Paediatric emergencies and critical care

41 NEET-PG practice questions on Paediatric emergencies and critical care, part of Paediatrics. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

1. Question 1 · Easy

   Under AHA 2025 guidance, what is the first action for a conscious infant who is choking and cannot cry or cough?

   1. AAlternate 5 back blows and 5 chest thrusts
   2. BA blind finger sweep of the mouth
   3. CAbdominal thrusts only
   4. DAlternate 5 back blows and 5 abdominal thrusts

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   Answer: A · Alternate 5 back blows and 5 chest thrusts

   For a choking infant, AHA 2025 advises alternating 5 back blows and 5 chest thrusts, the thrusts given with the heel of one hand, until the object comes out or the infant becomes unresponsive, when CPR starts. Abdominal thrusts are avoided in infants because of liver injury, and blind finger sweeps can push the object deeper.

   • B: Blind finger sweeps can push the object further in.
   • C: Abdominal thrusts alone are not used in infants.
   • D: Abdominal thrusts are for children and adults, not infants.

   Remember this

   Choking infant: 5 back blows alternating with 5 chest thrusts; no abdominal thrusts.

2. Question 2 · Medium

   An hour after the first saline bolus, a girl of 7 years with DKA (glucose 520 mg/dL, pH 7.12, potassium 4.6 mmol/L) is ready for insulin in the paediatric ward. Which insulin regimen is correct?

   1. AIV regular insulin 0.05-0.1 U/kg/hour, no bolus
   2. BIV regular insulin at 1 U/kg/hour, without a bolus
   3. CIV bolus of 0.1 U/kg, then 0.1 U/kg/hour
   4. DSC insulin glargine 0.5 U/kg once daily

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   Answer: A · IV regular insulin 0.05-0.1 U/kg/hour, no bolus

   Insulin is started at least an hour after fluid replacement begins, as a continuous IV infusion of regular insulin at 0.05-0.1 U/kg/hour. An initial bolus is not needed and may increase the risk of cerebral oedema and hypokalaemia. The infusion continues until the acidosis resolves; dextrose is added as glucose falls.

   • B: One U/kg/hour is a tenfold overdose.
   • C: An insulin bolus is not advised in children with DKA.
   • D: Long-acting SC insulin cannot be titrated to clear ketosis.

   Remember this

   Paediatric DKA: insulin infusion 0.05-0.1 U/kg/hour, started after an hour of fluids, no bolus.

3. Question 3 · Medium

   At a birthday party, a boy of 4 years suddenly clutches his throat after eating groundnuts; he cannot speak or cough but is conscious. A paediatrician among the guests steps in. According to AHA 2025, what should she do?

   1. AGive abdominal thrusts alone until the object clears
   2. BEncourage him to drink water to wash it down
   3. CAlternate 5 back blows and 5 chest thrusts
   4. DAlternate 5 back blows and 5 abdominal thrusts

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   Answer: D · Alternate 5 back blows and 5 abdominal thrusts

   AHA 2025 changed choking care for conscious children and adults: rescuers now alternate 5 back blows with 5 abdominal thrusts, whereas earlier child guidance was abdominal thrusts only. Chest thrusts with back blows are the method for infants. If the child becomes unresponsive, CPR begins.

   • A: Thrusts alone were the earlier advice; 2025 adds back blows.
   • B: Drinking can cause aspiration and does not clear an airway obstruction.
   • C: Chest thrusts with back blows are for infants.

   Remember this

   Choking child (AHA 2025): alternate 5 back blows and 5 abdominal thrusts.

4. Question 4 · Medium

   On infant chest compressions in AHA 2025: 1. The two-finger technique is no longer recommended. 2. The heel of one hand may be used. 3. The two-thumb encircling-hands technique may be used. 4. The target rate is 60-80 compressions per minute. Which are correct?

   1. A1, 2, 3 and 4
   2. B3 and 4 only
   3. C2 and 3 only
   4. D1, 2 and 3 only

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   Answer: D · 1, 2 and 3 only

   AHA 2025 removed the two-finger technique for infant compressions because it often gives too little depth. Rescuers now use the heel of one hand or the two-thumb encircling-hands technique. The compression rate stays at 100-120 per minute for all ages.

