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Rosh > Rosh Nugz > Flashcards

Rosh Nugz Flashcards

1
Q

Best 2 ways to see if ROM in preggo?

A
  1. Fern
  2. pH >6.5 Alkaline

*PROM 24-36 weeks consult, electrolysis, steroids

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2
Q

Diverticulitis Symptoms

A
  1. Fever
  2. LLQ pain
  3. Diarrhea or Constipation
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3
Q

Most common complication of diverticulitis

A

Phlegmon/abscess

  • Admit, Abx, bowel rest, surg consult
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4
Q

Tx diverticulitis w/ obstruction/

A

NG tube, bowel rest, Abx?

Fistulas wait until acute episode is over

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5
Q

Appendicitis under 5 characteristics

A
  • uncommon
  • Non specific/localized pain, N/V
  • High risk of perf- rebound tenderness*
  • Can look like gastritis
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6
Q

Biggest risk for third trimester painless bleeding?

A

Dx: Placenta Previa
From: previous C sections

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7
Q

RMSF muscle that gets sore?

A

calf

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8
Q

What lab tests tell you new MI if htey had one 1 week ago?

A
  1. CKMB
    or
  2. Trops trending up
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9
Q

Keep E spasm on your ddx!

A

trouble swallowing with chest pain and resovles

CCB Tx

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10
Q

true allergy to apsirin in MI give…

A

Clopidgrel (ADP inhibitor)

Aspirin has 23% reduce in 30 day mortality

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11
Q

Dysphagia ddx

A

Achalasia

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12
Q

Upper GI bleed- how do you decide between dischage home and endoscopy?
Guaic + and tarry stools

A

Glasgow-Blatchford Bleeding score
if 0=go home oupatient endo
>0= endoscopy in house

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13
Q

Previous dx of diverticulitis and similar presentation, do you get CT?

A

No

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14
Q

Hx of AAA repair (or syhpylsis, aortitis) and then GI bleed symptoms

A

Aorticenteric fistula

emergent EGD

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15
Q

Acute management of Varices

A

ABC (transfusion?)
Octreotide (shunts blood away from splanchnic, somatostatin analog)- Reduced need for transfusion but not mortality
Ceftriaxone (reduces re bleed and complications

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16
Q

What GI pill interferes with clopidgrel?`

A

PPIs

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17
Q

Non pharm GERD Tx

A

raise head of bed 30 degrees
weight loss
food avoidance

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18
Q

recent scope

pleuritc pain worse with neck flexion or swallowing

A

Borhaave

Abx and Surg

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19
Q

battery in stomach - get it or let it pass?

A

Let it pass if tolerating secretions

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20
Q

sharp and in stomach, go get it or let it pass?

A

go get it

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21
Q

upper GI series dx what?

A

ulcer, tumors, hernia, scarring, obsturction

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22
Q

What lab test tells you pancreatitis is biliary?

A

ALT 3x normal value

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23
Q

What is treatment for alcoholic hepatitis

A

Supportive care

Glucose, thiamine, hydration, lytes

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24
Q

Suspect Cholecystitis and US is equivocal, why next?

A

HIDA

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25
Q

Acute chole treatment

A

NPO
ABx
Fluids
Cholecystectomy within 3 days

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26
Q

How do you know if you should anticoagualte a person in A fib?

A

HAS BLED score

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27
Q

What medications are contraindicated in WPW?

A

BB and CCB

  • blocks AV node and further exacerbates the re-entreant pathways leading to v fib
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28
Q

how do you test for joint integrity after a large laceration over a joint space like the knee?

A

Inject 200 cc of saline into joint space away from laceration
+ test if you see fluid coming out of laceration

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29
Q

Young AA kid with stroke like symptoms> 3 things you need to do and what is the cause?

A

Sickle Cell stroke- not embolic or thrombotic- it is vasooccuslive or sticky

  1. CT
  2. baseline labs
  3. Exchange transfusion of blood to get Hgb above 10 and reduce HgbS under 20%
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30
Q

3 contraindications to nitro

A
  1. R inf STEMI- contractility is dependence on diastolic pressure bc RV is low volume pressure pump
  2. Phosphodiesterase inhibitors like sildenafil
  3. hypotension
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31
Q

Tx of brochiloitis?

A

supportive
Oxygen, nasal suction
positive pressure, humidified air thru NC
*day 2-3 is the worst

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32
Q

Reasons to admit bronchiloitis

A
  1. less than 3 mo old
  2. 34 week GA
  3. RR >70
  4. Ill appearing
  5. PO intake down
  6. Comorbids
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33
Q

loss of sensation area in radial nerve palsy?

A

snuff box area

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34
Q

last 5 steps of cardianl labor movements

A

FIEEE

flex, internal rotate, extend, external rotate, expulsion

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35
Q

Puncture wound wihtout going thru a shoe- what abx do you give/

A

Bactrim 5 days
Cover for staph
dont sew it up

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36
Q

wet wobbly wacky?

A

NPH

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37
Q

young AA F w/ SOB and new heart block?

A

think sarcoid

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38
Q

Things to think about in hisotry to see if you need a CT or not?

A 
LOC
Vomiting
AMS
headache
mechanism
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39
Q

3 abs to cover for MRSA?

A

Bactrim
Doxy
Clinda

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40
Q

What lab test or vital sign tells you shock?

A

None.

-clinical recognition of the presence of inadequate tissue perfusion and oxygenation

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41
Q

5 hard signs of vascula rinjnury after knee dislocation?

A
  1. ulsatile bleeding
  2. bruit
  3. palpable thrill
  4. distal ischemia
  5. expanding hematoma
    - look for neuro and pulse difference too
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42
Q

peds partial airway obstruction with normal vital signs> what next?

A
  1. keep them still
  2. Set up DL and needle cric at bedside just in case
  3. call ENT for them to come remove it
  • Back blows are used for chkoing infant less than 1 year old
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43
Q

what 4 things make you think Cavernous sinus thrombosis?

A
  1. orbital pain
  2. Proptosis
  3. EOM disability
  4. recent infection/clotting disorder
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44
Q

what hearing difficulty does Bells palsy have?

A

hyperacusis (sensitivity to certain pitch)

retroauriclar pain

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45
Q

2 causes of posterior shoulder dislocation

A

Electricity

seizures

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46
Q

inferior shoulder dislocation presents like what with what mechanism?

A

arm above head and external rotation
swimming pool with arm forward collision
Pull up and lateral to reduce

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47
Q

Ant shoulder dislocation and tx

A

indentation of deltoid (squared off) and abducted/external rotation
- from fall backwards onto outstretched hand

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48
Q

PR depression on ECG, ST elevation + uremia/recent virus + CP

A

pericarditis

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49
Q

involuntary contractions of face, torso, extremities ect

on antipshyctoics or anti-emetics

A

Acute dystonia reactions- mimics stroke!
Give Iv benadryl to cure this
*usually medication related, could be pesudoseizure

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50
Q

Tx of reyes syndrome?

A

Supportive

-hepatic failure and cerebral edema

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51
Q

Difference in somatization and hypochondriac

A

Somatization: they believe it is real
Hypochondriac: Symptoms blown out of proportion an doctor shop out of fear

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52
Q

Difference between dermoid cyst and Thyroglossal cyst?

both are midline

A

Dermoid- 1 under 3 years old and 2 does NOT move with tongue protrusion 3 above hyoid usually
Thyroglossal- under hyoid and DOES move with tongue

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53
Q

Geriatric borke hip now delirious? what next?

A

Give optiates to treat pain!

check for bladder retention and other causes of delirium

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54
Q

Kanavel criteria

A
  1. pain qith passive extension
  2. tenderness of flexor sheath into the palm
  3. sausage finger
  4. held in slight flexion

-local compartment syndrome with sheath
fluids, abx, surgery quickly

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55
Q

5 things to look for on gallbladder US

A
  1. sonogrpahic murphys
  2. pericholecystic fluid
  3. wall thickening
  4. stones/ slduge
  5. CBD dilation
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56
Q

fever, LA, eczema now vesicles and punched out lesions

A

eczema herpticum - superimposed infection

acyclovir

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57
Q

neurocysitissarcosis tx

A
  1. check eyes before tx or vision loss

2. albendazole +/- praziquantel

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58
Q

involuntary contractions of face, torso, extremities ect

on antipshyctoics or anti-emetics

A

Acute dystonic reactions
Give Iv benadryl to cure this
*usually medication related, could be pesudoseizure

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59
Q

chest pain in peds ddx

A
  1. PTX, pneumomediastinum (trauma to chest)
    - If it is tension pneumomediastinum incision at suprasternal notch
  2. Pericarditis
  3. PE
  4. PNA
  5. Conginental heart- HOCM, coronary artery abnromalities
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60
Q

thumb dislocation

A
  1. NV intact
  2. digital block
  3. longitnudianl traction and hyyper extend
  4. XR and assess for stability
  5. pslint in extension
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61
Q

What is considered massive hemopytsis and how do you manage it?

A
  • hypotension or impaired gas exchange or
  • 100/hr or 500/25 hr

Tx: Mainstem intubate the good lung and have them lie on the bleeding lung in decubtitus to not bleed into the good lung

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62
Q

asthma and albuterol and sats get intially worse- why?

A

VQ mismatch- aiwarys opened up to non ventilated lungs

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63
Q

Asthma
SE of Mag?
SE of Beta agonist?

A

Hypotension

Dehydration from increased RR- give them fluids

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64
Q

3 ways why hemoptysis?

A

erosion into a vessel
coagulaopthy
pulm HTN

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65
Q

why do we do needle before chest tube for tension?

A

needle gives immediate improvement then put in chest tube

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66
Q

COPD exacerbation tx

A 
Duonebs
Abx
steroids 
non invasive vemtialtion 
-avoid intubations as mortalrity increases
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67
Q

On US does vitreous hemorrhage artifacts move with they eye?

A

No

Retinal detachement- flashes of light with floaters

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68
Q

Risk factor +, symptoms + for CRAO- what 2 things can you do immediately?

A

ocular massage and co2 retention breathe into paper bag

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69
Q

Toxic shock syndrome tx?

A

Fluids
remove foreign body if possible
Clindamycin- blocks exotoxins and kills bacteria

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70
Q

Criteria for acute bronchitis dx?

A
  1. Less than 3 weeks
  2. VS normal
  3. Absence of Lung disease
  4. Asbcence of PNA PE findings
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71
Q

Herpes at tip of nose should tell you what?

A

possible eye involvement

give topical trifluridine/acyclovir

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72
Q

Is there allergic reaction cross reactivity to cephalsporins with PCN allergy?

A

1-8% Cross reactivity with the beta-lactam ring similiarty structure.
First/second gen cephs are more likely
Cefoxitin and cefazolin

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73
Q

Retrobulbar timeframe to vision loss?

A

2 hours

retina ischemia when central retinal artery occluded

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74
Q

what tiem point is activated charcoal useful?

A

1 hour

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75
Q

3 organisms in infant sepsis and Tx?

A

GBS, Staph, E coli- Amp and Gent or cefotaxime
for both <7 and >7 days presentation
+/- Acyclovir

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76
Q

idniciation for tpa in MI?

A

if patient will be >90 minutes to balloon time

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77
Q

What does scapula fractures tell you?

A
  1. High impact trauma- check skull, lungs etc

2. Check clavicle for scpaular dissocation=emergency surger

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78
Q

low risk appendicitis features

A
  • duration of pain for greater than 48 hour
  • previous episodes of similar pain
  • lack of migration and right lower quadrant pain
  • vomiting before the onset of pain

*obturator sign- keep knee stable and bring the foot out towards you and wall

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79
Q

HHS w/ glucose at 800>seizure— what next?

A

Fluids!. severe dehyradtion, hyperosmolar, electryltie abnormlaities leads to this

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80
Q

You give heloperidol and then neck and face contractions happens- what next?

A

Give benadryl or benztropine

-This reaction is caused by disruption in the balance between dopaminergic and cholinergic pathways in the basal ganglia. They tend to occur within 48 hours of administration of a neuroleptic agent. Patients often experience tongue protrusion, acute torticollis, sustained eye deviation (usually upwards) and arching of the back. Laryngospasm is rare but potentially life threatening. Because dystonic reactions occur as a result of cholinergic dominance, they should be treated with anticholinergic agents including benztropine and diphenhydramine. These agents typically reverse symptoms immediately.

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81
Q

Tx of pneumomediastinum?

A

Supportive care, dont increase pulm pressures, pain management

  • alveolar leak
  • complications= tension pnuemopericardium , PTX
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82
Q

hemopytsis, hematuria, renal disease?

A

Goodpastures

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83
Q

3 diagnoses of alveolahrhemorrhage syndromes

A
  1. pulmonary capillaritis- inflammaotry (lupus)
  2. Bland alveolaer hemorrhage- back up from heart, bleeding disorder, no inflammation
  3. Diffuse alveolar damage- edema + hylaine mebranes of alvoleoli that leads to ARDS
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84
Q

what is pseudohemoptysis?

A

blood coming from mouth or nose

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85
Q

impending worsening resp failure preceeded by?

A 
AMS
lethargy
minimal breath sounds
acidosis
worsenign hypoxia/hypercapnia
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86
Q

Acute asthma exacerbation w/ normal or elevated CO2?

A

impending respiratory fatigue/failure

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87
Q

COPD vs CHF differences in dx?

A
  1. CXR
  2. BNP
  3. PE for volume overload
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88
Q

Stable Cervical spine fractures

A
  1. Clay shovelers- C6,C7 transverse process
  2. unilateral facet
  3. Type 1 (tip) odontoid fracture
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89
Q

Unstable cervical spine fractures

A

Jefferson bit off a hangmans thumb

  1. jefferson burst fracture
  2. bilateral facet (dislocation i think)
  3. Odontoid 2, 3
  4. Hangman
  5. Teardrop
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90
Q

NEXUS criteria

A 
No focal neurologic deficits, 
normal alertness, 
no evidence of intoxication, 
no distracting injuries
no posterior midline cervical tenderness.
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91
Q

flail chest tx?

A

supportive- pain, resp support, do not wrap the chest
Intubate if it is big enough
*negtive insirpaotry pressure causes the segment to move inward

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92
Q

Benzocaine spray used in intubations and procedures can lead to …

A

methemoglobinemia
pulse ox right at 85%ish and not moving
if mild just oxygen, if above 25% give methylene blue
normal paO2

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93
Q

which topical anestehtic is most cardiottoxic?

A

bupivicaine

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94
Q

ester or amides more allergenic?

A

esters > PABA metbaolite

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95
Q

Kid with central cyanosis at 3 weeks. How do you determine if this is cardiac or pulmonary?

A

Hyperoxia test- need ABG
give 100% oxygen and if paO2 is <150 then cardiac congitnal disease- give prostaglandins- cyanosis wont improve
if it is greater than 150 then pulmonary- cyanosis will improve. Oxygen is able to get into the lungs not shutned away

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96
Q

Target like lesions on plams, soles, body. Causes and Tx?

A

Erythema multiforme, supportive vs steroids

HSV, medications, pregnency, mlaignancy, X rays

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97
Q

Painless, flashes of light, progressive, curtain like?

A

Retinal detachment

*between inner neruonal outer pigment layer- Get US!

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98
Q

testicuar pain DDx?

A 
torsion
appendage torsion, itis
orchitis
epididymitis
abscess
hernia
nephrolithiasis
gangrene
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99
Q

contraindications to Noninvaisve pressure ventilation?

A 
Altered or obtunded patient,
hemodynamic instability
inability to tolerate oral secretions
recent trauma or injury to the face
poor mask fit.
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100
Q

goals of tx for COPD?

A
  1. reduce obstruction with albuterol
  2. increase oxygen [] with supplemental
  3. reduce inflmmation with steorids
  4. tx infection
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101
Q

When to intubate in COPD?

