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A2 > Case files EM 2 > Flashcards

Case files EM 2 Flashcards

1
Q

What is the first lab to draw in any patient with AMS?

A

Blood glucose

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2
Q

What is the definition of stupor?

A

Level of decreased responsiveness where an individual requires aggressive or unpleasant stimulation

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3
Q

What is the defintion of obtunded?

A

Level of diminished arousal or awareness frequently from extraneous causes (infection, intoxication, metabolic states)

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4
Q

Compare delirium vs dementia in terms of: onset

A 
Delirium = abrupt
Dementia = progressive
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5
Q

Compare delirium vs dementia in terms of: timing of disorientation

A 
Delirium = early
Dementia = late
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6
Q

Compare delirium vs dementia in terms of: variability in mental status

A 
Delirium = very variable
Dementia = stable
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7
Q

Compare delirium vs dementia in terms of: level of consciousness

A 
Delirium = AMS
Dementia = Normal
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8
Q

Compare delirium vs dementia in terms of: attention span

A 
Delirium = short attention span
Dementia = reduced slightly
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9
Q

What are the four levels of eye opening in the glasgow coma scale?

A 
4 = spontaneous eye opening
3 = opens to verbal commands
2 = opens to painful stimuli
1 = no response
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10
Q

What are the five levels of verbal response in the glasgow coma scale?

A 
5 = oriented
4 = disoriented
3 = inappropriate words
2= incomprehensible sounds
1 = no response
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11
Q

What are the six levels of motor response in the glasgow coma scale?

A 
6 = obeys commands
5 = localizes to pain
4 = withdraws to pain
3 = abnormal flexion
2 = abnormal extension
1 = no response
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12
Q

What is the treatment for AMS caused by hyponatremia?

A

3% NS

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13
Q

What is the treatment for AMS caused by hypernatremia?

A

Rehydrate

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14
Q

What is the treatment for AMS caused by hypo and hypercalcemia respectively?

A 
Hypo = Ca replacement
Hyper = IVFs
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15
Q

What pharmacologic therapy can help reduce brain swelling 2/2 tumor or edema?

A

Steroids

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16
Q

What is the classic history of transient synovitis?

A

recent URI, with resultant arthralgias of a joint

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17
Q

What is the most common organism that causes septic arthritis?

A

Staph aureus

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18
Q

What is a slipped capital femoral epiphysis (SCFE)? What are the classic s/sx (3)? Treatment?

A

Fracture through the growth plate, resulting in slippage of the overlying end of the femur.

  • Groin pain
  • painful passive ROM of the hip
  • waddling gait

Ortho pinning

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19
Q

What is Legg-calve-perthes disease?

A

Childhood hip disorder resulting from idiopathic disruption of the blood supply to the femoral head, resulting in osteonecrosis

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20
Q

True or false: pts with septic arthritis almost always have a fever

A

False–many do not

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21
Q

What is the role of US in the workup of septic arthritis?

A

If no effusion is seen, very unlikely to be septic arthritis

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22
Q

What is the treatment for legg-calve-perthes disease?

A

keep femoral head within the acetabulum to allow healing to occur (bace. cast)

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23
Q

What is a Toddler’s fracture?

A

Nondisplaced fracture of the distal tibial shaft that occurs when a toddler is learning to walk

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24
Q

What is Osgood-schlatter syndrome?

A

an inflammation of the patellar ligament at the tibial tuberosity, resulting in fragmentation of the tibial tubercle. Usually the result of stress fracture.

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25
Q

Who is usually affected with a SCFE? What is their classic gait?

A

Obese children

Trendelenburg gait

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26
Q

What is the definition for a simple febrile seizure (age, presentation, s/sx)?

A

The definition for a simple febrile seizure is very specific: age between 6 months and 60 months, generalized tonic-clonic convulsions, spontaneous cessation of convulsion within 15 minutes, return to alert mental status after convulsion, documentation of fever (< 38.0 ° C), one convulsion with a 24-hour period, and absence of neurologic abnormality on examination.

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27
Q

True or false: simple febrile seizures require no further work up, just observation for a short period of time

A

True, if truly a simple febrile seizure

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28
Q

For AOM, children under what age should be treated with abx? Why?

A

2 years

Risk for intracrainial extension

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29
Q

What fraction of children with febrile seizures will have another by age 6? What is their chance of developing epilepsy?

A

1/3 will have another, but only 1% go on to develop epilepsy

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30
Q

What is the effect of antipyretics on the occurrence of simple febrile seizures?

A

Does not decrease rate

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31
Q

What is the age range that is concerning for low back pain?

A

age ∉ [18, 50]

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32
Q

What is the relative sensitivity and specificity of the SLR and crossed SLR?

