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Rosh > Quattttt > Flashcards

Quattttt Flashcards

1
Q

What is Oversensing? SENSEOr Failure to PACE?
Undersensing? SENSE failure
Failure to capture? PACING Failure
failure to output? PACING Failure

A
  • mistakes a fib, tremor, physical actvitiy for cardiac activity and doesn’t fire when it should. syncope. dropped beats
  • spikes in the middle of QRS or after (some spikes with QRS some without). doesn’t sense native cardiac activity=asynchromnous pacing

Capture- pacer stimulus doesnt lead to myocardial contractions - from MI maybe

output failure- not generated when it should

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2
Q

kid, recent infection, puffy eyes, pericardial effusion- Tx?

A

PSGN - HD for uremia (effusion) or hyperK, get lytes, and urine

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3
Q

serotonin syndrome tx

A

crypoheptadine

benzos

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4
Q

What is paraphimosis?

A

Para- one extra step, one extra word- is retracted foreskin

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5
Q

What is the keht blokmore test for preggos

A

it determines how much fetal hemobling is in theri blood ot see how much rohgam to give
any mom over 25 weeks need to get rohgam after blunt trauma

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6
Q

Eye is down and out, what nerve is out, + headache- why?

A

CN 3- Post comm artery anyeusm SAH

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7
Q

you give benzos, keppra, barbs, propfol nad not stopping… what next

A

B6, isoniazid- time to think outside the box

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8
Q

why repair the galea?

A

anchor point for frontalis muscle! trauma and then facial droop is from galea injury
it also stops hematom and infection
repair with 3-4.0 absorbable if greater than 1/2cm

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9
Q

Distention, looks like SBO in an old person, CT neg for SBO=

A

Ogilive syndrome- neostigmine (if HDS) if >12 cm

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10
Q

What does wellens look like, what is the story, what artery, tx/

A

Slight BAM to inverted T&raquo_space;> Deep invverted T in V2/3

CP w/ no EKG changes and then EKG chanegs with no CP symtoms

LAD

Heparin, urgent cath

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11
Q

peds 3 yo CAP tx?

A

amp

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12
Q

what do you poor onto a jelly fish sting?

A

vinegar - acid stops toxin spread. or hot water

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13
Q

What benzo do you give in AWS in cirrhtoic patients?

A

lorazepam! not acitve metbolites, still has ~10 hr half life

diazepam has active metabolties

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14
Q

Wide gap, AKI, AMS think about

A

ehtlyene glycol- get osmol gap to se eif high

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15
Q

Where do you do escahrotimies on burn chest compartment syndrome/

A

Bilateral ant axillary lines amd one across to connect - no blood, no pain!

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16
Q

What do you also need to give in hyperK that you dont right now/?????

A

Lasix!

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17
Q

AMS, miosis, Hypotension, Bradycardia, shallow breathing….

A

Clonidine

stope NE release in brain and stops symp outflow from brain

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18
Q

chronic pain, fibromyalgia, on opiates at home, breaktrhu pain- what next?

A

Pain dose ketamine - outpatient pain specialist

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19
Q

bullous pemphigoid tx/

A

steroids, dapsone

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20
Q

Three mainidications for lateral canthotomy

A

Iop40
Proptosis
Decreased visual acuity
APD

Lidocaine, clamp, incision 2 cm, scissors the ligament

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21
Q

Old, cheek swelling gotta think …

A

Supportive parotitis
Augmenting or unasyn
Toeralte secretions and PO

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22
Q

3 yo LOC , everything else normal- CT or nah?

A

0.8% risk, moderate risk catgeory- sahred decison making with parents

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23
Q

Recent Uri with anemia, kid, why?

A

Autoimmune hemolytic anemi- steroid- molecular mimicry

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24
Q

Swallowed bleach household- asymptomatic- what next?

A

Observe and discharge. Unlikely to damage the esophagus. Look out for aspiration.

Industrial bleach is more dangerous

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25
Q

Cryotococcus treatment

A

Flucytoclsine

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26
Q

CN toxicity

A

Anaerobic resp. Lactic acid
Hydrox- converts it to excretion 5 g IV

Nitrites makes metHgb to excrete
Sodium thisulfate makes it excretable

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27
Q

irst things you need to for lvads?

