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Flashcards in ICU/ER Deck (68):
1

What are 3 features of Cushings triad and what diagnosis does this point to?

Bradycardia
HTN
Irregular respirations
*increased intracranial pressure

2

What is the goal for blood pressure reduction in a patient with acute hypertensive crisis?

Reduce by 25% during the first 8 hrs and then slowly over the next 48 hours

3

What is the hypermetabolic state that leads to metabolic acidosis, hyperthermia and cardiac arrhythmia after administration of general anesthesia ?

Malignant hyperthermia

4

What symptoms would lead you to expect malignant hyperthermia (7 answers)?

Tachypnea
Fever
Muscle rigidity
Increased CO2 production
Cardiac arrhythmia
Elevated CK
Myoglobinuria

5

What is the treatment for malignant hyperthermia ? (3 answers)

Hyperventilation
Oxygen
Dantrolene

6

What diagnosis should you consider in a patient with fine reticular infiltrate on CXR after near drowning who presents with difficulty breathing a few hours later? What is the ultimate cause of mortality ?

Acute respiratory distress syndrome - multi organ failure

7

What are 7 common causes of ARDS ?

Drowning
Pneumonia
Aspiration
Lung contusion
Smoke inhalation
Transfusion
Sepsis

8

What diagnosis should you consider in a patient who presents with vomiting, muscle aches and labs showing low glucose, low sodium and high potassium?

Adrenal insufficiency

9

What diagnosis presents with electrolyte disturbances associated with adrenal insufficiency as well as candidiasis?

Autoimmune polyendocrinopathy

10

What diagnosis should you consider in a patient with hyponatremia, hyperkalemia and hypoglycemia who also had an elevated ADH level ?

Adrenal insufficiency (can have elevated ADH levels )

11

What diagnosis should you consider in a patient who presents with new onset afebrile seizure after recently being at a water park ? What 6 other conditions could be associated with this diagnosis?

Water intoxication / electrolyte abnormalities - feeding with dilute formula, malnutrition, excessive water intake, hypotonic IVF, glucocorticoid deficiency or hypothyroidism

12

What is the most appropriate first step in a patient with flail chest and respiratory distress?

Place chest tube

13

What is the key element of respiratory support in a patient with ARDS ?

PEEP

14

What is the correct imaging to order when presented with blunt abdominal trauma?

Abdominal CT with contrast

15

What is the best initial IV therapy for an infant in heart failure ?

Furosemide

16

A child is presented after sudden collapse and syncope. There is a family hx of sudden death and epilepsy. What is the most likely test to confirm the diagnosis?

EKG - prolonged QT

17

What medication should be given to an infant in heart failure with aortic stenosis ? Why?

Prostaglandin E1 (maintain open ductus arteriosis)

18

What is the most appropriate initial treatment for SVT?

Adenosine

19

What is the definition of pulsus paradoxus?

Decreased systolic BP during inspiration

20

What tests can be done to document the absence of vertebral and carotid artery blood flow in a patient with brain death?

Radio nucleotide scan
Angiography

21

What is the most important lab finding in a patient with impending liver failure ?

Elevated serum ammonia

22

What is the difference in urine osmolality when trying to diagnose pre-renal vs renal azotemia?

Pre-renal : increased urine osmolality (>350)
Renal : low urine osmolality (<350)

23

What is the fractional excretion of sodium in a patient with pre-renal azotemia? And in renal azotemia?

Prerenal: <1%
Renal: >1%

24

What is the ratio of compressions to breaths when performing CPR on an infant?

With 2 rescuers - 15:2
With 1 rescuer - 30:2

25

What is the rate of compressions per minute when performing CPR on an infant?

100 compressions per minute

26

What is the appropriate ventilation rate after establishment of an airway during CPR in an infant ?

8-10 breaths per minute

27

When should chest compressions be discontinued during infant CPR ?

HR > 60 and good perfusion

28

How do you determine the size of the ET tube when establishing an airway?

Childs age + 16 divided by 4

29

What is the first thing you should do when presented with a child who has ingested an unknown substance and is unresponsive ?

Establish an airway

30

How do you calculate tidal volume in a patient on a ventilator ?

7mL/kg

31

What 4 meds can be given via ET tube?

Lidocaine
Atropine
Narcan
Epinephrine

32

Which 5 y/o child is MOST in need of fever reducers...one with febrile seizures, encephalitis or CHF ?

CHF (reduce oxygen demand)

33

What are 6 types of wounds that require prophylactic antibiotics ?

Dirty wounds
Dog/human bites
Crush injury
Cartilage injury
Cuticle injury
Immunocompromised pt

34

What are the 3 common signs of a systemic reaction following bee sting?

Hypotension
Wheezing
Laryngeal edema

35

What is the appropriate treatment if a patient presents after spider bite which causes a painful target lesion within hours ? What is the likely spider ?

