Urgence Pediatrie 37 Qs

1) A 7-year-old boy was brought to the emergency department after falling onto his outstretched arm. He complains of pain in his left arm and refuses to move his arm at the elbow. On examination, the left arm is swollen, slightly pale, and edematous. His radial pulse is intact. The patient's radiograph is shown below. While the patient is waiting for the orthopedic resident on call to examine him, he continues to complain of increasing pain despite multiple doses of pain medication. Which of the following should you be most concerned about in this patient? pic
. Displacement of the fracture
. Transient neuropraxia
. Brachial artery injury
. Compartment syndrome
. Narcotic abuse
2) A 3-year-old girl is brought to the emergency department because she became partially unconscious, lethargic and febrile. Her mother claims that "she suddenly took a turn for the worse" 24 hours ago after an upper respiratory tract infection. She has no allergies, and was not taking oral antibiotics. Her blood pressure is 60/45mm Hg and pulse is 120/min. On examination, she appears emaciated and lethargic. Despite numerous attempts, it is impossible to start a peripheral intravenous line, and the child's condition continues to deteriorate. What is the best next step to obtain IV access in this patient?
Subclavian central line
Intraosseous
Jugular cut down
Femoral vein
Fluids down endotracheal tube
3) An infant who appears to be of normal size is noted to be lethargic and somewhat limp after birth. The mother is 28 years old, and this is her fourth delivery. The pregnancy was uncomplicated, with normal fetal monitoring prior to delivery. Labor was rapid, with local anesthesia and intravenous meperidine (Demerol) administered for maternal pain control. Which of the following therapeutic maneuvers is likely to improve this infant’s condition most rapidly?
Intravenous infusion of 10% dextrose in water
Administration of naloxone (Narcan)
Administration of vitamin K
Measurement of electrolytes and magnesium levels
Neurologic consultation
4) At 43 weeks’ gestation, a long, thin infant is delivered. The infant is apneic, limp, pale, and covered with “pea soup” amniotic fluid. Which of the following is the best first step in the resuscitation of this infant at delivery?
Intubation and suction of the trachea; provision of oxygen
Artificial ventilation with bag and mask
Chest compressions
Administration of 100% oxygen by mask
Catheterization of the umbilical vein
5) A 15-year-old is participating in high school football practice in August in Texas. He had complained of headache and nausea earlier in practice, but kept playing after a cup of water. He is now confused and combative. He is dizzy and sweating profusely. His temperature is 41°C (105.8°F). Therapy should consist of which of the following?
Provide oral rehydration solutions
Administer acetaminophen rectally
Order to rest on the bench until symptoms resolve
Initiate whole body cold water immersion
Tell him to go take a shower and rest until the next day’s practice
6) A fully immunized 2-year-old presents to the emergency room with several days of low-grade fever, barking cough, and noisy breathing. Over the past few hours he has developed a fever of 40°C (104°F) and looks toxic. He has inspiratory and expiratory stridor. The family has not noticed drooling, and he seems to be drinking without pain. Direct laryngoscopy reveals a normal epiglottis. The management of this disease process includes which of the following?
Intubation and intravenous antibiotics
Inhaled epinephrine and oral steroids
Inhaled steroids
Observation in a cool mist tent
Oral antibiotics and outpatient follow-up
7) A 2-year-old boy presents to the emergency department (ED) with severe wheezing. His symptoms have not improved even after three treatments with nebulizers. This is his third trip to the ED in the past two weeks. In the ED, he is given a dose of intravenous steroids, but continues to wheeze. On auscultation, there is no air entry bilaterally. His chest x-ray result is normal. His oxygen saturation is 91% on 6 liters of oxygen. What is the next best step in the management of this patient?
. Start theophylline
. Tracheostomy
. Mechanical ventilation
. Racemic epinephrine
. Intravenous antibiotics
8) A 7 -year-old Caucasian male with a history of peanut allergy develops sudden shortness of breath after lunch at school. On physical examination, his blood pressure is 70/50 mmHg and his heart rate is 130/min. Inspirations and expirations are labored and noisy. Which of the following is the best initial treatment?
Albuterol nebulizer
Subcutaneous epinephrine injection
Intravenous steroids
Intravenous diphenhydramine
Endotracheal intubation
9) You admitted to the hospital the previous evening a 1-year-old boy who presented with cough, fever, and mild hypoxia. At the time of his admission, he had evidence of a right upper lobe consolidation on his chest radiograph. A blood culture has become positive in less than 24 hours for Staphylococcus aureus. Approximately 20 hours into his hospitalization, the nurse calls you because the child has acutely worsened over the previous few minutes, with markedly increased work in breathing, increasing oxy- gen requirement, and hypotension. As you move swiftly to the child’s hospital room, you tell the nurse to order which of the following?
