SOAL

UKK EMERGENSI DAN RAWAT INTENSIF ANAK (ERIA)

1. A 2-year-old male is rushed to the ER by his parents after being found unconscious near
open botles of his antitussive syrup. The airway is secure and successful bag-valve
ventilations are started. He is pulseless and unresponsive and getting better after
cardiac pulmonary resuscitation was be done. Intravenous access is being obtained. The
cardiac monitor shows a wide complex tachycardia at a rate of 260. What is the next
step in management?
a. Shock the patient with 200 J
b. Shock the patient with 0.5 J/kg
c. Shock the patient with 2 J/kg
d. Administer epinephrine 0.01 mg/kg IV
e. Do the CPR

(kompetensi no 6.c )

2. A 2-month-old female presents with acute dyspneu and cyanosis. On examination the
pulse rate is 196 per minute and her respiration rate is 72x/minute. She has a grade 3/6
pansystolic murmur at the left sternal edge, basal crepitations and a liver measuring 5
cm below the right costal margin.
a. The most likely diagnosis is an atrial septal defect
b. She needs a diuretic
c. She needs titration of dobutamin
d. She should make a spontaneous recovery
e. Chest x-ray would be likely to show a small cardiac shadow

(Kompetensi no 6.d)

3. A 7-year-old child presents after a car accident. He was not wearing a seatbelt and he
was sitting at the point of impact in the left passenger seat. He complains of left upper
quadrant abdominal pain and left shoulder pain. Physical examination shows diffuse
abdominal tenderness but no obvious tenderness or trauma to the shoulder. Blood
pressure is 120/80 mmhg and heart rate is 120 beats/min. You have sent blood for a
complete blood count. Of the following, the most approriate next diagnostic study is:
a. Abdominal CT
b. Abdominal ultrasound
c. Barium contrast enema
d. Diagnostic peritoneal lavage
e. Upright plain abdominal x-ray

(kompetensi no.3)
4. A 1-year-old child referred to our hospital with the diagnosis of dengue shock syndrome.
He is somnolen, tachycardia and clammy acral. No data for the last urine output. The
previous hospital sent the patient because they found difficulty in inserting iv line. The
lab result showed thrombocitopenia 13.000 and increased hematocrite to 46%.
The next management is:
a. Inserting iv line peripheraly
b. Do the intraosseous access
c. Prepare central access
d. Venae sectie
e. Inserting nasogastric tube

(kompetensi 6.a)

5. A 2-year-old child hospitalized for waterry diarhea with dehydration. All the laboratory
examination at admission showed normal results except for the sodium serum level was
169 mmol/l and the potassium serum level at 2,6 mmol/l. Correction for potassium and
sodium level was done. One day after that the patient suffered from seizure and
decreased of consciousness. The patient then reffered to PICU, the result of the last
sodium level before the patient reffered to PICU was 144 mmol/l.
What is the caused of the seizure:
A. Encephalitis
B. Meningoencephalitis
C. Severe dehydration
D. Edema cerebri
E. Metabolic acidosis

(Kompetensi 4.d)

6. A 8 year-old child with recently diagnosed Leukemia Lymphoblastic Acute develops

septic shock after her first course of chemotherapy when her absolout neutrophil count
is 100/mm3. Appropriate antiobiotics are begun. She is resuscitated with 1 L of
crystalloid and her pulmonary capillary wedge pressure reading is 17 mmHg.
Epinephrine is begun at 4 𝜇g/minute and her heart rate goes from 110 beats/minute to
160 beats/minute. Systolic blood pressure which was initally 80 mmHg is now 85 mmHg.
What is the most appropriate intervention at this time?
A. Begin dopamine at 10 𝜇g/kg/minute
B. Begin norepinephrine at 1 𝝁g/kg/minute
C. Begin dobutamine at 7,5 𝜇g/kg/minute
D. Begin phenylephrine at 5 𝜇/kg/minute
E. Begin dopexamine at 2 𝜇/kg/minute

