Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pediatrics Board ⭐️ > Emergency / Critical Care > Flashcards

Emergency / Critical Care Flashcards

1
Q

A 27-day-old with fever 103°F for 1day, feeding well, no cough, no vomiting, no diarrhea. Physical examination is normal. What is the next best step?

A

Full sepsis evaluation (blood, urine and CSF testing) and empiric IV antibiotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

An 8-week-old with fever 103°F for 2days, feeding well, no cough, no vomiting, no diarrhea. Physical examination is normal. What is the next best step?

A

Complete blood count (CBC), urinalysis and urine culture (infants 38°C should be promptly evaluated)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

A 15-month-old with fever 103°F for 2days, feeding well, fussy when fever is high, playful for brief periods after receiving antipyretics, no cough, no vomiting, no diarrhea. Physical examination is normal. What is the next best step?

A

Reassurance (most likely viral syndrome, advise close follow-up)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Non-toxic, fully vaccinated toddler with nasal congestion has a barky cough, inspiratory stridor when agitated, but no resting stridor. What is the next best step?

A

Oral dexamethasone (viral croup)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

A well-appearing, 12-month-old with upper respiratory infection (URI) symptoms and fever presents with diffuse wheezing on lung auscultation. What is the next best step?

A

Clearance of nasal secretions and reassurance (acute viral bronchiolitis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Child with asthma, presenting with chest pain, chest tightness and diffuse bilateral expiratory wheezing in the setting of URI symptoms. What is the next best step?

A

Albuterol and ipratropium nebulizer treatments with oral steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Distressed, vaccinated toddler, with sudden onset of cough and inspiratory stridor while eating peanuts. What is the next best step?

A

Attention to ABCs (airway, breathing, circulation) and emergent subspecialty evaluation for a suspected foreign body in airway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

An unvaccinated child with inspiratory stridor at rest, toxic appearing, leaning forward and drooling. Next best step?

A

Attention to ABCs (airway, breathing, circulation) and emergent subspecialty evaluation for suspected epiglottitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Child with peanut allergy presents with diffuse hives and flushed skin after ingestion of peanuts, noted to have hypotension on initial vital signs. What is the definitive treatment for the underlying diagnosis?

A

IM epinephrine for anaphylaxis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Child presents to the emergency department (ED) with a dog bite. What is the next best step?

A

Wound cleaning with adequate pressure irrigation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

After cleaning the wound of dog or cat bite, what is the most appropriate prophylactic antibiotic?

A

Amoxicillin/clavulanate, cover both aerobes and anaerobes, especially Pasteurella

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Dog or cat bite and allergy to penicillin

A

Clindamycin plus trimethoprim-sulfamethoxazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Teenage patient punches another student in the teeth during an altercation at school and sustains puncture lacerations to knuckles; what is the most appropriate prophylactic antibiotic?

A

Amoxicillin/clavulanate, cover both aerobes and anaerobes, especially Eikenella

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

A fully vaccinated child with a bite from a stray dog that was not captured. The child was admitted on NPO status due to multiple puncture lacerations requiring surgical repair. What is the next best treatment?

A

Rabies prophylaxis (rabies vaccine and rabies immunoglobulin) and intravenous ampicillin-sulbactam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Adolescent with pain, redness, and tenderness in the foot after stepping on a rusty nail that punctured the foot. There is no fever and the rest of the exam is normal. Last tetanus vaccine was 7years ago. What is the best treatment?

A

Tdap vaccine and oral ciprofloxacin Pseudomonas aeruginosa infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Child with a sudden stinging sensation in the right foot after playing in the basement, within a few hours develops severe pain and enlarging erythema in the right foot, which 2days later becomes a hemorrhagic blister surrounded by an erythematous halo and dark eschar. What is the most likely cause?

A

Brown recluse spider bite (local pain, necrosis, and less systemic manifestations)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Child presents with sudden pinching sensation in the foot after playing in the basement, within 8h develops muscle cramping in the right leg, which progresses to the back and abdomen. O/E: elevated blood pressure, tachycardia, tender abdomen, target-like appearance redness in the foot. What is the most likely cause?

