Paramedics Exam Pediatric Emergencies 5 — Questions and Answers
Question 1: A 2-year-old suspected of child abuse has multiple bruises in various stages of healing. Which finding would be most consistent with non-accidental trauma?
- Bruising over the shins and knees
- Bruising in areas not typical of falls, such as the buttocks and torso (Correct answer)
- A single bruise on the forehead
- Scrape on the palm from catching a fall
Correct answer: Bruising in areas not typical of falls, such as the buttocks and torso
Bruises in protected areas such as the buttocks, torso, back, and face—especially in multiple stages of healing—are highly suspicious for non-accidental trauma.
Question 2: A 10-month-old presents limp with bulging fontanelle and a history of vomiting. Parents report the baby 'fell off the changing table.' What injury pattern is most concerning?
- Isolated clavicle fracture
- Retinal hemorrhages and subdural hematoma consistent with shaken baby syndrome (Correct answer)
- Skull fracture from direct impact
- Epidural hematoma from arterial injury
Correct answer: Retinal hemorrhages and subdural hematoma consistent with shaken baby syndrome
Retinal hemorrhages combined with subdural hematoma and an inconsistent history are classic findings of abusive head trauma (shaken baby syndrome).
Question 3: A 9-year-old in respiratory distress has a history of asthma. After two albuterol treatments there is no improvement. What does this indicate?
- Mild asthma exacerbation
- Status asthmaticus requiring escalated treatment (Correct answer)
- Resolution of bronchospasm
- Need for intubation as the only option
Correct answer: Status asthmaticus requiring escalated treatment
Status asthmaticus is a severe, prolonged asthma attack that does not respond to initial bronchodilator therapy and requires aggressive management including IV magnesium sulfate and possible CPAP.
Question 4: A 6-year-old presents with sudden onset of right-sided scrotal pain and swelling that has been present for 2 hours. What is the priority concern?
- Epididymitis
- Inguinal hernia
- Testicular torsion (Correct answer)
- Orchitis from mumps
Correct answer: Testicular torsion
Testicular torsion presents with sudden severe scrotal pain and is a surgical emergency with a viability window of approximately 4–6 hours from symptom onset.
Question 5: A 14-year-old female with a history of depression is found unresponsive. Her parents report finding an empty bottle of acetaminophen. What is the most significant delayed complication of acetaminophen overdose?
- Respiratory depression
- Hepatic failure (Correct answer)
- Renal failure
- Cardiac arrhythmia
Correct answer: Hepatic failure
Acetaminophen overdose causes hepatotoxicity that may not present clinically for 24–72 hours after ingestion, making it a delayed but potentially fatal complication.
Question 6: A 4-year-old is involved in a motor vehicle collision and presents with tachycardia, cool extremities, and capillary refill of 4 seconds. Blood pressure is 88/60 mmHg. What stage of shock does this represent?
- Compensated shock
- Decompensated (uncompensated) shock (Correct answer)
- Irreversible shock
- Distributive shock only
Correct answer: Decompensated (uncompensated) shock
Decompensated shock in children is indicated by hypotension alongside tachycardia and poor perfusion; hypotension is a late and ominous sign in pediatric patients.
Question 7: A 3-year-old ingests a button battery. Which complication is the most time-sensitive concern?
- Intestinal obstruction
- Esophageal perforation from electrical current and pressure necrosis (Correct answer)
- Heavy metal poisoning
- Gastric ulceration
Correct answer: Esophageal perforation from electrical current and pressure necrosis
Button batteries lodged in the esophagus generate an electrical current that causes rapid liquefaction necrosis, potentially perforation or tracheoesophageal fistula within hours.
Paramedics Exam Pediatric Emergencies 5
A 2-year-old suspected of child abuse has multiple bruises in various stages of healing.
Which finding would be most consistent with non-accidental trauma?