EM8 Flashcards
acid base disturbance in ASA tox
metabolic acidosis w/ resp alkalosis
spider bite + abd pain
black widow
necrotic spider bite after lifting log
brown recluse (violin shape)
should you give antivenin in coral snake bite
administer antivenin even w/o sx “red on yellow kill a fellow”
machine oil urine
hyperthermia
staccato cough
neonatal chlamydia (dev @ 4-12 weeks)
type 1 vs II error
type 1 = a (null hypothesis incorrectly rejected)
type 2= B (failure to reject null when its wrong)
class iv hemorrhage will present with
negligible urine output, confusion
NEXUS Criteria?
- N- Neuro deficit
- E- EtOH/intoxication
- X- distracting injury
- U- Unconsciousness/AMS
- S- servical tenderness
What injury is likely to be present in a child with a raised elbow fat pad?
Supracondylar fracture.
Posterior fat pad sign suggestive of ?
radial head fracture
Quincke’s pulse:
prominent nail pulsations ass w/ AR
major Duke’s criteria for endocarditis? 3
+blood cx, echo findings, new murmur
melena indicates where location of bleed
UGIB prox to ligament of treitz
MCC LBO
cancer
1st line tx for Crohns
5-ASA agents (sulfasalazine or mesalamine)
causes of inc unconjugated bili (2)
hemolysis (or inc production) or hepatocellular injury (problem w/ hepatocyte)
causes of inc conjugated bili
bile obstruction
vaccines for splenectomy pts?
cover encapsulated organisms (s pneumo, h influenza, n meningitiditis)
morbilliform rash after ampicillin
EBV
dx SCD sequestration (3)
Hb drop by 2 points, thrombocytopenia, reticulocytosis
Displacement of the radiocapitellar line suggestive of?
subluxation or dislocation of the radial head
What chemotherapeutic agent is associated with dilated cardiomyopathy?
doxorubicin
How long does it take for Gtube to mature?
4 weeks (before this g tube displacement should be admitted for IV Abx and monitor for peritonitis)
CI during thyroid storm?
Aspirin (because it displaces T4 from binding proteins leading to increased serum levels of T4 and T3 potentiating the thyrotoxicosis.)
Fusion beats ? Suggestive of?
occur when impulses from two different locations (one within the ventricle and one in a supraventricular location) activate the ventricle. The result is a QRS complex with morphology resembling a hybrid of a sinus beat and intraventricular beat. These are diagnostic of VT because they represent AV dissociation.
Capture beats?
Capture beats occur when a sinus beat is normally conducted and a single beat with the sinus QRS morphology occurs within a wide complex tachycardia.
Tx prinzmetal angina?
Nitrates and CACB
What three medications decrease mortality after a myocardial infarction?
ABC – Aspirin, beta-blockers, statins (anti-cholesterol)
Which kidney stone patients need admission?
Patients who have only one kidney and an obstructing stone need admission with urology consultation
Which kidney stones likely to pass? And not?
Treatment is:
< 5 mm: likely to pass spontaneously
> 8 mm: unlikely to pass, lithotripsy
Which finding on lung ultrasound is most specific for a diagnosis of spontaneous pneumothorax?
presence of a lung point sign, visualization of the junction of normal lung sliding adjacent to an area with absent lung sliding.
What viral foodborne disease presents with jaundice, dark urine, and diarrhea?
Hepatitis A.
Tx GuillianBarre Syndrome?
Treatment is supportive, plasmapheresis, or IVIG
MCC osteomyelitis?
S aureus
MC spread osteomyelitis?
Adults: contiguous spread
Children: hematogenous spread
Tx ketamine laryngospasm?
BVM
Best needle position for evacuation of PTX? PLeural effusion?
Air evacuation site: 2nd ICS, midclavicular line
Fluid evacuation site: ≥ 1 ICS below top of effusion in the midscapular or posterior axillary line
Standard sexual assault tx?
CDC recommends empiric treatment of gonorrhea, chlamydia, and trichomoniasis with ceftriaxone 250 mg IM, azithromycin 1 gm orally, and metronidazole 2 gm orally, respectively. Hep B vaccine only if not previously vaccinated
Best emergency contraception if >72 hours from encounter?
Ulipristal 30 mg orally is the preferred choice if it has been 72 hours or longer since the assault and in overweight or obese women. It is a selective progesterone receptor modulator which delays ovulation by as much as five days.
Best emergency contraception if <72 hours from encounter? (2)
Ethinyl estradiol 100 mcg and levonorgestrel 0.5 mg x two doses 12 hours apart is 80% effective if given within 72 hours of intercouse but is not well tolerated due to frequently associated nausea and vomiting. Levonorgestrel 1.5 gm is another treatment option for emergency contraception
Two types of local anesthetic classes?
Amides: lidocaine, bupivacaine (2 Is)
Esters: tetracaine, benzocaine (1 I)
(If allergic to one try the other class)
Tx local anesthetic OD?
