Missed Questions Flashcards
Pt that has metabolic acidosis should be treated with sodium bicarbonate in what conditions?
pH < 7.1
AKI
How long must a tick bite be attached for transmission to occur?
When should you give post-exposure prophylaxis?
48 hours
Tick attached > 36 hours, local infection rate > 20%
Infant with fever and 1st UTI should undergo what?
Renal and bladder US
What causes a jersey finger?
Presents how?
Rupture of flexor digitorum profundus tendon
CANNOT flex the DIP joint
LBBB, look at what leads and for what?
Lead I —> Large R wave
Lead V1 —> Large QS or rS
What is the treatment goal of a hyphema (blood in anterior chamber)?
What complications?
Further hemorrhage
Within first 72 hours
What is included in Ranson’s criteria?
Age > 55 Glucose > 200 Wbc > 16k AST > 250 LDH > 350
GCS scoring system?
Eye - 4
Verbal - 5
Motor - 6
What medication is used to trap ASA in the urine and enhance elimination?
Sodium bicarbonate
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?
Kerion
Oral griseofulvin
Where to perform thoracentesis?
Midscapular line, never below 8th posterior ICS, at least 1 interspace below top of effusion
Old Pt with a blood glucose of 750, normal pH and no AG that becomes weak, what is that most likely cause?
Infection
What generation is cefoxitin?
What else is in this gen?
Used to treat what?
2nd
Cefotetan
Acute appy
How do you rule of popliteal a injury after patella dislocation?
Serial PE, ABI, CTA, duplex US
What is a Mallet Finger deformity?
If not treated right, what is a complication?
Forced DIP into flexion
CANNOT extend
Swan neck deformity
What metabolic disturbance is commonly seen with targeted temperature management?
Hyperglycemia
What size ET should be used for intubation in massive hemoptysis?
8.0 to facilitate bronchoscopy
What medication can worsen uterine atony?
What is the treatment?
Magnesium bc it causes smooth muscle relaxation
Manual massage, oxytocin, PGs
What is omphalitis?
Can lead to what?
Infection of the umbilical stump
Nec Fasc
Level 1-3 billing requires how many ROS?
Level 4? How many PE?
Level 5? PE?
0, 1, 1
2, 5
10, 8
What is excluded from critical care time for billing purposes?
Insertion of a central line
What is the delayed sequalle that can occur after child ingestion of iron tablets?
Occurs when?
Gastric outlet obstruction
2-4 weeks
What random medication for AFib can cause epididymitis?
Amiodarone
What are the 3 leading causes of sbo?
adhesions
Adenocarcinoma
Hernia
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
Clonus is only seen in what Syndrome?
Serotonin syndrome
What test to order for knee dislocation?
CTA of LE
In adults, what is the MC location for foreign bodies to lodge?
Proximal airway - larynx, trachea, main bronchi
What is the parkland formula for Peds pts?
3mL of LR x kg x % body surface area
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
Patient that has an anterior and posterior fat pad sign on Xray has what?
What kind of injury is common?
Radial head fracture
FOOSH
IV magnesium toxicity causes what?
Hyporeflexia
Sickle cell pt presenting w/signs and sx of acute ischemic stroke should be treated how?
Exchange transfusion
What scoring system is used to classify severity of SAH?
Hunt and Hess
Grade 1-5
5 is v bad, only 10% survival
Isolated CN 3 palsy with NO pupil involvement means what?
Diabetic CN mononeuropathy (down and out eye)
What medication is used to reduce the vasospasm that occurs w/SAH?
MOA?
Nimodipine
CCB
What is a consequence of halogenated hydrocarbon inhalation (like spray cans from computes)?
Cardiac dysrhythmia
What are the 4 Ts which cause PPH?
Tone
Trauma
Tissue
Thrombin
What is Lemierre’s disease?
Septic thrombophlebitis of IJV caused by fusobacterium necrophorum
What kind of Salter-Harris fracture is only through the metaphysis?
Type 2 “above the growth plate”
What is the most reliable sign of uterine rupture?
Nonreassuring fetal HR
Formula for cuffed ETT size?
Age/4 + 3.5
What vascular structure is at risk of injury w/proximal fibular fracture?
Anterior tibial artery
How to make D5W aka 5% dextrose?
100mL of 50% dextrose to a 1 L bag of NS
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)
When does gynococcal eye infection occur in newborns?
Chlamydia trachomatis?
Days 2-4
Later —> days 5-14
What is an amp of D50?
50% dextrose means what?
25 grams of dextrose (100 cals)
50 grams in 100 mL
Describe a brown recluse spider bite
PAINLESS
Causes local tissue destruction via cytotoxin
Children with croup should be admitted when?
Persistent stridor at rest, retractions, tachypnea, hypoxia or require > 2 nebulized racemic Epi at rest
What tendons are effected in de Quervain’s tenosynovitis?
APL and EPB
ASD MC PE findings?
Pathophys?
Wide, fixed split S2
Persistent ostium secundum (incomplete adhesion bw FO flap and septum secundum)
Overdose of which NSAID is associated with seizure activity?
Mefenamic acid
Pt with anticholinergic toxicity can show what EKG changes?
Treat how?
QRS widening
Sodium bicarbonate
What foods can cause CN poisoning?
Prunus species - Apricot, bitter almond, cherry and peach
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
Burns of what category are included in the parkland formula?
Anything involving the dermis including anything with “superficial partial-thickness”
What is the MC cause of myocarditis in the U.S.?
Can be accompanied by what
Parvovirus B19
Pericarditis
What is it called when you have an inflammatory reaction which results from the aspiration of gastric acid fluid from the stomach?
Aspiration pneumonitis
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
What is the MC complication of diverticulitis?
Abscess
What is edrophonium?
Used to treat what?
short acting AchE inhibitor that increases ACh at the NMJ
M.G.
What O2 sat warrants hospitalization in bronchiolitis?
< 95% on RA
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
How to treat cocaine OD?
Benzo and phentolamine
Cushing reflex is in response to what?
Is done to try and do what?
Inc ICP
Maintain CPP
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
What is the MC surgical emergency in pregnant pts?
Appendicitis
Isolated non-displaced sternal fractures are associated with what?
Low mortality rates
What bone is MC fractured in a basilar skull fracture?
Temporal
Which side of the valve is the vegetation typically located in IE?
Superior
Which direction is antidromic?
Describe the morphology
Counter-Clockwise
Large QRS complexes that look like candles
What is the goal urine output in pts w/significant thermal burns?
