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Midterm Flashcards

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1
Q

When to get Well Child Checkups?

A

1 wk then 1, 2, 4, 6, 9, 12, 15, 18
24, 30 months
Every year from 3 to 21

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2
Q

When do you start charting BMI?

A

2 y/o

also start taking BP

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3
Q

What are the goals of WCC?

A 
1.Screening - anemia, vision, hearing, dental
Maybe TB, HIV, lead, inherited disorders
2. Mental health & risky behaviors
3. Immunizations
4. Anticipatory edu
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4
Q

What are the stages of development?

A
  1. Newborn
  2. Infancy 0-12mo
  3. Early childhood 1-4yrs
  4. Middle childhood 5-10yrs
  5. Adolescence 11-20yrs
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5
Q

At what age do you switch to ear temp?

A

> 2 mo.

<2 - rectal

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6
Q

What are the components of an APGAR score?

A
  1. Appearance
  2. Pulse
  3. Grimace
  4. Activity
  5. Respiration
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7
Q

When does the anterior fontanelle close?

A

4-26 mo

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8
Q

When does the posterior fontanelle close?

A

by 2 mo

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9
Q

Is S3 normal in infants?

A

Yes

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10
Q

When does the umbilical cord remnant fall off?

A

by 2 wks

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11
Q

What are the newborn reflexes?

A
  1. Palmar grasp
  2. Plantar grasp
  3. Moro reflex
  4. Asymmetric tonic neck reflex
    • Support reflex
  6. Anal reflex
    • Babinski
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12
Q

What are the infant reflexes?

A
  1. Triceps
  2. Brachioradialis
  3. Abdominal

Present starting at 6 mo

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13
Q

When do maxillary sinuses appear?

A

4 y/o

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14
Q

When should you start to give an infant food?

A

After 6 mo

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15
Q

What does the M-Chat look for?

A

Autism

Screen at 18 mo visit

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16
Q

What is the average birth weight & length?

A

3.2 kg

50 cm

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17
Q

How much does the average 1, 2 & 4 y/o weigh & length?

A

10kg 75 cm
12.5 85
15 100

After that they grow 5-6 cm/yr
Boys grow ~14 in & girls ~12 in at puberty

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18
Q

At what age would puberty be said to be delayed?

A

Girl >12

Boy >14

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19
Q

What is SCOFF?

A

Screening for eating disorders in adolescents

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20
Q

What is the Ballard score?

A

Way to estimate gestational age

Higher # = more maturity

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21
Q

What is IUGR & some causes?

A

Intrauterine growth restriction

Multiples, malnutrition, toxins, placental instability

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22
Q

What is a cause for LGA?

A

Gestational diabetes >90%

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23
Q

What are some causes of an absent red reflex?

A
  1. Cataracts (maybe due to infection)
  2. Retinoblastoma

Emergency - see ophthamologist

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24
Q

When do you see currant jelly stools?

