New content quiz March 2015

Primary tumours that cause osteosclerotic bony metastases include: prostate, carcinoid, small cell lung, Hodgkin’s lymphoma and medulloblastoma. Primary tumours that cause osteolytic bony metastases include: renal cell, small cell lung, thyroid, melanoma and lymphoma. (link)

Primary tumours that cause osteosclerotic bony metastases include: prostate, carcinoid, small cell lung, Hodgkin’s lymphoma and medulloblastoma. Primary tumours that cause osteolytic bony metastases include: renal cell, small cell lung, thyroid, melanoma and lymphoma. (link)

The therapeutic targets that are measurable immediately are most relevant to ED practice and include:MAP > 65mmHg; sBP > 100mmHg;  HR < 100/min. (assuming no tachyarrhythmia also present);  JVP >3cm H20; bedside US demonstrating adequate IVC or IJV filling. An additional targets that may be measurable within 1 hour is CVP 8-12 mmHg. Targets usually measurable only after 1 hour include: urine output > 0.5 mL/kg/hour; central venous or mixed venous oxygen saturation > 70% (although outcomes are probably no better than when CVP or CVO2 are not measured). (link)

Vertebal levels of T7-9 would be expected to produce neurological levels 3 levels below the vertebral level. (link)

A spinal cord injury at the L1 vertebral level would be expected to cause neurological findings at, and distal to, the neurological (myotome/dermatome) level of L5 (link)

Cutaneous mastocytomas are usually solitary lesions of 1 – 5 cm in diameter that may arise at any site. They usually appear before 6 months of age and lesions may even be present at birth. They may start as recurrent bullae or wheal that evolves into an infiltrated, pink – tan plaque rind like surface and hyperpigmentation may be prominent. Spontaneous involution usually occurs and trauma or rubbing may cause histamine release. (link)

Dishwashing liquid is usually only mildly alkaline and does not usually cause significant toxicity when swallowed, as distinct from dishwashing powders that are often strongly alkali. Single swallows that may cause a toddler include the following substances: ammonia fluoride/bifluoride; boric acid; disk batteries; hydrofluoric acid; selenious acid; herbal compounds such as camphor, eucalyptus oil,  oil of wintergreen (methyl salicylate), pennyroyal oil: hydrocarbons; imidazolines such as naphazoline, oxymetazoline, tetrahydrozoline, xylometazoline; insecticides/rodenticides/herbicides such as carbamates, diquat, lindane, nicotine, organophosphates and paraquat. (link)

The TRUST technique (tracheal rapid ultrasound saline test) is an US technique used to identify a saline filled ETT cuff at the level of the suprasternal notch. It uses a 5- 10-Hz linear transducer placed in a transverse orientation at the level of the suprasternal notch. In children less than 18 years of age, visualisation of the saline filled cuff at the level of the suprasternal notch is approximately 99% sensitive and 96% specific for correct ETT position. (link)

Common adverse effects from fluoroquinones include: GIT; headache;  dizziness, insomnia; pulmonary fibrosis; photosensitivity; tendinopathy / rupture; peripheral neuropathy; and fluctuations in blood glucose in diabetics. Haematuria is rarely reported. (link)

A trial of salbutamol for children < 12 months of age is no longer recommended as there is no evidence of efficacy, reducing admission rates or length of stay. (link)

In cardiac arrest in pregnancy chest compressions should be applied slightly higher on the sternum than in the non pregnant patient. The gravid uterus should be displaced laterally to the left or a tilt to left of 15-30 An IV fluid bolus should be considered and Mg therapy should be ceased (if in progress) and 10mL 10% CaCl administered in case of accidental Mg toxicity. Early intubation is recommended as hypoxia develops more rapidly in advanced pregnancy, bag mask ventilation is difficult and there is a high aspiration risk. (link)

The PLAX view on echocardiography is the best for macroscopically determining severity of the right (closest to probe) and non coronary cusps (furthest from probe), but not the left. One cusp often appears more diseased than the others. The PSAX view is best for determining the presence of a bicuspid valve and the apical five chamber view is best for measuring the pressure gradient across the valve. The subcostal and apical 4 chamber views do not visualise the aortic valve  (link)

Oxytocin 5 Units slow IV is the preferred first line pharmacological agent to stimulate uterine contraction. Ergometrine 0.25-0.5 mg slow IV or IM can also be used unless there is a history of hypertension and carboprost 0.25 mg IM repeated to a maximum of 8 doses unless there is a history of asthma. Misoprostol (prostaglandin E1 analogue) 1000mg PR is second or third line therapy. (link)

The recommended initial dose per kilogram (based on ideal body weight) of gentamicin for a 60 year old non neutropenic patient with septic shock using a single dose strategy is 7mg/kg. (link)

The formula to calculate lean body weight (in kg) in men based on their height (in cm) is lean body weight (kg) = 50kg + 0.9kg x each cm > 150cm in height. (link)

The formula to calculate lean body weight (in kg) in women based on their height (in cm) is lean body weight (kg) = 45kg + 0.9kg x each cm > 150cm in height. (link)

The recommended once daily initial doses of gentamicin for the treatment of non severe sepsis in non neutropenic patients are : Term neonate – 3.5mg/kg; children < 10 years of age – 7.5mg/kg up to 320mg:; 10 – 29 years of age – 6mg/kg up to 560mg; 30 – 60 years of age – 5mg/kg up to 460mg; > 60 years of age – 4mg/kg up to 400mg. (link)

The initial daily dose of gentamicin for a large patient 70 years of age with non neutropenic severe sepsis should not exceed 640mg. (link)

Single daily dose gentamicin therapy is not recommended for: febrile neutropenia; burns; SBP; and endocarditis. Once daily gentamicin is not contra-indicated in severe community acquired pneumonia. (link)

Plasmodium falciparum is the most common form in SE Asia, PNG and Indonesia and accounts for most deaths from malaria and approximately 60% of cases in returned travellers. Plasmodium vivax is the most prevalent on a worldwide basis, especially in Latin America, but is rare in sub-Saharan Africa and is responsible for about 20% of cases in returned travellers. Plasmodium ovale and Plasmodium malariae are less common forms. (link)

The analgesic effects of oral sucrose are unlikely to have any significant effect in children older than 4 months of age. (link)

In HSP rash is usually present in >95% of cases; joint pain/swelling in 66%; >95% will have haematuria and proteinuria at some stage however renal impairment is much less common and renal failure occurs in < 1% (more common in adults). Thrombocytosis is present in 65% but thrombocytopaenia is not a feature of HSP. (link)

Gianotti Crosti is most commonly associated with Hepatitis B virus and Epstein-Barr virus infections. Other associated conditions include: coxsackie virus, adenovirus, enterovirus, human herpes virus 6, reovirus, varicella, roseola, rotavirus, respiratory syncytial virus, Lyme borreliosis, Mycoplasma pneumonia, meningococcal infection, immunisation. (link)