Pediatric Emergency Medicine Secrets

Dedication......Page 4
Contributors......Page 5
Acknowledgments......Page 12
Preface......Page 13
Top 100 Secrets......Page 14
4. What is the typical age distribution of pediatric cardiopulmonary arrests?......Page 21
6. What are some prognostic factors for pediatric cardiopulmonary arrests?......Page 22
10. What is the recommended way to deliver supplemental oxygen to a child?......Page 23
12. When selecting an endotracheal tube, what sizing guidelines are suggested?......Page 24
14. What are the best methods to assess a child’s circulatory status?......Page 25
17. What are the options for vascular access in children?......Page 26
21. What are the new recommendations regarding epinephrine administration during pediatric resuscitation?......Page 27
22. Which resuscitation drugs are effective when given via an endotracheal tube?......Page 28
26. Does sodium bicarbonate still have a role in pediatric resuscitations?......Page 29
29. How is defibrillation best accomplished?......Page 30
30. Are AEDs useful for children with sudden collapse?......Page 31
4. What are the critical facts in the history that should be elicited, if possible, prior to delivery?......Page 32
7. How do you assess the condition of a newly born infant?......Page 34
9. What is the proper technique to assist ventilations in the newly born infant?......Page 35
12. When are chest compressions indicated in the resuscitation of the newly born infant?......Page 36
15. What are the most common drugs used in a neonatal resuscitation, and when are they indicated?......Page 37
16. Where is the best place to obtain IV access?......Page 38
17. Are there circumstances when resuscitation of the newly born infant may not be the appropriate action?......Page 39
5. Why do children get respiratory infections so frequently?......Page 40
7. How do I know which of the numerous children with respiratory symptoms will progress to respiratory failure?......Page 41
12. What is the value of a chest radiograph in evaluation of a child with suspected respiratory failure?......Page 42
15. What causes pulse oximeter readings to be inaccurate?......Page 43
20. How is respiratory failure defined? When does respiratory......Page 44
23. What are the indications to intubate the trachea of a child?......Page 45
24. What are the steps for emergency endotracheal intubation of a child?......Page 46
26. What should you consider if a patient deteriorates after endotracheal intubation?......Page 47
2. How can shock be recognized?......Page 48
7. What are the types (or mechanisms) of shock?......Page 49
16. Which is more important in the management of the child with septic shock: aggressive resuscitation at the referring hospital......Page 50
23. What are the classes of hemorrhage?......Page 51
29. What is the treatment for neurogenic shock?......Page 52
35. What is early, goal-directed therapy?......Page 53
39. Are there other forms of TSS?......Page 54
4. What are some extraintestinal causes of abdominal pain?......Page 55
7. Which blood tests may be useful in the evaluation of abdominal pain?......Page 58
12. Discuss the test characteristics (e.g., sensitivity, specificity) of limited computed tomography (CT) with rectal contrast i......Page 59
19. What abnormalities may appear on plain radiographs in children with abdominal pain?......Page 60
24. What is the most common cause of recurrent abdominal pain?......Page 61
26. When should a surgical consultation be obtained?......Page 62
3. What scales are in use to quantify altered mental status? Why should I use them?......Page 63
6. When should I consider obtaining a computed tomographic scan on a child with abnormal mental status?......Page 64
10. What are clues that a child may be ‘‘faking’’ an altered mental status?......Page 65
600 mg/dl, and mild changes of bicarbonate and ketone values. You suspect the presence of what endocrine disorder?......Page 66
18. A 4-year-old boy was brought to the ED because of sleepiness and ‘‘not acting right.’’ He had been born prematurely and had......Page 67
19. A 12-year-old boy is brought to the ED by his parents, who are concerned by his diminished responsiveness. He has a history......Page 68
5. What are some of the underlying causes of apnea?......Page 69
10. How should the evaluation of an infant with apnea begin?......Page 70
16. What laboratory tests should be ordered?......Page 71
ACKNOWLEDGMENT......Page 72
6. What common gastrointestinal condition causes chest pain?......Page 73
7. What is Texidor’s twinge?......Page 74
11. When should a pneumothorax be suspected in a child with chest pain?......Page 75
13. Why do some adolescents who present with hyperventilation also have chest pain?......Page 76
17. Why is fever associated with chest pain of concern?......Page 77
21. When should I be concerned about a cardiac infection as the cause of chest pain?......Page 78
27. What etiology should be considered in an afebrile, previously well toddler, with no injury, who reports sudden midsternal ch......Page 79
31. What is ‘‘devil’s grip’’?......Page 80
36. When should referral to a cardiologist be considered for a child with chest pain?......Page 81
4. How much coughing is normal?......Page 82
7. Is cough-variant asthma underdiagnosed?......Page 83
9. Does cough due to bronchitis respond to treatment with antibiotics?......Page 84
13. What is habitual cough?......Page 85
17. What is the strangest cause of persistent cough?......Page 86
5. Are there any effective treatments for colic?......Page 87
6. What is the most common medical problem in young infants that mimics colic?......Page 88
9. An 8-month-old white female presents with crying and a history of fever. In the ED, she is febrile but nontoxic in appearance......Page 89
11. Name three relatively common, life-threatening surgical emergencies of infancy that you would expect to present with crying......Page 90
12. Are screening laboratory and radiologic tests generally useful in the ED evaluation of the young crying child?......Page 91
4. What are common causes of chronic diarrhea?......Page 92
9. What is the role of daycare in childhood diarrheal disease?......Page 93
17. Should clear liquids be given by mouth until diarrhea resolves?......Page 94
20. What is the BRAT diet? Should children with diarrhea adhere to it?......Page 95
23. When are antibiotics indicated?......Page 96
27. What new therapies look promising in terms of managing the symptoms of diarrheal disease?......Page 97
6. How would you treat bacterial otitis media?......Page 98
