EM Board Review Flashcards
Causes of Elevated Anion Gap Metabolic Acidosis
4 categories:
1) Renal failure (uremia)
2) Lactic acidosis: Sepsis, Cardiac arrest, Liver failure, Iron, Metformin, Cyanide, Carbon monoxide,Thiamine deficiency
3) Ketoacidosis: Diabetic, Alcoholic, Starvation
4) Exogenous poisoning: Methanol, Ethylene glycol,Salicylate, Isoniazid
Most common cause of fracture in children less than 8 years old.
supracondylar fracture
Name age of ossification
CRITOE
1 - Capitellum
3 - Radial Head
5 - Internal (medial) epicondyle
7- Trochlea
9 - Olecranon
11 - External (lateral) epicondyle
Which branch of median nerve is commonly injured in supracondylar fractures?
anterior interosseous, integrity is checked my patient making the “ok” sign
What levels are DECREASED in iron deficiency anemia?
hemoglobin (anemia), MCV (microcytosis), MCH (hypochromia), MCHC (hypochromia), reticulocyte count, and ferritin
What levels are INCREASED in iron deficiency anemia?
increased TIBC, transferrin, and RDW (RBC Distribution Width)
What are cause of erythema multiforme?
Herpes simplex virus (most common)
Mycoplasma
Sulfonamides
Penicillin
Barbiturates
Phenytoin
Lupus
Hepatitis
Lymphoma
What can be used to minimized delayed absorption of phenytoin?
multi-dose activated charcoal, phenytoin has delayed and erratic GI absorption
What are signs of phenytoin toxicity?
- GI disturbances
- Nystagmus
- Ataxia
- Headache
- Drowsiness
- Dysphasia
- Dysrhythmia
- Death
What are side effects of phenytoin?
- Gingival hyperplasia
- N/V
- Stevens-Johnson Syndrome
- Bone marrow suppression
- Megaloblastic anemia
- Teratogenecity
What causes the cardiac toxicity in phenytoin? And what IV infusion rate?
Cardiac toxicity is due to the propylene glycol diluent, usually at a rate above 50 mg/min IV.
Phenytoin may be useful for dysrhythmias caused by what medication?
Digitalis
Is dialysis effective a removing phenytoin?
NO. Dialysis is NOT effective in removing phenytoin because it is highly protein bound.
When rewarming frostbite, what must be insured first?
Rewarming should be undertaken in an environment where there is no risk of refreezing, as doing so worsens the chance of recovery. A core temperature of at least 35°C must be achieved prior to actively rewarming the frostbitten area. he affected area should then be immersed in circulating water at 37°–39°C.
Most common cause of hemoptysis worldwide?
Tuberculosis
What causes hemoptysis and renal dysfunction?
Goodpasture’s syndrome or Granulomatosis with Polyangiitis (GPA, Wegener’s)
What causes hemoptysis in those with history of TB or sarcoidosis?
aspergilloma
Where should penile escharotomy be performed?
Penile escharotomy should be performed on the mid-lateral aspect of the shaft.
What is Brown-Sequard Syndrome?
See image
What are the different degress of frostbite?
see image
What are the symptoms and associations with myxedema coma?
see image
What could be used to treat epinephrine autoinjector injuries into the finger or hand?
Subcutaneous phentolamine injected into the original puncture site. It is the one treatment consistently described that rapidly reverses digital ischemia.
Mix 0.5 mL phentolamine and 0.5 mL 1% lidocaine
What pathogen causes fulminant bacteremic illness after a dog bite and is more common in alcoholics, post-splenectomy, or other immunosuppressed patients?
Capnocytophaga canimorsus
Formula for calculating osmolar gap
2*[Na}+{BUN}/2.8+{glucose}/18+{ethanol}/4.6
An osmolal gap> 10 mosmol/kg suggest a toxic alcohol ingestion
The presence of which component in urine is suggestive of ethylene glycol intoxication?
calcium oxalate crystals
What is the Ranson Criteria at admission?
Age > 55 years
WBCs > 16,000/mm3
Glucose > 200
LDH > 350
AST > 250
What is the Ranson Criteria 48 hours after admission?
Hematocrit fall > 10%
BUN rise > 5
Calcium > 8
PO2 < 60 mmHg
Base deficit > 4
Fluid sequestration > 6L
Name characteristics of Bullous Pemphigoid.
