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Rosh Review > Missed Questions > Flashcards

Missed Questions Flashcards

1
Q

Most common SERIOUS adverse reaction to N-Acetylcysteine (NAC)?

A

About 20% of patron can develop anaphylactic reaction.

This is non-IgE mediated reaction. Pt develop flushing, urticaria, and pruritus.

The infusion of NAC does not need to be stopped unless it becomes severe.

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2
Q

What is the King College criteria used for?

A

To determine if liver transplant is indicated.

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3
Q

Giant cell arteritis that effects young Asian women?

Presentation?
Dx?
Tx?
Ddx?

A

Takayasu arteritis

Large vessel arteritis affecting aorta and it’s major vessels

Presents with fever, malaise, arthralgia, claudication

PE: decreases pulses, bruits, asymmetric BP readings, vision changes

Dx: angiogram (MRI)
sed rate, CRP may be elevated

Tx: high dose prednisone

Ddx: giant cell (temporal) arteritis

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4
Q

Sensitivity of duplex ultrasonography?

A

95-99% for proximal venous thrombus.

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5
Q

Virchows triad

A

Stasis
Hypercoagulable state
Trauma

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6
Q

How does Epinephrine effectively treat anaphylaxis?

A

Activation of ALPHA - 1
:: decreases mucosal edema and induces peripheral vasoconstriction, improving hypotension.

Activation of BETA - 2
:: bronchodilation and stabilizes mast cells and basophils to limit further release of inflammatory mediators.

Activation of BETA - 1
:: increased heart rate (chronotropy) and contractility (inotropy)

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7
Q

Dose of Epi in anaphylaxis?

A

0.3 - 0.5mg IM

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8
Q

ECG changes in pericarditis

A

PR elevation in aVR
PR depression
Diffuse concave ST elevation (most prominent in precordium)

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9
Q

Most common infectious etiology of conjunctivitis in adults?

A

Adenovirus

#Bilateral red/pink eye
#PE: periauricular lymphadenopathy, copious watery discharge, scant mucoid discharge
#Tx: cool compresses, artificial tears, antihistamine for itching/redness
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10
Q

Lymphogranuloma venereum

Differentiating features

Presenting systems

Tx

A 
Differentiating features:
# presence of unilateral inguinal lymphadenopathy
# a chancre that is described to have a purple hue, occurs 7-30 days prior to onset

doxycycline

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11
Q

Idiopathic intracranial hypertension (formerly pseudotumor cerebri)

Physical exam findings

A 
Hx:
#Young, obese
# headache, vision changes, pulsatile tinnitus
# Diplopia with lateral gaze, CN VI palsy, loss of peripheral visual fields
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12
Q

Treatment of arterial gas embolism

A

Place supine
100% oxygen
Hyperbaric chamber

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13
Q

How might G6PD deficiency present?

A

African American male (present in 11% of this population)

Presents with scleral icterus after recently starting antibiotics

Antimalarias, sulfonamides, nitrofurantoin, fava beans -> oxidative stress leads to hemolytic anemia

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14
Q

What electrolyte abnormalities occurs with tumor lysis syndrome?

What are the down stream effects?

A

DNA breakdown -> hyperuricemia -> renal failure

Protein breakdown -> hyper phosphatemia -> hypocalcemia

Cytosol breakdown -> hyperkalemia -> cardiac dysrhythmia, neuromuscular irritability

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15
Q

Which class of medication is utilized as first line therapy for reduction of anginal episodes and improvement of exercise tolerance in patients with stable ischemic heart disease

A

Beta blocker

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16
Q

Triad of Aortic Stenosis

A

Dyspnea, Chest pain, syncope

In that order, and often exertional

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17
Q

What medications should be avoided in Aortic Stenosis

A

Nitroglycerin
Diuretics

Preload dependent state –> Stenosis leads to LV hypertrophy which limits diastolic filling and increases myocardial oxygen demand

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18
Q

What electrolyte abnormality can occur during massive transfusion protocol?

A

Hypocalcemia

Secondary to citrate in packed red blood cells

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19
Q

ECG finding with hypocalcemia

A

prolonged QT

check mag level also

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20
Q

Epsilon wave is indicative of what pathology

A

Arythmogenic Right Ventricular cardiomyopathy

:: positive terminal QRS deflection in V1 - V3

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21
Q

Arythmogenic Right Ventricular Cardiomyopathy

Pathology

Presentation

Tx

A

:: Autosomal dominant

:: fibrofatty replacement of right ventricle myocardium leads to dilated Right ventricle, causing poor contraction

:: symptoms include CHF, cardiomegaly, syncope and sudden death. Present with ventricular dysrhythmias

:: Beta-blockers or ICD

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22
Q

How do you differentiate between Antidromic and Orthodromic A Fib on ECG?

