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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. Ingesting Petrol. Cx?
Poisoning causes decreased cholinesterase activity.
Aspiration Pneumonia
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Discobalt edetate

2. What investigations should you do in suspected child abuse
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.
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
Bone scan for occult fracture

3. What psychiatric disease defined as childabuse?

4. 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
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Normally treated with sling alone. Seek advice.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

5. What is the most common caUse of acute laryngeal obstruction?
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Croup.
Digoxin Fab

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

7. Atropine
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

8. Epinephrine
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Intubate - tracheostromy or nebulized adrenaline.
Aspiration Pneumonia

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

10. Lead
Esmolol
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Neurotoxins - procagulants. Rhabdomyolysins.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

11. OSCE: What are the five princples of discharging a patient with a fracture?
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Poisoning causes decreased cholinesterase activity.
Nausea vomiting and anorexia.
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 -

12. Methanol
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 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.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Antidote is deferoxamine chelation. Charcoal is ineffective.

13. Organophosphates antidotes
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Neurotoxins - procagulants. Rhabdomyolysins.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Antidotes are atropine sulfate and pralidoxime chloride.

14. Salicylates
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
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.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
IM adrenaline: vasopressor and bronchodilator.

15. Anticholinergics
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Antidotes are atropine sulfate and pralidoxime chloride.

16. Acetaminophen
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Neurotoxins - procagulants. Rhabdomyolysins.

17. Management of near drowning.
Immobilize with plaster slab
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
Sling for 3 weeks - fracture clinic at 7 days.
Esmolol

18. Salicylates
Glucagon prefered - otherwise massive dose of adrenaline.
Munchausen's by proxy
Antidote is naloxone.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

19. Opiates
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.
Antidote is naloxone.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

20. What are the side effects of N-acety-p-benzoquinine?
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Antidotes are atropine sulfate and pralidoxime chloride.
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
Rash bronchospasm and hypotension.

21. Beta-blocker overdose antidote
Glucagon prefered - otherwise massive dose of adrenaline.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Give IM adrenaline - steroids - salbutamol - antihistamine.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

22. Organophosphates
Poisoning causes decreased cholinesterase activity.
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.
Rash bronchospasm and hypotension.
Calcium chloride

23. What is the most important investigation in suspected alcohol poisoning in young person?
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
Blood glucose level for hypoglycaemia!!
Objective signs of growth - tidiness - weight -
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

24. Iron
Antidote is deferoxamine chelation. Charcoal is ineffective.
Sling for 3 weeks - fracture clinic at 7 days.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

25. OSCE: how can i prevent accidents in my children
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
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
Neurotoxins - procagulants. Rhabdomyolysins.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.

26. Lidocaine
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

27. Tricyclic antidepressants overdose
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

28. 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
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Objective signs of growth - tidiness - weight -
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.

29. Anticholinergics
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Ceftriaxone
Causes BAD constipation. Upsets fluid and electrolyte balance.
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.

30. When is reduction required in fracture?
Skin or vascular compromise
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
'I WOULD CALL POISON HOTLINE'.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

31. What is the first line investigation in a young child who has consumed alcohol?
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
... blood sugars for hypoglycaemia
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.

32. What is the general management of poisoning?
Intubate - tracheostromy or nebulized adrenaline.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Objective signs of growth - tidiness - weight -

33. Undisplaced surgical neck of humerous?
Intubate - tracheostromy or nebulized adrenaline.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Sling for 3 weeks - fracture clinic at 7 days.

34. Digoxin antedote
Notify if abuse CONSIDERED. CONSIDERED.
Digoxin Fab
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.

35. Theophylline
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Bone scan for occult fracture
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.
Sling for 3 weeks - fracture clinic at 7 days.

36. Benzodiazepine overdose antidote
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
'I WOULD CALL POISON HOTLINE'.
Intubate - tracheostromy or nebulized adrenaline.
Flumazenil

37. what makes you suspicious of non-accidental injury.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Stomach pumping.
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.

38. Calcium gluconate
Glucagon prefered - otherwise massive dose of adrenaline.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

39. Legal requirement in childabuse
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
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
Notify if abuse CONSIDERED. CONSIDERED.

40. Sympathomimetics
Release NEUROTOXINS both have antivenom
Class of drugs encompassing decongestants - amphetamines - cocaine.
It can cause fatal bronchioloitis obliterans
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

41. When and how would you do whole bowel irrigation?
Antidote is naloxone.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Give steroids for management of serum sickness. Must do coagulation screen!!!
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.

42. A child has swallowed a battery. Mx
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Skin or vascular compromise
... blood sugars for hypoglycaemia
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy

43. How do snake bites damage?
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Neurotoxins - procagulants. Rhabdomyolysins.

44. What is the most appropriate examination in a child with suspected lead ingestion?
Rash bronchospasm and hypotension.
Abdo XRAY!!!! do it!
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.

45. What is the most important treatment for anaphylaxis
Cyanosis and irregular respiratory effort
Causes BAD constipation. Upsets fluid and electrolyte balance.
Collar and cuff. Check integrity of nerve.
IM adrenaline: vasopressor and bronchodilator.

46. What must you do before sending fracture to radiology?
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Immobilize with plaster slab
It can cause fatal bronchioloitis obliterans

47. Mx of critical asthma
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Flurescence in ultraviolet light.

48. Adenosine
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 temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Aspiration pneumonia even if intubated.
Skin or vascular compromise

49. Hydrocarbons
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
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.
Intubate - tracheostromy or nebulized adrenaline.

50. Carbon monoxide
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Calcium chloride
Aspiration Pneumonia
Flurescence in ultraviolet light.