PEM Sample Qs Flashcards
(136 cards)
1
Q
2 abx for prophylaxis in sexual abuse
A
- Ceftriaxone 250 mg IM or Cefixime 8 mg/kg PO once
- Azithromycin 1 g PO once or 15 mg/kg PO once
- if over 8 yrs: Doxy 100 mg BID x 7 days
- Flagyl
2
Q
3 viruses to counsel parents on:
A
- HIV
- Hep B
- Hep C
- HPV
3
Q
3 counselling instructions for vulvovaginitis
A
- Avoid bubble baths or use of perfumed soaps/creams
- Avoid tight fitting clothes/underwear
- Wipe front to back
- Apply zinc oxide or other topical emollient- will resolve with good hygeine
4
Q
4 pathogens (non STI) vulvovaginitis
A
- Group A strep
- Staph aureus
- S.pneumo / H flu / Moraxella
- Shigella
- STIs are uncommon
5
Q
5 features that distinguish mastitis from physiologic breast budding
A
- Erythema
- Unilateral
- Warmth
- Swelling
- Painful to palpation
- Assoc of fever
- Purulent discharge/drainage
6
Q
2 immediate interventions for mastitis
A
- Obtain IV access with labs (CBC, blood culture)
- If unwell, consider full septic work-up with labs, urine studies & LP
- C/S surgery for possible I&D
- Start IV antibiotics
7
Q
5 high risk factors for c-spine injury
A
- Age > 65 years old
- Presence of numbness/tingling/paresthesias
- Midline cervical pain
- Not ambulatory at scene
- Dangerous mechanism: fall > 3 ft, axial load, high speed MVC, ATV or motorized vehicle accident
8
Q
Signs of cervical injury (6)
A
- Motor paralysis
- Neurogenic shock: bradycardia, hypotension, flushed skin
- Spinal shock: flaccid paralysis, loss of rectal tone, loss of DTRs
- Neck: torticollis, muscle spasm, tenderness
- Sensory deficit with level
- Horner’s syndrome
9
Q
Label C-spine lines
A
- anterior vertebral line
- posterior vertebral line
- spinolaminar line
- posterior spinous line
10
Q
Hangman fracture
A
fx of C2 pedicle, hyperextension
-draw Swischuk line (C1-C3 through anterior spinous process circle), if C2 deviated > 2 mm on C3 = subluxation (if < 2 mm, pseudosubluxation)
11
Q
Type of C-spine fractures (5)
A
Type 1: wedge compression, stable, semirigid cervical collar
Type 2: teardrop, isolated anterior/inferior vertebral body fx w/ intact posterior element (abrupt neck extension), semirigid cc
Type 3: comminuted burst, intact posterior elements (unstable, need surgery)
Type 4/5: complex, involve post elements, unstable, poor prognosis
12
Q
Mgmnt of Pulseless VT (3)
A
- Defibrillation 2J/kg –> 4J/kg
- Epinephrine 0.1 ml/kg Q3-5min
- Amiodarone (Refractory) 5 mg/kg (150 mg)
13
Q
Systemic causes of prolonged QTc (4)
A
- Congenital: Romano Ward, Jervell-Lange-Nielson
- Metabolic: hypomagnesemia, hypocalcemia, hypokalemia
- Endocrine: hypoparathyroidism, hypothyroidism
- Neurologic: Stroke, subarachnoid hemorrhage, encephalitis
14
Q
Drugs that cause prolonged QTc
A
- Anti-emetics: ondansetron
- Antipsychotics: Haloperidol
- Loop diuretics: furosemide
- Antibiotics: macrolides
15
Q
Causes of abnormal S3
A
CHF
VSD
mitral regurg
dilated cardiomyopathy
16
Q
6 life threatening GI emergencies in solid organ transplant patients
A
- Portal venous thrombosis
- Biliary obstruction
- Typhilitis
- Liver failure with hepatic encephalopathy
- GI hemorrhage
- Renal artery stenosis
17
Q
8 diagnostic tests to help diagnosis of mediastinal mass
A
- Chest CT
- CBC
- BMP - electrolytes, renal function
- Urine / plasma catecholamines
- Alpha FP and BHCG
- LDH / uric acid
- BM biopsy
- Echo
18
Q
