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Pediatric Critical Care > Board Review > Flashcards

Board Review Flashcards

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1
Q

Phospholamban

A
  • Inhibits the affinity of SR Ca ATPase for Ca

- phosphorylation relieves inhibition

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2
Q

SERCA

A

sacroplasmic reticulum Ca ATPas

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3
Q

Gs

A
  • GDP –> GTP
  • adenylate cyclase converts ATP –> cAMP
  • PKA –> Ca release
  • receptors: beta 1, 2, D1, V2
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4
Q

Gi

A
  • reduce cAMP formation

- receptors = alpha 2

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5
Q

Flow =

A

change in pressure / resistance

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6
Q

Pm =

A

mean circulatory pressure (flow = 0)

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7
Q

Cerebral vasodilators

A
  • CO2
  • NO
  • prostacyclin
  • ET-1
  • increased metabolism
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8
Q

CVP waveform - a wave

A

atrial contraction, = RVEDP

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9
Q

CVP waveform - c wave

A

early systole - TV elevates into the RA

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10
Q

CVP waveform - x descent

A

atrial relaxation

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11
Q

CVP waveform - v wave

A

filling of RA in late systole

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12
Q

CVP waveform - y descent

A

TV opens and RV passively fills

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13
Q

CVP waveform - cannon a-waves

A

AV discordance

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14
Q

CVP waveform - fused C-V waves

A

TR

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15
Q

Normal CI

A

3.3-6 L/min/m2

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16
Q

Fick Equation

A

CO = VO2/(CaO2 - CvO2)

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17
Q

Thermodilution - AUC

A

inversely proportional to CO

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18
Q

Shunt fraction

A

Qs/Qt = (CpvO2 - CaO2)/(CpvO2 - CvO2)

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19
Q

Normal shunt fraction

A

3-7%

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20
Q

O2 extraction ratio (ERO2)

A

avDO2/CaO2 (normal = 25%)

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21
Q

SVR =

A

(MAP - CVP)/CO

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22
Q

PVR =

A

(MPAP - PCWP)/CO

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23
Q

Qp/Qs =

A

(SaO2 - SvO2) / (PpvO2 - SpaO2)

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24
Q

alpha-1 receptor

A

Gq –> increased IP3, 1,2-DG and Ca

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25
Q

alpha-2 receptor

A

Gi –> decrease cAMP

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26
Q

beta-1 receptor

A

Gs –> increase cAMP

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27
Q

beta-2 receptor

A

Gs –> increased cAMP

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28
Q

D1 receptor

A

Gs –> increased cAMP

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29
Q

Gq

A
  • phospholipase C (PLC) –> IP3 and DAG
  • PKA –> increase Ca
  • receptors: alpha 1, V1
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30
Q

V1 receptor

A

Gq; vascular bed and CNS

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31
Q

V2 receptor

A

Gs; renal collecting ducts

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32
Q

Vasopressin stimulation

A
  • osmolality changes

- change in BP of blood volume

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33
Q

Milrinone MOA

A

PDE3 inhibitor (prevents hydrolysis of cAMP)

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34
Q

Nesiritide

A

recombinant BNP –> direct vasodilation

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35
Q

Digoxin MOA

A

Inhibits Na/K ATPase –> increased intracellular Ca

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36
Q

Digoxin toxicity potentiated by

A
  • hypoK
  • alkalosis
  • hypoxemia
  • catecholamines
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37
Q

Mobitz type 1

A

progressively prolonged conduction; AV node

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38
Q

Mobitz type 2

A

abrupt failure to conduct; His conduction system

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39
Q

Pacing Terminology

A

Paced; Sensed; Response

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40
Q

Adenosine side effects

A

sinus arrest, bronchospasm, vasodilation

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41
Q

Action Potential - Phase 0 drugs

A

Quinidine, Procainamide, Lidocaine, Phenytoin, Flecainide

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42
Q

Action Potential - Phase 2 drugs

A

Verapamil, Diltiazem

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43
Q

Action Potenial - Phase 3 drugs

A

Amiodarone

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44
Q

CaO2 =

A

(1.34 x Hgb x SaO2) + (0.003 x PaO2)

