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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. Signs of psychological maltreatment?
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.
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
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

2. Methanol
Flumazenil
Collar and cuff. Check integrity of nerve.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.

3. Sodium Bicarbonate
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
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.
It can cause fatal bronchioloitis obliterans

4. Mx of petroleum overdose
Causes BAD constipation. Upsets fluid and electrolyte balance.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Collar and cuff. Check integrity of nerve.

5. Anticholinergics
Objective signs of growth - tidiness - weight -
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Flumazenil
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

6. What are the special features that must be done to correct haemorrhagic shock.
Aspiration Pneumonia
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Normally treated with sling alone. Seek advice.

7. Carbon monoxide
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.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Poisoning causes decreased cholinesterase activity.
Antidotes are atropine sulfate and pralidoxime chloride.

8. Organophosphates
Notify if abuse CONSIDERED. CONSIDERED.
Poisoning causes decreased cholinesterase activity.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

9. Anticholinergics
Ceftriaxone
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Aspiration pneumonia even if intubated.

10. What are the side effects of N-acety-p-benzoquinine?
Rash bronchospasm and hypotension.
Glucagon prefered - otherwise massive dose of adrenaline.
Digoxin Fab
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.

11. What are the early symptoms of paracetamol overdose?
Esmolol
Nausea vomiting and anorexia.
Skin or vascular compromise
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.

12. Calcium gluconate
Flumazenil
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

13. Sympathomimetics
Class of drugs encompassing decongestants - amphetamines - cocaine.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Severe illness - past history of injuries - 18 months or less - inconstent story.

14. Sympathomimetics
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Flumazenil
Stomach pumping.

15. When and how would you do whole bowel irrigation?
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Objective signs of growth - tidiness - weight -
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Collar and cuff. Check integrity of nerve.

16. Displaced surgical neck of humerous
Croup.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Objective signs of growth - tidiness - weight -
Normally treated with sling alone. Seek advice.

17. Salicylates
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
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

18. Legal requirement in childabuse
Notify if abuse CONSIDERED. CONSIDERED.
Discobalt edetate
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 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 -

19. Calcium channel blocker overdose antidote
Immobilize with plaster slab
Calcium chloride
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

20. What is a side effect of charcoal?
Causes BAD constipation. Upsets fluid and electrolyte balance.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Stomach pumping.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.

21. What is the most important investigation in suspected alcohol poisoning in young person?
Blood glucose level for hypoglycaemia!!
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
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

22. Digoxin antedote
Stomach pumping.
Digoxin Fab
Sling for 3 weeks - fracture clinic at 7 days.
Rash bronchospasm and hypotension.

23. Salicylates
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
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.
Flurescence in ultraviolet light.

24. Tricyclic antidepressants overdose
Causes BAD constipation. Upsets fluid and electrolyte balance.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Skin or vascular compromise

25. 20
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
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.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
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

26. Carbon monoxide
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
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
Skin or vascular compromise

27. Undisplaced radial shaft fracture
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 naloxone.
Collar and cuff. Check integrity of nerve.
Skin or vascular compromise

28. Ethylene glycol
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.
Flumazenil
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

29. Ethylene glycol
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 delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

30. Carbon monoxide
Class of drugs encompassing decongestants - amphetamines - cocaine.
Notify if abuse CONSIDERED. CONSIDERED.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.

31. Management of septicaemia shock

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32. Which is better - activated charcoal or gastric lavage.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
CHARCOAL! except for lithium - iron - alcohol - lead.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Munchausen's by proxy

33. Iron
Stomach pumping.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
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
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

34. A child has swallowed a battery. Mx
Antidotes are atropine sulfate and pralidoxime chloride.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Causes BAD constipation. Upsets fluid and electrolyte balance.
Calcium chloride

35. Iron
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Ceftriaxone
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

36. Opiates
Collar and cuff. Check integrity of nerve.
Antidote is naloxone.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
It can cause fatal bronchioloitis obliterans

37. Adenosine
Antidote is deferoxamine chelation. Charcoal is ineffective.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
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.
Give steroids for management of serum sickness. Must do coagulation screen!!!

38. What is one of the technicalities of childabuse.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
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
Before a child can be examined for child abuse - a parent or legal guardian must give consent

39. Amiodarone
Normally treated with sling alone. Seek advice.
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.
Intubate - tracheostromy or nebulized adrenaline.
Poisoning causes decreased cholinesterase activity.

40. What happens if charcoal is aspirated?
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
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.
Antidote is naloxone.

41. What is an important point to note about anaphylaxis?
'I WOULD CALL POISON HOTLINE'.
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 -
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.

42. Ethanol
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Abdo XRAY!!!! do it!
Cyanosis and irregular respiratory effort
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.

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

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44. Indications of non-accidental injury
Esmolol
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

45. Ibuprofen
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
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
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.
Before a child can be examined for child abuse - a parent or legal guardian must give consent

46. What investigations should you do in suspected child abuse
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Bone scan for occult fracture
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Skin or vascular compromise

47. Ingesting Petrol. Cx?
Aspiration Pneumonia
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Ceftriaxone
Esmolol

48. Theophylline
Rash bronchospasm and hypotension.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Digoxin Fab

49. When is reduction required in fracture?
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
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.
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
Skin or vascular compromise

50. Signs of abuse from the history
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker 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.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.