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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. Management of near drowning.
Flurescence in ultraviolet light.
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
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

2. Anticholinergics
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Cyanosis and irregular respiratory effort
Lead poisoning is defined as a serum level greater than ___ ug/dL.
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

3. Mx of critical asthma
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Normally treated with sling alone. Seek advice.
Flurescence in ultraviolet light.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

4. Iron
Flurescence in ultraviolet light.
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.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

5. How may you detect semen?
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Flurescence in ultraviolet light.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

6. What is the most common caUse of acute laryngeal obstruction?
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Croup.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Antidote is naloxone.

7. Cyanide
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
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.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Discobalt edetate

8. You must consider abuse in
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Calcium chloride
Antidote is deferoxamine chelation. Charcoal is ineffective.
Severe illness - past history of injuries - 18 months or less - inconstent story.

9. When and how would you do whole bowel irrigation?
'I WOULD CALL POISON HOTLINE'.
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
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)

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

11. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
Aspiration pneumonia even if intubated.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
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

12. Signs of abuse from the history
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Collar and cuff. Check integrity of nerve.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Poisoning causes decreased cholinesterase activity.

13. Methanol
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
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
Aspiration pneumonia even if intubated.
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

14. Mx of petroleum overdose
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Causes BAD constipation. Upsets fluid and electrolyte balance.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

15. Iron
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Aspiration pneumonia even if intubated.
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 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

16. Opiates
Antidote is naloxone.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Notify if abuse CONSIDERED. CONSIDERED.

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

18. What are the terminal signs of acute laryngeal obstruction?
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.
Cyanosis and irregular respiratory effort
Munchausen's by proxy
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

19. What is the first line investigation in a young child who has consumed alcohol?
Release NEUROTOXINS both have antivenom
CHARCOAL! except for lithium - iron - alcohol - lead.
... blood sugars for hypoglycaemia
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

20. Oedema causing laryngeal obstruction?
Poisoning causes decreased cholinesterase activity.
Discobalt edetate
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.
Intubate - tracheostromy or nebulized adrenaline.

21. Tricyclic antidepressants
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
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

22. 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.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.

23. What are the side effects of N-acety-p-benzoquinine?
Neurotoxins - procagulants. Rhabdomyolysins.
Notify if abuse CONSIDERED. CONSIDERED.
Rash bronchospasm and hypotension.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

24. Carbon monoxide
Give steroids for management of serum sickness. Must do coagulation screen!!!
Abdo XRAY!!!! do it!
Collar and cuff. Check integrity of nerve.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

25. What are the early symptoms of paracetamol overdose?
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Nausea vomiting and anorexia.
Immobilize with plaster slab

26. Displaced surgical neck of humerous
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Digoxin Fab
Normally treated with sling alone. Seek advice.
Esmolol

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

28. Sodium Bicarbonate
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.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Discobalt edetate
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

29. Procainamide
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.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
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.

30. Atropine
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
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 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.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

31. Sympathomimetics
Neurosurgery if trauma. Give mannitol.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Neurotoxins - procagulants. Rhabdomyolysins.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

32. OSCE: What are the five princples of discharging a patient with a fracture?
Sling for 3 weeks - fracture clinic at 7 days.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.

33. Middle Clavicle fracture management?
Causes BAD constipation. Upsets fluid and electrolyte balance.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Rash bronchospasm and hypotension.
... blood sugars for hypoglycaemia

34. Opiates
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
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.
Ceftriaxone

35. What is the most appropriate examination in a child with suspected lead ingestion?
Nausea vomiting and anorexia.
Digoxin Fab
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Abdo XRAY!!!! do it!

36. Salicylates
Class of drugs encompassing decongestants - amphetamines - cocaine.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Abdo XRAY!!!! do it!

37. What psychiatric disease defined as childabuse?

38. What are the other treatments for anaphylaxis?
Give IM adrenaline - steroids - salbutamol - antihistamine.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
... blood sugars for hypoglycaemia
Antidote is naloxone.

39. What is the most important investigation in suspected alcohol poisoning in young person?
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Blood glucose level for hypoglycaemia!!
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

40. Indications of non-accidental injury
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Antidote is naloxone.
Neurosurgery if trauma. Give mannitol.

41. What is a side effect of charcoal?
Esmolol
Causes BAD constipation. Upsets fluid and electrolyte balance.
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.
Severe illness - past history of injuries - 18 months or less - inconstent story.

42. Lead
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Neurotoxins - procagulants. Rhabdomyolysins.

43. Calcium channel blocker overdose antidote
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Flumazenil
Give IM adrenaline - steroids - salbutamol - antihistamine.
Calcium chloride

44. OSCE: how can i prevent accidents in my children
Objective signs of growth - tidiness - weight -
Blood glucose level for hypoglycaemia!!
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
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

45. Ethanol
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Intubate - tracheostromy or nebulized adrenaline.
Glucagon prefered - otherwise massive dose of adrenaline.

46. How do snake bites damage?
Aspiration pneumonia even if intubated.
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 -
Release NEUROTOXINS both have antivenom
Neurotoxins - procagulants. Rhabdomyolysins.

47. Calcium gluconate
Bone scan for occult fracture
Give IM adrenaline - steroids - salbutamol - antihistamine.
Normally treated with sling alone. Seek advice.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

48. What evidence should a doctor give about parental neglect
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Objective signs of growth - tidiness - weight -
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
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.

49. What happens if charcoal is aspirated?
It can cause fatal bronchioloitis obliterans
Objective signs of growth - tidiness - weight -
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

50. What else is in the management of snake bite?
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.