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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
Management of avulsed permanent tooth?
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
26
Clonus is only seen in what Syndrome?
Serotonin syndrome
27
What test to order for knee dislocation?
CTA of LE
28
In adults, what is the MC location for foreign bodies to lodge?
Proximal airway - larynx, trachea, main bronchi
29
What is the parkland formula for Peds pts?
3mL of LR x kg x % body surface area
30
MC cause of Ludwig’s angina? What is Ludwig’s?
Dental abscess that spreads into the soft tissue submental, sublingual, and submandibular spaces. Cellulitis of the submandibular and sublingual spaces w/associated tongue elevation
31
Patient that has an anterior and posterior fat pad sign on Xray has what? What kind of injury is common?
Radial head fracture FOOSH
32
IV magnesium toxicity causes what?
Hyporeflexia
33
Sickle cell pt presenting w/signs and sx of acute ischemic stroke should be treated how?
Exchange transfusion
34
What scoring system is used to classify severity of SAH?
Hunt and Hess Grade 1-5 5 is v bad, only 10% survival
35
Isolated CN 3 palsy with NO pupil involvement means what?
Diabetic CN mononeuropathy (down and out eye)
36
What medication is used to reduce the vasospasm that occurs w/SAH? MOA?
Nimodipine CCB
37
What is a consequence of halogenated hydrocarbon inhalation (like spray cans from computes)?
Cardiac dysrhythmia
38
What are the 4 Ts which cause PPH?
Tone Trauma Tissue Thrombin
39
What is Lemierre’s disease?
Septic thrombophlebitis of IJV caused by fusobacterium necrophorum
40
What kind of Salter-Harris fracture is only through the metaphysis?
Type 2 “above the growth plate”
41
What is the most reliable sign of uterine rupture?
Nonreassuring fetal HR
42
Formula for cuffed ETT size?
Age/4 + 3.5
43
What vascular structure is at risk of injury w/proximal fibular fracture?
Anterior tibial artery
44
How to make D5W aka 5% dextrose?
100mL of 50% dextrose to a 1 L bag of NS
45
What is scleroderma renal crisis? Treatment?
Can cause Raynaud, can cause kidney failure, HTN, hyperK+, and very high BUN and Cr Captopril (best ACE for preserving renal function)
46
When does gynococcal eye infection occur in newborns? Chlamydia trachomatis?
Days 2-4 Later —> days 5-14
47
What is an amp of D50? 50% dextrose means what?
25 grams of dextrose (100 cals) 50 grams in 100 mL
48
Describe a brown recluse spider bite
PAINLESS Causes local tissue destruction via cytotoxin
49
Children with croup should be admitted when?
Persistent stridor at rest, retractions, tachypnea, hypoxia or require > 2 nebulized racemic Epi at rest
50
What tendons are effected in de Quervain’s tenosynovitis?
APL and EPB
51
ASD MC PE findings? Pathophys?
Wide, fixed split S2 Persistent ostium secundum (incomplete adhesion bw FO flap and septum secundum)
52
Overdose of which NSAID is associated with seizure activity?
Mefenamic acid
53
Pt with anticholinergic toxicity can show what EKG changes? Treat how?
QRS widening Sodium bicarbonate
54
What foods can cause CN poisoning?
Prunus species - Apricot, bitter almond, cherry and peach
55
Pt with a 3cm linear forehead laceration and a CT that shows a non-depressed skull fracture means he has what? Treat how?
OPEN skull fracture Admit for observation and consult Neuro Will need to give ABx
56
Burns of what category are included in the parkland formula?
Anything involving the dermis including anything with “superficial partial-thickness”
57
What is the MC cause of myocarditis in the U.S.? Can be accompanied by what
Parvovirus B19 Pericarditis
58
What is it called when you have an inflammatory reaction which results from the aspiration of gastric acid fluid from the stomach?
Aspiration pneumonitis
59
What are the symptoms of primary adrenal insufficiency? What lab findings? Also called what?
Weakness, fatigue, weight loss, anorexia, orthostasis Dec in cortisol, hyperkalemia, hyponatremia Addison’s
60
What is the MC complication of diverticulitis?
Abscess
61
What is edrophonium? Used to treat what?
short acting AchE inhibitor that increases ACh at the NMJ M.G.
62
What O2 sat warrants hospitalization in bronchiolitis?
< 95% on RA
63
How to tell if a pt has ARDS with only using ABG? Peak pressure must be < what?
PaO2 : FiO2 < 200 Calculate by PaO2 / FiO2 (convert to decimal for FiO2) < 30
64
How to treat cocaine OD?
Benzo and phentolamine
65
Cushing reflex is in response to what? Is done to try and do what?
Inc ICP Maintain CPP
66
Pt who swallows cocaine packets but VS normal and nontender abdomen, what is the management?
Whole bowel irrigation w/polyethylene glycol —> speeds GI passage of the packets
67
What is the MC surgical emergency in pregnant pts?
Appendicitis
68
Isolated non-displaced sternal fractures are associated with what?
Low mortality rates
69
What bone is MC fractured in a basilar skull fracture?
Temporal
70
Which side of the valve is the vegetation typically located in IE?
Superior
71
Which direction is antidromic? Describe the morphology
Counter-Clockwise Large QRS complexes that look like candles
72
What is the goal urine output in pts w/significant thermal burns?
.5-1 mL/kg
73
What is the SF syncope rule?
``` CHESS CHF Hct < 30 EKG abnormal Systolic BP < 90 SOB ```
74
Pt that drank a lot and is in alcoholic ketoacidosis, what is the treatment? When do you add bicarbonate?
5% dextrose in NS pH < 7.1
75
Which kind of bronchoscopy should be used to remove a foreign body?
Rigid
76
What are the 5 components of Ranson’s criteria?
WAAGL ``` wbc Age AST Glucose LDH ```
77
What defines neutropenic fever?
Single oral temp >/= 101F OR Oral temp >/= 100.4 sustained for > 1 hour ANC < 1500
78
What does the rectal exam reveal in a newborn with Hirschsprung disease?
Increased rectal tone or rectal squirt
79
Pregnant pts, hx of OCPs, post-op, or hypercoaguable pt c/o ha or ams has what? What sign?
Central venous thrombosis Delta sign. (Non-Con) or Empty delta sign (Con CT)
80
Peds pt initial crystalloid Bolus is what dose? 2nd dose? If pt is hypotensive do what next?
20 mL/kg Repeat dose 10 mL/kg
81
What is the limbus of the eye?
The part of the anterior eye between the sclera and cornea
82
MOA of sumitriptan? Avoid in pts with what?
Vasoconstriction through vasoactive peptides Uncontrolled HTN, ischemic stroke, CAD, vasospastic angina
83
Bell’s palsy + facial varicella zoster infection = ?
Ramsay-Hunt syndrome
84
What causes Gamekeeper’s thumb? Will have what PE findings? Treat how?
injury to UCL of thumb Weak pincer grasp Thumb spica splint
85
MOA of Clonidine? Effects?
Alpha 2 agonist that binds presynaptic catecholamines receptors —> results in transient HTN OD you see pinpoint pupils
86
How to treat Red Man syndrome d/t Vancomycin reaction?
Stop infusion and give Benadryl
87
Common SE of desmopressin? How to prevent/treat?
Hyponatremia Fluid restriction
88
What are the 2 MC sites of blunt aortic injury?
Aortic isthmus Ascending aorta proximal to origin of brachiocephalic vessels
89
What sx occurs with nitrogen narcosis? Occurs when?
AMS Deep dives during descent
90
What is normal vaginal pH? pH of what indicates amniotic fluid? What is this test called?
3.5-6 > 6.5 Nitrazine test, should see ferning
91
MC location of extrapulmonary TB?
LNs
92
Which type of malaria has undulating fevers?
Vivax and ovale
93
What CXR finding leads you to dx Klebsiella PNA? How to treat?
Infiltrate in the upper lobes (MC the Right) w/bulging fissure 3rd gen cephalosporin and aminoglycoside
94
What is the best screening tool for epidural abscess? Treat how? To cover what?
ESR and CRP Van/Ceftriaxone to cover MRSA and Pseudomonas
95
What pediatric PNA causes a “shaggy” right heart border?
Pertussis PNA
96
Diver that comes up and then has MI like symptoms has what? Exhibits what on EKG?
Arterial gas embolism Anatomic ST elevation
97
What kind of child presents w/bacterial tracheitis?
