Test your basic knowledge |

Pediatric Emergency Medicine

Subjects : health-sciences, pediatrics

Instructions:

Answer 50 questions in 20 minutes. 2 minutes extra for reading the instructions.
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 else is in the management of snake bite?
Croup.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Glucagon prefered - otherwise massive dose of adrenaline.

2. Legal requirement in childabuse
Calcium chloride
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
Notify if abuse CONSIDERED. CONSIDERED.
Discobalt edetate

3. Amiodarone
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 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.
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 -
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

4. How do snake bites damage?
Collar and cuff. Check integrity of nerve.
Neurotoxins - procagulants. Rhabdomyolysins.
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
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy

5. Sympathomimetics
Antidote is naloxone.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Intubate - tracheostromy or nebulized adrenaline.

6. what makes you suspicious of non-accidental injury.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Causes BAD constipation. Upsets fluid and electrolyte balance.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

7. Acetaminophen
Cyanosis and irregular respiratory effort
Sling for 3 weeks - fracture clinic at 7 days.
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.

8. Indications of non-accidental injury
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
IM adrenaline: vasopressor and bronchodilator.

9. Opiates
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Neurotoxins - procagulants. Rhabdomyolysins.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
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.

10. 45; 70
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
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.
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
Give steroids for management of serum sickness. Must do coagulation screen!!!

11. Iron
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
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Cyanosis and irregular respiratory effort
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.

12. Ibuprofen
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Flumazenil
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
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

13. Ethylene glycol
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

14. Lidocaine
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Digoxin Fab
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

15. What are the side effects of N-acety-p-benzoquinine?
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 fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Rash bronchospasm and hypotension.

16. What evidence should a doctor give about parental neglect
Antidotes are atropine sulfate and pralidoxime chloride.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Objective signs of growth - tidiness - weight -

17. OSCE: how can i prevent accidents in my children
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
Ceftriaxone
Flurescence in ultraviolet light.

18. Epinephrine
Sling for 3 weeks - fracture clinic at 7 days.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

19. Iron
Severe illness - past history of injuries - 18 months or less - inconstent story.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Antidote is deferoxamine chelation. Charcoal is ineffective.

20. Salicylates
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Causes BAD constipation. Upsets fluid and electrolyte balance.

21. Which is better - activated charcoal or gastric lavage.
CHARCOAL! except for lithium - iron - alcohol - lead.
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
Munchausen's by proxy
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.

22. What is the general management of poisoning?
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
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 -
Skin or vascular compromise

23. Oedema causing laryngeal obstruction?
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.
Flumazenil
Intubate - tracheostromy or nebulized adrenaline.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

24. Atropine
Rash bronchospasm and hypotension.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
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

25. Anticholinergics
Class of drugs encompassing decongestants - amphetamines - cocaine.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
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.
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

26. Middle Clavicle fracture management?
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.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

27. Anticholinergics
Class of drugs encompassing decongestants - amphetamines - cocaine.
Antidote is naloxone.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

28. Mx of petroleum overdose
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Bone scan for occult fracture
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

29. Amphetamine antidote
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Esmolol

30. What happens if charcoal is aspirated?
It can cause fatal bronchioloitis obliterans
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
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 treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

31. Mx severe croup
Collar and cuff. Check integrity of nerve.
Stomach pumping.
'I WOULD CALL POISON HOTLINE'.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

32. What is an important point to note about anaphylaxis?
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
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 -
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Aspiration Pneumonia

33. Signs of abuse from the history
Objective signs of growth - tidiness - weight -
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Class of drugs encompassing decongestants - amphetamines - cocaine.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

34. What is the most important treatment for anaphylaxis
Release NEUROTOXINS both have antivenom
Normally treated with sling alone. Seek advice.
IM adrenaline: vasopressor and bronchodilator.
Abdo XRAY!!!! do it!

35. What is one of the technicalities of childabuse.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Munchausen's by proxy
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Before a child can be examined for child abuse - a parent or legal guardian must give consent

36. Mx raised intracranial pressure.
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 -
Neurosurgery if trauma. Give mannitol.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.

37. Beta-blocker overdose antidote
Neurosurgery if trauma. Give mannitol.
Sling for 3 weeks - fracture clinic at 7 days.
Glucagon prefered - otherwise massive dose of adrenaline.
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

38. Methanol
Give IM adrenaline - steroids - salbutamol - antihistamine.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

39. Mx of snake bit
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
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.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.

40. When is gastric lavage indicated and contraindicated?
Class of drugs encompassing decongestants - amphetamines - cocaine.
Blood glucose level for hypoglycaemia!!
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
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.

41. What are the early symptoms of paracetamol overdose?
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Collar and cuff. Check integrity of nerve.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Nausea vomiting and anorexia.

42. Ethanol
Cyanosis and irregular respiratory effort
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
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 -
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

43. What is the most important investigation in suspected alcohol poisoning in young person?
Collar and cuff. Check integrity of nerve.
Class of drugs encompassing decongestants - amphetamines - cocaine.
It can cause fatal bronchioloitis obliterans
Blood glucose level for hypoglycaemia!!

44. Benzodiazepine overdose antidote
Flumazenil
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.
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.
Causes BAD constipation. Upsets fluid and electrolyte balance.

45. Hydrocarbons
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
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.
Antidote is naloxone.

46. Undisplaced surgical neck of humerous?
Sling for 3 weeks - fracture clinic at 7 days.
Bone scan for occult fracture
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.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.

47. Management of septicaemia shock

48. You must consider abuse in
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.
Severe illness - past history of injuries - 18 months or less - inconstent story.
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.
Cyanosis and irregular respiratory effort

49. Carbon monoxide
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Objective signs of growth - tidiness - weight -
Cyanosis and irregular respiratory effort
Aspiration Pneumonia

50. What is the first line investigation in a young child who has consumed alcohol?
Poisoning causes decreased cholinesterase activity.
... blood sugars for hypoglycaemia
Rash bronchospasm and hypotension.
Skin or vascular compromise