A

Black widow spider bite (initial pinch or pinprick sensation, or unnoticed bite followed by significant systemic manifestations, muscle cramping, tachycardia, and hypertension)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Child stung on the left arm by a wasp, having pain, itching, erythema, and mild swelling in the left arm without any signs of systemic illness. What is the best treatment?

A

Removal of the stinger, application of cool compresses or ice packs, and mild oral analgesics and oral antihistamines to help alleviate pruritus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

A 1-year-old falls

A

Reassurance (very low risk of clinically significant traumatic brain injury [height of fall in 3ft is a high risk])

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

A 3-year-old falls

A

Reassurance (very low risk of clinically significant traumatic brain injury [height of fall in >2years of age >5ft is a high risk])

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

A 6-year-old boy fell and hit his head while running, loss of consciousness for 30s, one-time vomiting, headache that has slightly improved in the last 30min. Physical examination is normal except mild swelling in the forehead. What is the next best step?

A

Observation period 4–6h in ED

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Child brought to the ED after severe head trauma, continues to have persistent vomiting and altered level of consciousness. What is the next best step?

A

Attention to ABCs (airway, breathing, and circulation)—the child needs CT head but first requires stabilization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

A 6-year-old boy fell and hit his head, loss of consciousness for 2min, progressive headache, persistent vomiting. Physical examination is normal except mild swelling in the forehead. What is the next best diagnostic test?

A

Head CT scan without contrast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

A 6-year-old boy fell and hit his head, loss of consciousness, headache, vomiting, improvement for few hours (lucid interval) followed by deterioration of symptoms and loss of consciousness. CT head shows hyperdense lenticular-shaped mass situated between the brain and the skull. Most likely diagnosis?

A

Epidural hematoma—convex toward the brain and restricted by suture lines in CT scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Head trauma, severe headache, and drowsiness. Head CT scan showed hyperdense (white), crescent-shaped mass between the inner table of the skull and the surface of the cerebral hemisphere. Most likely diagnosis?

A

Subdural hematoma—concave toward the brain and unlimited by suture lines in CT scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Head trauma, bleeding from the ear, hearing loss, and facial paralysis. Most likely injury?

A

Temporal bone fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Head trauma, ecchymosis behind the ear (battle sign), periorbital ecchymosis (raccoon eyes), abducens nerve paralysis. Most likely injury?

A

Basilar skull fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Glasgow Coma Scale (GCS) of a child after head trauma who opens eyes only to sound, makes a few unintelligible sounds but does not say words, and localizes to pain

A

GCS = 10 (3 E/2 V/5 M)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Effect of clonidine, cholinergic, opiates, organophosphates, phencyclidine, phenothiazine, pilocarpine, and barbiturates (sedatives) on the pupil

A

Miosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Effect of atropine, antihistamines, antidepressants, amphetamine, and cocaine on the pupil

A

Mydriasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Ingestion of which agents can cause seizures, hyperthermia, agitation, decreased urine output, anhidrosis, flushing, and mydriasis?

A

Anticholinergic agents (e.g., Atropine , amitriptyline, diphenhydramine, jimson weed, or deadly nightshade)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Ingestion of which agent can cause pinpoint pupils, unresponsiveness, and respiratory depression?

A

Opiate intoxication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is the treatment of choice for opiate poisoning?

A

Naloxone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Child presents with neck spasms, oculogyric crisis, and tongue thrusting after accidental ingestion of promethazine (anti-nausea medication). What is the drug of choice to treat these symptoms?

A

Diphenhydramine; the patient has an acute dystonic reaction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Child ingests a large amount of a grandparent’s medicine, presents with hyperventilation, metabolic acidosis, high-anion gap, tinnitus, and confusion. Likely ingestion?

A

Aspirin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Healthy child ingests caretaker’s medicine, presents with altered mental status, seizure, drowsiness, lethargy, sinus tachycardia, widened QRS, prolonged QT interval. Likely ingestion?

