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Boards > Rosh > Flashcards

Rosh Flashcards

1
Q

Difference in strep vs mono on exam

A

B/l posterior lymphadenopathy (atypical WBCs, rash after abx)
Strep is anterior

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2
Q

PPH first two steps

A

1.Massage
2. Oxytoxcin 5 Unit bolus

Rule out retained prodcuts, vaginal trauma, DIC, uterine rupture

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3
Q

Ehrlichia LAbs

A

leukopenia, thrombocytopenia, Transmainits

Gram neg bacilli

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4
Q

Spinal epidural abscess Lab test highly sensitive

A

ESR
Not white count or Fever

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5
Q

Presentation MC in Giant biopsy

A

Jaw claudication

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6
Q

ALL
AML
CLL
CML

A

ALL- KIDS MC
AML- normo/normo anemia, leukocytosis, thrombocyopenia Auer rods, older
CLL- older, anemia, thrombocytopenia, lymphadenopahthy, splenomegaly
CML-PMNs leukocytosis

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7
Q

visceral bias
availabitly bias
confirmation bias
diagnosis momentum

A

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

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8
Q

what is the one idncation to use sodium bicarb in acidosis >7.1 (not severe)

A

AKI- reduces need for dialysis at 30 days

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9
Q

give 3% to Na levesl of…

A

Less than 110
or
Less than 120 with symptoms

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10
Q

is placental abruption painful

A

yes

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11
Q

Constipation, weakness in baby tx

A

<1 baby big form human for Ig
>1 is equine anti-toxin

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12
Q

acute alcohlic hepatiits with liver failure charactersitics tx

A

supportive care

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13
Q

MC type of hernia

A

Inguinal for men AND women!
femoral more common in womean but not as common as inguinal

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14
Q

Ketosis without acidosis…

A

isopropyl alcohol
normal pH, ketosis
tx is supportive
breaks down to acetone
elevated osmol gap ONLY!

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15
Q

anion gap acidosis with resp alkosliss

A

ASA OD
Sodium Bicarb

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16
Q

BUN >60 with chest pain tx

A

Hemodilaysis for percarditis

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17
Q

When do you ID perianal abscess, when do you gvie Abx after?

A

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)

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18
Q

Wide complex arrythmia after cocaine, tx?

A

Sodium Bicarb

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19
Q

Mlaignnat otits externa dx and tx

A

CT
Cipro +/- cefepime

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20
Q

Looks like SJS, but over multiple months- what is it?

A

Pemhisgus vulgaris
IgG deposition

bullous pemhogoid is nikolsky negative

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21
Q

post partum dizziness, elecytorlye deficienes =

A

PPH> pituitary apoplexy

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22
Q

what are the two long acting insulins,

A

detemir and glargine
detemir can peak and needs observation

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23
Q

ubicial cord prolapse treatment

A

raise fetal part
downward dog
trendelnburg
c section

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24
Q

UV keratits tx

A

Cycloplegics
Abx
optho follow up

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25
Q

prakland forumla

A

4XTBSAXKg

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26
Q

What do you need to make needle cric

A

5 3 16
5ml syringe w/ al ittle water in there
3 ETT adapter
16 guage needle

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27
Q

MC bug otitis externa

A

pseudmonas
then staph aureus and epidermidis

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28
Q

Highest predictor of HEart failure on physical exam

A

S3 sound

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29
Q

lead level for chelation therapy?

A

70

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30
Q

toxo vs cns lyphoma

A

RING + lots= toxo
solid 1 OR 2= CNS lymphoma

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31
Q

when to give steroids in PCP PNA for Pa gradient Less than

A

70
or >35 AA

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32
Q

kid, racoon eyes, abd distention and mass, twitching/eye movements =

A

Neruoblastoma
opsoclonus, myoclonus

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33
Q

Drinking collegeu always do this

A

Report to the state health program - dont confromnt him

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34
Q

ASA OD HD indications

A

lvl 100
AMS
Acidemia
Kidney or liver failure
pulm edema

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35
Q

AIDS, purple coalsecing rash - Tx

A

HSV KAposia sarcoma
Radiation and chemo!

