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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. Undisplaced radial shaft fracture
Collar and cuff. Check integrity of nerve.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
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

2. 20
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Objective signs of growth - tidiness - weight -
CHARCOAL! except for lithium - iron - alcohol - lead.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

3. What is the most appropriate examination in a child with suspected lead ingestion?
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Abdo XRAY!!!! do it!
Normally treated with sling alone. Seek advice.
Before a child can be examined for child abuse - a parent or legal guardian must give consent

4. Anticholinergics
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

5. Which is better - activated charcoal or gastric lavage.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
CHARCOAL! except for lithium - iron - alcohol - lead.
Antidotes are atropine sulfate and pralidoxime chloride.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

6. What happens if charcoal is aspirated?
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
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
It can cause fatal bronchioloitis obliterans
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.

7. Carbon monoxide
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.

8. Management of near drowning.
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
Stomach pumping.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
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

9. Benzodiazepine overdose antidote
Flumazenil
Antidotes are atropine sulfate and pralidoxime chloride.
'I WOULD CALL POISON HOTLINE'.
Lead poisoning is defined as a serum level greater than ___ ug/dL.

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

11. Iron
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Class of drugs encompassing decongestants - amphetamines - cocaine.
Antidotes are atropine sulfate and pralidoxime chloride.
Antidote is deferoxamine chelation. Charcoal is ineffective.

12. Sympathomimetics
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Digoxin Fab

13. 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.
Neurosurgery if trauma. Give mannitol.
'I WOULD CALL POISON HOTLINE'.
Rash bronchospasm and hypotension.

14. What is a side effect of charcoal?
CHARCOAL! except for lithium - iron - alcohol - lead.
Aspiration Pneumonia
Causes BAD constipation. Upsets fluid and electrolyte balance.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

15. Legal requirement in childabuse
Release NEUROTOXINS both have antivenom
Notify if abuse CONSIDERED. CONSIDERED.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.

16. What investigations should you do in suspected child abuse
Calcium chloride
Bone scan for occult fracture
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Notify if abuse CONSIDERED. CONSIDERED.

17. Digoxin antedote
CHARCOAL! except for lithium - iron - alcohol - lead.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Digoxin Fab
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.

18. What are the side effects of N-acety-p-benzoquinine?
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Rash bronchospasm and hypotension.

19. Methanol
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
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
Digoxin Fab

20. Acetaminophen
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Cyanosis and irregular respiratory effort
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.

21. Acetaminophen
Antidotes are atropine sulfate and pralidoxime chloride.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Release NEUROTOXINS both have antivenom
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.

22. When is reduction required in fracture?
IM adrenaline: vasopressor and bronchodilator.
Munchausen's by proxy
Skin or vascular compromise
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)

23. Ethylene glycol
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Abdo XRAY!!!! do it!
Neurotoxins - procagulants. Rhabdomyolysins.

24. OSCE: how can i prevent accidents in my children
Give steroids for management of serum sickness. Must do coagulation screen!!!
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
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
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

25. How may you detect semen?
Flurescence in ultraviolet light.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Flumazenil
Normally treated with sling alone. Seek advice.

26. Tricyclic antidepressants overdose
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Neurosurgery if trauma. Give mannitol.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

27. what makes you suspicious of non-accidental injury.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Class of drugs encompassing decongestants - amphetamines - cocaine.
Skin or vascular compromise
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

28. Procainamide
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Aspiration pneumonia even if intubated.
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.
Ceftriaxone

29. Ethylene glycol
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 - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Normally treated with sling alone. Seek advice.
Poisoning causes decreased cholinesterase activity.

30. Calcium gluconate
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

31. Organophosphates
Causes BAD constipation. Upsets fluid and electrolyte balance.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Nausea vomiting and anorexia.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

32. Hydrocarbons
Stomach pumping.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
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.
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.

33. What evidence should a doctor give about parental neglect
Causes BAD constipation. Upsets fluid and electrolyte balance.
Notify if abuse CONSIDERED. CONSIDERED.
Objective signs of growth - tidiness - weight -
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.

34. Displaced surgical neck of humerous
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.
Normally treated with sling alone. Seek advice.
Notify if abuse CONSIDERED. CONSIDERED.

35. Indications of non-accidental injury
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Causes BAD constipation. Upsets fluid and electrolyte balance.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Skin or vascular compromise

36. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
Aspiration pneumonia even if intubated.
Blood glucose level for hypoglycaemia!!
Causes BAD constipation. Upsets fluid and electrolyte balance.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

37. Beta-blocker overdose antidote
Croup.
It can cause fatal bronchioloitis obliterans
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Glucagon prefered - otherwise massive dose of adrenaline.

38. Oedema causing laryngeal obstruction?
Intubate - tracheostromy or nebulized adrenaline.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

39. Anticholinergics
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Give steroids for management of serum sickness. Must do coagulation screen!!!
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
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

40. Ethanol
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Cyanosis and irregular respiratory effort
'I WOULD CALL POISON HOTLINE'.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

41. Mx of critical asthma
Neurotoxins - procagulants. Rhabdomyolysins.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Skin or vascular compromise
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

42. Amiodarone
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
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.
... blood sugars for hypoglycaemia
Munchausen's by proxy

43. Adenosine
Antidote is deferoxamine chelation. Charcoal is ineffective.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Nausea vomiting and anorexia.

44. Atropine
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Flurescence in ultraviolet light.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

45. OSCE: What are the five princples of discharging a patient with a fracture?
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Sling for 3 weeks - fracture clinic at 7 days.

46. Anticholinergics
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
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.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Release NEUROTOXINS both have antivenom

47. What is the antibiotic for Epiglottitis?
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 -
Release NEUROTOXINS both have antivenom
Croup.
Ceftriaxone

48. What are the early symptoms of paracetamol overdose?
Nausea vomiting and anorexia.
Stomach pumping.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Croup.

49. Signs of abuse from the history
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
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Neurotoxins - procagulants. Rhabdomyolysins.

50. 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.
Sling for 3 weeks - fracture clinic at 7 days.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
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