Short Fellowship quiz 2

1 Standard drink = 10g of ethanol. Hazardous drinking in males is consumption of > 5-6 drinks per day and > 3-4 drinks per day for women. Dependence is uncommon with consumption of < 8-10 drinks per day in males and 6-8 drinks per day in females. (link)

The palmar grasp reflex is elicited by pressure on the palm or sole. it  appears at 28 weeks gestation, is well established by 32 weeks gestation and becomes weak and inconsistent between 2 -3 months of age. It is considered abnormal if it is absent before 2 – 3 months of age, persists beyond 3 months of age or is asymmetrical between arms. The reappearance of the grasp reflex in frontal lobe lesions reflects the unopposed parietal lobe activity. (link)

The speech area is in the left side of the brain in 99% of right handed people and 70% of left handed people, therefore left sided weakness and dysphasia due to a stroke is rare. Left hemispheric lesions cause dysphasia and right hemispheric lesions cause neglect, visuo-spatial and cognitive problems. (link)

Non-ischaemic priapism (also known as arterial or high flow priapism) is due to unregulated cavernous arterial inflow. The penis is usually not fully rigid nor painful and recent trauma to the perineum or penis is the most common cause. Perineal compression with the thumb may cause prompt detumescence in children (Piesis’ sign), however is of questionable use in adults. Cavernous blood gases are not hypoxic or acidotic. (link)

The Australian categorisation system is used by the New Zealand formulary but is different to the US FDA categorisation system. The categorisation of medicines for use in pregnancy does not follow a hierarchical structure. Human data are lacking or inadequate for drugs in the B1, B2 and B3 categories, however the allocation of a B category does not imply greater safety than a C category. Medicines in category D are not absolutely contraindicated during pregnancy (e.g.anticonvulsants).  Companies may apply a more restrictive category than can be justified on the basis of the available data. Products containing two or more active ingredients are categorised based on the active ingredient with the most restrictive pregnancy categorisation. (link)

The strongest indication for transcutaneous pacing is symptomatic bradyarrhthmias e.g. CHB with symptomatic hypotension. Also, the presence of RV infarction means transvenous pacing may be ineffective as the pacemaker tip may be in infarcted muscle. Transcutaneous pacemakers cannot usually pace at a rate fast enough to overdrive tachyarrhythmias and pacing a patient with beta blocker toxicity with an acceptable heart rate is neither indicated, nor likely to be effective, (link)

A Miller blade laryngoscope is preferred in children aged younger than 6 years.(link)

The most appropriate uncuffed ETT size for an average sized 2 year old child is 4.5. (Age/4)+ 4 (uncuffed) or (Age/4)+ 3 (cuffed). (link)

The appropriate ETT insertion length at the lips for an average sized 1 year old is 12.5cm. At lips = (age/2) + 12 cm, at nares = (age/2) + 15 cm. (link)

The appropriate initial IV dose of adrenaline for paediatric cardiac arrest is 0.1 mL/kg 1:10,000. (link)

The appropriate initial IO dose of adrenaline for paediatric cardiac arrest is the same as the IV dose – 0.1 mL/kg 1:10,000. (link)

The appropriate IV dose of midazolam to control seizures in a child is 0.15mg/kg (link)

The appropriate IV dose of 10% dextrose in paediatric resuscitation is 2- 5 mL/kg (link)

The approximate weight of an average 3 month old child is 6kg. (link)

The approximate daily maintenance fluid requirements of an average sized 6 month old child is 750mL. The expected weight of the child is 7.5kg (link) and the daily fluid requirement for 1-10kg children is 100mL/kg. (link)