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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. How may you detect semen?
Flurescence in ultraviolet light.
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.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Neurosurgery if trauma. Give mannitol.

2. What is gastric lavage?
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.
Stomach pumping.
Before a child can be examined for child abuse - a parent or legal guardian must give consent

3. What is the general management of poisoning?
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
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.
Discobalt edetate
Blood glucose level for hypoglycaemia!!

4. Mx raised intracranial pressure.
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
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.
Class of drugs encompassing decongestants - amphetamines - cocaine.

5. Management of near drowning.
Ceftriaxone
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
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

6. Beta-blocker overdose antidote
Glucagon prefered - otherwise massive dose of adrenaline.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy

7. Salicylates
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 treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
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
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.

8. Anticholinergics
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.

9. Sodium Bicarbonate
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Ceftriaxone

10. When and how would you do whole bowel irrigation?
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Cyanosis and irregular respiratory effort
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Rash bronchospasm and hypotension.

11. What are the side effects of N-acety-p-benzoquinine?
Antidote is naloxone.
Neurotoxins - procagulants. Rhabdomyolysins.
Rash bronchospasm and hypotension.
Cyanosis and irregular respiratory effort

12. Acetaminophen
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 tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Neurotoxins - procagulants. Rhabdomyolysins.

13. Calcium channel blocker overdose antidote
Causes BAD constipation. Upsets fluid and electrolyte balance.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Flurescence in ultraviolet light.
Calcium chloride

14. Which is better - activated charcoal or gastric lavage.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
CHARCOAL! except for lithium - iron - alcohol - lead.
IM adrenaline: vasopressor and bronchodilator.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

15. Amphetamine antidote
Immobilize with plaster slab
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Esmolol
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)

16. Methanol
Munchausen's by proxy
Poisoning causes decreased cholinesterase activity.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Intubate - tracheostromy or nebulized adrenaline.

17. Organophosphates antidotes
Antidotes are atropine sulfate and pralidoxime chloride.
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.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Sling for 3 weeks - fracture clinic at 7 days.

18. Opiates
Objective signs of growth - tidiness - weight -
Bone scan for occult fracture
Antidote is naloxone.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

19. Displaced surgical neck of humerous
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Discobalt edetate
Objective signs of growth - tidiness - weight -
Normally treated with sling alone. Seek advice.

20. Calcium gluconate
Notify if abuse CONSIDERED. CONSIDERED.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Poisoning causes decreased cholinesterase activity.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

21. What is the first line investigation in a young child who has consumed alcohol?
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
... blood sugars for hypoglycaemia
Notify if abuse CONSIDERED. CONSIDERED.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

22. Sympathomimetics
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
It can cause fatal bronchioloitis obliterans

23. Undisplaced surgical neck of humerous?
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 delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Abdo XRAY!!!! do it!

24. Legal requirement in childabuse
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
Notify if abuse CONSIDERED. CONSIDERED.
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

25. Undisplaced radial shaft fracture
Neurotoxins - procagulants. Rhabdomyolysins.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Collar and cuff. Check integrity of nerve.
Severe illness - past history of injuries - 18 months or less - inconstent story.

26. 45; 70
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
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
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
Aspiration Pneumonia

27. Theophylline
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

28. Tricyclic antidepressants overdose
Intubate - tracheostromy or nebulized adrenaline.
Class of drugs encompassing decongestants - amphetamines - cocaine.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Cyanosis and irregular respiratory effort

29. Sympathomimetics
Calcium chloride
Class of drugs encompassing decongestants - amphetamines - cocaine.
Skin or vascular compromise
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)

30. Iron
Esmolol
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.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Croup.

31. Funnel web and red back
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
Discobalt edetate
Release NEUROTOXINS both have antivenom
... blood sugars for hypoglycaemia

32. What are the three features of anaphylaxis
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Nausea vomiting and anorexia.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

33. Salicylates
CHARCOAL! except for lithium - iron - alcohol - lead.
Antidotes are atropine sulfate and pralidoxime chloride.
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 treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

34. Mx of critical asthma
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
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.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

35. Middle Clavicle fracture management?
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

36. Carbon monoxide
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Digoxin Fab
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Aspiration pneumonia even if intubated.

37. You must consider abuse in
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
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
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Severe illness - past history of injuries - 18 months or less - inconstent story.

38. Atropine
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Severe illness - past history of injuries - 18 months or less - inconstent story.
It can cause fatal bronchioloitis obliterans
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

39. What is one of the technicalities of childabuse.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Esmolol
Before a child can be examined for child abuse - a parent or legal guardian must give consent
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

40. Management of septicaemia shock

41. Cyanide
Flumazenil
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Skin or vascular compromise
Discobalt edetate

42. Lidocaine
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
It can cause fatal bronchioloitis obliterans
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.

43. Indications of non-accidental injury
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
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
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Bone scan for occult fracture

44. Organophosphates
Poisoning causes decreased cholinesterase activity.
Nausea vomiting and anorexia.
Give IM adrenaline - steroids - salbutamol - antihistamine.
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.

45. What is the antibiotic for Epiglottitis?
Aspiration Pneumonia
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Ceftriaxone
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

46. What are the other treatments for anaphylaxis?
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Bone scan for occult fracture
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
Give IM adrenaline - steroids - salbutamol - antihistamine.

47. What are the early symptoms of paracetamol overdose?
Aspiration pneumonia even if intubated.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Croup.
Nausea vomiting and anorexia.

48. 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.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Objective signs of growth - tidiness - weight -
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

49. What evidence should a doctor give about parental neglect
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Objective signs of growth - tidiness - weight -
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 -

50. Hydrocarbons
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.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
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.