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Rosh > Tres > Flashcards

Tres Flashcards

1
Q

Hypsarrthymia, infant seizures on waking, delay=

A

infantile spasms
give ACTH, predinsose and AEDs
tuberous sclerosis

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2
Q

what is LEMON
when to give suggammadex
Sux raises K by…?

A

Look -beard/facial trauma. Eval 332. Mallampati. Obstruction (neck cancer, obesity, hematoma,infllmmation in airway) Neck mobility
Rocurionium (just put LMA in)
0.5

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3
Q

vWF minro bleeding tx

severe

A

Desmopressin
Cryoprecipitate (hase vWF in it) or Factor 8 concentrate
PTT prolonged if 8 very low

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4
Q

Termination criteria

A

CO2<10
K >12
ph <6.9 i thiknk/????
hypothermia of body temp less than 57- not dead until warm and dead

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5
Q

fluticason or cetirizine?

A

fluticasone

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6
Q

rash dista then central, hypoNA, thrombocytopenia, lfts?

A

Rocky moutnain

dermacentor tick

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7
Q

how many mcg of ep i are you giving in anaphgylaxis?

A

300 (1:1000) giving 0.3 ml

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8
Q

Tachy, red skin, LARGE WGMA kactic acidosis, AMS, headache

A

CN toxicity
Hydroxycobaliamine- binds and is excreted thru kidneys
stops oxidative phsophirlyation

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9
Q

SCIWROA prognosis?

A

Full recovery

spianl cord injury wihtout radiographic evidence

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10
Q

Basilar skull fracture stuff

A

gtemproal bone fractrue
Tx: just pain meds, observation- surgery not needed
Look above the eye lid
Cranial nerve deficits

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11
Q

BB Txs in ODs

A 
GLucagon
clackum
fluids
IV insulin (increase contractiliy with carb utilization) an dglucose
lipid emulsions
vasioressrs

Bradycardia, HypoTN, hyperK, AMS

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12
Q

Next move, massve PE- heparin or tpa/

A

tpa

heparin for submassive or less severe

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13
Q

hypoNA, hypoGlucose, hypoTN, not getting better with fluids?

A

Adrenal -100 mg hydrocortisone (or 4 Dex)

COPDers nto tkaing meds anymore

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14
Q

Dsiposition of electical injury

A

Get UA, EKG, BMP looking for arrythmia, mygolbin, mucle damage
if skin burn - observe for severql hours then go , if nto can g hoem i f all negative

figure out if AC current- more severe, an dhwo much volts was used.

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15
Q

What score od you use for nec fasc to help you out? US?

A

LRINEC

US can help too

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16
Q

Positive Hiv quick test needs hat next to confirm?

A

blood test with Blot or immnunoassay

Post exp ppx cna be given within 72 hours of tripple therapy

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17
Q

What do you need to have ready in the back of yoru mind for lots of fentanyl doses?

A

Rigid chest syndrome

Naloxone and BVM and then parlaysis if needed

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18
Q

bloody diarrhea in kid

THrmobocytopenia, hemolytic anemia, Renal filure? Tx?

A

HUS

Supportivem NO Abx

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19
Q

RBBBLead 1 and V1

LBBB lead 1 and V1

A

Downward deflection, Up

Up, Down

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20
Q

Thumb cannot resis abduction force, no pincer grip- what ijnury/

A

UCL

Game keepter skiier thumb

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21
Q

fever, tahcycardia, chest pain, dysnpea, oxygen sats OK after blood transfusion you need to

A

stop and make sure its nto hemolytic

msot likely your antiboides against donro leukocytes

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22
Q

Weigh tloss, painless jaindice, palpable gall baldder-

A

COurverier sign for choangiocarcinoma

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23
Q

Fever, exteeme rigidity, AMS from what OD?

A

Anti Dopamine pills for NMS

Icludes anti emetics liek phenergan and metocprlmaide

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24
Q

ARDS diangosis

A

emonstration of diffuse bilateral pulmonary infiltrates on imaging, (2) exclusion of a cardiac etiology (through normal echocardiography, BNP, or right heart catheterization), and (3) a PaO2:FiO2 of less than 200

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25
Q

Looks ike retinal detahcment on US but it moves aroudn liek a wave on US with EOM…

A

POster vitreous detahcment- emegrent for risk of retinal detahcment
vitreous is an avascular layer of the eye attached anteriorly to the ora serrata, and posteriorly to the optic disc head. Symptoms include the sudden onset of monocular flashes and floaters that appear particularly with eye movement

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26
Q

VBG on COPD exacerbation

A

CO2 retention with bicarb comepensation - but hten the compensationdoens tmake sense and they are more acidoditc

