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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 severe croup
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Digoxin Fab
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

2. What are the three features of anaphylaxis
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
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 salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.

3. What is the most common caUse of acute laryngeal obstruction?
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 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.
Croup.
Collar and cuff. Check integrity of nerve.

4. What is the general management of poisoning?
Flumazenil
Intubate - tracheostromy or nebulized adrenaline.
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
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.

5. Organophosphates
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Poisoning causes decreased cholinesterase activity.
Aspiration pneumonia even if intubated.
Immobilize with plaster slab

6. Calcium channel blocker overdose antidote
Calcium chloride
Give IM adrenaline - steroids - salbutamol - antihistamine.
It can cause fatal bronchioloitis obliterans
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 are the other treatments for anaphylaxis?
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.
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. Anticholinergics
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Flumazenil
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

9. Displaced surgical neck of humerous
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Normally treated with sling alone. Seek advice.
Neurotoxins - procagulants. Rhabdomyolysins.
Sling for 3 weeks - fracture clinic at 7 days.

10. When is gastric lavage indicated and contraindicated?
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Esmolol

11. Undisplaced radial shaft fracture
Neurotoxins - procagulants. Rhabdomyolysins.
Collar and cuff. Check integrity of nerve.
Sling for 3 weeks - fracture clinic at 7 days.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.

12. Undisplaced surgical neck of humerous?
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Sling for 3 weeks - fracture clinic at 7 days.
Stomach pumping.
Neurotoxins - procagulants. Rhabdomyolysins.

13. Carbon monoxide
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Antidote is deferoxamine chelation. Charcoal is ineffective.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

14. How do snake bites damage?
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Neurotoxins - procagulants. Rhabdomyolysins.
Flumazenil
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

15. Anticholinergics
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Neurosurgery if trauma. Give mannitol.
IM adrenaline: vasopressor and bronchodilator.

16. Signs of psychological maltreatment?
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Neurosurgery if trauma. Give mannitol.
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.
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.

17. What is a side effect of charcoal?
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
CHARCOAL! except for lithium - iron - alcohol - lead.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Causes BAD constipation. Upsets fluid and electrolyte balance.

18. Iron
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
Sling for 3 weeks - fracture clinic at 7 days.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)

19. Salicylates
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.
Flumazenil
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.
Severe illness - past history of injuries - 18 months or less - inconstent story.

20. Procainamide
Flumazenil
Discobalt edetate
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.

21. Mx of petroleum overdose
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.
Blood glucose level for hypoglycaemia!!
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

22. When is reduction required in fracture?
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.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Skin or vascular compromise
Notify if abuse CONSIDERED. CONSIDERED.

23. What are the special features that must be done to correct haemorrhagic shock.
Flumazenil
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.

24. what makes you suspicious of non-accidental injury.
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
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Severe illness - past history of injuries - 18 months or less - inconstent story.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.

25. What happens if charcoal is aspirated?
Severe illness - past history of injuries - 18 months or less - inconstent story.
It can cause fatal bronchioloitis obliterans
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

26. Ethylene glycol
Give steroids for management of serum sickness. Must do coagulation screen!!!
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy

27. Iron
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Aspiration pneumonia even if intubated.
Croup.
Antidote is deferoxamine chelation. Charcoal is ineffective.

28. What else is in the management of snake bite?
Give steroids for management of serum sickness. Must do coagulation screen!!!
Digoxin Fab
Antidote is deferoxamine chelation. Charcoal is ineffective.
Causes BAD constipation. Upsets fluid and electrolyte balance.

29. Calcium gluconate
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Causes BAD constipation. Upsets fluid and electrolyte balance.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

30. 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.
Aspiration Pneumonia
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 -
Aspiration pneumonia even if intubated.

31. Carbon monoxide
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
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
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 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.

32. What investigations should you do in suspected child abuse
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.
Bone scan for occult fracture
Immobilize with plaster slab
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

33. What psychiatric disease defined as childabuse?

34. Cyanide
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.
Discobalt edetate
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Give steroids for management of serum sickness. Must do coagulation screen!!!

35. What are the terminal signs of acute laryngeal obstruction?
Ceftriaxone
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Cyanosis and irregular respiratory effort
Sling for 3 weeks - fracture clinic at 7 days.

36. 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.
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.
Blood glucose level for hypoglycaemia!!
Release NEUROTOXINS both have antivenom

37. OSCE: What are the five princples of discharging a patient with a fracture?
Cyanosis and irregular respiratory effort
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Munchausen's by proxy
Calcium chloride

38. What is the first line investigation in a young child who has consumed alcohol?
Before a child can be examined for child abuse - a parent or legal guardian must give consent
... blood sugars for hypoglycaemia
Immobilize with plaster slab
Release NEUROTOXINS both have antivenom

39. Lead
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
CHARCOAL! except for lithium - iron - alcohol - lead.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.

40. Anticholinergics
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Digoxin Fab
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

41. Digoxin antedote
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
Digoxin Fab
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
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

42. 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.
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Immobilize with plaster slab
Flurescence in ultraviolet light.

43. Opiates
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
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.

44. Middle Clavicle fracture management?
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.
Intubate - tracheostromy or nebulized adrenaline.

45. Adenosine
Esmolol
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Abdo XRAY!!!! do it!
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.

46. How may you detect semen?
Flurescence in ultraviolet light.
Notify if abuse CONSIDERED. CONSIDERED.
Stomach pumping.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.

47. What evidence should a doctor give about parental neglect
Notify if abuse CONSIDERED. CONSIDERED.
Glucagon prefered - otherwise massive dose of adrenaline.
Objective signs of growth - tidiness - weight -
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

48. What must you do before sending fracture to radiology?
Sling for 3 weeks - fracture clinic at 7 days.
Rash bronchospasm and hypotension.
Immobilize with plaster slab
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

49. What are the early symptoms of paracetamol overdose?
Class of drugs encompassing decongestants - amphetamines - cocaine.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Nausea vomiting and anorexia.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

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