July '21 Flashcards by Lauren Sophiea

In a flexion-type (Smith) fx or a reverse Colles fx, where will swelling be apparent? What deformity?

What nerve is at risk for injury?

volar aspect of wrist

garden spade deformity

Median nerve is at risk for injury

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Which artery is at risk in a Smith fx?

radial artery

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What does pregnancy do to blood pressure?

Pregnancy results in a 5-15 mm Hg fall in systolic and diastolic pressures during the second trimester, but pressures return to near normal levels in the third trimester

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What happens to hematocrit in pregnancy?

decreased

smaller increase in red cell volume relative to plasma volume

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What happens to WBC in pregnancy?

increases, not uncommon to see between 15-20k

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How is the pediatric airway different from adults?

The pediatric epiglottis is longer, narrower, and shaped differently (omega) than the adult epiglottis

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narrowest portion of the pediatric airway

cricoid cartilage, below vocal cords

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Risk of mainstem intubation higher in adult or peds?

peds, due to short trachea and bronchus

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MCC of airway obstruction in children

tongue

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Hard signs of Aerodigestive and Neurovascular Injury Following Penetrating Neck Trauma

airway obstruction/stridor

cerebral ischemia

major hemoptysis/hematemesis

decreased or absent radial pulse

expanding, pulsatile hematoma

fluid non responsive shock

severe acute bleeding

vascular bruit or thrill

FND

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Soft signs penetrating neck trauma

chest tube air leak

dysphagia or dysphonia

dyspnea

minor hematemeis or hemoptysis

mediastinal emphysema

non expanding hematoma

subcutaneous emphysema

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What is the most common congenital heart defect?

VSD

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where can you hear the classic VSD murmur best?

holosystolic murmur best heard at the lower left sternal border

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What syndrome is associated with a ventricular septal defect that results in R to L shunting?

Eisenmenger syndrome

progressive high pulmonary vascular pressure alters flow from L to R through the VSD to R to L, leading to cyanosis

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What is the MCC of pediatric hypertension?

essential/primary HTN

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Which incomplete spinal cord syndrome has the best prognosis of full recovery?

Brown sequard syndrome

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Want to do intubation, but concern for C-spine, collar in place, next step?

remove cervical collar and maintain inline immobilization, establish a definitive airway

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parkland formula

LR = 4mL x total body surface area of burn (%) x body weight kg

50% given in first 8 hours, remainder over 16 hours

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peds ETtube sizing

3.5 + (age/4) in mm

in pts between 2 and 8 yo

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MCC of neonatal hemorrhage?

failure to administer Vit K in the immediate postpartum period

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What test differentiates fetal from maternal blood?

Apt test

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When do Koplik spots occur in relation to the rash of measles?

prior to the onset of rash

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What is a major risk with perioral electrical burns?

at risk for delayed bleeding 5-21 days after the injury

(labial artery)

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What is a “kissing burn”?

burn at the flexor creases of the extremities. Due to current flowing across opposing surfaces and extremity forced into flexion by an electric shock

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Rx for lip/perioral burn

petroleum based abx

irregular shape pupil in setting of trauma...

penetrating globe injury

tx for penetrating globe rupture

elevating the patient's head (30 degrees) helps to reduce ocular swelling, eyeshield, antiemetics, analgesia NPO and emergent ophtho avoid tonometry

should you worry about the choice of paralytic if a patient with globe trauma needs to be intubated?

avoid succ, concern for increase intraocular pressure

Do digits or limbs tolerate longer ischemia time better?

digits less muscle mass to oxygenate and tolerate ischemia better than amputations more proximally along the limb 4-6 hours limb 8hrs digit

what are two contraindications to replantation?

unstable patient with other life-threatening injuries severe crush injury

what nerve is at risk of being compressed in a perilunate dislocation?

median nerve

\<1 year old, bilious vomiting, abdominal distention, tenderness, palpable mass

malrotation

2-6 weeks old, nonbilious projectile vomiting following feeding, baby hungrily refeeds, sometimes a mass

pyloric stenosis

premature infant, bilious emesis, abdominal pain, distention, grossly bloody stool

necrotizing enterocolitis

3mo to 5 year old, intermittent paroxysms of colicky abdominal pain, vomiting, currant jelly stools

intussusception

MCC painful rectal bleeding in infants

anal fissure

Drugs that can be delievered via ET tube adults

lipid-soluble drugs Naloxone Atropine Vasopressin Epinephrine Lidocaine

Drugs that can be delivered ET tube peds?

