OB/PEDS

Question 1

A 9-month-old male has had numerous episodes of vomiting and diarrhea. On assessment, the infant is listless. He has unlabored tachypnea; absent radial pulses and weak brachial pulses; and cool, mottled extremities. This infant is experiencing:

Answer 1

Severe dehydration with decompensated shock

Question 2

Immediately following delivery, your patient is experiencing heavy vaginal bleeding. In an attempt to control the bleeding, you should:

Answer 2

Firmly massage the fundus of her uterus

Question 3

A 20-kg child requires amiodarone for refractory ventricular fibrillation. Amiodarone is supplied as 150 mg in 3 mL. How many milliliters should you administer?

Answer 3

2 mL

The pediatric dose of amiodarone for refractory ventricular fibrillation or pulseless ventricular tachycardia is 5 mg/kg. Thus, a 20-kg child should receive 100 mg. Amiodarone is supplied as 150 mg in 3 mL (50 mg/mL). To deliver 100 mg, you should administer 2 mL.

Question 4

Emergency care for a child with suspected anemia should include:

Answer 4

Supplemental oxygen and transport

Question 5

Which of the following statements regarding the length-based resuscitation tape measure is correct?

Answer 5

It is used in children up to 34 kg to estimate their weight based on their height.

Question 6

A woman who is 37 weeks pregnant complains of severe neck pain following a motor-vehicle crash. After applying full spinal precautions and loading her into the ambulance, the patient suddenly becomes pale, diaphoretic, and tachycardic. What is the MOST likely explanation for this?

Answer 6

Decreased cardiac venous return

Question 7

You are performing CPR on a 20-kg child in asystole and have established intraosseous access. The correct dose and concentration of epinephrine for this child is:

Answer 7

2 mL of 1:10,000

The pediatric dose of epinephrine for cardiac arrest is 0.01 mg/kg (0.1 mL/kg) of a 1:10,000 solution. Therefore, a 20-kg child should receive 2 mL (20 X 0.1 = 2). A simple rule to remember is to administer 1 mL of epinephrine 1:10,000 for every 10 kg of body weight. Epinephrine 1:1,000 is not administered during cardiac arrest.

Question 8

A 20-kg child has been running a fever for the past 2 days. Today, he is lethargic and his skin is pale. His heart rate is 190 beats/min and his respiratory rate is 40 breaths/min. You should:

Answer 8

Administer a 400 mL normal saline bolus.

Treatment should involve treating the underlying problem that is causing him to compensate; in this case, you should administer a 20 mL/kg fluid bolus (400 mL in a 20-kg child)

Question 9

If a small child accidentally pulled a pot of boiling water off of the stovetop, you would MOST likely encounter:

Answer 9

A downward splash pattern of superficial and partial-thickness burns to the anterior aspect of the body.

Question 10

Which of the following female hormones stimulates ovulation?

Answer 10

Luteinizing hormone (LH)

Question 11

Standard treatment for an infant born at 34 weeks’ gestation, regardless of its appearance at birth, includes:

Answer 11

Taking extra measures to prevent rapid heat loss.

Question 12

A newborn’s mouth and nose are initially suctioned:

Answer 12

As soon as the head delivers, but before the next contraction.

Question 13

Treatment for an unresponsive 18-month-old child with a severe foreign body airway obstruction includes:

Answer 13

CPR, followed by attempts to visualize and remove the obstruction under direct laryngoscopy.

Question 14

A 9-month-old infant presents with respiratory distress. On appearance, the infant is active and has moderate retractions. Your assessment reveals diffuse wheezing; pink, warm, dry skin; and an oxygen saturation of 92%. This infant is MOST likely experiencing:

Answer 14

Broncholitis

Question 15

As you are assessing the skin color and condition of a newborn, you note that it is red and abnormally warm to the touch. Suspecting fever, you should recall that:

Answer 15

This is an uncommon finding and suggests a serious illness.

Question 16

You are assessing the cardiac rhythm of a 9-year-old child who says his chest is “fluttering.” P waves are not visible, the QRS complexes measure 70 ms in duration, the heart rate is 200 beats/min, and there is no variation in the R-R intervals when the child moves. These findings are MOST consistent with:

Answer 16

Reentry supraventricular tachycardia

Question 17

A 26-year-old woman has had abdominal pain since the end of her menstrual period approximately 10 days ago. She reports that the pain is in both lower quadrants, and she has a temperature of 100.5° F. What is the MOST likely cause of her symptoms?

