ABEM Flash cards
1
Q
Ehrlichiosis - organism and transmission?
A
Ehrlichia (gram neg, intracellular), lone star tick (Amblyomma)
2
Q
Babesiosis - organism and transmission
A
protozoan parasite, Ixodes tick
3
Q
tick borne relapsing fever - organism and transmission
A
spirochete Borrelia hermsii, Ornithodoros tick
4
Q
tick borne relapsing fever - clinical syndrome
A
fever, HA, myalgias, arthralgias, jaundice x3-6 days; then afebrile, x several cycles.
5
Q
colorado tick fever - organism and transmission?
A
RNA virus, wood tick Dermacentor
6
Q
class I hemorrhage: EBL and VS?
A
<750 cc’s. normal HR/BP, normal to elevated pulse pressure
7
Q
class II hemorrhage: EBL and VS?
A
750-1500 cc’s. HR 100-120, BP normal, decreased pulse pressure
8
Q
class III hemorrhage: EBL and VS?
A
> 1500 c’s. elevated HR, low BP, decreased pulse pressure
9
Q
MR murmur
A
apex, systolic murmur, radiates to axilla
10
Q
most common traumatic valvular injury
A
aortic valve
11
Q
diastolic murmurs
A
AR, MS, pulmonary regurg, PDA (continuous)
12
Q
systolic murmurs
A
AS, MR/TR, VSD, MVP, PDA (continuous)
13
Q
XR for toxic megacolon
A
dilated colon to 6 cm, loss of haustra, thumbprinting
14
Q
black widow spider bite symptoms
A
mostly local (including diaphoresis near site), occasional systemic. Caused by release of ACh and NE.
15
Q
bark scorpion (Centruroides) envenomation symptoms
A
localized pain, can cause severe neurologic sx in children (neuroexcitatory of sympathetic and parasympathetic nervous system causing ataxia, cranial nerve dysfunction, hypersalivation, muscle jerking, and unusual eye movements)
16
Q
GIB after aortic aneurysm repair = what diagnosis
A
aortoenteric fistula
17
Q
When is a patient’s risk for future stroke highest following a transient ischemic attack?
A
first 2 days
18
Q
Montaggia
A
prox ulnar fx and prox radial (head) dislocation
19
Q
smallpox vs chicken pox
A
smallpox = all the same age. chickenpox = lesions of varying ages
20
Q
indication, and absolute contraindication to physostigmine
A
anticholinergic syndrome. C/I if QRS >100 or if Na channel blockade
21
Q
dry socket syndrome and treatment
A
pain 2-3 days after dental extraction due to loss of protective clot. Irrigate with chlorhexidine 0.12% or warmed NS. If e/o infection, PCN (or clinda if PCN allergy)
22
Q
Best test for giardia
A
stool antigen test
23
Q
cyproheptadine is the treatment for?
A
serotonin syndrome
24
Q
antibiotics assoc with non convulsive status
A
PCNs
25
odynophagia in HIV patient: organisms?
Candida or CMV
26
cancer and lethargy/AMS
Hypercalcemia
27
recurrent food impactions and GERD despite PPI/antacids
eosinophilic esophagitis (can develop strictures)
28
superficial vs partial thickness burns?
superficial is painful, red, and blanching.
| partial is non-blanching, bright red, and may have blisters
29
how to treat amenorrhea 2/2 anorexia nervosa
weight gain - no OCPs!
