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A - Peer 9 Boards > Missed Qs > Flashcards

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

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2
Q

What criteria classify the stages of hepatic encephalopathy?

A

West Haven - stages 1 to 4 (coma)

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3
Q

What is the cardizem dose for AFib with RVR?

A

.25 mg/kg IV bolus

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4
Q

How to shock in stable VTach?

SVT?

A

Both synchronized cardioversion with 50J

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5
Q

How does Ciguatera present?

What is pathognomonic?

A

GI + Neuro symptoms

Cold allodynia

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6
Q

What causes NPH?

What symptoms develop early?

A

Abnormal absorption of CSF by the arachnoid villa

Ataxia and urinary incontinence

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7
Q

When can an external thrombosis hemorrhoid be incised?

A

48-72 hours

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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

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9
Q

MOA of physostigmine?

Used to treat what?

A

AChE-i

Antimuscarinic poisoning

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10
Q

What is the MC lab abnormality in COVID-19?

A

Lymphopenia (absolute count < 1500)

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11
Q

What sedating medication can cause increased ICP?

A

Ketamine

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12
Q

When does a pandemic flu occur?

A

New strain emerges (after antigenic SHIFT)

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13
Q

What is typhlitis?

A

Neutropenic enterocolitis

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14
Q

What is a SE of procainamide?

Should be given how?

A

HoTN

Slowly, over 45-60 minutes

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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

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16
Q

What is an indication for NG tube placement?

A

Rectal bleeding with hemodynamic instability

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17
Q

What is the MC complication from necrotizing external otitis?

A

CN 7 paralysis

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18
Q

What is postextraction alveolar osteitis?

Treat how?

A

Dry socket, occurs after wisdom teeth removal MC

Irrigate with saline Ir chlorhexidine .12%

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19
Q

What is the most likely complication from CSF overdrainage in pt with VP shunt?

A

Subdural hematoma

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20
Q

What medication is contraindicated in PPH in patients with asthma?

A

Prostaglandins, causes bronchoconstriction

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21
Q

What medication can help asthmatic patients who need intubation (not talking about ketamine)?

A

Propfol, causes deep sedation but has bronchodilating properties

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22
Q

What worm infection can cause hyper infestation in immunocompromised patients?

A

Strongyloides stercoralis infects the small intestine

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23
Q

When is the risk highest for future stroke following a TIA?

A

In the first 48 hours

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24
Q

Where does unilateral facet dislocation MC occur?

A

C3-C7

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25
Q

What medication is contraindicated in a Tet spell (ToF)?

A

Isoproterenol bc it decreases pulmonary blood flow and increases R—>L shunt

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26
Q

Major effect of BB overdose?

How to tell the difference between Sotalol and Propanolol?

A

Hypoglycemia, bradycardia, HoTN

Sotalol causes QTc prolongation, Propanolol causes QRS widening

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27
Q

What to think of after AAA repair and pt presenting with GI bleed?

A

Aortaenteric fistula

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28
Q

What symptom is most consistent with foreign body lodged in the bronchus?

Vocal cords?

A

Wheezing

Stridor or hoarseness

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29
Q

What criteria indicate “severe” OM and can be given antibiotics?

A

Symptoms greater than 48 hours
Temp greater than 39C
Bilateral infection
Age < 2

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30
Q

What symptom is MC with spinal epidural abscess?

A

Back pain

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31
Q

Pt has hiccups after pacemaker placement, what could be the cause?

Eval 1st with what?

A

Lead displacement

EKG

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32
Q

What causes anterior urethral injury?

Posterior?

A

Direct perineal trauma

Pelvic fractures, MC of the ischiopubic rami

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33
Q

1 cause in primary PTX?

What else?

A

Smoking

Tall and thin, young male, Marian

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34
Q

MC lab abnormalities for Ehrlichiosis?

What is the vector?

A

Thrombocytopenia, leukopenia, transaminitis

Lone Star tick

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35
Q

Where does the SC end in an infant?

Where should LP be performed?

A

L3

L4-L5 or L5-S1

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36
Q

What toxicity mimics tetanus?

MOA?

A

Strychnine

Inhibits glycine (inhibitory nt)

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37
Q

What presents with painless loss of monocular vision, cherry red spot at macula, pale retina with edema, and afferent pupillary defect?

A

CRAO

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38
Q

What findings indicate SBO?

What about large BO?

A

Dilated bowel with prominent place circulares

Dilated bowel with prominent haustra

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39
Q

How to treat late Lyme disease?

Manifestations?

A

2g IV Ceftriaxone

Arthritis, encephalitis

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40
Q

What is a sign of advance limb ischemia?

A

Blistering skin

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41
Q

What can happen in an attempted suicide by hanging?

A

Pulmonary effects causes delayed death

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42
Q

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?

A

Diazepam (shorter half-life compared to Ativan)

Pyridoxine (AR metabolism thing)

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43
Q

What defines high-output HF?

