Midterm Reverse Flashcards
(125 cards)
1
Q
1 wk then 1, 2, 4, 6, 9, 12, 15, 1824, 30 monthsEvery year from 3 to 21
A
When to get Well Child Checkups?
2
Q
2 y/oalso start taking BP
A
When do you start charting BMI?
3
Q
1.Screening - anemia, vision, hearing, dentalMaybe TB, HIV, lead, inherited disorders2. Mental health & risky behaviors3. Immunizations4. Anticipatory edu
A
What are the goals of WCC?
4
Q
- Newborn2. Infancy 0-12mo3. Early childhood 1-4yrs4. Middle childhood 5-10yrs5. Adolescence 11-20yrs
A
What are the stages of development?
5
Q
> 2 mo. <2 - rectal
A
At what age do you switch to ear temp?
6
Q
- Appearance2. Pulse3. Grimace4. Activity5. Respiration
A
What are the components of an APGAR score?
7
Q
4-26 mo
A
When does the anterior fontanelle close?
8
Q
by 2 mo
A
When does the posterior fontanelle close?
9
Q
Yes
A
Is S3 normal in infants?
10
Q
by 2 wks
A
When does the umbilical cord remnant fall off?
11
Q
- Palmar grasp2. Plantar grasp3. Moro reflex4. Asymmetric tonic neck reflex5. + Support reflex6. Anal reflex7. + Babinski
A
What are the newborn reflexes?
12
Q
- Triceps2. Brachioradialis3. Abdominal Present starting at 6 mo
A
What are the infant reflexes?
13
Q
4 y/o
A
When do maxillary sinuses appear?
14
Q
After 6 mo
A
When should you start to give an infant food?
15
Q
Autism Screen at 18 mo visit
A
What does the M-Chat look for?
16
Q
3.2 kg50 cm
A
What is the average birth weight & length?
17
Q
10kg 75 cm12.5 8515 100After that they grow 5-6 cm/yrBoys grow ~14 in & girls ~12 in at puberty
A
How much does the average 1, 2 & 4 y/o weigh & length?
18
Q
Girl >12 Boy >14
A
At what age would puberty be said to be delayed?
19
Q
Screening for eating disorders in adolescents
A
What is SCOFF?
20
Q
Way to estimate gestational ageHigher # = more maturity
A
What is the Ballard score?
21
Q
Intrauterine growth restrictionMultiples, malnutrition, toxins, placental instability
A
What is IUGR & some causes?
22
Q
Gestational diabetes >90%
A
What is a cause for LGA?
23
Q
- Cataracts (maybe due to infection)2. Retinoblastoma Emergency - see ophthamologist
A
What are some causes of an absent red reflex?
24
Q
when bowel dies from intussusception
A
When do you see currant jelly stools?
25
likelihoood of appendicitis
What is an Alvarado score?
26
Girls <9
At what age should you be concerned if a child hits puberty?
27
30-40Can be 60-80 during birth
What is a normal respiratory rate in a kiddo?
28
1. Female2. Breech3. 1st born 4. FH
Risk factors of hip dysplasia
29
2 mo
When should a baby lift his head?
30
8 mo
When should a baby pull himself up to stand?
31
7-9 mo
When should a baby start crawling?
32
2 mo
When should a newborn bring his hands together?
33
Of sexual development
What is Tanner staging?
34
1. Tay-Sachs2. PKU3. Hypothyroidism4. Congenital adrenal hyperplasia5. Galactosemia
What are the screenings for infants?
35
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.
What is failure to thrive?
36
Perform less invasive maneuvers early & potentially distressing maneuvers near the end 1. Observation2. Head, neck, heart, lungs, abdomen, GU3. Lower extremities, back4. Ears, mouth5. Eyes6. Skin7. Neurologic system8. Hips
What is the sequence for examining newborns?
37
Sign of congenital heart diseaseTongue & oral mucosa
Where are the best places to look for central cyanosis in kiddos?
38
1. Erythrocyte mass & plasma vol inc. 2. CO inc. 3. Systemic vascular resistance & pressure fall
CV changes during pregnancy
39
From wt gain & relaxin1. Lumbar lordosis2. Ligamentous laxity in the SI joints & pubic symphysis
MSK changes during pregnancy
40
Blue cervix & vagina from inc. blood flow
What is Chardwick's sign?
