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Emergency 2 Exam
Emergency Medicine: Abdominal, Head, Back, Pediatrics
| Term | Definition |
|---|---|
| Percentage of ED visits abdominal pain comprises? | 5-10% |
| What is the goal of Dx abdominal pain in the ED? | Rule out any life threatening disease |
| 3 types of abdominal pain | 1) Visceral 2) Somatic 3) Referred Pain |
| Generated by stretch receptors, dull, achey, cramping. What kind of pain? | Visceral |
| Receptors located in parietal peritoneum, sharp, discrete, localized. Responsible for palpation, guarding, rebound. What kind of pain? | Somatic |
| Discomfort perceived at cutaneous site is distant from diseased organ. What pain? | Referred |
| Initial approach to abd pain? | Determine stability! |
| 4 things not to miss in the elderly: (or anyone really) | 1) AAA 2) Mesenteric Ischemia 3) MI 4) Aortic Dissection |
| Deleted...Bad card | Sorry! |
| Biggest risk factor for AAA? | SMOKING |
| Rebound tenderness hallmark of _____________? | Peritoneal irritation |
| One thing you should get for every abdominal exam? | Rectal exam |
| T/F: Appendicitis will not always have rebound tenderness | True, retrocecal appendix requires a rectal exam |
| Most common cause of abdominal pain in the ED? | Non-specific abdominal pain |
| T/F: Chest XRAY is more helpful than a Abdominal XRAY in abdominal complaints | True, CXR helps Dx pneumonia, pleural effusion, and other pulmonary causes of abd pain. Abd XR helpful with intestinal obstruction |
| Free air on CXR? | Viscous rupture --> Surgery! |
| RUQ pain? Best imaging/testing for evaluation? | Ultrasound |
| Unclear abdominal etiology? Best imaging/testing to figure it out | CT can make Dx 95% of the time |
| When is angiography used in abdominal complaints? | Reserved for mesenteric ischemia or GI bleeding |
| What routine labs are used in helping Dx abdominal pain? | NO ROUTINE LABS, must be indicated in some other part of a condition |
| Important for a decision to discharge with abdominal pain complaint? | Patient able to take fluids |
| Anorexia and periumbilical pain followed by nausea. RLQ and vomiting in 50%. One of the most common surgical emergencies. Initial Tx? (3) | Appendicitis; Tx: NPO, Intravenous fluids, Surgery consult |
| Poorly localized, crampy pain with change in bowel habits, diffusely tender and distended with high pitched bowel sounds. Dx? Tx? (4) | Intestinal Obstruction; Dx: Abdominal XRAY: dilated loops of bowel w/ air-fluid levels. Tx: NG tube, IVF, surgical consultation, admission |
| Burning epigastric pain, sharp, dull, achy, empty, hungry. RF? (4) | PUD (Pelvic Ulcer Disease); RF: H. pylori, NSAIDs, smoking, hereditary |
| Sudden and severe abdominal pain. Pain may subside, then return after peritoneal secretions dilute the leaking gastric contents. Upper abdominal tenderness w/ rigidity of the abdomen will be present | Perforation |
| Tx for Perforated Peptic Ulcer (4) | NG tube, IVF, IV ABX, immediate surgical consultation |
| Steady, deep discomfort in LLQ, low grade fever, localized tenderness, rebound and guarding, left sided pain on rectal exam, occult blood. Dx? Tx? (3) | Diverticulitis; Dx: CT: Pericolic fat stranding; Tx: Metronidazole IV 500 mg and Ciprofloxacin IV 400 mg, IVF, NPO |
| Pain occuring in discrete episodes usually after eating a meal; Female, 40, fertile, fat, upper abdomen but usually localizes RUQ referring to scapula. Dx? Tx? | Biliary Colic; Dx: U/S: gallstones, dilated gallbladder or cystic duct; Tx: Disposition depends on exact etiology, but surgical consultation and pain control |
