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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. Salicylates
Before a child can be examined for child abuse - a parent or legal guardian must give consent
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.
Class of drugs encompassing decongestants - amphetamines - cocaine.
CHARCOAL! except for lithium - iron - alcohol - lead.

2. what makes you suspicious of non-accidental injury.
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.
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 salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

3. How do snake bites damage?
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Bone scan for occult fracture
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Neurotoxins - procagulants. Rhabdomyolysins.

4. Lidocaine
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Munchausen's by proxy
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Aspiration Pneumonia

5. Displaced surgical neck of humerous
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Normally treated with sling alone. Seek advice.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
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. Beta-blocker overdose antidote
Blood glucose level for hypoglycaemia!!
Glucagon prefered - otherwise massive dose of adrenaline.
Neurosurgery if trauma. Give mannitol.
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.

7. Sodium Bicarbonate
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.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
IM adrenaline: vasopressor and bronchodilator.

8. What are the three features of anaphylaxis
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

9. Ethylene glycol
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 delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

10. Ingesting Petrol. Cx?
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Notify if abuse CONSIDERED. CONSIDERED.
Aspiration Pneumonia
Intubate - tracheostromy or nebulized adrenaline.

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

12. Funnel web and red back
IM adrenaline: vasopressor and bronchodilator.
Release NEUROTOXINS both have antivenom
Cyanosis and irregular respiratory effort
Class of drugs encompassing decongestants - amphetamines - cocaine.

13. When is reduction required in fracture?
Skin or vascular compromise
Neurosurgery if trauma. Give mannitol.
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.
Blood glucose level for hypoglycaemia!!

14. What psychiatric disease defined as childabuse?

15. 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.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
'I WOULD CALL POISON HOTLINE'.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.

16. 45; 70
Croup.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
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

17. Indications of non-accidental injury
Notify if abuse CONSIDERED. CONSIDERED.
Discobalt edetate
Poisoning causes decreased cholinesterase activity.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

18. What is the most important investigation in suspected alcohol poisoning in young person?
Blood glucose level for hypoglycaemia!!
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
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 decreased cholinesterase activity.

19. Methanol
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
IM adrenaline: vasopressor and bronchodilator.
Bone scan for occult fracture

20. 20
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Release NEUROTOXINS both have antivenom
Lead poisoning is defined as a serum level greater than ___ ug/dL.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

21. Cyanide
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.
Discobalt edetate
Nausea vomiting and anorexia.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

22. When is gastric lavage indicated and contraindicated?
Aspiration Pneumonia
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Nausea vomiting and anorexia.
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

23. Amiodarone
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
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
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
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. Opiates
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Antidote is naloxone.
Notify if abuse CONSIDERED. CONSIDERED.

25. Acetaminophen
Poisoning causes decreased cholinesterase activity.
Flumazenil
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

26. Salicylates
... blood sugars for hypoglycaemia
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Flurescence in ultraviolet light.

27. A child has swallowed a battery. Mx
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Skin or vascular compromise
Notify if abuse CONSIDERED. CONSIDERED.

28. What is the first line investigation in a young child who has consumed alcohol?
... blood sugars for hypoglycaemia
Give steroids for management of serum sickness. Must do coagulation screen!!!
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

29. What happens if charcoal is aspirated?
It can cause fatal bronchioloitis obliterans
Release NEUROTOXINS both have antivenom
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.

30. What investigations should you do in suspected child abuse
Bone scan for occult fracture
Intubate - tracheostromy or nebulized adrenaline.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.

31. Middle Clavicle fracture management?
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
Class of drugs encompassing decongestants - amphetamines - cocaine.
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.

32. Sympathomimetics
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Class of drugs encompassing decongestants - amphetamines - cocaine.
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.

33. Acetaminophen
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
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 antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Digoxin Fab

34. Mx raised intracranial pressure.
Neurosurgery if trauma. Give mannitol.
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.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Lead poisoning is defined as a serum level greater than ___ ug/dL.

35. Legal requirement in childabuse
Notify if abuse CONSIDERED. CONSIDERED.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

36. What is an important point to note about anaphylaxis?
Munchausen's by proxy
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.
Blood glucose level for hypoglycaemia!!
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 -

37. What is the most important treatment for anaphylaxis
Discobalt edetate
IM adrenaline: vasopressor and bronchodilator.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Aspiration Pneumonia

38. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
Aspiration pneumonia even if intubated.
Sling for 3 weeks - fracture clinic at 7 days.
Antidotes are atropine sulfate and pralidoxime chloride.
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

39. What is the general management of poisoning?
Immobilize with plaster slab
Blood glucose level for hypoglycaemia!!
Give IM adrenaline - steroids - salbutamol - antihistamine.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.

40. Theophylline
'I WOULD CALL POISON HOTLINE'.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

41. Signs of abuse from the history
Cyanosis and irregular respiratory effort
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Munchausen's by proxy

42. You must consider abuse in
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Antidotes are atropine sulfate and pralidoxime chloride.

43. What evidence should a doctor give about parental neglect
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Objective signs of growth - tidiness - weight -
Collar and cuff. Check integrity of nerve.
Release NEUROTOXINS both have antivenom

44. What are the side effects of N-acety-p-benzoquinine?
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Rash bronchospasm and hypotension.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

45. Oedema causing laryngeal obstruction?
Antidote is naloxone.
Cyanosis and irregular respiratory effort
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Intubate - tracheostromy or nebulized adrenaline.

46. Undisplaced radial shaft fracture
Collar and cuff. Check integrity of nerve.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
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.

47. Methanol
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.
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 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.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.

48. Mx of petroleum overdose
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Aspiration Pneumonia
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 -
Ceftriaxone

49. 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.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
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.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

50. Iron
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
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
Abdo XRAY!!!! do it!