- Autoimmune disease of elderly
- Autoantibodies against basement membrane
- Subepidermal
- Begins as pruritic papules
- Large, tense blisters/bullae
- Older (>60 years) individuals
- Nikolsky negative
- Treatment is wound care, corticosteroids, doxycycline and immunosuppressants
Name characteristics of Pemphigus vulgaris.
- Younger (40-60 years)
- Involves mucuous membranes
- Flaccid blisters
- Nikolsky positive
- IgG autoantibodies to desmosomes
What are mycotic aneurysms?
- Material originating in the heart causes arterial wall infection and dilation
- Aneurysms associated with bacterial endocarditis (as defined by Osler)
- When in the femoral arteries, frequently associated with acute limb ischemia due to thrombosis within the aneurysm
What is hemolytic transfusion reaction?
- The most serious transfusion rxn
- ABO incompability
- Lysis of transfused RBCs
- Hemoglobinemia and hemoglubinuria
- Symptoms: immediate F/C, HA, N/V, myaglia, dark urine, hypotension
- Management: 1) strop transfusion, 2) immediate vigorous IVF, 3) diuretic therapy to maintain UOP 1-2 ml/kg/hr
What symptoms can massive transfusion cause?
coagulopathy, hypothermia, hypocalcemia
What is a febrile transfusion reaction?
- Cause by recipient antibody response to donor leukocytes, leading to release of cytokines
- Most common, generally self limited and entirely resolved w/slowing or stopping the transfusion
What is Graft-Versus Host Reastion for blood transfusion?
- Occurs when the donor blood attacks the lymphoid tissue of the recipient or host
- Exam will reveal hepatomegaly and labs with abnormal LFTs and pancytopenia
- Immunocompromise, rash
- Prevention: irradiated blood products in immunocompromised
What is transfusion-related acute lung injury (TRALI)?
- Like ARDS
- Non-cardiogenic pulmonary edema leading to bilateral patchy infiltrates within 4 hrs of transfusion
- Severe hypoxemia (<90% on room air), fever, hypotension, tachycardia
- Bilateral pulmonary infiltrates (w/in 6 hrs of transfusion)
- Rx: stop transfusion
How does a delayed transfusion reaction present?
- 3-4 weeks after transfusion
- Decreased hemoglobin
Organisms with highest false positive rates for blood cultures?
Coagulase negative staphlococcus
Bacillus species
Propionibacterium species
Viridans streptococci
What are the most common nutritional deficiencies that causes pancytopenia?
Vitamin B12 and folate deficiencies
What is the most common cause of hereditary pancytopenia?
Fanconi anemia
What are causes of pancytopenia?
Aplastic anemia
Chloramphenicol
Leishmania donovani
Megaloblastic anemia
Paroxysmal nocturnal hemoglobinuria (PNH)
Radiation sickness
Transfusion-associated GVHD
Name the position (medial vs lateral) to the inferior epigastric artery for direct and indirect inguinal hernias.
Indirect: abdominal contents pass lateral to the IEA, through the inguinal canal, into scrotum or labia through internal inguinal ring.
Direct: abdominal contents pass medial to the IEA, directly behind the superficial inguinal ring and do not extend into scrotum.
MDs Don’t Lie. (referring to position of hernia to IEA)
What is pathognomonic for Lisfranc fracture?
Ecchymosis on the plantar surface (bottom/sole) of the foot.
Where do Spigelian hernias occur?
Spigelian hernias occur at an area of abdominal muscle weakness at the lateral edge of the rectus abdominus muscle.
What is the most commonly first reported symptom of aortic stenosis?
dyspnea > CP > syncope
Which of the following laboratory studies is most consistent with a diagnosis of Rocky Mountain spotted fever?
hyponatremia (particularly common when there is CNS involvement)
Note: WBC and hematocrit are generally normal. pt may have thrombocytopenia and mild elevation of AST/ALT.
Fever present in 99% of pts
Treatment is ALWAYS doxycycline, even in children
What is the difference between epiglotitis vs group vs bacterial tracheitis vs retropharyngeal abscess?
See image.
