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a - rosh review boards > Missed Questions PGY2 > Flashcards

Missed Questions PGY2 Flashcards

1
Q

Treatment for constipation causing pain with stooling, anal fissure?

A

Polyethylene glycol

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2
Q

What defines UTI in sprapubic aspiration?

Cath?

A

> 1,000

> 50,000

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3
Q

Abrupt onset unilateral neck pain and HA around eye or frontal area in pt < 45 y/o with partial Horner syndrome has what?

Treat how?

A

Carotid a. Dissection

Heparin followed by warfarin

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4
Q

What kind of fish can cause scombroid (histamine) reaction?

A 
Tuna
Mahi
Mackerel
Marlin
Sardine
Herring
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5
Q

What is the Auspitz sign?

Seen in what common condition?

A

Punctate bleeding when scales scraped off

Psoriasis

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6
Q

Patient with sickle cell coming in with reticulocyte count < 0.5% has what?

A

Parvo B19 aplastic crisis

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7
Q

What bacteria are MC in acute chest syndrome in adults?

Kids?

A

Chlamydia PNA

Mycoplasma PNA

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8
Q

Which cells are infected by Mono?

A

B lymphocytes

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9
Q

Treatment for SBP d/t peritoneal dialysis?

What medication can reduce mortality?

A

Vancomycin + Cefepime

Albumin

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10
Q

Superficial laceration in hemophilia A patient, treat how?

A

Topical thrombin

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11
Q

HSP is also called what?

What type HS?

Associated with GI pathology?

A

IgA Vasculitis

3

Intussusception

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12
Q

Treat traumatic iritis how?

A

Cycloplegic —> homatropine drops

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13
Q

What is the strongest RF for postpartum endometritis?

What else?

A

C section

PROM > 24 hours, stage 2 labor > 12 hours, lots of pelvic

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14
Q

What sign on CXR to see with coarctation of the aorta?

A

Figure 3 sign on the right side of the mediastinum

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15
Q

Orbital blowout fracture what muscle gets entrapped?

CN?

A

Inferior rectus

4

SO4, LR6

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16
Q

What Benzo is better to give to EtOH withdrawal?

A

Diazepam (Valium)

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17
Q

Oropharynx eval tumors involving the base of the tongue/tonsils, MC assoc with what infection?

A

HPV 16

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18
Q

What is the MC cause of pulmonary HTN?

A

CHF

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19
Q

What can cause mitral valve regurgitation in a young patient with murmur?

Murmur for MR sounds like what?

A

PE

Holosystolic, high-pitched blooming murmur loudest at apex, radiates to carotid

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20
Q

What hernia carries highest risk of strangulation?

A

Femoral

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21
Q

Best way to diagnose esophageal atresia/rupture in kids?

A

Contrast esophagram

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22
Q

Patient getting blood that gets fever, chills, back pain, pain at site of transfusion and tachycardia has what?

Treat how?

A

Acute intramuscular hemolytic reaction

IVF after stopping blood

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23
Q

Stridor in young baby (< 1 y/o) that gets worse supine, agitation, infection is what?

A

Tracheomalacia

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24
Q

What is 2nd line med in pediatric status epilepticus?

MOA?

A

Fosphenytoin

Prolongs refractor period of VG Na channels

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25
Q

Patient that gets lots of IV BENZOs is at risk for becoming acidotic from what?

How?

A

Propylene glycol

Used to dilute BENZOs

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26
Q

MS presents with what murmur?

A

loud S1 with opening snap and low pitched rumbling diastolic apical murmur

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27
Q

1st line drug to treat pheochromctyoma?

A

Phentolamine

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28
Q

MOA of dabigatran?

Reversal agent called?

A

Direct thrombin inhibitor

Idarucizumab

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29
Q

Posterior vitreous detachment presents how?

Where to look on ocular US?

A

Intermittent flashes and floaters w/eye movement

Center, look for line

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30
Q

How to treat foreign body aspiration in crashing patient when abdominal thrusts do not work?

A

DL w/Magill forceps to remove it

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31
Q

What enzyme causes necrosis by brown recluse?

What med can help sx?

A

Sphingomyelinase D

Dapsone

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32
Q

Pt that gets hives and itching when getting a blood transfusion is having what?

Treat how?

A

Allergic rxn

Give Benadryl and CONTINUE transfusing

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33
Q

What is the MC extraintestinal manifestation in pts with Crohn’s disease?

A

Peripheral arthritis (knee effusion/pain)

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34
Q

SE of thiazides for BP?

A

hypercalcemia

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35
Q

What lab can tell you if pt had true seizure?

A

Prolactin (will be high)

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36
Q

What is a normal CSF of wbc?
PMN?
protein?
Glucose?

A

2
10%
20
60

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37
Q

How does oseltamivir work?

A

Prevents release of virus from infected cells

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38
Q

What describes apical displacement of the tricuspid valve with dilation of the right atrium?

Assoc with what arrhythmia?

A

Ebstein anomaly

WPW

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39
Q

Unstable pt with high suspicion for Aortic dissection, image how?

A

TEE at bedside

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40
Q

Middle ear barotrauma is the result of what?

A

Descent barotrauma

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41
Q

Patient with HIT reaction, do what next?

A

Stop heparin, give bivalirudin (direct thrombin inhibitor)

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42
Q

What is the IM Epinephrine dose for Peds in analyphylaxis?

A

.01 mL/kg of 1:1,000

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43
Q

MC extra-articular manifestation of ankylosing spondylitis?

A

Uveitis

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44
Q

What test has the highest specificity for herniated disc?

