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Flashcards in All Cards Deck (238):
1

Hangman vs Jefferson fracture

Jefferson - C1 burst fracture, usually from axial loading (like a diving injury)
Hangman - posterior C2 fracture, usually from hyperextension

2

symptoms and management of hydrofluoric acid burns?

used in glass etching, metal cleaning, and electronics manufacturing
hypocalcemia, hypomag, and hyperkalemia
treat with topical, intra-arterial, IV calcium gluconate

3

mild vs moderate vs severe hypothermia
(definitions and treatment)

mild 32-35: active external warming
moderate 28-32: +active core (bladder, gastric lavage)
severe < 28: ECMO, pleural lavage

4

treatment of shivering

BDZs

5

atropine dose

0.02mg/kg (minimum dose of 0.1mg)

6

What's a normal ankle-brachial index?

>0.9

7

disorder with mousy/musty odor

PKU

8

fishy odor

trimethylaminuria

9

sweaty feet smell

isovaleric acidemia

10

SIRS criteria

Core temp < 36 or >38.5
tachycardia or bradycardia
tachypnea
leukocytosis, lymphopenia, or 10%+ bandemia

11

Septic shock definition

sepsis + SIRS + continued cardiovascular dysfxn after 40ml/kg fluids

12

refractory septic shock definitions

fluid refractory: after 60ml/kg fluidscatecholamine refractory: after 10 mcg/kg/min of dopa, epi, or norepi

13

severe sepsis definition

when associated with:
ARDS
cardiovascular dysfxn
dysfxn of 2 or more organ systems

14

what is hydrogen sulfide

mustard gas
causes superficial skin burns, eye irritation, and resp tract irritation

15

What are the classifications of neutropenia

severe < 500
moderate 500-1000
mild 1000-1500

16

What is the discriminatory zone with HCG?

transvaginal US- 1,500 mIU/mL
transabdominal US- 6,000 mIU/mL

17

symptoms of carbemazepine toxicity

can cause resp compromise, altered mental status, vomiting, drowsiness, slurred speech, nystagmus, hallucinations, hypotension, coma, dystonic reactions, seizures has some anticholinergic properties false positive for TCAs on UDS

18

expected compensation for acute resp acidosis

increase in serum bicarb 0.1 meq for each 1 mmHg PCO2

19

expected compensation for acute metabolic acidosis

decrease in PCO2 1.2 mmHgfor each 1 meq of bicarb

20

expected compensation for acute resp alkalosis

decrease in serum bicarb 0.2 meq for each 1mmHg PCO2

21

expected compensation for acute metabolic alkalosis

increase in PCO2 0.6 mmHg for each 1meq of bicarb

22

how frequently can you repeat epi in anaphylaxis?

3-4 times every 5-15 minutes

23

what is the pathophys of staph scalded skin syndrome?

hematogenous spread of epidermolytic or exfoliative toxin; children are more affected that adults due to inefficient renal clearance

24

most common nerve injury in supracondylar fracture

median nerve

25

most common artery injury in supracondylar fracture

brachial artery

26

treatment of DUB

combo pills or progestin only pill taper

27

sites for IO access

proximal tibia
distal tibia
distal femur
proximal humerus
sternum in adults

28

MUDPILES

methanol/metabolic defects
uremia
DKA, alcoholic ketoacidosis, starvation
paraldehyde
iron and INH
lactic acidosis
ethylene glycol
salicylates
* also CO, cyanid, hydrogen sulfide, metformin, phenformin, sulfur, theophyllin, and toulene!

29

normal CSF opening pressure

< 20 cm H2O

30

LR +

= (positive test/presence of disease) / (positive test/absence of disease)
= sensitivity / (1 - specificity)

31

LR -

= (negative test/presence of disease) / (negative test/absence of disease)
= (1 - sensitivity) / specificity

32

How do you use LRs?

You have to convert the pretest probability to odds
This is pretest probability / (1 - pretest probability)
Then you multiply by the LR
Finally, you convert the odds BACK to the probability!

33

What are clinically significant LRs?

