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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. What is the first line investigation in a young child who has consumed alcohol?
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.
... blood sugars for hypoglycaemia
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

2. What evidence should a doctor give about parental neglect
Objective signs of growth - tidiness - weight -
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.

3. Iron
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Croup.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
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

4. Procainamide
Immobilize with plaster slab
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.
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.

5. What are the side effects of N-acety-p-benzoquinine?
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Stomach pumping.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Rash bronchospasm and hypotension.

6. Signs of psychological maltreatment?
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 delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Flumazenil
Class of drugs encompassing decongestants - amphetamines - cocaine.

7. 20
'I WOULD CALL POISON HOTLINE'.
Glucagon prefered - otherwise massive dose of adrenaline.
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.

8. Ethylene glycol
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Nausea vomiting and anorexia.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

9. What psychiatric disease defined as childabuse?

10. Opiates
Severe illness - past history of injuries - 18 months or less - inconstent story.
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.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

11. What investigations should you do in suspected child abuse
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Bone scan for occult fracture
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

12. Acetaminophen
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.
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.
Neurosurgery if trauma. Give mannitol.

13. Digoxin antedote
Causes BAD constipation. Upsets fluid and electrolyte balance.
Digoxin Fab
Intubate - tracheostromy or nebulized adrenaline.
Antidote is deferoxamine chelation. Charcoal is ineffective.

14. What are the special features that must be done to correct haemorrhagic shock.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Digoxin Fab
Release NEUROTOXINS both have antivenom

15. Anticholinergics
Glucagon prefered - otherwise massive dose of adrenaline.
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.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
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. What is an important point to note about anaphylaxis?
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 - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.

17. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
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.
Munchausen's by proxy
Aspiration pneumonia even if intubated.
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 -

18. What is the most common caUse of acute laryngeal obstruction?
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Rash bronchospasm and hypotension.
Normally treated with sling alone. Seek advice.
Croup.

19. Lead
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.
Skin or vascular compromise
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.

20. Iron
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
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.
Rash bronchospasm and hypotension.

21. Sympathomimetics
Class of drugs encompassing decongestants - amphetamines - cocaine.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
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
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

22. What is the most appropriate examination in a child with suspected lead ingestion?
Abdo XRAY!!!! do it!
Neurosurgery if trauma. Give mannitol.
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.

23. Mx raised intracranial pressure.
Abdo XRAY!!!! do it!
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Neurosurgery if trauma. Give mannitol.
Blood glucose level for hypoglycaemia!!

24. What is gastric lavage?
Stomach pumping.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Skin or vascular compromise
Aspiration pneumonia even if intubated.

25. Undisplaced radial shaft fracture
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Collar and cuff. Check integrity of nerve.
Aspiration Pneumonia

26. Beta-blocker overdose antidote
Digoxin Fab
Glucagon prefered - otherwise massive dose of adrenaline.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
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.

27. Ibuprofen
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Neurotoxins - procagulants. Rhabdomyolysins.
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 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.

28. Ethanol
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
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.
Neurotoxins - procagulants. Rhabdomyolysins.

29. Ingesting Petrol. Cx?
Aspiration Pneumonia
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
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

30. Organophosphates
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
Poisoning causes decreased cholinesterase activity.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
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

31. Sodium Bicarbonate
Esmolol
Glucagon prefered - otherwise massive dose of adrenaline.
Bone scan for occult fracture
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

32. What else is in the management of snake bite?
... blood sugars for hypoglycaemia
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Give steroids for management of serum sickness. Must do coagulation screen!!!

33. Indications of non-accidental injury
Antidote is naloxone.
Aspiration Pneumonia
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

34. Acetaminophen
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Abdo XRAY!!!! do it!
Cyanosis and irregular respiratory effort
Causes BAD constipation. Upsets fluid and electrolyte balance.

35. What happens if charcoal is aspirated?
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Objective signs of growth - tidiness - weight -
Severe illness - past history of injuries - 18 months or less - inconstent story.
It can cause fatal bronchioloitis obliterans

36. What is one of the technicalities of childabuse.
Cyanosis and irregular respiratory effort
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Before a child can be examined for child abuse - a parent or legal guardian must give consent

37. What is the most important treatment for anaphylaxis
IM adrenaline: vasopressor and bronchodilator.
Abdo XRAY!!!! do it!
Neurotoxins - procagulants. Rhabdomyolysins.
Intubate - tracheostromy or nebulized adrenaline.

38. Legal requirement in childabuse
Causes BAD constipation. Upsets fluid and electrolyte balance.
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.
Notify if abuse CONSIDERED. CONSIDERED.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

39. What is the most important investigation in suspected alcohol poisoning in young person?
Skin or vascular compromise
Blood glucose level for hypoglycaemia!!
Flumazenil
Lead poisoning is defined as a serum level greater than ___ ug/dL.

40. When is reduction required in fracture?
Normally treated with sling alone. Seek advice.
Skin or vascular compromise
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Causes BAD constipation. Upsets fluid and electrolyte balance.

41. Salicylates
Immobilize with plaster slab
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.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

42. Signs of abuse from the history
Intubate - tracheostromy or nebulized adrenaline.
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
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

43. Undisplaced surgical neck of humerous?
Sling for 3 weeks - fracture clinic at 7 days.
Discobalt edetate
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
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

44. what makes you suspicious of non-accidental injury.
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.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
'I WOULD CALL POISON HOTLINE'.

45. Mx of critical asthma
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.

46. Sympathomimetics
CHARCOAL! except for lithium - iron - alcohol - lead.
... blood sugars for hypoglycaemia
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.

47. Hydrocarbons
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
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.
Notify if abuse CONSIDERED. CONSIDERED.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

48. When is gastric lavage indicated and contraindicated?
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

49. A child has swallowed a battery. Mx
Stomach pumping.
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
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.

50. Funnel web and red back
Esmolol
Aspiration pneumonia even if intubated.
Release NEUROTOXINS both have antivenom
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