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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. Organophosphates antidotes
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Blood glucose level for hypoglycaemia!!
Antidotes are atropine sulfate and pralidoxime chloride.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.

2. Carbon monoxide
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
Severe illness - past history of injuries - 18 months or less - inconstent story.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

3. Cyanide
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Discobalt edetate
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.
Antidote is naloxone.

4. Calcium channel blocker overdose antidote
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
Calcium chloride
It can cause fatal bronchioloitis obliterans
Objective signs of growth - tidiness - weight -

5. Beta-blocker overdose antidote
Glucagon prefered - otherwise massive dose of adrenaline.
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
Causes BAD constipation. Upsets fluid and electrolyte balance.
Neurosurgery if trauma. Give mannitol.

6. Legal requirement in childabuse
Notify if abuse CONSIDERED. CONSIDERED.
'I WOULD CALL POISON HOTLINE'.
Cyanosis and irregular respiratory effort
IM adrenaline: vasopressor and bronchodilator.

7. 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
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
... blood sugars for hypoglycaemia
Aspiration pneumonia even if intubated.

8. Oedema causing laryngeal obstruction?
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Intubate - tracheostromy or nebulized adrenaline.
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.

9. Digoxin antedote
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 -
Immobilize with plaster slab
Digoxin Fab
Give IM adrenaline - steroids - salbutamol - antihistamine.

10. What are the early symptoms of paracetamol overdose?
Nausea vomiting and anorexia.
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
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Before a child can be examined for child abuse - a parent or legal guardian must give consent

11. Displaced surgical neck of humerous
Normally treated with sling alone. Seek advice.
It can cause fatal bronchioloitis obliterans
Severe illness - past history of injuries - 18 months or less - inconstent story.
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. Lidocaine
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Normally treated with sling alone. Seek advice.

13. Methanol
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Munchausen's by proxy
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.

14. Procainamide
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.
Immobilize with plaster slab
Flurescence in ultraviolet light.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

15. What is the antibiotic for Epiglottitis?
Ceftriaxone
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

16. Mx severe croup
Give IM adrenaline - steroids - salbutamol - antihistamine.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Release NEUROTOXINS both have antivenom
Collar and cuff. Check integrity of nerve.

17. Which is better - activated charcoal or gastric lavage.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
CHARCOAL! except for lithium - iron - alcohol - lead.
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.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

18. Anticholinergics
Release NEUROTOXINS both have antivenom
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.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

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

20. Management of septicaemia shock

21. What is the general management of poisoning?
Flumazenil
Esmolol
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.

22. Salicylates
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
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.
Blood glucose level for hypoglycaemia!!

23. What is a side effect of charcoal?
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
Calcium chloride
Causes BAD constipation. Upsets fluid and electrolyte balance.
Sling for 3 weeks - fracture clinic at 7 days.

24. What are the three features of anaphylaxis
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Cyanosis and irregular respiratory effort
Severe illness - past history of injuries - 18 months or less - inconstent story.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

25. A child has swallowed a battery. Mx
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
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy

26. What evidence should a doctor give about parental neglect
Calcium chloride
Objective signs of growth - tidiness - weight -
Croup.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

27. Anticholinergics
'I WOULD CALL POISON HOTLINE'.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

28. Calcium gluconate
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Lead poisoning is defined as a serum level greater than ___ ug/dL.

29. Management of near drowning.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Calcium chloride
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
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

30. How do snake bites damage?
Neurotoxins - procagulants. Rhabdomyolysins.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
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 causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.

31. Middle Clavicle fracture management?
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Flurescence in ultraviolet light.
Poisoning causes decreased cholinesterase activity.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

32. Mx of petroleum overdose
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Glucagon prefered - otherwise massive dose of adrenaline.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Release NEUROTOXINS both have antivenom

33. What is the most important investigation in suspected alcohol poisoning in young person?
Blood glucose level for hypoglycaemia!!
'I WOULD CALL POISON HOTLINE'.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.

34. Sympathomimetics
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Release NEUROTOXINS both have antivenom
Causes BAD constipation. Upsets fluid and electrolyte balance.
Bone scan for occult fracture

35. 20
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Collar and cuff. Check integrity of nerve.

36. Mx raised intracranial pressure.
CHARCOAL! except for lithium - iron - alcohol - lead.
Neurosurgery if trauma. Give mannitol.
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
Antidote is deferoxamine chelation. Charcoal is ineffective.

37. When is reduction required in fracture?
Skin or vascular compromise
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Ceftriaxone

38. Mx of critical asthma
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
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.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

39. Undisplaced surgical neck of humerous?
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Discobalt edetate
Sling for 3 weeks - fracture clinic at 7 days.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.

40. Sympathomimetics
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.
Nausea vomiting and anorexia.
Class of drugs encompassing decongestants - amphetamines - cocaine.

41. Hydrocarbons
Objective signs of growth - tidiness - weight -
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.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
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

42. What is the most appropriate examination in a child with suspected lead ingestion?
Abdo XRAY!!!! do it!
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 -
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.

43. Benzodiazepine overdose antidote
It can cause fatal bronchioloitis obliterans
Flumazenil
Digoxin Fab
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

44. Undisplaced radial shaft fracture
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Collar and cuff. Check integrity of nerve.
Antidote is naloxone.
Give IM adrenaline - steroids - salbutamol - antihistamine.

45. What is the first line investigation in a young child who has consumed alcohol?
Abdo XRAY!!!! do it!
CHARCOAL! except for lithium - iron - alcohol - lead.
... blood sugars for hypoglycaemia
IM adrenaline: vasopressor and bronchodilator.

46. What is the most important treatment for anaphylaxis
Collar and cuff. Check integrity of nerve.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
IM adrenaline: vasopressor and bronchodilator.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.

47. Signs of abuse from the history
Ceftriaxone
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

48. Adenosine
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.

49. Opiates
Antidote is naloxone.
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.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.

50. what makes you suspicious of non-accidental injury.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Aspiration pneumonia even if intubated.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child