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ABP Pediatric Emergency Medicine study materials
ABP Pediatric Emergency Medicine study resources

ABP Pediatric Emergency Medicine practice questions

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Question 1Pediatric Emergency Medicine content areas per ABP Subspecialty Content Outlines (weights not enumerated in source)

A 3-year-old is brought in after a witnessed tonic-clonic seizure lasting about 90 seconds that has now stopped. He is awake but postictal. Which single feature most strongly predicts recurrence of seizure in the next 24 hours?

  1. A seizure lasting more than 15 minutes or focal features Correct answer.
  2. A seizure accompanied by fever in a child under 5 years
  3. A seizure occurring during sleep in a neurologically normal child
  4. A first unprovoked seizure lasting under 2 minutes

Explanation

Prolonged duration (generally >15 minutes) and focal onset are recognized predictors of early seizure recurrence after a first unprovoked seizure, so these children warrant closer observation or EEG. Brief, generalized, self-limited seizures in an otherwise well child have lower immediate recurrence risk.

Question 2Pediatric Emergency Medicine content areas per ABP Subspecialty Content Outlines (weights not enumerated in source)

Which finding in a 6-week-old infant with vomiting most reliably distinguishes pyloric stenosis from a viral gastroenteritis?

  1. Bilious emesis occurring after every feed
  2. Nonbilious projectile vomiting with a palpable olive-shaped mass Correct answer.
  3. Watery diarrhea accompanying the vomiting
  4. Low-grade fever and household contact with gastroenteritis

Explanation

Hypertrophic pyloric stenosis classically presents at 3 to 6 weeks with progressive nonbilious projectile vomiting and a palpable pyloric olive; the vomiting is nonbilious because the obstruction is proximal to the ampulla. Gastroenteritis typically produces diarrhea and lacks a palpable mass.

Question 3Pediatric Emergency Medicine content areas per ABP Subspecialty Content Outlines (weights not enumerated in source)

A 4-year-old with asthma has diffuse wheezing, speaks in short phrases, and has an oxygen saturation of 89% on room air after three albuterol nebulizations. What is the most appropriate next step?

  1. Obtain a chest radiograph before giving any further bronchodilator therapy
  2. Begin continuous albuterol with supplemental oxygen and systemic corticosteroids Correct answer.
  3. Add ipratropium and continue observation in the emergency department
  4. Discharge home with an oral corticosteroid course

Explanation

Hypoxemia and inability to speak in full sentences mark a severe asthma exacerbation, which requires oxygen to maintain saturation, repeated or continuous inhaled beta-agonist, and early systemic corticosteroids. Imaging is reserved for suspected complications or atypical presentations.

Question 4Pediatric Emergency Medicine content areas per ABP Subspecialty Content Outlines (weights not enumerated in source)

A 10-month-old presents with a 3-day history of rhinorrhea, low-grade fever, and barky cough with inspiratory stridor at rest. Which intervention is the most appropriate initial therapy?

  1. Oral amoxicillin for 10 days
  2. Nebulized albuterol alone
  3. Immediate endotracheal intubation
  4. Nebulized racemic epinephrine plus a single dose of oral dexamethasone Correct answer.

Explanation

Croup with stridor at rest is managed with a single dose of systemic corticosteroid and nebulized epinephrine for moderate to severe symptoms. Antibiotics and beta-agonists are not effective for viral subglottic edema.

Question 5Pediatric Emergency Medicine content areas per ABP Subspecialty Content Outlines (weights not enumerated in source)

A 5-year-old is brought in with sudden onset of drooling, muffled voice, and difficulty swallowing, sitting forward and refusing to lie down. He appears toxic and has a high fever. What is the most appropriate immediate management step?

  1. Keep the child in a position of comfort and arrange urgent airway management in the operating room Correct answer.
  2. Give oral antibiotics and observe for one hour
  3. Inspect the posterior pharynx with a tongue blade
  4. Obtain a lateral neck radiograph before any intervention

Explanation

The presentation is consistent with epiglottitis, an airway emergency. The child should be kept calm in a position of comfort while personnel skilled in airway management prepare to secure the airway in a controlled setting.

