CEN Pediatric Emergencies 1 — Questions and Answers
Question 1: A 2-year-old presents with sudden onset barky cough, inspiratory stridor, and low-grade fever. What is the most likely diagnosis?
- Epiglottitis
- Croup (laryngotracheobronchitis) (Correct answer)
- Foreign body aspiration
- Bacterial tracheitis
Correct answer: Croup (laryngotracheobronchitis)
Croup is caused by parainfluenza virus and presents with the classic barky cough, stridor, and low-grade fever in children aged 6 months to 3 years.
Question 2: What is the first-line treatment for moderate croup (stridor at rest) in the emergency department?
- Inhaled racemic epinephrine only
- Oral or IM dexamethasone (Correct answer)
- Inhaled budesonide and observation
- Antibiotics and oxygen
Correct answer: Oral or IM dexamethasone
Oral or IM dexamethasone (0.6 mg/kg) is the first-line treatment for croup; it reduces airway inflammation and decreases the need for further interventions.
Question 3: What is the appropriate defibrillation dose in a pediatric patient in ventricular fibrillation?
- 1 J/kg
- 2 J/kg initial, 4 J/kg for subsequent shocks (Correct answer)
- 4 J/kg for all shocks
- 200 J regardless of weight
Correct answer: 2 J/kg initial, 4 J/kg for subsequent shocks
PALS guidelines recommend 2 J/kg for the initial pediatric defibrillation attempt and 4 J/kg for subsequent shocks.
Question 4: A 3-year-old with febrile seizure is actively seizing for 8 minutes. What is the first-line treatment?
- Lorazepam or diazepam IV/rectal (Correct answer)
- Phenobarbital 20 mg/kg IV
- Rectal acetaminophen only
- Phenytoin 20 mg/kg IV
Correct answer: Lorazepam or diazepam IV/rectal
Benzodiazepines (lorazepam IV or rectal diazepam) are the first-line agents to abort febrile status epilepticus in children.
Question 5: A 6-week-old infant presents with bilious vomiting, abdominal distension, and bloody stools. What is the most urgent concern?
- Pyloric stenosis
- Malrotation with midgut volvulus (Correct answer)
- Intussusception
- Gastroenteritis
Correct answer: Malrotation with midgut volvulus
Bilious vomiting in a neonate is malrotation with midgut volvulus until proven otherwise; it is a surgical emergency requiring immediate imaging and operative intervention.
Question 6: Which weight estimation formula is commonly used in pediatric emergencies when a scale is unavailable?
- Weight (kg) = age (years) + 4
- Weight (kg) = (age in years + 4) × 2 (Correct answer)
- Weight (kg) = age (years) × 3
- Weight (kg) = age in months / 2
Correct answer: Weight (kg) = (age in years + 4) × 2
The Broselow tape is preferred, but the formula Weight = (age + 4) × 2 is a common quick estimate for children aged 1–10 years.
CEN Pediatric Emergencies 1
A 2-year-old presents with sudden onset barky cough, inspiratory stridor, and low-grade fever.
What is the most likely diagnosis?