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The Prince Charles Hospital Paediatric Emergency Department
Property of the Paediatric Regional ACEM Fellowship Exam Program at TPCH
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Paediatric Regional ACEM Fellowship
Exam Preparation Program
The Prince Charles Hospital
Paediatric Emergency Department
2015 Manual
The Prince Charles Hospital Paediatric Emergency Department
Property of the Paediatric Regional ACEM Fellowship Exam Program at TPCH
2
Introduction:
Welcome to the Paediatric Regional ACEM Fellowship Exam modules at
The Prince Charles Hospital. These Fellowship Paediatric sessions have
been designed to allow you to cover the Paediatric syllabus in 6 sessions
over a period of 4 months leading toward the written component of the
Fellowship Examination.
The Program is overseen by our Fellowship Instructors to ensure
candidates cover the PEM syllabus for the ACEM Exam (30%), as well as
discussing a range of techniques for approaching the new Format SAQs
and EMQ.
After enrollment, candidates will be provided with a program manual
which is divided into 6 modules. A module will be covered each
fortnight, composed of ‘New Format’ SAQs, centered around a set of
topics from the PEM syllabus. Candidates are expected to complete the
assigned module before attending the session.
Candidates should endeavor to cover the recommended readings and
work through the questions for each session to gain maximum benefit
from the program.
There are no course fees for the program.
Enrolment is open to all ACEM Candidates in Queensland (or beyond)
who are planning to sit the exam in Feb 2016 and August 2016.
Please e-mail your name and contact details to the program coordinator.
Good luck and best wishes in your exam preparation.
Sincerely
Dr Alaa Ibrahim & Dr Zaahid Pandie
The Prince Charles Hospital Paediatric Emergency Department
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Faculty
Dr Zaahid Pandie FACEM FRACP PEM Director of Paediatric Emergency Medicine Department The Prince Charles Hospital Dr Kong Liew MBChB, FACEM Director of Paediatric Emergency Medicine Training Lady Cilento Children Hospital Dr Stephen Fahy MBChB, FACEM Emergency Physician The Prince Charles Hospital Dr Alaa Ibrahim MBChB FACEM MRCS Co-Director of Paediatric Emergency Medicine Training The Prince Charles Hospital Program coordinator
E-mail : [email protected]
Mobile: 0432072275
Dect phone: 0731396937
The Prince Charles Hospital Paediatric Emergency Department
Property of the Paediatric Regional ACEM Fellowship Exam Program at TPCH
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MODULES
Use the table below to guide your study to cover the PEM syllabus. Read through the
appropriate textbook chapters and work through the questions (to time) before attending
each session.
Module 1 Tuesday 13/10/2015 1800-2130 (Critical Care/ Airway/ Sedation/ Neonatal Emergency) Module 2 Tuesday 27/10/2015 1800-2130 (Respiratory, Cardiology, Infectious disease) Module 3 TBA 1800-2130 (Trauma / Orthopaedics/ Neurosurgical/ Retrievals) Module 4 TBA 1800-2130 (Neurology/ GIT/ Surgical/ Urology/ Renal/ Dermatology/ ENT) Module 5 TBA 1800-2130 (Endocrine/ Metabolic/ Haematology/ Gynaecology/ Eye) Module 6 TBA 1800-2130 (Toxicology/ Administration/ Psychiatry / Revision)
The Prince Charles Hospital Paediatric Emergency Department
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Disclaimer and Warning:
ACEM has recently changed the format of the Fellowship exam
and with the limited information available, our faculty have
interpreted the ACEM College instructions to produce new
format SAQ questions.
All reasonable care has been taken to provide questions of an
exam quality and standard. The faculty cannot guarantee success
in the ACEM exam and can not be held liable for candidates not
passing the ACEM Fellowship exam.
Attending our course does not guarantee success in the ACEM
Fellowship examination. Success or failure depends on the
candidate’s preparation and abilities.
