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ENPC PRE-COURSE EXAM WITH COMPLETE 250
QUESTIONS AND SOLUTIONS LATEST UPDATE JUST
RELEASED THIS YEAR
Question: A 3-month-old is brought to the emergency department with new onset of fever. You
note the child to be pale, tachypneic, and tachycardic, with weak distal pulses. Which
intervention is the priority for this patient?
a. administer an appropriate dose of an antipyretic
b. infuse rapid 10-20 mL/kg bolus of isotonic crystalloid
c. prepare a broad spectrum antibiotic infusion
d. administer a vasoactive medication - CORRECT ANSWER✔✔B.
This patient most likely has septic shock. An immediate goal is to reverse shock and restore
tissue perfusion with fluids. An antipyretic may be needed based on the temperature and
patient symptoms. An antibiotic should be started within an hour, and vasoactive medications
may not be needed if fluid resuscitation is successful.
Question: A 5-year-old with no health problems presents to the emergency department with a
sudden onset of chest pain and shortness of breath. Parents state that the family was involved
in a bad car crash two weeks ago. A thorough assessment and workup has not revealed any
abnormalities. Which of the following is the best next step to take?
a. ask about any new bed-wetting or sleep disturbances
b. discharge to home and follow up with PCP
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c. repeat a head to toe exam to identify any missed traumatic injuries
d. consult cardiology for appropriate follow-up - CORRECT ANSWER✔✔A.
Physical complaints are not uncommon in children following a traumatic event. Once any
physical injuries or illnesses have been ruled out, assessment for any behavioral concerns such
as anxiety would be indicated to facilitate appropriate care and follow-up. The incident occurred
two weeks prior, so the likelihood any severe medical issues is low.
Question:What is the priority intervention for symptomatic bradycardia in a four-year-old child?
a. IV atropine
b. IV epinephrine
c. bag-mask ventilation
d. transcutaneous pacing - CORRECT ANSWER✔✔C.
Identifying and treating other causes, chest compressions, and epinephrine are interventions
for pediatric bradycardia with signs of poor perfusion that are not improved by adequate
oxygenation and ventilation. Atropine and pacing may be considered if there is no response to
the other interventions.
Question: Which of the following patients should be evaluated first?
a. 3 yo with dislodged G-tube
b. 18m with bilious emesis
c. 12 you with vomiting after handlebar injury
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d. 3m with periods of inconsolable crying - CORRECT ANSWER✔✔B.
The presence of bilious emesis is especially concerning because it may be indicative of an
immediately life-threatening bowel obstruction. A dislodged gastrostomy tube should be
reinserted within 4-6 hours to prevent stoma closure. Vomiting following a handlebar injury
may be indicative of many possible injuries, but does not take precedence unless other
symptoms are present. Infantile colic is described as inconsolable crying in infants, 2 weeks to 4
months old, for up to 3 hours per day, more than 3 days per week, and lasting for more than 3
weeks.
Question: You need to draw blood from a 2-year-old. Which of the following is the best
approach for this patient?
a. allow them to hold the blood tubes before drawing
b. have them watch a cartoon on an ipad or cellphone
c. give them an explanation of what will happen
d. prepare the equipment in the room so they can see - CORRECT ANSWER✔✔B.
The best approach to a toddler who requires interventions is to provide distractions whenever
possible. They are in the cognitive development phase of "sensorimotor/preoperational" so
having the caregiver present is helpful. You should move from the least invasive to most invasive
tasks, and don't let them watch you prepare since it will increase anxiety.
Question: The caregiver of a 7-year old reports witnessing a seizure at home, but no seizure
history. The patient is post-ictal with a heart rate of 142 beats per minute, respiratory rate of 36
breaths per minute, and blood pressure of 86/72 mm Hg. Significant burns are noted to the
patient's back and lower extremities. The caregiver states the burns accidentally occurred three
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days ago, but was afraid to bring the patient in due to an ongoing child welfare investigation.
Which of the following groups of interventions are the priority for this patient?
a. call PD and child welfare and have security detain the caregiver
b. administer IV analgesics and obtain POCT glucose
c. draw metabolic panel, POCT glucose, and administer fluids
d. administer lorazepam and fluids and place of seizure precautions - CORRECT ANSWER✔✔C.
Burn injuries result in fluid and electrolyte shifts leading to hypovolemia and electrolyte
imbalances. Early identification and treatment of electrolyte imbalances can help prevent
further seizures. Contacting child protective services and other authorities can wait. The patient
is post-ictal so does not require lorazepam medication at this time. Pain medication can and
should be considered with significant burns, but is not a priority.
Question: A three-year-old is rescued after being submerged in a pool for several minutes. On
arrival the patient is responsive to painful stimuli with shallow respirations, diminished breath
sounds, and an occasional cough. Which of the following interventions is the initial
management priority?
a. initiation of abdominal thrusts to remove fluid from lungs
b. insertion of OG to remove water and debris from stomach
c. ETT intubation to provide PP ventilation
d. removal of wet clothes to prevent hypothermia - CORRECT ANSWER✔✔C.
