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Cam's Cards > Emergency Medicine EOR > Flashcards

Emergency Medicine EOR Flashcards

1
Q

Shoulder impingement syndrome is caused by compression of the tendon of what muscle?

A

Supraspinatus

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2
Q

What physical exam special test finding is most consistent with shoulder impingement syndrome?

A

A positive hawkins-kennedy test

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3
Q

How is the Hawkins-Kennedy test preformed?

What is a positive test?

A
  1. Stabilize shoulder
  2. Flex elbow 90 degrees
  3. Internally rotate shoulder

Positive test = pain with internal rotation

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4
Q

What is the most common risk factor for shoulder impingement syndrome?

A

Repetitive overhead activity

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5
Q

Treatment for shoulder impingement syndrome?

A

Rest, ice, NSAIDs, physical therapy

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6
Q

A positive O’Brien test indicates an injury where?

A

Superior labrum anterior and posterior tear

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7
Q

What indicates a positive O’Brien test?

A

While shoulder is flexed to 90 degrees, pain with downward pressure while internally rotated, and relief of pain with downward pressure while externally rotated.

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8
Q

A Speed test is used to evaluate for what injury?

A

Bicipital tendinitis

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9
Q

What is a Homans test used to evaluate?

A

For DVT

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10
Q

Which rotator cuff muscle is most commonly injured, inflamed, or torn?

A

The supraspinatus muscle.

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11
Q

What is the classic triad of symptoms for bacterial meningitis?

A

Fever, confusion, neck stiffness.

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12
Q

What are the most common causative agents of bacterial meningitis in adults?

A

Strep pneumo and Neisseria meningitidis

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13
Q

What are the typical CSF analysis results in bacterial meningitis?

A 
Cloudy/purulent fluid
CSF glucose <40% of serum glucose
WBC count >1000, predominantly polymorphonucleocytes (PMNs)
Elevated opening pressure
Increased protein level
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14
Q

What is a normal opening pressure for a lumbar puncture?

A

6-20

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15
Q

How would you expect CSF analysis results to differ in mycobacterium tuberculosis meningitis or fungal meningitis when compared to strep pneumo meningitis?

A

TB meningitis and fungal meningitis should have similar results, but cell count is typically lower, between 10-1000 cells/microL, with a predominance of lymphocytes rather than PMNs

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16
Q

What CSF analysis results would you expect in viral meningitis?

A

Clear fluid appearance
Normal-slightly elevated opening pressure
WBC count 25-2000 with lymphocyte predominance
Elevated protein
CSF glucose >60% serum glucose

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17
Q

Why is dexamethasone administered with antibiotics for suspected meningitis?

A

Decrease in mortality and long-term morbidity (e.g. hearing loss).

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18
Q

What two physical exam findings would you expect to be positive in a patient with meningitis?

A 
Brudzinski's sign (neck)
Kernig sign (Knee)
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19
Q

What causative agent of meningitis should you have concern for in HIV patients?

A

Cryptococcus

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20
Q

What is the empiric treatment for bacterial meningitis in a 18-50 year old patient?

A

Ceftriaxone + vancomycin

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21
Q

What is the empiric treatment for bacterial meningitis in a >50 year old patient?

A

Ceftriaxone + vancomycin + ampicillin (to cover Listeria)

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22
Q

Which are painful, internal or external hemorrhoids?

A

External (below dentate line)

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23
Q

What patients with thrombosed external hemorrhoids are good candidates for hemorrhoid excision?

A

Patient with acute (less than 48 hours) sever symptoms in otherwise healthy patients?

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24
Q

What patients should not have thrombosed hemorrhoids excised in the ED?

A

Immunocompromised patients, pregnant patients, patients with coagulopathies, and patients with symptoms >48 hours.

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25
Q

What type of excision should be made to remove a thrombosed hemorrhoid?

A

Elliptical incision

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26
Q

If a patient is not a good candidate for excision of a thrombosed hemorrhoid, what is the recommended treatment?

A

Stool softeners, sitz baths, PCP follow up.

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27
Q

How is rectal bleeding associated with hemorrhoids typically described?

A

Limited, at the end of defecation, either dripping into the bowl or on tissue paper.

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28
Q

What is the most consistent finding in patients with cauda equina syndrome?

A

Urinary retention

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29
Q

What imaging should you order emergently for patients you suspect cauda equina syndrome?

A

MRI

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30
Q

What is the treatment for cauda equina syndrome?

A

emergency surgery

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31
Q

What is the treatment for cauda equina syndrome secondary to a malignancy?

A

Emergent radiation therapy.

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32
Q

What is the reversal agent for warfarin?

A

Vitamin K

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33
Q

What is the INR goal for DVT prevention?

A

2-3

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34
Q

For a patient with an INR of 12, with no bleeding, what is the treatment?

A

Oral vitamin K, hold next warfarin dose, repeat labs in 24-48 hours.

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35
Q

What is the treatment for a patient with an INR of 8, with no bleeding?

A

Hold warfarin, no vitamin K necessary.

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36
Q

What is the pharmacologic treatment for a patient on warfarin with any INR, who has serious bleeding?

A

Four-factor prothrombin complex concentrate (4-factor PCC)
IV vitamin K
Hold warfarin

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37
Q

What blood product may be used to reverse warfarin?

A

Fresh frozen plasma.

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38
Q

A patient suspected of acute coronary syndrome has an elevated troponin without ST segment changes or T wave abnormalities. They have been given nitroglycerin, aspirin, an IV, and are being prepared for PCI. What other medication do they still need?

A

Ticagrelor (which is a P2Y12 adenosine diphosphate platelet receptor antagonist (P2Y12 antagonist))

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39
Q

Why is ticagrelor preferred over other P2Y12 anatagnoists such as clopidogrel or prasugrel in patients with ACS?

A

Studies have shown that it provides faster, greater, and more consistent ADP receptor inhibition

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40
Q

What is the dose of Ticagrelor that should be given for ACS?

A

180mg by mouth

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41
Q

What type of medication is tenecteplase?

A

A tissue plasminogen activator variant

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42
Q

When should Tenecteplase be given for ACS?

A

If PCI is thought to be longer than 120 minutes from first medical contact.

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43
Q

What are two modalities to evaluate for low-probability (patients with normal cardiac serum biomarkers and no acute ischemic ECG changes) ACS?

A

CT coronary angiography and nuclear medicine testing

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44
Q

What antiplatelet agent should be given to patients with ACS who have a true aspirin allergy?

A

Clopidogrel.

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45
Q

What is the pathophysiological of the disease process causing PSGN?

A

Immune complex deposition

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46
Q

How long after a strep infection does PSGN usually present?

A

2 weeks

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47
Q

What are the classic symptoms of PSGN?

A

HTN, edema, tea-colored urine or foamy urine

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48
Q

Urinalysis often shows what in PSGN?

A

Red blood cell casts and proteinuria

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49
Q

Do antibiotics help lower the incidence of poststreptococcal glomerulonephritis?

A

No.

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50
Q

What is the treatment for PSGN?

A

Supportive measures including salt and water restriction, furosemide if edema and HTN are present

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51
Q

What are the two most common risk factors for small bowel obstructions?

