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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. Mx of critical asthma
Severe illness - past history of injuries - 18 months or less - inconstent story.
Cyanosis and irregular respiratory effort
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

2. What are the side effects of N-acety-p-benzoquinine?
Flumazenil
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Rash bronchospasm and hypotension.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

3. What are the three features of anaphylaxis
Give steroids for management of serum sickness. Must do coagulation screen!!!
Flurescence in ultraviolet light.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

4. Carbon monoxide
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Bone scan for occult fracture
Give IM adrenaline - steroids - salbutamol - antihistamine.
Neurotoxins - procagulants. Rhabdomyolysins.

5. What is the first line investigation in a young child who has consumed alcohol?
... blood sugars for hypoglycaemia
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Rash bronchospasm and hypotension.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

6. What is the most appropriate examination in a child with suspected lead ingestion?
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Abdo XRAY!!!! do it!
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.
Antidote is deferoxamine chelation. Charcoal is ineffective.

7. Organophosphates
Sling for 3 weeks - fracture clinic at 7 days.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Poisoning causes decreased cholinesterase activity.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.

8. Calcium channel blocker overdose antidote
Calcium chloride
Stomach pumping.
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
Poisoning causes decreased cholinesterase activity.

9. What is the general management of poisoning?
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Discobalt edetate
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Flurescence in ultraviolet light.

10. What else is in the management of snake bite?
Calcium chloride
Give steroids for management of serum sickness. Must do coagulation screen!!!
CHARCOAL! except for lithium - iron - alcohol - lead.
IM adrenaline: vasopressor and bronchodilator.

11. Salicylates
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Causes BAD constipation. Upsets fluid and electrolyte balance.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

12. How may you detect semen?
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Sling for 3 weeks - fracture clinic at 7 days.
Flurescence in ultraviolet light.
Before a child can be examined for child abuse - a parent or legal guardian must give consent

13. Sympathomimetics
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
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.

14. What happens if charcoal is aspirated?
It can cause fatal bronchioloitis obliterans
Collar and cuff. Check integrity of nerve.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

15. When is gastric lavage indicated and contraindicated?
Poisoning causes decreased cholinesterase activity.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Neurotoxins - procagulants. Rhabdomyolysins.

16. What are the terminal signs of acute laryngeal obstruction?
Release NEUROTOXINS both have antivenom
Cyanosis and irregular respiratory effort
... 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.

17. Epinephrine
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 deferoxamine chelation. Charcoal is ineffective.
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.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.

18. Theophylline
Collar and cuff. Check integrity of nerve.
IM adrenaline: vasopressor and bronchodilator.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.

19. Procainamide
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
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.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
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.

20. Iron
CHARCOAL! except for lithium - iron - alcohol - lead.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Causes BAD constipation. Upsets fluid and electrolyte balance.
Antidote is deferoxamine chelation. Charcoal is ineffective.

21. Management of near drowning.
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
Class of drugs encompassing decongestants - amphetamines - cocaine.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
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

22. What is one of the technicalities of childabuse.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

23. What investigations should you do in suspected child abuse
Cyanosis and irregular respiratory effort
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Normally treated with sling alone. Seek advice.
Bone scan for occult fracture

24. 20
Skin or vascular compromise
Severe illness - past history of injuries - 18 months or less - inconstent story.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
... blood sugars for hypoglycaemia

25. Cyanide
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Sling for 3 weeks - fracture clinic at 7 days.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Discobalt edetate

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

27. What is a side effect of charcoal?
Causes BAD constipation. Upsets fluid and electrolyte balance.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Ceftriaxone

28. Methanol
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Sling for 3 weeks - fracture clinic at 7 days.
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.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

29. Mx raised intracranial pressure.
Neurosurgery if trauma. Give mannitol.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
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.

30. Salicylates
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
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
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.
Antidote is deferoxamine chelation. Charcoal is ineffective.

31. Ethylene glycol
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.
Class of drugs encompassing decongestants - amphetamines - cocaine.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

32. Funnel web and red back
Release NEUROTOXINS both have antivenom
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Poisoning causes decreased cholinesterase activity.
Neurosurgery if trauma. Give mannitol.

33. what makes you suspicious of non-accidental injury.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
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

34. Anticholinergics
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
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.
Munchausen's by proxy
Severe illness - past history of injuries - 18 months or less - inconstent story.

35. Digoxin antedote
Digoxin Fab
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
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

36. Oedema causing laryngeal obstruction?
Antidote is naloxone.
Intubate - tracheostromy or nebulized adrenaline.
Poisoning causes decreased cholinesterase activity.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

37. Ingesting Petrol. Cx?
Aspiration Pneumonia
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Poisoning causes decreased cholinesterase activity.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

38. Undisplaced radial shaft fracture
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Rash bronchospasm and hypotension.
Collar and cuff. Check integrity of nerve.
Digoxin Fab

39. 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.
Notify if abuse CONSIDERED. CONSIDERED.
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 -
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

40. What is the most important investigation in suspected alcohol poisoning in young person?
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Calcium chloride
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Blood glucose level for hypoglycaemia!!

41. When is reduction required in fracture?
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
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.
Skin or vascular compromise

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

43. Opiates
Esmolol
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Cyanosis and irregular respiratory effort
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 -

44. What are the other treatments for anaphylaxis?
Give IM adrenaline - steroids - salbutamol - antihistamine.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Notify if abuse CONSIDERED. CONSIDERED.
Discobalt edetate

45. What is the antibiotic for Epiglottitis?
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Ceftriaxone
Discobalt edetate
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.

46. Tricyclic antidepressants overdose
Causes BAD constipation. Upsets fluid and electrolyte balance.
Cyanosis and irregular respiratory effort
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.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

47. Undisplaced surgical neck of humerous?
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
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.
Sling for 3 weeks - fracture clinic at 7 days.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.

48. Sodium Bicarbonate
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
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 -
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.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

49. Acetaminophen
Aspiration pneumonia even if intubated.
Esmolol
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 nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

50. Sympathomimetics
Class of drugs encompassing decongestants - amphetamines - cocaine.
Nausea vomiting and anorexia.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Abdo XRAY!!!! do it!