Feb '22 Flashcards
treatment of TTP
plasma exchange
stable pneumomediastinum, whats next?
observe, probs discharge
giving calcium in hyperK can potentiate what drug toxicity?
digitalis toxicity
what is the common age and presentation of nephrogenic diabetes insipidus?
infancy, recurrent episodes of failure to thrive and dehydration
what steroids should be avoided in patients with muscular dystrophy?
dexamethasone and triamcinolone can induce worsening myopathy
differentiate ventricular aneurysm and acute stent thrombosis on ekg
ventricular aneurysm will have ST elevation without reciprocal changes. stent rethrombosis will have reciprocal changes
osler-weber-syndrome is aka
hereditary hemorrhagic telangiectasias
hereditary hemorrhagic telangiectasias presents with
AV malformations in multiple organs, including brain, liver, and lung
respiratory indices noting likely impending respiratory failure
A forced vital capacity < 20 mL/kg, maximum inspiratory pressure (negative inspiratory force) ≤ 30 cm H2O, or a maximum expiratory pressure of ≤ 40 cm H2O indicate impending failure
CSF findings in GBS
albuminocytologic dissociation - elevated protein and normal white count
ventricular dysrhythmia from inhaling hydrocarbons, treatment?
esmolol
inhalation/huffing hydrocrabons does what?
over sensitizes myocardium to catecholamines
besides tamponade, what can cause pulsus paradoxus?
asthma, COPD, constrictive pericarditis, PE
abx added to the first line agents in immunocompromised pt with flexor tenosynovitis
vanc to cover for MRSA
what is the most commonly overlooked condition in work up of pleural effusion?
PE
FB in ear is removed… next step?
amoxicillin if TM perf possible, otic drops for ppx for otitis externa
inferior or superior crus cut in lateral canthotomy?
inferior crus of lateral canthal tendon
features of nephrotic syndrome
proteinuria, edema, hypoalbuminemia, hyperlipidemia, hyponatremia
treatment of choice for minimal change in nephrotic syndrome?
prednisone
neonatal conjunctivitis 5-14 days, dx and tx
chlamydia trachomatis, tx with PO erythromycin
tx of gonorrheal conjunctivitis
IV cefotaxime
herpes zoster tx
acyclovir within 72 hours of onset, NSAIDs, tylenol, opiates
what lies behind a peritonsillar abscess?
internal carotid artery, internal jugular vein, CN
epiglottitis kid on brief exam and hx, next step
mobilize difficult airway team
H. influ is resistant to what IV abx?
ampicillin
pt with acute rheumatic fever, has severe penicillin allergy, tx?
azithro, clarithro, or clindamycin
prostatitis tx
bactrim, cipro or levo
pt traveled out of the country, most important illness to rule out
malaria
hallmark finding of isopropanol toxicity
in setting of elevated osmolar gap, ketosis without a wide anion gap metabolic acidosis
(ketosis without acidosis, acetone ingestion)
TXA in head bleed
no significant improvement
surgery is indicated in hyphema when
IOP not well controlled, >25 after 24 hours in pt with sickle cell, >50 after 6 days in other pt
or Grade IV
trigeminal nerve originates where
lateral pons
what CN are responsible for afferent and efferent corneal reflex
trigeminal and facial respectively
specific finding for post-streptococcal glomerulonephritis?
decreased serum C3
maltese cross sign is pathognmonic for
nephrotic syndrome
tx of hypercalcemia associated with malignancy
IV hydration and bisphosphonates
what makes a complex febrile seizure
> 15 minutes
seizure has focal component
1 in 24 hours
Fe containing fb in the eye, tx?
rust ring, see ophtho in 24 hours
acutely thrombosed external hemorrhoid
excision otherwise will ulcerate
severe neutropenia defined
ANC <500
WBC 4000 with <10% neutrophils
calculate ANC
WBC x %neutrophils
MC pathogen in neutropenic fever
Staph epidermidis
baby formula ratio
one scoop per 2 oz water
CSF finding with GBS
elevated CSF protein
tests that help determine need for intubation with GBS
vital capacity or negative inspiratory flow
pinworms/enterobius tx
albendazole
bacterial parotitis tx
IV ampicillin sulbactam
snake bite with ptosis, vertigo, paresthesias, slurred speech, drowsiness, dysphagia, restlessness, increased salivation, proximal muscle weakness
eastern coral snake, elapidae family
what is the risk of recurrent febrile seizure?