3-8 y/o, uri prodrome that intensifies quickly MC d/t S. Aureus
98
Auricular hematoma aka cauliflower ear is treated how?
I + D with pressure dressing
99
What are Cerebral T waves? Indicate what?
Deep, inverted T waves in V3, V4 Common following Left Frontal hemorrhage Increased ICP
100
What Abx to give for upper GI bleed 2/2 to variceal bleeding?
Ceftriaxone 1 g/day OR Ciprofloxacin 400mg bid
101
What is the MC complication of VP shunt? Pts with this are at risk of what?
Overdrainage of CSF Risk of developing subdural hematoma d/t higher risk of tearing bridging veins
102
What is the MC type of elbow dislocation? Most serious complication?
Posterior Brachial artery injury
103
Diff bw dislocated patella vs dislocated knee?
Patella dislocation is only the knee CAP Knee dislocation is when femur and tibia out of place
104
What tachydysrhythmia has a regular rhythm?
Atrial flutter
105
What type of malformation is located laterally, anterior to the border of the SCM, near the angle of the mandible?
Branchial cleft cyst
106
What is the difference between breast milk and breastfeeding jaundice?
Breastfeeding jaundice means kids do NOT gain weight correctly, have weight loss and nutritional deficiency
107
MOA of TCA? What other effects do they have?
Fast inward Na channel blockade anti-ACh effects
108
What symptoms seen in VP shunt obstruction?
Bulging fontanelle, sundown eyes (pt cannot look up), HA, nausea
109
Class III hemorrhage has how much blood loss? How do you know it is class 3?
30-40% Significant tachycardia w/HoTN Pt could be lethargic
110
What asthma med is contraindicated in pregnancy? What mechanism?
Epi is teratogenic w/in the 1st trimester of pregnancy Uterine vasoconstriction and reduced fetal oxygenation
111
What is the MC finding in children under < 5 y/o that presents to the ED for acute appendicitis?
Rebound tenderness
112
What lab values are elevated in Ehrlichiosis?
Elevated transaminases, LDH, ALP Leukopenia Thrombocytopenia
113
When is a pelvic binder used?
Reduce venous bleeding d/t SI disruption in open-book pelvic injuries
114
Hemophilia B is deficiency of what factor? Head trauma needs to be treated how?
9 100IU/kg bc delayed bleeding is COMMON
115
When do you need emergent hemodialysis for hypercalcemia? What is the main tx?
> 18 or neurologic symptoms IVF
116
How to tell the difference between VP shunt overdrainage vs obstruction?
Shunt overdrainage headaches will come and go | obstruction HA's are CONSTANT
117
How do you treat TIA?
ASA alone or + dipyridamole
118
What lab value to diagnose acute parotitis?
Amylase
119
What confirms compartment syndrome?
Delta pressure = 30 mmHg
120
What serum salicylate level is an indication for hemodialysis in the acute setting? What is considered a toxic dose of ASA?
> 100 mg/dL 200-300 mg/kg
121
What kind of injury is a tertiary blast injury? Typical characteristics?
Blast wave propels body into objects or large objects strike body Crush and blunt trauma
122
Far lateral unilateral disc herniation bw L4 and L5 compresses which nerve root?
L4
123
Le Fort Fracture pattern mnemonic?
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
124
What is the initial pediatric defibrillation dose?
2-4 Joules/Kg
125
Pts who are hemodynamically unstable that need cardiac pacing, what ampage should be set?
80 mA (the max)
126
What uncommon fracture indicates high-velocity or abuse?
Scapular
127
What are the early signs of acetaminophen OD?
Malaise, anorexia, nausea
128
What kind of organism is haemophilus ducreyi?
G (-) coccobacillus
129
What is another name for Kawasaki disease?
Mucocutaneous LN syndrome
130
What COHb level indicates Hyperbaric O2 therapy d/t CO poisoning regardless of sx? In pregnant pt?
> 25% > 15%
131
What meds to use to lower BP in aortic dissection? If asymmetric BPs, what artery is involved?
Esmolol + sodium nitroprusside Subclavian artery
132
1st step in a pt w/trach bleed?
Overinflation of the trach cuff
133
Pt with active ACS (STEMI or NSTEMI) should be given what other than ASA? MOA?
Ticagrelor 180mg PO P2Y12 antagonist
134
What is a contraindication to using methotrexate in treating ectopic pregnancy? How big must the pregnancy be to exclude its use?
Liver disease > 4cm
135
What sign seen on xray indicates radial head fracture?
Posterior fat pad
136
Pt with stable M.G. Exacerbation, what is the 1st step?
Measure negative inspiratory force
137
DOPE mnemonic for a pt on vent with inadequate o2?
Displacement Obstruction Pneumothorax Equipment
138
When to do lateral canthotomy in orbital cellulitis?
Dec visual acuity IOP > 40 Significant proptosis
139
What medicine should be used pre-treatment in RSI for pt w/increased ICP?
Fentanyl - turns down the increase in BP
140
When do you hold warfarin for a pt? When do you give Vit K?
INR > 5 but < 10 > 9 and no significant bleeding
141
What can be used in OD of phenytoin?
Multiple dose activated charcoal can minimized delayed absorption of the drug
142
What carpal bone is MC dislocated?
Lunate
143
How to evaluate for open knee joint?
Normal saline joint injection
144
What maneuvers make the click in MVP go later? Mechanism?
Squatting - inc preload Handgrip - inc afterload
145
Hangman fracture is what anatomically?
B/l fracture of the pars interarticularis (aka pedicle) at C2
146
What is dextromethorphan MOA? Known as what? OD Sx?
NMDA receptor antagonist, cough syrup Visual hallucinations, slurred speech, nystagmus, tachycardia
147
What drugs can be given via ET tube in adults? Kids?
NAVEL LANE (no vasopressin)
148
What OD causes dilated pupils, tachycardia, dry, hot, urinary retention? What kind of nt blockade?
TCA Anticholinergic
149
Pt w/penetrating trauma that loses pulse in transport or in the ED, what should you do? Where should incision be made into pericardium?
Resuscitative thoracotomy At the apex, near the diaphragm anterior and parallel to the left phrenic nerve
150
What is lye? What happens if you ingest it?
Alkaline material Need upper endoscopy w/in 12-24 hours
151
What is the goal PaCO2 after ROSC? Goal Temp? Serum glucose?
40-45 32-36 C 108-140
152
What is the antidote for digoxin OD in a pt in Vfib? Digoxin is derived from what plant?
20 vials of digoxin-specific Ab Foxglove
153
Toddler (age 3) with an isolated spiral fracture needs what treatment?
Long leg cast
154
What is Mackler TRIAD? Seen in what?
Lower chest pain, vomiting, subQ emphysema Boerhaave’s syndrome
155
What are the indications for emergent hemodialysis after acute ethylene glycol OD?
Ethylene glycol > 50 mg/dL AG > 20 Initial pH < 7.3 Glycolic acid > 8 mmol/L
156
Febrile seizure seen in what child ages?
6 months to < 5 years
157
What kind of eye infection causes fluffy white perivascular lesions on fundoscopic exam?
CMV retinitis
158
Pediatric female pt that is presenting with fever and vomiting only what is the most likely diagnosis? Treat how?
UTI Cefixime (3rd gen)
159
What type of mask should a PATIENT with TB wear during transport?
Surgical mask
160
Child with AMS d/t lead toxicity in the blood should be treated how?
Whole bowel irrigation if paint chis in the GI tract
161
How does NAC work?
It is a glutathione precursor or substitute, a sulfate precursor, and prevents binding of NAPQI to hepatocytes
162
What is a Jones fracture in the foot? Located where?
Transverse fracture at the base of the 5th metatarsal 1.5-3cm distal to the proximal tuberosity at the metadiaphyseal junction
163
What Carboxyhemoglobin level is in an indication for Hyperbaric O2 therapy d/t CO poisoning? In pregnancy?
> 25% > 15% in pregnancy
164
Femoral hernia occurs where?
Internal inguinal ring Below inguinal ligament and medial to femoral artery
165
Young pt with AS, what is the treatment?
Balloon valvuloplasty
166
Isopropyl alcohol is converted into what by alcohol dehydrogenase? What does the ABG look like?
Acetone (ketone) No AG, normal pH
167
What nerve is responsible for photophobia?
V1
168
How is secondary syphilis treated? What about early latent (< 1 year)?