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45
Q

CaO2 units

A

mL O2/dL

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46
Q

Hemoglobin Saturation Curve - Left Shift

A
  • increased affinity for O2

- decrease in CO2, temp, DPG

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47
Q

Hemoglobin Saturation Curve - Right Shift

A
  • decreased affinity for O2

- increase in CO2, temp or DPG

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48
Q

Cardiac Transplant - Hyperacute Rejection

A

HLA comparability; Tx = PLEX

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49
Q

Basiliximab

A

IL_2 receptor Ab

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50
Q

ATG MOA

A

T cell lysis

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51
Q

Calcinuerin inhibitors

A

T cell inhibition; ex = cyclosporine, tacrolimus

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52
Q

LaPlace’s Law

A

P = 2T/r

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53
Q

Time constant =

A

R x C; time it takes for volume of respiratory system to decrease by 63%; normal 0.3 sec (children)

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54
Q

Dead Space Fraction =

A

PaCO2 - PetCO2 / PaCO2

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55
Q

Hypoxic Regulation of Breathing

A

Ventilation increases steeply if PaO2 < 50 (not O2 content)

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56
Q

Hypercarbic Regulation of Breathing

A
  • H+ - carotid body
  • PaCO2 - brainstem/medulla
  • hypoxia –> augmented reponse
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57
Q

PAO2 =

A
  • FiO2 x (Patm - PH2O) - PaCO2/R
  • Patm = 760
  • PH20 = 47
  • R = 0.8
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58
Q

Normal A-a gradient

A

5-10 (increases with age)

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59
Q

Diaphragm Muscle Fiber

A
  • type I = fast twitch
  • type II A = good endurance
  • type II B = more susceptible to fatigue
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60
Q

Intercostal Muscles

A
  • external –> inspiration

- internal –> expiration

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61
Q

Treatment of Invasive Aspergillosis

A

Voriconazole

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62
Q

Tidal Volume - Normal

A

7 mL/kg

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63
Q

Vital Capacity - Norma

A

65 mL/kg

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64
Q

Residual Volume - Normal

A

15 mL/kg

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65
Q

FRC - Normal

A

30 mL/kg

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66
Q

FRC =

A

Expiratory Reserve Volume + Residual Volume

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67
Q

Myclonic spasm

A

Spinal cord mediated

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68
Q

DKA - risk factors for cerebral edema

A
  • Demographic: new onset, male, < 5 yo
  • Labs: hypocarbia, increased BUN
  • Treatment: bicarbonate
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69
Q

Osmolality =

A

2 x NA + glucose/18 + BUN/2.8

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70
Q

Toxic metabolite of APAP metabolism

A
  • NAPQI

- combines with glutathione –> non-toxic conjugates

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71
Q

Octreotide

A

synthetic long-acting form of somatostatin

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72
Q

Liver failure - cerebral edema

A

NH3 –> astrocyte –> glutamine

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73
Q

Methemoglobinemia

A
  • heme in ferric state unable to bind O2
  • Dx = co-oximetry (> 30% –> symptoms)
  • Tx = methylene blue
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74
Q

Organophosphate symptoms

A

SLUDGE or DUMBELS

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75
Q

Organophosphate mechanism

A

Binds acetylcholinesterase (AchE) –> increase Ach

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76
Q

Organophosphate treatment

A
  • Pralidoxime = reactivates AchE

- Atropine = muscarinic receptor antagonist

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77
Q

RMSF rash

A
  • wrists/ankles –> trunk

- erythematous/macular –> petechial

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78
Q

RMSF lab findings

A

thrombocytopenia, anemia, hypoNa

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79
Q

Neurologic complications of hypernatremia

A
  • SDH - tearing of bridging veins

- CVST - hyperosmolality

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80
Q

Arterial line - dampening

A
  • decreased SBP
  • increased DBP
  • capacitance increased by air bubbles, compliant tubing
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81
Q

