Other acute illnesses

Question 1

anaphylaxis presentation

Answer 1

• onset min-hours
• lethargic, fussy
• urticaria, pruritis, angioedema, flushing
• stridor, hoarse, oropharynx edema
• sneezing, rhinorrhea
• airway obstruction
• cough, dyspnea, bronchospasm, tachypnea
• tachycardia
• hypotension, shock, arrest
• N/V/D, abdo pain

2 systems involved = anaphylaxis

Question 2

management & discharge after anaphylaxis

Answer 2

IM epinephrine
1:1000 into anterolateral thigh (dose is 0.5mg = 0.5cc for adult, for kids 0.1mg/kg up to 0.5mg = max dose), repeat q5-15min

steroids PO or IV

IVF if hypotensive

salbutamol if bronchospasm

can add H1 and/or H2 blockers

discharge: observe 4-6h post epi, give rx for epipen. allergist referral. medic alert.

Question 3

GCS scale

Answer 3

eyes /4
verbal /5
motor /6

Question 4

what imaging & when for head trauma

Answer 4

xray: if <2 /w large, boggy hematoma or ?abuse

CT: if GCS <14. Or if “catch”:

• high risk: GCS<15 2h later, suspect #, hx worsening headache, irritability
• med risk: basal skull # (hemoTM, raccoon eyes, otorrhea, battles sign), large hematoma, dangerous mechanism (MVC, fall from height, bike no helmet)

if minor and 2+: can send home /w education to watch for decreased LOC, vomiting, worsening headache

Question 5

concussion red flags

Answer 5

• worsening headache
• seizures
• increasing confusion
• can’t recognize things
• repeated vomiting
• behavioural change
• focal signs
• neck pain
• drowsiness
• slurred speech

Question 6

return to play after concussion

Answer 6

steps:

• light aerobic
• sports specific
• non-contact training
• full contact practice
• games

if sx <1wk, wait untill sx free 2 weeks, then progress /w 24h between steps.

wait 1wk between steps if sx 1-4 weeks. See MD after step 1 if sx >4wks.

if sx return, wait 24h then return to previous step.

Question 7

ddx altered mental status

Answer 7

alcohol/toxins
epilepsy
encephalitis, meningitis
syncope / cardiac
sepsis
endocrine (thyroid storm, etc)
hypothermia
hypoglycemia
electrolytes
hypoxia
uremia
head trauma
psychosis
stroke
shock/hypotension

Question 8

Anticholinergic Toxidrome

Answer 8

dilated pupils
dry mouth
flushed, dry skin
aggitated
urinary retention, ileus
fever

Question 9

cholinergic toxidrome

Answer 9

• diarrhea
• sialorrhea
• vomiting
• diaphoresis
• seizures
• bradycardia
• miosis

Question 10

sedative-hypnotic toxidrome

Answer 10

• bradycardia
• hypotension
• delerium, confusion, seadation
• apnea

Question 11

opioid toxidrome

Answer 11

• apnea
• miosis
• hypothermia
• sedation

Question 12

sympathicomimetics

Answer 12

• agitation
• seizures
• tachycardia
• fever
• diaphoresis
• mydriasis

Question 13

investigations for ingestion

Answer 13

• lytes &extended
• blood ga
• glucose
• ECG
• tox screen
• acetaminophen level

call poison control!

Question 14

burn surface area in child

Answer 14

back = 18%
chest/abdo = 18%
arms = 18% together
legs = 27% together
head = 18%
perineum = 1%

Question 15

types of shock

Answer 15

• hypovolemic - hemorrhagic, dehydration, etc
• distributive - septic, anaphylactic
• cardiogenic
• neurogenic

Question 16

meningococcal disease presentation

Answer 16

• nuchal ridigity
• fever
• altered mental status
• kernig/brudzinski’s, jolt accentuation
• bulging fontanelle
• focal seizures

esp ages <1, 16-21

Question 17

meningococcemia disease presentation

Answer 17

fever
chills 
malaise
myalgias
prostration
rash

later: 
purpura
limb ischemia
coagulopathy
pulmonary edema
shock

+/- meningitis

Question 18

treatment of meningitis

Answer 18

• ceftriaxone + vanco
• step down to pen G if cultures back for N. Meningiditis

Treat close contacts (cipro for adults, rifampin for kids)

Question 19

DDx for fever + petechia

Answer 19

• meningococcal sepsis
• toxic shock syndrome
• RMSF
• bacterial endocarditis