A 
altered mental status
severe hypoxia
hypotension
 hypercarbia
* Altered mental status may suggest worsening hypercarbia as well as an inability to tolerate noninvasive positive pressure ventilation.
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102
Q

SSRI + dextromehtorphan…?

A

Serotinin syndrome
NMS=antipsychotics, muslce rigidity
MAOI + tyramine= sweaty, hyperthermic, flduhing

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103
Q

Which eye Dx common in sickle cell and which med do you want to avoid?

A

Hyphema

Acetazolamide- Lowers pH and exacerbates sickling and increases IOP

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104
Q

First line hyphema Rx?

A

Timolol

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105
Q

Cushings reflex?

A

HTN
Bradycardia
Bradypnea

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106
Q

hyperventilation wll vaso…

A

Constrict

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107
Q

dehyrdated old person with neck mass…

A

supportive parotitis- aggreisve infection

broad spectrum abx

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108
Q

AC joint displaced tx?

A

Grade 1 2 3 sling and follow up (it can still look pretty displaced and it is still follow up)- 456 get srugery for massive displacement

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109
Q

Which drugs given through an ETT?
Why?
What dose?
What complication to look for after giving it?

A

NAVEL, naloxone, atropine, vasopressin, epi, lido
no access, in arrest, no IO
2x IV dose
Transient hypoxia from liquid in lungs

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110
Q

complications of malingant otitis externa

A

brain abscess, CN, mastoiditis, menginitis, sinus thrombosis, osteo
-itching, foul discharge

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111
Q

Which antiviral for flu shold be avoided in COPD/lung patients?

A

Zanamivir

Oselatmvir- GI
-mantadines: Neuropsyh

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112
Q

how long do you have to prescribe an antivrial?

A

48 hrs

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113
Q

INH for 6 months if helathy

9 months if pregnant, HIV or 2-11 yrs old

A

nada

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114
Q

CAP outpatient tx?

inpatient?

A

macrolide or doxy

Add a 3rd gen ceph or just a flruoquinolone

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115
Q

looks like pulm TB all around an d on CXR but is a drunk bastard?

A

Lung abscess

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116
Q

unexplained pleural effusion - think what dx?

A

PE

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117
Q

small pleural effusions need what xray view

A

lay on side

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118
Q

where to do throacentsis?

A

2 interspaces below dullness inthe midscapular line

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119
Q

suspect T-E fistula, what next?

A

Place Ng tube and get x ray to see it coiled

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120
Q

blunt chest injury to sternum- what are you ocncerned for?

A

Cardiac contusion- dysrhtmias and heart failure can ensure- heart muscle is stunned needs telemetry montoring

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121
Q

subungal hematoma managament

A
  • use electrocautery. If acrylic nail polish use 18 G needle to manually drill
  • posterior nail edge disruption is a ocntraindication- need ot remove nail and repair laceration
  • just trpehination is enough for most, dontneed ot rpeair lacertion
  • repair lac with 6-0 absorbale gut, or glue, cover with nail or other cover and give abx
  • check for fracture
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122
Q

RSI a shock patient and they code, why?

A

intubation and they have their last catecholamine surge and you take it away with paralytics they might code right then

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123
Q

when to pack an abscess?

A

5 cm or greater
DM2/immunocompromised
pilondial abscess

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124
Q

known malinancy with pericardial effusion and normal VS- tx?

A

reassurance and f/u

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125
Q

what med can give you epipdidymitis?

A

amiodarone chemical induced

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126
Q

looks like croup but not better after epi and steroids and looks very sick?

A

bacterial tracheitis - OR airway management

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127
Q

waht maneurver can you do to reporduce costochondirits?

A

corwing rooster- both arms up like signlaing for a field goal- then i pull thier elbows bakc and up!

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128
Q

sudden sensorinural hearing loss tx

A

idiopathic= prednisone for 7-14 days (60 mg)

Sudden sensorineural hearing loss has numerous causes, including idiopathic, infectious, autoimmune disease, neoplasms, cerebrovascular disease, and ototoxic medications.
Could be conductive too

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129
Q

3 electorlytes distubrances to cause prolonged QT?

A

Low
Ca
Mg
K

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130
Q

bucket/corner metaphyseal fractures in peds…

A

Abuse- yanking on arms

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131
Q

UMN lesion signs

A

hyperrelfexia
spastic muscles
Babinski response

Spinal cord lesion*

LMN- hyporeflexia, low muscle tone, negative babinski

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132
Q

Co2 10 Bicarb 10 what pill intox an tx?

A

ASA- give sodium bicarb

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133
Q

what to use in NMS for muscle rigifity?

A

Dantrolene or bromocruptine for dopamine agonsit

mainly just stop the offending agent

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134
Q

aferile pedaitric patient 6 yo wit hip pain… Dx and tx

A

transeint synosvitis- after URi usually- dx of excusion- give steroids (between 3 and 10 yo)
rule out septic arthritis

remeber slipped cap and legg calfe perthes

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135
Q

how to tx a cat bite

A
  1. amox-clav
  2. secondary closure

Clinda/metro + Doxy or bactrim or cefuroxime

no doxy in kids

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136
Q

Peds pt N/V AMS and then

AGMA, HypoCa, Kideny failure

A

ethylene glycol- give fomepizole

watch out for kidney function

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137
Q

caustic ingestion management

A

fluids
pain
x ray to see if perf
endoiscopy

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138
Q

tx of oral candidiaisis?

A

clomtrizole
nystatin oral

refracotr is fluconsazole or Amphortericin B

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139
Q

tx of frost bite

A

warm, circulating water. gentle rewarming

Pathophys*As the temperature drops below 10°C, cutaneous sensation is compromised. With microvascular vasoconstriction, plasma begins to leak into the interstitial space. Ice crystals begin to form once the temperature approaches 0°C. Once crystals begin forming, intracellular osmolarity rises and cells begin to collapse and die.

  • once that cold, hyperkalmiec, acidotic blood return s to system then it is termed core temp after drop
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140
Q

AMA, HTN before 20 weeks, vomtting, blood in vagina 16 week spreggo

A

mole with trophopblastic disease and possible mets

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141
Q

emergent dialysis in hypercalcemia

A

> 18
CHF
renal failure
neuro symptoms

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142
Q

vision changes, headache, vomiting, weird neuro symtoms…

A

venous thrombosis!
aska bout clots and pregnancy
MRV and Heparin

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143
Q

weakness generalized, tired, uncoordinaed movements in an old person, what should you test for and how?

A

Think early parkinsons- bradykinesia.

  • speed, amplitude, and rhythm of skills such as finger tapping and rapid hand movements
  • refer to outpatient neurology
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144
Q

How to test for a DVT and what to do if +

A

3 point US of compressible vein

If non cimopressible- start LMWH and Warfarin outpatient

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145
Q

Clinically suspicious for DVT but negative scan= tx?

A

Outpatient US for DVT in 1 week

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146
Q

PHOTOPHOBIA + ciliary flush + trauma (or non) + low Visual acuity =?

A

Iritis - get slit lamp and look for cells

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147
Q

Pain with EOM=… (2)

A

Optic neuritis

Orbital cellulitis

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148
Q

How to treat a fight bite of the knuckles?

A

Augmenton

irrigiation

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149
Q

Can close a dog wound if:

A

The wound is clinically not infected, less than 12 hours old (24 hours for facial wounds)
is not located on the hands or feet
is not a crush injury or a puncture wound
is not heavily contaminated
the patient is not immunocompromised.

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150
Q

How do you treat unstable junctional rhythms?

A

Like bradycardia- Atropine and then transcutaneous pacing

_ it orignates in AV noe, HIS, or Ventricle. No p waves! Slow and narrow. If fast, narrow no p waves= Accelerated juncitona lrhtynm

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151
Q

How to treat stable and unstable a fib

A

Stable- Get echo (+/-), anticoagulate, cardiovert
Unstable (150-200J) sync cardiovert
Medical cardiovert- Dilt 15-20 mg bolus over 2 minutes and then go to 5-10 mg/hr. if that fails then give 25 mg in 15 minutes.
* verapamil, metorpolol, procainamide, amio

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152
Q

MAT tx

A

lytes distrubances/underlying trigger

Mag Sulfate 2 g IV over 1 minute

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153
Q

Abx for cat bite?

A

Amox- clav

+ x ray

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154
Q

EKG findings for dig toxicity

A

PVCs most common
and Heart block

-Block Na K atpase- HYPERKALEMIA
- Extra Na in cell leads to more Ca in cell bc of Na/Ca pump= ionotropy
Dont give IV calcium to this! stone heart

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155
Q

MVP pearls

A
  1. asymptomatic usually but : CP, palps, SOB
  2. INcrease Preload=later in systole click
  3. look for mitral regurg
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156
Q

ranson criteria

A

Age >55 years, glucose >200, WBC >16,000, AST>250, LDH>350
causes:
1. Steroids
2. Hyperlipiedmia

4-7% mortality for acute pancreatitis

lipase: 4-8 hours of symptom onset and peak at 24 hours. If biliary cause then LFTs/alk phos/bilirubin=biliary >now need an ERCP to reduce mortality!

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157
Q

SBP, give abx before paracentesis?

A

NO. false negative is very high. Give ceftriaxone (E coli and klebsiella) afterwards unless very sick and risk factors for it

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158
Q

Risks for spetic arthritis

A

intravenous drug use, rheumatoid arthritis, diabetes mellitus, recent joint surgery, or a prosthetic joint

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159
Q

most common dysrthhmia in kids and tx?

A

PSVT- Ice to face(15 seconds)/modified valsalva, TOngue dperessor back of mouth>ednosine
poor feeding, tachypnea, and irritability

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160
Q

Sepsis, hypotension depsite fludis and pressors

hypoG, hypoNa, HyperK…

A

adrenal crisis
Hydrocortisone 100 mg bolus then q6 hour

Drop in crit, back pain, AMS etc.
Can happen in MI, trauma, clots etc!

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161
Q

NEC keys

A

can occur up to 6 months old
can occur in term babies
vomting and distention- Xray

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162
Q

Huge inverted T waves in anterior leads…

A

elevated ICP- long QT

Stoke with edema, brain bleed

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163
Q

does subdurals cross suture lines

A

yes

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164
Q

seconds to minutes peds chest pain on L side of sternum worse with inspiration…

A

precordial catch

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165
Q

refractory seizure then WGMA… Tx?

A

B6 pyridoxune 5g IV push slow

INH interferes with GABA and metbaolism of b6

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166
Q

size of PTX to be on just oxygen alone?

A

20% or less

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167
Q

facial trauma and NG tube you worry about what fracture?

A

cribiform plate

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168
Q

QT prolonged in clonidine or methadone overdoses?

A

methadone

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169
Q

viral gastroenteritis with vomtinig and diarrhea, no blood. What are you thinking to see if they shoudl stay or go?

A

lyte distrubances?
tolerate PO?
playful?
if so then discharge home with reassruance this takes a week
*non bloody, non bilious, watery diarrhea
others at school have it

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170
Q

isolated plateltets are low, normal coags- tx?

A 
ITP
>50k observe
<50k prednisone
< 20 k not bleeding= iv methylpred
<20 bleeding= IVIG + steroids
-petechia, ecchymosis, mennorhagia, epistaxis

HepSplenmgaly, LA, pallor, bilirubin= leukemia, lymphoma

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171
Q

lymes testing?

A

ELISA testing with Western Blot and PCR

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172
Q

pericarditis has what else on EKG?

A

pr depression

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173
Q

Recent A fib and now bradycardia with heartblock, junctional rhythm… Dx and TX?

A

BB or CCB overdose

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174
Q

recent cancer Dx and chemo 48 hours ago and now N/V AKI, muscle aches, hallucinations

A

Tumor lysis syndrome- can have seziures, cardiac arrythemia and cardiac arrest
watch out for hyperK, hyperPO4, hypoCa,
give rasburicase/allopurinol and fluids

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175
Q

peritonsillar abscess Tx? fever, trismus, drooling

viral coinfection common?

A

Needle aspirate>abx>observe 6 hours> imporvement and tolerate PO=CYAAAAA
-Mono

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176
Q

DKA management in adults when the glucose drop sunder 250 switch to…

A

D5LR

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177
Q

3 main reasons why a stroke could be occurring?

A
  1. DVT
  2. Palps and a fib or ECHO needed
  3. Endocarditits
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178
Q

deconditioned patient (cancer too) and CT scan shows nothing acute, what is their dispo?

A

Can they tolerate PO and be safe at home for discahrge

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179
Q

blood transfusion and then fevers chills NV myalgias and hypoTN, now what?

A
  1. stop
  2. fluids (prssors if need be)
  3. diruetics to maintian UOP and sto renal damage
  • hemolysis so send for LDH and hapto to be high and low respectively
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180
Q

at what level calcium (symptomatic or not) do you need to treat for it?
when do you go to dialysis for it?

A

14-FLUIDS

18

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181
Q

name 5 of the symtpoms from hypercalcemia

A

atigue, weakness, confusion, hypertension, bradycardia, polyuria, polydipsia, dehydration, nausea, vomiting, constipation, ataxia, and coma

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182
Q

when do you use bisphosphos and clacitonin to hyperclaemia?

A

you can but it will take a while to work, hydration and fluids is the Tx mainstay

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183
Q

3 ekg changes with hypercalcemia?

A

Shortening of the QTc interval, PR prolongation, and QRS widening.

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184
Q

upper lobe PNA in a drinker +/- air fluid level? Dx and TX

A

Klebsiella
Rocpehin and gentamycin (aminoglycoside)

Strep pneumo is lower lobe and lobar consildation

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185
Q

AA w/ hemolytic anemia after new Rx or infection?

A

G6PD
no NADPH=no glutathione= cant handle oxidative stress and nothing to clean up free radicals
Aspirin, Bactrim, Macrobid etc

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186
Q

what is valentions synrome?

A

Perforated PUD and pain in lower quadrants bc of paracolic gutter leak
pain can be referred to here lower Quads bc leakage into the area

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187
Q

5 steps in varcieal bleed?

A
  1. fluids
  2. blood/FFP?
  3. Octreotide
  4. ceftriaxone
  5. BB
  • SB tube? surgery?
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188
Q

organizsm in Peritonsillar vs retro abscess?

A

Group A strep- needle aspirate

Strep viridans

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189
Q

what are JONES criteria major and minor?

A
  1. evidence of step throat w/ titer or swab
  2. Joints, cardiac murmur, painless Nodes over bones/tendons,rash sparing the face (erythema marginatium), syndeham chorea
  3. CRP/ESR, prolonged PR itnerval, arthralgia, fever
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190
Q

3 EKG changes usggestive of STEMI?

A

ST segment depression
new T wave inversions
hyperacute T waves.

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191
Q

You see a NSTEMI and give aspirin and…

A

TIcagrelor

shown to be better and reverisbel than ADP inhibtors

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192
Q

Oz sats hovering at 85% - what meds usually do this?

A

methemoglinemia

topical anesthetics

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193
Q

what bP cut off should a young person be evaluted for HTN immedietaly in ER vs PCP

A

Diatolic of 115

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194
Q

difference in chalazion vs hordeoulm?

A

hordelum hurts, bottom eyelid, infectious, acute

chalazion blocked meiboam gland, chronic, top eyelid

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195
Q

what is fluid between the parietal and vsiceral layers in the tunica vaginalis ?

A

hydrocele

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196
Q

varoceleces are sharp or dull pain?

A

dull

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197
Q

Pelvic instbaility and negative fast w/ hemo unstable=?

A

angio embolization

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198
Q

If there is a + fast and pelvic instabilit and hemo unstable=?

