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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. What psychiatric disease defined as childabuse?

2. Signs of psychological maltreatment?
Collar and cuff. Check integrity of nerve.
Nausea vomiting and anorexia.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
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.

3. What is the most common caUse of acute laryngeal obstruction?
Croup.
Notify if abuse CONSIDERED. CONSIDERED.
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.

4. Calcium channel blocker overdose antidote
Calcium chloride
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

5. Middle Clavicle fracture management?
Skin or vascular compromise
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
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.

6. You must consider abuse in
Severe illness - past history of injuries - 18 months or less - inconstent story.
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.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Stomach pumping.

7. How may you detect semen?
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
Flurescence in ultraviolet light.
Sling for 3 weeks - fracture clinic at 7 days.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

8. Epinephrine
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.
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.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.

9. 45; 70
Glucagon prefered - otherwise massive dose of adrenaline.
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
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

10. Carbon monoxide
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Digoxin Fab
Bone scan for occult fracture
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.

11. What is the most appropriate examination in a child with suspected lead ingestion?
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.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Abdo XRAY!!!! do it!

12. How do snake bites damage?
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Aspiration pneumonia even if intubated.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Neurotoxins - procagulants. Rhabdomyolysins.

13. Salicylates
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Rash bronchospasm and hypotension.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
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.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Croup.

15. Mx of snake bit
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!!!
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.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.

16. Beta-blocker overdose antidote
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Glucagon prefered - otherwise massive dose of adrenaline.
Bone scan for occult fracture

17. Ethanol
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Objective signs of growth - tidiness - weight -
Rash bronchospasm and hypotension.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

18. Organophosphates
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Give steroids for management of serum sickness. Must do coagulation screen!!!
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 decreased cholinesterase activity.

19. What investigations should you do in suspected child abuse
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.
CHARCOAL! except for lithium - iron - alcohol - lead.
Intubate - tracheostromy or nebulized adrenaline.
Bone scan for occult fracture

20. What is the most important treatment for anaphylaxis
IM adrenaline: vasopressor and bronchodilator.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
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
'I WOULD CALL POISON HOTLINE'.

21. What must you do before sending fracture to radiology?
Immobilize with plaster slab
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
... blood sugars for hypoglycaemia
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.

22. Ethylene glycol
IM adrenaline: vasopressor and bronchodilator.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
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.

23. 20
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
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Notify if abuse CONSIDERED. CONSIDERED.
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.

24. What are the special features that must be done to correct haemorrhagic shock.
Aspiration Pneumonia
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

25. Iron
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
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

26. Signs of abuse from the history
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
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
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

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

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

29. What is the first line investigation in a young child who has consumed alcohol?
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
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.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
... blood sugars for hypoglycaemia

30. What is an important point to note about anaphylaxis?
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Aspiration Pneumonia
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 -

31. Sodium Bicarbonate
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.

32. Management of septicaemia shock

33. Amiodarone
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.
Aspiration pneumonia even if intubated.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

34. Mx of critical asthma
Calcium chloride
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
CHARCOAL! except for lithium - iron - alcohol - lead.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

35. Displaced surgical neck of humerous
Normally treated with sling alone. Seek advice.
CHARCOAL! except for lithium - iron - alcohol - lead.
Antidote is deferoxamine chelation. Charcoal is ineffective.
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

36. Atropine
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Poisoning causes decreased cholinesterase activity.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.

37. Iron
Antidote is deferoxamine chelation. Charcoal is ineffective.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
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
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

38. Digoxin antedote
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Digoxin Fab
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
CHARCOAL! except for lithium - iron - alcohol - lead.

39. What are the other treatments for anaphylaxis?
Immobilize with plaster slab
Give IM adrenaline - steroids - salbutamol - antihistamine.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Nausea vomiting and anorexia.

40. What is one of the technicalities of 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 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.
Glucagon prefered - otherwise massive dose of adrenaline.
Before a child can be examined for child abuse - a parent or legal guardian must give consent

41. What are the early symptoms of paracetamol overdose?
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
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
Nausea vomiting and anorexia.

42. Procainamide
Flurescence in ultraviolet light.
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.
Aspiration Pneumonia
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.

43. Lidocaine
... blood sugars for hypoglycaemia
Esmolol
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

44. Which is better - activated charcoal or gastric lavage.
Neurotoxins - procagulants. Rhabdomyolysins.
CHARCOAL! except for lithium - iron - alcohol - lead.
Munchausen's by proxy
Antidotes are atropine sulfate and pralidoxime chloride.

45. What are the three features of anaphylaxis
Causes BAD constipation. Upsets fluid and electrolyte balance.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
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.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

46. Tricyclic antidepressants overdose
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
Antidote is deferoxamine chelation. Charcoal is ineffective.
Calcium chloride
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

47. What evidence should a doctor give about parental neglect
Give IM adrenaline - steroids - salbutamol - antihistamine.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Objective signs of growth - tidiness - weight -

48. Mx of petroleum overdose
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Aspiration Pneumonia
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

49. OSCE: how can i prevent accidents in my children
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
Class of drugs encompassing decongestants - amphetamines - cocaine.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Give IM adrenaline - steroids - salbutamol - antihistamine.

50. Calcium gluconate
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Munchausen's by proxy
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.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.