3 complications of mediastinal mass
A
- Tumor lysis syndrome
- Superior vena cava syndrome
- Superior mediastinal syndrome (SVC + obstruction of trachea)
19
Q
Indications for atropine use (2)
A
- symptomatic bradycardia
- cholinergic poisoning
20
Q
Indications for hospitalization of suicidal teenager (4)
A
- No follow-up arrangements possible
- Remains actively suicidal
- History of previous suicide attempts
- Unsupportive home environment (lack of appropriate adult sup)
21
Q
Risk factors for repeat suicide attempt (4)
A
- impulsivity
- Psychosocial factors
- Family: lack of supportive environment, fhx of SI, mental health dx in family
- Concomitant mood disorder
22
Q
4 causes of non-traumatic pancreatitis
A
- Gallstones / cholelithiasis
- Ethanol abuse
- Hypertriglyceridemia/hyperlipidemia
- Medication induced: azathioprine, asparaginase chemo
- Metabolic: hypercalcemia, hypothermia
23
Q
4 lab findings in pancreatitis that necessitate ICU care
A
- Hyperglycemia: BG > 11.1
- Hypocalcemia: Ca < 2.0
- Elevated BUN
- Elevated hematocrit
- PaO2 < 60 mmHg (needs intubation)
24
Q
Drugs that can be hemodialyzed in overdose (5)
A
- Aspirin
- Toxic alcohols: ethylene glycol, methanol
- Lithium
- Metformin
- Severe acetaminophen O/D
25
2 ingestions that can cause UGI bleeding
- button battery
- iron
26
2 common causes of UGI bleed in toddler
- mallory weiss
- gastritis / esophagitis
27
life threatening causes of GI bleed (4)
- Peptic ulcer disease
- Esophageal varices
- Vascular malformation
- Intestinal duplication
28
HSP - CF (5)
- Palpable purpuric rash, most notable of LE
- Arthritis/arthralgias
- Abdominal pain +/- GI bleeding
- HTN
- Orchitis
29
HSP - Lab findings (5)
- UA: hematuria, proteinuria
- Elevated CRP / ESR
- (+) fecal occult blood test
- Elevated platelets
- Anemia
30
4 C/I to enema reduction in intussusception
1. Perforation
2. Obstruction
3. Peritonitis
4. Presence of pneumatosis intestinalis
31
Burn Center Referral Criteria (8)
- TBSA \> 10 % partial thickness
- TBSA \> 5% full thickness injury
- Concern for NAT
- Burns on hands/feet/genitals
- Inhalation injury
- Chemical burn
- Major associated injuries
- High voltage burn injuries
32
5 features of NAT burns
1. Symmetrical, well delineated burns on hands/feet
2. Submersion burns sparing buttock
3. Patterned burns - distinct objects
4. Cigarette burn holes
5. Lack of splash pattern
6. Inappropriate explanation for mechanism
33
4 life threatening complications of DKA
1. Cerebral edema
2. Hypovolemic shock/ cardiovascular collapse
3. Profound metabolic acidosis
4. Electrolyte abnormalities: hypo/hyperkalemia
34
3 clinical features of anterior shoulder dislocation
1. arm is externally rotated
2. arm is abducted
3. pain
35
Nerve injury w/ anterior shoulder dislocation
axillary N
- test with sensation over lateral deltoid
36
Complications of shoulder reduction (3)
1. Axillary N/AA injury
2. Hill-Sachs lesion: cortical depression of humeral head
3. Bankart lesion: avulsion fx of ant inferior glenoid rim (labral tear)
37
MC elbow injury
supracondylar fx
38
4 XR features of elbow fracture
1. Posterior fat pad
2. Anterior humeral line does not bisect capitellum
3. Abnormal radiocapitellar line (does not bisect capitellum)
4. Elevation of anterior fat pad (sail sign)
39
MC N injury w/ supracondylar dx
anterior interosseuss (branch of median N)
40
Volkmann's contracture - what is it?
