EM EOR Topic List_Other Flashcards
(RR)
what is the difference in presenting symptoms for upper UTI vs lower UTI?
Lower UTI s/s are limited to GU system (dysuria, urgency, frequency, hematuria)
Upper UTI (pyelonephritis) also develop constitutional symptoms (fever, vomiting, malaise, back and flank pain)
(RR)
what is the duration of treatment for upper UTI infections?
10 to 14 days
(RR)
what is first line parenteral treatment of mild to moderate uncomplicated pyelonephritis?
what is a second option for treatment of mild to moderate uncomplicated pyelonephritis?
Ceftriaxone (it has excellent coverage of E. coli)
FQ’s are another option
(RR)
three common presenting s/s of nephrolithiasis
CVA tenderness
hematuria
Colicky unilateral back/flank pain radiating to the groin
(SmartyPance)
what size kidney stone is likely to pass on it’s own?
<5mm
(SmartyPance)
what size stone is likely to have complications?
> 10mm
treat as IP with fluid, fluid, fluid
(SmartyPance)
what is the treatment for uncomplicated cystitis?
nitrofurantoin
TMP-SMX for 3-5 days
(FQ’s only for people with no alternative options)
(SmartyPance)
common features of lower UTI/cystitis?
frequency, urgency, DYSURIA, suprapubic tenderness
Often appears following sexual intercourse in women
The exam usually unremarkable – sometimes SUPRAPUBIC TENDERNESS
(RR)
what is the initial treatment for acute prostatitis?
fluoroquinolone (like CIPROFLOXACIN)
for FOUR WEEKS
(or TMP-SMX)
(RR) BUZZWORDS
warm, exquisitely tender prostate
acute prostatitis
(RR)
what is the most important complication of sickle cell disease?
aplastic crisis
(RR) BUZZWORDS
body is unable to make enough RETICULOCYTES TO COMPENSATE FOR HEMOLYSIS
aplastic crisis of sickle cell disease
(RR)
what is the most common cause of aplastic crisis?
infection
human parvovirus B19 is most frequently implicated
(RR)
what is most common presentation of aplastic crisis?
INCREASING FATIGUE
SIGNS OF INFECTION, including fever, tachycardia
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what is the sequelae of aplastic crisis?
it is SELF-LIMITED, resolves in about 7-10 days
(RR)
what is the treatment for aplastic crisis of sickle cell disease?
care is supportive, TRANSFUSIONS given as needed
(RR)
how is diagnosis of BPH made?
by digital rectal exam
(RR)
what is the treatment of BPH?
alpha-blockers
5-reductase inhibitors
surgery (TURP)
(RR)
in terms of heart failure and pulmonary edema, venous distention, hepatomegaly or peripheral edema, what is happening to capillary pressures to cause these symptoms?
capillary pressures are increased
(heart failure –> “this results in increased capillary pressures that cause pulm edema, venous distention, hepatomegaly or peripheral edema”)
(RR)
two cardinal symptoms of PID
lower tract inflammation (cervicitis or friable cervix)
pelvic tenderness or mass
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treatment for PID
ceftriaxone IM and doxycycline PO x 14 days
(RR)
What is the treatment for adrenal crisis?
hydrocortisone
(RR)
what is impaired during primary adrenal insufficiency (Addison Disease)?
CORTISOL
ALDOSTERONE
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two predominating s/s of adrenal crisis
HYPOTENSION
hypovolemia
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how long does a single manic episode last to be used for diagnosis of bipolar I disorder?
AT LEAST ONE WEEK of PROFOUND MOOD DISTURBANCE
(RR)
initial treatment for bipolar
antipsychotics
(RR)
what is the difference between oppositional defiant disorder and conduct disorder?
oppositional defiant disorder: DOES NOT HAVE BEHAVIORS THAT VIOLATE THE BASIC RIGHTS OF OTHERS OR THE LAW
conduct disorder: does all those things (behaviors are typically a major violation of social expectations of pt’s age group…can include cruelty to animals and people, destruction of property, etc.)
(RR)
how long should s/s be present before suspecting oppositional defiant disorder in a child?
what is a key characteristic of ODD?
6 months
VINDICTIVENESS
(RR)
what is the most common, NON-pharmacologic cause of Stevens Johnson Syndrome?
Mycoplasma infection
Mycoplasma pneumoniae, to be exact
(RR) BUZZWORDS
“pus on tonsils”
think about MONO!
