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210 Cards in this Set
- Front
- Back
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Man waterskiing wiped out and is pulled out of water after 2 mins submersion. Comes back s/p CPR but still somnolent, temp normal, pulse ox is 95%. What's the next step?
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C-spine films
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Man waterskiing wiped out and is pulled out of water after 2 mins submersion. Comes back s/p CPR but still somnolent, temp normal, pulse ox is 95%. What's the next step?
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C-spine films
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What drugs (2) prevent acute mountain sickness?
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1. Dexamethasone
2. Acetazolamide (Inh bicarb absorption-->met acidosis-->incr RR) |
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What PE finding separates sympathomimetic crisis from anticholinergic?
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Sweating in symp not in anticholinergic
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Toxic appearance, worsening fever and meningismus...next step?
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IV ceftriaxone and dexamethasone...tx first when PE clearly points to meningitis
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How much is the lowest 1 time adult ingestion of tylenol that may require NAC? Peds dose?
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7.5g
(150mg/kg in peds) |
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x4 risk factors for PID? Tx?
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Young, mult partners, history of BV, smoking.
Tx: IM ceftriaxone + doxy or azithromycin |
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COPDer on home O2 looks crappy with O2 sat of 85% on 4L non-rebreather. Do you turn the O2 up, down, or leave it the same.
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UP! First step is get this pt O2 (90% is a reasonable goal with COPDers)..you can always intubate later if u blunt her resp drive.
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Lyme Disease:
-Where -Rash? -Sx's -Neuro? Tx? Doxy (amox for pregnant or kids) |
-Where: Northeast and midwest
-Rash: Erythema migrans (outward spread, central clearing) -Sx's: malaise, fatigue HAs -Neuro: CN Palsies (7 most common) Tx: Doxy (amox for pregnant or kids) |
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Belly pain with BHCG <1000. When can they go home and with what instructions?
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If ovarian US is clear, they can repeat HCG in two days.
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Knee knocking and clicking...think?
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Meniscal injury (typically medial meniscus)
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When do exercise induced asthma attacks geneally begin after the onset of exercise? What season is most common.
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Begin 5-10mins after exertion.
More common in winter. |
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Pt has clear dig toxicity and level of 8.5ng, you give fragments and her level jumps to 12ng...whats the next step?
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Nothing, the dig lab also measures the fragment, so the increase makes sense
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Three drugs to avoid in dig toxicity?
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-Procainamide (arrhythmias)
-Calcium chloride ("stone heart") -Potassium cholride unless absoltuely necessary |
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Pt has clear ICP ad you decide to hyperventilate...what is the ideal ETCO2 range for this purpose?
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Between 30-35 mmHg (less than 30 causes hypoxic brain injury)
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Pt comes in in anticholinergic crisis & needs sedation...what do you use?
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Benzos; they're anti-epileptic with no anticholinergic properties.
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You suspect Rt Sided MI...how do adjust your EKG leads?
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Switch V4 to rV4 (mirror image on the rt side, basicallt 5th intercostal space, mid-clavicular line)
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Most common form of botulism is (infant, food, cardiac, or wound?)
Botulism is chracterized by ______________ paralysis. |
1. Infant botulism (via honey)
2. Descending paralysis |
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Most likely BAD complication from feet first impact falls is?
50% of falls froma height > ___ stories results in death. |
1. Retroperitoneal bleed (2nd to hip fracture)
2. Four stories |
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Neonate has a seizure shortly after birth...most likely cause?
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HYPOXIA d/t intrapartum or antepartum asphyxia (way less likely would be IC hemorrhage, sepsis, metabolic, etc)
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S/p MVA B/L UE strength is 1/5; B/L LE strength is 4/5...Dx?
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Central cord syndrome
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What's the dose and route for epi ina refractory asthma attack?
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0.3ml 1/1,000 SQ
(Recall: SQ doses are always 1/1000 conc; IV is always 1/10,000) |
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Most likely organism for meningitis in:
1. Neonates 2. Teens-20s 3. 30s-70s 4. > 70 |
1. Group B Strep
2. Neisseria Menengitidis 3. Strep Pneumo 4. Listeria monocytogenes |
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DHE...what's its use and major side-effect?
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Dihydroergotamine for chronic daily HAs. Nausea is common so pre-treat w/ antiemetic.
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DM or Immune suppressed pt has purulent nasal discharge and black eschar in her nose...Dx?
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Mucormycosis
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How is tylenol metabolized?
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4 ways! (listed in order)
1. Glucuronidation 2. Sulfation (targeted by NAC) 3. P-450 (cause of liver tox) 4. Renal (only 5%) |
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Kid coughing up blood, most likely cause?
