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Pediatric Emergency Medicine

Subjects : health-sciences, pediatrics

Instructions:

Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can study here.
Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.

1. What investigations should you do in suspected child abuse
Bone scan for occult fracture
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

2. What are the terminal signs of acute laryngeal obstruction?
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Give IM adrenaline - steroids - salbutamol - antihistamine.
The most common accident in children in from car crashes 50% always make sure your child has an approptiate seat beat - that they are not sitting in the front seat before 12 and that if possible the car has airbags for the child. Always supervise chi
Cyanosis and irregular respiratory effort

3. Beta-blocker overdose antidote
Glucagon prefered - otherwise massive dose of adrenaline.
Blocks Na - K - Ca channels and beta-receptors in the myocardium. Also blocks alpha and beta-receptors in the periphery. Slows AV conduction and ventricular conduction. Used to treat hemodynamically stable VT - refractory VF - pulseless VT - and SVT.
Release NEUROTOXINS both have antivenom
Causes BAD constipation. Upsets fluid and electrolyte balance.

4. What is the most common caUse of acute laryngeal obstruction?
Antidote is naloxone.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Poisoning causes hyperpnea and tachypnea - mixed respiratory alkalosis and metabolic acidosis - fever - N/V - dehydration - tinnitus - agitation - and seizures. Lab studies show hyperglycemia - hypokalemia - prolonged PT/PTT.
Croup.

5. Acetaminophen
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Aspiration Pneumonia
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy

6. Management of near drowning.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Discobalt edetate
1) Mechanical ventilation 2) Stomach decompression 3) Saline and dopamine 4) cerebral oedema w/ mannitol 5) monitor for hypokaelamia (common) 6) give benpen if ventilation required to prevent pneumoccal pneumonia complication. Induce controlled hypot
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

7. Ethanol
Stomach pumping.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
It can be biphasic. You treat them - they get better - then a few hours later it HAPPENS AGAIN! Within 48 hours. So give 3 day coUse of pred - ranitidine -
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

8. Benzodiazepine overdose antidote
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Flurescence in ultraviolet light.
Intubate - tracheostromy or nebulized adrenaline.
Flumazenil

9. When and how would you do whole bowel irrigation?
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

10. Digoxin antedote
Glucagon prefered - otherwise massive dose of adrenaline.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Digoxin Fab
Neurotoxins - procagulants. Rhabdomyolysins.

11. Procainamide
Blocks open sodium channels and prolongs the action potential. Prolongs refractory period of atria and ventricles and decreases conduction. Used to treat SVT - stable VT with pulses.
Poisoning causes anticholinergic effects as well as prolonged PR interval - widened QRS complex - QT prolongation - and AV block due to blockage of sodium channels. Hypotension. Pulmonary oedema
Normally treated with sling alone. Seek advice.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)

12. Ethylene glycol
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
The most common accident in children in from car crashes 50% always make sure your child has an approptiate seat beat - that they are not sitting in the front seat before 12 and that if possible the car has airbags for the child. Always supervise chi

13. What is the most appropriate examination in a child with suspected lead ingestion?
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Abdo XRAY!!!! do it!
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

14. Undisplaced radial shaft fracture
Antidote is naloxone.
It can be biphasic. You treat them - they get better - then a few hours later it HAPPENS AGAIN! Within 48 hours. So give 3 day coUse of pred - ranitidine -
Flurescence in ultraviolet light.
Collar and cuff. Check integrity of nerve.

15. Amphetamine antidote
Discobalt edetate
Bone scan for occult fracture
Esmolol
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.

16. Adenosine
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Notify if abuse CONSIDERED. CONSIDERED.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.

17. Amiodarone
Flumazenil
Class of drugs encompassing decongestants - amphetamines - cocaine.
Blocks Na - K - Ca channels and beta-receptors in the myocardium. Also blocks alpha and beta-receptors in the periphery. Slows AV conduction and ventricular conduction. Used to treat hemodynamically stable VT - refractory VF - pulseless VT - and SVT.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

18. What happens if charcoal is aspirated?
Release NEUROTOXINS both have antivenom
It can cause fatal bronchioloitis obliterans
Aspiration pneumonia even if intubated.
Rash bronchospasm and hypotension.

