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1. Pediatrics > Emergency Medicine > Flashcards

Emergency Medicine Flashcards

1
Q

[EM/Toxicology]

Categories of drug for ‘excited’ (agitation, hypertension, tachycardia, hyperventilation, hyperthermia, mydriasis) (3)

A
  1. Anticholinergics (antihistamin, TCA, atropine)
  2. Sympathomimetics (pseudoephedrine, cocaine, amphetamine)
  3. Hallucinogens (LSD, Psilocybin)
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2
Q

[EM/Toxicology]

Categories of drugs for ‘depressed’ (obtundation, hypotension, bradycardia, hypoventilation, hypothermia, miosis) (4)

A
  1. Cholinergics (organophosphate, insecticides)
  2. Sympatholytics (clondine)
  3. Opiates (oxycodone)
  4. Sedative-hyponitcs (BZ, barbiturates)
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3
Q

[EM/Toxicology]

Anticholinergic toxidrome (7)

A

Dry, flushed skin
Hyperthermia
Mydriasis
Agitation, delirium, hallucinations
Urinary retention, decreased bowel sounds
Tachycardia, hypertension

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4
Q

[EM/Toxicology]

Cholinergic toxidrome (7)
D
U
M
B
E
L
S

A

Diarrhea
Urination
Miosis
Bronchorrhea, bronchospasm, bradycardia
Emesis
Lacrimation
Salivation

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5
Q

[EM/Toxicology]

Which toxidrome?

Muscle weakness, fasciculation, paralysis
Respiratory depression, lethargy, seizures, coma
Bradycardia

After Insecticides (organophosphate/carbamate) ingestion

A

Nicotinic toxidrome

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6
Q

[EM/Toxicology]

Which toxidrome?

CNS depression
Miosis
Respiratory depression/apnea
Bradycardia, hypotension

A

Opioid toxidrome

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7
Q

[EM/Toxicology]

Which toxidrome (class)?

Agitation, tremors, hallucinations, seizures
Tachycardia, hypertension
Mydriasis

Ingestion of
Pseudoephedrine
Psychostimulants, cocaine, amphetamines

A

Sympathomimetic toxidrome

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8
Q

[EM/Toxicology]

Which agent?

Sympathomimetic toxidrome (agitation, tachycardia, mydriasis)
With vertical nystagmus, miosis

A

PCP (Phencyclidine)

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9
Q

[EM/Toxicology]

Examples of anticholinergics (5)

A
  1. Antihistamin
  2. Neuroleptics (chorpromazine, quetiapine)
  3. Tricyclinc antidepressants
  4. Atropine
  5. Antispasmodics (hyoscyamine)
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10
Q

[EM/Toxicology]

Examples of sympathomimetics (5)

A
  1. Ephedrine
  2. Dextromethorphan
  3. Cocaine
  4. Amphetamine/methamphetamine
  5. MDMA (ecstasy)
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11
Q

[EM/Toxicology]

Examples of hallucinogens (3)

A
  1. LSD
  2. PCP
  3. Mescaline, psilocybin
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12
Q

[EM/Toxicology]

Examples of cholinergics

A

Insecticides (organophosphate, carbamate)

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13
Q

[EM/Toxicology]

Examples of sympatholytics (1)

A

Clonidine

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14
Q

[EM/Toxicology/Sadatives]

Examples of sedative-hypnotics (2)

A

Benzodiazepines
Barbiturates

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15
Q

[EM/Toxicology/AAP]

Acetaminophen minimal toxic dose is
___ mg/kg in < 12 years old
___ g in adults

A

150 mg/kg in < 12 years old
7.5 g in adolescent/adults

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16
Q

[EM/Toxicology/AAP]

Symptoms of acetaminophen toxicity

Stage 1 (0-24 hours): ___
Stage 2 (1-3 days): ___
Stage 3 (3-4 days): ___
Stage 4 (4-14 days): ___

A

Stage 1 (0-24 hours): nausea/vomiting, normal LFT
Stage 2 (1-3 days): RUQ pain, Increased LFT, PT/INR
Stage 3 (3-4 days): fulminant hepatic failure, coagulopathy
Stage 4 (4-14 days): recovery or death

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17
Q

[EM/Toxicology/AAP]

Treatment of acetaminophen toxicity

If less than 1 hour: ___
If toxicity is possible: ___

A

If less than 1 hour: activated charcoal
If toxicity is possible: NAC (N-acetylcysteine)

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18
Q

[EM/Toxicology]

Which ingestion?
Treatment?

Tinitus
GI: Nasuea/vomiting
Respiratory: tachypnea, respiratory alkalosis
Metabolic: anion gap acidosis,
CNS: agitation, coma

A

Salicylate ingestion

  • Treatment:
    Alkalinization with sodium bicarbonate
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19
Q

[EM/Toxicology]

Which class drug ingestion and treatment?

