Rosh 2020 Set 1

What is the best method of gastric decontamination for iron overdose?

Whole-bowel irrigation with miralax

Most common cause of mitral stenosis

rheumatic heart disease

Most common cause of osteomyelitis in sickle cell patients

salmonella

Inhaling gas near silo?

Methemoglobinemia. Methylene blue is the treatment of choice for symptomatic patients who are hypoxic, cyanotic, or unresponsive to supplemental oxygen. Other symptoms of severe toxicity include hypotension, pulmonary edema, and hemoptysis.

What is the treatment of methemoglobinemia?

Methylene blue

Which type of fracture of the leg would be concerning for child abuse?

Mid-shaft fracture.

Otitis Externa tx

Mild: Acetic acid/hydrocortisone Moderate: topical cipro

How do you make a sodium bicarbonate drip for treatment of TCA overdose?

Mix 150 mEq of sodium bicarbonate with 1 L of D5W.

What is the most common complication of meningococcemia?

Myocarditis with congestive heart failure or conduction abnormalities

What are the most common side effects of erythromycin?

Nausea, vomiting, and abdominal pain.

What is the best neck position and phase of respiration for obtaining a soft tissue neck X-ray when you are considering retropharyngeal abscess?

Neck extension and inspiration

What fluid should be used to resuscitate a hypothermic patient?

Normal saline because Lactated Ringer is poorly metabolized by the cold liver.

What is the cause of bidirectional ventricular tachycardia?

Digoxin toxicity.

What is a contraindication of giving dimercaprol?

Dimercaprol is diluted in peanut oil and should not be given to patients with a peanut allergy

Treatment for NMS?

Discontinue offending medication, supportive care, benzodiazepines, and neuromuscular blockade with airway management. Bromocriptine, amantadine, and dantrolene are often cited as treatment options but have not been shown to consistently provide benefit.

Management for torus fracture

Distal radius torus fractures should be splinted and seen by a primary care physician in three to four weeks.

Colles fx

Dorsally displaced distal radial fx

What is the endpoint of treatment with atropine for organophosphate toxicity?

Drying of bronchial secretions

What is the treatment of minor hearing loss associated with a serous effusion?

Observation—this is likely secondary to a resolved viral infection, and will likely be resorbed and not require any intervention.

Treatment timing for Herpes Zoster?

Only effective if given within 3 days of symptoms

Ethambutol side effects

Optic neuritis Red-Green Color blindness

What is the treatment of vulvocandidiasis if intravaingal tx fails?

Oral fluconazole

What is the most common complication of untreated dacryocystitis?

Orbital cellulitis.

most common cause of hyperviscosity syndrome

Waldenstrom's macroglobulinemia

Which acute coronary syndrome is characterized by deeply inverted or biphasic T waves in V2 and V3 in the absence of chest pain?

Wellens syndrome.

What is the MOA for txa

reduces plasminogen activation to plasmin

What is the #1 cause of blindness in AIDS

#1 cause of blindness in AIDS CD4 < 50 Cotton-wool exudates, retinal hemorrhages Ganciclovir CMV retinitis

Rubella

-German measles -Erythematous papular rash that begins on face then spreads to trunk. -Posterior cervical LAD -Forchheimer sports are pinpoint petechia on the soft palate

What are common causes of erythema Multiforme

-Herpes simplex is the most common viral cause -Mycoplasma is the most common bacterial infection -Sulfonamides -Penicillins

Ductal Dependent Lesions

-Transposition of the great vessels (most common cause in newborns) -Tetralogy of Fallot (most common in children > 1 year old) -Tricuspid atresia Interrupted aortic arch -Coarctation of the aorta -Hypoplastic left heart syndrome -Shock, "gray baby" within hours to days after birth -PGE1

When is succinylcholine contraindicated?

-succinylcholine is contraindicated in patients at risk for succinylcholine-induced hyperkalemia, such as with acute renal failure or neuromuscular disease like multiple sclerosis, amyotrophic lateral sclerosis, and muscular dystrophy -Patients with burns, crush injuries, and denervation syndromes like spinal cord injury or stroke are also at risk for succinylcholine-induced hyperkalemia, however the risk does not manifest until 5 days since the injury.

Rules of 5s for Neonatal Conjunctivitis

0 to 5 days: N. gonorrhoeae 5 days to 5 weeks: C. trachomatis 5 weeks - 5 years: Streptococcus or H. influenzae

What is the subcutaneous dose of epinephrine used to treat a severe asthma exacerbation in a child?

0.01 mg/kg to a maximum of 0.5 mg subcutaneously.

What is the appropriate dosing of tissue plasminogen activator (tPA) in ischemic strokes?

0.9 mg/kg up to 90 mg maximum dose with 10% given as a one-minute bolus and the remainder given over one hour.

What is the dose of electricity in supraventricular tachycardia in pediatrics?

1 joule/kilogram for the first dose and 2 joules/kilogram for subsequent doses.

What is the appropriate dose of insulin for the treatment of beta-blocker overdose?

1 unit/kg (10 times the dose used in diabetic ketoacidosis).

What is the most important risk factor for endometritis?

1. C-Section 2. PROM > 24 hours

Tetralogy of Fallot defect

1. R ventricular outflow tract obstruction 2. R ventricular hypertrophy 3. Ventricular septal defect 4. Overriding aorta

What is the longest laceration that can be repaired using hair apposition method?

10 cm

What is the treatment for acute cardic arrest in suspected digoxin overdose?

10 vials of digoxin-specific antibody

What is the dosing of alteplase for massive pulmonary embolism?

100 mg over 2 hours IV

How to setup needle cricothyrotomy

12 or 14 gauge angiocatheter - attach a 3 mL syringe with the plunger removed to the angiocatheter. The adapter of a 7-0 endotracheal tube can then be attached to the open end of the syringe. -Jet insufflaton

How long it takes for tracheostomy tract to mature

15-30 days

What is the average incubation period of syphilis infection?

2-4 weeks

What is the dosing for hypertonic saline in pediatric population?

2-6 ml/kg over 10-30 minutes

How long should CPR continue after fibrinolytics are given to a patient with cardiac arrest prior to pronouncing the patient dead if there is no return of spontaneous circulation?

20 minutes

What is the toxic dose of aspirin?

200 - 300 mg/kg

What is the goal PaCO2 in a ventilated patient with increased intracranial pressure?

30-35 mm Hg.

A pt with a rectal temp of 24C and is in cardiac arrest needs to be rewarmed to a minimum what temp

32 C

What is the parkland formula

4mL x %burn area x body weight (kg) = amount of ringer's lactate or normal saline needed in first 24 hours -50% over the first 8 hours and 50% over the next 16 hours -maintain UO to 1 cc/hr

What should the retropharyngeal space be on Xray that indicates retropharyngeal abscess

7mm at C2, 14mm at C6

Observation period for rattlesnake bite

8 hours

What mean arterial pressure goal is recommended in neurogenic shock?

85 to 90 mm Hg

What age do you do back blows

< 1 years old

In the case of uterine rupture, how much time is available for successful intervention before the onset of significant fetal mortality?

< 30 minutes

What age range is typically affected by Kawasaki's disease?

< 5 years old

How many cc's are considered normal in a post-void residual?

<100 cc

What is the serum salicylate level at which hemodialysis is indicated?

> 100 mg/dL in acute overdose and > 50 mg/dL in chronic overdose.

At what altitude do symptoms of acute mountain sickness typically begin?

> 6,500-8000 ft.

How long should a deer tick be attached before prophylactic treatment to prevent Lyme disease is recommended

>36 hours - Single does of doxy 200mg PO

What counts as "close contact" for N. Meningitis

A close contact includes anyone that was within 3 feet of the patient for > 8 hours in the week prior to their illness. This typically includes housemates, intimate partners, or anyone with direct exposure to oral secretions (e.g. kissing, endotracheal intubation, suctioning). To prevent the spread of meningitis, any patient with suspected or confirmed Neisseria meningitidis infection should be on droplet precautions until 24 hours after antibiotic therapy has been started. Prophylactic regimens include ceftriaxone, ciprofloxacin, and rifampin. These regimens are most effective if started as early as possible.

What is splenic sequestration crisis?

A condition seen in children with sickle cell disease when there is rapid sequestration of RBCs in the spleen causing splenomegaly and severe anemia.

Achalasia

Patient will be complaining of dysphagia to solids and liquids PE will show absent peristalsis in the lower esophagus Barium swallow shows "bird beak" appearance Diagnosis is made by esophageal manometry - increased LES pressure

Interstitial Nephritis

Patient will be complaining of fever, rash Labs will show eosinophiluria Most commonly caused by medications and infection

Behçet's Syndrome

Patient will be complaining of recurring genital and oral ulcerations, and relapsing uveitis PE will show painful genital and oral ulcers with a necrotic center and surrounding red rim

Posterior Wall MI

posterior wall myocardial infarction characterized by ST-segment depressions in leads V1, V2, and V3. Other findings can include tall, broad R waves in V2-V3 and a dominant R wave in V2 (R/S ratio > 1). The depressions in V1-V3 are actually the reciprocal findings of posterior ST elevation. Patients with findings suspicious for a posterior wall MI should have posterior leads placed on their back to look for elevations in leads V7 and V8.

Dressler syndrome

postmyocardial infarction syndrome; pericarditis. Occurs 2-10 weeks after MI -Resolves spontaneously -Use ibuprofen/ASA, steroids, colchicine

molluscum contagiosum caused by what

poxvirus

H pylori treatment

quad therapy: Bismuth, metronidazole, tetracycline triple therapy: Omeprazole, Clarithromycin, Amoxicillin (or metro if pcn allergic)

What type of hallucinations are more common in schizophrenic patients

auditory

Which foodborne illness is associated with premature delivery in pregnant women?

Listeria

Bartholin abscess location and tx

Locations: 4 o'clock, 8 o'clock Rx: I&D on mucosal surface, word catheter

Reticulocyte count in SCD pts

Look for high reticulocyte count -If its low, consider aplastic crisis which is most likely secondary to infection

What is half life of methadone

24 hours

What is the most common cause of peritonsillar abscess

GAS

haptoglobin in hemolytic anemia

LOW

What is dextromethorphan similar to?

PCP -Can cause serotonin syndrome -Nystagmus, mydriasis, hyperthermia, tachycardia

What is light bulb sign?

Posterior shoulder dislocation

what is the endpoint of atropine treatment for cholinergic toxicity?

Resolution of bronchorrhea.

Hydrocarbon Pneumonitis shows what on CXR

diffuse b/l infiltrates

Iron toxicity symptoms and tx

significant iron toxicity, as demonstrated by gastrointestinal distress, shock, and acidosis. Significant iron toxicity can occur with ingestions greater than 40 mg/kg of elemental iron. Treatment includes GI decontamination when appropriate, and for patients with severe iron toxicity, chelation therapy with deferoxamine. Indications for deferoxamine include iron levels greater than 500 mcg/dL, shock, acidosis, altered mental status, and severe refractory gastrointestinal symptoms.

Oleander toxicity

similar to digoxin - Toxic effects are similar to digoxin toxicity including cardiac dysrhythmias, hypotension, and cardiogenic shock.

What is most commonly injured in pediatric blunt abdominal trauma?

spleen

A 21-year-old man with a history of Down syndrome presents to the emergency department for testicular swelling. He is nonverbal, but his mother says she was told that he fell onto a carousel horse on a school field trip, landing on his groin. At home, she noticed testicular swelling in the shower that afternoon. On exam, his left testicle is enlarged at approximately 5 cm and feels dense and nodular. There are no scrotal or perineal skin changes. He does not express any signs of pain during the exam. Which of the following is the most likely diagnosis?

