EM6 Flashcards
BL putamen hemorrhages?
Methanol poisoning
Snow storm vision
Methanol poisoning
Methanol metabolism? Tx? (2)
Methanol —> formaldehyde —> Formic acid.
Can use folate to help Formic acid —> co2 and water
+ HD
Toxic alcohol found in coolants, polishes, and detergents
Ethylene glycol
Toxic alcohol found in paint products, windshield washer fluid, and antifreeze
Methanol
Metabolism of ethylene glycol? Tx? (2)
Ethylene glycol —> oxalic acid —> calcium oxalate
Thiamine and pyridoxine help remove toxic metabolites
+ HD
Toxic alcohol found in rubbing alcohol, solvents, paint thinners, skin and hair products, and antifreeze
Isopropyl alcohol
osmolal gap without an elevated anion gap.
Isopropyl alcohol
Toxic alcohol causing Hemorrhagic gastritis
Isopropyl alcohol
Torsades de pointes may be caused by? (2)
electrolyte disturbances (hypokalemia, hypomagnesemia, hypocalcemia), antiarrhythmic drugs that prolong the QT interval (procainamide, quinidine, disopyramide)
Tx torsades?
Stable: Mg, isoproterenol (overdrive pacing)
Unstable: cardioversion
Pulseless: defibrillation
Seizure tx?
1st: Benzodiazepines (lorazepam etc.)
2nd: Phenytoin or fosphenytoin
3rd: Pentobarbital
deeply and symmetrically inverted T waves in the anterior precordial leads? Tx?
Wellens. Urgent cath for likely critical stenosis of LAD
What is a de Winter ECG pattern?
Considered a STEMI equivalent seen with acute LAD occlusion, it is ST depression with peaked T waves in the precordial leads
Two types of Wellens syndrome?
Biphasic T waves (type A)
deeply and symmetrically inverted T waves in the anterior precordial leads (type B)
Hydrophobia
Rabies
What is CREST syndrome?
Calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasias.
What is the definitive management for patients with Brugada syndrome?
Implantable cardiac defibrillator.
Common lab abnormality heat stroke
Elevated LFTs
What is the mainstay of treatment for hypertrophic cardiomyopathy?
Long-term beta-blocker therapy.
Late pregnancy vaginal bleeding differential? (3)
Late pregnancy vaginal bleeding is never normal and raises suspicion for placental abruption, placenta previa and vasa previa; all potentially life threatening disorders to both the mother and fetus
What arterial blood gas finding is concerning for impending respiratory failure in an asthmatic?
A normal, elevated or rising carbon dioxide.
The optimal rate for chest compressions?
rate of 100-120/minute.
Diffuse maculopapular rash with white spots on the buccal mucosa
Measles (Rubeola)
A prodrome of fever, lymphadenopathy, and conjunctivitis followed by a maculopapular rash that starts on the face and spreads to the trunk and limbs
Rubella
rash typically starts on the face and spreads to the extremities.
Measles (Rubeola)
High fever for 3 days followed by the appearance of a pink maculopapular rash after defervescence
Roseola
“Blueberry muffin” spots.
Rubella
What are the electrocardiogram findings that suggest underlying Wolff-Parkinson-White syndrome? (3)
A short PR interval (< 0.12 seconds), a prolonged QRS complex (> 0.12 seconds), and a “delta wave” or slurred upstroke of the QRS complex.
AV and SA node receives blood flow from what vessel in most people?
RCA
The classic triad of aortic stenosis is
chest pain, dyspnea, and syncope.
Hernias relationship with inferior epigastric artery?
Medial to IEA: Direct;
Lateral to IEA: Indirect
(MDs dont LIe)
What mathematical formula is recommended to determine serum osmolarity (mOsm/kg)
2(Na) + (BUN/2.8) + (glucose/18).
Sciatic nerve palsy? Tx?
buttock injury, hip dislocation, ↓ knee flexion, foot drop
rx: analgelsics, physical therapy
Common peroneal nerve palsy? Tx?
proximal fibula injury, footdrop
rx: ankle splint
Radial nerve palsy? Tx?
crutches, sleeping drunk, wrist/finger drop
rx: wrist splint
Ulnar nerve palsy?
elbow injury, ↓ finger adduction/thumb grasp, 4th/5th digit paresthesias
Lateral femoral cutaneous nerve palsy?
inguinal ligament entrapment, upper thigh dysesthesia/numbness
Concerning PVR in cauda equina?
Volumes greater than 100–200 mL without a history of voiding difficulties suggests a neurologic etiology.