A

listen for hum
doppler pulse/art line- pulse may be absent
interrogate lvad device

hemolytic anemia common

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28
Q

36 wks rom- what next

A

abx gent amp
check for prolapsed cord/fetus
admit for induction of labor

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29
Q

bronchilitis

A 
ids <2 yrs old
look for dehydartion
resp compromise
apnea 
risk factors

nasal suction, hydration, 1-5 days, gets worse before better, humidified air

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30
Q

Drug intoxication with AMS, waes and wabnes, profound, sitmnualte them and they wake up…

A

GHB

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31
Q

recent infeciot nin kid now with joint pain and knee effusion?

A

reactive arthritis- HLA b 27

Cant see, cant pee , cant climb a tree

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32
Q

dermatitis, diarrhea, dementia- vitamin?

A

NIacine- B3

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33
Q

most cmmon gastoreneteritis?

A

NVD sick contacts- norovirus

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34
Q

Goal time for testicalu torision to urology?

A

6 hours high salvage rate

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35
Q

What is pathophys for HUS? PLEX or Fluids?

A

Shiga toxin endothelial damage- thrombcytopenia micornagiopathic hemolytic anemia
PLatels, Hematuria, AKI, N/V/D

FLUIDS! no plex, just supportive

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36
Q

ITP management

A

IVIG steroids - even if there is some bleeding

Add platelet tranfusion for: <10k (spontaneous intracranial hemorrhage) or major bleeding

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37
Q

Difference in Scleritis and episcleritis

A

Episcleritis- slef limtied, phenylephrine

Scleritis- very painful, ciclary flush, systmiec disease-NSAIDs steroids, optho-dilation of slera vessels

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38
Q

Modified sgarbossa

A
  1. 1mm concordant in any lead
  2. 1 mm discordant V1-V3
  3. 5mm discordance anywhere or 25% discordance of the S wave

Specific but not sensitive. + score= act fast. No score = doesn’t rule It out

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39
Q

2 additonal SE from etomidate/

A

mycolonus

N/V

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40
Q

amputation keys

A 
irrigate
wrap in guaze
slaine on guaze.
put in bag
put bag on ice
digits up to 8 hours
limbs 4-6 hours
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41
Q

difference in priapisms/

A

High flow- spinal cord/AVM arrterial flow. not painful. soft tip. observe

Low flow- ischemic, emergency (need blood gas), painful, hard tip. no venous outflow. sicklers, Drugs

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42
Q

be careful when putting lidocaine into kids! 12 kg only allows you 4.8-6.0 ml!

A

cool

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43
Q

How to exclude signifcant cardiac injruy after blunt chest trauma

A

Trop negative

EKG with no abnromalities (sinus tac, a fib, svt common)

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44
Q

5 causes of brady cardia

A
  1. VS !!!hypoxia, hypoglcyemia
  2. Hypothryoid
  3. Hypthermia
  4. MI
  5. BB
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45
Q

5 causes of low K

A 
Big cell shifts form insuoin
Renail- diruetics, RTA
GI, puke or poop
hypomag
Starvation
give mag!
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46
Q

Vent settings for lung protective

obsturcitve

A
  1. 8 cc/kg, 16 RR, 60 IFV, 40% FIO2, 5 PEEP - use table
    Isn hold: if platelau pressure is > 30= 7cc/kg
  2. 8 cc/kg, 10 RR- full expirationr, 60-80, 40%, PEEP 0-5
47
Q

What is NMS and how od you treat/

A

D2 antogonism - therpeuic dosages!
AMS, Hypthermic, lead pipe rigidity, Autonomic instability

benzos, cooling and supportive care

48
Q

MAT regular or irrgauler/

tx?

A

irregular

tx undelrying cause

49
Q

WHich tow acolols do you give ehtnaol or fomepizole to? why?

A

ethylene and mehtanol

all use alchol dehyrgaonse (inhbited by fomepizole) but acetone and isopropyl is equally as toxic

50
Q

PUlsatile tinniuts, headache, Horner syndrome, neck pain

A

Carotid artery dissection stroke- MRA or CTA

51
Q

recent hromone based tx to get preggo- what odyou need ot hin of

A

ovarian hyperstimualatin tx- DONT do a bimanual- can ruptue the ovary

abdominal, SOB, fatigue to hemoconcentration, liver failure, electrolyte derangements, coagulopathies, and renal failure, resulting in multiorgan system failure so the emergency physician should have a high index of suspicion in even a stable-appearing patient

volume- lytes- etc

52
Q

first step anal fissure tx in child?

