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Rapids Flashcards

1
Q

When do you/not remove a rust ring from an eye?

A

If overlying viusal field withvisual field defects (risk of scarring it, rust ring will soften over time)
if not, do it yourself and refer next day

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2
Q

Goodpasture vs Wegeners

A

GP (glomerular + Pulm), + antiglom Basement membrane Ab

Gran. polyangitis - Renal + pulm , ANCA

Churg strauss is eos. + asthma

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3
Q

acute headahce, bitemproal hemionspia, sellar hyperdensity

A

pituitary apoplexy (hemorrhage)>steroids and NSGY

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4
Q

Sudden headache, diplopia add to ddx

A

Pituitary apoplexy - microademona bleed into sella

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5
Q

bird/pet owner pna, sepsis

A

Psticcio - Doxycycline

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6
Q

Cardiac risk facotrs with vision loss

A

CRAO_ complete loss
CRVO- blurred and worse vision more vague

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7
Q

4 options cocaine induce chest pain

A

Phentolamine
Nitro
Benzos (and colling only affect mortality!)
CCB

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8
Q

on a mountain with progressive ataxia and AMS… DX and tx

A

HACE
Steroids, descent, oxygen, hyerbarics
HAPE - CCB

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9
Q

HUS triad and treatment

A

Renal, schitocytes, anemia, thrombocytopenia
Supportive

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10
Q

kid, red urine, edema, HTN…

A

PSGN (impetigo amd throat)
ABX, diruectis/antihypertenisves if needed, diaysis if needed

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11
Q

dress

A

Stop drug and high dose sterois
Rash, LFTs, eos,

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12
Q

Myocarditis- what is seen on US

A

diffuse hypokinesis, wall motion abnormlaities
clinically looks like tamponade and CHF in young person
supportive

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13
Q

Painful red spots on legs in vascular distbituion … think

A

pancreatic cancer - superficial thrombophlebitis

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14
Q

old person, pallor, ataxia, weakness, sore tongue-

A

pernicious anemia - or vit b12 deficinecy bc of autoimmune anema

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15
Q

Cullen sign
grey turner sign

A

Periumblivcal ecchymosis (from duodenum)
Flank ecchymosis

Think RP bleed

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16
Q

CO why do you treat
What time intervals do you need to remember?

A

To delay post neuro deficits down road
Time 90 minutes to oxygen it was out
30 mins hyperbarics

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17
Q

CN tx and co poison to think

A

Not sodium nitrite anymore!
Sodium thiosulfate
B12 or HYDPXYCPBALAMIN OR IV B12

CO

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18
Q

19% Carboxy, GCS 13, Stable vitals- Tx of CO poison?

A

NRB + HYPERBARICS
EKG changes, AMS, >25 (15) %, , ph 7.1, organ damage, LOC hx

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19
Q

Recent MI, New Pulseless leg- why

A

Poor cardiac motion leading to mural thrombus in LV

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20
Q

Hypercalcemia over 14
Polyuria polydipsia ams

A

Hypok hypo mg with it
I’ve fluids and bisphos
MC cause of HuperCa is hospitalized patients is cancer- lung breast and MM

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21
Q

Hypervigilance, irritable, angry

A

PTSD
Even if for secondary gain

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22
Q

Asthma patient, altered, oxygen 90 at NRB and duonebs- bipap or intubate

A

Boards is intubate
Bipap by definition cannot have AMS

Reasons to intubate asthmatic:
Altered
Cardiac arrest
Bradypnea
Physical exhaustion

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23
Q

MAP calculation

A

SBP + 2* DBP /3

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24
Q

Painful, Nikolsky rash, middle aged,
Tx and MC association?

A

Steroids
Myasthenia graves
Pemphogus vulgaris

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25
Q

Reversal agents for
Dabugatran
Xabans
Warfarin
Heparin

A

Idracuimab- backup PCC, back up hemodialysis
Andexant alpha- backup PCC
Vitamin K and PCC!
Protamine

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26
Q

Black widow spider bite tx for severe contractions

A

Benzos

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27
Q

Gono and chalmydia are difficult to culture

A

So uti that won’t go away or STD stuff think of that

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28
Q

ethylene glycol keys

A

Hypocalcemiq, long QT
Foemizole
Hemodialysis if there is acidosis or 50+ level
Gap Gap
Thiamine and b6!

