PEM Sample Qs Flashcards

1
Q

2 abx for prophylaxis in sexual abuse

A
  • Ceftriaxone 250 mg IM or Cefixime 8 mg/kg PO once
  • Azithromycin 1 g PO once or 15 mg/kg PO once
  • if over 8 yrs: Doxy 100 mg BID x 7 days
  • Flagyl
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2
Q

3 viruses to counsel parents on:

A
  • HIV
  • Hep B
  • Hep C
  • HPV
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3
Q

3 counselling instructions for vulvovaginitis

A
  1. Avoid bubble baths or use of perfumed soaps/creams
  2. Avoid tight fitting clothes/underwear
  3. Wipe front to back
  4. Apply zinc oxide or other topical emollient- will resolve with good hygeine
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4
Q

4 pathogens (non STI) vulvovaginitis

A
  • Group A strep
  • Staph aureus
  • S.pneumo / H flu / Moraxella
  • Shigella
  • STIs are uncommon
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5
Q

5 features that distinguish mastitis from physiologic breast budding

A
  • Erythema
  • Unilateral
  • Warmth
  • Swelling
  • Painful to palpation
  • Assoc of fever
  • Purulent discharge/drainage
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6
Q

2 immediate interventions for mastitis

A
  1. Obtain IV access with labs (CBC, blood culture)
  2. If unwell, consider full septic work-up with labs, urine studies & LP
  3. C/S surgery for possible I&D
  4. Start IV antibiotics
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7
Q

5 high risk factors for c-spine injury

A
  1. Age > 65 years old
  2. Presence of numbness/tingling/paresthesias
  3. Midline cervical pain
  4. Not ambulatory at scene
  5. Dangerous mechanism: fall > 3 ft, axial load, high speed MVC, ATV or motorized vehicle accident
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8
Q

Signs of cervical injury (6)

A
  1. Motor paralysis
  2. Neurogenic shock: bradycardia, hypotension, flushed skin
  3. Spinal shock: flaccid paralysis, loss of rectal tone, loss of DTRs
  4. Neck: torticollis, muscle spasm, tenderness
  5. Sensory deficit with level
  6. Horner’s syndrome
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9
Q

Label C-spine lines

A
  • anterior vertebral line
  • posterior vertebral line
  • spinolaminar line
  • posterior spinous line
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10
Q

Hangman fracture

A

fx of C2 pedicle, hyperextension
-draw Swischuk line (C1-C3 through anterior spinous process circle), if C2 deviated > 2 mm on C3 = subluxation (if < 2 mm, pseudosubluxation)

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11
Q

Type of C-spine fractures (5)

A

Type 1: wedge compression, stable, semirigid cervical collar
Type 2: teardrop, isolated anterior/inferior vertebral body fx w/ intact posterior element (abrupt neck extension), semirigid cc
Type 3: comminuted burst, intact posterior elements (unstable, need surgery)
Type 4/5: complex, involve post elements, unstable, poor prognosis

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12
Q

Mgmnt of Pulseless VT (3)

A
  • Defibrillation 2J/kg –> 4J/kg
  • Epinephrine 0.1 ml/kg Q3-5min
  • Amiodarone (Refractory) 5 mg/kg (150 mg)
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13
Q

Systemic causes of prolonged QTc (4)

A
  • Congenital: Romano Ward, Jervell-Lange-Nielson
  • Metabolic: hypomagnesemia, hypocalcemia, hypokalemia
  • Endocrine: hypoparathyroidism, hypothyroidism
  • Neurologic: Stroke, subarachnoid hemorrhage, encephalitis
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14
Q

Drugs that cause prolonged QTc

A
  • Anti-emetics: ondansetron
  • Antipsychotics: Haloperidol
  • Loop diuretics: furosemide
  • Antibiotics: macrolides
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15
Q

