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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
Patient that gets lots of IV BENZOs is at risk for becoming acidotic from what? How?
Propylene glycol Used to dilute BENZOs
26
MS presents with what murmur?
loud S1 with opening snap and low pitched rumbling diastolic apical murmur
27
1st line drug to treat pheochromctyoma?
Phentolamine
28
MOA of dabigatran? Reversal agent called?
Direct thrombin inhibitor Idarucizumab
29
Posterior vitreous detachment presents how? Where to look on ocular US?
Intermittent flashes and floaters w/eye movement Center, look for line
30
How to treat foreign body aspiration in crashing patient when abdominal thrusts do not work?
DL w/Magill forceps to remove it
31
What enzyme causes necrosis by brown recluse? What med can help sx?
Sphingomyelinase D Dapsone
32
Pt that gets hives and itching when getting a blood transfusion is having what? Treat how?
Allergic rxn Give Benadryl and CONTINUE transfusing
33
What is the MC extraintestinal manifestation in pts with Crohn’s disease?
Peripheral arthritis (knee effusion/pain)
34
SE of thiazides for BP?
hypercalcemia
35
What lab can tell you if pt had true seizure?
Prolactin (will be high)
36
What is a normal CSF of wbc? PMN? protein? Glucose?
2 10% 20 60
37
How does oseltamivir work?
Prevents release of virus from infected cells
38
What describes apical displacement of the tricuspid valve with dilation of the right atrium? Assoc with what arrhythmia?
Ebstein anomaly WPW
39
Unstable pt with high suspicion for Aortic dissection, image how?
TEE at bedside
40
Middle ear barotrauma is the result of what?
Descent barotrauma
41
Patient with HIT reaction, do what next?
Stop heparin, give bivalirudin (direct thrombin inhibitor)
42
What is the IM Epinephrine dose for Peds in analyphylaxis?
.01 mL/kg of 1:1,000
43
MC extra-articular manifestation of ankylosing spondylitis?
Uveitis
44
What test has the highest specificity for herniated disc?
Crossed straight leg raise test
45
Give the order of things that happen in an EKG in a patient with HyperK
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
46
What nerve runs along the lateral aspect of the LV pericardium?
Phrenic
47
How to manage entrapped urethral catheter?
Cut head of balloon inflation valve off and try to place flexible guidewire
48
Max dose of lido? W/Epi? Bupivacaine? W/Epi?
5 mg/kg, 7 2 mg/kg, 3
49
What is the most serious transfusion reaction? Lab shows what? Do what?
Hemolytic transfusion reaction + direct antiglobulin testing Stop transfusion, give fluids
50
What blood pressure to give in pts with Aortic Stenosis? What meds to avoid?
ACE-i BB, CCB
51
What is erythema nodosum caused by? Treat how?
Delayed type HS rxn, IBD, infection, drug, sarcoidosis potassium iodide
52
What can underestimate IOP on tonometry? What can over-estimate?
IOP > 30 Supine, off-center measurement
53
Patient that presents with new-onset weakness and HA after hydrogen peroxide ingestion needs what treatment? What is the pathology?
Hyperbaric O2 therapy Cerebral gas emboli
54
What causes high flow priapism? Treatment?
Arterial-cavernosal shunt formation usually d/t groin or STRADDLE injury, high SC injury Observation, not emergent and usually painless
55
US that shows systolic flattening of the interventricular septum indicates what pathology? What makes this worse?
Pulmonary HTN Fluids and intubation patient will decompensated
56
What is seen only in Le Fort II and III fractures?
CSF rhinorrhea
57
MC location for pediatric pseudosubluxation?
C2-C3
58
What features seen in orbital blow out fracture?
Infraorbital anesthesia Binocular Diplopia Diplopia on upward gaze d/t inferior rectus m. Entrapment Enophthalmos
59
Patient has a pacemaker and essential tremor. Comes in with syncope episode, what is the pacer malfunction?
Oversensing - thinks the tremor or noncardiac activity is the beat and interprets them as adequate cardiac beats. Therefore it will not pace
60
Pt w/GBS what is an indication for intubation?
FVC falls below 20 mL/kg
61
What are inflammatory lesions due to exposures to cold, damp environments called? What patients predisposed to it?
Chilblains aka perniones SLE, anti-phos lipid, Raynaud
62
What nerve is MC effected in cavernous sinus thrombosis?
CN 6 abducens
63
When to stop insulin pump in pt w/T1D?
