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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. Mx of critical asthma
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Notify if abuse CONSIDERED. CONSIDERED.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

2. Displaced surgical neck of humerous
Skin or vascular compromise
CHARCOAL! except for lithium - iron - alcohol - lead.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Normally treated with sling alone. Seek advice.

3. What psychiatric disease defined as childabuse?

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4. Sodium Bicarbonate
Sling for 3 weeks - fracture clinic at 7 days.
Calcium chloride
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

5. Anticholinergics
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
It can cause fatal bronchioloitis obliterans
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.

6. Organophosphates
Stomach pumping.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Poisoning causes decreased cholinesterase activity.
Immobilize with plaster slab

7. Iron
Antidote is deferoxamine chelation. Charcoal is ineffective.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Nausea vomiting and anorexia.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

8. Acetaminophen
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

9. Lidocaine
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Flurescence in ultraviolet light.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
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. What is a side effect of charcoal?
Causes BAD constipation. Upsets fluid and electrolyte balance.
Intubate - tracheostromy or nebulized adrenaline.
Flumazenil
Nausea vomiting and anorexia.

11. Atropine
Antidote is naloxone.
Glucagon prefered - otherwise massive dose of adrenaline.
Blood glucose level for hypoglycaemia!!
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

12. How may you detect semen?
Discobalt edetate
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Flurescence in ultraviolet light.
Antidotes are atropine sulfate and pralidoxime chloride.

13. What else is in the management of snake bite?
Flurescence in ultraviolet light.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

14. Cyanide
'I WOULD CALL POISON HOTLINE'.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Discobalt edetate
Intubate - tracheostromy or nebulized adrenaline.

15. When and how would you do whole bowel irrigation?
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Blood glucose level for hypoglycaemia!!
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 bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

16. Epinephrine
Lead poisoning is defined as a serum level greater than ___ ug/dL.
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 nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.

17. Legal requirement in childabuse
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Notify if abuse CONSIDERED. CONSIDERED.
Croup.

18. When is reduction required in fracture?
Notify if abuse CONSIDERED. CONSIDERED.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Skin or vascular compromise
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

19. Sympathomimetics
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Abdo XRAY!!!! do it!

20. Organophosphates
Rash bronchospasm and hypotension.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
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.

21. Undisplaced radial shaft fracture
Collar and cuff. Check integrity of nerve.
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
Digoxin Fab
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

22. Carbon monoxide
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Sling for 3 weeks - fracture clinic at 7 days.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

23. What are the early symptoms of paracetamol overdose?
Croup.
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.
Abdo XRAY!!!! do it!
Nausea vomiting and anorexia.

24. Management of near drowning.
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 -
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
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

25. Indications of non-accidental injury
Poisoning causes decreased cholinesterase activity.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Stomach pumping.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

26. What investigations should you do in suspected child abuse
Notify if abuse CONSIDERED. CONSIDERED.
Neurotoxins - procagulants. Rhabdomyolysins.
Bone scan for occult fracture
Release NEUROTOXINS both have antivenom

27. What is gastric lavage?
Stomach pumping.
Give IM adrenaline - steroids - salbutamol - antihistamine.
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 -
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.

28. What is the antibiotic for Epiglottitis?
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Ceftriaxone
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

29. Ethylene glycol
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.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
... blood sugars for hypoglycaemia
Flumazenil

30. Sympathomimetics
CHARCOAL! except for lithium - iron - alcohol - lead.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
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
Class of drugs encompassing decongestants - amphetamines - cocaine.

31. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Aspiration pneumonia even if intubated.
Normally treated with sling alone. Seek advice.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

32. Funnel web and red back
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
Flurescence in ultraviolet light.
Release NEUROTOXINS both have antivenom
Sling for 3 weeks - fracture clinic at 7 days.

33. Undisplaced surgical neck of humerous?
Sling for 3 weeks - fracture clinic at 7 days.
IM adrenaline: vasopressor and bronchodilator.
Rash bronchospasm and hypotension.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

34. Opiates
Digoxin Fab
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Intubate - tracheostromy or nebulized adrenaline.

35. Oedema causing laryngeal obstruction?
Intubate - tracheostromy or nebulized adrenaline.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Skin or vascular compromise
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

36. What is the most appropriate examination in a child with suspected lead ingestion?
Abdo XRAY!!!! do it!
Antidote is naloxone.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
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 -

37. 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 -
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
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

38. You must consider abuse in
Nausea vomiting and anorexia.
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.
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

39. OSCE: What are the five princples of discharging a patient with a fracture?
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Croup.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Immobilize with plaster slab

40. what makes you suspicious of non-accidental injury.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Flurescence in ultraviolet light.
Croup.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

41. Hydrocarbons
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
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
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.
Blood glucose level for hypoglycaemia!!

42. 45; 70
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Croup.
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
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

43. Salicylates
Antidote is naloxone.
Calcium chloride
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

44. Acetaminophen
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Normally treated with sling alone. Seek advice.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

45. What must you do before sending fracture to radiology?
Aspiration Pneumonia
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.
Croup.

46. What is the most common caUse of acute laryngeal obstruction?
Croup.
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
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Sling for 3 weeks - fracture clinic at 7 days.

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

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48. Beta-blocker overdose antidote
Glucagon prefered - otherwise massive dose of adrenaline.
... blood sugars for hypoglycaemia
Release NEUROTOXINS both have antivenom
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

49. Middle Clavicle fracture management?
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
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

50. 20
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Abdo XRAY!!!! do it!