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.
2
Q
What is the King College criteria used for?
A
To determine if liver transplant is indicated.
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
4
Q
Sensitivity of duplex ultrasonography?
A
95-99% for proximal venous thrombus.
5
Q
Virchows triad
A
Stasis
Hypercoagulable state
Trauma
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)
7
Q
Dose of Epi in anaphylaxis?
A
0.3 - 0.5mg IM
8
Q
ECG changes in pericarditis
A
PR elevation in aVR
PR depression
Diffuse concave ST elevation (most prominent in precordium)
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
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
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
12
Q
Treatment of arterial gas embolism
A
Place supine
100% oxygen
Hyperbaric chamber
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
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
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
16
Q
Triad of Aortic Stenosis
A
Dyspnea, Chest pain, syncope
In that order, and often exertional
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
18
Q
What electrolyte abnormality can occur during massive transfusion protocol?
A
Hypocalcemia
Secondary to citrate in packed red blood cells
19
Q
ECG finding with hypocalcemia
A
prolonged QT
check mag level also
20
Q
Epsilon wave is indicative of what pathology
A
Arythmogenic Right Ventricular cardiomyopathy
:: positive terminal QRS deflection in V1 - V3
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
22
Q
How do you differentiate between Antidromic and Orthodromic A Fib on ECG?
A
Orthodromic: Narrow
Antidromic: Wide
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
24
Q
Why can troponin be elevated in pericarditis?
A
Associated myocarditis
25
Umbilical cord prolapse:
| tx:
: 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
26
Botulism toxin
MOA:
Presentation:
Tx:
:: 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
27
Minimal change disease:
How does it present?
Complications?
Tx?
::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
28
Focal segmental glomerulosclerosis:
Nephrotic syndrome
AA
HIV/ IV drug abuse
29
Membranous nephropathy
Nephrotic syndrome
Caucasians
HBV, HCV, SLE, gold, penicillamine, malignancy
30
Sensitivity of CT w/o contrast for subarachnoid Hemorrhage at 24 hrs?
91%
31
In lightning strike injuries, what 2 ENT injuries are common?
Tympanic membrane rupture
Cataract formation (within days)
32
What are the 2 most common causes of death in lighting strike injuries?
Asystole
Asystole --> apnea --> hypoxia + V Fib
:: patients may have spontaneous recovery of cardiac activity; however, due to prolonged respiratory arrest, develop V Fib
33
How is triage different in a lightning strike compared to other mass casualty events
Highest priority should be given to cardiac and respiratory arrest
Resuscitation should continue even if pupils are fixed and dilated and they are unresponsive
34
What type of vomiting is relatively specific for SBO?
bilious vomiting (dark green/dark yellow)
35
How will Cushing's Syndrome present?
:: Amenorrhea, central obesity, depressive symptoms, easy bruising.
:: On exam, purple straie, moon face, buffalo hump, hypertension
36
Testing for Cushing Syndrome?
24 hr urine cortisol
testing ACTH levels
37
Most common cause of Cushing Syndrome
Exogenous steroid use
| non-iatrogenic) hypercortisolism from ACTH secreting pituitary tumor (then its Cushing disease..
38
Ddx for acute urinary retention
:: Obstruction (men: BPH, Women: prolapse/tumor)
::Neurogenic (diabetes)
:: Drugs (alpha - agonists)
Tx: foley, alpha antagonists (flomax/tamsulosin)
39
How is ischemic colitis different from mesenteric ischemia?
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
```
40
Goal SBP for subarachnoid hemorrhage?
140-160
41
What is it called when a ventriculoperitoneal shunt has intermittent overdraining and associated headaches?
Slit ventricle syndrome.
42
Pathophysiology of high altitude pulmonary edema
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
43
Uremic symptoms?
Nausea
Vomiting
Fatigue
Confusion -> coma
44
Lab values consistent with PRE-RENAL injury
BUN-to-creatinine ration >20
Fractional excretion of Sodium < 1.0%
(>1% in intrinsic and post-renal)
45
What are three conditions that can elevate blood urea nitrogen (BUN) levels and, thus, affect the BUN-to-creatinine ratio?