caused by compartment syndrome from supracondylar fx w/ ischemia to flexor mm of forearm causing fibrosis / contracture --\> permanent flexor contracture of hand = "claw hand"
41
5 feature of compartment syndrome on exam
- Pulseless
- Pallor
- Pain out of proportion
- Paresthesias
- Paralysis
42
Tilleaux fracture
- Salter harris 3 fx through physis and epiphysis of distal tibia
- Avulsion of anterolateral epiphysis (medial physis is partially closed in age 12-14 yr old)
If displaced \> 2 mm: CT scan, Ortho c/s, ORIF
43
EKG findings in cocaine O/D (4)
- ST elevation
- Sinus tachycardia
- SVT
- Tachyarrhythmia: V/fib, V.tach, torsade
44
EKG findings in myocarditis (4)
- Sinus tachycardia
- Low voltage QRS complex
- Low voltage T waves or T wave inversion
- Dysrhythmia (SVT, Vtach)
45
CXR findings in myocarditis (3)
- Cardiomegaly
- Increased interstitial infiltrates
- Pleural effusion
46
Non-infectious causes of myocarditis (3)
1. Medications - anthracyclines, cocaine, heavy metals
2. Radiation exposure
3. Systemic disorders - SLE, IBD, Thyrotoxicosis
47
6 complications of pericardiocentesis
1. Puncture of heart
2. Dysrhythmia
3. Laceration of coronary vessels
4. Local infection
5. Hemothorax/Pneumothorax
6. Diaphragmatic perforation
7. Puncture of peritoneal cavity
8. Hemopericardium
48
Medications for CV support in myocarditis
- Preload: lasix, nitroglycerin
- Pump: dopamine, dobutamine, epi
- Afterload: milrinone
49
Signs of organ rejection - liver transplant (2)
1. Elevated LFTs - cholestasis, itching
2. Abdominal pain, fever
50
Signs of organ rejection - kidney transplant (2)
1. Fever with graft tenderness
2. Uremia, elevated creatinine
51
Signs of organ rejection - heart transplant (2)
1. Tachycardia, low CO, sx of CHF
2. Pericardial effusion
52
Drugs that increase calcineurin inhibitor levels (tacrolimus, cyclosporin)
1. Antibiotics - macrolides, FQs, metronidazole
2. Antifungals - fluconazole, ketoconazole
3. Antivirals - indinavir, nelfinavir
4. CCB - nifedipine, nicardipine, diltiazem
53
Drugs that decrease calcineurin inhibitor levels (tacrolimus, cyclosporin)
1. Antibiotics - Rifampin
2. Antifungals - caspofungin (tacro only), terbinafine
3. Antivirals - nevirapine, efavirenz
4. Anticonvulsants - carbamazepine, phenobarbital, phenytoin
54
Causes of HYPERNATREMIA
1. Diarrhea
2. Diabetes insipidus (Uosm \< Sosm)
3. Hyperaldosteronism
4. Iatrogenic (wrong fluids)
5. Water deprivation, impaired thirst, improper formula mixing
6. Neurosurgery
7. Mod-severe burns
55
Complications of hypernatremia
1. Intracranial hemorrhage
2. osmotic demyelination syndrome (rapid correction)
3. sinus venous thrombosis
56
Risk factors for hyponatremia
1. Burns
2. children \< 6 mos
3. hospitalized children
4. hypotonic IVF
5. SIADH/Meds
6. Immediate post-op period
57
correction for pseudohyponatremia
1.6 meq/L of Na should be added for each 100 mg/dL increase in glucose above normal
58
Risk factors for HYPERKALEMIA
* Renal insufficiency
* Acidosis (extracellular shift)
* Cell lysis: burns, tumor lysis, crush injuries
* Necrotizing infections
* Medications
* Adrenal insufficiency
59
EKG changes in hyperkalemia
1. Peaked T waves
2. Prolonged PR and QRS intervals
3. Decreased amplitude of P waves
4. Sine wave pattern
60
Causes of HYPOKALEMIA
1. Decreased intake: malnutrition, eating dz
2. Extrerenal losses: diarrhea, ostomy output, severe vomiting
3. Increased intracellular uptake: akalosis, insulin, B-agonists (albuterol)
4. Renal losses: RTA type 1/2, ATN, Gitelman/Barter syndrome, loop and thiazide diuretics
61
EKG changes HYPOKALEMIA
1. Early: Flattened and shallow T waves, prominent U wave
2. Later: prolonged PR interval and QTc