Question 6Pediatric Emergency Medicine content areas per ABP Subspecialty Content Outlines (weights not enumerated in source)

Which combination of findings is most consistent with a diagnosis of diabetic ketoacidosis in a newly presenting child?

  1. Hypoglycemia, metabolic alkalosis, and low urine ketones
  2. Hyperglycemia, venous pH below 7.3, and elevated beta-hydroxybutyrate Correct answer.
  3. Normal glucose, respiratory alkalosis, and elevated lactate
  4. Hyperglycemia, metabolic alkalosis, and normal anion gap

Explanation

DKA is defined by hyperglycemia, a metabolic acidosis (venous pH < 7.3 or bicarbonate < 15 mEq/L), and ketonemia or significant ketonuria. Beta-hydroxybutyrate is the predominant ketone in DKA.

Question 7Pediatric Emergency Medicine content areas per ABP Subspecialty Content Outlines (weights not enumerated in source)

During treatment of a child with diabetic ketoacidosis, which practice most reduces the risk of cerebral edema?

  1. Rapid bolus of hypertonic saline at presentation for all patients
  2. Gradual rehydration with isotonic fluid and slow correction of hyperglycemia and osmolality Correct answer.
  3. Rapid normalization of glucose using high-dose intravenous insulin boluses
  4. Avoiding fluid boluses entirely and restricting total fluids

Explanation

Cerebral edema risk is reduced by gradual isotonic rehydration, avoiding overly rapid osmotic shifts, and using continuous low-dose insulin rather than boluses. Hypertonic saline or mannitol is used to treat established cerebral edema, not routinely at presentation.

Question 8Pediatric Emergency Medicine content areas per ABP Subspecialty Content Outlines (weights not enumerated in source)

A 2-year-old is evaluated for a possible ingested button battery. Which statement about management is correct?

  1. Button batteries that reach the stomach can be left in place indefinitely
  2. Button batteries are radiologically indistinguishable from coins and need no imaging
  3. Button batteries in the esophagus require emergent endoscopic removal Correct answer.
  4. Asymptomatic esophageal batteries may be observed with repeat films in one week

Explanation

A button battery lodged in the esophagus is a true emergency because it can cause liquefactive tissue injury within hours, so emergent endoscopic removal is indicated. Batteries in the stomach may be observed in selected asymptomatic patients but not indefinitely.

Question 9Pediatric Emergency Medicine content areas per ABP Subspecialty Content Outlines (weights not enumerated in source)

A 6-year-old is brought in after a drowning event and is now asymptomatic with normal vital signs and normal oxygen saturation. Which factor most strongly influences the decision to observe versus discharge?

  1. The duration of submersion and need for any resuscitation Correct answer.
  2. The presence of a parent at the scene
  3. The child's reported fear during the event
  4. The temperature of the water

Explanation

The need for resuscitation and the duration of submersion are the strongest predictors of subsequent respiratory deterioration after drowning. Children who are asymptomatic with normal oxygenation after brief submersion generally can be observed for a period and discharged if stable.

Question 10Pediatric Emergency Medicine content areas per ABP Subspecialty Content Outlines (weights not enumerated in source)

Which electrolyte and acid-base pattern is most typical of a child with severe acute gastroenteritis and dehydration?

  1. Hyperkalemia with metabolic acidosis
  2. Hyponatremia or normonatremia with metabolic acidosis and low bicarbonate Correct answer.
  3. Hypernatremia with metabolic alkalosis
  4. Hypokalemia with metabolic alkalosis

Explanation

Gastrointestinal losses of bicarbonate-rich fluid produce a non-anion-gap metabolic acidosis, and sodium may be low or normal depending on losses and intake. Potassium is typically depleted despite normal or low serum values.

Question 11Pediatric Emergency Medicine content areas per ABP Subspecialty Content Outlines (weights not enumerated in source)

A 3-year-old is brought in with a 2-day history of bloody diarrhea, decreased urine output, and lethargy. Labs show anemia, thrombocytopenia, and elevated creatinine with schistocytes on smear. What is the most likely diagnosis?

  1. Hemolytic uremic syndrome Correct answer.
  2. Henoch-Schonlein purpura
  3. Acute lymphoblastic leukemia
  4. Intussusception

Explanation

The triad of microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury after a diarrheal illness is classic for hemolytic uremic syndrome, most often associated with Shiga toxin-producing E. coli.