Trauma, gastrointestinal hemorrhage, and protein loading.
46
Addisons disease
Whats the pathophysiology?
Presentation?
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.
#Abd pain, nausea, vomiting, diarrhea, fever, confusion
#hypotension, hyperpigmentation of skin
#hypernatremia, hypokalemia
47
What is the initial neurologic finding of heat stroke
ataxia
48
Normal Pressure Hydrocephalus
pathophysiology?
Presentation?
Management?
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
```
49
What type of ionizing radiation is the primary cause of acute radiation syndrome?
Gamma Rays
50
Why should patients with posterior nasal packs be admitted to a monitored bed?
Posterior packing can cause vagal stimulation with resulting bradycardia and bronchoconstriction.
51
Epistaxis anatomy:
Anterior bleeds?
Posterior bleeds?
Anterior bleeds: Kiesselbach plexus
| Posterior bleeds: Sphenopalatine artery
52
Hypopyon
Pathophysiology
Presentation
White blood cells in the anterior chamber.
Suggests severe infectious keratitis or endophthalmitis (bacterial/fungal infection within eye)
53
Triad of Pheochromocytoma
Episodic headache
Diaphoresis
Tachycardia with hypertension
54
Pheochromocytoma
Pathophysiology
Dx
Tx
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
55
What four clinical variables are used to calculate the Assessment of Blood Consumption score to predict the need for massive transfusion?
```
# Penetrating mechanism of injury
# positive FAST exam
# systolic blood pressure < 90 mm Hg
# pulse rate > 120 beats/min.
```
56
What is the most common cause of neonatal hemorrhage?
Failure to administer vitamin K in the immediate postpartum period (associated with home births).
57
nonconducting atrial depolarizations without an accompanying QRS complex.
Second-degree AV block (Mobitz)
58
Complaining of low back pain and stiffness when walking that is relieved when leaning forward
Spinal Stenosis
59
Most common pathologic murmur in childhood
Ventricular septal defect
60
What is leukoria
White pupillary reflex
Strong association with retinoblastoma —> urgent referral to ophthalmology.
61
What is a hordeolum?
Abscess of the eyelid that usually self resolves
62
What is the most common infectious organism that is also a trigger for Stevens-Johnson syndrome and toxic epidermal necrolysis?
Mycoplasma pneumonia
63
What type of hypersensitivity reaction occurs immediately (min to hours - not days)?
Type 1 immunoglobulin E-mediated hypersensitivity reaction
64
Hypersensitivity reaction that occurs 1 week (or longer) after exposure to an offending agent.
Presents with hemolytic anemia, thrombocytopenia, or neutropenia
Type II antibody mediated cell deatruction
65
Hypersensitivity reaction that occurs weeks after offending agent.
Presents with purpuric rash and arthralgias. Serum sickness, vasculitis, or drug fever
Type III immune complex deposition.
Very uncommon
66
Hypersensitivity reaction that occurs weeks after exposure to offending agent
Presents with Steven Johnson syndrome, TEN, DRESS
Type IV T cell mediated hypersensitivity reaction
67
Major Complication of hydrogen peroxide ingestion?
Treatment?
Cerebral gas embolism —> can present with stroke like symptoms
Tx: hyperbaric oxygen
68
Medical Treatment for aortic dissection
Esmolol
Nitroprusside (after HR control)
Labetolol (HR + BP)
Goal HR <60, SBP 100-120
69
Treatment for Aortic dissection:
Type A vs Type B
Type A: surgical
Type B: medical
70
Patient receiving transfusion develops:
```
Fever
Chest pin
Myalgia
Dyspnea
Headache
```
Dx?
Febrile nonhemolytic transfusion reaction
Highest risk: platelets (5% incidence)
71
Mechanism of febrile nonhemolytic transfusion reaction
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.
72
Which diagnosis are associated with Intussusception?
