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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. Funnel web and red back
Release NEUROTOXINS both have antivenom
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
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 tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.

2. 45; 70
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.
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
Causes BAD constipation. Upsets fluid and electrolyte balance.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.

3. What is the first line investigation in a young child who has consumed alcohol?
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
... blood sugars for hypoglycaemia
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
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

4. What is the most important treatment for anaphylaxis
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
IM adrenaline: vasopressor and bronchodilator.
Neurosurgery if trauma. Give mannitol.
Croup.

5. Mx of snake bit
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
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.
Discobalt edetate
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.

6. What is gastric lavage?
Stomach pumping.
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.
Normally treated with sling alone. Seek advice.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.

7. What evidence should a doctor give about parental neglect
Neurotoxins - procagulants. Rhabdomyolysins.
Objective signs of growth - tidiness - weight -
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Bone scan for occult fracture

8. What is one of the technicalities of childabuse.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Give IM adrenaline - steroids - salbutamol - antihistamine.
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.
Give steroids for management of serum sickness. Must do coagulation screen!!!

9. Displaced surgical neck of humerous
Antidotes are atropine sulfate and pralidoxime chloride.
Normally treated with sling alone. Seek advice.
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
Aspiration pneumonia even if intubated.

10. Ethylene glycol
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
... blood sugars for hypoglycaemia
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
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.

11. Signs of psychological maltreatment?
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
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 delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

12. Organophosphates
Cyanosis and irregular respiratory effort
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Causes BAD constipation. Upsets fluid and electrolyte balance.

13. OSCE: how can i prevent accidents in my children
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.
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 nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Severe illness - past history of injuries - 18 months or less - inconstent story.

14. Methanol
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
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.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.

15. Beta-blocker overdose antidote
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Aspiration pneumonia even if intubated.
Glucagon prefered - otherwise massive dose of adrenaline.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

16. Ingesting Petrol. Cx?
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
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.
Blood glucose level for hypoglycaemia!!
Aspiration Pneumonia

17. Sympathomimetics
Glucagon prefered - otherwise massive dose of adrenaline.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Skin or vascular compromise
Class of drugs encompassing decongestants - amphetamines - cocaine.

18. Cyanide
Discobalt edetate
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

19. What is a side effect of charcoal?
Flurescence in ultraviolet light.
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 BAD constipation. Upsets fluid and electrolyte balance.
Neurosurgery if trauma. Give mannitol.

20. What happens if charcoal is aspirated?
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
It can cause fatal bronchioloitis obliterans
Ceftriaxone

21. Carbon monoxide
Give steroids for management of serum sickness. Must do coagulation screen!!!
Antidote is deferoxamine chelation. Charcoal is ineffective.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

22. Management of septicaemia shock

23. What must you do before sending fracture to radiology?
Antidote is deferoxamine chelation. Charcoal is ineffective.
... blood sugars for hypoglycaemia
Immobilize with plaster slab
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.

24. Sympathomimetics
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
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
Give steroids for management of serum sickness. Must do coagulation screen!!!
Class of drugs encompassing decongestants - amphetamines - cocaine.

25. When is reduction required in fracture?
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Skin or vascular compromise
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
Neurosurgery if trauma. Give mannitol.

26. Methanol
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Munchausen's by proxy
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

27. Calcium gluconate
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.
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.
Notify if abuse CONSIDERED. CONSIDERED.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

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

29. 20
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
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.

30. When is gastric lavage indicated and contraindicated?
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

31. Tricyclic antidepressants overdose
Causes BAD constipation. Upsets fluid and electrolyte balance.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
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 IM adrenaline - steroids - salbutamol - antihistamine.

32. Management of near drowning.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
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
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

33. Anticholinergics
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Neurosurgery if trauma. Give mannitol.

34. Amiodarone
Digoxin Fab
Cyanosis and irregular respiratory effort
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.

35. Oedema causing 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
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Intubate - tracheostromy or nebulized adrenaline.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy

36. 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
Glucagon prefered - otherwise massive dose of adrenaline.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
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.

37. Carbon monoxide
CHARCOAL! except for lithium - iron - alcohol - lead.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy

38. What else is in the management of snake bite?
Give steroids for management of serum sickness. Must do coagulation screen!!!
Antidotes are atropine sulfate and pralidoxime chloride.
Collar and cuff. Check integrity of nerve.
Aspiration pneumonia even if intubated.

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

40. Atropine
Antidote is deferoxamine chelation. Charcoal is ineffective.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Aspiration Pneumonia
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.

41. What are the three features of anaphylaxis
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Before a child can be examined for child abuse - a parent or legal guardian must give consent
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Aspiration pneumonia even if intubated.

42. Salicylates
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
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) 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

43. What are the other treatments for anaphylaxis?
Give IM adrenaline - steroids - salbutamol - antihistamine.
... blood sugars for hypoglycaemia
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Digoxin Fab

44. What are the early symptoms of paracetamol overdose?
Nausea vomiting and anorexia.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
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.

45. What is the most appropriate examination in a child with suspected lead ingestion?
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Discobalt edetate
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.
Abdo XRAY!!!! do it!

46. Adenosine
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Cyanosis and irregular respiratory effort
Discobalt edetate
Neurosurgery if trauma. Give mannitol.

47. Legal requirement in childabuse
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Notify if abuse CONSIDERED. CONSIDERED.
IM adrenaline: vasopressor and bronchodilator.

48. What psychiatric disease defined as childabuse?

49. 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.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Objective signs of growth - tidiness - weight -
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

50. Ethanol
Ceftriaxone
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
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
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.