62
EKG changes in pulmonary embolism
* Sinus tachycardia
* ST elevations/changes
* Right axis deviation
* RBBB: V1 - rSR' (W) and broad deep S wave in V6 (M)
* S1Q3T3 pattern
63
Causes of Hypercalcemia (4)
1. Malignancy - hematologic (ALL), solid tumors (often very high levels - PTHrP)
2. Hypervitaminosis - elevated vitamin D, vitamin A
3. Immobilization
4. Primary hyperparathyroidism (mild increase with elevated PTH, low/normal Phos)
64
Signs/Sx of **Hypercalcemia**
* **Bones** - bone pain, pathologic fx
* **Groans -** abdominal pain, chest pain
* **Moans** - CNS depression, psychosis, irritability
* **Stones -** hypercalciuria (impaired renal conc ability)
* **MSK -** hypotonia, hyporeflexia
65
Treatment of **hypercalcemia**
1. IVF - NS bolus
2. Bisphosphonates
3. Calcitonin \*\* for severe hypercalcemia
4. Furosemide (no longer recommended)
66
MCC of **Hypocalcemia**
* hypoparathyroidism (DiGeorge, acquired-surgical)
* Vitamin D deficiency
* Renal disease
* Pancreatitis (sequestration of calcium)
* Meds: furosemide, anticonvulsants
* Hyperventilation (resp alkalosis = calcium binds w/ albumin)
67
Signs/Sx of **hypocalcemia**
* **Neuroexcitability**
* paresthesias: perioral, hands/feet
* muscle cramps/spasms: Chvostek's sign, Trousseau sign
* hyperreflexia
* **Smooth muscle effect**s
* hypotension
* bronchospasm
* laryngospasm
68
Tx of **hypocalcemia**
* IV Calcium gluconate = **50-100 mg/kg max 1000-2000 mg**
69
Nephrotic syndrome (Signs/symptoms)
**NAPHROTIC mnemonic**
N = hyponatremia
A= hypoalbuminemia
P = proteinuria \> 3.5 g/day
H = hyperlipidemia
R = renal vein thrombosis
O = orbital edema (scrotal)
T = thromboembolism
I = infection (loss of IG)
C = coagulability
70
_Predisposing_ factors for suicide
* age \> 12 years
* psychiatric disorders
* previous suicide attempt (best predictor)
* fhx of mood dz or SI
* hx of abuse
* exposure to violence
71
**Precipitating factors for suicide**
* access to means ex weapon
* alcohol/drug use
* exposure to suicide
* social stress / isolation
* emotional/cognitive factors
72
Difference between BIPAP and CPAP
Bipap = two different airway pressures, one for inhalation and one lower one for exhalation (Uses: asthma, COPD, muscular dystrophy, CF)
CPAP = delivers set pressure regardless of inhalation / exhalation (Uses: OSA, bronchiolitis)
73
5 stages of iron toxicity
1. GI irritation: 30 min - 6 hours (NVD)
2. Latent: 6 hr-1day (recovery, may not occur in severe OD)
3. Shock: 12-24 hr (metabolic acidosis, increased AG, dehydration)
4. Hepatic failure: 24-96 hr (coagulopathy / hemorrhage)
5. Bowerl obstruction: 3-6 weeks (scarring of GI mucosa)
74
4 factors that determine O2 delivery via orofacial
1. oxygen concentration
2. delivery device: cannula vs mask
3. flow rate
4. patency of nares / airway
75
6 clinical features suggestive of respiratory failure in asthma
1. Accessory muscle use
2. Tachypnea
3. Altered mental status
4. Inability to speak in sentences
5. Nasal flaring/grunting
6. Cyanosis or SpO2 \< 90%
76
2 laboratory findings in asthma that suggest respiratory failure
1. PaCO2 \> 50 with pH \< 7.25
2. PaO2 \< 60 or O2 sat \< 90%
3. PaCO2 \> 40 with severe distress
77
Causes of Pulmonary Edema (case scenario is myocarditis)
1. Congestive heart failure with poor LV function
2. Fluid overload from aggressive IV hydration
3. ARDS - decreased alveolar capillary membrane
4. Decreased plasma oncotic pressure (malnutrition while ill, burns, trauma)
5. Post obstructive pulmonary edema
78
4 central causes of respiratory depression
1. Infection - meningitis, encephalitis
2. Structural - tumor, AVM, hydrocephalus
3. Immaturity - prematurity
4. Intoxication - benzodiazepines, ethanol
