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ROSH > ROSH1 > Flashcards

ROSH1 Flashcards

1
Q

triple acid base disorder

A 
ASA toxicity- 
resp alkalosis (hypervent), AG met acidosis (lactic acid), met alkalosis (vomitting)
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2
Q

anhidrotic hyperthermia

A

cholinergics

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3
Q

withdrawal from what 2 substances can cause hyperthermia

A

etoh and bzd

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4
Q

where to do fascia iliaca block?

A

lateral third of inguinal ligament

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5
Q

can get serotonin syndrome 2/2 what?

A

SSRIs, MAOI, TCAs, st johns wort, cocaine/mdma, dextrometrophan, zofran

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6
Q

CNVI palsy will give you what vision changes

A

binocular horizontal diplopia

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7
Q

what intervention results in greatest reduction in mortality for variceal GIB?

A

ceftriaxone

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8
Q

most common dx of LGIB in peds?

A

anal fissure

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9
Q

african american w/ hypercalcemia and elevated serum ACE

A

sarcoidosis

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10
Q

silo filler’s disease

A

nitrogen dioxide pnemonitis

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11
Q

What are the H’s and T’s for reversible causes of pulseless electrical activity?

A

The H’s are hypoglycemia, hypoxia, hydrogen ion (acidosis), hypo- and hyperkalemia, hypovolemia, and hypothermia. The T’s are tension pneumothorax, thrombosis (coronary), thrombosis (pulmonary embolism), tamponade (cardiac), and toxins.

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12
Q

acid fast bacilli

A

TB

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13
Q

BL hilar LAD

A

sarcoidosis

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14
Q

noncaseating granuloma

A

sarcoidosis

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15
Q

psych med that causes inc free water excretion

A

lithium

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16
Q

peds nl BP calculation

A

70 + (2 x age in years)

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17
Q

Which neoplastic disease has the highest risk of developing tumor lysis syndrome?

A

ALL

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18
Q

when dev tumor lysis syndrome

A

1-5 days after chemotherapy

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19
Q

What bacterial species is most frequently associated with cavernous sinus thrombosis?

A

staph aureus

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20
Q

envenomation causing tongue fasciculations, disconjugate gaze, temp reversal

A

scorpion

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21
Q

most likely cause of febrile illness in a patient returning from western Africa is

A

malaria- P. falciparum (deadliest)

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22
Q

How many days could a patient remain asymptomatic after exposure to the Ebola virus and thus should be questioned regarding possible exposure during this particular duration of time

A

21 days

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23
Q

cerebral malaria, Blackwater fever

A

P. falciparum

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24
Q

What is the diagnostic modality of choice for diaphragm injuries?

A

CT

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25
Q

CXR: NGT curled in chest

A

diaphragm rupture

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26
Q

diff b/w uterine rupture and placental abruption? 3

A

uterine rupture- loss of fetal station, easily palpable fetal anatomy, and the cessation of contractions

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27
Q

massive PE?

A

at least 1 of the following: sustained hypotension, pulselessness, or brady

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28
Q

submassive PE

A

PE w/o hypotension but with RV dysfxn or myocardial necrosis

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29
Q

What dose of alteplase is used in the treatment of massive pulmonary embolism?

A

100 mg over two hours.

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30
Q

HUS usu 2/2 what bug

A

Most cases occur following infectious diarrhea with Shiga toxin-producing E. coli O157:H7

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31
Q

Which opioid medications can lead to QRS widening or QT prolongation in overdose?

A

Loperamide and methadone.

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32
Q

suicidal hanging attempt ass with what inury

A

hippocampal ischemia (self-inflicted hangings are rarely associated with cervical spine fractures)

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33
Q

sudden severe vertigo, hearing loss, tinnitus, not recurrent

A

Labyrinthitis

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34
Q

What intraosseous sites can be used at any age?

A

Proximal tibia and distal femur.

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35
Q

What is the typical time of onset of neuroleptic malignant syndrome after initiation of therapy?

A

Within days to weeks (rather than minutes to hours with serotonin syndrome).

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36
Q

What are the benefits of closing galeal lacerations greater than 0.5 cm?

A

Prevents subgaleal infection, hematoma, and asymmetric facial muscle contraction.