A

ex lap

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199
Q

febrile seizure pearls

A
  1. tylenol doesnt prevent reoccurence
  2. A seizure puts them at increase risk for epilepsy from 1% to 2-3%
  3. the younger the mor elikley for epilepsy
  4. antioncvulsatns dont help long term
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200
Q

2 post complications of herpes zoster

A
  1. post herp neurlagia

2. bacterial infection

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201
Q

mild and severe treatment of tumor lysis?

A
  1. allopurinol, rasburicase IV

2. Hemodilaysis if severe

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202
Q

Tx for unilateral facet dislocation of C5 w/ normal exam?

A

C collar and follow up outpatient

other facet makes it stable

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203
Q

Tx for HIV oral candidiasis:

  • on therapy
  • not ontherapy
A
  • clomtrizole/nystatin

- fluconazole

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204
Q

Testicular cancer work up

A
  1. US
  2. down syndrome + large dense and painless
  3. AFP, LDH, BHcg

DDx: hemotcele, rupture

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205
Q

side effects of physostigmine?

A

dysrthmias

seizures

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206
Q

anticholonergic treatment?

A
  1. benzos
  2. cooling
  3. physostigmine
  4. WBI bc of slowed gastric emptying
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207
Q

how long do tonic cloncis last?

A

1-2 mins

post ictal for hours

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208
Q

first step if you suspect ectopic?

A

stable or unstable?

start resuscitiation quickly and if still tachy then surgery

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209
Q

young female with r sided weakness, left sided pain sensation loss and episode of vision loss 1 month ago?>

A

Think MS! give steroids

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210
Q

young kid with nystagmus, tachy, dialted pupils and AMS?

A

Dextromethoprhan PCP/opiate ingestion from cough syrup

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211
Q

dog bite tx?

A
  1. sutures
  2. irriagtaion
  3. abx
    - primary vs secondary closure no diff in infection
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212
Q

painless vag bleeding, next best step in 3rd trimester?

A

US- check for placenta previa! dont do cervical or speculum exam until this is ruled out

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213
Q

Causes for MAT
Criteria for MAT
Tx for MAT

A

COPD!! /hypoxia
irregular, different p waves, tachycardic
Treat COPD, oxygen & rate control

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214
Q

What is severe sepsis?

A

Organ disfunction
lactic acidoss
hypotension

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215
Q

barhtolin abscess tx?

A

ID & catheter drainage ongoing like a tube or Word catheter

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216
Q

opiate withdrawal clinidine dosing?

A

.1-.3 every hour with a max of 0.7 total in a day

alpha 2 agonist to give hypotension and decrease sympatethci tone

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217
Q

why desmopression in vWF?

A

stimualtes release of factor 8 by stimualting the release of vWF from endothelial cells

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218
Q

what is the pentad for TTP?

A
  1. Fever
  2. Renal failure
  3. Neuro complaints
  4. anemia
  5. thrombocytopenia
    * dont give plateltes it gets worse
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219
Q

DIC labs

A

High PT PTT
low platelts and fibrinogen
high D dimers and fibrin

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220
Q

lupus blood lab that is chronically low?

A

plateletes

collagen vascular disease leading to destruction of plateltes

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221
Q

missed dialysis can lead to:

  1. Heart
  2. Brain
  3. Blood
  4. GI
A

Uremia

  1. Pericardititis
  2. AMS
  3. plateltet dysfunction and bleeding
  4. N/V
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222
Q

Blood pearls
COombs tests for what?
retics high or low after parvo infection?

A
  • Ig or complement on RBCs in for autoimmuniehemolytic anemia, coombs negative in aplasitc anemia
  • low, aplstic anemia is no hemolysis
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223
Q

When to admit for hyphema?
IOP rx?
contraindicated Rx?
cycoplegics?

A 
mechanical tearing or shearing of the vasculature of the iris or ciliary body. 
over 33% or 30 IOP
Acetazolamide or timolol
ASA, ibuprofen
atropine/scoplamine
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224
Q

first line for acute otitis media?

A

amoxicillin 90mg/kg divided into BID or TID for 10 days

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225
Q

Fever, arthrlagies, headache + hypoNa + low platelets

A

RMSF- no rash can happen especially early!
also petiechiea after BP cuff inflation!
doxy

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226
Q

petiacheal rash in one arm w/ no other explanation?

A

Rumpele leede phenomena- rupture dermal capillaries with vascular pathology underlying like DM2 or HTN, or HTN emergency!

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227
Q

How do you treat seizures/AMS hypoNa?

A

HTS 3%: 100 cc over 10 min and then 100 cc over 50 minutes

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228
Q

Hyponatremia labs

A 
Serum Osms
Urine Osms
Thyroid
Cortisol for adrenal insuffiecny 
calculate FeNa
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229
Q

What do you need to check for after a blood transfusion?

A
  1. N/V hemolycitc reaction clincially

2. VOlume overload w/ legs, lungs and AMS

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230
Q

Febrile siezure treatment (3)?

A
  1. Observe for hours
  2. tylenol to drive fever down
  3. PO challenge them
    - education
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231
Q

3 lytes to give you torsades

A

hypo:
K
Mg
Ca

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232
Q

Dont give Sux to:

A
  • acute renal failure
  • neuromuscular disease like multiple sclerosis, amyotrophic lateral sclerosis, and muscular dystrophy.
  • spinal cord injuries 1 week to 3months after
  • burns 5 days after
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233
Q

Asthma intubations

A
  1. cardiac arrest
  2. Bradypena/resp failure
  3. respiratory exhaustion (somnolence, eyes closed, subcostal retractions)
  4. AMS
  • before you get there is Heliox, Bipap, Mag and terbutaline
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234
Q

Kanavels criteria

A
  1. Suasage finer
  2. tender along the entire flexor tendon
  3. Flexed
  4. pain with passive extnesion
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235
Q

Hypoglceymia pearls

A
  1. symptoms start at 50
  2. Long actign and sulonureas need 24 hour obs
  3. Catcho,aine surge leads to the sympmtoms when brains dont get their food
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236
Q

What does Alk phos high mean?

What does Alk phos and GGt high mean?

A

1.liver or cholestatic, if really high chlestatic
2. GGT + Alk = cholestatic
GGT + Alk+ High Conj bilirubin = Obstructive jaundice

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237
Q

Treat these blood transfuions: Stop it +…

  1. TRALI
  2. Allergic Hives
  3. Febrle rxn
  4. hemolytic reaction
A
  1. supportive
  2. Benadryl, supportive
  3. Tylenol
  4. Lots of immediate fluids and some diuretics
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238
Q

Simple 10% w/ stable vitals PTX Tx:

A
  1. Non rebreather at 15L
    *resrobes 4x faster than observation
    resrobes at 2% oer day and admit for obs
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239
Q

NPH Tx?

A

Large volume off in tap or a VP shunt

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240
Q

Dementia w/ shuffling gait, mood swings, bilateral paesthesia?

A

B12 deficneicy

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241
Q

difference between herpangina and hand foot mouth dz?

A

HFM is anterior mouth

herpangina is still coxsackie A but it is posteoir soft palate

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242
Q

what does metronidizole do when alcohol is given?

A

blocks aldehyde dehydorgenase

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243
Q

fever, 3 day spost partum, lower abd pain?

A

endometritis + fould smelling lochia

-c section is high risk

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244
Q

5 causes of stridor in kid?

A
  1. epiglottitis
  2. croup
  3. foreign body
  4. retroprhagnrala abscess
  5. tracheitits
    * give oxygen and racemic epi to help befor ientubation
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245
Q

how long does balloon time have to be to give altepalse?

A

2 hours

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246
Q

5 bronchiloitis treatments

A
  1. DONT give albuterol or solumedrol
  2. Fever maanagement/pulse ox/suction/hydration/02 if needed
  3. Discharge criteria
    90% sats
    reliable care taker
    Day 5 vs day2-3
    mild work of breathing
    4 wet diapers in 24 hours
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247
Q

5 spots to look for foot and ankle Fx

A

Posterior edge of medial and lateral malleolus

2) Base of 5th metatarsal
3) Navicular
4) Midfoot (for Lisfranc injury)
5) Proximal fibula (for Maisonneuve fracture)

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248
Q

difference between dancer and jones Fx?

A

proximal base of 5th is dancer and no surgery and Jones is distal and is surgery

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249
Q

what is a meckles and how do you test for it?

A

ectopic gastric mucosa caugin gastric acid an dlbeeding and T99 scan

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250
Q

WHat is meralgia paresthetica?

A

Meralgia paresthetica is the clinical syndrome of pain or dysesthesias, or both in the anterolateral, proximal thigh, due to a compressive neuropathy of the lateral femoral cutaneous nerve. Entrapment of this nerve under the inguinal ligament is common.
- COnfirmed by relfief of pain with lidociane

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251
Q

dfintiiion of status epilipticus

A

> 5 min seizure or not fully recovered siezure and then gets another one

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252
Q

somatization vs manchuens Vs malingering

A

lots of symtpoms but no caus
sympathy
external gain

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253
Q

whuich alcohol gives elevated osmool gap without a anion gap?

A

Isopropyl alcohol
Alcohol dehydo will make it into acetone and is read a s a ketone on the lab. Is is not charged so no acidosis but high OSm

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254
Q

steroid psychosis

A 
3% will commit suicide
very severe
previously nromal psych histry
within 5 days
equivalent of 40 mg prednisone
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255
Q

How many WBC is abnromal on UA?

what does nitrite mean?

A
  1. 5 WBCs abnromal with no suqames

2. E coli/enterobacter/Klebsiella- convert nitrates to nitrites

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256
Q

How do you know when to give TPA to PE?

A

Massive PE=dont give fluids to hypotension and give TPA

Hypotension

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257
Q

What 5 things to do you look for in croup patients?

A

AMS
stridor (@rest= epi, give them 3 hours to return to baseline)
cyanosis
retractions(@rest= epi, give them 3 hours to return to baseline)
air entry

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258
Q

why 3 sided dresseing for open pneumothroax?

A

to avoid Tension PTX

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259
Q

parkland formula

A

4 X Kg x % IN NUMBER of full thickness not partial thickness

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260
Q

What increases lithium toxicity?

A

THiazide diuretics
Symptoms of lithium toxicity include bradycardia, ataxia, tremor, hypothyroidism, eczema, edema, nephrogenic diabetes insipidus, and Ebstein’s anomaly in pregnancy.

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261
Q

Treatment for ITP?

A
  1. abive 20 K plateltes observe
  2. <10k= IVIG and steroids
  3. 10-20 + bleeding = IViG steroids
  4. Life threatneing bleeding = give platelts
  • Ab directed against plateltes, no bone marrow invovlement
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262
Q

Treatment and considerations for PCP intox?

  1. Agitation med to give and to avoid
  2. comlications to look for (3)
A
  1. Give benzos, not Haldol (seizures and arythmias)
  2. Rhabdo (check CK + fluids), Renal failure from CK, Traumatic injuries
    - NMDA antagonist
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263
Q

wants attention=? disoder psych

unexplained symtoms=?

A

Factitious

Somatic symptoms

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264
Q

Disposition for a deep perirecatal abscess?

A

Admission- if perirectal and supericial can be follow up

if deep and digit rectal exam feels the abscess then admit.

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265
Q

withdraw form whcih med?Tachy, Hypertheermic, rigdity, HTN

A

Dopamine drugs - NMS!! rigidity is the key here

If no rigidity then clonidine

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266
Q

Difference in preseptal and post septal cellutlitis

A

preseptal= NO orbital invovlement. No pain with EOM, No visual distrubances, no pupillary defect. Eye looks univolved.
If orbital- then get a CT

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267
Q

What do you need to avoid in any patient with a possibiltiy of HSV in the eye?

A

topical steorids !

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268
Q

Lid lacs keys

A

Dont repair:
1. through and throughs
2. Nasolacrimal ducts (use flurosceine) or lid margins
3. ptosis, tarsal plate or levator plapebrae
If <1 mm near margin it hels on its own
*look for corneal abrasian and ruptures here too

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269
Q

spontaneous hyphema in which patients…

A

sicklers

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270
Q

Phys exam blow out bfractures

A

entrapment
subQ emphysema
infraorbital paesthesia

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271
Q

LEsion on flurosceine of eye + high speed mechanism of foreign body=…

A

clincal penetrating injury to eye

It could have sealed up and siedels could be negative. Still give eye patch, antibitoics, anti emietics

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272
Q

Block beta and activate alpha in glaucoma- why?

A

it block aquehous humor production

BUT! wouldnti this dialte the eye and cuase decreased outflow?

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273
Q

Red looks pink with vision loss +/- pain in eye=?
what disease do you think of?
how to treat?

A

OPtic neuritis
MS (also sarcoid and syhpilis)
Steorids if MS

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274
Q

otitis externa treatment

A

make it more acidic- Hydrogen peroxide or acetic acid/hydrocrotisone
tpoical antibitoics
Look out for malgnant otitis externa into the skull

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275
Q

ottiis media complications:

A
  1. conducitve hearing loss (Self limited)
  2. TM perf (SL)
  3. Labrytinhitis
  4. cholesteatoma
  5. facial nerve paralysis - ENT emegrency
  6. Masotiditis
  7. Sinus thrombosis
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276
Q

Wax and insect removal form ear?

TM perfs

A
  1. insect 2% lidocaine
  2. wax= mineral oil, hydorgen eroioxde, sodium bicarb
  3. Heals spontaneously- antibtioics +/-
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277
Q

DDx tinnitis

A
  1. Abx, Nsaids, ASA
  2. Vascualr
  3. Mechanical
  4. Menireres
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278
Q

nasal septa hemtoma tx…

A

Lidocaine withou epi and drain it! dont want septum necrosis

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279
Q

Sinusiitis complications

A

-phenylephrine 4x per day for 3 days
-meningitis
-thombosis cavernous sinus
- intrcrainal abscess,
robital cellutlites,
osetmyeltiies

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280
Q

how long after you take cialis can you give nitrates in chest pain

A

best to wait 36 hours!

Tamsulosin is not a contraidinctation (alpha 1 blcoker for BPH)

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281
Q

8 causes of PEA? thinsk H and T

A
  1. hypoxia
  2. Thrombus (PE and MI) may need to give thrombolytics if suspected!!
  3. Hypothermia
  4. Acidosis
  5. Tnesion penumo
  6. TOx
  7. hyperK
  8. hypovolemia
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282
Q

Recent virus or MS or Lupus and then paralyzed from the waist down progressively + sensation loss to a distinct line?

A

Transverse myelitis

GIve high dose steroids- reoslves over weeks usually

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283
Q

Suspect temproal arteritis what else do you need ot be ocnerned for>?

A

Aortic dissection, caortid artery, opthalmic artery

give steroids

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284
Q

Suspect GBS- what do you need ot be worried about life threatening

A

diaphragm invovlement, intubate this patient

need plasmapheresis or IVIG

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285
Q

Difference betwwen anterior, central, hemi cord loss?

A

anterior = motor/pain gone but DCML good
Central= sensory and motor in upper>Lower
Hemi- ipsi motor and DCML &opposite pain

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286
Q

how to treat mesenteric ischemia?

A

thombolytivcs
srugery
embolectomy

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287
Q

Acteominophen tox perals

A
  1. takes 4 hours to start damage
  2. minimum requirement is 7.5 grams (150 mg/kg for peds) to do damage
  • Induced emesis- not proven to clincially benefit + complicaitons
  • Orogaatric laavge if <2 hours old- but complciations arise
  • charcoal reserved for spsecifc drugs- carbamazepine, dapsone, phenobarbital, quinine, or theophylline
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288
Q

5 causes of AMS that need emergent therapy?

A
  1. Hypoxia
  2. HTN encephalopathy
  3. Hypoglycemia
  4. CNSinfection
  5. high ICP
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289
Q

What do you give in Valproci acid overdose and why?

A
  1. L carnitiine!. ocnsider charcoal and Dialysis too if severe
  2. it blocks Carbomyl phos synthestase and makes high AMMONIA levels
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290
Q

Drugs to avoid in WPW?