19. Theophylline
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

20. What is the general management of poisoning?
Intubate - tracheostromy or nebulized adrenaline.
Causes tachypnea - coughing - respiratory distress - cyanosis - N/V - GI discomfort - and mental status changes. Gastric emptying should be avoided. Charcoal is ineffective. Patients should be monitored closely for aspiration.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

21. Tricyclic antidepressants
Flumazenil
Poisoning causes anticholinergic effects as well as prolonged PR interval - widened QRS complex - QT prolongation - and AV block due to blockage of sodium channels. Hypotension. Pulmonary oedema
Intubate - tracheostromy or nebulized adrenaline.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.

22. Mx raised intracranial pressure.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Severe illness - past history of injuries - 18 months or less - inconstent story.
Neurosurgery if trauma. Give mannitol.
Poisoning causes N/V - inebriation - increase in minute ventilation to offset increased anion gap metabolic acidosis - blurred vision/optic disc edema starting 18-24 hours after ingestion.

23. 20
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Poisoning causes N/V - inebriation - increase in minute ventilation to offset increased anion gap metabolic acidosis - blurred vision/optic disc edema starting 18-24 hours after ingestion.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

24. Lidocaine
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.

25. Calcium gluconate
Stomach pumping.
IM adrenaline: vasopressor and bronchodilator.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Notify if abuse CONSIDERED. CONSIDERED.

26. What are the special features that must be done to correct haemorrhagic shock.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Persitantly angry. Anxiously attached or ambivalent towards parents. Limited ability to enjoy things. Low self esteem - depressed or unresponsive. Poor social skills and developmental inhibition.
Collar and cuff. Check integrity of nerve.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

27. Legal requirement in childabuse
The most common accident in children in from car crashes 50% always make sure your child has an approptiate seat beat - that they are not sitting in the front seat before 12 and that if possible the car has airbags for the child. Always supervise chi
Blood glucose level for hypoglycaemia!!
Notify if abuse CONSIDERED. CONSIDERED.
Poisoning causes N/V - diarrhea - GI bleeding - acute liver failure - seizures - shock - and coma. Lab studies show elevated serum levels 3-5 hours after ingestion - metabolic acidosis - hyperglycemia - increased bilirubin and LFTs - prolonged PT - i

28. Signs of abuse from the history
Antidote is deferoxamine chelation. Charcoal is ineffective.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

29. What evidence should a doctor give about parental neglect
Abdo XRAY!!!! do it!
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Objective signs of growth - tidiness - weight -
Before a child can be examined for child abuse - a parent or legal guardian must give consent

30. Ethylene glycol
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Croup.
Poisoning causes anorexia - vomiting - lethargy - respiratory/CV collapse. Lab studes show metabolic acidosis with elevated anion gap - elevated serum ammonia - hypocalcemia - kidney failure - and calcium oxalate crystals on urinalysis.
Flurescence in ultraviolet light.

31. How may you detect semen?
Blocks open sodium channels and prolongs the action potential. Prolongs refractory period of atria and ventricles and decreases conduction. Used to treat SVT - stable VT with pulses.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
'I WOULD CALL POISON HOTLINE'.
Flurescence in ultraviolet light.

32. What is the first line investigation in a young child who has consumed alcohol?
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Chelation with EDTA or oral succimer should be initiated in children with a serum lead level greater than ___ ug/dL. With levels greater than ___ ug/dL - intramuscular dimercaprol should be added - and the child should be admitted for inpatient treat
... blood sugars for hypoglycaemia

33. Which is better - activated charcoal or gastric lavage.
Calcium chloride
Discobalt edetate
CHARCOAL! except for lithium - iron - alcohol - lead.
Collar and cuff. Check integrity of nerve.

