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A - Rosh Review Boards > Missed Questions > Flashcards

Missed Questions Flashcards

1
Q

Pt that has metabolic acidosis should be treated with sodium bicarbonate in what conditions?

A

pH < 7.1

AKI

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2
Q

How long must a tick bite be attached for transmission to occur?

When should you give post-exposure prophylaxis?

A

48 hours

Tick attached > 36 hours, local infection rate > 20%

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3
Q

Infant with fever and 1st UTI should undergo what?

A

Renal and bladder US

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4
Q

What causes a jersey finger?

Presents how?

A

Rupture of flexor digitorum profundus tendon

CANNOT flex the DIP joint

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5
Q

LBBB, look at what leads and for what?

A

Lead I —> Large R wave

Lead V1 —> Large QS or rS

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6
Q

What is the treatment goal of a hyphema (blood in anterior chamber)?

What complications?

A

Further hemorrhage

Within first 72 hours

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7
Q

What is included in Ranson’s criteria?

A 
Age > 55
Glucose > 200
Wbc > 16k
AST > 250
LDH > 350
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8
Q

GCS scoring system?

A

Eye - 4
Verbal - 5
Motor - 6

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9
Q

What medication is used to trap ASA in the urine and enhance elimination?

A

Sodium bicarbonate

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10
Q

What is a raised, boggy lesion with heaped up purulent nodules on the head of a black kid w/pmhx of tinea capitis?

Treat how?

A

Kerion

Oral griseofulvin

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11
Q

Where to perform thoracentesis?

A

Midscapular line, never below 8th posterior ICS, at least 1 interspace below top of effusion

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12
Q

Old Pt with a blood glucose of 750, normal pH and no AG that becomes weak, what is that most likely cause?

A

Infection

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13
Q

What generation is cefoxitin?

What else is in this gen?

Used to treat what?

A

2nd

Cefotetan

Acute appy

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14
Q

How do you rule of popliteal a injury after patella dislocation?

A

Serial PE, ABI, CTA, duplex US

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15
Q

What is a Mallet Finger deformity?

If not treated right, what is a complication?

A

Forced DIP into flexion
CANNOT extend

Swan neck deformity

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16
Q

What metabolic disturbance is commonly seen with targeted temperature management?

A

Hyperglycemia

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17
Q

What size ET should be used for intubation in massive hemoptysis?

A

8.0 to facilitate bronchoscopy

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18
Q

What medication can worsen uterine atony?

What is the treatment?

A

Magnesium bc it causes smooth muscle relaxation

Manual massage, oxytocin, PGs

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19
Q

What is omphalitis?

Can lead to what?

A

Infection of the umbilical stump

Nec Fasc

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20
Q

Level 1-3 billing requires how many ROS?

Level 4? How many PE?

Level 5? PE?

A

0, 1, 1

2, 5

10, 8

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21
Q

What is excluded from critical care time for billing purposes?

A

Insertion of a central line

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22
Q

What is the delayed sequalle that can occur after child ingestion of iron tablets?

Occurs when?

A

Gastric outlet obstruction

2-4 weeks

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23
Q

What random medication for AFib can cause epididymitis?

A

Amiodarone

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24
Q

What are the 3 leading causes of sbo?

A

adhesions
Adenocarcinoma
Hernia

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25
Q

Management of avulsed permanent tooth?

A

Rinse with NS
If extra-oral time < 60 minutes rinse and Reimplant

If extra-oral time > 60min soak in critic acid/fluoride and consult oral surgeon

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26
Q

Clonus is only seen in what Syndrome?

A

Serotonin syndrome

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27
Q

What test to order for knee dislocation?

A

CTA of LE

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28
Q

In adults, what is the MC location for foreign bodies to lodge?

A

Proximal airway - larynx, trachea, main bronchi

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29
Q

What is the parkland formula for Peds pts?

A

3mL of LR x kg x % body surface area

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30
Q

MC cause of Ludwig’s angina?

What is Ludwig’s?

A

Dental abscess that spreads into the soft tissue submental, sublingual, and submandibular spaces.

Cellulitis of the submandibular and sublingual spaces w/associated tongue elevation

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31
Q

Patient that has an anterior and posterior fat pad sign on Xray has what?

What kind of injury is common?

A

Radial head fracture

FOOSH

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32
Q

IV magnesium toxicity causes what?

A

Hyporeflexia

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33
Q

Sickle cell pt presenting w/signs and sx of acute ischemic stroke should be treated how?

A

Exchange transfusion

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34
Q

What scoring system is used to classify severity of SAH?

A

Hunt and Hess

Grade 1-5

5 is v bad, only 10% survival

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35
Q

Isolated CN 3 palsy with NO pupil involvement means what?

A

Diabetic CN mononeuropathy (down and out eye)

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36
Q

What medication is used to reduce the vasospasm that occurs w/SAH?

MOA?

A

Nimodipine

CCB

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37
Q

What is a consequence of halogenated hydrocarbon inhalation (like spray cans from computes)?

A

Cardiac dysrhythmia

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38
Q

What are the 4 Ts which cause PPH?

A

Tone
Trauma
Tissue
Thrombin

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39
Q

What is Lemierre’s disease?

A

Septic thrombophlebitis of IJV caused by fusobacterium necrophorum

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40
Q

What kind of Salter-Harris fracture is only through the metaphysis?

A

Type 2 “above the growth plate”

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41
Q

What is the most reliable sign of uterine rupture?

A

Nonreassuring fetal HR

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42
Q

Formula for cuffed ETT size?

A

Age/4 + 3.5

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43
Q

What vascular structure is at risk of injury w/proximal fibular fracture?

A

Anterior tibial artery

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44
Q

How to make D5W aka 5% dextrose?

A

100mL of 50% dextrose to a 1 L bag of NS

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45
Q

What is scleroderma renal crisis?

Treatment?

A

Can cause Raynaud, can cause kidney failure, HTN, hyperK+, and very high BUN and Cr

Captopril (best ACE for preserving renal function)

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46
Q

When does gynococcal eye infection occur in newborns?

Chlamydia trachomatis?

A

Days 2-4

Later —> days 5-14

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47
Q

What is an amp of D50?

50% dextrose means what?

A

25 grams of dextrose (100 cals)

50 grams in 100 mL

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48
Q

Describe a brown recluse spider bite

A

PAINLESS

Causes local tissue destruction via cytotoxin

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49
Q

Children with croup should be admitted when?

A

Persistent stridor at rest, retractions, tachypnea, hypoxia or require > 2 nebulized racemic Epi at rest

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50
Q

What tendons are effected in de Quervain’s tenosynovitis?

A

APL and EPB

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51
Q

ASD MC PE findings?

Pathophys?

A

Wide, fixed split S2

Persistent ostium secundum (incomplete adhesion bw FO flap and septum secundum)

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52
Q

Overdose of which NSAID is associated with seizure activity?

A

Mefenamic acid

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53
Q

Pt with anticholinergic toxicity can show what EKG changes?

Treat how?

A

QRS widening

Sodium bicarbonate

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54
Q

What foods can cause CN poisoning?

A

Prunus species - Apricot, bitter almond, cherry and peach

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55
Q

Pt with a 3cm linear forehead laceration and a CT that shows a non-depressed skull fracture means he has what?

Treat how?

A

OPEN skull fracture

Admit for observation and consult Neuro
Will need to give ABx

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56
Q

Burns of what category are included in the parkland formula?

A

Anything involving the dermis including anything with “superficial partial-thickness”

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57
Q

What is the MC cause of myocarditis in the U.S.?

Can be accompanied by what

A

Parvovirus B19

Pericarditis

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58
Q

What is it called when you have an inflammatory reaction which results from the aspiration of gastric acid fluid from the stomach?

A

Aspiration pneumonitis

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59
Q

What are the symptoms of primary adrenal insufficiency?

What lab findings?

Also called what?

A

Weakness, fatigue, weight loss, anorexia, orthostasis

Dec in cortisol, hyperkalemia, hyponatremia

Addison’s

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60
Q

What is the MC complication of diverticulitis?

A

Abscess

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61
Q

What is edrophonium?

Used to treat what?

A

short acting AchE inhibitor that increases ACh at the NMJ

M.G.

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62
Q

What O2 sat warrants hospitalization in bronchiolitis?

A

< 95% on RA

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63
Q

How to tell if a pt has ARDS with only using ABG?

Peak pressure must be < what?

A

PaO2 : FiO2 < 200
Calculate by PaO2 / FiO2 (convert to decimal for FiO2)

< 30

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64
Q

How to treat cocaine OD?

A

Benzo and phentolamine

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65
Q

Cushing reflex is in response to what?

Is done to try and do what?

A

Inc ICP

Maintain CPP

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66
Q

Pt who swallows cocaine packets but VS normal and nontender abdomen, what is the management?

A

Whole bowel irrigation w/polyethylene glycol —> speeds GI passage of the packets

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67
Q

What is the MC surgical emergency in pregnant pts?

A

Appendicitis

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68
Q

Isolated non-displaced sternal fractures are associated with what?

A

Low mortality rates

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69
Q

What bone is MC fractured in a basilar skull fracture?

A

Temporal

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70
Q

Which side of the valve is the vegetation typically located in IE?

A

Superior

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71
Q

Which direction is antidromic?

Describe the morphology

A

Counter-Clockwise

Large QRS complexes that look like candles

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72
Q

What is the goal urine output in pts w/significant thermal burns?

A

.5-1 mL/kg

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73
Q

What is the SF syncope rule?

A 
CHESS
CHF
Hct < 30
EKG abnormal
Systolic BP < 90
SOB
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74
Q

Pt that drank a lot and is in alcoholic ketoacidosis, what is the treatment?

When do you add bicarbonate?

A

5% dextrose in NS

pH < 7.1

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75
Q

Which kind of bronchoscopy should be used to remove a foreign body?

A

Rigid

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76
Q

What are the 5 components of Ranson’s criteria?

A

WAAGL

wbc
Age
AST
Glucose
LDH
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77
Q

What defines neutropenic fever?

A

Single oral temp >/= 101F
OR
Oral temp >/= 100.4 sustained for > 1 hour

ANC < 1500

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78
Q

What does the rectal exam reveal in a newborn with Hirschsprung disease?

