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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. Oedema causing laryngeal obstruction?
Intubate - tracheostromy or nebulized adrenaline.
Glucagon prefered - otherwise massive dose of adrenaline.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Bone scan for occult fracture

2. Management of near drowning.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
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
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

3. Which is better - activated charcoal or gastric lavage.
CHARCOAL! except for lithium - iron - alcohol - lead.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Aspiration Pneumonia
Intubate - tracheostromy or nebulized adrenaline.

4. What is the general management of poisoning?
CHARCOAL! except for lithium - iron - alcohol - lead.
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.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

5. Legal requirement in childabuse
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
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.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Notify if abuse CONSIDERED. CONSIDERED.

6. What is the antibiotic for Epiglottitis?
Stomach pumping.
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
Ceftriaxone
Croup.

7. A child has swallowed a battery. Mx
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Collar and cuff. Check integrity of nerve.
Aspiration pneumonia even if intubated.

8. 45; 70
Class of drugs encompassing decongestants - amphetamines - cocaine.
Stomach pumping.
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 bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

9. What is a side effect of charcoal?
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Causes BAD constipation. Upsets fluid and electrolyte balance.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

10. Undisplaced surgical neck of humerous?
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.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
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

11. Cyanide
Discobalt edetate
Causes BAD constipation. Upsets fluid and electrolyte balance.
Severe illness - past history of injuries - 18 months or less - inconstent story.
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.

12. Indications of non-accidental injury
Blood glucose level for hypoglycaemia!!
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 -
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.

13. Opiates
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 bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Give IM adrenaline - steroids - salbutamol - antihistamine.

14. Calcium gluconate
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.

15. Beta-blocker overdose antidote
Severe illness - past history of injuries - 18 months or less - inconstent story.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
... blood sugars for hypoglycaemia
Glucagon prefered - otherwise massive dose of adrenaline.

16. Ethylene glycol
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.

17. Amphetamine antidote
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Esmolol
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Poisoning causes decreased cholinesterase activity.

18. 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.
Glucagon prefered - otherwise massive dose of adrenaline.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Rash bronchospasm and hypotension.

19. OSCE: What are the five princples of discharging a patient with a fracture?
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Bone scan for occult fracture
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.

20. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Poisoning causes decreased cholinesterase activity.
Aspiration pneumonia even if intubated.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

21. Funnel web and red back
Release NEUROTOXINS both have antivenom
Give IM adrenaline - steroids - salbutamol - antihistamine.
Esmolol
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

22. What is the most important investigation in suspected alcohol poisoning in young person?
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
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 -
Blood glucose level for hypoglycaemia!!
Intubate - tracheostromy or nebulized adrenaline.

23. What are the early symptoms of paracetamol overdose?
Nausea vomiting and anorexia.
Antidotes are atropine sulfate and pralidoxime chloride.
Poisoning causes decreased cholinesterase activity.
Causes BAD constipation. Upsets fluid and electrolyte balance.

24. Ethanol
Croup.
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 bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

25. What is the first line investigation in a young child who has consumed alcohol?
... blood sugars for hypoglycaemia
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

26. Mx raised intracranial pressure.
Normally treated with sling alone. Seek advice.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Neurosurgery if trauma. Give mannitol.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

27. Organophosphates
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Flumazenil
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Glucagon prefered - otherwise massive dose of adrenaline.

28. Acetaminophen
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Munchausen's by proxy
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 -
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

29. 20
Flumazenil
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Poisoning causes decreased cholinesterase activity.
Nausea vomiting and anorexia.

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

31. Sympathomimetics
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.

32. When is reduction required in fracture?
Munchausen's by proxy
Skin or vascular compromise
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Blood glucose level for hypoglycaemia!!

33. Displaced surgical neck of humerous
Glucagon prefered - otherwise massive dose of adrenaline.
Normally treated with sling alone. Seek advice.
It can cause fatal bronchioloitis obliterans
Objective signs of growth - tidiness - weight -

34. What investigations should you do in suspected child abuse
Sling for 3 weeks - fracture clinic at 7 days.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Bone scan for occult fracture
Normally treated with sling alone. Seek advice.

35. You must consider abuse in
Severe illness - past history of injuries - 18 months or less - inconstent story.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Cyanosis and irregular respiratory effort

36. Epinephrine
Abdo XRAY!!!! do it!
Antidote is deferoxamine chelation. Charcoal is ineffective.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Esmolol

37. Tricyclic antidepressants overdose
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Collar and cuff. Check integrity of nerve.

38. Sodium Bicarbonate
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Poisoning causes decreased cholinesterase activity.
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 - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.

39. Procainamide
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.
IM adrenaline: vasopressor and bronchodilator.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
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

40. What is the most appropriate examination in a child with suspected lead ingestion?
Abdo XRAY!!!! do it!
'I WOULD CALL POISON HOTLINE'.
Sling for 3 weeks - fracture clinic at 7 days.
IM adrenaline: vasopressor and bronchodilator.

41. Hydrocarbons
Objective signs of growth - tidiness - weight -
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.
'I WOULD CALL POISON HOTLINE'.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

42. Iron
Antidote is deferoxamine chelation. Charcoal is ineffective.
Collar and cuff. Check integrity of nerve.
Give IM adrenaline - steroids - salbutamol - antihistamine.
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

43. Methanol
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.
Antidotes are atropine sulfate and pralidoxime chloride.
Cyanosis and irregular respiratory effort
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

44. Carbon monoxide
Release NEUROTOXINS both have antivenom
Objective signs of growth - tidiness - weight -
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
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

45. 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
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
Neurotoxins - procagulants. Rhabdomyolysins.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

46. Lead
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Munchausen's by proxy
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

47. Acetaminophen
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 irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Antidote is deferoxamine chelation. Charcoal is ineffective.

48. Salicylates
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
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.
Blood glucose level for hypoglycaemia!!
Immobilize with plaster slab

49. What is the most common caUse of acute laryngeal obstruction?
Croup.
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.
Immobilize with plaster slab
Abdo XRAY!!!! do it!

50. Ingesting Petrol. Cx?
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
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) 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
Aspiration Pneumonia