A

AV node bockers

BB CCB Adensoine Amiodarone

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291
Q

AMS old person Differntial ddx and labs

A 
1. dementia Alzherimers
parkinsons with rigidity, pyramidal symptoms
NPH- CT big ventricles 
Vascualr dementia if FND
depressed

CT head, CXR, LP
CBC BMP B12 Thyroid ESR UA HIV folate syph

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292
Q

AMS + Bradycardia and HTN=What drugs?

A
  1. dex 10 mg
  2. Mannitol .5-1.0 mg/kg
  3. hyperventilate
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293
Q

Main difference between central vs periperhal vertigo

A
  1. Peripheral is sudden and severe, positional, no FND, w/ N/V/Sweating , hearing loss
  2. Ill dfined spinning , can be sudden or gradual
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294
Q

DDx peripheral vertigo

A
  1. BPPV
  2. Menieres
  3. Labryinthitis
  4. Otototxicity drugs
  5. Vestibualr neuoniitis- Viral unilateral tinnitus + heairn gloss - No Rx
  6. Vestibular ganglionitis- Zoster- Ramsay Hunt- Acyclovir
  7. perilyhym fistula - vertigot with pressure liek flying, diving, coughing
  8. Labrytihnitis- Sudden vertigo + middle ear fidnings

Mcelinzine and benadryl
Zofran and benzos 2nd line

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295
Q

DDX centeal vertigo

A

Vertigo:

  1. BPPV
  2. Menieres
  3. Labryinthitis
  4. Otototxicity drugs
  5. Vestibualr neuoniitis- Viral unilateral tinnitus + heairn gloss
  6. Vestibular ganglionitis- Zoster- Ramsay Hunt
  7. perilyhym fistula - vertigot with pressure liek flying, diving, coughing
  8. Labrytihnitis- Sudden vertigo + middle ear fidnings
    - can also cocur with tumors, bleeds, post concussive

Central:
Cerebellar- HA, Truncal ataxia, ROmberg +, ataxia tandem gait
Lateral meduallry - dyspahgua, dysphonia, facial numbenss, corneal reflex out
Diplopia, dyspahiga, dysartrhia, drop attacks, dizzinies= vertebobasilar
Vertebal artery- truama, chiropracter, Neck pain, vertigo
MS
Vestibualr Migraine

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296
Q

how long can TOdds parlaysis last?

A

48 hours

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297
Q

pathophys to rheumatic fever?

A

Cross reacivity of Antibodies to heart, joints skin etc

JONES criteria

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298
Q

Get a head CT when to not to an LP?

A 
papilledema
AMS
FNDs
immunocompromised
-to avoid a mass or herniation or ICP high if blunted sulci
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299
Q

IBS

A

Can be lined with mucuous
Stress induced can be, crhonic pressure, better when poop
HYdration, exercise, fiber

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300
Q

Emergent intervention for a ear infection?

A

Faical paralysis, needs amyringotomy

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301
Q

Intusseciption Testing

A

US= 98% and 98%

Air or liquid enema

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302
Q

Tx of herpetic whitlow

A

COver and NSAIDs 3-4 weeks

give acylovir if immunocomprmised

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303
Q

Tx of rehumatic fever

A

Pen G

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304
Q

Initial treatment of chrons disease

A
  1. Hydration
  2. Check electrolytes, B12,Iron and rpeleace- also they are ADEK vitmain down as well
  3. metronidazole and cipro
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305
Q

Diabetic otitis media not getting better with otorhhea…

A

Malignant otitis externa- broad psecturm Abx (pseudo and staph)+ CT scan

Trismus=measseter invovled
CN invvlement= extenive

306
Q

Tx of penile fracture

A

Surgery - repair tunica albuginea and evCUATE HEMAOTMA

307
Q

risk factor for deathin anaphylaxis?

A

asthma

308
Q

Acute new systolic murmur with low oxygen sats- you suspect mitral regurg, what is th ecuases and treatments?

A

MI!, endocarditis, trauma

All about pulm edema- Nitrates, lasix, oxygen and positive pressure venitlation

309
Q

acute phenytoin toxicity can be treated with…

A

Charcoal, GI absorption takes awhile

310
Q

WHy is there hyperglycemia in CCB overdose?

A

Calcium mediates inuslin release

311
Q

Tx of malaria

A

Quinidine and doxy

312
Q

Shock index- HR/SBP . Anything great than 0.? is considered shock?

A

0.7

313
Q

NPO status, how long do you have to be NPO?

A

2 hours clears, 4 hours milk, 6 hours solids

NOT based on outcome studies but expert opinion only

314
Q

DCML pathyway
Coritcospinal
Pain and temp

A

DCML crosses at brain stem- ipsi loss when spinal cord take out
Corticospinal already crossed above so ipsi loss below
Pain and temp crossed in spinal canal so contra loss

315
Q

You defib someone do you pause to check fo r apulse directly after?

A

NO! not intil after the next round of comrpessions

316
Q

Severe ches tpain in an alcoholic you need ot think of

A

Borhaave- Give fluids, abx and do X ray or soluble water x ray

317
Q

Lidocain overdose dose is?

A

5 mg/kg without
7 mg/kg with
If you use ep becareful in ares iwht poor wound healing because pei decreases it and cuases poor healing
It lasts for up to 60 minutes, comes in seconds

318
Q

Management of Upper GIB

A
  1. Octreotide drip 50mcg bolus, 50 mcg/hr. Somatotatin anaolg to shunt splancnic blood away
    - Reduce transfusions not mortality
  2. 1 g Ceftriaxone- reduce rebleed and mortality
    - ———-
  3. PPI-no benefits with varcies
  4. NG tube little useo ther than lowers aspiration risk
  5. SB tube if unstable
319
Q

Uncomplicated Diverticuloitits Tx?
1st line & 2nd line
Complicated criteria

A
  1. Flagyl and Cipro
  2. Amox/clav
    - sepsis, perforation, uncontrolled pain, high fever, advanced age, significant comorbidities
    - fistual or obstruction
320
Q

Appy pearls

A

70% have leukocytosis

MOst ocmmonly caused by fecolith or LN enlargement

321
Q

how to treat pit roseaseca?

A

Self limited

steorids for itching

322
Q

Tx of hereditary angioedema?

A

FFP or c1 esterase inhibnitor rpelacement

GI an dupper resp invovlvemnt

323
Q

How man cm is conidered small bowel anlargement?

A

3 on x ray

324
Q

Type 1 vs Type 2 vWf

A

1- low levels = give desompressin

2- faulty vWF

325
Q

Menieres vs vestibular neuritis?

A

Menieres tinnititus, intermittent vertigo attacks an dheairn gloss
neuritis- one long attack, no hearing issues, after a virla infection

326
Q

Tylenol overdose shows up within 4 hours:

After 8 hours:

A
  1. LFTs and Tylenol level

2. Give 140 mg/kg of NAC

327
Q

Difference between physiologic, breaskt milk and breaksmilk failure jaunidcie ?

A
  1. Physiologic is days after birth bc fetla Hgb breakdown
  2. > 7 days w/ jaundice but good feeds and weight= guconuryl transferse def. and high unconj. bili
  3. Low brith weight, low feeds, dehydrated= failure

kernicterus is the brian damage as a result of high bili

328
Q

Food stuck in your Goose, what do you give?

A

GLucagon 1 mg slowly

Nitro sublingual can be used

Papin protelytic enzyme but esophigitis

329
Q

Peds + rash + joint pain + abd pain

A

HSP, igA vasulitis
get UA for neprhotic syndrome
watch out for GI intussicpetion and perf

DC on +/- Steroids if invivlement of organs is low

330
Q

Testing for Sypg

A

primary- Dark field micro
Secondard- RPR
Tertiary - fluroescent treponemal Ab test

Pupils will accomodate but not react to light

331
Q

time fram for acute graft rejectoin and is it reverisble?

A

1-12 weeks

Reverisible - fever, pain over the site , failure

332
Q

Hip pain in MVC- make sure to check for wha thip injury?

A

Posteori hip dislocation
If cant dorsifle or plantflex and decresaed sensation loss with leg deformity it is surgical emergency for avacualr necrosis

333
Q

WHat levels VPA and pH will send you to dialysis for VPA overdose?

A

1300
acute ammonia encpehalopathy
pH <7.1
Coma, shock

give L Carnitine to stop urea cycle and build up of ammonia

334
Q

Traua with pelvic fracture, & blood at the urethral meatus. What do you do next?

A

Retrograde urtehrogram,if negative pass a foley

335
Q

Iburpfren overdoses

A

USualy asymptomatic and not severe
if over 100mg/kg then in 4 hours they should be symptomatic.
1. Gete Tylenol level
2. watch out for eizure, hypotension, coma, acute renal failure, metabolic acidosis and upper gastrointestinal tract bleeding

336
Q

5 kawaski criteria and treatment?

A

4/5 criteria

  1. Mucous mebranes -even cracked lips
  2. Cervical LA
  3. Rash
  4. palms soles rash
  5. COnjucitivitis

IVIG and High dose apsirin within 10 days of fever. Coronary aneyrusm complications

337
Q

WHen do you go and get a bullet in an extremity?

A

If it is in fragments, near a nerve, vessel, palms/soles ror joint

If unco,plicated, in soft tissue and no infection jsut give pain meds and DC

338
Q

Tests for poplieal artery injury?

A

serial physical exams, ankle-brachial indices (ABI), CT angiography, conventional angiography, or duplex ultrasonography

339
Q

Stab wound to chest, Hypotensive and tachy but has a pulse- pericardiocentesis or throacotmy?

A

PEricardio

if it doesnt imprvoe then go to thoracotomy

340
Q

Hepatitis facts

A

C- lots of carriers, 20% chronic infection rate

B-5 % chronic infection

341
Q

Clavicle Fx manageent

A

Sling (not figure 8)and send home with follw up

Vascular injuries are rare, malunion is the most common complication

342
Q

When should you add steroids to abx for PNA infection?

A

PJP pneumonia with Hypoxia of 92% sats~ or pao2 of 70= steroids!!!! would help + Bactrim

343
Q 
Inrta cerebral hemorrhage
Which Rx(s) is useful
1. Hyperventilate
2. Nicardipiine
3. Manntiol
4. pheyntoin
5. Factor 7A
A
  1. No, CPP can lower
  2. YES!
  3. Mannitol, varying success
  4. Pheynotin- seizure snot a bad outcome
  5. No benefit
344
Q

fomepizole, HD or ehtanol is antifreeze toxicity?

A

FOmepizole first

Clincial symptoms and ocntinued acidosis for HD

345
Q

when do you get alk phos and ggt?

A

when you ssupect gall bladder disease-cholesstais

346
Q

Matching- scromboid vs ciguaterA and Tx
GI, Hot/cold, hypoTN, toothlessness feeling, paresthesias, bradycardia
FLushing, redness, metallic/pepper taste

A

1= Ciguatera- IVF, antiemeitcs, atropine

2= Scromboid- antihistamines

347
Q

Cocaine chest pain tx and ddx

A

NItraes, aspirin, possible hydralazine and benzos

Think about PTX< pnumomediastinum and Dissection

348
Q

Looks like raynauds but has GI symptoms, Hyper K and AKI? Tx and Dx

A

Scleroderma crisis
Treat hyperK and lytes
THEN give CAPTOPRIL for HTN and renal protection
Give Abx if Diarrhea bc of bacterial overgorwth

349
Q

High risk of limb ischemia is to what Art line placement?

A

Brachial artery

350
Q

HA< sweaty, HTN episodes> testing and tx

A

Pheo
MEtanpehrines
Phenoxybenzaprine
HYdral and phentolamine in acute crisis

351
Q

What cna you see on EKG with HOCM?

A

LVH and DEEP NARROW Qs (inferoir and lateral)

352
Q

Painting cielings and then a bunch of houlder pain, +neers test, +hawkins test—

A

Subacromial bursititis- NSAIDs, PT Steroid injections

353
Q

anyone over 50 years old and fvere and neck pain gets what ABx?

A

Amp

354
Q

MVC with tachycardia and sternal tenderness- Tests and complications of possible Dx

A

Myocardial contusion
EKG trops
watch out for arrythemias

355
Q

14 yo w/ exertional pre sncope, Arotic murmur worse with quatting needs…

A

Aortic stenosis, baloon valvuloplasty

356
Q

perimortem C section pearls

A
  1. should be done within 5 minutes of arrest, conitnue CPR
    1a. baby needs to have doppler heart tones
  2. Only if the fundus is above the belly button
  3. From pubic sympgysis to 5 cm below the Xiphphoid
  4. push bladder out fo the way and then do vertical incision on uterus
  5. it is htoguht to relive aortocaval pcmpresisonand return blood to heart
  6. dont do a bedside US, it dealys it
357
Q

difference in splen ic seuqestation and palastic crisis after a URI?

A

PArvo!
no reticulocyts are in aplastic
retics will be high in splenic sequestration

358
Q

Asthma Vent settings and what is plateau pressures?

A

Low TV (<8ml.kg), Low minute vent (<115 ml.kg), Low RR (permisseve hypercpania is OK to avoid barotrauma), long expiraotry time

Pleateu: end-inspiration pressure when flow is zero, and it correlates to small airway and alveoli pressures.

359
Q

DRESS syndrome presnetation and tx

A

MOrbillofrm rash on the body and spares mucous membranes at first
Fever
Internal organ ovlvoement (cna lead ot death)
mailasie, LA, pharyngitis,
IVIG/steroids
Anticonvuslants, Bactrim, Antivirals, dapsone etc

360
Q

Inorganic mercuray tx? (paint, thermometers)

Organic mercury tx? (pesiticdes, seafood)

A

Succimer/dimercaprol

NEVER give dimercaprol, give sucimer i think

361
Q

Chemotherpay, low neutrophils, fever that resolves and VS that look great= DC or admit?

A

Admit with IV abx. Source of infection only seen in 20% of patients w. neutorpenic fever and infection

362
Q

achilles tendon rupture splint…

A

Equinus splint

Posterior mold + stirrups plsint is for tib fibs stability

363
Q

How many WBC is inflammtory arthritis ?

A

> 3K but less than 50 K (septic arhtitis)

364
Q

BB overdose pearls and Tx

A

Heartblock, Hyper K, HypoG, bronchospasms

  1. Glucagon and fluids
  2. Pressor sif need be if bad and LIPID EMULSION IF real bad
  3. Calcium
  4. High dose insulin 1 unit/kg?
365
Q

does clonidine overodse have pinpoint pupils

A

yes

366
Q

does metoformin OD usually cause Hypotn and bradycardia?

A

NO

367
Q

UV Keratitis tx- think little corneal abrasions

A

Cyclopegics- atorpine, cyclopentalte
ABx
Optho follow up

368
Q

1 week ol with bilious vomiting, tx?

A

Malrotation + volvulus
NG tube, Abx, fluids
upper GI sereis if stable (corskscrew)
Surgery NOW

369
Q

what is transveres myeltisi

A

A transverse level of sensory impairment, paraplegia, and sphincter disturbance.

370
Q

Air embolism treatment

A

lay supine
100% oxygen
fluids

371
Q

Ranson crteria for pancreaitits mortlaity

A 
Age 55
WBC 16
GLucose >200
LDH 350
ASt 250
372
Q

AMS + ataxia + Oculomortor dysfunction

A

Wernickes- give 100 mg thiamine

anterograde amnseis is korsakoff!

373
Q

If you suspect mesenteric ischemia w/ nausea, diarrhea, voomiting but pain resolves…

A

Super high mortality
The nerve has now died, and they are getting close to bowel necrosis. Still need to get CTA abdomen!
Put abx on board and give fluids
use dobutmaine if you need pressors, vessels avoided
Always think about Veni thrombosis or clot in Celic or SMA or IMA! may need heparni!

