ABEM ABEM Pediatric & Obstetric Emergencies 2 — Questions and Answers
Question 1: A pregnant patient at 32 weeks presents with severe headache, BP 168/110, and 3+ proteinuria. What is the diagnosis?
- Gestational hypertension
- Severe preeclampsia (Correct answer)
- Chronic hypertension
- HELLP syndrome
Correct answer: Severe preeclampsia
Severe preeclampsia is defined by BP ≥160/110 with proteinuria or other severe features after 20 weeks gestation.
Question 2: A 25-year-old at 10 weeks gestation presents with vaginal bleeding and an empty uterus on ultrasound with no intrauterine pregnancy. β-hCG is 1,800 mIU/mL. What is the next step?
- Immediate methotrexate
- Repeat β-hCG in 48 hours (Correct answer)
- Emergency laparotomy
- Dilation and curettage
Correct answer: Repeat β-hCG in 48 hours
When β-hCG is below the discriminatory zone (~2,000 mIU/mL) and no IUP is seen, serial β-hCG in 48 hours is appropriate to differentiate ectopic from early IUP.
Question 3: Which medication is first-line for controlling severe hypertension in eclampsia?
- Nifedipine
- Labetalol IV (Correct answer)
- ACE inhibitors
- Hydralazine
Correct answer: Labetalol IV
IV labetalol is a first-line agent for acute severe hypertension in pregnancy due to its safety profile and rapid onset.
Question 4: A newborn delivered in the ED has no spontaneous respirations. After drying and stimulation, the heart rate is 80 bpm. What is the next step?
- Chest compressions
- Positive pressure ventilation (Correct answer)
- IV epinephrine
- Intubation only
Correct answer: Positive pressure ventilation
Positive pressure ventilation is indicated when HR is below 100 bpm or respirations are absent after initial newborn stabilization steps.
Question 5: A 16-year-old female presents with lower abdominal pain, fever, and cervical motion tenderness. What is the most likely diagnosis?
- Appendicitis
- Pelvic inflammatory disease (Correct answer)
- Ovarian torsion
- Ruptured ectopic pregnancy
Correct answer: Pelvic inflammatory disease
The classic triad of lower abdominal pain, adnexal tenderness, and cervical motion tenderness in a sexually active female indicates PID.
Question 6: A child presents with fever, refusal to bear weight, and a painful hip held in flexion and external rotation. Which finding best distinguishes septic arthritis from transient synovitis?
- Age of the patient
- ESR > 40 mm/hr alone
- WBC > 12,000 and fever > 38.5°C (Correct answer)
- Duration of symptoms
Correct answer: WBC > 12,000 and fever > 38.5°C
The Kocher criteria (fever >38.5°C, WBC >12,000, ESR >40, non-weight-bearing) help differentiate septic arthritis from transient synovitis.
ABEM ABEM Pediatric & Obstetric Emergencies 2
A pregnant patient at 32 weeks presents with severe headache, BP 168/110, and 3+ proteinuria.
What is the diagnosis?