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Cystic fibrosis is 65% of peds hemoptysis (distant 2nd is congenital cardiac, worth keeping in mind at tertiary care referral center)
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Shigella: Sx's & Tx
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High fever, abd pain, diarrhea and (only in 35%) bloody diarrhea. Tx with fluoroquinolone as its resistent to TMP-SMX
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Tx for uncomplicated community acquired PNA?
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Levofloxacin 500mg BID for 10d (Doxy also works)
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Oral derm finding and exact location with measels?
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Koplick spots (irregular red macules with white punctate lesions on buccal mucosa across from 2nd molars (most common location)
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Puking drunk has chemical pneumonitis: CXR findings and tx (Abx, steroids, neither, both?)
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bilateral midzone alveolar infiltrates; no tx needed (though abx are often inappropriately prescribed)
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You just intubated a pt, now they're "fighting the vent", what do you do?
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RSI drugs wore off & you didn't prescribe post-tube sedation. Bolus midaz & start a midaz drip.
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New chemo pt feels profoundly weak a few days s/p 1st dose chemo. Dx & Lab findings?
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Tumor lysis syndrome, hyperkalemia, hyperphosphatemia,
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Nikolsky's sign: What is it and which diseases (3) have it?
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Press a blister and it spreads wider into adjacent normal skin
1. Pemphigus Vulgaris (classic) 2. SSSS 3. TEN |
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Most common cause of myocarditis in US? Signs & labs?
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Cocksackie B myocarditis, look for CP, CHF-type complaints, and moderately elevated troponins s/p viral illness
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Age, gender, and race most likely to complete suicide.
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>75, male, white
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Hypothermic pt begins to actively rewarmed with warm saline, blankets and ambient temp, but temp continues to drop. Next step in management?
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This is a typical "afterdrop" phenomenon and is of no clinical importance. Continue to rewarm.
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Bupoprion overdose? What's your management and why?
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24 hours obs for seizure risk. Seizures are not able to be predicted by any means, no other notable sequelae.
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Anterior cord syndrome neuro deficit?
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Motor function + Pain and Temp.
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Old dude fall down the stairs and hits his head: Rank the likihood of these bleeds in order of most likely:
-Cerebral contusion -EDH -SAH -SDH |
1. Cerebral contusion
2. SDH 3. EDH 4. SAH |
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Top 2 causes of new onset seizure in AIDS pt?
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1) Mass effect 2/2 toxoplasmosis
2) Meningitis (i.e. cryptococcal) |
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25% of Guillan Barre episodes are preceded by _________?
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Campylobacter jejuni diarrhea
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_____ % of Guillan Barre will have respiratory failure requiring ventilation.
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25%
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Posterior fat pad in a posterior elbow film suggests _________ in children and _________ in adults?
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Children = supracondylar fracture
Adults = Radial head fracture |
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How do you diagnose Acute Rheumatic Fever?
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Jones Criteria
1. GAS infection documented + 2 of the 5 major manifestations (pancarditis, migratory arthritis, sydenham's chorea, erythema marginatum, subcutaneous nodules) OR 2. GAS infection documented + 1 major criteria and two minor (fever, arthralgia, history of ARF, or history of rh heart disease) |
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Scarlet fever dx vs Rheumatic Fever diagnosis?
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Both are GAS with high fever, scarlet fever has a sandpaper rash that starts in inguinal folds and becomes generalized fast.
ARF must meet jones criteria. 1. GAS infection documented + 2 of the 5 major manifestations (pancarditis, migratory arthritis, sydenham's chorea, erythema marginatum, subcutaneous nodules) OR 2. GAS infection documented + 1 major criteria and two minor (fever, arthralgia, history of ARF, or history of rh heart disease) |
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Community acquired PNA in a 3yo documented by focal infiltrates on CXR...organism and tx?
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Organism: Likely viral, but prudent to treat for strep pneumo with the infiltrate
Tx: High-dose amoxicillin (levofloxacin and doxycycline are contraindicated in kids!) |
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Community acquired PNA in a 3yo documented by focal infiltrates on CXR...organism and tx?
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Organism: Likely viral, but prudent to treat for strep pneumo with the infiltrate
Tx: High-dose amoxicillin (levofloxacin and doxycycline are contraindicated in kids!) |
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Mesenteric ischemia is caused by _________________ more than 60% of the time?
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Emboli in the SMA (from the LA or LV)
Plaque rupture only 15%, venous thrombosus of SMV 15% |
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Presentation and Two main mechanisms for POSTERIOR shoulder dislocation?