Tx hereditary Angioedema? (2)
C1 esterase inhibitor replacement or FFP
At what heart rate should CPR be initiated for a pediatric patient with bradycardia and poor perfusion despite adequate oxygenation?
60 bpm
Indications for urgent endoscopy for stomach foreign bodies ?
ingestion of sharp or long objects (e.g., toothpicks, needles), co-ingestion of a button battery and magnet, objects wider than 2 cm, objects longer than 6 cm, and localization proximal to the pylorus over 24 hours after ingestion.
Polycythemia Vera is Hb>
greater than 16 g/dL in women or greater than 16.5 g/dL in men.
NSAID toxicity occurs with ingestions of >
100 mg/kg
normal PaO2 despite cyanosis
Methemoglobinemia
Chocolate brown blood
Methemoglobinemia
Hypoxia that does not improve with supplemental o2
Methemoglobinemia
What is a quick way to decide whether a tachycardic rhythm is supraventricular or ventricular in origin?
Supraventricular has narrow QRS complexes and ventricular has wide QRS complexes.
Maltese cross sign
Nephrotic syndrome
HBsAg:
Active infection
HBsAb:
recovered or immunized
HBcAb IgM vs IgG
Anti-HBc IgM: early marker of infection, positive in window period
Anti-HBc IgG: best marker for prior HBV
HBeAg:
high infectivity
Anti-HBeAb:
low infectivity
HCV transmission?
IVDA, chronic, cirrhosis, carcinoma, carrier
HDV transmission?
Dependent on HBV coinfection
HEV transmission?
fecal-oral (enteric) high mortality rate among pregnant (expectant) patients, epidemics,
Which hepatitis transmitted fecal oral?
HAV and HEV are fecal-oral: “The vowels hit your bowels”
Which hepatitis has vaccines?
HAV and HBV have preventative vaccine available
Alcoholic hepatitis LFTs?
moderate transaminase elevation, AST > ALT (2:1)
What type of animal bite wounds require immediate postexposure prophylaxis for rabies?
Bite wounds sustained from a bat, raccoon, skunk, or fox.
most common pathogen in cat wounds
Pasteurella multocida
Tx cat bites? (2)
Abx for all cat wounds (amoxicillin-clavulanate)
Most cat wounds left open
Capnocytophaga canimorsus
Sepsis or gangrenous wound after dog bite
Dix hallpike vs epley maneuvers?
Dix-Hallpike maneuver can be used to support the diagnosis of BPPV. After performing a Dix-Hallpike, an Epley maneuver can be performed to expel the otolith from the labyrinth.
Levels of Sedation
Minimal Responsiveness: Normal Airway: Unaffected Ventilation: Unaffected Cardiovascular function: Unaffected
Moderate
Responsiveness: responds purposefully to verbal/tactile stimulation
Airway: No intervention required
Ventilation: adequate
Cardiovascular function” usually maintained
Deep
Responsiveness: Purposeful response after repeated/painful stimulation
Airway: Intervention may be required
Ventilation: may be inadequate
Cardiovascular function: usually maintained
General Anesthesia Responsiveness: unarousable Airway: requires intervention Ventilation: usually inadequate Cardiovascular function: may be impaired
Most common cause of hip pain in young child? Dx?
Transient synovitits. Dx-US with effusion
ST segment elevation in aVR greater than 1 mm or greater than the ST elevation seen in V1 is most concerning for occlusion of ?
the left main coronary artery (STEMI equivalent)
Chest tube placement where?
Chest tube placement should occur at the 4th or 5th intercostal space in the midaxillary line. The tube should placed over the superior aspect of the rib in order to avoid injuring the neurovascular bundle that runs under each rib.
What are the current recommendations for hospital admission for patients with hyphemas (independent of other injuries or conditions)?
Patients with 50% or greater hyphema volume or other risk factors as outlined above should be admitted.
Frostbite stages
1st degree - white plaques
2nd degree - clear blisters
3rd degree- hemorrhagic blisters
4th degree- full-thickness involvement of underlying muscle and bone
Chilblains vs immersion foot?
Chilblains- exposure to damp non freezing temps
AKA Trench foot- exposure to wet non freezing temps
What is the appropriate rewarming method for frostbite?
Rapid rewarming with immersion in 37–39°C circulating water until tissue feels pliable.
What is the most serious complication of impetigo?
Acute glomerulonephritis.
Esophagitis Treatment:
Candida:
CMV:
HSV:
Candida: fluconazole
CMV: Ganciclovir
HSV: acyclovir
When should you use flumazenil in BZD OD?
in benzodiazepine naive patients only bc can cause acute withdrawal in chronic users
Tx endometritis?
