EM boards Flashcards
________ is the most common lymphoma in children between 2-12 years of age
Non-Hodgkin lymphoma
Patient in house fire + coma + anion gap metabolic acidosis + increased lactate = poisoning? Tx?
Cyanide; hydroxocobalamin
Bacterial infection of the lacrimal sac and duct of eye?
Dacryocystitis
Tx = oral antibiotics i.e. augmentin
Which hernia carries the highest risk of developing strangulation?
Femoral hernia
1st line tx for mild bleeding in von willebrand disease?
Desmopressin
Promotes release of VWF from endothelial cells
Tx of acute intravascular hemolytic rxn
IV hydration
Pt will develop tachycardia, fever, chills, back pain and pain at site of transfusion
A 1-day-old boy presents to the ED with hypotonia, diminished responsiveness, and no interest in feeding. Patient was born without significant complications and had normal labs after birth. On physical exam, you note jaundice. A total bilirubin returns with a level of 28 mg/dL. The child’s blood type is B negative. Which of the following maternal blood types would result in this child’s presentation?
Type O, Rh negative
What happens to the PT(INR)/PTT in patients with primary immune thrombocytopenia?
Normal
You are transfusing the tenth unit of packed red blood cells to a bleeding patient. Her current vital signs are BP 115/85 mm Hg, HR 110 bpm, RR 24/min, and T 35.8°C. Laboratory results reveal hemoglobin 10.1 g/dL, platelets 105,000/microliter, international normalized ratio 2.2, fibrinogen 250 mg/dL, and calcium 8.3 mg/dL. Which of the following is the most appropriate to administer?
a) citrate b) cryo c) FFP
d) platelets
FFP
Administer platelets if count is < 100,000/microliter
Administer fresh frozen plasma for international normalized ratio > 1.5
Administer cryoprecipitate if fibrinogen level is < 150–200 mg/dL
Which of the following animal envenomations is associated with heightened sensitivity to touch in the affected area, along with local numbness and weakness?
Scorpion
Hallmark sx’s of amanita phalloides ingestion? (death cap)
- Fulminant liver failure
- DIC, elevated LFT’s, hyperbili
- Renal failure
Antibiotic tx for children <1mo with meningitis? MCC
Cefotaxime + AMP
or
Gent + AMP
E. coli, GBS, L. mono, gram negs
Which pressor used if tachydysrhythmia precludes use of levo?
Phenylephrine
3 components of Ottawa Foot Rule?
- TTP navicular
- TTP of 5th metatarsal
-Inability to bear weight
Tx of TB in pregnancy?
Rifampin + isoniazid + ethambutol
Female recently began hormone-based assisted reproductive therapy and presents with nausea + abdominal pain + distension; her vitals are unstable
What should be done?
Ovarian hyper stimulation syndrome; bimanual exam contraindicated
Start ppx AC + replete volume and correct electrolytes + consult OB
Absolute contraindications to IO placement
- Fracture
- Vascular interruption
Infection associated with unilateral periorbital swelling, cardiomyopathy and mega colon
Chagas’ disease caused by Trypanosoma Cruzi
Flu-like prodrome with cyclical episodes of chills followed by fever
Malaria
Causes hemolytic anemia
Imaging modality of choice for unstable patient with suspected traumatic aortic rupture?
Unstable = TEE
Stable = CTA
What is the HR and BP goal for aortic rupture?
BP <120 and HR 60-80
Use esmolol (titratable) and nitroprusside
Which medication given for seizures may cause cardiovascular collapse, leading to hypotension and bradycardia?
Phenytoin as it is diluted with propelyne glycol
Phenytoin blocks voltage gated sodium channels
What is Wellen’s syndrome and ECG pattern seen?
Critical occlusion of the LAD
Deeply inverted or biphasic T waves in anterior precordial leads (V2-V3)
A patient with hemophilia A presents to the ED after falling from a ladder. He has a hematoma on the posterior occiput.
How to manage?
Give factor VIII immediately —> CT brain
50 IU/KG
Normal optic nerve sheath diameter
<5mm; measured 3mm posterior to globe
Triad of Ménière disease
Tinnitus, vertigo and unilateral hearing loss
4 way to prevent postdural HA
- Use small caliber needle
- Use blunt needle
- Stylet replacement before needle removal
- Direction of bevel parallel to dural fibers
Which meds should be given immediately if angle-closure glaucoma is suspected?
