Test your basic knowledge |

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 is an important point to note about anaphylaxis?
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.
Give steroids for management of serum sickness. Must do coagulation screen!!!
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 -
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

2. Epinephrine
Neurosurgery if trauma. Give mannitol.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.

3. What is one of the technicalities of childabuse.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.

4. Amiodarone
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
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.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)

5. What evidence should a doctor give about parental neglect
Causes BAD constipation. Upsets fluid and electrolyte balance.
Glucagon prefered - otherwise massive dose of adrenaline.
Objective signs of growth - tidiness - weight -
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

6. What investigations should you do in suspected child abuse
Bone scan for occult fracture
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Digoxin Fab
Stomach pumping.

7. 45; 70
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
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
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.

8. Organophosphates antidotes
Lead poisoning is defined as a serum level greater than ___ ug/dL.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Antidotes are atropine sulfate and pralidoxime chloride.
Skin or vascular compromise

9. Salicylates
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.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

10. Carbon monoxide
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Abdo XRAY!!!! do it!
Glucagon prefered - otherwise massive dose of adrenaline.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.

11. What must you do before sending fracture to radiology?
... blood sugars for hypoglycaemia
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.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Immobilize with plaster slab

12. How may you detect semen?
Croup.
It can cause fatal bronchioloitis obliterans
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Flurescence in ultraviolet light.

13. Undisplaced surgical neck of humerous?
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.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
... blood sugars for hypoglycaemia
Sling for 3 weeks - fracture clinic at 7 days.

14. What is the most common caUse of acute laryngeal obstruction?
Intubate - tracheostromy or nebulized adrenaline.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
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.
Croup.

15. Acetaminophen
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.
Antidotes are atropine sulfate and pralidoxime chloride.
Intubate - tracheostromy or nebulized adrenaline.

16. What are the three features of anaphylaxis
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Notify if abuse CONSIDERED. CONSIDERED.

17. Cyanide
Discobalt edetate
Normally treated with sling alone. Seek advice.
Munchausen's by proxy
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

18. Digoxin antedote
Digoxin Fab
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Skin or vascular compromise
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

19. Ethanol
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.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

20. What are the early symptoms of paracetamol overdose?
IM adrenaline: vasopressor and bronchodilator.
Aspiration Pneumonia
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Nausea vomiting and anorexia.

21. What are the side effects of N-acety-p-benzoquinine?
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Rash bronchospasm and hypotension.
Abdo XRAY!!!! do it!

22. Carbon monoxide
Antidote is deferoxamine chelation. Charcoal is ineffective.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
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
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

23. Tricyclic antidepressants
Collar and cuff. Check integrity of nerve.
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
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.

24. What is the general management of poisoning?
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.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.

25. Amphetamine antidote
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Ceftriaxone
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Esmolol

26. When and how would you do whole bowel irrigation?
Flumazenil
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Sling for 3 weeks - fracture clinic at 7 days.
Objective signs of growth - tidiness - weight -

27. Management of near drowning.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
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
Munchausen's by proxy

28. Organophosphates
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.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Poisoning causes decreased cholinesterase activity.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.

29. Procainamide
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
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.
Cyanosis and irregular respiratory effort
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

30. Mx of snake bit
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.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Severe illness - past history of injuries - 18 months or less - inconstent story.
Antidote is naloxone.

31. Legal requirement in childabuse
Flumazenil
Notify if abuse CONSIDERED. CONSIDERED.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
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.

32. What is the antibiotic for Epiglottitis?
Ceftriaxone
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy

33. Opiates
'I WOULD CALL POISON HOTLINE'.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Antidote is deferoxamine chelation. Charcoal is ineffective.

34. What psychiatric disease defined as childabuse?

35. Undisplaced radial shaft fracture
Blood glucose level for hypoglycaemia!!
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Neurotoxins - procagulants. Rhabdomyolysins.
Collar and cuff. Check integrity of nerve.

36. Adenosine
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Release NEUROTOXINS both have antivenom
Normally treated with sling alone. Seek advice.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.

37. What are the other treatments for anaphylaxis?
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 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.
Give IM adrenaline - steroids - salbutamol - antihistamine.

38. Mx of petroleum overdose
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
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.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

39. Signs of abuse from the history
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Discobalt edetate

40. OSCE: how can i prevent accidents in my children
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
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
Antidote is deferoxamine chelation. Charcoal is ineffective.
Collar and cuff. Check integrity of nerve.

41. Ethylene glycol
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Sling for 3 weeks - fracture clinic at 7 days.
Glucagon prefered - otherwise massive dose of adrenaline.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

42. Methanol
IM adrenaline: vasopressor and bronchodilator.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Glucagon prefered - otherwise massive dose of adrenaline.
Skin or vascular compromise

43. What is the most important treatment for anaphylaxis
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.
IM adrenaline: vasopressor and bronchodilator.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

44. Management of septicaemia shock

45. What else is in the management of snake bite?
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 nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Give steroids for management of serum sickness. Must do coagulation screen!!!

46. What is the most important investigation in suspected alcohol poisoning in young person?
Neurosurgery if trauma. Give mannitol.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Blood glucose level for hypoglycaemia!!
CHARCOAL! except for lithium - iron - alcohol - lead.

47. Anticholinergics
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Blood glucose level for hypoglycaemia!!
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.
Flumazenil

48. Organophosphates
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

49. Ingesting Petrol. Cx?
Aspiration Pneumonia
Antidote is deferoxamine chelation. Charcoal is ineffective.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.

50. Mx severe croup
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.