30
red flag back symptoms
fever, weakness, weight loss/night sweats, hx of cancer, bowel/bladder, trauma
31
treatment for mild impetigo
Mupirocin ointment (or retapamulin)
32
predominant electrolyte abnormality in anorexia? treatment?
hypophos. treat promptly (PO vs IV depending on severity) to help prevent refeeding syndrome
33
Korsakoff syndrome
apathy, confabulation, anterograde and retrograde amnesia
34
abdominal pain, palpable purpura
HSP
35
diseases associated with HSP
meckel's, lymphoma, celiac, IBD
36
treatment for contact lens related corneal abrasions
topical anti-pseudomonal (cipro, oflox, tobramycin)
37
diffuse vesicular lesions in various stages of development
varicella
38
hard signs of vascular neck injuries
pulsatile bleeds, expanding hematoma, thrills/bruits, neurologic deficits, shock
39
sx of scombroid poisoning
flushing, GI sx, conj injection 30 mins after eating. Fish may be peppery, bitter, metallic
40
sx of ciguatera poisoning
GI + neuro sx (GI precedes neuro sx). pathognomonic sx = cold allodynia and worsening/recurrence with alcohol.
41
3 topical cycloplegic drugs
cyclopentolate, scopolamine, homatropine
42
first line treatment for obstruction + coffee bean sign on abd XR
dx: sigmoid volvulus. first line tx = sigmoidoscopy (if no gangrene)
43
#1 risk factor for IPV homocide
access to firearms
44
LVH
R (aVL) > 11 mm
S V1 + R V5/V6 > 35 mm
S deep + S V4 > 23 mm in M / 28 mm in F
45
dose of recomb factor VIII in life-threatening bleeds
50 units/kg (replaces 100% of factor levels)
46
chads2vasc: what ages give you points?
65-74 = 1 point. >75 = 2 points
47
chads2vasc: what sex give you points
female = 1, male = 0
48
chads2vasc: what conditions give you points
HTN, DM, stroke/TIA/VTE, vascular disease (MI, PAD, aortic plaque), CHF
49
xray findings suggestive of SBO
bowel dilation >3 cm, prominent plicae circulares, and multiple air-fluid levels.
50
first line abx for mastitis
keflex, dicloxacillin (against MSSA). If MRSA suspected, give Bactirim.
51
acute lung abscess: most likely organism?
oral anaerobes
52
what age for femur IO?
<1 year
53
Ehrlichiosis - clinical syndrome?
constitutional sx + hematologic abnormalities (thrombocytopenia/leukopenia). Usually no rash!
54
drugs that trigger gout
ASA, cyclosporine, diuretics
55
ketosis/ketonuria with normal AG = ?
isopropyl alcohol
56
electrolyte disturbances in tumor lysis
hyperuricemia, hyperK, hyperphosphatemia, hypoCa
57
Fluorescein pattern for UV keratitis
Multiple punctate erosions
58
hard signs of vascular injury
pulsatile bleed, diminished distal pulse, expanding hematoma, thrill/bruit
59
MOA of isoproterenol
beta-1 and beta-2 agonist (Increased heart rate. Increased heart contractility. Relaxation of bronchial, gastrointestinal, and uterine smooth muscle.)
60
normal CSF WBC, glucose, protein
WBC <5, glucose 60% of serum, <200 mg/dL
61
#1 inherited bleeding disorder
vWD
62
#1 inherited clotting (hypercoagulable) disorder
factor V leiden
63
EKG findings to look for in syncope
block, WPW, long QT, Brugada, HOCM, AVRD
64
pityriasis rosea description and treatment
herald patch followed by many scaly red plaques/patches. ?reactivation of HHV6/7, treat pruritis
65
distinguishing factors between bullous pemphigoid and pemphigus vulgaris
BP slightly older (>65), less mucosal involvement, neg Nikolsky.
PV involves mucosae and has +Nikolsky
66
neuro sx that worsen with fever, hot bath, warm environment
Uhthoff sign - think MS
67
#1 organism causing osteomyelitis assoc with puncture wounds
Pseudomonas
68
treatment of pediatric lead poisoning
Treatment depends on sx and blood lead levels. If symptomatic, ADMIT. If asymptomatic and elevated blood lead levels, outpatient chelation
69
SIRS criteria
HR >90
RR >20
WBC >12, <4, or >10% bands
Temp >38 or <36
70
difference between labyrinthitis and vestibular neuritis
no tinnitus or hearing loss in vestibular neuritis
71
definition of delta pressure for acute compartment syndrome. What delta is concerning?
diastolic BP - compartment pressure. <30 is concerning!