34. Opiates
Poisoning causes anticholinergic effects as well as prolonged PR interval - widened QRS complex - QT prolongation - and AV block due to blockage of sodium channels. Hypotension. Pulmonary oedema
Antidote is naloxone.
Blocks open sodium channels and prolongs the action potential. Prolongs refractory period of atria and ventricles and decreases conduction. Used to treat SVT - stable VT with pulses.
Severe illness - past history of injuries - 18 months or less - inconstent story.

35. What are the three features of anaphylaxis
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Poisoning causes anorexia - vomiting - lethargy - respiratory/CV collapse. Lab studes show metabolic acidosis with elevated anion gap - elevated serum ammonia - hypocalcemia - kidney failure - and calcium oxalate crystals on urinalysis.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.

36. what makes you suspicious of non-accidental injury.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Poisoning causes N/V - diarrhea - GI bleeding - acute liver failure - seizures - shock - and coma. Lab studies show elevated serum levels 3-5 hours after ingestion - metabolic acidosis - hyperglycemia - increased bilirubin and LFTs - prolonged PT - i

37. What is an important point to note about anaphylaxis?
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
It can be biphasic. You treat them - they get better - then a few hours later it HAPPENS AGAIN! Within 48 hours. So give 3 day coUse of pred - ranitidine -
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

38. Sodium Bicarbonate
Stomach pumping.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

39. Mx of snake bit
Poisoning causes N/V - diarrhea - GI bleeding - acute liver failure - seizures - shock - and coma. Lab studies show elevated serum levels 3-5 hours after ingestion - metabolic acidosis - hyperglycemia - increased bilirubin and LFTs - prolonged PT - i
Wrap upwards (even though some venom seap up still more painful and lasts longer) Premedicate w/ adrenaline. We give specifically both brown and tigersnake antivenom in victoria. Other states need to use polyvalent because other species too.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

40. Salicylates
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
The most common accident in children in from car crashes 50% always make sure your child has an approptiate seat beat - that they are not sitting in the front seat before 12 and that if possible the car has airbags for the child. Always supervise chi
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Esmolol

41. Sympathomimetics
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Antidote is naloxone.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Abdo XRAY!!!! do it!

42. Undisplaced surgical neck of humerous?
Sling for 3 weeks - fracture clinic at 7 days.
Neurosurgery if trauma. Give mannitol.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.

43. What is the most important investigation in suspected alcohol poisoning in young person?
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Blood glucose level for hypoglycaemia!!
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.

44. What is gastric lavage?
Stomach pumping.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Skin or vascular compromise
Release NEUROTOXINS both have antivenom

45. Organophosphates antidotes
Antidotes are atropine sulfate and pralidoxime chloride.
Neurosurgery if trauma. Give mannitol.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.

46. Carbon monoxide
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Sling for 3 weeks - fracture clinic at 7 days.

47. Ibuprofen
Antidote is naloxone.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Glucagon prefered - otherwise massive dose of adrenaline.
Poisoning causes N/V - anorexia - stomach pain - GI bleeding - mental status changes/coma/seizures if massive ingestion. Lab studies will show elevated serum levels 4 hours after ingestion - along with elevated transaminases - elevated alkaline phosp

48. Organophosphates
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
IM adrenaline: vasopressor and bronchodilator.
Notify if abuse CONSIDERED. CONSIDERED.

49. Tricyclic antidepressants overdose
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
'I WOULD CALL POISON HOTLINE'.
Neurotoxins - procagulants. Rhabdomyolysins.
Collar and cuff. Check integrity of nerve.

50. Signs of psychological maltreatment?
Immobilize with plaster slab
Persitantly angry. Anxiously attached or ambivalent towards parents. Limited ability to enjoy things. Low self esteem - depressed or unresponsive. Poor social skills and developmental inhibition.
Abdo XRAY!!!! do it!
1) Mechanical ventilation 2) Stomach decompression 3) Saline and dopamine 4) cerebral oedema w/ mannitol 5) monitor for hypokaelamia (common) 6) give benpen if ventilation required to prevent pneumoccal pneumonia complication. Induce controlled hypot