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
Rx for lip/perioral burn
petroleum based abx
26
irregular shape pupil in setting of trauma...
penetrating globe injury
27
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
28
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
29
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
30
what are two contraindications to replantation?
unstable patient with other life-threatening injuries severe crush injury
31
what nerve is at risk of being compressed in a perilunate dislocation?
median nerve
32
\<1 year old, bilious vomiting, abdominal distention, tenderness, palpable mass
malrotation
33
2-6 weeks old, nonbilious projectile vomiting following feeding, baby hungrily refeeds, sometimes a mass
pyloric stenosis
34
premature infant, bilious emesis, abdominal pain, distention, grossly bloody stool
necrotizing enterocolitis
35
3mo to 5 year old, intermittent paroxysms of colicky abdominal pain, vomiting, currant jelly stools
intussusception
36
MCC painful rectal bleeding in infants
anal fissure
37
Drugs that can be delievered via ET tube adults
lipid-soluble drugs Naloxone Atropine Vasopressin Epinephrine Lidocaine
38
Drugs that can be delivered ET tube peds?
lipid-soluble Lidocaine Atropine Naloxone Epinephrine
39
gold standard for dx UTI
suprapubic aspiration, growth of \>1000 CFU/ml of uropathogen
40
fact about the pediatric cervical spine
40% of children \<7yo demonstrate anterior displacement of the anterior border of C2 on C3, pseudosubluxation
41
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
42
spondylolysis of C2 aka
Hangman fracture
43
What is the break in a Hangman's fracture?
bilateral fx of the pedicles of the axis (c2)
44
extremely unstable burst fx of C1 caused by an axial load?
Jefferson fx
45
How long should you monitor a patient with TCA overdose?
until EKG has been normal for 12-24 hours
46
What lab studies are inaccurate when retrieved via IO?
WBC, K, ionized Ca, AST/ALT, blood oxygenation
47
What med may take 20-30s longer to take effect when delivered through an IO line than through a peripheral line?
succinylcholine
48
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
49
peds dose epi in tx of anaphylaxis
0.01 mg/kg 1:1,000 (1mg/mL) IM
50
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
51
kid with recent URI that improves and then worsens, dx?
bacterial tracheitis
52
dx of bacterial tracheitis requires
direct visualization with bronchoscopy or laryngoscopy showing laryngotracheal erythema, edema, and thick purulent secretions
53
first line tx for bacterial tracheitis
Vanc + third gen ceph or amp-sulbactam
54
MC bug that causes bacterial tracheitis?
Staph aureus
55
clinical dx: rhinitis, tachypnea, wheezing, cough, crackles, use of accessory muscles, nasal flaring
severe acute bronchiolitis
56
single finding most closely associated with acute otitis media?
bulging tympanic membrane
57
first line abx tx for uncomplicated AOM
high dose amoxicillin at 80-90 mg/kg/day
58
how many g/dL of deoxygenated blood is classically required before cyanosis is apparent?
5g/dL
59
60
child with prior sickness, does better, then confusion, agitation, vomiting, lethargy, mild icterus, hepatomegaly
Reye Syndrome post salicylate ingestion
61
3 substances that contain salicylates?
aspirin, bismuth subsalicylate, and oil of wintergreen
62
most specific test for confirming UTI
nitrites
63
3 causes of false positive nitrites in urine
contamination, exposure of dipstick to air, phenazopyridine
64
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
65
missed dx of SCFE
avascular necrosis of femoral head
66
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
67
what defines severe AOM
moderate to severe otalgia, otalgia for at least 48 hours, or temp \>39/102.2
68
what imaging modality can show abnormalities in patients with concussion in the acute setting?
PET scan
69
why are alkaline burns worse to the eye?
cause liquefactive necrosis and penetrate deep into the eye
70
Segond fx
avulsion injury of the lateral tibial plateau
71
What ligamentous injury accompanies Segond fx?