Topical beta-blocker (timolol) + alpha-agonist (apraclonidine) + acetazolamide
Myoclonus is a side effect of which agent used for procedural sedation?
Etomidate
Most common cardio complication of anorexia?
Mitral Valve Prolapse
How do you calculate shock index? Relevance?
= HR/systolic BP
SI >0.7 = presence of occult shock and need for transfusion
Mcc of erythema nodosum?
Streptococcus pyrogenes
In younger patients, SMA syndrome is most common following what procedure?
Corrective surgery for scoliosis
Lengthens spine and decreases angle between the SMA and aorta
What is tx for rapid reversal of warfarin?
PCC + Vit K
PCC contains factors II, VII, IX and X; can reverse the INR within minutes
What infection has been associated with the development of adult onset asthma?
Chlamydia pneumoniae
What is the primary mechanism of mortality from coral snake bites?
Temporary respiratory paralysis
*any patient who develops respiratory or neuro sx’s should be treated with anti-venom and intubation considered
What is the most common symptom of acute rheumatic fever.
When does acute rheumatic fever occur?
Migratory polyarthritis
Occurs 2-6 weeks after initial group A beta-hemolytic strep infection
JONES criteria
What is the Jones criteria for acute rheumatic fever?
J: joints; migratory polyarthritis
O: cardiac involvement
N: subcutaneous nodules
E: erythema marginatum (serpiginous rash)
S: sydenham chorea (involuntary jerking movements)
What lab finding favors a pure beta-blocker overdose vs ccb?
Hypoglycemia
Which beta blocker also has sodium channel blockade?
Propranolol
*increases QRS interval and may present with wide complex bradycardia
During neonatal resuscitation, below what heart rate should epinephrine be administered?
HR <60
An employee of a fish store develops a granulomatous lesion w/ ulceration and serosanguinous drainage. What is the culprit organism?
Mycobacterium marinum
*Tx with clarithromycin, minocycline, or TMP/SMX
Most common cause of erysipelas
Beta-hemolytic strep (S. pyogenes)
What is the dose of factor VIII replacement for major or life-threatening bleed in patient with hemophilia A?
50 IU/kg
Wt (kg) x 0.5 x % correction
What is the reversal agent for enoxaparin?
Protamine sulfate
Which anti-arrhythmic drug may enhance the anticoagulation effect of warfarin?
Amiodarone
*increased risk of bleeding
Which antibodies are most specific for SLE?
Anti-smith antibodies
Treatment of giardias?
Metronidazole 250mg TID x7 days
CSF findings in Guillain-Barré syndrome?
Albuminocytologic dissociation
High protein with low cell count
What is the lowest possible space to be considered to perform thoracentesis?
Between the eighth and ninth rib
What is the MAP goal in neurogenic shock?
What are the recommended pressors?
> 85-90 mmHg
1) NE and if necessary 2) Phenyephrine
Which lab abnormality is closely associated with breath holding spells?
Iron deficiency
Tx of anticholinergic toxidrome?
Physostigmine
Why is it important to avoid hypoxia and hypercapnia in patient with massive PE?
Can lead to pulmonary vasoconstriction
Why is positive pressure ventilation dangerous in patient with massive PE?
↑ intrathoracic pressure –> ↑ RV afterload –> ↓ RV output –> ↓ LV preload –> ↓ RV O2 delivery –> biventricular failure and circulatory collapse
Findings in central cord syndrome?
Weakness+ loss of pain + temperature > in the UE vs. LE
Findings in anterior cord syndrome?
Complete loss of motor, pain and temp below the injury
Retains proprioception and vibratory sensation
What is a Galeazzi fx?
Fracture of distal 1/3rd of radial shaft
Disruption of radioulnar joint
What is a Monteggia fracture?
Proximal to mid ulna fx
Radial head dislocation
Classic features of acute graft-versus-host disease?
Tc?
Macular or papular rash
N/V/D
Direct hypebilirubinemia
Tx: Steroids
PSGN is what type of hypersensitivity rxn?
Type III: immune complex mediated
What is the cause of encephalopathy associated with Valproic acid?