.5-1 mL/kg
What is the SF syncope rule?
CHESS CHF Hct < 30 EKG abnormal Systolic BP < 90 SOB
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
Which kind of bronchoscopy should be used to remove a foreign body?
Rigid
What are the 5 components of Ranson’s criteria?
WAAGL
wbc Age AST Glucose LDH
What defines neutropenic fever?
Single oral temp >/= 101F
OR
Oral temp >/= 100.4 sustained for > 1 hour
ANC < 1500
What does the rectal exam reveal in a newborn with Hirschsprung disease?
Increased rectal tone or rectal squirt
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)
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
What is the limbus of the eye?
The part of the anterior eye between the sclera and cornea
MOA of sumitriptan?
Avoid in pts with what?
Vasoconstriction through vasoactive peptides
Uncontrolled HTN, ischemic stroke, CAD, vasospastic angina
Bell’s palsy + facial varicella zoster infection = ?
Ramsay-Hunt syndrome
What causes Gamekeeper’s thumb?
Will have what PE findings?
Treat how?
injury to UCL of thumb
Weak pincer grasp
Thumb spica splint
MOA of Clonidine?
Effects?
Alpha 2 agonist that binds presynaptic catecholamines receptors —> results in transient HTN
OD you see pinpoint pupils
How to treat Red Man syndrome d/t Vancomycin reaction?
Stop infusion and give Benadryl
Common SE of desmopressin?
How to prevent/treat?
Hyponatremia
Fluid restriction
What are the 2 MC sites of blunt aortic injury?
Aortic isthmus
Ascending aorta proximal to origin of brachiocephalic vessels
What sx occurs with nitrogen narcosis?
Occurs when?
AMS
Deep dives during descent
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
MC location of extrapulmonary TB?
LNs
Which type of malaria has undulating fevers?
Vivax and ovale
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
What is the best screening tool for epidural abscess?
Treat how? To cover what?
ESR and CRP
Van/Ceftriaxone to cover MRSA and Pseudomonas
What pediatric PNA causes a “shaggy” right heart border?
Pertussis PNA
Diver that comes up and then has MI like symptoms has what?
Exhibits what on EKG?
Arterial gas embolism
Anatomic ST elevation
What kind of child presents w/bacterial tracheitis?
3-8 y/o, uri prodrome that intensifies quickly
MC d/t S. Aureus
Auricular hematoma aka cauliflower ear is treated how?
I + D with pressure dressing
What are Cerebral T waves?
Indicate what?
Deep, inverted T waves in V3, V4
Common following Left Frontal hemorrhage
Increased ICP
What Abx to give for upper GI bleed 2/2 to variceal bleeding?
Ceftriaxone 1 g/day
OR
Ciprofloxacin 400mg bid
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
What is the MC type of elbow dislocation?
Most serious complication?
Posterior
Brachial artery injury
Diff bw dislocated patella vs dislocated knee?
Patella dislocation is only the knee CAP
Knee dislocation is when femur and tibia out of place
What tachydysrhythmia has a regular rhythm?
Atrial flutter
What type of malformation is located laterally, anterior to the border of the SCM, near the angle of the mandible?
Branchial cleft cyst
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
MOA of TCA?
What other effects do they have?
Fast inward Na channel blockade
anti-ACh effects
What symptoms seen in VP shunt obstruction?
Bulging fontanelle, sundown eyes (pt cannot look up), HA, nausea
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
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
What is the MC finding in children under < 5 y/o that presents to the ED for acute appendicitis?
Rebound tenderness
What lab values are elevated in Ehrlichiosis?
Elevated transaminases, LDH, ALP
Leukopenia
Thrombocytopenia
When is a pelvic binder used?
Reduce venous bleeding d/t SI disruption in open-book pelvic injuries
Hemophilia B is deficiency of what factor?
Head trauma needs to be treated how?
9
100IU/kg bc delayed bleeding is COMMON
When do you need emergent hemodialysis for hypercalcemia?
What is the main tx?
> 18 or neurologic symptoms
IVF
How to tell the difference between VP shunt overdrainage vs obstruction?
Shunt overdrainage headaches will come and go
obstruction HA’s are CONSTANT
How do you treat TIA?
ASA alone or + dipyridamole
What lab value to diagnose acute parotitis?
Amylase
What confirms compartment syndrome?
Delta pressure = 30 mmHg
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
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
Far lateral unilateral disc herniation bw L4 and L5 compresses which nerve root?
L4
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
What is the initial pediatric defibrillation dose?
2-4 Joules/Kg
Pts who are hemodynamically unstable that need cardiac pacing, what ampage should be set?
80 mA (the max)
What uncommon fracture indicates high-velocity or abuse?
Scapular
What are the early signs of acetaminophen OD?
Malaise, anorexia, nausea
What kind of organism is haemophilus ducreyi?
G (-) coccobacillus
What is another name for Kawasaki disease?
Mucocutaneous LN syndrome
What COHb level indicates Hyperbaric O2 therapy d/t CO poisoning regardless of sx?
In pregnant pt?
> 25%
> 15%
What meds to use to lower BP in aortic dissection?
If asymmetric BPs, what artery is involved?
Esmolol + sodium nitroprusside
Subclavian artery
1st step in a pt w/trach bleed?
Overinflation of the trach cuff
Pt with active ACS (STEMI or NSTEMI) should be given what other than ASA?
MOA?
Ticagrelor 180mg PO
P2Y12 antagonist
What is a contraindication to using methotrexate in treating ectopic pregnancy?
How big must the pregnancy be to exclude its use?
Liver disease
> 4cm
What sign seen on xray indicates radial head fracture?
Posterior fat pad
Pt with stable M.G. Exacerbation, what is the 1st step?
Measure negative inspiratory force
DOPE mnemonic for a pt on vent with inadequate o2?
Displacement
Obstruction
Pneumothorax
Equipment
When to do lateral canthotomy in orbital cellulitis?
Dec visual acuity
IOP > 40
Significant proptosis
What medicine should be used pre-treatment in RSI for pt w/increased ICP?
Fentanyl - turns down the increase in BP
When do you hold warfarin for a pt?
When do you give Vit K?
INR > 5 but < 10
> 9 and no significant bleeding
What can be used in OD of phenytoin?
Multiple dose activated charcoal can minimized delayed absorption of the drug
What carpal bone is MC dislocated?
Lunate
How to evaluate for open knee joint?
Normal saline joint injection
What maneuvers make the click in MVP go later?
Mechanism?
Squatting - inc preload
Handgrip - inc afterload
Hangman fracture is what anatomically?