A large and dense testicular mass, especially when painless, is more likely to represent testicular cancer, which is the most common solid malignancy affecting adolescent and young men. Testicular cancer is also much more common in patients with Down syndrome. The mass should be further evaluated with a scrotal ultrasound, and tumor markers should also be sent including alpha-fetoprotein (AFP), beta human chorionic gonadotropin (beta-hCG), and lactate dehydrogenase (LDH).

A skin patch is defined a

A patch is defined as a flat, nonpalpable circumscribed lesion >5 mm in diameter. These lesions are seen in conditions such as tinea versicolor.

What is the definition of commotio cordis?

A primary electrical event resulting in the induction of ventricular fibrillation from direct blow to the anterior chest.

What is the initial treatment of a rheumatoid arthritis flare in the emergency department?

A single dose of methylprednisolone acetate 120 mg intramuscularly.

What is the definition of neutropenic fever?

A single oral temp > 100.9 or a temp greater than 38 (100.4) for > 1 hr. with ANC < 1500 or 1000

What is the definition of a fusion beat?

A supraventricular and a ventricular impulse coincide to produce a hybrid complex called a fusion beat. Indicates 2 foci of pacemaker cells firing spontaneously.

Which antibiotic should be prescribed to cover marine bacteria in seawater-associated wounds?

A third-generation cephalosporin or fluoroquinolone to cover Vibrio species.

What is the mechanism of action of adenosine?

AV nodal conduction blockage

An IO has what inacurrate and accurate diagnostic studies?

Accurate: Hgb, pH, pCO2, Bicarb -Inaccurate: WBC, potassium, Ca+

What medication is used as initial treatment for idiopathic intracranial hypertension?

Acetazolamide 250 mg twice daily

Achilles tendon rupture tx in ED

Achilles tendon ruptures are treated in the emergency department by splinting the affected foot and leg in an equinus splint which puts the foot into 20 degrees of plantar flexion. Definitive management is surgical for complete tears and surgical versus serial splinting for partial tears.

What is the acute and chronic management of gout?

Acute: NSAIDs, prednisone if pt cant tolerate NSAIDs, colchicine Chronic: Allopurinol or probenecid

What is the tx for acute cases of gout

Acute: colchicine, indomethacin Chronic: Allopurinol or colchicine

What is the treatment for HSV keratitis

Acyclovir and trifluridine

If vesicles are noted in the external ear canal of a patient with vertigo, what is the appropriate therapy?

Acyclovir for herpes zoster oticus (Ramsay Hunt Syndrome).

What formula is used to calculate the true sodium level in the setting of hyperglycemia without hypertriglyceridemia?

Add 1.6 mEq/L to the sodium value for every 100 mg/dL glucose over normal

What other complication of meningococcemia can contribute to ongoing hypotension and shock?

Adrenal hemorrhage, also known as Waterhouse-Friderichsen syndrome.

Which drugs are most commonly associated with Stevens-Johnson syndrome?

Allopurinol, antiepileptic drugs, and sulfamethoxazole.

What congenital syndrome results in hypocalcemia due to absence of the parathyroid glands?

DiGeorge syndrome.

Oleander is what type of toxicity?

Digoxin

What is the etiology for cardiovascular compromise related to intravenous phenytoin administration?

Although phenytoin is a class Ib antiarrhythmic, it is the propylene glycol diluent that produces cardiovascular compro

Amiodarone side effects

Amiodarone can cause chemical epididymitis - Thyroid issues, pulmonary fibrosis, Cardiac issues like heart blocks and prolonged QT, Hepatitis, N/V

In treating acute otitis media, what is the first-line agent, and what is its correct dose?

Amoxicillin 90 mg/kg per day divided into 2-3 doses for 10 days (high-dose amoxicillin)

What laboratory value's elevation can support the diagnosis of parotitis?

Amylase

What is a typical radiographic finding that supports a diagnosis of a Lisfranc dislocation-fracture?

An AP view which reveals lateral shift of the second metatarsal off the middle cuneiform.

What is the most common viral cause of rhabdomyolysis?

Answer: Influenza.

Between anterior cord, central cord, and brown sequard - what is the prognosis of each?

Anterior cord = poor Central cord = average Brown sequard = good

Which type of incomplete spinal cord syndrome can result from cross-clamping of the aorta?

Anterior cord syndrome.

What is the most common cause of traumatic hemarthrosis of the knee?

Anterior cruciate ligament tear

What vascular structure is at risk of injury with a proximal fibular fracture?

Anterior tibial artery

Which toxidrome would jimsonweed ingestion cause?

Anticholinergic

What class of medication can be given as adjunctive therapy for coral snake envenomation?

Anticholinesterases (neostigmine).

What cardic valve is most commonly injured from a blunt cardiac injury?

Aortic regurg

What is the most common surgical emergency in pregnant women?

Appendicitis

Stingray Injury tx

Apply HOT WATER (113 F) to wound - breaks down poison

What are the two most common fungal infections in neutropenic patients?

Aspergillus and Candida.

At what dose is PGE1 infusion typically started?

At 0.05-0.1 µg/kg/min

Ranson Criteria

At admission = (1) Age > 55; (2) WBC > 16,000; (3) Glucose > 200; (4) AST > 250; (5) LDH > 350 Score = 3 or more = 15% mortality

What is clay shoveler fracture

Avulsion of the spinous process of C6 or C7 - considered to be a stable cervical spine fracture

What is the recommended technique to establish a definitive airway in patients with severe epiglottitis?

Awake fiberoptic intubation in the operating room with the patient sitting up.

What is the most commonly injured nerve in proximal humerus fractures?

Axillary nerve.

A cough that lasts longer than 6 days has been linked to what condition 25% of the time?

B. pertussis, the causative agent of pertussis.

What is the most common viral cause of myocarditis?

B19 virus

What commonly prescribed cough suppressant causes fast sodium channel blockade and can present similarly to TCA overdose?

Benzonatate

What type of pneumonoconiosis can occur with aerospace workers

Berylliosis

What is the classic diagnostic finding for achalasia?

Bird-beak esophagus seen on barium swallow that represents dilation of the upper esophagus with narrowing of the lower esophagus.

What is the indicated treatment for digoxin toxicity with a serum level > 15 ng/mL or serum potassium of >5 mEq/L in a suspected ingestion?

Digoxin immune Fab fragments

What is the treatment of choice for RMSF in children under 8 years of age?

Doxycycline

Difference between herpangina vs hand foot mouth disease

Both can be caused by cox A virus. Herpangina may have fever and are located on the POSTERIOR soft palate while HFM disease is on the buccal mucosa

The risk of arterial thrombosis for an arterial line is greatest at what location?

Brachial artery

Branchial cleft cyst vs thyroglossal cyst

Branchial cleft cyst is lateral aspect of the neck Thyroglossal cyst is midline

BRUE

Brief resolved unexplained events (BRUE) [formerly ALTE] is an unexpected frightening episode characterized by some combination of apnea, color change, muscle tone change, choking or gagging, and fear that the child has died. The etiology is identified in only 50% of cases. The management of BRUE is variable, and admission criteria may vary between institutions. However, most experts agree that any infant who has an episode that lasts longer than one minute should be admitted for further workup. This infant is also at higher risk of serious underlying disorder or recurrence given he is less than 60 days old. Other indications for admission include gestational age ≤ 32 weeks and postconceptional age ≤ 45 weeks, occurrence of more than one BRUE, CPR by a trained professional, and concerning historical or physical exam features (e.g., family history of BRUE, recent illness, signs of trauma). BRUE is not a diagnosis but a description of an event. Underlying causes include CNS infection, seizure, gastroesophageal reflux, intracranial hemorrhage, botulism, airway obstruction, electrolyte abnormality, and sepsis.

What intervention is both diagnostic and therapeutic in the management of bacterial tracheitis?

Bronchoscopy.

Brudzinski Sign vs Kernig's sign

Brudzinski is when you flex neck and there's hip and knee flexion. Kernig is when you flex the hip and attempt to extend the knee

Skin lesion that is caused by IgG autoantibodies to desmosomes vs autoantibodies to basement membrane proteins

Bullous pemphigoid is basement membrane Phemphigus vulgaris is IgG autoantibodies to desmosomes

For lengthening the duration of anesthesia what local agent can provide pain relief for 4-8 hours?

Bupivacaine has a slower onset than lidocaine but lasts up to 8 hours.

What is the most common location for pediatric pseudosubluxation?

C2-C3 Pediatric pseudosubluxation refers to the normal mobility of C2 on C3 in flexion that may be so pronounced as to be mistaken for pathologic motion. It is normal in children under 8 years of age and is seen in up to 40% of children at C2-C3 and 14% of children at the C3-C4 level.

What anti-hypertensive is contraindicated in pediatrics with SVT

CCB in infants can cause profound hypotension and cardiovascular collapse. Avoided in patients youngerthan 12 months old

What is the tx for esophageal spasm?

CCB, TCAs

What is the highest risk for a spontaneous pneumothorax?

COPD hx

What are the indications for emergent HD in hypercalcemia

Ca+ > 18 Neurologic symptoms Presence of CHF Presence of renal failure

What is CREST syndrome?

Calcinosis, Raynaud's, esophageal dysmotility, Sclerodactyly, Telangiectasia Type of Scleroderma Labs will showanti-topoisomerase I (anti-Scl-70) antibody (specific for diffuse disease)anti-centromere antibody (specific for limited disease)

What is the danger of providing 100% O2 in COPD patients

Can cause hypercapnic respiratory failure

Tx for trigeminal neuralgia

Carbamazine first line -Gabapentin, lamotrigine, phenytoin

What condition must be suspected if oculomotor nerve palsy coexists with orbital cellulitis?

Cavernous sinus thrombosis

What is the most common cause of bowel obstruction in pregnancy?

Cecal volvulus

the recommended empiric treatment for a male who recently participated in receptive anal intercourse and complains of rectal discharge?

Ceftriaxone 250 mg IM and doxycyline 100 mg BID for 7 days

Delta sign on CT head?

Cerebral vein thrombosis

What is the most common cause of myocarditis worldwide?

Chagas

Right ventricular infarction characteristic ECG findings

Characteristic findings of right ventricular infarction are ST-segment elevation in the right sided leads, especially V4R and V5R.

A patient is undergoing procedural sedation with fentanyl and midazolam for a dislocated shoulder. What is a side effects of fentanyl cannot be reliably reversed by naloxone?

Chest wall rigidity is an uncommon complication of fentanyl which may impair ventilation. Whereas most of fentanyl's side effects may be reversed by naloxone, chest wall rigidity is not reliably reversed by naloxone, and neuromuscular blockade may be required to enable adequate ventilation.

What laboratory test can be used to determine the prognosis of patients with HIV disease and Pneumocystis pneumonia?

Lactate dehydrogenase level.

Chrondroblastoma vs Osteochondroma vs osteosarcoma

Chondroblastomas (A) are rare benign tumors of the epiphysis that will present as focal tenderness, most often at the distal femur. X-ray in these patients will reveal a well-circumscribed lytic lesion within the bone as opposed to an exostosis seen in osteochondromas. Osteosarcoma (D) is a common, malignant tumor with a bimodal age distribution (children under 15 and adults over 65 years of age), presenting with months of localized pain with a soft tissue mass. Imaging will show destruction of normal bone trabecular meshwork and periosteal reaction.

