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Intern Month > Misc > Flashcards

Misc Flashcards

1
Q

GCS

A

Best eye response

Spontaneously (+4)
To verbal command (+3)
To pain (+2)
No eye opening (+1)
Not assessable (trauma, edema, etc) (+1C)
Best verbal response
Oriented (+5)
Confused (+4)
Inappropriate words (+3)
Incomprehensible sounds (+2)
No verbal response (+1)
Intubated (+1T)
Best motor response
Obeys commands (+6)
Localizes pain (+5)
Withdrawal from pain (+4)
Flexion to pain (+3)
Extension to pain (+2)
No motor response (+1)
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2
Q

Centor Criteria

A

To determine testing for strep pharyngitis:

1 - absence of cough
2 - fever >38
3 - tonsilar exudates
4 - tender lymphadenopathy (anterior)

If 1 - no testing, no tx.
If 2-3, rapid strep, tx if +. Confirm with cx.
If 4, don’t test just treat.

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3
Q

Strep Pharyngitis Treatment

A

Penicillin (benzathine) IM 1.2 million U
OR - Penicillin V PO for 10d
OR - Amoxicillin PO for 10d
OR - if pen allergy, azithromysin PO for 5 d

treat with entire course to prevent rheumatic fever

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4
Q

Spontaneous bacterial peritonitis

A

ascites + T>100F OR abd pain OR AMS OR ascitic PMN >250 cells/mm3.

Most 2/2 gut bacteria but can also be 2/2 strep. Usually no organisms ID’d.

Rx broad spectrum abx: cefotaxime vs amp/gent.

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5
Q

Liver failure lab abnormalities

A

increase PPT, ALT/AST, bili, ammonia, LDH

decreased plts

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6
Q

What is tramadol

A

Opioid analgesic used for pain, moderate - severe

50-100 mg PO q4-6h prn

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7
Q

Vertigo treatment

A

antihistamines (meclizine, denadryk), benzos (diazepam/valium, loraz/ativan), antiemetics (compazine, phenergan/promethazine, reglan/metoclopramide, zofran)

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8
Q

MRSA Abx coverage

A

clinda, doxy, bactrim (can’t use doxy or bactrim in preg pts)

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9
Q

Hypotension in sepsis treatment

A

2L NS, if refractory, levophed(norepi) - 2-4 mcg/min IV; Start: 8-12 mcg/min IV, then titrate to effect; pts w/ septic shock may require higher doses

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10
Q

Bites: Abx prophylaxis

A

Augmentin 875/125 mg bid x5d
Human: always treat
Cat: 80% infection rate: augmentin, same dose
Dog: only 5% infx on hand/foot. same Tx

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11
Q

Uncomplicated UTI Rx, preg UTI Rx, pyelonephritis Rx

A
  • Nitrofurantoin monohydrate/macrocrystals (100 mg orally twice daily for 5 days);
  • Bactrim (TMP-SMX); one double strength tablet [160/800 mg] twice daily for 3 days);
  • Fosfomycin (3 grams single dose)

PREGNANT UTI
keflex (cephalexin), Unasyn (amp-sulb), Nitrofur.

PYELO Rx: Cipro 500 mg PO BID x7d
Fluoroquinolones are the only oral antimicrobials recommended for outpt empirical treatment of acute uncomplicated pyelo.

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12
Q

Osmolarity and Osmolar Gap Calculation

A

Calculated osmolarity = 2 x Na + Glu/18 + BUN/2.8
(can add ETOH/4)

OG = true osmolarity - calculated osmolarity = 10-20

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13
Q

Elevated anion gap calculation & causes

A

MUDPILES/MUKPILES
M - methanol
U - uremia
D - DKA [K - ketoacidosis (diabetic, alcoholic, starvation)]
P - paracetamil (tylenol), propelene glycol
I - INH, iron
L - lactic acidosis
E - ethylene glycol (antifreeze –> Ca oxalate)
S - salicylates + acute solvent inhalation (huffing)

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14
Q

Lorazepam

A

Ativan

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15
Q

Ativan

A

Lorazepam

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16
Q

Midazolam

A

Versed

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17
Q

Versed

A

Midazolam

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18
Q

Diazepam

A

Valium

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19
Q

Valium

A

Diazepam

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20
Q

VZV/Herpes Zoster Ophthalmicus

A

Reactivation of dormant varicella zoster virus residing within the ophthalmic nerve (the first division of the trigeminal nerve)

Viral prodrome
Preherpetic neuralgia
Rash, transitioning from papules to vesicles to pustules to scabs.
Hutchinson’s sign: cutaneous involvement of the tip of the nose, indicating nasociliary nerve involvement. A positive Hutchinson’s sign increases the likelihood of ocular complications associated with HZO.

