July '21 Flashcards
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
Which artery is at risk in a Smith fx?
radial artery
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
What happens to hematocrit in pregnancy?
decreased
smaller increase in red cell volume relative to plasma volume
What happens to WBC in pregnancy?
increases, not uncommon to see between 15-20k
How is the pediatric airway different from adults?
The pediatric epiglottis is longer, narrower, and shaped differently (omega) than the adult epiglottis
narrowest portion of the pediatric airway
cricoid cartilage, below vocal cords
Risk of mainstem intubation higher in adult or peds?
peds, due to short trachea and bronchus
MCC of airway obstruction in children
tongue
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
Soft signs penetrating neck trauma
chest tube air leak
dysphagia or dysphonia
dyspnea
minor hematemeis or hemoptysis
mediastinal emphysema
non expanding hematoma
subcutaneous emphysema
What is the most common congenital heart defect?
VSD
where can you hear the classic VSD murmur best?
holosystolic murmur best heard at the lower left sternal border
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
What is the MCC of pediatric hypertension?
essential/primary HTN
Which incomplete spinal cord syndrome has the best prognosis of full recovery?
Brown sequard syndrome
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
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
peds ETtube sizing
3.5 + (age/4) in mm
in pts between 2 and 8 yo
MCC of neonatal hemorrhage?
failure to administer Vit K in the immediate postpartum period
What test differentiates fetal from maternal blood?
Apt test
When do Koplik spots occur in relation to the rash of measles?
prior to the onset of rash
What is a major risk with perioral electrical burns?
at risk for delayed bleeding 5-21 days after the injury
(labial artery)
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
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
