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EM boards Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

________ is the most common lymphoma in children between 2-12 years of age

A

Non-Hodgkin lymphoma

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2
Q

Patient in house fire + coma + anion gap metabolic acidosis + increased lactate = poisoning? Tx?

A

Cyanide; hydroxocobalamin

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3
Q

Bacterial infection of the lacrimal sac and duct of eye?

A

Dacryocystitis

Tx = oral antibiotics i.e. augmentin

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4
Q

Which hernia carries the highest risk of developing strangulation?

A

Femoral hernia

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5
Q

1st line tx for mild bleeding in von willebrand disease?

A

Desmopressin

Promotes release of VWF from endothelial cells

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6
Q

Tx of acute intravascular hemolytic rxn

A

IV hydration

Pt will develop tachycardia, fever, chills, back pain and pain at site of transfusion

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7
Q

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?

A

Type O, Rh negative

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8
Q

What happens to the PT(INR)/PTT in patients with primary immune thrombocytopenia?

A

Normal

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9
Q

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

A

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

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10
Q

Which of the following animal envenomations is associated with heightened sensitivity to touch in the affected area, along with local numbness and weakness?

A

Scorpion

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11
Q

Hallmark sx’s of amanita phalloides ingestion? (death cap)

A
  • Fulminant liver failure
  • DIC, elevated LFT’s, hyperbili
  • Renal failure
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12
Q

Antibiotic tx for children <1mo with meningitis? MCC

A

Cefotaxime + AMP
or
Gent + AMP

E. coli, GBS, L. mono, gram negs

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13
Q

Which pressor used if tachydysrhythmia precludes use of levo?

A

Phenylephrine

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14
Q

3 components of Ottawa Foot Rule?

A
  • TTP navicular
  • TTP of 5th metatarsal
    -Inability to bear weight
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15
Q

Tx of TB in pregnancy?

A

Rifampin + isoniazid + ethambutol

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16
Q

Female recently began hormone-based assisted reproductive therapy and presents with nausea + abdominal pain + distension; her vitals are unstable

What should be done?

A

Ovarian hyper stimulation syndrome; bimanual exam contraindicated

Start ppx AC + replete volume and correct electrolytes + consult OB

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17
Q

Absolute contraindications to IO placement

A
  • Fracture
  • Vascular interruption
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18
Q

Infection associated with unilateral periorbital swelling, cardiomyopathy and mega colon

A

Chagas’ disease caused by Trypanosoma Cruzi

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19
Q

Flu-like prodrome with cyclical episodes of chills followed by fever

A

Malaria

Causes hemolytic anemia

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20
Q

Imaging modality of choice for unstable patient with suspected traumatic aortic rupture?

A

Unstable = TEE
Stable = CTA

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21
Q

What is the HR and BP goal for aortic rupture?

A

BP <120 and HR 60-80

Use esmolol (titratable) and nitroprusside

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22
Q

Which medication given for seizures may cause cardiovascular collapse, leading to hypotension and bradycardia?

A

Phenytoin as it is diluted with propelyne glycol

Phenytoin blocks voltage gated sodium channels

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23
Q

What is Wellen’s syndrome and ECG pattern seen?

A

Critical occlusion of the LAD

Deeply inverted or biphasic T waves in anterior precordial leads (V2-V3)

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24
Q

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?

A

Give factor VIII immediately —> CT brain

50 IU/KG

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25
Q

Normal optic nerve sheath diameter

A

<5mm; measured 3mm posterior to globe

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26
Q

Triad of Ménière disease

A

Tinnitus, vertigo and unilateral hearing loss

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27
Q

4 way to prevent postdural HA

A
  • Use small caliber needle
  • Use blunt needle
  • Stylet replacement before needle removal
  • Direction of bevel parallel to dural fibers
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28
Q

Which meds should be given immediately if angle-closure glaucoma is suspected?

A

Topical beta-blocker (timolol) + alpha-agonist (apraclonidine) + acetazolamide

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29
Q

Myoclonus is a side effect of which agent used for procedural sedation?

A

Etomidate

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30
Q

Most common cardio complication of anorexia?

A

Mitral Valve Prolapse

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31
Q

How do you calculate shock index? Relevance?

