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

2. Mx severe croup
Poisoning causes decreased cholinesterase activity.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

3. What are the three features of anaphylaxis
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
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
Skin or vascular compromise

4. Indications of non-accidental injury
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Stomach pumping.
IM adrenaline: vasopressor and bronchodilator.
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.

5. You must consider abuse in
Antidotes are atropine sulfate and pralidoxime chloride.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Severe illness - past history of injuries - 18 months or less - inconstent story.

6. Acetaminophen
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 nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Intubate - tracheostromy or nebulized adrenaline.
Flurescence in ultraviolet light.

7. Amphetamine antidote
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Blood glucose level for hypoglycaemia!!
Ceftriaxone
Esmolol

8. OSCE: how can i prevent accidents in my children
Nausea vomiting and anorexia.
Give IM adrenaline - steroids - salbutamol - antihistamine.
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
Immobilize with plaster slab

9. What is an important point to note about anaphylaxis?
Flurescence in ultraviolet light.
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 -
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
Digoxin Fab

10. Salicylates
Notify if abuse CONSIDERED. CONSIDERED.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
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.

11. Ethylene glycol
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.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

12. Sodium Bicarbonate
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Flumazenil
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.

13. What evidence should a doctor give about parental neglect
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Objective signs of growth - tidiness - weight -
IM adrenaline: vasopressor and bronchodilator.

14. Sympathomimetics
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Class of drugs encompassing decongestants - amphetamines - cocaine.
Flumazenil
Croup.

15. Hydrocarbons
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.
Immobilize with plaster slab
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.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

16. What is the most important investigation in suspected alcohol poisoning in young person?
Bone scan for occult fracture
Blood glucose level for hypoglycaemia!!
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
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.

17. what makes you suspicious of non-accidental injury.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
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.
Release NEUROTOXINS both have antivenom
Intubate - tracheostromy or nebulized adrenaline.

18. What else is in the management of snake bite?
Aspiration pneumonia even if intubated.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Neurotoxins - procagulants. Rhabdomyolysins.
Give steroids for management of serum sickness. Must do coagulation screen!!!

19. Iron
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Skin or vascular compromise
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

20. Anticholinergics
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Neurotoxins - procagulants. Rhabdomyolysins.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

21. Tricyclic antidepressants
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.
Glucagon prefered - otherwise massive dose of adrenaline.
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
Nausea vomiting and anorexia.

22. Oedema causing laryngeal obstruction?
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Intubate - tracheostromy or nebulized adrenaline.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.

23. Beta-blocker overdose antidote
Glucagon prefered - otherwise massive dose of adrenaline.
Notify if abuse CONSIDERED. CONSIDERED.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Cyanosis and irregular respiratory effort

24. Salicylates
Collar and cuff. Check integrity of nerve.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Severe illness - past history of injuries - 18 months or less - inconstent story.

25. What is the first line investigation in a young child who has consumed alcohol?
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
... blood sugars for hypoglycaemia
Immobilize with plaster slab
'I WOULD CALL POISON HOTLINE'.

26. Mx of petroleum overdose
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.

27. What is the most appropriate examination in a child with suspected lead ingestion?
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Abdo XRAY!!!! do it!

28. Calcium channel blocker overdose antidote
Calcium chloride
'I WOULD CALL POISON HOTLINE'.
Objective signs of growth - tidiness - weight -
Neurosurgery if trauma. Give mannitol.

29. Methanol
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.
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

30. Lead
Flumazenil
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

31. What is the antibiotic for Epiglottitis?
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.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Ceftriaxone

32. What investigations should you do in suspected child abuse
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Flumazenil
Bone scan for occult fracture

33. Calcium gluconate
Croup.
It can cause fatal bronchioloitis obliterans
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.

34. Atropine
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.
It can cause fatal bronchioloitis obliterans
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Class of drugs encompassing decongestants - amphetamines - cocaine.

35. Opiates
Rash bronchospasm and hypotension.
Antidote is naloxone.
Objective signs of growth - tidiness - weight -
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.

36. OSCE: What are the five princples of discharging a patient with a fracture?
Normally treated with sling alone. Seek advice.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
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.

37. What is the most important treatment for anaphylaxis
Ceftriaxone
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
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.

38. Tricyclic antidepressants overdose
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Flurescence in ultraviolet light.

39. 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.
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 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.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

40. 45; 70
Give steroids for management of serum sickness. Must do coagulation screen!!!
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
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
Croup.

41. When is reduction required in fracture?
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
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Skin or vascular compromise

42. What is gastric lavage?
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Stomach pumping.
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
Skin or vascular compromise

43. What psychiatric disease defined as childabuse?

44. What happens if charcoal is aspirated?
It can cause fatal bronchioloitis obliterans
Antidotes are atropine sulfate and pralidoxime chloride.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

45. How may you detect semen?
Bone scan for occult fracture
Digoxin Fab
Flurescence in ultraviolet light.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.

46. 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.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Calcium chloride
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.

47. Organophosphates antidotes
Immobilize with plaster slab
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Antidotes are atropine sulfate and pralidoxime chloride.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

48. 20
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Blood glucose level for hypoglycaemia!!
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Glucagon prefered - otherwise massive dose of adrenaline.

49. Legal requirement in childabuse
Bone scan for occult fracture
Notify if abuse CONSIDERED. CONSIDERED.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
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.

50. Anticholinergics
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
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.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.