5. Seizures
79
Poiseuille's law
resistance to airflor is inversely proportional to radius of lumen
R = 8 n l / n r 4
80
2 mechanisms for acidosis in severe asthma
1. Hypoventilation = hypercapnia (respiratory acidosis)
2. Hypoxia = hypoperfusion = elevated lactic acid (metabolic acidosis)
81
4 signs/sx of **acute hemolytic transfusion** reaction
1. Fever/chills/body aches
2. Dyspnea
3. Red/brown urine
4. Abdominal/flank pain
5. Hypotension
82
3 lab tests to confirm **acute hemolytic rxn**
1. DAT (direct antiglobulin test) aka Coombs test
2. CBC
3. Reticulocyte count
4. Repeat Type / Cross
83
4 steps in management of **acute hemolytic reaction**
1. Stop transfusion
2. Give IVF at 1.5-2 x MIVF
3. Hemodynamic support with pressors if needed
4. Diuretics if fluid overload
5. Draw blood for labs
84
Diagnostic tests for von Willebrand disease (3)
1. PT/PTT/INR
2. Factor VIII level/activity\*
3. plasma vWF antigen\*
4. plasma vWF activity = ristocetin assay\*
\*\* PTT can be normal in mild cases when factor VIII levels are normal
85
Tx of von Willebrands disease
1. DDAVP (desmopressin)
2. VWF concentrate or factor VIII replacement for severe bleeding
86
Complications of mediastinal mass
1. SVC syndrome
2. Superior mediastinum syndrome = SVC + tracheal obstruction
3. Airway compromise or obstruction
87
Lab findings in tumor lysis
Hyperkalemia
Hyperphosphatemia
Elevated uric acid
**hypocalcemia**
88
Indicators of splenic dysfunction
1. splenomegaly or atrophy on exam
2. recurrent infections / sepsis
3. (+) howell jolly and heinz bodies in blood
4. poor titers/response to previously given vaccines
89
Causes of Traveller's Diarrhea
E.coli
Norovirus
Entamoeba histolytica
Salmonella
Giardia lambia
90
Dukaral vaccine = ETEC (enterotoxicgenic e.coli) or cholera
91
4 non-infectious causes of hyperthermia
1. Heat stroke
2. Malignant hyperthermia
3. Ingestion - serotonin syndrome
4. Thyroid storm / thyrotoxicosis
92
Lab findings in congenital adrenal hyperplasia
Hyponatremia
Hyperkalemia
Hypoglycemia
Acidosis
93
indications for amiodarone
1. hemodynamically stable wide complex tachycardia
2. refractory pulseless VT and V fib
3. atrial fibrillation
4. SVT not responsive to adenosine or cardioversion
94
MOA of amiodarone
class III anti-arrhythmic: prolongs QT interval
blocks Ca channels and beta-channels: slows HR and AV nodal conduction
K+ and Na+ channel blocker: prolongs refractory period and slow intracardiac conduction
95
diagnostic criteria for migraine
* atleast 5 attacks
* duration 1-48 hours
* atleast 2 of the following features:
* bilateral or unilateral location
* pulsatile quality
* moderate/severe
* aggravation by routine activity
* during headache, atleast one:
* N/V
* photo/phonophobia
96
definition of **child neglect**
failure to provide the basic child needs - can be physical, educational or emotional
ex. medical neglect, FTT, abandonment, truancy
97
Adams scale for **child sexual abuse**
1. **Findings of newborns and nonabused children:** normal variants, caused by other medical conditions
2. **Indeterminant/nonspecific**: lesins with etiology confirmed, indeterminate specificity
3. **concerning for abuse**
4. **Clear evidence of abuse**
98
MOA of NAC (n-acetylcystein) in tylenol O/D
- Early administration prevents the covalent binding of NAPQI to hepatocytes and prevents hepatotoxicity. ( NAC acts as a glutathione precursor🡪NAPQI reduced by glutathione to non toxic mercaptate conjugate 🡪 urine )
Mechanisms include:
i. Acting as a precursor for glutathione to increase available glutathione (major).\*\*\*
11. Increasing non-toxic sulfation metabolism (major).\*\*\*\*
iii. Directly reducing NAPQI to APAP (minor).