A

when bowel dies from intussusception

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25
What is an Alvarado score?
likelihoood of appendicitis
26
At what age should you be concerned if a child hits puberty?
Girls <9
27
What is a normal respiratory rate in a kiddo?
30-40 Can be 60-80 during birth
28
Risk factors of hip dysplasia
1. Female 2. Breech 3. 1st born 4. FH
29
When should a baby lift his head?
2 mo
30
When should a baby pull himself up to stand?
8 mo
31
When should a baby start crawling?
7-9 mo
32
When should a newborn bring his hands together?
2 mo
33
What is Tanner staging?
Of sexual development
34
What are the screenings for infants?
1. Tay-Sachs 2. PKU 3. Hypothyroidism 4. Congenital adrenal hyperplasia 5. Galactosemia
35
What is failure to thrive?
Kid 2 or under w/ weight plotting below the 5& for age on more than 1 occasion or whose wt crosses 2 major percentiles downward on a standardized growth grid.
36
What is the sequence for examining newborns?
Perform less invasive maneuvers early & potentially distressing maneuvers near the end 1. Observation 2. Head, neck, heart, lungs, abdomen, GU 3. Lower extremities, back 4. Ears, mouth 5. Eyes 6. Skin 7. Neurologic system 8. Hips
37
Where are the best places to look for central cyanosis in kiddos?
Sign of congenital heart disease Tongue & oral mucosa
38
CV changes during pregnancy
1. Erythrocyte mass & plasma vol inc. 2. CO inc. 3. Systemic vascular resistance & pressure fall
39
MSK changes during pregnancy
From wt gain & relaxin 1. Lumbar lordosis 2. Ligamentous laxity in the SI joints & pubic symphysis
40
What is Chardwick's sign?
Blue cervix & vagina from inc. blood flow
41
How do you determine expected delivery date of a baby?
Naegele's rule Take 1st day of LMP, add 1 week, subtract 3 mo & add 1 year
42
How can you verify EDD & when?
1. Doptone - 10-12 wks 2. Fetoscope - 18 wks 3. Fetal mvmt - 18-24 wks 4. US
43
What is chronic HTN in a pregnant lady?
BP >140/>90 before 20 wks
44
What is gestational HTN?
BP >140/>90 after 20 wks
45
What is preeclampsia?
BP >140/>90 after 20 wks w/ protein in urine
46
What initial lab work should you do on a pregnant lady?
1. CBC 2. Blood typing 3. Hep panel 4. HIV 5. Syphilis 6. UA & culture 7. PAP smear 8. GC
47
What lab work should you do in pregnant ladies throughout their pregnancy?
1. UA for glucose & protein | 2. WBC
48
Health promotion for pregnancy
1. Nutrition 2. Wt gain 3. Exercise (30 min/day) 4. Smoking cessation, alcohol, drugs 5. Screen for domestic violence 6. Immunizations
49
When do you give RhoGAM?
to Rh - women at 28 wks & w/in 3 days of delivery
50
Which immunizations should pregnant ladies get?
1. Tetanus | 2. Flu (2&3rd trimesters)
51
What foods should pregnant people avoid?
1. Unpasteurized dairy products 2. Soft cheeses 3. Raw eggs 4. Delicatessen meats 5. Large amounts of Vit A 6. Sea-going fish
52
What is the 'sterile' color?
Blue
53
Where are gowns considered sterile?
In front from shoulder to waist level Sleeves from cuff to 2 in. above elbow
54
How far away must nonsterile people be from a sterile field?
12 inches
55
What are the types of Noninvasive Positive Pressure Ventilation? (NPPV)
1. High Flow Nasal Cannula (HFNC) 2. Continuous Positive Airway Pressure (CPAP) 3. Bilevel Positive Airway Pressure (BiPAP)
56
Contraindications to NPPV
1. Impaired level of consciousness 2. Respiratory arrest/apnea 3. Cardiac arrest 4. Acute MI 5. Inability to protect airway 6. Excessive secretions 7. Vomiting 8. Upper airway obstruction 9. Facial trauma 10. Burns involving face/airway
57
ADRs NPPV
1. Dec. myocardial perfusion 2. Barotrauma 3. Pneumothorax/pneumomediastinum 4. Aspiration 5. Anxiety 6. Nosocomial infections 7. Iatrogenic respiratory alkalosis
58
What is a big disadvantage to high flow nasal cannulas?
Difficult to measure & regulate the end-expiratory pressure | Higher risk of ADRs
59
How does CPAP effect L sided heart failure?
dec. preload & afterload
60
Indications for mechanical ventilation
1. Acute respiratory failure 2. Apnea 3. Impending respiratory failure 4. Inability to oxygenate or ventilate using NPPV 5. OD, head/spinal cord injury, anaphylaxis, infectious process needing airway
61
Settings for ventilation
1. Tidal volume (Vt) 2. Respiratory Rate (RR) 3. FiO2 - % of oxygen 4. PEEP
62
CMV
Continuous Mandatory Ventilation Machine does all breathing Know exact ventilation
63
AC