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No abduction or external rotation, may be very little pain
Seizure and (less commonly) FOOSH |
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Which is more dangerous AC or DC current?
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AC is 3 times more dangerous.
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Pedestrian vs car now has knee pain infero-lateral to patella with negative films and can bear weight. Next step in management?
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CT knee (tibial plateau fractures are often occult and need weeks of non-weight bearing)
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Dx test & tx of tibial stress fx?
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More likely in women with osteoporosis. Only 50% show up on Xray, so bone scan may be needed (not really an ED thing though). Tx with RICE.
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20% of asthmatics will experience __________ after intubation? Why does this happen and what is the tx?
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Hypotension d/t airtrapping causing increased intrathopracic pressure and a BP drop.
Tx with pre-intubation IVF bolus and GENTLE bagging (post intubation you can turn off vent and allow pt to exhale trapped air out via open ET tube) |
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What are the 6 characteristics of migraines (3/6 needed for the dx)?
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1. Unilateral
2.Throbbing 3. Moderate - severe 4. Pain worse with movement 5. N / V 6. Photo or phonophobia |
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Whats the most common cause of hypokalemia?
What specific subset of pts suffer serious pathology is hypokalemic? |
1. Diuretics
2. Post-MI pts are high risk for arrhythmias if K < 4.5 (most other pts tolerate hypokalemia very well actually) |
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Best tx for jellyfish nematocysts is?
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Bath generously in 5% vinegar, can also rinse in seawater (NOT fresh water)
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Pt has 8-ball hyphema, tx?
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Sit them up, apply eye sheild, update tetanus and call optho (they will give steroids)
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Bacterial proctatitis dx & tx?
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Fever, dysuria and boggy / tender prostate in an old man.
Tx with flouroquinolone (i.e. cipro) for THIRTY DAYS. |
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With adrenal insufficiency, what are the 3 most common abnormalities on BMP?
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Hyponatremia, Hyperkalemia, Hypoglycemia (think of it as pt has no aldosterone)
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64 yo F smoker with Na = 112; you give her 0.9NS...what's her dx and what happens?
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This is SIADH d/t small cell lung CA; tx is water restriction when mild or 3% NaCl when severe (as in this case)
0.9 NaCl makes it worse (just more volume for ADH to suck H20 out of) |
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Epididimitis:
A) Symptoms? B) Causitive organism by age group? And tx for each? |
A) Teste pain, scrotal tenderness, dysuria, low grade fever (HAS cremasteric reflex, no N/V, no flank pain
B) <35 = Chlamydia then gonococcus; tx with ceftri + doxy >35 = E. Coli; tx with TMP-SMX + Cipro |
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The lay term "tonsil" refers to which tonsils?
Which tonsils does a PTA involve? |
Palatine for both. (2 columns of Lymphoid tissue in the posterolateral aspect or the oropharynx)
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Tx and dispo of uterine prolapse?
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Try to manually reduce, can place pessary as stop-gap measure, non-emergent OB-Gyn follow-uo
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Most common side effect of the following opioids:
A) Propoxyphene B) Meperidine C) Fentanyl D) Morphine |
A) Propoxyphene = QRS prolongation
B) Meperidine = Seizures C) Fentanyl = Chest wall rigidity D) Morphine = Pruritis |
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Pediatric C-spine psuedosubluxation occurs in which 2 C-spine vertebrae?
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C2-C3
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What are the "lung protective" strategies for ARDS vent settings?
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Low tidal volume, high PEEP. May cause hypercapnia which is OK ("permissive hypercapnia")
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Name and describe the EKG pattern that often PRECEDES wpw?
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AVNRT (SVT with p-wave just after the QRS)--often the retrograde p-wave is visible, but also in continuity with the QRS complex, appearing as a "pseudo R prime" wave in lead V1 or a "pseudo S" wave in the inferior leads.
For actual wpw, look for short PR interval and a delta upstroke in the QRS |
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Microscopic hematuria in otherwise well appearing peds trauma...observe or work-up?
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Work-up. This is suggestive of liver, spleen or kidney trauma and a CT is needed.
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WHich of these predicts a good hypothermia outcome?
-large clear bleb formation in re-warmed area -violaceous color of area - woody firmness of SQ tissue - Lack of edema in re-warmed tissue |
Large clear bleb formation in re-warmed area is normal healing in hypothermia...all others are ominous signs
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Bizz-->Buzz
Hydrophobia (inability to swallow water d/t hyperactive airway reflexes)? |
Rabies
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Most common elderly C-spine injury? Key imaging step?
