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Procedures > Midterm > Flashcards

Midterm Flashcards

1
Q

When to get Well Child Checkups?

A

1 wk then 1, 2, 4, 6, 9, 12, 15, 18
24, 30 months
Every year from 3 to 21

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2
Q

When do you start charting BMI?

A

2 y/o

also start taking BP

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3
Q

What are the goals of WCC?

A 
1.Screening - anemia, vision, hearing, dental
Maybe TB, HIV, lead, inherited disorders
2. Mental health & risky behaviors
3. Immunizations
4. Anticipatory edu
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4
Q

What are the stages of development?

A
  1. Newborn
  2. Infancy 0-12mo
  3. Early childhood 1-4yrs
  4. Middle childhood 5-10yrs
  5. Adolescence 11-20yrs
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5
Q

At what age do you switch to ear temp?

A

> 2 mo.

<2 - rectal

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6
Q

What are the components of an APGAR score?

A
  1. Appearance
  2. Pulse
  3. Grimace
  4. Activity
  5. Respiration
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7
Q

When does the anterior fontanelle close?

A

4-26 mo

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8
Q

When does the posterior fontanelle close?

A

by 2 mo

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9
Q

Is S3 normal in infants?

A

Yes

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10
Q

When does the umbilical cord remnant fall off?

A

by 2 wks

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11
Q

What are the newborn reflexes?

A
  1. Palmar grasp
  2. Plantar grasp
  3. Moro reflex
  4. Asymmetric tonic neck reflex
    • Support reflex
  6. Anal reflex
    • Babinski
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12
Q

What are the infant reflexes?

A
  1. Triceps
  2. Brachioradialis
  3. Abdominal

Present starting at 6 mo

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13
Q

When do maxillary sinuses appear?

A

4 y/o

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14
Q

When should you start to give an infant food?

A

After 6 mo

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15
Q

What does the M-Chat look for?

A

Autism

Screen at 18 mo visit

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16
Q

What is the average birth weight & length?

A

3.2 kg

50 cm

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17
Q

How much does the average 1, 2 & 4 y/o weigh & length?

A

10kg 75 cm
12.5 85
15 100

After that they grow 5-6 cm/yr
Boys grow ~14 in & girls ~12 in at puberty

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18
Q

At what age would puberty be said to be delayed?

A

Girl >12

Boy >14

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19
Q

What is SCOFF?

A

Screening for eating disorders in adolescents

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20
Q

What is the Ballard score?

A

Way to estimate gestational age

Higher # = more maturity

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21
Q

What is IUGR & some causes?

A

Intrauterine growth restriction

Multiples, malnutrition, toxins, placental instability

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22
Q

What is a cause for LGA?

A

Gestational diabetes >90%

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23
Q

What are some causes of an absent red reflex?

A
  1. Cataracts (maybe due to infection)
  2. Retinoblastoma

Emergency - see ophthamologist

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24
Q

When do you see currant jelly stools?

A

when bowel dies from intussusception

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25
Q

What is an Alvarado score?

A

likelihoood of appendicitis

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26
Q

At what age should you be concerned if a child hits puberty?

A

Girls <9

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27
Q

What is a normal respiratory rate in a kiddo?

A

30-40

Can be 60-80 during birth

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28
Q

Risk factors of hip dysplasia

A
  1. Female
  2. Breech
  3. 1st born
  4. FH
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29
Q

When should a baby lift his head?

A

2 mo

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30
Q

When should a baby pull himself up to stand?

A

8 mo

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31
Q

When should a baby start crawling?

A

7-9 mo

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32
Q

When should a newborn bring his hands together?

A

2 mo

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33
Q

What is Tanner staging?

A

Of sexual development

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34
Q

What are the screenings for infants?

A
  1. Tay-Sachs
  2. PKU
  3. Hypothyroidism
  4. Congenital adrenal hyperplasia
  5. Galactosemia
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35
Q

What is failure to thrive?

A

Kid 2 or under w/ weight plotting below the 5& for age on more than 1 occasion or whose wt crosses 2 major percentiles downward on a standardized growth grid.

