Random Flashcards
Sail sign is associated with ____ in children and _____ in adults
Sail sign is most commonly associated with a supracondylar fracture in children and a radial head fracture in adults.
Risk factors for development of apnea in children with bronchiolitis
- prematurity
- age <2 months
- underlying pulmonary and cardiac disease
- hypoxemia at triage (<91% on room air)
- dehydration.
Sepsis medication for neonates < 30 days
Gentamicin & Ampicillin
Neonates <30 days old are at increased risk for Listeria monocytogenes, so require ampicillin, which has excellent CNS penetration and a strong sensitivity profile. An additional CNS-penetrating broad-spectrum antibiotic is further required for other potential bacterial meningitis causes such as S. agalactiae and E. coli. The 3rd-generation cephalosporin cefotaxime or an aminoglycoside such as gentamicin is recommended.
Maximum dose of lidocaine with epinephrine
7 mg/kg
Maximum dose of lidocaine without epinephrine
5 mg/kg
What’s the bug?
RLQ abdominal pain
Watery diarrhea
Yersinia enterocolitica
From untreated water and pork
Treat with ciprofloxacin or TMP-SMX
What’s the bug?
Diarrhea
Gillian barre
Campylobacter
Undercooked poultry / unpasteurized milk
Treatment - azithromycin or ciprofloxacin
Pressor for neurogenic shock
Norepinephrine
Has both alpha (vasoconstriction) and beta (helps treat the bradycardia from unopposed vagal tone) properties
Start at 0.1 mg/kg/min
Titrate for MAP 85-90
Most common viral cause of diarrhea
Norwalk virus
Associated with cruise ships
Fluids / supportive care
Treatment of primary syphilis
Benzathine penicillin 2.4 million units IM
Doxycycline 100mg BID x 14 days if penicillin allergic
Treatment for anaphylaxis refractory to epinephrine
Glucagon
Produces inotropic and chronitropic effects not mediated by beta receptors
Repeat this and epinephrine every 5-10 minutes and can then do IV infusions
Treatment for aplastic crisis
RBC transfusion if hemoglobin <6
Mushroom with sympathomimetic symptoms
Amanita muscaria
Mushroom with cholinergic symptoms
Clitocybe, inocybe
Mushroom with hallucinations
Psilocybe
Mushroom with disulfiram like reaction with alcohol ingestion
Coprinus
Mushroom with delayed GI symptoms then seizures
Gyromitra
Mushroom with delayed GI symptoms followed by kidney failure
Cortinarius orellanus
Mushroom with delayed GI symptoms followed by hepatotoxicity
Amanita phalloides
Treatment of erysipelas
Elevation
Ceftriaxone / cefazolin or flucloxacilln if severe infections with systemic compromise
Penicillin VK, amoxicillin, cephalexin if mild
Recommended medication for blood pressure control associated with intracerebral hemorrhage
Nicardipine
Leading cause of epiglottis in adults
Streptococcus pneumoniae
Recommended antibiotic regimen for patient with suspected epiglottis
Ceftriaxone plus vancomycin
Cholinergic toxidrome symptoms
SLUDGE
Salivation
Lacrimation
Urination
Diarrhea
Gastrointestinal cramps
Emesis
Also have diaphoresis, meiosis, bradycardia, muscular fasciculations, paralysis, agitation, seizures, coma
Management of cholinergic toxidrome
Decontomination
Atropine - titrate to drying of bronchial secretions
Pralidoxime (2-PAM) is the definitive antidote
Calcium channel blocker toxicity symptoms
Bradycardia, hypotension, hyperglycemia (due to inhibition of calcium-mediated insulin release)
Treatment of calcium channel blocker toxicity
High dose insulin and glucose
Symptoms of digitalis toxicity
GI symptoms and cardiac toxicity
Slow a fib with high degree AV block or bidirectional ventricular tachycardia
Anticholinergic toxicity symptoms
Dry skin and mouth
Mydriasis
Tachycardia
Bronchoconstriction
Constipation
Urinary retention
Treatment of anticholinergic toxicity
Physostigmine
Triad for meniere disease
Episodic vertigo
Sensorineural hearing loss
Tinnitus
Treatment - low salt diet, diuretics (HCTZ + triamterene)
Most common cause for bacterial tracheitis
Staphylococcus aureus
Looks like croup but sicker
Kids often get after croup, but influenza A is most common associated viral infection
Steeple sign on X-ray (subglottic narrowing)
Treatment - airway management in the OR, broad spectrum antibiotics, IV fluids, bronchoscopy
Treatment of acute closed-angle glaucoma
Topical timolol & acetazolamide
Also topical apraclonidine, topical prednisolone, mannitol, iridotomy
Most reliable physical exam finding for bacterial conjunctivitis
Symptoms of campylobacter enteritis
Diarrhea (often bloody)
Abdominal pain
Fever
Dysentery
Develop within 2-3 days after ingestion of contaminated food (undercooked poultry, contaminated beef / pork, raw milk)