Causes of abnormal S3

A

CHF
VSD
mitral regurg
dilated cardiomyopathy

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16
Q

6 life threatening GI emergencies in solid organ transplant patients

A
  1. Portal venous thrombosis
  2. Biliary obstruction
  3. Typhilitis
  4. Liver failure with hepatic encephalopathy
  5. GI hemorrhage
  6. Renal artery stenosis
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17
Q

8 diagnostic tests to help diagnosis of mediastinal mass

A
  1. Chest CT
  2. CBC
  3. BMP - electrolytes, renal function
  4. Urine / plasma catecholamines
  5. Alpha FP and BHCG
  6. LDH / uric acid
  7. BM biopsy
  8. Echo
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18
Q

3 complications of mediastinal mass

A
  1. Tumor lysis syndrome
  2. Superior vena cava syndrome
  3. Superior mediastinal syndrome (SVC + obstruction of trachea)
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19
Q

Indications for atropine use (2)

A
  • symptomatic bradycardia
  • cholinergic poisoning
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20
Q

Indications for hospitalization of suicidal teenager (4)

A
  • No follow-up arrangements possible
  • Remains actively suicidal
  • History of previous suicide attempts
  • Unsupportive home environment (lack of appropriate adult sup)
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21
Q

Risk factors for repeat suicide attempt (4)

A
  • impulsivity
  • Psychosocial factors
  • Family: lack of supportive environment, fhx of SI, mental health dx in family
  • Concomitant mood disorder
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22
Q

4 causes of non-traumatic pancreatitis

A
  1. Gallstones / cholelithiasis
  2. Ethanol abuse
  3. Hypertriglyceridemia/hyperlipidemia
  4. Medication induced: azathioprine, asparaginase chemo
  5. Metabolic: hypercalcemia, hypothermia
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23
Q

4 lab findings in pancreatitis that necessitate ICU care

A
  1. Hyperglycemia: BG > 11.1
  2. Hypocalcemia: Ca < 2.0
  3. Elevated BUN
  4. Elevated hematocrit
  5. PaO2 < 60 mmHg (needs intubation)
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24
Q

Drugs that can be hemodialyzed in overdose (5)

A
  • Aspirin
  • Toxic alcohols: ethylene glycol, methanol
  • Lithium
  • Metformin
  • Severe acetaminophen O/D
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25
Q

2 ingestions that can cause UGI bleeding

A
  • button battery
  • iron
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26
Q

2 common causes of UGI bleed in toddler

A
  • mallory weiss
  • gastritis / esophagitis
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27
Q

life threatening causes of GI bleed (4)

A
  • Peptic ulcer disease
  • Esophageal varices
  • Vascular malformation
  • Intestinal duplication
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28
Q

HSP - CF (5)

A
  • Palpable purpuric rash, most notable of LE
  • Arthritis/arthralgias
  • Abdominal pain +/- GI bleeding
  • HTN
  • Orchitis
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29
Q

HSP - Lab findings (5)

A
  • UA: hematuria, proteinuria
  • Elevated CRP / ESR
  • (+) fecal occult blood test
  • Elevated platelets
  • Anemia
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30
Q

4 C/I to enema reduction in intussusception

A
  1. Perforation
  2. Obstruction
  3. Peritonitis
  4. Presence of pneumatosis intestinalis
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31
Q

Burn Center Referral Criteria (8)

A
  • TBSA > 10 % partial thickness
  • TBSA > 5% full thickness injury
  • Concern for NAT
  • Burns on hands/feet/genitals
  • Inhalation injury
  • Chemical burn
  • Major associated injuries
  • High voltage burn injuries
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32
Q

5 features of NAT burns

A
  1. Symmetrical, well delineated burns on hands/feet
  2. Submersion burns sparing buttock
  3. Patterned burns - distinct objects
  4. Cigarette burn holes
  5. Lack of splash pattern
  6. Inappropriate explanation for mechanism
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33
Q

4 life threatening complications of DKA

A
  1. Cerebral edema
  2. Hypovolemic shock/ cardiovascular collapse
  3. Profound metabolic acidosis
  4. Electrolyte abnormalities: hypo/hyperkalemia
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34
Q

