Rosh 5 Flashcards
Target temperature when cooling someone with heat stroke?
102F
Criteria for simple febrile seizure?
- Age 6 mo to 5 years
- GTC
- only 1 sz in 24 hours
- non-focal
- normal neuro exam
How is malrotation diagnosed?
Upper GI series
When is surgery indicated in hyphema?
When IOP is uncontrolled
- > 25 after 24 hours in sickle patients
- > 50 for 6 days in healthy patients
*Also pediatric its with grade 4
Tx of septic joint in sickle cell patient?
Vanc + Cipro for better coverage of salmonella
PNA tx for cystic fibrosis pt?
-Vanc, Zosyn + amino glycoside for double pseudomonas coverage
Clinical presentation TTP?
Treatment?
- fever, thrombocytopenia, hemolytic anemia, neuro sx, renal failure
- PLEX + steroids
diagnosis in anemic patient with low MCV and target cells?
Beta thalassemia
Nerve commonly injured in peri-lunate dislocation?
Median
What nerve often gets injured with anterior knee dislocation?
What deficits do you get?
- Common Peroneal
- Impaired dorsiflexion
- sensory: Lateral lower leg, dorm of foot sparing lateral aspect
Which STEMI typically causes Papillary muscle rupture?
Inferior (STE in II, III, aVF)
How long after ingestion Acetaminophen should a level be checked?
4 hours
What dose of Tylenol is thought to = toxic dose?
150 mg/Kg
What meds can cause an increase in lithium concentration?
Diuretics, particularly thiazides.
Lithium excreted Renally
Indications for HD in lithium OD?
- level > 5
- level > 4 with any renal dysfunction
- seizure
- dysrythmia
- AMS
Most reliable lab abnormality in heat stroke?
Elevated AST/ALT
When should a febrile neonate receive acyclovir?
- ill appearing
- mucocutaneous vesicles
- maternal hx of genital herpes
- seizures
60 mg/kg/day divided TID
Fracture of what carpal bone is associated with ulnar nerve injury?
Hamate
What factors increase risk of non-union in clavicle fractures?
- elderly
- high risk mechanism
- female
- medial 1/3
- severely comminuted > 2 cm
- severely displaced > 100%
*n/v compromise, skin tenting, open fx = ortho consult
Slow A-fib = think patients with _____?
Hypothyroid (myxedema coma)
Mgmt post-strep glomerulonephritis
Lasix if edemetous
Polycythemia Vera treatment?
Hydroxyurea, aspirin, phlebotomy
Most common brain mass in kids?
-features?
Medulloblastoma
- solid appearing, homogenous, midline posterior fossa mass
- HA, n/v, ataxia, CN6 palsy
Features of astrocytoma in kids?
- cystic appearing
- rim enhancement with central necrosis
What 2 situations can lead to false negative d-diner?
- anticoagulation
- subacute thrombus > 7 days
What is seen on XR in intussusception?
Dilated small
Bowel
Absent has in colon
Obscured liver margin
Above what BP to you need to lower with meds before giving tPA for stroke?
185/110
Tx of herpes zoster ophthalmicus?
- oral acyclovir/valcyclovir
- topical steroids
- ophtho consult
How longs after chemotherapy are patients at highest risk of neutropenia and infection?
7 days
What electrolyte abnormality must be corrected for urinary alkalinization to be effective?
hypokalemia
What meds should you give in CCB overdose?
- calcium IV
- IVF
- insulin
- glucagon
- pressors if needed
- intralipid if needed
How is peritonitis diagnoses in a pt with peritoneal dialysis catheter?
How is it treated?
- > 100 wbc, > 50% neut
- intraperitoneal Abx
Indications for digibind in digoxin toxicity?
- elevates dig level 10-15
- potassium > 5
- dysrhythmias
- don’t give calcium….stone heart
Indications for HD in tumor lysis syndrome?
