Emergency and Toxicology Prometric Style Questions – 50 Cases with Answers

What this deck covers

Emergency and Toxicology — Prometric Style Questions, Set 1 in 50 board-style clinical cases with worked explanations. Each case gives you a clinical vignette, four options, the correct answer, and an explanation of why each of the other three is wrong, with the guideline or textbook it follows named on the answer.

Board-style teaching questions for paediatricians and trainees preparing for board, MRCPCH and Prometric examinations. Written from published guidelines and standard paediatric textbooks, with the source named on every answer.

The 50 cases, in order

1. Cold hands and full neck veins
2. Fast pulse, normal pressure
3. No pulses you can feel
4. Choosing fluid before the results
5. A flat line on the monitor
6. A rhythm with no pulse
7. A rate of 42 after good ventilation
8. Occasional gasps and a slow pulse
9. What comes after the primary survey
10. Bruises on a baby who cannot crawl
11. Why toddlers swallow things
12. When charcoal will not help
13. Lamp oil around the mouth
14. Chemical still on the skin
15. The dose that stopped working
16. Pinpoint pupils and a garlic smell
17. Still weak after the atropine
18. Normal bloods six hours after tablets
19. Timing the blood level
20. Ringing ears and deep breathing
21. Making the urine alkaline
22. Found by the pill box
23. Sleepy after mother’s tablets
24. A whole family with headaches
25. Bloody vomit after swallowing tablets
26. Drank from the radiator bottle
27. A wide QRS after antidepressants
28. Slow and flat after grandad’s tablets
29. Twisted neck after an antiemetic
30. Eating paint flakes at home
31. Hot and agitated after a party
32. Peaked T waves in renal failure
33. Too much of a good vitamin
34. Bleeding gums after a snake bite
35. Sweating and restless after a sting
36. Thirty minutes and still cold
37. What predicts a good recovery
38. Dark urine after an electric shock
39. Working out the fluid for a scald
40. Stridor minutes after a biscuit
41. Asking to go home after the reaction
42. Collapsed on the pitch in the heat
43. A child who can still talk
44. Checking the technique
45. Vomiting after a fall
46. How the neurotoxic bites kill
47. Swallowed the drain cleaner
48. Anxious after being hit by a car
49. Found on the bathroom floor
50. Still shocked after three boluses

Diagnoses and management options tested

Across the fifty cases you are asked to choose between options such as: Obstructive shock, Sodium chloride 0.45 percent with glucose 5 percent, Give atropine 20 micrograms/kg intravenously, Give activated charcoal and observe for four hours, Naloxone, Immediately, and repeated after two hours, Flumazenil, Activated charcoal at 1 g/kg, Adenosine by rapid intravenous push, Anticholinergic, Antivenom, Submersion for less than 5 minutes, Nebulised salbutamol with high flow oxygen, Perform a blind finger sweep of the pharynx.

Clinical pearls from this deck

• Look at the neck before you hang the fluid. Full veins mean the problem is mechanical, and a bolus will not touch it.
• In a child the blood pressure is the last thing to go and the first thing people look at. Trust the capillary refill.
• Isotonic and fast. Anything hypotonic in a resuscitation bolus is treating the wrong compartment.
• You never need the sodium before you resuscitate. Isotonic fluid is the right answer at every value.
• Two rhythms you shock, two you do not. Getting that wrong costs compression time, which is the only thing that reliably works.
• In this rhythm the drug buys time and the diagnosis saves the child. Work the list while compressions continue.

Work through the deck once for recognition, then again a week later to test yourself — each question gives the answer and explains why every other option fails.

More from this system: all Emergency and Toxicology case decks · pediatric reference values.