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SAEM Peds
All of the following are generally accepted indications for endotracheal intubation of the pediatric trauma patient, EXCEPT: Answers: 1.respiratory failure from hypoxia or hypoventilation 2.gastric distension due to excessive volume or rate of ventilation impairing ventilatory function 3.GCS score less than or equal 9, to secure airway and provide controlled hyperventilation 4.any trauma patient in decompensated shock and resistant to initial fluid resuscitation 5.any inability to ventilate by bag-valve-mask methods or the need for prolonged control of the airway - correct answer 2.gastric distension due to excessive volume or rate of ventilation impairing ventilatory function Regarding pediatric head injury, all the following are true EXCEPT: Answers: 1.Head trauma is the leading cause of death among injured children. 2.A child's cranial vault is larger and heavier in proportion to its total body mass than an adult's. 3.Pediatric epidural hematomas are venous in origin. 4.A brief seizure occurring immediately after the insult, with rapid return to normal level of consciousness is usually unassociated with intracranial parenchymal injury.
5.Retinal hemorrhages are a common finding in mild-moderate trauma. - correct answer 5.Retinal hemorrhages are a common finding in mild-moderate trauma. An 8 year old boy falls off his bike onto his outstretched hand with his elbow in extension. He presents to the emergency department with obvious anterior bowing of his distal humerus. His distal neurovascular exam is intact. The X-ray shows a transverse supracondylar humerus fracture with dorsal displacement and angulation of the distal fragment. Of the following, which is the most appropriate treatment? Answers: 1.Splinting the extremity in its current position, and arranging for orthopedic follow- up 2.Fracture reduction and casting by the E.D. physician 3.Orthopedic consultation for possible open reduction and internal fixation (ORIF) 4.CT scan of the elbow 5.Splinting and hospital admission for neurovascular checks - correct answer 3.Orthopedic consultation for possible open reduction and internal fixation (ORIF) A 7 year old boy falls off his bike onto his outstretched arm and sustains a supracondylar fracture. The fracture originates in the metaphysis and a portion of it extends into the physis (growth plate) without extending through to the epiphysis. How is this fracture classified? Answers: 1.Salter I 2.Salter II 3.Salter III
3.Clavicle fracture 4.Acromioclavicular joint separation 5.Fracture of the anterior glenoid lip (Bankart's fracture) - correct answer 1.Compression fracture of the posteriolateral aspect of the humeral head (Hill-Sachs deformity) What is the most common heart rhythm seen in pediatric arrest? Answers: 1.bradycardia 2.ventricular fibrillation 3.paroxysmal atrial tachycardia 4.Wolff-Parkinson-White syndrome 5.atrial fibrillation Points achieved: 0Incorrect - correct answer 1.bradycardia Which of the following factors in the fetus is NOT associated with an increased risk for neonatal resuscitation? Answers: 1.prematurity 2.intrauterine growth failure 3.multiple gestation
4.thick meconium in amniotic fluid 5.alkalosis (as assessed via fetal scalp capillary monitoring) - correct answer 5.alkalosis (as assessed via fetal scalp capillary monitoring) A 27 year old G2P1 female presents to the emergency department in labor at 41 weeks estimated gestational age. The amniotic sac breaks on admission and has thick, brown-tinted fluid. Prior to other steps in resuscitation, the newborn infant should: Answers: 1.be resuscitated with a bag-valve mask for 45 to 60 seconds. 2.receive 500,000u penicillin-G intramuscularly. 3.receive 8 mg doxycyline intravenously. 4.have his/her trachea suctioned. 5.be left unswaddled. - correct answer 4.have his/her trachea suctioned. All of the following are true regarding chest compressions in the infant EXCEPT: Answers: 1.An appropriate position for performing chest compressions is to encircle the chest with both hands and place the thumbs side by side on the sternum. 2.Chest compressions should be initiated whenever an infant's heart rate is less than 60 bpm. 3.Compressions should be performed at a rate of 90 per minute.