| RUQ or epigastric pain radiating to the back or shoulders. Initially dull and achy, later sharp and localized. Pain lasts longer than 6 hours, N/V, anorexia, fever, chills. Dx? | Acute Cholecysitis; Dx: U/S RUQ thickened gallbladder wall, sonographic Murphy's sign, HIDA (hepatobiliary iminodiacetic acid) scan. |
| Severe abdominal pain of sudden onset radiating to back, confined to low back, groin, genitalia, flank. Discrete palpable abdominal mass. Unequal lower extremity pulses palpated. Cullen Sign, Grey-Turner's Sign, Dx? Tx (4)? | Ruptured Abdominal Aortic Aneurysm (AAA); Dx: CT eval of choice, but may be unstable and resort to ultrasound. Tx: IV access, lab studies, type RBCs, emergent surgical consultation |
| Cullen's Sign | Periumbilical ecchymosis |
| Grey-Turner's sign | Flank ecchymosis |
| Consider in all elderly patients w/: AFib, recent MI, atheroscelrosis, CHF, digoxin, hypercoag, prior DVT, liver disease; sudden, severe, diffuse abd pain in mid/lower abdomen. May not look sick. Pt out of proportion to exam, unrelieved by narcotics. Dx | Mesenteric Ischemia; Dx: CT angiogram |
| Alcoholic w/ gallstones, severe hyperlipidemia; severe epigastric pain radiates toward back, N/V. Can present RUQ. Low grade fever, resp Sx -> pulm effusion, tachycardia, HypoTN, Cullen/Grey-Turner. Tx? (2) What do you not give unless severe? | Pancreatitis; Tx: NPO, IVF, no ABX unless disease severe |
| What should be considered in any women of child-bearing age that presents w/ abdominal pain? Amenorrhea, abd pain, vaginal bleeding. What should confirm (2)? ED management? (2) | Ectopic pregnancy. Preg test and U/S looking for free fluid or adenexal mass. M: large bore IVF, emergent OB consult and admission |
| Sudden unilateral lower abd or pelvic pain radiating to back, groin, flank. Hx of ovarian abnormalities. Dx? Management? | Ovarian Torsion Dx: U/S, but negative imaging CAN NOT rule out torsion. M: OB/GYN surgical consult |
| Most common cause of N/V? | Viral gastroenteritis |
| T/F: Most N/V requires intervention | False, most cases are self-limiting |
| 2 ways emesis triggered? | Multiple medullary neurons activated in sequential fashion (chemoreceptor trigger at postrema of 4th ventricle), and vagal activation |
| Unpleasant sensation preceding vomiting. Sx? (2) | Nausea; Sx: hypersalivation and repetitive swallowing |
| Pain preceding N/V indicative of | obstruction |
| Fever and diarrhea indicative of | Acute gastroenteritis |
| High urine specific gravity indicative of | dehydration |
| Ketones in urine indicative of (2): | 1) Diabetic ketoacidosis 2) Hyperemesis gravidarum |
| Secretory diarrhea w/ significant dehydration, not usually associated w/ fever or abd pain. Management? | Viral Gastroenteritis; M: self-limiting and requires only supportive care |
| Inflammatory or secretory diarrhea, possibly dysentery. Define dysentery. Tx? () | Bacterial Gastroenteritis; Dysentery: abd pain, bloody diarrhea, anorexia, dehydration/wt loss, stool Cx. Tx: supportive/hydration status/IVF, careful administration of ABX (Cipro) |
| Most common UGI bleed | Peptic Ulcer Disease |
| What should you do if someone is coughing up or vomiting bright red blood? (3) What if it is significant? | Large bore IV, NPO, surgical consult; significant: NG Tube |
| Most important lab of UGI bleed? Dx study of choice? | Type and Cross match blood. UGI endoscopy study of choice |
| Decreases the rate of gastric emptying, reduces smooth muscle contraction and blood flow within the intestine. Also suppresses pancreatic secretion | Octreotide |
| Passing of bright red, bloody stools or dark, tarry stools (melena). Common causes (4) | Lower GI bleed. Causes: Diverticular disease, colitis, polyps, malignancies |
| What do you always get with a lower GI bleed? What else will the patient get for Dx and Management? (3) | Digital rectal exam; Imaging (Either angiography, scintigraphy, or colonoscopy), will be admitted and most will go to surgery |