374
Q

Abdominal/flank pain + hypotension=

A

AAA!
Look for risk factors, look for femoral pulses (usually intact and perfusoin distal is uslaly OK)
GIVE fluids, better to maintain BP between 80-100 than possibly disrupt clot formation

375
Q

asystole- CPR or shock shows best result?

A

CPR, this is not a shockabel rhythm
if V fib or pulselss vtach hen both have shown good results
epi has not shwon to reduce mortlaity butgets ROSC
Cooling helps with post enuro sypmtoms

376
Q

Hyperbaric oxygen needs when CO poisoning

A

7.1 acidosis
25 or 15 if preggo
LOC
end organ ischemia

6 months old, preggo, older than 60, CAD risk factors

377
Q

Drunk guy satiing in the 80s whiel asleep and 90s when awake- what do you do?

A

Put Naso airway in

378
Q

White hazy irregular cornea, photophbia, foreign body sensation= Dx and Tx

A

Conreal ulceration

Its ifnected, Abx and optho

379
Q

What length is considered dialted IVC?

A

2.5 cm and <50% collapse on inspiration

380
Q

sexaul assault pearls

A
  1. Forensic evidence first
  2. cops only if the ywant it
  3. offer STD empiric treatment but not necessary to test for it bc postive STD could be used against them if it is positive
381
Q

Pancreatitis causes and tx

A

fluids they third space and vomit, pain control

Gall stones
Ethanol
trauma
Steroids
Mumps
Autoimmune
Scropion
Hyperlipidemia
ERCP
Drugs
382
Q

SDh tx

A

serial CTs if small, and supportive care
emergent if >5 mm midline shift or FNDs

between dura and subarachnoid

383
Q

Kid with unstable SVT

A

Sync cardiovert

if nto try ice bag and then adensoine

384
Q

Tx of Cynadie posioning after apricots kernels

A 
Hydoxycoablimine (binds cyandie tight)
or Nitrites (makes methemogbloin to bind to cyandie)

Look out for for sevfer acidosis

385
Q

Otitis externa Tx

A

Mild Acetic acid - avoid!! if you cant see the TM to rule out perf
Moderate - cipro and hydrocotrionse
Severe- Ear is completely cursted over = ““+ear wick

Psueomonas is top offedner

386
Q

Hepatic encpehalpathy pearl

A

not proporthional to ammonia level! but it is becasu eliver cant metabolize ammonia an dincresased glutmate in braine
GIVE lactulose

387
Q

Test of choice for lyme disease?

A

Bureelia antibody

388
Q

Approach to BUtt stuff

A

Thrombosed ext hemorrhois: 48-72 hours= Elliptical incison and removal. If longer then DC with sitz, pain, topical steroids
Perianal abscess- get a CT scan to see the extent of it. Makue sure its not perirectal. If simple then drain. If DM2 or cellutlitis then add Abx to it.

389
Q

simple febrile seizure is defined as

A

<15 mintues, no more than 1 in 24 hours, gernealized

menigisumus, complex, on abx, not immunized get an LP

390
Q

HD for ASA

A

100 level
AMS
Kidney liver failure

391
Q

Hyperbaric oxygen needs when CO poisoning

A

7.1 acidosis
25 or 15 if preggo
LOC
end organ ischemia

392
Q

Skull fx management

A

Linear, closed- DC to home i think
Linear, open- Admit obs
open depressed- Admit Abx
HemoTM, battle, raccon, basilar

393
Q

a fib RVR >48 hours Tx

A

Dilt 0.25 mg/kg or usually 10-15 mg max 25 bolus to rate control and leave them in A fib target 100 bpm

394
Q

How much IM versed in a seizure?

A

10 mg midazolam

2-4 mg IV

395
Q

How much propofol in a sezirue?

A

4 mg/kg bolus

1 mg/kg/hr infusion (up to mg/kg/hr)

396
Q

Mandibular Fx or angioedema of oral cavity, how do you intubate?

A

Fiberoptic nasally

397
Q

angioedema from drugs or c1 esterase- give what?

A

You can give anaphylaxis Rx but it wont help much
C1 or FFP if that is it
Supportive and Airway care is the other- ask them to say EEEEE

398
Q

Opiod constipation RX

A

Methylnaltrexone

399
Q

Abx in TM rupture?

A

Not if it is suspected to be clean

400
Q

Lead Posioing Tx?

Abd pain + headaches

A 
<70= Succimer outpatient
>70= Dimercaprol + EDTA
401
Q

Abd pain + GIB + history AAA repair

A

Aortoenteric fistula- always need outthink about this with syphilis and TB infections or a herald bleed picture!

402
Q

deep Laceration near knee- what do you need ot make sur eis not involved or else it is surgical emergency?

A

Joint capsule- inject 150 ml + in joint to see if it comes out the laceration = Abx and surgery

403
Q

What Induciton agent do you avoid in sepsis?

A

Etomidate to not suppress the adrenals

404
Q

Phenylephrine, soft pressures and want quick bump to sustain them

A

50-100 mcg

405
Q

Kid bites on a cord and get burn to lateral mouth- DC or admit if they are stable?

A

DC! delayed bleeding 5-21 days later but can go home without escahromtoy

406
Q

lead 1: Wide and positive

Leade V1: Negative QRS complex

A

LBBB

407
Q

Patella dislocation stuff

A

get x rays and peronal nerve testing after it
knee imbolizer and f/up ortho
just push on it medially

408
Q

UTI kids Abx

1st - 4th line

A

Cefixime
Augmenton
Bactrim
Cipro

409
Q

best ways to test for MS and what is lhermitte sign?

A

Flexion of nck and shooting pain down neck/back
Heat temp changes ysmptoms=uthoffs
MRI and LP

410
Q

What scoring system do you use in a GIB to see if they are high risk?

A

Glsaco-bltachford to see if they need scope or transfusions

411
Q

You suspect AKA, what type of acidosis is it and what is their pH?

A

WGMA- Dehydration, low gluyconeogensis, and high gluconaon/lowinsulin leads to ketones
normal pH bc Alkalosis usually too
Flduids and glucose

412
Q

tularemia tx?

A

Streptomycin

413
Q

How does tyramine cause HTn crisis?

A

It indirectly Activates catcehomlaines NE. Since it cantbe broken down by MAOIs it does this rapidly

414
Q

what is double sickening?

A

Getting betterna dthen worse with sinusitis. Viral>bacterial=give abx

415
Q

TV pacing nugz

A

R IJ or L Subclavian is best
Cardiac Pacing

Transcutaneous: 40 to 60 mA to capture
Transvenous: capture at 5 mA then decrease
Electrical capture without a palpable pulse = PEA

416
Q

Anemia, low platelets, Renal failure, diarrhea

A

HUS- damages little vessels leading ot shearing RBCs and plaeltes
UA- poreitnuria, RBCs
high haptoglobin, LDH high too.

Hydration an dpaincontorl and transfuions if need be

417
Q

Clogged G tube steps

A
  1. Flush it
  2. still clogged? replace it and then have them follow up

**within the last 4 weeksplaced? leave it be! immature tract.

418
Q

Why do we give antiplateltes in ACS?

A

Plaque thrombosis

419
Q

Mastitis vs engorement vs abscess Tx

A

Mstitis is unilateral infection, ocntinue to breastfeed, give Kelfex, usually fevers fatigue
Bilateral = engorement, non breastfeeding, cold compresses
Abscess, pocket, drain

420
Q

Inferior medial eye abscess looking thing- what do you?

A

Dacrocystitis- Dont ID it! give Oral clinda

421
Q

Fat embolism tx?

A

IVF and O2, nothing else shown to wokr

422
Q

Sinus Bradycardia DDx

A
  1. Vagal tone
  2. sick Sinus syndromee (SA node disease, fast/slow HR w/ syncope)
  3. BB
  4. Hypothyroid
  5. Hypothermia
  6. Hypoglycemia
423
Q

Synthetic function of the liver - INR and ..

A

albumin to see if you are in ALF

424
Q

RMSF stuff and tx. hwo do you tx peds?

A

DOxy and still doxy!
starts outside and spreads in
labs hypoNA, thrombocytopenia, neutropenia, LFTs

425
Q

Risks for pyloric stneosis

A

first born male, premature,, erythmycin use

426
Q

when do you treat methemoglboinemia- what level?

A

15% symptomatics

30% asymptomatics

427
Q

Tx third degree Heart block?

A

Pace them in ED if symtpomatic and get cards for pacemaker placement

428
Q

HAC tx?

A

descent, oxygen, steorids

429
Q

Significant MVC, do you get Abd CT?

A

Yes, it takes 5-10 rads to damage fetus and CT abd is 2.5-4.5 rads
worse when weeks 2-9 in pregnnayc

430
Q

umbilicus is blue and infected on newborn, Dx and TX?

A

Omphalitis of Nec Fasc, Broad specturm

431
Q

HIV ED testiing

A

NAAT testing not HIV ab testing if you suspect acute viral illness HIV (more prevlaent than asymtpomatic infection)

432
Q

PArvo or coxsackie for myocaridtis favorite?

A

Parvo

433
Q

unidirectnal nystagmus, central or peripheral?

A

Peripheral

COntinuous is more central, not episodic

434
Q

preterm neonate with resp distress, give what if after 1 hr of life?

A

Caffeine

surfactant if under 1 hour

435
Q

otitis media + TM perf= abx + consult/f-up/expectant

A

expectant manegment- heals on its own

436
Q

HypoK EKG changes

A
  1. PR long
  2. QT long
  3. ST depressed
  4. Shallow T
  5. U wave

Braydcardia and AV block

437
Q

How much fluid can you take off of a thoracentesis/

A

Until symptome resolve, you dont need to stop at 1.5L

438
Q

Which opiod give you mydriasis, Seizures, hallucinations?

A

Mepiridine

439
Q

Treatment of E vermicularis?

A

Albendoazole or mebendizole 1x time dose

440
Q

3 lower GIB causes?

A

Diverticular disease, angiodysplasia, and neoplasms

441
Q

5 things you see with aortic injury on x ray

A

R mainstem bronchus UP, left is down
Trachea Right, E tothe RIght
Wide mediastinum

442
Q

What % is cross reactive of cephs to pencillin?

A

Closer to 1% but techinically 1-10% for first and second gens. Neglgible for 3rd and fourth

443
Q

Sinusitis, + hemoptysis + Hematuria

A

Wegners, polyarteritis

444
Q

Lung + renal bleeding

A

Goodpasture

445
Q

Ashtma plus eopsinophils plus sinusitis

A

Churg strauss

446
Q

Stridor with crying in croup, do you give rac epi?

A

No, only when at rest. Give dex

447
Q

preseptal cellulitis symptoms vs post septal

A

will not have proptosis, ophthalmoplegia, visual changes, afferent pupillary defect, or decreased visual acuity.

448
Q

Recent eye surgery with a new hypopyon and loss of vision- Dx and TX

A

Endopthlamitis- needs and optho right away plus Abx

449
Q

before peridcardiocentesis what do you give the patient?

A

Fluid bolus- preload dependent

450
Q

2 yr old with bloody dirahhea, tachy, febrile, leukocytosis– which abx to give?

A

Shigellosis- Ceftriaxone

451
Q

Which spiral fracture is normal on a kiddo?

A

tibial- rotational fall

452
Q

Os and fetal tissues in the uterus for miss abortion?

A

Closed

Still in uterus

453
Q

Oral hairy leukoplakie is linked to what two viruses? Is is premalginant?

A

EBV-HIV

NO

454
Q

Conrerning MI hx, symptoms have resolved, Nomral inital trop but Biphasic T waves…

A

Wellnes Warning for LAD- Cath urgently

455
Q

how quckly should endoscopy be performed after a caustic ingestion

A

12-24 horus but def not after 24 for perforation

dont use charcoal

456
Q

Dacrocytisi Tx and Bug

A

Staph
The patient should be placed on topical and oral antibiotics, advised to use warm compresses and given analgesic medications. They should be provided with ophthalmologic referral for outpatient follow-up.

457
Q

Ptosis, Cant move eye up or medially but pupil reflex is intact—-Dx

A

Intraneural nutrient artery to CN3- seen in DiBEETS
THe artery is is still giving blood to parasymp peripherally but core is nto working for motor
If Refelx is out then thing bleed, tumor, stroke

458
Q

Tx of minimamlly dispalced humerus fracutre?

A

Sling and go home- watch out for Capsulitis and AVN

DONT need to sedate and reduce if minimal

459
Q

Which GI disease gives you mroe Kidney stones?

A

Chronhs- mmore oxalata, less Ca and fat absorption

460
Q

Why is BUN higher in an upper GI bleed?

A

Bc blood gets absorbed in GI tract and BLOOD urea nitrogen is aborbed

461
Q

UC treatment

A

IV fluids, analgesics, 5-aminosalicylates, systemic steroids, and antibiotics if there is concern for infection or perforation.

462
Q

Toxo Tx

A

pyrimethamine and sulfadiazine

463
Q

how do you use CURB 65

A

COnfusion BUN >19 RR>30 90/60 65
0-1 go home
2+ come in

464
Q

Aspiration pneumonai with pink frothy sputum in ETT, do you start ABx right away

A

NO, wait and see after intubation n

465
Q

Which kidney stones od you admit?

A

Obsturction and infection (hydro?)
Cant sotp pain or vomiting
One kidney, transplant

466
Q

Tx of HUS?

A

Supportive

467
Q

Dx and TX of Newborn from a gestational DM mother with mild resp distress and murmur?

A

INterventricular hypertrophy- resolves on its own usually

468
Q 
HOCM
mild
moderate 
severe
Tx
A

BB
Alcohol ablatoin
Low EF, sudden cardiadc death risk is ICD placement

469
Q

Normal TSH, barely low T3 and high T4- which med can cause this?

A

AMiodarone- wait for a couple months a redraw

470
Q

Thalessemia pearls

A

HbBarts or 4 gamma is alpha thal

Beta thelmessemia- is hbF and HbA2 is high

HbSC less evere sickle variant, nromocytic

471
Q

Kid drinking whole cows milk…. blood disorder

A

IDA

472
Q

Elevated Calcicotnin levels in thyroid cancer medullary after thryodiectomy, next move?

A

Get CT scan for metastic meduallry cancer bc Calcitoni levels are still high

473
Q

Low OSMs, high Urine SOdum and high urine Osms=Dx?

A

SIADH- absorba all water and pisss out salt

474
Q

GIB inpatient vs outpatient socring stuff to look at

A

Hemoglobin > 13.0 g/dL (men) or > 12.0 g/dL (women); BUN < 18.2 mg/dL; initial systolic blood pressure > 109 mm Hg; HR < 100/min; no melena or syncope at presentation and absence of hepatic disease or heart failure history.

475
Q

Caustic eye burn- first step and when do you stop

A

irrigate tiwth 2 liters fluid

then check make sure pH is 7.0-7.2

476
Q

most common sprained ligmanent

A

Anteriootalor fibular
Calcaneal fib and posterior talo fib is rare needs a lot of force
Grade 3 is joitn instability

477
Q

Alc liver failure labs
Macro or microcytic anemia?
GI?
Metabolic?

A

Macrocytic from folate
Pancreaititrs and PUD
elevated ammonia, estrogen, and progesterone level -
-decreased albumin level. Because the majority of calcium is bound to albumin, a decreased serum calcium will be noted but the free or ionized calcium level is typically normal.

478
Q

placental abruption, watch out for blood disorder…

A

DIC

479
Q

IV epi during arrest 1k or 10k

A

10k IV

480
Q

Why mitral ivovlement with ARF?

A

Ab cross reactivity with the valve tissues- leads topulm HTN leads to RHF

481
Q

amoutn of pRBC bolus to give a kid

A

10cc/kg

482
Q

what does FENA <1 and Urine Na <20 mean with AKI?

