Em - Cords

Front 1

What percentage of patients with Mycoplasma pneumoniae infection have extrapulmonary symptoms?

Back 1

33%

Front 2

MI: more common DULL or SHARP?

Back 2

DULL (50%)

(sharp 15%)

Front 3

Cocaine-induced chest pain --> avoid what drug class?

Back 3

Beta-blocker

(leads to unopposed alpha stim --> worse ischemia)

Front 4

What is the estimated one year mortality of patients with CARDIAC syncope?

Back 4

30%

(high!)

Front 5

Name for:

biphasic T-waves in the mid-precordial leads.

Back 5

Wellen's sign/syndrome

(LAD disease; may be painless)

Front 6

Describe:

Wellen's sign/syndrome

Back 6

finding of biphasic T-waves in the mid-precordial leads. It is highly specific for proximal LAD disease. This finding may be seen in the anginal or pain-free state and may or may not be accompanied by cardiac enzyme elevations.

Front 7

Treatment of choice for torsades de pointes?

Back 7

MAGNESIUM SULFATE

Front 8

Symptomatic 3rd degree heart block is best treated with:

Back 8

TransQ pacing

Front 9

ECG revealing hypertrophic cardiomyopathy: what direction (UPRIGHT OR INVERTED) are T waves in leads showing prominent pathologic Q waves?

Back 9

UPRIGHT

(discordant T wave)

Front 10

Acute heart failure: what is role of digixon?

Back 10

NO ROLE - only useful in CHRONIC heart failure

Front 11

Can watch & electively repair AAA if what size?

Back 11

<5cm

Front 12

If suspect AAA --> what is FIRST image?

Back 12

CT

(no U/S)

Front 13

Hypocalcemia:

What EKG finding?

Back 13

QT interval prolongation

Front 14

QT interval prolongation: suspect what lyte abnormality?

Back 14

HypoCa2+

Front 15

What is most common congenital cardiac defect?

Back 15

VSD

Front 16

chronic peripheral arterial insufficiency: is pain worse with STANDING or ELEVATING leg?

Back 16

pain worse w/ELEVATION

(relieved by standing)

Front 17

The benefit of reteplase (rPA) compared to tissue plasminogen activator (tPA) is:

Back 17

Can give a double-dose 30 minutes apart

(tPA reqs contin infusion)

Front 18

Sickle cell w/priapism: how tx?

Back 18

TRANSFUSION --> urologic drainage

Front 19

#1 complication of massive transfusion

Back 19

Bleeding

Front 20

DIC: increased or decreased:

-fibrinogen
-fibrin split products

Back 20

Fibrinogen: decreased

Split products: increased

Front 21

#1 cause of death for hemophiliacs

Back 21

AIDS!

(#2 is ICH)

Front 22

ITP: see what plt count? (#)

Spont remission common?

Back 22

30k-100k

No spont remit; wax-wane course

Front 23

Hemophilia A or B more common?

Back 23

B!

(1:30k)
(A is 1:100k)

Front 24

vWD: how affect PT? PTT?

Back 24

PT: normal

PTT: increased

Front 25

Where do lymphocytes mature? Granulocytes?

Back 25

Lymphos: spleen, LNs, thymus, bone marrow

Granu: Bone marrow & plasma

Front 26

FFP: contains coag factors?

Back 26

YES - 2, 7, 9, 10

Use it in hemorrhaging pt w/coumadin, liver dz

Front 27

One unit dose (or one random donor platelet concentrate) of transfused platelets should raise the platelet count by:

Back 27

7,000 - 10,000

Front 28

DIC: how affect:

-PT
-PTT

Back 28

PT: prolonged

PTT: no change

Front 29

Cryoprecipitate: contains what factors? use what disease?

Back 29

VIII (8)

vWD

Front 30

A 32 year old male presents with shortness of breath. He has a history of sinusitis and was started on trimethoprim-sulfamethoxazole today. Physical exam reveals a cyanotic patient whose pulse oximetry is 85% and does not improve on 100% oxygen. His lungs are clear. The nurse comments that his collected blood appears dark. The ABG on room air reveals a PaO2 of 94. Appropriate therapy for this patient would be:

Back 30

METHYLENE BLUE

(Sulfa --> form methemeglobin)
(NOT epi)

Front 31

What percentage of patients with HbSS are NOT African-American?