72
CSF findings in MS
oligoclonal bands
73
what kind of bundle/fascicular blocks are an indication for pacemaker placement following acute anterior MI?
RBBB + LAFB (has potential to progress to CHB)
74
PT/INR measures what clotting factors?
I, II, V, VII, X
75
age for walking? (developmental milestones)
~13 months
76
when to suspect NAT in spiral fracture of tibia
less than walking age, fx is proximal rather than distal
77
opiates that require renal dosing
morphine, tramadol, codeine, meperidine
78
reversal agent for Xa inhibitors
andexanet alfa, 4 factor PCC
79
DDx for wide QRS
hyperK, Na channel blockade, BBB, PM, WPW, ventricular beats, nonspecific IVCD
80
Marcus Gunn vs Argyl Robertson pupil
Marcus Gunn = APD (think optic neuritis/MS)
| Argyl Robertson = non reactive but accommodates (think neurosyphilis)
81
antibiotics which can trigger myasthenic crisis
fluoroquinolones, macrolides, aminoglycosides
82
what kind of parasite is Strongyloides stercoralis?
nematode (roundworm)
83
site of infection of Strongyloides stercoralis?
small intestine. Larvae migrate through skin
84
clinical syndrome of Strongyloides stercoralis?
typically asymptomatic, sometimes GI/dysentery. Larvae migrate through skin --> rash/pruritis.
Hyperinfestation in immune compromised or elderly can be deadly. (PNA, septicemia, meningitis, ileus)
85
who gets tetanus IVIG as prophylaxis?
<3 vaccines + complicated wound.
complicated wound = contaminated (dirt/feces/saliva), crush, burn, frostbite, puncture, missile
86
number 1 cause of arterial embolism?
AFib
87
What level is sensation over medial malleolus?
L4 nerve root
88
Weakness of great toe extension localizes to what nerve root?
L5
89
Bilateral subconjunctival hemorrhage in infants
raises concern for NAT
90
Facial swelling, cough, sob, HA
SVC syndrome
91
Earliest sign of HACE?
Ataxia (this is also the most specific finding)
92
Mainstay if PTSD pharmacotherapy
SSRI
93
Adjunct pharmacotherapy for specific sx of PTSD?
Prazosin for nightmares;
propranolol for anxiety/sympathetic activation symptoms
94
INTRACTIBLE seizures of neonate
Consider possible pyridoxine deficiency
95
GI sx, then shock, acidosis, hepatotoxicity, AMS/seizure
Iron toxicity
96
Specific Signs of orbital fracture in trauma
Enophthalmos, diplopia, infraorbital numbness, orbital step off
97
First steps to work up possible PM lead displacement
EKG, CXR
98
First line ppx after exposure to N. meningitidis
CTX, rifampin, ciprofloxacin
99
erythema marginatum is due to what disease
acute rheumatic fever
100
first medicine to give to treat pheo
alpha blockers before beta blockers
101
first medicine to give when treating thyroid storm
BB, then methimazole or PTU, then KI
102
risk factors for endometrial cancer
estrogen and more exposure to thickened endometrium
obesity, nulliparity, early menarche / late menopause, anovulatory cycles
103
#1 risk factor for developmet of hepatorenal syndrome
SBP
104
what volume of contrast should be used for cystourethrogram in trauma?
400 cc
105
cave exploration + respiratory sx =
histo (flu like illness, CXR with hilar LAD)
106
construction work + respiratory sx =
coccidiomycosis (fever/myalgias, CXR with LAD/focality/effusions)
107
alpha blocker for use in acute treatment of pheo
phentolamine or phenoxybenzamine
108
complications of therapeutic hypothermia
coagulopathy/bleeding, arrhythmias, hyperglycemia/insulin resistance, infection, "cold diuresis"
109
uncomplicated withdrawal - how many hours after last drink?