SINGLE injection of benzathine penicillin G Same
169
What mechanism do CCBs and BBs work by on the cardiac myocytes?
AV nodal blockade
170
What PE findings for Ludwig angina?
Brawny neck edema, submandibular swelling, elevation of the tongue secondary to edema of floor of the mouth
171
What is a layering of wbc in the anterior chamber called? Seen in what? Normally bc of what?
Hypopyon Endophthalmitis Post cataracts complication
172
What is the famous symptom of digoxin toxicity? Chronic symptom? Treatment?
Yellow color, halos and spots in their vision Ventricular dysrhythmias Dig Fab fragments
173
Pt with a bleeding peptic ulcer will have what abnormal lab value?
Elevated BUN
174
Pt with arm stuck in the “up” position has what? Usually from what? What complications?
Luxatio erecta aka inferior shoulder dislocation Axial load injury like swimming Auxiliary nerve and artery injury
175
What causes a beefy red ulcer that is painless in the genital area commonly in Africa and India? Treat how?
Donovanosis aka granuloma inguinale Azithro, doxy, Cipro
176
What shoulder technique is no longer recommended? Why?
Hippocractic technique Auxiliary nerve injury risk
177
Aortic dissection, what it the BP goal? What meds to treat?
100-120 systolic Esmolol or labetalol with nitroprusside
178
Painless nodular mass on testicle most likely what?
Cancer
179
What viral infection is commonly associated with Intussusception?
Adenovirus
180
What is Zanamivir? SEs?
Inhalation neuraminidase inhibitor used to treat flu or as prophlylaxis Wheezing, bronchospasm
181
What causes painless genital ulcer w/suppurative tender LAD?
Chlamydia trachomatis LGV serotype
182
What is sick sinus syndrome aka? Pathophys?
Tachycardia-bradycardia syndrome Injured SA and AV nodes
183
What causes facial flushing, HA, ABD cramping, diarrhea after eating at seafood restaurant w/peppery taste?
Scombroid fish poisoning (histidine metabolized into histamine)
184
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?
4 1,2 - crystalloid 3, 4 - crystalloid and blood 3 - greater than 120 4 - greater than 140
185
What is the MC salter-Harris fracture? Which requires surgery?
II IV/V
186
Pt that gets angioedema to ASA and having a STEMI, what do you give them?
Clopidogrel
187
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?
EKG, troponin Commotio cordis
188
AMS ddx?
``` AEIOU TIPS Acidosis, electrolyte, infection, opiates/OD, uremia Trauma Insulin Poison/psych/pharm Stroke, Seizure, syncope ```
189
What strange way can AFib present on EKG?
No P waves, uncoordinated atrial activity
190
What iron level requires Deferoxamine no matter what? SE of the drug?
> 500 mcg/dL HoTN
191
Rheumatic fever is what type of reaction? Forms what kind of rash?
Type 2 hypersensitivity from cross-reactivity of Abs to M protein Ags Erythema marginatum (evanescent rash w/ring margin)
192
How to assess a pt’s level of consciousness if they are altered?
Tickle posterior nasopharynx w/cotton swab
193
Pt with suspected rhabdomyolysis, what is the concern? What must you get?
Hyperkalemia EKG
194
What is the first thing affected by Necrotizing OE? What symptoms?
CN 7 trismus
195
Arthritic pain, abdominal pain, low grade fever, hematuria, and rash indicates what in kids? What intestinal disorder found with this disease?
HSP Intussusception
196
MC posterior nasal bleed location? Why do they need to be admitted?
Sphenopalatine ganglion Post packing causes vagaries stimulation —> can lead to bradycardia, bronchoconstriction, need tele
197
What area of the heart sits most anteriorly in the chest and is most prone to knife wound injury?
RV
198
What type of odontoid fracture is considered stable? Risk of type 2 fracture?
Type 1 Nonunion
199
What is De Winter syndrome?
STEMI Tall T waves in precoridal leads, upsloping ST depression > 1 mm at the J point ST elevation of .5-1mm in aVR
200
Treatment for spontaneous pneumomediastinum in a pt that is hemodynamically stable? Gold standard diagnostic test?
Discharge w/close follow up CT
201
What is accelerated idioventricular rhythm? Different than what? Caused by what?
Slow (50–75) ventricular rhythm VTach bc VTach is FAST, > 120 bpm Myocardial reperfusion
202
What is the treatment for uremic pericarditis?
Hemodialysis
203
Pt with pertussis, where can you obtain a sample for test?
Nasopharynx
204
What is Ludwig’s angina? Associate with what?
B/l cellulitis, abscess formation or both Acute airway obstruction
205
What penile pH level indicates an ischemic priapism? What is the initial treatment?
pH < 7.25 Intracavernosal phenylephrine then Cavernosal aspiration
206
What is the formula for the age-based max HR d/t sinus tachycardia?
220 - age
207
What describes a skin patch?
Flat, nonpalpable, circumscribed lesion > 5mm in diameter
208
What level of lead poisoning gets dimercaperol chelation therapy regardless if they have sx or not? Contraindication?
BLL > 70 microgram/dL Peanut allergy
209
When is cricothyrotomy contraindicated? What to do instead?
Children under 10 Needle cricothyrotomy with 12 or 14 guage angiocatheter
210
What are definitive signs of Methemoglobinemia?
Periroal cyanosis that does not resolve with 100% O2 Dark chocolate blood that does not become red after exposure to air
211
How to diagnose West Nile encephalitis?
Leukopenia with pronounced lymphopenia
212
Methemoglobinemia can occur when working around what? Treatment?
Silo filler’s disease —> Nitrogen oxides Methylene blue
213
How soon do you need to give Rhogam? How much?
Within 72 hours 50 mcg minimum
214
What are the 2 types of Welles’s syndrome? Specific for what?
A - biphasic T wave B - deeply inverted T wave critical stenosis of LAD
215
How do you determine if a laceration over the knee joint is considered open?
Inject saline into the knee joint , 200cc
216
Pts with DiGeorge Syndrome can have what other major defect? May present how?
Truncus arteriosus —> causes cyanosis and CHF Seizures
217
What is the Rhogam dose in a pt > 12 weeks? Before 12 weeks?
300 micrograms 50 micrograms
218
What is the lowest to highest level of EMS training? Which level can start IVs?
EMR < EMT < Advanced EMT < Paramedic Advanced EMT and higher
219
What D50 made of?
50g glucose in 100 mL saline
220
TCA overdose shows what on EKG?
Wide QRS | Terminal R wave in lead aVR (> 3mm)
221
Pt with food Bolus that is tolerating secretions, what is the next step in management?
IV glucagon
222
Proper dose of Epi during cardiac arrest?
1mg aka 10 mL of 1:10,000
223
What anti-seizure med is contraindicated in pts with sinus brady, SA block, 2nd and 3rd degree Heart blocks and Adams-Stokes syndrome? Why?
Phenytoin Prolongs effective refractory period
224
What temperature should frostbite rewarming occur at? Takes how long?
37-39 degrees C 15-30 minutes
225
How to cut thrombosed hemorrhoid?
Elevate overlying skin, make an elliptical incision
226
What is a Galeazzi fracture?
Distal radius fracture Distal Radioulnar joint dislocation “MU GR”
227
CXR which shows b/l pulmonary edema without evidence of cardiomegaly indicates what?
ARDS
228
What is it called when an adverse event leads to serious poor outcomes or death?
Sentinel event
229
What test has highest sensitivity to exclude PE?
Normal VQ scan
230
What fracture is pathognomonic for abuse?
Metaphysis fractures
231
What is the MC finding in a pt w/acute aortic dissection?
HTN
232
How can you decrease peak pressures in an intubated asthma pt?
Use a larger ET tube
233
Describe complex seizure
< 6mo or > 5 years > 15 minutes FOCAL
234
What is true about a Miller blade compared to a MAC blade?
Carries a higher risk of stimulating an airway reflex than a MAC
235
Pt with multiple miscarriages and chronic arthralgia has what? What other sx is common?
SLE Photosensitivity
236
What PO Abx to treat lung abscess? What IV meds?
Clindamycin Unasyn, carbapenem
237
Consensual photophobia indicates what? Treat how?
Iritis Cycloplegic —> homatropine
238
MC location for AAA?
Infarenal
239
What are the Hunter criteria?
Used for diagnosis of serotonin syndrome
240
What are the # 1, 2, MC causes of SJS in children?
