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PGY2 > Rosh Review > Flashcards

Rosh Review Flashcards

1
Q

encapsulated bugs

A

SHiN SKiS:
Strep pneumo, H.ib, neisseria meningitidis (NOT GONO), ecoli
Klebsiella, salmonella, and GBS

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2
Q

charcot triad

A

fever, abdominal pain, and jaundice

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3
Q

reynolds pentad

A

fever, abdominal pain, jaundice, confusion, hypotension

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4
Q

MCC of biliary obstruction

A

stones, stenosis (primary biliary sclerosis,), or malignancy

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5
Q

Dx cholangitis

A

RUQ US, CT, ERCP

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6
Q

TX acute cholangitis

A

Zosyn and ERCP; fluids

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7
Q

what is this

A

Boerhaave syndrome

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8
Q

Diagnosis Boerhaave Syndrome

A

CXR, Contrast esophagram, CT

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9
Q

TX Boerhaave

A

supportive, NPO, Abx (Zosyn), surgical consultation

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10
Q

US findings of cholecystitis

A

GB wall thickening (>3mm), pericholecystic fluid, sono murphy sign, cholethiasis

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11
Q
A

CHOLECYSTITS

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12
Q

MC surgical emergency in patients >65 yo

A

acute cholecystitis

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13
Q

Boas sign

A

hyperaesthesia, increased sensitivity, or altered below R scapula

for cholecystitis

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14
Q

gold standard diagnostic for cholecystitis

A

HIDA

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15
Q

cirrhosis + variceal bleed; what do you give to improve mortality

A

rocephin

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16
Q

Vasoactive drugs for esophageal variceal bleed

A

octreotide, vasopressin (reduces portal pressure), beta blocker

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17
Q

alkali ingestion type of necrosis

A

liquefactive

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18
Q

acid ingestion necrosis

A

coagulation necrosis

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19
Q

liquefactive necrosis can lead to

A

perforation, mediastinitis, peritonitis, and resp distress, shock

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20
Q

TX caustic ingestion

A
  1. decontamination - irrigation vs lavage
  2. dilution (first 30 mins)
  3. NPO
  4. airway
    5.IV PPI or H2 blocker
  5. if suspect mediastinitis or peritonitis - abx
  6. GI and surgical consult
    ***endoscopy must be performed within 12 hours and not > 24hr
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21
Q

veins that are bleeding in the setting of splenic vein thrombosis

A

short gastric veins

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22
Q

TX for CMV esophagitis

A

Ganciclovir

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23
Q

CMV CD4 count

A

<50

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24
Q

forceful retching

A

mallory weiss syndrome

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25
Q

TX mallory weiss

A

supportive (Zofran), endoscopy (active bleed), acid suppression - PPI (not active bleed)

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26
Q

pathology of mallory weiss

A

intramural dissection (longitudinal mucosal lacerations)

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27
Q

TX of esophageal candidiasis

A

Fluconazole x 14-21 days for

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28
Q

CD 4 count for esophageal candidiasis

A

<100

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29
Q

MC location of obstruction of swallowed foreign bodies in peds

A

C6; cricopharyngeus muscles (UES)

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30
Q

where is the coin located

A

esophagus

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31
Q

where is the coin located

A

trachea

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32
Q

GER vs GERD (peds)

A

GER = normal physiological process; GERD = weight loss, anorexia, dysphagia, sleep disturbance, resp sx

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33
Q

Tx GER

A

smaller more frequent feeds; formula change, thickened feeds, and positioning

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34
Q

what position decreases reflux symptoms in kids

A

prone

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35
Q

causes of splenic infarction

A

1.infection - EBV, CMV, malaira, babesiosis
2. clotting - factor V
3. cancer
4. thromboembolism - afib, endocarditis, PFO
5. vasculitis

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36
Q

mesenteric ischemia artery

A

sma

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37
Q

splenic artery originates from

A

celiac trunk

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38
Q
A

splenic infarct

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39
Q

Tx splenic infarcts

A

supportive & AC (heparin)

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40
Q

lifestyle RFs for GERD

A

chocolate, caffeine, etoh, and nicotine

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41
Q

Causes of tracheomalacia

A
  1. congenital
  2. complication of esophageal atresia repair or tracheoesophageal fistula
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42
Q

S/Sx of tracheomalacia

A

expiratory stridor, brassy/barking cough
**severe biphasic stridor, dyspnea with feeding