A

Tricyclic antidepressants (TCA) toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Adolescent currently on SSRI treatment for depression presents with confusion, sweating, and myoclonus admits to trying ecstasy at a party. Likely cause of symptoms?

A

Serotonin syndrome—hallmark is myoclonus Occurs with: monoamine oxidase inhibitor (MAOI) and linezolid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Child is brought to the ED after ingesting numerous pills of metformin. Possible laboratory finding?

A

Lactic acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Child presents with nausea, vomiting, abdominal pain 6h after accidental ingestion of pills, felt better for a short period, then 24h later presents with metabolic acidosis, shock, hepatic failure, and 6weeks later develops pyloric and gastrointestinal scarring. What is the most likely ingested substance?

A

Iron

40
Q

Child reaches the toxic level of acetaminophen 4h after accidental ingestion. What is the antidote?

A

N-acetylcysteine (NAC)

41
Q

Toddler ingests a small amount of windshield wiper fluid about 30min before the presentation, is asymptomatic. Caretaker calls primary care office for advice. What is the next best step?

A

Immediate referral to the ED for further laboratory testing (toxic alcohol ingestion→ methanol)

42
Q

Adolescent presents with slurred speech, tachypnea, cyanosis, pulmonary edema, renal failure, calcium oxalate crystals in the urine, high-anion gap metabolic acidosis. Likely ingestion?

A

Ethylene glycol

43
Q

Adolescent presents with visual disturbance, abdominal pain, and high-anion gap metabolic acidosis. Likely ingestion?

A

Methanol

44
Q

Child accidentally ingests window cleaner, presents with sore throat, dysphagia, and drooling. Next best step?

A

Caustic ingestion, immediate subspecialty consultation for endoscopy

45
Q

Child complains of a headache, weakness, fatigue, and nausea for 2–3weeks since the start of winter, caretaker reports self and 2 other siblings are feeling the same. Most likely exposure?

A

Carbon monoxide poisoning (measurement of carboxyhemoglobin on blood gas)

46
Q

Child at a party ate some cookies then starts vomiting, swelling of the lips, and trouble breathing, should be treated with which medication

A

IM epinephrine at 0.01mg/kg

47
Q

Toddler presents with right arm pain and decreased arm mobility after being lifted up by the right arm during play. No falls or trauma reported. Most likely diagnosis?

A

Nursemaid’s elbow (annular ligament displacement)

48
Q

Child tripped and fell on an outstretched hand presents with tenderness to distal humerus. No obvious fracture on elbow radiograph, although there is a posterior fat pad sign on the lateral view. Most likely diagnosis?

A

Occult supracondylar fracture

49
Q

Term neonate delivered vaginally had difficulty with vacuum extraction presents with “bump” over left clavicle 2weeks after birth. Most likely diagnosis?

A

Clavicular fracture with healing callus from a traumatic birth

50
Q

Chest radiograph performed on a healthy infant for evaluation of chronic cough reveals many callus formations to the posterior ribs bilaterally. Most likely diagnosis?

A

Non-accidental trauma/child abuse

51
Q

Toddler presents with left leg pain and limps after going down a slide and getting the left foot stuck and twisted on the edge of the slide. Radiograph of lower leg reveals a non-displaced spiral fracture of the lower third of the tibia. Most likely diagnosis?

A

Toddler’s fracture

52
Q

Which type of burn is associated with mild pain, swelling, and redness that blanches with pressure?

A

Superficial burn (formerly 1st-degree burn)

53
Q

Which type of burn is associated with severe pain, blebs, and blisters?

A

Partial thickness burn (formerly 2nd-degree burn)

54
Q

Which type of burn is painless with a dry and leathery appearance?

A

Full-thickness burn (formerly 3rd-degree burn)

55
Q

Child has electrical burns to the mouth after chewing on an electrical cord. Next best step?

A

Refer to burn surgeon—concern for labial artery bleeding

56
Q

Child who weighs 20kg has burns on 5% of the body surface area. What IV fluids should be given and how much?