9. You are evaluating a patient who presents with ear pain. On taking the history, you learn that the illness began with itchine......Page 99
14. You are examining a child who came to the ED because of fever and ear pain. You notice that his ear is red and swollen and s......Page 100
18. You have just examined a child who has a hearing aid battery in her external auditory canal. You have not been successful in......Page 101
22. As your patient leaves the examination room, his mother asks you whether it is safe for him to fly in an airplane even thoug......Page 102
26. Temporomandibular joint (TMJ) dysfunction is one of the most common causes of referred otalgia. How can I confirm this as a......Page 103
7. How does the body regulate temperature?......Page 104
13. Does otitis media increase tympanic membrane temperature?......Page 105
20. Why is the use of rubbing alcohol on children harmful?......Page 106
27. What is a ‘‘sepsis workup’’?......Page 107
29. Do young febrile infants with respiratory syncytial virus (RSV) bronchiolitis need a sepsis workup?......Page 108
32. How will universal pneumococcal vaccine use affect the incidence of occult bacteremia?......Page 109
38. What is the incidence of invasive bacterial disease in children with fever and petechiae?......Page 110
45. How do you decrease body temperature in children with heatstroke?......Page 111
46. What kind of fever is associated with bizarre movements in response to disco music?......Page 112
4. What are the common esophageal sites for lodgment of foreign bodies?......Page 113
8. How should an esophageal foreign body be removed?......Page 114
12. How quickly can a disc battery injure the esophagus?......Page 115
15. Classically, children with foreign bodies lodged in a bronchus or smaller airway have cough, decreased breath sounds, and ne......Page 116
20. What is the best way to diagnose an aspirated foreign body?......Page 117
24. What methods are available to remove nasal foreign bodies?......Page 118
27. Should children be sedated for ear or nose foreign-body removal?......Page 119
aura.......Page 120
9. How will I recognize the child with a brain tumor headache?......Page 121
10. Are chronic daily headaches common in children?......Page 122
12. What is the role of emergent neuroimaging in children with headache?......Page 123
15. What treatments are available for migraine headaches?......Page 124
16. Describe therapeutic options for tension-type headaches.......Page 125
5. Is there a way to determine glomerular versus nonglomerular blood in the urine?......Page 126
7. How would you evaluate a child with blunt abdominal trauma for renal injury?......Page 127
9. Hypertension with hematuria is associated with which diseases?......Page 128
12. Describe the etiology of nephrolithiasis in children.......Page 129
14. What are the most common causes of dysuria in children?......Page 130
19. What parasitic infection should be considered in a traveler or recent immigrant presenting with hematuria or dysuria?......Page 131
2. If a high blood pressure is found incidentally by the triage nurse, what two questions should you ask before you get too worr......Page 133
3. Which patients need evaluation and treatment in the emergency department (ED), and which patients can follow up with their pr......Page 134
6. What historical questions are important to ask the parent of a hypertensive child?......Page 135
9. If a child has a dangerously high blood pressure, should it be lowered to normal as quickly as possible?......Page 136
12. An adolescent boy is brought to the ED at 5:00......Page 137
13. A school-aged child is in your ED being evaluated for an upper respiratory tract infection. You notice he is hypertensive on......Page 138
5. What are the causes of unconjugated hyperbilirubinemia in a newborn?......Page 139
11. What are some indicators that jaundice is......Page 140
14. List the causes of conjugated hyperbilirubinemia in neonates.......Page 141
17. What treatment is required for neonates with conjugated hyperbilirubinemia?......Page 142
22. What medications can cause cholestasis leading to conjugated hyperbilirubinemia?......Page 143
25. What are the complications of severe hepatic disease (i.e., hepatic failure)?......Page 144
26. What treatment is required for an older infant or child with jaundice?......Page 145
4. Which is a better test for diagnosis and monitoring of bone and joint infections in children: C-reactive protein (CRP) or ESR......Page 146
6. What is the likelihood of the above-hip pathologies affecting both hips?......Page 147
9. Describe the benefits of ‘‘special’’ medical imaging tests when compared to plain films in the evaluation of a limping child.......Page 148
13. What is osteochondritis dissecans? What part of the body is most commonly involved?......Page 149
17. A 10-year-old girl presents with limping and pain over the lateral malleolus after twisting her ankle while playing basketba......Page 150
22. Match the following potential causes of limp with the location of pain.......Page 151
24. A 6-year-old boy presents with a 3-day history of diarrhea and a new limp. What pathogen would you expect to find in his sto......Page 152
7. How is the workup of a child with a neck mass conducted?......Page 153
14. What are the treatments for hemangiomas?......Page 155
19. How is radiologic imaging helpful in management of a dermoid cyst?......Page 156
25. What is the most common cause of acute cervical lymph node enlargement?......Page 157
31. Describe the clinical picture of cat scratch disease.......Page 158
34. When should a neoplastic lesion in the neck be suspected? What evaluation is necessary?......Page 159
2. What are four skin findings associated with syphilis?......Page 160
7. How does the rash of Rocky Mountain spotted fever change over time?......Page 161
10. List key features that help differentiate the purpuric rash of Henoch-Scho¨ nlein purpura from more serious infectious purpu......Page 162
13. How does scabies manifest in infants?......Page 163
18. How do the following two newborn rashes differ: transient pustular melanosis and erythema toxicum neonatorum?......Page 164
25. What causes roseola? What are the usual features?......Page 165
30. Contrast and compare smallpox with chickenpox.......Page 166
31. Describe and name the skin finding associated with Lyme disease.......Page 167
36. How can you distinguish irritant contact diaper rash from candidal diaper dermatitis?......Page 168
4. Describe the characteristics of bacterial conjunctivitis.......Page 169
