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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. What is an important point to note about anaphylaxis?
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
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 -
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy

2. What evidence should a doctor give about parental neglect
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
Objective signs of growth - tidiness - weight -
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Intubate - tracheostromy or nebulized adrenaline.

3. Lidocaine
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
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
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.

4. Anticholinergics
Munchausen's by proxy
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Nausea vomiting and anorexia.
Give steroids for management of serum sickness. Must do coagulation screen!!!

5. Opiates
Sling for 3 weeks - fracture clinic at 7 days.
Causes BAD constipation. Upsets fluid and electrolyte balance.
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 bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

6. What are the other treatments for anaphylaxis?
Give IM adrenaline - steroids - salbutamol - antihistamine.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Skin or vascular compromise

7. OSCE: how can i prevent accidents in my children
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 tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Intubate - tracheostromy or nebulized adrenaline.
Flurescence in ultraviolet light.

8. Displaced surgical neck of humerous
Croup.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Normally treated with sling alone. Seek advice.
Notify if abuse CONSIDERED. CONSIDERED.

9. Sodium Bicarbonate
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.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Calcium chloride

10. When is reduction required in fracture?
Objective signs of growth - tidiness - weight -
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Skin or vascular compromise
CHARCOAL! except for lithium - iron - alcohol - lead.

11. Which is better - activated charcoal or gastric lavage.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
CHARCOAL! except for lithium - iron - alcohol - lead.
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.

12. Tricyclic antidepressants overdose
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

13. Cyanide
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Antidote is naloxone.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Discobalt edetate

14. Mx raised intracranial pressure.
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.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Neurosurgery if trauma. Give mannitol.

15. Opiates
Antidote is naloxone.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Normally treated with sling alone. Seek advice.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

16. OSCE: What are the five princples of discharging a patient with a fracture?
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
Give steroids for management of serum sickness. Must do coagulation screen!!!
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.

17. Carbon monoxide
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
... blood sugars for hypoglycaemia
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

18. What is the antibiotic for Epiglottitis?
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
'I WOULD CALL POISON HOTLINE'.
Ceftriaxone
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

19. Acetaminophen
Aspiration Pneumonia
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.
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.

20. What is the most important treatment for anaphylaxis
Skin or vascular compromise
Croup.
IM adrenaline: vasopressor and bronchodilator.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

21. What is one of the technicalities of childabuse.
Normally treated with sling alone. Seek advice.
Release NEUROTOXINS both have antivenom
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

22. Mx of petroleum overdose
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Calcium chloride
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

23. Procainamide
Munchausen's by proxy
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 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.
Neurotoxins - procagulants. Rhabdomyolysins.

24. What are the terminal signs of acute laryngeal obstruction?
Cyanosis and irregular respiratory effort
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
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 -

25. 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.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Rash bronchospasm and hypotension.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

26. Funnel web and red back
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Release NEUROTOXINS both have antivenom
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.
Abdo XRAY!!!! do it!

27. Tricyclic antidepressants
Normally treated with sling alone. Seek advice.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
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
Flumazenil

28. What psychiatric disease defined as childabuse?

29. Sympathomimetics
Digoxin Fab
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Flurescence in ultraviolet light.
Ceftriaxone

30. Signs of abuse from the history
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
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
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

31. You must consider abuse in
Immobilize with plaster slab
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Severe illness - past history of injuries - 18 months or less - inconstent story.
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.

32. Beta-blocker overdose antidote
Glucagon prefered - otherwise massive dose of adrenaline.
Nausea vomiting and anorexia.
Flurescence in ultraviolet light.
It can cause fatal bronchioloitis obliterans

33. Anticholinergics
Munchausen's by proxy
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Esmolol
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

34. 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
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Poisoning causes decreased cholinesterase activity.

35. Iron
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Release NEUROTOXINS both have antivenom
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Antidote is deferoxamine chelation. Charcoal is ineffective.

36. Acetaminophen
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
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.
Class of drugs encompassing decongestants - amphetamines - cocaine.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

37. Ethylene glycol
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
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.
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.

38. What is the most common caUse of acute laryngeal obstruction?
Aspiration pneumonia even if intubated.
Aspiration Pneumonia
Abdo XRAY!!!! do it!
Croup.

39. How do snake bites damage?
Neurotoxins - procagulants. Rhabdomyolysins.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
IM adrenaline: vasopressor and bronchodilator.
Flurescence in ultraviolet light.

40. Undisplaced surgical neck of humerous?
Sling for 3 weeks - fracture clinic at 7 days.
Antidotes are atropine sulfate and pralidoxime chloride.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
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.

41. What is gastric lavage?
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
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.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

42. Organophosphates antidotes
Antidotes are atropine sulfate and pralidoxime chloride.
Poisoning causes decreased cholinesterase activity.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

43. Undisplaced radial shaft fracture
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
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.
Collar and cuff. Check integrity of nerve.
Stomach pumping.

44. 45; 70
Causes BAD constipation. Upsets fluid and electrolyte balance.
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
Neurotoxins - procagulants. Rhabdomyolysins.
Sling for 3 weeks - fracture clinic at 7 days.

45. Calcium channel blocker overdose antidote
Calcium chloride
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.
Abdo XRAY!!!! do it!
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

46. What happens if charcoal is aspirated?
It can cause fatal bronchioloitis obliterans
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Ceftriaxone

47. Anticholinergics
Aspiration Pneumonia
Neurosurgery if trauma. Give mannitol.
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 lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

48. Signs of psychological maltreatment?
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.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Immobilize with plaster slab
Bone scan for occult fracture

49. Theophylline
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
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.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.

50. Calcium gluconate
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Neurosurgery if trauma. Give mannitol.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Class of drugs encompassing decongestants - amphetamines - cocaine.