ROSH1 Flashcards
triple acid base disorder
ASA toxicity- resp alkalosis (hypervent), AG met acidosis (lactic acid), met alkalosis (vomitting)
anhidrotic hyperthermia
cholinergics
withdrawal from what 2 substances can cause hyperthermia
etoh and bzd
where to do fascia iliaca block?
lateral third of inguinal ligament
can get serotonin syndrome 2/2 what?
SSRIs, MAOI, TCAs, st johns wort, cocaine/mdma, dextrometrophan, zofran
CNVI palsy will give you what vision changes
binocular horizontal diplopia
what intervention results in greatest reduction in mortality for variceal GIB?
ceftriaxone
most common dx of LGIB in peds?
anal fissure
african american w/ hypercalcemia and elevated serum ACE
sarcoidosis
silo filler’s disease
nitrogen dioxide pnemonitis
What are the H’s and T’s for reversible causes of pulseless electrical activity?
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.
acid fast bacilli
TB
BL hilar LAD
sarcoidosis
noncaseating granuloma
sarcoidosis
psych med that causes inc free water excretion
lithium
peds nl BP calculation
70 + (2 x age in years)
Which neoplastic disease has the highest risk of developing tumor lysis syndrome?
ALL
when dev tumor lysis syndrome
1-5 days after chemotherapy
What bacterial species is most frequently associated with cavernous sinus thrombosis?
staph aureus
envenomation causing tongue fasciculations, disconjugate gaze, temp reversal
scorpion
most likely cause of febrile illness in a patient returning from western Africa is
malaria- P. falciparum (deadliest)
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
21 days
cerebral malaria, Blackwater fever
P. falciparum
What is the diagnostic modality of choice for diaphragm injuries?
CT
CXR: NGT curled in chest
diaphragm rupture
diff b/w uterine rupture and placental abruption? 3
uterine rupture- loss of fetal station, easily palpable fetal anatomy, and the cessation of contractions
massive PE?
at least 1 of the following: sustained hypotension, pulselessness, or brady
submassive PE
PE w/o hypotension but with RV dysfxn or myocardial necrosis
What dose of alteplase is used in the treatment of massive pulmonary embolism?
100 mg over two hours.
HUS usu 2/2 what bug
Most cases occur following infectious diarrhea with Shiga toxin-producing E. coli O157:H7
Which opioid medications can lead to QRS widening or QT prolongation in overdose?
Loperamide and methadone.
suicidal hanging attempt ass with what inury
hippocampal ischemia (self-inflicted hangings are rarely associated with cervical spine fractures)
sudden severe vertigo, hearing loss, tinnitus, not recurrent
Labyrinthitis
What intraosseous sites can be used at any age?
Proximal tibia and distal femur.
What is the typical time of onset of neuroleptic malignant syndrome after initiation of therapy?
Within days to weeks (rather than minutes to hours with serotonin syndrome).
What are the benefits of closing galeal lacerations greater than 0.5 cm?
Prevents subgaleal infection, hematoma, and asymmetric facial muscle contraction.
New LBBB + Chest Pain
MI until proven otherwise
Gold standard for diagnosis of myocarditis
endomyocardial biopsy
Congo red stain demonstrates apple-green birefringence under light microscopy
amyloidosis
Common causes of false-negative TB tests 3
human immunodeficiency virus, chemotherapy, and chronic steroid use.
Hip Dislocations- ant vs post:
PE will show?
ass injuries?
Posterior (MC): internally rotated, sciatic nerve injury
Anterior: externally rotated, femoral artery/vein/nerve injury
PNA w/ livestock exposure, inc LFTs? tx?
Coxiella burnetti. azithro
PNA w/ bird exposure, hyperpyrexia, severe HA? tx?
Chlamydophila psittacii. azithro
Most common organism proctitis:
N. gonorrhoeae
Common drugs that cause EM:
Sulfa, Oral hypoglycemics, Anticonvulsants, Penicillin, NSAIDs (SOAPS)
Atrial flutter is extremely responsive to ?
electrical cardioversion and less so to chemical cardioversion.
when are you likely to get PSGN?
This complication occurs one to two weeks after streptococcal pharyngitis and three to six weeks after streptococcal skin infection.