A

Adhesions from previous surgery

Cancer

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52
Q

What is the preferred imaging modality to diagnose a SBO?

A

CT

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53
Q

What is the most common cause of large bowel obstruction?

A

Neoplasm.

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54
Q

What is common to see on abd x-ray in a SBO?

A

Dilated bowel, air fluid levels, stack of coins or string of pearls sign.

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55
Q

Treatment for SBO?

A

NGT, surgery

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56
Q

What is the cause of a bowing fracture?

What is the treatment?

A

Cause: Longitudinal compression
Tx: Ortho consult

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57
Q

What is the cause of a greenstick fracture?

What is the treatment?

A

Cause: Axial compression with twisting
Tx: Casting and reduction

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58
Q

What is the cause of a Torus (Buckle) fracture?

What is the treatment?

A

Cause: axial compression
Tx: casting

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59
Q

What are two treatment options for acute uncomplicated cystitis?

A

TMP-SMX or nitrofurantoin x 3-5 days

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60
Q

What are the treatment options and duration for acute uncomplicated cystitis with comorbid conditions?

A

TMP-SMX or nitrofurantoin or a fluoroquinolone x 7 days

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61
Q

What is the treatment for acute cysitis in men?

A

TMP-SMX or nitrofurantoin x 7 days or a fluoroquinolone x 5 days

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62
Q

Why is asymptomatic bacteriuria treated in pregnant women?

A

It has been linked to increased risk of low birth weight infants as well as pyelonephritis in mothers.

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63
Q

What is the outpatient treatment for acute uncomplicated pyelonephritis?

A

Fluoroquinolone (I dont really know if someone does LMK)

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64
Q

The diagnosis of DKA can be made with the presence of what three findings?

A

Hyperglycemia, ketosis, and acidemia.

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65
Q

What are the three aims of treatment for DKA?

A

Insulin therapy, fluid resuscitation, and electrolyte replacement.

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66
Q

What electrolyte abnormality is typically found in DKA?

A

Hyperkalemia

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67
Q

Why should you give potassium to patients being treated for DKA?

A

Potassium levels decrease significantly as acidemia is corrected

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68
Q

What is the term for deep and labored breathing seen in patients with diabetic ketoacidosis?

A

Kussmaul respirations.

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69
Q

What are the 5 I’s that can cause DKA?

A

Infection, Ischemia (cardiac, mesenteric), Infarction, Insulin deficit (poor control), Intoxication.

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70
Q

What are the symptoms of DKA?

A

Abd pain, vomiting, fatigue.

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71
Q

What is temporal arteritis associated with?

A

polymyalgia rheumatica

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72
Q

What are the symptoms of polymyalgia rheumatica?

A

Anorexia, headache, jaw claudication, and fever.

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73
Q

What is the gold standard for dx of temporal arteritis?

A

Temporal artery biopsy

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74
Q

What is the treatment for temporal arteritis?

A

Corticosteroid treatment

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75
Q

What is another large-vessel vasculitis aside from giant cell (or temporal) arteritis?

A

Takayasu arteritis.

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76
Q

What lab finding is common in temporal arteritis?

A

Elevated ESR

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77
Q

What are the 6 different types of abortion?

A

Threatened, inevitable, incomplete, compete, missed, and septic.

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78
Q

The cervical os is open during what types of spontaneous abortion?

A

Inevitable, incomplete, and septic.

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79
Q

What is the most common pathogen responsible for septic abortion?

A

Staph aureus

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80
Q

What is the treatment for septic abortion?

A

evacuation of uterine contents as well as antibiotics (ampicillin-sulbactam or clindamycin + gentamicin)

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81
Q

Carpospasm while checking blood pressure is known as what sign?

A

Trousseau sign

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82
Q

What does Trousseau sign indicate?

A

Hypocalcemia

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83
Q

What sign other than Trousseau sign indicates hypocalcemia?

A

Chvostek sign

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84
Q

Describe a positive Chvostek sign.

A

Contraction of the ipsilateral facial muscles elicited by tapping the facial nerve just anterior to the ear.

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85
Q

What electrolyte abnormality can cause hemodynamic instability during massive transfusion protocol?

A

Hypocalcemia. Calcium levels can drop precipitously during transfusion secondary to the citrate present in packed red blood cells.

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86
Q

What ECG findings are associated with pericarditis?

A

Diffuse ST elevation with reciprocal ST depression in leads aVR and V1.

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87
Q

Describe the pain associated with pericarditis.

A

Sharp, pleuritic chest pain that is relieved by sitting up and leaning forward.

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88
Q

What is the treatment for pericarditis?

A

NSAIDs, cholchicine, and steroids for refractory cases.

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89
Q

What viruses commonly cause pericarditis?

A

Coxsackie viruses A and B, echovirus, adenovirus, HIV, Epstein-Barr virus, influenza, and hepatitis B.

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90
Q

What is the initial monotherapy for a low back strain?

A

NSAIDs or acetaminophen

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91
Q

What is the second line combination therapy for low back strains?

A

NSAIDs and muscle relaxants.

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92
Q

How does the back pain of a herniated disc present?

A

Electrical pain that radiates down the back of the leg.

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93
Q

What is the most common type of mesenteric ischemia?

A

Arterial embolism

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94
Q

What is the gold standard imaging for diagnosis of mesenteric ichemia?

A

Mesenteric CT angiography

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95
Q

How long after the onset of bowel ischemia does complete transmural necrosis complete?

A

Six hours.

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96
Q

What physical exam findings would give you concern for mesenteric ischemia?

A

Pain out of proportion to exam

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97
Q

What history findings with abdominal pain point towards mesenteric ischemia?

A

History of dysrhythmias, recent MI, CAD, valvular heart disease, prior thromboembolic events, hypercoagulable states, heart failure.

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98
Q

What lab finding is common in mesenteric ischemia?

A

Lactic acidosis

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99
Q

What is the difference between relative and absolute polycythemia?

A

Relative polycythemia is due to a decrease in plasma volume, commonly caused by dehydration or excessive diuresis.

Absolute polycythemia is an increase in RBC mass.

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100
Q

What is the difference between primary and secondary absolute polycythemia?

A

Primary is due to mutation in erythroid cell lines or EPO receptors.

Secondary is due to increased levels of circulating EPO.

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101
Q

How is polycythemia vera classified?

A

Polycythemia vera is an absolute primary polycythemia.

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102
Q

What gene mutation is associated with polycythemia vera?

A

JAK2 gene mutation

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103
Q

What are the classic symptoms of polycythemia vera?

A

Pruritis, particularly when exposed to hot water, and early satiety.

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104
Q

What is the name of the most life threatening complication of polycythemia vera?

A

Hyperviscosity syndrome

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105
Q

What is the triad of symptoms associated with hyperviscosity syndrome?

A

Vision changes, bleeding, and focal neurologic deficits.

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106
Q

Name some physical exam findings consistent with polycythemia vera.

A

Splenomegaly, plethoric facies, flushed skin, nail clubbing, and distal cyanosis.

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107
Q

What is the treatment for polycythemia vera?

A

low-dose aspirin and therapeutic phlebotomy.

Other treatments include ruxolitinib (a JAK1 and JAK2 inhibitor.)