Question 12Pediatric Emergency Medicine content areas per ABP Subspecialty Content Outlines (weights not enumerated in source)

A 4-year-old with a known ventricular shunt presents with headache, vomiting, and lethargy. Which initial step is most appropriate while awaiting imaging?

  1. Oral acetaminophen and discharge with follow-up
  2. Flat bed rest with observation for six hours
  3. Immediate lumbar puncture to rule out meningitis
  4. Urgent neurosurgical consultation and noncontrast head CT or rapid-sequence MRI Correct answer.

Explanation

Shunt malfunction or infection must be evaluated urgently; neuroimaging is the first step to assess ventricular size and shunt position, with early neurosurgical involvement. Lumbar puncture is deferred until increased intracranial pressure is excluded.

Question 13Pediatric Emergency Medicine content areas per ABP Subspecialty Content Outlines (weights not enumerated in source)

A 15-year-old presents with sudden-onset severe testicular pain that began two hours ago. Examination shows a high-riding testis with an absent cremasteric reflex. What is the most appropriate next step?

  1. Apply a heating pad and scrotal support
  2. Obtain a scrotal ultrasound before any intervention
  3. Prescribe antibiotics for epididymitis and reassess in 24 hours
  4. Attempt manual detorsion or immediate urologic consultation for exploration Correct answer.

Explanation

Testicular torsion is a surgical emergency; salvage rates fall sharply with time. Immediate urologic consultation for exploration, or manual detorsion when feasible, should not be delayed for imaging when the clinical picture is classic.

Question 14Pediatric Emergency Medicine content areas per ABP Subspecialty Content Outlines (weights not enumerated in source)

A 12-year-old presents with a severe headache, photophobia, and neck stiffness. Which finding would most strongly support bacterial meningitis and prompt immediate empiric antibiotics?

  1. Clear rhinorrhea and a normal mental status
  2. Isolated headache relieved by acetaminophen
  3. Petechial rash with altered mental status and hypotension Correct answer.
  4. Gradual onset over two weeks with no fever

Explanation

Petechiae, altered mental status, and shock are red flags for bacterial meningitis, particularly meningococcal disease, and mandate immediate empiric antibiotics and resuscitation. Antibiotics should not be delayed for lumbar puncture in an unstable child.

Question 15Pediatric Emergency Medicine content areas per ABP Subspecialty Content Outlines (weights not enumerated in source)

A 6-year-old with sickle cell disease presents with fever of 39 degrees Celsius and no localizing symptoms. Which management is most appropriate?

  1. Give oral fluids and reassess in 24 hours
  2. Discharge with antipyretics and outpatient follow-up
  3. Obtain blood cultures and give empiric intravenous antibiotics promptly Correct answer.
  4. Wait for culture results before starting antibiotics

Explanation

Children with sickle cell disease are functionally asplenic and at high risk for overwhelming bacterial sepsis, so fever warrants prompt cultures and empiric parenteral antibiotics, typically covering encapsulated organisms.

Question 16Pediatric Emergency Medicine content areas per ABP Subspecialty Content Outlines (weights not enumerated in source)

A 7-year-old is brought in after a witnessed generalized seizure that has lasted continuously for 12 minutes. After securing the airway and establishing IV access, what is the most appropriate first-line pharmacologic therapy?

  1. Intravenous fosphenytoin
  2. Intravenous levetiracetam loading
  3. Intravenous lorazepam Correct answer.
  4. Oral phenytoin

Explanation

Status epilepticus is managed first with a benzodiazepine such as intravenous lorazepam to terminate the seizure, followed by a second-line antiseizure medication if the seizure persists. Levetiracetam and fosphenytoin are second-line agents.

Question 17Resuscitation and Critical Care

A 6-month-old is apneic and pulseless. According to pediatric basic life support, what compression-to-ventilation ratio should be used when two rescuers are present?

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

Explanation

For infants and children receiving two-rescuer CPR, a compression-to-ventilation ratio of 15:2 is recommended to provide more frequent breaths given the likelihood of a respiratory cause of arrest. Single rescuers use 30:2. High ratios such as 5:1 or 3:1 are not part of current pediatric BLS guidance.

