Review Cards Flashcards
Chest Utz findings most sensitive for pneumothorax
Absence of Comet Tail and Sliding Sign
Agent Contraindicated in Isopropanol Toxicity?
Fomepizole
Treatment for Carbon Monoxide Poisoning
100% inspire 02, HBOT, Methemoglobinemia, Methylene Blue
Most Common consideration in patients presenting with sterile pyuria?
C. Trachomatis Infection
Most common pulmonary fungal infection worldwide?
H. CAPSULATUM
Treatment of Benzodiazepine toxicity
Flumanezil 0.2mg IV max of 3mg in adult 0.01 to 0.02 mg/kg in pedia
A finding in chest radiograph that is dome shaped, dense opacification and is indicative of Pulmonary Embolism?
Hamptom Hump
Most sensitive indicator of adequate cardiopulmonary resuscitation in infants?
Increased Heart Rate
Thunderclap headache is associated with?
Intracerebral.aneurysmal Leak
Otogenic Brain abscess found in the temporal lobe or cerebellum are primarily cause by?
Bacteriodes
Fever, adenopathy, neurpathies (unilateral or bilateral facial never palsy),cardiac abnormalities, arthritis, and multiple annular/ target shaped skin lesion?
Lyme disease- earlt disseminated disease
Gold Standard imaging study for the diagnosis of bladder injury?
Retrograde Cystrogram
Downward vertical nystagmus is pathognomonic of what condition? What is the treatment?
Anterior Canal BPPV Treated: Deep Head Hanging Maneuver
The Gold standard for investigating penetrating neck injury?
Angiography
The Gold standard for non invasive imaging for abdominal injury?
Abdominopelvic CT with IV Contrast
Drug of choice for severe malaria?
IV artesunate
A strong H3 and H1 antagonist that increases cochlear blood flow and decrease peripheral vestibular inputs?
Betahistine
Treatment for cysticercosis
Albendazole and praziquantel
Most common cause of acute food poisoning in the US?
C. Perfringens
Triad of flashes, floaters and field deficits?
Retinal Detachment
Triad of fever, centripetal rash and tick bite?
Rocky Mountain Spotted Fever
Treatment for rodenticides ingesion?
If INR >2, start oral Vit K 20mg/d in adults (1-5 mg for children) up to 10 months
Most common cardiac rhythm in Pulmonary Embolism?
Normal SInus rhythm
Oral Medications causing severe esophageal irritation?
Potassium chloride Tetracycline Doxycycline Aspirin
Blast injury sustained as a result of being thrown from the blast site or structural collapse?
Tertiary Injuries
Treatment for Acute Chest Syndrome?
IV Fluids, O2, antibiotics and analgesics
Causes of genital herpes and resides in the sacral ganglia?
HSV-2
Chest pain, fever, and pleural/pericardial effusions 2-4 weeks after cardiac trauma (or surgery)
Pericardial Inflammation Syndrome
Congenital Long QT Syndromes May be associated with?
Deafness (Jervell-Lange- Nielsen Syndrome)
Most common type of sporotrichosis
Lymphocutaneous Type
Fracture of both pedicles of C2 with anterior displacement of C2 and C3
Hangman’s Fracture/ Traumatic Spondylisthesis
A common cause of stridor in children >6 months
Croup
Route of Exposure that poses the highest risk of transmission for bloodborne disease
Percutaneous exposure
Triad of jaundice, black, emesis, albuminuria
Yellow Fever
Most Common cause of non compressive focal neuropathy
Diabetic Peripheral Neuropathy
Most commmon symptom of blunt cardiac trauma?
Chest pain
Treatment for Idiopathic intracranial hypertension?
Oral acetazolamide
Eosinophilic intracellular lesions found within the cerebral neurons that is pathognomonic for rabies?
Negri bodies
Common cause of Hypomagnesemia in the ED?
Alcoholism
Causes the symptoms seen in scromboid fish poisoning?
Histidine to Histamine
A condition associated with increase endolymph within the cochlea and labyrinth?
Meniere’s Syndrome
What is the target arterial BP for patients who are candidates fro rTPA therapy?
SBP < or = 185 mmHg and DBP of < or = 110 mmHg
Presence of this reflex rules out testicular torsion
Cremasteric Reflex
Most common central cause of vertigo
Vestibular Migraine
Gold Standard for the diagnosis of Blunt cerebral vascular injury of the neck?
Digital Subtraction angiography
Most common tumor of the third ventricle?
Third Vertical Colloid Cysts
Most frequently injured abdominal organ
Liver
Most common affected structure in Thoracic Outlet Syndrome
Ulnar Nerve
What Iron Formulation has the most Ionic Iron Formulation?
Ferrous Fumarate
This agent cause pharmacobezoars in abdominal Radiographs?
Chloral Hydrate
Cranial Nerve involve with herpes zoster infection? (Shingles)
CN 7
Millian Ear Sign is diagnostic of?
Erysipelas
Vertical upward and rotatory nystagmus and a positive Dix-Hallpike test is diagnostic of___?
BPPV
Most sensitive clinical finding for placental abruption after trauma?
Uterine irritability
It is classically described as contralateral homonymous hemianopsia and unilateral cortical blindness
Basilar Artery Occlusion
Contraindicated agent in cardiac ischemia caused by Cocaine/ Methamphetamine toxicity?
B-blockers
Most common aortic blunt injury?
Proximal descending aorta
Treatment of opoid overdose
Naloxone 0.1-0.4 mg IV, SC, IM (adult) or 0.1mg/kg (pedia)
Most serious ocular oppurtunistic infection and is the leading cause of blindness in AIDS patients?
Cytomegalovirus retinitis
Treatment of Iron Toxicity
Deferoxamine
Type III Skin abscess is caused by?
Vibrio Vulnificus
Treatment for Beta blocker toxicity
Glucagon 3-10 mg IV Bolus
Standard fronline agent for Trigeminal Neuralgia
Carbamazepine
Most common artery involved in stroke
Middle Cerebral Artery
Most common STD in USA
C. Trachomatis
Romana sign and chagoma are associated with?
Chagas’ Disease
Treatment of Organosphosphate Poisoning
Atropine 1mg (adult)or 0.01-0.04 mg/kg (children) IV until tracheobronchial secretions stop Pralidoxime 1-2 g for adults or 20-40 mg/kg in children
Most common complication of lumbar puncture?
Post lumbar puncture headache
Presents with dysuria, purulent penile discharge, petechial or pustular acral skin leasions on an erythematous base, asymmetric arthralgias, tenosynovitirs or septic arthritis?
Disseminated gonococcal infection
Most common cultured agent in a shunt infection?
Staphyloccocus epididymis
Most common site for epidural abscess?
Thoracic and Lumbar Spine
Second most common death in young athletes?
Commotio cordis
Neuroblastoma is often associated with this syndrome presenting as acute ataxia with rapid chaotic eye movement?
Opsoclonus-myoclonus
Headache characterized as at least 5 episodes that are severe, unilateral, lasts 15-180 min and has a circadian/circannual pattern?
Cluster headache
Most common site of spinal injury in the elderly?
T12-L1 and T7-T8
Most common cardiac manifestation in Lyme disease
AV Block
Contraindicated agents in theophylline toxicity?
Cimetidine Phenytoin
Antidote for digoxin toxicity
Digi-Fab
Most common cause of ischemic stroke in children
Sickle Cell Disease
Treatment of Anticholinergic Toxicity
Supportive Therapy Activated charcoal in acute ingestion Antidysrhythmia Sodium Bicarbonate Physostigmine
Autoimmune disorder associated with fluctuating muscle weakness and fatigue in the proximal limb muscles among older men with history of cigarette smoking and lung cancer?
Lamber- Eaton Syndrome
Classic Presentation of paralysis of Upper extremities with lack of lower extremity, paralysis or weakness (cruciate paralysis) after a high energy impact?
Antlanto-occipital dissociation (AOD)
Heterophile NEGATIVE infectious mononucleosis without exudative pharyngitis, and mild lymphadenopathy
CMV Infection
Most common pelvic injury in elderly? Most common type of this injury?
Pubic ramus fracture, lateral compression
Treatment for Arsenic Poisoning?
Dimercaprol IM (BAL) Succimer PO- stable patients
Most common tick attachment?
Scalp
Single spinous process avulsion seen in the lower cervical and upper thoracic spine
“Clay-Shoveler”Fracture
Agent used to reverse heparin-induced coagulopathy?
Protamine 1mg per 100 U of Heparin used
Treatment for Methanol and Ethylene Glycol Toxicity?
Fomepizole 15mg/kg IV load then 10 mg/kg every 4 hours for 4 additional doses Ethanol 800 mg/kg/ IV load then 100mg/kg/h infusion IV dextrose Methanol: Folinic acid Ethylene glycol: pyridoxine Sodium Bicarb for significant met acidosis
Most commonly reported neurologic opportunistic infection in HIV patients
Toxoplasmosis Encephalitis
A systemic vasculitis involving medium sized- large arteries and may result to optic neuropathy and profound visual loss and contralateral ocular involvement?
Temporal Arteritis
Most common condition associated with Balanoposthisis?
Diabetes
Esophageal motility disorder that is due to failure of lower esophageal sphincter to relax and a complete absence of esophageal perilstasis
Achalasia
Most common thoracic spine fracture?
Simple wedge ( Compression) fracture- usually stable
Blast injury due to rapidly increasing then decreasing atmospheric pressure?