(RR)
infectious mono - where do the lymph nodes swell?
nearly half of all patients will show what s/s?
POSTERIOR CERVICAL CHAINS
SPLENOMEGALY
(UpToDate)
what is the first line alternative agent for treating syphilis in nonpregnant adults?
doxycycline
(RR)
how do we diagnose infectious mono?
MONONUCLEAR SPOT TEST
“diagnosis is made by heterophile antibody test (mononuclear spot test) or a generalized maculopapular rash following administration of amoxicilin”
(RR)
the most common risk factor for the development of placental abruption is __________
HYPERTENSION
(RR)
common s/s of placental abruption
SUDDEN ONSET, constant ABDOMINAL PAIN
and
VAGINAL BLEEDING generally DARKER IN COLOR
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“A 9-year-old boy with no past medical history presents to the emergency department with facial swelling. He states that his symptoms started 1 day ago. He also notes that his urine has been more foamy than it usually is. His mom reports that he recently recovered from a sore throat and fever 2 weeks ago, which was treated with antibiotics. Urinalysis shows red blood cells and proteinuria. What is the pathophysiology of this disease process?”
IMMUNE COMPLEX DEPOSITION
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physical exam findings of hyphema
unequal pupils
injected conjunctiva or sclera
blood in anterior chamber
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what is the treatment of hyphema?
eye protection
limitation of activity
head elevation of 30-45 degrees
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presentation of placenta previa
painless
BRIGHT RED
vaginal bleeding, usually in
THIRD TRIMESTER
(RR)
how do we diagnose placenta previa?
U/S
(RR)
what is placenta previa?
placenta overlaps and implants on the cervix, covering the internal os to varying degrees
(RR)
“what is the most common risk factor of placenta previa?”
multiparity
(RR)
what do we NOT do with suspected placenta previa?
DO NOT DO A DIGITAL VAGINAL EXAM
(RR)
A pt with 20-40 minute episodes of dizziness ("room-spinning") with ringing sounds, worse w/ head movement and positional changes. What would be expected on physical exam?
a) conductive hearing loss
b) middle ear effusion
c) sensorineural hearing loss
d) vertical nystagmusC) SENSORINEURAL HEARING LOSS
(RR)
triad of Meniere Disease
episodic vertigo (a true spinning sensation)
sensorineural hearing loss
tinnitus
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what’s another name for Meniere Disease?
endolymphatic hydrops
(RR)
treatment for Meniere Disease?
management - reduce salt antihistamines (meclizine) benzodiazepines diuretics prednisone
(RR)
“Benign paroxysmal positional vertigo is thought to be caused by what?”
“BPPV is most commonly attributed to calcium debris w/in the post semicircular canal but may also occur in the lateral and anterior semicircular canals.”
(RR)
blood transfusions -
a single PRBCs unit will raise hemoglobin _____ and hematocrit _____
“A Single PRBCs unit will raise hemoglobin by 1g/dL and hematocrit by 3%.”
(RR)
“A 66 y/o woman presents for acute HA. She has a hx of HTN and migraines. She states the HA started suddenly after walking into a movie theater. She has associated n/v and states she has never had anything like this in the past. Phys exam is remarkable for the finding noted above (picture was included). What is the best first step in treatment of pt?”
apraclonidine
the picture was of a glaucoma eye - conjunctival injection, mid-sized fixed pupil, hazy cornea
(RR)
glaucoma treatment
topical BB and alpha-agonist
such as TIMOLOL and APRACLONIDINE (respectively)
along with ACETAZOLAMIDE
EMERGENCY CONSULT WITH OPTHAMOLOGY!!
(RR)
what is glaucoma?
GLAUCOMA is a group of disorders characterized by increased intraocular pressure that causes optic neuropathy and vision loss
(RR)
how is glaucoma diagnosed?
with the clinical features of CONJUNCTIVAL INJECTION MID-SIZED AND FIXED PUPIL HAZY CORNEA GLOBE THAT IS ROCK HARD TO TOUCH
(RR)
“what is the mechanism by which acute angle-closure glaucoma happens?”
“In acute angle-closure glaucoma or crisis, the lens or the peripheral iris blocks the trabecular meshwork, obstructing the outflow of aqueous humor and resulting in a rapid increase in intraocular pressure”
(RR)
what is the preferred treatment for Pneumocystis jirovecii pneumonia?
