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PEM Board Review > Misc PEM Q Book > Flashcards

Misc PEM Q Book Flashcards

1
Q

lab abnormality in hereditary angioedema

A

low C4

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2
Q

reasons to use VariZig

A

only for post-exposure ppx, but NOT once there is varicella infection

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3
Q

lab abnormalities in strep glomerulonephritis

A

low C3, nml C4.

if levels are normal, consider something else

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4
Q

non-ketotic hypoglycemia with metabolic acidosis should make you think of…

A

fatty acid oxidation disorder

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5
Q

classic lab findings in fatty acid oxidation disorder

A

non-ketotic hypoglycemia

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6
Q

anion gap formula

A

AG = Na - Cl - HCO3

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7
Q

calculated osmolarity

A

= 2 x Na + glucose/18 + BUN/2.8

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8
Q

Multi-casualty vs mass casualty event

A

multi-casualty = 5+ victims

mass casualty = strains the existing EMS system

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9
Q

what’s unique about the sterile pyuria of Kawasaki disease?

A

it is lymphocyte predominant

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10
Q 
What can different levels of responders do:
first responders?
EMT-B?
EMT-I?
EMT-P?
A

1st responders: airway clearance, control blood loss, AED, CPR
EMT-B: assessment, spinal immobilization, BVM, defibrillation
EMT-I: pacing, cardioversion, IO, EKG, needle thoracostomy, advanced airway management
EMT-P: arrhythmias, advanced airway management, intubation, cricothyrotomy, meds, fluids

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11
Q

Best pressors for shock that is:

  1. cold
  2. warm
  3. normal BP
A
  1. epi
  2. norepi
  3. dopa
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12
Q

CXR findings (measurements) for RPA

A

prevertebral soft tissue swelling >7mm at C2 or 14mm at C6

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13
Q

Lab findings concerning for a pulmonary EXUDATE

A 
WBC >10K
glucose < 50% of serum
protein > 50% of serum
amylase > 200
LDH > 60% of serum
pH < 7.0 (v. suggestive of empyema)
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14
Q

EKG findings in pericarditis

A

widespread ST elevation
PR depression
ST elevation in limb and precordial leads with concave elevations

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15
Q

Location for ____ nerve block at wrist:

1) ulnar
2) median
3) radial

A

1) ulnar - proximal ventral crease at ulnar styloid
2) median - medial tendon of flexor carpi radialis
3) radial - dorsal crease @ radial styloid

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16
Q

pressure readings associated with compartment syndrome

A

> 30 mmHg

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17
Q

Components of the pediatric trauma score

A
  1. size
  2. airway
  3. consciousness
  4. SBP
  5. fractures
  6. cutaneous
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18
Q

How do you determine size for:

  1. ET tube
  2. ET tube depth of insertion
  3. NG tube size
  4. chest tube size
A
  1. ET tube = age/4 + 4
  2. ET tube depth of insertion = ETT x 3
  3. NG tube size = ETT x2
  4. chest tube size = ETT x 4
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19
Q

low plasma alanine levels are associated with what IEM?

A

ketotic hypoglycemia

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20
Q

what are treatments for hyperammonemia?

A

IV arginine
sodium benzoate
phenylacetate
hemodialysis

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21
Q

what disease is associated with +reducing substances in the urine, cloudy cornea, and HSM?

A

galactosemia

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22
Q

What is the BP treatment for pheochromocytoma?

A

phenotalamine
2nd line is CCBs
NO beta-blockers!!!

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23
Q

Patient with a PAINFUL Horner’s syndrome should make you think of…

A

carotid artery dissection

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24
Q

treatment for HOCM emergency?

A

B-blockers and CCBs

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25
Q

what is the treatment for lichen sclerosis?

A

topical steroids

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26
Q

treatment of prolapsed urethra

A

topical estrogen

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27
Q

treatment for tet spells

A

morphine (decreases pulmonary venous return, relaxes the infundibulum)
phenylephrine (increases SVR)
sodium bicarb (reduces acidosis)
beta-blockers (relaxes infundibular spasm, decreases inotropic effect)

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28
Q

treatment of HOCM?

what should you avoid?

A

beta-blockers
CCBs
avoid - diuretics and digoxin

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29
Q

Criteria for Acute Rheumatic Fever

A

Major: carditis, polyarthritis, chorea, erythema marginatum, subcutaneous nodules
Minor: fever, prolonged PR, elevated ESR/CRP/WBC, previous rheumatic fever, arthralgias
*Polyarthritis is the most frequently found major criteria
*Dx if 2 major or 1 major + 2 minor

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30
Q

med to rapidly inhibit release of thyroid hormone in pediatrics

A 
potassium iodide 
(PTU is contraindicated in kids; methimazole doesn't work acutely)
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31
Q

SIRS criteria

A 
T 38
tachypnea
tachycardia
WBC 12K
10% bands
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32
Q

Symptoms of autonomic dysfxn syndrome

A

tachycardia, tachypnea, diffuse diaphoresis, hyperthermia, hypertension, mydriasis, and dystonia

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33
Q

Treatment of autonomic dysfxn/sympathetic storm

A

bromocriptine, dantrolene, benzodiazepines, clonidine, and narcotics

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34
Q

A painful Horner’s syndrome should make you concerned about…

A

a carotid artery dissection

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35
Q

What are the components of Cushing’s triad?