Answer 17

Pelvic inflammatory disease

Question 18

Assessment of a 20-month-old child reveals lethargy, poor skin turgor, dry mucous membranes, delayed capillary refill, and a heart rate of 190 beats/min. Which of the following is the MOST appropriate rate for fluid rehydration?

Answer 18

20 mL/kg

Question 19

A 25-year-old female who is 38 weeks pregnant tells you that her bag of waters ruptured 2 hours ago, and that she is now experiencing contractions every 6 minutes. Based on your assessment, you determine that delivery is not imminent. During transport, you should tell your partner to stop the ambulance and assist you with the patient if:

Answer 19

She tells you that she needs to move her bowels

Question 20

You are assessing the cardiac rhythm of a 6-year-old child. The rhythm is regular, the rate is 170 beats/min, the QRS complexes measure 0.11 seconds, and P waves are not visible. You should suspect:

Answer 20

Ventricular tachycardia

The cardiac rhythm described fits the definition of ventricular tachycardia (V-Tach). V-Tach in children is characterized by a regular rhythm, a rapid rate, QRS complexes that are greater than 0.09 seconds in duration, and absent P waves.

Question 21

Pregnant women with hyperemesis gravidarum are at greatest risk for:

Answer 21

Mallory-Weiss syndrome

Question 22

A 19-year-old woman, who is 28 weeks pregnant with her first baby, presents with a headache, edema to her ankles and hands, and a blood pressure of 144/88 mm Hg. She is conscious and alert. You should:

Answer 22

Establish vascular access, transport her, and monitor her for seizure activity.

Question 23

A 7-year-old, 45-pound child is in cardiac arrest. The ECG shows ventricular fibrillation. If the first defibrillation is unsuccessful, you should defibrillate with:

Answer 23

80 joules

Question 24

A 7-year-old boy was struck by a car while riding his bicycle. His BP is 60/40 mm Hg, pulse is 160 beats/min, and respirations are 34 breaths/min. How much IV fluid should you administer per bolus?

Answer 24

440 mL

You should first estimate the child’s weight based on his age: (age [in years] × 2) + 8 = weight in kilograms. On the basis of this formula, a typical 7-year-old child would weigh 22 kg. Fluid boluses for children are at 20 mL/kg; therefore, this child should receive 440 mL of crystalloid fluid per bolus.

Question 25

Which of the following is MOST consistent with a foreign body upper airway obstruction in a child?

Answer 25

Acute dyspnea without a fever

Question 26

You are assessing a 7-year-old boy who has signs of shock. A low normal systolic blood pressure for a child of this age is:

Answer 26

80-85 mm Hg

Question 27

What type of trauma is associated with the highest morbidity and mortality rate in infants and children?

Answer 27

Head

Question 28

While assessing a woman in labor, the paramedic notices that a loop of the umbilical cord is protruding from her vagina. The paramedic should:

Answer 28

Ensure that the umbilical cord continues to pulsate

Question 29

A 4-year-old child remains in supraventricular tachycardia following an initial dose of adenosine. The appropriate second dose of adenosine for this child is:

Answer 29

3.2 mg

The initial dose of adenosine (Adenocard) for an infant or child is 0.1 mg/kg rapid IV/IO push. (age [in years] × 2) + 8. On the basis of this formula, an average 4-year-old child weighs 16 kg (8 [4 × 2] + 8 = 16). Therefore, the appropriate initial dose of adenosine for this child is 1.6 mg (16 × 0.1 = 1.6). Do not exceed 6 mg for the initial dose. If needed, repeat adenosine at a dose of 0.2 mg/kg. For a 16-kg child, the second dose of adenosine is 3.2 mg (16 × 0.2 = 3.2). Do not exceed 12 mg for the second dose.

Question 30

A 29-year-old female complains of bilateral lower abdominal quadrant pain. Which of the following additional findings should make you the MOST suspicious for an ectopic pregnancy?

Answer 30

Intrauterine device use

Question 31

The mother of a 2-year-old girl reports that the child has had a fever for the past 2 days and that she screams every time she tries to pick her up. You note that the child is grabbing both sides of her head. These findings are MOST suggestive of:

Answer 31

Meningitis

Meningitis is defined as infection and inflammation of the meninges surrounding the brain and spinal cord. Signs and symptoms of meningitis include fever; headache; vomiting; and a stiff, painful neck (nuchal rigidity); among others.

