Pediatric Emergencies and PALS (Shock, Status Epilepticus, DKA, Poisoning) MCQs

Pediatrics · 49 free questions with answers & explanations.

1. A 3-year-old child is brought with fever, altered consciousness, and generalized tonic-clonic seizures lasting 35 minutes. IV lorazepam 0.1 mg/kg was given twice without effect. Which is the next most appropriate drug?
2. A 9-year-old with known type 1 diabetes presents with vomiting, Kussmaul breathing, blood glucose 420 mg/dL, and venous pH 7.12. Insulin infusion is started. After 2 hours the serum potassium drops to 2.8 mEq/L. What is the correct action?
3. During resuscitation of a 7-year-old in pulseless ventricular fibrillation (VF), after the first shock at 2 J/kg without return of spontaneous circulation, what is the correct next shock energy?
4. A 2-year-old ingests an unknown quantity of organophosphate pesticide at home. On arrival: miosis, excessive secretions, bradycardia, and fasciculations. After atropinisation the child develops agitation and confusion despite adequate secretion drying. What does this indicate?
5. A 5-year-old presents in septic shock with cold peripheries, capillary refill time 5 seconds, BP 65/40 mmHg, and HR 165/min. After two 20 mL/kg IV fluid boluses with no improvement, which agent should be started first?
6. A 6-year-old boy in septic shock has received 60 mL/kg isotonic saline boluses with minimal improvement. His BP is 60/40 mmHg, HR 170/min, CRT >5 seconds, and he remains confused. The next intervention per current PALS guidelines (FEAST trial informed) is:
7. A 10-year-old is admitted in refractory convulsive status epilepticus (CSE) — seizures persisting despite IV lorazepam 0.1 mg/kg twice and IV fosphenytoin 20 mg PE/kg. He continues seizing at 45 minutes. The most appropriate next step is:
8. A 12-year-old with new-onset type 1 DM presents in DKA: glucose 480 mg/dL, pH 7.12, bicarbonate 8, Na 128, K 6.2, Glasgow Coma Scale 12/15. After starting IV fluids, the MOST dangerous complication to monitor for during the first 24 hours of management is:
9. A 3-year-old ingests an unknown quantity of his grandfather's metformin. Six hours later he develops worsening tachypnea, altered sensorium, and blood lactate of 12 mmol/L with anion gap metabolic acidosis. The MOST effective treatment is:
10. A previously healthy 8-year-old presents with acute onset wheeze, generalized urticaria, and hypotension after eating peanuts at a school picnic. HR 140, BP 70/40, SpO2 90%. The single most critical initial intervention is:
11. A 7-year-old (weight 20 kg) presents in anaphylaxis after a bee sting. Per PALS guidelines, what is the correct dose and route of epinephrine?
12. A 4-year-old child with known epilepsy is brought with generalized convulsions lasting 20 minutes. IV access is unavailable. Which is the most appropriate immediate intervention according to current guidelines?
13. A 12-year-old with type 1 diabetes presents with vomiting, deep rapid breathing, and blood glucose of 520 mg/dL. Initial fluid resuscitation with 10 mL/kg NS is given. The rate of fluid deficit replacement over the subsequent 48 hours is calculated using the 5% dehydration deficit. For a 40 kg child, what is the total 48-hour fluid volume that should be infused (deficit + maintenance), excluding the initial bolus?
14. A 3-year-old ingests an unknown quantity of iron tablets. He presents 4 hours later with haematemesis and metabolic acidosis. Serum iron is 650 μg/dL. Which of the following is the MOST appropriate chelation therapy?
15. During PALS resuscitation of a pulseless child, after two minutes of CPR the rhythm check shows pulseless electrical activity (PEA). Which of the following reversible causes (Hs and Ts) is MOST common in the paediatric age group?
16. A 7-year-old weighing 20 kg is in septic shock with HR 160/min, BP 65/40 mmHg, and cold extremities. After two normal saline boluses of 10 mL/kg each, perfusion remains poor. According to PALS 2020 guidelines, which vasoactive agent is the FIRST-LINE choice for fluid-refractory septic shock in children?
