Select multiple choice questions for Arab Board exam preparation.

1. ED Arab Board Review
Pediatric Emergency Block
Fatima Farid- Ped Resident Yr 2

2. Please divide into 2 teams and choose one
friend to answer on behalf of the group
There are 3 rounds with around 10
questions each
Discuss and involve all team members
2
Good luck!

3. There are 2 teams working an
ED night shift in neighboring
hospitals.
Let’s see which one has the
better duty!
3

4. Round 1
Rapid Fire MCQs!
4

5. Question 1
In non- fatal drowning, the outcome is determined by the success of immediate
resuscitation efforts and the severity of hypoxic- ischemic injury to the brain.
All the following are considered as unfavorable prognostic markers except:
a. Need of CPR for more than 25 minutes
b. Continuing CPR at the hospital
c. GCS of 5 or less
d. Development of a seizure
e. Coma for 24 hours
5

6. 6

7. Question 2
Of the following, the commonest cause of poisoning in childhood is with?
a. Cosmetics
b. Iron
c. Antihistamines
d. Carbon monoxide
e. Aspirin
7

9. Question 3
Of the following, the commonest cause of fatal poisoning in children is?
a. Analgesics
b. Iron
c. Alcohol
d. Organophosphates
e. Cyanide
9

11. Question 4
Measuring random blood glucose is part of screening in toxicological diagnosis.
All the following can cause hypoglycemia except?
a. Ethanol
b. Isoniazid
c. Insulin
d. Propranolol
e. Salicylates
11

13. Question 5
Multiple doses of activated charcoal are considered in a patient who has ingested a life-
threatening amount of which substance?
a. Theophylline
b. Azithromycin
c. Ibuprofen
d. Acetaminophen
e. Sodium valproate
13

14. 14

15. Question 6
Enhanced elimination by alkalization of urine may be helpful in toxic ingestion of which
medicine?
a. Methotrexate
b. Acetaminophen
c. Oral hypoglycemic agents
d. Phenobarbitone
e. Metoprolol
15

17. Question 7
The specific antidote for organophosphates poisoning is?
a. Atropine
b. BAL
c. Naloxone
d. Methylene blue
e. Pralidoxime
17

19. Question 8
Rapid correction of hyponatremia (faster than 12 mEq/L/day) should be avoided because
of the risk for?
a. Central pontine myelinosis
b. Cerebral edema
c. Brain herniation
d. Acute tubular necrosis
e. Hypocalcemia
19

21. Question 9
Pseudohyponatremia is a laboratory artifact that is present if there is a high plasma
concentration of which substance?
a. Potassium
b. Zinc
c. Protein
d. Ascorbic acid
e. Chloride
21

23. Question 10
What is the classification of true hyponatremia based upon?
a. Consciousness level
b. Volume status
c. Renal function
d. Serum osmolality
e. Parathyroid hormone level
23

25. Question 11
Hyponatremia with high osmolality occurs in which condition?
a. Hyperglycemia
b. SIADH
c. Glucocorticoid deficiency
d. Hypothyroidism
e. Water intoxication
25

27. Question 12
Which of the following conditions leads to euvolemic hyponatremia?
a. Congenital heart failure
b. Cirrhosis
c. Nephrotic syndrome
d. Water intoxication
e. Hypoalbuminemia
27

29. Question 13
Hypokalemia most commonly occurs in children with?
a. Gastroenteritis
b. Low fluid intake
c. Renal losses
d. Receiving therapy with high dose beta- adrenergic agonists
e. Anorexia nervosa
29

31. Question 14
In treatment of hyperkalemia, which of the following measures removes potassium from
the body?
a. IV sodium bicarbonate infusion
b. IV or PO loop diuretics
c. IV insulin and glucose
d. Beta agonist (albuterol nebulizer)
e. IV calcium
31

33. Question 15
Which of the following is a case of metabolic acidosis with normal anion gap?
a. Lactic acidosis (shock)
b. Diarrhea
c. Ketoacidosis
d. Renal failure
e. Inborn errors of metabolism
33

35. Question 16
ECG changes of flattened T waves, depressed ST segment and appearance of U waves is
seen in which condition?
a. Hyperkalemia
b. Hyponatremia
c. Hypomagnesemia
d. Hypernatremia
e. Hypokalemia
35

37. Question 17
The combination of hypokalemia and metabolic acidosis is characteristic of which
condition?
a. Distal renal tubular acidosis
b. Gastric losses
c. Aldosterone excess
d. Diuretics
e. Gitelman syndrome
37