lipid-soluble Lidocaine Atropine Naloxone Epinephrine

gold standard for dx UTI

suprapubic aspiration, growth of \>1000 CFU/ml of uropathogen

fact about the pediatric cervical spine

40% of children \<7yo demonstrate anterior displacement of the anterior border of C2 on C3, pseudosubluxation

what kind of head injuries do children get?

cerebral edema and postinjury seizures are most common mass lesions (epidural and subdural) are less common when compared to adults

spondylolysis of C2 aka

Hangman fracture

What is the break in a Hangman's fracture?

bilateral fx of the pedicles of the axis (c2)

extremely unstable burst fx of C1 caused by an axial load?

Jefferson fx

How long should you monitor a patient with TCA overdose?

until EKG has been normal for 12-24 hours

What lab studies are inaccurate when retrieved via IO?

WBC, K, ionized Ca, AST/ALT, blood oxygenation

What med may take 20-30s longer to take effect when delivered through an IO line than through a peripheral line?

succinylcholine

What is the name of the benign lacy, reddish, mottled skin appearance of the extremities that may be associated with acrocyanosis?

cutis marmorata, which also occurs when newborn is exposed to low temps

peds dose epi in tx of anaphylaxis

0.01 mg/kg 1:1,000 (1mg/mL) IM

What is the second line tx for anaphylaxis in cases of hypotension refractory to multiple doses of IM epi?

IV epi at 0.1 mL of the 1:10,000 (0.1mg/mL) solution

kid with recent URI that improves and then worsens, dx?

bacterial tracheitis

dx of bacterial tracheitis requires

direct visualization with bronchoscopy or laryngoscopy showing laryngotracheal erythema, edema, and thick purulent secretions

first line tx for bacterial tracheitis

Vanc + third gen ceph or amp-sulbactam

MC bug that causes bacterial tracheitis?

Staph aureus

clinical dx: rhinitis, tachypnea, wheezing, cough, crackles, use of accessory muscles, nasal flaring

severe acute bronchiolitis

single finding most closely associated with acute otitis media?

bulging tympanic membrane

first line abx tx for uncomplicated AOM

high dose amoxicillin at 80-90 mg/kg/day

how many g/dL of deoxygenated blood is classically required before cyanosis is apparent?

5g/dL

child with prior sickness, does better, then confusion, agitation, vomiting, lethargy, mild icterus, hepatomegaly

Reye Syndrome post salicylate ingestion

3 substances that contain salicylates?

aspirin, bismuth subsalicylate, and oil of wintergreen

most specific test for confirming UTI

nitrites

3 causes of false positive nitrites in urine

contamination, exposure of dipstick to air, phenazopyridine

Differentiate epiglottitis from bacterial tracheitis

epiglottitis is rarely in vaccinated kids, is rapid progression, lateral neck XR will show enlarged epiglottis bacterial tracheitis does not have a vaccine, generally URI prodrome/ins and exp stridor, subglottic narrowing on XR, hazy density within tracheal lumen

missed dx of SCFE

avascular necrosis of femoral head

AA of Peds say do what with AOM

6mo to 2 yrs w/ unilateral AOM without otorrhea and \> 2yrs with uni or bilateral AOM without otorrhea OBS and repeat EVAL otherwise, 1)high dose amox 2) amox with clavulanic

what defines severe AOM

moderate to severe otalgia, otalgia for at least 48 hours, or temp \>39/102.2

what imaging modality can show abnormalities in patients with concussion in the acute setting?

PET scan

why are alkaline burns worse to the eye?

cause liquefactive necrosis and penetrate deep into the eye

Segond fx

avulsion injury of the lateral tibial plateau

What ligamentous injury accompanies Segond fx?

