In a pediatric patient presenting with severe hypertension, headache, and altered mental status suggesting both cardiac and neurologic compromise, what diagnostic or management step should be performed before giving intravenous antihypertensive agents?

Obtain imaging to rule out intracranial hemorrhage (for example, a head CT) before initiating IV antihypertensive therapy. The article emphasizes safety before treatment because lowering blood pressure rapidly with an intracranial bleed can worsen cerebral perfusion; IV labetalol is indicated only after intracranial hemorrhage is ruled out.

What common pitfall involves pediatric medication dosing?

Age-specific dosing pitfalls are a frequent source of error; exam-takers should focus on correct age-appropriate dosing when answering pediatric medication questions.

Which algorithm areas are high-yield for pediatric EM exam review?

Seizure and respiratory algorithm steps are highlighted as high-yield topics for pediatric emergency medicine exam preparation in the article.

Why avoid immediate IV labetalol in a hypertensive child with altered mental status?

Because you must first rule out intracranial hemorrhage; lowering blood pressure rapidly in the setting of a bleed can worsen cerebral perfusion. The article states IV labetalol is indicated only after intracranial hemorrhage is ruled out.

Why might IV furosemide or echocardiogram be distractors in the presented case?

They focus on pulmonary edema or cardiac causes and can distract from the need to evaluate the brain; addressing pulmonary edema or cardiac evaluation may miss the critical step of obtaining head imaging to exclude intracranial hemorrhage.

December 18, 2025

Pediatric EM — Most Missed Questions & High‑Yield Exam Review

By Med-Challenger · 1 minute read

Quick PEM exam‑prep takeaway: focus on age‑specific dosing pitfalls, seizure and respiratory algorithm steps, and common distractors on board‑style questions — these are the topics most often missed. Use the practice‑question approach below to identify misconceptions and target your review.

Screenshot 2025-02-17 121850

The right answer here is (b). Most of the incorrect answers were (d) IV labetalol and (c) IV furosemide, focusing on the hypertensive emergency that is being presented. But safety before treatment - starting antihypertensive medications before ruling out intracranial bleeding can be dangerous because lowering blood pressure rapidly in the context of a bleed is likely to worsen cerebral perfusion.

What the test-taker is supposed to pick up on is that you have both a cardiac and neurological emergency.

IV labetalol is indicated only after intracranial hemorrhage is ruled out.

Addressing the pulmonary edema with furosemide or an echocardiogram missed the need to evaluate the brain.

Relying on the patients stable appearance aside from the altered mental state and headache may delay a head CT. Always correlate neurological symptoms with hypertensive emergences, even subtle changes in consciousness are red flags.

This question appears in Med-Challenger Pediatric Emergency Medicine 3rd Edition Exam Review with CME

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