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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 other treatments for anaphylaxis?
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Calcium chloride
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.

2. What happens if charcoal is aspirated?
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.
It can cause fatal bronchioloitis obliterans
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.

3. Salicylates
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Esmolol
Abdo XRAY!!!! do it!

4. 45; 70
Cyanosis and irregular respiratory effort
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
Abdo XRAY!!!! do it!
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy

5. Ingesting Petrol. Cx?
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Aspiration Pneumonia
Antidotes are atropine sulfate and pralidoxime chloride.
'I WOULD CALL POISON HOTLINE'.

6. what makes you suspicious of non-accidental injury.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Nausea vomiting and anorexia.
Neurosurgery if trauma. Give mannitol.

7. Indications of non-accidental injury
Severe illness - past history of injuries - 18 months or less - inconstent story.
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
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Digoxin Fab

8. Anticholinergics
CHARCOAL! except for lithium - iron - alcohol - lead.
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
Collar and cuff. Check integrity of nerve.

9. 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.
Neurotoxins - procagulants. Rhabdomyolysins.
Poisoning causes decreased cholinesterase activity.
Class of drugs encompassing decongestants - amphetamines - cocaine.

10. Amphetamine antidote
Esmolol
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - 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 causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

11. Anticholinergics
CHARCOAL! except for lithium - iron - alcohol - lead.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
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.

12. What is the first line investigation in a young child who has consumed alcohol?
... blood sugars for hypoglycaemia
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
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.
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.

13. Calcium channel blocker overdose antidote
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Neurotoxins - procagulants. Rhabdomyolysins.
Calcium chloride
It can cause fatal bronchioloitis obliterans

14. Mx of critical asthma
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.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.

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

16. Adenosine
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.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Abdo XRAY!!!! do it!
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.

17. 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
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Calcium chloride
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.

18. When is reduction required in fracture?
Normally treated with sling alone. Seek advice.
Skin or vascular compromise
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

19. Procainamide
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.
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.
Aspiration pneumonia even if intubated.
Neurosurgery if trauma. Give mannitol.

20. Oedema causing laryngeal obstruction?
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Antidotes are atropine sulfate and pralidoxime chloride.
Release NEUROTOXINS both have antivenom
Intubate - tracheostromy or nebulized adrenaline.

21. Mx of snake bit
It can cause fatal bronchioloitis obliterans
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
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 decreased cholinesterase activity.

22. Atropine
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
'I WOULD CALL POISON HOTLINE'.

23. Anticholinergics
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

24. Methanol
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.
Notify if abuse CONSIDERED. CONSIDERED.
Calcium chloride

25. Cyanide
Sling for 3 weeks - fracture clinic at 7 days.
Discobalt edetate
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
Calcium chloride

26. When and how would you do whole bowel irrigation?
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.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.

27. Legal requirement in childabuse
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Notify if abuse CONSIDERED. CONSIDERED.
Severe illness - past history of injuries - 18 months or less - inconstent story.
It can cause fatal bronchioloitis obliterans

28. What is a side effect of charcoal?
Ceftriaxone
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Aspiration Pneumonia

29. You must consider abuse in
Skin or vascular compromise
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.
Calcium chloride
Severe illness - past history of injuries - 18 months or less - inconstent story.

30. Benzodiazepine overdose antidote
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
IM adrenaline: vasopressor and bronchodilator.
Flumazenil
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

31. What is the antibiotic for Epiglottitis?
Causes BAD constipation. Upsets fluid and electrolyte balance.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Ceftriaxone

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

33. How do snake bites damage?
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Neurotoxins - procagulants. Rhabdomyolysins.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.

34. What are the early symptoms of paracetamol overdose?
Nausea vomiting and anorexia.
Poisoning causes decreased cholinesterase activity.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
... blood sugars for hypoglycaemia

35. What are the terminal signs of acute laryngeal obstruction?
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 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.
Bone scan for occult fracture
Cyanosis and irregular respiratory effort

36. What psychiatric disease defined as childabuse?

37. Organophosphates antidotes
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Neurosurgery if trauma. Give mannitol.
Antidotes are atropine sulfate and pralidoxime chloride.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.

38. Carbon monoxide
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
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 treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

39. 20
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Calcium chloride
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

40. 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.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Antidotes are atropine sulfate and pralidoxime chloride.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.

41. Acetaminophen
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
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.
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.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

42. Beta-blocker overdose antidote
Glucagon prefered - otherwise massive dose of adrenaline.
Digoxin Fab
Discobalt edetate
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.

43. Salicylates
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
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.

44. What is the most common caUse of acute laryngeal obstruction?
Immobilize with plaster slab
Croup.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Give steroids for management of serum sickness. Must do coagulation screen!!!

45. What is the most important investigation in suspected alcohol poisoning in young person?
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.
Neurotoxins - procagulants. Rhabdomyolysins.
Blood glucose level for hypoglycaemia!!
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

46. What is the general management of poisoning?
Aspiration pneumonia even if intubated.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Esmolol
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.

47. When is gastric lavage indicated and contraindicated?
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Intubate - tracheostromy or nebulized adrenaline.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

48. Which is better - activated charcoal or gastric lavage.
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
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.
CHARCOAL! except for lithium - iron - alcohol - lead.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

49. What evidence should a doctor give about parental neglect
Objective signs of growth - tidiness - weight -
Nausea vomiting and anorexia.
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.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.

50. Undisplaced surgical neck of humerous?
Sling for 3 weeks - fracture clinic at 7 days.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)