Pediatric Critical Care Practice Questions

Q: Which is the prognostic scoring system for trauma in children?

Pediatric Trauma Score. ***Pediatric Trauma Score*** - The **Pediatric Trauma Score (PTS)** is a specific scoring system designed to assess the severity of injury and predict outcomes in injured children. - It considers factors like **weight**, **airway status**, **systolic blood pressure**, **CNS status**, **bone injury**, and presence of **cutaneous injury**. *CCS* - The **Canadian CT Head Rule (CCHR)** is a clinical decision rule used specifically in adults to determine the need for a head CT after minor head injury. - It is not a prognostic scoring system and is not validated for use in children. *AUDIT* - **AUDIT (Alcohol Use Disorders Identification Test)** is a screening tool used to identify hazardous and harmful alcohol consumption, not head injury prognosis. - It has no relevance to the assessment or prognosis of head injuries in any age group. *Injury severity score* - The **Injury Severity Score (ISS)** is a general anatomical scoring system that rates the severity of injuries in multiple body regions, primarily used for adults. - While it can be applied to children, it is not specifically designed for pediatric trauma and does not offer the same prognostic power as age-specific scores like the PTS.

Q: Most common cause of shock in children

Hypovolemic shock. ***Hypovolemic shock*** - In children, the most common cause of shock is **hypovolemia**, often due to **diarrhea** and vomiting leading to significant fluid loss or **hemorrhage** from trauma. - Children have a smaller circulating blood volume relative to their body size, making them more susceptible to shock from even moderate fluid loss. *Septic shock* - While a serious cause of shock in children, **septic shock** is less common than hypovolemic shock globally, particularly in areas with high rates of infectious diarrheal diseases. - It is caused by an overwhelming immune response to an infection, leading to widespread vasodilation and organ dysfunction. *Cardiogenic shock* - This type of shock results from the heart's inability to pump adequate blood despite sufficient intravascular volume, often due to congenital heart disease or myocarditis. - It is a less frequent cause of shock in otherwise healthy children compared to hypovolemia or sepsis. *Anaphylactic shock* - **Anaphylactic shock** is a severe, life-threatening allergic reaction that causes widespread vasodilation and increased capillary permeability. - While it can occur in children, it is typically triggered by specific allergens and is much less common as an overall cause of shock than hypovolemia.

Q: Which condition is characterized by conjunctival injection, pharyngeal injection, polymorphic rash, and cervical lymphadenopathy?

Kawasaki syndrome. ***Kawasaki syndrome*** - **Kawasaki syndrome** is characterized by a constellation of symptoms including **conjunctival injection**, **pharyngeal injection**, a **polymorphic rash**, and **cervical lymphadenopathy**, often described as the CRASH and burn criteria (Conjunctivitis, Rash, Adenopathy, Strawberry tongue, Hand/foot changes, and Fever). - It is an acute systemic vasculitis, primarily affecting young children, and without treatment, it can lead to **coronary artery aneurysms**. *Measles* - Measles is characterized by a maculopapular rash that typically starts on the face and spreads downwards (cephalocaudal), along with the presence of **Koplik spots** on the buccal mucosa. - While it presents with conjunctivitis and rash, the rash is not polymorphic in the same way as Kawasaki, and cervical lymphadenopathy is less prominent. *Scarlet fever* - **Scarlet fever** is caused by Group A Streptococcus and presents with pharyngitis, fever, and a characteristic **sandpaper-like erythematous rash** with circumoral pallor. - While it has pharyngeal involvement and rash, it lacks the **conjunctival injection** and **polymorphic nature of the rash** seen in Kawasaki syndrome. The rash is typically fine and blanching. - Cervical lymphadenopathy may be present but the overall constellation differs from Kawasaki. *Mumps* - Mumps is an acute viral infection primarily characterized by the swelling of the **parotid glands** (parotitis), often accompanied by fever, headache, and malaise. - It does not typically present with conjunctival injection, a polymorphic rash, or prominent cervical lymphadenopathy as seen in Kawasaki syndrome.

Q: What is the maintenance fluid requirement in a 6 kg child ?

600 ml/day. **600 ml/day** - The **Holliday-Segar formula** is used to calculate maintenance fluid requirements. For the first 10 kg of body weight, the requirement is 100 ml/kg/day. - For a 6 kg child, the calculation is 6 kg * 100 ml/kg/day = **600 ml/day**. *240 ml/day* - This value is significantly **lower** than the recommended maintenance fluid for a 6 kg child, which would lead to **dehydration**. - It does not align with the standard Holliday-Segar formula for this weight. *300 ml/day* - This amount is **insufficient** for a 6 kg child's daily maintenance fluid needs and would risk **hypovolemia**. - It represents roughly half of the calculated requirement based on standard pediatric guidelines. *1200 ml/day* - This volume is significantly **higher** than the maintenance fluid requirement for a 6 kg child and could lead to **fluid overload** and hyponatremia. - This calculation might be appropriate for a much heavier child or in situations of increased fluid loss.

Q: Which of the following statements about shock in children is correct?

