Misc PEM Q Book Flashcards Preview

PEM Board Review > Misc PEM Q Book > Flashcards

Flashcards in Misc PEM Q Book Deck (91):
1

lab abnormality in hereditary angioedema

low C4

2

reasons to use VariZig

only for post-exposure ppx, but NOT once there is varicella infection

3

lab abnormalities in strep glomerulonephritis

low C3, nml C4.
if levels are normal, consider something else

4

non-ketotic hypoglycemia with metabolic acidosis should make you think of...

fatty acid oxidation disorder

5

classic lab findings in fatty acid oxidation disorder

non-ketotic hypoglycemia

6

anion gap formula

AG = Na - Cl - HCO3

7

calculated osmolarity

= 2 x Na + glucose/18 + BUN/2.8

8

Multi-casualty vs mass casualty event

multi-casualty = 5+ victims
mass casualty = strains the existing EMS system

9

what's unique about the sterile pyuria of Kawasaki disease?

it is lymphocyte predominant

10

What can different levels of responders do:
first responders?
EMT-B?
EMT-I?
EMT-P?

1st responders: airway clearance, control blood loss, AED, CPR
EMT-B: assessment, spinal immobilization, BVM, defibrillation
EMT-I: pacing, cardioversion, IO, EKG, needle thoracostomy, advanced airway management
EMT-P: arrhythmias, advanced airway management, intubation, cricothyrotomy, meds, fluids

11

Best pressors for shock that is:
1. cold
2. warm
3. normal BP

1. epi
2. norepi
3. dopa

12

CXR findings (measurements) for RPA

prevertebral soft tissue swelling >7mm at C2 or 14mm at C6

13

Lab findings concerning for a pulmonary EXUDATE

WBC >10K
glucose < 50% of serum
protein > 50% of serum
amylase > 200
LDH > 60% of serum
pH < 7.0 (v. suggestive of empyema)

14

EKG findings in pericarditis

widespread ST elevation
PR depression
ST elevation in limb and precordial leads with concave elevations

15

Location for ____ nerve block at wrist:
1) ulnar
2) median
3) radial

1) ulnar - proximal ventral crease at ulnar styloid
2) median - medial tendon of flexor carpi radialis
3) radial - dorsal crease @ radial styloid

16

pressure readings associated with compartment syndrome

>30 mmHg

17

Components of the pediatric trauma score

1. size
2. airway
3. consciousness
4. SBP
5. fractures
6. cutaneous

18

How do you determine size for:
1. ET tube
2. ET tube depth of insertion
3. NG tube size
4. chest tube size

1. ET tube = age/4 + 4
2. ET tube depth of insertion = ETT x 3
3. NG tube size = ETT x2
4. chest tube size = ETT x 4

19

low plasma alanine levels are associated with what IEM?

ketotic hypoglycemia

20

what are treatments for hyperammonemia?

IV arginine
sodium benzoate
phenylacetate
hemodialysis

21

what disease is associated with +reducing substances in the urine, cloudy cornea, and HSM?

galactosemia

22

What is the BP treatment for pheochromocytoma?

phenotalamine
2nd line is CCBs
NO beta-blockers!!!

23

Patient with a PAINFUL Horner's syndrome should make you think of...

carotid artery dissection

24

treatment for HOCM emergency?

B-blockers and CCBs

25

what is the treatment for lichen sclerosis?

topical steroids

26

treatment of prolapsed urethra

topical estrogen

27

treatment for tet spells

morphine (decreases pulmonary venous return, relaxes the infundibulum)
phenylephrine (increases SVR)
sodium bicarb (reduces acidosis)
beta-blockers (relaxes infundibular spasm, decreases inotropic effect)

28

treatment of HOCM?
what should you avoid?

beta-blockers
CCBs
avoid - diuretics and digoxin

29

Criteria for Acute Rheumatic Fever

Major: carditis, polyarthritis, chorea, erythema marginatum, subcutaneous nodules
Minor: fever, prolonged PR, elevated ESR/CRP/WBC, previous rheumatic fever, arthralgias
*Polyarthritis is the most frequently found major criteria
*Dx if 2 major or 1 major + 2 minor

30

med to rapidly inhibit release of thyroid hormone in pediatrics

potassium iodide
(PTU is contraindicated in kids; methimazole doesn't work acutely)

31

SIRS criteria

T 38
tachypnea
tachycardia
WBC 12K
10% bands

32

Symptoms of autonomic dysfxn syndrome

tachycardia, tachypnea, diffuse diaphoresis, hyperthermia, hypertension, mydriasis, and dystonia

33

Treatment of autonomic dysfxn/sympathetic storm

bromocriptine, dantrolene, benzodiazepines, clonidine, and narcotics

34

A painful Horner's syndrome should make you concerned about...

a carotid artery dissection

35

What are the components of Cushing's triad?
What is the earliest and most sensitive indicator?

bradycardia, hypertension, irregular respirations
most sensitive/earliest: bradycardia

36

What are the impt landmarks for IJ venous access?