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21
Q

Vanc Dosing

A

20 mg/kg - cellulitis, skin/soft tissue infection, UTI
20 mg/kg - Dialysis patients
25 to 30 mg/kg - Pneumonia, meningitis, osteomyelitis, endocarditis, septic shock

MAXIMUM DOSE 2000 mg

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22
Q

Normal Gap Acidosis Differential

A 
"HARD UP"
Hyperventilation
Acetazolamide, Addison’s disease
RTA
Diarrhea, ileostomies, fistulae
Uremia
Pancreatoenterostomies
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23
Q

Top 2 causes of metabolic acidosis + resp alkalosis

A

aspirin OD or sepsis (lactic acidosis + hyperventilation)

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24
Q

Hypomagnesemia causes (6)

A 
malabsorption
alcoholism
diarrhea
redistribution (insulin)
RTA
diuretics
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25
Q

How to treat eclampsia

A

Mg and deliver

Mg - halves rate of progression from pre -> eclampsia
Eclamptic seizures – more effective than phenytoin or benzodiazepines
Dose: 4g over 5min -> 1g/hr (aim for a level of 2-4mmol/L)

Adverse effects of high levels = muscle weakness, respiratory muscle fatigue, slowed cardiac conduction (>7.5mmol/L) -> arrest (>12.5mmol/L)
toxicity unlikely if tendon reflexes are present

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26
Q

Ketamine (Dosing, & Contraindications)

A

Sedative/hypnotic for RSI.

RSI Dose: 1-2 mg/kg - give around 100-150 mg

Use for asthmatics, hypotensives.

Contraindications: extreme HTN, cocaine, tachycardia, increased IOP or ICP

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27
Q

Etomidate (Indications, Dosing, & Contraindications)

A

Sedative/hypnotic for RSI. No analgesic effects, mild increase in airway resistance. Can cause myoclonus.

RSI Dose: 0.3 mg/kg - give around 20-30 mg

Drug of choice for HTN or tachycardic pts!!! (no hemodynamic instability)

Contraindications:
adrenal insufficiency, (causes adrenocortical suppression).

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28
Q

Rocuronium

A

Competitive inhibitor of ACh receptors, prevents all muscle action. No fasciculations (non-depolarizing)

1 mg/kg (~70-100 for adults), effect in 45-60 secs, duration of action 45 min.

USE IN KIDS!!!

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29
Q

Succinylcholine

A

Ach analog that stimulates all receptors and then wear them out, transient fasciculations, then paralysis. Increases K.

Dose: 1.5 mg/kg (~100 for adults)
45 sec to effect
Duration: 6-10 min

DONT USE IN KIDS

Contraindications:
Causes HYPERKALEMIA (beware in renal pts, Crush or burn injury over 48h old, rhabdo, Malignant hypothermia)

Denervating diseases/injuries (MS, ALS, old strokes, old cord injury, prolonged immobilization)

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30
Q

3 ways to confirm placement of tube

A

Listen to chest
End tidal CO2 (waveform capnog)
CXR

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31
Q

Still desatting w/ ET tube, what could be wrong?

A

DOPES

D - Displacement of tube
O - Obstruction of the ETT
P - PTX (also: PE, pulmonary edema, collapse, bronchospasm, mucus plugging)
E - equipment — ventilator problems
S - ‘Stacked breaths’
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32
Q

What other 2 sedatives hypnotics can you use for RSI other than ketamine and etomidate?