Toxicity Rx: lipid emulsion
Sx Benzocaine OD?
methemoglobinemia
Sx Lidocaine OD:
seizures, hypotension
Sx Bupivicaine OD:
cardiotoxicity
Lidocaine Concentration 1% means what
1% = 1g/100mL = 10 mg/mL
What local anesthetics can be used subdermally in patients with allergic reactions to both amide and ester anesthetics? (2)
Diphenhydramine or benzyl alcohol with epinephrine.
Dx HIV?
- Dx: ELISA followed by HIV-1/HIV-2 differentiation immunoassay or Western blot
- Dx tests become positive during seroconversion (3-12 weeks after exposure)
HIV * Chronic watery diarrhea:
Cryptosporidium
HIV * White cottage cheese lesions:
Candida
HIV * Irremovable white lesions on lateral tongue:
hairy leukoplakia (EBV)
PCP PNA in HIV when?
CD4 < 200
TB in HIV when?
- TB: CD4 < 200, may have negative CXR/PPD
HIV * Ring-enhancing intracranial lesions + focal neurologic deficits:
Toxoplasma gondii
HIV * Ring-enhancing intracranial lesions + AMS:
primary CNS lymphoma
HIV * Meningitis, CD4 < 100:
Cryptococcus
HIV * Focal neurologic deficits, non-enhancing white matter lesions, CD4 < 200:
PML (JC virus)
HIV * Retinitis, cotton-wool spots:
CMV
HIV * Dark purple skin/mouth nodules:
Kaposi’s sarcoma
HIV * Cutaneous:
HSV, zoster reactivation
HIV dz when CD4< 250? (2)
Esophageal candidiasis, HSV
HIV dz when CD4< 200? (2)
PCP PNA, PML
HIV dz when CD4< 100? (4)
Toxoplasmosis, encephalopathy, crypto, military TB
HIV dz when CD4< 50? (2) px?
CMV retinitis, MAC
Start azithromycin for Px
How to calculate absolute lymphocyte count ?
absolute lymphocyte count is calculated by multiplying the percentage of lymphocytes by the total number of white blood cells
(An absolute lymphocyte count < 950 K/ml is predictive of a CD4 count below 200.)
Mackler’s triad for Boerhaaves?
chest pain, vomiting and subcutaneous emphysema
In which portion of the esophagus does rupture typically occur for Boerhaaves?
The posterolateral portion is the most common site of rupture.
Dx Boerhaaves?
esophogram with water-soluble oral contrast
massive transfusion cx-3
coagulopathy, hypocalcemia, hypothermia
transfusion rxn- hemolytic rxn? tx?
ABO incompatibility, d/c
transfusion rxn- allergic rxn?
urticaria or hives
transfusion rxn- TRALI? tx?
like ARDS. stop transfusion
transfusion rxn- delayed rxn? 3
3-4 weeks later, dec Hb, inc bilirubin
transfusion rxn- GVHD?- 4
prevention?
immunocompromised pt, rash, pancytopenia, inc LFTs. prevent w/ irradiated blood products in immunocompromised pt
how to open PDA?
prostaglandin E1
tetrology of fallot?
PROVe (pulm stenosis, RVH, overriding aorta, VSD)
2 most common infxns that cause Jarisch-herxheimer rxn after starting Abx?
lyme + syphillis
Abx —> lysis of spirochete bacteria
brudzinski sign
flex neck
kernig sign
extend knees
px of close contacts for meningitis
rifampin
5 indications for emergent HD
A-acidosis, E-electrolyte abnl, I-ingestion (lithium, methanol), O-overload, U-uremia
erythema multiforme
target-like lesions (can be 2/2 infxn, meds, autoimmiune)
erythema marginatum
rheumatic fever (macule w/ central clearing that spares face)
erythema nodosum
inflammatory nodules (can be 2/2 autoimmune, infxn, meds, preg)
erythema migrans
lyme disease (bull’s eye)
erythema infectiosum
parvo b19 (slapped cheek)
what rashes appear on palms-6
syphillis, RMSF, hand/foot/mouth, erythema multiforme, drug eruption, scabies
back pain in young pt w/ morning stiffness
seroneg spondyloarthropathy
back pain w/ extension, relief w/ flexion
spinal stenosis
carbon monoxide indication for hyperbaric tx?
if COHb<20% —> 100% O2 tx.
if COHb>25% then hyperbaric (>15% in preggos)
thermal burn grades-4?
superficial= like sunburn
superficial partial thickness= red + painful + blisters
deep partial thickeness= white + leathery + painless
full thickness= charred + insensate
which burns go to burn center? 6
any full thickness, partial thickness > 10% TBSA, burns of face/genitalia/hands/feet/major joints, high voltage or electrical, chemical, inhalation injury
clonic vs tonic
clonic= jerking, tonic= posturing
ICH where- homonymous hemianopsia
putamen
ICH where- sensory loss> motor loss
thalamus
ICH where- pinpoint pupils, decerebrate posturing, coma
pontine
finkelstein test dx of? tx?