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43
Q

dx tracheomalacia

A

water soluble swallow study

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44
Q
A

achalasia

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45
Q

S/Sx of achalasia

A

dysphagia to solids and liquids, difficulty belching, CP, regurg of undigested food

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46
Q

dx achalasia

A

esophageal manometry

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47
Q

TX achalasia

A

pneumatic dilation, surgical myotomy, botulinum injection

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48
Q

VACTERL

A

vertebral anomalies
anal atresia
cardiac anomalies
tracheoesophageal fistula
esophageal atresia
renal abnorms
limbs anomalies

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49
Q

resistance with NG tube placment

A

tracheoesophageal fistula

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50
Q

Dx tracheoesophageal fistula

A

Upper GI series with contrast, endoscopy with bronchoscopy, chest CT

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51
Q

H.Pylori treatment

A

triple: omeprazole, clarithromycin, and amoxicillin or flagyl
quad: bismuth, flagyl, tetracycline, omeprazole

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52
Q

MCC of impacted esophageal food boluses

A

schatzki rings

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53
Q

medication to help facilitate lower esophageal food bolus

A

glucagon

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54
Q

pyloric stenosis causes what laboratory abnormality

A

hypochloremic metabolic alkalosis

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55
Q

SBP fluid analysis `

A

PMNs >250, WBC >1000, pH <7.34

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56
Q

newborn with abdominal distention, inability to pass meconium and bilious vomiting

A

CF

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57
Q

bugs responsible for SBP

A

E.coli, klebsiella, and proteus

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58
Q

Dx pyloric stenosis

A

US abdomen

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59
Q

What is the most common, life-threatening cause of gastrointestinal bleeding after repair of an abdominal aortic aneurysm

A

aortoenteric fistula

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60
Q

carcinoid syndrome s/sx

A

R sided heart disease, bronchospasm, diarrhea, and skin flushing

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61
Q

dx carcinoid syndrome

A

urine 5 hydroxyindoleacetic acid level
CT or MRI

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62
Q

tx carcinoid syndrome

A

hydration, octreotide, and cyproheptadine

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63
Q

virchow node suggests

A

abdominal malignancy

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64
Q

virchow node location

A

L supraclavicular LN

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65
Q

Which of the following is the most common site of aortoenteric fistula formation?

A

duodenum

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66
Q

crohns disease

A

skip lesions, cobblestones, transmural, fistulas
mouth to anus
pANCA
nonbloody diarrhea

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67
Q

paralytic ileus has

A

air in colon and rectum on abdominal xr; no transition zone

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68
Q

Which of the following X-rays is the most sensitive imaging study to detect free air?

A

lateral chest xr

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69
Q
A

pneumatosis - necrotizing enterocolitis

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70
Q

Lab findings for NEC

A

hyperglycemia and lactic acidosis

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71
Q

TX NEC

A

bowel rest , NG tube, abx

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72
Q

S/sx of NEC

A

first few days of life; abdominal distention and vomiting, bloody stool or + guaiac ; pneumatosis

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73
Q

DX intussusception

A

US or contrast enema

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74
Q

abx for non-complicated diverticulitis

A

Augmentin

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75
Q

Salmonellosis tx

A

supportive care; ciprofloxacin if severe

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76
Q
A

pneumatosis - NEC

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77
Q

hirschsprung disease pathology

A

ailure of neuroblast migration so that ganglion cells do not extend to the distal end of the colon

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78
Q

hirschsprung disease s/sx

A

explosive passage of stook on DRE; failure to pass meconium

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79
Q
A
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80
Q

intestinal malrotation tx

A

NG tube, abx, emergent laparotomy

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81
Q

XR description of toxic megacolon

A

long segments of dilated colon with loss of haustra and “thumb printing” (areas of bowel wall edema).

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82
Q

DX hirshchsprung

A

rectal biopsy or contrast enema

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83
Q

tx of intussusceotion

A

air enema

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84
Q

most common cause of a small bowel obstruction in an 18-month-old previously healthy child?

A

Intussusception

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85
Q
A

cecal volvulus

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86
Q

high risk patients for sigmoid volvulus

A

long term care facilities; neuro and psych dz

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87
Q

tx signoid volvulus

A

flexible sigmoidoscopy; abdomen XR

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88
Q

lab findings with shigella

A

hyponatremia

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89
Q

complications of shigella

A

bacteremia, reactive arthritis, HUS, seizures,

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90
Q

dx intestinal malrotation

A

upper GI series

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91
Q

RF for NEC

A

prematurity

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92
Q

tx intussusception in adults

A

surgery

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93
Q

For which etiology of cardiac arrest does induced hypothermia carry the best improvement in survival with good neurologic outcome?