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36
Q

Kid with recent sinusitis, no Ataxia, FND but no signs of meningitis

A

CT head for brain Empyema

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37
Q

MC cause of gross hematuria in alll ages and kids

A

UTI
Bladder cancer for adults #2
Or post infectious neprbtiis for kids

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38
Q

Level where things get stuck in kids

A

C6
Cricopharygenous muscle

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39
Q

Epistaxis on warfarin, stopped, no
Posterior, next step if INR is 5.2?

A

2.5 mg K hold next dose
Of warfarin

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40
Q

Just got up to altitude with acute mountain sickness - first line tx

A

Acetazolamode! Even for run in the mill
Of severe or cerebral edema then Dex

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41
Q

Which bacteria causes HUS stuff?

A

EHEC

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42
Q

Dental abscess ABx first line and second line

A

Augmentin plus flagyl
Or clinda plus levo

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43
Q

MC skull fracture bone in kids

A

Parietal bone

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44
Q

8 yr old GIRL, pushes herself to get up, lower extremity weakenss, nail changes, rash near eyes… Dx Tx

A

juvenile dermatomyositis
steroids

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45
Q

Very common for IUDs to be out of place and cause pain

A

thats it

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46
Q

neonatal lip smaxking for hours…

A

give phenobarb
then full work up and admit - not EEG first

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47
Q

Tx of preseptal cellulitis

A

CLinda
Augmentin

staph and strep coverage

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48
Q

severe malaria tx?

A

artusenate

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49
Q

Red flag that needs urgent follow up for patella fx

A

Extensor mechanism for straigth legraise

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50
Q

HYpermag tx

A

Fluids, diuretics, Calcium

If AMS, Renal failure, paralysis= HD

Dysrhtmia, paralysis, respiratory failure (RR low) and death

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51
Q

MC ankle lig sprain

A

ATFL

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52
Q

MC bactermia bug in old ppl?

A

E coli- from UTI

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53
Q

Supr unstable vitals but awake, tamponade- THoracotomy or consult surgery?

A

Consult surgeyr

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54
Q

Chillblains is damp an dnon frezzig temp

A

Frost bit needs to be frezzing - supprotive care for threse

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55
Q

Carcinoid syndrome Tx

A

Octreatoide to sto psomatostatin receptors

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56
Q

If there is a cremsasteric reflex that is the most sensitve to rule out torsion

A
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57
Q

looks like zoster but no rash..

A

pain precedes the rash- still can be it

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58
Q

MC bug in SBP?

A

Klebsiella or E coli

250 PMNs on fluids

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59
Q

Does a TIA have a time frame or show up on MRI

A

NO
NO

FND that resolves and no sign on MRI

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60
Q

Reactivation TB Tx

A

RIPE

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61
Q

ear hematoma tx

A

ID, pressure, follow up in 1 week- usualy for big ones

if small maybe needle but generally wrong answerr on test

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62
Q

hyphema tx
what do you do with sicklers

A

timolo first
avoid acetazolamide!

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63
Q

vWF vs hemophila

A

vWF is all platelt bleeding so epistaxis and ginigival - n ohemarthrosis

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64
Q

Down out an dblown pupil on one side get…

A

CTA - anwuyrm for oculmotoer nerve palsy - PCA

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65
Q

hypermeesis gravidaru

A

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

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66
Q

pseydomembranous colitis tx

A

oral vanc for c diff

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67
Q

first line for IIH

A

Acetazlomaide

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68
Q

orbital blow ou tfx w/ entrapment treatment-

A

abx
outpatient optho in 2 days

onyl surgery if visioj changes or retrobulbar hemaatoma

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69
Q

sux copntraindications

A

spina cord damage up to 3 months
burns greater than 5 days
muscle stuff
GBS

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70
Q

when to prophylaxis against N menignitis

A

Hoiusehold contacts
healthcare workers with direct mucoasl contact and thats it
rifampin

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71
Q

BRUE send home for low risk

A

> 32 weeks gest
609 days old
less than a minmute
+++

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72
Q

psgn tx

A

Loops- mostly if resp symptoms!
anti-htn
HD

if nrphtic syndrome with protein in urine then prednisone!

