PEER 8 Flashcards
Electrolyte abnormalities in primary adrenal insuffiency
hyperkalemia, hyponatremia
radiation syndrome prodrome phase
nausea, vomiting, autonomic symptoms
Best indicator for prognosis in acute radiation syndrome
Absolute lymphocyte count
Systemic tx for Raynauds
Topical or oral CCBs
Treatment of PCP seizures
Benzos, then phenobarb
MC bug in SBP from PD
staph epi
Legionella treatment
Macrolides
Allergic disorders with persistent dsyphagia
eosinophilic esophagitis
Hyperglycemia, Na correction
1.6 decrease for eery 100 of glucose increased
Highest infectivity of pertussis
Carrahal phase
IUP diagnosis on TVUS
A gestational sac with a yolk sac in the uterus
double decidual sign
two concentric echogenic rings of tissue surrounding an intrauterine gestational sac, early sign of IUP
Contraindications to nail trephination
Nail edge disruption, arylic nails (flammable)
flexion of the proximal interphalangeal (PIP) joint and hyperextension of the distal interphalangeal (DIP) joint
boutonniere deformity
peds cardiac arrest epi dose in ml/kg with concentration
1:10,000, 0.1ml/kg
when LP needed in pediatric febilre seizure
meningeal sx, 6-12 months if immunizations deficient, those on antibiotics, 2nd day of illness, status
What virus is most frequently associated with febrile seizures in the United States?
Human herpes virus 6
MC reason for VP shunt malfunction
obstruction
MC location of anal fissure
posterior, midline
Topical medications for fissures in adults
Topical nifedipine and topical nitroglycerin, both of which increase local blood flow and promote healing
tx for spontaneous pnemomediastinum
rest, analgesia
dx of empyema on thora
+ culture, pH<7.2, glucose <60, WBC>50K, purulent fluid
VS differences in TACO vs TRALI
TRALI: hypotension, fever, TACO: hypertension, afebrile
MC viral cause of pancytopenia
Hep B
risk of tramadol
serotonin syndrome
electrolyte changes in rhabdo
hyperkalemia, hyperuricemia, hyperphosphetemia, hypocalcemia
MC complication of SCC
isosthenuria, inability to concentrate urine due to:cell sickling in the hypertonic and acidic medulla, resulting in infarction, renal papillary necrosis
Neutropenia definition
<500 ANC
What are indications for elective repair of an abdominal aortic aneurysm even if the patient is asymptomatic?
Diameter greater than 5.5 cm or an aneurysm that expands greater than 0.5 cm in a six month period
MCC endopthalmitis
coag-negative staph s/p cataract surgery
MC CN palsy in cavernous sinus thrombosis
VI, LR
MC bug in Ludwig’s angina
viridans strep
Indications for PO vanc in c. diff
> 60, T>38.3, albumin <3, WBC>15, Cr>1.5 pre disease
indication for surg c/s for hemorrhoids
stragulated internal
second line for syphillis
doxycycline
indication to aspirate blisters of frostbite
large, hemorrhagic blisters, especially those that cross joints, be aspirated and damaged tissue should be bandaged with sterile, dry gauze
tick disease that cuases fever, HA, N/V/D, leukopenia, thrombocytopenia, elevated LFTs
Ehrlichiosis
regions with chloroquine-sensitive malaria
Haiti, the Dominican Republic, most regions of the Middle East, and Central America west of the Panama Canal
chloroquine-resistant malaria regions
South America, South Asia, Africa
chloroquine-resistant malaria treatment
Quinine + doxy
Atovaquone/proguanil
Mefloquine
all PO
compliated malaria or P. falciparum treatment
Quinidine IV and doxycycline IV
four indications for admission of patients with uncomplicated malaria
Young children, immunocompromised patients, individuals with no acquired immunity (or those who live outside endemic regions), and patients with hyperparasitemia (four to ten percent)
EKG in propanolol OD
wide complex bradycardia
treatment BB overdose
glucagon, bicarb if QRS wide
BB with most significant NA channel blocking properties
propanolol
BB associated with ventricular dysrhythmias
Sotalol
Tx for traumatic iritis
steroids, mydriatics (muscarinic antagonists), analgesics
indication for lateral canthotomy
elevated intraocular pressures and evidence of optic neuropathy.
