Gen ER Flashcards Preview

PEM > Gen ER > Flashcards

Flashcards in Gen ER Deck (71):
1

What are three categories of stridor and at least three causes in each?

1) Supraglottic
(epiglottitis, peri/retro-pharyngeal abscess, adenotonsillar hypertrophy, craniofacial abN)

2) Glottic
(laryngomalacia, laryngospasm, VC paresis/paralysis/dysfunction, VC nodule/mass)

3) Subglottic
(laryngotracheobronchitis, anaphylaxis, bacterial tracheitis, subglottic stenosis, subglottic web, subglottic hemangioma, tracheomalacia)

2

What are the two categories of causes of epistaxis?
List five in each

LOCAL
- trauma
- inflammation (URTI, staph)
- congenital syphilis
- foreign body
- allergic rhinitis
- telangiectasia (Osler-W-R)
- juvenile angiofibroma
- nasopharyngeal lymphoepithelioma
- rhinitis sicca

SYSTEMIC
- hematologic (platelet or hemophilias ie ITP, leuk, aplastic anemia, vWD, DIC, vitK, ASA, VPA, NSAIDs)
- hypertension (arterial, superior vena cava syndrome, CF)
- vicarious menstruation

3

How to manage epistaxis?

- pressure, lean forward
consider:
- dental roll under front gums
- gauze soaked with epi 1:1000
- nasal packing, tampons
- cautery with silver nitrate stick

home therapies:
humidifier
petroleum jelly
consider antibiotic ointment
consider nasal decongestants

4

For nasal cauterization, name the indications, contraindications (2) and complications (3) of the procedure.

indications: failure to control bleed with pressure and topical vasoconstrictor

contraindications: bleeding diathesis (hemophilia, ITP) or previous cauterization within 6 weeks

complications: septal perforation, staining of the upper lip or nares, bacterial superinfection or the cauterized area

*refrain from cauterizing both sides of the nasal septum

5

For nasal packing, name indications and complications of the procedure.

indications: bleeding that cannot be controlled with pressure and topical vasoconstrictor, with a contraindication to or failure of cauterization

complications:
1) bacterial rhinosinusitis
2) toxic shock syndrome
3) nasal alar or columnar necrosis
4) septal ulceration or perforation
5) synechiae formation
6) hypoxemia or resp distress from nasal obstruction

6

Name the components of the GCS score

Eyes Verbal Motor

Eyes
4-open spontaneously
3-closed and open with voice
2-close and open with pain
1-closed

Verbal
5- coherent
4- confused
3- garbled
2- moans
1- nil

Motor
6- command
5- localizes
4- withdraws
3- decorticate
2- decerebrate
1- flaccid

7

Describe AVPU method of assessing level of consciousness

Alert
Voice
Painful
Unresponsive

8

Name the components of the pediatric trauma score and describe its relevance in practice

Size
Airway
Systolic blood pressure
Central nervous system
Skeletal
Cutaneous

The PTS emphasizes the importance of patient size and ability to maintain the airway. Studies have confirmed its use as a predictor of outcome: 9% mortality for PTS >8, 100% mortality for PTS <0 and a directly linear correlation between 0-8.

9

Name physical exam findings that would suggest a difficult airway

- small mouth
- inability to open the mouth
- TMJ abnormalities
- narrow receding mandible
- protuberant maxillae
- large tongue
- distance <6cm between mandible and thyroid prominence
- inability to place in the sniffing position
- short, full or bull necks
- neck mass
- significant penetrating trauma to face or neck

10

Describe ECG changes seen with hypothermia with a core temperature <32C

-marked sinus bradycardia
-1st degree AV block
-Osborn or J waves
-Ass' w/ long QT

11

Describe changes seen in hypothermia with temperatures:
31-32C
28-31C
<28

31-32C: normal vitals, loss of shivering
28-31C: decreased HR and BP, afib, dilated pupils
<28C: absent pulse and BP, Vfic, coma, fixed pupils

12

Name 5 management pearls of hypothermia resuscitation

Warm fluids to 43C
Correct hypoglycemia
Watch for coagulopathy
If VF defib no more than three times until temp >30C
Drugs rarely effective until T>30C

13

What are the stages of frostbite

-initial stinging
-cold, pale, decreased sensation
-blotchy and painful areas

14

Describe features of heat stroke

core temp >41C
dry, hot, ashen skin
ARF
rhabdo
headache, disorientation -> coma, weakness, gait disturbance

15

Describe features of heat exhaustion (or water depletion)

T <40C
lethargy
nausea, vomiting
heaadches
BP, incr HR

16

Name good and poor prognostic features with regards to submersion injury prognosis

Good:
ROSC <10 minutes
Submersion <5 minutes
PERL, NSR at scene

Poor:
Delayed CPR
ROSC >25 minutes
Submersion >10 minutes

17

Describe features of high voltage injuries

tetany *can prevent grip release, arching
muscle damage -> compartment syndrome -> rhabdo
CNS injury
VF / cardiac arrest
Monitor heart, urinanalysis

18

What are the features of a brown recluse spider bite?

local pain -> central blister -> subcutaneous discoloration ->ulcer
systemic reactions develop in small children: fever, n&v, joint pain, hematuria
treat with analgesia and local care, excision and grafting if severe

19

What snakes do you have to worry about in Canada?

