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 one week ago. A thorough assessment and workup
has not revealed any abnormalities. Which of the following steps is the best next
step to take? - ANSWER Ask about any new bed-wetting or sleep disturbances
Pediatric patients with anxiety and PTSD may present with physical complaints.
Assess for other behavioral symptoms to facilitate appropriate care and follow-up.
You are discharging a patient to home with a history of depression. Discharge
teaching should include which of the following? - ANSWER Ensuring all firearms in
the home are locked in a safe place with no access by the patient.
Promoting injury prevention with caregivers of patients with a history of depression or
suicidal ideation by encouraging that all firearms and medications are under lock to
prevent overdoses or suicide attempt.
A 2-year old has uniformly demarcated burns to bilateral lower extremities,
approximately 30% of the childs total body surface area. The father states he briefly
left the room while the child was in the bath and the child apparently played with the
faucet. Which of the following interventions has the highest priority? - ANSWER
Obtain vascular access for rapid fluid administration
Rapid vascular access and fluid administration are the priority interventions.
A 7-year-old arrives via ambulance. The patient's mother reports witnessing a
seizure at home. The patient has no seizure history. Upon examination, 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 mother states the burns accidentally
occurred 3 days ago, but she was afraid to bring patient in due to an ongoing child
welfare investigation. Which of the following are the MOST appropriate immediate
interventions? - ANSWER Draw and send a metabolic panel and venous blood gas,
administer a fluid bolus, and obtain a point of care glucose
Electrolyte imbalances need to be identified and treated to prevent another seizure.
What is the priority intervention for symptomatic bradycardia in a four-year-old child?
- ANSWER ventilation to address hypoxia is the priority intervention.
A 14-year-old high school student who was pitching for his baseball team was hit in
the chest by the ball and had a sudden cardiac arrest. Of the following, which is the
most likely cause of the cardiac arrest? - ANSWER Commotio cordis
, Comotio Cordis "occurs when chest is struck during the refractory period of the
cardiac conduction cycle. This type of injury usually occurs in recreational sports
such as baseball or ice hockey."
A 5-year-old child presents to the emergency department after being hit by a car.
She complains of left upper quadrant pain and the focused assessment with
sonography for trauma (FAST) exam shows fluid around her spleen. Which of the
following findings would be an early indication of ongoing blood loss? - ANSWER
Focused Assessment: Vital Signs: "As the patient compensates for altered tissue
perfusion, the pulse pressure narrows and the heart rate increases" - (need to
rewrite either the question or the answers)
Widening Pulse pressure - not correct (suppose to be narrow pulse pressure)
Bradycardia - not correct
Decreasing diastolic blood pressure - late sign
Weak peripheral pulses - late sign
A 5-year-old patient presents to the emergency department with severe dehydration
due to viral gastroenteritis. He has signs of shock due to his hypovolemia. Which of
the following physiologic responses to shock has the greatest impact on improving
cardiac output in the pediatric patient? - ANSWER Increasing heart rate
Pathophysiology: Cardiac Output. In pediatric patients, cardiac out is primarily
regulate by increasing heart rate
Which of the following patient presentations should increase suspicion of potential
child maltreatment? - ANSWER Bruising to the left ear of a newborn from sleeping
on his side
Pg 10- Any bruises in a non exploratory location (especially torso ears, neck) in
children younger than 4
Pg 11Any bruising in a child younger than 4 months.
All of the vaccine administrations listed are appropriate EXCEPT for which of the
following? - ANSWER Fifth Disease at 6 months
There is an animal vaccine, but not a human vaccine for Fifth Disease.
Which of the following statements indicates the caregiver understands your
discharge teaching on influenza? - ANSWER My child can go to daycare since they
have been off of Tylenol and fever free for 24 hours.
