River's Deck #3

Front 1

The ________ patient is often inappropriately calm in the setting of a devastating chief complaint, such as acute blindness or paralysis

Back 1

Hysterical

Front 2

A patient presents with severly agitated, violent behaivor. What is the most appropriate management?

Back 2

Physical restraint/seclusion followed by administration of Haloperidol (Haldol) 5 mg IM

Front 3

A patient who is disoriented to time and place but not to person has what type of illness?

Back 3

Organic brain syndrome

Front 4

What is the treatment of Multifocal Atrial Tachycardia?

Back 4

The most important consideration in this dysrhythmia is the aggressive treatment of the underlying cause(s).

Front 5

What are the common causes of sinus tachycardia?

Back 5

Anxiety (very common), Fever, Drugs, Hypervolemia, Hyperthyroidism, Pulmonary Embolism, Anemia, Hypoxia

Front 6

What are the ECG findings in digitalis toxicity?

Back 6

PVCs (most common - often bigeminal and mulltiform), Junctional tachycardia (common), SA and AV nodal block, A-Fib with a slow ventricular response, SVT - especially PAT with block, Ventricular tachycardia or fibrillation, Bidirectional V-tach (rare but highly suggestive of digitalis toxicity), Sinus bradycardia/sinus arrest

Front 7

Can impedance plethysmography be used to diagnose superior vena cava obstruction?

Back 7

No. While this study is useful in excluding proximal DVT (ileofemerol veins and inferior vena cava), a normal study does not rule out obstruction of the superior vena cava.

Front 8

A patient with the chief complaint of "syncope" has a systolic ejection-type murmur heard maximally either at the lower left sternal border or at the apex that increases with Valsalva maneuver. The ECG shows left ventricular hypertrophy. What is the suspected diagnosis?

Back 8

Hypertrophic cardiomyopathy

Front 9

What is the most common complication of thrombolytic therapy in patients with acute MI?

Back 9

Reperfusion dysrhythmias

Front 10

What the typical ECG findings in an acute inferior wall MI?

Back 10

Acutely, ST segment elevation occurs in leads II, III and aVF. Recipricol ST segment depression may occur in leads I, aVL and V1 - V6. Remember: Q-waves make take hours to develop or they may be absent ("non-Q wave" infarctions)

Front 11

Which drugs may be used for hypertensive emergencies in eclampsia prior to delivery?

Back 11

Hydralazine or Labetalol

Front 12

Which diagnosis should be ruled out in any patient older than 50 who presents with abdominal pain, back pain, weakness or syncope?

Back 12

Abdominal aortic aneurysm - Remember that the absence of a palpable abdominal mass and/or the presence of a palpable femerol pulse does not exclude this diagnosis.

Front 13

Name the most common ECG findings in the acute cor pulmonale.

Back 13

Non-specific ST and T wave abnormalities

Front 14

In the hypotensive patient with hyperglycemic hyperosmolar nonketotic coma (HHNC), fluid replacement should be initiated with ______ until the patient is normotensive. Then ______ may be used thereafter.

Back 14

Initial fluid replacement is with isotonic or normal saline; thereafter, one-half normal saline may be used.

Front 15

In which metabolic derangement may neurologic findings include: Hemiparesis, Hemisensory deficits, Focal or grand mal seizures?

Back 15

Hyperglycemic hyperosmolar nonketotic coma (HHNC)

Front 16

Severe hyperkalemia may be associated with which neurologic sequela?

Back 16

Generalized weakness, Ascending motor paralysis, Quadriplegia

Front 17

In the drug therapy of hyperkalemia, which treatment has the most rapid onset and the shortest duration of action?

Back 17

Calcium gluconate

Front 18

What is the appropriate disposition for a patient taking a sulfonylurea who presents with drug induced hypoglycemia?

Back 18

Admission - The long half-life of many of these drugs predisposesthe patient to recurrent episodes until the drug is metabolized. Chlorproamide has a half life of 36 hours with a duration of effect up to 2 - 5 days. Second generation drugs (glipizide, glyburide, glimepiride) have shorter half-lives but the duration of action ranges from 10 - 16 hours (glipizide) up to 24 hours (glyburide)

Front 19

The ______ ______ ______ of ionizing radiation determines the timing of the onset of symptoms. The higher the level of exposure, the ______ symptoms develop.

