Peds Emergency Medicine -Junkins

Question 1

A 12-month old male toddler is brought by his mother’s boyfriend with burn injuries to both of his legs. He states that the toddler climbed into a bath and was accidentally scalded by overly hot water. On examination, the child has circumferential burn injuries to his lower extremities from the knees down, as well as burns to his buttocks. Given the nature of these injuries, which of the following is NOT accurate:
A. 15-25 % of pediatric burns are the result of abuse
B. Burns due to abuse are less likely to involve both hands or both legs
C. 20% of pediatric burn admissions involve abuse or neglect
D. There is an increased risk of non-accidental (NAT) burns associated with single parent families and parental drug use
E. Burns due to NAT are more likely to require skin grafting and treatment in the intensive care unit

Answer 1

B. Burns due to abuse are less likely to involve both hands or both legs

Question 2

A five-year old presents with abdominal pain, vomiting and anorexia for 24 hours. She localizes tenderness to the right-lower quadrant. In a child this age, what is the specificity of the following classic examination findings for appendicitis: Rovsing, obturator, and iliopsoas signs?
A. 86 to 98 %
B. 52 to 75%
C. 28 to 49%
D. 13 to 25%

Answer 2

A. 86 to 98 %

Question 3

What US finding will be seen with Intussusception? What lab test should be ordered?

Answer 3

Target sign

may feel a sausage-shaped abd mass

-70% stool contains blood –> do a fecal occult test

Question 4

What is the definitive non-surgical management of intussusception?

Answer 4

Air enema reduction

Question 5

What does bilious emesis with severe abd dissension indicate? What is the treatment?

Answer 5

Malrotation with mid-gut volvulus

Tx: emergent surgical correction

Question 6

What are they signs/symptoms of hypovolemic shock?

Answer 6

Lethargy
Thirst
Dry mucous membranes, no tears
Decreased urine output
Tachycardia
Poor perfusion, cool
Pale, altered level of consciousness

Question 7

What does diarrhea in kids lead to? When should electrolytes be checked in a kiddo with diarrhea?

Answer 7

ISOTONIC volume depletion

check electrolytes if children are ill-appearing or have significant dehydration

Question 8

What is the best way to differentiate between moderate and severe hypovolemia?

Answer 8

Serum bicarbonate :

Question 9

What is the management of mild –> moderate dehydration? Severe?

Answer 9

-For mild to moderate dehydration:
Oral rehydration solution (ORS) for children with mild-to-moderate gastroenteritis. Breast milk is BEST*

-For severe dehydration:
Bolus of 20 mL/kg lactated Ringer’s (LR) or normal saline (NS)
-If pulse, perfusion, and/or mental status do not improve, give a second bolus

Question 10

What hematoma is associated with a lucid interval? What vessel is generally injured?

Answer 10

Epidural hematoma –> lens shaped

Middle meningeal A

Question 11

In a patient with a severe intracranial hemorrhage a complex series of physiologic changes may occur. Which of following is not expected to contribute to increased ICP?
A. Uncoupling of cerebral blood flow (CBF) and metabolic activity (loss of autoregulation)
B. Increased CSF production in response to cerebral hyperemia
C. Hypercapnia or hypoxia, causing vasoconstriction
D. Herniation, brain swelling, or subarachnoid hemorrhage, which may obstruct the flow of CSF
E. Cerebral contusions or cerebral edema which may increase intracranial volume.

Answer 11

C. Hypercapnia or hypoxia, causing vasoconstriction