ABEM Recert Exam pt. 6 Flashcards
1
Q
What nerve injury can a perilunate dislocation cause?
A
Median nerve compression
2
Q
Tick paralysis: si/sx
A
Ascending paralysis like GBS
First step in rx is to remove tick
3
Q
Tick paralysis: rx
A
Remove tick
4
Q
When should emergency contraception be initiated?
A
Within 72h
5
Q
Central retinal artery occlusion: rx
A
Digital massage of orbit
Acetazolamide
6
Q
Maximal dose for lidocaine without epi
A
7 mg/kg
7
Q
Maximal dose with lidocaine with epi
A
5 mg/kg
8
Q
Source of bleeding in anterior epistaxis
A
Kiesselbach’s plexus
9
Q
Toxic Shock Syndrome: What are most cases associated with?
A
Menstruation (but don’t have to leave tampon in for longer than normal)
10
Q
Toxic Shock Syndrome: Skin findings
A
Blanching macular rash
11
Q
Toxic Shock Syndrome: Bacteria causing
A
Staph aureus
12
Q
Most specific test for pediatric UTIs
A
Nitrite on urine dip test strips
13
Q
Bacerial tracheitis: MCC
A
Staph aureus
14
Q
Central retinal artery occlusion: Fundoscopic finidngs
A
Cherry red spots
15
Q
Central retinal vein occlusion: Fundoscopic findings
A
Blood and thunder
16
Q
Central retinal vein occlusion: rx
A
ASA & ophtho consult
17
Q
Pertussis: Best lab dx test for
A
PCR
18
Q
Meckel’s diverticulum: What’s the best test to use to dx?
A
Technetium-99 RBC scan (tagged RBC bleeding scan)
19
Q
Resuscitation dose of epi in kids
A
0.01 mg/kg
20
Q
Pediatric cardioversion energy dose
A
0.5 - 1 J/kg
21
Q
How to position patient with pulmonary contusion and hypoventilation/hypoxygenation?
A
Good lung down
22
Q
Where are most clavicle fractures?
A
Lateral 1/3
23
Q
Cause of most clavicle fractures?
A
Direct force to lateral shoulder
Causes fx to lateral 1/3 of clavicle, which is most common area of clavicle fractures
24
Q
Parkland formula for fluids in burn resuscitation
A
4 mL/kg per % BSA total in 24 hours
Give initial 50% in 1st 8h, then rest over next 16h
25
Pediatric adenosine dose
1st dose: 0.1 mg/kg IV/IO
| 2nd dose: 0.2 mg/kg IV/IO
26
Pediatric atropine dose
0.02 mg/kg IV/IO (minimum dose 0.1 mg)
27
Pediatric amiodarone dose
5 mg/kg IV/IO
28
Pediatric calcium chloride dose
20 mg/kg IV/IO
29
Pediatric epinephrine dose
0.01 mg/kg (1:10,000) or 0.1 mg/kg (1:1,000)
30
Pediatric glucose dose
1-2 mL/kg D50
2-4 mL/kg D25 (children)
5-10 mL/kg D10 (neonates)
31
Pediatric lidocaine dose
1 mg/kg
32
Pediatric magnesium sulfate dose
25-50 mg/kg bolus (max dose 2 gm)
33
Pediatric sodium bicarb dose
1 mEq/kg
34
Entamoeba histolytica infection: si/sx
fever
RUQ pain
Possible liver abscess
Rx is metronidazole
35
Most common primary headache
Tension
36
Endocarditis prophylaxis: When is it required
Previous endocarditis
Prosthetic heart valves
Unrepaired congenital cyanotic heart disease (but don't have to if repaired)
37
Endocarditis prophylaxis: What to use
Amoxicillin 2gm (kids 50 mg/kg) PO 1h before
If can't use amoxicillin:
Clindamycin, Azithomycin or Clarithromycin
38
Endophthalmitis: definition
Infection of deep structures of eye
39
Endophthalmitis: si/sx
Chemosis
Decreased visual acquity
Hazy opaque appearance of anterior and posterior chambers on slit lamp exam
40
ACA stroke: si/sx
Affects frontal lobe function
C/L sensorimotor deficits, leg > arm
41
MCA stroke: si/sx
C/L sensorimotor deficits, arm & face > leg
Aphasias
Gaze preference towards affected hemisphere
42
Posterior circulation stroke: si/sx
```
Crossed deficits (motor on one side, sensory on the other)
Cerebellar deficits
CN deficits
```
43
Central cord syndrome: si/sx
Upper extremity weakness > lower extremity weakness
44
Anterior cord syndrome: si/sx
Loss of pinprick and temperature below level of lesion
45
Brown-Sequard syndrome: si/sx
I/L motor & 2pv loss with C/L pinprick and temperature sensation
46
CNS Toxoplasmosis: rx
Pyrimethamine & sulfadiazine
47
What is first si/sx of flexor tenosynovitis?
Pain on passive extension of finger
48
Monoarticular septic arthritis: most common pathogen
S aureus
49
Felon: Rx
Single lateral incision on ulnar aspect of digits 2-4, radial aspect of digits 1, 5
50
Most common extraarticular manifestation of anklylosing spondylitis
Uveitis
51
Dacrocystitis: Definition
Inflammation of nasolacrimal duct
| Causes swollen & teary eyes
52
Formula to calculate how much factor to administer in hemophilia
wt(kg) x 0.5 x desired percentage change in factor
Assume starting at 0 activity
Need to get to 30-50% for hemarthrosis
Need to get to 100% for CNS & GI issues
53
How to phlebotomize for polycythemia?