A

Versed/Midazolam (0.2 mg/kg –> ~15 mg)

Propofol (1.5-3 mg/kg –> ~100 mg)

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33
Q

Causes of HYPERcalcaemia

A

Nature Bones, stones, groans and psychic moans

Causes>90% from Malignancy and Hyperparathyroidism

Basically: Tumour, increased PTH and increased Vit D

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34
Q

3 Ocular emergencies that need treatment IMMEDIATELY (before consult!)

A
  1. Chemical burn(alkali-worst, acid, solvents, detergents)
  2. Acute central retinal artery occlusion (CRAO)
  3. Elevated IOP from
    - Retrobulbar hematoma
    - Acute angle closure glaucoma
    - Ocular compartment syndrome
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35
Q

SIde effect of Proparacaine Eye Drops

A

Can cause keratitis with prolonged use! Don’t send patients home with this!

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36
Q

Retinal exam findings with central retinal artery occlusion

A

Box cars and cherry red spot (macula)

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37
Q

3 Most common causes of increased intraocular pressure

A
  1. retrobulbar hemorrhage (recent ocular trauma or surg)
  2. AA closure glaucoma
  3. Ocular compartment syndrome (congestion/sinusitis –> orbital cellulitis
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38
Q

Causes of Acute monocular vision loss

A

GO CART MTV

Glaucoma
Optic neuritis
CRAO, CRVO
Amaurosis fugal
Retinal detachment 
Trauma 
Migraine****
Temporal arteritis (GCA)
Vasculitis
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39
Q

6 causes of an afferent pupillary defect

A

retinal detachment

ischemic optic disease or retinal disease

severe glaucoma causing trauma to optic nerve

optic neuritis

direct optic nerve damage (trauma, radiation, tumor)

very severe macular degeneration

retinal infection (CMV, herpes)

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40
Q

Treatments for acute angle closure glaucome

A

acetazolamide, beta blocker timolol, alpha agonist ilodipine, Mannitol, steroid

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41
Q

What group gets central retinal artery occlusion frequently

A

Sickle cell disease

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42
Q

What does central retinal vein occlusion look like on retinal exam?

A

blood and thunder (retinal bleeds everywhere)

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43
Q

What 2 disease/symptoms occur with temporal arteritis?

A

GCA + polymyalgia rheumatica. They are at risk for monocular vision loss 2/2 inflammation of the ocular arteries

Rx: Corticosteroids are the mainstay of therapy.

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44
Q

Red Eyes: Diseases with perilimbal involvement (2) vs. Sparing (2)

A

Perilimbal involvement:
Iritis
Uveitis

Perilimbal sparing: Kawasaki Dz
Conjunctivitis

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45
Q

What’s Hutchinson’s Sign and why is it bad?

A

Vesicles on the tip of the nose that precedes the development of ophthalmic herpes zoster. Means nasociliary branch of the trigeminal nerve involved, which innervates cornea too, and can lead to painful vesicles on cornea & blindness,

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46
Q

Name the 12 cranial nerves

A 
CN I – Olfactory
CN II – Optic
CN III – Oculomotor
CN IV – Trochlear
CN V – Trigeminal
CN VI – Abducens
CN VII – Facial
CN VIII – Vestibulocochlear
CN IX – Glossopharyngeal
CN X – Vagus
CN XI – Accessory
CN XII – Hypoglossal
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47
Q

Which bug is bacterial conjunctivitis most likely?

A

Strep, treat with Polytrim or moxifloxacin

Polytrim is similar to bactrim, which covers GP skin flora and MRSA

Moxifloxacin is a fluoroquinolone that covers strep, enterics, and atypicals

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48
Q

What is superficial punctate keratitis?

A

inflammatory response to bright light (welding, snowboarders, tanners, etc.)

death of small groups of cells on the surface of the cornea Eye, watery, and sensitive to light, and vision may decrease somewhat. Most recover fully.

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49
Q

Define High Quality CPR (4)

A

Compressions 100-120/minute

Depth: 2 inches in adults, allow full recoil

Minimize time off chest (interruptions less than 10 sec)

Ventilate ~1 breath every 6-10 secs – do not hyperventilate.

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50
Q

malignant hyperthermia Rx?