Arterial line - ring

A
  • increased SBP
  • decreased DBP
  • high spike
  • resonance in system
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82
Q

GABA

A
  • main inhibitory NT in CNS

- Cl channel complex = binding site for BZD and barbituates

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83
Q

Metolazone

A
  • thiazide like diuretic
  • inhibits Na reabsorption in the proximal convoluted tubule
  • produces diuresis even in GFR is low
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84
Q

Myasthenia gravis pathophysiology

A
  • autoimmune reduction in number of Ach receptors on skeletal muscle
  • symptoms appear when < 30%
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85
Q

Long QT syndrome

A
  • associated with congenital deafness

- avoid volatile anesthetics, ketamine, succinylcholine

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86
Q

Most common FA oxidation defect

A

MCAD

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87
Q

EKG findings in hyperkalemia

A

narrow peaked T-waves –> prolonged PR and widened QRS –> sine wave

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88
Q

Timing of DAH after BMT

A

Peri-engraftment period

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89
Q

Pneumococci gram stain

A

lancet shaped gram postive diplococci

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90
Q

VOD risk factors

A
  • female
  • abdominal radiation
  • elevated AST
  • HLA disparity
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91
Q

Pharmacokinetics in infants

A
  • elevated gastric pH
  • slower gastric emptying and intestinal motility
  • increased % body water
  • lower capacity for protein binding
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92
Q

Renal failure in rhabdomyolysis

A
  • rerrihemate
  • tubular obstruction by myoglobin casts
  • alteration in GFR
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93
Q

Uncal herniation

A
  • lateral mass lesion
  • temporal lobe herniates medially into tectorial notch
  • stretching of 3rd CN
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94
Q

Transtentorial

A

downward displacement of thalamus and hypothalamus

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95
Q

Myocyte resting state

A

actin inhibited from binding to myosin by troponin-tropomyosin complex

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96
Q

CSF passageways

A
  • foramen of Monro = lateral ventricle to 3rd ventricle
  • aqueduct of Sylvius = 3rd to 4th
  • foramen of Magendie and Luschka = outlets of 4th ventricle
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97
Q

HUS

A
  • Shiga toxin = verotoxin
  • neurologic complications have greatest impact on mortality
  • non-diarrhea associated = poorer prognosis
98
Q

VO2

A

125 mL O2/min/m2

99
Q

Chylous effusion - source of lipids

A

long chain triglycerides absorbed by lacteals in small bowel

100
Q

Adrenal failure diagnosis

A

random cortisol < 18 and stimulation change < 9

101
Q

Relative adrenal insufficiency diagnosis

A

random cortisol < 20-25 and stimulation change < 9

102
Q

Cortisol and Mortality

A

greatest in patients with high random (> 34) and poor stimulation change (< 9)

103
Q

Effects of ASA toxicity

A
  • direct stimulation of respiratory center –> respiratory alkalosis
  • compensatory metabolic acidosis from urinary exertion
  • interferes with Krebs cycle and oxidative phosphorylation
104
Q

Tx of ASA toxicity

A
  • alkalization –> shifts ASA from tissue to blood enhancing urine exertion
  • ASA = weak acid –> ionizes in alkaline urine (ion trapping)
105
Q

EKG changes in ALCAPA

A
  • Q waves and ST elevation in leads I and aVL

- LVH in precordial leads

106
Q

Warfarin MOA

A
  • inhibits hepatic production of vitamin K dependent factors (II, VII, IX, X)
  • short half life = factor VII and protein C
  • long half life = factors II, IX, X
107
Q

Rationale for excluding high risk patients in RCT

A

reduce signal to noise ratio

108
Q

Remifentanyl PK

A

elimination half-life = minutes regardless of liver/renal function or duration of infusion