Back 31

5-10%

Front 32

What SC injury:

hyperextension --> disproportionately greater weakness in the,upper extremity

Back 32

Central cord syndrome

Front 33

What SC injury:

hyperflexion --> complete paralysis and loss of sensation to pain and temperature bilaterally below the lesion

Back 33

Anterior cord synd

Front 34

What is HANGMANS FX?

Back 34

Fx C2

Front 35

Name for:

ipsilateral motor paralysis and contralateral sensory hypethesia distal to the level of injury

Back 35

Brown-Sequard

Front 36

Which therapeutic intervention is the fastest to decrease ICP?

Back 36

Hyperventilation

Front 37

The most common cause of patient morbidity resulting in medical litigation in the radiographic evaluation of the cervical spine is the failure to visualize which area?

Back 37

C6-T1

#1 successful ligitation film

Front 38

Name for:

a subluxaion of the radial head commonly seen in childre

Back 38

Nursemaids elbow

Front 39

most common fracture in adults over the age of 50

Back 39

Colles fracture (fall on outstretched hand --> fx wrist)

Front 40

Which cardiac rhythms most characterizes digoxin poisoning?

Back 40

Atrial tachycardia with block

Front 41

Chronic anticholinesterase inhibitor: #1 S/E

Back 41

Periph neuropathy --> weakness (PERMENANT)

Front 42

Which commonly ingested material is not appreciably bound to activated charcoal?

Back 42

Lithium

Front 43

Hyperbaric O2: safe in pregnancy?

Back 43

YES - use more liberally! fetus esp vulnerable to CO & hypoxia

Front 44

Pt drinks propane:

-how long must obs in ED?
-admin epi if resp distress?

Back 44

6h - most appear asympto initially

No EPI! Propane desensitizes the heart --> epi induces vent dysrythm

Front 45

Gastric lavage:

-perform w/in how many mins-hrs of ingestion?
-S/E hypo or hypernatremia

Back 45

<60mins

HYPERnatremia (since using saline)

Front 46

Physostygmine serious S/E?

Back 46

Seizures

Front 47

What nomogram:

predicits ASA toxicity

Back 47

Done nomogram

Front 48

Dextromethorphan: s/e hypo OR hypertension?

Back 48

Hypo

Front 49

TCA toxicity: Hypo or HTN?

Back 49

HTN

Front 50

Metal fume fever:

-due to what particles?
-how appear CXR?

Back 50

zinc oxide

no change CXR

Front 51

Wood's lamp: see what substance?

Back 51

Ethylene glycol

Front 52

Primidone:
-txs what dz?
-metabolized to what drug?

Back 52

Seizures

--> phenobarb (may see false pos in urine screen)

Front 53

Lead above what level considered toxic?

Back 53

>10

Front 54

What poisoni:

Basophilic stippling

Back 54

Lead

Front 55

Mushroom-related deaths:

-what toxin?
-what organs fail?

Back 55

amatoxin

Liver & renal (3rd phase of toxicity)

Front 56

Digitalis: mxn? avoid use w/which other drug?

Back 56

Inhibition of Na+, K+ - ATPase pump

Avoid quinidine (decreases renal clearance of dig)

Front 57

Beta-blocker toxicity: give what med?

Back 57

Glucagon

Front 58

Class 1A antiarryth: see what EKG change?

Back 58

QRS prolong

Front 59

Admin Digibind in pt w/dig tox in what 2 scenarios?

Back 59

1. hyperK+ >5.5
2. Arryth --> unstable

Front 60

SCIWORA:

-what stand for?
-more common peds or adults?

Back 60

SC injury without radio abn

peds > adults
CANNOT CLEAR PEDS C-spine by radio alone!

Front 61

Scalp suture: what is deepest layer you suture?

Back 61

galea aponeurotica

(NOT subapo CT or periosteum)

Front 62

Anterior cord syndrome:

- due hyperextens or hyperflex of neck?
-how present?

