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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.

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2
Q

Tx HUS?

A

Supportive. Don’t give Abx

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3
Q

MC vessel involved with ischaemic stroke

A

MCA

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4
Q

Short QT syndrome is caused by

A

Hypercalcemia

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5
Q

U wave on ECG is caused by

A

Hypokalemia

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6
Q

In DKA, insulin should be held until a serum potassium is?

A

over 3.3

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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.

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8
Q

INH toxicity tx?

A

pyridoxine

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9
Q

what bug causes croup?

A

parainfluenza

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10
Q

steeple sign

A

croup

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11
Q

subglottic tracheal narrowing

A

croup

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12
Q

JONES criteria for rheumatic fever?

A 
Joints
Oh, no carditis!
Nodules
Erythema marginatum
Sydenham's chorea
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13
Q

tx cyanide toxicity (3)

A

hydroxocobalamin OR sodium nitrite and sodium thiosulfate

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14
Q

bradycardia, hypotension, severe lactic acidosis

A

cyanide poisioning

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15
Q

hypoxia not responsive to supplemental o2

A

methemoglobinemia

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16
Q

methemoglobinema tx

A

methylene blue

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17
Q

focal neuro deficit w/ diving ascent

A

arterial gas embolus

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18
Q

ascending paresthesias/paralysis w/ diving ascent

A

decompression sickness

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19
Q

severe pain w/ diving ascent

A

decompression sickness

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20
Q

AMS w/ diving ascent

A

nitrogen narcosis

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21
Q

cx of LV aneurysm?

A

thrombus formation (rupture rare bc aneurysm wall is formed of scar)

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22
Q

what type of anal fissure is always pathological?

A

lateral

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23
Q

M<10, limping, hip internally rotated

A

legg-calve-perthes (idiopathic avascular necrosis)

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24
Q

teen boy w/ leg pain and hip externally rotates w/ flexion

A

SCFE

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25
Q

What findings are typically seen on CSF analysis in tuberculous meningitis? (3)

A

Very low glucose, elevated protein and a slightly elevated opening pressure.

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26
Q

vaginal bleeding with closed internal os

A

Threatened abortion

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27
Q

vaginal bleeding with open os

A

Inevitable abortion

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28
Q

partial passage of products of conception (POC)

A

Incomplete abortion

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29
Q

complete passage of POC

A

Complete abortion

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30
Q

fetal death < 20 weeks without POC passage

A

missed abortion

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31
Q

coffee bean sign

A

sigmoid volvulus

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32
Q

sigmoid volvulus tx (2)

A

sigmoidoscopy + rectal tube decompression

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33
Q

what makes HOCM murmur louder? (2)

A

vasalva, standing up

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34
Q

what makes HOCM murmur softer? (4)

A

squatting, trendelenburg, hand grip, passive leg raise

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35
Q

1st step of cric?

A

3-5cm vertical incision over cricothyroid membrane

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36
Q

cric CI in what age group?

A

<10

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37
Q

tx for CaCB OD? (3)

A

calcium salts, glucagon, high dose insulin w/ glucose

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38
Q

brady, hypotension, hyperglycemia

A

CaCB OD

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39
Q

brady, hypotension, normo/hypoglycemia

A

BB OD

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40
Q

tearing of bridging veins

A

subdural

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41
Q

crescent shaped hyperdenisity bleed -

A

subdural

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42
Q

middle meningeal artery

A

epidural

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43
Q

biconvex lens shaped bleed

A

epidural

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44
Q

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?

A

2 and 10

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45
Q

reversal agent for dabigatran?

A

Idarucizumab

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46
Q

DIC labs? (5)

A

high: PT/PTT, D-Dimer, fibrin
low: platelets, fibrinogen

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47
Q

Add steroids for PCP tx when?

A
  1. PaO2 < 70 OR

2. A-a gradient >35

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48
Q

Molluscum contagiosum caused by

49
Q

How is alteplase (t-PA) dosed in ischemic CVA?

A

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
Q

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

A

occlusion of the left main coronary artery.