A

Crossed straight leg raise test

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45
Q

Give the order of things that happen in an EKG in a patient with HyperK

A
  1. Peak T waves
  2. P wave widening and flattening, PR interval prolongation, dropped P waves
  3. QRS prolongation
  4. Sinus Brady, slow AFib —> Sine waves
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46
Q

What nerve runs along the lateral aspect of the LV pericardium?

A

Phrenic

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47
Q

How to manage entrapped urethral catheter?

A

Cut head of balloon inflation valve off and try to place flexible guidewire

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48
Q

Max dose of lido? W/Epi?

Bupivacaine? W/Epi?

A

5 mg/kg, 7

2 mg/kg, 3

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49
Q

What is the most serious transfusion reaction?

Lab shows what?

Do what?

A

Hemolytic transfusion reaction

+ direct antiglobulin testing

Stop transfusion, give fluids

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50
Q

What blood pressure to give in pts with Aortic Stenosis?

What meds to avoid?

A

ACE-i

BB, CCB

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51
Q

What is erythema nodosum caused by?

Treat how?

A

Delayed type HS rxn, IBD, infection, drug, sarcoidosis

potassium iodide

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52
Q

What can underestimate IOP on tonometry?

What can over-estimate?

A

IOP > 30

Supine, off-center measurement

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53
Q

Patient that presents with new-onset weakness and HA after hydrogen peroxide ingestion needs what treatment?

What is the pathology?

A

Hyperbaric O2 therapy

Cerebral gas emboli

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54
Q

What causes high flow priapism?

Treatment?

A

Arterial-cavernosal shunt formation usually d/t groin or STRADDLE injury, high SC injury

Observation, not emergent and usually painless

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55
Q

US that shows systolic flattening of the interventricular septum indicates what pathology?

What makes this worse?

A

Pulmonary HTN

Fluids and intubation patient will decompensated

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56
Q

What is seen only in Le Fort II and III fractures?

A

CSF rhinorrhea

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57
Q

MC location for pediatric pseudosubluxation?

A

C2-C3

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58
Q

What features seen in orbital blow out fracture?

A

Infraorbital anesthesia
Binocular Diplopia
Diplopia on upward gaze d/t inferior rectus m. Entrapment
Enophthalmos

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59
Q

Patient has a pacemaker and essential tremor. Comes in with syncope episode, what is the pacer malfunction?

A

Oversensing - thinks the tremor or noncardiac activity is the beat and interprets them as adequate cardiac beats. Therefore it will not pace

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60
Q

Pt w/GBS what is an indication for intubation?

A

FVC falls below 20 mL/kg

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61
Q

What are inflammatory lesions due to exposures to cold, damp environments called?

What patients predisposed to it?

A

Chilblains aka perniones

SLE, anti-phos lipid, Raynaud

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62
Q

What nerve is MC effected in cavernous sinus thrombosis?

A

CN 6 abducens

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63
Q

When to stop insulin pump in pt w/T1D?

A

Ketoacidosis

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64
Q

What predisposes pt to umbilical cord prolapse?

A

Fetal malposition

Also multiple gestation, polyhydramnios, PROM, IGUR, preterm delivery

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65
Q

How to tell rubella from rubeola?

A

Rubella infection is mild, no significant conditions

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66
Q

What is a common presentation of newborn seizures?

A

Rhythmic beating of 1 arm or leg

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67
Q

When should you remove a rust ring from the eye?

A

24-48 hours after it develops

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68
Q

What level of dysfunction defines ARF in transplant patients?

A

20% compared to 50% in gen pop

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69
Q

Patient has hypoNa and is given Hypertonic saline to stop seizures. What fluid needs to be started once the seizures have stopped?

A

0.9% NS

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70
Q

How much Na does 3% hypertonic saline have?

A

513 mEq of Na

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71
Q

How fast can serum Na be corrected to prevent osmotic demyelination syndrome?

A

4-6 mEq/day with MAX of 12

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72
Q

What is the max BP for tPA in stroke?

MI?

A

185/110

180/110

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73
Q

MC presentation of ASD?

A

AFib

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74
Q

What diabetic drugs do not cause Hypoglycemia?

A

Thiazolidinediones, DDP4-I’s (Gliptins) and Biguanides (Metformin)

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75
Q

3 Ottawa Ankle rules?

A
  1. Can’t walk 4 steps immediately after injury AND at time of eval
  2. TTP posterior edge of distal 6cm or tip of medial Malleolus
  3. TTP post edge of distal 6cm or tip of lateral Malleolus
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76
Q

What drug withdrawal can cause delirium?

A

Benzo

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77
Q

When does food borne botulism (A and B) develop in adults?

Is the toxin heat labile or stable?

Where does intestinal colonization occur?

A

1-2 days

Labile

Only in infantile

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78
Q

What are the electrolyte derangements in rhabdomyolysis?

UO goal is what?

A

HyperK, hyperPO4, HypoCa early in the disease

200-300 cc/hr

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79
Q

Patient with juvenile dermatomyositis is at risk for what complications?

A

Atelectasis —> pneumonia

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80
Q

How to treat Toddler fracture?

A

Place in controlled ankle movement boot

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81
Q

MC symptoms of heat exhaustion?

A

N/V

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82
Q

What sx indicate heat stroke?

A

AMS
T > 40C
Anhydrosis

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83
Q

Describe the pediatric airway in infants compared to adults

A

Epiglottis is proportionally longer, narrower and omega-shaped in infants

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84
Q

What causes artificial widening of the retropharyngeal space on Xray?

A

Body rotation

Exhalation

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85
Q

What nerve is MC injured in supracondylar fractures?