Question 32

A 1-year-old child presents with a decreased level of alertness, bradypnea, cyanosis, and a heart rate of 50 beats/min. You should:

Answer 32

Ventilate with a BVM

Question 33

A slow onset of a low-grade fever and respiratory distress in a 3-year-old child is MOST characteristic of:

Answer 33

Croup

Croup, or laryngotracheobronchitis, is a viral upper respiratory infection that typically affects children between the ages of 6 months and 4 years. It is characterized by a slow onset of a low-grade fever and a classic “seal-bark” cough. In some cases, croup can progress to respiratory distress and failure.

Question 34

Which of the following is considered an effective method in reducing stress in an obviously anxious bystander at the scene of an emergency?

Answer 34

Assign the bystander minor, nonpatient care-related tasks.

Question 35

A 30-kg child presents with a regular, monomorphic, wide-complex tachycardia at 190 beats/min. He tells you that his chest feels funny, but otherwise has no other symptoms. He is conscious and alert and his vital signs are stable. Which of the following interventions is indicated?

Answer 35

Adenosine 3 mg

Question 36

You are transporting a woman who is 35 weeks pregnant. The patient complains of abdominal cramping, but denies vaginal bleeding. An IV of normal saline has been established and she is receiving supplemental oxygen. As you are reassessing her, she tells you that she is extremely lightheaded. Her skin is diaphoretic and her pulse is rapid and weak. You should:

Answer 36

Ensure that she is positioned on her left side

Question 37

A child with respiratory failure would MOST likely present with:

Answer 37

Bradypnea

Question 38

Which of the following represents the low normal systolic blood pressure for a 6-year-old child?

Answer 38

82 mm Hg

Question 39

Which of the following conditions would a woman MOST likely develop if she does not take prenatal vitamins throughout her pregnancy?

Answer 39

Anemia

Question 40

You have just delivered an infant born at 37 weeks’ gestation. After drying and warming the infant, you assess him and note that his respirations are rapid and irregular, his pulse rate is 90 beats/min, and his face and trunk are cyanotic. You should:

Answer 40

Give positive-pressure ventilations for 30 seconds and then reassess the newborn.

Question 41

After treating and transporting a child that you suspect has been physically abused, you should:

Answer 41

Report your suspicions to the receiving physician.

Question 42

A 23-year-old woman who is 35 weeks pregnant complains of right upper quadrant abdominal pain, bruising to her arms, a severe headache, and pain to her right shoulder. Her BP is 180/94 mm Hg, her pulse rate is 110 beats/min, and her oxygen saturation is 95%. The paramedic should suspect:

Answer 42

HELLP syndrome

HELLP syndrome is a life-threatening complication of pregnancy that typically occurs in the later stages of pregnancy; it is considered to be a variant of preeclampsia because it generally occurs in conjunction with hypertension and proteinuria. HELLP stands for Hemolysis, Elevated Liver enzymes, and Low Platelet count. Signs and symptoms of HELLP syndrome include hypertension, edema, headache, bruising, bleeding, right upper quadrant pain (from liver distention), shoulder pain, and visual disturbances. Women with HELLP syndrome who become critically ill or die most often experience liver rupture or hemorrhagic stroke.

Question 43

Which of the following is an obvious clinical indicator of decompensated shock in an infant?

Answer 43

Weak brachial pulses

Question 44

Which of the following statements regarding fetal circulation in utero is correct?

Answer 44

The ductus arteriosus and foramen ovale divert blood flow away from the fetus’s lungs.

Question 45

A 3-year-old child presents with a heart rate of 190 beats/min. Which of the following observations would MOST likely exclude a diagnosis of reentry supraventricular tachycardia?

Answer 45

No fluctuation in rhythm regularity when the child moves

Question 46

Which of the following interventions is ONLY performed at the end of the third stage of labor?

Answer 46

Massaging the uterine fundus in a circular motion

Question 47

A 5-year-old child has been seizing continuously for the past 25 minutes. The paramedic should:

Answer 47

Administer midazolam 0.1 mg/kg IM.

Midazolam (Versed), 0.1 mg/kg, is an appropriate pediatric dose.

Question 48

You respond to a daycare center for a 2-year-old female who is having a seizure. Upon arrival, you find the child lying in a bed. She is no longer seizing, but her level of alertness is decreased. Her skin is hot to the touch and she is tachypneic and tachycardic. According to a daycare center employee, she picked up the child after the seizure stopped, but the child began crying uncontrollably. You should suspect that this child has:

Answer 48

Bacterial meningitis

Question 49

When arriving at the scene of a chemical plant explosion with injuries, the incident commander should ask a plant representative to present a:

Answer 49

Bill of lading (freight bill).