A second chest radiograph to evaluate for pneumatocele formation
A large-bore needle and chest tube kit for aspiration of a probable tension pneumothorax
A change in antibiotics to include gentamicin
A sedative to treat the child’s attack of severe anxiety
A thoracentesis kit to drain his probable pleural effusion
10) A previously heathy 3-year-old boy is brought to the emergency department (ED) due to stridor of sudden onset. Last night, he suddenly developed a high fever followed by breathing difficulty. His temperature is 40C (104F), pulse is 130/min, and respirations are 40/min. In the ED, the child is toxic-appearing, sitting up, leaning forward and drooling. His lungs are clear, and oxygen saturation is 85% in room air. What is the most appropriate next step in management?
Admit the patient and start him on broad spectrum antibiotics
Start the patient on intravenous methylprednisolone
Endotracheal intubation with a set-up for tracheostomy
Admit the patient and start him on nebulized racemic epinephrine
Start the patient on oral dexamethasone
11) An 18-month-old infant is found with the contents of a bottle of drain cleaner in his mouth. Which of the following treatment options is most appropriate?
. Immediate emesis
. Endoscopic examination within the first 12 to 24 hours
. Decontamination by activated charcoal
. Neutralization by drinking a solution of the opposite pH
. Have the patient drink copious amounts of milk or water
12) A 2 week post mature baby is born and immediately exhibits severe respiratory distress. Previously, green-tinged meconium was noted in the amniotic fluid. Which of the following is the most appropriate next step?
. Emergency tracheostomy
. Intubation with mechanical ventilation
. Chest x-ray film
. Oxygen supplementation by face mask
. Suction the mouth and nasopharynx
13) A 2-year-old arrives in the emergency center after having swallowed a button battery from one of her toys. She is breathing comfortably, without stridor. Radiographs show the battery to be lodged in the esophagus. Which of the following is the correct next step?
. Induce emesis with syrup of ipecac
. Admit for observation, and obtain serial radiographs to document movement of the battery
. Discharge home with instructions to monitor the stool for the battery
. Immediate removal of the battery via endoscopy
. Encourage oral intake to assist in passage of the battery
14) A 9-month-old infant is brought to the emergency department with lethargy and tachypnea. He was healthy before developing fever and diarrhea four days ago. He has been taking some formula, but has had two to three episodes of diarrhea with each bottle. He has lost three pounds (1 .4 kg) since his routine check-up two weeks ago. He has had one wet diaper in the past twenty four hours. On examination, his temperature is 102.5F (39.1c), pulse is 200/min, respiratory rate is 42/min, and blood pressure is 70/45 mm Hg. He is lethargic with decreased tone and decreased deep tendon reflexes. His mucous membranes are dry. Cardiopulmonary exam reveals tachycardia and tachypnea. His abdominal exam is unremarkable. Capillary refill is four seconds. Laboratory results are shown below. Chemistry panel: Serum sodium 165 mEq/L, Serum potassium 4.5 mEq/L, Chloride 108 mEq/L, Bicarbonate 14 mEq/L, Blood urea nitrogen (BUN) 20 mg/dl, Serum creatinine 0.8 mg/dl, Calcium 10.0 mg/dl, Blood glucose 98 mg/dl. Which of the following fluids should be used as a bolus in the resuscitation of this infant?
0.9% saline
0.45% saline
5% dextrose
5% albumin
Packed red blood cells
15) A 5-year-old boy is brought into the ER immediately after an unfortunate altercation with a neighbor’s immunized Chihuahua that occurred while the child was attempting to dress the dog as a superhero. The fully immunized child has a small, irregular, superficial laceration on his right forearm that has stopped bleeding. His neuromuscular examination is completely normal, and his perfusion is intact. Management should include which of the following?
Irrigation and antimicrobial prophylaxis
Tetanus booster immunization and tetanus toxoid in the wound
Copious irrigation
Primary rabies vaccination for the child
Destruction of the dog and examination of brain tissue for rabies
16) Aunt Mary is helping her family move to a new apartment. During the confusion, 3-year-old Jimmy is noted to become lethargic. The contents of Aunt Mary’s purse are strewn about on the floor. In the ER, the lethargic Jimmy is found to have miosis, bradycardia, and hypotension. He develops apnea, respiratory depression, and has to be intubated. His condition would most likely benefit from which of the following therapies?