LR + > 10
LR - < 0.1

34

Amanita phalloides ingestion

white mushroom that can kill. classically:
stage I: 6-24hrs of no sxs
II: V/D 12-24hrs
III: seeming recovery
IV: 2-4d later with liver and renal failure

35

loss of contralateral pain and temperature
loss of ipsilateral motor

Brown Sequard syndrome
hemisection of the spinal cord

36

loss of motor and pain sensation
preserved temp and proprioception

Anterior cord syndrome
disruption of the anterior spinal artery

37

upper extremities affected more than lower extremities

central cord syndrome

38

Posterior cord syndrome

loss of proprioception and pain sensation

39

loss of proprioception and pain sensation

posterior cord syndrome

40

ectasy/MDMA intoxication

hyponatremia, concentrated urine, altered mental statusmay see serotonin syndrome

41

lab abnormality in hereditary angioedema

low C4

42

reasons to use VariZig

only for post-exposure ppx, but NOT once there is varicella infection

43

lab abnormalities in strep glomerulonephritis

low C3, nml C4. if levels are normal, consider something else

44

non-ketotic hypoglycemia with metabolic acidosis should make you think of...

fatty acid oxidation disorder

45

classic lab findings in fatty acid oxidation disorder

non-ketotic hypoglycemia

46

anion gap formula

AG = Na - Cl - HCO3

47

calculated osmolarity

= 2 x Na + glucose/18 + BUN/2.8

48

Multi-casualty vs mass casualty event

multi-casualty = 5+ victims
mass casualty = strains the existing EMS system

49

What can different levels of responders do:
first responders?
EMT-B?
EMT-I?
EMT-P?

1st responders: airway clearance, control blood loss, AED, CPR
EMT-B: assessment, spinal immobilization, BVM, defibrillation
EMT-I: pacing, cardioversion, IO, EKG, needle thoracostomy, advanced airway management
EMT-P: arrhythmias, advanced airway management, intubation, cricothyrotomy, meds, fluids

50

Best pressors for shock that is:
1. cold
2. warm
3. normal BP

1. epi
2. norepi
3. dopa

51

CXR findings (measurements) for RPA

prevertebral soft tissue swelling >7mm at C2 or 14mm at C6

52

Lab findings concerning for a pulmonary EXUDATE

WBC >10K
glucose < 50% of serum
protein > 50% of serum
amylase > 200
LDH > 60% of serum
pH < 7.0 (v. suggestive of empyema)

53

EKG findings in pericarditis

widespread ST elevation
PR depression
ST elevation in limb and precordial leads with concave elevations

54

Location for ____ nerve block at wrist:
1) ulnar
2) median
3) radial

1) ulnar - proximal ventral crease at ulnar styloid
2) median - medial tendon of flexor carpi radialis
3) radial - dorsal crease @ radial styloid

55

pressure readings associated with compartment syndrome

>30 mmHg

56

Components of the pediatric trauma score

1. size
2. airway
3. consciousness
4. SBP
5. fractures
6. cutaneous
ranges from -6 to 12
lower the score, the higher the chance of mortality

57

How do you determine size for:
1. ET tube
2. ET tube depth of insertion
3. NG tube size
4. chest tube size

1. ET tube = age/4 + 4
2. ET tube depth of insertion = ETT x 3
3. NG tube size = ETT x2
4. chest tube size = ETT x 4

58

low plasma alanine levels are associated with what IEM?

ketotic hypoglycemia

59

what are treatments for hyperammonemia?

IV arginine
sodium benzoate
phenylacetate
hemodialysis

60

what disease is associated with +reducing substances in the urine, cloudy cornea, and HSM?

galactosemia

61

What is the BP treatment for pheochromocytoma?

phenotalamine 2nd line is CCBs
NO beta-blockers!!!

62

Patient with a PAINFUL Horner's syndrome should make you think of...

carotid artery dissection

63

treatment for HOCM emergency?