9. List the differential diagnosis of red, teary eyes in a newborn.......Page 170
17. What other noninfectious conditions can mimic the physical findings of orbital cellulitis?......Page 171
25. Which conditions can mimic periorbital cellulitis?......Page 172
29. Describe the different types of allergic conjunctivitis.......Page 173
31. What are the characteristics of herpes simplex keratoconjunctivitis?......Page 174
4. What is manual detorsion?......Page 175
6. What is torsion of the appendix testis?......Page 176
8. Are there any rare entities causing scrotal pain or swelling that would be impressive to mention on rounds?......Page 177
9. How can I differentiate among the variety of painless scrotal masses?......Page 178
10. Someday, somehow, every male will be kicked in the testicles. When do I worry about the patient who has this chief complaint......Page 179
5. Which bacterial pharyngitis is the most common?......Page 180
10. What are the clinical features of GABHS pharyngitis?......Page 181
16. Do GABHS carriers need to be treated with antibiotics?......Page 182
22. How can recurrent episodes of rheumatic fever be prevented?......Page 183
3 years of age?......Page 184
7. Describe some possible complications of LP.......Page 185
children?......Page 186
18. Which congenital syndrome is identified by the triad of short neck (brevicollis), limited neck motion, and low occipital hai......Page 187
26. What is the name given to drug-induced torticollis?......Page 188
30. Summarize the extensive differential diagnosis of stiff neck in children.......Page 189
1. What are the four primary diagnostic considerations in a febrile child with acute stridor?......Page 191
5. What is the characteristic radiographic finding in a patient with croup? In epiglottitis?......Page 192
10. What is the best test for diagnosing laryngomalacia?......Page 193
13. A toddler born to an adolescent mother gradually develops hoarseness over a few-month period and presents with an acute exac......Page 194
17. What electrolyte abnormality has been associated with stridor?......Page 195
5. Name the potentially life-threatening causes of syncope in children and adolescents.......Page 196
9. Are there diagnostic tests that......Page 197
12. What are breath-holding spells?......Page 198
18. Name the medications and other drugs that may be associated with tachyarrhythmias.......Page 199
24. Which patients with syncope require referral to a cardiologist or neurologist?......Page 200
25. What findings in patients with syncope require admission?......Page 201
2. What is dysfunctional uterine bleeding (DUB)?......Page 202
5. What are the recommended therapies for dysfunctional uterine bleeding?......Page 203
6. What is primary dysmenorrhea?......Page 204
10. What are the causes of secondary dysmenorrhea?......Page 205
14. How is the diagnosis of cervicitis made?......Page 206
17. How is the diagnosis of PID made?......Page 207
Oral Therapy......Page 208
21. List the causes of vaginal discharge in the prepubertal girl.......Page 209
25. What is the initial approach to a patient with suspected ectopic pregnancy?......Page 210
29. How are genital ulcers caused by HSV treated?......Page 211
30. Describe the genital ulcers caused by syphilis and chancroid. How are they treated?......Page 212
3. What is the differential diagnosis of vomiting in the pediatric patient?......Page 213
4. The differential diagnosis for vomiting depends on the age of the pediatric patient. What are the life-threatening causes of......Page 214
5. What are the most common causes of vomiting in the different pediatric age groups?......Page 216
8. What clinical clues can be obtained from the appearance of the vomitus?......Page 217
10. What laboratory tests are indicated in the child with vomiting?......Page 218
12. Which radiographic tests are most useful when further evaluating specific causes of vomiting that may require surgical inter......Page 219
14. A 6-week-old infant presents with vomiting. What are the important historical findings that will help in distinguishing pylo......Page 220
17. An 8-year-old boy presents with headache and vomiting. How will you distinguish vomiting caused by an intracranial mass lesi......Page 221
4. What are common causes of anaphylaxis?......Page 222
7. What are anaphylactoid reactions? How do they differ from anaphylaxis?......Page 223
10. How should anaphylaxis be managed?......Page 224
13. What are the most common causes of death?......Page 225
17. Are H1 and H2 blockers effective in relieving symptoms of anaphylaxis?......Page 226
20. What are some unusual causes of anaphylaxis in children?......Page 227
25. Who should be discharged with EpiPens? What instructions should be given for their use?......Page 228
27. What other discharge instructions should be given?......Page 229
6. What are the initial steps in treatment for a patient with hemodynamically compromising bradycardia?......Page 231
11. What is the first treatment for patients with known familial long QT syndrome?......Page 232
18. Which initial steps should be performed in the management of a pediatric patient presenting with an excessively fast heart r......Page 233
23. What are the most likely causes of heart failure in neonates presenting to the ED?......Page 234
29. List some of the late complications after the Fontan operation that may be encountered in the ED.......Page 235
36. Describe the two murmurs that may be heard in a patient with tetralogy of Fallot.......Page 236
42. What are the cardiac conditions causing sudden death in young athletes?......Page 237
44. What are the common ECG findings in children with hypertrophic cardiomyopathy?......Page 238
7. What are infantile spasms?......Page 239
9. How are seizures distinguished from breath-holding spells?......Page 240
16. Is the risk of epilepsy increased in children with febrile seizures?......Page 241
22. What are some differentiating features of Guillain-Barre´ syndrome and transverse myelopathy?......Page 242
24. What simple grooming measure should be performed on any patient with acute onset of ascending paralysis?......Page 243
32. Acute cerebellar ataxia is most commonly attributed to which viral illness?......Page 244
41. Brain tumors in children commonly present with which ocular nerve palsy?......Page 245
43. What is the differential diagnosis of ADEM?......Page 246
3. What is the most common cause of hyperthyroidism in children?......Page 247
9. What is the emergency treatment for acute adrenal insufficiency?......Page 248
15. What usually leads to DKA?......Page 249
