Unattended Toddler Coughing and Gagging / Pediatrics Question Sample

Posted by Stuart C. Silverstein, MD Laughing Your Way to Passing the Pediatric Boards on Oct 18th 2023

Unattended Toddler coughing and gagging /What is your Diagnosis 

A 21 month-old toddler was found by his mother vomiting, coughing and gagging. The mother had just returned from shopping and the child was with his 17 year-old baby-sitter who noted that the toddler did go into the garage 20 minutes earlier for not more than 5 minutes while she ran to the kitchen to turn off the stove, which had been on for quite a while. The child has no past medical history of any respiratory problems including asthma. There are no household members or recent visitors who are taking any prescription medications. The toddler is brought to see you in the pediatric ER because the toddler cannot stop coughing and gagging.

On physical exam the child is afebrile with a HR 125, BP 90/50, SaO2 92% on room air. RR 60. Lungs are clear to auscultation with no wheezing or rales.

Question 1:

The most likely cause of the coughing and gagging in this toddler would be:

A) Inhalation of excess dust in the garage
B) Foreign body aspiration
C) Carbon Monoxide exposure
D) Hydrocarbon ingestion
E) Organophosphate Ingestion

Question 2:

What is the most appropriate first step in treatment?

A) Chest X-ray
B) Give supplemental O2
C) Syrup of ipecac
D) Albuterol nebulizer treatment
E) Arrange for transfer to a facility with a hyperbaric chamber

Question 3:

The most appropriate management of this patient would be:

A) ICU admission with continuous albuterol nebulizer treatments
B) CXR and discharge from ED if CXR is negative
C) CXR and observation with repeat CXR in 6 hours
D) IV atropine
E) Discharge on home nebulizer and oral steroids

In order to answer this pediatric sample question and vignette correctly you must first approach the question systematically. Folowing this process systematically often reveals clues that can turn a question from a mystery to a slam dunk let's move on to the next question scenario ! Yeah ! 

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