Board Review Flashcards
(201 cards)
1
Q
uncuffed/cuffed pediatric ett size
A
age/4+4
age/4+3.5
2
Q
foreign body aspiration in <1 year old tx
A
back blows and chest thrusts
3
Q
premature infants ett size
A
2.5-3.0 mm
4
Q
newborns ett size
A
3-3.5 mm
5
Q
needle cricothyrotomy time till crash
A
30-45 minutes
6
Q
age when you can do surgical cric
A
greater than 8
7
Q
medication associated with pill esophagitis
A
doxycyline
8
Q
neonate hr
A
100-160
9
Q
1-12 month hr
A
100-180
10
Q
1-2 yo hr
A
90-150
11
Q
2-4 year old hr
A
75-130
12
Q
4-8 yo hr
A
60-120
13
Q
> 8 year old hr
A
60-100
14
Q
normal sbp >1 yo
A
70+2*age
15
Q
1 month to 1 yo BP min normal
A
70
16
Q
<1 month old bp min normal
A
60
17
Q
what children get compressions
A
hr <60 and signs of poor perfusipn despite 100% O2
18
Q
what neonates get compressions
A
hr <100 despite 100% o2 for 30 secs
19
Q
pediatric compression depth
A
1/3 chest depth
20
Q
newborns rate of compressiond and breaths
A
90 compressions, 30 breaths per minute
21
Q
compression ventation ratio for 2 person cpr for children beyond newborns through 8
A
15:2, 100 per minute
22
Q
ratio for compressions to breaths for one person cpr
A
30:2
23
Q
defibrillation in peds for arrest dose
A
initial 2-4 joules/kg, then 4 joules/kg, then increase up to 10 joules/kg
24
Q
first thing if unrepsonsive with shockable rhythm
A
initiate cpr, then shock, resume cpr immediately 2 minutes before checking pulse. administer epinephrine before subsequent attempts
25
cardioversion dose in peds
0.5-1 joule/kg, can go up to 24 joules/kg
26
medications that can be given intratracheally
LEAN
| lidocaine, epinephrine, atropine, naloxone
27
intratracheal epinephrine dose
0.1 mg/kg (10x normal dose)
28
dose for non epi intratracheal meds
2-3x IV dose
29
how to give meds intratracheally
folled by 5 cc saline and several positive pressure ventilations
30
window for access to umbilical vein
up to 7 days post delivery
31
severe acidosis treatment in peds arrest
sodium bicarb 1 meq/kg (use 1 meq/ml 8.4 percent in kids, dilute to half in neonates) only after epi nt effective and good oxygenation and ventilation
32
peds calcium chloride dose in severe hyperkalemia arrest
calciun chloride 20 mg/kg ideally through central line or IO
33
hypoglycemia arrest treatment peds
1 g/kg of glucose
>2 year old 1-2 ml/kg d50
2 months to 2 yo 2-4 ml/kg of d25
<2 months 5-10 ml/kg of d10
34
naloxone arrest peds dose
0.1 mg/kg IV, up to 2 mg, use with caution since can cause life threatening withdrawal
35
arrest epinephrine peds dosing
0.01 mg/kg 1:10,000 IV, max 1 mg
0.1 mg/kg 1:1,000 via ET, max 2.5 mg
repeat every 3-5 minutes
36
epinephrine drip peds dosing, arrest, persisent bradycardia
0.1-1 mcg/kg/min IV
37
first line vs second line in peds brady arrythmias
epinepnrine first line
| atropine if increased vagal tone or primary AV block suspected
38
atropine peds dose
0.02 mg/kg IV, max of 0.5 mg in childen, 1 mg in adolescents. may repeat once. can be given every 20-30 minutes in anticholinergic toxidrome
39
adenosine pediatric dose
0.1 mg/kg, max 6 mg, if fail 0.2 mg/kg max 12
40
vtach unstable treatment with pulse
synchronized cardioversion 0.5-1 joules/kg, if unsuccessful 2 joules/kg
amiodarone 5 mg/kg IV over 20-60 minutes or procainamide 15 mg/kg IV over 30-60 minutes
41
vtach/vfib treatment without pulses
defibrillatation 2-4 joules/kg, if fails 4 j/kg up to 10 j/kg up to max adult dose
epinephrine
consider amiodarone 5 mg/kg iv, lidocaine 1 mg/kg IV
42
how to use apgar
assign at 1 and 5 minutes, if 5 minute less then 7, attain additional scores
43
apgar categorie scoring
0, 1, 2
activity - limp, decreased flexion, good flexion
pulse - absent, <100, >100
grimace - none, some motion, cry
appearance - blue/pale, body pink/ext blue, pink
respirations - absent, slow/irregular, good/crying
44
initial antiepileptic treatment order in neonates
phenobarbital 15-20 mg/kg iv over 10 minutes, addtional 5 mg/kg every 5 min up to max 40 mg/kg
then phenytoin 20 mg/kg iv
then benzos
give pyridoxine if refractory
45
congential diaphragmatic hernia treatment
immediate intubation, place og tube, ivf, surgery
46
tracheoesophageal fistula treatmenr
reverse trendelenberg, place suction catheter in edophageal pouch, surgery
47
omphalmocele and gastroschisis treatment
keep child warm, place og tube, cover intestines with sterule saline soaked gauze and place in plastic bag, IVF, antibiotics, surgery
48
onset of NEC usually in
first 2 weeks of life
49
NEC risk factors
hypertonic feeding solutions, pda, apneia, infection, exchange transfusions
50
NEC on radiograohy
pneumatosid intestinalis, separation of bowel loops, air fluid levels, portal vein gas, pneumoperitoneum, fixed dilated loop that doesnt move on serial radiograohs
51
cyanosis in newborn patholigic if persists beyond how long
20 minutes
52
cyanosis in newborn test
if 100 percent oxygen fails to bring pa02 over 100, then methemoglobinemia or cyanotic heart condition. otherwise sepsis, cns, lung problem if it does bring it up.
