Test your basic knowledge |

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 risk of gastrointestinal decompression in a person with decreased conscious state?
Nausea vomiting and anorexia.
Antidote is naloxone.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Aspiration pneumonia even if intubated.

2. How may you detect semen?
IM adrenaline: vasopressor and bronchodilator.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Flurescence in ultraviolet light.
Give steroids for management of serum sickness. Must do coagulation screen!!!

3. Ethanol
Cyanosis and irregular respiratory effort
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Sling for 3 weeks - fracture clinic at 7 days.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

4. What else is in the management of snake bite?
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Munchausen's by proxy
Give steroids for management of serum sickness. Must do coagulation screen!!!
Rash bronchospasm and hypotension.

5. What is the first line investigation in a young child who has consumed alcohol?
Aspiration pneumonia even if intubated.
Bone scan for occult fracture
... blood sugars for hypoglycaemia
Poisoning causes decreased cholinesterase activity.

6. How do snake bites damage?
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
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
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Neurotoxins - procagulants. Rhabdomyolysins.

7. Calcium gluconate
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Ceftriaxone
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

8. What is the general management of poisoning?
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
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
Digoxin Fab
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.

9. Ibuprofen
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
Munchausen's by proxy
Stomach pumping.
Sling for 3 weeks - fracture clinic at 7 days.

10. Sympathomimetics
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Collar and cuff. Check integrity of nerve.
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.

11. Calcium channel blocker overdose antidote
Release NEUROTOXINS both have antivenom
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
... blood sugars for hypoglycaemia
Calcium chloride

12. Theophylline
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Esmolol
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.

13. Tricyclic antidepressants overdose
Flurescence in ultraviolet light.
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.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

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

15. Management of near drowning.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
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 naloxone.

16. Mx of snake bit
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.
Aspiration pneumonia even if intubated.
Aspiration Pneumonia
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.

17. What is gastric lavage?
Stomach pumping.
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
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Munchausen's by proxy

18. Opiates
Antidote is naloxone.
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.
Causes BAD constipation. Upsets fluid and electrolyte balance.

19. What is an important point to note about anaphylaxis?
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Antidote is deferoxamine chelation. Charcoal is ineffective.
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 -
CHARCOAL! except for lithium - iron - alcohol - lead.

20. Iron
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.
... blood sugars for hypoglycaemia
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
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

21. Displaced surgical neck of humerous
Normally treated with sling alone. Seek advice.
Poisoning causes decreased cholinesterase activity.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.

22. Carbon monoxide
Notify if abuse CONSIDERED. CONSIDERED.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Release NEUROTOXINS both have antivenom
Abdo XRAY!!!! do it!

23. Procainamide
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
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.
Cyanosis and irregular respiratory effort
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.

24. Undisplaced radial shaft fracture
Discobalt edetate
Notify if abuse CONSIDERED. CONSIDERED.
Collar and cuff. Check integrity of nerve.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

25. Acetaminophen
Antidote is deferoxamine chelation. Charcoal is ineffective.
It can cause fatal bronchioloitis obliterans
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.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

26. Mx of petroleum overdose
Neurosurgery if trauma. Give mannitol.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

27. What are the side effects of N-acety-p-benzoquinine?
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 lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Rash bronchospasm and hypotension.

28. What are the three features of anaphylaxis
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
CHARCOAL! except for lithium - iron - alcohol - lead.
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
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

29. When and how would you do whole bowel irrigation?
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
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.
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
Bone scan for occult fracture

30. What psychiatric disease defined as childabuse?

31. What is the most important treatment for anaphylaxis
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Class of drugs encompassing decongestants - amphetamines - cocaine.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
IM adrenaline: vasopressor and bronchodilator.

32. Tricyclic antidepressants
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
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
Objective signs of growth - tidiness - weight -
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

33. What is the most appropriate examination in a child with suspected lead ingestion?
Abdo XRAY!!!! do it!
Glucagon prefered - otherwise massive dose of adrenaline.
Collar and cuff. Check integrity of nerve.
Skin or vascular compromise

34. Sodium Bicarbonate
Causes BAD constipation. Upsets fluid and electrolyte balance.
Glucagon prefered - otherwise massive dose of adrenaline.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

35. Cyanide
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.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Abdo XRAY!!!! do it!
Discobalt edetate

36. Ethylene glycol
Blood glucose level for hypoglycaemia!!
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Collar and cuff. Check integrity of nerve.
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.

37. Anticholinergics
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Croup.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

38. Organophosphates
Immobilize with plaster slab
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Glucagon prefered - otherwise massive dose of adrenaline.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

39. Beta-blocker overdose antidote
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Glucagon prefered - otherwise massive dose of adrenaline.

40. 20
Lead poisoning is defined as a serum level greater than ___ ug/dL.
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.
Objective signs of growth - tidiness - weight -
CHARCOAL! except for lithium - iron - alcohol - lead.

41. Epinephrine
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.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
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

42. What investigations should you do in suspected child abuse
Abdo XRAY!!!! do it!
Bone scan for occult fracture
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.

43. Hydrocarbons
Munchausen's by proxy
Bone scan for occult fracture
Severe illness - past history of injuries - 18 months or less - inconstent story.
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.

44. What are the terminal signs of acute laryngeal obstruction?
Blood glucose level for hypoglycaemia!!
Cyanosis and irregular respiratory effort
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Flurescence in ultraviolet light.

45. Digoxin antedote
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Digoxin Fab
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

46. Mx severe croup
Nausea vomiting and anorexia.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
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.

47. What are the special features that must be done to correct haemorrhagic shock.
Croup.
Poisoning causes decreased cholinesterase activity.
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!!!

48. When is reduction required in fracture?
Skin or vascular compromise
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.
Croup.

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

50. Acetaminophen
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Objective signs of growth - tidiness - weight -
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.