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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. 20
Digoxin Fab
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.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Lead poisoning is defined as a serum level greater than ___ ug/dL.

2. Sympathomimetics
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Aspiration pneumonia even if intubated.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
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.

3. A child has swallowed a battery. Mx
Class of drugs encompassing decongestants - amphetamines - cocaine.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Neurotoxins - procagulants. Rhabdomyolysins.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

4. Methanol
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Abdo XRAY!!!! do it!

5. What happens if charcoal is aspirated?
Give IM adrenaline - steroids - salbutamol - antihistamine.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
It can cause fatal bronchioloitis obliterans
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.

6. Which is better - activated charcoal or gastric lavage.
... blood sugars for hypoglycaemia
CHARCOAL! except for lithium - iron - alcohol - lead.
Collar and cuff. Check integrity of nerve.
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

7. What is one of the technicalities of childabuse.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
'I WOULD CALL POISON HOTLINE'.
Release NEUROTOXINS both have antivenom

8. Carbon monoxide
Blood glucose level for hypoglycaemia!!
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
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.
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 -

9. 45; 70
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
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
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

10. Amphetamine antidote
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)
Esmolol
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

11. What is a side effect of charcoal?
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Abdo XRAY!!!! do it!
Causes BAD constipation. Upsets fluid and electrolyte balance.
Notify if abuse CONSIDERED. CONSIDERED.

12. Opiates
Neurosurgery if trauma. Give mannitol.
Notify if abuse CONSIDERED. CONSIDERED.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Flumazenil

13. What is the most common caUse of acute laryngeal obstruction?
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Croup.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

14. 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.
Ceftriaxone
Esmolol
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

15. What is the antibiotic for Epiglottitis?
Ceftriaxone
Release NEUROTOXINS both have antivenom
Abdo XRAY!!!! do it!
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

16. Carbon monoxide
Ceftriaxone
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
IM adrenaline: vasopressor and bronchodilator.

17. Middle Clavicle fracture management?
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
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
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Notify if abuse CONSIDERED. CONSIDERED.

18. Iron
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.
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 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

19. Organophosphates
Flumazenil
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Poisoning causes decreased cholinesterase activity.
Munchausen's by proxy

20. What are the special features that must be done to correct haemorrhagic shock.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
CHARCOAL! except for lithium - iron - alcohol - lead.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

21. Mx of petroleum overdose
Digoxin Fab
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

22. Funnel web and red back
IM adrenaline: vasopressor and bronchodilator.
Aspiration Pneumonia
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Release NEUROTOXINS both have antivenom

23. When and how would you do whole bowel irrigation?
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Ceftriaxone
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Rash bronchospasm and hypotension.

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

25. Iron
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Antidote is deferoxamine chelation. Charcoal is ineffective.

26. Ingesting Petrol. Cx?
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Rash bronchospasm and hypotension.
Aspiration Pneumonia
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

27. What are the terminal signs of acute laryngeal obstruction?
Cyanosis and irregular respiratory effort
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.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

28. What else is in the management of snake bite?
It can cause fatal bronchioloitis obliterans
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.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

29. Benzodiazepine overdose antidote
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
Antidote is deferoxamine chelation. Charcoal is ineffective.
Flumazenil
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.

30. When is gastric lavage indicated and contraindicated?
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.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Collar and cuff. Check integrity of nerve.

31. What is gastric lavage?
Flurescence in ultraviolet light.
Stomach pumping.
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.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

32. Mx raised intracranial pressure.
Esmolol
Neurosurgery if trauma. Give mannitol.
Immobilize with plaster slab
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.

33. What evidence should a doctor give about parental neglect
Objective signs of growth - tidiness - weight -
CHARCOAL! except for lithium - iron - alcohol - lead.
Skin or vascular compromise
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

34. Theophylline
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
... blood sugars for hypoglycaemia
Neurosurgery if trauma. Give mannitol.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.

35. Legal requirement in childabuse
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
Notify if abuse CONSIDERED. CONSIDERED.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.

36. Beta-blocker overdose antidote
CHARCOAL! except for lithium - iron - alcohol - lead.
Intubate - tracheostromy or nebulized adrenaline.
Glucagon prefered - otherwise massive dose of adrenaline.
Lead poisoning is defined as a serum level greater than ___ ug/dL.

37. Carbon monoxide
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Ceftriaxone
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

38. Signs of psychological maltreatment?
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
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.

39. What are the three features of anaphylaxis
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Give IM adrenaline - steroids - salbutamol - antihistamine.
Antidote is naloxone.

40. How do snake bites damage?
Neurotoxins - procagulants. Rhabdomyolysins.
Flurescence in ultraviolet light.
Ceftriaxone
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

41. what makes you suspicious of non-accidental injury.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Severe illness - past history of injuries - 18 months or less - inconstent story.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Cyanosis and irregular respiratory effort

42. Indications of non-accidental injury
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.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Causes BAD constipation. Upsets fluid and electrolyte balance.

43. Anticholinergics
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
It can cause fatal bronchioloitis obliterans
Stomach pumping.

44. You must consider abuse in
Severe illness - past history of injuries - 18 months or less - inconstent story.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

45. Undisplaced radial shaft fracture
Discobalt edetate
Collar and cuff. Check integrity of nerve.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy

46. What are the side effects of N-acety-p-benzoquinine?
Class of drugs encompassing decongestants - amphetamines - cocaine.
Rash bronchospasm and hypotension.
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
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

47. Anticholinergics
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

48. Amiodarone
Nausea vomiting and anorexia.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
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.
Poisoning causes decreased cholinesterase activity.

49. What are the early symptoms of paracetamol overdose?
Nausea vomiting and anorexia.
Blood glucose level for hypoglycaemia!!
Poisoning causes decreased cholinesterase activity.
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. What is the most important treatment for anaphylaxis
Neurotoxins - procagulants. Rhabdomyolysins.
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.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
IM adrenaline: vasopressor and bronchodilator.