39. Question 18
Anaphylaxis is a medical emergency requiring prompt recognition and immediate
treatment. What is the mainstay early therapy?
a. Corticosteroids
b. Antihistamines
c. H2- receptor antagonists
d. Intramuscular epinephrine
e. Bronchodilators
39

41. Question 19
Food allergy or hypersensitivity reactions are the result of immune reactions to
glycoproteins and develop in genetically predisposed individuals.
In older children, which item accounts for the most reactions?
a. Peanuts
b. Cow milk
c. Eggs
d. Soybeans
e. Wheat
41

43. Question 20
Drug reactions to penicillin and cephalosporins are the most common allergic drug
reactions encountered in the pediatric population.
All the following are risk factors for reactions except?
a. Previous drug exposure
b. Older age
c. Higher dose
d. Intermittent repeated exposure
e. Atopic background
43

45. Question 21
If a child has reacted positively to a penicillin skin test, their risk of developing an
allergic reaction to cephalosporin antibiotic is less than?
a. 2%
b. 4%
c. 6%
d. 10%
e. 20%
45

47. Question 22
All the following are indications for hospitalization in a burn's patient except?
a. Burns to hands, feet and genitals
b. Inhalational injury regardless of burn size
c. High tension wire electrical burn
d. Suspected child abuse or neglect
e. Burns involving 9- 10% of body surface area
47

49. Question 23
All the following are contraindications for performing lumbar puncture except?
a. Platelet count 55,000
b. Brain tumor
c. Meningitis with flexion of upper extremities and extension of lower extremities
d. Skin infection at site of lumbar puncture
e. Spinal cord tumor
49

51. Question 24
What is the most common complication of acute hypophosphatemia?
a. Rhabdomyolysis
b. Acute respiratory failure
c. Slow weaning from ventilator
d. Proximal muscle weakness
e. Proximal muscle atrophy
51

53. Question 25
All the following are manifestations of severe hypophosphatemia except?
a. Cardiac dysfunction
b. Tremor
c. Seizures
d. Hemolysis
e. Leukocytosis
53

55. Question 26
All the following therapies are indicated in children with burns greater than 15% of body
surface area except?
a. Initial oral fluid therapy before starting IV hydration
b. Ringer lactate (10- 20 ml/kg/hour) given initially
c. Consultation with burn specialist is indicated
d. All inhalational injuries need IV access to control fluid intake
e. All high- tension and electrical injuries need IV access to provide forced alkaline
diuresis to avoid myoglobinuric renal damage
55

57. Question 27
A child appears in ER after ingestion of a button battery. What is the next step in
management?
a. Chest x- ray AP
b. Chest x- ray lateral
c. ENT consultation after chest x- ray results
d. Observation for 24 hours
e. Removal of the battery as quickly as possible
57

59. Question 28
A child appears in ER after aspiration of a coin. The child is asymptomatic. Flat surface
of the coin is visible in the AP view, and the edge of the coin is visible in the lateral view.
What is the next step in management?
a. Removal of the coin immediately
b. Observe for up to 24 hours
c. Observe for up to 48 hours
d. MRI study of the neck and upper part of thoracic cavity
e. IV glucagon
59

61. Question 29
A child appears in ER with meat impaction in the esophagus. The child is asymptomatic
and has no problem in handling secretions. What is the next step in management?
a. Meat should be removed immediately
b. Chest x- ray AP view
c. Chest x- ray lateral view
d. Observation for up to 12 hours
e. Observation for up to 48 hours
61

63. Question 30
A symptomatic child appears after aspiration of a plastic material. The plain x- ray
appears unremarkable. What is the next step in management?
a. Remove the foreign body
b. Barium contrast of the esophagus
c. MRI study of the esophagus
d. CT scan of the upper chest area
e. Observation for 24 hours
63

65. Question 31
Which is true regarding burns in children?
a. Chemical burns, from common household cleaners, are the most common type of burns in children.
b. The modified Lund–Browder surface area chart should be used to approximate the burned surface
area.
c. Children are more likely to be burned because of a larger body surface area to body mass ratio.
d. It is very easy to distinguish partial thickness from full-thickness burns.
e. Because patients with severe burns are hospitalized and relatively immobile they have decreased
caloric requirements.
65

