Tres Flashcards
Hypsarrthymia, infant seizures on waking, delay=
infantile spasms
give ACTH, predinsose and AEDs
tuberous sclerosis
what is LEMON
when to give suggammadex
Sux raises K by…?
Look -beard/facial trauma. Eval 332. Mallampati. Obstruction (neck cancer, obesity, hematoma,infllmmation in airway) Neck mobility
Rocurionium (just put LMA in)
0.5
vWF minro bleeding tx
severe
Desmopressin
Cryoprecipitate (hase vWF in it) or Factor 8 concentrate
PTT prolonged if 8 very low
Termination criteria
CO2<10
K >12
ph <6.9 i thiknk/????
hypothermia of body temp less than 57- not dead until warm and dead
fluticason or cetirizine?
fluticasone
rash dista then central, hypoNA, thrombocytopenia, lfts?
Rocky moutnain
dermacentor tick
how many mcg of ep i are you giving in anaphgylaxis?
300 (1:1000) giving 0.3 ml
Tachy, red skin, LARGE WGMA kactic acidosis, AMS, headache
CN toxicity
Hydroxycobaliamine- binds and is excreted thru kidneys
stops oxidative phsophirlyation
SCIWROA prognosis?
Full recovery
spianl cord injury wihtout radiographic evidence
Basilar skull fracture stuff
gtemproal bone fractrue
Tx: just pain meds, observation- surgery not needed
Look above the eye lid
Cranial nerve deficits
BB Txs in ODs
GLucagon clackum fluids IV insulin (increase contractiliy with carb utilization) an dglucose lipid emulsions vasioressrs
Bradycardia, HypoTN, hyperK, AMS
Next move, massve PE- heparin or tpa/
tpa
heparin for submassive or less severe
hypoNA, hypoGlucose, hypoTN, not getting better with fluids?
Adrenal -100 mg hydrocortisone (or 4 Dex)
COPDers nto tkaing meds anymore
Dsiposition of electical injury
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.
What score od you use for nec fasc to help you out? US?
LRINEC
US can help too
Positive Hiv quick test needs hat next to confirm?
blood test with Blot or immnunoassay
Post exp ppx cna be given within 72 hours of tripple therapy
What do you need to have ready in the back of yoru mind for lots of fentanyl doses?
Rigid chest syndrome
Naloxone and BVM and then parlaysis if needed
bloody diarrhea in kid
THrmobocytopenia, hemolytic anemia, Renal filure? Tx?
HUS
Supportivem NO Abx
RBBBLead 1 and V1
LBBB lead 1 and V1
Downward deflection, Up
Up, Down
Thumb cannot resis abduction force, no pincer grip- what ijnury/
UCL
Game keepter skiier thumb
fever, tahcycardia, chest pain, dysnpea, oxygen sats OK after blood transfusion you need to
stop and make sure its nto hemolytic
msot likely your antiboides against donro leukocytes
Weigh tloss, painless jaindice, palpable gall baldder-
COurverier sign for choangiocarcinoma
Fever, exteeme rigidity, AMS from what OD?
Anti Dopamine pills for NMS
Icludes anti emetics liek phenergan and metocprlmaide
ARDS diangosis
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
Looks ike retinal detahcment on US but it moves aroudn liek a wave on US with EOM…
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
VBG on COPD exacerbation
CO2 retention with bicarb comepensation - but hten the compensationdoens tmake sense and they are more acidoditc
what is eryothema nodosum
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
SAH Tx
nimodopine BP/ head control sz ppx neuro checks reverse cogaluaopthy
AIDS weight loss bowel obstrcuion picture
SMA syndrome
The duaodenum is pinned beteween aorta and SMA- the fat pad lessens
Define neutropenic fever
100.9 once or 100.4 for an hour with ANC of 500 or less
usually worst 6-10 days after chemo - cver psudomonas
FLu like prodrome + mice + single papule eschar?
Rickettsial Pox from a mite
6 weeks post parrtum + HTN + HA + abd Pain + blurry vision = TX?