A

= HR/systolic BP

SI >0.7 = presence of occult shock and need for transfusion

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32
Q

Mcc of erythema nodosum?

A

Streptococcus pyrogenes

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33
Q

In younger patients, SMA syndrome is most common following what procedure?

A

Corrective surgery for scoliosis

Lengthens spine and decreases angle between the SMA and aorta

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34
Q

What is tx for rapid reversal of warfarin?

A

PCC + Vit K

PCC contains factors II, VII, IX and X; can reverse the INR within minutes

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35
Q

What infection has been associated with the development of adult onset asthma?

A

Chlamydia pneumoniae

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36
Q

What is the primary mechanism of mortality from coral snake bites?

A

Temporary respiratory paralysis

*any patient who develops respiratory or neuro sx’s should be treated with anti-venom and intubation considered

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37
Q

What is the most common symptom of acute rheumatic fever.

When does acute rheumatic fever occur?

A

Migratory polyarthritis

Occurs 2-6 weeks after initial group A beta-hemolytic strep infection

JONES criteria

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38
Q

What is the Jones criteria for acute rheumatic fever?

A

J: joints; migratory polyarthritis
O: cardiac involvement
N: subcutaneous nodules
E: erythema marginatum (serpiginous rash)
S: sydenham chorea (involuntary jerking movements)

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39
Q

What lab finding favors a pure beta-blocker overdose vs ccb?

A

Hypoglycemia

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40
Q

Which beta blocker also has sodium channel blockade?

A

Propranolol

*increases QRS interval and may present with wide complex bradycardia

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41
Q

During neonatal resuscitation, below what heart rate should epinephrine be administered?

A

HR <60

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42
Q

An employee of a fish store develops a granulomatous lesion w/ ulceration and serosanguinous drainage. What is the culprit organism?

A

Mycobacterium marinum

*Tx with clarithromycin, minocycline, or TMP/SMX

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43
Q

Most common cause of erysipelas

A

Beta-hemolytic strep (S. pyogenes)

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44
Q

What is the dose of factor VIII replacement for major or life-threatening bleed in patient with hemophilia A?

A

50 IU/kg

Wt (kg) x 0.5 x % correction

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45
Q

What is the reversal agent for enoxaparin?

A

Protamine sulfate

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46
Q

Which anti-arrhythmic drug may enhance the anticoagulation effect of warfarin?

A

Amiodarone

*increased risk of bleeding

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47
Q

Which antibodies are most specific for SLE?

A

Anti-smith antibodies

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48
Q

Treatment of giardias?

A

Metronidazole 250mg TID x7 days

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49
Q

CSF findings in Guillain-Barré syndrome?

A

Albuminocytologic dissociation

High protein with low cell count

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50
Q

What is the lowest possible space to be considered to perform thoracentesis?

A

Between the eighth and ninth rib

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51
Q

What is the MAP goal in neurogenic shock?

What are the recommended pressors?

A

> 85-90 mmHg

1) NE and if necessary 2) Phenyephrine

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52
Q

Which lab abnormality is closely associated with breath holding spells?

A

Iron deficiency

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53
Q

Tx of anticholinergic toxidrome?

A

Physostigmine

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54
Q

Why is it important to avoid hypoxia and hypercapnia in patient with massive PE?

A

Can lead to pulmonary vasoconstriction

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55
Q

Why is positive pressure ventilation dangerous in patient with massive PE?

A

↑ intrathoracic pressure –> ↑ RV afterload –> ↓ RV output –> ↓ LV preload –> ↓ RV O2 delivery –> biventricular failure and circulatory collapse

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56
Q

Findings in central cord syndrome?

A

Weakness+ loss of pain + temperature > in the UE vs. LE

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57
Q

Findings in anterior cord syndrome?

A

Complete loss of motor, pain and temp below the injury

Retains proprioception and vibratory sensation

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57
Q

What is a Galeazzi fx?

A

Fracture of distal 1/3rd of radial shaft

Disruption of radioulnar joint

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57
Q

What is a Monteggia fracture?

A

Proximal to mid ulna fx

Radial head dislocation

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58
Q

Classic features of acute graft-versus-host disease?

Tc?

A

Macular or papular rash

N/V/D

Direct hypebilirubinemia

Tx: Steroids

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59
Q

PSGN is what type of hypersensitivity rxn?