B/l fracture of the pars interarticularis (aka pedicle) at C2
What is dextromethorphan MOA? Known as what?
OD Sx?
NMDA receptor antagonist, cough syrup
Visual hallucinations, slurred speech, nystagmus, tachycardia
What drugs can be given via ET tube in adults?
Kids?
NAVEL
LANE (no vasopressin)
What OD causes dilated pupils, tachycardia, dry, hot, urinary retention?
What kind of nt blockade?
TCA
Anticholinergic
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
What is lye?
What happens if you ingest it?
Alkaline material
Need upper endoscopy w/in 12-24 hours
What is the goal PaCO2 after ROSC?
Goal Temp?
Serum glucose?
40-45
32-36 C
108-140
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
Toddler (age 3) with an isolated spiral fracture needs what treatment?
Long leg cast
What is Mackler TRIAD?
Seen in what?
Lower chest pain, vomiting, subQ emphysema
Boerhaave’s syndrome
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
Febrile seizure seen in what child ages?
6 months to < 5 years
What kind of eye infection causes fluffy white perivascular lesions on fundoscopic exam?
CMV retinitis
Pediatric female pt that is presenting with fever and vomiting only what is the most likely diagnosis?
Treat how?
UTI
Cefixime (3rd gen)
What type of mask should a PATIENT with TB wear during transport?
Surgical mask
Child with AMS d/t lead toxicity in the blood should be treated how?
Whole bowel irrigation if paint chis in the GI tract
How does NAC work?
It is a glutathione precursor or substitute, a sulfate precursor, and prevents binding of NAPQI to hepatocytes
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
What Carboxyhemoglobin level is in an indication for Hyperbaric O2 therapy d/t CO poisoning?
In pregnancy?
> 25%
> 15% in pregnancy
Femoral hernia occurs where?
Internal inguinal ring
Below inguinal ligament and medial to femoral artery
Young pt with AS, what is the treatment?
Balloon valvuloplasty
Isopropyl alcohol is converted into what by alcohol dehydrogenase?
What does the ABG look like?
Acetone (ketone)
No AG, normal pH
What nerve is responsible for photophobia?
V1
How is secondary syphilis treated?
What about early latent (< 1 year)?
SINGLE injection of benzathine penicillin G
Same
What mechanism do CCBs and BBs work by on the cardiac myocytes?
AV nodal blockade
What PE findings for Ludwig angina?
Brawny neck edema, submandibular swelling, elevation of the tongue secondary to edema of floor of the mouth
What is a layering of wbc in the anterior chamber called?
Seen in what?
Normally bc of what?
Hypopyon
Endophthalmitis
Post cataracts complication
What is the famous symptom of digoxin toxicity?
Chronic symptom?
Treatment?
Yellow color, halos and spots in their vision
Ventricular dysrhythmias
Dig Fab fragments
Pt with a bleeding peptic ulcer will have what abnormal lab value?
Elevated BUN
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
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
What shoulder technique is no longer recommended?
Why?
Hippocractic technique
Auxiliary nerve injury risk
Aortic dissection, what it the BP goal?
What meds to treat?
100-120 systolic
Esmolol or labetalol with nitroprusside
Painless nodular mass on testicle most likely what?
Cancer
What viral infection is commonly associated with Intussusception?
Adenovirus
What is Zanamivir?
SEs?
Inhalation neuraminidase inhibitor used to treat flu or as prophlylaxis
Wheezing, bronchospasm
What causes painless genital ulcer w/suppurative tender LAD?
Chlamydia trachomatis LGV serotype
What is sick sinus syndrome aka?
Pathophys?
Tachycardia-bradycardia syndrome
Injured SA and AV nodes
What causes facial flushing, HA, ABD cramping, diarrhea after eating at seafood restaurant w/peppery taste?
Scombroid fish poisoning (histidine metabolized into histamine)
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
What is the MC salter-Harris fracture?
Which requires surgery?
II
IV/V
Pt that gets angioedema to ASA and having a STEMI, what do you give them?
Clopidogrel
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
AMS ddx?
AEIOU TIPS Acidosis, electrolyte, infection, opiates/OD, uremia Trauma Insulin Poison/psych/pharm Stroke, Seizure, syncope
What strange way can AFib present on EKG?
No P waves, uncoordinated atrial activity
What iron level requires Deferoxamine no matter what?
SE of the drug?
> 500 mcg/dL
HoTN
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)
How to assess a pt’s level of consciousness if they are altered?
Tickle posterior nasopharynx w/cotton swab
Pt with suspected rhabdomyolysis, what is the concern?
What must you get?
Hyperkalemia
EKG
What is the first thing affected by Necrotizing OE?
What symptoms?
CN 7
trismus
Arthritic pain, abdominal pain, low grade fever, hematuria, and rash indicates what in kids?
What intestinal disorder found with this disease?
HSP
Intussusception
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
What area of the heart sits most anteriorly in the chest and is most prone to knife wound injury?
RV
What type of odontoid fracture is considered stable?
Risk of type 2 fracture?
Type 1
Nonunion
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
Treatment for spontaneous pneumomediastinum in a pt that is hemodynamically stable?
Gold standard diagnostic test?
Discharge w/close follow up
CT
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
What is the treatment for uremic pericarditis?
Hemodialysis
Pt with pertussis, where can you obtain a sample for test?
Nasopharynx
What is Ludwig’s angina?
Associate with what?
B/l cellulitis, abscess formation or both
Acute airway obstruction
What penile pH level indicates an ischemic priapism?
What is the initial treatment?
pH < 7.25
Intracavernosal phenylephrine then Cavernosal aspiration
What is the formula for the age-based max HR d/t sinus tachycardia?
220 - age
What describes a skin patch?
Flat, nonpalpable, circumscribed lesion > 5mm in diameter
What level of lead poisoning gets dimercaperol chelation therapy regardless if they have sx or not?
Contraindication?
BLL > 70 microgram/dL
Peanut allergy
When is cricothyrotomy contraindicated?
What to do instead?
Children under 10
Needle cricothyrotomy with 12 or 14 guage angiocatheter
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
How to diagnose West Nile encephalitis?
Leukopenia with pronounced lymphopenia
Methemoglobinemia can occur when working around what?
Treatment?
Silo filler’s disease —> Nitrogen oxides
Methylene blue
How soon do you need to give Rhogam?
How much?
Within 72 hours
50 mcg minimum
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
How do you determine if a laceration over the knee joint is considered open?