Bradycardia, hypotension, ventricular dysrhythmias
Hypoglycemia

A

Antihypertensives (b-blocker)
(If HYPERglycemia, CCB)

Treatment:
Glucagon
Vasopressor

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20
Q

[EM/Toxicology]

Which class drug ingestion and treatment?

Bradycardia, hypotension, ventricular dysrhythmias
Hyperglycemia

A

Calcium channel blocker
(HYPOglycemia: b-blocker)

Treatment:
Calcium gluconate

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21
Q

[EM/Toxicology]

Which class drug ingestion?

CNS and respiratory depression, pinpoint pupils, bradycardia
Hypothermia
Anticholinergic effects; dry mouth, constipation

A

Clonidine (Symphatolytics)
(Opiate: no hypothermia/anticholinergic effects)

22
Q

[EM/Toxicology/Iron]

5 phases of iron ingestion?

A
  1. GI phase (30 min to 6 hours): nausea/vomiting, diarrhea
  2. Relative stability phase (6 hours to 1 day): asymptomatic
  3. Systemic toxicity phase (1-3 days): hypovolemic shock, anion gap metabolic acidosis
  4. Hepatic toxicity (within 2 days)
  5. GI/pyloric scarring (2-6 weeks): bowel obstruction
23
Q

[EM/Toxicology/Iron]

Treatment for iron toxicity?

A

Deferoxamine (if iron level > 500 µg/dL)

24
Q

[EM/Toxicology]

Which drug ingestion?
Treatment?

Convulsions, coma,
Cardiac dysrhythmias: QRS prolongation
Acidosis

A

TCA (triCyClic Antidepressants)

  • Treatment:
    Sodium bicarbonate
25
Q

[EM/Toxicology]

Serotonin syndrome vs NMS and its treatment

Myoclonus, hyperrefelxia
Hypertension, tachycardia
Confusion, hallucination

A

Serotonin syndrome (SSRIs, MAOIs)
(Myoclonus is specific to serotonin syndrome)

Treatment:
Benzodiazepine, cyproheptadine

26
Q

[EM/Toxicology]

Which class of drug ingestion?

Bruxism
Hyponatremia
Hypertension, tachycardia
Confusion, hallucination

A

MDMA (Ecstasy)
(Bruxism, hyponatremia is specific to Ecstasy)

27
Q

[EM/Toxicology]

Serotonin syndrome vs NMS

Muscle rigidity: torticolis, protruding tongue
Autonomic instability
Muscle rigidity
Hyperthermia
Confusion

A

Neuroleptic malignant syndrome
: idiosyncratic drug reaction to antipsychotics or metoclopramide
(Muscle rigidity and autonomic instability is NMS, not in serotonin syndrome)

28
Q

[EM/Toxicology]

Methemoglobinemia vs CO poisoning, and its treatment?

Low pulse oxymetry
Normal PaO2
Chocolate brown blood
Signs of amyl nitrites ingestion (poppers)

A

Methemoglobinemia

Treatment: methylene blue

29
Q

[EM/Toxicology]

Methemoglobinemia vs CO poisoning, and its treatment?

Flulike symptoms
Cherry-red skin
Normal pulse oxymetry
Normal PaO2

A

CO poisoning

Treatment: high flow oxygen with non-rebreather mask

30
Q

[EM/Toxicology]

Which metal poisoning and its name?

A

Lead poisoning

Burton line: blue line along the gum
Basophilic stippling

31
Q

[EM/Toxicology]

Which chemical poisoning?

Smoke inhalation
Profound lactic acidosis
High oxygen in venous gas

A

Cyanide poisoning

32
Q

[EM/Toxicology]

Which chemical poisoning?

Aspiration pneumonitis with ingested
Ventricular arrhythmias when inhaled
(no metabolic acidosis)

A

Hydrocarbons: gasoline, lighter fluid, etc

33
Q

[EM/Toxicology]

Ethanol vs methanol vs ethylene glycol and its treatment

CNS depression
Hypothermia
Hypoglycemia
High osmolal gap
High anion gap metabolic acidosis

A

Ethanol

Treatment:
IV fluid, ABCs, supportive care

34
Q

[EM/Toxicology]

Ethanol vs methanol vs ethylene glycol and its treatment

Visual disturbance
Abdominal pain
CNS depression
High osmolal gap
High anion gap metabolic acidosis without high lactate or ketones

A

Methanol: windshield washer, fuel additive

Treatment:
fomepizole
Folinic acid

35
Q

[EM/Toxicology]

Ethanol vs methanol vs ethylene glycol and its treatment

CNS depression
Acute kidney injury leading to renal failure
High osmolal gap
High anion gap metabolic acidosis without high lactate or ketones

A

Ethylene glycol: anti-freeze

Treatment:
Socium bicarbonate
Fomepizole
Thiamin, pyridoxine

36
Q

[EM/Toxicology]

Which chemical poisoning and its treatment?