Back 19

Whole body dose - Earlier

Front 20

What is the best predictor of survival in patients with radiation exposure?

Back 20

Absolute lymphocyte count, 48 hours after exposure

Front 21

What is the treatment of puncture wounds (stings) from sea urchins, sting rays or lionfish?

Back 21

1 - Remove spine (if possible), 2 - Wash with sea water or fresh water, 3 - Submerge wound in hot water for 30 - 90 minutes

Front 22

Concerning the initial management of patients with radioactive skin contamination, is it preferable only to wash or to wash AND scrub the skin?

Back 22

Washing with water and mild or nonionic soap is done in conjunction with GENTLE scrubbing. Harsh scrubbing may damage the skin with introduction of radioactive material into the underlying tissues.

Front 23

Does successful recovery from tetanus confer immunity to the disease? What is the primary cause of death in patients with tetanus?

Back 23

No! The patient needs full primary immunization plus boosters through the years as indicated - Pneumonia

Front 24

Which tick-borne illness is characterized by severe retro-orbital headache and photophobia and requires only suppotive therapy?

Back 24

Colorado tick fever

Front 25

CLINICAL PRESENTATION: a patient presents ill with fever and rash. The rash began as discrete red maculopapular lesions on the wrists and ankles. It then spread to the runk. Early on, the lesions were blanched but later became petechial. What disease characteristcally does this?

Back 25

Rocky Mountain Spotted Fever

Front 26

Circular lesions with a bright-red to blue-red border and a pale center are characteristic of ______ ______, which is the hallmark of early ______ ______?

Back 26

Erythema migrans - Lyme disease (Stage I)

Front 27

Antibiotic therapy for adults (nonpregnant and nonlactating) and children older than 8 years for Lyme disease stage I is ______?

Back 27

Doxycycline or tetracycline

Front 28

What is the initial diagnostic study of choice for a patient with suspect cholecystitis?

Back 28

Ultrasonography - because it detects almost 98% of patients with gallstones and is more readily available than cholescintigraphy (hepato-biliary nuclear scanning). However, cholescintigraphy is the procedure of choice for definitive diagnosis of cholecystitis since US seldom demonstrates signs of gallbladder inflammation.

Front 29

Which abnormal electrolyte finding is seen in patients with pancreatitis?

Back 29

Hypocalcemia

Front 30

Hemorrhagic shock is a potential complication of which inflammatory GI disorder?

Back 30

Pancreatitis

Front 31

What are the historical findings consistent with the diagnosis of irritable bowel syndrome?

Back 31

Excessive flatus, Intermittent episodes of constipation, Rectal urgency, Stable weight over the last year

Front 32

What are the most likely causes of lower GI bleeding in children?

Back 32

Meckel's diverticulum is the most common cause of SIGNIFICANT lower GI bleeding in children. Anal fissure is the most likely cause of MINOR lower GI bleeding in a healthy infant beyond the neonatal period without previous GI history.

Front 33

What is the most common cause of upper GI bleeding in pregnancy?

Back 33

Esophagitis - secondary to reflux and repeated vomiting

Front 34

A patient presents with sudden onset of LUQ pain associated with violent retching (but no vomiting). Upright films of the chest and abdomen reveal a distended stomach with one or two air-fluid levels. What is the diagnosis?

Back 34

Gastric volvulus

Front 35

What is the most common cancer of the small intestine?

Back 35

Adenocarcinoma - usually occurs in the proximal small bowel - Higher incidence in patients with long-standing Crohn's dz

Front 36

What is the most frequent site for aortoenteric and ileoenteric fistulae?

Back 36

The distal duodenum - Consider this diagnosis in patients with GI bleeding and a history of aneurysms

Front 37

What is the carcinoid syndrome?

Back 37

Carcinoid tumor cells (usually in the distal small bowel) secrete 5-hydroxytrytophan → wheezing/SOB, intermittent flushing, abdominal pain, diarrhea, signs and symptoms of right sided valvular heart disease. Diagnosis is confirmed by obtaining a urine level of 5-hydroxyindoleacetic acid (5-HIAA)

Front 38

What is the most sensitive indicator of gastric rupture after blunt trauma?

