That's Shocking
Best Treatment
two tees
Potpourri
Poison
100
Is it Hypovolemic, Distributive, or Cardiogenic Shock? 2 month old male infant with a 4 day history of vomiting and diarrhea is brought to the emergency department by his mother. Initial findings in the emergency department include: Airway: Breath sounds are normal. Airway is patent. Breathing: Breathing is regular at 45 breaths per minute, unlabored. Circulation: Proximal pulses are poor, distal pulses are absent, and extremities are cool. Feeling from the 5th toe upwards, the legs are cool up to the knee. Capillary refill is 8 seconds. Heart rate is 209 beats per minute, and blood pressure is 70mmHg systolic. The infant does not recognize his parents, is extremely lethargic, and responds to pain only, with a minimal grimace. The mucous membranes of the mouth are pink. An intraosseous (IO) is placed in the left tibia and 20cc/kg of normal saline is infused as rapidly as possible. The infant is reassessed. Airway and breathing remain stable. The heart rate is now 195. A repeat bolus of 20cc/kg is given and the patient is reassessed. After the 3rd fluid bolus is given, the patient becomes more alert, distal pulses return, and the patient improves throughout resuscitation. The heart rate has come down to 160.
What is Hypovolemic Shock
100
Best treatment for Digoxin poisoning, following activated charcoal and airway managment. Especially in presence of rhythm disturbance or cardiac instablity.
What is digoxin specific Fab
100
6 year old would have a positive ppd if ppd > how many mm in circumference?
What is > 15 mm
100
Treatment of H. Influenzae Pneumonia Vs. treatment of H. Influenzae meningitis.
What is Pneumona H. Influenzae: 3rd gen cephalosporin (ceftriaxone or cefotaxime) Meningitis H. Influ: 3rd gen cephaloporin (Ceftriaxone or cefotaxime) and dexamethasone (prevents hearing loss)
100
Diphenhydramine in high dosese can effect the following: Tell what happens to the following systmens (Need 6 for credit) Mental status: Heart Rate: Temp: Eye: Skin: Mouth: GI: UOP:
What is Mental status: Delirium, hallucinations Heart Rate:High Temp: Fever Eye: Mydriasis (Wide open pupils) skin: flushing Mouth: Dry GI: Ileus UOP: Urinary retention Note: Diphenhydramine can cause anticholinergic induced effects, as can TCAs
200
For Hypovolemic Shock, please specify if high/low Cardiac Output: Systemic Vascular Resistance: Central Venous Pressure:
What is Cardiac Output:Decreased Systemic Vascular Resistance:Increased Central Venous Pressure:Decreased
200
14 year old boy is seen in the emergency department after he had collapsed after a dental extraction in which prilocaine hydrochloride 3% was used as topical anesthesia. His mother tells the emergency physician that he felt unwell after the procedure and gradually became more and more drowsy. The patient is deeply cyanosed despite a good respiratory effort, a clear airway, and bilateral breath sounds. Although he initially responds to vocal commands, his level of consciousness soon deteriorates. Oxygen saturation is 60% with the patient breathing room air. An endotracheal tube is introduced and assisted ventilation started, but this does not improve his cyanosis or level of consciousness. Again, the patient is cyanosed, the cyanosis is unresponsive to ventilation, and there is no prior history of respiratory problems. Best treatment.
What is methylene blue Patient with methemoglobinemia
200
A mother who is 8 month's pregnant has positive PPD and negative chest xray. In 1 month she delivers healthy baby. What workup or treatment is now needed for infant.
What is No further evaluation needed for infant
200
Leading cause of death of kids between 4 and 15 years of age
What is Motor vehicle accidents
200
Patients on opiates (morphine, codeine, hydrocodone(vicodin), oxycodone, fentanyl, tramadol) have risk of side effects of Opiates posioning. What happens to following.Need all for credit. Mental Status: Eyes: Lungs: GI:
What is Mental Status: Obtunded Eyes: Pinpoint pupils Lungs:Decreased respiratory rate GI:Decrease bowel sounds
300
For Cardiogenic Shock Please specify if Low/High What is Cardiac Output: Systemic Vascular Resistance: Central Venous Pressure:
What is What is Cardiac Output:Decreased Systemic Vascular Resistance:Increased Central Venous Pressure:Increased
300
Best treatment for opiate poisoning, following securing airway.