Primary Blast injury
Massive hemothorax is defined in the adult as a volume of at least?
>1500 mL
How much fluid collection can be seen on upright or decubitus chest radiograph?
>200-300 mL
Autoimmune disease characterized by muscle weakness and fatigue, made worse after repetitive use of voluntary muscles
Myasthenia Gravis
Treatment for Opoid withdrawal?
Clonidine 0.1-0.3 mg PO
Etiologic agent for Lyme Disease?
B.Burgdorferi
First line of abortive therapy for migraine at home?
Triptans
Characterized by painless primary chancre with an appearance of purplish blue unilateral inquinal lymphadenopathy noted on the overlying skin
Lymphogranuloma venereum
Treatment of TCA Toxicity?
Supportive Therapy Activated Charcoal Norepi or Epi Drip for Hypotension NaHCO3 for severe acidosis Magnesium Sulfate for Torsade Benzos for Seizure
Neuroleptic syndrome treatment?
Non depolarizing agent for muscle rigidity Dantrolene 0.5-2.5mg/kg
Most common case of subarachnoid hemorrhage?
Ruptured aneurysm (75%)
Common cause of traveler’s Diarrhea
Enterotoxic E. Coli
Treatment of Lead Poisonin?
Whole bowel irrigation using Polyethylene glycol BAL ( Dimercaprol) for chelation therapy
Most common causes of fever without obvious localizing findings in an HIV patient?
Pneumocystis Jirovecii
Most common form of an focal neuropathy and a common etiology us injury due to repetitive use
Median Mononeuropathy (Carpal Tunnel Syndrome)
Causative agent for painful genital ulcers and Lymphadenitis
Haemophilus ducreyi
Most common cardiac artery involved in cardiac traumatic injury?
Left anterior descending artey
Fallen Fragment sign is seen in fractures involving
Simple (unicameral) bone cyst
Causative agent of donovanosis?
Klebsiella granulomatis
Pediatric handle injuries are commonly associated with?
Pancreatic and orr Small Bowel Injuries
Causes orolabial lesions and resides in the trigeminal ganglia?
HSV-1
Acute headache with vestibular symptoms (vertigo or ataxia) indicates what condition?
Cerebellar hemorrhage
Which bone is dorsally dislocated in a perilunate dislocation?
Capitate
Most frequently injured intra-abdominal organ from sports accident?
Spleen
Which Bone is dorsally dislocated in a perilunate disloacation
Capitate
Which ventricle is at the greatest risk in cardiac injury due to its large anterior exposure?
Right Ventricle
Transient focal deficit that is unilateral following a simple or complex focal seizure
Todd’s paralysis
What nerve root is involve with suspected cubital tunnel syndrome, presence of neck pain and worsening of symptoms with neck flexion
C8 Entrapment
Bulging fissure sign on radiologic imaging is seen in?
Klebsiella Pneumonia Infection
Treatment of severe pain in rib fractures
Intercostal nerve block or serratus anterior plane block with bupivacaine
Often responsible for most cases of HSV Encaphilitis
HSV 1
Demyelinating disorder of the peripheral nerves that involves ascending symmetric weakness or paralysis and areflexia or hyporeflexia?
Guillain Barre-syndrome
Earliest indicator in acute radiation syndrome?
Decrease in Lymphocytic count
Frontotemporal headache, neck pain, facepain , partial Horner’s syndrome
Carotid Artery Dissection
Common pathogen using Endocarditis in IV Drug users
S. Aureus
Flexion Teardrop Fracture of the Spine is associated with what injury?
Anterior Spinal cord Syndrome
Occurs in the treatment of early syphilis and presents as headache and myalgias within 24h after treatment
Jarisch Herxheimer reaction
Most commonly injured area of the neck?
Zone II
Adult and Pediatric dose of INH toxicity
Pedia: 70 mg/kg IV Adult 5 g IV
Presents with malodorous thin watery discharge, vulvar irritation, pruritus, dysuria, dyspareunia, and occassionally low abdominal pain?
Trichomonas vaginalis
Most common cause of CNS infection globally and the leading cause of adult onset seizure worldwide?
Neurocysticercosis
What maneuver should be considered as first line treatment for Posterior canal BPPV?
EPLEY Maneuver
Treatment of Acetaminophen Toxicity
Acetylcysteine
Treatment of Acetaminophen Toxicity
Acetylcysteine
It is characterized by deafness, vertigo and facial nerve palsy cause by Herpes zoster oticus
Ramsay Hunt Syndrome
Most common central cause of vertigo?
Vestibular Migraine
Serum assay highly sensitive and specific for cerebrospinal fluid leakage
Serum Beta-2 transferrin
Most common sites for aspiration pneumonia after severe trauma?
Right and lower lung fields
What causes headache, transient visual obscurations, back pain, pulsatile tinnitus and papilledema with otherwise normal neuro exam?
Pseudomotor cerebri
Prosthetic valve endocarditis is mainly caused by?
Coagulase Negative Staphylococci
Treatment for Alchohol toxicity
IV Dextrose for Hypoglycemia Thiamine 100 mg IV or IM for Wernicke’s Encephalopathy
Pediatric handle injuries are commonly associated with?
Pancreatic and Small bowel injuries
Imaging study of choice for mandibular fracture
PANOREX ( Dental Panoramic X-ray
Most common cause of acute hemorrhagic fever in temperate climates?
Neisseria meningitides
Bladder volume of __ is a cause for concern in a neurogenic bladder?
>100 mL (200mL)
Treatment of Cyanide Poisoning
Cyanide kit: Amyl nitrite inhaler, Sodium Nitrite, Sodium Thiosulfate Hydrocobalamin
Most common GI manifestation of Sepsis?
Ileus
First line for refractory status epilepticus?
Propofol 2-10mg/k/h infusion
Second most common neurodegenerative disorder?
Dementia with Lewy Bodies
Blunt or penetrating injuries due to materials thrown from explosive casing
Secondary blast injuries
Most common cause of blunt neck trauma
Road traffic accidents
Most common cause of fungal meningitis?
Cryptococcus neoformans followed by Coccidiodes immitis
Diffuse CNS dysfunction with lack of focal physical examination findings to point to a specific region of brain dysfunction?
Toxic Metabolic Coma
A key component of a central cause of acute vestibular syndrome
acute nystagmus
Causative agent of pontiac fever?
Legionella
Treatment for CO and Cyanide poisoning specially for patients exposed to sever smoke inhalation during a fire
Sodium Thiosulfate AVOID Nitrites!
According to AHA guidelines, when to we give aspirin for stroke patients?
The current AHA/ASA guidelines recommend the adminis- tration of oral (or by rectum if swallowing impairment is pres- ent) aspirin within 24 to 48 hours after stroke onset unless thrombolytics have been given within the prior 24 hours.19 No antiplatelet agent (including aspirin) should be given within 24 hours of receiving thrombolytic therapy.
Type of anemia seen in P. Falciparum infection?
Normochromic, normocytic anemia
Most common symptom in pseudomotor cerebri
Headache
Weakest Link in disaster management?
Communication
This type/s of ambulance have physical access between the drivers and patient care compartments?
Type 2 and 3 ambulance
Most important factor in surviving cardiac arrest?
Early defibrillation
Contraindication for applying cervical collar in the field because of potential airway compromise?
Patients with mandibular or soft tissue neck injuries
What is a operational limitation for air medical transport?
Weather
Overriding condition for air transport?
Safety
What is the largest single non-trauma indication in most helicopter EMS programs?
Cardiac
Most common complaints in cruise ships?
Shortness of breath and injuries
First and very effective method for decontamination?
Disrobe, brush off solid dusts or powders, wash and dry face
The only natural disaster where more injury and death occur during the recovery period than in acute
Hurricane
Type of primary blast injury that involves lung parenchyma exploding into alveolar spaces ( dense to less dense medium)?
Spalling
In an isolated tympanic membrane rupture after a bomb blast, you should order____ as an adjunct diagnostic?
Chest radiography to rule out Pulmonary barotrauma
Normal muscle compartment pressure? At what pressure causes muscle ischemia, irreversible nerve and muscle damage?
< 10 mmHg, > 30mmHg
Most common and consistent finding in compartment syndrome?
Pain
Type of gas that interrupt pulmonary diffusion, with a pleasant odor of new mown hay?
Phosgene
Second most common hazardous material?
Ammonia
In acute radiation syndrome at what level will have GI Sydrome and death most likely?
> 6 Gy
What preparation is used in patients with suspected molluscum contagiosum and dermatophytic infections?
Potassium hydroxide
Used in establishing diagnosis of herpes infections?
Tzanck Smear
Presence of these cells are indicative of herpes infection?
Multinucleated Giant Cells
Most frequently used topical corticosteroid in the outpatient setting?
Hydrocortisone
Corticosteroids of moderate potency used in treating severely inflamed skin and thicker skin area?
Triamcinolone acetonide Fluocinolone acetonide
Refers to the decrease in responsiveness to a drug as result of enzyme- mediated events?
Tachyphylaxis
Non tender erythema with skin flaking and scaling, thickening of skin, patient often has preexisting eczema or psoriasis
Exfoliative erythoderma
The rate of erythema multiforme recurrence is high in children with this concomitant infection?
Herpes simplex infection
Slippage of the epidermis from the dermis when slight rubbing pressure is applied to the skin
Nikolsky sign
Major complications and leading causes of death in toxic epidermal necrolysis?
