Pediatric Emergency Medicine

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. Methanol
Aspiration pneumonia even if intubated.
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.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.


2. Acetaminophen
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
CHARCOAL! except for lithium - iron - alcohol - lead.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Flumazenil


3. OSCE: how can i prevent accidents in my children
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
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Munchausen's by proxy
Release NEUROTOXINS both have antivenom


4. Atropine
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.
Rash bronchospasm and hypotension.
Poisoning causes decreased cholinesterase activity.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.


5. Which is better - activated charcoal or gastric lavage.
CHARCOAL! except for lithium - iron - alcohol - lead.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Digoxin Fab
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.


6. What investigations should you do in suspected child abuse
Bone scan for occult fracture
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Blood glucose level for hypoglycaemia!!


7. Salicylates
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.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - 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.
Glucagon prefered - otherwise massive dose of adrenaline.


8. Middle Clavicle fracture management?
Blood glucose level for hypoglycaemia!!
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
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.


9. How may you detect semen?
Cyanosis and irregular respiratory effort
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.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Flurescence in ultraviolet light.


10. What is the antibiotic for Epiglottitis?
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Ceftriaxone
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
IM adrenaline: vasopressor and bronchodilator.


11. What are the terminal signs of acute laryngeal obstruction?
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Ceftriaxone
Cyanosis and irregular respiratory effort
Discobalt edetate


12. What is one of the technicalities of childabuse.
... blood sugars for hypoglycaemia
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Digoxin Fab
CHARCOAL! except for lithium - iron - alcohol - lead.


13. Ethanol
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.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Antidote is deferoxamine chelation. Charcoal is ineffective.


14. What is the general management of poisoning?
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.


15. Anticholinergics
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Antidote is naloxone.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.


16. What are the special features that must be done to correct haemorrhagic shock.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
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
'I WOULD CALL POISON HOTLINE'.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.


17. Displaced surgical neck of humerous
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Normally treated with sling alone. Seek advice.
Discobalt edetate
IM adrenaline: vasopressor and bronchodilator.


18. Ingesting Petrol. Cx?
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
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.
Aspiration Pneumonia


19. Mx severe croup
Aspiration Pneumonia
Poisoning causes decreased cholinesterase activity.
Nausea vomiting and anorexia.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.


20. Methanol
Antidote is deferoxamine chelation. Charcoal is ineffective.
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.
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.


21. When and how would you do whole bowel irrigation?
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Digoxin Fab
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 -


22. How do snake bites damage?
Neurotoxins - procagulants. Rhabdomyolysins.
Digoxin Fab
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
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.


23. Epinephrine
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 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.
Flurescence in ultraviolet light.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.


24. OSCE: What are the five princples of discharging a patient with a fracture?
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Glucagon prefered - otherwise massive dose of adrenaline.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Neurosurgery if trauma. Give mannitol.


25. Indications of non-accidental injury
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
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
IM adrenaline: vasopressor and bronchodilator.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.


26. What is an important point to note about anaphylaxis?
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 -
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Release NEUROTOXINS both have antivenom
Antidote is deferoxamine chelation. Charcoal is ineffective.


27. Opiates
Neurosurgery if trauma. Give mannitol.
Neurotoxins - procagulants. Rhabdomyolysins.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Antidote is naloxone.


28. Legal requirement in childabuse
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.
Notify if abuse CONSIDERED. CONSIDERED.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Rash bronchospasm and hypotension.


29. Sympathomimetics
Neurotoxins - procagulants. Rhabdomyolysins.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Class of drugs encompassing decongestants - amphetamines - cocaine.
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


30. Signs of abuse from the history
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
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Notify if abuse CONSIDERED. CONSIDERED.


31. Management of near drowning.
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
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.
Notify if abuse CONSIDERED. CONSIDERED.
... blood sugars for hypoglycaemia


32. Mx raised intracranial pressure.
Neurosurgery if trauma. Give mannitol.
Glucagon prefered - otherwise massive dose of adrenaline.
Give IM adrenaline - steroids - salbutamol - antihistamine.
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


33. Organophosphates antidotes
Antidotes are atropine sulfate and pralidoxime chloride.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Release NEUROTOXINS both have antivenom
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.


34. What else is in the management of snake bite?
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Give steroids for management of serum sickness. Must do coagulation screen!!!
Notify if abuse CONSIDERED. CONSIDERED.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.


35. What is a side effect of charcoal?
Causes BAD constipation. Upsets fluid and electrolyte balance.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Esmolol
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.


36. Mx of petroleum overdose
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.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.


37. OSCE: what must you say you would do if someone is poisoned?


38. Iron
Antidote is deferoxamine chelation. Charcoal is ineffective.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
'I WOULD CALL POISON HOTLINE'.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.


39. When is reduction required in fracture?
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Skin or vascular compromise
It can cause fatal bronchioloitis obliterans
Nausea vomiting and anorexia.


40. Hydrocarbons
Flurescence in ultraviolet light.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Give IM adrenaline - steroids - salbutamol - antihistamine.
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.


41. Organophosphates
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Poisoning causes decreased cholinesterase activity.
Blood glucose level for hypoglycaemia!!


42. Beta-blocker overdose antidote
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Rash bronchospasm and hypotension.
Glucagon prefered - otherwise massive dose of adrenaline.
It can cause fatal bronchioloitis obliterans


43. What is the most important investigation in suspected alcohol poisoning in young person?
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Blood glucose level for hypoglycaemia!!
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.


44. Oedema causing laryngeal obstruction?
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
It can cause fatal bronchioloitis obliterans
Intubate - tracheostromy or nebulized adrenaline.


45. Lead
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.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Discobalt edetate
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.


46. Carbon monoxide
Poisoning causes decreased cholinesterase activity.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.


47. Calcium gluconate
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Skin or vascular compromise
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
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.


48. Ethylene glycol
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.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Poisoning causes decreased cholinesterase activity.


49. What is gastric lavage?
Poisoning causes decreased cholinesterase activity.
Stomach pumping.
Immobilize with plaster slab
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.


50. Opiates
Aspiration pneumonia even if intubated.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Poisoning causes decreased cholinesterase activity.