Deferoxamine
Pediatric intensive care unit (PICU) support and trial of naloxone
N-acetylcysteine (Mucomyst)
Atropine
Dimercaptosuccinic acid (DMSA, succimer)
17) An infant is born at terrn to a 27-year-old Caucasian female. The prenatal course was uncomplicated. The amniotic fluid is clear. Immediately after the delivery, the infant starts crying and is moving all four extremities actively. Heart rate is 140/min. He is making a grimace on the attempt to put the suction catheter into his nostrils. His body is pink, but extremities are cyanotic. Which of the following is the next best step in the management of the infant?
Intubate the child
Dry the infant and keep warm
Apply silver nitrate solution to the eyes
Administer vitamin K (IM)
Place umbilical catheter
18) A 15-year-old boy with Duchenne muscular dystrophy is brought to the emergency department with increasing respiratory distress and cyanosis. On examination, he is diaphoretic, with gasping respirations, poor air entry, and diminished responsiveness. He is tachycardic at 160 beats/min. His chest x-ray film shows a lingular pneumonia, and he is intubated. He improves over the next 10 days with antibiotics but is not extubated secondary to hypoventilation on weaning because of muscle weakness. Which of the following modalities will most likely help wean him off the ventilator?
. Nasopharyngeal tube
. Pressure controlled ventilation
. Pressure supported ventilation
. Supplemental oxygen
. Tracheostomy
19) A 6-year-old Hispanic boy is brought to your office by his mother because of severe pain in his right hip and refusal to walk for the last 2 days. His blood pressure is 100/70 mm Hg, pulse is 90/min, respirations are 18/min, and temperature is 38.7C (102.7F). His WBC count is 19,000/mm3 and ESR is 55 mm at one hour. On examination, he keeps his right hip externally rotated, and cries out in pain on any movement involving the right hip. Joint aspiration reveals a turbid fluid with total WBC: 90,000/mm3 and numerous bacteria. What is the most appropriate management in this patient?
Salicylates, rest and physical therapy
Intravenous antibiotics
Oral antibiotics
Emergency surgical drainage
Splint the hip joint and administer intravenous antibiotics
20) A newborn infant becomes markedly jaundiced on the second day of life, and a faint petechial eruption, first noted at birth, is now a generalized purpuric rash. Hematologic studies for hemolytic diseases are negative. Acute management should include which of the following?
Liver ultrasound
Isolation of the infant from pregnant hospital personnel
Urine drug screen on the infant
Discharge with an early follow-up visit in 2 days to recheck bilirubin
Thyroid hormone assay
21) A 14-year-old girl, angry at her mother for taking away her MP3 player, takes an unknown quantity of a friend’s pills. Within the first hour she is sleepy, but in the emergency center she develops a widened QRS complex on her electrocardiogram (ECG), hypotension, and right bundle branch block. The therapy you would initiate for this ingestion is which of the following?
N-acetylcysteine (Mucomyst)
Naloxone
Intensive care unit (ICU) admission, close monitoring, and possible Fab anti- body fragments
Ethanol
Deferoxamine
22) You are called to a delivery of a woman with no prenatal care; she is in active labor but has no history of amniotic rupture. The biophysical profile done in the emergency center revealed severe oligohydramnios. When you get this infant to the nursery, you should carefully evaluate him for which of the following?
Anencephaly
Trisomy 18
Renal agenesis
Duodenal atresia
Tracheoesophageal fistula
23) Parents bring a 5-day-old infant to your office. The mother is O negative and was Coombs positive at delivery. The term child weighed 3055 g (6 lb, 1 oz) at birth and had measured baseline hemoglobin of 16 g/dL and a total serum bilirubin of 3 mg/dL. He passed a black tarlike stool within the first 24 hours of life. He was discharged at 30 hours of life with a stable axillary temperature of 36.5°C (97.7°F). Today the infant’s weight is 3000 g, his axillary temperature is 35°C (95°F), and he is jaundiced to the chest. Parents report frequent yellow, seedy stool. You redraw labs and find his hemoglobin is now 14 g/dL, and his total serum bilirubin is 13 mg/dL. The change in which of the following parameters is of most concern?
