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Gen ER Flashcards

1
Q

What are three categories of stridor and at least three causes in each?

A

1) Supraglottic
(epiglottitis, peri/retro-pharyngeal abscess, adenotonsillar hypertrophy, craniofacial abN)

2) Glottic
(laryngomalacia, laryngospasm, VC paresis/paralysis/dysfunction, VC nodule/mass)

3) Subglottic
(laryngotracheobronchitis, anaphylaxis, bacterial tracheitis, subglottic stenosis, subglottic web, subglottic hemangioma, tracheomalacia)

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2
Q

What are the two categories of causes of epistaxis?

List five in each

A

LOCAL

  • trauma
  • inflammation (URTI, staph)
  • congenital syphilis
  • foreign body
  • allergic rhinitis
  • telangiectasia (Osler-W-R)
  • juvenile angiofibroma
  • nasopharyngeal lymphoepithelioma
  • rhinitis sicca

SYSTEMIC

  • hematologic (platelet or hemophilias ie ITP, leuk, aplastic anemia, vWD, DIC, vitK, ASA, VPA, NSAIDs)
  • hypertension (arterial, superior vena cava syndrome, CF)
  • vicarious menstruation
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3
Q

How to manage epistaxis?

A 
- pressure, lean forward
consider:
- dental roll under front gums
- gauze soaked with epi 1:1000
- nasal packing, tampons
- cautery with silver nitrate stick

home therapies:
humidifier
petroleum jelly
consider antibiotic ointment
consider nasal decongestants
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4
Q

For nasal cauterization, name the indications, contraindications (2) and complications (3) of the procedure.

A

indications: failure to control bleed with pressure and topical vasoconstrictor
contraindications: bleeding diathesis (hemophilia, ITP) or previous cauterization within 6 weeks
complications: septal perforation, staining of the upper lip or nares, bacterial superinfection or the cauterized area
* refrain from cauterizing both sides of the nasal septum

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5
Q

For nasal packing, name indications and complications of the procedure.

A

indications: bleeding that cannot be controlled with pressure and topical vasoconstrictor, with a contraindication to or failure of cauterization

complications:

1) bacterial rhinosinusitis
2) toxic shock syndrome
3) nasal alar or columnar necrosis
4) septal ulceration or perforation
5) synechiae formation
6) hypoxemia or resp distress from nasal obstruction

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6
Q

Name the components of the GCS score

A

Eyes Verbal Motor

Eyes
4-open spontaneously
3-closed and open with voice
2-close and open with pain
1-closed 
Verbal
5- coherent
4- confused
3- garbled
2- moans
1- nil
Motor
6- command
5- localizes
4- withdraws
3- decorticate
2- decerebrate
1- flaccid
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7
Q

Describe AVPU method of assessing level of consciousness

A

Alert
Voice
Painful
Unresponsive

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8
Q

Name the components of the pediatric trauma score and describe its relevance in practice

A 
Size 
Airway
Systolic blood pressure
Central nervous system
Skeletal
Cutaneous

The PTS emphasizes the importance of patient size and ability to maintain the airway. Studies have confirmed its use as a predictor of outcome: 9% mortality for PTS >8, 100% mortality for PTS <0 and a directly linear correlation between 0-8.

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9
Q

Name physical exam findings that would suggest a difficult airway

A
  • small mouth
  • inability to open the mouth
  • TMJ abnormalities
  • narrow receding mandible
  • protuberant maxillae
  • large tongue
  • distance <6cm between mandible and thyroid prominence
  • inability to place in the sniffing position
  • short, full or bull necks
  • neck mass
  • significant penetrating trauma to face or neck
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10
Q

Describe ECG changes seen with hypothermia with a core temperature <32C

A
  • marked sinus bradycardia
  • 1st degree AV block
  • Osborn or J waves
  • Ass’ w/ long QT
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11
Q

Describe changes seen in hypothermia with temperatures:
31-32C
28-31C
<28

A

31-32C: normal vitals, loss of shivering
28-31C: decreased HR and BP, afib, dilated pupils
<28C: absent pulse and BP, Vfic, coma, fixed pupils

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12
Q

Name 5 management pearls of hypothermia resuscitation

A 
Warm fluids to 43C
Correct hypoglycemia
Watch for coagulopathy
If VF defib no more than three times until temp >30C
Drugs rarely effective until T>30C
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13
Q

What are the stages of frostbite

A
  • initial stinging
  • cold, pale, decreased sensation
  • blotchy and painful areas
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14
Q

Describe features of heat stroke

A 
core temp >41C
dry, hot, ashen skin
ARF
rhabdo
headache, disorientation -> coma, weakness, gait disturbance
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15
Q

Describe features of heat exhaustion (or water depletion)

A 
T <40C
lethargy
nausea, vomiting
heaadches
BP, incr HR
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16
Q

Name good and poor prognostic features with regards to submersion injury prognosis

A

Good:
ROSC <10 minutes
Submersion <5 minutes
PERL, NSR at scene

Poor:
Delayed CPR
ROSC >25 minutes
Submersion >10 minutes

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17
Q

Describe features of high voltage injuries

A

tetany *can prevent grip release, arching
muscle damage -> compartment syndrome -> rhabdo
CNS injury
VF / cardiac arrest
Monitor heart, urinanalysis

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18
Q

What are the features of a brown recluse spider bite?

