Foreign Body Ingestion in Children
Vaccine Adverse Effects
Heat Related Illness
Systemic Sclerosis
Miscellaneous
100
True/False: Coins and Toys are the most likely ingested foreign bodies to cause injury/ serious complications
What is FALSE?
Button Batteries and Magnets are the most likely to cause injury/ serious complications.
Coins and toys are the most commonly ingested objects in children.
100
True/False: Egg allergy is a contraindication or precaution for any influenza vaccine.
What is: False
100
In the United States what high school sport is associated with the highest rates of heat related illness?
What is: High school football
x10 higher than all other high school sports combined
100
What has grade A evidence as first line therapy for Raynaud Phenomenon?
What is: Dihydropyridine Calcium Channel Blockers
100
True/False: Most episodes of thrombocytosis are from a secondary cause?
What is: True
Article cites a single center retrospective study of thrombocytosis. 83.1% of cases were secondary, 12.5 % cases primary and 4.4% unknown
200
While awaiting an EGD (if patient has swallowed a magnet), what should be advised to parents of the patient?
What is: Remove magnetic objects near the child such as clothes with metallic buttons or belts with buckles.
200
Administering _____ following vaccination may lesson reactogenicity with minimal or no blunting of the immune response, particularly in booster doses?
What is: Acetaminophen
200
When evaluating a patient after an exercise associated syncope, after what amount of time with prolonged recovery should a patient be referred for more urgent/ emergent evaluation before resuming physical activity?
What is: 15 minutes
Especially if associated with trauma, loss of consciousness during exercise, preceding cardiac symptoms, or cardiovascular risk factors.
200
What antibody is strongly associated with limited cutaneous System Sclerosis?
What is: Anti-Centromere antibody
200
Name two foods that the Interstitial Cystitis Network has published as food to avoid that may irritate the bladder for patients with Bladder Pain Syndrome?
What is:
1. Caffeine
2. Acidic foods
3. Alcohol
4. Sweeteners
5. Carbonation
300
What are two risk factors that decrease the chance for a coin to pass spontaneously?
What is:
1. Child is younger than 6 years old
2. Coin is located in the proximal or mid-esophagus
3. Coin spends more than 12 hours in the esophagus
4. The coin is wider than 23.5 mm (such as a quarter).
300
Name 1 vaccine that contains neomycin. Patients with this known allergy need to be counseled on risks.
What is: MMR, Varicella and inactivated influenza virus
300
What is the definition of Exertional Rhabdomyolysis?
What is: Serum Creatinine Kinase levels more than 10,000 U/L (167 ukat/L)
*Replaces lower threshold of 1,000 previously
Bonus (100 pts) :
What are 3 of the criteria for hospitalization?
Bonus pt 2 (100 pts):
When can patients return to activity?
300
A patient of yours with known Systemic Sclerosis presents to the ED with headache, visual changes, fatigue. ED noted pt to have pulmonary edema. Labs show severe proteinuria, thrombocytopenia, and anemia with high inflammatory markers. What should you be concerned for?
What is:
Scleroderma Renal Crisis
Bonus (100 pts):
What is the treatment?
300
What medication and what dose should be used for thromboprophylaxis in patients who have been diagnosed with essential thrombocytosis?
What is: Low dose Aspirin (81-100 mg)
* Twice daily doses can be considered for refractory cases
Bonus (100 pts) :
What condition should you be concerned about with thromboprophylaxis in patients with severe thrombocytosis?
400
More than 60% of ingested foreign body in children pass spontaneously. However, objects that are large (more than ____ cm in diameter or ____ cm in length) are unlikely to clear the duodenum or ileocecal value.
What is: 2.5 cm in diameter. 6 cm in length.
400
The American Academy of Family Physicians recommends administering this vaccine separately for the 1st dose in children 12 to 47 months of age?
What is: MMR and Varicella
Can increase risk of x1 extra febrile seizure for every 2,300 to 2,400 vaccines given.
400
What is one treatment that the article suggests to treat mild to moderate exercise associated hyponatremia?
What is:
1. Fluid restriction until diuresis ensures
2. Consumption of salty snacks or concentrated broths (three to four bouillon cubes or three ramen seasoning packets in 125 ml (4 0z of water)
400
After diagnosis of Systemic Sclerosis what are the recommended screening test for Pulmonary Arterial Hypertension (PAH)?
What is:
Annual Echocardiography
Annual NT-proBNP
Annual Pulmonary Function Test (spirometry and DLCO)
400
Patient presents for concerns of infertility. After discussion with the patient, you find that she has had intermenstrual bleeding, she had a ultrasound at the ED that showed echogenic endometrial thickening. You do a speculum exam and find this:
What is the most likely diagnosis?
What is: Endometrial Polyp
500
On the way to the emergency department, _____ can be used as a neutralizing agent when button batteries ingestion is suspected. In the hospital, _____ can be used as a neutralizing agent while waiting for esophagogastroduodenoscopy.
What is: Honey and Sulcrafate
* Do not use honey in children less than 12 months old.
* do not give if patient is having difficulty swallowing or is vomiting
Bonus points (extra 500 points)
What dose and how many doses?
500
This severe local reaction called Arthus reaction is most frequently seen with diphtheria and tetanus toxoids. What type of hypersensitivity reaction is this?
What is: Type III hypersensitivity reaction
Type III hypersensitivity reaction occurs when circulating antibody-antigen complexes deposit in tissue and can cause exaggerated pain, redness and swelling at the site of injection.
Bonus (100 pts) : What dose of DTaP is associated with this reaction and what is the treatment?
500
In the article what is the recommended water intake and work to rest ratio when the ambient temperature is 90 degrees F or 32.2 degrees C with heavy work?
What is:
20: 40 min
1 qt/ hour
This recommendation comes from Army Heat Center; Consortium for Health and Military Performance; Warrior Heat- and Exertion- Related Events Collaborative
500
Name one of the three first line therapies for a systemic sclerosis patient who has been diagnosed with interstitial lung disease?
What is:
1. Mycophenolate mofetil
2. Cyclophosphamide
3. Rituximab
500
In drowned children what resuscitative measures should be prioritized in contrast to following general cardiac arrest protocol?
What is: CPR over application of an AED
Only 1in 8 cardiac arrest after drowning have initial shockable rhythm. Hypoxia is the immediate consequence of drowning, so optimizing oxygenation is prioritized over placing an AED.
Less favorable neurologic outcomes were seen when AEDs were used.
These recommendations were provided by AHA and AAP.