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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. Ethanol
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.
Bone scan for occult fracture
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

2. Carbon monoxide
Collar and cuff. Check integrity of nerve.
Objective signs of growth - tidiness - weight -
Cyanosis and irregular respiratory effort
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.

3. Mx of critical asthma
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Abdo XRAY!!!! do it!
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Release NEUROTOXINS both have antivenom

4. Undisplaced surgical neck of humerous?
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Skin or vascular compromise
Sling for 3 weeks - fracture clinic at 7 days.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

5. Iron
Flumazenil
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
Abdo XRAY!!!! do it!
'I WOULD CALL POISON HOTLINE'.

6. Acetaminophen
Flurescence in ultraviolet light.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Neurosurgery if trauma. Give mannitol.

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

8. Salicylates
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Flurescence in ultraviolet light.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Collar and cuff. Check integrity of nerve.

9. Organophosphates antidotes
Antidotes are atropine sulfate and pralidoxime chloride.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
CHARCOAL! except for lithium - iron - alcohol - lead.
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

10. When is gastric lavage indicated and contraindicated?
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
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.

11. What are the side effects of N-acety-p-benzoquinine?
Rash bronchospasm and hypotension.
Flumazenil
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Discobalt edetate

12. What psychiatric disease defined as childabuse?

13. 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.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
... blood sugars for hypoglycaemia
Give IM adrenaline - steroids - salbutamol - antihistamine.

14. What is the most important treatment for anaphylaxis
IM adrenaline: vasopressor and bronchodilator.
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.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.

15. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
Aspiration pneumonia even if intubated.
Ceftriaxone
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
Objective signs of growth - tidiness - weight -

16. Sodium Bicarbonate
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
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.
Class of drugs encompassing decongestants - amphetamines - cocaine.

17. Displaced surgical neck of humerous
Normally treated with sling alone. Seek advice.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
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
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.

18. What is the most important investigation in suspected alcohol poisoning in young person?
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Blood glucose level for hypoglycaemia!!
Munchausen's by proxy

19. How may you detect semen?
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Collar and cuff. Check integrity of nerve.
Flurescence in ultraviolet light.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)

20. Indications of non-accidental injury
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

21. What is one of the technicalities of childabuse.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Blood glucose level for hypoglycaemia!!
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

22. What is a side effect of charcoal?
Intubate - tracheostromy or nebulized adrenaline.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

23. Hydrocarbons
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.
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 -
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

24. Management of near drowning.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
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.
Give steroids for management of serum sickness. Must do coagulation screen!!!
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

25. Organophosphates
Collar and cuff. Check integrity of nerve.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
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.

26. What must you do before sending fracture to radiology?
Immobilize with plaster slab
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Causes BAD constipation. Upsets fluid and electrolyte balance.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

27. Digoxin antedote
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Digoxin Fab
Flurescence in ultraviolet light.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

28. Lidocaine
Flurescence in ultraviolet light.
Cyanosis and irregular respiratory effort
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

29. What is the most common caUse of acute laryngeal obstruction?
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.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Croup.
Objective signs of growth - tidiness - weight -

30. Management of septicaemia shock

31. When and how would you do whole bowel irrigation?
Class of drugs encompassing decongestants - amphetamines - cocaine.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
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.

32. Benzodiazepine overdose antidote
Intubate - tracheostromy or nebulized adrenaline.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Flumazenil

33. Anticholinergics
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.
Stomach pumping.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Severe illness - past history of injuries - 18 months or less - inconstent story.

34. OSCE: how can i prevent accidents in my children
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
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
Give steroids for management of serum sickness. Must do coagulation screen!!!
Skin or vascular compromise

35. Atropine
Esmolol
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Munchausen's by proxy
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

36. what makes you suspicious of non-accidental injury.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Blood glucose level for hypoglycaemia!!
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
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.

37. Mx raised intracranial pressure.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Neurosurgery if trauma. Give mannitol.

38. Tricyclic antidepressants overdose
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.
Antidote is naloxone.
Antidotes are atropine sulfate and pralidoxime chloride.

39. Which is better - activated charcoal or gastric lavage.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
CHARCOAL! except for lithium - iron - alcohol - lead.
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.
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

40. What are the early symptoms of paracetamol overdose?
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Nausea vomiting and anorexia.
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.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.

41. OSCE: What are the five princples of discharging a patient with a fracture?
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.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Give IM adrenaline - steroids - salbutamol - antihistamine.

42. 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
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Stomach pumping.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

43. Ethylene glycol
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
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

44. Funnel web and red back
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 decreased cholinesterase activity.
Release NEUROTOXINS both have antivenom
Digoxin Fab

45. What is the general management of poisoning?
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

46. Legal requirement in childabuse
'I WOULD CALL POISON HOTLINE'.
Sling for 3 weeks - fracture clinic at 7 days.
Nausea vomiting and anorexia.
Notify if abuse CONSIDERED. CONSIDERED.

47. Procainamide
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.
Calcium chloride
Rash bronchospasm and hypotension.
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.

48. What are the three features of anaphylaxis
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Release NEUROTOXINS both have antivenom
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Flumazenil

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

50. Organophosphates
Poisoning causes decreased cholinesterase activity.
Glucagon prefered - otherwise massive dose of adrenaline.
'I WOULD CALL POISON HOTLINE'.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.