ABEM Flash cards
Ehrlichiosis - organism and transmission?
Ehrlichia (gram neg, intracellular), lone star tick (Amblyomma)
Babesiosis - organism and transmission
protozoan parasite, Ixodes tick
tick borne relapsing fever - organism and transmission
spirochete Borrelia hermsii, Ornithodoros tick
tick borne relapsing fever - clinical syndrome
fever, HA, myalgias, arthralgias, jaundice x3-6 days; then afebrile, x several cycles.
colorado tick fever - organism and transmission?
RNA virus, wood tick Dermacentor
class I hemorrhage: EBL and VS?
<750 cc’s. normal HR/BP, normal to elevated pulse pressure
class II hemorrhage: EBL and VS?
750-1500 cc’s. HR 100-120, BP normal, decreased pulse pressure
class III hemorrhage: EBL and VS?
> 1500 c’s. elevated HR, low BP, decreased pulse pressure
MR murmur
apex, systolic murmur, radiates to axilla
most common traumatic valvular injury
aortic valve
diastolic murmurs
AR, MS, pulmonary regurg, PDA (continuous)
systolic murmurs
AS, MR/TR, VSD, MVP, PDA (continuous)
XR for toxic megacolon
dilated colon to 6 cm, loss of haustra, thumbprinting
black widow spider bite symptoms
mostly local (including diaphoresis near site), occasional systemic. Caused by release of ACh and NE.
bark scorpion (Centruroides) envenomation symptoms
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)
GIB after aortic aneurysm repair = what diagnosis
aortoenteric fistula
When is a patient’s risk for future stroke highest following a transient ischemic attack?
first 2 days
Montaggia
prox ulnar fx and prox radial (head) dislocation
smallpox vs chicken pox
smallpox = all the same age. chickenpox = lesions of varying ages
indication, and absolute contraindication to physostigmine
anticholinergic syndrome. C/I if QRS >100 or if Na channel blockade
dry socket syndrome and treatment
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)
Best test for giardia
stool antigen test
cyproheptadine is the treatment for?
serotonin syndrome
antibiotics assoc with non convulsive status
PCNs
odynophagia in HIV patient: organisms?
Candida or CMV
cancer and lethargy/AMS
Hypercalcemia
recurrent food impactions and GERD despite PPI/antacids
eosinophilic esophagitis (can develop strictures)
superficial vs partial thickness burns?
superficial is painful, red, and blanching.
partial is non-blanching, bright red, and may have blisters
how to treat amenorrhea 2/2 anorexia nervosa
weight gain - no OCPs!
red flag back symptoms
fever, weakness, weight loss/night sweats, hx of cancer, bowel/bladder, trauma
treatment for mild impetigo
Mupirocin ointment (or retapamulin)
predominant electrolyte abnormality in anorexia? treatment?
hypophos. treat promptly (PO vs IV depending on severity) to help prevent refeeding syndrome
Korsakoff syndrome
apathy, confabulation, anterograde and retrograde amnesia
abdominal pain, palpable purpura
HSP
diseases associated with HSP
meckel’s, lymphoma, celiac, IBD
treatment for contact lens related corneal abrasions
topical anti-pseudomonal (cipro, oflox, tobramycin)
diffuse vesicular lesions in various stages of development
varicella
hard signs of vascular neck injuries
pulsatile bleeds, expanding hematoma, thrills/bruits, neurologic deficits, shock
sx of scombroid poisoning
flushing, GI sx, conj injection 30 mins after eating. Fish may be peppery, bitter, metallic
sx of ciguatera poisoning
GI + neuro sx (GI precedes neuro sx). pathognomonic sx = cold allodynia and worsening/recurrence with alcohol.
3 topical cycloplegic drugs
cyclopentolate, scopolamine, homatropine
first line treatment for obstruction + coffee bean sign on abd XR
dx: sigmoid volvulus. first line tx = sigmoidoscopy (if no gangrene)
1 risk factor for IPV homocide
access to firearms
LVH
R (aVL) > 11 mm
S V1 + R V5/V6 > 35 mm
S deep + S V4 > 23 mm in M / 28 mm in F
dose of recomb factor VIII in life-threatening bleeds
50 units/kg (replaces 100% of factor levels)
chads2vasc: what ages give you points?