A
  • SLR is sensitive, but not specific

- crossed SLR (where SLR on opposite leg produces pain down ipsilateral leg) is specific, but not sensitive

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33
Q

What is the pharmacologic treatment for cauda equina syndrome while waiting for surgery?

A

Steroids

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34
Q

What is the treatment for spinal infection?

A

abx and surgical decompression

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35
Q

What is the most sensitive s/sx for cauda equina?

A

Urinary retention / incontinence

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36
Q

What is the most common infectious cause of death in the US?

A

Pneumonia

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37
Q

What is the definition of hospital acquired pneumonia?

A

Pneumonia that arises 48 hours or more after hospital admission

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38
Q

What is healthcare associated pneumonia?

A

Pneumonia that occurs in a patient with substantial healthcare contact (intravenous antibiotics, chemotherapy, or wound care within the past 30 days; nursing home or long-term care facility resident; hospitalization for 2 or more days within the past 90 days; hemodialysis).

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39
Q

hospital acquired and healthcare associated pneumonia are most commonly caused by which organisms?

A

Aerobic, gram-negative bacilli, (e.g. pseudomonas, e. Coli, klebsiella)

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40
Q

Pneumonia that causes rust colored sputum = which bacteria? Currant Jelly sputum?

A

Rust = strep pneumo

Currant jelly = klebsiella

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41
Q

What are the s/sx of Legionnaires disease?

A

Severe illness with cough, lethargy, GI s/sx

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42
Q

What is the abx of choice for community acquired pneumonia in an otherwise relatively health pt, who has not had abx in the pst 3 months? What if they have comorbid conditions and/or used abx in the past 3 months?

A

Azithromycin

Levofloxacin

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43
Q

What are the abx used to treat pneumonia that requires ICU admission?

A

Beta lactam + (azithromycin or fluoroquinolone)

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44
Q

What is the abx of choice for aspiration pneumonia?

A

Clindamycin

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45
Q

Patients with concern for HAP or HCAP who are at a risk for multidrug-resistant pathogens should receive a 3-drug combination therapy of which abx?

A
  1. cefepime imipenem
  2. cipro piperacillin tazobactam
  3. linezolid or vanco
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46
Q

Which has a greater potential for hemorrhage and significant volume depletion: upper or lower GI bleeding?

A

Upper

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47
Q

Why is upper endoscopy so crucial in diagnosing the cause of upper GI bleed?

A

Slow bleeding ulcer vs hemorrhagic varices require different treatments

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48
Q

What anatomic landmark is used to distinguish upper from lower GI bleeds?

A

Ligament of Trietz

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49
Q

If a patient has lower GI bleeding, what age determines if they should have a colonoscopy, of sigmoidoscopy?

A

Under 40, sigmoid. Otherwise full colon

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50
Q

What is the major risk factor for an aortoenteric fistula?

A

H/o prior AAA reconstruction

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51
Q

What pharmacotherapy should be given to all pts with upper GI bleeds undergoing treatment?

A

PPIs

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52
Q

Is tylenol use a risk factor for ulcers?

A

No

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53
Q

What condition always needs to be r/o with CHF exacerbations?

A

MI

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54
Q

What is a major issue with treating diastolic heart failure?

A

They are preload dependent, so must carefully diurese them o/w risk hypotension

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55
Q

Why is intra-arterial monitoring of BP needed in CHF pts who are hypotensive?

A

Noninvasive techniques inaccurate, as there is peripheral vasoconstriction

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56
Q

When is a BNP lab most useful? What values are indeterminant?

A

In determining between COPD vs CHF

x ∈ [100,500] means indeterminant

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57
Q

What medication can be given to CHF exacerbation pts to rapidly reduce their pulmonary congestion?

A

NTG

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58
Q

What is the treatment for cocaine intoxication?

A

Benzos + supportive care

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59
Q

Why should haldol be avoided in acute cocaine intoxication”?

A

Lowers seizure threshold

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60
Q

What is the drug f choice to decrease HTN in cocaine intoxication?

A

Alpha-1 antagonists like phentolamine

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61
Q

Rotatory nystagmus is classic for what street drug intoxication?

A

PCP

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62
Q

What are the EKG changes associated with cocaine intoxication?

A

Widening of QT interval, wide complex dysrhythmias

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63
Q

What amount of acetaminophen is considered toxic?

A

More than 200 mg/kg or more than 10 g in one day

or 6 g over two days

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64
Q

NAC is most effective if administered within what timeframe of acetaminophen ingestion?

A

8 hours

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65
Q

What is the toxic metabolite of acetaminophen? What produces it, and what reduces it?

A

NAPQI produced by the p450 enzyme system, is reduced by glutathione

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66
Q

What is the MOA of NAC in the treatment of acetaminophen overdose?