18. Is there a standard treatment for DKA?......Page 250
21. What is the probable abnormality in type 2 diabetes mellitus?......Page 251
28. In the ED, what are the most urgent laboratory studies to perform if CAH is suspected?......Page 252
30. What are the most common symptoms of pheochromocytoma?......Page 253
2. What are the most reliable clinical examination findings that help you predict how dry a child has become?......Page 254
7. What stock should be used after the initial IV bolus or if the child is not dehydrated?......Page 255
9. Will use of hypotonic maintenance solutions cause dangerous hyponatremia?......Page 256
15. When should oral rehydration not be used?......Page 257
21. How do I treat hyperkalcemia?......Page 258
22. How do I treat hypocalcemia?......Page 259
4. What is the best way to remove an esophageal coin?......Page 260
7. Distinguish among hematemesis, hematochezia, and melena.......Page 261
13. What is another test that can help localize the source of GI bleeding?......Page 262
17. What are the clinical features of malrotation with volvulus?......Page 263
19. Is a ‘‘currant jelly’’ stool classic for intussusception?......Page 264
24. What are some therapies for......Page 265
26. What are some of the extraintestinal features of ulcerative colitis and Crohn’s disease?......Page 266
31. What is the classic triad of findings associated with hemolytic uremic syndrome?......Page 267
35. What is cyclic vomiting syndrome?......Page 268
39. What is the suggested imaging study in suspected intussusception associated with Henoch-Scho¨ nlein purpura?......Page 269
3. A healthy 14-year-old girl presents with symptoms of urgency, frequency, and dysuria, as well as intermittent lower-abdominal......Page 270
9. A 3-year-old African-American girl presents to the ED with vaginal bleeding and a donut-shaped mass of purplish tissue protru......Page 271
14. A 13-year-old female patient arrives in your ED with abnormal vaginal bleeding. Her menarche was around age 12. Her menstrua......Page 272
18. How is PID diagnosed?......Page 273
22. What are the long-term complications of PID?......Page 274
28. What is the clinical profile of a ruptured ectopic pregnancy, and what is the most crucial therapy?......Page 275
31. What is the leading cause of teenage short-term recurring school absenteeism in the United States?......Page 276
5. What causes painful crisis in patients with SCD?......Page 277
10. Which virus frequently leads to aplastic crisis in children with SCD?......Page 278
15. An ill-appearing 6-year-old girl presents with weakness for 2 days. On examination she has jaundice and pale conjunctivae bu......Page 279
21. How do patients with idiopathic (or immune) thrombocytopenic purpura (ITP) typically present?......Page 280
28. Why are children with malignancies at risk for sepsis?......Page 281
32. What comprises the differential diagnosis of an anterior mediastinal mass in a child?......Page 282
37. A 4-year-old girl with lymphoma presents with shortness of breath. What are some possible causes of her symptoms?......Page 283
40. What is tumor lysis syndrome (TLS)?......Page 284
ACKNOWLEDGMENT......Page 285
4. How is an infant......Page 286
8. What is the most common cause of sepsis in newborns?......Page 287
11. How helpful is C-reactive protein in detecting serious bacterial infection in febrile children?......Page 288
OPHTHALMIC INFECTIONS 14. Distinguish between the presentation of preseptal and orbital cellulitis in children.......Page 289
17. For children discharged from the ED with the diagnosis of preseptal cellulitis, which antibiotics are best?......Page 290
20. A 5-year-old girl presents to the ED with ‘‘burning and itchy’’ eyes. She describes a sensation of ‘‘chalk in her eyes,’’ wi......Page 291
23. Distinguish the features of deep neck infections in children.......Page 292
29. List the three major causes of exudative pharyngitis in children.......Page 293
33. Which pathogens are implicated in acute otitis media?......Page 294
38. You decide to intubate the trachea of a young patient who presents with severe respiratory distress and stridor. On endotrac......Page 295
43. What is the differential diagnosis of acute bacterial sinusitis?......Page 296
47. What is Pott’s puffy tumor?......Page 297
50. What diagnostic test results in the ED support the suspicion of myocarditis?......Page 298
54. How do you make the diagnosis of infective endocarditis?......Page 299
URINARY TRACT INFECTIONS 58. How common are urinary tract infections in infants and children?......Page 300
62. Should all infants age 2–24 months with a fever be evaluated for a UTI?......Page 301
67. What is the etiology of vaginitis in postpubertal girls? What characteristics distinguish the infections?......Page 302
68. What is the differential diagnosis for genital ulcers? How do you distinguish between each disease process?......Page 303
73. What is the differential diagnosis of perianal dermatitis/cellulitis?......Page 304
76. What findings may be associated with an invasive skin or soft tissue infection?......Page 305
78. Lymphadenopathy isolated to a particular region may indicate a specific infection. List some of these associations......Page 306
SEPSIS 82. Distinguish among bacteremia, systemic inflammation response syndrome (SIRS), sepsis, severe sepsis, and septic shock......Page 307
84. What are the antibiotic choices for empirical therapy in infants and children presenting in septic shock?......Page 308
88. What is acute arthritis and dermatitis syndrome?......Page 309
91. Which two infectious agents are most commonly associated with erythema multiforme minor and major (Stevens-Johnson syndrome)......Page 310
94. Match the following ED scenarios with the appropriate management. Management Options......Page 311
99. Why is ampicillin used to treat meningitis in the 0to 3-month-old infant?......Page 312
103. How can viral meningitis be distinguished from bacterial meningitis?......Page 313
106. A 10-year-old boy has a fever and is suddenly acting strangely, with combative behavior and garbled speech. What is the dif......Page 314
TICK-BORNE DISEASE 109. What is the appropriate treatment for a child who presents with erythema migrans?......Page 315
114. Describe the distribution of the rash in RMSF.......Page 316
117. What laboratory abnormalities are found in ehrlichiosis?......Page 317
123. A 3-month-old infant presents with a 3-day history of constipation, progressively poor feeding, and lethargy. On physical e......Page 318
124. Why is the diagnosis of......Page 319