1-6 h
110
alcoholic hallucinosis occurs how many hours after last drink?
onset 12-24h after last drink, can last 1-2 days
111
withdrawal seizures occur how many hours after last drink?
6-48 hours
112
DTs occur how many hours after last drink?
onset 72-96 hours after last drink
113
treatment for baclofen withdrawal seizures
BZD
114
unstable pregnant patient with CP and widened mediastinum. What test to order next?
TEE for dx of possible AO dissection
115
ETT for regular sized neonate
3.0 uncuffed
116
what is a helminth
parasitic worm (types = roundworm/nematode, fluke/trematode, tapeworm/cestode)
117
PERC vs Wells
PERC has age, hormone use
| Wells has immobilization, hx cancer, PE #1 ddx
118
calculated serum osms
2*Na + glucose/18 + BUN/2.8 + etoh/4.6
| mg/dl
119
toxin ketosis without acidosis
isopropyl alcohol
120
effects of methylene glycol
CNS, CV, QT prolongation, RENAL effects (AKI, kidney stone)
121
effects of methanol
CNS and VISUAL ("snowstorm")
122
where do you check sensation for L5 nerve root
first web space (between great/2nd toe)
123
how to treat PJP pneumonia
Bactrim. If A-a grad >35 or PaO2 < 70, add steroids.
124
treatment of tetanus disease
administer tetanus immune globulin, surgical wound debridement, abx, supportive care
125
fentanyl affects mu receptors and has what additional activity?
serotonergic
126
indication for HD in salicylate toxicity
pulmonary edema
127
unstable TdP: cardiovert or defib?
unstable but +pulse: cardiovert
| only defib if pulseless
128
SCIWORA: risk factors, mechanism, location?
```
young age
flex/extension mechanism
#1 c spine
```
129
#1 cause of cardiogenic shock
MI
130
mean incubation period for COVID-19
4-5 days
131
secondary gain vs volitional
secondary gain means there is something other than resolution of the primary health concern at play. Can be malingering or non-volitional such as in conversion disorder, where what is to be gained is avoidance of psychological stressor
132
mech of action of nitroprusside
venous/arteriolar smooth muscle relaxation --> afterload reduction
133
BP goal in acute ischemic stroke prior to tPA
SBP <185 and DBP <110
134
mech of action of tetanospasmin
inhibits release of glycine (CNS inhibitor neurotransmiter) producing involuntary muscle contractions
135
strychnine poison mech of action
antagonizes glycine (CNS inhibitory neurotransitter) receptors, which produce involuntary muscle contractions
136
child with exercise related syncope
think long QT, HOCM!
137
turner syndrome is associated with what vascular pathology
aortic dissection
138
how does esophageal web present
poor PO tolerance after introduction of solid foods
139
neonate 1-2 days with feeding difficulties and excessive drooling (not infectious)
think TE fistula
140
electrolyte disturbances in rhabdo
hyperK, hyperphos, hypOcalcemia
141
treatment of PD-related peritonitis
intraperitoneal vanc or first gen cephalosporin
142
toxic substance with natural gas + rotten egg smell
hydrogen sulfide
143
severe hydrogen sulfide toxicity symptoms?
CN-like toxicity
| severe lactic acidosis, AKI, CNS, cardiac sx.
144
what to use against ESBL?
carbapenems
extended spectrum cephalosporin + betalactamase
ESBL has activity against beta lactams and aztreonam
145
sensitivity of NCHCT for SAH decreases with...
time, anemia, atypical presentation (isolated neck pain)
146
#1 cause of large bowel obstruction
CRC
147
oleander poisoning
rapid GI sx, hyperK, dysrhythia (like dig)
148
pt presents with significant hyperthermia in setting of sympathomimetic use. What medication should be avoided?