109
Q

Tx of flail chest

A
  • Pain control
  • NIPPV
  • Operative fixation = last resort
110
Q

CGD

A
  • mutation in NADPH oxidase complex
  • PNA and skin/soft tissue infections
  • Staph, Serratia, Burkholderia, Aspergillosis, Nocardia
111
Q

SCID

A
  • deficiency in ADA enzyme –> severe lymphopenia

- mutation in common gamma chain –> defective function of IL-2R

112
Q

X-linked gammaglobulinemia

A
  • mutation in Bruton tyrosine kinase

- Pseudomonas, HiB, S. pneumoniae, enterovirus

113
Q

Naloxone dosing

A
  • 0.001 to 0.005 mg/kg every 2 min

- 0.1 mg/kg = full reversal

114
Q

Heparin MOA

A

binds ATIII –> converts to rapid inhibitor of serine proteases (factors Xa and IIa)

115
Q

CO poisoning

A
  • CO affinity for Hgb 204x greater than O2

- Binding of CO to Hgb –> decrease in DPG –> left shift

116
Q

Indications for hyperbaric oxygenation in CO poisoning

A
  • neurologic/cardiac symptoms
  • unconscious on scene
  • pregnant with COHb > 15%
  • COHb > 25%
117
Q

Definition of PH

A
  • PAP > 25
  • normal PCWP (< 15)
  • elated PVR (> 3 Wood units)
118
Q

Retinal findings in fungal infections

A
  • Candida = cotton like lesions

- Aspergillus = yellowish macular infiltrates

119
Q

Tetantus

A
  • Clostridium tetani = gram positive, anerobic
  • Tetanospasm - blocks release of inhibitory NTs (glycine, GABA)
  • Tetanolysin - RBC hemolysis
  • Tx = TIG, Flagyl, debridement
120
Q

Hemolytic transfusion reactions

A
  • IgM = severe reactions to major blood group Ag

- IgG = less severe reaction to minor antigens

121
Q

Digoxin toxicity

A
  • symptoms = fatigue, disturbed color perception, HA, delirium
  • PVCs = earliest sign of toxicity
  • HyperK = best prognostic correlation
  • Tx = Dig-specific Ab fragments (Dfab)
122
Q

MUDPILES

A
  • methanol
  • uremia
  • paraldehyde
  • isoniazid
  • lactate
  • ethanol
  • salicylates
123
Q

West Zones

A 
1 = apical, PA > Pa > Pv
2 = Pa > PA > Pv
3 = basilar, Pa > Pv > PA
124
Q

Half life calculation

A
  • Zero order: concentration/2 x kel

- First order: 0.694/kel

125
Q

Volume of distribution (Vd) =

A

amount of drug in body (mg) / peak serum concentration (mg/L) x body weight (kg)

126
Q

Tx of cerebral vasospasm

A
  • hypertension
  • hypervolemia
  • hemodilution
  • nimodipine
127
Q

Renin

A
  • released by JGA in response to low blood flow
  • Converts AG to AG1 –> AGII –> vasoconstriction and release of aldosterone
  • Aldosterone –> increased renal Na and water retention
128
Q

r2

A
  • coefficient of determination

- % variability in x explained by y

129
Q

Reye syndrome

A
  • vomiting
  • hyperNH3
  • increases LFTs/PT
  • cerebral edema
130
Q

Moyamoya

A
  • noninflammatory vasculopathy
  • “hazy, cloudy puff of smoke”
  • T21, NF1, SCD, CCHD (TOF, CoA)
131
Q

Acinetobacter

A
  • gram negative coccobacillus

- resistance from 1) beta lactamase, 2) underexpression of porin, 3) over expression of efflux pumps

132
Q

Colistin

A
  • increased cell membrane permeability by displacing Mg and Ca from LPS
  • anti-endotoxin - binds to lipid A portion of LPS
  • nephro and neurotoxicity
133
Q

