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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. Sympathomimetics
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.

2. Management of septicaemia shock

3. Carbon monoxide
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
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 treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
CHARCOAL! except for lithium - iron - alcohol - lead.

4. Calcium gluconate
Nausea vomiting and anorexia.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Collar and cuff. Check integrity of nerve.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

5. You must consider abuse in
Severe illness - past history of injuries - 18 months or less - inconstent story.
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.
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

6. Ingesting Petrol. Cx?
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.
Aspiration Pneumonia
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

7. Displaced surgical neck of humerous
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.
Normally treated with sling alone. Seek advice.
Severe illness - past history of injuries - 18 months or less - inconstent story.

8. What is the first line investigation in a young child who has consumed alcohol?
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
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.
... blood sugars for hypoglycaemia

9. A child has swallowed a battery. Mx
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Skin or vascular compromise
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy

10. What is one of the technicalities of childabuse.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.

11. Sympathomimetics
Digoxin Fab
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Rash bronchospasm and hypotension.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.

12. What are the side effects of N-acety-p-benzoquinine?
Rash bronchospasm and hypotension.
Ceftriaxone
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy

13. what makes you suspicious of non-accidental injury.
Esmolol
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.

14. Lidocaine
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
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.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.

15. Benzodiazepine overdose antidote
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Flumazenil
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

16. What is the most appropriate examination in a child with suspected lead ingestion?
Abdo XRAY!!!! do it!
Immobilize with plaster slab
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

17. Mx raised intracranial pressure.
Antidotes are atropine sulfate and pralidoxime chloride.
Neurosurgery if trauma. Give mannitol.
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

18. Methanol
Abdo XRAY!!!! do it!
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Class of drugs encompassing decongestants - amphetamines - cocaine.
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.

19. 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
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Notify if abuse CONSIDERED. CONSIDERED.

20. What is the most important treatment for anaphylaxis
Discobalt edetate
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
IM adrenaline: vasopressor and bronchodilator.

21. Amiodarone
Class of drugs encompassing decongestants - amphetamines - cocaine.
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 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 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

22. Salicylates
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
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

23. 20
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
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

24. Digoxin antedote
Esmolol
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Digoxin Fab
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

25. Signs of abuse from the history
Class of drugs encompassing decongestants - amphetamines - cocaine.
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.
Ceftriaxone
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

26. What must you do before sending fracture to radiology?
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
Neurosurgery if trauma. Give mannitol.
Immobilize with plaster slab
Objective signs of growth - tidiness - weight -

27. Organophosphates
Poisoning causes decreased cholinesterase activity.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Severe illness - past history of injuries - 18 months or less - inconstent story.

28. Management of near drowning.
Antidote is naloxone.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
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.
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

29. Anticholinergics
Cyanosis and irregular respiratory effort
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Calcium chloride

30. Oedema causing laryngeal obstruction?
Intubate - tracheostromy or nebulized adrenaline.
Flurescence in ultraviolet light.
Give steroids for management of serum sickness. Must do coagulation screen!!!
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.

31. Middle Clavicle fracture management?
Digoxin Fab
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Neurotoxins - procagulants. Rhabdomyolysins.

32. Mx of snake bit
Collar and cuff. Check integrity of nerve.
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.
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. What are the early symptoms of paracetamol overdose?
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.
Nausea vomiting and anorexia.
Normally treated with sling alone. Seek advice.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

34. What investigations should you do in suspected child abuse
Bone scan for occult fracture
Antidote is deferoxamine chelation. Charcoal is ineffective.
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
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.

35. Mx of critical asthma
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Neurosurgery if trauma. Give mannitol.
Immobilize with plaster slab
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.

36. What happens if charcoal is aspirated?
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
It can cause fatal bronchioloitis obliterans

37. Carbon monoxide
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 decreased cholinesterase activity.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Nausea vomiting and anorexia.

38. What are the three features of anaphylaxis
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 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
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.

39. Tricyclic antidepressants
Rash bronchospasm and hypotension.
Antidotes are atropine sulfate and pralidoxime chloride.
Bone scan for occult fracture
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

40. Opiates
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Release NEUROTOXINS both have antivenom
Antidote is naloxone.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

41. Undisplaced surgical neck of humerous?
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Intubate - tracheostromy or nebulized adrenaline.
Sling for 3 weeks - fracture clinic at 7 days.
Before a child can be examined for child abuse - a parent or legal guardian must give consent

42. Tricyclic antidepressants overdose
Poisoning causes decreased cholinesterase activity.
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)
Intubate - tracheostromy or nebulized adrenaline.

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

44. 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
Aspiration Pneumonia
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

45. What psychiatric disease defined as childabuse?

46. What is an important point to note about anaphylaxis?
Glucagon prefered - otherwise massive dose of adrenaline.
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 -
Flurescence in ultraviolet light.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

47. Salicylates
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
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.

48. What is the most important investigation in suspected alcohol poisoning in young person?
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Blood glucose level for hypoglycaemia!!
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

49. What is a side effect of charcoal?
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Causes BAD constipation. Upsets fluid and electrolyte balance.

50. Ethanol
Skin or vascular compromise
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.