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Pediatric Boards > Emergency Med and Toxicology > Flashcards

Emergency Med and Toxicology Flashcards

1
Q

Acute dystonic reactions are commonly seen with what types of drugs?

A

Anti-convulsants, anti-psychotics, anti-emetics, and anti-depressants
Sustained contractions of different muscles of the face/neck/trunk/pelvis/extremities

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2
Q

How do you treat dystonic reactions?

A

IV or IM Benadryl 1-2 mg/kg

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3
Q

CPR ideal compressions per minute?

A

100-120 compressions/min

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4
Q

How often should you rotate compressors?

A

Every 2 minutes

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5
Q

Two-thumb encircling technique should be used for what age?

A

<1 years old

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6
Q

Heimlich maneuver should be used at what ages?

A

Ages 1-8 years old

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7
Q

At what depth should you push during compressions?

A

1/3 of AP diameter
<1 years old: 1.5 inches
1 years old: ~2 inches

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8
Q

What substance is found in “poppers”? Toxicity of this substance can cause what complication?

A

Amyl nitrate (vasodilator, euphoria, drops blood pressure, relaxes muscle sphincters–vaginal/anal).
Used to enhance sexual experience, especially for men who have sex with men.
Oxidizes (Fe2+ to Fe3+) oxyhemoglobin to methemoglobin– irreversibly displaces O2 off of Hgb
Hypoxemia unresponsive to oxygen administration, cyanosis, and hypotension

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9
Q

How do you reverse toxicity caused by amyl nitrate?

A 
Need to reverse methemoglobinemia-- use methylene blue
Reduces methemoglobin (Fe3+ to Fe2+), allowing oxygen to bind to Hgb again
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10
Q

Examples of hallucinogenic drugs?

A

PCP (phencyclidine), LSD, Mescaline (peyote), psilocybin mushrooms, nutmeg

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11
Q

PCP toxicity signs?

A

Paranoia, agitation, extreme mania, delusions, rhabdomyolysis

Treat with haloperidol

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12
Q

LSD toxicity?

A

Significant audio/visual hallucinations, comes from a mushroom, LSD “trip,” unpredictable aggressive behavior, can have flashbacks after trip is over

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13
Q

Risk factors for poor prognosis in a drowning incident?

A

Asystole after submersion
Submersion of >10min
Time of onset of resuscitation >10min
Resuscitation efforts >25 min

Submersion in cold water <10C can be neuroprotective.

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14
Q

Activated charcoal can be used in what type of ingestions?

A

Inactivates and prevents the absorption of anti-depressants, anti-convulsants, aspirin, tylenol

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15
Q

Activated charcoal is ineffective against which ingestions?

A

Heavy metal ingestions, caustic chemicals, alcohol

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16
Q

Iron toxicity?

A

Several phases:
I- indigestion, nausea/vomiting, abd pain, hematemesis
R- resolution
O- cardiovascular collapse and liver damage
N- narrowing of different parts of the GI tract

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17
Q

Which alcohol does not cause an anion gap metabolic acidosis, but does cause an osmolar gap?

A

Isopropyl alcohol

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18
Q

Clues for isopropyl alcohol ingestion?

A

Rubbing alcohol ingestion, fruity odor of breath (from acetone production)

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19
Q

Ibuprofen overdose?

A

Any symptoms (mostly GI symptoms) would happen within the first four hours, can discharge after that

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20
Q

True or False. Limit fluid intake in salicylate toxicity.

A

True. Due to significant metabolic/respiratory derangements, risk of death by cerebral and pulmonary edema.

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21
Q

Signs of salicylate toxicity.

A

Initially respiratory alkalosis– stimulates respiratory drive.
Also decreased GI motility. Decreased GI motility: need to do gastric lavage/charcoal and bicarbonate to alkalinize the urine
Concurrent metabolic acidosis: uncoupling of oxidative phosphorylation from aerobic respiration.

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22
Q

Treatment for iron toxicity

A

Deferoxamine

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23
Q

Treatment for any alcohol-related toxicity

A

Fomepizole (prevents the production of formic acid, which is destructive to several organs)

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24
Q

Treatment for lead toxicity

A

EDTA, dimercaprol or dipenicillinamine

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25
Q

True or False. Clonidine can have anti-cholinergic effects.

A

True.

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26
Q

Clonidine toxicity.