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37
Q

New LBBB + Chest Pain

A

MI until proven otherwise

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38
Q

Gold standard for diagnosis of myocarditis

A

endomyocardial biopsy

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39
Q

Congo red stain demonstrates apple-green birefringence under light microscopy

A

amyloidosis

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40
Q

Common causes of false-negative TB tests 3

A

human immunodeficiency virus, chemotherapy, and chronic steroid use.

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41
Q

Hip Dislocations- ant vs post:
PE will show?
ass injuries?

A

Posterior (MC): internally rotated, sciatic nerve injury

Anterior: externally rotated, femoral artery/vein/nerve injury

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42
Q

PNA w/ livestock exposure, inc LFTs? tx?

A

Coxiella burnetti. azithro

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43
Q

PNA w/ bird exposure, hyperpyrexia, severe HA? tx?

A

Chlamydophila psittacii. azithro

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44
Q

Most common organism proctitis:

A

N. gonorrhoeae

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45
Q

Common drugs that cause EM:

A

Sulfa, Oral hypoglycemics, Anticonvulsants, Penicillin, NSAIDs (SOAPS)

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46
Q

Atrial flutter is extremely responsive to ?

A

electrical cardioversion and less so to chemical cardioversion.

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47
Q

when are you likely to get PSGN?

A

This complication occurs one to two weeks after streptococcal pharyngitis and three to six weeks after streptococcal skin infection.

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48
Q

What is the most common cause of gross hematuria in children presenting to the emergency department?

A

uti

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49
Q

What two medications can make urine look red with the appearance of gross hematuria?

A

Rifampin and phenazopyridine.

50
Q

What treatment is recommended for patients who require manual extraction of the placenta?

A

Ampicillin or first-generation cephalosporin for infection prophylaxis.

51
Q

delivery steps

A

engagement, descent, flexion, internal rotation, extension, external rotation, expulsion

Suction nares, oropharynx immediately after fetal head delivery
Anterior shoulder delivered first

52
Q

most common and most important predisposing risk factor found in patients with aortic dissection?

A

Chronic HTN

53
Q

What screening laboratory test can be used to assist in ruling out ab aortic dissection in patients at low risk for the disease?1

A

D-dimer

54
Q

pts on pyrimethamine and sulfadiazine for toxoplasmosis should also be started on

A

leukovorin (to prevent pancytopenia)

55
Q

Which antithyroid hormone treatments are recommended in pregnant patients with hyperthyroidism?

A

Treat with a beta-blocker and then propylthiouracil. (PTU) if Pregnant

56
Q

what lab test is most sensitive for detecting a spinal epidural abscess?

A

ESR

57
Q

What is the most common causing organism for spinal epidural abscesses?

A

staph aureus

58
Q

cranial nerve IV (trochlear nerve) palsy

A

Inward and upward deviation of the eye

59
Q

oculomotor (cranial nerve III) palsy

A

Ptosis, mydriasis, and down and out deviation of the eye

60
Q

cranial nerve VI (abducens nerve) palsy

A

lateral gaze palsy

61
Q

PE will show bilateral papilledema, CN VI palsy

A

Idiopathic Intracranial Hypertension (Pseudotumor Cerebri)

62
Q

how to control bleeding in von willebrand pts?

A

desmopressin DDAVP

63
Q

labs in von willebrand pts? 2

A

decreased factor VIII, prolonged bleeding time

64
Q

How long after delivery of the fetus should the placenta be delivered?

A

The placenta should be delivered within 20 minutes of fetal delivery to reduce the risk of postpartum hemorrhage.

65
Q

What is painless vaginal bleeding in the second or third trimester considered to be until proven otherwise?

A

Placenta previa.

66
Q

target UOP in burns?

A

Target urine output: 0.5 - 1 mL/kg/h in adults;

1 - 2 mL/kg/h in children

67
Q

SE lithium? 2

A

diabetes insipidus, syndrome of irreversible lithium-effectuated neurotoxicity (SILENT)

68
Q

Common causes of elevated IOP? 3

A

acute angle closure glaucoma, orbital compartment syndrome, and ocular hypertension.

+ corneal scar (false positive)

69
Q

What is the mainstay of management of a suspected globe rupture?

