Paediatric ED

Question 1

A healthy child with a limp should be assumed to have

until proven otherwise (based on age <4, 4-9, >9):

Answer 1

• Hip dysplasia if younger than 4 years old
• Perthes disease if 4-9 years old
• Slipped upper femoral epiphysis if older than 9 years

Question 2

What is the antidote for sodium nitrite?

Answer 2

Methylene blue

Question 3

What is the antidote for propranolol poisoning?

Answer 3

Glucagon

Question 4

What is the antidote for tricyclic poisoning?

Answer 4

NaHCO3

Question 5

What are the diagnostic criteria for Kawasaki?

Answer 5

Temp >39 with 4/5 of

• eye signs (conjunctival hyperemia, limbal sparing, non exudative)
• oral changes (cheilitis, lipstick sign/strawberry tongue)
• peripheral skin changes
• rash (perineal important, can have nearly anything)
• lympadenopathy (sentinel node)

Question 6

With SSRI toxicity, what symptom do you NOT get?

Answer 6

Coma

Question 7

What is the most likely ingestion in a teenager with
confusion, sweating and blurred vision, hyperthermic with T 40°C and CK is 40000U/L?

Answer 7

MDMA/ecstasy; supportive therapy only

Question 8

What is the antidote for organophosphate poisoning?

Answer 8

Atropine

Question 9

What ingestion might you suspect in a 4-year-old with constricted pupils, sweating and increased salivation?

Answer 9

• This is a CHOLINERGIC toxidrome from mushrooms, organophosphate, carbamate insecticides
• DUMBBELLS - Diarrhoea, Urination, Miosis [ pinpoint pupils], Bradycardia, (Bronchorrhoea/spasm kill you particularly with organophoshates) Emesis, Lacrimation, Lethargy and Salivation
• so it could be organophosphates

Question 10

What happens at different carboxyhaemoglobin levels?

Answer 10

• 0 – 1%: Normal (smokers often 5 – 10%)
• 10 – 30%: Headache, SOBOE, confusion
• 30 – 50%: Severe headache, N+V, tachycardia/tachypnoea, visual disturbances, memory loss, ataxia
• 50 – 70%: Convulsions, coma, severe cardiorespiratory compromise
• 70%: dead

Question 11

What is the next resus step for haemodynamically stable VT?

Answer 11

Adenosine

Question 12

What do you do for PEA?

Answer 12

• 0.01mg/kg adrenaline

- DO NOT SHOCK

Question 13

What do you do for shocked SVT?

Answer 13

If IV access, adenosine 100mcg/kg; if not shock 1J/kg synchronized

Question 14

What is the cut off for investigation following repeated supratherapeutic ingestion of paracetamol?

Answer 14

• 24hrs >200mg/kg
• 48hrs >150mg/kg/24hrs
• 72hrs >100mg/kg/24hrs

Question 15

What do you give for digoxin overdose?

Answer 15

Digoxin FAb/Digibind if >4mg ingested or arrest/life threatening arrhythmia

Question 16

What are contraindications to use of continuous NO for sedation?

Answer 16

• Fractured ribs
• Acute asthma
• B12 deficiency

Question 17

How do you calculate positive and negative likelihood ratios?

Answer 17

Positive LR = sensitivity/(100% - specificity)

Negative LR = (100% - sensitivity)/specificity

Question 18

What is a type one error?

Answer 18

• rejecting a null hypothesis when it is actually correct (you see a result when there is actually no difference)
• chance of this is known as alpha

Question 19

What is a type 2 error?

Answer 19

• failing to reject a null hypothesis when the null hypothesis is wrong (i.e. you get no difference but there should be)
• chance of this is known as beta

Question 20

What is the definition of power?

Answer 20

Power = probability test will reject false null Ho
• Power = 1- β = sensitivity target 0.8 or 0.9
Determined by:
• Population size
• Size of effect
• Variance within populations – Test used

Question 21

How do you calculate serum osmolality?

Answer 21

2 x (Na + K) + Glucose

Question 22

What are the GCS parameters?

Answer 22

Best Motor Response
1 = none
2 = extensor response to pain
3 = abnormal flexion to pain
4 = withdraws from pain
5 = localises pain
6 = responds to commands

Eye Opening
1 = none
2 = to pain
3 = to speech
4 = spontaneous

Best Verbal Response
1 = none
2 = incomprehensible sounds
3 = inappropriate words
4 = appropriate words but confused
5 = fully orientated

Question 23

How do you calculate clearance of a drug?

Answer 23

Clearance = (0.693 x Volume of distribution) / half life

Question 24

What is the classical presentation of digoxin toxicity?

Answer 24

• GI problems
• Hyperkalemia and life-threatening dysryhthmias
• CVS: enhanced automaticity (atrial tachycardias (e.g. flutter, AF) with AV block, VF, VT, ventricular ectopic beats), bradyarrhythmias (Conduction delays / blocks, slow or regularised AF), hypotension, shock
• Confusion/lethargy