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Oral boards > Basics > Flashcards

Basics Flashcards

1
Q

Hypotensive trauma patient- imaging

A

FAST, pelvis XR, CXR

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2
Q

INtubating trauma patient- what to do first

A

Discuss c spine, obtain quick GCS/neuro exam

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3
Q

Pregnant trauma patient- what to do

A

Position on left side

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4
Q

Question to ask patient up front

A

Is there anyone else here with you?

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5
Q

PINFAT

A 
Pain
IVF
N/v
Fever
Abx
Tetanus
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6
Q

Penicillin rash

A

Avoid any related drugs

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7
Q

Extra testing to perform on child

A

Fontanelle, tone, capillary refill

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8
Q

Trauma ABCDES

A

ABC
Disability- ask for four extremity pulses, address any cold extremities, etc
Exposure- expose the patient

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9
Q

Psych- what to always have in room

A

Guard

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10
Q

What to say about labs

A

I would like you to draw a rainbow of labs and i will let you know which ones I need after examining the patient

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11
Q

Reassessing vitals-

A

After the 1L of fluids is in, could you please let me know what the repeat vitals are?

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12
Q

What to do after splint

A

Post-splint neurovascular check

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13
Q

Nitroglycerin- what to ask

A

Ask about viagra, ED meds

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14
Q

Heparin- also do

A

CXR, rectal exam

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15
Q

Minimum child BP

A

70+ (age x2)

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16
Q

Neonate HR<100

A

BVM

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17
Q

Neonate HR<60

A

Chest compressions

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18
Q

When to intubated- ask if managing secretions and if they have what

A

Gag reflex

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19
Q

Concern for heart failure- what can you do to make sure no volume overload

A

Check for crackles on exam after giving 500cc

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20
Q

ETT size for child

A

(Age/4)+4

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21
Q

Newborn hypotension

A

SBP<60

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22
Q

Infant hypotension

A

SBP<70

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23
Q

When do you use a cuffed tube

A

Down to 1 year of age

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24
Q

Normal newborn heart rate range

A

80 to 200

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25
Q

3 mo to 2 year heart rate range

A

75 to 190

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26
Q

Heart rate for 2 to 10 years old

A

60 to 140

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27
Q

> 10 year heart rate

A

50 to 100

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28
Q

Blade to use at birth

A

Miller 0 to 1

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29
Q

Miller blade for infants/toddlers

A

1 to 2

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30
Q

Ketamine RSI dosing

A

1.5 to 2mg/kg

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31
Q

Etomidate RSI dosing

A

0.3 to 0.4mg/kg

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32
Q

Maintenance IVF rates for children

A

4ml/kg for first 10kg
2ml/kg for second 10kg
1ml/kg for each kg over 20

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33
Q

Parkland formula

A

Weight in kgx%TBSAx4ml= fluid in 24 hours

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34
Q

How to administer fluid in burns

A

1/2 in first 8 hours, second half in last 8 hours

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35
Q

Cancer patient with headache/fever- imaging to get

A

CT Head

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36
Q

Other person in room

A

Don’t forget to recognize them, ask if any questions

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37
Q

Kocher criteria for septic joint

A

Non-weight bearing
ESR>40
Fever
WBC>12K

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38
Q

Overweight young teen with hip pain- diagnosis

A

SCFE

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39
Q

Inflammation of the growth plate in teens with pain at hte tibial tuberosity

A

Osgood schlatter

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40
Q

Persistent crying differential

A 
Corneal abrasion
Hair tourniquet
UTI
Meningitis 
Abuse
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41
Q