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C2; open-mouth odontoid view Xray
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Bizz-Buzz:
Osborn wave? J wave? |
Hypothermia
Two terms for the same thing, common hypothermia EKG finding |
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Azithromycin (macrolide) coverage is included in community acquired PNA coverage to cover what 3 bugs?
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Legionella, Mycoplasma, and Chlamydia (the "atypicals")
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Azithromycin (macrolide) coverage is included in community acquired PNA coverage to cover what 3 bugs?
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Legionella, Mycoplasma, and Chlamydia (the "atypicals")
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What is holiday heart?
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Afib with RvR within 48 hours of a drinking binge.
Can happen in young peopl too, often goes away on its own. |
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What drug class is useful in prevnting cerebral vasospasm in SAH?
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Peripheral CCBs
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What PE test can differentiate a shoulder AC separation from a dislocation?
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AC separation can touch the opposite shoulder with the hand on the affected side whereas dislocs cannot.
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What unique physical exam finding is present with Adenovirus Pharyngitis 30-50% of the time?
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Conjunctivitis
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Child has mono, takes a drug and then presents with a morbilaform rash...what drug did he take?
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Ampicillin (or amoxicillin)
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Pt with neck injury has horner's syndrome...next step?
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Carotid angiography (ptosis, miosis, and anhidrosis presumable from damage to sympathetic fibers that circle the carotid)
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Most common mitral valve prolapse symptom?
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Palpitations
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Describe a copperhead? How severe is an envenomation?
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Reddish-brown with yellow-green tail; two fangs.
Least venemous of the pit viper family. |
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What anatomical location is te appropriate site for rabies immunoglobulin (HRIG) to be administered?
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At the wound site.
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What drug causes "selective vasoconstriction of the splanchnic vasculature" and when should it be given?
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Octreotide, variceal bleeds.
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SSSS Tx?
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Nafcillin
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______ ulcers wake you up at night.
______ ulcers improve with food? |
Duodenal, Duodenal
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Top two sequelae of chronic methanol ingestion?
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Blindness and parkinsonian symptoms
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Colles fracture has _______ angulation of the distal radius?
_______ nerve is at risk for neuropathy? |
Dorsal, Median
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In Smith fracture _______ nerve is at risk for neuropathy?
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Median (same as colles)
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Name four classic physical exam findings for orbital floor fracture?
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Hypoesthesia over maxilla
Inability to look up Enopthalmos Periorbital emphysema |
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Four questions about Temporal (aka Giant Cell) Arteritis:
1) Most specific symptom? 2) Most sensative symptom? 3) Average age? 4) % with permanent vision loss? |
Spec: Jaw claudication
Sens: Headache Ave age: 70 % blind: 15 |
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"Backpacker's Diarrhea"
1) Organism 2) Stool finding 3) Treatment |
1) Giardia
2) Ova/parasites but NO WBCs 3) Metronidazole |
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What's Wernicke's Triad?
Add what to get Wernicke-Korsakoff's? |
1) AMS, Ataxia, Nystagmus (or other oculomotor issues)
2) Add Confabulation and Memory Loss for korsakoff's |
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What's the #1 viral cause of Acute Otitis Media?
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RSV (influenza is distant 2nd)
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Hirschprung's Disease:
1) Description 2) Demographics 3) Symptoms |
1) Aganglionic or nearly aganglionic portion of bowel from birth
2) Typically within a few weeks of birth, but can present up to 6 months 3) Small or absent stools, mild abdominal distention, bilious emesis, empty rectal vault, failure to thrive (!) |
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What's the difference between phenytoin and phosphenytoin?
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Phenytoin is diluted in propylene glycol (a drug that can cause dysrhythmias if administered too quickly) and can only be given at a rate of less than 50mg/min
Phosphenytoin does not have this problem |
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Avoid ______ in controlling scorpion bite pain. (Bonus for knowing why?)
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Narcotics (case reports of arrhythmias from morphine after a scorpion bite)
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Initial treatment for aortic dissection?
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Esmolol first to control HR (then use nitroprusside for BP control)
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What electrolyte abnormalities (x2) are present in primary adrenal insufficiency (aka Addisons), but not secondary?
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Hyponatremia and Hyperkalemia (effect of not having aldosterone)
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What are the four phases of Acute Radiation Syndrome and their characteristic symptoms?