   • A: Statement 4 is false: the rate is 100-120 per minute.
   • B: Statement 4 is false, and statements 1 and 2 are true.
   • C: Statement 1 is also true.

   Remember this

   Infant CPR (AHA 2025): heel of one hand or two thumbs, not two fingers, at 100-120/min.

5. Question 5 · Medium

   Consider these statements on DKA in children under ISPAD 2022: 1. Bicarbonate should be given routinely when the pH is below 7.1. 2. The fluid deficit is replaced evenly over 24-48 hours. 3. An insulin bolus at the start is unnecessary and may raise the risk of cerebral oedema. 4. A measured sodium that does not rise as glucose falls is a warning sign. Which statements are true?

   1. A2 and 3 only
   2. B1, 2 and 3 only
   3. C2, 3 and 4 only
   4. D1 and 4 only

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   Answer: C · 2, 3 and 4 only

   Bicarbonate does not improve outcome and is linked to cerebral oedema and hypokalaemia; it is kept only for life-threatening hyperkalaemia or severe acidosis with poor cardiac function. The deficit is replaced over 24-48 hours, and insulin starts as an infusion without a bolus. As glucose falls, measured sodium should rise; failure to rise suggests excess free water and cerebral oedema risk.

   • A: Statement 4 is also true.
   • B: Statement 1 is false: bicarbonate is not routine in DKA.
   • D: Statement 1 is false and statements 2 and 3 are true.

   Remember this

   Paediatric DKA: no routine bicarbonate, no insulin bolus, slow deficit replacement, watch the sodium trend.

6. Question 6 · Easy

   Opium (afeem) was given by a grandmother to quieten a crying infant of 8 months; now the baby is drowsy, with pinpoint pupils and slow, shallow breathing at 10/min. Which antidote should be given?

   1. APralidoxime
   2. BFlumazenil
   3. CNaloxone
   4. DAtropine

   Answer and explanation in LearnFree account

7. Question 7 · Medium

   Stridor at rest and moderate chest indrawing improve within 15 minutes of nebulised L-adrenaline in a girl of 18 months with croup in casualty; dexamethasone was also given. The resident wants to send her home now. Why should she be observed for at least 2-4 hours?

   1. AAdrenaline wears off in about 2 hours, so stridor may return
   2. BAdrenaline commonly causes ventricular arrhythmias hours later
   3. CCroup usually turns into bacterial tracheitis
   4. DDexamethasone causes early hypoglycaemia

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8. Question 8 · Medium

   In a village in Maharashtra at night, a boy of 8 years is stung on the foot by a red scorpion. Two hours later he is sweating heavily, vomiting and salivating, with cold extremities, priapism, BP 150/100 mmHg and HR 130/min; fine crackles are starting at the lung bases. Which drug is most appropriate?

   1. AIV calcium gluconate
   2. BOral prazosin
   3. CSublingual nifedipine
   4. DIV atropine

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9. Question 9 · Medium

   Haemophilus influenzae type b is grown from the blood of a child with acute epiglottitis who was intubated yesterday. At home is an unvaccinated brother of 2 years. What should the family receive?

   1. ARifampicin for all household contacts
   2. BCiprofloxacin for the brother only
   3. CNo prophylaxis; watch for symptoms
   4. DHib vaccine for the brother and no drug

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10. Question 10 · Medium

    ECG: a regular narrow-complex tachycardia at 280/min without visible P waves and with no beat-to-beat variation. It belongs to an infant of 2 months brought for poor feeding for a few hours; she is alert and pink, with capillary refill of 2 s and normal BP. Which should be tried first?

    1. AAn ice-water bag held over the face
    2. BIV verapamil
    3. CIV adenosine by rapid push
    4. DSynchronised cardioversion

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11. Question 11 · Medium

    Fever for 2 days, then lethargy: on arrival at a medical college PICU, a girl of 5 years (18 kg) has HR 160/min, capillary refill 5 s, cold mottled limbs, BP 84/50 mmHg and a lactate of 5 mmol/L. Ventilators and intensive care are available. Which initial fluid plan is best?

