Test your basic knowledge |

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 the most important investigation in suspected alcohol poisoning in young person?
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Antidotes are atropine sulfate and pralidoxime chloride.
IM adrenaline: vasopressor and bronchodilator.
Blood glucose level for hypoglycaemia!!

2. What is the most important treatment for anaphylaxis
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
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
IM adrenaline: vasopressor and bronchodilator.
Blood glucose level for hypoglycaemia!!

3. Ethylene glycol
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Nausea vomiting and anorexia.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Severe illness - past history of injuries - 18 months or less - inconstent story.

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

5. Organophosphates
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Poisoning causes decreased cholinesterase activity.
Aspiration pneumonia even if intubated.
Neurosurgery if trauma. Give mannitol.

6. A child has swallowed a battery. Mx
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Intubate - tracheostromy or nebulized adrenaline.

7. Iron
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Intubate - tracheostromy or nebulized adrenaline.

8. Atropine
Flumazenil
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.

9. Anticholinergics
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Glucagon prefered - otherwise massive dose of adrenaline.

10. Cyanide
Neurosurgery if trauma. Give mannitol.
Discobalt edetate
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.

11. Ethylene glycol
Neurosurgery if trauma. Give mannitol.
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
Blood glucose level for hypoglycaemia!!

12. What are the side effects of N-acety-p-benzoquinine?
Rash bronchospasm and hypotension.
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.
Flurescence in ultraviolet light.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

13. Salicylates
Flumazenil
Before a child can be examined for child abuse - a parent or legal guardian must give consent
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.

14. Opiates
Antidote is naloxone.
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
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

15. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
Glucagon prefered - otherwise massive dose of adrenaline.
Aspiration pneumonia even if intubated.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.

16. Tricyclic antidepressants
Before a child can be examined for child abuse - a parent or legal guardian must give consent
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
Esmolol
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

17. Funnel web and red back
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 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.
Release NEUROTOXINS both have antivenom
Give IM adrenaline - steroids - salbutamol - antihistamine.

18. Epinephrine
Cyanosis and irregular respiratory effort
Intubate - tracheostromy or nebulized adrenaline.
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.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.

19. When and how would you do whole bowel irrigation?
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

20. What must you do before sending fracture to radiology?
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Immobilize with plaster slab
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 irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

21. Anticholinergics
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Flurescence in ultraviolet light.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Notify if abuse CONSIDERED. CONSIDERED.

22. Mx of petroleum overdose
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Croup.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

23. Opiates
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Antidotes are atropine sulfate and pralidoxime chloride.

24. Signs of psychological maltreatment?
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.
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 -
Nausea vomiting and anorexia.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

25. Organophosphates
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
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.

26. Ethanol
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
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 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

27. Sympathomimetics
Neurotoxins - procagulants. Rhabdomyolysins.
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.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Class of drugs encompassing decongestants - amphetamines - cocaine.

28. What investigations should you do in suspected child abuse
Bone scan for occult fracture
Lead poisoning is defined as a serum level greater than ___ ug/dL.
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 -
Munchausen's by proxy

29. Legal requirement in childabuse
Aspiration pneumonia even if intubated.
Notify if abuse CONSIDERED. CONSIDERED.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
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 -

30. 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.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Stomach pumping.

31. Calcium channel blocker overdose antidote
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Calcium chloride
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Notify if abuse CONSIDERED. CONSIDERED.

32. Sympathomimetics
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.

33. What else is in the management of snake bite?
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Poisoning causes decreased cholinesterase activity.
Give steroids for management of serum sickness. Must do coagulation screen!!!
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

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

35. Salicylates
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.

36. How may you detect semen?
Flurescence in ultraviolet light.
Neurotoxins - procagulants. Rhabdomyolysins.
Poisoning causes decreased cholinesterase activity.
Causes BAD constipation. Upsets fluid and electrolyte balance.

37. What is the general management of poisoning?
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
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. 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.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Munchausen's by proxy

39. What happens if charcoal is aspirated?
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Discobalt edetate
It can cause fatal bronchioloitis obliterans

40. Which is better - activated charcoal or gastric lavage.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
CHARCOAL! except for lithium - iron - alcohol - lead.
Immobilize with plaster slab
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.

41. What is one of the technicalities of childabuse.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Calcium chloride
Abdo XRAY!!!! do it!
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

42. Calcium gluconate
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Poisoning causes decreased cholinesterase activity.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.

43. Carbon monoxide
Antidote is deferoxamine chelation. Charcoal is ineffective.
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 treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

44. Methanol
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

45. You must consider abuse in
Severe illness - past history of injuries - 18 months or less - inconstent story.
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
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 causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

46. Middle Clavicle fracture management?
Croup.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Before a child can be examined for child abuse - a parent or legal guardian must give consent

47. What evidence should a doctor give about parental neglect
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
Aspiration Pneumonia
Objective signs of growth - tidiness - weight -
Bone scan for occult fracture

48. OSCE: What are the five princples of discharging a patient with a fracture?
Antidote is deferoxamine chelation. Charcoal is ineffective.
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 -
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

49. Tricyclic antidepressants overdose
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
CHARCOAL! except for lithium - iron - alcohol - lead.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

50. Beta-blocker overdose antidote
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Glucagon prefered - otherwise massive dose of adrenaline.
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 salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.