Cholinergic effects: DUMBLES
Nicotinic: twitching, weakness, paralysis

A

Organophosphate: pesticides

Treatment:
Atropine
Pralidoxime

37
Q

[EM/Envenomation]

Which insect bite and its treatment for systemic?

Painless for 2-8 hours
Hemorrhagic blister in 1-2 days
Necrotic ulceration
Some develop systemic symptoms: fever, N/V, myalgias, rash

A

Brown recluse spider

Treatment:
If systemic, steroid

38
Q

[EM/Envenomation]

Which insect bite and its treatment?

Pain starts within 30-60 minutes
Rash with hallow target sign
Diaphoresis, muscle cramping, abdominal pain
Agitation
Hypertension
Rhabdomyolysis

A

Black widow spider

Treatment:
Supportive care
Antivenom is not used due to mortality

39
Q

[EM/Trauma/Burn]

Burn surface area determination, > 14 years old

Head and neck: ___
Each upper limb: ___
Thorax and abdomen, front: ___
Thorax and abdomen, back: ___
Perineum: ___
Each lower limb: ___

A

Head and neck: 9%
Each upper limb: 9%
Thorax and abdomen, front: 18%
Thorax and abdomen, back: 18%
Perineum: 1%
Each lower limb: 18%

40
Q

[EM/Trauma/Burn]

Burn fluid calculation

Parkland formula for 14 years old: ___
ABA criteria for < 14 years old: ___

A

Parkland formula for 14 years old: 4 ml/kg x BSA
ABA criteria for < 14 years old: 3 ml/kg x BSA

50% in the first 8 hours and the rest in 16 hours

41
Q

[EM/Trauma/Bone]

Growth plate injuries: Salter-Harris classification

Type 1: S___
Type 2: A___
Type 3: L___
Type 4: T___
Type 5: R___

A

Type 1: Straight across
Type 2: Above
Type 3: Lower
Type 4: Through
Type 5: Rammed together

42
Q

[EM/Trauma/Bone]

Name of fracture and its management?

A

Greenstick fracture: one side of cortex is broken

Management:
If no deformation, immobilization

43
Q

[EM/Trauma/Bone]

Name of fracture?
Its mechanism and management?

A

Torus (Buckle) fracture

Mechanism: falling on outstretched hand
Management: immobilization

44
Q

[EM/Trauma/Bone]

Name of fracture?
Its mechanism and management?

A

Spiral fracture

Mechanism:
Nonambulatory child - child maltreatment
Toddler - twist or jump

Management: immobilization

45
Q

[EM/Trauma/Bone]

Name of fracture?
Its mechanism?
Complication if untreated ischemic damage?

A

Supracondylar fracture

Mechanism: falling on outstretched hand

High risk for neurovascular complications: brachial artery, median/radial nerve

If untreated: Volkmann contractures

46
Q

[EM/Trauma/Bone]

Diagnosis and its mechanism and treatment?

A

Acromioclavicular sprain

Mechanism: direct blow to the shoulder
Treatment: Sling immobilizer

47
Q

[EM/Trauma/Bone]

Diagnosis and its mechanism and treatment?

A

Anterior shoulder dislocation

Mechanism: abducted, extended, externally rotated shoulder

Treatment: reduction

48
Q

[EM/Shock]

Target systolic BP minimum in shock?

A

60 mmHg for 1 month old
70 + 2 x age for > 1 month to 10 years old
90 mmHg for > 10 years old

49
Q

[EM/Toxicology]

Which drug reaction and its reaction name, treatment?

Intermittent spasmodic contraction
Or sustained involuntary contractions of muscles
: Torticollis, oculogyric crisis, facial grimacing

A

Chlorpromazine, Promethazine

Dystonic reaction to antipsychotic drugs

Treatment:
Diphenhydramine IV

50
Q

[EM/Toxicology]

Which chemical toxicity?

A

Lead poisoning

Linear line in the density of the metaphyses

51
Q

[EM/Envenomation]

Cause?

From Arizona, New Mexico
Local numbness and swelling without significant erythema
Severe systemic symptoms
- both sympathetic: tachycardia, hyperthermia
- parasympathetic: drooling, wheezing
- neuromuscular symptoms: restlessness, muscular fasciculations, ataxia, abnormal eye movements

A

Scorpion sting

1. Pediatrics (22 decks)

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