Test your basic knowledge |

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. Opiates
Neurotoxins - procagulants. Rhabdomyolysins.
Antidote is naloxone.
Croup.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

2. Carbon monoxide
Antidotes are atropine sulfate and pralidoxime chloride.
... blood sugars for hypoglycaemia
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Cyanosis and irregular respiratory effort

3. Organophosphates
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Ceftriaxone

4. Epinephrine
Ceftriaxone
Antidote is naloxone.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Abdo XRAY!!!! do it!

5. Benzodiazepine overdose antidote
Flumazenil
Antidotes are atropine sulfate and pralidoxime chloride.
Flurescence in ultraviolet light.
Notify if abuse CONSIDERED. CONSIDERED.

6. What investigations should you do in suspected child abuse
Bone scan for occult fracture
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Neurosurgery if trauma. Give mannitol.
Neurotoxins - procagulants. Rhabdomyolysins.

7. What is gastric lavage?
Discobalt edetate
... blood sugars for hypoglycaemia
Stomach pumping.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

8. OSCE: What are the five princples of discharging a patient with a fracture?
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
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.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Abdo XRAY!!!! do it!

9. 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
It can cause fatal bronchioloitis obliterans
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

10. Opiates
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.

11. What is the most important investigation in suspected alcohol poisoning in young person?
Blood glucose level for hypoglycaemia!!
IM adrenaline: vasopressor and bronchodilator.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Esmolol

12. What is a side effect of charcoal?
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Causes BAD constipation. Upsets fluid and electrolyte balance.

13. 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.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
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 by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

14. Calcium gluconate
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Antidote is naloxone.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
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

15. Mx severe croup
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
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.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

16. Undisplaced surgical neck of humerous?
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Munchausen's by proxy
Sling for 3 weeks - fracture clinic at 7 days.
Give steroids for management of serum sickness. Must do coagulation screen!!!

17. Calcium channel blocker overdose antidote
... blood sugars for hypoglycaemia
Calcium chloride
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.

18. How do snake bites damage?
Neurosurgery if trauma. Give mannitol.
Neurotoxins - procagulants. Rhabdomyolysins.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.

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

20. How may you detect semen?
Flurescence in ultraviolet light.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Give IM adrenaline - steroids - salbutamol - antihistamine.

21. What evidence should a doctor give about parental neglect
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Notify if abuse CONSIDERED. CONSIDERED.
It can cause fatal bronchioloitis obliterans
Objective signs of growth - tidiness - weight -

22. What are the terminal signs of acute laryngeal obstruction?
Cyanosis and irregular respiratory effort
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.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

23. Ibuprofen
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 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
Skin or vascular compromise
Causes BAD constipation. Upsets fluid and electrolyte balance.

24. Organophosphates
Poisoning causes decreased cholinesterase activity.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Intubate - tracheostromy or nebulized adrenaline.
Munchausen's by proxy

25. Indications of non-accidental injury
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Nausea vomiting and anorexia.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
'I WOULD CALL POISON HOTLINE'.

26. Legal requirement in childabuse
Notify if abuse CONSIDERED. CONSIDERED.
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) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Sling for 3 weeks - fracture clinic at 7 days.

27. Tricyclic antidepressants overdose
Before a child can be examined for child abuse - a parent or legal guardian must give consent
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.

28. Methanol
Croup.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Blood glucose level for hypoglycaemia!!
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. Digoxin antedote
Aspiration pneumonia even if intubated.
Digoxin Fab
Aspiration Pneumonia
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

30. What happens if charcoal is aspirated?
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
It can cause fatal bronchioloitis obliterans
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

31. Iron
It can cause fatal bronchioloitis obliterans
Antidote is deferoxamine chelation. Charcoal is ineffective.
Stomach pumping.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

32. Tricyclic antidepressants
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
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
Intubate - tracheostromy or nebulized adrenaline.
Croup.

33. Signs of abuse from the history
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

34. Salicylates
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.
Glucagon prefered - otherwise massive dose of adrenaline.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Antidote is naloxone.

35. Ethylene glycol
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
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 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 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.

36. Management of septicaemia shock

37. What is the antibiotic for Epiglottitis?
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Ceftriaxone
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

38. What is an important point to note about anaphylaxis?
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Cyanosis and irregular respiratory effort
Stomach pumping.
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 -

39. What is the most appropriate examination in a child with suspected lead ingestion?
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Abdo XRAY!!!! do it!
Flurescence in ultraviolet light.
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

40. Anticholinergics
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

41. Atropine
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
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.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

42. What is the first line investigation in a young child who has consumed alcohol?
Objective signs of growth - tidiness - weight -
... blood sugars for hypoglycaemia
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.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

43. Anticholinergics
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

44. Amphetamine antidote
... blood sugars for hypoglycaemia
Flumazenil
Esmolol
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

45. Displaced surgical neck of humerous
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Normally treated with sling alone. Seek advice.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
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

46. 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.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Skin or vascular compromise
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.

47. Adenosine
Class of drugs encompassing decongestants - amphetamines - cocaine.
Collar and cuff. Check integrity of nerve.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
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.

48. Which is better - activated charcoal or gastric lavage.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
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
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.
CHARCOAL! except for lithium - iron - alcohol - lead.

49. What are the other treatments for anaphylaxis?
Give IM adrenaline - steroids - salbutamol - antihistamine.
Nausea vomiting and anorexia.
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
Cyanosis and irregular respiratory effort

50. Ingesting Petrol. Cx?
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Aspiration Pneumonia
Rash bronchospasm and hypotension.