Retropharyngeal abscess presents with toxic appearance, drooling, muffled voice, and fever much the same as epiglottitis; however, lateral soft tissue neck radiographs will reveal prevertebral widening of the soft tissues as opposed to a “thumbprint sign.” Retropharyngeal lymph nodes tend to involute and atrophy by about 5 years of age making it a rare diagnosis in older children. Typically it presents in children between the ages of 2 and 4.
What are the differences between LeFort Fractures Type I, II,and III?
See image. LeFort Fractures II/III are associated with CSF rhinorrhea
Why do you not want to start an inuslin drip first in hyperosmolar hyperglycemic syndrome?
Insulin is not started before hydration is addressed because it causes water and electrolytes to move into the cells, potentially worsening intravascular volume depletion and hypokalemia. The recommended target for maintaining a reasonable blood sugar without a high likelihood of iatrogenic hypoglycemia is 250-300 mg/dL.
What antibiotics should be used for hepatic abscesses?
Ceftriaxone and flagyl.
What is the algorithm for pediatric pulseless arrest?
See image.
What is the diagnosis criteria for SBP?
a polymorphonuclear leukocyte count ≥ 250 cells/mm3
WBC count > 1000 cells/mm3
or pH < 7.34.
What is the diagnosis criteria of SBP for peritoneal dialysis?
See image.
Name the scoring systems of the NIHSS.
See image
What laboratory result is most suggestive of Guillain-Barré syndrome?
Albuminocytologic dissociation on CSF analysis (elevated protein with a low white blood cell count).
Is arthralgia associated with erythema nodosum?
Yes,in 90% of cases
Name and characterize the 4 hypersentivity reactions.
see attached
What should be given acutely for management of tumor lysis syndrome in the ED?
IVF. Do not start rasburicase in the ED (there are some absolute contraindications)
What are the indications for hemodialysis in tumor lysis syndrome?
- Potassium >6
- Significant renal insufficiency (Creatinine >10)
- Uric Acid >10
- Symptomatic hypocalcemia
- Serum phosphorus >10
- Volume overload
What is the calculation for uncuffed ETT in pediatric airways >2 years?
4 + (age/4)
What are the indications for urgent thoracotomy based on chest tube output?
- initial chest tube output of > 20 mL/kg (or 1500 mL)
- subsequent output of > 200 mL/hour
- persistent bleeding at a rate >7 ml/kg/h
Describe the different blast category injuries.
see image
What is the greatest predictor of emergency physician burnout?
compassion fatigue (emotional exhaustion) from contact with others
Describe the 5 Salter Harris fractures.
see attached
The plaintiff must prove that the physician violated what four legal elements to win a lawsuit?
- Duty: reasonably competent care, legal duty exists
- Breach of Duty/Abandonment
- Causation: proximate cause
- Damages: tangible injury occurred
What electrolyte abnormalities occur early in rhabdomyolysis?
Hypocalcemia (most common)
hyperkalemia
hyperphosphatemia
What diagnosis does a positive head impulse test point to in a patient with continuous vertigo?
Vestibular neuritis
Describe the difference in decompression sickness vs arterial gas embolism.
see image
What are the symptoms associated with an organic cause of psychosis?
Older patient
Sudden onset
Waxing and waning cognition
Disoriented
Aphasia
Visual hallucinations
Abnormal vital signs, physical exam
What compound is increased in rhabdomyolysis due to direct cell membrane damage?
cytoplasmic calcium concentration and ultimately apoptosis
At what gestational age is the greatest overall radiation risk?
2-8 weeks when organogenesis occurs
At what gestational age is the greatest risk to the developing central nervous system?
Weeks 10-17 of gestation
What test is helpful in ruling out the diagnosis of systemic lupus erythematosus?
antinuclear antibody
What fluid should be used to resuscitate a hypothermic patient?
Normal saline because Lactated Ringer is poorly metabolized by the cold liver.
Describe symptoms of labyrinthitis.
