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Rosh > Rosh PGY-2 deuce > Flashcards

Rosh PGY-2 deuce Flashcards

1
Q

Open fx abx recs for
Grade 1/2 (>1 cm with extensive soft tissue damage)
Gade3+

A

Ancef

Ancef + gentamycin

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2
Q

NPH tx and expectations from tx

A

Normal opening pressure
large olume
better symptoms after LP

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3
Q

Scloderma crisis things to look out for and Tx

A
  1. HTN - give captoprol or CCB
  2. AKI- BP control or dialysis/ lytes
  3. dysrthmias, cardiomyopathy
  4. PAH
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4
Q

Post flu infeciton in the lung causes…

Antrhax causes ___ on CXR

A

Caviatry lesion form MRSA

widened mediatinum and LA

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5
Q

what is tyhplitis?

A

Inflammation of cecum in innumosuppressed (chemo)
life threatenening
abd + flu like ysmtpoms

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6
Q

Fever, pulsatile mass in groin, acute limb sichemia signs =

A

Mycotic anysursym
Abx and surgery
IVDA, recent cath, reent infection,

septic emboli causing anuyrsm, thrombsis of it

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7
Q

blunt abd trauma in 27 wk female needs what 3 thigns?

A

300 mcg rhogam
4 hours minimum obs
betke-kleinhaur test to evlaute further

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8
Q

contraindicaitons ot ecahromtoies?

A

pretty much nothing- do it. unless estbalished gangrene already

not even hihg INR or low plateletes

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9
Q

What do you need to Dx PID and tx?

A

Abd pain + cervical,uterine,adenxal tenernss.
Helpful if: fever, ESR, discharge, STD present
CFTX 1X, doxy 2 wks and metronidaxzole 2 wks

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10
Q

TCA OD recetrs it acts on?

A 
Gaba>seizures
Anticholinergics
Alpha1> hypotension
sodium > QRS wide
anithistamine>sedation
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11
Q

Chronic cough
oculur involvement
weird rash/skin or purple liek rash aorund face
DX TX

A

Sarcoid
Get CXR, lytes
Steroids

watch out for CHF and neuropathies

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12
Q

symptoms and Tx of hypercalcemia?

what lvl dalysis?

A

Bone breaks, keidney stones, psych, abd pain

IVF, maybe steroids of bisphospos

18

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13
Q

albuterol tx

A 
BIOMES
Beta
Ipra
Ocygen
Mag
Epi (erbuatline)
Steroids (dexmaehtaosin, shorter and less NV)
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14
Q

caustic ingestion approach

caustic to skin liek wet cement?

A 
decontaminate
airway
suportive care
diagonose complicaitons (CXR or scope)
surgery/admit

LOTS of irrigation, injury may hapen hours after event -alkali up to 12

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15
Q

6 weeks after acute hpatitis ____ can happen

A

aplastic anemia

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16
Q

old, AMS, Dm2, urinary Fq gotta also think about?

A

HHS
Amino acids go to liver- glygoenolysis and lguconeogensis lead ot more glucose and profound dehydrations

DKA is more FFA to ketones

How doe sinsulin work to lower gap? stop ketosis and FFA and glucagonsecretion

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17
Q

Metabolic alkoslis symptoms
Lytes derangments because of it
5 main causes

A

weakness, myalgias, palpitations, nausea, muscle spasms, paresthesias.- seizures!
HYPOOOOO mg, K, Po, Ca

Vomiting
excessive minerlatocorticoids
Renal/diuretics
Laxative abuse
contraction alkalsosis

remmerber- low volume= renal hold on to Na and dump K/H (contraction) so give back Normal Saline

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18
Q

Painless penile ulcer and unilateral painless LA- DX and TX

A

Chlamydia trach
Lymph venerum
Doxy

Remember: bilateral, painful is ducriey or chancoird - Azitrho

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19
Q

beffy red ulcer near penis and painful

A

Klebsiella - DoXY - Granuloma Inguinale

Donovan bodies

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20
Q

When you see Hyponatremia whats the very next step you need to do?
What is the end point for HTS?

A

Assess whether this is hypo, Eu or hypervolemia - then look up the chart
Stop seizure or AMS and then NS infusion

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21
Q

Old lady with lots of stress, STEMI and trop +, cath - =?

