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

2. How may you detect semen?
Flurescence in ultraviolet light.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Skin or vascular compromise
Abdo XRAY!!!! do it!

3. What is the first line investigation in a young child who has consumed alcohol?
Bone scan for occult fracture
Skin or vascular compromise
Sling for 3 weeks - fracture clinic at 7 days.
... blood sugars for hypoglycaemia

4. Mx of petroleum overdose
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.

5. What is a side effect of charcoal?
Normally treated with sling alone. Seek advice.
Munchausen's by proxy
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Causes BAD constipation. Upsets fluid and electrolyte balance.

6. What are the terminal signs of acute laryngeal obstruction?
Cyanosis and irregular respiratory effort
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.
Munchausen's by proxy

7. Iron
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
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 tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.

8. Amphetamine antidote
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Croup.
Esmolol
Blood glucose level for hypoglycaemia!!

9. Epinephrine
Flumazenil
Antidote is deferoxamine chelation. Charcoal is ineffective.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.

10. 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
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.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Skin or vascular compromise

11. Calcium channel blocker overdose antidote
Aspiration pneumonia even if intubated.
Calcium chloride
Esmolol
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

12. Lead
Intubate - tracheostromy or nebulized adrenaline.
Cyanosis and irregular respiratory effort
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 -
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

13. Undisplaced radial shaft fracture
Collar and cuff. Check integrity of nerve.
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.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Severe illness - past history of injuries - 18 months or less - inconstent story.

14. Ibuprofen
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 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
CHARCOAL! except for lithium - iron - alcohol - lead.
Cyanosis and irregular respiratory effort

15. Sympathomimetics
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.

16. Procainamide
Glucagon prefered - otherwise massive dose of adrenaline.
Stomach pumping.
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
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.

17. What is the most important investigation in suspected alcohol poisoning in young person?
Blood glucose level for hypoglycaemia!!
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Stomach pumping.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

18. How do snake bites damage?
Neurotoxins - procagulants. Rhabdomyolysins.
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 tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
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.

19. What is gastric lavage?
Aspiration pneumonia even if intubated.
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
Stomach pumping.
Give IM adrenaline - steroids - salbutamol - antihistamine.

20. Mx raised intracranial pressure.
Neurosurgery if trauma. Give mannitol.
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.
Digoxin Fab
Give IM adrenaline - steroids - salbutamol - antihistamine.

21. 20
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.
Flurescence in ultraviolet light.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Antidotes are atropine sulfate and pralidoxime chloride.

22. Funnel web and red back
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Antidotes are atropine sulfate and pralidoxime chloride.
Release NEUROTOXINS both have antivenom
Ceftriaxone

23. What are the early symptoms of paracetamol overdose?
Nausea vomiting and anorexia.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
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

24. Indications of non-accidental injury
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

25. Carbon monoxide
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Rash bronchospasm and hypotension.

26. Organophosphates antidotes
Neurotoxins - procagulants. Rhabdomyolysins.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Discobalt edetate
Antidotes are atropine sulfate and pralidoxime chloride.

27. Carbon monoxide
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
It can cause fatal bronchioloitis obliterans
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.
Ceftriaxone

28. What investigations should you do in suspected child abuse
Bone scan for occult fracture
Notify if abuse CONSIDERED. CONSIDERED.
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.
IM adrenaline: vasopressor and bronchodilator.

29. Opiates
It can cause fatal bronchioloitis obliterans
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

30. What else is in the management of snake bite?
Aspiration Pneumonia
Objective signs of growth - tidiness - weight -
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.
Give steroids for management of serum sickness. Must do coagulation screen!!!

31. Anticholinergics
Digoxin Fab
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Bone scan for occult fracture

32. What is the most important treatment for anaphylaxis
Antidotes are atropine sulfate and pralidoxime chloride.
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 -
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
IM adrenaline: vasopressor and bronchodilator.

33. Management of septicaemia shock

34. Signs of abuse from the history
IM adrenaline: vasopressor and bronchodilator.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

35. Salicylates
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.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Nausea vomiting and anorexia.
IM adrenaline: vasopressor and bronchodilator.

36. Anticholinergics
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
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.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.

37. Signs of psychological maltreatment?
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
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 tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
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.

38. Organophosphates
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Cyanosis and irregular respiratory effort
Poisoning causes decreased cholinesterase activity.

39. Mx severe croup
Bone scan for occult fracture
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

40. What evidence should a doctor give about parental neglect
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.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Collar and cuff. Check integrity of nerve.
Objective signs of growth - tidiness - weight -

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

42. Middle Clavicle fracture management?
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Glucagon prefered - otherwise massive dose of adrenaline.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

43. When is reduction required in fracture?
Skin or vascular compromise
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Sling for 3 weeks - fracture clinic at 7 days.
Intubate - tracheostromy or nebulized adrenaline.

44. what makes you suspicious of non-accidental injury.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Esmolol
Calcium chloride
Abdo XRAY!!!! do it!

45. You must consider abuse in
Intubate - tracheostromy or nebulized adrenaline.
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.
Bone scan for occult fracture
Severe illness - past history of injuries - 18 months or less - inconstent story.

46. Acetaminophen
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Nausea vomiting and anorexia.
Give IM adrenaline - steroids - salbutamol - antihistamine.

47. When and how would you do whole bowel irrigation?
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
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

48. A child has swallowed a battery. Mx
Bone scan for occult fracture
Antidote is deferoxamine chelation. Charcoal is ineffective.
Aspiration Pneumonia
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy

49. Ethanol
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Abdo XRAY!!!! do it!
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

50. Legal requirement in childabuse
Notify if abuse CONSIDERED. CONSIDERED.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Aspiration pneumonia even if intubated.
Collar and cuff. Check integrity of nerve.