Rosh 2 Flashcards
4 year old with s crape do you give tdap?
they get their last dose at 18months
a booster at 4-6 years
and then at 12 years
so if they have had 3 doses and not contmainted then they good
if unsure- give it plus Ig
Severe sepsis is gone!
Its just sepsis and spetic shock!
Septic chokc is pressors and lacate elevation
sepsis is Qsofa (AKI, plus V changes ike hypotension or Tahcycardia)- you need a score of 2 to hit sepsis
PPH uterine massage
put a hand in the vagina
unstable oelvis, unstable vitals, - FAST
embo
+ FAST is surgery
kid, everything looks like lymes disease but multiple ring like rashes?
A rheum fever
peds ETT sizing equation
Age/4 + 4 = Uncuffed!
half size it down for cuffed or Age/4+3.5
phlegmasia cerula dolens and alba are both
From DVTS!
if sudden cool dusky leg it is from arterial embolism
E perf
water solubale E gram
Abx
surgery
MC spot is POsteriolateral E Distal
Down and out CN3 and sudden headache- CT head normal …
do a LP to rule out SAH for anyrusmal bleed
MC cause of ulcers and spot
Duodenal and H pylori NOT NSAIDS
bevel parallell in LP helps reduces post LP heradaches, and small bore non cutting
AC high voltage injury- gotta do what to guidemanagement
foely catheter and urinary output for high risk of rhabdo
sudden onset hearing loss- next test CT or MRI
MRI
Back and forth movement from the tongue in an altered and liver patient shoudl make you think
Hepatic encaophloapthy - another form of asterisks
from to much nitrogen byoroduct build up
Risks fo rhtis are
GIB!
infection
TIPS procedure
Large meal
Tx lactulose
whic hworm causes microcytic anemia
hokwork - americanus
MC adult cause of TE fistula
Cancer
PCKD needs what med alwasys
Anti HTN lisonprol
4 yr old with vaginal discharge needs
procedural sedation for pelvic exam for vaginal FB
do you give steroids to EM
yes
young syncoep ith deep TWI in V4-6
HOCM
not PE
nusring home AMS-
make sure ot get collateral infofrom family over other testing first
pencil lead in skin you need to
cut it out or else it will tatoo
en blac if on face
skiiers or game keeper thrumb- which ligmaent
UCL
hyperabduction of the thumb
do you need prep for pertussis if you are vaccinated and a close contact
yes
nromal Z pak dosing
looks like ulnar nerve disruption but also has thumb opposition then what is disrupted…
T1 nerve root
concern for myocarditis- need echo or trop to confirm
echo
can bacterial meningitis have neg gram stains?
how to distiniguish fungal form bacterial
Fungal= up to 1000 cells, lymphocytes
Bacterial= >1000 cells, PMNs
both have elevated proteins and can have negative gram stain!
eye stuff
puntcum is medial and connecs ot the nasolacrimal duct
lacrimal gland is at 11 o clock
8 ball sign is hypehma!
cells and flare is iritis
cant see TM with otitis externa- med to avoid
acetic acid! go cirpi dex and ear wick
next best step for H pylori testng
Urea breath test PCP
not gastro doc
MC PUD
blowing murmur along 3rd space after s2…
aortic regurg
next steps astham after steroids and duonebs
mag
terbutaline 0.25 mg subQ x 3 doses q 20
if neg Duplex 1 week ago for DVT an dsymptoms looking like dvt…
do another duplex
dimer can be used to avoid duplex
just started HD but now you have headache and vomting after a session
dysequilibrium syndrome- cerebal edema needs mannitol !!!
some fetal tissue passed
incomplete abortion
ineveitble if no tissue passed
dixhallpike
is rotational and veritcal nystagmus not hroizontal?
4 weeker with what looks like RSV but oncjivitvitis too
think chlamydia PNA with interstial markings too
Dx tests and MC symptoms of ballder ruptrue?
Conventional retrograde cystography and retrograde CT cystography.
Hematuria (not high prostate or inability to pee)
superifical femorla vein is it ia DVT
yes start AC
looks liek hypocalcemia but not an answer…
hypoMagn
seen in alcoholism fo rhypoK, Mg, Ca
what do you do to an IO line in a Kid to reduce the main complication
flush lido thru it
pain is biggest thing
any med can go thru it
MC brian herniation after trauma
uncal
off the temproal lobe
ranson!
55
G 200
WBC 16k
LDH 350
AST 250
c diff MC in…
Cipro!
clinda
cephs
PCNs
avulsed tooth care
hold crown
put it in milk!
rinse with slaine
shove it back in
> 60 min: soak in citric or fluoride and consult oral surgeao
MDR UTI outpaitent tx
IM ertepenem
fosfomycin
is beta hydorxybutryate presenest in AKA
yes
when do you put in acitc acid for mairn elife
and hot water
jelly fish acid
warm water urchins
dermato and polymyositis
very simialr but deramto has the grotten papules and asocaited with cancer - proximal muscle weakness
HIV stuff with CD4 count
<50 is CMV retinits and MAC
<100 is toxo and crytpo
<200 PJP
HYpereeis grav fludis of choice
D5LR or d5NS
inspiration woht neck extension for RPA in kids
yup
oschgooods perals
No steroids
no knee imblizer
rest
NSAIds
return to acitivity
INR 2.5 on warfarin - tpa to a stroke or no?
NO! INR 1.7!
24 hours for thombecotmy for patient arent tpa candidates
aspiritation pneumonitis - give emrpiric ab or no
NO
what blood type of mom usually leads to jaundice and hypber bili in kids on day 1?
O neg (A / B antibodies!)
abx or hand surgery consutl fo rflexor teno?
they say abx ffirst? jsut read the question
BUT…..
Febrile renal abscess is consult IR not Iv abx first …… bc abx ishard to control the source fo r this one
truama with oral lac and displacement of inferio alvolars…
admit for Iv abx for open mandivular fx
pleurisy , stable tx
NSAIDS (even indomehtacin)
compartment pressures
Difference of 30 between pressures and diasotlic with in 555555555555555 cm of fx site
trach fistula and bleeding steps
- irect pressure
- ## over inflate cuff
- tube them
- finger
what are iron stages
GI
recovery
acidosis
hepatic failure
randomization or noniferioritiy to acutlaly use a drug over the standard of care in trial from going forward
randomization
exopthlamos is specific to graves
lid lag (upper lid retraction) is hyperthroyidm in general)
HD in hypercalcemia for levels…
> 18
stright leg test
Riaisng SYmptomatic leg
pain raidaites down that leg at 45 deg
epiploic appendagitis tx
NSAIDs
painful visoon loss over several days an doclor disturnace….
optic neuritis - demyelination of nerve
unexplained symtpoms is
faking symptoms are
somatic symptoms
facitious disorder (muchnahusen)
cloazapine side effect
pehynytoni side effect
Angranulocytosis and eukopenia
APlasitc anemia!
Kid with b/l cervical LA for 5 days - LN biopsy or observe
observe
LN biopsy for supraclavicular or…
3 cm, duration greater than four to six weeks, firm or hard consistency, and associated symptoms of weight loss, night sweats, and fatigue.
AOM tx for PCN allergy
Cefdinir or cefpodoxime
if anaphylaxis to PCN:
CLinad and bactrim!
psorisiais tx
topical steorids
Chest tube output to surgery numbers
1500
or 200 over 3 hours
sxhizoid
scizotypal
schizoaffective
no friends, flat, to theirslef
very similar but magical thinking
NOT personality - it is basically bipolar - delusiosn and mood disorder
magnesium and COPD
very little to no evidecne for usage of COPD exacerbations
ecent stroke or head truam ain last 3 motnhs is a no go for tpa
yup
brown ring aroudn the eye, ataxia, heatic stuff
pencillaimine wilson disease
PE on heparin and then a cold blue arm 3 days later - next step
Stop heparin
start bivalruidin for HIT!!!
digital clubbing and Right axis on ekg with a kid heart defect - no murmur
VSD - eismemeger syndrome
radicuolpathy upper arm
c5- brachrioradiais
c6- biceps
c7- triceps
c8- ulanr region
BB MC to give you siezures
propranolol for BB OD- very lipophylic
upperlobe PNA on immunosuppresants- aspergillus or TB?
TB
kid test torsion
they said analgesia then detorse
what is enopthamos>?
posterior dsiplacement of globe - opposite of proptosis
do pacifiers reduce sids
yes
hydrocarbons tx or apsiration of gasoline
observe 6 hours- CXR after later 6 hrs
hyperoxia test doesnt get better when..
rthere is right to left shunting- oxygen never gets to tlungs
like Tet fallot
tricupsid atresia
all cyantoic heart stuff
acute urinary retention with a recent uroloigc prolcudre for prostate = foley or suprapubic cath
suprapubic
what is finklesteins test?
for dequvains
splint an NSAIDs
which blood procutc do you give to :
DIC
Warfairn OD head bleed
Cryo (low fibrinogn)
PCC
looks liek hand foot mouth but on uvual and no other rash
herpangina Cox A
be eweary of herptic whitlow looking like a phelon
worst prognsisi spinal cord
Anterior spinal cord syndrome
fluconazole
over nystatin for esophogeal candida too
viral load for HIV an dmost infectious udirng acute pahse or AIDS phase
acute phase
verbal gcs
motor gcs
5 normal
4 confused
3 inappropriate
2 incomp
1 nothing
6 obeys
5 across midline to pain
4 to pain
3 decorticare
2 decrebrate
1 nothing
if they give you trauma, JVD , no breath sonds =
Tension decompress
Dont fall into FAST or pericardiocentesis - they will not give you negative breath sounds if they want a heart diagnosis
ARVD may look like burgaga
but if you see the delta wave and TWI go for it - leads to syncope
when to give nalozne to a newborn
IT IS CONTRAINDICATED IN DRUG ABUSE! basically never give it- seziure
unless NRP isnt working and a non addicated mom had opiods during labor
can you do a semi circular IandD of auricular hematoma at 5 days
yes if less than 7 and greater than 2 cm
if >7 days is ENT
lytic trnafusion reaction tx
Fludis diruects sto tranfsuion
straight from rosh
Overlying erythema is not an absolute contraindication to arthrocentesis in cases of suspected septic joint.
what asthma med is contraidicated in pregnancy
epi! in first trimester for fetal hypoxia and teratogenciity
not steroids
orthostatics
20 SBP
10 DBP
needs 3/3 things to be peripheral on test and not be central form this HINTS and skew exam
abnormal head impulse demonstrating a
delayed saccade
unidirectional, non- rotary nystagmus
Skew deviation is absent - not there
= peripehral if it says it
= central if not all three present
Nasal bone fx and epistaxis need abx?
No
looks like a pregnnacy is in the uterus but empty number and there shoudl be
empty sac, + pain and free fluid is ecotpic
antibiotics in dirreha to…
Immunocomrpised old
or
symptoms greater than a week, high fever LOTS of bloody stool
how to plsint a achilles tendon rupture
equinus splint or put in plantar flexion
looks like nitorgne narcosis but less than 100 feet down =
barotitis
> 100 is nitorgen narcosis
endometriris with sepsis tx
broad spectrum and surgery
(but dot pick abx if not broad! anarebos liekly)
cat bite needs what abx
augmentin
not macrolides if nto suggestive of cat crathc disease
B2 defcieincy
cracked lips and angular sotmatitis
B3 deficiancy is
pellagare DDD
B1 can look a helluva lot liek B12 or gfolate but the neuro portion of it
in another question for truama
it says POC US over tubing (not decomrpess tho) to figure out if tmapnade or not
silaolithaisis is MC in
submNDIBULAR gland
MC NVD virus
NORO (dont need crusie ship_
adeno and rota common too
neuropshypilis tx
4 mil units Q4 houors for days after a CSF VDRL test
reverisble harin gloss drug and irreverisble
ASA
Erythmycin
gentamycin
tetracyclines
what is lis fran cinjruy
tarsal-metatasral dislocation and maybe px
what shoudler reduciton method is contraidciated
hippocratic- basically stanidng and flaling/pulling on it
what is the squirt sign?
finger then gas and poo from hirshcprun disease
meconium ileus in a CF baby
SSSS
can be localized to an area
dicloxacillin is an option
clinda is more for toxic shock syndrome with hypotension
absolute contras to IO insertion
Fracture!
not overlyiny cellulitis or OI
condlyoma lata is…
syphylisis
kid jaundice
for acouple days is physiologic
4-7 das good feeder and all indiriect bili - breastfeeding jaundcie
inadequate breastfeed!!!! bad is breast feed failur ejaundice and kernicterus
paracentesis is
2 below belly button
or 4 and 1 to ASIS
out in the sun for a littl eand then this big ol nasty plaques
Lupus
superior alveolar nerve block
pot
med
anterior all the way up to buck teeth
MC chronic infection haptatis
C
MC comokiction form stoma
hyponatremia
how to dx compartment syndorme
cant do physical exam
direct over 30
diastolic-direct <30
how long can acrocyanosis last on newborn
up to 2 days
nromal o2 sats at 30 min!
epididymisi tx
old=levoflox
sexy=ceftx+doxy
homosexual=cftx + levo
what is a stage 1 ulcer
eryehtam
stge 2 is skin breakdown and shalow ulcer
3= slugh, eschar, fat
4= ‘’ ‘’ + msucle/bone
MC burst vessel in htn bleed
penetrating artery
sarcoid does it have low or high pth levels
low
bc high calcium from macraphges
need for deforoximine therpay in iron OD
500 or hgiher
aciodis
AMS
shcok
Refracotry GI sypmtosm
viral meningitis
protein can be normal! (doesnt need to be suer high)
glucose canbe low or nromal
low PMNs
avr elevation should mke you think…
Left main
acut enasal septal hematoma tx
I And D
LACERATION + Skull Fx= admit or discharge
admit obs
next step cecal vovlulus
sigmoig oscoy - not NG tube or surgery
lateral neck ex ray
usually not uvular deviation
X ray with obvious widening in lateral neck x ray for RPA vs PTA
when to do hyperbarics for scubas decompresisons bends?
anything neyond skin and MSK= hyperbarics
otherise its just oxygen
ogilve syndrome tx
neostigmine if large
yellow greasy scales on a head of neonate=
seborrhaic dermatitis or cradle cap
tx wait it out
steroids
ketoconozle
petroleum jelly
also has slamon patchesin diaper!
looks like a kidney stone but… syncope =
AAA! CT with contrast!
rifampin adverse reaction
liver
scleordermic crisis
is rapid renal invovlement and HTN enceophalopthy with collagen deopsition
also can effect all other organ systems
- captopril
- lower BP
3 year old with spiral fx of tibia - seltal survery or cal ortho
call ortho
thi si toddler fx to have spiral fx
flail chest management
intubate! reduces mortality
especially if other injruies or other co-morbids
cigutera vs histamine (scombroid)
histamine or scormboid = peppery , flushed, red, wheezing- antihistmaines
- mackeral, mahi mahi, tuna, marlin
Cigutera:
cold reversal, bradycardia, GI
BARRACUDA AND RED SNAPPer GROUPER
ANC number
1500
nadir is 6-10 days after chemo
CRVO tx
optho consnult
narrowt portion of peds airway
circoid
LP for infants should be at what level?
L4/l5 and below
their cords are loinger
lithium HD indications
5
4 + AKI
AMS
painless ulcer with lymphadenopathy - tx
PCN - still think syphilis
not clhamydia or anything
medullay and MED for thyroif cancer
yuip
prognositc factor in dig OD
hyperkalemia
when to cool
shocklable rhythm out of hsopital ROSC and still unresponsive
baby in extremis - give abx or alprostadil
alprostdil if mentions heart and cyandosis
randos
HAPE is worse than HACE
bacterial eye infection red nd pus and th elid margins
is multi lobar infarcts ocntrainidcatin on CT to tpa?
Yes
retropertoenal structures
Adrenals
Aorta/IVC
Duodenum (except proximal)
Pancreas (except tail)
Ureters
Colon (except transvere)
Kidneys
Esop
Rectums
Grey turner is flanks and can resut in pancreas! dont need cullen sign for this
cant extend your IP joingts on 4/5th fingers
Ulnar nerve
recurrent branch of median gets the intrinic thumb muscles
radial woundt do this
If you have PIP joint invovlement after playing basketball (mallet finger fine but mallet finger of the pip) …
keep PIPI extnednign and the other joitns free range to avoid bouteinarere deformity
which bug gives you a high fver and relative bradycardia?
slamonella faget sign
legionella
mycoplasma
tularemia
ct radiation to baby
worse 2-8 weeks
worse 10-17 for CNS development
water, conjunctival suffusion (red nto exudates!), fever, travel
leptospirosis
Doxy or Augmentin
return to ed for sitiched out near ajoint
10-14 days
body stuffer with no symptoms really
admit and miralax!
electrylotes in rhabdo
hyperK
hyerpPhos
HypoCalcemia
Ck 5 x uppe rlimit
10% reduction in drug
20% in control
NNT?
.2-.1= .1
1/.1 = 10
MC basilar skull fx sign
hemotypmanum
iron ingestion tx if in tomach
WBI
tx of butt STD
CFTX DOXY
stable ectoptic pregnancy tx
MTX
Not surgery!
first diagnosis of crhosnguve steroids or meslamine
meslamine
prognisis for melanoma
depth or LN involvent
Depth
child with a wet cough for >4 weeks=
protracted bronchitis
give Augmenitn for weeks
peds trauma hypotension first step
fluid bolus 20 cc/kg
then give your blodo bolus!
MC cause of cor pulonael
COPD
ehrlichia
HypoNA or low platelts
low plateltes!
low Na is RMSF!
severe burn in a preggo- best tx
ig and tdap
alocholic with CAP- klebseilla or strep pneumo
Strep pneumo!!!!!
kelbsiella second
hematuria
UTI is the MC cause of hematuria in all ages BUT if they dont give you an infecitous picutre and an old person it is i cancer
lab abnromality cuasing hiccups
hyponatremia
cold tem after death MC complication
hyperglycemia
costochondiritis risk factors
heavy bag on one shoulder
recent illness
The oNLY possible tx for Iburpofen OD
Charcoal
mycotic anyrusm
from infeciton (not from fungus) usually form endocariditis
kid corkscrew barium study =
midgut vlvus
surgery
MC cause vaginal bleedin gin older women
vaginal atrophy
but thickend endomretiral strope is cacer
always think cancer but MC is atrophy
vitmain to give in methanol
folci acid
b1 and b6 for ethylene glycol
does RA invovle the cervical spine?
yes
kerion tx?
oral antifungal
always first line for head fungus
is lisinopril nephrotoxic or protective
nephrototoixc
lymphogranuleum venereum - chalm
chancroid
granuloma inguinale - klebs
small non tender rupilish lesion that goes away then inguinal lymphadenopthay - Chlamydia- DOXY!
mult small painful lesions on penis + inguinal bubo(ducreyi)
beefy red ulcer porixmal- painless papule on dick (klebs)
blunt cardiac injury
MC complication is pericardial effusion
MDD needs 2 or 4 weeks
2
E perf- get egram or consult htoracics
thoracics
MC risk factor for aortic dissection
HTN
scarelt fever
starts in groin, blanches, sand paper rash
red tongue
exudates in throat
pallor around mouth
give PCN (not autoimmune)
works in factory- smells like garlic
dx and tx
arsenic gas
exchange transfusion
tx of psgn
abx if stil infected
loops or fluid restrict
HTN if severe
functional neurlogic symtpom disorder is also knwo as……………
conversiond isorder
hrodoelum anc halaziaon tx
warm comrpesses
refracotry analpkhyalxis next step
epi drip and glucagon!
tx for rheuamtic fever in PCN anaphylaxis allergy
erythomycin
even tho it is auto immune you still do antibitoics!
treating strep throat reduces rheumatic fever by 70%!
graft rejection
cd8 first
and then cd4 and luminal narrowing of kiensey vesels
pregnenat TB tx
RIE
no P for preggos
what is HELLP
hemoalysis
liver enzymes
lowe platelts
it is the exact tx of PRe-E- mageneisum, BP and delivery
do you ever defibrillate with a pulse
no- pulse VT is syndochizned
spigleian hernia
level of arcuate line
lateral to rectus
hallmark of lateral medullary syndrome (wallenberg)
Ipsilateral face- contralateral body! hall mark and HORNERS
Basilar is very simialr - vertigo, dysphagia, cn 7
travelers diarrhea tx
preggo kids tx
cipro
azithro
MAC HIV tx
malasiae diarrhea poor apeitite
macrolie
Rifambitin
ethambutol
fatigue, b/l lower ext edema next step
echo
rule out PAH
transvere myeltitis tx
steroids first
exchange transfusion or ivig
