What is the
most appropriate intervention?
A. Administer positive-pressure ventilation
B. Administer racemic epinephrine and IV dexamethasone
C. Attempt to perform the Heimlich maneuver
D. Administer IV dexamethasone and nebulized albuterol
20. The appropriate size endotracheal tube for an infant born at 35 weeks and
weighing 2600g is:
A. 2 mm
B. 2.5 mm
C. 3 mm
D. 3.5 mm
21. A 3-year-old presents with a history of a recent cold. Over the past hour he has
developed difficulty breathing with significant inspiratory retractions. He is
drooling and has a temperature of 104.7. He has peripheral cyanosis. What would
be the most appropriate initial intervention?
A. Look in the posterior pharynx for foreign body using a tongue depressor
B. Administer IV dexamethasone
C. Call anesthesia to attempt endotracheal intubation
D. Administer IV fluid bolus