PEM

Question 1

Anticholinergic poisoning

Sxs:
example drugs:

Answer 1

Sxs: 
Hot as a hare
Red as a beet
Dry as a bone
Blind as a bat
Mad as a hatter
Full as a flask

example drugs: antihistamines, TCAs, atropine, scopolamine, Benztropine (used for parkinsons)

Question 2

Cholinergic poisoning

Sxs:
example drugs:

Answer 2

Sxs: can give muscarinic and nicotinic sx

muscarinic: DUMBELLS
Diarrhea, diaphoresis
Urination
Miosis
Bradycardia
Emesis
Lacrimation
Lethargy
Salivation

nicotinic: adds muscle fasciculations and flaccid paralysis

example drugs: organophosphates, pilocarpine

Question 3

Sympathomimetic poisoning

Sxs:
example drugs:

Answer 3

Sxs:
Mydriasis
Tachycardia
Hypertension
Hyperthermia
Seizures

(to differentiate from anticholinergic, sympathomimetic has diaphoresis and increased bowel sounds)

example drugs: cocaine, amphetamines, ephedrine, PCP

Question 4

Drug poisoning that causes hypotension

Answer 4

CRASH

Clonidine, calcium channel blockers
Rodenticides (containing arsenic, cyanide)
Antidepressants, aminophylline, antihypertensive (beta blockers)
Sedative hypnotics
Heroin or other opioids

Question 5

Drugs that cause Miosis

Answer 5

COPS

Cholinergics, clonidine
Opiates, organophosphates
Phenothiazides (antipsychotics), pilocarpine, pontine hemorrhage
Sedative-hypnotics

Question 6

Drugs that cause Mydriasis

Answer 6

SAW

sympathomimetics
anticholinergics
withdrawal

Question 7

Antidote for TCA overdose

Answer 7

Sodium bicarb

Question 8

Antidote for organophosphate poisoning

Answer 8

Atropine and pralidoxime

Question 9

Antidote for beta blockers

Answer 9

glucagon; insulin/glucose

Question 10

Antidote for calcium channel blockers

Answer 10

insulin/glucose

Question 11

Antidote for cyanide

Answer 11

hydroxocobalamin

Question 12

Antidote for methemoglobinemia

Answer 12

methylene blue

works by oxidizing NADPH which is able to convert the methemoglobin to hemoglobin so it is able to carry oxygen again

Question 13

Antidote for sulfonylureas

Answer 13

octreotide

Question 14

Antidote for iron

Answer 14

deferoxamine

Question 15

Gases that can make you quickly pass out

Answer 15

Hydrogen sulfide (manure pit)
Cyanide (tx with:
1.) hydrocobalamin (b12)- converts cyanide to nontoxic form
2.)sodium nitrate (causes methemoglobin which cyanide preferentially bonds to)DONT USE IN FIRES
3.) sodium thiosulfate (converts cyanide to nontoxic form also)

Question 16

bladder capacity formula

Answer 16

(age+2) x 30

Question 17

dental abscess tx

Answer 17

can start with amoxicillin or penicillin

If worsening go to augmentin or clindamycin

Question 18

MAS labs

Answer 18

• super high ferritin
• One characteristic feature of macrophage activation syndrome is a paradoxical decrease in the erythrocyte sedimentation rate. This phenomenon is due to the consumption of serum fibrinogen, which results in more rapid sedimentation of erythrocytes within the laboratory assay.

Question 19

Ketamine mechanism of action

Answer 19

mechanism of action:
noncompetitive NDMA antagonist and glutamate receptor antagonist, partial agonist on mu opioid receptors

produces dissociative state and provides pain control

watch for resp depression if administered too fast

duration of action 5 to 15 minutes

Question 20

Dislocation of the AC joint cc measurement

Answer 20

Look at the AP view is the coracoclavicular ligament distance is greater than 1.3 rupture if the CC joint is probable

Question 21

Bell-van Riet test

Answer 21

Affected arm is passively raises to full adduction to 90 degrees and crossed in front of the patient while maintains extension. Then the pt attempts to elevate the arm against resistance. If have focal pain at the AC joint and inability to keep arm up there is likely an unstable AC joint

Question 22

ingestion causes of hypoglycemia

Answer 22

ethanol, beta blockers, and oral hypoglycemics

Question 23

othro injuries least likely to correct without intervention

Answer 23

fractures of the diaphysis, bowing >10 and rotational malalignment

Question 24

injuries that can be managed initially by the ED with outpt ortho fu

Answer 24

1) nondisplaced salter 1 (excluding femur and proximal tibia)
2) clavicle fractures
3) non displaced upper extremity fractures
4) incomplete, non-displaced fractures of the long bones of the lower extremities
5) non-displaced fractures of the hand and foot

Question 25

Torus fracture

Answer 25

buckle fracture

Question 26

bowing deformity management

Answer 26

all should be referred to an orthopedic surgeon

Question 27

compartment syndrome cause

Answer 27

obstruction in venous outflow leading to increased pressure and then you eventually occlude the arteries and capillaries

Question 28

antibiotics for open fracture

Answer 28

cefazolin (if large add gentamicin) OR ceftriaxone *can also consider adding ampicillin for coverage against anaerobes if at high risk (like if on a farm)

Question 29

Nerve injury with humerus injury

Answer 29

Radial nerve injury Numbness of the dorsum of the hand between 1st and 2nd metacarpals and decrease strength with wrist and thumb extension and forearm supination

Question 30

Supracondylar fractures look for injury of

Answer 30

Brachial artery Median (especially anterior interosseous nerve(test strength of thumb when pt says okay)), radial or ulnar nerve

Question 31

impetigo tx

Answer 31

if localized: topical mupirocin if large area: oral cephalexin 40-50 mg/kg/day divided TID. (or augmentin 45 mg/kg/day of amox component BID max of 875 BID) Kind of an old study from JAMA 1989 but it had about 30% due to betahemolytic step so that's why augmentin vs amox.

Question 32

monteggia fracture

Answer 32

ulnar shaft fracture with radial head dislocation

Question 33

galeazzi fracture

Answer 33

radius fracture with radioulnar joint dislocation

Question 34

pyloric stenosis measurements

Answer 34

thickness greater than 3 mm and length greater than 15mm

Question 35

octreotide MOA

Answer 35

binds to somatostatin receptors coupled to phospholipase C through G proteins and leads to smooth muscle contraction in the blood vessels

Question 36

Terbutaline dosing

Answer 36

Inhalation: | 0.5 mg

Question 37

Versed for procedures dosing

Answer 37

IV 0.05- 0.1 mg/kg repeated, max 0.6 mg/kg total no more than 6mg for up to 5 years old and no more than up to 10 mg for older Intranasal 0.5 mg/kg max at 5mg to 10 mg Oral 0.5 mg/kg max at 20 mg

Question 38

acute respiratory failure

Answer 38

HCO3 will increase by 1 for every 10 increase in CO2

Question 39

chronic respiratory failure

Answer 39

HCO3 will increase by 4 for every 10 increase in CO2

Question 40

Flumazenil dosing

Answer 40

0.01 mg/kg max of 0.2 mg, repeated as needed up to total of 1mg

Question 41

dose of albuterol during an exacerbation

Answer 41

0.25 puff/kg