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Exam Questions & Answers (Grade
A+)
Here's a quick review of high-yield Peds ICU concepts. Happy Studying 🔥 you got this! What would be a management plan for topical anesthesia toxicity? - correct answer 🔥• Topical anesthetics can be systemically absorbed with prolonged or repeated applications.
- Prilocaine toxicity results is methemoglobinemia, while lidocaine toxicity can cause central nervous system dysfunction and seizure activity.
- Methylene blue is the treatment of choice for methemoglobinemia due to prilocaine intoxication.
- Intralipid infusion is used to treat lidocaine intoxication by creating a reservoir for the hydrophobic lidocaine molecules. What is the difference between tPA versus streptokinase/urokinase? - correct answer 🔥• tPA is first bound to fibrin and then its affinity increases 500-fold.
Exam Questions & Answers (Grade
A+)
- Streptokinase and urokinase-type plasminogen activator bind to both fibrin-bound and circulating plasminogen to convert it into plasmin. Cardiac procedures can lead to cranial nerve dysfunction. What is the likely mechanism? - correct answer 🔥• Cardiac procedures that involve aortic arch dissection confer a higher risk of recurrent laryngeal nerve injury.
- Vocal cord paralysis manifests with immediate inspiratory stridor and dyspnea when the endotracheal tube is removed.
- 48% of patients with arch work esp. Norwood. What are the principles surrounding NIRs? - correct answer 🔥• Changes in brain oxygenation may precede any changes in pulse oximetry.
Exam Questions & Answers (Grade
A+)
- The organ most commonly injured and missed on a FAST was liver (41%).
- FAST gives no differences in time in the ED, costs, or need for abdominal CT; no better at sites with higher f compared to lower. Where are spinal cord injuries the most common? - correct answer 🔥Because of the larger size of the head and the relatively weak neck musculature, the cervical area is most commonly involved in spinal cord injury in children younger than 8 years of age. Plan appropriate therapy for a child with acute amphetamine intoxication - correct answer 🔥Treatment for amphetamine exposure is primarily supportive and may include benzodiazepines or barbiturates for seizures, antipyretics for hyperthermia, and combined ɑ and ß blocking agents for hypertension.
Exam Questions & Answers (Grade
A+)
What is an optimal maximal coronary perfusion pressure? - correct answer 🔥DBP - RAP >15 [best achieved by Epi] Recognize the cardiopulmonary interactions with the liver in the setting of hepatic failure - correct answer 🔥chronic liver disease and cirrhosis may develop pulmonary hypertension. Hepatopulmonary syndrome is defined as the triad of
- hypoxemia, 2) intrapulmonary vasodilation (IPVD),
- advanced liver disease and/or portal hypertension. Inappropriate vasodilation to areas in the lung that are hypoventilated. Understand mechanisms and scenarios associated with the development of postobstructive pulmonary edema - correct answer 🔥POPE 1: the airway is suddenly obstructed, as occurs during choking, foreign body
Exam Questions & Answers (Grade
A+)
(during expiration) is known as pulse pressure variation. Recent studies demonstrate that pulse pressure variation during the respiratory cycle of a patient receiving mechanical ventilation is a useful predictor of volume responsiveness during hypovolemia. [>10%] Neuromuscular Blockers - correct answer 🔥 What type of edema is PRESS? - correct answer 🔥One European model suggests that the diagnosis of PRES should include the following: 1 One or more acute neurological symptom(s) 2 One or more risk factor(s) 3 Brain imaging demonstrating bilateral vasogenic edema What are the drug mileu effects of posaconazole? - correct answer 🔥Environment with a higher pH, such
Exam Questions & Answers (Grade
A+)
as the duodenum, can decrease the maximum plasma concentration by as much as 40%. What are the drug mileu effects of tacrolimus? - correct answer 🔥A high-pH environment can substantially increase its absorption and would normally increase the risk of toxicity What is the gold standard to measure VO2? - correct answer 🔥Oxygen consumption (V ̇O2) is the amount of oxygen removed from the blood per minute (mL O2/min). The gold standard for determining VPO2 is by measuring oxygen consumption and carbon dioxide production through the respiratory system (termed indirect calorimetry or direct respirometry). What is the Cori cycle - correct answer 🔥However, if oxygen supply is inadequate, pyruvate is converted to lactate and transported to the liver for gluconeogenesis via the Cori cycle.
Exam Questions & Answers (Grade
A+)
Echinocandin antifungals caspofungin and micafungin have activity against most Candida species and are a reasonable choice in patients with neutropenia. What is the relationship between PaCO2 & blood flow to the brain? - correct answer 🔥For every 1 mm Hg increase in the PaCO2, the blood flow to the brain increases by about 4%. In a patient who has hypertensive emergency. What is the goal reduction in blood pressure in the first few hours? - correct answer 🔥Immediate reduction of blood pressure by 10% to alleviate symptoms with no more than 25% reduction in the first 2 hours When do both parents have to sign consent before enrolling a child in a research project? - correct answer 🔥For studies that involve more than a minimum risk and no potential benefit to the child,
Exam Questions & Answers (Grade
A+)
both parents must sign the consent before enrolling the child in the research project. Assent usually > 9 years old In a multicenter study, it is not necessary to enumerate all the centers involved in the research project on the consent form. What is the pericardial pressure volume relationship? - correct answer 🔥 Describe the relationship between the x descent and the y descent during acute - correct answer 🔥Normally in adults ~15-45 mL of fluid is present between the 2 layers of the pericardium The x descent is normally seen due to a fall in right atrial pressure, and the y descent is normally seen after opening of tricuspid valves and passive filling of the right ventricle.
