Emergency

Question 1

Features of serotonin syndrome?

Myoclonus is most specific feature

Answer 1

1. Autonomic hyperactivity: HYPERTENSION, tachycardia, diaphoresis, hyperthermia (can be >41°C), diarrhoea/ ­ GI motility, Sialorrhoea (inability to control oral secretions)
2. Neuromuscular abnormalities: Hyperreflexia, myoclonus, ocular clonus, tremor
3. Mental state changes: agitation, confusion, hyperactivity

Question 2

Features of anticholinergic toxidrome?

Answer 2

“mad as a hatter” - altered mental state
“blind as a bat” - dilated pupils
“red as a beet” - flushed skin
“hot as a hare” - hyperthermia
“dry as a bone” - dry skin, urinary retention
absent bowel sounds
tachycardia

Question 3

How does anticholinergic toxidrome differ from serotonin syndrome, NMS

Answer 3

No clonus or hyperreflexia
Dry skin
Absent bowel sounds

Question 4

Management of anticholinergic toxidrome?

Answer 4

IVT
Diazepam
Anticholinesterase inhibitor

Question 5

Toxidrome seen with organophosphate poisoning (or mushrooms)?

Answer 5

Cholinergic toxidrome

Question 6

Features of cholinergic toxidrome?

Answer 6

Diarrhoea
Urination
Miosis (constricted)
Bronchorrhoea
Bronchospasm
Emesis
Lacrimation
Salivation

Question 7

Management of cholinergic toxidrome?

Answer 7

Atropine
IVT
consider IDC
Diazepam for seizures??

Pralidoxime can bind organophosphates

Question 8

Features of opioid intoxication

Answer 8

CPR 3H
Coma
Pinpoint pupils
Resp depression
Hypotension
Hypothermia
Hyporeflexia

Question 9

Paracetamol dose that may be associated with hepatic injury?

Answer 9

> 200mg/kg or 10g over a period of <8hrs

(or repeated ingestion of same over a 24hr period)

Question 10

When can charcoal be used in paracetamol OD?

Answer 10

<4hrs of SR overdose or <2hrs of IR overdose

Question 11

Child presents post paracetamol OD, When should paracetamol level be taken?

Answer 11

2hrs for liquid
4hrs for tablet

Question 12

Examples of “one pill can kill” drugs

Answer 12

Alpha adrenergics eg clonidine
Sulfonylureas
Calcium channel blockers
Beta blockers
Opioids
Salicylates
Amphetamines

Question 13

Agents which DON’T bind well to charcoal

Answer 13

Iron
Lithium
Ethanol/methanol
Potassium, Lead, Arsenic, Mercury
Corrosives

Question 14

Indications for whole bowel irrigation (in overdose)

Answer 14

• Iron overdose >60mg/kg
• Slow release KCl
• SR Verapamil or diltiazem
• Lead ingestion

Question 15

Typical blood volume of an infant?

Answer 15

80ml/kg

(child >1yr = 70ml/kg)

Question 16

What is a monteggia injury?

Answer 16

Proximal ulna fracture with radial head dislocation (distally)

Question 17

Which type of salter Harris fracture is most common?

Answer 17

Type 2: fracture through the physis and metaphysics

Question 18

What is a type 1 salter Harris fracture?

Answer 18

Fracture just through the physis

Question 19

What is a type 2 salter Harris fracture?

Answer 19

Fracture through the physis and metaphysis

Question 20

what is type 3 salter Harris fracture?

Answer 20

Fracture through physis and epiphysis (ie into the joint)

Question 21

What is type 4 salter Harris fracture?

Answer 21

fracture through physis, epiphysis and metaphysis

Question 22

what is type 5 salter Harris fracture?

Answer 22

crush injury to the physis

Question 23

Which drugs can cause hypoglycaemia in overdose?

Answer 23

Insulin
Sulfonylurea and oral anti glycemic agents
Beta blockers
Sodium valproate
Salicylate
Quinine and chloroquine

Question 24

Complication of scaphoid fracture?

Answer 24

Avascular necrosis of proximal fragment

Question 25

Structures at risk in supracondylar fracture?

Answer 25

Median nerve
Brachial artery

(particularly with Gartland III)

Question 26

Posterior fat pad in elbow suggests which injury?

Answer 26

Supracondylar fracture (distal humerus).

Anterior fat pad is normal

Question 27

Nerve commonly injured in anterior shoulder dislocations or proximal humerus fractures?

Answer 27

Axillary nerve