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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. Sympathomimetics
Class of drugs encompassing decongestants - amphetamines - cocaine.
Nausea vomiting and anorexia.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Aspiration Pneumonia

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

3. Carbon monoxide
Ceftriaxone
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Release NEUROTOXINS both have antivenom
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

4. Beta-blocker overdose antidote
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Glucagon prefered - otherwise massive dose of adrenaline.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

5. Iron
'I WOULD CALL POISON HOTLINE'.
... blood sugars for hypoglycaemia
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Antidote is deferoxamine chelation. Charcoal is ineffective.

6. Mx raised intracranial pressure.
Neurosurgery if trauma. Give mannitol.
Class of drugs encompassing decongestants - amphetamines - cocaine.
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.

7. What psychiatric disease defined as childabuse?

8. 20
Give steroids for management of serum sickness. Must do coagulation screen!!!
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Bone scan for occult fracture
Lead poisoning is defined as a serum level greater than ___ ug/dL.

9. Signs of psychological maltreatment?
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
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.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

10. Tricyclic antidepressants
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
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
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

11. What is the most important investigation in suspected alcohol poisoning in young person?
Blood glucose level for hypoglycaemia!!
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
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
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 -

12. Digoxin antedote
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
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.
Digoxin Fab
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

13. OSCE: how can i prevent accidents in my children
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.
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
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.

14. Methanol
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
'I WOULD CALL POISON HOTLINE'.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Release NEUROTOXINS both have antivenom

15. Oedema causing laryngeal obstruction?
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
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.
Intubate - tracheostromy or nebulized adrenaline.
Cyanosis and irregular respiratory effort

16. OSCE: What are the five princples of discharging a patient with a fracture?
Immobilize with plaster slab
Flumazenil
Cyanosis and irregular respiratory effort
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.

17. Displaced surgical neck of humerous
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Normally treated with sling alone. Seek advice.
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.

18. What are the terminal signs of acute laryngeal obstruction?
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Nausea vomiting and anorexia.
Cyanosis and irregular respiratory effort
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.

19. Opiates
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.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

20. You must consider abuse in
'I WOULD CALL POISON HOTLINE'.
Severe illness - past history of injuries - 18 months or less - inconstent story.
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 -
Before a child can be examined for child abuse - a parent or legal guardian must give consent

21. Amiodarone
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Croup.
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.
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.

22. 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.
Intubate - tracheostromy or nebulized adrenaline.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
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

23. When and how would you do whole bowel irrigation?
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Cyanosis and irregular respiratory effort
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

24. Mx of snake bit
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
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.
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 -
Immobilize with plaster slab

25. Methanol
Discobalt edetate
Antidote is naloxone.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
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.

26. Which is better - activated charcoal or gastric lavage.
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.
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
Immobilize with plaster slab

27. What are the early symptoms of paracetamol overdose?
'I WOULD CALL POISON HOTLINE'.
Nausea vomiting and anorexia.
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.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.

28. Epinephrine
CHARCOAL! except for lithium - iron - alcohol - lead.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
'I WOULD CALL POISON HOTLINE'.
Flumazenil

29. Organophosphates antidotes
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
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.
Antidotes are atropine sulfate and pralidoxime chloride.
Normally treated with sling alone. Seek advice.

30. Undisplaced radial shaft fracture
Neurotoxins - procagulants. Rhabdomyolysins.
Collar and cuff. Check integrity of nerve.
Sling for 3 weeks - fracture clinic at 7 days.
Poisoning causes decreased cholinesterase activity.

31. Salicylates
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.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Poisoning causes decreased cholinesterase activity.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

32. When is reduction required in fracture?
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
IM adrenaline: vasopressor and bronchodilator.
Skin or vascular compromise
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

33. What is a side effect of charcoal?
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
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
Causes BAD constipation. Upsets fluid and electrolyte balance.

34. Cyanide
Neurosurgery if trauma. Give mannitol.
CHARCOAL! except for lithium - iron - alcohol - lead.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Discobalt edetate

35. What is the antibiotic for Epiglottitis?
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 salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Ceftriaxone
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

36. What is the first line investigation in a young child who has consumed alcohol?
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Flurescence in ultraviolet light.
... blood sugars for hypoglycaemia
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

37. Mx severe croup
... blood sugars for hypoglycaemia
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

38. Ibuprofen
Abdo XRAY!!!! do it!
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 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 irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

39. How do snake bites damage?
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
Neurotoxins - procagulants. Rhabdomyolysins.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Give steroids for management of serum sickness. Must do coagulation screen!!!

40. Benzodiazepine overdose antidote
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Flumazenil
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 -

41. Ingesting Petrol. Cx?
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Aspiration Pneumonia

42. Sodium Bicarbonate
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
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

43. Mx of petroleum overdose
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) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Give steroids for management of serum sickness. Must do coagulation screen!!!
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

44. What investigations should you do in suspected child abuse
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Bone scan for occult fracture
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy

45. Adenosine
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
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 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
Ceftriaxone

46. 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.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
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. Acetaminophen
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Aspiration pneumonia even if intubated.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

48. What must you do before sending fracture to radiology?
Immobilize with plaster slab
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

49. What is gastric lavage?
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Stomach pumping.
Blood glucose level for hypoglycaemia!!
Bone scan for occult fracture

50. Lead
Aspiration pneumonia even if intubated.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Munchausen's by proxy