A

Increased rectal tone or rectal squirt

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79
Q

Pregnant pts, hx of OCPs, post-op, or hypercoaguable pt c/o ha or ams has what?

What sign?

A

Central venous thrombosis

Delta sign. (Non-Con) or Empty delta sign (Con CT)

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80
Q

Peds pt initial crystalloid Bolus is what dose? 2nd dose?

If pt is hypotensive do what next?

A

20 mL/kg
Repeat dose

10 mL/kg

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81
Q

What is the limbus of the eye?

A

The part of the anterior eye between the sclera and cornea

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82
Q

MOA of sumitriptan?

Avoid in pts with what?

A

Vasoconstriction through vasoactive peptides

Uncontrolled HTN, ischemic stroke, CAD, vasospastic angina

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83
Q

Bell’s palsy + facial varicella zoster infection = ?

A

Ramsay-Hunt syndrome

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84
Q

What causes Gamekeeper’s thumb?

Will have what PE findings?

Treat how?

A

injury to UCL of thumb

Weak pincer grasp

Thumb spica splint

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85
Q

MOA of Clonidine?

Effects?

A

Alpha 2 agonist that binds presynaptic catecholamines receptors —> results in transient HTN

OD you see pinpoint pupils

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86
Q

How to treat Red Man syndrome d/t Vancomycin reaction?

A

Stop infusion and give Benadryl

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87
Q

Common SE of desmopressin?

How to prevent/treat?

A

Hyponatremia

Fluid restriction

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88
Q

What are the 2 MC sites of blunt aortic injury?

A

Aortic isthmus

Ascending aorta proximal to origin of brachiocephalic vessels

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89
Q

What sx occurs with nitrogen narcosis?

Occurs when?

A

AMS

Deep dives during descent

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90
Q

What is normal vaginal pH?

pH of what indicates amniotic fluid?
What is this test called?

A

3.5-6

> 6.5
Nitrazine test, should see ferning

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91
Q

MC location of extrapulmonary TB?

A

LNs

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92
Q

Which type of malaria has undulating fevers?

A

Vivax and ovale

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93
Q

What CXR finding leads you to dx Klebsiella PNA?

How to treat?

A

Infiltrate in the upper lobes (MC the Right) w/bulging fissure

3rd gen cephalosporin and aminoglycoside

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94
Q

What is the best screening tool for epidural abscess?

Treat how? To cover what?

A

ESR and CRP

Van/Ceftriaxone to cover MRSA and Pseudomonas

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95
Q

What pediatric PNA causes a “shaggy” right heart border?

A

Pertussis PNA

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96
Q

Diver that comes up and then has MI like symptoms has what?

Exhibits what on EKG?

A

Arterial gas embolism

Anatomic ST elevation

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97
Q

What kind of child presents w/bacterial tracheitis?

A

3-8 y/o, uri prodrome that intensifies quickly

MC d/t S. Aureus

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98
Q

Auricular hematoma aka cauliflower ear is treated how?

A

I + D with pressure dressing

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99
Q

What are Cerebral T waves?

Indicate what?

A

Deep, inverted T waves in V3, V4

Common following Left Frontal hemorrhage

Increased ICP

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100
Q

What Abx to give for upper GI bleed 2/2 to variceal bleeding?

A

Ceftriaxone 1 g/day
OR
Ciprofloxacin 400mg bid

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101
Q

What is the MC complication of VP shunt?

Pts with this are at risk of what?

A

Overdrainage of CSF

Risk of developing subdural hematoma d/t higher risk of tearing bridging veins

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102
Q

What is the MC type of elbow dislocation?

Most serious complication?

A

Posterior

Brachial artery injury

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103
Q

Diff bw dislocated patella vs dislocated knee?

A

Patella dislocation is only the knee CAP

Knee dislocation is when femur and tibia out of place

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104
Q

What tachydysrhythmia has a regular rhythm?

A

Atrial flutter

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105
Q

What type of malformation is located laterally, anterior to the border of the SCM, near the angle of the mandible?

A

Branchial cleft cyst

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106
Q

What is the difference between breast milk and breastfeeding jaundice?

A

Breastfeeding jaundice means kids do NOT gain weight correctly, have weight loss and nutritional deficiency

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107
Q

MOA of TCA?

What other effects do they have?

A

Fast inward Na channel blockade

anti-ACh effects

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108
Q

What symptoms seen in VP shunt obstruction?

A

Bulging fontanelle, sundown eyes (pt cannot look up), HA, nausea

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109
Q

Class III hemorrhage has how much blood loss?

How do you know it is class 3?

A

30-40%

Significant tachycardia w/HoTN
Pt could be lethargic

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110
Q

What asthma med is contraindicated in pregnancy?

What mechanism?

A

Epi is teratogenic w/in the 1st trimester of pregnancy

Uterine vasoconstriction and reduced fetal oxygenation

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111
Q

What is the MC finding in children under < 5 y/o that presents to the ED for acute appendicitis?

A

Rebound tenderness

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112
Q

What lab values are elevated in Ehrlichiosis?

A

Elevated transaminases, LDH, ALP
Leukopenia
Thrombocytopenia

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113
Q

When is a pelvic binder used?

A

Reduce venous bleeding d/t SI disruption in open-book pelvic injuries

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114
Q

Hemophilia B is deficiency of what factor?

Head trauma needs to be treated how?

A

9

100IU/kg bc delayed bleeding is COMMON

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115
Q

When do you need emergent hemodialysis for hypercalcemia?

What is the main tx?

A

> 18 or neurologic symptoms

IVF

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116
Q

How to tell the difference between VP shunt overdrainage vs obstruction?

A

Shunt overdrainage headaches will come and go

obstruction HA’s are CONSTANT

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117
Q

How do you treat TIA?

A

ASA alone or + dipyridamole

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118
Q

What lab value to diagnose acute parotitis?

A

Amylase

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119
Q

What confirms compartment syndrome?

A

Delta pressure = 30 mmHg

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120
Q

What serum salicylate level is an indication for hemodialysis in the acute setting?

What is considered a toxic dose of ASA?

A

> 100 mg/dL

200-300 mg/kg

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121
Q

What kind of injury is a tertiary blast injury?

Typical characteristics?

A

Blast wave propels body into objects or large objects strike body

Crush and blunt trauma

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122
Q

Far lateral unilateral disc herniation bw L4 and L5 compresses which nerve root?

A

L4

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123
Q

Le Fort Fracture pattern mnemonic?

A

1 - Speak no evil - base of maxilla, teeth can move but not nose
2 - See no evil - freely movable midface including nose
3 - Hear no evil - complete craniofacial dissociation, face freely movable

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124
Q

What is the initial pediatric defibrillation dose?

A

2-4 Joules/Kg

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125
Q

Pts who are hemodynamically unstable that need cardiac pacing, what ampage should be set?

A

80 mA (the max)

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126
Q

What uncommon fracture indicates high-velocity or abuse?

A

Scapular

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127
Q

What are the early signs of acetaminophen OD?

A

Malaise, anorexia, nausea

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128
Q

What kind of organism is haemophilus ducreyi?

A

G (-) coccobacillus

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129
Q

What is another name for Kawasaki disease?

A

Mucocutaneous LN syndrome

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130
Q

What COHb level indicates Hyperbaric O2 therapy d/t CO poisoning regardless of sx?

In pregnant pt?

A

> 25%

> 15%

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131
Q

What meds to use to lower BP in aortic dissection?

If asymmetric BPs, what artery is involved?

A

Esmolol + sodium nitroprusside

Subclavian artery

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132
Q

1st step in a pt w/trach bleed?

A

Overinflation of the trach cuff

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133
Q

Pt with active ACS (STEMI or NSTEMI) should be given what other than ASA?

MOA?

A

Ticagrelor 180mg PO

P2Y12 antagonist

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134
Q

What is a contraindication to using methotrexate in treating ectopic pregnancy?

How big must the pregnancy be to exclude its use?

A

Liver disease

> 4cm

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135
Q

What sign seen on xray indicates radial head fracture?

A

Posterior fat pad

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136
Q

Pt with stable M.G. Exacerbation, what is the 1st step?

A

Measure negative inspiratory force

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137
Q

DOPE mnemonic for a pt on vent with inadequate o2?

A

Displacement
Obstruction
Pneumothorax
Equipment

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138
Q

When to do lateral canthotomy in orbital cellulitis?

A

Dec visual acuity
IOP > 40
Significant proptosis

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139
Q

What medicine should be used pre-treatment in RSI for pt w/increased ICP?

A

Fentanyl - turns down the increase in BP

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140
Q

When do you hold warfarin for a pt?

When do you give Vit K?

A

INR > 5 but < 10

> 9 and no significant bleeding

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141
Q

What can be used in OD of phenytoin?

A

Multiple dose activated charcoal can minimized delayed absorption of the drug

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142
Q

What carpal bone is MC dislocated?

A

Lunate

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143
Q

How to evaluate for open knee joint?

A

Normal saline joint injection

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144
Q

What maneuvers make the click in MVP go later?

Mechanism?

A

Squatting - inc preload

Handgrip - inc afterload

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145
Q

Hangman fracture is what anatomically?

A

B/l fracture of the pars interarticularis (aka pedicle) at C2

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146
Q

What is dextromethorphan MOA? Known as what?

OD Sx?

A

NMDA receptor antagonist, cough syrup

Visual hallucinations, slurred speech, nystagmus, tachycardia

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147
Q

What drugs can be given via ET tube in adults?

Kids?

A

NAVEL

LANE (no vasopressin)

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148
Q

What OD causes dilated pupils, tachycardia, dry, hot, urinary retention?

What kind of nt blockade?

A

TCA

Anticholinergic

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149
Q

Pt w/penetrating trauma that loses pulse in transport or in the ED, what should you do?

Where should incision be made into pericardium?

A

Resuscitative thoracotomy

At the apex, near the diaphragm anterior and parallel to the left phrenic nerve

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150
Q

What is lye?

What happens if you ingest it?

A

Alkaline material

Need upper endoscopy w/in 12-24 hours

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151
Q

What is the goal PaCO2 after ROSC?

Goal Temp?

Serum glucose?

A

40-45

32-36 C

108-140

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152
Q

What is the antidote for digoxin OD in a pt in Vfib?

