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194 Cards in this Set
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When do you change from NS to 1/2 NS in the Tx of DKA?
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When glucose is <250
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19 y/o M presents w/severe pain to the right testicle which occurred suddenly while he was playing baseball. PE reveals a tender, swollen, firm testicle w/o transverse lie. There is no cremasteric reflex on that side. What is the Dx?
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Testicular torsion
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How does disulfiram (Antabuse) work?
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It inhibits the enzyme acetaldehyde dehydrogenase
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What are the S&S of heat exhaustion?
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*Dizziness or fatigue w/nml mental status
*N/V *HA *Positional hypotension/syncope *Mildly incr. temp *Diaphoresis *Prickly heat, heat cramps, heat tetany |
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MCC of painless lower GI bleeding in older patients?
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Diverticulosis
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What is the MC pediatric dysrhythmia?
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SVT
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What is the MC level of a C-spine fx? C-spine subluxation?
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1- C5
2- C5 on C6 |
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Why are beta-blockers contraindicated in cocaine toxicity?
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B/c the unopposed alpha-stimulation may increase BP
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Describe tonic-clonic (grand mal) seizures.
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*LOC, followed imm by tonic contract of muscles then clonic contraction
*Pt may be cyanotic or apneic *Urinary incontinence poss *Postictal period |
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What is the tx for Guillain- Barrie syndrome?
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*Plasmapheresis
*IVIG *Intubate if there is resp compromise |
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How do you treat a calcaneal fx?
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Nondisplaced --> posterior splint
Displaced --> sx repair |
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What are the S&S, location, & pathology of UC?
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*bloody diarrhea, rectal pain
*limited to rectum & colon *inflammation of mucosa only (exudates of pus, blood & mucus from the "crypt abscess") |
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What are the S&S, location, & pathology of Crohn's?
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*Crampy abd pain in RLQ, fatigue, malaise
*any part of GI tract *inflammation involves all bowel wall layers, which may lead to fistulas & abscesses; rectal sparing in 50% |
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What are the complications of UC vs. Crohn's?
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UC --> perforation, stricture, toxic megacolon
Crohn's --> abscesses, fistulas, obstruction, perianal lesions |
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Why is metabolic acidosis present in ASA toxicity?
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Uncoupling of oxidative phosphorylation leads to anaerobic metabolism w/lactic acidosis
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A stroke due to the vertebrobasilar artery will cause what condition of the eyes?
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diplopia
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What are the colonoscopy findings of UC?
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Continuous lesions, lead pipe colon appearance due to chronic scarring & subsequent retraction & loss of haustra
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What are the colonoscopy findings of CD?
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Skip lesions, apthous ulcers, cobblestone appearance from submucosal thickening interspersed w/mucosal alteration
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When should you consider elective cardioversion for A-fib?
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<48 hours duration
if >48 hrs, use anticoagulants for 4 wks prior to cardioversion |
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What are some characteristics of a pt with PCP pneumonia?
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*HIV +
*Low CD4 count (i.e.54) *No Antiretroviral meds *No bactrim *Hypoxic on RA *Elevated LDH *Diffuse bilateral infiltrates on CXR |
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What are some high-output states that can lead to heart failure?
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*Pregnancy
*Thyrotoxicosis *Wet beriberi *AV fistulae *Paget's disease *Severe chronic anemia |
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25 y/o F, post high-speed MVA presents w/dyspnea & tachycardia. There is local bruising over R-side of chest. CXR show RUL consolidation. What is the Dx?
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Pulmonary contusion
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What is cardiac tamponade usually seen in?
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*Penetrating thoracic trauma
*May occ be seen w/blunt thoracic trauma |
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What is Beck's triad?
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*Muffled heart sounds
*Hypotension *Inc JVD |
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Define pregnancy-induced HTN.
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*BP >140/90
*Increase in systolic BP >20 or inc in diastolic BP >10 |
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7 y/o M presents w/a high fever, myalgias & a rash of 2 days that consists of 2-6 mm pink, blanchable macules that first appear peripherally on wrists, forearms, ankles, palms & soles, then spread to the trunk. What is the dx?
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RMSF
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T or F: Transfuse platelets in a pt w/ TTP.
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FALSE!! This could kill them!
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What are the S&S of TTP?
