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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. Epinephrine
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Antidotes are atropine sulfate and pralidoxime chloride.
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.
Bone scan for occult fracture

2. Theophylline
'I WOULD CALL POISON HOTLINE'.
Cyanosis and irregular respiratory effort
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.

3. Salicylates
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
'I WOULD CALL POISON HOTLINE'.
Ceftriaxone
Intubate - tracheostromy or nebulized adrenaline.

4. What else is in the management of snake bite?
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Give steroids for management of serum sickness. Must do coagulation screen!!!
Give IM adrenaline - steroids - salbutamol - antihistamine.

5. Ethylene glycol
Esmolol
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.
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.

6. What evidence should a doctor give about parental neglect
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Objective signs of growth - tidiness - weight -
Blood glucose level for hypoglycaemia!!

7. 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
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

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

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9. Displaced surgical neck of humerous
Normally treated with sling alone. Seek advice.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.

10. Mx of snake bit
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
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.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Discobalt edetate

11. Which is better - activated charcoal or gastric lavage.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
CHARCOAL! except for lithium - iron - alcohol - lead.
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.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

12. Undisplaced surgical neck of humerous?
Sling for 3 weeks - fracture clinic at 7 days.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Notify if abuse CONSIDERED. CONSIDERED.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

13. Ethylene glycol
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Croup.

14. Funnel web and red back
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Release NEUROTOXINS both have antivenom
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.

15. Ibuprofen
Discobalt edetate
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
Antidotes are atropine sulfate and pralidoxime chloride.
Bone scan for occult fracture

16. Oedema causing laryngeal obstruction?
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Neurotoxins - procagulants. Rhabdomyolysins.
Intubate - tracheostromy or nebulized adrenaline.
IM adrenaline: vasopressor and bronchodilator.

17. Legal requirement in childabuse
Notify if abuse CONSIDERED. CONSIDERED.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

18. Sympathomimetics
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
Class of drugs encompassing decongestants - amphetamines - cocaine.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.

19. Undisplaced radial shaft fracture
Causes BAD constipation. Upsets fluid and electrolyte balance.
Flurescence in ultraviolet light.
Collar and cuff. Check integrity of nerve.
'I WOULD CALL POISON HOTLINE'.

20. Methanol
IM adrenaline: vasopressor and bronchodilator.
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.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Collar and cuff. Check integrity of nerve.

21. You must consider abuse in
Skin or vascular compromise
Severe illness - past history of injuries - 18 months or less - inconstent story.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Aspiration pneumonia even if intubated.

22. Iron
Flurescence in ultraviolet light.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

23. What is 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.
Stomach pumping.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
CHARCOAL! except for lithium - iron - alcohol - lead.

24. 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
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Objective signs of growth - tidiness - weight -
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.

25. What must you do before sending fracture to radiology?
Immobilize with plaster slab
Digoxin Fab
Poisoning causes decreased cholinesterase activity.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

26. Signs of psychological maltreatment?
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 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.

27. Digoxin antedote
Rash bronchospasm and hypotension.
Digoxin Fab
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Objective signs of growth - tidiness - weight -

28. How do snake bites damage?
It can cause fatal bronchioloitis obliterans
Neurotoxins - procagulants. Rhabdomyolysins.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Munchausen's by proxy

29. Anticholinergics
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.
Stomach pumping.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

30. Iron
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
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)
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

31. 45; 70
Croup.
Neurotoxins - procagulants. Rhabdomyolysins.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
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

32. OSCE: how can i prevent accidents in my children
Croup.
Skin or vascular compromise
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

33. Carbon monoxide
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
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

34. Organophosphates
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
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 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.
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.

35. 20
Give IM adrenaline - steroids - salbutamol - antihistamine.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Immobilize with plaster slab
Ceftriaxone

36. Methanol
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
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

37. What is the most common caUse of acute laryngeal obstruction?
Croup.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
... blood sugars for hypoglycaemia
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

38. Ethanol
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Blood glucose level for hypoglycaemia!!
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

39. What happens if charcoal is aspirated?
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
It can cause fatal bronchioloitis obliterans
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Give IM adrenaline - steroids - salbutamol - antihistamine.

40. Benzodiazepine overdose antidote
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
Flumazenil
CHARCOAL! except for lithium - iron - alcohol - lead.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

41. What is the antibiotic for Epiglottitis?
Ceftriaxone
Nausea vomiting and anorexia.
Collar and cuff. Check integrity of nerve.
Calcium chloride

42. What is the most appropriate examination in a child with suspected lead ingestion?
Abdo XRAY!!!! do it!
Munchausen's by proxy
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
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.

43. A child has swallowed a battery. Mx
Normally treated with sling alone. Seek advice.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Aspiration pneumonia even if intubated.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy

44. Hydrocarbons
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Immobilize with plaster slab
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.
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.

45. Amphetamine antidote
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Esmolol
It can cause fatal bronchioloitis obliterans
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.

46. Tricyclic antidepressants
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
CHARCOAL! except for lithium - iron - alcohol - lead.
It can cause fatal bronchioloitis obliterans
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

47. Middle Clavicle fracture management?
Notify if abuse CONSIDERED. CONSIDERED.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
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 lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

48. Sodium Bicarbonate
Notify if abuse CONSIDERED. CONSIDERED.
Flumazenil
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

49. Carbon monoxide
IM adrenaline: vasopressor and bronchodilator.
Blood glucose level for hypoglycaemia!!
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 lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.

50. Ingesting Petrol. Cx?
Aspiration Pneumonia
Bone scan for occult fracture
Blood glucose level for hypoglycaemia!!
Release NEUROTOXINS both have antivenom