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27
Q

what is eryothema nodosum

A

tender looking bruises in the shins- delayed hypersenistivty inflammoatry reaction between demis and adipose
after bactrim, infection or AI dz like lupus or sarcoid
self limited for 6 weeks
arthralgias

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28
Q

SAH Tx

A 
nimodopine 
BP/ head control
sz ppx
neuro checks
reverse cogaluaopthy
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29
Q

AIDS weight loss bowel obstrcuion picture

A

SMA syndrome

The duaodenum is pinned beteween aorta and SMA- the fat pad lessens

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30
Q

Define neutropenic fever

A

100.9 once or 100.4 for an hour with ANC of 500 or less

usually worst 6-10 days after chemo - cver psudomonas

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31
Q

FLu like prodrome + mice + single papule eschar?

A

Rickettsial Pox from a mite

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32
Q

6 weeks post parrtum + HTN + HA + abd Pain + blurry vision = TX?

A

IV Mag and HTN Meds

this is pre ecmaplmpsia- risk for stroke

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33
Q

What do you do with an avulsed tooth?

A

carry it in milk
put it back in after your rinse it within 60 mintues
call oral surgeon if after 60 mintues

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34
Q

ear pain + vesicels + facial droop=

A

Ramsay hunt syndrome - Zoster otiticus

Watch out for menintigits and givr acyclovir

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35
Q

you give zofran or anatheor antiemeitc and then all of a sudden they want to leave - why/

A

Akasthesia- offer them benztropine or benadryl

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36
Q

COPD Tx?

A

Duonebs
Abx
Steorids
Bipap if encessayr

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37
Q

Asthma exacerbation on all the treatments getting wrose- what med?
Vent settings?

A

IM epi- repeat every 30 mins to 60 mins

Intubaitons is not that scary- 6 cc/kg, low PEEP at 5 to vercome tube resistance, I:E ratio 1:4/5, rate 10-12

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38
Q

5 complications from brown reculse bite?

A 
Hemolysis
DIC
AKI
Rhabdo
Arthalgias

Supportive, ABCs, Hct lvl, avoid ointments, ice

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39
Q

What is Kohler disease?

A 
Navicluar bone AVNecrosis
BOYS, 4-5 years old
can be bilateral
X ray shows necrosis , sclrosis of navicualr
Walking boto and gets better in 6 months

Think of the foot as Hind foot talus/calcanoues
mid foot navicualr, cuenifroms
and forefoot is metatarasl and digits

Freiberg is adolescent females - at the metatarsal - PIP joint AVN.

40
Q

open vs closed mandibular fx tx?

how to test for occult fx?

A

admit op. and iv abx vs dc home to dentist w/ abx

bite on tongue blade and try to break it

41
Q

pulmonary contusion complications

A

edema, hemorrhage, cardiovascular compromise

possible pulmonary laceration

occurs 6-8 hours after blunt chest trauma

bad lung toward ceiling

42
Q

A fib ddx

A

OUtside in

  1. Systemic- Infection, Thyroid, Drugs, Caffeine, hypovolemia
  2. Lungs- PE, PNA, COPD, hypoxia
  3. Pericardium- Itis aor effusion
  4. Myocardium- MI, itis
  5. Endo- itis, mitral stenosis!!
43
Q

Diffuse ST elevation DDx:

A
  1. Proixmal LAD
  2. Pericarditis
  3. Myocarditis
  4. Benign eary repole
  5. POst MI anysursym
44
Q

Seizure vs syncope?

A
  1. Tongue/pissy pants
  2. POst ictal
  3. Amnesia
  4. No prodrome
  5. epilepsy

Trauma to head?

45
Q

Why Seizure? Sz antidotes?

A

AMS workup

HTS, Oxygen, flucose, B6 for INH, Mg for Eclampsia

46
Q

UA +, flank pain, N/V Fever Tx- appears well

A

Pyelo, DC with augmenton, fluroquinolone, bactrim or third gen.
no sepsis, appears well= go home

47
Q

Bleeding fistula site, pressure and it stops, what next?

A

Vascualr surgeon consult

make sure htere is a thrill and that there isnt a thrombosis

48
Q

THrombosed hemorrhoid - when do you not take it out?

A

Immunocompromised patients, pregnant women, those with coagulopathies, >72 hours old

If not - elliptical incision and tkae it out

49
Q

Tx for PCKD?

A

ACE and BP control

watch out for cerebral anyrusms

50
Q

First step you ALWASY need to do when thinking baouthyponatremia?

If seizing what do you do?