The medial approach uses the apex of the triangle formed by the sternal and clavicular heads of the SCM.
Best localized with mild hyperextension of the neck.

37

Location for a distal ulnar nerve block?

just proximal to the ulnar styloid process

38

Nerve block achieved at: just proximal to the ulnar styloid process

ulnar nerve block

39

Location for a distal median nerve block?

between the palmaris longus and flexor carpi radialis tendons

40

Nerve block achieved at: between the palmaris longus and flexor carpi radialis tendons

median nerve block

41

Reasons to refer a patient to a burn center (4)

1) partial thickness depth >10% if 20% BSA > 11 years)
2) full thickness depth > 2% BSA
3) high risk for disability or poor cosmetic outcome (e.g., hands, feet, face, circumferential burns and those overlying joints)
4) associated inhalation injury or trauma

42

Parkland Formula

4 x BSA x wt (kg)
Give half in first 8 hours
Give second half in subsequent 16 hours
Does NOT account for maintenance fluids
Should only include partial and full thickness burns in BSA calculation
Only apply if 15% BSA is involved

43

Max dose of bupivicaine

2mg/kg without epi
3mg/kg with epi

44

1% lidocaine is how many mg/ml
0.25% bupivicaine is...

10mg/ml
2.5mg/ml

45

Things that can cause false positive guaiac stools

Horseradish
Turnips
Cherries
Tomatoes

46

Things that can cause red stool that isn't bloody

cefdinir/omnicef
red food dye
licorice
blueberries
spinach
beets
bismuth
iron preparations

47

Most common reason for child to have hypoglycemia?
What's low/wrong?

ketotic hypoglycemia
low alanine stores in muscles

48

Distinction between organic acidemias and urea cycles defects?

OA: elevated ammonia and acidotic
UC: VERY high ammonia (1000s) and usually NOT acidotic; low BUN, nml lactate, encephalopathy

49

IEM associated with reducing substances in urine?

galactosemia

50

Lab that is usually diagnostic for CAH

17-hydroxyprogesterone (17-OHP)

51

IEM mimic of child abuse with macrocephaly, chronic subdural effusions?
How to diagnose?

glutaric acidemia type I
dx with urine organic acids
dx usually made during crises (intercurrent illnesses) with metabolic acidosis, hyperammonemia and encephalopathy.

52

Management of Kawasaki when acute?
When convalescent?

Acute: IVIG, high dose ASA
Conv: low dose ASA (3-5mg/kg/day)

53

Management of dry gangrene in scleroderma

tx with systemic or topical nitro; or CCBs

54

How do you calculate sodium deficit?

Figure out the volume deficit
Na/1000 x 0.6 x volume deficit

55

Labs in RTA type IV

hyperkalemic, hyperchloremic, metabolic acidosis with normal AG

56

Winter's Formula

PCO2 = 1.5 x HCO3 + 8 +/- 2

57

Symptoms of scorpion sting

local pain, restlessness, hyperactivity, roving eye movements, and respiratory distress. More severe signs include seizures, drooling, wheezing, hyperthermia, cyanosis, GI hemorrhage, respiratory distress and death from shock or respiratory paralysis

58

Envenomation associated with metallic taste

rattlesnake

59

systemic symptoms of brown recluse spider bite

fever, chills, malaise, weakness, nausea, vomiting, joint pain, petechial morbilliform rash, intravascular hemolysis, hematuria, and renal failure

60

fish that cause scombroid

tuna, mackerel, and bonito

61

fish that cause ciguatera

barracuda, grouper, and snapper

62

what do you need to avoid when treating a patient with ciguatera poisoning?

opioids - may interact with toxin and cause hypotension

63

order of tissues with resistance to electricity

Bone > fat > tendon > skin > muscle > nerve.

64

when should you consider active rewarming measures

cardiovascular instability, T < 32ºC, or inadequate response to passive re-warming methods

65

how do you grade frostbite injuries?

