EM4 Flashcards
1
Q
Indications for dialysis in lithium OD (4)
A
lithium concentration > 4 mEq/L, any elevated level with neurologic symptoms, renal failure and inability to tolerate intravenous hydration.
2
Q
Tx HUS?
A
Supportive. Don’t give Abx
3
Q
MC vessel involved with ischaemic stroke
A
MCA
4
Q
Short QT syndrome is caused by
A
Hypercalcemia
5
Q
U wave on ECG is caused by
A
Hypokalemia
6
Q
In DKA, insulin should be held until a serum potassium is?
A
over 3.3
7
Q
What BUN and creatinine are considered triggers for the initiation of dialysis in patients with CKD?
A
A BUN of 100 mg/dl and a Cr of 10 mg/dl.
8
Q
INH toxicity tx?
A
pyridoxine
9
Q
what bug causes croup?
A
parainfluenza
10
Q
steeple sign
A
croup
11
Q
subglottic tracheal narrowing
A
croup
12
Q
JONES criteria for rheumatic fever?
A
Joints Oh, no carditis! Nodules Erythema marginatum Sydenham's chorea
13
Q
tx cyanide toxicity (3)
A
hydroxocobalamin OR sodium nitrite and sodium thiosulfate
14
Q
bradycardia, hypotension, severe lactic acidosis
A
cyanide poisioning
15
Q
hypoxia not responsive to supplemental o2
A
methemoglobinemia
16
Q
methemoglobinema tx
A
methylene blue
17
Q
focal neuro deficit w/ diving ascent
A
arterial gas embolus
18
Q
ascending paresthesias/paralysis w/ diving ascent
A
decompression sickness
19
Q
severe pain w/ diving ascent
A
decompression sickness
20
Q
AMS w/ diving ascent
A
nitrogen narcosis
21
Q
cx of LV aneurysm?
A
thrombus formation (rupture rare bc aneurysm wall is formed of scar)
22
Q
what type of anal fissure is always pathological?
A
lateral
23
Q
M<10, limping, hip internally rotated
A
legg-calve-perthes (idiopathic avascular necrosis)
24
Q
teen boy w/ leg pain and hip externally rotates w/ flexion
A
SCFE
25
What findings are typically seen on CSF analysis in tuberculous meningitis? (3)
Very low glucose, elevated protein and a slightly elevated opening pressure.
26
vaginal bleeding with closed internal os
Threatened abortion
27
vaginal bleeding with open os
Inevitable abortion
28
partial passage of products of conception (POC)
Incomplete abortion
29
complete passage of POC
Complete abortion
30
fetal death < 20 weeks without POC passage
missed abortion
31
coffee bean sign
sigmoid volvulus
32
sigmoid volvulus tx (2)
sigmoidoscopy + rectal tube decompression
33
what makes HOCM murmur louder? (2)
vasalva, standing up
34
what makes HOCM murmur softer? (4)
squatting, trendelenburg, hand grip, passive leg raise
35
1st step of cric?
3-5cm vertical incision over cricothyroid membrane
36
cric CI in what age group?
<10
37
tx for CaCB OD? (3)
calcium salts, glucagon, high dose insulin w/ glucose
38
brady, hypotension, hyperglycemia
CaCB OD
39
brady, hypotension, normo/hypoglycemia
BB OD
40
tearing of bridging veins
subdural
41
crescent shaped hyperdenisity bleed -
subdural
42
middle meningeal artery
epidural
43
biconvex lens shaped bleed
epidural
44
To perform a dorsal penile block, the needle should be directed towards the center of the shaft from what two "clock positions" at the base of the shaft?
2 and 10
45
reversal agent for dabigatran?
Idarucizumab
46
DIC labs? (5)
high: PT/PTT, D-Dimer, fibrin
low: platelets, fibrinogen
47
Add steroids for PCP tx when?