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36
Q

What is the sequence for examining newborns?

A

Perform less invasive maneuvers early & potentially distressing maneuvers near the end

  1. Observation
  2. Head, neck, heart, lungs, abdomen, GU
  3. Lower extremities, back
  4. Ears, mouth
  5. Eyes
  6. Skin
  7. Neurologic system
  8. Hips
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37
Q

Where are the best places to look for central cyanosis in kiddos?

A

Sign of congenital heart disease

Tongue & oral mucosa

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38
Q

CV changes during pregnancy

A
  1. Erythrocyte mass & plasma vol inc.
  2. CO inc.
  3. Systemic vascular resistance & pressure fall
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39
Q

MSK changes during pregnancy

A

From wt gain & relaxin

  1. Lumbar lordosis
  2. Ligamentous laxity in the SI joints & pubic symphysis
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40
Q

What is Chardwick’s sign?

A

Blue cervix & vagina from inc. blood flow

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41
Q

How do you determine expected delivery date of a baby?

A

Naegele’s rule

Take 1st day of LMP, add 1 week, subtract 3 mo & add 1 year

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42
Q

How can you verify EDD & when?

A
  1. Doptone - 10-12 wks
  2. Fetoscope - 18 wks
  3. Fetal mvmt - 18-24 wks
  4. US
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43
Q

What is chronic HTN in a pregnant lady?

A

BP >140/>90 before 20 wks

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44
Q

What is gestational HTN?

A

BP >140/>90 after 20 wks

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45
Q

What is preeclampsia?

A

BP >140/>90 after 20 wks w/ protein in urine

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46
Q

What initial lab work should you do on a pregnant lady?

A
  1. CBC
  2. Blood typing
  3. Hep panel
  4. HIV
  5. Syphilis
  6. UA & culture
  7. PAP smear
  8. GC
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47
Q

What lab work should you do in pregnant ladies throughout their pregnancy?

A
  1. UA for glucose & protein

2. WBC

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48
Q

Health promotion for pregnancy

A
  1. Nutrition
  2. Wt gain
  3. Exercise (30 min/day)
  4. Smoking cessation, alcohol, drugs
  5. Screen for domestic violence
  6. Immunizations
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49
Q

When do you give RhoGAM?

A

to Rh - women at 28 wks & w/in 3 days of delivery

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50
Q

Which immunizations should pregnant ladies get?

A
  1. Tetanus

2. Flu (2&3rd trimesters)

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51
Q

What foods should pregnant people avoid?

A
  1. Unpasteurized dairy products
  2. Soft cheeses
  3. Raw eggs
  4. Delicatessen meats
  5. Large amounts of Vit A
  6. Sea-going fish
52
Q

What is the ‘sterile’ color?

A

Blue

53
Q

Where are gowns considered sterile?

A

In front from shoulder to waist level

Sleeves from cuff to 2 in. above elbow

54
Q

How far away must nonsterile people be from a sterile field?

A

12 inches

55
Q

What are the types of Noninvasive Positive Pressure Ventilation? (NPPV)

A
  1. High Flow Nasal Cannula (HFNC)
  2. Continuous Positive Airway Pressure (CPAP)
  3. Bilevel Positive Airway Pressure (BiPAP)
56
Q

Contraindications to NPPV

A
  1. Impaired level of consciousness
  2. Respiratory arrest/apnea
  3. Cardiac arrest
  4. Acute MI
  5. Inability to protect airway
  6. Excessive secretions
  7. Vomiting
  8. Upper airway obstruction
  9. Facial trauma
  10. Burns involving face/airway
57
Q

ADRs NPPV

A
  1. Dec. myocardial perfusion
  2. Barotrauma
  3. Pneumothorax/pneumomediastinum
  4. Aspiration
  5. Anxiety
  6. Nosocomial infections
  7. Iatrogenic respiratory alkalosis
58
Q

What is a big disadvantage to high flow nasal cannulas?

