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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 the most important treatment for anaphylaxis
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.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

2. Indications of non-accidental injury
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Skin or vascular compromise
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
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

3. Which is better - activated charcoal or gastric lavage.
Skin or vascular compromise
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
CHARCOAL! except for lithium - iron - alcohol - lead.

4. Mx severe croup
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.
Notify if abuse CONSIDERED. CONSIDERED.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

5. Lead
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.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

6. Hydrocarbons
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
Blood glucose level for hypoglycaemia!!
Normally treated with sling alone. Seek advice.
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.

7. Signs of psychological maltreatment?
Flumazenil
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
CHARCOAL! except for lithium - iron - alcohol - lead.
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.

8. Mx of critical asthma
Calcium chloride
Sling for 3 weeks - fracture clinic at 7 days.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

9. Lidocaine
Causes BAD constipation. Upsets fluid and electrolyte balance.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Normally treated with sling alone. Seek advice.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.

10. Adenosine
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Immobilize with plaster slab
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

11. Anticholinergics
Bone scan for occult fracture
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.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

12. Management of near drowning.
Blood glucose level for hypoglycaemia!!
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
Stomach pumping.
Discobalt edetate

13. Salicylates
IM adrenaline: vasopressor and bronchodilator.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
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
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

14. How do snake bites damage?
Antidotes are atropine sulfate and pralidoxime chloride.
Immobilize with plaster slab
Flumazenil
Neurotoxins - procagulants. Rhabdomyolysins.

15. Amphetamine antidote
Collar and cuff. Check integrity of nerve.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Bone scan for occult fracture
Esmolol

16. What evidence should a doctor give about parental neglect
Objective signs of growth - tidiness - weight -
Digoxin Fab
Neurosurgery if trauma. Give mannitol.
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.

17. 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.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
It can cause fatal bronchioloitis obliterans
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy

18. what makes you suspicious of non-accidental injury.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
CHARCOAL! except for lithium - iron - alcohol - lead.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

19. When is reduction required in fracture?
Notify if abuse CONSIDERED. CONSIDERED.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Skin or vascular compromise

20. When is gastric lavage indicated and contraindicated?
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Intubate - tracheostromy or nebulized adrenaline.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.

21. Tricyclic antidepressants overdose
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
Digoxin Fab
Antidote is deferoxamine chelation. Charcoal is ineffective.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

22. Acetaminophen
Digoxin Fab
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Croup.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.

23. Middle Clavicle fracture management?
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
It can cause fatal bronchioloitis obliterans

24. Organophosphates antidotes
Discobalt edetate
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Poisoning causes decreased cholinesterase activity.
Antidotes are atropine sulfate and pralidoxime chloride.

25. Mx raised intracranial pressure.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
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.
Neurosurgery if trauma. Give mannitol.

26. Ethylene glycol
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Aspiration Pneumonia
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.

27. What investigations should you do in suspected child abuse
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Bone scan for occult fracture
Cyanosis and irregular respiratory effort
Class of drugs encompassing decongestants - amphetamines - cocaine.

28. Management of septicaemia shock

29. Anticholinergics
Objective signs of growth - tidiness - weight -
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 -
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

30. Organophosphates
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Calcium chloride
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Poisoning causes decreased cholinesterase activity.

31. What is the most appropriate examination in a child with suspected lead ingestion?
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.
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 -
Abdo XRAY!!!! do it!
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. What is gastric lavage?
Antidote is naloxone.
Stomach pumping.
Discobalt edetate
Digoxin Fab

33. Beta-blocker overdose antidote
Glucagon prefered - otherwise massive dose of adrenaline.
IM adrenaline: vasopressor and bronchodilator.
Objective signs of growth - tidiness - weight -
Flumazenil

34. Anticholinergics
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Ceftriaxone
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

35. Opiates
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Antidote is naloxone.
Give IM adrenaline - steroids - salbutamol - antihistamine.

36. Calcium gluconate
Aspiration Pneumonia
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

37. Tricyclic antidepressants
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
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.
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

38. Carbon monoxide
CHARCOAL! except for lithium - iron - alcohol - lead.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Cyanosis and irregular respiratory effort
Severe illness - past history of injuries - 18 months or less - inconstent story.

39. Organophosphates
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.

40. Ibuprofen
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
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 temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

41. Atropine
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.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
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.

42. Signs of abuse from the history
Blood glucose level for hypoglycaemia!!
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

43. Opiates
'I WOULD CALL POISON HOTLINE'.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Neurosurgery if trauma. Give mannitol.

44. You must consider abuse in
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Stomach pumping.
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

45. Salicylates
Discobalt edetate
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.
Objective signs of growth - tidiness - weight -
Release NEUROTOXINS both have antivenom

46. Sympathomimetics
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Esmolol
Class of drugs encompassing decongestants - amphetamines - cocaine.
Glucagon prefered - otherwise massive dose of adrenaline.

47. OSCE: how can i prevent accidents in my children
Bone scan for occult fracture
Severe illness - past history of injuries - 18 months or less - inconstent story.
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
Intubate - tracheostromy or nebulized adrenaline.

48. Carbon monoxide
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
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
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
Croup.

49. Funnel web and red back
Give steroids for management of serum sickness. Must do coagulation screen!!!
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.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.

50. When and how would you do whole bowel irrigation?
Normally treated with sling alone. Seek advice.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.