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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 else is in the management of snake bite?
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 nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
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
Give steroids for management of serum sickness. Must do coagulation screen!!!

2. 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
Nausea vomiting and anorexia.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
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.

3. Indications of non-accidental injury
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
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.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.

4. Salicylates
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Bone scan for occult fracture

5. Methanol
Skin or vascular compromise
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.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

6. Sympathomimetics
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Aspiration pneumonia even if intubated.

7. 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.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Sling for 3 weeks - fracture clinic at 7 days.
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.

8. Calcium channel blocker overdose antidote
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Calcium chloride

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

10. Displaced surgical neck of humerous
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Normally treated with sling alone. Seek advice.
Immobilize with plaster slab
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

11. Ingesting Petrol. Cx?
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.
Collar and cuff. Check integrity of nerve.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Aspiration Pneumonia

12. What are the early symptoms of paracetamol overdose?
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.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Nausea vomiting and anorexia.

13. Atropine
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Poisoning causes decreased cholinesterase activity.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Class of drugs encompassing decongestants - amphetamines - cocaine.

14. What are the terminal signs of acute laryngeal obstruction?
Cyanosis and irregular respiratory effort
Poisoning causes decreased cholinesterase activity.
Nausea vomiting and anorexia.
Release NEUROTOXINS both have antivenom

15. Mx of petroleum overdose
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.

16. What is the general management of poisoning?
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Aspiration Pneumonia
... blood sugars for hypoglycaemia
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.

17. What is the antibiotic for Epiglottitis?
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Ceftriaxone
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Objective signs of growth - tidiness - weight -

18. Mx raised intracranial pressure.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Esmolol
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
Neurosurgery if trauma. Give mannitol.

19. What is the most important treatment for anaphylaxis
IM adrenaline: vasopressor and bronchodilator.
Aspiration pneumonia even if intubated.
'I WOULD CALL POISON HOTLINE'.
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

20. Sympathomimetics
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Class of drugs encompassing decongestants - amphetamines - cocaine.
Normally treated with sling alone. Seek advice.
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

21. Middle Clavicle fracture management?
CHARCOAL! except for lithium - iron - alcohol - lead.
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)
Discobalt edetate

22. What must you do before sending fracture to radiology?
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Intubate - tracheostromy or nebulized adrenaline.
Immobilize with plaster slab
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

23. Management of near drowning.
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
Aspiration pneumonia even if intubated.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

24. Carbon monoxide
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 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.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.

25. Procainamide
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Sling for 3 weeks - fracture clinic at 7 days.
Antidote is naloxone.
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.

26. Ethylene glycol
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Neurotoxins - procagulants. Rhabdomyolysins.
It can cause fatal bronchioloitis obliterans
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

27. Ethanol
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Glucagon prefered - otherwise massive dose of adrenaline.
Neurotoxins - procagulants. Rhabdomyolysins.
Bone scan for occult fracture

28. 45; 70
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
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
Causes BAD constipation. Upsets fluid and electrolyte balance.

29. Cyanide
It can cause fatal bronchioloitis obliterans
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Digoxin Fab
Discobalt edetate

30. Opiates
Neurotoxins - procagulants. Rhabdomyolysins.
Calcium chloride
Esmolol
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

31. Organophosphates
Poisoning causes decreased cholinesterase activity.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
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

32. Calcium gluconate
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Skin or vascular compromise

33. 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
Antidote is naloxone.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

34. OSCE: What are the five princples of discharging a patient with a fracture?
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Rash bronchospasm and hypotension.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

35. What evidence should a doctor give about parental neglect
Give steroids for management of serum sickness. Must do coagulation screen!!!
Objective signs of growth - tidiness - weight -
Flurescence in ultraviolet light.
CHARCOAL! except for lithium - iron - alcohol - lead.

36. What are the special features that must be done to correct haemorrhagic shock.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Intubate - tracheostromy or nebulized adrenaline.

37. Anticholinergics
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
... blood sugars for hypoglycaemia
CHARCOAL! except for lithium - iron - alcohol - lead.
IM adrenaline: vasopressor and bronchodilator.

38. Anticholinergics
Calcium chloride
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Antidotes are atropine sulfate and pralidoxime chloride.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

39. Digoxin antedote
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Digoxin Fab
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

40. Mx severe croup
Esmolol
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

41. What is the most appropriate examination in a child with suspected lead ingestion?
Abdo XRAY!!!! do it!
Notify if abuse CONSIDERED. CONSIDERED.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Stomach pumping.

42. Tricyclic antidepressants overdose
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 -
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

43. Which is better - activated charcoal or gastric lavage.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
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
CHARCOAL! except for lithium - iron - alcohol - lead.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

44. How may you detect semen?
Flurescence in ultraviolet light.
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.
Esmolol
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)

45. Acetaminophen
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
IM adrenaline: vasopressor and bronchodilator.
'I WOULD CALL POISON HOTLINE'.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.

46. What investigations should you do in suspected child abuse
Bone scan for occult fracture
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Give steroids for management of serum sickness. Must do coagulation screen!!!
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

47. Theophylline
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
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

48. Oedema causing laryngeal obstruction?
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
Munchausen's by proxy
Intubate - tracheostromy or nebulized adrenaline.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

49. Epinephrine
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Nausea vomiting and anorexia.

50. Mx of snake bit
Calcium chloride
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.
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 tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.