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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. How do snake bites damage?
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Neurotoxins - procagulants. Rhabdomyolysins.
Skin or vascular compromise
Intubate - tracheostromy or nebulized adrenaline.

2. Theophylline
Abdo XRAY!!!! do it!
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.
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

3. What is the general management of poisoning?
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.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
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. What is the most appropriate examination in a child with suspected lead ingestion?
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Abdo XRAY!!!! do it!
Class of drugs encompassing decongestants - amphetamines - cocaine.
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.

5. 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.
Calcium chloride
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Neurotoxins - procagulants. Rhabdomyolysins.

6. Undisplaced radial shaft fracture
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Antidote is naloxone.
Collar and cuff. Check integrity of nerve.

7. Ethanol
Poisoning causes decreased cholinesterase activity.
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
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.

8. What are the other treatments for anaphylaxis?
Aspiration Pneumonia
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Antidote is naloxone.
Give IM adrenaline - steroids - salbutamol - antihistamine.

9. Benzodiazepine overdose antidote
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Flumazenil
Digoxin Fab

10. What are the three features of anaphylaxis
Collar and cuff. Check integrity of nerve.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Rash bronchospasm and hypotension.
Flumazenil

11. Management of septicaemia shock

12. what makes you suspicious of non-accidental injury.
Collar and cuff. Check integrity of nerve.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
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

13. Mx raised intracranial pressure.
Skin or vascular compromise
Neurosurgery if trauma. Give mannitol.
Collar and cuff. Check integrity of nerve.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

14. What are the early symptoms of paracetamol overdose?
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Skin or vascular compromise
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Nausea vomiting and anorexia.

15. Sympathomimetics
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Flumazenil
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Bone scan for occult fracture

16. 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
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.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.

17. Cyanide
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
Discobalt edetate
Before a child can be examined for child abuse - a parent or legal guardian must give consent

18. Funnel web and red back
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.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Normally treated with sling alone. Seek advice.
Release NEUROTOXINS both have antivenom

19. OSCE: how can i prevent accidents in my children
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
Give IM adrenaline - steroids - salbutamol - antihistamine.
Intubate - tracheostromy or nebulized adrenaline.
IM adrenaline: vasopressor and bronchodilator.

20. When is reduction required in fracture?
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Skin or vascular compromise

21. Opiates
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
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
Antidote is naloxone.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.

22. Calcium gluconate
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
Munchausen's by proxy
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Antidotes are atropine sulfate and pralidoxime chloride.

23. Ingesting Petrol. Cx?
Aspiration Pneumonia
Esmolol
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

24. Indications of non-accidental injury
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
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Flumazenil
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.

25. When is gastric lavage indicated and contraindicated?
Antidotes are atropine sulfate and pralidoxime chloride.
Aspiration pneumonia even if intubated.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.

26. 20
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Lead poisoning is defined as a serum level greater than ___ ug/dL.

27. 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.
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.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.

28. Mx of petroleum overdose
Munchausen's by proxy
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Antidote is naloxone.

29. Signs of psychological maltreatment?
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
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.

30. What is gastric lavage?
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Stomach pumping.
Munchausen's by proxy

31. What are the special features that must be done to correct haemorrhagic shock.
Antidote is naloxone.
Normally treated with sling alone. Seek advice.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

32. Organophosphates antidotes
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 bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Antidotes are atropine sulfate and pralidoxime chloride.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.

33. What are the terminal signs of acute laryngeal obstruction?
Antidotes are atropine sulfate and pralidoxime chloride.
Cyanosis and irregular respiratory effort
Esmolol
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.

34. Epinephrine
Class of drugs encompassing decongestants - amphetamines - cocaine.
Immobilize with plaster slab
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Notify if abuse CONSIDERED. CONSIDERED.

35. Iron
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 deferoxamine chelation. Charcoal is ineffective.
'I WOULD CALL POISON HOTLINE'.
IM adrenaline: vasopressor and bronchodilator.

36. Amiodarone
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.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Neurotoxins - procagulants. Rhabdomyolysins.
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.

37. Tricyclic antidepressants overdose
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Notify if abuse CONSIDERED. CONSIDERED.
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.
Severe illness - past history of injuries - 18 months or less - inconstent story.

38. Ethylene glycol
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
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.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

39. Organophosphates
Release NEUROTOXINS both have antivenom
Calcium chloride
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
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

40. Carbon monoxide
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Munchausen's by proxy
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

41. Hydrocarbons
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 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
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.

42. Opiates
Release NEUROTOXINS both have antivenom
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
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

43. What is one of the technicalities of childabuse.
Antidotes are atropine sulfate and pralidoxime chloride.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
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.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.

44. Acetaminophen
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Ceftriaxone
IM adrenaline: vasopressor and bronchodilator.
Blood glucose level for hypoglycaemia!!

45. You must consider abuse in
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Notify if abuse CONSIDERED. CONSIDERED.

46. What is an important point to note about anaphylaxis?
Lead poisoning is defined as a serum level greater than ___ ug/dL.
IM adrenaline: vasopressor and bronchodilator.
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 -
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.

47. Atropine
Rash bronchospasm and hypotension.
IM adrenaline: vasopressor and bronchodilator.
Esmolol
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

48. Anticholinergics
Croup.
Class of drugs encompassing decongestants - amphetamines - cocaine.
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.

49. What evidence should a doctor give about parental neglect
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Flumazenil
Intubate - tracheostromy or nebulized adrenaline.
Objective signs of growth - tidiness - weight -

50. Salicylates
CHARCOAL! except for lithium - iron - alcohol - lead.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
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.