EM7 Flashcards
1
Q
common causes of APD? 4
A
Common causes include central retinal artery or vein occlusion, optic neuritis, and retrobulbar neuritis.
2
Q
when can you see IUP on US?
A
This range is referred to as the “discriminatory zone” and is 1000-2000 mIU/mL for transvaginal scans and 6500 mIU/mL for transabdominal scans.
3
Q
: At what week gestation is cardiac activity usually present?
A
6 weeks
4
Q
brugada tx?
A
Automatic implantable cardioverter-defibrillator (AICD) placement
5
Q
most common surgical emergency in patients older than 65 years of age
A
cholecystitis
6
Q
painful vs painless vision loss (5)
A
painful- AACG, optic neuritis, iritis, temporal artertitis, corneal abrasion
painless- RD, CRAO/CRVO, amaourosis, MD, CVA
7
Q
Wernicke’s encephalopathy triad?
A
opthalmoplegia, ataxia and confusion
8
Q
What is diagnostic of appendicitis on ultrasound?
A
Diameter of 7 mm
9
Q
What is the normal safe dose of 1% lidocaine solution injected subcutaneously?
A
3–5 mg/kg, not to exceed 300 mg per injection. 1% lidocaine contains 10 mg/mL of lidocaine.
10
Q
Which electrolye abnormality is the predominant cause of refeeding syndrome?
A
hypophosphatemia
11
Q
The presence of progressive cognitive decline, in addition to two of the following three features - fluctuating cognition, visual hallucinations and parkinsonism
A
Lewy Body Dementia
12
Q
What is the common side effect of the administration of hydroxycobalamin?
A
Skin turns red
13
Q
most common cause of nontraumatic hip pain in children.
A
Transient synovitis
14
Q
proptosis, pain and limitation of extraocular movements
A
Orbital cellulitis
15
Q
Diff between preseptal and orbital cellulitis?
A
OC- May have proptosis, vision impairment, diplopia, opthalmoplegia, cheimosis
16
Q
painful, shallow, cluster of vesicles
A
Herpes
17
Q
painless chancre
A
Syphillis
18
Q
painless ulcer, inguinal lymphadenopathy
A
Lymphogranuloma venereum (C. Trachomatis)
19
Q
painful chancres, inguinal bubo
A
Chancroid: H. ducreyi
20
Q
beefy red genital ulcer
A
Granuloma inguinalea: K. granulomatis
21
Q
Dermatitis, diarrhea, dementia
A
Niacin (B3) deficiency (pellagra)
22
Q
Toxidrome- hypoglycemia and then fulminant liver failure
A
Amanita phyllodes
23
Q
What would a neonate with abdominal pain and bilious vomiting suggest?
A
Bilious vomiting suggests malrotation with midgut volvulus.
24
Q
Pericardiocentesis procedure
A
spinal needle insertion at the left sternal border between the 5th and 6th ribs.
25
Patients without vomiting 6 hours after exposure will not have major toxicity
Iron toxicity
26
Deferoxamine indications:
systemic illness, serum Fe level >350 mcg/dL + symptoms
27
Dx SBP? (3)
PMNs > 250, WBC > 1,000, pH < 7.34
28
Tx endometritis?
Inpt- clinda, gent
| Outpt- augmentin
29
Epididymitis Treatment is?
< 35 y/o ceftriaxone/doxycycline,
| > 35 y/o ciprofloxacin
30
Best location for temperature probe:
esophagus
31
ROSC cooling Target temperature:
33 - 36°C
32
Normal ABI?
ABI > 0.9
| If less, needs angiography
33
Lab findings of microangiopathic hemolytic anemia? (4)
schistocytes on peripheral blood smear, as well as anemia with decreased haptoglobin, and elevated LDH and unconjugated bilirubin.
34
Tx TTP?
Plasmapheresis
35
What are three other emergent causes of microangiopathic hemolytic anemia besides TTP?
Hemolytic uremic syndrome, HELLP syndrome (hemolysis, elevated liver function tests, low platelets), and disseminated intravascular coagulation.
36
Trichophyton rubrum
Tinea cruris (jock itch)
37
What correlates with level of severity of placental abruption?
Fibrinogen
38
Tx SAH?
Treatment is supportive and nimodipine (decreases vasospasm)
39
Simple Febrile seizure? (3) tx?
1. Patient will be a child 6 months to 5 years of age
2. With a history of fever > 38º C
3. Complaining of a single tonic-clonic seizure lasting < 15 mins
Treatment is supportive care. If lasting > 5 min, a dose of diazepam gel or suppository into the rectum can be used
40
multinucleated giant cells on Tzanck smear
Herpes
41
most common site of orbital blowout
Inferior- the maxillary bone is most commonly fractured.
42
Eczema on what surfaces?
Flexor
43
Signs of upper motor neuron deficits (3)
lower extremity spasticity, hyperreflexia and a positive Babinski sign.