Question 18Resuscitation and Critical Care

A 4-year-old is in cardiac arrest. What is the recommended chest compression depth for this child?

  1. At least 6 cm regardless of size
  2. Exactly half the chest diameter
  3. About 1 cm to avoid organ injury
  4. About one third of the anteroposterior chest diameter Correct answer.

Explanation

Pediatric compressions should depress the chest by approximately one third of the anteroposterior diameter, roughly 4 cm in infants and 5 cm in children. Depth should be adequate to generate perfusion while allowing full recoil. Fixed depths and very shallow compressions do not match pediatric guidance.

Question 19Resuscitation and Critical Care

An infant is unresponsive and not breathing normally. Which pulse check is most appropriate to determine whether chest compressions are needed?

  1. Radial pulse for 30 seconds
  2. Femoral pulse for 60 seconds
  3. Brachial pulse for no more than 10 seconds Correct answer.
  4. Carotid pulse for 10 seconds

Explanation

In infants the brachial artery is the recommended site for pulse assessment, and the check should take no more than 10 seconds so that compressions are not delayed. If a pulse is absent or uncertain, compressions should begin. Carotid and radial sites are less reliable in infants.

Question 20Resuscitation and Critical Care

A child in respiratory arrest has a palpable pulse but is not breathing. What is the most appropriate initial ventilatory support?

  1. Chest compressions alone
  2. High-flow nasal cannula at 2 L/min
  3. Bag-mask ventilation with 100% oxygen Correct answer.
  4. Immediate intubation before any ventilation

Explanation

In respiratory arrest with a pulse, rescue breathing should begin promptly, and bag-mask ventilation with high-concentration oxygen is the first-line approach. Effective bag-mask ventilation is preferred over immediate advanced airway placement. Compressions are not indicated while a good pulse is present.

Question 21Resuscitation and Critical Care

Which rhythm is most commonly associated with sudden cardiac arrest in children?

  1. Ventricular fibrillation
  2. Asystole Correct answer.
  3. Sinus bradycardia
  4. Atrial flutter

Explanation

Most pediatric arrests are asystolic or pulseless electrical activity, typically following respiratory failure or shock. Ventricular fibrillation is less common in children than in adults, though it must be recognized when present. Bradycardia and atrial flutter are not typical arrest rhythms.

Question 22Resuscitation and Critical Care

A 2-year-old is in ventricular fibrillation. After one shock and two minutes of CPR, the rhythm remains ventricular fibrillation. What is the recommended next pharmacologic step?

  1. Calcium chloride 20 mg/kg IV/IO
  2. Amiodarone 5 mg/kg IV/IO bolus Correct answer.
  3. Epinephrine 0.01 mg/kg IV/IO
  4. Sodium bicarbonate 1 mEq/kg IV/IO

Explanation

For shock-refractory ventricular fibrillation or pulseless ventricular tachycardia, amiodarone is given after the second shock at 5 mg/kg IV/IO, and epinephrine is administered around the shock cycles. Amiodarone is the antiarrhythmic of choice in this setting. Bicarbonate and calcium are not routine arrest medications.

Question 23Resuscitation and Critical Care

During resuscitation of a 10-kg child, what is the appropriate initial IV/IO dose of epinephrine for cardiac arrest?

  1. 0.01 mg/kg of the 0.1 mg/mL concentration Correct answer.
  2. 1 mg flat dose regardless of weight
  3. 0.1 mg/kg of the 0.1 mg/mL concentration
  4. 0.05 mg/kg of the 1 mg/mL concentration

Explanation

The cardiac arrest dose of epinephrine is 0.01 mg/kg (0.1 mL/kg of the 0.1 mg/mL solution), repeated every 3 to 5 minutes. This equals 0.1 mg for a 10-kg child. Using the concentrated 1 mg/mL solution at these volumes risks a tenfold overdose.

Question 24Resuscitation and Critical Care

A child is found unresponsive and pulseless after a witnessed collapse. What is the correct initial defibrillation energy for biphasic defibrillation?

