AEMCA Pediatric Emergencies 4 — Questions and Answers
Question 1: A 10-month-old presents with a 3-day history of vomiting and diarrhea. Signs include sunken fontanelle, dry mucous membranes, absent tears, and capillary refill of 4 seconds. What level of dehydration does this represent?
- Mild (5% body weight loss)
- Moderate (5–10% body weight loss)
- Severe (>10% body weight loss) (Correct answer)
- No significant dehydration
Correct answer: Severe (>10% body weight loss)
Severe dehydration (>10% body weight loss) presents with multiple systemic signs including prolonged capillary refill, sunken fontanelle, and hemodynamic compromise.
Question 2: A 6-year-old is struck by a car. On assessment, you note absent breath sounds on the left, tracheal deviation to the right, distended neck veins, and hypotension. What intervention is immediately required?
- Bilateral chest decompression
- Needle thoracostomy on the left side at the second intercostal space, midclavicular line (Correct answer)
- Rapid sequence intubation and transport
- Pericardiocentesis
Correct answer: Needle thoracostomy on the left side at the second intercostal space, midclavicular line
These findings are classic for tension pneumothorax; immediate needle decompression on the affected (left) side relieves the life-threatening pressure.
Question 3: Which of the following signs is most consistent with increased intracranial pressure (ICP) in a pediatric trauma patient?
- Hypotension, tachycardia, and diaphoresis
- Hypertension, bradycardia, and irregular respirations (Cushing's triad) (Correct answer)
- Hypotension, bradycardia, and fever
- Tachycardia, tachypnea, and hyperthermia
Correct answer: Hypertension, bradycardia, and irregular respirations (Cushing's triad)
Cushing's triad (hypertension, bradycardia, irregular respirations) is a late and ominous sign of severely elevated ICP indicating impending herniation.
Question 4: A 4-year-old with a history of asthma presents with severe respiratory distress, diffuse wheezing, accessory muscle use, and SpO2 of 89%. After two albuterol treatments, minimal improvement is noted. What medication should be considered next?
- Epinephrine 1:1,000 SQ 0.01 mg/kg
- Magnesium sulfate IV
- Ipratropium bromide nebulized (Correct answer)
- Diphenhydramine IV
Correct answer: Ipratropium bromide nebulized
Ipratropium bromide (an anticholinergic) is added to albuterol for moderate-to-severe pediatric asthma exacerbations unresponsive to initial beta-agonist therapy.
Question 5: When assessing the AVPU scale in a 2-year-old, the child responds only to painful stimuli by withdrawing. What AVPU level does this represent?
- Alert (A)
- Verbal (V)
- Pain (P) (Correct answer)
- Unresponsive (U)
Correct answer: Pain (P)
Response only to painful stimuli places the child at the 'P' (Pain) level on the AVPU scale, indicating significant neurological compromise.
Question 6: A 12-year-old presents with productive cough, fever of 39.5°C, localized decreased breath sounds, and dullness to percussion at the right base. What is the most likely diagnosis?
- Spontaneous pneumothorax
- Pneumonia with possible pleural effusion (Correct answer)
- Pulmonary embolism
- Pleuritis without effusion
Correct answer: Pneumonia with possible pleural effusion
Fever, productive cough, dullness to percussion, and localized decreased breath sounds in a child strongly suggest pneumonia, potentially with a parapneumonic effusion.
Question 7: A 5-year-old is found unresponsive with pinpoint pupils, bradycardia, and excessive secretions after playing in a shed containing pesticides. What antidote is indicated?
- Naloxone (Narcan) IV/IM
- Flumazenil IV
- Atropine IV/IM followed by pralidoxime (Correct answer)
- Activated charcoal only
Correct answer: Atropine IV/IM followed by pralidoxime
Organophosphate poisoning (SLUDGE/DUMBELS toxidrome) is treated with atropine to block muscarinic effects and pralidoxime (2-PAM) to reactivate acetylcholinesterase.
AEMCA Pediatric Emergencies 4
A 10-month-old presents with a 3-day history of vomiting and diarrhea.
Signs include sunken fontanelle, dry mucous membranes, absent tears, and capillary refill of 4 seconds.
What level of dehydration does this represent?