B-blockers and CCBs

64

what is the treatment for lichen sclerosis?

topical steroids

65

treatment of prolapsed urethra

topical estrogen

66

treatment for tet spells

morphine (decreases pulmonary venous return, relaxes the infundibulum)
phenylephrine (increases SVR)
sodium bicarb (reduces acidosis)
beta-blockers (relaxes infundibular spasm, decreases inotropic effect)

67

treatment of HOCM?
what should you avoid?

beta-blockers
CCBs
avoid - diuretics and digoxin

68

Criteria for Acute Rheumatic Fever

JONES (major) PEACE (minor)
Joints - arthritis
O - heart - pancarditis
Nodules (subcutaneous
Eythema marginatum
Sydenham chorea

PR prolonged
ESR elevated
Arthralgias (rather than arthritis)
CRP/WBC elevated
Elevated temp >39C
(previous rheumatic fever too)

*Polyarthritis is the most frequently found major criteria
*Dx if 2 major or 1 major + 2 minor
Tx: PCN

69

med to rapidly inhibit release of thyroid hormone in pediatrics

potassium iodide (PTU is contraindicated in kids; methimazole doesn't work acutely)

70

Symptoms of autonomic dysfxn syndrome

tachycardia, tachypnea, diffuse diaphoresis, hyperthermia, hypertension, mydriasis, and dystonia

71

Treatment of autonomic dysfxn/sympathetic storm

bromocriptine, dantrolene, benzodiazepines, clonidine, and narcotics

72

What are the components of Cushing's triad?
What is the earliest and most sensitive indicator?

bradycardia, hypertension, irregular respirations
most sensitive/earliest: bradycardia

73

What are the impt landmarks for IJ venous access?

The medial approach uses the apex of the triangle formed by the sternal and clavicular heads of the SCM.
Best localized with mild hyperextension of the neck.

74

Location for a distal ulnar nerve block?

just proximal to the ulnar styloid process

75

Location for a distal median nerve block?

between the palmaris longus and flexor carpi radialis tendons

76

Nerve block achieved at: between the palmaris longus and flexor carpi radialis tendons

median nerve block

77

Reasons to refer a patient to a burn center (4)

1) partial thickness depth >10% if 20% BSA > 11 years)
2) full thickness depth > 2% BSA
3) high risk for disability or poor cosmetic outcome (e.g., hands, feet, face, circumferential burns and those overlying joints)
4) associated inhalation injury or trauma

78

Parkland Formula

4 x BSA x wt (kg)
Give half in first 8 hours
Give second half in subsequent 16 hours
Does NOT account for maintenance fluids
Should only include partial and full thickness burns in BSA calculation
Only apply if 15% BSA is involved

79

Max dose of bupivicaine

2mg/kg without epi
3mg/kg with epi

80

1% lidocaine is how many mg/ml
0.25% bupivicaine is...

10mg/ml
2.5mg/ml

81

Things that can cause false positive guaiac stools

Horseradish
Turnips
Cherries
Tomatoes

82

Things that can cause red stool that isn't bloody

cefdinir/omnicef
red food dye
licorice
blueberries
spinach
beets
bismuth
iron preparations

83

Most common reason for child to have hypoglycemia?What's low/wrong?

ketotic hypoglycemia
low alanine stores in muscles

84

Distinction between organic acidemias and urea cycles defects?

OA: elevated ammonia and acidotic
UC: VERY high ammonia (1000s) and usually NOT acidotic; low BUN, nml lactate, encephalopathy

85

IEM mimic of child abuse with macrocephaly, chronic subdural effusions?
How to diagnose?

glutaric acidemia type I
dx with urine organic acidsdx usually made during crises (intercurrent illnesses) with metabolic acidosis, hyperammonemia and encephalopathy.

86

Lab that is usually diagnostic for CAH

17-hydroxyprogesterone (17-OHP)

87

IEM associated with reducing substances in urine?

galactosemia

88

Management of Kawasaki when acute?
When convalescent?

Acute: IVIG, high dose ASA
Conv: low dose ASA (3-5mg/kg/day)

89

Management of dry gangrene in scleroderma

tx with systemic or topical nitro; or CCBs

90

How do you calculate sodium deficit?