A molar pregnancy increases the risk of what malignancy?

Choriocarcinoma

What is a risk factor for central retinal vein occlusion?

Chronic glaucoma

A 10-year-old boy presents to the emergency department complaining of nausea, vomiting, perioral numbness, blurry vision, and feeling his tactile sensation of hot temperature seems off. He admits to eating out and having grouper at a local restaurant. No other family members report illness. What is this and tx?

Ciguatera Ciguatoxin concentrates in larger fish (barracuda, grouper, red snapper, and parrot fish) that eat smaller fish. Symptoms begin two to 30 hours after ingestion and are associated with gastrointestinal findings (abdominal pain, vomiting, and diarrhea), unique neurological findings (hot-cold reversal, sensation of tooth looseness, ataxia, and altered mental status), and cardiovascular findings (bradycardia, hypotension, pulmonary edema). Management is mainly supportive with antiemetics, IV fluids for hypotension, and atropine for bradydysrhythmias.

What is the cardinal sign of uveitis or iritis?

Ciliary flush or a red ring around the iris. Pinpoint or smaller pupil

Which is the most common bone to accidentally fracture in children under 2 years of age?

Clavicle

What is the first line intravenous antibiotic therapy for patients with endometritis?

Clindamycin and gentamicin

How can clonidine present like a opioid OD?

Clonidine overdose can present with apnea and pinpoint pupils and may respond to naloxone, but clonidine is not an opioid and does not cross-react with the assay.

rattlesnake bites sxs and tx

Coagulapathy, thrombocytopenia, bleeding, rhabdomyolysis -Crotalidae polyvalent immune Fab -Antivenin -Observe dry bites for 8 hours

What therapy, when used in the acute phase, may be effective in preventing recurrent symptoms of pericarditis?

Colchicine

Most common drug that causes Erythema multiforme

Common drugs that cause EM: Sulfa, Oral hypoglycemics, Anticonvulsants, Penicillin, NSAIDs (SOAPS)

function of common peroneal nerve

Common peroneal: ↓ foot eversion/dorsiflexion

What is the term used for sudden cardiac death from a dysrhythmia caused by a direct blow to the anterior chest?

Commotio cordis.

Concerning sonographic signs of malignancy for ovaries

Concerning sonographic findings that are consistent with malignancy include solid components that are nodular or papillary, thick septations greater than 2 to 3 mm, demonstration of color Doppler flow in a solid component, presence of ascites, peritoneal masses, or enlarged lymph nodes.

What is the difference between condyloma acuminatum and condyloma lata?

Condyloma acuminatum are broad-based, pedunculated, cauliflower-like warts caused by human papillomavirus. Condyloma lata are broad-based, flat, moist papules due to Treponema pallidum.

What are the two diagnostic procedures of choice for bladder injury?

Conventional retrograde cystography and retrograde CT cystography.

Whats the treatment for ischemic priapism?

Corporal aspiration and intracavernosal phenylephrine @ 2 and 10 oclock location

What is a consequence of a long-term toluene abuse?

Cortical atrophy and dementia.

A pt with hypertrophic cardiomyopathy - what will increase his murmur?

Crescendo-decrescendo murmur that will increase with valsalva and standing up

Which agent has a bitter almond smell and interferes with oxygen utilization?

Cyanide

What is the treatment for bleeding in von Willebrand disease?

DDAVP - desmopressin

Amanita phalloides

Death cap mushroom - delayed n/v/d and hepatic failure

Compartment syndrome numbers

Delta pressure = diastolic BP - direct pressure. Delta pressure < or equal to 30 mm Hg

Is the Miller Fisher variant of GBS associated with ascending or descending paralysis?

Descending

A 13-year-old boy with a history of Type 1 von Willebrand disease presents to the emergency department with epistaxis. He tried compression at home without relief. His vital signs are stable. He is currently bleeding from his right naris. The source is unable to be visualized. What is the most appropriate next intervention?

Desmopressin

Which commonly prescribed over the counter drug is associated with serotonin syndrome?

Dextromethorphan, the cough suppressant, blocks serotonin reuptake

What is a good lab value is prognostic in acute radiation exposure

Due to this destruction of peripheral lymphocytes, the lymphocyte count is the best marker to grade the extent of injury at 48 hours. An absolute lymphocyte count (ALC) of > 1500 cells per mm3 is a good prognostic marker while an ALC of < 1500 cells per mm3 pertains a poor prognosis

Endometriosis symptoms

Dysmenorrhea, dyspareunia, dyschezia

What are the most common bacteria for fournier's or necrotizing fasciitis

E coli and B. Fragilis

Which infectious agent is associated with Burkitt lymphoma?

EBV

Treatment for syphilis

Early stage: 1x penicillin G, doxy Late stage: 1x penicillin G for weeks 3s

What are symptoms of ASA toxicity

Early symptoms include hyperventilation, nausea, vomiting, diarrhea, and tinnitus. Uncoupling of oxidative phosphorylation can result in hyperthermia. Patients can subsequently develop altered mental status, pulmonary edema, and coma. Patients will have a mixed acid-base abnormality with a respiratory alkalosis and an elevated anion gap metabolic acidosis.

What findings on lumbar puncture would be seen in transverse myelitis?

Elevated white blood cell count with increased protein and elevated IgG index.

When do you need a dental consult for pulpotomy for tooth fracture

Ellis III fracture when the pulp, dentin, and enamel has been fractured

What is the treatment of cauda equina syndrome?

Emergent decompression (a surgical emergency).

What foodborne cause of diarrhea is associated with a liver abscess?

Entamoeba histolytica.

What is the rash's name for lyme disease

Erythema migrans

What effect does alcohol have on your heart

Ethanol abuse is associated with the development of atrial dysrhythmias, specifically, atrial fibrillation. Alcohol ingestion (acute or chronic) has multiple effects on the cardiovascular system. It can exacerbate coronary artery disease, lead to cardiomyopathy and produce dysrhythmias. Left ventricular dysfunction is common in patients with moderate alcohol consumption. Additionally, these patients may have diastolic dysfunction. Supraventricular and ventricular dysrhythmias are common. The so called "holiday heart" that occurs with heavy drinking can present as atrial fibrillation or, in unusual cases, ventricular tachycardia. Additionally, electrolyte deficiencies (hypokalemia and hypomagnesemia) predispose to dysrhythmias.

What is required jones criteria for acute rheumatic fever?

Evidence of streptococcal infection and two major criteria or one major and two minor

Pathophysiology of arterial air embolism

Expanding gas ruptures alveoli → air enters circulation

Factitious disorder

Factitious Disorder (Munchausen syndrome) is most common in men 20-40 years of age. These patients view themselves as important people and usually have extensive knowledge of medical terminology. The syndrome is characterized physical and/or psychological symptoms that are exhibited in order to assume the "sick role". -NO EXTERNAL INCENTIVE to gain attention, sympathy, or reassurance to themselves

What is the most reliable way to r/o ovarian torsion with a high pretest probability of torsion?

Laparoscopic visualization

How does mitral stenosis result in hoarseness?

Left atrial enlargement can cause compression of the recurrent laryngeal nerve resulting in hoarseness.

What is the best position for a pregnant trauma patient?

Left lateral decubitus

What is the most common source of arterial emboli?

Left ventricular thrombus formation resulting from myocardial infarction.

Fat embolism syndrome

Fat embolism syndrome is due to fat emboli that lodge in the peripheral circulation and lung vasculature. It is primarily due to release of fat globules from long bone fractures, but can be seen in extensive trauma of smaller caliber bones. Diagnosis is clinical. The mortality rate is 20%. Patients commonly present within 48 hours of an inciting event with respiratory distress, hypoxia, altered mental status, agitation, and a petechial rash, most commonly over the chest. Laboratory testing may reveal thrombocytopenia. Supportive care including intravenous fluids and supplemental oxygen as needed is the only known treatment. No specific medication or maneuver has been effective in improving morbidity or mortality.

What induction agent can cause chest wall rigidity?

Fentanyl

How is the definitive diagnosis of late tracheostomy bleed made?

Flexible or rigid bronchoscopy in the operating room.

What is the treatment for sigmoid volvulus

Flexible sigmoidoscopy to reduce volvulus. Common in elderly, bedridden patients or pts with profound neurologic or psychiatric illness

What is the antidote to benzodiazepine poisoning?

Flumazenil

How much will administration of 50 mL of sodium bicarbonate change serum pH?

For every 50 mL of sodium bicarbonate administered, serum pH increases by 0.1.

Provided vital signs remain normal, at what point should a therapeutic thoracentesis be stopped?

For therapeutic thoracentesis, collection can be stopped once the patient experiences chest discomfort or coughing or has worsening of their vital signs.

What substance is responsible for the toxic effects of methanol? Ethylene Glycol? Isopropyl alcohol?

Formic acid Oxalic acid Acetone

What is the most common electrocardiogram finding associated with digoxin toxicity?

Frequent premature ventricular contractions

When are patients contagious with measles?

From 1 to 2 days before symptoms and 4 days after the rash appears.

A 25-year-old woman makes a rapid unplanned ascent while scuba diving at a depth of 50 feet. One minute after surfacing, she suffers a loss of consciousness. She is towed to shore and two minutes later goes into cardiac arrest. What position should the first responders use during her resuscitation?

From there, the air embolism can travel to the brain and heart, causing sudden neurologic deficit and cardiovascular collapse. Immediate intervention includes placement of the patient in a supine position, administration of 100% oxygen by face mask, and intravenous fluids to increase perfusion. Definitive treatment involves rapid recompression using hyperbaric therapy.

What is the long term toxicity of iron toxicity?

GI mucosa healing can lead to scarring which can cause bowel obstruction

What is the risk of developing epilepsy in the general population and in patients that have experienced a febrile seizure?

General is 0.5-1% and after a febrile seizure it is 1-2%.

the most common form of joint infection in adults under 35 years of age

Gonococcal arthritis

What is podagra?

Gout of the great toe

What are complications in necrotizing otitis externa

Granulation tissue in the floor of the ear canal at the bony cartilaginous junction is characteristic of the disease. Trismus indicates involvement of the masseter muscle or temporomandibular joint. The seventh cranial nerve is usually the first cranial nerve involved and is a serious sign of extension of the infection. Cranial nerves IX, X, XI, can also be involved.

What are the indications for emergent exploratory thoracotomy

Greater than > 20 ml/kg output initially -Output > 200 ml/hr for first 3 hours -Persistent bleeding rate > 7 mL/kg/hr

Difference between aortic and HCOM murmur

HCOM - Valsalva or standing increases the murmur, and squatting decreases the murmur Aortic stenosis - squatting increases the murmur. VAlsalva or standing decreases the murmur

Which virus is associated with Kaposi sarcoma?

HHV8

Which complication is infection with E. Coli O157:H7 associated with?

HUS

Chancroid

Haemophilus ducreyi -PAINFUL ulcerations and inguinal bubo

Forceful contraction of which muscle is responsible for causing the most common type of pelvic avulsion fracture?

Hamstring muscle.

What immunologic disorder results in delayed separation of the umbilical cord from the umbilicus?

Leukocyte adhesion deficiency

If someone is hit in the head with a baseball bat and has a history of hemophilia B - tx?

