Emergency Flashcards
1
Q
Measured serum osmolality estimate formula
A
2[Na+]+[glucose]/18+[BUN]/2.8
2
Q
Anticholinergic toxidrome
A
Mad as a hatter, dry as a bone, red as a beet, hot as a hare, blind as a bat (tachycardia, urinary retention, ileus)
3
Q
Cholinergic-muscarinic toxidrome
A
DUMBELLS Diarrhoea, urination, miosis. Brady/bronchoconstrict Emesis Lacrimation Lethargy Salivation
4
Q
Cholinergic-nicotinic toxidrome
A
Days of week Miosis Tachycardia Weakness Tremors Fasiculations Seizures Somulence
5
Q
Anion gap
A
[Na+]-([Cl-]+[HCO3-])
6
Q
Resist adrenaline dose
A
10mcg/kg
7
Q
Toxins which constrict and dilate pupils
A
Constrict: organophosphates, cholinergics (tears everywhere - salivation, lacrimation, sweat, incontinent )
Dilated: anticholinergics including TCA(mad as a hatter, red as a beet, dry as a bone, Lind as s bat, hot as hell)
8
Q
Serotonin syndrome clinically
A
Agitated, delirium Tachycardia Fever Sweating Dilated pupils Nausea and vomiting Increased tone and reflexes and myoclonic jerks
9
Q
Pupils in ecstasy
A
Dilated
Cyprhepidate if antidote critical
10
Q
Carbon monoxide most important toxic mechanism
A
Reverse binding to cytochrome A3
11
Q
Iron chelation agent in overdose
A
Desferoxamine
12
Q
Snake bite most common manifestation
A
Coagulopathy
13
Q
Lead poisoning on X-ray
A
Dense white metsphysesl bands
14
Q
Mnemonic for wormian bones
A
PORK CHOPs
Pyknodysostosis Osteogenesis imperfection Rickets Kinky hair Cleidocranial dysostosis Hypothyroid hypophosphataemia Idiopathic Progeria Syndromes
15
Q
Do retinal haemorrhages occur in pertussis
A
No
16
Q
NAI fracture types
A
Spiral fracture and fracture of distal metaphasis (bucket handle and corner fracture)
17
Q
Myocarditis causes
A
Coxsackie, adeno, echo
Drugs
Immune mediated
18
Q
Chest wall rigidity SE of..
A
Fentanyl
19
Q
Hangmans frscture
A
C2 pedicels
20
Q
Jefferson frscture
A
Burst C1
21
Q
Sclerotic bone lesion
A
Think osteosarcoma
22
Q
Monteggia and galeazzi #
A
GRUesome MURder
Galeazzi radius fracture ulnur dislocation
Monteggia ulnar fracture radial head dislocation
23
Q
If VF or pulseless VT witness in monitor then..
A
Defibrillate straight away
24
Q
Adrenaline dose IM and IV
A
IM 0.01ml/kg 1:1000
IV 0.1ml/kg of 1:10000
25
What is commotio cordis
Sudden death Vf in blunt trauma to anterior chest
26
Risk with supracondylar fracture
Median nerve and brachial artery
27
How much percent pseudosubluxation. Ervicso spine 2-3 in <8 y
40%
28
Acute vestibular neuritis any hearing loss
No
29
Retinitis pigmentosa assoc with
Bardot-Bielefeld (finger and limb abnormalities)
| Usher (SNHL)
30
How common eczema in NZ kids
15-20%
31
FLG gene for filaggrin important in
Skin barrier
32
Fingertip unit steroid =
0.5g covers size of two palms of hand
33
Thumb and steeple sign on neck X-ray indicate
Thumb - epiglottitis
| Steeple - croup
34
Snake bite management
Apply a pressure immobilisation bandage - immobilise joints either side of bite (use a splint), lay the patient down. The aim is to prevent lymphatic spread of venom, not to stop blood supply
Antivenom
35
The classic findings of a what are unilateral, purulent, malodorous, sometimes bloody discharge.
Nasal FB
36
VF and pulseless VT give amiodarone when
After 3rd shock
37
Shock straight away
When witness change to a shockable rhythm on ECG
38
Beta blocker and calcium blocker antidote
Isoniazid antidote
Benzodiazepines antidote
Sulphonurea antidote
Glucagon (and calcium glauconate)
Pyridoxine
Flumazanil
Octreotide
39
Meckles investigation
• 99m Technetium pertechnetate scan for ectopic gastric mucosa
Sensitivity improved by ranitidine
Laparoscopy
40
What changes on X-ray suspicious for supracondylar fracture
Posterior fat pad (anterior can be normal)
41
Ossification centres elbow
Ossification centres
• Appear in a predictable order
• Mnemonic: CRITOE
• Ages of appearance are approximately
• capitellum (age 1)
• radial head (age 3)
• internal epicondyle (age 5)
• trochlea (age 7)
• olecranon (age 9)
• external epicondyle (age 11)
42
Salter Harris two and three
ME
2: metaphasis
3: epiphysis
43
Spinal shock HR and BP
Both low
44
RF arthritis treatment
Naproxen
45
Penicillin prophylaxis until what age with severe
40y
46
Cardiac Surgery within 6m need IE prophylaxis?