What is Naloxone
300
Name some side effects of Rifampin therapy. Name 4 for credit
What is reddish orange color to urine and tears, also saliva. "Flulike" symptoms. It also induces P-450 (decrease half life of warfarin, digoxin, thyroxine, birth control). And if more than 1 month thrombocytopenia and/or leukopenia
300
16 week Scottish baby is in critical care is currently stable in critical care. Originally patient reported to ED following 16 days of poor feeding weak cry, constipation, and lethargy. No history of fever, GI or resp symptoms. On exam diminshed body tone (generalized weakness) and diminshed gag all other symptoms negative. Reports say the infant became ill following sucking on a “dummy” (pacifier) dipped in honey. Best diagnostic method to diagnose patient.
What is stool study for botulism toxin
300
Organophosphates such as insecticides or pesticides can cause cholinergic symptoms. What happens to the following systems. Eye: Mouth: Heart rate: Lungs: GI: UOP:
What is Eye:Pinpoint pupils (Miosis), Lacrimation Mouth:Salivation Heart rate:Bradycardia Lungs: Bronchospasm GI:Diarrhea, Emesis UOP:Urination
400
For Distributive shock, please specify if low/high: What is Cardiac Output: Systemic Vascular Resistance: Central Venous Pressure:
What is What is Cardiac Output:Increased Systemic Vascular Resistance:Decreased Central Venous Pressure:Decreased
400
Best treatment for a level of serum iron > 500 ug/dl
What is Deferoxamine
400
If 5 y/o with PPD Positive, negative chest xray (latent infxn) and TB was known to be INH resistant: What is best med for prophylaxis:
What is Rifampin 6 months
400
Of the following, which effect is the opposite for Dobutamine, compared to Dopamine. Is it Contractility Heart Rate Peripheral vasoconstriction Conduction velocity
What is peripheral vasoconstriction. As Dobutamine does peripheral vasodilation All others same: Tachycardia, increase contractility, and increase conuction velocity all same
400
What is treatment of Organiphosphate (Cholinergic) poisoning?
What is atropine and pralidoxime
500
Name some causes of cardiogenic shock. At least 5 for credit.
What is Congenital heart disease, ischemic heart disease, anoxia, Kawasaki's disease, traumatic, infectious cardiomyopathies, drug toxicity, and cardiac tamponade.
500
Best treatment for Acetaminophen posioning following charcoal decontamination and gastric lavage.
What is N-acetylcysteine
500
If HIV positive patient with PPD approx 9mm and positive chest xray. What steps are needed next.
What is 1. Gastric aspirate or sputum collected for culture and sensitivity. 2. One of the following 2A. Daily rifampin, INH, pyrazinamide for 2 months, followed by daily INH and rifampin for 4 more months or 2B. Daily rifampin, INH, pyrazinamide for 2 months, followed by twice weekly INH and rifampin for 4 more months. 3. Directly observe compliance with therapy (contact state agency)
500
13 month old female infant presents to the emergency department via ambulance in full arrest. His mother left him playing in the living room. After 20 minutes, she was not able to find him inside the house. He was found at the bottom of the swimming pool. Initially, he was cold, blue and limp. She started CPR after calling 911. The EMS team performs CPR and resuscitation en route to the hospital. The infant is intubated and epinephrine is administered via the tracheal tube. An intraosseous (IO) line is started and epinephrine is given IO as well. After 40 minutes of resuscitation efforts in the emergency department, the infant is pronounced dead. What would have been the best measure of intervention that best prevents accidental pool drownings. Hint: mom's eyes need to sleep at least once every 24 hours
What is Pool Fence
500
Treatment for Anticholinergic poisoning
What is Physostigmine For agitation component do benzodiazepines
M
e
n
u