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Rosh 2 Flashcards

1
Q

4 year old with s crape do you give tdap?

A

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

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2
Q

Severe sepsis is gone!
Its just sepsis and spetic shock!

A

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

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3
Q

PPH uterine massage

A

put a hand in the vagina

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4
Q

unstable oelvis, unstable vitals, - FAST

A

embo

+ FAST is surgery

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5
Q

kid, everything looks like lymes disease but multiple ring like rashes?

A

A rheum fever

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6
Q

peds ETT sizing equation

A

Age/4 + 4 = Uncuffed!

half size it down for cuffed or Age/4+3.5

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7
Q

phlegmasia cerula dolens and alba are both

A

From DVTS!

if sudden cool dusky leg it is from arterial embolism

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8
Q

E perf

A

water solubale E gram
Abx
surgery
MC spot is POsteriolateral E Distal

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9
Q

Down and out CN3 and sudden headache- CT head normal …

A

do a LP to rule out SAH for anyrusmal bleed

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10
Q

MC cause of ulcers and spot

A

Duodenal and H pylori NOT NSAIDS

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11
Q

bevel parallell in LP helps reduces post LP heradaches, and small bore non cutting

A
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12
Q

AC high voltage injury- gotta do what to guidemanagement

A

foely catheter and urinary output for high risk of rhabdo

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13
Q

sudden onset hearing loss- next test CT or MRI

A

MRI

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14
Q

Back and forth movement from the tongue in an altered and liver patient shoudl make you think

A

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

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15
Q

whic hworm causes microcytic anemia

A

hokwork - americanus

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16
Q

MC adult cause of TE fistula

A

Cancer

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17
Q

PCKD needs what med alwasys

A

Anti HTN lisonprol

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18
Q

4 yr old with vaginal discharge needs

A

procedural sedation for pelvic exam for vaginal FB

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19
Q

do you give steroids to EM

A

yes

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20
Q

young syncoep ith deep TWI in V4-6

A

HOCM
not PE

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21
Q

nusring home AMS-

A

make sure ot get collateral infofrom family over other testing first

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22
Q

pencil lead in skin you need to

A

cut it out or else it will tatoo
en blac if on face

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23
Q

skiiers or game keeper thrumb- which ligmaent

A

UCL
hyperabduction of the thumb

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24
Q

do you need prep for pertussis if you are vaccinated and a close contact

A

yes
nromal Z pak dosing

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25
Q

looks like ulnar nerve disruption but also has thumb opposition then what is disrupted…

A

T1 nerve root

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26
Q

concern for myocarditis- need echo or trop to confirm

A

echo

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27
Q

can bacterial meningitis have neg gram stains?
how to distiniguish fungal form bacterial

A

Fungal= up to 1000 cells, lymphocytes
Bacterial= >1000 cells, PMNs
both have elevated proteins and can have negative gram stain!

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28
Q

eye stuff

A

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

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29
Q

cant see TM with otitis externa- med to avoid

A

acetic acid! go cirpi dex and ear wick

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30
Q

next best step for H pylori testng

A

Urea breath test PCP
not gastro doc
MC PUD

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31
Q

blowing murmur along 3rd space after s2…

A

aortic regurg

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32
Q

next steps astham after steroids and duonebs

A

mag
terbutaline 0.25 mg subQ x 3 doses q 20

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33
Q

if neg Duplex 1 week ago for DVT an dsymptoms looking like dvt…

A

do another duplex
dimer can be used to avoid duplex

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34
Q

just started HD but now you have headache and vomting after a session

A

dysequilibrium syndrome- cerebal edema needs mannitol !!!

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35
Q

some fetal tissue passed

A

incomplete abortion
ineveitble if no tissue passed

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36
Q

dixhallpike

A

is rotational and veritcal nystagmus not hroizontal?

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37
Q

4 weeker with what looks like RSV but oncjivitvitis too

A

think chlamydia PNA with interstial markings too

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38
Q

Dx tests and MC symptoms of ballder ruptrue?

A

Conventional retrograde cystography and retrograde CT cystography.
Hematuria (not high prostate or inability to pee)

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39
Q

superifical femorla vein is it ia DVT

A

yes start AC

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40
Q

looks liek hypocalcemia but not an answer…

A

hypoMagn
seen in alcoholism fo rhypoK, Mg, Ca

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41
Q

what do you do to an IO line in a Kid to reduce the main complication

A

flush lido thru it
pain is biggest thing
any med can go thru it

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42
Q

MC brian herniation after trauma

A

uncal
off the temproal lobe

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43
Q

ranson!

A

55
G 200
WBC 16k
LDH 350
AST 250

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44
Q

c diff MC in…

A

Cipro!
clinda
cephs
PCNs

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45
Q

avulsed tooth care

A

hold crown
put it in milk!
rinse with slaine
shove it back in

> 60 min: soak in citric or fluoride and consult oral surgeao

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46
Q

MDR UTI outpaitent tx

A

IM ertepenem
fosfomycin

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47
Q

is beta hydorxybutryate presenest in AKA

A

yes

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48
Q

when do you put in acitc acid for mairn elife
and hot water

A

jelly fish acid

warm water urchins

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49
Q

dermato and polymyositis

A

very simialr but deramto has the grotten papules and asocaited with cancer - proximal muscle weakness

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50
Q

HIV stuff with CD4 count

A

<50 is CMV retinits and MAC
<100 is toxo and crytpo
<200 PJP

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51
Q

HYpereeis grav fludis of choice

A

D5LR or d5NS

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52
Q

inspiration woht neck extension for RPA in kids

A

yup

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53
Q

oschgooods perals

A

No steroids
no knee imblizer

rest
NSAIds
return to acitivity

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54
Q

INR 2.5 on warfarin - tpa to a stroke or no?

A

NO! INR 1.7!
24 hours for thombecotmy for patient arent tpa candidates

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55
Q

aspiritation pneumonitis - give emrpiric ab or no

A

NO

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56
Q

what blood type of mom usually leads to jaundice and hypber bili in kids on day 1?

A

O neg (A / B antibodies!)

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57
Q

abx or hand surgery consutl fo rflexor teno?

A

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

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58
Q

truama with oral lac and displacement of inferio alvolars…

A

admit for Iv abx for open mandivular fx

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59
Q

pleurisy , stable tx

A

NSAIDS (even indomehtacin)

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60
Q

compartment pressures

A

Difference of 30 between pressures and diasotlic with in 555555555555555 cm of fx site

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61
Q

trach fistula and bleeding steps

A
  1. irect pressure
  2. ## over inflate cuff
  3. tube them
  4. finger
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62
Q

what are iron stages

A

GI
recovery
acidosis
hepatic failure

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63
Q

randomization or noniferioritiy to acutlaly use a drug over the standard of care in trial from going forward

A

randomization

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64
Q

exopthlamos is specific to graves

A

lid lag (upper lid retraction) is hyperthroyidm in general)

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65
Q

HD in hypercalcemia for levels…

A

> 18

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66
Q

stright leg test

A

Riaisng SYmptomatic leg
pain raidaites down that leg at 45 deg

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67
Q

epiploic appendagitis tx

A

NSAIDs

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68
Q

painful visoon loss over several days an doclor disturnace….

A

optic neuritis - demyelination of nerve

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69
Q

unexplained symtpoms is

faking symptoms are

A

somatic symptoms

facitious disorder (muchnahusen)

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70
Q

cloazapine side effect

pehynytoni side effect

A

Angranulocytosis and eukopenia

APlasitc anemia!

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71
Q

Kid with b/l cervical LA for 5 days - LN biopsy or observe

A

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.

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72
Q

AOM tx for PCN allergy

A

Cefdinir or cefpodoxime

if anaphylaxis to PCN:
CLinad and bactrim!

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73
Q

psorisiais tx

A

topical steorids

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74
Q

Chest tube output to surgery numbers
1500
or 200 over 3 hours

A
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75
Q

sxhizoid
scizotypal
schizoaffective

A

no friends, flat, to theirslef

very similar but magical thinking

NOT personality - it is basically bipolar - delusiosn and mood disorder

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76
Q

magnesium and COPD

A

very little to no evidecne for usage of COPD exacerbations

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77
Q

ecent stroke or head truam ain last 3 motnhs is a no go for tpa

A

yup

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78
Q

brown ring aroudn the eye, ataxia, heatic stuff

A

pencillaimine wilson disease

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79
Q

PE on heparin and then a cold blue arm 3 days later - next step

A

Stop heparin
start bivalruidin for HIT!!!

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80
Q

digital clubbing and Right axis on ekg with a kid heart defect - no murmur

A

VSD - eismemeger syndrome

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81
Q

radicuolpathy upper arm

A

c5- brachrioradiais
c6- biceps
c7- triceps
c8- ulanr region

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82
Q

BB MC to give you siezures

A

propranolol for BB OD- very lipophylic

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83
Q

upperlobe PNA on immunosuppresants- aspergillus or TB?

A

TB

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84
Q

kid test torsion

A

they said analgesia then detorse

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85
Q

what is enopthamos>?

A

posterior dsiplacement of globe - opposite of proptosis

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86
Q

do pacifiers reduce sids

A

yes

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87
Q

hydrocarbons tx or apsiration of gasoline

A

observe 6 hours- CXR after later 6 hrs

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88
Q

hyperoxia test doesnt get better when..

A

rthere is right to left shunting- oxygen never gets to tlungs

like Tet fallot
tricupsid atresia
all cyantoic heart stuff

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89
Q

acute urinary retention with a recent uroloigc prolcudre for prostate = foley or suprapubic cath

A

suprapubic

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90
Q

what is finklesteins test?

A

for dequvains
splint an NSAIDs

91
Q

which blood procutc do you give to :

DIC

Warfairn OD head bleed

A

Cryo (low fibrinogn)

PCC

92
Q

looks liek hand foot mouth but on uvual and no other rash

A

herpangina Cox A

93
Q

be eweary of herptic whitlow looking like a phelon

A
94
Q

worst prognsisi spinal cord

A

Anterior spinal cord syndrome

95
Q

fluconazole

A

over nystatin for esophogeal candida too

96
Q

viral load for HIV an dmost infectious udirng acute pahse or AIDS phase

A

acute phase

97
Q

verbal gcs
motor gcs

A

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

98
Q

if they give you trauma, JVD , no breath sonds =

A

Tension decompress

Dont fall into FAST or pericardiocentesis - they will not give you negative breath sounds if they want a heart diagnosis

99
Q

ARVD may look like burgaga

A

but if you see the delta wave and TWI go for it - leads to syncope

100
Q

when to give nalozne to a newborn

A

IT IS CONTRAINDICATED IN DRUG ABUSE! basically never give it- seziure

unless NRP isnt working and a non addicated mom had opiods during labor

101
Q

can you do a semi circular IandD of auricular hematoma at 5 days

A

yes if less than 7 and greater than 2 cm

if >7 days is ENT

102
Q

lytic trnafusion reaction tx

A

Fludis diruects sto tranfsuion

103
Q

straight from rosh

A

Overlying erythema is not an absolute contraindication to arthrocentesis in cases of suspected septic joint.

104
Q

what asthma med is contraidicated in pregnancy

A

epi! in first trimester for fetal hypoxia and teratogenciity

not steroids

105
Q

orthostatics

A

20 SBP
10 DBP

106
Q

needs 3/3 things to be peripheral on test and not be central form this HINTS and skew exam

A

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

107
Q

Nasal bone fx and epistaxis need abx?

A

No

108
Q

looks like a pregnnacy is in the uterus but empty number and there shoudl be

A

empty sac, + pain and free fluid is ecotpic

109
Q

antibiotics in dirreha to…

A

Immunocomrpised old

or

symptoms greater than a week, high fever LOTS of bloody stool

110
Q

how to plsint a achilles tendon rupture

A

equinus splint or put in plantar flexion

111
Q

looks like nitorgne narcosis but less than 100 feet down =

A

barotitis

> 100 is nitorgen narcosis

112
Q

endometriris with sepsis tx

A

broad spectrum and surgery

(but dot pick abx if not broad! anarebos liekly)

113
Q

cat bite needs what abx

A

augmentin

not macrolides if nto suggestive of cat crathc disease

114
Q

B2 defcieincy

A

cracked lips and angular sotmatitis

115
Q

B3 deficiancy is

A

pellagare DDD

116
Q

B1 can look a helluva lot liek B12 or gfolate but the neuro portion of it

A
117
Q

in another question for truama

A

it says POC US over tubing (not decomrpess tho) to figure out if tmapnade or not

118
Q

silaolithaisis is MC in

A

submNDIBULAR gland

119
Q

MC NVD virus

A

NORO (dont need crusie ship_

adeno and rota common too

120
Q

neuropshypilis tx

A

4 mil units Q4 houors for days after a CSF VDRL test

121
Q

reverisble harin gloss drug and irreverisble

A

ASA

Erythmycin
gentamycin
tetracyclines

122
Q

what is lis fran cinjruy

A

tarsal-metatasral dislocation and maybe px

123
Q

what shoudler reduciton method is contraidciated

A

hippocratic- basically stanidng and flaling/pulling on it

124
Q

what is the squirt sign?

A

finger then gas and poo from hirshcprun disease

meconium ileus in a CF baby

125
Q

SSSS

A

can be localized to an area
dicloxacillin is an option
clinda is more for toxic shock syndrome with hypotension

126
Q

absolute contras to IO insertion

A

Fracture!

not overlyiny cellulitis or OI

127
Q

condlyoma lata is…

A

syphylisis

128
Q

kid jaundice

A

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

129
Q

paracentesis is

A

2 below belly button
or 4 and 1 to ASIS

130
Q

out in the sun for a littl eand then this big ol nasty plaques

A

Lupus

131
Q

superior alveolar nerve block

A

pot
med
anterior all the way up to buck teeth

132
Q

MC chronic infection haptatis

A

C

133
Q

MC comokiction form stoma

A

hyponatremia

134
Q

how to dx compartment syndorme

A

cant do physical exam
direct over 30
diastolic-direct <30

135
Q

how long can acrocyanosis last on newborn

A

up to 2 days
nromal o2 sats at 30 min!

136
Q

epididymisi tx

A

old=levoflox
sexy=ceftx+doxy
homosexual=cftx + levo

137
Q

what is a stage 1 ulcer

A

eryehtam
stge 2 is skin breakdown and shalow ulcer
3= slugh, eschar, fat
4= ‘’ ‘’ + msucle/bone

138
Q

MC burst vessel in htn bleed

A

penetrating artery

139
Q

sarcoid does it have low or high pth levels

A

low
bc high calcium from macraphges

140
Q

need for deforoximine therpay in iron OD

A

500 or hgiher
aciodis
AMS
shcok
Refracotry GI sypmtosm

141
Q

viral meningitis

A

protein can be normal! (doesnt need to be suer high)
glucose canbe low or nromal
low PMNs

142
Q

avr elevation should mke you think…

A

Left main

143
Q

acut enasal septal hematoma tx

A

I And D

144
Q

LACERATION + Skull Fx= admit or discharge

A

admit obs

145
Q

next step cecal vovlulus

A

sigmoig oscoy - not NG tube or surgery

146
Q

lateral neck ex ray

A

usually not uvular deviation
X ray with obvious widening in lateral neck x ray for RPA vs PTA

147
Q

when to do hyperbarics for scubas decompresisons bends?

A

anything neyond skin and MSK= hyperbarics
otherise its just oxygen

148
Q

ogilve syndrome tx

A

neostigmine if large

149
Q

yellow greasy scales on a head of neonate=

A

seborrhaic dermatitis or cradle cap
tx wait it out
steroids
ketoconozle
petroleum jelly

also has slamon patchesin diaper!

150
Q

looks like a kidney stone but… syncope =

A

AAA! CT with contrast!

151
Q

rifampin adverse reaction

A

liver

152
Q

scleordermic crisis

A

is rapid renal invovlement and HTN enceophalopthy with collagen deopsition
also can effect all other organ systems

  1. captopril
  2. lower BP
153
Q

3 year old with spiral fx of tibia - seltal survery or cal ortho

A

call ortho
thi si toddler fx to have spiral fx

154
Q

flail chest management

A

intubate! reduces mortality
especially if other injruies or other co-morbids

155
Q

cigutera vs histamine (scombroid)

A

histamine or scormboid = peppery , flushed, red, wheezing- antihistmaines
- mackeral, mahi mahi, tuna, marlin

Cigutera:
cold reversal, bradycardia, GI
BARRACUDA AND RED SNAPPer GROUPER

156
Q

ANC number

A

1500
nadir is 6-10 days after chemo

157
Q

CRVO tx

A

optho consnult

158
Q

narrowt portion of peds airway

A

circoid

159
Q

LP for infants should be at what level?

A

L4/l5 and below
their cords are loinger

160
Q

lithium HD indications

A

5
4 + AKI
AMS

161
Q

painless ulcer with lymphadenopathy - tx

A

PCN - still think syphilis
not clhamydia or anything

162
Q

medullay and MED for thyroif cancer

A

yuip

163
Q

prognositc factor in dig OD

A

hyperkalemia

164
Q

when to cool

A

shocklable rhythm out of hsopital ROSC and still unresponsive

165
Q

baby in extremis - give abx or alprostadil

A

alprostdil if mentions heart and cyandosis

166
Q

randos

A

HAPE is worse than HACE

bacterial eye infection red nd pus and th elid margins

167
Q

is multi lobar infarcts ocntrainidcatin on CT to tpa?

A

Yes

168
Q

retropertoenal structures

A

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

169
Q

cant extend your IP joingts on 4/5th fingers

A

Ulnar nerve

recurrent branch of median gets the intrinic thumb muscles

radial woundt do this

170
Q

If you have PIP joint invovlement after playing basketball (mallet finger fine but mallet finger of the pip) …

A

keep PIPI extnednign and the other joitns free range to avoid bouteinarere deformity

171
Q

which bug gives you a high fver and relative bradycardia?

A

slamonella faget sign
legionella
mycoplasma
tularemia

172
Q

ct radiation to baby

A

worse 2-8 weeks
worse 10-17 for CNS development

173
Q

water, conjunctival suffusion (red nto exudates!), fever, travel

A

leptospirosis
Doxy or Augmentin

174
Q

return to ed for sitiched out near ajoint

A

10-14 days

175
Q

body stuffer with no symptoms really

A

admit and miralax!

176
Q

electrylotes in rhabdo

A

hyperK
hyerpPhos
HypoCalcemia

Ck 5 x uppe rlimit

177
Q

10% reduction in drug
20% in control
NNT?

A

.2-.1= .1

1/.1 = 10

178
Q

MC basilar skull fx sign

A

hemotypmanum

179
Q

iron ingestion tx if in tomach

A

WBI

180
Q

tx of butt STD

A

CFTX DOXY

181
Q

stable ectoptic pregnancy tx

A

MTX
Not surgery!

182
Q

first diagnosis of crhosnguve steroids or meslamine

A

meslamine

183
Q

prognisis for melanoma
depth or LN involvent

A

Depth

184
Q

child with a wet cough for >4 weeks=

A

protracted bronchitis
give Augmenitn for weeks

185
Q

peds trauma hypotension first step

A

fluid bolus 20 cc/kg
then give your blodo bolus!

186
Q

MC cause of cor pulonael

A

COPD

187
Q

ehrlichia
HypoNA or low platelts

A

low plateltes!

low Na is RMSF!

188
Q

severe burn in a preggo- best tx

A

ig and tdap

189
Q

alocholic with CAP- klebseilla or strep pneumo

A

Strep pneumo!!!!!

kelbsiella second

190
Q

hematuria

A

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

191
Q

lab abnromality cuasing hiccups

A

hyponatremia

192
Q

cold tem after death MC complication

A

hyperglycemia

193
Q

costochondiritis risk factors

A

heavy bag on one shoulder
recent illness

194
Q

The oNLY possible tx for Iburpofen OD

A

Charcoal

195
Q

mycotic anyrusm

A

from infeciton (not from fungus) usually form endocariditis

196
Q

kid corkscrew barium study =

A

midgut vlvus
surgery

197
Q

MC cause vaginal bleedin gin older women

A

vaginal atrophy
but thickend endomretiral strope is cacer

always think cancer but MC is atrophy

198
Q

vitmain to give in methanol

A

folci acid

b1 and b6 for ethylene glycol

199
Q

does RA invovle the cervical spine?

A

yes

200
Q

kerion tx?

A

oral antifungal
always first line for head fungus

201
Q

is lisinopril nephrotoxic or protective

A

nephrototoixc

202
Q

lymphogranuleum venereum - chalm
chancroid
granuloma inguinale - klebs

A

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)

203
Q

blunt cardiac injury

A

MC complication is pericardial effusion

204
Q

MDD needs 2 or 4 weeks

A

2

205
Q

E perf- get egram or consult htoracics

A

thoracics

206
Q

MC risk factor for aortic dissection

A

HTN

207
Q

scarelt fever

A

starts in groin, blanches, sand paper rash
red tongue
exudates in throat
pallor around mouth

give PCN (not autoimmune)

208
Q

works in factory- smells like garlic
dx and tx

A

arsenic gas
exchange transfusion

209
Q

tx of psgn

A

abx if stil infected
loops or fluid restrict
HTN if severe

210
Q

functional neurlogic symtpom disorder is also knwo as……………

A

conversiond isorder

211
Q

hrodoelum anc halaziaon tx

A

warm comrpesses

212
Q

refracotry analpkhyalxis next step

A

epi drip and glucagon!

213
Q

tx for rheuamtic fever in PCN anaphylaxis allergy

A

erythomycin

even tho it is auto immune you still do antibitoics!
treating strep throat reduces rheumatic fever by 70%!

214
Q

graft rejection

A

cd8 first

and then cd4 and luminal narrowing of kiensey vesels

215
Q

pregnenat TB tx

A

RIE
no P for preggos

216
Q

what is HELLP

A

hemoalysis
liver enzymes
lowe platelts

it is the exact tx of PRe-E- mageneisum, BP and delivery

217
Q

do you ever defibrillate with a pulse

A

no- pulse VT is syndochizned

218
Q

spigleian hernia

A

level of arcuate line
lateral to rectus

219
Q

hallmark of lateral medullary syndrome (wallenberg)

A

Ipsilateral face- contralateral body! hall mark and HORNERS

Basilar is very simialr - vertigo, dysphagia, cn 7

220
Q

travelers diarrhea tx
preggo kids tx

A

cipro
azithro

221
Q

MAC HIV tx

A

malasiae diarrhea poor apeitite

macrolie
Rifambitin
ethambutol

222
Q

fatigue, b/l lower ext edema next step

A

echo
rule out PAH

223
Q

transvere myeltitis tx

A

steroids first
exchange transfusion or ivig

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