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Pediatric Emergency Medicine

Subjects : health-sciences, pediatrics

Instructions:

Answer 50 questions in 15 minutes.
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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 the most important investigation in suspected alcohol poisoning in young person?
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Esmolol
Blood glucose level for hypoglycaemia!!

2. Anticholinergics
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
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.
Croup.

3. Beta-blocker overdose antidote
Glucagon prefered - otherwise massive dose of adrenaline.
Sling for 3 weeks - fracture clinic at 7 days.
Nausea vomiting and anorexia.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.

4. Signs of abuse from the history
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
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.
Objective signs of growth - tidiness - weight -

5. You must consider abuse in
Skin or vascular compromise
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
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.

6. Carbon monoxide
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
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 tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

7. 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
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.
Notify if abuse CONSIDERED. CONSIDERED.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

8. 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
Bone scan for occult fracture
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.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.

9. 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.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Abdo XRAY!!!! do it!
Antidote is naloxone.

10. When is gastric lavage indicated and contraindicated?
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 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
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

11. Opiates
Antidote is naloxone.
Rash bronchospasm and hypotension.
Severe illness - past history of injuries - 18 months or less - inconstent story.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

12. What is the most common caUse of acute laryngeal obstruction?
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
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 -
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Croup.

13. What is the first line investigation in a young child who has consumed alcohol?
... blood sugars for hypoglycaemia
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Notify if abuse CONSIDERED. CONSIDERED.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

14. What evidence should a doctor give about parental neglect
Objective signs of growth - tidiness - weight -
Ceftriaxone
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Nausea vomiting and anorexia.

15. Middle Clavicle fracture management?
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Digoxin Fab
Croup.
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.

16. Calcium gluconate
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Abdo XRAY!!!! do it!
Objective signs of growth - tidiness - weight -

17. What is the most important treatment for anaphylaxis
IM adrenaline: vasopressor and bronchodilator.
... blood sugars for hypoglycaemia
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Normally treated with sling alone. Seek advice.

18. Sympathomimetics
Give IM adrenaline - steroids - salbutamol - antihistamine.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Immobilize with plaster slab

19. Lead
Calcium chloride
Cyanosis and irregular respiratory effort
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

20. Displaced surgical neck of humerous
Normally treated with sling alone. Seek advice.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Give steroids for management of serum sickness. Must do coagulation screen!!!

21. What is the antibiotic for Epiglottitis?
Give steroids for management of serum sickness. Must do coagulation screen!!!
Causes BAD constipation. Upsets fluid and electrolyte balance.
Blood glucose level for hypoglycaemia!!
Ceftriaxone

22. What is a side effect of charcoal?
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Neurosurgery if trauma. Give mannitol.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

23. What are the three features of anaphylaxis
Nausea vomiting and anorexia.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Aspiration Pneumonia
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

24. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
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
Esmolol
Aspiration pneumonia even if intubated.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

25. What investigations should you do in suspected child abuse
Bone scan for occult fracture
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Antidote is naloxone.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

26. A child has swallowed a battery. Mx
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.
Rash bronchospasm and hypotension.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.

27. Indications of non-accidental injury
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Notify if abuse CONSIDERED. CONSIDERED.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Neurotoxins - procagulants. Rhabdomyolysins.

28. When is reduction required in fracture?
Skin or vascular compromise
Flurescence in ultraviolet light.
Neurosurgery if trauma. Give mannitol.
Give IM adrenaline - steroids - salbutamol - antihistamine.

29. Salicylates
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
Munchausen's by proxy
Blood glucose level for hypoglycaemia!!
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

30. Carbon monoxide
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 steroids for management of serum sickness. Must do coagulation screen!!!
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.

31. Organophosphates antidotes
Munchausen's by proxy
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
IM adrenaline: vasopressor and bronchodilator.
Antidotes are atropine sulfate and pralidoxime chloride.

32. How do snake bites damage?
Neurotoxins - procagulants. Rhabdomyolysins.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Collar and cuff. Check integrity of nerve.
Stomach pumping.

33. Adenosine
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Sling for 3 weeks - fracture clinic at 7 days.
It can cause fatal bronchioloitis obliterans
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.

34. Salicylates
Severe illness - past history of injuries - 18 months or less - inconstent story.
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.
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
Nausea vomiting and anorexia.

35. 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.
Skin or vascular compromise
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Causes BAD constipation. Upsets fluid and electrolyte balance.

36. What happens if charcoal is aspirated?
Causes BAD constipation. Upsets fluid and electrolyte balance.
It can cause fatal bronchioloitis obliterans
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
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.

37. Organophosphates
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Poisoning causes decreased cholinesterase activity.
IM adrenaline: vasopressor and bronchodilator.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

38. OSCE: What are the five princples of discharging a patient with a fracture?
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Blood glucose level for hypoglycaemia!!
Glucagon prefered - otherwise massive dose of adrenaline.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.

39. Opiates
Cyanosis and irregular respiratory effort
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Aspiration pneumonia even if intubated.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

40. Sympathomimetics
... blood sugars for hypoglycaemia
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Immobilize with plaster slab
Class of drugs encompassing decongestants - amphetamines - cocaine.

41. Funnel web and red back
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Skin or vascular compromise
Intubate - tracheostromy or nebulized adrenaline.
Release NEUROTOXINS both have antivenom

42. 20
Give steroids for management of serum sickness. Must do coagulation screen!!!
Lead poisoning is defined as a serum level greater than ___ ug/dL.
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

43. Undisplaced radial shaft fracture
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Collar and cuff. Check integrity of nerve.
... blood sugars for hypoglycaemia
Release NEUROTOXINS both have antivenom

44. What is the most appropriate examination in a child with suspected lead ingestion?
Abdo XRAY!!!! do it!
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Rash bronchospasm and hypotension.
Antidote is deferoxamine chelation. Charcoal is ineffective.

45. What is the general management of poisoning?
Bone scan for occult fracture
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.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

46. Epinephrine
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
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.

47. What are the other treatments for anaphylaxis?
Abdo XRAY!!!! do it!
Give IM adrenaline - steroids - salbutamol - antihistamine.
CHARCOAL! except for lithium - iron - alcohol - lead.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

48. Organophosphates
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

49. Cyanide
Discobalt edetate
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.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Class of drugs encompassing decongestants - amphetamines - cocaine.

50. Ethylene glycol
'I WOULD CALL POISON HOTLINE'.
... blood sugars for hypoglycaemia
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
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.