We recommend using these modules in combination with your
base hospital fellowship-teaching program.
Read through the appropriate textbook chapters recommended
by the college.
Good luck in your exam preparation
Program Faculty
The Prince Charles Hospital Paediatric Emergency Department
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The ACEM Paediatric Emergency Medicine Curriculum
Expert level of practice topics are in BOLD and UNDERLINED, high level of practice topics
are in BOLD and general topics are just listed. The expert and high level of practice topics are
usually the ones tested in SAQ and EMQ.
RESUSCITATION
Airway
Airway Management
Life Support
Shock (SVM)
Age-specific differences
ANAESTHETICS
General Anaesthetic Techniques
Local Anaesthetic Techniques
Pain Management
Procedural Analgesia and Sedation
(SVM)
Cardiovascular
ECG’s / CXR’s
Valvular disorders
Disorders of the myocardium
Atrial septal defect
Ventricular septal defect
Dextrocardia
Disorders of the pericardium
Acute pericarditis
Constrictive pericarditis
Pericardial effusion
Pericardial tamponade
Disturbances of cardiac rhythm
Bradycardias
Tachycardias
Narrow complex regular
Narrow complex irregular
Wide complex regular
Wide complex irregular
Torsade des pointes
Ventricular fibrillation
Accessory pathways
Wolff-Parkinson-White syndrome
International guidelines for the
management of Arrhythmias
Endocarditis
Tumours
Congential heart disease
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Cyanotic heart disease
Rheumatic fever
Respiratory
Upper airway obstruction
Croup
Bronchiolitis
Pneumonia / CXR
Empyema
Acute lung injury/respiratory distress
syndrome
Asthma
Haemoptysis
Cavitating lung lesions
Isolated “coin” lesions on chest x-ray
Congenital/neonatal
Bronchopulmonary dysplasia
Cystic fibrosis
Gastrointestinal
Gastroesophageal reflux
Tracheo-oesophageal fistula
Inflammatory bowel disease
Gastroenteritis
Hepatic disorders
Jaundice
Interpretation of liver function tests
Hepatic failure
Hepatitis
Neurological
Disorders of the cranial nerves
Facial nerve paralysis
Headache and facial pain
Indications for imaging (CT, MRI)
Migraine
Raised intracranial pressure
Thrombotic CVA
Altered mental state
Coma
Approach to ataxia and gait disturbances
Seizures
The floppy infant
Status epilepticus
Dystonic reactions
Lumbar puncture
Interpretation of CSF fluid biochemistry,
cell count and microbiology
Infectious disorders of the CNS and PNS
Meningitis /Encephalitis
Abscess
Tuberculosis
Toxoplasmosis
Cryptococcal infection
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HIV
Guillain-Barré syndrome
Multiple sclerosis
Botulism
Diphtheria
Tetanus
Myopathy
Periodic paralysis
Hydrocephalus
Complications of the central nervous
system devices (V)
Disorders of the spinal cord
Endocrine
Hypoglycaemia
Diabetic ketoacidosis
Adrenal disorders
Acute adrenal insufficiency (adrenal
crisis)
Congenital adrenal insufficiency
Cushing’s disease
Conn’s syndrome
Phaeochromocytoma
Thyroid disorders – thyroid storm
Pituitary disorders
Panhypopituitarism
Haematological
Interpretation of haematological
investigations
Anaemia
Abnormal haemoglobins
Disorders of haemostasis and
coagulation
Neutropenia
Thrombocytopenia
Disorders of white cells
Oncology
Acute spinal cord compression
Complications related to
myelosuppression
Febrile neutropenia
Immunosuppression and opportunistic
infections
Thrombocytopaenia and haemorrhage
Renal
Interpretation of urine dipstick
microscopy and culture
UTI
Pyelonephritis
Infected obstructed kidney
Acute renal failure
Chronic renal failure
Hyperkalaemia in renal failure
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Renal dialysis
Peritoneal
Intermittent haemodialysis
Continual renal replacement therapies
Complications of renal dialysis
Haemolytic uremic syndrome
Polycystic kidney disease
Rhabdomyolysis
Rheumatology
Juvenile Chronic arthritis
Approach to limping child
Dermatology
Dermatitis and eczema