antipsychotics: lower seizure threshold (can worsen hyperthermia)
149
first line prevention for cluster headaches
verapamil
150
niacin (B3) deficiency
pellagra:
| photosensitive dermatitis, diarrhea, dementia
151
Westermark sign
decreased vascular markings (vascular cutoff sign)
| sign of PE
152
Hamman sign
crunching sound heard over the mediastinum in the presence of mediastinal air
153
most sensitive Xray for free air
lateral CXR
154
fever, RLQ abd pain, diarrhea, normal appendix
Yersinia enterocolitica (mimics appy)
155
steps to acid-base
1. acidosis vs alk
2. AG = Na - Cl - bicarb (>20 = primary AG acidosis)
3. EAG = AG + bicarb - 12 (>30 = metabolic alkalosis; <24 non-gap metabolic acidosis)
4. compensation? PaCO2 should = decimals of pH
156
When to suspect CN toxicity?
burn + AG acidosis + lactate > 8
| bradycardia, hypotension
157
best lab for epidural abscess
ESR
158
Maltese cross sign in urine
pathognomonic for nephrotic syndrome
159
UA with +blood but neg RBCs
myoglobinuria (think rhbado)
160
what dysrhythmia is associated with dig toxicity?
ANY, but make assoc with bidirectional VT and AF without RVR
161
preferred approach for knee arthrocentesis
anterolateral or superolateral
162
what voltage is high voltage?
~600 V (household 120 - 240 volts)
163
treatment for air embolism stroke
HBO
164
#1 complication of hyphema
elevated IOP
165
most common life-threatening arrhythmia immediately following a lightning injury
asystole
166
Test of choice for GIB if endoscopy neg
CTA
167
treatmet for acute chest
O2, fluids, abx, pain control
168
PIP and DIP nodes: RA or OA?
OA (absence of DIP points towards RA)
169
HR for admission in anorexia
<50 awake / <45 asleep
| +orthostatics (>20 bmp)
170
Temp for admit in anorexia
<35.56
171
BP for admit in anorexia
SBP<90
| +orthostatics (+10 mm Hg)
172
weight for admit in anorexia
<75% IBW or losing weight despite therapy
173
strongest indications for HBO
syncope, CO-Hb >25% (or >20% in pregnancy), severe acidosis pH < 7.10, evidence of end organ damage
174
direct vs indirect inguinal hernia
indirect = in scrotum
175
Hill-Sachs vs Bankart
```
Hill-Sachs = on humeral head
Bankart = on glenoid
```
176
how long does it take for molluscum contagiosum to resolve
months
177
clothes of sexual assault victims -> how to dispose?
paper bag and give to police
178
different drugs for thyroid storm
thionamide, iodine, BB, steroids
179
features of inflammatory back pain
subacute, nighttime pain, improvement with activity, no improvement with rest
180
staccato cough
chlamydia pnuemonia in children
181
#1 tendon injury in athletes
mallet finger
182
how to splint mallet finger
in slight hyperextension at DIP, FROM at PIP
183
congestion, facial pain --> fever, HA + lateral gaze palsy. Dx?
cavernous sinus thrombosis
184
#1 disease associated with anterior uveitis
ankylosing spondylitis
185
ratio of powdered baby formula to water
1 scoop to 2 ounces
186
how to tell difference between primary and secondary adrenal insufficiency
hyperK often seen in primary but never in secondary
187
what is a normal ABI
> 0.9
188
#1 assoc injury with knee disloc
popliteal artery
189
toxic dose of ibuprofen
100 mg/kg
190
what is rubella?
mostly abroad due to vaccination, caused by togavirus, causes mild illness with rash, can cause congenital rubella
191
congenital rubella
cataracts, hearing loss, blueberry muffin rash
192
rash assoc with non-congenital rubella
pinpoint, erythematous, blanching macules that spread cephalocaudal
generalizes within 24 h and lasts for 3 d
193
what respiratory fluoroquinolones do not have good Pseudomonas coverage?
moxi, levoflox
194
intussusception = what belly exam?
sausage shaped mass in RUQ
195
pyloric stenosis = what belly exam?