Ketoacidosis
64
What predisposes pt to umbilical cord prolapse?
Fetal malposition | Also multiple gestation, polyhydramnios, PROM, IGUR, preterm delivery
65
How to tell rubella from rubeola?
Rubella infection is mild, no significant conditions
66
What is a common presentation of newborn seizures?
Rhythmic beating of 1 arm or leg
67
When should you remove a rust ring from the eye?
24-48 hours after it develops
68
What level of dysfunction defines ARF in transplant patients?
20% compared to 50% in gen pop
69
Patient has hypoNa and is given Hypertonic saline to stop seizures. What fluid needs to be started once the seizures have stopped?
0.9% NS
70
How much Na does 3% hypertonic saline have?
513 mEq of Na
71
How fast can serum Na be corrected to prevent osmotic demyelination syndrome?
4-6 mEq/day with MAX of 12
72
What is the max BP for tPA in stroke? MI?
185/110 180/110
73
MC presentation of ASD?
AFib
74
What diabetic drugs do not cause Hypoglycemia?
Thiazolidinediones, DDP4-I’s (Gliptins) and Biguanides (Metformin)
75
3 Ottawa Ankle rules?
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
76
What drug withdrawal can cause delirium?
Benzo
77
When does food borne botulism (A and B) develop in adults? Is the toxin heat labile or stable? Where does intestinal colonization occur?
1-2 days Labile Only in infantile
78
What are the electrolyte derangements in rhabdomyolysis? UO goal is what?
HyperK, hyperPO4, HypoCa early in the disease 200-300 cc/hr
79
Patient with juvenile dermatomyositis is at risk for what complications?
Atelectasis —> pneumonia
80
How to treat Toddler fracture?
Place in controlled ankle movement boot
81
MC symptoms of heat exhaustion?
N/V
82
What sx indicate heat stroke?
AMS T > 40C Anhydrosis
83
Describe the pediatric airway in infants compared to adults
Epiglottis is proportionally longer, narrower and omega-shaped in infants
84
What causes artificial widening of the retropharyngeal space on Xray?
Body rotation | Exhalation
85
What nerve is MC injured in supracondylar fractures?
Anterior interosseous —> OK sign
86
CRITOE is for what? | Means what?
``` Elbow ossification center 1 - capitellum 3 - radial head 5 - internal epicondyle 7 - trochlea 9 - olecranon 11 - external epicondyle ```
87
What is the triple therapy tx for h. Pylori?
Clarithromycin 500mg bid Amoxicillin 1g bid PPI bid
88
What is the 1st line inpatient treatment of cap in a child?
Ampicillin
89
What are the MC complications of ileostomy?
Chemical dermatitis | Hyponatremia and dehydration
90
What is high volume stoma output defined as? How much Na excreted?
> 2L day 60 mEq/day which is 3x more than normal
91
At what age of gestation does the CNS develop while mom is pregnant?
Weeks 10-17
92
What kind of metabolic derangement does isopropyl (rubbing) alcohol cause?
Elevated osmolar gap and serum ketones It does NOT cause metabolic acidosis
93
What substance causes the most damage when pressure injected?
Paint solvent
94
Pt with sulfonylurea overdose, what medication to give other than glucose? MOA?
Octreotide Inhibits insulin release via closing VG Ca channels
95
Valproic acid toxicity causes what? Treat how?
HyperK one is L-carnitine
96
What eye symptoms are present in Wernicke encephalopathy?
Lateral rectus palsy
97
Where to put a chest tube? This procedure is called what?
4-5th ICS Anterior axillary line
98
What site is the preferred spot for CVC in hypotension pt? Why
RIJ It is compressible, subclavian is not
99
What is the most sensitive finding for UTI? Most specific?
Leukocyte esterase Nitrite
100
What drug to use to treat pediatric pt under 8 with erythema migrants from Lyme?
Doxycycline as long as treatment period is < 21 days Or amoxicillin
101
What is the lethal triad in trauma?
Coagulopathy, metabolic acidosis, hypothermia
102
What lab abnormalities in hyperemesis gravidarum?
``` Hypokalemia Ketonuria Low TSH Elevated LFTs Weight loss > 5% pre-pregnancy weight ```
103
Where does the carotid artery lie in relation to the tonsils? How deep can you insert a needle for peritonislar drainage of an abscess?
Posterior lateral No more than 8-10mm
104
What is the MC immunoglobulin in multiple myeloma?
IgG
105
What lab changes indicate severe digoxin toxicity?