Acidosis _______ microvascular blood flow

A

increases

134
Q

Neontal myocardium

A
  • SR underdeveloped - no T tubules
  • predominance of PS innervation
  • lower capacity to use fatty acids
  • decrease proportion of contractile elements
135
Q

AEDs - GABA

A
  • phenobarbital
  • BZD
  • VPA - increases GABA concentration
136
Q

AEDs - Na channel blockade

A
  • Phenytoin

- Carbamazepine

137
Q

Fe Overdose - Phases of Toxicity

A

1) vomiting
2) recovery
3) recurrent GI symptoms, coma, acidosis, coagulopathy, shock
4) hepatic failure
5) GI healing with pyloric scarring

138
Q

Fe Overdose - Treatment

A
  • whole bowel irrigation with polyethylene glycol

- deferoxamine = chelation; indicated if AG acidosis, Fe > 500 or significant pills on AXR

139
Q

Heart surgeries associated with higher rate of phrenic nerve injury

A
  • arterial switch
  • Fontan
  • BT shunt
140
Q

Effects of hypocarbia

A
  • cerebral vasoconstriction –> parasthesias, syncope
  • SVR/BP decrease, CO increase
  • cutaneous vasoconstriction
  • decreased coronary blood flow
141
Q

Cocaine MOA

A
  • blocks catecholamine reuptake

- increased serotonin, glutamate and aspartate –> euphoria

142
Q

Infections with Complement Deficiency

A
  • S. pneumoniae
  • H. influenzae
  • Neisseria (but milder disease)
143
Q

Chediak-Higashi

A
  • abnormal packaging of neutrophil lysosomes
  • staph aureus
  • albinism, photophobia and nystagmus
144
Q

Most common cause of sepsis after splenectomy

A

S. pneumoniae

145
Q

Cryptococcal meningitis

A
  • risk factors = HIV, steroids, organ transplant
  • CD4 response important for eradication
  • India ink stain
  • Tx = amphotericin and flucytosine
146
Q

CMV

A
  • most common viral infection after transplant
  • endoscopy = shallow erosions or ulcers
  • pathology = intranuclear inclusion bodies (owl’s eyes)
  • Tx = ganciclovir
147
Q

Parkland formula

A
  • 4 x wt x BSA = fluid over 24 hours
  • 1/2 over 8 hours; 1/2 over 16 hours
  • also add maintenance fluids
  • LR
148
Q

Phenytoin Toxicity

A
  • ataxia, nystagmus, tremors
  • hypoalbuminemia –> increased free phenytoin
  • large Vd and extensively bound to plasma protein
149
Q

EKG changes in hypothermia

A
  • prolonged PR, QRS and QT

- J wave = upward deflection after QRS

150
Q

Hyper-IgM

A
  • recurrent pyogenic pneumonia
  • parasitic diarrhea
  • stomatitis
151
Q

CCBs

A
  • bind to L-type Ca channels

- Verapamil = most cardioselective

152
Q

Hypoxemia after Bi-directional Glenn

A

hypoventilation –> increased CBF –> increased PBF

153
Q

SEM

A
  • dispersion of mean value calculated form experiment

- allows for 68% CI over the range of mean values

154
Q

Tx of Mg Overdose

A

Ca

155
Q

CPP (with correction for vertical height)

A

(mean MP - mean ICP) - elevation (in cm)/1.36

156
Q

Lung development

A
  • begins at 7 weeks
  • conducting airways complete by 16 weeks
  • mature alveoli at 36 weeks
  • pre-acinar vessels follow development of airways
  • alveolar septa transition from 2 –> 1 capillary system
157
Q

Cold calorics

A

COWS = cold opposite, warm away (refers to fast nystagmus)

158
Q

Sick euthyroid syndrome

A
  • decrease in T3
  • increase in rT3
  • normal thyrotropin
  • normal total T4
159
Q