A

Vfib

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94
Q

what are lateral anal fissures concerning for?

A

systemic illness - crohns, HIV, leukemia, TB, and syphyllis

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95
Q
A

Aortic coarctation

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96
Q

Dx aortic coarctation

A

echo

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97
Q

tx pinworms

A

albendazole

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98
Q

tx lice and scabies

A

permethrin

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99
Q

tx tapeworms

A

praziquantel

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100
Q

beta blocker overdose presentation in children

A

hypoglycemia, seizures, and dysrhythmias

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101
Q

cardiac arrest due to ACS mc presents as

A

Vtach or Vfib

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102
Q

TX transposition of the great vessels

A

prostaglandin at birth (keep ductus arteriosus open), balloon septostomy, surgery

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103
Q

neonate HR < 60; first step

A

1 min of Pos pressure vent then compresssions

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104
Q

side effect of prostaglandin

A

vasodilation, hypotension, hyperthermia, and apnea

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105
Q

tx brugada

A

icd

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106
Q

contraindication for targeted temp management

A

non-compressible bleeding

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107
Q

MC location of anal fissure

A

posterior midline

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108
Q

dyspnea and sweating during feeds

A

anomalous left coronary artery

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109
Q

what is an epsilon wave?

A

small positive deflection buried in the end of the QRS complex

for HOCM

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110
Q

What does an epsilon wave indicate

A

arrhythmogenic right ventricular cardiomyopathy; can cause sudden death in young patient.

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111
Q

Dx arrhythmogenic right ventricular cardiomyopathy

A

EKG, echo, cardiac MRI

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112
Q

tx of WPW orthodromic (narrow complex)

A

vagal, adenosine, CCB, BB, and synchronized cardioversion

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113
Q

tx of WPW antidromic (wide)

A

procainamide

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114
Q

meds for vtach

A

procainamide, amiodarone

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115
Q
A

SVT

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116
Q
A

svt

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117
Q
A

atrial flutter

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118
Q
A

afib

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119
Q
A

vtach

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120
Q
A

svt

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121
Q

blood supply to av node

A

RCA

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122
Q
A

afib with WPW

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123
Q
A

arrhythmogenic right ventricular cardiomyopathy

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124
Q

tx arrhythmogenic right ventricular cardiomyopathy

A

activity restriction, bb(Sotalol), implantable defibrillator,

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125
Q
A

L: orthodromic; R: antidromic

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126
Q

Why is adenosine contraindicated in antidromic WPW

A

adenosine can enhance anterograde conduction through the accessory pathway, leading to degeneration of the rhythm into ventricular tachycardia or ventricular fibrillation.

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127
Q

what does orthodromic mean

A

electrical impulse goes through the AV node into the ventricle and returns to atria via the accessory pathway.

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128
Q

electrolyte abnormalities assoc with torsades

A

hypokalemia and hypocalcemia

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129
Q

what is brugada

A

Cardiac ion channel dysfunction associated with sudden cardiac arrest
Structurally normal heart

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129
Q

fusion beats are diagnostic for

A

vtach

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129
Q

Lown-Ganong-Levine syndrome

A

cardiac preexcitation syndrome similar in category to Wolff-Parkinson-White syndrome. It causes paroxysms of tachycardia

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129
Q

criteria for lown-ganong-levine syndrome

A
  1. short PR
  2. normal QRS
  3. bundle of james
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130
Q
A
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130
Q
A
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130
Q

when to defib vs synch cardioversion in vtach

A

unstable: synch
pulseless: defib

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130
Q
A

wellens; deeply inverted or biphasic t waves in V2-3

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130
Q

HOCM EKG findings

A

LVH, inverted deep t waves

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131
Q

Which of the following is the biggest risk factor for the development of a left ventricular aneurysm?

A

left anterior descending coronary artery infarction

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132
Q

persistent ste >2 weeks after MI

A

left ventricular aneurysm

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133
Q

HOCM murmur heard best when

A

standing up (+valsalva)

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134
Q

tx HOCM

A

beta blockers

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135
Q

Avoid what meds in HOCM

A

nitroglycerin, nifedipine, and diuretics

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136
Q

What is the most common presentation of a patient with hypertrophic cardiomyopathy?

