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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. Sodium Bicarbonate
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.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Notify if abuse CONSIDERED. CONSIDERED.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.

2. What are the side effects of N-acety-p-benzoquinine?
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Rash bronchospasm and hypotension.
Stomach pumping.
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. Ethylene glycol
Glucagon prefered - otherwise massive dose of adrenaline.
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.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
CHARCOAL! except for lithium - iron - alcohol - lead.

4. Acetaminophen
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
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!!!
Rash bronchospasm and hypotension.

5. Anticholinergics
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Give IM adrenaline - steroids - salbutamol - antihistamine.
Severe illness - past history of injuries - 18 months or less - inconstent story.

6. Methanol
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Class of drugs encompassing decongestants - amphetamines - cocaine.
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 - inebriation - increase in minute ventilation to offset increased anion gap metabolic acidosis - blurred vision/optic disc edema starting 18-24 hours after ingestion.

7. What must you do before sending fracture to radiology?
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Blood glucose level for hypoglycaemia!!
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Immobilize with plaster slab

8. Tricyclic antidepressants overdose
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
IM adrenaline: vasopressor and bronchodilator.
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.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

9. Indications of non-accidental injury
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

10. Anticholinergics
It can cause fatal bronchioloitis obliterans
Skin or vascular compromise
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

11. Amphetamine antidote
Nausea vomiting and anorexia.
It can cause fatal bronchioloitis obliterans
Aspiration Pneumonia
Esmolol

12. How may you detect semen?
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
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.
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.
Flurescence in ultraviolet light.

13. OSCE: how can i prevent accidents in my children
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
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
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

14. what makes you suspicious of non-accidental injury.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
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.
Release NEUROTOXINS both have antivenom

15. What is an important point to note about anaphylaxis?
Nausea vomiting and anorexia.
Discobalt edetate
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 -
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.

16. Displaced surgical neck of humerous
Normally treated with sling alone. Seek advice.
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) 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
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.

17. Opiates
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Antidote is naloxone.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
It can cause fatal bronchioloitis obliterans

18. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
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
Bone scan for occult fracture
Neurotoxins - procagulants. Rhabdomyolysins.
Aspiration pneumonia even if intubated.

19. Legal requirement in childabuse
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
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.
... blood sugars for hypoglycaemia
Notify if abuse CONSIDERED. CONSIDERED.

20. Ethanol
Lead poisoning is defined as a serum level greater than ___ ug/dL.
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.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.

21. What is the most common caUse of acute laryngeal obstruction?
Croup.
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.
Sling for 3 weeks - fracture clinic at 7 days.

22. Signs of abuse from the history
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Munchausen's by proxy
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

23. When and how would you do whole bowel irrigation?
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
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.
Class of drugs encompassing decongestants - amphetamines - cocaine.

24. Ibuprofen
Release NEUROTOXINS both have antivenom
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
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

25. Calcium gluconate
Flurescence in ultraviolet light.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.

26. What is the most important investigation in suspected alcohol poisoning in young person?
Antidote is naloxone.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
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
Blood glucose level for hypoglycaemia!!

27. Organophosphates antidotes
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Antidotes are atropine sulfate and pralidoxime chloride.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Rash bronchospasm and hypotension.

28. OSCE: What are the five princples of discharging a patient with a fracture?
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
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 - inebriation - increase in minute ventilation to offset increased anion gap metabolic acidosis - blurred vision/optic disc edema starting 18-24 hours after ingestion.
Causes BAD constipation. Upsets fluid and electrolyte balance.

29. Tricyclic antidepressants
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
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
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
Antidote is naloxone.

30. Ingesting Petrol. Cx?
Aspiration Pneumonia
Flurescence in ultraviolet light.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
CHARCOAL! except for lithium - iron - alcohol - lead.

31. Digoxin antedote
IM adrenaline: vasopressor and bronchodilator.
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.
Immobilize with plaster slab
Digoxin Fab

32. Lidocaine
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
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.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.

33. Mx of petroleum overdose
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Munchausen's by proxy
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Croup.

34. What is a side effect of charcoal?
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Causes BAD constipation. Upsets fluid and electrolyte balance.
It can cause fatal bronchioloitis obliterans
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

35. Ethylene glycol
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.
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.

36. What is the first line investigation in a young child who has consumed alcohol?
Neurotoxins - procagulants. Rhabdomyolysins.
... blood sugars for hypoglycaemia
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.

37. Mx of snake bit
Causes BAD constipation. Upsets fluid and electrolyte balance.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
CHARCOAL! except for lithium - iron - alcohol - lead.
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.

38. Carbon monoxide
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Esmolol
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
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.

39. Mx severe croup
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
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.
Skin or vascular compromise
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

40. Opiates
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
Skin or vascular compromise
Flurescence in ultraviolet light.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

41. You must consider abuse in
Severe illness - past history of injuries - 18 months or less - inconstent story.
Aspiration Pneumonia
Cyanosis and irregular respiratory effort
Antidotes are atropine sulfate and pralidoxime chloride.

42. What are the three features of anaphylaxis
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Croup.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

43. Carbon monoxide
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
Munchausen's by proxy
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Causes BAD constipation. Upsets fluid and electrolyte balance.

44. 20
Cyanosis and irregular respiratory effort
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Discobalt edetate

45. Sympathomimetics
Flumazenil
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Flurescence in ultraviolet light.

46. Cyanide
Rash bronchospasm and hypotension.
Severe illness - past history of injuries - 18 months or less - inconstent story.
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.
Discobalt edetate

47. What are the terminal signs of acute laryngeal obstruction?
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Cyanosis and irregular respiratory effort
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

48. What is one of the technicalities of childabuse.
Esmolol
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Give IM adrenaline - steroids - salbutamol - antihistamine.
Neurosurgery if trauma. Give mannitol.

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

50. 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.
Skin or vascular compromise
Class of drugs encompassing decongestants - amphetamines - cocaine.