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Fever, pallor, petechiae, colicky pain, waxing & waning
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How do pts w/retropharyngeal abscesses prefer to sit?
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recumbently w/hyperextension of the neck
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When should you admit a pt with hepatitis?
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*Encephalopathy
*Excessive bleeding *INR >3 *Intractable vomiting *Immunosuppressed *Due to ETOH *Hypoglycemic *Bilirubin >25 |
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What does the Dx of TTP include? i.e. which tests?
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*clinical suspicion & correlation with labs
*peripheral blood smear-- schistocytes & helmet cells *CBC- anemia, thrombocytopenia, inc retic *BUN/Cr-- azotemia *UA-- hematuria, red cell casts, proteinuria *LFTs- elev LDH, bilirubin, low haptoglobin |
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How do cerebellar artery strokes present?
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*Central vertigo
*N/V *HA *inability to sit/stand w/o support |
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What are the S&S of vertebrobasilar strokes?
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*Syncope, weakness
*Cranial nerve changes *Crossed findings-- ipsilateral CN changes w/contralateral motor weakness *Ataxia *Diplopia, dysphagia, dysarthria |
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What are the S&S of HUS?
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*GI symptoms
*Oliguria *Pallor *GI bleeding *Seizures-- as complication of RF, due to HTN, hyponatremia, fluid overload, & electrolyte imbalances |
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Who gets prophylactic ABX in dog bites? Which ABX?
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*immunocompromised & frail
*Outpt --> amoxicillin/clav (Augmentin) *Inpt --> ampicillin/sulbactam (Unasyn) |
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What is the etiology of cellulitis? Name the organisms involved...
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#1 --> Strep pyogenes (MC)
2--> Staph 3--> H. flue -- immuno 4--> enterobacteria -- DM |
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In Vtach w/a pulse, what do you do if the pt is UNstable?
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immediate synchronized cardioversion
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How do you treat cellulitis w/head & face involvement or in the immunocompromised?
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Inpt-- IV ABXs
i.e. Cefazolin 1 g IV qid & Nafcillin OR oxacillin 2 g IV q4 hr. Use ceftriaxone or imipenem for severe cases |
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What is a normal response for the corneal reflex cotton wisp test? What two things must be intact for this to occur?
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*a blink
*V1 of CN V- trigeminal (sensory) & CN VII- facial (motor) |
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What is the initial insulin infusion in the tx of DKA?
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Bolus --> 0.1 U/kg IV ... then..
Infusion --> 0.1 U/kg/hr |
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Where is the majority of ethanol absorbed?
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proximal small bowel
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List the causes of NORMAL anion gap metabolic acidosis.
HINT --> HARDUP |
Hyperparathyroidism
Adrenal insufficiency Renal tubular necrosis Diarrhea Ureteroenteric fistula Pancreatic fistula |
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What is the optimization for ischemic stroke management?
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O2 supplementation
BP: MAP >60, SBP >90 Serum glucose: <150 Normal temp Thrombolytics |
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When should you tx HTN in the management of ischemic stroke?
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When MAP >130
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How is NAC given in APAP OD?
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*Rumack-Matthew nomogram
*ID pts w/a toxic level of APAP w/in 8 hrs of ingestion *Give loading dose of 140mg/kg PO followed by 70 mg/kg q4hr for 17 more doses |
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Describe 2nd degree Type II AV block.
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Constant PR interval w/lost beat (QRS).
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What are the S&S of heatstroke?
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CNS- ataxia, hallucinations, seizures, hemiplegia, coma
RF- dec Ca, dec PO4, etc. Coagulation LF, hypotension, death |
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Central cord syndrome is seen in what type of injuries? What are the S&S?
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*hyperextension injuries, i.e. whiplash
*weakness > UE than LE, distal worse than proximal. i.e. pt will have a weak handshake |
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What are some risk factors for TTP?
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*Pregnancy
*Drugs -- quinine, cyclosporin, immunosuppressives, OCPs, PCN, H2 blockers *Autoimmune disorders *Infection - E.coli, shigella *Allogenic bone marrow transplant *Malignancy |
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Define thrombotic thrombocytopenic purpura (TTP).
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Severe disorder in which fibrin strands are deposited in multiple small vessels. This damages passing RBCs & platelets & results in thrombocytopenia & microangiopathic hemolytic anemia.