A

dyspnea

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137
Q

low output HF

A

dilated cardiomyopathy, chronic HTN, and vale heart disease

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138
Q

high output HF

A

hyperTSH, beriberi, AV fistula, Paget disease, severe anemia, preggo

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139
Q

Sgarbossa criteria (STEMI with LBBB)

A

1) concordant ST elevation ≥ 1 mm in any lead with a positive QRS complex
2) concordant ST depression ≥ 1 mm in V1, V2, or V3
3) excessive discordant ST elevation as ≥ 25% of the depth of the preceding S wave

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140
Q
A

left ventricular aneurysm(2 weeks after MI)

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141
Q

nitroglycerin MOA

A

vasodilates and reduces preload and afterload

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142
Q

Which laboratory abnormality has been associated with a worse prognosis in heart failure

A

hyponatremia, poor kidney function, hypoalbuminemia, elevated LFTs

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143
Q

findings of a L circumflex artery occlussion

A

ST segment elevation in V5 and 6

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144
Q

posterior wall MI changes

A

STD in V1-3

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145
Q

tx NSTEMI

A

heparin, nitrates, and asa

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146
Q

what test has high negative predictive value and can be used to risk stratify patients with ACS

A

coronary CTA

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147
Q

What is the most common cause of tricuspid regurgitation?

A

dilation of R atrium and ventricle; usually with pulmonary HTN

148
Q

precursor of squamous cell CA

A

actinic keratoses

149
Q
A

actinic keratoses

150
Q

Which of the following clinical manifestations carries the poorest prognosis for untreated aortic stenosis?

151
Q

who gets ppx before dental procedures?

A

prosthetic heart valves, a history of previous infective endocarditis, unrepaired cyanotic congenital heart disease, or congenital heart disease repaired with prosthetic material or devices.

152
Q

lipodermatosclerosis

A

tapering of legs above knees (upside down champagne bottle), brown/red pigmentation, venous stasis

153
Q

murmur associated with turner syndrome

A

aortic stenosis

154
Q

MC complaint of AS

A

dyspnea with exertion, decreased exercise tolerance, syncope, and angina

155
Q

most common complication in patients with endocarditis?

156
Q

Mycotic aneurysm is most commonly a complication of

A

endocarditis

157
Q

ICD + magnet

A

turns off defibrillator

158
Q

pacemaker + magnet

A

goes to default settings and pace at set rate

159
Q

marfan associated with what murmur

160
Q
A

erythema nodosum

161
Q

Erythema nodosum etiology

A

delayed hypersensitivity reaction; erythematous tender nodules on shins

162
Q

Tx of erythema nodosum

A

NSAIDs, potassium iodide, steroids

163
Q
A

Erythema multiforme

164
Q

erythema multiforme etiology

A

immune mediated rash ; reactivated herpes simplex; often involve palms and soles

165
Q

tx of erythema multiforme

A

supportive, topical steroids, antivirals

166
Q

Tx of necrotizing fasciitis

A

vanco, zosyn, and clindamycin

167
Q

appearance of nec fasc

A

cellulitis progressing to dusky blue with bullae or vesicles; pai out of portion; subq emphysema

168
Q

Tx pityriasis rosea

A

supportive, antihistamine, zinc oxide

169
Q
A

benign hemangioma

170
Q

jock itch medical name and bacteria

A

trichophyton rubrum; tinea cruris

171
Q

Tinea cruris characteristics

A

scaly dermatitis, does not fluoresce

172
Q

difference between erysipelas and nec fasc

A

well demarcated borders

173
Q

Tx erysipelas

A

elevated limb, mild - penicillin, amoxicillin, cephalexin
severe- rocephin

174
Q
A

pityriasis rosea

175
Q

drug induced hypersensitivity syndrome presentation

A

rash, elevated liver enzymes, eosinophilia, elevated ESR CRP

176
Q

tx of drug induced hypersensitivity syndrome

A

corticosteroids

177
Q

soft, mobile, nontender subcutaneous mass without surrounding erythema. what is this

178
Q

omphalitis

A

purulent discharge from umbilical stump with surrounding erythema and induration

179
Q

tx omphalitis

A

vanco and gentamicin

180
Q

tx simple cellulits

A

cephalexin, amoxicillin

181
Q

tx MRSA cellulits

A

TMP SMX, doxycycline, clindamycin

182
Q

tx inpatient cellulitis

A

Rocephin, clindamycin, zosyn +/- vanco

183
Q

nec fasc bacteria

A

polymicrobial

184
Q

description of erythema multiforme

A

surrounded by a pale area and halo erythema

185
Q

tx scabies

A

permethrin

186
Q

Which of the following is most commonly associated with erythema nodosum?