A

Hypotension and possible rebound hypertension, anti-cholinergic effects, dystonic reactions (cogwheel rigidity)

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27
Q

Digoxin toxicity

A

Arrhythmias, poor appetite, nausea/vomiting
Prone to arrhythmias if you have hypokalemia or hypomagnesemia (relative depolarized state)

Correct electrolyte issues, give charcoal if within the hour of ingestion, give digibind if concerned about toxic ingestion

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28
Q

True or false. CO poisoning can show 100% oxygen saturation.

A

True.

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29
Q

5H’s and 4T’s of reversible causes of arrhythmias in resuscitation.

A 
Hypothermia
Hypovolemia
Hypoxemia 
Hypo/hyper-kalemia
Hypoglycemia
Toxins
Tamponade (cardiac)
Tension pneumothorax
Thrombosis (coronary or pulmonary)
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30
Q

Toluene toxicity

A

Exposure to paint thinners
Hydrocarbon inhalation can cause– cardiac arrhythmias, non-anion gap metabolic acidosis (especially with chronic abuse)
Initial response: disinhibition and euphoria (kind of like being drunk)
Second response: CNS depression

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31
Q

What is the most common tissue injury caused by hydrocarbons?

A

Chemical pneumonitis due to high volatility and low viscosity of hydrocarbons (gasoline for example).

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32
Q

Cyanide poisoning can occur in what setting? How do you treat?

A

Fire in closed spaces, ingestion of apple/peach seeds.
Description of a bitter almond smell.
Inhibition of oxidative phosphorylation– anaerobic respiration.
Treat with amyl nitrate, sodium thiosulfate (need an oxidizing substance, will take cyanide from cytochrome oxidase and form methemoglobin)– frees up cytochrome oxidase to resume oxidative phosphorylation.

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33
Q

Treatment of serotonin syndrome?

A

Benzodiazepines (1st line), if this doesn’t work– can try cyproheptadine (anti-histamine/anti-HT2A activity–receptor where serotonin acts).

34
Q

Methemoglobinemia can lead to what oxygen saturations?

A

Partial pressure of O2 (PaO2) normal with lower oxygen saturation on ABG (oxygen is displaced)

35
Q

True or False. Bruising in a pre-ambulatory child should decrease threshold of considering NAT.

A

True. Kids who don’t cruise, rarely bruise.

36
Q

Axillary nerve dysfunction is commonly associated with what kind of injury?

A

Anterior shoulder displacement

37
Q

Cubitus varus can result from what type of injury?

A

Elbow fractures– notched bone healing (gunstock deformity due to improperly reduced of elbow)

38
Q

A nursemaid’s elbow is also known as?

A

Radial head subluxation (involving displacement of the annular ligament that anchors the radius to the ulna)

39
Q

How do you fix a nursemaid’s elbow?

A

One of two techniques:

(1) Hyperpronate the extended arm OR
(2) Supinate and flex the affected arm

40
Q

What is an alternative treatment for bite wounds in someone who cannot take Augmentin?

A

Clindamycin + Bactrim (or Doxycycline for kids >8 yrs old)

Prescribe for all types of human bites and dog/cat bites on the hand only.

41
Q

Bactrim coverage

A

Gram positive organisms (MSSA, MRSA, strep) and some gram negative organisms, especially GI/GU bugs (Proteus, E.coli, Klebsiella)

42
Q

Mechanism of metabolic acidosis for salicylate poisoning.

A

Salicylates uncoupled oxidative phosphorylation from aerobic respiration; promotion of anaerobic respiration–> lactic acidosis/ketosis.

43
Q

People with salicylate poisoning producing progressive (ACIDIC/BASIC) urine.

A

Acidic. Respiratory alkalosis, induces compensatory metabolic acidosis by promoting excretion of bicarbonate and retention of H+ at the expense of K+.

At one point, too much K+ is sacrificed–> switch to potassium sparing and excreting H+. Urine becomes paradoxically and progressively more acidic.

44
Q

Rule of 9’s to estimate BSA for burn injuries?

A 
Head and neck: 9%
FRONT of chest and abdomen: 18%
BACK of chest and abdomen: 18%
Upper extremity: 9% each whole extremity
Lower extremity: 18% each whole extremity
Perineum: 1%
45
Q

ABA form to calculate resuscitation fluids for burn injuries?