Supportive care / brown recluse

36

What is the appropriate treatment for a patient who presents with muscle cramping and HTN after spider bite? What is the likely spider ?

Benzodiazepines and calcium gluconate for cramping
Anti hypertensives
Narcotics
*black widow (antivenom is only used if supportive measures fail)

37

What should you do if a patient was bit by a snake with a round head without fangs or a rattle ?

Wound cleaning and tetanus (if needed)

38

What should you do if a patient is bit by a snake with a triangular head and fangs?

Stabilization of ABCs
Immobilize limb and let it hang by patients side

39

What type of stripe indicates a coral snake?

Red and yellow racing stripes

40

What should you do if you see a wound with fang marks, redness and swelling ?

ABCs, immobilize limb by patients side

41

When should you apply a tourniquet and ice to a snake bite?

Never

42

What are the 4 symptoms associated with external warming in a patient with hypothermia ?

Peripheral vasodilation
Decreased BP
Acid base imbalance
Arrhythmias

43

What are 5 most common animal transmitters of rabies?

Foxes
Bats
Raccoons
Skunks
Ferrets

44

What is the appropriate treatment for s child with contact with a bat but no known bite reported ??

Treat with human rabies IG and 5 doses of rabies vaccine !!

45

What is first line treatment for status epilepticus?

Phenytoin 20mg/kg

46

What is the appropriate vasopressin medication for a patient in septic shock?

Norepinephrine

47

What is the appropriate vasopressor for cardiogenic shock?

Dobutamine

48

What diagnosis should you consider in a patient who deteriorates hours after head trauma? What is the appropriate treatment?

Epidural hematoma - neurosurgery

49

What is the most common hematoma found in shaken baby syndrome? What electrolyte disturbance can be associated with this finding?

Subdural hematoma - siadh

50

What is the probable diagnosis in an infant with tachypnea, diminished pulses, hepatomegaly and gallop rhythm?

Cardiogenic shock

51

What are the points given for eye opening when determine a Glasgow coma scale?

No response - 1
Response to pain - 2
Response to voice - 3
Spontaneous eye opening - 4

52

What are the points given for verbal responses when determining the Glasgow coma scale?

No response - 1
Incomprehensible - 2
Inappropriate words - 3
Disoriented - 4
Conversational - 5

53

What are the points given for motor response when assessing the Glasgow coma scale?

No response - 1
Decerebrate posture - 2
Decorticate posture - 3
Withdraws to pain - 4
Localizes pain - 5
Obeys commands - 6

54

What is the appropriate treatment for swelling of the nasal septum after trauma ?

ENT consult for drainage (prevent saddle nose deformity)

55

What diagnosis should you consider in a 3 month old patient with swelling of the face, cortical thickening of the long and flat bones and fever?

Caffey disease (infantile cortical hyperostosis)

56

What is the best next step in a patient with clear rhinorrhea, bruising of the ear and periorbital bruising?

CT brain to rule out basilar skull fracture

57

What type of fracture is associated with bleeding from the ear and facial paralysis ?

Temporal bone fracture

58

You are presented with a patient with acute elbow injury, decreased grip strength and decreased radial pulse. XRay shows posterior fat pad. are these physical findings the result of direct vascular injury or transient neurological deficit?

Transient neurological deficit due to compression of radial artery. Will resolve with reduction of the fracture

59

What should you consider in a patient with medial clavicle fracture with anterior displacement ?

Consider displacement of trachea or mediastinal structures - immobilize shoulder

60

A teenager sustains shoulder injury and has pain over the distal clavicle with superiority located point tenderness. He cannot raise arm and X-ray is negative for fracture ? What is the likely injury?

Acromioclavicular separation (more common than fractures in skeletally mature patients)

61

What is the first step for treatment of minor burns?

Debridement and irrigation
Gentle cleansing with soap and water

62

What is the estimate percentage of each area (arm, leg, trunk, head) when calculating total body surface following a burn in a child older than 9 years old?

Arm - 9% each
Leg - 18% each
Trunk - 18% back + 18% chest
Head - 10%

63

What is the most common cause of wound infection following a puncture through a shoe?

Staph and strep (pseudomonas should be considered if resistant to treatment)

64

What should you do for a 6 y/o African American girl with vaginal bleeding and red round mass protruding from the vagina?

Warm sitz baths and follow up with urologist

65

What diagnosis should you consider in a patient with headache, vomiting, high fever and altered mental status as well as a rash that progresses from papules to vesicles to pustules and then scabs over?

Small pox (variola)

66

How is small pox diagnosed ? How would you treat?

Pharyngeal swab or culture of lesions

Cidofovir

67

How can you distinguish varicella from small pox?

In small pox, lesions are all in the same stage of evolution/healing

68

What should you suspect and how would you treat a patient with unilateral pupil dilation?

Uncal hernia room/oculomotor nerve compression
Osmotic agents