ACL injury

Oval shaped fragment adjacent to the lateral tibial plateau

segond fx, avulsion

which pelvic fx are most associated with injury to the urinary bladder?

anterior arch pelvic fractures

transverse fx occurring the diaphysis of the bone at least 1.5 cm distal to the end of the bone (fifth metatarsal)

Jones fx

tx of Jones fx

immobilized in posterior splint, crutches for amb without wt bearing. wt bearing causes fx to displace further

fx involving the proximal 5th metatarsal reaching the articular surface

pseudo jones fx

tx of alkaline burn to eye

irrigation facilitated by topical anesthetics until pH of 7-7.2 topical erythromycin if no corneal defect and normal anterior chamber on slit lamp examination (if damage, cycloplegic agent must be added)

tx of post traumatic intracranial hypertension to lower ICP

hypertonic saline 250mL over 30 minutes

indication for acetazolamide

carbonic anyhdrase inhibitor used in initial management of pseudotumor cerebri (IIH)

cerebral perfusion pressure is measured by

CPP=MAP-ICP

cushing triad

HTN, bradycardia, irregular/shallow respirations means increased ICP

in case of hemothorax, what is an indication for operative management?

chest tube bleeding \>2-3 mL/kg/hr or hypotension unresponsive to transfusion

what is teardrop sign on imaging?

herniated tissue and muscle d/t inferior orbital wall fx

inferior orbital wall fx physical exam

entrapped inferior rectus muscle, unilateral no upward gaze ability

lightbulb sign

posterior shoulder dislocation

hampton hump

pathognomonic, wedge shaped infarct on CXR in PE pt

what CN is compressed in pt with uncal herniation?

oculomotor nerve or CN III

what surgical emergency of the hand are the Kanavel signs used for dx?

flexor tenosynovitis

2 yo with painless rectal bleeding

Meckel diverticulum

tx for pt with intussusception

air or barium enema

complications of basilar skull fx

CN palsies 2-3 days post injury bacterial meningitis (rare but increases if leaking CSF for greater than 7 days)

MC complication of penetrating neck trauma in children

vascular injury

how do you best assess a patient's ability to protect their airway?

spontaneous or volitional swallowing

tx of retrobulbar hematoma (compartment syndrome of the eye)

lateral canthotomy

what syndrome is associated with tetralogy of Fallot?

DiGeorge Syndrome

unstable pt with widened mediastinum, what imaging should be done?

TEE

how wide would you expect the mediastinum to be in an upright chest XR in patient with thoracic aortic injury

greater than 6 cm

how do you diagnose neurogenic shock in a trauma patient?

diagnosis of exclusion

pressor tx of neurogenic shock with MAP goal?

norepi to maintain MAP at least 85 to 90 mmHg

spinal cord injuries above what level can result in neurogenic shock?

at or above T5

Where is the abdominal wall defect in gastroschisis relative to the umbilicus?

typically to the right of the umbilicus

five branches of the facial nerve

temporal, zygomatic, buccal, marginal mandibular, and cervical

initial tx of achilles tendon rupture

immobilization with the ankle in slight plantarflexion

sudden, brief, and now resolved episode of vital sign abnormalities in an infant

Brief Resolved Unexplained Event (BRUE)

3 most likely disorders that can be elicited on history and exam as a cause to an apparent life-threatening event, thus, negating the diagnosis of BRUE

respiratory infection gastroesophageal reflux leading to laryngospasm seizure

MC dysrhythmia associated with cardiac contusion

sinus tachy

CAP tx in fully immunized child

IV ampicillin, for S. pneumoniae

CAP tx for non immunized kid

IV ceftriaxone

burns with what acid may cause systemic effects, and what is the appropriate tx?

Hydrofluoric acid can cause electrolyte derangements, tx with calcium repletion

what is a relative contraindication for replantation of an amputated digit?

digital amputation proximal to flexor digitorum superficialis insertion

When is clostridium coverage with penicillin recommended?

farm accidents and gross contamination, esp with soil or gut flora

unstable patient, other sources of bleeding has been excluded on CT scan, what is the tx of choice?

angiography with embolization

how much blood can be accomodated in the pelvis?

up to 4 liters

function of spinothalamic tract

pain and temp

Children who do not improve with 60mL/kg of IV fluids, antibiotics, and inotropes may have...... and should be treated with....

relative adrenal insufficiency and treated with 2-4mg/kg of hydrocortisone

palpable fetal parts, s/p trauma, vaginal bleeding

uterine rupture

gold standard for dx of placental abruption

tococardiography

severe ligament damage in the knee in morbidly obese pt

tibiofemoral dislocation

tx of tibiofemoral dislocation

ankle brachial index, immediate reduction, serial neurovascular checks to popliteal artery, common peroneal nerve

nontraumatic intramural duodenal hematomas are most commonly attributed to what condition?

coagulation abnormalities

which type of odontoid fracture has the poorest prognosis due to high malunion risk?

type II

July '21 Flashcards

(121 cards)