Question 50

A 4-year-old female presents with lethargy, weak intercostal retractions, and a heart rate of 70 beats/min. You should:

Answer 50

Ventilate the child with high-flow oxygen.

The child in this scenario is clearly in respiratory failure; her mental status is depressed, she has weak intercostal retractions (a sign of physical exhaustion), and bradycardia. Immediate treatment for a child with respiratory failure involves providing positive-pressure ventilations (PPV) with high-flow oxygen.

Question 51

You are treating a patient with suspected cardiac chest pain and elect to start an IV line; however, you did not advise the patient of this in advance. As a result, you could be held liable for:

Answer 51

Battery

Question 52

A 39-year-old female, who is 35 weeks pregnant, presents with acute abdominal pain, irregular contractions, and vaginal bleeding. She is confused, her blood pressure is 70/48 mm Hg, pulse is 120 beats/min and weak, and respirations are 24 breaths/min and shallow. Her abdomen is tender to palpation and her uterus feels rigid. She is MOST likely experiencing:

Answer 52

Abruptio placenta

Question 53

A 29-year-old female presents with lower abdominal pain and minor vaginal bleeding. She recently had a dilation and curettage (D&C) procedure following a spontaneous abortion. Her blood pressure is 108/68 mm Hg, pulse is 110 beats/min, and respirations are 20 breaths/min. Her temperature is 102.4° F. You should be MOST suspicious for:

Answer 53

Endometritis

Endometritis is an inflammation of the inner uterine lining (endometrium), usually due to infection. It may also occur following gynecologic surgery (ie, D&C), abortion, or intrauterine device use. Symptoms include malaise, fever, constipation, vaginal bleeding or discharge, and lower abdominal or pelvic pain.

Question 54

A 24-year-old woman presents with severe nausea and vomiting for the past 36 hours. She tells you that she is 12 weeks pregnant with her first child. She is tachycardic, lightheaded, and extremely weak. You begin transport, establish vascular access, and give her IV fluid boluses en route. Which of the following medications would MOST likely control her nausea and vomiting?

Answer 54

Diphenhydramine (benadryl)

Your patient likely has hyperemesis gravidarum, a condition of persistent nausea and vomiting during pregnancy. Hyperemesis gravidarum is a serious condition that may cause dehydration and malnutrition, which can have negative effects on the fetus. Diphenhydramine (Benadryl), an antihistamine, can also be given; the dose is 10 to 50 mg by deep IM or IV injection (pregnancy category B). Although primarily used to treat allergic reactions, diphenhydramine possesses antiemetic properties

Question 55

A 9-year-old child has generalized weakness; blood in the stool; and bruising, even from minor trauma. These findings are MOST consistent with:

Answer 55

Leukemia

Question 56

A 4-year-old boy has a high fever and deep, rapid respirations. The child’s mother states that she thinks her child got into the medicine cabinet. Which of the following medications has the child MOST likely ingested?

Answer 56

Aspirin

Aspirin (acetylsalicylic acid [ASA]) toxicity produces a high fever (hyperpyrexia) and metabolic acidosis. As the respiratory system attempts to rid the body of the excess acid and hydrogen ions, the patient’s respirations become deep and rapid.

Question 57

You are assessing an 18-month-old female with a high fever. The child is crying, and is tachypneic and tachycardic. There is no evidence of a rash, her rectal temperature is 102.6° F, and her capillary refill time is 1 second. The child’s mother states that her daughter has not experienced vomiting or diarrhea, and further denies any past medical history. You should:

Answer 57

Remove her clothing to minimize heat retention, give ibuprofen, and transport.

Question 58

Abdominal pain, vaginal bleeding, and amenorrhea (absence of menstruation )in a 25-year-old female should make the paramedic MOST suspicious for:

Answer 58

Ectopic pregnancy

Question 59

You are triaging first-grade students at a school bus crash and encounter a small child who is unresponsive and apneic. After opening the child’s airway, he remains apneic. You should:

Answer 59

Assess for a palpable pulse

Question 60

A 4-year-old male presents with audible stridor, a barking cough, and increased work of breathing. He is conscious and alert; has pink, warm skin; and has a heart rate of 120 beats/min. Further assessment reveals clear and equal lung sounds bilaterally, an oxygen saturation of 97%, and a temperature of 99.2° F. You should:

Answer 60

Let him assume a position of comfort, offer oxygen via the blow-by technique, and administer a 2.25% solution of racemic epinephrine via nebulizer.

