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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. 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.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
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

2. What is an important point to note about anaphylaxis?
Aspiration pneumonia even if intubated.
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 -
Neurosurgery if trauma. Give mannitol.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.

3. Management of septicaemia shock

4. Signs of abuse from the history
Immobilize with plaster slab
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

5. What is the most important investigation in suspected alcohol poisoning in young person?
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
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.
Blood glucose level for hypoglycaemia!!

6. 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
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
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
Skin or vascular compromise

7. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
'I WOULD CALL POISON HOTLINE'.
It can cause fatal bronchioloitis obliterans
Aspiration pneumonia even if intubated.
Glucagon prefered - otherwise massive dose of adrenaline.

8. What are the special features that must be done to correct haemorrhagic shock.
IM adrenaline: vasopressor and bronchodilator.
Flumazenil
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
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.

9. Ethylene glycol
Rash bronchospasm and hypotension.
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 -
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

10. 20
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
Lead poisoning is defined as a serum level greater than ___ ug/dL.
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

11. What are the three features of anaphylaxis
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
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 -
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

12. Methanol
Lead poisoning is defined as a serum level greater than ___ ug/dL.
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.
Antidote is naloxone.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

13. Anticholinergics
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - 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.
Flurescence in ultraviolet light.

14. Middle Clavicle fracture management?
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Antidote is naloxone.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Give steroids for management of serum sickness. Must do coagulation screen!!!

15. 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.
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
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
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

16. What are the side effects of N-acety-p-benzoquinine?
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Rash bronchospasm and hypotension.
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

17. What investigations should you do in suspected child abuse
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Bone scan for occult fracture
IM adrenaline: vasopressor and bronchodilator.
Blood glucose level for hypoglycaemia!!

18. Undisplaced radial shaft fracture
Collar and cuff. Check integrity of nerve.
Blood glucose level for hypoglycaemia!!
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

19. Carbon monoxide
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.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Calcium chloride
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

20. Carbon monoxide
Collar and cuff. Check integrity of nerve.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

21. When is gastric lavage indicated and contraindicated?
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Rash bronchospasm and hypotension.

22. 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.
Collar and cuff. Check integrity of nerve.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Antidote is deferoxamine chelation. Charcoal is ineffective.

23. What is the antibiotic for Epiglottitis?
Collar and cuff. Check integrity of nerve.
Aspiration Pneumonia
Ceftriaxone
Neurotoxins - procagulants. Rhabdomyolysins.

24. Benzodiazepine overdose antidote
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Flumazenil
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Give IM adrenaline - steroids - salbutamol - antihistamine.

25. Digoxin antedote
Nausea vomiting and anorexia.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Digoxin Fab
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

26. Methanol
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Collar and cuff. Check integrity of nerve.
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.

27. You must consider abuse in
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Immobilize with plaster slab
Objective signs of growth - tidiness - weight -

28. Salicylates
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 -
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 treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
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

29. How do snake bites damage?
Croup.
Calcium chloride
Neurotoxins - procagulants. Rhabdomyolysins.
Blood glucose level for hypoglycaemia!!

30. What is the most common caUse of acute laryngeal obstruction?
... blood sugars for hypoglycaemia
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Croup.

31. A child has swallowed a battery. Mx
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.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Glucagon prefered - otherwise massive dose of adrenaline.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy

32. Ethanol
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Sling for 3 weeks - fracture clinic at 7 days.
Munchausen's by proxy
Poisoning causes decreased cholinesterase activity.

33. Signs of psychological maltreatment?
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
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.
It can cause fatal bronchioloitis obliterans

34. Ingesting Petrol. Cx?
Bone scan for occult fracture
Rash bronchospasm and hypotension.
Aspiration Pneumonia
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy

35. Organophosphates
Normally treated with sling alone. Seek advice.
Poisoning causes decreased cholinesterase activity.
IM adrenaline: vasopressor and bronchodilator.
Objective signs of growth - tidiness - weight -

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

37. What is one of the technicalities of childabuse.
Neurotoxins - procagulants. Rhabdomyolysins.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Abdo XRAY!!!! do it!

38. Iron
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
'I WOULD CALL POISON HOTLINE'.
CHARCOAL! except for lithium - iron - alcohol - lead.
Antidote is deferoxamine chelation. Charcoal is ineffective.

39. Funnel web and red back
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Release NEUROTOXINS both have antivenom
Antidotes are atropine sulfate and pralidoxime 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.

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

41. What are the other treatments for anaphylaxis?
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Bone scan for occult fracture
Give IM adrenaline - steroids - salbutamol - antihistamine.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

42. Mx of petroleum overdose
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Rash bronchospasm and hypotension.
Digoxin Fab
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

43. Acetaminophen
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
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.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

44. 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.
Skin or vascular compromise
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

45. 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
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
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

46. Beta-blocker overdose antidote
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.
Glucagon prefered - otherwise massive dose of adrenaline.
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.

47. Undisplaced surgical neck of humerous?
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
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.

48. 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.
Aspiration Pneumonia
Abdo XRAY!!!! do it!
Severe illness - past history of injuries - 18 months or less - inconstent story.

49. Sympathomimetics
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
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.
Collar and cuff. Check integrity of nerve.

50. Legal requirement in childabuse
'I WOULD CALL POISON HOTLINE'.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Calcium chloride
Notify if abuse CONSIDERED. CONSIDERED.