A

Type III: immune complex mediated

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60
Q

What is the cause of encephalopathy associated with Valproic acid?

A

Increased ammonia levels

Tx with L-carnitine

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61
Q

Patchy, non-scarring areas of hair loss with peripheral hair breakage and scaling is characteristic of?

A

Tinea Capitis

Tx with oral terbinafine or griseofulvin

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62
Q

What risk factor is most strongly associated with cellulitis?

A

Lymphedema

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63
Q

What is the dominant risk factor for development of thoracic aortic aneurysm in patient <55 y/o?

A

Genetic predisposition

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64
Q

What fracture of the lower extremity has the highest risk of compartment syndrome?

A

Tibial plateau fracture

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65
Q

What is the fundoscopic finding seen in central retinal artery occlusion?

A

Pale retina with a hyperemic macula

cherry red macula think red = artery

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66
Q

How do you correct acute vs. chronic hypernatremia within 24 hrs?

A

Acute = fast –> 140 mmol/L

Chronic = slow –> ≤10 mmol/L

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67
Q

What are the criteria for giving -lytics in patient with MI?

A

Symptom onset within 12 hours and cannot receive primary PCI within 120 minutes

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68
Q

Tx for pulseless patient with torsades?

A

Defib

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69
Q

Tx of box jellyfish sting?

A

Acetic acid (vinegar) + hot water immersion

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70
Q

What is a Pott puffy tumor?

A

Subperiosteal abscess or osteomyelitis of the frontal bone that results from contiguous spread of frontal sinusitis.

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71
Q

Which TB drug is associated with retrobulbar neuritis, decreased visual acuity and red-green color blindness?

A

Ethambutol

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72
Q

Why does eyelid lac with visible fat protrusion require emergent consult to optho?

A

Suggests violation of orbital septum –> high risk of levator muscle damage + orbital injury

*Obtain CT orbit

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73
Q

An abscess in the superior natal cleft represents?

A

Pilonidal abscess

I&D –> surgery f/u

Abx if there surrounding erythema

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74
Q

1st line tx for patient with cyanide + suspected CO poisoning?

A

Hydroxycobalamin (5g IV over 15 mins)

*Avoid nitrate meds as there is risk of methemoglobinemia

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75
Q

Which symptom is high characteristic of rubella and is not seen in rubeola (measles)?

A

Arthralgias

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76
Q

How does tramadol cause seizures?

A

Reuptake of serotonin and NE + opioid agonist

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77
Q

Which atypical antipsychotic is associated with agranulocytosis?

A

Clozapine

*Presents as leukopenia

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78
Q

Which two periodic table elements are associated with aplastic anemia?

A

Arsenic + Gold

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79
Q

Presence of hematuria + proteinuria + RBC casts is suggestive of?

A

Acute glomerulonephritis

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80
Q

Earliest sign on U/S suggestive of IUP

A
  • Gestational sac at hcg 1500 (earliest)
  • Yolk sac (1st definitive sign)
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81
Q

What is a key differentiating factor between pulmonary effects of tularemia vs. anthrax?

A

Anthrax = widened mediastinum + hemoptysis

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82
Q

How are high-pressure injection injuries treated and injection of what causes the most severe injury?

A

Surgical emergency!

Paint solvents

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83
Q

What measurements are indicative of compartment syndrome?

A

Compartment pressure: >30 mmHg

Delta pressure: <30 mmHg (DBP - compartment pressure)

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84
Q

In addition to fomepizole, a patient with ethylene glycol tox should receive?

A

Thiamine and pyridoxine

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85
Q

What antibiotic can be used as an alternative to clindamycin for toxin suppression in toxic shock syndrome?

A

Linezolid

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86
Q

When should erythema multiforme be treated with oral corticosteroids?

A

Significant mucous membrane involvement

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87
Q

Tx of pituitary apoplexy?

A

Urgent NS decompression or high-dose IV steroids

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88
Q

How should steroids be prescribed in acute illness associated with adrenal insufficiency?

A

3x increase in dose x3 days

The 3x3 rule

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89
Q

What imaging study has the highest sensitivity and specificity for the diagnosis of acute cholecystitis?