(Kompentensi 8.a)
7. A 12 year-old-boy with severe head injury after the traffica accident crush, was admitted
to the hospital with moderate intracranial haemorrhage (GCS = E-1V-ETTM-3). He was put
in invasive positive pressure ventilation support. On the fourth day of ICU stay, he
developed fever (36,8°C), a rise in total leucocyte count (15.600/mm3 with 93 %
Neutrophil) and hetergenous, ill-defined shadows in the right lower zone in chest X-ray.
Chest auscultation revealed bronchial breathing in the right infra-axilliary area, and the
nurse reported an increase in amount and purulence of secreations requiring frequent
suctioning.
What is the best choiche of the treatment in this patient?
A. Both orally or intravenous antibiotic initial should be give immediately
B. The gram-negative bacteria (GNB) including ESBL-producing Klabsiella, MDR
Acinetobacter, methicillin-resistent Staphylococcus aureus (MRSA) are the
common organism causing ventilatory-associated pnemonia as the guideline to
give ceftriaxone or ampicillin / sulbactam
C. The suggested recommendation is to use carbapenem as empirical therapy
D. If there is delay in obtaining samples for logistic reason beyond an hour, antibiotic
should be given after the procedure to avoid the possibility of resistance
E. If the no organism found in the culture of bronchoalveolar lavage, we should try to
look for other couse of lung shadows such as atelectasis or aspiration

(Kompetensi 5.a dan 5.g)

8. A 14 year-old girl was admitted to the hospital with history of consumption of some
amount of wild cassava while she was camping near the forrest. She was followed by
vomitting, cephalgia, and seizure. Her skin was reddish appearance like cherry. She was
brought to ER with respiratory distress and comatous after the seizure attack. The blood
pressure was 85/50 mmHg and heart rate was irregulary 110 beat/minute.
The antidotum for this patient is:
A. Natrium bicarbonat 84% 2 mL/kg BW
B. Sulphate Atropine 0,05-0,1 mg/kgBW every 10-30 minutes until atrophinization is
ended
C. Sodium Nitroprussid 3% 0,33 mL/kg BW
D. Sodium thiosulphate 25% 1,6 mL/kg BW
E. There is no antidotum for this situation, just doing the symptomatic treatment

(Kompetensi 9)

9. A 1-year-old infant admitted to pediatric intensive care unit (PICU) with fever, shock and
letargy. After administering fluid boluses and starting of inotropes, he was intubated and
supported by mechanical ventilation. Investigation showed leucocytosis and
thromobocytopenia with severe metabolic acidosis. Within 6 hours after admission,
urine ouput decrease and he started bleeding from the nasogastric tube. He had
 persistent tachycardia with cold extremities. Investigation showed persistent metabolic
acidosis, elevated liver enzymes, severe coagulopathy and rising serum creatinin.
Which is the appropriate renal replacement therapy for this infant?
A. Peritoneal dyalisis
B. Continuous venovenous hemofiltration (CVVH)
C. Continuous arteriovenous hemofiltration (CAVH)
D. Intermittent hemodyalisis
E. Renal transplant

(Kompentensi 7.e)

10. A 15-year-old female is brought to the Emergency Room by her college roommate who
states that the patient vomited all night. The patient complains of a sore throat and says
she has not eaten for the last two days. She admits to a "sugar problem" and quit taking
her medication because she has not been eating. Examination reveals an ill-appearing
woman. Her temperature is 37.9 C (100.2 F), blood pressure is 118/78 mm Hg, pulse is
160/min, and respirations are 30/min. The patient's lips and mucous membranes are
dry. There is a fruity odor noted to the patient's breath. The lung and cardiac
examination are unremarkable except for mild tachypnea and tachycardia.
Urinalysis is positive for ketones.
Blood analysis shows:
Sodium......................130 mEq/L
Potassium..................6.1 mEq/L
Chloride....................100 mEq/L
Bicarbonate...............8 mEq/L
Urea nitrogen............10 mg/dL
Creatinine.................1.0 mg/dL
Glucose....................680 mg/dL
pH...........................7.15
pCO2.......................30 mm Hg
pO2.........................85 mm Hg

Which of the following is the most appropriate initial step in management?

