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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. Sympathomimetics
Cyanosis and irregular respiratory effort
Class of drugs encompassing decongestants - amphetamines - cocaine.
Normally treated with sling alone. Seek advice.
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

2. Ethylene glycol
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Blood glucose level for hypoglycaemia!!
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Poisoning causes decreased cholinesterase activity.

3. Indications of non-accidental injury
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
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 -
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

4. What is the most important investigation in suspected alcohol poisoning in young person?
Cyanosis and irregular respiratory effort
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Blood glucose level for hypoglycaemia!!
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

5. Theophylline
Nausea vomiting and anorexia.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Flurescence in ultraviolet light.

6. Calcium channel blocker overdose antidote
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Calcium chloride
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
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.

7. Adenosine
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Immobilize with plaster slab
Rash bronchospasm and hypotension.
Causes BAD constipation. Upsets fluid and electrolyte balance.

8. What is a side effect of charcoal?
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Causes BAD constipation. Upsets fluid and electrolyte balance.

9. What are the three features of anaphylaxis
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Rash bronchospasm and hypotension.
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.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

10. Carbon monoxide
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Immobilize with plaster slab
Give steroids for management of serum sickness. Must do coagulation screen!!!

11. 20
Lead poisoning is defined as a serum level greater than ___ ug/dL.
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 irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Antidotes are atropine sulfate and pralidoxime chloride.

12. What is an important point to note about anaphylaxis?
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.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
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 -
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

13. What are the early symptoms of paracetamol overdose?
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Rash bronchospasm and hypotension.
IM adrenaline: vasopressor and bronchodilator.
Nausea vomiting and anorexia.

14. Methanol
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
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.
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

15. Undisplaced radial shaft fracture
Collar and cuff. Check integrity of nerve.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
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. Middle Clavicle fracture management?
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Ceftriaxone
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

17. Ethylene glycol
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
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.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

18. What psychiatric disease defined as childabuse?

19. Amphetamine antidote
Esmolol
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
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
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)

20. Procainamide
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
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 tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.

21. Atropine
Rash bronchospasm and hypotension.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

22. What is the first line investigation in a young child who has consumed alcohol?
... blood sugars for hypoglycaemia
Rash bronchospasm and hypotension.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.

23. 45; 70
Immobilize with plaster slab
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
Esmolol
Calcium chloride

24. Benzodiazepine overdose antidote
Flumazenil
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.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Antidote is deferoxamine chelation. Charcoal is ineffective.

25. What is the general management of poisoning?
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Aspiration Pneumonia

26. What must you do before sending fracture to radiology?
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Immobilize with plaster slab
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

27. Calcium gluconate
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Normally treated with sling alone. Seek advice.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

28. Acetaminophen
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Antidotes are atropine sulfate and pralidoxime 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
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

29. Anticholinergics
Immobilize with plaster slab
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Discobalt edetate
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

30. When is reduction required in fracture?
Skin or vascular compromise
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Intubate - tracheostromy or nebulized adrenaline.

31. What is better for alcohol - charcoal or gastric lavage?

32. You must consider abuse in
'I WOULD CALL POISON HOTLINE'.
Croup.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Severe illness - past history of injuries - 18 months or less - inconstent story.

33. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
Aspiration pneumonia even if intubated.
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
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
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.

34. Opiates
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
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 bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

35. What happens if charcoal is aspirated?
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
It can cause fatal bronchioloitis obliterans
Class of drugs encompassing decongestants - amphetamines - cocaine.
Sling for 3 weeks - fracture clinic at 7 days.

36. Anticholinergics
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
IM adrenaline: vasopressor and bronchodilator.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
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.

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

38. Tricyclic antidepressants
It can cause fatal bronchioloitis obliterans
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 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.

39. What are the other treatments for anaphylaxis?
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Poisoning causes decreased cholinesterase activity.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

40. What is the most important treatment for anaphylaxis
IM adrenaline: vasopressor and bronchodilator.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Flumazenil
CHARCOAL! except for lithium - iron - alcohol - lead.

41. What is the antibiotic for Epiglottitis?
'I WOULD CALL POISON HOTLINE'.
Neurotoxins - procagulants. Rhabdomyolysins.
Ceftriaxone
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

42. Organophosphates
Aspiration Pneumonia
Abdo XRAY!!!! do it!
Antidote is naloxone.
Poisoning causes decreased cholinesterase activity.

43. Digoxin antedote
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Digoxin Fab

44. Iron
Antidote is deferoxamine chelation. Charcoal is ineffective.
Neurosurgery if trauma. Give mannitol.
Objective signs of growth - tidiness - weight -
It can cause fatal bronchioloitis obliterans

45. Organophosphates
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
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 delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Digoxin Fab

46. What evidence should a doctor give about parental neglect
Causes BAD constipation. Upsets fluid and electrolyte balance.
Objective signs of growth - tidiness - weight -
Flurescence in ultraviolet light.
Cyanosis and irregular respiratory effort

47. Signs of abuse from the history
Immobilize with plaster slab
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 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 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.

48. Displaced surgical neck of humerous
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.
Normally treated with sling alone. Seek advice.
It can cause fatal bronchioloitis obliterans

49. What is the most appropriate examination in a child with suspected lead ingestion?
Rash bronchospasm and hypotension.
Abdo XRAY!!!! do it!
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Calcium chloride

50. When is gastric lavage indicated and contraindicated?
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
It can cause fatal bronchioloitis obliterans
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.