3 clinical features of anterior shoulder dislocation

A
  1. arm is externally rotated
  2. arm is abducted
  3. pain
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35
Q

Nerve injury w/ anterior shoulder dislocation

A

axillary N
- test with sensation over lateral deltoid

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36
Q

Complications of shoulder reduction (3)

A
  1. Axillary N/AA injury
  2. Hill-Sachs lesion: cortical depression of humeral head
  3. Bankart lesion: avulsion fx of ant inferior glenoid rim (labral tear)
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37
Q

MC elbow injury

A

supracondylar fx

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38
Q

4 XR features of elbow fracture

A
  1. Posterior fat pad
  2. Anterior humeral line does not bisect capitellum
  3. Abnormal radiocapitellar line (does not bisect capitellum)
  4. Elevation of anterior fat pad (sail sign)
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39
Q

MC N injury w/ supracondylar dx

A

anterior interosseuss (branch of median N)

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40
Q

Volkmann’s contracture - what is it?

A

caused by compartment syndrome from supracondylar fx w/ ischemia to flexor mm of forearm causing fibrosis / contracture –> permanent flexor contracture of hand = “claw hand”

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41
Q

5 feature of compartment syndrome on exam

A
  • Pulseless
  • Pallor
  • Pain out of proportion
  • Paresthesias
  • Paralysis
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42
Q

Tilleaux fracture

A
  • Salter harris 3 fx through physis and epiphysis of distal tibia
  • Avulsion of anterolateral epiphysis (medial physis is partially closed in age 12-14 yr old)
    If displaced > 2 mm: CT scan, Ortho c/s, ORIF
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43
Q

EKG findings in cocaine O/D (4)

A
  • ST elevation
  • Sinus tachycardia
  • SVT
  • Tachyarrhythmia: V/fib, V.tach, torsade
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44
Q

EKG findings in myocarditis (4)

A
  • Sinus tachycardia
  • Low voltage QRS complex
  • Low voltage T waves or T wave inversion
  • Dysrhythmia (SVT, Vtach)
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45
Q

CXR findings in myocarditis (3)

A
  • Cardiomegaly
  • Increased interstitial infiltrates
  • Pleural effusion
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46
Q

Non-infectious causes of myocarditis (3)

A
  1. Medications - anthracyclines, cocaine, heavy metals
  2. Radiation exposure
  3. Systemic disorders - SLE, IBD, Thyrotoxicosis
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47
Q

6 complications of pericardiocentesis

A
  1. Puncture of heart
  2. Dysrhythmia
  3. Laceration of coronary vessels
  4. Local infection
  5. Hemothorax/Pneumothorax
  6. Diaphragmatic perforation
  7. Puncture of peritoneal cavity
  8. Hemopericardium
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48
Q

Medications for CV support in myocarditis

A
  • Preload: lasix, nitroglycerin
  • Pump: dopamine, dobutamine, epi
  • Afterload: milrinone
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49
Q

Signs of organ rejection - liver transplant (2)

A
  1. Elevated LFTs - cholestasis, itching
  2. Abdominal pain, fever
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50
Q

Signs of organ rejection - kidney transplant (2)

A
  1. Fever with graft tenderness
  2. Uremia, elevated creatinine
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51
Q

Signs of organ rejection - heart transplant (2)

A
  1. Tachycardia, low CO, sx of CHF
  2. Pericardial effusion
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52
Q

Drugs that increase calcineurin inhibitor levels (tacrolimus, cyclosporin)

A
  1. Antibiotics - macrolides, FQs, metronidazole
  2. Antifungals - fluconazole, ketoconazole
  3. Antivirals - indinavir, nelfinavir
  4. CCB - nifedipine, nicardipine, diltiazem
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53
Q

Drugs that decrease calcineurin inhibitor levels (tacrolimus, cyclosporin)