1 - meds | 2 - mycoplasma pneumoniae
241
What vessel of the heart covers the septal area? What leads?
LAD V1-V4
242
What is an Ellis II fracture? Treat how?
Enamel + dentin Calcium hydroxide paste
243
Pt w/VP shunt that is getting headaches, blurry vision, and nausea intermittently has what? Caused by what?
Slit ventricle syndrome Shunt overdrainage
244
What is the MC cause of mastoiditis?
Strep pneumo
245
What is Cushing response?
bradycardia, HTN, dec RR
246
If you cannot give NSAIDs to a pt with gout and chronic renal insufficiency, what can you give?
Prednisone
247
What is a pathognomonic finding for SAH on physical exam? What drug can be used to decrease vasospasm?
Retinal subhyaloid hemorrhage (11-33% of cases) Nimodipine
248
What is the genetic makeup of partial moles?
69 XXY
249
What is anticonvulsant hypersensitivity syndrome? What happens initially?
DRESS Spares mucous membranes and rash starts 1-2 weeks after nonspecific sx
250
What kind of injury is a primary blast injury? Typical characteristics?
Direct effect from blast shockwave Shear and stress forces on tissues aka TMs, lung, eyes
251
How much does pH decrease with induced hypothermia?
Decreases by .012 for every 1 degrees C below 37
252
What antiviral is helpful in treating immunocompromised pts w/severe RSV?
Ribavirin
253
Treatment for toxoplasmosis is what? How is it acquired?
Pyrimethamine, sulfadiazine, folinic acid Reactivation of a latent virus
254
If you fuck up and put anesthetic in the carotid sheath when trying to do an inferior alveolar block, what can happen?
Horner’s syndrome - ptosis, anhydrosis, miosis Also trismus
255
What med is contraindicated with a hyphema?
Ibuprofen and ASA (NSAIDs)
256
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?
Low voltage go home if less than 240V High voltage > 1000 V admit for obs Need EKG and skin exam
257
What 2 serious illnesses can mimic kidney stones?
Aortic/ilia aneurysm | Renal vein thrombosis
258
What is conus medullaris syndrome? How to distinguish?
Distal SC compression - causes both UMN and LMN Sudden and BILATERAL
259
Patients with rupture of UCL requires what?
Immobilization and urgent surgical management
260
What is Ludwig’s angina? MC sx?
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
What are the major Duke criteria for endocarditis?
2 + blood CXR New murmur Abnormal echo
262
Describe MAT on EKG 1st line action? Treatment?
3 diff P waves, rate of 100-180, irregular IVF Underlying cause, CCB
263
What is an ischemic form of venous occlusion d/t massive iliofemoral thrombosis that involves most of the venous collateral system?
Phlegmasia cerulea dolens
264
How to treat acute arsenic gas toxicity? If not at level of toxicity yet then do what? What clinical signs?
Urinary alkalinization Dimercaprol Garlic breath, ABD pain, hematuria, jaundice, PMHx of working at semiconductor factory
265
CN 3 palsy + orbital cellulitis = ?
Cavernous sinus thrombosis
266
Bell’s Palsy presents how? Treatment?
Unilateral facial weakness, drooling, loss of taste, CANNOT raise eyebrow on affected side Prednisone and eye care
267
Age group of Retropharyngeal abscess? Most diagnostic PE finding? MC bacteria?
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
What is a stye?
Hordeolum
269
What time frame for a head CT to r/o SAH has a sensitivity of nearly 100%
6 hours
270
Sinus tachycardia, low voltage QRS and electrical alternans seen in what?
Pericardial tamponade
271
What Platelet level is an absolute contraindication to tPA? What about INR? Blood glucose level?
< 100,000 > 1.7 < 50
272
What is the formula for ETTs that are cuffed? UNCUFFED?
Age/4 + 3.5 Age/4 + 4 —> bigger size bc there is no cuff duh
273
What is a V common reason for pneumomediastinum on CXR in a young pt w/pleuritic chest pain of acute onset?
Asthma exacerbation
274
What is a blockage of the Meibomian glands called? Located where?
Chalazion Above the eyelashes on the upper lid
275
How will the penis appear in ischemic priapism?
Shaft is rigid and painful Glans is soft
276
What level of hypoNa requires 3% saline infusion?
Serum Na < 110 Or Na < 120 with symptoms
277
Any patient that presents w/signs and symptoms of decompression sickness, what is the treatment?
Hyperbaric oxygen
278
What are the neurologic complications of EBV?
encephalitis Meningitis GBS
279
How does Hct change in hypothermia?
2% increase in Hct for every 1 degree C drop in temperature
280
Pt that gets strep, is given amoxicillin and then gets a non-allergic rash over a week later has what?
Type 4 hypersensitivity
281
When should therapeutic thoracentesis be stopped as long as vital signs are stable?
After the onset of chest discomfort or cough
282
What type of cells seen in DIC?
Schistocytes
283
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?
Heterotopic pregnancy Infertility treatment
284
RBBB, look at what leads and for what?
Lead I —> Wide S wave | Lead V1 —> RSR’
285
Risk factors for anorectal abscess?
Crohns diabetes Chronic steroid use
286
What is the dosing for tPA in ischemic stroke?
0.9 mg/kg with max of 90mg 10% given as 1 minute bolus Remainder give over 1 hour
287
Pt taking exogenous thyroid hormone what is the tx?
BB, dexamethasone Do NOT need PTU or KI
288
Pt w/mesenteric ischemia that gets a CT scan, what is the most common radiographic finding?
Bowel wall edema
289
What kind of injury is a quaternary blast injury? Typical characteristics?
Environmental contamination from the device Burns, inhalation, toxic substances touch you
290
What is the treatment protocol for acetaminophen overdose?
Loading dose of 140 mg/kg PO of NAC | Followed by 70 mg/kg PO q4 hours for a total of 17 doses
291
Do ligaments and joints get strained or sprained?
Sprained
292
What rash is target-like with a central dark papule surrounded by a pale area and a halo of erythema? Seen in what?
Erythema multiforme HSV
293
What is the treatment for peri-oral electric burns in an infant? What can happen?
DC w/bleeding precautions, can use topical Abx and gentle swabbing Bleeding from superior labial artery
294
Central cord syndrome occurs with what type of injury?
Extension Mnemonic: Extra Credit Injury
295
How does uterine rupture present (other than abd pain and vaginal bleeding)?
GRADUAL worsening abd pain and fetal distress, loss of station of the fetus, palpation of fetal parts directly through ABD wall
296
What is a contraindication to nail trephination?
Posterior nail edge disruption
297
What do cocaine screen tests test for? How long is cocaine in your system for?
Metabolite benzoylecgonine 3 days up to 8 in heavy users
298
How do you calculate total body K+ deficit?
Each 0.3 mEq drop in potassium below normal = 100 mEq deficit
299
Treatment for Lyme in pregnant pt?
Amoxicillin 500mg bid for 14 days
300
How should you treat a stingray wound?
Immerse in tap water at 45 C (113 F)
301
Old Pt with UE weakness, sensory deficits and urinary retention has what? Mechanism? Prognosis?
Central Cord Syndrome Hyperextension Medium
302
Pt that comes in with a traumatic hyphema needs what test 1st? What medical condition is associated with spontaneous hyphema?
Seidel Sickle cell disease
303
How to treat acute mountain sickness? When do sx usually begin?
IVF Acetazolamide/dexamethasone Delay of further ascent 6500 - 8000 ft
304
What chemical is used in glass etching, home rust remover, metal cleaning, and electronic manufacturing? Treat how?
Hydrofluoric acid Topical calcium gluconate bc that acid causes profound hypoCa
305
What is the pathophysiology of polymyositis? Clinical Sx?
Degradation of muscle cells Subacute proximal muscle weakness and myalgia
306
What is the treatment for spontaneous PTX?
100% O2 on non rebreather mask if < 20% in healthy pt
307
Child >8 y/o with hypoglycemia, what is the dose?
1) estimate weight: (2 x age in years) + 8 2) 50/50 = 1 mL/kg of D50 3) weight x dose
308
How to treat VTach?
Pulseless —> immediate defibrillation Unstable —> synchronized cardioversion
309
What structure may rupture in the inner ear with rapid ascent?
Round window
310
What is the major enzyme involved in the production of NAPQI? What happens when this system is overwhelmed in Tylenol OD toxicity?