Yes
47
Wormian bones differential
PORK CHOPS
Pyknodysostosis
• Osteogenesis imperfecta
• Rickets (healing phase)
• Kinky hair (Menkes disease)
• Cleidocranial dysostosis
• Hypothyroidism/Hypophosphatasia
• IdiOpathic
• Pachydermoperiostosis/Primary acro-
osteolysis/Progeria
• S
48
Cocaine antidote
Sodium bicarbonate
49
Snake bite (brown, tiger and red bellied black effects)
Brown - consumptive coagulopathy can collapse and have cardiac arrest
Tiger - consumptive coagulopathy and systemic symptoms common
Red bellied black - anticoagulant and common to have systemic symptoms
50
Dance sign RLQretracted in
Intussusception
51
Wrist drop from
Radial nerve
52
Mx bleeding oesophageal varices
Gastroscopy and balloon tamponade
Octreotide
Fix clotting
Beta blocker and PPI
53
Most common bacterial infection and causes
```
OM
viral (25%)
Streptococcus pneumoniae (35%)
non-typable strains of Haemophilus influenzae (25%)
Moraxella catarrhalis (15%).
(Second is UTI)
```
54
Burns resuscitation fluid if what percent or more body surface burnt
10%
55
Recent trip to Asia
| Fever + 2 of myalgia, retro-orbital pain, arthralgia, headache, leucopoenia, haemorrhagic manifestations
Dengue fever
56
India travel
| Constipation, abdominal pain. Diarrhoea a late sign. Rose spots rare in childhood
Typhoid
57
Respiratory
GI neuro fever
Trip overseas
Think malaria
58
Ramsay Hunt syndrome can cause
painful shingles rash, facial paralysis and hearing loss in the affected ear.
59
```
Presents with muscle weakness
Tingling, numbness, and/or burning in the feet, hands, arms, and legs
Confusion or forgetfulness
Paranoia
Macrocytic anaemia
Homocysteinuria and MMA in urine
Cause?
```
12 deficiency
60
Lacy rash after red cheeks illness cause
Parvovirus B19
61
When will surgeons correct undesc testes
6-12m
62
Age to operate hydrofoils and umbilical hernia
3y
63
```
In children with reading disability (developmental dyslexia) the underlying neurocognitive deficit most
commonly occurs in:
A. attention.
B. auditory processing.
C. phonemic awareness.
D. saccadic visual tracking.
E. sensorimotor perception
```
C
64
Horners and brachial plexus injury at what level
T1
65
4/5th digits sensation
Ulnar nerve
| Rest fingers by median nerve (affected in carpal tunnel)
66
What is the most common cause of persistent hypoglycaemia under 2 years? The presence of ketonuria and/or ketonaemia makes this diagnosis very unlikely.
Hyperinsulinism
DDx no ketones and fatty acids in blood and Carnitine / acylcarnitine in blood is fatty acid disorder
67
Reducing substances in urine with hypoglycaemia indicate either
Galactosaemia
| Fructosaemia
68
Urinary amino acids and organic acids indicate
Urea cycle defect
69
Reversal agent if collapse from local anaesthetic
IV lipid emulsion
70
BP drop more 10mmHg in systolic BP with inspiration
| Two other pulmonary causes
PE and tension pneumothorax
| Tamponade
71
Infant presents like MAS with ferritin >10,000 caused by?
HLH
(Neonatal haemochromatosis presents earlier)
Can be induced by EBV
72
Hearing affected with vestibular neuritis or labyrinthitis?
Labyrinthitis
73
Chorea treatment
Carbamazepine
74
Klumpke and Rebs roots?
C5-7 Rebs
| C8/T1 klumpke
75
Enzyme immunoassay used to detect
Antigen
76
Antidote to antifreeze (ethylene glycol or methanol)
Ethanol
| Fomepizole
77
10 year old with ataxia worsening, hypertrophic cardiomyopathy, diabetes and scoliosis
Diagnosis?
Friedreichs ataxia
78
Arnold chiari malformation associated with?
CT disorders
79
Three triples repeats and one that doesn't exhibit anticipation
You hunt animals and put them in the cage: Huntington Disease CAG
You SEE a Gross Guy: Fragile X Syndrome CGG
You SEE Tonic Gestures: Myotonic dystrophy CTG
GAA with FXN friedreichs ataxia
80
Heinz bodies and bite cells on film indicate?
G6PD
81
Collage affected in osteogenesis imperfect
Collagen 1
| COL1A1 and 1A2
82
Egg anaphylaxis can you give MMR?
Yes
83
Three causes of eisenmenger syndrome
| Clubbing, cyanotic, RVH, increased P2 from plum HTN
PDA
VSD
AVSD
84
Diagnostic changes in sexual abuse found in what percent
4%
