Test Bank For Pediatric Emergency Medicine
Secrets, 4th Edition
Authors: Steven M. Selbst,Jillian S. Savage DO
, Chapter 1: Childhood Resuscitation
Clinical/Application MCQs
Question 1
A 3-year-old boy is brought to the emergency department after being found submerged in a
backyard pool. He is unresponsive and apneic. His pulse is 55 beats/min with poor
perfusion. Bag-mask ventilation is initiated with 100% oxygen.
What is the most appropriate next step?
A. Continue ventilation only because a pulse is present
B. Begin chest compressions while continuing effective ventilation
C. Administer atropine immediately
D. Perform immediate endotracheal intubation before further interventions
Correct Answer: B. Begin chest compressions while continuing effective ventilation
Explanation
Pediatric cardiac arrest commonly results from respiratory failure rather than primary
cardiac disease. A heart rate below 60 beats/min accompanied by poor perfusion despite
adequate oxygenation and ventilation requires initiation of chest compressions.
Ventilation remains essential because correction of hypoxia is often the key intervention.
Why the other options are incorrect
• A. Bradycardia with signs of poor perfusion requires compressions; ventilation
alone is insufficient.
• C. Atropine is reserved for specific causes of bradycardia such as increased vagal
tone or cholinergic toxicity.
• D. Airway management is important but should not delay compressions and
ventilation.
Question 2
A previously healthy 7-month-old infant develops severe bronchiolitis. Despite high-flow
oxygen, the infant becomes lethargic with shallow respirations and oxygen saturation of
78%.
Which intervention is the highest priority?
,A. Chest radiography
B. Intravenous antibiotics
C. Assisted ventilation with bag-mask ventilation
D. Nebulized epinephrine
Correct Answer: C. Assisted ventilation with bag-mask ventilation
Explanation
The immediate priority is restoring oxygenation and ventilation. Bag-mask ventilation is
often the fastest and most effective initial intervention before advanced airway placement.
Why the other options are incorrect
• A. Imaging should not delay stabilization.
• B. Antibiotics are not immediately indicated without evidence of bacterial infection.
• D. Nebulized medications cannot replace ventilatory support in respiratory failure.
Question 3
A 6-year-old child is undergoing resuscitation after ventricular fibrillation is identified on
the monitor. High-quality CPR is in progress.
What is the next priority?
A. Administer sodium bicarbonate
B. Immediate defibrillation
C. Administer calcium chloride
D. Insert a urinary catheter
Correct Answer: B. Immediate defibrillation
Explanation
Ventricular fibrillation is a shockable rhythm. Early defibrillation significantly improves
survival when combined with effective CPR.
Why the other options are incorrect
• A. Sodium bicarbonate is not routinely indicated.
• C. Calcium is reserved for selected conditions such as hyperkalemia or calcium-
channel blocker overdose.
, • D. Catheter placement has no role during immediate resuscitation.
Question 4
A 4-year-old develops pulseless electrical activity (PEA) following severe dehydration from
gastroenteritis.
Which intervention is most likely to reverse the arrest?
A. Immediate synchronized cardioversion
B. Rapid isotonic fluid resuscitation while continuing CPR
C. Magnesium sulfate
D. Lidocaine infusion
Correct Answer: B. Rapid isotonic fluid resuscitation while continuing CPR
Explanation
PEA requires identification and treatment of reversible causes. Severe hypovolemia is
corrected with rapid isotonic fluid administration.
Why the other options are incorrect
• A. Cardioversion is used for unstable tachyarrhythmias with a pulse.
• C. Magnesium is mainly indicated for torsades de pointes.
• D. Lidocaine treats ventricular arrhythmias, not hypovolemic PEA.
Question 5
A 9-year-old with severe asthma becomes progressively somnolent. End-tidal CO₂ rises
steadily despite aggressive bronchodilator therapy.
Which finding most strongly suggests impending respiratory arrest?
