Missed Qs Flashcards
1
Q
Other than dendrites how can HSV present in the eye?
A
Keratoprecipitates, usually unilateral
Disciform keratitis - deeper, disc-shaped, localized area of corneal edema
2
Q
What criteria classify the stages of hepatic encephalopathy?
A
West Haven - stages 1 to 4 (coma)
3
Q
What is the cardizem dose for AFib with RVR?
A
.25 mg/kg IV bolus
4
Q
How to shock in stable VTach?
SVT?
A
Both synchronized cardioversion with 50J
5
Q
How does Ciguatera present?
What is pathognomonic?
A
GI + Neuro symptoms
Cold allodynia
6
Q
What causes NPH?
What symptoms develop early?
A
Abnormal absorption of CSF by the arachnoid villa
Ataxia and urinary incontinence
7
Q
When can an external thrombosis hemorrhoid be incised?
A
48-72 hours
8
Q
What is the intrinsic reabsorption rate for a PTX?
What does supplemental O2 do?
A
1-2 % per day
Increase reabsorption by 3-4x as much
9
Q
MOA of physostigmine?
Used to treat what?
A
AChE-i
Antimuscarinic poisoning
10
Q
What is the MC lab abnormality in COVID-19?
A
Lymphopenia (absolute count < 1500)
11
Q
What sedating medication can cause increased ICP?
A
Ketamine
12
Q
When does a pandemic flu occur?
A
New strain emerges (after antigenic SHIFT)
13
Q
What is typhlitis?
A
Neutropenic enterocolitis
14
Q
What is a SE of procainamide?
Should be given how?
A
HoTN
Slowly, over 45-60 minutes
15
Q
What is the max pressure to inflate an esophageal balloon?
A
50 mmHg
Should decrease by 5 every 3 hours to reach 25 mmHg
16
Q
What is an indication for NG tube placement?
A
Rectal bleeding with hemodynamic instability
17
Q
What is the MC complication from necrotizing external otitis?
A
CN 7 paralysis
18
Q
What is postextraction alveolar osteitis?
Treat how?
A
Dry socket, occurs after wisdom teeth removal MC
Irrigate with saline Ir chlorhexidine .12%
19
Q
What is the most likely complication from CSF overdrainage in pt with VP shunt?
A
Subdural hematoma
20
Q
What medication is contraindicated in PPH in patients with asthma?
A
Prostaglandins, causes bronchoconstriction
21
Q
What medication can help asthmatic patients who need intubation (not talking about ketamine)?
A
Propfol, causes deep sedation but has bronchodilating properties
22
Q
What worm infection can cause hyper infestation in immunocompromised patients?
A
Strongyloides stercoralis infects the small intestine
23
Q
When is the risk highest for future stroke following a TIA?
A
In the first 48 hours
24
Q
Where does unilateral facet dislocation MC occur?
A
C3-C7
25
What medication is contraindicated in a Tet spell (ToF)?
Isoproterenol bc it decreases pulmonary blood flow and increases R—>L shunt
26
Major effect of BB overdose?
How to tell the difference between Sotalol and Propanolol?
Hypoglycemia, bradycardia, HoTN
Sotalol causes QTc prolongation, Propanolol causes QRS widening
27
What to think of after AAA repair and pt presenting with GI bleed?
Aortaenteric fistula
28
What symptom is most consistent with foreign body lodged in the bronchus?
Vocal cords?
Wheezing
Stridor or hoarseness
29
What criteria indicate “severe” OM and can be given antibiotics?
Symptoms greater than 48 hours
Temp greater than 39C
Bilateral infection
Age < 2
30
What symptom is MC with spinal epidural abscess?
Back pain
31
Pt has hiccups after pacemaker placement, what could be the cause?
Eval 1st with what?
Lead displacement
EKG
32
What causes anterior urethral injury?
Posterior?
Direct perineal trauma
Pelvic fractures, MC of the ischiopubic rami
33
#1 cause in primary PTX?
What else?
Smoking
Tall and thin, young male, Marian
34
MC lab abnormalities for Ehrlichiosis?
What is the vector?
Thrombocytopenia, leukopenia, transaminitis
Lone Star tick
35
Where does the SC end in an infant?
Where should LP be performed?
L3
L4-L5 or L5-S1
36
What toxicity mimics tetanus?
MOA?
Strychnine
Inhibits glycine (inhibitory nt)
37
What presents with painless loss of monocular vision, cherry red spot at macula, pale retina with edema, and afferent pupillary defect?
CRAO
38
What findings indicate SBO?
What about large BO?
Dilated bowel with prominent place circulares
Dilated bowel with prominent haustra
39
How to treat late Lyme disease?
Manifestations?
2g IV Ceftriaxone
Arthritis, encephalitis
40
What is a sign of advance limb ischemia?
Blistering skin
41
What can happen in an attempted suicide by hanging?