A

miralax - if stoool witholding

53
Q

What s DRESS Or drug hypersentiivity syndrome? causes? tx

A

Basically flu like with GI, muscles after AEDs, Or Abx with a large mrobillofrm rash, eos
get a smear
fever, facial edema, skin tenderness, blistering, erythroderma, or mucositis - 2 weeks after Rx

Observe and supportive

54
Q

Three contraidictions to anticogaulaiton someone

A

neurosurgery 10 days ago
20 K plateles
bleeding

55
Q

Why do you not givr Wha tin R MI?

A

Nitro- dorps pre load even less getting to LV now

56
Q

5 causes of hypoxia?

A

VQ mismiatch: corrects with supplemnts O2- PNA, PE, COPD, Asthma
Shunt- Puss or blood in avolei-no O2 helps- shunts blood to diff part of lung
low FIO2 altitude
hypoventlation
Iterstitial lung dz

57
Q

eat fish, wheezing, ithcing, flushing 3o minutes later- what ifsh- Peppery taste

toothlessnes- ataxia- CNS- GI- Hypotension

A

scormboid or hsitmaine reaction
tuna, mackeral, mahi mahi

red snapper is ciguatera- BRADYCARDIA- HEat/Cold stuff. FLudis and atropine, maybe mannitol

58
Q

treatment for symptomaitc MVP

A

BB

59
Q

dispo phimosis

A

outpatient

no sugar- just topical steorids and follow up

60
Q

how to evlauate for wood foriegn body/

A

US

61
Q

TTP VS DIC

A

TTP- platelts problem. Vwf WITHOUT inhibtiory DAMST13. platelte plugs with end organ damage. thrombocytopenia, LDH, end organ damage, schisotcytes. GIve 2 units plasma. put in a line, bleeding is rare! go femoral.

DIC: secondary. too much thrombin. consumes factors to make bleeding, but in prothombotic state bc of thrombin, finbrinlysis also in play. D imer up, fibrinogen down, plates down, coags ups. No specific transfusion threshold, you CAN transfuse if bleeding or need procedure. give cryo 10 units if fibrinogen <150, transfuse if getting worse.

d Dimer is product of to fibrin vlots arc welded by factr 13 and fibrninlysis.
thrombin ceanes to make fibrin clot!

62
Q

What can you treat PEs like?

A

Pulm HTN! inhaled nitric oxide. dont intubate. no fluids.

catheter, vs surgercal, vs medicine clot removal.

go epi and then vasopressin

remember the RV is very suspeiclpte to hypotension and ishcemia- poor RV is a poor LV and CO- look for Interventricular flattening

63
Q

elecytlees that are off in sarcoid/

A

hypercalcemic, look at kidneys

ACE up

64
Q

Hemophilia A or B with superificallac and continuous ooze Tx?

A

Topical thrombin! or Txa

65
Q

which infectionis < 4.5 vag?

A

candida

66
Q

Tamiflu stuff

A

give to ppl <2 (high risk!) or >65. <5 is actually considered high risk too.
immunocompromised, pregnant
COPD, CHF, sicklers, Renal/liver disease
obese, DM2

best if under 48 hours, up to 5 days, maybe. N/V/D/headache SE. shortens duration by 17 hours

67
Q

knee dislocation

A
  • warm foot still may be possible and a palpable DP pulse still may be possible. X ray. Check 1/2 interspace never for common peroneal. consider CTA vs surgery
68
Q

NRP flow

A

gasping or <100 HR is MR SOPA, think Psitive pressure early (21% full term, 21-30% preemies)

HR 60-100 focus on airway and breathing stuff - think about PTX and hypovolemia. RR 40-60

if <60 CPR< intubate and epi

69
Q

lunate is…

A

spilled teacup!

periluante is captiate displacemet

70
Q

unstable thoracic aorta imaging…

A

TEE

71
Q

trauamtic iritis- homatroptoine or timolol?