A

Orthodromic: Narrow

Antidromic: Wide

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23
Q

Mechanism of action for Furosemide

A

Inhibits the resorption of sodium and chloride in the Ascending Loop of Henle and proximal and distal renal tubules

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24
Q

Why can troponin be elevated in pericarditis?

A

Associated myocarditis

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25
Q

Umbilical cord prolapse:

tx:

A

: Cord precedes presenting part increasing cord pressure leading to fetal anoxia

::Emergent C-section

::Until then, elevate presenting fetal part, trandelenberg positioning, knees to chest

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26
Q

Botulism toxin

MOA:
Presentation:
Tx:

A

:: Prevents release of acetylcholine from motor neurons

:: Descending, symmetric, flaccid paralysis (“Floppy baby”)
::Most common age <12mo, hx of eating honey or corn syrup

:: IV botulism Ig

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27
Q

Minimal change disease:

How does it present?

Complications?

Tx?

A

::Most common cause of nephrotic disease in children

:: typically 2-6 yo male

:: pitting edema, hypertension, proteinuria. Preceded by viral URI

:: Kidney function will be normal

** risk of thromboembolism **
Hypercoagulable state: Antithrombin III, Protein S, and plasminogen lost in urine

:: Prednisone

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28
Q

Focal segmental glomerulosclerosis:

A

Nephrotic syndrome

AA

HIV/ IV drug abuse

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29
Q

Membranous nephropathy

A

Nephrotic syndrome

Caucasians

HBV, HCV, SLE, gold, penicillamine, malignancy

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30
Q

Sensitivity of CT w/o contrast for subarachnoid Hemorrhage at 24 hrs?

A

91%

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31
Q

In lightning strike injuries, what 2 ENT injuries are common?

A

Tympanic membrane rupture

Cataract formation (within days)

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32
Q

What are the 2 most common causes of death in lighting strike injuries?

A

Asystole

Asystole –> apnea –> hypoxia + V Fib
:: patients may have spontaneous recovery of cardiac activity; however, due to prolonged respiratory arrest, develop V Fib

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33
Q

How is triage different in a lightning strike compared to other mass casualty events

A

Highest priority should be given to cardiac and respiratory arrest

Resuscitation should continue even if pupils are fixed and dilated and they are unresponsive

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34
Q

What type of vomiting is relatively specific for SBO?

A

bilious vomiting (dark green/dark yellow)

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35
Q

How will Cushing’s Syndrome present?

A

:: Amenorrhea, central obesity, depressive symptoms, easy bruising.

:: On exam, purple straie, moon face, buffalo hump, hypertension

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36
Q

Testing for Cushing Syndrome?

A

24 hr urine cortisol

testing ACTH levels

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37
Q

Most common cause of Cushing Syndrome

A

Exogenous steroid use

non-iatrogenic) hypercortisolism from ACTH secreting pituitary tumor (then its Cushing disease..

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38
Q

Ddx for acute urinary retention

A

:: Obstruction (men: BPH, Women: prolapse/tumor)

::Neurogenic (diabetes)

:: Drugs (alpha - agonists)

Tx: foley, alpha antagonists (flomax/tamsulosin)

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39
Q

How is ischemic colitis different from mesenteric ischemia?

A

Mesenteric ischemia: embolic phenomenon

Ischemic colitis: Caused by a global low-flow state. Affects watershed areas i.e. splenic flexure and rectosigmoid junction

#Heart failure
#MI
#sepsis
#Hemorrhage
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40
Q

Goal SBP for subarachnoid hemorrhage?

A

140-160

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41
Q

What is it called when a ventriculoperitoneal shunt has intermittent overdraining and associated headaches?

A

Slit ventricle syndrome.

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42
Q

Pathophysiology of high altitude pulmonary edema

A

Noncardiogenic pulmonary edema caused by high microvascular pressure in the pulmonary arterial bed in patients exposed to high altitudes.

The relative hypoxia in high altitudes results in diffuse pulmonary vasoconstriction, forcing fluid from the pulmonary vasculature into the relatively lower pressure alveoli

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43
Q

Uremic symptoms?

A

Nausea
Vomiting
Fatigue
Confusion -> coma

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44
Q

Lab values consistent with PRE-RENAL injury

A

BUN-to-creatinine ration >20

Fractional excretion of Sodium < 1.0%

(>1% in intrinsic and post-renal)

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45
Q

What are three conditions that can elevate blood urea nitrogen (BUN) levels and, thus, affect the BUN-to-creatinine ratio?

