PICU MCQ

Question 1

A weak central pulse may indicate

Answer 1

Decompensated shock

Question 2

where to do CRT

Answer 2

central (eg. chest) to minimize environmental involvement

Question 3

formula for determining the lower
limit of acceptable BP

Answer 3

minimal systolic blood pressure = 70 + [2 x age in years]

Question 4

Evaluate the brainstem by

Answer 4

checking the responses in each pupil to a direct beam of
light

Question 5

Evaluate the motor activity by

Answer 5

looking for symmetrical movement of the extremities, seizures, posturing or flaccidity

Question 6

Sinus Tachycardia is a consistent sign of shock… Except:

It might be the only sign in compensated shock

Answer 6

cardiogenic shock
from bradycardia or spinal cord injury

Question 7

Most serious sign of shock

Answer 7

Hypotension

Question 8

How to assess disability

Answer 8

1. APVU scale
2. Glascow coma scale

Question 9

what are clinical manifestations of shock

Answer 9

1. Poor peripheral circulation ( cold hands and feet)
2. ↑ CRT ( >2s)
3. increased HR
4. Weak / thready pulse
5. Evidence of poor organ perfusion ( Oliguria / metabolic acidosis)
6. ↓ BP
7. Altered level of conscioussness

ordered from mild to severe

Question 10

For children with normal systolic blood
pressures, how to classify shock

Answer 10

by Pulse pressure:

- hypovolemic and
cardiogenic shock → Narrow pulse pressure

- distributive shock → Widening of pulse pressure

Narrow pulse pressure : dt ↑ DBP as the result of a compensatory ↑ in SVR
Widening of pulse pressure: dt ↓BP as the result of a compensatory ↓ in SVR

Question 11

in shock, Fever (or hypothermia in young infants) is suggestive of

Answer 11

Septic shock

Question 12

most common cause of shock

Answer 12

hypovolemia from diarrhea

Question 13

how to differentiate between cardiogenic & hypovolemic shock

Answer 13

by work of breathing and PVC

• Cardiogenic shock → Grunts, flaring , Accessory muscle use
• PVC can clinically be heard as crackles in the lungs and visualized as jugular vein distension.

Question 14

how to differentiate between cardiogenic & obstructive shock

Answer 14

by the contractility of the heart. In
obstructive shock, heart contractility is normal, although pumping function is not.

Question 15

patient is cyanotic and/or hypotensive,
experiences chest pain, and has respiratory
distress without lung pathology or airway
obstruction.

Answer 15

most likely Pulmonary embolism