A

Pre renal azotemia or pre renal AKI bc tubes still work to retain Na
ATN from infection, drugs or toxnis would be elevated

483
Q

sting ray

cold and salt or warm and fresh?

A

Warm and fresh water

484
Q

Perilunate vs lunate Dislocation- Tx of perilunates?

A

Perilunate dislocation is actually capitate dorsal dislocation. Teacup is up. Emergent ortho surgery. check median nerve, avoid AVN
Lunate is dislocated and curve facing down

485
Q

Blast degrees

A

primary- shcokwave
secodnayr- fragments
tertiary- propel into obejcts

486
Q

What do you get after you hae a first positive RPR?

A

FTA ABS

487
Q

How to Tx Primary/secondary syph
Late syph
Neruosyph

A

How to Tx Primary/secondary syph
Late syph
Neruosyph

488
Q

Kidney stone pain, abd pain, back pain, syncope all should make you thknk

A

AAA

489
Q

what level of ANC is considered neutropenic

A

500

490
Q

What is HELLP? Tx? Complications?

A

Labetalol and dleivery
Hepatic hematoma! DICHemolysis, LFTs, emolysis, LFTs,
Low plateltes usually with HTN like preecamlsia

491
Q

Subclavian Positive and negatvie Central line

A

Least infection (half as much as internal jugular), PTX

492
Q

What acronym do you use for ETT Rx?

A 
NAVEL (no V for kids)
Naloxone
atropine
Vaso
Epi
lidocain
493
Q

Diaphysis longn brone fracture- NAT or no?

A

NAT

494
Q

Symptomatic and _____ hyponatremia

Asymptomatic and ______ hypoantremia get 3% sodium 100 ml over 10 mins and possible a x2 over 50 minutes

A

120
110
Always think are they low, eu or hypervolemic?
if hypovolemic aim for 0.5 meq an hour

495
Q

Deeo inverted Ts in v1-v4

ST elevation in V2 and V3 minimal ===

A

Wellenes or tight stenosis of LAD

496
Q

Wake up with sudden sensorineural hearing loss> next test?

A

Brain MRI! most liekly a Viral cause but rule our brainstem strone, pontine angle mass
Air>bone conduction
maybe give sterdois and acylcovir

497
Q

PAraphimosis vs Phimosis Dx and Tx

A

Para (paramedics)- urologic emergency- foreksin is stuck up and cant reduce. reduce with frim pressure 5-10 minutes. No uroglogy? Lidociane plus dorsal slit

Phimosis- cant retract foreskin

498
Q

xtrapyramidal symptoms come about because too Much ____ and not enough ___

A

Ach
Dopamine
Benztropine block ACH receptors and blocks reuptake of Dopamine

499
Q

DUKE major

A

Echo evidence of valve regurg
Blood cx
new murmur
the rest you would think woudl be minor criteria

500
Q

beefy red ulcer with a painless papule on the dick=

A

Klebsiella

501
Q

pulseless torsades, Mg or defib first?

A

Defib! Mg for a pulse

502
Q

Suicide risk factors 2 points

A

Hopelessness/depressio
previos attmept
intent
rational thinking loss

503
Q

TCA Sodium bicarb stuff

A

Sodium bicarbonate is the antidote of choice and works via overcoming the sodium channel blockade by providing a sodium load and via inducing an alkalosis to decrease drug binding to sodium channels. Indications for sodium bicarbonate include a QRS duration > 100 ms, ventricular dysrhythmias, and hypotension.
Look for Terminal R wave in in AVR

504
Q

Skiers thumb management

A

Lots of stress on the inside of your thumb, like you ginfers didn the splits. And then the UCL ulnar ligmenat is torn and has laxity >35 degress. Thumb spica and urgent surigcal follow up

505
Q

Tx of low grade moutnaitn sickness?

A

IVF, acetazolamide and nof urhter ascent progresso n to descent and dex if that doesnt wokr

506
Q

is infectivity the hgihest in acute infection or AIDS inHIV?

A

Acut einfection

507
Q

BIpapa in HF does what?

A

Decresae afterload and pre load by increased intrahtoac pressure

508
Q

difference in conus medulalris an cauda equina?

A

any UMN is conus, very sudden, bilateral, Ankles gone w/ preserved Knees

509
Q

Mono pearls

A

Posterior Cerv LA (Ant is strep throat) with exudated in post OP
Almost always rash after pen/amox
splenomgaly dont play sports for 4 weeks after
heterophile Ab test and atypica llymphocuytes

510
Q

Tx auricalr hematoma- incisr and drainif large, if small needle aspirate and pressure dressing to not let it reaccumulate

A

nah

511
Q

muliutple painful ulcers with inguinal LA- what type of organizsm is this?

A

GN coccobacilli- H Ducreyi

512
Q

How to treat Cerebal edema in DKA?

A

Mannitol! begins 6-10 hours after therpay for unknown reason- 90% mortality, usually kids

513
Q

What 2 co factors do you give inehtlyene glycol and what 2 levels do you get HD?

A

B6 and B1 to shunt the pathway
Ehtlyene glycol 50
glyciolic acid 8

514
Q

significant pain with menses young femal tx?

A

Iburpfoen and Tylenol - dysmenorrhea - prostaglandins mediated

515
Q

PE massive vs submassive

A

systolic blood pressure < 90 mm Hg for > 15 minutes, a systolic blood pressure of < 100 mm Hg with a history of hypertension, or a > 40% reduction in baseline systolic blood pressure. Tachy. RV dialtion hypokinesis. Hypoixc and hypoTN think lytics

516
Q

CHF 3 things ot tx with and HTN

A

BIpap
IV Nitro
furoesmide

517
Q

TBI management 2 main things

A

Hypoxia- intubate

Hypotension - SBP 90

518
Q

AVNRT tx

A

Adenosine this is PSVT or valsalva

If it is wide or irregular then think procainamide

519
Q

garlic odor on poinsing Tx? abd pain, hematuria an jaundicie

A

Arsenic- urinay alkinalization

520
Q

traumatic iritis treatment?

A

Homatotropine

521
Q

Papilledema and LP

A

You can do itin IIH but make sure this no mass ocupying lesion and CN abnromalities! it is diagnositic if you have papilledmea
INR <1.5 and platletes 50K are the cut offs

522
Q

2 meds used in cuhusing syndrome

A

Cushing disease is pituriaty tumor, syndrome is steroids

- Keotconazole and metyrapone to stop steroigensis or take out hte tumor

523
Q

what do you do with an accelracted idioventricular rhythm?

A

Nothing, it is from the ventricles and usally after a reprufion to myocaridum. wide complex and regular, 40-100 beats

524
Q

What complications for neisseria menigitis can you get?

A

Ecchymosis and DIC and ganrene of extmeities

Waterson F

525
Q

How sure can rule out a SAH if you get a CT within 6 vs 24 hours?

A

100 vs 92%

526
Q

asymptomatic bacturia complications and 3 tx options

A

Kelfex, augmenton, Macrobid NOT cipro or bactrim
Uterus is big and porgesterone relaxes smoth muscle so risk of Pyelo is 30%, preterm labor, IUGR, sepsis, UTI, neonatal death

527
Q

What does posterior MI look like?

A

Deep ST depression in V1 and V2
Either from Right coroanry or Left circumflex artery
get posterior ekg

528
Q

What do you give in a MI

A

Apsirin
Slopidrgrel
heparain
Nitro to vasodialte coraonry arteries (not right sided)
90 minutes from door to balloon time or else thromblytics
120 if transferred

529
Q

full thikcness lateral wall MI looks like

A

5 6 lead 1 and AVL STEMI

530
Q

Subendocardial ischami in ant wall ekg

A

ST depression in anteriro leads

Same look if it was right sided, 2 3 F

531
Q

baby had GERD what do you put him on first?

A

Proetien hydorylsatye AMnio acid formula

if weight loss and esophigitis and ill appearing them do histamine or ppi therpay

532
Q

liver abscess

A

CFTX for + and - coverage and metornidazole for anaerobes and E. hisolytica infection

533
Q

empyema Dx and Tx

A

GRam stain with bacteria
7.1 pH 50k WBC glucose <60
usualy a parapenumonic effusion

534
Q

fiberoptic intubations indiations to secure airwway

A

Clinical findings may include subcutaneous emphysema or crepitus, dysphonia, stridor, hemoptysis, laryngeal tenderness, anterior neck pain with tongue movement, or anterior neck pain with head rotation.

535
Q

fungal infection Tx of erytehma nodosum, erythema multiforma and rash with lung involvment

A

FLuconazole, itraconazole for occicodio

536
Q

Heart block and MI

A

narrow complex 3rd degree AV block + inferoir wall MI is transeiint and good prognosis
Right bundle, left bundle, posterieor ehmi block have increased rsk of shock, v fib, big infarct size and poor mortality

537
Q

GI pain, WGMA_ ingestion hypoTN

A

IRON OD

deferoximine

538
Q

hydroflurouic acid- what type of gel do you put on it?

A

Calcium gluconate- if you suspect deep invovlement may need to push it IV bc it binds to those ions
watch out arrythmias

539
Q

25 RBC on UA follwing a MVC- DC or CT?

A

DC microscopic without gross heamturia

if gross then CT

540
Q

cells to look at in acute radiaitonexposure syndrome?

A

<1500 lymphoytes

541
Q

Pathophys and complications of HELLP

A

MIcorangiopathic thrombosis

Patients with HELLP syndrome are at risk for bleeding complications, including disseminated vascular coagulation (DIC), intracranial hemorrhage, placental abruption, and spontaneous hepatic or splenic hemorrhage. Hepatic hemorrhage can progress to hepatic rupture

542
Q

Most common cuase of SVC syndrome, is it life threatenitng,

A

Lung cancer

rarely

543
Q

Drug OD: hallucinate, HTN, Tachy, dilated pupils

A

Dextromehtorphan

544
Q

pathophys and TX of TTP

A

ADAMST13 ab cleaving vWF into smaller thigns to glom up vessels
Plasma exchnage

545
Q

colitis = Diagnosis name

A

MEsenteric ishcamia- need abx

546
Q

impriving hemorrhid >72 hours TX

A

Sitz bath and steroids

<72 = cut it out

547
Q

Neck trauma managmeent

A

Soft signs= CT angio +/- EGD and bronch
HArd= OR
ZOne 1= SC to cricoid
HArd= Non reposnsive shock, no radial pulses, FND, massive hmoptysis

548
Q

Fevers, quick malar rash- Dx and TX

A 
Erysieplas of superficial dermis- systemic so give IV CFTX if not then give amoxicillin
Strep pyo (B)
549
Q

Mitral stenosis pearls

A

DSypena on exertion
diasotlic rumble
hoarseness bc L atrium onto recurrent larygeal nerve

550
Q

What is the cut off ibuprofen OD mg/kg

A 
100
if less than discharge home 
You would need 28 g or 140 pills in 70 kg person
Common:GI and CNS
Rare: hypoTN seizure coma
551
Q

every RBC infusion reaction is supportive care excpet for…

A

Hemolysis

Diuretics and fludis

552
Q

RBC transfuons and your patient gets a fever what do you do?

A
  1. Stop, could be non hemolytic or hemolytic
  2. repeat cross match, haptoglobin, LDH, direct antigen test
  3. Blood cultures
  4. once hmeoysis is ruled out- restart and give tlyenol. can use leuokcyte recude blood
553
Q

gamekeeprs thumb injury spot and what do they have toruble doing

A

Weak pincer grasp bc ulnar colateral lig on medial side . valgus stress

554
Q

kid huffs keyboard cleaner, passes out- what is happening?

A

cardiac dysrhytmia bc catecholamine release and senstize myocaridum - give BB

555
Q

small PTX TX

A

100% O2 and reshoot xray in 6 hours, DC after

556
Q

sigmoid volvus Tx

A

needs flex sig and then opertion to prevent recurrence

557
Q

Heartblock + a ST depression of a sloped nature=

A

Digoxin “Dig” that slope

558
Q

young monagmous prstatitis treatment

A

E coli

bactirm or flkuoruinoline

559
Q

unstable angina…

A

Doesnt have ot be just at rest, it can be new or worsenign anginal pain

560
Q

sternal fractures

A

need lateral chest x ray
restrained drivers
low mortality, doesnt alwya smean underying injury

561
Q

TBI RSI drugs…

A

Etomidate- ressur eneutral and quick
sux- quick to reassess mental status afterwards
avoid hypoxia and hypoTN

562
Q

Malraia perals

A

P. malariae is every third day — vivax, faciparum, ovale is every other day
- recurrence after months of exporusre is vivax or ovale dormant= needs primaquine

563
Q

what is enoopathlmos?

A

posterior displacement of the globe - truama

564
Q

shooting pain when you chew…

A

Trigeminal neurlagia

565
Q

what si t called when you get vertigo or joint paint 1 day after you dive and fly?

A

decomrpession sickenss

566
Q

Youo stick a chest tube in someone for a PTX and now has an opacity, hypoxic and dyspneic?

A

Reexpansion pulmonary edema. happens when you turn on suction from a PTX that has usually been there for a few days and repaid expansion of the lung causes fluid shifts. Dont turn on suction right away. Supportive and self limited, PPV if need be

567
Q

bradycarida with wide QRS- do yu give clacium gluconate or pace them?

A

Calcum gluconate and try to get K down first

568
Q

Ectopic preganncy

A

Repeat if below 1000 in 48 hours
Can be an empty gestastional sac AND a actopic pregnancy it does nto rule it out

Rhogam to Rh neg patients an bleeding

MTX 85-93% medical therpay in early ectopic

569
Q

Tetanus treamtment

A 
Tetanis Ig
Metronidzaole
Benzos and 
ROcuronium!
opiods
570
Q

nerves in spine come out above or below the vertebra?

A

Below

571
Q

Esiemnegrner syndrome

A

L-R shint progresses to R to left shunt! bc overload into the lungs an dpulm HTN

Oxygen wont increase the sats!

572
Q

WHat to do with an avulsed tooth

A

60 minutes=rinse and reimplant
>60 minute= soak in citric acid and emergent dental follow up (1% per minute)
kid under 6 years- dont put it back in

573
Q

differenc betwen grade 2 and grade 1 sprain ankle

A

grade 2 in decreased ROM but still can wlak on it. Partial tear. immobilize
Grade 1 is full ROM with pain and can walk. microscopic tears
3= no walk, full tear. surgery

574
Q

treatment of pneumomediastinum?

A

Supportive if no PTX

575
Q

periodic paralysis

A

hyperkalemic, hypokalemic, thyrtoxic types. happens after heavy exercise and high carbs! PAralysis + BMP
give carbonic anydrahes and K sparing siruetics in hypokalemic which is common
ion channel problem. famimlial

576
Q

when to admit for obs in electircal shock?

A

> 240 V even if they are asymptomatic - lytes, CK, cardiaac arrtyhmias

577
Q

when to give tamoflu post 48 hours?

A

old
copd
ummunocompormised

578
Q

what other durgs treats herpes keratitis?

A

trifluridiine

579
Q

lung cancer, afebrile dullnness to persucssion =

A

pulmonary effusion

580
Q

rash, myalagis, travel, rash, fever, headache…

A

dengue fever

581
Q

diagnosis of rpecemaplsia to trear

A

160/110

plus AMS, labs, pulm edema ect

582
Q

treatment in peds anal fissure

A

WASH
Warm water, analgesics, st

MC anorectal disorder- if it isnot midline think crohns, orinfectoius

583
Q

Peritonsillar abscess complication…

A

internal carotid is 2-3 cm inferior lateral

584
Q

Drowning mangement

A

Interventions start with rales in pulm fields- low flow oxygen in the ED- if none then go home
Rales in all field sis high flow oxygen and ICU and if Abnromal BP then conisder intubate and ICU- 3&4 needs hgi flow oxygne

585
Q

near hanging post complications

A

neurgenic pulm edema
obsturvive pulm edema
ARDS

586
Q

flail chest with inadequate oxygenation on NRB- =?