Hyperkalemia above 5.0
106
What is the max dose of factor replacement that should ever be given?
50 IU/kg
107
What is the MC blunt thoracic trauma injury?
Pulmonary contusion
108
What is variola?
Smallpox
109
What is a spiral fracture of the prox 1/3 fibula and tear of the distal tib/fib syndesmosis and interosseous membrane called?
Maisonneuve fracture
110
What does the nadir of neutropenia occur in pts receiving chemotherapy?
Days 6-10
111
What is the normal width of the retropharyngeal space on lateral neck xray?
7mm at C2
112
What is the MC location for blunt aortic injury?
Left subclavian artery origin where the ligamentum flavum is fixed
113
Describe how adverse effects of antipsychotics occur (pathophys)?
Anti-dopaminergic effects cause increased ACh available due to imbalance in the basal ganglia
114
What Tb drug may be teratogenic? | All cross placenta barrier
Pyrazinamide
115
Treatment for pt with chest pain after cocaine use?
ASA + Benzo
116
What is an indication for CT head in a pediatric pt that had a fall?
Slowed response = decreased GCS
117
Criteria for nail trephination?
Painful subungual hematoma < 48 hours old, not spontaneously draining, intact nail folds
118
Patient intubated and receiving compressions, how often to deliver the breath?
1 ventilation q 6-8 seconds
119
Where to perform paracentesis? (Landmark)
4cm superior and 1cm medial to ASIS
120
What is the treatment for Bullous pemphigoid?
Dapsone, tetracycline, steroids
121
MOA of physostigmine?
AChE-i —> increases amount of ACh available
122
MSM pts with proctitis, treat how?
250 Rocehpin IM + 100 Doxycycline bid x 7 days
123
What is the MC cause of splenic infarction?
Cardiogenic emboli —> pt may have abnormal echo
124
Compression To ventilation ratio in newborn child?
3:1 Total of 90:30 per minute
125
Where to perform elbow arthrocentesis?
In the middle of the triangle bw radial head, lateral epicondyle, and tip of olecranon process
126
What is a risk factor for developing kidney stones?
Peptic ulcer disease bc these people eat lots of calcium containing foods
127
What kind of snake is poisonous?
Elapidae - coral, cobra, kraits, mambas
128
What is a Smith fracture? What nerve at risk for injury? What artery?
Flexion injury of the hand aka Reverse Colles Median n Radial a
129
What causes death in cold water exposure and give time frames
Dysrhythmia in first 3-5 minutes Muscle fatigue 3-30 minutes Hypothermia > 30 minutes
130
Cavernous sinus thrombosis effects what first? ABx treatment?
Abducens nerve (CN 6) —> pt has lateral rectus gaze palsy Ceftriaxone, Metro, Nafcillin
131
What is the MC cause of death in people with AD poly cystic kidney disease?
CAD
132
Describe physiologic changes in pregnancy in regards to pulmonary stuff? What should ABG look like?
Progesterone causes Inc in minute ventilation Respiratory alkalosis that gets partial compensation by renal Bicarb excretion
133
What is the finding on CXR of people with vaping associated lung injury?
Diffuse hazy opacities
134
Fever + bradycardia is called what? Due to what?
Faget sign (sphygomthermic dissociation) Yellow fever, typhoid, tularemia, brucellosis, CO tick fever, legionella, myco pna
135
What is the most sensitive indicator of effectiveness of resuscitation of newborn with PPV?
Increased HR
136
Treatment for iritis?
Cycloplegics like homatropine and topical steroids
137
Epinephrine has what beta-2 agonist effect?
Bronchodilation and stabilizes mast cells and basophils to limit further release of inflammatory mediators
138
What is the goal MAP in pts with neurogenic shock?
85-90 due to higher risk of SC ischemia
139
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?
Anaphylactoid reaction (20%) Usually do nothing, it is non-IgE mediated Vomiting
140
What are the only situations in which the “BAD” lung should be positioned downwards?
Massive hemoptysis Large pulmonary abscess Unilateral emphysema
141
What is the earliest finding of cardiac tamponade?
RA collapse
142
What does the EKG look like if TVP is against the RV wall (desired location)? In PA? Free RV?
ST elevation in V1 Normal QRS and P wave P wave invert and QRS amplitude will decrease
143
What can cause hypermagnesemia? Eliminated how? Treat how?