CYP2E1 Shunts to CYP450
311
Black widow bites how do you treat?
Supportive but also opioids and Benzodiazepines
312
Pt that goes into a woodshed can have difficulty breathing d/t what? What medicine is contraindicated?
Hydrocarbon ingestion Epinephrine
313
Define what is meant by a when a pt has a test that is normal, the likelihood the patient does not have the disease?
NPV
314
What is the pathophysiology behind Type 3 vWF disease?
No vWF produced AND low levels of Factor 8
315
What is chemosis? Seen in what? What is enophthalamos? Seen in what?
Swelling of the conjuctiva, orbital cellulitis Posterior displacement of the globe w/in the orbit, seen in orbital trauma and blowout fractures
316
Sickle cell pt that has very low Hg and No reticulocytosis has what? Do what?
Aplastic crisis Transfuse
317
What is Sever disease? Causes what? Treatment?
Calcaneal apophysitis Posterior heel pain in males 8-12 y/o Supportive care
318
What is the 1st line treatment for seizures in neonates? Dose? Repeat dose? Max?
Phenobarbital 20-30 mg/kg IV 10-20 mg/kg, Max is 50 mg/kg in 24 hours
319
What opioid can cause mydriasis in cases of toxicity?
Meperidine
320
What vessels make up Kiesselbach’s plexus?
Septal branch of superior labial branch of the facial a. Lateral nasal branch of SP artery Septal branch of the anterior ethmoidal artery
321
CC of flank pain in old person that is not kidney stones, what must you consider?
ruptured AAA
322
Aerospace manufacturing lung disease cause? Welders and silver polishes? Sandstone, clay, granite? Classic CXR finding?
Berylliosis Siderosis Silicosis, basilar alveolar filling
323
Where does phosgene gas fuck up airway? Smells like what? Causes what?
Oxygen diffusion in the alveoli Musty hay or freshly mown grass Pulmonary edema, injury
324
Pelvic avulsion fracture MC type? Treat how? What mechanism does it happen?
Ischial tuberosity avulsion Non-weight bearing for 6 weeks Forceful kicking, like a soccer ball (due to hamstrings)
325
What is the treatment for anal fissure?
Topical nitroglycerin or topical nifedipine
326
When to add steroids in pt with PCP? What’s the alternative treatment other than Bactrim?
PaO2 < 70 or o2 sat < 93% and AA gradient > 35 Pentamidine
327
What accounts for the greatest % of heat loss in cool environments?
Radiation
328
What PE sign indicates retrocecal appendix? How do you do it?
Psoas sign Extend pt right leg why lying on left side, pain is (+)
329
What defines neutropenic fever? Admitted where?
> 38.3C or sustained 38C for more than 1 hour AND Neutrophil count < 500 cells/microL General Medical Floor
330
What are some examples of non-ionizing radiation?
Microwaves, infared, radio, thermal Basically anything that does start with a Greek letter or 1 letter
331
What is the most likely cause of macrocytic anemia?
Direct EtOH toxicity
332
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?
Anorectal abscess
333
What is a common finding of high altitude pulmonary edema?
Right middle lobe involvement will show patchy alveolar infiltrates
334
What presents w/sudden onset of high fever, retro-orbital HA, nausea, vomiting, severe myalgia and morbiliform rash?
Dengue fever 4-7 day incubation period
335
Old person in pain, how to treat their delirium? What environment should they be in?
Opiates Quiet, low-light
336
What are the cardinal signs of anterior uveitis (3)?
Ciliary flush Marked injection at the limbus Red ring around the iris
337
Pt with hepatorenal syndrome has what abnormal lab value? Treat how?
Progressive rise in serum Cr Vasopressors to cause splanchnic vasoconstriction
338
What is the target PaCO2 in a hyperventilated head injury pt? Onset of effect?
30-35 W/in 30 seconds
339
How does herpes simplex keratitis present? Treatment?
Unilateral eye pain w/dendritic pattern Trifluridine
340
Pt w/3rd degree heart block, which med to give first? If it fails?
Atropine Dopamine
341
Formula for correct cuffed ETT size? Uncuffed?
(Age/4) + 3.5 (Age/4) + 4
342
How to treat large iron ingestion in a kid?
Whole bowel irrigation with polyethylene glycol aka MiraLAX
343
Wernicke’s encephalopathy triad?
Encephalopathy, oculomotor dyfx, gait ataxia
344
SALTER Harris types 1-5?
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
What Abx used to treat skin lesions in scleroderma?
Minocycline
346
Pt with an unexplained pleural effusion should be worked up for what?
PE
347
Major SE of zidovudine? Efavirenz? Didanosine?
Bone marrow suppression Vivid dreams Pancreatitis
348
Child 1-8 y/o with hypoglycemia, what is the dose?
1) estimate weight | 2) 50/2.5 = 2mL/kg of D25
349
What is the MC oculomotor sign in pts w/Wernicke’s encephalopathy?
Lateral nystagmus
350
Oral hairy leukoplakia indicates what else?
Confection by HIV Lesions caused by EBV, NOT precancerous
351
How much bleeding output is indication for emergent thoracotomy?
> 7 mL/kg/hr following chest tube placement Output > 200 mL/hr for the first 3 hours
352
What vaccine is safe in pregnancy?
Tdap Hepatitis Inactivated influenza
353
What is Brudzinski sign?
Neck flexion causes hip and knee flexion For meningitis
354
Pt experiencing decompression sickness has what sx? What will they NOT have?
Vertigo, myalgia, Dyspnea, parasthesia, burning, mottling Loss of consciousness
355
What is defined by the fractions of patients who truly have a disease and are identified as so with a test?
Sensitivity
356
What is the dosing for tPA?
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
What is the MC abnormal radiologic finding in foreign body aspiration?
Obstructive emphysema
358
In the first moments of life, what should goal O2 sat be in a neonate?
Titrated up until 10 minutes of life where O2 saturation should be > 90%
359
Who is at risk for aortoenteric fistula? Dx how?
PMHx of AAA, aortic repair/graft EGD
360
How to avoid Boutonnières deformity with splinting?
PIP in extension, DIP and MCP joints should have full ROM
361
Albuterol has what short term electrolyte effects?
Hyperglycemia Hypokalemia Dec Mg and PO4
362
Ankle arthrocentesis should be performed in which location and direction?
Medial to tibialis anterior tendon and directed toward the anterior edge of the medial Malleolus
363
What is the goal pH for irrigation in cases of a chemical burn?
7.0-7.2
364
What causes painful suppurative ulceration on the penis and painful inguinal LAD?
Haemophilus ducreyi
365
48 y/o guy that suddenly becomes unresponsive and goes into VFib and achieves ROSC most likely has what?
CAD
366
What is Oil of wintergreen? Treatment for OD?
Salicylic acid (Aspirin) Sodium bicarbonate and activate charcoal if < 1 hour from ingestion
367
LVH w/deep, narrow Q waves in the lateral and inferior leads are seen in what condition?
HOCM
368
What kind of objects need endoscopic removal?
Sharp ones Longer than 5cm OR Wider than 2.5cm
369
Ingestion less than what level of NSAIDs are unlikely to cause significant toxicity and do not require observation?
< 100 mg/kg
370
Child < 1 y/o with hypoglycemia, what is the dose?
1. Estimate weight: (2 x age in yrs) + 8 2) 50/10 (10 for D10) 3) weight * 5mL/kg
371
Which direction is orthodromic? Describe the morphology
Clockwise Deep Q waves
372
What is the tube insertion site for a cricothyrotomy?
Superior to cricoid cartilage Inferior to thyroid cartilage
373
What is a Swan neck deformity?
PIP in hyperextension DIP in flexion SwanEEE
374
Child w/SVT, what is the cardioversion energy?
1st attempt 0.5-1 J/kg 2nd attempt 2 J/kg
375
What is oxymetazoline? Used for what? MOA?
Nasal spray decongestant for rhinosinusitis A1 agonist and a2 partial agonist
376
Pt that takes meds and a week later develops allergic symptoms has what type?
Serum sickness - type 3
377
Treatment for Croup?
Decadron, racemic epi
378
AIDS pt w/ring-enhancing ICL + AMS = ?
Primary CNS lymphoma
379
Fracture-dislocation of the tarsometatarsal joints is called what? What radiographic finding?
Lisfranc injury Lateral shift of the 2nd metatarsal off the middle cuneiform
380
How much blood loss in class II hemorrhage?
