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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. Procainamide
Poisoning causes decreased cholinesterase activity.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Aspiration Pneumonia
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.

2. When is reduction required in fracture?
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
... blood sugars for hypoglycaemia
Skin or vascular compromise

3. Sodium Bicarbonate
Esmolol
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Intubate - tracheostromy or nebulized adrenaline.
Before a child can be examined for child abuse - a parent or legal guardian must give consent

4. Management of septicaemia shock

5. Mx of snake bit
Severe illness - past history of injuries - 18 months or less - inconstent story.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
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 treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

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

7. Undisplaced surgical neck of humerous?
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Sling for 3 weeks - fracture clinic at 7 days.
Release NEUROTOXINS both have antivenom
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

8. Management of near drowning.
Antidote is deferoxamine chelation. Charcoal is ineffective.
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
Bone scan for occult fracture
Nausea vomiting and anorexia.

9. You must consider abuse in
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Blood glucose level for hypoglycaemia!!
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

10. What psychiatric disease defined as childabuse?

11. Amphetamine antidote
Esmolol
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
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 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.

12. Mx of critical asthma
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.
IM adrenaline: vasopressor and bronchodilator.
Esmolol
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

13. Carbon monoxide
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
Flumazenil
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.

14. Indications of non-accidental injury
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.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
'I WOULD CALL POISON HOTLINE'.
Collar and cuff. Check integrity of nerve.

15. Opiates
Croup.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
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.

16. Benzodiazepine overdose antidote
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.
Flumazenil
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Skin or vascular compromise

17. What are the terminal signs of acute laryngeal obstruction?
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
Cyanosis and irregular respiratory effort
Munchausen's by proxy
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

18. Tricyclic antidepressants overdose
'I WOULD CALL POISON HOTLINE'.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Flumazenil
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.

19. what makes you suspicious of non-accidental injury.
Neurotoxins - procagulants. Rhabdomyolysins.
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.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

20. What is an important point to note about anaphylaxis?
'I WOULD CALL POISON HOTLINE'.
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 -
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Neurosurgery if trauma. Give mannitol.

21. Organophosphates antidotes
Flurescence in ultraviolet light.
IM adrenaline: vasopressor and bronchodilator.
Digoxin Fab
Antidotes are atropine sulfate and pralidoxime chloride.

22. What is a side effect of charcoal?
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
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 treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Causes BAD constipation. Upsets fluid and electrolyte balance.

23. What is the most appropriate examination in a child with suspected lead ingestion?
Abdo XRAY!!!! do it!
CHARCOAL! except for lithium - iron - alcohol - lead.
Rash bronchospasm and hypotension.
Discobalt edetate

24. Opiates
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.
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 causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

25. Atropine
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
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.
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
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

26. Signs of abuse from the history
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Lead poisoning is defined as a serum level greater than ___ ug/dL.

27. Hydrocarbons
Discobalt edetate
Skin or vascular compromise
CHARCOAL! except for lithium - iron - alcohol - lead.
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.

28. What must you do before sending fracture to radiology?
CHARCOAL! except for lithium - iron - alcohol - lead.
Immobilize with plaster slab
Antidote is deferoxamine chelation. Charcoal is ineffective.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

29. Cyanide
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Notify if abuse CONSIDERED. CONSIDERED.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Discobalt edetate

30. What is the most common caUse of acute laryngeal obstruction?
Croup.
CHARCOAL! except for lithium - iron - alcohol - lead.
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
Neurosurgery if trauma. Give mannitol.

31. Anticholinergics
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
CHARCOAL! except for lithium - iron - alcohol - lead.
'I WOULD CALL POISON HOTLINE'.
Neurosurgery if trauma. Give mannitol.

32. Digoxin antedote
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 -
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Digoxin Fab
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

33. Methanol
Sling for 3 weeks - fracture clinic at 7 days.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Skin or vascular compromise
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.

34. Legal requirement in childabuse
Antidote is deferoxamine chelation. Charcoal is ineffective.
Notify if abuse CONSIDERED. CONSIDERED.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

35. OSCE: What are the five princples of discharging a patient with a fracture?
Flumazenil
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

36. Which is better - activated charcoal or gastric lavage.
Abdo XRAY!!!! do it!
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Rash bronchospasm and hypotension.
CHARCOAL! except for lithium - iron - alcohol - lead.

37. Sympathomimetics
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Class of drugs encompassing decongestants - amphetamines - cocaine.

38. What are the three features of anaphylaxis
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Flumazenil
Aspiration Pneumonia
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.

39. Ethanol
Calcium chloride
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 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
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

40. Adenosine
Discobalt edetate
Flumazenil
Intubate - tracheostromy or nebulized adrenaline.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.

41. How may you detect semen?
Digoxin Fab
Croup.
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
Flurescence in ultraviolet light.

42. 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
Class of drugs encompassing decongestants - amphetamines - cocaine.
Causes BAD constipation. Upsets fluid and electrolyte balance.

43. Mx severe croup
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Normally treated with sling alone. Seek advice.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Stomach pumping.

44. Epinephrine
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Abdo XRAY!!!! do it!
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
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

45. Beta-blocker overdose antidote
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Glucagon prefered - otherwise massive dose of adrenaline.
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 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.

46. What evidence should a doctor give about parental neglect
Class of drugs encompassing decongestants - amphetamines - cocaine.
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.
Objective signs of growth - tidiness - weight -

47. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
Aspiration pneumonia even if intubated.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Give steroids for management of serum sickness. Must do coagulation screen!!!
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.

48. What happens if charcoal is aspirated?
It can cause fatal bronchioloitis obliterans
Antidote is deferoxamine chelation. Charcoal is ineffective.
Sling for 3 weeks - fracture clinic at 7 days.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

49. Calcium gluconate
Digoxin Fab
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.

50. Iron
Antidote is naloxone.
Cyanosis and irregular respiratory effort
Intubate - tracheostromy or nebulized 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