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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. Amphetamine antidote
Esmolol
Normally treated with sling alone. Seek advice.
Skin or vascular compromise
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.

2. What is the most common caUse of acute laryngeal obstruction?
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.
Collar and cuff. Check integrity of nerve.
Aspiration pneumonia even if intubated.

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

4. Anticholinergics
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Release NEUROTOXINS both have antivenom
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Give steroids for management of serum sickness. Must do coagulation screen!!!

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

6. What else is in the management of snake bite?
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.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

7. Mx of petroleum overdose
Esmolol
Causes BAD constipation. Upsets fluid and electrolyte balance.
Sling for 3 weeks - fracture clinic at 7 days.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

8. Benzodiazepine overdose antidote
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Flumazenil

9. Carbon monoxide
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Neurotoxins - procagulants. Rhabdomyolysins.
Nausea vomiting and anorexia.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

10. What investigations should you do in suspected child abuse
Bone scan for occult fracture
Class of drugs encompassing decongestants - amphetamines - cocaine.
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.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

11. What is gastric lavage?
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.
Stomach pumping.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

12. OSCE: What are the five princples of discharging a patient with a fracture?
Notify if abuse CONSIDERED. CONSIDERED.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

13. Mx of critical asthma
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Abdo XRAY!!!! do it!
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

14. Sympathomimetics
Esmolol
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Collar and cuff. Check integrity of nerve.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

15. Anticholinergics
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

16. Calcium channel blocker overdose antidote
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Normally treated with sling alone. Seek advice.
Calcium chloride

17. Carbon monoxide
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Give steroids for management of serum sickness. Must do coagulation screen!!!
Causes BAD constipation. Upsets fluid and electrolyte balance.

18. Iron
Rash bronchospasm and hypotension.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Antidote is deferoxamine chelation. Charcoal is ineffective.

19. Opiates
Sling for 3 weeks - fracture clinic at 7 days.
Antidote is naloxone.
Aspiration pneumonia even if intubated.
It can cause fatal bronchioloitis obliterans

20. What is the most appropriate examination in a child with suspected lead ingestion?
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Abdo XRAY!!!! do it!
Glucagon prefered - otherwise massive dose of 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.

21. A child has swallowed a battery. Mx
... blood sugars for hypoglycaemia
Intubate - tracheostromy or nebulized adrenaline.
Croup.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy

22. Funnel web and red back
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Stomach pumping.
Release NEUROTOXINS both have antivenom
Lead poisoning is defined as a serum level greater than ___ ug/dL.

23. What is the first line investigation in a young child who has consumed alcohol?
Give steroids for management of serum sickness. Must do coagulation screen!!!
... 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.
Antidotes are atropine sulfate and pralidoxime chloride.

24. Amiodarone
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
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)

25. Procainamide
Calcium chloride
Bone scan for occult fracture
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.
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.

26. Beta-blocker overdose antidote
Glucagon prefered - otherwise massive dose of adrenaline.
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
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.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

27. What are the early symptoms of paracetamol overdose?
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Nausea vomiting and anorexia.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

28. Methanol
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
It can cause fatal bronchioloitis obliterans
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

29. 20
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
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 irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Lead poisoning is defined as a serum level greater than ___ ug/dL.

30. What is a side effect of charcoal?
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.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

31. what makes you suspicious of non-accidental injury.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
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.

32. What is the most important investigation in suspected alcohol poisoning in young person?
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Notify if abuse CONSIDERED. CONSIDERED.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Blood glucose level for hypoglycaemia!!

33. Displaced surgical neck of humerous
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Ceftriaxone
Normally treated with sling alone. Seek advice.
Calcium chloride

34. What evidence should a doctor give about parental neglect
... blood sugars for hypoglycaemia
Intubate - tracheostromy or nebulized adrenaline.
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
Objective signs of growth - tidiness - weight -

35. Signs of abuse from the history
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Antidote is deferoxamine chelation. Charcoal is ineffective.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

36. You must consider abuse in
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Severe illness - past history of injuries - 18 months or less - inconstent story.

37. Management of septicaemia shock

38. OSCE: how can i prevent accidents in my children
Neurotoxins - procagulants. Rhabdomyolysins.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
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
Collar and cuff. Check integrity of nerve.

39. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
Croup.
Aspiration pneumonia even if intubated.
Rash bronchospasm and hypotension.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

40. Which is better - activated charcoal or gastric lavage.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Cyanosis and irregular respiratory effort
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

41. Management of near drowning.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Skin or vascular compromise
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. Salicylates
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Calcium chloride
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Give steroids for management of serum sickness. Must do coagulation screen!!!

43. Adenosine
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

44. How may you detect semen?
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.
Flurescence in ultraviolet light.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

45. Ethylene glycol
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Croup.
'I WOULD CALL POISON HOTLINE'.
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.

46. Acetaminophen
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
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
'I WOULD CALL POISON HOTLINE'.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

47. What are the special features that must be done to correct haemorrhagic shock.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

48. Anticholinergics
IM adrenaline: vasopressor and bronchodilator.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
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 delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

49. Sodium Bicarbonate
It can cause fatal bronchioloitis obliterans
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.

50. Organophosphates
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
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 decreased cholinesterase activity.