Figure out the volume deficitNa/1000 x 0.6 x volume deficit

91

Labs in RTA type IV

hyperkalemic, hyperchloremic, metabolic acidosis with normal AG

92

Winter's Formula

PCO2 = 1.5 x HCO3 + 8 +/- 2
explains what the appropriate CO2 response should be to metabolic acidosis

93

Symptoms of scorpion sting

local pain, restlessness, hyperactivity, roving eye movements, and respiratory distress. More severe signs include seizures, drooling, wheezing, hyperthermia, cyanosis, GI hemorrhage, respiratory distress and death from shock or respiratory paralysis

94

Envenomation associated with metallic taste

rattlesnake

95

systemic symptoms of brown recluse spider bite

fever, chills, malaise, weakness, nausea, vomiting, joint pain, petechial morbilliform rash, intravascular hemolysis, hematuria, and renal failure

96

what do you need to avoid when treating a patient with ciguatera poisoning?

opioids - may interact with toxin and cause hypotension

97

order of tissues with resistance to electricity

Bone > fat > tendon > skin > muscle > nerve.

98

when should you consider active rewarming measures

cardiovascular instability, T < 32ºC, or inadequate response to passive re-warming methods

99

how do you grade frostbite injuries?

1st degree- numbness and erythema with no tissue loss
2nd - superficial blistering, with clear to milky fluid, surrounded by edema and erythema
3rd - deeper blisters with blood containing fluid (leave blisters alone)
4th - affects muscle and bone.

100

in hypothermia, resuscitate to at least what temperature

The patient should be resuscitated until a body temperature of 32 – 34ºC

101

Symptoms of lithium toxicity

coarse tremor, ataxia, dysarthria, vomiting, diarrhea, cardiovascular changes and renal dysfunction. Later signs: impaired consciousness, muscle fasciculations, myoclonus, seizures, coma and death.

102

Best med for an agitated (possibly delirious) child?

haldol
NOT BDZs (could loosen inhibitions or worsen delirium)

103

What are the different levels of sedation?

Minimal - respond normally to verbal commands and not asleep.
Moderate - does not need repeated painful stimulation to be aroused and should not require intervention to maintain a patent airway.
Deep sedation - patient cannot be easily aroused but respond purposefully after repeated verbal or painful stimulation; ability to independently maintain ventilatory function may be impaired.
General anesthesia is not arousable, even by painful stimulation.

104

What are the ASA classifications?

I - normal, healthy patient
II - mild systemic illness without functional limitation
III - severe systemic disease with definite functional limitation
IV - severe systemic disease that is a constant threat to life
V - moribund patient who is not expected to survive without the procedure

105

Epi dose for bradycardia in neonatal resuscitation

0.01 mg/kg of 1:10,000

106

How do you differentiate between main types of neonatal conjunctivitis?

Gonococcal - 3-5 days after birth.
Chlamydial - 5- 14 days after birth.
Negative gram stain (obligate intracellular parasite) Non-gonococcal, non-chlamydial bacterial - after the first 2 weeks of life.
Chemical (due to silver nitrate prophylaxis) - first day of life and resolves in 2-4 days.

107

Symptoms of morning glory intoxication?

mydriasis, hyper or hypothermia, perspiration, bronchorrhea and increased salivation

108

What's the difference between:
boutonniere deformity
swan neck deformity
hammer/mallet finger

boutonniere - flexed PIP, extended DIP
swan neck - extended PIP, flexed DIP
hammer - flexed DIP due to rupture of extensor digitorum tendon

109

Fruity odor, ingestion with no acidosis, but +osmolar gap?

isopropyl alcohol (odor is from acetone metabolic byproduct)

110

How often do physically restrained patients need their restraints renewed according to JACHO?

< 9 years - every hour
9-17 years - every 2 hours
adults - every 4 hours.
Patients must be evaluated, face-to-face, by the physician ordering the restraints within 1 hour of placing the order.

111

Findings in cardiac tamponade

Beck's triad: hypotension, muffled heart sounds, and distended neck veins
Low QRS voltages in all leads
Electrical alternans in precordial leads

112

What is the dose for naloxone?

0.1mg/kg

113

x-ray findings in RPA

>7mm at C2
>14mm at C6

114

EKG findings in pericarditis

An ECG will demonstrate changes of epicardial inflammation with widespread ST elevation, PR depression, ST elevation in limb and precordial leads. The elevations are concave.