A

Replenishes glutathione so that NAPQI is reduced properly

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67
Q

What are the four phases of acetaminophen toxicity (name, duration)?

A 
1= preinjury (30 minutes - 24 hours)
2 = Injury onset (24-72hrs)
3 = Max liver injury (72-96 hrs)
4 = recovery (4-10 days)
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68
Q

What are the s/sx of the four phases of acetaminophen intoxication?

A 
1 = nonspecific 
2 = n/v RUQ pain, 
3 = liver failure s/sx, metabolic disturbances
4 = resolution
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69
Q

When is the best time to draw acetaminophen levels if the ingestion time is known?

A

4 hours post ingestion

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70
Q

When should activated charcoal be given in acetaminophen OD?

A

separating dose of NAC with charcoal by 1-2 hours (o/w charcoal will absorb it)

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71
Q

What is the antidote for crotalidae envenomation?

A

Crotalidae polyvalent immune Fab

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72
Q

What is the antidote for hypermagnesemia?

A

Calcium gluconate/chloride

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73
Q

What is the antidote for hypocalcemia?

A

Calcium gluconate/chloride

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74
Q

What is the antidote for black widow spider bite?

A

CaCl2

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75
Q

What is the antidote for CN?

A

amyl nitrate

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76
Q

What is the antidote for Hydrogen sulfide

A

Sodium nitrate

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77
Q

What is the antidote for CCB or beta blocker poisoning?

A

Glucagon

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78
Q

What is the antidote for hypoglycemia after oral hypoglycemic ingestion?

A

Octreotide

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79
Q

What is the antidote for heparin?

A

protamine

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80
Q

What is the antidote for Na channel blockers

A

NaHCO3

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81
Q

Why is theophylline intoxication so concerning

A

Very, very narrow TI

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82
Q

The Rumack-Matthew nomogram is not applicable for ingestions more than (__) hours prior to evaluation.

A

24 hours

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83
Q

What are the typical s/sx of acute chest syndrome 2/2 sickle cell disease?

A

Pleuritic chest pain, cough, fever, subtle findings of pulmonary exam, and opacity on CXR

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84
Q

What is the treatment of acute chest syndrome?

A

Supportive

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85
Q

What is the definition of acute chest syndrome?

A

The presence of a new lobar or segmental infiltrate on chest radiography in the presence of fever, respiratory symptoms, and/ or chest pain in patient with sickle cell disease.

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86
Q

Who is susceptible to sickle cell crises?

A

Homozygotes for the condition (AR inheritance pattern)

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87
Q

What is often the first physical exam finding of sickle cell disease?

A

Dactylitis

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88
Q

What is a major cause of death in sickle cell patients?

A

Pneumococcal sepsis

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89
Q

When is exchange transfusion indicated in the treatment of sickle cell crisis?

A

If fall in HgB by more than 2, or CNS s/sx

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90
Q

What is the treatment of strokes in children and adults with sickle cell disease?

A 
Children = exchange transfusion
Adults = usual stroke meds
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91
Q

What is the most common cause of acute exacerbation of anemia in sickle cell patients?

A

Acute splenic sequestration

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92
Q

What is the treatment for splenic crisis in sickle cell patients?

A

pRBCs and splenectomy

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93
Q

What is usual cause of transient aplastic anemia in sickle cell disease? Treatment?

A

Parvovirus B19

IVIG

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94
Q

What is the treatment for priapism 2/2 sickle cell disease?

A

Corpus cavernosus drainage and irrigation with epi

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95
Q

True or false: sickle cell pts are often overtreated for pain

A

False–very much undertreated

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96
Q

Which opiate can cause serotonin syndrome?

A

Meperidine

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97
Q

What is the technical definition of hypothermia?

A

Core body temp below 35 C or 95F

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98
Q

What is frostnip?

A

Deposition of superficial ice crystals on the skin. It can be a warning sign for impending frostbite. Typically it is a retrospective diagnosis because it is defined by the absence of tissue damage upon rewarming.

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99
Q

What is trench foot?

A

Constant exposure to low levels of cold (like 50s), cause capillary constriction and eventual destruction of surrounding tissue

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100
Q

In terms of thermoregulation, what is the hunting reactio?

A

of irregular, 5- to 10-minute cycles of alternating periods of vasodilation and vasoconstriction that protect the extremities against sustained periods of vasoconstriction.

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101
Q

What is the classic EKG manifestation of hypothermia?

A

J (Osborn) wave, which is a R wave immediately after the QRS complex

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102
Q

At what temperature does frostbite occur? What causes the damage?

A

When tissues are less than 0 C or 32 F

Venous stasis, and freezing of cellular fluids

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103
Q

What is the pre freeze phase of frostbite?

A

Tissue temps drop to 50 F (10 C), causing a loss of sensation

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104
Q

What is the freeze thaw phase of frostbite?