Nondisplaced oblique distal tibial fracture from minor twist

A

Toddler’s fracture

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42
Q

Location of LP procedure

A

L3-L4 interspace

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43
Q

Normal intracranial pressure

A

10 to 20cm H20

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44
Q

Treatment of <1mo sepsis

A

Ampicillin 50mg/kg IV, gentamicin 2.5mg/kg IV +/- acyclovir

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45
Q

Altered mental status- always get

A

CT Head

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46
Q

Altered mental status labs to always add

A

UDS, Tylenol, aspirin, ETOH

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47
Q

Treatment of thyrotoxicosis

A

Dexamethasone
Propranolol
PTU
Oral potassium

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48
Q

Hyponatremia+focal signs/seizure

A

3% hypertonic saline 100cc over 10mins then 100cc over next hour

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49
Q

Management of hypoglycemia in neonate/infant<1

A

D10 at 5cc/kg

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50
Q

Management of hypoglycemia in child between 1 and 8

A

D25 at 2cc/kg

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51
Q

Management of hypoglycemia in kid>8

A

D50 at 1cc/kg

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52
Q

Maintenance dextrose for infants

A

10% dextrose at 6–8 mL/kg/hr IV

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53
Q

Crotaline

A

Pit vipers- rattlesnakes, water mocassin

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54
Q

Elapidae

A

Coral snakes

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55
Q

How do crotaline venom work

A

Damage the capillary endothelium and cell membranes resulting in a vascular breakdown and capillary leak

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56
Q

What is immediate effect of crotaline bites

A

Edema- so watch out for compartment syndrome and airway compression if bites to face

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57
Q

Treatment of pain in crotaline snake bite

A

Opioids or Tylenol given risk of bleeding

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58
Q

Dressing for crotaline snake bite

A

Compression dressing or splint

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59
Q

Monitoring of snake bite

A

Measure every 15-30 minutes

Asymptomatic should be monitored for minimum 8hrs, 12-24 if any tissue damage

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60
Q

Labs/work up for crotaline snake bite

A

complete blood count, coagulation factors including fibrinogen, type and screen, creatinine kinase, urinalysis, and comprehensive metabolic profile. An ECG is

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61
Q

When to give crofab

A

Moderate: progression of swelling beyond bite site, non-life threatening symptoms
Severe: shock, severe local envenomation, coagulopathies

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62
Q

How to administer crofab

A

initial control dose of 3-12 vials followed by scheduled re-dosing of 2 vials at 6, 12, and 18 hours.

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63
Q

How elapidae venom works

A

elapidae venom has no proteolytic activity and thus causes fewer local symptoms but does have a potent neurotoxic component

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64
Q

How long to observe elapidae bite victims

A

24 to 48 hours

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65
Q

Worst possible outcome of elapidae bite

A

Paralysis lasting 3-5 days-> respiratory failure

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66
Q

Dispo for elapidae bite victims

A

All should be admitted, even if asymptomatic for 24-48 hours due to risk of paralysis

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67
Q

Additional exam point in pediatric males that you should complete

A

Testicular exam, diaper exam

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68
Q

When is testicular salvage possible

A

After less than 12 hours of symptoms, but almost impossible after 24 hours

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69
Q

Additional testing that should occur for testicular torsion

A

Epididymitis, check UA/GC

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70
Q

Describe manual detorsion

A

Elevate affected testicle toward inguinal ring, rotate one and half rotations in a medial to lateral motion. relief of pain is indicator that procedure is complete

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71
Q

Elderly abdominal pain- also order

A

Troponin

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72
Q

Concern for peritonitis- what to start right away

A

Antibiotics

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73
Q

Backup imaging for free air if CT scan not available

A

Upright abdominal series and CXR

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74
Q

Treatment for pertussis

A

Azithromycin (also can do erithromycin)

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75
Q

What you should try before intubating

A

Airway maneuvers- chin thrust, oropharyngeal suctioning, pulling tongue forward

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76
Q

If animal passes out, what to think of

A

Carbon monoxide poisoning

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77
Q

Additional labs to order if concern for COHB

A

COHb, arterial blood gas

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78
Q

Definite indications for hyperbaric chamber in COHB poisoning

A

Abnormal neuro exam, altered mental status, coma, syncope, seizure. Relative- 4hours after 100% O2, pregnancy, persistent acidosis, concurrent thermal/chemical burns