Neostigmine MOA

A

inhibits AchE –> muscarinic effects of PS nervous system (bronchorrhea, bronchospasm, bradycardia, miosis)

160
Q

Most common cause of epiglottis

A

GAS

161
Q

Medications removed with HD

A
  • ASA
  • Li
  • Theophylline
  • Depakote
  • Barbituates
  • Ethylene glycol
  • Methanol
162
Q

Phase 1 reactions

A

= functionalization reactions (reduction/oxidation/hydrolysis)

163
Q

Phase 2 reactions

A

= conjugation reactions

164
Q

Incidence =

A

new cases in period / total population at risk (assess etiology)

165
Q

Prevalence =

A

total # of cases in a period /total population at risk

166
Q

Measure of CO2 production

A

exhaled volume x fraction of exhaled CO2

167
Q

Sinogenic intracranial complications

A
  • subdural/epidural empyema
  • brain abscess
  • orbital cellulitis
  • Pott’s puffy tumor
  • CSF WBC usually < 200
168
Q

Airborne precautions

A
  • Aspergillus
  • TB
  • Measles
  • Varicella
169
Q

Cost utility analysis =

A

cost vs. quality adjusted life-year

170
Q

Methotrexate

A
  • folate antimetabolite

- CNS toxicity = AMS, hemiparesis, seizures

171
Q

Bradykinin

A
  • vasoactive peptide
  • activated by factor XIIa
  • stimulates phospholipase A, ventilation, increased permeability
172
Q

Phospholipase A/C

A
  • activated by bradykinin

- hydrolyzes arachidonic acid and PAF from cell membrane

173
Q

Thromboxane A (TXA)

A
  • primary source = activated platelets

- platelet aggregation, vasoconstriction, increased permeability

174
Q

Platelet activating factor (PAF)

A
  • g-protein

- increased permeability, vasoconstriction, neutrophil activation

175
Q

Hypersensitivity pneumonitis

A
  • trigger = bird droppings

- antigen binds to lung IgG –> complement and macrophages activation

176
Q

Indications for surgery in hemothorax

A

> 20 mL/kg or 2-4 mL/kg/hr blood loss

177
Q

Indications for intubation in GBS

A

VC < 12-15 mL/kg

NIF < - 20

178
Q

NMB Monitoring

A
  • TOF - 4 < 75%, 3 = 80%, 2 = 85%, 1 = 90%, 0 = 100%
  • Onset: small muscles –> large muscles –> special muscles
  • head lift > 5 second = most sensitive for assessing muscle strength
179
Q

Wiskott Aldrich

A
  • WASp protein
  • thrombocytopenia
  • severe eczema
180
Q

Endothelin

A
  • released from endothelial cells in repose to thrombin

- vasoconstriction

181
Q

Galactosemia

A
  • urine reducing substances, GALT enzyme
  • E. coli sepsis
  • cataracts
182
Q

Steroids in meningitis

A

benefit only demonstrated with H. flu

183
Q

Citrate lock

A
  • low iCa

- high total Ca

184
Q

CGD diagnosis

A

NBT, DHR, cytrochrome reduction

185
Q

CGD management

A
  • Bactrim ppx

- IFN gamma

186
Q

Lightning injury

A
  • internal burns = rare
  • massive catecholamine release –> HTN and tachycardia
  • Keraunoparalysis = transient, lower extremities, loss of sensation
  • Fixed/dilated pupils 2/2 ocular nerve damage
187
Q

Diptheria

A
  • gram positive bacillus

- toxin –> CNS and cardiac effects

188
Q

Urea cycle defects

A
  • NH3 > 150, normal AG and glucose
  • arginine deficiency –> neurologic injury
  • Tx = Na phenyl acetate and Na benzoate (N2 scavengers)
189
Q

