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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. Displaced surgical neck of humerous
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
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 nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Normally treated with sling alone. Seek advice.

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

3. Methanol
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.

4. Carbon monoxide
Notify if abuse CONSIDERED. CONSIDERED.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker 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.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.

5. How do snake bites damage?
Munchausen's by proxy
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Neurotoxins - procagulants. Rhabdomyolysins.
Rash bronchospasm and hypotension.

6. Calcium channel blocker overdose antidote
Bone scan for occult fracture
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
Calcium chloride
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

7. Signs of psychological maltreatment?
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
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.
Munchausen's by proxy
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)

8. Amphetamine antidote
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Sling for 3 weeks - fracture clinic at 7 days.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Esmolol

9. Funnel web and red back
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
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
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.

10. Ethanol
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

11. What must you do before sending fracture to radiology?
Immobilize with plaster slab
Blood glucose level for hypoglycaemia!!
Aspiration Pneumonia
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

12. What are the special features that must be done to correct haemorrhagic shock.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Blood glucose level for hypoglycaemia!!
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

13. Organophosphates
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 salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Calcium chloride

14. Tricyclic antidepressants
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Discobalt edetate
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

15. What are the other treatments for anaphylaxis?
Flurescence in ultraviolet light.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Class of drugs encompassing decongestants - amphetamines - cocaine.
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. What are the three features of anaphylaxis
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Croup.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
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

17. Mx of petroleum overdose
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
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Release NEUROTOXINS both have antivenom
Immobilize with plaster slab

18. What investigations should you do in suspected child abuse
Bone scan for occult fracture
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Sling for 3 weeks - fracture clinic at 7 days.
Rash bronchospasm and hypotension.

19. Procainamide
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.
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.
IM adrenaline: vasopressor and bronchodilator.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

20. Lidocaine
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
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

21. Anticholinergics
Abdo XRAY!!!! do it!
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
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.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

22. Undisplaced radial shaft fracture
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Collar and cuff. Check integrity of nerve.
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 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.

23. Carbon monoxide
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Nausea vomiting and anorexia.

24. Anticholinergics
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Aspiration pneumonia even if intubated.
Notify if abuse CONSIDERED. CONSIDERED.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

25. Salicylates
Give steroids for management of serum sickness. Must do coagulation screen!!!
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.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

26. Oedema causing laryngeal obstruction?
Objective signs of growth - tidiness - weight -
Intubate - tracheostromy or nebulized adrenaline.
It can cause fatal bronchioloitis obliterans
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

27. Lead
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Normally treated with sling alone. Seek advice.
Croup.

28. Carbon monoxide
CHARCOAL! except for lithium - iron - alcohol - lead.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Digoxin Fab

29. Management of near drowning.
It can cause fatal bronchioloitis obliterans
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.
Nausea vomiting and anorexia.

30. Opiates
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Cyanosis and irregular respiratory effort
Antidote is naloxone.

31. Sympathomimetics
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Nausea vomiting and anorexia.
Class of drugs encompassing decongestants - amphetamines - cocaine.
It can cause fatal bronchioloitis obliterans

32. Tricyclic antidepressants overdose
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Flurescence in ultraviolet light.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

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

34. 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!
Nausea vomiting and anorexia.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

35. What is the general management of poisoning?
Neurosurgery if trauma. Give mannitol.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
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.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.

36. What is gastric lavage?
Digoxin Fab
... blood sugars for hypoglycaemia
Stomach pumping.
Blood glucose level for hypoglycaemia!!

37. Iron
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 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
'I WOULD CALL POISON HOTLINE'.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

38. Epinephrine
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
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
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Aspiration pneumonia even if intubated.

39. Ethylene glycol
Objective signs of growth - tidiness - weight -
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

40. Signs of abuse from the history
IM adrenaline: vasopressor and bronchodilator.
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 irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

41. Ibuprofen
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Abdo XRAY!!!! do it!
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
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

42. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
Skin or vascular compromise
Munchausen's by proxy
Aspiration pneumonia even if intubated.
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

43. What psychiatric disease defined as childabuse?

44. 20
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

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.
... blood sugars for hypoglycaemia
Give IM adrenaline - steroids - salbutamol - antihistamine.
Calcium chloride

46. How may you detect semen?
Bone scan for occult fracture
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Flurescence in ultraviolet light.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

47. What happens if charcoal is aspirated?
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
It can cause fatal bronchioloitis obliterans
CHARCOAL! except for lithium - iron - alcohol - lead.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.

48. A child has swallowed a battery. Mx
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 delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Severe illness - past history of injuries - 18 months or less - inconstent story.

49. What are the terminal signs of acute laryngeal obstruction?
Cyanosis and irregular respiratory effort
IM adrenaline: vasopressor and bronchodilator.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Neurosurgery if trauma. Give mannitol.

50. What else is in the management of snake bite?
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Give steroids for management of serum sickness. Must do coagulation screen!!!
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
'I WOULD CALL POISON HOTLINE'.