41
Naegele's ruleTake 1st day of LMP, add 1 week, subtract 3 mo & add 1 year
How do you determine expected delivery date of a baby?
42
1. Doptone - 10-12 wks2. Fetoscope - 18 wks3. Fetal mvmt - 18-24 wks4. US
How can you verify EDD & when?
43
BP >140/>90 before 20 wks
What is chronic HTN in a pregnant lady?
44
BP >140/>90 after 20 wks
What is gestational HTN?
45
BP >140/>90 after 20 wks w/ protein in urine
What is preeclampsia?
46
1. CBC2. Blood typing3. Hep panel4. HIV5. Syphilis6. UA & culture7. PAP smear8. GC
What initial lab work should you do on a pregnant lady?
47
1. UA for glucose & protein2. WBC
What lab work should you do in pregnant ladies throughout their pregnancy?
48
1. Nutrition2. Wt gain3. Exercise (30 min/day)4. Smoking cessation, alcohol, drugs5. Screen for domestic violence6. Immunizations
Health promotion for pregnancy
49
to Rh - women at 28 wks & w/in 3 days of delivery
When do you give RhoGAM?
50
1. Tetanus2. Flu (2&3rd trimesters)
Which immunizations should pregnant ladies get?
51
1. Unpasteurized dairy products2. Soft cheeses3. Raw eggs4. Delicatessen meats5. Large amounts of Vit A6. Sea-going fish
What foods should pregnant people avoid?
52
Blue
What is the 'sterile' color?
53
In front from shoulder to waist levelSleeves from cuff to 2 in. above elbow
Where are gowns considered sterile?
54
12 inches
How far away must nonsterile people be from a sterile field?
55
1. High Flow Nasal Cannula (HFNC)2. Continuous Positive Airway Pressure (CPAP)3. Bilevel Positive Airway Pressure (BiPAP)
What are the types of Noninvasive Positive Pressure Ventilation? (NPPV)
56
1. Impaired level of consciousness2. Respiratory arrest/apnea3. Cardiac arrest4. Acute MI5. Inability to protect airway6. Excessive secretions7. Vomiting8. Upper airway obstruction9. Facial trauma10. Burns involving face/airway
Contraindications to NPPV
57
1. Dec. myocardial perfusion2. Barotrauma3. Pneumothorax/pneumomediastinum4. Aspiration5. Anxiety6. Nosocomial infections7. Iatrogenic respiratory alkalosis
ADRs NPPV
58
Difficult to measure & regulate the end-expiratory pressureHigher risk of ADRs
What is a big disadvantage to high flow nasal cannulas?
59
dec. preload & afterload
How does CPAP effect L sided heart failure?
60
1. Acute respiratory failure2. Apnea3. Impending respiratory failure4. Inability to oxygenate or ventilate using NPPV5. OD, head/spinal cord injury, anaphylaxis, infectious process needing airway
Indications for mechanical ventilation
61
1. Tidal volume (Vt)2. Respiratory Rate (RR) 3. FiO2 - % of oxygen4. PEEP
Settings for ventilation
62
Continuous Mandatory Ventilation Machine does all breathing Know exact ventilation
CMV
63
Assist controlMachine makes breaths but Pt can make machine breaths too Risk of hyperventilation, air trapping, inc. intrathoracic pressure
AC
64
Synchronized Intermittent Mandatory Ventilation Machine makes breaths but Pt can make own breaths
SIMV
65
Pressure Support Ventilation Machine gives extra push to Pt breaths
PSV
66
1. Chronic end stage heart failure if at risk of death from cardiogenic shock2. LV EF
Indications for LVAD
67
1. >652. Diabetes w/ end organ damage3. Chronic renal failure (Cr >2.5)4. Comorbidites that predict poor long term survival (CA, CVA, COPD)5. Social History
Who is not eligible for heart transplant?
