Creepy crawlies
Poirot investigates
Humpty Dumpty sat on the wall!
Wash your hands!
Special children
100
The most common type of toxin associated with scorpion sting is this and two predictors of increased mortality in children following scorpion stings are these
What is neurotoxin causing excessive sympathetic and parasympathetic overdrive What are myocarditis, metabolic acidosis, tachypnea, pulmonary edema, priapism,and encephalopathy. If victims can survive the first 48 hours without the above, prognosis is good
100
A 2 year old was in a house fire and found unconscious on the 2nd floor of a burning building. Extraction was prolonged. On exam he is obtunded, has evidence of smoke inhalation and has 50% BSA burns. He is intubated and oxygenated. His blood gas is the following: 7.20/35/12/BE-8, Lactate is 12 COHb is 25. The next immediate therapy? What is a contraindicated treatment?
What is hydroxycobolamine? What is cyanide kit? Exacerbates hypoxia due to the conversion of carboxyhb to metHb
100
A 13 year old boy was at a family barbecue when someone threw gasoline on the gas grill which then exploded. The boy was thrown out about 4 feet. No LOC. On exam he is alert and oriented with GCS 15. He has first and 2nd degree burns to his face, 2nd degree burns around his mouth, singeing of nares and smells of gasoline. His voice is a little raspy. His Pulse is 130, RR is 45 His oxygenation is 100% on RA. This would be the most critical next step in his management after oxygenation, and IV fluids ?
What is intubation. Singeing of nares, 2nd degree burns around the mouth and burns around his mouth denote possible deeper injury. Securing his airway is critical before edema sets in. Edema after thermal injury can set in anywhere from minutes to hours later.
100
Figure 7 Diagnosis Etiology Treatment
What is herpetic whitlow HSV 1 Topical acyclovir
100
Figure 10 A 2 year old girl comes with c/o bleeding in underwear. No fever, vomiting or diarrhea On exam there is a reddish doughnut shaped mass in the genital area Diagnosis? Treatment
What is urethral proloapse Mild cases - sitz baths, Vaseline, emollients, estrogen cream If necrotic tissue - surgery
200
A 6 year old is bitten by a snake on family farm. The family kills and brings the snake for identification. These 5 features suggest that is venomous
What is triangular head, elliptical pupils, heat sensor pit between eye and nose, single row of sub caudal plates, presence of fangs (Figure 1)
200
A 15 year old boy presents after ingesting huge amounts of tylenol. The indications for NAC are
What is ingestion of > 140mg/dL, level of > 150microm/L
200
See Figure 4; Name the fracture and what is the indication for reduction?
What is boxer's fracture What is angulation of > 30 degrees Needs to be splinted for at least 4 weeks
200
Figure 8 Diagnosis Complication Treatment
What is felon What is ischemia due to rise in pressure Incision and drainage EVEN if not fluctuant Longitudinal incision
200
A teen delivers a newborn in your ED. The baby is full term and has no spontaneous respirations. You dry and gently stimulate the baby with new response. HR= 50 RR= 0, After 30 seconds you bag the baby with no change in the heart rate. After another 30 secs of bagging you next step should be
What is intubation And if no response CPR
300
A family of four went camping and ate caught fish for dinner. Shortly thereafter they all develop perioral numbness, paresthesias, and muscle weakness. You correctly diagnosis this fish, this toxin and anticipate this complication
What is puffer fish, tetrodotoxin, and respiratory arrest
300
A 2year old is found unconscious in the garage. He is obtunded on exam. After attending to his ABCs, his labs are as follows: 7.0/35/10/Lactate is 1 Na= 143, Cl-105, Bicarb is 10, Osmolality is 350, BUN is 4, Glucose is 104. You correctly diagnose this Two indications for hemodialysis are:
What is Ethylene glycol What are EG level >50mg/dL and renal insufficiency EG: Profound Anion gap acidosis WITHOUT ketoacidosis, high osmolar gap, low calcium due to calcium oxalate crystals Methanol: high anion gap acidosis, osmolar gap, triad symptoms of GI, eyes (snowstorm), metabolic acidosis, formic acid is formed IPA: ketonemia, no or little acidosis is classic, osmolar gap
300
