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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. Ingesting Petrol. Cx?
Munchausen's by proxy
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Aspiration Pneumonia

2. What are the terminal signs of acute laryngeal obstruction?
Rash bronchospasm and hypotension.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Cyanosis and irregular respiratory effort
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

3. Amphetamine antidote
Esmolol
Intubate - tracheostromy or nebulized adrenaline.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Bone scan for occult fracture

4. OSCE: how can i prevent accidents in my children
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.
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

5. Mx of snake bit
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.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

6. Benzodiazepine overdose antidote
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Munchausen's by proxy
Flumazenil
Poisoning causes decreased cholinesterase activity.

7. What psychiatric disease defined as childabuse?

8. Anticholinergics
Esmolol
Neurotoxins - procagulants. Rhabdomyolysins.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

9. Hydrocarbons
Neurosurgery if trauma. Give mannitol.
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 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!!

10. Sympathomimetics
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Class of drugs encompassing decongestants - amphetamines - cocaine.
Release NEUROTOXINS both have antivenom
Rash bronchospasm and hypotension.

11. Legal requirement in childabuse
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
'I WOULD CALL POISON HOTLINE'.
Discobalt edetate
Notify if abuse CONSIDERED. CONSIDERED.

12. Beta-blocker overdose antidote
Release NEUROTOXINS both have antivenom
Aspiration pneumonia even if intubated.
Glucagon prefered - otherwise massive dose of adrenaline.
Rash bronchospasm and hypotension.

13. When is reduction required in fracture?
Collar and cuff. Check integrity of nerve.
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.
Skin or vascular compromise
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

14. What is the first line investigation in a young child who has consumed alcohol?
... blood sugars for hypoglycaemia
Sling for 3 weeks - fracture clinic at 7 days.
Abdo XRAY!!!! do it!
Lead poisoning is defined as a serum level greater than ___ ug/dL.

15. Anticholinergics
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.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Give IM adrenaline - steroids - salbutamol - antihistamine.

16. 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.
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.
Normally treated with sling alone. Seek advice.

17. What investigations should you do in suspected child abuse
IM adrenaline: vasopressor and bronchodilator.
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.
Bone scan for occult fracture
Aspiration Pneumonia

18. What are the early symptoms of paracetamol overdose?
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Glucagon prefered - otherwise massive dose of adrenaline.
Immobilize with plaster slab
Nausea vomiting and anorexia.

19. Ethylene glycol
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.
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 deferoxamine chelation. Charcoal is ineffective.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

20. 20
Antidote is deferoxamine chelation. Charcoal is ineffective.
Neurosurgery if trauma. Give mannitol.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Lead poisoning is defined as a serum level greater than ___ ug/dL.

21. Ethanol
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 lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

22. Displaced surgical neck of humerous
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Normally treated with sling alone. Seek advice.
Collar and cuff. Check integrity of nerve.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

23. What is the most appropriate examination in a child with suspected lead ingestion?
Abdo XRAY!!!! do it!
Munchausen's by proxy
Give steroids for management of serum sickness. Must do coagulation screen!!!
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.

24. Iron
Digoxin Fab
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
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.

25. What are the special features that must be done to correct haemorrhagic shock.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Blood glucose level for hypoglycaemia!!
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Immobilize with plaster slab

26. What is one of the technicalities of childabuse.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Bone scan for occult fracture
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Before a child can be examined for child abuse - a parent or legal guardian must give consent

27. What is the most important treatment for anaphylaxis
Poisoning causes decreased cholinesterase activity.
Notify if abuse CONSIDERED. CONSIDERED.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
IM adrenaline: vasopressor and bronchodilator.

28. Salicylates
Blood glucose level for hypoglycaemia!!
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.
Rash bronchospasm and hypotension.
Abdo XRAY!!!! do it!

29. Mx of critical asthma
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
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Neurosurgery if trauma. Give mannitol.
Objective signs of growth - tidiness - weight -

30. Management of septicaemia shock

31. Ethylene glycol
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Abdo XRAY!!!! do it!
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

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 salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

33. What is the general management of poisoning?
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Poisoning causes decreased cholinesterase activity.
Notify if abuse CONSIDERED. CONSIDERED.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.

34. Funnel web and red back
Release NEUROTOXINS both have antivenom
Intubate - tracheostromy or nebulized adrenaline.
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
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.

35. Undisplaced surgical neck of humerous?
Sling for 3 weeks - fracture clinic at 7 days.
Release NEUROTOXINS both have antivenom
Give steroids for management of serum sickness. Must do coagulation screen!!!
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.

36. Mx raised intracranial pressure.
Esmolol
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Skin or vascular compromise
Neurosurgery if trauma. Give mannitol.

37. 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.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy

38. Oedema causing laryngeal obstruction?
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Sling for 3 weeks - fracture clinic at 7 days.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Intubate - tracheostromy or nebulized adrenaline.

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

40. Amiodarone
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 tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

41. Theophylline
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Neurotoxins - procagulants. Rhabdomyolysins.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

42. Organophosphates
Poisoning causes decreased cholinesterase activity.
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.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
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.

43. Calcium channel blocker overdose antidote
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Immobilize with plaster slab
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Calcium chloride

44. What are the other treatments for anaphylaxis?
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.
Digoxin Fab
Give IM adrenaline - steroids - salbutamol - antihistamine.
Abdo XRAY!!!! do it!

45. Acetaminophen
Antidotes are atropine sulfate and pralidoxime chloride.
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 nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Nausea vomiting and anorexia.

46. What is a side effect of charcoal?
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Skin or vascular compromise
Causes BAD constipation. Upsets fluid and electrolyte balance.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

47. Calcium gluconate
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
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.
Flurescence in ultraviolet light.

48. What is the antibiotic for Epiglottitis?
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.
Ceftriaxone
Severe illness - past history of injuries - 18 months or less - inconstent story.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.

49. 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
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.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Aspiration Pneumonia

50. What happens if charcoal is aspirated?
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
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.
It can cause fatal bronchioloitis obliterans