68
1. Aspirate & ID stomach contents2. Differentiate upper/lower GI bleed 3. Remove air, blood, ingested substances & gastric contents4. Provide nutritional support
Indications of NG tube
69
1. Esophageal stricture or alkali ingestion2. Recent surgery on esophagus/stomach3. Gastrectomy/bariatric surgery4. Severe coagulopathy5. Facial trauma/basilar Fx
Contraindications of NG tubes
70
1. Trauma - bleeding2. Place tube into trachea/lung3. Gastric hemorrhage4. Aspiration PNA5. Sinusitis
Complications of NG tubes
71
1. Inject air while auscultating LUQ2. Aspirate contents & Check pH (<3)3. Xray - Gold Standard
How might you check NG tube position?
72
1. Central venous pressure monitoring2. Rapid volume resuscitation3. No peripheral IV sites4. Routine serial blood draws5. Infusion of hyperalimentation & other solns6. Placement of pulmonary artery catheter, transvenous pacemaker, performance of cardiac cath, hemodialysis
Indications for Central line
73
1. Useful in trauma - cervical collar not in way2. Preferred during CPR3. L subclavian has direct route to SVC so preferred for pacemaker placement & CVP monitoring
Indications for subclavian central line
74
1. Useful during CPR2. Arterial punctures easy to control3. R IJ has direct route to SVC
Indications for internal jugular central line
75
1. More simpler anatomy & superficial2. Emergency cardiopulm bypass for resusciation3. Charcoal hemoperfusion in OD4. Dialysis accessHigher rates of infection
Indications for femoral central line
76
1. Local cellulitis 2. Distorted anatomy or landmarks3. Morbid obesity4. Combativeness5. Suspected proximal vascular injury6. Bleeding disorders7. Anticoag/thrombolytic therapy8. Previous radiation therapy
Contraindications of central lines
77
Same side as trauma - risk of pneumo
Which side should you put a subclavian central line if there is trauma on one side?
78
SAME side
What side should you do a central line if you had other failed attempts?
79
1. Cellulitis2. Osteomyelitis3. Iatrogenic Fx of physeal plate injury in kids4. Fat embolism
Complications of IO access
80
1. Proximal Fx2. Ipsilateral vascular injury3. Severe osteoporosis
Contraindications of IO access
81
1. Proximal tibia2. Medial mallelous3. Distal femur4. Sternum5. Humerus6. Ileum
What bones can you use for IO access?
82
1. Benzocaine (Anbesol)2. Cocaine3. Novocaine (Procaine) 4. TetracaineAll pretty fast acting & short duration
What are the ester anesthetics?
83
1. Lidocaine (Xylocaine)2. Mepivacaine (Carbocaine)3. Bupivacaine (Marcaine)4. Dibucaine (Nupercaine)5. Prilocaine (EMLA)
What are the amide anesthetics?
84
1% 4.5mg/kgw/ epi - 7 mg/kg
Max dose of lidocaine w/ & w/o epi?
85
0.25%2 mg/kgw/ epi - 3.5 mg/kg
Max dose of Bupivacaine w/ & w/o epi?
86
1. Temp2. Sensation3. Pain4. Touch5. Deep pressure6. Motor
Order of effect from anesthetics?
87
junction of dermis & hypodermiswhere nerves are transversing
Where do you inject local anesthetics?
88
Estersalso more likely to have allergies
Which types of anesthetics are more likely to have liver/renal potency?
89
Cocaine
Which anesthetic is NOT a vasodilator?
90
Fingers, toes, nose & hoes(penis, scrotum)
Where should you avoid using epi w/ anesthetics?
91
EMLA in babies <1y/o
Which drug do you worry about methemoglobinemia with?
92
1. UnTx hyperthyroidis2. Pheocromocytoma3. Appendages4. CAD
Contraindications to epi?
93
1. Epi2. Benadryl3. CorticosteroidsAlways observe for late reactions
Tx anaphylaxis?
94
1. Benadryl2. Normal saline3. Conscious sedation4. Topical Gauber's cold spray
What are alternatives to anesthesia?
95
Mucous membranes
Where is viscous lidocaine used?
96
Benadryl 5% 1 mL + 4 mL normal saline
How do you make a Benadryl solution for anesthesia?
97
1. Gauze2. Chlorhexidine3. Isopropyl alcohol4. Iodine solution
Wound cleansing materials?