Exam Questions & Answers (Grade
A+)
What did the RESTORE study show in terms of use of Dex? - correct answer 🔥The RESTORE study secondary analysis has shown that addition of dexmedetomidine as a secondary agent in the pediatric intensive care unit did not provide additional benefit to achieve targeted sedation levels, especially in critically ill patients such as the patient in the vignette. Palliative care sedation - correct answer 🔥 How do you use the Bernouilli equation - correct answer 🔥Bernoulli equation (gradient = 4 × [velocity]2), one can estimate the right ventricular pressure. In this case, the velocity is 4.4 m/s, and therefore, the gradient across the tricuspid valve is 4 × (4.4) 2 = 78 mm Hg.
Exam Questions & Answers (Grade
A+)
Assuming that the right atrial pressure is at least 10 mm Hg, the estimated right ventricular pressure would be about 88 mm Hg. This would suggest that the pulmonary artery is at least 88 mm Hg, which is indeed greater than the systemic systolic pressure of 78 mm Hg, as stated in the case in the vignette. What is the SIRS criteria? - correct answer 🔥Temperature = greater than 38°C or less than 36°C Heart rate = greater than 90 beats/min Respiratory rate = greater than 20 breaths/min or partial pressure of carbon dioxide (PaCO2 ) less than 32 mm Hg White blood cell count = greater than 12,000/μL or less than 4,000/μL What is the SOFA score? - correct answer 🔥Respiratory = PaO2/FiO2 ratio
Exam Questions & Answers (Grade
A+)
What is the difference between airborne transmission and droplet? - correct answer 🔥Airborne transmission refers to the transmission of pathogens with a size of greater than 5 μm and can be easily aerosolized to spread greater than 5 ft. Examples include tuberculosis and varicella. Droplet transmission refers to the transmission of pathogens with a size of greater than 5 μm that are not aerosolized but can remain on the ground or be suspended in droplet nuclei in the air and blown away for long distances (eg, measles virus). Which patients need negative pressure rooms? - correct answer 🔥Negative pressure rooms are used for patients with diseases such as tuberculosis, measles, or varicella. Which patients need positive pressure rooms? - correct answer 🔥Positive pressure rooms are therefore ideal for patients who do not have healthy immunity, as they prevent infections being introduced to the patient from outside.
Exam Questions & Answers (Grade
A+)
How does dead space fraction change in ARDS? - correct answer 🔥The alveolar dead space (day 2) fraction was a better predictor than either initial oxygenation index or PaO2/FiO2 and was independently associated with mortality, after adjustment for severity of illness, immunocompromised status, and organ failures in a multivariate analysis. Healthy person - what is FRC compared to VC? - correct answer 🔥FRC is at 35% of VC. What is the equation for the total work of breathing? - correct answer 🔥Airflow Resistive Work + Lung Elastic Recoil (passive) - Energy stored in chest wall. A patient with ascites has increased work of breathing due to which mechanisms? - correct answer 🔥Chest Wall Compliance is down Chest Wall Elastance is up [increased chest wall elastic work] ➡️ resting VC is low and there is increased work to expand the chest wall. FRC down
Exam Questions & Answers (Grade
A+)
iNOS causes vasodilation in sepsis. Nitric oxide then has the opportunity to react with superoxide, leading to peroxynitrite formation and cell toxicity. What abnormalities would be seen in a patient with severe thrombocytosis? - correct answer 🔥Measured serum potassium levels will increase by 0.15 mEq/L for every 100,000 μL increase in the platelet count. What is the classification of hemodynamically significant PDA? - correct answer 🔥If the diastolic flow across the PDA is 50% or more greater than the systolic flow, the PDA is categorized as restrictive. What are the components of Hoffman Degradation? - correct answer 🔥pH and temperature: Hofmann degradation is pH- and temperature- dependent. Acidosis and hypothermia will decrease activity and prolong the duration of action of cisatracurium
Exam Questions & Answers (Grade
A+)
Why can cisatricurium be epileptogenic? - correct answer 🔥Laudanosine is a tertiary amine analog of morphine and a metabolite of cisatracurium
- seizures have occurred when administered to animals What type of data is appropriate for Wilcox Rank Sum test? - correct answer 🔥A nonparametric test, like the Wilcoxon rank-sum test, is most appropriate for comparing the median of a skewed distribution like hospital length of stay. between two groups. What type of data is appropriate for t-test? - correct answer 🔥Comparing the mean of a normally distributed outcome measure between two groups What type of data is used for an ANOVA? - correct answer 🔥ANOVA is used to compare means of a normally distributed outcome measure between multiple groups.
