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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?
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
It can cause fatal bronchioloitis obliterans
Sling for 3 weeks - fracture clinic at 7 days.

2. Procainamide
Antidote is naloxone.
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.
Flurescence in ultraviolet light.
Bone scan for occult fracture

3. Ingesting Petrol. Cx?
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.
Ceftriaxone
Neurosurgery if trauma. Give mannitol.
Aspiration Pneumonia

4. What are the early symptoms of paracetamol overdose?
It can cause fatal bronchioloitis obliterans
Nausea vomiting and anorexia.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Calcium chloride

5. Opiates
Antidote is naloxone.
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.
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 -
Lead poisoning is defined as a serum level greater than ___ ug/dL.

6. What is the antibiotic for Epiglottitis?
Poisoning causes decreased cholinesterase activity.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Ceftriaxone

7. 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 -
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.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Antidote is deferoxamine chelation. Charcoal is ineffective.

8. What is a side effect of charcoal?
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Causes BAD constipation. Upsets fluid and electrolyte balance.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

9. Tricyclic antidepressants
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
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 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

10. 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.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Intubate - tracheostromy or nebulized adrenaline.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

11. OSCE: What are the five princples of discharging a patient with a fracture?
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.

12. Anticholinergics
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
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Antidotes are atropine sulfate and pralidoxime chloride.

13. Ethylene glycol
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.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

14. Sympathomimetics
Class of drugs encompassing decongestants - amphetamines - cocaine.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Cyanosis and irregular respiratory effort

15. Sympathomimetics
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.
Ceftriaxone
Esmolol

16. Mx of petroleum overdose
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) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Causes BAD constipation. Upsets fluid and electrolyte balance.
Poisoning causes decreased cholinesterase activity.

17. Cyanide
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Discobalt edetate
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

18. Benzodiazepine overdose antidote
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Flumazenil
Glucagon prefered - otherwise massive dose of adrenaline.

19. Lead
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Intubate - tracheostromy or nebulized adrenaline.
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.

20. What is the general management of poisoning?
Nausea vomiting and anorexia.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

21. Salicylates
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 treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
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 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.

22. A child has swallowed a battery. Mx
Munchausen's by proxy
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Antidote is deferoxamine chelation. Charcoal is ineffective.
Nausea vomiting and anorexia.

23. Management of septicaemia shock

24. Calcium gluconate
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.

25. Ethylene glycol
Stomach pumping.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Give steroids for management of serum sickness. Must do coagulation screen!!!
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.

26. Iron
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
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
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

27. What are the terminal signs of acute laryngeal obstruction?
Class of drugs encompassing decongestants - amphetamines - cocaine.
Discobalt edetate
Digoxin Fab
Cyanosis and irregular respiratory effort

28. Salicylates
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
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.
Calcium chloride
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.

29. Amphetamine antidote
IM adrenaline: vasopressor and bronchodilator.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Esmolol
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

30. What is the first line investigation in a young child who has consumed alcohol?
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Collar and cuff. Check integrity of nerve.
... blood sugars for hypoglycaemia
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

31. Organophosphates
Skin or vascular compromise
IM adrenaline: vasopressor and bronchodilator.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

32. Theophylline
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

33. Undisplaced surgical neck of humerous?
Sling for 3 weeks - fracture clinic at 7 days.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Abdo XRAY!!!! do it!

34. When is gastric lavage indicated and contraindicated?
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Neurotoxins - procagulants. Rhabdomyolysins.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Croup.

35. Signs of psychological maltreatment?
It can cause fatal bronchioloitis obliterans
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.
Neurosurgery if trauma. Give mannitol.
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.

36. Lidocaine
Munchausen's by proxy
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

37. Signs of abuse from the history
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.
Glucagon prefered - otherwise massive dose of adrenaline.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy

38. What must you do before sending fracture to radiology?
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.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Immobilize with plaster slab
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

39. Middle Clavicle fracture management?
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Nausea vomiting and anorexia.

40. 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.
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.
'I WOULD CALL POISON HOTLINE'.
Collar and cuff. Check integrity of nerve.

41. What is gastric lavage?
Stomach pumping.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Flurescence in ultraviolet light.

42. How may you detect semen?
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Flurescence in ultraviolet light.
Munchausen's by proxy
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.

43. Methanol
Stomach pumping.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Aspiration Pneumonia
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

44. Legal requirement in childabuse
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
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.
Digoxin Fab

45. Carbon monoxide
CHARCOAL! except for lithium - iron - alcohol - lead.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Blood glucose level for hypoglycaemia!!
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.

46. 20
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
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.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
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.

47. Funnel web and red back
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.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

48. Organophosphates antidotes
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Antidotes are atropine sulfate and pralidoxime chloride.
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.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

49. Calcium channel blocker overdose antidote
Cyanosis and irregular respiratory effort
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Calcium chloride
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

50. When is reduction required in fracture?
Skin or vascular compromise
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)