98
1% Lidocaine + 1% Carbocaine1. Procedures on distal to midproximal phalanx2. Nail avulsion3. Paronychial4. Finger lacerations
What do you use for digital blocks & indications?
99
Wallerian degeneration
What way do nerves heal?
100
1. Dec. time to healing2. Reduce infection likelihood3. Dec. scarring4. Repair the loss of structure & function5. Cosmetic improvements
Goals of wound closures?
101
1. Open >8h2. FB3. Extensive wounds w/ neurovascular compromise
Contraindications to wound closure
102
1. Hemostasis2. Inflammation3. Proliferation4. Remodeling
Steps of wound healing
103
Primary intention - all layers closed, least scarring, done on clean/clean-contaminated woundsSecondary - Deep layers closed & outer close on ownDelayed primary closure - Deep layers close the reassess on 4th day & close if no infection
Wound closure classifications
104
1. Old wounds2. Deeper3. Avulsion injury4. Devitalized tissue5. Contaminated6. Gunshot7. Crush wounds8. Burn9. Frostbite10. Corneal abrasions
What are the tetanus prone wounds?
105
1. Trismus2. Nuchal rigidity3. Dysphagia4. Severe spasms5. Opsithotonus6. Resp. failure7. Death
S/S tetanus
106
Tetanus prone wound - current vaccines - update if >5yrsNon-tetanus prone - Vaccinate if >10yrs Tetanus prone & unknown - update & give TIG
Rules for tetanus immunizations
107
Horizontal mattress stitch
What kind of stitch is good for old farts?
108
1. Old wounds >12h2. Bites3. Crush wounds4. Contaminated wounds5. Wounds involving avascular areas6. Open Fx or deep wounds beyond fascia7. Severe paronychia or felons8. Pts w/ valvular heart disease9. Immunocompromised
When should you write antibiotics when suturing?
109
1. Meningitis2. Subarachnoid hemorrhage3. Tx pseudotumor cerebri4. CNS syphilis5. Unexplained seizures6. Administration of meds7. Suspected demyelinating/inflammatory CNS process8. CNS CA
Indications for LP
110
1. Inc. ICP2. Local infection3. Coagulation disorder
Contraindications to LP
111
After LPLay supine CSF leak at puncture site Better w/ smaller needle/noncutting needleTx - blood patch, caffeine
Who gets postdural puncture HAs?
112
1. Postdural puncture HA2. Herniation3. Nerve damage4. Infection5. Bleeding6. Epidermoid tumor7. Backache & radicular Sx8. Needle breakage
Complications of LP
113
0.35 mL/min
How fast is CSF produced?
114
A - L1I - L3
Where does the spinal cord terminate in infants & adults?
115
1. Pneumothorax2. Cough3. Infection4. Hemothorax, splenic or hepatic injury, abdominal hemorrhage, air embolism, unilat pulm edema
Complications of thoracentesis
116
1-2 ICS below highest level of effusion in midscapular/posterior axillary lineNot lower than btwn 8&9th ribsScapula comes down to 7th rib
Where do you inject for thoracentesis?
117
1. Pneumothorax2. Hemothorax3. Empyema
Indications of tube thoracostomy
118
1. Infection2. Laceration of intercostal vessel3. Laceration of lung4. Intra-abdominal or solid organ placement5. SQ emphysema6. Tube dislodgement/incorrect placement
Complications of tube thoracostomy
119
2nd ICS midclavicular
Where do you stab for tension pneumothorax?
120
Mid to anterior axillary line in 4th/5th ICS Incision site should be lateral to the edge of the pectoralis major & breast tissue
Insertion site for tube thoracostomy?
121
Should be removed w/in 1 wk for infections1. Improvement in resp status2. Drainage
When do you remove a chest tube?
122
1. Adhesions2. Bowel obstruction3. 2/3rd trimester of pregnancy
When should you use US guidance w/ paracentesis?
123
Best is based on prior paracentesisOR2cm below belly buttonEither lower quadrant, 4-5cm cephalad & medial to ant. sup. iliac spine
Site of entry for paracentesis
124
1. Pericardial effusion2. Tamponade
Indications of pericardiocentesis
125
Btwn xiphoid process & L costal margin at 30-45 degree angle to the skinAim at L shoulder
Where to stab for pericardiocentesis?