A

homatrtopine, parlayes cilairy body

timolol stops aquesous flow

72
Q

Septic bursitis

A

needs OR I&D, IV abx, still needs arthrocentesis

73
Q

Bronchitis Dx and tx

A

cough, mucous, inflammation for 5 days-4 weeks usually after URI. fever none usually

symptomatic relief with expectorants, antihistamines, mucolytics, and antitussives such as dextromethorphan
prednisone if underying COPD

74
Q

Prolonged QT 5`

A
  1. Women @ 480 is high, 500 is severe
  2. Look for hypoK or HypoMg
  3. Think MI, drugs, lytes, congenital K channels
  4. BB tx
  5. risk for tachydysrhtimas
75
Q

formula for HypoG in kids

A

2Xage + 8= Kg

<1 yr is = 2-5 ml/kg D10
1-8= 2 ml/kg D25
8= 1 ml/kg D50

76
Q

Jefferson bit off a hangmans thimb

A

Jefferson, axial load- ant/post
Bilateral facets- jumped facets
odontoid- tip stable, base of tip and down unstable
Atlantoaxial dissocaiton - TP is very anterior on C spine X ray (flexion from Downs or RA)
hangman extension, posteroi
Thumb- tear drop with anteroir fx and retropulsion

77
Q

what is segund fx?

A

Lateral avulasion fx for ACL injury

78
Q

what is toddler fracture?

A

wont walk or put weight on it. Negative on X ray. immoblizie it (or a boot) and it will develpo over thenext several weeks. occult fracture from playing running around

79
Q

Open joint, CT or saline load?

A

CT is 100% sensistve on one study! you can do a lad if that is negative.
pull the fluid out after!
wash it out yourslelf before OR wash out

vanc and levaquine- but really doesn tneed ot be a big gun deal- ancef or gent if bad lac

80
Q

How to drain a paroncynia?

Felon?

A

Felon- volar- lateal and higher! or else insensate!

Dorsal is the same thign but dorsal! just poke it and reliev the rpessure

81
Q

Flash pulmonary edema

A

Sublingual nitro in the mean time!

1.25 mg of IV enalapril - or captoril cn abe helpful

becareful for Aoritc stenosis with high doses of NItor to drop thier afterload!

Nitro in the hsort term, high doses is notgoing ot hurt them! we underdose this, ust like high doses bezosare nto goign to hurt AWS.

Get lasix on baord quickly!

82
Q

Dissection earls

A

dont need ot be super HTN!

Sudden, severe, maximal, thoracic!! pain. or above an ebloew diaphragm.

pulse deficits/arotic murmur only 15%

Think about stemi and cath lab stuff and anticoagulant?

Stat CXR (20% normal), 
D Dimer + clinical tool = decent study and usabel to see if CTA needed
US: suprasternal with flap in your vessel

If there is anaphylaxis to contrast - intubate them and then CTA and then OR

Tx: consultant coagulaopthy based reversal, 50/50!
Check for tamponade.
control pain.

83
Q

Hyperammonia stuff

A

Ammonia in gut, metoblized in liver, excreted in kidney. If bad liver, Or TIPS, them excess glutamate.
give lactulose. no amount of ammonia is too high, use AMS as guide

84
Q

avulsed tooth care

A

<60 minutes = wash and remip,ant

>60 minutes= oral surgeon

85
Q

narrowst portion of peds ariway is…below the cords

A

ya

86
Q

Psudojones dx and tx vs jones

A

Jones is 1.5 cm distal, splint nad crusthces

pseduo- proximal, hard sole and wieght beraing as tolerated

87
Q

what is chillbains

A

cold exposire, red toes, burning toes, maybe from autoimmune stuff too. supprotive

88
Q

recent conolsocopy three weeks ago with bleeding

A

sloughing of the skin or coagluated eschar. can last weeks. just observe for nto dropping crit. be careful its not arterial

89
Q

What is Pals brady algorpthim

A

AMS, Hypotension, Shocky + HR <60 = all of the things

  1. 01 epi (or 0.1 mg/kg epi)
  2. 02 mg/kg atoprine
90
Q

when to treat for SBP

A

250 PMNs or

pH of < 7.34 (A) or a pH gradient between arterial blood and ascitic fluid > 0.10

91
Q

cocoaine and meth tachyc dysrhtymias tx

A

Benzos and cooling

then sodium bicarb! cocaine cna be sodium channel blocker

92
Q

how to detorse and blue dot

A

blue dot is torsion of apepndi

medial to lateral 360

93
Q

pre septal cellulilitis vs post septal dx tx and disp

A

peds usually pre septal. NO pain wth EOM! or eye involvement.
CT if bad exam. abx and 24 hour optho follow up.

