Poisoning/ Pediatric Emergencies/ shock/ lead poisoning/ trauma/ anaphylaxis

Question 1

The following statements about poisoning in children is/are TRUE:
A. More than 90% of toxic exposures in children occur in the home and most involve a mixture of substances.
B. Poisoning in children 6-12 yr old are much more common than in smaller childen.
C.Poison prevention education should be an integral part of all well-child visits, starting at the 6 month visit.
D. Exposures in the adolescent age group are primarily accidental and thus often result in more severe toxicity.

Answer 1

C.Poison prevention education should be an integral part of all well-child visits, starting at the 6 month visit.

Question 2

A 2 year old boy was brought to the ER due to accidental ingestion of a cold syrup prescribed for his colds 3 days ago. What is the expected ocular examination finding in this child?

Answer 2

Mydriasis

Question 3

May be seen on KUB x-ray as radiopaque substance
A. Zinc
B. Iron
C. Play-Doh
D. All of the above

Answer 3

D. All of the above

Question 4

Which of the following poison-antidote pair do not match?
A. Carbon Monoxide - Oxygen
B. Benzodiazepines - Flumazenil
C. Lead - Dimercaprol
D. Calcium channel blocker - Insulin
E. None of the above

Answer 4

E. None of the above

Question 5

What is the dose of Pyridoxine for Isoniazid poisoning?

Answer 5

1 gram per gram of INH ingested

70 mg Pyridoxine/ kg BW

Question 6

Which of the following is NOT TRUE regarding the recommended use of activated charcoal for poisoning?
A. It should not be used in cases of caustic ingestion.
B. The abdominal examination must be benign before use is considered.
C. It is most likely effective when given after the first hour of poison ingestion.
D. There is little utility and potential morbidity in the awake, uncooperative child or adolescent who refuses to drink activated charcoal.

Answer 6

C. It is most likely effective when given after the first hour of poison ingestion.

Question 7

The acute toxic dose of drugs listed are CORRECT, except:
A. Salicylates : 150 mg/kg
B. Ibuprofen: >400mg/kg
C. Iron: >40mg/kg
D. TCA: 10-20 mg/kg
E. None of the above

Answer 7

E none

Question 8

IV or oral N-acetylcysteine for Acetaminophen overdose must be instituted no later than ___ from the time of ingestion.

Answer 8

8 hours

Question 9

Upon reading on FB that gasoline can be used as a disinfectant for COVID-19, Cynthia, a teenage mother, filled her pocket sanitizer bottle with gasoline. After a while, she noticed her 2-yr old son Harry holding the bottle half empty and his mouth smelling of gasoline. Harry was rushed to the ER. Your management will include:

Answer 9

Provide supportive oxygenation and ventilation as necessary

Emesis and lavage is contraindicated.
Activated charcoal does not bind hydrocarbon
Chest x-ray may show pneumonitis on the 6th hour, not immediately
Prophylactic antibiotics nor steroids do not show clear benefit (fever and leukocytosis may be present but does not imply bacterial superinfection)

Question 10

10. After being bashed on FB for being negligent, Cynthia, decided to end her life by ingesting all the contents of her pill bottle containing 100 ferrous fumarate pills. You were on duty at the ER and performed your work diligently by obtaining a complete history from which you elicited that the time of intake was 2 hrs ago and she has been having episodes of vomiting, abdominal pain and blood streaked stools. Knowing the 4 stages of iron toxicity, you know that these GI symptoms will become quiescent on the :

Answer 10

6-24th hour post-ingestion

Question 11

Harry fortunately did not develop symptoms of hydrocarbon poisoning. However, while at the ward, he was noted to have anemia and hyperactivity. On review of history, you learned that his father Manny rebuilds very old houses and he takes Harry to his job on weekdays. Upon hearing this, you considered exposure to paint chips and decided to request for lead screening. His results showed a BLL of 10 mcg/dL. Which of the following is NOT expected to be seen in Harry as a manifestation of lead exposure?

Answer 11

seizure

Question 12

What BLL will require Harry to undergo chelation therapy?