    1. A60 ml/kg of 0.9% saline over 15 minutes, without reassessing
    2. BNo bolus; maintenance fluids only
    3. C20 ml/kg of 6% hydroxyethyl starch
    4. DBoluses of 10-20 ml/kg crystalloid, reassessing after each

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12. Question 12 · Hard

    A boy of 3 years treated for croup at a CHC three days ago is brought back much worse. His immunisations are complete for age. He now has a fever of 39.8 °C, looks toxic, and has a brassy cough, inspiratory and expiratory stridor and thick purulent secretions that he coughs up. He lies flat comfortably and is not drooling. Stridor did not improve with nebulised adrenaline in casualty. A neck X-ray shows a ragged, irregular tracheal outline. During bronchoscopy, thick membranes are removed from the trachea. Which organism is most likely?

    1. AParainfluenza virus type 1
    2. BHaemophilus influenzae type b
    3. CStaphylococcus aureus
    4. DCorynebacterium diphtheriae

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13. Question 13 · Hard

    In a household where the grandfather is taking isoniazid 300 mg tablets as TB preventive treatment, a boy of 3 years (14 kg) is found beside an open strip with 6 tablets missing. Within an hour he has repeated generalised seizures that do not stop after two doses of IV midazolam. Blood gas: pH 7.02, bicarbonate 7 mmol/L, lactate 9 mmol/L; blood glucose 110 mg/dL. Electrolytes are normal. The casualty doctor is preparing a phenytoin infusion. What is the specific treatment?

    1. AIV sodium bicarbonate alone
    2. BIV pyridoxine, about 1 g per gram of isoniazid taken
    3. CIV phenytoin loading dose
    4. DHaemodialysis as the first measure

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14. Question 14 · Hard

    Haematocrit values in a boy of 9 years with dengue shock on day 5 of fever: at admission 48% (his baseline last year was 38%); after 2 hours of crystalloid at 10 ml/kg/hour, 36%. He remains restless, with HR 150/min, cold limbs and BP 80/66 mmHg. His platelet count is 18,000/µL, and he has just passed a black, tarry stool. What is the best next step?

    1. AStop fluids and give IV furosemide
    2. BTransfuse platelet concentrate
    3. CGive a colloid bolus for the persistent shock now
    4. DTransfuse fresh whole blood or packed red cells

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15. Question 15 · Medium

    Heart rate stays at 48/min in an infant of 3 months in the PICU after 30 seconds of effective bag-mask ventilation with oxygen for apnoea during bronchiolitis. He is pale and mottled, with capillary refill of 5 s and weak pulses. What is the next step?

    1. ABegin transcutaneous pacing
    2. BStart chest compressions
    3. CContinue ventilation and recheck in 5 minutes
    4. DGive IV atropine as the first drug

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16. Question 16 · Medium

    For second-line treatment of convulsive status epilepticus in children, consider: 1. Levetiracetam, fosphenytoin and valproate stopped seizures at similar rates in the ESETT trial. 2. Phenytoin should be diluted in 5% dextrose. 3. Second-line treatment follows at most two doses of a benzodiazepine. 4. Phenobarbitone is an accepted alternative where the others are not available. Which are correct?

    1. A1, 2 and 3 only
    2. B1 and 3 only
    3. C1, 3 and 4 only
    4. D2 and 4 only

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17. Question 17 · Medium

    Venous blood gas in a newly diagnosed diabetic boy of 11 years: pH 7.15, pCO2 22 mmHg, bicarbonate 8 mmol/L; plasma glucose 460 mg/dL; blood beta-hydroxybutyrate 5.2 mmol/L. By the ISPAD 2022 criteria, how severe is his DKA?