A

intubate and positive pressure ventilation

if 8 ribs, old, shock, resp fail, comorbids then do this early to reduce mortality

587
Q

very stressful event, enlarged heart, EKG looks like MI but then cath is negative…

A

Takotsubo

588
Q

what is a lizfranc Fx, how do you dx it and tx it?

A

Tarasal-metatarsal dislocation- cuneifrom and cuboid
keep calc stabel and twist foot. Xray
Nondisplaced= walking boot. Displaced is surgical

589
Q

Hyperhma stuff

A

CHeck IOP- eye hsield, rest- f/up

it is a bleeding oiris or ciliary body -

590
Q

Compartment pressure meausring

A

When Diastolic - compartment pressure is >30

591
Q

What is slit venricle syndrome?

A

VP shunt with intermittent headaches around exercise and stress
Overdrainage and the ventirlces collapse and now obstruct the shunt altogether an dimproves with rest. Needs nuerusurg consults and lay supine/treneldumburg

592
Q

perforated TM Tx

A

Discharge and KEep dry

593
Q

loss of aurerbach plexus…

A

Aclashia

594
Q

bulemia metabolci derangements…

A

HYPO all the way (even hypochloremia)

met alkalosis

595
Q

fenanyl chest wall rigidity tx

A

NOT naloxone

needs paralytic

596
Q

Tx of isopropyl alcohol?

A

Supportive not fomepizole

597
Q

TRALI

A

neutrophils causing enodthelial injruy and vascualr leakege in the lungs

598
Q

SJS Tx

A

Burn treatment
including fluid repletion to replace insensible losses, wound care, and prophylactic antibiotics as indicated. Patients with severe oral or airway involvement may require intubation for airway protection as well as transfer to a burn center, depending on the degree of involvement
Mycopalsma can cause this

599
Q

HF acid treatment

A

glass etching
White figners directly after— GIve clacium gluconate bc QT and arrtynmais can happen 24 hours later even for 1-5% of surface area

600
Q

blast injruy apears normal, check_____ to discahrge them

A

TM

601
Q

Kid needs Abx and has leukemia, no access- wait or do IO?

A

IO if can tbe accessed in 1 mintue

602
Q

Paraphimossi Tx

A

If ischemic then penile block, and Ab oitnment and dorsal slit
IF non ischemoc soak a sauzein mannitol ro sugar and osmosis to reduce swelling

603
Q

What INR should you immediaitely reverse it?

A

Over 4, even if metal valve

K and PCC

604
Q

ACLS and PEA

A

Patients not in a “shockable” rhythm should receive high-quality CPR, epinephrine, and a diligent search for potentially correctable causes of arrest should be undertaken. Therefore, because the patient is in cardiac arrest with a rhythm on the monitor but no pulse, chest compressions is the next most appropriate step. Causes include hypothermia, hypoxemia, hypovolemia, hemorrhage, hyperkalemia, hypokalemia, severe acidosis, tension pneumothorax, pericardial tamponade, pulmonary embolism, myocardial infarction, traumatic injury, and toxic ingestion or overdose. Chest compressions should continue with minimal pauses during bag ventilation, definitive airway establishment, or defibrillation (if indicated). Compression depth is 5 to 6 cm (maximum 6 cm), and the compression-to-breath ratio is 30:2 (30 compressions followed by 2 breaths delivered by 100% FiO2 through a bag-valve mask). Once a definitive airway is established, the ventilation rate is 10 breaths per minute or one breath every 6 seconds. Once return of spontaneous circulation (ROSC) is achieved, post-cardiac arrest care may include percutaneous coronary intervention, early goal-directed therapy, targeted temperature management, or aggressive glycemic control.

605
Q

PLace an NG in Borrhaves?

A

NO- IVF ABx and surgery

606
Q

What time period do you give streptokinae in STEMI?

A

2 hours to PCI

apsirin too nless allerguc

607
Q

perichornidiritis from a piercing

A

Pseudomonas coverage plus think staph and strep

cartilage receives its blood supply from the surroungin perichondrium - disrupt htese layres and worse blood flow

608
Q

is type 1 odontoid fracture stable?

A

Yes

Ant mid and posterior columns keep this in line. need to knokc out 2 columns for instbaility

609
Q

Cecal volvulus stuff

A

it is embryogenic where ileum, cecum and ascedning colon did not adheere to posterior wall. LUQ will shwo the trnasition point
young 30-50

610
Q

is the teacup up or down in perilunate dislocations

A

UP
The CAPITATE is what is actually displaced here and the lunate will be up and over the radius

lunate idlsocation is spilled and off the radius

611
Q

what does mycoarditis look olike on echo

A

diffuse hypokinesis with multichamber dilation

612
Q

RCC paraneoplastic syndromes

A

erythcytosis from erythpoeitnin
PTH, low phosphae
HTN from Renin
Hyperglycmeria from ACTH

613
Q

bilious emesis and distention in a 1 week old with normal vitals and nromal x ray- youhsould get…

A

Upper GI series (or abd ultrasound) for midgut volvulus

614
Q

nursing home variables for PNA

A

1=33% 2=50% chance of PNA

HR, RR 30, febrile, no wheezing, leukocytosis, crackles, confusion

615
Q

trach tube wiht resp distrees first move

A

3 ml NS with suction

616
Q

stroke and hyperG…

A

contorl it bc poor neuro outcomes

617
Q

CRETST=

A

CREST syndrome are Calcinosis, Raynaud phenomenon, Esophageal dysmotility, Sclerodactyly and Telangiectasias. Most treatment is aimed at symptomatic relief although there is some evidence for the use of methotrexate as an immunosuppressive agent

618
Q

Rhabdo pearls

A

CK >5X the upper limits

Get an EKG - renal failure> hypoCa- HyperK-hyperP

619
Q

How do you treat ermegence reastion from ketamine

A

benzos

620
Q

when do you not redcue and go to surgeyr first?

A

severe pain, is febrile, or has a leukocytosis, then an emergency surgical consultation
Vitals too, Phys exam

621
Q

Short PR, wide Qrs, upstroke slurred- contradiciated is…

A

These can be remembered by the mnemonic “ABCD”– adenosine, beta-blockers, calcium channel blockers, and digoxin. Atenolol is a beta blocker and is therefore contraindicated.
AV nodal blockers

622
Q

lower extremity edema, shortness of breath, hypertension, and microscopic hematuria 1 week after skin infection
VS
URI 2 days later microhematuria

A

PSGN- weeks plus throat or skin

IgA=URI and then 2 days you get hematuria

623
Q

HypoNA or SIADH drugs

A

Carbamazapine/Oxcarb
Anitdepressenats
Antipsychotics
HCTZ and Loops

624
Q

febirle siezure age range

A

6 months-5 years

625
Q

myocarditis

A

The treatment of myocarditis is supportive and aimed at maintaining cardiac output. This includes management of associated rhythm disturbances and congestive heart failure to hemodynamic support with vasopressors, ventricular assist devices, aortic balloon pumps, and even cardiac transplantation in fulminant cases. Endomyocardial biopsy is the historical “gold standard” for diagnosis of myocarditis, confirming microscopic features of myocardial inflammation and necrosis. However, some studies have questioned the sensitivity and specificity of endomyocardial biopsy, and in the future cardiac MRI may supplant endomyocardial biopsy as the test of choice for myocarditis.

626
Q

lymes rx

A

doxycycline.
In pregnant women or children under the age of 8 years, amoxicillin should be substituted.
Patients with neurologic or cardiac manifestations should be admitted and treated with IV ceftriaxone
CNS and AV block is 4 weeks later.

627
Q

does renal fialure acidosis need bicarb?

A

yes
Studies have shown that patients with renal failure and metabolic acidosis have a reduced need for dialysis and reduced mortality at 28 days when treated with sodium bicarbonate.
DKA no shown benefit

628
Q

order of hyperTSH drugs to be given?

A

Propranolol, PTU, Idodide, Dex

Propylthiouracil is then administered to block synthesis of thyroid hormone and also block peripheral conversion of T4 to T3. Approximately one hour after administration of propylthiouracil, you would then administer potassium iodide to prevent release of stored thyroid hormone. This is done with a one-hour delay to prevent the utilization of the iodide by the hyperactive thyroid to make new thyroid hormone. Dexamethasone is then administered due to concern for adrenal insufficiency in association with severe hyperthyroidism, as well as its ability to decrease peripheral conversion of T4 to T3.

629
Q

what does high riding prostate mean and the most commone sign for bladder injury is…

A

Urethreal innjury

gross hematuria

630
Q

glargien or glimpiride for hypoglycemic events?

A

Glimpiridie- sulfonurea 24 hours of half life and peak activitiy
glargine is lng acting but never has peak activity

631
Q

prevention and tx of air embolism in divers

A

dont hold yor breath

hyperbarics

632
Q

when to get LP on suspected SAH

A

if CT negaitve and you stil suspect it

633
Q

Dx of entomeba hisotlytica?

A

US and then prtozoan in stool

IV metornidazole- drain only if refractory

634
Q

Middle lobe bugling fissure on rught?
Pna and bullous myringitis?
Wide mediastinum sick gram positive?

A

Klebsiella
Mycoplasma pneumo
Anthrax

635
Q

Eos in urine Plus AKI

A

AIN
acute renal failure resulting from immune-mediated tubulointerstitial injury. The presence of eosinophiluria in a patient with acute kidney injury suggests acute interstitial nephritis, which is typically an allergic reaction to medications such as penicillins, sulfa-containing antibiotics and diuretics, NSAIDs and proton pump inhibitors. Patients with acute interstitial nephritis may also present with a rash, fever, eosinophilia, and other constitutional symptoms

636
Q

CATCH 22

A 
DiGeorge
Cardiac
abnromal face
Thymic
Cleft platate
hypocalcemia
22 chorme
637
Q

Umbilical prolapse

A

Trendelmburg or knees and elbowes to c section immedietely or if you cant try tp put it back in the uterue

638
Q

macule is small and ____

patch is large and ____

A

flat

Flat

639
Q

WHat is LBBB on EKG?

A

Postive and wide in 1
negative QS in V1

RBBB is negative and thenin V1 it is triphasic

640
Q

Mech action of organopshospahte posions

A

blocks acethcolinesterase-
2PAM regerneates it

Wach out for brady cardia, bronchsopsms and bronchorrhea - All muscarinic effecgts

nicotninic is fascilautions and paralysis

641
Q

necrotizing gingivitis Tx

A

augmenton
oral hygiene rinsies
follow up with dentist for debirdement

642
Q

A CAT of MUDPILES?

A

Aspirin
CO CN Caffeine
Acetominophen
Theophyliine

643
Q

Deep oinverted T waves in Anterior leads

A

Wellens warning

644
Q

treatment of radiation protolcitis

A

Steorid enemas
stool softenres
DC to home

645
Q

symptomatic seizure of hyponatremia- give ___ml/kg of 3% saline

A

2-6 ml/kg

646
Q

needle cric tips

A

To perform a needle cricothyrotomy a 12 or 14-gauge angiocatheter is inserted into the cricothyroid membrane. If the commercial kit is available, the oxygen delivery tubing with an on/off valve is attached and periodically insufflated for breaths. However, two alternatives exist when the commercial kit is not available. The end of a 3-5 endotracheal tube can be directly attached to the angiocatheter and a subsequent bag valve mask to the endotracheal tube tip. This circuit will have significant resistance although the patient can ultimately be ventilated. An additional option is to attach a 3 mL syringe with the plunger removed to the angiocatheter. The adapter of a 7-0 endotracheal tube can then be attached to the open end of the syringe.

647
Q

suspected urterhal injury- suprbpuic cath or retro uterhogrm?

A

Retro urethrogram

648
Q

alcoholic hepatities

A

looks like ascending cholangitis a little bit but no stone noted and fatty/cirrhotic liver

649
Q

Tumor luysis syndomre lytes

A

K
PO
Uric Acid high

low Ca

650
Q

Addiosons

A 
Primary low cortisol and aldosterone
Hyper K, hypoNa
low glucose 
hypotn and shock 
Pigmentation

hydrocortiosne

651
Q

lithium toxicity

A

HD 5, 4+kidneys or 2.5 and symptomatic (especially siezures)

If low and mild then NS at 2x main rate

652
Q

button battery in E

button battery in somtach

A

go get

repeat x ray 48 hours

653
Q

PUD + Intractable post-prandial vomiting, early satiety =

A

gastric outlet syndrome

654
Q

most common pediatric site for foreign body ot get stuck

A

c6 Cricpharygenal

655
Q

pacreatitis ddx

A

BAD SHIT: Biliary, Alcohol, Drugs, Scorpion, Hyperlipidemia, Iatrogenic (ERCP), Trauma

656
Q

hemorrhagic panreatitis signs

A

Hemorrhagic: Cullen sign (ecchymosis around umbilicus), Grey Turner (ecchymosis around flanks)

657
Q

ransons cirteria

A 
16 WBC
55 Age
200 GLucose
250 AST 
350 LDH
658
Q

SBP WBC and PMNs

A

1000

250

659
Q

Air or air-fluid level in the gallbladder =

A

emphysematous cholecystitis (higher risk of perforation 🡪 emergent surgical consult

‘Acalculous: elderly, diabetes, trauma, burns: high risk of perforation and death

Gallstone ileus: stone goes into small bowel with obstruction at ileocecal valve

660
Q

porcelein gal bladder

A

increased risk fo cancer

661
Q

galls otne pacnreatitis needs….

A

emergent decomrpession

662
Q

reynolds pentad

A 
fever
RUQ
jaunidce
hypoTN
AMS
663
Q

a fib + abd pain + old= what test?

