Equations

Question 1

Anion gap

Answer 1

Na - (Cl + HCO3) <= 12
MUDPILES
Methanol, Uremia, DKA/AKA, Paraldehyde/phenformin, Iron/INH, Lactic acidosis, Ethylene glycol, Salicylates

Question 2

Osmolar gap

Answer 2

2Na + BUN/2.8 +glucose/18 + ETOH/4.6 = 285-295

>10: toxic alcohols, mannitol, lorazepam drip

Question 3

Total body water (L)

Answer 3

Wt (kg) x 0.6

Question 4

Parkland formula

Answer 4

4 mL x Wt (kg) x %BSA
1st 1/2 in 8 hours
2nd 1/2 in 16 hours

Question 5

MAP

Answer 5

1/3 SBP + 2/3 DBP or DBP + (SBP - DBP)/3

Question 6

Pediatric ETT size

Answer 6

Age/4 + 4 (uncuffed) and age/4 + 3 (cuffed) (or minus 0.5)
2 x ETT = NG/OT/foley
3 x ETT + depth of ETT
4 x ETT = chest tube
Neonate: premature 2.5 uncuffed, full-term 3.0 uncuffed

Question 7

A-a gradient

Answer 7

140 - (PaO2 + PaCO2)

normal = (age +10)/4

Question 8

Corrected Na in hyperglycemia

Answer 8

Na + 2.4 (glucose-100)/100

Or use 1.6

Question 9

Winters formula (expected pCO2)

Answer 9

1.5 x HCO3 + 8 (+/- 2)
To assess respiratory compensation in metabolic acidosis
“Rule of 15” - if there’s a metabolic acidosis
HCO3 + 15 (+/-2) = pCO2 + last 2 digits of pH (non mixed)

Question 10

GCS

Answer 10

Eye (spontaneous 4, verbal 3, pain 2, none 1)
Voice (oriented 5, confused 4, inappropriate 3, moaning 2, none 1)
Movement (obeys 6, localize pain 5, withdraws 4, flex 3, extend 2, none 1)

Question 11

Fluid maintenance

Answer 11

“4 - 2 - 1”
0-10 kg: + 4 ml/kg/hr
10-20 kg: + 2 ml/kg/hr
>20 kg: 1 ml/kg/hr

Question 12

Ranson criteria

Answer 12

On admission - GLOWS
Glucose >200, LDH >350, older age >55, WBC >16k, AST (SGOT) >250
At 48 hours - BOB CHF
Base deficit (24 - HCO3) > 4, O2 < 60, BUN increase >5, Ca < 8, Hct drop > 10%, fluid deficit > 6L

Question 13

Jones criteria

Answer 13

2 major or 1 major + 2 minor
Major: polyarthritis, carditis, subcutaneous nodules (wrist/elbow/knees), erythema marginatum, syndeham chorea
Minor: fever, arthralgia, h/o RF, prolonged PR, elevated CRP/ESR, GBS infection

Question 14

Diabetes diagnosis

Answer 14

Fasting blood glucose > 126
Random blood glucose > 200 + symptoms
Blood glucose > 200 after glucose tolerance test
Hgb A1c > 6.5%

Question 15

DKA diagnosis

Answer 15

Serum glucose > 250
pH < 7.3
Serum bicarb < 12
AG > 10
\+ serum/urine ketones

Question 16

Water deficit

Answer 16

0.6 x wt (kg) x [Na/140 - 1]
50% in first 12 hours, rest over next 24 hours
Hypernatremia goal, decrease 1-2 meq/hour

Question 17

Hypercalemia symptoms

Answer 17

Bones, stones, moans, thrones, and psychic overtones
Bone pain, urinary/biliary stones, abdominal pain, N/V, polyuria (porcelain throne), depression, anxiety, insomnia
Shortened QT
< 12 no treatment, 12-14 symptoms based, >14 treat
Lithium causes hypercalcemia

Question 18

Hypocalcemia symptoms

Answer 18

Tetany
Trousseau's sign (BP cuff)
Chvostek sign (cheek)
Seizure
QT prolongation

Question 19

Pituitary hormones

Answer 19

GOATFLAPS
Growth hormone, Oxytocin, Antidiuretic hormone, TSH, FSH, LH, ACTH, prolactin
FLAT PiG - FSH, LH, ACTH, TSH, prolactin, GH and ADH and oxytocin (posterior pituitary)
Prolactinomas = treated with bromocriptine

Question 20

Scarbossa criteria in LBBB (>=3 points)

Answer 20

> 1 mm concordant ST elevation = 5 points
1 mm ST depression in V1-V3 = 3 points
5 mm discordant ST elevation = 2 point

Question 21

Causes of infant cyanosis

Answer 21

1,2,3,4,5 truncus arteriosus, transposition of the great vessels, tricuspid atresia, tetralogy of Fallot, total anamolous pulmonary venous return

Question 22

Salter-Harris

Answer 22

I: straight/slip through
II: metaphysis –> physis (above - *think femur)
III: epiphysis –> physis (low)
IV: both metaphysis and epiphysis (through)
V: crush/ram

Question 23

Indication for thoracotomy in traumatic hemothoraces

Answer 23

Initial output > 1.5L
250mL/hour x 4 hours
Worsening hemothorax
Hemodynamic instability
Cardiac arrest

Question 24

APGAR

Answer 24

Activity (active 2, flexed 1)
Pulse (>100 2)
Grimace (strong cry 2, whimper 1)
Appearance (pink 2, peripheral cyanosis 2)
Respiration (normal 2, slow 1)

Question 25

Most common cause of death in sickle cell anemia?