Methanol ingestion

A
  • N/V, HA, blurred vision, metabolic acidosis
  • primary toxin = formic acid
  • Tx = bicarbonate, ethanol, HD
190
Q

Thiazide diuretic site of action

A

distal convoluted tubule

191
Q

Nephrotic syndrome

A
  • increased glomerular permeability (injury to podocyte foot process)
  • complications = infection (pneumoccocal peritonitis), VTE
  • Tx = steroids
192
Q

Hyperglycemia hyperosmlolar syndrome (HHS)

A
  • Dx = glucose > 600, osm > 330, lack of significant ketosis
  • Tx = more fluids, less insulin
  • cerebral edema uncommon but risk of VTE
193
Q

Atrial natriuretic peptide (ANP)

A
  • RAAS antagonist –> reduced Na/H20 reabsorptoin

- vascular smooth muscle relaxation

194
Q

Standard deviation

A
  • measure of variability
  • 68% of individuals w/in 1 SD
  • 95% w/in 2 SD
195
Q

Succinylcholine

A
  • Ach receptor agonist
  • metabolized by pseudocholinesterase
  • adverse events = arrhythmias, HTN, increased IOP/ICP, myoglobinuria, hyperK
  • activation of muscarinic receptors –> bradycardia
196
Q

Pulmonary flow volume loop

A
  • flow = y axis
  • volume = x axis
  • restrictive = normal/increased flows with small TV
  • obstruction = scalloped, redid expiratory flow loop
  • normal = mid points have equal flow rate
197
Q

Coral snake

A
  • neurotoxin –> blockage of nicotinic receptors

- ptosis, salivation, vomiting, fasciculation’s, weakness

198
Q

Black widow

A
  • alpha-latrotoxin –> influx of Ca and massive release of Its –> autonomic stimulation
  • tachycardia, diaphoresis, HTN, muscle spasm, abdominal pain
199
Q

Brown recluse

A

local skin ulceration, DIC, renal failure

200
Q

Changes in venous return curve with PEEP

A
  • decrease in maximum venous return
  • shift inflection point of curve
  • decrease slope of curve
  • increase RAP required to inhibit venous return
201
Q

FENa =

A

(Una x Pcr) / (Ucr x Pna)

202
Q

Etomidate

A

competitive inhibitor of 11-hydroxylase

203
Q

VOD

A
  • tender hepatomegaly, hyperbilirubinemia, fluid retention
  • 30 days post-BMT
  • US - decreased hepatic vein flow, reversal of portal vein flow
204
Q

TMA diagnosis

A
  • 4% shistocytes
  • thrombocytopenia
  • increased LDH
  • decreased Hgb and haptoglobin
205
Q

Ludwig angina

A
  • gangrenous cellulitis of neck/floor of mouth
  • polymicrobial
  • “woody” induration of submandibular area
206
Q

Mycophenolate mofetil

A

inhibits inosine monophosphate dehydrogenase –> cytostatic effect on T/B cells

207
Q

Sirolimus

A

mTOR kinase inhibitor –> inhibits T cells

208
Q

HIE pathophysiology

A
  • increase in intracellular Ca
  • release of glutamate
  • vulnerable areas = CA1 region of hippocampus, cerebral cortical layers, basal ganglia, amygdala, cerebellar Purkinje cells
209
Q

Ethylene glycol ingestion

A
  • glycolic acid –> calcium oxalate –> AKI and shock
  • metabolites inhibit mitochondrial e transport chain
  • metabolism –> increased AG acidosis and decrease in osmolar gap
  • Tx = ethanol/fomepizole, HD
210
Q

Steady state drugs level after ____ half-lives

A

5

211
Q

Malignant hyperthermia

A
  • abnormal ryanodine receptor in skeletal muscle
  • trigger –> massive release of Ca
  • Tx = dantrolene, cooling
212
Q

