BCEN Pediatric Emergencies 2 — Questions and Answers
Question 1: A 3-year-old presents with inspiratory stridor, a barking cough, and low-grade fever. Which intervention is the priority?
- Immediate intubation
- Nebulized racemic epinephrine (Correct answer)
- IV antibiotics
- Needle decompression
Correct answer: Nebulized racemic epinephrine
Nebulized racemic epinephrine reduces subglottic edema in croup (laryngotracheobronchitis) and is the priority treatment.
Question 2: When assessing a pediatric burn patient, which formula is used to estimate fluid resuscitation in the first 24 hours?
- Holliday-Segar formula
- Parkland formula (Correct answer)
- Broselow tape calculation
- Rule of Nines adjusted for age
Correct answer: Parkland formula
The Parkland formula (4 mL/kg/% TBSA burned) guides fluid resuscitation in pediatric burn patients.
Question 3: A 7-year-old with known sickle cell disease presents with fever of 38.8°C and no focal infection. What is the most critical next step?
- Discharge with oral antibiotics
- Blood cultures and empiric IV antibiotics (Correct answer)
- Acetaminophen and observation
- Hydroxyurea dose adjustment
Correct answer: Blood cultures and empiric IV antibiotics
Febrile children with sickle cell disease are at risk for overwhelming sepsis and require blood cultures and empiric IV antibiotics urgently.
Question 4: A 10-month-old is brought in unresponsive after a witnessed choking episode. No cry or cough is present. What is the correct intervention sequence?
- 5 back blows then 5 chest thrusts (Correct answer)
- Abdominal thrusts (Heimlich)
- Blind finger sweeps then ventilation
- Start CPR immediately
Correct answer: 5 back blows then 5 chest thrusts
For infants under 1 year with complete airway obstruction, alternating 5 back blows and 5 chest thrusts is the recommended technique.
Question 5: Which finding in a pediatric patient is most indicative of increased intracranial pressure (ICP)?
- Tachycardia with hypotension
- Cushing's triad (bradycardia, hypertension, irregular respirations) (Correct answer)
- Fever and nuchal rigidity
- Bilateral pinpoint pupils
Correct answer: Cushing's triad (bradycardia, hypertension, irregular respirations)
Cushing's triad is a late sign of critically elevated ICP and indicates impending herniation.
Question 6: A 5-year-old with type 1 diabetes presents with Kussmaul respirations, fruity breath, and a glucose of 520 mg/dL. The priority after airway management is:
- Immediate insulin bolus IV
- IV fluid resuscitation with normal saline (Correct answer)
- Sodium bicarbonate administration
- Potassium replacement first
Correct answer: IV fluid resuscitation with normal saline
IV fluid resuscitation with isotonic saline is the first priority in DKA to restore circulating volume before insulin is started.
Question 7: A 2-year-old presents after ingesting an unknown number of iron tablets. Which finding would indicate severe toxicity?
- Mild nausea and vomiting
- Metabolic acidosis and cardiovascular collapse (Correct answer)
- Constipation and dark stools
- Mild abdominal cramping only
Correct answer: Metabolic acidosis and cardiovascular collapse
Severe iron toxicity causes metabolic acidosis, hepatotoxicity, and cardiovascular collapse, representing the systemic toxicity phase.
BCEN Pediatric Emergencies 2
A 3-year-old presents with inspiratory stridor, a barking cough, and low-grade fever.
Which intervention is the priority?