53
o2 sat in newborns if only extremities blue
>94%
54
how long for physiologic jaundoce to resolve
1-2 weeks
55
treatment for Tet slell from tetrology of Fallot
place child in prone knee to chest, give o2, morphine. if fails consider propanolol, pheylephrine and peds consult
56
inspiratory stridor in peds means
obstruction at or above larynx
57
biphasic stridor in peds means
obstructuon below larynx
58
expiratory stridor means
bronchial or lowert tracheal obstruction
59
lung appearance with inhaled foreign body
hyperinflated on side with shift away from side with foreign body
60
croup usually caused by
parainfluenza
61
treatment for croup
racemic epi if resting stridor or resp distress
steroids
heliox of racemic epi fails
62
how does tracheitis present in peds
several days of coup symptoms then more ill, fevers, toxic
63
tracheitis tx
ent consult for visualization, antibiotics
64
rpa age of typical onset
6 months to 6 years, peak 3-5
65
bronchiolitis usually caused by
rsv
66
<4 week old pneumonia treatment
ampicillin and gentamicin or ampicillin and cefotaxime
67
infants 1-3 month pneumonia treatment
ampicillin and third gen cephalosporin, add a macrolide if chlamydia trachomatis or bordetella pertussis is suspected
68
pneumonia treatment 3 months to 5 years
second or third gen cephlosporin, add macrolide if chlamdyia or mycoplasma suspected
69
At what age can you consider outpatient pneumonia treatment
older than 3 months
70
CXR and lab values consistent with pertsusis
WBC 20,000-50,000 and CXR with peribronchial thickening or a "shaggy" heart border
71
Who should be hospitalized for pertussis?
children <6 months, children with hypoxia, cyanosis during coughing spells or apnea
72
prophylaxis for whooping cougn
erythromycin 10-14 days
73
what pediatrix population should get US for UTI
all males, females under 5 years, all recurrent
74
kawasaki treatment
IV immunoglobulin
| oral aspirim
75
febrile seizure age group
6 months to 5 years
76
ativan dose for pedatric seizure
lorazepam 0.1 mg/kg IV
77
midgut volvulus demo
usually under 1 year, most common in 1st month
78
midgut volvulus on xray
small bowel overlying liver, gaseous distention, air fluid levels
79
intussception demo
males 3 mo to 5 years, most common 6-12 months
80
intussception on xray
abdominal mass or filling defect in RUQ, bowel obstruction, free air
81
pylotic stenosis demo
males, 2-6 weeks old
82
electrolyte findings with pyloric stenosis
hypochloremic, hypokalemic metabolic alkalosis
83
nornal pr interval
0.12-0.20 seconds
84
normal qrz
0.06-0.1 seconds
85
vfib in hypothermic patient protocol
defribillate up to 3 times, if unsuccessful, rewarm to 30 c (86 f) and try again
try magnesium, can spontaneously convert
86
warm and dead temp
35 c (95 f)
87
digitalis toxicity cardiologic effects
av blocks, bradydysrhytmias
88
treatment of hyperkalrmia with digoxin toxicity
FAB, do not give calcium
89
tachydysrhytmia treatment with digoxin toxicity
phenytoin and lidocaine are drugs of choice
magnesium useful in suppression
avoid cardioversion except as last resort and use lowest energy level
dont use breytlium, procainamide or isoproterenol
90
treatment of symptomatic bradycardia with digoxin toxicity
atropine, then pacing if fails external preferred, while waiting for FAB to work
91
who should get fab with digoxin toxicity
vemtricular dysrhythmias, symptomatic bradycardia unresponsive to atropine, hyperkalemia, large doses, coingestion of cardiotoxic agents, plants with dysrthymia ingestion
92
Classical presentation of MAT from
theophylline toxicitt for COPD
93
type of MI causing bradycardia
inferior wall
94
medication treatment for symptomatic bradycardia
atropine 0.5 - 1 mg every 5 minutes
95
when should you be cautious with atropine and symptomatic bradycardia
acute MI, mobitz II and 3rd degree heart block
96
medication for symptomatic bradycardia if atropine fails and pacing not available
dopamine then epineprine
97
treatment for unstable svt
cardioversion, start at 50 joules
98
stable vtach treatment
procainamide or amiodarone
99
unstable vtach treatment
synchronized cardioversion
100
atrial fibrilation shock treatment
synchronized cardioversion starting at 120 joules
101
shocking for atrial flutter