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1. Prodromal--Immediate mild autonomic and GI issues (ie tachy and queasy)
2. Latent--Asymptomatic period up to 48 hours 3. Manifest illness--Pancytopenia and severe GI symptoms (+/- ominous sign of CV instability) 4. Recovery or Death--Death will include CV collapse and AMS |
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What is the most common and most sensative symptom of Cauda Equina?
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Urinary Retention (90% sens)
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Four causes of bloody diarrhea and treatment of each?
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1. E. Coli 0157
2. Campylobacter jejuni 3. Shigella 4. Salmonella Treat all of the above with fluroquinolones |
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Two causes of foul smelling, mucousy diarrhea?
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1. Giardia (backpacker's diarrhea)
2. Amoebiasis (i.e. Enteramoeba Histolytica--long term time abroad...liver cysts is nightmare sequelae) |
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Common sulfonylurea, mechanism of action, and its antidote?
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Glyburide (sulfonylureas release preformed insulin)
Antidote is octreotide whichh is a synthetic LONG ACTING simatostatin (these inhibit insulin release) |
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Classically PCP overdose induced seizures do NOT respond to ___________?
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Phenytoin (use benzos or phenobarb in a pinch)
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How do you calculate corrected Na with hyperglycemia?
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Every 100mg/dL glucose above the 100 baseline increases Na by 1.6 mEq/L
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Sickle cell pt with retic count less than _____ is in aplastic crisis. What is the treatment if severe?
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3% (0.5% would be really bad)
Treat with RBC transfusion |
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Acute chest syndrome is defined as __________ ?
4 elements of therapy? |
"infiltrates on chest radiograph accompanied
by chest pain and fever." Pain medication, oxygen, and antibiotics are the mainstays of treatment. Exchange transfusion is key b/c it decreases the number of sickled cells without increasing Hb. |
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What sequelae of AIDS start to occur at the following CD4 count levels:
1) <200 2) <100 3) <50 |
<200: PJP
<100: oral thrush and candidal esophagitis, CNS infections with Cryptococcus neoformans or Toxoplasma gondii. <50: Mycobacterium avium complex (dMAC) and cytomegalovirus (CMV) retinitis |
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What is Prinzmetal's angina? EKG changes?
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aka Variant Angina is a coronary vasospasm similar to cocaine use, except there is some (possibly mild) underlying CAD.
ST elevation, OCCURS AT REST. |
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Why is an Anterior Wall MI and new 3rd degree heart block EXTREME BADNESS!
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An LAD infarct big enough to hit the AV node (septum) is likely to be fatal.
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What is the classic RV infarct EKG?
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STEMI in 2, 3, AvF & also in V4r (r is for reversed, V4 lead is placed in the mirror position on the RIGHT side of the chest)
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What is the classic posterior infarct EKG?
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1. R waves > S waves in V1 & V2
2. Upright Twaves 3. ST depression in V1 & V2 *Note: Basically this is a reversed image of normal MI badness. he big Rs are reversed Qwaves, inverted s look normal and STEMI is ST depression. |
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WPW with Afib...tx?
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CARDIOVERT! This is an emergency/BADNESS you have an arrhythmia over an abberant pathway.
(Note: you may have to slow it down to diagnose the underlying WPW or you'll have PMH) |
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What dose of adenosine is recommended for stable afib?
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TRICK! adenosine is contraindicated (can throw you into VT/VF).
Use Bblockers, Ca Channel Blockers or electricity are first line |
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What are the most likely valves to be affected by endocarditis? (List them 1-4)
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1. Mitral
2. Aortic 3. Tricuspid (#1 in AVDU or indwelling catheters) 4. Pulmonic |
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What bug is most likely affecting these types of valves in endocarditis?
1. Native valve 2. IV Drug user 3. Prosthetic valve |
1. Strep viridans
2. Staph aureus 3. Staph aureus or Staph epidermidis |
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Two ways to make HCM murmur louder? softer?
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Basically your AS murmur (systolic blowing cresendo/decresendo at LLSB) but...
LOUDER with valsalva or standing (ie decr preload) (softer) with squatting or handgrip (incr preload) |
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How do the warts of HPV and Syphilis differ (give the name of each and three traits of each's appearance)
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HPV: Condylomata acuminatum
-Cauliflower shape (groups of "pedunculated papules"), very dry, keratinized, asymptomatic Syphilis: Condyloma Lata -Weepy, wart-like, foul odor |
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[Diuretic A] helps rhabdomyolysis and [Diuretic B] worsens it. Why for each?
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A) Mannitol helps by increasing volume of urine without affecting pH
B) Lasix makes rhabdo worse by acidifying the urine which makes myoglobin insoluble |
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What is Nursemaid's Elbow and how is it treated?
