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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 else is in the management of snake bite?
'I WOULD CALL POISON HOTLINE'.
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 decreased cholinesterase activity.
Give steroids for management of serum sickness. Must do coagulation screen!!!

2. Acetaminophen
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

3. Signs of abuse from the history
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
It can cause fatal bronchioloitis obliterans
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

4. Calcium channel blocker overdose antidote
Flumazenil
Cyanosis and irregular respiratory effort
Severe illness - past history of injuries - 18 months or less - inconstent story.
Calcium chloride

5. Oedema causing laryngeal obstruction?
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Objective signs of growth - tidiness - weight -
Give steroids for management of serum sickness. Must do coagulation screen!!!
Intubate - tracheostromy or nebulized adrenaline.

6. Epinephrine
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Digoxin Fab
Sling for 3 weeks - fracture clinic at 7 days.
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.

7. Which is better - activated charcoal or gastric lavage.
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 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
CHARCOAL! except for lithium - iron - alcohol - lead.
It can cause fatal bronchioloitis obliterans

8. What are the terminal signs of acute laryngeal obstruction?
Cyanosis and irregular respiratory effort
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Give steroids for management of serum sickness. Must do coagulation screen!!!
Stomach pumping.

9. When is gastric lavage indicated and contraindicated?
Immobilize with plaster slab
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
Release NEUROTOXINS both have antivenom
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.

10. Sympathomimetics
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Antidotes are atropine sulfate and pralidoxime chloride.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.

11. Mx of critical asthma
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
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.

12. What is the most common caUse of acute laryngeal obstruction?
Calcium chloride
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Croup.
'I WOULD CALL POISON HOTLINE'.

13. Carbon monoxide
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Poisoning causes decreased cholinesterase activity.
Ceftriaxone

14. What is the antibiotic for Epiglottitis?
Class of drugs encompassing decongestants - amphetamines - cocaine.
Ceftriaxone
Objective signs of growth - tidiness - weight -
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

15. Undisplaced radial shaft fracture
Collar and cuff. Check integrity of nerve.
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
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
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.

16. Signs of psychological maltreatment?
Discobalt edetate
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
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.
IM adrenaline: vasopressor and bronchodilator.

17. Ethylene glycol
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
CHARCOAL! except for lithium - iron - alcohol - lead.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

18. What are the three features of anaphylaxis
Croup.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
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

19. What is an important point to note about anaphylaxis?
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.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
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.

20. Anticholinergics
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!!
Glucagon prefered - otherwise massive dose of adrenaline.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

21. When is reduction required in fracture?
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 -
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
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy

22. Calcium gluconate
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 -
Give steroids for management of serum sickness. Must do coagulation screen!!!
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
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

23. Beta-blocker overdose antidote
Collar and cuff. Check integrity of nerve.
Glucagon prefered - otherwise massive dose of adrenaline.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Severe illness - past history of injuries - 18 months or less - inconstent story.

24. What are the other treatments for anaphylaxis?
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
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
It can cause fatal bronchioloitis obliterans
Give IM adrenaline - steroids - salbutamol - antihistamine.

25. Undisplaced surgical neck of humerous?
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Sling for 3 weeks - fracture clinic at 7 days.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

26. Sodium Bicarbonate
Severe illness - past history of injuries - 18 months or less - inconstent story.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

27. Mx severe croup
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.
Flurescence in ultraviolet light.
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 -

28. Carbon monoxide
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Digoxin Fab
Antidote is deferoxamine chelation. Charcoal is ineffective.
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.

29. What is the general management of poisoning?
Neurotoxins - procagulants. Rhabdomyolysins.
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
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Notify if abuse CONSIDERED. CONSIDERED.

30. Organophosphates antidotes
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Abdo XRAY!!!! do it!
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Antidotes are atropine sulfate and pralidoxime chloride.

31. OSCE: how can i prevent accidents in my children
Glucagon prefered - otherwise massive dose of adrenaline.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
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

32. Digoxin antedote
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Flumazenil
Blood glucose level for hypoglycaemia!!
Digoxin Fab

33. Opiates
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Antidote is naloxone.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

34. What is the most important treatment for anaphylaxis
... blood sugars for hypoglycaemia
IM adrenaline: vasopressor and bronchodilator.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Calcium chloride

35. What is gastric lavage?
Glucagon prefered - otherwise massive dose of adrenaline.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Poisoning causes decreased cholinesterase activity.
Stomach pumping.

36. What investigations should you do in suspected child abuse
Cyanosis and irregular respiratory effort
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Aspiration Pneumonia
Bone scan for occult fracture

37. Hydrocarbons
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
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.

38. 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) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
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.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

39. When and how would you do whole bowel irrigation?
Cyanosis and irregular respiratory effort
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.

40. Anticholinergics
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Give IM adrenaline - steroids - salbutamol - antihistamine.

41. Methanol
Stomach pumping.
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
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.

42. Organophosphates
Munchausen's by proxy
Digoxin Fab
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.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

43. 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.
Antidote is deferoxamine chelation. Charcoal is ineffective.
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
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.

44. what makes you suspicious of non-accidental injury.
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
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

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

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46. How may you detect semen?
Flurescence in ultraviolet light.
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.
Digoxin Fab

47. Anticholinergics
Rash bronchospasm and hypotension.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Normally treated with sling alone. Seek advice.

48. What psychiatric disease defined as childabuse?

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49. Acetaminophen
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
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.
Before a child can be examined for child abuse - a parent or legal guardian must give consent

50. 45; 70
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Discobalt edetate
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
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