ABEM ABEM Pediatric & Obstetric Emergencies 1 — Questions and Answers
Question 1: A 2-year-old presents with inspiratory stridor and a barking cough. Which intervention is first-line for moderate croup?
- Nebulized epinephrine
- Dexamethasone 0.6 mg/kg IM/PO (Correct answer)
- Heliox therapy
- Racemic epinephrine only
Correct answer: Dexamethasone 0.6 mg/kg IM/PO
Dexamethasone (0.6 mg/kg) is the first-line treatment for moderate croup, reducing airway edema and decreasing return visits.
Question 2: An 8-month-old presents with high fever, bulging anterior fontanelle, and irritability. What is the most appropriate next step?
- Lumbar puncture immediately
- CT head before lumbar puncture
- IV antibiotics then lumbar puncture (Correct answer)
- Blood cultures only
Correct answer: IV antibiotics then lumbar puncture
IV antibiotics should be administered promptly in suspected bacterial meningitis before LP if signs of elevated ICP are present.
Question 3: A 4-year-old swallowed a button battery 3 hours ago. X-ray shows it in the esophagus. What is the correct management?
- Observe 24 hours and repeat X-ray
- Immediate endoscopic removal (Correct answer)
- Induce vomiting
- Administer activated charcoal
Correct answer: Immediate endoscopic removal
Esophageal button batteries require immediate endoscopic removal due to rapid tissue necrosis from electrical current and alkaline injury.
Question 4: A 6-week-old male presents with projectile non-bilious vomiting after feeding. What is the most likely diagnosis?
- Intussusception
- Pyloric stenosis (Correct answer)
- Volvulus
- GERD
Correct answer: Pyloric stenosis
Pyloric stenosis classically presents in 2–8 week old males with projectile, non-bilious vomiting and a palpable olive-shaped mass.
Question 5: A 10-year-old presents with acute onset severe scrotal pain for 2 hours. What is the priority management?
- Ultrasound then urology consult
- Immediate surgical exploration (Correct answer)
- Doppler ultrasound only
- Analgesics and observation
Correct answer: Immediate surgical exploration
Testicular torsion requires immediate surgical exploration; time to detorsion directly determines testicular salvage rates.
Question 6: A 3-year-old presents with sudden-onset choking and unilateral decreased breath sounds. What is the most likely diagnosis?
- Asthma exacerbation
- Foreign body aspiration (Correct answer)
- Pneumothorax
- Bronchiolitis
Correct answer: Foreign body aspiration
Sudden choking with unilateral decreased breath sounds in a toddler is foreign body aspiration until proven otherwise.
ABEM ABEM Pediatric & Obstetric Emergencies 1
A 2-year-old presents with inspiratory stridor and a barking cough.
Which intervention is first-line for moderate croup?