Acute Care

Question 1

Resp and CVS effects of
1. PEEP
2. PIP

Answer 1

1. increases oxygenation, decreases venous return
2. increases ventilation, affects mean airway pressure

Question 2

Lung protection ventilation in ARDS

Answer 2

Oxygenation more important than ventilation
Ideally delta P < 15, PIP < 32

Question 3

When can you start insulin for DKA

Answer 3

After 1 hour of fluids
K > 3

Question 4

SIADH vs cerebral salt wasting

Answer 4

SIADH: euvolemic hyponatremia, low or normal U/O
CSW: hypovolemic hyponatremia, elevated U/O
Serum osm are low in both, urine Na is high

Question 5

Bilious emesis in an infant < 1 year

Answer 5

Malrotation with volvulus until proven otherwise

Question 6

Diagnosis of malrotation

Answer 6

UGI

Question 7

Are the sats reliable in CO poisoning? Why?

Answer 7

No
Sat probe can’t tell the difference between Hb bound to O2 vs CO
So sats will be falsely elevated

Question 8

Difference between witnessed vs unwitnessed cardiac arrests

Answer 8

Witnessed = Call EMS and get AED first
Unwitnessed = 2 mins of CPR then call for help/AED

Question 9

Treatment of choice for DVT or PE

Answer 9

Heparin or LMWH

Question 10

How long to treat
1. Transient provoked
2. Idiopathic
Clot

Answer 10

1. 3 months
2. 6-12 months

Question 11

Dangerous ingredient in energy drinks

Answer 11

Guarana

Question 12

Treatment for acute dystonic reactions

Answer 12

Anticholinergic agents (diphenhydramine or benztropine)
Benzos second line

Question 13

Age for ondansetron

Answer 13

> 6 months

Question 14

Complications of rapid correction of chronic
1. Hyponatremia
2. Hypernatremia

Answer 14

1. Osmotic demyelination syndrome
2. Cerebral edema

Question 15

Criteria for burn admission to hospital

Answer 15

Partial thickness burns > 10% BSA
Burns to hands, face, feet, genitals, perineum, or joints
Full thickness burns
Electrical or chemical burns
Evidence of inhalational injury

Question 16

Most common cause of sudden death in adolescents

Answer 16

Hypertrophic cardiomyopathy

Question 17

Empiric abx for
1. 0-7 days
2. 8-28 days
3. 29-60 days
4. 61-90 days

Answer 17

1. Amp and gent/tobra or cefotax if meningitis
2. Amp and gent/tobra or cefotax if meningitis
3. CTX and vanco if meningitis
4. CTX and vanco if meningitis (if UTI and low risk, could do PO cefixime)

Question 18

When does death from iron ingestion typically occur

Answer 18

Third stage (12-36 hours)

Question 19

Treatment for iron overdose

Answer 19

Whole bowel irrigation
Deferoxamine is chelator for moderate to severe intoxication

Question 20

Whole bowel irrigation is best for

Answer 20

Substances not well adsorbed by charcoal (Li, iron)
Transdermal patches
Foreign bodies
Drug packets
Some sustained release preparations

Question 21

ETT sizing

Answer 21

Uncuffed: age/4 + 4
Cuffed: age/4 + 3.5

Question 22

Sympathomimetic signs and antidote

Answer 22

Mydriasis
Sweaty*
Tachycardic
Hypertensive
Hyperthermic
Agitated
Antidote: benzos

Question 23

Anticholinergic symptoms and antidote

Answer 23

Same as symapthomimetic but DRY
Physostigmine is antidote, but can also manage with benzos

Question 24

Parkland formula

Answer 24

4 x kg x % BSA
Half given over first 8 hours, half over the next 16 hours
You need to ADD maintenance fluids on top of this

Question 25

Rule of nines

Answer 25

Only valid for children > 14 Head and neck = 9% Each arm = 9% Trunk = 36% Each leg = 18% Genitalia = 1%

Question 26

What percentage BSA burns need tetanus prophylaxis

Answer 26

> 10 % If < 10% but not fully immunized they should get it

Question 27

What size pneumothorax can have spontaneous resolution

Answer 27

< 30%

Question 28

Treatment for 1. Mild 2. Moderate 3. Severe dehydration

Answer 28

1. 50 mL/kg ORS over 4 hours 2. 100 mL/kg ORS over 4 hours 3. IV fluids

Question 29

Who should you avoid valproate in

Answer 29

Potential mitochondrial disease <2 years with unexplained developmental delay

Question 30

Best test to diagnose esophageal perforation

Answer 30

CT neck and chest

Question 31

TCA ingestion

Answer 31

Anticholinergic activity and inhibit cardiac fast Na channels Coma, convulsions, cardiac dysrhythmias, acidosis Widened QRS, prolonged QTc If QRS prolongation or arrhythmia = give Na bicarb Can give activated charcoal if within 1 hr

Question 32

Organophosphate poisoning (mechanism, management)

Answer 32

Cholinergic and nicotinic Secretions everywhere! Miosis Twitching, weakness, paralysis Atropine, can give pralidoxime in addition

Question 33

Which acute head trauma patients need a CT

Answer 33

Moderate and severe TBI (GCS 13 or less) GCS 14-15 with persistent symptoms after 18-24 hours may need a CT

Question 34

Drowning episode, now well - how long to watch in ED

Answer 34

At least 8 hours

Question 35

BRUE definition

Answer 35

< 1 year with 1 or more of: 1. Altered LOC 2. Absent, decreased, or irregular breathing 3. Cyanosis or pallor 4. Marked change in tone No explanation on H+P, brief and now resolved

Question 36

Low risk BRUE criteria

Answer 36

ALL of Age > 2 mo GA 32 weeks + Only 1 (no prior) Lasting < 1 min No CPR by trained provider Unremarkable H+P

Question 37

Management of low risk BRUE

Answer 37

Education Offer CPR training Follow up within 24 hours Optional: brief admission <4 hrs with sat monitoring and serial exams, ECG, pertussis swab

Question 38

Treatment for splenic sequestration

Answer 38

Fluid resuscitation Careful blood transfusions

Question 39

What to do if button battery is in 1. Esophagus 2. Stomach

Answer 39

1. Emergent scope 2. If < 5 and battery 20+ mm, remove, if not then may be able to be managed as outpatient

Question 40

CT findings of diffuse axonal injury

Answer 40

Small hemorrhages throughout the white matter Especially at gray-white junction