IgA vasculitis
| Rotavirus
73
Characteristic features of Vulvovaginal candidiasis
Cottage cheese like discharge
pH < 4.5
KOH neg
pseudo hyphae, spores
74
What bacterial infection has been associated with the onset or exacerbation of obsessive-compulsive disorder in some children?
Group A Streptococcus infection
75
What agents cause CHOLINERGIC toxicity
Insecticides
Drugs (methyl, aldicarb)
Nerve agents (Sarin)
76
How does Cholinergic toxicity present
SLUDGE: Salivation/Sweating, Lacrimation, Urination, Defecation, Gastrointestinal distress, Emesis
Killer B's: Bradycardia, Bronchorrhea, Bronchospasm
77
Cholinergic Toxicity Treatment
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
Which infantile illness is easily misdiagnosed as inflammatory bowel disease due to a similar presentation?
Lactose intolerance.
79
Treatment for erythema nodosum
supportive, NSAIDs, Potassium Iodide
80
What is the appropriate starting defibrillation energy in children with ventricular fibrillation or pulseless ventricular tachycardia?
2J/Kg
81
What is Courvoisier sign
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
What is Boas sign
scapular hyperesthesia, most commonly associated with gallbladder inflammation in acute cholecystitis.
83
What is Kehr sign
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
Causes of methemoglobinemia
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
Methemoglobinemia presentation
SOB + clear lungs on PE + normal CXR
Cyanosis
Brown blood
Pulse ox in high 80s, will not respond to O2
86
What worrisome maternal history should you consider in a neonate with seizures?
Maternal drug use during pregnancy may lead to withdrawal seizures in the newborn.
87
First line treatment in neonatal seizures
phenobarbital
88
Lead poisoning:
H/P, labs, imaging, treatment
```
# 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
What is the most common cause of erysipelas?
Streptococcus pyogenes infection.
90
In CPR, what lab values can be used as indicators to end resuscitative measures
Potassium > 12 mEq/L
| End-tidal carbon dioxide > 10 mm Hg
91
Rubeolla presentation
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
Rubella Presentation
German Measles
presents with a mild fever, marked postauricular and suboccipital LYMPHADENOPATHY and a nonspecific, DIFFUSE, erythematous, maculopapular rash
93
Varicella Presentation
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
Variola Presentation
Smallpox
Viral prodrome
Deep-seated, firm, well-circumscribed lesions
centrifugal Distribution
95
Transfusion-related acute lung injury (TRALI)
What is it?
Unique characteristics
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
Parkland Formula
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
What happens to cardiac output immediately following a severe burn injury?
Cardiac output decreases. This is one reason why significant fluid resuscitation is needed.
98
Histoplasmosis vs blastomycosis
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
What treatment should be provided for pregnant women with candida vulvovaginitis?
Topical azole therapy should be used as oral fluconazole should be avoided in pregnancy.
100
What happens when a magnet is placed over a pacemaker?
It will temporarily switch the device to asynchronous mode. It will also prevent an ICD, if present, from firing.
101
Pacemaker malfunction:
| Describe Over-sensing
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
Pacemaker malfunction:
Describe Failure to Capture
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
Pacemaker malfunction:
Describe undersensing
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
Auricular perichondritis
1st line Abx
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
What is the dose for Factor VIII replacement in the setting of life threatening bleed
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
Outpatient Abx for PID
ceftriaxone 250 mg IM in a single dose plus doxycycline 100 mg PO bid for 14 days
107
Which coronary artery is most likely to be involved in aortic dissection?
Right coronary artery.
108
Differentiate between High-flow and Low-flow priapism
Low-flow: venous, painful, emergency
Low-flow Rx: aspiration, intracavernosal phenylephrine
High-flow: arterial, semi-erect, painless
High-flow Rx: observation, arterial embolization
109
What are the two lab findings that should raise your suspicion for hookworm infection?
Microcytic anemia and marked eosinophilia
110
What electrolyte abnormalities are commonly seen in refeeding syndrome
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
Most common organism that causes bacterial tracheitis?
1st line Abx?