A

Immediate placement of an eye shield and emergent ophthalmic consultation.

70
Q

Thoracotomy indications:

A

initial chest tube output of > 20 mL/kg (or 1500 mL) or subsequent output of > 200 mL/hour

71
Q

What diagnosis should be considered in a young woman, with a history of infertility, presenting with spontaneous hemothorax of the right side of the chest?

A

Endometriosis

72
Q

Patients with HIV should not receive live bacteria or virus vaccines. What is the one exception?

A

Measles-mumps-rubella vaccine.

73
Q

presents in CHF within 1st 3 weeks of life? tx?

A

hypoplastic left heart (duct dependent). give initial dose is 0.1 mcg/kg/min, followed by a continuous infusion at the lowest effective dose (usually 0.05 mcg/kg/min).

74
Q

SE prostaglandin E1

A

apnea (be ready to intubate)

75
Q

What are common complete blood cell count and differential findings in patients with serum sickness?

A

Neutropenia, eosinophilia, reactive lymphocytosis, and mild thrombocytopenia

76
Q

When should cautious intravenous bicarbonate be considered in patients with diabetic ketoacidosis?

A

Only in rare cases of life-threatening hyperkalemia or extreme acidosis (pH < 6.9).

77
Q

lower back pain and stiffness that is worse in the morning and improves with activity? tx?

A

sacroilitis. nonsteroidal anti-inflammatories and physical therapy.

78
Q

pain worsens at night and with activity and improves with rest

A

OA

79
Q

What is Waterhouse-Friderichsen syndrome?

A

Bilateral adrenal hemorrhage and failure due to an overwhelming bacterial infection; most commonly Neisseria meningitidis.

80
Q

What injury should be suspected in a pediatric patient with acute neurological deficits following trauma despite normal initial imaging studies?

A

Spinal Cord injury without radiological abnormality (SCIWORA).

81
Q

3 types of odontoid fx?

A

Type I: Avulsion of the tip (usually stable)
Type II: Fracture at base of dens (most common, unstable fracture)
Type III: Fracture at junction of odontoid and body of C2 (unstable fracture)

82
Q

Non-pregnant patients with life-threatening vaginal bleeding should be given ? Vs Patients with menorrhagia that is not life-threatening may be treated with

A

intravenous estrogen

nonsteroidal anti-inflammatory drugs, progesterone, oral contraceptives, tranexamic acid, or an intrauterine device.

83
Q

Oral contraceptives are absolutely contraindicated in smokers over what age?

A

35

84
Q

What is the most common cause of a pleural effusion in a patient residing in a developing nation?

A

TB

85
Q

ulcerative colitis cx?

A

Toxic megacolon, ↑ colon cancer risk

86
Q

Rabies post-exposure prophylaxis if NOT vaccinated? if vaccinated?

A

NOT vaccinated: 20U/kg RIG around wound AND vaccine on days 0, 3, 7, 14

Vaccinated: NO RIG and vaccine on day 0, 3 only

87
Q

Which cranial nerve do cluster headaches exclusively involve? tx? 3

A

Cranial nerve V, the trigeminal nerve, is the exclusive site of pain and symptoms. 100% high-flow oxygen, Outpatient treatments include verapamil CACB and corticosteroids to reduce both the length and number of cluster episodes

88
Q

A previously healthy patient who presents with a first-time, cluster-type headache should be evaluated for what?

A

Carotid dissection.

89
Q

How is the visual field defect of optic neuritis typically characterized?

A

Central scotoma, which is a gray, black, or blind spot in the middle of one’s vision.

90
Q

4 characteristics of optic neuritis? tx?

A

acute monocular vision loss, pain worse with eye movements, loss of color (red) vision, and transient worsening of vision with increased body temperature (Uhthoff’s phenomenon). methylpred

91
Q

Which type of cancer is the most common cause of hypercortisolism and can present with signs and symptoms of Cushing syndrome?

A

Small cell lung cancer.

92
Q

best tx for pinworm?

A

Pyrantel pamoate/mebendazole/albendazole administered at the initial visit with repeat dose in two weeks to kill worms that were eggs at the time of initial treatment. tx family too

93
Q

Which helminth infection can metronidazole be used to treat?

A

Amebiasis, or Entamoeba histolytica, infection.