IV Mag and HTN Meds
this is pre ecmaplmpsia- risk for stroke
What do you do with an avulsed tooth?
carry it in milk
put it back in after your rinse it within 60 mintues
call oral surgeon if after 60 mintues
ear pain + vesicels + facial droop=
Ramsay hunt syndrome - Zoster otiticus
Watch out for menintigits and givr acyclovir
you give zofran or anatheor antiemeitc and then all of a sudden they want to leave - why/
Akasthesia- offer them benztropine or benadryl
COPD Tx?
Duonebs
Abx
Steorids
Bipap if encessayr
Asthma exacerbation on all the treatments getting wrose- what med?
Vent settings?
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
5 complications from brown reculse bite?
Hemolysis DIC AKI Rhabdo Arthalgias
Supportive, ABCs, Hct lvl, avoid ointments, ice
What is Kohler disease?
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.
open vs closed mandibular fx tx?
how to test for occult fx?
admit op. and iv abx vs dc home to dentist w/ abx
bite on tongue blade and try to break it
pulmonary contusion complications
edema, hemorrhage, cardiovascular compromise
possible pulmonary laceration
occurs 6-8 hours after blunt chest trauma
bad lung toward ceiling
A fib ddx
OUtside in
- Systemic- Infection, Thyroid, Drugs, Caffeine, hypovolemia
- Lungs- PE, PNA, COPD, hypoxia
- Pericardium- Itis aor effusion
- Myocardium- MI, itis
- Endo- itis, mitral stenosis!!
Diffuse ST elevation DDx:
- Proixmal LAD
- Pericarditis
- Myocarditis
- Benign eary repole
- POst MI anysursym
Seizure vs syncope?
- Tongue/pissy pants
- POst ictal
- Amnesia
- No prodrome
- epilepsy
Trauma to head?
Why Seizure? Sz antidotes?
AMS workup
HTS, Oxygen, flucose, B6 for INH, Mg for Eclampsia
UA +, flank pain, N/V Fever Tx- appears well
Pyelo, DC with augmenton, fluroquinolone, bactrim or third gen.
no sepsis, appears well= go home
Bleeding fistula site, pressure and it stops, what next?
Vascualr surgeon consult
make sure htere is a thrill and that there isnt a thrombosis
THrombosed hemorrhoid - when do you not take it out?
Immunocompromised patients, pregnant women, those with coagulopathies, >72 hours old
If not - elliptical incision and tkae it out
Tx for PCKD?
ACE and BP control
watch out for cerebral anyrusms
First step you ALWASY need to do when thinking baouthyponatremia?
If seizing what do you do?
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.
Painful ulcers
pailness
Painful is chancroid, HSV
CLamydia granuloma, klebsiella beefy ulcer granuomae, syphilis
Assymetircal motor neurons?
Assymetircla distal motor and sensory/
ALS
Mononeuropahty multiplex
difference in transverse myelits and GBS? Tx of TM/
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
What FVC do you need to tinubate and ventilate for them?
<20 cc/kg FVC
one eye Central scotoma, roetroorbital eye pain, affernt pupillary defect?
MS and optic neuritis
Central scotoma= Optic neuroitis or macular degeneration
FOOSH- TX and things you need to chekc for?
Scpahiod, snuffbox, thumb spica
CXR lung mass with weird nuro symptoms and lab abnromalities?
Think squamos cell, paraneoplastic syndrome . HYpercalcemia
AMS, hyponatremia, hyperK, hypoglyemia, HEadache with globe and pupil abnromalmities, CT with sellar mass-
pituitary apoplplexy- sudden hemorrhage into the pituitary- think hydrocoritcsone for glucocorticoids and minieralocorticoids for adrenal insufficiency
What do glucocorticoids do vs minerlaocorticoids
Min- all kidneys. H and K secretion (aldosteorne/fludricotrisone)
Gluc- responsiveness to catecholmines, gluconeogeneis, proten catabloism, immunosuppresion and slowed healing, weak minerlaocorticoids (everything else)
10 year old kid with viral illness, given RX then has AMS, N/V and LFTs high?
Aspirin- reyes syndrome
HSP labs
normal plateltes
get UA for kidney invovlement
arthritis
watchout for intussicpetion
bug bite with rigid abdomen tx?
