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Neurons
Trauma-Life in the ER
Orthopods
Dr. Tox
In Your Eyes
100
Which of the following is the most common cause of seizures in children? / A. Fever / B. Head injury / C. Metabolic disturbances / D. Hypoxia / E. Ischemia /
A. Fever / But... in the first 2-3 days of life the most common cause of seizures is hypoxia / In full term and premature infants up to 65% of seizures are due to hypoxicischemic encephalopathy. (HIE)
100
This upstate New York educational institution has a mascot with "appeal."
What is Syracuse University
100
Which of the following statements regarding the Salter-Harris classification of epiphyseal fractures is FALSE? / A. The prognosis of a type III Salter Harris fracture is worse than that of a Type I or Type II / B. Type II is the most common / C. A type III involves a fracture of the metaphysis with extension into the epiphyseal plate. / D. A Type V is a crush fracture of the epiphyseal center
C. A type III involves a fracture of the metaphysis with extension into the epiphyseal plate. / the higher the number, the poorer the prognosis / type II (MOST COMMON) is a fracture of the metaphysis with extension into the epiphyseal plate
100
Activated charcoal is absolutely contraindicated in the treatment of toxic ingestions of / A. Caustics (acids/alkalis) / B. Acetaminophen / C. Lithium / D. Heavy metals /
A. Caustics (acids/alkalis) / The only ABSOLUTE contraindication to using activated charcoal. It does not absorb these compounds and does not prevent tissue damage caused by these agents. Charcoal can also interfere with subsequent endoscopy.
100
A 3 year old boy presents after being poked in the left eye with a stick 2 hours PTA. He has worsening pain, photophobia, and cannot see clearly. His left pupil is elliptically shaped and poorly reactive to light. He can discern light only with the left eye. What is the MOST appropriate next step? / A. Give PO ibuprofen for pain / B. Apply topical antibiotic ointment to eye / C. Have him lie down with HOB elevated to 45 degrees / D. Place an occlusive eye patch over the left eye / E. Sedate him with ketamine for comfort
C. Have him lie down and HOB elevated to 45 degrees / If you are concerned for globe rupture, take the following steps: - recumbent position with HOB at 45 degrees - - avoid medications that might increase ICP (ketamine) - - avoid NSAIDs (intraocular bleeding) - - avoid occlusive eye patches, eye shields are ok - - don't forget tetanus prophylaxis
200
List at least 4 headache "red flags"
sudden onset or headache with exertion / abnormal neuro exam / seizure / worsening headache under observation / abnormal vital signs (fever, Cushing's) / first or worst (severe) headache / new onset headache in immunocompromised host
200
A 10-year-old girl develops abdominal pain and bilious vomiting several days after injuring herself over the handlebars of her bicycle. What is the MOST LIKELY diagnosis?
What is Duodenal Hematoma
200
This NFL team is scheduled to play the Buffalo Bills this Sunday, November 17, 2013.
What is the New York Jets.
200
Which of the following signs and symptoms is NOT a manifestation of the cholinergic toxidrome? / A. Muscle fasciculations / B. GI upset/cramping / C. Mydriasis / D. Diarrhea/Diaphoresis
C. Mydriasis / Cholinergic poisoning - DUMBBELS / Diarrhea / Urinary incontinence / Miosis / Bronchospasm/Bronchorrhea / Bradycardia / Emesis / Lacrimation / Salivation / Also - nicotinic effects: muscle fasciculations, weakness, diaphoresis and CNS effects: confusion, seizures, coma
200
This popular condiment was first manufactured in Rochester, NY in 1904.
What is mustard!