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108
Q

What is the treatment for hyperviscosity syndrome?

A

IV fluid hydration and hematology consult.

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109
Q

What is the term for pruritis following a warm bath of shower?

A

Aquagenic pruritis

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110
Q

What is a leukemoid reaction?

A

Significant leukocytosis (50,000/μL) in the absence of hematologic malignancy.

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111
Q

How can you differentiate an ischemic priapism from a nonischemic priapism?

A

A nonischemic priapism is painless, and the glans is hard.

An ischemic priapism is painful, and the glans is soft. The blood gas has a pH <7.25, pCO2>60 and pO2<40.

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112
Q

What is the treatment for an ischemic priapism?

A

Corporal aspiration with intracavernosal phenylephrine

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113
Q

What is the initial treatment of ischemic priapism in patients with sickle cell disease?

A

Initial treatment is the same with aspiration and intracavernosal phenylephrine.

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114
Q

What type of leukemia are the following cells found in:
Auer rods
Smudge cells
Philidelphia chromosome

A

Auer rods = AML (ask me later, in an auer)
Smudge cells = CLL (the sound it would make if you rolled the car window down with your face pressed against it, and it would leave a smudge)
Philidelphia chromosome = CML (Check My Location)

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115
Q

What is a risk factor for development of CML?

A

Exposure to ionizing radiation.

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116
Q

Is a spontaneous pneumothorax more common in males or females?

A

Males:Females = 3:1

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117
Q

What sign seen on supine chest XR is indicative of pneumothorax?

A

Deep sulcus sign (profound lateral costophrenic angle)

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118
Q

Where should a tube thoracostomy be inserted?

A

Fourth or fifth intercostal space, above the rib, midaxillary line (usually coincides with nipple line).

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119
Q

What physical exam findings may be present in a spontaneous pneumothorax?

A

Decreased breath sounds, decreased fremitus, and hyperresonance to percussion

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120
Q

What antibiotic is first line treatment for mastitis?

A

Dicloxacillin

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121
Q

What is the treatment for a breast abscess?

A

Antibiotics and ultrasound-guided needle aspiration.

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122
Q

Should patients with mastitis continue breast feeding?

A

Yes, it helps avoid progression to abscess.

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123
Q

What are the symptoms of autoimmune hemolytic anemia?

A

Most often just fatigue and pallor after exposure to a medication or viral infection.

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124
Q

What is the treatment for autoimmune hemolytic anemia?

A

Glucocorticoids

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125
Q

Which class of medications is the most common cause of drug-induced immune hemolytic anemia?

A

Cephalosporins.

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126
Q

What condition is Lhermitte sign seen in?

A

Multiple sclerosis

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127
Q

What are the symptoms of optic neuritis?

A

Painful vision loss

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128
Q

What is the treatment for an acute exacerbation of multiple sclerosis?

A

High dose steroid such as methylprednisolone

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129
Q

In what condition can ophthalmoplegia be seen in an alcoholic?

A

Wernicke encephalopathy.

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130
Q

CSF analysis showing oligoclonal IgG bands supports what diagnosis?

A

Multiple sclerosis

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131
Q

What brain MRI findings support a diagnosis of MS?

A

Periventricular white matter lesions

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132
Q

Each unit of packed red blood cells raises hemoglobin by ____ and hematocrit by _____.

A

Each unit of packed red blood cells raises hemoglobin by 1g/dL and hematocrit by 3%.

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133
Q

For most patients, transfusion should be initiated for hemoglobin less than ___.

A

7g/dL

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134
Q

A unit of platelets will increase a patients platelet count by approximately how much?

A

50,000/microL

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135
Q

What is the appropriate ratio of red cells, platelets, and plasma in a massive transfusion protocol?

A

1:1:1.

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136
Q

Relief of pain associated with elevation of the affected testicle is known as what sign?

A

Phren sign

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137
Q

What is Phren sign associated with?

A

epididymitis

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138
Q

Where is pain typically located in epididymitis?

A

The posterolateral aspect of the testicle

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139
Q

What is the treatment for epididymitis in patients who do not have high risk sexual behavior?

A

A fluoroquinolone such as levofloxacin.

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140
Q

What is the treatment for epididymitis in patients with high risk sexual behavior?

A

Ceftriaxone and doxycycline

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141
Q

What is the first line medication for septic shock with hypotension?

A

Norepinephrine is the first line vasopressor

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142
Q

What does a plethoric inferior vena cava on ultrasound indicate in the setting of septic shock?

A

It means that the patient would not benefit from additional fluids

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143
Q

What is the first-line vasopressor or inotropic agent of choice for cardiogenic shock?

A

Norepinephrine. Although norepinephrine acts primarily on the vasculature to increase vascular tone, it is still the first recommended agent for cardiogenic shock.

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144
Q

What type of cord injury is characterized by complete loss of motor, pain, and temperature below injury, but retained proprioception and vibratory sensation?

A

Anterior cord syndrome

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145
Q

What are the most common mechanisms of injury for anterior cord syndrome?

A

Hyperflexion or vascular injuries

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146
Q

What cord syndrome is characterized by sensory and motor deficits greater in the upper extremities than the lower extremities?

A

Central cord syndrome

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147
Q

What is the most common mechanism of injury to cause central cord syndrome?

A

Forced hyperextension

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148
Q

What cord syndrome is characterized by ipsilateral loss of motor, vibratory sensation, and proprioception with contralateral loss of pain and temperature sensation?

A

Brown-Sequard syndrome

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149
Q

What is the most common mechanism of injury causing Brown-Sequard syndrome?

A

Penetrating trauma

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150
Q

What are the National Emergency X-Radiography Utilization Study (NEXUS) criteria for not obtaining imaging of the cervical spine in blunt trauma?

A

Imaging may be avoided if the patient does not have cervical midline tenderness, focal neurologic deficit, altered mental status, intoxication, or a distracting injury.

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151
Q

What is clicking rib syndrome?

A

A lower rib pain syndrome characterized by lower rib pain at the costal margin that is reproducible with palpation.

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152
Q

What signs and symptoms associated with chest pain are positive likelihood ratios for chostochondritis?

A

Pain worsens with breathing, movement, and horizontal arm flexion (crowing rooster maneuver).
Pain reproducible with palpation over the costochondral junctions

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153
Q

Papillary muscle rupture is associated with what type of MI?

A

Inferior MI

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154
Q

How long after MI do symptoms of papillary muscle rupture present?

A

3-5 days after infarction

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155
Q

What valvular disease occurs secondary to papillary muscle rupture?

A

Mitral regurgitation

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156
Q

What are the symptoms of mitral regurgitation?

A

Pulmonary edema, dyspnea, heart failure, and even cardiogenic shock.

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157
Q

What is the name of the tendinous structures that connect the mitral valve leaflets to the papillary muscle?

A

Chordae tendinae.

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158
Q

What shoulder injury presents with a “squared off” shoulder, slight shoulder abduction, and external rotation?

A

Anterior shoulder dislocation

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159
Q

What is a Hill-Sachs Lesion?

A

Posterolateral humeral head compression fracture

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160
Q

What is a Bankart lesion?

A

An avulsion of the glenoid labrum

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161
Q

Which nerve is most commonly injured in shoulder dislocations?