Yes, the patient needs to be afebrile WITHOUT the use of antipyretics to be able to
go back to daycare or school.
sudden onset of chest pain and shortness of breath. Parents state that the family
was involved in a bad car crash one week ago. A thorough assessment and workup
has not revealed any abnormalities. Which of the following steps is the best next
step to take? - ANSWER Ask about any new bed-wetting or sleep disturbances
Pediatric patients with anxiety and PTSD may present with physical complaints.
Assess for other behavioral symptoms to facilitate appropriate care and follow-up.
You are discharging a patient to home with a history of depression. Discharge
teaching should include which of the following? - ANSWER Ensuring all firearms in
the home are locked in a safe place with no access by the patient.
Promoting injury prevention with caregivers of patients with a history of depression or
suicidal ideation by encouraging that all firearms and medications are under lock to
prevent overdoses or suicide attempt.
A 2-year old has uniformly demarcated burns to bilateral lower extremities,
approximately 30% of the childs total body surface area. The father states he briefly
left the room while the child was in the bath and the child apparently played with the
faucet. Which of the following interventions has the highest priority? - ANSWER
Obtain vascular access for rapid fluid administration
Rapid vascular access and fluid administration are the priority interventions.
A 7-year-old arrives via ambulance. The patient's mother reports witnessing a
seizure at home. The patient has no seizure history. Upon examination, 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 mother states the burns accidentally
occurred 3 days ago, but she was afraid to bring patient in due to an ongoing child
welfare investigation. Which of the following are the MOST appropriate immediate
interventions? - ANSWER Draw and send a metabolic panel and venous blood gas,
administer a fluid bolus, and obtain a point of care glucose
Electrolyte imbalances need to be identified and treated to prevent another seizure.
What is the priority intervention for symptomatic bradycardia in a four-year-old child?
- ANSWER ventilation to address hypoxia is the priority intervention.
A 14-year-old high school student who was pitching for his baseball team was hit in
the chest by the ball and had a sudden cardiac arrest. Of the following, which is the
most likely cause of the cardiac arrest? - ANSWER Commotio cordis
, Comotio Cordis "occurs when chest is struck during the refractory period of the
cardiac conduction cycle. This type of injury usually occurs in recreational sports
such as baseball or ice hockey."
A 5-year-old child presents to the emergency department after being hit by a car.
She complains of left upper quadrant pain and the focused assessment with
sonography for trauma (FAST) exam shows fluid around her spleen. Which of the
following findings would be an early indication of ongoing blood loss? - ANSWER
Focused Assessment: Vital Signs: "As the patient compensates for altered tissue
perfusion, the pulse pressure narrows and the heart rate increases" - (need to
rewrite either the question or the answers)
Widening Pulse pressure - not correct (suppose to be narrow pulse pressure)
Bradycardia - not correct
Decreasing diastolic blood pressure - late sign
Weak peripheral pulses - late sign
A 5-year-old patient presents to the emergency department with severe dehydration
due to viral gastroenteritis. He has signs of shock due to his hypovolemia. Which of
the following physiologic responses to shock has the greatest impact on improving
cardiac output in the pediatric patient? - ANSWER Increasing heart rate
Pathophysiology: Cardiac Output. In pediatric patients, cardiac out is primarily
regulate by increasing heart rate
Which of the following patient presentations should increase suspicion of potential
child maltreatment? - ANSWER Bruising to the left ear of a newborn from sleeping
on his side
Pg 10- Any bruises in a non exploratory location (especially torso ears, neck) in
children younger than 4
Pg 11Any bruising in a child younger than 4 months.
All of the vaccine administrations listed are appropriate EXCEPT for which of the
following? - ANSWER Fifth Disease at 6 months
There is an animal vaccine, but not a human vaccine for Fifth Disease.
Which of the following statements indicates the caregiver understands your
discharge teaching on influenza? - ANSWER My child can go to daycare since they
have been off of Tylenol and fever free for 24 hours.
Yes, the patient needs to be afebrile WITHOUT the use of antipyretics to be able to
go back to daycare or school.