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79
Q

What to remember during trauma intubations

A

C spine precuations

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80
Q

What to do if teeth are missing

A

CXR for missing teeth

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81
Q

What to ask during ABCs for trauma

A

4 extremity pulses

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82
Q

Absolute contraindications for cricothyrotomy

A

Tracheal transection, damage to larynx or cricoid cartilage

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83
Q

Technique for cric

A

Hyperextend neck
Identify cricothyroid membrane below thyroid cartilage and above cricoid cartilage (one finger breadth below laryngeal prominence)
Incise skin and cricothyroid membrane with single horizontal stabl-like incision.
Make 90 degree turn, place boogie into hole, pass tube above it

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84
Q

What to do before giving any medications

A

Ask if they have allergies

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85
Q

Labs to get during burn

A

Lactate, carboxyhemoglobin

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86
Q

Dose of atropine for bradycardia

A

0.5mg q5mins up to 3mg

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87
Q

What should you ask for immediately with symptomatic bradycardia

A

Ask to place pacer pads on patient

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88
Q

Things to order in bradycardia

A

CXR, TSH, EKG, =/- head CT, BNP, ?echo, rectal temperature

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89
Q

Management of myxedema coma

A

Passive rewarming, hydrocortisone 100mg IV, levothyroxine (T4) 100-500mcg, treat concurrent conditions, admit to MICU

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90
Q

Treatment of beta blocker overdose

A

3-5mg IV glucagon slow push, high dose insulin therapy 1unit/kg regular insulin IV push with IV dextrose bolus then 1unit/kg/hr with dextrose supplementation as needed, can consider use of CCL, lipid emulsion is last resort

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91
Q

treatment of ca blocker overdose

A

Calcium gluconate/chloride, high dose insulin therapy

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92
Q

How to distinguish CCB vs BB toxicity

A

CCB causes hyperglycemia, BB cause hypoglycemia/hyperkalemia

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93
Q

Technique for transcutaneous pacing

A

Place pads on the patient
Put defibrillator in pace mode
Set rhythm to 70
Start at minimum current and increase the current until capture is noted

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94
Q

Dose of epinephrine in severe asthma attack

A

0.4mg IM (0.01mg/kg in peds)

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95
Q

Management of severe asthma attack

A 
IV magnesium
Albuterol 
ipratroprium
Epinephrine/terbutaline
Steroids
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96
Q

Lab test to obtain in asthma attack

A

ABG

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97
Q

Additional history to consider obtaining

A

Sexual history, HIV, etc

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98
Q

SJS- additional exam and people to consut

A

Eye exam, consult ophthalmology.

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99
Q

Treatment of GBS

A

IVIG/plasmapharesis

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100
Q

Before intubating, if you have time, what should you do

A

Update family

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101
Q

Lower extremity weakness, additional things to order

A

LP, head CT

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102
Q

Ophthalmoplegia, ataxia, lower extremity weakness- diagnosis

A

Miller Fischer variant

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103
Q

Botulism weakness

A

Descending weakness iwth CN involvement generally first

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104
Q

Additional diagnosis to consider with LE weakness

A

Tick paralysis

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105
Q

symmetric limb weakness, greatly diminished or absent tendon reflexes, and minimal loss of sensation despite paresthesia

A

G

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106
Q

Additional things to do with LE weaknes

A

Sphincter tone, NIF, ask about bowel/bladder incontinence

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107
Q

Management after SBO diagnosis

A

NGT, consult surgery, NPO

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108
Q

Treatment of hypertension from cocaine use

A

IV phentolamine, cannot use beta blocker as would cause unchecked alpha surge

109
Q

Treatment of cocaine induced chest pain

A

IV benzoes, admit for cardiac monitoring/continued troponins.

110
Q

When to do LP in children >12mo

A

Focal seizure
Toxic and not playful in postictal
Follow up is a concern
Patient already receiving abx

111
Q

Seizing infant <6mos should always get

A

LP

112
Q

Work up for febrile seizure

A

Can get labs, UA

113
Q

Simple febrile seizure

A

Generalized tonic clinic <15 mins with return to neuro baseline

114
Q

Discharging someone- what should you do

A

Counsel regarding medications, call PCP

115
Q

Anaphylaxis treatment

A

Methylprednisone (1-2mg/kg) IV, Benadryl IV, epinephrine IM, fluids, famotidine, aluterol