A

strepinfection

187
Q

shingles contact precautions

A

airborne with contact

188
Q

hypocalcemia s/sx

A

chvostek sign, perioral numbness, trousseau sign , tetany, lethargy

189
Q

primary adrenal insufficiency electrolyte issues

A

Hyponatremia, hypoglycemia, hyperkalemia

190
Q

tx primary adrenal insufficiency

A

hydrocortisone, supportive, fludrocortisone

191
Q

What is the most common worldwide cause of primary adrenal insufficiency?

A

TB; chronic corticosteroid therapy

192
Q

PE of primary adrenal insufficiency

A

hyperpigmentation, hypotension

193
Q

s/sx of primary adrenal insufficiency

A

ab pain, N/V, diarrhea

194
Q

what is associated with pemphigus vulgaris

A

myasthenia gravis and thymoma

195
Q

bullae and flaccid blisters that slough easily

A

pemphigus vulgaris

196
Q

Which of the following is typically seen in Korsakoff syndrome?

A

impairment of short term memory (long term preserved), confabulation and apathy

197
Q

difference between TEN and SJS

A

TEN >30%; SJS <10%

198
Q

causes of TEN

A

sulfa, carbamazepine, lamotrigine, allopurinol, NSAIDs, mycoplasma PNA

199
Q

primary hyperPTH labs

A

increased PTH, increased calcium, decreased phos

200
Q

MCC of primary hyperPTH

201
Q
A

HSP’ IgA vasculitis; purpura, arthralgias, and abdominal pain (intussusception)

202
Q

s/sx of pernicious anemia

A

peripheral neuropathy, ataxia, personality change, dementia, glossitis

203
Q

staph scalded skin syndrome tx

A

cephalexin or dicloxacillin

204
Q

PE of staph scalded skin syndrome

A

erythroderma, large, flaccid bullae, desquamation

206
Q

peds dextrose administration in hypoglycemia formula

A

2 x age in years +8, then apply to dose

207
Q

hypoglycemia formula for >8 year old

A

D50; 1ml/kg

208
Q

hypoglycemia formula for 1-8 year olds

A

D25; 2ml/kg

209
Q

hypoglycemia formula for <1 year-old

A

D10; 2-5ml/kg

210
Q

what class of medications are associated with hypoglycemic episodes

A

sulfonylurea

211
Q

sulfonylurea toxicity

A

calcium influx and stimulates insulin secretion –> increase responsiveness of beta cells

212
Q

tx sulfonylurea toxicity

A

D50 & octreotide

213
Q

MCCs of SIADH

A

lung infections, CNS disorders, and drugs

214
Q

long acting sulfonylurea

215
Q

signs patient has renal aa stenosis

A

hypertension that is refractory to antihypertensive medications, hypokalemia, and metabolic alkalosis

216
Q

laxatives can cause what electrolyte abnormality

A

hypermagnesemia

217
Q

Tx hypermagnesemia

A

IVF, furosemide, and calcium

218
Q

hypermagnesemia s/sx

A

loss of DTRs, weakness, hypotension, vasodilation, dysrhythmia, asystole

219
Q

tx hypercalcemia

A

IVF, bisphosphonates, steroids, calcitonin, dialysis

220
Q

hypercalcemia ekg changes

221
Q

stones, bones, groans, and psych overtones

A

hypercalcemia

222
Q

what is the end point of HHS

A

correction of serum osmolality

223
Q

refeeding syndrome electrolyte abnormality

A

hypophosphatemia

224
Q

hypermagnesemia ekg changes

A

prolonged qt, widened qrs, dysthymia

225
Q

presentation of myxedema coma

A

thickened, nonpitting edema of skin; puffy face, enlarged thyroid, bradycardia, hypothermia

226
Q

lab findings of myxedema coma

A

hypoglycemia, hyponatremia, hypoxemia, hypercapnia, prolonged QT, pericardial effusion

227
Q

tx myxedema coma

A

supportive, hydrocortisone, levothyroxine

228
Q

why does hypothyroidism cause hyponatremia

A

decreased metabolic rate leading to decreased kidney function and water excretion

229
Q

subacute thyroiditis presentation

A

fever, myalgias, fatigue, anterior neck pain

230
Q

lab values of subacute thyroiditis

A

decreased TSH and elevated T3/4

231
Q

tx subacute thyroiditis

232
Q

types of thyroiditis

A

hashimoto, post partum, subacute, and infectious

233
Q

order of tx for hyperthyroidism

A

propranolol, PTU, methimazole, iodine, steroids

234
Q

Which o history or physical exam findings is most common in a child with hyperthyroidism?