Inject saline into the knee joint , 200cc
Pts with DiGeorge Syndrome can have what other major defect?
May present how?
Truncus arteriosus —> causes cyanosis and CHF
Seizures
What is the Rhogam dose in a pt > 12 weeks?
Before 12 weeks?
300 micrograms
50 micrograms
What is the lowest to highest level of EMS training?
Which level can start IVs?
EMR < EMT < Advanced EMT < Paramedic
Advanced EMT and higher
What D50 made of?
50g glucose in 100 mL saline
TCA overdose shows what on EKG?
Wide QRS
Terminal R wave in lead aVR (> 3mm)
Pt with food Bolus that is tolerating secretions, what is the next step in management?
IV glucagon
Proper dose of Epi during cardiac arrest?
1mg aka 10 mL of 1:10,000
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
What temperature should frostbite rewarming occur at?
Takes how long?
37-39 degrees C
15-30 minutes
How to cut thrombosed hemorrhoid?
Elevate overlying skin, make an elliptical incision
What is a Galeazzi fracture?
Distal radius fracture
Distal Radioulnar joint dislocation
“MU GR”
CXR which shows b/l pulmonary edema without evidence of cardiomegaly indicates what?
ARDS
What is it called when an adverse event leads to serious poor outcomes or death?
Sentinel event
What test has highest sensitivity to exclude PE?
Normal VQ scan
What fracture is pathognomonic for abuse?
Metaphysis fractures
What is the MC finding in a pt w/acute aortic dissection?
HTN
How can you decrease peak pressures in an intubated asthma pt?
Use a larger ET tube
Describe complex seizure
< 6mo or > 5 years
> 15 minutes
FOCAL
What is true about a Miller blade compared to a MAC blade?
Carries a higher risk of stimulating an airway reflex than a MAC
Pt with multiple miscarriages and chronic arthralgia has what?
What other sx is common?
SLE
Photosensitivity
What PO Abx to treat lung abscess?
What IV meds?
Clindamycin
Unasyn, carbapenem
Consensual photophobia indicates what?
Treat how?
Iritis
Cycloplegic —> homatropine
MC location for AAA?
Infarenal
What are the Hunter criteria?
Used for diagnosis of serotonin syndrome
What are the # 1, 2, MC causes of SJS in children?
1 - meds
2 - mycoplasma pneumoniae
What vessel of the heart covers the septal area?
What leads?
LAD
V1-V4
What is an Ellis II fracture?
Treat how?
Enamel + dentin
Calcium hydroxide paste
Pt w/VP shunt that is getting headaches, blurry vision, and nausea intermittently has what?
Caused by what?
Slit ventricle syndrome
Shunt overdrainage
What is the MC cause of mastoiditis?
Strep pneumo
What is Cushing response?
bradycardia, HTN, dec RR
If you cannot give NSAIDs to a pt with gout and chronic renal insufficiency, what can you give?
Prednisone
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
What is the genetic makeup of partial moles?
69 XXY
What is anticonvulsant hypersensitivity syndrome?
What happens initially?
DRESS
Spares mucous membranes and rash starts 1-2 weeks after nonspecific sx
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
How much does pH decrease with induced hypothermia?
Decreases by .012 for every 1 degrees C below 37
What antiviral is helpful in treating immunocompromised pts w/severe RSV?
Ribavirin
Treatment for toxoplasmosis is what?
How is it acquired?
Pyrimethamine, sulfadiazine, folinic acid
Reactivation of a latent virus
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
What med is contraindicated with a hyphema?
Ibuprofen and ASA (NSAIDs)
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
What 2 serious illnesses can mimic kidney stones?
Aortic/ilia aneurysm
Renal vein thrombosis
What is conus medullaris syndrome?
How to distinguish?
Distal SC compression - causes both UMN and LMN
Sudden and BILATERAL
Patients with rupture of UCL requires what?
Immobilization and urgent surgical management
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
What are the major Duke criteria for endocarditis?
2 + blood CXR
New murmur
Abnormal echo
Describe MAT on EKG
1st line action?
Treatment?
3 diff P waves, rate of 100-180, irregular
IVF
Underlying cause, CCB
What is an ischemic form of venous occlusion d/t massive iliofemoral thrombosis that involves most of the venous collateral system?
Phlegmasia cerulea dolens
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
CN 3 palsy + orbital cellulitis = ?
Cavernous sinus thrombosis
Bell’s Palsy presents how?
Treatment?
Unilateral facial weakness, drooling, loss of taste, CANNOT raise eyebrow on affected side
Prednisone and eye care
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
What is a stye?
Hordeolum
What time frame for a head CT to r/o SAH has a sensitivity of nearly 100%
6 hours
Sinus tachycardia, low voltage QRS and electrical alternans seen in what?
Pericardial tamponade
What Platelet level is an absolute contraindication to tPA?
What about INR?
Blood glucose level?
< 100,000
> 1.7
< 50
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
What is a V common reason for pneumomediastinum on CXR in a young pt w/pleuritic chest pain of acute onset?
Asthma exacerbation
What is a blockage of the Meibomian glands called?
Located where?
Chalazion
Above the eyelashes on the upper lid
How will the penis appear in ischemic priapism?
Shaft is rigid and painful
Glans is soft
What level of hypoNa requires 3% saline infusion?
Serum Na < 110
Or
Na < 120 with symptoms
Any patient that presents w/signs and symptoms of decompression sickness, what is the treatment?
Hyperbaric oxygen
What are the neurologic complications of EBV?
encephalitis
Meningitis
GBS
How does Hct change in hypothermia?
2% increase in Hct for every 1 degree C drop in temperature
Pt that gets strep, is given amoxicillin and then gets a non-allergic rash over a week later has what?
Type 4 hypersensitivity
When should therapeutic thoracentesis be stopped as long as vital signs are stable?
After the onset of chest discomfort or cough
What type of cells seen in DIC?
Schistocytes
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
RBBB, look at what leads and for what?
Lead I —> Wide S wave
Lead V1 —> RSR’
Risk factors for anorectal abscess?
Crohns
diabetes
Chronic steroid use
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
Pt taking exogenous thyroid hormone what is the tx?
BB, dexamethasone
Do NOT need PTU or KI
Pt w/mesenteric ischemia that gets a CT scan, what is the most common radiographic finding?
Bowel wall edema
What kind of injury is a quaternary blast injury?
Typical characteristics?
Environmental contamination from the device
Burns, inhalation, toxic substances touch you
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
Do ligaments and joints get strained or sprained?
