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ABEM Peds EM study materials
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ABEM Peds EM practice questions

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Question 1Pediatric Emergency Medicine

A 3-year-old presents with drooling, tripod positioning, and muffled voice after a febrile illness. Which diagnosis should be suspected first?

  1. Retropharyngeal abscess
  2. Croup
  3. Bacterial tracheitis
  4. Acute epiglottitis Correct answer.

Explanation

The combination of fever, drooling, muffled voice, and tripod posturing in a toxic-appearing child is the classic presentation of acute epiglottitis, a true airway emergency. Airway management takes priority over imaging or phlebotomy.

Question 2Pediatric Emergency Medicine

Which finding best distinguishes bronchiolitis from asthma in a 6-month-old with wheezing?

  1. Diffuse wheeze on auscultation
  2. Prolonged expiratory phase
  3. Improvement with nebulized albuterol
  4. Preceding low-grade fever with coryza and age under 12 months Correct answer.

Explanation

Bronchiolitis is a viral lower respiratory infection most common under 12 months, typically preceded by coryza and low-grade fever. Asthma is uncommon before age 12 months and tends to respond to bronchodilators.

Question 3Pediatric Emergency Medicine

A 2-year-old with 3 days of diarrhea and vomiting is lethargic with sunken eyes and delayed capillary refill. What is the most appropriate initial fluid therapy?

  1. Maintenance fluids only
  2. Oral rehydration solution by mouth
  3. 20 mL/kg isotonic crystalloid bolus Correct answer.
  4. 5 mL/kg isotonic crystalloid bolus

Explanation

Signs of shock with severe dehydration warrant an isotonic crystalloid bolus of 20 mL/kg, reassessed after each bolus. Oral rehydration is reserved for mild to moderate dehydration in alert children.

Question 4Pediatric Emergency Medicine

Which immunization is most strongly associated with intussusception in infants?

  1. DTaP
  2. Hepatitis B vaccine
  3. Pneumococcal conjugate vaccine
  4. Rotavirus vaccine Correct answer.

Explanation

Rotavirus vaccination, particularly the older rotavirus vaccine, has an established association with intussusception in young infants. DTaP, hepatitis B, and PCV are not associated with intussusception.

Question 5Pediatric Emergency Medicine

A 4-year-old has sudden onset of severe abdominal pain with currant-jelly stools. Which imaging study is best for confirming the diagnosis?

  1. Abdominal ultrasound Correct answer.
  2. Upper GI series
  3. Upright abdominal radiograph
  4. CT abdomen with contrast

Explanation

Abdominal ultrasound is the preferred initial imaging for intussusception, showing a target or pseudokidney sign. It is sensitive, specific, and avoids radiation.

Question 6Pediatric Emergency Medicine

Which finding is most characteristic of a febrile seizure?

  1. Focal motor activity lasting 30 minutes
  2. Post-ictal focal deficit
  3. Occurrence in a child with known epilepsy
  4. Generalized tonic-clonic activity lasting under 15 minutes in a child 6 months to 5 years Correct answer.

Explanation

Simple febrile seizures are generalized, brief (under 15 minutes), and occur in children 6 months to 5 years with fever and no CNS infection. Focal or prolonged features suggest complex febrile seizure or another cause.

Question 7Pediatric Emergency Medicine

A 5-year-old is brought after a suspected ingestion of an unknown substance and is lethargic with miosis and respiratory depression. Which antidote should be given empirically?

  1. Atropine
  2. N-acetylcysteine
  3. Naloxone Correct answer.
  4. Flumazenil

Explanation

Miosis with respiratory depression and lethargy suggests opioid toxicity, for which naloxone is the antidote. Flumazenil is avoided in unknown ingestions due to seizure risk.

Question 8Pediatric Emergency Medicine

What is the recommended compression-to-ventilation ratio for two-rescuer CPR in an infant?

  1. 5:1
  2. 15:2 Correct answer.
  3. 30:2
  4. 3:1

Explanation

For two-rescuer pediatric CPR, the compression-to-ventilation ratio is 15:2 to provide more frequent breaths. Single-rescuer CPR uses 30:2.

