1. General Principles

Question 1

Cause of fever on 6th post-op day with blood cultures growing coag-neg staph and no problems with wound or abdominal pain?

Answer 1

Central line or catheter assoc infection

Question 2

AG metabolic acidosis, radiopaque pills, abdominal pain, N/V/D, and hematemesis is due to ingestion of what?

Answer 2

Iron - occurs within 30 min to 6 h of ingestion

Tx: deferoxamine chelation

Question 3

In case of amputation injury, amputated parts should be managed how?

Answer 3

Place the amputated part in saline-moistened gauze in a plastic bag; place bag on bed of ice and bring it with the patient to the ED

Question 4

Those with a normal (neg) FAST exam, but high-risk features such as anemia or abdominal guarding should be managed how if hemodynamically stable?

Answer 4

Should undergo subsequent CT scan of the abdomen. Splenic injury is one of the MC intra-abdominal complications of blunt abdominal trauma.

Question 5

What are the 3 components of the GCS score for a TBI/mental status?

Answer 5

Eye opening (1-4)
Verbal response (1-5)
Motor response (1-6)
Note: this is not for coma dx (disrupted pupillary light, extraocular, and corneal reflexes), but can tell severity and prognosis of coma.

Question 6

RF for lead poisoning? Dx? Management

Answer 6

home built bf 1978, Pica, sibling with lead poisoning, low socioeconomic status, immigrant
Dx by fingerstick. Confirm with venous lead level. Tx with DMSA if moderate. Dimercaprol + EDTA if severe. Remove child from environ if exposure is ongoing after confirming

Question 7

CXR with persistent PTX despite chest tube placement and pneumomediastinum, and subQ emphysema in a patient with recent rapid decal chest trauma likely has what?

Answer 7

Bronchial rupture.

Question 8

If a child has ingested alkaline substance, what should you do? What shouldn’t you do?

Answer 8

Should: remove contam clothes, do upper GI endoscopy to eval injury extent.
DONT: neutralize bc may trigger vomiting –L further mucosal damage.

Question 9

Differentiate heat stroke from malignant hyperthermia

Answer 9

Heat stroke: acute confusion, extreme hyperthermia, tachy, coagulopathic bleeding after heavy work in direct sun
Malignant hyperthermia: after use during anesthesia involving agents like halothane and succinylcholine

Question 10

Patients with cervical spine injuries require initial stabilization of the cervical spine. Orotracheal intubation with rapid-seq intubation is preferred to establish an airway in an apneic patient with a c-spine injury. Why is a nasotracheal intubation contraindicated in this case? Why is needle cric not ideal

Answer 10

Nasotracheal intubation is a blind procedure. It is also contraindicated if the patient has a basilar skull fx bc there is risk of cribiform plate disruption –> intracranial passage of tube
Note: needle cric is not ideal in pt with head injury bc risk of CO retention (pt might need hyperventilation to prevent or treat intracranial HTN)

Question 11

T/F: Caustic poisoning causes alteration in consciousness

Answer 11

False - presents with dysphagia, severe pain, heavy salivation, and mouth burns. GI tissue necrosis. Can result in peritonitis or mediastinitis

Question 12

How do you define mild, moderate and severe hypothermia? Management?

Answer 12

Mild: 90-95C, inc shivering; fluids, passive warming
Moderate: 82-90F, dec shivering, hypoventilation, active warming (warm blankets, heating pad, warm baths)
Severe: 82F, coma, CV collapse, vent arrhythmias; active internal rewarming (peritoneal irrigation, warmed o2)

Question 13

In patients with traumatic spinal cord injuries, patients should have what done to prevent urinary retention and acute bladder distension and damage?

Answer 13

urinary cath placement