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List the possible causes of acute inflammatory pericarditis.
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*Infection (viral > bacterial)
*Post MI *Trauma *Uremia *Post-irradiation *Aortic dissection *Tumors |
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What are some S&S of Posterior Cerebral Artery stroke?
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*vision changes
*sensory changes *usually have subtle presentations |
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Define aortic stenosis.
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Valve hardening that obstructs blood flow from the LV.
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What does aortic stenosis lead to? What does it predispose to?
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*Progressive LVH, dec CO, hypertrophic & later dilated cardiomyopathy
*Endocarditis |
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What is the management for ethylene glycol toxicity?
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1- get blood levels of ethanol, methanol, & ethylene glycol
2-ethanol infusion or fomepizole 3-Ca prn for hypocalcemia 4-Pyridoxine & thiamine 5- Dialysis prn clinically or if levels are >25 6- Admit |
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What are the S&S of trich?
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*Copious, foamy, y/g, malodorous d/c w/pH >5.5
*Strawberry cervix *Labial irritation or swelling *Dyspareunia *Dysuria *Men may be asymptomatic |
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What is the Tx of epiglottitis?
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*Intubation prn for airway
*Ceftriaxone (Rocephin) *ICU admission |
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What is the MC site of FB ingestion in adults? In kids?
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Adults --> LES
Kids --> cricopharyngeus muscle |
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What is the tx of pseudogout?
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*Splint the joint
*Aspiration is dx & therapeutic *NSAIDs |
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What does serotonin syndrome usually result from? (ie. which drugs?)
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Combo of SSRI w/:
*MAOI *Cocaine *MDMA (ecstasy) *Lithium/tryptophon |
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When do you do dialysis in ethylene glycol toxicity?
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When clinically indicated or when the ethylene glycol level is >25 mg/dL
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In nephrolithiasis, what size stones pass?
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They rarely fully obstruct ureter b/c of shapes.
*<5 mm -- almost always pass freely *5-8 mm -- 15% will pass freely *>8 mm -- only 5% will pass freely |
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Define phimosis.
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Inability to retract foreskin over the glans (proximally)
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What is a possible clinical finding in phimosis?
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Urinary retention secondary to pain or obstruction of the urethra
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What is the etiology of phimosis?
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*Infection
*Poor hygiene *Old injury w/scarring |
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What causes vaso-occlusive crisis in sickle cell anemia? How is it treated?
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*Cause-- vascular sludging & thrombosis
*Tx -- IVF & analgesics ... b/c crisis is often precipitated by infxn, have a low threshold for ABXs |
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What is the Tx of Torsades?
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IV Mg sulfate...cardioversion if unstable
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At what b-hCG level can you usually visualize IUP with transvaginal US? Transabdominal US?
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*1000-1500
*6,000 |
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Where do you place a tube thoracostomy?
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4th or 5th ICS, midaxillary line
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What should acute seizures be managed with? (w/head trauma)
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*diazepam
*lorazepam *phenytoin *burr hole may be necessary |
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What are the risk factors for intussusception?
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50% have recent viral infection
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Define acute cholecystitis.
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Obstruction of the cystic duct w/pain lasting longer, fever, chills, nausea, & + Murphy's sign
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What is Murphy's sign?
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The arrest of inspiration while palpating the RUQ. 95% sensitive for acute cholecystitis. Less sensitive in elderly.
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Define choledocholithiasis.
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Stone in the common bile duct
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Re: PUD complications, posterior perfs may lead to _______.
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Pancreatitis
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Ca gluconate can be used to Tx hyperkalemia. How does it work?
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Cardio protective-- Stabilizes cardiac membrane.
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Re: 3rd degree AV block: what is the rhythm & how do you get the block?
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*No conduction of atrial signal & p wave through ventricle. Independent atrial & ventricular rhythms.
*Congenital or acquired |
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What is the classic triad of ectopic pregnancy?
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*Vaginal bleeding
*Abdominal pain *Amenorrhea |
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What acid/base disturbances are present in ASA toxicity?
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*Resp alkalosis
*Metabolic acidosis *Metabolic alkalosis |
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Define epiglottitis.