Question 9Pediatric Emergency Medicine

A 7-year-old with sickle cell disease presents with fever of 39°C. What is the immediate priority?

  1. Transfuse platelets
  2. Give hydroxyurea
  3. Give oral hydration and discharge
  4. Obtain blood cultures and start empiric parenteral antibiotics Correct answer.

Explanation

Fever in a child with sickle cell disease is a medical emergency due to risk of overwhelming sepsis from encapsulated organisms; cultures and prompt antibiotics are indicated.

Question 10Pediatric Emergency Medicine

A 10-year-old with asthma has silent chest, diminished breath sounds, and rising PaCO2. What does this indicate?

  1. Mild exacerbation
  2. Imminent respiratory failure Correct answer.
  3. Anxiety only
  4. Improving status

Explanation

A silent chest and rising PaCO2 in severe asthma signal impending respiratory failure from poor air movement and fatigue. Immediate escalation with ventilatory support is needed.

Question 11Pediatric Emergency Medicine

Which is the most appropriate first-line treatment for anaphylaxis in a child?

  1. Intramuscular epinephrine Correct answer.
  2. Intravenous corticosteroids
  3. Oral diphenhydramine
  4. Nebulized albuterol

Explanation

Intramuscular epinephrine is the first-line treatment for anaphylaxis and should be given immediately. Antihistamines, bronchodilators, and steroids are adjuncts.

Question 12Pediatric Emergency Medicine

A 3-week-old presents with projectile nonbilious vomiting and a palpable olive-shaped mass. What is the most likely diagnosis?

  1. Intussusception
  2. Gastroesophageal reflux
  3. Malrotation with volvulus
  4. Pyloric stenosis Correct answer.

Explanation

Projectile nonbilious vomiting in a 2-6 week old with a palpable olive mass is classic for hypertrophic pyloric stenosis. Ultrasound confirms the diagnosis.

Question 13Pediatric Emergency Medicine

What is the most common cause of bacterial meningitis in a 2-month-old infant?

  1. Haemophilus influenzae type b
  2. Streptococcus pneumoniae
  3. Neisseria meningitidis
  4. Group B Streptococcus Correct answer.

Explanation

In neonates and young infants, group B Streptococcus and gram-negative organisms predominate. S. pneumoniae and N. meningitidis become more common in older children.

Question 14Pediatric Emergency Medicine

A child with a suspected forearm fracture has pain out of proportion, pallor, and pain with passive stretch. What is the most urgent intervention?

  1. Give oral analgesics
  2. Apply ice and splint
  3. Obtain MRI
  4. Remove constricting bandages and elevate the limb Correct answer.

Explanation

These findings suggest compartment syndrome; urgent measures include removing constricting material and elevating the limb, with surgical consultation. Delay risks permanent ischemic injury.

Question 15Pediatric Emergency Medicine

Which feature best supports a diagnosis of Kawasaki disease?

  1. Fever with unilateral joint swelling
  2. Fever with petechiae and hypotension
  3. Fever for 2 days with isolated rash
  4. Fever for 5 days with conjunctivitis, rash, and mucositis Correct answer.

Explanation

Kawasaki disease requires fever for at least 5 days plus characteristic features such as conjunctivitis, rash, mucositis, extremity changes, and cervical lymphadenopathy. Treatment with IVIG prevents coronary complications.

Question 16Pediatric Emergency Medicine

A 2-year-old presents with a barking cough, inspiratory stridor, and hoarse voice. What is the most appropriate initial treatment for moderate croup?

  1. Nebulized albuterol
  2. Oral amoxicillin
  3. Intravenous furosemide
  4. Nebulized epinephrine and dexamethasone Correct answer.

Explanation

Moderate croup is treated with a single dose of dexamethasone and nebulized epinephrine for stridor at rest. Antibiotics and diuretics are not indicated.

