Pediatric Examination and Board Review by Robert Daum, Jason Canel Page B

100, respiratory rate while bagging 22, temperature 34.5°C, and oxygen saturation 100%. Auscultation of the chest reveals wheezing in the right hemithorax and coarse breath sounds throughout. The cardiac rhythm is sinus and there are no murmurs. The only other part of the physical examination that is abnormal is the neurologic examination. The child remains unresponsive to pain or voice. Pupils are 4 mm bilaterally and are very sluggish in response to light. The muscle tone is generally reduced and there is no rectal tone.
    SELECT THE ONE BEST ANSWER
     
    1. The condition of this child dictates the need for the following
(A) obtaining an AP chest film
(B) obtaining a blood sample for toxicology
(C) obtaining imaging studies of the head and cervical spine
(D) obtaining left and right lateral decubitus chest films
(E) obtaining imaging of the abdomen and pelvis
    2. The clinical scenario that best predicts poor outcome in drowning is
(A) cardiopulmonary resuscitation (CPR) required at the scene of the accident
(B) CPR required in the emergency department
(C) failure to achieve spontaneous cardiac rhythm for 25 minutes
(D) submersion time longer than 5 minutes
(E) Glasgow Coma Scale score of 10 in the emergency department
    3. The clinical scenario that best predicts good outcome in drowning is
(A) core temperature on arrival in the emergency department of less than 32°C
(B) return of spontaneous circulation in the emergency department
(C) responsive pupils in the emergency department
(D) continuing or resuming circulation at the accident scene
(E) a Glasgow Coma Scale score of 4 in the emergency department
    4. Which of the following is the most common cause of morbidity and mortality in drowning?
(A) hypoxic encephalopathy
(B) acute hypoxic respiratory failure
(C) renal failure
(D) acute hyponatremia from water absorption
(E) B and C
    5. Which of the following statements is true?
(A) saltwater drowning is more common than drowning in fresh water
(B) the lung injury that occurs in a freshwater drowning is more severe than the lung injury that occurs in salt water
(C) the clinical features of saltwater and freshwater drowning are more alike than they are different
(D) drowning results in the aspiration of large volumes of water into the tracheobronchial tree and lungs, irrespective of the type of water
(E) none of the above
    6. The frequency of drowning in the United States is best described as
(A) an uncommon cause of death
(B) the second most common cause of pediatric death in many states
(C) more likely in girls irrespective of age
(D) more likely in boys younger than the age of 6, but it is of equal magnitude between the genders in older children
(E) most common in adolescent girls
    7. The most important intervention that prevents accidental pool drowning is
(A) swimming lessons
(B) flotation devices
(C) fencing surrounding a pool
(D) pool covers
(E) alarms
    8. On the second hospital day, the child’s examination was consistent with brain death. This diagnosis would not be possible to make by clinical examination if
(A) the child’s temperature is 35°C
(B) the child’s temperature is 36°C
(C) the patient’s phenobarbital level is 10 mg/dL or more
(D) the patient has a C1-2 fracture
(E) the patient has an L4-5 fracture
    9. The definition of brain death in children requires that the child be
(A) older than 7 days of age and term at birth
(B) older than 6 months old, irrespective of gestational age
(C) older than 1 year of age, irrespective of gestational age
(D) older than 2 years of age, irrespective of gestational age
(E) older than 60 weeks’ postconceptual age
    10. Confirmatory tests for brain death include all of the following except
(A) brain nuclear blood flow study
(B) MRI of the brain
(C) cerebral angiogram
(D) EEG
(E) A and C
    11. Which of the following may be present and still have the patient meet brain death criteria as of 2004, according to the American Academy of Pediatrics guidelines?
(A) spinal