Sprained
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
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
Central cord syndrome occurs with what type of injury?
Extension
Mnemonic: Extra Credit Injury
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
What is a contraindication to nail trephination?
Posterior nail edge disruption
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
How do you calculate total body K+ deficit?
Each 0.3 mEq drop in potassium below normal = 100 mEq deficit
Treatment for Lyme in pregnant pt?
Amoxicillin 500mg bid for 14 days
How should you treat a stingray wound?
Immerse in tap water at 45 C (113 F)
Old Pt with UE weakness, sensory deficits and urinary retention has what?
Mechanism?
Prognosis?
Central Cord Syndrome
Hyperextension
Medium
Pt that comes in with a traumatic hyphema needs what test 1st?
What medical condition is associated with spontaneous hyphema?
Seidel
Sickle cell disease
How to treat acute mountain sickness?
When do sx usually begin?
IVF
Acetazolamide/dexamethasone
Delay of further ascent
6500 - 8000 ft
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
What is the pathophysiology of polymyositis?
Clinical Sx?
Degradation of muscle cells
Subacute proximal muscle weakness and myalgia
What is the treatment for spontaneous PTX?
100% O2 on non rebreather mask if < 20% in healthy pt
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
How to treat VTach?
Pulseless —> immediate defibrillation
Unstable —> synchronized cardioversion
What structure may rupture in the inner ear with rapid ascent?
Round window
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
Black widow bites how do you treat?
Supportive but also opioids and Benzodiazepines
Pt that goes into a woodshed can have difficulty breathing d/t what?
What medicine is contraindicated?
Hydrocarbon ingestion
Epinephrine
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
What is the pathophysiology behind Type 3 vWF disease?
No vWF produced AND low levels of Factor 8
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
Sickle cell pt that has very low Hg and No reticulocytosis has what?
Do what?
Aplastic crisis
Transfuse
What is Sever disease?
Causes what?
Treatment?
Calcaneal apophysitis
Posterior heel pain in males 8-12 y/o
Supportive care
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
What opioid can cause mydriasis in cases of toxicity?
Meperidine
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
CC of flank pain in old person that is not kidney stones, what must you consider?
ruptured AAA
Aerospace manufacturing lung disease cause?
Welders and silver polishes?
Sandstone, clay, granite? Classic CXR finding?
Berylliosis
Siderosis
Silicosis, basilar alveolar filling
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
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)
What is the treatment for anal fissure?
Topical nitroglycerin or topical nifedipine
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
What accounts for the greatest % of heat loss in cool environments?
Radiation
What PE sign indicates retrocecal appendix?
How do you do it?
Psoas sign
Extend pt right leg why lying on left side, pain is (+)
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
What are some examples of non-ionizing radiation?
Microwaves, infared, radio, thermal
Basically anything that does start with a Greek letter or 1 letter
What is the most likely cause of macrocytic anemia?
Direct EtOH toxicity
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
What is a common finding of high altitude pulmonary edema?
Right middle lobe involvement will show patchy alveolar infiltrates
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
Old person in pain, how to treat their delirium?
What environment should they be in?
Opiates
Quiet, low-light
What are the cardinal signs of anterior uveitis (3)?
Ciliary flush
Marked injection at the limbus
Red ring around the iris
Pt with hepatorenal syndrome has what abnormal lab value?
Treat how?
Progressive rise in serum Cr
Vasopressors to cause splanchnic vasoconstriction
What is the target PaCO2 in a hyperventilated head injury pt?
Onset of effect?
30-35
W/in 30 seconds
How does herpes simplex keratitis present?
Treatment?
Unilateral eye pain w/dendritic pattern
Trifluridine
Pt w/3rd degree heart block, which med to give first?
If it fails?
Atropine
Dopamine
Formula for correct cuffed ETT size?
Uncuffed?
(Age/4) + 3.5
(Age/4) + 4
How to treat large iron ingestion in a kid?
Whole bowel irrigation with polyethylene glycol aka MiraLAX
Wernicke’s encephalopathy triad?
Encephalopathy, oculomotor dyfx, gait ataxia
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
What Abx used to treat skin lesions in scleroderma?
Minocycline
Pt with an unexplained pleural effusion should be worked up for what?
PE
Major SE of zidovudine?
Efavirenz?
Didanosine?
Bone marrow suppression
Vivid dreams
Pancreatitis
Child 1-8 y/o with hypoglycemia, what is the dose?
1) estimate weight
2) 50/2.5 = 2mL/kg of D25
What is the MC oculomotor sign in pts w/Wernicke’s encephalopathy?
Lateral nystagmus
Oral hairy leukoplakia indicates what else?
Confection by HIV
Lesions caused by EBV, NOT precancerous
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
What vaccine is safe in pregnancy?
Tdap
Hepatitis
Inactivated influenza
What is Brudzinski sign?
Neck flexion causes hip and knee flexion
For meningitis
Pt experiencing decompression sickness has what sx?
What will they NOT have?
Vertigo, myalgia, Dyspnea, parasthesia, burning, mottling
Loss of consciousness
What is defined by the fractions of patients who truly have a disease and are identified as so with a test?
Sensitivity
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
What is the MC abnormal radiologic finding in foreign body aspiration?
Obstructive emphysema
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%
Who is at risk for aortoenteric fistula?
Dx how?
PMHx of AAA, aortic repair/graft
EGD
How to avoid Boutonnières deformity with splinting?
PIP in extension, DIP and MCP joints should have full ROM
Albuterol has what short term electrolyte effects?
Hyperglycemia
Hypokalemia
Dec Mg and PO4
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
What is the goal pH for irrigation in cases of a chemical burn?
7.0-7.2
What causes painful suppurative ulceration on the penis and painful inguinal LAD?
Haemophilus ducreyi
48 y/o guy that suddenly becomes unresponsive and goes into VFib and achieves ROSC most likely has what?
CAD
What is Oil of wintergreen?
Treatment for OD?
Salicylic acid (Aspirin)
Sodium bicarbonate and activate charcoal if < 1 hour from ingestion
LVH w/deep, narrow Q waves in the lateral and inferior leads are seen in what condition?
HOCM
What kind of objects need endoscopic removal?
Sharp ones
Longer than 5cm
OR
Wider than 2.5cm
Ingestion less than what level of NSAIDs are unlikely to cause significant toxicity and do not require observation?
< 100 mg/kg
Child < 1 y/o with hypoglycemia, what is the dose?
- Estimate weight: (2 x age in yrs) + 8
2) 50/10 (10 for D10)
3) weight * 5mL/kg
Which direction is orthodromic?