A

Extracellular ice crystals form, and water leaves cells osmotically

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105
Q

What is the progressive microvascular collapse phase of frostbite?

A

Red cells sludge and form microthrombi during the first few hours after the tissues are thawed.

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106
Q

What are the signs of superficial frostbite?

A

Clear vesicles

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107
Q

What are the signs of deep frostbite injury?

A

Hemorrhagic blisters

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108
Q

Why shouldn’t patients with frostbite/hypothermia always be warmed PTA?

A

Interruption/refreezing tissues is disastrous

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109
Q

Why is it crucial to check BG in hypothermia?

A

Correction of hypoglycemia can help restore shivering reflex

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110
Q

What is done to rewarm pts with hypothermia? How long is this done for?

A

Warm IVFs
Place extremities in warm bath (100-105 F)

Until tissue it pliable and distal erythema is noted

111
Q

What is the role of gentle tissue massage in frostbite?

A

Avoid-causes more damage

112
Q

What is the treatment for post-frostbite care?

A
  • Raising extremities with hand exercises to decrease venous stasis
  • Wrapping extremities
  • Debridement of clear blisters (not hemorrhagic)
113
Q

What are the three general ways to rewarm hypothermic pts?

A

In order of increasing severity:

  • blankets (passive external)
  • warm air / bath (active external)
  • Internal rewarming (warm IVFs, warm vent)
114
Q

What is the afterdrop in terms of hypothermia?

A

Pts core body temp continues to drop after brought inside

115
Q

True or false: no one is dead until they are warm and dead

A

True

116
Q

What is the minimum time required to assess the need for amputation of severely frostbitten extremities?

A

3 weeks

117
Q

What is the most common arrhythmia seen in hypothermic pts?

A

Atrial fibrillation

118
Q

Which type of blisters in frostbite should be debrided and why?

A

clear blisters should be debrided since these contain thromboxane, which is bad for tissues

Hemorrhagic should not be debrided, because will worsen tissue destruction

119
Q

What is the definition of drowning?

A

Death following a submersion event.

120
Q

What is the definition of a submersion victim?

A

Patient with some degree of submersion distress requiring medical evaluation and treatment.

121
Q

What is the definition of immersion syndrome?

A

Syncope or sudden death that occurs after submersion in water that is at least 5 ° C less than body temperature. Due to dysrhythmias induced by vagal stimulation.

122
Q

What is the pathophysiology of pulmonary edema in drowning?

A

Aspirating water washes out surfactant, leading to atelectasis, decreased gas exchange, and pulmonary edema

123
Q

True or false: Neurological deficits at the time of initial evaluation of drowning portend a poor patient outcome.

A

False–not necessarliy

124
Q

Why is the Heimlich maneuver no long recommended for drowning?

A

Increases aspiration risk

125
Q

What is the role of D5NS in treating drowning victims?

A

Avoid unless hypoglycemic–worsens outcomes

126
Q

True or false: a head CT r/o SAH

A

False–may not show for some time

127
Q

What is the classic presentation of pseudotumor cerebri?

A

Young, obese female with visual changes and papilledema

128
Q

Which CNs are classically affected with a SAH?

A

III or VI

129
Q

What is the gold standard of diagnosis for a SAH?

A

Xanthochromia (but this may not appear for up to 12 hours after onset)

130
Q

What is the DOC for preventing arterial vasospasm post stroke or SAH?

A

Nimodipine

131
Q

What is the treatment for idiopathic intracranial HTN?

A

Acetazolamide and Serial LPs

132
Q

What is the MOA and use of dihydroergotamine (DHE)?

A

Migraine HAs

Nospecific 5HT agonists

133
Q

What is the MOA of sumatriptan?

A

5HT agonist

134
Q

What is the definition of heat stress?

A

Feeling of discomfort and physiologic strain with normal core temperatures. These patients exhibit decreased exercise tolerance and no other symptoms.

135
Q

What is the definition of heat exhaustion?

A

Mild dehydration, with or without sodium abnormalities. Patients have profuse sweating, thirst, nausea, vomiting, confusion and headache, and may have collapsed. Core temperatures range from 38 ° C to 40 ° C (100 ° F-104 ° F). Generally, the victim is not able to continue his/ her activities as the result of the environmental conditions.

136
Q

What is the definition of heat stroke?

A

Severe dehydration with core temperature greater than 40 ° C. Patients are flushed, with hot, dry skin. Symptoms include those associated with CNS disturbances.

137
Q

What is the definition of exertional heat stroke?

A

Heat stroke affecting individuals involved in strenuous physical activities.

138
Q

What is the goal temperature in treating heat stroke? Why?

A 
104 F (40 C)
Do not want to overshoot
139
Q

What is heat edema? Treatment?

