Advanced Paediatric Emergency Medicine
The APEM Course
  • Home
  • ACE the ACEM
  • PEM MCQs
  • PEM Lectures
  • Streaming Video Webinars
  • Med Student Resources
  • Blog

ACE the ACEM PEM MCQ's - references and resources listed further below


INFECTIOUS DISEASES

The Febrile Child – see guidelines website - tpched.org (fever)
​
1. With regards to febrile illness in previously well children in a fully vaccinated population, which one of the following is the best option:
  1. Temperatures of 40 degrees are likely to cause neurological damage.
  2. Temperature should be controlled with Ibuprofen in order to prevent febrile seizures.
  3. Conjugate pneumococcal vaccination programs have significantly reduced the incidence of occult bacteraemia.
  4. In well appearing children over the age of 2 months, a WCC should be requested.

2. An immunized previously well child of 2 years age presents with a fever of 39.8 degrees and no obvious focus of infection. The child appears well. Which one of the following is the best option:
  1. A poor response to Ibuprofen requires a full sepsis workup.
  2. The WCC is a good screening test for excluding occult bacteraemia.
  3. A positive blood culture in this setting is highly specific and sensitive.
  4. The risk of occult bacteraemia is less than 1%.


3. With regard to petechial rash in children,which of the following is the best option:
  1. The risk of meningococcal infection is 20%.
  2. A well appearing child with petechiae on the thorax does not need further investigation.
  3. A toxic appearing child with petechiae in the SVC distribution who has been vomiting does not need investigation.
  4. A well appearing child with petechiae in the SVC distribution who has been coughing does not need further investigation.

4. A 2-month-old child presents with high fever and no focus of infection. The child appears well and has normal vital signs. Which of the following is the best option:
  1. The Yale Observation Scale is accurate is assessing toxicity in this age group.
  2. E. Coli, Listeria Monocytogenes and group B Streptococcus are possible bacterial pathogens in this group.
  3. Lumbar puncture is indicated in this group.
  4. A CXR is likely to be abnormal in this setting.

References:

Fever guidelines - QCH - tpched.org

The Royal Children’s Hospital Melbourne, Clinical Practice Guidelines. Febrile Child under 3 yr. Available online:
www.rch.org.au/clinicalguide/cpg.cfm?doc_id=5181

Nathan W. Mick. CHAPTER 165 – Pediatric Fever. In: Marx: Rosen's Emergency Medicine, 7th ed.Copyright © 2009 Mosby, An Imprint of Elsevier.

NICE clinical guideline 47: Issue date: May 2007 Feverish illness in children Assessment and initial management in children younger than 5 years. NICE
Developed by the National Collaborating Centre for Women’s and Children’s Health


RENAL DISEASE / GUT
Urinary Tract Infection


5. With regards to UTI in children 3-36 months of age who are previously well, which one of the following is the best option:
  1. To exclude urinary tract infection, a suprapubic aspirate, a urethral catheter sample or a bag-urine sample are all equally sensitive.
  2. If the urine dipstick is positive for either leucocyte esterase or nitrites, the probability of the child having a UTI is 18%.
  3. If the urine microscopy is positive for bacteria, the post-test probability of UTI is 80%.
  4. If the child is febrile and systemically unwell, the current recommended empiric therapy is intravenous ciprofloxacin.


Reference
Urinary tract infection in children. NICE Guideline. Urinary tract infection in children: diagnosis, treatment and long-term management.
​

Williams GB et al. Diagnosis and Management of urinary tract infection in children. Journal of Paediatrics and Child Health 48 (2012) 296-30.


6. A 3yo boy presents to ED with 4 days of vomiting,frequent loose watery stools and clinical evidence of dehydration. He fails an attempt at oral and nasogastric rehydration therapy – IV access is obtained and an intravenous infusion of Normal saline is planned. His laboratory findings are as follows:

WCC 10 x10 9/L (4-11x10 9/L)
Neutrophils 4 x10 9/L (2.5-7.5x109/L)
Hb 70g/L (130-160g/L)
Platelets 20 x109 /L (150-400 x 109/L)
Urea 14 umol/L (1-6umol/L)
Creatinine 200 umol/L (30-75umol/L)
Na 124mmol/L
K 6.8mmo/L

Which of the following is the best option:
  1. This patient will benefit from IV Gentamycin
  2. Encephalopathy is a possible complication
  3. IV 'pulse' Methylprednisolone should be administered
  4. Antimotility agents have been shown to improve outcome



References:
Marx: Rosen's Emergency Medicine, 7th ed. Genitourinary and renal tract disorders
http://emedicine.medscape.com/article/201181-overview - Parmar MS. Haemolytic-Uremic Syndrome. Available at: http://emedicine.medscape.com/article/201181-overview Accessed: 5/11/2018


ENDOCRINE

7. A previously well 3yo boy has had a viral illness for 3 days.He presents to ED with fatigue and poor feeding. He appears dehydrated, his capillary refill time is 3 seconds, heart rate is 122 and he has not passed urine for 6 hours.

