Question 1

Your patient is an eight-year-old girl. As you approach her, you note that she is holding her right arm against her body, cradling it with the left arm. To find out what happened, which of the following is the best approach?

Accepted Answer

A)   Ask the parents to tell you what happened while you examine the child.
B)   Sit next to the patient and ask her what happened.
C)   Take the parents aside and ask them what happened.
D)   Ask the parents to leave the room so you can talk to the patient. B

Question 2

Which of the following conditions does NOT cause an upper airway obstruction?

Accepted Answer

A)   Epiglottitis
B)   Croup
C)   Bacterial tracheitis
D)   Asthma D

Question 3

A 16-year-old girl has been complaining of abdominal pain, nausea, polyuria, and polydipsia for the past 4 days. She has no significant medical history. You suspect she may be suffering from:

Accepted Answer

A)   ovarian cysts.
B)   diabetic ketoacidosis.
C)   meningitis.
D)   ectopic pregnancy. B

Question 4

Which of the following best explains the cause of sudden infant death syndrome (SIDS)?

Accepted Answer

A)   Congenital absence of the Hering-Breuer reflex
B)   SIDS, by definition, has no identifiable cause.
C)   Diffuse axonal injury occurring due to "shaken baby syndrome"
D)   Aspiration of vomited formula or breast milk

Question 5

You are at the scene of a collision involving a school bus carrying elementary school age children. You are concerned that some of the children may have spinal injuries. Which of the following is TRUE of cervical spine injuries in children?

Accepted Answer

A)   They are more often due to penetrating trauma than in adults.
B)   The heavier head of the child increases the incidence of cervical distraction injuries.
C)   Pediatric patients do not require cervical spine immobilization, as their bodies will self-splint the injury.
D)   The pediatric cervical spine should be immobilized in a position of moderate hyperextension.

Question 6

Your patient is a seven-month-old boy whose mother called because he suddenly became lethargic and pale. Your assessment reveals that he is in a supraventricular tachycardia at a rate of 244 per minute. The patient's extremities are mottled and his capillary refill time is 4 seconds. Which of the following is the best treatment plan for this patient?

Accepted Answer

A)   Adenosine, 0.1 mg/kg rapid IV push, repeated at 0.2 mg/kg if unsuccessful
B)   Verapamil, 0.3 mg/kg over 3 to 5 minutes
C)   Diltiazem, 0.25 mg/kg over 2 minutes
D)   Synchronized cardioversion beginning at 0.5-1.0 joules/kg

Question 7

Your 12-month-old patient has burns covering the full length of both lower extremities circumferentially. Which of the following is the most accurate estimate of the percentage of total body surface area involved?

Accepted Answer

A)   20 percent
B)   36 percent
C)   14 percent
D)   28 percent

Question 8

Your patient is a 14 month-old girl who has been taking an antibiotic for three days for an ear infection. Her parents have called EMS because the patient has not been eating or drinking, is irritable, has a fever, and generally appears very sick. Which of the following should you most highly suspect?

Accepted Answer

A)   Herpes zoster
B)   Bacterial meningitis
C)   Fifth disease
D)   An allergic reaction to the antibiotic

Question 9

Which of the following statements regarding prehospital care of pediatric patients is TRUE?

Accepted Answer

A)   Up to 85 percent of children treated by EMS need nothing more than basic life support skills.
B)   The majority of pediatric calls are for allergic reactions.
C)   More than 50 percent of pediatric patients require advanced life support.
D)   Most pediatric patients seen by EMS personnel are from low-income families.

Question 10

Your 15-year-old male patient was kicked in the scrotum while playing with some friends. He is complaining of excruciating pain in his testicles. Which of the following guidelines applies to the examination of this patient?

Accepted Answer

A)   Make sure the procedure takes place in a medical office.
B)   Make sure another paramedic is present during the exam.
C)   Make sure a paramedic of the same sex performs the exam.
D)   Make sure a paramedic of the opposite sex performs the exam.

Question 11

All of the following are associated with an increased incidence of SIDS, EXCEPT:

Accepted Answer

A)   female infant.
B)   age between two and four months.
C)   low birth weight.
D)   fall and winter months.

Question 12

Which of the following is NOT an acceptable estimate of the correct size of endotracheal tube for a pediatric patient?