Staph aureus
Vancomycin
3rd gen cephalosporin
112
Jimson Weed has what mechanism of action
Anticholinergic
```
Mad as a hatter
Blind as a bat
Red as a beet
Hot as a hare
Dry as a Bone
```
113
Treatment for Anticholinergic overdose
physostigmine, an acetylcholinesterase inhibitor
114
Differentiate synovial fluid analysis between inflammatory and infectious arthritis
Infectious: WBC > 50,000 with > 75%PMNs
Inflammatory: WBC 2,000 - 50,000 with > 50% PMNs
115
What finding can help distinguish between septic arthritis and immunoglobulin A vasculitis in a child who refuses to bear weight?
Immunoglobulin A vasculitis often affects both lower extremities symmetrically, whereas septic arthritis is typically unilateral.
116
Patient with PURULENT cellulitis require what extra coverage?
What abx are used?
Oral antibiotics with MRSA coverage include doxycycline, trimethoprim-sulfamethoxazole, clindamycin, and linezolid
117
In pediatrics, what is the narrowest portion of the trachea?
Narrowest portion is the cricoid cartilage (below the vocal cords)
This is why uncuffed tubes are used in the pediatric population
118
Dabigatran reversal agent
Idarucizumab is a monoclonal antibody reversal agent
Dabigatran (Pradaxa) is an oral direct thrombin inhibitor
119
Rivaroxaban, Apixaban, Edoxaban - reversal agent
Andexanet alfa
| Factor Xa inhibitors
120
How many days after chemotherapy is the nadir (lowest point) of the absolute neutrophil count
5 to 14 days
121
What is the most common cause of septic arthritis in sickle cell patients?
Staphylococcus aureus, like the general population, but their risk of infection secondary to Salmonella arthritis is increased due to their functional asplenia
122
Wilson Disease
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
Treatment timeframe goals for STEMI
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
For how many hours after a possible HIV exposure is post-exposure prophylaxis indicated?
72 hours
125
Niacin Deficiency:
The 3 Ds
Pellagra:
Dermatitis (photosensitive)
Diarrhea
Dementia
Vitamin B3 = Niacin
a/w alcoholism or long-term isoniazid therapy
126
What is the classic cardiac manifestation of thiamine deficiency?
High output heart failure seen in wet beriberi.
127
What bacteria are most commonly implicated in acute chest crisis?
Chlamydia pneumoniae in adults and Mycoplasma pneumoniae in children.
128
What is the name of the disease process when a patient has evidence of vesicles within the ear canal, as well as hyperacusis?
Ramsay Hunt syndrome.
129
What is the biggest risk factor for neuroinvasive West Nile Virus
Advanced Age
130
What is the typical distribution of weakness caused by West Nile meningoencephalitis?
Asymmetric and isolated facial involvement may also be seen.
131
What is the correct location to perform an arthrocentesis of the ankle joint with the anteromedial approach?
medial to the extensor hallucis longus tendon and lateral to the medial malleolus
132
Effects of Clonidine in overdose
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
Skier's thumb / gamekeepers thumb
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
In acute respiratory acidosis, how much will the bicarb increase relative to PaCO2
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
What will the rate of junctional escape rhythm be?
40-60 bpm
136
Most common chronic cause of cor pulmonale?
Most common acute cause?
Chronic: COPD
Acute: PE
137
How do you differentiate between Hordeolum (stye) vs Chalazion?
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
Most common corneal lesion in Herpes Zoster Opthalmicus?
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
What is Hutchinson sign?
Herpes Zoster Opthalmicus: Involvement of the tip of the nose
140
Difference between Premenstrual Syndrome (PMS) and Premenstrual dysmorphic syndrome (PMDD)?
Both have sleep disturbances, decreased focus, emotional lability, breast tenderness, or HA
PMDD: Symptoms result in significant distress or interference in usual activities.
141
What complication is possible from clamping a chest tube?
If an intrathoracic air leak is present, a tension pneumothorax can develop.
142
What is the most commonly associated complication of mitral valve stenosis?