Increased ammonia levels
Tx with L-carnitine
Patchy, non-scarring areas of hair loss with peripheral hair breakage and scaling is characteristic of?
Tinea Capitis
Tx with oral terbinafine or griseofulvin
What risk factor is most strongly associated with cellulitis?
Lymphedema
What is the dominant risk factor for development of thoracic aortic aneurysm in patient <55 y/o?
Genetic predisposition
What fracture of the lower extremity has the highest risk of compartment syndrome?
Tibial plateau fracture
What is the fundoscopic finding seen in central retinal artery occlusion?
Pale retina with a hyperemic macula
cherry red macula think red = artery
How do you correct acute vs. chronic hypernatremia within 24 hrs?
Acute = fast –> 140 mmol/L
Chronic = slow –> ≤10 mmol/L
What are the criteria for giving -lytics in patient with MI?
Symptom onset within 12 hours and cannot receive primary PCI within 120 minutes
Tx for pulseless patient with torsades?
Defib
Tx of box jellyfish sting?
Acetic acid (vinegar) + hot water immersion
What is a Pott puffy tumor?
Subperiosteal abscess or osteomyelitis of the frontal bone that results from contiguous spread of frontal sinusitis.
Which TB drug is associated with retrobulbar neuritis, decreased visual acuity and red-green color blindness?
Ethambutol
Why does eyelid lac with visible fat protrusion require emergent consult to optho?
Suggests violation of orbital septum –> high risk of levator muscle damage + orbital injury
*Obtain CT orbit
An abscess in the superior natal cleft represents?
Pilonidal abscess
I&D –> surgery f/u
Abx if there surrounding erythema
1st line tx for patient with cyanide + suspected CO poisoning?
Hydroxycobalamin (5g IV over 15 mins)
*Avoid nitrate meds as there is risk of methemoglobinemia
Which symptom is high characteristic of rubella and is not seen in rubeola (measles)?
Arthralgias
How does tramadol cause seizures?
Reuptake of serotonin and NE + opioid agonist
Which atypical antipsychotic is associated with agranulocytosis?
Clozapine
*Presents as leukopenia
Which two periodic table elements are associated with aplastic anemia?
Arsenic + Gold
Presence of hematuria + proteinuria + RBC casts is suggestive of?
Acute glomerulonephritis
Earliest sign on U/S suggestive of IUP
- Gestational sac at hcg 1500 (earliest)
- Yolk sac (1st definitive sign)
What is a key differentiating factor between pulmonary effects of tularemia vs. anthrax?
Anthrax = widened mediastinum + hemoptysis
How are high-pressure injection injuries treated and injection of what causes the most severe injury?
Surgical emergency!
Paint solvents
What measurements are indicative of compartment syndrome?
Compartment pressure: >30 mmHg
Delta pressure: <30 mmHg (DBP - compartment pressure)
In addition to fomepizole, a patient with ethylene glycol tox should receive?
Thiamine and pyridoxine
What antibiotic can be used as an alternative to clindamycin for toxin suppression in toxic shock syndrome?
Linezolid
When should erythema multiforme be treated with oral corticosteroids?
Significant mucous membrane involvement
Tx of pituitary apoplexy?
Urgent NS decompression or high-dose IV steroids
How should steroids be prescribed in acute illness associated with adrenal insufficiency?
3x increase in dose x3 days
The 3x3 rule
What imaging study has the highest sensitivity and specificity for the diagnosis of acute cholecystitis?
HIDA scan
Which antibiotic, when used chronically in patients with cystic fibrosis, has an anti-inflammatory effect that decreases the frequency of pulmonary exacerbations?
Azithromycin
What symptom differentiates Meniere disease from other causes of vertigo?
Tinnitus
First line for anticholinergic toxidrome?
Benzo’s + cooling –> consider physostigmine
Which test should be performed in an infant presenting with rectal prolapse?
Sweat Chloride
*Cystic Fibrosis is major cause
Which finding is most suggestive of chronic hypo-parathyroidism?
Chronic mucocutaneous candidiasis
2 hallmark findings of TTP?
Microangiopathic hemolytic anemia
+
Thrombocytopenia
What toxidrome is caused by Jimson Weed? Tx?
- Anti-cholinergic
- Physostigmine (AChE inhibitor)
Blind as a bat, red as beet, mad as a hatter, dry as a bone, hot as a desert
A patient who recently had an MI presents with fever, pleuritic chest pain and a pericardial effusion.