Massasauga and Western rattlesnake

20

Name indications for admission in anorexia nervosa (8)

systolic <90
HR<45 bpm (some <40 bpm)
orthostatic changes of 30 bpm
systolic 20 mmHg
temp <35.5C
75% of goal weight
support and comorbidity
failure of outpatient

21

What is the management of neonatal mastitis?

Treat as a potentially severe infection in infants <2 months of age with septic work-up (use low risk criteria to determine LP or not in >1 month), IV antibiotics and admit.

22

What inborn error of metabolism should you suspect if there is hypoglycemia, hyperammonemia and metabolic acidosis?

What if there are urine ketones as well?

Fatty acid oxidation disorder

Organic aciduria

23

What inborn error of metabolism should you suspect with neonatal hypoglycemia and lactic acidosis?

Glycogen storage disease

24

What inborn error of metabolism should you suspect with very high serum ammonia?

Urea cycle defect

25

What are BRUE low risk criteria?

- age >60 days
- born at >/= 32wks and CGA >/=45wks
- no CPR by trained medical professional
- event lasted <1 minute
- first event

26

What investigations may you consider in a low-risk BRUE patient?

ECG
pertussis
brief monitoring with continuous O2 and rechecks

27

What is an oral ranula and how do you treat?

A ranula is a mucus extravasation cyst involving a sublingual gland and is a type of mucocele found on the floor of the mouth.

Self resolve in 3-6 weeks

28

What are risk factors for SCFE?

obesity
steroid use
Down's syndrome
endocrinopathy
osteodystrophy

29

What are the P's of compartment syndrome?

pain out of proportion to PE findings
passive stretch exacerbation
paresthesias
point discrimination loss
paresis
pallor
pulselessness

30

Name medications which may cause methhemoglobinemia?

dapsone
benzocaine
sodium nitrate
sulfonamides
quinones
well water
phenozopiridine

31

How does macrophage activation syndrome or reactive hemophagocytic lymphohistiocytosis present and who is at risk?

Presentation with fever, HSM, rash and liver dysfunction.
- cytopenias >2 cell lines
- hypertriglyceridemia
- hypofibrinogenemia
- elevated ferritin

Varios auto-immune disorders are at risk

32

What is the most specific test for SLE?

dsDNA

33

Which populations is ARF most common in?

Fiji, Tonga, India, Pakistan, Turkey, Mozambique

34

Dermatomyositis is complicated by what deficiencies?

complicated by velopalatine muscle weakness
- cough, nasal voice, difficulty handling secretions
- PTX, ILD, GI hemorrhage & perf, soft tissue calcinosis

35

How does juvenile dermatomyositis present?

5-10yoM with proximal muscle weakness
photosensitive rash involving nasolabial folds
Gottron papules
lab abnormalities (aldolase, AST, ALT, LDH, CPK)

36

What should you suspect with high fever, salmon rash, leukocytosis, anemia and thrombocytosis?

JIA

37

If a Kawasaki patient is on aspirin therapy and you suspect that they have the flu, what should you do?

Don't stop treatment! Start tamiflu!

38

Name three possible treatments for hereditary angioedema? What to send to confirm?

icabitant
ecallantide
recombinant C-1 inhibitor

send serum complement factor 4
C1 inhibitor level

39

What to consider in a patient with fever, urticaria and arthritis?

Serum sickness!
1-2 weeks post offending agent
type III hypersensitivity reaction, immune-complex mediated

40

What is the classic presentation of DRESS?

2-6 weeks post medication (antiseizure)
morbilliform rash -> exfoliative -> fever, liver, LADN, edema, mucosal involvement in 50%

41

What is the mode of inheritance and classic presentation of Wiskott Aldrich?
What is most lethal?

eczema, thrombocytopenia, recurrent infections
x-linked
susceptibility to infxns with S. pneumo, N. meningitides, H. influenza
bleeding risk is deadly! ICH, massive GI

42

What is the risk of anaphylaxis with Ceftriaxone in a penicillin-allergic patient?

<1%

43

How can you manage an accidental epipen auto-injection?

-observation
-soaking in warm water
-topical nitroglycerin
-phentolamine injection (reversible alpha agonist)

44

What inborn error of metabolism presents with intermittent encephalopathy, ataxia, confusion, coma and hyperammonemia?

Ornithine transcarbamylase deficiency, a urea cycle defect
x-linked dominant
female heterozygotes have a milder episode presentation exacerbated by a high protein diet and stress

45

A failure to thrive baby with jaundice and an E. coli UTI should be suspected of what condition?

galactosemia!
lethargy, poor feeding, FTT, hypoglycemia, eventually direct hyperbilirubinemia
galactose deposition in liver = HSM, eyes = cataracts, heart = MR

46

An 18mo presents with hypoglycemia in the context of a gastrointestinal illness, no ketones are present in their urine. What diagnosis should you suspect? How to confirm?`

MCAD (AR)
order urine organic acids and acylcarnitine profile

47

What to suspect with lethargy, vomiting, seizures, acidosis, hyperammonemia and ketones?