Clindamycin + gentamicin
DKA Management summary?
- Start insulin gtt at 0.1mg/kg when serum K+>3.3
- Switch from NS to D5 1/2NS when BG 200-250
- Taper insulin gtt (0.02-0.05) and start SC insulin when BG < 200 AND at least two of the following goals are met:
———-serum anion gap < 12 mEq/L
———-serum bicarbonate ≥ 15 mEq/L
———-venous pH > 7.30.
Wells criteria for PE? (7)
Sign/Sx-3 No other dx more likely-3 HR>100 - 1.5 Immobilization- 1.5 Previous PE/DVT- 1.5 Hemoptysis is- 1 Malignancy- 1
Bence-Jones proteins
Multiple myeloma
Rouloux formation
Multiple myeloma
What plants are known to cause an anticholinergic toxidrome? (2)
Jimson weed and belladonna
eating reheated rice - diarrhea
Bacillus cereus
canned food - diarrhea
C. botulinum
reheated meat or canned foods within 24 hours - watery diarrhea and epigastric pain
Clostridium perfringens
sea bass, grouper, red snapper - diarrhea
Ciguatera
undercooked meat - diarrhea, HUS
E. coli O157:H7
poultry, meat, eggs - diarrhea
Salmonella
peppery tasting fish - diarrhea
Scombroid
eating meats, mayonnaise, custard 1 - 6 hours ago - nausea, vomiting, abdominal pain and diarrhea
Staphylococcus aureus
shellfish and seafood - diarrhea
V. parahaemolyticus, V. vulnificus
undercooked pork - pseudoappendicitis, bloody diarrhea
Yersinia
Chvostek sign?
Contraction of facial muscles after tapping facial nerve (hypocalcemia)
What is the most accurate test in the diagnosis of adrenal insufficiency?
A cortisol level.
Hypoparathroidism labs? (3)
Labs will show low PTH, low calcium, high phosphorus
extremity and perioral paresthesias, tetany, and lethargy
Hypocalcemia (consider hypoparathyroidism)
MAP goal for LVAD pt?
goal MAP is between 70 and 90 mm Hg.
What dialysis-related complication presents with altered mental status, headache, and vomiting?
Dialysis disequilibrium syndrome.
What are the indications for dialysis in a patient with tumor lysis syndrome?
Potassium >6 mEq/L, uric acid >20 mg/dL, creatinine >10 mg/dL, phosphorus >10 mg/dL, volume overload, or symptomatic hypocalcemia.
4 stages of labor
1-dilate to 10cm
2- deliver baby
3-deliver placenta
4-postpartum
hematuria, proteinuria, RBC casts
acute glomerulonephritis
edema, proteinuria but NO hematuria
nephrotic syndrome
dose of factor VIII for bleeding hemophiliac
50 IU/kg
target UOP in rhabdo
200-300cc/hr
gastroenteritis + febrile sz
shigella
which tineas need PO antifungals
capitis + unguium
What is an appropriate inspiratory:expiratory ratio for a pediatric patient with a percutaneous needle cricothyrotomy?
1:4 to 1:5.
The straight leg raise test is considered positive if
A positive test results in radicular pain below the knee of the affected leg.
L3 radiculopathy?
weakness with hip flexion with decreased sensation of the anterior thigh
L4 radiculopathy?
weakness with knee extension, and decreased sensation of medial leg.
L5 radiculopathy?
MC. back pain that radiates down the lateral leg with weakness with dorsiflexion of the foot. Sensation will be decreased in dorsum of the foot and and webspace between the first and second toe
S1 radiculopathy?
decreased plantar flexion at the ankle and numbness of the lateral foot/posterior leg
Hyperosmolar hyperglycemic state differs from diabetic ketoacidosis primarily because of
because of the lack of or very low levels of ketoacidosis.
Labs will show Glc > 600 and negative ketones
HHS management? 3
Immediate 15–20 mL/kg intravenous isotonic fluid bolus, start intravenous regular insulin drip (0.05–0.1 unit/kg/hr) if or when blood glucose does not fall by 50–70 mg/dL per hour, replace potassium when level is less than 5.3 mEq/L
dermatomyositis? 3
gottrans papules on extensor surfaces and heliotrope rash on eyelids w/ proximal muscle weakness
What is the most common cause of meningitis in adult patients?
Streptococcus pneumoniae
dacroadenitis vs dacrocystitis?
dacroAdenitis- Above (upper eyelid)
dacrocystitis- lower eyelid
On plain film, what is the best image on which to see free air
the lateral chest X-ray
strain vs sprain
strain- muscle belly or tendons
sprain- ligaments to bone
