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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. Management of near drowning.
Immobilize with plaster slab
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
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
It can cause fatal bronchioloitis obliterans

2. Opiates
Abdo XRAY!!!! do it!
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Skin or vascular compromise
Antidote is naloxone.

3. What is the most important treatment for anaphylaxis
Antidote is naloxone.
IM adrenaline: vasopressor and bronchodilator.
Poisoning causes decreased cholinesterase activity.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.

4. Calcium gluconate
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Digoxin Fab
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Flumazenil

5. Sympathomimetics
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Discobalt edetate
Severe illness - past history of injuries - 18 months or less - inconstent story.

6. What must you do before sending fracture to radiology?
Immobilize with plaster slab
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Flurescence in ultraviolet light.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

7. Opiates
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Antidote is naloxone.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Release NEUROTOXINS both have antivenom

8. Undisplaced surgical neck of humerous?
Sling for 3 weeks - fracture clinic at 7 days.
Blood glucose level for hypoglycaemia!!
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'.

9. Atropine
Bone scan for occult fracture
Objective signs of growth - tidiness - weight -
Munchausen's by proxy
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

10. Mx of critical asthma
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
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.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

11. When is gastric lavage indicated and contraindicated?
Flumazenil
Immobilize with plaster slab
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.

12. What is gastric lavage?
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Stomach pumping.
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

13. What is a side effect of charcoal?
Croup.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Causes BAD constipation. Upsets fluid and electrolyte balance.

14. Tricyclic antidepressants
Objective signs of growth - tidiness - weight -
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 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
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.

15. Cyanide
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Discobalt edetate

16. Acetaminophen
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

17. Mx raised intracranial pressure.
Glucagon prefered - otherwise massive dose of adrenaline.
Neurosurgery if trauma. Give mannitol.
Collar and cuff. Check integrity of nerve.
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.

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

19. Benzodiazepine overdose antidote
Flumazenil
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

20. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
Aspiration pneumonia even if intubated.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
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.
Notify if abuse CONSIDERED. CONSIDERED.

21. Sympathomimetics
Class of drugs encompassing decongestants - amphetamines - cocaine.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Poisoning causes decreased cholinesterase activity.

22. How do snake bites damage?
Normally treated with sling alone. Seek advice.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
'I WOULD CALL POISON HOTLINE'.
Neurotoxins - procagulants. Rhabdomyolysins.

23. Methanol
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
It can cause fatal bronchioloitis obliterans
Intubate - tracheostromy or nebulized adrenaline.

24. Salicylates
Blood glucose level for hypoglycaemia!!
Before a child can be examined for child abuse - a parent or legal guardian must give consent
... blood sugars for hypoglycaemia
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.

25. 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.
Antidote is naloxone.
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

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

27. Carbon monoxide
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Munchausen's by proxy
Immobilize with plaster slab
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

28. Calcium channel blocker overdose antidote
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
CHARCOAL! except for lithium - iron - alcohol - lead.
Calcium chloride
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.

29. Hydrocarbons
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
'I WOULD CALL POISON HOTLINE'.
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.

30. What psychiatric disease defined as childabuse?

31. 20
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
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.

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

33. Acetaminophen
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 delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
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

34. What evidence should a doctor give about parental neglect
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Ceftriaxone
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Objective signs of growth - tidiness - weight -

35. Ingesting Petrol. Cx?
Immobilize with plaster slab
Aspiration Pneumonia
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.

36. what makes you suspicious of non-accidental injury.
Esmolol
Antidote is deferoxamine chelation. Charcoal is ineffective.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Nausea vomiting and anorexia.

37. Lead
Give steroids for management of serum sickness. Must do coagulation screen!!!
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
IM adrenaline: vasopressor and bronchodilator.

38. 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
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.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Normally treated with sling alone. Seek advice.

39. What is the most important investigation in suspected alcohol poisoning in young person?
CHARCOAL! except for lithium - iron - alcohol - lead.
Blood glucose level for hypoglycaemia!!
Flurescence in ultraviolet light.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

40. Organophosphates antidotes
Antidotes are atropine sulfate and pralidoxime chloride.
Blood glucose level for hypoglycaemia!!
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.

41. Anticholinergics
Collar and cuff. Check integrity of nerve.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Neurotoxins - procagulants. Rhabdomyolysins.
Croup.

42. What else is in the management of snake bite?
Give steroids for management of serum sickness. Must do coagulation screen!!!
Immobilize with plaster slab
'I WOULD CALL POISON HOTLINE'.
Objective signs of growth - tidiness - weight -

43. Beta-blocker overdose antidote
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Bone scan for occult fracture
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Glucagon prefered - otherwise massive dose of adrenaline.

44. Mx of snake bit
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.
IM adrenaline: vasopressor and bronchodilator.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Antidote is naloxone.

45. Undisplaced radial shaft fracture
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Stomach pumping.
Collar and cuff. Check integrity of nerve.
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.

46. Procainamide
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.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
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 lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.

47. What is the most common caUse of acute laryngeal obstruction?
Croup.
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.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Severe illness - past history of injuries - 18 months or less - inconstent story.

48. 45; 70
Rash bronchospasm and hypotension.
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
Flumazenil
Nausea vomiting and anorexia.

49. Mx severe croup
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Rash bronchospasm and hypotension.

50. What is the first line investigation in a young child who has consumed alcohol?
Ceftriaxone
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
... blood sugars for hypoglycaemia
Blood glucose level for hypoglycaemia!!