Digoxin is derived from what plant?

A

20 vials of digoxin-specific Ab

Foxglove

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153
Q

Toddler (age 3) with an isolated spiral fracture needs what treatment?

A

Long leg cast

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154
Q

What is Mackler TRIAD?

Seen in what?

A

Lower chest pain, vomiting, subQ emphysema

Boerhaave’s syndrome

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155
Q

What are the indications for emergent hemodialysis after acute ethylene glycol OD?

A

Ethylene glycol > 50 mg/dL
AG > 20
Initial pH < 7.3
Glycolic acid > 8 mmol/L

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156
Q

Febrile seizure seen in what child ages?

A

6 months to < 5 years

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157
Q

What kind of eye infection causes fluffy white perivascular lesions on fundoscopic exam?

A

CMV retinitis

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158
Q

Pediatric female pt that is presenting with fever and vomiting only what is the most likely diagnosis?

Treat how?

A

UTI

Cefixime (3rd gen)

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159
Q

What type of mask should a PATIENT with TB wear during transport?

A

Surgical mask

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160
Q

Child with AMS d/t lead toxicity in the blood should be treated how?

A

Whole bowel irrigation if paint chis in the GI tract

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161
Q

How does NAC work?

A

It is a glutathione precursor or substitute, a sulfate precursor, and prevents binding of NAPQI to hepatocytes

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162
Q

What is a Jones fracture in the foot?

Located where?

A

Transverse fracture at the base of the 5th metatarsal

1.5-3cm distal to the proximal tuberosity at the metadiaphyseal junction

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163
Q

What Carboxyhemoglobin level is in an indication for Hyperbaric O2 therapy d/t CO poisoning?

In pregnancy?

A

> 25%

> 15% in pregnancy

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164
Q

Femoral hernia occurs where?

A

Internal inguinal ring

Below inguinal ligament and medial to femoral artery

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165
Q

Young pt with AS, what is the treatment?

A

Balloon valvuloplasty

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166
Q

Isopropyl alcohol is converted into what by alcohol dehydrogenase?

What does the ABG look like?

A

Acetone (ketone)

No AG, normal pH

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167
Q

What nerve is responsible for photophobia?

A

V1

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168
Q

How is secondary syphilis treated?

What about early latent (< 1 year)?

A

SINGLE injection of benzathine penicillin G

Same

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169
Q

What mechanism do CCBs and BBs work by on the cardiac myocytes?

A

AV nodal blockade

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170
Q

What PE findings for Ludwig angina?

A

Brawny neck edema, submandibular swelling, elevation of the tongue secondary to edema of floor of the mouth

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171
Q

What is a layering of wbc in the anterior chamber called?

Seen in what?

Normally bc of what?

A

Hypopyon

Endophthalmitis

Post cataracts complication

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172
Q

What is the famous symptom of digoxin toxicity?

Chronic symptom?

Treatment?

A

Yellow color, halos and spots in their vision

Ventricular dysrhythmias

Dig Fab fragments

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173
Q

Pt with a bleeding peptic ulcer will have what abnormal lab value?

A

Elevated BUN

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174
Q

Pt with arm stuck in the “up” position has what?

Usually from what?

What complications?

A

Luxatio erecta aka inferior shoulder dislocation

Axial load injury like swimming

Auxiliary nerve and artery injury

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175
Q

What causes a beefy red ulcer that is painless in the genital area commonly in Africa and India?

Treat how?

A

Donovanosis aka granuloma inguinale

Azithro, doxy, Cipro

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176
Q

What shoulder technique is no longer recommended?

Why?

A

Hippocractic technique

Auxiliary nerve injury risk

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177
Q

Aortic dissection, what it the BP goal?

What meds to treat?

A

100-120 systolic

Esmolol or labetalol with nitroprusside

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178
Q

Painless nodular mass on testicle most likely what?

A

Cancer

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179
Q

What viral infection is commonly associated with Intussusception?

A

Adenovirus

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180
Q

What is Zanamivir?

SEs?

A

Inhalation neuraminidase inhibitor used to treat flu or as prophlylaxis

Wheezing, bronchospasm

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181
Q

What causes painless genital ulcer w/suppurative tender LAD?

A

Chlamydia trachomatis LGV serotype

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182
Q

What is sick sinus syndrome aka?

Pathophys?

A

Tachycardia-bradycardia syndrome

Injured SA and AV nodes

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183
Q

What causes facial flushing, HA, ABD cramping, diarrhea after eating at seafood restaurant w/peppery taste?

A

Scombroid fish poisoning (histidine metabolized into histamine)

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184
Q

How many stages of shock are there?

Which stages require fluid replacement and with what?

What is the highest HR for the two highest classes?

A

4

1,2 - crystalloid
3, 4 - crystalloid and blood

3 - greater than 120
4 - greater than 140

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185
Q

What is the MC salter-Harris fracture?

Which requires surgery?

A

II

IV/V

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186
Q

Pt that gets angioedema to ASA and having a STEMI, what do you give them?

A

Clopidogrel

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187
Q

Pt with blunt injury to the chest, like hitting steering wheel in MVC, what do you do to diagnose?

SCD caused by dysrhythmia in this nature called what?

A

EKG, troponin

Commotio cordis

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188
Q

AMS ddx?

A 
AEIOU TIPS
Acidosis, electrolyte, infection, opiates/OD, uremia
Trauma
Insulin
Poison/psych/pharm
Stroke, Seizure, syncope
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189
Q

What strange way can AFib present on EKG?

A

No P waves, uncoordinated atrial activity

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190
Q

What iron level requires Deferoxamine no matter what?

SE of the drug?

A

> 500 mcg/dL

HoTN

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191
Q

Rheumatic fever is what type of reaction?

Forms what kind of rash?

A

Type 2 hypersensitivity from cross-reactivity of Abs to M protein Ags

Erythema marginatum (evanescent rash w/ring margin)

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192
Q

How to assess a pt’s level of consciousness if they are altered?

A

Tickle posterior nasopharynx w/cotton swab

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193
Q

Pt with suspected rhabdomyolysis, what is the concern?

What must you get?

A

Hyperkalemia

EKG

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194
Q

What is the first thing affected by Necrotizing OE?

What symptoms?

A

CN 7

trismus

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195
Q

Arthritic pain, abdominal pain, low grade fever, hematuria, and rash indicates what in kids?

What intestinal disorder found with this disease?

A

HSP

Intussusception

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196
Q

MC posterior nasal bleed location?

Why do they need to be admitted?

A

Sphenopalatine ganglion

Post packing causes vagaries stimulation —> can lead to bradycardia, bronchoconstriction, need tele

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197
Q

What area of the heart sits most anteriorly in the chest and is most prone to knife wound injury?

A

RV

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198
Q

What type of odontoid fracture is considered stable?

Risk of type 2 fracture?

A

Type 1

Nonunion

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199
Q

What is De Winter syndrome?

A

STEMI

Tall T waves in precoridal leads, upsloping ST depression > 1 mm at the J point

ST elevation of .5-1mm in aVR

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200
Q

Treatment for spontaneous pneumomediastinum in a pt that is hemodynamically stable?

Gold standard diagnostic test?

A

Discharge w/close follow up

CT

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201
Q

What is accelerated idioventricular rhythm?

Different than what?

Caused by what?

A

Slow (50–75) ventricular rhythm

VTach bc VTach is FAST, > 120 bpm

Myocardial reperfusion

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202
Q

What is the treatment for uremic pericarditis?

A

Hemodialysis

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203
Q

Pt with pertussis, where can you obtain a sample for test?

A

Nasopharynx

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204
Q

What is Ludwig’s angina?

Associate with what?

A

B/l cellulitis, abscess formation or both

Acute airway obstruction

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205
Q

What penile pH level indicates an ischemic priapism?

What is the initial treatment?

A

pH < 7.25

Intracavernosal phenylephrine then Cavernosal aspiration

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206
Q

What is the formula for the age-based max HR d/t sinus tachycardia?

A

220 - age

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207
Q

What describes a skin patch?

A

Flat, nonpalpable, circumscribed lesion > 5mm in diameter

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208
Q

What level of lead poisoning gets dimercaperol chelation therapy regardless if they have sx or not?

Contraindication?

A

BLL > 70 microgram/dL

Peanut allergy

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209
Q

When is cricothyrotomy contraindicated?

What to do instead?

A

Children under 10

Needle cricothyrotomy with 12 or 14 guage angiocatheter

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210
Q

What are definitive signs of Methemoglobinemia?

A

Periroal cyanosis that does not resolve with 100% O2

Dark chocolate blood that does not become red after exposure to air

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211
Q

How to diagnose West Nile encephalitis?

A

Leukopenia with pronounced lymphopenia

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212
Q

Methemoglobinemia can occur when working around what?

Treatment?

A

Silo filler’s disease —> Nitrogen oxides

Methylene blue

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213
Q

How soon do you need to give Rhogam?

How much?

A

Within 72 hours

50 mcg minimum

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214
Q

What are the 2 types of Welles’s syndrome?

Specific for what?

A

A - biphasic T wave
B - deeply inverted T wave

critical stenosis of LAD

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215
Q

How do you determine if a laceration over the knee joint is considered open?

A

Inject saline into the knee joint , 200cc

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216
Q

Pts with DiGeorge Syndrome can have what other major defect?

May present how?

A

Truncus arteriosus —> causes cyanosis and CHF

Seizures

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217
Q

What is the Rhogam dose in a pt > 12 weeks?

Before 12 weeks?

A

300 micrograms

50 micrograms

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218
Q

What is the lowest to highest level of EMS training?

Which level can start IVs?

A

EMR < EMT < Advanced EMT < Paramedic

Advanced EMT and higher

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219
Q

What D50 made of?

A

50g glucose in 100 mL saline

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220
Q

TCA overdose shows what on EKG?

A

Wide QRS

Terminal R wave in lead aVR (> 3mm)

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221
Q

Pt with food Bolus that is tolerating secretions, what is the next step in management?

A

IV glucagon

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222
Q

Proper dose of Epi during cardiac arrest?

A

1mg aka 10 mL of 1:10,000

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223
Q

What anti-seizure med is contraindicated in pts with sinus brady, SA block, 2nd and 3rd degree Heart blocks and Adams-Stokes syndrome?