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Radial head subluxation from forced extension
Tx with flexion, supination, and pressure on radial head |
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Rocky Mountain Spotted Fever Tx? What about if pregnant )& why)?
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Doxycycline
Pregnant: Chloramphenicol (doxy can cause grey baby syndrome where kids have grey icky teeth) |
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Where will a person with an anterior shoulder be numb? What nn is injured (presuming nn injury)
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Axial nerve injury, numb over deltoid muscle
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Reiter's sydrome is a seronegative spondyloarthropathy that occurs after these 5 infections?
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1) GU: Chlamydia
2-5) GI: Campylobacter, Salmonella, Shigella, Yersinia |
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Reciprocal ST depressions are most common in _______ MIs?
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Inferior MIs (ST el in II, III, avF & ST dep in V1-V6)
* They can happen in any type of MI though |
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#1 cause of mitral stenosis by far?
Most common complication of MS? |
1) Rheumatic fever
2) Afib |
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3 traits of an ACA stroke distal to the anterior communicating artery?
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1) Leg > arm weakness
2) Personality changes 3) Tongue / face sparing |
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Peds radiology finding that suggests an occult elbow fracture?
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POSTerior fat pad (sail sign)
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Pertussis treatment?
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Erythromycin (azithromycin also works)
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What is a positive Nikolsky sign?
Tx of this disease? |
Pemphigus blisters -- they grow when you put pressure by their margins
Tx with steroids |
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#1 cause of GI bleed in alcoholics?
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PUD
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Physiologic changes of pregnancy?
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1. Increase Tidal Vol (with normal RR)
2. Increase WBC 3. Increase Hb (lower plasma volume) 4. Increase GFR 5. Increase cardiac output |
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Rash ID: Erythematous maculopapular rash on face, torso & extremities w/ sub-occipital and post-auricular nodes/cervical nodes?
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Rubella (aka German Measels)
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Rash ID: Tender erythema starts on oral mucosa and later appears on buttocks?
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Cocksackie
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Displacement of Colles fracture (mneumonic?)
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Dorsal (Collie is a Dog)
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Mnemonic for Monteggia vs Galeazzi fracture?
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MUGGER
Monteggia Ulna broke (radius disloc) G Galeazzi E Radius broke (ulnar disloc) |
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Bell's Palsy tx?
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Acyclovir, steroids, tape eye shut at night.
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Bizz-Buzz "Groove sign"
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Stage 1 of Lymphogranuloma venereum (followed by huge lymphnodes topped by painful ulcer...tx with doxy)
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Three types of angioedema and tx for each?
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1. 2/2 ACE Inhibitor--FFP or C1 Compliment
2. Hereditary--FFP or C1 Compliment 3. Allergic--Antihistamines / epi / steroids |
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Erythema nodosum top 2 causes?
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1) Idiopathic
2) Strep pharyngitis (close 2nd) These two make up 90-95% of all causes (drugs distant 3rd) |
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Medical tx of SMA embolism?
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Papaverine (real life is probably embolectomy f/ surgery)
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Name the 5 Ranson's criteria for ED baseline eval?
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1. Age > 55
2. Glucose > 200 3. WBC > 16,000 4. AST > 250 5. LDH > 350 3 or more is a poor prognosis |
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Bizz-Buzz: Diarrhea with turtle or iguana contact
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salmonella
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Bizz-Buzz: Diarrhea with Guillan Barre
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Campylobacter
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Bizz-Buzz: Diarrhea with appy presentation
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Yersinia
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Bizz-Buzz: Diarrhea within 6 hours post food
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Staph (pre-formed toxin)
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Scromboid poisoning:
-Agent -Presentation -Tx |
-Agent: Tuna, Marlin, Mahi-mahi
-Presentation (histamine release): Flushing, palpitation, diarrhea, bitter-peppery taste -Tx: H1&H2 blocker |
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Ciguetera poisoning:
-Agent -Presentation -Tx |
-Agent: Reef fish, red snapper, barracuda
-Presentation: Paradoxical reverse temperature sensation, teeth "feel loose" -Tx: Supportive |
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How does botulism paralysis present?
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Descending
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Why do some people get ABGs to confirm a PE? What are they looking for?
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Increased A-a gradient (more of a medicine thing)
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Bizz-Buzz: "Catamenial"
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Menstrating, endometriosis, pneumothorax
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COPDer whose EKG shows variable PR intervals and 3 different p-wave sizes...Dx & Tx?
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Multifocal Atrial Tachycardia...tx underlying disease
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PJP PNA CXR finding, Lab finding, and tx?