  1. 4 J/kg
  2. 2 J/kg Correct answer.
  3. 1 J/kg
  4. 0.5 J/kg

Explanation

The initial dose for defibrillation in children is 2 J/kg, with subsequent shocks at 4 J/kg or higher (not exceeding adult maximum settings). Lower energies may fail to terminate the arrhythmia. Escalation is used if the initial shock is ineffective.

Question 25Resuscitation and Critical Care

A 5-year-old is in septic shock with hypotension despite 40 mL/kg of crystalloid. Which vasoactive infusion is recommended as first-line for fluid-refractory septic shock?

  1. Phenylephrine infusion
  2. Dopamine at high dose
  3. Epinephrine or norepinephrine infusion Correct answer.
  4. Vasopressin as first-line

Explanation

For fluid-refractory septic shock, epinephrine or norepinephrine is recommended as the first-line vasoactive agent depending on the shock phenotype. Dopamine is no longer preferred because of higher arrhythmia risk. Phenylephrine and vasopressin are not first-line choices.

Question 26Resuscitation and Critical Care

A 3-year-old has a heart rate of 60/min with poor perfusion and hypotension after a drowning event. What is the most appropriate immediate action?

  1. Apply transcutaneous pacing pads
  2. Give atropine 0.5 mg IV
  3. Start chest compressions Correct answer.
  4. Give a 20 mL/kg fluid bolus

Explanation

Bradycardia with poor perfusion and hypotension in a child is treated as cardiac arrest; chest compressions should be started immediately. Compressions provide perfusion while the underlying cause is addressed. Atropine and pacing are not the initial step in this scenario.

Question 27Resuscitation and Critical Care

A child with severe asthma has increasing respiratory fatigue, a silent chest, and rising PaCO2. What is the most appropriate next step?

  1. Start noninvasive ventilation as definitive therapy
  2. Give oral corticosteroids and discharge
  3. Continue nebulized albuterol alone
  4. Prepare for endotracheal intubation and mechanical ventilation Correct answer.

Explanation

A silent chest with rising PaCO2 indicates impending respiratory failure, and the child requires airway control and mechanical ventilation. Continued bronchodilator therapy alone is insufficient at this stage. Noninvasive support may be trialed but is not definitive when fatigue is advanced.

Question 28Resuscitation and Critical Care

A 6-year-old in cardiac arrest has received two doses of epinephrine without return of spontaneous circulation. Which reversible cause should be specifically considered and treated?

  1. Tension pneumothorax Correct answer.
  2. Hyperkalemia
  3. Hypoglycemia
  4. Hyperthermia

Explanation

Tension pneumothorax is a common reversible cause of pediatric arrest and requires immediate needle decompression. Other reversible causes include hypoxia, hypovolemia, acidosis, and toxins. Hypoglycemia and hyperkalemia are also treatable but are less commonly the primary driver in this context.

Question 29Resuscitation and Critical Care

A 1-year-old is unresponsive and apneic after a witnessed choking episode. The child is now limp. What is the correct sequence?

  1. Perform abdominal thrusts until the object is expelled
  2. Give five back blows and reassess
  3. Attempt blind finger sweeps
  4. Begin CPR with compressions and ventilations Correct answer.

Explanation

Once an obstructed child becomes unresponsive, CPR should begin with compressions and ventilations, and the airway should be inspected when opening it. Blind finger sweeps are contraindicated because they can push the object deeper. Abdominal thrusts are for the conscious choking child.

Question 30Resuscitation and Critical Care

A 7-year-old is in refractory shock with suspected adrenal insufficiency. Which medication should be considered?

  1. Fludrocortisone
  2. Levothyroxine
  3. Insulin
  4. Hydrocortisone Correct answer.

Explanation

Hydrocortisone is recommended for children with catecholamine-resistant shock and suspected or confirmed adrenal insufficiency. It addresses cortisol deficiency that impairs vasopressor responsiveness. Fludrocortisone, levothyroxine, and insulin are not indicated in this acute setting.

Question 31Resuscitation and Critical Care

A 4-year-old is being ventilated after intubation. Capnography shows an abrupt loss of waveform and falling oxygen saturation. What is the most likely cause?