A
  1. Antibiotics - Rifampin
  2. Antifungals - caspofungin (tacro only), terbinafine
  3. Antivirals - nevirapine, efavirenz
  4. Anticonvulsants - carbamazepine, phenobarbital, phenytoin
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54
Q

Causes of HYPERNATREMIA

A
  1. Diarrhea
  2. Diabetes insipidus (Uosm < Sosm)
  3. Hyperaldosteronism
  4. Iatrogenic (wrong fluids)
  5. Water deprivation, impaired thirst, improper formula mixing
  6. Neurosurgery
  7. Mod-severe burns
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55
Q

Complications of hypernatremia

A
  1. Intracranial hemorrhage
  2. osmotic demyelination syndrome (rapid correction)
  3. sinus venous thrombosis
56
Q

Risk factors for hyponatremia

A
  1. Burns
  2. children < 6 mos
  3. hospitalized children
  4. hypotonic IVF
  5. SIADH/Meds
  6. Immediate post-op period
57
Q

correction for pseudohyponatremia

A

1.6 meq/L of Na should be added for each 100 mg/dL increase in glucose above normal

58
Q

Risk factors for HYPERKALEMIA

A
  • Renal insufficiency
  • Acidosis (extracellular shift)
  • Cell lysis: burns, tumor lysis, crush injuries
  • Necrotizing infections
  • Medications
  • Adrenal insufficiency
59
Q

EKG changes in hyperkalemia

A
  1. Peaked T waves
  2. Prolonged PR and QRS intervals
  3. Decreased amplitude of P waves
  4. Sine wave pattern
60
Q

Causes of HYPOKALEMIA

A
  1. Decreased intake: malnutrition, eating dz
  2. Extrerenal losses: diarrhea, ostomy output, severe vomiting
  3. Increased intracellular uptake: akalosis, insulin, B-agonists (albuterol)
  4. Renal losses: RTA type 1/2, ATN, Gitelman/Barter syndrome, loop and thiazide diuretics
61
Q

EKG changes HYPOKALEMIA

A
  1. Early: Flattened and shallow T waves, prominent U wave
  2. Later: prolonged PR interval and QTc
62
Q

EKG changes in pulmonary embolism

A
  • Sinus tachycardia
  • ST elevations/changes
  • Right axis deviation
  • RBBB: V1 - rSR’ (W) and broad deep S wave in V6 (M)
  • S1Q3T3 pattern
63
Q

Causes of Hypercalcemia (4)

A
  1. Malignancy - hematologic (ALL), solid tumors (often very high levels - PTHrP)
  2. Hypervitaminosis - elevated vitamin D, vitamin A
  3. Immobilization
  4. Primary hyperparathyroidism (mild increase with elevated PTH, low/normal Phos)
64
Q

Signs/Sx of Hypercalcemia

A
  • Bones - bone pain, pathologic fx
  • Groans - abdominal pain, chest pain
  • Moans ​- CNS depression, psychosis, irritability
  • Stones - hypercalciuria (impaired renal conc ability)
  • MSK - hypotonia, hyporeflexia
65
Q

Treatment of hypercalcemia

A
  1. IVF - NS bolus
  2. Bisphosphonates
  3. Calcitonin ** for severe hypercalcemia
  4. Furosemide (no longer recommended)
66
Q

MCC of Hypocalcemia

A
  • hypoparathyroidism (DiGeorge, acquired-surgical)
  • Vitamin D deficiency
  • Renal disease
  • Pancreatitis (sequestration of calcium)
  • Meds: furosemide, anticonvulsants
  • Hyperventilation (resp alkalosis = calcium binds w/ albumin)
67
Q

Signs/Sx of hypocalcemia

A
  • Neuroexcitability
    • paresthesias: perioral, hands/feet
    • muscle cramps/spasms: Chvostek’s sign, Trousseau sign
    • hyperreflexia
  • Smooth muscle effects
    • hypotension
    • bronchospasm
    • laryngospasm
68
Q