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73
Q

seizure and then bradycardia an dhypotension after yuou givew what AED?

A

phenytoin– propylene glycol if too pushed too fast

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74
Q

mononuclear predominance on CSF is for what infection

A

fungal

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75
Q

Diarrhea pearls

A

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

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76
Q

Bad ekg, better symtpoms now - how do you tx wellens
Cath now
or heparin, trops, admit and early cath tomorrow

A

cath tomorrow , treated as NSTEMI

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77
Q

cant see bleed on epistaxis- ant or post packing

A

post

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78
Q

quicke or whitacre needle better for post lp headaches?

A

whitacre

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79
Q

lightning stuff

A

MC is TM ruptrue and Cataracts!
rare rhabdo and deep burns
asystole most common not VF

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80
Q

trigeminal meurlagaia tx

A

carbamazapine - yes we give that not prednisone here

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81
Q

cirrhosis MC complication GIB or asictes

A

ascites

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82
Q

neutropenic fever cut off reg and severe

A

1500
500

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83
Q

spontaneous pneumomediastinum Dispo

A

DC home if stable?!

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84
Q

spontaneous cartoid artery dissection tx

A

TPA?! if FND present
usualy after some sort of weird movement or exertion

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85
Q

allen test bullshit

A

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

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86
Q

superior vena cava syndrome either fro mclot or malignancy

A

malignancy

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87
Q

4 things on tet fallot

A

RVH not left!
RVOFTO
VSD
overriding aorata

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88
Q

climber with elbow pain

A

over use syndromem like meidal epicondultitis for tenonopathy
not bursitis

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89
Q

TTP- is INR elevated?

A

NO!
FAT RN
no coagulopathy - plateltes

90
Q

took a new abx then you get an oval, violacieous, itchy spot (used to be a birth mark there)- what is it/.

A

fixed drug reation - supportive care

91
Q

MC site of oral cancer

92
Q

what is pellagra

A

niacin - Derm diarrha dementia

93
Q

B1 def
B2

A

beri beri
angular stomatiies/mouth stuff for riboflavin
niacin is b3
b6 i smouth stuff but with neruo
b5 is burning feet

94
Q

MC phys exam finding in endocarditis

95
Q

confirmatory test for botulism

A

fecal toxin

96
Q

chest pain after MVC- X ray look at

A

sternum- EKG and chest CT

97
Q

Dog bite abx no PCN

A

CLinda
Cipro
tetanus + x ray

98
Q

wound care for pressure ulcers

A

hydrogel for the ound but dry around the wound
ABx only if acitvely infected
surgery consultation if signs of necrosis such as sliugh or escar present >needs debridement

99
Q

freshly cut hay posion and tx

A

phosgene
admit for obs for supporitve care

100
Q

does a cabg or fake aortic valve need ppx before dental procedures/

A

aortic valve

101
Q

pre-pubertal female with vulvovaginitis tx

A

amoxacillin
augmenitn or clinda
from poor hygiene

102
Q

droplet vs airborne
meales
varicella
TB
influenza

A

airborne
airborne
airborne
droplet (bigger particles)

103
Q

is SSSS nikolsky +?
does it go in mouth?

104
Q

WHat is scerlodermic crisis

A

collagen everyhere- especially in kidneys
ACE -i is tx - HD if it meets crtieria for any other kidney injury

CREST Ca, Raynauds, E dys, scleordactly, telganectasia

105
Q

corneal abrasion abx for contact lens wearers

A

fluro
or
tobramycin

106
Q

this is it, CT or load the joint for joint invovlement?

107
Q

FDA approved fibromyalgia drugs

A

SSRI, SNRI, Pregabalin

108
Q

hirschprung disease Dx test

A

barium enema - biopsy to confirm

109
Q

need head ct before LP

A

FND
immunocmpromised
papilledema
New seziure
AMS

110
Q

knee dislcoation gets wha nerve`

A

peroneal nerve
Foot drop and 1/2 web space gone

111
Q

Acute chest management

A

Abx
supprotive
excahneg transfusaion (not blood transfusion)

give blood in splenic sequestration, aplastic crisis
usually below 9 hgb

112
Q

outpatient PNA tx
healthy
Risk facotrs

A

Aug, Doxy, Azithro

Aug + Doxy or azitrho OR moxifloxacin

113
Q

pressure injection injuries are determined most by pressure ot the chemical

114
Q

admit or discharge a nroma looking hisotry for aspiration?

A

admit if old

115
Q

lithium HD
and acut elithium OD tx

A

WBI!!!

lithium level is greater than 5 mEq/L, when the lithium level is greater than 4 mEq/L in the setting of renal insufficiency, and in patients who present with altered mental status, seizures or life-threatening complications regardless of their lithium level

116
Q

is atropine recomended in RSI for kids?

A

not anymore
Sux or roc can be used

117
Q

first imagaing study to get whenn suspecting a wilms tumir on a kid

A

US then CT

118
Q

cleans fish tanks with papules then shallow ulcers

A

mycobacertium marinae

119
Q

ocular chlamydia tx for neonate at days

A

oral erythmycin
IV CFTX if Gonorrhea

120
Q

INR <10
INR >10

no bleeding

A

hold next dose
hold and give po vit K

121
Q

sweling on side of face just below the ear, us goes into the mout hthru stensons duct
inpateint tx
outpatient

A

unasyn
augmentin

upproitve parotitis

122
Q

lefort fxs

A

speak no evil - teeth
see- up to nasal brindge/eyes
hear- all they way across

123
Q

Neonate gonorrhea Tx

A

Admit for IV Ceph

124
Q

oral candidiaiasis
HIV
normal patients

A

FLuconazole
nystatin

125
Q

HACE tx

126
Q

most accurate way to confirm ett placement

A

Coloiemter!

127
Q

stable PTX tx, DC or rpeat x ray in 6 hours

A

repeat x rays

128
Q

can anticholinergic OD happen with benadryl?

129
Q

looks liek meningitis- do you give abx or ct hen lumabr first

130
Q

straight p opoiod OD, RR 14 do you give narcan

A

no, ETCO2 an domnitor and give it if rsp depression!

131
Q

vertical and verticla incisions for perimortem c section

132
Q

first step with treacho innominate fistula

A

overinflate cuff then!
then ETT and digial compression if that doesnt work

133
Q

any mention of steroids and hypotension think adrenals and hydcort

134
Q

another word for ideal body weight is

A

predicited body weight

135
Q

Workng in a silo, hypoxic, chest pain- why?

A

nitrogen dioxide

136
Q

hypo mag hyper or hypo reflexia

137
Q

hypotonia with high ro low calcium

138
Q

perio oral paresthesia with hihg or low calcium

139
Q

curtain coming down, flashers, floaters, usually anchored to optic disk

A

ret detach

140
Q

medial examiner for…

A

laws broken or unexplained reason

141
Q

candidia ph < or > 4.5

A

<4 - topical or oral azole (fluc PO)

142
Q

recent MI with deep Q or QS waves and STEMI in v1/V2 =

A

Vent anyrieusm

143
Q

jelly fish stings (even box)

A

acetic acid
hot water

144
Q

autrailain box jelly fish or stone fish need

145
Q

defib- when is your next pulse check

A

after another round of comrpessions

146
Q

RAD + TWI and STD in V1-V4 =

A

cor pulmonale or right side heart fialure form th elungs

147
Q

Pen allergic strep throat tx

A

pcn
cephalos
clinda
macrolides

148
Q

adult onset astha by what bug?

A

chlamydia pna

149
Q

Which bugs ot what

bullous myringitis
Rusty sputum
stoacco cough
diarrhea

A

Mycoplasma
strep pneumo
chlamydia
legionella

150
Q

preseptal cellulitis tx

A

auhgmentin

151
Q

MC cause hypo Mg

152
Q

HypoG dosing
<1
1-8
>8 yrs old

A

2-5 D10

2 ml/kg D25

1 mlkg d50

153
Q

Acute bronchiits tx

A

Dextropemthrophan
mucoltics
expectorants
anithistmaines

Prednisone if asthma or COPD

154
Q

if it looks like pericarditis but has big vital sign changes and signs of HF then ithink

A

myocarditis
MC compliciton is cardiomyopathy

155
Q

young person, severe chest pain for 30 minutes every morning, ST evleations during it and then itgoes away =

A

prinzmental or vasospastic anigna
CCB or nitrates

156
Q

severe MG crisis

A

plasmapheres or IVIG

157
Q

when to do lytics for STEMIs

A

When contact to balloon is > 2 hours
cant give asa to allergy to asa

158
Q

Painless VB in 24 weeks preggo- best next step? n contractions and everything else nromal

A

US
(rhogam needs mention of their blood type)
this is placenta previa

159
Q

METH ABUSE make sure you check thier

160
Q

heat stroke- start cooling at scene or transfer

A

cool at scene and then transfer

161
Q

scelral icterus RUQ pain, tick borne…

A

ehrlichia
anaplasmosis

162
Q

small RCT with blinding or well excuecuted observational study with large effect?

A

Obs study
Small RCTs only give moderate effect

163
Q

Gold silver bronze
Meta abalysis/Systemeitc review
RCT
Cohort study

A

In order
Gold
Silver
bronze

statisical power provides a that a value is acutally true

164
Q

peds septic joint kocher criteria

A

ESR 40
WBC 12
Fever 38.5
NWB

165
Q

hyperleukocysosits is MC in which malignancy?

A

AMLeukemia

166
Q

Unstable MAT tx first step, second step

A

Oxygen
Rate control
NOT sync cardiovert!

167
Q

omphalitis need surgery or iv abx?

168
Q

autoimmune off their immuniologics with new eye pain and redness think…

A

scleritis (bleu hue) give steroid - pain worse with mvoement

OR UC with eye pain think iritis or ant uvetis

169
Q

Lymes disease pearls

A

Upper midwest can be a place for it too if they say midwest!

Doxy can be used in kids under 8 yrs old if given for less than 3 weeks
preggos get amoxacllin

tx is for 2-3 weeks!

PPx is 200 mg PO doxy one time

170
Q

how to tx outpatient atypical PNA?

A

Doxy!

Of note, the rate of macrolide-resistant Streptococcus pneumoniae in the USA exceeds 40% and azithromycin alone is no longer recommended in the treatment of pneumonia as a sole agent.

171
Q

kawasakis cirteria

A

fever 5 days
eyes
mouth
hands/feet
polymorphous rash
neck LA

172
Q

when to go immediately to OR for penentrating neck wound?

A

symptomatic patient or hard signs

173
Q

lsiteria coverage in menigitis criteria?

A

50 yrs
alcohol
immunospruressed
infants

174
Q

echange tranfusions oor hydorxyura reducies sickling?

A

hydorxurea

175
Q

newly pregnant RLQ pain - best next test is MRI, CT or TVUS…

176
Q

MC cause PTA
MC cause bug RPA

A

Strep A
Strep Viridans

177
Q

what does strabismus in a neonate make uyou concerned for>

A

retinbloastoma
luekocoria

178
Q

looks like transient synovitis, inflammaotry markers low - tap it or DC it?

179
Q

menintigits tx 1 month to 50 years old=
over 50=
under 1 month

A

Vnac and CFTX
add amp
amp and gent or cefotax

180
Q

difference between tyhroglossal duct cyst and dermoid cyst in kid?

A

both midline
thyroglossal duct moves with tongue

brachial cleft is lateral

181
Q

dont do LP in vert fx?

A

Nope but you can in spinal mets case?? wtf

182
Q

know your GCS

183
Q

Does toa require surgery?

A

No IV abx
Unless over 9 cm, sepsis, doesnt get better

184
Q

What reducers long term morbidity in anal fissures

A

Outpatient GI referral

185
Q

Eos in urine is from…

A

Interstitial cystitis

186
Q

blast
primary
sec
tert
quat

A

shockwave - hollow
shrapnel
body thrown into objects
environemtnal expisure - burns

187
Q

first line asymptomatic bacturia in preggos

A

amox or keflex

not nitrofurantoin

188
Q

what is takutusbo?

A

dialted cardimyopathy after emotions
looks like STEMI
great prognosis

189
Q

infant bilious emesis- best test
X ray
US
Upper GI series

A

upper GI series

190
Q

MC blunt abd injury in truama in kids

191
Q

what looks like mulluscom but it isnt?

A

dissemintated cryptococcus

192
Q

asymptatic HTN- which screenign test has shown utility in this?

A

serum Cr not EKG

193
Q

most sensitive on UA Leuk est or Bacteria>?

A

leuks

most specific is nitrite

194
Q

indications for urgent endoscopy for foreign bodies

A

BUtton +++++ magnet
Long or sharp
2x6 cm
in stomach 24 hrs after ingestion

195
Q

frostbite tx

A

re-warming bath

196
Q

toxo tx

A

leucovorin
Sulfadiazine and pyridazinme

197
Q

run in the mill ingrown toenail tx?

A

Partial nail removal - you are removing the FB!
if paronychia (has to have purluent drainage or abscess) then I and D

if paronychia with uot big abscess can do warm water soaks and abx

198
Q

hyper or hypocalcemia in MM

199
Q

stroke stuff

A

terrible neuro exam with:
Upward gaze= thalamic stroke/hem.
total paralysis with pinpoint pupils=pontine
fixed and dialed, hemiplegia, gzae= putamen

200
Q

looks like bacterial sinusitis but it has been 24 hrs of symtpoms - give..

A

affrin and supprotive
if no improvement over days then abx

201
Q

pregnangcy induced HTN before 20 weeks=

A

molar pregnancy

202
Q

rbb
lbbb

A

R= down and wide S + bunny ears in V1
L= WIDe WRS lead 1, DOwn QRS in V1

203
Q

unstable c spine

A

Jefferson- C1
Hangman- b/l pars c2
b/l facet
odontoid 2/3
teardrop
A/O

204
Q

NNT

A

35/50 tx
20/50 control

50/15= NNT

205
Q

hyperpth = PHos? Ca?

A

Low phos
HIgh ca

alwasy inverse- hight PTH = high Ca

206
Q

recurrent PUD now with cancer symtpoms=

A

zolliner syndrome or gastrinoma - too much acid

plummer vinsons is IDA w/ Esophogeal webs

207
Q

RMSF can spare the palms and soles

A

if it looks like it then it is

208
Q

secondary syph- one time Pen G or or for weeks?

209
Q

1 yr old with b/l otitis and erythematous throat=

210
Q

looks like osler node but polyarhtritis

A

Goncoccemia

211
Q

what is enopthlamitis

A

bacterial infection after cataracts or trauma

212
Q

hearing loss, ataxia, faicla nerve involvemnt=

A

schwannoma

213
Q

FLu coverage with tamiflu [

A

65 + or under 2 yrs
pregnancy or PPD 2 weeks
ung disease
immunocomprimised
renal disease
heart disease
obese > 40
DM
Cancer
nursing home reisdents

reduces symptoms by 17 hours

214
Q

what is factitious disorder imposed on self?

A

Munchausen syndrome
DO things to themsleves to be the sick patient without secondary gain

215
Q

pregnent, VB, abd pain, trauma + Hypotension =

A

emergenct C section for abrutped placenta

216
Q

breath holding spell doesnt have to be intentional

217
Q

superficial thormbosis - when do you AC and when do you not

A

> 5 cm long or < 5 cm from the deep venous system

otherwise supportive care and repeat US

218
Q

mellt vs jersey finger

A

mallet cant extend- basketball
jersey, cant make a full fist, cant flex DIP

219
Q

do you irriagte or test ph then irrigate in eye chemicals?

220
Q

remember in COPD if acutely short of breath then they will be acidodic bc no time to compensate yet with bicarb

221
Q

refeeding syndrome gotta ewatch out our for what main lyte?

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