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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. Acetaminophen
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
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.
'I WOULD CALL POISON HOTLINE'.

2. Mx of critical asthma
Intubate - tracheostromy or nebulized adrenaline.
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
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
'I WOULD CALL POISON HOTLINE'.

3. Ethylene glycol
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

4. Mx raised intracranial pressure.
Notify if abuse CONSIDERED. CONSIDERED.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Cyanosis and irregular respiratory effort
Neurosurgery if trauma. Give mannitol.

5. 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.
Neurotoxins - procagulants. Rhabdomyolysins.
Nausea vomiting and anorexia.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.

6. Acetaminophen
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Neurosurgery if trauma. Give mannitol.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

7. Salicylates
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Antidote is naloxone.
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 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

8. Amphetamine antidote
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.
Aspiration Pneumonia
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

9. 20
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 lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

10. Organophosphates
Objective signs of growth - tidiness - weight -
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.
Collar and cuff. Check integrity of nerve.

11. Displaced surgical neck of humerous
Normally treated with sling alone. Seek advice.
Severe illness - past history of injuries - 18 months or less - inconstent story.
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
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

12. Carbon monoxide
Collar and cuff. Check integrity of nerve.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Flurescence in ultraviolet light.
Intubate - tracheostromy or nebulized adrenaline.

13. Adenosine
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.
Discobalt edetate
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

14. What are the special features that must be done to correct haemorrhagic shock.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Neurosurgery if trauma. Give mannitol.
Flumazenil
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

15. Salicylates
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
Give IM adrenaline - steroids - salbutamol - antihistamine.
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.

16. what makes you suspicious of non-accidental injury.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Rash bronchospasm and hypotension.

17. What must you do before sending fracture to radiology?
Immobilize with plaster slab
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Aspiration Pneumonia
Causes BAD constipation. Upsets fluid and electrolyte balance.

18. Iron
Esmolol
Bone scan for occult fracture
Before a child can be examined for child abuse - a parent or legal guardian must give consent
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

19. Opiates
Stomach pumping.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
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.

20. Middle Clavicle fracture management?
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
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Esmolol
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

21. Organophosphates
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 delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Poisoning causes decreased cholinesterase activity.

22. Hydrocarbons
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.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Poisoning causes decreased cholinesterase activity.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

23. Atropine
Antidote is deferoxamine chelation. Charcoal is ineffective.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.

24. Benzodiazepine overdose antidote
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Flumazenil
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Blood glucose level for hypoglycaemia!!

25. What is the most common caUse of acute laryngeal obstruction?
Antidotes are atropine sulfate and pralidoxime chloride.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Flurescence in ultraviolet light.
Croup.

26. Digoxin antedote
Objective signs of growth - tidiness - weight -
Digoxin Fab
Neurotoxins - procagulants. Rhabdomyolysins.
Aspiration Pneumonia

27. A child has swallowed a battery. Mx
Give IM adrenaline - steroids - salbutamol - antihistamine.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Calcium chloride
Aspiration pneumonia even if intubated.

28. Which is better - activated charcoal or gastric lavage.
CHARCOAL! except for lithium - iron - alcohol - lead.
Aspiration pneumonia even if intubated.
Flumazenil
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

29. Undisplaced radial shaft fracture
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Collar and cuff. Check integrity of nerve.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

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

31. When and how would you do whole bowel irrigation?
Poisoning causes decreased cholinesterase activity.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

32. Lidocaine
Aspiration pneumonia even if intubated.
Munchausen's by proxy
Blood glucose level for hypoglycaemia!!
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.

33. What is gastric lavage?
Collar and cuff. Check integrity of nerve.
Munchausen's by proxy
Stomach pumping.
Before a child can be examined for child abuse - a parent or legal guardian must give consent

34. What is an important point to note about anaphylaxis?
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 -
... blood sugars for hypoglycaemia
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
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.

35. Sympathomimetics
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 tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.

36. Signs of abuse from the history
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Class of drugs encompassing decongestants - amphetamines - cocaine.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

37. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
Aspiration pneumonia even if intubated.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Release NEUROTOXINS both have antivenom
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

38. What happens if charcoal is aspirated?
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Objective signs of growth - tidiness - weight -
IM adrenaline: vasopressor and bronchodilator.
It can cause fatal bronchioloitis obliterans

39. Tricyclic antidepressants overdose
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
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.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

40. What is one of the technicalities of childabuse.
IM adrenaline: vasopressor and bronchodilator.
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.
Aspiration pneumonia even if intubated.
Before a child can be examined for child abuse - a parent or legal guardian must give consent

41. OSCE: What are the five princples of discharging a patient with a fracture?
Collar and cuff. Check integrity of nerve.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

42. What is the most appropriate examination in a child with suspected lead ingestion?
Abdo XRAY!!!! do it!
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
CHARCOAL! except for lithium - iron - alcohol - lead.
Flurescence in ultraviolet light.

43. Carbon monoxide
Poisoning causes decreased cholinesterase activity.
Ceftriaxone
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.

44. What is the antibiotic for Epiglottitis?
Normally treated with sling alone. Seek advice.
Glucagon prefered - otherwise massive dose of adrenaline.
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.
Ceftriaxone

45. Legal requirement in childabuse
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Antidotes are atropine sulfate and pralidoxime chloride.
Notify if abuse CONSIDERED. CONSIDERED.
Esmolol

46. Ethanol
Notify if abuse CONSIDERED. CONSIDERED.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
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.
Munchausen's by proxy

47. Tricyclic antidepressants
Nausea vomiting and anorexia.
Cyanosis and irregular respiratory effort
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
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

48. What evidence should a doctor give about parental neglect
Objective signs of growth - tidiness - weight -
Poisoning causes decreased cholinesterase activity.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Nausea vomiting and anorexia.

49. 45; 70
Poisoning causes decreased cholinesterase activity.
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
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Blood glucose level for hypoglycaemia!!

50. What else is in the management of snake bite?
Release NEUROTOXINS both have antivenom
Give steroids for management of serum sickness. Must do coagulation screen!!!
Causes BAD constipation. Upsets fluid and electrolyte balance.
Neurotoxins - procagulants. Rhabdomyolysins.