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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. Calcium gluconate
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Flurescence in ultraviolet light.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.

2. Funnel web and red back
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.
Release NEUROTOXINS both have antivenom
It can cause fatal bronchioloitis obliterans
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.

3. Ibuprofen
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
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.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

4. Ethylene glycol
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
Aspiration pneumonia even if intubated.
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.
Lead poisoning is defined as a serum level greater than ___ ug/dL.

5. Benzodiazepine overdose antidote
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Flumazenil
Flurescence in ultraviolet light.

6. Sodium Bicarbonate
Release NEUROTOXINS both have antivenom
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Ceftriaxone

7. Lead
Discobalt edetate
Notify if abuse CONSIDERED. CONSIDERED.
Bone scan for occult fracture
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

8. When and how would you do whole bowel irrigation?
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.

9. Iron
Cyanosis and irregular respiratory effort
Antidote is deferoxamine chelation. Charcoal is ineffective.
Blood glucose level for hypoglycaemia!!
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)

10. Carbon monoxide
Cyanosis and irregular respiratory effort
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Munchausen's by proxy
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

11. Signs of psychological maltreatment?
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.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Flurescence in ultraviolet light.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.

12. what makes you suspicious of non-accidental injury.
Antidotes are atropine sulfate and pralidoxime chloride.
... blood sugars for hypoglycaemia
Give IM adrenaline - steroids - salbutamol - antihistamine.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

13. Sympathomimetics
Munchausen's by proxy
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

14. What is the first line investigation in a young child who has consumed alcohol?
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
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
... blood sugars for hypoglycaemia

15. What are the terminal signs of acute laryngeal obstruction?
Flurescence in ultraviolet light.
Rash bronchospasm and hypotension.
Cyanosis and irregular respiratory effort
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

16. Organophosphates
Flumazenil
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Digoxin Fab
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

17. Beta-blocker overdose antidote
Glucagon prefered - otherwise massive dose of adrenaline.
Flurescence in ultraviolet light.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Poisoning causes decreased cholinesterase activity.

18. Oedema causing laryngeal obstruction?
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Intubate - tracheostromy or nebulized adrenaline.
Neurosurgery if trauma. Give mannitol.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

19. Iron
Give steroids for management of serum sickness. Must do coagulation screen!!!
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
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

20. Ingesting Petrol. Cx?
Aspiration Pneumonia
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.
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.

21. What investigations should you do in suspected child abuse
Bone scan for occult fracture
Aspiration pneumonia even if intubated.
Stomach pumping.
IM adrenaline: vasopressor and bronchodilator.

22. Signs of abuse from the history
... blood sugars for hypoglycaemia
Croup.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

23. Lidocaine
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Immobilize with plaster slab
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Antidote is deferoxamine chelation. Charcoal is ineffective.

24. What is a side effect of charcoal?
Causes BAD constipation. Upsets fluid and electrolyte balance.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Glucagon prefered - otherwise massive dose of adrenaline.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

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

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26. Mx raised intracranial pressure.
Neurosurgery if trauma. Give mannitol.
'I WOULD CALL POISON HOTLINE'.
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.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

27. Digoxin antedote
Abdo XRAY!!!! do it!
Give IM adrenaline - steroids - salbutamol - antihistamine.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Digoxin Fab

28. Organophosphates antidotes
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Antidotes are atropine sulfate and pralidoxime chloride.
CHARCOAL! except for lithium - iron - alcohol - lead.

29. 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.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

30. When is gastric lavage indicated and contraindicated?
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
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Esmolol
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.

31. What happens if charcoal is aspirated?
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
It can cause fatal bronchioloitis obliterans
Flumazenil
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.

32. You must consider abuse in
It can cause fatal bronchioloitis obliterans
Collar and cuff. Check integrity of nerve.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Stomach pumping.

33. Theophylline
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Nausea vomiting and anorexia.
Stomach pumping.

34. How may you detect semen?
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Antidote is naloxone.
Flurescence in ultraviolet light.

35. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
... blood sugars for hypoglycaemia
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Aspiration pneumonia even if intubated.

36. Atropine
Discobalt edetate
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Abdo XRAY!!!! do it!
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

37. Middle Clavicle fracture management?
Discobalt edetate
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Ceftriaxone
Aspiration pneumonia even if intubated.

38. What evidence should a doctor give about parental neglect
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.
Objective signs of growth - tidiness - weight -
Munchausen's by proxy
Release NEUROTOXINS both have antivenom

39. Legal requirement in childabuse
Notify if abuse CONSIDERED. CONSIDERED.
Collar and cuff. Check integrity of nerve.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Antidotes are atropine sulfate and pralidoxime chloride.

40. When is reduction required in fracture?
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
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
Skin or vascular compromise
Calcium chloride

41. Procainamide
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 -
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.
Release NEUROTOXINS both have antivenom
Before a child can be examined for child abuse - a parent or legal guardian must give consent

42. Management of septicaemia shock

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43. What are the three features of anaphylaxis
Collar and cuff. Check integrity of nerve.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Intubate - tracheostromy or nebulized adrenaline.

44. Indications of non-accidental injury
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
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.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

45. Which is better - activated charcoal or gastric lavage.
Release NEUROTOXINS both have antivenom
Immobilize with plaster slab
CHARCOAL! except for lithium - iron - alcohol - lead.
Munchausen's by proxy

46. What is the most appropriate examination in a child with suspected lead ingestion?
Give steroids for management of serum sickness. Must do coagulation screen!!!
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Abdo XRAY!!!! do it!

47. How do snake bites damage?
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.
Neurosurgery if trauma. Give mannitol.
Neurotoxins - procagulants. Rhabdomyolysins.
Sling for 3 weeks - fracture clinic at 7 days.

48. Mx of snake bit
Objective signs of growth - tidiness - weight -
Antidote is deferoxamine chelation. Charcoal is ineffective.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
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.

49. Salicylates
Neurosurgery if trauma. Give mannitol.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Causes BAD constipation. Upsets fluid and electrolyte balance.

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

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