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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. A child has swallowed a battery. Mx
Antidotes are atropine sulfate and pralidoxime chloride.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
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

2. What must you do before sending fracture to radiology?
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Immobilize with plaster slab
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Skin or vascular compromise

3. What is the most important investigation in suspected alcohol poisoning in young person?
Blood glucose level for hypoglycaemia!!
Class of drugs encompassing decongestants - amphetamines - cocaine.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Poisoning causes decreased cholinesterase activity.

4. Beta-blocker overdose antidote
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Ceftriaxone
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Glucagon prefered - otherwise massive dose of adrenaline.

5. Oedema causing laryngeal obstruction?
Intubate - tracheostromy or nebulized adrenaline.
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.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.

6. Sodium Bicarbonate
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

7. When and how would you do whole bowel irrigation?
Esmolol
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Antidotes are atropine sulfate and pralidoxime chloride.

8. Salicylates
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
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.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Antidote is deferoxamine chelation. Charcoal is ineffective.

9. Carbon monoxide
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Digoxin Fab
Poisoning causes decreased cholinesterase activity.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

10. Mx of snake bit
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Glucagon prefered - otherwise massive dose of adrenaline.
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.

11. What are the special features that must be done to correct haemorrhagic shock.
Antidote is naloxone.
Blood glucose level for hypoglycaemia!!
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
IM adrenaline: vasopressor and bronchodilator.

12. What is the most appropriate examination in a child with suspected lead ingestion?
Aspiration Pneumonia
Munchausen's by proxy
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Abdo XRAY!!!! do it!

13. What are the terminal signs of acute laryngeal obstruction?
Blood glucose level for hypoglycaemia!!
Cyanosis and irregular respiratory effort
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

14. 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.
... blood sugars for hypoglycaemia
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Objective signs of growth - tidiness - weight -

15. Ethanol
Glucagon prefered - otherwise massive dose of adrenaline.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Sling for 3 weeks - fracture clinic at 7 days.

16. What is the antibiotic for Epiglottitis?
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.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Ceftriaxone
Objective signs of growth - tidiness - weight -

17. You must consider abuse in
Severe illness - past history of injuries - 18 months or less - inconstent story.
Poisoning causes decreased cholinesterase activity.
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!!!

18. What is the most common caUse of acute laryngeal obstruction?
Croup.
Sling for 3 weeks - fracture clinic at 7 days.
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.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)

19. Mx of petroleum overdose
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
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.

20. Calcium channel blocker overdose antidote
Calcium chloride
Give IM adrenaline - steroids - salbutamol - antihistamine.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

21. What psychiatric disease defined as childabuse?

22. Iron
Causes BAD constipation. Upsets fluid and electrolyte balance.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Antidote is deferoxamine chelation. Charcoal is ineffective.

23. What else is in the management of snake bite?
Give steroids for management of serum sickness. Must do coagulation screen!!!
Calcium chloride
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.
Rash bronchospasm and hypotension.

24. Lead
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Normally treated with sling alone. Seek advice.

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

26. Undisplaced surgical neck of humerous?
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.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Sling for 3 weeks - fracture clinic at 7 days.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

27. What is the first line investigation in a young child who has consumed alcohol?
Poisoning causes decreased cholinesterase activity.
... blood sugars for hypoglycaemia
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
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.

28. What are the side effects of N-acety-p-benzoquinine?
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Sling for 3 weeks - fracture clinic at 7 days.
Rash bronchospasm and hypotension.
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.

29. What investigations should you do in suspected child abuse
Bone scan for occult fracture
Discobalt edetate
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Sling for 3 weeks - fracture clinic at 7 days.

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

31. what makes you suspicious of non-accidental injury.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Neurotoxins - procagulants. Rhabdomyolysins.
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.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

32. Funnel web and red back
Antidotes are atropine sulfate and pralidoxime chloride.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Release NEUROTOXINS both have antivenom
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

33. Sympathomimetics
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 tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Glucagon prefered - otherwise massive dose of adrenaline.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

34. Anticholinergics
Blood glucose level for hypoglycaemia!!
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Skin or vascular compromise

35. Calcium gluconate
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

36. Legal requirement in childabuse
Cyanosis and irregular respiratory effort
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.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)

37. Mx raised intracranial pressure.
Neurotoxins - procagulants. Rhabdomyolysins.
... blood sugars for hypoglycaemia
Neurosurgery if trauma. Give mannitol.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.

38. Procainamide
Skin or vascular compromise
Digoxin Fab
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.
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.

39. Carbon monoxide
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Cyanosis and irregular respiratory effort

40. 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.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Aspiration Pneumonia
Give IM adrenaline - steroids - salbutamol - antihistamine.

41. Opiates
Blood glucose level for hypoglycaemia!!
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

42. Acetaminophen
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 -
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)

43. How do snake bites damage?
Neurotoxins - procagulants. Rhabdomyolysins.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Croup.
Lead poisoning is defined as a serum level greater than ___ ug/dL.

44. Ethylene glycol
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
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

45. What is gastric lavage?
Stomach pumping.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

46. Mx severe croup
Esmolol
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
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Immobilize with plaster slab

47. Signs of abuse from the history
Aspiration pneumonia even if intubated.
Discobalt edetate
Stomach pumping.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

48. Management of septicaemia shock

49. Anticholinergics
'I WOULD CALL POISON HOTLINE'.
Sling for 3 weeks - fracture clinic at 7 days.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

50. 20
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Neurosurgery if trauma. Give mannitol.