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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. Procainamide
Give IM adrenaline - steroids - salbutamol - antihistamine.
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.
Stomach pumping.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

2. Opiates
Antidote is naloxone.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

3. What psychiatric disease defined as childabuse?

4. Middle Clavicle fracture management?
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
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
It can cause fatal bronchioloitis obliterans
Stomach pumping.

5. Lead
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Skin or vascular compromise
Give IM adrenaline - steroids - salbutamol - antihistamine.

6. 45; 70
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
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.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

7. Calcium gluconate
Glucagon prefered - otherwise massive dose of adrenaline.
Bone scan for occult fracture
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

8. What is a side effect of charcoal?
Skin or vascular compromise
Causes BAD constipation. Upsets fluid and electrolyte balance.
Antidote is naloxone.
Ceftriaxone

9. Mx severe croup
Objective signs of growth - tidiness - weight -
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.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

10. Organophosphates
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 salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Bone scan for occult fracture
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.

11. When is reduction required in fracture?
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Skin or vascular compromise
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.

12. Hydrocarbons
Antidote is deferoxamine chelation. Charcoal is ineffective.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
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.

13. Digoxin antedote
Digoxin Fab
Glucagon prefered - otherwise massive dose of adrenaline.
Neurosurgery if trauma. Give mannitol.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

14. What happens if charcoal is aspirated?
It can cause fatal bronchioloitis obliterans
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.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
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.

15. Amphetamine antidote
Sling for 3 weeks - fracture clinic at 7 days.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Esmolol
Aspiration pneumonia even if intubated.

16. How do snake bites damage?
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Neurotoxins - procagulants. Rhabdomyolysins.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Release NEUROTOXINS both have antivenom

17. What are the terminal signs of acute laryngeal obstruction?
Cyanosis and irregular respiratory effort
Bone scan for occult fracture
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Munchausen's by proxy

18. What is one of the technicalities of childabuse.
Class of drugs encompassing decongestants - amphetamines - cocaine.
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.
Discobalt edetate
Before a child can be examined for child abuse - a parent or legal guardian must give consent

19. Signs of abuse from the history
Skin or vascular compromise
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Collar and cuff. Check integrity of nerve.
Neurotoxins - procagulants. Rhabdomyolysins.

20. Carbon monoxide
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
It can cause fatal bronchioloitis obliterans
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Aspiration pneumonia even if intubated.

21. What are the other treatments for anaphylaxis?
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Bone scan for occult fracture
Give IM adrenaline - steroids - salbutamol - antihistamine.
Give steroids for management of serum sickness. Must do coagulation screen!!!

22. OSCE: What are the five princples of discharging a patient with a fracture?
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
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.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.

23. Undisplaced radial shaft fracture
Discobalt edetate
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
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Collar and cuff. Check integrity of nerve.

24. What is the general management of poisoning?
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
Sling for 3 weeks - fracture clinic at 7 days.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

25. Mx raised intracranial pressure.
Objective signs of growth - tidiness - weight -
Neurosurgery if trauma. Give mannitol.
Stomach pumping.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.

26. What is the first line investigation in a young child who has consumed alcohol?
Nausea vomiting and anorexia.
'I WOULD CALL POISON HOTLINE'.
... blood sugars for hypoglycaemia
Croup.

27. Cyanide
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Normally treated with sling alone. Seek advice.
Discobalt edetate
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

28. Ethylene glycol
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.
Antidotes are atropine sulfate and pralidoxime chloride.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

29. How may you detect semen?
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Calcium chloride
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Flurescence in ultraviolet light.

30. Organophosphates
... blood sugars for hypoglycaemia
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Poisoning causes decreased cholinesterase activity.

31. Mx of snake bit
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
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.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

32. Undisplaced surgical neck of humerous?
Rash bronchospasm and hypotension.
Sling for 3 weeks - fracture clinic at 7 days.
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 with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

33. What are the early symptoms of paracetamol overdose?
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Nausea vomiting and anorexia.
Neurosurgery if trauma. Give mannitol.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

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

35. Methanol
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.
... blood sugars for hypoglycaemia
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.

36. Carbon monoxide
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
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
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

37. Management of near drowning.
IM adrenaline: vasopressor and bronchodilator.
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
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
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

38. what makes you suspicious of non-accidental injury.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Immobilize with plaster slab
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

39. 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 -
Skin or vascular compromise
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
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

40. 20
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Aspiration pneumonia even if intubated.
Antidote is naloxone.
Lead poisoning is defined as a serum level greater than ___ ug/dL.

41. Opiates
Abdo XRAY!!!! do it!
Sling for 3 weeks - fracture clinic at 7 days.
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.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

42. Ibuprofen
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
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 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 salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

43. Iron
Neurotoxins - procagulants. Rhabdomyolysins.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Antidote is deferoxamine chelation. Charcoal is ineffective.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

44. Management of septicaemia shock

45. What investigations should you do in suspected child abuse
Bone scan for occult fracture
Discobalt edetate
Abdo XRAY!!!! do it!
Nausea vomiting and anorexia.

46. Oedema causing laryngeal obstruction?
Intubate - tracheostromy or nebulized adrenaline.
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
Croup.
Sling for 3 weeks - fracture clinic at 7 days.

47. Mx of critical asthma
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
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

48. Theophylline
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Neurosurgery if trauma. Give mannitol.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Rash bronchospasm and hypotension.

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

50. Acetaminophen
Croup.
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
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.