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. Sympathomimetics
Blood glucose level for hypoglycaemia!!
Flurescence in ultraviolet light.
Antidotes are atropine sulfate and pralidoxime chloride.
Class of drugs encompassing decongestants - amphetamines - cocaine.

2. Signs of abuse from the history
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 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
Stomach pumping.
Flumazenil

3. Sympathomimetics
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.
Blood glucose level for hypoglycaemia!!
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.

4. Theophylline
Antidote is naloxone.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Nausea vomiting and anorexia.

5. Amiodarone
Aspiration Pneumonia
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.
Stomach pumping.
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.

6. Legal requirement in childabuse
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Notify if abuse CONSIDERED. CONSIDERED.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

7. What is the most important investigation in suspected alcohol poisoning in young person?
Give steroids for management of serum sickness. Must do coagulation screen!!!
Blood glucose level for hypoglycaemia!!
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.
It can cause fatal bronchioloitis obliterans

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

9. Management of septicaemia shock

10. Opiates
Antidote is naloxone.
Notify if abuse CONSIDERED. CONSIDERED.
Aspiration Pneumonia
Discobalt edetate

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

12. Beta-blocker overdose antidote
Glucagon prefered - otherwise massive dose of adrenaline.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
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 -
Sling for 3 weeks - fracture clinic at 7 days.

13. Middle Clavicle fracture management?
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
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.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

14. Which is better - activated charcoal or gastric lavage.
Bone scan for occult fracture
Discobalt edetate
CHARCOAL! except for lithium - iron - alcohol - lead.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

15. Undisplaced surgical neck of humerous?
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
... blood sugars for hypoglycaemia
Sling for 3 weeks - fracture clinic at 7 days.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.

16. What else is in the management of snake bite?
Bone scan for occult fracture
Give steroids for management of serum sickness. Must do coagulation screen!!!
Croup.
Aspiration Pneumonia

17. Mx raised intracranial pressure.
Skin or vascular compromise
Neurosurgery if trauma. Give mannitol.
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!!

18. Mx of snake bit
Normally treated with sling alone. Seek advice.
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 lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
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

19. Tricyclic antidepressants
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
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
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

20. When and how would you do whole bowel irrigation?
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.

21. Sodium Bicarbonate
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.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

22. Hydrocarbons
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.
Collar and cuff. Check integrity of nerve.
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 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

23. Opiates
Skin or vascular compromise
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
Causes BAD constipation. Upsets fluid and electrolyte balance.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

24. What are the other treatments for anaphylaxis?
'I WOULD CALL POISON HOTLINE'.
Flurescence in ultraviolet light.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.

25. Calcium gluconate
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
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.
Neurotoxins - procagulants. Rhabdomyolysins.

26. Digoxin antedote
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Digoxin Fab
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Cyanosis and irregular respiratory effort

27. Anticholinergics
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Aspiration Pneumonia
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

28. What investigations should you do in suspected child abuse
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.
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.
Bone scan for occult fracture
Glucagon prefered - otherwise massive dose of adrenaline.

29. When is gastric lavage indicated and contraindicated?
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
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.

30. Benzodiazepine overdose antidote
Poisoning causes decreased cholinesterase activity.
It can cause fatal bronchioloitis obliterans
Immobilize with plaster slab
Flumazenil

31. What evidence should a doctor give about parental neglect
Digoxin Fab
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Antidotes are atropine sulfate and pralidoxime chloride.
Objective signs of growth - tidiness - weight -

32. Management of near drowning.
Abdo XRAY!!!! do it!
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
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

33. What is the most common caUse of acute laryngeal obstruction?
Croup.
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
Skin or vascular compromise
It can cause fatal bronchioloitis obliterans

34. Anticholinergics
Aspiration pneumonia even if intubated.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Munchausen's by proxy
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

35. What is the first line investigation in a young child who has consumed alcohol?
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
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
... blood sugars for hypoglycaemia
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.

36. Methanol
Blood glucose level for hypoglycaemia!!
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.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.

37. How do snake bites damage?
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Release NEUROTOXINS both have antivenom
Neurotoxins - procagulants. Rhabdomyolysins.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

38. 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.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

39. Lead
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 with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
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.

40. Methanol
Intubate - tracheostromy or nebulized adrenaline.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Ceftriaxone
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

41. What are the three features of anaphylaxis
Esmolol
Rash bronchospasm and hypotension.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

42. When is reduction required in fracture?
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.
Skin or vascular compromise
It can cause fatal bronchioloitis obliterans
Before a child can be examined for child abuse - a parent or legal guardian must give consent

43. Mx severe croup
IM adrenaline: vasopressor and bronchodilator.
Stomach pumping.
Bone scan for occult fracture
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

44. Oedema causing laryngeal obstruction?
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
Intubate - tracheostromy or nebulized adrenaline.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)

45. Displaced surgical neck of humerous
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Aspiration Pneumonia
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Normally treated with sling alone. Seek advice.

46. Carbon monoxide
IM adrenaline: vasopressor and bronchodilator.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Poisoning causes decreased cholinesterase activity.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

47. OSCE: What are the five princples of discharging a patient with a fracture?
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
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
Objective signs of growth - tidiness - weight -
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.

48. Signs of psychological maltreatment?
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Poisoning causes decreased cholinesterase activity.
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 lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

49. What is the antibiotic for Epiglottitis?
Esmolol
Ceftriaxone
Normally treated with sling alone. Seek advice.
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.

50. Cyanide
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 -
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Discobalt edetate