A

dantrolene

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51
Q

Post intubation sedation options

A

Most commonly for medical patients: fentanyl & propofol

  1. Bolus fentanyl 100 mcg/IV (1-2 mcg/kg bolus)
  2. Start fentanyl drip at 50 mcg/hour
  3. Start propofol drip at 20 mcg/kg/min

Titration:

  • fentanyl, increase 25 mcg/hour
  • propofol, increase 10 mcg/kg/min

Post intubation sedation for trauma patients:
Fentanyl and Midazolam/versed + Vec (0.1 mg/kg)

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52
Q

Post intubation sedation for trauma patients

A

Trauma: Fentanyl and Midazolam/versed + Vec (0.1 mg/kg)

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53
Q

Difficult laryngoscopy mnemonic

A

LEMON

Look externally
Eval the 3-3-2 rule
Mallampati
Obstruction (ex. Subglottic stenosis)
Neck mobility
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54
Q

ETT size and depth in premature infants

A

Premature tube size 0.1X gest age in weeks and then downsize to next smaller tube

Ex. 34 weeks –> 3.4 –> 3.0

Depth: 3X size of tube (ex tube size 3.0 x 3 = 9 cm)

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55
Q

Massive Transfusion Protocol

A

MTP → 1:1:1 (PRBC’s, platelets and plasma) has better survival
Blood is then sent every 20-25 minutes

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56
Q

Abx choice for typical community acquired PNA

A

ceftriaxone + azithromycin

plus zosyn or levaquin if pseudomonas

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57
Q

Abx choice for atypical community acquired PNA

A

(for mycoplasma, chlamydia, legionella)

azithromycin, doxy, or levaquin

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58
Q

Healthcare Assoc. PNA criteria

A
  1. hospitalized for 2+ days in the 90 days preceding the infection
  2. reside in a nursing home or long-term care facility
  3. IV abx, chemotherapy, chronic dialysis, or wound care in the 30 days preceding the pneumonia
  4. pneumonia that developed at least 48 hours after hospitalization
59
Q

Healthcare Assoc. PNA Rx

A

Typical combination would be zosyn, levaquin, vanc.

Two antipseudomonal
Choose from: zosyn, levaquin, Gent, imi/meropenem, 3rd gen ceph → cefepime or ceftazidime

MRSA coverage → vanc.

60
Q

How long to get to cath lab for ACS?

A

within 12h of sx onset, within 90 min of entering hospital (or 120 if a transfer)

61
Q

PNA: alcoholics (3)

A

S. aureus, Klebsiella, enteric orgs (Aspiration)

62
Q

PNA: bat caves/southeast USA

A

Histoplasma

63
Q

PNA: bird handler (2)

A

chlamydia psittaci, histoplasma

64
Q

PNA: bullous myringitis

A

mycoplasma pneumoniae

65
Q

PNA: burn unit

A

Pseudomonas (Rx: zosyn or levaquin)

66
Q

PNA: California

A

coccidioides spp.

67
Q

PNA: cavitary lesions (2)

A

TB

Staph aureus

68
Q

PNA: Cold agglutinins

A

Mycoplasma pneumoniae

69
Q

PNA: college aged (2)

A

Mycoplasma pneumoniae

Chlamydia spp

70
Q

PNA: convention

A

legionella

71
Q

PNA: COPD (2)

A

H. flu, Moraxella cat.

72
Q

PNA: currant jelly sputum

A

klebsiella

73
Q

PNA: cystic fibrosis (2)

A

Pseudomonas or S. aureus

74
Q

PNA: cystic fibrosis (2)

A

Pseudomonas or S. aureus

75
Q

PNA: elevated LFTs/hyponatremia

A

Legionella

76
Q

PNA: HIV

A

same orgs as rest of pop, +TB, PCP

77
Q

PNA: immigration

A

TB

78
Q

PNA: IVDU

A

Staph aureus

79
Q

PNA: periodontal dz (2)

A

anaerobes, polymicrobial

80
Q

PNA: post-influenza

A

staph aureus

81
Q

PNA: rabbits/hunters

A

tularemia

82
Q

PNA: rigor

A

strep pneumoniae

83
Q

PNA: sheep/farm animals

A

Q fever (Coxiella burnetti)

84
Q

PNA: sickle cell

A

strep pneumo (encapsulated

85
Q

PNA: splenectomy

A

strep pneumo (encapsulated)

86
Q

encapsulated organisms

A 
Streptococcus pneumoniae
Neisseria meningitidis
Klebsiella pnemoniae
Haemophilus influenzae
Salmonella typhi
Cryptococcus neoformans
Pseudomanas aeruginosa
87
Q

HELLP Syndrome Dx and Tx

A

Usually in 3rd trimester. Complete or incomplete.