Tx of hypocalcemia

A
  • IV Calcium gluconate = 50-100 mg/kg max 1000-2000 mg
69
Q

Nephrotic syndrome (Signs/symptoms)

NAPHROTIC mnemonic

A

N = hyponatremia

A= hypoalbuminemia

P = proteinuria > 3.5 g/day

H = hyperlipidemia

R = renal vein thrombosis

O = orbital edema (scrotal)

T = thromboembolism

I = infection (loss of IG)

C = coagulability

70
Q

Predisposing factors for suicide

A
  • age > 12 years
  • psychiatric disorders
  • previous suicide attempt (best predictor)
  • fhx of mood dz or SI
  • hx of abuse
  • exposure to violence
71
Q

Precipitating factors for suicide

A
  • access to means ex weapon
  • alcohol/drug use
  • exposure to suicide
  • social stress / isolation
  • emotional/cognitive factors
72
Q

Difference between BIPAP and CPAP

A

Bipap = two different airway pressures, one for inhalation and one lower one for exhalation (Uses: asthma, COPD, muscular dystrophy, CF)

CPAP = delivers set pressure regardless of inhalation / exhalation (Uses: OSA, bronchiolitis)

73
Q

5 stages of iron toxicity

A
  1. GI irritation: 30 min - 6 hours (NVD)
  2. Latent: 6 hr-1day (recovery, may not occur in severe OD)
  3. Shock: 12-24 hr (metabolic acidosis, increased AG, dehydration)
  4. Hepatic failure: 24-96 hr (coagulopathy / hemorrhage)
  5. Bowerl obstruction: 3-6 weeks (scarring of GI mucosa)
74
Q

4 factors that determine O2 delivery via orofacial

A
  1. oxygen concentration
  2. delivery device: cannula vs mask
  3. flow rate
  4. patency of nares / airway
75
Q

6 clinical features suggestive of respiratory failure in asthma

A
  1. Accessory muscle use
  2. Tachypnea
  3. Altered mental status
  4. Inability to speak in sentences
  5. Nasal flaring/grunting
  6. Cyanosis or SpO2 < 90%
76
Q

2 laboratory findings in asthma that suggest respiratory failure

A
  1. PaCO2 > 50 with pH < 7.25
  2. PaO2 < 60 or O2 sat < 90%
  3. PaCO2 > 40 with severe distress
77
Q

Causes of Pulmonary Edema (case scenario is myocarditis)

A
  1. Congestive heart failure with poor LV function
  2. Fluid overload from aggressive IV hydration
  3. ARDS - decreased alveolar capillary membrane
  4. Decreased plasma oncotic pressure (malnutrition while ill, burns, trauma)
  5. Post obstructive pulmonary edema
78
Q

4 central causes of respiratory depression

A
  1. Infection - meningitis, encephalitis
  2. Structural - tumor, AVM, hydrocephalus
  3. Immaturity - prematurity
  4. Intoxication - benzodiazepines, ethanol
  5. Seizures
79
Q

Poiseuille’s law

A

resistance to airflor is inversely proportional to radius of lumen

R = 8 n l / n r 4

80
Q

2 mechanisms for acidosis in severe asthma

A
  1. Hypoventilation = hypercapnia (respiratory acidosis)
  2. Hypoxia = hypoperfusion = elevated lactic acid (metabolic acidosis)
81
Q

4 signs/sx of acute hemolytic transfusion reaction

A
  1. Fever/chills/body aches
  2. Dyspnea
  3. Red/brown urine
  4. Abdominal/flank pain
  5. Hypotension
82
Q

3 lab tests to confirm acute hemolytic rxn

A
  1. DAT (direct antiglobulin test) aka Coombs test
  2. CBC
  3. Reticulocyte count
  4. Repeat Type / Cross
83
Q

