Rosh 7 Flashcards
Tx for Neurocysticercosis?
Albendazole
What is the time course of acute organ rejection?
What is the pathology?
1-12 weeks after transplant
CD8 mediated, leukocyte infiltration of Grady vessels, impairing perfusion
Patient with painful genital lesions and tender inguinal LAD?
Diagnosis?
Organism?
Treatment?
Chancroid
Hemophilus ducreyi
Options:
- azithro 1g PO
- ctx 250 IM
- cipro 500 PO
*consider empiric tx for syphyllis
What medications can induce acute angle closure glaucoma?
- antihistamines
- anticholinergics
- sympathomimetics
- topical mydriatics
Anything that dilates pupils
What classes of medications (and examples for each) are used to treat acute glaucoma?
- topical beta blockers (Timolol)
- topical alpha agonists (apraclonidine)
- CA inhibitors (acetazolamide, dorzamide)
- topical muscarinic agonists (pilocarpine)
What med is contraindicated during thyroid storm because it increases serum T4 and T3?
Aspirin
Partial thickness burns > what % requires burn center?
10
*exception = hand or genital involvement
What abx for NEC in newborn?
Cefotaxime
Ampicillin
Flagyl
In frost bite, should blisters be de-brided?
- yes for 2nd degree (clear blisters)
- No if 3rd degree (hemorrhagic blisters)
Woman who recently gave birth, having seizures, without hx of seizure? Dx and management?
Eclampsia (can occur up to 6 weeks post partum)
Tx with IV Magnesium
-4 to 6 g bolus then 1-2g/hr drip
How can you distinguish LV aneurysm from stent thrombosis?
Lack of pain, no reciprocal changes
What cofactor needs to be administered in ethylene glycol poisoning?
Methanol poisoning?
- thiamine
- folate
Child 1-5 years old pw abdominal mass, asymptomatic. Diagnosis?
Wilm’s tumor (nephroblastoma)
-May also have hematuria or HTN
Tx = surgery and chemo (good prognosis)
How can you differentiate staph scalded skin syndrome from SJS/TEN?
SSSS = no mucous membrane involvement, usually preceding infectious symptoms, no medication exposures
*both SJS/TEN and SSSS can have bullae and nikolsky sign
Treatment options for low flow priapism?
- cavernosal phenylephrine 100 - 500 mcg
- terbutaline subq or PO
- cavernosal methylene blue
- blood aspiration
- in sickle cell —> exchange transfusion
How does head impulse test help differentiate peripheral and central vertigo?
- normal = central
- abnormal = peripheral
Patient with risk factors presents with no chest pain, but has biphasic or inverted T waves in anterior leads without ST changes….management?
Catch lab
*wellen’s EKG. Signifies critical LAD lesion. Usually an area that gets re-perfused with collaterals
Wellen’s sign is ______ on EKG.
Deep inverted T waves or biphasic T waves in sterile leads, usually V2 and V3.
Frequently chest pain free!
What is de-winter’s ekg ?
- acute LAD lesion
- ST depression of 1-3 mm with rapid upslope into peaked T waves in precordial leads
Aside from elderly or infant patients, who else needs ampicillin added to meningitis empiric treatment?
- chronic alcoholics
- immunosuppressed
XR in primary TB vs reactivation?
Primary = Ghon focus, unilateral peri-hilar or peri-tracheal LAD, sometimes normal CXR
reactivation = upper lobe infiltrate/consolidation, Cavitary lesion
Antibiotic choice for pre-septal cellulitis?
Something with MRSA coverage
How do patients with Sarin gas poisoning present?
Cholinergic toxidrome
1st line Abx for bacterial tracheitis?
Unasyn or clinda + ceftriaxone
Bilateral facial nerve palsy = ?
Lyme
Management of myxedema coma
- airway (can have macroglossia and decr respiration’s)
- hydrocortisone
- T4
Plus minus T3
Treatment for bullous pemphigoid?
- topical steroids for localized
- systemic steroids for widespread diffuse, severe cases
What does actinic keratosis look like and what is it a precursor for?
- well defined red or brown thickened, scaly lesions on sun exposed areas on fair skinned pts
- squamous fell CA
What is most recent recommendation for work up for r/o SAH within 6 hours?
New generation scanners = CT only, no need for LP
What is desired UOP for patient getting hydration for rhabdo?
200-300 mL/hr
Diagnosis in diver who develops confusion and impaired coordination upon reaching depth?