A

Trauma, gastrointestinal hemorrhage, and protein loading.

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46
Q

Addisons disease

Whats the pathophysiology?

Presentation?

A

Abd pain, nausea, vomiting, diarrhea, fever, confusion

Primary adrenal insufficiency -> failure of the adrenal gland to produce cortisol.

hypothalamic-pituitary-adrenal axis (HPA axis) remains intact. Elevated cortisol levels -> decrease in adrenocorticotropin hormone (ACTH) via negative feedback on the anterior pituitary gland.

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47
Q

What is the initial neurologic finding of heat stroke

A

ataxia

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48
Q

Normal Pressure Hydrocephalus

pathophysiology?

Presentation?

Management?

A

Wet (urinary incontinence)
Wobbly (ataxia)
Wacky (dementia)

Increase in CSF in the ventricles 2/2 decreased CSF reabsorption

# LP to remove CSF
# neurosurgery consult for ventriculoperitoneal shunting
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49
Q

What type of ionizing radiation is the primary cause of acute radiation syndrome?

A

Gamma Rays

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50
Q

Why should patients with posterior nasal packs be admitted to a monitored bed?

A

Posterior packing can cause vagal stimulation with resulting bradycardia and bronchoconstriction.

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51
Q

Epistaxis anatomy:

Anterior bleeds?
Posterior bleeds?

A

Anterior bleeds: Kiesselbach plexus

Posterior bleeds: Sphenopalatine artery

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52
Q

Hypopyon

Pathophysiology

Presentation

A

White blood cells in the anterior chamber.

Suggests severe infectious keratitis or endophthalmitis (bacterial/fungal infection within eye)

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53
Q

Triad of Pheochromocytoma

A

Episodic headache
Diaphoresis
Tachycardia with hypertension

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54
Q

Pheochromocytoma

Pathophysiology

Dx

Tx

A

Most commonly caused by catecholamine-secreting tumor located in the adrenal glands

Diagnosis is made by assay of urinary catecholamines and metanephrines, and plasma metanephrine levels

Treatment is surgery, α-blocker (ie phentolamine, phenoxybenzamine) prior to β-blockade to prevent unopposed alpha agonism

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55
Q

What four clinical variables are used to calculate the Assessment of Blood Consumption score to predict the need for massive transfusion?

A 
# Penetrating mechanism of injury
# positive FAST exam
# systolic blood pressure < 90 mm Hg
# pulse rate > 120 beats/min.
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56
Q

What is the most common cause of neonatal hemorrhage?

A

Failure to administer vitamin K in the immediate postpartum period (associated with home births).

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57
Q

nonconducting atrial depolarizations without an accompanying QRS complex.

A

Second-degree AV block (Mobitz)

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58
Q

Complaining of low back pain and stiffness when walking that is relieved when leaning forward

A

Spinal Stenosis

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59
Q

Most common pathologic murmur in childhood

A

Ventricular septal defect

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60
Q

What is leukoria

A

White pupillary reflex

Strong association with retinoblastoma —> urgent referral to ophthalmology.

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61
Q

What is a hordeolum?

A

Abscess of the eyelid that usually self resolves

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62
Q

What is the most common infectious organism that is also a trigger for Stevens-Johnson syndrome and toxic epidermal necrolysis?

A

Mycoplasma pneumonia

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63
Q

What type of hypersensitivity reaction occurs immediately (min to hours - not days)?

A

Type 1 immunoglobulin E-mediated hypersensitivity reaction

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64
Q

Hypersensitivity reaction that occurs 1 week (or longer) after exposure to an offending agent.

Presents with hemolytic anemia, thrombocytopenia, or neutropenia

A

Type II antibody mediated cell deatruction

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65
Q

Hypersensitivity reaction that occurs weeks after offending agent.

Presents with purpuric rash and arthralgias. Serum sickness, vasculitis, or drug fever

A

Type III immune complex deposition.

Very uncommon

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66
Q

Hypersensitivity reaction that occurs weeks after exposure to offending agent

Presents with Steven Johnson syndrome, TEN, DRESS

A

Type IV T cell mediated hypersensitivity reaction

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67
Q

Major Complication of hydrogen peroxide ingestion?

Treatment?

A

Cerebral gas embolism —> can present with stroke like symptoms

Tx: hyperbaric oxygen

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68
Q

Medical Treatment for aortic dissection

A

Esmolol
Nitroprusside (after HR control)
Labetolol (HR + BP)

Goal HR <60, SBP 100-120

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69
Q

Treatment for Aortic dissection:

Type A vs Type B

A

Type A: surgical

Type B: medical

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70
Q

Patient receiving transfusion develops:

Fever
Chest pin
Myalgia
Dyspnea
Headache

Dx?