A

Axillary nerve.

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162
Q

What is the first line treatment for acute bacterial sinusitis?

A

Augmentin 875/125 BID

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163
Q

What is the first line pharmacotherapy and dose for SVT?

A

Adenosine 6mg rapid bolus, followed by 12mg if first dose is unsuccessful

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164
Q

What is the most common cause of a pleural effusion in a patient residing in a developing nation?

A

Tuberculosis.

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165
Q

Does pleural effusion cause increased or decreased tactile fremitus?

A

Decreased

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166
Q

What is the classic EKG finding of pericardial effusion?

A

Electrical alternans

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167
Q

What is the definitive therapy for pericardial effusion with tamponade?

A

Pericardiocentesis

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168
Q

What is the triad of symptoms associated with pericardial effusion?

A

Becks triad - hypotension, JVD< and muffled heart sounds

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169
Q

What is the most common cause of atraumatic pericardial effusion with tamponade?

A

Malignancy.

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170
Q

What is the most common cause of atypical pneumonia?

A

Mycoplasma pneumonia

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171
Q

What are the expected chest XR findings in atypical pneumonia?

A

Patchy infiltrates

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172
Q

What is the first line therapy for atypical pneumonia?

A

Macrolides of respiratory fluoroquinolones

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173
Q

Which electrolyte abnormality is seen in Legionella pneumonia?

A

Hyponatremia

174
Q

What rash presents with golden crusted lesions?

A

Impetigo

175
Q

What is the first line treatment for impetigo?

A

Mupirocin (or retapamulin)

176
Q

What is the causative agent of impetigo?

A

Staph aureus (most common)

Can also be caused by strep

177
Q

What renal complication may occur following impetigo?

A

Poststreptococcal glomerulonephritis.

178
Q

Why would a patient with a medication-induced dystonic reaction develop airway compromise?

A

Laryngeal dystonia leading to airway obstruction.

179
Q

What clinical feature is MOST suggestive of appedicitis?

A

Periumbilical pain that migrates to the right lower quadrant.

180
Q

What is the treatment for acute appendicitis?

A

Appendectomy

181
Q

What special tests would you preform on a patient in whom you expect appendicitis?

A

Check for McBurney point tenderness, Rovsing sign, Psoas sign, and Obturator sign.

182
Q

Is appendicitis more common in men or women?

A

Appendicitis is more common in men and boys.

183
Q

What is the most common cause of appendicitis?

A

Fecolith

184
Q

What are the expected ultrasound findings in acute cholecysitis?

A

Pericholecystic fluid and gallbladder wall thickening greater than 4-5mm

185
Q

What is a positive murphy sign?

A

Inspiratory pause or arrest with deep palpation of the right upper quadrant.

186
Q

Where does acute cholecystitis cause referred pain?

A

The right shoulder

187
Q

Fever, right upper quadrant pain, and jaundice suggest what pathology?

A

Ascending cholangitis.

188
Q

What is the most likely diagnosis for asymmetric oligoarthritis 1-4 weeks following urethritis or enteric infection?

A

Reactive arthritis

189
Q

What is the preferred imaging modality for aortic disection?

A

CTA of the aorta

190
Q

What is the initial treatment for aortic dissection?

A

Aggressive BP control with a BB such as esmolol.

191
Q

When might an aortic dissection cause stroke symptoms?

A

Dissection near the carotid artery

192
Q

What are the systolic BP and HR goals for a patient with an aortic dissection?

A

SBP 120-100

HR <60

193
Q

Why is lowering the heart rate, not only the blood pressure, also an important step in the management of aortic dissection?

A

Lowering the heart rate in aortic dissection decreases the potential propagation of the dissection flap by decreasing the shearing forces.

194
Q

In patients with nephrolithiasis, when has medical expulsive therapy with tamsulosin been shown to be most effective?

A

When the stone size is less than 10 mm.

195
Q

What are most kidney stones made of?I

A

Calcium oxalate

196
Q

What would you be concerned about if a patient was found to have a struvite stone?

A

Infection - struvite is produced by urease-producing bacteria

197
Q

Describe the typical patient in which you would find a kidney stone made of cystine.

A

A child with metabolic disease(s)

198
Q

What is the most common cause of croup?

A

Parainfluenza virus

199
Q

What is the treatment for croup?

A

Oral or IM dexamethasone, plus nebulized racemic epi for mod-severe cases.

200
Q

What x-ray finding would likely be found in a croup patient?

A

Steeple sign

201
Q

What is the oseltamivir dose for prophylaxis of influenza?

A

75mg PO QD X 7 days

202
Q

What is the oseltamivir dose for treatment of influenze?

A

75mg PO BID x 5 days

203
Q

T/F? Oseltamivir should only be started in patients with symptoms <2 days

A

False, high-risk outpatients should be treated with oseltamivir regardless of symptom duration.

204
Q

Which antiviral medication is recommended for the treatment of influenza patients who are unable to tolerate oral oseltamivir?

A

Intravenous peramivir.

205
Q

What is the most common bacteria causing infection after cat bites?

A

Pasturella multocida

206
Q

What antibiotic should be prescribed for cat bites?

A

Augmentin

207
Q

What characteristics of mammal bite wounds indicate that they should be closed primarily?

A

Injury to the face or scalp, presentation within six hours, and no host immunosuppressive conditions.

208
Q

What technique may improve the chance of diagnosing a Lisfranc injury on plain radiograph?

A

Including weight-bearing (stress) views.

209
Q

What medication can be given to non-pregnant patients with abnormal uterine bleeding to slow the bleeding?

A

IV estrogen

210
Q

What are the 4 structural causes of abnormal uterine bleeding?

A

Polyp
Adenomyosis
Leiomyoma
Malignancy/hyperplasia

211
Q

What are the 5 non-structural causes of abnormal uterine bleeing?

A 
Coagulopathy
Ovulatory dysfunction
Endometrial
Iatrogenic
Not yet classified
212
Q

What medication is used to treat postpartum hemorrhage due to atony?

A

Misoprostol

213
Q

Oral contraceptives are absolutely contraindicated in smokers over what age?

A

35 years.

214
Q

A holosystolic murmur with radiation to the axilla describes what type of murmur?

A

Chronic mitral regurg

215
Q

Name two diastolic murmurs.

A

Mitral stenosis and aortic insufficiency.

216
Q

A patient has epigastric pain radiating to the back. A chest XR shows free air under the diaphragm. What is the most likely diagnosis?

A

Perforated peptic ulcer

217
Q

What is the first and second most common cause of peptic ulcer disease?

A

First - H. pylori

Second - Aspirin or NSAID use

218
Q

How long after acute injury is compartment syndrome typically seen?

A

Between two hours and 6 days post injury

219
Q

What is the classic physical exam finding in compartment syndrome?

A

Pain out of proportion to physical exam findings

220
Q

What is normal compartment pressure?

A

10-12mmHg

221
Q

What is the delta pressure when using a tonometer?

Delta pressure greater than ___ should get a fasciotomy.

A

Delta pressure is diastolic blood pressure - intracompartmental pressure.
Delta pressure >/= 30 probably needs a fasciotomy

222
Q

What are the 6 P’s of compartment syndrome?