4 steps in management of acute hemolytic reaction

A
  1. Stop transfusion
  2. Give IVF at 1.5-2 x MIVF
  3. Hemodynamic support with pressors if needed
  4. Diuretics if fluid overload
  5. Draw blood for labs
84
Q

Diagnostic tests for von Willebrand disease (3)

A
  1. PT/PTT/INR
  2. Factor VIII level/activity*
  3. plasma vWF antigen*
  4. plasma vWF activity = ristocetin assay*

** PTT can be normal in mild cases when factor VIII levels are normal

85
Q

Tx of von Willebrands disease

A
  1. DDAVP (desmopressin)
  2. VWF concentrate or factor VIII replacement for severe bleeding
86
Q

Complications of mediastinal mass

A
  1. SVC syndrome
  2. Superior mediastinum syndrome = SVC + tracheal obstruction
  3. Airway compromise or obstruction
87
Q

Lab findings in tumor lysis

A

Hyperkalemia

Hyperphosphatemia

Elevated uric acid

hypocalcemia

88
Q

Indicators of splenic dysfunction

A
  1. splenomegaly or atrophy on exam
  2. recurrent infections / sepsis
  3. (+) howell jolly and heinz bodies in blood
  4. poor titers/response to previously given vaccines
89
Q

Causes of Traveller’s Diarrhea

A

E.coli

Norovirus

Entamoeba histolytica

Salmonella

Giardia lambia

90
Q

Dukaral vaccine = ETEC (enterotoxicgenic e.coli) or cholera

A
91
Q

4 non-infectious causes of hyperthermia

A
  1. Heat stroke
  2. Malignant hyperthermia
  3. Ingestion - serotonin syndrome
  4. Thyroid storm / thyrotoxicosis
92
Q

Lab findings in congenital adrenal hyperplasia

A

Hyponatremia

Hyperkalemia

Hypoglycemia

Acidosis

93
Q

indications for amiodarone

A
  1. hemodynamically stable wide complex tachycardia
  2. refractory pulseless VT and V fib
  3. atrial fibrillation
  4. SVT not responsive to adenosine or cardioversion
94
Q

MOA of amiodarone

A

class III anti-arrhythmic: prolongs QT interval

blocks Ca channels and beta-channels: slows HR and AV nodal conduction

K+ and Na+ channel blocker: prolongs refractory period and slow intracardiac conduction

95
Q

diagnostic criteria for migraine

A
  • atleast 5 attacks
  • duration 1-48 hours
  • atleast 2 of the following features:
    • bilateral or unilateral location
    • pulsatile quality
    • moderate/severe
    • aggravation by routine activity
  • during headache, atleast one:
    • N/V
    • photo/phonophobia
96
Q

definition of child neglect

A

failure to provide the basic child needs - can be physical, educational or emotional

ex. medical neglect, FTT, abandonment, truancy

97
Q

Adams scale for child sexual abuse

A
  1. Findings of newborns and nonabused children: normal variants, caused by other medical conditions
  2. Indeterminant/nonspecific: lesins with etiology confirmed, indeterminate specificity
  3. concerning for abuse
  4. Clear evidence of abuse
98
Q

MOA of NAC (n-acetylcystein) in tylenol O/D

A
  • Early administration prevents the covalent binding of NAPQI to hepatocytes and prevents hepatotoxicity. ( NAC acts as a glutathione precursor🡪NAPQI reduced by glutathione to non toxic mercaptate conjugate 🡪 urine )

Mechanisms include:

i. Acting as a precursor for glutathione to increase available glutathione (major).***
11. Increasing non-toxic sulfation metabolism (major).****
iii. Directly reducing NAPQI to APAP (minor).
iv. Directly conjugating NAPQI (minor).
v. Mitigation of adverse intracellular cascades even after NAPQI covalent binding occurs.