Laxative abuse, renal insufficiency with meds high on Mag 60% stool, 40% renal IVF, Lasix, Cal Gluc
144
Pt with presenting cancer, what is the initial imaging study if they have jaundice present?
US
145
What can you use to treat Methanol poisoning with? How does it work?
50mg Folinic acid q4 Cofactors that breaks town formic acid to CO2 + aqua
146
What is the MC corneal lesion in herpes zoster ophthalmicus? Caused by what? Lies dormant where?
Punctuate epithelial keratitis VZV Trigeminal (V) ganglion
147
What is the empiric treatment of acute angle closure glaucoma?
Timolol Apraclonidine (alpha-agonist) Pilocarpine (Miocic, use after IOP decreased)
148
Max dose of lido? Lido with Epi?
5 mg/kg 7 mg/kg
149
Max dose of bupivicaine? With Epi?
2 mg/kg 3 mg/kg
150
MC location of spontaneous bleeding in kids? Adults?
Ankle Knee
151
When to transfuse platelets in someone with NO bleeding? Why?
Plts < 10,000 Inc risk of spontaneous ICH
152
What is the MC bowel site of bleeding for Aortoenteric fistula?
Duodenum
153
What brain lesion in HIV patients is usually found around the basal ganglia?
Toxoplasmosis
154
Can Cryptococcous infection be seen on Brain CT?
No
155
What causes a blowing diastolic murmur after S2? Heard where? Can cause what acutely?
Aortic regurgitation 2nd or 3rd ICS left sternal border Pulmonary edema
156
Describe the murmur of MS
Mid-diastolic rumbling murmur best heard in axilla
157
What is Reynaud’s Pentad? Treatment?
Fever, jaundice, RUQ pain, HoTN, AMS Zosyn
158
How to treat Carbamazepine OD?
Dialysis
159
Family member that comes in close contact with TB patient and has 7mm of induration, what is the course of action?
Treatment for latent TB, > 5mm is cutoff for close contact
160
What is the timeframe to excise acutely thrombosis hemorrhoids?
Less than 72 hours
161
What are the symptoms of tracheomalacia?
Brassy, barking cough after TEF repair, collapse during expiration causing stridor and wheezing
162
At what vertebral level does the carina sit?
T6
163
What drug can cause aplastic anemia and thus pancytopenia?
Phenytoin
164
What abnormality is also associated with molar pregnancy?
New onset HTN < 20 weeks
165
What is a Mantoux test?
tuberculin skin test
166
Where should a pelvic binder be placed?
Across the greater trochanter
167
What does a retinal detachment with vitreous hemorrhage look like on US?
Swirling effect, called washing machine sign as they look side to side
168
What is in the assessment of blood consumption score for MTP?
Penetrating MOI + FAST BP < 90 HR > 120
169
What has the highest PPV for biliary etiology of pancreatitis? What number?
ALT > 150
170
How to treat otitis media in child with PCN allergy that is a rash?
2nd or 3rd gen cephalosporin | Cefuroxime (2nd) or cefpodoxime/cefdinir
171
What cohort of peds patients should have urine sent in fever > 102.2F?
F < 2 y/o Uncircumcised male < 1 y/o Circumcised male < 6 months
172
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?
Ketoconazole 2% cream w/low potency topical corticosteroid (1% hydrocortisone) Diaper rash SINCE BIRTH
173
What is a tripod fracture?
Lateral orbit Zygoma Maxilla LoMZ
174
What bone is fractured in the presence of CSF rhinorrhea?
Ethmoid bone
175
What is the antidote dose for intralipid?
1.5 mg/kg over 2-3 minutes then .25 mg/kg/min infusion
176
What does an absence of respiratory fluctuation or decrease in drainage imply for chest tube insertion?
System is blocked, usually in drainage tube
177
What does bubbling in the 3rd chamber of chest tube suction set indicate?
Air leak present
178
What indicates successful placement of TVP in RV?
Left BBB with LAD
179
What is the formula to calculate systolic HoTN in children?
70 + (age x 2) for ages 1-10
180
What signs indicate cardiopulmonary compromise in pediatrics? When to start CPR? Epinephrine dose?
HoTN, LOC HR < 60 .01 mg/kg IV
181
What is the max size of normal GB wall?
3 mm
182
What is the classic skin finding in pts with sarcoidosis? How to treat?
Lupus pernio, presents w/papules along the nasal ala Infliximab and methotrexate
183
What malaria species is dominant outside of Africa? Pts present how?