A

Anterior interosseous —> OK sign

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86
Q

CRITOE is for what?

Means what?

A 
Elbow ossification center
1 - capitellum
3 - radial head
5 - internal epicondyle
7 - trochlea
9 - olecranon 
11 - external epicondyle
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87
Q

What is the triple therapy tx for h. Pylori?

A

Clarithromycin 500mg bid
Amoxicillin 1g bid
PPI bid

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88
Q

What is the 1st line inpatient treatment of cap in a child?

A

Ampicillin

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89
Q

What are the MC complications of ileostomy?

A

Chemical dermatitis

Hyponatremia and dehydration

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90
Q

What is high volume stoma output defined as?

How much Na excreted?

A

> 2L day

60 mEq/day which is 3x more than normal

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91
Q

At what age of gestation does the CNS develop while mom is pregnant?

A

Weeks 10-17

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92
Q

What kind of metabolic derangement does isopropyl (rubbing) alcohol cause?

A

Elevated osmolar gap and serum ketones

It does NOT cause metabolic acidosis

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93
Q

What substance causes the most damage when pressure injected?

A

Paint solvent

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94
Q

Pt with sulfonylurea overdose, what medication to give other than glucose?

MOA?

A

Octreotide

Inhibits insulin release via closing VG Ca channels

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95
Q

Valproic acid toxicity causes what?

Treat how?

A

HyperK one is

L-carnitine

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96
Q

What eye symptoms are present in Wernicke encephalopathy?

A

Lateral rectus palsy

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97
Q

Where to put a chest tube?

This procedure is called what?

A

4-5th ICS

Anterior axillary line

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98
Q

What site is the preferred spot for CVC in hypotension pt?

Why

A

RIJ

It is compressible, subclavian is not

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99
Q

What is the most sensitive finding for UTI?

Most specific?

A

Leukocyte esterase

Nitrite

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100
Q

What drug to use to treat pediatric pt under 8 with erythema migrants from Lyme?

A

Doxycycline as long as treatment period is < 21 days

Or amoxicillin

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101
Q

What is the lethal triad in trauma?

A

Coagulopathy, metabolic acidosis, hypothermia

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102
Q

What lab abnormalities in hyperemesis gravidarum?

A 
Hypokalemia
Ketonuria
Low TSH
Elevated LFTs
Weight loss > 5% pre-pregnancy weight
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103
Q

Where does the carotid artery lie in relation to the tonsils?

How deep can you insert a needle for peritonislar drainage of an abscess?

A

Posterior lateral

No more than 8-10mm

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104
Q

What is the MC immunoglobulin in multiple myeloma?

A

IgG

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105
Q

What lab changes indicate severe digoxin toxicity?

A

Hyperkalemia above 5.0

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106
Q

What is the max dose of factor replacement that should ever be given?

A

50 IU/kg

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107
Q

What is the MC blunt thoracic trauma injury?

A

Pulmonary contusion

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108
Q

What is variola?

A

Smallpox

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109
Q

What is a spiral fracture of the prox 1/3 fibula and tear of the distal tib/fib syndesmosis and interosseous membrane called?

A

Maisonneuve fracture

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110
Q

What does the nadir of neutropenia occur in pts receiving chemotherapy?

A

Days 6-10

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111
Q

What is the normal width of the retropharyngeal space on lateral neck xray?

A

7mm at C2

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112
Q

What is the MC location for blunt aortic injury?

A

Left subclavian artery origin where the ligamentum flavum is fixed

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113
Q

Describe how adverse effects of antipsychotics occur (pathophys)?

A

Anti-dopaminergic effects cause increased ACh available due to imbalance in the basal ganglia

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114
Q

What Tb drug may be teratogenic?

All cross placenta barrier

A

Pyrazinamide

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115
Q

Treatment for pt with chest pain after cocaine use?

A

ASA + Benzo

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116
Q

What is an indication for CT head in a pediatric pt that had a fall?

A

Slowed response = decreased GCS

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117
Q

Criteria for nail trephination?

A

Painful subungual hematoma < 48 hours old, not spontaneously draining, intact nail folds

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118
Q

Patient intubated and receiving compressions, how often to deliver the breath?

A

1 ventilation q 6-8 seconds

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119
Q

Where to perform paracentesis? (Landmark)

A

4cm superior and 1cm medial to ASIS

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120
Q

What is the treatment for Bullous pemphigoid?

A

Dapsone, tetracycline, steroids

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121
Q

MOA of physostigmine?

A

AChE-i —> increases amount of ACh available

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122
Q

MSM pts with proctitis, treat how?

A

250 Rocehpin IM + 100 Doxycycline bid x 7 days

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123
Q

What is the MC cause of splenic infarction?

A

Cardiogenic emboli —> pt may have abnormal echo

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124
Q

Compression To ventilation ratio in newborn child?

A

3:1

Total of 90:30 per minute

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125
Q

Where to perform elbow arthrocentesis?

A

In the middle of the triangle bw radial head, lateral epicondyle, and tip of olecranon process

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126
Q

What is a risk factor for developing kidney stones?

A

Peptic ulcer disease bc these people eat lots of calcium containing foods

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127
Q

What kind of snake is poisonous?

A

Elapidae - coral, cobra, kraits, mambas

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128
Q

What is a Smith fracture?

What nerve at risk for injury?

What artery?

A

Flexion injury of the hand aka Reverse Colles

Median n

Radial a

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129
Q

What causes death in cold water exposure and give time frames

A

Dysrhythmia in first 3-5 minutes

Muscle fatigue 3-30 minutes

Hypothermia > 30 minutes

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130
Q

Cavernous sinus thrombosis effects what first?

