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182 Cards in this Set

  • Front
  • Back
What is the slippage of the femoral head on the femoral neck at the growth plate?
-slipped capital epiphysis
-What is a hyperextension childhood injury with a positive lachman and drawer test on PE?
-avulsion acl injury
-What condition is an inflammation of growth plate at the tibial tuberosity?
-osgood-schlatters
-What causes Osgood-schlatters?
-repetitive over use injury to tibial apophysis
-What causes sinding-larsen syndrome?
-repetitive stress injury to junction of patella and patellar tendon
-How do you treat Osgood-schlatters and sinding-larsen?
-rest 4-6 wks
-What is little league elbow injury called?
-avulsion medial epicondyle
-If little league elbow heals improperly what problem could occur?
-flexion contracture (elbow cant extend all the way)
-At what size of avulsion does surgery need to be done in avulsion medial epicondyle injury?
->5mm
-What injury is caused by repetitive stress injury to the calcaneal apophysis?
-severs disease
What condition is idiopathic osteonecrosis of femoral head?
-legg-calves disease
-What is the treatment for meniscal tears?
-arthroscopic debridement, quad strengthening
-What PE tests are positive in meniscus tears?
-mcmurrays, apleys compression
-What is the treatment for 1st degree collateral ligament injury?
-ROM therapy, quad strengthening for 4-6 wks, early weight bearing
-What is the treatment for 2nd degree collateral ligament injury?
-60 degree locked brace for 4 wks, therapy for 16 wks
-What is the treatment for 3rd degree collateral ligament injury?
-surgical reapair
-What syndrome has chronic pain with aerobic events and climbing stairs?
-patellofemoral syndrome
-What feature of womens anatomy causes patellofemoral syndrome?
-increased Q angle
-What PE tests are positive in patellofemoral syndrome?
-patellar apprehension test, patellar inhibition test
-What is the treatment for patellofemoral syndrome?
-vastus medialus strengthening

-nsaids

-patella stabilizing brace, mcconnell taping
What surgery is done if treatment for PF syndrome failed after 2 years?
-lateral retinacular release
-What condition is dead area in femoral condyle?
-osteochondritis dessicans
-How do you treat O.D.?
-cylinder cast 6-8 wks
-What is the most common cause of ankle sprains?
-inversion injuries (85%)
-What criteria decides if an ankle sprain needs to be xrayed?
-ottawa rules
-What is a grade 1 ankle sprain?
-lateral injury, negative xray, negative drawer test
-How is grade 1 ankle sprain treated?
-early motion, early wt bearing, therabrand ex’s, full activity
-What is a grade 2 ankle sprain?
-both medial and lateral ligaments involved
-How do you treat a grade 2 ankle sprain?
-immobilize 2-4 wks, PT, full activity > 6wks
-What is a grade 3 ankle sprain?
-medial and lateral injury, positive drawer test, instability
How do you treat a grade 3 ankle sprain?
-surgical repair
-What type of shoulder dislocation is caused by falling on an outstretched arm?
-glenohumeral
-What type of shoulder dislocation is caused by a direct blow?
-acromioclavicular
-Which type of shoulder dislocation needs xray and reduction?
-glenohumeral
-What are impingement signs in rotator cuff strains?
-inpingement arc, pain at ROM extremes, negative drop arm test
-What is the treatment for a scaphoid fracture?
-long arm cast 10-20 wks
-What injury presents as shin splints after prolonged activity?
-stress fracture
-What system classifies fractures surrounding a growth plate?
-salter-harris classification
-What 3 things are evaluated in the glascow coma score?
-eye response, verbal response, motor response
-What is cushings triad (sign of increased ICP)?
-hypertension, bradycardia, hyperpnea
What are other signs of increased ICP on PE?
-bulging fontanel, unequal pupils, decorticate/decerebrate posturing
-What is given if pts blood sugar is <60?
-bolus of D25, or 0.5-1 mg glucagons if no IV access
-What does AEIOU TIPS stand for?
-alcohol/abuse, electrolytes/encephalopathy, infection/ingestion, overdose, uremia, trauma, insulin/inborn errors of metabolism, psychogenic, seizures/stroke/shock/shunts
-What is the most common cause of death in pediatrics?
-trauma (head injuries)
-What are 6 poor outcome predictors in trauma?
-cardiac arrest > 25 min, blood sugar >250, found unresponsive, GCS <8, pH <7.1, coma > 24hrs
-When is emesis never used in pts with toxic ingestion?
-comatose, seizing pts