Back 38

Peritoneal lavage

Front 39

A patient with a history of blunt trauma to the face has enophthalmos (recognizable as slight ptosis) on the physical exam. What diagnosis should be considered?

Back 39

Blowout fracture of the orbit

Front 40

What is the currently recommended emergency treatment for complete laryngeal obstruction due to trauma?

Back 40

Tracheostomy; Cricothyrotomy is not feasible because the injury is frequently below the cricothyroid membrane, Blind nasotracheal intubation attempts may penetrate the mediastinum, Percutaneous transtracheal insufflation is currently under investigation

Front 41

What is the most common cause of "red eye?"

Back 41

Conjunctivitis (bacterial and viral)

Front 42

Acute bacterial conjunctivitis is most commonly due to ______ and ______.

Back 42

Staph aureus (the most common cause of mucopurulent conjunctivitis) and Pneumococcus

Front 43

What are the characteristic fluorescein uptake patterns in keratitis due to exposure, acanthamoeba, and herpes simplex?

Back 43

Exposure keratitis - horizontal band, Acanthamoeba keratitis - ring shape, Herpes simplex keratitis - branching dendritic pattern

Front 44

How do you differentiate between central retinal artery occlusion and acute ophthalmic artery occlusion on fundoscopic exam?

Back 44

Patients with centeral retinal artery occlusion have a cherry-red spot in the center of the fovea; those with acute ophthalmic artery occlusion do not.

Front 45

What causes acute thermal epiglottitis?

Back 45

A direct thermal insult from ingestion of hot food or liquid (or from smoking cocaine) may precipitate thermal epiglottitis

Front 46

Neonatal conjunctivitis (ophthalmia neonatorum) occurs in the first 3 - 15 days of life. Which organisms are likely to be responsible?

Back 46

If it occurs in the first 3 - 5 days then N. gonorrhea and or HSV should be suspected; If it occurs between 5 - 15 days then chlamydia (concomitant pneumonia may be present), HSV, hemophilus, strep, or staph should be suspected.

Front 47

Which orgnaism is the most common cause of orbital cellulitis?

Back 47

Staph. Aureus

Front 48

CLINICAL PRESENTATION: A patient is seen with headache, swelling and cyanosis or plethora of the face and upper extremities and shortness of breath. What is the diagnosis?

Back 48

Superior vena cava syndrome

Front 49

Which drugs should you avoid in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency?

Back 49

Sulfa, pyridium, nitrofurantoin, antimalarials, dapsone

Front 50

Can thrombocytopenia result from an exchange transfusion?

Back 50

Dilutional thrombocytopenia occurs in cases of massive transfusion, exchange transfusion or extracorporeal circulation

Front 51

You are seeing a child who took some of Grandpa's coumadin. There is no evidence of bleeding and the PT is normal. Do you administer vitamin K or just observe him?

Back 51

Observe. Vitamin K is indicated for serious bleeding since the result of overdose is a functional deficiency of vitamin K.

Front 52

What is the best radiographic modality for the evaluation of renal trauma?

Back 52

Contrast-enhanced CT has become the study of choice because it provides more information than the IVP. (Current literature recommends that adults with microscopic hematuria < 100 RBCs/HPF do not require emergent CT unless it is accompanied by hypotension ... including in the field)

Front 53

What are the most common sequela following blunt abdominal trauma during pregnancy?

Back 53

Preterm contractions

Front 54

What is the most common site of penetrating trauma to the heart?

Back 54

The right ventricle

Front 55

A multiple-injured patient with head injury and long-bone fractures undergoes a dramatic worsening of his neurological status. What diagnosis should be considered in this scenario?

Back 55

Fat Embolism Syndrome (The classic triad of sx's is: acute respiratory failure, global neurologic dysfunction and petichial rash

Front 56

What are two common complications of the use of the esophageal obturator airway?

Back 56

Inadvertant intubation of the trachea and Aspiration of gastric contents

Front 57

Sensory loss on the chest or abdomen is presumptive evidence of ______.