115

treatment of malignant hyperthermia

dantrolene

116

Treatment of labial adhesions?
Treatment of urethral prolapse?
Treatment of lichen sclerosis?

1st line: topical estrogen cream; 2nd line: topical steroids
topical estrogen
topical steroids

117

medical treatment of phimosis

topical steroids

118

epi dosing for anaphylaxis

1:1000 epi
0.01 mg/kg
0.01 ml/kg

119

epi dosing for codes

1:10,000
0.01 mg/kg
0.1 ml/kg

120

management of frenulum lacerations

expectant - do not suture as they heal spontaneously

121

With regards to hemothorax, what amount of bloody output should trigger operative management?

Immediate return of 1500mL or 10-15ml/kg
>200ml/hr or 2-4ml/kg/hr of bloody drainage

122

Immediate treatment of commotio cordis?

defibrillation

123

What qualifies for a positive DPL?

free aspiration of gross blood, gastrointestinal contents, vegetable fibers or bile through the lavage catheter upon entering the abdominal cavity
presence of ≥100,000 RBC/mm3
≥500 WBC/mm3
bacteria on Gram stain of the lavage fluid.

124

Malaria mimic seen in New England?
Transmission?
How do you diagnose it?
Treatment?

Babesiosis
Ixodes tick
dx with thick and thin smears (like malaria); may see the Maltese cross
atovaquone + azithromycin OR clinda + quinine

125

Cutaneous ulcer OR purulent conjunctivitis with preauricular lymph nodes should make you think of this disease:

tularemia

126

Bloody diarrhea infectious agent associated with vaginitis?

Shigella

127

Bloody diarrhea infectious agent associated with bandemia on CBC?

Shigella

128

treatment of Shigella dysentery?

5d of azithro; can also do bactrim, 3rd gen cephalosporin, fluoroquinolones

129

infectious diarrhea agent to treat with antibiotics?

Shigella

130

tx for tularemia

streptomycin, gentamicin, doxycycline, cipro

131

responsible organism in Lemierre's disease?
treatment?

Fusobactermium necrophorum
unasyn

132

Pt with fever, PNA, endocarditis, flu-like symptoms.
Dx?
Tx?

Q-fever (Coxiella burnetti, rickettsial organism)
tx with doxy, fluoroquinolone

133

Treatment for cat scratch dz

Can usually observe, but if abx desired, try azithromycin to reduce duration of lymphadenopathy
Can also try rifampin, bactrim, and cipro

134

formula for NNT

NNT = 1/ARR
ARR = absolute risk reduction

135

type I error

rejecting the null hypothesis when it's actually correct
false positive study
alpha

136

type II error

failure to reject the null hypothesis appropriately
false negative study
beta

137

failure to reject the null hypothesis appropriately

type II error

138

rejecting the null hypothesis when it's actually correct

type I error

139

What 3 factors do you need to look at to determine the appropriate type of statistical test to perform?

1. is the distribution parametric or not?
2. is your data continuous, nominal/ordinal, or categorical?
3. are your tested populations dependent or independent?

140

Sensitivity =

TP / TP+FN

141

Specificity =

TN / TN+FP

142

Power

1 - beta
beta = type II error rate

143

PPV =

TP / TP+FP

144

NPV =

TN / TN+FN

145

Incidence vs Prevalence

Incidence = RATE of new diseases over a period of time
Prevalence = number of existing disease cases at a specific POINT in time

146

What do you need to calculate the sample size for a study?

1. the effect size
2. the type I error rate
3. the type II error rate

147

what is the reciprocal of the rate difference?

the NNT

148

What is the other name for the Mann-Whitney U test?

Wilcoxon rank-sum test

149

What is another name for the Wilcoxon rank-sum test?