69. Question 32
Which of the following is true regarding the epidemiology of submersion injury?
a. Unintentional injuries such as submersion are second only to childhood cancers as
the most common cause of childhood mortality.
b. The peak of pediatric submersion injury occurs in the 10–14 year-old age range.
c. Toddlers most commonly suffer from submersion injury in oceans where the
strength of the tides overpowers their strength.
d. Submersion injury is more common in males than females.
e. Alcohol is rarely involved in submersion injury.
69

71. Round 2
Clinical Case Scenarios!
71

72. Question 1
An 18-month-old boy was brought to the ED suffering from a non- fatal drowning. Mother
describes the episode as he was swimming with his siblings at home when they
suddenly shouted for help. Soon she arrived and removed him from the swimming pool.
He was unconscious when she started resuscitation. He responded well within a few
minutes and regained consciousness. He is now alert with normal vitals.
72

73. Question 1
Of the following, the most appropriate next action is?
a. Admit to general ward for 24 hours
b. Send for neuroimaging
c. Observe for 6- 12 hours
d. Start prophylactic antibiotics
e. Reassure and send home
73

74. 74

75. Question 2
A child appears with history of muscle cramps and pains for the last one month. He
develops numbness, tingling and stiffness of the hands/ feet for the last 7 days.
What is the most likely finding on further assessment?
a. Elevated serum calcium level
b. Low serum phosphorus level
c. Elevated serum ALP level
d. Short QT interval
e. Positive Chovstek or Trousseau sign
75

77. Question 3
An 11-month-old girl presents after ingestion of a tasteless alkali. Her initial endoscopy
revealed full- thickness liquefaction necrosis of the esophagus.
She underwent successful dilatation of esophageal strictures 3 weeks after the
accident.
Her mother is asking about any other future risks of this condition.
77

78. Question 3
Of the following, the most appropriate explanation includes:
a. As she has passed the acute illness successfully, no other complication is expected
b. The likelihood of recurrence of esophageal stricture is high
c. She needs long term follow- up as there is a high risk of esophageal carcinoma
d. There is a possibility of re- infection of the affected site
e. Long term esophageal motility disorder is expected and will need follow- up
78

79. Question 4
An 18-month-old girl brought is brought to the ED after ingestion of a small button
battery left by her father after repair of his watch. On examination, she is sitting
comfortably with no complaints apart from mild drooling of saliva.
Chest x- ray shows a rounded shadow in the middle of the esophagus.
79

80. Question 4
Of the following, the best action is to?
a. Send child home with advice to come back after 12- 24 hours
b. Advise plenty of milk and fluid to move the battery down
c. Use a Foley's catheter to pull the foreign body up
d. Arrange for endoscopic interference
e. Keep under observation in ER for 24 hours
80

82. Question 5
A 2-year-old girl is brought to the ED because of decreased level of consciousness.
The family states that she was complaining of abdominal pain yesterday, and the
grandmother gave her a traditional medicine.
Her vitals are normal, but pupils are constricted, and she is only responding to painful
stimuli.
82

83. Question 5
All the following are considered as supportive therapy in this case of suspected
poisoning except?
a. Protecting and maintaining the airway
b. Glucose 1 g/kg intravenously
c. Naloxone
d. Glucagon
e. 100% oxygen
83

85. Question 6
A child presents with psychiatric symptoms such as confusion, disorientation,
depression, psychosis and hallucinations. The child is also hypotonic and lethargic.
What are lab tests most likely to reveal?
a. Low serum calcium
b. High serum calcium
c. Low serum magnesium
d. High serum magnesium
e. High serum phosphorus
85

87. Question 6
What is the first line of therapy in patients with hypercalcemia?
a. Loop diuretic
b. Calcitonin
c. Glucocorticoids
d. Bisphosphonates
e. Hydration with normal saline
87

89. Question 7
A 16-year-old boy appears in the ER at 4 AM.
He has an alcoholic aroma in his breath. He is severely depressed, disoriented, lethargic
and unresponsive. Pupils are normal in size and reactive to light. Fundoscopy is normal.
Labs reveal a serum alcohol level of 65 mg/dL.
89

90. Question 7
What is the most likely cause of his depressed condition?
a. Alcohol overdose syndrome
b. Psychiatric illness
c. Cerebral hemorrhage
d. Brain tumor
e. Ingestion of other drugs with alcohol
90

92. Question 7
What is the usual mechanism of death from alcohol overdose syndrome?
a. Cardiac failure
b. Cerebral hemorrhage
c. Acute GI bleeding
d. Respiratory depression
e. Encephalopathy
92

