Rosh PGY-2 deuce Flashcards
Open fx abx recs for
Grade 1/2 (>1 cm with extensive soft tissue damage)
Gade3+
Ancef
Ancef + gentamycin
NPH tx and expectations from tx
Normal opening pressure
large olume
better symptoms after LP
Scloderma crisis things to look out for and Tx
- HTN - give captoprol or CCB
- AKI- BP control or dialysis/ lytes
- dysrthmias, cardiomyopathy
- PAH
Post flu infeciton in the lung causes…
Antrhax causes ___ on CXR
Caviatry lesion form MRSA
widened mediatinum and LA
what is tyhplitis?
Inflammation of cecum in innumosuppressed (chemo)
life threatenening
abd + flu like ysmtpoms
Fever, pulsatile mass in groin, acute limb sichemia signs =
Mycotic anysursym
Abx and surgery
IVDA, recent cath, reent infection,
septic emboli causing anuyrsm, thrombsis of it
blunt abd trauma in 27 wk female needs what 3 thigns?
300 mcg rhogam
4 hours minimum obs
betke-kleinhaur test to evlaute further
contraindicaitons ot ecahromtoies?
pretty much nothing- do it. unless estbalished gangrene already
not even hihg INR or low plateletes
What do you need to Dx PID and tx?
Abd pain + cervical,uterine,adenxal tenernss.
Helpful if: fever, ESR, discharge, STD present
CFTX 1X, doxy 2 wks and metronidaxzole 2 wks
TCA OD recetrs it acts on?
Gaba>seizures Anticholinergics Alpha1> hypotension sodium > QRS wide anithistamine>sedation
Chronic cough
oculur involvement
weird rash/skin or purple liek rash aorund face
DX TX
Sarcoid
Get CXR, lytes
Steroids
watch out for CHF and neuropathies
symptoms and Tx of hypercalcemia?
what lvl dalysis?
Bone breaks, keidney stones, psych, abd pain
IVF, maybe steroids of bisphospos
18
albuterol tx
BIOMES Beta Ipra Ocygen Mag Epi (erbuatline) Steroids (dexmaehtaosin, shorter and less NV)
caustic ingestion approach
caustic to skin liek wet cement?
decontaminate airway suportive care diagonose complicaitons (CXR or scope) surgery/admit
LOTS of irrigation, injury may hapen hours after event -alkali up to 12
6 weeks after acute hpatitis ____ can happen
aplastic anemia
old, AMS, Dm2, urinary Fq gotta also think about?
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
Metabolic alkoslis symptoms
Lytes derangments because of it
5 main causes
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
Painless penile ulcer and unilateral painless LA- DX and TX
Chlamydia trach
Lymph venerum
Doxy
Remember: bilateral, painful is ducriey or chancoird - Azitrho
beffy red ulcer near penis and painful
Klebsiella - DoXY - Granuloma Inguinale
Donovan bodies
When you see Hyponatremia whats the very next step you need to do?
What is the end point for HTS?
Assess whether this is hypo, Eu or hypervolemia - then look up the chart
Stop seizure or AMS and then NS infusion
Old lady with lots of stress, STEMI and trop +, cath - =?
Taksubo or stress cardiomyopathy
EF decreased that will improve
Otitis complications
Tympanic membrane perforation, mastoiditis, facial nerve palsy, osteomyelitis, labyrinthitis, sinus venous thrombosis, meningitis, extradural or subdural empyema, and brain abscess.
chronic otitis= choelstotoma
Lymes disease kids Tx
DOXYYYYY
Where does fluid go for hypovolemia
renal, GI, skin, third space
Recent sinutisits with Blurry vision/HA need to think
Cavernous sinus thrombosis
CN 6 palsy
Chemosis/eye infection
What is EPS and Tx
dystonia, parkinsonism, and akathisia.
anticholinergic
Radiation stuff
GI onvovlemnt means bad
48 hours after absolute lymph count prognosis
Acute limb ischemia tx?
heparin
Nail trephinoation indicaitons
contraindications
<48 hrs old (clots after this)
Painful
nail folds intact
trapped and not spontaneluosly draining
Nail bed innjury, infection, fx contraindicaiotns
Well circumscribed, painful, boggy, rash on top of AA head?
Kerion - tinea capitis
Oral griseolfulvin, hair loss alopecia
PJP PNA
When to give steroids?
Tx?
