Pediatric Emergency Medicine

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. Methanol
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Blood glucose level for hypoglycaemia!!
IM adrenaline: vasopressor and bronchodilator.
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.


2. A child has swallowed a battery. Mx
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Antidote is naloxone.
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 - inebriation - increase in minute ventilation to offset increased anion gap metabolic acidosis - blurred vision/optic disc edema starting 18-24 hours after ingestion.


3. Theophylline
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
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 tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
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


4. Organophosphates
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Poisoning causes decreased cholinesterase activity.
Antidote is naloxone.
Cyanosis and irregular respiratory effort


5. Funnel web and red back
Release NEUROTOXINS both have antivenom
Flurescence in ultraviolet light.
Aspiration Pneumonia
Cyanosis and irregular respiratory effort


6. What is the most important treatment for anaphylaxis
IM adrenaline: vasopressor and bronchodilator.
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.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.


7. What are the terminal signs of acute laryngeal obstruction?
Cyanosis and irregular respiratory effort
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Immobilize with plaster slab
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.


8. Management of septicaemia shock


9. Sympathomimetics
Sling for 3 weeks - fracture clinic at 7 days.
Stomach pumping.
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.


10. Which is better - activated charcoal or gastric lavage.
CHARCOAL! except for lithium - iron - alcohol - lead.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.


11. Displaced surgical neck of humerous
Causes BAD constipation. Upsets fluid and electrolyte balance.
Normally treated with sling alone. Seek advice.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Give steroids for management of serum sickness. Must do coagulation screen!!!


12. Ethylene glycol
Abdo XRAY!!!! do it!
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.
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.


13. Sympathomimetics
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.


14. Anticholinergics
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Neurosurgery if trauma. Give mannitol.


15. How do snake bites damage?
It can cause fatal bronchioloitis obliterans
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Neurotoxins - procagulants. Rhabdomyolysins.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.


16. What happens if charcoal is aspirated?
CHARCOAL! except for lithium - iron - alcohol - lead.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
It can cause fatal bronchioloitis obliterans
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.


17. What is gastric lavage?
Stomach pumping.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Severe illness - past history of injuries - 18 months or less - inconstent story.


18. Signs of abuse from the history
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.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Poisoning causes decreased cholinesterase activity.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.


19. Opiates
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.
Notify if abuse CONSIDERED. CONSIDERED.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.


20. Iron
Antidote is deferoxamine chelation. Charcoal is ineffective.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Digoxin Fab


21. Acetaminophen
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.


22. When and how would you do whole bowel irrigation?
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Abdo XRAY!!!! do it!


23. OSCE: What are the five princples of discharging a patient with a fracture?
Flurescence in ultraviolet light.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.


24. 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.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Notify if abuse CONSIDERED. CONSIDERED.
Class of drugs encompassing decongestants - amphetamines - cocaine.


25. Epinephrine
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
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


26. What are the side effects of N-acety-p-benzoquinine?
Blood glucose level for hypoglycaemia!!
Notify if abuse CONSIDERED. CONSIDERED.
Croup.
Rash bronchospasm and hypotension.


27. What is one of the technicalities of childabuse.
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.
'I WOULD CALL POISON HOTLINE'.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.


28. Sodium Bicarbonate
Give IM adrenaline - steroids - salbutamol - antihistamine.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.


29. What must you do before sending fracture to radiology?
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
Sling for 3 weeks - fracture clinic at 7 days.
Immobilize with plaster slab


30. What are the three features of anaphylaxis
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.
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
Hypotension - bronchospasma and upper airway obstruction becasue of oedema


31. Lead
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Bone scan for occult fracture
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.


32. Undisplaced surgical neck of humerous?
Causes BAD constipation. Upsets fluid and electrolyte balance.
Digoxin Fab
Sling for 3 weeks - fracture clinic at 7 days.
Flumazenil


33. Iron
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
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
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)


34. What is the most important investigation in suspected alcohol poisoning in young person?
Ceftriaxone
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Blood glucose level for hypoglycaemia!!


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


36. What evidence should a doctor give about parental neglect
Lead poisoning is defined as a serum level greater than ___ ug/dL.
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.
Objective signs of growth - tidiness - weight -
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.


37. Anticholinergics
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Calcium chloride
Esmolol
Collar and cuff. Check integrity of nerve.


38. What is the first line investigation in a young child who has consumed alcohol?
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Croup.
... blood sugars for hypoglycaemia
Bone scan for occult fracture


39. What is a side effect of charcoal?
Causes BAD constipation. Upsets fluid and electrolyte balance.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
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


40. 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.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.


41. Mx raised intracranial pressure.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Ceftriaxone
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.
Neurosurgery if trauma. Give mannitol.


42. Amphetamine antidote
Esmolol
Aspiration Pneumonia
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Ceftriaxone


43. Signs of psychological maltreatment?
Nausea vomiting and anorexia.
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.
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.


44. Indications of non-accidental injury
Glucagon prefered - otherwise massive dose of adrenaline.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
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 delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.


45. Mx severe croup
Calcium chloride
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.


46. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
'I WOULD CALL POISON HOTLINE'.
Intubate - tracheostromy or nebulized adrenaline.
Aspiration pneumonia even if intubated.


47. What psychiatric disease defined as childabuse?


48. When is gastric lavage indicated and contraindicated?
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
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.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.


49. Atropine
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Ceftriaxone
Flumazenil
Abdo XRAY!!!! do it!


50. Hydrocarbons
Lead poisoning is defined as a serum level greater than ___ ug/dL.
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.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.