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1
Q

Sail sign is associated with ____ in children and _____ in adults

A

Sail sign is most commonly associated with a supracondylar fracture in children and a radial head fracture in adults.

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2
Q

Risk factors for development of apnea in children with bronchiolitis

A
  • prematurity
  • age <2 months
  • underlying pulmonary and cardiac disease
  • hypoxemia at triage (<91% on room air)
  • dehydration.
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3
Q

Sepsis medication for neonates < 30 days

A

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.

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4
Q

Maximum dose of lidocaine with epinephrine

A

7 mg/kg

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5
Q

Maximum dose of lidocaine without epinephrine

A

5 mg/kg

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6
Q

What’s the bug?

RLQ abdominal pain
Watery diarrhea

A

Yersinia enterocolitica

From untreated water and pork
Treat with ciprofloxacin or TMP-SMX

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7
Q

What’s the bug?

Diarrhea
Gillian barre

A

Campylobacter

Undercooked poultry / unpasteurized milk
Treatment - azithromycin or ciprofloxacin

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8
Q

Pressor for neurogenic shock

A

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

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9
Q

Most common viral cause of diarrhea

A

Norwalk virus

Associated with cruise ships

Fluids / supportive care

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10
Q

Treatment of primary syphilis

A

Benzathine penicillin 2.4 million units IM

Doxycycline 100mg BID x 14 days if penicillin allergic

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11
Q

Treatment for anaphylaxis refractory to epinephrine

A

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

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12
Q

Treatment for aplastic crisis

A

RBC transfusion if hemoglobin <6

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13
Q

Mushroom with sympathomimetic symptoms

A

Amanita muscaria

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14
Q

Mushroom with cholinergic symptoms

A

Clitocybe, inocybe

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15
Q

Mushroom with hallucinations

A

Psilocybe

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16
Q

Mushroom with disulfiram like reaction with alcohol ingestion

A

Coprinus

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17
Q

Mushroom with delayed GI symptoms then seizures

A

Gyromitra

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18
Q

Mushroom with delayed GI symptoms followed by kidney failure

A

Cortinarius orellanus

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19
Q

Mushroom with delayed GI symptoms followed by hepatotoxicity

A

Amanita phalloides

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20
Q

Treatment of erysipelas

A

Elevation

Ceftriaxone / cefazolin or flucloxacilln if severe infections with systemic compromise

Penicillin VK, amoxicillin, cephalexin if mild

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21
Q

Recommended medication for blood pressure control associated with intracerebral hemorrhage

A

Nicardipine

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22
Q

Leading cause of epiglottis in adults

A

Streptococcus pneumoniae

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23
Q

Recommended antibiotic regimen for patient with suspected epiglottis

A

Ceftriaxone plus vancomycin

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24
Q

Cholinergic toxidrome symptoms

A

SLUDGE
Salivation
Lacrimation
Urination
Diarrhea
Gastrointestinal cramps
Emesis

Also have diaphoresis, meiosis, bradycardia, muscular fasciculations, paralysis, agitation, seizures, coma

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25
Q

Management of cholinergic toxidrome

A

Decontomination

Atropine - titrate to drying of bronchial secretions

Pralidoxime (2-PAM) is the definitive antidote

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26
Q

Calcium channel blocker toxicity symptoms

A

Bradycardia, hypotension, hyperglycemia (due to inhibition of calcium-mediated insulin release)

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27
Q

Treatment of calcium channel blocker toxicity

A

High dose insulin and glucose

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28
Q

Symptoms of digitalis toxicity

A

GI symptoms and cardiac toxicity

Slow a fib with high degree AV block or bidirectional ventricular tachycardia

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29
Q

Anticholinergic toxicity symptoms

A

Dry skin and mouth
Mydriasis
Tachycardia
Bronchoconstriction
Constipation
Urinary retention

30
Q

Treatment of anticholinergic toxicity

A

Physostigmine

31
Q

Triad for meniere disease

A

Episodic vertigo
Sensorineural hearing loss
Tinnitus

Treatment - low salt diet, diuretics (HCTZ + triamterene)

32
Q

Most common cause for bacterial tracheitis

A

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

33
Q

Treatment of acute closed-angle glaucoma

A

Topical timolol & acetazolamide

Also topical apraclonidine, topical prednisolone, mannitol, iridotomy

34
Q

Most reliable physical exam finding for bacterial conjunctivitis

A
35
Q

Symptoms of campylobacter enteritis

A

Diarrhea (often bloody)
Abdominal pain
Fever
Dysentery
Develop within 2-3 days after ingestion of contaminated food (undercooked poultry, contaminated beef / pork, raw milk)