| Initial stabilization procedures for GI bleeding (management) (3) | 1) ABCs 2) cardiac monitor 3) 2 large bore IV catheters |
| Difference between primary HA and secondary HA | Prime: HA itself is disease, Tx HA (60%). Second: HA underlying Sx of another disease, Tx disease (40%) |
| >50 yo w/ a new onset of headaches what, generally, is this a strong predictor of? | Intracranial pathology |
| DD: Thunderclap HA (1) | Subarachnoid Hemorrhage (SAH) |
| DD: Worst HA ever (2) | SAH, cerebral venous thrombosis |
| DD: HA in pregnancy (2) | Eclampsia, central venous thrombosis |
| HA w/ change in vision and eye movement pain | Optic neuritis, glaucoma |
| Fever, HA, confusion, seizures, viral, requires LP for Dx | Encephalitis |
| Fever, global HA, stiff neck, photophobia, malaise, LP for Dx (w/in 30 min of arrival) | Meningitis |
| How does cold weather/winter associate w/ HAs? | Carbon monoxide poisoning from heaters |
| 3 physical signs of head trauma | Battle's sign, depressed skull, scalp laceration |
| Battle's sign | mastoid ecchymosis or bruising behind an ear |
| Horner's Syndrome | Ptosis (droopy eyelid), miosis (constricted pupil), anhydrosis (can't sweat) |
| Periorbital eccymosis (raccoon eyes) indicates (more specific than trauma) | basilar skull fracture |
| Papilledema on fundoscopic exam reflects: | elevated intracranial pressure (ICP) |
| 2 conditions a unilateral red eye (on fundoscopy) indicates. What should you do (during said fundoscopy?) | 1) Glaucoma 2) cluster headache; measure IOP |
| CSF otorrhea and hemotympanum suggests | skull fracture |
| CSF rhinorrhea suggests | basilar skull fracture |
| Maneuver for Meningitis | Kernigs and Brudzinski |
| Jolt Maneuver | ask patient to rapidly shake head from side to side. With fever, if this accentuates a HA, "100% sensitive and 54% specific" for meningitis |
| Petechial rash with HA may be indicative of | meningitis |
| Motor deficit? What is very sensitive and well used to test for it? | Pronator Drift |
| What lab test would be elevated in someone with temporal arteritis | Sed rate |
| When can carbon monoxide be incidentally elevated? | In smokers! |
| Xanthrochromia is Dx for what? | SAH (Subarachnoid Hemorrhage) |
| Most widely available and useful neuroimaging test available | Non-contrasted Head CT scan |
| Absolute CONTRA to LP (2) | 1) Unequal pressures btwn supra and infratentorial compartments and 2) infected skin over needle site |
| Relative CONTRA to LP (3) | 1) ICP 2) Coagulopathy 3) Brain Abscess |
| Main indications for head/brain CT PRIOR to LP (6) | 1) immunocompromised 2) known CNS lesions 3) who have had a seizure w/in 1 week of presentation 4) LOC 5) papilledema 6) suspect subarachnoid hemorrhage |
| H/A w/o aura caused by physiological, dietary, environmental aspects | Common migraine |
| H/A w/ aura (transient focal neurological phenomenon such as scotoma [spotted lights]), unilateral and pulsating, N/V, photo/phonophobia, duration 4-72 hours | Classic migraine |
| T/F: Narcotics not generally recommended for migraines | True |
| Tx of migraines (specify that combo she liked IV) | NSAIDs, caffeine, TRIPTANS, ergotamines, Reglan/Decadron/Benadryl cocktail IV |
| HA w/ ipsilateral lacrimation, rhinorrhea, eyelid edema 4-6th decades in life. Sharp/stabbing unilateral pain. Tx? (3) | Cluster HAs; Tx: O2, Triptans, analgesia |
| Bilateral pain with tightness like a band. Tx? | Tension HAs; Tx: NSAIDs. |
| Intermittent sharp pain in head and face, normal neuro exam; Management? | Trigeminal neuralgia: M: refer to Neuro, should include eval for more serious causes |
| SSNOOP red flags...for what? | Headache! Systemic sx, Secondary rf, Neurologic sx, Onset, Older, Positional/Prior HA/Papilledema |