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CXR: Bat-wing infiltrate
Lab: HIgh LDH Tx: Bactrim |
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PCP PNA is usually treated with bactrim but you can also use pentamidine. What complication is possible with pentamidine?
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PTX
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PNA Bizz-buzz: Lobar, rust-colored sputum
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Strep pneumo PNA
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PNA Bizz-buzz: Lobar or patchy infiltrates in COPDer or smoker
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H. Influenzae PNA
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PNA Bizz-buzz: Pleural effusion, necrotizing abscess in context opf post-viral or IVDA
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Staph PNA
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PNA Bizz-buzz: Patchy, multi-lobar, HAP
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Pseudomonas PNA
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PNA Bizz-buzz: Patchy, foul smelling, alcoholic/poor dentition
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Anaerobes PNA
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PNA Bizz-buzz: RUL infiltrate with bulging fissure, DM or ETOH
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Klebsiella PNA
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PNA Bizz-buzz: Cold aglutinins
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Mycoplasma PNA
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PNA + Diarrhea + looks sick?
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Legionella PNA
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RSV CXR & Tx?
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CXR: Hyperinflated
Tx: Trial of albuterol, supportive care, NO steroids |
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Bizz-buzz: Goat handler
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Qfever (PNA + hepatitis or endocarditis)
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Stereotypical pt demographics that DIE from asthma?
How do they die? |
Black, inner city female
Air trapping, then mucus plugging, then hypercarbic arrest |
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Lab results for transudative vs exudative pleural fluid?
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Transudate:
LDH < 200 Pleural/Serum Prot ratio < 0.5 Total protein < 3 Exudate: LDH > 200 Pleural/Serum Prot ratio > 0.5 Total protein > 3 |
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Scuba guy comes halfway up from a deep dive suddenly without exhaling. He's still underwater but acting drunk...Dx?
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Nitrogen narcosis
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Diver comes up fast and on the boat he instantly has a seizure or looks like a stroke picture...Dx?
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Nitrogen arterial gas embolus
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Cause & onset of "The Bends"
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Rapid ascent, delayed onset (typically > 1 hr)
aka: Decompression Sickness |
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List the three high altitude illness from mildest to worst.
Bonus: tx for each? |
AMS-->HACE-->HAPE
Tx: Acetazolamide-->Acetazolamide--> RAPID descent |
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Guys gets slashed by a piece of coral...3 steps of therapy?
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1. Decontaminate
2.Antihistamines 3. Topical steroids |
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What type of cuts do you make to do an escharotomy on someone with full chest burns?
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Large wide "H" shape on the chest
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Bug bite that mimics an appy in its presentation?
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Black Widow
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Name of the brown recluse antivenin?
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TRICK! No antivenin, treat with dapsone, hyperbarics or surgery if tx is needed (typically supportive care is enough)
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Prognosis if lymphocyte count is <300 48hrs s/p radiation exposure?
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100% death
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Kid > 3 months has stiff neck, high fever, and rash...tests or treat first? Specifiy what?
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Treat with dexamethasone and IV ceftriaxone first thing
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Anthrax gram stain, likely demographics (2 groups) and tx?
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Gram + Rod (spore forming)
Woolsorters (classic) & Govt Employees (terror age) treat with cipro, doxy or PCN G |
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Massive hemolysis: Next step in work-up?
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Bronch!
Not CXR or CT even if it sounds like TB or cancer. |
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Name 7 contraindications to thrombolysis?
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1. Big surgery in the past 3 weeks
2. Ischemic stroke in the past 3 months 3. GI or GU bleed in last 3 weeks (menses excluded) 4. Acute pericarditis 5. Persistent very high BPs 6. Brain neoplasm 7. Active bleeding |
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New Multiple Sclerosis suspicion...is first step steroids or MRI?
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Steroids (decreases 2 yr incidence of having MS)
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What size diverticular abscess gets:
1. Admitted? 2. Sent to surgery? |
Admit if > 4 mm
Surgery if > 5 CENTImeter |
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______ % of lung abscesses communicate with a bronchiole?
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75%
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Infectious lung abscesses are typically locate (2 anatomic locations)?
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Basal segments of Lower Lobes
Posterior segments of upper lobes |
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Neoplastic caused lung abscesses are typically locate (1 anatomic location)?
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Anterior portion of the lung
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What are the two types of liver abscesses and what lab test distinguishes them (bonus, which is more common?)
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Pyogenic (RARE) dx'd because Tbili is high
Aomebic (Common) c normal Tbili |
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Old man with neck mass, most likely dx?