44
What age is a contraindication for the administration of tPA in the 3-4.5 hour time frame?
Greater than 80 years.
45
Stroke deficit Anterior cerebral artery:
frontal lobe dysfct, apraxia, contralat paralysis (lower > upper)
46
Stroke deficit Middle cerebral artery:
contralat paralysis (upper > lower), hemianopsia, aphasia
47
Stroke deficit Posterior cerebral artery and VBI:
LOC, nausea/vomiting, CN dysfct, ataxia, visual agnosia
48
What are the five NEXUS criteria for clinically clearing the cervical spine? I
No focal neurologic deficits, normal alertness, no evidence of intoxication, no distracting injuries, and no posterior midline cervical tenderness.
49
How to escharotomy?
Incise through skin into subcutaneous tissue
Neck: incise from clavicle to mastoid process
Chest wall: incise along anterior axillary line from 2nd to 12th rib
Extremities: incise on medial and lateral aspects 1 cm proximal to 1 cm distal to burn
50
How can you diagnose papilledema with ultrasound?
Optic nerve sheath diameter > 5 mm, measured 3 mm posterior to the globe.
51
If MRI is not available, what other radiographic modality may identify cord compression?
CT Myelography.
52
most useful marker for severity of radiation injury
Absolute lymphocyte count @ 48 hours
| Excellent outcomes are expected for normal levels, fair for 500–1000/mm3, and essentially fatal for < 100/mm3
53
When to give steroids for PCP PNA? (2) tx?
PaO2<75 or A-a gradient >35
| Give steroids first then Bactrim
54
Pressure ulcer stages?
1- nonblanching erythema - cover w/ transparent film
2- open, erythematous (partial thickness)
3- SC fat (full thickness skin) - hydrogel, Surg debridement if eschar
4- bone, tendon, muscle (full thickness tissue)
55
Tx of premature rupture of membranes ?
If the fetus is immature (24 – 34 weeks of gestation), corticosteroids (+amp/amox) should be considered to accelerate pulmonary maturity. Over 34 weeks of gestation, delivery is preferred.
56
Nitrazine test?
If nitrazine paper turns blue —> premature rupture of membranes
57
Pooling test?
Collection of amniotic fluid in vaginal fornixes—> premature rupture of membranes
58
Ferning test?
Vaginal fluid on microscope slide will crystallize —> +amniotic fluid —> premature rupture of membranes
59
Terry Thomas sign? Tx ?
Scapholunate dislocation . Thumb spica
60
Hand bones?
So Long To Pinky, Here Comes The Thumb
61
cephalocaudal spread (2)
rubeola (measles), rubella (german measles)
62
boxer fx
fx of neck of 5th mcp
63
galeazzi fx
fx of distal radius w/ disruption of radioulnar joint (MU/GR)
64
monteggia fx
fx of proximal 1/3 ulna w/ dislocation of radial head (MU/GR)
65
TOF-4
VSD, overriding aorta, pulmonic stenosis (R--> L shunt), RVH
66
gram stain- s aureus
gm+ in clusters
67
gram stain- s pneumo
gm+ diplococci
68
tPA reversal (2)
amicar (aminocaproic acid) + cryo
69
centrifugal rash
smallpox (variola)
70
hot-cold sensation reversal?
ciguatera
71
conjunctivitis, cough, coryza
rubeola (measles)
72
vitals in neurogenic shock
hypotension, hypothermia, bradycardia
73
positive whiff test? tx?
bacterial vaginosis, flagyl
74
clue cells? tx?
bacterial vaginosis, flagyl
75
bennett fx
fx of base of 1st MCP
76
bohler angle
calcaneal fx, angle of 28-40 degrees=normal
77
fat emboli tx? (3)
steroids, supportive, NO heparin
78
cough + widened mediastinum on CXR
pulm anthrax
79
osmolar gap w/o acidosis
isopropyl alcohol
80
opioid w/ dilated pupils or seizures
meperidine (demerol)
81
maltese crosses in urine - tox
ethylene glycol
82
glass etcher, rust remover, metal cleaners- tox
hydrofluoric acid
83
ETT Tube calculation
(age/4) + 4
ie: 4 yo= 5 ETT uncuffed
minus 0.5 cuffed (ie: 4.5)
valid age 1-10
84
ETT tube depth
ETT size x 3
85
CXR w/ FB- where is it?
coin in esophagus- frontal
| coin in trachea- sagittal
86
cri de canard (duck cry)
RPA
87
thumbprint sign
epiglottitis
88
what nerve is blocked- upper lid, lower lid, lower lip
upper lid- supraorbital
lower lid-infraorbital
lower lip- mental
89
BL adrenal hemorrhage
Waterhouse-friderichsen meningococcemia
90
nail punctures through snearkers
pseudomonas
91
rubella aka? sx? 2
german measles, (LAD, forscheimer spots)
92
rash spreads on neck/trunk and spreads to face/extremities
roseola
93
ALS
motor fxn loss (UMN + LMN) but sensation intact
94
port wine stain + seizures
sturge-weber syndrome
95
strawberry cervix? tx?
