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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 evidence should a doctor give about parental neglect
Class of drugs encompassing decongestants - amphetamines - cocaine.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Objective signs of growth - tidiness - weight -
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.

2. Organophosphates
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Cyanosis and irregular respiratory effort

3. Methanol
IM adrenaline: vasopressor and bronchodilator.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
It can cause fatal bronchioloitis obliterans
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.

4. Signs of abuse from the history
Aspiration Pneumonia
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
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.

5. What are the terminal signs of acute laryngeal obstruction?
Blood glucose level for hypoglycaemia!!
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
Cyanosis and irregular respiratory effort
Discobalt edetate

6. What is the general management of poisoning?
Aspiration Pneumonia
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
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
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.

7. What is gastric lavage?
Release NEUROTOXINS both have antivenom
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Stomach pumping.

8. Iron
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
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
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Antidote is naloxone.

9. Lidocaine
Class of drugs encompassing decongestants - amphetamines - cocaine.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Immobilize with plaster slab
Before a child can be examined for child abuse - a parent or legal guardian must give consent

10. Oedema causing laryngeal obstruction?
Intubate - tracheostromy or nebulized adrenaline.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
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'.

11. What happens if charcoal is aspirated?
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Immobilize with plaster slab
Release NEUROTOXINS both have antivenom
It can cause fatal bronchioloitis obliterans

12. Organophosphates antidotes
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 -
Antidotes are atropine sulfate and pralidoxime chloride.
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.
Neurotoxins - procagulants. Rhabdomyolysins.

13. Legal requirement in childabuse
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
Severe illness - past history of injuries - 18 months or less - inconstent story.
Notify if abuse CONSIDERED. CONSIDERED.
Antidotes are atropine sulfate and pralidoxime chloride.

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

15. Atropine
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
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 - 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
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

16. Salicylates
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Collar and cuff. Check integrity of nerve.
Blood glucose level for hypoglycaemia!!
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy

17. Mx raised intracranial pressure.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
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
Flurescence in ultraviolet light.
Neurosurgery if trauma. Give mannitol.

18. Displaced surgical neck of humerous
Normally treated with sling alone. Seek advice.
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.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

19. Ibuprofen
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
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
Flumazenil
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

20. What are the three features of anaphylaxis
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Severe illness - past history of injuries - 18 months or less - inconstent story.

21. Anticholinergics
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Aspiration Pneumonia
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

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

23. What else is in the management of snake bite?
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
Give steroids for management of serum sickness. Must do coagulation screen!!!
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
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.

24. OSCE: What are the five princples of discharging a patient with a fracture?
Abdo XRAY!!!! do it!
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
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
... blood sugars for hypoglycaemia

25. Ingesting Petrol. Cx?
Discobalt edetate
Abdo XRAY!!!! do it!
Aspiration Pneumonia
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

26. Hydrocarbons
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.
IM adrenaline: vasopressor and bronchodilator.
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 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.

27. Ethanol
Esmolol
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.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

28. Carbon monoxide
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Flurescence in ultraviolet light.
Poisoning causes decreased cholinesterase activity.

29. What investigations should you do in suspected child abuse
Bone scan for occult fracture
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
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.

30. Organophosphates
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
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 decreased cholinesterase activity.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.

31. Tricyclic antidepressants overdose
Bone scan for occult fracture
Rash bronchospasm and hypotension.
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) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

32. Amphetamine antidote
Skin or vascular compromise
'I WOULD CALL POISON HOTLINE'.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Esmolol

33. Mx severe croup
Munchausen's by proxy
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Lead poisoning is defined as a serum level greater than ___ ug/dL.

34. Undisplaced radial shaft 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.
Collar and cuff. Check integrity of nerve.
Sling for 3 weeks - fracture clinic at 7 days.
Bone scan for occult fracture

35. Middle Clavicle fracture management?
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
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.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

36. What are the early symptoms of paracetamol overdose?
Nausea vomiting and anorexia.
Skin or vascular compromise
Aspiration Pneumonia
Ceftriaxone

37. Anticholinergics
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Intubate - tracheostromy or nebulized adrenaline.
... blood sugars for hypoglycaemia
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

38. Management of near drowning.
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
Antidote is deferoxamine chelation. Charcoal is ineffective.
Digoxin Fab
Normally treated with sling alone. Seek advice.

39. Ethylene glycol
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
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
Release NEUROTOXINS both have antivenom

40. Theophylline
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.

41. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Aspiration pneumonia even if intubated.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.

42. What is the most appropriate examination in a child with suspected lead ingestion?
Abdo XRAY!!!! do it!
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Aspiration pneumonia even if intubated.
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

43. what makes you suspicious of non-accidental injury.
Esmolol
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.

44. What is the most important treatment for anaphylaxis
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) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
IM adrenaline: vasopressor and bronchodilator.
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 -

45. When is gastric lavage indicated and contraindicated?
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.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
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.
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.

46. Ethylene glycol
Sling for 3 weeks - fracture clinic at 7 days.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
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.

47. Tricyclic antidepressants
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
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
Nausea vomiting and anorexia.

48. What are the other treatments for anaphylaxis?
Give IM adrenaline - steroids - salbutamol - antihistamine.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Release NEUROTOXINS both have antivenom

49. How may you detect semen?
Flurescence in ultraviolet light.
Notify if abuse CONSIDERED. CONSIDERED.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.

50. Beta-blocker overdose antidote
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Glucagon prefered - otherwise massive dose of adrenaline.
Blood glucose level for hypoglycaemia!!