ABx treatment?

A

Abducens nerve (CN 6) —> pt has lateral rectus gaze palsy

Ceftriaxone, Metro, Nafcillin

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131
Q

What is the MC cause of death in people with AD poly cystic kidney disease?

A

CAD

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132
Q

Describe physiologic changes in pregnancy in regards to pulmonary stuff?

What should ABG look like?

A

Progesterone causes Inc in minute ventilation

Respiratory alkalosis that gets partial compensation by renal Bicarb excretion

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133
Q

What is the finding on CXR of people with vaping associated lung injury?

A

Diffuse hazy opacities

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134
Q

Fever + bradycardia is called what?

Due to what?

A

Faget sign (sphygomthermic dissociation)

Yellow fever, typhoid, tularemia, brucellosis, CO tick fever, legionella, myco pna

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135
Q

What is the most sensitive indicator of effectiveness of resuscitation of newborn with PPV?

A

Increased HR

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136
Q

Treatment for iritis?

A

Cycloplegics like homatropine and topical steroids

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137
Q

Epinephrine has what beta-2 agonist effect?

A

Bronchodilation and stabilizes mast cells and basophils to limit further release of inflammatory mediators

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138
Q

What is the goal MAP in pts with neurogenic shock?

A

85-90 due to higher risk of SC ischemia

139
Q

What is the MC serious SE that can result from IV NAC treatment for OD on Tylenol?

Manage how?

Common SE of oral NAC tx?

A

Anaphylactoid reaction (20%)

Usually do nothing, it is non-IgE mediated

Vomiting

140
Q

What are the only situations in which the “BAD” lung should be positioned downwards?

A

Massive hemoptysis
Large pulmonary abscess
Unilateral emphysema

141
Q

What is the earliest finding of cardiac tamponade?

A

RA collapse

142
Q

What does the EKG look like if TVP is against the RV wall (desired location)?

In PA?

Free RV?

A

ST elevation in V1

Normal QRS and P wave

P wave invert and QRS amplitude will decrease

143
Q

What can cause hypermagnesemia?

Eliminated how?

Treat how?

A

Laxative abuse, renal insufficiency with meds high on Mag

60% stool, 40% renal

IVF, Lasix, Cal Gluc

144
Q

Pt with presenting cancer, what is the initial imaging study if they have jaundice present?

A

US

145
Q

What can you use to treat Methanol poisoning with?

How does it work?

A

50mg Folinic acid q4

Cofactors that breaks town formic acid to CO2 + aqua

146
Q

What is the MC corneal lesion in herpes zoster ophthalmicus?

Caused by what?

Lies dormant where?

A

Punctuate epithelial keratitis

VZV

Trigeminal (V) ganglion

147
Q

What is the empiric treatment of acute angle closure glaucoma?

A

Timolol
Apraclonidine (alpha-agonist)
Pilocarpine (Miocic, use after IOP decreased)

148
Q

Max dose of lido?

Lido with Epi?

A

5 mg/kg

7 mg/kg

149
Q

Max dose of bupivicaine?

With Epi?

A

2 mg/kg

3 mg/kg

150
Q

MC location of spontaneous bleeding in kids?

Adults?

A

Ankle

Knee

151
Q

When to transfuse platelets in someone with NO bleeding?

Why?

A

Plts < 10,000

Inc risk of spontaneous ICH

152
Q

What is the MC bowel site of bleeding for Aortoenteric fistula?

A

Duodenum

153
Q

What brain lesion in HIV patients is usually found around the basal ganglia?

A

Toxoplasmosis

154
Q

Can Cryptococcous infection be seen on Brain CT?

A

No

155
Q

What causes a blowing diastolic murmur after S2?

Heard where?

Can cause what acutely?

A

Aortic regurgitation

2nd or 3rd ICS left sternal border

Pulmonary edema

156
Q

Describe the murmur of MS

A

Mid-diastolic rumbling murmur best heard in axilla

157
Q

What is Reynaud’s Pentad?

Treatment?

A

Fever, jaundice, RUQ pain, HoTN, AMS

Zosyn

158
Q

How to treat Carbamazepine OD?

A

Dialysis

159
Q

Family member that comes in close contact with TB patient and has 7mm of induration, what is the course of action?

A

Treatment for latent TB, > 5mm is cutoff for close contact

160
Q

What is the timeframe to excise acutely thrombosis hemorrhoids?

A

Less than 72 hours

161
Q

What are the symptoms of tracheomalacia?

A

Brassy, barking cough after TEF repair, collapse during expiration causing stridor and wheezing

162
Q

At what vertebral level does the carina sit?

A

T6

163
Q

What drug can cause aplastic anemia and thus pancytopenia?

A

Phenytoin

164
Q

What abnormality is also associated with molar pregnancy?

A

New onset HTN < 20 weeks

165
Q

What is a Mantoux test?

A

tuberculin skin test

166
Q

Where should a pelvic binder be placed?

A

Across the greater trochanter

167
Q

What does a retinal detachment with vitreous hemorrhage look like on US?

A

Swirling effect, called washing machine sign as they look side to side

168
Q

What is in the assessment of blood consumption score for MTP?

A

Penetrating MOI
+ FAST
BP < 90
HR > 120

169
Q

What has the highest PPV for biliary etiology of pancreatitis?

What number?

A

ALT

> 150

170
Q

How to treat otitis media in child with PCN allergy that is a rash?

