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84 Cards in this Set

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A child is brought to the ED and is non-responsive. What is your first step?
Airway.
How do you pick an ET tube size for a 4yo?
Child's age + 16 then divide by 4.
4+16 = 20/4 = 5; ET tube size 5
Which meds can be given through the ET tube?

Going down the LANE
Lidocaine
Atropine (for bradycardia, not asystole)
Narcan
Epineprine
True or False.
Too low a dose of atropine may cause worsening of bradycardia.
True
Name 4 situations in which calcium would be beneficial in the acute management setting?
Hyperkalemia
Hypocalcemia
Hypermagnesemia
CCB ingestion
How do you calculate tidal volume on a vent?
7ml/kg
What is the best way to measure temperature?
A digital thermometer
A 7yo girl has noted an evanescent rash and morning stiffness for the past few weeks. She is brought in because of fever lasting 1 week. She has no exposures and no uri or uti symptoms. What is her most likely diagnosis?
JRA
Which of the following kids is MOST in needs of antipyretics?
A) A 5yo with febrile seizure
B) A 5yo with OM
C) A 5yo with encephalitis
D) A 5yo with CHF
E) A 5yo with pneumonia
D. The CHF kid will need reduction of fever so oxygen demand is reduced and thus demand for cardiac output is reduced.
The febrile seizure age has almost passed. The OM is not a priority. The encephalitis and pneumonia need antibiotics more than antipyretics.
What is the workup for a 2 week old with fever?
LP, Blood Culture, U/A

CXR is optional
What are the medications for anaphylactic shock?
Epinephrine 1:1000 and IV benadryl
A child comes in with a cat bite. What bug do you cover and what drug do you give?
Cover pasturella. Give augmentin
What are the shapes of dog, human and cat bites?
Dogs are tears; Cats puncture and Humans send you to the moon (1/2 moon)
What is the first step after a bite?
High pressure irrigation
What is the diagnosis and treatment for this bite?
This is a bite by a brown recluse spider? Supportive care
A young boy was bitten by a black widow spider. He didn't notice the bite, so he ignored it. 8 hours later he presents to the ED with muscle aches and hypertension. How do you treat him?
Narcotic pain meds and nifedipine.
True or False
The treatment for a snake bite is a tight fitting tournaquet.
False. It is a loose fitting restriction band.
What would be the result of external rewarming without internal warming in a hypothermic patient?
You would get peripheral vasodilation and hypotension, along with acidosis and arrhythmias.
What are two techniques for internal warming?
IV fluids and gastric lavage
Which two of the following is not a carrier of rabies?
A) Wild Dog
B) Wild Cat
C) Racoon
D) Squirrel
E) Skunk
F) Rabbit
G) Fox
H) Bat
D and F
Which of these animals is not high risk for rabbies?
A) Beavers
B) Whoodchuck
C) Mice
D) Groundhog
E) Oppossum
F) Bat
G) Wolves
C.
What is the treatment for a bite when you have high suspicion for rabies? (3 steps)
Wash and debride
RIG
5 doses of Rabies vaccine
A child sustains a bug bite and a few days later develops signs of localized infection. What is your treatment choice?
Augmentin
What is the first line medication for acute seizure?
IV Ativan. It has a LONGER anti-epileptic action
What are the best choices for long acting seizure medication in kids?
Phosphenytoin and phenobarbital
What is the alternative to IV ativan in infants when IV access is a problem?
PR diazepam
What is the risk of rapid infusion of phenytoin in infants?
Bradycardia
What are the early and late findings in shock?
Delayed cap refill is the early finding and hypotension is the late finding
A patient presents with septic shock. What is the best treatment?
Fluids and norepinephrine to improve central perfusion.
What is the first line med for cardiogenic shock or "cold" shock?
Dobutamine
What are 4 things to do for a patient with increased ICP?
Intubate
Mannitol
Lasix
Hyperventilation.
True or False.
Papilledema is an early sign of ICP.
False. It is a late sign.
What type of hematoma is associated with shaken baby syndrome? What are two other key signs?
Subdural hematoma
retinal hemorrhages and bulging fontanelle
What is the treatment for subdural hematoma?
Subdural tap or surgery.
A child has bloody discharge from his left ear s/p MVA. What is his likely injury?
Temporal Bone Fracture
A patient undergoes a head injury and was quite lucid for the first 12 hours but is now delirious. An LP is done and reveals an atraumatic tap but lots of red cells. What is your diagnosis and treatment?
Epidural hematoma. Call neurosurgery STAT.
Which of the following is good indicators for poor prognosis of a patient in coma. (Choose all that apply)
A) GCS < 8
B) GCS < 10
C) Cerebral bleeding
D) Coma > 6 hours
E) Brain Edema
All but B. Coma is < 8.
True or False.
A GCS < 5 is normal for kids unless using the infant scale.
True