Lorazepam form black widow muscle spasms- Autonomic instbaility
Antivenin for severe cases
What is rsi dosing for Ketamine bronchorrhea-larygnsoapsm-HTN Prop Etomidate Fentanyl hypotension
Sux
Rock long
1.5 mg
1.5 mg
.3 mg
2 mcg
- 5
- 0-1.2
WHat is Brash syndrome?
Bradycardia Renal failure AV nodal blockers Shock HyperK a cycling downward spiral
kid rash with multiple stages ofhealing complciaiton?
chicken pox zoster
bacterial superinfection
(penimonitis, encepjlaitis)
diverticulitis complication s you need to care about
perforaiton, obsturction, abscess, fistula
constipation is more common than diarrhea
recent MI coming in wirth SOB, resp distress - you need ot think about what?
mitral regurg, papillarty rupture.
listen for new murmur, may come in as shock.
can also happen after trauma, rheamtic, or endocarditis
Dx and tx for…
Ellis 1
ellis 2
ellis 3
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
Cause, Tx, DX for
DIC
TTP
ITP
DIC- supportive, they look sick, thrombin excess
TTP- endolthelin defect, Pentad FAT RN, PLEX, IVIG
ITP- Ab against PLatlets, Kids/illness, IVIG/steroids/steroids
PNA + low sodium?
legionella - cover atypicals
Difference between TRALI and TACO?
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!
Recent MI 2 weeks ago with a cough, SOB. no chest pain, PErsistent STEMI in V3-V6? Dx and complications form it
Ventircular anysrusm
Poor perfusion to mycoardial scar
CHF, thrombus, rupture, dysrhytmia
chronic UTI despite mutliple Abx given- what is your next ABx of choice Oral outpatient?
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
RSI dosing KEtamine Prop fentanyl etomidate
Sux
Roxk
1.5 mg- bronchorrhea, larynospma, HTN
1.5 mg
fent 2 mcg- hypotension
.3
- 5
- 2
first 4 steps for TE fistula
- Hyerinflate
- secure airway from above
- Take tube out
- compress
what does worsenign hpercpania mean on vbg?
Going ot icu
indiciations for tpa in PE?
Shock or CPR
if more stable0 hypoxemia, RH enlargement, excessive clot burden
TLS labs
High everything
low Ca
Dispo for iron ingestion?
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
what lab do you look at for biliary pancreatitis etiology?
ALT 3x upper limit
95% spec sendfor gallstone panc
What two things are bad to do in PAH patients?
Fluids (interventirclar septum bowing)
Intubation - increases pulmonary pressures and could cause them to code
Duodenal hematoma Pathphys
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.
How do you reverse dabigatran?
How do you reverse Xarelto
Idarucizumab or PCC
Adexenat
Why do you give HSV meds in bells palsy?
Bc ramsay hunt syrnome
pnuemomedisasinum TX?
Supplmentla O2
What is ARVD
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
Bloo dtransfusion urticaria, do you need to stop?
no
if you think hemolysis: positive antiglobulin, look out for ARF and DIC
leukemia stuff
super old, very high white count
kid. bone pain, LA
Older but still kids, higher complication/death risk, thrombocytopenia, neuropenia, fevr, fatigue
CLL
ALL
AML\
Similar presntation for CML
Dose for organophospahe poisning?
1-2 mg every 5 minutes until secretions dry
2pam
accuminata vs lata
lata is huge and syphylis
accuminata is small and hpv 6 o4
hypotension with necorsis and bullae in the setting of infection should be…
nec fasc
How do you define enutropenic fever?
Dotn do what phys exam move/
100.9 once or 100.4 1 hr - ANC <1500
DRE!
ddx rhabdo
3 main things you want to avoid?
Drugs and alcohol, falls, trauma, exercise, heat
DIC, ARF (aim for at least 200 cc hr uop), Lytes bad (Calcium)
Hyperemeis gravidarum 1 2 3 line tx?
D5 NS , clear ketones and doxyalmine + b6 (Class A)
then meclizine/benadryl or reglan zofran (ClassB)
big ol painful scrotum- gotta think about
incarcerated hernia
hydrocarbon- gasoline ingestion Tx and things to look out for
What do you need to look out for hydrogen peroxide ingestion?
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
Blue/hemorrhgae, outside, crpeitus, bullae lesion?
C perfringens causing myonecrosis
