Question 1

Your 15-year-old male patient has a stab wound along the right sternal border at the fourth intercostal space. The patient responds to painful stimuli and shows little evidence of external bleeding. His respirations are 30, his breath sounds are clear and equal, and his radial pulse is weak and disappears on inspiration. The patient has distended jugular veins and is dyspneic. This patient is most likely suffering from ________ shock due to ________.

Accepted Answer

The patient's presentation is consistent with obstructive shock, which can be caused by cardiac tamponade. The location of the stab wound along the right sternal border at the fourth intercostal space, in close proximity to the heart, suggests that the injury has caused blood to accumulate in the pericardial sac, compressing the heart and preventing it from filling properly during diastole. This leads to inadequate cardiac output, which can result in decreased arterial pressure and impaired tissue perfusion. The presence of distended jugular veins and dyspnea further support the diagnosis of cardiac tamponade. Hypovolemic shock, distributive shock, and hypoxic shock are less likely given the patient's symptoms and injury location. Hemothorax and tension pneumothorax are also possible differentials, but the absence of external bleeding and clear breath sounds make these less likely compared to cardiac tamponade.

Question 2

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

The patient's clinical presentation, including cool, mottled extremities, lethargy, tachycardia, tachypnea, and hypotension, indicate decompensated shock. The lack of an exit wound suggests the bullet may still be inside the patient's body, which can lead to ongoing bleeding and further worsen his condition. Immediate intervention is necessary to save this patient's life.

Question 3

Which of the following is TRUE of asthma in the pediatric patient?

Accepted Answer

Oxygen and nebulized beta agonists are the initial treatment for asthma attacks in pediatric patients. Bronchodilators and steroids may also be necessary depending on the severity of the attack, but they are not always more effective in pediatric patients and are not rarely indicated. Rehydration, mucolytic agents, and anti-inflammatory agents are not primary therapeutic goals in the initial phase of an asthma attack.

Question 4

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

The child is actively seizing, so the priority is to stop the seizure as soon as possible. Administering intranasal midazolam is the most effective option to stop the seizure quickly. Oxygen should also be given to support the child's breathing. Transport to a hospital is necessary for further evaluation and treatment. Administering fluids or actively cooling/warming the child are not necessary interventions in this situation.

Question 5

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

Accepted Answer

Asthma is a condition that causes inflammation and narrowing of the airways in the lungs, not the upper airway. The other conditions listed (epiglottitis, croup, and bacterial tracheitis) all involve swelling of the airway structures in the upper respiratory tract, which can lead to obstruction.

Question 6

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

Accepted Answer

Intrathoracic injury without external bruising of the thorax is the most common result of blunt chest trauma in children. This is because children have more pliable and elastic chest walls, which absorb the impact and prevent external evidence of injury. Therefore, intrathoracic injuries such as pulmonary contusions, pneumothorax or hemothorax are more common. A, C and D are less common or not specifically related to children.

Question 7

Your patient is a five-year-old girl who awoke with a harsh cough, sore throat, drooling, and high fever. She has shallow respirations of 40 and inspiratory stridor. She is completely focused on breathing, leaning forward on her outstretched arms. Which of the following is the best course of action?

Accepted Answer

The patient's symptoms suggest a severe upper airway obstruction, likely due to epiglottitis, given the high fever, sore throat, drooling, inspiratory stridor, and the "tripod" position. The best course of action is to minimize distress and avoid procedures that could provoke complete airway obstruction, such as inspecting the throat or attempting intubation outside of a controlled setting. Providing blow-by oxygen and ensuring rapid transport to a medical facility are key steps in managing this condition safely.

Question 8

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

Nasal passages occluded by mucus is the most concerning assessment finding in a 1-week-old infant with a fever and rhonchi in the left lower lobe because it can lead to respiratory distress.

Question 9

Your patient is a seven-year-old girl with a history of bee-sting anaphylaxis. She was stung by a bee and nearly immediately began having difficulty swallowing and breathing. Her father administered her prescribed 0.15 mg epinephrine auto-injector without result. On your arrival, the patient responds to painful stimuli; has labored, rapid, wheezing respirations; a heart rate of 60; and a blood pressure of 92/60 mmHg. Which of the following is the best sequence of treatment for this patient?