Urticarial and allergic rashes
Viral exanthems
Macular rashes
Maculopapular lesions
Erythema multiforme
Erythema nodosum
Petechial and purpuric rashes
Vesicular and bullous rashes
Pemphigus/ Pemphigoid
Staphylococcal scalded skin syndrome
Stevens-Johnson syndrome
Toxic epidermal necrolysis
Herpetic infections
Dermatological manifestations of
underlying systemic disease
Infectious disorders
Febrile infant management
Bacteraemia
Systemic inflammatory response
syndrome
Sepsis, severe sepsis and septic shock
Multiple organ dysfunction
Toxic shock syndrome
Infections in the returned traveller
Malaria
Dengue fever
Haemorrhagic fevers
Typhoid
Food poisoning
Meningococcaemia
Tuberculosis and other mycobacterial
infections
Haemophilus influenzae
Infectious mononucleosis
Influenza/parainfluenza
Herpes simplex /Herpes zoster
Mycoplasma infections
Fungal infections
Tick-borne infections
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Immunology
Allergic reactions /Anaphylactoid
reactions
Anaphylaxis
Angioedema
Drug allergies
Systemic lupus erythematosus
Vasculitis
Polyarteritis nodosa
Wegener’s granulomatosis
Kawasaki's disease
Henoch Schonlein Purpura
Sarcoidosis
Complication of immunosuppressant
agents
Metabolic
Hypokalaemia /Hyperkalaemia
Hyponatraemia/Hypernatraemia
Hypocalcaemia /Hypercalcaemia
Hypermagnesaemia / Hypomagnesaemia
Hyperphosphataemia
Hypochloraemia / Hyperchloraemia
Inappropriate ADH syndrome
Interpretation of the electrocardiograph
in electrolyte disturbance
Acid Base Disorders
As applied to paediatric metabolic
disorders / DKA / Renal tubular acidosis /
pyloric stenosis
Neonates and Infants
Apnoea of prematurity
Hyperbilirubinaemia
Feeding problems
Congenital heart disease
Diaphragmatic hernia
Congenital syndromes
Gastroesophaegeal reflux
Metabolic disease
Necrotising enterocolitis
Respiratory distress
Seizures
Infections/sepsis / Occult bacteraemia
Sudden infant death syndrome
SURGICAL
Trauma – expert level knowledge
expected
Assessment and management of head
trauma
Minor head injury
Post concussive syndrome
Chest trauma
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Abdominal trauma
Genitourinary trauma
Pelvic trauma
Spinal cord injury
Cord syndromes / SCIWORA
Neck trauma
Maxillofacial trauma
Trauma in children and differences in
management
NAI
Burns
Assessment and management of trauma
in children
Paediatric aspects of trauma
management
Non-accidental injury
Thoracic
Mediastinal masses
Oesophageal foreign body
Tracheobronchial foreign body
Abdominal
Assessment and management of
abdominal pain
Non-traumatic splenic rupture
Bowel obstruction
Malrotation / Volvulus
Congenital pyloric stenosis
Intussusception
NGT insertion
Meckel’s diverticulum
Acute appendicitis
Constipation
Anal fissure
Orthopaedic and Hand
Salter-Harris classification
Injuries about the elbow
The child with a limp
Osgood-Schlatter disease
Perthe’s disease
Slipped capital femoral epiphysis
Transient synovitis
Developmental hip dislocation
Elbow
Pulled elbow
Forearm bones
Wrist
Supracondylar fractures
Neurosurgical
Cerebral tumours
Shunt complications
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Intracranial abscesses
Cerebral venous thrombosis
Urology
Urinary catheter insertion
Vesico-ureteric reflux
Acute scrotum/ Epididymitis / Orchitis
Testicular torsion / Torsion of the
testicular appendage
Phimosis/paraphimosis
ENT
Otitis media / mastoiditis/ Sinusitis
Stomatitis /Pharyngitis / Tonsilitis /
Peritonsillar abscess/ Retropharyngeal abscess
Epiglottitis /Laryngitis /Tracheitis
Post-tonsillectomy bleed
Foreign bodies
PSYCHIATRY
Deliberate self-harm /Adolescent issues /Depression /
Eating disorders/ Anxiety disorders
The “challenging” ED patient /Frequent presenter / Munchausen’s by proxy
Involuntary detention of the child
LEGAL
Consent / Capacity to consent Children and adolescents
Guardianship Board
Privacy and confidentiality
Reporting Child abuse/child at risk.
