Test your basic knowledge |

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. What else is in the management of snake bite?
Give steroids for management of serum sickness. Must do coagulation screen!!!
Neurosurgery if trauma. Give mannitol.
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Esmolol

2. What is the most common caUse of acute laryngeal obstruction?
Give IM adrenaline - steroids - salbutamol - antihistamine.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
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.
Croup.

3. Sympathomimetics
Class of drugs encompassing decongestants - amphetamines - cocaine.
Croup.
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
IM adrenaline: vasopressor and bronchodilator.

4. Methanol
Release NEUROTOXINS both have antivenom
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.
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Digoxin Fab

5. What are the early symptoms of paracetamol overdose?
Blood glucose level for hypoglycaemia!!
Nausea vomiting and anorexia.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Lead poisoning is defined as a serum level greater than ___ ug/dL.

6. Digoxin antedote
Cultures but don't delay treat with flucloxacillin IV and cefotaxime IV. Give oxygen and Dopamine. Don't do lumbar puncture until child stabilized.
Skin or vascular compromise
Nausea vomiting and anorexia.
Digoxin Fab

7. Tricyclic antidepressants
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 tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Collar and cuff. Check integrity of nerve.

8. What is gastric lavage?
Stomach pumping.
Croup.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
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.

9. What are the terminal signs of acute laryngeal obstruction?
Cyanosis and irregular respiratory effort
Aspiration Pneumonia
Immobilize with plaster slab
Severe illness - past history of injuries - 18 months or less - inconstent story.

10. 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.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Munchausen's by proxy
Blood glucose level for hypoglycaemia!!

11. What must you do before sending fracture to radiology?
Give steroids for management of serum sickness. Must do coagulation screen!!!
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Immobilize with plaster slab
Normally treated with sling alone. Seek advice.

12. Anticholinergics
Poisoning causes salivation - lacrimation - urination - defecation - gastric cramping - emesis - small but reactive pupils - sweating - muscle fasciculations - confusion - and coma.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.
Release NEUROTOXINS both have antivenom
CHARCOAL! except for lithium - iron - alcohol - lead.

13. Atropine
Nausea vomiting and anorexia.
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.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

14. What are the other treatments for anaphylaxis?
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Discobalt edetate
Give IM adrenaline - steroids - salbutamol - antihistamine.
Stomach pumping.

15. Organophosphates
Neurosurgery if trauma. Give mannitol.
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
... blood sugars for hypoglycaemia
Poisoning causes decreased cholinesterase activity.

16. Signs of abuse from the history
Notify if abuse CONSIDERED. CONSIDERED.
Severe illness - past history of injuries - 18 months or less - inconstent story.
Poisoning causes bradycardia - hypotension - decreased respiratory rate - pinpoint pupils - somnolence - and coma.
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.

17. Salicylates
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.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
Treatment includes ethanol to block metabolism - sodium bicarbonate to correct metabolic acidosis - and folate to hasten metabolite elimination.

18. Procainamide
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 -
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.
Collar and cuff. Check integrity of nerve.
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.

19. What are the three features of anaphylaxis
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Causes BAD constipation. Upsets fluid and electrolyte balance.
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 -
The antidote is N-acetylcysteine. Gastric emptying (within 1 hour of ingestion) and activated charcoal administration (within 4 hours of ingestion) may also help.

20. Acetaminophen
Croup.
Increases the blood pH. Used to treat refractory metabolic acidosis - hyperkalemia - and sodium channel blocker (ex. tricyclic antidepressant) overdose.
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
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.

21. You must consider abuse in
Objective signs of growth - tidiness - weight -
Severe illness - past history of injuries - 18 months or less - inconstent story.
Poisoning causes decreased cholinesterase activity.
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

22. What is the most appropriate examination in a child with suspected lead ingestion?
Abdo XRAY!!!! do it!
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 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.
Esmolol

23. What is the most important treatment for anaphylaxis
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
IM adrenaline: vasopressor and bronchodilator.
Antidotes are fomepizole or ethanol. Sodium bicarbonate and hemodialysis may also be helpful.
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

24. Mx severe croup
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.
Notify if abuse CONSIDERED. CONSIDERED.
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

25. What is the antibiotic for Epiglottitis?
Antidote is deferoxamine chelation. Charcoal is ineffective.
Give IM adrenaline - steroids - salbutamol - antihistamine.
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.
Ceftriaxone

26. What is a side effect of charcoal?
Causes BAD constipation. Upsets fluid and electrolyte balance.
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
ABC - drugs - drawbloods and decontamination. Conscious and serious: 1) nasogastric charcoal or lavage. 2 Bowel irrigation + charcoal. 3) Tracheal intubation.
Release NEUROTOXINS both have antivenom

27. Middle Clavicle fracture management?
Sling for 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
... blood sugars for hypoglycaemia
Antidote is naloxone.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.

28. What is the most important investigation in suspected alcohol poisoning in young person?
Give steroids for management of serum sickness. Must do coagulation screen!!!
Blood glucose level for hypoglycaemia!!
Neurotoxins - procagulants. Rhabdomyolysins.
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.

29. Calcium gluconate
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Abdo XRAY!!!! do it!
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
Treats hypocalcemia - hyperkalemia - hypermagnesemia - and calcium channel blocker overdose.

30. what makes you suspicious of non-accidental injury.
Poisoning treated with 100% oxygen - or hyperbaric 100% oxygen if poisoning is severe.
Flurescence in ultraviolet light.
Less than one year and femur fracture. Spiral fractures in a non-ambulatory child
Normally treated with sling alone. Seek advice.

