Rosh questions Flashcards
“weakness with overhead activity”
rotator cuff tear
Supraspinatous movement
Abduction
infraspinatous movement
ER
teres minor movement
ER
subscapularis
IR
pain with reaching up back; brushing hair
rotator cuff tear
+ drop arm
rotator cuff
+ empty can test
rotator cuff
+ neer test
rotator cuff
+ hawkins
rotator cuff
Congenital cardiac malformation associated with maternal lithium use
Ebstein’s anomaly
stable SVT tx
vagal (valsalva, cold water) –> adenosine
unstable SVT
cardiovert
Pounding pulses with machine like murmur
PDA
PDA radiates to?
back
What do you use to close a PDA?
indomethicin
back pain better with flexion, worse with extension?
spinal stenosis
pneumothorax: tactile fremitus
decresed
pneumothorax: resonance
hyper-resonance
in a tension pneumothorax the trachea deviates?
away from affected side
what is the most commonly damaged intra-abdominal structure in blunt abdominal trauma?
spleen
What do you do if you have a positive FAST exam?
CT scan
unstable + negative FAST?
repeat fast or DPL
unstable + positive FAST?
laparotomy
gold standard for management of intra-abdominal bleeding following trauma?
lapartotomy
what is the active ingredient in anti-freeze?
ethylene glycol
anti-freeze/ethylene glycol OD CM?
early: N/V, CNS depression
Late: anion gap metabolic acidosis, hypocalcemia, kidney failure, maltese crosses
antidote for anti-freeze/ethylene glycol OD?
fomepizole
MCC of anterior knee dislocation?
MVA
Knee instability in multiple directions?
anterior knee/tibiofemoral dislocation
Tx of anterior knee dislocation
immediately reduced
Likely structures damaged in anterior knee dislocation?
common peroneal nerve; popliteal artery
When is reduction CI in knee dislocation?
“dimple sign” which indicates posterolateral dislocation
Posterolateral knee dislocation tx
immediate open reduction
MCC of atlanto-occipital dislocation?
high-speed MVA
MC population for atlanto-occipital dislocation?
children
closure of PDA begins when what increases in the immediate post-natal period?
bradykinin
HCM inheritance pattern?
AD
crescendo-decrescendo pattern loudest over LLSB
HCM
ECG of HCM?
LV hypertrophy, prominent septal Q waves
Tx of HCM?
avoid activity, BB
MC presenting symptom of HCM?
dyspnea on exertion
MCC of SCD in young athletes
HCM
Heat stroke body temp
> 104 F
heat stroke symptoms
AMS, organ damage, anhidrosis
Tx heat stroke
whole body cooling and IV fluids
heat exhuastion temp
100-103
heat exhuastion symptoms
dehydration, N/V, weakness
heat exhaustion tx
fans, oral water
heat cramps symptoms
muscle cramping of calves/abdomen
heat cramps tx
oral water
lead poisoning can present like?
microcytic anemia
Basophilic stippling of RBC with GI/CNS symptoms
lead poisoning
tx for lead poisoning
succimer (sucs to eat lead)
What type of bursitis occurs commonly in runners?
pes anserinus
what muscles insert at pes anserinus?
gracillis, sartorius, and semitendinosus
anterior medial knee pain below joint like and TTP over bursa
pes anserinus
benzo antidote
flumazenil
APAP antidote
N-acetylcysteine
opioid antidote
naloxone
WPW (narrow) stable tx
1) vagal
2) adenosine
unstable WPW (narrow) tx
synchronized cardiovert
antidromic (wide complex) tx
procainamide
WPW in pregnancy tx
sotalol or flecainide
myocarditis can result in what type of cardiomyopathy?
dilated
gold standard for diagnosing myocarditis
endomyocardial biopsy
first line meds for prevention/tx of OA
bisphosphonates (alendronate, ibandronate, risedronate, zoledronic acid)
iron is directly corrosive to?
GI mucosa
When should you get serum levels of iron OD?
4 hours after ingestion
Brugada syndrome is assoc with what arrythmia?
V. fib
MC arrythmia associated with TCA tox
sinus tach
pupils in TCA OD?
mydriasis
TCAs result in what toxic syndrome?
anticholinergic
antidote for TCAs?
sodium bicarb
Scleroderma: crest syndrome?
calcinosis, raynaud’s, esophageal dysmotility, sclerodactyly, telangiectasias
ductal-dependent cardiac lesion
coarctation of the aorta
Temporal arteritis tx?
no vision loss: prednisone
Vision loss: methylprednisolone IV
anterior/posterior fat pad in adults?
radial head fx
anterior/posterior fat pad in kids?
supracondylar fx
Increased ventricular chamger with normal or reduced wall thickness
dilated cardiomyopathy
Only BB proven in HF
bisoprolol, carvedilol, metoprolol
MC cardiomyopathy
dilated
what types of bites should close by secondary intention?
animal bites on hands and feet
MC long bone fx
tibia
MC cancers presenting as spinal cord compression
lung, prostate, breast
when should you think spinal cord compression?