Why?

A

Phenytoin

Prolongs effective refractory period

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224
Q

What temperature should frostbite rewarming occur at?

Takes how long?

A

37-39 degrees C

15-30 minutes

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225
Q

How to cut thrombosed hemorrhoid?

A

Elevate overlying skin, make an elliptical incision

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226
Q

What is a Galeazzi fracture?

A

Distal radius fracture
Distal Radioulnar joint dislocation

“MU GR”

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227
Q

CXR which shows b/l pulmonary edema without evidence of cardiomegaly indicates what?

A

ARDS

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228
Q

What is it called when an adverse event leads to serious poor outcomes or death?

A

Sentinel event

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229
Q

What test has highest sensitivity to exclude PE?

A

Normal VQ scan

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230
Q

What fracture is pathognomonic for abuse?

A

Metaphysis fractures

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231
Q

What is the MC finding in a pt w/acute aortic dissection?

A

HTN

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232
Q

How can you decrease peak pressures in an intubated asthma pt?

A

Use a larger ET tube

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233
Q

Describe complex seizure

A

< 6mo or > 5 years
> 15 minutes
FOCAL

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234
Q

What is true about a Miller blade compared to a MAC blade?

A

Carries a higher risk of stimulating an airway reflex than a MAC

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235
Q

Pt with multiple miscarriages and chronic arthralgia has what?

What other sx is common?

A

SLE

Photosensitivity

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236
Q

What PO Abx to treat lung abscess?

What IV meds?

A

Clindamycin

Unasyn, carbapenem

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237
Q

Consensual photophobia indicates what?

Treat how?

A

Iritis

Cycloplegic —> homatropine

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238
Q

MC location for AAA?

A

Infarenal

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239
Q

What are the Hunter criteria?

A

Used for diagnosis of serotonin syndrome

240
Q

What are the # 1, 2, MC causes of SJS in children?

A

1 - meds

2 - mycoplasma pneumoniae

241
Q

What vessel of the heart covers the septal area?

What leads?

242
Q

What is an Ellis II fracture?

Treat how?

A

Enamel + dentin

Calcium hydroxide paste

243
Q

Pt w/VP shunt that is getting headaches, blurry vision, and nausea intermittently has what?

Caused by what?

A

Slit ventricle syndrome

Shunt overdrainage

244
Q

What is the MC cause of mastoiditis?

A

Strep pneumo

245
Q

What is Cushing response?

A

bradycardia, HTN, dec RR

246
Q

If you cannot give NSAIDs to a pt with gout and chronic renal insufficiency, what can you give?

A

Prednisone

247
Q

What is a pathognomonic finding for SAH on physical exam?

What drug can be used to decrease vasospasm?

A

Retinal subhyaloid hemorrhage (11-33% of cases)

Nimodipine

248
Q

What is the genetic makeup of partial moles?

249
Q

What is anticonvulsant hypersensitivity syndrome?

What happens initially?

A

DRESS

Spares mucous membranes and rash starts 1-2 weeks after nonspecific sx

250
Q

What kind of injury is a primary blast injury?

Typical characteristics?

A

Direct effect from blast shockwave

Shear and stress forces on tissues aka TMs, lung, eyes

251
Q

How much does pH decrease with induced hypothermia?

A

Decreases by .012 for every 1 degrees C below 37

252
Q

What antiviral is helpful in treating immunocompromised pts w/severe RSV?

253
Q

Treatment for toxoplasmosis is what?

How is it acquired?

A

Pyrimethamine, sulfadiazine, folinic acid

Reactivation of a latent virus

254
Q

If you fuck up and put anesthetic in the carotid sheath when trying to do an inferior alveolar block, what can happen?

A

Horner’s syndrome - ptosis, anhydrosis, miosis

Also trismus

255
Q

What med is contraindicated with a hyphema?

A

Ibuprofen and ASA (NSAIDs)

256
Q

What pts can be observed and admitted for 12 hours in ED and what pts can be discharge in electrical burn cases?

What workup is needed?

A

Low voltage go home if less than 240V

High voltage > 1000 V admit for obs

Need EKG and skin exam

257
Q

What 2 serious illnesses can mimic kidney stones?

A

Aortic/ilia aneurysm

Renal vein thrombosis

258
Q

What is conus medullaris syndrome?

How to distinguish?

A

Distal SC compression - causes both UMN and LMN

Sudden and BILATERAL

259
Q

Patients with rupture of UCL requires what?

A

Immobilization and urgent surgical management

260
Q

What is Ludwig’s angina?

MC sx?

A

Deep space infection of the floor of the mouth and neck which can lead to edema and displacement of soft tissues leading to upper airway obstruction

Tongue elevation, brawny edema, dysphagia, drooling

261
Q

What are the major Duke criteria for endocarditis?

A

2 + blood CXR
New murmur
Abnormal echo

262
Q

Describe MAT on EKG

1st line action?

Treatment?

A

3 diff P waves, rate of 100-180, irregular

IVF

Underlying cause, CCB

263
Q

What is an ischemic form of venous occlusion d/t massive iliofemoral thrombosis that involves most of the venous collateral system?

A

Phlegmasia cerulea dolens

264
Q

How to treat acute arsenic gas toxicity?

If not at level of toxicity yet then do what?

What clinical signs?

A

Urinary alkalinization

Dimercaprol

Garlic breath, ABD pain, hematuria, jaundice, PMHx of working at semiconductor factory

265
Q

CN 3 palsy + orbital cellulitis = ?

A

Cavernous sinus thrombosis

266
Q

Bell’s Palsy presents how?

Treatment?

A

Unilateral facial weakness, drooling, loss of taste, CANNOT raise eyebrow on affected side

Prednisone and eye care

267
Q

Age group of Retropharyngeal abscess?

Most diagnostic PE finding?

MC bacteria?

A

3-5 bc they have large retropharyngeal LNs that are prone to infection and involuted after age 4

Pain with neck extension

Staph, strep anaerobes

268
Q

What is a stye?

269
Q

What time frame for a head CT to r/o SAH has a sensitivity of nearly 100%

270
Q

Sinus tachycardia, low voltage QRS and electrical alternans seen in what?

A

Pericardial tamponade

271
Q

What Platelet level is an absolute contraindication to tPA?

What about INR?

Blood glucose level?

A

< 100,000

> 1.7

< 50

272
Q

What is the formula for ETTs that are cuffed?

UNCUFFED?

A

Age/4 + 3.5

Age/4 + 4 —> bigger size bc there is no cuff duh

273
Q

What is a V common reason for pneumomediastinum on CXR in a young pt w/pleuritic chest pain of acute onset?

A

Asthma exacerbation

274
Q

What is a blockage of the Meibomian glands called?

Located where?

A

Chalazion

Above the eyelashes on the upper lid

275
Q

How will the penis appear in ischemic priapism?

A

Shaft is rigid and painful

Glans is soft

276
Q

What level of hypoNa requires 3% saline infusion?

A

Serum Na < 110
Or
Na < 120 with symptoms

277
Q

Any patient that presents w/signs and symptoms of decompression sickness, what is the treatment?

A

Hyperbaric oxygen

278
Q

What are the neurologic complications of EBV?

A

encephalitis
Meningitis
GBS

279
Q

How does Hct change in hypothermia?

A

2% increase in Hct for every 1 degree C drop in temperature

280
Q

Pt that gets strep, is given amoxicillin and then gets a non-allergic rash over a week later has what?

A

Type 4 hypersensitivity

281
Q

When should therapeutic thoracentesis be stopped as long as vital signs are stable?

A

After the onset of chest discomfort or cough

282
Q

What type of cells seen in DIC?

A

Schistocytes

283
Q

What to think of when a pt comes in with pelvic US showing a 7 week IUP AND an ovarian mass w/free fluid in the pelvis?

MC cause?

A

Heterotopic pregnancy

Infertility treatment

284
Q

RBBB, look at what leads and for what?

A

Lead I —> Wide S wave

Lead V1 —> RSR’

285
Q

Risk factors for anorectal abscess?

A

Crohns
diabetes
Chronic steroid use

286
Q

What is the dosing for tPA in ischemic stroke?

A

0.9 mg/kg with max of 90mg

10% given as 1 minute bolus
Remainder give over 1 hour

287
Q

Pt taking exogenous thyroid hormone what is the tx?

A

BB, dexamethasone

Do NOT need PTU or KI

288
Q

Pt w/mesenteric ischemia that gets a CT scan, what is the most common radiographic finding?

A

Bowel wall edema

289
Q

What kind of injury is a quaternary blast injury?

Typical characteristics?

A

Environmental contamination from the device

Burns, inhalation, toxic substances touch you

290
Q

What is the treatment protocol for acetaminophen overdose?

A

Loading dose of 140 mg/kg PO of NAC

Followed by 70 mg/kg PO q4 hours for a total of 17 doses

291
Q

Do ligaments and joints get strained or sprained?

292
Q

What rash is target-like with a central dark papule surrounded by a pale area and a halo of erythema?

Seen in what?

A

Erythema multiforme

HSV

293
Q

What is the treatment for peri-oral electric burns in an infant?

What can happen?

A

DC w/bleeding precautions, can use topical Abx and gentle swabbing

Bleeding from superior labial artery

294
Q

Central cord syndrome occurs with what type of injury?

A

Extension

Mnemonic: Extra Credit Injury

295
Q

How does uterine rupture present (other than abd pain and vaginal bleeding)?

A

GRADUAL worsening abd pain and fetal distress, loss of station of the fetus, palpation of fetal parts directly through ABD wall

296
Q

What is a contraindication to nail trephination?

A

Posterior nail edge disruption

297
Q

What do cocaine screen tests test for?

How long is cocaine in your system for?

A

Metabolite benzoylecgonine

3 days up to 8 in heavy users

298
Q

How do you calculate total body K+ deficit?

A

Each 0.3 mEq drop in potassium below normal = 100 mEq deficit

299
Q

Treatment for Lyme in pregnant pt?

A

Amoxicillin 500mg bid for 14 days

300
Q

How should you treat a stingray wound?

A

Immerse in tap water at 45 C (113 F)

301
Q

Old Pt with UE weakness, sensory deficits and urinary retention has what?

Mechanism?

Prognosis?