Question 17Pediatric Emergency Medicine

What is the initial management of a pediatric patient with suspected tension pneumothorax and hemodynamic instability?

  1. Chest radiograph
  2. Needle decompression Correct answer.
  3. Observation
  4. Tube thoracostomy after imaging

Explanation

Hemodynamic instability with suspected tension pneumothorax requires immediate needle decompression without waiting for imaging. Tube thoracostomy follows.

Question 18Pediatric Emergency Medicine

A 12-year-old with type 1 diabetes presents with vomiting, abdominal pain, and Kussmaul respirations. Which initial fluid strategy is most appropriate?

  1. Oral glucose
  2. Isotonic saline bolus followed by insulin infusion Correct answer.
  3. Immediate insulin bolus before fluids
  4. Free water bolus

Explanation

Diabetic ketoacidosis requires isotonic fluid resuscitation first, followed by insulin infusion once perfusion is restored. Insulin before fluids can worsen hypotension.

Question 19Pediatric Emergency Medicine

Which finding is most concerning for nonaccidental trauma in an infant?

  1. Bruise on the knee after a fall
  2. Single bruise on the shin
  3. Bruising in a nonmobile infant Correct answer.
  4. Minor abrasion on the elbow

Explanation

Bruising in a nonmobile infant (who cannot cruise or walk) is highly concerning for abuse. Minor injuries in ambulatory children are less specific.

Question 20Pediatric Emergency Medicine

A 6-year-old has a headache and fever with nuchal rigidity. Which test is most definitive for bacterial meningitis?

  1. Peripheral white blood cell count
  2. CT head
  3. Lumbar puncture with CSF analysis Correct answer.
  4. Blood cultures

Explanation

Lumbar puncture with CSF analysis, including cell count, protein, glucose, and culture, is definitive for bacterial meningitis. Blood cultures are supportive but not definitive.

Question 21Pediatric Emergency Medicine

Which is the appropriate initial management for a child with a severe asthma exacerbation not responding to albuterol?

  1. Give oral antibiotics
  2. Add ipratropium bromide and systemic corticosteroids Correct answer.
  3. Give acetaminophen
  4. Start antiviral therapy

Explanation

Severe asthma is treated with repeated albuterol, ipratropium, and systemic corticosteroids. Antibiotics and antivirals are not routine.

Question 22Pediatric Emergency Medicine

A 3-year-old is in cardiac arrest with suspected hypovolemia. What is the preferred vascular access approach?

  1. Subcutaneous injection
  2. Peripheral IV only
  3. Intraosseous access Correct answer.
  4. Central venous catheter

Explanation

In pediatric cardiac arrest, intraosseous access is preferred when IV access cannot be rapidly obtained. It provides rapid delivery of fluids and medications.

Question 23Pediatric Emergency Medicine

A 4-year-old with a history of tetralogy of Fallot has a hypercyanotic spell. What is the initial treatment?

  1. Epinephrine
  2. Vasodilators
  3. Knee-chest position and supplemental oxygen Correct answer.
  4. Diuretics

Explanation

Tet spells are managed with knee-chest positioning to increase systemic vascular resistance, oxygen, and fluids. Vasodilators and diuretics worsen the physiology.

Question 24Pediatric Emergency Medicine

Which is the most appropriate management for a febrile infant aged 21 days with a temperature of 38.2°C?

  1. Outpatient urine culture
  2. Observation at home
  3. Antipyretics only
  4. Full sepsis evaluation and empiric antibiotics Correct answer.

Explanation

Febrile infants under 28 days require a full sepsis evaluation and empiric antibiotics due to high risk of serious bacterial infection.

Question 25Pediatric Emergency Medicine

A 9-year-old has sudden severe testicular pain and swelling. What is the most appropriate next step?

  1. Antibiotics and discharge
  2. Warm compresses and observation
  3. Immediate urologic consultation and surgical exploration Correct answer.
  4. Ultrasound before any intervention

Explanation

Testicular torsion is a surgical emergency requiring immediate exploration; salvage depends on time to detorsion. Ultrasound should not delay surgery.