Hemoglobin
Temperature
Body weight
Bilirubin
Stool
24) A 20-month-old child is brought to the ED because of fever and irritability and refusal to move his right lower extremity. Physical examination reveals a swollen and tender right knee that resists passive motion. Which of the following is the most likely to yield the diagnosis in this patient?
Examination of joint fluid
X-ray of the knee
Erythrocyte sedimentation rate (ESR)
CBC and differential
Blood culture
25) A 12-year-old boy presents to his pediatrician with frequent episodes of headache, nausea, blurry vision, and sweating. On physical examination, his temperature is 37.4 C (99.3 F), blood pressure is 148/94 mm Hg, pulse is 92/min, and respirations are 18/min. The rest of his examination is unremarkable. His 24-hour urinary vanillylmandelic acid (VMA) and metanephrines are increased. An abdominal CT reveals an extrarenal mass above the left kidney. Which of the following is the most appropriate pharmacotherapy?
Alpha-adrenergic blocker
Angiotensin-converting enzyme inhibitor
Beta-adrenergic blocker
Calcium channel blocker
Diuretics
26) A 12-year-old girl with mild asthma comes to the office for a health maintenance visit. Her mother states that she is using her albuterol inhaler 2-3 times a week and that she has a cough that wakes her up at night about 3 times a month. On physical examination, she has diffuse inspiratory and expiratory wheezes. She has no accessory muscle use. Pulse oximetry shows 95% oxygen saturation on room air. Which of the following is the most appropriate treatment for her at this time?
Albuterol nebulized treatment
Cromolyn sodium nebulized treatment
Oxygen via nasal cannula
IV steroids
Subcutaneous epinephrine
27) A 2-week postmature neonate exhibits severe respiratory distress immediately after birth. Previously, greentinged meconium was noted in the amniotic fluid. Which of the following is the most appropriate next step in management?
Chest x-ray
Suctioning of the mouth and nasopharynx
Oxygen supplementation by face mask
Intubation with mechanical ventilation
Emergency tracheostomy
28) A 3-month-old, previously well male infant presents to the emergency department in January with a 2-day history of clear rhinorrhea, low-grade fever, and poor appetite, but no cough. On physical examination, there are mild subcostal retractions, coarse breath sounds heard throughout the lung fields, and scattered expiratory wheezes. The child receives an intravenous fluid bolus in the emergency department and is admitted for observation. Which of the following is the most severe, life-threatening complication of this child's illness?
Apnea
Congestive heart failure
Dehydration
Hypoxemia
Wheezing
29) A father brings his 18-month-old daughter to the office for the evaluation of fever for the past 10 days. The father, who works as a phlebotomist, says that the temperature seems higher in the morning and again at night, often reaching 40.5C (105F), and is sometimes associated with shaking chills. He remembers that the child developed severe respiratory distress and skin rash when treated with penicillin in the past. He has heard about the development of 'liver toxicities' in children treated with aspirin, and he is interested in knowing everything about his daughter's condition. On examination, the child is in no acute distress. Her temperature is 39.4C (103F), pulse rate is 90/min, and blood pressure is 100/60 mmHg. Her sclerae are anicteric. There is bulbar conjunctival injection, and the oropharynx shows diffuse mucosal injection with fissuring and crusting of the lips. There are numerous hyperemic macules over her entire body, and her palms appear edematous. Based on the above description, which of the following is the most accurate statement?
Latex agglutination test is more accurate than streptococcal throat test in determining the etiology of this condition
Immediate desensitization & treatment with penicillin V will prevent further renal complications
Thrombocytopenia is an important marker in the second week of this illness
Acetaminophen is the drug of choice for alleviation of high temperatures in this child
She needs to be hospitalized and treated with intravenous immune globulin (IVIG) and aspirin
30) A 6-year-old, fully immunized boy is brought to the emergency room with a 3-hour history of fever to 39.5°C (103.1°F) and sore throat. The child appears alert, but anxious and toxic. He has mild inspiratory stridor and is drooling. He is sitting on the examination table leaning forward with his neck extended. A lateral radiograph of his neck is shown below. Which of the following is the most appropriate immediate management of this patient?pic
Examine the throat and obtain a culture
Obtain an arterial blood gas and start an IV line
Administer a dose of nebulized epinephrine
Prepare to establish an airway in the operating room
Admit the child and place him in a mist tent
31) A 6-month-old boy presents to the Emergency Department with a three-day history of cough, congestion and low grade fever. The mother states that the baby has not been feeding well and has used only two diapers over the past 24 hours. Physical examination reveals a pale infant with a temperature of 37.8 C (100.1 F), pulse of 170/min, respirations of 60/min and oxygen saturation of 88% on room air. The patient exhibits nasal flaring, subcostal and intercostal retractions. Lung examination reveals diffuse wheezing. Cardiac examination reveals a regular but tachycardic rhythm with no murmur. Central capillary refill is four seconds. The remainder of the examination is normal. Which of the following is the most appropriate initial step in management?