| Major etiology of SAH | ruptured saccular aneurysm |
| African Americans 2x than whites, women> men, >50 yo, as many as 60% die in the first month, smokers and drinkers, coarctation of aorta, HTN. Imaging based off demographics and RF? | SAH; CT head is what we typically use. Gold standard is angiography (CTA or MRA) |
| 3 general things we do for SAH in ED. | 1) Dx 2) Emergent Neurosurgery Consult 3) Supportive therapy. |
| Classically occurs first thing in the AM or causes pt to awaken. More common in adults? More common in children? | Brain tumors; Supratentorial (Cerebrum) more common in adults. Infratentorial (cerebellum) more common in pediatrics |
| First line imaging for suspected intracranial mass | CT head w/ contrast |
| Unilateral HA, jaw claudication, temporal artery tenderness, blurred vision, ESR> 50, Dx? Tx? | Temporal arteritis; Dx: temporal artery Bx; Tx: High dose steroids |
| HA, diplopia, neurological deficit. Rare. Can be caused by OCPs, sinusitis/mastoiditis/meningitis. Dx? Tx? | Cerebral Venous Thrombosis; Dx: CT Venography or MRI. Tx: anticoagulation |
| HA, N/V, double vision, papilledema. Dx? Tx? | Pseudotumor Cerebri; Dx: LP w/ CSF opening pressure >25 cmH2O. Tx: Diamox or Lasix |
| Tx for acutely ill patients with Encephalitis: | Administration of acyclovir and/or ABX and/or steroids ASAP |
| HA w/ pulsatile pain exacerbated by upright position usually in cervical/sub-occipital position. After previous ER visit or admission (Hint: what happened during that visit?) Tx? | Post-LP HA: Tx: Blood patch |
| Primary vs Secondary Head Injury | Primary: irreversible cellular damage as a direct result. Prevent event. Secondary: Damage to cells not initially injured. Prevent hypoxia and ischemia |
| How to airway control w/ cervical spine immobilization (as seen w/ head injuries) | Orotracheal RSI (Rapid Sequence Intubation |
| Management of circulation in head injury (3 main things) | 1) Aggressive fluid resuscitation (doesn't raise ICP) 2) Vasopressors 3) Transfuse if HypoTN and Hct <30 |
| Severity of TBI? GCS (Glasgow Coma Score) 14-15, 80% of TBIs, LOC, amnesia, vomiting, diffuse HA | Mild TBI of medium risk |
| Severity of TBI? GCS <9, 40% mortality | Severe TBI |
| T/F: All pediatric patients that come in with a severe head injury should get a CT | FALSE! Should try to avoid if you can since it can lead to blood cancer down the road |
| How do you Dx a TBI? | Concussion Sx Dx! (not CT) (Clinically) |
| What is normal cranial pressure? ICP? What kind of management can help with ICP and how? | Normal: <15 mmHg; ICP: >20-25 mmHg (NOTE: ICP not usually available in EDs and must rely on PE). M: Hypertonic saline improves cerebral cranial pressure (CCP) by lowering ICP by 35%. Mannitol also effective |
| CSF otorrhea and rhinorrhea, Battle Sign, Racoon sign, vertigo, hearing loss, hemotympanum. Prophylaxis? | Basilar fracture w/ dural tear; P: Ceftriaxone 1-2 gm IV |
| Most common CT finding in moderate to severe TBI. What Tx helps? | Traumatic Subarachnoid Hemorrhage. Nimodipine (CCB) reduces death and disability by 55% (reduces vasospasm and free bleeding) |
| Brain anatomy from brain to scalp | Brain -> Pia mater -> Subarachnoid space w/ CSF -> Arachnoid mater -> subdural space -> Dura mater -> epidural space -> skull -> scalp |
| Head injury -> awake lucid interval -> decline in mental status -> alterations of consciousness -> collapse and death. Often associated w/ skull fractures | Epidural hematoma |
| Sudden acceleration-deceleration injury w/ tearing of bridging veins | Subdural hematoma |