A

local pain -> central blister -> subcutaneous discoloration ->ulcer
systemic reactions develop in small children: fever, n&v, joint pain, hematuria
treat with analgesia and local care, excision and grafting if severe

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19
Q

What snakes do you have to worry about in Canada?

A

Massasauga and Western rattlesnake

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20
Q

Name indications for admission in anorexia nervosa (8)

A 
systolic <90
HR<45 bpm (some <40 bpm)
orthostatic changes of 30 bpm
systolic 20 mmHg
temp <35.5C
75% of goal weight
support and comorbidity
failure of outpatient
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21
Q

What is the management of neonatal mastitis?

A

Treat as a potentially severe infection in infants <2 months of age with septic work-up (use low risk criteria to determine LP or not in >1 month), IV antibiotics and admit.

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22
Q

What inborn error of metabolism should you suspect if there is hypoglycemia, hyperammonemia and metabolic acidosis?

What if there are urine ketones as well?

A

Fatty acid oxidation disorder

Organic aciduria

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23
Q

What inborn error of metabolism should you suspect with neonatal hypoglycemia and lactic acidosis?

A

Glycogen storage disease

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24
Q

What inborn error of metabolism should you suspect with very high serum ammonia?

A

Urea cycle defect

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25
What are BRUE low risk criteria?
- age >60 days - born at >/= 32wks and CGA >/=45wks - no CPR by trained medical professional - event lasted <1 minute - first event
26
What investigations may you consider in a low-risk BRUE patient?
ECG pertussis brief monitoring with continuous O2 and rechecks
27
What is an oral ranula and how do you treat?
A ranula is a mucus extravasation cyst involving a sublingual gland and is a type of mucocele found on the floor of the mouth. Self resolve in 3-6 weeks
28
What are risk factors for SCFE?
``` obesity steroid use Down's syndrome endocrinopathy osteodystrophy ```
29
What are the P's of compartment syndrome?
``` pain out of proportion to PE findings passive stretch exacerbation paresthesias point discrimination loss paresis pallor pulselessness ```
30
Name medications which may cause methhemoglobinemia?
``` dapsone benzocaine sodium nitrate sulfonamides quinones well water phenozopiridine ```
31
How does macrophage activation syndrome or reactive hemophagocytic lymphohistiocytosis present and who is at risk?
Presentation with fever, HSM, rash and liver dysfunction. - cytopenias >2 cell lines - hypertriglyceridemia - hypofibrinogenemia - elevated ferritin Varios auto-immune disorders are at risk
32
What is the most specific test for SLE?
dsDNA
33
Which populations is ARF most common in?
Fiji, Tonga, India, Pakistan, Turkey, Mozambique
34
Dermatomyositis is complicated by what deficiencies?
complicated by velopalatine muscle weakness - cough, nasal voice, difficulty handling secretions - PTX, ILD, GI hemorrhage & perf, soft tissue calcinosis
35
How does juvenile dermatomyositis present?
5-10yoM with proximal muscle weakness photosensitive rash involving nasolabial folds Gottron papules lab abnormalities (aldolase, AST, ALT, LDH, CPK)
36
What should you suspect with high fever, salmon rash, leukocytosis, anemia and thrombocytosis?
JIA
37
If a Kawasaki patient is on aspirin therapy and you suspect that they have the flu, what should you do?
Don't stop treatment! Start tamiflu!
38
Name three possible treatments for hereditary angioedema? What to send to confirm?
icabitant ecallantide recombinant C-1 inhibitor send serum complement factor 4 C1 inhibitor level
39
What to consider in a patient with fever, urticaria and arthritis?
Serum sickness! 1-2 weeks post offending agent type III hypersensitivity reaction, immune-complex mediated
40
What is the classic presentation of DRESS?
2-6 weeks post medication (antiseizure) | morbilliform rash -> exfoliative -> fever, liver, LADN, edema, mucosal involvement in 50%
41
What is the mode of inheritance and classic presentation of Wiskott Aldrich? What is most lethal?
eczema, thrombocytopenia, recurrent infections x-linked susceptibility to infxns with S. pneumo, N. meningitides, H. influenza bleeding risk is deadly! ICH, massive GI
42
What is the risk of anaphylaxis with Ceftriaxone in a penicillin-allergic patient?
<1%
43
How can you manage an accidental epipen auto-injection?
- observation - soaking in warm water - topical nitroglycerin - phentolamine injection (reversible alpha agonist)
44
What inborn error of metabolism presents with intermittent encephalopathy, ataxia, confusion, coma and hyperammonemia?
Ornithine transcarbamylase deficiency, a urea cycle defect x-linked dominant female heterozygotes have a milder episode presentation exacerbated by a high protein diet and stress
45
