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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 is the antibiotic for Epiglottitis?
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Ceftriaxone
... blood sugars for hypoglycaemia

2. When and how would you do whole bowel irrigation?
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Croup.
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

3. Which is better - activated charcoal or gastric lavage.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
CHARCOAL! except for lithium - iron - alcohol - lead.
It can cause fatal bronchioloitis obliterans

4. Ingesting Petrol. Cx?
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Aspiration Pneumonia
'I WOULD CALL POISON HOTLINE'.

5. Opiates
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Antidote is naloxone.
'I WOULD CALL POISON HOTLINE'.
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. What is the most appropriate examination in a child with suspected lead ingestion?
'I WOULD CALL POISON HOTLINE'.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Abdo XRAY!!!! do it!
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

7. Hydrocarbons
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
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.

8. Acetaminophen
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
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 decreased cholinesterase activity.
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.

9. What must you do before sending fracture to radiology?
Blood glucose level for hypoglycaemia!!
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Immobilize with plaster slab
Lead poisoning is defined as a serum level greater than ___ ug/dL.

10. What is the most important investigation in suspected alcohol poisoning in young person?
Discobalt edetate
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.
Blood glucose level for hypoglycaemia!!
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

11. Undisplaced surgical neck of humerous?
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Sling for 3 weeks - fracture clinic at 7 days.
Poisoning causes decreased cholinesterase activity.
Blood glucose level for hypoglycaemia!!

12. Anticholinergics
Antidotes are atropine sulfate and pralidoxime chloride.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
CHARCOAL! except for lithium - iron - alcohol - lead.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

13. Adenosine
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
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 -
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Rash bronchospasm and hypotension.

14. Displaced surgical neck of humerous
Digoxin Fab
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
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.
Normally treated with sling alone. Seek advice.

15. 20
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
It can cause fatal bronchioloitis obliterans
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

16. Sympathomimetics
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 drugs encompassing decongestants - amphetamines - cocaine.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

17. What are the side effects of N-acety-p-benzoquinine?
Rash bronchospasm and hypotension.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Esmolol

18. Legal requirement in childabuse
Immobilize with plaster slab
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.
Notify if abuse CONSIDERED. CONSIDERED.
Bone scan for occult fracture

19. What is the most important treatment for anaphylaxis
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Nausea vomiting and anorexia.
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.
IM adrenaline: vasopressor and bronchodilator.

20. Opiates
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
Stomach pumping.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

21. What psychiatric disease defined as childabuse?

22. Lead
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Give steroids for management of serum sickness. Must do coagulation screen!!!

23. Undisplaced radial shaft fracture
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.
Collar and cuff. Check integrity of nerve.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Antidote is deferoxamine chelation. Charcoal is ineffective.

24. Iron
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
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
Nausea vomiting and anorexia.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

25. Oedema causing laryngeal obstruction?
Intubate - tracheostromy or nebulized adrenaline.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

26. Salicylates
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Flumazenil
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. Atropine
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

28. Ethanol
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
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.

29. What are the terminal signs of acute laryngeal obstruction?
Ceftriaxone
Give IM adrenaline - steroids - salbutamol - antihistamine.
Munchausen's by proxy
Cyanosis and irregular respiratory effort

30. Lidocaine
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Aspiration pneumonia even if intubated.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.

31. Mx severe croup
Causes BAD constipation. Upsets fluid and electrolyte balance.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Rash bronchospasm and hypotension.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

32. A child has swallowed a battery. Mx
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Notify if abuse CONSIDERED. CONSIDERED.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.

33. Mx of petroleum overdose
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Class of drugs encompassing decongestants - amphetamines - cocaine.
Rash bronchospasm and hypotension.
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.

34. Management of near drowning.
Flumazenil
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.
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
Bone scan for occult fracture

35. Organophosphates
Poisoning causes decreased cholinesterase activity.
Abdo XRAY!!!! do it!
Stomach pumping.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

36. You must consider abuse in
Severe illness - past history of injuries - 18 months or less - inconstent story.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

37. Mx of critical asthma
Bone scan for occult fracture
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
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.

38. Ethylene glycol
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
Causes BAD constipation. Upsets fluid and electrolyte balance.
Neurotoxins - procagulants. Rhabdomyolysins.
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.

39. Tricyclic antidepressants overdose
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.

40. What is the first line investigation in a young child who has consumed alcohol?
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
CHARCOAL! except for lithium - iron - alcohol - lead.
Objective signs of growth - tidiness - weight -
... blood sugars for hypoglycaemia

41. Carbon monoxide
Normally treated with sling alone. Seek advice.
Esmolol
CHARCOAL! except for lithium - iron - alcohol - lead.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.

42. OSCE: how can i prevent accidents in my children
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
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
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Antidote is deferoxamine chelation. Charcoal is ineffective.

43. Management of septicaemia shock

44. What are the other treatments for anaphylaxis?
Give IM adrenaline - steroids - salbutamol - antihistamine.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Digoxin Fab

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

46. Acetaminophen
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Notify if abuse CONSIDERED. CONSIDERED.
Neurosurgery if trauma. Give mannitol.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

47. What is a side effect of charcoal?
Objective signs of growth - tidiness - weight -
Causes BAD constipation. Upsets fluid and electrolyte balance.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.

48. Cyanide
Discobalt edetate
Release NEUROTOXINS both have antivenom
Neurosurgery if trauma. Give mannitol.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.

49. What evidence should a doctor give about parental neglect
Abdo XRAY!!!! do it!
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
Objective signs of growth - tidiness - weight -
Discobalt edetate

50. What is the most common caUse of acute laryngeal obstruction?
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Croup.