Tachycardia is a sensitive indicator of shock in children.. ***Tachycardia is a sensitive indicator of shock in children.*** - **Tachycardia** is often the first and most reliable sign of **compensated shock** in children, as their cardiovascular system initially maintains cardiac output by increasing heart rate. - Children have a remarkable ability to compensate for significant fluid loss, and an elevated heart rate helps maintain **perfusion** before blood pressure drops. *Mottling of extremities is an early sign of shock.* - **Mottling** of extremities is typically a sign of **decompensated shock** and indicates significant vasoconstriction and poor tissue perfusion. - It is a **late sign** that suggests the child's compensatory mechanisms are failing. *Confusion and stupor are early signs of shock.* - **Altered mental status**, such as confusion or stupor, usually indicates **severe shock** and reduced cerebral perfusion. - These are generally **late signs** of shock, appearing after initial compensatory mechanisms have failed. *Respiratory rate is a more sensitive indicator of shock than heart rate.* - While **tachypnea** can be present in shock due to metabolic acidosis or compensatory mechanisms, **tachycardia** is a more consistently sensitive and earlier indicator of circulatory compromise. - Respiratory changes can also be influenced by other factors like pain, fever, or respiratory illness, making heart rate a more specific initial marker for shock.

Q: At what rate should dopamine be administered for inotropic support in a severely dehydrated child?

1-5 microgram/kg/min. ***1-5 microgram/kg/min*** - This dosage range of **dopamine** primarily targets **beta-1 adrenergic receptors**, leading to **increased myocardial contractility** (inotropic effect) and improved cardiac output. - It is appropriate for managing **hypotension** and poor perfusion in a severely dehydrated child after initial **fluid resuscitation** has been attempted but was insufficient. *0.1-0.5 microgram/kg/min* - This very low dose range of dopamine primarily stimulates **dopaminergic receptors** in the renal and mesenteric vascular beds. - Its main effect is **vasodilation** in these areas, which increases blood flow to the kidneys and gut, but it provides minimal to no **inotropic support**. *1-5 mg/kg/min* - This dosage is significantly too high, as it is in milligrams rather than micrograms. - Administering dopamine at this rate would lead to severe **toxicity**, including profound **tachycardia**, ventricular arrhythmias, and extreme **vasoconstriction**. *10-15 mg/kg/min* - This dopamine dosage is also excessively high, again due to being in milligrams per minute rather than micrograms per minute. - Such a dose would be **lethal**, causing catastrophic cardiovascular collapse due to overwhelming **alpha-adrenergic stimulation** and severe arrhythmias.

Q: What is the recommended CPR ratio for infants when performed by 2 rescuers?

15 : 2. ***15 : 2*** - For **infants and children**, when there are **two or more rescuers**, the recommended compression-to-ventilation ratio is **15 compressions to 2 breaths**. - This ratio provides a better balance between compressions and ventilations to optimize outcomes in pediatric cardiac arrest. *30 : 2* - The **30:2 ratio** is primarily recommended for **adult CPR**, or for **single rescuers** performing CPR on infants and children. - Using this ratio for two-rescuer infant CPR would likely lead to inadequate ventilation and potentially worse outcomes. *1 : 3* - A 1:3 ratio (1 compression to 3 breaths) is not a standard recommended ratio for CPR in any age group based on current guidelines. - This ratio would significantly prioritize ventilations over chest compressions, which is not ideal for maintaining circulation. *1 : 5* - A 1:5 ratio (1 compression to 5 breaths) is not a standard recommended ratio for CPR in any age group. - This ratio heavily emphasizes ventilations and would result in insufficient chest compressions, which are crucial for blood flow.

Q: What is the recommended dosage of intravenous fluid for a 2-year-old child with severe dehydration due to diarrhoea for initial rapid rehydration?

100 ml/Kg in 3 hours. ***100 ml/Kg in 3 hours*** - For **severe dehydration** in children aged 12 months or older, the WHO Plan C recommends administering **100 mL/kg** intravenously over 3 hours for rapid rehydration. - This volume is typically given as **30 mL/kg in the first 30 minutes**, followed by **70 mL/kg over the next 2.5 hours**, to quickly restore circulating volume and perfusion. - This aggressive approach addresses the severe fluid deficit and helps prevent hypovolemic shock. *50 ml/Kg in 3 hours* - This volume is **insufficient** for initial rapid rehydration in a child with severe dehydration. - Administering only 50 mL/kg (half the recommended dose) may not adequately correct the significant fluid deficit and could lead to **persistent hypovolemia and inadequate tissue perfusion**. *75 ml/Kg in 3 hours* - This volume is **less than the WHO recommended dose** for severe dehydration (Plan C) in children aged 12 months or older. - It might not fully address the fluid deficit, potentially delaying recovery or risking inadequate rehydration in a critical situation where rapid restoration of circulating volume is essential. *80 ml/Kg in 3 hours* - This volume is also **suboptimal for severe dehydration**, which requires the full 100 mL/kg as per WHO guidelines for adequate fluid resuscitation. - Using 80 mL/kg (20% less than recommended) could be inadequate to correct the profound fluid losses seen in severe dehydration, especially within the critical initial rehydration phase.