| Disruption of axons in white matter and brainstem. Injury occurs immediately and is irreversible. Usually left in a persistent vegetative state. What are some examples where this occurs? (2) | Diffuse Axonal Injury; MVC or shaken baby syndrome |
| What percentage of people recover from a concussion after 1 year? | 85-90% |
| First of all, what direction is axial or an axial load. What vertebrae is vulnerable to it? What is the fracture of that vertebrae called? Stable/unstable? | Axial load is when the head comes down caudally. C1 is vulnerable and it is called a Jefferson's Fracture. Extremely unstable |
| What is C2 vulnerable to? What is that fracture called? Stable/unstable? | Hyperextension; Hangman's fracture. Unstable |
| Strong flexion of the vertebrae forces a wedge shaped fragment to break off body. Stable/unstable? | Flexion teardrop injury. Unstable. |
| Direct blow to the back of the neck or MVC causes what fracture? Stable/unstable? | Clay Shovelers fracture (abrupt flexion of head in opposition to strong supraspinous ligament resulting in avulsion fracture). Stable |
| Name for flexion distraction fractures | Chance Fracture |
| No motor or sensory function below injury level | Complete SCI (Spinal Cord Injury) |
| Any Sensory/motor function below level of injury | Incomplete SCI (Spinal Cord Injury) |
| Descending motor pathway. What spinal tract? | Corticospinal tract |
| Pain/temperature. What spinal tract? | Spinothalamic tract |
| Vibratory/proprioception. What spinal tract? | Dorsal column pathway |
| Primary spinal injury is | a mechanical injury |
| Secondary spinal injury is (3) | vascular abnormalities/free radicals/inflammation etc. |
| Which tracts are injured during an incomplete SCI that is anterior spinal cord syndrome? | Corticospinal and spinothalamic |
| Where is the injury during an incomplete SCI that is a posterior spinal cord syndrome? | Dorsal column |
| Decreased strength and pain/temperature of upper extremities compared to lower extremities due to hyperextension injuries or _____ spinal stenosis | Incomplete SPI: Central cord syndrome; central spinal stenosis |
| Affects the transverse hemisection of spinal cord. Ipsilateral loss of motor function and contralateral loss of pain/temperature sensation. Cause? | Brown Sequard Syndrome (Incomplete SCI); Penetrating injury or lateral cord compression. |
| Phenomenon charcterized by loss of all spinal cord function caudal to level of injury: flaccid paralysis, hypotonia, areflexia, priapism, venous pooling. Outcome? | Spinal Shock; spastic paresis and hyper-reflexia |
| Type of distributive shock characterized by loss of adrenergic tone due to sympathetic denervation: HypoTN, Bradycardia, Hypothermia classic triad. Management? (3) | Neurogenic Shock; IVF, Vasopressor support, atropine |
| First management other than ABCs with spine injury? | Immobilization |
| T/F: No difference in immobilization with a cervical collar than there is with a cervical collar and spine board | FALSE, there is significant improvement w/ both |
| Indications for spinal XR (4) | TRAUMA: 1) midline tenderness 2) Neuro deficits 3) altered consciousness 4) Intoxicated pts |
| What view exposes 90% of cervical spine fractures on XR? What must be seen to be considered an adequate XR? | Lateral C-Spine XR; Top of T1 must be seen |
| Which is better for detecting C-spine injuries: Nexus or CCR (Canadian C-Spine)? | Canadian C-Spine |
| 3 high risk factors based on CCR chart (rules in needing radiography) | 1) >65 yo 2) Dangerous mechanism 3) Paresthesias in extremities |
| 5 low risk factors based on CCR chart (rules out needing radiography) | 1) simple MVC 2) sitting position in ED 3) Ambulatory at any time 4) Delayed onset of neck pain 5) absence of midline C-spine tenderness |
| How do steroids effect spinal cord trauma? | Inhibit free radical induced lipid peroxidation |