51
Q

Ellis classification

A

Ellis I: - * Enamel * Rx: smooth edges
Ellis II: - Enamel + dentin * Rx: calcium hydroxide paste
Ellis III - Enamel + dentin + pulp * Rx: dental consult, pulpectomy

52
Q

Dx mediastinitis

A

CT neck and chest

53
Q

Psoas sign

A

RLQ pain on extension of right hip

54
Q

Obturator sign

A

RLQ pain on internal rotation of flexed right hip

55
Q

Rovsing sign

A

right lower quadrant pain when the left lower quadrant is palpated

56
Q

Afterload

A

Afterload is considered the amount of pressure the heart is contracting against, or the blood pressure

57
Q

preload

A

Preload is considered the amount of blood presenting to the heart from the circulation

58
Q

Tx c diff mild vs fulminant

A

Mild- PO Vanc or Fidaxomicin

Ful- PO Vanc and IV flagyl

59
Q

Pericardial knock

A

Constrictive pericarditis

60
Q

Portal venous gas

A

Necrotizing Enterocolitis

61
Q

Tx of constrictive pericarditis

A

pericardiectomy

62
Q

Cherry red fovea

A

central retinal artery occlusion

63
Q

Blood and thunder

A

central retinal vein occlusion

64
Q

MC bacteria in osteomyelitis

A

Staph aureus

65
Q

Low-flow vs high flow priapism?

A

Low flow: venous, emergency Low-flow rx: ice packs, phenylephrine, aspiration

High-flow: arterial, semierect, painless High-flow rx: observation

66
Q

Priapism after cervical spine injury

A

C5 fracture

67
Q

Lab abnormalities of rhabdo? (3)

A

Hyperkalemia, hyperphosphatemia, hypocalcemia

68
Q

What is the most specific test for diagnosis of secondary syphilis.

A

Fluorescent treponemal antibody absorption

69
Q

Dx syphillis

A

VDRL and RPR positive 4-6 weeks after infection

70
Q

Stages of syphillis

A

Primary: painless chancre
Secondary: lymphadenopathy, condyloma lata, rash on palms/soles
Tertiary: gummas

71
Q

Tx primary syphillis

A

Primary/secondary: IM benzathine penicillin G x 1 dose

Tertiary: IM benzathine penicillin G qwk x 3 weeks

72
Q

What are the maximum doses of bupivacaine with and without epinephrine?

A

2.5 mg/kg without epinephrine and 3 mg/kg with epinephrine.

73
Q

Tx local bupivicaine OD?

A

Intralipids

74
Q

What is the treatment for metformin-induced lactic acidosis?

75
Q

1 amp of D50 is how much glucose?

A

50% of 50g/100mL = 25g of glucose = 100 calories

76
Q

Super high fever resolves then rash appears in 2 yr old

A

Roseola (HHV6)

77
Q

Dx diabetes? (3)

A
  1. Any random fasting BG > 200
  2. Fasting BG > 126 x 2 times
  3. HbA1c > 6.5%
78
Q

Which of the personality disorders are associated with an increased risk of suicide attempts? (2)

A

Borderline and histrionic personality disorders.

79
Q

What medications can be considered for patients with alcohol withdrawal syndrome who do not respond to benzodiazepines? (2)

A

Barbiturates (e.g., phenobarbital) and propofol.

80
Q

2 FDA approved first-line medications for alcohol use disorder?

A

Naltrexone and acamprosate

81
Q

Above what blood pressure is it required to institute antihypertensive therapy prior to giving thrombolytics in acute ischemic stroke?.

A

> 185/110 mm Hg

82
Q

Hypertensive Emergency Tx? (2)

A

1- reduction of mean arterial pressure (MAP) by 25% over the first 1 hour.
2- nicardipine gtt or labetolol

83
Q

mountain sickness vs HACE vs HAPE altitudes?

A

Mountain sickness > 6500 ft
HACE>10k ft
HAPE>14k ft

84
Q

Direct vs indirect Coombs test?