Back 62

HyperFLEX

complete paralysis and loss of sensation to pain and temperature bilaterally below the lesion

Front 63

Central cord syndrome:

-2/2 hyper FLEX or EXTENS neck?
-how present?

Back 63

EXTENS

arms weaker than legs

Front 64

Fastest way to decrease ICP?

Back 64

hypervent

Front 65

MVA: which more common - EDH or SDH?

Back 65

SDH 6x > EDH

Front 66

Horner's syndrome: due to injury of which specific SYMP ganglion?

Back 66

Stellate's

Front 67

Construction worker hit on head: what XR VIEW will most likely show fx?

Back 67

Open mouth

(loading injury)

Front 68

Neonate: start chest compressions at what HR?

Back 68

HR <60

(or b/w 60-80 and not increasing)

Front 69

Right axis deviation is present in children until approximately what age?

Back 69

3-4yo

Front 70

Presents what age?:
Heart failure secondary to patent ductus arteriosu

Back 70

NEONATE

(NOT infant)

Front 71

Rectal prolapse in a child should lead the clinician to consider this associated condition:

Back 71

Cystic fibrosis

Front 72

Klinefelter: see what heart defect?

Back 72

VSD (only- no other defects)

Front 73

Fetal EtOH synd: see what heart defect?

Back 73

VSD (only)

Front 74

Congenital rubella: what heart defect(s)?

Back 74

PDA
Pulm sten
VSD
Ao coarct

Front 75

Suspect intussception --> what is first diagnostic step?

Back 75

PLAIN film (r/o perf, etc)

NOT enema

Front 76

What percent of patients dying of apparent Sudden Infant Death Syndrome (SIDS) are later discovered to have died of child abuse?

Back 76

5-10%

Front 77

Reye's:

-how affect LFTS?

Back 77

increased LFTs WITHOUT jaundice

Front 78

Reye's:

How long after onset do focal neuro sxs appear?

Back 78

NO FOCAL NEURO

(see encephalo)

Front 79

Reyes:

Occurs how soon after febrile illness?

Back 79

1w

(NOT immed)

Front 80

True or false:

At four years of age, the liver edge should be no lower than one centimeter below the right costal margin

Back 80

true

Front 81

most common cause of cyanotic congenital heart disease in children older than 4 years of age

Back 81

TOF

Front 82

What pedi dz:

hypercyanotic or "tet spells" and a boot shaped heart on chest x-ray

Back 82

tof

Front 83

Neonate: definition of hypoglycemia

Back 83

<40

(do NOT give dextrose if >40)

Front 84

Pectus excavatum is associated with what congenital cardiac defect?

Back 84

Pulmonary stenosis

Front 85

What is the predominant cause of hypoglycemia until age two?

Back 85

ASA ingestion

(2-10yo - EtOH)

Front 86

Button battery: causes ALKALINE or ACIDIC caustic injury

Back 86

ALKALINE

(can also conductt electrical current)

Front 87

Child in shock: safe to use dextrose-containing solutions?

Back 87

NO - osmotic diuresis

Front 88

Greenstick fx of radius: how tx?

Back 88

MUST BREAK OTHER SIDE (the buckled side)

--> otherwise different rates of growth

Front 89

A one year old patient would be considered to be tachycardic if his/her heart rate were

Back 89

>150

Front 90

Which of the following is the most common cause of chronic renal failure in children under 5 years of age?

Back 90

Dysplastic kidney

Front 91

What dzs:

-fever --> face/trunk rash WITHOUT fever
- fever & rash simultan

Back 91

HHV-6 (roseola infantum): FEVER STOPS --> THEN RASH

Measles: simultan

Front 92

Colic (peds) most often resolves at what age?

Back 92

3-4 months

Front 93

What dz:

5 day old with DOWNWARD DEVIATING EYES and distended scalp veins

Back 93

Communicating hydrocephalus (2/2 SAH during premature birth)

downward eyes nearly pathnognomic

Front 94

Trigeminal neuralgia: most common in which branch?

Back 94

MAXILLARY of CN V

Front 95

What dz:

reactivation syndrome of herpes zoster in the geniculate ganglion. It has variable presentation which may include Bell's palsy, deafness, vertigo and pain

Back 95

Ramsay Hunt syndrome

Front 96

Severely agitated EtOHic who may have had a seizure:

Admin what med?

