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1
Q

What medications constitute triple therapy for Helicobacter pylori?

A

Clarithromycin, Amoxicillin (or metronidazole) and a proton pump inhibitor

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2
Q

Kanavel’s signs? (4) -

A

1) symmetrical swelling of the involved finger, 2) finger held in flexion at rest, 3) tenderness along the flexor tendon sheath, and 4) pain with passive extension.

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3
Q

Epi cardiac vs anaphylactic dosing?

A

Cardiac- 1:10,000 IV, 1 mg (10ml)

Anaphylactic- 1:1000 IM, 300mcg (0.3ml)

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4
Q

Try this medicine for refractory hypotension in patient with known HTN

A

Glucagon

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5
Q

Beck’s triad for cardiac tamponade

A

hypotension, JVD, muffled heart sounds

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6
Q

Which bacteria is associated with many variants of Guillain-Barré syndrome that are preceded by diarrhea?

A

Campylobacter jejuni

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7
Q

What is Fitz-Hugh-Curtis?

A

Perihepatitis associated with PID

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8
Q

Most sensitive exam finding for cauda Equina?

A

Urinary retention (Post void residual> 100ml) followed by urinary incontinence

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9
Q

What is the Parkland formula for fluid resuscitation in burns?

A

Total Body Surface Area Burned x Weight (kg) x 4mL. First half is administered in first 8 hours followed by the second half in the next 16. (LR)

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10
Q

MCC neonatal Meningitis? Tx?

A

GBS. Amp/gent or amp/cefotaxime

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11
Q

Tx of meningitis in <18 vs >18?

A

(Cefotaxime)/ceftriaxone + vanc

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12
Q

Tx of meningitis in >50 or alcoholic?

A

CTX + vanc + amp

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13
Q

MCC meningitis in adults?

A

Strep pneumo

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14
Q

Difference between placenta previa and placenta abruptio? (3)

A

PP- Painless third trimester bleeding. Dx with ultrasound. Placenta lying over cervix

PA- Painful third trimester bleeding. Poorly seen with ultrasound. Premature Placenta separation from uterus

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15
Q

Tx Kawasaki disease (2)

A

ASA + IVIG

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16
Q

Ketosis without AG acidosis

A

Isopropyl alcohol toxicity

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17
Q

Tx of primary adrenal insufficiency?

A

100mg hydrocortisone IV (bc both glucocorticoid and mineralocorticoid)

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18
Q

What is the most common worldwide cause of primary adrenal insufficiency?

A

TB

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19
Q

What special population has an increased risk of cecal volvulus?

A

Marathon runners

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20
Q

Tx for intussusception

A

air enema

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21
Q

Tx for midgut volvulus or malrotation? (3)

A

IVF, NGT, Surgery

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22
Q

Tx for HAPE?

A

Descent

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23
Q

What treatments may prevent the development of acute mountain sickness? (3)

A

Acetazolamide, dexamethasone, slow ascent

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24
Q

Classic pentad for TTP?

