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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. Organophosphates
Poisoning causes decreased cholinesterase activity.
Cyanosis and irregular respiratory effort
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.

2. Acetaminophen
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.

3. 20
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Nausea vomiting and anorexia.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

4. Oedema causing laryngeal obstruction?
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
Causes BAD constipation. Upsets fluid and electrolyte balance.
Intubate - tracheostromy or nebulized adrenaline.
Flumazenil

5. What is an important point to note about anaphylaxis?
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.
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.

6. What are the early symptoms of paracetamol overdose?
Nausea vomiting and anorexia.
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.
CHARCOAL! except for lithium - iron - alcohol - lead.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.

7. What is gastric lavage?
Neurosurgery if trauma. Give mannitol.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Stomach pumping.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

8. Iron
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
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
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
Nausea vomiting and anorexia.

9. Methanol
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Antidote is naloxone.
Normally treated with sling alone. Seek advice.

10. Opiates
Release NEUROTOXINS both have antivenom
Antidote is naloxone.
Neurotoxins - procagulants. Rhabdomyolysins.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

11. What happens if charcoal is aspirated?
CHARCOAL! except for lithium - iron - alcohol - lead.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
It can cause fatal bronchioloitis obliterans
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

12. What is the most appropriate examination in a child with suspected lead ingestion?
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
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Discobalt edetate

13. When and how would you do whole bowel irrigation?
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Digoxin Fab
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 lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

14. Mx severe croup
Normally treated with sling alone. Seek advice.
... blood sugars for hypoglycaemia
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
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

15. 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.
Flurescence in ultraviolet light.
Discobalt edetate
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.

16. Displaced surgical neck of humerous
Abdo XRAY!!!! do it!
Normally treated with sling alone. Seek advice.
Sling for 3 weeks - fracture clinic at 7 days.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

17. You must consider abuse in
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Stomach pumping.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.

18. Ethylene glycol
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
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 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.
Stomach pumping.

19. Amphetamine antidote
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 with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Esmolol

20. What else is in the management of snake bite?
Give steroids for management of serum sickness. Must do coagulation screen!!!
Causes BAD constipation. Upsets fluid and electrolyte balance.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

21. Theophylline
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Esmolol

22. Carbon monoxide
Bone scan for occult fracture
Antidote is naloxone.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

23. What is a side effect of charcoal?
Causes BAD constipation. Upsets fluid and electrolyte balance.
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
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Poisoning causes decreased cholinesterase activity.

24. Epinephrine
Bone scan for occult fracture
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Give steroids for management of serum sickness. Must do coagulation screen!!!
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

25. Organophosphates antidotes
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Antidotes are atropine sulfate and pralidoxime chloride.
Flurescence in ultraviolet light.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)

26. What are the other treatments for anaphylaxis?
Poisoning causes decreased cholinesterase activity.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Give IM adrenaline - steroids - salbutamol - antihistamine.
IM adrenaline: vasopressor and bronchodilator.

27. What are the terminal signs of acute laryngeal obstruction?
Cyanosis and irregular respiratory effort
Munchausen's by proxy
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
Normally treated with sling alone. Seek advice.

28. What is one of the technicalities of childabuse.
Glucagon prefered - otherwise massive dose of adrenaline.
It can cause fatal bronchioloitis obliterans
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

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

30. Salicylates
Intubate - tracheostromy or nebulized adrenaline.
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 decreased cholinesterase activity.
CHARCOAL! except for lithium - iron - alcohol - lead.

31. Atropine
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
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.
Esmolol
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. Organophosphates
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Rash bronchospasm and hypotension.
Notify if abuse CONSIDERED. CONSIDERED.
CHARCOAL! except for lithium - iron - alcohol - lead.

33. Funnel web and red back
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Release NEUROTOXINS both have antivenom
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Ceftriaxone

34. Beta-blocker overdose antidote
Give IM adrenaline - steroids - salbutamol - antihistamine.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Glucagon prefered - otherwise massive dose of adrenaline.
Discobalt edetate

35. What is the first line investigation in a young child who has consumed alcohol?
Cyanosis and irregular respiratory effort
Notify if abuse CONSIDERED. CONSIDERED.
Neurosurgery if trauma. Give mannitol.
... blood sugars for hypoglycaemia

36. How may you detect semen?
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.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
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

37. Cyanide
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Neurotoxins - procagulants. Rhabdomyolysins.
Discobalt edetate

38. Iron
IM adrenaline: vasopressor and bronchodilator.
Bone scan for occult fracture
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Antidote is deferoxamine chelation. Charcoal is ineffective.

39. Digoxin antedote
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Digoxin Fab
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

40. Anticholinergics
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.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
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.

41. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
Ceftriaxone
Causes BAD constipation. Upsets fluid and electrolyte balance.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Aspiration pneumonia even if intubated.

42. Benzodiazepine overdose antidote
Flumazenil
Immobilize with plaster slab
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
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

43. What is the antibiotic for Epiglottitis?
Ceftriaxone
Objective signs of growth - tidiness - weight -
Digoxin Fab
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

44. Carbon monoxide
Sling for 3 weeks - fracture clinic at 7 days.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.

45. Anticholinergics
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Release NEUROTOXINS both have antivenom

46. What is the general management of poisoning?
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Sling for 3 weeks - fracture clinic at 7 days.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

47. Calcium gluconate
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.
Objective signs of growth - tidiness - weight -

48. Methanol
Antidote is naloxone.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
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
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.

49. Tricyclic antidepressants overdose
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Glucagon prefered - otherwise massive dose of adrenaline.
Immobilize with plaster slab
Causes BAD constipation. Upsets fluid and electrolyte balance.

50. Calcium channel blocker overdose antidote
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
... blood sugars for hypoglycaemia
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Calcium chloride