Vivax Get better, then symptoms can return weeks/months later
184
What atypical drugs cause Serotonin syndrome?
``` Tramadol Li Triptans Mepiridine Dextromethorphan Linezolid ```
185
What defines a candidal rash in newborn?
Well-demarcated erythematous lesions w/smaller satellite lesions separate from larger areas of dermatitis
186
What is an indication for IVC filter placement in presence of DVT?
Neurosurgery in last 10 days Active bleeding Plt < 20,000
187
What causes thick purulent vaginal discharge and itching in a pre-puberty female with no concerns for STD? Treat how?
Vulvovaginitis Amoxicillin
188
What spider bite presents with intense pain at the site, diaphoresis, and priapism, located in South America?
Armed banana spider
189
IT CRIES mnemonic?
``` Infection Trauma Tourniquet Cardiac Reflux, rectal fissure Intussusception Eye stuff Strangulation, hernat ```
190
Pt with COPD and acidosis on ABG after intubation, what is the first step to correct? Why?
Increase TV Decreases chance of air-trapping and auto-PEEP if you do this 1st instead of increasing RR
191
What is the initial treatment for a seizure due to HoNa?
100-150 mL of 3% hypertonic saline over 15-20 minutes
192
When do you inflate the balloon in TVP? Do what next? Stop when? How do you know in right place?
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
Pt with HUS symptoms with NO diarrhea is due to what?
Strep pneumo
194
What TB drug is contraindicated in pregnancy? Why?
Streptomycin Causes congenital deafness
195
What are the MC findings of a scorpion sting?
Heightened sensitivity to touch in area of sting, local numbness and weakness
196
What is the 1st line treatment for Asx bacteruria in pregnant pts?
Amoxicillin or Cephalexin
197
What is the lowest level to perform thoracentesis?
8th ICS
198
What can occur after corrective surgery for scoliosis? Presents how?
SMA syndrome Acute or insidiously with bilious vomiting
199
What med reduces hospital length of stay in mod-severe croup?
Decadron
200
MC complication of systemic sclerosis (scleroderma)?
Acute kidney crisis
201
What can decrease levels of BNP?
Obesity | Pericardial constriction
202
What type HS is contact dermatitis?
4
203
What PCWP indicates a non-cardiac etiology?
< 18
204
What are the possible consequences of lightning strike? MC cause of death?
Cataracts formation TM rupture Keraunoparalysis - temporary LE paralysis Asystole
205
What is the most specific marker for pheochromacytoma?
Metanephrine levels
206
What is the first line treatment in neonatal seizures? Can present how?
Phenobarbital Lip smacking
207
What causes AKI in hepatorenal syndrome? This causes what?
Arterial vasodilation in the splanchnic system activates the RAAS system Decreased GFR
208
What toxicity presents with coma or CNS depression, normal VS and midposition pupils?
Benzo OD
209
What injury occurs with direct injury to perineum in men? What PE finding is characteristic?
Anterior urethral injury (straddle MOA) Hematoma (ecchymosis) in the perineal area
210
How to distinguish TRALI from TACO (transfusion-associated circulatory overload)?
Fever
211
What characterizes Lewy Body Dementia?
EPS and recurrent visual hallucinations
212
What part of the duodenum is the ascending part? What artery lies over it?
4th part SMA
213
What clavicle fractures are prone to nonunion?
Superior displaced or type II distal clavical fxs
214
How much output from a chest tube mandates exploratory thoracotomy?
> 1500
215
MC cause of septic arthritis in Sickle cell pts?
Staph aureus, salmonella is MC for osteomyelitis
216
What is the optimal needle size for diagnostic paracentesis? What location? MC complication?
22 gauge Pt lies in left lateral recumbent, 3cm superior/inferior to ASIS Ascitic fluid leak
217
MC organ injured in blunt trauma?
Spleen
218
What personality disorder has magical thinking and metaphoric speech?
Schizotypal
219
What personality disorder prefers few friends and is a loner?
Schizoid
220
What is the approximate strength of tissue adhesive (glue)
5-0 nylon suture
221
Sickle cell patients at inc risk of what more rare bacteria? Why?
pasteurella encapsulated —> SHiNE SKiS
222
What is the MC atypical complaint in elderly complaining of generalized weakness that have ACS?
Dyspnea
223
Young child that has a (+) direct antiglobulin test (Coombs) after viral infection has what? Treat how
Autoimmune hemolytic anemia Glucocorticoids
224
What is a special feature of SJS/TEN?