99
Q

Drugs that cause miosis

A
  1. opioids
  2. clonidine
  3. cholinergic drugs - OPP
  4. nicotine
  5. sedatives: barbiturates / benzos
  6. antipsychotics
100
Q

Drugs that cause mydriasis

A
  1. amphetamines
  2. anticholinergics
  3. LSD
  4. inhalants
  5. anti-convulsants
101
Q

6 complications of chronc methamphetamine use

A
  1. coronary ischemia / arrhythmias
  2. psychosis
  3. seizures
  4. periodontal disease
  5. AKI –> rhabdo
  6. pulmonary HTN / edema
102
Q

Precursors of GHB (2)

A
  1. gamma butyrolactone
  2. butanediol
103
Q

2 eye findings in GHB o/d

A
  1. dysconjugate gaze
  2. nystagmus
  3. loss of peripheral vision
104
Q

3 excitatory/neuro sx with GHB o/d

A
  1. hallucinations
  2. agitation
  3. euphoria
105
Q

Indications for WBI (3)

A
  1. Iron and other metal o/d
  2. Extended release medications
  3. Body packing of illicit substances
  4. Pharmaceutical patches

*500 ml/hr in toddlers

2 L/hr in adolescents/adults

106
Q

charcoal is not effective for these types of drugs…

A

Iron

Lithium

Alcohols

Hydrocarbons

Acids/bases

Cyanide

107
Q

4 main effects of calcium channel toxicity with associated mechanism

A
  1. hypotension: smooth mm relaxation = vasodilation
  2. bradycardia: decrease inotropy, slow conduction through AV node
  3. hyperglycemia: decrease insulin release
  4. metabolic acidosis: poor perfusion
108
Q

6 sx of ASA toxicity

A
  • hypoglycemia
  • fever
  • tachypnea with hyperventilation
  • NVD
  • tinnitus
  • vertigo
  • agitation / delirium
109
Q

Drugs that are amenable to dialysis

A

ASA

Lithium

Alcohols

Methotrexate

Valproic acid

* low vol dis, low mw, low protein binding*

110
Q

what meds can use you to tx HTN/tachycardia in stimulant O/D

A

alpha antagonist: phentolamine

nitroprusside

** do not give B-block, will get unopposed alpha stimulation and cause worsening HTN and tachycardia

111
Q

Heat labile toxins (marine envenomations)

A

Stingray

Jellyfish

Portugese man of war

Lionfish

Scorpionfish

Catfish

Sea urchin

112
Q
A
113
Q

EKG findings in hypothermia

A

J waves / Osborn waves - proportional to degree of hypothermia

T wave inversions

Prolonged intervals

Bradycardia

V.fib –> asystole in profound hypothermia

114
Q

EKG changes/progression in pericarditis

A
  1. ST elevation and PR depression
  2. ST segment and PR normalize
  3. Diffuse T wave inversions
  4. Normalize or T waves stay inverted

* may also see decreased voltages

115
Q

5 cardiac problems in anorexia nervosa

A
  1. cardiomyopathy
  2. dysrhythmia - prolonged QTc
  3. pericardial effusion
  4. decreased cardiac mass and chamber volume
  5. bradycardia
  6. mitral valve prolapse
116
Q

Structural causes of ventricular fibrillation

A

Hypertrophic cardiomyopathy

Dilated cardiomyopathy

History of cardiac surgery, ex. TOF repair

Aortic stenosis

ALCAPA (coronary artery abnormalities)

Myocardial infarction

117
Q

Electrophysiologic causes of ventricular fibrillation

A

Prolonged QT

Brugada syndrome

Commotio Cordis

Toxic ingestion of drugs that prolong QT

118
Q

Good prognostic factors for pediatric cardiac arrest

A

1. in hospital

  1. witnessed arrest w/ early bystander CPR
  2. high quality CPR
  3. no prior underlying medical history
  4. shorter duration of CPR with fewer doses of Epi
  5. shorter EMS scene time
119
Q

qualities of heart murmur that necessitate further work-up

A
  1. diastolic murmur
  2. high grade > 3/6
  3. radiation to back
  4. harsh quality
  5. abnormal heart sounds
120
Q

