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Pediatric Emergency Medicine

Subjects : health-sciences, pediatrics

Instructions:

Answer 50 questions in 15 minutes.
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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 are the side effects of N-acety-p-benzoquinine?
Digoxin Fab
Give IM adrenaline - steroids - salbutamol - antihistamine.
Rash bronchospasm and hypotension.
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

2. Undisplaced radial shaft fracture
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Collar and cuff. Check integrity of nerve.
Causes BAD constipation. Upsets fluid and electrolyte balance.

3. What is a side effect of charcoal?
Intubate - tracheostromy or nebulized adrenaline.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

4. Ethylene glycol
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
Neurotoxins - procagulants. Rhabdomyolysins.
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.
Discobalt edetate

5. Sympathomimetics
IM adrenaline: vasopressor and bronchodilator.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Poisoning causes decreased cholinesterase activity.
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.

6. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
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 tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Aspiration pneumonia even if intubated.
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

7. What is the first line investigation in a young child who has consumed alcohol?
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
... blood sugars for hypoglycaemia
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.
Class of drugs encompassing decongestants - amphetamines - cocaine.

8. What are the early symptoms of paracetamol overdose?
Nausea vomiting and anorexia.
Poisoning causes decreased cholinesterase activity.
Notify if abuse CONSIDERED. CONSIDERED.
Abdo XRAY!!!! do it!

9. Atropine
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

10. What are the terminal signs of acute laryngeal obstruction?
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Cyanosis and irregular respiratory effort
Intubate - tracheostromy or nebulized adrenaline.

11. Methanol
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
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.
Nausea vomiting and anorexia.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

12. Which is better - activated charcoal or gastric lavage.
Intubate - tracheostromy or nebulized adrenaline.
CHARCOAL! except for lithium - iron - alcohol - lead.
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

13. Acetaminophen
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Flurescence in ultraviolet light.
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

14. When and how would you do whole bowel irrigation?
Give IM adrenaline - steroids - salbutamol - antihistamine.
Stomach pumping.
Immobilize with plaster slab
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.

15. What is one of the technicalities of childabuse.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Stomach pumping.
Aspiration pneumonia even if intubated.

16. What is an important point to note about anaphylaxis?
Ceftriaxone
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 -
Glucagon prefered - otherwise massive dose of adrenaline.
Intubate - tracheostromy or nebulized adrenaline.

17. Mx of critical asthma
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Bone scan for occult fracture
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Nausea vomiting and anorexia.

18. Mx severe croup
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
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
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

19. Opiates
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Poisoning causes decreased cholinesterase activity.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

20. Benzodiazepine overdose antidote
Esmolol
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
Give steroids for management of serum sickness. Must do coagulation screen!!!
Flumazenil

21. What is the most common caUse of acute laryngeal obstruction?
Immobilize with plaster slab
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Croup.
It can cause fatal bronchioloitis obliterans

22. Ingesting Petrol. Cx?
Aspiration Pneumonia
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Rash bronchospasm and hypotension.
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.

23. Salicylates
Skin or vascular compromise
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Neurosurgery if trauma. Give mannitol.

24. Beta-blocker overdose antidote
Ceftriaxone
Glucagon prefered - otherwise massive dose of adrenaline.
Blood glucose level for hypoglycaemia!!
Neurotoxins - procagulants. Rhabdomyolysins.

25. 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.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Severe illness - past history of injuries - 18 months or less - inconstent story.

26. Amphetamine antidote
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.
Esmolol
Glucagon prefered - otherwise massive dose of adrenaline.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

27. Anticholinergics
Antidotes are atropine sulfate and pralidoxime chloride.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Ceftriaxone
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

28. Organophosphates
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Release NEUROTOXINS both have antivenom
It can cause fatal bronchioloitis obliterans
Poisoning causes decreased cholinesterase activity.

29. Cyanide
Flurescence in ultraviolet light.
Discobalt edetate
Neurotoxins - procagulants. Rhabdomyolysins.
Intubate - tracheostromy or nebulized adrenaline.

30. Anticholinergics
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Ceftriaxone
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

31. 20
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Lead poisoning is defined as a serum level greater than ___ ug/dL.
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

32. Calcium gluconate
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Poisoning causes decreased cholinesterase activity.

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

34. How do snake bites damage?
Flurescence in ultraviolet light.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
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.
Neurotoxins - procagulants. Rhabdomyolysins.

35. What must you do before sending fracture to radiology?
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.
Immobilize with plaster slab
Nausea vomiting and anorexia.
Stomach pumping.

36. Iron
Antidote is deferoxamine chelation. Charcoal is ineffective.
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 -
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.

37. Management of near drowning.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
IM adrenaline: vasopressor and bronchodilator.
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
Glucagon prefered - otherwise massive dose of adrenaline.

38. Mx raised intracranial pressure.
Neurosurgery if trauma. Give mannitol.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Rash bronchospasm and hypotension.

39. How may you detect semen?
Calcium chloride
Flurescence in ultraviolet light.
Abdo XRAY!!!! do it!
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

40. What evidence should a doctor give about parental neglect
... blood sugars for hypoglycaemia
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.
Objective signs of growth - tidiness - weight -
Antidote is naloxone.

41. Signs of abuse from the history
Antidote is deferoxamine chelation. Charcoal is ineffective.
Normally treated with sling alone. Seek advice.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Severe illness - past history of injuries - 18 months or less - inconstent story.

42. Salicylates
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Normally treated with sling alone. Seek advice.
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.

43. Carbon monoxide
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
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 tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

44. Carbon monoxide
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Antidotes are atropine sulfate and pralidoxime chloride.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

45. Acetaminophen
Collar and cuff. Check integrity of nerve.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Intubate - tracheostromy or nebulized adrenaline.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

46. Tricyclic antidepressants
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
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
Notify if abuse CONSIDERED. CONSIDERED.
Ceftriaxone

47. Middle Clavicle fracture management?
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
Objective signs of growth - tidiness - weight -
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

48. 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.
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
Notify if abuse CONSIDERED. CONSIDERED.
Aspiration Pneumonia

49. Displaced surgical neck of humerous
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Neurosurgery if trauma. Give mannitol.
Normally treated with sling alone. Seek advice.

50. Management of septicaemia shock