What is the earliest and most sensitive indicator?

A

bradycardia, hypertension, irregular respirations

most sensitive/earliest: bradycardia

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36
Q

What are the impt landmarks for IJ venous access?

A

The medial approach uses the apex of the triangle formed by the sternal and clavicular heads of the SCM.
Best localized with mild hyperextension of the neck.

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37
Q

Location for a distal ulnar nerve block?

A

just proximal to the ulnar styloid process

38
Q

Nerve block achieved at: just proximal to the ulnar styloid process

A

ulnar nerve block

39
Q

Location for a distal median nerve block?

A

between the palmaris longus and flexor carpi radialis tendons

40
Q

Nerve block achieved at: between the palmaris longus and flexor carpi radialis tendons

A

median nerve block

41
Q

Reasons to refer a patient to a burn center (4)

A

1) partial thickness depth >10% if 20% BSA > 11 years)
2) full thickness depth > 2% BSA
3) high risk for disability or poor cosmetic outcome (e.g., hands, feet, face, circumferential burns and those overlying joints)
4) associated inhalation injury or trauma

42
Q

Parkland Formula

A 
4 x BSA x wt (kg)
Give half in first 8 hours
Give second half in subsequent 16 hours
Does NOT account for maintenance fluids
Should only include partial and full thickness burns in BSA calculation
Only apply if 15% BSA is involved
43
Q

Max dose of bupivicaine

A

2mg/kg without epi

3mg/kg with epi

44
Q

1% lidocaine is how many mg/ml

0.25% bupivicaine is…

A

10mg/ml

2.5mg/ml

45
Q

Things that can cause false positive guaiac stools

A

Horseradish
Turnips
Cherries
Tomatoes

46
Q

Things that can cause red stool that isn’t bloody

A 
cefdinir/omnicef
red food dye
licorice
blueberries
spinach
beets
bismuth
iron preparations
47
Q

Most common reason for child to have hypoglycemia?

What’s low/wrong?

A

ketotic hypoglycemia

low alanine stores in muscles

48
Q

Distinction between organic acidemias and urea cycles defects?

A

OA: elevated ammonia and acidotic
UC: VERY high ammonia (1000s) and usually NOT acidotic; low BUN, nml lactate, encephalopathy

49
Q

IEM associated with reducing substances in urine?

A

galactosemia

50
Q

Lab that is usually diagnostic for CAH

A

17-hydroxyprogesterone (17-OHP)

51
Q

IEM mimic of child abuse with macrocephaly, chronic subdural effusions?
How to diagnose?

A

glutaric acidemia type I
dx with urine organic acids
dx usually made during crises (intercurrent illnesses) with metabolic acidosis, hyperammonemia and encephalopathy.

52
Q

Management of Kawasaki when acute?

When convalescent?

A

Acute: IVIG, high dose ASA
Conv: low dose ASA (3-5mg/kg/day)

53
Q

Management of dry gangrene in scleroderma

A

tx with systemic or topical nitro; or CCBs

54
Q

How do you calculate sodium deficit?

A

Figure out the volume deficit

Na/1000 x 0.6 x volume deficit

55
Q

Labs in RTA type IV

A

hyperkalemic, hyperchloremic, metabolic acidosis with normal AG

56
Q

Winter’s Formula

A

PCO2 = 1.5 x HCO3 + 8 +/- 2

57
Q

Symptoms of scorpion sting

A

local pain, restlessness, hyperactivity, roving eye movements, and respiratory distress. More severe signs include seizures, drooling, wheezing, hyperthermia, cyanosis, GI hemorrhage, respiratory distress and death from shock or respiratory paralysis

58
Q

Envenomation associated with metallic taste

A

rattlesnake

59
Q

systemic symptoms of brown recluse spider bite

A

fever, chills, malaise, weakness, nausea, vomiting, joint pain, petechial morbilliform rash, intravascular hemolysis, hematuria, and renal failure

60
Q

fish that cause scombroid

A

tuna, mackerel, and bonito

61
Q

fish that cause ciguatera

A

barracuda, grouper, and snapper

62
Q

what do you need to avoid when treating a patient with ciguatera poisoning?

A

opioids - may interact with toxin and cause hypotension

63
Q

order of tissues with resistance to electricity

A

Bone > fat > tendon > skin > muscle > nerve.

64
Q

when should you consider active rewarming measures

A

cardiovascular instability, T < 32ºC, or inadequate response to passive re-warming methods

65
Q

how do you grade frostbite injuries?