31. What is one of the technicalities of childabuse.
Blood glucose level for hypoglycaemia!!
Before a child can be examined for child abuse - a parent or legal guardian must give consent
Poisoning causes irritability - apathy - hyperactivity - abdominal pain - constipation - behavioral problems - developmental delay - and acute encephalopathy.
Digoxin Fab

32. What evidence should a doctor give about parental neglect
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.
Objective signs of growth - tidiness - weight -
Abdo XRAY!!!! do it!
Has alpha and beta-adrenergic effects. Used to treat pulseless VT/VF - asystole - bradycardia - and shock.

33. A child has swallowed a battery. Mx
Can cause electrolysis corrosion. Perforate esophageus or cause oesaphageal tracheal fistula. Endoscopy
Hypotension - bronchospasma and upper airway obstruction becasue of oedema
Discobalt edetate
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.

34. What is an important point to note about anaphylaxis?
Instructions on plaster care - analgesia for home. Greensticks by GP - all others at fracture clinic.
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 -
It can cause fatal bronchioloitis obliterans
1) WARM the blood. 2) monitor serum calcium - potasium - acid base and coagulation in massive transfusion.

35. Ethanol
Nausea vomiting and anorexia.
Poisoning causes lethargy - CNS depression - N/V - ataxia - respiratory depression - hypotension - hypothermia - and coma. Laboratory studies show hypoglycemia - hypokalemia - elevated anion gap metabolic acidosis.
Munchausen's by proxy
Notify if abuse CONSIDERED. CONSIDERED.

36. Displaced surgical neck of humerous
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.
Normally treated with sling alone. Seek advice.
Neurotoxins - procagulants. Rhabdomyolysins.
Class of medications encompassing atropine - scopolamine - first-generation antihistamines - and tricyclic antidepressants.

37. Iron
Neurosurgery if trauma. Give mannitol.
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.
Antidote is deferoxamine chelation. Charcoal is ineffective.

38. How do snake bites damage?
Poisoning causes nausea - vomiting - anorexia. Serum levels elevated 4-24 hours after ingestion. Late elevation of heaptic transaminases and PT.
Neurotoxins - procagulants. Rhabdomyolysins.
Calcium chloride
Nebulized adrenaline and Dexamethasone. Children admitted to a general medical ward should NOT be administer O2 as it masks their true stats.

39. Mx raised intracranial pressure.
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.
Digoxin Fab
Rash bronchospasm and hypotension.
Neurosurgery if trauma. Give mannitol.

40. Organophosphates antidotes
Antidotes are atropine sulfate and pralidoxime chloride.
Its done with polyethylene glycol. Indicated in iron - delayed preparations and slow release.
Release NEUROTOXINS both have antivenom
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.

41. Mx of critical asthma
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.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Esmolol
Salbutamol. Methylprednisalone. Nebulized ipratropium. Aminophyline. Mgs04.

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

43. Anticholinergics
Severe illness - past history of injuries - 18 months or less - inconstent story.
'I WOULD CALL POISON HOTLINE'.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Physostigmine may be used as an antidote. Other treatments include gastric emptying - activated charcoal - whole-bowel irrigation - seizure control - and benzodiazepines for agitation.

44. Acetaminophen
Discobalt edetate
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.
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.

45. 20
6 month old rolled from coach to carpet (not developed enough). Have you been particularly stressed and shaken or rough handled your child lately.
Lead poisoning is defined as a serum level greater than ___ ug/dL.
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Immobilize with plaster slab

46. What are the side effects of N-acety-p-benzoquinine?
Gastric lavage as charcoal doesn't work. (everyone gets stomach pumped)
Poisoning causes lethargy - irritability - confusion - dizziness - headache - nausea - irregular breathing - cyanosis - progression to coma/death.
Rash bronchospasm and hypotension.
Blood glucose level for hypoglycaemia!!

47. Mx of petroleum overdose
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
Competitive antagonist of mACh receptors. Used to treat bradycardia and AV nodal block.
1) CXR 2) measure oxygenation. May get convulsion vomitting hepatorenal toxicity
Causes temporary atrioventricular node conduction block and interrupts re-entry circuits. Used to treat hemodynamically stable SVTs.

48. Sympathomimetics
Poisoning causes tachycardia - hypertension - fever - large but reactive pupils - sweating - agitation - psychosis - and seizures. Lab studies show hyperglycemia - hypokalemia - EKG changes.
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 2-3 weeks. Lump up to one year. No sport for 6 weeks. No xray review.
CHARCOAL! except for lithium - iron - alcohol - lead.

49. Calcium channel blocker overdose antidote
Neurotoxins - procagulants. Rhabdomyolysins.
1) sodium bicarbonate 2) hyperventilation 3) diazepam (anticonvuslant) 4) antidysrhytmia (phenytoin)
Calcium chloride
CHARCOAL! except for lithium - iron - alcohol - lead.

50. Theophylline
Abdo XRAY!!!! do it!
Poisoning causes tachycardia - hypotension - tachypnea - vomiting - agitation - seizures. Lab studies show hyperglycemia - hypokalemia - acidosis - hypercalcemia - hypophosphotemia - and EKG changes.
Retinal haemorrhages in unexplained headinjury.Must be assessed by opthalmologist. Do coagulation as this can manifest as bruising.
Digoxin Fab