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29
Q

Methanol keys

A

Seeing a snow storm vision
Foneizole or hemodialysis if gap or 50+
Gap gap
Bicarb
Folate

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30
Q

Isopropyl

A

Only osmol gap!!
Supportive care only!

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31
Q

infant, cough, eosinophils, patchy infiltrates, quick/interrupted cough, no fever

A

Chalmydia PNA - Azithro

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32
Q

PACEMAKERS
Failure to capture
Failure to Pace or Oversensing
Failure to Sense

A

Capture:appropriate spike, not strong enough to cause QRS
Pace: too much signa from body
Sense: Spike too close behind QRS (+/- depolarization)

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33
Q

Bat found in room of 6 yr old kid, no bite marks, DC or treat?

A

Treat
Ig and then Vaccine series

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34
Q

barky cough but toxic appearing kid

A

bacterial trach

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35
Q

headcahe, maialse, other ppl with same sympromsin house- test for CO or give oxygen if not hypoxic

A

give oxygen

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36
Q

PID pearls

A

Previous STD biggest risk factor (not recent birth or iud)
IUD doesn’t need to come out immediately

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37
Q

Open fractures
1
2
3

A

All get cefazolin- stage 3 gets gentamicin
<1 cm
1-10 moderately contaminated
>10 cm

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38
Q

SCC MC of Acute chest

A

Is leading cause mortality Acute chest
Mycoplasma and atypicals

Remember they do have risk for encapsulated organisms tho (used to be strep pneumonia)

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39
Q

Encapsulated organisms
Some nasty killers contain caps PS

A

Strep pneumonia
Neiserria
Klebsiella
Pseumonas
Capnocytophahia (dog bite)
Cryptoscoccus
Salmonella typhus

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40
Q

Dka hhs pearls

A

Remember to half you insulin and add Dexteose when bellow 300 ish
4.5 ish cut off for potassium
Hypoglycemia biggest risk bc of management

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41
Q

NMS and SS

A

NMS is benzos and dantrolene and bromide. Antipsychotics over days
SS is cyprohep. Over hours, opioids, ssri, lithium, maoi, linesolid

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42
Q

Meningitis ppx
Neisseri not streptococcus!

A

Health care workers if no Ppe or intubation
Rifmapin 600 bid two days
Cftx for preggos
Household, daycare, travel partners for 8 hours
Close contacts

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43
Q

LVAD

A

MC pump failure/ no hum- thrombosis- high flow alarm

MC complication: bleeding and GI bleed

Doppler BP 60-90 MAP, too high is bad for pump too

If asystplic- CPR still!

MC hypotension and LVAD failure= Suction event: preload dependent and give fluids
Infection MC in drive line

Dysthymia’s and battery failure

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44
Q

Do you go grab a razor blade past the pylorus?

A

No

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45
Q

Swallowed FB pearls and urgent endoscopy

A

Proximal to the pylorus (not if not tender, looking fine, eating)
Sharp
2x6
Button batteries

Adults is LES
Kids C6

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46
Q

Shingles

A

Ramsay hunt= needs steroids
Eye needs IV meds and admission
MC complication- post hepretocnneurlagia

No IC, preggos or kids near
Them but no airborne precautions

Treat if <72 hours or if past that and new lesions

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47
Q

AUB Tx

A

Stable:
1. Oral TXA 1 g Q8
2. OCPs
3. Progestin only if hx or high risk for clots

Unstable:
1. PRBCs
2. 25 mg q4 IV estrogen

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48
Q

MC for AAA expansion and rupture

A
  1. Smoking
  2. Size

Stable no symptoms and low is US outpatient
Stable and symptoms is CT
Unstable and symptoms is surgeon and stabilize

Anything over 5 and symptoms is admit

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49
Q

2 indications in ED to start a DOAC -bans

A

PE or Dvt
New onset non valvular A fib

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50
Q

When to give crofab? and earls

A

same dose in kids as in adults
only give in severe cases - systemic symptoms or symptoms more than 50 cm form the site

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51
Q

onyl facial fx reuqiring abx?