A

HIDA scan

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90
Q

Which antibiotic, when used chronically in patients with cystic fibrosis, has an anti-inflammatory effect that decreases the frequency of pulmonary exacerbations?

A

Azithromycin

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91
Q

What symptom differentiates Meniere disease from other causes of vertigo?

A

Tinnitus

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92
Q

First line for anticholinergic toxidrome?

A

Benzo’s + cooling –> consider physostigmine

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93
Q

Which test should be performed in an infant presenting with rectal prolapse?

A

Sweat Chloride

*Cystic Fibrosis is major cause

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94
Q

Which finding is most suggestive of chronic hypo-parathyroidism?

A

Chronic mucocutaneous candidiasis

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95
Q

2 hallmark findings of TTP?

A

Microangiopathic hemolytic anemia

+

Thrombocytopenia

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96
Q

What toxidrome is caused by Jimson Weed? Tx?

A
  • Anti-cholinergic
  • Physostigmine (AChE inhibitor)

Blind as a bat, red as beet, mad as a hatter, dry as a bone, hot as a desert

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97
Q

A patient who recently had an MI presents with fever, pleuritic chest pain and a pericardial effusion.

A

Post-MI syndrome (Dressler)

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98
Q

Window for TPA?

A

4.5 hours

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99
Q

Earliest sonographic finding of cardiac tamponade?

A

Right atrial collapse

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100
Q

4 steps to managing bleeding tracheostomy site?

A
  1. Overinflation of cuff (up to 50mL air)
  2. Endotracheal intubation
  3. Remove tracheostomy tube
  4. Digitally compress innominate artery.
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101
Q

+002
All patients suspected of being bitten by a coral snake should be monitored how?

A
  • Monitor for neuromuscular sx’s
  • Pulmonary function testing
  • Neuro checks

*THINK BOTULISM

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102
Q

Which priapism is painful/painless? causes?
pH?

A

High flow = painless; traumatic AV fistula; pH 7.4

Low flow = painful; med, SSD, malignancy; pH <7.25

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103
Q

What is a Hangman Fracture; caused by?

A

B/l fracture or displacement of C2 pedicles

Wide canal at C2

Hyperextension injury

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104
Q

What is the most common MISSED caused of bilateral leg swelling?

A

Pulmonary HTN

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105
Q

What is the goal PaCO2 for patients with elevated intracranial pressure (ICP) who are being mechanically ventilated?

A

30-35 mm Hg

106
Q

Optimal method for measuring core temp in severe hypothermia (<28 C)?

A

Esophageal (distal 1/3rd)

107
Q

Gold standard for diagnosing necrotizing fasciitis?

A

Surgical exploration

108
Q

Define gestational HTN

A

BP >140/90 after 20th week of pregnancy or immediately post-partum

109
Q

What is the only opioid safe to take with an MAO inhibitor?

A

Morphine

110
Q

Most common hernia

A

Indirect (2x more common)

*Protrude through internal inguinal ring –> lateral to inferior epigastric vessels

111
Q

SBP is often associated with renal failure; what has been shown to decrease the incidence of this complication

A

Albumin

112
Q

An awake and alert patient presenting 2 hours after OD of tylenol should receive what?

A

Activated charcoal

113
Q

2 common risks associated with nephrotic syndrome

A
  • Thromboembolic events
  • Severe infection

*Due to loss of complement, antibodies and immune-related proteins in urine

114
Q

What is characteristic of the rash seen with RMSF?

A

Starts on wrists and ankles and spreads inward (centripetal)

115
Q

What paralytic should be used for myasthenia crisis?

A

Non-depolarizing agent (Roc) at 1/2 the dose

116
Q

Glucose levels in beta-blocker vs. CCB OD?

A

Beta-blocker = hypo
CCB = hyper

117
Q

Describe the Ortolani and Barlow test.

A

Ortolani: thigh ABducted –> femoral head relocates anterior into acetabulum

Barlow: hip ADDucted; femoral head dislocates POSTERIOR

118
Q

Which type of urethral injury are perineal hematoma (straddle injury) more often associated with?

A

Anterior urethral injury

119
Q

What med regimen has been shown to prolong survival and is treatment of choice for 36-week pregnant patient with peripartum cardiomyopathy?

A

Hydralazine + nitrates

120
Q

When is a patient’s risk for future stroke highest following TIA?

