Rosh 2

Question 1

Right Bundle Branch Block (RBBB) ecg

Answer 1

wide QRS
QRS interval will be > 0.12 s

predominantly positive QRS in V1
rSR or rsR in lead V1
Wide S in lead I and V6

Question 2

Osgood-Schlatter disease

Answer 2

acute inflammation of the patellar ligament at the tibial tuberosity

manifests as tenderness and swelling at the insertion of the patellar tendon on the tibial tubercle and pain with knee extension against resistance

Question 3

most commonly detected viruses in croup are

Answer 3

parainfluenza
respiratory syncytial virus
rhinovirus.

Question 4

treatment of croup

Answer 4

is based on the severity of symptoms.
corticosteroids
racemic epinephrine for stridor at rest.
antipyretics

Question 5

Management after racemic epi for croup

Answer 5

Patients who are treated with racemic epinephrine should be observed for a minimum of 3 hours to ensure that stridor and airway obstruction does not recur.

Patients with persistent stridor at rest, retractions, tachypnea or hypoxia, or those who require more than two treatments of racemic epinephrine should

Question 6

What classic X-ray finding is seen in croup?

Answer 6

Subglottic trachea narrowing (Steeple sign).

Question 7

Laryngotracheitis (Croup) basics

Answer 7

Patient will be a non-toxic appearing child, 6-months to 3-years-old
Complaining of URI symptoms with barky, seal-like cough, inspiratory stridor, low-grade fever
X-ray will show “steeple sign” on PA view
Most commonly caused by Parainfluenza virus
Treatment is steroids, aerosolized epinephrine

Question 8

most common complication of diverticulitis

Answer 8

abscess formation

Question 9

AFib with RVR stands for?

Answer 9

atrial fibrillation with rapid ventricular response

Question 10

There are 2 major strategies in the care of patients with AFib with RVR

Answer 10

rhythm control and rate control.
Rhythm control involves converting the patient from AFib to normal sinus rhythm.
Rate control involves reducing the ventricular response but leaving the patient in AFib.

Question 11

__________ is a cardiac glycoside that acts at the AV node for rate control.

Answer 11

Digoxin

Question 12

Atrial Fibrillation > 48 hours and cardioversion

Answer 12

anticoagulate for 21 days prior to cardioversion

Determine the need for anticoagulation by using CHADS2

Question 13

patients taking INH and showing evidence of toxicity such as seizures and metabolic acidosis should be treated with ____________ and dose!

Answer 13

B6. The empiric dose of pyridoxine is 5 g IV slow IV push.

Isoniazid (INH) Toxicity

↓ B6 → ↓ GABA → refractory seizures with AG metabolic acidosis
Antidote: B6

Question 14

S1Q3T3 pattern associated with right heart strain means?

Answer 14

An S wave in lead I, and a Q wave and inverted T wave in lead III

Question 15

rx for body packers- aka swallowed packets of drugs

Answer 15

• Admit for tele
• Whole bowel irrigation with polyethylene glycol to speed gastrointestinal passage of the packets.
• Activated charcoal
• Endoscopic retrieval of the packets is not first-line treatment because of concern for packet rupture during the procedure.
• In the case of rupture, may be taken emergently to the OR to try to remove the packets and save the patient’s life.

Question 16

Pertussis (“Whooping Cough”) rx

Answer 16

Most commonly caused by Bordetella pertussis

Treatment is a macrolide - azithromycin

Question 17

Boerhaave Syndrome

Answer 17

Diagnosis is made by esophogram with water-soluble oral contrast

Chest X-ray will show pneumomediastinum

Treatment is emergent surgical consult and broad-spectrum antibiotics

Question 18

Serum Sickness

Answer 18

• type III hypersensitivity reaction/ immune complex-mediated reaction
• immune complexes are deposited on vessel walls leading to local inflammation and eventually tissue injury
• presents with rash, fever, polyarthralgias and polyarthritis usually begins 1-2 weeks after exposure to a causative agent.