17. A 6-year-old presents with refractory convulsions lasting 45 minutes despite two doses of intravenous lorazepam (0.1 mg/kg each) and fosphenytoin 20 mg PE/kg. This is now classified as refractory status epilepticus. Which agent is appropriate as THIRD-LINE therapy?
18. A 12-year-old known type-1 diabetic presents with blood glucose 450 mg/dL, pH 7.12, bicarbonate 9 mEq/L, deep sighing respirations, and altered sensorium. Fluid resuscitation is commenced. Regarding insulin therapy in pediatric DKA, which of the following is the CURRENT recommendation?
19. A 3-year-old is brought with miosis, bradycardia, excessive secretions, and fasciculations after playing in a recently pesticide-sprayed field. Pralidoxime (2-PAM) is administered. What is the PRIMARY mechanism by which pralidoxime acts in organophosphate poisoning?
20. During PALS resuscitation, a pulseless 8-year-old with ventricular fibrillation on cardiac monitor receives two unsuccessful defibrillation attempts. What is the recommended defibrillation energy dose in pediatric VF/pulseless VT per PALS 2020 guidelines?
21. A 2-year-old presents with altered consciousness, coma score 8, and is found to have salicylate poisoning after ingesting aspirin tablets. Blood gas shows pH 7.55, pCO2 22 mmHg, HCO3 18 mEq/L. Urine pH is 5. Which intervention is MOST critical for enhancing salicylate elimination?
22. A 3-year-old child presents in cardiac arrest. The resuscitation team is administering epinephrine. According to current PALS guidelines, what is the recommended IV/IO dose of epinephrine for pediatric cardiac arrest?
23. A 7-year-old child with known seizure disorder is brought in with a generalized tonic-clonic seizure lasting 12 minutes. IV access is established. The first dose of lorazepam 0.1 mg/kg is given but the seizure continues. What is the next step in management per current status epilepticus protocols?
24. A 10-year-old child with type 1 diabetes presents with vomiting, abdominal pain, Kussmaul breathing, and blood glucose of 420 mg/dL. pH is 7.18, bicarbonate 8 mEq/L. Weight is 30 kg. Fluid resuscitation with normal saline 10 mL/kg has been given. What is the appropriate insulin infusion rate?
25. An 18-month-old ingests an unknown quantity of iron tablets from his mother's prenatal supply. He presents 3 hours later with vomiting, diarrhea, and lethargy. Serum iron level is 580 micrograms/dL. Which of the following is the correct antidote and route of administration?
26. A 4-year-old child in the emergency department is found to have a shockable rhythm (pulseless VT) on the cardiac monitor. According to PALS, what is the correct energy dose for the first defibrillation attempt?
27. A 6-year-old presents with sudden onset of stridor, drooling, dysphagia, and a 'tripod' position. He appears toxic with high fever. Neck X-ray shows a 'thumb sign.' Which organism is most likely responsible?
28. A 7-year-old child (weight 20 kg) is in pulseless ventricular fibrillation. As per PALS guidelines, what is the correct initial defibrillation energy dose?
29. A 10-year-old (25 kg) with known type 1 DM presents in DKA with blood glucose 480 mg/dL, pH 7.12, bicarbonate 8 mEq/L. After initial fluid resuscitation, insulin infusion is started. What is the correct insulin infusion rate?
30. A 5-year-old child (18 kg) presents in status epilepticus. After two doses of lorazepam have failed, which drug should be administered next as per current PALS guidelines, and what is its dose?
31. An 8-month-old infant (8 kg) with septic shock unresponsive to two 10 mL/kg boluses of normal saline remains hypotensive. Which vasoactive agent is first-line in fluid-refractory septic shock in children?
32. A 3-year-old is brought to the emergency department 30 minutes after accidentally ingesting iron tablets (estimated 40 mg/kg of elemental iron). Which of the following features would MOST warrant immediate chelation therapy with deferoxamine?
