Annual exam Flashcards
IO access in children
Site: two finger-widths (2 cm) below the tibial tuberosity on the medial, flat surface of the proximal tibia
Other sites for ADULTS: medial malleolus, distal femur, sternum, humerus, and ileum
Contraindication for IO access
- proximal ipsilateral fracture
- ipsilateral vascular injury
- severe osteoporosis or osteogenesis imperfecta
Complications of IO
- cellulitis
- osteomyelitis
- iatrogenic fracture or physeal plate injury
- fat embolism (rare)
following formula can reasonably estimate the cuffed endotracheal tube size, as measured by internal diameter, in children >1 year of age
(age/4) + 4
TRUE or FALSE: Straight laryngoscope blades (Miller) are preferred to curved blades in young children
TRUE
Depth can be estimated using the formula
Tube internal diameter × 3 = Tube depth at the lips
Ex: For example, a 4.0-mm internal diameter tube should be 12 cm at the lips. Length-based systems can also be used
Cornea anatomy
Top to bottom:
- Pavement epithelium
- bowman layer
- Stroma
- Descemet membrane
- Endothelium
Sclera anatomy
the collagenous protective coating of the eye, which is the thinnest (and prone to rupture) at the insertion of the rectus muscles
Layers:
- Episclera
- Stroma
- Lamina Fusca
- Endothelium
- Choroid
UTZ finding of globe rupture
US findings of globe rupture include distortion of the normal shape of the globe, decrease in the size of the globe, anterior chamber collapse, and vitreous hemorrhage
Peak incidence of acute OM in children
6 and 12 months of age
*Breastfeeding in infancy is protective and decreases the risk of AOM
True or False: Compared with adults, the eustachian tube in children is shorter and more horizontally oriented
TRUE
Most common bacterial pathogens in Acute OM in children
- Streptococcus pneumoniae (23.6%), nontypeable Haemophilus influenzae (29.1%), Streptococcus pyogenes (3.7%), and Moraxella catarrhalis (2.8%)
*Viruses: picornaviruses (e.g., rhinovirus, enterovirus), respiratory syncytial virus, and parainfluenza virus
Most common acute complication of Acute OM
tympanic membrane perforation
Gold standard for the diagnosis of Acute OM
Tympanocentesis is the gold standard for diagnosis
*Diagnosis is clinical
True or False: Erythema of the tympanic membrane alone is insufficient for the diagnosis of AOM because erythema can be caused by middle ear inflammation, crying, or fever
TRUE
Clinical Criteria for Acute OM
- Moderate to severe bulging of the tympanic membrane
- Mild bulging of the tympanic membrane and at least 1 of the following: Acute onset of ear pain (<48 h), Intense erythema of the tympanic membrane
- New onset of otorrhea not due to otitis externa or foreign body (indicating perforation of the tympanic membrane or AOM in a child with tympanostomy tubes)
TRUE or False: Apply topical analgesics in patients with perforation of the tympanic membrane and those with tympanostomy tubes
FALSE: Contraindicated
require prompt treatment with antibiotics (Acute OM)
- <6 months old
- have severe signs or symptoms,
- <24 months old with bilateral AOM
- recurrent AOM
- AOM with perforation
- have myringotomy tubes
- and/or have underlying craniofacial abnormalities
- immunodeficiencies
(Initial Antibotics) first line treatment for Acute OM
- High-dose amoxicillin (45 milligrams/kg per dose PO twice daily) for 5 to 10 days is the first line treatment
*With initiation of appropriate antibiotics, fever and ear pain should be expected to persist for 24 to 48 hours
When alternating black-and-white lines are passed from one side to another in front of a patient’s eyes __ will occur
involuntary horizontal nystagmus or optokinetic nystagmus
*The presence of optokinetic nystagmus excludes blindness in a patient with an otherwise normal examination who claims he or she cannot see (hysterical blindness)
HOW: The test can be performed by placing thick black lines approximately 1 in. apart on a 2-ft strip of cardiac monitor paper, which is passed back and forth at eye level a distance of 1 ft from the patient
Used to confirm posterior BPPV
Dix-Hallpike Maneuver
NOTES:
* Vertical upward and rotary nystagmus - positive
* Epley maneuver – first line treatment for posterior BPPV
- Horizontal canal BPPV – Treatment: Gufoni Maneuver
- Anterior canal BPPV – Treatment: Deep head hanging
Skin temperature when frostbite occurs
<OC (<32F)
*Frostbite can develop within 2 to 3 seconds when metal surfaces that are at or below –15°C (5°F) are touched
areas most commonly affected by frost bite
Head (face, nose, ears)
Hands (distal part of extremities)
Feet
three zones of frostbite injury
- zone of coagulation is the most severe (distal, irreversible)
- Zone of statis is the middle ground (severe, but possibly reversible, cell damage)
- zone of hyperemia is the most superficial (proximal, least cellular damage, recovers without treatment <10 days)
*it is in the middle zone for which treatment may have benefit if the circulation in the frozen area can be restored
Least to most sensitive tissu in frost bite
(CLB-CEB-MNB)
cartilage
ligament
blood vessel
cutis
epidermis
bone
muscle
nerve
bone marrow
True or False: technetium-99 scintigraphy (bone scan) has prognostic value and may guide subsequent therapy
TRUE
First definitive step in the treatment of frostbite
Rapid rewarming is the first definitive step of frostbite therapy and should be initiated as soon as the risk of refreezing injury can be avoided