94
Q

How can you kill someone with adneosine?

A

central access (use 3 mg)
little old lady with sinus tach
wide and irregular

95
Q

DKA pearl

A

if they arent getting better with tx, you are missing osmeh9itng! infection, OD, dissection.

If you give bicarb, you are going to wrosen both hypoK and osmlarlity

96
Q

tylenol and iburpofen dosing?

A

15 mg/kg 4-6 hrs

10 mg kg 6-8 hrs

97
Q

fever ddx peds to rule out if they look good?

A

pneumonia, urinary tract infection, Kawasaki disease, measles, respiratory syncytial virus, meningitis, bacteremia, cellulitis, and appendicitis +

98
Q

what is the wernicke encpealphythy?

A

ataxia
opethlamoplegia
enceplapthy

99
Q

DDx in sicklers- think head down

A 
Stroke
acute chest
sepsis
splenic sequestration
cholecystitis
aplastic crisis-anemia
acute pain crisis
osteonecoriss
Clot-Anywhere! renal infarct

CXR can be normal- get CT. Abx. exchange transfusion.

100
Q

cracked windpipe appraoch

A

fiberoptic scope to guid eyour intubation if necessary. Esopgus and other neck structures likely damaged. very deadly.

101
Q

Angio pelvis when? binder when?

A

negative fast and unstable! ex lap wotn find it

binder on in vertical not compression fx

102
Q

what are your mrsa risk factors? cellutlitis

A

dilaysis, recent hpsitlaiztion, hiv, puruluence, in a home.

if not, then think simpler with amociliin, augmentin or keflex

103
Q

what is alveolar ostetisi? complication of periapical apbscess/

A

Dry socket, post removal. pack it with iodoform gauze. inflammation of local ostemotlytietis

erdoesinto max sinus

104
Q

blepahrtiis tx

A

warm comrpess, possible eeyrhtmycin ointment

105
Q

how do you repair a bleeding fisutla site?

A

hand above and beloew it to tamponade
use a NON cutting needle, 5-0 prolene, the needle will make a smaller hole than the string to clog it up (taper needle and figure -8 it

106
Q

What is right heart train in EKG?

A

TWI in V1-V3

look for RAD too

107
Q

anytime you see a abbay iwth consitpation and drooling and poor feeding…

A

gotta think botulsim
fecal toxin
baby big
blocks acetlycholine at pre synapase

108
Q

how do you set up epi drip

A

1 bag NS to flushed in
1 bag NA w/ 1 mg epi is 1ug/1ml

start 1 ug per min and titrate up to effect

get either epi- if IM it can be hooked up to the bag. if not draw it up and needle it in

109
Q

poor feeding, lethargic, AMS in newborn…

A

think hypoglycemia!

110
Q

Pleurisy rule out DDx

A

PE, pericarditis, MI, PNA, pleural effusion, PTX///Rheum lupus- post infectious pleusiy

rule out bad and then NSAIDs Indomethicin to PCP

111
Q

Sicklers at risk for which infections

A 
Encapsulated, asplenic
Shine Skis Pasteruella
Strep strep
H flu
Neisseriea
E coli
Klebsiess
salmonella
112
Q

PEA think like this

A

Brady- wide= Sodium channel blocker OD or HyerpK
Sodimun bicarb or calcium

Narrow- PE, PTX, Tamponase

113
Q

superficial thrombophlebitis

A

Uncomplicated: venous segment involvement < 5 cm, being remote from the saphenofemoral or saphenopopliteal junctions, and lack of medical risk factors for hypercoagulability.

treatment for uncomplicated superficial thrombophlebitis includes NSAIDs, extremity elevation, and compression therapy

Rosh (14 decks)

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