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

2. Mx of critical asthma
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 decreased cholinesterase activity.
Antidotes are atropine sulfate and pralidoxime chloride.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

3. Organophosphates
Intubate - tracheostromy or nebulized adrenaline.
Abdo XRAY!!!! do it!
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Poisoning causes decreased cholinesterase activity.

4. Cyanide
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Discobalt edetate
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
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

5. What are the early symptoms of paracetamol overdose?
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Antidote is naloxone.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Nausea vomiting and anorexia.

6. OSCE: how can i prevent accidents in my children
Neurotoxins - procagulants. Rhabdomyolysins.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Antidote is naloxone.
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

7. Ethylene glycol
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 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) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.

8. What are the special features that must be done to correct haemorrhagic shock.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Antidotes are atropine sulfate and pralidoxime chloride.
Calcium chloride
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

9. When is reduction required in fracture?
Skin or vascular compromise
Flurescence in ultraviolet light.
Normally treated with sling alone. Seek advice.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.

10. Sympathomimetics
Intubate - tracheostromy or nebulized adrenaline.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.

11. Signs of abuse from the history
Objective signs of growth - tidiness - weight -
Release NEUROTOXINS both have antivenom
Causes BAD constipation. Upsets fluid and electrolyte balance.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

12. Anticholinergics
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
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

13. Carbon monoxide
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Croup.
'I WOULD CALL POISON HOTLINE'.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

14. Undisplaced radial shaft fracture
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
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.
Collar and cuff. Check integrity of nerve.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.

15. what makes you suspicious of non-accidental injury.
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.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Esmolol
Give steroids for management of serum sickness. Must do coagulation screen!!!

16. Opiates
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Antidote is naloxone.
Aspiration pneumonia even if intubated.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.

17. A child has swallowed a battery. Mx
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
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.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy

18. 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.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Notify if abuse CONSIDERED. CONSIDERED.

19. When is gastric lavage indicated and contraindicated?
Notify if abuse CONSIDERED. CONSIDERED.
Antidote is naloxone.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

20. Ibuprofen
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
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
Collar and cuff. Check integrity of nerve.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

21. What is the first line investigation in a young child who has consumed alcohol?
Intubate - tracheostromy or nebulized adrenaline.
... blood sugars for hypoglycaemia
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Rash bronchospasm and hypotension.

22. What is the most appropriate examination in a child with suspected lead ingestion?
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.
Abdo XRAY!!!! do it!
Cyanosis and irregular respiratory effort

23. Organophosphates
Neurotoxins - procagulants. Rhabdomyolysins.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
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

24. Displaced surgical neck of humerous
Poisoning causes decreased cholinesterase activity.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Normally treated with sling alone. Seek advice.
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

25. Acetaminophen
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Rash bronchospasm and hypotension.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.

26. Legal requirement in childabuse
Notify if abuse CONSIDERED. CONSIDERED.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
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
Antidote is naloxone.

27. Adenosine
Blood glucose level for hypoglycaemia!!
Normally treated with sling alone. Seek advice.
Skin or vascular compromise
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.

28. 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
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.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
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

29. Mx severe croup
Notify if abuse CONSIDERED. CONSIDERED.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Skin or vascular compromise
Objective signs of growth - tidiness - weight -

30. Undisplaced surgical neck of humerous?
Digoxin Fab
Skin or vascular compromise
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 -
Sling for 3 weeks - fracture clinic at 7 days.

31. What happens if charcoal is aspirated?
Stomach pumping.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
It can cause fatal bronchioloitis obliterans

32. What are the other treatments for anaphylaxis?
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
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
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy

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

34. Funnel web and red back
Release NEUROTOXINS both have antivenom
Normally treated with sling alone. Seek advice.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Lead poisoning is defined as a serum level greater than ___ ug/dL.

35. What is the most important investigation in suspected alcohol poisoning in young person?
Causes BAD constipation. Upsets fluid and electrolyte balance.
Skin or vascular compromise
Blood glucose level for hypoglycaemia!!
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

36. Hydrocarbons
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.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Notify if abuse CONSIDERED. CONSIDERED.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.

37. OSCE: What are the five princples of discharging a patient with a fracture?
Croup.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Skin or vascular compromise
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

38. What is the antibiotic for Epiglottitis?
Skin or vascular compromise
Antidote is naloxone.
Ceftriaxone
Discobalt edetate

39. You must consider abuse in
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Severe illness - past history of injuries - 18 months or less - inconstent story.
Release NEUROTOXINS both have antivenom
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

40. Ingesting Petrol. Cx?
Normally treated with sling alone. Seek advice.
Aspiration Pneumonia
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.
Release NEUROTOXINS both have antivenom

41. What investigations should you do in suspected child abuse
Bone scan for occult fracture
Lead poisoning is defined as a serum level greater than ___ ug/dL.
IM adrenaline: vasopressor and bronchodilator.
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.

42. Mx raised intracranial pressure.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Neurosurgery if trauma. Give mannitol.

43. Tricyclic antidepressants overdose
Aspiration Pneumonia
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.
Nausea vomiting and anorexia.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

44. When and how would you do whole bowel irrigation?
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Bone scan for occult fracture
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

45. Lead
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

46. What is the general management of poisoning?
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
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
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Release NEUROTOXINS both have antivenom

47. Indications of non-accidental injury
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Discobalt edetate
Class of drugs encompassing decongestants - amphetamines - cocaine.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

48. Signs of psychological maltreatment?
Glucagon prefered - otherwise massive dose of adrenaline.
Class of drugs encompassing decongestants - amphetamines - cocaine.
... blood sugars for hypoglycaemia
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.

49. Iron
'I WOULD CALL POISON HOTLINE'.
Sling for 3 weeks - fracture clinic at 7 days.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

50. Lidocaine
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Aspiration pneumonia even if intubated.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Neurotoxins - procagulants. Rhabdomyolysins.