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.RoshReview > July '21 > Flashcards

July '21 Flashcards

1
Q

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?

A

volar aspect of wrist

garden spade deformity

Median nerve is at risk for injury

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2
Q

Which artery is at risk in a Smith fx?

A

radial artery

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3
Q

What does pregnancy do to blood pressure?

A

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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4
Q

What happens to hematocrit in pregnancy?

A

decreased

smaller increase in red cell volume relative to plasma volume

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5
Q

What happens to WBC in pregnancy?

A

increases, not uncommon to see between 15-20k

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6
Q

How is the pediatric airway different from adults?

A

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

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7
Q

narrowest portion of the pediatric airway

A

cricoid cartilage, below vocal cords

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8
Q

Risk of mainstem intubation higher in adult or peds?

A

peds, due to short trachea and bronchus

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9
Q

MCC of airway obstruction in children

A

tongue

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10
Q

Hard signs of Aerodigestive and Neurovascular Injury Following Penetrating Neck Trauma

A

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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11
Q

Soft signs penetrating neck trauma

A

chest tube air leak

dysphagia or dysphonia

dyspnea

minor hematemeis or hemoptysis

mediastinal emphysema

non expanding hematoma

subcutaneous emphysema

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12
Q

What is the most common congenital heart defect?

A

VSD

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13
Q

where can you hear the classic VSD murmur best?

A

holosystolic murmur best heard at the lower left sternal border

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14
Q

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

A

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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15
Q

What is the MCC of pediatric hypertension?

A

essential/primary HTN

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16
Q

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

A

Brown sequard syndrome

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17
Q

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

A

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

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18
Q

parkland formula

A

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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19
Q

peds ETtube sizing

A

3.5 + (age/4) in mm

in pts between 2 and 8 yo

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20
Q

MCC of neonatal hemorrhage?

A

failure to administer Vit K in the immediate postpartum period

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21
Q

What test differentiates fetal from maternal blood?

A

Apt test

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22
Q

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

A

prior to the onset of rash

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23
Q

What is a major risk with perioral electrical burns?

A

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

(labial artery)

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24
Q

What is a “kissing burn”?

A

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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25
Q

Rx for lip/perioral burn

A

petroleum based abx

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26
Q

irregular shape pupil in setting of trauma…

A

penetrating globe injury

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27
Q

tx for penetrating globe rupture

A

elevating the patient’s head (30 degrees) helps to reduce ocular swelling, eyeshield, antiemetics, analgesia

NPO and emergent ophtho

avoid tonometry

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28
Q

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

A

avoid succ, concern for increase intraocular pressure

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29
Q

Do digits or limbs tolerate longer ischemia time better?

A

digits

less muscle mass to oxygenate and tolerate ischemia better than amputations more proximally along the limb

4-6 hours limb

8hrs digit

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30
Q

what are two contraindications to replantation?

A

unstable patient with other life-threatening injuries

severe crush injury

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31
Q

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

A

median nerve

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32
Q

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

A

malrotation

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33
Q

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

A

pyloric stenosis

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34
Q

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

A

necrotizing enterocolitis

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35
Q

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

A

intussusception

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36
Q

MCC painful rectal bleeding in infants

A

anal fissure

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37
Q

Drugs that can be delievered via ET tube adults

A

lipid-soluble drugs

Naloxone

Atropine

Vasopressin

Epinephrine

Lidocaine

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38
Q

Drugs that can be delivered ET tube peds?

A

lipid-soluble

Lidocaine

Atropine

Naloxone

Epinephrine

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39
Q

gold standard for dx UTI

A

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

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40
Q

fact about the pediatric cervical spine

A

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

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41
Q

what kind of head injuries do children get?

A

cerebral edema and postinjury seizures are most common

mass lesions (epidural and subdural) are less common when compared to adults

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42
Q

spondylolysis of C2 aka

A

Hangman fracture

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43
Q

What is the break in a Hangman’s fracture?

A

bilateral fx of the pedicles of the axis (c2)

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44
Q

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

A

Jefferson fx

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45
Q

How long should you monitor a patient with TCA overdose?

A

until EKG has been normal for 12-24 hours

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46
Q

What lab studies are inaccurate when retrieved via IO?

A

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

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47
Q

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

A

succinylcholine

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48
Q

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

A

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

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49
Q

peds dose epi in tx of anaphylaxis

A

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

50
Q

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

A

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

51
Q

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

A

bacterial tracheitis

52
Q

dx of bacterial tracheitis requires

A

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

53
Q

first line tx for bacterial tracheitis

A

Vanc + third gen ceph or amp-sulbactam

54
Q

MC bug that causes bacterial tracheitis?

A

Staph aureus

55
Q

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

A

severe acute bronchiolitis

56
Q

single finding most closely associated with acute otitis media?

A

bulging tympanic membrane

57
Q

first line abx tx for uncomplicated AOM

A

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

58
Q

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

A

5g/dL

59
Q
A
60
Q

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

A

Reye Syndrome

post salicylate ingestion

61
Q

3 substances that contain salicylates?

