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Pediatric Board Review > Emergency Care > Flashcards

Emergency Care Flashcards

0
Q

Is there a sex bias with sexual abuse?

A

Yes girls account for 75% of reported cases. 1 in 4 girls and 1 in 10 boys.

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1
Q

Is there a sex bias to physical abuse?

A

Yes, boys more than girls

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2
Q

What is the age of a bruise that is red?

A

< 1 day

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3
Q

What is the age of a bruise that is blue in color?

A

Day 1-4

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4
Q

How old is a bruise when it is green in color?

A

Day 5-7

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5
Q

What is the age of a bruise when it is yellow in color?

A

Day 7-10

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6
Q

Burns account for what percentage of abuse?

A

5%

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7
Q

What feature make a burn less likely to be abuse?

A

Asymmetric location

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8
Q

A head injury in a child <1 year usually represents?

A

Abuse

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9
Q

Are there bone fractures more specific for abuse?

A

Bucket handle (epiphyseal-metaphysical) and rib fractures

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10
Q

When should you consider abuse in fractures of what bones?

A

Skull, femur, ribs

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11
Q

What type of scans are useful for detecting rib fractures?

A

Bone scans- a soft callus forms at 7-10 and before this time there is a sharp fracture

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12
Q

Do sexually abuse children have abnormal genital or anal findings?

A

Very few

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13
Q

What is miosis?

A

Pinpoint pupils

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14
Q

What is mydriasis?

A

Dilated pupils

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15
Q

What are the common drugs that induce miosis?

A

COPS: Cholinergics, clonidine; Opiates, organophosphates; Phencyclidine, phenothiazines, pilocarpine; Sedatives (barbiturates)

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16
Q

What are the common causes of mydriasis?

A

AAAS: Anticholinergics (atropine); antihistamines; Antidepressants (cyclic); Sympathomimetics (amphetamine, cocaine, LSD

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17
Q

What are the common causes of diaphoretic skin?

A

SOAP: Sympathomimetics (amphetamine, cocaine, LSD), organophates, aspirin (salicylates), PCP (phencyclidine)

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18
Q

What are the causes of red skin?

A

Carbon monoxide, boric acid

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19
Q

What are the common causes of blue skin?

A

Cyanosis, methemoglobin

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20
Q

What might increase anion gap?

A

MUDPILES: methanol, uremia, DKA, phenol, iron, INH, lactate, ethanol, ethylene glycol, salicylates

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21
Q

What substances might be seen on an X-Ray?

A

CHIPES: choral hydrate, calcium, heavy metals, iron, phenothiazines, enteric coated substances, sustained release tablets

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22
Q

How much activate charcoal should be given?

A

1 gm/kg

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23
Q

When is charcoal ineffective or contraindicated?

A

CHEMICAL CamP

Caustics, Hydrocarbons, Electrolytes, Metals, Iron, Cyanide, Alcohols, Lithium, Camphor, phosphorus

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24
Q

Is Ipecac recommended for home use?

A

No

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25
Q

What are the symptoms of Anticholinergic ingestion?

A

Dry as a bone, red as a beet, blind as a bat, mad as a hatter, hot as a hare

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26
Q

What is the treatment for Anticholinergic ingestion?

A

Charcoal

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27
Q

How many stages of iron toxicity are there?

A

5

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28
Q

What is the first stage of iron toxicity?

A

GI stage: duration 30 min to 6 hours

  • nausea- vomiting,
  • hematemesis & bloody diarrhea
  • symptoms related to direct damage to GI
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29
Q

What is the second stage of iron toxicity?

A

Stability: duration of 6-12 hours

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30
Q

What is the third stage of iron toxicity?

A

Systematic toxicity- within 48 hours

  • hypovolemic shock, cardiovascular shock
  • severe metabolic acidosis - anions gap
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31
Q

What is the fourth stage of iron toxicity?