A

1st degree- numbness and erythema with no tissue loss
2nd - superficial blistering, with clear to milky fluid, surrounded by edema and erythema
3rd - deeper blisters with blood containing fluid (leave blisters alone)
4th - affects muscle and bone.

66
Q

pressor of choice in heat stroke

A

dobutamine - maintains peripheral vasodilation

67
Q

in hypothermia, resuscitate to at least what temperature

A

The patient should be resuscitated until a body temperature of 32 – 34ºC

68
Q

Symptoms of lithium toxicity

A

coarse tremor, ataxia, dysarthria, vomiting, diarrhea, cardiovascular changes and renal dysfunction.
Later signs: impaired consciousness, muscle fasciculations, myoclonus, seizures, coma and death.

69
Q

Best med for an agitated (possibly delirious) child?

A 
haldol
NOT BDZs (could loosen inhibitions or worsen delirium)
70
Q

What are the different levels of sedation?

A

Minimal - respond normally to verbal commands and not asleep.
Moderate - does not need repeated painful stimulation to be aroused and should not require intervention to maintain a patent airway.
Deep sedation - patient cannot be easily aroused but respond purposefully after repeated verbal or painful stimulation; ability to independently maintain ventilatory function may be impaired.
General anesthesia is not arousable, even by painful stimulation.

71
Q

What are the ASA classifications?

A

I - normal, healthy patient
II - mild systemic illness without functional limitation
III - severe systemic disease with definite functional limitation.
IV - severe systemic disease that is a constant threat to life.
V - moribund patient who is not expected to survive without the procedure

72
Q

Epi dose for bradycardia in neonatal resuscitation

A

0.01 mg/kg of 1:10,000

73
Q

How do you determine ETT sizes in neonatal resuscitation?

A

2.5 = < 1000g, 3000g, >38wks

74
Q

How do you differentiate between main types of neonatal conjunctivitis?

A

Gonococcal - 3-5 days after birth.
Chlamydial - 5- 14 days after birth. Negative gram stain (obligate intracellular parasite)
Non-gonococcal, non-chlamydial bacterial - after the first 2 weeks of life.
Chemical(due to silver nitrate prophylaxis) - first day of life and resolves in 2-4 days.

75
Q

Symptoms of morning glory intoxication?

A

mydriasis, hyper or hypothermia, perspiration, bronchorrhea and increased salivation

76
Q

What’s the difference between:
boutonniere deformity
swan neck deformity
hammer/mallet finger

A

boutonniere - flexed PIP, extended DIP
swan neck - extended PIP, flexed DIP
hammer - flexed DIP due to rupture of extensor digitorum tendon

77
Q

Fruity odor, ingestion with no acidosis, but +osmolar gap?

A

isopropyl alcohol (odor is from acetone metabolic byproduct)

78
Q

How often do physically restrained patients need their restraints renewed according to JACHO?

A

< 9 years - every hour
9-17 years - every 2 hours
adults - every 4 hours.
Patients must be evaluated, face-to-face, by the physician ordering the restraints within 1 hour of placing the order.

79
Q

Findings in cardiac tamponade

A

Beck’s triad: hypotension, muffled heart sounds, and distended neck veins
Low QRS voltages in all leads
Electrical alternans in precordial leads

80
Q

What is the dose for naloxone?

A

0.1mg/kg

81
Q

x-ray findings in RPA

A

> 7mm at C2

>14mm at C6

82
Q

EKG findings in pericarditis

A

An ECG will demonstrate changes of epicardial inflammation with widespread ST elevation, PR depression, ST elevation in limb and precordial leads. The elevations are concave.

83
Q

treatment of malignant hyperthermia

A

dantrolene

84
Q

Treatment of labial adhesions?
Treatment of urethral prolapse?
Treatment of lichen sclerosis?

A

1st line: topical estrogen cream; 2nd line: topical steroids
topical estrogen
topical steroids

85
Q

medical treatment of phimosis

A

topical steroids

86
Q

epi dosing for anaphylaxis

A

1: 1000 epi
0. 01 mg/kg
0. 01 ml/kg

87
Q

epi dosing for codes

A

1: 10,000
0. 01 mg/kg
0. 1 mg/kg

88
Q

management of frenulum lacerations

A

expectant - do not suture as they heal spontaneously

89
Q

With regards to hemothorax, what amount of bloody output should trigger operative management?

A

Immediate return of 1500mL or 10-15ml/kg

>200ml/hr or 2-4ml/kg/hr of bloody drainage

90
Q

Immediate treatment of commotio cordis?

A

defibrillation

91
Q

What qualifies for a positive DPL?

A

free aspiration of gross blood, gastrointestinal contents, vegetable fibers or bile through the lavage catheter upon entering the abdominal cavity or the presence of ≥100,000 RBC/mm3, ≥500 WBC/mm3 or bacteria on Gram stain of the lavage fluid.

PEM Board Review (8 decks)

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