A 
Paresthesia
Pallor
Pulselessness
Poikilothermia
Paralysis
Pain out of proportion
223
Q

Compartment syndrome of the deep posterior compartment of the lower leg will lead to which passive movement producing intense pain?

A

Toe extension.

224
Q

Blood in the anterior chamber of the eye is known as a?

A

Hyphema

225
Q

What can you do for a patient with a hyphema while waiting for ophthalmology consult?

A

Elevate the head of the bed to 45 degrees to promote settling of blood and prevent occlusion of the trabecular meshwork

226
Q

Explain the grading system for hyphema.

A

Grade I = <1/3 anterior chamber volume
Grade II = 1/3-1/2 anterior chamber volume
Grade III = >1/2 anterior chamber volume
Grace IV = Total anterior chamber volume

227
Q

What disease are spontaneous hyphemas commonly associated with?

A

Sickle cell disease.

228
Q

C5 radiculopathy would effect what finger(s)?

A

None

229
Q

C6 radiculopathy would effect what finger(s)?

A

Thumb

230
Q

C7 radiculopathy would effect what finger(s)?

A

2nd and 3rd digits

231
Q

C8 radiculopathy would effect what finger(s)

A

4th and 5th digits

232
Q

What is Lhermitte phenomenon?

A

Shock-like paresthesias that occur with neck flexion. This can be a sign of compression of the spinal cord from a midline disk herniation or spondylosis.

233
Q

What rhythm is characterized by a sawtooth pattern?

A

A flutter

234
Q

What is the treatment for rate control of rapid atrial flutter in a stable patient?

A

A non-dihydropyridine calcium channel blocker or a beta-blocker.

235
Q

What are some risk factors for the development of plantar fasciitis?

A

Obesity, prolonged standing or jumping, and flat feet.

236
Q

A westermark sign seen on chest XR is specific for what?

A

Pulmonary embolism

237
Q

What are some abnormalities that may be seen on chest XR in a patient with CHF?

A

Kerley B lines
Increased cardiac silhouette
Increased interstitial and alveolar edema
Peribronchial cuffing

238
Q

What causes Kerley B lines on chest X-ray?

A

Engorgement of lymphatic vessels.

239
Q

What tests can be used to diagnose mononucleosis?

A

Mono-spot or herterophile antibody test

240
Q

Between strep and mono, which classically has anterior cervical LAD and which has posterior cervical LAD?

A

Strep - anterior

Mono - posterior

241
Q

What organomegaly is concerning during mononucleosis?

A

Splenomegaly

242
Q

What medications will cause a rash if given to a patient with mononucleosis?

A

Amoxicillin or ampicillin

243
Q

When is the false-negative rate highest for the heterophile antibody test?

A

During the first week of symptoms.

244
Q

What CBC and blood smear findings are common in mononucelosis?

A

Left shift and atypical lymphocytes.

245
Q

What is the mechanism of action of lactulose and rifaximin in treating hepatic encephalopathy?

A

Lactulose acidifies gut contents and causes a loss of NH4+ in the stool, and rifaximin is an antibiotic against colonic flora that produce ammonia.

246
Q

What is the most common valve affected by infectious endocarditis?

A

Mitral valve

247
Q

What is the most common valve involved in infective endocarditis in IV drug users?

A

Tricuspid valve

248
Q

What is the most common pathogen causing infective endocarditis in all populatuions?

A

Staph aureus

249
Q

What is a reasonable empiric therapy for suspected infective endocarditis?

A

Vancomycin plus gentamycin

250
Q

What variant of endocarditis is found in patients with systemic lupus erythematosus?

A

Libman-Sacks endocarditis, a noninfectious (sterile) thrombotic form of endocarditis.

251
Q

What physical exam findings are suggestive of infective endocarditis?

A

FROM JANE

Fever
Roth spots
Osler nodes
Murmur

Janeway Lesions
Anemia
Nailbed hemorrhages (splinter hemorrhages)
Emboli

252
Q

What neurovascular structure is most frequently injured with a tibiofemoral dislocation?

A

Peroneal nerve

Popliteal artery is the most common artery injury

253
Q

What is the ankle-brachial index?

A

The ratio of the systolic blood pressure at the ankle compared to the systolic brachial pressure. An ABI of < 0.9 is considered abnormal.

254
Q

What is the most common type of knee dislocation?

A

Anterior knee dislocation (tibia is displaced anteriorly relative to the femoral condyle)

255
Q

What is the primary treatment intervention for a patient with sickle cell anemia who presents to the emergency department with an acute ischemic stroke?

A

Transfusion therapy.

256
Q

What is the most common cause of SJS and TEN?

A

Drugs - PEC SLAPP

Penicillin
Ethosuximide
Carbamazepine

Sulfa
Lamotrigine
Allopurinol
Phenytoin
Phenobarbital
257
Q

What is the second most common cause of SJS and TEN?

A

Mycoplasma pneumoniae infections

258
Q

Name two disorders other than SJS/TEN that have a positive Nikolsky sign.

A

Pemphigus vulgaris and staphylococcal scaleded skin syndrome

259
Q

Why is ipratropium bromide not used while hospitalized?

A

It is shown to reduce hospitalization rate but not hospitalization duration.

260
Q

What is the blood supply to anterior nosebleeds?

Posterior?

A

Anterior - Kiesselbach Plexus

Posterior - Sphenopalatine artery

261
Q

What is included in the initial management of an anterior nosebleed?

A

Vasoconstrictive medications such as oxymetazoline or phenylephrine, and pressure.

262
Q

How long should packing remain for the treatment of an anterior nosebleed?

A

48 hours

263
Q

How can you tell the difference between an incarcerated hernia from a strangulated hernia?

A

Strangulated hernias have necrosis and overlying skin changes.
Patients with strangulated hernias also often have elevated white count and/or lactate.

264
Q

What is the treatment for a strangulated hernia?

A

IV cefoxitin and emergent surgery consult

265
Q

What is the difference between a direct and an indirect inguinal hernia?

A

Direct passes directly through a defect in the transversalis fascia, whereas indirect passes through a patent processus vaginalis in the inguinal ring.

266
Q

How much water should a patient with a detected kidney stone drink within the first 24 hours?

A

2 L.

267
Q

What is quadruple therapy for H pylori consist of?

A

Bismuth
Metronidazole
Tetracycline
Omeprazole

268
Q

What is triple therapy for H pylori?

A

Omeprazole, clairithromycin, and amoxicillin

269
Q

How many patients infected with H. pylori will develop an ulcer?

A

5–10%.

270
Q

Are gastric ulcers or duodenal ulcers more common?

A

duodenal

271
Q

What lead are R and R’ waves seen in in a left bundle branch block?
Right bundle branch block?

A

R and R’ (bunny ears) are seen in V6 in a left BBB.

They are seen in V1 in a right BBB

272
Q

What are causes of left bundle branch block?

A

Myocardial ischemia, myocardial infarction or myocarditis, but most often is caused by the degeneration of the conduction system with age.

273
Q

What is the most common cause of osteomyelitis in children?

A

Staph aureus

274
Q

What bacteria may cause osteomyelitis in patients who have a history of sickle cell disease?