A

is is hypovolemia, euvolemia, hypervolemia?!
then Mental status
Like amarhton runner is hypovolemic and will need hypertonic and volume

give 100-150 cc bolus of HTS, rpeat 3 times as needed. D onot raise 8–12 mEq/L during the first 24 hours for fear of osmotic demyelination syndrome.

51
Q

Painful ulcers

pailness

A

Painful is chancroid, HSV

CLamydia granuloma, klebsiella beefy ulcer granuomae, syphilis

52
Q

Assymetircal motor neurons?

Assymetircla distal motor and sensory/

A

ALS

Mononeuropahty multiplex

53
Q

difference in transverse myelits and GBS? Tx of TM/

A

Definitive line of changes. IV steroids vs plasma exhange - inflammoatyr condiiton of spinal cord which can occur after an illness like GBS

GBS is moleclar mimcyr for myelination of the nerves

54
Q

What FVC do you need to tinubate and ventilate for them?

A

<20 cc/kg FVC

55
Q

one eye Central scotoma, roetroorbital eye pain, affernt pupillary defect?

A

MS and optic neuritis

Central scotoma= Optic neuroitis or macular degeneration

56
Q

FOOSH- TX and things you need to chekc for?

A

Scpahiod, snuffbox, thumb spica

57
Q

CXR lung mass with weird nuro symptoms and lab abnromalities?

A

Think squamos cell, paraneoplastic syndrome . HYpercalcemia

58
Q

AMS, hyponatremia, hyperK, hypoglyemia, HEadache with globe and pupil abnromalmities, CT with sellar mass-

A

pituitary apoplplexy- sudden hemorrhage into the pituitary- think hydrocoritcsone for glucocorticoids and minieralocorticoids for adrenal insufficiency

59
Q

What do glucocorticoids do vs minerlaocorticoids

A

Min- all kidneys. H and K secretion (aldosteorne/fludricotrisone)
Gluc- responsiveness to catecholmines, gluconeogeneis, proten catabloism, immunosuppresion and slowed healing, weak minerlaocorticoids (everything else)

60
Q

10 year old kid with viral illness, given RX then has AMS, N/V and LFTs high?

A

Aspirin- reyes syndrome

61
Q

HSP labs

A

normal plateltes
get UA for kidney invovlement
arthritis
watchout for intussicpetion

62
Q

bug bite with rigid abdomen tx?

A

Lorazepam form black widow muscle spasms- Autonomic instbaility
Antivenin for severe cases

63
Q 
What is rsi dosing for
Ketamine bronchorrhea-larygnsoapsm-HTN
Prop
Etomidate
Fentanyl hypotension

Sux
Rock long

A

1.5 mg
1.5 mg
.3 mg
2 mcg

  1. 5
  2. 0-1.2
64
Q

WHat is Brash syndrome?

A 
Bradycardia
Renal failure
AV nodal blockers
Shock
HyperK
a cycling downward spiral
65
Q

kid rash with multiple stages ofhealing complciaiton?

A

chicken pox zoster
bacterial superinfection
(penimonitis, encepjlaitis)

66
Q

diverticulitis complication s you need to care about

A

perforaiton, obsturction, abscess, fistula

constipation is more common than diarrhea

67
Q

recent MI coming in wirth SOB, resp distress - you need ot think about what?

A

mitral regurg, papillarty rupture.
listen for new murmur, may come in as shock.

can also happen after trauma, rheamtic, or endocarditis

68
Q

Dx and tx for…
Ellis 1
ellis 2
ellis 3

A

Enamel- file it and sne dhome dental
+dentin- yellowish white, cover with calcium hydroxide
+ pulp- wipe with white cloth to look for pink/red, immediate dentla consult

69
Q

Cause, Tx, DX for
DIC
TTP
ITP

A

DIC- supportive, they look sick, thrombin excess
TTP- endolthelin defect, Pentad FAT RN, PLEX, IVIG
ITP- Ab against PLatlets, Kids/illness, IVIG/steroids/steroids

70
Q

PNA + low sodium?

A

legionella - cover atypicals

71
Q

Difference between TRALI and TACO?

A

Lung injury= hypotension- aburptly or within 6 hours- usually with FFP or platelets
Taco= HTN

TRALI- endolthelial damage and then leaking, fever, tachy, hypoxic, hypotension. Stop an surrpotive care

ABO- fever, chills, chest restriction, joint pain, hemolysis

allergic can be anaphylaxis!

72
Q

Recent MI 2 weeks ago with a cough, SOB. no chest pain, PErsistent STEMI in V3-V6? Dx and complications form it

A

Ventircular anysrusm
Poor perfusion to mycoardial scar
CHF, thrombus, rupture, dysrhytmia

73
Q

chronic UTI despite mutliple Abx given- what is your next ABx of choice Oral outpatient?

