Need to knows

Question 1

Triad a/w Wernicke’s encephalopathy in heavy drinkers ?

Answer 1

1. Nystagmus &ophthalmoplegia (eye muscle weakness)
2. Poor coordination or ataxia
3. Confusion or memory impairment.
   Tx = 500mg IV Thiamine infused over 30 mins

Question 2

Lyme Disease Tx

Answer 2

Doxycline 100mg BID x 14d

Question 3

Hypercalcemia

Answer 3

short QT
“Bones (pain), Stones (renal/biliary), Groans (abd pain, n/v), and Thrones (polyuria), psychic overtones (depression, anxiety, insomnia)

Question 4

Electrical alternans (differing sizes in QRS heights on the same EKG)

Answer 4

Suggestive of Pericardial Effusion / Tamponade

Question 5

MC organisms causing Bacterial Meningitis in neonates <1mo old

Answer 5

E. Coli   (G-)
Listeria  monocytogenese (anaerobe) 
GBS       (G+) 
H. Flu
Nisseria meningiditis 
ABX: Cefotaxmine (Ceftriaxone) / Gentamicin + Ampicillin

Question 6

Treatment for Hyper K+

Answer 6

1) Calcium chloride or Calcium Gluconate (10mL IV over 10 mins)
2) Insulin+ D50 and/or nebulized Albuterol (10mg)
3) Sodium bicarb w/ loop diuretic; kayexalate; dialysis

Question 7

Human Bite

Cat Bite

Answer 7

Eikenella corrodens
Pasteurella multocida
Tx: Augmentin - Leave OPEN!

Question 8

NEXUS Criteria

Answer 8

No midline c-spine tenderness
Not intoxicated
No AMS
No neurological deficits
No distracting injuries 
(if any can't be met need x-ray)

Question 9

Suture Size per location

Answer 9

Scalp- 3-0 or staples Remove 7 day s
Trunk/ Prox extremities - 4-0
Forehead/ Hand/Finger- 5-0 Remove 7 days
Inside Mouth 5-0 Absorbable Remove 5 days
Face - 6-0 Remove 5 days

Question 10

Specific pathogens:

1) Farming accidents
2) fresh water
3) High-pressure water systems (power-washer)

Answer 10

1) Clostridium perfringens
2) Aeromonas hydrophilia
3) Acinetobacter calcoaceticus

Question 11

Hemolytic Uremic Syndrome

HUS

Answer 11

Triad: Hemolytic Anemia, low plts, renal failure
MC Children <5yo
MC cx’ed by E. Coli (bloody diarrhea)
Tx: Plasmapheresis

Question 12

TTP

Answer 12

Triad: Hemolytic Anemia, low plts, renal failure +/- neuro abnormalities and fever
MC Adults
MC cx’ed idiopathic, preg, HIV etc
Deficiency of ADAMTS13 which lead to an increase in Von Willebrand Factor
Tx: Plasmapheresis , do NOT give PLTs

Question 13

Kernicterus

Answer 13

Neurotoxic Hyperbilirubinemia
Children < 1 yo
Bili > 25
S/S: Lethargy, hypotonia, and poor feeding

Question 14

Intussusception

Answer 14

Invagination of one portion of bowel into an adjacent segment “Telescoping”
MC ileocecal region
MC cx of intestinal obstruction in children 3mo-5yrs
s/s: Colicky abd pain, vomiting, bloody/ current jelly stools
Dx: Abd Ultrasound
Tx: Surgery consult; air enema

Question 15

Hand-Foot-Mouth Dz

Answer 15

Coxsackievirus A
Fecal-Oral Transmission
MC Fall & Summer
S/s: Fever, Malaise, Sore throate, Anorexia, rash
Tx: Self-limted 7-10 days, Pain medicine, magic mouth wash

Question 16

Transudative vs Exudative

Answer 16

Transudate: Low protein & LDH
Exudate: High protein & LDH

Question 17

Acute Angle Closure Glaucoma

Answer 17

Painful VL, Vomiting, seeing halos around lights
PE: cloudy cornea & Fixed dilate pupil
Labs: IOP > 21mmHg
Tx: Tpical BB, Carbonic anhydrase inhibitors, topical steroids, miotics

Question 18

ALS

Amyotrophic Lateral Sclerosis

Answer 18

Asymmetrical distal weakness w/out sensory findings

Bowel/bladder func intact

Question 19

Aplastic Crisis

Answer 19

MC a/w Parovirus B19

Question 20

Subdural Hematoma

Answer 20

Elderly/ EtoH’s
Fall/Traumatic Brain Injury
HA, mental status change
Crescent shaped hematoma crosses suture lines but not the midline. Injury to Bridging Veins

Question 21

Epidural Hematoma

Answer 21

Injury to Middle Meningeal Artery.

May cross midline, but does not cross suture lines

Question 22

Subarachnoid Hemorrhage

Answer 22

Ruptured Berry Aneurysm

Hemorrhagic Stroke

Question 23

Intracerebral Hemorrhage

Answer 23

Ruptured microaneurysms MC basal ganglia