Rosh Flashcards
Difference in strep vs mono on exam
B/l posterior lymphadenopathy (atypical WBCs, rash after abx)
Strep is anterior
PPH first two steps
1.Massage
2. Oxytoxcin 5 Unit bolus
Rule out retained prodcuts, vaginal trauma, DIC, uterine rupture
Ehrlichia LAbs
leukopenia, thrombocytopenia, Transmainits
Gram neg bacilli
Spinal epidural abscess Lab test highly sensitive
ESR
Not white count or Fever
Presentation MC in Giant biopsy
Jaw claudication
ALL
AML
CLL
CML
ALL- KIDS MC
AML- normo/normo anemia, leukocytosis, thrombocyopenia Auer rods, older
CLL- older, anemia, thrombocytopenia, lymphadenopahthy, splenomegaly
CML-PMNs leukocytosis
visceral bias
availabitly bias
confirmation bias
diagnosis momentum
Bad case then you miss easy info on next patient
recent memory of diagnosis
looking to confirm your own reconcetions
acecting another docotrs handoff and framing of the case
omissions bias- looking at actions as worse than equally bad omssions or inactions
what is the one idncation to use sodium bicarb in acidosis >7.1 (not severe)
AKI- reduces need for dialysis at 30 days
give 3% to Na levesl of…
Less than 110
or
Less than 120 with symptoms
is placental abruption painful
yes
Constipation, weakness in baby tx
<1 baby big form human for Ig
>1 is equine anti-toxin
acute alcohlic hepatiits with liver failure charactersitics tx
supportive care
MC type of hernia
Inguinal for men AND women!
femoral more common in womean but not as common as inguinal
Ketosis without acidosis…
isopropyl alcohol
normal pH, ketosis
tx is supportive
breaks down to acetone
elevated osmol gap ONLY!
anion gap acidosis with resp alkosliss
ASA OD
Sodium Bicarb
BUN >60 with chest pain tx
Hemodilaysis for percarditis
When do you ID perianal abscess, when do you gvie Abx after?
If simple perianal, does NOT involve rectum
DM, comorbids, assocaited cellulits
if rectum then OR drainage (dont need OR for bad diabetcis and perianal abscess)
Wide complex arrythmia after cocaine, tx?
Sodium Bicarb
Mlaignnat otits externa dx and tx
CT
Cipro +/- cefepime
Looks like SJS, but over multiple months- what is it?
Pemhisgus vulgaris
IgG deposition
bullous pemhogoid is nikolsky negative
post partum dizziness, elecytorlye deficienes =
PPH> pituitary apoplexy
what are the two long acting insulins,
detemir and glargine
detemir can peak and needs observation
ubicial cord prolapse treatment
raise fetal part
downward dog
trendelnburg
c section
UV keratits tx
Cycloplegics
Abx
optho follow up
prakland forumla
4XTBSAXKg
What do you need to make needle cric
5 3 16
5ml syringe w/ al ittle water in there
3 ETT adapter
16 guage needle
MC bug otitis externa
pseudmonas
then staph aureus and epidermidis
Highest predictor of HEart failure on physical exam
S3 sound
lead level for chelation therapy?
70
toxo vs cns lyphoma
RING + lots= toxo
solid 1 OR 2= CNS lymphoma
when to give steroids in PCP PNA for Pa gradient Less than
70
or >35 AA
kid, racoon eyes, abd distention and mass, twitching/eye movements =
Neruoblastoma
opsoclonus, myoclonus
Drinking collegeu always do this
Report to the state health program - dont confromnt him
ASA OD HD indications
lvl 100
AMS
Acidemia
Kidney or liver failure
pulm edema
AIDS, purple coalsecing rash - Tx
HSV KAposia sarcoma
Radiation and chemo!
Kid with recent sinusitis, no Ataxia, FND but no signs of meningitis
CT head for brain Empyema
MC cause of gross hematuria in alll ages and kids
UTI
Bladder cancer for adults #2
Or post infectious neprbtiis for kids
Level where things get stuck in kids
C6
Cricopharygenous muscle
Epistaxis on warfarin, stopped, no
Posterior, next step if INR is 5.2?
2.5 mg K hold next dose
Of warfarin
Just got up to altitude with acute mountain sickness - first line tx
Acetazolamode! Even for run in the mill
Of severe or cerebral edema then Dex
Which bacteria causes HUS stuff?
EHEC
Dental abscess ABx first line and second line
Augmentin plus flagyl
Or clinda plus levo
MC skull fracture bone in kids
Parietal bone
8 yr old GIRL, pushes herself to get up, lower extremity weakenss, nail changes, rash near eyes… Dx Tx
juvenile dermatomyositis
steroids
Very common for IUDs to be out of place and cause pain
thats it
neonatal lip smaxking for hours…
give phenobarb
then full work up and admit - not EEG first
Tx of preseptal cellulitis
CLinda
Augmentin
staph and strep coverage
severe malaria tx?
artusenate
Red flag that needs urgent follow up for patella fx
Extensor mechanism for straigth legraise
HYpermag tx
Fluids, diuretics, Calcium
If AMS, Renal failure, paralysis= HD
Dysrhtmia, paralysis, respiratory failure (RR low) and death
MC ankle lig sprain
ATFL
MC bactermia bug in old ppl?
E coli- from UTI
Supr unstable vitals but awake, tamponade- THoracotomy or consult surgery?
Consult surgeyr
Chillblains is damp an dnon frezzig temp
Frost bit needs to be frezzing - supprotive care for threse
Carcinoid syndrome Tx
Octreatoide to sto psomatostatin receptors
If there is a cremsasteric reflex that is the most sensitve to rule out torsion
looks like zoster but no rash..
pain precedes the rash- still can be it
MC bug in SBP?
Klebsiella or E coli
250 PMNs on fluids
Does a TIA have a time frame or show up on MRI
NO
NO
FND that resolves and no sign on MRI
Reactivation TB Tx
RIPE
ear hematoma tx
ID, pressure, follow up in 1 week- usualy for big ones
if small maybe needle but generally wrong answerr on test
hyphema tx
what do you do with sicklers
timolo first
avoid acetazolamide!
vWF vs hemophila
vWF is all platelt bleeding so epistaxis and ginigival - n ohemarthrosis
Down out an dblown pupil on one side get…
CTA - anwuyrm for oculmotoer nerve palsy - PCA
hypermeesis gravidaru
first is b6 and doxyalmine
then benadryl, meclizine, dimenhydrante
third line is zofran d and reglan
5% eight loss or ketonuria/hypoK is big deal
pseydomembranous colitis tx
oral vanc for c diff
first line for IIH
Acetazlomaide
orbital blow ou tfx w/ entrapment treatment-
abx
outpatient optho in 2 days
onyl surgery if visioj changes or retrobulbar hemaatoma
sux copntraindications
spina cord damage up to 3 months
burns greater than 5 days
muscle stuff
GBS
when to prophylaxis against N menignitis
Hoiusehold contacts
healthcare workers with direct mucoasl contact and thats it
rifampin
BRUE send home for low risk
> 32 weeks gest
609 days old
less than a minmute
+++
psgn tx
Loops- mostly if resp symptoms!
anti-htn
HD
if nrphtic syndrome with protein in urine then prednisone!
seizure and then bradycardia an dhypotension after yuou givew what AED?
phenytoin– propylene glycol if too pushed too fast
mononuclear predominance on CSF is for what infection
fungal
Diarrhea pearls
osmotic, infectious or infalmmatory
oral rehdyration first, it promost coloncytes to function properly and gut integrity
IV only if cant tolerate PO
antidirrheals are avoided
antiboics in severe cases, old, immunocompromosed with cipro
idf fatty or foul smelling then add flagyl for giardia
Bad ekg, better symtpoms now - how do you tx wellens
Cath now
or heparin, trops, admit and early cath tomorrow
cath tomorrow , treated as NSTEMI
cant see bleed on epistaxis- ant or post packing
post
quicke or whitacre needle better for post lp headaches?
whitacre
lightning stuff
MC is TM ruptrue and Cataracts!
rare rhabdo and deep burns
asystole most common not VF
trigeminal meurlagaia tx
carbamazapine - yes we give that not prednisone here
cirrhosis MC complication GIB or asictes
ascites
neutropenic fever cut off reg and severe
1500
500
spontaneous pneumomediastinum Dispo
DC home if stable?!
spontaneous cartoid artery dissection tx
TPA?! if FND present
usualy after some sort of weird movement or exertion
allen test bullshit
ulnar artery needs to be released and show perfusion
if you relesease radial artery and it perfuses that does no good bc youneed collaterall flow from ulnar
superior vena cava syndrome either fro mclot or malignancy
malignancy
4 things on tet fallot
RVH not left!
RVOFTO
VSD
overriding aorata
climber with elbow pain
over use syndromem like meidal epicondultitis for tenonopathy
not bursitis