Annual exam

Question 1

IO access in children

Answer 1

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

Question 2

Contraindication for IO access

Answer 2

• proximal ipsilateral fracture
• ipsilateral vascular injury
• severe osteoporosis or osteogenesis imperfecta

Question 3

Complications of IO

Answer 3

• cellulitis
• osteomyelitis
• iatrogenic fracture or physeal plate injury
• fat embolism (rare)

Question 4

following formula can reasonably estimate the cuffed endotracheal tube size, as measured by internal diameter, in children >1 year of age

Answer 4

(age/4) + 4

Question 5

TRUE or FALSE: Straight laryngoscope blades (Miller) are preferred to curved blades in young children

Answer 5

TRUE

Question 6

Depth can be estimated using the formula

Answer 6

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

Question 7

Cornea anatomy

Answer 7

Top to bottom:
- Pavement epithelium
- bowman layer
- Stroma
- Descemet membrane
- Endothelium

Question 8

Sclera anatomy

Answer 8

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

Question 9

UTZ finding of globe rupture

Answer 9

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

Question 10

Peak incidence of acute OM in children

Answer 10

6 and 12 months of age

*Breastfeeding in infancy is protective and decreases the risk of AOM

Question 11

True or False: Compared with adults, the eustachian tube in children is shorter and more horizontally oriented

Answer 11

TRUE

Question 12

Most common bacterial pathogens in Acute OM in children

Answer 12

• 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

Question 13

Most common acute complication of Acute OM

Answer 13

tympanic membrane perforation

Question 14

Gold standard for the diagnosis of Acute OM

Answer 14

Tympanocentesis is the gold standard for diagnosis

*Diagnosis is clinical

Question 15

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

Answer 15

TRUE

Question 16

Clinical Criteria for Acute OM

Answer 16

• 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)

Question 17

TRUE or False: Apply topical analgesics in patients with perforation of the tympanic membrane and those with tympanostomy tubes

Answer 17

FALSE: Contraindicated

Question 18

require prompt treatment with antibiotics (Acute OM)

Answer 18

• <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

Question 19

(Initial Antibotics) first line treatment for Acute OM

Answer 19

• 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

Question 20

When alternating black-and-white lines are passed from one side to another in front of a patient’s eyes __ will occur

Answer 20

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

Question 21

Used to confirm posterior BPPV

Answer 21

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

Question 22

Skin temperature when frostbite occurs

Answer 22

<OC (<32F)

*Frostbite can develop within 2 to 3 seconds when metal surfaces that are at or below –15°C (5°F) are touched

Question 23

areas most commonly affected by frost bite

Answer 23

Head (face, nose, ears)
Hands (distal part of extremities)
Feet

Question 24

three zones of frostbite injury

Answer 24

• 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

Question 25

Least to most sensitive tissu in frost bite

Answer 25

(CLB-CEB-MNB)
cartilage
ligament
blood vessel
cutis
epidermis
bone
muscle
nerve
bone marrow

Question 26

True or False: technetium-99 scintigraphy (bone scan) has prognostic value and may guide subsequent therapy

Answer 26

TRUE

Question 27

First definitive step in the treatment of frostbite

Answer 27

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