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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. Lidocaine
Poisoning causes decreased cholinesterase activity.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

2. What is the most important treatment for anaphylaxis
Aspiration Pneumonia
Before a child can be examined for child abuse - a parent or legal guardian must give consent
IM adrenaline: vasopressor and bronchodilator.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

3. Organophosphates
Poisoning causes decreased cholinesterase activity.
Normally treated with sling alone. Seek advice.
Bone scan for occult fracture
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

4. Mx severe croup
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
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
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.

5. What happens if charcoal is aspirated?
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
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
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
It can cause fatal bronchioloitis obliterans

6. When and how would you do whole bowel irrigation?
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
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.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

7. Management of near drowning.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
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
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

8. Signs of psychological maltreatment?
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.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
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.

9. Oedema causing laryngeal obstruction?
Intubate - tracheostromy or nebulized adrenaline.
It can cause fatal bronchioloitis obliterans
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 decreased cholinesterase activity.

10. What evidence should a doctor give about parental neglect
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Objective signs of growth - tidiness - weight -
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

11. Undisplaced surgical neck of humerous?
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Sling for 3 weeks - fracture clinic at 7 days.
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.
It can cause fatal bronchioloitis obliterans

12. What is the most appropriate examination in a child with suspected lead ingestion?
Abdo XRAY!!!! do it!
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
Neurotoxins - procagulants. Rhabdomyolysins.
CHARCOAL! except for lithium - iron - alcohol - lead.

13. Ethanol
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

14. How do snake bites damage?
Neurotoxins - procagulants. Rhabdomyolysins.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.

15. Digoxin antedote
Give IM adrenaline - steroids - salbutamol - antihistamine.
Neurosurgery if trauma. Give mannitol.
'I WOULD CALL POISON HOTLINE'.
Digoxin Fab

16. What else is in the management of snake bite?
Give steroids for management of serum sickness. Must do coagulation screen!!!
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
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.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

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

18. Cyanide
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Discobalt edetate
Release NEUROTOXINS both have antivenom

19. Organophosphates
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
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.

20. What must you do before sending fracture to radiology?
Neurotoxins - procagulants. Rhabdomyolysins.
Antidote is naloxone.
Immobilize with plaster slab
Severe illness - past history of injuries - 18 months or less - inconstent story.

21. OSCE: how can i prevent accidents in my children
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
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
... blood sugars for hypoglycaemia
Antidote is deferoxamine chelation. Charcoal is ineffective.

22. Benzodiazepine overdose antidote
Notify if abuse CONSIDERED. CONSIDERED.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Flumazenil
Glucagon prefered - otherwise massive dose of adrenaline.

23. Calcium channel blocker overdose antidote
Calcium chloride
IM adrenaline: vasopressor and bronchodilator.
Intubate - tracheostromy or nebulized adrenaline.
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.

24. When is gastric lavage indicated and contraindicated?
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

25. What is the antibiotic for Epiglottitis?
Ceftriaxone
Collar and cuff. Check integrity of nerve.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Digoxin Fab

26. Opiates
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
It can cause fatal bronchioloitis obliterans
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Antidote is naloxone.

27. Mx of petroleum overdose
... blood sugars for hypoglycaemia
'I WOULD CALL POISON HOTLINE'.
Rash bronchospasm and hypotension.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

28. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Flurescence in ultraviolet light.
Release NEUROTOXINS both have antivenom
Aspiration pneumonia even if intubated.

29. Middle Clavicle fracture management?
Flurescence in ultraviolet light.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

30. Calcium gluconate
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
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
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Collar and cuff. Check integrity of nerve.

31. Adenosine
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.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Antidotes are atropine sulfate and pralidoxime chloride.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.

32. What is one of the technicalities of childabuse.
Munchausen's by proxy
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Rash bronchospasm and hypotension.
Before a child can be examined for child abuse - a parent or legal guardian must give consent

33. 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.
IM adrenaline: vasopressor and bronchodilator.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

34. 20
Neurosurgery if trauma. Give mannitol.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Discobalt edetate

35. Tricyclic antidepressants
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Severe illness - past history of injuries - 18 months or less - inconstent story.
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
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

36. 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
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Antidotes are atropine sulfate and pralidoxime chloride.

37. Epinephrine
Cyanosis and irregular respiratory effort
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Notify if abuse CONSIDERED. CONSIDERED.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

38. Funnel web and red back
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Glucagon prefered - otherwise massive dose of adrenaline.
Aspiration pneumonia even if intubated.
Release NEUROTOXINS both have antivenom

39. Tricyclic antidepressants overdose
Flumazenil
Esmolol
Normally treated with sling alone. Seek advice.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

40. Acetaminophen
Sling for 3 weeks - fracture clinic at 7 days.
'I WOULD CALL POISON HOTLINE'.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
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 -

41. 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.
Normally treated with sling alone. Seek advice.
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)

42. Indications of non-accidental injury
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
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.
Antidotes are atropine sulfate and pralidoxime chloride.

43. Salicylates
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Aspiration pneumonia even if intubated.
Immobilize with plaster slab
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

44. 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.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Glucagon prefered - otherwise massive dose of adrenaline.
Causes BAD constipation. Upsets fluid and electrolyte balance.

45. What are the other treatments for anaphylaxis?
Neurotoxins - procagulants. Rhabdomyolysins.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Calcium chloride
Give IM adrenaline - steroids - salbutamol - antihistamine.

46. Iron
Normally treated with sling alone. Seek advice.
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
Antidote is deferoxamine chelation. Charcoal is ineffective.
Abdo XRAY!!!! do it!

47. Iron
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
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
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
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

48. What are the three features of anaphylaxis
Cyanosis and irregular respiratory effort
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
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
Flurescence in ultraviolet light.

49. what makes you suspicious of non-accidental injury.
Antidote is naloxone.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Poisoning causes decreased cholinesterase activity.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

50. Sympathomimetics
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
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.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Collar and cuff. Check integrity of nerve.