15-30%
381
Malocclusion of the jaw and pain with eating indicates what? This is different from what? How?
TMJ disease TMJ dislocation —> cannot open the mouth
382
What is the management for a lateral patella dislocation?
Closed reduction | Post reduction xray, with splint
383
Treatment for anticholinergic associated hyperthermia?
Ice water immersion Evaporative cooling Benzodiazepines
384
What street drug can cause prolonged QT/Torsades?
Methadone
385
Obstructing DVT of the proximal ileofemoral vein is called what? Treat how?
Phlegmasia cerulea dolens Heparin + vascular consult
386
What neck fracture is considered stable?
Clay-shoveler fracture aka avulsion of the SP of C6 or C7
387
What is the atropine dose in a pt w/symptomatic bradycardia w/a pulse?
0.5 mg IV push
388
What kind of follow up do buckle fractures need?
Primary care in 3 weeks Apparently not ortho, ya right
389
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?
Green stick Less than 10
390
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?
Coral snake Inhibition of muscarinic AChRs Neostigmine (ACh-Es)
391
Temporal arteritis can effect what else?
Aortic involvement leading to valvular insufficiency, aortic arch syndrome and dissection
392
What is the MC vital sign abnormality in PE? MC presenting symptom? #2?
tachypnea Dyspnea at rest or exertion, Pleuritic pain
393
How do you make a sodium bicarbonate drip for treatment of TCA OD?
Mix 150 mEq of NaHCO3 with 1 L of D5W
394
How does transverse myelitis present?
Post viral Defective or absent motor, sensory, ANS fx w/clearly demarcated spinal level Progressive onset over hours to days
395
What is the management of a patient that has a fever and has a catheter for dialysis?
Get blood cultures, give ABx but LEAVE catheter in
396
Achilles’ tendon rupture requires what kind of splint?
Equinus splint
397
What finding indicates acute traumatic aortic disruption?
Elevation of the right mainstem bronchus
398
Alcoholic patient that has chest pain, muscle cramping, numbness, tingling and low calcium can be treated with what?
Magnesium 2g
399
Female pt that has severe chest pain after eating that resolves within 30 minutes has what? Treat how?
DES CCB (Diltiazem) or TCA
400
What is the triad for HUS?
MAHA thrombocytopenia Renal insufficiency
401
What is the 1st line treatment for lice in ALL populations?
Permethrin
402
Pt that develops painless visual loss w/flashes of light followed by cloudy, curtain-like loss has what?
Retinal detachment
403
When should a pt with a STEMI get tPA?
Nearest facility is further than 2 hours away AND pt presents w/in 12 hours of symptom onset
404
Primary teeth are present for how long? Avulsed primary tooth treated how?
6months - 6 years Do not replace tooth, urgent dental referral
405
How to figure out size needed cuff or UNCUFFED tube?
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
What Syndrome associated w/bilateral injury of the spinothalamic and CST tracts? Mechanism? Cx?
Anterior cord syndrome Flexion or vascular Complete loss of motor, pain and temp below injury, retain 2pt/proprio
407
What is the MC organism in bacterial tracheitis? What virus increases susceptibility?
Staph aureus Influenza A
408
Neonate that is gasping and continues to have poor respiratory drive or bradycardia should have what intervention? Goal O2 sat of what?
PPV w/bag mask with room air 60-70%
409
When should you pack an abscess?
> 5cm Pilonidal Pt is diabetic or immunocompromised
410
What drugs can you use for uterine atony? And what is the dose for the #1 choice?
Oxytocin - 10IU IM Methylergonovine Carboprost
411
Pt that comes in with suspected ibuprofen OD, what should you do? What is not helpful?
Acetaminophen level activated charcoal
412
Wellens’ syndrome shows what on EKG?
Deeply inverted T waves in V2-V4 (type B) Or Biphasic T waves in V2-V4 (type A)
413
How to calculate shock index? What is normal?
HR / systolic BP .5 - .7
414
How to dx intussusception? Tx?
US Air contrast enema
415
How many cc’s are considered normal in a post-void residual? What is the MC location of prostate metastasis to bone?
< 100cc T-spine
416
Blood and thunder seen on Ophthalmology exam indicates what? What is the treatment? What are the clinical sx?
Central retinal vein occlusion Referral to ophthalmology Sudden, painless monocular loss of vision
417
Pt camping in the Midwest of the U.S. that has RUQ pain has what?
Entamoeba histolytica
418
How to correct for potassium in the setting of acidosis?
Subtract 0.6 mEq from K for every .1 decrease in pH from 7.4
419
CURB-65 stands for what?
Confusion Urea > 7 RR > 30 BP (systolic) < 90
420
What drugs induce CYP 450? Inhibit? Inducing CYP means what?
Phenytoin, nafcillin, phenobarbital, rifampin Cimetidine Gets rid of the drug faster meaning the drug doesn’t work as well
421
Pt not bleeding but has other signs (petechiae) and Plt < 20,000; what is the treatment? Same scenario but WITH bleeding?
Prednisone IVIG + IV methylprednisolone
422
Describe roseola What virus #?
Abrupt onset of fever that lasts 3-4 days. Fever resolves then rash appears and lasts 1-2 days HHV 6
423
What nerve supplies sensation to the anteriomedial face including cheek and upper lip? Branch of what larger nerve?
Inferior orbital nerve Maxillary division (V2) of CN 5
424
Pt that has a pelvic fracture and is hemodynamically unstable, what is the treatment?
Angiographic embolization
425
Pt w/complete loss of motor, pain, temp below injury but retains prop/vibratory has what? Mechanism? Prognosis?
Anterior cord syndrome Flexion or vascular Poor
426
Diffuse macular, blanching erythroderma that looks like sunburn is what? Treat how?
Toxic shock syndrome rash Clindamycin
427
How to treat malaria?
Quinidine and Doxycycline
428
What is a fracture of the distal radius with dorsal displacement called? What injury is MC assoc w/it?
Colles fracture Ulnar styloid
429
What EKG changes can digoxin cause?
Downsloping ST depression w/slurred appearance Flattened/inverted or biphasic T waves Shortened QT interval
430
What is the max dose of lidocaine with epinephrine that can be injected into the peripheral tissues? Bupivicaine?
5 mg/kg without Epi, 7 mg/kg with 1.5 without, 3 with
431
Pregnant pt with umbilical cord prolapse, how to proceed before emergency C section?
Trendelenburg position Knee-chest position Bladder filling Manual replacement of the cord
432
How do you know when to give fluids after seeing IVC on US?
If IVC collapses > 50% on inspiration this indicates decrease in blood volume and predicts fluid responsiveness
433
How is octreotide dosed in upper GI bleed?
Bolus of 50 mcg then infusion of 50 mcg/hr
434
Where is a lacrimal duct injury located? Where is the lacrimal gland located? Eyelid laceration > what length needs to be repaired?
Medically to the puncture Superolateral space next to each eye > 1 mm
435
Where does the supraorbital nerve originate from?
Branch of the frontal nerve which is a branch of V1
436
Pts w/HELLP syndrome are at risk for what?
Hepatic rupture
437
What is the max distance that can be repaired using the hair apposition technique?
10cm
438
What medicine is used to treat opioid induced constipation?
Methylnaltrexone given subQ
439
What is the treatment for fat embolism?
IVF and supplemental O2
440
Posterolateral unilateral disc herniation bw L4 and L5 results in compression of what root?
L5
441
Alcoholic pt with vomiting needs what resuscitation? LR or NS? Why?
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
How to treat Portuguese man of war nematocysts?
Hot water and topical lidocaine If don’t have access to that use salt water
443
Pt in a mass casualty situation has RR > 30, triage what color?
Red
444
What are some characteristics of organic (medical reason) confusion?
Visual hallucination
445
What is the relationship of hydromorphine to morphine?
Hydro is 7x as strong 1mg of hydro = 7mg of morphine
446
What recommendation says a treatment benefit = risk and thus should not be administered?
Class III
447
What is the MC cause of dacryocystitis?
Staph aureus
448
Benzo withdrawal seizure is most likely with what feature?
Injury during the episode
449
What leads to look at in a right sided EKG? ST elevation in these leads indicate what?
V4R, V5R, V6R Right ventricular infarct
450
What antieliptic drug has a SE of hyponatremia?
Oxcarbazepine
451
What is the definition of empyema?
