PEM Sample Qs Flashcards
2 abx for prophylaxis in sexual abuse
- Ceftriaxone 250 mg IM or Cefixime 8 mg/kg PO once
- Azithromycin 1 g PO once or 15 mg/kg PO once
- if over 8 yrs: Doxy 100 mg BID x 7 days
- Flagyl
3 viruses to counsel parents on:
- HIV
- Hep B
- Hep C
- HPV
3 counselling instructions for vulvovaginitis
- Avoid bubble baths or use of perfumed soaps/creams
- Avoid tight fitting clothes/underwear
- Wipe front to back
- Apply zinc oxide or other topical emollient- will resolve with good hygeine
4 pathogens (non STI) vulvovaginitis
- Group A strep
- Staph aureus
- S.pneumo / H flu / Moraxella
- Shigella
- STIs are uncommon
5 features that distinguish mastitis from physiologic breast budding
- Erythema
- Unilateral
- Warmth
- Swelling
- Painful to palpation
- Assoc of fever
- Purulent discharge/drainage
2 immediate interventions for mastitis
- Obtain IV access with labs (CBC, blood culture)
- If unwell, consider full septic work-up with labs, urine studies & LP
- C/S surgery for possible I&D
- Start IV antibiotics
5 high risk factors for c-spine injury
- Age > 65 years old
- Presence of numbness/tingling/paresthesias
- Midline cervical pain
- Not ambulatory at scene
- Dangerous mechanism: fall > 3 ft, axial load, high speed MVC, ATV or motorized vehicle accident
Signs of cervical injury (6)
- Motor paralysis
- Neurogenic shock: bradycardia, hypotension, flushed skin
- Spinal shock: flaccid paralysis, loss of rectal tone, loss of DTRs
- Neck: torticollis, muscle spasm, tenderness
- Sensory deficit with level
- Horner’s syndrome
Label C-spine lines
- anterior vertebral line
- posterior vertebral line
- spinolaminar line
- posterior spinous line
Hangman fracture
fx of C2 pedicle, hyperextension
-draw Swischuk line (C1-C3 through anterior spinous process circle), if C2 deviated > 2 mm on C3 = subluxation (if < 2 mm, pseudosubluxation)
Type of C-spine fractures (5)
Type 1: wedge compression, stable, semirigid cervical collar
Type 2: teardrop, isolated anterior/inferior vertebral body fx w/ intact posterior element (abrupt neck extension), semirigid cc
Type 3: comminuted burst, intact posterior elements (unstable, need surgery)
Type 4/5: complex, involve post elements, unstable, poor prognosis
Mgmnt of Pulseless VT (3)
- Defibrillation 2J/kg –> 4J/kg
- Epinephrine 0.1 ml/kg Q3-5min
- Amiodarone (Refractory) 5 mg/kg (150 mg)
Systemic causes of prolonged QTc (4)
- Congenital: Romano Ward, Jervell-Lange-Nielson
- Metabolic: hypomagnesemia, hypocalcemia, hypokalemia
- Endocrine: hypoparathyroidism, hypothyroidism
- Neurologic: Stroke, subarachnoid hemorrhage, encephalitis
Drugs that cause prolonged QTc
- Anti-emetics: ondansetron
- Antipsychotics: Haloperidol
- Loop diuretics: furosemide
- Antibiotics: macrolides
Causes of abnormal S3
CHF
VSD
mitral regurg
dilated cardiomyopathy
6 life threatening GI emergencies in solid organ transplant patients
- Portal venous thrombosis
- Biliary obstruction
- Typhilitis
- Liver failure with hepatic encephalopathy
- GI hemorrhage
- Renal artery stenosis
8 diagnostic tests to help diagnosis of mediastinal mass
- Chest CT
- CBC
- BMP - electrolytes, renal function
- Urine / plasma catecholamines
- Alpha FP and BHCG
- LDH / uric acid
- BM biopsy
- Echo
3 complications of mediastinal mass
- Tumor lysis syndrome
- Superior vena cava syndrome
- Superior mediastinal syndrome (SVC + obstruction of trachea)
Indications for atropine use (2)
- symptomatic bradycardia
- cholinergic poisoning
Indications for hospitalization of suicidal teenager (4)
- No follow-up arrangements possible
- Remains actively suicidal
- History of previous suicide attempts
- Unsupportive home environment (lack of appropriate adult sup)
Risk factors for repeat suicide attempt (4)
- impulsivity
- Psychosocial factors
- Family: lack of supportive environment, fhx of SI, mental health dx in family
- Concomitant mood disorder
4 causes of non-traumatic pancreatitis
- Gallstones / cholelithiasis
- Ethanol abuse
- Hypertriglyceridemia/hyperlipidemia
- Medication induced: azathioprine, asparaginase chemo
- Metabolic: hypercalcemia, hypothermia
4 lab findings in pancreatitis that necessitate ICU care
- Hyperglycemia: BG > 11.1
- Hypocalcemia: Ca < 2.0
- Elevated BUN
- Elevated hematocrit
- PaO2 < 60 mmHg (needs intubation)
Drugs that can be hemodialyzed in overdose (5)
- Aspirin
- Toxic alcohols: ethylene glycol, methanol
- Lithium
- Metformin
- Severe acetaminophen O/D
2 ingestions that can cause UGI bleeding