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75% will be cancer in old men (squamous cell is common)
Neck masses in kids are generally benign |
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Preferred INDUCTION agent for intubation in an asthmatic?
Preffered SEDATION agent post-intubation in same pt? |
Ketamine for induction (bronchodilator & releases cathechols)
Propofol for sedation (bronchodilator) |
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What physical exam finding differentiates pre from post-orbital cellulitis?
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Pain with EOMs in post-orbital (aka badness)
Both have general eye pain, eye swelling and possible fever |
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3 classic findings of mononucleosis; causitive organism, and finding on diagnostic test?
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BL painful swollen cervical glands, severe BL pharyngeal exudates, enlarged spleen
EBV Heterophil antibodies on Monospot |
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Strep throa tx?
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PCN (for Group A Strep).
If allergic use macrolide |
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How should a pt position themselves so you can best hear Hamman's crunch?
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Left Lateral Decubitus (crunching sound is in sync with heart beat)
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Most likely organism causing diarrhea in AIDS?
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Cryptosporidium
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Four steps to treating REALLY high T4?
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Inhibit hormone synthesis: PTU (propylthiouracil), methimazole
Block hormone release: iodine, lithium Prevent peripheral conversion of T4 to T3: dexamethasone Block peripheral effects: beta-blockade (propranolol) |
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Bug for contact lens ulcer?
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pseudomonas
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Steps for treating acute angle closure glaucoma (5)?
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Suppress aqueous production
Topical beta-blocker: timolol Alpha-adrenergic: apraclonidine Carbonic anhydrase inhibitor: acetazolamide Dehydrate the eyeball: mannitol Open the angle: pilocarpine |
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Organisms and tx of Acute Necrotizing Ulcerative Gingivitis
(aka Trench-mouth) |
Fusobacteria and spirochetes
Tx: compresses, antibiotics |
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Thrombotic Thrombocytopenic Purpura Classic pentad ?
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1. Thrombocytopenia
2. Hemolytic anemia 3. Fluctuating neurologic exam 4. Renal disease (mild) 5. Fever Tx: plasmapharesis |
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Lyme disease rash, organism, insect vector, and tx?
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ECM: erythema chronicum migrans
Microbe: Borrelia burgdorferi Vector: Ixodes scapularis Tx: doxycycline |
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Criteria and tx for Kawasaki's?
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Fever > 5 days and four of five
1. Bilateral conjunctival injection 2. Oral mucosal changes 3. Rash (not vesicles) 4. Extremity changes 5. Cervical adenopathy Tx: aspirin + gamma globulin |
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Rhabdo UA finding and key lab?
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Urine positive for hemoglobin, but no red cells on microscopy
Total CPK increased more than 5 times normal |
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Rhabdo UA finding and key lab?
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Urine positive for hemoglobin, but no red cells on microscopy
Total CPK increased more than 5 times normal |
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Priapism tx for acute and persistent?
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Tx: trial sub-q terbutaline
Persistent: corpora aspiration, irrigation with phenylephrine |
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What is the patent area of the aoric valve (in sq cm) when aortic stenosis becomes critical?
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0.8 sq cm
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Methemoglobinemia:
1. What % MetHb causes cyanosis? 2. Is cyanosis relieved by O2? 3. What 3 meds can cause MetHb? 4. What color is someone's blood with MetHb? 5. What is the tx for MetHb? |
1. 10%
2. No 3. Pyridium, Benzocaine, Dapsone 4. Chocolate colored 5. Methylene Blue |
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What is the tx for cyanide toxicity and what side effect does it induce?
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Sodium Nitrite (causes MetHb which is the lesser of two evils)
CyanoKit contains: -inhaled dose of amyl nitrite -intravenous sodium nitrite -intravenous sodium thiosulfate Hydroxocobalamin, another antidote, is newly approved as well |
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Looking for a cause of SIADH...which two organ systems should come to mind?
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CNS: Tumor, Trauma, Infection
Pulm: TB, CA |
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What is the most common site to fx the mandible?
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Angle of the mandible
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40 yo man with severe viral prodrome, temp = 101, retro-orbital HA, and photophobia after a known tick exposure. Diagnosis and Tx?
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Colorado Tick Fever (only US tick illness that's viral). Supportive care.
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Cardiac death is most common type of electrical death. Which lethal arrhythmia is caused by...
1. Low voltage AC current? 2. High voltage AC current? 3. Low voltage DC current? 4. High voltage DC current? |
1. AC < 1amp --> Vfib
2. AC >10amps-->Asystole 3 & 4. All DC currents-->Asystole |