65-74 = 1 point. >75 = 2 points
chads2vasc: what sex give you points
female = 1, male = 0
chads2vasc: what conditions give you points
HTN, DM, stroke/TIA/VTE, vascular disease (MI, PAD, aortic plaque), CHF
xray findings suggestive of SBO
bowel dilation >3 cm, prominent plicae circulares, and multiple air-fluid levels.
first line abx for mastitis
keflex, dicloxacillin (against MSSA). If MRSA suspected, give Bactirim.
acute lung abscess: most likely organism?
oral anaerobes
what age for femur IO?
<1 year
Ehrlichiosis - clinical syndrome?
constitutional sx + hematologic abnormalities (thrombocytopenia/leukopenia). Usually no rash!
drugs that trigger gout
ASA, cyclosporine, diuretics
ketosis/ketonuria with normal AG = ?
isopropyl alcohol
electrolyte disturbances in tumor lysis
hyperuricemia, hyperK, hyperphosphatemia, hypoCa
Fluorescein pattern for UV keratitis
Multiple punctate erosions
hard signs of vascular injury
pulsatile bleed, diminished distal pulse, expanding hematoma, thrill/bruit
MOA of isoproterenol
beta-1 and beta-2 agonist (Increased heart rate. Increased heart contractility. Relaxation of bronchial, gastrointestinal, and uterine smooth muscle.)
normal CSF WBC, glucose, protein
WBC <5, glucose 60% of serum, <200 mg/dL
1 inherited bleeding disorder
vWD
1 inherited clotting (hypercoagulable) disorder
factor V leiden
EKG findings to look for in syncope
block, WPW, long QT, Brugada, HOCM, AVRD
pityriasis rosea description and treatment
herald patch followed by many scaly red plaques/patches. ?reactivation of HHV6/7, treat pruritis
distinguishing factors between bullous pemphigoid and pemphigus vulgaris
BP slightly older (>65), less mucosal involvement, neg Nikolsky.
PV involves mucosae and has +Nikolsky
neuro sx that worsen with fever, hot bath, warm environment
Uhthoff sign - think MS
1 organism causing osteomyelitis assoc with puncture wounds
Pseudomonas
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
SIRS criteria
HR >90
RR >20
WBC >12, <4, or >10% bands
Temp >38 or <36
difference between labyrinthitis and vestibular neuritis
no tinnitus or hearing loss in vestibular neuritis
definition of delta pressure for acute compartment syndrome. What delta is concerning?
diastolic BP - compartment pressure. <30 is concerning!
CSF findings in MS
oligoclonal bands
what kind of bundle/fascicular blocks are an indication for pacemaker placement following acute anterior MI?
RBBB + LAFB (has potential to progress to CHB)
PT/INR measures what clotting factors?
I, II, V, VII, X
age for walking? (developmental milestones)
~13 months
when to suspect NAT in spiral fracture of tibia
less than walking age, fx is proximal rather than distal
opiates that require renal dosing
morphine, tramadol, codeine, meperidine
reversal agent for Xa inhibitors
andexanet alfa, 4 factor PCC
DDx for wide QRS
hyperK, Na channel blockade, BBB, PM, WPW, ventricular beats, nonspecific IVCD
Marcus Gunn vs Argyl Robertson pupil
Marcus Gunn = APD (think optic neuritis/MS)
Argyl Robertson = non reactive but accommodates (think neurosyphilis)
antibiotics which can trigger myasthenic crisis
fluoroquinolones, macrolides, aminoglycosides
what kind of parasite is Strongyloides stercoralis?
nematode (roundworm)
site of infection of Strongyloides stercoralis?
small intestine. Larvae migrate through skin
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)
who gets tetanus IVIG as prophylaxis?
<3 vaccines + complicated wound.
complicated wound = contaminated (dirt/feces/saliva), crush, burn, frostbite, puncture, missile
number 1 cause of arterial embolism?
AFib
What level is sensation over medial malleolus?
L4 nerve root
Weakness of great toe extension localizes to what nerve root?
L5
Bilateral subconjunctival hemorrhage in infants
raises concern for NAT
Facial swelling, cough, sob, HA
SVC syndrome
Earliest sign of HACE?
Ataxia (this is also the most specific finding)
Mainstay if PTSD pharmacotherapy
SSRI
Adjunct pharmacotherapy for specific sx of PTSD?
Prazosin for nightmares;
propranolol for anxiety/sympathetic activation symptoms