June 2017

Question 1

What are 6 treatment categories for thyroid storm?

Answer 1

1. Block symapathetic surge
   - Propanolol 1 mg
2. Block T4 production
   - PTU
   - Methimazole
3. Block TSH release
   - Potassium iodine
4. Treat AI
   - Hydrocortisone 100 mg or Dex 4 mg
5. Supportive
   - Benzos, IVF,
6. L-carnitine - blocks T4 entry into cells
   Cholesytramine - blocks enterohepatic recirculation

Question 2

What are BP targets for 1.Ischemic stroke (lytics vs. none), 2. SAH 3. IPH

Answer 2

1. Stroke - lytics <185/105. No lytics <220/110 (12-25% reduction in 24h)
2. SAH <140/90
3. IPH <160 sys or what stroke wants

Question 3

ddx RAD

Answer 3

Structural

• RVH
• PE
• Pulm HTN
• COPD
• Pediatric

Electrical

• RBBB
• Lateral MI
• LPFB
• WPW

Drugs/metabolic

• TCA
• Na chan blocker
• Hyper K

Question 4

What are the 7 mechanisms of TCA?

Answer 4

1. Na channel blocker
2. K channel blocker
3. NE and DA reuptake inhibitor
4. Anti- muscarinic
5. Anti- Gaba
6. Alpha blocker
7. Histamine release

Question 5

What are 7 Hard and 8 soft signs of neck trauma?

Answer 5

Hard Signs

1. Airway compromise
2. Expanding hematoma
3. Severe active bleeding
4. Shock non responsive to fluids
5. Decr or absent radial pulse
6. Vascular bruit/thrill
7. Cerebral ischemia

Soft signs

1. Hemoptysis/hematemasis
2. Orophargyneal blood
3. Dyspnea
4. Dysphonia/Dysphagia
5. SQ air or mediastinal air
6. Chest tube air leak
7. Non-expanding hematoma
8. Focal neuro deficits

Question 6

What does C3PO+R2D2 mean? DVT wells score

Answer 6

Cancer
Calf swelling
Collateral v. 
Prev DVT
Oedema
Tender calf
Recent Immobilization
Recent sx
DVT unlikely (-2)

Question 7

What are 5 abdominal injuries missed by CT?

Answer 7

1. Pancreatic
2. Bilary system
3. Diaphramatic
4. Bowel/holoviscous
5. Subacute presentations?

Question 8

What are 6 findings of hypoK on ecg?

Answer 8

1. Peaked p
2. Prolonged PR
3. Flat T
4. U wave
5. STD
6. QT prolongation

Question 9

Where are U waves found on ecg? in hypoK

Answer 9

usu v1-v3 precordial

Question 10

What are 10 causes of hypoK?

Answer 10

Incr loss
GI
- Diarrhea
- vomiting
- Laxatives

Renal

• RTA
• DKA
• Hyperaldosteronism
• Diuretics

Decr intake: ETOH, malnutrition

Shift:

• Alkalosis
• Insulin
• B agonists

Question 11

A 0.3 mmol/L drop in K is how much total body depletion?

Answer 11

100 mmol

Question 12

Why give Mg with K?

Answer 12

• Needed for Na-K ATPase low Mg results in K+ excretion

-

Question 13

List 10 causes of hyperK

Answer 13

False elevation:
* Hemolysis —> during, after blood draw

Renal Failure:
* Acute or chronic —> decreased elimination

Shift —> acidosis

• DKA
• Addison’s
• Adrenal insufficiency
• Type 4 RTA

Cell death:

• Rhabdomyolysis
• Tumor lysis syndrome
• Massive hemolysis
• Massive transfusion
• Crush injury
• Burn

Drugs:

• BBs
• Acute dig toxicity
• Succ
• ACE-I / ARBs
• NSAIDs
• Spironolactone
• Amiloride (K sparring diuretic)
• K tabs

Question 14

what are Na and K in AI?

Answer 14

Hyponatremia, hyperkalemia.

Question 15

5 ecg findings hyperK

Answer 15

1. Peak T waves
2. Flat P
3. prolonged PR
4. Widened QRS
5. Sine wave
6. STE

Question 16

10 symptoms of hyper Ca

Answer 16

Psychiatric - depression, psychosis
Abdominal pain
Renal colic
Polyuria
Bone pain
Loss of appetite.
Nausea and vomiting.
Constipation and abdominal pain.
Increased thirst and frequent urination.
Fatigue, weakness, and muscle pain.
Confusion, disorientation, and difficulty thinking.
Headaches.
Depression.

Question 17

3 ecg changes in hyper Ca

Answer 17

The main ECG abnormality seen with hypercalcaemia is

1. shortening of the QT interval
2. Osborn waves (J waves) - severe
3. Ventricular irritability and VF arrest has been reported with extreme hypercalcaemia