IEM and cardiomyopathy

A
  • hypertrophic = Beckwitih Wiedemann, Hunter, Pompe

- dilated = oxidative phosphylation defects, FA oxidation defects

213
Q

Tranexamic acid

A

antifibrinolytic - inhibits activation of plasminogen to plasmin

214
Q

Toll-like receptors (TLRs)

A
  • expressed on APC (phagocytes, NK cells)
  • recognize DAMPs and PAMPs
  • remove inhibition on NF-kB —> transcription of TNFa, IL-1, IL-2
215
Q

Leukocyte adhesion deficiency

A
  • mutation in beta2-integrin CD18
  • high WBC
  • imparted wound healing
216
Q

NMB metabolism

A
  • hepatic = rocuronium

- renal = pancuronium, vecuronium

217
Q

Rapid shallow breathing index

A

< 8 breaths/min/mL/kg = predictive of extubation success in children

218
Q

Ideal position for PWCP

A

west zone 3

219
Q

Carbamazepine overdose

A
  • hepatic metabolism
  • active metabolite = 10-11-epoxide
  • symptoms = AMS, ataxia, hallucinations, blurred vision, abdominal pain, shock
  • blood dyscrasia
220
Q

Ipratroprium

A
  • blocks muscarinic Ach receptors
  • acts on proximal airways
  • onset = 15-30 minutes
221
Q

Action Potential: Phase 0

A
  • rapid depolarization

- rapid influx of Na (m gate, h gate)

222
Q

Action Potential: Phase 1

A
  • early repolarization

- K efflux

223
Q

Action Potential: Phase 2

A
  • plateau

- C influx

224
Q

Action Potential: Phase 3

A
  • repolarization

- K efflux > Ca influx

225
Q

CO2 transport

A
  • bicarb (60%), carbaminohemoglobin (30%), dissolved (10%)

- deoxygenation –> increased ability to carry CO2 (Haldane effect)

226
Q

Nicotinic receptors

A
  • autonomic ganglia

- skeletal muscle

227
Q

Muscarinic receptors

A
  • cardiac/visceral smooth muscle
  • secretory glands
  • sweat glands (innervated by SNS)
228
Q

Eagle effect

A

Decrease effectiveness in PCN at high concentration of organisms

229
Q

Risk factors for coronary artery aneurysm in KD

A
  • age < 1 or > 8 yo
  • CRP > 100
  • WBC > 30 K
  • male
230
Q

Coronary perfusion pressure =

A

aortic DBP - RA pressure

231
Q

Miller Fischer varient

A

ophthalmoplegia

232
Q

Sodium correction for hyperglycemia

A

True NA = measure Na + 1.6 x ((glucose - 100)/100)

233
Q

Sildenafil

A
  • PDE5 inhibitor

- blocks degradation of cGMP

234
Q

Reynolds number =

A

2Vrp/n (< 2000 = laminar, > 4000 = turbulent)

235
Q

Pheochromocytoma management

A
  • phentolamine (alpha blockade)

- beta blockade AFTER

236
Q

Arsenic poisoning

A
  • bloody, “rice water” diarrhea

- stocking glove peripheral neuropathy

237
Q

Lead poisoning treatment

A
  • dimercaprol (BAL) and EDTA (lead > 70)

- succorer (lead 45-69)

238
Q

Mercury poisoning treatment

A
  • dimercaprol (BAL) if clear history

- Do NOT give BAL if organic mercury –> increased CNS concentration

239
Q

Edrophonium MOA

A

AchE inhibitor

240
Q

APRV

A
  • Phigh - set at/above plateau pressure
  • Thigh = 4-6 s
  • Plow
  • Tlow = 0.3-0.8 s
  • requires spontaneous ventilation
241
Q

Burns

A
  • superficial = 1st degree
  • superficial dermal = superficial 2nd degree (painful, dry edema, blanching, resemble sunburn)
  • deep derma = deep 2nd degree (waxy)
  • full thickness = 3rd degree (leathery, dry, painless)

Pediatric Critical Care (7 decks)

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