93. Question 7
What is the preferred therapy in those with a blood alcohol level more than 450 mg/dL?
a. Charcoal through NG tube
b. Ipecac
c. Charcoal enema
d. Dialysis
e. Phenobarbital
93

95. Question 8
A 20-month-old female presents to your office with a burn to the dorsum of her left hand
and forearm after pulling a pot of hot water off the stove.
On physical examination, she is crying inconsolably in her mother’s arms. She has
blistering and open superficial partial thickness burns over the back of her left hand and
forearm.
95

96. Question 8
How would you best manage this child’s pain?
a. Ask that child’s mother to try and comfort her.
b. Give the child a dose of ibuprofen.
c. Give the child a dose of acetaminophen with codeine.
d. Give the child a dose of acetaminophen with oxycodone.
e. Apply topical lidocaine cream and send the patient to the ED for additional
management.
96

98. Question 9
An 18-month-old female, rescued from a house fire, arrives in the ED. As you begin your
assessment you note that she is alert and crying due to pain.
Her head, neck, and face are not burned, there is no carbonaceous sputum, no stridor,
normal work of breathing, and clear breath sounds.
Her pajamas are burnt, and she has superficial and deep partial thickness burns over
most of her posterior trunk, buttocks, and left thigh. You suspect a full thickness burn
approximately the size of the patient’s palm in the middle of the left buttock. You
estimate the extent of burn surface area to be 28%.
98

99. Question 9
Which of the following statements is TRUE regarding the patient in this scenario?
a. The patient will not require intubation during her illness because she lacks burns to her head or neck, increased work of
breathing, or circumferential burns on her chest.
b. After airway assessment, immediate management should include removal of all clothes, placement of the patient into
an ice bath to prevent ongoing thermal injury, treatment of pain, IVF resuscitation, and confirmation of tetanus
immunization.
c. Transfer to a burn center for admission is not indicated as she does not have a circumferential burn, chemical or
electric burn, or burns involving the hands, feet, face, or genitalia.
d. Regarding wound management, this patient should initially be dressed with dry gauze; further management may include
debridement, topical antibiotics, nonadherent dressings, silver impregnated dressings, and potentially skin grafting to
achieve wound coverage.
e. The pattern of burn described in this scenario is highly suspicious for child abuse and Child Protective Services must be
notified.
99

101. Question 10
A mother checks on her 12-year-old daughter in the bathroom and finds her submerged in
the bathtub. The girl had been in her usual healthy state before going to the bathroom to
take a bath.
Her mother calls 911 and begins CPR.
When EMS arrives, they find the girl limp with shallow respirations and a weak pulse.
Bag-valve mask ventilation is begun as she is brought to the ED.
101

102. Question 10
Which of the following is true?
a. It is common to have serum electrolyte shifts due to the significant hypotonic fluid
aspiration.
b. Patients with epilepsy, prolonged QT syndrome, or a history of cardiac arrhythmias are
counseled not to take baths alone.
c. A Glasgow Coma Score of less than 15 on arrival to the ED predicts a poor neurologic
outcome.
d. It is rare for water to be aspirated into the lungs as laryngospasm prevents movement of
water in that direction.
e. By current definitions, this is a case of near drowning.
102

104. Question 11
A 15-year-old boy was with friends on a camping trip. The youths were drinking heavily, and
the boy slipped from a tree branch into a river.
By the time the friends were able to pull him from the water, he suffered a prolonged
submersion.
Rescue workers were called, and the boy was ultimately transported to a local emergency
department.
104

105. Question 11
Which of the following is true about the effects of submersion on the body?
a. Most severe submersion victims have intact neurologic status after recovery. Initially they present with
decreased consciousness, but the condition usually resolves in the first hour after the event.
b. Cardiac dysrhythmias, cardiac dysfunction, and hypotension are caused primarily by direct myocardial
hypoxia or ischemia.
c. Victims rarely swallow water during submersion.
d. Freshwater drowning results in water absorption into the vascular space from the lungs through
osmosis and resultant hypervolemia and hemolysis.
e. Laryngospasm prevents the water from being aspirated into the lungs and most drownings are
considered dry drownings.
105

107. Round 3
Picture- based Questions!
107

108. 108

109. 109

110. 110

111. 111

112. 112

113. 113

114. 114

115. 115

116. 116

117. 117

118. Good Job!