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164 Cards in this Set

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What percentage of patients with Mycoplasma pneumoniae infection have extrapulmonary symptoms?
33%
MI: more common DULL or SHARP?
DULL (50%)

(sharp 15%)
Cocaine-induced chest pain --> avoid what drug class?
Beta-blocker

(leads to unopposed alpha stim --> worse ischemia)
What is the estimated one year mortality of patients with CARDIAC syncope?
30%

(high!)
Name for:

biphasic T-waves in the mid-precordial leads.
Wellen's sign/syndrome

(LAD disease; may be painless)
Describe:

Wellen's sign/syndrome
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.
Treatment of choice for torsades de pointes?
MAGNESIUM SULFATE
Symptomatic 3rd degree heart block is best treated with:
TransQ pacing
ECG revealing hypertrophic cardiomyopathy: what direction (UPRIGHT OR INVERTED) are T waves in leads showing prominent pathologic Q waves?
UPRIGHT

(discordant T wave)
Acute heart failure: what is role of digixon?
NO ROLE - only useful in CHRONIC heart failure
Can watch & electively repair AAA if what size?
<5cm
If suspect AAA --> what is FIRST image?
CT

(no U/S)
Hypocalcemia:

What EKG finding?
QT interval prolongation
QT interval prolongation: suspect what lyte abnormality?
HypoCa2+
What is most common congenital cardiac defect?
VSD
chronic peripheral arterial insufficiency: is pain worse with STANDING or ELEVATING leg?
pain worse w/ELEVATION

(relieved by standing)
The benefit of reteplase (rPA) compared to tissue plasminogen activator (tPA) is:
Can give a double-dose 30 minutes apart

(tPA reqs contin infusion)
Sickle cell w/priapism: how tx?
TRANSFUSION --> urologic drainage
#1 complication of massive transfusion
Bleeding
DIC: increased or decreased:

-fibrinogen
-fibrin split products
Fibrinogen: decreased

Split products: increased
#1 cause of death for hemophiliacs
AIDS!

(#2 is ICH)
ITP: see what plt count? (#)

Spont remission common?
30k-100k

No spont remit; wax-wane course
Hemophilia A or B more common?
B!

(1:30k)
(A is 1:100k)
vWD: how affect PT? PTT?
PT: normal

PTT: increased
Where do lymphocytes mature? Granulocytes?
Lymphos: spleen, LNs, thymus, bone marrow

Granu: Bone marrow & plasma
FFP: contains coag factors?
YES - 2, 7, 9, 10

Use it in hemorrhaging pt w/coumadin, liver dz
One unit dose (or one random donor platelet concentrate) of transfused platelets should raise the platelet count by:
7,000 - 10,000
DIC: how affect:

-PT
-PTT
PT: prolonged

PTT: no change
Cryoprecipitate: contains what factors? use what disease?
VIII (8)

vWD
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:
METHYLENE BLUE

(Sulfa --> form methemeglobin)
(NOT epi)
What percentage of patients with HbSS are NOT African-American?
5-10%
What SC injury:

hyperextension --> disproportionately greater weakness in the,upper extremity
Central cord syndrome
What SC injury:

hyperflexion --> complete paralysis and loss of sensation to pain and temperature bilaterally below the lesion
Anterior cord synd
What is HANGMANS FX?
Fx C2
Name for:

ipsilateral motor paralysis and contralateral sensory hypethesia distal to the level of injury
Brown-Sequard
Which therapeutic intervention is the fastest to decrease ICP?
Hyperventilation
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?
C6-T1

#1 successful ligitation film
Name for:

a subluxaion of the radial head commonly seen in childre
Nursemaids elbow
most common fracture in adults over the age of 50
Colles fracture (fall on outstretched hand --> fx wrist)
Which cardiac rhythms most characterizes digoxin poisoning?
Atrial tachycardia with block
Chronic anticholinesterase inhibitor: #1 S/E
Periph neuropathy --> weakness (PERMENANT)
Which commonly ingested material is not appreciably bound to activated charcoal?
Lithium
Hyperbaric O2: safe in pregnancy?
YES - use more liberally! fetus esp vulnerable to CO & hypoxia
Pt drinks propane:

-how long must obs in ED?
-admin epi if resp distress?
6h - most appear asympto initially

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

-perform w/in how many mins-hrs of ingestion?
-S/E hypo or hypernatremia
<60mins

HYPERnatremia (since using saline)
Physostygmine serious S/E?
Seizures
What nomogram:

predicits ASA toxicity
Done nomogram
Dextromethorphan: s/e hypo OR hypertension?
Hypo
TCA toxicity: Hypo or HTN?
HTN
Metal fume fever:

-due to what particles?
-how appear CXR?
zinc oxide

no change CXR
Wood's lamp: see what substance?
Ethylene glycol
Primidone:
-txs what dz?
-metabolized to what drug?
Seizures

--> phenobarb (may see false pos in urine screen)
Lead above what level considered toxic?
>10
What poisoni:

Basophilic stippling
Lead
Mushroom-related deaths:

