Paediatric Regional ACEM Fellowship Exam Preparation · PDF fileProperty of the Paediatric Regional ACEM Fellowship Exam ... (Neurology/ GIT/ Surgical/ Urology/ Renal/ Dermatology

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



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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



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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]

[email protected]

Mobile: 0432072275

Dect phone: 0731396937

mailto:[email protected]

mailto:[email protected]



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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)



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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



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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.


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


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


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)


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.


Property of the Paediatric Regional ACEM Fellowship Exam Program

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Documents

Paediatric Regional ACEM Fellowship Exam Preparation · PDF fileProperty of the Paediatric Regional ACEM Fellowship Exam ... (Neurology/ GIT/ Surgical/ Urology/ Renal/ Dermatology