Maple syrup urine disease
aka methylmalonic acidemia = organic aciduria

48

What is the best way to confirm the appropriate location of an IUD?

pelvic ultrasound
then AXR
then CT / MRI

49

What is the presentation of a septic abortion?
How to manage?

abdominal pain
foul-smelling discharge
chills or fever
(can be seen post-misoprostol)

Rx Genta & Clinda, U/S +/- D&C

50

If a subdermal implant is suspected to have been broken, what is the best way to evaluate it?

Ultrasound

51

If a young girl presents with painful vaginal ulcers in the context of diarrhea, what should you suspect?

shigella vaginitis
culture to rule-out sexual abuse
treat with azithro

52

How do you treat phimosis? labial adhesion?

phimosis: reassurance mostly, topical steroids
labial adhesions: topical estrogen

53

What testing should you consider for abnormal uterine bleeding?
Management?

CBC & iron studies
STI testing
pregnancy
trauma
TSH, testo, LH, FSH
vWF
head imaging if neuro findings, galactorrhea

Consider TXA, monophasic combined OCP BID x 7 days

54

How do you manage a urethral prolapse?

confirm with catheter if doubt
surgery if necrosed
otherwise topical estrogen cream and sitz baths

55

What are the diagnostic criteria for bacterial vaginosis and treatment options?

3/4 of
1) homogeneous, thin, grayish-white discharge adherent to vaginal walls
2) vaginal pH >4.5
3) positive whiff test after KOH prep
4) >20% clue cells on wet prep

treat with Metronidazole or Clinda

56

What is a grape-like mass near the vaginal introitus?

rule-out sarcoma botryoides

57

Name causes of vaginal bleeding in a premenarchal girl

- nonhormonal: trauma, tumour, urethral prolapse, infectious vaginitis, intravaginal foreign body, genital warts
- hormonal: neonatal bleeding, exogenous estrogen, precocious puberty

58

Name causes of vaginal bleeding in a post-menarchal girl

menses
hormonal contraception
endometritis
dysfunctional uterine bleeding
bleeding diathesis
complications of pregnancy

59

With a chemical injury to the eye, when do you stop irrigating?

stop irrigating when the pH of the affected eye is comparable to the unaffected eye (a little while after finishing, normal is 6.5-7.5, otherwise pH 5.5 = NS)
20 minutes minimum or 2L of fluid
sedate if they won't cooperate!

60

What is Brown-Sequard syndrome?

a hemisection of the spinal cord:

ipsilateral loss of motor, proprioception, vibratory sensation
contralateral loss of pain and temperature

61

What is central cord syndrome?

bilateral motor paresis, upper > lower, distal > proximal

62

What is anterior cord syndrome?

paralysis below the level with loss of pain and temp

63

What is posterior cord syndrome?

loss of proprioception and vibration

64

What are the four types of hypersensitivity reactions and how are they mediated?

1: anaphylaxis, IgE
2: cytotoxic, IgG/IgM binds to host cell
3: immune complex, IgG with soluble antigen
4: cell mediated, T-cells

65

What elements of the CATCH CT head rule suggest a CT scan is indicated?

GCS <15 2hrs after injury
Suspected open or depressed skull fracture
Worsening headache
Irritability
Basal skull fracture
Boggy scalp hematoma
Dangerous mechanism (>3ft, MVC, bike without helmet)

66

What are the PECARN indications to absolutely do a non-contrast head CT?

GCS =14
Altered mental status
Palpable skull fracture <2
Signs of basilar skull fracture >2

67

What are the PECARN indications to consider doing a head CT vs observation?

<2:
Non-frontal scalp hematoma
LOC ≥ 5 seconds
Severe injury mechanism
head struck by high-impact object
Abnormal activity per parents

>2-18:
History of vomiting^
LOC
Severe injury mechanism
Head struck by high-impact object
Severe headache

68

For air transport considerations, what two laws do you need to take into account and what do they imply clinically?

Boyle's law: as pressure decreases, volume increases
significant considerations for pneumothoraces
Dalton's law: at higher altitudes, the concentration of gas decreases
hypoxia increases at higher altitudes

69

With the following WBC counts following knee aspiration, what is your suspected diagnosis?
<2000
2-50,000
>50,000

<2,000 non-inflammatory (PMN <25%)
2-50,000 inflammatory (PMN 50%)
>50,000 infectious (PMN >75%)

70

What are the 5 layers of the scalp?

SCALP
Skin
Dense Connective Tissue
Epicranial Aponeurosis
Loose Areolar Connective Tissue
Periosteum

71

What are the three reportable STIs in Canada?

chlamydia
gonorrhea
syphilis