300
List at least 4 criteria for a SIMPLE febrile seizure
6 months to 5 years of age / Generalized (no focal findings) / Duration less than 15 minutes / Single episode / Neurologically normal child on exam/history with normal development on history / Fever (and seizure) is not caused by meningitis, encephalitis, or other CNS illness/process
300
A 4 year old boy presents with a deep burn on his lower lip after his mother found him playing near an electrical outlet where the vacuum cleaner was plugged in. The vacuum cleaner cord has teeth marks on it. He had significant bleeding at home, which has since resolved. What is the BEST management for this patient? / A. Admit to monitored bed for 12-24 hours / B. Discharge home with outpatient plastic surgery follow-up / C. Observe for 6 hours and d/c home if stable / D. Suture burn and discharge home /
B. Discharge home with outpatient plastics follow up / Warn parents that labial artery injury is possible and that bleeding could recur / Don't suture burns / No evidence that burns on lip correlated with cardiac injury
300
A 5-year-old boy presents with elbow pain following a fall on his outstretched arm. Elbow xrays reveal small anterior and posterior fat pads but no obvious cortical break of bone. The presumptive diagnosis is: / A. elbow sprain / B. occult radial head fracture / C. nondisplaced supracondylar fracture / D. lateral epicondyle fracture / E. nursemaid’s elbow
C. nondisplaced supracondylar fracture / Unlike a small physiological anterior fat pad which is normal, a posterior fat pad of any size is abnormal and indicates hemarthrosis and an intra-articular elbow fracture. / In adults, a posterior fat pad without obvious cortical break implies an occult radial head fracture / But...in children, the most common etiology is a supracondylar fracture.
300
An 18 month old boy presents with altered mental status after playing with his grandmother's medicine bottles which contained "pills for her heart." He is somnolent and responds only to pain. Temp 38.6, HR 130, RR 56, BP 90/60. Pupils are midsize and reactive. What is the MOST likely explanation for this presentation? / A. Aspirin ingestion / B. intracranial hemorrhage / C. lisinopril ingestion / D. metoprolol ingestion / E. sepsis
A. Aspirin Ingestion / fever, nausea/vomiting, diarrhea tinnitus / For more severe ingestions: tachypnea, tachycardia, hypoglycemia, metabolic gap acidosis, AMS, seizures
300
An infant who was delivered at home and received no prenatal care is brought in at 2 days of age for evaluation of purulent eye discharge. She has diffuse conjunctival injection, a clear cornea and copious, purulent discharge. Pupils are normal. What is the most likely etiology?
What is Neisseria gonorrhoeae / erythromycin eye prophylaxis is given to all infants born in the hospital (and some born at home) - it prevents gonorrhea but NOT chlamydia eye infections / gonorrhea conjunctivitis presents a few days after delivery, chlamydia presents later (5-14 days)
400
A Rochester Red Wings vs. Pawtucket Red Sox is the longest game in baseball history. How many innings were played? (plus or minus 4 innings)
What is 33 innings - 8 hours 25 minutes of play - Pawtucket won :(
400
A 14 year old boy is brought in by EMS after falling 30 feet from a tree. He is intubated with GCS of 5. Temp 36.5, HR 140, BP 80/60, O2 sat 100% (vented). There is an obvious right femur deformity. Abdomen is non-distended and breath sounds are equal. He is given 20 cc/kg NS bolus x 2, after which HR is 70 bpm and BP is 76/45. What is the MOST likely explanation for the boy's persistent hypotension? / A. blood loss from femur fracture / B. epidural hematoma / C. hemothorax / D. liver laceration / E. spinal cord injury
E. spinal cord injury / hypotension, not fluid responsive with relative bradycardia --> think neurogenic shock / neurogenic shock: disruption of autonomic pathways below T6 level / remember that hemorrhagic hypovolemia is the most common cause of hypotension in the setting of trauma
400
15. What is the name of this type of fracture? (SEE PICTURE) / A. Galeazzi fracture / B. Monteggia fracture / C. Ghazala fracture / D. Hume fracture
B. Monteggia fracture - proximal ulnar fracture with anterior radial head dislocation / Galeazzi: radial fracture with radio-ulnar dislocation / Ghazala: not a real fracture / Hume: fracture of olecranon with associated anterior dislocation of the radial head
400