LBP + history of CA
What tool is used with APAP toxicity?
Rumack-Matthew Nomogram
When is Rumack-Matthew Nomogram used?
4 hours after APAP toxicity
If after 8 hours of ingestion of APAP?
give 140 mg/kg loading dose N-acetylcysteine
SE of NAC?
anaphylactoid rx
How many steps in Ottawa ankle rules?
4 steps
How many cm in Ottawa ankle rules?
distal 6 cm
Burn with no blisters
1st degree
burn with blisters
superficial partial thickness (2nd degree)
burn that is white, leathery, and painless
deep partial thickness (second degree)
full-thickness = what degree?
third
parkland formula:
4 mL/kg x % total BSA
50% in first 8 hours, remainder over 16 hours
Bilateral facet dislocation occurs with what MOI?
hyperflexion of neck
What med should be considered in patients with chronic stable angina who remain symptomatic despite optimal agents of BB, CCB, nitrates?
ranolazine
First line tx of tension pneumo
thoracostomy at 2nd ICS and midclavicular line with chest tube placement
Tx to remove fluid from pleural space?
thoracocentesis
How many doses is human rabies immunoglobulin?
one dose
How many doses is the inactivated rabies vaccine?
4x over 14 d
Not-previously vaccinated w/ rabies exposure
RIG 10 U/kg infiltrate wound
Vaccine 1 mL IM delt day 0, 3, 7, 14
Previously vaccinated w/ rabies exposure
RIG not indicated
Vaccine 1 mL IM delt day 0, 3
MC congenital heart disease
VSD
What rabies treatment is never given alone?
human rabies immunoglobin
AMS CM?
HA + GI upset, weakness, fatigue, dizzy, lightheadedness, insomnia
AMS tx?
stop ascent, supportive care (APAP, ibuprofen)
-Acetazolamide, oxygen
High altitude cerebal edema?
ataxia, confusion, AMS
high altitude cerebral edema tx?
immediate descent
Cyanotic congenital heart diseases start wtih what letter?
T
Common spinal fx in football?
Jeferson fx
Acute SCFE CM?
ER deformity, limited ROM at hip, inability to bear weight
chronic SCFEE CM?
dull, achy pain in hip, groin, thigh, or knee
OD on BB tx?
atropine
What cholesterol med can exacerbate gout?
Niacin
Calcaneal apophysiitis?
Sever disease
apophysitis of tuberosicty of 5th metatarsal
Islen’s
Salicilate toxicity (ASA) acid/base
metabolic acidosis and respiratory alkalosis
OD with v/d, fever, tinnitus, and vertigo
ASA/salicylate
antedote for salicilate toxicity (ASA)
sodium bicarb
Organophosphate toxicity results in what toxidrome?
cholinergic
cholinergic mneumonic
SLUDGE: salivation, lacrimation, urination, diarrhea, GI cramps, emesis
DUMBBELLS: diarrhea, urination, MIOSIS, brady, bronchospasm, emesis, lacrimation, lethargy, salivation/seizure
organophosphate treatment
1) decontamination
2) atropine
- pralidoxime is definitive antidote
proximal humerus fracture tx
immobilization
common n injured in proximal humerus fracture
axillary
Acetaminophen toxicity stages
I: <24 hours; anorexia N/V
II: 1-3 d; transaminitis, increased INR, increased bilirubin, RUQ pain
III: 3-4 d: multiorgan failure, coma, death
IV: 4d-2 weeks: resolution
Hyphema categories:
I: <1/3
II: 1/3 - 1/2
III: >1/2
IV: total anterior chamber volume
What EKG findings show concern for left main coronary artery?
ST elevation in aVR >1 mm or greater than the elevation seen in the ST segement of V1
PCI contact to device time
90 minutes
Non-PCI center: transfer if contact to device can be less than?
120 minutes
non-PCI center: thrombolytics if contact to device >
120 minutes
thrombolytics in x minutes of ED arrival, if selected
30 minutes
Meperidine eyes?
causes miosis, but in cases of toxicity, unlike other opioids, causes mydriasis in cases of toxicity
Hematoma more likely to be associated with concurrent brain injury and parenchymal damage?
subdural hematoma