235
Q

what condition should you not give ketamine

A

pheochromocytoma

236
Q

why is ASA contraindicated with thyroid storm

A

displaces t4 form binding proteins and potentiate thyrotoxicosis

237
Q

what medications blocks the release of stored thyroid hormone?

238
Q

what can distinguish primary adrenal insufficiency from secondary adrenal insufficiency?

A

hyperkalemia: secondary affects pt gland or hypothalamus and would have normal aldosterone

239
Q

thyroid storm clinical presentation

A

tachycardia, heart failure, hypotension, afib, hyperpyrexia, agitation,

240
Q

scorpion s/sx

A

extremity jerking that resembles seizures, oculomotor dysfunction, pharyngeal dysfunction, respiratory compromise, tongue fasciculations, motor restlessness, and hypersalivation.

241
Q

components of decompression sickness

A

the bends - pain in joints
the staggers - neuro s/sx
the chokes - pul and cardiac s/sx

242
Q

MC bacteria in dog bites

A

pasteurella

243
Q

fatal bacteria from dog bites

A

Capnocytophaga canimorsus,

244
Q

what early sign that is most suggestive of high-altitude cerebral edema?

245
Q

Which blood cells are preferentially damaged in acute radiation injuries?

A

lymphocytes

246
Q

copperhead snake description

A

triangular head, nostrils pits, elliptical pupils, folding fangs

247
Q

type 1 vs 2 of decompression sickness

A

1 - msk, skin, and lymphatics
2 - neuro, ear, lungs

248
Q

acute mountain sickness elevation

249
Q

keraunoparalysis

A

temporary paralysis of the extremities which may appear blue, mottled, and cold.

250
Q

sea urchin tx

A

hot water immersion

251
Q

tx of HACE

A

descent, dexamethasone,

252
Q

what creature bite can mimic acute abdomen

A

black widow

253
Q

primary cause of the septal necrosis that results from a button battery lodged in the nose?

A

electrical current

254
Q

lab findings of heat stroke

A

transaminitis, AKI, metabolic acidosis, DIC

255
Q

exertional heat stroke lab findings

A

rhabdomyolysis

256
Q

bullous myringitis MC bacteria

A

strep. pneumo

257
Q

abx after foreign body removal from ear canal

A

ciprofloxacin drops

258
Q

tx perichondritis

A

ciprofloxacin

258
Q

perichondritis bacteria

A

pseudomonas

259
Q

necrotizing external otitis s/sx

A

CN palsies; otorrhea unresponsive to treatment; periauricular pain and swelling

260
Q

tx of necrotizing external otitis

A

IV fluroquinolone or anti pseudomonas coverage

261
Q

labyrinthitis s/sx

A

after viral infection; vertigo, hearing loss, and tinnitus; horizontal nystagmus

262
Q

complication of bacterial labyrinthitis

A

meningitis

263
Q

MCC of viral labyrinthitis

A

rubella and rubeola

264
Q

caloric testing (ear)1

A

cold water = nystagmus opposite side; hot water = same side

265
Q

Meniere disease triad

A

episodic vertigo, sensorineural hearing loss, tinnitus

266
Q

meniere disease etiology

A

increased endolymph

267
Q

when do observe vs tx otitis media

A

> 6 months: non-severe and within 48-72 hours

268
Q

what do you NOT do for frost bite

269
Q

abx for mastoiditis

A

IV Vancomycin

270
Q

insect removal from ear steps

A
  1. kill with mineral oil orlidocaine
  2. remove
271
Q

vestibular neuritis exam findings

A

positive head impulse test, neg test of skew, fall toward affected side

272
Q

superficial punctate epithelial lesions on eye exam

A

radiation keratitis

273
Q
A

papilledema

274
Q
A

retinal vein occlusion; cotton wool spots

275
Q

ethmoid sinusitis can lead to what

A

orbital cellulitis

276
Q

optic neuritis s/sx

A

sudden monocular vision loss, pain with EOM, loss of r4ed vision, worsens with increased body temp

277
Q

causes of optic neuritis

A

MS, infection, autoimmune, methanol, b12 def, diabetes

278
Q

tx optic neuritis

A

IV steroids

279
Q

what patients do you admit for a hyphema

A

sickle cell

280
Q

chalazion vs hordeolum (stye)

