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PGY2 > Shift > Flashcards

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1
Q

Atropine dosing

A

1mg IV q5min

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2
Q

peds atropine dosing

A

.01-.03mg/kg

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3
Q

Diltiazem dosing

A

.25 mg/kg IV over 2 min
repeat q15 mins at .35mg/kg IV

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4
Q

Diltiazem infusion

A

5mg/hr -> 10 -> 15

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5
Q

ACAT MUDPILES

A

alc ketoacidosis, carbon monoxide, ASA, Toluene
Methanol, uremia, DKA
Paraldehyde, iron/INH, lactic acidosis, ethylene glycol, starvation/sepsis

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6
Q

When do you give insulin with K+ levels in HHS

A

> 5 = nothing
4-5 = 20-30 mEq in 1st liter then 20 mEq/hr
3-4 = 40 mEq
<3 = hold insulin & give 10-20 mEq until >3.3

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7
Q

Tx for hypoglycemia

A

1.D5W
2. Octreotide
3. glucagon
***if adrenal insuff then give hydrocortisone

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8
Q

glucagon dosing

A

0.5-2mg IV/IM/SC

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9
Q

peds glucagon dosing

A

.03-.1

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10
Q

Hydrocortisone dosing

A

100mg IV

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11
Q

Dx HHS

A
  1. pH > 7.3
  2. BG >600
  3. HCO3 >15
  4. Serum osm >320
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12
Q

purpura description

A

non-blanchable, palpable

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13
Q

Venous stasis MC s/sx

A

pruritus

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14
Q

MC location of venous stasis ulcers

A

proximal to medial malleolus

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15
Q

DX osteomyelitis

A

MRI

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16
Q

Dx venous air embolism

A

bubble study

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17
Q

churning sound on auscultation of heart

A

air embolism

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18
Q

position for arterial air embolism

A

supine

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19
Q

position for venous air embolism

A

left lateral decubitus or trendelenburg

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20
Q

Pancreatitis abx

A

fluoroquinolone + metronidazole

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21
Q

Abx covering gram neg

A

Aminoglycosides, Monobactams, Ciprofloxacin, Cephalosporins, Carbapenems, Fluoroquinolones, Polymyxins, and Fosfomycin

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22
Q

abx covering anaerobes

A

Augmentin, Unasyn, Zosyn, Cefoxitin, carbapenems, moxifloxacin, clindamycin

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23
Q

abx covering MRSA

A

doxycycline, vancomycin, daptomycin, TMP SMX, clindamycin, linezolid, 5th gen cephalosporin

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24
Q

abx covering pseudomonas

A

Zosyn, ceftazidime, Rocephin, carbapenems, quinolones, amnioglycoside

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25
Q

Ranson Criteria on admission

A

Age >55 yr
WBC count >16,000 mm3
Blood glucose >200 mg/dL
Serum lactate dehydrogenase >350 IU/L
AST >250 IU/L

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26
Q

triad of Salicylate toxicity

A
  1. respiratory alkalosis (earliest sign)
  2. AG metabolic acidosis
  3. metabolic (contraction) alkalosis
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27
Q

Tx of Salicylate toxicity

A
  1. airway - avoid intubation
    2.decontamination - charcoal vs irrigation
  2. D5W - impairs glucose metab
  3. Bicarb - NaHCO3 1-2mEq/kg IV bolus; then 3amp bicarb in 1L D5W at 2-3mL/kg/hr
  4. dialysis
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28
Q

pathophys of Salicylate tox

A

Uncouples oxidative phosphorylation → increased metabolic rate and hyperthermia

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29
Q

s/sx of salicylate tox

A
  1. N/V
  2. resp alkalosis
  3. AG metab acidosis
  4. hyperthermia
  5. AMS
    6.pul edema - increased pul vascularity
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30
Q

anaphylaxis epi dosing

A

.3-.5mg IM

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31
Q

epi cardiac arrest

A

1mg

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32
Q

push dose epi

A

10mg syringe with NS –> remove 1cc -> add 1cc epi

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33
Q

management of transient global amnesia

A
  1. Rule out CVA (clinically or with further workup)
  2. Neurology referral
  3. Once diagnosed, no specific treatment needed
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34
Q

s/sx of transient global amnesia

A

Anterograde amnesia
Unaware of their memory loss
Normal attention and social skills
Struggle with delayed recall
Periods of time typically less than 24 hrs, but typically lasts 4-6 hrs
No localizing symptoms

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35
Q

isopropyl metabs to

A

acetone

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36
Q

isopropyl alcohol

A
  • AG metab acidosis
    +osmolar gap
    +ketones
  • ca ox stones
    + reduced vision
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37
Q

Work up for toxic alcohols

A

Fingerstick glucose
Complete metabolic panel
Serum ketones
Serum Osmolality
Urinalysis
VBG
Aspirin/Tylenol levels
ECG
Serum alc level
Total CK