olive shaped mass in upper abdomen
196
which maneuver is better for nursemaids?
hyperpronation > flexion/supination
197
encapsulated organisms
```
SHiNE SKiS
Strep pneumo
H. influenza
Neisseria meningitis
E coli
Salmonella typhi
Klebsiella pneuoniae
Strep group B
```
198
#1 most common lung cancer
adenocarcinoma
199
lung cancers centrally located
small cell
| squamous cell
200
common contaminants in blood cultures
coag neg Staph, Bacillus, Propionibacterium
201
systemic JIA clinical
quotian (once daily) fever, arthritis, rash
202
why do nasal button batteries produce septal necrosis?
electrical current
203
most sensitive physical exam finding to exclude torsion
cremasteric reflex
204
dose of pediatric code epi
0.01 mg/kg 1:10,000
205
Parkland formula
4 cc * % BSA * kg in first 24 hrs
| 50% in first 8 hours, remainder over 16 hours
206
PPV/NPV vs LR+ / LR-
PPV/NPV are calculated based on disease prevalence and cannot be applied to populations outside the study population
LRs can be applied to pre-test probabilities to attain post test probabilities.
207
formula for LR+
sens / (1 - spec)
208
formula for LR-
(1 - sens) / spec
209
etanercept is what kind of medication
anti TNF (for AS, JIA, psoriasis, RA)
210
anti TNF produces what side effects
immune suppression
211
best way to prevent pediatric drowning
fence and latch (swim lessons not effective enough)
212
#1 most common cause of death after resuscitation from hypothermia
pulmonary edema
213
#1 cause of SBO in pregnancy
adhesions
214
time frame and mechanism of acute rejection in renal transplantation.
What cells involved?
within weeks of transplant.
CD8 mediated, type IV hypersensitivity
leukocyte infiltration to graft vessels impairing perfusion
215
Treatment of epididymitis
< 35 years OR high risk sexual behavior: CTX/doxy
| > 35 years: levofloxacin (2nd line Bactrim)
216
diagnostic test for suspected Boerhaave syndrome
contrast esophagram
217
Reed sternberg cells have what appearance and are associated with what dx?
owl's eye
| Hodgkin lymphoma
218
treatment for hypercalcemia of malignancy
fluids +/- bisphosphonates / calcitonin
219
bilateral pedicle fracture of C2 is what fracture, and what is the mechanism of the fracture?
hangman fx, extension
220
farm/animal + atypical pneumonia
Q fever (Coxiella burnetii)
221
features of atopic dermatitis for clinical dx
flexor involvement, onset prior to age 2, hx atopy, intense itching
222
treatment for Jefferson fracture
halo
| C1 burst fx, often football player or diver
223
phimosis vs paraphimosis
```
phimosis = foreskin cannot be retracted
paraphimosis = foreskin cannot be extended
```
phimosis in Greek means "muzzle"
224
typhoid fever clinical picture
travel, GI sx, rash, bradycardia relative to fever
225
What anatomic structure delineates internal from external hemorrhoids?
dentate line
226
treatment for hypothermic arrest
ECMO / CPB
227
#1 non-device related complication of LVAD pts
bleeding
228
what coagulation factors are NOT made in the liver?
factor VIII and vWF
229
how do you dose rhogam?
50 mcg for <12 weeks gestation
300 mcg for hemorrhage up to 30 cc's
Kleihauer-Betke test if >30 cc's is suspected (e.g. abruption at full term)
230
ddx of neonatal conjugated hyperbilirbinemia
sepsis, TORCH infection, biliary atresia, CF, inborn errors
231
#1 cause of neonatal seizures
HIE
232
DDx for narrow complex PEA
tension, tamponade, PE, hypovolemia, ischemia
233
risk factors for PRES
HTN, renal failure, immune suppression, autoimmune disorders, pregnancy
234
clinical dx of carpal tunnel syndrome
Tinel and Phalen are neither sensitive nor specific.
| Most sensitive is altered sensation at second finger pad
