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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. Anticholinergics
Class of drugs encompassing decongestants - amphetamines - cocaine.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
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 treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

2. What is the general management of poisoning?
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
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

3. When and how would you do whole bowel irrigation?
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
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
Notify if abuse CONSIDERED. CONSIDERED.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.

4. What is the most important investigation in suspected alcohol poisoning in young person?
Munchausen's by proxy
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
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Blood glucose level for hypoglycaemia!!

5. Calcium channel blocker overdose antidote
IM adrenaline: vasopressor and bronchodilator.
Calcium chloride
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Release NEUROTOXINS both have antivenom

6. What is the most common caUse of acute laryngeal obstruction?
Glucagon prefered - otherwise massive dose of adrenaline.
IM adrenaline: vasopressor and bronchodilator.
Skin or vascular compromise
Croup.

7. Procainamide
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Munchausen's by proxy
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.
Croup.

8. What are the special features that must be done to correct haemorrhagic shock.
'I WOULD CALL POISON HOTLINE'.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
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.

9. Funnel web and red back
Digoxin Fab
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Release NEUROTOXINS both have antivenom
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

10. 20
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Blood glucose level for hypoglycaemia!!
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

11. When is reduction required in fracture?
Skin or vascular compromise
Objective signs of growth - tidiness - weight -
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Causes BAD constipation. Upsets fluid and electrolyte balance.

12. 45; 70
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.
Neurotoxins - procagulants. Rhabdomyolysins.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

13. What must you do before sending fracture to radiology?
Release NEUROTOXINS both have antivenom
Normally treated with sling alone. Seek advice.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Immobilize with plaster slab

14. Mx of petroleum 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
Calcium chloride
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)

15. 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.
Esmolol
It can cause fatal bronchioloitis obliterans
Calcium chloride

16. Sodium Bicarbonate
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Blood glucose level for hypoglycaemia!!
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Nausea vomiting and anorexia.

17. You must consider abuse in
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.
Antidotes are atropine sulfate and pralidoxime chloride.
Severe illness - past history of injuries - 18 months or less - inconstent story.
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.

18. Opiates
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Bone scan for occult fracture
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Antidote is naloxone.

19. Adenosine
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
IM adrenaline: vasopressor and bronchodilator.
Poisoning causes decreased cholinesterase activity.

20. Lidocaine
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 -
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.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.

21. Opiates
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Antidotes are atropine sulfate and pralidoxime chloride.
Ceftriaxone
Poisoning causes decreased cholinesterase activity.

22. Ethanol
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Neurotoxins - procagulants. Rhabdomyolysins.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

23. Anticholinergics
Intubate - tracheostromy or nebulized adrenaline.
Aspiration Pneumonia
Glucagon prefered - otherwise massive dose of adrenaline.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

24. Tricyclic antidepressants
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Aspiration Pneumonia
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

25. OSCE: What are the five princples of discharging a patient with a fracture?
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Class of drugs encompassing decongestants - amphetamines - cocaine.

26. Salicylates
Ceftriaxone
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.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Skin or vascular compromise

27. Ingesting Petrol. Cx?
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.
Normally treated with sling alone. Seek advice.
Aspiration Pneumonia

28. Signs of psychological maltreatment?
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
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 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
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.

29. What is the most important treatment for anaphylaxis
Antidotes are atropine sulfate and pralidoxime chloride.
Poisoning causes decreased cholinesterase activity.
Munchausen's by proxy
IM adrenaline: vasopressor and bronchodilator.

30. What happens if charcoal is aspirated?
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 -
Antidote is deferoxamine chelation. Charcoal is ineffective.
It can cause fatal bronchioloitis obliterans
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.

31. Iron
Cyanosis and irregular respiratory effort
Antidote is deferoxamine chelation. Charcoal is ineffective.
Antidote is naloxone.
CHARCOAL! except for lithium - iron - alcohol - lead.

32. What is the most appropriate examination in a child with suspected lead ingestion?
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Immobilize with plaster slab
Abdo XRAY!!!! do it!
IM adrenaline: vasopressor and bronchodilator.

33. Which is better - activated charcoal or gastric lavage.
CHARCOAL! except for lithium - iron - alcohol - lead.
Esmolol
Antidotes are atropine sulfate and pralidoxime chloride.
Nausea vomiting and anorexia.

34. What are the side effects of N-acety-p-benzoquinine?
Rash bronchospasm and hypotension.
Glucagon prefered - otherwise massive dose of adrenaline.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Abdo XRAY!!!! do it!

35. What are the three features of anaphylaxis
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Lead poisoning is defined as a serum level greater than ___ ug/dL.
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

36. Anticholinergics
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
It can cause fatal bronchioloitis obliterans
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.

37. What are the other treatments for anaphylaxis?
Neurosurgery if trauma. Give mannitol.
Neurotoxins - procagulants. Rhabdomyolysins.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Give IM adrenaline - steroids - salbutamol - antihistamine.

38. Benzodiazepine overdose antidote
Intubate - tracheostromy or nebulized adrenaline.
Ceftriaxone
Flumazenil
CHARCOAL! except for lithium - iron - alcohol - lead.

39. Amphetamine antidote
Cyanosis and irregular respiratory effort
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Esmolol

40. What is a side effect of charcoal?
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
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 delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Causes BAD constipation. Upsets fluid and electrolyte balance.

41. Sympathomimetics
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
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.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Class of drugs encompassing decongestants - amphetamines - cocaine.

42. Carbon monoxide
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Poisoning causes decreased cholinesterase activity.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.

43. Organophosphates
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.
Calcium chloride
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 salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

44. How do snake bites damage?
Sling for 3 weeks - fracture clinic at 7 days.
Neurotoxins - procagulants. Rhabdomyolysins.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

45. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
Blood glucose level for hypoglycaemia!!
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Aspiration pneumonia even if intubated.
Digoxin Fab

46. Tricyclic antidepressants overdose
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
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
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

47. Cyanide
Discobalt edetate
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

48. What is the antibiotic for Epiglottitis?
Ceftriaxone
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 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.
Abdo XRAY!!!! do it!

49. what makes you suspicious of non-accidental injury.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Ceftriaxone
'I WOULD CALL POISON HOTLINE'.
Lead poisoning is defined as a serum level greater than ___ ug/dL.

50. Organophosphates
Antidote is naloxone.
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 -
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 decreased cholinesterase activity.