TMP SMX
this is the most common opportunistic infection seen in HIV patients, esp w/ CD4 count <200 cells/microL
(RR)
how does urticaria present?
pruritus and an ERYTHEMATOUS PLAQUE WITH CENTRAL PALLOR (possibly with deeper dermal swelling)
(RR)
treatment of urticaria
antihistamines
a short course of oral steroids can be given for more severe symptoms
(RR)
“What type of hypersensitivity reaction is contact dermatitis?”
type IV
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what is urticaria most commonly caused by (in terms of the body’s reaction)?
IgE-mediated reaction to an allergen
(RR)
what is the main distinction between mastitis and breast abscess?
fluctuance
“On exam, pts with mastitis will have erythema, tenderness to palpation and warmth to affected area. The presence of fluctuance is suggestive of a breast abscess.”
(RR)
what are the most common causes of puerperal mastitis?
Staph aureus
may also be caused by E. coli and Strep
(RR)
what antibiotics cover for mastitis pathogens?
DICLOXACILLIN
cephalexin
clindamycin
(RR)
management of mastitis
cool compresses
analgesics b/w feedings
CONTINUE BREAST FEEDING!
(SmartyPance)
how do we diagnose DKA?
BS > 250 mg/dL
anion gap acidosis
pH < 7.3
bicarb < 18
pts may be hyperkalemic
(SmartyPance)
s/s for DKA
ABD PAIN thirst polyuria polydypsia nocturia weakness fatigue convusion n/v fatigue chest pain
(SmartyPance)
treatment of DKA
IVF = 1st CRITICAL STEP!
(lowers serum glucose, switches body from catabolic to anabolic state)
if severe acidosis,
K
bicarb
(SmartyPance)
diagnosis of BV
milky vaginal discharge + pH.4.5 + amine "whiff" test of fishy odor CLUE CELLS (gram negative)
AMSEL criteria
(SmartyPance)
treatment for BV
metonidazole (PO or intravag)
or
clindamycin
may need prolonged treatment (6 months)
(SmartyPance)
dx of trichomonas
saline wet mount to see dancing parasites
PE may show strawberry cervix
(SmartyPance)
treatment of trich
metonidazole (PO only)
partner treatment -
retest in 2 weeks to 3 months (“test of cure”
(SmartyPance)
dx of candidiasis
wet mount –> KOH
(SmartyPance)
treatment for candidiasis
fluconazole 150 mg PO x1
if bad, redose 72 hrs later
7-day course works better
(RR)
s/s of thyroid storm
hyperthermia
HTN
tachycardia
(RR)
how do we treat thyroid storm?
BB (e.g. propranolol)
propylthiouracil or methimazole (antithyroid medications)
then, iodine
“The hyperadrenergic effects of thyroid storm (i.e. tachycardia, HTN) should be treated with a beta-blocker.”
(RR)
what do we give to block peripheral conversation of thyroxine (T4) to triiodothyronine (T3) after the first steps of treating thyroid storm are completed?
glucocorticoids
(RR)
what lab results are indicative of thyroid storm?
low TSH
high free T4 or T3
(RR)
“When should hypertension be treated in the setting of an acute ischemic stroke?”
“if the systolic is greater than 220mm Hg, the diastolic is greater than 110mm Hg, or if the pt has another condition that would benefit from bp control”
(RR)
what s/s indicate anterior cerebral artery ischemic stroke?
frontal lobe dysfunction apraxia contralateral paralysis (lower > upper)
(RR)
what s/s indicate middle cerebral artery ischemic stroke?
contralateral paralysis (upper > lower) aphasia
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what s/s indicate posterior cerebral artery and VBI?
LOC nausea or vomiting CN dysfunction ataxia visual agnosia
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what do we see on CT of ischemic stroke?
“CT reveals loss of gray-white interface, acute hypodensity”
(RR)
what is the equation for calculating appropriate fluid resuscitation for burn patients (the Parkland formula)?
4 x pt wt (kg) x % TBSA of burns (not the superficial ones) = # of mL of LR to given in first 24 hrs
*half in first 8 hours, other half over following 16 hours
(RR) Rule of Nines for burns: torso head arms legs
torso: front = 18%, back = 18%
head: 9%
each arm: 9%
each leg: 18%
(RR)
what do we use for first-line treatment for minor bleeding in patients with von Willebrand disease?