A

Fosomycic- good againt E coli and E facelis- and MDRs. check a culture.
Side effect- vagnitis, HEadache, NV, diarrhea

bacteriocidal against cell walll- high [ ] in bladder

74
Q 
RSI dosing
KEtamine
Prop
fentanyl
etomidate

Sux
Roxk

A

1.5 mg- bronchorrhea, larynospma, HTN
1.5 mg
fent 2 mcg- hypotension
.3

  1. 5
  2. 2
75
Q

first 4 steps for TE fistula

A
  1. Hyerinflate
  2. secure airway from above
  3. Take tube out
  4. compress
76
Q

what does worsenign hpercpania mean on vbg?

A

Going ot icu

77
Q

indiciations for tpa in PE?

A

Shock or CPR

if more stable0 hypoxemia, RH enlargement, excessive clot burden

78
Q

TLS labs

A

High everything

low Ca

79
Q

Dispo for iron ingestion?

A 
Get  IRON level 4-6 hours after ingestion (500 is seriours)
need 40-60 mg/kg for symptoms/toxicity
GI phase happens witin 6 hrs
then latent pahse fr 24 hours
then dsitrbituiv shock after that
80
Q

what lab do you look at for biliary pancreatitis etiology?

A

ALT 3x upper limit

95% spec sendfor gallstone panc

81
Q

What two things are bad to do in PAH patients?

A

Fluids (interventirclar septum bowing)

Intubation - increases pulmonary pressures and could cause them to code

82
Q

Duodenal hematoma Pathphys

A

Pinned against vertebral body, hematoma forms, obstrucitons and hematemsis happens

Chilaiditi syndrome refers to the presence of right upper abdominal pain plus the overlying position of the right colon relative to the liver underneath the right hemidiaphragm. This may be misinterpreted on radiography as pneumoperitoneum.
A Dieulafoy lesion refers to a large gastric vessel that can result in a significant amount of upper gastrointestinal bleeding.

83
Q

How do you reverse dabigatran?

How do you reverse Xarelto

A

Idarucizumab or PCC

Adexenat

84
Q

Why do you give HSV meds in bells palsy?

A

Bc ramsay hunt syrnome

85
Q

pnuemomedisasinum TX?

A

Supplmentla O2

86
Q

What is ARVD

A

Fibrofaty replacement in RV causing ventricular dysrhytmias
PSOITIVE deflection at the end of QRS

aneyrusm is QS waves or deep QRS complex into a st elevation

87
Q

Bloo dtransfusion urticaria, do you need to stop?

A

no

if you think hemolysis: positive antiglobulin, look out for ARF and DIC

88
Q

leukemia stuff
super old, very high white count
kid. bone pain, LA
Older but still kids, higher complication/death risk, thrombocytopenia, neuropenia, fevr, fatigue

A

CLL
ALL

AML\
Similar presntation for CML

89
Q

Dose for organophospahe poisning?

A

1-2 mg every 5 minutes until secretions dry

2pam

90
Q

accuminata vs lata

A

lata is huge and syphylis

accuminata is small and hpv 6 o4

91
Q

hypotension with necorsis and bullae in the setting of infection should be…

A

nec fasc

92
Q

How do you define enutropenic fever?

Dotn do what phys exam move/

A

100.9 once or 100.4 1 hr - ANC <1500

DRE!

93
Q

ddx rhabdo

3 main things you want to avoid?

A

Drugs and alcohol, falls, trauma, exercise, heat

DIC, ARF (aim for at least 200 cc hr uop), Lytes bad (Calcium)

94
Q

Hyperemeis gravidarum 1 2 3 line tx?

A

D5 NS , clear ketones and doxyalmine + b6 (Class A)

then meclizine/benadryl or reglan zofran (ClassB)

95
Q

big ol painful scrotum- gotta think about

A

incarcerated hernia

96
Q

hydrocarbon- gasoline ingestion Tx and things to look out for

What do you need to look out for hydrogen peroxide ingestion?

A

It is not well absorbed- systemic toxicity is rare
very volatile from stomach- Pneumoniitis risk! watch for 6 hour evaluating for pneumonitis and need for ventilation hypercarbia, severe respiratory distress, CNS depression, and hypoxia.

or asyhpxiant if inhaled- displaces oxygen

hhydorgen peroxide ingestion? Gas emboli in brain! hyperbarics

97
Q

Blue/hemorrhgae, outside, crpeitus, bullae lesion?

A

C perfringens causing myonecrosis

Rosh (14 decks)

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