A

2nd or 3rd gen cephalosporin

Cefuroxime (2nd) or cefpodoxime/cefdinir

171
Q

What cohort of peds patients should have urine sent in fever > 102.2F?

A

F < 2 y/o
Uncircumcised male < 1 y/o
Circumcised male < 6 months

172
Q

How to treat seborrheic dermatitis that is on parts of the body other than head of a child that is healthy?

What is the distinguishing feature?

A

Ketoconazole 2% cream w/low potency topical corticosteroid (1% hydrocortisone)

Diaper rash SINCE BIRTH

173
Q

What is a tripod fracture?

A

Lateral orbit
Zygoma
Maxilla

LoMZ

174
Q

What bone is fractured in the presence of CSF rhinorrhea?

A

Ethmoid bone

175
Q

What is the antidote dose for intralipid?

A

1.5 mg/kg over 2-3 minutes then .25 mg/kg/min infusion

176
Q

What does an absence of respiratory fluctuation or decrease in drainage imply for chest tube insertion?

A

System is blocked, usually in drainage tube

177
Q

What does bubbling in the 3rd chamber of chest tube suction set indicate?

A

Air leak present

178
Q

What indicates successful placement of TVP in RV?

A

Left BBB with LAD

179
Q

What is the formula to calculate systolic HoTN in children?

A

70 + (age x 2) for ages 1-10

180
Q

What signs indicate cardiopulmonary compromise in pediatrics?

When to start CPR?

Epinephrine dose?

A

HoTN, LOC

HR < 60

.01 mg/kg IV

181
Q

What is the max size of normal GB wall?

A

3 mm

182
Q

What is the classic skin finding in pts with sarcoidosis?

How to treat?

A

Lupus pernio, presents w/papules along the nasal ala

Infliximab and methotrexate

183
Q

What malaria species is dominant outside of Africa?

Pts present how?

A

Vivax

Get better, then symptoms can return weeks/months later

184
Q

What atypical drugs cause Serotonin syndrome?

A 
Tramadol
Li
Triptans
Mepiridine
Dextromethorphan 
Linezolid
185
Q

What defines a candidal rash in newborn?

A

Well-demarcated erythematous lesions w/smaller satellite lesions separate from larger areas of dermatitis

186
Q

What is an indication for IVC filter placement in presence of DVT?

A

Neurosurgery in last 10 days
Active bleeding
Plt < 20,000

187
Q

What causes thick purulent vaginal discharge and itching in a pre-puberty female with no concerns for STD?

Treat how?

A

Vulvovaginitis

Amoxicillin

188
Q

What spider bite presents with intense pain at the site, diaphoresis, and priapism, located in South America?

A

Armed banana spider

189
Q

IT CRIES mnemonic?

A 
Infection
Trauma Tourniquet 
Cardiac
Reflux, rectal fissure
Intussusception 
Eye stuff
Strangulation, hernat
190
Q

Pt with COPD and acidosis on ABG after intubation, what is the first step to correct?

Why?

A

Increase TV

Decreases chance of air-trapping and auto-PEEP if you do this 1st instead of increasing RR

191
Q

What is the initial treatment for a seizure due to HoNa?

A

100-150 mL of 3% hypertonic saline over 15-20 minutes

192
Q

When do you inflate the balloon in TVP?

Do what next?

Stop when?

How do you know in right place?

A

10-12cm

Advance until tip is at wall of RV

Usually 20cm

STE on EKG, capture evidenced by pacer spike followed by wide QRS

193
Q

Pt with HUS symptoms with NO diarrhea is due to what?

A

Strep pneumo

194
Q

What TB drug is contraindicated in pregnancy?

Why?

A

Streptomycin

Causes congenital deafness

195
Q

What are the MC findings of a scorpion sting?

A

Heightened sensitivity to touch in area of sting, local numbness and weakness

196
Q

What is the 1st line treatment for Asx bacteruria in pregnant pts?

A

Amoxicillin or Cephalexin

197
Q

What is the lowest level to perform thoracentesis?

A

8th ICS

198
Q

What can occur after corrective surgery for scoliosis?

Presents how?

A

SMA syndrome

Acute or insidiously with bilious vomiting

199
Q

What med reduces hospital length of stay in mod-severe croup?

A

Decadron

200
Q

MC complication of systemic sclerosis (scleroderma)?

A

Acute kidney crisis

201
Q

What can decrease levels of BNP?

A

Obesity

Pericardial constriction

202
Q

What type HS is contact dermatitis?

A

4

203
Q

What PCWP indicates a non-cardiac etiology?

A

< 18

204
Q

What are the possible consequences of lightning strike?

MC cause of death?

A

Cataracts formation
TM rupture
Keraunoparalysis - temporary LE paralysis

Asystole

205
Q

What is the most specific marker for pheochromacytoma?

A

Metanephrine levels

206
Q

What is the first line treatment in neonatal seizures?

Can present how?

A

Phenobarbital

Lip smacking

207
Q

What causes AKI in hepatorenal syndrome?

This causes what?

A

Arterial vasodilation in the splanchnic system activates the RAAS system

Decreased GFR

208
Q

What toxicity presents with coma or CNS depression, normal VS and midposition pupils?

A

Benzo OD

209
Q

What injury occurs with direct injury to perineum in men?

What PE finding is characteristic?

A

Anterior urethral injury (straddle MOA)

Hematoma (ecchymosis) in the perineal area

210
Q

How to distinguish TRALI from TACO (transfusion-associated circulatory overload)?

A

Fever

211
Q

What characterizes Lewy Body Dementia?

A

EPS and recurrent visual hallucinations

212
Q

What part of the duodenum is the ascending part?

What artery lies over it?