Slowly, 1-1.5L over 24h
| Also rx with ASA 81 mg daily
54
What are platelets like in vWd?
Normal levels of, but they don't work as well
55
What are the 2 most serious opportunistic infections in HIV & when do they occur?
CMV retinitis; MAC
| Don't occur until CD4
56
What is most common clinical manifestation of rheumatic fever?
Migratory polyarthritis
57
Kawasaki's dz: What is definitive rx and what are other rxs
IVIG is definitive (can cause hypotension)
| High-dose ASA also used
58
What does HBsAg mean?
Surface antigen (caused by virus envelope)
59
What does anti-HBs mean?
Antibody that develops against HBsAg
60
What does HBcAg mean?
Core of Hepatitis B virus
61
What does HBeAg mean?
Indicates active Hep B infection; thought to be the degredation of HBcAg
62
What Hep B serology do you see in someone who's been vaccinated but not exposed?
anti-HBs but no HBcAg (patient has developed anti-HBs to the vaccine envelope but has never actually been exposed to core of virus
63
Histoplasmosis: Where is it seen? What does it cause?
Fungal infection seen in Ohio & Mississippi river valleys
Causes erythema nodosum
64
What findings do you see with malaria?
Inc LFTs, hepatomegally, anemia
65
What must BP be below to use tPa?
185/110
66
Myoclonic atonic sz: What do you see?
Sudden jerk forward, often loss of postural tone and fall forward
Usually in children
67
What is the first u/s sign of pregnancy?
Gestational sac
68
At what point in gestation do you no longer need to give steroids or tocolytics for preterm labor
After 34 weeks
69
Naltrexone: Use and mechanism
mu-receptor antagonist
| Used to reduce alcohol cravings and decreases alcohol-induced euphoria
70
What is goal UOP in rhbdomyolysis?
3 ml/kg/hr
71
What is initial rx for post-strep glomerulonephritis?
HCTZ
72
What lab values are seen with HUS?
Anemia, Increased creatinine (renal failure), thrombocytopenia
73
How to tell if pleural effusion is exudate or transudate?
exudate = pleural fluid protein / serum protein > 0.5
74
How to rx post viral pneumonia with abscess?
CAP coverage (most are s auerus) and Vanco
75
gamma-hydroxybutyric acid (GHB) OD: si/sx
Agitation, then coma, then full return to consciousness
76
Bleach ingestion: disposition
d/c home without observation (it's benign)
77
When to surgically repair patella fx?
If extensor mechanism is disrupted (e.g. can't fully extend knee)
78
Radial head fx: Rx
Splinting or arm sling followed by early ROM
79
Most common skull bone fractured in kids
Parietal
80
Rx for adult and pediatric tooth avulsions
Reimplant permanent adult, don't reimplant kids primary
81
Cause of foot puncture wound osteomyelitis
pseudomonas
82
Can you trephinate subungual hematoma over an underlying fx?
Yes
| Blood remains fluid/liquid for up to 36h
83
Nerve injury often seen with Motegia fx
Radial nerve injury
84
Erysipelas: Definition & cause
Rapidly advancing superficial skin infection from GASen
Usually, but not always, seen on LE
Also has burning sensation and is bright red & shinny
85
Erysipelas: How to diff from regular cellulitis?
Erysipelas has elevated advancing margin of infection
86
What is first rx is hypercalcemia?
NS (patients are usually volume depleted)
87
What is most specific lab test for alcoholic ketoacidosis?
Increased beta-hydroybutyrate
88
What does Vit A OD cause?
intracranial HTN, hepatotoxicity, hypercalcemia
89
What does Vit A deficiency cause?
Night blindness
90
What does B1 (thiamine) deficiency cause?
Wernicke-Korsakoff syndrome
91
What does B3 (niacin) deficiency cause?
Pellagra (Diarrhea, Dementia, Dermatitis)
92
What does B3 (niacin) excess cause?
Flushing
93
What does B6 (pyridoxine) excess cause?
Peripheral neuropathies
94
What dose Vit C deficiency cause?
Scurvy (bleeding gums, poor wound healing)
95
What does Vit D excess cause?
Hypercalcemia
96
What electrolyte abnormality can cause adynamic small bowel ileus?
Hypokalemia
97
What are phases of acute radiation syndrome?
1. Prodromal phase: self-limiting autonomic stuff like n/v
2. Latent phase: period of no smptoms
3. Manifest illness: depends on severity of exposure
4. Recovery or death
98
What happens during manifest illness phase of acute radiation syndrome?
1st: Hematopoietic: decrease in lymphocytes, then pancytopenia. Absolute lymphocyte count at 48h is best progrostic indicator
2nd: GI: N/V/D
3rd: CNS
Extent of progression depends of amount of radiation exposed to. Never had CNS without hematopoietic and GI first
99
What happens in cold water immersion syndrome?
Cardiac dysrhytmias upon sudden contact with water much colder than core temperature
100
Pathophysiology of decompression sickness
Formation of nitrogen gas bubbles during ascent
101
Decompression sickness type I
More common
| Skin, lymphatic and musculoskeletal system involvement
102
Decompression sickness type II
Less common
| CNS, inner ear and lungs
103
What do you see with arterial gas embolism?
Diver who surface unconscious or looses consciouness within 10 minutes of sufracing
104
Chalazion: Def & Rx
Tender red nodule under eyelid
Due to blockage of Meibomian gland
Rx with warm compresses
105
Sty (hordeolum): Def & Rx
Pustule secondary to S aureus
Seen on outside of eyelid
Rx with warm compresses, but often also requires topical abs