A

Febrile nonhemolytic transfusion reaction

Highest risk: platelets (5% incidence)

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71
Q

Mechanism of febrile nonhemolytic transfusion reaction

A

secondary to recipient antibodies against donor leukocytes as well as the release of cytokines by the donor leukocytes during storage. These reactions can occur during the transfusion or within 4 hours of its completion and are most common in patients who have been exposed to multiple antigens, such as those requiring frequent transfusions.

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72
Q

Which diagnosis are associated with Intussusception?

A

IgA vasculitis

Rotavirus

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73
Q

Characteristic features of Vulvovaginal candidiasis

A

Cottage cheese like discharge
pH < 4.5
KOH neg
pseudo hyphae, spores

74
Q

What bacterial infection has been associated with the onset or exacerbation of obsessive-compulsive disorder in some children?

A

Group A Streptococcus infection

75
Q

What agents cause CHOLINERGIC toxicity

A

Insecticides
Drugs (methyl, aldicarb)
Nerve agents (Sarin)

76
Q

How does Cholinergic toxicity present

A

SLUDGE: Salivation/Sweating, Lacrimation, Urination, Defecation, Gastrointestinal distress, Emesis

Killer B’s: Bradycardia, Bronchorrhea, Bronchospasm

77
Q

Cholinergic Toxicity Treatment

A

ATROPINE is an anticholinergic (antimuscarinic) and acts as a competitive inhibitor at the muscarinic receptor.

PRALIDOXIME works to regenerate acetylcholinesterase (the enzyme that breaks down acetylcholine), thereby limiting the amount of acetylcholine and reducing the muscarinic and nicotinic effects.

78
Q

Which infantile illness is easily misdiagnosed as inflammatory bowel disease due to a similar presentation?

A

Lactose intolerance.

79
Q

Treatment for erythema nodosum

A

supportive, NSAIDs, Potassium Iodide

80
Q

What is the appropriate starting defibrillation energy in children with ventricular fibrillation or pulseless ventricular tachycardia?

A

2J/Kg

81
Q

What is Courvoisier sign

A

Enlarged, palpable, nontender gallbladder in the presence of painless jaundice

It has been classically associated with biliary obstruction that is not caused by gallstones, such as underlying gallbladder or pancreatic malignancy

82
Q

What is Boas sign

A

scapular hyperesthesia, most commonly associated with gallbladder inflammation in acute cholecystitis.

83
Q

What is Kehr sign

A

is pain in the shoulder caused by irritation of the peritoneal cavity, such as that resulting from intra-abdominal blood. Pain in the left shoulder in the context of abdominal trauma is most commonly associated with a ruptured spleen.

84
Q

Causes of methemoglobinemia

A

Dapsone, Benzocaine, nitrates, antimalarials

Substances known to cause acquired methemoglobinemia include dapsone and topical anesthetics, especially mucous membrane use of benzocaine, although it has been reported with lidocaine, tetracaine, or prilocaine use. Most reported cases are thought to be due to high doses or a break in the mucosal barrier such as by mucositis or thrush.

85
Q

Methemoglobinemia presentation

A

SOB + clear lungs on PE + normal CXR
Cyanosis
Brown blood
Pulse ox in high 80s, will not respond to O2

86
Q

What worrisome maternal history should you consider in a neonate with seizures?

A

Maternal drug use during pregnancy may lead to withdrawal seizures in the newborn.

87
Q

First line treatment in neonatal seizures

A

phenobarbital

88
Q

Lead poisoning:

H/P, labs, imaging, treatment

A 
# Patient will be a complaining of headache, joint pain, and constipation
# X-ray will show hyperdense lines at metaphyses ("lead lines")
# Labs will show normocytic, hypochromic anemia, and basophilic stippling on peripheral smear
# Treatment is oral succimer or IV EDTA (calcium disodium edetate, given after dimercaprol)

“It SUCCs to eat lead”

89
Q

What is the most common cause of erysipelas?

A

Streptococcus pyogenes infection.

