Test your basic knowledge |

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. Opiates
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
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

2. Carbon monoxide
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
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.

3. What happens if charcoal is aspirated?
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
It can cause fatal bronchioloitis obliterans

4. Ethylene glycol
Lead poisoning is defined as a serum level greater than ___ ug/dL.
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.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
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.

5. Indications of non-accidental injury
Sling for 3 weeks - fracture clinic at 7 days.
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
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

6. Sympathomimetics
... blood sugars for hypoglycaemia
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
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.

7. 20
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Antidotes are atropine sulfate and pralidoxime chloride.
Stomach pumping.
Lead poisoning is defined as a serum level greater than ___ ug/dL.

8. Sodium Bicarbonate
Flumazenil
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
It can cause fatal bronchioloitis obliterans
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

9. What is the antibiotic for Epiglottitis?
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Ceftriaxone
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 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

10. 45; 70
Ceftriaxone
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
... blood sugars for hypoglycaemia
Sling for 3 weeks - fracture clinic at 7 days.

11. What are the three features of anaphylaxis
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Objective signs of growth - tidiness - weight -
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Flumazenil

12. Undisplaced surgical neck of humerous?
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Sling for 3 weeks - fracture clinic at 7 days.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Class of drugs encompassing decongestants - amphetamines - cocaine.

13. Salicylates
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Poisoning causes decreased cholinesterase activity.
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)

14. 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.
Discobalt edetate
CHARCOAL! except for lithium - iron - alcohol - lead.
Cyanosis and irregular respiratory effort

15. What is gastric lavage?
Digoxin Fab
Stomach pumping.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

16. Hydrocarbons
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.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.

17. 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
Croup.
Aspiration Pneumonia
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

18. What are the terminal signs of acute laryngeal obstruction?
Neurosurgery if trauma. Give mannitol.
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.
Cyanosis and irregular respiratory effort
Aspiration pneumonia even if intubated.

19. Mx of petroleum overdose
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Bone scan for occult fracture
Neurosurgery if trauma. Give mannitol.

20. Amiodarone
Calcium chloride
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.
It can cause fatal bronchioloitis obliterans
Antidotes are atropine sulfate and pralidoxime chloride.

21. Ingesting Petrol. Cx?
Skin or vascular compromise
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
Aspiration Pneumonia
Normally treated with sling alone. Seek advice.

22. Undisplaced radial shaft fracture
Release NEUROTOXINS both have antivenom
Stomach pumping.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Collar and cuff. Check integrity of nerve.

23. Calcium channel blocker overdose antidote
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Calcium chloride

24. Beta-blocker overdose antidote
Blood glucose level for hypoglycaemia!!
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
Glucagon prefered - otherwise massive dose of adrenaline.
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.

25. When and how would you do whole bowel irrigation?
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Ceftriaxone

26. What investigations should you do in suspected child abuse
Bone scan for occult fracture
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Skin or vascular compromise
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.

27. What is the most important investigation in suspected alcohol poisoning in young person?
It can cause fatal bronchioloitis obliterans
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Blood glucose level for hypoglycaemia!!
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

28. Iron
Sling for 3 weeks - fracture clinic at 7 days.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
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 IM adrenaline - steroids - salbutamol - antihistamine.

29. What is the most important treatment for anaphylaxis
Class of drugs encompassing decongestants - amphetamines - cocaine.
Antidotes are atropine sulfate and pralidoxime chloride.
Rash bronchospasm and hypotension.
IM adrenaline: vasopressor and bronchodilator.

30. What are the side effects of N-acety-p-benzoquinine?
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.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Normally treated with sling alone. Seek advice.

31. A child has swallowed a battery. Mx
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy

32. What is an important point to note about anaphylaxis?
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
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 -
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
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.

33. Mx of critical asthma
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 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.
Antidotes are atropine sulfate and pralidoxime chloride.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

34. Acetaminophen
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

35. Organophosphates
Poisoning causes decreased cholinesterase activity.
Digoxin Fab
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.

36. What is the most appropriate examination in a child with suspected lead ingestion?
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Aspiration Pneumonia
Abdo XRAY!!!! do it!
Aspiration pneumonia even if intubated.

37. Carbon monoxide
Discobalt edetate
Nausea vomiting and anorexia.
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.

38. Oedema causing laryngeal obstruction?
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.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
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

39. Funnel web and red back
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Release NEUROTOXINS both have antivenom
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
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

40. How may you detect semen?
Flumazenil
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Flurescence in ultraviolet light.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

41. What are the early symptoms of paracetamol overdose?
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Nausea vomiting and anorexia.
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.

42. Lidocaine
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.
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.

43. Organophosphates antidotes
Antidotes are atropine sulfate and pralidoxime chloride.
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 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 tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.

44. Ethanol
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Aspiration Pneumonia
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 delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

45. Cyanide
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.
Discobalt edetate
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Flumazenil

46. What are the other treatments for anaphylaxis?
Give IM adrenaline - steroids - salbutamol - antihistamine.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

47. Which is better - activated charcoal or gastric lavage.
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.
Intubate - tracheostromy or nebulized adrenaline.
CHARCOAL! except for lithium - iron - alcohol - lead.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

48. Organophosphates
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Cyanosis and irregular respiratory effort
Causes BAD constipation. Upsets fluid and electrolyte balance.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

49. Carbon monoxide
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

50. Digoxin antedote
Give IM adrenaline - steroids - salbutamol - antihistamine.
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
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Digoxin Fab