March 2003 

Revised June 2011
American College of Emergency Physicians Section of Pediatric Emergency Medicine 

Peter S. Auerbach, MD, FACEP
 

The Children's Hospital at Legacy Emanuel Medical Center, Portland, OR

• 1.The most concerning physical finding in an infant with an acute respiratory infection or RAD exacerbation is:
  1. Tachypnea
  2. Grunting
  3. Abdominal breathing
  4. Retractions
  5. Wheezing
     
      
   

  2.All of the following are consistent with the diagnosis of bacterial tracheitis EXCEPT:

   

  1. High fever
  2. Preceding viral URI 
  3. Minimal sputum production
  4. Stridor
  5. Drooling
   
• 3. What proportion of bronchiolitis cases are caused by respiratory syncytial virus (RSV)?

   

  1. 15%
  2. 35%
  3. 50%
  4. 70%
  5. 90%
     
      

   

  4. Which of the following is the most likely diagnosis in a 2-month-old infant with a 10 day history of mild cough, who is in no distress in the ED and has a normal physical examination:

  1. FB ingestion
  2. Viral bronchiolitis
  3. Bacterial pneumonia
  4. Congenital airway anomaly
  5. Pertussis
   

   

• 5. The BEST induction agent for intubation of infants greater than 3-months-old with respiratory failure due to bronchiolitis is:
  1. Versed
  2. Etomidate
  3. Thiopental
  4. Ketamine
  5. Fentanyl
     
      
   

  1. In the absence of other concerning associated signs, APNEA is defined as a respiratory pause of greater than:

     1. 10 seconds
     2. 15 seconds
     3. 20 seconds
     4. 30 seconds
     5. 1 minute
        
         
      

  2. Of the following causes of upper airway obstruction, which is LEAST likely to result in an acute, precipitous deterioration in the ED?

     1. Croup
     2. Epiglottis
     3. Foreign body ingestion
     4. Retropharygeal abscess
     5. Smoke inhalation/thermal injury

      

   

   

  1. Which of the following is the LEAST LIKELY cause of stridor in an infant or child < 6 years old?

     1. Bacterial tracheitis
     2. Retropharyngeal abscess
     3. Foreign body aspiration
     4. Croup
     5. Peritonsillar abscess
        
         
      

  2. Which of the following is NOT independently associated with the need for admission in the context of an asthma exacerbation?

     1. Poor social situation
     2. Failure to respond to bronchodilators and steroids
     3. Altered mental status or fatigue
     4. Pneumothorax on CXR
     5. Pneumomediastinum on CXR
        
         
      

  3. TRUE or FALSE: The administration of beta-agonists via MDI with a spacer has been shown to be as effective as the use of a nebulizer for the reversal of acute bronchospasm in all age groups (infants, children and adults).

   

   11. All of the following are currently considered standard treatments for bronchiolitis EXCEPT:

   

  a. Hydration (oral or IV)
   

        b. Trial of albuterol (via MDI or nebulized

c. Trial of racemic epinephrine (nebulized)

        d. Steroids (oral, IV or IM)

        e. Supplemental oxygen as needed

 

12. Compared with the adult airway, which of the following is NOT characteristic of the pediatric airway:

1. More easily visualized with a straight (eg, Miller) blade
2. Narrowest portion located at the cricoid cartilage
3. More posterior location
4. Smaller diameter and shorter length
5. More easily obstructed by edema, secretions or posterior displacement of the tongue
    

• 13. TRUE or FALSE: ral dexamethasone is as effective as IM dexamethasone in the treatment of croup.

   

•  14. RSV testing would be LEAST helpful in the management of which of the following patients:

  1. 3-week-old neonate with nasal congestion and mild cough
  2. 6-month-old ex-preemie with BPD and cough/congestion
  3. 4-month-old previously healthy infant with significant URI Sx's and wheezing but no fever
  4. 5-month-old intubated for respiratory failure with a peri-bronchial infiltrate on CXR
     
      
   

• 15. All of the following support a clinical diagnosis of pertussis EXCEPT:

  1. Prolonged course
  2. Known contact with prolonged cough
  3. History of incomplete vaccination
  4. Temperature > 101 degrees fahrenheit
  5. Elevated white blood cell count with marked lymphocytosis
     
      
   

• 16. The most common CXR finding in infants with bronchiolitis is:

  1. Normal
  2. Hyperinflation
  3. Atelectasis
  4. Focal infiltrate
  5. Pneumothorax
     
      
   

• 17. TRUE or FALSE: Antibiotics given for "Whooping Cough" (pertussis) shorten the course of symptoms.

• 18. All of the following statements are true of croup (viral laryngotracheobronchitis) EXCEPT:

  1. It is most commonly caused by parainfluenza virus.
  2. It can easily be confused with bacterial tracheitis.
  3. It primarily affects children aged 6-36 months.
  4. It is characterized by a barky cough, hoarse voice, and inspiratory stridor.
  5. Symptoms are often worse at night.
     
      
   
   

• 19.Regarding pneumonia in the neonate, all of the following are TRUE EXCEPT:

  1. Maternally-acquired Group B Strep (GBS) remains the most common bacterial pathogen.
  2. Mortality is low when promptly diagnosed and appropriately treated.
  3. Viral etiologies are common.
  4. Full sepsis work-up, including LP, is mandatory.
  5. Admission and IV ampicillin & cefotaxime (or gentamicin) is required in all cases.
     
      
   

• 20. Which of the following is the most likely cause of pneumonia in a generally well-appearing 8-year-old with a gradually progressive cough over two weeks and bilateral crackles on lung exam?

  1. Mycoplasma 
  2. S. pneumoniae 
  3. Klebsiella 
  4. Pertussis
  5. Influenza
     
      
   

• 21. All of the following are true of croup EXCEPT:

  1. First-line treatment includes steroids.
  2. Oral steroids are as effective as parenteral steroids.
  3. Racemic epinephrine need only be given to children with stridor at rest (while not agitated) or who appear to be in significant respiratory distress.
  4. Well-appearing children with croup, who have improved after receiving nebulized racemic epinephrine, can safely be discharged within 1-2 hours of treatment.
     
      
   

BONUS: A 3-week-old infant with several days of mild diarrhea and decreased oral intake presents with severe tachypnea, cyanosis and lethargy. The initial oxygen saturation is 87%, breath sounds are clear throughout and the cardiac exam is normal. Peripheral perfusion is poor (CR > 4 sec.) and the administration of 100% oxygen by face mask results in a saturation of only 94%. A portable CXR is normal. Of the following tests, which is MOST likely to reveal a diagnosis?

1. ECG
2. ABG
3. echocardiogram
4. RSV
5. methemoglobin level

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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