90
Q

In CPR, what lab values can be used as indicators to end resuscitative measures

A

Potassium > 12 mEq/L

End-tidal carbon dioxide > 10 mm Hg

91
Q

Rubeolla presentation

A

Measles

presents with a prodrome of COUGH, CONJUNCTIVITIS, and CORYZA followed by the development of KOPLIK spots, which are tiny red spots with a white and bluish hued center that appear on the buccal mucosa opposite the lower molars. Finally, patients develop an erythematous, maculopapular rash BEGINING at the HAIRLINE and then spreading from the head to the feet over ~3 days

92
Q

Rubella Presentation

A

German Measles

presents with a mild fever, marked postauricular and suboccipital LYMPHADENOPATHY and a nonspecific, DIFFUSE, erythematous, maculopapular rash

93
Q

Varicella Presentation

A

presents with a rash that is initially maculopapular, but then becomes VESICULAR with lesions occurring in crops and at multiple stages of development. These lesions will SPARE the palms and soles

94
Q

Variola Presentation

A

Smallpox

Viral prodrome
Deep-seated, firm, well-circumscribed lesions
centrifugal Distribution

95
Q

Transfusion-related acute lung injury (TRALI)

What is it?

Unique characteristics

A

Occurs within 6 hours of transfusion

Similar to ARDS –> pathophysiology is thought to be due to an acute neutrophilic response that leads to endothelial damage and massive capillary leak in the pulmonary vasculature

Hypotension, tachycardia, and fever are common.

Fever is not common in transfusion-associated circulatory overload (TACO)

96
Q

Parkland Formula

A

Fluid required = 4 mL x body weight (kg) x % total body surface area of burn (second or third degree)

50% given in first 8 hours, remainder over 16 hours

97
Q

What happens to cardiac output immediately following a severe burn injury?

A

Cardiac output decreases. This is one reason why significant fluid resuscitation is needed.

98
Q

Histoplasmosis vs blastomycosis

A

Both found in Mississippi and Ohio river valley

flu like symptoms

blastomycosis also have extrapulmonary symptoms, including verrucous skin lesions or osteomyelitis

Histoplasmosis - patient will have history of caving

99
Q

What treatment should be provided for pregnant women with candida vulvovaginitis?

A

Topical azole therapy should be used as oral fluconazole should be avoided in pregnancy.

100
Q

What happens when a magnet is placed over a pacemaker?

A

It will temporarily switch the device to asynchronous mode. It will also prevent an ICD, if present, from firing.

101
Q

Pacemaker malfunction:

Describe Over-sensing

A

Sensing refers to the pacemaker’s ability to detect native cardiac activity. When a pacemaker senses native heart beats, it is inhibited and does not fire. The pacemaker will fire when it doesn’t sense native cardiac beats. Oversensing occurs when the pacemaker inappropriately senses noncardiac activity, such as muscle movement, or irregular cardiac activity, such as fibrillatory waves in atrial fibrillation, and interprets them as adequate cardiac beats. This patient’s pacemaker is oversensing his activities and his essential tremor as native cardiac beats. As a result, the pacer is inhibited and does not produce any pacer spikes, resulting in syncope due to his sinus node dysfunction.

102
Q

Pacemaker malfunction:

Describe Failure to Capture

A

the pacemaker is generating pacer spikes but there is no cardiac beat produced. You will see pacer spikes without an associated cardiac beat on ECG

103
Q

Pacemaker malfunction:

Describe undersensing

A

the pacemaker is not detecting native heart beats and, therefore, continues to fire at inappropriate times. It is not pacing in a coordinated pattern with the heart’s native rhythm, and there will be pacer spikes in the middle of QRS complexes.

104
Q

Auricular perichondritis

1st line Abx

A

oral ciprofloxacin for 1 week and otolaryngology follow-up in 24 hours. Quinolones are preferred first-line agents in perichondritis, as many cases are caused by Pseudomonas aeruginosa. Other bacteria involved include skin flora such as Staphylococcus aureus and Streptococcus pyogenes.

105
Q

What is the dose for Factor VIII replacement in the setting of life threatening bleed

A

Patients with major or life-threatening bleeding should be given 50 IU/kg of factor VIII.

( 1 IU/kg of factor VIII will increase the circulating factor VIII level by 2% –> goal should be to achieve a circulating level of 100%)

Hemophilia A = Factor VIII deficiency

106
Q

Outpatient Abx for PID

A

ceftriaxone 250 mg IM in a single dose plus doxycycline 100 mg PO bid for 14 days

107
Q

Which coronary artery is most likely to be involved in aortic dissection?

A

Right coronary artery.

108
Q

Differentiate between High-flow and Low-flow priapism

A

Low-flow: venous, painful, emergency
Low-flow Rx: aspiration, intracavernosal phenylephrine

High-flow: arterial, semi-erect, painless
High-flow Rx: observation, arterial embolization

109
Q

What are the two lab findings that should raise your suspicion for hookworm infection?