When id it not miliar TB?
paO2<70
Bactrim
elevated LDH
If very spotty on Xray then miliary- its spread by hemaotgenous and goes everywhere- watch out for hyponatremia
Explain actions taken for the DOPES?
Attach ETco2 to verify tube Put a suction catheter thru the tube US/CXR Disconnect venitlator and BVM Disconnect
what is peds seduosublux in c spine?
C2 anteroir displacement forward
Posterior arch of TP of C2 has t be less thean 2mm in line with C3
<8 yrs old
When can opiate withdrawal be life threatening?
Naoloxine induce catacholaime surge
Buprenoropine or methadone can be given- but do we?
ROmberg positive, no Patellar reflexes, neuropathy in feet, no vibrationin feet, finger-nose/fingertap intact =?
B12 - elevated homocysteine (terminal Ileum)
check MCV
GI upset and depression
dorsal column of psinal canal but cereballum is OK
Aoritc dissection
SBP goal
HR goal
after BB then it is…
100-120
60
Nitropussy after HR contorlled
Lunate dislocation
spilled or not?
capitate in line or not?
Spilled
capitate in line with radius
perilunate- LUnate is OKAY its the cpaitate that is out of line
Difference between
coccidiomycosis
leptpspirosis
hanta
Imuunocompromised- Lung and MSK stuff
Lepto- flu like then liver/kidney failure
hanta- flu like then cardiogenic shock
what 3 complications do you need to think about with ludwig angina beside airway?
Mediastinitis
Cranial extension
internal jugualr thrombosis
Shock cold-tachy-decreased preload cold tachy increased preload warm tachy decreased preload warm, normal, decreased preload
hypovolemic
cardiogenic
septic
neurogenic -cord lvl T6 and above- no sypathtic tone- think about atorpine for unoppposed paraysmp
one pill kills
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)
ranson criteria and why do we care
mortality age 55 ldh 350 ast 250 glucose 200 wbc 16
class 1-4 vitals fo rhemorrhagic
normal
HR >100
BP decreased, big UOP drop (blood starts here to give)
AMS
What is Stress fx
jones fx
pseudo jones?
mid shaft 5th (most distal)- hihg rates of maluniion?
Proximal 5th transverse fx
MOst proixmal- tip of 5th transverse fx
post arrest stuff
32-36 cooling
glucose- no recs no improvmeent shown
aovid oxygen toxicity- keep between 94-100
GET EEG!
seizures, lots of benzos then WGMA why?
benzos worsneing lactic acidosi bc of prolyene glycol
of the Ps- what means later on in acute limb ischemia/.
Paresthesias and parlaysis - surgical
roseola?
rubeola?
HHV6
CCCC paramyxovirus
hypotension wiht ocncenr for spesis in PAH- reach for what early?
Pressors- cant tolerate ltos of lfuids!
somatization vs hypochondriac
thinking it is real vs
worrying despite reassurance
factitipous is they want ot be the sick patient- malingering they ant somehtign out of it
SAH CT head and Lumabr puncture
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
Dig toxicity acute vs chronic
Bradycardia (same txs)
Ventriclar dyshrtmias
HyperK
give digfab
give me all the MFing kawasakis now.
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
syinrgmyelia vs central cord syndrom?
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
ICH with elevated INR and BP- which first?
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
differnece in vit K, PCC, FFP
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
AAA stuff
constipation can be a symptos
bleeds tretoperitoneally! US wont catch that
<4 cm is very rare to rupture
LAcy rash on lower extremities nodules and palpable purpura GI Nueropthy ORchitis and increased blood flow Hep B or C
polyartetiris nodosa
Steroids
Rash on hands + mechanic hands
Rash on face in nasolabial folds in malar region
proximal muscle weakness
elevated CK,LFTs
Dermatomyositis
ILD, occult malignancy
steroids and cancer screening
polymylagia rheumatica is jsut prox muscle and temp arteritis
refeeding ysndrome
High insulin state so …
Hypophospahte = diaphragm/heart weakness
Hypo K
CHF/edema complications
mutliple family members with headaches?
CO
Painful submandular mass with mass near frenulum?Tx?
Silaolithiasis- tart candy and massage
Monteggia Fx
PRox ulna Fx
Radial head dislocaiton
big broad based wart vs small little ones
Syphilis LATA
Warts accuminata (Bryce accumululates this)
HA, Fever, FND not meningitis
Brain empyema
new a fib and lid lag?
Graves disease
Recent sinusitis, proptosis, visual acuity -what test next?