Post-MI syndrome (Dressler)
Window for TPA?
4.5 hours
Earliest sonographic finding of cardiac tamponade?
Right atrial collapse
4 steps to managing bleeding tracheostomy site?
- Overinflation of cuff (up to 50mL air)
- Endotracheal intubation
- Remove tracheostomy tube
- Digitally compress innominate artery.
+002
All patients suspected of being bitten by a coral snake should be monitored how?
- Monitor for neuromuscular sx’s
- Pulmonary function testing
- Neuro checks
*THINK BOTULISM
Which priapism is painful/painless? causes?
pH?
High flow = painless; traumatic AV fistula; pH 7.4
Low flow = painful; med, SSD, malignancy; pH <7.25
What is a Hangman Fracture; caused by?
B/l fracture or displacement of C2 pedicles
Wide canal at C2
Hyperextension injury
What is the most common MISSED caused of bilateral leg swelling?
Pulmonary HTN
What is the goal PaCO2 for patients with elevated intracranial pressure (ICP) who are being mechanically ventilated?
30-35 mm Hg
Optimal method for measuring core temp in severe hypothermia (<28 C)?
Esophageal (distal 1/3rd)
Gold standard for diagnosing necrotizing fasciitis?
Surgical exploration
Define gestational HTN
BP >140/90 after 20th week of pregnancy or immediately post-partum
What is the only opioid safe to take with an MAO inhibitor?
Morphine
Most common hernia
Indirect (2x more common)
*Protrude through internal inguinal ring –> lateral to inferior epigastric vessels
SBP is often associated with renal failure; what has been shown to decrease the incidence of this complication
Albumin
An awake and alert patient presenting 2 hours after OD of tylenol should receive what?
Activated charcoal
2 common risks associated with nephrotic syndrome
- Thromboembolic events
- Severe infection
*Due to loss of complement, antibodies and immune-related proteins in urine
What is characteristic of the rash seen with RMSF?
Starts on wrists and ankles and spreads inward (centripetal)
What paralytic should be used for myasthenia crisis?
Non-depolarizing agent (Roc) at 1/2 the dose
Glucose levels in beta-blocker vs. CCB OD?
Beta-blocker = hypo
CCB = hyper
Describe the Ortolani and Barlow test.
Ortolani: thigh ABducted –> femoral head relocates anterior into acetabulum
Barlow: hip ADDucted; femoral head dislocates POSTERIOR
Which type of urethral injury are perineal hematoma (straddle injury) more often associated with?
Anterior urethral injury
What med regimen has been shown to prolong survival and is treatment of choice for 36-week pregnant patient with peripartum cardiomyopathy?
Hydralazine + nitrates
When is a patient’s risk for future stroke highest following TIA?
First 2 days (50%)
What therapy is contraindicated for a first-time presentation of demyelinating optic neuritis?
Oral prednisone
What complication is seen 4-6 weeks after hepatitis?
Aplastic anemia
What 4 symptoms are commonly seen with posterior reversible encephalopthy syndrome?
1) HA
2) AMS
3) Visual disturbances
4) Seizure
MCC of erysipelas?
Strep pyogenes
Most common hernia to strangulate?
Femoral > indirect > direct
What infectious organism is associated with intussusception?
Rota virus
1st line tx of C. diff
ORAL vanc
What is the core temp goal in cardiac arrest/hypothermic patient before terminating resuscitation efforts?
32C
What differentiates PTSD from grief?
Fearful nightmares
MCC of neonatal seizures?
Hypoxic ischemic encephalopathy
Neonatal seizure = first 30 days of life
MCC ataxia in children?
Acute cerebellar ataxia
Occurs 2 weeks after a viral illness
More common in child <6 y/o
Indirect inguinal hernias occur as a result of incomplete closure of which stricture?
Processus vaginalis
The absence of involvement of what joint distinguishes RA from OA?
DIP
*RA spares the distal joints
MCC injured organ in BLUNT abdominal trauma?
Liver
Which policy was established by the United States government to provide grants to support mental health and resiliency in healthcare workers?
Dr. Lorna Breen Health Care Provider Protection Act
What finding distinguishes cauda equina syndrome from conus medullaris syndrome?