  1. Mild bronchospasm
  2. Hyperventilation
  3. Endotracheal tube dislodgement Correct answer.
  4. Adequate tube position

Explanation

An abrupt loss of the capnography waveform with desaturation strongly suggests tube dislodgement or obstruction. Immediate reassessment of tube position and patency is required. Bronchospasm typically produces a sloped waveform rather than complete loss.

Question 32Resuscitation and Critical Care

A 9-year-old with a severe traumatic brain injury has a Glasgow Coma Scale score of 6. Which combination best supports cerebral perfusion?

  1. Permissive hypotension and hyperventilation to a PaCO2 of 25 mm Hg
  2. Maintain normotension, normocapnia, and head elevation Correct answer.
  3. Aggressive hyperventilation and fluid restriction
  4. Flat positioning with permissive hypercapnia

Explanation

In pediatric traumatic brain injury, maintaining adequate blood pressure, normal ventilation, and slight head elevation optimizes cerebral perfusion while avoiding secondary injury. Hyperventilation is reserved for impending herniation because it reduces cerebral blood flow. Hypotension and hypercapnia worsen outcomes.

Question 33Trauma and Injury Prevention

A 6-year-old is brought to the emergency department after a fall. Which finding is most consistent with a severe traumatic brain injury by Glasgow Coma Scale score?

  1. GCS of 8 with no eye opening to pain Correct answer.
  2. GCS of 15 with a scalp hematoma
  3. GCS of 13 with vomiting once
  4. GCS of 14 with brief confusion

Explanation

Severe traumatic brain injury is defined by a post-resuscitation Glasgow Coma Scale score of 8 or less. Scores of 13 to 15 represent mild injury and 9 to 12 moderate injury. A score of 8 with absent eye opening reflects severely depressed consciousness.

Question 34Trauma and Injury Prevention

Which is the most appropriate first-line method to estimate the weight of a critically injured child when the weight is unknown and a length-based tape is unavailable?

  1. Apply an age-based formula such as (age in years x 2) + 8 kg Correct answer.
  2. Assume a weight of 20 kg for all children
  3. Weigh the child on the stretcher scale after resuscitation
  4. Use the parent's estimate of weight

Explanation

When actual weight is unknown, age-based formulas such as (age x 2) + 8 kg provide a rapid estimate for children roughly 1 to 10 years old. This guides drug dosing and equipment sizing during resuscitation. Length-based tapes are preferred when available because they correlate better with true weight.

Question 35Trauma and Injury Prevention

A child sustains a burn to the anterior trunk and the entire right arm. Using the pediatric rule of nines, what percentage of total body surface area is affected?

  1. 22% Correct answer.
  2. 27%
  3. 36%
  4. 18%

Explanation

In children the anterior trunk is approximately 18% and each entire upper limb is approximately 9% of total body surface area. Adding 18% and 9% gives 22%. The pediatric rule of nines differs from the adult version because the head is proportionally larger and the lower limbs smaller.

Question 36Trauma and Injury Prevention

Which of the following is the recommended primary injury-prevention counseling for an infant car seat at discharge from the newborn nursery?

  1. Rear-facing in the back seat until at least age 2 years or until outgrowing the seat Correct answer.
  2. Booster seat use beginning at 6 months of age
  3. Forward-facing in the front seat once the infant reaches 9 kg
  4. Rear-facing in the front seat with the airbag active

Explanation

Current guidance recommends keeping children rear-facing in the back seat as long as possible, typically until at least 2 years of age or until they exceed the rear-facing seat's height or weight limit. The back seat avoids airbag-related injury. Forward-facing and booster transitions occur only after outgrowing the rear-facing seat.

Question 37Trauma and Injury Prevention

A 3-year-old presents with a spiral fracture of the humerus. The history is vague and inconsistent with the injury pattern. Which feature most raises concern for non-accidental trauma?

  1. The child cried during the examination
  2. The caregiver delays seeking care and gives changing explanations Correct answer.
  3. The fracture occurred during documented rough play
  4. The child has a history of one prior healed forearm fracture

Explanation

Inconsistent or evolving histories and delayed presentation are red flags for child abuse. Certain fracture patterns, including spiral fractures in non-ambulatory children, also warrant evaluation. The combination of a suspicious mechanism and inconsistent caregiver account should prompt a thorough assessment and reporting per local mandates.

