CEN Pediatric Emergencies 2 — Questions and Answers
Question 1: A 4-year-old presents with sudden choking while eating peanuts, and now has unilateral decreased breath sounds and hyperresonance on the right. What is the most likely diagnosis?
- Pneumonia
- Foreign body airway obstruction in the right mainstem bronchus (Correct answer)
- Spontaneous pneumothorax
- Asthma exacerbation
Correct answer: Foreign body airway obstruction in the right mainstem bronchus
Unilateral decreased breath sounds and hyperresonance after choking in a child is classic for a right-sided bronchial foreign body, as the right mainstem bronchus is more vertical.
Question 2: What is the Pediatric Assessment Triangle (PAT) composed of?
- Heart rate, respiratory rate, and blood pressure
- Appearance, work of breathing, and circulation to skin (Correct answer)
- GCS, AVPU, and pupil response
- Oxygen saturation, temperature, and mental status
Correct answer: Appearance, work of breathing, and circulation to skin
The PAT assesses three components—Appearance (tone, interactivity), Work of Breathing, and Circulation to skin—to rapidly determine if a child is stable or critically ill.
Question 3: A 14-month-old presents with a spiral femur fracture and bruising in multiple stages of healing. The history is inconsistent. What must be considered?
- Osteogenesis imperfecta only
- Non-accidental trauma (child abuse) (Correct answer)
- Rickets causing fragile bones
- Accidental toddler fracture
Correct answer: Non-accidental trauma (child abuse)
Spiral fractures in non-ambulatory infants, multiple bruises in different stages of healing, and inconsistent history are red flags for non-accidental trauma.
Question 4: Intussusception most commonly occurs at which anatomical location?
- Jejunum-ileum junction
- Ileocecal valve (ileocolic) (Correct answer)
- Sigmoid colon
- Duodenojejunal junction
Correct answer: Ileocecal valve (ileocolic)
Ileocolic intussusception at the ileocecal valve is the most common type in children, often presenting with intermittent colicky pain and currant jelly stools.
Question 5: What is the appropriate initial fluid bolus for a child in septic shock?
- 20 mL/kg NS or LR IV over 5–10 minutes, reassess after each bolus (Correct answer)
- 10 mL/kg D5NS over 30 minutes
- 40 mL/kg NS bolus without reassessment
- Colloid only
Correct answer: 20 mL/kg NS or LR IV over 5–10 minutes, reassess after each bolus
PALS recommends 20 mL/kg of isotonic crystalloid (NS or LR) IV over 5–10 minutes for pediatric septic shock, reassessing after each bolus for response and fluid overload.
Question 6: Which finding in a febrile infant under 30 days old warrants a full sepsis workup including lumbar puncture?
- Temperature of 37.9°C rectally with otherwise normal exam
- Any temperature ≥38.0°C rectally (Correct answer)
- Temperature ≥38.5°C with URI symptoms
- Fever only with a positive RSV test
Correct answer: Any temperature ≥38.0°C rectally
Any rectal temperature ≥38.0°C in an infant under 30 days old warrants a full sepsis evaluation including CBC, blood culture, UA, urine culture, and lumbar puncture.
CEN Pediatric Emergencies 2
A 4-year-old presents with sudden choking while eating peanuts, and now has unilateral decreased breath sounds and hyperresonance on the right.
What is the most likely diagnosis?