BP 90/66
RR 22
Temp 37
GCS 15

His biochemistry is as follows:
BSL 33 mmol/L
PH 7.04
HCO3 10 mmol/L
K 5.9 mmol/L
Na 142 mmol/L

Which of the following is the correct option:
  1. A fluid bolus of 20ml/kg Normal Saline is indicated immediately
  2. Immediate commencement of an Insulin infusion is indicated.
  3. Potassium supplementation should commence after urine output is
    established.
  4. 0.45% Saline (Half Normal Saline) is an appropriate fluid for replacing
    the deficit volume over 72 hours.


References
Australasian Paediatric Endocrine Group (2011). Clinical practice guidelines: Type 1 diabetes in children and adolescents.
​RCH DKA guidelines
tpched.org guidelines - DKA


RESPIRATORY DISEASE
8. A 7-month-old child with no previous medical illness presents with a 3 day history of coryza and cough.
Vital signs include:
RR 44,
HR 120,
Saturations 94% and mild subcostal recession.
Examination reveals widespread inspiratory crepitations and expiratory wheeze with bilateral equal air entry. 2 other children in the family have ‘flu-like illness’. The child is breastfeeding comfortably in the mother’s arms. There is no family history of atopy or asthma.

Which of the following is the best option:
  1. An NPA is important in this clinical setting.
  2. Salbutamol is likely to be of benefit.
  3. A trial of hypertonic 3% saline may be beneficial.
  4. A period of observation is indicated.

tpched.org - bronchiolitis guidelines

Fitzgerald D A. Viral bronchiolitis for the clinician. Journal of Paediatrics & Child Health 2011;47(4):160-166.

Gadomski AM, Bhasale AL. Bronchodilators for bronchiolitis. Cochrane Database Syst. Rev. 2006; CD001266.

Seiden J A, Scarfone R J. Bronchiolitis: An Evidence-Based Approach to Management . Clin Ped Emerg Med 2009; 10:75-81.


9. An ex-premature (30week gestation) 4month-old boy has a 2-day history of cough and coryza with associated wheeze. He has had 3 previous episodes of bronchiolitis with documented minimal response to ventolin.

His vitals are:
HR 144,
Temp 37.8°C,
RR 50,
saturations in R/A: 91%.

He has marked respiratory distress with recession and widespread inspiratory and expiratory wheeze and crepitations. Which of the following is the correct option:
  1. A trial of salbutamol is useful.
  2. A trial of hypertonic 3% saline may be useful.
  3. A trial of High flow nasal cannula humidified oxygen is indicated
  4. High Flow Humidified Nasal Cannula Oxygen provides a degree of positive end expiratory pressure approximating 15 cm of H2O.

tpched.org guidelines


10.With regard to asthma and wheeze in children, which of the following is the best option:
  1. In moderate cases of asthma, a CXR is useful for excluding pneumonia.
  2. An arterial blood gas is useful to assess fatigue in severe asthma.
  3. Preschool aged children with wheeze responsive to salbutamol do not benefit from oral steroids, unless they are moderate -to –severely unwell and require admission to hospital.
  4. Nebulised Magnesium Sulphate is not effective in the management of asthma.


tpched.org - asthma guidelines and wheeze guideline in children

Global Strategy for Asthma Management and Prevention in Children 5 Years and Younger 2018
GINA for children over 5

National Asthma Council of Australia Handbook website

Panickar J, Lakhanpaul M, Lambert PC, et al. Oral Prednisolone for Children with Virus-Triggered Wheezing. N Engl J Med 2009;36(4):329-338.