Dr. Wiegand chose the University of Iowa for undergrad based on their (excellent) program for this sport. / A. Hockey / B. Baseball / C. Fencing / D. Tae Kwon Do / E. Football
D. Tae Kwon Do. / Other fun Tim facts: - creative writing major - - family has season tickets to the Green Bay Packers - - practices Bikram (hot) yoga
400
A 14 year old boy presents with left eye pain which started acutely while he was mowing the lawn. On initial exam, visual acuity is 20/25 in the left eye, conjunctiva is injected, there is no visible foreign body. No corneal abrasion is seen on fluorescein staining. What is the next BEST step? / A. dilated ophthalmic exam / B. eversion of the eyelid / C. Seidel test / D. Slit lamp exam
B. Eversion of the eyelid / ocular foreign body is most likely given history / dilated eye exam allows you to visualize the retina, not worried about retinal pathology in this case / Seidel test: used for globe rupture - you will see fluorescein flowing from the rupture site / slit lamp: helps to evaluate for anterior and posterior chamber disease, less of a concern in this patient
500
All of the following statements regarding botulism are accurate EXCEPT: / A. symptoms usually develop within 24-48 hours of ingestion of improperly preserved foods that are contaminated with botulin toxin / B. The earliest and most reliable symptoms are dry mouth, dysphasia and dysarthria / C. The toxin produces symptoms by preventing the release of acetylcholine from nerve endings / D. The usual cause of death is respiratory paralysis
B. The earliest and most reliable symptoms are dry mouth, dysphasia and dysarthria / the earliest and most common symptoms of botulism are BLURRED VISION and DIPLOPIA. These are present in 90% of cases.
500
11. Which of the following is TRUE concerning traumatic thoracic injuries in children? / A. pulmonary contusion is rarely seen without an associated rib fracture / B. diaphragmatic injuries can be reliably diagnosed with chest CT / C. tension pneumothorax is more of a concern due to increased mediastinal mobility / D. thoracic injuries are usually not associated with other organ injuries / E. rib fractures are more common than in adults
C. Tension PTX is more a concern due to increased mediastinal mobility as compared to adults. / The classic thoracic injury in children is a pulmonary contusion in the absence of an overlying rib fracture, due to the incompletely calcified pediatric bone and the increased pliability of the chest wall. / A rib fracture in children is less common than adults and implies significant force. / More than 2/3 of thoracic injuries in children are associated with other organ system injuries. / Laparoscopy is needed to definitively exclude suspected diaphragmatic injury.
500
All of the following concerning the pediatric cervical spine is true EXCEPT: / A. interspinous ligaments are more flexible than adults / B. the pre-dens space can be larger than adults / C. facet joints are flatter than adults / D. most fractures occur in the lower cervical spine / E. mild subluxation of C2 on C3 anteriorly can be a normal variant
D. Most fracture occur in the lower cervical spine / Because of the increased flexibility of the upper cervical spine and the relatively larger head, most fractures in children occur in the C1-C2 region
500
A 4 year old girl presents to the ED after glyburide ingestion. She initially had altered mental status and hypoglycemia which were reversed by EMS with dextrose. What medication should you administer next? / A. Diazoxide / B. Glucagon / C. Octreotide / D. Somatostatin
C. octreotide. / Octreotide is a somatostatin analogue that antagonizes the release of insulin and has been shown to prevent hypoglycemic episodes in the setting of sulfonylurea ingestion. / Diazoxide could be administered if octreotide is not available. It has the theoretical risk of HYPOTENSION. / Glucagon could be used, but glycogen stores have likely already been used up in the setting of symptomatic hypoglycemia secondary to sulfonylurea ingestion. / Somatostatin works like octreotide, but doesn't last as long as octreotide.
500
Blunt ocular trauma can produce all of the lesions listed below. Which of these listed is NOT typically associated with a decrease in visual activity? / A. Very large hyphen / B. Traumatic lens dislocation / C. Blowout fracture of the orbit / D. Traumatic iritis
C. Blowout fracture of the orbit / Blowout fractures of the orbit can be associated with diplopia but do not, by themselves, cause decreased visual acuity.