127. Should a child who has been in proximity to bats (e.g., in the same room during sleep), but without known physical contact,......Page 320
133. Describe the characteristics of pertussis in infancy.......Page 321
139. A 10-year-old presents with nonproductive cough, low-grade fever, and malaise. On physical examination, the patient appears......Page 322
141. Which antimicrobials can be used for outpatient treatment of communityacquired pneumonia?......Page 323
with a neutrophil predominance. What diagnosis is likely?......Page 324
VIRAL ILLNESSES/EXANTHEMS 150. What is the classic description of roseola (primary human herpesvirus-6 infection)?......Page 325
156. How long is the child with chicken pox contagious?......Page 326
161. What is the differential diagnosis of Kawasaki disease?......Page 327
165. Match the bioterrorist disease with the organism and symptoms.......Page 328
UNUSUAL INFECTIONS 169. What is SARS and how can it be diagnosed?......Page 329
172. What are the distinguishing features of malaria?......Page 330
6. What are the most common poisons to which young children are exposed?......Page 331
11. What are the most dangerous substances, according to reports to the American Association of Poison Control Centers?......Page 332
16. How can the anticholinergic toxidrome be differentiated from the sympathomimetic toxidrome?......Page 333
23. What is the gastrointestinal decontamination technique of choice for most poisonings?......Page 335
30. What are the characteristics of the ideal toxic agent that would be amenable to multiple-dose activated charcoal?......Page 336
37. What are the pitfalls of urinary alkalinization?......Page 337
41. How is acetaminophen intoxication diagnosed?......Page 338
48. Describe the treatment for acute salicylate poisoning.......Page 339
54. What are the clinical manifestations of iron poisoning?......Page 340
59. What electrocardiographic findings correlate with potential toxicity from cyclic antidepressants?......Page 341
65. List problems associated with flumazenil administration after drug overdose.......Page 342
70. What common pediatric drug toxicity closely mimics opiate intoxication but does not reliably respond to naloxone?......Page 343
77. Name seven hyperthermic syndromes in toxicology.......Page 344
82.......Page 345
90. How does ethanol intoxication lead to life-threatening hypoglycemia in young children?......Page 346
97. When should an ingested button battery be emergently removed?......Page 347
Disadvantages:......Page 348
108. Do any hydrocarbons have serious systemic toxicity?......Page 349
113. How should coagulopathy from the warfarin-like rodenticides be treated?......Page 350
119. Describe the characteristic brain abnormalities after significant CO poisoning on magnetic resonance imaging of the brain.......Page 351
126. What are the clinical classifications syndromes for toxic mushrooms syndromes, typical clinical findings, and poisoning tre......Page 352
128. What other plants have potential for severe toxicity? Describe the treatment.......Page 355
133. What are the indications for administration of antivenin to a patient following Crotaline envenomation?......Page 356
to those of brown recluse spiders......Page 357
3. Which is the most common psychiatric emergency in children?......Page 358
8. How should the psychiatric evaluation be incorporated into the ED management of a child with a psychiatric emergency?......Page 359
10. Describe the proper procedure in the use of physical restraint.......Page 360
DRUG-INDUCED PSYCHIATRIC EMERGENCIES 12. What is neuroleptic malignant syndrome? How is it treated?......Page 361
16. How can a clinician assess the presence of depression and suicidal potential of the depressed patient?......Page 362
19. What are some medications associated with depression?......Page 363
21. List essential criteria for outpatient disposition of the suicidal child/adolescent.......Page 364
27. What are some of the medical complications of persistent purging or starvation seen in anorexia nervosa or bulimia?......Page 365
28. What is the initial medical evaluation for a patient with a suspected eating disorder?......Page 366
2. What is the pulmonary index?......Page 367
7. What are the indications for obtaining arterial blood gas (ABG) analysis in a patient with asthma?......Page 368
11. What is the role of exhaled nitric oxide (NO) measurement in the assessment of asthma?......Page 369
13. Isn’t nebulization a more effective means of delivering inhaled beta-agonists than a metered dose inhaler (MDI)?......Page 370
19. When should steroids be administered?......Page 371
25. What is the dose of magnesium sulfate for asthma?......Page 372
29. What are the two most common complications of mechanical ventilation?......Page 373
33. Who is at risk for severe disease?......Page 374
38. What is palivizumab?......Page 375
40. What is the differential diagnosis of croup?......Page 376
45. Is there any scientific evidence that steroids are beneficial in the treatment of croup?......Page 377
PNEUMONIA 49. How reliable are signs and symptoms in diagnosing pneumonia in young children?......Page 378
51. What organisms are most commonly associated with pleural effusion?......Page 379
3. What are the immediate management priorities for a child with a tracheostomy who presents in respiratory distress?......Page 380
7. What can I do if I am unable to replace a dislodged tracheostomy tube?......Page 381
11. How is dislodgement of a gastrostomy tube managed in the emergency department (ED)?......Page 382
16. What are some complications that can occur in relation to the stoma?......Page 383
20. When should shunt infection be suspected? How can I differentiate CSF shunt infection from obstruction?......Page 384
22. What techniques can an emergency medicine practitioner use to treat the critically ill patient with a CSF shunt obstruction?......Page 385
4. Does teething cause fever?......Page 386
9. What are the indications for hospital admission for a patient with a dental abscess?......Page 388
12. What is meant by the term......Page 389
13. What is a ranula? How does it differ from a mucocoele?......Page 390
15. Name three eponymous anaerobic infections associated with the mouth.......Page 391
suggestive of appendicitis?......Page 392
9. What is the value of computed tomography (CT) in diagnosing appendicitis?......Page 393
13. Which of these patients with appendicitis is most likely to present with a perforation? Why?......Page 394
21. How does the child with intussusception present?......Page 395
