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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. Calcium channel blocker overdose antidote
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.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Calcium chloride
Class of drugs encompassing decongestants - amphetamines - cocaine.

2. What is the most common caUse of acute laryngeal obstruction?
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Croup.
Normally treated with sling alone. Seek advice.

3. Opiates
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Antidote is naloxone.
It can cause fatal bronchioloitis obliterans
CHARCOAL! except for lithium - iron - alcohol - lead.

4. Amiodarone
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
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.
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.

5. Signs of psychological maltreatment?
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.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Give IM adrenaline - steroids - salbutamol - antihistamine.

6. What are the other treatments for anaphylaxis?
Bone scan for occult fracture
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Skin or vascular compromise
Give IM adrenaline - steroids - salbutamol - antihistamine.

7. Mx severe croup
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
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.
Give IM adrenaline - steroids - salbutamol - antihistamine.

8. What is an important point to note about anaphylaxis?
Antidote is naloxone.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
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 -

9. Salicylates
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
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.
Aspiration Pneumonia
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy

10. Mx raised intracranial pressure.
Neurosurgery if trauma. Give mannitol.
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
CHARCOAL! except for lithium - iron - alcohol - lead.
Immobilize with plaster slab

11. Procainamide
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
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.
Poisoning causes decreased cholinesterase activity.

12. Cyanide
Discobalt edetate
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
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
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

13. OSCE: What are the five princples of discharging a patient with a fracture?
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Croup.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

14. Middle Clavicle fracture management?
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Stomach pumping.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Sling for 3 weeks - fracture clinic at 7 days.

15. What are the side effects of N-acety-p-benzoquinine?
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Rash bronchospasm and hypotension.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Neurotoxins - procagulants. Rhabdomyolysins.

16. Oedema causing laryngeal obstruction?
Nausea vomiting and anorexia.
Intubate - tracheostromy or nebulized adrenaline.
Glucagon prefered - otherwise massive dose of adrenaline.
Lead poisoning is defined as a serum level greater than ___ ug/dL.

17. When is reduction required in fracture?
Antidote is naloxone.
Skin or vascular compromise
Croup.
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

18. Funnel web and red back
Rash bronchospasm and hypotension.
Release NEUROTOXINS both have antivenom
Discobalt edetate
Intubate - tracheostromy or nebulized adrenaline.

19. What is a side effect of charcoal?
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
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) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Causes BAD constipation. Upsets fluid and electrolyte balance.

20. Atropine
Esmolol
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

21. When is gastric lavage indicated and contraindicated?
Give steroids for management of serum sickness. Must do coagulation screen!!!
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

22. Mx of critical asthma
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Ceftriaxone
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 -
Class of drugs encompassing decongestants - amphetamines - cocaine.

23. Carbon monoxide
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.
Objective signs of growth - tidiness - weight -
... blood sugars for hypoglycaemia

24. 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
Poisoning causes decreased cholinesterase activity.
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.
Sling for 3 weeks - fracture clinic at 7 days.

25. Ethanol
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.
Aspiration pneumonia even if intubated.
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. What investigations should you do in suspected child abuse
Antidotes are atropine sulfate and pralidoxime chloride.
IM adrenaline: vasopressor and bronchodilator.
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
Bone scan for occult fracture

27. Sodium Bicarbonate
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Normally treated with sling alone. Seek advice.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

28. What is the first line investigation in a young child who has consumed alcohol?
Collar and cuff. Check integrity of nerve.
Glucagon prefered - otherwise massive dose of adrenaline.
... blood sugars for hypoglycaemia
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

29. Management of septicaemia shock

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30. 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
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Antidotes are atropine sulfate and pralidoxime chloride.
Munchausen's by proxy

31. What is the antibiotic for Epiglottitis?
Ceftriaxone
Neurosurgery if trauma. Give mannitol.
Sling for 3 weeks - fracture clinic at 7 days.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

32. Carbon monoxide
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
CHARCOAL! except for lithium - iron - alcohol - lead.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Give IM adrenaline - steroids - salbutamol - antihistamine.

33. Organophosphates
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.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
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.

34. How may you detect semen?
Flurescence in ultraviolet light.
Ceftriaxone
Calcium chloride
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.

35. Benzodiazepine overdose antidote
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
Objective signs of growth - tidiness - weight -
Calcium chloride
Flumazenil

36. Mx of petroleum overdose
Glucagon prefered - otherwise massive dose of adrenaline.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

37. Lead
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
Causes BAD constipation. Upsets fluid and electrolyte balance.
Ceftriaxone
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

38. Undisplaced surgical neck of humerous?
Rash bronchospasm and hypotension.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Sling for 3 weeks - fracture clinic at 7 days.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.

39. Displaced surgical neck of humerous
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Normally treated with sling alone. Seek advice.
Glucagon prefered - otherwise massive dose of adrenaline.

40. Management of near drowning.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
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
CHARCOAL! except for lithium - iron - alcohol - lead.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

41. Tricyclic antidepressants overdose
Croup.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Objective signs of growth - tidiness - weight -
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

42. Salicylates
Abdo XRAY!!!! do it!
Blood glucose level for hypoglycaemia!!
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

43. Methanol
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
It can cause fatal bronchioloitis obliterans
'I WOULD CALL POISON HOTLINE'.
Sling for 3 weeks - fracture clinic at 7 days.

44. Theophylline
Rash bronchospasm and hypotension.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Antidotes are atropine sulfate and pralidoxime chloride.

45. Organophosphates antidotes
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Antidotes are atropine sulfate and pralidoxime chloride.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
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

46. Acetaminophen
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.
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
Intubate - tracheostromy or nebulized adrenaline.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

47. Indications of non-accidental injury
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.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.

48. Carbon monoxide
Give IM adrenaline - steroids - salbutamol - antihistamine.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.

49. Iron
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
Esmolol
Antidote is deferoxamine chelation. Charcoal is ineffective.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

50. Organophosphates
Poisoning causes decreased cholinesterase activity.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
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.