A

Difficult to measure & regulate the end-expiratory pressure

Higher risk of ADRs

59
Q

How does CPAP effect L sided heart failure?

A

dec. preload & afterload

60
Q

Indications for mechanical ventilation

A
  1. Acute respiratory failure
  2. Apnea
  3. Impending respiratory failure
  4. Inability to oxygenate or ventilate using NPPV
  5. OD, head/spinal cord injury, anaphylaxis, infectious process needing airway
61
Q

Settings for ventilation

A
  1. Tidal volume (Vt)
  2. Respiratory Rate (RR)
  3. FiO2 - % of oxygen
  4. PEEP
62
Q

CMV

A

Continuous Mandatory Ventilation
Machine does all breathing
Know exact ventilation

63
Q

AC

A

Assist control
Machine makes breaths but Pt can make machine breaths too

Risk of hyperventilation, air trapping, inc. intrathoracic pressure

64
Q

SIMV

A

Synchronized Intermittent Mandatory Ventilation

Machine makes breaths but Pt can make own breaths

65
Q

PSV

A

Pressure Support Ventilation

Machine gives extra push to Pt breaths

66
Q

Indications for LVAD

A
  1. Chronic end stage heart failure if at risk of death from cardiogenic shock
  2. LV EF <14
  3. Stage IV HF for 60 days
  4. Stage III for 28 days & either intra-aortic balloon pump support for 14 days or 2 failed attempts to wean inotropes
67
Q

Who is not eligible for heart transplant?

A
  1. > 65
  2. Diabetes w/ end organ damage
  3. Chronic renal failure (Cr >2.5)
  4. Comorbidites that predict poor long term survival (CA, CVA, COPD)
  5. Social History
68
Q

Indications of NG tube

A
  1. Aspirate & ID stomach contents
  2. Differentiate upper/lower GI bleed
  3. Remove air, blood, ingested substances & gastric contents
  4. Provide nutritional support
69
Q

Contraindications of NG tubes

A
  1. Esophageal stricture or alkali ingestion
  2. Recent surgery on esophagus/stomach
  3. Gastrectomy/bariatric surgery
  4. Severe coagulopathy
  5. Facial trauma/basilar Fx
70
Q

Complications of NG tubes

A
  1. Trauma - bleeding
  2. Place tube into trachea/lung
  3. Gastric hemorrhage
  4. Aspiration PNA
  5. Sinusitis
71
Q

How might you check NG tube position?

A
  1. Inject air while auscultating LUQ
  2. Aspirate contents & Check pH (<3)
  3. Xray - Gold Standard
72
Q

Indications for Central line

A
  1. Central venous pressure monitoring
  2. Rapid volume resuscitation
  3. No peripheral IV sites
  4. Routine serial blood draws
  5. Infusion of hyperalimentation & other solns
  6. Placement of pulmonary artery catheter, transvenous pacemaker, performance of cardiac cath, hemodialysis
73
Q

Indications for subclavian central line

A
  1. Useful in trauma - cervical collar not in way
  2. Preferred during CPR
  3. L subclavian has direct route to SVC so preferred for pacemaker placement & CVP monitoring
74
Q

Indications for internal jugular central line

A
  1. Useful during CPR
  2. Arterial punctures easy to control
  3. R IJ has direct route to SVC
75
Q

Indications for femoral central line

A
  1. More simpler anatomy & superficial
  2. Emergency cardiopulm bypass for resusciation
  3. Charcoal hemoperfusion in OD
  4. Dialysis access

Higher rates of infection

76
Q

Contraindications of central lines

A
  1. Local cellulitis
  2. Distorted anatomy or landmarks
  3. Morbid obesity
  4. Combativeness
  5. Suspected proximal vascular injury
  6. Bleeding disorders
  7. Anticoag/thrombolytic therapy
  8. Previous radiation therapy
77
Q

Which side should you put a subclavian central line if there is trauma on one side?

A

Same side as trauma - risk of pneumo

78
Q

What side should you do a central line if you had other failed attempts?