1. PaO2 < 70 OR
| 2. A-a gradient >35
48
Molluscum contagiosum caused by
Poxvirus
49
How is alteplase (t-PA) dosed in ischemic CVA?
0.9 mg/kg (up to 90 mg) with 10% of the dose given as a bolus and the rest of the dose given as an infusion over 1 hour.
50
ST segment elevation in lead aVR greater than 1 mm or greater than the elevation seen in the ST segment of V1 should prompt concern for
occlusion of the left main coronary artery.
51
Ellis classification
Ellis I: - * Enamel * Rx: smooth edges
Ellis II: - Enamel + dentin * Rx: calcium hydroxide paste
Ellis III - Enamel + dentin + pulp * Rx: dental consult, pulpectomy
52
Dx mediastinitis
CT neck and chest
53
Psoas sign
RLQ pain on extension of right hip
54
Obturator sign
RLQ pain on internal rotation of flexed right hip
55
Rovsing sign
right lower quadrant pain when the left lower quadrant is palpated
56
Afterload
Afterload is considered the amount of pressure the heart is contracting against, or the blood pressure
57
preload
Preload is considered the amount of blood presenting to the heart from the circulation
58
Tx c diff mild vs fulminant
Mild- PO Vanc or Fidaxomicin
Ful- PO Vanc and IV flagyl
59
Pericardial knock
Constrictive pericarditis
60
Portal venous gas
Necrotizing Enterocolitis
61
Tx of constrictive pericarditis
pericardiectomy
62
Cherry red fovea
central retinal artery occlusion
63
Blood and thunder
central retinal vein occlusion
64
MC bacteria in osteomyelitis
Staph aureus
65
Low-flow vs high flow priapism?
Low flow: venous, emergency Low-flow rx: ice packs, phenylephrine, aspiration
High-flow: arterial, semierect, painless High-flow rx: observation
66
Priapism after cervical spine injury
C5 fracture
67
Lab abnormalities of rhabdo? (3)
Hyperkalemia, hyperphosphatemia, hypocalcemia
68
What is the most specific test for diagnosis of secondary syphilis.
Fluorescent treponemal antibody absorption
69
Dx syphillis
VDRL and RPR positive 4-6 weeks after infection
70
Stages of syphillis
Primary: painless chancre
Secondary: lymphadenopathy, condyloma lata, rash on palms/soles
Tertiary: gummas
71
Tx primary syphillis
Primary/secondary: IM benzathine penicillin G x 1 dose
| Tertiary: IM benzathine penicillin G qwk x 3 weeks
72
What are the maximum doses of bupivacaine with and without epinephrine?
2.5 mg/kg without epinephrine and 3 mg/kg with epinephrine.
73
Tx local bupivicaine OD?
Intralipids
74
What is the treatment for metformin-induced lactic acidosis?
Dialysis
75
1 amp of D50 is how much glucose?
50% of 50g/100mL = 25g of glucose = 100 calories
76
Super high fever resolves then rash appears in 2 yr old
Roseola (HHV6)
77
Dx diabetes? (3)
1. Any random fasting BG > 200
2. Fasting BG > 126 x 2 times
3. HbA1c > 6.5%
78
Which of the personality disorders are associated with an increased risk of suicide attempts? (2)
Borderline and histrionic personality disorders.
79
What medications can be considered for patients with alcohol withdrawal syndrome who do not respond to benzodiazepines? (2)
Barbiturates (e.g., phenobarbital) and propofol.
80
2 FDA approved first-line medications for alcohol use disorder?
Naltrexone and acamprosate
81
Above what blood pressure is it required to institute antihypertensive therapy prior to giving thrombolytics in acute ischemic stroke?.
>185/110 mm Hg
82
Hypertensive Emergency Tx? (2)
1- reduction of mean arterial pressure (MAP) by 25% over the first 1 hour.
2- nicardipine gtt or labetolol
83
mountain sickness vs HACE vs HAPE altitudes?