    1. ANot DKA but a hyperosmolar state
    2. BMild
    3. CSevere
    4. DModerate

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18. Question 18 · Medium

    Minutes after eating a cashew sweet at a wedding, a boy of 6 years (20 kg) develops lip swelling, hives, wheeze and a hoarse voice; his BP is 76/40 mmHg. Which is the best first drug and route?

    1. AIV adrenaline 1 mg/ml, 0.2 ml as a push
    2. BIV hydrocortisone 100 mg
    3. CIM adrenaline 1 mg/ml, 0.2 ml into the thigh
    4. DSC adrenaline 1 mg/ml, 0.2 ml in the upper arm

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19. Question 19 · Easy

    Treated for asthma with nebulisation at a clinic, a girl of 8 years is referred because her breathing stays deep and fast. She has lost 3 kg in a month, drinks a lot of water, has started wetting the bed again and has vomited twice today. Her chest is clear, SpO2 is 98%, and her breath smells fruity. What is the most likely diagnosis?

    1. AAcute severe asthma
    2. BAcute gastroenteritis with dehydration
    3. CDiabetic ketoacidosis
    4. DSalicylate poisoning

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20. Question 20 · Medium

    Barking cough and a hoarse voice since last night in a boy of 2 years after 2 days of a runny nose; his temperature is 38 °C. He is playful, with no stridor at rest and no chest indrawing; SpO2 98%. Which treatment is most appropriate?

    1. AOral amoxicillin for 5 days
    2. BNebulised adrenaline and admission for observation
    3. CA single oral dose of dexamethasone, then home
    4. DMist tent humidification overnight

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21. Question 21 · Easy

    Urine nitroprusside dipsticks for ketones do not detect which ketone body, the main one in DKA?

    1. AAcetoacetate
    2. BPyruvate
    3. CBeta-hydroxybutyrate
    4. DAcetone

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22. Question 22 · Hard

    Coughing, drooling and refusing food for an hour, a boy of 2 years is brought to a taluk hospital after his sister saw him put a small round battery from the TV remote in his mouth. A chest X-ray shows a round radio-opaque object at the thoracic inlet with a double-ring (halo) outline on the AP view and a step-off on the lateral view. He is breathing comfortably with SpO2 98%, and there is no blood in his saliva. The nearest endoscopy unit is 1 hour away by road. What is the best plan?

    1. AObserve and repeat the X-ray in 24 hours
    2. BEmergency endoscopic removal; give honey on the way
    3. CGive a laxative to hasten its passage
    4. DInduce vomiting to expel it

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23. Question 23 · Easy

    In children with shock, which sign usually appears last and marks decompensation?

    1. ATachycardia
    2. BCool peripheries
    3. CProlonged capillary refill
    4. DHypotension

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24. Question 24 · Hard

    Six hours into treatment for severe DKA in the PICU, a girl of 9 years who had been talking now complains of a worsening headache, then becomes confused and incontinent of urine. Her heart rate has fallen from 124 to 62/min and her BP has risen to 138/90 mmHg. Her measured serum sodium has dropped from 136 to 132 mmol/L while glucose fell from 610 to 310 mg/dL. A capillary glucose taken now is 290 mg/dL, and her pupils are equal and reacting. What is the most appropriate immediate step?

    1. AUrgent CT brain, then decide on treatment
    2. BIV sodium bicarbonate to correct the acidosis
    3. CIncrease the IV fluid rate to restore perfusion
    4. DIV mannitol 0.5-1 g/kg over 10-15 minutes, before imaging

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25. Question 25 · Medium

    IMNCI Plan C is being followed in a CHC for a girl of 2 years (10 kg) with severe dehydration from acute watery diarrhoea: she is lethargic, with sunken eyes and a skin pinch that goes back very slowly. An IV line is in place, and she does not have SAM. How should Ringer lactate be given?

    1. A30 ml/kg in 30 minutes, then 70 ml/kg in 2½ hours
    2. B30 ml/kg in 1 hour, then 70 ml/kg in 5 hours
    3. C100 ml/kg spread evenly over 24 hours
    4. D20 ml/kg in 20 minutes, then reassess before giving more

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