Treatment of campylobacter enteritis
Supportive (fluids)
Antibiotics (fluoroquinolone, azithromycin) only in severe disease - (high fever, significant bloody stools, symptoms > 1 week) or in people at risk of severe disease (pregnant, immunocompromised, older)
Food poisoning cause after ingestion of fried rice
Bacillus cereus
Late onset complications of campylobacter
Reactive arthritis
Guillain-Barre
What antidysrhythmic medication is contraindicated in acute phase of myocarditis
Beta blockers
Can promote further inflammation and necrosis
What is the preferred choice for treating patients with opioid withdrawal symptoms
Buprenorphine
Partial opioid agonist and weak antagonist
Typically give 8mg sublingual for acute withdrawal
Can be initiated as maintenance therapy
Historically alpha 2 agonists (eg clonidine) were used
Benzos can also be used
Preferred first line treatment for sympayhomimetic toxidrome
Benzodiazepines
treatment of mastoiditis in children
Vancomycin 15 mg/kg
Criteria for quick sequential organ failure assessment
GCS < 15
Systolic BP </= 100
Respiratory rate >/= 22
Fracture of which carpal bone is associated with ulnar nerve injury
Hamate
Electrolyte abnormality seen with pyloric stenosis
Hypochloremic hypokalemic metabolic alkalosis
Name for non bacterial thrombotic endocarditis in patients with malignancy
Marantic endocarditis
Medication given to infants presenting in shock to maintain patency of ductus arteriosus
Alprostadil
Definition of abdominal compartment syndrome
Intra-abdominal pressures > 20 mm ahh with evidence of new organ dysfunction
Medications to decrease aqueous humor production in patients with acute angle closure glaucoma
Topical beta blockers
Carbonic anhydrase inhibitors (eg acetazolamide)
Systemic osmotic agents (mannitol)
Which pathogens cause diarrhea >/= 7 days after ingestion
Protozoal pathogens like cryptosporidium parvum
How long should a scaphoid fracture be immobilized
6-12 weeks
Treatment for cyanide toxicity
Hydroxocobalamin, sodium nitrite, and sodium thiosulfate
Nausea medication that does not have effect on QTc interval
Tigan
Person with AICD comes in with this EKG, weak, hypotensive. What do you do?
Electrical cardioversion
Person in unstable vtach
Gold standard for diagnosing Giant cell / temporal arteritis
Temporal artery biopsy
Indications for hyperbaric oxygen in carbon monoxide exposure
Level > 25% (or 15% if pregnant)
Loss of consciousness
PH < 7.1
End organ ischemia
ECG changes, chest pain, altered mental status
Syncope
Pneumonia + Bird exposure
Disease and treatment
Psittacosis
Supportive care
Antibiotics - doxycycline, tetracycline, erythromycin, chloramphenicol
Associated with rare cancer - ocular adnexal lymphoma
Anatomic site of central venous access with lowest risk of infection
Subclavian
What is Brodie sign
black spot that shows up on the skin - signals beginning of very rapid propagation of necrosis and clinical deterioration
Lachman test
How do you do it and what does it test for
Most sensitive test (98%) for ACL tear
Knee in 20-30% flexion. One hand on tibia with thumb on tibial tuberosity. One hand on thigh. Pull tibia anteriorly. Positive test have soft end point.
What is a segued fracture
Avulsion of lateral tibial condyle - associated with ACL injury
McMurray test
What does it test for and how do you do it
Meniscal tears
Patient supine, flex foot and extend the knee, internally and externally rotate tibia.
Clicking = positive test
Thompson test
What does it test for and how do you do it
Evaluate integrity of achilles tendon
Patient prone, squeeze the calf. Plantar flexion of ankle joint is normal, if ankle doesn’t flex then achilles injury
Flexor digitorum superficialis function
Flexion at proximal interphalangeal joint
Innervation - median nerve
Flexor digitorum profundus function
Flexion at the DIP joint
Helps with flexion at MCP
How do you test motor and sensory function for median nerve
Motor - OK sign
Sensory - two point discrimination tip of index finger
How do you test motor and sensory function for ulnar nerve
Motor - abduct index finger (scissors motion)
Sensory - two point discrimination over tip of 5th finger
How do you test motor and sensory function for radial nerve
Motor - wrist and finger extension
Sensory - dorsal thumb / index finger web space
4 elements that must be proved by plaintiff in medical malpractice case
Professional duty to the patient
Breach of this duty
Injury caused by the breach
Resultant damages
Most common lab abnormality seen in people with ehrlichiosis
Leukopenia
Ketosis without acidosis
Isopropyl alcohol ingestion