A

First 2 days (50%)

121
Q

What therapy is contraindicated for a first-time presentation of demyelinating optic neuritis?

A

Oral prednisone

122
Q

What complication is seen 4-6 weeks after hepatitis?

A

Aplastic anemia

123
Q

What 4 symptoms are commonly seen with posterior reversible encephalopthy syndrome?

A

1) HA
2) AMS
3) Visual disturbances
4) Seizure

124
Q

MCC of erysipelas?

A

Strep pyogenes

125
Q

Most common hernia to strangulate?

A

Femoral > indirect > direct

126
Q

What infectious organism is associated with intussusception?

A

Rota virus

127
Q

1st line tx of C. diff

A

ORAL vanc

128
Q

What is the core temp goal in cardiac arrest/hypothermic patient before terminating resuscitation efforts?

A

32C

129
Q

What differentiates PTSD from grief?

A

Fearful nightmares

130
Q

MCC of neonatal seizures?

A

Hypoxic ischemic encephalopathy

Neonatal seizure = first 30 days of life

131
Q

MCC ataxia in children?

A

Acute cerebellar ataxia

Occurs 2 weeks after a viral illness

More common in child <6 y/o

132
Q

Indirect inguinal hernias occur as a result of incomplete closure of which stricture?

A

Processus vaginalis

133
Q

The absence of involvement of what joint distinguishes RA from OA?

A

DIP

*RA spares the distal joints

134
Q

MCC injured organ in BLUNT abdominal trauma?

A

Liver

135
Q

Which policy was established by the United States government to provide grants to support mental health and resiliency in healthcare workers?

A

Dr. Lorna Breen Health Care Provider Protection Act

136
Q

What finding distinguishes cauda equina syndrome from conus medullaris syndrome?

A

Absence of upper motor neuron signs

UMN signs: increased muscle tone, hyperreflexia, upgoing plantar response (Babinski)

137
Q

Most common site of pathologic fracture from metastatic disease?

A

Femur, humerus, tibia (long bones)

137
Q

What lab finding is most likely to be noted in discitis?

A

Elevated ESR

138
Q

What is the MCC of mortality in patients presenting with hypothermia?

A

Pulmonary edema

139
Q

What clinical finding distinguishes labyrinthitis from vestibular neuritis?

A

Labyrinthitis presents with hearing loss

140
Q

What is a normal E-point septal separation?

A

<7mm and >10 = heart failure

141
Q

When do you give PTU before propranolol in thyroid storm?

A

Signs of heart failure

142
Q

Reversal for direct thrombin inhibitor vs. factor Xa inhibitor?

A

Direct thrombin (dabigatran) = idarucizumab

Factor Xa (rivaroxaban, apixiban) = andexanet alfa

143
Q

Which tick-borne illness is caused by gram-negative coccobacillus?

A

Tularemia

144
Q

CBD diameter to suggest choledocholithiasis?

A

≥6mm

145
Q

What rash is associated with the Epstein-Barr virus?

A

Papular acrodermatitis (i.e., Gianotti-Crosti)

146
Q

What bone is fractured in the presence of CSF rhinorrhea?

A

Ethmoid (cribiform plate)

147
Q

What clinical finding is pathognomonic for Leptospirosis?

A

Conjunctival suffusion (redness w/o exudates)

Tx with doxy, PCN or azithro

148
Q

What is the hemoglobin goal for a patient with acute chest syndrome?

A

10 g/dL

149
Q

Most common severe complication of primary varicella infection in children?

A

Bacterial skin infection i.e. cellulitis, myositis, nec fasc, TSS

150
Q

Which lung CA is associated with hypercalcemia?

SIADH?

A

Hypercalcemia –> Squamous cell carcinoma

SIADH –> Small cell

151
Q

What do you need to monitor closely in patient with abdominal compartment syndrome?

A

Urine output –> surrogate marker of the severity of the compartment syndrome

152
Q

Absolute contraindication to using physostigmine?

A

QRS widening

153
Q

Minimum platelet count for LP?

A

50k

154
Q

What is the MOA for acetazolamide use in treating altitude sickness?

A

Induces mild metabolic acidosis through loss of bicarb in urine –> increase RR and improves oxygenation

*mirrors physio adaption to altitude

155
Q

Most common cardiac manifestation of lyme disease?

