Paediatric emergencies: raised intracranial pressure: practice question

A Pediatrics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pediatrics · Paediatric emergencies: raised intracranial pressure

Sample item

A child with severe head injury shows decerebrate posturing and a dilating pupil. Which therapy is appropriate to lower the intracranial pressure, and which fluid should be avoided?

A3 percent saline or mannitol; avoid hypotonic fluidsBDextrose 5 percent boluses; avoid mannitolCHyperventilation to PaCO2 of 15 mmHg; avoid all osmotherapyDPlain water; avoid saline

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. 3 percent saline or mannitol; avoid hypotonic fluids

Raised ICP is managed with head elevation, adequate oxygenation, and osmotherapy with 3 percent saline or mannitol, and brief hyperventilation only for herniation. Hypotonic fluids such as 5 percent dextrose worsen cerebral oedema.

Option by option

A. 3 percent saline or mannitol; avoid hypotonic fluids (correct)
Correct. Osmotherapy is used and hypotonic fluids avoided.
B. Dextrose 5 percent boluses; avoid mannitol
Dextrose-containing hypotonic fluids worsen oedema.
C. Hyperventilation to PaCO2 of 15 mmHg; avoid all osmotherapy
Prolonged severe hyperventilation causes ischaemia.
D. Plain water; avoid saline
Free water causes hyponatraemia and swelling.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Pediatrics question

What is the answer to this Pediatrics question?

The best answer is A, 3 percent saline or mannitol; avoid hypotonic fluids. Raised ICP is managed with head elevation, adequate oxygenation, and osmotherapy with 3 percent saline or mannitol, and brief hyperventilation only for herniation.

Why is "Dextrose 5 percent boluses; avoid mannitol" not the answer?

Dextrose-containing hypotonic fluids worsen oedema.

Why is "Hyperventilation to PaCO2 of 15 mmHg; avoid all osmotherapy" not the answer?

Prolonged severe hyperventilation causes ischaemia.

Why is "Plain water; avoid saline" not the answer?

Free water causes hyponatraemia and swelling.

What concept does this question test?

It tests Paediatric emergencies: raised intracranial pressure in Pediatrics. Hypotonic fluids such as 5 percent dextrose worsen cerebral oedema.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Paediatric emergencies: raised intracranial pressure?

Memorise milestones and the vaccine schedule as tables and revise them often. Then use the flashcards and the other Pediatrics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.