Question 26Pediatric Emergency Medicine

A 6-month-old is brought to the emergency department with a 2-day history of poor feeding, grunting, and a temperature of 39.1°C. On examination the infant is ill-appearing with a bulging fontanelle. Which organism is the most likely cause of this presentation in a fully immunized infant of this age?

  1. Neisseria meningitidis
  2. Listeria monocytogenes
  3. Streptococcus pneumoniae Correct answer.
  4. Escherichia coli

Explanation

Beyond the neonatal period, Streptococcus pneumoniae is the leading cause of bacterial meningitis in infants and children, followed by Neisseria meningitidis. Listeria and E. coli predominate in neonates under about 1 month of age.

Question 27Pediatric Emergency Medicine

A 4-year-old is pulled from a swimming pool and is unresponsive. After opening the airway and finding no normal breathing, what is the correct next step in single-rescuer pediatric CPR?

  1. Give 30 chest compressions before the first breath
  2. Check a pulse for a full 60 seconds
  3. Deliver 2 rescue breaths before starting compressions Correct answer.
  4. Begin compressions at a rate of 60 per minute

Explanation

For a child found unresponsive with no normal breathing, lay-rescuer CPR begins with 2 rescue breaths followed by cycles of 30 compressions to 2 breaths. Compressions are delivered at 100 to 120 per minute.

Question 28Pediatric Emergency Medicine

A 3-year-old is brought after a generalized tonic-clonic seizure that lasted 4 minutes and has now stopped. The child is postictal but vital signs are stable and the temperature is 38.9°C. Which factor most strongly predicts recurrence of febrile seizures?

  1. Family history of febrile seizures in a first-degree relative
  2. Occurrence before 12 months of age Correct answer.
  3. Peak temperature above 40°C
  4. Duration of the seizure longer than 15 minutes

Explanation

Young age at first febrile seizure, particularly under 12 to 18 months, is a strong predictor of recurrence, along with family history and brief duration between fever onset and seizure. Prolonged or focal seizures instead raise concern for epilepsy.

Question 29Pediatric Emergency Medicine

A 7-year-old is brought in with a 3-day history of sore throat, fever, and a diffuse sandpaper-like rash with circumoral pallor. Which finding on examination would best support the suspected diagnosis?

  1. Vesicles on an erythematous base in a dermatomal pattern
  2. Honey-crusted lesions around the nares
  3. Strawberry tongue with palatal petechiae Correct answer.
  4. Koplik spots on the buccal mucosa

Explanation

Scarlet fever from group A streptococcus produces a sandpaper rash, circumoral pallor, and a strawberry tongue with palatal petechiae. Koplik spots indicate measles, dermatomal vesicles indicate zoster, and honey-crusted lesions suggest impetigo.

Question 30Pediatric Emergency Medicine

A 2-year-old is brought in after a witnessed generalized seizure that has continued for 6 minutes. After securing the airway and providing oxygen, what is the most appropriate first-line medication?

  1. Oral levetiracetam
  2. Intravenous fosphenytoin
  3. Intramuscular midazolam or intravenous lorazepam Correct answer.
  4. Intravenous phenobarbital

Explanation

Status epilepticus is first treated with a benzodiazepine, such as intravenous lorazepam or intramuscular midazolam when access is delayed. Second-line agents like fosphenytoin or levetiracetam are used if seizures persist.

Question 31Pediatric Emergency Medicine

A 15-month-old presents with 4 days of fever, conjunctivitis, cracked lips, and a polymorphous rash. An echocardiogram is obtained. Which coronary finding is most characteristic of the suspected diagnosis?

  1. Diffuse coronary vasospasm
  2. Pericardial effusion with tamponade
  3. Dilated coronary arteries or aneurysms Correct answer.
  4. Coronary ostial stenosis

Explanation

Kawasaki disease causes a medium-vessel vasculitis that can dilate the coronary arteries and produce aneurysms, which is why echocardiography is performed. Vasospasm, ostial stenosis, and tamponade are not typical findings.