Infection Hypovolemia and electrolye disordersd
Generalized mucocutaneous, autoimmune blistering eruption with a grave prognosis characterized by intraepidermal acatholytic blistering
Pemphigus vulgaris
A severe adverse drug reaction that usually develops within 8 weeks of initiation of drug therapy?
Drug rash with eosinophilia and Systemic symptoms syndrome
Dermatologic triad of wide-spread ecchymoses, hemorrhagic bullae and epidermal necrosis
Purpura Fulminans
Side effects seen in higher potency topical corticosteroids on the face for more than a few days while treating sever seborrheic dermatitis
Perioral dermatitis or steroid rosacea
Causative agent of Tinea barbae? Treatment?
Tricophyton Treatment is Terbinafine 250mg PO daily 2-4 weeks
Results from reactivation of varicella zoster virsu in the genticulate ganglion and presents with ear pain, vesicles in the external auditory canal, facial nerve paralysis and vestibulocochlear dysfunction
Ramsay-Hunt syndrome
Etiologic agents that fluoresce from Wood’s lamp?
Nits Lice Microsporum Malassezia
Most common dermatophyte infection that can spread from involvement of the feet?
Tricophyton rubrum and tricophyton mentagophytes
Appears as short chopped hyphae and yeast forms termed “sphaghetti and meatballs” under potassium hydroxide preparation?
Malassezia infection
The 5 Ps hallmark of lichen planus?
Purple Polygonal Pruritic Planar Papules
Are fine white lacy reticulate lines that adhere to the papules and are pathognomonic of Lichen Planus?
Wickham striae
This condition is identical to lichen planus except they tend to be more generalized and photodistributed and there is a history of drug ingestion?
Lichenoid drug eruptions
May present as papular lesions 2-5 mm in, generalized and are reddish to copper in color with palmar-plantar involvement with a collarete scale?
Secondary syphilis- late stage
Treatment for Secondary Syphilis?
Benzathine Pen G 2.4 million U IM single dose
A vasvular leak in the superficial dermis of the skin characterized by transient pruritic wheals and welts
Urticaria
The presence of large edematous areas that involve the deeper dermis and the subcutaneous tisse?
Angioedema
An unusual allergy characterized by acute urticaria or anaphylaxis is allergy to meat (beef, lamb, pork) 4 hours after being bitten by a Lone Star tick bite?
Allergy to galactose-a- 1, 3 glactose
Idiopathic, intensely pruritic eruption that begins in the third trimester of pregnancy?
Polymorphic eruption of pregnancy
Treatment for Erythema Migrans in non-pregnant patients?
Doxycycline 200 mg PO-single dose
A symptom common with drug eruption but often absent in a viral exanthem?
Pruritus
Drug reaction that Occurs as a solitary or occasionally multiple, discrete, round to oval erythematous patches that turn dusky red or violaceous?
Fixed drug eruption
May occur within 3-5 days of initiation of warfarin and heparin that starts as a single painful area followerd by erythema that rapidly turns blue black with subsequent necrosis of the skin?
Anticoagulant necrosis
An infection after priamry exposure to varicella, the virus remains latent in the dorsal root ganglia until it later reactivates and spreads down the sensory to the skin
Herpes zoster
Most common autoimmune blistering disease in the elderly?
Bullous pemphigoid
Chemical produced by the “blister beetle”which when released after the insect is crush produces vesicles and blisters on the exposed areas?
Canthadrin
Common molluscum contagiosum seen in children? In HIV infections?
M. Contagiosum V1 in children, V2 in HIV infections
Causative agent for “Hot tub folliculitis”?
Pseudomonas aeruginosa
Causative agent for Kaposi’s sarcoma?
Human Herpesvirus 8
Treatment for Hidradenitis suppurativa?
Clindamycin 1% lotion twice daily and use of antibacterial soaps such as chlorhexidine, once to twice daily
Rapidly developing ulcer that begins as a pustule or erythematous nodule and has violaceous over hanging borders
Pyoderma Gangrenosum
Triad of diabetic foot ulcers?
Neuropathy Deformity Trauma
Third most common chronic mycobacterial infection in humans?
Buruli Ulcer caused by Mycobacterium ulcerans
Involves direct injury of the peripheral nerves of the foot sustained from prolonged cooling and accelerate by wet conditions?
Trench foot
Characterized by mild but uncomfortable inflammatory lesions of the skin caused by long-term intermittent exposure to damp, non-freezing ambient temperatures.
Chillblains aka pernio
Treatment for Chillblains?
Nifedipine Pentoxyfylline Limaprost
Mild necrosis of subcutaneous fat tissue that develops during prolonged exposure to temperatures just above freezing?
Panniculitis
At what skin temp does frostbite occur?
Skin temp is <0 C( <32 F)
Zone in frostbite injury that may benefit if the circulation in the frozen area can be restored
Zone of Stasis
Most susceptible tisse to frostbite injuries
Bone marrow
Frostbite injuries that involve tissue loss of entire thickness of the skin, hemorrhagic blisters
Third Degree
First definitive step of frostbite therapy and should be initiated as soon as the risk of refreezing injury can be avoided
Rapid rewarming @ 37C-39 C ( 98.6 to 102.2 F) for 20-30 minute
When should thrombolytic therapy be given as management of pulse deficits after rewarming of frostbite injury?
Within 24h
Involuntary drop in core temperature below 35 C (<95 F)?
Accidental hypothermia
Type of heat loss that occurs when a warm body makes direct contact with a cold object?
Conductive heat loss
A type of heat loss that occurs due to the energy required for water to phase change from a liquid to a gas?
Evaporative heat loss
Referred as the continuing drop fo core temp even after the patient is removed from the cold environment?
Afterdrop
Most common iatrogenic causes of hypothermia?
Massive transfusion and large volume crystalloid resuscitation
Used to describe cardiac arrest that can commonly occur during extrication, transport or treatment of a deeply hypothermic patient?
Rescue collapse
Expected dysrhythmias seen in hypothermic cardiac response?
Atrial fibrillation and flutter
Can be misdiagnosed as ST Elevation MI and usually occurs below 32 C?
Osborn J waves
The renal response to hypothermia?
Cold Diuresis
Preferred site for core temp measurement in an intubated patient as it closely measures cardiac temp?
24cm below the larynx or lower third of the esophagus
Type of heat injury that occurs during periods of high environmental stress, and over a period of hours to days?
Classic heat injury
Acute inflammation of the sweat ducts caused by blockage of the sweat pores by macerated stratum corneum
Prickly heat aka Lichen tropicus
Cardinal Symptoms of heat stroke?
Hyperthermia and altered mental status
What cross reacts with individuals sensitized to other hymenoptera stings?
Fire ant venom
Causes target lesions associated with immediate pinprick sensation, diffuse myalgias involving larger muscle groups after being bitten
Black widow bites
Only North american scorpion that produces systemic toxicity
Bark Scorpion ( Centruroides Sculpturatus)
Systemic ascending paralysis caused by tick borne illness
Tick paralysis
Initial bite of this insect is painless and linear, feed on blood of sleeping victims
Kissing Bugs and Bed Bugs (Hemiptera)
An absence of systemic symptoms or hematologic abnormalities after 8-12 hour after an unidentified snake bite indicate?
Dry bite
Treatment for Crotaline snakes or pit viper bite?
Crotalidae Immune Fab (Fab AV): 4-6 vials + 250 cc NSS over one hour then repeat dose of 4-6 vials if initials control is not achieved
Immediate cause of death after an Elapid snake bite?
Paralysis of respiratory muscles
Antibiotic for marine associated wound infections cause by vibrio Species Coverage
Fluoroquinolone
Treatment for jellyfish envenomation?
Irrigation with seawater and hot water immersion, Application of topical lidocaine
Characterized by mild local effects with localized pain and erythema. 20-30 minutes later, severe generalized pain in the abdomen, back chest head and limbs develop after being bitten by the Australian box jellyfish
Irukandji Syndrome
How many hours should a diver wait before flying after the last divibg exposure?
12 to 24h?
Absolutr contraindication to hyperbaric therapy?
Untreated pneumothorax
Factors associated with poor resuscitation prognosis in near drowning?
Need for bystander CPR at scene CPR in the ED Asystole at the ED after warming
Factors associated with poor resuscitation prognosis in near drowning?
Need for bystander CPR at scene CPR in the ED Asystole at the ED after warming
The critical driver of altitude illness
Sleeping altitude
A drug induces bicarbonate diuresis, greatly facilitates this process thru its inhibition of carbonic anhydrase, thus counteracting ascent-related respiratory alkalosis
Acetazolamide
Criteria for an unacclimitize persons become unconscious?
SaO2- 50-60% PaO2- <30mmHg JVPO2- < 15mmHg
A syndrome characterized by headache along with some combination of nausea or vomiting, dizziness, fatigue or sleep disturbance and occurs in the setting of more gradual and less severe hypoxic insult than acute hypoxia syndrome?
Acute Mountain Sickness
Side effects of high dose acetazolamide?
Peripheral Paresthesias Nausea Drowsiness
Defined by progressive neurologic deterioration or ataxia in individual who has recently ascended to high altitude?
High altitude cerebral edema
Highest priority in treatment of HACE?
Descent (Then O2 supplementation and steriod therapy)
Main etiology for High altitude PE?
High microvascular pressure
Hallmark of High altitude PE?
