SAEM QUESTIONS AND ANSWERS GRADED A

SAEM QUESTIONS AND ANSWERS GRADED A subungual hematoma drane using 18 guage needle and discharge home Correct Answer: diagnosis and management etomidate (Cardioprotective) Correct Answer: induction agent of choice when decreased myocardial contractility is a concern etomidate Correct Answer: induction agent known to cause transient adrenal suppression, causing its use in septic patients to be controversial heel (sural nerve block) Correct Answer: portion of plantar aspect of foot not anesthetized by posterior tibial nerve block age (somewhere between 5-12, controversial) Correct Answer: only absolute contraindication to cricothyrotomy lightheadedness and diziness Correct Answer: first signs of lidocaine toxicity can place deep structures at risk Correct Answer: reason why vertical mattress sutures are not recommended for the palm fentanyl (reverse with naloxone, if not effective may need neuromuscular blockade and intubation) Correct Answer: analgesic which can cause respiratory depression, chest wall rigidity and glottic spasm mallampati Class 1 = full visualization of epiglottis Class 2: mostly full Class 3: barely visualized Class 4 = no visualization of epiglottis Correct Answer: scale which allows communication of ability to visualize structures of the posterior pharynx as a means of estimating intubation difficulty headache Correct Answer: most common complication of LP paronchyia digital block, surgical intervention (partiial removal of nail, and abx) Correct Answer: diagosis and management panic disorder Correct Answer: psychiatric disease with highest risk of suicide silent suicide Correct Answer: act of slowly killing oneself by nonviolent means, such as starvation or non compliance with essential medical treatment occult suicide Correct Answer: self destructive acts disguised as an accident C. elderly and caucasian Correct Answer: Suicidal risk is increased in this patient population: A. patients who have not been involuntarily committed b. patients who directly questioned about suicide c. elderly and caucasian D. patients taking lithium for bipolar disorder flexion and supination of elbow (imaging usually not needed if pain resolves after reduction) Correct Answer: management of radial head subluxation (nurse maids elbow) hill sachs deformity (compression fracture of the posterior lateral aspect of the humeral head) Correct Answer: most common fracture associated with shoulder dislocation asystole (followed by bradycardia) Correct Answer: most common rhythm seen in pediatric arrest 1. dry, warm, position, suction, stimulate 2. oxygen 3. ventilation 4. chest compressions 5. medications Correct Answer: order of operations for neonatal resuscitation maternal blood (ask about bleeding from nipples) Correct Answer: one possible cause of blood in vomit of a healthy appearing infant hypoxemia Correct Answer: most likely underlying cause of bradycardia in a newborn tube mm = (16 + age) /4 Correct Answer: equation for estimating endotrachael tube size 4 back blows If still obstructed 4 chest compressions If still obstructed jaw thrust, mouth inspected and removal of visual FB If still obstructed, mouth to mouth ventilation Repeat Correct Answer: management of choking infant under 1 year of age Childs nares childs little finger Body length broselow conversionn Age in years + 16 / 4 Correct Answer: 4 different methods for estimating pediatric endotracheal tube size hypovolemia Correct Answer: most common cause of shock in the pediatric population B. gastric distension due to excessive volume or rate of ventilation impairing ventilatory function The answer is B. Early placement of a nasogastric tube to facilitate decompression of the stomach will help to prevent further impairment of ventilation. The rest are indications for endotrachael intubation in the pediatric trauma patient. Correct Answer: All of the following are generally accepted indications for endotracheal intubation of the pediatric trauma patient, EXCEPT: A. GCS score less than or equal 9, to secure airway and provide controlled hyperventilation B. gastric distension due to excessive volume or rate of ventilation impairing ventilatory function C. any inability to ventilate by bag-valve-mask methods or the need for prolonged control of the airway D. respiratory failure from hypoxia or hypoventilation E. any trauma patient in decompensated shock and resistant to initial fluid resuscitation B. Salter II Correct Answer: A 7 year old boy falls off his bike onto his outstretched arm and sustains a supracondylar fracture. The fracture originates in the metaphysis and a portion of it extends into the physis (growth plate) without extending through to the epiphysis. How is this fracture classified? A. Salter I B. Salter II C. Salter III D. Salter IV E. Salter V SALTR type 1 - slipped - fracture plane passes through growth plate only type 2 - above - fracture passes through growth plate and metaphysis type 3 - lower - fracture plane passes through growth plate and epiphysis type 4 - through - fracture passes through eiphysis, growth plate and metaphysis type 5 - ruined - no fracture, but growth plate damaged from crush injury Correct Answer: Salter Harris Fracture CLasifcation The answer is C. Chest compressions should be started when an infant's heart rate is less than 60 bpm only if oxygen and adequate ventilation have first been tried and failed to increase the heart rate. The other choices are all correct regarding the use of chest compressions in the infant. -- For further reading, see Rosen's Emergency Medicine: Concepts and Clinical Practice, 5th edition, page 105. Correct Answer: All of the following are true regarding chest compressions in the infant EXCEPT: A. Compressions should be performed at a rate of 90 per minute. B. Chest compressions should be accompanied by a ventilatory rate of 30 per minute. C. Chest compressions should be initiated whenever an infant's heart rate is less than 60 bpm. D. An appropriate position for performing chest compressions is to encircle the chest with both hands and place the thumbs side by side on the sternum. E. Correct depth of compressions is one-third the anteroposterior diameter of the chest. B Digoxin The answer is B. The drugs which may be given by endotracheal rout