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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. Organophosphates
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 salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Skin or vascular compromise
Normally treated with sling alone. Seek advice.

2. Indications of non-accidental injury
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Antidotes are atropine sulfate and pralidoxime chloride.

3. Middle Clavicle fracture management?
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
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.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

4. What investigations should you do in suspected child abuse
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
Normally treated with sling alone. Seek advice.
Bone scan for occult fracture
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.

5. When is reduction required in fracture?
CHARCOAL! except for lithium - iron - alcohol - lead.
Skin or vascular compromise
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.

6. What psychiatric disease defined as childabuse?

7. What are the three features of anaphylaxis
Glucagon prefered - otherwise massive dose of adrenaline.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Ceftriaxone

8. When and how would you do whole bowel irrigation?
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Esmolol
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.

9. Mx of petroleum overdose
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

10. Iron
Antidote is deferoxamine chelation. Charcoal is ineffective.
Give IM adrenaline - steroids - salbutamol - antihistamine.
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

11. A child has swallowed a battery. Mx
It can cause fatal bronchioloitis obliterans
'I WOULD CALL POISON HOTLINE'.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy

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

13. Sympathomimetics
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.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Antidotes are atropine sulfate and pralidoxime chloride.

14. what makes you suspicious of non-accidental injury.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
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.
Antidote is naloxone.

15. 45; 70
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
'I WOULD CALL POISON HOTLINE'.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
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.

16. Anticholinergics
Antidotes are atropine sulfate and pralidoxime chloride.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
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

17. Mx raised intracranial pressure.
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.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

18. Opiates
Release NEUROTOXINS both have antivenom
Blood glucose level for hypoglycaemia!!
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 bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

19. Lidocaine
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.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Esmolol
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. Atropine
CHARCOAL! except for lithium - iron - alcohol - lead.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Calcium chloride

21. Legal requirement in childabuse
Objective signs of growth - tidiness - weight -
Aspiration pneumonia even if intubated.
Normally treated with sling alone. Seek advice.
Notify if abuse CONSIDERED. CONSIDERED.

22. What are the side effects of N-acety-p-benzoquinine?
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
Rash bronchospasm and hypotension.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Digoxin Fab

23. How may you detect semen?
Flurescence in ultraviolet light.
Digoxin Fab
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Skin or vascular compromise

24. What is an important point to note about anaphylaxis?
Lead poisoning is defined as a serum level greater than ___ ug/dL.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
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 -

25. 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.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Bone scan for occult fracture
Blood glucose level for hypoglycaemia!!

26. Procainamide
Severe illness - past history of injuries - 18 months or less - inconstent story.
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.
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.

27. Which is better - activated charcoal or gastric lavage.
CHARCOAL! except for lithium - iron - alcohol - lead.
Notify if abuse CONSIDERED. CONSIDERED.
Immobilize with plaster slab
Collar and cuff. Check integrity of nerve.

28. Ethylene glycol
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.
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.
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 -
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.

29. Management of septicaemia shock

30. How do snake bites damage?
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Neurotoxins - procagulants. Rhabdomyolysins.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

31. What is gastric lavage?
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
CHARCOAL! except for lithium - iron - alcohol - lead.
Stomach pumping.

32. You must consider abuse in
Croup.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Severe illness - past history of injuries - 18 months or less - inconstent story.

33. What must you do before sending fracture to radiology?
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Immobilize with plaster slab
Neurosurgery if trauma. Give mannitol.

34. Theophylline
IM adrenaline: vasopressor and bronchodilator.
Aspiration Pneumonia
Release NEUROTOXINS both have antivenom
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.

35. Hydrocarbons
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
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.
Calcium chloride
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

36. Cyanide
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Blood glucose level for hypoglycaemia!!
Discobalt edetate

37. What is one of the technicalities of childabuse.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Aspiration pneumonia even if intubated.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Objective signs of growth - tidiness - weight -

38. 20
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

39. Salicylates
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.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
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.

40. What is the most common caUse of acute laryngeal obstruction?
Croup.
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
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

41. What is the most appropriate examination in a child with suspected lead ingestion?
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Abdo XRAY!!!! do it!
Esmolol

42. Anticholinergics
Flurescence in ultraviolet light.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Skin or vascular compromise

43. OSCE: What are the five princples of discharging a patient with a fracture?
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Aspiration pneumonia even if intubated.
Sling for 3 weeks - fracture clinic at 7 days.
Causes BAD constipation. Upsets fluid and electrolyte balance.

44. Acetaminophen
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Abdo XRAY!!!! do it!
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Bone scan for occult fracture

45. Sodium Bicarbonate
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
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

46. Organophosphates antidotes
Antidotes are atropine sulfate and pralidoxime chloride.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
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.

47. OSCE: how can i prevent accidents in my children
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
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.

48. Carbon monoxide
Cyanosis and irregular respiratory effort
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Calcium chloride
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.

49. What are the early symptoms of paracetamol overdose?
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Nausea vomiting and anorexia.
Digoxin Fab
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

50. Anticholinergics
Munchausen's by proxy
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Before a child can be examined for child abuse - a parent or legal guardian must give consent