A

aspirin, bismuth subsalicylate, and oil of wintergreen

62
Q

most specific test for confirming UTI

A

nitrites

63
Q

3 causes of false positive nitrites in urine

A

contamination, exposure of dipstick to air, phenazopyridine

64
Q

Differentiate epiglottitis from bacterial tracheitis

A

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

65
Q

missed dx of SCFE

A

avascular necrosis of femoral head

66
Q

AA of Peds say do what with AOM

A

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

67
Q

what defines severe AOM

A

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

68
Q

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

A

PET scan

69
Q

why are alkaline burns worse to the eye?

A

cause liquefactive necrosis and penetrate deep into the eye

70
Q

Segond fx

A

avulsion injury of the lateral tibial plateau

71
Q

What ligamentous injury accompanies Segond fx?

A

ACL injury

72
Q

Oval shaped fragment adjacent to the lateral tibial plateau

A

segond fx, avulsion

73
Q

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

A

anterior arch pelvic fractures

74
Q

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

A

Jones fx

75
Q

tx of Jones fx

A

immobilized in posterior splint, crutches for amb without wt bearing.

wt bearing causes fx to displace further

76
Q

fx involving the proximal 5th metatarsal reaching the articular surface

A

pseudo jones fx

77
Q

tx of alkaline burn to eye

A

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)

78
Q

tx of post traumatic intracranial hypertension to lower ICP

A

hypertonic saline 250mL over 30 minutes

79
Q

indication for acetazolamide

A

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

80
Q

cerebral perfusion pressure is measured by

A

CPP=MAP-ICP

81
Q

cushing triad

A

HTN, bradycardia, irregular/shallow respirations

means increased ICP

82
Q

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

A

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

83
Q

what is teardrop sign on imaging?

A

herniated tissue and muscle d/t inferior orbital wall fx

84
Q

inferior orbital wall fx physical exam

A

entrapped inferior rectus muscle, unilateral no upward gaze ability

85
Q

lightbulb sign

A

posterior shoulder dislocation

86
Q

hampton hump

A

pathognomonic, wedge shaped infarct on CXR in PE pt

87
Q

what CN is compressed in pt with uncal herniation?

A

oculomotor nerve or CN III

88
Q

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

A

flexor tenosynovitis

89
Q

2 yo with painless rectal bleeding

A

Meckel diverticulum

90
Q

tx for pt with intussusception

A

air or barium enema

91
Q

complications of basilar skull fx

A

CN palsies 2-3 days post injury

bacterial meningitis (rare but increases if leaking CSF for greater than 7 days)

92
Q

MC complication of penetrating neck trauma in children

A

vascular injury

93
Q

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

A

spontaneous or volitional swallowing

94
Q

tx of retrobulbar hematoma (compartment syndrome of the eye)

A

lateral canthotomy

95
Q

what syndrome is associated with tetralogy of Fallot?

A

DiGeorge Syndrome

96
Q

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

A

TEE

97
Q

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

A

greater than 6 cm

98
Q

how do you diagnose neurogenic shock in a trauma patient?

A

diagnosis of exclusion

99
Q

pressor tx of neurogenic shock with MAP goal?

A

norepi to maintain MAP at least 85 to 90 mmHg

100
Q

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

A

at or above T5

101
Q

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

A

typically to the right of the umbilicus

102
Q

five branches of the facial nerve

A

temporal, zygomatic, buccal, marginal mandibular, and cervical

103
Q

initial tx of achilles tendon rupture

A

immobilization with the ankle in slight plantarflexion

104
Q

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

A

Brief Resolved Unexplained Event (BRUE)

105
Q

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

A

respiratory infection

gastroesophageal reflux leading to laryngospasm

seizure

106
Q

MC dysrhythmia associated with cardiac contusion

A

sinus tachy

107
Q

CAP tx in fully immunized child

A

IV ampicillin, for S. pneumoniae

108
Q

CAP tx for non immunized kid

A

IV ceftriaxone

109
Q

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

A

Hydrofluoric acid can cause electrolyte derangements, tx with calcium repletion

110
Q

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

A

digital amputation proximal to flexor digitorum superficialis insertion

111
Q

When is clostridium coverage with penicillin recommended?

A

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

112
Q

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

A

angiography with embolization

113
Q

how much blood can be accomodated in the pelvis?

A

up to 4 liters

114
Q

function of spinothalamic tract

A

pain and temp

115
Q

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

A

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

116
Q

palpable fetal parts, s/p trauma, vaginal bleeding

A

uterine rupture

117
Q

gold standard for dx of placental abruption

A

tococardiography

118
Q

severe ligament damage in the knee in morbidly obese pt

A

tibiofemoral dislocation

119
Q

tx of tibiofemoral dislocation

A

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

120
Q

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

A

coagulation abnormalities

121
Q

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

A

type II

.RoshReview (11 decks)

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