33. In a child with distributive (warm) septic shock, which hemodynamic profile best describes the expected findings?
34. A 7-year-old boy presents with fever, altered consciousness, and generalized tonic-clonic seizures lasting 35 minutes despite two doses of IV lorazepam (0.1 mg/kg each) given 10 minutes apart. His blood glucose is 82 mg/dL. Which is the MOST appropriate next pharmacological intervention?
35. A 4-year-old girl is brought with 6 hours of repeated emesis, diffuse abdominal pain, and progressive lethargy after reportedly ingesting her grandmother's heart medication. Examination shows bradycardia (HR 44/min), BP 70/40 mmHg, and first-degree AV block on ECG. Which treatment is MOST specifically indicated?
36. A 12-year-old known type 1 diabetic presents in DKA: blood glucose 480 mg/dL, pH 7.08, bicarbonate 6 mEq/L, serum sodium 128 mEq/L. After 1 hour of normal saline resuscitation (10 mL/kg), his neurological status suddenly deteriorates and he becomes unresponsive. CT head reveals diffuse cerebral edema. Which factor is MOST strongly associated with this complication in pediatric DKA?
37. A 2-year-old presents with 3 days of high fever, irritability, and poor feeding. Examination reveals HR 180/min, RR 60/min, capillary refill 4 seconds, cool peripheries, and BP 55/30 mmHg. Lung fields are clear. He does not improve after two 10 mL/kg NS boluses. Urgent bedside echo shows markedly reduced left ventricular function. Which inotrope/vasopressor combination is MOST appropriate for this presentation?
38. During PALS resuscitation of a 5-year-old in pulseless ventricular fibrillation (VF), the first shock at 2 J/kg fails to convert. After a 2-minute CPR cycle, VF persists. Epinephrine has been given. Which is the CORRECT dosing and timing for amiodarone in this context?
39. A 7-year-old child in anaphylactic shock has received intramuscular epinephrine and two fluid boluses but remains hypotensive with persistent bronchospasm. The second-line vasopressor of choice for refractory anaphylactic shock in pediatric PALS is:
40. A 5-year-old child presents with a generalized tonic-clonic seizure lasting 20 minutes despite two doses of lorazepam IV. The next step per current PALS guidelines for refractory convulsive status epilepticus is:
41. A 12-year-old newly diagnosed diabetic presents in DKA with pH 7.08, glucose 520 mg/dL, and clinical dehydration estimated at 7%. The most feared complication of DKA management in children and the single most important preventive measure is:
42. A 3-year-old is brought after ingesting multiple iron tablets. He is currently alert. Serum iron level at 4 hours post-ingestion is 390 mcg/dL. The correct management is:
43. During PALS, a child in pulseless ventricular fibrillation receives a defibrillation shock but remains in VF. The correct energy dose for the second and subsequent defibrillation attempts in children is:
44. A 7-year-old child is brought unconscious after a witnessed generalized tonic-clonic seizure lasting 35 minutes. Two doses of IV lorazepam have been given without effect. The next most appropriate pharmacological intervention according to PALS guidelines is:
45. During resuscitation of a 3-year-old child (weight 15 kg) in pulseless VF arrest, the correct defibrillation dose is:
46. A 12-year-old with known type 1 diabetes is brought with vomiting and deep Kussmaul breathing. Blood glucose is 480 mg/dL, pH 7.10, bicarbonate 8 mEq/L. Which electrolyte must be carefully monitored and replaced before starting insulin infusion?
47. A 2-year-old child presents with pinpoint pupils, bradycardia, excessive secretions, bronchospasm and muscle fasciculations after playing in a field recently sprayed with insecticide. The antidote with the highest priority is:
48. A 6-year-old is in septic shock not responding to two fluid boluses of 10 mL/kg each of normal saline. He remains hypotensive with cool extremities. The most appropriate next step is:
49. A toddler accidentally ingests ferrous sulfate tablets. The urine turns grey-green on treatment with deferoxamine. Which finding indicates systemic toxicity and mandates IV deferoxamine?