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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 an important point to note about anaphylaxis?
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 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.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

2. What is one of the technicalities of childabuse.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
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 -
Give IM adrenaline - steroids - salbutamol - antihistamine.
Rash bronchospasm and hypotension.

3. Acetaminophen
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.
It can cause fatal bronchioloitis obliterans
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

4. 45; 70
Digoxin Fab
Aspiration Pneumonia
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 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.

5. You must consider abuse in
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
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Severe illness - past history of injuries - 18 months or less - inconstent story.

6. Signs of psychological maltreatment?
Bone scan for occult fracture
Collar and cuff. Check integrity of nerve.
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.
Esmolol

7. Indications of non-accidental injury
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.
Neurotoxins - procagulants. Rhabdomyolysins.
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

8. A child has swallowed a battery. Mx
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Aspiration Pneumonia

9. Amphetamine antidote
Esmolol
Antidote is naloxone.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

10. Theophylline
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
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 -
Objective signs of growth - tidiness - weight -
Poisoning causes decreased cholinesterase activity.

11. Mx raised intracranial pressure.
Neurosurgery if trauma. Give mannitol.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.

12. What is the antibiotic for Epiglottitis?
Ceftriaxone
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.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
CHARCOAL! except for lithium - iron - alcohol - lead.

13. Organophosphates
Intubate - tracheostromy or nebulized adrenaline.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
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.

14. Digoxin antedote
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Aspiration pneumonia even if intubated.
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
Digoxin Fab

15. Ethanol
Antidotes are atropine sulfate and pralidoxime chloride.
IM adrenaline: vasopressor and bronchodilator.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

16. Methanol
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.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Notify if abuse CONSIDERED. CONSIDERED.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

17. When and how would you do whole bowel irrigation?
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Ceftriaxone
It can cause fatal bronchioloitis obliterans
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.

18. Ingesting Petrol. Cx?
Objective signs of growth - tidiness - weight -
Aspiration Pneumonia
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.
Skin or vascular compromise

19. What else is in the management of snake bite?
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Intubate - tracheostromy or nebulized adrenaline.
Give steroids for management of serum sickness. Must do coagulation screen!!!

20. what makes you suspicious of non-accidental injury.
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.
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.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
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.

21. Undisplaced surgical neck of humerous?
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Sling for 3 weeks - fracture clinic at 7 days.
Abdo XRAY!!!! do it!
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.

22. Iron
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
Normally treated with sling alone. Seek advice.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Aspiration Pneumonia

23. How may you detect semen?
Glucagon prefered - otherwise massive dose of adrenaline.
Flurescence in ultraviolet light.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Give IM adrenaline - steroids - salbutamol - antihistamine.

24. Anticholinergics
Normally treated with sling alone. Seek advice.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Sling for 3 weeks - fracture clinic at 7 days.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

25. What is a side effect of charcoal?
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Blood glucose level for hypoglycaemia!!
Nausea vomiting and anorexia.
Causes BAD constipation. Upsets fluid and electrolyte balance.

26. Management of near drowning.
Poisoning causes decreased cholinesterase activity.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) 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
Stomach pumping.

27. What are the side effects of N-acety-p-benzoquinine?
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.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.

28. Management of septicaemia shock

29. Tricyclic antidepressants
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.
Antidote is naloxone.
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

30. What must you do before sending fracture to radiology?
Immobilize with plaster slab
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
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.

31. What are the terminal signs of acute laryngeal obstruction?
Notify if abuse CONSIDERED. CONSIDERED.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Cyanosis and irregular respiratory effort
Discobalt edetate

32. When is reduction required in fracture?
Abdo XRAY!!!! do it!
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Flumazenil
Skin or vascular compromise

33. OSCE: how can i prevent accidents in my children
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
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
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
'I WOULD CALL POISON HOTLINE'.

34. Carbon monoxide
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.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Croup.

35. Mx of petroleum overdose
Flurescence in ultraviolet light.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

36. What is the most important treatment for anaphylaxis
CHARCOAL! except for lithium - iron - alcohol - lead.
'I WOULD CALL POISON HOTLINE'.
IM adrenaline: vasopressor and bronchodilator.
Lead poisoning is defined as a serum level greater than ___ ug/dL.

37. Funnel web and red back
Antidote is naloxone.
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 -
Release NEUROTOXINS both have antivenom
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

38. Undisplaced radial shaft fracture
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Collar and cuff. Check integrity of nerve.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.

39. Legal requirement in childabuse
Digoxin Fab
Aspiration Pneumonia
Notify if abuse CONSIDERED. CONSIDERED.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

40. Ibuprofen
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
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 tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

41. Oedema causing laryngeal obstruction?
Antidote is deferoxamine chelation. Charcoal is ineffective.
... blood sugars for hypoglycaemia
Intubate - tracheostromy or nebulized adrenaline.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

42. Salicylates
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Rash bronchospasm and hypotension.
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.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

43. What happens if charcoal is aspirated?
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
IM adrenaline: vasopressor and bronchodilator.
It can cause fatal bronchioloitis obliterans
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.

44. Sodium Bicarbonate
Notify if abuse CONSIDERED. CONSIDERED.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

45. What is the most common caUse of acute laryngeal obstruction?
Croup.
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.
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.

46. What psychiatric disease defined as childabuse?

47. How do snake bites damage?
Give IM adrenaline - steroids - salbutamol - antihistamine.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Neurotoxins - procagulants. Rhabdomyolysins.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.

48. Carbon monoxide
Severe illness - past history of injuries - 18 months or less - inconstent story.
Abdo XRAY!!!! do it!
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. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
Munchausen's by proxy
Aspiration pneumonia even if intubated.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Give IM adrenaline - steroids - salbutamol - antihistamine.

50. Atropine
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Blood glucose level for hypoglycaemia!!
Antidote is naloxone.