A

Salmonella.

275
Q

A pregnant patients pelvic ultrasound shows a psuedosac with surrounding free fluid. What is this concerning for?

A

Ectopic pregnancy

276
Q

What is the most common site of implantation for ectopic pregnancy?

A

The ampulla of the fallopian tube.

277
Q

What is the most accepted hCG discriminatory zone for visualizing an intrauterine pregnancy on transvaginal ultrasound?

A

1,500 IU/L.

278
Q

What is the most common cause of bronchiolitis?

A

RSV

279
Q

What is the first step in management for a child with bronchiolitis?

A

Nasal suctioning

280
Q

In what age group does bronchiolitis primarily occur in?

A

Children < 2

281
Q

Bronchiolitis is most common during what time of the year?

A

In North America, bronchiolitis has a peak occurrence between November and March.

282
Q

What is the preferred treatment for a peritonsillar abscess?

A

Drainage by needle aspiration and augmentin or clindamycin.

283
Q

What are the CENTOR criteria for streptococcal pharyngitis?

A

Absence of cough, tonsillar exudates, fever, and tender anterior cervical lymphadenopathy.

284
Q

What are the causes of central diabetes inspididus?

A

Head trauma, congenital, and genetic disorders

285
Q

What is the most appropriate first line treatment for minor bleeding in patients with von Willebrand disease?

A

Desmopressin

286
Q

What is the role of von Willebrand factor?

A

Assists with platelet adhesion and is a carrier for factor VIII

287
Q

What is the treatment for severe bleeding in a patient with von Willebrand disease?

A

recombinant von Willebrand Factor

or cryoprecipitate

288
Q

What additional medication can help decrease menorrhagia in patients with von Willebrand disease?

A

Oral contraceptives.

289
Q

What is the treatment for acute bacterial parotitis?

A

Ampicillin/sulbactam
or
nafcillin + metronidazole or clindamycin

290
Q

What is the most common pathogen associated with acute bacterial parotitis?

A

Staph aureus

291
Q

What antibiotic is appropriate for a pediatric patient with bacterial parotitis and a severe penicillin allergy?

A

Clindamycin.

292
Q

What is the treatment for a-fib with RVR?

A

Beta blocker or CCB

293
Q

In underdeveloped countries, what underlying disease is most frequently associated with atrial fibrillation?

A

Rheumatic heart disease.

294
Q

A patient with a lithium level greater than ____ should be considered for dialysis.

A

> 5 mEq/L

or >4mEq/L in the setting of impaired renal function

295
Q

True or false: activated charcoal is effective in binding lithium.

A

False, lithium is a metal, therefore, activated charcoal will not be effective, as it does not bind metals.

296
Q

Name 4 special tests to evaluate an ankle injury.

A

Squeeze test - syndesmotic sprain
Anterior drawer - anterior displacement of talus on tibia
External rotation test -
Talar tilt test -

297
Q

What are the structures injured in lateral ankle sprain?

A

Anterior talofibular ligament, calcaneofibular ligament, and posterior talofibular ligament.

298
Q

What are the 5 components of management of acute COPD exacerbation?

A

Beta-adrenergic agonists (albuterol)
Anticholinergic agents (Ipratropium)
Oral glucocorticoid therapy (prednisone)
Noninvasive positive pressure ventilation
Antibiotics (for moderate to severe exacerbations, azithromycin or augmentin are good choices)

299
Q

True or false: intravenous corticosteroids have been shown to be superior to oral corticosteroids in the management of an acute COPD exacerbation.

A

False.

300
Q

What is the first line medication, concentration, and instructions for a scabies infection?

A

Permethrin 5% cream on day 1, then reapply in 1 week.

301
Q

In what type of scabies are thousands of mites present?

A

Crusted or Norwegian scabies.

302
Q

What is the most common risk factor for new-onset childhood immune thrombocytopenia?

A

Viral infection.

303
Q

Reduced factor VIII activity level is found in what bleeding disorder?

A

Hemophilia A

304
Q

What is the most likely diagnosis in a patient with painless BRBPR and constipation?

A

Diverticulosis

305
Q

What electrolyte abnormality is commonly seen in hypothyroidism?

A

Hyponatremia.

306
Q

List 3 types of definitive airway?

A

Orotracheal tube, nasotracheal tube, surgical airway

307
Q

What antibiotic is used for infection prophylaxis before surgery?

A

Cefazolin

308
Q

What is the antibiotic regimen of choice if an open fracture is deemed to be large (> 10 cm) or very contaminated?

A

First-generation cephalosporin and gentamicin.

309
Q

If a child under one year of age aspirates a foreign body and is choking, what is the appropriate management?

A

Holding the head lower than the feet, alternate five back blows with five chest thrusts.

310
Q

What imaging should be ordered to detect a foreign body aspiration that is not radiopaque?

A

lateral decubitus chest XR - it will detect air trapping. If you hear wheezing on right, do a right lateral decubitus, on left, left lateral decubitus.

311
Q

What disease is associated with urinary incontinence, ataxia, and dementia?

A

Normal pressure hydrocephalus.

312
Q

What special test has the highest sensitivity for sciatica?

What about specificity?

A

Sensitivity - straight leg raise

Specificity - crossed straight leg raise

313
Q

A patient with sciatica and weakness with toe extension likely has compression of what nerve root?

A

L5.

314
Q

Does unstable angina have any EKG changes or troponin elevation?

A

Neither

315
Q

How long can an elevated troponin level be detected after acute myocardial infarction?

A

Up to seven days.

316
Q

What nerve injury is most common with a fibular head fracture?

A

Common peroneal nerve injury

317
Q

What are the expected BUN:Cr ratios for pre-renal, intrarenal, and post-renal causes of renal failure?

A 
Pre-renal = BUN:Cr >20
Intrarenal = BUN:Cr<10:1
Post-Renal = BUN:Cr 10-20:1
318
Q

What is an extraintestinal manifestation of celiac disease?

A

Dermatitis herpetiformis

319
Q

What is an extraintestinal manifestation of inflammatory bowel disease?

A

Ankylosing spondylosis

320
Q

Pernicious anemia is a type of selective malabsorption leading to a deficiency in what vitamin?

A

Vitamin B12 (cobalamin).

321
Q

Orthostatic hypotension can be diagnosed by a decrease in SBP by how much when going from sitting to standing?

DBP?

A

Fall >20 SBP

Fall >10 DBP

322
Q

Which is the more common finding in volume-depleted adults: hypokalemia or hyperkalemia?

A

Hypokalemia.

323
Q

Is a Wenckebach heart block Mobitz I or Mobitz II?

A

Mobitz I

324
Q

Describe the PR interval and QRS complexes in a Wenckeback heart block. (Mobitz I)

A

Progressively longer PR interval until a QRS is dropped.

325
Q

Describe the PR intervals and QRS complexes in a Mobitz II block.

A

Regular PR interval with random dropped QRS complexes.

326
Q

Describe the P waves and QRS complexes in a complete heart block?

A

P waves and QRS complexes march out, but QRS complexes have no releation to P waves.

327
Q

What does a notched P wave on ECG potentially indicate?

A

Left atrial enlargement.

328
Q

What is the characteristic EKG finding of WPW?