Question 38Trauma and Injury Prevention

A 10-year-old is struck by a car and has a distended abdomen with hypotension after 20 mL/kg of crystalloid. Which is the most appropriate next step in management?

  1. Give a second 20 mL/kg bolus and observe
  2. Obtain a CT scan of the abdomen before further resuscitation
  3. Perform diagnostic peritoneal lavage
  4. Transfuse packed red blood cells and activate massive transfusion as needed Correct answer.

Explanation

Hemodynamic instability with abdominal distension after a blunt trauma suggests ongoing hemorrhage, often from a solid organ injury. In an unstable child, blood products should be given early rather than repeated crystalloid, and operative or angiographic control considered. CT scanning is reserved for hemodynamically stable patients.

Question 39Trauma and Injury Prevention

A child has a suspected cervical spine injury after a diving accident. Which maneuver best maintains spinal alignment during airway management?

  1. Turning the head to the side to clear secretions
  2. Manual in-line stabilization with jaw thrust Correct answer.
  3. Hyperextension of the neck to open the airway
  4. Head tilt-chin lift without stabilization

Explanation

Manual in-line stabilization limits cervical movement while allowing airway maneuvers. A jaw thrust avoids extending the neck and is preferred in suspected cervical injury. Head tilt and neck extension can worsen a spinal injury.

Question 40Trauma and Injury Prevention

A 7-year-old with a head injury has a Glasgow Coma Scale score of 15 and no vomiting or loss of consciousness. Which statement best reflects current guidance on imaging?

  1. Observation without imaging is reasonable when validated clinical decision rules indicate low risk Correct answer.
  2. CT of the head is mandatory for all head injuries
  3. MRI of the brain should be obtained emergently
  4. Skull radiographs should be obtained to exclude fracture

Explanation

Validated pediatric clinical decision rules can identify children at very low risk of clinically important traumatic brain injury, allowing observation rather than CT. This limits radiation exposure. Skull radiographs and emergent MRI are not first-line in this setting.

Question 41Trauma and Injury Prevention

A 4-year-old has a suspected open tibial fracture with active bleeding. Which action should be performed first?

  1. Splint the leg in its deformed position
  2. Obtain radiographs of the leg
  3. Apply direct pressure to control hemorrhage Correct answer.
  4. Administer intravenous antibiotics

Explanation

Life-threatening hemorrhage takes priority over imaging and definitive orthopedic care. Direct pressure controls bleeding before splinting or radiographic evaluation. Antibiotics for open fractures are important but follow hemorrhage control.

Question 42Trauma and Injury Prevention

Which finding in a child after blunt chest trauma most strongly suggests a tension pneumothorax?

  1. Localized chest wall tenderness
  2. Isolated rib fracture on radiograph
  3. Tracheal deviation away from the affected side with hypotension Correct answer.
  4. Subcutaneous emphysema without respiratory distress

Explanation

Tension pneumothorax produces progressive respiratory and hemodynamic compromise with mediastinal shift, manifesting as tracheal deviation away from the affected side and hypotension. It is a clinical diagnosis requiring immediate decompression. Tenderness, isolated rib fracture, and subcutaneous emphysema alone do not indicate tension physiology.

Question 43Trauma and Injury Prevention

A 12-year-old falls onto an outstretched hand and has wrist pain. Which injury pattern is most common in this age group?

  1. Ulnar shaft fracture
  2. Distal radius fracture Correct answer.
  3. Scaphoid fracture
  4. Carpal dislocation

Explanation

Distal radius fractures are the most common pediatric fractures, frequently resulting from a fall onto an outstretched hand. Scaphoid fractures are less common in children than in adults. Carpal dislocations and isolated ulnar shaft fractures are rare.

Question 44Trauma and Injury Prevention

A 5-year-old has a partial-thickness scald burn to the chest. Which intervention most directly reduces the depth of the burn in the first minutes after injury?

  1. Applying ice directly to the burn
  2. Applying butter or oil to the wound
  3. Cool running water for approximately 20 minutes Correct answer.
  4. Covering the burn with a dry sterile dressing only

Explanation

Prompt cooling with running water for about 20 minutes limits burn progression and reduces pain. Ice and topical home remedies can worsen tissue injury or cause hypothermia. Dressings are important after cooling but do not by themselves limit depth.