Progression of dyspnea with exertion to dyspnea t rest
Treatment of choice for HAPE?
Immediate descent
Prophylaxis for those who have previously experience HAPE
Nifedipine 20 mg every 8 hours while ascending
Blunts hypoxic pulmonary vasoconstriction thru generation of nitric oxide, prevents HAPE in susceptible individuals
Tadalafil > sildenafil
Characterized by excessive polycythemia for a given altitude which causes symptoms of headache, muddle thinking, difficulty of sleeping, impaired peripheral circulation, drowsiness and chest congestion
Monge’s disease or chronic mountain sickness
Two major asphyxiants?
Carbon monoxide and Hydrogen cyanide
Corner stone of initial treatment for chemical burn
Agressive large volume irrigation
Most important chemical burn feature that HCW may alter
Contact time
Use to remove or rinse phenol or carbolic acid injury?
isopropyl alcohol rinse is equivalent to polyethylene glycol
Most common orthopedic injury commonly seen in electrical injury
posterior shoulder dislocations
Neurologic/ msucular stunning associated with cardio respiratory arrest after a lightning injury
Keraunoparalysis
Pathognomonic for lightning strike injury, consist of a red superficial feathering or ferning patter
Lichtenberg figures
Mushrooms causing muscarinic poisoning
Inocybe annd Clitocybe genera (SLUDGE)
Amatoxin in A. phalloides that appears the most psychoactive
a- aminitin
Time to peak Carbon monoxide levels is
>8hours
Common area of the brain most sensitive to neurotoxic effects of CO?
Basal Ganglia
The only accurate measurement tool for carboxyhemoglobin?
Co-oximetry
CO poisoning is associated with one specific radiographic finding?
Globus pallidus lesions
Most common cardiovascular cause of sudden cardiac death in young athletes?
Hypertrophic cardiomyopathy
Most frequent coronary artery anomaly?
Anomalous origin of the left coronary artery from the Pulmonary artery syndrome
Most commonly affect men and consists of a prominent J-wave with a characteristic downsloping ST-segment elevation in ECG leads V1-V3
Brugada Syndrome
Characterized as prominent notch like J wave on the QRS downlope, followed by upsloping of ST Segment elevation
Early repolarization syndrome
Type of shock described by increase preload, increased afterload, increase SVR, decareas CO
Cardiogenic shock
End points of Resuscitation:
MAP >65mmhg CVP of 8-12 mmHg ScVO2>70% UO >0.5ml/kg/h during ED Resuscitation
Commonly used in trauma centers and EDs to detect occult shock
Measurement of lactate and base deficit
Acceptable SBP target for hypotensive resuscitation?
110 mmHg for civilian trauma and 100 mmHg for combat casualties
Massive transfusion pack consists of ?
6 U RBCS 4 U FFP One (5 pack) platelet
Common side effext for massive transfusion?
Hypocalcemia
Responsible for initiating vasodilation and increasing vascular permeability, heart rate contraction and glandular secretion during an anaphylactic reaction
Histamin
Alternative agent for patients with anaphylaxis but are taking beta blockers?
Glucagon IV
Best screening test for hereditary angioedema?
C4 level < 30% of normal
Ig- E mediated allergic reaction to ingestion of red meat containing mammalian oligosaccharide epitope alpha-gal
Galactose- alpha-1,3- galactose (Mammallian meat allergy
Chronic hypoventilation seen in extremely obese patients
Pickwickian syndrome
Normal Alverolar-arterial gradient (PaO2/FiO2 ration) in young adults?
<15mmHG
Factitiously low value of [Na+] that occurs in the setting of sever hyperproteinemia and hyperlipidemia
Pseudohyponatremia or Iso-Osmolar Hyponatremia
Impaired ability of kidney to reabsorb free water, associated with polyuria, polydipsia and increased volume of hypoosmalar urine
Diabetes insipidus
Most common cause of hyperkalemia?
Factitious hyperkalemia
Occurs when a patient is treated with mannitol, which binds to molybdate in the serum causing an artificially low value when phosphate is measured
Pseudohypophosphatemia
Initial treatment for symptomatic patients with congenital long QT syndrome
B-blockers
Agents indicated for the conversion of recent-onset atrial fibrillation (<7days) to sinus rhythm
Propafenon and flecainide
Antiarrhythmic agent reserved for patients in whom atrial fibrillation or atrial flutter is highly symptomatic and alternative safer agents are contraindicated?
Dofetilide
Most commonly used push dosed pressor for acute onset hypotension?
Phenylephrine
Metatarsal shaft fracture in unconditioned foot soldier?
March Fracture
Gustillo- Anderson Classification caused by High energy fracture pattern with a wound > 10 Cm and gross contamination
Grade IIIA
COntraindication of sling and swathe principle in the prehospital level
Anterior dislocation of the shoulder
Possible injury sustained by a direct blow to the anterior shoulder, fall on the outstretched arm, seizure or electroconvulsive muscular activity
Posterior dislocation of the shoulder
Two important nerves to be inspected if there is a suspected anterior dislocation of the shoulders
Axillary nerve and the musculocutaneous nerve
Splint used for fracture of the proximal phalanx of the ring finger or little finger or for fracture of the fourth and fifth metacarpala?
Short arm Ulnar gutter
Normal 2 point discrimination width for a sensory exa?m?
4-6mm
Compartment pressures exceeding ____ results in Compartment syndrome?
30 mmHg
Muscles that composes the Thenar Muscles?
abductor pollicis brevis, opponens pollicis and flexor pollicis brevis
Froment’s sign is indicative of what pathology?
Ulnar nerve injury
Flexor tendon injury zone considered a no man’s land due to poor outcomes?
Zone II
Most common tendon injury in athletes?
Mallet Finger
Result’s from chronic mallet finger, when the lateral bands are displaced dorsally resulting in increast extension forces on the PIP Joint
Swan Neck Deformity
Most common distal phalanx fracture and associated with nail bed lacerations?
Tuft Fractures
High pressure injection injury occurs at what pressure?
2000-10000 psi
Area between two palmar arches that is inherently weak?
Space of Poirier
Most common fracture in the wrist
Fracture of the distal radius
Most commonly injured ligament of the wrist?
Scapholunate ligament
Second most common carpal bone injury?
Triquetrum fractures
Vertical fractures and are analogous to a Bennet’s fracture
Trapezium Fracture
Association of scaphoid and capitate fracture
Scapholunate syndrome
Elbow “terrible triad” injury?
Elbow dislocation Fracture of the radial head and fracture of the coronoid
Most often occur after a fall on an oustretched hand with the elbow in full flexion
Extension-Type Supracondylar Fractures
Affected structure with supracondylar fracture?
Anterior interosseous nerve
What nerve is affected in olecranon fractures?
Ulnar nerve injury
Disruption of the triangular fibrocartilage complex of the wrist and interosseus membrane between the radius and ulna, causing dissociation of the distal radioulnar joint
Essex- lopresti lesion
Fracture resulting from the natural response to raise the forearm in defense of a strike?
Isolated Ulna Fracture or Nightstick fracture
Fracture of the distal third of the radial shaft accompanied by a dislocation of the distal radioulnar joint
Galeazzi’s Fracture-dislocation
Major suspensory ligament of the upper extremity and provides vertical stability tot the AC JOINT?
Coracoclavicular ligmaent
Most common structure injured in anterior glenohumeral joint dislocation?
Axillary Nerve
Most common complication of Glenohumeral Dislocation?
Recurrence of dislocation
Most common site for humeral fracture?
Middle third of the humerus
Gold standard in evaluating pelvic injury?
CT- Scan of the Abdomen
Most common cause of pathologic femur fractures in pediatric patients?
Unicameral bone cysts
Blood loss can be as high as ____ mL in femoral shaft fractures
1200 mL
Pathognomonic of ACL injury?
Segond’s fracture
Commonly injured and represents 85% of all ankle sprains
Lateral ligament complex
Untreated midfoot injuries in diabetics can lead to the development of____
Charcot’s foot
Irreversible damage in compartment syndrome occurs after___ without treatment
8 hours
Most effective modality for ROSC?
Early Defibrillation
Initial treatment and dose for treatment of torsade de pointes?
Magnesium: In cardiac arrrest: 1-2 gm + 10 cc D5W in 1 minute If with pulse 1-4 gm + 50c D5W in 60 min
Most likely sinus wall to break in blunt eye trauma?
Ethmoid bone
Px experiences painless monocular vision loss associated with a history of atrial fibrillation and carotid stenosis?
Central retinal arterial occlusion
Signaled by “flashing lights” and curtain/veil”Vision?
Retinal detachment
Caused by pathology that prevent light from getting to the CNS and the swinging flash test notes dilation of the opposit pupil if their is an afferent pupillary defect
Marcus Gunn Pupil
Normal intraocular pressure?
10-20 mmHg
Shining a light on the unaffected eye causes pain the affected eye is highly suggestive of what condition? Treatment?
Iritis Tx: homatropine/tropicamide to decrease pain
Painless vision loss and sudden appearance of black spots/ generalized hazy vision associated with subarachnoid hemorrhage
Subhyaloid hemorrhage (vitreous hemorrhage0
Contraindicate in large corneal abrasions in the central axis
Topical anesthetic
Eye condition associated with Sickle cell disease
Spontaneous Hyphema
A complication of pharyngitis causing suppurative thrombophlebitis of the internal jugular vein, with or without bacteremia and septic emboli?