MRI MRV for cavernous sinus thrombosis
vomtoning and corneal clouding is acute angle glaucoma
Slowed speech, flat affect and leg defiicits in stoke is what artery?
ACA
MCA dominant is speech, contra motor and sensory. Non dominant think sensory then too to clue you in
Meningitis Tx
Dex and then ABx
for edema
kid, back pain, fever, radicualr symptoms
Discitis
ES high, WBC usually normal
Risks of adverse events EHart socre 0-3
4-6?
1-1.7%
12-16%
parklands
%xKgX4
first half in 8 hours
2nd half in the next 16 hours
Burn center transfer
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
Female Fever
HEadache myalgias
rash on palms, mouth
SSSS
check for tampon
>3 organ systems, shock, rash=SSSS
could be from an abscess too
100.7 fever, phtophobia, mild neck stiffness, VS OK and appears well
CSF protein 80, HSV neg
the rest normal
DX and Tx
Viral meningitis (HSV, VZV, Ebstein BArr, Echo, arbovirus)
Still acyclovir
DC and follow up
What is the inherent pacemaker rate of AV node?
40-60 Bpm
severe cramping from a bite, waht is it?
Black widwo- neurotoxin- antivenin if severe
Brown reculsue is scytotoxin
Sepsis stuff
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
Hemophilia 9 # of units needed ?
usually need a level 40-60 for most problems
Kg Xdesired % = units (9-1-1)
Opiate withdraw meds
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
Young asian woman
fever, blurry vision, extremity pain, HTN
get what labs, and imaging?
ESR CRP, Aortic scan
takyaysu arteritis - Steroids , large vessel vascultisi
Aspirin tixicity labs and Tx
Sodim Biacrb excretion=Acidosis
LAcitc acid and FA consumption- WGMA
Brain- hypervent= Resp Alkalosis
Na Bicarb drip and bolus
Young guy with bakc stiffness better htoughtouh the day, what does X rya look like?
HYper white line ad the top of each vert body and then clacificaitonsin the middle of the bodies
What i hemoerhrgic shcok index?
HR/SBP
>.7=shock
lethal triad in truama
met acidosis, hypothermia, coagulopathy
How long does it take SJS and TENS and DRESS to devleop after a drug?
weeks, can be t cell type 4 hypersensitvity (doesnt always have to be type 3)
type 2 is ab mediated
posterior LA, head to body rash—/
Rubella
self limited
anemia and bilirbuin after a med?
G6PD
bilateral painless LA after infection 1 week ago in kid =?
observe, normal
teacup spilled=?
lunate dislocation
capitiate inline with radial head
most sensitive for cauda equina?
- Urinary retention
2. urinary incontinence
quick reminder, any question of nec fasc- be done and CT scan
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
quick hypoxia adter a successful intubation?
PTX or right mainstem
HypoGlycemia DDx?
ReExplaained! renal exogenuos/sulfonureas.SGLT2 liverpituitary sinfusficieny ASA infeciton drugs adrneal fialure alcohol
What is BRUE and what is low risk
<1 min, resolved bakc ot basleine
GA 32+ wks, >60 day sold, no CPR, no arrest, only 1 episode
HYperthermic treatments Dantrolene? tylenol? ice baths? Benzos?
not effective
may cause liver damage
you can use it, NO risk for cooling to fast.
use if they are shivering
achilles tenodn rupture management
SPlint plantarflexion and follow up
OImperfecta
osteomyleities
cellutlies over top of bone
fracutre tibia
Which of these is the baoslute NO NO for IO?
Fracutred Tibia! fluid out and ocmpartment syndrome and worse fracture
Aortic enteirc fisutla
US is not helpful bc may be bleeding into the GI tract
GEt surgeyr on baord now
delayed fistual can happen after infecitons
Hyponatreemia causes and management tree
VOlume up: cirrhosis, CHF, renal failure
Normal volume: SIADH/Water intoxication
Volume down: diruetics, vomtingn, sweating
we dotn get into the whole FENA thing
When can you close a mammalian bite?
Face/Scalp, healthy person, and DOG
not extremities and cat/human
Fever, RUQ pain, AMS, Hypo, Jaundice= Tx?
Abx on baord before anything else!
What is high output Heart fialure, DDx?
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!
joint pain in akids ogotta think..
OSteosarcoma
Crotalid Symptoms and Tx
Tissue damage, coagulopthy, plaetlet dysfunction inhibition or activaiton
Analgesia, wound site elvation, Antivenin, tetanu
