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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. Theophylline
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 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 drugs encompassing decongestants - amphetamines - cocaine.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.

2. Benzodiazepine overdose antidote
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Flumazenil
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Croup.

3. Which is better - activated charcoal or gastric lavage.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
CHARCOAL! except for lithium - iron - alcohol - lead.
Antidotes are atropine sulfate and pralidoxime chloride.
Stomach pumping.

4. Tricyclic antidepressants
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Calcium 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
Class of drugs encompassing decongestants - amphetamines - cocaine.

5. Management of near drowning.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Stomach pumping.
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
It can cause fatal bronchioloitis obliterans

6. what makes you suspicious of non-accidental injury.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
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 -
'I WOULD CALL POISON HOTLINE'.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

7. Mx of critical asthma
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Aspiration pneumonia even if intubated.
Ceftriaxone
CHARCOAL! except for lithium - iron - alcohol - lead.

8. Opiates
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.
Ceftriaxone
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.

9. Opiates
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Flumazenil
Immobilize with plaster slab
Give steroids for management of serum sickness. Must do coagulation screen!!!

10. Displaced surgical neck of humerous
Skin or vascular compromise
Collar and cuff. Check integrity of nerve.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Normally treated with sling alone. Seek advice.

11. Salicylates
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.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

12. What happens if charcoal is aspirated?
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
It can cause fatal bronchioloitis obliterans
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 -

13. What is the general management of poisoning?
Give steroids for management of serum sickness. Must do coagulation screen!!!
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.

14. Calcium channel blocker overdose antidote
Calcium chloride
Normally treated with sling alone. Seek advice.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Ceftriaxone

15. What are the special features that must be done to correct haemorrhagic shock.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
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 -

16. Anticholinergics
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

17. Amphetamine antidote
Esmolol
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.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

18. Digoxin antedote
Digoxin Fab
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
Glucagon prefered - otherwise massive dose of adrenaline.
Neurosurgery if trauma. Give mannitol.

19. Tricyclic antidepressants overdose
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
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.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.

20. Anticholinergics
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Blood glucose level for hypoglycaemia!!
Rash bronchospasm and hypotension.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.

21. You must consider abuse in
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Esmolol
Poisoning causes decreased cholinesterase activity.

22. What is the most common caUse of acute laryngeal obstruction?
Sling for 3 weeks - fracture clinic at 7 days.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Croup.
Skin or vascular compromise

23. Epinephrine
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.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

24. 20
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Nausea vomiting and anorexia.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Flurescence in ultraviolet light.

25. 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.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Antidote is naloxone.

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

27. Atropine
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.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

28. Anticholinergics
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.
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 tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Give steroids for management of serum sickness. Must do coagulation screen!!!

29. Ibuprofen
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
Bone scan for occult fracture
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Antidote is deferoxamine chelation. Charcoal is ineffective.

30. A child has swallowed a battery. Mx
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
'I WOULD CALL POISON HOTLINE'.
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 -

31. Sympathomimetics
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Glucagon prefered - otherwise massive dose of adrenaline.
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.
Class of drugs encompassing decongestants - amphetamines - cocaine.

32. Acetaminophen
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Antidote is naloxone.
Calcium chloride
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

33. Mx raised intracranial pressure.
Neurosurgery if trauma. Give mannitol.
Ceftriaxone
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
It can cause fatal bronchioloitis obliterans

34. What is better for alcohol - charcoal or gastric lavage?

35. Sodium Bicarbonate
Rash bronchospasm and hypotension.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Croup.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

36. How may you detect semen?
Flurescence in ultraviolet light.
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 tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.

37. Ingesting Petrol. Cx?
Objective signs of growth - tidiness - weight -
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Aspiration Pneumonia
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

38. Salicylates
Munchausen's by proxy
Discobalt edetate
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Esmolol

39. What investigations should you do in suspected child abuse
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Bone scan for occult fracture
Release NEUROTOXINS both have antivenom
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

40. Amiodarone
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Notify if abuse CONSIDERED. CONSIDERED.
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.
Nausea vomiting and anorexia.

41. Funnel web and red back
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Objective signs of growth - tidiness - weight -
Release NEUROTOXINS both have antivenom
Abdo XRAY!!!! do it!

42. What is the most important investigation in suspected alcohol poisoning in young person?
Causes BAD constipation. Upsets fluid and electrolyte balance.
Blood glucose level for hypoglycaemia!!
Abdo XRAY!!!! do it!
Release NEUROTOXINS both have antivenom

43. What is the most appropriate examination in a child with suspected lead ingestion?
Class of drugs encompassing decongestants - amphetamines - cocaine.
Abdo XRAY!!!! do it!
Collar and cuff. Check integrity of nerve.
Discobalt edetate

44. Mx severe croup
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Discobalt edetate
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Croup.

45. Sympathomimetics
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Release NEUROTOXINS both have antivenom
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.

46. Acetaminophen
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
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.

47. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
Class of drugs encompassing decongestants - amphetamines - cocaine.
Aspiration pneumonia even if intubated.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Blood glucose level for hypoglycaemia!!

48. What is the most important treatment for anaphylaxis
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 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.
Stomach pumping.
IM adrenaline: vasopressor and bronchodilator.

49. What is a side effect of charcoal?
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Causes BAD constipation. Upsets fluid and electrolyte balance.
Objective signs of growth - tidiness - weight -
Croup.

50. Oedema causing laryngeal obstruction?
Intubate - tracheostromy or nebulized adrenaline.
Croup.
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
Antidote is naloxone.