- potassium > 6
- creatinine > 10
- Uric acid > 10
- phos > 10
- volume overload
- symptomatic hypocalcemia
*give IVF, rasburicase, allopurinol
What meds should you administer to a woman with Pre-term, premature rupture of membranes (P-PROM)?
- steroids
- ampicillin or amoxicillin
- consider tocolysis
What size is diagnostic for appendicitis on ultrasound?
-6-7 mm non compressible tubular structure
Indication for methylene blue in methemoglobinemia
Methemoglobin level 20% or greater
Dose for pediatric adenosine?
0.1 mg/kg
Patient with tongue or lip telangiectasis, hx of nosebleeds, could be ____?
- Emergencies related to this disease?
- Osler Weber Rendu syndrome
- AV malformations in brain, liver, lung –> bleeding. Sometimes high output heart failure
Management of jellyfish sting?
*4 things
- remove nematocysts (scrape off)
- Hot water immersion 40 to 45 degC
- Acetic acid
- antivenin if applicable
In patients with PID who have an IUD in place, do you need to remove IUD?
No!
Pt with PID and strawberry cervix (punctate hemorrhages)….what organism is responsible?
Trichomons vaginalis
When should etoh or fomepazole be given in Methanol intoxication?
Methanol level > 20
- Can also give Folate
- Dialysis if very sick or level >50
management of CRAO?
- Orbital massage
- Acetazolamide or mannitol or timolol
- Vasodilators (pentoxyfylline, nitroglycerin, isosorbide)
- ophtho consult
What are the 2 earliest clinical indicators of a significant radiation exposure?
- Decr in absolute lymphocyte count
- Vomiting
Is blunt abdominal trauma an indication for Rho-Gam in a pregnant Rh neg mom?
Yes! even without e/o bleeding
Dose: 300 mcg, but 50 if < 12 weeks
- Though giving 300 is not harmful
- Given IM
Epi dose for Peds cardiac arrest?
0.01 mg/Kg IV
Hordeolum (stye) vs Chalazion?
Hordeolum:
- At or near eyelash follicle
- Tender
- bacterial infection
Chalazion:
- Above eyelashes usually upper lid
- Painless
- blocked oil gland
EKG finding in hypothermia?
-Osborne waves
Positive deflection at ST segment
EKG findings in ARVD?
- Epsilon wave (positive deflection after QRS)
- TWI in V1-V3 without RBBB
- Prolonged S wave upstroke in V1-V3
What is the treatment of a pregnant patient with syphilis and a penicillin allergy?
Admission for penicillin desensitization as only penicillin is effective in these patients.
what med should you avoid in pt w GBS?
-Succynylcholine
Early manifestation of cystic fibrosis?
Meconium ileus
All infants with meconium ileum should be tested for _____?
Cystic fibrosis (sweat test)
How do you diagnose meconium ileum?
Hyperosmolar contrast enema
*can also be therapeutic
circumstances for closing a dog bite?
- Clinically not infected
- < 12 hours old
- Not deep and no crush injury
- Not on hand or foot
What infectious process should you suspect in someone traveled to Africa or S America, who initially has viral like syndrome, followed by improvement, who then goes on to dev. febrile illness again with multi-organ dysfunction including severe GI bleed and Leukopenia?
Yellow fever
How is alteplase (t-PA) dosed in ischemic CVA?
0.9 mg/kg (up to 90 mg) with 10% of the dose given as a bolus and the rest of the dose given as an infusion over 1 hour.
Under what age is a surgical cricothyrotomy not recommended?
4 years old
What to administer for someone with active Tetany having truisms, muscle spasms, etc?
- Tetanus toxoid
- Tetanus Immunoglobulin
- Flagyl
- Benzos for spasms
Nausea in pregnancy, which meds to use and when?
- Pyridoxine alone or with doxylamine for early n/v
- Add Benadryl or meclizine
- Zofran for severe sx, ketonuria, weight loss, etc
