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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. Oedema causing laryngeal obstruction?
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Intubate - tracheostromy or nebulized adrenaline.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

2. What is an important point to note about anaphylaxis?
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
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
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 -
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

3. OSCE: how can i prevent accidents in my children
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Munchausen's by proxy
Notify if abuse CONSIDERED. CONSIDERED.
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. Salicylates
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.
Flurescence in ultraviolet light.
Sling for 3 weeks - fracture clinic at 7 days.
Digoxin Fab

5. What are the early symptoms of paracetamol overdose?
Skin or vascular compromise
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Nausea vomiting and anorexia.
Collar and cuff. Check integrity of nerve.

6. Methanol
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
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 with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

7. What investigations should you do in suspected child abuse
Give IM adrenaline - steroids - salbutamol - antihistamine.
Bone scan for occult fracture
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Discobalt edetate

8. What is the first line investigation in a young child who has consumed alcohol?
Nausea vomiting and anorexia.
... blood sugars for hypoglycaemia
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Objective signs of growth - tidiness - weight -

9. What must you do before sending fracture to radiology?
Release NEUROTOXINS both have antivenom
Immobilize with plaster slab
Antidote is naloxone.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.

10. Sodium Bicarbonate
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
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
Flurescence in ultraviolet light.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

11. Methanol
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Flumazenil
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.

12. What are the side effects of N-acety-p-benzoquinine?
Rash bronchospasm and hypotension.
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.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.

13. Mx of snake bit
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
Esmolol
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
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.

14. Mx of petroleum overdose
Bone scan for occult fracture
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

15. Tricyclic antidepressants overdose
Rash bronchospasm and hypotension.
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) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

16. Organophosphates antidotes
Antidotes are atropine sulfate and pralidoxime chloride.
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.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

17. What are the terminal signs of acute laryngeal obstruction?
Cyanosis and irregular respiratory effort
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
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.

18. Opiates
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Skin or vascular compromise
Discobalt edetate
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.

19. Organophosphates
Aspiration Pneumonia
Flurescence in ultraviolet light.
Poisoning causes decreased cholinesterase activity.
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.

20. Ibuprofen
Immobilize with plaster slab
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
Munchausen's by proxy
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

21. 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
Stomach pumping.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

22. Mx of critical asthma
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
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.
CHARCOAL! except for lithium - iron - alcohol - lead.

23. Epinephrine
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
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Digoxin Fab
... blood sugars for hypoglycaemia

24. Carbon monoxide
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
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.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.

25. Carbon monoxide
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Sling for 3 weeks - fracture clinic at 7 days.
... blood sugars for hypoglycaemia
'I WOULD CALL POISON HOTLINE'.

26. Ethylene glycol
Stomach pumping.
Glucagon prefered - otherwise massive dose of adrenaline.
Flurescence in ultraviolet light.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

27. Funnel web and red back
Release NEUROTOXINS both have antivenom
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Abdo XRAY!!!! do it!
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.

28. 45; 70
Aspiration Pneumonia
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
Flurescence in ultraviolet light.
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

29. Mx raised intracranial pressure.
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.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Neurosurgery if trauma. Give mannitol.
Calcium chloride

30. What else is in the management of snake bite?
Give steroids for management of serum sickness. Must do coagulation screen!!!
Neurotoxins - procagulants. Rhabdomyolysins.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

31. Organophosphates
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 lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
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 salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

32. Mx severe croup
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
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 bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Munchausen's by proxy

33. Atropine
Ceftriaxone
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
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.

34. What evidence should a doctor give about parental neglect
Flurescence in ultraviolet light.
Aspiration pneumonia even if intubated.
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.

35. What are the other treatments for anaphylaxis?
Give IM adrenaline - steroids - salbutamol - antihistamine.
Discobalt edetate
Aspiration pneumonia even if intubated.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.

36. Cyanide
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Discobalt edetate
Intubate - tracheostromy or nebulized adrenaline.

37. Beta-blocker overdose antidote
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Intubate - tracheostromy or nebulized adrenaline.
'I WOULD CALL POISON HOTLINE'.
Glucagon prefered - otherwise massive dose of adrenaline.

38. Signs of abuse from the history
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
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 - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.

39. Middle Clavicle fracture management?
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Croup.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

40. What is the most common caUse of acute laryngeal obstruction?
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
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.
Croup.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

41. Displaced surgical neck of humerous
Skin or vascular compromise
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Normally treated with sling alone. Seek advice.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

42. What is the most important investigation in suspected alcohol poisoning in young person?
Blood glucose level for hypoglycaemia!!
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.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

43. When and how would you do whole bowel irrigation?
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Rash bronchospasm and hypotension.

44. When is reduction required in 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.
Blood glucose level for hypoglycaemia!!
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.
Skin or vascular compromise

45. How may you detect semen?
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
Esmolol
Flurescence in ultraviolet light.
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

46. Hydrocarbons
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
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.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

47. Which is better - activated charcoal or gastric lavage.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
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 -
CHARCOAL! except for lithium - iron - alcohol - lead.
Flumazenil

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

49. Ingesting Petrol. Cx?
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Aspiration Pneumonia
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.
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

50. Acetaminophen
Notify if abuse CONSIDERED. CONSIDERED.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
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.