- button battery
- iron
2 common causes of UGI bleed in toddler
- mallory weiss
- gastritis / esophagitis
life threatening causes of GI bleed (4)
- Peptic ulcer disease
- Esophageal varices
- Vascular malformation
- Intestinal duplication
HSP - CF (5)
- Palpable purpuric rash, most notable of LE
- Arthritis/arthralgias
- Abdominal pain +/- GI bleeding
- HTN
- Orchitis
HSP - Lab findings (5)
- UA: hematuria, proteinuria
- Elevated CRP / ESR
- (+) fecal occult blood test
- Elevated platelets
- Anemia
4 C/I to enema reduction in intussusception
- Perforation
- Obstruction
- Peritonitis
- Presence of pneumatosis intestinalis
Burn Center Referral Criteria (8)
- TBSA > 10 % partial thickness
- TBSA > 5% full thickness injury
- Concern for NAT
- Burns on hands/feet/genitals
- Inhalation injury
- Chemical burn
- Major associated injuries
- High voltage burn injuries
5 features of NAT burns
- Symmetrical, well delineated burns on hands/feet
- Submersion burns sparing buttock
- Patterned burns - distinct objects
- Cigarette burn holes
- Lack of splash pattern
- Inappropriate explanation for mechanism
4 life threatening complications of DKA
- Cerebral edema
- Hypovolemic shock/ cardiovascular collapse
- Profound metabolic acidosis
- Electrolyte abnormalities: hypo/hyperkalemia
3 clinical features of anterior shoulder dislocation
- arm is externally rotated
- arm is abducted
- pain
Nerve injury w/ anterior shoulder dislocation
axillary N
- test with sensation over lateral deltoid
Complications of shoulder reduction (3)
- Axillary N/AA injury
- Hill-Sachs lesion: cortical depression of humeral head
- Bankart lesion: avulsion fx of ant inferior glenoid rim (labral tear)
MC elbow injury
supracondylar fx
4 XR features of elbow fracture
- Posterior fat pad
- Anterior humeral line does not bisect capitellum
- Abnormal radiocapitellar line (does not bisect capitellum)
- Elevation of anterior fat pad (sail sign)
MC N injury w/ supracondylar dx
anterior interosseuss (branch of median N)
Volkmann’s contracture - what is it?
caused by compartment syndrome from supracondylar fx w/ ischemia to flexor mm of forearm causing fibrosis / contracture –> permanent flexor contracture of hand = “claw hand”
5 feature of compartment syndrome on exam
- Pulseless
- Pallor
- Pain out of proportion
- Paresthesias
- Paralysis
Tilleaux fracture
- Salter harris 3 fx through physis and epiphysis of distal tibia
- Avulsion of anterolateral epiphysis (medial physis is partially closed in age 12-14 yr old)
If displaced > 2 mm: CT scan, Ortho c/s, ORIF
EKG findings in cocaine O/D (4)
- ST elevation
- Sinus tachycardia
- SVT
- Tachyarrhythmia: V/fib, V.tach, torsade
EKG findings in myocarditis (4)
- Sinus tachycardia
- Low voltage QRS complex
- Low voltage T waves or T wave inversion
- Dysrhythmia (SVT, Vtach)
CXR findings in myocarditis (3)
- Cardiomegaly
- Increased interstitial infiltrates
- Pleural effusion
Non-infectious causes of myocarditis (3)
- Medications - anthracyclines, cocaine, heavy metals
- Radiation exposure
- Systemic disorders - SLE, IBD, Thyrotoxicosis
6 complications of pericardiocentesis
- Puncture of heart
- Dysrhythmia
- Laceration of coronary vessels
- Local infection
- Hemothorax/Pneumothorax
- Diaphragmatic perforation
- Puncture of peritoneal cavity
- Hemopericardium
Medications for CV support in myocarditis
- Preload: lasix, nitroglycerin
- Pump: dopamine, dobutamine, epi
- Afterload: milrinone
Signs of organ rejection - liver transplant (2)
- Elevated LFTs - cholestasis, itching
- Abdominal pain, fever
Signs of organ rejection - kidney transplant (2)
- Fever with graft tenderness
- Uremia, elevated creatinine
Signs of organ rejection - heart transplant (2)
- Tachycardia, low CO, sx of CHF
- Pericardial effusion
Drugs that increase calcineurin inhibitor levels (tacrolimus, cyclosporin)
- Antibiotics - macrolides, FQs, metronidazole
- Antifungals - fluconazole, ketoconazole
- Antivirals - indinavir, nelfinavir
- CCB - nifedipine, nicardipine, diltiazem
Drugs that decrease calcineurin inhibitor levels (tacrolimus, cyclosporin)
- Antibiotics - Rifampin
- Antifungals - caspofungin (tacro only), terbinafine
- Antivirals - nevirapine, efavirenz
- Anticonvulsants - carbamazepine, phenobarbital, phenytoin
Causes of HYPERNATREMIA
- Diarrhea
- Diabetes insipidus (Uosm < Sosm)
- Hyperaldosteronism
- Iatrogenic (wrong fluids)
- Water deprivation, impaired thirst, improper formula mixing
- Neurosurgery
- Mod-severe burns