A. Persistent wheezing
B. Hyperactive reflexes
C. Declining mental status with rising CO₂
D. Mild tachycardia
Correct Answer: C. Declining mental status with rising CO₂
Explanation
Secrets, 4th Edition
Authors: Steven M. Selbst,Jillian S. Savage DO
, Chapter 1: Childhood Resuscitation
Clinical/Application MCQs
Question 1
A 3-year-old boy is brought to the emergency department after being found submerged in a
backyard pool. He is unresponsive and apneic. His pulse is 55 beats/min with poor
perfusion. Bag-mask ventilation is initiated with 100% oxygen.
What is the most appropriate next step?
A. Continue ventilation only because a pulse is present
B. Begin chest compressions while continuing effective ventilation
C. Administer atropine immediately
D. Perform immediate endotracheal intubation before further interventions
Correct Answer: B. Begin chest compressions while continuing effective ventilation
Explanation
Pediatric cardiac arrest commonly results from respiratory failure rather than primary
cardiac disease. A heart rate below 60 beats/min accompanied by poor perfusion despite
adequate oxygenation and ventilation requires initiation of chest compressions.
Ventilation remains essential because correction of hypoxia is often the key intervention.
Why the other options are incorrect
• A. Bradycardia with signs of poor perfusion requires compressions; ventilation
alone is insufficient.
• C. Atropine is reserved for specific causes of bradycardia such as increased vagal
tone or cholinergic toxicity.
• D. Airway management is important but should not delay compressions and
ventilation.
Question 2
A previously healthy 7-month-old infant develops severe bronchiolitis. Despite high-flow
oxygen, the infant becomes lethargic with shallow respirations and oxygen saturation of
78%.
Which intervention is the highest priority?
,A. Chest radiography
B. Intravenous antibiotics
C. Assisted ventilation with bag-mask ventilation
D. Nebulized epinephrine
Correct Answer: C. Assisted ventilation with bag-mask ventilation
Explanation
The immediate priority is restoring oxygenation and ventilation. Bag-mask ventilation is
often the fastest and most effective initial intervention before advanced airway placement.
Why the other options are incorrect
• A. Imaging should not delay stabilization.
• B. Antibiotics are not immediately indicated without evidence of bacterial infection.
• D. Nebulized medications cannot replace ventilatory support in respiratory failure.
Question 3
A 6-year-old child is undergoing resuscitation after ventricular fibrillation is identified on
the monitor. High-quality CPR is in progress.
What is the next priority?
A. Administer sodium bicarbonate
B. Immediate defibrillation
C. Administer calcium chloride
D. Insert a urinary catheter
Correct Answer: B. Immediate defibrillation
Explanation
Ventricular fibrillation is a shockable rhythm. Early defibrillation significantly improves
survival when combined with effective CPR.
Why the other options are incorrect
• A. Sodium bicarbonate is not routinely indicated.
• C. Calcium is reserved for selected conditions such as hyperkalemia or calcium-
channel blocker overdose.
, • D. Catheter placement has no role during immediate resuscitation.
Question 4
A 4-year-old develops pulseless electrical activity (PEA) following severe dehydration from
gastroenteritis.
Which intervention is most likely to reverse the arrest?
A. Immediate synchronized cardioversion
B. Rapid isotonic fluid resuscitation while continuing CPR
C. Magnesium sulfate
D. Lidocaine infusion
Correct Answer: B. Rapid isotonic fluid resuscitation while continuing CPR
Explanation
PEA requires identification and treatment of reversible causes. Severe hypovolemia is
corrected with rapid isotonic fluid administration.
Why the other options are incorrect
• A. Cardioversion is used for unstable tachyarrhythmias with a pulse.
• C. Magnesium is mainly indicated for torsades de pointes.
• D. Lidocaine treats ventricular arrhythmias, not hypovolemic PEA.
Question 5
A 9-year-old with severe asthma becomes progressively somnolent. End-tidal CO₂ rises
steadily despite aggressive bronchodilator therapy.
Which finding most strongly suggests impending respiratory arrest?
A. Persistent wheezing
B. Hyperactive reflexes
C. Declining mental status with rising CO₂
D. Mild tachycardia
Correct Answer: C. Declining mental status with rising CO₂
Explanation