116
Q

What to do at discharge for anaphylaxis

A

Steroids, Benadryl, famotidine for 3 days, epipen, counsel parents, call PCP/allergist

117
Q

Exam to do in woman with abdominal pain

A

Pelvic exam

118
Q

Does an abscess need antibiotics

A

Only if systemic symptoms

119
Q

What to remember in ectopic pregnancy

A

Rhogam for O-

120
Q

+beta hcg + no IUP=

A

Ectopic pregnancy until proven otherwise

121
Q

Lab work to assess in alcohol use disorder

A

UDS, Tylenol, alcohol, anion gap, osmolar gap

122
Q

Meds to give in alcohol use disorder

A

Thiamine, folate, MV

123
Q

Anion gap calculation

A

(NA+K)- (HCO3+CL)

124
Q

Treatment of AKA

A

D5NS until rehydrated then D5 1/2NS, give thiamine before dextrose fluids

125
Q

What electrolyte to monitor in AKA

A

Potassium- treatment can induce insulin production

126
Q

Definition DKA

A

Glu >250, ph<7.3, ketosis

127
Q

How to replete potassium in DKA

A

If K > 5.2 mEq/L, no repletement is necessary, and insulin can be started.
If K is 3.3-5.2 mEq/L, provide PO K (20 mEq) and peripheral IV at 10 mEq/hr while starting insulin.
If K < 3.3 mEq/L, hold insulin until > 3.3. Start PO and IV potassium.

128
Q

Fluid resuscitation in DKA

A

200ml/hr after blouses have been given

129
Q

MI in II, III, aVF

A

Inferior MI- get right sided leads

130
Q

Questions to ask about with diarrhea

A

Social history- travel, risk factors for immune compromise, antibiotic use

131
Q

What to send in a stool sample

A

Ova/parasites, fecal leukocytes, giardia antigen, c. Diff toxin, E. coli O157:H7 toxin assay

132
Q

Persistent diarrhea is most consistent with what type of pathogens

A

enteric bacterial or protozoal pathogens

133
Q

How long is subacute diarhrea

A

15-29 days

134
Q

Treatment for invasive bacterial diarrhea

A

Ciprofloxacin (500 mg orally twice daily) or levofloxacin (500 mg orally once daily) for 3-5 days (avoid in pregnant patient

135
Q

Treatment for diarrhea in children

A

Avoid antibiotics until stool cultures return

136
Q

What to remember to do when discharging a patient

A

Make sure to arrange follow up

137
Q

Petechia, altered mental status, microangiopathic hemoltytic anemia, thrombocytopenia, renal impairment, CNS impairment

A

TTP

138
Q

Concern for TTP- what to order

A

Peripheral smear

139
Q

Peripheral smear in TTP

A

Anemia, thrombocytopenia, schistocytes, helmet cells, fragmented RBC

140
Q

Treatment for TTP

A

Prednisone, PLEX

141
Q

Altered mental status- things to look for

A

Med list, history from bystanders, contact information in wallet, old chart, medic alert tag

142
Q

What to give with thiamine

A

Glucose

143
Q

Critical actions for ludwigs

A

Consult ENT, unasyn 3g (or Clindamycin), awake intubation to protect airway for ICU

144
Q

Steps for awake endotracheal intubation

A

Dry (Robinho), Topicalize (4% nebulized lidocaine at 5lpm), Sedate (ketamine in 20mg aliquots), Intubate using ETT. Have boogie at bedside

145
Q

Describe nasal intubation

A
  • phenylephrine/oxymetalazine spray
  • topical anesthesia with 2-4% viscous lidocaine
  • place a lubricated nasal airway to keep it open
  • choose nare that is most patent
  • lubricate ETT
146
Q

Describe thoracotomy

A

Patient’s undergoing thoracotomy should be intubated; however, this should not delay starting the procedure and can be performed by another member of the trauma team. On arrival bilateral chest tubes should be placed. Placement of a right sided chest tube enables clinicians to identify potential injuries in the right thorax. In order to expose the heart and lungs, a left anterolateral thoracotomy is performed regardless of site of penetrating trauma. The incision begins at the 4thor 5th intercostal space and extends from the posterior axillary line to the sternum. Retractors are inserted to expose the left thorax for evacuation of blood and clamping of vasculature to achieve hemostasis. The pericardium is then exposed by moving the left lung, and a pericardiotomy is performed through incision of the pericardial sac extending from apex to aortic root. The heart can then be exposed with evacuation of pericardial blood or clots and inspection for myocardial defects or lacerations. These injuries can be repaired with sutures or staples, and larger defects may be tamponaded off with a foley balloon. The aorta is then cross clamped and cardiac massage is initiated. Presence of hemothorax often makes it difficult to distinguish the aorta from the esophagus. To locate the aorta, the anterior aspect of the spinal column should be palpated and the parietal pleura overlying the aorta will then be located and can be digitally opened.1 Placement of a nasogastric tube or bougie into the esophagus can help distinguish the aorta from the esophagus through palpation.1,6If no etiology of hemodynamic collapse is identified, the incision can be extended to the right side of the chest for inspection of the right thorax and better visualization of the right atrium and ventricle. The most common injuries that can be intervened upon involve the right ventricle, due to its anterior location in the chest cavity. If return of spontaneous circulation is achieved, the patient should be transported to the operating room for definitive intervention.

147
Q

What should do if family member is there during private exam

A

Ask to leave both for exam and sensitive parts of the history

148
Q

Treatment of tubo-ovarian abscess

A
  • Cefotetan 2 g IV every 12 hours plus doxycycline 100 mg PO or IV every 12 hours OR
  • Cefoxitin 2 g IV every 6 hours plus doxycycline 100 mg PO or IV every 12 hours OR
  • Clindamycin 900 mg IV every 8 hours plus gentamicin loading dose IV/IM 2 mg/kg followed by maintenance dose of 1.5 mg/kg every 8 hours.
149
Q

Dispo for TOA

A

Admission for IV antibiotics

150
Q

Discharge intstructions for TOA

A
  • Recommendation of abstinence from sexual activity until 1 week after completion of treatment for both partners and/or until symptoms have resolved.
  • Strong encouragement of partner evaluation and treatment.
  • Education on use of barrier contraceptives and “safe sex” techniques.
  • Follow-up in 3 days in ED or with primary care physician/OBGYN.
151
Q

What to do at beginning of every trauma

A

Make sure C spine is protected

152
Q

Treatment of cerebral venous sinus thrombosis

A

Steroids (?), abx- vancomycin, Rocephin, flagyl

153
Q

Something to keep people in the room

A

I’m going to quickly assess for any collateral info- is EMs, family, or records here for me to evaluate?

154
Q

What to order in a paracentesis

A

Culture, cell count, glucose, gram stain, ?LDH, protein

155
Q

What to do after cardioversion

A

Repeat ECG to assess for sinus

156
Q

Diagnostic criteria for kawasakis

A
  1. Fever of at least five days duration
  2. 4/5 of following:
    - conjunctival injection
    - lips/oral mucosal findings
    - extremity findings (erythema of palms, etc)
    - polymorphous rash
    - cervical lymphadenopathy
157
Q

Test during cauda equina exam

A

Perianal sensation, straight leg raise signs, ankle reflexes

158
Q

Medication to give in cauda equina

A

Talk to neurosurgery about dexamethasone`

159
Q

Who to include during pediatric code

A

Social worker/clergy for family

160
Q

What to direct people to do in a code

A

Have someone keep time and monitor quality of compressions, nurse to draw meds, rotating people doing CPR

161
Q

How to monitor quality of CPR

A

Attach them to end tidal CO2 detector

162
Q

Describe intubating a child

A

Place a shoulder roll under their shoulders,

163
Q

Defib dose for children in cardiac arrest

A

2-4K/kg

164
Q

What to specify when giving adenosine

A

IV close to heart, followed by rapid flush

165
Q

Epi dosing in PALS

A

0.01 mg/kg (0.1 mL/kg of the 0.1 mg/mL concentration)- follow it with rapid NS push

166
Q

Hs/Ts

A 
Hypovolemia
Hypoxia
Hypothermia
Hypo/hyperkalemia
Hypovolemia
Hydrogen ion
Tension pneumo
Tamponade
Thrombosis, pulm
Thrombosis, cardiac
167
Q

Lidocaine dosing in PALS

A

1mg/kg loading dose

168
Q

most common cause of septic arthritis in the sexually active patient population

A

N. Gonorrhea- also obtain throat, vaginal swabs, etc

169
Q

Abx for septic joint

A

Vancomycin +/- rocephin (if there are gram negatives or no bacteria seen)

170
Q

Describe knee arthrocentesis

A
  1. Patient lies supine or knees bent at 10-20 degrees
  2. Superior- 1cm superior and 1cm either medial or lateral to the patella.
    Midpoint- 1cm medial or lateral to the midpoint of the patella.
  3. With an 18-20g needle, insert the needle through the region of tissue has been anesthetized. Regardless of the approach being taken, the directionality of the needle should be posterior to the patella while horizontal to the joint space. Proceed into the joint space and maintain negative pressure on the syringe while advancing until fluid is readily returning into the syringe
171
Q

Rash on palms/soles and spreading to trunk

A

RMSF

172
Q

Lab counts that suggest tickborne illness

A

high WBC count, hyponatremia, elevated LFTs

173
Q

Treatment of acute chest syndrome

A

Blood transfusion, exchange transfusion, antibiotics, consult hematology, admit to MICU

174
Q

Treatment of stroke in sickle cell disease

A

Exchange transfusion

175
Q

Describe kernig’s sign

A

Contraction of hamstrings in response to knee extension

176
Q

Describe brudzinski’s sign

A

Flexion of hips/knees in response to neck flexion

177
Q

Gram neg diplococci

A

Neisserria meningitidis

178
Q

Gram positive diplococci

A

Strep pneumo

179
Q

Gram neg rods

A

E. Coli

180
Q

Extra steps to do with meningococcemia

A

Contact close contacts- start rifampin BID

181
Q

When to admit someone with pericarditis

A

Pericardial effusion or myocarditis

182
Q

Imaging to do with pericarditis

A

Echo, CXR

183
Q

How to distinguish acute mountain illness from HACE

A

Neuro effects

184
Q

Treatment of HACE

A

Steroids, descent

185
Q

Most lethal form of altitude sickness

A

HAPE (Pulm edema)

186
Q

Lab level to check in digoxin toxicity

A

Potassium level (hyperkalemia increases mortality)

187
Q

Critical actions for digoxin toxicity

A 
EKG
Atropine/pacer pads
Digital
Treat hyperkalemia
CCu
188
Q

Side effect of digifab

A

Hypokalemia

189
Q

ECG finding of digoxin

A

Curved upstroke at end of ventricular depolarization, catch, AV block

190
Q

Empiric treatment for acute digoxin toxicity

A

10-20 vials

191
Q

Empiric treatment for chronic digoxin toxicity

A

3-6 vials

192
Q

Equations to calculate required number of vials

A

=(Dose mg x 0.8)/0.5

=(level ng/ml x weight kg)/100

193
Q

What to consider about heart disease in kids <1mo

A

Left sided lesion- always ducal dependent

194
Q

How to manage Ductal dependent lesions

A

Fluids in 5-10ccg/kg aliquots, PGE1, early abx

195
Q

Big four causes of neonatal cyanosis

A

Congenital Heart Disease
Sepsis
Respiratory disorders (i.e., pneumonia, ARDS)
Hemaglobinopathy (i.e., polycythemia, methemoglobinemia)

196
Q

How to perform hyperoxia test in baby

A

Apply 100% O2 for 5-10 mins and see if O2 improves. If so- probably a resp etiology

197
Q

Boot shaped heart on CXR

A

ToF

198
Q

Snowman on CXR

A

Total anomalous venous return

199
Q

Egg on string on CXR

A

Transposition of great arteries

200
Q

Cyanosis w/o resp distress- what to order

A

Methemoglobin

201
Q

What to use for pediatric intubation in CHD

A

Etomidate

202
Q

Treatment of INH seizure

A

Benzo, benzo, pyridoxine (1mg for every gram ingested, or 5G dose if unknown ingestion)

203
Q

Size kidney stone to consult urology for

A

> 6mm

204
Q

First line treatment for status epilepticu

A
  • Lorazepam IV: 4mg q4 minutes, may repeat once (*often underdosed in observational studies)
  • Midazolam IM: 10 mg IM once (*often underdosed in observational studies)
205
Q

Define status epilepticus

A

-seizure >5minutes or recurrent seizure without returns to baseline

206
Q

Side effect of phenytoin

A

Can cause cardiac effects because of Na channel blockade (fosphenytoin less likely to have this effect)

207
Q

Second line treatment for status epilepticus

A

-Levetiracetam 60 mg/kg IV, max 4500mg
-Fosphenytoin or Phenytoin 20 mg/kg IV, max 1500mg
avoid in toxicologic causes of seizure
-Valproate 40 mg/kg IV, max 3000mg
contraindicated in pregnancy

208
Q

when to intubate in seizure

A

If aspirating or apneic

2. If no response to first adequate dose of benzodiazepine

209
Q

Paralytic of choice for seizure

A

Succinylcholine if seizure<25 mins

210
Q

Abx treatmnet for fournier

A

Clindamycin+ vancomycin+ Zosyn

211
Q

Treatment for intussusception

A

Air contrast enema

212
Q

Labs to add on to PJP pneumonia

A

LDH, ABG

213
Q

Treatment for PJP pneumonia

A

Bactrim, prednisone

214
Q

When to give prednisone in PJP pnuemonia

A

PaO2<70, A-a gradient >35

215
Q

How to give prednisone in PJP pneumonia

A

PO regimens taper from 40 mg BID for 5 days to 40 mg daily for 5 days to 20 mg daily for 11 days

216
Q

Most common intracranial infection in HIV

A

Cryptococcus

217
Q

Treatment for cryptocococcal meningitis

A

IV amphotericin B and flucytosine, followed by prolonged oral therapy with fluconazole. (Get LP pressure)

218
Q

Differential for AMS in HIV/AIDS

A

toxoplasmosis, EBV-related lymphoma, tuberculosis, and progressive multifocal leukoencephalopathy caused by the JC virus

219
Q

At what levels can neurogenic shock occur

A

Above T6

220
Q

Lesions above what level can cause diaphragm paralyisis

A

L5

221
Q

Nexus Cspine criteria

A 
No midline tenderness
No pain with neck movement
No distracting injury
No neuro deficit
No alcohol or drugs
No altered mental status
222
Q

Fracture of C2

A

Hangman’s fracture

223
Q

Vertical force transmitted from skull to occipital condyles

A

Jefferson fracture

224
Q

Patients that should be admitted to the hospital for pyelo

A

Unstable vital signs, e.g. persistent tachycardia, hypotension, tachypnea, or signs of septic shock
Resistance to oral antibiotics or complicated antibiogram with history of repeat infections
Inability to take oral medications regardless of medical interventions
Refractory pain
Psychosocial issues hindering self-care
Pregnancy
Immunocompromised state
Infected transplanted graft
Repeat presentation to the emergency department with worsening condition
Imaging demonstrating obstructing urolithiasis, abscess, cyst, or abnormal genitourinary tract anatomy

225
Q

Diarrhea in kids plus microangiopathic hemolytic anemia (MAHA), thrombocytopenia, and acute kidney injury (AKI)

A

HUS

226
Q

Compare TTP vs HUS

A

TTP has more neuro symptoms, HUS more AKI

227
Q

Disposition for HUS

A

Talk with ICU/nephro, admit to ICU

228
Q

How much Tylenol is concerning for overdose

A

140mg/kg or >7.5G per day

229
Q

Treatment for mobitz 1 (wenkebach)

A

Usually nothing, but if symptomatic, can use atropine

230
Q

Second degree block- what to consider

A

RCA occlusion because 90% of AV nodes are supplied by RCA

231
Q

Treatment for mobitz 2

A

Pacing

232
Q

How to distinguish mobitz 1 and 2

A

Mobitz 1 will respond to atropine, mobitz 2 will not and will typically have a wide QRS due to below AV node