A

Palpitations

156
Q

Which beta-blocker is associated with delayed toxicity?

A

Sotalol

157
Q

Which area of brain most susceptible to damage from hydrostatic edema in the setting of acute HTN from posterior reversible encephalopathy syndrome?

A

Occipital lobe

158
Q

PCO2 goal on capnography in an intubated patient who sustained moderate TBI?

A

35 to 45 mm Hg

159
Q

Resuscitative hysterotomy must be performed how quickly?

A

Within 4 minutes of cardiac arrest in patient >24 weeks pregnant

160
Q

Which antiepileptic can lead to hypotension and bradycardia?

A

Pheytoin

161
Q

Regimen for tx of latent TB?

A

Rifampin + isoniazid x3 months

162
Q

What ankle-brachial index (ABI) is suggestive of PAD?

A

ABI <0.9

163
Q

What is the only 3rd gen cephalosporin with Pseudomonas coverage?

A

Ceftazidime

164
Q

Which cause of bloody diarrhea is common in Scandinavia and Europe?

A

Yersinia Enterocolitica

Can present as pseudo-appendicitis

Tx severe dz with TMP-SMX or fluoroquinolone

165
Q

MCC foodborne bacterial enteritis in Japan?

A

Vibrio parahaemolyticus

Oysters, clams, shrimps, crabs

166
Q

Which bacterial gastroenteritis is associated with febrile seizures?

A

Shigella

167
Q

A bite from which snake family can result in neurotoxicity (ptosis, vertigo, paresthesias, slurred speech, etc.) & respiratory failure?

A

Elapidae = coral snakes

168
Q

2 major side effects procainamide?

A

Hypotension & prolonged QT

169
Q

What age is cricothyrotomy contraindicated?

A

<10-12 y/o

170
Q

Which drug to tx vaginal bleeding should be avoided in asthma?

A

Carboprost

171
Q

4 MCC’s of afferent pupillary defect?

A

1) CRVO
2) CRAO
3) Optic neuritis
4) Retrobulbar neuritis

172
Q

When to use overdrive pacing?

A

Torsades

173
Q

Most common bacteria implicated in Lemierr syndrome?

A

Fusobacterium

174
Q

Which size ET tube for infant born <28 weeks, 28-34 weeks and 34-38 weeks?

A

< 28 = 2.5 cuffed
28-34 = 3.0 cuffed
34-38 = 3.5 cuffed

175
Q

Most common cause of massive hemoptysis worldwide?

A

Tuberculosis

176
Q

MCC of drug induced neutropenia in children?

A

Antibiotics i.e. macrolides, cephalosporins and PCN

177
Q

Therapeutic hypothermia effect on glucose?

A

Hypoglycemia due to insulin resistance

178
Q

What therapy should be started in patient with scleroderma experiencing renal crises?

A

ACE inhibitor

179
Q

MCC of bacterial superinfection complicating influenza virus infection?

A

Strep pneumoniae

180
Q

Differentiate anterior vs. central cord syndrome.

A

Anterior: loss of motor, pain and temp below injury (poor prognosis)

Central cord: sensory and motor deficit upper > lower extremities

181
Q

Which vaginal infection is associated with pH <4.5?

A

Candida

182
Q

Most common pediatric CNS tumor

A

Medulloblastoma

183
Q
A
184
Q

Quadruple therapy for H. pylori

A
  • Bismuth
  • Metronidazole
  • Tetracycline
  • PPI
185
Q

Definition (%) of a small PTX

A

<20% of lung volume

186
Q
A
187
Q

Best first step in management of vaso-occlusive crises?

A

Analgesia

188
Q

Most common congenital heart defect

A

VSD (holosystolic murmur at left sternal border)

189
Q

When is expected nadir (days) for neutrophil count following chemo?

A

6-10 days

190
Q

If cluster HA fails to improve with O2 what is next tx?

A

Sumatriptan

191
Q

What electrolyte abnormality commonly causes ileus?

A

HypoKalemia

192
Q

Biggest RF for developing spinal epidural abscess?

A

DIABETES

193
Q

What abnormal test result is the earliest indicator of biological damage from whole-body penetrating irradiation?