A

Delta waves

329
Q

What is the treatment for a tension pneumothorax?

A

Needle thoracostomy

330
Q

What are the physical exam findings of a tension pneumothorax?

A

Diminished breath sounds, distended neck veins, hypotension, and tracheal deviation.

331
Q

In what other location can needle decompression be performed if unable to reach the pleura from the anterior midclavicular space?

A

Fourth or fifth intercostal space in the midaxillary plane may also be used (the same location as tube thoracotomies).

332
Q

What is an appropriate treatment plan for a patient with HOCM with a syncopal episode?

A

Admission and cardiology consult

333
Q

What is an appropriate treatment plan for a patient with HOCM found incidentally who has no symptoms?

A

Outpatient cardiology follow up

334
Q

Describe the murmur associated with HOCM.

A

Harsh crescendo-decrescendo systolic murmur that increases intensity with valsalva and decreases with squatting.

335
Q

What is the appropriate dosing of heparin in ST elevation myocardial infarction patients?

A

A 60 units/kg bolus (up to 4,000 units) followed by a 12 units/kg/hr infusion (up to 1,000 units/hr).

336
Q

What is the initial treatment for acute angle closure glaucoma?

A

A topical beta blocker and alpha agonist, such as timolol and apraclonidine, along with acetazolamide.

337
Q

You’ve diagnosed a patient with acute angle closure glaucoma and ophthalmology is on the way. You’ve treated the patient with timolol, apraclonidine, and acetazolamide, and a recheck of IOP is 50 mmHg. What is the next appropriate treatment?

A

IV mannitol

338
Q

A FOOSH injury with snuffbox tenderness is concerning for what injury?

A

Scaphoid fracture

339
Q

What is an appropriate splint for a scaphoid fracture?

A

Thumb spica splint

340
Q

What is the most concerning complication for scaphoid fractures?

A

AVN of the proximal pole of the scaphoid.

341
Q

What type of hypersensitivity reaction is contact dermatitis?

A

Type IV.

342
Q

What is the dose of atropine in symptomatic bradycardia with a pulse?

A

1 mg IV push.

343
Q

Which three chemicals should not be treated with immediate water irrigation if splashed into the eye because of their harmful exothermic effects?

A

Dry lime; elemental metals, such as sodium, potassium, magnesium, phosphorus, lithium, cesium, and titanium tetrachloride; and phenol.

344
Q

What is the goal pH of the eye after irrigating a chemical burn?

A

7.0-7.5

345
Q

What is worse, acid or alkaline chemical burn of the eye?

A

alkaline - penetrates deeper and faster.

346
Q

What type of chemical burns to the eye cause liquefaction necrosis, and what type cause protein coagulation?

A

Liquefaction necrosis - alkaline burns

Protein coagulation - acidic burns

347
Q

What is the normal range of intraocular pressures?

A

10 to 20 mm Hg.

348
Q

What mechanism is the main cause of acute angle closure glaucoma?

A

Obstruction of the aqueous humor outflow (trabecular meshwork)

349
Q

What types of hepatitis are transmitted by fecal-oral contamination?

A

A and E (The vowels hit your bowels)

350
Q

What hepatitis is dependent on hep B coinfection?

A

Hep D

351
Q

What laboratory value will be decreased (aside from hemoglobin or hematocrit) in an acute episode of hemolytic anemia?

A

The haptoglobin level as it scavenges free hemoglobin released by lysed red blood cells.

352
Q

When should hypertension be treated in the setting of an acute ischemic stroke?

A

If the systolic is greater than 220 mmHg, the diastolic is greater than 110 mmHg, or if the patient has another condition that would benefit from blood pressure control.

353
Q

What laboratory test can help differentiate between acute heart failure and an exacerbation of chronic obstructive pulmonary disease in a dyspneic patient?

A

Brain natriuretic peptide.

354
Q

What is the most common cause of small bowel obstruction?

A

Adhesions

355
Q

What are the first two steps of treating a small bowel obstruction?

A

Keeping patient NPO and placing a NG tube

356
Q

What type of hernia is most commonly associated with small bowel obstruction?

A

Inguinal hernia.

357
Q

What is the best benzodiazepine to give for status epilepticus?

A

Lorazepam

358
Q

What is the best benzodiazepine for treatment of status epilepticus in a patient without intravenous access?

A

IM midazolam

359
Q

What is the most oikely diagnosis for a patient in respiratory distress with bilateral rales, tachypnea, tachycardia, and a high pitched blowing murmur occurring after S2 is heard best along the left sternal border in the third intercostal space?

A

Aortic regurgitation

360
Q

True or false: increases in blood pressure worsen aortic regurgitation.

A

True. Tachycardia and afterload reduction will reduce regurgitation, whereas slower heart rates and increases in afterload will worsen the regurgitation.

361
Q

What is the innervation of the biceps muscle?

A

The musculocutaneous nerve. The nerve roots for the musculocutaneous nerve are C5, C6, and C7.

362
Q

What is the classic ECG finding in de Winter syndrome?

A

J point depression with a sloping ST segment into a peaked, hyperacute T wave in the precordial leads. This suggests a complete LAD occlusion and should be treated as an ST elevation myocardial infarction equivalent.

363
Q

What is Wellens syndrome?

A

Critical stenosis of the LAD with either biphasic t waves or deeply invereted t waves.

364
Q

What is the appropriate empiric treatment for urethritis in a male with two new sexual partners?

A

Ceftriaxone 500mg IM and doxycycline 100mg BID x 7 days

365
Q

True or false: Chlamydia trachomatis is identified on Gram stain as gram-negative diplococci.

A

False. Chlamydia is a small gram-negative bacterium that is an obligate intracellular parasite as it can only replicate within a host cell.

366
Q

What is gonorrhea reported as on a gram stain?

A

Gram negative diplococci

367
Q

What is the first line treatment of severe hypertension in the setting of an acute MI?

A

Nitroglycerine

368
Q

What is the first line treatment of severe hypertension in the setting of aortic disection?

A

Esmolol

369
Q

What is the first line treatment of severe hypertension in the setting of eclampsia?

A

Magnesium sulfate

370
Q

What is the first line treatment of severe hypertension in the setting of a hypertensive encephalopathy?

A

Nicardipine

371
Q

True or false: Focal deficits resulting from hypertensive encephalopathy may present on opposite sides of the body.

A

True. Focal deficits do not follow an anatomic pattern and may be present on opposite sides of the body`

372
Q

An EKG shows a rate of 160, irregularly irregular, with 3 different P wave morphologies. What is the most likely diagnosis?

A

Multifocal atrial tachycardia.

373
Q

What is the treatment for multifocal atrial tachycardia?

A

Treat underlying cause, do not give rate-limiting medications.`

374
Q

What is an appropriate treatment for a patient with a fib with RVR?

A

IV diltiazem

375
Q

What is an appropriate treatment for rhythm control for tachydysrhythmias?

A

procainamide

376
Q

What is considered a safe time period for cardioversion in new-onset atrial fibrillation or atrial flutter?

A

48 hours.

377
Q

Describe the murmur of mitral valve prolapse.

A

Late systolic crescendo murmur

378
Q

What is the most common ultrasound finding in a patient with ovarian torsion?