A

chalazion = upper lid & painless
stye+ lower & tender

281
Q

dacryoadenitis

A

enlarged lacrimal gland, pain, supratemporal region

282
Q

dacryocystits

A

obstruction of nasolacrimal duct, painful, inframedial region

283
Q

dendritic lesion on eye exam that stains poorly with fluorescein

A

herpes zoster ophthalmicus

284
Q

drug for glaucoma

285
Q

anterior uveitis (iritis) assoc with

A

ankylosing spondylitis

286
Q

ITP lab values

A

normal WBC, normal hgb, thrombocytopenia,

287
Q

ITP s/sx

A

petechiae, gingival bleeding, epistaxis, gi bleed, intracranial hemorrhage

288
Q

tx ITP

A

IVIG, supportive, platelets, corticosteroids,

289
Q

what does croup look similar to

A

bacterial tracheitis

290
Q

TTP pentad

A

fever, thrombocytopenia, kidney injury, neuro findings, anemia

291
Q

tx TTp

A

plasmapharesis

292
Q

causes of TTP

A

preggo, AIDs, lupus, scleroderma, Sjogren, tacrolimus/cyclosporine/quinidine

293
Q

adult vs child ITP

A

child = after viral infection
adult = chronic

294
Q

pericoronitis

A

local inflammation/infection due to food trapping under gum flap

295
Q

DIC labs

A

low platelets and fibrinogen
high PT, PTT, thrombin clotting time

296
Q

factor replacement for hemophilia A

A

factor VIII

297
Q

factor replacement for hemophilia B

298
Q

factor V leiden resistance to

299
Q

MC artery to bleed with tracheostomy

A

innominate artery

300
Q

tx alveolar osteitis

A

Iodoform gauze packing moistened with oil of clove

301
Q

tx parotitis outpatient

A

augmentin or clindamycin or cephalosporin + flagyl

302
Q

tx parotitis inpatient

A

ampicillin-sulbactam, cephalosporin + flagyl

303
Q

tx epiglottitis

304
Q
A

necrotizing ulcerative gingivitis
gingival papillae, bacterial plaques, edematous gums

305
Q

tx necrotizing ulcerative gingivitis

A

debridement, chlorhexidine rinse, and augmentin

306
Q

mechanism of DIC

A

peripheral destruction of cells

307
Q

RA

A

morning stiffness, MCP and PIP involvement, Boutonniere vs swan neck joiny deformity

308
Q

multiple myeloma s/sx

A

hypercalcemia, elevated total protein, kidney insufficiency, and anemia

309
Q

tx kawasaki disease

A

IVIG, aspirin, and steroids

310
Q

acute vs chronic kidney rejection

A

acute: CD8+ T cell mediated process against donor tissue resulting in leukocyte infiltration of graft vessels impairing perfusion
Chronic: CD4+ T cell mediated process resulting in the proliferation of the vascular intima and fibrosis of renal vessels causing a marked decrease in lumen size

311
Q

tx for refractory anaphylaxis

A

epi infusion, vasopressors, glucagon (if on beta blockers)

312
Q

rule out SLE with

313
Q

CREST syndrome

A

C - calcinosis of skin
R - Raynauds
E - esophageal dysmotility
S- sclerodactylyl
T - telangiectasia

314
Q

scleroderma renal crisis s/sx

A

acute oliguria, hypertension, normal UA

315
Q

tx RA vs OA

A

RA - Methotrexate
OA - prednisone

316
Q

HSP (IgA vasculitis)

A

After viral illness: abdominal pain (intussusception) with heme positive stool, microscopic hematuria, proteinuria, elevated BUN/Cr, and joint pain (knees and ankles)

317
Q

MC abx for causing serum sickness

A

cefaclor or amoxicillin

318
Q

Jones criteria (acute rheumatic fever)

A

carditis - new murmur
polyarthritis
chorea
subcutaneous nodules
erythema marginatum

319
Q
A

discoid lupus

320
Q

tx hyperviscosity syndrome

A

leukapheresis

321
Q

contact dermatitis is what type of HS reaction

322
Q

bronchiolitis obliterans

A

chronic lung transplant rejection

323
Q
A

mucocuntaneous lymphadenopathy aka strawberry tongue aka kawasaki

324
Q

Zika virus s/sx

A

low fever, maculopapular pruritic, arthralgias, conjunctivitis

325
Q

labs for Ehrlichiosis

A

leukopenia and thrombocytopenia

326
Q

where does small pox rash start

A

oral xanthem

327
Q

lyme disease prevention tx

A

doxycycline once

328
Q

lyme disease tx

A

doxycycline 21 days

329
Q

Which medication is the drug of choice for the parenteral treatment of severe, complicated malaria in the United States?