A

4th part

SMA

213
Q

What clavicle fractures are prone to nonunion?

A

Superior displaced or type II distal clavical fxs

214
Q

How much output from a chest tube mandates exploratory thoracotomy?

A

> 1500

215
Q

MC cause of septic arthritis in Sickle cell pts?

A

Staph aureus, salmonella is MC for osteomyelitis

216
Q

What is the optimal needle size for diagnostic paracentesis?

What location?

MC complication?

A

22 gauge

Pt lies in left lateral recumbent, 3cm superior/inferior to ASIS

Ascitic fluid leak

217
Q

MC organ injured in blunt trauma?

A

Spleen

218
Q

What personality disorder has magical thinking and metaphoric speech?

A

Schizotypal

219
Q

What personality disorder prefers few friends and is a loner?

A

Schizoid

220
Q

What is the approximate strength of tissue adhesive (glue)

A

5-0 nylon suture

221
Q

Sickle cell patients at inc risk of what more rare bacteria?

Why?

A

pasteurella

encapsulated —> SHiNE SKiS

222
Q

What is the MC atypical complaint in elderly complaining of generalized weakness that have ACS?

A

Dyspnea

223
Q

Young child that has a (+) direct antiglobulin test (Coombs) after viral infection has what?

Treat how

A

Autoimmune hemolytic anemia

Glucocorticoids

224
Q

What is a special feature of SJS/TEN?

A

+ Nikolsky sign

225
Q

How to treat anticholinergic toxicity?

What MOA does it work by?

A

Physostigmine

It is an ACh-I —> gets rid of ACh faster

226
Q

How does PSGN present?

Treatment?

A

Dark urine, puffy eyes, pericardial effusion

Hemodialysis

227
Q

What organ is MC injured in stab wounds?

GSW?

A

Liver

Small bowel

228
Q

Pregnant patients with flu should be treated with what medicine?

What time frame?

A

Oseltamivir

Up to 4 days from symptom onset

229
Q

What labs are abnormal with RMSF?

A

Thrombocytopenia
Mild transaminitis
Hyponatremia

230
Q

What causes loss of red perception on exam?

A

Optic neuritis

231
Q

What is a contraindication for flu anti-viral treatment?

A

Hospitalization

Kid < 12 y/o but older than 2 (maybe up to 5)

232
Q

MOA of pralidoxime?

A

Regenerates ACh-E thus decreasing amount of ACh around

233
Q

MOA of physostigmine?

Use when?

A

Reversible AChE-i, this will increase ACh levels

Anti-cholinergic poisoning (Jimson weed/belladonna ingestion)

234
Q

What pH level indicates SBP?

Or pH gradient > what?

A

pH < 7.34

0.1

235
Q

What bacterial gastroenteritis is associated with febrile seizures?

A

Shigella

236
Q

What ASA level is indication for HD?

A

> 100

237
Q

What is the MC infection post transplant in the 1st month?

1st - 6th months?

After 6 months?

A

Staph a, pseudomonas, strep

CMV, EBV

Viruses and fungi

238
Q

How does thalassemia present on lab values?

A

Low Hgb
Low Mcv
Normal ferritin

239
Q

How to obtain lateral xray to r/o Retropharyngeal abscess?

A

On inspiration with next extension

I to E

240
Q

What causes an invasive mass of the left atrium?

A

Primary cardiac sarcoma

241
Q

Adverse effects of chronic isoniazid ingestion?

A

Hepatotoxicity

peripheral neuropathy

242
Q

Where is B12 absorbed?

A

Ileum

243
Q

Where is folate absorbed?

A

Jejunum

244
Q

Where is iron absorbed?

A

Duodenum

ID

245
Q

How to prevent falsely elevated intra-abdominal pressure?

A

Give Rocuronium

246
Q

Describe the lab values found in sarcoidosis

A

Hypercalcemia thus causing Low PTH
Elevated ACE
elevated Vitamin D

247
Q

Antidote for CN toxicity after house fire?

A

5g IV hydroxocobalamin

248
Q

What is the MC Cause of arterial thromboembolism?

A

LV thrombus formation resulting from MI

249
Q

DDH, what is the test called?

How to reduce?

A

Barlow - stabilize pelvis, adduct and flex hip, apply downward pressure
Ortolani - abduct hip and apply upward (ant) pressure

Femoral head relocates anteriorly into the acetabulum

250
Q

What categorizes subjects into unranked groups?

A

Nominal data

251
Q

Pts with biliary colic complain of what kind of pain?

A

Steady RUQ/epigastric pain

252
Q

What is the pathology of recipient antibodies against donor leukocytes?

What sx?

A

Febrile nonhemolytic reactions

Fever, tachycardia

253
Q

MC cause of pain in pt with testicular pain and a tumor?

A

Intratumoral hemorrhage

254
Q

What is type 3 HS?

A

Immune complex

Serum sickness
SLE
RA

255
Q

What are the 3 stages of ARDS?

A

Exudative
Fibroproliferative
Fibrotic

256
Q

Infection from what can cause adult onset asthma?

A

Chlamydia pneumonia

257
Q

What defines severe acute OM?

A

Mod-severe otalgia
Pain > 48H
Temp > 39C (102.2F)

258
Q

What is associated with oligoarticular juvenile arthritis?

A

Uveitis (MC)
TMJ arthritis
Leg-length discrepancy

259
Q

What is the MC site of infection in LVAD?
2nd MC?

What Abx to use?

A

Driveline
Pump pocket

Cover staph a and pseudomonas

260
Q

What is a Segund fracture?

Associated w/what additional injury?