Give oxygen via the blow-by technique, if tolerated. Consider giving nebulized racemic epinephrine (0.5 mL of a 2.25% solution in 3 mL of normal saline). Epinephrine reduces upper airway edema through vasoconstriction.

Question 61

An 8-year-old child is in ventricular tachycardia. He has a weak pulse; a decreased level of consciousness; and cool, pale skin. You should:

Answer 61

Perform synchronized cardioversion at 1 j/kg.

Question 62

Which of the following is the earliest sign of shock in an 18-month-old child?

Answer 62

Delayed cap refill

Question 63

A 33-year-old female presents with a headache, extreme weakness, chills, and a high fever for the past 10 days. She denies vaginal discharge, urinary difficulty, or painful intercourse. Assessment of her abdomen reveals palpable tenderness to the left upper quadrant. Which of the following is the MOST likely cause of her symptoms?

Answer 63

Cytomegalovirus

Question 64

You receive a call for an 18-month-old female who is not breathing. When you arrive at the scene, emergency medical responders are providing effective two-rescuer CPR. According to the child’s father, she had a cough and runny nose for the past several days, but when he tried to wake her up from her nap, she was unresponsive. When you apply the cardiac monitor, you will MOST likely see:

Answer 64

Asystole

Since most cases of cardiopulmonary arrest in the pediatric population are the result of respiratory failure, you would most likely encounter asystole or bradycardic PEA

Question 65

Post-cardiac arrest care for a child may include:

Answer 65

A dopamine infusion for fluid-refractory hypotension.

Question 66

A 27-year-old female overdosed on an unknown type of drug. Her skin is hot and flushed and her breathing is rapid and deep. Her BP is 98/64 mm Hg and her heart rate is 120 beats/min. Which of the following drugs would MOST likely explain her clinical presentation?

Answer 66

Aspirin

Aspirin toxicity causes significant metabolic acidosis; the respiratory buffer system responds by increasing the rate and depth of breathing, resulting in a compensatory respiratory alkalosis.

Question 67

After delivering a baby, you clear the airway and take measures to prevent hypothermia. As you assess the newborn, you note the presence of central cyanosis and a pulse rate of 90 beats/min. Treatment should include:

Answer 67

Positive pressure ventilation

Question 68

An infant or child with cardiogenic shock:

Answer 68

Often presents with increased work of breathing and an enlarged liver.

Question 69

A 29-year-old female, who is 32 weeks pregnant, presents with a blood glucose level of 305 mg/dL. This is MOST likely the result of:

Answer 69

Placental hormones blocking the action of insulin.

Question 70

Evaluation of a newborn reveals that it has a pink body, but blue hands and feet; a strong cry; a pulse rate of 110 beats/min; and some spontaneous flexion of the extremities. It pulls its leg away when stimulated. You should assign an APGAR score of:

Answer 70

8

According to the APGAR scoring system, the newborn receives 1 point for appearance (pink body, blue hands and feet), 2 points for pulse rate (greater than 100 beats/min), 2 points for grimace/irritability (cries or pulls away when stimulated), 1 point for activity/muscle tone (some flexion of the extremities), and 2 points for respiratory effort (strong cry).

Question 71

A 4-year-old child has partial-thickness burns to the entire face and head, anterior torso, and both anterior upper extremities. What percentage of the total body surface area does this represent?

Answer 71

42%

For infants (less than 1 year of age), the head and face (front and back) represents 18% of the total body surface area (TBSA), the torso represents 36% (front and back), each upper extremity represents 9% (front and back), the groin represents 1%, and each lower extremity represents 13.5% (front and back). For each year over 1 year of age, subtract 1% from the head and add 0.5% to each lower extremity; use this formula until adult Rule of Nine values are reached. Based on this age modification, a 4-year-old child’s head and face represents 15% (3% is subtracted from the head based on his age), the anterior torso represents 18%, and both anterior upper extremities represent 9%. Cumulatively, this represents 42% of the TBSA.

Question 72

The risks of vomiting and aspiration are greater in unresponsive pregnant women than non-pregnant women because:

Answer 72

The enlarged uterus displaces the stomach and intestines upward and laterally.