-absent gag reflex

-swallowed sharp objects

-swallowed strong acids, bases or hydrocarbons
-When can emesis be used in toxic ingestions?
-if patient ingested substance within 30-60 min
-Lavage as a treatment for toxic ingestion is most effective in what timeframe?
-within one hour
-Whole gut lavage with polyethelene glycol is used for what types of ingestion?
-sustained release medications, substances poorly absorbed by charcoal, to get mechanical movement of items through bowel
-What is the dose of activated charcoal used?
1-2 g/kg repeated every 2-6 hrs
Charcoal is not effective for what kinds of ingestion?
-iron, lithium, caustics
-What are the 3 methods for enhancing excretion of toxic substances?
-urinary alkalinization, dialysis, natural diuresis
-Sodium bicarb is administered when what 2 substances are ingested?
-ASA, Phenobarbital (pKa < 7.5)
-Dialysis may need to be done after high levels of ingestion of what 3 things?
-ethanol, ASA, lithium
-What is the most common co-ingestion in a suicide attempt?
-ethanol
-What is the metabolic degradation rate of ethanol?
20 mg/hr
-What is the toxic metabolite of acetaminophen?
NAPQI
-How does the pt appear in Phase I (first 24 hrs) of acetaminophen ingestion?
nausea, vomiting, anorexia
- How does the pt appear in Phase II (second 24 hrs) of acetaminophen ingestion?
asymptomatic
- How does the pt appear in Phase III (48-96 hrs) of acetaminophen ingestion?
elevated LFTs, bilirubin, PT, RUQ pain, nausea, vomiting, fulminant hepatic failure
How does the pt appear in Phase IV (7-8 days) of acetaminophen ingestion?
-recovering
-What is the treatment for acetaminophen overdose and in what forms does it come?
-N-acetylcysteine

-Mucomyst PO, Acetadote IV
-N-acetylcysteine is most effective if given when?
-within 8 hrs
-If pt presents after 4 hrs of acetaminophen ingestion what do you do?
-give charcoal, draw blood levels and plot on rumack-matthew nomogram, maybe give mucomyst if blood level is hepatotoxic
-If pt arrives after 24 hours after ingestion and acetaminophen level is >10 or AST is elevated, what do you give?
-N-acetylcysteine
-What are the symptoms of aspirin intoxication?
-hyperventilation, sweating, dehydration, fever, nausea, vomiting, tinnitus
-What is the toxic dose of aspirin?
-150 mg/kg
-An ABG on a pt with an aspirin ingestion may show what?
-metabolic acidosis
-What treatment is given to pt with an aspirin ingestion?
-charcoal within 4 hrs, sodium bicarb to raise urine pH to > 7.5
-Hemodialysis is needed when serum aspirin levels are what level?
> 100 mg/dl
What is the treatment for a kid that ingested less than 100 mg/kg of ibuprofen?
-drink 4 ounces of milk or water
-What is the treatment for a kid that ingested more than 400 mg/kg of ibuprofen?
-gastric lavage or activated charcoal
-What are the symptoms of Beta blocker ingestion within 6 hrs?
-bradycardia, cardiogenic shock, arrhythmias, hyper/hypo glycemia, ECG changes: wide QRS, increased PR interval, BBB
-What is the treatment for beta blocker ingestion?
-supportive care, monitor vitals/EKG/lytes/glucose, charcoal if < 4 hrs
-What are the symptoms of digoxin or cardiac glycoside ingestion?
-nausea, vomiting, diarrhea, headache, MS change, dysrhythmias
-What should you not give to pt with digoxin ingestion?
-potassium
-What is the antidote for digoxin ingestion?
-digoxin immune Fab (Digiband)
-What will appear on CBC with lead intoxication?
-normo or microcytic with basophilic stipling (small dots at periphery of RBCs which are accumulations of rRNA)
-What is the treatment for lead ingestion if pt is asymptomatic and lead level is 45-69?
-outpatient chelation with oral dimercaptol, check blood levels in 48 hrs
- What is the treatment for lead ingestion if pt is symptomatic and lead level is >69?
-admit pt, IV dimercaptol and edentate