synchronized cardioversiom starting at 50 joules
102
synptomatic MAT after treating underlying cause fails, then
dilt/verapamil
| magnesium
103
treatment for jumctional rhythm
underlying rhythm, unless precipitating dangerous rhythms then procainamide
104
chemical conversion for afib meds
amiodarone, procainamide, ibutilide, flecainide, propafenone
105
treatment for symptomatic pvcs when treating cause fails
lidocaine or procainamide if lidocaine contraindicated, betablockers, mangnesium, dont treat if from ischemia
106
how do you treat symptomatic escape pvs associsted with bradycardia
atropine
107
pulseless vtach shock regimen
defrillation at 200 joules
108
hemodynamically unstable vtach treatment with pulse
synchronized cardioversion at 100 joules
109
monomorphic stable vtach med treatment
procainamide, amiodarone, sotalol
110
torsades treatment unstable or sustained
direct cardioversion (unsynchronized), starting at 200 joules, then start magnesium
111
stable torsades treatment
magnesium, if fails, overdrive pacing
112
vfib shock treatment
begin at max joules 360 monophasic defibrilator, 200 for biphasic defibrillator
113
symptomatic mobitz I treatment
atropine, if fails then pacing
114
mobitz type II associated with MI of
anteroseptal region affecting infranodal conduction system
115
mobitz type II tx
pacing (no atropine!)
116
mobitz type I associated with MI of
inferior wall
117
third degree heart block associated with MI of
anterior wall for wide complex
inferior wall for narrow complex
118
3rd degree heart block tx
narrow complex -atropine, if fails pacemaker
wide complex - pacemaker, epi/dopa as bridge
119
wpw treatment
narrow complex - same as SVT
wide complex - unstable - cardioversion, stable - procainamide or amiodarone
with afib/flutter - cardioversion if unstable, if stable - procainamide
120
signs of pacemaker failure
slowing of rate means battery failure, urgent replacement if 10 percent or more
vtach is runaway pacemaker and can be battery depletion or circuitry malfunction
121
treatment for runaway pacemaker
use magnet, if fails and unstable externalize and cut wires
122
when do you get posterior ekg
depression in v1, v2, v3
123
when to get right sided ekg
elevation in II, III, aVf
| isolated st elevation in V1 or V1 and V2
124
non pci hospatal transfer time
<120 minutes
125
goal in pci hospital stemi
90 minutes field contact to baloon
126
thrombolytics goal if non pci hospital
30 minutes
127
years until failure of mechanical versus bioprosthetic valve
20 years vs 10 years
128
mycobacterus avium intracellulare presentation
AIDS patient with lung disease and pancytopenia
129
mycobacteriun avium intracellulare treatment
macrolide plus ethambutol plus rifampin. add aminoglycoside if severe disease, surgery for local nodule
130
skin infection for fish/aquarium handlerd and treatment
mycobacterium marinum
clarithromycin plus ethambutol or rifampin
surgery if deep tissue
131
mycobacteria ulcerans tx
wide excision of ulcers, treat small lesions with rifampin + clarithromycin + streptomycin infections
132
mycobacteria kansaii tx
rifampin + isoniazid + pyodoxine + ethambutol
133
TB infection tx
isoniazid + rifampin + pyraxinamide + ethambutol for 9 months
134
isoniazid complications
neuropathy, increases lfts
135
rifampin complications
fluids orange
136
etgambutol complications
optic neuritis, red green failure to differentiate
137
cryptococcus tx
fluconaxole oral if mild, otherwise amphotericin b
138
histopladmosis region
ohio and mississippi river valleys
139
histoplasmosis tx
long term itraconazole, amphotericin b
140
toxoplasmosis tx
pyrimethamine
141
vector for malaria
fenale anopheles mosquito
142
test needed for malaria
thick and thin blood smears for ring forms plis giemsa or wright stain
143
malaria tx
chloroquine possibly plus doxycycline
144
hantavirus vector
aerodolized rodent excretions
145
pcp tx
bactrim
steroids if pao2 < 70 or aa gradient > 35
second line is inhaled pentamidine
146
roseola classic presentation
6 mo to 2 years sudden high fever, resolves, then rash on trunk spreads to head neck, not pruritic
147
measles (rubeola) classic presentation
cough, coryza, conjunctivits, rash on head spreads downward, turns brown
148
