Pre test fellow penyegaran

A boy, four years old, in ER, collapse and apnea, unpalpable pulse, ECG with sinus rhythm, heart rate 70 x/m, SpO2 85%, BP cannot be detected in monitor.

What should you do immediately?

• Ventilation 20 – 30 times in a minute

• Head tilt and chin lift maneuver

• High Quality CPR in 2 minute

• Intubation

• Defibrillation

A 5-year-old girl, leukemia, in ER with lethargy and a high fever.

HR 170/min; RR 35/min; BP 86/35 mmHg (P5-50) ; bounding pulse and flash capillary refill time, petechiae in extremities.

What is the child's most likely condition?

• Obstructive shock

• Hemorrhagic shock

• Septic shock

• Hypovolemic shock

• Cardiogenic shock

A 6 year old girl brought to emergency department due to syncope. The physical examination showed: patient unconscious, gasping and no pulse.

The monitor showed:

What is the next management after you did CPR?

• Give epinephrine 1:10.000

  0.1 ml/kgBW

• Give amiodarone 5 mg/kgBW

• Do cardioversion 1 J/kgBW

• Do defibrillation 4 J/kgBW

• Do cardio-pulmonary resuscitation

The following were included in exposure evaluation in primary survey:

• GCS evaluation before admitted to emergency

• Difficulty of breathing

• Previous history of shock

• History of medication

• Evaluation for pale or mottled

A 2 years old girl was admitted in emergency department with respiratory failure and planned for intubation.

What is estimated ETT size in this case?

• Uncuff 4.5 mm

• Cuff 4.5 mm

• Uncuff 5.0 mm

• Cuff 5.0 mm

A, 10 month old girl, 8 kg, diarrhea since 3 days ago.

PE: lethargic, sunken fontanel. The baby was assessed as severe dehydration.

Lab: Sodium 125, potassium 3.5, chloride 97.

What is the next appropriate management for this electrolyte imbalance of this case?

• Give 48 ml NaCl 0.9% in 3 hours

• Give 155 ml NaCl 0.9% in 6 hours

• Give 48 ml NaCl 3% in 3 hours

• Give 155 ml NaCl 3% in 6 hours

According to Surviving Sepsis Campaign 2020 (paediatric sepsis). If we have a shock septic child without hypotension and have no PICU facility, we should:

• Give crystalloid maintenance

• Give crystalloid 10 mL/kg BW until are

  achived therapeutic goal

• Give albumin 5% 20 mL/kg BW until hepatomegaly found

• Give crystalloid 40 mL/kg BW until rales found

• Give albumin 5% 40 mL/kg BW until MAP > P5

A 6 months old, girl, in PICU due to severe bronchiolitis. Patient was intubated and alarm was sounded.

PE: irritable, prolonged expiration, rales at posterior aspect of both lung.

Ventilator settings: PC/AC, PIP 15, PEEP 5, RR: 30 x/min, Ti: 0.6. FiO2 30%. MV 1.1. Lab: pH 7.24, pCO2 60, pO2 95.

What is appropriate management for this case?

• Reintubate the patient

• Decreased Δpressure

• Decreased Ti

• Give more sedation

• Give bronchodilator

P, 6 mo, BW 7 kg, post Kasai Procedure, failed to extubate with increased respiratory effort. Patient was sedated with Midazolam 1 mcg/kg BW/minute. BP P50. Edema +, increased inspiratory effort, saturation 95-97%, symmetric lung air entry, TV 6-7 ml/kg, intraabdominal pressure 14 cmH2O.

Which of the following option is the most possible cause of increased respiratory failure?

• The patient was still under sedation

• The patient had intrathoracal intraparenchymal lung problem

• The patient had intrathoracal extraparenchymal problem

• The patient had extrathoracal problem

• The patient had hemodynamic problem

A, 4 months-old, 5 kg BW, post laparatomy exploration due to invagination. Patient was bleeding 20 ml from surgical site and had fluid loading. About one hour after loading, the patient suddenly had sinus bradycardia, with blood pressure below P5 (systolic and diastolic).

The result of non-invasive hemodynamic measurement revealed:

low FTC, normal INO, low SVRI, normal PKR.

What is the most appropriate treatment for this condition?

• Sulfas Atropin

• Furosemide

• Dobutamine

• Epinephrine

• Amiodaron