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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. Adenosine
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.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.

2. Anticholinergics
Antidotes are atropine sulfate and pralidoxime chloride.
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.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Class of drugs encompassing decongestants - amphetamines - cocaine.

3. What are the early symptoms of paracetamol overdose?
Nausea vomiting and anorexia.
... blood sugars for hypoglycaemia
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

4. Calcium gluconate
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Calcium chloride
Sling for 3 weeks - fracture clinic at 7 days.
Cyanosis and irregular respiratory effort

5. What psychiatric disease defined as childabuse?

6. Methanol
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
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.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

7. What happens if charcoal is aspirated?
Bone scan for occult fracture
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
Skin or vascular compromise
It can cause fatal bronchioloitis obliterans

8. Ethanol
Antidote is naloxone.
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.
'I WOULD CALL POISON HOTLINE'.

9. Signs of psychological maltreatment?
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Flurescence in ultraviolet light.
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.

10. Opiates
Munchausen's by proxy
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

11. Acetaminophen
Give steroids for management of serum sickness. Must do coagulation screen!!!
Stomach pumping.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Croup.

12. Lead
CHARCOAL! except for lithium - iron - alcohol - lead.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

13. OSCE: how can i prevent accidents in my children
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
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

14. Calcium channel blocker overdose antidote
Collar and cuff. Check integrity of nerve.
Flurescence in ultraviolet light.
Calcium chloride
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

15. Hydrocarbons
'I WOULD CALL POISON HOTLINE'.
Neurosurgery if trauma. Give mannitol.
Intubate - tracheostromy or nebulized adrenaline.
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.

16. Undisplaced surgical neck of humerous?
Sling for 3 weeks - fracture clinic at 7 days.
Stomach pumping.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Collar and cuff. Check integrity of nerve.

17. OSCE: What are the five princples of discharging a patient with a fracture?
Esmolol
Munchausen's by proxy
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.

18. Funnel web and red back
Notify if abuse CONSIDERED. CONSIDERED.
Release NEUROTOXINS both have antivenom
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Stomach pumping.

19. Acetaminophen
Release NEUROTOXINS both have antivenom
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.
Neurotoxins - procagulants. Rhabdomyolysins.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

20. Displaced surgical neck of humerous
Discobalt edetate
Stomach pumping.
Normally treated with sling alone. Seek advice.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

21. What are the special features that must be done to correct haemorrhagic shock.
Immobilize with plaster slab
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

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

23. You must consider abuse in
... blood sugars for hypoglycaemia
Sling for 3 weeks - fracture clinic at 7 days.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

24. What is the most common caUse of acute laryngeal obstruction?
Discobalt edetate
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Croup.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.

25. Tricyclic antidepressants
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.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
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
Croup.

26. What is gastric lavage?
Neurotoxins - procagulants. Rhabdomyolysins.
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.
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
Stomach pumping.

27. Ethylene glycol
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.
Croup.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
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.

28. Sympathomimetics
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
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.
Notify if abuse CONSIDERED. CONSIDERED.

29. Management of near drowning.
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
Glucagon prefered - otherwise massive dose of adrenaline.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Discobalt edetate

30. 45; 70
Nausea vomiting and anorexia.
Cyanosis and irregular respiratory effort
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
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

31. Organophosphates
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
... blood sugars for hypoglycaemia
Calcium chloride

32. Organophosphates
Class of drugs encompassing decongestants - amphetamines - cocaine.
Poisoning causes decreased cholinesterase activity.
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.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

33. Digoxin antedote
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
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
Digoxin Fab
Ceftriaxone

34. Which is better - activated charcoal or gastric lavage.
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.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Causes BAD constipation. Upsets fluid and electrolyte balance.
CHARCOAL! except for lithium - iron - alcohol - lead.

35. What are the terminal signs of acute laryngeal obstruction?
Cyanosis and irregular respiratory effort
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Nausea vomiting and anorexia.
Normally treated with sling alone. Seek advice.

36. Epinephrine
Intubate - tracheostromy or nebulized adrenaline.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Rash bronchospasm and hypotension.

37. Atropine
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

38. How do snake bites damage?
Abdo XRAY!!!! do it!
Neurotoxins - procagulants. Rhabdomyolysins.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Objective signs of growth - tidiness - weight -

39. Cyanide
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
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
Discobalt edetate
Antidotes are atropine sulfate and pralidoxime chloride.

40. What else is in the management of snake bite?
Abdo XRAY!!!! do it!
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

41. Tricyclic antidepressants overdose
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

42. Management of septicaemia shock

43. Iron
Normally treated with sling alone. Seek advice.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Causes BAD constipation. Upsets fluid and electrolyte balance.

44. What is the most important treatment for anaphylaxis
Abdo XRAY!!!! do it!
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.
IM adrenaline: vasopressor and bronchodilator.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

45. What is a side effect of charcoal?
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Causes BAD constipation. Upsets fluid and electrolyte balance.
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. Carbon monoxide
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Poisoning causes decreased cholinesterase activity.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

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

48. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
Glucagon prefered - otherwise massive dose of adrenaline.
Release NEUROTOXINS both have antivenom
Aspiration pneumonia even if intubated.
Collar and cuff. Check integrity of nerve.

49. Mx of petroleum overdose
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
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 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

50. 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.
Poisoning causes decreased cholinesterase activity.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
IM adrenaline: vasopressor and bronchodilator.