The primary survey assessment and treatment of deficits are the priority. Airway control and
positive pressure ventilation while preparing for intubation of a child who meets intubation
criteria (GCS < 8) should be performed while also maintaining cervical spine stabilization. The
ENPC PRE-COURSE EXAM WITH COMPLETE 250
QUESTIONS AND SOLUTIONS LATEST UPDATE JUST
RELEASED THIS YEAR
Question: A 3-month-old is brought to the emergency department with new onset of fever. You
note the child to be pale, tachypneic, and tachycardic, with weak distal pulses. Which
intervention is the priority for this patient?
a. administer an appropriate dose of an antipyretic
b. infuse rapid 10-20 mL/kg bolus of isotonic crystalloid
c. prepare a broad spectrum antibiotic infusion
d. administer a vasoactive medication - CORRECT ANSWER✔✔B.
This patient most likely has septic shock. An immediate goal is to reverse shock and restore
tissue perfusion with fluids. An antipyretic may be needed based on the temperature and
patient symptoms. An antibiotic should be started within an hour, and vasoactive medications
may not be needed if fluid resuscitation is successful.
Question: A 5-year-old with no health problems presents to the emergency department with a
sudden onset of chest pain and shortness of breath. Parents state that the family was involved
in a bad car crash two weeks ago. A thorough assessment and workup has not revealed any
abnormalities. Which of the following is the best next step to take?
a. ask about any new bed-wetting or sleep disturbances
b. discharge to home and follow up with PCP
, Page 2 of 51
c. repeat a head to toe exam to identify any missed traumatic injuries
d. consult cardiology for appropriate follow-up - CORRECT ANSWER✔✔A.
Physical complaints are not uncommon in children following a traumatic event. Once any
physical injuries or illnesses have been ruled out, assessment for any behavioral concerns such
as anxiety would be indicated to facilitate appropriate care and follow-up. The incident occurred
two weeks prior, so the likelihood any severe medical issues is low.
Question:What is the priority intervention for symptomatic bradycardia in a four-year-old child?
a. IV atropine
b. IV epinephrine
c. bag-mask ventilation
d. transcutaneous pacing - CORRECT ANSWER✔✔C.
Identifying and treating other causes, chest compressions, and epinephrine are interventions
for pediatric bradycardia with signs of poor perfusion that are not improved by adequate
oxygenation and ventilation. Atropine and pacing may be considered if there is no response to
the other interventions.
Question: Which of the following patients should be evaluated first?
a. 3 yo with dislodged G-tube
b. 18m with bilious emesis
c. 12 you with vomiting after handlebar injury
, Page 3 of 51
d. 3m with periods of inconsolable crying - CORRECT ANSWER✔✔B.
The presence of bilious emesis is especially concerning because it may be indicative of an
immediately life-threatening bowel obstruction. A dislodged gastrostomy tube should be
reinserted within 4-6 hours to prevent stoma closure. Vomiting following a handlebar injury
may be indicative of many possible injuries, but does not take precedence unless other
symptoms are present. Infantile colic is described as inconsolable crying in infants, 2 weeks to 4
months old, for up to 3 hours per day, more than 3 days per week, and lasting for more than 3
weeks.
Question: You need to draw blood from a 2-year-old. Which of the following is the best
approach for this patient?
a. allow them to hold the blood tubes before drawing
b. have them watch a cartoon on an ipad or cellphone
c. give them an explanation of what will happen
d. prepare the equipment in the room so they can see - CORRECT ANSWER✔✔B.
The best approach to a toddler who requires interventions is to provide distractions whenever
possible. They are in the cognitive development phase of "sensorimotor/preoperational" so
having the caregiver present is helpful. You should move from the least invasive to most invasive
tasks, and don't let them watch you prepare since it will increase anxiety.
Question: The caregiver of a 7-year old reports witnessing a seizure at home, but no seizure
history. The patient is post-ictal with a heart rate of 142 beats per minute, respiratory rate of 36
breaths per minute, and blood pressure of 86/72 mm Hg. Significant burns are noted to the
patient's back and lower extremities. The caregiver states the burns accidentally occurred three
, Page 4 of 51
days ago, but was afraid to bring the patient in due to an ongoing child welfare investigation.
Which of the following groups of interventions are the priority for this patient?
a. call PD and child welfare and have security detain the caregiver
b. administer IV analgesics and obtain POCT glucose
c. draw metabolic panel, POCT glucose, and administer fluids
d. administer lorazepam and fluids and place of seizure precautions - CORRECT ANSWER✔✔C.
Burn injuries result in fluid and electrolyte shifts leading to hypovolemia and electrolyte
imbalances. Early identification and treatment of electrolyte imbalances can help prevent
further seizures. Contacting child protective services and other authorities can wait. The patient
is post-ictal so does not require lorazepam medication at this time. Pain medication can and
should be considered with significant burns, but is not a priority.
Question: A three-year-old is rescued after being submerged in a pool for several minutes. On
arrival the patient is responsive to painful stimuli with shallow respirations, diminished breath
sounds, and an occasional cough. Which of the following interventions is the initial
management priority?
a. initiation of abdominal thrusts to remove fluid from lungs
b. insertion of OG to remove water and debris from stomach
c. ETT intubation to provide PP ventilation
d. removal of wet clothes to prevent hypothermia - CORRECT ANSWER✔✔C.
The primary survey assessment and treatment of deficits are the priority. Airway control and
positive pressure ventilation while preparing for intubation of a child who meets intubation
criteria (GCS < 8) should be performed while also maintaining cervical spine stabilization. The
