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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. How may you detect semen?
Bone scan for occult fracture
Antidote is deferoxamine chelation. Charcoal is ineffective.
Aspiration pneumonia even if intubated.
Flurescence in ultraviolet light.

2. Which is better - activated charcoal or gastric lavage.
Neurotoxins - procagulants. Rhabdomyolysins.
Rash bronchospasm and hypotension.
Abdo XRAY!!!! do it!
CHARCOAL! except for lithium - iron - alcohol - lead.

3. Sodium Bicarbonate
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

4. Signs of abuse from the history
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.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

5. Digoxin antedote
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Digoxin Fab
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.

6. Indications of non-accidental injury
Cyanosis and irregular respiratory effort
Poisoning causes decreased cholinesterase activity.
Notify if abuse CONSIDERED. CONSIDERED.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

7. 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 lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Aspiration Pneumonia

8. What are the side effects of N-acety-p-benzoquinine?
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
It can cause fatal bronchioloitis obliterans
Neurosurgery if trauma. Give mannitol.
Rash bronchospasm and hypotension.

9. Signs of psychological maltreatment?
Give steroids for management of serum sickness. Must do coagulation screen!!!
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.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Severe illness - past history of injuries - 18 months or less - inconstent story.

10. Management of near drowning.
Notify if abuse CONSIDERED. CONSIDERED.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
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

11. Hydrocarbons
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
Immobilize with plaster slab
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.

12. OSCE: how can i prevent accidents in my children
Digoxin Fab
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
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Causes BAD constipation. Upsets fluid and electrolyte balance.

13. Calcium gluconate
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

14. 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.
It can cause fatal bronchioloitis obliterans
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

15. Cyanide
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.
Discobalt edetate
Objective signs of growth - tidiness - weight -
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.

16. What is one of the technicalities of childabuse.
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
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Discobalt edetate

17. Organophosphates antidotes
Severe illness - past history of injuries - 18 months or less - inconstent story.
Esmolol
Antidotes are atropine sulfate and pralidoxime chloride.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

18. Anticholinergics
'I WOULD CALL POISON HOTLINE'.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
... blood sugars for hypoglycaemia

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

20. Lidocaine
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
CHARCOAL! except for lithium - iron - alcohol - lead.
Calcium chloride
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy

21. Beta-blocker overdose antidote
Aspiration Pneumonia
Glucagon prefered - otherwise massive dose of adrenaline.
Blood glucose level for hypoglycaemia!!
Ceftriaxone

22. what makes you suspicious of non-accidental injury.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Discobalt edetate
Poisoning causes decreased cholinesterase activity.

23. Sympathomimetics
Poisoning causes decreased cholinesterase activity.
Skin or vascular compromise
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.

24. Ethylene glycol
Immobilize with plaster slab
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.
Glucagon prefered - otherwise massive dose of adrenaline.
Lead poisoning is defined as a serum level greater than ___ ug/dL.

25. What is the antibiotic for Epiglottitis?
Ceftriaxone
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Intubate - tracheostromy or nebulized adrenaline.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

26. OSCE: What are the five princples of discharging a patient with a fracture?
Cyanosis and irregular respiratory effort
Collar and cuff. Check integrity of nerve.
Blood glucose level for hypoglycaemia!!
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.

27. What is an important point to note about anaphylaxis?
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
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
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 -
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.

28. Amiodarone
... blood sugars for hypoglycaemia
Severe illness - past history of injuries - 18 months or less - inconstent story.
Antidote is deferoxamine chelation. Charcoal is ineffective.
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.

29. Lead
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
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 -
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

30. Middle Clavicle fracture management?
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
Digoxin Fab
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

31. When is reduction required in fracture?
Munchausen's by proxy
Skin or vascular compromise
Collar and cuff. Check integrity of nerve.
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

32. When is gastric lavage indicated and contraindicated?
Stomach pumping.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)

33. Mx of snake bit
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Discobalt edetate
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.
Croup.

34. Carbon monoxide
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Esmolol
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.

35. What is the most important treatment for anaphylaxis
Discobalt edetate
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
IM adrenaline: vasopressor and bronchodilator.

36. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
Release NEUROTOXINS both have antivenom
Aspiration pneumonia even if intubated.
Antidotes are atropine sulfate and pralidoxime 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.

37. Ethylene glycol
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.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
Notify if abuse CONSIDERED. CONSIDERED.

38. Anticholinergics
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Before a child can be examined for child abuse - a parent or legal guardian must give consent

39. Ibuprofen
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
Give steroids for management of serum sickness. Must do coagulation screen!!!
Discobalt edetate
Sling for 3 weeks - fracture clinic at 7 days.

40. What must you do before sending fracture to radiology?
Cyanosis and irregular respiratory effort
Antidote is deferoxamine chelation. Charcoal is ineffective.
Rash bronchospasm and hypotension.
Immobilize with plaster slab

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

42. What is the most common caUse of acute laryngeal obstruction?
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Croup.

43. Funnel web and red back
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Release NEUROTOXINS both have antivenom
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Antidote is naloxone.

44. Anticholinergics
Poisoning causes delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Discobalt edetate
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

45. Theophylline
IM adrenaline: vasopressor and bronchodilator.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
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 -
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

46. 20
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Sling for 3 weeks - fracture clinic at 7 days.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

47. 45; 70
Neurotoxins - procagulants. Rhabdomyolysins.
Flumazenil
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 medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

48. When and how would you do whole bowel irrigation?
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Flumazenil
Intubate - tracheostromy or nebulized adrenaline.

49. What are the early symptoms of paracetamol overdose?
Nausea vomiting and anorexia.
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.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

50. Epinephrine
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
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.
Poisoning causes decreased cholinesterase activity.