Test your basic knowledge |

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 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 -
Release NEUROTOXINS both have antivenom
Poisoning causes decreased cholinesterase activity.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.

2. Atropine
Immobilize with plaster slab
Aspiration pneumonia even if intubated.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Flurescence in ultraviolet light.

3. Methanol
Discobalt edetate
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.
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.

4. Carbon monoxide
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Immobilize with plaster slab
Poisoning causes decreased cholinesterase activity.
Nausea vomiting and anorexia.

5. What is one of the technicalities of childabuse.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Notify if abuse CONSIDERED. CONSIDERED.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

6. What happens if charcoal is aspirated?
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
It can cause fatal bronchioloitis obliterans
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Cyanosis and irregular respiratory effort

7. What are the three features of anaphylaxis
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

8. Tricyclic antidepressants overdose
Severe illness - past history of injuries - 18 months or less - inconstent story.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Cyanosis and irregular respiratory effort
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

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

10. OSCE: What are the five princples of discharging a patient with a fracture?
Release NEUROTOXINS both have antivenom
Cyanosis and irregular respiratory effort
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.

11. What is the most appropriate examination in a child with suspected lead ingestion?
Abdo XRAY!!!! do it!
Severe illness - past history of injuries - 18 months or less - inconstent story.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Causes BAD constipation. Upsets fluid and electrolyte balance.

12. What must you do before sending fracture to radiology?
Normally treated with sling alone. Seek advice.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Immobilize with plaster slab

13. Calcium gluconate
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
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.
'I WOULD CALL POISON HOTLINE'.
Glucagon prefered - otherwise massive dose of adrenaline.

14. 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.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Nausea vomiting and anorexia.

15. Beta-blocker overdose antidote
Glucagon prefered - otherwise massive dose of adrenaline.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Skin or vascular compromise

16. 45; 70
Abdo XRAY!!!! do it!
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Chelation with EDTA or oral succimer should be initiated in children with a serum lead level greater than ___ ug/dL. With levels greater than ___ ug/dL - intramuscular dimercaprol should be added - and the child should be admitted for inpatient treat
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

17. Iron
Antidote is deferoxamine chelation. Charcoal is ineffective.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.

18. Mx of petroleum overdose
Nausea vomiting and anorexia.
Stomach pumping.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Objective signs of growth - tidiness - weight -

19. What is a side effect of charcoal?
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Aspiration Pneumonia
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Causes BAD constipation. Upsets fluid and electrolyte balance.

20. Sympathomimetics
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Rash bronchospasm and hypotension.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

21. Mx of critical asthma
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Intubate - tracheostromy or nebulized adrenaline.
Nausea vomiting and anorexia.

22. Sympathomimetics
Class of drugs encompassing decongestants - amphetamines - cocaine.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Release NEUROTOXINS both have antivenom
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.

23. How do snake bites damage?
Discobalt edetate
Neurotoxins - procagulants. Rhabdomyolysins.
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
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.

24. Displaced surgical neck of humerous
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Collar and cuff. Check integrity of nerve.
Normally treated with sling alone. Seek advice.

25. What is the first line investigation in a young child who has consumed alcohol?
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
... blood sugars for hypoglycaemia
Neurosurgery if trauma. Give mannitol.

26. When is reduction required in fracture?
Skin or vascular compromise
Neurosurgery if trauma. Give mannitol.
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.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

27. Organophosphates antidotes
Munchausen's by proxy
Antidotes are atropine sulfate and pralidoxime chloride.
Sling for 3 weeks - fracture clinic at 7 days.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

28. Cyanide
Discobalt edetate
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Stomach pumping.

29. You must consider abuse in
Give IM adrenaline - steroids - salbutamol - antihistamine.
Blood glucose level for hypoglycaemia!!
Aspiration Pneumonia
Severe illness - past history of injuries - 18 months or less - inconstent story.

30. Ibuprofen
IM adrenaline: vasopressor and bronchodilator.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Intubate - tracheostromy or nebulized adrenaline.
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

31. Carbon monoxide
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Nausea vomiting and anorexia.
Abdo XRAY!!!! do it!
Antidotes are atropine sulfate and pralidoxime chloride.

32. Theophylline
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.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
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.

33. Undisplaced radial shaft fracture
Severe illness - past history of injuries - 18 months or less - inconstent story.
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.
Collar and cuff. Check integrity of nerve.
Nausea vomiting and anorexia.

34. Lead
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
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.
It can cause fatal bronchioloitis obliterans

35. Calcium channel blocker overdose antidote
Calcium chloride
Digoxin Fab
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Intubate - tracheostromy or nebulized adrenaline.

36. What psychiatric disease defined as childabuse?

37. Carbon monoxide
Abdo XRAY!!!! do it!
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
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 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

38. OSCE: how can i prevent accidents in my children
Aspiration pneumonia even if intubated.
Objective signs of growth - tidiness - weight -
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
Nausea vomiting and anorexia.

39. Anticholinergics
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Neurosurgery if trauma. Give mannitol.
Esmolol

40. Procainamide
Munchausen's by proxy
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.
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.

41. Opiates
Abdo XRAY!!!! do it!
Antidote is naloxone.
Digoxin Fab
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

42. Signs of abuse from the history
Release NEUROTOXINS both have antivenom
Notify if abuse CONSIDERED. CONSIDERED.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

43. Ingesting Petrol. Cx?
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Intubate - tracheostromy or nebulized adrenaline.
Aspiration Pneumonia
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

44. Digoxin antedote
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Digoxin Fab
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

45. What are the side effects of N-acety-p-benzoquinine?
Rash bronchospasm and hypotension.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Calcium chloride
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.

46. Oedema causing laryngeal obstruction?
Intubate - tracheostromy or nebulized adrenaline.
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.
Bone scan for occult fracture
Flumazenil

47. 20
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
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
Lead poisoning is defined as a serum level greater than ___ ug/dL.

48. Legal requirement in childabuse
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Poisoning causes decreased cholinesterase activity.
Notify if abuse CONSIDERED. CONSIDERED.
Sling for 3 weeks - fracture clinic at 7 days.

49. Benzodiazepine overdose antidote
Neurotoxins - procagulants. Rhabdomyolysins.
It can cause fatal bronchioloitis obliterans
Flumazenil
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.

50. 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.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Stomach pumping.
Flurescence in ultraviolet light.