-monitor lytes, calcium, creatinine, and UA
What symptoms could develop in a pt with lead blood levels > 60?
-GI/renal effects, encephalopathy, ICP, seizures
-What are the 5 most common sites for a foreign body to become lodged?
-cricopharyngeal area

-middle 1/3 of esophagus

-lower esophageal sphincter

-pylorus

-ileocecal valve
-What is the best way to remove an ingested foreign body?
-endoscopy
-What foreign bodies cause symptomatic patients and need to be removed?
-batteries, caustic or sharp objects
-What could be symptoms of a lower respiratory tract foreign body?
-episode of choking followed by no sx for days

-then fever/cough, and signs of pneumonia and atelectasis
-How would a coin in the trachea appear on xray?
-sideways (sitting in between rings of cartilage)
-What should not be done for a pt with a nasal foreign body?
-decongest area with topical pseudoefedrine or oxymetazoline
-What should you always consider in child burns?
-child abuse
-What differentiates a 1st degree from a 2nd degree burn?
-no blistering in 1st degree
-How deep do 3rd degree burns extend into the tissue?
-“full thickness” though epidermis and dermis
Why are circumferential burns very serious?
-can lead to compartment syndrome
-What defines a major burn?
- > 10% of BSA consisting of 1st and 2nd degree burns

- or > 2% of BSA of 3rd degree burn

-or any burn to face, hands, feet, or perineum
-What is the parkland formula for fluid resuscitation for first 24 hrs after burn?
-total lactated ringers 4 ml/kg x BSA
-What is the rate of infused lactated ringers solution over the first 8 hours, and then next 16 hrs?
-50% over first 8 hrs

-remaining 50% over next 16 hrs
-What Is near drowning?
-survival (even if temporary) beyond 24 hrs after a submersion episode
-Aspiration of water causes dilution and wash out of what in the lungs?
-alveolar surfactant
-Hypothermia is defined as a core temp of what?
- < 35 celcius
-What are the 7 poor prognostic indicators from drowning?
-submersion longer than 10 min

-resucitation duration greater than 25 min

-GCS < 5

-Age < 3

-water temp > 10 celcius

-ABG pH <7.1

-CPR needed in ED
-What are the battle signs in head injuries?
-bruising behind ears, raccoon eyes
-What 5 things in a head injury indicate that a CT should be done?
-LOC, persistent vomiting, mental status change, signs of skull fracture, abnormal PE findings
What rectal temp constitutes a fever?
-38 celcius (101 F)
-Despite the cause of a fever they should all be treated with what?
-tylenol q4, or motrin q6
-A full septic work up should be done in all infants at what age with a fever?
-less than 28 days
-What infection and fever is most common in 5-10 y.o.?
-strep throat
-What infection and fever is most common in children < 2 years?
-otitis media
-What kind of bacteria cause meningitis at 0-2 months?
-Group B strep, E.coli, listeria monocytogenes
-What kind of viruses cause meningitis at 0-2 months?
-herpes simplex, cytomegalovirus, enterovirus
-What kind of bacteria cause meningitis at 2 mo-5yrs?
-strep pneumoniae, meisseria meningitides, beta hemolytic strep, haemophilus influenza B, rickettsia, salmonella, E.coli
-What viruses cause meningitis at 2 mo – 5 yrs?
-HSV, enterovirus, arbovirus
-What bacteria cause meningitis in 5-21 y.o.?
-strep pneumoniae, neisseria meningitidis
What viruses cause meningitis in 5-21 y.o.?
-HSV, entero/arbovirus, EBV, Influenza A/B
-What are symptoms of meningitis in infants?
-irritability, inconsolability, hypotonia, lethargy, bulging fontanelle
-What are symptoms of meningitis in older children?
-headache, photophobia, nausea, vomiting, neck stiffness
-What are 4 severe symptoms of meningitis?
-shock, seizure (20-30%), coma, SIADH (30-60%)
-What is seen on CSF analysis in a case of bacterial meningitis?
-WBC >1000, PMN > 50