de quervain’s tendinopathy (flex thumb + ulnar deviation). tx= thumb spica
tx DVT in preggo
LMWH
tetanus px for low risk wound? high risk?
low risk= dT
high risk= dT and TIG (250 U IM)
order of drugs in hyperthyroidism/thyroid storm? 3
1- propranolol
2- PTU/methimazole
3-iodine/steroids
tx scabies- 2
(interdigit burrows) permethrin, ivermectin
pinworm tx- 3
albendazole or mebendazole. pyrantel pamoate
PNA- ohio/mississippi river valley, bird/bat droppings
histoplasmosis
PNA- southwest, arthritis, erythema nodosum
coccidiodomycosis
PNA- midwestern, south east, budding yeast, bone lesions
blastomycosis
weber localizes to affected ear, Rinne abnl (BC>AC)
conductive hearing loss (OM, cerumen)
weber localized to unaffected ear, Rinne normal (AC>BC)
sensorineural hearing loss (noise exposure, drugs, aging)
basophilic stipling + microcytic anemia? tx?
lead poisioning, tx= succimer (it SUCCs to eat lead)
SCD: low Hb, reticolytosis
tx? (3)
splenic sequestration crisis. tx= transfuse, supportive, splenectomy
SCD: low Hb, no reticolytosis
tx? (2)
aplastic crisis (parvo b18) tx= transfuse, supportive
vent tx breath stacking?
dec RR, then inc TV
MC bug in resp secretions for CF kids? adults?
kids- staph
adults- pseudomonas
status epilepticus tx? (3)
- BZDs
- phenytoin/fosphenytoin OR valproic acid OR pheonobarb OR levitiracetam
- pentobarb OR propofol
anterior nosebleeds from what vessel? posterior?
anterior- kiesselbach plexus
posterior- sphenopalatine artery (posterolateral)
What is the first maneuver that should be attempted when a patient with a tracheostomy presents with massive bleeding concerning for a tracheoinnominate artery fistula?
Hyperinflate the cuff of the trachea to attempt to tamponade the bleeding vessel. If this fails, orotracheal or nasotracheal intubation followed by direct digital pressure should be pursued.
how long does it take for a trach site to mature?
7 days
stages of pertussis?
- catarrhal: 1-2 weeks of URI
- paroxysmal: 2-6 weeks of cough attacks
- convalescent: 1-2 weeks of getting better
post-exposure px for pertussis?
macrolide (erythromycin, azithromycin, clarithromycin). Bactrim if allergic
tx toxic shock syndrome?
Clindamycin as it suppresses toxin production.
if treating aspiration PNA, what antibiotic should you use?
ampicillin-sulbactam (for aerobe and anaerobe coverage)
What solutions should be used to unclog a gastrostomy tube?
Warm water (found to be superior to colas) or pancreatic enzymes dissolved in a bicarbonate solution.
MC source of embolization from the heart?
atrial appendage (small area in the left lateral wall of the left atrium where clots form)
*esp w/ afib
What is the international normalized ratio (INR) target when treating atrial fibrillation with warfarin?
2.0 to 3.0.
What artery is at risk of injury with a supracondylar fracture?
Brachial artery.
what meds is associated with anhidrotic hyperthermia in overdose?
antihistamines (eg: scopolamine)
when do you transfuse FFP?
bleeding pt w/ INR > 1.7
when do you tranfuse cryo?
bleeding pt w/ fibrinogen < 100
tx giardia?
MNZ
marcus gunn pupil?
APD
bartholin’s cyst tx?
NO tx unless sympomatic or >40 (these are diff from bartholin’s abscess)
1st-3rd line tx for hypotension in septic shock?
- levophed
- vasopressin or epi
- glucocorticoids
treatment of choice in bradydysrhythmias in cardiac transplant patients
isoproterenol (atropine doesnt work bc denervation during transplant –> no vagal tone)
Transplant Rejection
Hyperacute rejection:
Acute rejection:
Chronic rejection:
tx?
Hyperacute rejection: minutes-hours post-transplant, irreversible graft destruction, due to preformed antibodies
Acute rejection: weeks-months post-transplant, humoral/T-cell mediated
Chronic rejection: months–years post-transplant
Transplant rejection Rx: steroids
MC bug in lung abscess
Peptostreptococcus
tx of tet spells? (3)
knee-to-chest position, morphine to decrease the respiratory rate and improve oxygenation, and phenylephrine, which increases systemic vascular resistance, improving blood flow to the pulmonary artery for proper oxygenation.
“painless jaundice.”
pancreatic cancer
migratory thrombophlebitis
pancreatic cancer (Trousseaus syndrome)
palpable nontender gallbladder
pancreatic cancer (Courvoisier sign)
Palpable left supraclavicular lymph node
pancreatic cancer (Virchows node)
palpable nodule bulging into the umbilicus
pancreatic cancer (Sister Mary Joseph sign)