A

Avulsion injury of the lateral tibial plateau

ACL

261
Q

What tx can prevent coronary aneurysm in Kawasaki disease?

A

IVIG

262
Q

Describe Le Fort II fracture

A

Pyramid shaped, involves the Lacrimal bone and nasal bridge

263
Q

What is the treatment of CCB?

If that doesn’t work then do what?

A

4mg Glucagon

2g CaCl through Central Line

264
Q

Pt presenting with placenta previa in the ED, what is the best next step?

A

Pelvic US (unless Trans-abdominal is an option?)

265
Q

MC organism associated with mastoiditis?

MC physical exam finding?

A

Strep pneumo

Osteitis

266
Q

MC complication of anterior shoulder dislocation?

A

Hill-Sachs Lesion

267
Q

What to change fluids and what do you change them to in management of pediatric DKA?

Why?

A

bG < 200 change to .45% NS w/5% dextrose

Avoid hypoglycemia and cerebral edema

268
Q

What is the difference between perinatal and perirectal abscess?

What is the management for them?

A

perirectal found lateral to anal verge

Perianal palpable at anal verge only

Perirectal get CT
Perianal I+D

269
Q

Pt that has SCFE and presents weeks after surgery with weight-bearing groin pain is due to what?

A

AVN due to injury to the lateral epiphysis artery injury

270
Q

What are the physiologic effects of NIPPV in a patient with COPD?

Pt with HF?

A

Inc TV, inc MV
Dec dead space

Dec Venous return, Dec afterload
Inc Left Heart Output

271
Q

Greatest risk of placing suprapubic catheter in ED?

A

Pt with prior lower abdominal surgery —> can lead to bowel perf

272
Q

How to decrease air trapping (auto-PEEP) in COPD/asthma pts?

A

Max I:E (1:4)
Dec TV
Inc inspiratory flow rate

273
Q

Pt presenting with meningitis, what med to order 1st?

Next?

A

Dexamethasone

Vancomycin/Ceftriaxone

274
Q

When you should order a CT before doing LP in cases of meningitis?

A 
FAILS
FND
AMS
Immunosuppressed
Lesions on spine
Seizure
275
Q

Describe erythema nodusm

MC co-effect?

A

TENDER erythematous subQ nodules that have a blue hue as they spontaneously resolve

Arthralgia

276
Q

How does Valsalva effect preload?

A

Decreases it

277
Q

What muscle is located in the deep volar compartment of forearm?

A

Flexor digitorum profundus
Flexor pollicus longish
Pronator quadratus muscles

278
Q

What kind of transfusion reaction is caused by causes respiratory distress, severe angioedema, and hives?

Treatment?

A

IgA deficiency —> anaphylactic transfusion reaction

Stops transfusion, give IM Epi

279
Q

What type of transfusion reaction causes fever, flank pain, hemoglobinuria?

What pathophys?

Treat how?

A

ABO incompatibility

Hemolytic reaction which causes rapid destruction of donor rbcs

Stop transfusion, give lots of IVF

280
Q

What is the gold standard to test for DVT?

A

Venography

281
Q

What are the main patient populations for treating patients with oseltamivir?

A 
< 2 and > 65
Pregnant 
Immunocompromised (on methotrexate)
Chronic Renal failure
Cancer
DM / Obesity with BMI > 40
282
Q

MC cause of acute arterial occlusion?

A

AFib

283
Q

What causes afferent pupillary defect and acute monocular loss of vision?

A

Optic neuritis —> M.S.

284
Q

What is a potential cause of hepatic encephalopathy? What else?

How?

A

Occult GI Bleed, high protein large meal

Inc nitrogen supply

285
Q

What is a Zone I finger amputation?

II

III?

A

Pulp and distal nail

Exposed bone

Involve the eponychium (nail fold)

286
Q

What presents with RUQ pain, jaundice, boggy gall bladder on ABD US in peds?

Called what?

A

Kawasaki

Hydrops of the gall bladder

287
Q

What are the 2 types of Nec Fasc?

A

1 - polymicrobial

2 - GrpA strep

288
Q

How to cut off rings made of hard metal like titanium or steel?

A

Dremel saw

289
Q

How to treat hypernatremia that is acute?

What is the correction factor for chronic hyperNa?

A

Goal of Na < 140 within 24 hours

10 mmol/24 hours

290
Q

What does tick paralysis cause?

A

Ascending weakness, begins days 4-7

291
Q

What is the Miller Fisher variant of GBS?

A

Ocular and cerebellar features

Ophthalmologist, ataxia, areflexia

292
Q

What is a symptom concerning for decompression sickness?

A

Joint pain that begins after ascent from diving

293
Q

What anti-seizure med can acutely cause cardiovascular collapse?

How?

What is max recommended infusion rate?

A

Phenytoin

Due to diligent of propylene glycol

50 mg/min

294
Q

How to tell difference between IDA and thalassemia?

A

RDW increased in IDA

295
Q

What drugs requires less adenosine?

Which ones require you to use more bc they cause antagonistic effects?

A

Carbamazepine, dipyridamole, cardiac transplant

Methylxanthines, theophylline, caffiene

296
Q

What does phosgene cause?

Need to treat how?

A

Delayed pulmonary edema or acute lung injury

24 hour cardiopulmonary monitoring

297
Q

What presents as floaters in 1 eye with cloudy areas in the visual field that blocks vision?

Treat how?

A

Posterior vitreous detachment

Emergent Ophthalmology consult

298
Q

Patient with Reiter’s syndrome, what will synovial fluid look like?