A

maxillary sinus fx
the rest if closed dont need them

52
Q

Rember MCA is weakness and dysahgia
ACA is…

A

Sensory and motor

53
Q

Whooping cough Complications

A

Ppx for hosuehold members
apnea in infants
Pneumothroax, neumomediastinum, too much coughing

54
Q

when to give immunefab or antivenin in black widow spider bite?

A

Preggos, elderly, kids
give supportive care and fluids, benxos, nto calcium glcuonate

55
Q

what to give in borwn recule bites if serious?

A

dapsone

56
Q

MC fever from travlling pearls

A

tylenol and supportive
NOT NSAIDS (for their antcogaltuion) they can go into hemorrhagic shock
dont fluid overload them from vasvular leaks

57
Q

Primary blast injuries MC sites

A

TM
Lung
Abd

2:shrapnel
3: being thrown
4:burns

58
Q

First spot to go in FAST

A

Subxiphoid

FAST is higher spec then sensitivity

59
Q

Pericarditis someone to admit

A

FEVER
older age, ummunsuppressed, elevated trop too

60
Q

hypothyrid lab abnormality

A

Hypercholesterolemia!
hypoNA
hypercapnia

61
Q

HUS tx
renal, plts, anemia
SOB several weeks after illness

A

supportive
HypoNa
HypoCa
MC acute kidney ijnury requiring trnaplant!

62
Q

Occult trauma in preggo - they look fine

A

Stable- Tocomonitoring
Unstable- CT scan
Most concern for placental abruption

63
Q

Travelers diarrhea Tx

A

Supportive
If severe: bloody, fever, or dehyrdation = 750 ciprofloxicin, 2nd line is Azithro (kids) (or India/thailand)

64
Q

TCA OD tx

A

Sodium bicarb
(lidocaine and oehnyotin can be used)

65
Q

drowning

A

Time in water is the worst, nto time to CPR
under 5, AA, males
no Abx ppx
Recue breaths first

66
Q

Hypehmas

A

Sicklers: Avoid Nsaids and acetazolamide - needs optho(for sickerls)
give timolol

67
Q

Hep B exposure

A

If unvaccinated and source is + its Ig and vaccine then

if vaccinated or patient is Hep B S ag is = do nothing

68
Q

Pediatric PNA

A

5-16 yrs = Azithro
recent influenza= staph
under 5 is Amoxicillin

69
Q

Mountain sickness

A

Mild:Desecend acetazmide and dex
Severe: add hyperbarics

HAPE= add CCB (prevent and treat) and oxygen

70
Q

HOCM EKG

A

Deep Q waves
or
GIant TWI (but Deeo TWI can be wellens)

71
Q

MOtrin OD

A

CO ingestion awlays test for it
100 mg/kg is mild
300 is severe
supportive

72
Q

IO labs you cant trust
IO pearls

A

WBC, Plts, Na, K, Ca, LFTs, blood oxygen level
Peds= tibia and femur
You can infuse ANY drug thru them

Contraindications: fx, prox fx, overlying cellulitis, prev failed attempt at that site

73
Q

HIV diarrhea tx

A

HARRT therpay and fluids

74
Q

Factory fire, seizures> Tx

A

Hydorxycobalmine
then Sodium thosulfate for SN toxicity

75
Q

PID

A

MC is chlamydia
prev PID, contraception use, young
dont need to remove IUD if infected (they dont inrease risk)
dont need diagnotsics to confirm
perihepatitis- Fitx Hugh is capsule not stormal so no LFTs elevated

76
Q

Meckels

A

2 tyes of tissues + gastric
2x2 cm
painless and resloves spontabeous
MC complication is intuss and obstruction
t-99 scan
2 ft rpoixmal to IC valve
50% by age of 2

77
Q

HIV PNA

A

Unheard of in USA but MC is bllod transfuion then Anal intercourse

78
Q

Dehydration, AMSolyruia, polydipsia still gotta think

A

Hypercalcemia!
MC in malginancy (breast, non small Lung, MM)
14 is severe= IV bisphosphs and fluids
Loops are not main stay therpay
HypoK and HypoMg with it!