A

Central Cord Syndrome

Hyperextension

Medium

302
Q

Pt that comes in with a traumatic hyphema needs what test 1st?

What medical condition is associated with spontaneous hyphema?

A

Seidel

Sickle cell disease

303
Q

How to treat acute mountain sickness?

When do sx usually begin?

A

IVF
Acetazolamide/dexamethasone
Delay of further ascent

6500 - 8000 ft

304
Q

What chemical is used in glass etching, home rust remover, metal cleaning, and electronic manufacturing?

Treat how?

A

Hydrofluoric acid

Topical calcium gluconate bc that acid causes profound hypoCa

305
Q

What is the pathophysiology of polymyositis?

Clinical Sx?

A

Degradation of muscle cells

Subacute proximal muscle weakness and myalgia

306
Q

What is the treatment for spontaneous PTX?

A

100% O2 on non rebreather mask if < 20% in healthy pt

307
Q

Child >8 y/o with hypoglycemia, what is the dose?

A

1) estimate weight: (2 x age in years) + 8
2) 50/50 = 1 mL/kg of D50
3) weight x dose

308
Q

How to treat VTach?

A

Pulseless —> immediate defibrillation

Unstable —> synchronized cardioversion

309
Q

What structure may rupture in the inner ear with rapid ascent?

A

Round window

310
Q

What is the major enzyme involved in the production of NAPQI?

What happens when this system is overwhelmed in Tylenol OD toxicity?

A

CYP2E1

Shunts to CYP450

311
Q

Black widow bites how do you treat?

A

Supportive but also opioids and Benzodiazepines

312
Q

Pt that goes into a woodshed can have difficulty breathing d/t what?

What medicine is contraindicated?

A

Hydrocarbon ingestion

Epinephrine

313
Q

Define what is meant by a when a pt has a test that is normal, the likelihood the patient does not have the disease?

314
Q

What is the pathophysiology behind Type 3 vWF disease?

A

No vWF produced AND low levels of Factor 8

315
Q

What is chemosis? Seen in what?

What is enophthalamos? Seen in what?

A

Swelling of the conjuctiva, orbital cellulitis

Posterior displacement of the globe w/in the orbit, seen in orbital trauma and blowout fractures

316
Q

Sickle cell pt that has very low Hg and No reticulocytosis has what?

Do what?

A

Aplastic crisis

Transfuse

317
Q

What is Sever disease?

Causes what?

Treatment?

A

Calcaneal apophysitis

Posterior heel pain in males 8-12 y/o

Supportive care

318
Q

What is the 1st line treatment for seizures in neonates?

Dose?

Repeat dose? Max?

A

Phenobarbital

20-30 mg/kg IV

10-20 mg/kg, Max is 50 mg/kg in 24 hours

319
Q

What opioid can cause mydriasis in cases of toxicity?

A

Meperidine

320
Q

What vessels make up Kiesselbach’s plexus?

A

Septal branch of superior labial branch of the facial a.
Lateral nasal branch of SP artery
Septal branch of the anterior ethmoidal artery

321
Q

CC of flank pain in old person that is not kidney stones, what must you consider?

A

ruptured AAA

322
Q

Aerospace manufacturing lung disease cause?

Welders and silver polishes?

Sandstone, clay, granite? Classic CXR finding?

A

Berylliosis

Siderosis

Silicosis, basilar alveolar filling

323
Q

Where does phosgene gas fuck up airway?

Smells like what?

Causes what?

A

Oxygen diffusion in the alveoli

Musty hay or freshly mown grass

Pulmonary edema, injury

324
Q

Pelvic avulsion fracture MC type?

Treat how?

What mechanism does it happen?

A

Ischial tuberosity avulsion

Non-weight bearing for 6 weeks

Forceful kicking, like a soccer ball (due to hamstrings)

325
Q

What is the treatment for anal fissure?

A

Topical nitroglycerin or topical nifedipine

326
Q

When to add steroids in pt with PCP?

What’s the alternative treatment other than Bactrim?

A

PaO2 < 70 or o2 sat < 93% and AA gradient > 35

Pentamidine

327
Q

What accounts for the greatest % of heat loss in cool environments?

328
Q

What PE sign indicates retrocecal appendix?

How do you do it?

A

Psoas sign

Extend pt right leg why lying on left side, pain is (+)

329
Q

What defines neutropenic fever?

Admitted where?

A

> 38.3C or sustained 38C for more than 1 hour

AND

Neutrophil count < 500 cells/microL

General Medical Floor

330
Q

What are some examples of non-ionizing radiation?

A

Microwaves, infared, radio, thermal

Basically anything that does start with a Greek letter or 1 letter

331
Q

What is the most likely cause of macrocytic anemia?

A

Direct EtOH toxicity

332
Q

Pt that presents with pain and fullness in the rectal area and has a palpable, tender swelling of the internal side wall of the rectum has what?

A

Anorectal abscess

333
Q

What is a common finding of high altitude pulmonary edema?

A

Right middle lobe involvement will show patchy alveolar infiltrates

334
Q

What presents w/sudden onset of high fever, retro-orbital HA, nausea, vomiting, severe myalgia and morbiliform rash?

A

Dengue fever

4-7 day incubation period

335
Q

Old person in pain, how to treat their delirium?

What environment should they be in?

A

Opiates

Quiet, low-light

336
Q

What are the cardinal signs of anterior uveitis (3)?

A

Ciliary flush
Marked injection at the limbus
Red ring around the iris

337
Q

Pt with hepatorenal syndrome has what abnormal lab value?

Treat how?

A

Progressive rise in serum Cr

Vasopressors to cause splanchnic vasoconstriction

338
Q

What is the target PaCO2 in a hyperventilated head injury pt?

Onset of effect?

A

30-35

W/in 30 seconds

339
Q

How does herpes simplex keratitis present?

Treatment?

A

Unilateral eye pain w/dendritic pattern

Trifluridine

340
Q

Pt w/3rd degree heart block, which med to give first?

If it fails?

A

Atropine

Dopamine

341
Q

Formula for correct cuffed ETT size?

Uncuffed?

A

(Age/4) + 3.5

(Age/4) + 4

342
Q

How to treat large iron ingestion in a kid?

A

Whole bowel irrigation with polyethylene glycol aka MiraLAX

343
Q

Wernicke’s encephalopathy triad?

A

Encephalopathy, oculomotor dyfx, gait ataxia

344
Q

SALTER Harris types 1-5?

A

1 - slipped: separation through the ephysis (NO break, just separation)
2 - above: fracture through a portion of the growth plate that extends through the metaphysis
3 - lower: fracture through growth plate that extends through epiphysis and into joint —> Unstable
4 - through: ACROSS the metaphysis, growth plate, and epiphysis —> need ORIF
5 - ER crush injury to growth plate

345
Q

What Abx used to treat skin lesions in scleroderma?

A

Minocycline

346
Q

Pt with an unexplained pleural effusion should be worked up for what?

347
Q

Major SE of zidovudine?

Efavirenz?

Didanosine?

A

Bone marrow suppression

Vivid dreams

Pancreatitis

348
Q

Child 1-8 y/o with hypoglycemia, what is the dose?

A

1) estimate weight

2) 50/2.5 = 2mL/kg of D25

349
Q

What is the MC oculomotor sign in pts w/Wernicke’s encephalopathy?

A

Lateral nystagmus

350
Q

Oral hairy leukoplakia indicates what else?

A

Confection by HIV

Lesions caused by EBV, NOT precancerous

351
Q

How much bleeding output is indication for emergent thoracotomy?

A

> 7 mL/kg/hr following chest tube placement

Output > 200 mL/hr for the first 3 hours

352
Q

What vaccine is safe in pregnancy?

A

Tdap
Hepatitis
Inactivated influenza

353
Q

What is Brudzinski sign?

A

Neck flexion causes hip and knee flexion

For meningitis

354
Q

Pt experiencing decompression sickness has what sx?

What will they NOT have?

A

Vertigo, myalgia, Dyspnea, parasthesia, burning, mottling

Loss of consciousness

355
Q

What is defined by the fractions of patients who truly have a disease and are identified as so with a test?

A

Sensitivity

356
Q

What is the dosing for tPA?

A

15mg IV push bolus followed by two infusions of 0.75 mg/kg over 30 minutes and 0.5 mg/kg over 60 minutes

357
Q

What is the MC abnormal radiologic finding in foreign body aspiration?

A

Obstructive emphysema

358
Q

In the first moments of life, what should goal O2 sat be in a neonate?

A

Titrated up until 10 minutes of life where O2 saturation should be > 90%

359
Q

Who is at risk for aortoenteric fistula?

Dx how?

A

PMHx of AAA, aortic repair/graft

EGD

360
Q

How to avoid Boutonnières deformity with splinting?

A

PIP in extension, DIP and MCP joints should have full ROM

361
Q

Albuterol has what short term electrolyte effects?

A

Hyperglycemia
Hypokalemia
Dec Mg and PO4

362
Q

Ankle arthrocentesis should be performed in which location and direction?

A

Medial to tibialis anterior tendon and directed toward the anterior edge of the medial Malleolus

363
Q

What is the goal pH for irrigation in cases of a chemical burn?

364
Q

What causes painful suppurative ulceration on the penis and painful inguinal LAD?

A

Haemophilus ducreyi

365
Q

48 y/o guy that suddenly becomes unresponsive and goes into VFib and achieves ROSC most likely has what?

366
Q

What is Oil of wintergreen?

Treatment for OD?

A

Salicylic acid (Aspirin)

Sodium bicarbonate and activate charcoal if < 1 hour from ingestion

367
Q

LVH w/deep, narrow Q waves in the lateral and inferior leads are seen in what condition?

368
Q

What kind of objects need endoscopic removal?

A

Sharp ones

Longer than 5cm
OR
Wider than 2.5cm

369
Q

Ingestion less than what level of NSAIDs are unlikely to cause significant toxicity and do not require observation?

A

< 100 mg/kg

370
Q

Child < 1 y/o with hypoglycemia, what is the dose?

A
  1. Estimate weight: (2 x age in yrs) + 8
    2) 50/10 (10 for D10)
    3) weight * 5mL/kg
371
Q

Which direction is orthodromic?

Describe the morphology

A

Clockwise

Deep Q waves

372
Q

What is the tube insertion site for a cricothyrotomy?