Labyrinthitis is a generally benign, self-limiting inflammation of the cochlear and vestibular apparatus. It may either be suppurative, caused by otitis media, mastoiditis, or meningitis, or serous, caused by an inflammatory response to a viral infection in close proximity. As such, serous labyrinthitis is typically preceded by a viral infection. Symptoms include rapid onset of severe vertigo, nausea, vomiting, and unilateral hearing loss, a distinguishing feature between labyrinthitis and vestibular neuritis. On physical exam, patients may have middle ear findings suggestive of a viral infection, such as serous fluid behind the tympanic membrane, and nystagmus, which may be unilateral, horizontal, or torsional. The Weber test is a physical exam test used to detect unilateral conductive and sensorineural hearing loss. It is conducted by striking a tuning fork and placing it on the middle of the patient’s forehead. Sound should localize to both ears equally in patients without sensorineural or conductive hearing loss. In patients with unilateral sensorineural hearing loss, such as those with labyrinthitis, sound localizes to the unaffected ear. Sound localizes to the affected ear in patients with conductive hearing loss. The diagnosis of labyrinthitis is made clinically. Symptoms may last for days to weeks. Treatment includes corticosteroids and vestibular suppressants, such as benzodiazepines and antihistamines, particularly in the acute phase.
What physical exam finding can help differentiate costochondritis?
“The crowing rooster”
The patient’s hands are placed behind their head with their neck in extension. Their pain is reproduced with posterior traction of both of their abducted elbows.
What are the indications for emergent HD in ethylene glycol ingestion?
- Glycolic acid level >8
- Ethylene glycol level >50
- Anion gap >20
- Initial pH <7.3
- Renal failure
What 2 co-factor adjuncts should be given in acute ethylene glycol overdose?
Thiamine and pyridoxine.
What are the lab abnormalities of ethylene glycol intoxication?
Labs will show anion gap metabolic acidosis, ↑ osmol gap, hypocalcemia, acute renal failure, envelope (or Maltese cross) shaped crystals in urine, fluorescent urine under Wood lamp
What is the toxic byproduct of ethylene glycol?
oxalic acid
How do you treat ethylene glycol intoxication?
fomepizole
What oral antibiotics can cover MRSA for outpatient treatment of cellulitis?
1) amoxicillin and minocycline
2) amoxicillin and doxycycline
3) trimethoprim-sulfamethoxazole
4) clindamycin.
What is atopic dermatitis?
it is eczema. It is a chronic remitting disorder of dry skin that frequently frustrates parents and patients and is sometimes referred to as “the itch that rashes.” It begins early in life between birth and six months of age and is characterized by papules and plaques that are erythematous and pruritic with occasional oozing, weeping, and crusting.
What is asteatotic eczema?
A form of dry skin that also appears as cracked skin with red fissures and scale and is usually seen in adolescents during the winter.
What is dyshidrotic eczema?
Characterized by tiny clustered vesicles usually on the palms, soles, and lateral digits.
What are symptoms of vitamin B1 (thiamine) deficiency?
Beriberi - CHF (wet beriberi), aphonia, peripheral neuropathy, Wernicke encephalopathy (nystagmus, ophthalmoplegia, ataxia), confusion, or coma
What are symptoms of vitamin B2 (riboflavin) deficiency?
Edema of mucosa membrane, angular stomatitis, glossitis, and seborrheic dermatitis (e.g. nose, scrotum)
List symptoms of vitamin deficiencies for Vitmains A, B, C, D, E, K?
A: Night vision loss, dry skin, growth retardation, Bitot spots on the conjunctiva
B1 (Thiamine): Alcohol use, malnutrition, Wernicke-Korsakoff syndrome
B2 (Riboflavin): Cheilosis, corneal vascularization (the 2 Cs of B2)
B3 (Niacin): Dermatitis, dementia, diarrhea, corn-based diet (Pellagra)
B6 (Pyridoxine): Sideroblastic anemia, convulsions, peripheral neuropathy, INH use
B12 (Cobalamin): Megaloblastic anemia + neurological symptoms, hypersegmented neutrophils
C (Ascorbic acid): Scurvy (↑ bleeding, anemia, loose teeth)
D: Rickets (children), osteomalacia, tetany
E: Anemia, peripheral neuropathy, ataxia
K: ↑ bleeding, ↑ PTT, ↑ PT
What is commonly seen in patients struck by lightening?
Paralysis of the lower extremities which are blue and mottled.
Due to transient vascular spasm and sympathetic nervous system instability, this is more commonly seen in the lower extremities and often resolves in a few hours. Keraunoparalysis is seen in up to two-thirds of patients with lightning injuries.
What are two self-limited complications of traveler’s diarrhea?
Temporary lactose intolerance and transient irritable bowel symptoms may persist for weeks after a self-resolving diarrheal illness.