Head trauma is considered a major risk factor for a possible life-threatening intracranial bleeding in patients with hemophilia and requires factor replacement therapy. CNS bleeding is the leading cause of death in patients with hemophilia, therefore any patient with hemophilia and head trauma requires an early CT of the head without contrast in the ED. Even if CT is negative for acute hemorrhage, prophylactic therapy with factor IX must be started, as delayed bleeding is common. Dose and duration of replacement therapy depend on the severity of bleeding. Typically, replacement therapy dose can be calculated if patient's baseline factor activity level is known. Head trauma and traumatic deep tissue injuries are considered life-threatening events and require treatment to a goal of 100% factor activity. In an emergency, it is assumed that patient's baseline factor activity level is zero, which means that 100 IU/kg dose can be used. Therefore, you should administer 100 IU x patient's weight (kg) to reliably achieve 100% factor IX activity.

What infectious conditions have been associated with Raynaud phenomenon?

Hepatitis B and C and mycoplasma infections.

Heptorenal syndrome causes and tx

Hepatorenal syndrome is a potential cause of acute kidney injury in patients with end-stage liver disease, usually in patients with severe alcoholic hepatitis and portal hypertension due to cirrhosis. It is characterized by a progressive rise in serum creatinine with a benign urine sediment in patients with established liver disease and with no other reason for acute kidney injury. Hepatorenal syndrome is a diagnosis of exclusion. Portal congestion and hypertension appear to trigger arterial vasodilation in the splanchnic circulation, which in turn leads to an overall reduction in systemic vascular resistance. This leads to a decline in renal perfusion. Renin is released in an attempt to increase blood pressure, but this further compromises the glomerular filtration rate. Using vasopressors (such as norepinephrine, vasopressin, or midodrine) to cause splanchnic vasoconstriction corrects the systemic and renal hemodynamic abnormalities. There are two types of hepatorenal syndrome. Type I is more severe and is defined as a two-fold rise in serum creatinine to a level above 2.5 mg/dL over a period of less than two weeks. Type II is less severe and presents as ascites that is resistant to diuretics.

Which illegal street drug most commonly causes noncardiogenic pulmonary edema?

Heroin

What to think about with a scapular fracture

High energy trauma

What is the first line therapy for treatment of bacterial pneumonia in infants and preschool aged children?

High-dose amoxicillin (80-90 mg/kg/day).

Two weeks after returning from a spelunking trip in Illinois, a previously healthy 25-year-old man presents with a flu-like illness. Which of the following is the most likely causative organism?

Histoplasma capsulatum

A carotid bruit plus ptosis and an abnormal pupil suggest what diagnosis?

Horner syndrome (ptosis, miosis, and anhidrosis) due to carotid artery dissection

How much pericardial fluid can cause tamponade?

How much pericardial fluid can cause tamponade?

When do you use hyperbaric chamber therapy for CO toxicity and what is it used for?

Hyperbaric oxygen therapy (HBOT) is reserved for patients with severe symptoms including syncope, altered mental status, seizure, coma, focal neuro deficit, COHb > 15% in pregnancy and > 25% in all other patients, or evidence of acute myocardial ischemia. While normobaric oxygen will eventually correct the COHb, HBOT applied to symptomatic patients has been shown to decrease neurocognitive sequelae due to carbon monoxide poisoning at 6 weeks and 12 months compared to treatment with normobaric 100% oxygen after only 3 sessions within 24 hours. However, there is no data suggesting benefit if HBOT is started over 12 hours post exposure.

What is hangman fracture?

Hyperextension - b/l pars interarticularis fracture - unstable

What is the most common risk factor for placental abruption?

Hypertension

What is Cushing's response?

Hypertension, bradycardia, and decreased respiratory rate in response to elevated intracranial pressure

What two electrolyte abnormalities are classically associated with exposure to hydrofluoric acid?

Hypocalcemia and hypomagnesemia.

What are some lab findings for adrenal insufficiency

Hyponatremia, hypoglycemia, and hyperkalemia

What are the two major side effects of procainamide?

Hypotension and prolonged QT

What is the preferred treatment for Neisseria gonorrhoeae?

IM ceftriaxone + oral azithromycin, which is given regardless of the status of co-infection with Chlamydia trachomatis.

What is the treatment during DKA treatment for cerebral edema?

IV Mannitol

ITP

Idiopathic thrombocytopenic purpura (ITP) is an acquired autoimmune disease that results in rapid destruction of platelets. It is characterized by thrombocytopenia, the presence of purpura or petechiae, normal bone marrow, and no other identifiable cause for the thrombocytopenia. It is more common in children than in adults. The physical exam may reveal petechiae, epistaxis, gingival bleeding, and menorrhagia. The presence of lymphadenopathy, hepatosplenomegaly, pallor, or hyperbilirubinemia should suggest an alternative diagnosis such as leukemia, lymphoma, lupus, mono, or hemolytic anemia. Management is predicated primarily on the severity of thrombocytopenia and bleeding. Drugs that interfere with platelet function are discontinued. In general, asymptomatic patients with platelet counts >20,000/µL require no treatment. When the platelet count is < 20,000/µL, corticosteroid treatment is indicated. Intravenous (IV) immunoglobulin is co-administered for patients with counts < 20,000-30,000/µL and active bleeding.

Stepping on nail abx

If it goes through the shoe you have to cover for pseudomonas -If its just bare foot - cover for MRSA

When are glucocorticoids indicated in the treatment of acute pericarditis?

If there is a contraindication to NSAIDs or for specific conditions (e.g., lupus, pregnancy)

When should you start abx for shigellosis?

Immunocompromised, clinical sxs of bacteremia (Temp > 102.2), require hospitalization - rocephin is tx

HSP aka immunoglobulin A vasculitis

Immunoglobulin A vasculitis occurs secondary to IgA and immune complex deposition in small vessels throughout the body. It is most common in boys between the ages of 3 and 10 years and is often preceded by a viral illness. Clinical features include gastrointestinal distress, renal impairment, lower extremity edema, and palpable purpura. Diagnosis is based on clinical findings. Blood and protein are often found on urinalysis. Creatinine may be normal or elevated. Thrombocytopenia and coagulopathy generally do not occur. Treatment is largely supportive, but corticosteroids may be given, especially if renal insufficiency is present.

A 27-year-old multiparous woman presents to the emergency department at 38 weeks gestation for abdominal contractions and vaginal loss of fluid. Examination reveals a fully dilated and effaced cervix with the fetal head presenting at the introitus. After delivery of the fetal head, a cord-like structure is noted around the fetus's neck that cannot be reduced manually. Which of the following is the best next step in management?

In a precipitous emergency department delivery, the provider is unlikely to be aware prior to delivery of the presence of this condition and should be prepared to manually reduce the cord if possible by slipping the cord over the fetal head. However, if the cord cannot be reduced, the best next step is to clamp and cut the cord structure.

ITP tx

In general, patients with platelet count of 10,000-20,000 µL and mucosal bleeding or those with platelet counts < 10,000 µL and no bleeding are treated with corticosteroids or intravenous immunoglobulin (IVIG) or both. Asymptomatic patients with platelets > 20,000µL can be observed, as the condition is often self-limited.

What are risk factors of decompression sickness

Increasing depth of dive, rapidity of ascent, air flight soon after dive -Usually within 6 hours

Indications for emergent surgery of subdural hematoma

Indications for emergent surgery in a patient with a subdural hematoma include neurologic deterioration or midline shift > 5 mm on CT

Endophthalmitis

Infection of anterior, posterior, vitreous chambers Trauma intravitrealABX, ophthalmology consultation, admission Hypopyon

Back pain red flags

Infectious - fever, IVDU Fracture - history of trauma Cancer - weight loss, history of cancer Cauda equina - urinary retention, fecal incontinence, saddle anesthesia, distal weakness Nocturnal pain

What is the most common cause of viral pneumonia in adults?

Influenza virus

Phosogene toxicity and smell?

Inhalation injury from chemicals, fumes, or vaprs from plastics, dyes, polyureythane. -Phosgene is hydrolyzed into hydrochloric acid at the level of the alveoli. This reaction is slow and causes delayed pulmonary injury. The pulmonary damage causes significant edema and inflammation, leading to the interruption of pulmonary diffusion. -Smells like musty hay or freshly mown grass smell.

What is the most appropriate technique to obtain a lateral soft tissue neck radiograph when evaluating a patient for suspected retropharyngeal abscess?

Inspiration with neck in slight extension

What is a common complication of Meckel's diverticulum?

Intestinal obstruction caused by intussusceptions or volvulus.

Why should vitamin K be given as a slow intravenous infusion?

Intravenous vitamin K may cause an anaphylactoid reaction and should be given slowly.

What are cerebral T waves

Inverted, wide, DEEP T Waves - most notably in precordial leads -Associated with increased ICP

A 2-year-old boy is brought to the emergency department by his pregnant mother with complaints of hematemesis and bloody diarrhea. HIs mother also describes an episode of shaking that looked like a seizure. The patient has no past medical history; immunizations are up-to-date. His vital signs are BP 68/32 mm Hg, HR 170 beats per minute, RR 30 breaths per minute, temperature 98.24°F (36.8°C), and oxygen saturation 96% on room air. On physical exam, the child appears pale and lethargic. HEENT exam is normal with moist mucosa. His abdomen is nondistended but tender on palpation with active bowel sounds. His skin is cool and clammy. His stool is negative for occult blood. Laboratory results are as follows: sodium 137 mEq/L, potassium 5 mEq/L, chloride 99 mEq/L, BUN 10 mg/dL, creatinine 0.5 mg/dL, bicarbonate 16 mg/dL, glucose 280 mg/dL, WBC count 17,000/µL, and platelets: 250/µL. His aPTT, PT, and urinalysis are normal. His drug and serum tox screens are negative. What is this?

Iron toxicity - causes an anion gap metabolic acidosis GI necrosis and hemorrhage

What is the approximate time between development of orbital compartment syndrome and the onset of irreversible vision loss?

Irreversible visual loss can be expected with retinal ischemia that lasts longer than 120 minutes.

What size pneumothorax can be observed in patients with stable vital signs?

Isolated pneumothoraces less than 20% can be observed.

Which medication for TB is associated with lupus like syndrome

Isoniazid

Why should ceftriaxone be avoided in infants less than 1 month of age?

It can lead to hyperbilirubinemia by displacing albumin-bound bilirubin.

EBV is associated with

It is associated with infectious mononucleosis, B-cell lymphoma, Hodgkin disease, Burkitt lymphoma, and nasopharyngeal carcinoma. EBV can affect nearly all organ systems. Neurologic complications such as encephalitis, meningitis, and Guillain-Barré have been reported.

Does rectal aspirin have a similar benefit to chewed aspirin for acute myocardial infarction?

It is believed that 600 mg of rectally-administered aspirin provides a sufficient level of salicylic acid within 90 minutes that meets or exceeds the level provided by standard doses of chewed aspirin.

Dengue fever

It is transmitted by the Aedes aegypti mosquito. Travelers returning from Africa, the Americas and the Indian subcontinent tend to have classic dengue. Those returning from Southeast Asia usually have the hemorrhagic variant. Classic dengue manifests as sudden onset of high fever, with retro-orbital headache, nausea, vomiting, severe myalgias, and a rash. It is also known as "breakbone fever" due to the severe myalgias. Hemorrhagic dengue can result in death due to fever and shock. Diagnosis is clinical and confirmed with ELISA for IgM. Treatment is supportive with both variants.

West Nile virus symptoms

It is transmitted by the Aedes mosquito, with birds serving as the intermediate host. Most people with West Nile encephalitis will remain asymptomatic or have a mild viral syndrome. Patients with encephalitis will present with new psychiatric symptoms, cognitive deficits, seizures, flaccid paralysis, and tremors. Most will have a headache and low-grade fever. In patients with meningoencephalitis, a lumbar puncture will show a pleocytosis with mostly lymphocytes, normal to elevated glucose, and increased protein. Pts will have leukopenia and pronounced and prolonged lymphopenia

On a normal lateral radiograph of the elbow, where should the anterior humeral line pass through the elbow?