A

Vasodilation and pooling of fluids in dependent areas

elevate extremities

140
Q

What is the cause, symptoms, and treatment for: heat rash

A
  • Blockage of sweat glands, causing staph infx
  • Pruritic, erythematous maculopapular rash
  • Antihistamines, abx PRN
141
Q

What is the cause, symptoms, and treatment for: heat cramps

A
  • Salt depletion
  • cramps
  • IVFs
142
Q

What is the cause, symptoms, and treatment for: heat syncope?

A
  • vasodilation and volume depletion
  • Postural hypotension
  • Rehydration and remove from heat
143
Q

What is the cause, symptoms, and treatment for: heat exhaustion

A
  • Water and salt depletion
  • Sweating, weakness
  • Rest and volume replacement
144
Q

What is the treatment for rhabdo in the setting of heat stroke?

A

IVFs
Mannitol
Alkanization of urine

145
Q

What is the DOC for shivering in the setting of heat stroke?

A

Benzos

146
Q

True or false: all pts with heat stroke or exhaustion should be admitted

A

True

147
Q

What is the most common cause of death after a lightning strike?

A

Cardiac arrest

148
Q

What is the formula for Ohm’s law? What is the significance of this in electrocutions?

A

I = V/R

Nerves, vessels and mucous membranes have low R, and therefore will communicate electricity

149
Q

Burns on both hands after an electrocution indicates that the electricity flowed through what organ?

A

Heart = badness

150
Q

Which is more dangerous :AC or DC? Why? Which form is lightning?

A

AC, since can cause the “locking on” effect

Lightning is DC

151
Q

In terms of lightning strikes, what is: a side flash (splash)

A

Current is discharged from a victim to a nearby person

152
Q

In terms of lightning strikes, what is: ground current or stride potential

A

When lightning strikes ground, and enters through one foot and out the other

153
Q

In terms of lightning strikes, what is: the flashover phenomenon

A

Blast effect of lighting

154
Q

In terms of lightning strikes, what is: keraunoparalysis?

A

Temporary paralysis with loss of sensation. Resolves within a few hours

155
Q

In terms of lightning strikes, what is the most dangerous area of the spinal cord to be affected?

A

Respiratory control center in the medulla

156
Q

What causes the Lichtenberg figures of lightning strike burns?

A

Low resistance sweat

157
Q

What HENT issue is common following lightning strikes?

A

TM ruptures

158
Q

True or false: Typical signs of brain death, fixed/ dilated pupils and apnea, do not necessarily indicate brain death in electrical victims.

A

true

159
Q

What is the goal urine output when transfusing someone?

A

1.0-1.5 ml/kg/hr

160
Q

What are the three major complications that can result from transfusion reactions?

A

Acute tubular necrosis
DIC
MI

161
Q

How can you definitively diagnose hemolytic transfusion reaction? What is involved in this test?

A

Direct antigen test

anti-human-Ab against Abs on RBCs

162
Q

What is the most common and least worrisome transfusion rxn? S/sx?

A

Febrile nonhemolytic transfusion rxn

Fevers/chills, without hemodynamic instability

163
Q

Why should fever in a first-time transfusion recipient should be treated as an acute hemolytic reaction until proven otherwise?

A

Since any other rxn requires previous exposure

164
Q

What is the most common cause of an anaphylactic transfusion rxn?

A

IgA deficiency pt

165
Q

Why do pts who take ACEIs harder to treat in anaphylaxis?

A

Cannot break down bradykinin

166
Q

What is the pathophysiology of TRALI?

A

Anti-leukocyte antibodies the result in systemic inflammation, and PMN mediated lung injury

167
Q

What are the hallmark findings of TRALI?

A

respiratory distress with the presence of diffuse, bilateral alveolar and interstitial infiltrates on radiographic imaging.

168
Q

What is the relative heart pressure in TRALI vs pulmonary edema?

A

Low left heart pressure in TRALI

169
Q

What is delayed hemolytic transfusion rxn?

A

MIld s/sx of rxn 2/2 antibody formation long after transfusion has occurred.

170
Q

What is the prognosis for GVHD?

A

90% fatality rate

171
Q

What is the pathophysiology of post-transfusion purpura? What is the most severe manifestation of this? Treatment?

A
  • Native platelet destruction mediated by antibodies to platelet antigen PLA1.
  • Intracranial hemorrhage
  • Transfusion with PLA1 negative platelets
172
Q

What is the most common bacteria isolated in stored blood?

A

Yersinia enterocolitica

173
Q

When is testing of donor blood with Gram stain and culture indicated?

A

Any transfusion that causes hypotension and fever

174
Q

When, generally, is platelet transfusion indicated?