Pulmonary effects causes delayed death
42
What is the 1st line treatment in seizures in neonates?
If this doesn’t work after multiple doses and fosphenytoin is not an answer consider what?
Diazepam (shorter half-life compared to Ativan)
Pyridoxine (AR metabolism thing)
43
What defines high-output HF?
Inc CO with low SVR
44
When is a G-tube tract mature?
What to do if pt presents with dislodge g-tube 1 week after placement?
2-3 weeks
Sx consult, consider imaging and Abx
45
What size ETT for premature neonate?
Full term (1.6 - 3kg)?
What is special about this population?
2. 5 uncuffed
3. 0 uncuffed
Only patients you use Uncuffed 1st line, other peds use cuffed
46
Pt with chronic digoxin poisoning, what is the best indication for giving Digibind?
Bidirectional VTach
47
Pt with Parkinson’s disease that has dyskinesia, treat how?
Benzo, it decreases involuntary muscle movements
48
Pt involved in MVC and has a wedge-shaped deformity of the anterior column of L2, what injury can be missed?
Need what?
Burst fracture (unstable d/t retropulsion of bone fragments into spinal canal)
Spinal CT
49
What is a chance fracture?
Able to see on what film?
Complete disruption through vertebral boy and assoc structures in horizontal plane
LATERAL film (also spinal CT)
50
Proximal ulnar Fracture, what other Injury occurs and what is this called?
MC injured nerve?
Monteggia, PROXIMAL radial dislocation
Posterior interosseous nerve
51
What is the NIH categorization for severe COVID19 disease?
Critical?
SpO2 = 93% on RA, RR > 30, PaO2 / FiO2 of < 300 or severe PNA
Failure, shock
52
How to manage minor H2S exposure?
Severe?
Normal saline irrigation
Same, Decon and supportive care
53
What is a normal CBD diameter size?
How does this change with age?
7 mm
After age 70, every 10 years increases by 1 mm
54
What is the most efficient and fast way to diagnose TB?
What is the confirmatory test?
Interferon-gamma release assay
Sputum collection with culture
55
What is 3,4-methylenedioxymethaphetamine?
MDMA aka Molly
56
When does ASO titer peak in Grp A strep?
2-4 weeks will be detectable
So if question is asking about GrpA vs Mono, consider timing for which test comes +
57
Where to look for central cyanosis?
Oral mucosa including tongue, also the conjunctiva
58
What are the MC organisms that cause Acute chest syndrome in sickle cell pts?
Mycoplasma and Chlamydia pneumoniae
Not Strep pneum
59
What is the MC cause of PNA in young children with cystic fibrosis?
S. Aureus
Pseudomonas is more common as patients age
60
What is the treatment algorithm for acute angle glaucoma?
Timolol drops 1st
If it doesn’t work then 1 dose of Acetazolamide 500 mg IV/PO
1% pilocarpine drops can be used once IOP has been lowered
61
How does biliary atresia present?
Jaundice after 2 weeks of age, elevated direct bilirubin, FTT, HSM, acholic stools
62
How does breast milk jaundice present?
After the 5th day with indirect hyperbilirubinemia
63
What is the median incubation period for covid19?
4-5 days
64
What is excited delirium syndrome?
Main clinical feature?
Aka agitated delirium, presents w/AMS, severe excitement or aggressiveness
High tolerance to pain, tachypnea, sweating, tactile hyperthermia
65
What is the MC complication in pt with LVAD?
What does the pump do?
Caused by what?
Suction event
Has “low-flow” alarm
Dec preload, MC d/t reduced hypovolemia but also arrhythmia
66
What alarm occurs in a pump failure?
MC cause of this?
Treat how?
“High power”
Pump thrombosis
Heparin, but if unstable give tPA
67
What is the definition of anaphylaxis?
```
Must involve 2 systems:
ENT - swelling of lips, throat, tongue
CV - tachycardia, HoTN
Resp - SOB, wheezing, cough
Skin - rash, hives, itchiness
```
68
What presentation of HSV indicates immunocompromised state?
Involvement of 3 or more dermatomes aka disseminated zoster
Consider HIV/AIDS
69
Pt with LVAD what is the MC site of infection? #2?
Infection occurs MC when?
Driveline #1, then pump pocket
2 weeks to 2 months
70
What is the MC non-device related complication in LVAD?
Why?
Bleeding
Usually on Warfarin and stress on blood through device causes acquired vWF deficiency
71
What is acute cerebellar ataxia?
Postinfectious condition that occurs 2 weeks after viral illness, MC in kids < 6 y/o
72
What role do PPIs play in GI bleeds from PUD?
Decreases rate of rebleeding, LOS, transfusion requirements, likelihood of endoscopic interventions
73
Pt presents with clogged G tube, 1st step?
Next?
Then what?
