Rosh 2 Flashcards
Treatment for pt with Von willebrand dz with bleeding?
Desmopressin
-If severe, factor8 concentrate
What are some indications for emergent HD in aspirin/salicylate toxicity?
- Salicylate level > 100 mg/dL
- rapidly rising levels
- AMS (cerebral edema)
- Seizures
- kidney or liver failure
- pulm edema
- severe acid base abnormality
For every ___ mL of sodium bicarb given, serum pH rises by 0.1
50
Initial screening test for Lyme?
ELISA testing with western blot and PCR
What drug might you want ready for RSI in kids <2 yo?
- Atropine
* tought to attenuate reflex bradycardia from succynylcholine administration
A boutonniere deformity is caused by _____ and looks like ______.
To fix it, splint should____
- Central slip injury (inserts at base of middle phalanx and lateral edges of distal phalanx), aids in extension
- PIP in flexion, DIP in hyperextension
-Splint: PIP in extension. DIPand MCP full ROM
What are some signs of cor pulmonale on EKG?
- RAD
- prominent R in V1
- inverted T waves in V1-v3 or 4
- Large S wave in I, II, III
- Large Q wave in III
- Tall P waves in II, III, AvF
What level are ICPs in patients with IIH (aka pseudotumor cerebri)?
> 20 in non-obese
>25 in obese
Tx for cryptococcal meningitis?
- Amphotericin B + Flucytosine x2 weeks
- Fluconazole for 8 weeks after that
Diagnostic criteria for Kawasaki disease?
Fever for 5 days plus 4/5 of the following:
- Cervical LAD
- oropharyngeal changes
- b/l conjunctivitis
- Rash on torso
- Erythema or desquamation on hands or feet
Formulas for determining whether CO2 retention/acidosis is acute vs chronic?
- Acute: delta pH 0.008 x (40 - CO2)
- Chronic: same but with 0.003
What drugs can cause drug-induced Lupus syndrome?
- Hydralazine
- Isoniazid
- Procainamide
- Phenytoin
also..methlydopa, chlorpromazine, quinidine, minocyclin
Triple therapy meds for H pylori?
- Clarithromycin
- Amoxicillin (or Flagyl)
- PPI
10-14 days**
What is the treatment for TCA overdose? (other than supportive stuff)
-NA-Bicarb.
50 meq IV at a time until QRS normalizes and bicarb drip
How do you calculate Shock index? What does it tell you?
- HR / SBP
- 0.5 -0.7 = normal, >0.7 = more sensitive than VS alone in diagnosis occult shock/need for transfusion
What is the Amsel criteria for diagnosing bacterial vaginosis?
- Thin, white homogenous discharge,
- clue cells,
- pH > 4.5,
- positive whiff test.
Tx for Bacterial vaginosis?
_Flagyl 500 mg po BID x7 days
On Lateral elbow Xray…no visible fracture but post + anterior fat pads visible….
- Diagnosis in adults?
- Diagnosis in kids?
- Adults: Radial head fracture
- Kids: Supracondylar fracture
What should be immediate treatment in Digoxin toxicity?
- Digoxin immune Fab
- It also improves hyperkalemia. DON’T give Calcium, as it can cause “stone heart” since calcium is already high with digoxin use
What type of cardioversion should be used when needed for SVT?
-Synchronized
What’s a good drug to start for Pt w/ ascending aortic dissection?
- Why?
- What dose?
- Esmolol
- Decreases HR too. Dropping just BP can lead to reflex tachy. Easily titratable
- Blous of 500 mcg/kg then infusion 50-200 mcg/kg/min
Main derrangement clinically and metabolically in Cyanide poisoning?
treatment?
- Severe met. acidosis. Severe dyspnea, LOC, seizures, dysrythmias
- Nitrites or Thiosulfate
Tx of choice for sinus Brady 2/2 Beta Blocker Overdose?
Glucagon
What surgery is often complicated by complete heart block?
Aortic valve repair or replacement
EKG findings in pericarditis?
- PR depression
- diffuse STE
Target SBP for ruptured/leaking AAA patient with hypotension?
80 - 100. Give NS or blood
With traumatic hyphema rebreeding tends to occur within ______days/hours.
72 hours. Treatment is supportive. Just stop anti platelets, AC, etc, eye shield to avoid repeat trauma
What is the management for traumatic iritis?
- Cycloplegics such as homatropine. This paralyzes the ciliary body
- Maybe topical steroids (discuss with ophtho)
Treatment for UV keratitis (aka superficial punctate keratitis)
topical NSAIDs
When is surgery indicated for orbital floor fracture?
> 50% of floor, extra ocular must. entrapment, exophthalmos, diplopia
Target ocular pH when flushing/irrigating a chemical burn of the eye?
7 - 7.2
What is the goal PaO2/SpO2% for an intubated ARDS patient?
55-80 PaO2 or 88-95% SpO2
How should octreotide be dosed in upper GI bleed?
bolus of 50 mcg followed by an infusion of 50 mcg/hour.
What is initial treatment of mild IBD?
Mesalamine
Which lab marker elevation has the highest positive predictive value for a biliary etiology in patients diagnosed with acute pancreatitis?
ALT
-ALT levels more than 150 IU/L have 96% specificity and 95% positive predictive value for gallstone pancreatitis.
Treatment for Peds shigellosis (when required, i.e sick patient)?
-Ceftriaxone 50 mg/Kg IV daily
can also do copra
What serologies will be positive in acute hep B infection?
- HBsAg
- Anti hep B core antigen IgM
what is the best marker of HBV immunity?
Anti-Hepatitis B surface antibody (anti-HBsAb)
What organism is likely responsible for a cavitary lesion on CXR in alcoholic patient with fever/chills/cough?
Klebsiella
-Tx: 3rd gen cephalosporin and aminoglycoside
What are adverse effects of Zanamivir? In which patients is it contraindicated?
- Wheezing, severe bronchospasm, resp distress
- Asthma, COPD, other structural lung disease
*Zanamivir is an inhaled version of Tamil essentially
What is the lowest you should enter for a thoracentesis?
-8th intercostal space (posterior)
Diagnosis in a patient who handles fish/works at aquarium….develops skin lesion over course of weeks after an abrasion/laceration, gets red, tracks up lymphatics?
treatment?
- fish tank granuloma
- Mycobacterium marinum
-Tx: Minocycline or Clarithromycin
What findings/lab values would you expect to see with an exudative pleural effusion?
- pH < 7.2
- Glucose < 60
- WBC > 50K
- pleural fluid protein to serum protein is greater than 0.5
- pleural fluid LDH to serum LDH is greater than 0.6
Pyridoxine needs to be administered in conjunction with ______ (medication) to prevent ______
- Isoniazid
- neuropathy, seizures, etc
The “blush sign” on CT around the Spleen is an indication for ________
Angioembolization via IR
*Only if HD stable
What deficits do you expect with anterior cord syndrome?
- Complete loss of Moto, pain, and temperature sensation below injury
- Intact proprioception/vibratory sensation
What deficits do you expect with central cord syndrome?
What is the usual mechanism?
- Sensory and motor deficits upper > lower
- Forced hyperextension
What is normal intra-occular pressure?
10 - 21 mm Hg
What vascular structure is at risk of injury with a proximal fibular fracture?
Anterior tibial artery.
What nerve/nerves provides sensation to lateral aspect of dorm of the foot?
Sural nerve and lateral dorsal cutaneous nerve
What nerve(s) provide sensation to the medial malleolus area?
Saphenous nerve and Medial sural cutaneous nerve
What nerve provides sensation to posterior calf?
Saphenous and rural nerves
Most common nerve injury with distill radius fracture?
-Median nerve
Indications for emergent surgery in a patient with a subdural hematoma include _________
neurologic deterioration
or
midline shift > 5 mm on CT
How do you calculate MAP?
DBP + 1/3(SBP-DBP)
Management of pt with orbital blowout fracture with entrapment?
- Ice
- elev HOB during sleep
- nasal decongestants
- no blowing nose
- NSAIDs
- Antibiotics (augmentin)
**OK to discharge!
EKG features of WPW?
- Slurred upstroke of QRS complex (delta wave)
- Widened QRS
- Shortened PR
Most common organism for pediatric PNA in the following age groups:
- 0-3 weeks?
- 3 wk - 3 mo?
- 3 mo - 5 y?
- 6-8 y?
- GBS
- Chlamydia trach.
- RSV
- Mycoplasma
Which statistical values are influenced by prevalence?
- PPV
- NPV
Treatment of Sporothrichosis?
- Itraconazole
* Amphotericin for severe, systemic disease