A

Inc CO with low SVR

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44
Q

When is a G-tube tract mature?

What to do if pt presents with dislodge g-tube 1 week after placement?

A

2-3 weeks

Sx consult, consider imaging and Abx

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45
Q

What size ETT for premature neonate?

Full term (1.6 - 3kg)?

What is special about this population?

A
  1. 5 uncuffed
  2. 0 uncuffed

Only patients you use Uncuffed 1st line, other peds use cuffed

46
Q

Pt with chronic digoxin poisoning, what is the best indication for giving Digibind?

A

Bidirectional VTach

47
Q

Pt with Parkinson’s disease that has dyskinesia, treat how?

A

Benzo, it decreases involuntary muscle movements

48
Q

Pt involved in MVC and has a wedge-shaped deformity of the anterior column of L2, what injury can be missed?

Need what?

A

Burst fracture (unstable d/t retropulsion of bone fragments into spinal canal)

Spinal CT

49
Q

What is a chance fracture?

Able to see on what film?

A

Complete disruption through vertebral boy and assoc structures in horizontal plane

LATERAL film (also spinal CT)

50
Q

Proximal ulnar Fracture, what other Injury occurs and what is this called?

MC injured nerve?

A

Monteggia, PROXIMAL radial dislocation

Posterior interosseous nerve

51
Q

What is the NIH categorization for severe COVID19 disease?

Critical?

A

SpO2 = 93% on RA, RR > 30, PaO2 / FiO2 of < 300 or severe PNA

Failure, shock

52
Q

How to manage minor H2S exposure?

Severe?

A

Normal saline irrigation

Same, Decon and supportive care

53
Q

What is a normal CBD diameter size?

How does this change with age?

A

7 mm

After age 70, every 10 years increases by 1 mm

54
Q

What is the most efficient and fast way to diagnose TB?

What is the confirmatory test?

A

Interferon-gamma release assay

Sputum collection with culture

55
Q

What is 3,4-methylenedioxymethaphetamine?

A

MDMA aka Molly

56
Q

When does ASO titer peak in Grp A strep?

A

2-4 weeks will be detectable

So if question is asking about GrpA vs Mono, consider timing for which test comes +

57
Q

Where to look for central cyanosis?

A

Oral mucosa including tongue, also the conjunctiva

58
Q

What are the MC organisms that cause Acute chest syndrome in sickle cell pts?

A

Mycoplasma and Chlamydia pneumoniae

Not Strep pneum

59
Q

What is the MC cause of PNA in young children with cystic fibrosis?

A

S. Aureus

Pseudomonas is more common as patients age

60
Q

What is the treatment algorithm for acute angle glaucoma?

A

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
Q

How does biliary atresia present?

A

Jaundice after 2 weeks of age, elevated direct bilirubin, FTT, HSM, acholic stools

62
Q

How does breast milk jaundice present?

A

After the 5th day with indirect hyperbilirubinemia

63
Q

What is the median incubation period for covid19?

64
Q

What is excited delirium syndrome?

Main clinical feature?

A

Aka agitated delirium, presents w/AMS, severe excitement or aggressiveness

High tolerance to pain, tachypnea, sweating, tactile hyperthermia

65
Q

What is the MC complication in pt with LVAD?

What does the pump do?

Caused by what?

A

Suction event

Has “low-flow” alarm

Dec preload, MC d/t reduced hypovolemia but also arrhythmia

66
Q

What alarm occurs in a pump failure?

MC cause of this?

Treat how?

A

“High power”

Pump thrombosis

Heparin, but if unstable give tPA

67
Q

What is the definition of anaphylaxis?

A 
Must involve 2 systems: 
ENT - swelling of lips, throat, tongue
CV - tachycardia, HoTN
Resp - SOB, wheezing, cough
Skin - rash, hives, itchiness
68
Q

What presentation of HSV indicates immunocompromised state?

A

Involvement of 3 or more dermatomes aka disseminated zoster

Consider HIV/AIDS

69
Q

Pt with LVAD what is the MC site of infection? #2?

Infection occurs MC when?

A

Driveline #1, then pump pocket

2 weeks to 2 months

70
Q

What is the MC non-device related complication in LVAD?

Why?

A

Bleeding

Usually on Warfarin and stress on blood through device causes acquired vWF deficiency

71
Q

What is acute cerebellar ataxia?

A

Postinfectious condition that occurs 2 weeks after viral illness, MC in kids < 6 y/o

72
Q

What role do PPIs play in GI bleeds from PUD?

A

Decreases rate of rebleeding, LOS, transfusion requirements, likelihood of endoscopic interventions

73
Q

Pt presents with clogged G tube, 1st step?

Next?

Then what?

A

Milk the tube backward

Irrigate with high pressure

Get contrast film study if that worked

74
Q

Describe progression of a stye

A

1st comes a stye (Hordeolum) THEN comes Chalazion

Treat with warm compresses

75
Q

What causes tick-borne relapsing fever?