25. What are the only absolute contraindications to enema in the diagnosis of intussusception?......Page 396
31. A 10-month-old, previously well child presents to the emergency department (ED) with acute onset of abdominal pain associate......Page 397
38. How does the metabolic derangement occur?......Page 398
40. What are the most common surgically correctable causes of vomiting in the following infant age groups: First week of life? F......Page 399
44. What is the difference between a pilonidal dimple and a pilonidal sinus?......Page 400
49. Your 10-year-old patient with presumed appendicitis is in extreme pain. His tearful mother is asking if there is anything yo......Page 401
4. What are the signs of increased ICP?......Page 403
8. Which medications are recommended in the treatment of increased ICP?......Page 404
10. What are the complications of CSF shunt placement in pediatric patients?......Page 405
14. What is the treatment of CSF shunt malfunction?......Page 406
19. Can a patient have a shunt infection with normal spinal fluid collected by lumbar puncture?......Page 407
24. Headache is a very common pediatric symptom. What are the historical features of headache that should prompt concern for bra......Page 408
26. What are the possible factors leading to subdural empyema and epidural abscesses?......Page 409
30. What is the treatment for focal suppurative CNS infections?......Page 410
35. What are the common signs and symptoms of nontraumatic spinal cord compression in the pediatric patient?......Page 411
36. What is the ED approach to suspected nontraumatic spinal cord compression?......Page 412
4. List and describe briefly the four types of orbital wall fractures.......Page 413
11. While attempting to repair a superficial forehead laceration, some of the cyanoacrylate glue drips into the child’s eye and......Page 414
16. Why is a burn from an alkali more damaging to the eye than an acid burn?......Page 415
20. What are the symptoms of lens dislocation?......Page 416
24. What is the best solution to use for ocular decontamination after a chemical injury?......Page 417
4. What imaging studies are indicated when osteomyelitis is suspected?......Page 419
6. What historical features should raise suspicion for osteomyelitis (and/or septic arthritis) from......Page 421
9. Describe the signs and symptoms of septic arthritis.......Page 422
12. Which organisms are commonly seen in septic arthritis?......Page 423
16. How is pyomyositis treated?......Page 424
19. What concerns should the ED physician have when a child younger than 4 years presents with back pain?......Page 425
21. What is the approach to the patient with suspected SCFE in the ED?......Page 426
23. What are some of the features of growing pains?......Page 427
7. What steps should be taken for a patient who has a nosebleed in the emergency department (ED)?......Page 428
13. What is a parapharyngeal abscess?......Page 430
18. How does CT assist in RPA management?......Page 431
25. How does a patient who has acute mastoiditis present?......Page 432
29. What is a Bezold’s abscess?......Page 433
37. How should you manage a patient who is actively bleeding after tonsillectomy in the ED?......Page 434
43. What should be considered in your differential diagnosis of a PTA?......Page 435
47. What findings would make you suspect Lemierre’s syndrome?......Page 436
4. Can epididymitis be treated on an outpatient basis?......Page 437
8. How do a ‘‘communicating’’ and a ‘‘noncommunicating’’ hydrocele differ?......Page 438
14. What is the first evaluation to do for a patient with ‘‘blood in the urine’’?......Page 439
19. How does the clinical presentation of UTI vary with the age of the patient?......Page 440
23. How should dipstick indicators be used to screen for UTI?......Page 441
29. Which patients with UTI should be admitted for parenteral antibiotics?......Page 442
35. What are the symptoms of urolithiasis in children?......Page 443
42. What laboratory tests should I order for suspected acute glomerulonephritis?......Page 444
48. Should all patients with nephrotic syndrome be admitted?......Page 445
49. What is the treatment for priapism?......Page 446
5. When is it appropriate to assess for abdominal injury in the pediatric patient with multiple trauma?......Page 447
10. Which laboratory studies are useful for evaluating patients with abdominal trauma?......Page 448
13. So which is better, CT or US?......Page 449
16. What is meant by the nonoperative management of blunt abdominal trauma in children?......Page 450
18. What is the clinical approach to penetrating abdominal trauma?......Page 451
3. How are different depths of burns classified?......Page 452
6. Why is it important to interview the paramedics who arrive with fire victims?......Page 453
8. What is the initial treatment of major burns in a child?......Page 454
12. What are the indications for referral to a regional burn center?......Page 456
16. What are the indications for intubation of the trachea of a fire victim?......Page 457
20. How is the half-life of carboxyhemoglobin affected at different oxygen concentrations?......Page 458
24. List the major therapeutic actions of hyperbaric oxygen.......Page 459
30. What is the most effective measure in reducing mortality from burns and smoke inhalation?......Page 460
8. What has happened to the incidence of abuse over the past 20 years?......Page 462
17. Which specific fractures have a high probability of being caused by child abuse?......Page 463
21. What criteria should be used to order a skeletal survey for trauma?......Page 464
25. A 6-month-old boy is brought to the ED for new onset of seizures. You note retinal hemorrhages. A CT scan of the brain is re......Page 465
32. How can you tell a ‘‘bloody tap’’ from a CNS hemorrhage?......Page 466
41. If a child is immersed in hot water while wearing some articles of clothing, what should physical examination of the burn re......Page 467
48. What are the characteristics of a parent who may be involved in Mu¨nchhausen syndrome by proxy?......Page 468
55. Should vaginal, pharyngeal, and rectal cultures be performed on every child undergoing a sexual abuse evaluation?......Page 469
64. What are the two types of child abuse cases in the court system? What are the differences?......Page 470
68. What is the most important step in managing a child abuse case?......Page 471
3. What are the other components of the tooth?......Page 472
6. How do I accurately describe which tooth is injured?......Page 473
9. How are root fractures diagnosed?......Page 474