A

Microcytic anemia and marked eosinophilia

110
Q

What electrolyte abnormalities are commonly seen in refeeding syndrome

A

most commonly hypophosphatemia, but also includes hypokalemia and hypomagnesemia.

Once amino acids become available for the body to use for protein synthesis, phosphorus quickly shifts into the intracellular space and becomes extracellularly depleted

111
Q

Most common organism that causes bacterial tracheitis?

1st line Abx?

A

Staph aureus

Vancomycin
3rd gen cephalosporin

112
Q

Jimson Weed has what mechanism of action

A

Anticholinergic

Mad as a hatter
Blind as a bat
Red as a beet
Hot as a hare
Dry as a Bone
113
Q

Treatment for Anticholinergic overdose

A

physostigmine, an acetylcholinesterase inhibitor

114
Q

Differentiate synovial fluid analysis between inflammatory and infectious arthritis

A

Infectious: WBC > 50,000 with > 75%PMNs

Inflammatory: WBC 2,000 - 50,000 with > 50% PMNs

115
Q

What finding can help distinguish between septic arthritis and immunoglobulin A vasculitis in a child who refuses to bear weight?

A

Immunoglobulin A vasculitis often affects both lower extremities symmetrically, whereas septic arthritis is typically unilateral.

116
Q

Patient with PURULENT cellulitis require what extra coverage?
What abx are used?

A

Oral antibiotics with MRSA coverage include doxycycline, trimethoprim-sulfamethoxazole, clindamycin, and linezolid

117
Q

In pediatrics, what is the narrowest portion of the trachea?

A

Narrowest portion is the cricoid cartilage (below the vocal cords)

This is why uncuffed tubes are used in the pediatric population

118
Q

Dabigatran reversal agent

A

Idarucizumab is a monoclonal antibody reversal agent

Dabigatran (Pradaxa) is an oral direct thrombin inhibitor

119
Q

Rivaroxaban, Apixaban, Edoxaban - reversal agent

A

Andexanet alfa

Factor Xa inhibitors

120
Q

How many days after chemotherapy is the nadir (lowest point) of the absolute neutrophil count

A

5 to 14 days

121
Q

What is the most common cause of septic arthritis in sickle cell patients?

A

Staphylococcus aureus, like the general population, but their risk of infection secondary to Salmonella arthritis is increased due to their functional asplenia

122
Q

Wilson Disease

A

Copper accumulates in the liver, kidneys, brain, and eyes

Autosomal recessive disease of copper metabolism

Young patients: symptoms of liver disease
Older patients: neuropsych symptoms

Labs: Low ceruplasmin, low serum copper

Tx: Penicillamine (a copper chelator)

123
Q

Treatment timeframe goals for STEMI

A

The American College of Cardiology Foundation/American Heart Association guidelines target a treatment goal of less than 90 minutes for patients arriving at a hospital with PCI capability, or 120 minutes or less for patients arriving at a hospital without PCI capability to account for transfer time. Fibrinolysis should be given within 30 minutes of ED arrival if PCI cannot be accomplished within these time frames.

124
Q

For how many hours after a possible HIV exposure is post-exposure prophylaxis indicated?

A

72 hours

125
Q

Niacin Deficiency:

The 3 Ds

A

Pellagra:

Dermatitis (photosensitive)
Diarrhea
Dementia

Vitamin B3 = Niacin

a/w alcoholism or long-term isoniazid therapy

126
Q

What is the classic cardiac manifestation of thiamine deficiency?

A

High output heart failure seen in wet beriberi.

127
Q

What bacteria are most commonly implicated in acute chest crisis?

A

Chlamydia pneumoniae in adults and Mycoplasma pneumoniae in children.

128
Q

What is the name of the disease process when a patient has evidence of vesicles within the ear canal, as well as hyperacusis?

A

Ramsay Hunt syndrome.

129
Q

What is the biggest risk factor for neuroinvasive West Nile Virus

A

Advanced Age

130
Q

What is the typical distribution of weakness caused by West Nile meningoencephalitis?

A

Asymmetric and isolated facial involvement may also be seen.

131
Q

What is the correct location to perform an arthrocentesis of the ankle joint with the anteromedial approach?