Cochrane Review: Magnesium sulfate for treating exacerbations of acute asthma in the emergency department. Rowe BH, Bretzlaff J, Bourdon C, Bota G, Blitz S, Camargo CA. Published Online: July 8, 2009

Cochrane Review: Inhaled magnesium sulfate in the treatment of acute asthma Blitz M, Blitz S, Beasely R, Diner B, Hughes R, Knopp JA, Rowe BH
Published Online: July 8, 2009



Multiple Choice Question Resources

Respiratory Illness

Asthma

tpched.org guidelines website
National Asthma Council

Bronchiolitis

bronchiolitis_guidelines.pdf
File Size: 1174 kb
File Type: pdf
Download File

nicebronchiolitisguideline.pdf
File Size: 152 kb
File Type: pdf
Download File

viral_bronchiolitis_review_2011.pdf
File Size: 121 kb
File Type: pdf
Download File

High Flow Nasal O2

high_flow_nasal_oxygen review.pdf
File Size: 109 kb
File Type: pdf
Download File

_hfnp_guideline.doc
File Size: 619 kb
File Type: doc
Download File

Wheezing under 5

wms-gina-2018-report-v1.3-002.pdf
File Size: 5517 kb
File Type: pdf
Download File

Global Initiative for Asthma

Croup

croupguidelines.pdf
File Size: 1198 kb
File Type: pdf
Download File

croup_vs_epiglottitis_2011_review.pdf
File Size: 191 kb
File Type: pdf
Download File

Pneumonia

pneumonia_british thoracic guidelines-2011.pdf
File Size: 912 kb
File Type: pdf
Download File

PedInfectiousDisSocietyAmerica2011CAPchildren.pdf
File Size: 875 kb
File Type: pdf
Download File

Infectious Diseases

Fever 

Fever guidelines 2016 QCH
feverniceguideline.pdf
File Size: 197 kb
File Type: pdf
Download File

nice_meningococcalandmeningitis-update.pdf
File Size: 202 kb
File Type: pdf
Download File

UTI

_uti_review2012.pdf
File Size: 161 kb
File Type: pdf
Download File

niceutiguideline.pdf
File Size: 153 kb
File Type: pdf
Download File

Sepsis

survivingsepsiscampaign-guidelines2012.pdf
File Size: 3471 kb
File Type: pdf
Download File

Surviving Sepsis Campaign

Inflammatory Conditions

kawasaki_review2006.pdf
File Size: 273 kb
File Type: pdf
Download File

AHA_kawasaki_disease2015.pdf
File Size: 1238 kb
File Type: pdf
Download File

HSP Review article.pdf
File Size: 479 kb
File Type: pdf
Download File

Gastrointestinal

abdo_pain_guidelines.pdf
File Size: 202 kb
File Type: pdf
Download File

constipation_nice_guideline.pdf
File Size: 172 kb
File Type: pdf
Download File

__gastroenteritis.pdf
File Size: 1185 kb
File Type: pdf
Download File

Haematological

NICE2012 CPG sickle-cell-disease.pdf
File Size: 108 kb
File Type: pdf
Download File

LINK - rch melbourne CPG - Sickle Cell Disease

Endocrine

dka_guideline.pdf
File Size: 306 kb
File Type: pdf
Download File

apeg_type_i_diabetes_guidline.pdf
File Size: 3503 kb
File Type: pdf
Download File

Neonatology

_hyperbilirubinemia.pdf
File Size: 110 kb
File Type: pdf
Download File

queensland_jaundice_guidelines.pdf
File Size: 1080 kb
File Type: pdf
Download File

_neonatal_seizure5-0.pdf
File Size: 530 kb
File Type: pdf
Download File

Trauma / Non- accidental Injury 

nai_nice_guideline.pdf
File Size: 171 kb
File Type: pdf
Download File

_ultrasound_reviewpediatrics-2008-levy-e1404-12.pdf
File Size: 312 kb
File Type: pdf
Download File

QHealthHeadInjuryCPGfeb2013.pdf
File Size: 754 kb
File Type: pdf
Download File

Neurology

status_epilepticusfeb_2013.pdf
File Size: 534 kb
File Type: pdf
Download File

_infant_botulism.pdf
File Size: 74 kb
File Type: pdf
Download File

Metabolic Disease

Approachmetabolicillness.pdf
File Size: 160 kb
File Type: pdf
Download File

Dx & early mx metabolic dx neonates.pdf
File Size: 94 kb
File Type: pdf
Download File

hypoglycaemia_guideline.pdf
File Size: 334 kb
File Type: pdf
Download File

Adolescent Medicine

QHealthGuideline eatingdisorders.doc
File Size: 662 kb
File Type: doc
Download File

RANZCP eating-disorders-cpg.pdf
File Size: 672 kb
File Type: pdf
Download File

consent-matureminorsinaustralia.pdf
File Size: 148 kb
File Type: pdf
Download File

Other Links:
http://www.healthlawcentral.com/decisions/consent-minors/
​
Copyright © 2015