Answer 12

45 mcg/dL

Question 13

Manny also claimed that Harry has peanut allergy. Which of the following antidote for lead poisoning is contraindicated?

Answer 13

BAL

Question 14

In emergencies, a quick assessment of the pediatric child must be done at the ER. Which of the following is part of the primary assessment?

Answer 14

A. Airway
B. Breathing
C. Circulation
D. Disability

Question 15

A child with obstruction should be managed at the ER sequentially. Which is the correct sequence?

Answer 15

Head-tilt, chin-lift maneuver > visual inspection > finger-sweep > suctioning

Question 16

The correct uncuffed ET size in mm for a 10 year old child is:

Answer 16

6.5 mm

Question 17

This maneuver helps to reduce aspiration of gastric contents during intubation as the stomach cannot be emptied before intubation.

Answer 17

Sellick maneuver

Question 18

Which of the following statements on shock is FALSE?
A. The definition of shock does not include hypotension.
B. The management of shock consists of optimizing the oxygen content of the blood, improving volume and CO, as well as correcting metabolic derangements.
C. For hypovolemic and obstructive shock, aggressive volume resuscitation is the mainstay of therapy.
D. An initial state of compensation redistributes blood flow from the skin and GI tract to the brain, heat and kidney.

Answer 18

C. For hypovolemic and obstructive shock, aggressive volume resuscitation is the mainstay of therapy.

For hypovolemic and DISTRIBUTIVE shock, aggressive volume resuscitation is the mainstay of therapy

Question 19

Which of the following is not an etiology of distributive shock?
A. Sepsis
B. Dengue Fever
C. Burn injury
D. pulmonary embolism

Answer 19

d. Pulmonary embolism

Question 20

What type of shock is expected to occur with PDA closure in a patient with ductus-dependent systemic blood flow?

Answer 20

obstructive

Question 21

Which of the following is NOT considered a “red flag” in the evaluation of patients with syncope?
A. Syncope precipitated by a loud noise or extreme emotion
B. Syncope associated with prolonged standing
C. Syncope associated with palpitations
D. Syncope associated with anemia

Answer 21

B. Syncope associated with prolonged standing

Question 22

A Glasgow Coma Scale of ____ will warrant aggressive management including stabilization of airway and breathing via ET intubation and mechanical ventilation.

Answer 22

<8

Question 23

A 10 kg patient in the ICU developed ventricular fibrillation. What is the initial shock energy for defibrillation?

Answer 23

20J

Question 24

After delivering the first shock, you resumed CPR for 2 minutes. After CPR, the cardiac monitor again showed tracing of venticular fibrillation, what is the shock energy to be delivered this time?

Answer 24

40 J

Question 25

Children with a Pediatric Trauma Score of __ are at increased risk of mortality as well as morbidity.

Answer 25

<6

Question 26

The Beck Triad of cardiac tamponade consists of the following features, EXCEPT:
A. Decreased or muffled heart sounds
B. Distended neck vein from increased venous pressure
C. Contralateral tracheal deviation
D. Hypotension with pulsus paradoxus

Answer 26

C. Contralateral tracheal deviation

Question 27

Which is the appropriate IV fluid for resuscitation of a pediatric trauma patient in early shock?

Answer 27

PLRS 20 mL/kg IV bolus

Question 28

Which of the following management is recommended for trauma patients with signs of increased ICP?
A. Mannitol
B. Hyperventilation
C. Hypertonic saline
D. All of the above

Answer 28

D. All of the above

Question 29

A child sitting on the passenger seat of a car sustained trauma from vehicular accident. On examination, he has a GCS of 15, no difficulty of breathing and sign of chest trauma. However, he complained of pain on the left shoulder. This may signify____.

Answer 29

Splenic trauma

Question 30

Accdg. to the prediction rule for Identification of children at Very Low Risk of clinically important intrabdominal injury after blunt trauma, The following should be ABSENT (NONE) to signify low risk for clinically significant abdominal injury:

Answer 30

History of vomiting

GCS ≤ 14

Question 31

in victims of drowning, neurologic examination and progression during the _____ hr are the best prognosticators of long-term CNS outcome

Answer 31

24-72HOL