tricomoniasis, flagyl
96
thin grey-white vaginal discharge? tx?
bacterial vaginosis, flagyl
97
6 unstable cervical spine fxs
"Jefferson bit off a hangman's thumb"
- jefferson fx
- BL facet dislocation
- odontoid type II and type III fx
- any fx/dislocation
- hangman fx
- teardrop fx
98
smith fx
reverse colles fx -distal radius fx w/ volar displacement
99
jones fx
fx of base of 5th MTP distal to styloid process (surgical)
100
pseudojones fx?
styloid process fx of 5th MTP (better prognosis)
101
gamekeeper fx
UCL of thumb, lose pincer grasp
102
lisfranc fx
fx at base of 2nd MTP
103
bleeding baby after home delivery
vit K deficiency
104
perioral burn after biting electrical cord
delayed labial artery bleeding in 7-10 days
105
PNA w/ marked lymphocytosis + shaggy R heart border on CXR
pertussis
106
PNA after air travel
legionalla
107
PNA + GI sx
legionella
108
PNA + hyponatremia
legionella
109
pinpoint pupils- 4
```
POCO
pontine bleed
opioids
clonidine
organophosphates
```
110
yellow halos- tox
digoxin
111
pepto bismol OD - tox
salicylates
112
Neers test?
Supraspinatus tendinitis
113
B symptoms?
fevers, night sweats, and weight loss (Hodgkin's lymphoma)
114
Reed-Sternberg cells
Hodgkin's lymphoma
115
At what size is an ovarian mass at high risk for torsion?
5 cm or greater, although any mass size can cause torsion
116
endolymphatic hydrops
Menieres disease (excess fluid buildup in the labrynithe system)
117
tx menieres? (2)
low salt diet, diuretics (HCTZ + triamterene)
118
MC organism causing endorcarditis in IVDA? native valve?
IVDA: staph (R sided, TV)
| non-IVDA: strep (L sided, MV)
119
tx endorcarditis?
piperacillin-tazobactam and vancomycin with gentamicin (for double gram-negative coverage) and micafungin (for fungal coverage in severely ill patients or patients being sent to the intensive care unit) + source control
120
retroperitoneal structures?
kidneys, adrenal glands, pancreas, and retroperitoneal portions of the duodenum, colon, aorta, and inferior vena cava
121
What physical exam finding can differentiate ethylene glycol ingestion from methanol ingestion?
Visual acuity, as methanol leads to blurry vision and blindness rapidly if not treated
122
The historical feature that most increases the likelihood that the patients discomfort is ischemic is ?
chest pain that radiates into bilateral arms.
123
cx of nephrotic syndrome?
DVT bc they are hypercoaguable
124
what hyperK tx can drive K intracellularly? 3
insulin, albuterol, sodium bicarb
125
what hyperK tx can drive eliminate K? 3
lasix, kayexelate, HD
126
What is a potential complication of acyclovir administration if administered rapidly or with a high dose?
Crystal-induced nephropathy (treated with IV hydration and lowering the dose).
127
tx transverse myeitis in adults? 2
high dose steroids, plasmapheresis if refractory
128
tx complete heart block stable vs unstable?
Asymptomatic - none
Symptomatic - atropine or isoproterenol
Unstable- transcutaneous vs venous pacing
129
The most sensitive diagnostic maneuvers for meningitis?
| most specific exam maneuvers for meningitis?
sensitive- jolt accentuation of headache
| specific- brudzinski
130
Which infectious agent warrants administration of steroids in the treatment of meningitis?
Streptococcus pneumoniae.
131
Etiologies of high-output heart failure include? 5
sepsis, hyperthyroidism, beriberi, preg, and arteriovenous fistulas.
132
tx toxic shock syndrome? how do they work?
1- clindamycin is bacteriostatic, as it does not actively cause cell death but rather stops protein synthesis and the bacteria’s ability to replicate.
2- Vancomycin is bactericidal by causing cell wall damage.
133
tx RPA
Ampicillin-sulbactam is the antibiotic of choice with intravenous dexamethasone
134
spont pneumomediastinum in peds ass with
asthma
135
narrow vs wide complex PEA?
narrow- RV problem, obstruction
| wide- ischemia, metabolic
136
type I DM vs type II? (3)
type I- Autoantibodies, low insulin levels, and decreased C-peptide levels
137
tx acute myasthenic crisis?
plasmapheresis or IVIG
138
normal CBD size?
<4mm
139
indications to intubate near-drowning pt? (3)
- neurologic deterioration
- PCO2 above 50 mm Hg.
- inability to maintain PO2 above 60 mm Hg despite supplemental oxygen