79
Q

Fludis or insulin in HHS?

A

Flduis
insulin is more for ketoacids

80
Q

Pelvic Fxs

A

Unstable and neg FAST= angiography
Unstable and + FAST= OR - its not chase plevic fx then
Venous bleeding is more MC

81
Q

Ectopics MC and MOst trongly associated risk factor

A

MC is PID
Stronger= recent hx of ectopics
90% is fallopian tube
pregnancy + IUD= more likely ectopic

82
Q

PPH pearls

A

MC is uterine atony
1: Manual + oxytocin
If unstable 1st step is MTP
Tears are second, then PLacental retention

83
Q

White Phosphorus treatment?

A

GEt a woods lamp to see whats left
TONS of water
It ignites with AIR - slow an dinsidious burn
Transfer to burn center
electrolyte abnromality
from fireworks

84
Q

HTN 230s, sounds like a Dissection- next step- CTA or BP meds

A

BP meds - CP could be from HTN

20-25% down in 1 hour if encephaolpathc

85
Q

Pancreatitis

A

needs 3x upper limit liapse
If lipase and N/V = no CT needed (evidence based)
lots of fluids, NPO, no Abx

86
Q

Dont give EKtamine to…

A

Schizophrenics

87
Q

Skin + GI =

A

epi

88
Q

Kawasaki pearls

A

MC in kids in Under 5
Mucocutaneous LN syndrome
Fever, Mouth, LN, Rash, Edema to hands of feet, desquamation

89
Q

Fastest way to redcue temp in hyperthemia

A

Is Submersion!
but then Convection cooling with water and air

90
Q

Thoractomomy

A

Never: found dead in field, conconmint terrible head injnury, down for longer than 15 mins - NO surgeon is not availble within 30 mins (abd diminshes chances

Indications: Blunt truama that loses ulses in fornt of you- penetrating throacic, pulses less than 15 mines

91
Q

GSW to abd, stable vitals, + FAST- next step

A

CT
Unstable is OR

92
Q

Osteomyelitis in kids MC bugs and neonateal bug
Heme spreading

A

Kids is staph (get x ray)
Neonates is GBS

93
Q

Painful, dark vaginal bleeding in Preggos- what lab test and what next

A

Fibrinogen <200
Monitoring toco

94
Q

Dystonia:
Akasthesia:
Tardive:

A

Acute facial, tongue trunk spasm

Restless

Later onset of lip smacking and facial/trunk stuff

95
Q

Reducing hernia perlas

A

Trend.
Proximal pressure first! Not distal
Pain meds is the biggest!

96
Q

BB overdose tx

A

Glucagon and High Dose insulin

97
Q

Hypercalcemia ekg finding

A

Shortened QT
Bradycardia
Osborn!
Flattened wide t waves

98
Q

Mc meningitis

A

Strep pneumonia for everyone except kids GBS 1-3 months

Listeria and Neisseria still not as common

99
Q

Tension Pneumo

A

Late is trachea and BP

100
Q

MC bug in kids and adults

A

GBS
Step penumo (even older adults is more than listeria and Nesiseria for young adults)

101
Q

HIV infections pearls

A

PCP: MC infection in HIV, Bactrim (+dex if hypoxic)

Interstial edema is CMV pneumo
Mult pulm nodules is cryptococcus

102
Q

HF acid

A

Hypocalcemia, Hypo Mg, QTc torsaded
Topical calcium gel
decon

103
Q

HyperKalemia EKG

A

remeber ST segment can be altered!
and PR interval is elongated. PR is PRolonged
QT shortened

104
Q

Hypercalcemia EKG

A

Osborns
Bradycardia
Short QT!