A. Immediate intubation
B. Intravenous insulin
C. Intramuscular ceftriaxone
D. IV fluid bolus with normal saline and potassium
E. Mannitol
(Kompetensi 7.c)
11. A 12-year-old boy with Duchenne muscular dystrophy is brought to the emergency
department with increasing respiratory distress and cyanosis. On examination, he is
diaphoretic, with gasping respirations, poor air entry, and diminished responsiveness. He
is tachycardic at 160 beats/min. His chest x-ray film shows a lingular pneumonia, and he
is intubated. He improves over the next 10 days with antibiotics but is not extubated
secondary to hypoventilation on weaning because of muscle weakness.
Which of the following modalities will most likely help wean him off the ventilator?
A. Nasopharyngeal tube
B. Pressure controlled ventilation
C. Pressure controlled ventilation
D. Supplemental oxygen
E. Tracheostomy
(Kompetensi 4.c)

12. A 5-year-old boy suddenly begins coughing while eating peanuts. He is choking and
gagging. When he is brought to the emergency department, but he is awake and is able
to give his name. On physical examination, his vital signs are stable. On examination of
the chest, inspiratory stridor and intercostal and suprasternal retractions are apparent.
Which of the following is the most appropriate initial step in management?
A. Allow patient to clear foreign object by spontaneous coughing
B. Clear oropharynx with multiple blind sweeps with finger
C. Position patient and perform back blows
D. Stand behind patient and perform abdominal thrusts
E. Perform emergency tracheostomy and take to surgery
(Kompetensi 5.d)

13. A 5-month-old infant presents with diarrhea and decreased activities for the past 3 days.
On physical examination, his pulse is 162/min. His anterior fontanelle is sunken, and he
has skin tenting. Laboratory investigation reveals sodium, 165 mEq/L; potassium, 5.8
mEq/L; chloride, 128 mEq/L, bicarbonate, 14 mEq/L; creatinine, 0.9 mg/dL; blood urea
nitrogen, 49 mg/dL; and glucose, 154 mg/dL. Eight hours after IV fluid therapy is started,
the infant develops a generalized seizure.
Which of the following is the most likely etiology of the seizure?
A. Hyperglycemia
B. Hyperkalemia
C. Idiopathic epilepsy
 D. Rapid correction of hypernatremia
E. Rapid correction of metabolic acidosis
(Kompetensi 7.a)

14. An 8-year-old male presents to the emergency department with decreased mental
status. His mother states that she has noticed he has been drinking and urinating more
frequently over the past several weeks. He was hard to wake up this morning and
complained of abdominal pain. Physical examination reveals an afebrile drowsy male
with clear airways and mild tachycardia. Mucous membranes are dry and his lips are
cracked. His abdomen is mildly tender to palpation diffusely, but there is no rebound or
guarding.
Laboratory evaluation reveals a glucose of 560 mg/dL and potassium of 5.9 mEq/L. An
arterial blood gas analysis reveals a pH of 7.18. A urinalysis is positive for ketones and
glucose. CT scan of the abdomen is normal. A chest x-ray film is clear. Two hours after
initiation of treatment the physician adds potassium to the patient's IV fluids.
Which of the following best explains this therapeutic decision?
A. Acidosis causes extracellular depletion of potassium
B. Hyperglycemia causes potassium to shift to the extracellular space
C. Hyperkalemia will protect the patient against dysrhythmias
D. Hypokalemia will result as acidosis is corrected
E. Potassium should not have been added to the IV fluids
(Kompetensi 7.d)

15. A 3-month old infant is brought to a pediatrician's office because of increased lethargy
and irritability. The parents state that the child rolled off the couch and fell on the floor
one day prior to presentation. His parents report that the child has been previously
healthy and is up to date on his vaccinations. He has been meeting his development
milestones. His fontanelles are full. While in office the patient develops a tonic clonic
seizure.
Which of the following is the next appropriate step?
A. Obtain a head computerized tomography scan
B. Perform a retinoscopic examination
C. Check serum levels of ammonia
D. Administer intravenous benzodiazepines
E. Perform a lumbar puncture
(Kompetensi 4.b)