A

Lymphopenia

194
Q

Which med is contraindicated in the setting of sickle cell patients with hyphema?

A

Acetazolamide

195
Q

Major cause of respiratory insufficiency in flail chest?

A

Pulmonary contusion

196
Q

Upper limit of normal for GB wall thickness? CBD?

A

GB wall = 3mm
CBD = 7mm

197
Q

When to give steroids in premature labor?

A

<34 weeks

*Also give ABx (i.e., ampicillin, amox, azitho)

198
Q

Which med is most helpful in non-fatal drowning victim?

A

Inhaled beta-agonist

199
Q

Glucagon is most helpful in which overdose (BB or CCB)?

A

Beta-blocker

200
Q

MCC of septic shock in pregnancy?

A

Pyelonephritis

201
Q

MCC of traumatic ureteral injury?

A

GSW

202
Q

MCC of hospitalization in peds with varicella?

A

Skin and soft tissue infection

203
Q

What med can be given for ACE-inhibitor-induced angioedema?

A

TXA

204
Q

Which HIV med is known to cause depression, psychosis and nightmares?

A

Efavirenz

205
Q

Threshold for ordering platelets

A

<50k

206
Q

In patients with HIV and pneumocystis pneumonia, what are 3 indications for steroids?

A
  • PaO2 <70 mmHg
  • A-a gradient >35

-SpO2 <92% of RA

207
Q

Which finding distinguishes uterine rupture from placental abruption?

A

Tetanic uterine contractions (uterine rupture)

208
Q

Transfer to PCI center for patient with MI is recommended in what time frame?

A

Within 2 hours of presentation

209
Q

What therapy should be initiated in ARDS patient with hypoxemia refractory to ventilator titration and aggressive sedation?

A

Neuromuscular blockade

210
Q

Which med is contraindicated in sickle cell patient presenting with increased IOP?

A
  • Carbonic anhydrase inhibitor
  • ↓ aqueous pH –> RBC sickle and can lead to further elevation of IOP
211
Q

What 2 drug classes decrease production of aqueous humor

A
  • Beta-blockers
  • Alpha-agonists
212
Q

Reversal for heparin

A

Protamine

213
Q

Should pregnant patient receive MMR vaccine?

A
  • No it’s contraindicated
  • Give IVIG for PEP
214
Q

Organisms that require airborne precautions

A
  • Measles
  • Varicella
  • TB
  • Disseminated herpes zoster
  • SARS
215
Q

Calculations for sensitivity, specificity, PPV and NPV

A

Sens = TP/ (TP+FN)
Spec = TN/(TN+FP)
PPV = TP/(TP+FP)
NPV = TN/(TN+FN)

216
Q

Which therapy for pericarditis can prevent recurrence?

A

Colchicine

1-2 mg x1 day –> 0.5-1 mg/day x3 months

217
Q

Abx associated with nonconvulsive status epilepticus

A
  • Beta-lactams i.e. ceph’s, PCN’s
  • Fluoroquinolones
218
Q

What should be given to bleeding patient with severe von Willebrand disease?

A

Factor VIII: 25-50 U/Kg

Also Desmopressin

219
Q

1st line tx for orthodromic AVRT in WPW?

A

Adenosine

Orthodromic will be narrow

220
Q

What should be given to patient with cerebral venous thrombosis associated with small parietal intraparenchymal hematoma?

A

Heparin

221
Q

Tx of amebic dysentery and hepatic abscess (E. Histolytica)?

A
  • Metronidazole
    or
  • Tinidazole

Paromomycin if preg

221
Q

What is adequate urine output during fluid resus?

A

0.5-1 mL/kg/hr (adults)

1-1.5 mL/kg/hr (child)

222
Q

What to give for SBP if patient can’t receive cephalosporin?

A

Cipro or levo

223
Q

MCC of viral myositis?

A

Influenza A and B

224
Q

1st line tx for scleroderma renal crises?

A

Captopril

*May add nitroprusside for severe HTN

225
Q

Which med to avoid in pheochromocytoma?

A

Glucocorticoids

226
Q

Most common causes of drug-induced mysasthenia crisis?

A
  • Aminoglycosides
  • Macrolides
  • Fluoroquinolones
  • Beta-blockers
  • Procainamide
  • Magnesium
  • Anti-malarials
227
Q

Inappropriate pacemaker impulses that occur soon after intrinsic depolarizations is known as?

