Download PICU/PEM MCQ EXAM QUESTIONS AND ANSWERS and more Exams Nursing in PDF only on Docsity!
AND ANSWERS
Boy with 20% BSA 3rd degree burn, 20kg, what's his initial replacement fluid order? A. 50 cc/hr B. 100 C. 200 D. 400 - correct answer ✅B: 100 (parkland formula) 4 mL x %BSA x wt (kg) 4 x 20 x 20 = 800 first 8 hours and 800 next 16 hours 800/8 = 100 cc/hr A 16yo is brought to ER after attending a music festival. He is agitated and slightly violent. BP 150/100, HR 110. No nystagmus. Best treatment? A. Activated charcoal B. Chlorpromazine C. Diazepam D. Physical restraint - correct answer ✅C. Diazepam
AND ANSWERS
In situations of extreme agitation or seizures, use of benzodiazepines may be warranted. Could be LSD or MDMA causing sympathomimetic toxidrome (tachycardia, hypertension, hyperthermia, dilated pupils, diaphoresis) Hamilton PEM: What is the most common cause of paediatric deaths in children aged 1- 4 years? A. Congenital heart disease B. Trauma C. Submersion injury D. Sepsis - correct answer ✅B. Trauma Hamilton PEM: What is the most effective strategy to prevent submersion injuries in children? A. Personal flotation device in children > 12 months B. 4 sided fence with self-locking, self-closing gates
AND ANSWERS
C. Right bundle branch block D. Osborn waves - correct answer ✅D. Osborn waves Positive deflection at the J point (negative in aVR and V1) with a dome or hump configuration Typically seen < 30-32C Also seen in Brugada, hypercalcemia May be caused by academia in cold temps Can also have marked sinus brady, first degree AV block, Osborn/J waves, prolonged QT Ozzy likes the cold "When I slept outside in winter, it wasn't unusual for me to wake up blue in the face with icicles on my nose. In those days, there was no such thing as hypothermia." Epsilon waves (arrhythmogenic right ventricular dysplasia (ARVD)) Small positive deflection ("blip" or "wiggle") buried in the end of the QRS complex
AND ANSWERS
In ARVD, myocytes are replaced by fat, producing islands of viable myocytes in a sea of fat. This causes a delay in excitation of some of the myocytes of the right ventricle, producing a small "blip" seen during the ST segment of the ECG. Hamilton PEM: A 5 y.o. male is pulled from a lake and presents to the ED apneic and pulseless in PEA. His core temp is 29 C. The most reasonable course of action is? A. BVM, CPR and IV epinephrine 1:10 000 B. BVM, CPR and IV bretylium C. RSI, CPR and active external and internal rewarming D.RSI, CPR and defibrillation to a maximum of 3 shocks - correct answer ✅C. RSI, CPR and active external and internal rewarming PEA= non-shokable Hamilton PEM:
AND ANSWERS
A 10 y.o. male was found unconscious near high tension wires. He is ventilated but stable. His ongoing management demands attention to which of the following sequelae? A. Respiratory failure B. Delayed spinal cord injury C. Acute renal failure D. Asystolic arrest - correct answer ✅C. Acute renal failure Muscle damage → Compartment syndrome, rhabdomyolysis → ARF Hamilton PEM: A 6 y.o. male presents with a metabolic acidosis after emerging from a house fire. there is no upper airway evidence of smoke inhalation. What is your next step in management? A. Cyanocobalamin kit B. Chest x-ray C. 100% oxygen
AND ANSWERS
D.Admit for observation - correct answer ✅A. Cyanocobalamin kit Cyanide poisoning Hamilton PEM: A 17 y.o. male ingested an unknown quantity of Jimson weed. Which of the following is most consistent with his (anticholinergic) toxidrome? A. Hyperthermia, dry skin, mydriasis, tachycardia B. Hyperthermia, diaphoresis, mydriasis, tachycardia C. Hyperthermia, dry skin, miosis, tachycardia D. Hypothermia, diaphoresis, miosis, tachycardia - correct answer ✅A. Hyperthermia, dry skin, mydriasis, tachycardia Hamilton PEM: A 16 y.o. female presents with Temp 38.6, HR 156, RR 28, pupils 5 mm, and diaphoresis. She is alert but not agitated. What is the most likely (sympathomimetic) toxidrome? A. Serotonin syndrome
AND ANSWERS
D. Cough syrup containing dextromethorphan - correct answer ✅A. Loperamide (lmodium) Hamilton PEM: A 10 y.o. male ingested 25 tablets of extra strength Tylenol an unknown time ago. He refuses activated charcoal. The most reasonable course of action is? A. Comply with his refusal B. Insert an NG tube and deliver charcoal C. Await a 4-hour acetaminophen level before starting NAC D. Perform gastric lavage following endotracheal intubation - correct answer ✅A. Comply with his refusal Needs NAC ASAP Activated charcoal "PHAILS" in.... - correct answer ✅Potassium Hydrocarbons Alcohols Iron
AND ANSWERS