DESMOPRESSIN (DDAVP)
(RR)
what do you do if desmopressin does not work or if the patient presents with life-threatening bleeding for von Willebrand Disease?
give von Willebrand factor (recombinant or cryoprecipitate)
(RR)
what is the most common inherited bleeding disorder, autosomal dominant?
von Willebrand Disease
(RR)
what do labs show for von Willebrand Disease?
decreased factor VIII
prolonged bleeding time
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what is the treatment for most cases of subacute thyroiditis?
NSAIDs
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common s/s of subacute thyroiditis
FEVER MYALGIAS FATIGUE malaise ANTERIOR NECK PAIN
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what is the hallmark physical exam finding for subacute thyroiditis?
TENDERNESS OVER THE THYROID GLAND
(RR) BUZZWORDS
tenderness over the thyroid gland
subacute thyroiditis
(RR)
how do we diagnose subacute thyroiditis?
clinically
…“but thyroid studies will reveal a suppressed TSH w/ elevated T3 and T4 in early phases in illness”
(RR)
another name for subacute thyroiditis
de Quervain thyroiditis
(RR)
how do we treat reactive arthritis?
first - treat underlying infections
then - treat symptoms with PT, anti-inflammatories, potentially short course of steroids
(RR) BUZZWORDS
“can’t pee, can’t see, can’t climb a tree”
reactive arthritis
urethritis, conjunctivitis, uveitis, arthritis
(RR)
what do labs show for reactive arthritis?
HLA-B27
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what is central vertigo?
vertigo from a central cause such as a cerebellar or brainstem hemorrhage or infarction.
LESS PRONOUNCED SYMPTOMS SUGGEST A CENTRAL CAUSE RATHER THAN A PERIPHERAL CAUSE
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common PE findings for central vertigo
BS SYMPTOMS
severe gait impairment w/ inability to walk, or limb dysmetria
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in a hemothorax, what should be done after airway is secure and packed RBCs are being infused?
chest thoracostomy tube
can be both diagnostic and guide further management, and should be done before sending pt to OR
(RR)
“what is the most common cause of DIC?”
infection
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first line treatment of status epilepticus
benzos (LORAZEPAM)
(RR)
second line treatment of status epilepticus
phenytoin or fosphenytoin
valproic acid
levetiracetam
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what is third line treatment for status epilepticus?
pentobarbital
propofol
phenobarbital
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“what is the best benzo for treatment of status epilpeticus in a pt w/o intravenous access?”
IM Midazolam
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what is the most common complication from a midshaft humerus fracture?
radial nerve injury
“clinically, pts may exhibit radial nerve palsy with wrist drop” …“loss of extension of fingers, thumb, and wrist”
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osteomyelitis - most common pathogen and treatment
S. aureus
“long term abx”
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“what bacteria may cause osteomyelitis in patients who have a history of sickle cell disease?”
Salmonella
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nephrolithiasis -
once pyelonephritis, cystitis, biliary colic or aortic aneurysm are ruled out, what is the next step for pt treatment?
“Once these etiologies are ruled out, a pt with recurrent nephroliathiasis and adequate pain control can be DISCHARGED W/O FURTHER WORKUP.”
(RR)
five clinical signs of nephrolithiasis
hematuria (1/3 of pts) abd/flank pain urinary frequency dysuria fever (sometimes)
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what imaging is used for nephrolithiasis workup?
plain xray
u/s
CT scan (w/o contrast)
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what is the management of nephrolithiasis?
supportive
IV hydration
tamsulosin
renal/urology consult
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papilledema is the hallmark funduscopic finding of _____?
IDIOPATHIC INTRACRANIAL HYPERTENSION
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“what is an alternative to fundoscopy when evaluating for papilledema?
ocular u/s
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what is the PE finding of papilledema?
OPTIC DISK SWELLING
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what is the treatment of papilledema?
“TREATMENT IS THE TREATMENT OF THE UNDERLYING DISORDER”
(RR) BUZZWORDS
Philadelphia chromosome
chronic myelogenous leukemia
(RR) BUZZWORDS
auer rods
acute myelogenous leukemia
(RR) BUZZWORDS
clue cells
bacterial vaginosis
(RR) BUZZWORDS
smudge cells
chronic lymphocytic leukemia
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what is first line treatment for scabies mites?