Q: What is the recommended initial dose of packed red blood cells (PRBCs) for a child with polytrauma?

10 ml/kg. ***10 ml/kg*** - This is the standard initial dose for **packed red blood cells (PRBCs)** in pediatric trauma patients. - This dose is generally expected to raise the **hemoglobin** by approximately 2-3 g/dL. *20 ml/kg* - This dose is typically used for **intravenous fluid resuscitation** with crystalloids, not for PRBCs. - Administering 20 ml/kg of PRBCs initially would be an **overdose** and potentially harmful. *30 ml/kg* - This dose is significantly higher than the recommended initial bolus for PRBCs in children. - It could lead to **fluid overload** and other transfusion-related complications. *40 ml/kg* - This dose is excessive and not recommended for initial PRBC transfusion in pediatric trauma. - Such a large volume greatly increases the risk of **transfusion reactions** and hemodynamic instability.

Q: Rehydration therapy in a 2 year old severely dehydrated child is -

30 ml/kg in 30 min, 70 ml/kg in 2.5 hours. ***30 ml/kg in 30 min, 70 ml/kg in 2.5 hours*** - This option reflects the recommended rehydration protocol for a severely dehydrated child aged **12 months to 5 years**, where the first 30 ml/kg are given rapidly over 30 minutes, followed by 70 ml/kg over the next 2.5 hours. - This rapid initial infusion helps to quickly restore **circulating volume** and improve perfusion during severe dehydration. *30 ml/kg in 1 hour, 70 ml/kg in 5 hours* - This protocol is typically used for children with **some dehydration**, not severe dehydration, and is usually administered orally when possible. - The slower rate of rehydration would be insufficient for a severely dehydrated child requiring more urgent fluid replacement. *20 ml/kg in 30 min, 80 ml/kg in 2.5 hours* - While reflecting a rapid initial phase, the total volume and distribution of fluids differ from the WHO guidelines for **severe dehydration** in this age group. - The **initial 20 ml/kg over 30 minutes** is generally a slightly lower first bolus than recommended for very severe cases, and the subsequent phase is also adjusted. *75 ml/kg in 4 hours* - This represents a **lower total volume** (75 ml/kg compared to 100 ml/kg) and a different time distribution for severely dehydrated children in the 12 month to 5 year age group. - This protocol is more aligned with the management of **some dehydration** rather than the urgent requirements of severe dehydration.

Question 1

Which is the prognostic scoring system for trauma in children?

Accepted Answer

Pediatric Trauma Score

Answer

AUDIT

Answer

CCS

Answer

Injury severity score

Question 2

Most common cause of shock in children

Accepted Answer

Hypovolemic shock

Answer

Septic shock

Answer

Cardiogenic shock

Answer

Anaphylactic shock

Question 3

Which condition is characterized by conjunctival injection, pharyngeal injection, polymorphic rash, and cervical lymphadenopathy?

Accepted Answer

Kawasaki syndrome

Answer

Measles

Answer

Scarlet fever

Answer

Mumps

Question 4

What is the maintenance fluid requirement in a 6 kg child ?

Accepted Answer

600 ml/day

Answer

240 ml/day

Answer

300 ml/day

Answer

1200 ml/day

Question 5

Which of the following statements about shock in children is correct?

Accepted Answer

Tachycardia is a sensitive indicator of shock in children.

Answer

Mottling of extremities is an early sign of shock.

Answer

Confusion and stupor are early signs of shock.

Answer

Respiratory rate is a more sensitive indicator of shock than heart rate.

Question 6

At what rate should dopamine be administered for inotropic support in a severely dehydrated child?

Accepted Answer

1-5 microgram/kg/min

Answer

0.1-0.5 microgram/kg/min

Answer

1-5 mg/kg/min

Answer

10-15 mg/kg/min

Question 7

What is the recommended CPR ratio for infants when performed by 2 rescuers?

Accepted Answer

15 : 2

Answer

30 : 2

Answer

1 : 3

Answer

1 : 5

Question 8

What is the recommended dosage of intravenous fluid for a 2-year-old child with severe dehydration due to diarrhoea for initial rapid rehydration?

Accepted Answer

100 ml/Kg in 3 hours

Answer

50 ml/Kg in 3 hours

Answer

75 ml/Kg in 3 hours

Answer

80 ml/Kg in 3 hours

Question 9

What is the recommended initial dose of packed red blood cells (PRBCs) for a child with polytrauma?

Accepted Answer

10 ml/kg

Answer

20 ml/kg

Answer

30 ml/kg

Answer

40 ml/kg

Question 10

Rehydration therapy in a 2 year old severely dehydrated child is -

Accepted Answer

30 ml/kg in 30 min, 70 ml/kg in 2.5 hours

Answer

75 ml/kg in 4 hours

Answer

30 ml/kg in 1 hour, 70 ml/kg in 5 hours

Answer

20 ml/kg in 30 min, 80 ml/kg in 2.5 hours

Pediatric Critical Care — MCQs

Pediatric Critical Care — MCQs

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