A

Hepatotoxic its - 2-3 days post ingestion
Hepatic failure
Coagulation failure worsens GI bleeding

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32
Q

What is the 5th stage of iron toxicity?

A

GI/ pyloric scarring- 2-6 weeks post-ingestion

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33
Q

A serum iron level 4 hours post ingestion of a toxic ingestion should be?

A

> 500 mcg/dL

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34
Q

What is the treatment for iron toxicity?

A

IV deferoxamine

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35
Q

What is the classic triad of opiate ingestion?

A

Coma, respiratory depression, and pinpoint pupils (miosis).

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36
Q

What is seen with phenothiazine ingestion?

A

Dose dependent dystonia of the neck, tongue, and oculogyric crisis.

37
Q

What is the treatment for phenothiazine ingestion?

A

IV or IM Benadryl

38
Q

What are the acute findings of salicylate ingestion? Remember oil of wintergreen

A

GI-nausea/vomiting

Respiratory- hypernea leading to respiratory alkalosis, and TINNITUS

39
Q

Name the common electrolyte abnormalities in theophylline toxicity?

A

Increase glucose and calcium and decreased potassium and phosphate and metabolic acidosis

40
Q

What are the findings in tricyclic antidepressant ingestion?

A

Tachycardia, hyper or hypotension, widen QRS, and prolonged QT.

41
Q

What are the common findings of TCA ingestion?

A

CCCA- coma, convulsions, cardiac dysrhythmiaa, acidosis

42
Q

What is the treatment for TCA overdose?

A

Charcoal, sodium bicarbonate, and lidocaine for the dysrhythmiaa

43
Q

Carbon monoxide toxicity has what symptoms

A

Headache, malaise, nausea, cherry red skin even coma and seizures

44
Q

What is the treatment for carbon monoxide toxicity?

A

High flow oxygen- decreases half life of CO

45
Q

How should you diagnose CO toxicity?

A

Blood gas

46
Q

Acid ingestion can cause severe gastritis, perforation, or late strictures without mouth/esophagus burns?

A

Yes

47
Q

What are the similarities between ethanol, methanol, and ethylene glycol ingestion?

A

High osmolal gap, metabolic acidosis, GI symptoms (N/V), drowsiness, ataxia

48
Q

What are the differences between ethanol, methanol, and ethylene glycol ingestion?

A

Ethanol- hypothermia, hypoglycemia
Methanol- blurry vision with photophobia, optic nerve damage
Ethylene glycol- respiratory problems, renal failure, cardiac failure

49
Q

Organophosphate ingestion leads to the inhibition of cholesterase and what symptoms?

A

DUMBELS:

Diarrhea, Urination, miosis, Bronchorrhea/bronchi spasm, Emesis, Lacrimation, salivation

50
Q

What is the treatment for organophosphate ingestion?

A

Charcoal, atropine, and pralidoxime (2-PAM)

51
Q

What plants have a Digitalis effect?

A

Foxglove, lily of the valley and oleander

- confusion, irregular pulse, loss of appetite, palpitations

52
Q

What plants give atropine like effects?

A

Jimpson weed, deadly nightshade-

Bradycardia, irregular heart rhythms, dilated pupils, dry mouth, ataxia

53
Q

What plants have cyanide effects?

A

Pear and apple seeds, peach pit, bitter almond

-inhibits complex IV-weakness, HA, giddiness, vertigo,

54
Q

What are two common organism found in a cat bite infection?

A

Pasteurella and staph aureus.

55
Q

What organisms are found in dog bites?

A

Pasteurella, staph aureus and DF2

56
Q

What is the best treatment for snake bites?

A

Keep area BELOW the heart and provide wound pressure(do not excise and suction)

57
Q

How are burns classified?

A

By burn depth.

58
Q

What is the leading cause of unintentional pediatric death?

A

Burns

59
Q

What are first degree burns?