-what toxin?
-what organs fail?
amatoxin

Liver & renal (3rd phase of toxicity)
Digitalis: mxn? avoid use w/which other drug?
Inhibition of Na+, K+ - ATPase pump

Avoid quinidine (decreases renal clearance of dig)
Beta-blocker toxicity: give what med?
Glucagon
Class 1A antiarryth: see what EKG change?
QRS prolong
Admin Digibind in pt w/dig tox in what 2 scenarios?
1. hyperK+ >5.5
2. Arryth --> unstable
SCIWORA:

-what stand for?
-more common peds or adults?
SC injury without radio abn

peds > adults
CANNOT CLEAR PEDS C-spine by radio alone!
Scalp suture: what is deepest layer you suture?
galea aponeurotica

(NOT subapo CT or periosteum)
Anterior cord syndrome:

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

complete paralysis and loss of sensation to pain and temperature bilaterally below the lesion
Central cord syndrome:

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

arms weaker than legs
Fastest way to decrease ICP?
hypervent
MVA: which more common - EDH or SDH?
SDH 6x > EDH
Horner's syndrome: due to injury of which specific SYMP ganglion?
Stellate's
Construction worker hit on head: what XR VIEW will most likely show fx?
Open mouth

(loading injury)
Neonate: start chest compressions at what HR?
HR <60

(or b/w 60-80 and not increasing)
Right axis deviation is present in children until approximately what age?
3-4yo
Presents what age?:
Heart failure secondary to patent ductus arteriosu
NEONATE

(NOT infant)
Rectal prolapse in a child should lead the clinician to consider this associated condition:
Cystic fibrosis
Klinefelter: see what heart defect?
VSD (only- no other defects)
Fetal EtOH synd: see what heart defect?
VSD (only)
Congenital rubella: what heart defect(s)?
PDA
Pulm sten
VSD
Ao coarct
Suspect intussception --> what is first diagnostic step?
PLAIN film (r/o perf, etc)

NOT enema
What percent of patients dying of apparent Sudden Infant Death Syndrome (SIDS) are later discovered to have died of child abuse?
5-10%
Reye's:

-how affect LFTS?
increased LFTs WITHOUT jaundice
Reye's:

How long after onset do focal neuro sxs appear?
NO FOCAL NEURO

(see encephalo)
Reyes:

Occurs how soon after febrile illness?
1w

(NOT immed)
True or false:

At four years of age, the liver edge should be no lower than one centimeter below the right costal margin
true
most common cause of cyanotic congenital heart disease in children older than 4 years of age
TOF
What pedi dz:

hypercyanotic or "tet spells" and a boot shaped heart on chest x-ray
tof
Neonate: definition of hypoglycemia
<40

(do NOT give dextrose if >40)
Pectus excavatum is associated with what congenital cardiac defect?
Pulmonary stenosis
What is the predominant cause of hypoglycemia until age two?
ASA ingestion

(2-10yo - EtOH)
Button battery: causes ALKALINE or ACIDIC caustic injury
ALKALINE

(can also conductt electrical current)
Child in shock: safe to use dextrose-containing solutions?
NO - osmotic diuresis
Greenstick fx of radius: how tx?
MUST BREAK OTHER SIDE (the buckled side)

--> otherwise different rates of growth
A one year old patient would be considered to be tachycardic if his/her heart rate were
>150
Which of the following is the most common cause of chronic renal failure in children under 5 years of age?
Dysplastic kidney
What dzs:

-fever --> face/trunk rash WITHOUT fever
- fever & rash simultan
HHV-6 (roseola infantum): FEVER STOPS --> THEN RASH

Measles: simultan
Colic (peds) most often resolves at what age?
3-4 months
What dz:

5 day old with DOWNWARD DEVIATING EYES and distended scalp veins
Communicating hydrocephalus (2/2 SAH during premature birth)

downward eyes nearly pathnognomic
Trigeminal neuralgia: most common in which branch?
MAXILLARY of CN V
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
Ramsay Hunt syndrome
Severely agitated EtOHic who may have had a seizure:

Admin what med?
LORAZEPAM

(benzo safe in W/D; not acute intox)
Which cause of coma is due to destruction of the ventral pontine motor tracks?
Locked-in
Locked-in syndrome: destroy what structure?
Ventral pontine motor tracks
Locked-in: able to look UP or SIDE-to-Side?
UP

(NOT horiz)
Only benzo suitable for IM injection
Midazolam

(NOT loraz, diaz)
Fosphenytoin contraI in what type of heart disease?
2-3rd degree block
Absence szs: drug of chocie?
Ethosuximide
The initial anticonvulsant of choice for status epilepticus (after checking glucose and possibly administering thiamine) is?
Lorazepam
How tx:

INH-induced sz
Pyridoxine
Trigeminnal neuralgia: how tx?
Carbamazepine
In a patient with intracranial hemorrhage caused by hypertension, initial management of severe blood pressure elevation is best obtained with what med?
Nitroprusside
The risk of thromboembolism is greatest during which stage of pregnancy? (TM1-3, during labor, post-part?)
POST-PARTUM
Pregnant with asthma:

-how tx? (meds)
-steroids safe in preg?
albuterol, terbutaline, corticosteroids

Steroid inactivated by placenta
Preeclampsia: 3 components
hypertension, pathologic edema, and proteinuria
Safe in preg?:

-Nitrofurantoin
-Bactrim
-Amox/amp
Yes: nitro, amp/amox

No: Bactrim (not in TM1 or TM3)
Pregnant w/UTI: what abx?
Nitrofurantoin
Molar preg: dx in which TM?
TM2
What dz:

Snowstorm uterus
Molar preg

(hydropic uterine vessels)
Molar preg: uterus smaller or larger than expected?
LARGER
Safe in preg?:

-ASA
-Dilantin
-Sulfa
-oral hypoglycemics
NONE SAFE
Generic name:

Dilantin
Phenytoin
Most reliable indicator of TRUE contractions (vs. false)?
Cervical dilation
Perimortem C-section: initiate w/in how many minutes-hrs of maternal cardiopulm arrest?
w/in 4 minutes of arrest

(wow! perform the C-section while someone else continues ACLS on mom)
2' syphilis: is rash contagious?
YES - highly!
Toxic Shock Synd: find bacteremia?
NO - suggests sxs 2/2 toxin
Clostridia infxn: give what abx?
HIGH DOSE PCN
Malaria: early in dz - present with low or high fever?
Low

Do not see high until later
Malaria: classic paroxysms of f/c often absent in which species of malaria?
p. falciparum
Pulmonary anthrax: admin abx via which route?
Initiatelly IV!!!! then switch to po
Oral thrush: which more effective:

nystatin suspension or clotrimazole troches
Clotrimazole troches
RMSF: what abx?
doxy
Malaria in subSahara Africa: give what ppx abx?
Mefloquine
HIV: how affect:

-PTT
-plt count
-bleed time
Decrease plt --> increase bleed time

Increase PTT
HIV:

-what % pts develop PCP PNA at some time?
-CXR negative in what % PCP PNA?
80% HIV pts will develop PCP PNA

10% CXR will be negative
PCP PNA:

See hilar adenopathy?
No

(suspect concurrent histo, TB, lmyphoma)
MAC:

easy or difficult to dx with stains & cultures?
EASY
most common cause of focal encephalitis in HIV and AIDS patients?
Toxo gondii!
the only AIDS related illness that causes pneumothorax
Kaposis sarcoma
Mumps:

-tx w/what abx?
-more severe in child or adult?
-see rash?
NO ABX (only give abx if parotid swelling)

worse in ADULTS

Rarely see rash
Erysiplas: what pathogen?
GAS
Jones criteria: what dz?
Rheumatic fever (strep)
Temporal arteritis: is plt count related to risk of vision loss?
Elevated plts (>400k) --> increased risk vision loss!
Temporal arteritis: does normal ESR r/o?
NO! can have normal ESR
most common cause of glomerulonephritis in children
post-strep glomerulonephritis
post-strep glomerulonephritis: what is most important test to order?
LYTES --- check K+ (life-threatening)
What dz:

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

(check lytes)
If allergic to lidocaine -->> use what anesthetic to repair lac?
cardiac lidocaine (no preservative)

NOT ester anesthetics (usu have higher rates of allergic rxns than amides)
Jarisch-Herheimer reaction:

what dz?

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

Tx w/fluids and ASA
How tx lupus cerebritis?
high-dose IV steroids
ACE-I induced angioedema: due what 2 chem mediators?
bradykinin and substance P
What is dz?:

blue-black scrotal dot
Torsion of APPENDAGE

(NOT testic torsion)
Prostatis: common or rare:

-Pseudomonas
-Chlamydia
Pseudomonas common!

Chlamydia rare!
Epididymitis:

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

>35yo: bactrim & doxy
Epididymitis:

-what % pts have WBC on UA?
-avg age onset?
50% have WBCs; absence does not r/o dx

avg age 25yo
#1 pathogen vaginitis? how tx?
Trich (NOT BV)
What dz:

Strawberry cervix
Trich
>35yo with epididymitis: 2 most common pathogens
1. E coli
2. Pseudomonas
Lifetime prevalance of sexual assault in females
20%
What dz:

-unable to retract foreskin
-unable to push foreskin over head of penis distally
Phimosis (penis with hat on)

Paraphimosis (foreskin bunched up proximally)
Etiology OR treatment for priapism?:

Papaverine injection into the corpora cavernosum
Etiology
Orchitis: common to see involvement of epidydmis? begins before or after swelling of parotids?
85% inv epidid

BEFORE parotid swell
Safe in preg?:

-Nystatin
-Metronidazole
Nystatin: yes

Metro: NOT IN TM1
What dz:

absence of cremasteric reflex
Testic torsion
What drug to tx 1' HSV vaginitis
ACV po
Male complaining of burning with urination: how tx if:

-no discharge
-pussy discharge
no discharge = chlamydia urethritis --> give doxy

discharge = gonorrhea --> give ceftriax
What antibiotic:

Antabuse-like reaction
Metronidazole
If asymptomatic --> should you treat gardnella vaginitis?
NO
Hydrocele: more common young or old?
Old
Varicocele: more common L or R?
L