See page 772 of Pass the Boards
A child is brought in after a fall. She has a bruise over the mastoid bone and black and blue eyes. She is not able to close her eyes and unable to look outward. There is clear discharge from her nose and ears. What is her likely injury and treatment.
CT will find basilar skull fracture. Call surgery and do not start antibiotics
What is the first step in hematoma of the nasal septum or of the pinna?
Call ENT
Which category of child is more likely to be abused?
A) A child with ADHD
B) A child with CF
C) A preemie
D) A child born to a depressed parent
E) A child of a substance abusing parent
F) All of the above.
F.
Which of the following are risks for child abuse? (choose all that apply)
A) parental education
B) poor housing
C) Multiple young children in home
D) Parental employment status
E) Gender of child
A) parental education - no
B) poor housing - yes
C) Multiple young children in home - yes
D) Parental employment status - no
E) Gender of child - no
True or False.
Lesions of child abuse are rarely symmetrical.
True
True or False.
Hypophosphatemia and Osteoid Osteoma can result in fractures that mimic abuse.
True
Fracture + Blue Sclera =
Osteogenisis imperfecta
3 month old with fever, facial swelling fo face and jaws is noted to have cortical thickening of the long and flat bones. What is her diagnosis?
Infantile cortical hyperostosis (Caffey Disease)
A patient has bowing of his legs and a decreased alk phos. What is his likely metabolic problem?
Hypophophatasea
True or Falses
Macular rashes of varying color are usually consistent with abuse.
True
True or False.
Cupping and Coining in an Asian child are not considered abuse.
True
A child has bloody discharge from his left ear s/p MVA. What is his likely injury?
Temporal Bone Fracture
A patient undergoes a head injury and was quite lucid for the first 12 hours but is now delirious. An LP is done and reveals an atraumatic tap but lots of red cells. What is your diagnosis and treatment?
Epidural hematoma. Call neurosurgery STAT.
Which of the following is good indicators for poor prognosis of a patient in coma. (Choose all that apply)
A) GCS < 8
B) GCS < 10
C) Cerebral bleeding
D) Coma > 6 hours
E) Brain Edema
All but B. Coma is < 8.
True or False.
A GCS < 5 is normal for kids unless using the infant scale.
True

See page 772 of Pass the Boards
A child is brought in after a fall. She has a bruise over the mastoid bone and black and blue eyes. She is not able to close her eyes and unable to look outward. There is clear discharge from her nose and ears. What is her likely injury and treatment.
CT will find basilar skull fracture. Call surgery and do not start antibiotics
Periorbital ecchymosis.
What is the associated diagnosis?
Neuroblastoma
Toddler swinging by his arms
What is the associated diagnosis?
Subluxation of the radial head
Retinal hemorhage
What is the associated diagnosis?
Abuse
Which of the following fractures is most likely secondary to abuse?
A) Non-displaced linear skull fracture
B) Clavicular fracture
C) Supracondylar elbow fracture
D) Buckle fracture of distal radiusm
E) Bucket handle fracture
E.

