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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
Calcium chloride
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
CHARCOAL! except for lithium - iron - alcohol - lead.
Discobalt edetate

2. What are the side effects of N-acety-p-benzoquinine?
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.
Immobilize with plaster slab
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.
Rash bronchospasm and hypotension.

3. Salicylates
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Release NEUROTOXINS both have antivenom
Immobilize with plaster slab
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

4. Organophosphates antidotes
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Antidotes are atropine sulfate and pralidoxime chloride.
Flurescence in ultraviolet light.

5. What is an important point to note about anaphylaxis?
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 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.
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 delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.

6. Mx of snake bit
Flurescence in ultraviolet light.
Bone scan for occult fracture
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.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema

7. What is the risk of gastrointestinal decompression in a person with decreased conscious state?
Rash bronchospasm and hypotension.
Objective signs of growth - tidiness - weight -
Aspiration pneumonia even if intubated.
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.

8. Calcium channel blocker overdose antidote
Calcium chloride
IM adrenaline: vasopressor and bronchodilator.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

9. Hydrocarbons
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
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.

10. When is gastric lavage indicated and contraindicated?
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
Abdo XRAY!!!! do it!
Collar and cuff. Check integrity of nerve.

11. Lead
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Ind: already intubated. Contr: Corrosives - hydrocarbons or petrochemicals.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

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

13. Sympathomimetics
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 delirium - drowsiness - hallucinations - seizure - flushing - fixed dilated pupils - fever - cardiac dysrhythmias - dry mouth - speech and swallowing difficulties - nausea - and vomiting.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
Class of drugs encompassing decongestants - amphetamines - cocaine.

14. What is the most common caUse of acute laryngeal obstruction?
Give steroids for management of serum sickness. Must do coagulation screen!!!
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Croup.
Aspiration pneumonia even if intubated.

15. OSCE: What are the five princples of discharging a patient with a fracture?
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Neurotoxins - procagulants. Rhabdomyolysins.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

16. Indications of non-accidental injury
Antidotes are atropine sulfate and pralidoxime chloride.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Neurosurgery if trauma. Give mannitol.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

17. Carbon monoxide
Neurotoxins - procagulants. Rhabdomyolysins.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.

18. Beta-blocker overdose antidote
Glucagon prefered - otherwise massive dose of adrenaline.
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
Nausea vomiting and anorexia.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.

19. A child has swallowed a battery. Mx
Neurosurgery if trauma. Give mannitol.
Immobilize with plaster slab
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.

20. Iron
Cyanosis and irregular respiratory effort
Antidote is deferoxamine chelation. Charcoal is ineffective.
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. Signs of psychological maltreatment?
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
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.
Flumazenil

22. Mx of petroleum overdose
Collar and cuff. Check integrity of nerve.
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.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity

23. Mx of critical asthma
It can cause fatal bronchioloitis obliterans
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
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.
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

24. 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.
Glucagon prefered - otherwise massive dose of adrenaline.
Blood glucose level for hypoglycaemia!!
Causes BAD constipation. Upsets fluid and electrolyte balance.

25. Mx raised intracranial pressure.
Blood glucose level for hypoglycaemia!!
Neurosurgery if trauma. Give mannitol.
Poisoning causes decreased cholinesterase activity.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

26. Sodium Bicarbonate
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Cyanosis and irregular respiratory effort

27. Ethylene glycol
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.
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.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.

28. Legal requirement in childabuse
Rash bronchospasm and hypotension.
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
Notify if abuse CONSIDERED. CONSIDERED.
'I WOULD CALL POISON HOTLINE'.

29. Amiodarone
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.
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
Poisoning treated by alkalinization of the serum to promote renal excretion - correction of hypokalemia - possible hemodialysis.

30. Atropine
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.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Immobilize with plaster slab
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.

31. What is the first line investigation in a young child who has consumed alcohol?
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.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
... blood sugars for hypoglycaemia
Release NEUROTOXINS both have antivenom

32. Mx severe croup
Bone scan for occult 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.
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.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

33. Undisplaced surgical neck of humerous?
Sling for 3 weeks - fracture clinic at 7 days.
It can cause fatal bronchioloitis obliterans
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Munchausen's by proxy

34. Procainamide
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
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.
Notify if abuse CONSIDERED. CONSIDERED.
It can cause fatal bronchioloitis obliterans

35. How do snake bites damage?
Intubate - tracheostromy or nebulized adrenaline.
Neurotoxins - procagulants. Rhabdomyolysins.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.

36. what makes you suspicious of non-accidental injury.
Sling for 3 weeks - fracture clinic at 7 days.
IM adrenaline: vasopressor and bronchodilator.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child

37. Tricyclic antidepressants overdose
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
CHARCOAL! except for lithium - iron - alcohol - lead.
Flurescence in ultraviolet light.

38. What happens if charcoal is aspirated?
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
'I WOULD CALL POISON HOTLINE'.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
It can cause fatal bronchioloitis obliterans

39. What are the early symptoms of paracetamol overdose?
Nausea vomiting and anorexia.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
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

40. What investigations should you do in suspected child abuse
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
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.

41. Epinephrine
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
Ceftriaxone
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

42. Undisplaced radial shaft fracture
Blocks fast sodium channels - decreases ventricular automaticity and surpresses ventricular arrhythmias. Used to treat pulseless VT/VF - VT with pulses.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Collar and cuff. Check integrity of nerve.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

43. Signs of abuse from the history
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

44. Calcium gluconate
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
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.
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.

45. What are the special features that must be done to correct haemorrhagic shock.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.
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

46. Opiates
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
Antidote is naloxone.
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.

47. Theophylline
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Croup.
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. Carbon monoxide
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 lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Class of drugs encompassing decongestants - amphetamines - cocaine.
Cyanosis and irregular respiratory effort

49. Ethanol
Antidote is deferoxamine chelation. Charcoal is ineffective.
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Collar and cuff. Check integrity of nerve.

50. 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.
Laboratory indices of poisoning include metabolic acidosis with normal PaO2 - myoglobinuria on urine dipstick - and increased blood carboxyhemoglobin.
Skin or vascular compromise
Cyanosis and irregular respiratory effort