Reasons to give prophylaxis antibiotics during dental procedures to prevent infective endocarditis?
see image
What is the Duke Criteria for diagnosing infective endocardiits?
Fever, Roth spots, Osler nodes, Murmur, Janeway lesions, Anemia, Nailbed hemorrhages, Emboli (FROM JANE)
What is the immediate ED management of a patient with polycythemia vera and altered mental status?
Phlebotomy of at least 500 mL of blood.
Other treatments: hydrourea, aspirin
What radiographic finding is characteristic of high altitude pulmonary edema?
patchy alveolar infiltrates, most commonly involving the right middle lobe
What medications should be avoided in aortic stenosis?
vasodilators and diuretics b/c pts with aortic stenosis are preload dependent
What is considered critical aortic stenosis?
a heart valve area of less than 0.8 cm2
What is the most common cause of neonatal chemical conjunctivitis?
Erythromycin ointment.
How do you treat chlamydial ophthalmia neonatorum, or chlamydial conjunctivitis?
Erythromycin, usually present at 5 days to 5 weeks old
How do you treat gonococcal ophthalmia neonatorum?
ceftriaxone or cefotaxime in neonate at risk of high bilirubin, presentsat 2-5 days
What does a venous stasis ulcer look like?
See image.
In contrast, arterial ulcer is most often caused by chronic changes due to peripheral artery disease (PAD). Ulceration is typically very painful and occurs at pressure points such as the base of the heel and toe joints.
What are class I recommendations for interentions or treatments?
Usually given to those interventions or treatments that are supported by large prospective studies with consistently positive results.
What are class IIa recommendations for interventions and treatments?
given to those interventions or treatments that have high levels of supporting evidence with consistently positive results
What are class IIb recommendations for interentions and treatments?
given to those interventions or treatments that have an intermediate level of evidence supporting them and will generally (but not consistently) have positive results reported in the medical literature
What are class III recommendations for interventions and treatments?
given to those interventions or treatments that are considered unacceptable, and studies may suggest or even confirm harm to patients receiving them
What medications are commonly implicated in avascular necrosis in adult patients?
Chronic steroid use and bisphosphonates (isolated to the jaw with bisphosphonates).
What are reversal agents for dabigatran?
1st line: Idarucizumab
2nd line: Activated Prothrombin Complex Concentrate (PCC)
What are the reversal agents for Rivaroxaban, apixaban, and edoxaban?
1st line: Andexanet alfa
2nd line: 4-factor unactivated prothrombin complex concentrate (PCC)
What is the difference between 4-factor and 3 factor prothrombin complex concentrate?
4-factor concentrate contains factor VII while 3-factor concentrate contains little to no factor VII.
What is the best initial management for Hemolytic uremic syndrome (HUS)?
supportive care and volume expansion with aggressive fluid resuscitation
What is the accepted PaO2 goal in ARDS?
The oxygenation goal in ARDS is often lower than other conditions. The accepted goal is generally a PaO2 of 55-80 mmHg or SpO2 88-95%.
What does a normal vs abnormal retrograde urethrogram look like?
see image
What is an ultrasound of a lipoma most likely to show?
hyperechoic (more echogenic (brighter) than normal) mass without posterior acoustic enhancement
What lesion clinically resembles a lipoma except it is painful and found primarily in children, adolescents, and individuals with HIV after starting antiretroviral therapy?
Angiolipoma
What ocular findings may be seen in RMSF?
Nonexudative conjunctivitis and periorbital edema.
What is characteristic of the rash associated with Rocky Mountain spotted fever?
centripetal rash (from ankles/wrists to trunk)
How do you manage a toddler’s fracture or hildhood accidental spiral tibial (CAST) fracture?
short leg orthopedic cast or CAM walking boot for several weeks
Occurs 9 months to 3 years
Which type of fracture of the leg would be concerning for child abuse?
Mid-shaft fracture.
What is a bowing pediatric fracture?
Longitudinal compression
Orthopedic consultation
What is a Greenstick pediatric fracture?
Axial compression with twisting
Cortex fractured on one side
Casting and reduction
What is a torus pediatric fracture?
Axial compression
Wrinkling/buckling of cortex
Distal radius (most common)
Casting
What medication is contradindicated in acute thyroid storm?
Aspirin.