A

A positive direct Coombs test identifies autoantibodies attached to red blood cells while a positive indirect Coombs test confirms autoantibodies in the serum.

85
Q

Lab findings consistent with an acute hemolytic anemia include? (3)

A

an elevated LDH, low haptoglobin, and elevated indirect bilirubin.

86
Q

What is the most common organism that causes malignant otitis externa?

A

Pseudomonas aeruginosa.

87
Q

most common injury associated with a traumatic posterior hip dislocation?

A

Acetabular fx

88
Q

Cocaine mech?

A

Stimulate alpha adrenergic rec

89
Q

PCP mechanism?

A

NMDA rec antagonist

90
Q

How can you estimate the gestational age of a fetus on physical exam?

A

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
Q

What is the appropriate pediatric dose in Joules/kg for cardioversion?

A

Initial dose is 0.5-1 Joules/kg, followed by 2 Joules/kg with subsequent doses.

92
Q

What characteristic smell allows identification of hydrogen sulfide?

A

Rotten eggs.

93
Q

Tx of hydrofluoric acid poisoning?

A

Calcium gluconate

94
Q

Tx for hydrogen sulfide poisoning?

A

Sodium nitrite or amyl nitrite

95
Q

What is the target temperature for cooling in heat stroke?

A

The patient should be cooled to 102°F within 10 minutes. Cooling beyond this can cause the patient to have overshoot hypothermia.

96
Q

3 meds that can cause methemoglobinemia

A

benzocaine (likely given during the procedure for oral anesthesia), dapsone, and chloroquine

97
Q

new holosystolic murmur best heard over the midaxillary line as well as symptoms of acute left heart failure

A

New onset MR

98
Q

New acute MR is most commonly associated with? ECG?

A

transmural infarction of the inferior wall of the heart. STE inferior leads

99
Q

What is the most common cause of septic arthritis in children?

A

Staphylococcus aureus.

100
Q

Isolated tibial or perineal DVT Tx?

A

Repeat Zus In 5 days

101
Q

Hyperbaric tx indications for CO2tox? 3

A

Neuro deficit, LOC, end organ damage

102
Q

Dx aortic stenosis on echo??

A

Aortic Valve area < 1cm2

103
Q

MCC Herpangina?

A

Coxsackie. Supportive (but milrinone if severe CV dz with enterococcus)

104
Q

New MR in CAD pt is associated with?

A

Inferior STEMI

105
Q

Diff between Crohns and UC?

A

Crohns- mouth to anus, full thickness lesions,

UC- mucosal/submucosal lesions only,

106
Q

Worse vision with high body temp ?

A

Optic neuritis

107
Q

Rash starts in groin/axilla spreads to trunk

A

Scarlet fever

108
Q

Strawberry tongue and circumoral pallor?

A

Scarlet fever

109
Q

Sandpaper rash? Tx?

A

Scarlet fever. Penicillin (if allergic- azithromycin)

110
Q

3 C’s of measles?

A

Cough, coryza, conjunctivitis

111
Q

Tx UTI in pregnancy?

A

Amoxicillin, Keflex
Bactrim- 2nd trimester only
Macrobid- 1-2 trimester only

112
Q

At what acetaminophen level would treatment with N-acetyl cysteine be warranted at four hours?

A

acetaminophen level of 150 μg/mL.

(Above Rumack-Matthew nomogram line: treat
Below Rumack-Matthew nomogram line: no treatment necessary)

113
Q

Bilateral internuclear ophthalmoplegia

A

(eyes can’t look at nose)

Multiple Sclerosis

114
Q

MS flare tx?

A

Methylprednisolone

115
Q

CSF will show ↑ IgG protein, WBC pleocytosis

116
Q

PE will show spinal electric shock sensation with neck flexion

A

MS (Lhermitte phenomenon)

117
Q

VZV isolation?

A

Until the vesicles are crusted over, patients required airborne isolation (negative pressure room) with contact precautions for anyone entering the room.

118
Q

Influenza isolation?

A

Droplet precautions

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