A

Superior to cricoid cartilage

Inferior to thyroid cartilage

373
Q

What is a Swan neck deformity?

A

PIP in hyperextension

DIP in flexion

SwanEEE

374
Q

Child w/SVT, what is the cardioversion energy?

A

1st attempt 0.5-1 J/kg

2nd attempt 2 J/kg

375
Q

What is oxymetazoline? Used for what?

MOA?

A

Nasal spray decongestant for rhinosinusitis

A1 agonist and a2 partial agonist

376
Q

Pt that takes meds and a week later develops allergic symptoms has what type?

A

Serum sickness - type 3

377
Q

Treatment for Croup?

A

Decadron, racemic epi

378
Q

AIDS pt w/ring-enhancing ICL + AMS = ?

A

Primary CNS lymphoma

379
Q

Fracture-dislocation of the tarsometatarsal joints is called what?

What radiographic finding?

A

Lisfranc injury

Lateral shift of the 2nd metatarsal off the middle cuneiform

380
Q

How much blood loss in class II hemorrhage?

381
Q

Malocclusion of the jaw and pain with eating indicates what?

This is different from what?
How?

A

TMJ disease

TMJ dislocation —> cannot open the mouth

382
Q

What is the management for a lateral patella dislocation?

A

Closed reduction

Post reduction xray, with splint

383
Q

Treatment for anticholinergic associated hyperthermia?

A

Ice water immersion
Evaporative cooling
Benzodiazepines

384
Q

What street drug can cause prolonged QT/Torsades?

385
Q

Obstructing DVT of the proximal ileofemoral vein is called what?

Treat how?

A

Phlegmasia cerulea dolens

Heparin + vascular consult

386
Q

What neck fracture is considered stable?

A

Clay-shoveler fracture aka avulsion of the SP of C6 or C7

387
Q

What is the atropine dose in a pt w/symptomatic bradycardia w/a pulse?

A

0.5 mg IV push

388
Q

What kind of follow up do buckle fractures need?

A

Primary care in 3 weeks

Apparently not ortho, ya right

389
Q

What kind of fracture is a bone that is bent with a fracture line that does not extend completely through the width of the bone?

What degree of angulation can be splinted?

A

Green stick

Less than 10

390
Q

What kind of snake bite causes neurotoxicity manifesting as muscle weakness, bulbar paralysis w/ptosis, ophthalmoplegia, dysarthria and dysphagia?

Through what mechanism?

What meds can be used as adjunctive treatment?

A

Coral snake

Inhibition of muscarinic AChRs

Neostigmine (ACh-Es)

391
Q

Temporal arteritis can effect what else?

A

Aortic involvement leading to valvular insufficiency, aortic arch syndrome and dissection

392
Q

What is the MC vital sign abnormality in PE?

MC presenting symptom? #2?

A

tachypnea

Dyspnea at rest or exertion, Pleuritic pain

393
Q

How do you make a sodium bicarbonate drip for treatment of TCA OD?

A

Mix 150 mEq of NaHCO3 with 1 L of D5W

394
Q

How does transverse myelitis present?

A

Post viral

Defective or absent motor, sensory, ANS fx w/clearly demarcated spinal level

Progressive onset over hours to days

395
Q

What is the management of a patient that has a fever and has a catheter for dialysis?

A

Get blood cultures, give ABx but LEAVE catheter in

396
Q

Achilles’ tendon rupture requires what kind of splint?

A

Equinus splint

397
Q

What finding indicates acute traumatic aortic disruption?

A

Elevation of the right mainstem bronchus

398
Q

Alcoholic patient that has chest pain, muscle cramping, numbness, tingling and low calcium can be treated with what?

A

Magnesium 2g

399
Q

Female pt that has severe chest pain after eating that resolves within 30 minutes has what?

Treat how?

A

DES

CCB (Diltiazem) or TCA

400
Q

What is the triad for HUS?

A

MAHA
thrombocytopenia
Renal insufficiency

401
Q

What is the 1st line treatment for lice in ALL populations?

A

Permethrin

402
Q

Pt that develops painless visual loss w/flashes of light followed by cloudy, curtain-like loss has what?

A

Retinal detachment

403
Q

When should a pt with a STEMI get tPA?

A

Nearest facility is further than 2 hours away AND pt presents w/in 12 hours of symptom onset

404
Q

Primary teeth are present for how long?

Avulsed primary tooth treated how?

A

6months - 6 years

Do not replace tooth, urgent dental referral

405
Q

How to figure out size needed cuff or UNCUFFED tube?

A

Cuff means more space, so only add 3.5

Uncuffed means less stuff there so you can use a bigger size so add 4

406
Q

What Syndrome associated w/bilateral injury of the spinothalamic and CST tracts?

Mechanism?

Cx?

A

Anterior cord syndrome

Flexion or vascular

Complete loss of motor, pain and temp below injury, retain 2pt/proprio

407
Q

What is the MC organism in bacterial tracheitis?

What virus increases susceptibility?

A

Staph aureus

Influenza A

408
Q

Neonate that is gasping and continues to have poor respiratory drive or bradycardia should have what intervention?

Goal O2 sat of what?

A

PPV w/bag mask with room air

60-70%

409
Q

When should you pack an abscess?

A

> 5cm
Pilonidal
Pt is diabetic or immunocompromised

410
Q

What drugs can you use for uterine atony?

And what is the dose for the #1 choice?

A

Oxytocin - 10IU IM
Methylergonovine
Carboprost

411
Q

Pt that comes in with suspected ibuprofen OD, what should you do?

What is not helpful?

A

Acetaminophen level

activated charcoal

412
Q

Wellens’ syndrome shows what on EKG?

A

Deeply inverted T waves in V2-V4 (type B)

Or Biphasic T waves in V2-V4 (type A)

413
Q

How to calculate shock index?

What is normal?

A

HR / systolic BP

.5 - .7

414
Q

How to dx intussusception?

Tx?

A

US

Air contrast enema

415
Q

How many cc’s are considered normal in a post-void residual?

What is the MC location of prostate metastasis to bone?

A

< 100cc

T-spine

416
Q

Blood and thunder seen on Ophthalmology exam indicates what?

What is the treatment?

What are the clinical sx?

A

Central retinal vein occlusion

Referral to ophthalmology

Sudden, painless monocular loss of vision

417
Q

Pt camping in the Midwest of the U.S. that has RUQ pain has what?

A

Entamoeba histolytica

418
Q

How to correct for potassium in the setting of acidosis?

A

Subtract 0.6 mEq from K for every .1 decrease in pH from 7.4

419
Q

CURB-65 stands for what?

A

Confusion
Urea > 7
RR > 30
BP (systolic) < 90

420
Q

What drugs induce CYP 450?

Inhibit?

Inducing CYP means what?

A

Phenytoin, nafcillin, phenobarbital, rifampin

Cimetidine

Gets rid of the drug faster meaning the drug doesn’t work as well

421
Q

Pt not bleeding but has other signs (petechiae) and Plt < 20,000; what is the treatment?

Same scenario but WITH bleeding?

A

Prednisone

IVIG + IV methylprednisolone

422
Q

Describe roseola

What virus #?

A

Abrupt onset of fever that lasts 3-4 days. Fever resolves then rash appears and lasts 1-2 days

HHV 6

423
Q

What nerve supplies sensation to the anteriomedial face including cheek and upper lip?

Branch of what larger nerve?

A

Inferior orbital nerve

Maxillary division (V2) of CN 5

424
Q

Pt that has a pelvic fracture and is hemodynamically unstable, what is the treatment?

A

Angiographic embolization

425
Q

Pt w/complete loss of motor, pain, temp below injury but retains prop/vibratory has what?

Mechanism?

Prognosis?

A

Anterior cord syndrome

Flexion or vascular

Poor

426
Q

Diffuse macular, blanching erythroderma that looks like sunburn is what?

Treat how?

A

Toxic shock syndrome rash

Clindamycin

427
Q

How to treat malaria?

A

Quinidine and Doxycycline

428
Q

What is a fracture of the distal radius with dorsal displacement called?

What injury is MC assoc w/it?

A

Colles fracture

Ulnar styloid

429
Q

What EKG changes can digoxin cause?

A

Downsloping ST depression w/slurred appearance
Flattened/inverted or biphasic T waves
Shortened QT interval

430
Q

What is the max dose of lidocaine with epinephrine that can be injected into the peripheral tissues?

Bupivicaine?

A

5 mg/kg without Epi, 7 mg/kg with

1.5 without, 3 with

431
Q

Pregnant pt with umbilical cord prolapse, how to proceed before emergency C section?

A

Trendelenburg position
Knee-chest position
Bladder filling
Manual replacement of the cord

432
Q

How do you know when to give fluids after seeing IVC on US?

A

If IVC collapses > 50% on inspiration this indicates decrease in blood volume and predicts fluid responsiveness

433
Q

How is octreotide dosed in upper GI bleed?

A

Bolus of 50 mcg then infusion of 50 mcg/hr

434
Q

Where is a lacrimal duct injury located?

Where is the lacrimal gland located?

Eyelid laceration > what length needs to be repaired?

A

Medically to the puncture

Superolateral space next to each eye

> 1 mm

435
Q

Where does the supraorbital nerve originate from?

A

Branch of the frontal nerve which is a branch of V1

436
Q

Pts w/HELLP syndrome are at risk for what?

A

Hepatic rupture

437
Q

What is the max distance that can be repaired using the hair apposition technique?

438
Q

What medicine is used to treat opioid induced constipation?

A

Methylnaltrexone given subQ

439
Q

What is the treatment for fat embolism?

A

IVF and supplemental O2

440
Q

Posterolateral unilateral disc herniation bw L4 and L5 results in compression of what root?

441
Q

Alcoholic pt with vomiting needs what resuscitation?

LR or NS? Why?

A

Glucose even if reading is normal

NS bc vomiting causes Cl- loss and NS has 155 and LR only has 109 of Cl- ions

442
Q

How to treat Portuguese man of war nematocysts?

A

Hot water and topical lidocaine

If don’t have access to that use salt water

443
Q

Pt in a mass casualty situation has RR > 30, triage what color?

444
Q

What are some characteristics of organic (medical reason) confusion?

