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. What is gastric lavage?
Cyanosis and irregular respiratory effort
Stomach pumping.
Abdo XRAY!!!! do it!
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

2. What else is in the management of snake bite?
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Sling for 3 weeks - fracture clinic at 7 days.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Give steroids for management of serum sickness. Must do coagulation screen!!!

3. Lead
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
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.
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.

4. What is the most important investigation in suspected alcohol poisoning in young person?
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
Blood glucose level for hypoglycaemia!!
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Causes BAD constipation. Upsets fluid and electrolyte balance.

5. What are the terminal signs of acute laryngeal obstruction?
Antidote is naloxone.
Flurescence in ultraviolet light.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Cyanosis and irregular respiratory effort

6. Anticholinergics
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.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Antidote is deferoxamine chelation. Charcoal is ineffective.

7. Carbon monoxide
Poisoning causes decreased cholinesterase activity.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Rash bronchospasm and hypotension.

8. What investigations should you do in suspected child abuse
Aspiration Pneumonia
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Bone scan for occult fracture
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. What happens if charcoal is aspirated?
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.
It can cause fatal bronchioloitis obliterans
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Abdo XRAY!!!! do it!

10. Cyanide
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Antidotes are atropine sulfate and pralidoxime chloride.
Discobalt edetate
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

11. Iron
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
'I WOULD CALL POISON HOTLINE'.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

12. Iron
Antidote is deferoxamine chelation. Charcoal is ineffective.
Croup.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
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

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

14. Ibuprofen
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
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 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.

15. Hydrocarbons
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.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Release NEUROTOXINS both have antivenom

16. Legal requirement in childabuse
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Esmolol
Notify if abuse CONSIDERED. CONSIDERED.
Aspiration pneumonia even if intubated.

17. What are the other treatments for anaphylaxis?
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Stomach pumping.
Give IM adrenaline - steroids - salbutamol - antihistamine.
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 -

18. Sympathomimetics
Aspiration pneumonia even if intubated.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Class of drugs encompassing decongestants - amphetamines - cocaine.

19. What is an important point to note about anaphylaxis?
Antidote is deferoxamine chelation. Charcoal is ineffective.
Class of drugs encompassing decongestants - amphetamines - cocaine.
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 -
Causes BAD constipation. Upsets fluid and electrolyte balance.

20. What is one of the technicalities of childabuse.
Neurosurgery if trauma. Give mannitol.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Flurescence in ultraviolet light.

21. Mx of snake bit
Release NEUROTOXINS both have antivenom
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.
'I WOULD CALL POISON HOTLINE'.
Aspiration Pneumonia

22. What are the side effects of N-acety-p-benzoquinine?
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Skin or vascular compromise
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Rash bronchospasm and hypotension.

23. 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
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

24. Methanol
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
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.
Rash bronchospasm and hypotension.
Intubate - tracheostromy or nebulized adrenaline.

25. Tricyclic antidepressants
Abdo XRAY!!!! do it!
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
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
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

26. 20
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Objective signs of growth - tidiness - weight -
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

27. 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.
Collar and cuff. Check integrity of nerve.
... blood sugars for hypoglycaemia
Immobilize with plaster slab

28. What is the antibiotic for Epiglottitis?
IM adrenaline: vasopressor and bronchodilator.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Ceftriaxone
Flumazenil

29. What is the first line investigation in a young child who has consumed alcohol?
... blood sugars for hypoglycaemia
Give steroids for management of serum sickness. Must do coagulation screen!!!
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
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

30. Adenosine
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Cyanosis and irregular respiratory effort
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.

31. Mx severe croup
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Release NEUROTOXINS both have antivenom
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.
Discobalt edetate

32. When is gastric lavage indicated and contraindicated?
Class of drugs encompassing decongestants - amphetamines - cocaine.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Aspiration pneumonia even if intubated.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.

33. Lidocaine
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
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 -
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Lead poisoning is defined as a serum level greater than ___ ug/dL.

34. Carbon monoxide
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Objective signs of growth - tidiness - weight -
Notify if abuse CONSIDERED. CONSIDERED.

35. Mx raised intracranial pressure.
Aspiration pneumonia even if intubated.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Neurosurgery if trauma. Give mannitol.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)

36. OSCE: What are the five princples of discharging a patient with a fracture?
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Before a child can be examined for child abuse - a parent or legal guardian must give consent

37. Undisplaced surgical neck of humerous?
Sling for 3 weeks - fracture clinic at 7 days.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Immobilize with plaster slab

38. When is reduction required in fracture?
Abdo XRAY!!!! do it!
Flurescence in ultraviolet light.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Skin or vascular compromise

39. Calcium channel blocker overdose antidote
Calcium chloride
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Poisoning causes decreased cholinesterase activity.
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 -

40. What is the most important treatment for anaphylaxis
Cyanosis and irregular respiratory effort
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
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
IM adrenaline: vasopressor and bronchodilator.

41. Indications of non-accidental injury
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Severe illness - past history of injuries - 18 months or less - inconstent story.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

42. What are the early symptoms of paracetamol overdose?
Nausea vomiting and anorexia.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
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.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

43. Digoxin antedote
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Digoxin Fab

44. 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.
Stomach pumping.
Antidote is naloxone.
Neurotoxins - procagulants. Rhabdomyolysins.

45. Benzodiazepine overdose antidote
Flumazenil
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
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

46. 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.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

47. Salicylates
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.
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
Antidote is deferoxamine chelation. Charcoal is ineffective.

48. Epinephrine
Munchausen's by proxy
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.

49. Ingesting Petrol. Cx?
Stomach pumping.
Class of drugs encompassing decongestants - amphetamines - cocaine.
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 -
Aspiration Pneumonia

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