Figure 5 Name the injury Mechanism of injury What is injured specifically Name 2 indications for surgery
What is Mallets finger (baseball's finger) Forcible flexion of finger when catching baseball Extensor tendon at DIP Operation required if fracture involves >25% of joint surface, or if joint is sublimed
300
A 2 year old is found playing with a dead bat in his room. HE is asymptomatic. The family enquires about rabies. You advise them
What is Rabies immunoglobulin and rabies vaccine on days 0,3,7,14 for an unvaccinated child For a previously vaccinated person, days 0 and 3 only and IG
300
Figure 9 Name of injury Name the main complication that can occur
What is Stubbed toe fracture of distal physis of 1st toe Osteomyelitis Fracture of ANY distal physis of toes should be treated with antibiotics
400
a 2 year old is brought with a possible spider bite. The family has brought the spider with them for identification. (Figure 2) You identify the spider as this from this feature on the spider. The main toxin is this which causes release of these two things
What is black widow (red hourglass shape on the ventral abdomen) neurotoxin causing release of acetylcholine and norepinephrine at the synaptic junctions ( ppt)
400
A 16 year old female presents after ingestion of unknown medication. She is obtunded on exam. Her pulse is 130, RR is 24, BP is 80/40. Her EKG is shown in figure 3. The immediate next step should be this. Name 3 major side effects of the medication ingested that are responsible for most toxic reactions
What is sodium bicarbonate 1meQ/kg What are a) anticholinergic, b) excessive blockade of norepinephrine reuptake at the postganglionic synapse and c) direct quinidine like effects on the myocardium
400
Figure 6 Name of injury Mechanism of injury What is injured treatment
What is Boutonniere deformity Direct blow to finger Central slip of extensor tendon at PIP joint with volar subluxation of lateral bands of tendon If no fracture, splint in extension
400
Erythema migrans , an important feather of Lyme's disease occurs in this percent of patients The most common neurological finding in Lyme's disease is
What is 60% of patients What is aseptic meningitis
400
A 6 year old presents with vomiting and diarrhea. On exam he is listless, pale, with cap refill of 4 secs. You place on oxygen, give a fluid bolus. He continues to be lethargic on reassessment. Your immediate next step should be
What is obtain accucheck
500
A family is vacationing in Martha's vineyard when the 10 year old is stung by Chesapeake sea nettle. She is in severe pain and family asks you (an innocent bystander) what they should put on the wound. You tell them to do this but not that
What is application of 50% baking soda but not vinegar. Vinegar causes discharge of nematocysts in this case. Vinegar can be used for Hawaiian box jelly fish, australian box jelly fish, and portugese man of war stings Vinegar should not be used in sea nettle, lion's mane, oceanic jelly fish,
500
A 2 year presents after ingesting several iron pills. The 3 indications for antidote in this child would be the following:
What are 1) presence of shock (hypotension, lethargy) irrespective of serum iron levels and TIBC levels 2) Serum iron level is > TIBC 3) Serum iron level > 300-350 micrograms/dL
500
This is the most common closed flexion tendon injury in the adolescent athlete Most commonly affected digit is this Mechanism of injury Cardinal sign Treatment
What is Jersey finger What is ring finger Hyperextension injury to DIP Unable to flex the DIP joint Seen in football when the players finger gets caught in a jersey Surgery
500
A 16 year old female who is sexually acrtive presents with fever and abdominal pain. On exam, she has adnexal tenderness and some discharge She is febrile. These are the 3 treatment options for her
What are a) cefotetan + Doxycycline or cefoxitin + Doxycycline Clinidamycin + Gentamycin
500
A 10 year known cardiac kid comes in complaining of chest pain. He suddenly becomes lethargic. His EKG reveals wide complex tachycardia. On exam he has no pulses. You defibrillate at 2J/K and start CPR. After 2 mins his rhythm persists causing you to give 4J/K shock and 1 dose f epi. At next rhythm check he has no pulses. What is the next step
What is defibrillation at 4J/K
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