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Pediatric Board Prep > Emergency Medicine and Maltreatment syndromes > Flashcards

Emergency Medicine and Maltreatment syndromes Flashcards

1
Q

What is the best treatment for dog/ cat bites?

A

Amoxicillin-clavulanate (Augmentin)

-use Bactrim with Clindamycin if penicillin allergic

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2
Q

What is the most common complication following fracture of the orbital floor from direct blunt trauma?

A

Limitation of upward gaze (due to inferior rectus muscle entrapment)

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3
Q

what are the contraindications to use of activated charcoal for GI decontamination?

A
  1. risk of aspiration (leads to depressed mental status)
  2. late presentations (after 1 hour)
  3. requiring endoscopy
  4. heavy metal ingestion
  5. alcohol ingestion
  6. inorganic ion ingestion
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4
Q

What is the most likely diagnosis for pt presenting with coma/ minimal responsiveness, respiratory distress, miosis (pinpoint pupils), hypotension and bradycardia?

A

Opiate intoxication

treat with naloxone and supportive care with respiratory support, EKG monitoring and BP management

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5
Q

What is the most likely diagnosis for patient presenting with left upper quadrant pain, left shoulder pain, abdominal distention, rigid abdomen and echhymoses of abdomen after trauma?

A

Splenic rupture

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6
Q

What is the most likely diagnosis for child presenting with drooling, irritability, decreased oral intake, esophageal corrosion on endoscopy and Xray showing double density shadow (halo or poker chip sign) on anterior image?

A

Ingestion of button battery

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7
Q

What is the most likely diagnosis of pt presenting with sudden onset agitation, slurred speech, clenched teeth, drooling, unilateral torticollis, and fixed lateral gaze after ingestion of medication?

A

Dystonic reaction

(due to neuroleptic, antiemetic- promethazine, antidepressant)

(tx: diphenhydramine and benzotropine)

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8
Q

What is the most likely diagnosis for pt (1-4 years old) presenting with leg pain and Xray showing faintly visible, lucent line crossing the right middistal tibia obliquely?

A

Todler’s fracture

due to twisting

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9
Q

what is the difference between the 5 types of Salter- Harris fractures?

A

1: widening of growth plate, fracture through physis
2: fracture thru physis and metaphysis, metaphyseal bone fragment
3: fracture thru physis into adjacent joint, epiphyseal bone fragment
4: fracture thry physis, epiphysis and metaphysis
5: crush injury

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10
Q

What is the most likely diagnosis for pt presenting with gastric distension, abdominal pain, anorexia, bilious vomiting, palpable upper abdominal mass and XRay showing air fluid level in dilated duodenal loop, a distended air filled stomach and paucity of gas elsewhere after blunt abdominal trauma?

A

Intramural hematoma

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11
Q

What are the two diagnosis that should be of concern when a patient has been in a closed space fires?

A
  1. Cyanide poisoning (tx; O2, hydroxycobalamin, Na thiosulfate)
  2. Carbon monoxide poisoning (oxygen at 100% FiO2)
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12
Q

What is the best initial treatment for pt presenting with Serotonin syndrome (confusion, hallucinations, agitation, autonomic symptoms-diaphoresis/ shivering/ HTN/ tacycardia/ hyperthermia/ diarrhea, deep tendon hyper-reflexia, and myclonus) if diphenhydramine does not work?

A

Cyproheptadine

serotonin antagonist

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13
Q

What is the most likely diagnosis for pt presenting with hemotympanum, CSF rhinorrhea/ otorrhea, cranial nerve impairment (6,7,8), subcutaneous bleeding over mastoid process and/ or orbit 1-3 days after fall or blunt trauma to head?

A

Basilar skull fracture

Battle sign and/or Raccoon eyes

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14
Q

What is the best treatment for a pt presenting with a human bite?

A

irrigation with sterile saline and oral Augmentin (amox clav)

-closure if cosmesis or exposure of underlying vital structures demands it

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15
Q

What is the most likely diagnosis for pt presenting with discoloration of blood, decreased oxygen saturation level (SaO2), normal PaO2, and clinical cyanosis?

A

Methemoglobinemia

(can be related to taking amyl/ butyl/ isobutyl nitrites used for euphoria and anal sphincter relaxation or benzocaine)

(tx: methylene blue)

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16
Q

What is the most likely diagnosis for pt presenting with linear increased in density of the metaphysis of bone, microcytic anemia, and basophillic stippling on peripheral smear?

A

Lead intoxication

linear lines are lead lines

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17
Q

what is the most likely diagnosis of pt presenting with jaundice, fatigue, anemia with schistocytes and microspherocutes and necrotic, gangrenous ulceration at a previously erythematous site on hand?

A

Brown recluse spider bite

(brown, violin shaped marking on dorsal hand)

(tx: supportive care)

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18
Q

What toxidrome results in maniac like state, mydriasis, tachycardia, hypertension, hallucinations and nystagmus?

A

Phencyclidine PCP

aka angel dust, dummy dust, peace pill, rocket fuel, whack

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19
Q

What are factors associated with poor prognosis after submersion event? (4)

A
  1. CPR for more than 25 minutes
  2. Submersion for more than 10 minutes
  3. Delay in initiation of CPR of more than 10 minutes
  4. Submersion in water greater than 10 degrees C
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20
Q

What is the most common pediatric elbow fracture in a child 5-10 years old who falls on an outstretched hand with the elbow fully extended?

A

Supracondylar fracture of distal humerus

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21
Q

What are potential complications of a supracondylar fracture of the distal humerus? (4)

A
  1. radial/median nerve damage
  2. brachial artery damage (absent radial pulse)
  3. compartment syndrome (results in claw like deformity, Volkmann contracture)
  4. Cubitus varus (gunstock deformity)
22
Q

What is the most likely diagnosis of pt presenting with salivation, lacrimation, urination, defecation, GI discomfort, emesis, miosis (pinpoint pupils) and bronshospasm with coughing after playing outside?

A

Insecticide (organophosphate) ingestion

(SLUDGE or DUMBELS)

(tx: atropine and pralidoxine)

23
Q

what is the most concerning complication of kerosene/ gasoline (hydrocarbon) ingestion?

A

Aspiration pneumonitis

24
Q

What is the treatment for Salicylate overdose?

A

urine alkalinization

25
Q

What electrolyte derangement can prevent urine alkalinization?

A

Hypokalemia

26
Q

what metabolite is responsible for the hepatotoxicity of acetaminophen?

A

N-acetyl-p-benzoquinone (NAPQI)

27
Q

what laboratory finding on urinalysis is consistent with ethylene gycol (car radiator fluid, windshield wiper fluid) ingestion?

A

Calcium oxalate crystals

28
Q

What is the most likely diagnosis and best treatment for pt who presents with refusal to use arm, holding forearm in pronated position against body with elbow slightly bent, and pain with movement of elbow after longitudinal traction applied to extended elbow?

A 
Nursemaid Elbow
(annular ligament entrapped in radiohumeral joint; radial head subluxation)

tx: hyperpronate extended forearm (click along lateral aspect of elbow) or supinating forearm followed by flexion of elbow

29
Q

What is the calculation to determine fluid replacement in burn pediatric patient?

A

3 ml/kg for every 1% body surface area with partial or full thickness burn

(9% for head and neck, each arm)
(18% for front of thorax and abdomen, back of thorax and abdomen, each leg)
(1% for perineum)

30
Q

What is the rule of 9’s for burn patient (older than 14)?

A
  • 9% for head and neck, each arm
  • 18% for front of thorax and abdomen, back of thorax and abdomen, each leg
  • 1% for perineum
31
Q

What is the treatment for ethylene glycol ingestion?

A

IV ethanol or fomepizole

32
Q

What medication is a pt withdrawing from if they present with diaphoresis, shaking chills, agitation, confusion, psychosis, anxiety, tachycardia, hypertension and possible seizures?

A

Benzodiazepenes

similarly alcohol withdrawal can cause this

33
Q

What illicit drug can result in rhabdomyolysis (muscle tenderness, elevated CK, myoglobinurina- change in urine color, positive for blood, but no RBC seen)?

A

Phencyclidine (PCP)

34
Q

What is the most likely diagnosis for pt with rigidity and spams of masseter muscle on intubation during surgery, rhabdomyolysis (elevated CK, myoglobinurina), acidosis, and hyperthermia?

A

Malignant hyperthermia
(secondary to inhalation anesthetic)
(autosomal dominant)

35
Q

What is the treatment for malignant hyperthermia/

A

IV dantrolene

36
Q

What illicit drug ingestion is associated with hyponatremia?

A

MDMA (3,4-methylenedioxymethamphetamine)

37
Q

What is the 1st line of treatment for a pt who suffers from a venomous snake bite?

A

cleanse the wound and immbolize site

38
Q

What is the treament for iron overdose?

A

IV deferoxamine for chelation

supportive care for hypotension related to GI upset

39
Q

What substance’s ingestion results in pt presenting with fever, tachycardia, hyperpnea (rapid breathing), nausea, vomiting, and a metabolic acidosis?

A

Salicylate

40
Q

What is the most likely diagnosis for pt presenting with erythematous, blanching circular patch with central punctum (appearing like urticaria) lesion along with localized pain, muscular pain, abdominal distress, localized diaphoresis, elevated transaminases, HTN and tachycardia?

A

Black Widow Spider bite

tx: cleanse, pain control (may need IV benzo or opioid), tetanus prophylaxis

41
Q

When should a burn victim be referred to the burn center? (3)

A
  1. partial thickness burns greater than 10%
  2. full thickness burns
  3. burns on face, hands, feet, perineum, major joints
42
Q

What is the best management for a unconscious patient found to be pulseless with organized cardiac electrical activity?

A

CPR and epinephrine every 3 to 5 minutes

check pulses after 2 minutes of chest compressions

43
Q

What is the next best step in management of a unconscious patient found to have V-fib or V-tach and pulse?

A

Defibrillate at 2 j/kg (if need to repeat, increased to 4 j/kg)

44
Q

How do you determine the minimum systolic blood pressure of a child aged 1 to 10 years old?

A

70 + ( 2 times age)

45
Q

What is the treatment for hypovolemic shock?

A

20 ml/kg NS boluses until reach minimum systolic blood pressure

46
Q

What is the next best step in management of child under 2 years old presenting with signs of suspected child abuse?

A

skeletal survey

47
Q

What is the next best step in management of pt presenting with cardiac signs of hyperkalemia?

A

calcium gluconate

stabilize the cardiac membrane

48
Q

what is the best initial step for patient presenting with stable ventricular tachycardia (wide complex QRS)?

A

IV amiodarone

49
Q

What type of child abuse is reported to CPS most frequently?

A

Neglect

50
Q

What percentage of girls experiencing sexual abuse have contracted sexually transmitted infections (STIs)?

A

8%

Pediatric Board Prep (26 decks)

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