A

medial to the extensor hallucis longus tendon and lateral to the medial malleolus

132
Q

Effects of Clonidine in overdose

A

Alpha-2 adrenergic agonist = inhibits release of peripheral catecholamines = decreased HR, BP, cardiac output. (may see transient HTN immediately after ingestion)

Stimulates mu-receptor = miotic pupils and lethargy

133
Q

Skier’s thumb / gamekeepers thumb

A

Rupture of ulnar collateral ligament

Most common mechanism is acute forced abduction of the thumb at the metacarpal phalangeal (MCP) joint -> skier falls on outstretched hand while holding a ski pole

Patient will be unable to resist abduction of the thumb

134
Q

In acute respiratory acidosis, how much will the bicarb increase relative to PaCO2

A

in acute respiratory acidosis, we expect the bicarbonate to increase by 1 for each 10 mm Hg of PaCO₂

In chronic we expect the bicarbonate to increase by 4 for each 10 mm Hg of PaCO₂

135
Q

What will the rate of junctional escape rhythm be?

A

40-60 bpm

136
Q

Most common chronic cause of cor pulmonale?

Most common acute cause?

A

Chronic: COPD

Acute: PE

137
Q

How do you differentiate between Hordeolum (stye) vs Chalazion?

A

Chalazion is less acute and less painful then hordeolum

Also: Hordeulum is at or near eye lash follicle
vs
Chalazion is found above eyelashes on the upper lid

** Treatment is same: warm compresses**

138
Q

Most common corneal lesion in Herpes Zoster Opthalmicus?

A

The most common corneal lesion is punctate epithelial keratitis, where the cornea takes on a ground-glass appearance due to stromal edema. Pseudodendrites are also associated with zoster ophthalmicus and are typically located in the periphery. Pseudodendrites stain poorly with fluorescein and, unlike true dendrites, lack rounded terminal bulbs.

139
Q

What is Hutchinson sign?

A

Herpes Zoster Opthalmicus: Involvement of the tip of the nose

140
Q

Difference between Premenstrual Syndrome (PMS) and Premenstrual dysmorphic syndrome (PMDD)?

A

Both have sleep disturbances, decreased focus, emotional lability, breast tenderness, or HA

PMDD: Symptoms result in significant distress or interference in usual activities.

141
Q

What complication is possible from clamping a chest tube?

A

If an intrathoracic air leak is present, a tension pneumothorax can develop.

142
Q

What is the most commonly associated complication of mitral valve stenosis?

A

Atrial fibrillation.

143
Q

Neutropenic Fever

A

temperature of 38°C or greater persisting for longer than 1 hour or a temperature of 38.3°C or greater once with an associated absolute neutrophil count less than 1.0 x 109/L

144
Q

Differentiate between Gastroschisis and Omphalocele

A

Gastroschisis involves an abdominal wall defect with pure evisceration of bowel and sometimes other contents, whereas an omphalocele involves herniation that is covered by a thin membranous sac.

145
Q

T-test vs ANOVA

A

t test: compares means of 2 groups

ANOVA: compares means of 3 groups

146
Q

What is the most common gram-negative pathogen identified in neutropenic fever?

A

Pseudomonas aeruginosa.

147
Q

Management of Salter Harris Fractures

A

I/II: nonoperative

IV/V: surgery required

148
Q

What counseling should you offer parents of children with electrical burns of the lip?

A

The labial artery typically bleeds two to five days after the injury. You should teach them how to hold pressure on the area should this occur.

149
Q

What laboratory test is almost universally abnormal, and remains so the longest, in patients with heat stroke?

A

LFTs

150
Q

3 drugs that contain salicylate

A

Aspirin, wintergreen, bismuth subsalicylate

151
Q

Salicylate toxicity

A

Respiratory alkalosis + anion gap metabolic acidosis

152
Q

Salicylate toxicity treatment

A

Treatment includes bicarbonate and charcoal (if <2 hr). Alkalinization of urine is achieved with a bicarbonate drip with a urine pH goal of 7.5–8

153
Q

What electrolyte abnormality must be corrected in order to adequately alkalinize the urine?

A

hypokalemia

154
Q

What is the role of benzodiazepines in hyperthermia?

A

To manage agitation and shivering (due to rapid cooling).

155
Q

The diagnostic test of choice if methemoglobinemia is suspected is

A

laboratory co-oximetry, which measures methemoglobin levels. Use of fingertip co-oximetry is not as reliable for diagnosis and, therefore, blood-based testing should be used when available. Methemoglobin interferes with pulse-oximetry readings, and measurements are characteristically around 85%

156
Q

In addition to pralidoxime, what other treatment is indicated for patients with organophosphate poisoning?

A

Atropine, titrated to drying of secretions.

SLUDGE - salivation, lacrimation, urination, diarrhea, gastrointestinal distress, and emesis. An alternative mnemonic is DUMBBELLSS - diarrhea, urination, miosis, bradycardia, bronchospasm, emesis, lacrimation, lethargy, salivation and seizures.