Answer 25

Sepsis (especially pneumonia) -- asplenia --> infection due to encapsulated organisms (ie strep pneumoniae, e coli, H flu) Stroke also common > aplastic crisis > splenic sequestration

Question 26

Non-anion gap

Answer 26

HARDUP - GI and renal causes | Hypoaldosteronism, Acetazolamide, Renal tubular acidosis, Diarrhea, Ureterosigmoidostomy, Pancreatic fistula

Question 27

Criteria for anaphylaxis

Answer 27

1) acute onset derm/mucosal reaction + respiratory compromise or hypotension 2) acutely at least 2 of the following with known allergen: derm/mucosal involvement, respiratory compromise, hypotension, GI symptoms 3) hypotension in setting of unknown allergen

Question 28

Indications for perimortem C-section

Answer 28

> 24 weeks (or 4 finger breaths above umbilicus) | Witnessed arrest and can be done in 4-5 minutes

Question 29

DIC lab findings

Answer 29

Hemolytic anemia --> decreased haptoglobulin, increased indirect bili, increased LDH, schistocytes Increased thrombin generation --> decreased fibrinogen, elevated coags Increased fibrinolysis --> elevated Ddimer and fibrin degradation products Moderate-severe thrombocytopenia

Question 30

Kocher criteria for septic arthritis in pads

Answer 30

``` Fever > 101.3F non-weight bearing ESR > 40 serum WBC > 12K All 4 --> 99% specific ```

Question 31

Sudden unexplained infant death risks

Answer 31

3rd leading cause of infant death Most common at age 2-4 months Prone sleeping, sleeping on soft surface, maternal smoking during or after pregnancy, overheating from heavy bedding/clothing, late or no prenatal care, long maternal age, prematurity, low birth weight, male sex

Question 32

EKG findings in PE

Answer 32

Sinus tach Twave inversions V1-V3 RBBB S1Q3T3

Question 33

Endocarditis pathogens

Answer 33

Prosthetic valves: < 2 months, staph aureus, coag-neg staph, staph epidermis --> late: strep viridans, serratia pseudomonas Native valve: staph aureus, older patients strep viridian's

Question 34

Encapsulated bacteria

Answer 34

Klebsiella (gram neg bacilli), Neiserria (diplococci), Salmonella, Gp B strep (gram pos cocci in pairs), H flu

Question 35

Ectopic pregnancy risk factors

Answer 35

Prior ectopic, h/o PID, h/o tubal surgery, presence of IUD, assisted reproductive therapy

Question 36

Causes of neonatal jaundice

Answer 36

Non-serious: physiologic, breast milk (substances in milk inhibit glucuronyl transferase), breast feeding (inadequate feeding) Serious: sepsis, biliary atresia (elevated direct bilirubin), metabolic dysfunction, blood disorder --> check CBC, bilirubin, Coombs, T & S

Question 37

ABCD2 score in TIA (likelihood of stroke in 2 days

Answer 37

Age > 60 = 1 pt BP: SBP >140 or DBP > 90 = 1 pt Clinical feature: unilateral weakness = 2 pts, speech disturbance without weakness = 1 pt Duration: 10-59 minutes = 1 pt, >60 minutes = 2 pts History of DM = 1 pt Low risk = 0-3 --> discharge 4-5 moderate risk, 6-7 high risk

Question 38

Mechanical complications after MI

Answer 38

Rupture of LV free wall --> cardiac tamponade, check echo, pericardiocentesis, fluids, inotropes, surgical repair Septal rupture --> holosystolic murmur best at left sternal border, check echo, afterload reduction, inotropes, intraaortic balloon pump, surgical repair MV regurgitation --> early/mid/holosystolic murmur best at apex, check echo, afterload reduction promotes forward flow, surgical repair

Question 39

Murmurs

Answer 39

mitral stenosis - loud S1, opening snap, diastolic murmur heard best at apex mitral prolapse - early/mid click, high-pitched late systolic murmur heard best at left lateral border Aortic stenosis - crecendo-decrecendo murmur radiating to neck Aortic regurgitation - high-pitched diastolic murmur heard best at left sternal border

Question 40

Well's score

Answer 40

``` Low < 2, moderate 2-6, high > 6 Clinical S/s DVT = 3 pts Heart rate > 100 = 1.5 pts Immobilization >=3 days or surgery in last 4 weeks = 1.5 pts Previous DVT/PE = 1.5 pts Hemoptysis = 1 pt Malignancy = 1 pt Likely PE = 3 pts ```

Question 41

Causes of late decelerations

Answer 41

Uteroplacental insufficiency: abruption, excessive uterine contractions/hyperstimulation, materal hypotension NOT cord compression (variable decels)

Question 42

Indications for HBO

Answer 42

Neuro deficits, AMS, cardiovascular compromise, MI, syncope, dysrhythmia, COHb level > 25%, pregnant with COHb level > 15%

Question 43

Encapsulated orangisms

Answer 43

"Some Nasty Killers Have Some Capsule Protection" | Strep pneumo, Neiserria meningitidis, Klebsiella, H flu, Salmonella, Cryptococcus, Pseudomonas

Question 44

Fluid analysis in SBP

Answer 44

PMN > 250 Total leukocyte count > 500-1000 Tx: 3rd generation cephalosporin