Aspirin is contraindicated during thyroid storm because it displaces T4 from binding proteins leading to increased serum levels of T4 and T3 potentiating the thyrotoxicosis.
What drugs are used to treat thyroid storm and in what order?
See image
What lab value can distinguish beta blocker from calcium channel blocker toxicity?
hypoglycemia can occur in beta blocker toxicity
Which adult patients with burns should be transferred to a burn center?
Partial thickness burns > 10% TBSA; Burns involving the face, hands, feet, genitalia, perineum, and/or major joints; Any full-thickness burn; High-voltage or electrical burns; Chemical burns; Inhalation injury.
What is the Parkland Formula for burns?
Volume of LR solution = 4 ml X total BSA of burn (%) x weigth kg
- First half given over first 8 hrs
- Second half given over next 16 hours
What is the maximum amount by which the sodium can be reduced safely over 24 hours in hypernatremia?
No more than 0.5 mEq/L/h or no greater than a 10 to 12 mEq/L reduction in the serum sodium over 24 hours. The fluid of choice is D5W or oral free water if less severe, and the patient is able to tolerate oral fluids.
Which salivary gland is most frequently affected by sialolithiasis?
submandibular
What is a long term complication of mycarditis?
dilated cardiomyopathy
The most common etiology worldwide is Chagas disease, caused by the protozoan Trypanosoma cruzi.
The most common infectious cause in the United States is Parvovirus B-19.
Fracture of which of the following structures should prompt a high index of suspicion for high-energy trauma?
scapula
Fractures of the scapula are uncommon and represent < 1% of all fractures.
What is the most common complication after permanent pacemaker placement?
Pacemaker Syndrome
Occurring in up to 20% of patients after permanent pacemaker placement, is the result of loss of atrioventricular synchrony and the presence of retrograde ventriculoatrial conduction.
What is the most common organism isolated on respiratory cultures in bacterial tracheitis?
Staphylococcus aureus
What is Courvoisier sign?
an enlarged, palpable, nontender gallbladder in the presence of painless jaundice
What is the mechanism of dabigatran?
direct thrombin inhibitor
Reversal Agent: idarucizumab
What is the mechanism of action of rivaroxaban, apixaban, and edoxaban?
factor Xa inhibitors
Reversal Agent: andexanet alfa
What cough medication may cause life-threatening sodium channel blockade toxicity in children with just one dose?
Benzonatate (tessalon perles)
What is the delta ratio?
(Measured anion gap-12)/(24-measured HCO3)
See image for signifiance
What are the hard and soft signs of penetrating neck trauma?
see image
List members of the Elapidae snake family.
Coral
Cobra
Kraits
Mambas
(see image for more info)
What antibiotic regimen is most appropriate for cat bites?
Ciprofloxacin and Clindamycin.
Ciprofloxacin and other fluoroquinolones provide adequate coverage against P. Multocida, while clindamycin has adequate anaerobic coverage.
What is a complication of a retropharyngeal abscess?
nectrotizing mediastinitis
Which TB medication is contraindicated in pregnancy?
pyrazinamide
What does smallpox look like?
see image
What do the 5 letters of a pacemaker mean?
see attached
How do you manage a type I or II suprachondylar fracture?
Splinted without reduction and transferred for immediate orthopedic specialist involvement. Reduction could lead to neurovascular compromise.
What are contraindications to methotrexate use for ectopic pregnancy?
- Presence of fetal heart tones
- Ectopic gestational sac >4 cm
- Beta hCG levels above 5000
True of false: hyperbaric oxygen therapy has been shown to reduce the risk of neurologic sequelae in carbon monoxide poisoning?
True
What is the mechanism of action of phenobarbital?
Increases GABA receptor opening duration
What are the upper extremity dermatomes?
What are signs of cyclosporine toxicity?
hyperkalemia, nephrotoxicity
What are signs of azathioprine toxicity?
BM suppression, hepatotoxicity, pancreatitis
What are signs of hyperacute transplant rejection?
minutes-hours post-transplant, irreversible graft destruction, due to preformed antibodies
What are signs of acute transplant rejection?