105
Q

Traumatic Aortic Injury

A

Treat as if a regular Traumatic injury, if high BP then lower it.
they have upper extremity HTN usually
Descending aorta just distal to subclavian artery is the MC site

106
Q

Transfusions

A

febrile non hemolytic reaction is MC reaction, cytokines
TRALI= ARDS, supportive
TACO= SCAPE, NIPV, diuretics etc - fluird overlodad
High mortlaity for the both of them

107
Q

Hyphema managament , IOP 27> Tx

A

Timolol!! first, eye shield and head of bed
>50% or sicklers are admit or re-bleeds
cycloplegics only if no open globe

Avoid -zloamides and NSAIDS in sicklers

108
Q

Sick kid with concern fo rintuss- next step?

A

KUB

109
Q

GBS pearls

A

MC flccid paralysis in kids
sensation lost is NOT hallmark
up to 30% need a tube,

110
Q

Compartment syndrome MC compartment

A

Anterior - Deep peroneal nerve, toe web space
Deep posterior is MC missed, post tibial nerve
Pain out of prortion and pain with passive stretch first!

sural- sup post
laterl- sup peroneal

111
Q

Lightning strikes

A

AC - worst, outlets, V fib
DC- less ocmplications, aystole, BEtter outcomes!
Path of least of resistance, Nerve then most is fat and bone
paralysis and conservative treatment
fern - nothing to do

112
Q

Cocaine
HTN
Arrythmia

A

HTN or CP= Benzos
VT or arrythmia= Sodium Bicarb (narrows the QRS) NOT procainamide!

They are high risk for MI (31X), need a trop! dont discharge without it even if young patient

crack lung is pulm edema, hypoxia induced cocaine

113
Q

excited delirum

A

Cant leave AMA, try verbal de-escalation
Benzos first, ketamine second
Haldol would LOWER seizure threshold and slower acting!
SO HIGH
Silly, OD, HyperTSH, Infection, GLucose, HEad trauma!!!!

114
Q

NMS vs SS

A

NMS haldol, rgidity, CK/LFTs, hyPO reflexia
SS clonus, hyeprfelxia, some rigdity

115
Q

Ectopic Pregnancy

A

Biggest risk: prev ectopic
Previous STDs and scarring is MC risk
smoking and age also increases risk
IUD doesnt increase risk, but if they are pregnant with it in there is more of a chance to be ectopic
Vaginal bleeding MC sypmtom

116
Q

Priapsim Tx cascase

A

Aspirate
Cold saline
then phenylephine \

117
Q

Risk factors for SAH

A
  1. Smoking greatest risk facorts for rupture
  2. HTN
  3. Family Hx
118
Q

CCB OD

A

Fluids, Levo and high dose Insulin (1 unit/kg, 1 unit per kg hour after) to support myocardium with energy
NOT glucagon, not calcium (you can give it a shot if you want)
Lipid Emulsoin on th test

WBI is correct if Sustained release!
Glucose is not the tell- all, BB is hypO and CCB is Hyper

119
Q

Head ache and neck pain add to DDx

A

Intracranial dissection or vert dissection
bigger risk of thromboembolism
Horner syndorm ein a qurter of them, pulsatile tinnitus or storke stuff

120
Q

GCA pearls

A

Cant diagnose it in ED (biopsy) so treat if suspected with high dose steroids
Vision loss is not reversibel and it can occur in the other eye

121
Q

Lymes Tx
1. PPx
2. Dosing
3. Preggos
4. general

A
  1. 24 hrs or engorement of tick
  2. 1x dose of 200 Doxy
  3. Amox TID for 14 days
  4. if erythema migrans is 200 mg QD 14 days
  5. meningits for CFTX
122
Q

Trach bleeding steps

A
  1. apply rpesure posterily at stenral notch
  2. overilnate cuff with up to 50 ml air
  3. secure airway
  4. digital comrpession
123
Q

Kidney stones

A

heamturia present ealry on
Cnt rely on CVA tendernss
Fluids dont help, clacium restriction doesnt help

124
Q

Recent sinusitis in a kid with new ataxia, FND, no signs of meningitis…

A

Brain empyema
CT head

125
Q

If puncture wound with water add what ABx?
If puncture wound with salt water add what?

A

Fluro
Doxy

126
Q

what is shcok index

A

HR/SBP

> 0.7

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