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Life-threatening inflammatory condition of the epiglottis & the aryepiglottic folds & periglottic folds
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Describe some drugs that prolong the QTc interval. (General)
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*Antimicrobials
*Antiarrhythmics *Anti-depressants (TCAs) *Antipsychotics *Other |
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Up to 10% of ethanol is eliminated by ______.
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Lungs, urine, sweat
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Define an inevitable abortion.
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Vaginal bleeding with open cervical os, but no passage of POC.
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What is the MCC of SBO? Second?
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1- adhesions
2- incarcerated hernias |
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In the dx of perfs due to PUD, what is involved?
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Upright CXR to look for free air (useful for 70% ant perfs)
** does NOT pick-up post perfs b/c posterior duodenum is retroperitoneal |
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What is the most sensitive film for free air?
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Upright CXR
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List the signs of Mg toxicity.
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*Hyporeflexia or absent of DTRs
*Resp depression *Bradydysrhythmias |
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What US result is highly suggestive of ectopic pregnancy?
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Presence of echogenic adnexal mass & free fluid in the pelvis
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What is cholelithiasis?
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Stone in the gallbladder
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What is the MCC of appendicitis?
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fecalith
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What are the symptoms of a typical vaso-occlusive crisis in sickle cell anemia?
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Pain & arthralgias
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How do you tx the pregnant pt with bacteruria? With pyelo?
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1- Tx with ABX
2- Admit for IV ABX **High risk of miscarriage with UTI! |
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What is the Tx of phimosis?
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Dorsal slit or circumcision
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How do you tx a tension PTX?
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1- immediate needle decompression
2- chest tube |
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Define preeclampsia.
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Syndrome of:
*HTN *Proteinuria *Edema that occurs >20 weeks of pregnancy |
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What are the clinical features of a hip fx?
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1- Hx of a fall
2- Inability to bear weight 3- Leg shortened & ext rotated |
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How do you tx temporal arteritis? What is a possible complication if left untreated?
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*Prednisone
*Vision loss |
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How do you dx temporal arteritis?
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S&S: severe, throbbing, frontal HA, tender temp artery
ESR >50 mm Def: temporal artery bx showing giant cells-- but don't wait for results before starting tx!! |
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Define temporal arteritis. Who is it MC in?
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*Systemic panarteritis affecting the temporal artery
*Women >50 y/o |
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Soft tissue neck x-rays and ______ can be useful in epiglottitis dx, but NEVER do ______ because....
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*fiberoptic laryngoscopy
*direct laryngoscopy, b/c this may induce fatal laryngospasm |
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What is the mainstay therapy for PE?
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anticoagulation --> may consist of heparin & coumadin or LMWH (enoxaparin)
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27 y/o F w/ PNA bullous myringitis and CXR that looks worse than expected. What is the likely dx?
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mycoplasma PNA
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50 y/o M alcoholic presents w/ midepigastric pain radiating to the back. He is leaning forward on his stretcher and vomiting. What is the likely dx?
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pancreatitis
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How do you treat cardiac tamponade?
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Immediate decompression via...
1- needle pericardiocentesis 2- pericardial window... OR 3- thoracotomy w/manual decompression |
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Define biliary colic.
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Transient gallstone obstruction of the cystic duct causing intermittent RUQ pain lasting a few hours after a meal.
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What are the 6 P's? Which is the most reliable for compartment syndrome?
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*Pain
*Paresthesia --> *** *Pallor *Pulselessness *Paralysis *Poikilothermia |
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______ are responsible for more drug-related deaths than any other prescription medication.
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TCAs
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What is the MC organism to cause septic arthritis overall across all age groups?
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Staph aureus
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Define cellulitis.
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A local erythematous inflammatory rxn of the subQ tissue following a cutaneous breach which leads to infection.
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39 y/o F presents w/a rash on her R. leg that she initially thought was an insect bite. It is an erythematous annular plaque w/a central clearing. Most likely dx...?
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ECM (erythema chronicum migrans)... rash of lyme disease. It is seen 2-20 days from site of tick bite.
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41 y/o F w/known hyperthyroidism is brought in by her family who state that she has had days of diarrhea & is acting "crazy" w/labile mood. Febrile to 102, pulse 140, rales on ausc. Dx?