Back 96

LORAZEPAM

(benzo safe in W/D; not acute intox)

Front 97

Which cause of coma is due to destruction of the ventral pontine motor tracks?

Back 97

Locked-in

Front 98

Locked-in syndrome: destroy what structure?

Back 98

Ventral pontine motor tracks

Front 99

Locked-in: able to look UP or SIDE-to-Side?

Back 99

UP

(NOT horiz)

Front 100

Only benzo suitable for IM injection

Back 100

Midazolam

(NOT loraz, diaz)

Front 101

Fosphenytoin contraI in what type of heart disease?

Back 101

2-3rd degree block

Front 102

Absence szs: drug of chocie?

Back 102

Ethosuximide

Front 103

The initial anticonvulsant of choice for status epilepticus (after checking glucose and possibly administering thiamine) is?

Back 103

Lorazepam

Front 104

How tx:

INH-induced sz

Back 104

Pyridoxine

Front 105

Trigeminnal neuralgia: how tx?

Back 105

Carbamazepine

Front 106

In a patient with intracranial hemorrhage caused by hypertension, initial management of severe blood pressure elevation is best obtained with what med?

Back 106

Nitroprusside

Front 107

The risk of thromboembolism is greatest during which stage of pregnancy? (TM1-3, during labor, post-part?)

Back 107

POST-PARTUM

Front 108

Pregnant with asthma:

-how tx? (meds)
-steroids safe in preg?

Back 108

albuterol, terbutaline, corticosteroids

Steroid inactivated by placenta

Front 109

Preeclampsia: 3 components

Back 109

hypertension, pathologic edema, and proteinuria

Front 110

Safe in preg?:

-Nitrofurantoin
-Bactrim
-Amox/amp

Back 110

Yes: nitro, amp/amox

No: Bactrim (not in TM1 or TM3)

Front 111

Pregnant w/UTI: what abx?

Back 111

Nitrofurantoin

Front 112

Molar preg: dx in which TM?

Back 112

TM2

Front 113

What dz:

Snowstorm uterus

Back 113

Molar preg

(hydropic uterine vessels)

Front 114

Molar preg: uterus smaller or larger than expected?

Back 114

LARGER

Front 115

Safe in preg?:

-ASA
-Dilantin
-Sulfa
-oral hypoglycemics

Back 115

NONE SAFE

Front 116

Generic name:

Dilantin

Back 116

Phenytoin

Front 117

Most reliable indicator of TRUE contractions (vs. false)?

Back 117

Cervical dilation

Front 118

Perimortem C-section: initiate w/in how many minutes-hrs of maternal cardiopulm arrest?

Back 118

w/in 4 minutes of arrest

(wow! perform the C-section while someone else continues ACLS on mom)

Front 119

2' syphilis: is rash contagious?

Back 119

YES - highly!

Front 120

Toxic Shock Synd: find bacteremia?

Back 120

NO - suggests sxs 2/2 toxin

Front 121

Clostridia infxn: give what abx?

Back 121

HIGH DOSE PCN

Front 122

Malaria: early in dz - present with low or high fever?

Back 122

Low

Do not see high until later

Front 123

Malaria: classic paroxysms of f/c often absent in which species of malaria?

Back 123

p. falciparum

Front 124

Pulmonary anthrax: admin abx via which route?

Back 124

Initiatelly IV!!!! then switch to po

Front 125

Oral thrush: which more effective:

nystatin suspension or clotrimazole troches

Back 125

Clotrimazole troches

Front 126

RMSF: what abx?

Back 126

doxy

Front 127

Malaria in subSahara Africa: give what ppx abx?

Back 127

Mefloquine

Front 128

HIV: how affect:

-PTT
-plt count
-bleed time

Back 128

Decrease plt --> increase bleed time

Increase PTT

Front 129

HIV:

-what % pts develop PCP PNA at some time?
-CXR negative in what % PCP PNA?

Back 129

80% HIV pts will develop PCP PNA

10% CXR will be negative

Front 130

PCP PNA:

See hilar adenopathy?

Back 130

No

(suspect concurrent histo, TB, lmyphoma)

Front 131

MAC:

easy or difficult to dx with stains & cultures?