1st degree- numbness and erythema with no tissue loss
2nd - superficial blistering, with clear to milky fluid, surrounded by edema and erythema
3rd - deeper blisters with blood containing fluid (leave blisters alone)
4th - affects muscle and bone.

66

pressor of choice in heat stroke

dobutamine - maintains peripheral vasodilation

67

in hypothermia, resuscitate to at least what temperature

The patient should be resuscitated until a body temperature of 32 – 34ºC

68

Symptoms of lithium toxicity

coarse tremor, ataxia, dysarthria, vomiting, diarrhea, cardiovascular changes and renal dysfunction.
Later signs: impaired consciousness, muscle fasciculations, myoclonus, seizures, coma and death.

69

Best med for an agitated (possibly delirious) child?

haldol
NOT BDZs (could loosen inhibitions or worsen delirium)

70

What are the different levels of sedation?

Minimal - respond normally to verbal commands and not asleep.
Moderate - does not need repeated painful stimulation to be aroused and should not require intervention to maintain a patent airway.
Deep sedation - patient cannot be easily aroused but respond purposefully after repeated verbal or painful stimulation; ability to independently maintain ventilatory function may be impaired.
General anesthesia is not arousable, even by painful stimulation.

71

What are the ASA classifications?

I - normal, healthy patient
II - mild systemic illness without functional limitation
III - severe systemic disease with definite functional limitation.
IV - severe systemic disease that is a constant threat to life.
V - moribund patient who is not expected to survive without the procedure

72

Epi dose for bradycardia in neonatal resuscitation

0.01 mg/kg of 1:10,000

73

How do you determine ETT sizes in neonatal resuscitation?

2.5 = < 1000g, 3000g, >38wks

74

How do you differentiate between main types of neonatal conjunctivitis?

Gonococcal - 3-5 days after birth.
Chlamydial - 5- 14 days after birth. Negative gram stain (obligate intracellular parasite)
Non-gonococcal, non-chlamydial bacterial - after the first 2 weeks of life.
Chemical(due to silver nitrate prophylaxis) - first day of life and resolves in 2-4 days.

75

Symptoms of morning glory intoxication?

mydriasis, hyper or hypothermia, perspiration, bronchorrhea and increased salivation

76

What's the difference between:
boutonniere deformity
swan neck deformity
hammer/mallet finger

boutonniere - flexed PIP, extended DIP
swan neck - extended PIP, flexed DIP
hammer - flexed DIP due to rupture of extensor digitorum tendon

77

Fruity odor, ingestion with no acidosis, but +osmolar gap?

isopropyl alcohol (odor is from acetone metabolic byproduct)

78

How often do physically restrained patients need their restraints renewed according to JACHO?

< 9 years - every hour
9-17 years - every 2 hours
adults - every 4 hours.
Patients must be evaluated, face-to-face, by the physician ordering the restraints within 1 hour of placing the order.

79

Findings in cardiac tamponade

Beck's triad: hypotension, muffled heart sounds, and distended neck veins
Low QRS voltages in all leads
Electrical alternans in precordial leads

80

What is the dose for naloxone?

0.1mg/kg

81

x-ray findings in RPA

>7mm at C2
>14mm at C6

82

EKG findings in pericarditis

An ECG will demonstrate changes of epicardial inflammation with widespread ST elevation, PR depression, ST elevation in limb and precordial leads. The elevations are concave.

83

treatment of malignant hyperthermia

dantrolene

84

Treatment of labial adhesions?
Treatment of urethral prolapse?
Treatment of lichen sclerosis?

1st line: topical estrogen cream; 2nd line: topical steroids
topical estrogen
topical steroids

85

medical treatment of phimosis

topical steroids

86

epi dosing for anaphylaxis

1:1000 epi
0.01 mg/kg
0.01 ml/kg

87

epi dosing for codes

1:10,000
0.01 mg/kg
0.1 mg/kg

88

management of frenulum lacerations

expectant - do not suture as they heal spontaneously

89

With regards to hemothorax, what amount of bloody output should trigger operative management?

Immediate return of 1500mL or 10-15ml/kg
>200ml/hr or 2-4ml/kg/hr of bloody drainage

90

Immediate treatment of commotio cordis?

defibrillation

91

What qualifies for a positive DPL?

free aspiration of gross blood, gastrointestinal contents, vegetable fibers or bile through the lavage catheter upon entering the abdominal cavity or the presence of ≥100,000 RBC/mm3, ≥500 WBC/mm3 or bacteria on Gram stain of the lavage fluid.