PEER Review VIII Flashcards by Lucy Luu

Adrenal crisis in ptx w/ chronic adrenal insufficiency

Hypotension fails to respond to standard resuscitation

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Prognostic indicator for Acute radiation syndrome (ARS)

Absolute lymphocyte count at 48hrs (1200 = good prognosis)

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Most common causes of increased confusion in febrile elderly ptx

Respiratory, urinary or skin infxn

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D-dimer is elevated, decreased or normal in primary fibrinolytic?

Normal

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Hyperkalemia is present in primary or secondary adrenal insufficiency?

Primary

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What’s the difference between cauda equina and conus medullaris syndromes?

Cauda equina - LMN lesion, lumbosacral radiculopathy, dermatomal distribution

Conus medullaris - UMN lesion, spinal cord compression, non-dermatomal

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Most common bug in peritoneal dialysis infection

Staph epidermidis > Strep sp > E. coli and proteus > S. Aureus

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Treatment for rebound hypoglycemia due to sulfonylurea poisoning

Dextrose + Octreotide, glucagon IM

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Treatment for scabies

Topical permethrin

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Cold water immersion syndrome

Syncope resulting from cardiac dysrhythmia on sudden contact w/ water that is at least 5C lower than body temp

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Medications to help with alcohol craving

Naltrexone, Acamprosate, Disulfiram

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Opportunistic infxns in HIV ptx

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Benefit of hyperbaric O2 therapy for CO poisoning

Reduce risk of delayed neurologic complication

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Treatment for narcotic withdrawal

Clonidine patch

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Goal of UOP in rhabdo w/ acute renal injury

3 ml/kg/hr

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Txt of CCB poisoning

Calcium, glucagon, vasopressor, insulin + dextrose

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STD treatment

Ceftriaxone 250 mg IM (or cefexime 400 mg PO) + Azithromycin 1g PO

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Txt for acute angle closure glaucoma

Timolol 0.5% + Apraclonidine 0.1% + prednisolone 1% + Acetazolamide 500 mg PO or IV + Mannitol 1-2 g/kg IV

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Most common type of primary headache

Tension headache

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Caloric reflex test (oculovestibular response)

COWS nystagmus

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What happens when a magnet is placed over a pacemaker?

Disable pacemaker sensor of native beats and set pacemaker to asynchronous fixed-rate mode

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What is failure to capture of pacemaker?

Pacemaker impulses fail to trigger myocardial depolarization

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Posterior fat pad sign on X-ray

SCH fx in kids and radial head dx in adults

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Clonidine mimics overdose of what class of medication?

Opioid

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Esophageal food bolus impaction treatment

2 doses of 1 mg glucagon, carbonated beverages, NTG

Factor VIII replacement should be done before or after CT head in a patient of hemophilia A with head trauma?

Before

Which part of skull is most likely to be fractured in infants?

Parietal > occipital, temporal > frontal (least likely)

What are the most effective treatment of heat stroke?

Evaporated cooling (fans and spray bottle) and ice water immersion Placing ice packs on the axillae and groin (adjunctive)

Most common cause of death in pediatric trauma

Head injury

What is the early cardinal sign of flexor tenosynovitis?

Pain on passive extension of the finger (early), flexed position of the finger at rest, symmetric swelling of the finger, tenderness over the course of the flexor sheath

What can you see on the slit lamp with HSV infection?

Superficial corneal epithelial dendritic defect

What is the definition of simple febrile seizure?

Age (6 months to 5 yo), Duration (less than 15 min), Episode (1 episode in 24 hr period), location (generalized)

Treatments for tet spell

Prostaglandin E, phenylephrine, propranolol, morphine sulfate

Most common pathogen and monoarticular septic arthritis

Staph aureus

Which structure has the highest rate of infection due to animal bite?

Hand

What is the absolute contraindication to succinylcholine?

Neuromuscular disease such as Myasthenia gravis

Treatment for impetigo

Topical Mupirocin

Calculation for factor VIII replacement in hemophilia A

Kg x % activity x 0.5

What's the location of stroke given these sx? Coma, hypothermia, pinpoint pupils, loss of cornea reflexes, abnormal caloric response

Pon

What condition causes a headache with Horner syndrome and contralateral stroke symptoms?

Carotid artery dissection

What structure should be avoided when performing I&D of a peritonsillar abscess?

Carotid artery (2.5 cm behind and lateral to the tonsil)

Which type of burn causes more injury to the eye? (Acid vs Alkaline)

Alkaline agents cause a liquefactive necrosis (continue to penetrate until removed). Acid burn cause coagulation necrosis that limit penetration

Which vitamin toxicity can cause intracranial hypertension?