36
Q

Treatment of campylobacter enteritis

A

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)

37
Q

Food poisoning cause after ingestion of fried rice

A

Bacillus cereus

38
Q

Late onset complications of campylobacter

A

Reactive arthritis

Guillain-Barre

39
Q

What antidysrhythmic medication is contraindicated in acute phase of myocarditis

A

Beta blockers

Can promote further inflammation and necrosis

40
Q

What is the preferred choice for treating patients with opioid withdrawal symptoms

A

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

41
Q

Preferred first line treatment for sympayhomimetic toxidrome

A

Benzodiazepines

42
Q

treatment of mastoiditis in children

A

Vancomycin 15 mg/kg

43
Q

Criteria for quick sequential organ failure assessment

A

GCS < 15
Systolic BP </= 100
Respiratory rate >/= 22

44
Q

Fracture of which carpal bone is associated with ulnar nerve injury

A

Hamate

45
Q

Electrolyte abnormality seen with pyloric stenosis

A

Hypochloremic hypokalemic metabolic alkalosis

46
Q

Name for non bacterial thrombotic endocarditis in patients with malignancy

A

Marantic endocarditis

47
Q

Medication given to infants presenting in shock to maintain patency of ductus arteriosus

A

Alprostadil

48
Q

Definition of abdominal compartment syndrome

A

Intra-abdominal pressures > 20 mm ahh with evidence of new organ dysfunction

49
Q

Medications to decrease aqueous humor production in patients with acute angle closure glaucoma

A

Topical beta blockers
Carbonic anhydrase inhibitors (eg acetazolamide)
Systemic osmotic agents (mannitol)

50
Q

Which pathogens cause diarrhea >/= 7 days after ingestion

A

Protozoal pathogens like cryptosporidium parvum

51
Q

How long should a scaphoid fracture be immobilized

A

6-12 weeks

52
Q

Treatment for cyanide toxicity

A

Hydroxocobalamin, sodium nitrite, and sodium thiosulfate

53
Q

Nausea medication that does not have effect on QTc interval

A

Tigan

54
Q

Person with AICD comes in with this EKG, weak, hypotensive. What do you do?

A

Electrical cardioversion

Person in unstable vtach

55
Q

Gold standard for diagnosing Giant cell / temporal arteritis

A

Temporal artery biopsy

56
Q

Indications for hyperbaric oxygen in carbon monoxide exposure

A

Level > 25% (or 15% if pregnant)
Loss of consciousness
PH < 7.1
End organ ischemia
ECG changes, chest pain, altered mental status
Syncope

57
Q

Pneumonia + Bird exposure

Disease and treatment

A

Psittacosis

Supportive care
Antibiotics - doxycycline, tetracycline, erythromycin, chloramphenicol

Associated with rare cancer - ocular adnexal lymphoma

58
Q

Anatomic site of central venous access with lowest risk of infection

A

Subclavian

59
Q

What is Brodie sign

A

black spot that shows up on the skin - signals beginning of very rapid propagation of necrosis and clinical deterioration

60
Q

Lachman test

How do you do it and what does it test for

A

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.

61
Q

What is a segued fracture

A

Avulsion of lateral tibial condyle - associated with ACL injury

62
Q

McMurray test

What does it test for and how do you do it

A

Meniscal tears

Patient supine, flex foot and extend the knee, internally and externally rotate tibia.
Clicking = positive test

63
Q

Thompson test

What does it test for and how do you do it

A

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

64
Q

Flexor digitorum superficialis function

A

Flexion at proximal interphalangeal joint

Innervation - median nerve

65
Q

Flexor digitorum profundus function

A

Flexion at the DIP joint
Helps with flexion at MCP

66
Q

How do you test motor and sensory function for median nerve

A

Motor - OK sign

Sensory - two point discrimination tip of index finger

67
Q

How do you test motor and sensory function for ulnar nerve

A

Motor - abduct index finger (scissors motion)

Sensory - two point discrimination over tip of 5th finger

68
Q

How do you test motor and sensory function for radial nerve

A

Motor - wrist and finger extension

Sensory - dorsal thumb / index finger web space

69
Q

4 elements that must be proved by plaintiff in medical malpractice case

A

Professional duty to the patient
Breach of this duty
Injury caused by the breach
Resultant damages

70
Q

Most common lab abnormality seen in people with ehrlichiosis

A

Leukopenia

EM (7 decks)

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