Assist control Machine makes breaths but Pt can make machine breaths too Risk of hyperventilation, air trapping, inc. intrathoracic pressure
64
SIMV
Synchronized Intermittent Mandatory Ventilation Machine makes breaths but Pt can make own breaths
65
PSV
Pressure Support Ventilation Machine gives extra push to Pt breaths
66
Indications for LVAD
1. Chronic end stage heart failure if at risk of death from cardiogenic shock 2. LV EF <14 4. Stage IV HF for 60 days 5. Stage III for 28 days & either intra-aortic balloon pump support for 14 days or 2 failed attempts to wean inotropes
67
Who is not eligible for heart transplant?
1. >65 2. Diabetes w/ end organ damage 3. Chronic renal failure (Cr >2.5) 4. Comorbidites that predict poor long term survival (CA, CVA, COPD) 5. Social History
68
Indications of NG tube
1. Aspirate & ID stomach contents 2. Differentiate upper/lower GI bleed 3. Remove air, blood, ingested substances & gastric contents 4. Provide nutritional support
69
Contraindications of NG tubes
1. Esophageal stricture or alkali ingestion 2. Recent surgery on esophagus/stomach 3. Gastrectomy/bariatric surgery 4. Severe coagulopathy 5. Facial trauma/basilar Fx
70
Complications of NG tubes
1. Trauma - bleeding 2. Place tube into trachea/lung 3. Gastric hemorrhage 4. Aspiration PNA 5. Sinusitis
71
How might you check NG tube position?
1. Inject air while auscultating LUQ 2. Aspirate contents & Check pH (<3) 3. Xray - Gold Standard
72
Indications for Central line
1. Central venous pressure monitoring 2. Rapid volume resuscitation 3. No peripheral IV sites 4. Routine serial blood draws 5. Infusion of hyperalimentation & other solns 6. Placement of pulmonary artery catheter, transvenous pacemaker, performance of cardiac cath, hemodialysis
73
Indications for subclavian central line
1. Useful in trauma - cervical collar not in way 2. Preferred during CPR 3. L subclavian has direct route to SVC so preferred for pacemaker placement & CVP monitoring
74
Indications for internal jugular central line
1. Useful during CPR 2. Arterial punctures easy to control 3. R IJ has direct route to SVC
75
Indications for femoral central line
1. More simpler anatomy & superficial 2. Emergency cardiopulm bypass for resusciation 3. Charcoal hemoperfusion in OD 4. Dialysis access Higher rates of infection
76
Contraindications of central lines
1. Local cellulitis 2. Distorted anatomy or landmarks 3. Morbid obesity 4. Combativeness 5. Suspected proximal vascular injury 6. Bleeding disorders 7. Anticoag/thrombolytic therapy 8. Previous radiation therapy
77
Which side should you put a subclavian central line if there is trauma on one side?
Same side as trauma - risk of pneumo
78
What side should you do a central line if you had other failed attempts?
SAME side
79
Complications of IO access
1. Cellulitis 2. Osteomyelitis 3. Iatrogenic Fx of physeal plate injury in kids 4. Fat embolism
80
Contraindications of IO access
1. Proximal Fx 2. Ipsilateral vascular injury 3. Severe osteoporosis
81
What bones can you use for IO access?
1. Proximal tibia 2. Medial mallelous 3. Distal femur 4. Sternum 5. Humerus 6. Ileum
82
What are the ester anesthetics?
1. Benzocaine (Anbesol) 2. Cocaine 3. Novocaine (Procaine) 4. Tetracaine All pretty fast acting & short duration
83
What are the amide anesthetics?
1. Lidocaine (Xylocaine) 2. Mepivacaine (Carbocaine) 3. Bupivacaine (Marcaine) 4. Dibucaine (Nupercaine) 5. Prilocaine (EMLA)
84
Max dose of lidocaine w/ & w/o epi?
1% 4.5mg/kg w/ epi - 7 mg/kg
85
Max dose of Bupivacaine w/ & w/o epi?
0.25% 2 mg/kg w/ epi - 3.5 mg/kg
86
Order of effect from anesthetics?
1. Temp 2. Sensation 3. Pain 4. Touch 5. Deep pressure 6. Motor
87
Where do you inject local anesthetics?
junction of dermis & hypodermis where nerves are transversing
88
Which types of anesthetics are more likely to have liver/renal potency?
Esters also more likely to have allergies
89
Which anesthetic is NOT a vasodilator?
Cocaine
90
Where should you avoid using epi w/ anesthetics?
Fingers, toes, nose & hoes | penis, scrotum
91
Which drug do you worry about methemoglobinemia with?
EMLA in babies <1y/o
92
Contraindications to epi?
1. UnTx hyperthyroidis 2. Pheocromocytoma 3. Appendages 4. CAD
93
Tx anaphylaxis?
1. Epi 2. Benadryl 3. Corticosteroids Always observe for late reactions
94
What are alternatives to anesthesia?
1. Benadryl 2. Normal saline 3. Conscious sedation 4. Topical Gauber's cold spray