11. A 2-year-old patient struck his mouth on a coffee table. He reports pain with occlusion and chewing. Both maxillary central......Page 475
16. How is an intrusion injury to a permanent tooth treated?......Page 476
21. Why is it so important to reimplant a permanent tooth within 30 minutes?......Page 477
25. Summarize the appropriate timing of dental consultation for patients with dental trauma.......Page 478
26. A mother brings her adolescent son for his yearly physical, and you learn he is very active in sports. What information shou......Page 479
2. What unique categories of fractures are commonly seen in pediatrics as a result of these differences?......Page 481
8. How does a mallet finger deformity differ in children and adults?......Page 482
DIAGNOSIS 13. In what situations are comparison films most useful?......Page 483
18. What is the difference between Galeazzi and Monteggia fractures?......Page 484
24. What factors determine the need for fracture reduction?......Page 485
COMPLICATIONS 29. What clinical findings suggest a compartment syndrome?......Page 486
ABUSE INJURIES 33. Describe the diagnosis and management of metaphyseal chip fractures.......Page 487
ELBOW INJURIES 35. Explain the term......Page 488
39. What radiologic findings on a lateral elbow film suggest the presence of an occult fracture?......Page 489
41. What are the three classifications of supracondylar fractures?......Page 490
5. What are the common pitfalls in evaluating children with eye injuries?......Page 492
14. Which eye injuries are possible when a child is a restrained passenger in the front seat and is involved in a car crash with......Page 493
18. Describe the management of the child with ‘‘something in my eye.’’......Page 494
22. When and how does traumatic iritis present?......Page 495
25. What is the major pitfall when diagnosing an orbital wall fracture?......Page 496
27. What aspects of the history or physical examination place patients at high risk for globe perforation or rupture?......Page 497
30. Which are more severe—alkali or acid burns?......Page 498
31. An emergency physician attempts to repair a forehead laceration of a young child using cyanoacrylate glue. Some of the glue......Page 499
5. Name the ways in which infants differ from older children with regard to head trauma.......Page 500
9. Since CT is available, are skull films ever indicated?......Page 501
13. What is a concussion? How are concussions graded?......Page 502
18. What are the indications for imaging in those who are alert with a nonfocal neurologic examination and no signs of skull fra......Page 503
21. How does increased ICP occur?......Page 504
27. Why are discharge instructions important in patients with head trauma?......Page 505
28. When can a child return to sports after a concussion?......Page 506
7. When should delayed closure of a wound be considered?......Page 507
15. What are the contraindications to the removal of a foreign body in the ED?......Page 508
21. How can the pain of infiltration of a local anesthetic be decreased?......Page 509
24. What are the appropriate types of sutures and techniques for closure of various wounds?......Page 510
26. When can tissue adhesives be used?......Page 511
28. What are some important considerations in the evaluation of puncture wounds?......Page 512
34. How are lacerations of the external ear treated?......Page 513
38. Describe the approach to nail bed injuries.......Page 514
40. What are the signs of wound infection?......Page 515
45. A young boy is brought to the ED after being stuck by a needle on the playground. The needle has crusted blood along the met......Page 516
46. When is rabies prophylaxis indicated?......Page 517
48. What is the best course of management for a fishhook embedded in soft tissue?......Page 518
49. What is the best way to remove a ring that is stuck on a child’s finger?......Page 519
1. What is the importance of trauma to the health of children?......Page 520
4. Describe the prehospital care capability for children with potentially serious injuries.......Page 521
7. Is hypertonic saline beneficial in the fluid resuscitation of the multiply injured trauma patient with severe head injury?......Page 522
10. What initial radiographic and laboratory studies are important in trauma?......Page 523
16. Which visceral injuries are more common in children?......Page 524
17. True or false: To open the airway in a pediatric trauma patient, the head-tilt chin-lift maneuver is the recommended procedu......Page 525
23. How might airbags and pediatric restraint devices in vehicles influence motor vehicle crash–related injuries?......Page 526
28. What are the important aspects of medical history in seriously injured children?......Page 527
31. When a trauma patient requires transfer to a trauma center, what are the responsibilities of the transferring physician?......Page 528
4. How should the airway and breathing be managed in a child with neck injury?......Page 529
8. What are the major differences between pediatric and adult cervical spines?......Page 530
13. What is the best way to read cervical spine radiographs?......Page 531
16. Why should patients with Down syndrome receive cervical spine radiographs before participating in sports?......Page 532
19. Why is the administration of steroids in pediatric spinal cord injuries controversial?......Page 533
4. How are renal injuries classified?......Page 534
7. Which are the most commonly found symptoms in bladder injuries?......Page 535
13. How does testicular rupture present?......Page 536
16. What is the best predictor of abdominal injury in children with pelvic fractures?......Page 537
17. What are the most common diagnostic findings in children with pelvic fractures?......Page 538
4. What is ‘‘Little League elbow’’?......Page 539
8. What is the recommended management for Sever disease?......Page 540
ACUTE INJURIES 12. What is the most dreaded complication of returning to sports too soon following a concussion?......Page 541
18. What is the most commonly injured nerve in acute shoulder dislocation?......Page 543
23. A running football player was struck in the thigh by another player’s helmet. Radiographs are negative, yet the patient has......Page 544
24. What is the typical mechanism for an injury to the anterior cruciate ligament in children?......Page 545
28. What measures can be used to prevent pediatric sports injuries?......Page 546
3. How do I evaluate a patient with thoracic trauma?......Page 547
7. What signs and symptoms are associated with pulmonary contusion?......Page 548
