Test your basic knowledge |

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. Salicylates
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.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
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.
Skin or vascular compromise

2. Mx of snake bit
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.
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.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.

3. Opiates
Class of drugs encompassing decongestants - amphetamines - cocaine.
Neurotoxins - procagulants. Rhabdomyolysins.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

4. When is gastric lavage indicated and contraindicated?
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.

5. What happens if charcoal is aspirated?
Blood glucose level for hypoglycaemia!!
... blood sugars for hypoglycaemia
Esmolol
It can cause fatal bronchioloitis obliterans

6. Management of septicaemia shock

7. What evidence should a doctor give about parental neglect
Objective signs of growth - tidiness - weight -
Notify if abuse CONSIDERED. CONSIDERED.
Aspiration Pneumonia
Antidote is deferoxamine chelation. Charcoal is ineffective.

8. Legal requirement in childabuse
Notify if abuse CONSIDERED. CONSIDERED.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
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

9. When and how would you do whole bowel irrigation?
Cyanosis and irregular respiratory effort
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
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Neurotoxins - procagulants. Rhabdomyolysins.

10. Salicylates
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Blood glucose level for hypoglycaemia!!
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

11. What is the most appropriate examination in a child with suspected lead ingestion?
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Abdo XRAY!!!! do it!
Digoxin Fab
It can cause fatal bronchioloitis obliterans

12. Ethanol
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Poisoning causes decreased cholinesterase activity.
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.

13. Beta-blocker overdose antidote
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Cyanosis and irregular respiratory effort
Glucagon prefered - otherwise massive dose of adrenaline.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

14. Amiodarone
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) 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
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

15. Ethylene glycol
Flurescence in ultraviolet light.
Croup.
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.
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.

16. Carbon monoxide
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Aspiration pneumonia even if intubated.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

17. 20
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Antidote is naloxone.
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.

18. Undisplaced surgical neck of humerous?
Objective signs of growth - tidiness - weight -
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
Sling for 3 weeks - fracture clinic at 7 days.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

19. OSCE: What are the five princples of discharging a patient with a fracture?
... blood sugars for hypoglycaemia
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.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

20. Carbon monoxide
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Abdo XRAY!!!! do it!
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Causes BAD constipation. Upsets fluid and electrolyte balance.

21. Calcium channel blocker overdose antidote
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Calcium chloride
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

22. You must consider abuse in
Neurosurgery if trauma. Give mannitol.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Flumazenil
Immobilize with plaster slab

23. Methanol
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Digoxin Fab

24. Oedema causing laryngeal obstruction?
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Intubate - tracheostromy or nebulized adrenaline.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)

25. Ibuprofen
Causes BAD constipation. Upsets fluid and electrolyte balance.
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
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.

26. What is one of the technicalities of childabuse.
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.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Antidote is naloxone.
It can cause fatal bronchioloitis obliterans

27. Indications of non-accidental injury
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
IM adrenaline: vasopressor and bronchodilator.
Give steroids for management of serum sickness. Must do coagulation screen!!!

28. Signs of psychological maltreatment?
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 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.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
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.

29. Sympathomimetics
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Normally treated with sling alone. Seek advice.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
CHARCOAL! except for lithium - iron - alcohol - lead.

30. Amphetamine antidote
Croup.
Esmolol
Neurotoxins - procagulants. Rhabdomyolysins.
Antidote is deferoxamine chelation. Charcoal is ineffective.

31. What are the three features of anaphylaxis
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
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.
Lead poisoning is defined as a serum level greater than ___ ug/dL.

32. What is an important point to note about anaphylaxis?
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
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 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.
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 -

33. Middle Clavicle fracture management?
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

34. What is the general management of poisoning?
Antidote is naloxone.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Bone scan for occult fracture
Skin or vascular compromise

35. Mx severe croup
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 lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Flumazenil
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

36. What is gastric lavage?
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Stomach pumping.
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.

37. Ethylene glycol
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
... blood sugars for hypoglycaemia
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
IM adrenaline: vasopressor and bronchodilator.

38. What is the most common caUse of acute laryngeal obstruction?
Croup.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
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.

39. What is the most important investigation in suspected alcohol poisoning in young person?
Blood glucose level for hypoglycaemia!!
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Give steroids for management of serum sickness. Must do coagulation screen!!!

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

41. Undisplaced radial shaft fracture
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 lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Collar and cuff. Check integrity of nerve.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.

42. What else is in the management of snake bite?
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Sling for 3 weeks - fracture clinic at 7 days.
It can cause fatal bronchioloitis obliterans
Give steroids for management of serum sickness. Must do coagulation screen!!!

43. Methanol
Aspiration Pneumonia
Stomach pumping.
Class of drugs encompassing decongestants - amphetamines - cocaine.
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.

44. What are the other treatments for anaphylaxis?
Give IM adrenaline - steroids - salbutamol - antihistamine.
Flumazenil
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

45. A child has swallowed a battery. Mx
Severe illness - past history of injuries - 18 months or less - inconstent story.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Croup.

46. Anticholinergics
Flurescence in ultraviolet light.
'I WOULD CALL POISON HOTLINE'.
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 nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

47. 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.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Aspiration pneumonia even if intubated.
Rash bronchospasm and hypotension.

48. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Aspiration pneumonia even if intubated.
Before a child can be examined for child abuse - a parent or legal guardian must give consent

49. What is the first line investigation in a young child who has consumed alcohol?
Munchausen's by proxy
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
... blood sugars for hypoglycaemia
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)

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