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The Program Modules
Model 1
(Critical Care/ Airway/ Sedation/ Neonatal Emergency)
Resuscitation including Neonatal and physiological differences in
resuscitation. (Expert)
Advanced Paediatric airway management ( Expert)
Upper airway obstruction: Croup, Epiglottitis, FB (Expert)
The shocked neonate (Expert)
Procedures including sedation and analgesia management (Expert)
Advanced Life support algorithm (Paediatric and Neonate) (Expert)
Emergency Vascular Access (Expert)
SAQ Learning Objectives:
Assessment and Management of Paediatric and Neonatal Resuscitation questions
with focus on DDX and the key points in history, examination and investigation with
justification.
Knowledge of the drugs and accurate dosing that can be used in Paediatric
Resuscitation.
Assessment, Preparation and Management of all Paediatric Airway Emergencies
including procedural sedation.
Assessment and Management of “The collapsed neonate”, wide DDX and risk
stratification.
Protocols around Paediatric Procedural Sedation.
Anatomical and physiological differences adults VS children in terms of airway
management, equipment, and Resuscitation algorithms.
Outline / Describe Advanced Intravenous access.
Describe and interpret Radiology imaging of critically ill children (CXR , CT , Lateral
Neck)
Describe and interpret blood results in critical care scenarios.
Blood Gases in critical care / metabolic abnormalities.
Description and interpretation of clinical photos of the critically ill children.
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Module 2
(Respiratory, Cardiology, Infectious disease)
Asthma (Expert)
Anaphylaxis (Expert)
Pneumonia
Chronic lung disease , CF etc
Congenital Heart disease
Paediatric ECGs
Congenital Conduction disorders
Paediatric tachyarrhythmia (Expert)
Febrile Child/ Neonate – Meningitis / UTI / Meningococcal / Sepsis
SAQ learning objectives:
Assessment, management and disposition of severe asthma in children.
Expert knowledge of asthma pharmacological agents and dosing.
Critical care management for Life Threatening Asthma – Intubation, RSI and
Ventilation parameters and pitfalls.
Management of paediatric tachy-arrhythmias including selection of drugs.
Assessment and management of febrile child including investigation, escalation
therapy, right selection of antibiotics and safe disposition.
Assessment, DDX and Management of Sepsis questions
Description and interpretation of Paediatric ECGs.
Description and interpretation of Paediatric Chest radiology / FB / Lateral neck.
Interpretation of CSF results and DDX
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Module 3
(Trauma /Orthopaedics/ Neurosurgical/ Retrievals/Environmental)
Differences in Paediatric trauma management
Head injury – major trauma vs Minor Head Injury
C spine controversies
Retrieval issues for paediatrics
Orthopaedics including the limping child and fracture management
(expert)
Near Drowning, Heat Stroke & Burns
Non-accidental Injury – recognition, Differentials, Investigation,
Management and Protocols.
SAQ Learning Objectives:
Assessment, Preparation and Management of Paediatric Trauma – modification of
approach
Paediatric Minor Head and C-spine injury, including risk stratification and published
Head Injury and C-Spine rules.