Abx prophylaxis for infectious endocarditis

A

- prosthetic heart valves

  • repaired CHD within 6 months or w/ residual shunt
  • previous hx of IE
  • unrepaired cyanotic CHD
  • cardiac transplant w/ valvular regurgitation
121
Q

Eye findings in uncal herniation

A

Ipsilateral pupil fixed and dilated (CN3 compressed)

Ipsilateral eye down and out + ptosis (unopposed CN IV and VI)

homonymous hemianopsia

122
Q

Doll’s eye maneuver

  • what CN does it test?
  • what is it?
A
  • tests CN 3, 6, 8
  • normally, when head is turned the eyes go in opposite direction
  • tests integrity of the brainstem (test in unconscious people)
123
Q

causes of diplopia (7)

A
  1. CN palsy - CN 3,4,6
  2. ocular migraine
  3. drug intoxication - PCP
  4. mass lesion (optic chiasm)
  5. pseudotumor cerebri
  6. Miller-Fisher variant of GBS
  7. myastenia gravis
  8. botulism
  9. conversion disorder
124
Q

CATCH study - high RF for neurosurgical intervention

A
  1. GCS < 15 @ 2 hours
  2. Open or depressed skull fx
  3. Hx of worsening headache
  4. irritability on exam
125
Q

CATCH study - medium RF for (+) CT findings

A
  1. Sx of basilar skull fx
  2. large, boggy scalp hematoma
  3. dangerous MOI: MVC, fall > 3 ft or5 steps, fall off bicycle w/o helmet
126
Q

Causes of acute urinary retention

A
  1. UTI or vulvovaginitis
  2. obstruction: constipation, imperforate hymen
  3. drugs: anticholinergic
  4. UPJ obstruction
  5. hypermagnesemia
  6. Neuro - ADEM, GBS
127
Q

3 causes of priapism in a 6 year old

A
  • sickle cell disease
  • leukemic infiltration
  • trauma
  • medications
  • black widow bite
128
Q

ddx testicular swelling / erythema (4)

A
  1. testicular torsion
  2. epididimytis
  3. orchitis
  4. testicular hematoma s/p trauma
  5. tumor
  6. varicocele
129
Q

complications of not surgically correcting testicular trauma

A
  1. unsalvageable testicular rupture
  2. missed torsion
  3. infection
  4. damage to spermatic cord - infertility
  5. testicular necrosis
130
Q

RF for perforation with intussusception reduction

A
  1. age < 3 mos or > 5 yr
  2. hematochezia
  3. evidence of SBO on xr
  4. > 2 day of sx
  5. dehydration
131
Q

US findings in appendicitis

A
  1. dilated appendix > 6 mm
  2. non-compressible, tubular structure
  3. mesenteric fat stranding
  4. free fluid in pelvis
  5. (+) appendicolith
  6. loss of peristalsis of surrounding bowel
  7. TTP with graded compression
132
Q

endocrine causes of peptic ulcer dz

A
  1. Zollinger-Ellison syndrome (neuroendocrine tumors)
  2. primary hyperparathyroidism
  3. MEN1 syndrome
133
Q

causes of proctitis

A
  1. IBD (ulcerative colitis)
  2. infectious: c.diff, shigella, salmonella
  3. ischemic
  4. GVHD
  5. medication induced (abx)
  6. radiation therapy
  7. ischemic
134
Q

causes of massive GI bleed in liver failure

A
  1. esophageal varices
  2. coagulopathy
  3. mallory weiss syndrome
  4. PUD / stress gastritis
135
Q

charcots triad / reynolds pentad

A
  1. fever
  2. abdominal pain (RUQ)
  3. jaundice
  4. hypotension
  5. AMS
136
Q

components of pediatric trauma score

A

Weight

Airway

Systolic BP

CNS

Open wound

Skeletal (fx?)

Scores of -1, 1 or 2

Scores < 8 require pediatric trauma center referral