A

Below 10,000 if not bleeding
Between 10-20000 if bleeding
Below 50000 if severe trauma

175
Q

What is the role of diuretics in the treatment of TRALI? Why?

A
  • Not effective
  • Problem 2/2 capillary destruction, not fluid overload, and these pts already have low left heart preload. Diuretics will exacerbate perfusion problems
176
Q

What are the classic predisposing factors for testicular torsion?

A

Young, teenage athlete

177
Q

What is the classic clinical findings of epididymitis? Treatment?

A
  • TTP, erythema, d/c, and + Prehn sign

- Abx, scrotal elevation

178
Q

What is Prehn’s sign, and what is it indicative of?

A

Relief of pain with elevation of the testicle

Epididymitis

179
Q

What are the s/sx of orchitis? Treatment?

A
  • TTP, edema, and systemic s/sx.

- Abx if bacterial. O/w supportive

180
Q

What is the most common type of testicular tumor?

A

Seminomas

181
Q

What is appendageal torsion? S/sx? Treatment?

A
  • Twisting of one of four vestigial structures of the testes
  • ACute scrotal pain with small, tender nodules
  • Analgesia and bed rest
182
Q

True or false: testicular torsion may resolve spontaneously

A

True

183
Q

Testicular pain that persists for more than (___) after scrotal trauma is not normal and merits further investigation.

A

one hour

184
Q

If you are able to detorse a testicle, what should be done next?

A

D/c with f/u for surgery

185
Q

What skin findings in an unconscious patient is a diagnosis of hemorrhagic shock presumed until proven otherwise?

A

Cool and mottled skin

186
Q

True or false: children will slowing develop signs of shock, since they cannot compensate well

A

False–they compensate so well, until they suddenly drop

187
Q

What is the normal HR, BP, and RR for: 0-1 years old

A

120 bpm
80/40
40 breathes pm

188
Q

What is the normal HR, BP, and RR for: 1-5 years

A

100 bpm
100/60
30 rr

189
Q

What is the normal HR, BP, and RR for: 5-10 years

A

80 bpm
120/80
20 rr

190
Q

the initial signs of shock, including tachycardia, skin changes, and lethargy, represent a loss of approximately what percent of the child’s blood is lost?

A

25%

191
Q

What is the initial treatment for hypovolemic shock in children?

A

20 mL/kg of warmed crystalloid

192
Q

If vitals worsen during a head CT of a trauma patient, what should be done?

A

Abandon the CT, and go to surgery

193
Q

What are grade 1-5 of the pediatric GCS verbal scores?

A 
5= appropriate words or social smile
4 = cries, but consolable
3 = persistently irritable
2 = restless, agitated
1= none
194
Q

What happens to the following in a child if there is less than 25% blood loss:

  • Pulse
  • Consciousness
  • Urine output
A
  • Pulse = Weak
  • Consciousness = agitated/confused
  • Urine output = unchanged
195
Q

What happens to the following in a child if there is 25%-45% blood loss:

  • Pulse
  • Consciousness
  • Urine output
A
  • Pulse = tachycardic
  • Consciousness = dulled pain response
  • Urine output = minimal
196
Q

What happens to the following in a child if there is over 45% blood loss:

  • Pulse
  • Consciousness
  • Urine output
A
  • Pulse = Hypotension, tachy, then brady
  • Consciousness = comatose
  • Urine output = none
197
Q

What are the major factors that are associated with reduced independence of the elderly s/p trauma? (5)

A
  • Shock upon admission
  • GCS score of less than 7
  • Over 75 years
  • Head injury
  • sepsis
198
Q

What is the definition of menorrhagia?

A

Excessive vaginal bleeding, classically exceeding 80 mL or more than 7 days

199
Q

What is the definition of menometrorrhagia?

A

Prolonged and/or excessive vaginal bleeding at irregular intervals

200
Q

What is the definition of oligomenorrhea?

A

Menses at intervals greater than 35 days

201
Q

What is the definition of amenorrhea?

A

Absence for more than 6 months

202
Q

How reliable is self reported amounts of vaginal bleeding?

A

Very unreliable

203
Q

Blood stains down the legs of a woman with a cc of vaginal bleeding indicates what?

A

Need for transfusion

204
Q

What is the pharmacotherapy for hemodynamically stable excessive vaginal bleeding?

A

oral contraception

205
Q

When should endometrial sampling be performed for dysfunctional uterine bleeding?

A

When pts are over 35

206
Q

What is the acute treatment for dysfunctional uterine bleeding?

A

DandC or IV estrogen

207
Q

Why is the esophagus more susceptible to perforation than other areas of the GI tract?

A

Lacks a serosal layer

208
Q

What are the components of the Macker triad for Boerhaave syndrome?

A

Emesis
Lower chest pain
SQ emphysema

209
Q

What causes the decreased breath sounds on the side of the rupture in Boerhaave’s syndrome?

