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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
Antidotes are atropine sulfate and pralidoxime chloride.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Glucagon prefered - otherwise massive dose of adrenaline.

2. Methanol
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.
Flumazenil
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

3. Anticholinergics
Bone scan for occult fracture
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Notify if abuse CONSIDERED. CONSIDERED.
CHARCOAL! except for lithium - iron - alcohol - lead.

4. Organophosphates
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)

5. What investigations should you do in suspected child abuse
Aspiration pneumonia even if intubated.
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.
Bone scan for occult fracture
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

6. Amphetamine antidote
Discobalt edetate
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Munchausen's by proxy
Esmolol

7. Organophosphates
Poisoning causes decreased cholinesterase activity.
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.
... blood sugars for hypoglycaemia
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.

8. What is the most common caUse of acute laryngeal obstruction?
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Croup.
Collar and cuff. Check integrity of nerve.

9. What is a side effect of charcoal?
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.
Aspiration pneumonia even if intubated.
... blood sugars for hypoglycaemia
Causes BAD constipation. Upsets fluid and electrolyte balance.

10. How do snake bites damage?
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Neurotoxins - procagulants. Rhabdomyolysins.
Nausea vomiting and anorexia.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.

11. Oedema causing laryngeal obstruction?
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
Intubate - tracheostromy or nebulized adrenaline.
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.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

12. What are the side effects of N-acety-p-benzoquinine?
Rash bronchospasm and hypotension.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
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.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.

13. Acetaminophen
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
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.
Aspiration pneumonia even if intubated.
Munchausen's by proxy

14. Signs of abuse from the history
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 -
Flurescence in ultraviolet light.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

15. Ibuprofen
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
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
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Flurescence in ultraviolet light.

16. What is the most appropriate examination in a child with suspected lead ingestion?
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Neurosurgery if trauma. Give mannitol.
Abdo XRAY!!!! do it!
'I WOULD CALL POISON HOTLINE'.

17. what makes you suspicious of non-accidental injury.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

18. How may you detect semen?
Flurescence in ultraviolet light.
It can cause fatal bronchioloitis obliterans
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Cyanosis and irregular respiratory effort

19. Acetaminophen
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
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.
Normally treated with sling alone. Seek advice.
Intubate - tracheostromy or nebulized adrenaline.

20. Mx of petroleum overdose
Aspiration pneumonia even if intubated.
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) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Blood glucose level for hypoglycaemia!!

21. Opiates
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 bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Collar and cuff. Check integrity of nerve.

22. What else is in the management of snake bite?
Nausea vomiting and anorexia.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Give steroids for management of serum sickness. Must do coagulation screen!!!
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

23. What happens if charcoal is aspirated?
It can cause fatal bronchioloitis obliterans
Neurotoxins - procagulants. Rhabdomyolysins.
Normally treated with sling alone. Seek advice.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

24. Signs of psychological maltreatment?
Nausea vomiting and anorexia.
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.
Antidotes are atropine sulfate and pralidoxime chloride.
Cyanosis and irregular respiratory effort

25. Ingesting Petrol. Cx?
Blood glucose level for hypoglycaemia!!
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Aspiration Pneumonia
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy

26. 45; 70
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
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
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Ceftriaxone

27. When and how would you do whole bowel irrigation?
Give IM adrenaline - steroids - salbutamol - antihistamine.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Rash bronchospasm and hypotension.

28. Cyanide
Abdo XRAY!!!! do it!
Discobalt edetate
Cyanosis and irregular respiratory effort
Neurotoxins - procagulants. Rhabdomyolysins.

29. OSCE: how can i prevent accidents in my children
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
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
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.

30. Organophosphates antidotes
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.
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
Antidotes are atropine sulfate and pralidoxime chloride.

31. Opiates
Aspiration Pneumonia
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Antidote is naloxone.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.

32. What is the most important treatment for anaphylaxis
'I WOULD CALL POISON HOTLINE'.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
IM adrenaline: vasopressor and bronchodilator.
Rash bronchospasm and hypotension.

33. Sodium Bicarbonate
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Antidote is deferoxamine chelation. Charcoal is ineffective.
Bone scan for occult fracture
IM adrenaline: vasopressor and bronchodilator.

34. Mx raised intracranial pressure.
Flurescence in ultraviolet light.
Neurosurgery if trauma. Give mannitol.
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.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

35. Benzodiazepine overdose antidote
Digoxin Fab
Flumazenil
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Aspiration Pneumonia

36. A child has swallowed a battery. Mx
Class of drugs encompassing decongestants - amphetamines - cocaine.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
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

37. Undisplaced surgical neck of humerous?
Sling for 3 weeks - fracture clinic at 7 days.
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 -
Poisoning causes decreased cholinesterase activity.
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.

38. Lead
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Sling for 3 weeks - fracture clinic at 7 days.
CHARCOAL! except for lithium - iron - alcohol - lead.
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

39. Which is better - activated charcoal or gastric lavage.
CHARCOAL! except for lithium - iron - alcohol - lead.
Neurotoxins - procagulants. Rhabdomyolysins.
Intubate - tracheostromy or nebulized adrenaline.
Skin or vascular compromise

40. Calcium gluconate
Give steroids for management of serum sickness. Must do coagulation screen!!!
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Antidote is naloxone.

41. Atropine
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
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.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

42. What are the special features that must be done to correct haemorrhagic shock.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Neurotoxins - procagulants. Rhabdomyolysins.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

43. 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 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 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.

44. What psychiatric disease defined as childabuse?

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

46. Iron
Antidote is deferoxamine chelation. Charcoal is ineffective.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Neurotoxins - procagulants. Rhabdomyolysins.

47. Mx of snake bit
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
Antidotes are atropine sulfate and pralidoxime chloride.
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.
Poisoning causes decreased cholinesterase activity.

48. Beta-blocker overdose antidote
Give steroids for management of serum sickness. Must do coagulation screen!!!
Glucagon prefered - otherwise massive dose of adrenaline.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
... blood sugars for hypoglycaemia

49. Undisplaced radial shaft fracture
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Collar and cuff. Check integrity of nerve.
Normally treated with sling alone. Seek advice.
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

50. Carbon monoxide
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Sling for 3 weeks - fracture clinic at 7 days.