+ Nikolsky sign
225
How to treat anticholinergic toxicity? What MOA does it work by?
Physostigmine It is an ACh-I —> gets rid of ACh faster
226
How does PSGN present? Treatment?
Dark urine, puffy eyes, pericardial effusion Hemodialysis
227
What organ is MC injured in stab wounds? GSW?
Liver Small bowel
228
Pregnant patients with flu should be treated with what medicine? What time frame?
Oseltamivir Up to 4 days from symptom onset
229
What labs are abnormal with RMSF?
Thrombocytopenia Mild transaminitis Hyponatremia
230
What causes loss of red perception on exam?
Optic neuritis
231
What is a contraindication for flu anti-viral treatment?
Hospitalization | Kid < 12 y/o but older than 2 (maybe up to 5)
232
MOA of pralidoxime?
Regenerates ACh-E thus decreasing amount of ACh around
233
MOA of physostigmine? Use when?
Reversible AChE-i, this will increase ACh levels Anti-cholinergic poisoning (Jimson weed/belladonna ingestion)
234
What pH level indicates SBP? Or pH gradient > what?
pH < 7.34 0.1
235
What bacterial gastroenteritis is associated with febrile seizures?
Shigella
236
What ASA level is indication for HD?
> 100
237
What is the MC infection post transplant in the 1st month? 1st - 6th months? After 6 months?
Staph a, pseudomonas, strep CMV, EBV Viruses and fungi
238
How does thalassemia present on lab values?
Low Hgb Low Mcv Normal ferritin
239
How to obtain lateral xray to r/o Retropharyngeal abscess?
On inspiration with next extension I to E
240
What causes an invasive mass of the left atrium?
Primary cardiac sarcoma
241
Adverse effects of chronic isoniazid ingestion?
Hepatotoxicity | peripheral neuropathy
242
Where is B12 absorbed?
Ileum
243
Where is folate absorbed?
Jejunum
244
Where is iron absorbed?
Duodenum ID
245
How to prevent falsely elevated intra-abdominal pressure?
Give Rocuronium
246
Describe the lab values found in sarcoidosis
Hypercalcemia thus causing Low PTH Elevated ACE elevated Vitamin D
247
Antidote for CN toxicity after house fire?
5g IV hydroxocobalamin
248
What is the MC Cause of arterial thromboembolism?
LV thrombus formation resulting from MI
249
DDH, what is the test called? How to reduce?
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
What categorizes subjects into unranked groups?
Nominal data
251
Pts with biliary colic complain of what kind of pain?
Steady RUQ/epigastric pain
252
What is the pathology of recipient antibodies against donor leukocytes? What sx?
Febrile nonhemolytic reactions Fever, tachycardia
253
MC cause of pain in pt with testicular pain and a tumor?
Intratumoral hemorrhage
254
What is type 3 HS?
Immune complex Serum sickness SLE RA
255
What are the 3 stages of ARDS?
Exudative Fibroproliferative Fibrotic
256
Infection from what can cause adult onset asthma?
Chlamydia pneumonia
257
What defines severe acute OM?
Mod-severe otalgia Pain > 48H Temp > 39C (102.2F)
258
What is associated with oligoarticular juvenile arthritis?
Uveitis (MC) TMJ arthritis Leg-length discrepancy
259
What is the MC site of infection in LVAD? 2nd MC? What Abx to use?
Driveline Pump pocket Cover staph a and pseudomonas
260
What is a Segund fracture? Associated w/what additional injury?
Avulsion injury of the lateral tibial plateau ACL
261
What tx can prevent coronary aneurysm in Kawasaki disease?
IVIG
262
Describe Le Fort II fracture
Pyramid shaped, involves the Lacrimal bone and nasal bridge
263
What is the treatment of CCB? If that doesn’t work then do what?
4mg Glucagon 2g CaCl through Central Line
264
Pt presenting with placenta previa in the ED, what is the best next step?
Pelvic US (unless Trans-abdominal is an option?)
265
MC organism associated with mastoiditis? MC physical exam finding?
Strep pneumo Osteitis
266
MC complication of anterior shoulder dislocation?
Hill-Sachs Lesion
267
What to change fluids and what do you change them to in management of pediatric DKA? Why?
bG < 200 change to .45% NS w/5% dextrose Avoid hypoglycemia and cerebral edema
268
What is the difference between perinatal and perirectal abscess? What is the management for them?
perirectal found lateral to anal verge Perianal palpable at anal verge only Perirectal get CT Perianal I+D
269
Pt that has SCFE and presents weeks after surgery with weight-bearing groin pain is due to what?