1-12 weeks post-transplant, humoral/T-cell mediated
What are signs of chronic transplant rejection?
months-years post-transplant, tissue fibrosis
What are signs of graft-versus-host disease?
post allogeneic BMT, rash, diarrhea
What are signs of renal transplant rejection?
increased creatinine, tenderness, decreased urine output
What are signs of lung transplant rejection?
cough, chest tightness
What are signs of heart transplant rejection?
fatigue, HF, no angina/CP
What are signs of liver transplant rejection?
fever, abnormal LFTs, RUQ pain
What topical antiviral medication is recommended for herpes simplex keratitis?
Trifluridine
What is the best predictor of opioid intoxication?
bradypnea or hypoventilation
How do you treat sarcoidosis?
Prednisone burst.
Glucocorticoids can reduce serum calcium concentration by decreasing calcitriol production in the activated mononuclear cells in the lung and lymph nodes.
What medication commonly used by young women has been associated with the development of erythema nodosum?
oral contraceptives
What is the mechanism of cholinergic toxicity due to organophosphate poisoning?
Binding to the acetylcholinesterase enzyme preventing the metabolism of acetylcholine
What is the mechanism of the tetanus toxin?
Prevention of the presynaptic release of inhibitory neurotransmitters
What is the mechanism of the botulism toxin?
Inhibition of the presynaptic release of acetylcholine
What is the mechanism of myasthenia gravis?
autoantibody binding to nicotinic acetylcholine receptors
What adjunct technique has been shown to be most helpful and practical in obtaining optimal cerebrospinal fluid (CSF) volume and diagnostic quality in the infant ED patient?
Ultrasonic confirmation of the location of interspinous spaces
Name the 3 criteria for the Ottawa Ankle Rule.
(1) Tenderness at the posterior edge of the distal 6 cm or the tip of the lateral malleolus;
(2) Tenderness at the posterior edge of the distal 6 cm or the tip of the medial malleolus;
(3) Inability to bear weight for at least four steps both immediately after the injury and at the time of evaluation.
When should a foot xray be obtained when using the Ottawa Ankle Rule?
(1) Bone tenderness at the navicular bone and
(2) Inability to bear weight for at least four steps both immediately after the injury and at the time of evaluation.
(3) Bone tenderness at the base of the 5th metatarsal
What is characteristic of MDMA toxicity?
Hyponatremia, rhabdomyolysis, elevated Cr
Both sympathomimetic and serotonergic effects. Toxicity is manifested by euphoria, agitation, hyperthermia, dehydration, rhabdomyolysis, and elevated creatinine.
MDMA works by stimulating the release and inhibiting the reuptake of the following neurotransmitters: norepinephrine, dopamine, and serotonin.
What is Parinaud syndrome?
paralysis of vertical gaze
What CSF finding is most sensitive for Lyme meningitis?
Borrelia burgdorferi antibody
What are patients with Juvenile dermatomyositis at risk of developing?
pneumonia
Patients with untreated dermatomyositis are at risk of diaphragm weakness, respiratory insufficiency, and atelectasis. These patients may present with a bacterial pneumonia or pneumonitis from aspiration.
What is Felty Syndrome?
The classic triad of Felty syndrome is rheumatoid arthritis, neutropenia, and splenomegaly.
Visual differences between Condyloma lata vs Condyloma acuminata?
see image
What does erythema marginatum associated with acute rheumatic fever look like? And how do you test for acute rheumatic fever?
Antistreptolysin O titer
Which virus is found to be reactivated in half of patients with drug reaction with eosinophilia and systemic symptoms?
Human herpesvirus 6.
How do you diagnose appendicitis on ultrasound?
See image
What are the 4 evidence based ways to reduce post LP headaches?
- Use of a higher gauge spinal needle (which corresponds to a smaller caliber needle)
- Use blunt needle
- Stylet replacement before removing needle
- Direction of bevel parallel to dural fibers
How do you treat an insulinoma?
Diazoxide is used to reduce insulin secretion. Hydrochlorothiazide should be administered concurrently as it counteracts the edema and hyperkalemia caused by diazoxide. Octreotide may also be used to prevent hypoglycemia. Definitive management is by surgical resection.
If there is no history of trauma or previous infection as the cause of flexor tenosynovitis, what additional antibiotic coverage should be considered?
Ceftriaxone for disseminated gonorrhea.
What is the mechanism of action of albuterol?
Albuterol causes bronchodilation by stimulating the enzyme adenyl cyclase, which breaks down intracellular ATP and increases cyclic adenosine monophosphate (c-AMP).