“permethrin 5% cream on day 1, then reapply in 1 week”
“oral ivermectin is also an option.”
(RR)
what type of hypersensitivity reaction takes place with scabies mites?
type IV hypersensitivity reaction causing intense pruritus
(RR)
MC presentation of Hodgkin lymphoma in a 17 year old boy?
painless cervical lymphadenopathy
“Most adolescents present with painless lymphadenopathy in the cervical or supraclavicular region.”
(RR) BUZZWORDS
Reed Sternberg Cell (Owl’s eye)
Hodgkin lymphoma
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what is Reye syndrome?
progressive encephalopathy with hepatic dysfunction
(RR) BUZZWORDS
aspirin exposure in the setting of a viral illness
think Reye syndrome (progressive encephalopathy with hepatic dysfunction)
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how do we treat/manage Reye syndrome?
“There is no specific cure, and MANAGEMENT IS SUPPORTIVE”
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“what is the most common acid-base disturbance in Reye syndrome?”
metabolic acidosis and respiratory alkalosis
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what do labs show in Reye Syndrome?
hypoglycemia
elevated liver enzymes
hyperammonemia
metabolic acidosis
(RR) "which of the following conditions has a negative Nikolsky sign?" a) bullous pemphigoid b) pemphigus vulgaris c) Staphylococcal scalded skin syndrome d) toxic epidermal necrolysis
A) BULLOUS PEMPHIGOID
(RR)
In a pt with low-to-moderate risk for DVT, the appropriate workup includes…..what? and in what order?
“…AT LEAST A NEGATIVE HIGH-SENSITIVITY D-DIMER TEST IN ORDER TO COMPLETE THE WORKUP W/O IMAGING”
(If duplex ultrasonography is performed in a moderate risk pt and is negative, either a high-sensitivity D-dimer test should be sent and should be negative or the pt should seek serial duplex ultrasonography.)
(RR)
Lithium toxicity is associated w/ several different forms of renal injury, but which is the most common?
“NEPHROGENIC DIABETES INSIPIDUS is by far the most common”
(RR)
what is the PO treatment of pyelonephritis?
FQ’s CIPROFLOXACIN or LEVOFLOXACIN
or
TMP-SMX
(RR)
MC causes of acute prostatitis, for pts <35 yrs old and pts >35 yrs old
<35yrs: N. gonorrhoeae, C. trachomatis
(treat w/ ceftriaxone IM and doxy)
> 35 yrs: E. coli
(treat w/ TMP-SMX or FQ for 4 weeks)
(RR)
what do we use for first-line treatment for corneal ulceration to cover against eyeball Pseudomonas aeruginosa infection?
TOPICAL CIPROFLOXACIN
and emergent ophthalmologic consultation
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what is the most common injury in children w/ severe blunt chest trauma?
PULMONARY CONTUSION,
occurring in nearly half of such victims (even w/ no external signs or even rib fractures…cuz kids are spongy)
(RR)
Bell Palsy physical exam will show CN VII palsy that _________ spare the forehead?
DOES NOT
“PE will show CN VII palsy that does NOT spare the forehead”
(RR)
if a pt presents with signs of Bell palsy and stroke, what do the eyebrows tell us?
“preserved ability to raise the eyebrows suggests a central process. This is because the forehead receives bilateral upper motor neuron innervation, so a central stroke will SPARE THE FOREHEAD AND ALLOW THE PT TO RAISE THE EYEBROWS”
(RR)
what is first line treatment for trigeminal neuralgia?
carbamazepine
(RR)
after DKA has been managed with aggressive IVF and insulin drip, what do we do after the glucose is <200 mg/dL and the anion gap is closed?
“glucose-containing fluids should be initiated to prevent hypoglycemia”
(RR) BUZZWORDS
drusen spots on the macula
macular degeneration
(RR) BUZZWORDS
bilateral gradual central field vision loss
macular degneration
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what is the treatment for an ill-appearing female with vomiting and high fever with signs of PID?
admit, she’s sick!
inpatient management with IV cefotetan and doxycyline
(RR)
what findings in the synovial fluid analysis of an arthrocentesis indicate septic arthritis?