Question 45Trauma and Injury Prevention

A 2-year-old presents after a witnessed fall from a bunk bed. Which finding most strongly suggests a skull fracture requiring further evaluation?

  1. A small scalp abrasion
  2. Mild localized scalp swelling
  3. Bilateral periorbital ecchymosis Correct answer.
  4. A single episode of crying

Explanation

Raccoon eyes (bilateral periorbital ecchymosis) can indicate a basilar skull fracture and warrant imaging and close observation. Scalp abrasions, crying, and mild localized swelling are common and nonspecific. Any suspected basilar skull fracture should prompt careful evaluation for associated injury.

Question 46Trauma and Injury Prevention

A 9-year-old is rescued from a house fire and has soot in the oropharynx, hoarseness, and singed nasal hairs. Which is the most appropriate immediate action?

  1. Obtain a chest radiograph before any airway management
  2. Secure the airway early with intubation Correct answer.
  3. Observe for 6 hours before intervening
  4. Administer nebulized albuterol and discharge

Explanation

Soot in the oropharynx, hoarseness, and singed nasal hairs suggest inhalation injury with impending airway edema. Early intubation before edema progresses is critical. Waiting or relying on radiographs risks a lost airway.

Question 47Trauma and Injury Prevention

A 6-year-old is in cardiac arrest after a bicycle crash with suspected massive hemorrhage. Which approach best reflects damage-control resuscitation?

  1. Rapid administration of vasopressors before hemorrhage control
  2. Large-volume crystalloid boluses to restore blood pressure
  3. Aggressive diuresis to prevent pulmonary edema
  4. Balanced blood product transfusion with permissive hypotension until hemorrhage control Correct answer.

Explanation

Damage-control resuscitation emphasizes early balanced blood products, limited crystalloid, and permissive hypotension until hemorrhage is controlled. This reduces dilutional coagulopathy and acidosis. Vasopressors before hemorrhage control and diuresis are not appropriate.

Question 48Trauma and Injury Prevention

A 13-year-old has a suspected pelvic fracture after a high-speed collision with hypotension. Which initial maneuver is most appropriate while awaiting definitive care?

  1. Insert a urinary catheter before any stabilization
  2. Apply a pelvic binder at the level of the greater trochanters Correct answer.
  3. Place the patient in the Trendelenburg position for 30 minutes
  4. Perform repeated log-rolling to assess stability

Explanation

A pelvic binder applied at the level of the greater trochanters reduces pelvic volume and helps tamponade bleeding in suspected unstable pelvic fractures. Repeated manipulation can dislodge clots and worsen hemorrhage. Urinary catheterization should follow stabilization and assessment for urethral injury.

Question 49Toxicology and Environmental Emergencies

A 3-year-old is brought to the emergency department 45 minutes after swallowing an unknown number of adult iron tablets. Which finding best indicates serious iron toxicity and the need for aggressive chelation therapy?

  1. A normal abdominal radiograph
  2. Vomiting and abdominal pain alone
  3. Transient nausea that resolves within one hour
  4. Serum iron level and clinical status including metabolic acidosis and shock Correct answer.

Explanation

Severe iron poisoning is assessed by the combination of serum iron concentration, estimated ingestion, and clinical signs such as metabolic acidosis, shock, and hepatic injury. Vomiting and abdominal pain are common early findings and are not specific for severe toxicity. Radiographs may be normal because iron tablets are not always radiopaque.

Question 50Toxicology and Environmental Emergencies

A child presents with a classic opioid toxidrome after suspected ingestion of a parent's medication. Which finding is most characteristic?

  1. Bradycardia with hypertension and piloerection
  2. Mydriasis with tachycardia and agitation
  3. Hyperthermia with dry flushed skin
  4. Pinpoint pupils with respiratory depression and depressed mental status Correct answer.

Explanation

Opioids produce the triad of miosis, respiratory depression, and central nervous system depression. Naloxone reverses this toxidrome. The other choices describe anticholinergic, sympathomimetic, or clonidine-like patterns.