95
Where is viscous lidocaine used?
Mucous membranes
96
How do you make a Benadryl solution for anesthesia?
Benadryl 5% 1 mL + 4 mL normal saline
97
Wound cleansing materials?
1. Gauze 2. Chlorhexidine 3. Isopropyl alcohol 4. Iodine solution
98
What do you use for digital blocks & indications?
1% Lidocaine + 1% Carbocaine 1. Procedures on distal to midproximal phalanx 2. Nail avulsion 3. Paronychial 4. Finger lacerations
99
What way do nerves heal?
Wallerian degeneration
100
Goals of wound closures?
1. Dec. time to healing 2. Reduce infection likelihood 3. Dec. scarring 4. Repair the loss of structure & function 5. Cosmetic improvements
101
Contraindications to wound closure
1. Open >8h 2. FB 3. Extensive wounds w/ neurovascular compromise
102
Steps of wound healing
1. Hemostasis 2. Inflammation 3. Proliferation 4. Remodeling
103
Wound closure classifications
Primary intention - all layers closed, least scarring, done on clean/clean-contaminated wounds Secondary - Deep layers closed & outer close on own Delayed primary closure - Deep layers close the reassess on 4th day & close if no infection
104
What are the tetanus prone wounds?
1. Old wounds 2. Deeper 3. Avulsion injury 4. Devitalized tissue 5. Contaminated 6. Gunshot 7. Crush wounds 8. Burn 9. Frostbite 10. Corneal abrasions
105
S/S tetanus
1. Trismus 2. Nuchal rigidity 3. Dysphagia 4. Severe spasms 5. Opsithotonus 6. Resp. failure 7. Death
106
Rules for tetanus immunizations
Tetanus prone wound - current vaccines - update if >5yrs Non-tetanus prone - Vaccinate if >10yrs Tetanus prone & unknown - update & give TIG
107
What kind of stitch is good for old farts?
Horizontal mattress stitch
108
When should you write antibiotics when suturing?
1. Old wounds >12h 2. Bites 3. Crush wounds 4. Contaminated wounds 5. Wounds involving avascular areas 6. Open Fx or deep wounds beyond fascia 7. Severe paronychia or felons 8. Pts w/ valvular heart disease 9. Immunocompromised
109
Indications for LP
1. Meningitis 2. Subarachnoid hemorrhage 3. Tx pseudotumor cerebri 4. CNS syphilis 5. Unexplained seizures 6. Administration of meds 7. Suspected demyelinating/inflammatory CNS process 8. CNS CA
110
Contraindications to LP
1. Inc. ICP 2. Local infection 3. Coagulation disorder
111
Who gets postdural puncture HAs?
After LP Lay supine CSF leak at puncture site Better w/ smaller needle/noncutting needle Tx - blood patch, caffeine
112
Complications of LP
1. Postdural puncture HA 2. Herniation 3. Nerve damage 4. Infection 5. Bleeding 6. Epidermoid tumor 7. Backache & radicular Sx 8. Needle breakage
113
How fast is CSF produced?
0.35 mL/min
114
Where does the spinal cord terminate in infants & adults?
A - L1 I - L3
115
Complications of thoracentesis
1. Pneumothorax 2. Cough 3. Infection 4. Hemothorax, splenic or hepatic injury, abdominal hemorrhage, air embolism, unilat pulm edema
116
Where do you inject for thoracentesis?
1-2 ICS below highest level of effusion in midscapular/posterior axillary line Not lower than btwn 8&9th ribs Scapula comes down to 7th rib
117
Indications of tube thoracostomy
1. Pneumothorax 2. Hemothorax 3. Empyema
118
Complications of tube thoracostomy
1. Infection 2. Laceration of intercostal vessel 3. Laceration of lung 4. Intra-abdominal or solid organ placement 5. SQ emphysema 6. Tube dislodgement/incorrect placement
119
Where do you stab for tension pneumothorax?
2nd ICS midclavicular
120
Insertion site for tube thoracostomy?
Mid to anterior axillary line in 4th/5th ICS Incision site should be lateral to the edge of the pectoralis major & breast tissue
121
When do you remove a chest tube?
Should be removed w/in 1 wk for infections 1. Improvement in resp status 2. Drainage <200mL in 24h 3. Change from bloody drainage to minimal output of serous drainage 4. No bubbling/fluctuation seen in water seal chamber during expiration/cough
122
When should you use US guidance w/ paracentesis?
1. Adhesions 2. Bowel obstruction 3. 2/3rd trimester of pregnancy
123
Site of entry for paracentesis
Best is based on prior paracentesis OR 2cm below belly button Either lower quadrant, 4-5cm cephalad & medial to ant. sup. iliac spine
124
Indications of pericardiocentesis
1. Pericardial effusion | 2. Tamponade
125
Where to stab for pericardiocentesis?
Btwn xiphoid process & L costal margin at 30-45 degree angle to the skin Aim at L shoulder

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