A

Intravenous artesunate

330
Q

uncomplicated malaria tx in chloroquine resistant areas

A

Atovaquone-proguanil; quinine and doxycycline

331
Q

uncomplicated malaria tx in chloroquine sensitive areas

A

chloroquine

332
Q

ebola virus incubation period

333
Q

eye problems that develop from lyme disease

334
Q

labs for hemolytic anemia

A

low haptoglobin and increased indirect bilirubin

335
Q
A

erythema migrans
lyme disease

336
Q
A

erythema marginatum
acute rheumatic fever

337
Q

erythema nodosum

A

inflammatory nodules
infection, autoimmune, meds, preggo, neoplasm

338
Q
A

erythema mulitiforme
immune mediated

339
Q

Which of the following is the most accurate test for diagnosing osteomyelitis?

340
Q

What is the most common site of osteosarcoma in children?

A

distal femur

341
Q

osteochondroma XR presentation

A

sessile or pedunculated outgrowth along the surface of the bone.

342
Q

rubella rash description

A

maculopapular, pinpoint, and pink, which starts on the face and spreads caudally to the trunk and extremities.

343
Q

MC complication of scaphoid fracture

A

avascular necrosis

344
Q

dengue fever s/sx

A

several days of fever, period of improvement, followed by several days of resumed symptoms

hemorrhagic fever: bleeding, thrombocytopenia

345
Q

yellow fever initial period of infection s/sx

A

transaminitis

346
Q

What is the most common cause of death in unvaccinated children infected with measles?

347
Q

Kocher criteria (peds septic joint)

A
  1. ESR >40
  2. non WB on affected side
  3. WBC > 12k
  4. Fever
348
Q

s/sx of juvenile idiopathic arthritis

A

poly arthritis > 6 weeks; fever at least for two weeks , salmon colored rash

349
Q

tx juvenile idiopathic arthritis

A

nsaids, methotrexate, steroids, DMARDS

350
Q

What exams are the highest sensitivity and specificity for sciatica

A

straight leg raise test and crossed straight leg raise

351
Q

shoulder impingement syndrome

A

positive Neer and Hawkins

352
Q

goal of fluids with rhabdomyolysis

A

urine output of 3ml/kg/hr

353
Q

location of tenderness for achilles tendinitis

A

2 to 6 cm above posterior calcaneus

354
Q

Which of the following is the most common finding in patients with septic arthritis?

A

pain with ROM

355
Q
356
Q

cauda equina vs conus medullaris

A

cauda = hyporeflexia
conus = spasticity

357
Q

alternative name for osgood schlatter disease

A

tibial apophysitis

358
Q

labs for dermatomyositis

A

increased CK and adolase

359
Q

sx for migraine vs HA

360
Q

Lhermitte sign

A

electrical pain that radiates down the neck and spine when head is flexed (MS)

361
Q

VP shunt complications

A

overdrainage
infection
seizure
hemorrhage from catheter placement
mechanical shunt failure or blocked
abdominal injury

362
Q

tx VP shunt failure

A

increase HOB, hyperventilation, osmotic diuresis, and drainage form shunt resevoir

363
Q

trigeminal neuralgia brainstem location

A

trigeminal nerve (V) -> lateral pons

364
Q

tx flexor tenosynovitis

A

IV amp-sulbactam and vancomycin OR IV zosyn

365
Q

MS diagnosis modality

A

MRI brain and spine

366
Q

S/Sx of transverse myelitis

A

symmetrical back pain, LE weakness and pain, urinary retention

367
Q

transverse myelitis tx

A

methylprednisolone

368
Q

MC finding for bacterial meningitis in <1yo

A

paradoxical irritability (irritable when picked up; fine when left alone)

369
Q

MC malignant brain tumor in children

A

medulloblastoma

370
Q

acute flaccid myelitis

A

dysfunction of anterior horn cells

371
Q

acute flaccid myelitis s/sx

A

URI prodrome, rapid onset weakness, limb paralysis

372
Q

acute flaccid myelitis dx

373
Q

acute flaccid myelitis TX

A

ivig, +/- steroid, PT/OT

374
Q

brain abscess tx

A

Rocpehin + Flagyl +/- vanco

375
Q

tx MG

A

pyridostigmine

376
Q

tx for neurocysticercosis

A

albendazole +/- praziquantel

PGY2 (10 decks)

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