A

3ml/kg x body weight (kg) x BSA % (as a whole #, not decimal) = volume in mL that needs to be given in the next 24 hours

Split volume into halves; first half in the first 8 hours, next half in the next 16 hours.

46
Q

What age is appropriate to use the rule of 9’s to approximate partial thickness burns?

A

Age 14 or older

47
Q

Name degree of burn: Blistering, painful to even light touch, reddish-white, moist or dry lesions.

A

Partial thickness burn involving epidermis and part of dermis.

48
Q

Name the degree of burn: waxy/leathery burn that is painless. What is the risk associated with this type of burn if circumferential?

A

Full thickness burn. Can lead to circumferential eschar formation with constriction, which can cause ischemia to area distal to eschar.

49
Q

Imipramine and Aripiprazole are what class of medications? Overdose on this class of medications would lead to what type of physical findings?

A

Tricyclic antidepressants.
Cardiac conduction abnormalities, QT prolongation.
Hypotension, CNS depression.
Also has anti-cholinergic properties– dry mouth, urinary retention, gastric ileus.

50
Q

Salter Harris Classification of fractures of long bones?

A

S- straight across the physis, separation at the growth plate
A- above the physis or involving physis and metaphysis
L- lower than the physis or involving physis and epiphysis
T- through both the epiphysis and metaphysis, involving the physis
R- rammed or crush injury

51
Q

ADHD treatment?

A

Stimulant meds: Amphetamines (Adderral, Vyvanse); Methylphenidate (Ritalin, Focalin…)
Non-stimulant meds: alpha agonists (clonidine, guanfacine); SNRI (serotonin NE reuptake inhibitor– atomoxetine)

52
Q

Name the likely drug intoxication:
Decline in school performance/apathy.
Conjunctival injection and dry ENT mucous membranes.
Male gynecomastia.
Used to treat anxiety by some.
Impacts working/short-term memory, can slur speech, delayed reaction time.

A

Marijuana (THC)

53
Q

Breath-holding spells–name two types.

A

Pallid- usually in response to sudden, expected event/fear. Patient goes pale with LOC and similar jerking.

Cyanotic- upsetting trigger, excess exhalation phase of crying, turns blue with LOC. Can have hypotonia and even mild jerking/seizures. Seizures are non-threatening.

Both self-recover within 30-60 seconds, no long-lasting effects from seizures. Can D/C home immediately, no need for observation.

54
Q

Name the likely drug intoxication:
Attended party, took something called Spice or K2.
Conjunctival injection, ataxia, nystagmus.
Not normally detectable on regular urine drug screening.
Psychosis/paranoia/delusions/short-term memory loss.

A 
Synthetic cannabinoids (THC). 
More potent than marijuana and more dangerous adverse effects (can cause seizures, MI, etc).
55
Q

What drug(s) is FDA approved for aggressive/self-injurious behavior management in patients >5 years old along autism spectrum? What is its main side-effect?

A

Risperidone (Risperdal) and Aripiprazole.

Specifically for Risperidone: can cause dyslipidemia, QT prolongation and galactorrhea/elevated prolactin (atypical anti-psychotic)
Anti-dopaminergic agent: dopamine inhibits secretion of prolactin, without dopamine–prolactin levels increase

56
Q

True or False about Rett Syndrome.

(1) Language development is always lost in Rett Syndrome.
(2) Growth failure from a head circumference standpoint is usually the earliest sign of this syndrome.
(3) Gait is usually not affected.

A

(1) True
(2) True
(3) False– kids develop significant motor dysfunction and gait apraxia.

57
Q

What part of OTC cough and cold medicine is often abused?

A

Dextromethorphan (produces effects similar to hallucinogens like PCP, ketamine, LSD)

58
Q

What part of OTC cough and cold medicine is a precursor for methamphetamine synthesis?

A

Pseudoephedrine

59
Q

How long does a UDS stay positive for one-time marijuana use vs chronic marijuana use?

A

One-time: up to a week

Chronic: up to 4-6 weeks

60
Q

Name the likely drug intoxication:
Perioral/perinasal dermatitis
History of nose-bleeds, chronic resp infections.
Concerns for aspiration related lung injury.
Decreased inhibition, euphoria, stupor, sluggish.
Increase ENT secretions (rhinorrhea, lacrimation, salivation due to irritated mucus membranes).