| Why is the use of methyprednisolone controversial in spinal cord trauma | Linked w/ increased mortality in isolated head injury |
| T/F: About 90% of all LBP episodes will resolve within 6 weeks regardless of treatment approach or lack of treatment | True |
| Most common cause of disability in people younger than 45 yo | Low back pain |
| 5 DDs where Sx of these DDs are red flags in a low back assessment | 1) Cauda Equina Syndrome 2) Spinal fracture 3) Cancer 4) AAA 5) Infection |
| Dull and achy, exacerbation w/moving, relieved w/ rest, no radiation, no dermatomal pattern, normal DTRs (Benign or malignant?) | Benign Sx of LBP |
| Irritation of sciatic nerve passing under ________ muscle --> pain on resisted abduction/external rotation (Patrick maneuver) | Piriformis syndrome |
| Subtle presentation: pain w/ walking (shopping cart sign), mistaken for claudication. Management long term? | Lumbar Spinal Stenosis; Ortho consult if progressive long term |
| Tx for benign backpain (4) | Cortico dose pack, NSAIDs, Flexiril (muscle relaxer), minimal pain meds if any |
| Urinary retention/incontinence, saddle anesthesia. Where is the injury below? Management? | Cauda Equina Syndrome; Injury below L1; orthopedic or neurosurgical emergent consult and MRI |
| Most common aneurysm of arterial tree. 50% mortality if ruptured. Usually presents as flank pain or a painless throbbing mass. Can complain of back pain or syncope. Dx? Tx? (5) | Abdominal Aortic Aneurysm (AAA); Ultrasound! Tx: 1) O2 2) Two large bore IVs 3) Cardiac monitoring 4) BP control 5) Surgical consult |
| T/F: Observation of the child is more predictive of serious illness than standard PE techniques | True |
| Breathing Red flags (3) | 1) RR >60 <2 yo; 2) RR >40 >2 yo; O2 <92% |
| #1 cause for pediatric cardiopulmonary arrest? 4 causes of that? | Primary Respiratory Disturbance; 1) Localized infxs 2) Asthma 3) Upper Airway Obstruction 4) Sepsis |
| Airway management in alert vs lethargic child | Alert: Allow child to maintain position of comfort. Leth: head tilt/chin tilt and padding under shoulder so head flops back |
| Medications for imminent respiratory failure in a child (2) | 1) Albuterol 2) Nebulized epinephrine |
| Initial fluid support for peds not in shock but that need a bolus. Boluses in shock? | 20 cc/kg; 60cc/kg |
| What is the Broselow Pediatric tape used for? (3) | estimates weight, doses, and equipment sized based on heights |
| Tachypnea, tachycardia, oliguria, mottled extremities, altered mental status. Late sign? | Pediatric shock; HypoTN is a late sign in children...30-50% acute blood loss!!! |
| Acute wt loss, sunken eyes, dry mucous membanes, delayed cap refill, tachycardia. Cause? Best Tx(s) | Dehydration: CV emergency! Cause: V/D. Best Tx: water by mouth, but IV indicated if necessary. Odansetron if necessary (they have dissolving tablets |
| Base dehydration based off of these 3 things | 1) Mucus membranes 2) cap refill 3) pulse |
| Respiratory Sx: tachypnea, wheezing, rales, rhonchi, poor feeding, sweating or color change. Hepatomegaly, weak pulses WORSENING W/ FLUID ADMINISTRATION. Tx? (3) | Congestive Heart Failure; Tx: Furosemide, Digoxin, Dopamine |
| Causes of CHF in: 1 day old, 2 weeks, 10 years + | PDA (patent ductus arteriosus), Coarctation of the Aorta, Rheumatic Fever |
| Describe the steps of the hyperoxia test for CHF (3) | 1) Obtain room air ABG 2) administer 10 min of 100% O2 3) repeat ABG will be unchanged (pts w/ CHF will have unchanged ABG) |
| Apnea in infants: Definition | D: cessation of breathing for 20 seconds |
| Apnea with stressors such as scolding: Definition. Tx? | Breath Holding Spells; D: transient episodes of breath holding up to 1 minute; No intervention required |