It should transect the middle third of the capitellum

Jones criteria for rheumatic fever

JONES (JO)int Pain (often migrates) (N)odules (E)rythyma Marginatum (S)yndenham's Chorea

Jefferson fx

Jefferson fracture (C) occurs when an axial or vertical compression force is transmitted downward through the occipital condyles, producing a burst fracture which forces the lateral masses of C1 apart. A Jefferson fracture is considered unstable.

Criteria for Emergent Hemodialysis in tumor lysis syndrome

K > 6 Uric acid > 10 Cr > 10 Phopshorus > 10 Volume overload Symptomatic hypocalcemia

Most common location for nosebleeds?

Kiesselbachs plexus

Treatment for valproic acid toxicity

L-Carnitine

A 25-year-old man with epilepsy presents after intentional overdose of one of his anticonvulsant medications. His respiratory rate is 10 breaths/minute and he is difficult to arouse. His pupils are 4 mm are reactive bilaterally. His labs include an elevated serum ammonia level. Which of the following therapies should be administered?

L-carnitine. Valproate can cause elevated serum ammonia level. Otherwise ECMO

De Winter ECG pattern?

LAD occlusion -Upsloping STE in aVR -ST depression and tall T waves in precordial leads

Lab findings of TTP

Laboratory evidence of TTP includes platelets 10,000-50,000 / mm3, decreased haptoglobin, increased reticulocyte count (to replace the hemolyzed RBC), increased indirect bilirubin (due to hemolysis), schistocytes on peripheral smear (due to hemolysis), and increased lactate dehydrogenase (due to hemolysis).

What are potential complications of inhaling aerosol sprays

Lower viscosity and higher volatility hydrocarbon compounds are the most toxic. Lower viscosity compounds (furniture polish) readily spread throughout the respiratory system and highly volatile compounds (propane, butane) readily displace alveolar oxygen, causing hypoxia. Once hydrocarbons are absorbed in blood and tissues, they cause euphoria through fast CNS distribution. Halogenated and aromatic hydrocarbons (difluoroethane) are known to cause sudden death due to sensitization of the myocardium to catecholamines, inducing lethal cardiac dysrhythmias. Typically, there is a precipitating high-intensity event, such as a police chase, with subsequent catecholamine surge inducing fatal dysrhythmias. This phenomenon is known as a "sudden sniffing death".

What is the most common fatal primary blast injury?

Lung barotrauma

What is the leading nonobstetric cause of maternal death in a pregnant patient?

MVC

Tinea Versicolor

Malassezia furfur. Hypo or hyperpigmented. Diagnosed with KOH prep and spaghetti and meatballs appearance. Management: Topical antifungals or oral antifungal for severe version.

What is the most common mode of transmission of the human immunodeficiency virus in the United States?

Male to male sexual intercourse

Mallet Finger vs Jersey Finger

Mallet - disruption of extensor tendon and results in flexion of DIP. SPLINT for 6-8 weeks Jersey: rupture of flexor tendon and can't actively flex the DIP joint

What is the management of someone with achilles tendon rupture

Management in the ED includes immobilization of the extremity in a short-leg splint, keeping the foot in plantarflexion. The patient should be non-weight-bearing until seen by an orthopedic surgeon. Definitive repair is surgical.

What readily available condiment will kill adult lice within 10 minutes of application?

Mayonnaise

What NSAID toxicity is associated with seizures

Mefenamic acid - Ponstel - for pain associated with menstruation

What type of pediatric trauma is almost pathognomonic for NAT?

Metaphyseal or bucket handle or corner fracture

What is the formula for calculating the minimum systolic blood pressure in a child?

Minimum SBP = 70 + (2 x age in years).

Patients with silicosis have a positive purified protein derivative skin test at what induration?

More than or equal to 10 mm.

Boerhaave most common location

Most common location is left posterolateral distal esophagus

Which cardiac tumor has the greatest predilection for causing embolisms?

Myxoma

Which cause of peripheral vertigo is due to an increased amount of endolymph within the cochlea and labyrinth?

Ménière's syndrome.

What are drugs that can be delivered via endotracheal tubes

NAVEL Naloxone Atropine Vasopressin Epinephrine Lidocaine

Why are NSAIDs contraindicated in patients on cyclosporine?

NSAIDs exacerbate cyclosporine-induced renal insufficiency by further reducing glomerular filtration. Cyclosporine decreases renal blood flow and has a direct toxic effect on renal tubules.

For what type of packing would you commonly provide prophylactic antibiotics to prevent toxic shock syndrome?

Nasal packing.

What are indications for nonoperative management of fingertip amputations?

No bone or tendon exposed and less than 2 cm of skin loss.

Should prophylactic antibiotics be used in a subungual hematoma associated with a tuft fracture in a healthy patient?

No, even though it is still considered an "open fracture."

Which drugs can cause an acute respiratory acidosis?

Opioids, benzodiazepines, barbiturates, alcohol.

Oxcarbazepine causes hyponatremia < 125 in 2.5 percent of patients. Most patients develop hyponatremia within the first three months of initiating oxcarbazepine treatment

Oxcarbazepine causes hyponatremia < 125 in 2.5 percent of patients. Most patients develop hyponatremia within the first three months of initiating oxcarbazepine treatment, t

Tx for flail chest

PEEP, bipap or intubation

Which divers are at particular risk for air embolism?

PFO

Requirement for SBP

PMN > 250, will have low glucose concentration because neutrophils consume glucose

Several months after pacemaker insertion, a patient presents with the same symptoms that occurred leading to insertion. What is this called?

Pacemaker syndrome. This is recurrence of symptoms secondary to loss of AV synchrony.

Which of the following signs of acute arterial occlusion requires emergent surgical intervention?

Paralysis

Paraphimosis vs phimosis

Paraphimosis has edematous foreskin. Phimosis is the inability to retract the foreskin

What is the most frequently involved site of pediatric linear skull fractures?

Parietal bone

High Altitude Pulmonary Edema CXR findings

Patchy alveolar infiltrates most commonly involving the right middle lobe

Benign paroxysmal positional vertigo (BPPV)

Patient will be complaining of sudden onset sensation of room spinning in connection with positional changes of the head, lasting seconds to minutes Diagnosis is made by Dix-Hallpike Most commonly caused by the presence of an otolith in the labyrinth system Treatment is Epley maneuver

Pityriasis Rosea

Patient with a history of a larger lesion one week prior, herald patch Complaining of rash on the back PE will show diffuse papulosquamous rash on the trunk, Christmas tree-like distribution Treatment is self-limiting disease, topical corticosteroids or oral antihistamines for itching

Traveler's Diarrhea

Patient with a history of recent travel Complaining of abrupt onset of watery diarrhea, nausea, and abdominal cramping Most commonly caused by enterotoxigenic Escherichia coli (ETEC) Treatment is rehydration and ciprofloxacin or azithromycin (pregnant women and children)

Rocky Mountain spotted fever (RMSF)

Patient with a history of recently being in the woods hiking or camping Complaining of abrupt onset of severe headache, photophobia, vomiting, diarrhea, and myalgia PE will show maculopapular eruption on the palms and soles Diagnosis is made by skin biopsy Most commonly caused by Rickettsia rickettsia Treatment is ALWAYS doxycycline, even in children

Serotonin Syndrome

Patient with a history of taking multiple medications that increase the amount of serotonin PE will show mental status changes, autonomic instability, and neuromuscular abnormalities Treatment is BZDs, cyproheptadine

Management of pt's with scleroderma with AKI

Patients with acute kidney injury from scleroderma will initially need to have any life-threatening electrolyte changes treated, particularly hyperkalemia, which should be managed with calcium gluconate, insulin, dextrose, and potentially sodium bicarbonate. The patient should be started on captopril, which is the best ACE inhibitor for preserving renal function, as it is nephroprotective and has been demonstrated to have the best outcomes for scleroderma renal crisis. It is also the preferred medication for management of the acute hypertension that typically accompanies scleroderma renal crisis.

In a patient with a dirty wound, how soon after the last booster is a repeat tetanus booster indicated?

Patients with dirty wounds should have a tetanus booster if it has been > 5 years since their last dose.

Indications for treatment of hyponatremia

Patients with hyponatremia who require treatment are those with severe asymptomatic hyponatremia with a serum [Na] < 110 mEq/L and those with acute symptomatic hyponatremia with a serum [Na] < 120 mEq/L.

Perilunaate vs lunate dislocation

Perilunate is dorsal displacement of capitate Lunate is volar displacement of lunate

Rumpel-Leede phenomenon

Petechiae formation after bp cuff - RMSF

What is most characteristic of acute iritis?

Photophobia

What to use for anticholinergic toxicity

Physostigmine

What is the hyperoxia test?

Placing a child on 100% oxygen for 10 minutes and obtaining an ABG. Is PaO2 < 150, more likely to be cardiac disease

Penetrating violation of which neck muscle is concerning for injury to the underlying neck structures?

Platysma

Hemlock

Poison hemlock (Conium maculatum) contains the toxin coniine, which is structurally similar to nicotine. Water hemlock (Cicuta maculata) contains the neurotoxin cicutoxin. Death from overdose from poison hemlock is caused by respiratory failure secondary to nicotinic receptor overstimulation. Initial symptoms after ingestion may include nausea, vomiting, and sympathomimetic effects such as tachycardia, diaphoresis, and anxiety. Within hours, parasympathetic findings and paralysis may ensue and result in death if intervention does not occur. Severe toxicity from water hemlock can cause intractable seizures and can lead to death. Treatment is supportive, including respiratory care, IV fluids, antidysrhythmics, and anticonvulsants. GI decontamination with activated charcoal may also be used.

In a patient with liver cirrhosis suspected of having hepatorenal syndrome with a creatinine of 2.9 g/dL, what should be the goal of therapy?

Portal congestion and hypertension appear to trigger arterial vasodilation in the splanchnic circulation, which in turn leads to an overall reduction in systemic vascular resistance. This leads to a decline in renal perfusion. Renin is released in an attempt to increase blood pressure, but this further compromises the glomerular filtration rate. Using vasopressors (such as norepinephrine, vasopressin, or midodrine) to cause splanchnic vasoconstriction corrects the systemic and renal hemodynamic abnormalities.

What is the disposition of posterior nasal packing for epistaxis?

Posterior nasal packing causes vagal stimulation and therefore can cause bradycardia and bronchoconstriction. In addition to the bleeding risks, these patients are at increased risk for dysrhythmia and airway compromise. Therefore, they should be admitted to at least a telemetry monitored bed.

What is the most common type of elbow dislocation? What do you have to worry about neurovascularly? What type of splint?

Posterolateral Brachial artery and ulnar nerve Posterior splint

What is the most common type of elbow dislocation and what can be injured NV?

Posterolateral. Brachial artery and ulnar nerve

Hospital admission criteria for pts with pelvic inflammatory disease

Pregnancy Severe Illness Persistent N/V High fever Tubo-ovarian abscess Sunable to follow or tolerate an outpatient oral regimen

What is the drug of choice for STABLE ventricular tachycardia?

Procainamide - superior to amiodarone and lidocaine

A 71-year-old woman presents to the Emergency Department with right ear otalgia and otorrhea. These symptoms began three days ago and have been getting progressively worse. The pain is exacerbated with chewing. On physical exam, she has pain when traction is applied to the pinna. The external auditory canal appears edematous with discharge. Point of care glucose is 381 mg/dL. Which of the following is the most likely causative organism?

