September 2003
American College of Emergency Physicians Section of Pediatric Emergency Medicine

Ghazala Q. Sharieff, MD, FACEP
Associate Clinical Professor
Department of Emergency Medicine
Children's Hospital and Health Center
University of California, San Diego
Director of Pediatric Emergency Medicine
Palomar-Pomerado Hospitals
San Diego, CA

1. A 10-day old male presents with bilious emesis. What is the most likely diagnosis?

   1. Appendicitis
   2. Pyloric stenosis
   3. Malrotation with midgut volvulus
   4. Feeding intolerance
      
      

2. A 2-week-old-male presents with lethargy and vomiting. His electrolytes reveal sodium of 121 meq/L, potassium of 7.0-meq/l and blood glucose of 40 mg/dl. What is the most likely diagnosis?

   1. Dehydration
   2. Congenital adrenal hyperplasia
   3. Inborn error of metabolism
   4. Pyloric stenosis
      
      

3. The drug of choice for treating a newborn with presumed ductal-dependant cyanotic congenital heart disease is:

   1. Morphine
   2. Dobutamine
   3. Prostaglandin E1
   4. Indomethacin
      
      

4. How should a neonate with lethargy and a blood sugar of 20mg/dl be treated?

   1. Oral feeds with apple juice
   2. 25% dextrose solution
   3. 10% dextrose solution
   4. 50% dextrose solution
      
      

5. A 2-day-old female presents with abdominal distension and vomiting. She has not yet passed a meconium stool. What is the most likely diagnosis?

   1. Hirschsprung Disease
   2. Malrotation with midgut volvulus
   3. Necrotizing enterocolitis
   4. Constipation
      
      

6. A 3-week-old female presents with persistent seizures despite aggressive management with benzodiazepines and phenobarbital. The mother reports giving her daughter some water to "stop her from getting dehydrated." What is the most likely cause of her status epilepticus?

   1. Hypoglycemia
   2. Diabetes insipidus
   3. Hyponatremia
   4. Hypokalemia
      
      

7. A 1-week-old male presents with some mild erythema around his umbilicus extending onto the abdominal wall. Which of the following is the correct management for this patient?

   1. Reassurance and continue with alcohol wipes of umbilicus
   2. Topical antibiotic ointment and recheck the patient the next day
   3. Discharge on cephalexin and recheck the next day
   4. Perform a full septic workup and admit the patient
      
      

8. A 5-day old, well-appearing male is brought to the ED by his mother today because she noted that he has a cluster of vesicles on his scalp. Which of the following should be the management approach?

   1. Skin biopsy
   2. IV acyclovir and a full septic workup
   3. Oral acyclovir
   4. Discharge, with next day follow up
      
      

9. Which of the following heart rates is most suggestive of supraventricular tachycardia in a newborn?

   1. 180 BPM
   2. 230 BPM
   3. 150 BPM
   4. 210 BPM
      
      

10. Vaginal bleeding in a 3-day-old female is:

    1. Is always indicative of child abuse
    2. May be due to withdrawal of maternal hormones
    3. Is suspicious for gonorrhea
    4. Is most commonly due to a vaginal foreign body-such as baby wipes
       
       

11. A 3-week old male presenting to the emergency department with vomiting and altered mental status and acidosis. What additional laboratory test should be included in your evaluation?

    1. Ammonia level
    2. Cortisol level
    3. Serum acetone
    4. Thyroid function test
       
       

12. Which of the following are causes of shock in the newborn?

    1. Infection
    2. Inborn errors of metabolism
    3. Child abuse
    4. Thyrotoxicosis
    5. All of the above

Copyright 2004 American College of Emergency Physicians. Pediatric Emergency Medicine Section quizzes may be reproduced for educational purposes only. To obtain permission to reprint for any other purpose, please submit your written request to: Deputy Executive Director, American College of Emergency Physicians, PO Box 619911, Dallas, TX 75261.

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