Assessment of the limping child, DDX, Limitation of investigation.
Near Drowning , Heat Stroke, cooling methods, Prognostic evaluation.
Paediatric retrieval consideration and pitfalls.
NAI – Assessment, Management, Administration, Medico-legal, notification.
Describe and interpret different type of Paediatric fractures.
Description and management of Paediatric specific fractures / orthopedics – Elbow /
Salter Harris / SUFE / Perthes
Describe and interpret Head CT images and outline Managements.
Burns assessment, description ,and management
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Module 4
(Neurology/ GIT/ Surgical/ Urology/ Renal/ Dermatology/ ENT)
Status Epileptics (Expert)
Headache in children / adolescents
Meningitis/encephalitis
Neurosurgical shunts / reservoirs
The Floppy Infant / Neuromuscular / Guillain Barre Syndrome
Abdominal Pain across neonates / Infants / Toddlers / School aged/
adolescents
Surgical emergencies – Intussusception / Appendicitis / Malrotation /
Volvulus
Bowel obstruction/ Constipation
Neonatal Jaundice
Urticaria/ Viral Exanthems/ Petechiae/ Purpura/ SSSS/ TEN
Kawasaki Disease
Acute Scrotum
Acute renal failure / Nephrotic Syndrome / HUS
SAQ Learning Objectives:
Discussion, Management of Status Epileptics including in depth Pharmacology and
drafting protocols.
Assessment of Paediatric loss of consciousness / Headache/CNS Infection
Paediatric acute abdominal emergency including investigation modalities.
Risk stratification / assessment of appendicitis
Assessment of neonatal Jaundice.
Assessment of acute Scrotum
Describe and interpret different types of rashes – develop differentials
Outline management of Paediatric dermatology emergencies.
Describe and interpret CSF results.
Describe and interpret Paediatric abdominal radiology.
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CT Head – neurosurgical complications / hydrocephalus
Shunt problems and complex neurological patients assessment.
Renal Function / Biochem / Gas / Urinalysis
Tonsillitis, retro-pharyngeal abscess , CT Neck
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Module 5
(Endocrine/ Metabolic/ Haematology/ Gynaecology/ Eye)
DKA / Hypoglycemia (expert)
Congenital Adrenal Hyperplasia
Addisonian crisis / Cushings Syndrome / Thyroid storm
Anemia / ITP / TTP / DIC / Leukemia / HSP
Teenager Pregnancy/ PID
Pre and orbital cellulitis
Metabolic Diseases
Ophthalmology Emergencies: Trauma and infections
SAQ Learning Objectives:
Management of Paediatric DKA, Fluid , Insulin , Complications.
Assessment and management of neonatal metabolic emergencies.
Assessment and dealing with parents of pregnant teenager.
Assessment of PID / Sexual assault in Paediatric population.
Assessment of anemia and haematological disorders, Lab results.
Describe and interpret metabolic and electrolyte abnormalities.
Describe and interpret Paediatric Ophthalmology Emergencies – slit lamp exam /
retinal images / Papilloedema/ Hyphema / Eye infection
Interpretation of Haematological disorders – FBC / smear
Interpretation of VBG, ABG and metabolic abnormalities.
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Module 6
(Toxicology/ Administration/ Psychiatry / Revision session)
‘Two pills can kill’ (expert)
Modification of approach in toxicology to a child
Breaking bad news (expert)
Gillick competence
Mental Health Acts / Guardian Act / Child Protection Act
Consent/leaving against advice / Reporting (expert)
Protocols in Paediatrics
Child Abuse/ NAI (neglect/FTT, physical/sexual/psychological abuse) ( expert)
SAQ Learning Objectives:
Assessment, management and disposition of Paediatric Toxicology questions.
Dealing with child abuse.
Dealing with aggressive child including self harm.
NAI images – burns /patterns /bruising / specific fractures
Brain storming revision of important Pediatric question.
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