30%
magical thinking is seen in
schizotypal
macrocytic anemias
Pernicious/B12 and folate
Fe deficiency anemia is
microcytic
lightening strike triage
dead looking person may just have respiratory arrest and should be tended to
amyl nitrite causes
methhemoglonemia
travel, low grade fever, maculopapular rash, arthralgias, conjunctivitis
Zika virus
homonymous quadrantanopia is due to
optic radiations lesions
swallowed foreign bodies in peds most often obstruct where
cricopharyngeus muscle
high risk wound with uncertain tetanus vaccine status
dT and TIG
5-15 yo with migratory polyarthritis, multiple erythematous ring lesions with central clearing
acute reheumatic fever
DKA treatment, K at what level do you supplement with insulin contemporaneously
3.3- 5.2 K
sensation and finding in most lower leg compartment syndrome
decreased sensation between first and second toes, decreased dorsiflexion
anterior compartment
thrombocytopenia with petechiae in kid following viral illness
ITP - tx with corticosteroids
normal PaO2
70-100
bee sting with wheezing
epi
COPDer basic vent settings
volume control, rate 10, allows for appropriate exhale time
iron toxicity late complication
pyloric stenosis
infantile spasms
occur in clusters, crescendo decrescendo, west syndrome
anticholinergic toxidrome
hot as a hare, mad as a hatter, etc
antihistamines and benadryl
insectisides overdose could cause
cholinergic symptoms - increased lacrimation, salivation, urination, and defecation
goal of treatment for cholinergic (crop duster) toxicity
drying of secretions with atropine tx
weakness over a few hours, or first noticed upon waking, tendon reflexes are lost, negative everything work up
skin exam - tick paralysis
MC presentation of nontuberculous mycobacterium in young children
lymphadenitis
leading cause of poisoning morbidity and mortality in the US
CO poisoning
differentiate serotonin syndrome v NMS
clonus is defining feature of SS
splenic vein thrombosis, what causes varices?
short gastric veins create varices in distal esophagus
early presentation of salicylate tox
hyperpnea, GI upset, tinnitus - hyperventilation causes respiratory alkalosis THEN followed by anion gap metabolic acidosis
harsh systolic murmur, best heard at apex of heart and loudest in early or mid systole?
mitral regurg
tx influenza in these pts
> 65 yo, nursing home, pregnant, and up to 2 weeks postpartum, or chronic illness pt, morbid obesity, and american indian, kids <2 yo
TCA overdose with EKG changes, next step
sodium bicarb
necrotizing otitis externa on exam - next step
pip tazo
perfed TM from blast injury, next step?
chest XR
magnet on ICD will cause
default to pace maker mode
tx of nail plate avulsion
original nail plate and sterile matrix should be rinsed with saline and reattached to the nail bed to maintain patency of the nail fold
fever associated with systemic juvenile idiopathic arthritis?
intermittent high fever, spikes about once a day
ASIS avulsion fracture tx
d/c with crutches and symptomatic treatment
contraindications to mtx for ectopic -
relative with fetal heart activity, hemodynamic instability, evidence of rupture, sac >4 cm
patient with refractory septic shock -
consider hydrocortisone and levothyroxine when indicated
acid base disturbance caused by pyloric stenosis?
hypochloremic metabolic alkalosis
electrolyte change with digoxin tox? tx?
hyperK
give digoxin antibodies
allergy to lidocaine, what should be used as anesthetic?
procaine, or tetracaine for ocular, topical, and epidural
mouth injury with dental step off
mandibular fracture
tx of acute lithium overdose
whole bowel irrigation, hemodialysis if lithium level >5, or >4 plus renal insuff, and in pt with AMS, seizures or other
rapid fluid resus should be through
16 gauge or larger AC
hyperviscosity syndrome labs
elevated serum protein, or leukocytosis
indications for hyperbaric oxygen therapy in setting of CO poisoning?
signs of end organ damage, syncope, coma, seizures, confusion, focal neuro deficit, visual symptoms
eye ball with violet bluish hue with scleral edema and vascular engorgement
scleritis