Absence of upper motor neuron signs
UMN signs: increased muscle tone, hyperreflexia, upgoing plantar response (Babinski)
Most common site of pathologic fracture from metastatic disease?
Femur, humerus, tibia (long bones)
What lab finding is most likely to be noted in discitis?
Elevated ESR
What is the MCC of mortality in patients presenting with hypothermia?
Pulmonary edema
What clinical finding distinguishes labyrinthitis from vestibular neuritis?
Labyrinthitis presents with hearing loss
What is a normal E-point septal separation?
<7mm and >10 = heart failure
When do you give PTU before propranolol in thyroid storm?
Signs of heart failure
Reversal for direct thrombin inhibitor vs. factor Xa inhibitor?
Direct thrombin (dabigatran) = idarucizumab
Factor Xa (rivaroxaban, apixiban) = andexanet alfa
Which tick-borne illness is caused by gram-negative coccobacillus?
Tularemia
CBD diameter to suggest choledocholithiasis?
≥6mm
What rash is associated with the Epstein-Barr virus?
Papular acrodermatitis (i.e., Gianotti-Crosti)
What bone is fractured in the presence of CSF rhinorrhea?
Ethmoid (cribiform plate)
What clinical finding is pathognomonic for Leptospirosis?
Conjunctival suffusion (redness w/o exudates)
Tx with doxy, PCN or azithro
What is the hemoglobin goal for a patient with acute chest syndrome?
10 g/dL
Most common severe complication of primary varicella infection in children?
Bacterial skin infection i.e. cellulitis, myositis, nec fasc, TSS
Which lung CA is associated with hypercalcemia?
SIADH?
Hypercalcemia –> Squamous cell carcinoma
SIADH –> Small cell
What do you need to monitor closely in patient with abdominal compartment syndrome?
Urine output –> surrogate marker of the severity of the compartment syndrome
Absolute contraindication to using physostigmine?
QRS widening
Minimum platelet count for LP?
50k
What is the MOA for acetazolamide use in treating altitude sickness?
Induces mild metabolic acidosis through loss of bicarb in urine –> increase RR and improves oxygenation
*mirrors physio adaption to altitude
Most common cardiac manifestation of lyme disease?
Palpitations
Which beta-blocker is associated with delayed toxicity?
Sotalol
Which area of brain most susceptible to damage from hydrostatic edema in the setting of acute HTN from posterior reversible encephalopathy syndrome?
Occipital lobe
PCO2 goal on capnography in an intubated patient who sustained moderate TBI?
35 to 45 mm Hg
Resuscitative hysterotomy must be performed how quickly?
Within 4 minutes of cardiac arrest in patient >24 weeks pregnant
Which antiepileptic can lead to hypotension and bradycardia?
Pheytoin
Regimen for tx of latent TB?
Rifampin + isoniazid x3 months
What ankle-brachial index (ABI) is suggestive of PAD?
ABI <0.9
What is the only 3rd gen cephalosporin with Pseudomonas coverage?
Ceftazidime
Which cause of bloody diarrhea is common in Scandinavia and Europe?
Yersinia Enterocolitica
Can present as pseudo-appendicitis
Tx severe dz with TMP-SMX or fluoroquinolone
MCC foodborne bacterial enteritis in Japan?
Vibrio parahaemolyticus
Oysters, clams, shrimps, crabs
Which bacterial gastroenteritis is associated with febrile seizures?
Shigella
A bite from which snake family can result in neurotoxicity (ptosis, vertigo, paresthesias, slurred speech, etc.) & respiratory failure?
Elapidae = coral snakes
2 major side effects procainamide?
Hypotension & prolonged QT
What age is cricothyrotomy contraindicated?
<10-12 y/o
Which drug to tx vaginal bleeding should be avoided in asthma?
Carboprost
4 MCC’s of afferent pupillary defect?
1) CRVO
2) CRAO
3) Optic neuritis
4) Retrobulbar neuritis
When to use overdrive pacing?
Torsades
Most common bacteria implicated in Lemierr syndrome?
Fusobacterium
Which size ET tube for infant born <28 weeks, 28-34 weeks and 34-38 weeks?
< 28 = 2.5 cuffed
28-34 = 3.0 cuffed
34-38 = 3.5 cuffed
Most common cause of massive hemoptysis worldwide?
