Rosh review 1 Flashcards
Whats the dose of propofol for procedural sedation
0.5 to 1 mg/kg
Treatment for Corneal abrasion?
Topical Abx:
- Erythromycin ointment
- Cipro drops
- Contact lenses = need tx for Psudomonas
Classic phys exam finding associated with Endophthalmitis?
Hypopyon
Induction agent of choice for RSI of severe asthma exac
Ketamine
Mechnical vent settings for Asthma patient?
Objective = maximize expiratory time
- Low RR
- High insp flow rate
- maintain plateau press > 30
- Permissive hypercapnia to avoid breath stacking
Neonatal fever: what is fluid admin. rate and what is antibiotic choice?
- 20 mL/Kg
- Ampicillin and Cefotxime (consider Acyclovir)
Suspected Meningitis in pt >65 years old, what should antibiotic choice be?
- Ampicillin (Listeria)
- Ceftriaxone
- Vancomycin
What is normal Retropharyngeal space width in children on Lateral plain film?
-
What is initial therapy for HIV patient with PNA in whom you expect a low CD4 count ?
Cover PCP, especially if hypoxic
- Azithro
- Ceftriaxone
- Bactrim
- +/- Prednisone (PaO2 35 mm/Hg)
*Alternative PCP treatment = Pentamidine
Initial tx of ITP?
- Prednisone + IVIG
* Platelets only if life-threatening hemorrhage
Clinical/lab features of TTP?
- Fever
- Microangiopathic hemolytic anemia
- Thrombocytopenia
- MS changes
- Renal failure
*Tx = Plasmapheresis
Tx of Thyroid storm 2/2 exogenous thyroid consumption?
- Beta blocker (propanolol)
- Dexamethasone (blocks periph conversion of T4 to T3)
Tx of endogenous thyroid storm?
- BB
- Dexamethasone
- PTU or methimazole (blocks thyroid hormone production)
- Potassium-Iodide (blocks release from gland)
*PTU should be given at least 1 hr prior to K-I, otherwise K-I can cause incr hormone production by gland
Jones criteria for Dx of Acute Rheumatic fever?
Major criteria:
- Carditis (including valve)
- Polyarthritis
- Chorea
- Subq nodules
- Erythema marginatum
Minor criteria:
- Fever
- Arthralgia
- Elevated ESR or CRP
- Prolonged PR interval on EKG
*Need 2 major, or 1 major + 2 minor
What can cause exaggerated, super deep inverted T waves on EKG with QT prolongation ?
-Cerebral T waves
Casued by incr ICP from ICH, SAH, etc
For WPW pt….Give _____ drug ______ mg IV
Procainamide
100 mg
Tx for HF acid exposure?
- Ca-gluconate (topical + IV)
* Fluoride bind calcium and Mg avidly, decr calcium in blood –> Dysrhythmias
What are the 5 major classes of QT prolonging drugs?
antidysrhythmics
nonsedating antihistamines, macrolide antibiotics, antidepressants, and antipsychotics.
Management of decompression illness? (4 things)
- 100% O2
- IV fluids
- Aspirin
- hyperbaric chamber
What lab value can be abnormal in HIV pts with PCP PNA?
Incr LDH
EKG differentiating factors in TCA overdose vs other anticholinergic overdose?
TCA:
- QRS prolongation
- Terminal R wave in AvR (big R wave…R:S ration >0.7)
When does Ibuprofen toxicity occur following ingestion?
typically within 4 hours, and typically mild stuff. Always check a tylenol level too
Diagnosis in a child 3-6ish, who had recent URI which turned into suddenly worsening High fever, stridor, cough, toxic appearance?
Organism?
Management?
- Bacterial tracheitis (like croup but bacterial, more toxic appearing)
- Staph Aureus
- IV Abx, fluids, OR intubation
Tx of Meniere’s dz?
Thiazide diuretic
-inhibits Na rab in distal tubule
What vital sign abnormality might you expect in ruptured ectopic, but can be absent? And why?
- Tachycardia.
- Pts can have a reflex Bradycardia 2/2 vagal nerve irritation in peritoneal cavity
How is pH affected by cooling in pt’s with arrest?
Decreases (falsely)
Which factor is deficient in Hemophilia A?
Factor 8
-use recombinant factor 8, cryoprecipitate, or FFP
Serotonin syndrome Clinical presentation:
- MS changes
- Agitation, pressured speech - Autonomic instability
- Tachy, diarrhea, sweating, mydriasis, shivering - Neuromusc. abnormalities:
- Clonus, Hyperreflexia (lower>upper), tremor, seizure
Serotonin synd tx?
- Benzos
- Hydration + cooling
- Cyproheptadine
Mnemonic and list of unstable C-spine fractures/dislocations?
-Jefferson Bit Off a Hangman’s thumb.
- Jefferson burst fracture
- bilateral facet dislocation
- Odontoid type 2 and type 3 fractures
- Hangman’s fracture (any fracture involving dislocation)
What are the five NEXUS criteria for clinically clearing the cervical spine?