A

Undersensing

228
Q

Graft versus host disease is most common in what transplant?

A

Stem cell; occurs in up to 50% of allogenic hematopoietic stem cell transplants

229
Q
A
230
Q

Volkmann contracture is a complication most commonly associated with what type of injury?

A
  • Supracondylar fx of distal humerus
  • Claw-like flexion of the fingers and wrist
  • Brachial artery injury –> forearm compartment syndrome
231
Q

Tx for giardia diarrhea?

A

Metronidazole or Tinidazole or Furazolidone

*Single dose

231
Q

Antibiotic regimen of choice for treating Ludwig’s angina in patient with severe PCN allergy?

A

Levofloxacin + Metronidazole

232
Q
A
233
Q

What injury is associated with an avulsion deformity art the base of proximal phalanx of the thumb?

A

Ulnar collateral ligament injury = skier’s thumb

234
Q

Type IV hypersensitivity reactions involve which immune cells?

A

CD4+ T lymphocytes

235
Q

What on CSF analysis helps differentiate fungal meningitis?

A

Extremely elevated protein level

235
Q

Therapy of choice for acute limb ischemia?

A

Unfractionated heparin

236
Q

1st line tx options for ppx of Neisseria meningitis?

A
  • Rifampin
  • Ciprofloxacin
  • Ceftriaxone (pregnancy)
237
Q

Age range for using Ottawa SAH rule?

A

14-39

238
Q

Why is it important to add potassium when treating salicylate OD?

A

Hypokalemia –> urine acidemia via H+ excretion –> increased salicylate reabsorption

239
Q

Winter’s forumla

A

PaCO2 = [(1.5 x measured HCO3) + 8] +/- 2

240
Q

Double bubble sign is seen in

A

Duodenal atresia

241
Q

String sign is seen in

A

Pyloric stenosis

242
Q

Platelet count in HSP?

A

Normal despite purpura

243
Q

What medication is recommended for managing refractory pediatric cardiac arrest 2/2 Vfib?

A

Amiodarone (5mg/kg over 20-60 mins)

244
Q

Most common serious side effect of tacrolimus?

A

Nephrotoxicity

245
Q

What physiologic VS change in pregnancy is most important to consider during trauma evaluation?

A

Delayed onset of hypotension in the setting of blood loss

246
Q

Where should central line be placed in SVC syndrome

A

Femoral Vein

247
Q

Elevated opening pressure during VP shunt tap indicates

A

Distal catheter obstruction

*Proximal is most common site

248
Q

Ppx for migraines

A

Propranolol

249
Q

After aggressive hydration what can be given to treat hypercalcemia?

A

IV bisphosphonates: zoledronic acid or pamidronate

*Dialysis is an option

250
Q

What med can improve symptoms of chronic cough associated with GERD after a PPI?

A

Gabapentin

251
Q

Calculating MAP

A

DBP + 1/3 (SBP-DBP)

252
Q

Aggressive periosteal reaction + medullary and cortical bone destruction with a moth-eaten appearance.

A

Osteosarcoma

253
Q

Tx of Bell’s Palsy

A

Prednisone 60-80 mg/day x7 days and started within 72 hours of symptoms

254
Q

Blood supply to SA node?

A

RCA –> inferior MI –> bradycardia

255
Q

Most SPECIFIC finding on EKG for PE?

A

T-wave inversion in inferior and right precordial leads

256
Q

What electrolyte abnormality is associated with myxedema coma?

A

Hyponatremia

Excess vasopressin = impaired free water excretion

257
Q

Which envenomation can cause abdominal pain and muscle cramping that can closely mimic an acute surgical abdomen

A

Black Widow

258
Q

1st med given for traumatic iritis

A

Topical cyclopentolate or scopolamine

Antimuscarinics cause mydriasis and cycloplegia

259
Q

Dispo for Legg-Calve-Perthes disease

A

Weight-bearing as tolerated, symptomatic management and outpatient ortho referral

260
Q

Anti-psychotics with highest associated risk of weight gain, dyslipidemia and diabetes

A

Olanzapine and Clozapine

261
Q
A

Emergency Medicine (1 decks)

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