Tuberculosis
MCC of drug induced neutropenia in children?
Antibiotics i.e. macrolides, cephalosporins and PCN
Therapeutic hypothermia effect on glucose?
Hypoglycemia due to insulin resistance
What therapy should be started in patient with scleroderma experiencing renal crises?
ACE inhibitor
MCC of bacterial superinfection complicating influenza virus infection?
Strep pneumoniae
Differentiate anterior vs. central cord syndrome.
Anterior: loss of motor, pain and temp below injury (poor prognosis)
Central cord: sensory and motor deficit upper > lower extremities
Which vaginal infection is associated with pH <4.5?
Candida
Most common pediatric CNS tumor
Medulloblastoma
Quadruple therapy for H. pylori
- Bismuth
- Metronidazole
- Tetracycline
- PPI
Definition (%) of a small PTX
<20% of lung volume
Best first step in management of vaso-occlusive crises?
Analgesia
Most common congenital heart defect
VSD (holosystolic murmur at left sternal border)
When is expected nadir (days) for neutrophil count following chemo?
6-10 days
If cluster HA fails to improve with O2 what is next tx?
Sumatriptan
What electrolyte abnormality commonly causes ileus?
HypoKalemia
Biggest RF for developing spinal epidural abscess?
DIABETES
What abnormal test result is the earliest indicator of biological damage from whole-body penetrating irradiation?
Lymphopenia
Which med is contraindicated in the setting of sickle cell patients with hyphema?
Acetazolamide
Major cause of respiratory insufficiency in flail chest?
Pulmonary contusion
Upper limit of normal for GB wall thickness? CBD?
GB wall = 3mm
CBD = 7mm
When to give steroids in premature labor?
<34 weeks
*Also give ABx (i.e., ampicillin, amox, azitho)
Which med is most helpful in non-fatal drowning victim?
Inhaled beta-agonist
Glucagon is most helpful in which overdose (BB or CCB)?
Beta-blocker
MCC of septic shock in pregnancy?
Pyelonephritis
MCC of traumatic ureteral injury?
GSW
MCC of hospitalization in peds with varicella?
Skin and soft tissue infection
What med can be given for ACE-inhibitor-induced angioedema?
TXA
Which HIV med is known to cause depression, psychosis and nightmares?
Efavirenz
Threshold for ordering platelets
<50k
In patients with HIV and pneumocystis pneumonia, what are 3 indications for steroids?
- PaO2 <70 mmHg
- A-a gradient >35
-SpO2 <92% of RA
Which finding distinguishes uterine rupture from placental abruption?
Tetanic uterine contractions (uterine rupture)
Transfer to PCI center for patient with MI is recommended in what time frame?
Within 2 hours of presentation
What therapy should be initiated in ARDS patient with hypoxemia refractory to ventilator titration and aggressive sedation?
Neuromuscular blockade
Which med is contraindicated in sickle cell patient presenting with increased IOP?
- Carbonic anhydrase inhibitor
- ↓ aqueous pH –> RBC sickle and can lead to further elevation of IOP
What 2 drug classes decrease production of aqueous humor
- Beta-blockers
- Alpha-agonists
Reversal for heparin
Protamine
Should pregnant patient receive MMR vaccine?
- No it’s contraindicated
- Give IVIG for PEP
Organisms that require airborne precautions
- Measles
- Varicella
- TB
- Disseminated herpes zoster
- SARS
Calculations for sensitivity, specificity, PPV and NPV
Sens = TP/ (TP+FN)
Spec = TN/(TN+FP)
PPV = TP/(TP+FP)
NPV = TN/(TN+FN)
Which therapy for pericarditis can prevent recurrence?
Colchicine
1-2 mg x1 day –> 0.5-1 mg/day x3 months
Abx associated with nonconvulsive status epilepticus
- Beta-lactams i.e. ceph’s, PCN’s
- Fluoroquinolones
What should be given to bleeding patient with severe von Willebrand disease?
Factor VIII: 25-50 U/Kg
Also Desmopressin
1st line tx for orthodromic AVRT in WPW?
Adenosine
Orthodromic will be narrow
What should be given to patient with cerebral venous thrombosis associated with small parietal intraparenchymal hematoma?