  1. Hemolysis (LDH >600)
  2. Elevated Liver enzymes (AST >70)
  3. Low Platelets <1002/2 plt aggregation)

Sx: tender RUQ, edema, polyuria from nephrogenic DI

Complications: hemorrhage, infarction, preterm delivery

Tx: resuscitation (for hemorrhage), deliver, antiHTN, Mg for eclampsia prophylaxis, steroids for lung maturity

88
Q

Preterm Labor Tocolytics (3)

A
  1. Magnesium 4g IV bolus over 30 minutes
  2. Terbutaline 2.5 mg PO or 0.25 mg subQ (old)
  3. Nifedipine (CCB)
89
Q

Postpartum hemorrhage drugs

A

Oxytocin (Pitocin) – 40 units in 1L NS, run at 20ml/min or 600/hr. Can give 10 Units IM if no IV access. Beware of cramping, nausea, hypotension.
Methergine (methylergonovine) – 0.2mg IM. Can cause serious hypertension. Beware of nausea and cramping.
Hemabate (carboprost tromethamine, prostaglandin F2a) – 0.25mg IM q15 min.

90
Q

Eclampsia treatment

A

LOTS OF magnesium
Start at 6g IV bolus then 4g/hr and keep going until they lose their reflexes

Seizure control:

  • Versed (midaz)
  • Keppra, Dilantin (phenytoin)
  • phenobarbital

BP control - Mg or Labetalol, hydralazine

Definitive management is immediate delivery.

Can still occur up to 4 weeks post-partum.

91
Q

What is terbutaline

A

b2 agonist used in asthma and preterm labor (tocolytic), but has a lot of side effects

92
Q

Giving fluids for burns

A

4 ml/kg x %TBSA = LR volume

1st 8 hours since injury = give 50% of the volume

Then for 16 hrs = give 50% of the volume

Don’t forget tetanus in burn patients

93
Q

Describe: Cutaneous drug rash/Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)

A

Recently started new med. Fever, malaise. Rash over trunk, starting as scattered bumps, spreading. Rash can change over time. Swollen face with painful cervical lymph nodes, Abd pain. Anticonvulsants, Sulfa, NSAIDs, Allopurinol. Delayed reaction: 3-8 weeks after initiation.

94
Q

Describe: Measles

A

Descending Rash - starts at head and go down. Unvaccinated population. Highly contagious. Cough, Conjunctivitis, Coryza + Fever. Koplik spots.

95
Q

Describe: HSP

A

In children, palpable purpura in LEs, vasulitis, JARS (joints, abd pain, renal, skin rash). Could lead to intussusception. Supportive care.

96
Q

Describe: Neisseria gonorrhoeae → Meningococcemia

A

fever, HA, cough → lethargy, AMS. IMMEDIATE antibiotics, rifampin or cipro prophylaxis for contacts

97
Q

Describe: Rocky Mountain Spotted Fever

A

Spread through ticks. Non blanching, on palms & soles. Viral prodrome, fever, HA, myalgias. Starts out and works was into trunk. Treat with doxy.

98
Q

Describe: Kawasaki

A

<5 yo, fever x5 days, Rash (perineum, torso) Skin changes on hands/feet (erythema, edema or later finding of desquamation), vasculitis, cervical lymphadenopathy, limbic sparing conjunctivitis, strawberry tongue. Later, coronary artery dilation.