157
Q

True or false: antibiotic coverage for perichondritis requires Pseudomonas aeruginosa coverage.

A

True. Antibiotics should also cover Staphylococcus aureus and Streptococcus pyogenes.

158
Q

Differentiate Tularemia from Anthrax on CXR?

A

With Tularemia, an important distinction from anthrax infection is the absence of a widened mediastinum.

Chest X-ray may show peribronchial infiltrates, bronchopneumonia, or pleural effusions.

159
Q

Treatment for Tularemia

A

The first-line treatment for tularemia is either streptomycin or gentamicin.

160
Q

What three metabolic derangements are most often found in infants with an inborn error of metabolism?

A

Acid-base disorder, hypoglycemia, and hyperammonemia.

161
Q

In a 3rd trimester patient, post trauma, What is the minimum amount of time for observation to adequately rule out uterine or fetal traumatic injuries?

A

4 - 6 hours

162
Q

What type of clavicle fractures require emergent ortho evaluation

A

open fractures, neurovascular compromise, and tenting of the skin.

163
Q

Why do superiorly displaced clavicle fractures need to be referred to ortho?

A

prone to non-union

164
Q

Galeazzi fracture dislocation

A

Distal radius fracture
Distal radioulnar joint dislocation

Mnemonic: GRUesome MURder
G: Galeazzi R: radius fracture U: ulna (radioulnar joint) dislocation
M: Monteggia U: ulna fracture R: radial head dislocation

165
Q

Monteggia fracture dislocation

A

Proximal to mid ulna fracture
Radial head dislocation

Mnemonic: GRUesome MURder
G: Galeazzi R: radius fracture U: ulna (radioulnar joint) dislocation
M: Monteggia U: ulna fracture R: radial head dislocation

166
Q

What systemic disease is frequently associated with temporal arteritis?

A

Polymyalgia rheumatica (in 30–40% of patients).

167
Q

Which common extrapyramidal symptom is irreversible?

A

Tardive dyskinesia develops over months to years of antipsychotic exposure and is usually irreversible.

168
Q

If the cortex and brainstem are intact, What is the expected oculovestibular reflex if tested with cold water?

A

Fast component of nystagmus away from irrigated ear

169
Q

Which is the best sonographic view to assess for cardiac wall motion abnormalities?

A

Parasternal short-axis view.

170
Q

What disease commonly presents with vertigo, hearing loss, and tinnitus?

A

Ménière disease

171
Q

Why are Salter-Harris type III, IV, and V fractures typically managed by open reduction and internal fixation?

A

Because these fractures typically involve the germinal matrix and growth may be significantly disrupted even with anatomic reduction.

172
Q

Optic Neuritis

A

is an inflammatory condition often associated with demyelinating diseases, such as multiple sclerosis. It involves loss of central vision, and fundoscopic examination is often unremarkable because of the retrobulbar location of the inflammation. The majority of patients complain of painful ocular movements

173
Q

Central retinal vein occlusion

A

painless vision loss caused by thrombotic obstruction of the retinal vein. Fundoscopic examination reveals the classic “blood and thunder” or “pizza pie” appearance.

174
Q

How many weeks are required for maturation of the cystostomy tract after a new suprapubic catheter is placed, limiting replacement of an accidentally removed catheter?

A

6 weeks

175
Q

Painful genital ulcers

A

Chancroid (hamaephilus ducreyi)

Genital herpes (HSV)

176
Q

Painless genital ulcers

A

Lymphogranuloma venereum (chlamydia trachomatis)

Granuloma inguinale (klebsiella granulomatis)

Primary syphilis (treponema pallidum)

177
Q

What is the most common viral cause of rhabdomyolysis?

A

Influenza A

178
Q

Treatment for Primary Immune Thrombocytopenia (ITP)

A

Observation, steroids, IVIG

Transfusion if platelet count under 10,000

179
Q

What odor is classically associated with organophosphates?

A

garlic

180
Q

How can you distinguish between Malaria and Dengue hemorrhagic fever?

A

A distinction between malaria and dengue hemorrhagic fever is that dengue hemorrhagic fever can cause an elevated hematocrit due to vascular permeability, whereas malaria causes a hemolytic anemia.

181
Q

Besides Hirschsprung disease, which other conditions are associated with delayed passage of meconium?

A

Cystic fibrosis and intestinal atresia.

182
Q

Which virus is most commonly implicated in hand, foot, and mouth disease?

A

Group A coxsackievirus, with A16 and A71 responsible for most outbreaks.

Rosh Review (1 decks)

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