| inspiratory stridor, dyspnea, tachypnea, nasal flaring, retractions | Upper Airway Obstruction |
| Classic association of stridor? Dx? | Epiglottits (rare now), but lateral neck XR will show thumb sign |
| Main Tx for anaphylaxis other than ABCs (4) | Epinephrine, H1 blockers, corticos, H2 blockers |
| Abrupt complete obstruction w/ protracted course of wheezing. Management: | Laryngoscopy or bronchoscopy for removal |
| Which side does a lower airway foreign body usually choose? Tx? | Right side; bronchoscopy |
| Barky cough w/ retraction and tachypnea but no hypoxia; Imaging? Dx? Tx? | Croup; Imaging: AP XR w/ steeple sign. Dx: Clinical Dx. Tx: Nebulized racemic epinephrine, albuterol if that epi doesn't work |
| What must you do if you give epinephrine? | Observe child for 2 hours to ensure there is no rebound |
| Main indications for hospitalization for croup (3) | 1) No improvement w/ Tx 2) Decreased LOC 3) Family unable to care for child |
| Sudden onset w/o barking cough, drooling, febrile. Prevalence? Etiology? Tx? | Epiglottis; Rare due to Hib vaccine. Tx: DO NOT agitate child w/ exams/labs/Tx |
| "hot potato" voice, no barky cough, fever, drooling/difficulty swallowing | Peritonsillar or Retropharyngeal Abscesses |
| Acute lower respiratory tract infection in December. Etiology? Management? | Bronchiolitis; E: RSV (Respiratory Syncytial Virus). M: Supportive care, albuterol trial ONLY if benefit is noted. |
| Wheezing, cough, SOB, chest tightness. Loud biphasic (ex and inspiratory) wheezing (most severe obstruction may be absent). Tx? (FOR ACUTE) | ACUTE Asthma 1) SABA (albuterol) 2) Ipratropium (anti-cholinergic) 3) Magnesium sulfate |
| Pediatric Glascow Coma scale score that indicates intubation? | < 8 |
| Seizures that are precipitated by fever | Simple Febrile Seizures |
| Focal or prolonged or multiple seizures | Complex Febrile Seizures |
| Major seizure cause in younger children | metabolic disturbance |
| New seizure evaluation labs (5) | CBC, CMP, CSF, EEG, U/A |
| Local warmth, erythema, refusal to move limb, knees and hips most commonly affected. Etiology for Neonates? Adolescents? Tx? | Septic Arthritis; E: N- S aureus or GBS OR A- gonorrhea. Tx: IV ABX for at least 3 weeks and ortho admission |
| Most common cause of acute hip pain. Inflammation --> arthralgia/arthritis, presents as limp. Low grade fever. Recent viral infection. Tx? | Toxic synovitis; Tx: NSAIDs and rest |
| Difference between Septic Arthritis and Toxic Synovitis Dx | Septic Arthritis: ESR>40, WBC>12,000 |
| Fever, warmth, erythema, swelling; usually hematologic spread involving femur, tibia, humerus (long bones). Etiology? Etiology w/ foot wound? Initial Imaging? Tx? | Acute Osteomyelitis; E: staph aureus. Puncture: Pseudomonas; Imaging: XR initially, MRI after). Tx: IV ABX 4-6 weeks |
| When is endoscopy indicated regarding GI foreign bodies? | 3 days (only 2 days w/ a battery |
| Microangiopathic, hemolytic anemia, thrombocytopenia, acute renal failiure often following viral/bacterial illness. Can develop bloody diarrhea/prodromal gastroenteritis. Etiology? | Hemolytic Uremic Syndrome (HUS); E.coli 0157:H7 |
| Lab evaluation for HUS (4). Tx? (3) What to avoid? | CBC, elevated creatinine, U/A, stool Cx. Tx: supportive, steroids, dialysis. Avoid: anti-motility, ABX |
| Polyuria, polydipsia, V, altered mental status, Kussmaul breathing, sweet odor, hypovolemic. Tx? | Diabetic Ketoacidosis; Tx: Fluid resuscitation and small dose insulin |
| Tx of cerebral edema (HA, V, worsening altered mental status, sudden onset) | Osmotic diuresis (mannitol which lets tissues shrink) |
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crward88
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