-Glucose < 30

-Protein >100
-What empiric abx are given to child < 8 wks old with meningitis?
-ampicillin + cefotaxime, maybe add acyclovir for herpes
-What empiric abx are given to child 2 mo or older with meningitis?
-ceftriaxone, consider vancomycin for pneumococcal meningitis
-What med is given to increase glucose and decrease protein/lactate in CSF in a case of meningitis?
-dexamethasone
-When do you give dexamethasone to a patient with meningitis?
-20 minutes before first does of abx, then every 6 hrs
-CF is caused by defects in a transmembrane conductance regulator. What does this defect cause?
-decreased hydration of mucus, stickier mucus leading to infection
What is the principal cause of death in CF?
-end-stage lung disease
-What enzyme causes persistence of inflammation, structural damage, and impaired gas exchange in CF patients?
-neutrophil elastase
-What mechanical bowel problems are seen in CF patients?
-sludging of intestinal contents, intestinal obstruction, impaction, intussusception
-What causes pancreatic insufficiency in CF patients?
-reduced bicarbonate secretion in response to secretin stimulation

-pancreatic enzymes cant work at their optimal pH
-What liver/gallbladder problems result in CF?
-increased bile viscosity, gallstones, obstructive cirrhosis
-What are some early presentations that point towards a diagnosis of CF?
-meconium ilius, recurring respiratory infections/pneumonia, steatorrhea, failure to thrive
-What test for chloride content in sweat is used to diagnose CF?
-quantitative pilocarpine iontophoresis test
-What level of chloride in sweat is consistent with a diagnosis of CF?
> 60 mmol/L
-What neonatal enzyme is screened for CF?
-immunoreactive trypsinogen
-What is the hallmark of CF lung disease?
-airway inflammation
What type of diet should a CF patient have?
-high energy, high –fat, fat soluble vitamins and minerals
-What is the best activity for a CF patient?
-canoe paddling (seriously go buy a canoe)
-What medication is given to CF pt to assist in digestion of proteins, starches, and fats?
-pancrelipase (creon, pancrease, ultrase, viokase)
-Taking pancrelipase with what other meds may increase the effect of the enzymes?
-H2 antagonists, proton pump inhibitors
-CF patients are unable to absorb what vitamins properly?
-A,D,E,K (fat soluble)
-What med is given for airway clearance in CF patients?
-albuterol neb
-What mucolytics help to improve airway clearance in CF patients?
-Dornase alfa (pulmozyme) via nebulizer

-hypertonic saline
-What inhaled antibiotic is effective in CF pts > 6 mo?
-tobramycin
-What abx is combined with penicillins to treat pseudomonad infections in CF pts?
-gentamicin
-What abx are effective against pseudomonas, streptococci, and MRSA infections in CF?
-ciprofloxacin
What is the definition of flail chest?
-2 or more consecutive ribs broken in 2 or more places
- Any injured patient who is cool and tachycardic is considered to be in shock unless proven otherwise T/F?
-True
-What is the most common cause of shock in an injured patient?
-hemorrhage
-How do treat shock by giving fluids?
-start 2 large bore IVs (at least 16G), warm isotonic solution (NS or LR), blood products
-What is the best GCS, and what is a severe GCS?
-15 is best, severe is 3-8
-If you suspect neurologic deterioration because of ICP what do you do?
-Mannitol, controlled hyperventilation, anticonvulsants, deep sedation, raise head of bed to 30 degrees, neurosurgery consult
-What are the 4 areas of FAST obtained during primary survey in a trauma?
-ultrasounds of the RUQ, LUQ, Pelvis, sub-xiphoid
-Ultrasound of the RUQ could show fluid accumulation in what area?
-Morison’s pouch (hepatorenal recess)
-Hyperechoic areas on an ultrasound could indicate what in a trauma?
-accumulation of blood or fluid
-Ultrasound of the sub-xiphoid area could show what in a trauma?
-pericardial effusion
During the head to toe secondary survey of a trauma, what does DCAP BTLS stand for?
-deformities, contusions, abrasions/avulsions, penetrations/punctures, burns, tenderness, lacerations, swelling
-What describes the first class of hemorrhagic shock?
-15% blood volume loss, HR < 100, BP= normal

