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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 happens if charcoal is aspirated?
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
Lead poisoning is defined as a serum level greater than ___ ug/dL.
It can cause fatal bronchioloitis obliterans

2. Ingesting Petrol. Cx?
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.
Aspiration Pneumonia
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.

3. Calcium channel blocker overdose antidote
Release NEUROTOXINS both have antivenom
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Calcium chloride

4. Methanol
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Croup.
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.
Flurescence in ultraviolet light.

5. Lidocaine
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Discobalt edetate
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.
Immobilize with plaster slab

6. What evidence should a doctor give about parental neglect
Objective signs of growth - tidiness - weight -
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.
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 irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

7. Sympathomimetics
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Class of drugs encompassing decongestants - amphetamines - cocaine.
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.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

8. A child has swallowed a battery. Mx
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Poisoning causes decreased cholinesterase activity.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy

9. Atropine
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
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
Flurescence in ultraviolet light.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.

10. What is gastric lavage?
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Objective signs of growth - tidiness - weight -
Stomach pumping.
'I WOULD CALL POISON HOTLINE'.

11. Salicylates
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
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 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.

12. Management of near drowning.
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.
Bone scan for occult fracture
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
Calcium chloride

13. Methanol
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Antidotes are atropine sulfate and pralidoxime chloride.
Bone scan for occult fracture

14. Oedema causing laryngeal obstruction?
Notify if abuse CONSIDERED. CONSIDERED.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Intubate - tracheostromy or nebulized adrenaline.
Calcium chloride

15. What psychiatric disease defined as childabuse?

16. When is reduction required in fracture?
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Skin or vascular compromise
Esmolol

17. Calcium gluconate
IM adrenaline: vasopressor and bronchodilator.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Bone scan for occult fracture
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

18. Mx of critical asthma
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Nausea vomiting and anorexia.

19. What else is in the management of snake bite?
Give steroids for management of serum sickness. Must do coagulation screen!!!
... blood sugars for hypoglycaemia
Neurotoxins - procagulants. Rhabdomyolysins.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.

20. Funnel web and red back
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Release NEUROTOXINS both have antivenom
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.
Class of drugs encompassing decongestants - amphetamines - cocaine.

21. What is the general management of poisoning?
Objective signs of growth - tidiness - weight -
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.

22. What is a side effect of charcoal?
Flumazenil
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Causes BAD constipation. Upsets fluid and electrolyte balance.

23. Opiates
Immobilize with plaster slab
Antidote is naloxone.
Collar and cuff. Check integrity of nerve.
Stomach pumping.

24. Undisplaced radial shaft fracture
Flurescence in ultraviolet light.
Collar and cuff. Check integrity of nerve.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Neurotoxins - procagulants. Rhabdomyolysins.

25. What are the terminal signs of acute laryngeal obstruction?
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Cyanosis and irregular respiratory effort

26. What are the side effects of N-acety-p-benzoquinine?
Flumazenil
Rash bronchospasm and hypotension.
Croup.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

27. Mx of petroleum overdose
CHARCOAL! except for lithium - iron - alcohol - lead.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

28. What is the most appropriate examination in a child with suspected lead ingestion?
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Abdo XRAY!!!! do it!
Aspiration Pneumonia
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 -

29. What is the most common caUse of acute laryngeal obstruction?
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Croup.
Nausea vomiting and anorexia.

30. Amphetamine antidote
Esmolol
Sling for 3 weeks - fracture clinic at 7 days.
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
It can cause fatal bronchioloitis obliterans

31. Theophylline
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
'I WOULD CALL POISON HOTLINE'.
CHARCOAL! except for lithium - iron - alcohol - lead.

32. Iron
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
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
Antidote is deferoxamine chelation. Charcoal is ineffective.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

33. Benzodiazepine overdose antidote
IM adrenaline: vasopressor and bronchodilator.
Flumazenil
Objective signs of growth - tidiness - weight -
Give steroids for management of serum sickness. Must do coagulation screen!!!

34. When is gastric lavage indicated and contraindicated?
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Blood glucose level for hypoglycaemia!!
Aspiration pneumonia even if intubated.

35. You must consider abuse in
Severe illness - past history of injuries - 18 months or less - inconstent story.
CHARCOAL! except for lithium - iron - alcohol - lead.
Antidote is naloxone.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.

36. Tricyclic antidepressants overdose
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Skin or vascular compromise
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
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.

37. Ethanol
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.
Rash bronchospasm and hypotension.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

38. Carbon monoxide
Give steroids for management of serum sickness. Must do coagulation screen!!!
Severe illness - past history of injuries - 18 months or less - inconstent story.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

39. What is the most important treatment for anaphylaxis
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
IM adrenaline: vasopressor and bronchodilator.
Notify if abuse CONSIDERED. CONSIDERED.

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

41. Opiates
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
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 bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Aspiration Pneumonia

42. Undisplaced surgical neck of humerous?
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.
Sling for 3 weeks - fracture clinic at 7 days.
Collar and cuff. Check integrity of nerve.
Flurescence in ultraviolet light.

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

44. Indications of non-accidental injury
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Aspiration Pneumonia
Poisoning causes decreased cholinesterase activity.

45. Tricyclic antidepressants
Poisoning causes decreased cholinesterase activity.
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
Collar and cuff. Check integrity of nerve.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

46. Digoxin antedote
Causes BAD constipation. Upsets fluid and electrolyte balance.
Nausea vomiting and anorexia.
Digoxin Fab
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

47. 20
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Poisoning causes decreased cholinesterase activity.
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

48. What is an important point to note about anaphylaxis?
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Antidote is naloxone.
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.
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 -

49. Carbon monoxide
Cyanosis and irregular respiratory effort
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Antidotes are atropine sulfate and pralidoxime chloride.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.

50. Mx of snake bit
Objective signs of growth - tidiness - weight -
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
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.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.