iv. Directly conjugating NAPQI (minor).
v. Mitigation of adverse intracellular cascades even after NAPQI covalent binding occurs.
99
Drugs that cause miosis
1. opioids
2. clonidine
3. cholinergic drugs - OPP
4. nicotine
5. sedatives: barbiturates / benzos
6. antipsychotics
100
Drugs that cause mydriasis
1. amphetamines
2. anticholinergics
3. LSD
4. inhalants
5. anti-convulsants
101
6 complications of chronc methamphetamine use
1. coronary ischemia / arrhythmias
2. psychosis
3. seizures
4. periodontal disease
5. AKI --\> rhabdo
6. pulmonary HTN / edema
102
Precursors of GHB (2)
1. gamma butyrolactone
2. butanediol
103
2 eye findings in GHB o/d
1. dysconjugate gaze
2. nystagmus
3. loss of peripheral vision
104
3 excitatory/neuro sx with GHB o/d
1. hallucinations
2. agitation
3. euphoria
105
Indications for WBI (3)
1. Iron and other metal o/d
2. Extended release medications
3. Body packing of illicit substances
4. Pharmaceutical patches
\*500 ml/hr in toddlers
2 L/hr in adolescents/adults
106
charcoal is not effective for these types of drugs...
Iron
Lithium
Alcohols
Hydrocarbons
Acids/bases
Cyanide
107
4 main effects of calcium channel toxicity with associated mechanism
1. hypotension: smooth mm relaxation = vasodilation
2. bradycardia: decrease inotropy, slow conduction through AV node
3. hyperglycemia: decrease insulin release
4. metabolic acidosis: poor perfusion
108
6 sx of ASA toxicity
* hypoglycemia
* fever
* tachypnea with hyperventilation
* NVD
* tinnitus
* vertigo
* agitation / delirium
109
Drugs that are amenable to dialysis
ASA
Lithium
Alcohols
Methotrexate
Valproic acid
\* low vol dis, low mw, low protein binding\*
110
what meds can use you to tx HTN/tachycardia in **stimulant O/D**
alpha antagonist: **phentolamine**
**nitroprusside**
\*\* do not give B-block, will get unopposed alpha stimulation and cause worsening HTN and tachycardia
111
Heat labile toxins (marine envenomations)
Stingray
Jellyfish
Portugese man of war
Lionfish
Scorpionfish
Catfish
Sea urchin
112
113
EKG findings in hypothermia
J waves / Osborn waves - proportional to degree of hypothermia
T wave inversions
Prolonged intervals
Bradycardia
V.fib --\> asystole in profound hypothermia
114
EKG changes/progression in pericarditis
1. ST elevation and PR depression
2. ST segment and PR normalize
3. Diffuse T wave inversions
4. Normalize or T waves stay inverted
\* may also see decreased voltages
115
5 cardiac problems in anorexia nervosa
1. cardiomyopathy
2. dysrhythmia - prolonged QTc
3. pericardial effusion
4. decreased cardiac mass and chamber volume
5. bradycardia
7. mitral valve prolapse
116
Structural causes of **ventricular fibrillation**
Hypertrophic cardiomyopathy
Dilated cardiomyopathy
History of cardiac surgery, ex. TOF repair
Aortic stenosis
ALCAPA (coronary artery abnormalities)
Myocardial infarction
117
Electrophysiologic causes of **ventricular fibrillation**
Prolonged QT
Brugada syndrome
Commotio Cordis
Toxic ingestion of drugs that prolong QT
118
Good prognostic factors for **pediatric cardiac arrest**
**1.** in hospital
2. witnessed arrest w/ early bystander CPR
3. high quality CPR
4. no prior underlying medical history
5. shorter duration of CPR with fewer doses of Epi
6. shorter EMS scene time
119
qualities of **heart murmur that necessitate further work-up**
1. diastolic murmur
2. high grade \> 3/6
3. radiation to back
4. harsh quality
5. abnormal heart sounds
120
Abx prophylaxis for **infectious endocarditis**
**-** prosthetic heart valves
- repaired CHD within 6 months or w/ residual shunt
- previous hx of IE
- unrepaired cyanotic CHD
- cardiac transplant w/ valvular regurgitation
121
Eye findings in **uncal herniation**
Ipsilateral pupil **fixed and dilated** (CN3 compressed)
Ipsilateral eye **down and out + ptosis** (unopposed CN IV and VI)
homonymous hemianopsia
122
Doll's eye maneuver
- what CN does it test?