WBC > 50,000 w/ more than 75% neutrophils
fluid would look cloudy and yellow
(no crystals present, that’s gout)
(RR)
what are the empiric antibiotics of choice for septic arthritis?
vanc and ceftriaxone
(RR)
missed abortion =
intrauterine fetal death prior to 20 weeks gestation
closed cervical os
retention of the pregnancy
(RR)
the antibiotics for Mastitis -
what are the two anti-staph abx?
what is the antibiotic for beta-lactam allergic pts?
anti-staph abx = DICLOXACILIN, cephalexin
beta-lactam sensitive pts = clindamycin
(RR)
antibiotics for MASTITIS -
what is the abx when concerned for MRSA?
what abx if given in an in-patient setting?
MRSA: TMP-SMX
In-patient: vancomycin
(RR)
erysipelas characteristics
abrupt onset of fever, chills, malaise, followed by development of bright red, well-demarcated, indurated area of skin,
and -
you might see peau d’orange!
or malar distribution on the face!
(RR)
pathogen most commonly causing erysipelas, and it’s treatment
MC caused by beta-hemolytic streptococci (Strep pyogenes)
“Treatment is elevation and antibiotics”
Ceftriaxone, cefazolin (systemic symptoms)
amoxicillin, cephalexin (mild)
(RR) BUZZWORDS
no cremaster reflex
think testicular torsion
(RR)
what test is most sensitive for a UTI on urine dipstick testing?
LEUKOCYTE ESTERASE
second - nitrites
(bac converting urinary nitrates to nitrites, but the bac have to act on the urine for 6 hours and an ideal specimen is collected from first void of the day)
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three key features of primary hyperparathyroidism
high parathyroid hormone
high calcium
low phosphorous
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what is the fun saying about the results of hypercalcemia?
“bones, stones, groans, and psychiatric overtones”
bones - abnormal bone remodeling and fracture risk
stones - increased risk for kidney stones
groan - abdominal cramping, nausea, ileus, constipation
psych - lethargy, depressed mood, psychosis, cognitive dysfunction
(RR)
hypercalcemia is a common complication of….
….malignancy
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a painful severe diffuse headache with abrupt onset, photophobia, phonophobia, and pain with extraocular movements - what should you be thinking about?
SUBARACHNOID HEMORRHAGE (they don't all say "thunderclap headache" or "worst headache of life")
(RR)
treatment of subarachnoid hermorrhage
supportive
NIMODIPINE (decreases vasospasm)
(RR)
if patients have rhinorrhea or conjunctivitis with pharyngitis, they are more likely to have which type of etiology?
VIRAL
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treatment for pts with aplastic crisis of sickle cell disease
transfused with packed red blood cells
(in particular if they are experiencing signs of decrease end-organ perfusion such as demand ischemia (painful!) or exertional dyspnea)
(RR)
treatment for alcohol withdrawal syndrome
lorazepam
(chronic alcohol use leads to the CNS adapting by upregulating NMDA channels (stimulatory) and downregulating GABA channels (inhibitory). when pt suddenly stops consuming alcohol the pt can have withdrawal seizures….so give a benzo such as lorazepam which stimulates GABA receptors.)
(RR)
most commonly affected vessel in ischemic stroke
MCA
(RR)
typical symptoms of MCA ischemic stroke
contralateral hemiparesis
facial weakness
sensory loss
(usually affect upper extremity and face more than lower extremity, which is a distinguishing factor of MCA strokes, and differentiates them from ACA strokes)
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MC drugs that cause serotonin syndrome (LE hyperreflexia, clonus, hypersalivating, mydriasis, etc.)
antidepressants (SSRI, MAOI, SNRI, TCA, atypicals) such as: TRAMADOL lithium linezolid triptans meperidine DEXTROMETHORPHAN
(RR)
what organisms most likely cause sepsis in asplenic patients?
ENCAPSULATED BACTERIA
Strep pneumo
Neisseria meningitidis
Haemophilus influenza
(these may lead to meningitis, so treat accordingly!)
(RR)
what neurotransmitter imballance leads to dystonic reactions with involuntary contractions of muscles to extremities, face, neck, pelvis?
dopamine receptor blockade leading to INCREASED CHOLINERGIC ACTIVITY
(most common causative agents: first gen antipsychotics and antiemetic medications)
treat with anticholinergic meds like diphenhydramine or benztropine, relax the pt with a benzo
(RR)
three s/s of infectious mono
atypical lymphocyte
tonsillar exudate
enlarged spleen
(caused by Epstein-Barr virus)