A

angiogngraphy for emsneteric ischemia

664
Q

SBO

A

1 cause is adhesions

Hernia is #2 cause
Treatment: NG tube, IVF

665
Q

LBO

A

1 cause is tumor

X-ray show distended large bowel with no stool in the vault
Treatment: NG tube, IVF

666
Q

VOlvulus

A

signmoidopscopy or rectal tube and then surgery to takc it down

cecal volvuslus is striaght to tsrugery i think

667
Q

hernia

A

Indirect Inguinal
Most Common
Passage through persistent processus vaginalis deep ingeuinal ring baove/lateral the inferior epigastric

Direct Inguinal
Passage through transversalis fascia and external inguinal canal beoow/medial the epigastric

Femoral
Passage below inguinal ligament (more common in females) and medial to femoral artery

Spigelian
Passage lateral to rectus muscle (difficult to diagnose

Incarcerated = irreducible
Strangulated = irreducible with vascular compromise
Treatment: manual reduction. If strangulated or time of incarceration unknown, do not try to reduce

668
Q

Crohn’s pt with back pain + limp =

A

psoas abscess

Extraintestinal manifestation: arthritis, uveitis, sclerosing cholangitis, erythema nodosum

669
Q

Divertitculitis

A

May cause urinary symptoms because of irritation of underlying GU structures
Do not miss colon cancer
Outpatient Treatment: Cipro + Flagyl for 7-10 days
Inpatient Treatment: obstruction, peritonitis, immunocompromised, abscess

670
Q

Abd abscess over ___ cm need drainage

A

4= percutaneous drianage

671
Q

Prolapsed non-reducible internal hemorrhid Tx

A

surgery

672
Q

anal fissure tx

A

sitz, stool softener, high fiber

673
Q

anal abascess stuff

A

Dull, aching rectal pain, erythema, induration, +/- fever, +/- fluctuance
Rectal exam to rule out intersphincteric abscess
Ischiorectal abscess – lateral
Simple perianal abscess maybe drained in the ED, all others in the OR
Abx not routinely recommended
Think of STDs if they have proctitis

674
Q

when to remove anal FB

A

Smooth edged body: remove in the ED (awaiting spontaneous passage can lead to infection and perforation
Signs of perforation: consult surgery

675
Q

GIB stuff

A

Platelets:
<50,000 give one per 6 pack of RBC

Liver Failure + GI bleed: octreotide, PPI (reduces rebleeding and transfusion requirement but no mortality benefit), Antibiotics: mortality benefit

676
Q

diarrhea

A 
Toxogenic diarrhea
Abrupt: <24 hours; +/- abd pain
No systemic symptoms
Invasive diarrhea
Slower onset: > 24 hours
Fevers, abd pain, blood/mucous/pus in stool (dysentery)

Testing:
Helps to distinguish between invasive vs toxogenic
Usually not done through ER
Stool cultures important for: HIV, food handlers, healthcare workers, C.diff for recent hospitalizations or antibiotic use
O&P – not routinely done but important in men who have sex with men, AIDS, foreign travel

677
Q

Diarrhea Tx

A

Dehydration: oral preferred, IV otherwise
Pt’s fed earlier do better
Antidiarrheals:
Loperamide: anti-motility agent, recommended for patient that is afebrile or low grade fever
Bismuth: less effective than Loperamide but can be used with fever and dysentry
Antibiotics: moderate to severe diarrhea with signs of invasive bacterial infection, elderly, immunocompromised
Oral Flagyl and Vancomycin for C.diff
Fluorquinolone: 3-5 days unless proven E.coli 0157:H7
Azithromycin if resistance/allergy suspected

678
Q

Diarrhe pearls

A

Symptoms within 6 hrs: preformed toxin (B. cereus)
Symptoms within 6-18 hrs: C. perfringens
Pregnant women eating unpasteurized products: 20 times increase of Listerosis
Shigella can cause seizures in infants
Yersenia – may present like appendicitis
Campylobacter jejuni #1 cause of infectious diarrhea in United States
Amoeba histolytica causes liver abscess

679
Q

protein c s defieincy

Factor 5 leidein

A

hypercoagable bc it is unable to stop the cascade

hypercoagable bc it is unable to accept the effects of protein C so cant sotp the cascade

680
Q

plateltes

A

Consequences of decreased platelets
<50,000: excess bruising with minor trauma
<30,000: spontaneous petechiae and bruising
<10,000: spontaneous visceral hemorrhage
1 unit considered to raise recipient’s count by 10,000

681
Q

palpable vs on plapable purura

A

Non palpable purpura: think low or dysfunctional platelets

Palpable purpura: think angiopathy/vasculitis

682
Q

low plateltes DDX

A

Decreased production: Aplastic anemia, malignancy, meylofibrosis, radiation, viral infections, drugs (ethanol, thiazides, estrogens, chemotherapeutics, heparin)
Increased destruction:
ITP/TTP/HUS/DIC/viruses/drugs (heparin)

Splenic sequestration
Enlarged spleen can hold half of blood volume and 90% of platelets

Malaria, rheumatoid arthritis, TB…

Platelet loss
Bleeding, hemodialysis

683
Q

ITP kids vs adult

transfusion threhsolds

A

50K bleeding
20 K non bleeding
Kids resovle, adults dont
steorids and IVIG if less than 5

684
Q

TTP Tx

A

Steroids, FFPPlex
80% mrtality if untreated
Schixotcytes

685
Q

DIC

A

Consumptive coagulopathy
Extrinsic pathway problem
Liberation of tissue activating factor 🡪small fibrin and blood clots deposit in microcirculation 🡪 consume clotting factors and causes hypoxemia🡪fibrinolysis🡪elevated fibrin split products
Etiologies: trauma, sepsis (meningococcemia), transfusion reaction, envenomation, retained products of conception
Labs:
Increased fibrin split products and d-dimer, thrombin time, PTT
Decreased platelets, fibrinogen (may be normal)

TX
Treat the underlying cause
If primarily bleeding follow the PT (best single test in this setting)
PCCs
FFP (10-15 mL/kg)
Vitamin K
Folate
If primarily thrombosis consider low dose heparin infusion
686
Q

1 week after heparin and then drop of platelts by 50%- 3 dos and 2 donts

A

HIT

  1. stop heparin 2. reverse warfarin (warfarin necorsis risk) 3. give Ruidn or Agrotroban (direct 2a thrombin inhibuor bc they are high risk of thromobosis)
  2. Dont give warfarin or 2. plateltes
687
Q

Direct thrombin inhihibitor and CKD and bleeding

A

Dialysis need, rneally excreted

Bleeding and on drugs:
Consider tranexamic acid (fibrinolytic inhibitor),

desmopressin (transports VIII and stimulates release of von Willebrand factor
PCC maybe too

688
Q

Sickle cell

A

ACS- pulm vasculature from infection, infarction

Oxygen
Antibiotics (include a macrolide)
Incentive spriometry
Pain control
Bronchodilator therapy
Transfusion (especially if high risk)- for al tyes of crisis if bad enough

Renal, brian, hand and foot, priapism (echange and asiration)

Watch out for splenic sequestration and aplasitc crissis- low theshold for Abx

689
Q

VwF Tx

A

Desmopressin

Factor 8 trnsfuion rare

690
Q

CPP=?

A

MAP-ICP
Ideal CPP >60
80-15 is great

head trauama:
Elevate head of bed
Maintain adequate oxygenation, ventilation, systemic perfusion
Mannitol 1 g / kg
Hyperventilation (temporizing) to Pco2 of 30-35 mmHg
Emergency decompressive craniotomy

691
Q

spinal fractures unstable

A

Jefferson= C burst from axial load
Type 2 and 3 odotoid fractures form flexion (body of dens invovlenmnt)
Hangbmans’ C2 displaced anteriorly bilateral pedicle Fx
Teardrop- flexion or extension but spinal cord injury - frnt of vertbal body is brokena nd pushed the body into th epsinal cord

692
Q

paralysis and pain below the level, DCML crude tough still intact =

A

Anteori cord form spinal artery injury

DCML is still intact

693
Q

most important thing to do in head trauma

A

avoid hypotension

694
Q

basilar skull fractures can have a normal..

A

Head CT

695
Q

HARD bruit neck signs

A 
HypoTN
Art bleed
rapid expangin hematoma
Deficit neuro
Buit
696
Q

What is SCIWORA

A

spinal cord injury with out rads evidence
Kids>adults
C sine>TL

697
Q

Trauma stuff

A

Chest x ray can lag hours and get worse

Sucking chest wound= 3 sided not Chest tube through it
Tension= needle nto x ray

698
Q

OR throactomy for hemothroax?

A

1500
1 for 6 hours
200 for 3 hours
air leak cant get a hole of

699
Q

THoracotmy inidications

A

Penetrating trauma and lose vital suddenly
NOT blunt trauma
If you do it, go anteroiro to avoid phrenic nerve

700
Q

Truauma and then decompensate (RR) 3 weeks later…

CT normal but peritoenal?

A

Diahrgam injury - CT can miss it

Hollow viscus small bowle injury, CT can miss it

Pancreas easily missed to

701
Q

MC blunt and penetraitng trauma injury in abdoemn

A

Spleen

Liver

702
Q

Old person down with briginid bilteraly iliacs?

A

Grey turner retorperitonnal bleed

703
Q

CT shows bladder injnury, what test next and hwich gets surgery ?

A

Retorgrade cystogram?
Intrapertineoal is surgery, extra just sticka foley in

retrograde urethrogram- urethral injury- dont put a foley

704
Q

Pelvic injruries

A

Fall from heigh ti si latreal comrpession and vertical shear

MVC is AP and urethral tears

Sacral fracture can have cauda equina

705
Q

next step for compression hand injuries?

A

dont inject into it

hand surgeon iedialtely

706
Q

compatment pressures

A

> 20
30 for sure
pulse goes last, pain and paresthsia first

707
Q

when do you give tetanus Ig?

A

Unvaccinated + bad injury = Ig!

lidocaine 4mgkg and 7 mg kg epi

708
Q

Kid brun parkland

A

Same thing but extra 9 to head

legs are 14 a piece instead of 18

709
Q

Burns

A

acid is coagulative burns

3rd degree, 2nd 10% and up, face, hands genitals, inuhaltion, electrical, acid== ALL need burn center!

710
Q

Peds trauma

A 
MCC of pediatric death > 1 year
Follows same ATLS protocol
Airway:
Large occiput tends to flex neck
ETT size : (age/4) + 4
ETT depth: 3 x tube size
No cricothyroidotomy if < 8 years old
Temporize with Transtracheal jet ventilation: oxygenation but poor ventilation
Circulation:
pRBC: 10 cc/kg
Disability:
C-spine fractures less likely than adults
SCIWORA: dx by MRI- if still complaining of neuro injury
711
Q

Preggo trauma

A

Uterine rupture, baby is usually dead, way worse, no uterine contour, maternal shock

minor fall but no bleeding- placenta abruption - concelaed bleeding
MOre bleeding with preggo pelvic fractures

712
Q

Blasts

A
  1. pressure (lungs, TM, small bowel ) -air filled organs
  2. debris hitting you
  3. throws you
  4. burn injury, anything else
713
Q

FASTS

A

needed if unstable, dont go to CT scanner

GO straight to OR if postivr fast

714
Q

10 hours ago MI symtpoms started, 80 minutes ot next center
Tpa?
Transfer?
Dont transfer?

A

Transfer- if you can get to the center within the 120 minute hten transfer him

you can give tpa within 12 ours of sympomts, 30 minutes form symptom onset

715
Q

sudden bilious emeiss ina 4 weeker

  1. upper gi series?
  2. NG tube?
  3. surgery consult?
A

surgery ocnuslt

the other 2 come after

716
Q

appy Abx?

A

Cefotetan or ceofixitn
2nd gen for gram neg and anerboes

keflex is fist gen

717
Q

Sugungal Hemtoma
trephination
nailremoval

hand surgery

A

Trephination is indicated for subungual hematomas that are less than 48 hours old, are not spontaneously draining, and are painful

hematoma involves the nail fold or there is a fingertip avulsion that requires subungual sutures for repair, then the entire nail should be removed instead of trephination

large hematoma and tuft fracture DOES NOT need anything more thn trephination

bad fracture or nailbed exporsure is surgery

718
Q

MTX in abortions

A

<4cm
stable
no liver disease
not ruptured

719
Q

cuffend vs uncuffed equations in kids

A

uncuffed is 4s

cuffed is age/4+3.5

720
Q

hemoperitoenum reflex?

A

BRADYCARDIA

721
Q

camping + low palttes and LFTs high=

A

ehrichia

give doxy

722
Q

stupid stuff

A

dont cause paint in AMS, asthma and eczema hx, CAD and V fib most ocmmon not hyperK

723
Q

Do kids need abx in asymptomatic bacturia?

A

no

724
Q

non HCAP aspiratoin PNA abxx?

A

Amp and sulbactam

not pip tazo and vanc

725
Q

hypo ca and hypo mag, why?

A

malbaosroption, poor diet and pth resistance

726
Q

GI cocktail?

A

Viscous lidocaine 2%, 30 mL aluminum hydroxide and 150 mg ranitidine

727
Q

islated CN3 palsy, pupils reat, check,,…

A

glucose

728
Q

bullous pemphigoid

A

nikolsky negative, old ppl, basement membrane antibodies, oral steorid s

729
Q

cards syncope

A

Historical elements indicating cardiac causes of syncope, as opposed to orthostatic or neurocardiogenic episodes, include syncope during exertion, palpitations at the time of syncope, ECG findings of dysrhythmogenesis (e.g., bifascicular block, intraventricular conduction delay, QT interval abnormalities, Brugada pattern findings), and lack of postdrome. Prolonged prodrome and postdrome symptoms are common with vasovagal etiologies, with fatigue and nausea lingering well beyond the event itself, whereas true cardiac etiologies typically have no harbingers or postepisode symptomatology.

730
Q

NASH Tx?

A

weight loss thats it

MC liver disease herer

731
Q

food is stuck when to get enisopcpy?

A

resp distress

GLucaogon X2 20 min apart and observation if not

732
Q

painless beefy red ulcer on dick that bleeds easily…

A

Klebsiella, Donovanosis
Granuloma Inguniale. Klebsiella Ingunale
DOxy or azithro

Lymopgranuloa venereum is Chlamydia
chancroid can have LA too

733
Q

outpatient DVT meds

A

LMWH and Warfarin

734
Q

GOlfer elbow
tennis
little league
radial tunnel synrome

A

Meidal, pain with resisted flexion
lateral, pain with resised extension
medial elbow pain in kids
compression of posterior interossius nerve

735
Q

Galezii fx

A

Radius fx and ulna dislocation
watch out for compartment syndrome
OK sign to test for ant interosseos smedian nerve!!!

736
Q

Monteggia Fx

A

Ulna fx radial head dislocation

737
Q

Ulnar nerve roots for c spine…

A

C8 - T1

738
Q

How to repleace K

A

Each 0.3 meq drop needs about 100 mew replaced

739
Q

Heart failure comes in with biphasic T waves NOT in v1 or v2

A

HypoK on diuretics, long QT
St depression with shallo T right into a U wave
possible dig overdose

740
Q

what is redman syndorme caused by

A

hustmaine release, not true allergy

741
Q

first degree heart block tx

A

supportive

742
Q

epirudal abscess imag8uine

A

full spine for skip lesions

743
Q

What does early R wave tell you

A

R sight sided problem like RBBB or RI MI

744
Q

ST depression everywhere make sure to check…

A

AvR for roximal LAD or left mian one of the two

745
Q

AICD with v fib, first move

A

Magnet over it will shock them

and emporary stop to recongize dysrhtmyia

746
Q

sick sinus syndrome

A

tachy and brady trading off
needs both pacemaker and for slow and dysrthymics for fast long term
It is usually kn older ppl

atropine is tough to use bc then you get tachy

747
Q

Match
Deep blue hue with vision changes

blanching with phenylpehinre, one spot focial redness, no vision

A

slcerititis- neocrtiing vascultitis of slcera- optho and steroids

epislceritits

748
Q

light in opposite eye makes the opposite eye hurt?

A

Iritis

749
Q

You see ciliary flush and hypoyon=

A

Ant uveitis or iritis

uvea= chorid, iris and cilairy body so need same day optho

750
Q

DOnt give ____ to Myasthenia gravis

A

Magnesium

751
Q 
PNA
Rigors= 
Necrotizing PNA= 
Young person looks good but CXR looks bad= 
bulllous myrigintis=
A

strep pneunmo
staph
mycoplasma
mycoplasma

752
Q

PE X ray findings

A

PE hmaptons hump: infarct wedge

westermark: not as much blood vessels distal

753
Q 
ITP= Tx
TTP= Tx
A

steroids

PLEX

754
Q

DDx dyspahgia transfer stage

A

Transfer- first 2 seconds of swallowng MG, ALS and stroke

Trnasport dysphgia- obstrucive (schzatkis ring vs achlaisa)

755
Q

button battery for sure***

A

Button battery to be removed immediately in the E & the nose. If it is in the stomach youc an repeat x ray is asymptomatic.

756
Q

ID

A

turtle= slamonella
Ciguatera- hot and cold discpernacy
Peppry fish and histmaine- scromboid
Aids- cryptosporidium

757
Q

cecal volvus trnaspitoin on x ray in where

A

LUQ usually

758
Q

CPP=

ICP=

A

60

15

759
Q

TDAP

A

Clean and no known is TDAP, or clean an dknow is less 10 years tdap

Dirty and no nown is iG and tdap and dirty with known is give TDAP if under5 yers

760
Q

MG NIF of -20 needs

A

Intubate and plex

2x sux and half of roc

761
Q

GB tx?

A

PLEX IVIG

Rosh (14 decks)

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