Back 57

Spinal instability

Front 58

What percentage of patients with a C-spine fracture have a second, noncontiguous vertebral fracture?

Back 58

10% (If present, this warrants complete radiographic screening of the entire spine)

Front 59

What are the criteria for the diagnosis of "Brain Death?"

Back 59

1 - Glascow Coma Scale score = 3, 2 - Nonreactive pupils, 3 - Absent brainstem reflexes (oculocephalic, oculovestibular, corneal) and no gag reflex, 4 - No spontaneous ventilatory effort

Front 60

Damage to which nerve is frequently associated with acetabular fractures?

Back 60

Sciatic

Front 61

What is the most common dislocation of the patella?

Back 61

Lateral

Front 62

Answer the following concerning hip dislocations: 1 - What is the most common type of hip dislocation? 2 - What are the expected physical findings? 3 - What is the most serious complication?

Back 62

Posterior dislocation occurs in 90% of cases; The leg is shortened, adducted and internally rotated; The most serious complication is avascular necrosis of the femoral head. The chance of this problem occurring is in direct proportion to delays in reduction.

Front 63

A patient with a history of knee injury states that he heard a "popping" sound at the time of injury. On examination, you find hemarthrosis of the joint. What structure is most likely injured?

Back 63

Anterior cruciate ligament

Front 64

Where are the tendinous insertions of the muscles comprising the rotator cuff?

Back 64

The subscapularis inserts on the lesser tubercle of the humerus. The supraspinatus, infraspinatus and teres minor all insert on the greater tubercle.

Front 65

What is the most likely bacterial organism causing meningitis in an 8 year old girl?

Back 65

Streptococcus pneumoniae predominates from the ages of 3 months up to 18 years. However, Neisseria meningitidis and Hemophilus influenzae are also very important etiologic agents. The incidence of H. influenzae meningitis has declined significantly since the advent of routine immunization. Nore: All of these can be detected by counterimmune electrophoresis (CIE).

Front 66

What is the most common presenting neurologic manifestation of diphtheria?

Back 66

Paralysis of the palatal muscles

Front 67

What is a primary consideration for the etiology of meningitis inan AIDS patient?

Back 67

Cryptococcus neoformans

Front 68

Concerning patients suspected of cryptococcal meningitis, which studies should be ordered on the CSF examination?

Back 68

Cryptococcal antigen and India ink preparation

Front 69

Where does the spinal cord originate and terminate?

Back 69

The spinal cord begins at the medulla oblongata (approximately at the atlanto-occipital junction) and ends between T12 and L3

Front 70

What is the main cause of radiculopathy in patients > 65 years old?

Back 70

Spinal Stenosis - is an unusual narrowing of the spinal canal that impinges on the cauda equina and nerve roots. This results in pain in one or both extremities brought on by walking, relieved by rest and exacerbated by back extension.

Front 71

An elderly woman who was rear-ended in a motor vehicle accident sustains cervical injury. She complains of neck pain. You find upper extremity weakness that does not localize to any particular spinal level. What is the diagnosis?

Back 71

Central cord syndrome

Front 72

An absent deep tendon reflex at the ankle sugests a lesion at which nerve root?

Back 72

S1

Front 73

Is the discovery of an inguinal hernia in an infant a surgical emergency?

Back 73

No, UNLESS the child is symptomatic and/or the hernia is not reducible. Other wise, these hernias should be repaired on an elective basis.

Front 74

A child without a spleen is particularly susceptible to which illness?

Back 74

Bacteremia or sepsis from gram-positive encapsulated organisms. Strepococcus pneumoniae (pneumococcus) heads the list

Front 75

Which respiratory tract infection is most commonly confused with asthma?

Back 75

Bronchiolitis - This ia a viral disease. 90% of cases are caused by the RSV. Less commonly implicated viruses are parainfluenxa, adenovirus, and influenza

Front 76

Which infection generally occurs from seeding during sepsis or from spread of a contaiguous infection, such as otitis media?

Back 76

Meningitis

Front 77

What diagnosis should be considerd in children between ages of 6 and 18 months who present with abdominal pain?

Back 77

Intussusception

Front 78

Why is the fundascopic examination important in the suspected child abuse victim?