-Replace fluid PO or IV
-What describes class II of hemorrhagic shock?
-15-30% blood loss, HR 100-120, BP normal, CNS mildly anxious

-Replace fluid IV
-What describes class III of hemorrhagic shock?
-30-40% blood loss, HR 120-140, BP decreased, CNS anxious/confused

-Replace fluid IV + Blood
-What describes class IV hemorrhagic shock?
- >40% blodd loss, HR >140, BP decreased, CNS confused/lethargic

-Replace fluid IV + Blood
-“Blood on the floor and 4 more” describes obvious signs of bleeding plus what 4 things?
-bleeding in the chest (hemothorax), abdomen (do FAST), pelvis (fractures), long bones (femur)
-What are 3 causes of obstructive non-hemorrhagic shock?
-tension pneumothorax, pericardial tamponade, massive PE
-What are 5 causes of cardiogenic non-hemorrhagic shock?
-dysrhythmia, MI, cardiomyopathy, valvular dysfunction, septum rupture
-What is the classic display of neurogenic non-hemorrhagic shock?
-hypotension without tachycardia or cutaneous vasoconstriction
-How do you threat neurogenic shock?
-fluids, vasopressors, atropine
What is the most common cause of distributive shock?
-sepsis
-What are the symptoms of sepsis?
-fever, rigors, hypotension, hyperglycemia, altered MS
-Stephen Johnson syndrome is a type of this 3rd degree burn?
-toxic epidermal necrolysis
-IV fluids should be given to patients with burns over how much of their body?
- >20% BSA
-Which type of burn appears wet and is hypersensitive?
-2nd degree
-Which type of burn does not blanch with pressure?
-3rd degree
-How is the Baux score calculated for predicting burn mortality?
-Age + percent burn
-What are the more serious cause of chemical burns?
-alkali burns
-Rhabdomyolysis from electrical burns cause release of what?
-myoglobin
-What can be given to help flush pigments such as myoglobin out of the body?
-mannitol
What can be given to trap myoglobin in the urine and aid in excretion?
-sodium bicarb
-Acute mesenterich ischemia may produce elevations of what enzyme in the blood?
-lactate (from conversion of aerobic to anaerobic metabolism)
-Plain film xrays can be used to diagnose what abdominal conditions?
-bowel obstruction, perforation, foreign body
-CT can be used to diagnose what abdominal conditions?
-looks at organs and vasculature, mesenteric ischemia
-Ultrasound can be used to diagnose what abdominal conditions?
-abdominal aortic aneurism, ovarian/testicular torsion
-What multiple organ dysfunction syndromes may result from sepsis?
-ARDS, tubular necrosis and kidney failure, hepatic injury/failure, DIC
-What parameters are seen in systemic inflammatory response syndrome (in sepsis)?
-temp >100.4 or < 96.8, HR >90, RR >20 or PaCO2 <32, WBC >12,000 or <4,000 or >10% bands
-2 or more of these criteria =
sepsis
-What is the BP in septic shock?
systolic < 90 or reduction of > 40 mmHg from baseline
-How much fluid should be given for every 1L of blood loss?
-3 L
What abx are given for sepsis?
-3rd or 4th gen cephalosporin, flagyl, vancomycin
What kind of electrical current is more likely to cause ventricular fib?
AC