Rosh 4

Question 1

Which infectious disease can predispose to aortic dissection?

Answer 1

Tertiary syphilis.

Question 2

Alcoholic hepatitis LFT pattern

Answer 2

Alcoholic hepatitis can present with liver enzymes as high as the 500s with AST elevation greater than ALT in a 2:1

Question 3

Slipped Capital Femoral Epiphysis (SCFE) basics

Answer 3

obese boy 12 to 16-years-old
progressive limp and knee pain
oss of hip internal rotation
X-ray will show “scoop of ice cream slipping off an ice cream cone”
Diagnosis is made by AP and frog-lateral X-rays
Treatment is non-weight bearing and urgent orthopedic consultation

Question 4

Caustic Ingestions basics

Answer 4

Chest pain, dysphagia, drooling
Alkali: corrosive damage with liquefactive necrosis
Acid: coagulation necrosis
NPO, endoscopy, monitor airway
Monitor children with history of possible ingestion

Question 5

What bacterial pathogen is typically associated with contact lens use?

Answer 5

Pseudomonas aeruginosa.

Question 6

When is linezolid indicated instead of vancomycin as first-line empiric treatment in the emergency department for pneumonia?

Answer 6

In patients who present in septic shock or with respiratory failure due to pneumonia because linezolid inhibits bacterial toxin production.

Question 7

diagnosis of globe rupture is by__________, which will often demonstrate a positive Seidel test.

Answer 7

fluorescein staining exam

Question 8

Globe Rupture

Answer 8

PE will show teardrop pupil. Aqueous flow on fluorescein testing (Seidel sign)
Diagnosis is made by CT orbit
Treatment is bed elevation, ABX, emergent ophthalmology consultation
Comments: IOP measurement contraindicated

Question 9

Scarlet fever is manifest with a characteristic ____________

Answer 9

sandpaper, confluent, erythematous rash, which is usually self-limited.

Streptococcus pyogenes
Sandpaper rash
Strawberry tongue
Circumoral pallor
Pastia’s lines: petechiae in skin folds
Complications: PSGN, rheumatic fever
Rx: PCN

Question 10

iagnosis of globe rupture is by fluorescein staining exam, which will often demonstrate a positive _______.

Answer 10

Seidel test

Question 11

Measles is a potentially fatal disease characterized by

Answer 11

a morbilliform, maculopapular rash that lasts about 10 days.
associated with a prodrome of high fever, brassy cough, coryza, and conjunctivitis, as well as an enanthem (Koplick’s spots).

Question 12

Roseola is clinically characterized by

Answer 12

a sustained high fever, 104°F to 105°F
irritability without significant focal signs
fever abruptly resolves after two to five days and a subtle, rose-pink rash appears on the face, trunk, and extremities.

Question 13

Seidel test

Answer 13

A positive Seidel test is defined by a flowing stream of fluorescein down the globe on staining exam, which demonstrates extrusion of intraocular contents.

ddx for globe rupture

Question 14

Loss of 15% or less of blood volume is consistent with ___________, which is generally well tolerated and does not affect the hemodynamic profile

Answer 14

Class I hemorrhage

Question 15

Loss of 40% or more of blood volume is consistent with ___________. the patient is likely to be lethargic, stuporous and even comatose.

Answer 15

Class IV hemorrhagic shock

Question 16

Negligible urine output is consistent with what class of acute hemorrhage?

Answer 16

Class IV.

Question 17

Class I hemorrhage

Answer 17

Loss of 15% or less of blood volume is consistent with Class I hemorrhage, which is generally well tolerated and does not affect the hemodynamic profile

Question 18

Altered Mental Status (AMS) Etiology

AEIOU TIPS

Answer 18

A: Alcohol/Acidosis
E: Endocrine/Epilepsy/Electrolytes/Encephalopathy
I: Infection
O: Opiates/Overdose
U: Uremia

T: Trauma
I: Insulin
P: Poisoning/Psychosis/Pharmacology
S: Stroke/Seizure/Syncope