- No focal neurologic deficits -normal alertness
- no evidence of intoxication –no distracting injuries
- no posterior midline cervical tenderness.
Dangerous effect of inhaled hydrocarbons? treatment?
Cardiac sensitization –> inciting event causing catecholamin surge –> Incr sensitivity with catechol –> dysrhythmia
Tx = Beta blockers
In anaphylaxis, what is the Epi dose for mild symptoms in adults vs children?
What’s the dose for severe symptoms in adults vs children?
Mild:
- Adults: 0.3 to 0.5 mL 1:1000 solution IM q15 minutes
- Children: 0.01 mL/kg 1:1000 solution IM q15 minutes
Severe:
- Adults: 1-5 mL 1:10,000 solution IV over 10 minutes
- Children: 0.01 mL/kg 1:10,000 solution IV prn
What are characteristics of complex febrile seizures?
- multiple seizures during same febrile illness
- prolonged seizures (>15 minutes)
- Focal component of seizures
*simple febrile seizures are generalized
Treatment of choice in Acute otitis media?
-Amoxicillin 90 mg/kg per day divided into 2–3 doses for 10 days (high-dose amoxicillin)
Treatment (including duration) for bacterial prostatitis?
4-6 week course of oral ciprofloxacin or trimethoprim-sulfamethoxazole
If systemic infection, unstable, etc –> admit
What is the dosing of alteplase for massive pulmonary embolism?
100 mg IV over 2 hours
What are treatment options for stable V-tach?
- Amiodarone
- Procainamide
- Lidocaine
What small bowel diameter on radiographs indicates small bowel dilatation?
3 cm or more.
Why do you not want to give NSAIDs to a transplant patient on Cyclosporine?
-It can worsen or precipitate renal failure since cyclosporine already causes renal damage on its own
What is the recommended energy level for pediatric cardioversion?
0.5-1 J/kg.
What are clinical features of Coarctation of aorta?
- CHF possible
- HTN
- Bounding pulses in UE, weak in LE
- Rib notching on CXR
Treatment of Tylenol tox with NAC needs to be initiated within ______ hours of ingestion
8
Describe the phases of tylenol toxicity
1 - < 24 hrs. Vague, anorexia, N/V
2- 1 to 3 days. Transaminitis, elev INR, incr Bili, RUQ pain
3 - 3 to 4 days. Fulm hep failure, multiorgan failure
Name 2 potential US findings with ovarian torsion (not including decr/absent flow)
- Ovarian enlargement
- Peripherally displaced follicles
Which classes of Abx are most commonly assoc with C diff?
Lincosamides (clinda) , Cephalosporins, Fluoroquinolones
A bradycardic patient who fails to respond to Atropine can get ______ or _____?
Epinephrine or Dopamine
What are some EKG findings assoc. with Hypokalemia?
- QT prolongation
- Incr amplitude and widening of P wave
- Flattened or inverted T waves
- U waves ** (upward deflection following T wave)
What are some digitalis effects on EKG?
- Downward sloping ST segments
- Flattened, inverted, or biphasic T waves
- Shortened QT segment
What are the EKG findings assoc with Brugada syndrome?
- Incomplete RBBB
- ST segment elev in leads V1 thru V3
What nerve is commonly injured in knee dislocations?
Peroneal nerve (common fibular)
When an Rh negative mom miscarries….administer _____ug of rhoGam within _____ hours
- 300
- 72
*this is true even if she’s received Rhogam with previous pregnancies
What are some drugs you can give to lower IOP?
- topical BB (Timolol)
- Topical alpha agonists
- Carbonic anhydrase inhibitors (Acetazolamide po, IV, topical)
- IV mannitol
**In sickle cell pts with hyphema which can cause incr IOP, dont give acetazolamide bc it can incr sickling
First line Abx for pts with post-partum endometritis?
**2-3 days post c-section, fever, abd/pelv pain, foul smelling discharge, incr WBC
-Clinda + Gentamycin
how much pRBC should a child get if they have already been fluid resucitated with NS?
-10 mL/Kg
What is the formula for calculating the minimum systolic blood pressure in a child?
Minimum SBP = 70 + (2 x age in years).
Which antibiotic should be prescribed to cover marine bacteria in seawater-associated wounds?
A third-generation cephalosporin or fluoroquinolone to cover Vibrio species
Patient presenting with the following CVA Sx:
- Vertigo
- ipsilateral Horner’s
- ipsilateral facial numbness
- contralateral trunk and limb sensory loss
- Bulbar symptoms
What area is infarcted?
What artery?
Name of this syndrome?
- Lateral Medulla
- Vertebral artery
- Wallenberg syndrome
Patient presents with stroke symptoms that include coma, quadriplegia, “locked in syndrome”
What artery was occluded?
Basilar Artery
Patient presents with stroke symptoms that include:
- Aphasia or neglect
- homonymous hemianopsia contralateral
- Contralateral focal deficits to extremities worse in upper
What artery is occluded?
MCA