Back 78

Retinal hemorrhages may be seen in the "shaken baby syndrome."

Front 79

Which one of the common childhood diseases is a cause of aseptic meningitis?

Back 79

Mumps

Front 80

An asthmatic presents with severe hypoxia. Respirations are 40/minute and shallow. There is no wheezing on chest auscultation. What is your initial intervention.

Back 80

Epinephrine 0.3mg IM

Front 81

Which diagnosis should be considered in a patient who presents with a cough productive of fetid and bloody sputum?

Back 81

Lung abscess

Front 82

You have just intubated a 70kg asthmatic. The pH is 7.0, pO2 is 50 and pCO2 is 100. What are your initial ventilator settings?

Back 82

pO2 = 100%, TV = 450, RR = 10, PEEP? No

Front 83

What is the common pathologic cause of a large pleural effusion?

Back 83

Group A Strep

Front 84

Which type of caustic ingestion is worse - acid or alkali?

Back 84

Alkali

Front 85

In patients with organophosphate poisoning, large doses of this drug are frequently needed and may be repeated until tracheobronchial secretions dry up. What is this drug?

Back 85

Atropine - The dosages are: Adult: 2 mg IV q5 - 15 minutes prn; Child: 0.05 mg/kg q15 minutes prn

Front 86

Intoxication with this substance may cause hyperthermia which may be sudden and leathal. What is the substance?

Back 86

Cocaine

Front 87

In patients with hydrofluoric acid burns, definitive therapy includes intradermal injection of ______ _____ or _____ ______ into the affected area.

Back 87

Magnesium Sulfate - Calcium Gluconate Note: Calcium Chloride should never be used as it can cause significant injury on its own

Front 88

What is the major hazard of barbiturate abuse?

Back 88

Unintentional overdose (abuse of barbiturates does not lead to tolerance of its toxic effects. As larger doses are taken, the greater the likelihood of an unintentional overdose)

Front 89

What are the signs of benzodiazepine toxicity?

Back 89

Ataxia, Diplopia, Impaired gag reflex

Front 90

What is the treatment of Fournier's gangrene?

Back 90

MANDATORY TREATMENT includes immediate surgical debridement and administration of broad spectrum parenteral antibiotics. Hyperbaric oxygen theraoy should also be employed if it is available.

Front 91

What is the emergency treatment of paraphimosis if the foreskin cannot be reduced manually?

Back 91

Local anesthesia is administered followed by a superficial dorsal midline incision

Front 92

In the third trimester of pregnancy, this antibiotic should NOT be used in the therapy of unrinary tract infections.

Back 92

Sulfonamides - The risk to the fetus is kernicterus because of a rise in serum bilirubin

Front 93

What is the most frequent opportunistic bacterial infection in patients with AIDS?

Back 93

Mycobacterium avium

Front 94

What is the most common cause of hemoptysis in HIV-infected patients?

Back 94

Kaposi's sarcoma

Front 95

Name the leading cause of septic shock.

Back 95

Gram negative bacteremia

Front 96

Regarding Pseudomonas infections: 1 - What is/are the drug(s) of choice? 2 - What are alternative choices? 3 - Which drug has been associated with multiple treatment failures and is no longer recommended?

Back 96

1 - The mainstays are the aminoglycosides, such as gentamicin, tobramycin and amikacin; 2 - alternative choices (with or without AGs) include carbenicillin, ticarcillin, ciprofloxacin, imipenem, ceftazidime, cefoperazone and aztreonam; 3 - Erythromycin has been associated with multiple treatment failures and is no longer recommended.

Front 97

Angioedema associated with ACE inhibitors has a predilection for which areas of the body?

Back 97

Lips, tongue and laryngeal soft tissues

Front 98

What is the most common cause of a drug reaction?

Back 98

Penicillin (especially ampicillin)

Front 99

What is the treatment for a paronychia?

Back 99

Incision and drainage is the choice, along with an oral cephalosporin and warm soaks. The usual organism is S. aureus, sometime with concomitant streptococcal infection. Local measures alone commonly fail. If the process extends UNDER the nail, a portion of the nail must be removed.

Front 100

How does one treat a felon?

Back 100

Incision and drainage