AVN due to injury to the lateral epiphysis artery injury
270
What are the physiologic effects of NIPPV in a patient with COPD? Pt with HF?
Inc TV, inc MV Dec dead space Dec Venous return, Dec afterload Inc Left Heart Output
271
Greatest risk of placing suprapubic catheter in ED?
Pt with prior lower abdominal surgery —> can lead to bowel perf
272
How to decrease air trapping (auto-PEEP) in COPD/asthma pts?
Max I:E (1:4) Dec TV Inc inspiratory flow rate
273
Pt presenting with meningitis, what med to order 1st? Next?
Dexamethasone Vancomycin/Ceftriaxone
274
When you should order a CT before doing LP in cases of meningitis?
``` FAILS FND AMS Immunosuppressed Lesions on spine Seizure ```
275
Describe erythema nodusm MC co-effect?
TENDER erythematous subQ nodules that have a blue hue as they spontaneously resolve Arthralgia
276
How does Valsalva effect preload?
Decreases it
277
What muscle is located in the deep volar compartment of forearm?
Flexor digitorum profundus Flexor pollicus longish Pronator quadratus muscles
278
What kind of transfusion reaction is caused by causes respiratory distress, severe angioedema, and hives? Treatment?
IgA deficiency —> anaphylactic transfusion reaction Stops transfusion, give IM Epi
279
What type of transfusion reaction causes fever, flank pain, hemoglobinuria? What pathophys? Treat how?
ABO incompatibility Hemolytic reaction which causes rapid destruction of donor rbcs Stop transfusion, give lots of IVF
280
What is the gold standard to test for DVT?
Venography
281
What are the main patient populations for treating patients with oseltamivir?
``` < 2 and > 65 Pregnant Immunocompromised (on methotrexate) Chronic Renal failure Cancer DM / Obesity with BMI > 40 ```
282
MC cause of acute arterial occlusion?
AFib
283
What causes afferent pupillary defect and acute monocular loss of vision?
Optic neuritis —> M.S.
284
What is a potential cause of hepatic encephalopathy? What else? How?
Occult GI Bleed, high protein large meal Inc nitrogen supply
285
What is a Zone I finger amputation? II III?
Pulp and distal nail Exposed bone Involve the eponychium (nail fold)
286
What presents with RUQ pain, jaundice, boggy gall bladder on ABD US in peds? Called what?
Kawasaki Hydrops of the gall bladder
287
What are the 2 types of Nec Fasc?
1 - polymicrobial | 2 - GrpA strep
288
How to cut off rings made of hard metal like titanium or steel?
Dremel saw
289
How to treat hypernatremia that is acute? What is the correction factor for chronic hyperNa?
Goal of Na < 140 within 24 hours 10 mmol/24 hours
290
What does tick paralysis cause?
Ascending weakness, begins days 4-7
291
What is the Miller Fisher variant of GBS?
Ocular and cerebellar features | Ophthalmologist, ataxia, areflexia
292
What is a symptom concerning for decompression sickness?
Joint pain that begins after ascent from diving
293
What anti-seizure med can acutely cause cardiovascular collapse? How? What is max recommended infusion rate?
Phenytoin Due to diligent of propylene glycol 50 mg/min
294
How to tell difference between IDA and thalassemia?
RDW increased in IDA
295
What drugs requires less adenosine? Which ones require you to use more bc they cause antagonistic effects?
Carbamazepine, dipyridamole, cardiac transplant Methylxanthines, theophylline, caffiene
296
What does phosgene cause? Need to treat how?
Delayed pulmonary edema or acute lung injury 24 hour cardiopulmonary monitoring
297
What presents as floaters in 1 eye with cloudy areas in the visual field that blocks vision? Treat how?
Posterior vitreous detachment Emergent Ophthalmology consult
298
Patient with Reiter’s syndrome, what will synovial fluid look like?
Wbc of 2,000 to 64,000
299
What are the 4 required elements for med mal claim?
Duty owed Duty breached Breach caused injury Damage
300
What labs indicate a hookworm infection? What are the types of hookworms?
Microcytic anemia and eosinophilia Necator and ancylostoma
301
What kind of skin lesion presents with raised pearly margins and visible vessels?
BCC
302
How does SCC of the face present?
Indurated and ulcerated papules
303
What is the antidote for enoxaparin?