Type of virus that ebola is
Filoviridae, RNA virus
Type of virus Dengue is
Flaviviridae
WEE, EEE virus type
Togaviridae
Hantavirus transmitting animal
deer mouse
Phases of hantavirus
fever, cardiopulmonary phase, oliguric/diuretic, convalescent
Lab abnormalities in EBV
lymphocytosis, elevated LFTs
sciatic nerve branches
common peroneal and tibial nerve
common peroneal nerve branches
superifical peroneal and deep peroneal
superficial peroneal nerve innervation
sensation to lateral lower leg and dorsum of foot
deep peroneal nerve innervation
dorsiflexion of feet/toes and sensation between first and second toes
lateral cutaneous nerve innervation
upper, lateral thigh
obturator nerve innervation
leg adduction, medial thigh sensation
posterior tibial nerve innervation
sole of the foot, the distal foot and toes, and occasionally the heel
why common peroneal nerve is vulerable to compression injury
winds around the fibular head
Injury of what nerve can result in inability to flex at the knee and a flail foot
sciatic nerve
best emergency contraceptive oral option
ulipristal, a selective progesterone receptor modulator
What is the standard dose of oral N-acetylcysteine when treating acetaminophen overdose?
Loading dose of 140 mg/kg followed by 70 mg/kg every four hours for an additional 17 doses
Toxic dose of ASA
200-300mg/kg
MC vessel of occlusion in mesenteric ischemia
SMA
Appearance of cecal volvulus on plain films
coffee bean appearance or comma appearance
Risk factors for cecal volvulus
marathon rummers, younger, GI malignancy
most significant risk factor for endometritis
cesarean section
MCC acute mitral regurg
infective endocarditis
MC bug in erysipleas
strep pyogenes (beta hymeolytic)
Earliest findings in papilledema
loss of spontaneous venous pulsations
What finding on ocular ultrasound is an indication of increased intracranial pressure?
An optic nerve sheath diameter > 5 mm in adults predicts an intracranial pressure of > 20 mm Hg.
Winter’s formula
PCO2=1.5 x HCO3- + 8 ± 2
Earliest signs of HACE
ataxia
What altitude does cerebral edema occur?
3000 meters
How fast should perimortem ceserian be performed?
4 minutes
How to differentiate hordeolum from chalazion
horedolum tender found near folicle, chalazion painless and above eyelashes
First line tx for trigeminal neuralgia
carbamazepine
MC area to sustain skull fracture
parietal area
MC symptom of primary brain tumor
seiuzre
MC causea of vaginal bleeding in the post-menopausal woman
uterine atrophy or vaginal atrophy
anterior cord syndrome
Complete loss of motor, pain and temp below injury, retaine proprioception and vibratory sensation
cord syndrome with worst prognosis
anterior cord syndrome
Alternative for INH for LTBI
Rifampin x 4 months
Grey-turner sign
Flank ecchymosis associated with retroperitoneal hemorrhage
Cullen sign
Peri-umbilical ecchymosis
How is a continuous naloxone infusion dosed
One-half to two-thirds of the total dose that initially was effective in reversing the respiratory depression is given hourly and titrated as needed.
Virus associated with CNS lymphoma
EBV
MC benign breast mass
Fibroadenomas, firm non-tender, mobile mass
Most useful historical features in appendicitis
migration, pain prior to vomiting, abscence of similar pain in past
Most useful physical exam findings in appendicitis
RLQ TTP, McBurney’s TTP and abdominal wall rigidity
Treatment of anthrax
cipro, doxy or amox
RSI dose etomidate
0.3mg/kg
RSI succinylcholine dose
1.5 mg/kg
RSI ketamine dose
1.5 mg/kg
Low risk BRUE
Age>60 GA >32 wk and post conception age>45 weeks No prior BRUE <1min No CPR No concerning H&P
Lab test to differentiate mild from severe dehydration
bicarb
Diseases that require airborne precautions
TB, Measles, VZV (shingles or chicken pox)
Artery most at risk for arterial ischemia due to art catheter
brachial artery
Pediatric rule of nines
head 18%, arms 9% legs 14%, trunk (18% one side)
What is the appropriate dosing regimen for the administration of thrombolytics for ST elevation myocardial infarction?
Administration of alteplase 15 mg IV push followed by two subsequent alteplase infusions (0.75 mg/kg over 30 minutes and 0.5 mg/kg over 60 minutes).
What is the maximum dose of local lidocaine that can be given?
5 mg/kg for plain lidocaine and 7 mg/kg for lidocaine with epinephrine.
Lights criteria
Pleural:serum protein >0.5, LDH>0.6, >2/3 upper limit of normal
MC site of obstruction with esophageal FB
cricopharyngeal muscle
greatest risk factor for spontaneous PTX
smoking
scorpion bite presentation
neuronal Na depolarization: jerking, hypersalivation, fasciulations, CN deficits, tachy, hypertensive