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Thyroid storm
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55 y/o M, diabetic presents w/a RLE that is red, warm & tender to touch. Poorly demarcated borders & has been spreading over the last day. Febrile (101). Dx?
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Cellulitis
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MCC of adrenal crisis?
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Abrupt withdrawal of steroid therapy
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What is the tx for an inevitable abortion?
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*D&C (evacuation of preg)
*Rh isoimmunization prn |
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What is the most frequently injured foot bone?
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calcaneous
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Hg S means... ?
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sickle cell anemia
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How does the fx of the calcaneous usually occur?
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Fall from a height w/pt landing on their feet.
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Where is compartment syndrome most common?
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LE
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Is the use of bicarb in DKA tx routinely recommended?
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NO
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73 y/o diabetic female w/altered mental status ran out of her meds 4 days ago. Fingerstick glucose is >1,000. What is the most likely dx?
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NKHC --> nonketotic hyperosmolar coma
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What is the US used for in suspected ectopic pregnancy?
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to establish the presence or absence of IUP
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Eclampsia can occur up to ____ days postpartum.
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10
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Gout vs. Pseudogout... what kind of crystals are each?
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Gout --> neg. birefringent crystals
Pseudo --> pos birefringent crystals |
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29 y/o F with hx of PID, presents w/abd pain and vaginal spotting. LMP was 10 wks ago. NO IUP can be seen on u/s. Most likely dx?
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Ectopic pregnancy
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In trauma, when is a foley contraindicated?
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In suspected urethral transection (i.e. w/pelvic fx). If suspected, perform retrograde urethrogram BEFORE placing foley.
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Most frequently injured solid organ associated w/blunt trauma? #2?
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#1 --> spleen
#2 --> liver |
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Most frequently injured solid organ associated w/penetrating trauma? #2?
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#1 --> liver
#2 --> small bowel |
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What is virtually diagnostic of urethral injury? What should you do if you find this?
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*Blood at the urethral meatus.
*Early retrograde urethrogram before foley placement. |
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Head CT can miss up to ____% of SAH. What must you do because of this?
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*15%
*LP to check for xanthochromia or blood if the CT is negative in suspected SAH. |
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What is Guillain-Barre syndrome?
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*Ascending peripheral neuropathy
*Usually hx of viral illness *Loss of DTRs *Distal weakness>proximal *Symmetrical weakness |
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All pts w/posterior nosebleeds should have this.
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*Emergent ENT consult
*Are usually admitted too |
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What are the mainstay of tx in the seizing pt?
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Benzos!
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What is a reason spiral CT is more often the dx TOC for PE?
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It can also identify alternative dx
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What is the classic sign of epiglottitis on x-ray?
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"thumbprint sign"
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How do pts w/epiglottis prefer to sit?
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*tripod
*leaning forward w/neck slightly flexed |
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How is the needle decompression performed in tension pneumo?
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Placing a needle (or needle over a catheter) into the 2nd ICS @ midclavicular line followed by a tube thoracostomy
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MCC of airway obstruction in the unconscious victim?
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the tongue
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A choking victim is coughing and/or speaking. What do you do?
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Nothing-- do NOT interfere. Coughing is the most effective way to clear a FB & ability to speak indicates adequate ventilation is still occurring.
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What would you suspect if you saw diffuse ST elevations across all leads?
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Pericarditis (along w/PR depression)
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What is the tx for eclampsia/preeclampsia?
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1- bed rest
2- left, lat decubitus to inc blood flow to uterus 3- hydralazine for BP control 4- Mg sulfate for seizures 5- maintain UO @ 30cc/hr 6- Def. tx: delivery of baby! |
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S&S of aortic stenosis.
(SAD) |
*Syncope on exertion
*Angina *Dyspnea on exertion *sudden death *low-pitched <> murmur @ base radiating to carotids *carotid pulse weak (parvus) & slow rising (tardus) S3S4 |
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S & S of thyroid storm.
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*fever
*tachycardia *high-output CHF & volume depletion *exhaustion *GI-- diarrhea, abd pain *CNS-- agitation, coma, etc *JAUNDICE = late & OMINOUS sign |
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Possible etiologies of appendicitis. What is the MC?
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*fecalith-- MC
*lymphoid hyperplasia *worms *granulomatous disease *inspissated barium *tumors *adhesions *dietary matter such as seeds |
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Define heatstroke.