A

Taksubo or stress cardiomyopathy

EF decreased that will improve

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22
Q

Otitis complications

A

Tympanic membrane perforation, mastoiditis, facial nerve palsy, osteomyelitis, labyrinthitis, sinus venous thrombosis, meningitis, extradural or subdural empyema, and brain abscess.

chronic otitis= choelstotoma

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23
Q

Lymes disease kids Tx

A

DOXYYYYY

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24
Q

Where does fluid go for hypovolemia

A

renal, GI, skin, third space

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25
Q

Recent sinutisits with Blurry vision/HA need to think

A

Cavernous sinus thrombosis
CN 6 palsy
Chemosis/eye infection

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26
Q

What is EPS and Tx

A

dystonia, parkinsonism, and akathisia.

anticholinergic

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27
Q

Radiation stuff

A

GI onvovlemnt means bad

48 hours after absolute lymph count prognosis

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28
Q

Acute limb ischemia tx?

A

heparin

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29
Q

Nail trephinoation indicaitons

contraindications

A

<48 hrs old (clots after this)
Painful
nail folds intact
trapped and not spontaneluosly draining

Nail bed innjury, infection, fx contraindicaiotns

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30
Q

Well circumscribed, painful, boggy, rash on top of AA head?

A

Kerion - tinea capitis

Oral griseolfulvin, hair loss alopecia

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31
Q

PJP PNA
When to give steroids?
Tx?

When id it not miliar TB?

A

paO2<70
Bactrim
elevated LDH

If very spotty on Xray then miliary- its spread by hemaotgenous and goes everywhere- watch out for hyponatremia

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32
Q

Explain actions taken for the DOPES?

A 
Attach ETco2 to verify tube
Put a suction catheter thru the tube 
US/CXR
Disconnect venitlator and BVM
Disconnect
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33
Q

what is peds seduosublux in c spine?

A

C2 anteroir displacement forward

Posterior arch of TP of C2 has t be less thean 2mm in line with C3

<8 yrs old

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34
Q

When can opiate withdrawal be life threatening?

A

Naoloxine induce catacholaime surge

Buprenoropine or methadone can be given- but do we?

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35
Q

ROmberg positive, no Patellar reflexes, neuropathy in feet, no vibrationin feet, finger-nose/fingertap intact =?

A

B12 - elevated homocysteine (terminal Ileum)
check MCV
GI upset and depression

dorsal column of psinal canal but cereballum is OK

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36
Q

Aoritc dissection

SBP goal
HR goal
after BB then it is…

A

100-120
60
Nitropussy after HR contorlled

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37
Q

Lunate dislocation
spilled or not?
capitate in line or not?

A

Spilled
capitate in line with radius

perilunate- LUnate is OKAY its the cpaitate that is out of line

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38
Q

Difference between
coccidiomycosis
leptpspirosis
hanta

A

Imuunocompromised- Lung and MSK stuff
Lepto- flu like then liver/kidney failure
hanta- flu like then cardiogenic shock

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39
Q

what 3 complications do you need to think about with ludwig angina beside airway?

A

Mediastinitis
Cranial extension
internal jugualr thrombosis

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40
Q 
Shock
cold-tachy-decreased preload
cold tachy increased preload
warm tachy decreased preload
warm, normal, decreased preload
A

hypovolemic
cardiogenic
septic
neurogenic -cord lvl T6 and above- no sypathtic tone- think about atorpine for unoppposed paraysmp

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41
Q

one pill kills

A

opiods liek buprenoprhine
CCB
sulfonnureas
class 1 a anti arrytmics

watch over night bc of loinghalf life (ntiro brady and hypotension is so hsort actig)

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42
Q

ranson criteria and why do we care

A 
mortality
age 55
ldh 350
ast 250
glucose 200
wbc 16
43
Q

class 1-4 vitals fo rhemorrhagic

A

normal
HR >100
BP decreased, big UOP drop (blood starts here to give)
AMS

44
Q

What is Stress fx
jones fx
pseudo jones?

A

mid shaft 5th (most distal)- hihg rates of maluniion?
Proximal 5th transverse fx
MOst proixmal- tip of 5th transverse fx

45
Q

post arrest stuff

A

32-36 cooling
glucose- no recs no improvmeent shown
aovid oxygen toxicity- keep between 94-100
GET EEG!

46
Q

seizures, lots of benzos then WGMA why?

A

benzos worsneing lactic acidosi bc of prolyene glycol

47
Q

of the Ps- what means later on in acute limb ischemia/.

A

Paresthesias and parlaysis - surgical

48
Q

roseola?

rubeola?

A

HHV6

CCCC paramyxovirus

49
Q

hypotension wiht ocncenr for spesis in PAH- reach for what early?

A

Pressors- cant tolerate ltos of lfuids!

50
Q

somatization vs hypochondriac

A

thinking it is real vs
worrying despite reassurance

factitipous is they want ot be the sick patient- malingering they ant somehtign out of it

51
Q

SAH CT head and Lumabr puncture

A

almost 100% within 6 hours
98% between 6-12 hours (still get LP if you suspect it)
91% at 24 hours and so on more time
get LP if you suspect it - deadly

Hunt Hess gradign scale
2-6% population has anyrsym

52
Q

Dig toxicity acute vs chronic

A

Bradycardia (same txs)
Ventriclar dyshrtmias
HyperK

give digfab

53
Q

give me all the MFing kawasakis now.