Describe the morphology
Clockwise
Deep Q waves
What is the tube insertion site for a cricothyrotomy?
Superior to cricoid cartilage
Inferior to thyroid cartilage
What is a Swan neck deformity?
PIP in hyperextension
DIP in flexion
SwanEEE
Child w/SVT, what is the cardioversion energy?
1st attempt 0.5-1 J/kg
2nd attempt 2 J/kg
What is oxymetazoline? Used for what?
MOA?
Nasal spray decongestant for rhinosinusitis
A1 agonist and a2 partial agonist
Pt that takes meds and a week later develops allergic symptoms has what type?
Serum sickness - type 3
Treatment for Croup?
Decadron, racemic epi
AIDS pt w/ring-enhancing ICL + AMS = ?
Primary CNS lymphoma
Fracture-dislocation of the tarsometatarsal joints is called what?
What radiographic finding?
Lisfranc injury
Lateral shift of the 2nd metatarsal off the middle cuneiform
How much blood loss in class II hemorrhage?
15-30%
Malocclusion of the jaw and pain with eating indicates what?
This is different from what?
How?
TMJ disease
TMJ dislocation —> cannot open the mouth
What is the management for a lateral patella dislocation?
Closed reduction
Post reduction xray, with splint
Treatment for anticholinergic associated hyperthermia?
Ice water immersion
Evaporative cooling
Benzodiazepines
What street drug can cause prolonged QT/Torsades?
Methadone
Obstructing DVT of the proximal ileofemoral vein is called what?
Treat how?
Phlegmasia cerulea dolens
Heparin + vascular consult
What neck fracture is considered stable?
Clay-shoveler fracture aka avulsion of the SP of C6 or C7
What is the atropine dose in a pt w/symptomatic bradycardia w/a pulse?
0.5 mg IV push
What kind of follow up do buckle fractures need?
Primary care in 3 weeks
Apparently not ortho, ya right
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
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)
Temporal arteritis can effect what else?
Aortic involvement leading to valvular insufficiency, aortic arch syndrome and dissection
What is the MC vital sign abnormality in PE?
MC presenting symptom? #2?
tachypnea
Dyspnea at rest or exertion, Pleuritic pain
How do you make a sodium bicarbonate drip for treatment of TCA OD?
Mix 150 mEq of NaHCO3 with 1 L of D5W
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
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
Achilles’ tendon rupture requires what kind of splint?
Equinus splint
What finding indicates acute traumatic aortic disruption?
Elevation of the right mainstem bronchus
Alcoholic patient that has chest pain, muscle cramping, numbness, tingling and low calcium can be treated with what?
Magnesium 2g
Female pt that has severe chest pain after eating that resolves within 30 minutes has what?
Treat how?
DES
CCB (Diltiazem) or TCA
What is the triad for HUS?
MAHA
thrombocytopenia
Renal insufficiency
What is the 1st line treatment for lice in ALL populations?
Permethrin
Pt that develops painless visual loss w/flashes of light followed by cloudy, curtain-like loss has what?
Retinal detachment
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
Primary teeth are present for how long?
Avulsed primary tooth treated how?
6months - 6 years
Do not replace tooth, urgent dental referral
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
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
What is the MC organism in bacterial tracheitis?
What virus increases susceptibility?
Staph aureus
Influenza A
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%
When should you pack an abscess?
> 5cm
Pilonidal
Pt is diabetic or immunocompromised
What drugs can you use for uterine atony?
And what is the dose for the #1 choice?
Oxytocin - 10IU IM
Methylergonovine
Carboprost
Pt that comes in with suspected ibuprofen OD, what should you do?
What is not helpful?
Acetaminophen level
activated charcoal
Wellens’ syndrome shows what on EKG?
Deeply inverted T waves in V2-V4 (type B)
Or Biphasic T waves in V2-V4 (type A)
How to calculate shock index?
What is normal?
HR / systolic BP
.5 - .7
How to dx intussusception?
Tx?
US
Air contrast enema
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
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
Pt camping in the Midwest of the U.S. that has RUQ pain has what?
Entamoeba histolytica
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
CURB-65 stands for what?
Confusion
Urea > 7
RR > 30
BP (systolic) < 90
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
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
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
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
Pt that has a pelvic fracture and is hemodynamically unstable, what is the treatment?
Angiographic embolization
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
Diffuse macular, blanching erythroderma that looks like sunburn is what?
Treat how?
Toxic shock syndrome rash
Clindamycin
How to treat malaria?
Quinidine and Doxycycline
What is a fracture of the distal radius with dorsal displacement called?
What injury is MC assoc w/it?
Colles fracture
Ulnar styloid
What EKG changes can digoxin cause?
Downsloping ST depression w/slurred appearance
Flattened/inverted or biphasic T waves
Shortened QT interval
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
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
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
How is octreotide dosed in upper GI bleed?
Bolus of 50 mcg then infusion of 50 mcg/hr
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
Where does the supraorbital nerve originate from?
Branch of the frontal nerve which is a branch of V1
Pts w/HELLP syndrome are at risk for what?
Hepatic rupture
What is the max distance that can be repaired using the hair apposition technique?
10cm
What medicine is used to treat opioid induced constipation?
Methylnaltrexone given subQ
What is the treatment for fat embolism?
IVF and supplemental O2
Posterolateral unilateral disc herniation bw L4 and L5 results in compression of what root?
L5
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
How to treat Portuguese man of war nematocysts?
Hot water and topical lidocaine
If don’t have access to that use salt water
Pt in a mass casualty situation has RR > 30, triage what color?
Red
What are some characteristics of organic (medical reason) confusion?
Visual hallucination
What is the relationship of hydromorphine to morphine?
Hydro is 7x as strong
1mg of hydro = 7mg of morphine
What recommendation says a treatment benefit = risk and thus should not be administered?
Class III
What is the MC cause of dacryocystitis?
Staph aureus
Benzo withdrawal seizure is most likely with what feature?
Injury during the episode
What leads to look at in a right sided EKG?
ST elevation in these leads indicate what?
V4R, V5R, V6R
Right ventricular infarct
What antieliptic drug has a SE of hyponatremia?
Oxcarbazepine
What is the definition of empyema?
Presence of bacteria on Gram stain of the pleural fluid after it has been drained
How to treat GC?
Ceftriaxone 250mg IM
+
Azithromycin 1g
Do muscles get sprained or strained?
Strained
Echocardiogram that shows hyperkinetic heart motion indicates what?