rubella presentation
rash on face, spreads to trunk and limbs in viral syndrome
149
blepharitis common cause
staph/strep chronic infx
150
blepharitis tx
lid scrub with baby shampoo, topical antibiotics
151
blepharitis looks like
eyelid swelling with dandruff
152
what is hordeolum
acute painful nodule of blocked gland of lid margin
153
usual cause of Hordeolum
staph
154
hordeolum tx
warm compresses, antibiotic ointment, i&d if refractory
155
what is a chalazion
chronic internal granulomatous reaction of meibomian glands
| chronic stye thats nontender
156
chalazion tx
warm compresses - refer to ophtomology for excision
157
subconjunctival hemorrgae tx
cold compress
158
what is dacryocystitis
inflammation of tear duct caused by staph
159
dacrocystitis tx
warm compresses, oral antibiotics
160
ice rink sign on flourescin indicates
eyelid foreign body
161
what is hypopyon
inflammatory condition of anteriot chamber causing layering of white blood cells at bottom
162
tx for acute angle glaucoma
acetazolamide, beta blocker topical (timolol) pilocarpine,
163
presentation of optic neuritis
sudden reduced vision, specifically color vision, pain with eye movement
164
causes of optic neuritis
MS, methanol, ethambutol, SLE, syphilis, lyme, herpes, zoster
165
central retinal artery occlusion presentation
sudden, painless, unilateral vision loss
166
CRAO exam
arteriolar narrowing, cherry red spot
167
central retinal vein occlusion presentation
sudden, painless, unilateral vision loss
168
crvo on exam
artetiolar narrowing, blood and thunder retina with dilated veins, hemmorages, edema
169
crao tx
lowet IOP with acetazolamide, maybr hyperbarics...
170
tx for 8 ball hyphema
surgery
171
labyrinthitis presentation
severe acute vertigo, hearing loss, tinnitus
| post viral symdrome or otitis
172
menieres disease presentation
progressive hearing loss, tinnitus with vertigo, possibly with recurrent attacks
173
menieres tx
diurectics and salt restriction
| surgery if severe
174
acoustic neuroma presentation
vertigo, hearing loss, ataxia, tinnitus refractory to symptomatic management
175
what is cholesteoma
epidermal cyst of middle ear
176
cholesteoma presentation
hearing loss, otorrhea, tinnitus, vertigo, facial nerve sx
177
cholesteoma tx
surgery referral
178
what is cavernous sinus thrombosis
blood clot with usually associated infection of csvernous sinus
179
presentation of cavernous sinus thrombosis
fever, ill appearing, edema of face/eyelids, proptosis, chemosis, cn palsies
180
location of most nose bleeds
anterior - kiesselbachs plexus
181
posterior nose bleed from what source
sphenopalatine artery
182
when ct for sinusitus
resistanf to tx or immunocompromised
183
apthous ulcer tx
topical steroid, mouth rinse, benzocaine gel
184
herpangina caused by
coxsackie virus
185
herpangina presentation
fever, sore throat with painful ulcers of mouth, sparing buccal mucosa, gingiva and tongue
186
acute necrotizing ulcerative gingivitis treatment
meteonidazole or clindamycin
187
causes of acute necrotizing ulcerative gingavitis
phenytoin toxicity, acute leukemia, hiv
188
dry socket tx
pain meds, irrigate, pack with gauze, abx
189
tx for mandible dislocation
posterior and inferior pressure
190
massive hemoptysis definition
600 cc in 24 hours
191
how many cc blood to fill tracheobronchial tree
150-300cc
192
massive hemoptysis, which side down
bleeding side to avoid spilling over
193
medications that turn you blue
```
silver toxicity (agyri), and amiodarone
dapsone and pyridium from methemoglobonemia
```
194
role of lateral decubitis cxr in foreign body inhalation
dependent lung should look smaller, if same size or larger, suspect obstruction
195
unusual causes of left sided pleural effusion
boerhaves syndrome
| aortic dissection type B
196
asthma arrest from intubated obstructive shock tx
disconnext vent, squeeze chest, bilatersl chest tubes, IV fluids
197
definition of ARDS
pulmonary edema without heart failure, pao2 < 60 with fio2>0.5
198
tx of ards
permissive hypercapnia, low volumes 4-6 cc/kg
199
bacullis anthracis presentation
eschar, possibly gi, possibly pneumonia
200
bacillus anthacis tx
pennicilin or doxycycline
201
yersinia pestis presentation
bubos then lungs, necrosis of dista extremities
