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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. Lidocaine
Aspiration Pneumonia
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Esmolol
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.

2. Salicylates
Neurotoxins - procagulants. Rhabdomyolysins.
Skin or vascular compromise
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
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.

3. What is one of the technicalities of childabuse.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
... blood sugars for hypoglycaemia
CHARCOAL! except for lithium - iron - alcohol - lead.
Before a child can be examined for child abuse - a parent or legal guardian must give consent

4. Acetaminophen
Digoxin Fab
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Flurescence in ultraviolet light.
Ceftriaxone

5. Lead
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.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Collar and cuff. Check integrity of nerve.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

6. Ethanol
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Digoxin Fab
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

7. What psychiatric disease defined as childabuse?

8. Methanol
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.
CHARCOAL! except for lithium - iron - alcohol - lead.
Flurescence in ultraviolet light.
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.

9. Amiodarone
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
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 IM adrenaline - steroids - salbutamol - antihistamine.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.

10. What is a side effect of charcoal?
Bone scan for occult fracture
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Causes BAD constipation. Upsets fluid and electrolyte balance.
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.

11. Carbon monoxide
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Stomach pumping.

12. 20
Collar and cuff. Check integrity of nerve.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Flumazenil
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

13. Iron
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.
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 lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

14. Beta-blocker overdose antidote
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Glucagon prefered - otherwise massive dose of adrenaline.
Antidote is naloxone.
Bone scan for occult fracture

15. Management of near drowning.
Objective signs of growth - tidiness - weight -
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
Digoxin Fab
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

16. Sympathomimetics
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
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.

17. What else is in the management of snake bite?
'I WOULD CALL POISON HOTLINE'.
Intubate - tracheostromy or nebulized adrenaline.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Give steroids for management of serum sickness. Must do coagulation screen!!!

18. Organophosphates
Poisoning causes decreased cholinesterase activity.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
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 -
Cyanosis and irregular respiratory effort

19. What is the first line investigation in a young child who has consumed alcohol?
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Normally treated with sling alone. Seek advice.
Antidote is deferoxamine chelation. Charcoal is ineffective.
... blood sugars for hypoglycaemia

20. Mx of critical asthma
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
'I WOULD CALL POISON HOTLINE'.
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.

21. What is the most common caUse of acute laryngeal obstruction?
Croup.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
CHARCOAL! except for lithium - iron - alcohol - lead.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.

22. Carbon monoxide
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
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 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
Give steroids for management of serum sickness. Must do coagulation screen!!!

23. Anticholinergics
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Stomach pumping.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Blood glucose level for hypoglycaemia!!

24. Signs of psychological maltreatment?
Antidotes are atropine sulfate and pralidoxime chloride.
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.
Flumazenil
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.

25. Methanol
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.
Normally treated with sling alone. Seek advice.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

26. Procainamide
Class of drugs encompassing decongestants - amphetamines - cocaine.
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.
... blood sugars for hypoglycaemia
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

27. Mx raised intracranial pressure.
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 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
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
Neurosurgery if trauma. Give mannitol.

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

29. what makes you suspicious of non-accidental injury.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Sling for 3 weeks - fracture clinic at 7 days.
Aspiration pneumonia even if intubated.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

30. What evidence should a doctor give about parental neglect
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Objective signs of growth - tidiness - weight -
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Calcium chloride

31. What happens if charcoal is aspirated?
It can cause fatal bronchioloitis obliterans
CHARCOAL! except for lithium - iron - alcohol - lead.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Skin or vascular compromise

32. What is an important point to note about anaphylaxis?
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
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 -
Cyanosis and irregular respiratory effort
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.

33. Benzodiazepine overdose antidote
Rash bronchospasm and hypotension.
Flumazenil
Aspiration Pneumonia
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

34. Epinephrine
... blood sugars for hypoglycaemia
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
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 -
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.

35. Legal requirement in childabuse
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Notify if abuse CONSIDERED. CONSIDERED.
Croup.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.

36. What are the three features of anaphylaxis
Collar and cuff. Check integrity of nerve.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Esmolol

37. Signs of abuse from the history
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
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Digoxin Fab
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.

38. What are the early symptoms of paracetamol overdose?
Causes BAD constipation. Upsets fluid and electrolyte balance.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Nausea vomiting and anorexia.

39. 45; 70
Bone scan for occult fracture
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 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.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

40. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Collar and cuff. Check integrity of nerve.
Aspiration pneumonia even if intubated.
Immobilize with plaster slab

41. When is gastric lavage indicated and contraindicated?
Stomach pumping.
Abdo XRAY!!!! do it!
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
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.

42. Management of septicaemia shock

43. 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.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Notify if abuse CONSIDERED. CONSIDERED.

44. What is the antibiotic for Epiglottitis?
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
Ceftriaxone
Collar and cuff. Check integrity of nerve.
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

45. What is the most appropriate examination in a child with suspected lead ingestion?
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Poisoning causes decreased cholinesterase activity.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Abdo XRAY!!!! do it!

46. What must you do before sending fracture to radiology?
Glucagon prefered - otherwise massive dose of adrenaline.
Objective signs of growth - tidiness - weight -
Immobilize with plaster slab
Ceftriaxone

47. 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.
IM adrenaline: vasopressor and bronchodilator.
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

48. How do snake bites damage?
Neurotoxins - procagulants. Rhabdomyolysins.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
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.
Neurosurgery if trauma. Give mannitol.

49. Which is better - activated charcoal or gastric lavage.
CHARCOAL! except for lithium - iron - alcohol - lead.
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.
Antidote is naloxone.
Objective signs of growth - tidiness - weight -

50. Atropine
Neurotoxins - procagulants. Rhabdomyolysins.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Poisoning causes decreased cholinesterase activity.