Pseudomonas - necrotizing otitis externa

What physical exam test looks for retrocecal appenditicits

Psoas sign

What is the leading cause of in-hospital death caused by near hanging?

Pulmonary Edema

What are the two side effects associated with long term use of flecainide?

QRS widening and PR prolongation.

What is the most serious ECG finding in hypocalcemia?

QT prolongation

Tx for P. falciparum

Quinidine IV or PO quinine + doxycycline - Found in South Asia, Africa, South America

What are the Cyanotic Congenital Heart Diseases and Acyanotic CHD?

R-->L Shunt: Truncus arteriosus, Transposition of great vessels, Tricuspid Atresia, Tetralogy of Fallot, Total anomalous pulmonary vascular return L --> R ASD, VSD, PDA, Coarctation of aorta

A 65-year-old man presents with marked bradycardia. His ECG shows third-degree heart block. Where should a central line be placed to facilitate transvenous pacing?

RIJ

What seronegative spondyloarthropathies other than sacroiliitis are associated with HLA- B27?

Reactive arthritis, psoriatic arthritis, and arthritis associated with inflammatory bowel disease.

After administration of hydroxocobalamin, what color do you expect the patient and their urine to turn?

Red

What is the color scheme of coral snake and toxicity?

Red next to yellow, kill a fellow. Coral snake venom causes neurotoxicity by competitive inhibition of the muscarinic acetylcholine receptors at the neuromuscular junction. On physical exam, neurotoxicity may be demonstrated by descending muscle weakness as well as bulbar paralysis including ptosis, ophthalmoplegia, dysarthria, and dysphagia. Signs of neurotoxicity may be delayed up to 12 hours after envenomation. Local edema and skin changes at the bite site are mild and less apparent than with pit viper envenomation. Coagulation studies and creatinine kinase should be ordered in all patients with suspected coral snake envenomation. Obtaining a forced vital capacity and negative inspiratory pressure may be helpful in determining the extent of respiratory muscle paralysis. Management should be focused on supportive care and respiratory support if needed. Antivenom should be administered promptly in patients with a history or findings suggestive of coral snake envenomation.

Vision loss with curtain coming down?

Retina detachment

What are the indications for exchange transfusion in sickle cell disease?

Retinal infarction, stroke, priapism, and pulmonary infarction.

What is the BP recommendation for intracranial hemorrhage

SBP 140-160

What is the shock index?

SI = HR/SBP 0.5 - 0.7 = Normal > 0.7 is shock

What are the ECG findings of a right ventricular infarct?

ST elevation in V1. This is the only standard ECG lead looking directly at the right ventricle.

Salter-Harris Fractures

Salter-Harris Fractures I: S (Slipped epiphysis) II: A (fracture Above physis), most common III: L (fracture beLow physis) IV: T (fracture Through physis) V: ER (ERasure of the growth plate) Management:I/II: nonoperativeIV/V: surgery required Negative radiographs do not r/o a Salter I fracture

What is the most common physeal fracture?

Salter-Harris Type II

Uterine atony is treated by

bimanual uterine compression and massage, with one hand inside the vagina pushing upward against the body of the uterus while the other hand pushes downward on the uterine fundus from the abdominal wall.

Sarcoidosis

Sarcoidosis is a multisystem disorder characterized by noncaseating granulomas in multiple organs, most commonly seen in young, African American female patients. Pulmonary manifestations of sarcoidosis include cough and dyspnea. The classic chest radiographic finding is hilar adenopathy. In addition to clinical and radiographic findings, the diagnosis of sarcoidosis involves biopsy of an accessible lymph node. Patients with sarcoidosis have an increased calcitriol production (1, 25-dihydroxyvitamin D, active metabolite of Vitamin D), which may lead to hypercalcemia. Glucocorticoids can reduce serum calcium concentration by decreasing calcitriol production in the activated mononuclear cells in the lung and lymph nodes. This is a helpful adjunctive therapy for patients with sarcoidosis and hypercalcemia.

Scombroid poisoning

Scombroid results when bacteria in improperly stored fish metabolize histidine into histamine and other bioactive amines. Scombroid occurs most commonly in fish in the Scombridae family (tuna, mackerel, and bonito), but can also be seen in other species. Symptoms occur within 30 minutes to 24 hours of ingestion and include facial flushing, rash, headache, palpitations, abdominal cramping, and diarrhea. Patients may report a "peppery" taste of the fish. Scombroid is often misdiagnosed as an allergic reaction

What is the name for cervical lymphadenitis from Mycobacterium tuberculosis infection?

Scrofula

What are the risk factors for local lidocaine

Seizures, hypotension, dysrhythmias. Bupivacaine is the most cardiotoxic though

What is Lemierre's disease?

Septic thrombophlebitis of the internal jugular vein caused most commonly by Fusobacterium necrophorum.

What potentially fatal toxidrome can dextromethorphan precipitate?

Serotonin syndrome.

Sever disease

Sever disease or calcaneal apophysitis is the most common cause of posterior heel pain in athletic 8 to 12-year old males. The apophysis is the cartilaginous structure that serves as the tendon insertion site of the growing bone. Apophysitis is unique to adolescent patients with skeletal immaturity and involves inflammation of this actively growing bone prominence that is under tensile stress. Sever's disease is bilateral in 60% of the cases. The key is that the pain is exacerbated by impact activities such as running and jumping and relieved by rest. The pain is present at the Achilles tendon insertion site and plantar fascia of the calcaneus. Pain is elicited by squeezing the calcaneus and dorsiflexion of the heel is restricted secondary to tight heel cords

Colchicine Toxicity

Severe gastroenteritis first 24 hours -2-7 days: Bone marrow suppression, Rhabdo, renal failure, metabolic acidosis, ARDS > 7 days: Rebound leukocytosis, Transient alopecia, Complete recovery if still alive

Signs of Transfusion related acute lung injury

Severe hypoxemia B/l pulmonary infiltrates w/in 6 hrs of transfusion Fever, hypotension, tachycardia

What other gastrointestinal infections have been linked with hemolytic uremic syndrome?

Shigella and Salmonella.

What are the most common ECG findings in hypercalcemia?

Shortening of the QTc interval, PR prolongation, and QRS widening.

A 24-year-old woman with a history of idiopathic intracranial hypertension and ventriculoperitoneal shunt presents with worsening headaches for the last three days. Her headaches are intermittent and primarily occur during exercise. They are associated with transient blurry vision and nausea. Between the episodes, she is asymptomatic. What is the most likely diagnosis?

Shunt overdrainage can lead to slit ventricle syndrome. It is characterized by slit-like ventricles on computed tomography of the head. As overdrainage worsens, the structures just proximal to the shunt collapse and occlude the shunt. Subsequently, cerebrospinal fluid collects and the intracranial pressure increases until the occlusion is overcome by distending forces. This pattern of overdrainage and relief is responsible for patient's intermittent symptoms of increased intracranial pressure on presentation. Treatment is with neurosurgical consultation for shunt revision or reprogramming. While awaiting definitive management, symptoms may be improved by keeping the patient flat or in Trendelenburg.

complex vs simple febrile seizure - What is the difference in type of seizure?

Simple has no focal features -Complex seizures has focal features

What is the most likely cause and treatment of severe diarrhea in a patient with scleroderma?

Small intestinal bacterial overgrowth from stasis, which is treated with antibiotics (metronidazole, ciprofloxacin, neomycin, rifaximin, amoxicillin, or doxycycline)

Sudden Unexpected Infant Death timing

Some 95% of sudden unexpected infant death (SUID) infants die before 6 to 8 months of age, with a peak occurring between 2 and 4 months of age. SUID may occur at any time during the first two years of life, but it is rare in children younger than 1 month of age and in those older than 1 year of age.

Spigelian hernias

Spigelian hernias occur at an area of abdominal muscle weakness at the lateral edge of the rectus abdominus muscle

What is the most common organism isolated on respiratory cultures in bacterial tracheitis?

Staph Aureus

What is the dosage for a narcane gtt

Starting it at 2/3 of the bolus dose that resulted in symptom reversal

Which intraosseous site has the highest flow rate?

Sternum

Steroid-induced psychosis

Steroid-induced psychosis is a constellation of signs and symptoms that can develop within the first 5 days of treatment with a corticosteroid. Signs and symptoms commonly include emotional lability, anxiety, distractibility, pressured speech, sensory flooding, insomnia, depression, agitation, auditory and visual hallucinations, intermittent memory impairment, mutism, disturbances of body image, delusions and hypomania. The amount necessary to produce this effect is thought to be greater than 40 mg of prednisone daily (or an equivalent dose of another corticosteroid). It is important to note that previous history of psychological disease does not predict the development of steroid psychosis. Symptoms can be quite severe. Patients should be warned when they are prescribed this type of medication as up to 3% of patients with steroid psychosis will commit suicide. Non-psychiatric causes of acute psychosis should be considered in patients who present with acute psychotic symptoms, are greater than 35 years of age and have no previous psychiatric history.

What is the most common mechanism of trauma that causes urethral injuries?

Straddle injuries

Most common causes of acute otits media

Strep, H. influ, moraxella

What is the most common bacteria cause of acute mastoiditis

Streptococcus pneumoniae

A 16-year-old girl presents with right thumb pain after a fall while skiing. Physical examination reveals pain and swelling of the right thumb. X-ray of the thumb is negative. Valgus stress at the metacarpophalangeal joint results in increased pain and deviation of 40 degrees. What treatment is indicated?

Stress should be applied to the metacarpophalangeal (MCP) joint in full extension and at 30 degrees of flexion. If there is more than 35 degrees of joint laxity or 15 degrees of laxity beyond the unaffected thumb, a complete UCL rupture should be suspected. Rupture of ulnar collateral ligament - thumb spica thumb and urgent referral for surgical management

Studies have shown that patients with renal failure and metabolic acidosis have a reduced need for dialysis and reduced mortality at 28 days when treated with sodium bicarbonate.

Studies have shown that patients with renal failure and metabolic acidosis have a reduced need for dialysis and reduced mortality at 28 days when treated with sodium bicarbonate.

Asymmetric pulses in the upper extremity will occur only if which artery is involved in an aortic dissection?

Subclavian artery.

Difference between anticholinergic vs sympathomimetic toxicity

Sympathomimetic toxicity (D) is very similar to anticholinergic toxicity, with the only clinically significant difference patients who present with the sympathomimetic toxidrome are diaphoretic, while patients with anticholinergic poisoning are dry.

What primary disease process is associated with sterile vegetation endocarditis on both sides of the involved valve?

Systemic lupus erythematosus.

What is the most common cause of pericarditis in Africa?

TB

What is the most common presenting sign for PE?

Tachypnea

What area of the brain is most often affected by herpes simplex virus infection?

Temporal lobes

What adverse side effect of fluoroquinolones such as ciprofloxacin prevent routine use in children?

Tendinitis and tendon rupture.

What toxin is found in puffer fish?

Tetrodotoxin

What is a common complication within 24 hours of initiation of antibiotic treatment of Lyme disease?

The Jarisch-Herxheimer reaction.

How can the risk of transfusion-associated cardiac overload (TACO) be decreased?

The administration of furosemide between units of transfused blood products.

What are the sxs of decompression illness

The bends - musculoskeletal Pulmonary - the chokes Neurology - The staggers Dermatologic - Skin bends

What is the most common side effect of IV amiodarone?

hypotension

What is the treatment for angle closure glaucoma?