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Rapid rise in core temp (>104) associated with:
*altered mental status *sx of heat exhaustion *anhydrosis *loss of temp regulation |
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Risk factors for HUS.
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*Infxn w/ E. coli 0157:H7 or shigella dysenteriae
*Ingestion of undercooked meats & unpasteurized products |
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Who gets TTP?
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*Female > male
*10-45 yrs |
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How do you dx HUS?
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Same as TTP & test for E. coli 0157 infxn
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6 y/o female presents w/abd pain, oliguria, diarrhea, fever. Several kids @ school have same after b-day party @ local hamburger chain. Labs show ARF. What is the most likely dx?
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HUS
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Tx of gout: in the ED and outpatient.
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ED --> indomethacin is 1st line. Colchiacine is 2nd line.
Outpt --> Allopurinol for prophylaxis. Do NOT give in acute phase! |
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GCS--> best motor response scoring.
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6- Obeys verbal command
5- Localized pain to stimuli 4- Flexion withdrawal 3- Decorticate rigidity 2- Decerebrate rigidity 1- No response |
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What are the side effects of using bicarb in DKA tx?
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*lowering intracellular pH
*hypokalemia *shifting O2 dissociation curve |
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How do you Tx GB?
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*Plasmapheresis
*IVIG *Intubation as needed |
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How do you dx GB?
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LP--> reveals increased CSF protein, w/nml glucose & cell count
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When might bicarb be used in the tx of DKA?
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pH <7.1
severe hyperkalemia OR refractory hypotension |
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How do you tx thrombophlebitis? Dosing?
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Anticoagulation w/heparin if DVT or PE present.. 80 U/kg IV bolus followed by 18 U/kg/hr infusion. LMWH can be used for DVT w/o PE
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What are the transvaginal u/s findings in IUP at each b-hCG level? I.e. At what level will you see the gestational sac? Yolk sac? Heart tones?
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Gest sac --> 1,000
Yolk sac --> 2,500 Heart tones --> 10,500-17,000 |
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In chronic renal failure, when is emergent hemodialysis indicated?
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1- electrolyte abnormalities (hyperkalemia is MC)
2- volume overload 3- intractable acidosis, bicarb <10 4- severe uremia |
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S & S of metabolic alkalosis of ASA toxicity...?
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*vomiting
*diaphoresis *tachypnea *these all cause dehydration & volume contraction |
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In what conditions is Mg sulfate useful? When should you give it?
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*Torsades de pointes
*Suspected hypomagnesemia |
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MCC of epiglottitis? Second?
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#1-- Hib
#2-- streptococcus |
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Explain the prognosis for central cord syndrome.
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Much better prognosis than the others, i.e. anterior cord syndrome (BAD!!)
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What is the return of fxn of central cord syndrome?
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LE, then UE, then the hands finally recover strength
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Describe extensor posture. Where is the lesion?
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abnormal ext of BOTH the arms & legs... lesion is BELOW red nucleus.
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Describe flexor posture. Where is the lesion?
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Abnormal flexion of the arm & wrist w/ext of the leg... lesion is ABOVE red nucleus.
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S&S, location, pathology of UC vs. Crohn's.
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UC-->
*bloody diarrhea *limited to rectum & colon *mucosa only; crypt abscesses Crohns--> *crampy abd pain, RLQ *any part of GI tract *all bowel layers, fistulas *rectal sparing in 50% |
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What are the complications of UC? Crohn's?
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UC --> perforation, stricture, toxic megacolon
Crohn's --> abscesses, fistulas, obstruction, perianal lesions |
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Why is metabolic acidosis present in ASA toxicity?
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uncoupling of oxidative phosphorylation leads to anaerobic metabolism w/lactic acidosis
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When do you consider elective cardioversion for A-fib?
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<48 hrs duration-- can do this then. If >48 hrs, use anticoagulants for 4 wks prior to cardioversion
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Describe a pt w/PCP pneumonia.
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*HIV
*low CD4 count (i.e. 52) *No antiretroviral meds *No bactrim *Hypoxic on RA *Elevated LDH *Diffuse bilateral infiltrates on CXR |
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What are some high-output states that can lead to heart failure?