A

Wbc of 2,000 to 64,000

299
Q

What are the 4 required elements for med mal claim?

A

Duty owed
Duty breached
Breach caused injury
Damage

300
Q

What labs indicate a hookworm infection?

What are the types of hookworms?

A

Microcytic anemia and eosinophilia

Necator and ancylostoma

301
Q

What kind of skin lesion presents with raised pearly margins and visible vessels?

A

BCC

302
Q

How does SCC of the face present?

A

Indurated and ulcerated papules

303
Q

What is the antidote for enoxaparin?

A

Heparin sulfate

304
Q

How does 1 IU raise factor level replacement in hemophilia A?

B?

A

2% so for full factor replacement need 50 IU

1%, need 100 IU

305
Q

What type of AV block is MC associated with acute inferior MI?

A

Type I 2nd degree (Wenckebach)

306
Q

What gastric hormone is hypersecreted in polycythemia Vera?

A

Histamine

307
Q

What is the scientific name for death cap mushroom?

A

Amanita phalloides

308
Q

How does death cap mushroom present?

A

GI toxicity 6-24 hours
Recovery period
Elevated LFTs, hyperbili, DIC, multi organ failure (mostly Liver)

309
Q

How to test for methemoglobinemia?

Presents how?

Treat How?

A

Co-oximetry in the lab

Perioral cyanosis that does not improve with oxygen

methylene blue

310
Q

Describe the dosing and age range for giving dextrose to infants and kids

A

< 1 y/o give D10
1 to 8 give D25
> 8 give D50

311
Q

What is a unique feature of cluster HA?

A

Restlessness or pacing behavior

312
Q

What presents in HIV pt not on HAART with fever, night sweats, diarrhea, weight loss?

Treat how?

A

Disseminated MAC

Clarithromycin, ethambutol, rifabutin for 12 mo

313
Q

What is pulsus paradoxus?

What causes it?

What conditions?

A

Larger decrease in SBP ( > 10) during inspiration

Inc intrathoracic pressure restricting venous return

Asthma, cardiac tamponade, PE, Vena cava thrombus, const pericard

314
Q

When to add Abx in abscess after I+D?

A

Surrounding cellulitis
Immunocompromised
Sx of systemic infection

315
Q

What fish syndrome has peppery taste?

What is the MOA?

A

Scombroid

Histamine fish toxicity

316
Q

Treatment for staphylococcal scalded skin syndrome?

A

Dicloxacillin

317
Q

MC site of oral cancer?

A

Tongue

318
Q

How to diagnose MS?

A

MRI of the brain OR spine!

319
Q

MC source of arterial emboli?

A

LV thrombus from MI

320
Q

What back pathology in kids with avg age around 7 and midline vertebral tenderness?

Do what?

Caused by what?

A

Pediatric discitis

MRI

Staph a

321
Q

What is a contraindication to performing I+D of PTA?

A

Severe trismus

322
Q

Probably of septic arthritis based on # of Kocher criteria?

A

1 - 3%
2 - 40%
3 - 93%
4 - 99%

323
Q

Kocher criteria mnemonic

A 
NEWT
Non-weight bearing
ESR > 40
Wbc > 12,000
Temp > 38.5 C
324
Q

How to rule out blunt cardiac injury?

A

Normal EKG
Normal troponin x1
Can go home, no need for extended monitoring

325
Q

What area of the C spine do peds patients usually injure?

A

C1-C4

326
Q

What eye disease associated with R.A.?

Presents how?

Tx?

A

Scleritis

Ocular erythema and scleral edema w/severe pain on EOM

NSAIDs and glucocorticoids

327
Q

What determines the degree of pulmonary insult in a drowning patient?

A

Quantity of liquid aspirated, not length of time

328
Q

What is a complication of acute hepatitis?

Occurs when?

A

Aplastic anemia —> dec wbc, plt, rbc

6-12 weeks after hepatitis

329
Q

What is the MOA of CO poisoning?

A

Direct inhibition of O2 binding to Hgb

330
Q

MC cause of cavernous sinus thrombosis?

A

Acute bacterial sinusitis

331
Q

2?

MC arrhythmia in blunt cardiac injury?

A

Sinus tachycardia

AFib

332
Q

What additional lab value can be deranged with ethylene glycol ingestion?

A

Hypocalcemia

333
Q

What is beer potomania?

A

Hyponatremia in chronic beer drinkers

334
Q

Describe pupils in GHB ingestion?

What else is characteristic?

A

Small and minimally responsive to light

Comatose pt requires intubation but then has abrupt awakening

335
Q

What is Mallet finger?

If untreated then it turns to what?

A

Forced hyperflexion of DIP

Swan neck deformity

336
Q

What is Zone 1 of neck?

A

Cricoid cartilage to sternum

337
Q

Zone 2 of neck?

A

Cricoid to angle of mandible

338
Q

Zone 3 of neck?

A

Superior to angle of mandible

339
Q

Injury to what zone of the neck has highest morbidity?

Best prognosis?

A

Zone 1

Zone 2

340
Q

What is the loxosceles genus?

A

Brown recluse

341
Q

What is the lowest level to perform thoracentesis?

Where to normally perform procedure?

A

8th ICS

1 interspace below dullness to percussion midscapular or posterior auxiliary line

342
Q

What is the biggest RF for cellulitis?

A

Lymphedema

343
Q

What is the only muscle that opens the mandible that can be affected by PTA?

A

Lateral pterygold

344
Q

What does Jimson weed cause?

Antidote?

MOA?

A

Anticholinergic toxicity

Physostigmine

AChE-inhibitor

a - rosh review boards (3 decks)

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