- what is it?
- tests CN 3, 6, 8
- normally, when head is turned the eyes go in opposite direction
- tests integrity of the brainstem (test in unconscious people)
123
causes of diplopia (7)
1. CN palsy - CN 3,4,6
2. ocular migraine
3. drug intoxication - PCP
4. mass lesion (optic chiasm)
5. pseudotumor cerebri
6. Miller-Fisher variant of GBS
7. myastenia gravis
8. botulism
9. conversion disorder
124
CATCH study - high RF for neurosurgical intervention
1. GCS \< 15 @ 2 hours
2. Open or depressed skull fx
3. Hx of worsening headache
4. irritability on exam
125
CATCH study - medium RF for (+) CT findings
1. Sx of basilar skull fx
2. large, boggy scalp hematoma
3. dangerous MOI: MVC, fall \> 3 ft or5 steps, fall off bicycle w/o helmet
126
Causes of acute urinary retention
1. UTI or vulvovaginitis
2. obstruction: constipation, imperforate hymen
3. drugs: anticholinergic
4. UPJ obstruction
5. hypermagnesemia
6. Neuro - ADEM, GBS
127
3 causes of priapism in a 6 year old
- sickle cell disease
- leukemic infiltration
- trauma
- medications
- black widow bite
128
ddx testicular swelling / erythema (4)
1. testicular torsion
2. epididimytis
3. orchitis
4. testicular hematoma s/p trauma
5. tumor
6. varicocele
129
complications of not surgically correcting testicular trauma
1. unsalvageable testicular rupture
2. missed torsion
3. infection
4. damage to spermatic cord - infertility
5. testicular necrosis
130
RF for perforation with intussusception reduction
1. age \< 3 mos or \> 5 yr
2. hematochezia
3. evidence of SBO on xr
4. \> 2 day of sx
5. dehydration
131
US findings in appendicitis
1. dilated appendix \> 6 mm
2. non-compressible, tubular structure
3. mesenteric fat stranding
4. free fluid in pelvis
5. (+) appendicolith
6. loss of peristalsis of surrounding bowel
7. TTP with graded compression
132
endocrine causes of peptic ulcer dz
1. Zollinger-Ellison syndrome (neuroendocrine tumors)
2. primary hyperparathyroidism
3. MEN1 syndrome
133
causes of proctitis
1. IBD (ulcerative colitis)
2. infectious: c.diff, shigella, salmonella
3. ischemic
4. GVHD
5. medication induced (abx)
6. radiation therapy
7. ischemic
134
causes of **massive GI bleed in liver failure**
1. esophageal varices
2. coagulopathy
3. mallory weiss syndrome
4. PUD / stress gastritis
135
charcots triad / reynolds pentad
1. fever
2. abdominal pain (RUQ)
3. jaundice
4. hypotension
5. AMS
136
components of **pediatric trauma score**
Weight
Airway
Systolic BP
CNS
Open wound
Skeletal (fx?)
Scores of -1, 1 or 2
Scores \< 8 require pediatric trauma center referral