Atrial fibrillation.
143
Neutropenic Fever
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
Differentiate between Gastroschisis and Omphalocele
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
T-test vs ANOVA
t test: compares means of 2 groups
| ANOVA: compares means of 3 groups
146
What is the most common gram-negative pathogen identified in neutropenic fever?
Pseudomonas aeruginosa.
147
Management of Salter Harris Fractures
I/II: nonoperative
| IV/V: surgery required
148
What counseling should you offer parents of children with electrical burns of the lip?
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
What laboratory test is almost universally abnormal, and remains so the longest, in patients with heat stroke?
LFTs
150
3 drugs that contain salicylate
Aspirin, wintergreen, bismuth subsalicylate
151
Salicylate toxicity
Respiratory alkalosis + anion gap metabolic acidosis
152
Salicylate toxicity treatment
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
What electrolyte abnormality must be corrected in order to adequately alkalinize the urine?
hypokalemia
154
What is the role of benzodiazepines in hyperthermia?
To manage agitation and shivering (due to rapid cooling).
155
The diagnostic test of choice if methemoglobinemia is suspected is
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
In addition to pralidoxime, what other treatment is indicated for patients with organophosphate poisoning?
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
True or false: antibiotic coverage for perichondritis requires Pseudomonas aeruginosa coverage.
True. Antibiotics should also cover Staphylococcus aureus and Streptococcus pyogenes.
158
Differentiate Tularemia from Anthrax on CXR?
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
Treatment for Tularemia
The first-line treatment for tularemia is either streptomycin or gentamicin.
160
What three metabolic derangements are most often found in infants with an inborn error of metabolism?
Acid-base disorder, hypoglycemia, and hyperammonemia.
161
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?
4 - 6 hours
162
What type of clavicle fractures require emergent ortho evaluation
open fractures, neurovascular compromise, and tenting of the skin.
163
Why do superiorly displaced clavicle fractures need to be referred to ortho?
prone to non-union
164
Galeazzi fracture dislocation
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
Monteggia fracture dislocation
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
What systemic disease is frequently associated with temporal arteritis?
Polymyalgia rheumatica (in 30–40% of patients).
167
Which common extrapyramidal symptom is irreversible?
Tardive dyskinesia develops over months to years of antipsychotic exposure and is usually irreversible.
168
If the cortex and brainstem are intact, What is the expected oculovestibular reflex if tested with cold water?
Fast component of nystagmus away from irrigated ear
169
Which is the best sonographic view to assess for cardiac wall motion abnormalities?
Parasternal short-axis view.
170
What disease commonly presents with vertigo, hearing loss, and tinnitus?
Ménière disease
171
Why are Salter-Harris type III, IV, and V fractures typically managed by open reduction and internal fixation?
Because these fractures typically involve the germinal matrix and growth may be significantly disrupted even with anatomic reduction.
172
Optic Neuritis
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
Central retinal vein occlusion
painless vision loss caused by thrombotic obstruction of the retinal vein. Fundoscopic examination reveals the classic “blood and thunder” or “pizza pie” appearance.
174
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?
6 weeks
175
Painful genital ulcers
Chancroid (hamaephilus ducreyi)
Genital herpes (HSV)
176
Painless genital ulcers
Lymphogranuloma venereum (chlamydia trachomatis)
Granuloma inguinale (klebsiella granulomatis)
Primary syphilis (treponema pallidum)
177
What is the most common viral cause of rhabdomyolysis?
Influenza A
178
Treatment for Primary Immune Thrombocytopenia (ITP)
Observation, steroids, IVIG
Transfusion if platelet count under 10,000
179
What odor is classically associated with organophosphates?
garlic
180
How can you distinguish between Malaria and Dengue hemorrhagic fever?
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
Besides Hirschsprung disease, which other conditions are associated with delayed passage of meconium?
Cystic fibrosis and intestinal atresia.
182
Which virus is most commonly implicated in hand, foot, and mouth disease?
Group A coxsackievirus, with A16 and A71 responsible for most outbreaks.
