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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. Theophylline
Flurescence in ultraviolet light.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
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
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

2. 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
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.
Intubate - tracheostromy or nebulized adrenaline.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

3. Salicylates
Digoxin Fab
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

4. When is reduction required in fracture?
Collar and cuff. Check integrity of nerve.
Normally treated with sling alone. Seek advice.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Skin or vascular compromise

5. What is the most important treatment for anaphylaxis
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
IM adrenaline: vasopressor and bronchodilator.

6. what makes you suspicious of non-accidental injury.
Antidotes are atropine sulfate and pralidoxime chloride.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

7. What psychiatric disease defined as childabuse?

8. How do snake bites damage?
Flumazenil
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 -
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
Neurotoxins - procagulants. Rhabdomyolysins.

9. When and how would you do whole bowel irrigation?
Normally treated with sling alone. Seek advice.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

10. What must you do before sending fracture to radiology?
Immobilize with plaster slab
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Blood glucose level for hypoglycaemia!!
Normally treated with sling alone. Seek advice.

11. Undisplaced radial shaft fracture
Collar and cuff. Check integrity of nerve.
'I WOULD CALL POISON HOTLINE'.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Release NEUROTOXINS both have antivenom

12. What are the side effects of N-acety-p-benzoquinine?
Sling for 3 weeks - fracture clinic at 7 days.
Intubate - tracheostromy or nebulized adrenaline.
Rash bronchospasm and hypotension.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)

13. You must consider abuse in
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Severe illness - past history of injuries - 18 months or less - inconstent story.
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.
IM adrenaline: vasopressor and bronchodilator.

14. Lead
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 irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Lead poisoning is defined as a serum level greater than ___ ug/dL.

15. Oedema causing laryngeal obstruction?
Intubate - tracheostromy or nebulized adrenaline.
Normally treated with sling alone. Seek advice.
Nausea vomiting and anorexia.
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

16. Calcium gluconate
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Nausea vomiting and anorexia.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Glucagon prefered - otherwise massive dose of adrenaline.

17. Undisplaced surgical neck of humerous?
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Aspiration pneumonia even if intubated.
Sling for 3 weeks - fracture clinic at 7 days.

18. Management of septicaemia shock

19. What is the most appropriate examination in a child with suspected lead ingestion?
Neurosurgery if trauma. Give mannitol.
Abdo XRAY!!!! do it!
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

20. Tricyclic antidepressants
Aspiration pneumonia even if intubated.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
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

21. Lidocaine
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.

22. Methanol
Aspiration pneumonia even if intubated.
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.
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 irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

23. Mx severe croup
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.
It can cause fatal bronchioloitis obliterans
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

24. Iron
Antidote is deferoxamine chelation. Charcoal is ineffective.
Collar and cuff. Check integrity of nerve.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Glucagon prefered - otherwise massive dose of adrenaline.

25. Adenosine
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
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
Glucagon prefered - otherwise massive dose of adrenaline.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

26. 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.
Glucagon prefered - otherwise massive dose of adrenaline.
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.

27. What evidence should a doctor give about parental neglect
Esmolol
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Objective signs of growth - tidiness - weight -
... blood sugars for hypoglycaemia

28. What are the three features of anaphylaxis
Discobalt edetate
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

29. Funnel web and red back
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Release NEUROTOXINS both have antivenom
'I WOULD CALL POISON HOTLINE'.
Antidotes are atropine sulfate and pralidoxime chloride.

30. Organophosphates
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Blood glucose level for hypoglycaemia!!
Poisoning causes decreased cholinesterase activity.

31. Sympathomimetics
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
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 lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Aspiration Pneumonia

32. What are the special features that must be done to correct haemorrhagic shock.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
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

33. Atropine
Munchausen's by proxy
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
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.

34. Epinephrine
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Poisoning causes decreased cholinesterase activity.
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.

35. Ethylene glycol
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Blood glucose level for hypoglycaemia!!
Cyanosis and irregular respiratory effort
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.

36. Middle Clavicle fracture management?
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Munchausen's by proxy
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

37. Anticholinergics
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
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
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.

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

39. Ethylene glycol
Flurescence in ultraviolet light.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
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.
... blood sugars for hypoglycaemia

40. What is the antibiotic for Epiglottitis?
Discobalt edetate
Objective signs of growth - tidiness - weight -
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Ceftriaxone

41. OSCE: what must you say you would do if someone is poisoned?

42. Acetaminophen
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
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.
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.

43. Opiates
Blood glucose level for hypoglycaemia!!
Calcium chloride
Collar and cuff. Check integrity of nerve.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

44. Mx of snake bit
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.
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
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.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

45. What is gastric lavage?
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Stomach pumping.
Neurotoxins - procagulants. Rhabdomyolysins.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

46. 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.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
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
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

47. 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
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
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 glucose level for hypoglycaemia!!

48. Sympathomimetics
Croup.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Immobilize with plaster slab

49. What happens if charcoal is aspirated?
Stomach pumping.
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
Antidotes are atropine sulfate and pralidoxime chloride.

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