ACL injury
72
Oval shaped fragment adjacent to the lateral tibial plateau
segond fx, avulsion
73
which pelvic fx are most associated with injury to the urinary bladder?
anterior arch pelvic fractures
74
transverse fx occurring the diaphysis of the bone at least 1.5 cm distal to the end of the bone (fifth metatarsal)
Jones fx
75
tx of Jones fx
immobilized in posterior splint, crutches for amb without wt bearing. wt bearing causes fx to displace further
76
fx involving the proximal 5th metatarsal reaching the articular surface
pseudo jones fx
77
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)
78
tx of post traumatic intracranial hypertension to lower ICP
hypertonic saline 250mL over 30 minutes
79
indication for acetazolamide
carbonic anyhdrase inhibitor used in initial management of pseudotumor cerebri (IIH)
80
cerebral perfusion pressure is measured by
CPP=MAP-ICP
81
cushing triad
HTN, bradycardia, irregular/shallow respirations means increased ICP
82
in case of hemothorax, what is an indication for operative management?
chest tube bleeding \>2-3 mL/kg/hr or hypotension unresponsive to transfusion
83
what is teardrop sign on imaging?
herniated tissue and muscle d/t inferior orbital wall fx
84
inferior orbital wall fx physical exam
entrapped inferior rectus muscle, unilateral no upward gaze ability
85
lightbulb sign
posterior shoulder dislocation
86
hampton hump
pathognomonic, wedge shaped infarct on CXR in PE pt
87
what CN is compressed in pt with uncal herniation?
oculomotor nerve or CN III
88
what surgical emergency of the hand are the Kanavel signs used for dx?
flexor tenosynovitis
89
2 yo with painless rectal bleeding
Meckel diverticulum
90
tx for pt with intussusception
air or barium enema
91
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)
92
MC complication of penetrating neck trauma in children
vascular injury
93
how do you best assess a patient's ability to protect their airway?
spontaneous or volitional swallowing
94
tx of retrobulbar hematoma (compartment syndrome of the eye)
lateral canthotomy
95
what syndrome is associated with tetralogy of Fallot?
DiGeorge Syndrome
96
unstable pt with widened mediastinum, what imaging should be done?
TEE
97
how wide would you expect the mediastinum to be in an upright chest XR in patient with thoracic aortic injury
greater than 6 cm
98
how do you diagnose neurogenic shock in a trauma patient?
diagnosis of exclusion
99
pressor tx of neurogenic shock with MAP goal?
norepi to maintain MAP at least 85 to 90 mmHg
100
spinal cord injuries above what level can result in neurogenic shock?
at or above T5
101
Where is the abdominal wall defect in gastroschisis relative to the umbilicus?
typically to the right of the umbilicus
102
five branches of the facial nerve
temporal, zygomatic, buccal, marginal mandibular, and cervical
103
initial tx of achilles tendon rupture
immobilization with the ankle in slight plantarflexion
104
sudden, brief, and now resolved episode of vital sign abnormalities in an infant
Brief Resolved Unexplained Event (BRUE)
105
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
106
MC dysrhythmia associated with cardiac contusion
sinus tachy
107
CAP tx in fully immunized child
IV ampicillin, for S. pneumoniae
108
CAP tx for non immunized kid
IV ceftriaxone
109
burns with what acid may cause systemic effects, and what is the appropriate tx?
Hydrofluoric acid can cause electrolyte derangements, tx with calcium repletion
110
what is a relative contraindication for replantation of an amputated digit?
digital amputation proximal to flexor digitorum superficialis insertion
111
When is clostridium coverage with penicillin recommended?
farm accidents and gross contamination, esp with soil or gut flora
112
unstable patient, other sources of bleeding has been excluded on CT scan, what is the tx of choice?
angiography with embolization
113
how much blood can be accomodated in the pelvis?
up to 4 liters
114
function of spinothalamic tract
pain and temp
115
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
116
palpable fetal parts, s/p trauma, vaginal bleeding
uterine rupture
117
gold standard for dx of placental abruption
tococardiography
118
severe ligament damage in the knee in morbidly obese pt
tibiofemoral dislocation
119
tx of tibiofemoral dislocation
ankle brachial index, immediate reduction, serial neurovascular checks to popliteal artery, common peroneal nerve
120
nontraumatic intramural duodenal hematomas are most commonly attributed to what condition?
coagulation abnormalities
121
which type of odontoid fracture has the poorest prognosis due to high malunion risk?
type II