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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. Salicylates
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
... blood sugars for hypoglycaemia
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Croup.

2. Carbon monoxide
Aspiration Pneumonia
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

3. What are the three features of anaphylaxis
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
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
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Calcium chloride

4. When is gastric lavage indicated and contraindicated?
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Immobilize with plaster slab
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.

5. OSCE: how can i prevent accidents in my children
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Croup.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
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. Acetaminophen
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Cyanosis and irregular respiratory effort
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
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

7. Calcium gluconate
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
Collar and cuff. Check integrity of nerve.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

8. Organophosphates
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 salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Antidote is deferoxamine chelation. Charcoal is ineffective.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

9. What is the most important treatment for anaphylaxis
Aspiration Pneumonia
Intubate - tracheostromy or nebulized adrenaline.
IM adrenaline: vasopressor and bronchodilator.
Ceftriaxone

10. What are the side effects of N-acety-p-benzoquinine?
Rash bronchospasm and hypotension.
It can cause fatal bronchioloitis obliterans
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 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

11. Mx of snake bit
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 bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

12. Lidocaine
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
Bone scan for occult fracture
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
... blood sugars for hypoglycaemia

13. What is the general management of poisoning?
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Normally treated with sling alone. Seek advice.

14. Management of septicaemia shock

15. What happens if charcoal is aspirated?
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
It can cause fatal bronchioloitis obliterans
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

16. When is reduction required in fracture?
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Cyanosis and irregular respiratory effort
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.
Skin or vascular compromise

17. What investigations should you do in suspected child abuse
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
Bone scan for occult fracture
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Give steroids for management of serum sickness. Must do coagulation screen!!!

18. Carbon monoxide
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Glucagon prefered - otherwise massive dose of adrenaline.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
'I WOULD CALL POISON HOTLINE'.

19. What must you do before sending fracture to radiology?
Immobilize with plaster slab
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Ceftriaxone
Blood glucose level for hypoglycaemia!!

20. What evidence should a doctor give about parental neglect
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.
Croup.
Objective signs of growth - tidiness - weight -
Discobalt edetate

21. Anticholinergics
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Flumazenil
Release NEUROTOXINS both have antivenom
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

22. Adenosine
Nausea vomiting and anorexia.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

23. Signs of abuse from the history
Give steroids for management of serum sickness. Must do coagulation screen!!!
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 -
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

24. Beta-blocker overdose antidote
Glucagon prefered - otherwise massive dose of adrenaline.
Immobilize with plaster slab
Severe illness - past history of injuries - 18 months or less - inconstent story.
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.

25. What is an important point to note about anaphylaxis?
Digoxin Fab
Notify if abuse CONSIDERED. CONSIDERED.
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 -
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

26. Legal requirement in childabuse
Notify if abuse CONSIDERED. CONSIDERED.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Croup.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

27. Oedema causing laryngeal obstruction?
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Rash bronchospasm and hypotension.
Intubate - tracheostromy or nebulized adrenaline.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

28. Undisplaced surgical neck of humerous?
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
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.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Sling for 3 weeks - fracture clinic at 7 days.

29. Mx of petroleum overdose
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.
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.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
IM adrenaline: vasopressor and bronchodilator.

30. OSCE: What are the five princples of discharging a patient with a fracture?
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.

31. Salicylates
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
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 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.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

32. Epinephrine
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
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Give steroids for management of serum sickness. Must do coagulation screen!!!

33. Ingesting Petrol. Cx?
Objective signs of growth - tidiness - weight -
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.
Aspiration Pneumonia
Munchausen's by proxy

34. What are the terminal signs of acute laryngeal obstruction?
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.
Cyanosis and irregular respiratory effort
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.

35. Lead
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

36. Methanol
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Skin or vascular compromise
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

37. What is gastric lavage?
Stomach pumping.
Neurotoxins - procagulants. Rhabdomyolysins.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

38. What is a side effect of charcoal?
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
Causes BAD constipation. Upsets fluid and electrolyte balance.
Antidotes are atropine sulfate and pralidoxime chloride.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

39. Opiates
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Calcium chloride
Blood glucose level for hypoglycaemia!!

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

41. What is the most appropriate examination in a child with suspected lead ingestion?
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Abdo XRAY!!!! do it!
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Intubate - tracheostromy or nebulized adrenaline.

42. Calcium channel blocker overdose antidote
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.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Flumazenil
Calcium chloride

43. Sympathomimetics
Causes BAD constipation. Upsets fluid and electrolyte balance.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Glucagon prefered - otherwise massive dose of adrenaline.

44. You must consider abuse in
Neurotoxins - procagulants. Rhabdomyolysins.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Poisoning causes decreased cholinesterase activity.
Severe illness - past history of injuries - 18 months or less - inconstent story.

45. what makes you suspicious of non-accidental injury.
Immobilize with plaster slab
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.
Skin or vascular compromise
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

46. Signs of psychological maltreatment?
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Calcium 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.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

47. Organophosphates antidotes
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Neurotoxins - procagulants. Rhabdomyolysins.
Antidotes are atropine sulfate and pralidoxime chloride.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)

48. Mx of critical asthma
Flumazenil
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Croup.

49. What are the special features that must be done to correct haemorrhagic shock.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
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
Croup.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.

50. Funnel web and red back
Aspiration Pneumonia
Release NEUROTOXINS both have antivenom
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.