Mann-Whitney U test

150

What is the t-test?

statistical test for parametric, continuous data that is independent

151

what is the paired t-test?

statistical test for parametric, continuous data that is paired

152

what is the ANOVA?

statistical test for parametric, continuous data with 3 or more independent groups

153

what is the wilcoxon signed-rank sum test?

statistical test for non-parametric, continuous data that is paired
non-parametric corollary to paired t-test

154

what is the wilcoxon ranked-sum test?

statistical test for non-parametric, continuous data that is independentnonparametric corollary to t-testalso called the mann-whitney u test

155

what is the kruskal-wallis?

statistical test for non-parametric, continuous data with 3 or more independent groupsnonparametric corollary to ANOVA

156

what is the Chi-square test?

statistical test for parametric, categorical data with independent groups

157

what is the Fisher's exact test?

statistical test for parametric, categorical data with independent groups if there are <5 measurements/group

158

what is logistic regression?

statistical test to predict the relationship between a DICHOTOMOUS outcome vs a set of variables while controlling for other variables in the analysis

159

what is Bonferroni's correction

a method to correct for multiple repeated testing on the same data set

160

what is Kolmogorov-Smirnov?

test to determine if data is parametric or not

161

what is Shaprio-Wilk?

test to determine if the data is parametric or not

162

formula for odds ratio

(AxD)/(BxC) in standard 2x2 table

163

what's the difference between odds ratio and relative risk?

relative risk is used when patients are followed over time.
odds ratio is used when patients already have the outcome and you look back retrospectively at an exposure of interest

164

In treating hypothermia, at what temperature should you initiate resuscitation meds and defibrillation attempts?

T > 30C

165

What are treatments for high altitude pulmonary edema? (4)

descent
acetazolamide
dexamethasone
nifedipine

166

pressor to use in heat stroke

dobutamine - supports BP and HR while keeping vessels dilated for heat dissipation

167

radiopaque toxins (5)

***COINS***
1. chloral hydrate
2. opiate packets
3. iron and Hg, As, Li
4. neuroleptics
5. SR/enteric coated meds

168

poisonings that activated charcoal won't work for (3)

ions/metals
acids/bases
alcohols

169

toxin that smells like rotten eggs

hydrogen sulfide

170

Morning Glory poisoning symptoms

hallucinations, mydriasis, perspiration, bronchorrhea, salivation, hyper or hypothermia, diarrhea

171

Treatment to reduce thyroid uptake of radioactive iodine?

Potassium iodine

172

Fish associated with scombroid poisoning?

tuna, mackerel, bonito, mahi-mahi, bluefish, sardines, anchovies

173

Fish associated with cigautera poisoning?

barracuda, snapper, grouper, amberjack, moray eels, triggerfish, parrotfish

174

bidirectional v tach is pathognomic for what toxicity?

digoxin toxicity

175

what is unique about digoxin toxicity related hyperkalemia?

do NOT give calcium - it can cause a "stone heart" from excessive intracellular calcium and cardiac tetany

176

what is the treatment for digoxin toxicity?

atropine
digiFab
mag, potassium
consider PHYT, lidocaine

177

treatment for cesium radiation poisoning

prussian blue

178

EKG findings in TCA OD

sinus tach, prolonged PR, QRS, and QT intervals

179

Symptoms of scorpion sting

local pain, restlessness, hyperactivity, roving eye movements, and respiratory distress.
More severe signs include seizures, drooling, wheezing, hyperthermia, cyanosis, GI hemorrhage, respiratory distress and death from shock or respiratory paralysis

180

envenomation associated with metallic taste

rattlesnake

181

systemic symptoms of brown recluse spider bite

fever, chills, malaise, weakness, nausea, vomiting, joint pain, petechial morbilliform rash, intravascular hemolysis, hematuria, and renal failure

182

toxic dose of acetaminophen?

150mg/kg in adults
200-250mg/kg in kids

183

toxicity of ethelyne glycol vs methanol?

ethylene glycol: metabolized into oxalic acid, will crystals in urine and possible ARF
methanol: metabolized into formic acid, injures the eyes

184

normal serum osmolality

285-295

185

treatment of organophosphate poisoning

atropine if wet/killer Bs
pralidoxime for for weakness (works at nicotinic skeletal muscle receptors)

186

Coral snake vs king snake?

red on black, venom lack;
red on yellow, kill a fellow.