She was pulled into a CORNER and hit with a BUCKET. Then SPIRALING to the ground and fracturing her RIB and SPINE. READ THIS 5 times
A 8yo boy falls onto his outstretched arm that is hyperextended at the elbow. He has pain on passive extension of the fingers and there is some pallor and cyanosis of the distal extremity. What is his injury? What will you see on x-ray?
Supracondylar fracture. Note the neurovascular compromise. You may only see a posterior fat pad.
Age 11-15 falls on an outstretched arm wich is supinated with the elbow partially extended. What injury is this? Is there neurovascular compromise?
Elbow dislocation. there could be neurovascular compromise
Older child suffers direct impact with arm laterally rotated on impact. What injury is this? Is there neurovascular compromise?
This is epiphyseal fracture. No neurovascular compromise.
The forearm is supinated in this fall. What injury is this? Is there neurovascular compromise?
Lateral condyle fracture. No neurovascular compromise
Which way is supinated?
Supinated is palms forward to hold soup!
A patient has an elbow injury and has decreased grip strength and decreased radial pulse. You correctly diagnose supracondylar fracture. Is this a direct vascular injury or is this a transient neurologic effect?
This is a transient neurologic deficit because the absent pulse is likely due to compression and the neurologic problem may be a result of that. Fix the fracture and he will be fine.
A child falls on an outstretched hand. The cortex and periosteum remain intact on one side and broken on the other. What is this?
A Greenstick fracture

Imagine a stick that is bent on one side and broken on the other side.
What is the management for a clavicular fracture?
Check if it is lateral or medial. If medial, then check for displacement of the trachea or mediastinal structures. If lateral, no worries.

Either way, immobilize the shoulder.
How do you distinguish acromioclavicular separation from clavicular fracture?
The AC joint separation will have a palpable step off of the right anterior shoulder joint in the absence of crepitus.

Also teens will separate, kids will fracture
A teenage baseball player has sustained a shoulder injury. He has pain over the distal clavicle with point tenderness over the superior aspect. He cannot rais the arm above his head. X-ray is negative for clavicular fracture, shoulder fracture or dislocation. What is the most likely injury?
A) Occult clavicular fracture
B) Shoulder separation
C) Muscle strain
D) Acromioclavicular separation
D. Shoulder separation would be more diffuse pain, not point tenderness.
An afebrile toddler is irritable and the medical student notes bruises of varying stages. What is your next step?
Head CT and skeletal survey
You have hish suspicion for a skull fracture or head bleed. What is your first step?
ABCs
True or False.
Collodion babies (icthyosis) or SJS babies may mask as child abuse.
True.
Which one of these descriptions would indicate an accidental burn?
A) Full thickness burn
B) Splash configuration
C) Stocking and glove distribution
D) Distinct margins
E) Varying depths
B.
What is the first step in management of a minor burn?
Debridement and irrigation with soap and water.
What is the rule of 9s for kids older than 9.
9% for each hand
18% for each leg
36% for the torso
10% for the head and neck
1% for the perineum
What is the only positive vaginal culture that definitively confirms sexual abuse?
Neisseria gonorrhea because mom can pass down chlamydia but not gonorrhea.
True or False
Condyloma accuminata is typically sexual abuse.
False. it is not.
True or False
Hymenal damage or labial adhesions are confirmatory of abuse.
False. They can occur in many ways.
What is a possible explanation of vaginal bleeding in a 5yo African American girl?
Urethral prolapse. You will note vaginal mass.
Vaginal discharge in a child on antibiotics =
yeast infection
Foul odor from vagina =
Foreign body, like toilet paper
A child returns from Afghanistan and is brought in because she has had a rash that began as papules then became vescicles then pustules then scabs. What is the most likely diagnosis?
Small pox.
What is the treatment for small pox?
Cidofovir
How do you diagnose small pox?
Pharyngeal swab or culture of the lesions.
How do you distinguish small pox from varicella?
Varicella comes in crops. Small pox are all at the same stage.