99
Q

Describe: Staph Scalded Skin Syndrome

A

Children <5 yo

Staph exotoxin, breaks down desmosomes. Fever + diffuse erythema → desquamatino, bullae

100
Q

Describe: Necrotizing Fasciitis

A

Rapidly progressive, SEVERE pain out of proportion, erythema that is growing fast (mark skin!). Posibly crepitus. Can develop bullae later.
XR: Gas in tissues
Lab risk indicator: high CRP, WBCs, Hgb, Na (low), creat (high), glucose (high)
Types
Polymicrobial (most common type)
Monomicrobial (GaS)
Vibrio (marine exposure, GNR)
MRSA
Antibiotics: Broad spectrum, need to cover for all 4! Vanc+Zosyn+Clinda (stop toxin formation from GAStrep)
CT scan

101
Q

Describe: Toxic Shock Syndrome

A

sunburn like rash, mucous membrane involvement. Etiology: Toxin superantigen causes massive T cell activation. 2-3d after inciting factor begins. Viral prodrome → rapid prog to shock. Supportive care- fluid, pressors.
Staph - associated w tampons
Strep - local tissue invasion of Group A strep
Rx: supportive care
Abx don’t help as much (toxin mediated)
Side note: Clinda ↓ toxin formation in nec fasc., but don’t need it here

102
Q

Describe: Bullous pemphigoid

A

Older people, no mucous membrane involvement, auto-ab hemidesmosomes. Subepidermal/deep blisters that are tense and firm (-Nikolski’s sign). Favorable prognosis.

103
Q

Describe: Pemphigus Vulgaris

A

Younger people, +mucous membrane involvement, auto-ab desmoglein 3. SUperficial blisters that are flaccid and rupture easily (+Nikolski’s sign). Poor prognosis. Can look like SJS

104
Q

Describe: SJS/TEN

A

Immune complex mediated hypersensitivity, Toxic appearing with viral-type prodrome and sudden onset of painful rash, Mucous membrane involvement (Eyes, Mouth, Genitals).
Etiology: DRUGS (allopurinol, psych meds, many), infection, malignancy, idiopathic.
<10% BSA of epidermal detachment → SJS, TEN is >30%
Admit to burn

105
Q

Hill-Sachs fracture

A

posterolateral humeral head compression fracture, seen with anterior dislocation of shoulder

106
Q

Bankart fracture

A

may be seen as a fracture of the anteroinferior aspect of the glenoid, seen with anterior dislocation of shoulder

107
Q

mnemonic & names for carpal bones

A

Some lovers try positions that they can’t handle:

scaphoid
lunate
triquetrum
pisiform
trapezium
trapezoid
capitate
hamate
108
Q

lunate vs perilunate dislocation

A

Perilunate dislocation - Lunate remains in position relative to the distal radius

3 c’s on lateral view: distal radius, lunate, capitate

If capitate not in line, called a perilunate dislocation

Lunate dislocation is when the middle of the 3 (the lunate) is out, “Spilled teacup”

109
Q

Distal/midshaft radial fracture + Ulnar dislocation

A

Galeazzi fracture
Distal/midshaft radial fracture + Ulnar dislocation (+ styloid fracture 60%)
Ulnar nerve injury + compartment syndrome

110
Q

Proximal ulnar fracture + radial head dislocation

A

Monteggia fracture

Proximal ulnar fracture + radial head dislocation
Radial nerve injury + compartment syndrome

“GRUM” - Galeazzi radius broken, Monteggia, ulnar broken

111
Q

Segond fracture

A

Avulsion fracture of the lateral tibial plateau
Associated with ACL injury (75-100%)
Associated with meniscal injury (70%)

112
Q

Maisonneuve fracture

A

Maisonneuve fracture is the combination of a spiral fracture of the proximal fibula and unstable ankle injury which could manifest radiographically by widening of the ankle joint due to distal tibiofibular syndesmosis and/or deltoid ligament disruption, or fracture of the medial malleolus.

113
Q

Ottowa Ankle Rules:

A

Ankle X-ray is only required if -
There is any pain in the malleolar zone; and,
Any one of the following:
Bone tenderness at distal posterior edge of the tibia or tip of the medial malleolus, OR
Bone tenderness at distal posterior edge of the fibula or tip of the lateral malleolus
An inability to bear weight both immediately and in the emergency department for four steps.