A

Inhalation (bagging or huffing) of hydrocarbons (toluene in paint thinner, gasolene/kerosene), hydrofluorocarbons in pressurized aerosolized containers, acetone, markers, etc.

61
Q

What is a common side-effect of alpha-adrenergic agonists used to treat ADHD?

A

Clonidine and Guanfacine.

Can cause sedation– will take at least 2 weeks to get used to this, do not abruptly stop medication.

62
Q

What complication(s) can occur with abuse of anabolic steroids?

A

Early epiphyseal closure, oligospermia, elevated LFTs, hypertension, gynecomastia, decreased testicular size, increased irritability

63
Q 
Name the drug toxicity: 
Paranoid/delusional/anxious, "bad trip"
Muscle rigidity, hyperreflexia, clonus. 
\+Nystagmus
Increased blood pressure and temp instability.
Rhabdomyolysis.
A

PCP (phencyclidine)

64
Q

Possible adverse effect of abruptly stopping chronic benzodiazepine use?

A

Life-threatening seizures.

65
Q

Reversal agent of benzo overdose?

A

Flumazenil

66
Q

Name the drug being abused:

Constant skin picking.
Poor dentition with significantly dry mouth.
Thin body habitus with significant weight loss.
Disturbed sleep/insomnia/agitation.

A

Methamphetamine.

67
Q

Party rape drug used to incapacitate victims from being able to resist sexual assault.

A

Gamma-hydroxybutarate (GHB) or rohypnol

68
Q

Main effect of snorting bath salts.

A

Hallucinogenic, can also cause paranoia. Stimulant like PCP, LSD.

69
Q

Adverse effects of MDMA/ecstasy/molly use.

A

Hyperthermia, hyponatremia (can also be secondary to excessive water drinking), muscle rigidity, rhabdo, possible seizures related to hyponatremia.

70
Q

Name the drug toxicity:

Increased sense of self-esteem, alertness and awareness.
Decreased need for sleep and decreased appetite.
Can cause one to become anxious/paranoid.
Chronic nosebleeds, perforated nasal septum.
Complications of long-term use include MI, strokes and related seizures.

A

Cocaine (potent vasoconstrictor).

71
Q

Ibuprofen use within 24 hours of a UDS can lead to a false positive for what substance?

A

PCP, THC, benzos, barbiturates.

72
Q

PPI use within 24 hours of a UDS can lead to a false positive for what substance?

A

THC (cannabinoids).

73
Q

True or False. ADHD and tic disorders can often co-exist.

A

True.

74
Q

In the case that a patient being treated for ADHD has worsening of their tics, what medication can you add to their regimen to help control tics?

A

Alpha-adrenergic agonist (Clonidine, Guanfacine).

75
Q

Difference between night terrors and nightmares? What stages of sleep do each occur in?

A

Night terrors: during non-REM sleep, so usually occurs during the first third of the night; peak ages 3-12 years, not conscious during episode– no motor inhibition; usually will not recall the event the next day.

Night-mares: during REM sleep (last third of the night), muscle tone inhibited during REM sleep–so cannot move, may recall night-mare the next day

76
Q

What is the most likely cause of premature death in a patient with Rett syndrome and why?

A

Cardiac arrhythmia– MECP2 gene mutation leads to prolonged QT, which can precipitate an arrhythmia

77
Q

You can see what type of alterations in breathing patterns in children with Rett Syndrome?

A

Prolonged apnea mixed with hyperventilation spells due to autonomic dysregulation.

78
Q

True or False. Sleep-walking occurs during REM phase of sleep.

A

False– occurs during non-REM phase of sleep.

79
Q

What is a method of breaking cycle of night-terrors?

A

Pre-emptive awakening before episodes (night terror episodes tend to occur around the same time every night). Provide reassurance, will resolve by adolescence typically.

80
Q

Name the drug toxicity:

Nystagmus with respiratory depression, sluggishness, slurred speech, ataxia.

A

Barbiturates.

81
Q

Conduct disorder vs Anti-social Personality Disorder age cut-off?

A

18 years of age.

82
Q

Chronic alcohol abuser presenting with macrocytic anemia. What is the most common vitamin deficiency that you suspect?

A

Vitamin B9 or folic acid deficiency (moreso than vitamin B12).

Pediatric Boards (19 decks)

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