A

Red eyes
mucous membrane inovlement (even lips or pharynx)
hands/soles
gernalized plymrphous, non vesicular/bullae rash
cerfical LA
kids 1.5-4 years old most ocmmon

54
Q

syinrgmyelia vs central cord syndrom?

A

pain and temp is lost in cape like manner, light touch is fine- valsalva worsens it

light touch and motor is out for central cord

55
Q

ICH with elevated INR and BP- which first?

A

Vit K and PCC (reverses it minutes, goal 1.4 INR)
then BP

MOst common spot cerebellum (HTN penetrating arteries) then basal ganglia and then pons
Lobar old= amyloid
lobar young- More common for HTN? also AVM

56
Q

differnece in vit K, PCC, FFP

A

Vit K 4-6 hours intrinci clotting facotr for warfarin
FFP 13-24 hours - low irsk thormbosis-all clotting facotrs
CCP 3 factor 2,9,10 <15 mintues, superior
4 factor- 2,7,9,10, c s, <15 mimutes, has heparin in it tho

Cryo- 8,13,vwf,fibrinogen, fibronectin

57
Q

AAA stuff

A

constipation can be a symptos
bleeds tretoperitoneally! US wont catch that
<4 cm is very rare to rupture

58
Q 
LAcy rash on lower extremities 
nodules and palpable purpura
GI
Nueropthy
ORchitis and increased blood flow
Hep B or C
A

polyartetiris nodosa

Steroids

59
Q

Rash on hands + mechanic hands
Rash on face in nasolabial folds in malar region
proximal muscle weakness
elevated CK,LFTs

A

Dermatomyositis

ILD, occult malignancy
steroids and cancer screening

polymylagia rheumatica is jsut prox muscle and temp arteritis

60
Q

refeeding ysndrome

A

High insulin state so …
Hypophospahte = diaphragm/heart weakness
Hypo K
CHF/edema complications

61
Q

mutliple family members with headaches?

A

CO

62
Q

Painful submandular mass with mass near frenulum?Tx?

A

Silaolithiasis- tart candy and massage

63
Q

Monteggia Fx

A

PRox ulna Fx

Radial head dislocaiton

64
Q

big broad based wart vs small little ones

A

Syphilis LATA

Warts accuminata (Bryce accumululates this)

65
Q

HA, Fever, FND not meningitis

A

Brain empyema

66
Q

new a fib and lid lag?

A

Graves disease

67
Q

Recent sinusitis, proptosis, visual acuity -what test next?

A

MRI MRV for cavernous sinus thrombosis

vomtoning and corneal clouding is acute angle glaucoma

68
Q

Slowed speech, flat affect and leg defiicits in stoke is what artery?

A

ACA

MCA dominant is speech, contra motor and sensory. Non dominant think sensory then too to clue you in

69
Q

Meningitis Tx

A

Dex and then ABx

for edema

70
Q

kid, back pain, fever, radicualr symptoms

A

Discitis

ES high, WBC usually normal

71
Q

Risks of adverse events EHart socre 0-3

4-6?

A

1-1.7%

12-16%

72
Q

parklands

A

%xKgX4
first half in 8 hours
2nd half in the next 16 hours

73
Q

Burn center transfer

A

artial thickness burns > 10% TBSA; Burns involving the face, hands, feet, genitalia, perinuem, and/or major joints; Any full-thickness burn; High-voltage or electrical burns; Chemical burns; Inhalation injury

74
Q

Female Fever
HEadache myalgias
rash on palms, mouth

A

SSSS
check for tampon
>3 organ systems, shock, rash=SSSS
could be from an abscess too

75
Q

100.7 fever, phtophobia, mild neck stiffness, VS OK and appears well
CSF protein 80, HSV neg
the rest normal
DX and Tx

A

Viral meningitis (HSV, VZV, Ebstein BArr, Echo, arbovirus)
Still acyclovir
DC and follow up

76
Q

What is the inherent pacemaker rate of AV node?

A

40-60 Bpm

77
Q

severe cramping from a bite, waht is it?

A

Black widwo- neurotoxin- antivenin if severe

Brown reculsue is scytotoxin

78
Q

Sepsis stuff

A

Cx, Abx, 30 ml/kg, repeat LA if >2. LA necessay
Sepsis- uses SOFA score, need 2 organs (24 for organ failure), still use SIRS just to clue you in
Septic shock- need vasopressors

79
Q

Hemophilia 9 # of units needed ?