Presence of bacteria on Gram stain of the pleural fluid after it has been drained
452
How to treat GC?
Ceftriaxone 250mg IM + Azithromycin 1g
453
Do muscles get sprained or strained?
Strained
454
Echocardiogram that shows hyperkinetic heart motion indicates what?
High output Heart Failure
455
People who cannot recognize their illness fail to demonstrate what part of capacity?
Appreciation
456
What is the 1st line treatment regimen for diverticulitis? 2nd line?
Cipro 500mg bid + metro 500mg q8 Augmentin 875/125 q8 for 10 days
457
What is the 1st line treatment for BP in aortic dissection? 2nd line?
Labetalol or esmolol Nitroprusside
458
How to correct for sodium in cases of hyperglycemia?
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
What is the best antidote for rivaroxaban? What’s the new drug that provides “decoy” factor X receptors?
IV 4 factor prothrombin complex concentrate Has factors II, VII, IX, X, protein C and S Andexanet
460
What is the treatment for idiopathic sudden sensorineural hearing loss?
Prednisone 60mg 7-14 days
461
Describe rash distribution of RMSF? Treatment in children?
Begins on ankles and wrist, then spreads to chest, back Doxycycline, ALWAYS
462
Blurred vision, bradycardia, ECG w/hyperK and peaked t waves is what?
Digoxin toxicity
463
First step with suspected penile fracture? Mechanism of pathology?
Call urology Disruption of the tunica albuginea surrounding the corpus cavernosa
464
How to treat Valproic acid toxicity? What do these pts commonly have?
L-carnitine administration Hyperammonemia
465
What infection is the MC that presents w/erythema multiforme? What else?
HSV Mycoplasma Lupus, hepatitis Drugs
466
Formula for uncuffed ETT size?
(Age/4) + 4
467
What is the parkland formula?
4mL x tot % body surface area x body weight (kg)
468
What is a Pseduo-Jones fracture? Treatment?
Fracture fo the proximal 5th metatarsal reaching the articular surface (5th metatarsal tuberosity) RICE
469
What is the pathophysiology behind Type 1 vWF disease? What else?
Decreased production of the glycoproteins Also low levels of Factor 8
470
What do the labs show in TTP?
Elevated LDH Elevated indirect bilirubin Normal coags Plt < 50,000
471
What medication can be used for prophylaxis of migraine headaches?
Propanolol Also verapamil and topiramate
472
What is the order of 7 cardinal movements of labor?
Engagement, descent, flexion, IR, Extension, ER, Expulsion EDF IEEE
473
What cells of the pancreases have exocrine fx? Like what enzymes?
Acinar Trypsin, chymotrypsin, lipase, amylase
474
When should hiccups be evaluated? How? Treatment?
More than 48 hours straight H+P, basic labs, CXR PPI, baclofen, gabapentin, Reglan, CHLORPROMAZINE (fda approved)
475
Old pt that has AMS, febrile, tachycardia, diaphoresis, midrange pupils, and rigidity is withdrawing from what? Has what?
Levodopa NMS
476
Treat tension PTX how?
Needle thoracostomy 2nd ICS, midclavicular line with 14 gauge catheter
477
Hirschsprung enterocolitis can occur before or after surgical repair, what is the treatment?
Metronidazole w/or w/out rectal irrigation
478
What is another name for bucket handle fracture or corner fracture? Pathognomonic for what?
Metaphyseal fracture Non-accidental trauma
479
What is type 1 of Brugada? Type 2? Pathophys?
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
Dosing of tPA for massive PE?
100 mg over 2 hours IV
481
What tick borne illness can cause fever, RUQ pain, scleral icterus +/- rash?
Ehrlichiosis
482
Pt with suspected tertiary syphilis, evaluate and treat how?
Send a CSF VDRL and give IV PCN G 4 million units
483
Pt fractures humerus, what is a Hil-Sachs lesion? What is a Bankart lesion?
Compression fracture of posterolateral numeral head Fracture of the inferior glenoid rim
484
Thrombosed hemorrhoid present for greater than 72 hours, what is the management?
Topical hydrocortisone cream with lidocaine
485
Where can primary chancre from syphilis occur?
Genitals or oropharynx
486
How much energy to convert hemodynamically unstable AFib with RVR?
120-200 K biphasic 200 mono
487
What is a common presenting symptom in pts with optic neuritis? What time course? Treatment?
Color perception decreased Dec vision gradually over a few days Severe central vision loss IV methylprednisolone
488
What is oxymetazoline? Similar to what med?
A1 agonist, partial a2 agonist Clonidine (a2 agonist that inhibits release of peripheral catecholamines)
489
what are the findings of a patellar rupture?
Can’t extend knee Superior patellar displacement Tenderness inferior to patella
490
What causes cauda equine syndrome?
Lumbo-sacral Nerve root impingement
491
How much glucose and fluid is in an amp of D50?
25g glucose in 50 mL
492
Most serious consequence of knee dislocation is what? Hard sign?
Popliteal a injury palpable thrill, visible expanding hematoma
493
What is the Abx treatment for post C-section endometritis? Post vag delivery endometritis?
Clindamycin + gentamicin ampicillin + gentamicin
494
Sexual assault victims, what is the 1 thing that is recommended as part of eval and tx?
Forensic evidence collection
495
When to use linezolid instead of vancomycin as 1st line empiric treatment?
Pts w/septic shock or respiratory failure d/t pneumonia
496
Delta pressure = ? What indicates compartment syndrome? What occurs first, loss of pulses or sensory deficits?
Diastolic BP - intracompartment pressure < 30 means compartment syndrome Sensory deficits
497
What is the pediatric dose of pediatric IV epinephrine in a code?
0.01 mg/kg
498
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?
blunt laryngotracheal compromise leading to progressive airway obstruction intubate with fiberoptic scope
499
What is a boutonnière deformity?
PIP in flexion DIP in extension BP Fucks
500
Side effect of etomidate?
Myoclonus
501
What is the management of extraperitoneal bladder rupture?
Non surgical - Foley for 1-2 weeks to allow for spontaneous healing
502
Inferior displaced patella means what? Superiorly displaced?
Quad tendon rupture Patella tendon rupture
503
Young child that presents with myalgia, thrombocytopenia and hyponatremia after camping has what?
RMSF
504
Perichondritis MUST be treated for what? Use what?
Pseudomonas Ciprofloxacin
505
Where do you palpate the posterior tibial artery pulse?
Posterior and inferior to medial Malleolus
506
Child w/opsoclonus-myoclonus syndrome has what? Need to do what?
Neuroblastoma MRI of chest, abdomen, pelvis
507
What lab study is most prognostic in acute radiation exposure? What particle has the greatest mass?
Lymphocyte count Alpha
508
Ring-enhancing IC lesions + FND = ?
Toxoplasmosis
509
What are the risk factors for TRALI?
``` Hx of liver transplant Chronic EtOH abuse Smoker Shock + fluid balance high Peak pressures on vent ```
510
Bolus dose of 3% hypertonic saline for treatment of seizure 2/2 to hyponatremia is what?
2 mL/kg given over 10 minutes
511
What common drug cannot be given in pregnancy?
Epinephrine
512
ITP presents how? Treatment?
Petechiae rash and low Plts IVIG and prednisone
513
Anterior cord syndrome comes with what kind of injury? What else can cause this?
Flexion w/contusion to anterior portion of the cord Mnemonic: Free Agent Cross clamping the aorta
514
What induction agent should be avoided in septic pts? Why?
Etomidate Adrenal suppression
515
What valve abnormality is most likely to develop after blunt cardiac injury?
Aortic Regurgitation
516
What scoring system helps ID patients w/upper GI bleed who are candidates for outpt therapy?
Glasgow-Blatchford Bleeding Score
517
What kind of needle is used for LP? What level does the SC end in adults?
Whitacre L1
518
What high-risk feature has the highest +LR in ACS?
Radiation to right arm or shoulder (LR+ 4.7) Both arms LR+ 4.1
519
Young pt w/signs and symptoms of pericarditis, what else must you consider?
Myocarditis
520
How is the glottis opening different in children compared to adults? Formula for predicting UNCUFFED ET size in children?
More anterior (Age + 16) / 4
521
MC cause of Cushing syndrome? 2nd MC?
Iatrogenic steroid use Cushing Disease d/t pituitary tumor
522
Cat bites with puncture wounds should be closed how?