What is the most common cause of gross hematuria in children presenting to the emergency department?
uti
What two medications can make urine look red with the appearance of gross hematuria?
Rifampin and phenazopyridine.
What treatment is recommended for patients who require manual extraction of the placenta?
Ampicillin or first-generation cephalosporin for infection prophylaxis.
delivery steps
engagement, descent, flexion, internal rotation, extension, external rotation, expulsion
Suction nares, oropharynx immediately after fetal head delivery
Anterior shoulder delivered first
most common and most important predisposing risk factor found in patients with aortic dissection?
Chronic HTN
What screening laboratory test can be used to assist in ruling out ab aortic dissection in patients at low risk for the disease?1
D-dimer
pts on pyrimethamine and sulfadiazine for toxoplasmosis should also be started on
leukovorin (to prevent pancytopenia)
Which antithyroid hormone treatments are recommended in pregnant patients with hyperthyroidism?
Treat with a beta-blocker and then propylthiouracil. (PTU) if Pregnant
what lab test is most sensitive for detecting a spinal epidural abscess?
ESR
What is the most common causing organism for spinal epidural abscesses?
staph aureus
cranial nerve IV (trochlear nerve) palsy
Inward and upward deviation of the eye
oculomotor (cranial nerve III) palsy
Ptosis, mydriasis, and down and out deviation of the eye
cranial nerve VI (abducens nerve) palsy
lateral gaze palsy
PE will show bilateral papilledema, CN VI palsy
Idiopathic Intracranial Hypertension (Pseudotumor Cerebri)
how to control bleeding in von willebrand pts?
desmopressin DDAVP
labs in von willebrand pts? 2
decreased factor VIII, prolonged bleeding time
How long after delivery of the fetus should the placenta be delivered?
The placenta should be delivered within 20 minutes of fetal delivery to reduce the risk of postpartum hemorrhage.
What is painless vaginal bleeding in the second or third trimester considered to be until proven otherwise?
Placenta previa.
target UOP in burns?
Target urine output: 0.5 - 1 mL/kg/h in adults;
1 - 2 mL/kg/h in children
SE lithium? 2
diabetes insipidus, syndrome of irreversible lithium-effectuated neurotoxicity (SILENT)
Common causes of elevated IOP? 3
acute angle closure glaucoma, orbital compartment syndrome, and ocular hypertension.
+ corneal scar (false positive)
What is the mainstay of management of a suspected globe rupture?
Immediate placement of an eye shield and emergent ophthalmic consultation.
Thoracotomy indications:
initial chest tube output of > 20 mL/kg (or 1500 mL) or subsequent output of > 200 mL/hour
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?
Endometriosis
Patients with HIV should not receive live bacteria or virus vaccines. What is the one exception?
Measles-mumps-rubella vaccine.
presents in CHF within 1st 3 weeks of life? tx?
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).
SE prostaglandin E1
apnea (be ready to intubate)
What are common complete blood cell count and differential findings in patients with serum sickness?
Neutropenia, eosinophilia, reactive lymphocytosis, and mild thrombocytopenia
When should cautious intravenous bicarbonate be considered in patients with diabetic ketoacidosis?
Only in rare cases of life-threatening hyperkalemia or extreme acidosis (pH < 6.9).
lower back pain and stiffness that is worse in the morning and improves with activity? tx?
sacroilitis. nonsteroidal anti-inflammatories and physical therapy.
pain worsens at night and with activity and improves with rest
OA
What is Waterhouse-Friderichsen syndrome?
Bilateral adrenal hemorrhage and failure due to an overwhelming bacterial infection; most commonly Neisseria meningitidis.
What injury should be suspected in a pediatric patient with acute neurological deficits following trauma despite normal initial imaging studies?
Spinal Cord injury without radiological abnormality (SCIWORA).
3 types of odontoid fx?
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)
Non-pregnant patients with life-threatening vaginal bleeding should be given ? Vs Patients with menorrhagia that is not life-threatening may be treated with
intravenous estrogen
nonsteroidal anti-inflammatory drugs, progesterone, oral contraceptives, tranexamic acid, or an intrauterine device.
Oral contraceptives are absolutely contraindicated in smokers over what age?