A

usually need a level 40-60 for most problems

Kg Xdesired % = units (9-1-1)

80
Q

Opiate withdraw meds

A

Clonidine 1.2 mg per day max
benzo diazepam 1-10 mg
Phenergan 25 mg- antihistamine,antichoniliergic
loperamide 4 mg, octreotide 50 mcg can be used to control diarrhea.
500 cc LR
4- 8 mg buprenoprphine or 10-20 mg methadone

81
Q

Young asian woman
fever, blurry vision, extremity pain, HTN
get what labs, and imaging?

A

ESR CRP, Aortic scan

takyaysu arteritis - Steroids , large vessel vascultisi

82
Q

Aspirin tixicity labs and Tx

A

Sodim Biacrb excretion=Acidosis
LAcitc acid and FA consumption- WGMA
Brain- hypervent= Resp Alkalosis

Na Bicarb drip and bolus

83
Q

Young guy with bakc stiffness better htoughtouh the day, what does X rya look like?

A

HYper white line ad the top of each vert body and then clacificaitonsin the middle of the bodies

84
Q

What i hemoerhrgic shcok index?

A

HR/SBP
>.7=shock

lethal triad in truama
met acidosis, hypothermia, coagulopathy

85
Q

How long does it take SJS and TENS and DRESS to devleop after a drug?

A

weeks, can be t cell type 4 hypersensitvity (doesnt always have to be type 3)

type 2 is ab mediated

86
Q

posterior LA, head to body rash—/

A

Rubella

self limited

87
Q

anemia and bilirbuin after a med?

A

G6PD

88
Q

bilateral painless LA after infection 1 week ago in kid =?

A

observe, normal

89
Q

teacup spilled=?

A

lunate dislocation

capitiate inline with radial head

90
Q

most sensitive for cauda equina?

A
  1. Urinary retention

2. urinary incontinence

91
Q

quick reminder, any question of nec fasc- be done and CT scan

A

Necrotizing soft tissue infections can progress at a rapid pace and quickly lead to bacteremia, sepsis, and death. Diagnosis is based on clinical assessment in conjunction with laboratory tests and imaging, if the picture is unclear. The clinician should not only rely on “hard” signs of necrotizing fasciitis, such as crepitus, skin necrosis, hypotension, or gas on a radiograph. Resuscitation and antibiotic therapy need to be initiated as quickly as possible

92
Q

quick hypoxia adter a successful intubation?

A

PTX or right mainstem

93
Q

HypoGlycemia DDx?

A 
ReExplaained!
renal
exogenuos/sulfonureas.SGLT2
liverpituitary sinfusficieny
ASA
infeciton
drugs
adrneal fialure
alcohol
94
Q

What is BRUE and what is low risk

A

<1 min, resolved bakc ot basleine

GA 32+ wks, >60 day sold, no CPR, no arrest, only 1 episode

95
Q 
HYperthermic treatments
Dantrolene?
tylenol?
ice baths?
Benzos?
A

not effective
may cause liver damage
you can use it, NO risk for cooling to fast.
use if they are shivering

96
Q

achilles tenodn rupture management

A

SPlint plantarflexion and follow up

97
Q

OImperfecta
osteomyleities
cellutlies over top of bone
fracutre tibia

Which of these is the baoslute NO NO for IO?

A

Fracutred Tibia! fluid out and ocmpartment syndrome and worse fracture

98
Q

Aortic enteirc fisutla

A

US is not helpful bc may be bleeding into the GI tract
GEt surgeyr on baord now
delayed fistual can happen after infecitons

99
Q

Hyponatreemia causes and management tree

A

VOlume up: cirrhosis, CHF, renal failure

Normal volume: SIADH/Water intoxication

Volume down: diruetics, vomtingn, sweating

we dotn get into the whole FENA thing

100
Q

When can you close a mammalian bite?

A

Face/Scalp, healthy person, and DOG

not extremities and cat/human

101
Q

Fever, RUQ pain, AMS, Hypo, Jaundice= Tx?

A

Abx on baord before anything else!

102
Q

What is high output Heart fialure, DDx?

A

Increased CO with low SVR
well-perfused extremities from peripheral vasodilation, tachycardia even at rest, a widened pulse pressure, a hyperdynamic precordium

obesity, arteriovenous fistulae, cirrhosis, widespread erythroderma, myeloproliferative disorders, hyperthyroidism, sepsis, beriberi, anemia, and chronic lung diseases

look for glossitis and recent bariatirc surgery for BeriEBri!

103
Q

joint pain in akids ogotta think..

A

OSteosarcoma

104
Q

Crotalid Symptoms and Tx

A

Tissue damage, coagulopthy, plaetlet dysfunction inhibition or activaiton

Analgesia, wound site elvation, Antivenin, tetanu

Rosh (14 decks)

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