Question 32Pediatric Emergency Medicine

A 5-year-old with a known peanut allergy develops hives, vomiting, and wheezing minutes after eating a cookie. Intramuscular epinephrine is given. Which medication is the most appropriate adjunct to treat the gastrointestinal symptoms?

  1. Intravenous diphenhydramine Correct answer.
  2. Inhaled ipratropium
  3. Intramuscular epinephrine is the only indicated therapy
  4. Oral prednisone

Explanation

Epinephrine is the cornerstone of anaphylaxis treatment, but H1 antihistamines such as diphenhydramine are used as adjuncts for cutaneous and gastrointestinal symptoms. They do not treat airway or hemodynamic compromise.

Question 33Pediatric Emergency Medicine

A 6-year-old is brought in with a 2-day history of colicky abdominal pain, vomiting, and passage of bloody stools. On examination there is a tender sausage-shaped mass in the right upper quadrant. Which imaging study is most appropriate to confirm the suspected diagnosis?

  1. Upper gastrointestinal series
  2. Abdominal ultrasound Correct answer.
  3. Abdominal CT with contrast
  4. Plain abdominal radiograph

Explanation

Ileocolic intussusception is best confirmed with abdominal ultrasound, which shows a target or pseudokidney sign. Ultrasound is preferred because it avoids radiation and has high sensitivity.

Question 34Pediatric Emergency Medicine

A 3-year-old presents with a 2-day history of fever, drooling, and a muffled voice. The child is sitting forward and refuses to lie down. Which is the most appropriate immediate management step?

  1. Obtain a lateral neck radiograph in the supine position
  2. Obtain a throat swab for rapid strep testing
  3. Inspect the throat with a tongue blade
  4. Keep the child calm and upright while assembling airway equipment Correct answer.

Explanation

Drooling, fever, and a muffled voice suggest epiglottitis, a potential airway emergency. The child should be kept calm and upright, and airway equipment and personnel should be readied before any instrumentation.

Question 35Pediatric Emergency Medicine

A 10-year-old with a known seizure disorder is brought in after a 30-minute generalized seizure. The child received two doses of a benzodiazepine without effect. Which medication is an appropriate second-line agent?

  1. Intravenous morphine
  2. Oral carbamazepine
  3. Intravenous fosphenytoin Correct answer.
  4. Intramuscular haloperidol

Explanation

After benzodiazepines fail, second-line antiseizure medications include fosphenytoin, levetiracetam, or valproate. Fosphenytoin is a standard choice for status epilepticus.

Question 36Pediatric Emergency Medicine

A 2-month-old presents with poor feeding, lethargy, and a temperature of 38.3°C. A full sepsis evaluation is planned. Which factor most strongly determines the need for lumbar puncture in this infant?

  1. The infant's age under 3 months Correct answer.
  2. The infant's weight at presentation
  3. The white blood cell count on complete blood count
  4. The presence of a bulging fontanelle

Explanation

Infants under 3 months with fever require a complete sepsis evaluation including lumbar puncture because signs of meningitis are often subtle and the risk of serious bacterial infection is high. Weight and fontanelle findings do not reliably exclude meningitis.

Question 37Pediatric Emergency Medicine

A 9-year-old falls onto an outstretched hand and reports wrist pain. There is tenderness over the distal radius and mild swelling. Which finding on examination most suggests a fracture requiring immobilization rather than a simple sprain?

  1. Pain reproduced only with finger flexion
  2. Diffuse mild swelling without point tenderness
  3. Point tenderness over the distal radius with pain on axial loading Correct answer.
  4. Full painless range of motion

Explanation

Focal bony tenderness and pain with axial loading suggest a fracture and warrant immobilization and imaging. Diffuse swelling without focal tenderness and full painless motion favor a sprain.

Question 38Pediatric Emergency Medicine

A 4-year-old presents with a 1-day history of fever, ear pain, and a bulging, erythematous, opaque tympanic membrane. The child has no drug allergies. Which is the most appropriate first-line antibiotic?