114
Q

What pressor to use for septic shock (and dose)

A

Levophed (norepinephrine)

Start drip at 5 mcg/min

Titrate up to 50 mcg/min

Could also use phenylephrine for septic shock
Maintain MAP >65 mmHg

115
Q

Pressor receptors

A

Alpha-1 Adrenergic - Located in:
Vascular wall → Vasoconstriction
Heart→ Increase contractility

Beta Adrenergic
Beta-1 → Heart → ↑Inotropy and chronotropy
Beta-2 → Blood vessels → Vasodilation (and bronchodilation)

Dopamine
Renal, Splanchnic(mesenteric), coronary, cerebral → Vasodilation
Subtype → Vasoconstriction

116
Q

Which abx cover pseudomonas?

A 
zosyn
levaquin
Gentamycin
imi/meropenem, 
3rd gen ceph → cefepime or ceftazidime
117
Q

What does zosyn cover?

A

Gram positive (Strep, MSSA)
Gram negatives
Anaerobes
Pseudomonas

118
Q

What does vanc cover?

A

Gram positives (including MRSA)

119
Q

How do you treat atypical PNA?

A

Azithro (cover legionella, mycobacteria) and resp fluoroquinolone –> levaquin

120
Q

What would you treat community acquired PNA with?

A

Rocephin/ceftriaxone and and resp fluoroquinolone –> levaquin

121
Q

Nec fasc Rx

A

clindamycin to decrease anti toxin

122
Q

Suspected meningitis empirix Rx

A

Ampicillin (listeria)
Acyclovir (HSV)
& Cefepime (GP, GN, anaerobes)

123
Q

Abx choice for febrile neonate <29d

A

ampicillin, gentamycin, acyclovir

124
Q

Abx choice for febrile neonate 29-60d

A

ceftriaxone(rocephin) + vanc

125
Q

APAP/acetaminophen toxicity

A

treat after 4h with NAC (look at nomogram)

test synthetic fxn: coags, tibili (not enzymes as much)

can give metabolic acidosis

die from cerebral edema 2/2 liver failure

126
Q 
Hot as a hare
Blind as a bat (loss of accommodation) 
Mad as a hatter 
Dry as a bone 
Red as a beet
A

Antimuscarinic (anticholinergic)

Signs and symptoms: Mydriasis (wide pupils), loss of accommodation, tachycardia, bronchodilation, decreased gastric motility, urinary retention, depressed salivary and sweat gland activity, and CNS effects

Causes: Belladonna alkaloids (atropine, hyoscyamine), diphenhydramine/Benadryl, cyclobenzaprine, TCAs, phenothiazines,

Tx: Physostigmine (reversible acetylcholinesterase inhibitor) , but can cause seizures, bradycardia, Bronchoconstriction.

Beware in epileptics, evidence of AV block or Na channel blocking effects on ECG, asthma

Treatment: Supportive care, benzodiazepines

127
Q

Sympathomimetic

OD Rx

A

Treatment: Supportive, benzodiazepines (GIVE ENOUGH!), hydration, cooling (wet and windy) if hyperthermic

COMPLICATION: rhabdo (get temp!!!), start cooling early!, All can result in DIC

Note: Cocaine is a sodium channel blocking drug and may cause a widened QRS. Treat a wide QRS from cocaine with iIV sodium bicarbonate.

Note: Do not treat hypertension in cocaine or sympathomimetic crisis with beta blockers. Beta blockers may cause unopposed alpha stimulation, worsening the hypertension and coronary vasospasm.

128
Q

Opioid OD

A

Does not show up on drug screen: fentanyl, oxycodone, methadone

Mimics: alpha 2 agonists

Tx: naloxone → Give just enough! If you give too much → opioid withdrawal
Supportive care

129
Q

Describe and Tx Opioid Withdrawal

A

Signs and symptoms: Piloerection, yawning, abdominal cramping, N/V/D, rhinorrhea No fever or altered mental status
Treatment: Supportive care, clonidine, antiemetics, antidiarrheals

130
Q

What is this syndrome?

Diarrhea 
Urination 
Miosis 
Bronchorrhea 
Bradycardia 
Emesis 
Lacrimation 
Salivation
A

Cholinergic overdose

Wet, “slimed”, Seizures, AMS

Rx: atropine → GIVE ENOUGH!!

