Pre-hospital paediatric emergencies: DipIMC practice questions
PHEM curriculum unit 2.9 · Theme 2: Providing Pre-hospital Emergency Medical Care
The DipIMC is blueprinted against phase 1 of the UK Pre-hospital Emergency Medicine (PHEM) curriculum. This page covers unit 2.9, Manage injured or ill children in the pre-hospital environment.
Below are 3 free practice questions from the DipIMC.Ninja bank, in the Part A single best answer format. Every answer names the textbook page, guideline or statute it was written from, so you can check it rather than take it on trust. The bank holds 90 questions on this unit.
Question 1 · Paediatrics & Obstetrics · Easy
Using the WETFLAG estimation, what is the approximate weight of a 4-year-old child?
A12 kg
B14 kg
C16 kg
D18 kg
E20 kg
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Answer: C
16 kg
For ages 1 to 5 years, (age + 4) × 2 = (4 + 4) × 2 = 16 kg. ABC of Prehospital Emergency Medicine (Table 29.1) and the Oxford Handbook write the same formula as (2 × age) + 8, which gives the identical answer. For older children the formula becomes (3 × age) + 7 (5–12 years in the ABC table, 6–12 years in the Oxford Handbook). JRCALC's Page for Age chart for 4 years carries a guide weight of 16 kg, so the estimate and the national chart agree. JRCALC also says that where the child's weight is known it is better to dose by weight than by age, and that where a child is clearly larger or smaller than expected for their age the Page for Age chart that most closely reflects their actual weight should be chosen. The ABC adds that weight formulae are prone to miscalculation, so the result should be confirmed by a second practitioner.
Where this comes from
ABC of Prehospital Emergency Medicine
Ch. 29 Care of Special Groups: The Paediatric Patient · Size and weight — Table 29.1 Weight estimation formulae · p. 159“1–5 years (2 × age in years) + 8”
Ch. 29 Care of Special Groups: The Paediatric Patient · Size and weight · p. 159“prone to error through miscalculation so must be confirmed by a second practitioner”
Oxford Handbook of Pre-Hospital Carep. 525Ch. 8 Child health · Identification and management of the seriously ill or injured child: weight“Weight 1–5 = (Age x2)+8”
JRCALC Clinical Guidelines — Page for Age, 4 yearsJRCALC / AACE·Page for Age 4 years (P0100): guide weight 16 kg“Page for Age 4 years (P0100) — guide weight row”
A 3-year-old with suspected septic shock has a prolonged capillary refill and tachycardia. What initial fluid bolus do Resuscitation Council UK Guidelines 2025 recommend?
A5 ml/kg crystalloid, reassessing after each bolus
B10 ml/kg crystalloid, reassessing after each bolus
C20 ml/kg colloid, reassessing after each bolus
D30 ml/kg crystalloid, reassessing after each bolus
ENo fluid before hospital; reassess and convey quickly
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Answer: B
10 ml/kg crystalloid, reassessing after each bolus
Septic shock is one of the commonest forms of distributive shock, and Resuscitation Council UK Guidelines 2025 recommend one or more fluid boluses of 10 ml/kg in children in hypovolaemic, obstructive or distributive shock. The first-line fluid is a balanced isotonic crystalloid (normal saline if that is unavailable), and the child is reassessed after each bolus for signs of fluid overload or cardiac failure. Repeated 10 ml/kg boluses may be needed, but vasoactive drugs should be started no later than after three to four boluses (30-40 ml/kg), with noradrenaline the first-line vasopressor, so 30 ml/kg describes that ceiling rather than an initial bolus. A cautious 5 ml/kg bolus is what RCUK suggests for cardiogenic shock. Colloid is not the first-line fluid, and withholding fluid from a shocked child is not an option. JRCALC's Page for Age tables likewise give 10 ml/kg for medical emergencies in children. Note the divergence: the Oxford Handbook of Pre-Hospital Care (2021) still gives 20 ml/kg of warmed crystalloid for medical shock in a child; RCUK 2025 is the more recent guidance and the one this question tests. In septic shock RCUK also advises starting broad-spectrum antibiotics as soon as possible, within 1 hour, after initial ABCDE management. NICE's paediatric sepsis guideline (NG254) is not held here and is not the basis of this answer.
JRCALC Clinical Guidelines — Page for Age, 3 yearsJRCALC / AACE·Page for Age 3 years (P0090): fluid 10 ml/kg = 140 ml (medical emergencies)“Page for Age 3 years (P0090) — fluid 10 ml/kg row”
ABC of Prehospital Emergency Medicinep. 36Ch. 8 Circulation Assessment and Management · Distributive shock“Septic, anaphylactic and neurogenic shock are the most common subtypes of distributive shock.”
Oxford Handbook of Pre-Hospital Carep. 488Ch. 8 Child health · Circulatory emergencies in children: initial fluid bolus (older position)“20ml/kg of warmed crystalloid in medical shock”
An ambulance crew is called at night to a 4-year-old girl who has not been immunised. Over the past three hours she has developed a temperature of 39.6 °C, a soft inspiratory stridor and drooling. She is sitting upright on her mother's knee, leaning forward and refusing to talk, and she has no cough. Which is the most appropriate management?
AKeep her on her mother's knee and convey without examining her throat
BExamine her throat with a tongue depressor to confirm the diagnosis first
CLie her flat on the stretcher and support her airway with a jaw thrust
DSite an intravenous cannula on scene before moving her to the ambulance
EGive oral dexamethasone and observe her at home for the next hour
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Answer: A
Keep her on her mother's knee and convey without examining her throat
Rapid onset, high fever, drooling and no cough in a child aged 2–8 years point to epiglottitis rather than croup (Oxford Handbook of Pre-Hospital Care, Table 8.3). The Handbook's treatment is not to examine or disturb the child, to keep her comfortable nursed on a parent's knee, and to accompany her to hospital; ABC of Prehospital Emergency Medicine (Table 29.8) says the same for stridor: do not examine the throat and do not upset the child — no needles, no nebulisers. Distress, examination with a tongue depressor, cannulation on scene or taking her off her mother's knee to lie her flat all risk turning partial obstruction into complete obstruction; the Handbook notes that collapse in epiglottitis is usually due to airway obstruction, for which needle cricothyroidotomy is the emergency airway. Oral dexamethasone and observation at home is the management of mild croup, and the Handbook is explicit that if croup and epiglottitis cannot be distinguished, admission is mandatory.
Where this comes from
Oxford Handbook of Pre-Hospital Care
Ch. 8 Child health · Paediatric emergencies: epiglottitis, treatment · p. 491“Do not examine or disturb the child”
Ch. 8 Child health · Paediatric emergencies: epiglottitis, treatment · p. 491“Keep the child comfortable, nursed on a parent’s knee”
Ch. 8 Child health · Paediatric emergencies: croup, note · pp. 490–491“If it is not possible to distinguish between croup and epiglottitis, admission is MANDATORY.”
ABC of Prehospital Emergency Medicine
Ch. 29 Care of Special Groups: The Paediatric Patient · Management of paediatric medical emergencies (Table 29.8, stridor) · p. 162“Do not examine throat”
Ch. 29 Care of Special Groups: The Paediatric Patient · Management of paediatric medical emergencies (Table 29.8, stridor) · p. 162“Do not upset the child (no needles, nebs, etc.)”