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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. What are the three features of anaphylaxis
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Collar and cuff. Check integrity of nerve.
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 lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

2. Carbon monoxide
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.
Munchausen's by proxy
Neurosurgery if trauma. Give mannitol.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

3. Amiodarone
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.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and 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

4. Acetaminophen
It can cause fatal bronchioloitis obliterans
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Flumazenil
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.

5. You must consider abuse in
Severe illness - past history of injuries - 18 months or less - inconstent story.
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
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
Before a child can be examined for child abuse - a parent or legal guardian must give consent

6. What happens if charcoal is aspirated?
It can cause fatal bronchioloitis obliterans
Give steroids for management of serum sickness. Must do coagulation screen!!!
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

7. A child has swallowed a battery. Mx
Neurosurgery if trauma. Give mannitol.
Normally treated with sling alone. Seek advice.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy

8. Ethylene glycol
'I WOULD CALL POISON HOTLINE'.
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.
IM adrenaline: vasopressor and bronchodilator.
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.

9. Hydrocarbons
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
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.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

10. Which is better - activated charcoal or gastric lavage.
CHARCOAL! except for lithium - iron - alcohol - lead.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Rash bronchospasm and hypotension.

11. What is the most important investigation in suspected alcohol poisoning in young person?
Blood glucose level for hypoglycaemia!!
Collar and cuff. Check integrity of nerve.
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.
Discobalt edetate

12. How may you detect semen?
... blood sugars for hypoglycaemia
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 even if intubated.
Flurescence in ultraviolet light.

13. What is gastric lavage?
Stomach pumping.
Rash bronchospasm and hypotension.
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 -
Calcium chloride

14. Methanol
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
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.
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.
Antidote is naloxone.

15. Atropine
Intubate - tracheostromy or nebulized adrenaline.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Notify if abuse CONSIDERED. CONSIDERED.

16. Cyanide
Rash bronchospasm and hypotension.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Discobalt edetate
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.

17. Mx of critical asthma
Ceftriaxone
Munchausen's by proxy
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
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.

18. What is the general management of poisoning?
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
... blood sugars for hypoglycaemia
Cyanosis and irregular respiratory effort
Give steroids for management of serum sickness. Must do coagulation screen!!!

19. What are the early symptoms of paracetamol overdose?
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Croup.
Nausea vomiting and anorexia.
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

20. 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
Antidotes are atropine sulfate and pralidoxime chloride.
Nausea vomiting and anorexia.
Causes BAD constipation. Upsets fluid and electrolyte balance.

21. Ethanol
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
'I WOULD CALL POISON HOTLINE'.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Flurescence in ultraviolet light.

22. Adenosine
Give steroids for management of serum sickness. Must do coagulation screen!!!
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Antidotes are atropine sulfate and pralidoxime chloride.
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

23. Management of near drowning.
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
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
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
Before a child can be examined for child abuse - a parent or legal guardian must give consent

24. What investigations should you do in suspected child abuse
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
... blood sugars for hypoglycaemia
Bone scan for occult fracture
Severe illness - past history of injuries - 18 months or less - inconstent story.

25. Funnel web and red back
Cyanosis and irregular respiratory effort
Nausea vomiting and anorexia.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Release NEUROTOXINS both have antivenom

26. OSCE: What are the five princples of discharging a patient with a fracture?
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
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
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

27. What is the most appropriate examination in a child with suspected lead ingestion?
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Abdo XRAY!!!! do it!
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.

28. Organophosphates antidotes
Antidotes are atropine sulfate and pralidoxime chloride.
Aspiration Pneumonia
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

29. What is an important point to note about anaphylaxis?
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 -
Blood glucose level for hypoglycaemia!!
Skin or vascular compromise
Release NEUROTOXINS both have antivenom

30. Benzodiazepine overdose antidote
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Flumazenil
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.

31. Salicylates
Discobalt edetate
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
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

32. What else is in the management of snake bite?
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
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
Give steroids for management of serum sickness. Must do coagulation screen!!!

33. Tricyclic antidepressants
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
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 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

34. Anticholinergics
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Cyanosis and irregular respiratory effort
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

35. Indications of non-accidental injury
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Antidote is naloxone.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

36. What is the most important treatment for anaphylaxis
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Neurotoxins - procagulants. Rhabdomyolysins.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
IM adrenaline: vasopressor and bronchodilator.

37. Opiates
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Intubate - tracheostromy or nebulized adrenaline.
CHARCOAL! except for lithium - iron - alcohol - lead.

38. What is the first line investigation in a young child who has consumed alcohol?
... blood sugars for hypoglycaemia
Calcium chloride
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)

39. Ibuprofen
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
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
Blood glucose level for hypoglycaemia!!
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

40. What is one of the technicalities of childabuse.
Collar and cuff. Check integrity of nerve.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Rash bronchospasm and hypotension.
Before a child can be examined for child abuse - a parent or legal guardian must give consent

41. Procainamide
Antidote is deferoxamine chelation. Charcoal is ineffective.
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.
Release NEUROTOXINS both have antivenom
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

42. How do snake bites damage?
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Notify if abuse CONSIDERED. CONSIDERED.
Immobilize with plaster slab
Neurotoxins - procagulants. Rhabdomyolysins.

43. what makes you suspicious of non-accidental injury.
Esmolol
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Flumazenil
Glucagon prefered - otherwise massive dose of adrenaline.

44. Ingesting Petrol. Cx?
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Aspiration Pneumonia
Neurosurgery if trauma. Give mannitol.

45. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
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
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Aspiration pneumonia even if intubated.
Class of drugs encompassing decongestants - amphetamines - cocaine.

46. Epinephrine
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Esmolol
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.

47. Undisplaced radial shaft fracture
Collar and cuff. Check integrity of nerve.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Abdo XRAY!!!! do it!
Give IM adrenaline - steroids - salbutamol - antihistamine.

48. Calcium gluconate
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
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 irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Class of drugs encompassing decongestants - amphetamines - cocaine.

49. Mx raised intracranial pressure.
Neurosurgery if trauma. Give mannitol.
Flumazenil
Rash bronchospasm and hypotension.
Digoxin Fab

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