A

Parkland formula: 4ml/kg/% of the burn area of lactated Ringer’s Total: 400mL with 200mL (50% of total) given in the first 8h and 200mL over the next 16h

57
Q

A toddler who presents with scald burns over legs in a stocking distribution (clearly demarcated) needs what further evaluation

A

Evaluation for intentional injury/abuse

58
Q

Toddler presents with sudden onset vomiting and lethargy, bedside point-of-care glucose and venous blood gas are normal with a non-focal neurologic exam, soft abdomen, and no concern for ingestion. Next best test?

A

Ileocolic US to rule out intussusception

59
Q

Toddler presents with intermittent screaming episodes followed by periods of normalcy; caretaker reports a pink “jelly”-like stool. Most likely location of the intussusception?

A

Ileocolic

60
Q

Adolescent female with acute onset of severe left lower pelvic pain, nausea, and vomiting; exam reveals severe tenderness and guarding in the left lower quadrant. Next best test?

A

Pelvic US to rule out acute ovarian torsion

61
Q

Adolescent male with acute onset of severe right testicular pain with nausea and vomiting; exam reveals high riding testicle with absent cremasteric reflex. Next best test?

A

Testicular US to rule out acute testicular torsion

62
Q

Child with 1day of nonbilious emesis and diarrhea, fever, periumbilical abdominal pain, and tenderness that is radiating to the right lower quadrant. Most likely diagnosis?

A

Acute appendicitis

63
Q

What is the initial imaging study of choice in cases of suspected acute appendicitis?

A

Abdominal US

64
Q

A 4-week-old with 10days of worsening projectile vomiting and 1day of intermittent apneic spells, found on ultrasound to have hypertrophic pyloric stenosis. Most likely laboratory finding?

A

Hypokalemic, hypochloremic metabolic alkalosis

65
Q

A healthy infant with 1day of intermittent bilious emesis. Stable vital signs on arrival. Next best test?

A

Upper GI series to rule out malrotation

66
Q

Child sustained blunt trauma to the abdomen, all vital signs are normal, and the abdominal ultrasound (US) is positive for splenic rupture. What is the best management?

A

For hemodynamically stable grades I–III, conservative management with monitoring of vital signs, surgical consult, serial hemoglobin, and hematocrit measurements

67
Q

Child sustained blunt trauma to the abdomen, low blood pressure, tachycardia, cold, clammy skin, and abdominal US is positive for splenic rupture. What is the best management?

A

Abdominal exploration

68
Q

Child presents with nausea, vomiting, and malaise. O/E: the liver is slightly enlarged. Laboratory findings include elevated liver enzymes, high direct bilirubin, hypoglycemia, and prolonged prothrombin time. What is the most likely diagnosis?

A

Acute hepatic failure

69
Q

Child presents to the ED with rapid breathing, low blood pressure, and normal oxygen saturation. O/E: tachypnea, tachycardia, clear lungs, and muffled heart sounds and widened pulse pressure. What is the most likely diagnosis?

A

Cardiac tamponade

70
Q

A 12-year-old girl was transferred to the ED after a car accident. She is complaining of chest pain on the left side and difficulty breathing. O/E: vital signs are normal; however, she has fast and shallow breathing, a segment of the left chest moves inward upon inspiration and outward upon expiration. What is the most likely diagnosis?

A

Flail chest

71
Q

What is the next best step in the previous case of flail chest?

A

Pain control, pulmonary toilet. Ensure adequate ventilation and oxygenation

72
Q

A 5-year-old boy with 2days history of severe vomiting and diarrhea. He is lethargic and not able to drink by mouth. O/E: awake but minimally interactive, low-grade fever, tachypnea, tachycardia, low blood pressure, delayed capillary refill time, cold skin, dry mucous membranes, skin tenting, and diminished peripheral pulses. What is the most likely diagnosis?

