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. Sodium Bicarbonate
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
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.
Objective signs of growth - tidiness - weight -

2. Amiodarone
Causes BAD constipation. Upsets fluid and electrolyte balance.
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.
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 bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

3. Cyanide
Digoxin Fab
Discobalt edetate
Abdo XRAY!!!! do it!
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

4. Sympathomimetics
Class of drugs encompassing decongestants - amphetamines - cocaine.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

5. Acetaminophen
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
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
Abdo XRAY!!!! do it!
Aspiration pneumonia even if intubated.

6. What are the special features that must be done to correct haemorrhagic shock.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
... blood sugars for hypoglycaemia
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

7. Lead
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
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.
Discobalt edetate

8. What are the early symptoms of paracetamol overdose?
Nausea vomiting and anorexia.
Munchausen's by proxy
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
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

9. What is gastric lavage?
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Stomach pumping.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Sling for 3 weeks - fracture clinic at 7 days.

10. Opiates
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Digoxin Fab
Antidote is naloxone.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

11. What investigations should you do in suspected child abuse
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Aspiration pneumonia even if intubated.
Collar and cuff. Check integrity of nerve.
Bone scan for occult fracture

12. Mx severe croup
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.
Esmolol
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

13. Lidocaine
Severe illness - past history of injuries - 18 months or less - inconstent story.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
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
Aspiration Pneumonia

14. Organophosphates
Poisoning causes decreased cholinesterase activity.
Neurotoxins - procagulants. Rhabdomyolysins.
Blood glucose level for hypoglycaemia!!
Antidote is naloxone.

15. Salicylates
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 treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Aspiration pneumonia even if intubated.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

16. 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.
Nausea vomiting and anorexia.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

17. Mx of critical asthma
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Calcium chloride
Discobalt edetate
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

18. Indications of non-accidental injury
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.
Collar and cuff. Check integrity of nerve.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

19. Benzodiazepine overdose antidote
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Flumazenil
Immobilize with plaster slab
Normally treated with sling alone. Seek advice.

20. Signs of psychological maltreatment?
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Munchausen's by proxy
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
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.

21. You must consider abuse in
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Severe illness - past history of injuries - 18 months or less - inconstent story.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
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. 20
'I WOULD CALL POISON HOTLINE'.
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 treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Lead poisoning is defined as a serum level greater than ___ ug/dL.

23. What is the general management of poisoning?
Croup.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Skin or vascular compromise
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.

24. Funnel web and red back
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
Sling for 3 weeks - fracture clinic at 7 days.
Release NEUROTOXINS both have antivenom
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.

25. Management of near drowning.
IM adrenaline: vasopressor and bronchodilator.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
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

26. 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.
Neurosurgery if trauma. Give mannitol.
Release NEUROTOXINS both have antivenom
Croup.

27. Opiates
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Give steroids for management of serum sickness. Must do coagulation screen!!!
... blood sugars for hypoglycaemia
Glucagon prefered - otherwise massive dose of adrenaline.

28. Legal requirement in childabuse
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.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Notify if abuse CONSIDERED. CONSIDERED.
Release NEUROTOXINS both have antivenom

29. Signs of abuse from the history
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Collar and cuff. Check integrity of nerve.
Nausea vomiting and anorexia.
'I WOULD CALL POISON HOTLINE'.

30. Ethylene glycol
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
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.
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.

31. Iron
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Skin or vascular compromise

32. Calcium channel blocker overdose antidote
Skin or vascular compromise
Neurosurgery if trauma. Give mannitol.
Calcium chloride
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

33. Management of septicaemia shock

34. Ethanol
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
IM adrenaline: vasopressor and bronchodilator.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.

35. OSCE: how can i prevent accidents in my children
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.
Flumazenil
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
Munchausen's by proxy

36. Organophosphates antidotes
Antidotes are atropine sulfate and pralidoxime chloride.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Blood glucose level for hypoglycaemia!!
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

37. OSCE: What are the five princples of discharging a patient with a fracture?
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
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

38. Methanol
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
Digoxin Fab
'I WOULD CALL POISON HOTLINE'.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

39. 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.
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.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Antidote is naloxone.

40. What is one of the technicalities of childabuse.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
CHARCOAL! except for lithium - iron - alcohol - lead.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
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.

41. Anticholinergics
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Notify if abuse CONSIDERED. CONSIDERED.
Glucagon prefered - otherwise massive dose of adrenaline.
Immobilize with plaster slab

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

43. Ethylene glycol
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Calcium chloride
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

44. Calcium gluconate
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

45. Carbon monoxide
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Esmolol
Ceftriaxone

46. Digoxin antedote
Digoxin Fab
Stomach pumping.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

47. What are the terminal signs of acute laryngeal obstruction?
It can cause fatal bronchioloitis obliterans
Digoxin Fab
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Cyanosis and irregular respiratory effort

48. 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.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.

49. Organophosphates
Give IM adrenaline - steroids - salbutamol - antihistamine.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Antidote is naloxone.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

50. Mx raised intracranial pressure.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Neurosurgery if trauma. Give mannitol.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Cyanosis and irregular respiratory effort