A

Pleural effusioin

210
Q

What is the role of endoscopy in the evaluation of Boerhaave’s syndrome?

A

no role–may perforate further

211
Q

What is the treatment for Boerhaave’s syndrome?

A

NPO
NG tube
antiemetics/analgesics

212
Q

What is the classic presentation of pericarditis?

A
  • Pain which worsens when supine, and improves when sitting up
  • Pericardial friction rub
  • Diffuse ST/T wave elevation
213
Q

What type of oral contrast should be used to evaluate for Boerhaave’s syndrome? Why?

A

Gastrografin

Not as irritating to tissues

214
Q

True or false: its takes large changes in K to cause EKG changes

A

False–correlation between K levels and EKG changes are very poor; Patients may have severe hyperkalemia with minimal ECG changes, and prominent ECG changes with mild hyperkalemia.

215
Q

What is the very first drug given in hyperkalemia? What does it do?

A

CaCl or calcium gluconate

Stabilizes cell membranes

216
Q

What is the difference in CaCl vs calcium gluconate? Which is used when?

A

CaCl is more caustic and is used only in cardiac arrest, whereas Ca gluconate is used more widely

217
Q

What is the second line agent for hyperkalemia after CaCl? How does it work?

A

NaHCO3

Shifts K into cells by increased pH of the blood

218
Q

What is the ultimate treatment for all ESRD pts with hyperkalemia?

A

Dialysis

219
Q

What is the treatment for pyelonephritis (drug, duration)?

A

10-14 days of a fluoroquinolone

220
Q

What are the top three organisms that cause UTIs, in order?

A

E. coli
Staph saprophyticus
Proteus

221
Q

What is the treatment for uncomplicated cystitis?

A

Bactrim (TMP-SMX)

222
Q

What is the use of phenazopyridine? Side effect?

A

Abx for UTIs

Orange urine

223
Q

True or false: all pregnant pts with pyelonephritis require admission

A

True

224
Q

What is the abx of choice for complicated pyelonephritis requiring inpatient admission?

A

TMP-SMX

Fluoroquinolones

225
Q

What is the treatment for asymptomatic bacteriuria in pregnant women?

A

PCNs or cephalosporins

226
Q

What is unique about the treatment of male UTIs?

A

Always tear as complicated, and prescribe 14 days of abx

227
Q

What are the 7 P’s of intubation?

A
  1. Prepare pt and materials
  2. Preoxygenation
  3. Pretreatment
  4. Paralysis (induction)
  5. Position and protection
  6. Placement with proof
  7. Postintubation management
228
Q

What is the 3-3-2 rule for intubation?

A

The patient should be able to insert at least 3 fingers into his/ her mouth in the vertical orientation, between the upper and lower front teeth; the hyomental distance (from the hyoid cartilage to the chin) should be at least 3 fingers breadth; and there should be at least 2 fingers breadth between the floor of the mouth and the thyroid cartilage.

229
Q

What is the formula to predict ET tube size in children over 2?

A

(age in years +16) / 4

230
Q

What are the components for the mnemonic SOAP ME IV for the materials needed for intubation?

A 
Suction
Oxygen
Airway adjuncts
Pharm
Monitoring Equipment
IV
231
Q

HOw many assisted breaths should be given to a patient for preoxygenation if they’re apneic?

A

8 ventilations over 1 minute

232
Q

What are the advantages of using etomidate as an induction agent for RSI?

A

Hemodynamically neutral, and may be neuroprotective

233
Q

What are the advantages and disadvantages of ketamine as an induction agent?

A

Increases BP
Protects airway reflexes
Analgesic properties

Contraindicated in pts with CAD

234
Q

What are the contraindications to using succinylcholine as a paralytic for RSI?

A

Hyperkalemia will worsen

235
Q

What is the best way to confirm ET tube placement?

A

Watching it go through the vocal cords (CXR cannot differentiate between tracheal vs esophageal placement)

236
Q

What type of drug is Jimson weed?

A

Antimuscarinics

237
Q

What is the best initial treatment for anticholinergic poisoning?

A

Benzos and physostigmine

238
Q

Who is best treated with activated charcoal?

A

In patients that are awake, protecting their airway, and ingested material less than 1 hour ago

239
Q

Who is best treated with gastric lavage?

A

Only patients who have ingested material less than 1 hour prior, and have a potentially life threatening ingestion

240
Q

What is the role of nasogastric lavage in poisoning?

A

NASO-gastric lavage is useless. Don’t do it.

241
Q

What are the materials that are poorly absorbed by activated charcoal? (4)

A

Alcohols
Acids/bases
Hydorcarbons
Li/other salts

242
Q

What is whole bowel lavage?