Back 131

EASY

Front 132

most common cause of focal encephalitis in HIV and AIDS patients?

Back 132

Toxo gondii!

Front 133

the only AIDS related illness that causes pneumothorax

Back 133

Kaposis sarcoma

Front 134

Mumps:

-tx w/what abx?
-more severe in child or adult?
-see rash?

Back 134

NO ABX (only give abx if parotid swelling)

worse in ADULTS

Rarely see rash

Front 135

Erysiplas: what pathogen?

Back 135

GAS

Front 136

Jones criteria: what dz?

Back 136

Rheumatic fever (strep)

Front 137

Temporal arteritis: is plt count related to risk of vision loss?

Back 137

Elevated plts (>400k) --> increased risk vision loss!

Front 138

Temporal arteritis: does normal ESR r/o?

Back 138

NO! can have normal ESR

Front 139

most common cause of glomerulonephritis in children

Back 139

post-strep glomerulonephritis

Front 140

post-strep glomerulonephritis: what is most important test to order?

Back 140

LYTES --- check K+ (life-threatening)

Front 141

What dz:

strep throat txed with pcn --> periorbital edema 1 week later

Back 141

Post-strep glomerulonephritis

(check lytes)

Front 142

If allergic to lidocaine -->> use what anesthetic to repair lac?

Back 142

cardiac lidocaine (no preservative)

NOT ester anesthetics (usu have higher rates of allergic rxns than amides)

Front 143

Jarisch-Herheimer reaction:

what dz?

how tx?

Back 143

2' syphilis/lyme disease treated with PCN --> flushing, red palms due to spirochete toxin release

Tx w/fluids and ASA

Front 144

How tx lupus cerebritis?

Back 144

high-dose IV steroids

Front 145

ACE-I induced angioedema: due what 2 chem mediators?

Back 145

bradykinin and substance P

Front 146

What is dz?:

blue-black scrotal dot

Back 146

Torsion of APPENDAGE

(NOT testic torsion)

Front 147

Prostatis: common or rare:

-Pseudomonas
-Chlamydia

Back 147

Pseudomonas common!

Chlamydia rare!

Front 148

Epididymitis:

-how tx <35yo?
-how tx >35yo?

Back 148

<35yo: doxy

>35yo: bactrim & doxy

Front 149

Epididymitis:

-what % pts have WBC on UA?
-avg age onset?

Back 149

50% have WBCs; absence does not r/o dx

avg age 25yo

Front 150

#1 pathogen vaginitis? how tx?

Back 150

Trich (NOT BV)

Front 151

What dz:

Strawberry cervix

Back 151

Trich

Front 152

>35yo with epididymitis: 2 most common pathogens

Back 152

1. E coli
2. Pseudomonas

Front 153

Lifetime prevalance of sexual assault in females

Back 153

20%

Front 154

What dz:

-unable to retract foreskin
-unable to push foreskin over head of penis distally

Back 154

Phimosis (penis with hat on)

Paraphimosis (foreskin bunched up proximally)

Front 155

Etiology OR treatment for priapism?:

Papaverine injection into the corpora cavernosum

Back 155

Etiology

Front 156

Orchitis: common to see involvement of epidydmis? begins before or after swelling of parotids?

Back 156

85% inv epidid

BEFORE parotid swell

Front 157

Safe in preg?:

-Nystatin
-Metronidazole

Back 157

Nystatin: yes

Metro: NOT IN TM1

Front 158

What dz:

absence of cremasteric reflex

Back 158

Testic torsion

Front 159

What drug to tx 1' HSV vaginitis

Back 159

ACV po

Front 160

Male complaining of burning with urination: how tx if:

-no discharge
-pussy discharge

Back 160

no discharge = chlamydia urethritis --> give doxy

discharge = gonorrhea --> give ceftriax

Front 161

What antibiotic:

Antabuse-like reaction

Back 161

Metronidazole

Front 162

If asymptomatic --> should you treat gardnella vaginitis?

Back 162

NO

Front 163

Hydrocele: more common young or old?

Back 163

Old

Front 164

Varicocele: more common L or R?

Back 164

L