A failure to thrive baby with jaundice and an E. coli UTI should be suspected of what condition?
galactosemia! lethargy, poor feeding, FTT, hypoglycemia, eventually direct hyperbilirubinemia galactose deposition in liver = HSM, eyes = cataracts, heart = MR
46
An 18mo presents with hypoglycemia in the context of a gastrointestinal illness, no ketones are present in their urine. What diagnosis should you suspect? How to confirm?`
MCAD (AR) | order urine organic acids and acylcarnitine profile
47
What to suspect with lethargy, vomiting, seizures, acidosis, hyperammonemia and ketones?
Maple syrup urine disease | aka methylmalonic acidemia = organic aciduria
48
What is the best way to confirm the appropriate location of an IUD?
pelvic ultrasound then AXR then CT / MRI
49
What is the presentation of a septic abortion? | How to manage?
abdominal pain foul-smelling discharge chills or fever (can be seen post-misoprostol) Rx Genta & Clinda, U/S +/- D&C
50
If a subdermal implant is suspected to have been broken, what is the best way to evaluate it?
Ultrasound
51
If a young girl presents with painful vaginal ulcers in the context of diarrhea, what should you suspect?
shigella vaginitis culture to rule-out sexual abuse treat with azithro
52
How do you treat phimosis? labial adhesion?
phimosis: reassurance mostly, topical steroids | labial adhesions: topical estrogen
53
What testing should you consider for abnormal uterine bleeding? Management?
``` CBC & iron studies STI testing pregnancy trauma TSH, testo, LH, FSH vWF head imaging if neuro findings, galactorrhea ``` Consider TXA, monophasic combined OCP BID x 7 days
54
How do you manage a urethral prolapse?
confirm with catheter if doubt surgery if necrosed otherwise topical estrogen cream and sitz baths
55
What are the diagnostic criteria for bacterial vaginosis and treatment options?
3/4 of 1) homogeneous, thin, grayish-white discharge adherent to vaginal walls 2) vaginal pH >4.5 3) positive whiff test after KOH prep 4) >20% clue cells on wet prep treat with Metronidazole or Clinda
56
What is a grape-like mass near the vaginal introitus?
rule-out sarcoma botryoides
57
Name causes of vaginal bleeding in a premenarchal girl
- nonhormonal: trauma, tumour, urethral prolapse, infectious vaginitis, intravaginal foreign body, genital warts - hormonal: neonatal bleeding, exogenous estrogen, precocious puberty
58
Name causes of vaginal bleeding in a post-menarchal girl
``` menses hormonal contraception endometritis dysfunctional uterine bleeding bleeding diathesis complications of pregnancy ```
59
With a chemical injury to the eye, when do you stop irrigating?
stop irrigating when the pH of the affected eye is comparable to the unaffected eye (a little while after finishing, normal is 6.5-7.5, otherwise pH 5.5 = NS) 20 minutes minimum or 2L of fluid sedate if they won't cooperate!
60
What is Brown-Sequard syndrome?
a hemisection of the spinal cord: ipsilateral loss of motor, proprioception, vibratory sensation contralateral loss of pain and temperature
61
What is central cord syndrome?
bilateral motor paresis, upper > lower, distal > proximal
62
What is anterior cord syndrome?
paralysis below the level with loss of pain and temp
63
What is posterior cord syndrome?
loss of proprioception and vibration
64
What are the four types of hypersensitivity reactions and how are they mediated?
1: anaphylaxis, IgE 2: cytotoxic, IgG/IgM binds to host cell 3: immune complex, IgG with soluble antigen 4: cell mediated, T-cells
65
What elements of the CATCH CT head rule suggest a CT scan is indicated?
GCS <15 2hrs after injury Suspected open or depressed skull fracture Worsening headache Irritability Basal skull fracture Boggy scalp hematoma Dangerous mechanism (>3ft, MVC, bike without helmet)
66
What are the PECARN indications to absolutely do a non-contrast head CT?
GCS =14 Altered mental status Palpable skull fracture <2 Signs of basilar skull fracture >2
67
What are the PECARN indications to consider doing a head CT vs observation?
``` <2: Non-frontal scalp hematoma LOC ≥ 5 seconds Severe injury mechanism head struck by high-impact object Abnormal activity per parents ``` ``` >2-18: History of vomiting^ LOC Severe injury mechanism Head struck by high-impact object Severe headache ```
68
For air transport considerations, what two laws do you need to take into account and what do they imply clinically?
Boyle's law: as pressure decreases, volume increases significant considerations for pneumothoraces Dalton's law: at higher altitudes, the concentration of gas decreases hypoxia increases at higher altitudes
69
With the following WBC counts following knee aspiration, what is your suspected diagnosis? <2000 2-50,000 >50,000
<2,000 non-inflammatory (PMN <25%) 2-50,000 inflammatory (PMN 50%) >50,000 infectious (PMN >75%)
70
What are the 5 layers of the scalp?
``` SCALP Skin Dense Connective Tissue Epicranial Aponeurosis Loose Areolar Connective Tissue Periosteum ```
71
What are the three reportable STIs in Canada?
chlamydia gonorrhea syphilis

1-PEMbyC (14 decks)

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