A

Administration of Polyethylene glycol and electrolyte solution to move bowels

243
Q

HOw many charcoal+sorbitol doses can be given before switching to regular activated charcoal?

A

1

244
Q

When is hemodialysis effective in the treatment of intoxication?

A

If drug is highly water soluble, and thus has a low volume of distribution

245
Q

What is charcoal hemoperfusion?

A

similar to arterial venous hemodialysis, except that the drug is passed through a charcoal filter prior to systemic return. This is particularly effective in phenobarbital and theophylline overdoses as they adsorb well to charcoal.

246
Q

What is urinary alkalinization in the treatment of intoxication?

A

a treatment regimen that increases poison elimination by the administration of intravenous sodium bicarbonate to produce urine with a pH > 7.5. Alkaline urine facilitates ion trapping and excretion. This method is particularly useful for aspirin and phenobarbital toxicities.

247
Q

What is the nomogram for determining when to administer NAC in acetaminophen poisoning?

A

Rumack-Matthew nongram

248
Q

What is the treatment for salicylate poisoning? At what level should this begin?

A

levels above 30 mg/ dL should be treated with bicarbonate infusion and potassium supplementation to increase urinary elimination

249
Q

What are the EKG manifestations of Na channel blocking drugs?

A

Prolonged/slurred QRS complexes

250
Q

What are the EKG manifestations of K or Ca channel blocking drugs?

A

QT prolongation

251
Q

Treatment with sodium bicarbonate for a prolonged QRS can lead to what unintended complication?

A

QT prolongation and Tdp

252
Q

What happens to vital signs with sedative hypnotic ODs?

A

Normal vitals, usually

253
Q

What is the goal of treatment with narcan (naloxone)?

A

Get pt breathing again, not necessarily to get them awake

254
Q

Naloxone administration should be avoided in an intubated patient with opiate or opioid overdose since this will lead to what complication?

A

Emesis

255
Q

What is the major difference in presentation of antimuscarinic vs sympathomimetic overdoses?

A

Sympathomimetics usually have diaphoretic skin, whereas anticholinergics are dry

256
Q

What is the typical cause of mortality in pts with sympathomimetic overdose? What is used to prevent this?

A

Hyperthermia

Cooling

257
Q

Why must you sedate a pt with sympathomimetic OD if you restrain them?

A

Fighting could lead to rhabdo

258
Q

What is the mnemonic for the antimuscarinic toxidrome?

A

Mad as a hatter
Dry as a bone
Red as a beat
Blind as a bat

259
Q

What is the most common pathogen and abx for skin abscesses?

A

Staph Aureus

TMP-SMX or vanco

260
Q

What is the most common pathogen and abx for non-purulent cellulitis?

A

Beta hemolytic strep

Cephalexin or cefazolin

261
Q

What is the most common pathogen and abx for necrotizing soft tissue infection (NSTI)?

A

S aureus or clostridium

Clindamycin /vanco / piperacillin-tazobactam

262
Q

When are abx indicated for abscesses?

A

If larger than 5 cm, immunocompromised

263
Q

What are the features of the rash and presentation of: rubella

A
  • Pink, macular rash beginning on face, spreading to trunk and extremities
  • Rash before fever with URI s/sx
264
Q

What are the features of the rash and presentation of: rubeola (measles)

A
  • Red to brown maculopapular rash beginning on face, spreading downwards
  • Three C’s: cough, coryza, conjunctivitis
  • Fever before rash
265
Q

What are the features of the rash and presentation of: roseola (HHV-6)

A
  • Face sparing pink maculopapular rash

- Sudden onset after high fever

266
Q

What are the features of the rash and presentation of: Fifth disease (erythema infectiosum)

A
  • Bright red cheeks with lacy reticular rash

- Aplastic crises possible (parvovirus B19)

267
Q

What are the features of the rash and presentation of: hand foot and mouth disease?

A
  • Ulcer-like eruption in mouth with macular rash on palms and soles
  • fever followed by rash
268
Q

What are the features of the rash and presentation of: scarlet fever

A
  • Sandpaper rash with increased redness in skin folds

- Strawberry tongue, pastia sign

269
Q

What are the features of the rash and presentation of: varicella

A
  • Papules to vesicles that starts on the trunk and spreads outward.
  • Lesions in different stages
270
Q

What are the features of the rash and presentation of: lyme disease

A

-Erythema migrans

271
Q

What are the features of the rash and presentation of: RMSF

A
  • Pink macules to red papules

- begins on wrists and spreads inwards

272
Q

What are the features of the rash and presentation of: secondary syphilis

A
  • Maculopapular rash that begins on trunk and spreads to palms and soles
  • Appears 2-3 months after chancre
273
Q

What is the most specific feature of a contact dermatitis?

A

Linear confluence

A2 (26 decks)

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