Vitamin A

What is the management of a button battery being lodged in the esophagus or stomach?

Emergency removal if it's in the esophagus (alkaline injury can cause perforation to the esophageal mucosa) discharge home and follow up next day if it is in the stomach (make sure it pass the pylorus in 48 hours)

Spontaneous bleeding of hyphema can occur in pt with which condition?

Sickle cell disease (avoid acetazolamide) | - can use topical B-blocker to decrease IOP

Which type of orbital fracture requires an emergent surgical consultation?

Orbital roof fracture (concomitant brain injury)

What medication should you give patient with polycythemia in ED?

ASA (prevent stroke)

Which type of lymphadenopathy is most likely to be associated with a serious underlying pathology?

Supraclavicular

Which medication help with renal stones expulsion?

Tamsulosin and Nifedipine

What is the effect of soma or carisoprodol?

Sedative-hypnotic agent (active metabolite meprobamate can cause myoclonus encephalopathy)

What is the hallmark sign of Fournier gangrene?

Gas in the scrotal wall

Treatment of subungual hematoma

Nail trephination (nail removal is necessary only if there is significant nail bed injury and an unstable fingertip)

Treatment for inhalation anthrax (widened mediastinum, hilarious adenopathy and effusions on CXR)

IV Ciprofloxacin

Which electrolyte abnormality cause adynamic (paralytic) small bowel ileus?

Hypokalemia

Which disease has blood-and-thunder appearance of retina?

Central retinal vein occlusion (diffuse hemorrhages and dilated vessels)

Most common cause of unilateral Bell palsy

HSV

Most common cause of bilateral Bell palsy

Lyme disease

Treatment for high altitude sickness syndrome

Ibuprofen, compazine, Acetazolamide, Dexamethasone

Why should nitroprusside be avoided in event of ICH?

Increase ICP

Most common organ injured by gunshot wound to abdomen

Small intestine > colon > liver

Most common organ injured by stab wound to the abdomen

Liver > small intestine > diaphragm > colon

What are the absolute contraindications to tPA?

Any prior hemorrhagic stroke, ischemic stroke within 3 months, active bleeding, known intracranial neoplasm, structural cerebral vascular malformation, suspected dissection/pericarditis

How to differentiate between CCB and BB toxicity?

CCB toxicity causes hyperglycemia

Txt for acute radiation proctocolitis

Analgesics and sulcrafate

Pt taking linezolid should avoid which drugs?

MAO inhibitor (dextromethorphan, pseudoephedrine, serotonergic drug)

Txt for Hirsprung disease in ED

Gastric and rectal decompression, Abx, IVF

Most common cause of death in ptx with severe Parkinson's disease

Respiratory failure

Txt for bubonic plague

Streptomycin or gentamicin

Most common zone of injury to penetrating trauma to the neck

Zone 2

Most common cause of esophageal perforation

EGD

What are the significant side effects of Venlafaxine?

QRS prolongation and convulsions

Signs of scombroid poisoning

Facial flushing, throbbing headache, diarrhea, abdominal cramp

Contraindication to Coude catheter

Hx or urethral strictures (creation of false tracts)

Most common fracture in anterior shoulder dislocation

Hill-Sachs deformity (compression fx of posterolateral humeral head)

Side effects of IVIG therapy

Vomiting, hypotension, seizure

Which ophthalmologic disease associated with temporal arteritis?

Central retinal artery occlusion (CRAO)

What is the most reliable sign of uterine rupture during labor?

Non-reassuring fetal heart rate patterns

What are the absolute contraindications to the use of succinylcholine?

Ischemic stroke, myopathy

Spontaneous pneumothorax is mostly closely associated with which pathogen in HIV patient?

Pneumocystis Jiroveci

Most common neurovascular injury in posterior elbow dislocation

Ulnar nerve > brachial artery

Which anti-epileptic medication is ineffective in controlling lithium-induced seizures?

Phenytoin

What treatment should be added to bactrim in Pneumocystis Jiroveci with PaO2

Steroids for 3wks

What is the most common cause of Ludwig angina?

Dental abscess

Triad ymptoms of Wernicke encephalopathy

encephalopathy, opthalmoplegia and ataxia

What is the primary reason to use HBO therapy in common monoxide poisoning?

Delay neurologic complications

Common medications that can induce serotonin syndrome

Dextromethorphan, Lithium, Tramadol, Linezolid

EKG abnormalities in SAH

Deep T-wave inversion, U wave, QT prolongation