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*Pregnancy
*Thyrotoxicosis *Wet beriberi *AV fistulae *Paget's disease *Severe chronic anemia |
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25 y/o F, post high-speed MVA presents w/dyspnea & tachycardia. There is local bruising over R-side of chest. CXR shows RUL consolidation. What is the most likely dx?
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Pulmonary contusion
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What is cardiac tamponade usually seen in?
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Penetrating thoracic trauma, may be seen w/blunt thoracic trauma.
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25 y/o F was found febrile & confused. On PE she is tachycardic, has mucosal bruising, trace heme + stools, waxing & waning mental status. Labs show 22,000 platelets, PT/PTT nml, elevated bilirubin, BUN/Cr = 40/2.0. Peripheral smear shows schistocytes & helmet cells. What is the most likely dx?
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TTP
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GCS-- what is the verbal response scoring?
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5- oriented & converses
4- disoriented & converses 3- inappropriate words 2- incomprehensible sounds, i.e. grunts/moans 1- no response |
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How do you tx uncomplicated cellulitis in healthy individuals?
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Cephalexin (Keflex) or dicloxacillin 500 mg qid x 10 days... OR Azithromycin 500 mg x1 then 250 mg qd x4days
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What is the prodrome of symptoms w/in the first two days of tick bite happens in RMSF?
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*high fever
*myalgia *severe HA *rigors *nausea *photophobia |
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What is NAC? How does it work?
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N-acetylcysteine: used in acetaminophen OD. After 24 hrs it acts as a hepatocellular protectant
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What is the hallmark of ethylene glycol toxicity?
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Ca+ oxalate crystals in the urine, but it is only present in 50%.
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What meds are used to tx aortic dissection while waiting for sx?
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antihypertensives--
*labetalol IV 0.25 mg/kg over 2 min then... *nitroprusside 0.3 to 10 ug/kg/min |
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S & S of eclampsia/preeclampsia.
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1- weight gain >5 lbs/week
2- HA, visual disturbances 3- Peripheral edema 4- Pulmonary edema 5- oliguria |
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Tx of NKHC...?
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*Replace fluids w/NS (8-10L)
*1/2 NS when K+ <4.5 *Less insulin needed than in DKA *ID & tx precipitating factor |
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Tx of DKA... ?
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*Rapid IVF replacement (NS)
*Insulin infusion until glucose is <250 & ketoacidosis resolved. *Monitor & add K+ to IVF when K+ <4.5 *Replace other electrolytes *ID & tx precipitating factor *Bicarb = controversial |
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What does CXR often reveal in heart failure?
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*Cardiomegaly
*Pulmonary vascular redistribution *Pulmonary venous congestion *Kerly B lines *Alveolar edema *Pleural effusions |
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How do you tx TTP?
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*Plasmapheresis
*Do NOT give platelets!! *Admit to ICU *Monitor for & tx acute bleeds * |
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How does free Fe+ in circulation lead to toxicity in Fe+ OD?
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*Direct corrosive effect on GI tract
*Causes vasodilation & myocardial depression *Disrupts oxidatve phosphorylation, which leads to build-up of lactic acid (metabolic acidosis) |
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What are the possible etiologies of an upper GI bleed? What is the MC?
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*PUD -- MC
*Varices *Gastric erosions *Mallory-Weiss tear *Esophagitis *Duodentitis |
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Should you rapidly reduce the BP in eclampsia/preeclampsia? Why or why not?
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NO-- b/c it may decrease uterine blood flow & lead to fetal distress.
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MC EKG rhythm in pulmonary embolism?
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sinus tachycardia
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AAA is most frequently misdiagnosed as ______.
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renal colic
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S&S of respiratory alkalosis in ASA toxicity.
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Direct stimulation of the medulla:
*tachypnea *hyperapnea |
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GCS-- what is the eye scoring?
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4- opens eyes spontaneously
3- opens to verbal command 2- opens to pain 1- no response |
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What is the MC location for a stroke?
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middle cerebral artery
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What are the S&S of a middle cerebral artery stroke?
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*Contralateral weakness & numbness of ARMS > legs
*Aphasia *Homonymous hemianopsia (loss of vision on R or L side of BOTH eyes) |
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How can the Glasgow Coma Scale be used to classify head injuries?
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Severe--> <8
Moderate --> 9-13 Milk --> 14-15 |