5.asystole - correct answer 5.asystole In the post-arrest setting, which of the following is the drug of choice in treating hypotension in a child: Answers: 1.epinephrine infusion 2.dobutamine infusion 3.dobutamine bolus 4.dopamine infusion 5.nitroprusside infusion - correct answer 1.epinephrine infusion Low body temperatures in newborns can lead to severe physiologic consequences, which include all EXCEPT: Answers: 1.metabolic acidosis 2.increased oxygen consumption 3.hypoglycemia 4.apnea 5.hyperglycemia - correct answer 3.hypoglycemia hich of the following vital signs is a cause for concern in the term newborn? Answers:
1.heart rate of 165 2.respiratory rate of 50 3.heart rate of 95 4.respiratory rate of 70 5.systolic blood pressure of 65 - correct answer 3.heart rate of 95 Which of the following describes the most commonly indicated initial approach in neonatal resuscitation? Answers: 1.dry, warm, position, suction, stimulate 2.chest compressions 3.medications 4.establish effective ventilation 5.oxygen - correct answer 1.dry, warm, position, suction, stimulate Which of the following statements regarding intraosseous (IO) access is INCORRECT? Answers: 1.Drug delivery by endotracheal route is preferred over the intraosseous route 2.Anterior compartment syndrome is a recognized complication of IO access
A 4-month-old infant presents with 1 day of episodic fussiness followed by normal activity. In the last several hours he has vomited 2-3 times. The patient is interactive and has a normal exam. While his parents receive discharge instructions he becomes fussy and passes a large reddish, jelly-like stool. What is the next course of action? Answers: 1.abdominal CT scan to rule out appendicitis 2.admit him for observation 3.arrange for a barium enema and surgical consultation 4.give him antibiotics for infectious diarrhea - correct answer 3.arrange for a barium enema and surgical consultation n a newborn, bradycardia is most commonly an indicator of: Answers: 1.hypoxemia 2.hypoglycemia 3.hyperglycemia 4.hypothermia 5.hyperthermia - correct answer 1.hypoxemia All the following are signs of hypoxemia in a newborn, EXCEPT: Answers: 1.cyanosis
2.lethargy 3.tachycardia 4.unresponsiveness 5.bradycardia - correct answer 3.tachycardia Which of the following is NOT a frequent cause of airway obstruction in the neonate? Answers: 1.mucus 2.blood 3.meconium 4.tongue 5.maternal drugs - correct answer 5.maternal drugs Approximately what inside diameter size endotracheal tube is appropriate for an 8 year old child? Answers: 1.4 mm 2.6 mm 3.8 mm
5.Heimlich maneuver then chest thrust - correct answer 2.back blow then chest thrust Which of the following is NOT suggestive of perinatal asphyxia? Answers: 1.umbilical artery academia (pH < 7.00) 2.5-minute Apgar score of 5- 3.neonatal neurological sequelae 4.multiorgan dysfunction 5.5-minute Apgar score of 3 or less - correct answer 3.The pediatric airway is more posterior than the adult airway. All of these steps are involved in pediatric rapid sequence intubation (RSI) EXCEPT: Answers: 1.If administering succinylcholine, pretreatment with atropine is always indicated in children under age 10. 2.Lidocaine pretreatment is usually provided to children with head trauma. 3.When deciding which size endotracheal tube to use, one may approximate by using the size of the small finger or nares as a reference. 4.Due to the fragility of the pediatric C-spine, a cervical collar should always be placed prior to intubation for children under age ten. 5.Uncuffed endotracheal tubes are the preferred devices used in children under 6- years of age. - correct answer 4.Due to the fragility of the pediatric C-spine, a cervical collar should always be placed prior to intubation for children under age ten.
Which of the following methods is NOT used to establish the correct endotracheal tube size in a pediatric patient over 1 year of age: Answers: 1.(age in years + 16) divided by 4 2.approximation with child's little finger 3.age in months divided by 3 4.approximation with child's nares 5.body length using a Broselow emergency tape - correct answer 3.age in months divided by 3 A 5 year old child was eating an almond when he experienced sudden, intermittent bouts of choking and wheezing. Assuming this child aspirated an almond, which of the following is most likely to be seen on chest X-ray? Answers: 1.Atelectasis of the affected lung 2.Diaphragmatic flattening of the non-affected lung 3.Foreign body in the shape of an almond 4.Hypoinflation of the non-affected lung - correct answer 1.Atelectasis of the affected lung A 2 year old is brought in to the emergency department by his mother for difficulty breathing. The mother thinks he might have swallowed or aspirated something. In regards to this patient, which of the following is TRUE regarding foreign body aspiration or ingestion? Answers:
