Cardinal Signs 2

Question 1

Asthma vent settings

Answer 1

Low TV 6-8 ml/kg to prevent barotrauma. Low ventilatory rate to avoid breath stacking. Permissive hypercapnia. Low PEEP.

Question 2

COPD exacerbation treatment regimen

Answer 2

Supplemental o2 sats over 90. Duoneb. Solumedrol. Give ABx to all copd on test day; beta lactam plus macrolide

Question 3

HF/pulm edema nitro drip rate

Answer 3

10-20 ug/min, increase if needed

Question 4

Escalating meds for HF exacerbation

Answer 4

Lasix 40-80/bumex 2-4. Nitro. biPAP. Consider ACEI eg captopril 12.5-25 mg if severe HTN (synergistic benefit with nitro). Dobutamine. Last resort for cardio genic shock: intra-aortic balloon pump

Question 5

Pneumonia abx for aids

Answer 5

Bactrim

Question 6

Pna abx possible aspiration

Answer 6

Unasyn

Question 7

Pna influenza Tx

Answer 7

Oseltamivir if within 48 hrs

Question 8

Ludwig’s angina critical actions

Answer 8

call for cricothyroidotomy tray to be at bedside early, IV abx, ENT emergent consult, ICU admit

Question 9

Ludwig’s angina abx

Answer 9

unasyn or clindamycin

Question 10

Epiglottitis management decision algorithm

Answer 10

Unstable + suspicion = crich tray to bedside stat, stat consult ENT, to OR with anesthesia + ENT to control airway. Stable: lateral neck XR, consult ENT, abx. For boards, all will need definitive airway.

Question 11

Epiglottitis abx with peds dosing

Answer 11

ceftriaxone 50 mg/kg

Question 12

Abdominal pain + shock ddx

Answer 12

mesenteric ischemia, pancreatitis, AAA, ACS, dissection, GI hemorrhage, cholangitis, perforated viscus, MI

Question 13

Abd pain: consider these extras on exam

Answer 13

jaundice, rectal exam, pelvic and scrotal exam

Question 14

R/o SBP ascitic studies

Answer 14

WBC/cell counts, gram stain, culture, albumin, bilirubin, LDH.

Question 15

Peritoneal dialysis pt and concern for SBP - how to assess?

Answer 15

Send PD effluent for cell count, gram stain, and culture

Question 16

Pt has fever + ascites. Diagnosed with PNA. Do they need paracentesis?

Answer 16

Yes. still do it in pt with cirrhosis + ascites + fever.

Question 17

Paracentesis criteria for SBP with ascites? with PD pt?

Answer 17

> 500 WBC or >250 PMNs/cc.

PD effluent >100 WBC or >50 PMNs.

Question 18

Treatment for SBP including inpt/outpt, cirrhotic ascites vs PD

Answer 18

Non-PD: 3rd gen cephalosporin or quinolone (inpt), quinolone (outpt)
PD: vanco or 1st gen caphalosporin added to dialysis fluid until 7d after first neg effluent culture

Question 19

When to give abx with SBO

Answer 19

febrile or volvulus

Question 20

Bowel obstruction diagnosed on XR -> pt declines/unstable -> surgery demands CT -> ____

Answer 20

OR. No CT.

Question 21

Bowel obstruction. Zofran not working for nausea. Other options

Answer 21

NG. Compazine. (reglan being promotility could theoretically worsen things, though prob not)

Question 22

when to get rectal exam/FOBT besides obvious

Answer 22

working up for mesenteric ischemia (occult blood may be present early)

Question 23

Admitting service

Answer 23

Remember to admit directly to surgery on boards (medicine does not take all admits with surgical consult)

Question 24

Diverticulitis + systemic symptoms e.g. fever, critical actions

Answer 24

Consult surgery, fluids, ceftriaxone + flagyl, admit to surgical service

Question 25

Peritoneal abdomen –> critical actions

Answer 25

abx and call surgery

Question 26

Upper GI bleed meds

Answer 26

omeprazole bolus + gtt, octreotide bolus + gtt, blood, ffp if elevated INR, ceftriaxone if suspicious for varices

Question 27

lower GI bleed escalating approach to management

Answer 27

(Do a rectal exam!) fluids, blood, reverse anticoagulation, angiography to identify source if ongoing/severe with possibility of arterial embolization

Question 28

Suspected AAA order of operations

Answer 28

IVO2monitor, ABC, bedside US, surgical consult. If unstable, straight to OR (no definitive imaging!). If stable may have CT, but talk to surgery first.

Question 29

R/o epidural abscess order of management

Answer 29

Exam incl strength, sensation, and reflexes. Labs including BC, consult neurosurgery right away if BP + neuro deficit, abx (do not wait for imaging if suspicion is high), MRI with gadolinium (CT myelogram as a back up)

Question 30

Epidural abscess tx

Answer 30

Neurosurgery cons, cefepime and vanco, fluids, pain control. Steroids not indicated.

Question 31

When would you avoid lovenox?

Answer 31

renal impairment

Question 32

Normal synovial fluid findings. Synovial fluid diagnostic of septic joint

Answer 32

Normal: WBC <200, PMNs <25%
Septic: WBC >50,000, PMNs >50%, culture pos

Question 33

Interpret + ddx of this synovial fluid: WBC 200-50k, PMNs > 50%, negative culture

Answer 33

Inflammatory synovial fluid. Ddx gout, pseudogout, RA, lupus, Lyme disease

Question 34

Interpret + ddx of this synovial fluid: WBC 200-2,000, PMNs <25%, negative culture

Answer 34

Noninflammatory synovial fluid. Ddx osteoarthritis or trauma

Question 35

Joint too small/unable to tap but suspicious for septic joint –» _____

Answer 35

Use ESR, CRP , CBC to assess possibility

Question 36

Kanavel signs for flexor tenosynovitis (4)

Answer 36

held in slight flexion, sausage, tender along flexor sheath, pain with passive extension

Question 37

Management of flexor tenosynovitis

Answer 37

IV abx, surgical emergency - consult hand surgery, immobilize and elevate hand

Question 38

Concern for compartment syndrome; when to cut?

Answer 38

Fasciotomy if compartment pressure is within 20-30 mmHg of the diastolic pressure