94
Q

nocturnal pruritus ani? dx? tx?

A

pinworm. tape test.

Pyrantel pamoate/mebendazole/albendazole

95
Q

Reactive arthritis triad

A

syndrome of conjunctivitis, arthritis, and urethritis in which Chlamydia trachomatis is implicated

96
Q

What ECG finding is most consistent with a ventricular aneurysm?

A

QS wave with ST elevation

97
Q

What is the blood pressure goal for patients with intracranial bleeding?

A

less than 140/90 mm Hg.

98
Q

DM with rapidly progressive sinus pain and swelling with pink nasal discharge and headache? tx?

A

rhinocerebral mucormycosis.

Amphotericin B intravenously and otolaryngology consult

99
Q

What antibiotic is the most appropriate treatment for malignant otitis externa, also commonly seen in diabetic patients?

A

Levofloxacin or ciprofloxacin.

100
Q

Labs will show
anti-topoisomerase I (anti-Scl-70) antibody (specific for diffuse disease)
anti-centromere antibody (specific for limited disease)

A

scleroderma

101
Q

dx aortoenteric fistula

A

computed tomography angiography scan of the abdomen

102
Q

Fundoscopy will show “boxcar” look or “cherry red spot”

A

CRAO

103
Q

What is propofol infusion syndrome?

A

It is a rare syndrome that occurs in patients on a propofol drip for a long period of time and can result in hypertriglyceridemia, heart and kidney failure, metabolic acidosis, and rhabdomyolysis.

104
Q

how to reverse rivaroxaban?

A

andexanet alfa. It is an inactive form of factor Xa that acts by binding and sequestering the anticoagulant.

105
Q

how to reverse dabigatran?

A

Idarucizumab is a specific reversal agent for dabigatran. If it is not available, give activated prothrombin complex concentrate PCC such as factor eight inhibitor bypassing activity (FEIBA).

106
Q

What factors are found in 4-factor prothrombin complex concentrate?

A

Factors II, VII, IX, and X, as well as protein C and protein S.

107
Q

What is the classic presentation of patients with chronic mesenteric ischemia?

A

Intermittent postprandial pain.

108
Q

What is the most common presenting complaint of arrhythmogenic right ventricular cardiomyopathy?

A

Palpitations

109
Q

endometriosis triad? dx?

A

Patient will be complaining of pre or mid-cycle Dysmenorrhea, Dyspareunia, Dyschezia (painful bowel movement). MC lesions on ovaries. laparoscopy

110
Q

Which class of cardiac medication more commonly leads to medication-induced peripheral edema as a side effect?

A

Dihydropyridine calcium channel blockers.

111
Q

What drug class is most commonly implicated as the cause of delirium in the elderly?

A

anticholinergics

112
Q

what can help differentiate infectious mononucleosis from streptococcal pharyngitis?

A

EBV- Presence of bilateral POSTERIOR cervical lymphadenopathy

113
Q

When are false-negative rates highest for the heterophile antibody test for mononucleosis?

A

In the first week of clinical symptoms.

114
Q

At what rate should sodium be corrected to avoid central pontine myelinolysis?

A

0.5 mg/dL/hr or a goal of 8–10 mg/dL/day.

115
Q

kawasaki lab abnormalities

A

elevated acute phase reactants (ESR, C-reactive protein), urinalysis showing sterile pyuria, elevated WBC, thrombocytosis, and abnormal LFTs.

116
Q

significant chest pain after vomiting, forceful coughing? tx?

A

Boerhaave syndrome. emergent surgical consult and broad-spectrum antibiotics

117
Q

What finding in the ear is virtually pathognomonic for necrotizing otitis externa?

A

Friable granulation tissue at the floor of the osseocartilaginous junction.

118
Q

What rare inherited condition should be considered in a patient presenting with many epidermoid cysts on the extremities?

A

Gardner syndrome.

119
Q

What is a common cause of stridor in patients after prolonged intubation?1

A

Subglottic stenosis.

120
Q

insp vs expiratory stridor?

A

Inspiratory stridor: obstruction above the glottis

Expiratory stridor: intrathoracic obstruction

121
Q

Chronic stridor in infants

A

tracheomalacia

ROSH (1 decks)

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