A

SAME side

79
Q

Complications of IO access

A
  1. Cellulitis
  2. Osteomyelitis
  3. Iatrogenic Fx of physeal plate injury in kids
  4. Fat embolism
80
Q

Contraindications of IO access

A
  1. Proximal Fx
  2. Ipsilateral vascular injury
  3. Severe osteoporosis
81
Q

What bones can you use for IO access?

A
  1. Proximal tibia
  2. Medial mallelous
  3. Distal femur
  4. Sternum
  5. Humerus
  6. Ileum
82
Q

What are the ester anesthetics?

A
  1. Benzocaine (Anbesol)
  2. Cocaine
  3. Novocaine (Procaine)
  4. Tetracaine

All pretty fast acting & short duration

83
Q

What are the amide anesthetics?

A
  1. Lidocaine (Xylocaine)
  2. Mepivacaine (Carbocaine)
  3. Bupivacaine (Marcaine)
  4. Dibucaine (Nupercaine)
  5. Prilocaine (EMLA)
84
Q

Max dose of lidocaine w/ & w/o epi?

A

1%

4.5mg/kg

w/ epi - 7 mg/kg

85
Q

Max dose of Bupivacaine w/ & w/o epi?

A

0.25%

2 mg/kg

w/ epi - 3.5 mg/kg

86
Q

Order of effect from anesthetics?

A
  1. Temp
  2. Sensation
  3. Pain
  4. Touch
  5. Deep pressure
  6. Motor
87
Q

Where do you inject local anesthetics?

A

junction of dermis & hypodermis

where nerves are transversing

88
Q

Which types of anesthetics are more likely to have liver/renal potency?

A

Esters

also more likely to have allergies

89
Q

Which anesthetic is NOT a vasodilator?

A

Cocaine

90
Q

Where should you avoid using epi w/ anesthetics?

A

Fingers, toes, nose & hoes

penis, scrotum

91
Q

Which drug do you worry about methemoglobinemia with?

A

EMLA in babies <1y/o

92
Q

Contraindications to epi?

A
  1. UnTx hyperthyroidis
  2. Pheocromocytoma
  3. Appendages
  4. CAD
93
Q

Tx anaphylaxis?

A
  1. Epi
  2. Benadryl
  3. Corticosteroids

Always observe for late reactions

94
Q

What are alternatives to anesthesia?

A
  1. Benadryl
  2. Normal saline
  3. Conscious sedation
  4. Topical Gauber’s cold spray
95
Q

Where is viscous lidocaine used?

A

Mucous membranes

96
Q

How do you make a Benadryl solution for anesthesia?

A

Benadryl 5% 1 mL + 4 mL normal saline

97
Q

Wound cleansing materials?

A
  1. Gauze
  2. Chlorhexidine
  3. Isopropyl alcohol
  4. Iodine solution
98
Q

What do you use for digital blocks & indications?

A

1% Lidocaine + 1% Carbocaine

  1. Procedures on distal to midproximal phalanx
  2. Nail avulsion
  3. Paronychial
  4. Finger lacerations
99
Q

What way do nerves heal?

A

Wallerian degeneration

100
Q

Goals of wound closures?

A
  1. Dec. time to healing
  2. Reduce infection likelihood
  3. Dec. scarring
  4. Repair the loss of structure & function
  5. Cosmetic improvements
101
Q

Contraindications to wound closure

A
  1. Open >8h
  2. FB
  3. Extensive wounds w/ neurovascular compromise
102
Q

Steps of wound healing

A
  1. Hemostasis
  2. Inflammation
  3. Proliferation
  4. Remodeling
103
Q

Wound closure classifications

A

Primary intention - all layers closed, least scarring, done on clean/clean-contaminated wounds

Secondary - Deep layers closed & outer close on own

Delayed primary closure - Deep layers close the reassess on 4th day & close if no infection

104
Q

What are the tetanus prone wounds?