High output Heart Failure
People who cannot recognize their illness fail to demonstrate what part of capacity?
Appreciation
What is the 1st line treatment regimen for diverticulitis?
2nd line?
Cipro 500mg bid + metro 500mg q8
Augmentin 875/125 q8 for 10 days
What is the 1st line treatment for BP in aortic dissection?
2nd line?
Labetalol or esmolol
Nitroprusside
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
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
What is the treatment for idiopathic sudden sensorineural hearing loss?
Prednisone 60mg 7-14 days
Describe rash distribution of RMSF?
Treatment in children?
Begins on ankles and wrist, then spreads to chest, back
Doxycycline, ALWAYS
Blurred vision, bradycardia, ECG w/hyperK and peaked t waves is what?
Digoxin toxicity
First step with suspected penile fracture?
Mechanism of pathology?
Call urology
Disruption of the tunica albuginea surrounding the corpus cavernosa
How to treat Valproic acid toxicity?
What do these pts commonly have?
L-carnitine administration
Hyperammonemia
What infection is the MC that presents w/erythema multiforme?
What else?
HSV
Mycoplasma
Lupus, hepatitis
Drugs
Formula for uncuffed ETT size?
(Age/4) + 4
What is the parkland formula?
4mL x tot % body surface area x body weight (kg)
What is a Pseduo-Jones fracture?
Treatment?
Fracture fo the proximal 5th metatarsal reaching the articular surface (5th metatarsal tuberosity)
RICE
What is the pathophysiology behind Type 1 vWF disease?
What else?
Decreased production of the glycoproteins
Also low levels of Factor 8
What do the labs show in TTP?
Elevated LDH
Elevated indirect bilirubin
Normal coags
Plt < 50,000
What medication can be used for prophylaxis of migraine headaches?
Propanolol
Also verapamil and topiramate
What is the order of 7 cardinal movements of labor?
Engagement, descent, flexion, IR, Extension, ER, Expulsion
EDF IEEE
What cells of the pancreases have exocrine fx?
Like what enzymes?
Acinar
Trypsin, chymotrypsin, lipase, amylase
When should hiccups be evaluated?
How?
Treatment?
More than 48 hours straight
H+P, basic labs, CXR
PPI, baclofen, gabapentin, Reglan, CHLORPROMAZINE (fda approved)
Old pt that has AMS, febrile, tachycardia, diaphoresis, midrange pupils, and rigidity is withdrawing from what?
Has what?
Levodopa
NMS
Treat tension PTX how?
Needle thoracostomy 2nd ICS, midclavicular line with 14 gauge catheter
Hirschsprung enterocolitis can occur before or after surgical repair, what is the treatment?
Metronidazole w/or w/out rectal irrigation
What is another name for bucket handle fracture or corner fracture?
Pathognomonic for what?
Metaphyseal fracture
Non-accidental trauma
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
Dosing of tPA for massive PE?
100 mg over 2 hours IV
What tick borne illness can cause fever, RUQ pain, scleral icterus +/- rash?
Ehrlichiosis
Pt with suspected tertiary syphilis, evaluate and treat how?
Send a CSF VDRL and give IV PCN G 4 million units
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
Thrombosed hemorrhoid present for greater than 72 hours, what is the management?
Topical hydrocortisone cream with lidocaine
Where can primary chancre from syphilis occur?
Genitals or oropharynx
How much energy to convert hemodynamically unstable AFib with RVR?
120-200 K biphasic
200 mono
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
What is oxymetazoline?
Similar to what med?
A1 agonist, partial a2 agonist
Clonidine (a2 agonist that inhibits release of peripheral catecholamines)
what are the findings of a patellar rupture?
Can’t extend knee
Superior patellar displacement
Tenderness inferior to patella
What causes cauda equine syndrome?
Lumbo-sacral Nerve root impingement
How much glucose and fluid is in an amp of D50?
25g glucose in 50 mL
Most serious consequence of knee dislocation is what?
Hard sign?
Popliteal a injury
palpable thrill, visible expanding hematoma
What is the Abx treatment for post C-section endometritis?
Post vag delivery endometritis?
Clindamycin + gentamicin
ampicillin + gentamicin
Sexual assault victims, what is the 1 thing that is recommended as part of eval and tx?
Forensic evidence collection
When to use linezolid instead of vancomycin as 1st line empiric treatment?
Pts w/septic shock or respiratory failure d/t pneumonia
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
What is the pediatric dose of pediatric IV epinephrine in a code?
0.01 mg/kg
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
What is a boutonnière deformity?
PIP in flexion
DIP in extension
BP Fucks
Side effect of etomidate?
Myoclonus
What is the management of extraperitoneal bladder rupture?
Non surgical - Foley for 1-2 weeks to allow for spontaneous healing
Inferior displaced patella means what?
Superiorly displaced?
Quad tendon rupture
Patella tendon rupture
Young child that presents with myalgia, thrombocytopenia and hyponatremia after camping has what?
RMSF
Perichondritis MUST be treated for what?
Use what?
Pseudomonas
Ciprofloxacin
Where do you palpate the posterior tibial artery pulse?
Posterior and inferior to medial Malleolus
Child w/opsoclonus-myoclonus syndrome has what?
Need to do what?
Neuroblastoma
MRI of chest, abdomen, pelvis
What lab study is most prognostic in acute radiation exposure?
What particle has the greatest mass?
Lymphocyte count
Alpha
Ring-enhancing IC lesions + FND = ?
Toxoplasmosis
What are the risk factors for TRALI?
Hx of liver transplant Chronic EtOH abuse Smoker Shock \+ fluid balance high Peak pressures on vent
Bolus dose of 3% hypertonic saline for treatment of seizure 2/2 to hyponatremia is what?
2 mL/kg given over 10 minutes
What common drug cannot be given in pregnancy?
Epinephrine
ITP presents how?
Treatment?
Petechiae rash and low Plts
IVIG and prednisone
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
What induction agent should be avoided in septic pts?
Why?
Etomidate
Adrenal suppression
What valve abnormality is most likely to develop after blunt cardiac injury?
Aortic Regurgitation
What scoring system helps ID patients w/upper GI bleed who are candidates for outpt therapy?
Glasgow-Blatchford Bleeding Score
What kind of needle is used for LP?
What level does the SC end in adults?
Whitacre
L1
What high-risk feature has the highest +LR in ACS?
Radiation to right arm or shoulder (LR+ 4.7)
Both arms LR+ 4.1
Young pt w/signs and symptoms of pericarditis, what else must you consider?