13. How can I tell if a patient has a tracheobronchial injury?......Page 549
18. How is the diagnosis of a traumatic rupture of the aorta (TRA) made?......Page 550
20. How concerned should I be about blunt cardiac injury in patients with thoracic trauma?......Page 551
21. What are the four conditions that must be present for sudden circulatory arrest to occur after a nonpenetrating blow to the......Page 552
4. Which bites should be routinely treated with prophylactic antibiotics?......Page 553
11. What is papular urticaria?......Page 554
16. Which group of the order......Page 555
21. How does the venom of the Arizona bark scorpion work?......Page 556
26. How is the bite of a brown recluse spider treated?......Page 557
33. How does tularemia present? How is it treated?......Page 558
38. How important is the duration of attachment of ticks to the skin?......Page 559
39. What are the most effective precautions to avoid Lyme disease?......Page 560
4. Is hypothermia protective?......Page 561
7. What are the tenets of management in resuscitation of the unresponsive drowning patient?......Page 562
11. Can some drowning patients be sent home from the ED?......Page 563
14. What are predictors of outcome in drowning?......Page 564
16. How can pediatric drowning be prevented?......Page 565
17. Should patients with seizures be allowed to participate in water-related activities?......Page 566
6. How may electrical injuries affect the respiratory system?......Page 567
11. How should fluid resuscitation be approached in victims of electrical injury?......Page 568
17. What is the voltage potential in a lightning strike?......Page 569
23. What are the risks of sustaining a lightning injury indoors?......Page 570
24. What is the ‘‘30–30 Rule’’?......Page 571
4. Why are children at a greater risk for heat-related illnesses than adults?......Page 572
11. What is heat syncope? How is it treated?......Page 573
16. Describe the clinical characteristics of heat stroke.......Page 574
21. What is the best way to provide external cooling for victims of heat-related illnesses?......Page 575
25. What are the current recommendations for modification of activity in hot, humid weather?......Page 576
28. How much fluid should a child drink while exercising in a hot climate?......Page 577
29. What are the benefits of flavored sports drinks?......Page 578
5. What clinical clues should prompt measurement of core temperature?......Page 579
9. Describe the major causes of hypothermic death during rescue and resuscitation.......Page 580
12. What standard treatments are usually safe and effective in hypothermia?......Page 581
17. If active external rewarming is sought, what is the best method?......Page 582
20. Does hypothermia alter usual prognostic indicators?......Page 583
21. Cite exceptions to the rule, ‘‘no one is dead until they’re warm and dead.’’......Page 584
3. What did we learn from the anthrax outbreak of 2001?......Page 585
8. Which of these features were observed in the 1995 Tokyo sarin attack?......Page 586
11. Why may children be disproportionately affected by both chemical and biologic agents?......Page 587
12. What are the principal biologic agent threats?......Page 588
16. What problems are associated with management of children exposed to anthrax?......Page 593
21. What are the principal components of the federal response plan?......Page 594
22. How does the federal plan apply to children?......Page 598
6. What is a first responder?......Page 599
9. How can one become an intermediate provider?......Page 600
15. What is EMS-C?......Page 601
20. What is the doctrine of implied consent?......Page 602
4. Why are children in the ED at particular risk for error?......Page 603
7. What is the most common outcome of medication errors in the pediatric ED?......Page 604
12. When caring for a patient with limited English proficiency in the ED, would a family member interpreter be sufficient?......Page 605
16. How should an ED physician approach a family after an error is discovered?......Page 606
17. What can be done to prevent errors in a pediatric ED?......Page 607
21. What resources are available?......Page 608
4. How is the ‘‘standard of care’’ defined?......Page 609
9. What role does good communication play in reducing malpractice suits?......Page 610
14. What is an emancipated minor?......Page 611
19. How should an ED physician proceed if the referring primary care doctor disagrees with the ED physician’s assessment and pla......Page 612
20. What is EMTALA?......Page 613
26. What are ‘‘good Samaritan statutes’’?......Page 614
31. What is the recommendation of ACEP to manage telephone orders called to the ED by outside physicians?......Page 615
32. Does the presence of family members at the resuscitation of a relative increase the risk of litigation for emergency physici......Page 616
3. What are tolerance, physical dependence, and addiction?......Page 617
7. How much time should elapse between the last oral intake of food or liquid and PSA?......Page 618
10. During PSA, which equipment is needed to monitor the patient and to be immediately available at the bedside?......Page 619
14. What are the expected rates of success and complications for PSA in children?......Page 620
18. Discuss the role of etomidate for PSA.......Page 621
20. A bead is located in the ear canal of an 8-year-old boy. Initial attempts to remove it cause considerable anxiety and discom......Page 622
23. A 10-year-old boy has displaced and angulated fractures to his ulna and radius that require closed reduction. What agent(s)......Page 623
26. What are the top 10 pitfalls in administering sedation and analgesia to children in the ED?......Page 624
27. What are the recommended starting doses for sedatives and analgesics commonly used in children?......Page 625
6. Describe the advantages and disadvantages of transport by helicopter.......Page 626
8. Without parental consent, can a minor be transported?......Page 627
13. What type of skills should be considered imperative for transport personnel?......Page 628
17. What information should be gathered and documented at the time of patient referral?......Page 629
21. What is the appropriate response to inadequate care during transport?......Page 630
26. How serious is the concern about problems related to altitude?......Page 631
31. Should parents accompany a pediatric transport?......Page 632
34. List strategies for follow-up to a stressful transport or patient care experience.......Page 633
Index
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