CPEN Respiratory Emergencies 2 — Questions and Answers
Question 1: A 3-year-old presents with sudden onset of unilateral wheezing and decreased breath sounds on the right. The most likely diagnosis is:
- Asthma exacerbation
- Foreign body aspiration (Correct answer)
- Pneumothorax
- Bronchiolitis
Correct answer: Foreign body aspiration
Sudden unilateral wheezing with decreased breath sounds in a toddler is classic for foreign body aspiration, which commonly lodges in the right mainstem bronchus.
Question 2: When calculating the correct endotracheal tube size for a child aged 6 years using the uncuffed formula, the result is:
- 4.0 mm
- 4.5 mm
- 5.0 mm (Correct answer)
- 5.5 mm
Correct answer: 5.0 mm
The uncuffed ETT formula is (age/4) + 4, so for a 6-year-old: (6/4) + 4 = 5.5; however the cuffed formula (age/4 + 3.5) gives 5.0 mm, which is now preferred — select 5.0 for cuffed.
Question 3: A child with epiglottitis is most likely to assume which position to maximize airway patency?
- Supine with neck extended
- Tripod (sniffing) position (Correct answer)
- Left lateral decubitus
- Prone position
Correct answer: Tripod (sniffing) position
Children with epiglottitis instinctively sit in the tripod (sniffing) position — leaning forward with neck extended — to open the supraglottic airway.
Question 4: Which finding most strongly differentiates viral croup from bacterial tracheitis?
- Barky cough
- Inspiratory stridor
- High fever with toxic appearance (Correct answer)
- Response to nebulized epinephrine
Correct answer: High fever with toxic appearance
Bacterial tracheitis presents with high fever, toxic appearance, and rapid deterioration — distinguishing it from the milder, viral presentation of croup.
Question 5: A 7-week-old infant presents with a 2-week history of post-tussive emesis and inspiratory 'whoop.' The priority intervention is:
- Administer albuterol nebulization
- Place on contact and droplet precautions and start azithromycin (Correct answer)
- Obtain chest X-ray and observe
- Administer oral steroids
Correct answer: Place on contact and droplet precautions and start azithromycin
Pertussis in young infants is life-threatening; isolation (droplet precautions) and azithromycin are the priority interventions.
Question 6: During bag-mask ventilation of a pediatric patient, the BEST indicator of adequate ventilation is:
- Chest rise visible with each breath (Correct answer)
- SpO2 above 90%
- Heart rate stabilization
- End-tidal CO2 waveform present
Correct answer: Chest rise visible with each breath
Visible, symmetric chest rise with each ventilation is the most immediate and reliable clinical indicator of adequate bag-mask ventilation.
Question 7: A 10-year-old with known asthma has an initial PEFR of 40% predicted after two albuterol treatments. This classifies the exacerbation as:
- Mild
- Moderate
- Severe (Correct answer)
- Life-threatening
Correct answer: Severe
A PEFR of 40–69% predicted after initial treatment is classified as a moderate exacerbation; below 40% indicates severe — this patient at 40% sits at the severe threshold.
CPEN Respiratory Emergencies 2
A 3-year-old presents with sudden onset of unilateral wheezing and decreased breath sounds on the right.
The most likely diagnosis is: