Pediatric Emergency Medicine

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. Anticholinergics
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Aspiration pneumonia even if intubated.
CHARCOAL! except for lithium - iron - alcohol - lead.
Antidotes are atropine sulfate and pralidoxime chloride.


2. Legal requirement in childabuse
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
Nausea vomiting and anorexia.
Notify if abuse CONSIDERED. CONSIDERED.
Before a child can be examined for child abuse - a parent or legal guardian must give consent


3. Opiates
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Antidote is naloxone.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.


4. Ethylene glycol
Class of drugs encompassing decongestants - amphetamines - cocaine.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.


5. What happens if charcoal is aspirated?
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
It can cause fatal bronchioloitis obliterans
Intubate - tracheostromy or nebulized adrenaline.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.


6. Beta-blocker overdose antidote
Esmolol
Glucagon prefered - otherwise massive dose of adrenaline.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Discobalt edetate


7. Displaced surgical neck of humerous
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
... blood sugars for hypoglycaemia
Notify if abuse CONSIDERED. CONSIDERED.
Normally treated with sling alone. Seek advice.


8. What must you do before sending fracture to radiology?
Immobilize with plaster slab
IM adrenaline: vasopressor and bronchodilator.
Calcium chloride
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.


9. Calcium gluconate
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Cyanosis and irregular respiratory effort
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.


10. Mx of petroleum overdose
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Flurescence in ultraviolet light.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity


11. Ethylene glycol
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.
Stomach pumping.
Abdo XRAY!!!! do it!
Intubate - tracheostromy or nebulized adrenaline.


12. Funnel web and red back
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Release NEUROTOXINS both have antivenom
Rash bronchospasm and hypotension.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.


13. Methanol
Poisoning causes decreased cholinesterase activity.
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.
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.


14. what makes you suspicious of non-accidental injury.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
... blood sugars 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


15. Acetaminophen
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Immobilize with plaster slab
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Rash bronchospasm and hypotension.


16. Amphetamine antidote
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.
Esmolol
Immobilize with plaster slab
Munchausen's by proxy


17. Organophosphates
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.
Cyanosis and irregular respiratory effort
Stomach pumping.
Poisoning causes decreased cholinesterase activity.


18. Atropine
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Discobalt edetate


19. Mx severe croup
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
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.


20. 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.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Neurosurgery if trauma. Give mannitol.
Antidote is naloxone.


21. You must consider abuse in
Immobilize with plaster slab
Severe illness - past history of injuries - 18 months or less - inconstent story.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.


22. 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
Abdo XRAY!!!! do it!
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.


23. Opiates
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 bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
'I WOULD CALL POISON HOTLINE'.
Class of drugs encompassing decongestants - amphetamines - cocaine.


24. What are the side effects of N-acety-p-benzoquinine?
Neurotoxins - procagulants. Rhabdomyolysins.
... blood sugars for hypoglycaemia
Rash bronchospasm and hypotension.
Objective signs of growth - tidiness - weight -


25. When is reduction required in fracture?
Immobilize with plaster slab
Skin or vascular compromise
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
Intubate - tracheostromy or nebulized adrenaline.


26. Salicylates
... blood sugars for hypoglycaemia
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Skin or vascular compromise
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


27. Signs of psychological maltreatment?
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Collar and cuff. Check integrity of nerve.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
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.


28. Sympathomimetics
Poisoning causes decreased cholinesterase activity.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.


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


30. What is the first line investigation in a young child who has consumed alcohol?
Notify if abuse CONSIDERED. CONSIDERED.
Flumazenil
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
... blood sugars for hypoglycaemia


31. A child has swallowed a battery. Mx
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy


32. Carbon monoxide
Munchausen's by proxy
'I WOULD CALL POISON HOTLINE'.
... blood sugars for hypoglycaemia
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.


33. What is one of the technicalities of childabuse.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Digoxin Fab
Before a child can be examined for child abuse - a parent or legal guardian must give consent


34. Carbon monoxide
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Discobalt edetate
Aspiration Pneumonia
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.


35. What is the most appropriate examination in a child with suspected lead ingestion?
Aspiration Pneumonia
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
Abdo XRAY!!!! do it!
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.


36. Iron
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.
Aspiration pneumonia even if intubated.
Antidote is deferoxamine chelation. Charcoal is ineffective.


37. When and how would you do whole bowel irrigation?
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 even if intubated.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.


38. What is the general management of poisoning?
Antidotes are atropine sulfate and pralidoxime chloride.
Bone scan for occult fracture
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
IM adrenaline: vasopressor and bronchodilator.


39. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
Objective signs of growth - tidiness - weight -
Aspiration Pneumonia
Skin or vascular compromise
Aspiration pneumonia even if intubated.


40. What is the most important treatment for anaphylaxis
IM adrenaline: vasopressor and bronchodilator.
Collar and cuff. Check integrity of nerve.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.


41. Organophosphates antidotes
Objective signs of growth - tidiness - weight -
Antidotes are atropine sulfate and pralidoxime chloride.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Discobalt edetate


42. Tricyclic antidepressants overdose
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Collar and cuff. Check integrity of nerve.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Skin or vascular compromise


43. 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
Sling for 3 weeks - fracture clinic at 7 days.
Flumazenil
Rash bronchospasm and hypotension.


44. Digoxin antedote
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Digoxin Fab


45. Undisplaced radial shaft fracture
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Discobalt edetate
Aspiration Pneumonia
Collar and cuff. Check integrity of nerve.


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


47. Middle Clavicle fracture management?
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
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 -
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.


48. Mx raised intracranial pressure.
Neurosurgery if trauma. Give mannitol.
Bone scan for occult fracture
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.


49. Iron
Antidote is deferoxamine chelation. Charcoal is ineffective.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
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
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.


50. Salicylates
Sling for 3 weeks - fracture clinic at 7 days.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
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.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.