Transmitted by what?

A

Spirochete —> borrelia hermsii

Ornithodoros ticks

76
Q

What is the management of acute central venous thrombosis?

A

Anticoagulation —> heparin

NOT endovascular intervention

77
Q

What facial bone has the lowest rate of infection?

Why?

A

Zygomatic

Not close to the sinuses

78
Q

Adult with epiglottitis, what RF inc chance of intubation?

A

Stridor or drooling
rapid onset of symptoms
Hx of diabetes

79
Q

What the MC RF for PRES?

A

Immunosuppression (esp medications like cyclosporine)
HTN
CKD
Pregnancy

80
Q

How does CO effect cerebral vasculature?

A

Hypocarbia causes cerebral vasoconstriction —> can lead to syncope

Ie in hyperventilation 2/2 anxiety

81
Q

What is the MC complication from peritoneal dialysis?

Dx how?

Treat how?

A

Peritonitis

Dialysis fluid with > 100 wbcs and 50% neutrophils

1st Gen Cephalosporin or Vancomycin INTRAPERITONEALLY

82
Q

What is criteria for hospital admission in young healthy pt with dx of pericarditis?

What else can you admit on?

A

Fever (d/t suspicion of bacterial cause)

Effusion > 2cm, hx of anticoagulant use

83
Q

What best estimates BP in LVAD pts?

How to measure this?

A

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
Q

What to prone patients with ARDS?

A

PF < 150 based on the PROSEVA trial demonstrated NNT 6

85
Q

MC cause of polymorphic VT?

Monomorphic?

A

Myocardial ischemia

Re-entrant mechanism through scarred myocardium

86
Q

How to manage asymptomatic child with button battery in the stomach?

A

Discharge home with outpatient follow up

87
Q

How does varicella PNA present?

Treat how?

A

Vesicular lesions with bilateral interstitial pattern on CXR

IV acyclovir (if patient pregnant or needs admission)

88
Q

Lindane SE?

A

Seizures, CNS effects, can cause death

89
Q

What finding is most suggestive of myocarditis?

A

Tachycardia out of proportion to fever

90
Q

What condition indicates a need for LVAD?

What must be present to be eligible?

A

End-stage CHF

Functioning RV aka cannot have Bi-ventricular HF

91
Q

When to give 50 mcg of RhoGAM and when to give 300?

A

Less than 12 weeks, give 50

Greater than 12 weeks, give 300

92
Q

What bone is fracture in all Le Fort fractures?

A

Pterygoid plate

93
Q

What are the RF for endometrial cancer?

A

Obesity
Nullparity
Anovulatory cycles
Late menopause

94
Q

What type of blood should a man receive that does not know his blood type?

A

O+

Save the O- for women

95
Q

How common is hematuria in renal stone?

96
Q

Where are the 3 locations kidney stones get stuck?

A

UPJ
Pelvic rim
UV junction

97
Q

How does TTP present on blood smear?

A

Schistocytes

98
Q

What is pseudocyanosis?

Found in what conditions?

A

Abnormal skin pigmentation

Hemochromatosis and other heavy metals

99
Q

What is the algorithm for difficulty passing catheter in old male?
Start to finish (4 steps)

A

1 - try 14 Fr
2 - coude
3 - Urology consult
4 - if not available, suprapubic tube

100
Q

How to calculate free water deficit?

A

.6 x kg x [(current Na / 140) -1 ]

For female the multiplier is .5

101
Q

When to use Nimbex in ARDS?

What evidence?

A

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
Q

Why prescribe valcyclovir over acyclovir?

A

Valcyclovir only has to be given bid, acyclovir is 5x/day

103
Q

MC cause of DIC?

104
Q

What is zoledronic acid?

Treats what?

A

Bisphosphonate

Hypercalcemia

105
Q

What is the target UO for pt with Rhabdo?

A

3 cc/kg/hr or 200 cc/hr

106
Q

What is the cyanotic hyperoxia test?

Indicates what?

A

ABG while on supplemental O2 with PaO2 less than 100 and failure to rise more than 20 after applying O2

congenital heart disease

107
Q

What kind of snake causes fang marks, localized swelling and dec Plt, dec fibrinogen?

A

Rattlesnake

108
Q

What symptoms do coral snake bites cause?

A

Neurotoxic - respiratory failure

Small fangs, no big bite marks

109
Q

What is an unexpected lab finding in Kawasaki disease?

A

Wbc in UA, sterile pyruia

Plt will be high in first 7 days

110
Q

What causes peripheral cyanosis?

A

Low CO states i.e. Dilated cardiomyopathy
Environmental exposure to cold with vasoconstriction
Arterial or venous occlusion
Redistribution of blood flow

111
Q

What PaCO2 level triggers SIRS criteria?

A - Peer 9 Boards (1 decks)

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