A

Visual hallucination

445
Q

What is the relationship of hydromorphine to morphine?

A

Hydro is 7x as strong

1mg of hydro = 7mg of morphine

446
Q

What recommendation says a treatment benefit = risk and thus should not be administered?

447
Q

What is the MC cause of dacryocystitis?

A

Staph aureus

448
Q

Benzo withdrawal seizure is most likely with what feature?

A

Injury during the episode

449
Q

What leads to look at in a right sided EKG?

ST elevation in these leads indicate what?

A

V4R, V5R, V6R

Right ventricular infarct

450
Q

What antieliptic drug has a SE of hyponatremia?

A

Oxcarbazepine

451
Q

What is the definition of empyema?

A

Presence of bacteria on Gram stain of the pleural fluid after it has been drained

452
Q

How to treat GC?

A

Ceftriaxone 250mg IM
+
Azithromycin 1g

453
Q

Do muscles get sprained or strained?

454
Q

Echocardiogram that shows hyperkinetic heart motion indicates what?

A

High output Heart Failure

455
Q

People who cannot recognize their illness fail to demonstrate what part of capacity?

A

Appreciation

456
Q

What is the 1st line treatment regimen for diverticulitis?

2nd line?

A

Cipro 500mg bid + metro 500mg q8

Augmentin 875/125 q8 for 10 days

457
Q

What is the 1st line treatment for BP in aortic dissection?

2nd line?

A

Labetalol or esmolol

Nitroprusside

458
Q

How to correct for sodium in cases of hyperglycemia?

A

Add 1.6 mEq to Na for every 100 mg/dL of glucose above 100

Ex. Glucose is 550, Na is 129

129 + 1.6 x ((550-100)/100) = 136.2

459
Q

What is the best antidote for rivaroxaban?

What’s the new drug that provides “decoy” factor X receptors?

A

IV 4 factor prothrombin complex concentrate
Has factors II, VII, IX, X, protein C and S

Andexanet

460
Q

What is the treatment for idiopathic sudden sensorineural hearing loss?

A

Prednisone 60mg 7-14 days

461
Q

Describe rash distribution of RMSF?

Treatment in children?

A

Begins on ankles and wrist, then spreads to chest, back

Doxycycline, ALWAYS

462
Q

Blurred vision, bradycardia, ECG w/hyperK and peaked t waves is what?

A

Digoxin toxicity

463
Q

First step with suspected penile fracture?

Mechanism of pathology?

A

Call urology

Disruption of the tunica albuginea surrounding the corpus cavernosa

464
Q

How to treat Valproic acid toxicity?

What do these pts commonly have?

A

L-carnitine administration

Hyperammonemia

465
Q

What infection is the MC that presents w/erythema multiforme?

What else?

A

HSV

Mycoplasma
Lupus, hepatitis
Drugs

466
Q

Formula for uncuffed ETT size?

A

(Age/4) + 4

467
Q

What is the parkland formula?

A

4mL x tot % body surface area x body weight (kg)

468
Q

What is a Pseduo-Jones fracture?

Treatment?

A

Fracture fo the proximal 5th metatarsal reaching the articular surface (5th metatarsal tuberosity)

RICE

469
Q

What is the pathophysiology behind Type 1 vWF disease?

What else?

A

Decreased production of the glycoproteins

Also low levels of Factor 8

470
Q

What do the labs show in TTP?

A

Elevated LDH
Elevated indirect bilirubin
Normal coags
Plt < 50,000

471
Q

What medication can be used for prophylaxis of migraine headaches?

A

Propanolol

Also verapamil and topiramate

472
Q

What is the order of 7 cardinal movements of labor?

A

Engagement, descent, flexion, IR, Extension, ER, Expulsion

EDF IEEE

473
Q

What cells of the pancreases have exocrine fx?

Like what enzymes?

A

Acinar

Trypsin, chymotrypsin, lipase, amylase

474
Q

When should hiccups be evaluated?

How?

Treatment?

A

More than 48 hours straight

H+P, basic labs, CXR

PPI, baclofen, gabapentin, Reglan, CHLORPROMAZINE (fda approved)

475
Q

Old pt that has AMS, febrile, tachycardia, diaphoresis, midrange pupils, and rigidity is withdrawing from what?

Has what?

A

Levodopa

NMS

476
Q

Treat tension PTX how?

A

Needle thoracostomy 2nd ICS, midclavicular line with 14 gauge catheter

477
Q

Hirschsprung enterocolitis can occur before or after surgical repair, what is the treatment?

A

Metronidazole w/or w/out rectal irrigation

478
Q

What is another name for bucket handle fracture or corner fracture?

Pathognomonic for what?

A

Metaphyseal fracture

Non-accidental trauma

479
Q

What is type 1 of Brugada?

Type 2?

Pathophys?

A

Coved V1, V2 - ST descends w/upward convexity, INVERTED T wave

Saddle back - ST descends towards baseline then rises for upright or biphasic T wave

Underlying Na of Ca+ channel mutations

480
Q

Dosing of tPA for massive PE?

A

100 mg over 2 hours IV

481
Q

What tick borne illness can cause fever, RUQ pain, scleral icterus +/- rash?

A

Ehrlichiosis

482
Q

Pt with suspected tertiary syphilis, evaluate and treat how?

A

Send a CSF VDRL and give IV PCN G 4 million units

483
Q

Pt fractures humerus, what is a Hil-Sachs lesion?

What is a Bankart lesion?

A

Compression fracture of posterolateral numeral head

Fracture of the inferior glenoid rim

484
Q

Thrombosed hemorrhoid present for greater than 72 hours, what is the management?

A

Topical hydrocortisone cream with lidocaine

485
Q

Where can primary chancre from syphilis occur?

A

Genitals or oropharynx

486
Q

How much energy to convert hemodynamically unstable AFib with RVR?

A

120-200 K biphasic

200 mono

487
Q

What is a common presenting symptom in pts with optic neuritis?

What time course?

Treatment?

A

Color perception decreased

Dec vision gradually over a few days
Severe central vision loss

IV methylprednisolone

488
Q

What is oxymetazoline?

Similar to what med?

A

A1 agonist, partial a2 agonist

Clonidine (a2 agonist that inhibits release of peripheral catecholamines)

489
Q

what are the findings of a patellar rupture?

A

Can’t extend knee
Superior patellar displacement
Tenderness inferior to patella

490
Q

What causes cauda equine syndrome?

A

Lumbo-sacral Nerve root impingement

491
Q

How much glucose and fluid is in an amp of D50?

A

25g glucose in 50 mL

492
Q

Most serious consequence of knee dislocation is what?

Hard sign?

A

Popliteal a injury

palpable thrill, visible expanding hematoma

493
Q

What is the Abx treatment for post C-section endometritis?

Post vag delivery endometritis?

A

Clindamycin + gentamicin

ampicillin + gentamicin

494
Q

Sexual assault victims, what is the 1 thing that is recommended as part of eval and tx?

A

Forensic evidence collection

495
Q

When to use linezolid instead of vancomycin as 1st line empiric treatment?

A

Pts w/septic shock or respiratory failure d/t pneumonia

496
Q

Delta pressure = ?

What indicates compartment syndrome?

What occurs first, loss of pulses or sensory deficits?

A

Diastolic BP - intracompartment pressure

< 30 means compartment syndrome

Sensory deficits

497
Q

What is the pediatric dose of pediatric IV epinephrine in a code?

A

0.01 mg/kg

498
Q

Pt in MVA that has blunt trauma to larynx/trachea and is complaining of dysphonia, dyspnea, anterior neck pain, what must you worry about?

do what 1st?

A

blunt laryngotracheal compromise leading to progressive airway obstruction

intubate with fiberoptic scope

499
Q

What is a boutonnière deformity?

A

PIP in flexion

DIP in extension

BP Fucks

500
Q

Side effect of etomidate?

501
Q

What is the management of extraperitoneal bladder rupture?

A

Non surgical - Foley for 1-2 weeks to allow for spontaneous healing

502
Q

Inferior displaced patella means what?

Superiorly displaced?

A

Quad tendon rupture

Patella tendon rupture

503
Q

Young child that presents with myalgia, thrombocytopenia and hyponatremia after camping has what?

504
Q

Perichondritis MUST be treated for what?

Use what?

A

Pseudomonas

Ciprofloxacin

505
Q

Where do you palpate the posterior tibial artery pulse?

A

Posterior and inferior to medial Malleolus

506
Q

Child w/opsoclonus-myoclonus syndrome has what?

Need to do what?

A

Neuroblastoma

MRI of chest, abdomen, pelvis

507
Q

What lab study is most prognostic in acute radiation exposure?

What particle has the greatest mass?

A

Lymphocyte count

Alpha

508
Q

Ring-enhancing IC lesions + FND = ?

A

Toxoplasmosis

509
Q

What are the risk factors for TRALI?

A 
Hx of liver transplant
Chronic EtOH abuse
Smoker
Shock
\+ fluid balance
high Peak pressures on vent
510
Q

Bolus dose of 3% hypertonic saline for treatment of seizure 2/2 to hyponatremia is what?

A

2 mL/kg given over 10 minutes

511
Q

What common drug cannot be given in pregnancy?

A

Epinephrine

512
Q

ITP presents how?

Treatment?

A

Petechiae rash and low Plts

IVIG and prednisone

513
Q

Anterior cord syndrome comes with what kind of injury?

What else can cause this?

A

Flexion w/contusion to anterior portion of the cord

Mnemonic: Free Agent

Cross clamping the aorta

514
Q

What induction agent should be avoided in septic pts?

Why?

A

Etomidate

Adrenal suppression

515
Q

What valve abnormality is most likely to develop after blunt cardiac injury?

A

Aortic Regurgitation

516
Q

What scoring system helps ID patients w/upper GI bleed who are candidates for outpt therapy?

A

Glasgow-Blatchford Bleeding Score

517
Q

What kind of needle is used for LP?

What level does the SC end in adults?

A

Whitacre

L1

518
Q

What high-risk feature has the highest +LR in ACS?

A

Radiation to right arm or shoulder (LR+ 4.7)

Both arms LR+ 4.1

519
Q

Young pt w/signs and symptoms of pericarditis, what else must you consider?

A

Myocarditis

520
Q

How is the glottis opening different in children compared to adults?