Nitrogen narcosis
What are the only FDA approved meds to help with etoh abuse?
Naltrexone
Acamprosate
At what Tylenol level would treatment with NAC be warranted at 4 hours?
150
Most common cause of osteomyelitis in all age groups except neonates?
Staph
*exceptions = salmonella most common in SIckle cell
Pasteurella when 2/2 penetrating dog bite
Patient on psych med people AMS, muscle rigidity, fever, autonomic instability….diagnosis and treatment?
NMS
Stop agent, supportive care, dantrolene, bromocriptine
Most common organisms causing SBP?
E. coli and klebsiella
Treatment for seizing hyponatremic baby and dose?
- hypertonic saline
- 4-6 mL/Kg
Aside from COOx level, what other features warrant hyperbaric tx for CO poisoning?
- LOC
- acidosis pH < 7.1
- signs of end organ ischemia
Pressor of choice in kid in shock who feels cold vs kid who is hot, flushed, etc?
Cold = epi
Hot = levophed
Patient with whitish plaque on lateral tongue that doesn’t scrape off…..
Diagnosis?
Associated condition?
Associated virus?
Oral hairy leukoplakia
HIV
EBV
What are indications for admitting a pt with hyphema? (Not necessarily surgery, but admission)
- 50% or greater hyphema
- risk factors like sickle cell, anticoagulantion, bleeding disorders
Patient with symptoms of CHF that is warm and well perfused, bounding pulses, hyperdynamic heart?
Diagnosis and possible etiologies
- high output Heart failure
- AV fistula/malformation, hyperthyroidism, Beriberi (thiamine def), paget’s disease, severe anemia, pregnancy
What factors increase the likelihood of a child with febrile seizure going on to develop epilepsy?
- 1st degree relative with epilepsy
- complex febrile seizure
- abnormal neurological or developmental status prior to febrile seizure
What is reversal for dabigatran?
Idarucizumab
At what CRL do you start to see fetal heart tones?
5 mm
What central line location has lowest rate of infection and thrombosis?
Subclavian
Patient is a building fire with lactic acidosis….diagnosis and treatment?
- cyanide poisoning
- 1st line = hydroxocobalamin, 2nd = amyl nitrite or sodium thiosulfate
What does hyperbaric O2 therapy prevent?
Neurological sequelae
*no effect on mortality, MI, dysrrhythmia
First step in managing patient with traumatic urethral injury with large distended bladder?
- suprapubic cath
* even before urology consult for surgery (surgery often delayed a while 2/2 inflammation)
Patient with recent ear piercing with erythema and tenderness around cartilage…
Diagnosis, etiology, management?
Perichondritis
Infection 2/2 pseudomonas most commonly
Ciprofloxacin
Indication for excising thrombosis hemorrhoid?
Presenting within 72 hours
Management of isolated public rami fractures?
Conservative. PT, etc
EKG findings in hypercalcemia?
Shortened QT
*think this in metastatic CA patient and show that ekg
For high altitude Pulm edema, what can you give other than O2 and hyperbarics?
Nifedipine
What are features of type 1 hypersensitivity?
IgE
Anaphylaxis, urticaria, angioedema
Requires 2 separate exposures
Characteristics and examples of type 2 hypersensitivity?
IgG or IgM antibodies react with cell antigens resulting in COMPLEMENT activation
Autoimmune hemolytic anemia, Erythroblastosis fetalis, goodpasture syndrome
Also requires 2 exposures
Type 3 hypersensitivity features
IgG or IgG immune complex activation and deposition in tissues
Serum sickness, SLE, rheumatoid arth , post strep glomerulonephritis
Formula for serum osmolarity?
2(Na) + BUN/2.8 +glucose/18
Fever 39 deg, unknown source….who gets urine sent? Who gets CBC and cultures?
Urine = girls < 2, uncircumcised boys < 1, circumcised boys < 6 mo
CBC and cultures = unvaccinated, < 6 months old, ill appearing or immunosuppressed
What antibiotic drops are safe in ruptured TM?
Cipro or ofloxacin
Indications for exploratory thoracotomy in setting of hemothorax? 6 things
- initial drainage of 20/kg or 1500cc
- > 200/hr for 3+ hours
- persistent bleeding > 7 cc/kg/hr
- increasing size on XR
- remains hypotension despite blood transfusions (without other source of bleeding)
- pt decompensates after initial response to resuscitation
