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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. Cyanide
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Discobalt edetate
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

2. Amiodarone
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.
Release NEUROTOXINS both have antivenom
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.

3. What is the general management of poisoning?
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
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Discobalt edetate

4. Ethylene glycol
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.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

5. Carbon monoxide
Poisoning causes decreased cholinesterase activity.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Rash bronchospasm and hypotension.
IM adrenaline: vasopressor and bronchodilator.

6. Iron
Esmolol
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
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

7. what makes you suspicious of non-accidental injury.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
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
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
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. Indications of non-accidental injury
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.
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.

9. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Digoxin Fab
Abdo XRAY!!!! do it!
Aspiration pneumonia even if intubated.

10. Adenosine
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Bone scan for occult fracture
Intubate - tracheostromy or nebulized adrenaline.

11. What must you do before sending fracture to radiology?
Severe illness - past history of injuries - 18 months or less - inconstent story.
Immobilize with plaster slab
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

12. What are the three features of anaphylaxis
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Discobalt edetate
Croup.

13. Signs of abuse from the history
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Discobalt edetate
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

14. A child has swallowed a battery. Mx
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.
Croup.
Cyanosis and irregular respiratory effort

15. Management of near drowning.
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 - 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
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

16. What is the most common caUse of acute laryngeal obstruction?
Croup.
Intubate - tracheostromy or nebulized adrenaline.
Esmolol
Flumazenil

17. Salicylates
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
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.
Rash bronchospasm and hypotension.
Give steroids for management of serum sickness. Must do coagulation screen!!!

18. What happens if charcoal is aspirated?
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Aspiration Pneumonia
It can cause fatal bronchioloitis obliterans
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.

19. How do snake bites damage?
Abdo XRAY!!!! do it!
Neurotoxins - procagulants. Rhabdomyolysins.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
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.

20. Salicylates
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

21. Procainamide
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
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.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
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.

22. Anticholinergics
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Severe illness - past history of injuries - 18 months or less - inconstent story.
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.

23. OSCE: What are the five princples of discharging a patient with a fracture?
It can cause fatal bronchioloitis obliterans
Skin or vascular compromise
Objective signs of growth - tidiness - weight -
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.

24. Ibuprofen
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Neurotoxins - procagulants. Rhabdomyolysins.
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. Opiates
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 naloxone.
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

26. Amphetamine antidote
Intubate - tracheostromy or nebulized adrenaline.
Cyanosis and irregular respiratory effort
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Esmolol

27. Benzodiazepine overdose antidote
Flumazenil
Neurotoxins - procagulants. Rhabdomyolysins.
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.

28. Theophylline
Flumazenil
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
Aspiration pneumonia even if intubated.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.

29. Undisplaced radial shaft fracture
Collar and cuff. Check integrity of nerve.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.

30. Middle Clavicle fracture management?
Skin or vascular compromise
Croup.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

31. What is the antibiotic for Epiglottitis?
Sling for 3 weeks - fracture clinic at 7 days.
Ceftriaxone
Notify if abuse CONSIDERED. CONSIDERED.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

32. What is the most important treatment for anaphylaxis
Digoxin Fab
Release NEUROTOXINS both have antivenom
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
IM adrenaline: vasopressor and bronchodilator.

33. 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
Release NEUROTOXINS both have antivenom
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

34. Carbon monoxide
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Antidotes are atropine sulfate and pralidoxime chloride.
CHARCOAL! except for lithium - iron - alcohol - lead.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

35. 45; 70
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
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
Esmolol

36. 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
Bone scan for occult fracture
... blood sugars for hypoglycaemia
Severe illness - past history of injuries - 18 months or less - inconstent story.

37. Ethylene glycol
Bone scan for occult fracture
Flurescence in ultraviolet light.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

38. Anticholinergics
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
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.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Stomach pumping.

39. Signs of psychological maltreatment?
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.
CHARCOAL! except for lithium - iron - alcohol - lead.
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.

40. Calcium gluconate
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Intubate - tracheostromy or nebulized adrenaline.

41. Ingesting Petrol. Cx?
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
Aspiration Pneumonia

42. What is a side effect of charcoal?
Aspiration pneumonia even if intubated.
Intubate - tracheostromy or nebulized adrenaline.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Causes BAD constipation. Upsets fluid and electrolyte balance.

43. Anticholinergics
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
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.
Stomach pumping.

44. When and how would you do whole bowel irrigation?
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.
Ceftriaxone
It can cause fatal bronchioloitis obliterans
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.

45. Sympathomimetics
Class of drugs encompassing decongestants - amphetamines - cocaine.
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.
Munchausen's by proxy
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)

46. OSCE: how can i prevent accidents in my children
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
It can cause fatal bronchioloitis obliterans
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
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.

47. What investigations should you do in suspected child abuse
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Bone scan for occult fracture
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.

48. When is gastric lavage indicated and contraindicated?
Give steroids for management of serum sickness. Must do coagulation screen!!!
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Give IM adrenaline - steroids - salbutamol - antihistamine.

49. What are the special features that must be done to correct haemorrhagic shock.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Give IM adrenaline - steroids - salbutamol - antihistamine.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

50. Funnel web and red back
Rash bronchospasm and hypotension.
Release NEUROTOXINS both have antivenom
Skin or vascular compromise
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.