. Chest x-ray film
. Albuterol nebulizer treatment
. Bolus of intravenous fluids
. Oxygen therapy
. Intravenous steroids
32) A 6-year-old boy is often teased at school because he has stooled in his underwear almost daily for the last 3 months. He was toilet trained at 2 years of age without difficulty, but over the last 2 years he had developed ongoing constipation. His family is frustrated because they cannot believe him when he says “I didn’t know I had to go.” He is otherwise normal; school is going well, and his home life is stable. His only finding on examination is significant for stool in the rectal vault. The plain radiograph of his abdomen is shown. Initial management of this problem should include which of the following?pic
Barium enema and rectal biopsy
Family counseling
Time-out when he stools in his underwear
Clear fecal impaction and short-term stool softener use
Daily enemas for 4 weeks
33) A 15-year-old Caucasian male is brought to the office by his mother for the evaluation of a six-month history of unstable gait and speech difficulty which are getting worse over time. His past medical history is insignificant. He is not taking any medications, and denies smoking or alcohol consumption. His blood pressure is 120/70 mmHg and pulse is 80/min. Musculoskeletal examination showed scoliosis and feet deformity with 'hammer toes.' The neurologic examination showed dysarthria, dysmetria, nystagmus, and absence of deep plantar reflexes on lower extremities. What is the most common cause of death in this patient population?
Cardiomyopathy
Renal failure
Diabetes-related complications
Malignancy
Septic shock
34) An 8-month-old male infant is brought to the emergency department (ED) by his mother due to vomiting and a decreased urine output. Three days ago, he had a fever, sore throat and ear pain. He was subsequently diagnosed with otitis media and treated with oral amoxicillin. Today, in the ED, his temperature is 40.0C(104F), pulse is 80/min, respirations are 40/min and irregular, blood pressure is 100/60 mm Hg, and weight is 8kgs ( 15 lbs). He is lethargic and arousable only to painful stimuli. His anterior fontanel is full and tense. His tympanic membranes are red and bulging. His pupils are reactive, but his eyes do not focus well on his parents. What is the most appropriate next step in the management of this patient?
Lumbar puncture
Start intravenous amoxicillin
CT scan of the brain
MRI of the brain
Start cefotaxime
35) A 17-year-old girl is found unconscious in a bathroom after ingesting a large amount of unknown sleeping pills. On arriving at the emergency department, she is somnolent; her temperature is 37.2 C (98.9 F), blood pressure is 120/74 mm Hg, pulse is 68/min, and respirations are 12/min. She responds to painful stimuli and to hearing her name loudly by opening her eyes briefly. However, she returns to the somnolent state immediately afterward. Which of the following is the most appropriate initial intervention?
. IV administration of caffeine
. IV administration of droperidol
. IV administration of 500 mL of normal saline
. Ipecac-induced emesis
. Gastric lavage
36) A 3-month-old infant is brought to your office for pallor and listless- ness. Your physical examination reveals tachycardia that is constant and does not vary with crying. He has no hepatomegaly and the lungs are clear. His ECG is shown. Which of the following is the most appropriate initial management of this patient?pic
Rapid verapamil infusion
Transthoracic pacing of the heart
Carotid massage
DC cardioversion
Precordial thump
37) A 6-year-old child, attempting to pet a neighbor's domestic dog while the dog is eating, is bitten in the hand. The dog has been vaccinated regularly. Which of the following steps are needed for rabies prophylaxis in this case?
. The child should receive rabies immunoglobulin only
. The child should receive rabies immunoglobulin plus vaccine
. The child should receive rabies vaccine only
. The dog should be killed and the brain examined for signs of rabies
. The dog should be observed for behavioral changes suggestive of rabies
{"name":"Urgence Pediatrie 37 Qs", "url":"https://www.quiz-maker.com/QPREVIEW","txt":"how are u?","img":"https://www.quiz-maker.com/3012/images/ogquiz.png"}
Powered by: Quiz Maker