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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. Mx severe croup
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 -
Class of drugs encompassing decongestants - amphetamines - cocaine.
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
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

2. Calcium gluconate
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
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
Munchausen's by proxy
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

3. Carbon monoxide
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.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
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.

4. What evidence should a doctor give about parental neglect
Objective signs of growth - tidiness - weight -
Causes BAD constipation. Upsets fluid and electrolyte balance.
Release NEUROTOXINS both have antivenom
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

5. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Aspiration pneumonia even if intubated.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

6. What is the most important treatment for anaphylaxis
Objective signs of growth - tidiness - weight -
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Discobalt edetate
IM adrenaline: vasopressor and bronchodilator.

7. Undisplaced surgical neck of humerous?
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 tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Sling for 3 weeks - fracture clinic at 7 days.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

8. What are the side effects of N-acety-p-benzoquinine?
Antidote is naloxone.
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.
Rash bronchospasm and hypotension.

9. Ethanol
Flumazenil
Poisoning causes decreased cholinesterase activity.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Calcium chloride

10. Sympathomimetics
Intubate - tracheostromy or nebulized adrenaline.
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
Class of drugs encompassing decongestants - amphetamines - cocaine.
Neurosurgery if trauma. Give mannitol.

11. Signs of abuse from the history
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
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.
Rash bronchospasm and hypotension.

12. what makes you suspicious of non-accidental injury.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Severe illness - past history of injuries - 18 months or less - inconstent story.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

13. Epinephrine
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
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
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.

14. What is the antibiotic for Epiglottitis?
Ceftriaxone
Antidotes are atropine sulfate and pralidoxime chloride.
IM adrenaline: vasopressor and bronchodilator.
Cyanosis and irregular respiratory effort

15. Undisplaced radial shaft fracture
Blood glucose level for hypoglycaemia!!
Collar and cuff. Check integrity of nerve.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy

16. When is gastric lavage indicated and contraindicated?
Abdo XRAY!!!! do it!
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
It can cause fatal bronchioloitis obliterans
Poisoning causes decreased cholinesterase activity.

17. What is a side effect of charcoal?
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
Digoxin Fab
Intubate - tracheostromy or nebulized adrenaline.
Causes BAD constipation. Upsets fluid and electrolyte balance.

18. 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
Aspiration Pneumonia
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Glucagon prefered - otherwise massive dose of adrenaline.

19. Legal requirement in childabuse
Flumazenil
Abdo XRAY!!!! do it!
Notify if abuse CONSIDERED. CONSIDERED.
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 -

20. What must you do before sending fracture to radiology?
Neurosurgery if trauma. Give mannitol.
Immobilize with plaster slab
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Collar and cuff. Check integrity of nerve.

21. What is the most appropriate examination in a child with suspected lead ingestion?
Abdo XRAY!!!! do it!
Croup.
Sling for 3 weeks - fracture clinic at 7 days.
Antidotes are atropine sulfate and pralidoxime chloride.

22. What is gastric lavage?
Give IM adrenaline - steroids - salbutamol - antihistamine.
Stomach pumping.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Give steroids for management of serum sickness. Must do coagulation screen!!!

23. What are the other treatments for anaphylaxis?
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Give IM adrenaline - steroids - salbutamol - antihistamine.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

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

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25. OSCE: What are the five princples of discharging a patient with a fracture?
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.
Poisoning causes decreased cholinesterase activity.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.

26. Funnel web and red back
Class of drugs encompassing decongestants - amphetamines - cocaine.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
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.

27. Displaced surgical neck of humerous
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 irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Normally treated with sling alone. Seek advice.

28. Salicylates
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Notify if abuse CONSIDERED. CONSIDERED.

29. Methanol
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.
Release NEUROTOXINS both have antivenom
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.
Normally treated with sling alone. Seek advice.

30. Sodium Bicarbonate
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Cyanosis and irregular respiratory effort
CHARCOAL! except for lithium - iron - alcohol - lead.
Give steroids for management of serum sickness. Must do coagulation screen!!!

31. What else is in the management of snake bite?
Antidotes are atropine sulfate and pralidoxime chloride.
Cyanosis and irregular respiratory effort
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Give steroids for management of serum sickness. Must do coagulation screen!!!

32. Mx of petroleum overdose
Rash bronchospasm and hypotension.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Croup.

33. Anticholinergics
Blood glucose level for hypoglycaemia!!
Stomach pumping.
Rash bronchospasm and hypotension.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

34. Carbon monoxide
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
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
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.
Stomach pumping.

35. Mx raised intracranial pressure.
Neurosurgery if trauma. Give mannitol.
Aspiration Pneumonia
It can cause fatal bronchioloitis obliterans
Abdo XRAY!!!! do it!

36. Ethylene glycol
Nausea vomiting and anorexia.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
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.
Calcium chloride

37. Middle Clavicle fracture management?
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
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
Stomach pumping.

38. Tricyclic antidepressants overdose
IM adrenaline: vasopressor and bronchodilator.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Stomach pumping.
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

39. Lead
Rash bronchospasm and hypotension.
Neurotoxins - procagulants. Rhabdomyolysins.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Croup.

40. 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.
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
Neurosurgery if trauma. Give mannitol.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.

41. Indications of non-accidental injury
Immobilize with plaster slab
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Antidote is deferoxamine chelation. Charcoal is ineffective.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

42. Which is better - activated charcoal or gastric lavage.
Antidotes are atropine sulfate and pralidoxime chloride.
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.
Sling for 3 weeks - fracture clinic at 7 days.
CHARCOAL! except for lithium - iron - alcohol - lead.

43. Anticholinergics
Causes BAD constipation. Upsets fluid and electrolyte balance.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
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 - 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

44. Calcium channel blocker overdose antidote
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Calcium chloride
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

45. Anticholinergics
Notify if abuse CONSIDERED. CONSIDERED.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.

46. What are the three features of anaphylaxis
Calcium chloride
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

47. What investigations should you do in suspected child abuse
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Bone scan for occult fracture
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

48. Amiodarone
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.
Cyanosis and irregular respiratory effort
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Immobilize with plaster slab

49. What is the most important investigation in suspected alcohol poisoning in young person?
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
Blood glucose level for hypoglycaemia!!
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Abdo XRAY!!!! do it!

50. Organophosphates
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
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
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.