Mountain sickness > 6500 ft
HACE>10k ft
HAPE>14k ft
84
Direct vs indirect Coombs test?
A positive direct Coombs test identifies autoantibodies attached to red blood cells while a positive indirect Coombs test confirms autoantibodies in the serum.
85
Lab findings consistent with an acute hemolytic anemia include? (3)
an elevated LDH, low haptoglobin, and elevated indirect bilirubin.
86
What is the most common organism that causes malignant otitis externa?
Pseudomonas aeruginosa.
87
most common injury associated with a traumatic posterior hip dislocation?
Acetabular fx
88
Cocaine mech?
Stimulate alpha adrenergic rec
89
PCP mechanism?
NMDA rec antagonist
90
How can you estimate the gestational age of a fetus on physical exam?
Measure the fundal height: fundus at the pubic symphysis = 12 weeks gestational age, umbilicus = 20 weeks gestational age, xiphoid process = 36 weeks gestational age.
91
What is the appropriate pediatric dose in Joules/kg for cardioversion?
Initial dose is 0.5-1 Joules/kg, followed by 2 Joules/kg with subsequent doses.
92
What characteristic smell allows identification of hydrogen sulfide?
Rotten eggs.
93
Tx of hydrofluoric acid poisoning?
Calcium gluconate
94
Tx for hydrogen sulfide poisoning?
Sodium nitrite or amyl nitrite
95
What is the target temperature for cooling in heat stroke?
The patient should be cooled to 102°F within 10 minutes. Cooling beyond this can cause the patient to have overshoot hypothermia.
96
3 meds that can cause methemoglobinemia
benzocaine (likely given during the procedure for oral anesthesia), dapsone, and chloroquine
97
new holosystolic murmur best heard over the midaxillary line as well as symptoms of acute left heart failure
New onset MR
98
New acute MR is most commonly associated with? ECG?
transmural infarction of the inferior wall of the heart. STE inferior leads
99
What is the most common cause of septic arthritis in children?
Staphylococcus aureus.
100
Isolated tibial or perineal DVT Tx?
Repeat Zus In 5 days
101
Hyperbaric tx indications for CO2tox? 3
Neuro deficit, LOC, end organ damage
102
Dx aortic stenosis on echo??
Aortic Valve area < 1cm2
103
MCC Herpangina?
Coxsackie. Supportive (but milrinone if severe CV dz with enterococcus)
104
New MR in CAD pt is associated with?
Inferior STEMI
105
Diff between Crohns and UC?
Crohns- mouth to anus, full thickness lesions,
UC- mucosal/submucosal lesions only,
106
Worse vision with high body temp ?
Optic neuritis
107
Rash starts in groin/axilla spreads to trunk
Scarlet fever
108
Strawberry tongue and circumoral pallor?
Scarlet fever
109
Sandpaper rash? Tx?
Scarlet fever. Penicillin (if allergic- azithromycin)
110
3 C’s of measles?
Cough, coryza, conjunctivitis
111
Tx UTI in pregnancy?
Amoxicillin, Keflex
Bactrim- 2nd trimester only
Macrobid- 1-2 trimester only
112
At what acetaminophen level would treatment with N-acetyl cysteine be warranted at four hours?
acetaminophen level of 150 μg/mL.
(Above Rumack-Matthew nomogram line: treat
Below Rumack-Matthew nomogram line: no treatment necessary)
113
Bilateral internuclear ophthalmoplegia
(eyes can't look at nose)
| Multiple Sclerosis
114
MS flare tx?
Methylprednisolone
115
CSF will show ↑ IgG protein, WBC pleocytosis
MS
116
PE will show spinal electric shock sensation with neck flexion
MS (Lhermitte phenomenon)
117
VZV isolation?
Until the vesicles are crusted over, patients required airborne isolation (negative pressure room) with contact precautions for anyone entering the room.
118
Influenza isolation?
Droplet precautions