233
Q

Coved ST in V1-V2

A

Brugada

234
Q

Management of asymptomatic brugada

A

Aggressively treat fever, close f/u with cardiology/EP

235
Q

Management of symptomatic brugada

A

Admit for ICD

236
Q

CCB treatment for SVT

A

Diltiazem 2.5 mg/min, until termination of AVNRT or total dose of 50 mg

237
Q

Ddx for narrow complex regular tachycardi

A

ST, SVT, atrial flutter

238
Q

Ddx for narrow complex irregular tachycardia

A

Afib, atrial flutter with variable conduction, MAT

239
Q

Additional blood work to obtain in hypothermia

A

DIC work up- coags, fibrinogen, LDH

240
Q

When to terminate resuscitation in hypothermia

A

> 32C and K>12

241
Q

Active rewarming measures

A

ECMO

Thoracic lovage

242
Q

Active rewarming should continue until a core temperature of what is achieved

A

32C

243
Q

What else should be worked up in hyperthermia

A

investigated for rhabdomyolysis, AKI, liver failure and concomitant infection

244
Q

Disposition for hyperthermia

A

ICU, at risk for rebound

245
Q

Goal for treating hyperthermia

A

Patients should be rapidly cooled (< 30 min) to a target temperature of 38.3oC (101oF)

246
Q

Antiplatelet before PCI

A

Ticagrelor 180mg, UFH

247
Q

Sources of fever in nursing home patients

A

Pneumonia, UTI, cellulitis, decubitus ulcer

248
Q

Cooling in hypothermia should be done until what temp

A

40c

249
Q

What to set synchronized cardio version at for vtach

A

100-200J

250
Q

Medical management of VTach

A

Give amiodarone 150mg IV over 10minutes
Give Lidocaine 1-1.5mg/kg IV over 2-3 minutes
Give Procainamide up to a max dose of 10-20mg/kg IV

251
Q

Goals of treatment in TCA overdose

A

bicarb drip until QRS duration <100, vitals stable, Na ~150, pH ~7.55. Watch for hypokalemia and hypocalcemia with bicarb drip. Consider hypertonic saline (3%) if refractory or if serum pH>7.55.

252
Q

Ketamine procedural sedation pediatric dose

A

1-2mg/kg

253
Q

Propofol prcoedural sedation dose

A

0.5-1mg/kg IV over 3-5 mins, repeat 0.5 mg/kg q3-5 min PRN

254
Q

Ketofol procedural sedation dose

A

0.5mg/kg of both

255
Q

Ddx for bloody neonate stool

A

NEC, malrotation with volvulus, hirshcsurping disease, systemic coagulopathy

256
Q

Treatment for SBP

A

Rocephin daily

Albumin if Cr >1.1, BUN>30, Tbili>4

257
Q

When gastric lavage may be indicated

A

Colchicine toxicity

258
Q

When to treat diarrhea with antibiotics

A

If patient has bloody diarrhea (after first ruling out e coli O157:H7), severe symptoms (fever, >6 episodes per day), dehydration, or foreign travel, empiric antibiotic treatment may be warranted.

259
Q

Dose of pyriidoxone to give in seizure

A

5G, otherwise 1:1 ratio with isoniazid consumed

260
Q

Negatively bifirigent crystals

A

Gout

261
Q

Positively bifirgent crystals

A

Pseudogout

262
Q

Reversal for novel AC

A

4 factor PCC, kcentra

263
Q

Pediatric morphine dose

A

0.05-0.1mg/kg

264
Q

Concern for RPA, wHat should you do first?

A

Prepare airway equipment

265
Q

Dose of dexamethasone in children

A

0.6mg/kg

266
Q

Management of croup in children

A
  • 0.6mg/kg dexamethasone- should work in 2 hours

- racemic epi q2h x3- doesn’t work- ICU and ent consult for other cause

267
Q

Assessment of inborn error of metabolism

A

Ammonia

268
Q

ETT for 1-2 yo

A

3.5

269
Q

ETT for <1

A

3.0

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