Paediatric emergencies: hypertensive emergency: 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: hypertensive emergency

Sample item

A 9-year-old with acute glomerulonephritis has BP 165/115 mmHg, severe headache, vomiting and a generalised seizure. Which approach is recommended?

AOral enalapril alone with outpatient reviewBWithhold treatment until an MRI is completedCSublingual nifedipine to bring the pressure to normal within an hourDContinuous intravenous nicardipine or labetalol with gradual blood pressure reduction

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

The answer and the reasoning

D. Continuous intravenous nicardipine or labetalol with gradual blood pressure reduction

Severe hypertension with neurological symptoms is a hypertensive emergency. Treat with a titratable intravenous infusion such as nicardipine or labetalol, lowering pressure gradually over hours, because abrupt falls risk cerebral and renal hypoperfusion.

Option by option

A. Oral enalapril alone with outpatient review
Oral enalapril alone and discharge is inadequate for a seizing child with end-organ symptoms.
B. Withhold treatment until an MRI is completed
Delaying treatment for imaging exposes the child to ongoing risk of encephalopathy and haemorrhage.
C. Sublingual nifedipine to bring the pressure to normal within an hour
Sublingual nifedipine causes unpredictable abrupt falls and is discouraged.
D. Continuous intravenous nicardipine or labetalol with gradual blood pressure reduction (correct)
Correct. A titratable intravenous agent allows controlled gradual reduction and protects cerebral perfusion.

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 D, Continuous intravenous nicardipine or labetalol with gradual blood pressure reduction. Severe hypertension with neurological symptoms is a hypertensive emergency.

Why is "Oral enalapril alone with outpatient review" not the answer?

Oral enalapril alone and discharge is inadequate for a seizing child with end-organ symptoms.

Why is "Withhold treatment until an MRI is completed" not the answer?

Delaying treatment for imaging exposes the child to ongoing risk of encephalopathy and haemorrhage.

Why is "Sublingual nifedipine to bring the pressure to normal within an hour" not the answer?

Sublingual nifedipine causes unpredictable abrupt falls and is discouraged.

What concept does this question test?

It tests Paediatric emergencies: hypertensive emergency in Pediatrics. Treat with a titratable intravenous infusion such as nicardipine or labetalol, lowering pressure gradually over hours, because abrupt falls risk cerebral and renal hypoperfusion.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. 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: hypertensive emergency?

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.