Rosh Review

Question 1

Beta-Blocker Toxicity

Answer 1

• PE will show hypotension, bradycardia, and heart block.
• Labs may show hypoglycemia
• Treatment is hemodynamic support, glucagon, calcium salts, high-dose insulin with dextrose, lipid emulsion therapy

1. Beta-blocker toxicity primarily affects the cardiovascular system but may also affect the CNS and pulmonary systems, and it may cause metabolic abnormalities.
2. The hallmark of severe beta-blocker toxicity is bradycardia, due to sinus node suppression with shock.
3. Other signs and symptoms include hypotension, AMS, seizures, hypothermia, and hypoglycemia, which is often used to differentiate pure beta-blocekr toxicity from calcium channel toxicity.
4. Beta-blockers with activity against sodium channels, such as propranolol, increase the QRS interval and may present as a wide complex bradycardia.
5. Seizures and a Brugada pattern on ECG are also seen more often with propranolol.
6. The treatment for beta-blocker toxicity attempts to increase organ perfusion by stimulating myocardial contractility, increasing the heart rate, or boith.
   7.

Question 2

Beta-Blocker Toxicity

Beta-Blocker Toxicity

Question 3

Beta-Blocker Toxicity

Which beta-blocker may prolong the QTc?

Answer 3

Sotalol, a class III antidysrhythmic, due to its blockade of potassium channels

Question 5

Infant

What is the average duration of crying in the first 3 months of life?

Answer 5

“Normal” for infants < 3 months old ranges from 68 - 133 minutes per day. The duration is greatest during the first 6 weeks and gradually declines after 8-9 weeks of age.

Question 6

Infant Colic

Infant Colic

Answer 6

• Persistent or excessive crying; inconsolability
• Benign, self-limited
• Wessel criteria: > 3 hr/day, > days/week, > 3 weeks in duration; otherwise healthy and feeding well
• Resolves by 3 to 4 months
• Tx: reassurance and supportive measures; consider 1 week trial of extensive hydrolysate formula or hypoallergenic maternal diet (if breastfeeding)