A 
1- microangiopathic hemolytic anemia
2- thrombocytopenia
3- fever
4- renal pathology
5- CNS abnormality
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25
What bacterial diarrheal organism can lead to TTP?
Shiga toxin producing E Coli
26
What is the first sign of magnesium toxicity?
Loss of patellar tendon reflexes.
27
Epididymitis tx <35 vs >35?
<35: ceftriaxone + doctor >35: levoflox/cipro or bactrim
28
Prehn's sign?
Relief of pain when the scrotum is lifted (indicates inflammation of the epididymis.)
29
Patients with sickle cell disease are at higher risk of bacteremia and osteomyelitis from which organism?
Salmonella
30
What is the most rapid method of rewarming?
Cardiopulmonary bypass circuit.
31
MC age for quad tendon rupture vs patellar Tendon Rupture?
<40 : PTR >40: QTR
32
Differential for AG metabolic acidosis?
MUDPILES: Methanol, uremia, diabetic ketoacidosis (as well as alcoholic and starvation ketoacidosis), propylene glycol/paracetamol (acetaminophen), iron/isoniazid, lactate, ethylene glycol, salicylates.
33
Tx beta-blocker OD? (3)
Glucagon, vasopressor, high dose insulin
34
TCA OD tx? until?
Sodium bicarb 50mEq until QRS narrows
35
AAA triad?
Abdominal/back pain, hypotension and a pulsatile abdominal mass.
36
Radiation injuries prognosis?
Lymphocyte count in 48 hours
37
organophosphate poisoning tx?
Atropine + pralidoxime
38
Diltiazem OD Tx? (3)
calcium chloride, high dose insulin and glucose, and, in severe cases, intralipid
39
Anticholinergics toxicity tx? (3)
Physostigmine, BZDs, cooling
40
At how many weeks gestation should one expect fetal cardiac activity?
6 weeks
41
Tx UTI in pregnancy?
Macrobid, keflex
42
Spontaneous pneumothorax tx?
<20% observe | >20% chest tube
43
How to dx intestinal malrotation?
Upper GI series with oral contrast
44
Virchow's node?
Left supraclavicular LAD usu from gastric malignancy
45
HIV post-exposure prophylaxis
(if mucous membrane exposure or skin compromise) Tenofovir + emtricitabine plus raltegravir
46
HBV post-exposure prophylaxis
Prior vaccination: PEP not needed No prior immunization: HBIG + HBV vaccine
47
HCV post-exposure prophylaxis
No PEP available
48
What is the most common viral cause of cirrhosis in the United States?
HCV
49
How to calculate maintenance fluids rate
100 ml/kg/day for the first 10 kg, 50 ml/kg/day for the next 10 kg, and 20 ml/kg/day for each additional kilogram. The total is then divided by 24 hours.
50
Hypersensitivity reactions? (4)
ACID 1-Anaphylactic/urticarial (igE, needs 2 exposures, immediate) 2-Cytotoxic/Complement (igG/igM, hemolytic anemia, 2 exposures) 3-Immune complex (igG/igM, SLE/RA/serum Sickness) 4-Delayed (T cells, immune mediated, TB/Contact dermatitis/transplant rejection)
51
3 types of pelvic fractures + mech?
1- lateral compression (T-bone MVC/pedestrian hit from side) 2- AP fracture (head on MVC) 3- vertical shear (fall)
52
Where do most esophageal Foreign body's get stuck?
C6 cricopharyngeus muscle
53
What size FB needs to be removed from stomach
Any foreign body longer than 5 cm or wider than 2.5 cm diameter should be removed as they are highly unlikely to pass the duodenum.
54
Dx compartment syndrome? (2) Tx?
compartment pressure >30 mmHg or delta pressure (DBP - compartment pressure) <30 mmHg indicates significant CS. tx= fasciotomy
55
SIRS criteria? 2 or more of the following:
T >38° or <36° HR > 90 bpm RR > 20 bpm or PCO2 < 32 mmHg WBC >12000/mm3 or <4000/mm3
56
What is the immediate ED management of a patient with polycythemia vera and altered mental status?
Phlebotomy of 500cc of blood
57
3 neck injury zones + prognosis ?
Zone I: clavicle to cricoid cartilage (highest morbidity and mortality) Zone II: cricoid cartilage to mandible (best prognosis, most accessible) Zone III: mandible to skull base
58
Tx for achilles tendon rupture
posterior splint in plantarflexion, orthopedic consult
59
Cushing reflex: (3)
Hypertension + bradycardia + respiratory depression
60
Decorticate posturing:
upper extremity flexion, lower extremity extension
61
Decerebrate posturing:
upper/lower extremity extension
62
Oculocephalic response:
eyes moving in opposite direction of head turning = intact brainstem function
63
Oculovestibular response:
irrigation of saline into the ear; no eye movement = brainstem injury
64
Which two maneuvers should be attempted first in a patient with shoulder dystocia
Suprapubic pressure and McRoberts maneuver
65
When should an asymptomatic AAA be referred for repair?
>5cm
66
Tx for jellyfish sting
Immersion in acetic acid (vinegar)
67
tx for cholinergic poisoning? until?
Atropine and 2-PAM (pralidoxime) until sessation of secretions
68
Symmetric descending paralysis
Botulism
69
At what ages should infants begin to roll over and walk?
5 months and 12-15 months, respectively.
70
Difference between phimosis and paraphimosis? Which more dangerous?
Paraphimosis- needs PARAmedics (more dangerous)- cannot retract foreskin over exposed edematous glans Phimosis- can't pull back foreskin
71
Diff between breast feeding failure and breast milk jaundice
BFF- presents within first week. Dec bilirubin excretion bc poor feeding BMJ- benign. Well appearing just delay in gut flora
72
Colicky abd pain, sausage shaped mass, current jelly stool
Intussception
73
Bullous pemphigoid vs pemphigus vulgaris?
BP- Old, tense, neg Nikolsky, benign, topical steroids PV- 40-60, flaccid, pos Nikolsky, life threatening, mucosal involvement