Heparin sulfate
304
How does 1 IU raise factor level replacement in hemophilia A? B?
2% so for full factor replacement need 50 IU 1%, need 100 IU
305
What type of AV block is MC associated with acute inferior MI?
Type I 2nd degree (Wenckebach)
306
What gastric hormone is hypersecreted in polycythemia Vera?
Histamine
307
What is the scientific name for death cap mushroom?
Amanita phalloides
308
How does death cap mushroom present?
GI toxicity 6-24 hours Recovery period Elevated LFTs, hyperbili, DIC, multi organ failure (mostly Liver)
309
How to test for methemoglobinemia? Presents how? Treat How?
Co-oximetry in the lab Perioral cyanosis that does not improve with oxygen methylene blue
310
Describe the dosing and age range for giving dextrose to infants and kids
< 1 y/o give D10 1 to 8 give D25 > 8 give D50
311
What is a unique feature of cluster HA?
Restlessness or pacing behavior
312
What presents in HIV pt not on HAART with fever, night sweats, diarrhea, weight loss? Treat how?
Disseminated MAC Clarithromycin, ethambutol, rifabutin for 12 mo
313
What is pulsus paradoxus? What causes it? What conditions?
Larger decrease in SBP ( > 10) during inspiration Inc intrathoracic pressure restricting venous return Asthma, cardiac tamponade, PE, Vena cava thrombus, const pericard
314
When to add Abx in abscess after I+D?
Surrounding cellulitis Immunocompromised Sx of systemic infection
315
What fish syndrome has peppery taste? What is the MOA?
Scombroid Histamine fish toxicity
316
Treatment for staphylococcal scalded skin syndrome?
Dicloxacillin
317
MC site of oral cancer?
Tongue
318
How to diagnose MS?
MRI of the brain OR spine!
319
MC source of arterial emboli?
LV thrombus from MI
320
What back pathology in kids with avg age around 7 and midline vertebral tenderness? Do what? Caused by what?
Pediatric discitis MRI Staph a
321
What is a contraindication to performing I+D of PTA?
Severe trismus
322
Probably of septic arthritis based on # of Kocher criteria?
1 - 3% 2 - 40% 3 - 93% 4 - 99%
323
Kocher criteria mnemonic
``` NEWT Non-weight bearing ESR > 40 Wbc > 12,000 Temp > 38.5 C ```
324
How to rule out blunt cardiac injury?
Normal EKG Normal troponin x1 Can go home, no need for extended monitoring
325
What area of the C spine do peds patients usually injure?
C1-C4
326
What eye disease associated with R.A.? Presents how? Tx?
Scleritis Ocular erythema and scleral edema w/severe pain on EOM NSAIDs and glucocorticoids
327
What determines the degree of pulmonary insult in a drowning patient?
Quantity of liquid aspirated, not length of time
328
What is a complication of acute hepatitis? Occurs when?
Aplastic anemia —> dec wbc, plt, rbc 6-12 weeks after hepatitis
329
What is the MOA of CO poisoning?
Direct inhibition of O2 binding to Hgb
330
MC cause of cavernous sinus thrombosis?
Acute bacterial sinusitis
331
MC arrhythmia in blunt cardiac injury? #2?
Sinus tachycardia AFib
332
What additional lab value can be deranged with ethylene glycol ingestion?
Hypocalcemia
333
What is beer potomania?
Hyponatremia in chronic beer drinkers
334
Describe pupils in GHB ingestion? What else is characteristic?
Small and minimally responsive to light Comatose pt requires intubation but then has abrupt awakening
335
What is Mallet finger? If untreated then it turns to what?
Forced hyperflexion of DIP Swan neck deformity
336
What is Zone 1 of neck?
Cricoid cartilage to sternum
337
Zone 2 of neck?
Cricoid to angle of mandible
338
Zone 3 of neck?
Superior to angle of mandible
339
Injury to what zone of the neck has highest morbidity? Best prognosis?
Zone 1 Zone 2
340
What is the loxosceles genus?
Brown recluse
341
What is the lowest level to perform thoracentesis? Where to normally perform procedure?
8th ICS 1 interspace below dullness to percussion midscapular or posterior auxiliary line
342
What is the biggest RF for cellulitis?
Lymphedema
343
What is the only muscle that opens the mandible that can be affected by PTA?
Lateral pterygold
344
What does Jimson weed cause? Antidote? MOA?
Anticholinergic toxicity Physostigmine AChE-inhibitor

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