Lithium Solvents Hamilton PEM: A 16 y.o. male undergoing a dental procedure presents in status epilepticus after receiving local anesthetic. How would you manage his condition? A. Lorazepam followed by phenytoin load B. Lorazepam and intralipid C. Lorazepam followed by nephrology consult for consideration of hemodialysis D. Midazolam followed by phenobarbital load - correct answer ✅B. Lorazepam and intralipid For life-threatening IV overdoses of local anesthetics Hamilton PEM: A 14 y.o. female ingested 15 tablets of her own diabetes medication. She presents with a metabolic acidosis and bedside glucose of 5.6. What is the most likely agent ingested? A. Glyburide
AND ANSWERS
A 3 y.o. female accidentally ingested methyl salicylate. She presents tachypnic and seizing with an elevated plasma salicylate. What is the preferred therapeutic modality? A. Early endotracheal intubation B. Early and aggressive serum alkalinization C. Start IV phenytoin infusion D. Hemodialysis - correct answer ✅D. Hemodialysis *Any CNS symptoms in ASA poisoning Want hyperventilation to correct acidosis (Alkalinize!!) Hamilton PEM: A 3 year old female presents inebriated after an unknown ingestion. Her capillary gas is normal but her osmolar gap is 26 mOsm and her serum ketones are elevated. Which of the following was most likely ingested? A. Ethylene glycol B. Isopropyl alcohol
AND ANSWERS
C. Ethanol D. Methanol - correct answer ✅B. Isopropyl alcohol *Ketosis (metabolized to ketones) All others metabolized to alcohol Hamilton PEM: A 2 y.o. F presents with ataxia after playing in the garage. Her parents noticed the smell on antifreeze on her clothing. She is ataxic but otherwise VSS. Her OG is 12, AG is 16, and her serum pH is 7.16. What is the most reasonable course of action? A. Administer fomepizole IV B. Initiate hemodialysis C. Administer calcium gluconate IV D. Administer thiamine IV - correct answer ✅B. Initiate hemodialysis ACIDOSIS
AND ANSWERS
D. Verapamil - correct answer ✅D. Verapamil (CCB) Hamilton PICU: 2y to ED w/ 2d cough, fever, and stridor today • Prev healthy, immunized • In ED: PO dexamethasone (4h ago), epi neb Q1h minimal effect Vitals: HR 168, BP 108/60, RR 42, sat 87% w/ NRB, T 38.2 C Severe indrawing/stridor awake, improves slightly when calmed What is the most appropriate next step? A. Administer IV dexamethasone B. Consult anesthesia for intubation C. Administer vancomycin and oseltamivir D. Administer lorazepam - correct answer ✅B. Consult anesthesia for intubation *Severe hypoxia, UAO Hamilton PICU: 6y F, 25kg to ED with status epilepticus
AND ANSWERS
Apneic post-treatment, no obstruction, easy to ventilate Requires intubation What is the most appropriate endotracheal tube size? A. 4.0 cuffed ETT B. 4.5 cuffed ETT C. 5.0 cuffed ETT D. 5.5 cuffed ETT - correct answer ✅C. 5.0 cuffed ETT Cole's formula: Age/4 + 3.5 (cuffed) Hamilton PICU: 4y in ED post-drowning event with poor resp effort and hypoxia • Intubated, ETT in good position on CXR While awaiting transfer to regional PICU, RRT reports sat's 87% despite suctioning tube and increasing from 40% to 80% FiO2 Normal breath sounds bilaterally, gas = ph 7.32, pCO2 48, HCO3 26 Current settings: PEEP 5, PC 14, Rate 30/min What is the most appropriate ventilation change to make?
AND ANSWERS
Hamilton PICU: 12y M w/ pneumonia on general ward for 1L/min O and IV ampicillin • Day 2 of admission, increased WOB and 4L/min O2 for sat's 93% • Remains alert, hemodynamically stable, dec. breath sounds L side • CXR shows interval white-out of L hemi-thorax Which one of the following is the most appropriate next step? A. Place left-sided chest tube B. Needle decompression of the left chest C. Change antibiotics to vancomycin D. Ultrasound of the chest - correct answer ✅D. Ultrasound of the chest Hamilton PICU: 14y F to ED w/ vomiting and shortness of breath • Ate shrimp pad thai 1 hour earlier • Vitals: HR 158, BP 82/28, RR 28, sat 91% w/ simple face mask, T 37.0 C • Exam: decreased LOC, laboured breathing, bilateral wheeze, urticarial rash, bounding pulses, CRT < 2s A. Distributive Shock B. Hypovolemic Shock C. Disssociative shock
AND ANSWERS
D. Cardiogenic Shock E. Obstructive shock What is your most important next step? A. Methylprednisolone 2mg/kg IV B. 0.9% Saline 20mL/kg IV bolus C. Epinephrine 0.01mg/kg IM D. Intubate and ventilate E. Epinephrine 0.01mg/kg IV - correct answer ✅C. Distributive Shock Dissociative (CO poisoning, cyanide, anemia) C. Epinephrine 0.01mg/kg IM Hamilton PICU: 16y M w/ leukemia on treatment, to ED w/ fever and neutropenia • Blood cultures taken, broad spectrum antibiotics given • Given total 60mL/kg IVF boluses for ↑ HR, ↓ BP and anuria • Current vitals: HR 148, BP 98/38, RR 26, T 39.1 • Pulses bounding, CRT 2