A

Hypovolemic shock (low intravascular volume)

73
Q

What is the next step in the previous case with Hypovolemic shock

A

Aggressive fluid resuscitation: 20ml/kg bolus of normal saline or Ringer’s lactate over 5–10min, additional boluses may be required based on clinical assessment and ongoing losses

74
Q

A 2-month-old with a history of congenital heart disease presents with hepatomegaly, and cardiomegaly, 20ml/kg of normal saline leads to new crackles, worsening hypotension, and tachycardia. What type of shock is this?

A

Cardiogenic shock

75
Q

Type of shock that is associated with bradycardia, hypotension, and is often associated with spinal cord injury?

A

Neurogenic shock

76
Q

A 5-year-old boy with high fever 104°F for 2days. He is lethargic and not able to drink by mouth. O/E: awake but minimally interactive, temperature 104.9°F, ill-looking, tachypnea, tachycardia, low blood pressure, delayed capillary refill time, diminished peripheral pulses. WBC count is 29,000. What is the most likely diagnosis?

A

Septic shock (cold shock)

77
Q

The patient in septic shock continues to have low blood pressure, refractory to fluid resuscitation and antibiotics in the first 15min. What is the next best step?

A

Start epinephrine infusion

78
Q

A 5-year-old boy stung by a bee rapidly developed hives, pruritus, facial swelling, wheezing, difficulty breathing. His blood pressure is low. What is the next best step?

A

Epinephrine IM immediately

79
Q

A 3-year-old girl arrived in PICU with prolonged cardiac arrest after choking on a hot dog. Her pupils are dilated and fixed, absent gag reflex, absence of spontaneous eye movements during oculovestibular and oculocephalic testing. No spontaneous movement. Lack of any respiratory effort without ventilatory support. What is the next best step to confirm brain death?

A

Neurological exam followed by apnea test (after 12 hours of supportive care)

80
Q

Child presents with no pulse; the EKG shows ventricular tachycardia. What would be the next step in the management of the arrhythmia?

A

Defibrillate 2J/kg

81
Q

Child presents with tachycardia, hypercarbia, generalized muscle rigidity, and hyperthermia immediately after surgery. What is the diagnosis and treatment?

A

Malignant hyperthermia , IV dantrolene

82
Q

What is the most important poor prognostic factor in near drowning?

A

Submersion time >5min

83
Q

Child was found submerged in the pool, is unconscious and not breathing; what is the next best step?

A

Call for help and begin chest compressions

84
Q

What is the best way to confirm successful ETT placement?

A

Colorimetric capnography

85
Q

What is the depth of CPR compression for infants through puberty?

A

One-third the depth of the chest

86
Q

What is the ratio of chest compressions to breaths in single rescuer CPR?

A

30:2

87
Q

What is the ratio of chest compressions to breaths in 2- rescuer CPR?

A

15:2

88
Q

What is the age range in which pediatric defibrillator pads should be used?

A

1–8years

89
Q

A 6-year-old boy is in cardiac arrest, a pediatric defibrillator is not available, but an adult AED is present. What should be done?

A

Use the adult defibrillator/adult pads

90
Q

A 15-year-old male presents after an ATV accident. He is bradycardic, GCS is 7, and the right pupil is dilated and unresponsive. What are the next steps in management?

A

Neuroprotective measures, including emergent endotracheal intubation

91
Q

Neurosurgery places an intracranial monitoring device in the previous case. What would be the target cerebral perfusion pressure (CPP) for this age?

A

More than 50mmHg (less than 5years of age >40mmHg, 6–17years of age >50mmHg)

92
Q

What is the size of the ETT for a 4-year-old child?

A

5mm uncuffed 4–4.5mm cuffed

93
Q

What is the recommended sequence of CPR per PALS guidelines?

A

C-A-B-D: Circulation—Airway—Breathing—Defibrillate

94
Q

For which type of cerebral edema is dexamethasone indicated?

A

Vasogenic

95
Q

A patient with persistent intracranial hypertension now has unilateral third nerve palsy and unilateral fixed dilated pupils deviating downward and laterally. What is the type of herniation?

A

Uncal herniation

96
Q

What would be the likely location of uncial herniation in the brain?

A

Midbrain

Pediatrics Board ⭐️ (30 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions