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PNP 749 Assessment & Diagnostic > Final > Flashcards

Final Flashcards

1
Q

What are s/s of sympathomimetic toxidrome poisoning?

A 
Hyperthermia
Tachycardia
Hypertension
Warm/moist skin
Agitated delirium
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2
Q

What are some examples of sympathomimetic toxins?

No antidote?? Supportive care??

A

Cocaine
Amphetamine/meth
Phencyclidine (PCP)
Withdrawal

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3
Q

What are s/s of cholinergic toxidrome poisoning?

A

Muscarinic: DUMBELS (diarrhea/diaphoresis, urination, miosis, bradycardia, emesis, lacrimation, salivation) or SLUDGE

Nicotinic (opposite of muscarinic) & CNS receptor effects

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4
Q

What are some examples of cholinergic toxins?

Antidote?

A

Pesticides, nerve agents

Antidote: Atropine, 2-pralidoxime

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5
Q

What are s/s of anticholinergic toxidrome poisoning?

A 
Hyperthermia (HOT)
Tachycardia/HTN
Red, hot, dry skin (DRY, RED)
Mydriasis (BLIND)
Absent bowel sounds
Urinary retention
Confusion/hallucinations (MAD)
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6
Q

What are some examples of anticholinergic toxins?

Antidote?

A 
Antihistamines
Antipsychotics
Atropine/scopolamine
Tricyclic antidepressants
Skeletal muscle relaxants

Antidote: Physostigmine

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7
Q

What are s/s of opioid toxidrome poisoning?

A

Miosis, CNS depression, respiratory depression

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8
Q

What are some examples of opioid toxins?

Antidote?

A

Opiates (morphine, codeine), Opioids

Antidote: Naloxone

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9
Q

How does serotonin syndrome present?

Antidote?

A

Agitation, autonomic (VS) instability, NMJ effects (tremor, hyperreflexia)

Antidote: Cyproheptadine

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10
Q

What poison is glucagon used as an antidote?

Insulin?

A

Beta blocker

Calcium channel blocker

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11
Q

What is the antidote for iron poisoning?

A

Supportive care, deferoxamine chelation

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12
Q

What is the antidote for benzodiazepines?

A

Flumazenil

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13
Q

What are 4 causes of respiratory failure?

A

Mechanical dysfunction of the lung
Loss of respiratory control d/t impaired central respiratory drive
Upper/lower airway obstruction
Multisystem organ failure, cardiac arrest

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14
Q

What ventilator changes can you make when the problem is oxygenation (low O2)?

A

Increase mean airway pressure (MAP) by increasing PIP, PEEP, or I-time

Increase FiO2

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15
Q

What ventilator changes can you make when the problem is ventilation (high CO2)?

A

Increase alveolar ventilation by increasing tidal volume or rate

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16
Q

What are some examples of restrictive lung disease?

What vent mode and settings do you want?

A

ARDS, aspiration pneumonia

Mode: AC

Settings: high PEEP, low tidal volume

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17
Q

What are some examples of obstructive airway disease?

What vent mode and settings do you want?

A

COPD, asthma

Mode: AC (volume > pressure) or SIMV+ PS

Settings: low rate, short I-time

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18
Q

What is part of the respiratory exam for a patient on mechanical ventilation?

A

WOB (retractions, belly-breathing, nasal flaring, head bobbing), breath sounds, waveforms on vent, patient-ventilator “synchrony”

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19
Q

What are 4 causes/troubleshooting for a distressed vent patient or decompensation on mechanical vent?

A

D - displacement of tube
O - obstruction
P - pneumothorax
E - equipment failure

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20
Q

Capnography - decreasing EtCO2

Causes?

A

ETT cuff leak
ETT in hypopharynx
partial obstruction

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21
Q

Capnography - sudden increase in EtCO2

Causes?

A

ROSC

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22
Q

Capnography - bronchospasm (shark fin appearance)

Causes?

A

Asthma

COPD

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23
Q

Capnography - decreased EtCO2 (variable changes)

Causes?

A

Apnea

Sedation

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24
Q

Vent adjustments for dynamic hyperinflation. and evidence of auto-PEEP?

A

decrease rate, I-time

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25
Q

What are some examples of severe metabolic acidosis?

What vent mode do you want?

A

Salicylate poisoning, septic shock, toxic exposures, DKA

Mode: PS

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26
Q

What are the diagnostic criteria for AIDS?

A

HIV positive

CD4 T-cell count < 200 cell/min or the development of an opportunistic infection

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27
Q

What is the hospital plan management for a newborn of HIV+ mom?

A
  1. Zidovudine 4mg/kg BID in first 12hrs of life
  2. Labs: HIV qual RNA PCR, CBC w diff (do NOT send HIV antibody)
  3. Consult peds ID for 2wk f/u
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28
Q

What are the metabolic anomalies associated w/ tumor lysis syndrome?

A

Hyperuricemia (uric acid > 8)
Hyperkalemia (K > 6)
Hyperphosphatemia (PO4 > 6.5)
Hypocalcemia (Ca < 7)

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29
Q

What is tx for (or prevention of) tumor lysis syndrome?

A

IV fluids, no K
allopurinol/rasburicase - to dec uric acid
sevelamer - to dec phos

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30
Q

What are 4 complications of hyperleukocytosis (WBC > 100k)?

A

tumor lysis syndrome, hemorrhage/intracranial bleed, pulmonary leukostasis, sudden death

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31
Q

What is tx for mediastinal mass?

A

empiric therapy, corticosteroids, radiation therapy

avoid intubation if possible d/t difficult airway

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32
Q

What is tx for increased ICP?

A

elevate HOB, dexamethasone, mannitol and/or 3% saline, intubate and hyperventilate

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33
Q 
WBC 1,200
Neutrophils 57%
Lymphocytes 32%
Monocytes 8%
Eosinophils 2%
Basophils 1%

What is ANC?

A

ANC = WBC x [(%segs + %bands) / 100]

ANC = 1,200 x (57% / 100) = 684

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34
Q

What abx do you choose for hem-onc patient presenting with fever & neutropenia (ANC < 500)?

A

Cefepime
+/- vanco (for sepsis s/s)
+/- flagyl (metronidazole) or zosyn (for GI s/s)

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35
Q

What are the 3 criteria for engraftment after a patient receives stem cell infusion?

A
  1. ANC > 500 x3 consecutive days
  2. Plts > 20k x1 week (w/o transfusions)
  3. Hct > 25% x20 days (w/o transfusion)
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36
Q

What are 3 main organs involved in aGVHD?

A

skin, liver, GI tract (intestine)

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37
Q

What are diagnostic clinical features of aGVHD?

A

maculopapular rash, increasing bilirubin levels, diarrhea (w/wo hematochezia)

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38
Q

What are the stages and grade of the following presentations of skin, liver, intestine in aGVHD?

rash >50% of BSA
bilirubin 3-6 mg/dL
diarrhea 1000-1500 mL/day

A

skin 3
liver 2
intestine 2

aGVHD grade: III

rash <25, 25-50, >50, generalized
liver 2-3, 3-6, 6-15, >15
diarrhea 0.5-1k, 1-1.5k, >1.5k, gross blood

0: none
I: skin 1-2
II: skin 3, liver/GI 1
III: skin 3, liver/GI 2-3
IV: 4 of any
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39
Q

How do you manage GVHD?

A
  1. steroids (first line)
  2. cyclosporine
  3. methotrexate
  4. tacrolimus
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40
Q

What immunizations should you NOT give during chemotherapy?

A

Live vaccines (oral polio, rotavirus, nasal flu, varicella, MMR)

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41
Q

What EKG rhythm(s) would you consider using atropine?

A

slow HR rhythms (sinus brady, Mobitz II 2nd degree HB, complete HB)

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42
Q

What med class would you consider using for high HR arrhythmias?

A

Beta blocker

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43
Q

How would you treat unstable vs stable SVT?

A

Unstable - synch cardiovert

Stable - vagal maneuvers, adenosine

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44
Q

What do these represent:
P wave
QRS complex
T wave

A

P - atrial depol
QRS - vent depol
T - vent repol

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45
Q

What are causes of ST segment elevation? ST segment depression?

A

Elevation - acute MI, pericarditis, ventricular hypertrophy

Depression - myocardial ischemia

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46
Q

What may you see on the EKG when a patient has hyperkalemia? hypokalemia?

A

Hyperkalemia - peaked T waves

Hypokalemia - U waves

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47
Q

What is the tx for DKA?

A

Fluid bolus
Insulin gtt 0.05-1 U/kg/hr
2 bag system 1.5-2x mIVF NS & D10NS + 20 KCl

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48
Q

What is the most worrisome complication of DKA?

How would it present?

How would you tx it?

A

Cerebral edema

Headache, slowing HR, rising BP, change in neuro status

Tx - 3% saline 3-5mL/kg fast push or mannitol

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49
Q

How would DKA present?

A

Dehydration, Kussmaul respirations (deep, sighing), n/v, abdominal pain, confusion, drowsiness

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50
Q

What would you expect to see on labs for DKA?

A 
BG > 250
pH < 7.3
bicarb < 18
anion gap > 10
elevated serum/urine ketones
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51
Q

How would define polydipsia? Polyuria?

A

Polydip - inc thirst (>2L/m2 daily)

Polyur - inc urine output (>2L/m2 daily)

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52
Q

What condition results from not enough ADH?

What happens to Na levels and urine?

A

diabetes insipidus

Na high (>150)
UOP high (>3)
dilute, spec grav < 1.005
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53
Q

What condition results from too much ADH?

What happens to Na levels and urine?

A

SIADH

Na low (<130)
UOP low (<1)
concentrated, spec grav > 1.020
54
Q 
Labs: 
serum Na < 130
urine Na > 60
serum Osm < 275
urine Osm > 500
spec grav > 1.020
UOP < 1

What condition is this?

A

SIADH

55
Q 
Labs:
serum Na > 150
urine Na < 40
serum Osm > 305
urine Osm < 250
spec grav < 1.005
UOP > 3

What condition is this?

A

DI

56
Q 
Labs:
serum Na < 130
urine Na > 150
serum Osm < 275
urine Osm > 300
spec grav > 1.010
UOP > 3

What condition is this?

A

cerebral salt wasting

57
Q

SIADH tx?

A

fluid restrict (1/4 - 1/2 mIVF)

salt
NaCl 1g 3-4x/day
3% saline

58
Q

How would differentiate between central DI and nephrogenic DI during a water deprivation study?

A

Give DDAVP if urine osm < 600 any time during or at the end of the study

If:
urine osm 2x over next hr -> cDI
urine osm no response -> nDI

59
Q

How would you r/o or dx DI during a water deprivation study?

A

If urine osm > 600 during the test, okay to r/o

urine osm < 600 = inability to concentrate urine -> DI

60
Q

What are the 3 stages of triphasic response?

A
  1. transient DI
  2. hyponatremia/SIADH
  3. permanent DI
61
Q

Tx for DI?

cDI vs nDI?

A

correct Na slowly (dec shouldn’t be faster than 12mEq/L every 24 hours)

Low salt, low protein diet

cDI - DDAVP
nDI - thiazide diuretics (hydrochlorothiazide)

62
Q 
What are spirometry values in obstructive lung dz?
-FVC
-FEV1
-FEF 25-75%
FEV1/FVC

-flow shape

A

FVC > 80%
FEV1 < 80%
FEF 25-75% < 55%
FEV1/FVC < 70-80%

-caved in, left shift

63
Q 
What are spirometry values in restrictive lung dz?
-FVC
-FEV1
-FEF 25-75%
FEV1/FVC

-flow shape

A

FVC < 80%
FEV1 < 80%
FEF 25-75% > 55%
FEV1/FVC > 70-80%

-circular (d/t dec volume), right shift

64
Q

What are 4 things you need to know to perform spirometry?

A

Height
Gender
Smoker status
Ethnicity

65
Q

How would you differentiate between restrictive vs obstructive lung dz with PFTs?

A

Obstructive - dec FEV1/FVC
-Asthma dx if FEV1 or FVC inc >12% post bronchodilator tx

Restrictive - dec FVC, inc FEV1/FVC

66
Q

What sxs would be in each of the 4 stages of asthma severity?

  • stage 1 intermittent
  • stage 2 mild persistent
  • stage 3 mod persistent
  • stage 4 severe persistent
A

1: sxs < 1x/wk, night <2x/month, FEV1/PEFR >80% predicted
2: sxs > 1x/wk (not daily), night > 2x/month, FEV1/PEFR > 80% predicted w 20-30% variability
3: sxs daily, night > 1x/wk, FEV1/PEFR 60-80% predicted w >30% variability
4: sxs continuous, night frequent, FEV1/PEFR < 60% w >30% variability

67
Q

How well controlled (well, not well, very poor) is this patient’s asthma?
>2 days/wk sxs
>2 nighttime awakenings/month
>2 days/wk albuterol use

What would recommend as a tx?

A

not well controlled

Start long term controller therapy (inhaled, systemic corticosteroid)

68
Q

Where is the ideal position for PICCs and CVCs on CXRs?

A

Superior to cavoatrial junction in the superior vena cava (SVC-RA junction); 2 vertebral body heights below carina

69
Q

Where is the ideal position of an ETT on CXR?

A

2-4cm above carina (T2-T4)

-carina located ~T6 (T5-T6)

70
Q

On a CXR, you see air in the pleural space (no lung markings past a sharp line). What do you suspect?

A

Pneumothorax

No lung markers w sharp line = suspect collapsed lung

71
Q

Steeple sign on CXR implies what dx?

A

Croup

72
Q

Deviated trachea on CXR implies what dx?

A

Mediastinal mass

73
Q

What does increased lung translucency imply?

A

Air trapping (asthma, bronchiolitis, COPD, CF), upper airway (tracheal) obstruction

74
Q

What is the order (pneumonic) of reviewing CXR?

A 
A - airway
B - bones
C - cardiac
D - diaphragms
E - everything else
75
Q

What makes kids’ bones different?

A
  1. More flexible
  2. Growth plates (cartilage) at the end of bones
  3. Bones heal faster. Periosteum is thicker and stronger
76
Q

What is the SALTER-harris classification?

A 
S - separate/straight through physis
A - above physis 
L - lower/below physis
T - through metaphysis & epiphysis
R - cRush/erasure of growth plate
77
Q

What is the most common fracture site in pediatrics?

What is the mechanism of this fracture?

A

Wrist, distal radius via FOOSH

78
Q

How would a child present that makes you suspect a nursemaid’s elbow?

How would you tx?

A

Sxs: refuse to bend or rotate elbow or use arm

Tx: reduce via supination and elbow flexion or hyperpronation

79
Q

What are the ottawa ankle rules?

A

Get an xray for:

  • tenderness over lateral malleolus
  • inability to bear weight for 4 steps
  • tenderness over medial malleolus
80
Q

What is the most common adolescent hip disorder?

How does it present?

Tx?

A

Slipped capital femoral epiphysis

sxs: pain in groin, thigh, or knee; pain w hip motion; obligate ER w hip flexion
tx: in situ screw fixation

81
Q

What are 5 causes of traumatic knee effusion?

A 
Occult fracture
Patella dislocation
Cruciate ACL/PCL injury
Collateral MCL/LCL injury
Meniscus injury
82
Q

What should you suspect if there is tenderness over a physis?

A

Fracture, until proven otherwise

83
Q

What are the 4 indications for ETT intubation?

A
  1. inadequate oxygenation/ventilation
  2. inability to maintain/protect airway
  3. potential for clinical deterioration
  4. prolonged diagnostic studies or patient support
84
Q

What are indications for an LP?

A

diagnostic (suspect CNS infection, subarachnoid hemorrhage)

therapeutic (drug delivery, contrast media, relief of pseudotumor cerebri)

85
Q

What is the target location for an LP?

What position should the patient be in?

A

L4-L5 or L5-S1

Lateral decubitus or sitting

86
Q

What are the normal events of healing?

A

Injury, hematoma, inflammation and activation of factors to heal wound

87
Q

What are the weakest part of the suture?

A

Knots

88
Q

What is the difference between square knot and surgeon’s knot?

A

Square knot: once round around needle for each throw

Surgeon’s knot: twice round for first throw and once round for subsequent throws

89
Q

What is the pneumonic for acid base gases?

A

ROME
respiratory opposite
metabolic equal

90
Q

What are some causes of metabolic acidosis?

A

DKA, severe diarrhea, renal failure, shock

91
Q

What are some causes of respiratory alkalosis?

A

Hyperventilation (from fear, anxiety, PE), mechanical ventilation

92
Q

What are some causes of metabolic alkalosis?

A

Severe vomiting, excessive GI suctioning, diuretics, excessive NaHCO3

93
Q

What are some causes of respiratory acidosis?

A

Anesthesia, drug overdose, pneumonia

94
Q

What causes L shifts to the O2 Hgb dissociation curve?

A

Inc affinity, more O2 in blood, dec temp, dec pCO2, inc pH, respiratory alkalosis

95
Q

What causes R shifts to the O2 Hgb dissociation curve?

A

dec affinity, less O2 in blood, inc temp, inc pCO2, dec pH, respiratory acidosis

96
Q

What are disadvantages and advantages of subclavian cannulation vs IJ?

A

+ lower incidence of infections and thrombosis

  • higher incidence of mechanical complications
  • “pinch off” syndrome
97
Q

Why are children more prone to respiratory distress?

-5 reasons

A
  1. Higher O2 metabolism
  2. Lower functional residual capacity
  3. More prone to fatigue of respiratory muscles
  4. Smaller tidal volumes
  5. Higher tendency to be agitated
98
Q

What is tx for croup?

A

Racemic epi
Dexamethasone
PPV measures (bagging)

99
Q

What is the difference between bronchiolitis and asthma?

A

Acute inflammation of bronchioles vs chronic inflammation

100
Q

What is tx for bronchiolitis?

A

Positioning (towel under shoulders), O2 if sats < 90%

101
Q

What is tx for acute asthma exacerbation?

A
  • O2 + positioning
  • bronchodilators + anticholinergics (albuterol/ipratropium)
  • steroids (dex)
  • sq vs IM epi
  • hydration if needed

AVOID intubation if possible

102
Q

What breath sounds may help you distinguish between 4 types of respiratory types?

A

Upper airway obstruction - stridor (usually insp), barking cough, hoarseness

Lower airway obstruction - wheezing (usually exp), prolonged exp phase

Lung tissue dz - grunting, crackles, dec breath sounds

Disordered control of breathing - normal

103
Q

When should mothers get screening for syphilis in high prevalence settings?

A
  • First presentation to care (prenatal)
  • early 3rd trimester (24-48 wks)
  • at delivery
104
Q

What is the reverse algorithm for syphilis testing?

A

Trep –> nontrep RPR if positive

105
Q

What could this mean?
first +trep
second -nontrep
third +trep

A

Possible past, successfully treated syphilis

106
Q

What could this mean?
first +trep
second -nontrep
third -trep

A

likely false positive screening test

107
Q

What could this mean?
first +trep
second +nontrep

A

likely untreated or recently treated syphilis

108
Q

What is the recommended tx for primary, secondary, and early non-prim non-sec syphilis?

A

single dose BPG (pen G) 2.4 million units

109
Q

What is the tx for neurosyphilis?

A

aqueous crystalline penG 19-24 million units per day administered as 3-4 million units IV q3-4h or continuous infusion for 10-14 days

110
Q

What are clinical manifestations of congenital syphilis if newborn is symptomatic?

S/s manifests years after birth?

A

FTT, restlessness, fever, rhinorrhea, maculopapular rash, hepatosplenomegaly

Hutchinson triad - interstitial keratitis, CN 8 deafness, Hutchinson teeth (triangular)

111
Q

What tests does a newborn need if mom is seropositive?

A

serologic test nontrep RPR –> CSF studies

112
Q

What might you see on a CSF study if infant is seropositive?

A

high protein, low glucose +/- high WBC

high WBC –> neurosyphilis

113
Q

Tx for syphilis seropositive newborn?

A

crystalline penG 100,000-150,000 units/kg/day x10 days

114
Q

F/u plan for seropositive newborn treated in hospital before discharge?

A

Repeat nontrep titers at 3, 6, 12 months to document falling titers

Neurosyphilis must follow w/ serologic tests and CSF determination every 6 months for at least 3 years or until CSF findings normal

115
Q

How do you calculate hourly fluid needs? daily?

A

Hourly: 4-2-1
Daily: 100-50-20

116
Q

What are the 3 types of donor choices for cancer patients?

What has the lowest risk of GVHD? Highest risk?

A

Autologous - patient’s own stem cells (no GVHD risk)

Syngeneic - identical twin (no signifiant GVHD risk)

Allogeneic - donated stem cell (highest risk)

117
Q

What are the 3 sources of allogeneic (donated stem cells)?

A 
related HLA match (sibling)
unrelated HLA match (donor registry)
haploidentical match (parent)
118
Q

What are 4 things you would prefer to have in an unrelated donor selection?

A
  1. CMV negative
  2. If female, preferably nulliparous
  3. Younger
  4. Similar ethnic background
119
Q

Hem-onc patient presents with decreased oral intake, pain, ulcers, mucosal bleeding, n/v. What is this complication? What’s the biggest worry? How would you manage?

A

Mucositis

Risk of airway compromise

Tx: TPN, pain management (PCA), tranfusions, mouth/perineal care

120
Q

Hem-onc patient presents with weight gain, ascites, painful hepatomegaly, increasing bilirubin. What is this complication? How would you manage this?

A

Veno-occlusive disease

Tx: Fluids, diuretics, CVVH (continuous veno-venous hemofiltration), defribotide

121
Q

How would a hem-onc patient with pulmonary toxicity present? How would you treat?

A

Crackles, hypoxia, respiratory distress

Tx: intubate, mechanical ventilation

122
Q

How would a hem-onc patient with transplant associated microangiopathy (TA-TMA) present? How would you treat?

A

microangiopathic hemolytic anemia, renal dysfunction +/- neuro abnormalities

Tx: hydrate, transfuse, withdraw immunosuppression when possible, treat BK viruria/viremia, eculizumab

123
Q

How would you define these 3 types of asthma control: well controlled, not well controlled, very poorly controlled?

A

well controlled: <2 days/wk, <1 night/month, <2 days/wk bronchodilator

not well controlled: >2 days/wk, >2 nights/month, > 2 days/wk bronchodilator

very poorly controlled: daily sxs and multiple doses of albuterol per day

124
Q

What would you recommend for managing exercise-induced bronchospasm?

A

Warm up and cool down

Take SABA 15-20 mins and LABAs 30 mins prior to exercise

125
Q

How would you do a hand neuro exam on a toddler?

A 
Rock = median nerve
Paper = radial nerve
Scissors = ulnar nerve
126
Q

What are the 3 fractures you cannot, should not miss?

A
  1. Monteggia fracture-dislocation: ulna fx with dislocated radial head
  2. Medial epicondyle fracture (or entrapped medial epicondyle) - associated w elbow dislocation
  3. SCFE
127
Q

What does the PR interval represent?

A

Time between depol of SA node to onset of vent depol

128
Q

What does QRS duration represent?

A

Time for vent depol (normal 0.06-0.10 secs)

129
Q

What does QT interval represent?

A

The time it takes for ventricles to depol to beginning of repol

130
Q

What does ST segment represent?

A

The time between ventricles finishing depol and beginning repol

131
Q

What are flattened or small T waves associated with?

A

Resolving pericarditis, digoxin, myocarditis

132
Q

Anion gap calc?

A

Na + K - Cl

PNP 749 Assessment & Diagnostic (8 decks)

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