Accepted Answer

In a case of anaphylaxis, the first-line treatment is epinephrine. Since the auto-injector did not work, the next step is to administer epinephrine 1:10,000 intravenously to rapidly increase blood pressure and reverse bronchoconstriction. Administration of diphenhydramine IV is also recommended as it can help with relief of itching and rash, but it should not delay administration of epinephrine as it is not a first-line treatment. IM administration of epinephrine is not recommended in severe anaphylaxis as there is delayed and unpredictable absorption.

Question 10

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

Accepted Answer

Male infants have a higher incidence of SIDS than female infants. The other choices are risk factors for SIDS.

Question 11

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

Accepted Answer

SIDS is a diagnosis given when no other identifiable cause of death can be found, so by definition it has no clear cause.

Question 12

Your patient is a three-year-old girl who has had vomiting and diarrhea for 24 hours. Which of the following is the best way to gain her cooperation when assessing her vital signs?

Accepted Answer

Offering to check the doll first can help the child become more comfortable with the procedures and gain her trust, making it more likely that she will cooperate when it is time for her own vital signs to be assessed. It is important to approach the assessment in a gentle and caring manner, rather than rushing through it or using language that may be intimidating or confusing to a young child.

Question 13

Your four-year-old female patient has injuries suspicious of abuse. Statistically, who is most likely the abuser?

Accepted Answer

Statistically, mothers are most often identified as the perpetrators of child abuse, especially in cases involving very young children. This is partly because mothers are more likely to be the primary caregivers and thus have more opportunities for abusive interactions.

Question 14

You have just arrived on the scene where an infant stopped breathing. You find a three-month-old child being held tightly by his mother, who is sobbing uncontrollably. On examination, you find that the child is apneic and pulseless and has dependent lividity and early rigor mortis. There are no obvious signs of injury. Which of the following is the best course of action?

Accepted Answer

The presence of dependent lividity and early rigor mortis are clear indicators that the infant has been deceased for some time, and resuscitative efforts would not be appropriate or effective. The most compassionate and appropriate action is to gently inform the mother of the situation and allow her to hold her child, respecting the grieving process.

Question 15

Your patient is an 11-year-old male quadriplegic who depends on a phrenic nerve stimulator to stimulate contraction of his diaphragm and allow him to breathe. You are called to the home during a thunderstorm that has caused a power outage. Which of the following is the best course of action?

Accepted Answer

Assisting the patient's breathing with a bag-valve-mask device and transporting him to a facility where he can receive the necessary support is the most immediate and effective way to ensure his safety and well-being during a power outage.

Question 16

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

The symptoms of not eating or drinking, irritability, fever, and appearing very sick in a child who is already taking antibiotics for an ear infection are highly suspicious for bacterial meningitis. It is important for EMS to transport the patient to the hospital quickly for evaluation and treatment. Herpes zoster and fifth disease typically do not present with these symptoms, and while an allergic reaction to the antibiotic is a possibility, it is not as likely given the timing of the symptoms appearing after three days of antibiotic use.

Question 17

You arrive at an MCI. You see a non-ambulatory child who has been evaluated using the JumpSTART algorithm with a yellow tag. What does this represent?

Accepted Answer

A yellow tag in the JumpSTART algorithm represents delayed response. While the patient may not have significant external signs of injury, they still require medical attention as they are non-ambulatory. Therefore, the best choice is to check for external signs of injury before moving on to other patients.

Question 18

What is NOT one of the objectives of JumpSTART?

Accepted Answer

The objective of JumpSTART is not to allow responders to "think with their hearts" when treating injured children. The objective is to optimize primary triage, enhance resource allocation, and reduce emotional burden on triage personnel.

Question 19

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

It is recommended that a paramedic of the same sex perform the exam on a patient complaining of pain in their genital area. This can help the patient feel more comfortable and respected during the examination. It is not necessary to perform the exam in a medical office or have another paramedic present, although additional support may be helpful in some situations. Having a paramedic of the opposite sex perform the exam may make the patient feel uncomfortable and should be avoided if possible.

Question 20

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

The heavier head of a child increases the incidence of cervical distraction injuries, which can occur even with relatively minor trauma. Therefore, it is important to immobilize the pediatric cervical spine as a precautionary measure to prevent potential spinal cord damage. Options A and C are incorrect as cervical spine injuries in children are not more often due to penetrating trauma and pediatric patients do require cervical spine immobilization. Option D is incorrect as the pediatric cervical spine should be immobilized in a position of neutral alignment.

Quiz 4: Pediatrics