Lemierre’s syndrome
Careful drainage of the peritonsillar abscess should be done in order to avoid damaging the____?
Internacl carotid artery
Most frequent site for orbital blow out fractures?
Inferior wall (maxillary sinus) and medial wall ( ethmoid sinus through the lamina papyracea
Treatment for global rupture
metal eye shield, Broad spectrum antibiotics, elevate head, sedation, analgesia and TT vaccine, definitive: ophthalmology surgery
Clinical findings of eye pain, proptosis, impaired EOMs and decrease vision, an afferent pupilary defect and intraocular pressure > 40 mmHg
Postseptal hemorrhage Treatment for orbital compartment sydrome: lateral canthotomy
Condition precipitated by intranasal coccaine use, nebulization of B- sympathomimetic and anticholinergic medications?
Acute angle -closure glaucoma
Clinical findings of eye pain, cloudy cornea, fixed midposition pupil and rock hard globe? Treatment
Acute angle -closure glaucoma Tx; Acetazolamide, Topical timolol, topical apraclonidine
Sudden profound painless monocular loss of vision preceded by amaurosis fugax
Central artery occlusion
Vague blurring to rapid, painless and monocular loss of vision, with fundoscope finding so of optic disk edema and diffuse retinal hemorrhage
Central retinal vein occlusion
findings of flashes of light, floaters, and a dark veil or curtain in field of vision and decreased peripheral and/or central visual acuity
Retinal detachment
Causes Inhibition of ipsilateral medial gaze and upward gaze, downward gaze and ptosis?
Acute Cranial Nerve III palsy secondary to Post. communicating artery aneurysm
Neck pain and acute findings ptosis and miosis and anhidrosis?
Carotid artery dissection
Most common fibular fracture results in an oblique injury at the tibio-fibular syndesmosis which is usually disrupted?
Fracture of distal fibula With deltoid ligament rupture
The appropriate PCO2 range for hyperventilation the results in modest cerebral vasoconstriction without hypoxia?
30-35 mmHg
Earliest symptom noted in patients with GBS?
muscle weakess
Classical contraindications to digoxin toxicity?
IV Calcium transvenous and transcutaneous pacing electrical cardioversion
Strongest risk factor for ectopic pregnancy?
Prior ectopic pregnancy
“Wine and cheese” reaction is associated with?
Use of monoamine oxidase inhibitors
Stable Spinal fractures?
wedge fracture spinous and transverse process fractures unilateral facet dislocation vertebral burst fracture (with the exception of a Jefferson fracture, which is a burst fracture of C1).
The presentation of a painless morning limp that improves throughout the day in children less than 10 years old and is associated with uveitis?
Pauciarticular juvenile arthritis
Initial treatment of idiopathic sensorineural hearing loss
Prednisone 60 mg OD x 7days
Topical Agents safe for TM perforations in Acute Otitis Externa?
Ciprofloxacin, dexamethason and ofloxacin
first Cranial nerve to be affected by cranial extension of malignant otitis externa
Cranial Nerve 7
Initial treatment of Acute otitis media?
Amoxicilin 1gm TID
Most common intracranial complications of Otitis Media?
Meningitis and brain abscess
Most common complication of cochlear implants?
dizziness and vestibular symptoms
Most common causative agent of facial cellulitis?
Streptococcus species
discrete, superficial bacterial epidermal infection characterized by amber crusts or fluid filled vesicles common in children
Impetigo
Most common causative agent of viral parotitis?
Paramyxovirus
Conditions associated with mumps in adults?
Unilateral orchitis and oophoritis
characteriized by unilateral swelling and tenderness around the salivary gland, that is also exacerbated by meals
Sialolithiasis
Radiographic view preferred for TMJ injuries
Panorex view
Most common manibular dislocation
Anterior mandibular dislocation
Most common source of nosebleeds?
Kiesselbach plexus
Inflammation of the operculum or the gingival tissue overlying the occlusal surface of an erupting tooth
Pericoronitis
definitive treatment for irreversible pulpitis
Root canal therapy or dental extraction
Extension of pulp disease, inflammation or necrosis into the tissues surrounding the root and the apex of the tooth.
Periradicular periodontitis
Cellulitis of bilateral submandibular spaces and lingual space
Ludwig’s Angina
Most common cause of gingival abscess?
entrapment of foreign matter
Characterized by pain, ulcerated or punched out interdental papillae and gingival bleeding
Acute necrotizing ulcerative gingivitis
Mainstay of treatment for Vincent’s disease?
Chlorhexidine oral rinse BID and professional debridement and scaling are the mainstay of treatment
drugs with strongest association to gingival hyperplasia
Phenytoin, nifedipine and cyclosporine
treatment of choice for total displacement of tooth from its socket?
Replantation at the scene
A complication of pharyngitis causing suppurative thrombophlebitis of the internal jugular vein with or without bacteremia and septic emboli
Lemierre’s syndrome
A structure to avoid during careful drainage of peritonsillar abscess
Internal carotid artery
The “thumb print sign” suggests what disorder?
Epiglotittis
Diagnostic of Choice of retropharyngeal abscess?
Contrast Enhanced CT of the neck
Most significant posttonsillectomy bleeding occurs betwern day ____?
5 to 10 days post op
The greatest risk for non-obstetric cause of death?
Major Trauma
Vasopressors that are Category C of pregnant patients?
Phenylephrine and Ephedrine
Most common cause of septic shock in pregnancy?
Pyelonephritis
Medications contraindicated in Resuscitation of Pregnant patients
Amiodarone Magnesium Sulfate
Preferred Surgical airway for children under age 8?
Tracheotomy
Vascular structure often injured during cricothyrotomy?
Thyroid ima artery
Most common cause of death in patients with an implantable cardioverter-defibrillators?
Congestive heart failure
Most catastrophic complication of fibrinolytics?
Intracranial bleeding
Results from inflammation adjacent on the epicardial surface of a transmural infarction often 2-4 days after an AMI?
Pericarditis
Late post-AMI syndrome occurs 2 to 10 weeks after AMI presenting with chest pain fever and pleuro pericarditis?
Dressler’s syndrome
Most sensitive diagnostic test for Carpal tunnel syndrome?
Phalen test
Reflex mediated syncope associated with carotid sinus hypersensitivity characterized by bradycardia or hypotension?
Carotis sinus syndrome
Most frequent psychiatric diagnosis associated with syncope?
General anxiety disorder and major depressive disorder
Most common cause of mitral stenosis worldwide?
Mitral stenosis
Most common cause of mitral regurgitation primarily see in the elderly?
Fibroelastic deficiency syndrome
Most common valvular heart disease in industrialized countries?
Mitral valve prolapase
Classic triad of aortic stenosis
Dyspnea, chest pain and syncope
Characterized by RV dilatation accompanied by normal LV wall thickness
Dilated cardiomyopathy
Echocardiographic hallmark for LV Hypertrophy Cardiomyopathy?
LV Wall thickening > 15mm
Should be considered in patients presenting with congestive heart failure but no evidence of cardiomegaly or systolic dysfunction?
Restrictive cardiomyopathy
Most common and important physical finding in pericarditis?
Pericardial friction rub
Patients without prior heart disease generally begin to experience symptom from PE at least ____ of lung vasculature?
20%
Joints with the highest risk for venous thromboemoblism?
HIP
Calf pain that occurs with passive foot dorsiflexion in patients with DVT?
Homan’s sign
Unfractionated heparin dose for DVT and PE
80 U/kg then 18 Ukg/h infusion
Best imaging of choice for diagnosis VTE in pregnancy?
Pulmonary vascular imaging
Withdrawal syndrome occurs with abrupt discontinuation of oral or transdermal clonidine, potentiated by B-blockers
Acute catecholaminergic syndrome
First line agent for patients with pheochromocytoma and a hypertensive emergency?
IV phentolamine
Most common ECG abnormality in Pulmonary Hypertension?
Right Axis deviation
Most common cardiovascular complication of Marfan’s syndrome?
Aortic root disease and Type A dissection
Treatment of choice for aortic dissection?
Antihypertensives: B-blocker- Esmolol ( 0.1-0.5 mg/kg IV in one minute then 0.025 to 0.2 mg/kg/min infusion) and Labetalol ( 10-20 mg IV max of 300 mg) Vasodilators: IV nicardipine, clevidipine, Nitroglycerine, and nitroprussied
Most common peripheral aneurysm?
Popliteal artery aneurysms
Classic triad of ruptured abdominal aortic aneurysm?
Abdominal pain, pulsatile abdominal mass, hypotension
Diameter of aortic aneurysm where surgical repair should be considered?
> or equal to 5 cm
Characterized by jaundice, biliary colic and upper GI bleeding associated with hemobilia?
Leaking hepatic artery aneurysm
Most common cause of acute limb ischemia?
Thrombotic occlusion
Most common areas where emboli tends to lodge, causing limb ischemia?
Bifurcation of femoral artery followed popliteal artery
Ankle brachial index threshold for chronic peripheral arterial disease?
ABI of <0.9
Therapy of choice of Acute limb ischemia?
IV UFH ( 80 U/kg as IV bolus then 18 U/kg/h infusion Cilostazol
Considered to be the Gold Standard for quantifying the severity of px pain?
Self reporting
An opoid that weakly binds inhibits the reuptake of norepinephrine and serotonin, producing central opoid analgesic?
Tramadol
An effective analgesic for mild to moderate pain but not effective for persistent to chronic pain?
