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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. Atropine
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
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.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Munchausen's by proxy

2. What is the antibiotic for Epiglottitis?
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 -
Ceftriaxone
IM adrenaline: vasopressor and bronchodilator.
Neurosurgery if trauma. Give mannitol.

3. Benzodiazepine overdose antidote
Flumazenil
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Neurotoxins - procagulants. Rhabdomyolysins.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.

4. What are the special features that must be done to correct haemorrhagic shock.
Abdo XRAY!!!! do it!
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Causes BAD constipation. Upsets fluid and electrolyte balance.

5. Signs of psychological maltreatment?
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.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
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.
Objective signs of growth - tidiness - weight -

6. Undisplaced surgical neck of humerous?
Neurotoxins - procagulants. Rhabdomyolysins.
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 3 weeks - fracture clinic at 7 days.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

7. Sympathomimetics
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

8. What else is in the management of snake bite?
Antidote is deferoxamine chelation. Charcoal is ineffective.
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 -
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

9. Hydrocarbons
Flurescence in ultraviolet light.
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
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.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.

10. Salicylates
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Immobilize with plaster slab

11. 45; 70
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
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
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.

12. Cyanide
Discobalt edetate
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
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Skin or vascular compromise

13. Funnel web and red back
Give steroids for management of serum sickness. Must do coagulation screen!!!
Release NEUROTOXINS both have antivenom
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

14. 20
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
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Cyanosis and irregular respiratory effort

15. Epinephrine
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

16. Ethanol
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Neurotoxins - procagulants. Rhabdomyolysins.
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.

17. Ingesting Petrol. Cx?
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.
Aspiration Pneumonia
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
Aspiration pneumonia even if intubated.

18. What is the most important investigation in suspected alcohol poisoning in young person?
Blood glucose level for hypoglycaemia!!
Cyanosis and irregular respiratory effort
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.

19. Methanol
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.
... blood sugars for hypoglycaemia
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.
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

20. What are the side effects of N-acety-p-benzoquinine?
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.
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 -
Rash bronchospasm and hypotension.
IM adrenaline: vasopressor and bronchodilator.

21. Adenosine
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Sling for 3 weeks - fracture clinic at 7 days.
Stomach pumping.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

22. Anticholinergics
Aspiration pneumonia even if intubated.
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.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Antidotes are atropine sulfate and pralidoxime chloride.

23. 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
Release NEUROTOXINS both have antivenom
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
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.

24. Middle Clavicle fracture management?
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Skin or vascular compromise
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

25. What is one of the technicalities of childabuse.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Bone scan for occult fracture
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
Immobilize with plaster slab

26. Undisplaced radial shaft fracture
Collar and cuff. Check integrity of nerve.
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
Croup.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

27. Methanol
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Notify if abuse CONSIDERED. CONSIDERED.
Cyanosis and irregular respiratory effort
Skin or vascular compromise

28. What is the most appropriate examination in a child with suspected lead ingestion?
Abdo XRAY!!!! do it!
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Class of drugs encompassing decongestants - amphetamines - cocaine.

29. Calcium channel blocker overdose antidote
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Ceftriaxone
Calcium chloride
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.

30. Organophosphates
It can cause fatal bronchioloitis obliterans
Poisoning causes decreased cholinesterase activity.
Flurescence in ultraviolet light.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

31. What evidence should a doctor give about parental neglect
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Objective signs of growth - tidiness - weight -
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.

32. Ethylene glycol
Give IM adrenaline - steroids - salbutamol - antihistamine.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Neurosurgery if trauma. Give mannitol.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

33. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
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 tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Aspiration pneumonia even if intubated.

34. Mx of critical asthma
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

35. Carbon monoxide
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Glucagon prefered - otherwise massive dose of adrenaline.
Lead poisoning is defined as a serum level greater than ___ ug/dL.

36. OSCE: What are the five princples of discharging a patient with a fracture?
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Bone scan for occult fracture
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.

37. Calcium gluconate
Immobilize with plaster slab
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
CHARCOAL! except for lithium - iron - alcohol - lead.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

38. Tricyclic antidepressants
Poisoning causes decreased cholinesterase activity.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
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 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

39. Mx of petroleum overdose
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Stomach pumping.
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.

40. Carbon monoxide
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
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.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy

41. What is a side effect of charcoal?
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Stomach pumping.

42. What is the most common caUse of acute laryngeal obstruction?
Notify if abuse CONSIDERED. CONSIDERED.
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.
Croup.
'I WOULD CALL POISON HOTLINE'.

43. Acetaminophen
IM adrenaline: vasopressor and bronchodilator.
Blood glucose level for hypoglycaemia!!
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 nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

44. 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 treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
... blood sugars for hypoglycaemia

45. What investigations should you do in suspected child abuse
Notify if abuse CONSIDERED. CONSIDERED.
Bone scan for occult fracture
Neurosurgery if trauma. Give mannitol.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

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

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47. Procainamide
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
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.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

48. When is reduction required in fracture?
Skin or vascular compromise
CHARCOAL! except for lithium - iron - alcohol - lead.
Calcium chloride
Stomach pumping.

49. What are the terminal signs of acute laryngeal obstruction?
Severe illness - past history of injuries - 18 months or less - inconstent story.
Cyanosis and irregular respiratory effort
Stomach pumping.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

50. What are the other treatments for anaphylaxis?
Antidote is deferoxamine chelation. Charcoal is ineffective.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Give IM adrenaline - steroids - salbutamol - antihistamine.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity