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Rosh Review > Rosh 3 > Flashcards

Rosh 3 Flashcards

1
Q

Tx for pt with V-tach, unstable, WITH a pulse?

A
  • Synchronized cardioversion

* If no pulse, Defib

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2
Q

Tx for pt with V-tach, unstable, without pulse?

A

-Defib

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3
Q

Tx for a patient with V-tach, stable, with a pulse?

A
  • Amio
  • Procainamide
  • Lidocaine
  • Sotalol
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4
Q

Tx for polymorphic V-tach with pulse?

A
  • Defib

* only time you defibrillator with a pulse?

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5
Q

What is a jones fracture and pseudo-jones fracture?

A
  • Jones - 5th metatarsal mataphysis (not involving styloid or articular surface)
  • Pseudo-jones - 5th metatarsal styloid avulsion fracture
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6
Q

What is a Lisfranc fracture?

A

injury of the foot in which one or more of the metatarsal bones are displaced from the tarsus

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7
Q

Signs and symptoms of heat stroke?

*What differentiates it from heat exhaustion?

A

temperature greater than 106°F, mental status changes ranging from irritability to coma, and organ damage such as renal failure, cardiac myocyte injury, rhabdomyolysis from skeletal muscle breakdown, or coagulopathy

*Presence of CNS dysfunction differentiates heat exhaustion from heat stroke

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8
Q

What vessel is responsible for the majority of inferior myocardial infarctions?

A

Right coronary artery (80%) with the remainder due to occlusion of a dominant left circumflex artery.

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9
Q

Management of jellyfish sting?

4 steps…

A
  • Remove nematocysts (scrape off)
  • Hot water immersion
  • Acetic acid
  • Antivenom
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10
Q

What is the normal width of the retropharyngeal space on lateral neck X-ray?

A

7 mm (at C2) in both children and adults.

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11
Q

What components are contained in cryoprecipitate?

A

Factor VIII, XIII, von Willebrand factor (vWF), fibrinogen and fibronectin.

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12
Q

EKG findings in pericarditis?

A
  • diffuse STE
  • PR depression
  • PR elevation in aVR
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13
Q

When does tumor lysis syndrome typically occur in relation to chemo?

A

1 - 5 days after

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14
Q

Clinical triad of infantile spasms? AKA West syndrome

*Management?

A
  1. seizures/myoclonus (especially on awakening)
  2. Hypsarrhythmia on EEG
  3. developmental delay

*ACTH, Steroids, Benzos

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15
Q

When anticoagulating a patient with a deep venous thrombosis with enoxaparin and warfarin, when is it safe to have the patient stop administering the enoxaparin?

A

When the INR is greater than 2.0 for two consecutive days.

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16
Q

What meds do you give for hyperthyroid and in what order?

A
  1. Propanalol
  2. PTU
  3. methimazole (slower onset and teratogenic)
  4. Iodine (do not give before methimazole) at least 1 hr later
  5. Steroids
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17
Q

Outside of sinus tachycardia, what is the most common dysrhythmia seen in blunt cardiac injury?

A

Atrial fibrillation.

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18
Q

What is diagnosis in a neonate 2 - 5 days old with purulent eye discharge?
treatment?

A
  • Gonorrheal conjunctivitis

- IV Cefotaxime and admission

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19
Q

In PECARN imaging rules for kids….what 2 factors automatically merit a head CT?

A
  • GCS < or equal to 14

- evidence of skull fracture

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20
Q

Management of nasal septal hematoma?

A

-I&D,antibiotics (Augmentin), ENT followup

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21
Q

Clinical presentation of measles?

A
  • Cough, coryza, conjunctivitis
  • fever
  • maculopapular rash 2-4 days later (begins on face, spreads down)
  • Koplik spots
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22
Q

Most common malignant brain tumor in children?

other 2 most common?

A
  • Medulloblastoma: HA, nausea, eventually ataxia + cerebellar stuff
  • Astrocytoma and ependymoma also common
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23
Q

What is the treatment for a hemodynamically unstable child with supraventricular tachycardia?

A

Cardioversion at 0.5 to 1 J/kg. If unsuccessful, increase energy dose to 2 J/kg on subsequent attempts

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24
Q

Slow atrial fibrillation is pathognomonic of_______ toxicity?

A

Digoxin

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25
Q

Someone exposed to a pt with bacterial meningitis should receive ______

A
  • Rifampin 600mg PO BID x 2 days

* other options, though less effective: Ceftriaxone 250 mg IM. or Cipro 500 mg PO x7 days

26
Q

Methylene blue can cause hemolytic anemia in what subset of patients?

A

Methylene blue causes oxidative stress which should be avoided in patients with glucose-6-phosphate dehydrogenase deficiency.

27
Q

What are signs of severe/complicated malarial infection?

A
  • Seizures
  • Kidney failure
  • > 5% parasitemia
  • hypoglycemia
28
Q

Treatment of severe/complicated malaria?

A
  • IV quinidine gluconate + doxycycline
29
Q

What diameter of the colon is diagnostic for toxic megacolon on abdominal X-ray?

A

> 6 cm

30
Q

Diagnostic criteria for toxic megacolon:

A

> 6 cmdiameter + at east 3 of the following:

  • Fever
  • HR >120
  • WBC > 10.5
  • Anemia

PLUS at least 1 of the following:

  • Deydration
  • AMS
  • Electrolyte imbalance
  • hypotension
31
Q

What is the maximum dose of lidocaine without epinephrine?

A

5 mg/kg.

32
Q

What important structures pass through the cavernous sinus?

-clinical findings?

A
  • internal carotid artery, CN 3, 4, 6 (also portion of 5)
  • HA
  • fevers
  • periorbital edema
  • lateral gaze palsy (CN 6) most common CN abnormality on exam
33
Q

Most common organism in CST?

A

-Staph aureus

34
Q

Treatment of hypercalcemia?

A
  • IVF
  • Calcitonin
  • bisphosphonates
  • Maybe loop diuretics
  • avoid thiazides
  • HD in severe cases
35
Q

What is your BP goal after giving tPA for stroke?

A

< 180/105

36
Q

What diagnostic test can help identify right coronary artery involvement vs left circumflex involvement in an acute inferior wall myocardial infarction?

A

Right-sided electrocardiogram with a focus on V4R; an upright T wave in lead V4R indicates involvement of the distal right coronary artery (RCA), and ST segment elevation indicates proximal RCA lesion.

37
Q

What are the contraindications for succinylcholine?

A

-malignant hyperthermia
-motor neuron disease
-muscular dystrophies
myotonic distrophies
-GBS
-severe burns (>5 days after)
-spinal cord damage (1 week - 3 months)

38
Q

In which patients do you need to give a lower dose of Such to?

A
  • organophosphate poisoning
  • Eaton-lambert syndrome
  • hypothyroidism
39
Q

What med do you give to a pt with Von Willebrand disease and mild bleeding? (epistaxis, mucosal bleeding, etc)

A

-DDAVP (desmopressin)

40
Q

What med do you give to a pt with Von Willebrand disease and severe or life-threatening bleeding?

A

Factor 8

41
Q

Describe a Galeazzi fracture

A
  • fracture of distal 3rd of radius and disruption of distal radioLunar joint
  • Concurrent ulnar styloid fracture is common
42
Q

Describe a Monteggia fracture

A
  • proximal to mid ulna fracture

- radial head dislocation

43
Q

Describe the clinical course of scarlet fever:

A

Age group:
-kids 2 - 10 years

Rash

  • Starts 1-2 days after fever, begins in groin and axilla, spares palms and soles
  • blanching
  • sandpaper

Circumoral pallor

strawberry tongue

*caused by strp pyogenes

44
Q

Smudge cells are seen in which malignancy?

A

CLL

45
Q

Which lab values drawn from an IO line are coparable to venous?

Which are inaccurate?

A

comparable:

  • Hgb
  • VBG
  • Cl
  • BUN
  • Creatinine
  • Glucose
  • serum drug levels

Inaccurate:

  • WBC
  • K
  • Calcium
  • AST/ALT
  • O2 sat
46
Q

Which antihypertensive agent is recommended in a patient who presents to the emergency department with a hypertensive emergency related to cocaine overdose and intoxication?

A

Phentolamine

47
Q

In eye exposure to acid or alkali, what is the target pH when you irrigate?

A

7 - 7.2

48
Q

Which patients with carbon monoxide toxicity should be treated with hyperbaric oxygen?

A

Patients with neurologic abnormalities, cardiovascular instability and a COHb level > 25 % (or 15% in pregnant women) should have hyperbaric oxygen therapy.

49
Q

What is the discriminatory zone in pregnancy?

A

The discriminatory zone is the ßhCG level at which a normally developing pregnancy should be seen. In general transvaginal ultrasound level is 1,000 - 2,000mIU/ml and transabdominal ultrasound level is 6,500mIU/ml.

50
Q

In a patient who presents to the Emergency Department after an acute digoxin overdose, at what level of potassium should digoxin immune fab be administered without first obtaining a digoxin level?

A

Potassium > 5 mEq/L

51
Q

What EKG finding is seen in hypothermia?

A

Osborn waves

-J-wave, positive deflection at the J-point

52
Q

Treatment of polycythemia vera?

A
  • Hydroxyurea for elevated uric acid
  • Phlebotomy
  • Aspirin
53
Q

What antibiotic(s) should empirically be used to treat bacterial meningitis in an infant less than 28 days old?

A

-Cefotaxime + Ampicillin

OR

-Gentamicin + Ampicillin

54
Q

What antibiotic(s) should empirically be used to treat meningitis in an infant (1 - 3 months)?

A

-Ceftriaxone + Ampicillin + Vancomycin

55
Q

What antibiotic(s) should empirically be used to treat meningitis in a child ( 3 months - 18 years) ?

A
  • Ceftriaxone + vancomycin

* Same as adults

56
Q

What dose of phenytoin or phospheny do you give if Benzos didn’t work for status epileptics?

A

-20 mg/Kg IV

57
Q

Most splenic lacs are now managed non-operatively with observation and/or IR embolization. What are the contraindications of non-operative management?

A
  • persistent hemodynamic instability,
  • generalized peritonitis,
  • inability to follow clinically
  • high-grade splenic injury (grade IV or higher)
  • need for operative management of other intra-abdominal injuries.
  • Age > 55 is a relative contraindication
58
Q

What immunizations are indicated in patients after splenectomy?

A

Pneumococcal, meningococcal, and H. influenzae type b (Hib) vaccines

59
Q

What common bile duct diameter is considered dilated in a patient who still has a gallbladder?

A

8 mm

60
Q

Tx of typhoid?

A
  • IVF

- Fluoroquinolone

61
Q

In a potential overdose pt who has bradycardia, hypotension, and hyperglycemia….think ______

A

Calcium channel blockers

62
Q

Treatment of CCB OD?

A
  • Calcium chloride IV 6 grams followed by drip
  • Glucagon
  • High dose insulin + D50
  • Fluids
  • vasoppressor support as necessary

Rosh Review (7 decks)

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