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38
Q

tx isopropyl toxicity

A

supportive

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39
Q

ethylene glycol

A

+AG metab
+osmolar gap
-ketones
+ca ox stones
- reduced vision

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40
Q

tx ethylene glycol toxicity

A

Fomepizole, thiamine, B6, dialysis

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41
Q

Methanol

A

+AG metab
-ketones
-ca ox
+ reduced vision

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42
Q

tx methanol toxicity

A

fomepizole, etoh, folinic acid

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43
Q

Clinical features of CRAO

A

sudden, painless, monocular vision loss

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44
Q

Work up for CRAO

A

ESR & CRP, carotid US, EKG, echocardiogram

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45
Q

Managment of CRAO

A

high ESR/CRP -> start steroids & ophthalmology consult

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46
Q

Ativan dose for seizures

A

2mg

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47
Q

CIWA score to start benzos

A

8-10

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48
Q

management of type I AC joint injury

A

rest, ice, sling
ROM and strengthening exercises

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49
Q

management of type II AC joint injury

A

rest, ice, sling 3-7 days
ROM and strengthening exercises

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50
Q

management of Type III AC injury

A

rest, ice, sling 2-3 weeks
ROM and strengthening exercises
return to sport/work 6-12 weeks after injury
ortho consult within one week

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51
Q

Type IV & V AC joint injury

A

surgery; ortho consult

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52
Q

RSI induction agents

A

Etomidate
Versed
Propofol
Ketamine

53
Q

etomidate dosing

A

0.2-0.4mg/kg

54
Q

etomidate onset and duration

A

onset: 1 min
duration 30-60 mins

55
Q

Versed dosing

A

0.2-0.3mg/kg

56
Q

Versed onset and duration

A

onset: 1-2 mins
duration: 30-60 mins

57
Q

propofol dosing

A

1-3mg/kg

58
Q

propofol duration

A

10-15 mins

59
Q

Ketamine dosing

A

1-2 mg/kg

60
Q

ketamine duration

A

30 mins

61
Q

RSI paralytics

A

succinylcholine, rocuronium, vecuronium

62
Q

succinylcholine dosing

A

1.5mg/kg

63
Q

succinylcholine onset and duration

A

onset: 45 seconds
duration: 4-6 mins

64
Q

Rocuronium dosing

A

1.2mg/kg

65
Q

Rocuronium onset and duration

A

onset: 60 seconds
duration: 25-60 mins

66
Q

Vecuronium dosing

A

0.1mg/kg

67
Q

vecuronium onset and duration

A

onset 60-90 seconds
duration: 65 mins

68
Q

COPD exacerbation tx

A

CPAP/BiPAP, Duonebs (albuterol/ipratropium), steroids, magnesium, +/- abx

69
Q

Tx for outpatient CAP with no comorbidities

A

amoxicillin or doxycycline

70
Q

Tx for outpatient CAP with comorbidities (chronic heart, liver, lung, and renal disease; DM, alcoholism, malignancy, or asplenia)

A

Augmentin or cephalosporin + macrolide or doxycycline

71
Q

Tx for inpatient CAP (non-severe)

A

beta lactam + macrolide OR fluoroquinolone

72
Q

TX for inpatient CAP (severe)

A

beta lactam + macrolide OR beta lactam + fluoroquinolone

73
Q

Causes of proctitis

A

radiation, autoimmune, vasculitis, ischemia, infectious (STI)

74
Q

causes of epididymitis

A

STI ; e.coli, pseudomonas, TB, syphillis

75
Q

tx epididymitis

A

STI: rocephin and doxy
STi and enteric: rocpehin and levofloxacin
only enteric: Levofloxacin
Peds: Bactrim or augmentin

76
Q

Bacteria that causes cellulitis

A

staph and strep

77
Q

COVID 19 tx outpatient

A

Paxlovid, remdesivir,

78
Q

COVID tx outpatient or inpatient requiring new or increased oxygen

A

Dexamethasone

79
Q

Normal vent settings

A

TV: 8
RR: 10-12
PEEP: 5

80
Q

lung protective vent settings

A

TV: 6
RR:12-20
PEEP: 2-15

81
Q

obstructive vent settings

A

TV: 6
RR: 5-8
PEEP: 0-5

82
Q

Hypovol vent settings

A

TV: 8
RR: 10-12
PEEP: 0-5

83
Q

SCAPE (sympathetic crashing acute pul edema) s/sx

A

rales/crackles
SBP >180
Tachycardia
Tachypnea

84
Q

Tx SCAPE

A

GOAL: vasodilate arterial side and maintain oxygenation
BiPAP
Nitroglycerin
if dehydrated: IVF
captopril

