Rosh 7 Flashcards by Luiz Filho

Tx for Neurocysticercosis?

Albendazole

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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

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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

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What medications can induce acute angle closure glaucoma?

antihistamines
anticholinergics
sympathomimetics
topical mydriatics

Anything that dilates pupils

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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)

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What med is contraindicated during thyroid storm because it increases serum T4 and T3?

Aspirin

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Partial thickness burns > what % requires burn center?

*exception = hand or genital involvement

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What abx for NEC in newborn?

Cefotaxime
Ampicillin
Flagyl

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In frost bite, should blisters be de-brided?

yes for 2nd degree (clear blisters)

- No if 3rd degree (hemorrhagic blisters)

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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

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How can you distinguish LV aneurysm from stent thrombosis?

Lack of pain, no reciprocal changes

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What cofactor needs to be administered in ethylene glycol poisoning?

Methanol poisoning?

thiamine

- folate

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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)

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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

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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

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How does head impulse test help differentiate peripheral and central vertigo?

normal = central

- abnormal = peripheral

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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

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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!

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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

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Aside from elderly or infant patients, who else needs ampicillin added to meningitis empiric treatment?

chronic alcoholics

- immunosuppressed

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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

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Antibiotic choice for pre-septal cellulitis?

Something with MRSA coverage

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How do patients with Sarin gas poisoning present?

Cholinergic toxidrome

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1st line Abx for bacterial tracheitis?

Unasyn or clinda + ceftriaxone

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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