Heparin
Tx of amebic dysentery and hepatic abscess (E. Histolytica)?
- Metronidazole
or - Tinidazole
Paromomycin if preg
What is adequate urine output during fluid resus?
0.5-1 mL/kg/hr (adults)
1-1.5 mL/kg/hr (child)
What to give for SBP if patient can’t receive cephalosporin?
Cipro or levo
MCC of viral myositis?
Influenza A and B
1st line tx for scleroderma renal crises?
Captopril
*May add nitroprusside for severe HTN
Which med to avoid in pheochromocytoma?
Glucocorticoids
Most common causes of drug-induced mysasthenia crisis?
- Aminoglycosides
- Macrolides
- Fluoroquinolones
- Beta-blockers
- Procainamide
- Magnesium
- Anti-malarials
Inappropriate pacemaker impulses that occur soon after intrinsic depolarizations is known as?
Undersensing
Graft versus host disease is most common in what transplant?
Stem cell; occurs in up to 50% of allogenic hematopoietic stem cell transplants
Volkmann contracture is a complication most commonly associated with what type of injury?
- Supracondylar fx of distal humerus
- Claw-like flexion of the fingers and wrist
- Brachial artery injury –> forearm compartment syndrome
Tx for giardia diarrhea?
Metronidazole or Tinidazole or Furazolidone
*Single dose
Antibiotic regimen of choice for treating Ludwig’s angina in patient with severe PCN allergy?
Levofloxacin + Metronidazole
What injury is associated with an avulsion deformity art the base of proximal phalanx of the thumb?
Ulnar collateral ligament injury = skier’s thumb
Type IV hypersensitivity reactions involve which immune cells?
CD4+ T lymphocytes
What on CSF analysis helps differentiate fungal meningitis?
Extremely elevated protein level
Therapy of choice for acute limb ischemia?
Unfractionated heparin
1st line tx options for ppx of Neisseria meningitis?
- Rifampin
- Ciprofloxacin
- Ceftriaxone (pregnancy)
Age range for using Ottawa SAH rule?
14-39
Why is it important to add potassium when treating salicylate OD?
Hypokalemia –> urine acidemia via H+ excretion –> increased salicylate reabsorption
Winter’s forumla
PaCO2 = [(1.5 x measured HCO3) + 8] +/- 2
Double bubble sign is seen in
Duodenal atresia
String sign is seen in
Pyloric stenosis
Platelet count in HSP?
Normal despite purpura
What medication is recommended for managing refractory pediatric cardiac arrest 2/2 Vfib?
Amiodarone (5mg/kg over 20-60 mins)
Most common serious side effect of tacrolimus?
Nephrotoxicity
What physiologic VS change in pregnancy is most important to consider during trauma evaluation?
Delayed onset of hypotension in the setting of blood loss
Where should central line be placed in SVC syndrome
Femoral Vein
Elevated opening pressure during VP shunt tap indicates
Distal catheter obstruction
*Proximal is most common site
Ppx for migraines
Propranolol
After aggressive hydration what can be given to treat hypercalcemia?
IV bisphosphonates: zoledronic acid or pamidronate
*Dialysis is an option
What med can improve symptoms of chronic cough associated with GERD after a PPI?
Gabapentin
Calculating MAP
DBP + 1/3 (SBP-DBP)
Aggressive periosteal reaction + medullary and cortical bone destruction with a moth-eaten appearance.
Osteosarcoma
Tx of Bell’s Palsy
Prednisone 60-80 mg/day x7 days and started within 72 hours of symptoms
Blood supply to SA node?
RCA –> inferior MI –> bradycardia
Most SPECIFIC finding on EKG for PE?
T-wave inversion in inferior and right precordial leads
What electrolyte abnormality is associated with myxedema coma?
Hyponatremia
Excess vasopressin = impaired free water excretion
Which envenomation can cause abdominal pain and muscle cramping that can closely mimic an acute surgical abdomen
Black Widow
1st med given for traumatic iritis
Topical cyclopentolate or scopolamine
Antimuscarinics cause mydriasis and cycloplegia
Dispo for Legg-Calve-Perthes disease
Weight-bearing as tolerated, symptomatic management and outpatient ortho referral
Anti-psychotics with highest associated risk of weight gain, dyslipidemia and diabetes
Olanzapine and Clozapine