  1. Trimethoprim-sulfamethoxazole
  2. Azithromycin
  3. Ciprofloxacin
  4. Amoxicillin Correct answer.

Explanation

High-dose amoxicillin is the first-line treatment for acute otitis media in children without penicillin allergy. It covers the common pathogens Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.

Question 39Pediatric Emergency Medicine

A 13-year-old presents with acute onset of scrotal pain that began 2 hours ago. On examination the left hemiscrotum is swollen and tender, and the cremasteric reflex is absent. What is the most appropriate next step?

  1. Apply a warm compress and reassess in 2 hours
  2. Administer antibiotics for epididymitis and discharge
  3. Immediate urologic consultation for surgical exploration Correct answer.
  4. Obtain a scrotal ultrasound before any intervention

Explanation

Acute scrotal pain with an absent cremasteric reflex suggests testicular torsion, which is a surgical emergency. Immediate urologic consultation for exploration is warranted; imaging should not delay detorsion when suspicion is high.

Question 40Pediatric Emergency Medicine

A 5-year-old presents with a 2-day history of fever, sore throat, and a grayish membrane over the tonsils. The child is unimmunized. Which is the most appropriate initial step?

  1. Give corticosteroids to reduce airway swelling
  2. Obtain a throat culture and start antibiotics only after results
  3. Perform an emergency tonsillectomy
  4. Administer diphtheria antitoxin after clinical suspicion Correct answer.

Explanation

The pseudomembrane and unimmunized status suggest diphtheria, which requires prompt antitoxin administration based on clinical suspicion without waiting for culture. Antibiotics are given concurrently.

Question 41Pediatric Emergency Medicine

A 6-year-old is brought in with a 1-day history of fever, headache, and a rash that does not blanch with pressure. The child is alert but has a heart rate of 140 beats per minute and capillary refill of 4 seconds. What is the most appropriate initial intervention?

  1. Oral antibiotics and outpatient follow-up
  2. Intravenous fluid bolus and parenteral antibiotics Correct answer.
  3. Antihistamines and observation
  4. Immediate lumbar puncture before any treatment

Explanation

A nonblanching petechial rash with fever and shock suggests meningococcemia. Prompt fluid resuscitation and parenteral antibiotics are the priorities, and lumbar puncture should not delay treatment.

Question 42Pediatric Emergency Medicine

A 7-year-old with severe asthma exacerbation has received three albuterol treatments and systemic corticosteroids but continues to have severe retractions and hypoxemia. Which therapy is most appropriate to add now?

  1. Subcutaneous epinephrine
  2. Inhaled salmeterol
  3. Oral montelukast
  4. Intravenous magnesium sulfate Correct answer.

Explanation

Intravenous magnesium sulfate is recommended as adjunctive therapy for severe asthma exacerbations that do not respond to standard bronchodilators and corticosteroids. Long-acting beta-agonists and leukotriene modifiers have no role in acute exacerbations.

Question 43Pediatric Emergency Medicine

A 2-year-old is brought in after a generalized tonic-clonic seizure. The child is now awake and behaving normally, and the temperature is 38.6°C. Which factor best distinguishes a simple febrile seizure from a complex one?

  1. Focal features or duration longer than 15 minutes Correct answer.
  2. Peak temperature during the illness
  3. Duration of fever before the seizure
  4. Family history of febrile seizures

Explanation

Complex febrile seizures are defined by focal features, duration longer than 15 minutes, or recurrence within 24 hours. Simple febrile seizures are generalized and brief.

Question 44Pediatric Emergency Medicine

A 14-year-old presents with a 2-day history of severe unilateral scrotal pain, fever, and dysuria. On examination the cremasteric reflex is present and the testis is in normal position. What is the most likely diagnosis?

  1. Hydrocele
  2. Epididymitis Correct answer.
  3. Inguinal hernia
  4. Testicular torsion

Explanation

Epididymitis presents with gradual-onset scrotal pain, fever, dysuria, a preserved cremasteric reflex, and a normally positioned testis. Torsion more often has abrupt onset, an absent cremasteric reflex, and a high-riding testis.