A

Superficial, red, dry, minor swelling and pain. Heal in 5-7 days

60
Q

What are second degree burns?

A

Partial thickness, red, wet, very painful, heal in 2-5 weeks. The tissue underneath is still well perfused

61
Q

What is a third degree burn?

A

Full thickness, dry, leathery, waxy, and there is no pain. They require grafts for healing

62
Q

What are the rule of “9” in calculating burn surface area?

A 
Head & neck=9%
Each upper limb=9%
thorax and abdomen-front=18%
Thorax & back=18%
Perineum=1%
Each lower limb=18%
63
Q

What is the rule Palm

A

Each child’s Palm not including fingers=1%

64
Q

How do manage a near drowning victim.

A

Hospitalize all near drowning patients for at least 12 hours. Respiratory symptoms will develop within 8 hours.

65
Q

What are the findings of basilar skull fracture?

A

Raccoon eyes, battle sign, and hemotympnorium

66
Q

Describe the findings of a temporal bone fracture?

A

Bleeding from external auditory canal, CSF otorrhea, hearing loss, facial paralysis.

67
Q

When is CT with bone windows preferred?

A

Depressed mental status, focal neuro signs, seizures, irritability, bulging fontelle, LOC> 1 min

68
Q

How are growth plate fractures classified?

A

Salter-Harris classification

69
Q

What is a Salter-Harris type 1 fracture?

A

Fracture through the epiphysis and metaphysics. Growth plat is left intact. Cannot occur if growth plate is fused.

70
Q

What is a Salter-Harris type 2 fracture?

A

A fracture where the metaphyseal bone separates from the epiphysis. The growth plate remains intact. Remember this by “above” growth plate up through the metaphysics. Most common.

71
Q

What is a Salter-Harris-Harris 3 fracture?

A

A fracture through the epiphysis extending to the epiphyseal plate. Surgery is usually required. This is a fracture down through the epiphysis.

72
Q

What is a type 4 Salter-Harris fracture?

A

A fracture that extends from the articular surface , through the epiphysis, and through the metaphysics. Surgery is required and there is growth plate compromise. The proliferate and reserve zones are interrupted.

73
Q

What is a type 5 Salter-Harris fracture?

A

A crush fracture to the epiphysis.

74
Q

What is the most common fracture in children < 10 years?

A

Clavicle fx. Treatment is immobilization

75
Q

Where is the most common place for a buckle fracture?

A

Distal radial metaphysics

76
Q

In a young child with a spiral fracture of a lower extremity, femur- is called what?

A

A toddler’s fracture.

77
Q

A spiral fracture in a non-walking child should make you suspicious of what?

A

Abuse.

78
Q

What is the concern for a distal humerus fracture?

A

Neuro vascular status due to brachial artery, median and radial nerves near.

79
Q

What is compartment syndrome?

A

Common with tibial and supra condylar fractures- swelling that compromises vascular system and ischemia.

80
Q

What is nursemaids elbow?

A

Subluxation of the radial head.

81
Q

When are the usual ages for nursemaid’s elbow to occur?

A

6 months to 5 years.

82
Q

How does subluxation happen?

A

Axial traction on an out stretched arm, the annular ligament slides over the radial head.

83
Q

How is the subluxation reduced?

A

Supinate the forearm and flex the elbow

84
Q

What is the definition of a sprain?

A

Injury to a ligament around a joint.

85
Q

What are the common findings is a sprain?

A

Tenderness, swelling and bruising

86
Q

How do you treat an ankle sprain?

A

RICE: rest, ice, compression, elevation

87
Q

What are the symptoms of corneal abrasion?

A

Pain, tearing, photophobia, decreased vision

88
Q

What is hyphenated?

A

Blood in the anterior chamber of the eye.

89
Q

Does chest compressions change location in infants versus children?

A

Blows to the back < 1 and Heimlich > 1 year

Pediatric Board Review (10 decks)

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