74
RIJ placement depth
13 +/- 2 cm
75
Nerve injury associated with shoulder dislocation
Axillary nerve (sensation over deltoid)
76
Hill-Sachs lesion
2/2 shoulder dislocation, posterolateral humeral head compression fx
77
Bankhart lesion
2/2 shoulder dislocation, injury to labrum of glenoid
78
Thompson test?
Lack of plantar flexion with calf squeeze= Achilles tendon rupture
79
Diff between uterine rupture and placental rupture?
UR- No palpable fetus, loss of contractions, heavy bleeding
80
pseudo-obstruction seen in elderly debilitated patients with chronic constipation?
Ogilvie syndrome
81
Which organisms cause bloody diarrhea (6)
Salmonella, Shigella, Campylobacter, Yersinia, enterohemorrhagic Escherichia coli, enteroinvasive E. coli, and Entamoeba histolytica.
82
Organism most related to reactive Arthritis
Chlamydia
83
Hypothermia, hypotension, bradycardia
Myxedema coma
84
MCC Tricuspid Regurg
RA And RV dilatation
85
Cold calories, expected nystagmus?
COWS. Cold water causes opposite side nystagmus , warm water causes same side nystagmus
86
Double bubble sign
Duodenal atresia
87
Sx of hypercalcemia
Patient will be complaining of bone pain (Bones), kidney stones (Stones), abdominal pain (Groans), lethargy, psychosis (Psychiatric overtones)
88
Saltar Harris Classification? Tx?
``` I: S (Slipped epiphysis) II: A (fracture Above physis), most common III: L (fracture beLow physis) IV: T (fracture Through physis) V: ER (ERasure of growth plate) ``` I/II rx: nonoperative IV/V rx: surgery required
89
Hypoproteinemia, proteinuria, edema
Nephrotic syndrome
90
Tx malaria?
Uncomplicated, no resistance areas Rx: chloroquine | Complicated, P. falciparum Rx: quinidine + doxycycline
91
Target pH for Morgan lens irrigation
7-7.2
92
Diff between acid vs alkali burns (ocular)
Acid- protein coagulation. | Alkali- liquefactive necrosis. Worse
93
Tx of wernicke-korsakoff syndrome?
thiamine *then* glucose
94
Tx of serotonin syndrome
Supportive then cyproheptadine
95
Diff between serotonin syndrome and neuroleptic malignant syndrome
Both can cause hyperthermia, automatic instability, AMS but hyperreflexia and clonus are more specific to SS
96
MC location of anal fissure
posterior midline (6pm)
97
Diff between internal and external hemorrhoids
Internal bleed | External hurt
98
At what level does the spinal cord end in adults?
L1-L2
99
What medications do you use to treat hypertension caused by cocaine toxicity? (2)
Benzodiazepines and phentolamine.
100
Terminal R wave in aVR
TCA poisioning
101
VP shunt reservoir interpretations?
difficult-to-depress reservoir is suggestive of a distal obstruction (thrombus) whereas delayed refilling of the reservoir > 3 seconds is suggestive of a proximal obstruction (choroid plexus or inc CSF)
102
Common cause of food bolus?
Shiatzki rings
103
TX SJS?
Supportive + refer to burn center
104
Sea urchin tx
Hot water immersion
105
Peds coiled NG tube
Tracheoesophagel fistula
106
What labs are unreliable from IO line?
CBC (only HB is reliable) + K + pO2
107
Tx preseptal cellulitis?
Oral augmentin or clindamycin
108
Dosing for rhogam?
<12 weeks: 50mcg >12 weeks: 300 mcg antiD immunoglobulin IM but no harm in giving 300 so might as well
109
Toluidine blue: | Wood's lamp:
Toluidine blue: detects vulvar tears | Wood's lamp: detects semen stains
110
triad nephrotic syndrome?
hypoproteinemia, edema, proteinuria (greater than 3.5 gm per day or 3+ to 4+ on dipstick)
111
nephrotic syndrome in children, preceded by URI. rx?
Minimal change disease | rx= steroids
112
nephrotic syndrome in African-Americans, HIV/IVDA
Focal segmental glomerulosclerosis
113
nephrotic syndrome in Caucasians, HBV, HCV, SLE, gold, penicillamine, malignancy
Membranous nephropathy
114
maculopapular rash with lesions in the same stage of development? tx?
smallpox (variola) | tx= supportive
115
vague flu-like symptoms and fever that can progress to hemorrhagic mediastinitis? tx?
anthrax. cipro or doxy
116
sudden onset febrile flu-like illness that can progress to pleuropneumonitis? tx?
tularemia. streptomycin.
117
gram-negative sepsis with or without flu-like symptoms or bobo lesions? tx?
Yersinia pestis, or the plague. streptomycin or gentamicin
118
PERC out? (8)
``` age>50 HR>100 O2<95% prior hx recent trauma/surgery hemoptysis OCP UL leg swelling ``` all must be neg to PERC out
119
What are the three components of Horner’s syndrome caused by disruption of the sympathetic chain?
Ptosis, miosis and anhidrosis.
120
ptosis, diplopia and blurred vision
myasthenia gravis
121
Improvement of muscle strength with repeated stimulation
Lambert-Eaton syndrome
122
antibodies target the calcium channels which results in a reduction of acetylcholine release
Lambert-Eaton syndrome
123
autoimmune destruction of the nicotinic acetylcholine receptors on the postsynaptic membrane --> less total receptors
myasthenia gravis
124
ice bag test
lid lag in MG improves w/ ice | because improved neuromuscular transmission at lower muscle temperatures
125
tx of TM rupture 2/2 AOM?
amox + otic drops
126
What delivery method is preferable in cases of placental abruption involving a term pregnancy when the mother and fetus are stable?
oxytocin assisted vag delivery
127
pseudomembranes w/ mucopurulent sputum or cough
bacterial tracheitis

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