The best initial step in management is to administer pilocarpine eye drops, which constrict the pupil and increase drainage from the anterior chamber. This effect can be rapid, thus administering pilocarpine drops early is critical in management. Other treatments include acetazolamide, which decreases aqueous humor production; latanoprost, which dilates the Schlemm canal and increases drainage; and topical beta-blockers such as timolol, which also decrease aqueous humor production. Topical prednisolone can be given to decrease inflammation and nerve damage, and mannitol can reduce intraocular pressure as it acts as an osmotic diuretic. An ophthalmology consultation should be promptly obtained, and iridotomy may be necessary to mechanically create a channel of drainage to reduce intraocular pressure.

What is the most frequent site of arterial embolism?

The bifurcation of the common femoral artery.

Diagnostic criteria for retropharyngeal abscess on xray

The diagnosis is suggested when the retropharyngeal space at C2 is twice the diameter of the vertebral body or greater than one half the width of the vertebral body of C4. Contrast enhanced CT can also be diagnostic and aid in defining the extent of the abscess formation. Treatment in the Emergency Department includes careful assessment and stabilization of the airway, intravenous antibiotics (e.g. ampicillin-sulbactam) and emergency consultation with an otolaryngologist for definitive incision and drainage of the abscess.

What is the initial pediatric defibrillation dose?

The dose is 2-4 Joules/Kg

First line tx for seizures in neonates

The first-line treatment for seizures in neonates is phenobarbital. It is the most widely accepted medication, the most well studied, and most effective to date. The dose is 20 to 30 mg/kg intravenously. If the seizures do not resolve after the first dose, then a repeat dose of 10 to 20 mg/kg intravenously should be given to a maximum of 50 mg/kg in a 24-hour period.

When is a death required to be reviewed by a medical examiner

The laws vary by state, but in general, cases requiring review by an examiner include those where the manner of death is unclear or unexpected, or where a law may have been broken. This includes traumatic deaths, deaths due to natural disasters, deaths where suicide or homicide are suspected, deaths of individual in police custody, sudden unexplained deaths, and most pediatric deaths.

What sinus is most commonly affected by barotrauma?

The maxillary sinus.

Most common cause of transverse myelitis

The most common cause of transverse myelitis is postviral, likely due to an immune-mediated reaction. Other causes include multiple sclerosis, lupus, and idiopathic cases. Evaluation should include an MRI to rule out compressive lesions such as epidural abscess or hematoma. MRI may also show signs of nonspecific inflammation, but this is not consistently seen. Treatment includes high-dose steroids to reduce swelling and cord compression as well as neurosurgical consult and admission for further evaluation and treatment. Most patients will have improvement in symptoms over weeks to months, although they may not completely resolve.

What is the most likely cause of his VP shunt malfunction?

The most common cause of ventriculoperitoneal shunt malfunction is proximal tubing obstruction by the choroid plexus or increased protein within the cerebrospinal fluid (CSF).

In a COPD pt that is in exacerbation, in a patient that has multifocal atrial tachycarida - what is the tx

The most common underlying etiology is chronic obstructive pulmonary disease (COPD). Treatment is focused on the underlying cause of the MAT, but rate control can be attempted with a calcium channel blocker if necessary. In the case of a COPD exacerbation, treatment should focus on decreasing the work of breathing, decreasing significant hypercapnia, and improving oxygenation. In this case, starting bronchodilatory and oxygen therapy to improve pulmonary function with help decrease atrial ectopy. Noninvasive positive pressure ventilation should also be started which will decrease the work of breathing, decrease preload, improve oxygenation, and reduce the degree of hypercapnia.

Contraindications to nail trephination

The primary contraindication to nail trephination is a disrupted nail edge indicative of deep nail bed laceration that necessitates repair. The nail bed can be repaired with either an absorbable suture, such as 6-0 gut, or with adhesive, such as 2-octylcyanoacrylate. The nail or an alternative cover is then replaced after the adhesive has dried. Nail trephination with electrocautery is typically painless and does not require anesthesia. The nail should be prepared with povidone-iodine solutio

Patients with aortic dissection may present with hoarseness due to compression of which nerve?

The recurrent laryngeal nerve.

What is the most cost-effective screening test for a mandibular fracture?

The tongue-blade test is performed by attempting to twist a tongue-blade that is held between a patient's molars. If the examiner is able to break the tongue-blade by twisting without causing the patient pain, mandibular fracture has been ruled out.

What differentiates a penile contusion from a penile fracture?

The tunica albuginea will remain intact in a contusion.

What criteria must be met for a dog bite to be closed?

The wound is clinically not infected, less than 12 hours old (24 hours for facial wounds), is not located on the hands or feet, is not a crush injury or a puncture wound, is not heavily contaminated, and the patient is not immunocompromised.

A 23-year-old healthy man presents with scrotal pain after a physical altercation. His BP is 150/80 mm Hg, and his heart rate is 135 beats per minute. He is nauseated and appears uncomfortable. Genital exam reveals a swollen and ecchymotic scrotum with a single testicle. What is happening here?

This patient's presentation is highly suspicious for a traumatic dislocation of the testicle. Physical exam findings consistent with this diagnosis include a swollen and ecchymotic scrotum with an absent testis. Emergent operative intervention is required by a urologist to relocate the displaced testicle (usually from the abdominal wall).

What is the most common location for shingles to occur?

Thorax, followed by the face (trigeminal nerve).

What are indications for a prompt endoscopy for epigastric pain

Those with a classic history and absence of alarm features can be managed with a trial of proton pump inhibitors, cessation of offending medications like NSAIDS, and primary care referral for H. pylori testing and treatment. Alarm features, which raise concern for GI malignancies as well as other potentially serious conditions, should warrant prompt endoscopy. These include age > 55, early satiety, dysphagia, persistent vomiting, anemia or GI bleeding, jaundice, unexplained weight loss, and presence of an abdominal mass.

What are common lab findings for RMSF

Thrombocytopenia and hyponatremi

How is motor function of the median nerve tested?

Thumb opposition to fifth finger (recurrent motor branch) and "OK" sign (anterior interosseous branch).

What can you use for refractory hypotension for anaphylaxis for pt on antihypertensive medications

To circumvent the beta-receptor, glucagon can be administered, which will bypass the beta-adrenergic second messenger system, potentiate the circulating epinephrine, and help restore vasomotor tone.

A 34-year-old man spilled a liquid chemical on his hands while etching glass. His fingertips are white, but without ulceration. He complains of intense hand pain, which appears out of proportion to physical exam. Which is the most appropriate therapy for this patient?

Topical calcium gluconate. This is hydrofluoric acid from glass etching, home rust remover, metal cleaning, and electronic manufacturing. Topical calcium gluconate, intraarterial calcium

Treatment for anal fissure?

Topical nifedipine, nitroglycerin, topical analgesic, stool softener, sitz bath, fiber

What is the phenomena of "core temperature after-drop" in frostbite management?

When large areas are rewarmed, vasoconstriction is relieved and cold, hyperkalemic and acidic blood returns to the central circulation.

Treatment for anticholinergic toxicity

Treating this life-threatening complication should be the first priority. Similar to tricyclic antidepressant overdose, the treatment of choice is sodium bicarbonate, which works by sodium loading and improving acidosis. First-generation antihistamines such as diphenhydramine have multiple receptor effects, including muscarinic, alpha-adrenergic, and sodium-channel blockade. They also inhibit the inward rectifying potassium current, which, in combination with sodium-channel effects, leads to QRS widening. This patient should receive an immediate bolus of intravenous sodium bicarbonate (1-2 mEq/kg), with repeat administration in 3-5 minutes if the QRS widening persists. IF PT IS AGITATED GIVE PHYSOSTIGMINE

Treatment for carotid or vertebral artery dissection

Treatment for carotid or vertebral artery dissection is anticoagulation with heparin intravenously followed by warfarin.

Tx for Lyme disease

Treatment for early Lyme disease and mild acute disseminated Lyme disease is doxycycline for 3-4 weeks. In pregnant women, amoxicillin should be substituted. In children under the age of 8 years, doxycycline is indicated as primary treatment as long as treatment length is <21 days. Patients with neurologic or cardiac manifestations should be admitted and treated with IV ceftriaxone. Patients with exposure to deer ticks require post-exposure prophylaxis only if the tick was attached for > 36 hours based on certainty of time of exposure or degree of engorgement, the local rate of infection is greater than 20% and doxycycline is not contraindicated. Given the short duration of exposure, discharge home without prophylaxis is indicated for this patient.

Arsine gas poisoning tx

Treatment includes exchange transfusion, urinary alkalinization, and ultimately hemodialysis in cases of renal failure.

Tx for TB

Treatment is:Latent TB: INH for 9 months, rifampin for 4 months, or INH/rifapentine for 3 monthsActive/reactivation TB: rifampin, INH, pyrazinamide, ethambutol (RIPE)

Treatment for lead poisoning?

Treatment of lead toxicity consists of chelation therapy. Patients with a BLL > 70 µg/dL, regardless of symptoms, should be admitted to the hospital for parenteral chelation therapy with dimercaprol followed by CaNa2EDTA. Patients with a BLL of 45-69 µg/dL can be treated as an outpatient with oral 2,3-dimercaptosuccinic acid (DMSA)

INDICATION FOR nail trephination

Trephination is indicated for subungual hematomas that are less than 48 hours old, are not spontaneously draining, and are painful. If the hematoma involves the nail fold or there is a fingertip avulsion that requires subungual sutures for repair, then the entire nail should be removed instead of trephination.

Location of tricuspid regurg vs mitral regurg

Tricuspid pansystolic murmur at left sternal border. Mitra at apex of heart that auscultates to the axillae

Wellens syndrome

Type A - Biphasic T waves Type B - Deeply inverted T waves In leaves V1-V3 Sign of LAD STENOSIS NOT OCCLUSION

Types of odontoid fractures

Type I - oblique fx through the tip (Only one stable) Type II - horizontal fx at base Type III - fx line extends through body of axis

What is the reduction in 30-day mortality if aspirin is given to patients having an acute MI?

Typically, a 23% reduction.

What fracture is commonly associated with a colles Fx?

Ulnar styloid fracture

What percentage of individuals have a physiologic 1 mm difference in pupillary size?

Up to 20%

What is the gold standard for diagnosis of pediatric midgut volvulus

Upper GI Study

What is the most common congenital heart defect in children?

VSD

Difference between central retinal vein and artery occlusion

Vein is painless blood and thunder fundus exam artery is painful and cherry red spots on fovea

What is the best method of directly monitoring intracranial pressure?

Ventricular catheter.

wernickes vs korsakoff?

Wernicke encephalopathy is characterized by oculomotor dysfunction (most commonly nystagmus), cerebellar dysfunction, and altered mental status. The result of thiamine deficiency. OCULOMOTOR Dysfunction shows the greatest response to treatment Korsakoff is anterograde and retrograde amnesia

What toxicity is associated with the use of nitroprusside?

What toxicity is associated with the use of nitroprusside?

What are contraindications to using sumatriptans

While the evidence is limited, due to their mechanism, triptans should generally be avoided in conditions where vasoconstriction could be harmful, including patients with histories of uncontrolled hypertension, ischemic stroke, coronary artery disease, and vasospastic angina. It is also generally avoided in pregnancy, though can be used as second-line therapy.

Treatment for bronchopulmonary dysplasia?

Within 1 hour you give surfactant - After 1 hour you can give caffeine

Do angiotensin receptor blockers (ARBs) cause angioedema?