Accepted Answer

A)   The patient's age in years plus 16, divided by 4
B)   The diameter of the little finger
C)   A length-based resuscitation tape
D)   Twice the width of the naris

Question 13

You are in the home of a 28-month-old boy whose mother called EMS because he fell while running and struck his forehead on the corner of a table. The patient has a hematoma on his forehead but seems to have forgotten about the injury and is entertaining himself with some building blocks. Which of the following is the best way to begin assessing the child?

Accepted Answer

A)   To avoid upsetting him, observe him from a distance and make no physical contact with him.
B)   Make him feel comfortable by calling him by a nickname.
C)   Sit next to him and ask if you can play with some of his toys.
D)   Ask his mother to pick him up and hold him on her lap.

Question 14

You have been called for a 1-week-old infant who is sick. Assessment reveals him to have a fever and rhonchi in the left lower lobe. Which of the following assessment findings would be most concerning to you, given the age of this patient?

Accepted Answer

A)   Respiratory rate of 33 breaths per minute
B)   Skin that is pink and warm
C)   Continual moaning and crying
D)   Nasal passages occluded by mucus

Question 15

Your patient is a conscious eight-month-old infant who has a severe airway obstruction as a result of choking on a slice of canned peach. Which of the following is your FIRST intervention?

Accepted Answer

A)   A portable suction device, using a rigid tonsil tip and no more than 100 mmHg of vacuum
B)   The use of a manually triggered, flow-restricted, oxygen-powered ventilation device
C)   Abdominal thrusts interspersed with attempts to ventilate
D)   An alternating series of back blows and chest thrusts

Question 16

A woman has called 911 after not being able to wake her eight-year-old son. Upon arrival, the mother tells you that her son is a diabetic, and that his diabetic alert dog awoke her in the night indicating the child's blood sugar was low. You perform a blood glucose check and find that your glucometer reads 28 mg/dL. You should:

Accepted Answer

A)   administer IV dextrose at 30% concentration.
B)   administer 1 mg of IV glucagon.
C)   administer 1 mg of IM glucagon.
D)   administer IV dextrose at 25% concentration.

Question 17

You are delayed getting to a residence where a 16-month-old boy is actively seizing. The mother reports that he has had a fever for the past two days. A firefighter on scene informs you that the child has been seizing since their arrival approximately 15 minutes ago. You should:

Accepted Answer

A)   apply oxygen, administer intranasal midazolam, and transport.
B)   apply oxygen, administer fluids, and transport.
C)   actively cool the child with ice packs to the groin and axilla.
D)   actively warm the child with blankets.

Question 18

Which of the following is the most common result of blunt chest trauma in children?

Accepted Answer

A)   Anterior flail segment
B)   Intrathoracic injury without external bruising of the thorax
C)   Associated spinal cord injury
D)   Fractured ribs with a high incidence of hemothorax

Question 19

Your patient is a 12-year-old boy who was accidentally shot with a handgun by a playmate. You note one gunshot wound to the right upper quadrant of the abdomen, but no exit wound. The patient is pale, with cool, mottled extremities. He is lethargic, has a heart rate of 140, a respiratory rate of 30, and a blood pressure of 92/60 mmHg. Which of the following can be said for certain about this patient?

Accepted Answer

A)   He is in compensated shock.
B)   He is in irreversible shock.
C)   He is in decompensated shock.
D)   It is not possible to say anything for certain about this patient.

Question 20

Your patient is a four-year-old boy with a history of asthma. He ran out of his inhaled bronchodilator while visiting his grandparents' farm. The patient has pale, cool, moist skin with cyanosis of his nail beds. He has audible wheezing with a respiratory rate of 18, accessory muscle use, and a heart rate of 130. He appears fatigued, he is unable to speak more than one or two words at a time, and his head bobs with each breath. Which of the following best describes this patient's respiratory status?

Accepted Answer

A)   Because of decreased respiratory, cardiovascular, and stored energy reserves, the child's muscles have fatigued and he is now in respiratory failure.
B)   The child is in the early stages of his asthma attack, and is showing signs of respiratory distress.
C)   The patient is having some respiratory difficulty; however, a nebulizer treatment will likely correct all issues.
D)   The child's asthma was exacerbated by exercise and he is therefore tired. Rest will ease his respiratory distress.

Exam 4: Pediatrics