A

Ovarian enlargement due to venous and lymphatic engorgement.

379
Q

What is the whirlpool sign?

What is it highly specific for?

A

Whirlpool sign is the presence of coiled vessels on ultrasound of an ovary which is nearly 90% accurate in diagnosing ovarian torsion.

380
Q

What is the treatment for purulent cellulitis vs non-purulent cellulitis?

A

Purulent cellulitis should be covered for MRSA, with doxycycline, bactrim, clindamycin, or linezolid.
Non-purulent cellulitis can be treated with cephalexin, amoxicillin, or dicloxacillin

381
Q

What is the most common pathogen implicated in erysipelas?

A

Beta-hemolytic streptococci.

382
Q

Is diarrheal onset or emesis onset more likely to be a bacterial cause of gastroenteritis?

A

Diarrheal onset

383
Q

Which pathogen is most responsible for infantile malnutrition from persistent diarrhea in low-resource countries?

A

Shiga toxin-producing enteropathogenic Escherichia coli.

384
Q

Progressive encephalopathy with hepatic dysfunction is characteristic of what syndrome?

A

Reye syndrome

385
Q

What is the biggest risk factor for Reye syndrome?

A

Salicylate use

386
Q

Is WPW with a wide QRS orthodromic or antidromic?

A

Antidromic

387
Q

What are the only two appropriate treatments for antidromic WPW?

A

Procainamide or cardioversion

388
Q

What is the triad of EKG changes in WPW?

A

Slurred upstroke of QRS complex (delta wave)
Wide QRS
Short PR interval

389
Q

What class of antiarrhythmics does procainamide belong to

A

Class 1a.

390
Q

What type of organisms are asplenic patients high risk for contracting infections from?

A

encapsulated organisms

391
Q

What are the most common organisms to cause sepsis in asplenic patients?

A

Strep pneumo, Neisseria meningitidis, and H. influenzae.

also consider salmonella, although it is not as common

392
Q

Name 7 encapsulated bacteria.

A 
SHiNE SKiS
Strep pneumo
H. influenzae (type B)
Neisseria meningitidis
E. coli

Salmonella typhi
Klebsiella pneumoniae
Streptococcus (group B)

393
Q

What common viral illness puts a patient at risk for splenic injury and rupture?

A

Epstein-Barr virus infection.

394
Q

What is the appearance of PJP on chest XR?

A

Bilateral interstitial infiltrates. (bat wing apperance)

395
Q

What is the treatment for PJP?

A

TMP-SMX

396
Q

What lab findings are associated with PJP?

A

CD4 <200

Increased LDH

397
Q

What is the most common cause of aortic stenosis?

A

Calcific dengeration

398
Q

Describe the murmur assocaited with aortic stenosis.

A

systolic Crescendo-decrescendo murmur that radiates to the carotids

399
Q

What is the only cardiac valve that has two cusps instead of three?

A

Mitral valve.

400
Q

Episodic vertigo, sensorineural hearing loss, and tinnitus is characteristic of?

A

Meniere disease

401
Q

What is the treatment for meniere disease?

A

avoidance of alcohol, caffeine, stress, sodium, MSG, and nicotine

402
Q

Benign paroxysmal positional vertigo (BPPV) is thought to be caused by what?

A

BPPV is most commonly attributed to calcium debris within the posterior semicircular canal but may also occur in the lateral and anterior semicircular canals.

403
Q

What is the most likely diagnosis for a patient presenting with painless visual disturbances, floaters, flashing lights, and a curtain-lowering sensation to his vision?

A

Retinal detachment.

404
Q

Describe the “classic” pseudotumor cerebri (idiopathic intracranial hypertension) patient.

A

A young woman with obesity.

405
Q

What are the symptoms of psuedotumor cerebri?

A

intermittent visual changes, headache, and pulsatile tinnitus.

406
Q

What are the hallmark findings in pseudotumor cerebri?

A

Papilledemia, elevated opening pressure on lumbar puncture.

407
Q

What is the treatment for pseudotumor cerebri?

A

Low sodium diet, weight loss, acetazolamide, optic nerve sheath fenestration, shunt.

408
Q

What is an alternative to funduscopy when evaluating for papilledema?

A

Ocular ultrasound.

409
Q

True or false: positive birefringence on crystal analysis is consistent with gout.

A

False

410
Q

What is the most common presentation of Hodgkin lymphoma in a 17-year-old boy?

A

Painless cervical LAD

411
Q

Does hodgkin or non-hodgkin lymphoma have reed-sternberg cells?

A

Hodgkin

412
Q

What are the two methods of reducing a nursemaids elbow?

A

Supination and flexion or hyperpronation

413
Q

What is the best initial diagnostic test for a suspected pheochromocytoma?

A

24-hour urine fractionated metanephrine and catacholamine level or a plasma fractionated metanephrine.

414
Q

What is a pheochromocytoma?

A

A neoplasm of the chromaffin cells within the adrenal medulla.

415
Q

What is the treatment for hypertension in the setting of pheochromocytoma?

A

An alpha blocker (phenoxybenzamine is preferred) and then a beta blocker after an alpha blockade has been established.

416
Q

What is the triad of symptoms for pheochromocytoma?

A

Episodic headache, diaphoresis, and tachycardia with hypertension.

417
Q

What is the most common cause of a transient aplastic crisis in a sickle cell patient?

A

A recent parvovirus B19 infection

418
Q

What is the most common complication from a midshaft humeral fracture?

A

Radial nerve injury

419
Q

What neurological findings are consistent with radial nerve injury after a midshaft humeral fracture?

A

Wrist drop, loss of extension of fingers, thumb, and wrist

420
Q

What is an alternative agent for the treatment of PJP pneumonia?

A

Pentamidine.

421
Q

What is the most common cause of DIC?

A

Infection.

422
Q

Which ACL physical exam test provides the best sensitivity and specificity for ACL rupture?

A

The Lachman test.

423
Q

What is the technique to detorse a testicular torsion?

A

Medial to lateral rotation

424
Q

What is the most appropriate test to diagnose a bile leak status post cholecystectomy?

A

Hepatic iminodiacetic acid (HIDA) scan.

425
Q

HIV and antiretroviral therapies can cause what cardiovascular disorder?

A

Dilated cardiomyopathy

426
Q

What is the cause of Chagas disease, the leading cause of dilated cardiomyopathy in Central and South America?

A

A protozoan infection with Trypanosoma cruzi.

427
Q

What is the first line treatment for candidal balanitis?

A

Topical clotrimazole cream

428
Q

What type of medication is chlordiazepoxide?

A

benzodiazepine

429
Q

Which frequently used benzodiazepine is unaffected by hepatic metabolism status?

A

Lorazepam. In contrast, diazepam, midazolam, and chlordiazepoxide all undergo significant hepatic metabolism, which can result in accumulation of parent drug and associated prolonged drug effects in those with impaired liver function.

430
Q

A radial/ulnar wrist facture with dorsal displacement is known as a ______ fracture.

A

Colles (dinner fork deformity)

431
Q

A radial/ulnar wrist facture with ventral displacement is known as a ______ fracture.

A

Smith (garden spade deformity)

Cam's Cards (103 decks)

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