Not at all Let them heal naturally by secondary intention
523
What scoring system estimates risk of major bleeding on patients on anticoagulation to assess risk in AFib?
HAS-BLED ``` HTN Abn kidney or liver fx Stroke Bleeding Labeled INRs Elderly > 65 Drugs or EtOH ```
524
Pt in DKA that suddenly has headache and ams, has what? Treat how?
Cerebral edema Mannitol
525
Spontaneous PTX d/t COPD, what is the treatment?
20F chest tube directed superiorly
526
What size ETT cap will attach to the angiocatheter in order to bag the pt?
3-5
527
What is a common complication of perinatal and perirectal abscess? Do you need surgery consultation?
Fistula formation Most often no
528
High altitude cerebral edema should be treated how?
Dexamethasone is 1st line for rescue (pt will be ataxic, altered)
529
What is the goal fluid resuscitation urine output in septic Peds pt?
> 1 mL/kg/hr
530
What is the treatment for hyphema? Mechanism? What meds to avoid in sickle cell patients?
Timolol Topical BB that Dec aqueous humor production and lowers IOP CA-Is
531
What is the most sensitive test for Lyme meningitis?
B. Burgorferi antibody
532
What finding on a UA is most sensitive for UTI?
Leukocyte esterase (83%)
533
In hospital death after near death hanging or strangulation is d/t what?
Pulmonary edema and ARDS
534
How does TXA work? Mechanism?
Reduces plasminogen activation to plasmin Competitively blocks lysine bidding sites on the enzyme preventing binding of fibrin thus inhibiting clot breakdown
535
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?
Capnocytophaga canimorsus
536
What medication is contraindicated in sickle cell pts with hyphema? Why?
CA-Is They lower pH - increase sickling
537
What is a delta pressure?
Diastolic BP - direct pressure
538
What are the labs expected with hemolytic transfusion reaction?
Inc LDH Dec haptoglobin (+) direct Ag test
539
Cavernous sinus thrombosis first causes a palsy of which CN?
6
540
For every 50 mL of HCO3 how much does the pH change?
Increases by 0.1
541
How should pregnant trauma pts be managed?
Chest tube thoracostomy should be performed in a relatively higher position during pregnancy
542
Pt with a left atrial mass has what? How to manage?
Atrial myxoma Transfer to tertiary care center d/t high risk of acute decompensation
543
What kind of injury is a secondary blast injury? Typical characteristics?
Impact of FRAGMENTS Penetrating trauma, lacs, amputations
544
What does Clonidine poisoning cause?
Lethargy, miosis, Bradycardia
545
What ECG findings indicate a RV infarct?
ST elevation in V1
546
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?
Froment’s sign Ulnar nerve palsy
547
What is the smallest amount of free fluid that can be viewed on a FAST exam?
75-250 mL
548
What is the name of a ventricular-originated rhythm with a rate < 100 bpm?
Idioventricular rhythm
549
What site for arterial line placement has the highest risk of limb ischemia?
Brachial artery
550
Which central line location has the lowest rate of infection?
Subclavian
551
What is the PaO2 goal in ARDS? This converts to what % O2?
55-80 mmHg 88-95%
552
What is the Kocher criteria used for? What composes it?
Septic arthritis in Peds 1) non-weight bearing 2) ESR > 40 3) fever > 38.5C 4) wbc > 12,000
553
What is an indication that shock is occurring?
Confusion —> shock is a Cx diagnosis No lab test or VS can diagnose it
554
MC cause of isolated abducens nerve palsy?
Microvascular ischmeia from diabetes or HTN
555
What is the pathophysiology behind Type 2 vWF disease?
Glycoprotein is produced but NOT functional
556
Infant w/bilious vomiting that occurs in the 1st week has what? Classic xray findings? Treatment?
Malrotation w/midgut volvulus Dilated stomach w/duodenal bulb Ladd procedure
557
What is the major SE of TTM? Through what mechanism? what is the Goal?
Hypoglycemia metabolism slows, causes insulin resistance bG of 108-140
558
What is the earliest ECG finding in acute MI?
Hyperacute T waves
559
What are the RF for uterine atony?
``` Multiple gestations Macrosomia Polyhydramnios Prolonged labor Use of tocolytics ```
560
Patient that has a bartholin gland abscess I&D’ed in the ED, what is the next management?
Word catheter for 4-6 weeks
561
What can be given to prevent BPD in infants? What else w/special time frame? What else does this treat?
Caffeine Surfactant w/in 1 hour of life Apnea of prematurity
562
What kind of Salter Harris fracture only involves the epiphysis?
Type 3 | Aka “lower than the growth plate”
563
What is the MC sequela of myocarditis/pericarditis?
Dilated cardiomyopathy
564
Describe EKG of posterior MI?
Tall R waves in V1-V3 with horizontal ST depression and upright T waves
565
How to discharge pts in a mass casualty blast situation?
Otoscopic eval of TMs
566
Describe the following in a sickle cell pt w/aplastic crisis: Retic count Coombs test Haptoglobin level
Dec Negative Normal
567
Pt with heavy bleeding and INR of 8 should be treated how?
Vit K and PCC PCC is more effective than FFP
568
What is a Boutonnière finger?
DIP joint extension with proximal IP joint flexion
569
What are the risk factors for placenta previa?
Prior C section Multiple gestations/mulparity Multiple induce abortions Old woman
570
What indicates acute appendicitis on US?
Diameter > 6mm Wall thickness > 3mm Target sign
571
Light’s Criteria?
Pleural:serum protein > 0.5 Pleural:serum LDH > 0.6 Pleural LDH > 2/3 upper limit of normal for serum LDH
572
How to treat acute asthma exacerbation?
``` BIOMES Beta agonists Ipratropium O2 Mag sulfate Epi Steroids ```
573
What does whole bowel irrigation mean?
Using MiraLAX
574
What features suggest VTach over SVT?
Capture and fusion beats AV dissociation
575
MC finding in salicylate OD? What derangement first? When to hemodialysis?
Hyperthermia Respiratory alkalosis w/hyperventilation Then Metabolic acidosis w/inc Bicarbonate excretion > 100 mg/dL
576
Functional cause of confusion means what? What is an example of a cause?
Psychiatric Auditory hallucinations
577
How do you test the motor function of the median nerve?
Thumb and 5th finger opposition (recurrent n.) OK sign (ant interosseous branch)
578
What describes unstable angina?
New in onset that occurs at REST or w/minimal exertion OR A worsening change in a previously diagnosed unstable angina
579
When is shingles treated? Who should avoid pts w/shingles?
Within the first 3 days Pregnant patients
580
What has the highest LR+ in adult pts for appendicitis?
RLQ pain
581
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?
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
What nerve innervates the platysma muscle?
Cervical branch of facial nerve
583
What is a potential complication of chest tube placement in a PTX that has been present for several days? How to avoid?
Re-expansion noncardiogenic pulmonary edema Do not suction and limit amount of fluid initially drained
584
What does a fundoscopic “blood and thunder” exam indicate? Seen in what condition?
Central Retinal vein occlusion Chronic glaucoma
585
Posterior shoulder dislocation results in what Xray finding?
Light bulb sign or rim sign
586
What meds are contraindicated in WPW?
Adenosine Beta blocker CCB Digoxin
587
Treatment for tularemia that is disseminated to cause PNA?
Streptomycin Doxy for local rxn
588
What is the treatment for herpes keratitis?
Acyclovir or Trifluridine
589
Age group of Staph scalded skin syndrome? Treatment?
Avg age 2, usually children < 6 y/o Supportive, ABx to cover MRSA
590
What is the pathophys behind cecal volvulus? Presents when? tx?
Congenital defect in peritoneum resulting in twisting of the mobile segment of the Cecum 30s-50s Surgery
591
How to diagnose midgut volvulus?
Upper GI series
592
What type of MI has the best prognosis?
Narrow complex 3rd degree AV block in an inferior wall MI Usually transient and resolves spontaneously
593
What bacteria must you worry about in human bites?
Eikenella corrodens Treat with Augmentin
594
Diffuse punctate corneal lesions seen with fluorescein staining indicates what?
UV keratitis —> can be due to welding
595
Retrobulbar hemorrhage can cause what subsequent injury?
Occlusion of the central retinal artery
596
Bite from what causes hemiballismus, AMS, rotary nystagmus? Painful or not?
Centruroide (bark scorpion) Painful yes

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