Question 45Pediatric Emergency Medicine

A 3-year-old is brought in with a 2-day history of fever, irritability, and refusal to bear weight on the right leg. On examination there is tenderness over the distal femur with limited range of motion. Which is the most appropriate next step?

  1. Perform an arthrocentesis before any antibiotics
  2. Obtain blood cultures and start empiric intravenous antibiotics Correct answer.
  3. Apply a cast and discharge with orthopedic follow-up
  4. Order an MRI and await results before treating

Explanation

Fever, focal bone tenderness, and refusal to bear weight suggest osteomyelitis or septic arthritis. Blood cultures should be drawn and empiric intravenous antibiotics started promptly; imaging should not delay treatment.

Question 46Pediatric Emergency Medicine

A 4-year-old presents with a 3-day history of fever, cough, and tachypnea. On examination there are crackles over the right lower lobe and oxygen saturation of 89% on room air. Which is the most appropriate disposition?

  1. Discharge with a chest radiograph scheduled as an outpatient
  2. Admit for supplemental oxygen and parenteral antibiotics Correct answer.
  3. Prescribe a bronchodilator and reassess in 24 hours
  4. Discharge with oral antibiotics and follow-up

Explanation

Hypoxemia and focal findings in a child with pneumonia warrant admission for oxygen and parenteral antibiotics. Outpatient management is appropriate only for well-appearing children with adequate oxygenation.

Question 47Pediatric Emergency Medicine

A 2-year-old ingests an unknown number of iron tablets. The child is vomiting and has bloody diarrhea. Which is the most appropriate initial antidote?

  1. Deferoxamine Correct answer.
  2. Naloxone
  3. Activated charcoal alone
  4. N-acetylcysteine

Explanation

Deferoxamine is the chelating antidote for severe iron poisoning, indicated by signs of toxicity or a high serum iron level. N-acetylcysteine treats acetaminophen toxicity, and naloxone reverses opioids.

Question 48Pediatric Emergency Medicine

A 5-year-old is brought in with a 2-day history of fever to 39°C, rash, and red eyes. The child has been treated with amoxicillin for 3 days. On examination there is a diffuse erythematous rash with mucosal involvement and skin peeling. Which diagnosis is most likely?

  1. Measles
  2. Stevens-Johnson syndrome Correct answer.
  3. Scarlet fever
  4. Staphylococcal scalded skin syndrome

Explanation

Stevens-Johnson syndrome presents with fever, mucosal involvement, and a painful erythematous rash with epidermal detachment, often triggered by medications such as antibiotics. Scalded skin syndrome typically lacks mucosal involvement.

Question 49Pediatric Emergency Medicine

A 6-month-old presents with a 1-day history of fever, irritability, and a bulging anterior fontanelle. A lumbar puncture is performed. Which cerebrospinal fluid finding is most consistent with bacterial meningitis?

  1. Elevated white blood cell count with neutrophil predominance and low glucose Correct answer.
  2. Normal white blood cell count with high glucose
  3. Elevated white blood cell count with lymphocyte predominance and normal glucose
  4. Elevated red blood cell count with normal protein

Explanation

Bacterial meningitis typically produces a neutrophilic pleocytosis, low glucose, and elevated protein. Viral meningitis more often shows lymphocyte predominance with normal glucose.

Question 50Pediatric Emergency Medicine

A 1-year-old presents with a 2-day history of fever, drooling, and difficulty swallowing. On examination there is a swollen, erythematous epiglottis. Which is the most appropriate airway management approach?

  1. Await spontaneous improvement with observation
  2. Prepare for controlled intubation in the operating room with anesthesia and ENT present Correct answer.
  3. Perform immediate blind nasotracheal intubation
  4. Obtain a CT scan of the neck before airway management

Explanation

Suspected epiglottitis requires controlled airway management in the operating room with anesthesia and otolaryngology present, ideally with the child kept calm. Blind intubation and imaging delays risk airway loss.