Myocarditis
How is the glottis opening different in children compared to adults?
Formula for predicting UNCUFFED ET size in children?
More anterior
(Age + 16) / 4
MC cause of Cushing syndrome?
2nd MC?
Iatrogenic steroid use
Cushing Disease d/t pituitary tumor
Cat bites with puncture wounds should be closed how?
Not at all
Let them heal naturally by secondary intention
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
Pt in DKA that suddenly has headache and ams, has what?
Treat how?
Cerebral edema
Mannitol
Spontaneous PTX d/t COPD, what is the treatment?
20F chest tube directed superiorly
What size ETT cap will attach to the angiocatheter in order to bag the pt?
3-5
What is a common complication of perinatal and perirectal abscess?
Do you need surgery consultation?
Fistula formation
Most often no
High altitude cerebral edema should be treated how?
Dexamethasone is 1st line for rescue (pt will be ataxic, altered)
What is the goal fluid resuscitation urine output in septic Peds pt?
> 1 mL/kg/hr
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
What is the most sensitive test for Lyme meningitis?
B. Burgorferi antibody
What finding on a UA is most sensitive for UTI?
Leukocyte esterase (83%)
In hospital death after near death hanging or strangulation is d/t what?
Pulmonary edema and ARDS
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
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
What medication is contraindicated in sickle cell pts with hyphema?
Why?
CA-Is
They lower pH - increase sickling
What is a delta pressure?
Diastolic BP - direct pressure
What are the labs expected with hemolytic transfusion reaction?
Inc LDH
Dec haptoglobin
(+) direct Ag test
Cavernous sinus thrombosis first causes a palsy of which CN?
6
For every 50 mL of HCO3 how much does the pH change?
Increases by 0.1
How should pregnant trauma pts be managed?
Chest tube thoracostomy should be performed in a relatively higher position during pregnancy
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
What kind of injury is a secondary blast injury?
Typical characteristics?
Impact of FRAGMENTS
Penetrating trauma, lacs, amputations
What does Clonidine poisoning cause?
Lethargy, miosis, Bradycardia
What ECG findings indicate a RV infarct?
ST elevation in V1
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
What is the smallest amount of free fluid that can be viewed on a FAST exam?
75-250 mL
What is the name of a ventricular-originated rhythm with a rate < 100 bpm?
Idioventricular rhythm
What site for arterial line placement has the highest risk of limb ischemia?
Brachial artery
Which central line location has the lowest rate of infection?
Subclavian
What is the PaO2 goal in ARDS?
This converts to what % O2?
55-80 mmHg
88-95%
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
What is an indication that shock is occurring?
Confusion —> shock is a Cx diagnosis
No lab test or VS can diagnose it
MC cause of isolated abducens nerve palsy?
Microvascular ischmeia from diabetes or HTN
What is the pathophysiology behind Type 2 vWF disease?
Glycoprotein is produced but NOT functional
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
What is the major SE of TTM?
Through what mechanism?
what is the Goal?
Hypoglycemia
metabolism slows, causes insulin resistance
bG of 108-140
What is the earliest ECG finding in acute MI?
Hyperacute T waves
What are the RF for uterine atony?
Multiple gestations Macrosomia Polyhydramnios Prolonged labor Use of tocolytics
Patient that has a bartholin gland abscess I&D’ed in the ED, what is the next management?
Word catheter for 4-6 weeks
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
What kind of Salter Harris fracture only involves the epiphysis?
Type 3
Aka “lower than the growth plate”
What is the MC sequela of myocarditis/pericarditis?
Dilated cardiomyopathy
Describe EKG of posterior MI?
Tall R waves in V1-V3 with horizontal ST depression and upright T waves
How to discharge pts in a mass casualty blast situation?
Otoscopic eval of TMs
Describe the following in a sickle cell pt w/aplastic crisis:
Retic count
Coombs test
Haptoglobin level
Dec
Negative
Normal
Pt with heavy bleeding and INR of 8 should be treated how?
Vit K and PCC
PCC is more effective than FFP
What is a Boutonnière finger?
DIP joint extension with proximal IP joint flexion
What are the risk factors for placenta previa?
Prior C section
Multiple gestations/mulparity
Multiple induce abortions
Old woman
What indicates acute appendicitis on US?
Diameter > 6mm
Wall thickness > 3mm
Target sign
Light’s Criteria?
Pleural:serum protein > 0.5
Pleural:serum LDH > 0.6
Pleural LDH > 2/3 upper limit of normal for serum LDH
How to treat acute asthma exacerbation?
BIOMES Beta agonists Ipratropium O2 Mag sulfate Epi Steroids
What does whole bowel irrigation mean?
Using MiraLAX
What features suggest VTach over SVT?
Capture and fusion beats
AV dissociation
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
Functional cause of confusion means what?
What is an example of a cause?
Psychiatric
Auditory hallucinations
How do you test the motor function of the median nerve?
Thumb and 5th finger opposition (recurrent n.)
OK sign (ant interosseous branch)
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
When is shingles treated?
Who should avoid pts w/shingles?
Within the first 3 days
Pregnant patients
What has the highest LR+ in adult pts for appendicitis?
RLQ pain
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)
What nerve innervates the platysma muscle?
Cervical branch of facial nerve
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
What does a fundoscopic “blood and thunder” exam indicate?
Seen in what condition?
Central Retinal vein occlusion
Chronic glaucoma
Posterior shoulder dislocation results in what Xray finding?
Light bulb sign or rim sign
What meds are contraindicated in WPW?
Adenosine
Beta blocker
CCB
Digoxin
Treatment for tularemia that is disseminated to cause PNA?
Streptomycin
Doxy for local rxn
What is the treatment for herpes keratitis?
Acyclovir or Trifluridine
Age group of Staph scalded skin syndrome?
Treatment?
Avg age 2, usually children < 6 y/o
Supportive, ABx to cover MRSA
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
How to diagnose midgut volvulus?
Upper GI series
What type of MI has the best prognosis?
Narrow complex 3rd degree AV block in an inferior wall MI
Usually transient and resolves spontaneously
What bacteria must you worry about in human bites?
Eikenella corrodens
Treat with Augmentin
Diffuse punctate corneal lesions seen with fluorescein staining indicates what?
UV keratitis —> can be due to welding
Retrobulbar hemorrhage can cause what subsequent injury?
Occlusion of the central retinal artery
Bite from what causes hemiballismus, AMS, rotary nystagmus?
Painful or not?
Centruroide (bark scorpion)
Painful yes