Yes, although the incidence is less than for ACE-inhibitors.

nitrogen narcosis

actions before his death are consistent with nitrogen narcosis, or dangerously high tissue nitrogen concentration. At increasing depths underwater, the nitrogen, a natural component in gas tanks, is more easily dissolved into tissues. Thus, divers' risk for this condition increases at depths past 100 feet and reaches significantly high risk past 150 feet. Diagnosis is clinical. Patients will have resolution of their symptoms upon ascent. This reverse in symptoms with ascent helps to confirm the diagnosis. Patients will commonly present with transient nausea, vision changes, disorientation, dyspnea, and shivering. Drowning most commonly occurs at depths over 150 feet due to poor judgment and impaired motor skills and over 300 feet due to the anesthetic effects of nitrogen. The most important management of this condition is prevention. Patients who present with resolved symptoms that are consistent with nitrogen narcosis should be instructed to limit the depth of their dives and use mixed gas tanks for any dive over 100-120 feet, with a strong emphasis on overall dive safety.

Symptoms and tx for angle closure glaucoma

acute angle-closure glaucoma, which is associated with painful vision loss, headache, nausea, and vomiting. It is caused by an outflow obstruction of aqueous humor from the anterior chamber to the canal of Schlemm. As a result, intraocular pressure (IOP) rises and the pupil becomes mid-dilated with sluggishness or nonreactivity to light. There is often ciliary flush, and the cornea appears steamy or hazy. Patients often describe blurry vision with halos around lights. -Miotics: Timolol, Pilocarpine, Apraclonidine, acetazolamide, Mannitol

What is acute cerebellar ataxia seen in kids

acute cerebellar ataxia, a postinfectious condition that occurs about 2 weeks after a viral illness. It is the most common cause of ataxia in children, found in more than one-third of cases of pediatric ataxia and more common in children younger than 6 years. Infection with coxsackie B virus, echovirus 6, Epstein-Barr virus, influenza, mumps, varicella, and other viruses has been associated with acute cerebellar ataxia. In addition to acute onset, the effects on gait predominate and are worst early on. Effects on the trunk are more pronounced than those on the extremities. The emergency department evaluation of a patient presenting with ataxia must eliminate potential life-threatening causes such as masses, injury, or infection. The examination should evaluate mental status, extraocular movement, gait (if possible), and deep tendon reflexes; cerebellar testing should be performed. In most cases, acute postinfectious cerebellar ataxia resolves on its own in 2 to 3 weeks.

Age range for staphylococcal scalded skin syndrome

affects children under 2 years of age and rarely seen in children older than 6 years of age

Anticonvulsant hypersensitivity syndrome

aka DRESS: drug rash with eosinophilia and systemic symptoms) is a potentially fatal complication of anticonvulsant therapy. The rash occurs after one to two weeks of nonspecific symptoms. It is erythematous and initially spares the mucous membranes. The classic triad is fever, rash, and internal organ involvement. Within one to two weeks, multi-organ system failure and death can occur. Treatment is with intravenous steroids and immunoglobulin. The offending drug should be discontinued.

Timing for Rh isoimmunization

anti-D immune globin must be administered within 72 hours to be effective -For abortions < 12 weeks only 50 mcg is needed. After 12 weeks, 300 mcg

digoxin toxicity symptoms

bradycardia, hypotension, and elevated potassium levels. Hyperkalemia, which develops in part from digoxin-mediated inhibition of the Na/K ATPase pump, is the most important predictor of outcome in the setting of digoxin toxicity, with a mortality rate in untreated patients of nearly 100% when potassium levels exceed 5.5 mEq/L. The treatment of choice for digoxin toxicity is digoxin-specific antibody fragment (Fab) that also improves hyperkalemia.

What is the antidote for magnesium toxicity

calcium gluconate

Ciguatera

caused by eating reef fish contaminated by a dinoflagellate, Gambierdiscus toxicus, which produces ciguatera toxin. Symptoms include muscle weakness, paresthesias, vomiting, diarrhea, and reversal of hot-cold sensation. Treatment is supportive.

What is Reye syndrome

characterized by encephalopathy and fatty degeneration of the liver. It has been associated with aspirin exposure in the setting of a viral illness. Its major cause of morbidity and mortality is cerebral edema leading to increased intracranial pressure. There is no specific cure, and management is supportive.

What is Mallet Finger Deformity? Tx?

closed disruption of the distal extensor apparatus, often occurring when there is sudden forceful flexion of an extended finger, such as when struck by a ball -The treatment involves immobilizing the DIP joint in slight hyperextension for 6-8 weeks to allow tendon healing. The proximal interphalangeal (PIP) joint and metacarpophalangeal (MCP) joints should be allowed to move freely

where is the cricothyroid membrane

cricothyroid membrane, which is found inferior to the thyroid cartilage and superior to the cricoid cartilage)

A 57-year-old woman presents to the emergency department for a facial laceration. She was outside shoveling snow and slipped on ice, landing forward on her face. She denies loss of consciousness and reports only right orbital pain and eyelid laceration. A fluorescein exam is performed, and the dye is noted to stream directly from the laceration. Given this test finding, where is this patient's laceration?

deep lacerations medial to either punctum can lead to lacrimal duct damage

Direct signs of acute appendicitis on ultrasound include

diameter > 6 mm, wall thickness > 3 mm, target sign, appendicolith, and noncompressible appendix (perforated appendicitis may be compressible)

tx for lyme disease

doxycycline -In pregnant women or children under 8 years - amoxillicin

Diagnosis for boerhaave syndrome

esophagram using a water soluble contrast material

Best way to intubate ludwig angina

fiberoptic or awake intubation

What is seen most frequently in the initial evaluation of a patient with a basilar skull fracture?

hemotympanum

Most common viral cause of erythema multiforme

herpes simplex

oral hairy leukoplakia.

his is a disease of the lingual squamous epithelium and is thought to be caused by the Epstein-Barr virus (EBV). It is relatively specific for concomitant HIV infection and rarely seen in other immunocompromised states. Oral hairy leukoplakia is often confused with oral candidiasis (thrush). However, unlike the lesions of thrush, Oral hairy leukoplakia cannot be scraped off the tongue.

central cord syndrome

hyperextension injuries to the cervical spine, such as a fall chin-first onto the ground. Symptoms include bilateral motor weakness, worse in the upper extremities. Patients also exhibit a variable degree of sensory loss below the level of the injury and bladder dysfunction. Risk factors include preexisting cervical osteoarthritis and spondylosis

What increases risk of digoxin toxicity

hypokalemia

Legg-Calve-Perthes Disease

idiopathic avascular necrosis of the proximal femoral epiphysis, most commonly occurs in male children between the ages of three and 12 years with a peak between five and seven years of age. It often presents with a limp that has an insidious or stuttering onset. The associated pain is generally mild, refers to the groin, anteriomedial aspect of the thigh or knee, and is often relieved by rest, and generally worse at the end of the day

The most common type of hernia in both men and women is

indirect inguinal hernia

hydrofluoric acid tx

it can cause liquefactive necrosis similar to an alkaline solution. The burn associated with hydrofluoric acid results in progressive destruction of tissue and causes intense pain. The skin can develop a blue-grey appearance with surrounding erythema and eschar may develop. Although concentrated solutions cause immediate symptoms, dilute solutions (< 20%) may not show symptoms for 12-24 hours. If left untreated, full-thickness burns can develop. Immediate treatment consists of copious irrigation for at least 15-30 minutes. If any pain persists after irrigation, detoxification of the fluorine ion is required using topical, infiltrative or intra-arterial calcium. If the burn is superficial, calcium gluconate gel (3.5 g of calcium gluconate powder mixed with water-soluble lubricant) should be applied with an occlusive cover.

What are the indications for packing an incised abscess

large > 5 cm, or abscess in pts with DM or who are immunocompromised

What are the indications for emergent HD in acute aspirin toxicity

levels > 100 AMS Kidney or liver failure Pulmonary edema

What is the tx for pasteurella if pt is allergic to penicillins

mentronidazole or clindamycin + doxycyline/TMP/moxifloxacin/cefuroxime

Snake envenomations can cause what classic oral manifestation?

metallic taste

What are the risk factors of benzocaine?

methemoglobinemia

blowing holosystolic murmur, best heard at apex with radiation to axilla

mitral regurg

Children with opsoclonus-myoclonus syndrome - think of what?

neuroblastomas. 50% presents in the adrenal gland. Need to have MRI of chest, abd, pelvis and urine VMA and HVA

What are absolute contraindications of anticoagulation

neurosurg within the past 10 days Active bleeding Severe bleeding diathesis Platelet count < 20k Severe allergy

What is the most reliable sign of uterine rupture?

nonreassuring Fetal heart rate

organic vs functional confusion

organic means a pathological cause of confusion

Most common benign bone tumor?

osteochondroma Most commonly men in 20s PAINLESS

What is the by product of ethylene glycol

oxalic acid

What is the evaluation for preterm rupture of membranes

pH testing of vaginal fluid ( > 6.5) and evaluation for ferning.

What is key feature of acute necrotizing ulcerative gingivits vs simple gingivitis?

pain with ANUG

What are ECG findings for ventricular aneurysm after an MI

persistent QS waves and STE

Painless vaginal bleeding

placenta previa

Under what platelet count should patients be excluded from consideration of thrombolytic therapy in an acute ischemic stroke?

platelets < 100k

What type of organisms are seen with necrotizing fasciitis?

polymicrobial infection with gram-negative, gram-positive, and anaerobic bacteria.

What are complications of draining a pneumothorax or a pleural effusion?

reexpansion pulmonary edema, a form of noncardiogenic pulmonary edema, is one of them. It is an uncommon complication but is potentially life-threatening. It usually occurs after rapid reexpansion of a lung that has been collapsed for several days. It can occur after drainage of a pneumothorax or a pleural effusion. Patients typically present shortly after completion of the procedure, and symptoms include cough, dyspnea, and hypoxemia, but symptoms can be delayed for up to 48 hours. Suggestions for prevention of this complication include avoiding suction for expansion of the lung and limiting the amount of fluid initially drained. Treatment is supportive with positioning, fluid restriction, and positive pressure ventilation as needed. The disease is self-limited.

Even a single event of hypotension or hypoxemia has been described as causing significant increase in mortality in severe TBI

remember

A bite from what can cause pancreatitis?

scorpion stings

What is the most common cause of pneumonia in pts with cystic fibrosis

staph aureus

What central venous catheter placement has the lowest risk of infection?

subclavian

What is the most common bone fracture in basilar skull fracture

temporal bone

Isopropyl alcohol ingestion

the hallmark laboratory finding of isopropyl alcohotoxicity: ketosis without acidosis. Acetone is also responsible for the elevated osmolar gap typical of isopropyl alcohol toxicity as well as the fruity breath seen in patients who have ingested isopropyl alcohol. Symptoms of toxicity include central nervous system depression and gastrointestinal irritation. -Treatment is supportive, and gastrointestinal decontamination is not recommended in the absence of coingestion. Severe cases may require hemodialysis.

What is the most common type of herniation

uncal herniation of the temporal lobe

What is the most common xray finding of airway obstruction?

unilateral obstructive emphysema

Jellyfish treatment?

vinegar - 5% acetic acid By inactivating the nematocysts still embedded in the skin. (Not recommended for Portuguese man-of-war stings.)

How soon after potential exposure to Rh-positive fetal blood does an Rh-negative mother need to receive RhoGAM for it to be effective?

within 72 hours