35
What is the most common cause of a pleural effusion in a patient residing in a developing nation?
TB
ulcerative colitis cx?
Toxic megacolon, ↑ colon cancer risk
Rabies post-exposure prophylaxis if NOT vaccinated? if vaccinated?
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
Which cranial nerve do cluster headaches exclusively involve? tx? 3
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
A previously healthy patient who presents with a first-time, cluster-type headache should be evaluated for what?
Carotid dissection.
How is the visual field defect of optic neuritis typically characterized?
Central scotoma, which is a gray, black, or blind spot in the middle of one’s vision.
4 characteristics of optic neuritis? tx?
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
Which type of cancer is the most common cause of hypercortisolism and can present with signs and symptoms of Cushing syndrome?
Small cell lung cancer.
best tx for pinworm?
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
Which helminth infection can metronidazole be used to treat?
Amebiasis, or Entamoeba histolytica, infection.
nocturnal pruritus ani? dx? tx?
pinworm. tape test.
Pyrantel pamoate/mebendazole/albendazole
Reactive arthritis triad
syndrome of conjunctivitis, arthritis, and urethritis in which Chlamydia trachomatis is implicated
What ECG finding is most consistent with a ventricular aneurysm?
QS wave with ST elevation
What is the blood pressure goal for patients with intracranial bleeding?
less than 140/90 mm Hg.
DM with rapidly progressive sinus pain and swelling with pink nasal discharge and headache? tx?
rhinocerebral mucormycosis.
Amphotericin B intravenously and otolaryngology consult
What antibiotic is the most appropriate treatment for malignant otitis externa, also commonly seen in diabetic patients?
Levofloxacin or ciprofloxacin.
Labs will show
anti-topoisomerase I (anti-Scl-70) antibody (specific for diffuse disease)
anti-centromere antibody (specific for limited disease)
scleroderma
dx aortoenteric fistula
computed tomography angiography scan of the abdomen
Fundoscopy will show “boxcar” look or “cherry red spot”
CRAO
What is propofol infusion syndrome?
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.
how to reverse rivaroxaban?
andexanet alfa. It is an inactive form of factor Xa that acts by binding and sequestering the anticoagulant.
how to reverse dabigatran?
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).
What factors are found in 4-factor prothrombin complex concentrate?
Factors II, VII, IX, and X, as well as protein C and protein S.
What is the classic presentation of patients with chronic mesenteric ischemia?
Intermittent postprandial pain.
What is the most common presenting complaint of arrhythmogenic right ventricular cardiomyopathy?
Palpitations
endometriosis triad? dx?
Patient will be complaining of pre or mid-cycle Dysmenorrhea, Dyspareunia, Dyschezia (painful bowel movement). MC lesions on ovaries. laparoscopy
Which class of cardiac medication more commonly leads to medication-induced peripheral edema as a side effect?
Dihydropyridine calcium channel blockers.
What drug class is most commonly implicated as the cause of delirium in the elderly?
anticholinergics
what can help differentiate infectious mononucleosis from streptococcal pharyngitis?
EBV- Presence of bilateral POSTERIOR cervical lymphadenopathy
When are false-negative rates highest for the heterophile antibody test for mononucleosis?
In the first week of clinical symptoms.
At what rate should sodium be corrected to avoid central pontine myelinolysis?
0.5 mg/dL/hr or a goal of 8–10 mg/dL/day.
kawasaki lab abnormalities
elevated acute phase reactants (ESR, C-reactive protein), urinalysis showing sterile pyuria, elevated WBC, thrombocytosis, and abnormal LFTs.
significant chest pain after vomiting, forceful coughing? tx?
Boerhaave syndrome. emergent surgical consult and broad-spectrum antibiotics
What finding in the ear is virtually pathognomonic for necrotizing otitis externa?
Friable granulation tissue at the floor of the osseocartilaginous junction.
What rare inherited condition should be considered in a patient presenting with many epidermoid cysts on the extremities?
Gardner syndrome.
What is a common cause of stridor in patients after prolonged intubation?1
Subglottic stenosis.
insp vs expiratory stridor?
Inspiratory stridor: obstruction above the glottis
Expiratory stridor: intrathoracic obstruction
Chronic stridor in infants
tracheomalacia
