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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 evidence should a doctor give about parental neglect
Objective signs of growth - tidiness - weight -
Calcium chloride
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

2. Indications of non-accidental injury
Skin or vascular compromise
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
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.

3. Ingesting Petrol. Cx?
Aspiration Pneumonia
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Croup.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

4. Salicylates
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Digoxin Fab
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Objective signs of growth - tidiness - weight -

5. What are the early symptoms of paracetamol overdose?
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Croup.
Nausea vomiting and anorexia.

6. Which is better - activated charcoal or gastric lavage.
CHARCOAL! except for lithium - iron - alcohol - lead.
Flurescence in ultraviolet light.
Aspiration Pneumonia
Lead poisoning is defined as a serum level greater than ___ ug/dL.

7. Tricyclic antidepressants
Digoxin Fab
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 treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Skin or vascular compromise

8. Acetaminophen
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
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 -
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 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.

9. Opiates
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Antidote is naloxone.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Causes BAD constipation. Upsets fluid and electrolyte balance.

10. Signs of abuse from the history
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Notify if abuse CONSIDERED. CONSIDERED.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

11. What is the most appropriate examination in a child with suspected lead ingestion?
Normally treated with sling alone. Seek advice.
Neurosurgery if trauma. Give mannitol.
Abdo XRAY!!!! do it!
Antidote is deferoxamine chelation. Charcoal is ineffective.

12. What are the three features of anaphylaxis
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
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
Aspiration pneumonia even if intubated.
... blood sugars for hypoglycaemia

13. Lidocaine
Aspiration Pneumonia
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
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
Skin or vascular compromise

14. What else is in the management of snake bite?
Flurescence in ultraviolet light.
Digoxin Fab
Give steroids for management of serum sickness. Must do coagulation screen!!!
CHARCOAL! except for lithium - iron - alcohol - lead.

15. Benzodiazepine overdose antidote
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Flumazenil
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

16. Mx of snake bit
Flurescence in ultraviolet light.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
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.
Flumazenil

17. When and how would you do whole bowel irrigation?
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Neurotoxins - procagulants. Rhabdomyolysins.
Rash bronchospasm and hypotension.

18. What is the most important investigation in suspected alcohol poisoning in young person?
Collar and cuff. Check integrity of nerve.
Blood glucose level for hypoglycaemia!!
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Causes BAD constipation. Upsets fluid and electrolyte balance.

19. Calcium gluconate
Stomach pumping.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
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
Calcium chloride

20. Theophylline
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
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
Notify if abuse CONSIDERED. CONSIDERED.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.

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

22. Undisplaced radial shaft fracture
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Collar and cuff. Check integrity of nerve.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Intubate - tracheostromy or nebulized adrenaline.

23. Opiates
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Nausea vomiting and anorexia.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.

24. Adenosine
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Neurotoxins - procagulants. Rhabdomyolysins.
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
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.

25. Calcium channel blocker overdose antidote
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Calcium chloride
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Antidote is deferoxamine chelation. Charcoal is ineffective.

26. What is an important point to note about anaphylaxis?
Sling for 3 weeks - fracture clinic at 7 days.
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.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
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 -

27. What is a side effect of charcoal?
Normally treated with sling alone. Seek advice.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.

28. 20
Flurescence in ultraviolet light.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

29. Sympathomimetics
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
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.

30. What happens if charcoal is aspirated?
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
It can cause fatal bronchioloitis obliterans
Release NEUROTOXINS both have antivenom

31. When is gastric lavage indicated and contraindicated?
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
CHARCOAL! except for lithium - iron - alcohol - lead.
Aspiration pneumonia even if intubated.

32. Epinephrine
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Aspiration pneumonia even if intubated.
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.

33. Ethanol
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Munchausen's by proxy
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

34. Displaced surgical neck of humerous
Glucagon prefered - otherwise massive dose of adrenaline.
... blood sugars for hypoglycaemia
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Normally treated with sling alone. Seek advice.

35. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
Aspiration pneumonia even if intubated.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Ceftriaxone
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

36. Ethylene glycol
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Munchausen's by proxy
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Nausea vomiting and anorexia.

37. Ibuprofen
Ceftriaxone
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Antidote is deferoxamine chelation. Charcoal is ineffective.
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

38. 45; 70
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) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Flumazenil
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

39. Organophosphates
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
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.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

40. OSCE: What are the five princples of discharging a patient with a fracture?
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 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.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Notify if abuse CONSIDERED. CONSIDERED.

41. Iron
Antidote is deferoxamine chelation. Charcoal is ineffective.
Flurescence in ultraviolet light.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Give IM adrenaline - steroids - salbutamol - antihistamine.

42. Management of near drowning.
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
Collar and cuff. Check integrity of nerve.
Release NEUROTOXINS both have antivenom
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

43. Atropine
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Discobalt edetate
Ceftriaxone

44. When is reduction required in fracture?
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Skin or vascular compromise
Collar and cuff. Check integrity of nerve.
Immobilize with plaster slab

45. Funnel web and red back
Croup.
Release NEUROTOXINS both have antivenom
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
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.

46. Sodium Bicarbonate
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Flurescence in ultraviolet light.

47. Mx of critical asthma
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Aspiration Pneumonia
Give IM adrenaline - steroids - salbutamol - antihistamine.
Discobalt edetate

48. Carbon monoxide
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
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
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Sling for 3 weeks - fracture clinic at 7 days.

49. How may you detect semen?
Notify if abuse CONSIDERED. CONSIDERED.
Flurescence in ultraviolet light.
Release NEUROTOXINS both have antivenom
Croup.

50. Middle Clavicle fracture management?
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Flurescence in ultraviolet light.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.