Formula for predicting UNCUFFED ET size in children?

A

More anterior

(Age + 16) / 4

521
Q

MC cause of Cushing syndrome?

2nd MC?

A

Iatrogenic steroid use

Cushing Disease d/t pituitary tumor

522
Q

Cat bites with puncture wounds should be closed how?

A

Not at all

Let them heal naturally by secondary intention

523
Q

What scoring system estimates risk of major bleeding on patients on anticoagulation to assess risk in AFib?

A

HAS-BLED

HTN
Abn kidney or liver fx
Stroke
Bleeding
Labeled INRs
Elderly > 65
Drugs or EtOH
524
Q

Pt in DKA that suddenly has headache and ams, has what?

Treat how?

A

Cerebral edema

Mannitol

525
Q

Spontaneous PTX d/t COPD, what is the treatment?

A

20F chest tube directed superiorly

526
Q

What size ETT cap will attach to the angiocatheter in order to bag the pt?

527
Q

What is a common complication of perinatal and perirectal abscess?

Do you need surgery consultation?

A

Fistula formation

Most often no

528
Q

High altitude cerebral edema should be treated how?

A

Dexamethasone is 1st line for rescue (pt will be ataxic, altered)

529
Q

What is the goal fluid resuscitation urine output in septic Peds pt?

A

> 1 mL/kg/hr

530
Q

What is the treatment for hyphema?

Mechanism?

What meds to avoid in sickle cell patients?

A

Timolol

Topical BB that Dec aqueous humor production and lowers IOP

CA-Is

531
Q

What is the most sensitive test for Lyme meningitis?

A

B. Burgorferi antibody

532
Q

What finding on a UA is most sensitive for UTI?

A

Leukocyte esterase (83%)

533
Q

In hospital death after near death hanging or strangulation is d/t what?

A

Pulmonary edema and ARDS

534
Q

How does TXA work?

Mechanism?

A

Reduces plasminogen activation to plasmin

Competitively blocks lysine bidding sites on the enzyme preventing binding of fibrin thus inhibiting clot breakdown

535
Q

Sickle cell pts that most likely do not have a functional spleen at adulthood are at risk for what bacteria in a dog bite normal people aren’t?

A

Capnocytophaga canimorsus

536
Q

What medication is contraindicated in sickle cell pts with hyphema?

Why?

A

CA-Is

They lower pH - increase sickling

537
Q

What is a delta pressure?

A

Diastolic BP - direct pressure

538
Q

What are the labs expected with hemolytic transfusion reaction?

A

Inc LDH
Dec haptoglobin
(+) direct Ag test

539
Q

Cavernous sinus thrombosis first causes a palsy of which CN?

540
Q

For every 50 mL of HCO3 how much does the pH change?

A

Increases by 0.1

541
Q

How should pregnant trauma pts be managed?

A

Chest tube thoracostomy should be performed in a relatively higher position during pregnancy

542
Q

Pt with a left atrial mass has what?

How to manage?

A

Atrial myxoma

Transfer to tertiary care center d/t high risk of acute decompensation

543
Q

What kind of injury is a secondary blast injury?

Typical characteristics?

A

Impact of FRAGMENTS

Penetrating trauma, lacs, amputations

544
Q

What does Clonidine poisoning cause?

A

Lethargy, miosis, Bradycardia

545
Q

What ECG findings indicate a RV infarct?

A

ST elevation in V1

546
Q

What is the test called when you hold a piece of paper bw the thumb and index finger in a pinching grasp?

Tests for what?

A

Froment’s sign

Ulnar nerve palsy

547
Q

What is the smallest amount of free fluid that can be viewed on a FAST exam?

548
Q

What is the name of a ventricular-originated rhythm with a rate < 100 bpm?

A

Idioventricular rhythm

549
Q

What site for arterial line placement has the highest risk of limb ischemia?

A

Brachial artery

550
Q

Which central line location has the lowest rate of infection?

A

Subclavian

551
Q

What is the PaO2 goal in ARDS?

This converts to what % O2?

A

55-80 mmHg

88-95%

552
Q

What is the Kocher criteria used for?

What composes it?

A

Septic arthritis in Peds

1) non-weight bearing
2) ESR > 40
3) fever > 38.5C
4) wbc > 12,000

553
Q

What is an indication that shock is occurring?

A

Confusion —> shock is a Cx diagnosis

No lab test or VS can diagnose it

554
Q

MC cause of isolated abducens nerve palsy?

A

Microvascular ischmeia from diabetes or HTN

555
Q

What is the pathophysiology behind Type 2 vWF disease?

A

Glycoprotein is produced but NOT functional

556
Q

Infant w/bilious vomiting that occurs in the 1st week has what?

Classic xray findings?

Treatment?

A

Malrotation w/midgut volvulus

Dilated stomach w/duodenal bulb

Ladd procedure

557
Q

What is the major SE of TTM?

Through what mechanism?

what is the Goal?

A

Hypoglycemia

metabolism slows, causes insulin resistance

bG of 108-140

558
Q

What is the earliest ECG finding in acute MI?

A

Hyperacute T waves

559
Q

What are the RF for uterine atony?

A 
Multiple gestations
Macrosomia
Polyhydramnios
Prolonged labor 
Use of tocolytics
560
Q

Patient that has a bartholin gland abscess I&D’ed in the ED, what is the next management?

A

Word catheter for 4-6 weeks

561
Q

What can be given to prevent BPD in infants?
What else w/special time frame?

What else does this treat?

A

Caffeine
Surfactant w/in 1 hour of life

Apnea of prematurity

562
Q

What kind of Salter Harris fracture only involves the epiphysis?

A

Type 3

Aka “lower than the growth plate”

563
Q

What is the MC sequela of myocarditis/pericarditis?

A

Dilated cardiomyopathy

564
Q

Describe EKG of posterior MI?

A

Tall R waves in V1-V3 with horizontal ST depression and upright T waves

565
Q

How to discharge pts in a mass casualty blast situation?

A

Otoscopic eval of TMs

566
Q

Describe the following in a sickle cell pt w/aplastic crisis:

Retic count

Coombs test

Haptoglobin level

A

Dec

Negative

Normal

567
Q

Pt with heavy bleeding and INR of 8 should be treated how?

A

Vit K and PCC

PCC is more effective than FFP

568
Q

What is a Boutonnière finger?

A

DIP joint extension with proximal IP joint flexion

569
Q

What are the risk factors for placenta previa?

A

Prior C section
Multiple gestations/mulparity
Multiple induce abortions
Old woman

570
Q

What indicates acute appendicitis on US?

A

Diameter > 6mm
Wall thickness > 3mm
Target sign

571
Q

Light’s Criteria?

A

Pleural:serum protein > 0.5
Pleural:serum LDH > 0.6
Pleural LDH > 2/3 upper limit of normal for serum LDH

572
Q

How to treat acute asthma exacerbation?

A 
BIOMES
Beta agonists
Ipratropium
O2
Mag sulfate
Epi
Steroids
573
Q

What does whole bowel irrigation mean?

A

Using MiraLAX

574
Q

What features suggest VTach over SVT?

A

Capture and fusion beats

AV dissociation

575
Q

MC finding in salicylate OD?

What derangement first?

When to hemodialysis?

A

Hyperthermia

Respiratory alkalosis w/hyperventilation
Then
Metabolic acidosis w/inc Bicarbonate excretion

> 100 mg/dL

576
Q

Functional cause of confusion means what?

What is an example of a cause?

A

Psychiatric

Auditory hallucinations

577
Q

How do you test the motor function of the median nerve?

A

Thumb and 5th finger opposition (recurrent n.)

OK sign (ant interosseous branch)

578
Q

What describes unstable angina?

A

New in onset that occurs at REST or w/minimal exertion
OR
A worsening change in a previously diagnosed unstable angina

579
Q

When is shingles treated?

Who should avoid pts w/shingles?

A

Within the first 3 days

Pregnant patients

580
Q

What has the highest LR+ in adult pts for appendicitis?

581
Q

How to calculate post-test odds?

10% pre-test odds and LR+ of 16, what is the post test odds?

Do what next to calculate post-test probability?

A

Pre test ods x LR+

1:9 X 16 = 16/9

Post-test odds / (1 + post-test odds) = post-test probability

16/9 / (1 + 16/9)

582
Q

What nerve innervates the platysma muscle?

A

Cervical branch of facial nerve

583
Q

What is a potential complication of chest tube placement in a PTX that has been present for several days?

How to avoid?

A

Re-expansion noncardiogenic pulmonary edema

Do not suction and limit amount of fluid initially drained

584
Q

What does a fundoscopic “blood and thunder” exam indicate?

Seen in what condition?

A

Central Retinal vein occlusion

Chronic glaucoma

585
Q

Posterior shoulder dislocation results in what Xray finding?

A

Light bulb sign or rim sign

586
Q

What meds are contraindicated in WPW?

A

Adenosine
Beta blocker
CCB
Digoxin

587
Q

Treatment for tularemia that is disseminated to cause PNA?

A

Streptomycin

Doxy for local rxn

588
Q

What is the treatment for herpes keratitis?

A

Acyclovir or Trifluridine

589
Q

Age group of Staph scalded skin syndrome?

Treatment?

A

Avg age 2, usually children < 6 y/o

Supportive, ABx to cover MRSA

590
Q

What is the pathophys behind cecal volvulus?

Presents when?

tx?

A

Congenital defect in peritoneum resulting in twisting of the mobile segment of the Cecum

30s-50s

Surgery

591
Q

How to diagnose midgut volvulus?

A

Upper GI series

592
Q

What type of MI has the best prognosis?

A

Narrow complex 3rd degree AV block in an inferior wall MI

Usually transient and resolves spontaneously

593
Q

What bacteria must you worry about in human bites?

A

Eikenella corrodens

Treat with Augmentin

594
Q

Diffuse punctate corneal lesions seen with fluorescein staining indicates what?

A

UV keratitis —> can be due to welding

595
Q

Retrobulbar hemorrhage can cause what subsequent injury?

A

Occlusion of the central retinal artery

596
Q

Bite from what causes hemiballismus, AMS, rotary nystagmus?

Painful or not?

A

Centruroide (bark scorpion)

Painful yes

A - Rosh Review Boards (3 decks)

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