Milk the tube backward
Irrigate with high pressure
Get contrast film study if that worked
74
Describe progression of a stye
1st comes a stye (Hordeolum) THEN comes Chalazion
Treat with warm compresses
75
What causes tick-borne relapsing fever?
Transmitted by what?
Spirochete —> borrelia hermsii
Ornithodoros ticks
76
What is the management of acute central venous thrombosis?
Anticoagulation —> heparin
NOT endovascular intervention
77
What facial bone has the lowest rate of infection?
Why?
Zygomatic
Not close to the sinuses
78
Adult with epiglottitis, what RF inc chance of intubation?
Stridor or drooling
rapid onset of symptoms
Hx of diabetes
79
What the MC RF for PRES?
Immunosuppression (esp medications like cyclosporine)
HTN
CKD
Pregnancy
80
How does CO effect cerebral vasculature?
Hypocarbia causes cerebral vasoconstriction —> can lead to syncope
Ie in hyperventilation 2/2 anxiety
81
What is the MC complication from peritoneal dialysis?
Dx how?
Treat how?
Peritonitis
Dialysis fluid with > 100 wbcs and 50% neutrophils
1st Gen Cephalosporin or Vancomycin INTRAPERITONEALLY
82
What is criteria for hospital admission in young healthy pt with dx of pericarditis?
What else can you admit on?
Fever (d/t suspicion of bacterial cause)
Effusion > 2cm, hx of anticoagulant use
83
What best estimates BP in LVAD pts?
How to measure this?
MAP
Doppler US on brachial a., inflate manual BP cuff until Doppler is lost. Deflating the cuff to the # at which the flow is detectable represents the MAP
84
What to prone patients with ARDS?
PF < 150 based on the PROSEVA trial demonstrated NNT 6
85
MC cause of polymorphic VT?
Monomorphic?
Myocardial ischemia
Re-entrant mechanism through scarred myocardium
86
How to manage asymptomatic child with button battery in the stomach?
Discharge home with outpatient follow up
87
How does varicella PNA present?
Treat how?
Vesicular lesions with bilateral interstitial pattern on CXR
IV acyclovir (if patient pregnant or needs admission)
88
Lindane SE?
Seizures, CNS effects, can cause death
89
What finding is most suggestive of myocarditis?
Tachycardia out of proportion to fever
90
What condition indicates a need for LVAD?
What must be present to be eligible?
End-stage CHF
Functioning RV aka cannot have Bi-ventricular HF
91
When to give 50 mcg of RhoGAM and when to give 300?
Less than 12 weeks, give 50
Greater than 12 weeks, give 300
92
What bone is fracture in all Le Fort fractures?
Pterygoid plate
93
What are the RF for endometrial cancer?
Obesity
Nullparity
Anovulatory cycles
Late menopause
94
What type of blood should a man receive that does not know his blood type?
O+
Save the O- for women
95
How common is hematuria in renal stone?
85%
96
Where are the 3 locations kidney stones get stuck?
UPJ
Pelvic rim
UV junction
97
How does TTP present on blood smear?
Schistocytes
98
What is pseudocyanosis?
Found in what conditions?
Abnormal skin pigmentation
Hemochromatosis and other heavy metals
99
What is the algorithm for difficulty passing catheter in old male?
Start to finish (4 steps)
1 - try 14 Fr
2 - coude
3 - Urology consult
4 - if not available, suprapubic tube
100
How to calculate free water deficit?
.6 x kg x [(current Na / 140) -1 ]
For female the multiplier is .5
101
When to use Nimbex in ARDS?
What evidence?
Use in severe ARDS
2010 ACURASYS trial showed mortality benefit with Nimbex, NNT = 11, also showed reduced barotrauma, increased Vent free days
2019 ROSE trial tried to replicate, showed no benefit, maybe more weakness
102
Why prescribe valcyclovir over acyclovir?
Valcyclovir only has to be given bid, acyclovir is 5x/day
103
MC cause of DIC?
Infection
104
What is zoledronic acid?
Treats what?
Bisphosphonate
Hypercalcemia
105
What is the target UO for pt with Rhabdo?
3 cc/kg/hr or 200 cc/hr
106
What is the cyanotic hyperoxia test?
Indicates what?
ABG while on supplemental O2 with PaO2 less than 100 and failure to rise more than 20 after applying O2
congenital heart disease
107
What kind of snake causes fang marks, localized swelling and dec Plt, dec fibrinogen?
Rattlesnake
108
What symptoms do coral snake bites cause?
Neurotoxic - respiratory failure
Small fangs, no big bite marks
109
What is an unexpected lab finding in Kawasaki disease?
Wbc in UA, sterile pyruia
Plt will be high in first 7 days
110
What causes peripheral cyanosis?
Low CO states i.e. Dilated cardiomyopathy
Environmental exposure to cold with vasoconstriction
Arterial or venous occlusion
Redistribution of blood flow
111
What PaCO2 level triggers SIRS criteria?
< 32