A
  1. Old wounds
  2. Deeper
  3. Avulsion injury
  4. Devitalized tissue
  5. Contaminated
  6. Gunshot
  7. Crush wounds
  8. Burn
  9. Frostbite
  10. Corneal abrasions
105
Q

S/S tetanus

A
  1. Trismus
  2. Nuchal rigidity
  3. Dysphagia
  4. Severe spasms
  5. Opsithotonus
  6. Resp. failure
  7. Death
106
Q

Rules for tetanus immunizations

A

Tetanus prone wound - current vaccines - update if >5yrs

Non-tetanus prone - Vaccinate if >10yrs

Tetanus prone & unknown - update & give TIG

107
Q

What kind of stitch is good for old farts?

A

Horizontal mattress stitch

108
Q

When should you write antibiotics when suturing?

A
  1. Old wounds >12h
  2. Bites
  3. Crush wounds
  4. Contaminated wounds
  5. Wounds involving avascular areas
  6. Open Fx or deep wounds beyond fascia
  7. Severe paronychia or felons
  8. Pts w/ valvular heart disease
  9. Immunocompromised
109
Q

Indications for LP

A
  1. Meningitis
  2. Subarachnoid hemorrhage
  3. Tx pseudotumor cerebri
  4. CNS syphilis
  5. Unexplained seizures
  6. Administration of meds
  7. Suspected demyelinating/inflammatory CNS process
  8. CNS CA
110
Q

Contraindications to LP

A
  1. Inc. ICP
  2. Local infection
  3. Coagulation disorder
111
Q

Who gets postdural puncture HAs?

A

After LP

Lay supine
CSF leak at puncture site
Better w/ smaller needle/noncutting needle

Tx - blood patch, caffeine

112
Q

Complications of LP

A
  1. Postdural puncture HA
  2. Herniation
  3. Nerve damage
  4. Infection
  5. Bleeding
  6. Epidermoid tumor
  7. Backache & radicular Sx
  8. Needle breakage
113
Q

How fast is CSF produced?

A

0.35 mL/min

114
Q

Where does the spinal cord terminate in infants & adults?

A

A - L1

I - L3

115
Q

Complications of thoracentesis

A
  1. Pneumothorax
  2. Cough
  3. Infection
  4. Hemothorax, splenic or hepatic injury, abdominal hemorrhage, air embolism, unilat pulm edema
116
Q

Where do you inject for thoracentesis?

A

1-2 ICS below highest level of effusion in midscapular/posterior axillary line

Not lower than btwn 8&9th ribs

Scapula comes down to 7th rib

117
Q

Indications of tube thoracostomy

A
  1. Pneumothorax
  2. Hemothorax
  3. Empyema
118
Q

Complications of tube thoracostomy

A
  1. Infection
  2. Laceration of intercostal vessel
  3. Laceration of lung
  4. Intra-abdominal or solid organ placement
  5. SQ emphysema
  6. Tube dislodgement/incorrect placement
119
Q

Where do you stab for tension pneumothorax?

A

2nd ICS midclavicular

120
Q

Insertion site for tube thoracostomy?

A

Mid to anterior axillary line in 4th/5th ICS

Incision site should be lateral to the edge of the pectoralis major & breast tissue

121
Q

When do you remove a chest tube?

A

Should be removed w/in 1 wk for infections

  1. Improvement in resp status
  2. Drainage <200mL in 24h
  3. Change from bloody drainage to minimal output of serous drainage
  4. No bubbling/fluctuation seen in water seal chamber during expiration/cough
122
Q

When should you use US guidance w/ paracentesis?

A
  1. Adhesions
  2. Bowel obstruction
  3. 2/3rd trimester of pregnancy
123
Q

Site of entry for paracentesis

A

Best is based on prior paracentesis

OR

2cm below belly button
Either lower quadrant, 4-5cm cephalad & medial to ant. sup. iliac spine

124
Q

Indications of pericardiocentesis

A
  1. Pericardial effusion

2. Tamponade

125
Q

Where to stab for pericardiocentesis?

A

Btwn xiphoid process & L costal margin at 30-45 degree angle to the skin
Aim at L shoulder

Procedures (4 decks)

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