Acetaminophen
Preferred opoids for patients with renal failure?
Hydromorphone and fentanyl
Analgesics contraindicated in patients with MAJOR trauma?
NSAIDS
Treatment for patients with local anesthetic systemic toxicity?
IV 20% lipid emulsion, start at 1.5 ml/kg infused over 1 minute then 0.25ml/kg based on lean body mass infused for 10 minutes. Max of 10ml/kg
Amides the can cause methemoglobin?
Prilocaine and benzocaine
Normal 2 point discrimination at the the fingertips?
< 6mm
Anesthetic of choice for femoral nerve blocks?
Ropivacaine
Characterized by a level of depressed consciousness and a slower but purposeful motor response to verbal or tactile stimuli?
Moderate Sedation
Sedative of choice from procedures such as cardioversion?
Etomidate 0.1-0.2mg/kg
Etomidate is characterized by 2 side effects?
Adrenocortical suppression and myoclonus
Is a potentially damaging complication after repair of auricular lacerations?
Perichondral hematoma
Most common bacterial species isolated from human bite wounds?
Staphylococcus aureus
Hallmark of significant right to left shunting?
Failure of arterial oxygen levels to increase in response to supplemental oxygen
Nerves involved in the hiccup reflex?
Phrenic, vagus and thoracic sympathetic chain
Drug treatment for persistent hiccups?
Chlorpromazine and metoclopramid
First line of choice of treatment for traveler’s diarrhea in South and Southeast Asia?
Azithromyicin 1000 mg in a single dose
How much fluid is there for pleural fluid in the hemithorax to be seen in upright chest radiography?
150-200 mL
Acute drainage of larger volumes in patients with pleural effusion may result in?
Reexpansion pulmonary edem
What is false aneurysm of dilated blood vessels crossing the wall of a tuberculosis cavity?
Rasmaussen’s aneurysm?
Leading cause of hemoptysis world-wide?
Tuberculosis
Preferred diagnostic tool for evaluating massive hemoptysis?
Multidetector CT
Initial and most effective treatment of massive recurrent hemoptysis?
Bronchial artery embolization followed by bronchoscopy
Most common document causative agent in acute bronchitis?
Respiratory viruses
Most common causal agent for the common cold?
Rhinovirus
Treatment of choice for pertussis?
Azithromycin 500 mg PO on day 1 and 250 mg PO on days 2-5
New pulmonary infection occuring more than or equal to 48 hours after hospital admission?
Hospital-acquired pneumonia
Most common cause of severe community acquired pneumoniae in otherwise health individuals?
Streptococcus pneumonia and Legionalla
Causative agent for Community acquired pneumonia, presenting as multiple patchy nonsegmental infiltrates with occasional cavitation and pleural effusion?
Legionella pneumophilia
Causative organism transmitted via infected animal through dried urine that is inhaled or unpasteurized milk, causing pneumonia, endocarditis and hepatitis?
Q fever- Coxiella burnetti
Most common cause of bacterial pneumonia in patients with HIV?
S. Pneumonia
The risk of pneumocystis pneumonia is more likely when the CD4+ count is ?
<200 cells/mm3
Second leading infectious cause of death especially among those with HIV?
Tuberculosis
Is a tubercle appearing as calcified hilar lymph nodes?
Ghon complex
Most common extrapulmonary site of TB?
Lymphatic system
Most common chest radiograph finding in TB patients?
Normal Chest radiograph
Hypercalcemia noted in any patient’s receiving treatment for tuberculosis?
Paradoxical reaction or immune reconstiution syndrome
Most common extrapulmonary presentation of tuberculosis in children?
Cervical lymphadenitis
Air medical experts recommend no high-altitude flying for how many days after an pneumothorax resolution?
7-14 days
Best predecitor of hospitalization in patients with acute asthma in the ED?
Repeat FEV1 + PEFR 1 hour after treatment
Most common early complications of bariatic surgery patients?
Leakages, stenosis and bleeding
Abdominal compartment syndrome occurs as increased intrabdomonal pressure is ____?
>20mmHg
A syndrome characterized by recurrent nausea and vomiting seperated by a symptom-free period?
Cyclic vomiting syndrome
Most common causative agent that involves onset of diarrhea after administration of antibiotics or 2 weeks of their discontinuation?
Clostridium difficile
One of the most common causes of myocardial ischemia and infarction in infants, mostly anterolateral infarct?
Anomalous coronary artery arising from the pulmonary artyer
Toxic megacolon most likely develops in?
advanced Ulcerative colitis
A clinical disorder with signs and symptoms and radiographic appearance of acute large bowel obstruction with no evidence of distal colonic obstruction?
Ogilvie’s syndrome
type of diverticulosis most likely to bleed?
right sided diverticula
Has more potential value over angiography if lower GI bleed occurs intermittently, but requires a minimum of 3mL of blood to pool
Scintigraphy
Full thickness perforation of the esophagus after a sudden rise in intraesophageal pressure?
Boerhaave’s syndrome
What kind of anemia is H. pylori infection is associated with?
iron-deficiency anemia
most common cause of dyspepsia?
70% no definite findings on endoscopy
Biomarker more specific to pancreatic injury and remains elevated for longer after the onset of symptoms ?
Lipase
Most complication of gallstone disease?
Biliary colic
Most sensitive and specific serum marker of choledocholithiasis?
Abnormal y- glutamyl transpeptidase
the decompression procedure of choice for patients with cholangitis?
endoscopic retrograde cholangiopancreatograohy
gall bladder wall infection more common in diabetic older patients?
Emphysematous chiolecystitis
Classic radiographic findings of small bowel obstruction, pneumobilia and ectopic gallstone
Gallstone ileus
hallmark of liver failure?
Hepatic Encephalopathy
biomarker more specific to hepatocyte inury?
Alanine aminotransferase
Ascitic fluid aspirate with a total wbc >1000/mm3 or neurtophil count >250/mm3 points to what condition?
Spontaneous bacterial peritonitis
One of the most common causes of hepatocellular carcinoma?
Hepatitis C virus
Recommended albumin dose for every ascites fluid removed that is greater than 4L?
IV albumin 6-8 mg for every liter of fluid removed
First line of treatment for Spontaneous Bacterial Peritonitis?`
Cefotaxime
What stage of Hepatic encephalopathy presents with stupor hyperreflexia, extensor plantar reflexes
Stage III (Stage I- general apathy, stage II- lethargy, drowsiness, variable orientaiton, asterixis, Stage IV-coma)
Current Mainstaty of treatment for hepatic encephalopathy?
Lactulose (oral: 20 gm in glass of water or 300 mL syrup in 700 cc of water or NSS via rectum)
What is the thrombotic obstruction of the post hepatic portal venous system , has both acute and chronic presentation that progress from abdominal pain and hepatomegaly through ascites?
Budd-Chiari Syndrome or Hepatic Vein thrombosis
The most common position for routine digital reactal examination and anoscopy?
Lateral sims position
Findings that include painless, bright red rectal bleeding and defecation
internal hemorrhoids
Presents as tearing pain with defecation and rectal bleeding but invariably subsides between movements?
Anal fissures
Characterized as anal pain, spasm and itching with out without bleeding?
Cryptitis
Condition producing painless, blood stained mucus, peri-anal itching and malodorous discharge associated with throbbing pain that is constant and worsened by sitting, moving and defecation?
Fistula- in- ano
Most common location of anorectal abscess?
perianal
the only typer of anorectal abscess that can be adequately treated in the ED?
Isolated perianal abscess
May appear as painless, maroon colored protruding anal mass with possible mucus and blood.
Rectal prolapse
Third most common site of malignatn melanoma?
anal canal
Common cause of pruritis ani in children?
Pinworms ( enterobius vermicularis)
Most common location of abscessed pilonidal sinus
Posterior midline over the sacrum and coccyx
Results from the blockage of perianal surface containing hair follicles and apocrine sweat glands
Hidradenitis suppurativa
Earliest cause of post op fever in General Surgical Patients?
Atelectasis
rectal prolapse can occur after any anorectal surgery and likely is related to what injury?
Puborectalis muscle
Diagnostic of choice as initial imaging modality in both pregnant females and children with suspected acute appendicitis>?
Graded Compression USD
Treatment for immunocompetent patients that have CT-confirmed, uncomplicated acute diverticulitis with mild symptoms and without systemic red flags?
Observation without antibiotics
Most common cause of cause of small bowel obstruction?
Adhesions after abdominal surgery
Most common cause of post renal AKI in the elderly?
Prostatic hyperthrophy
Medications that causes arterial changes precipitating significant AKi in a patient with undiagnosed bilateral renal artery stenosis?
Angiontensin converting ezyme inhibitors
Criteria for witholding metformin in patients for IV Contrast imaging?
GFR < or = to 30 ml/mon/ 1.73 m2 at the tim of contrast infusion and 48h post procedure
Most common reasons for emergent dialysis?
Fluid overload Hyperkalemia Severe acid base disturbance
Most common reason for non emergent dialysis?
UREMIA
Most frequent neurologic manifestationsn of ESRD, associated with greater lower limb involvement
Peripheral neuropathy
Most common cause of heart failure in ESRD patients?
Hypertension
Treatment of choice for bleeding diasthesis in ESRD patients?
Desmopressin 0m3 mcg/kg IV or SC or Cryprecipitate 10 u over 30 min or Conjugated estrogens 25 mg IV or 6mg/kg/d or Tranexamic Acid
Most common complications of hemodialysis vascular access?
Failure to provide adequate flow Infection
Most common organism causing Dialysis Catheter related infection?
S. AUREUS
Branham Sign in ESRD indicates what condition?
High output failure
Most frequent complication of hemodialysis occuring during 50 % of treatment?
Hypotension
A clinical syndtome occuring at the end of dialysis and is characteristized by nausea and vomiting and hypertension which can progress to coma and death?
Dialysis disequilibrium
Most common complication of peritoneal dialysis?
Peritonitis
Most common causative organisms that cause peritoneal dialysis access Site complication
S. AUREUS and PSeudomonas aeruginosa
First Line of treatment for uncomplicated UTI in Adult female?
Nitrofurantoin 100 mg BIDx 5days TMX-SMZ ( 160/800 mg ) 1 tab BIDx 3 days Fosfomycin
First line of treatment for asymptomaric bacteriuria and simple cystitis in pregnant px?
Amoxicillin 500 mg TID x 3-7days Cefalexin 500 mg 2-4 x 3-7days
Is a true urologic emergency, there is an inability to reduce the proximal foreskin distally over the glans penis into its natural position
Paraphimosis
How many houfs should surgery be done in a patient with a fractured penis?
8 hours
Painless pathologic erection of the penis secondary to traumatic fistulae between cavernosal artery.and corpus cavernosum
Non- ischemic priapism
Characterized as asymptomatic testicular mass with firmness or induration?
Testicular malignance
Most common cause of staghorn calculi
struvite stones
Present as a pelvic mass caused by growth pf ectopic endometrial tissue with an ovary and usually contain thick brown fluid
Endometrioma’s
Most dreaded complications of ovarian hyperstimulation syndrome
Venous and arterial thrombosis
Ultrasound finding of ovary more than 4 cm associated with lower abdominal pain tenderness, guarding, unilateral adnexal tenderness on bimanual examination, points to what condition?
Ovarian torsion
Absolute levels of this hormone are lower in pathologic pregnancies and fall when pregnancy fails?
Progesterone
Most commonly used medical therapy for uncomplicated ectopic pregnancy?
Methotrexate 50 mg/m2 as single IM Dose
most common cause of fetal loss?
Chromosomal abnormalities
Treatment for pregnant women with vaginal bleeding who are Rh negative?
Rh0 D immunoglobulin
early sign of starvation in patients suffering from hyperemesis gravidarum
Ketonuria
Goals for maintaining euglycemia in pregnant DM Patients?
FBS of < or = to 95 mg/dL 2hour Postprandia;l glucose concentraion: < or = 120 mg/dL (6.66 mmol/L)
First line for insulin treatment in pregnant women?
Neutral protamine Hagedorn (NPH) insulin: 0.7 U/kg/d in 1st trimester then 1 U/kg/d in 3rd trimester
Only antiarrhythmic beta blocker drug classified as Class D for Pregnant patients
Atenolol
Most common non sinus tachycardia in women of child bearing age
Paroxysmal supraventricular age
Most common cause of pregnancy related acute myocardial infarction?
Spontaneous coronary artery dissection
third most common cause of non obstetric maternal death?
Subarachnoid hemorrhage
first-line agent for chronic hypertension in pregnancy?
Labetalol 100 mg PO twice daily
Inpatient treatment for postpartum endometritis?
Clindamycin 900 mg q8h plus Gentamicin 5mg/kg q24h
Most common cause of vaginitis in acutely symptomatic women?
Bacterial vaginosis
Right upper quadrant pain, occasionally high elevated transaminases in women with lower abdominal pain, abnormal vaginal discharge, poistcoital bleeding
Fitz-Hugh-Curtis syndrome
Most common causative agent of puerperal mastitis?
S. aureus
Presents as recurrent multiple abscess, sinus tracts and scarring of the breast folds, axillae, groin perineum
Hidradenitis suppuritiva
Most specific EKG finding for acute pericarditis?
PR depression also seen Concave ST Depression
Most common cause of atraumatic hip pain in children?
Transient synovitis
Causative organism that causes severe malaria, cerebral malaria and blackwater fever?
Plasmodium falciparum
Central cyanosis infants indicates at least how much of hemoglobin present?
4-5 grams/dL
Presents as persistent respiratory distress at birth with a “seesaw” side to side respiratory pattern due to the severely hypoplastic ipsilateral lung, with abdomen appears as scaphoid.
Congenital diaphragmatic hernia
Vasopressor of choice in children? Dosage?
Epinephrine 0.1-0.1 mcg/kg/min
Most commonly injured solid organ in children im abdominal blunt trauma?
Spleen
Most common lumbar spine fracture associated with intrabdominal injury?
Chance Fracture
Most common cause pf neonatal pneumonia?
Group B Streptoccocus
Characterized by constipation weak cry, and feeding difficulties with late symptoms of ocular palsies, apnea, weakness or hypotonia and lethargy in a neonate
Infantile botulism
Defined as paroxysm of crying for > 3 days per weeks over a 3 week period in neonates without any physical or laboratory abnormalities?
Infantile colic
Leading cause of viral meningitis worldwide
Enteroviruses
Most common acute complication of otitis media?
Tympanic membrane perforation
First line of treatment for pediatric otitis media?
Amoxicillin 45 mg/kg per dose 2x a day
initial management of Otitis media with effusion that is uncomplicated in children?
Watchful waiting as it will resolves spontaneously
Presents as otalgia, Itching, sense of fullness, tenderness of tragus/ pinna, diffuse ear canal edema and/or erythema? Treatment?
Otitis Externa Topical ofloxacin or ciprofloxacin
Advance mastoiditis may cause nerve palsies of which cranial nerves?
CN VI and VII
Uncorrected strabismus can lead to what condition?
Amblyopia
A positive Hirschberg test would indicate?
True strabismus
Inpatient treatment for dacrocystitis?
Cefuroxime IV or Cefazolin IV or CLindamycin IV
Characterized by eyelid or periorbital inflammation accompanied by proptosis, impaired EOMs, pain with eye movement, decrease visual acuity, chemosis and afferemt pupillary defect?
Orbital cellulitis
expected corneal diameter of children <1 year of age
should not have corneal diameter of >12mm
pathognomonic of abusive head trauma
Retinal hemorrhage
Most common predisposing factor for acute sinusitis?
Diffuse mucositis secondary to viral rhinosinusitis
Most common origin of epistaxis in the pediatric age?
Kiesselbach plexus
Presents in adolescents as profuse unilateral epistaxis that requires packing?
Juvenile nasal angiofibroma
Most common causative agent for Herpangina?
Coxsackie A and B
Most common presentation of primary herpes in children?
Acute herpetic gingivostomatitis
Most common cause of acute viral pharyngitis? treatment?
Epstein Barr virus Treatment is mainly supportive
Centor Criteria for likelihood of Group A B-hemolytic Streptoccocus Pharyngitis?
Tonsillar exudates Tender Anterior Cervical Adenopathy Absence of Cough History of fever
Treatment of Choice for Group A B-hemolytic Streptoccocus Pharyngitis?
Penicillin V 250 mg BID x 10days, Amoxicillin 50 mg/kg Once a day or Benzathine Pen G (<27kg= 600,000U, >27Kg=1.2U)
Causative agent associated with retropharyngeal abscess and Lemierre syndrome?
Fusobacterium Necrophorum
Permanent teett hat has become avulsed must be implanted in how many minutes?
5 minutes
Treatment for Acute necrotizing gingivitis with systemic symptoms?
local debridement and Pencillin or metronidazole
most common childhood malignancy of the head and neck?
Lymphoma
Most common neonatal laryngeal problems resulting from a developmentally weak larynx
Laryngomalacia
First line of treatment for croup?
Nebulized epinephrone and corticosteroids
A child who will not fully extend his or her neck to look up points to what condition?
Retropharyngeal abscess
infective agent causing Hacking dry cough, headache sore throat, wheezing in school age children and associated with extrapulmonary symptoms
Mycoplasma pneumonia
Most common cyanotic heart lesion manifesting in the newborn period?
Transposition of great arteries
Acyanotic heart disease that is characterized by decreased pulses in the lower extremities
Coarctation of the aorta
What syndrome is characterized by supravalvular aortic stenosis, elfin facies, mental retardation, and pulmonary stenosis?
William’s syndrome
Inotrope of choice for improving cardiac contractility in congestive heart failure pediatric patients that are stable
Digoxin
When does coronary artery aneurysm develop in patients with Kawasaki disease?
3rd and 4th weeks
Most common type of syncope in children
Neurogenic syncope
Results from abnormal development of the sensory and autonomic ganglia, due to a genetic defect that inhibits neurotransmitter production and is the most common pediatric autonomic disorder
Riley-day syndrome
Pathognomonic electrolyte abnormalities in Pyloric stenosis?
Hyponatremic, hypokalemic hypochloremic metabolic alkalosis
What drug is contraindicated in children <2 years for those with bloody stools and suspected bacterial gastroenteritis from Salmonella, Shigella, Campylobacter?
Loperamide
Most common cause of Hyponatremia in children?
Iatrogenic complication of IV Fluid therapy
Pneumatosis intestinalis ( air in the bowel wall) and portal venous gas are both pathognomonic of what condition in a pediatric patient?
Necrotising enterocolitis
Most common cause of acute intestinal obstruction in children under 2 years of age presenting as colicky abdominal pain, vomiting, bloody stools
Intussuscpetion
Drug of choice for esophageal variceal bleeding in patients whom endoscopy can not be performed?
Octeotride ( 1-2mcg/kg bolus up to 50 mcg followed by 1-2 mcg/kg/h infusion
Pediatric fracture with a very low incidence of growth disturbance?
Salter-Harris Type I Fractures
Compressive forces that result in a bulging or buckling of the periosteum in children?
Torus fractures
Bowing and bending fractures that are exclusively limited to the forearm and lower leg bones associated with pain out of proportion to physical examination?
Plastic deformities
Fractures in infants and toddles strongly linked to child abuse?
Spiral oblique fractures of the humeral diaphysis
What is commonly injured in spiral fractures of the humeral diaphysis in children?
Radial nerve
Most common elbow fracture in children, and it’s common type?
Supracondylar fracture extension fracture
The dislocation of the radial head (proximal radioulnar joint) with fracture of the ulna
Monteggia fracture-dislocation
Fracture of the distal third of the radial head accompanied by the dislocation of the radioulnar joint?
Galeazzi-fracture
Characterized by slipping of the femoral epiphysis of the hip that presents with hip (groin) pain, or pain referred tot he thigh or to the knee?
Slipped capital femoral epiphysis
What structures are injured when theres is distal femoral metaphysis?
Popliteal artery and peroneal nerve
Pediatric patients with this condition is noted to have high grade fever, CRP >20 mg/L, leukocytosis (>12,000 cells/mm3), severe pain, tenderness on palpation, spasm and refusal to walk?
Acute septic arthritis
Most common cause of acute hip pain in children less than 10 years of age?
Transient synovitis of the hip
Pediatric disorder causing intermittent pain and tenderness over the anterior aspect of the knee and tibial tuberosity?
Osgood- Schlatter Disease
Pediatric disorder associated with nonmigratory mono- or oligoarthritis after a infection of the pharynx?
Poststreptococcal reactive arthritis
Treatment of choice for Tinea capitis?
Griseofulvin
Painless, indurated sharply demarcated, red smooth base appearing 2-4 weeks on the genitals?
Primary syphilis
Most widely used neuraminidiase inhibitor against influenza virus
Oseltamivir 75 mg BID x 5days
This condition mimics an autoimmune event with lymphadenitis, fever and other symptoms after beginning ART often during tubercolosis therapy
Immune reconstitution syndrome
Most common CNS complication of Infective Endocarditis?
Embolic stroke involving the middle cerebral artery
C. Tetani exotoxin that causes the clinical manifestations?
Tetanoplasmin
Centrally mediated motor hyperexcitability with persistence and intense spasms in the proximal lower limbs and lumbar paraspinal muscles?
Stiff person syndrome
Contraindicate vaccines in patients with AIDS?
Oral polio vaccine Smallpox Vaccine Live attenuated influenza vaccine
Most common agent required as additional treatment to eradicate P.vivax and ovale hypnozoites from the the liver?
Primaquine Phosphate
Most common bacterial waterborne illness associated with Guillain Barre syndrome
Campylobacter
Parasitic infection causing dysuria, frequency, terminal hematuria and possibly, squamous cell CA of the bladder?
Schistosoma haematobium
Chronic non fatal filirial disease leading to subcutaneous skin changes and blindness?
Onchocerciasis
Patient experiences recurrent bouts of fever lasting 2-3 weeks associated with warmth and tenderness overlying a lymphatic vessel followed by retrograde lymphangitis
Lymphatic filariasis
Patients experience lancinating pain at the back of the head, stabbing or electric shock like in quality ?
Occipital neuralgia
Treatment for Pseudomotor cerebri?
Oral acetazolamide
Most common area of intracerebral hemorrhage?
Putamen (Thalamus, pons, then cerebellum )
Condition presenting with dizziness, vertigo, occipital headache, diplopia and other visual disturbance, with neck pain or face pain
Vertebral Aryery dissection
The only laboratory test result prior to thrombolytic therapy?
Bedside glucose
Dose for thromobolytic therapy in ellegible stroke patients?
IV alteplase 0.9 mg/kg IV max of 90 mg, 10% of the the dose as IV bolus over 1 minute then the remaining infused over 60 minutes
Dyssynergia, dysmetria, dysdiadochokinesia (clumsy rapid movements) may indicate what cerebellar lesion?
Lateral cerebellar lesion
Ear pain, tinnitus and hearing loss onset 1 or more days before vertigo?
Labyrinthitis
Vertigo and hearing loss after head trauma or pressure changes to the middle ear?
Perilymph fistula
Abnormal head impulse test due to infection of the labyrinth may indicate what condition?
Anterior inferior cerebellar artery stroke
Ascending symmetric weakeness or paralysis and areflexia or hyporeflexia occuring after a viral or bacterial illness?
Guillan Barre syndrome
Treatment for Guillan Barre Syndrome?
IV Ig and plasma exchange
What diagnostic modality is warranted when patient presents with facial paralysis sparing the forehead or inability to abduct the eye?
CT scan of the brain to rule out stroke
Occurs in cyclists from prolonged compression of the wrist against the handlebars
Guyon’s canal syndrome
Most common site of plexopathy?
Brachial plexus
Patient presents with descending symmetric paralysis, no sensory deficit, no pain and pupils are often dilated and non reactive to light?
Botulism
Primary treatment for diabetic neuropathy?
Pregabalin
Presents with rapidly progressive limb weakness, monotonal speech, muscle atrophy, fasciculation and hyperreflecia but without other CNS dysfunction
Amyotrophic lateral sclerosis (Lou Gehrig’s disease
Most common presentinf symptom of Myasthenia Gravis?
Ptosis and diploplia
Treatment for controlling symptoms and preventing myasthenic crisis?
Prednisoen with or without azathioprine
Presents with muscle fascicualtions, respiratory depression, salivation, lacrimation, urinary incontinence, diarrhea, GI upset and emesis, miosis,bronchial secretions
Cholinergic crisis
Presents with paresthesias, gait difficulty, extremity weakness, poor coordination, vision disturbance that often occur with a relapsing ang remitting clinical course
Multiple sclerosis
Most commmon area of the brain affected by Parkinson’s Disease
substansia nigra
Contraindication for lumbar puncture in patients with bacterial meningitis?
Platelet count of < or equal to 20,000/uL or INR> or equal 1.5
Chemoprophylaxis for those exposed to patients with confirmed N. Meningitidis and H. Influenza bacterial meningitis?
Rifampin 10 mg/kg q6H x 4 doses or Ciprofloxacin 500 mg single doseor ceftriaxone 250 mg IM once
Triad of back pain, fever and neurologic symptoms?
Epidural abscess
Chronic vasculitis commonly seen in young Asian women>
Takayasu’s Arteritis
What condition is associated sudden blindness, jaw and tongue claudicaion?
Giant cell arteritis
Treatment of refractory hypoglycemia secondary to sulfonylureas?
Octeotride 50-100 ug SC
Treatment of cerebral edema as a complication of DKA Treament?
Mannition 1g/kg
Most common cause of acute adrenal insufficiency?
Prolonged steroid used with abrupt steroid withdrawal or exposure to stress.
An infection of the nail fold?
Paronychia
Kanavel’s four cardinal signs of flexor tenosynovitis?
Percussion Tenderness Uniform Swelling Intense Pain Flexion Posture
What condition is associated with the inflammation or scarring of the flexor sheath resulting in impingement and snap release of the tendon as the finger is extended froma flexed position?
Trigger finger
Pain during a finkelstein test is indicative of what condition?
DeQuervain tenosynovisits
Characterized by increase inflammation or infection of the lateral or medial aspects of the toenail?
Onychocryptosis
Characterized by pain on the plantar surface of the foot worsened by walking and tenderness over the anterior medial calcaneus worsened by dorsiflexion of the toes?
Plantar fascities
What condition is associated with numbness or burning of he sole or heel worsening at night after running or standing?
Tarsal tunnel syndrome
Absence of plantar flexion with squeezing of the calf indicates what condition?
Achilles tendon rupture
Characterized by burning cramping or aching over the metatarsal head and numbness in the toe
Morton Neuroma
What condition presents with schizophrenia signs and symptoms for less than 6 months?
Shizophreniform disorder
Characterized by persistent worry or tension without discrete panic attacks for at least 6 months?
General anxiety disorder
Recommend emergency contraception if there is suspected sexual assault
Levonorgestrel 1.5 mg PO in single dose (available OTC) or ulipristal acetate 30 mg PO single dose
Recommended STD Prophylaxis regimen when there is suspected sexual assault
Ceftriaxone 250 mg IM SIngle dose PLUS Metronidazole 2 g PO PLUS Azithromycin 1g PO or Doxycycline 100 mg PO BID x 7days
Conditions most commonly associated in IV drug users who practice “pocket shooting”?
Pneumothorax and hemothorax
Common cardiac site affected in Injection drug users with endocarditis?
Right sided hear involving the tricuspid valve
It is characterized by sudden onset of petechiae or purpura weeks after an infectious illness in pedia patients?
Idiopathic thrombocytopenic purpura
what condition is characterized by severe decrease in platelets, severe microangiopathic hemolytic anemia with red cell fragmentation, transient neuro deficits, renal failure and fever
Thrombotic Thrombocytopenic Purpura
Most common presentation of Sickle Cell Vasoocclusive Crisis
Ischemic musculoskeletal pain (next is abdominal pain)