85
Q

acute post infectious cerebellar ataxia

A

sudden ataxia after viral infection
can be seen on MRI
onset 5-10 days after

86
Q

psychogenic non-epileptic seizures tx

A

if new: EEG
lorazepam 1-2mg or hydroxyzine 50-100mg

87
Q

psychogenic non-epileptic seizures eval

A

same as seizure

88
Q

transient synovitis s/sx

A

unilat hip pain; children <10 yo; recent URI

89
Q

transient synovitis eval

A

XR, ESR, CBC, CRP

90
Q

transient synovitis tx

A

NSAIDs

91
Q

Retropharyngeal abscess s/sx

A

early: sore throat, fever, dysphagia, torticollis
Late: stridor, resp distress, chest pain, drooling, neck stiffness

92
Q

Retropharyngeal abscess dx

A

CT with IV contrast or XR soft tissues

93
Q

Retropharyngeal abscess tx

A

ENT for I&D
clindamycin or cefoxitin or zosyn

94
Q

types of supracondylar fx that needs ortho and surgery

A

type II & III

95
Q

splint for supracondylar

A

double sugar tong or long arm posterior

96
Q

XR findings of supracondylar fracture

A

anterior fat pad, posterior fat pad, and anterior humeral line

97
Q

tx refractory vfib

A

ap pad placement

98
Q

refractory vfib definition

A

continues after three successful shocks from a defib

99
Q

Miller fisher syndrome

A

(GBS variant) ophthalmoplegia, ataxia, areflexia

100
Q

neutropenic enterocolitis s/sx

A

10-14days after toxic drug (chemo), fever, RLQ pain, N/V

101
Q

neutropenic enterocolitis dx

A

neutropenia, thrombocytopenia
CT: cecal distention, wall thickening, pneumatosis, perf, fat stranding

102
Q

neutropenic enterocolitis tx

A

NPO, NG to suction, IVF, TPN, flagyl + cefepime or zosyn or amphotericin B

103
Q

chance fx

A

unstable; caused by flexion distraction forces (seatbelt from MVC)

104
Q

MC location for chance fx

A

T12-L2

105
Q

chance fx tx

A

if no neuro deficits: immobilize
neuro deficits: surgery

106
Q

ITP s/sx

A

petechiae, epistaxis, gingival bleeding, menorrhagia, GI bleed, intracranial bleed

107
Q

ITP tx

A

adults: high dose steroids
peds: IVIG and steroids

108
Q

tx mesenteric adenitis

A

only if ill: ciporfloxacin or TMP/SMX to cover for yersinia

109
Q

Tx HAPE

A

O2, hyperbarics, nifedipine (30mg ER)

110
Q

Tx of hypercalcemia of malignancy

A

only if s/sx or >14; fluids, calcitonin, bisphosphonates; dialysis

111
Q

when do you give dialysis for hypercalcemia

A

Anuric with renal failure
Failing all other therapy
Severe hypervolemia not amenable to diuresis
Serum Calcium level >18mg/dL
Neurologic symptoms
Heart failure with reduced ejection fraction (unable to provide fluids)

112
Q

refeeding syndrome electrolyte abnormalities

A

hypophos, hypomag, metab acidosis, hypokal, prolonged QT

113
Q

starting BiPAP settings

A

IPAP of 8-10 cm H2O and an EPAP of 2-4 cm H2O.

114
Q

Traditional initial mechanical vent settings

A

FiO2: 100%, rate: 8-12, PEEP 0-5, TV: 5-8, I:E: 1:2

115
Q

LVAD complications

A

pump thrombosis, batteries, suction event (cannula malposition, tamponade, or vascular resistance), arrhythmia, infection, bleeding

116
Q

how to measure BP with LVAD

A

BP cyff with doppler

117
Q

Elevated LDH >1150 for LVAD patients

A

pump thrombosis

118
Q

when to start compressions on a LVAD patient

A

patient is unresponsive with MAP less than 50mmHg, end tidal carbon dioxide level less than 20mmHg, or LVAD cannot be restarted

119
Q

NMS presentation

A

AMS, hyperthermia, lead pipe rigidity (MC), tachycardia, HTN, diaphoresis

120
Q

Tx NMS

A

benzos, IVF, cooling; +/- dantrolene and bromocriptine

121
Q

NMS cause

A

antipsychotics or DA anti nausea

122
Q

How to tell difference between NMS and serotonin syndrome

A

NMS has elevated CK, LFTs, and WBCs and decreased iron

123
Q

serotonin syndrome presentation

A

clonus (MC), more acute, hyperreflexia, AMS, tremor

124
Q

tx serotonin sydrome

A

benzos, cyproheptadine, chlorpromazine

125
Q

malignant hyperthermia causes

A

anesthesia

126
Q

malignant hyperthermia tx

A

dantrolene, O2, bicarb

127
Q

malignant hyperthermia presentation

A

fever, muscle contraction (Masseter), hypercarbia

128
Q

tx of asthma exacerbation

A

O2, albuterol, ipratropium, steroids (dexamethasone or methylprednisone), magnesium, epi (0.5mg), terbutaline,

129
Q

tx lymphadenitis

A

abx - cephalexin, augmentin

PGY2 (7 decks)

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