Causes: Organophosphates (phos, fos, thion in name), nerve agents, carbamate insecticide, medicinal Ach-esterase inhibitors (physostigmine, pyridostigmine, neostigmine), etc. 3

Treatment: Decontamination, airway, atropine, pralidoxime (organophosphates), benzodiazepines

131
Q

TCA OD & Rx

A

EKG: VTach, wide complex tachycardia, look at aVR to look for Na channel blocking effects (terminal R wave changes)
Rx: bicarb

Mechanisms of toxicity: sodium channel blocking effects, antimuscarinic effects, alpha1 blocking effects
The more acidemic the patient, the more binding of the TCA to the sodium channel.
Wide QRS = sodium bicarbonate IVP

Seizures-treat aggressively with benzos and then watch the monitor for QRS widening. Seizure → acidemia → increased risk of QRS widening

132
Q

Low back pain red flags

A

Age <20, >55 (less likely to be benign pain)

Severe systemic disease

Non-MSK complaints (fevers, rashes, etc.)

Non-MSK pain (i.e. moving around for kidney stones)

ANY new Neurologic symptoms (like urinary retention, new numbness/saddle anesthesia, leg weakness)

133
Q

Spine pain + spinal mass in a 25 yo M

A

testicular Ca

134
Q

Spinal epidural abscess bugs, RFs, and Rx

A

Common orgs: staph, strep, TB
Route: hematologic, LP/epidural (super rare)
RFs: IVDU, immunocompromised pts, ANY RECENT INFECTION
Sx: infx sx, back pain

135
Q

HTN emergency

  • labs
  • Rx
A 
CBC, BMP, UA
ECG
Creatinine (renal function)
Chest x-ray
Urine drug screen
Pregnancy test
Head CT to rule out SAH
Consider TSH/T4
  • decrease MAP by 20%
  • Nicardipine 10 mg bolus then drip (don’t use in HF)
  • Nitro drip (use for HF)
  • Labetalol or Esmolol

Clonidine takes 4h :(

136
Q

HTN outpatient meds and SEs (3)

A

Out pt meds

Amlodipine (causes swelling, not in pregnancy)

Lisinopril (great for remodeling, angioedema)

HCTZ (makes pee, orthostatic, kidney stones)

137
Q

What is the number one risk factor for stroke?

A

HTN, 30% of americans have HTN

HTN increases MI risk 3X

138
Q

When to use PERC?

A

Already have a Low pretest probability <15%, yes or no for do you work up PE or not?

PERC is for YOUNG HEALTHY people, no one under age 50, no one with comorbidities, no one on OCP use.

139
Q

If mod-high pretest prob for PE, what scores can we use? (2)

A

Already committed to PE w/u, What tests do I order?

Wells score
Modified Geneva Score

140
Q

Asthma Mimics

A 
anaphylaxis
airway stenosis
FB
CHF (most common)
tumor
laryngeal dysmotility
141
Q

Steps after ROSC (4)

A

Maintain, optimize oxygen and ventilation

Treat hypotension (IVF bolus, vasopressor-levophed)

EKG!!!! To determine if pt goes to cath

Is pt following commands? If not → therapeutic hypothermia

142
Q

Treating hyponatremia too quickly? Results in…

A

If you correct too quickly → Central pontine myelinolysis/Osmotic demyelination syndrome

If they were hypoNa for >2 days, 8 mEq Na/day is the MAX!

143
Q

When can you treat hypoNa quickly? Tx?

A

When is it acute in onset (<1-2d) and have AMS, Sz, focal neuro findings.

Use hypertonic 3% saline → 100 cc’s to acutely bump Na 2-3 mEq. (Only use if <120 and have acute sx.)

144
Q

HyperCa 2 most common causes, Tx?

A

Cancer
Hyperparathyroid

Treat with lots of saline!

  1. ABC/NGT
  2. NSS (150-200 ccs/hour) - slow bc might develop pulm edema
  3. Lasix - use it only for fluid balance, allows the saline and Ca to leave
  4. Follow K, follow Mg
  5. Get a Bisphosphonate??? Level (with oncologist/internist)

Intern Month (5 decks)

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