187

ricin poisoning

inhalational: sudden onset of fever, chest tightness, cough, dyspnea, nausea, and arthralgias, progressing to cyanosis, pulmonary edema and respiratory failure

188

Tularemia: symptoms and treatment

fever, malaise, pneumoniatx: streptomycin

189

aerosolized toxin that smells of "newly mown hay"?
symptoms?

phosgene - ocular and nasal irritation, resp symptoms

190

inhalational anthrax - presentation

initial mild symptoms followed by abrupt onset resp distress, cyanosis, diaphoresis 1-6 days later. may see widened mediastinum on CXR.

191

inhalational anthrax ppx

cipro or doxy

192

staph enterotoxin b symptoms

sudden onset of fever, chills, headache, myalgias and nonproductive cough

193

pneumonic plague symptoms

The initial presentation includes respiratory symptoms, fever, cough and myalgia. The clinical course is rapidly progressive with bloody sputum, dyspnea, cyanosis, circulatory collapse and a bleeding diathesis.

194

The initial presentation includes respiratory symptoms, fever, cough and myalgia. The clinical course is rapidly progressive with bloody sputum, dyspnea, cyanosis, circulatory collapse and a bleeding diathesis.

pneumonic plague

195

toxin with sudden onset of fever, chills, headache, myalgias and nonproductive cough

staph enterotoxin b

196

initial mild symptoms followed by abrupt onset resp distress, cyanosis, diaphoresis 1-6 days later. may see widened mediastinum on CXR.

inhalational anthrax

197

bitter almond odor is associated with this toxin

cyanide

198

treatment of plagueppx?

tx: doxy or streptomycinppx: doxycycline

199

ingestions where multidose activated charcoal may be helpful?

phenobarbital, carbamazepine, theophylline, and dapsone

200

carbamezepine toxicity

can cause resp compromise, altered mental status, vomiting, drowsiness, slurred speech, nystagmus, hallucinations, hypotension, coma, dystonic reactions, seizures has some anticholinergic properties false positive for TCAs on UDS

201

symptoms and management of hydrofluoric acid burns?

used in glass etching, metal cleaning, and electronics manufacturinghypocalcemia, hypomag, and hyperkalemiatreat with topical, intra-arterial, IV calcium gluconate

202

IV Meds to Tx HTN Emergency (4)

1. labetalol 0.2-1mg/kg
2. nitroprusside gtt
3. nicardipine gtt
4. fenoldapam

203

HOCM murmur

systolic murmur that gets louder with valsalva or standing from squatting

204

DDx of Late Pregnancy Bleeding? (3)
What do you do?

DDx: placenta previa, placental abruption, preterm labor
Actions: get OB STAT and don't do a pelvic

205

Management Options for Laryngospasm (5)

-reposition airway
-give sustained BVM pressure/PEEP
-stimulate "laryngospasm notch" (behind the earlobe, the soft area between the skull base, mastoid bone, and mandible)
-sux 0.1-0.2mg/kg
-propofol 0.5-1mg/kg

206

If you see metabolic acidosis + respiratory alkalosis, you should think of this poisoning

salicylate poisoning

207

characteristic EKG finding of hypothermia

J-waves/Osborn waves

208

treatment of adrenal crisis

1-2mg/kg of hydrocortisone

209

meds to acutely treat thyroid storm (4)

1. propanolol
2. iodide/lugols
3. methimazole
4. steroids

210

Patient comes in with occipital HA associated with ataxia/vertigo, dysarthria with short period of LOC. Symptoms resolve after emesis. What less scary dx should you think of?

basilar artery migraine

211

zones of the neck

3. angle of mandible to base of skull
2. cricoid to angle of mandible
1. cricoid to clavicles/thoracic inlet

212

Patient with alkaline serum but aciduria - what is this???

paradoxical aciduria secondary to potassium depletion

213

Cutaneous ulcer OR purulent conjunctivitis with preauricular lymph nodes should make you think of this disease:

tularemia

214

toxin that smells like almonds

cyanide

215

toxin that smells like garlic

arsenic

216

toxic alcohol resulting in large ketosis

isopropyl alcohol

217

penile fracture is disruption of what?

tunica albuginea/corpus cavernosa

218

presentation of CN III palsy

"down and out" eye
b/c parasympathetics ride on CN III, may also see ptosis and mydriasis

219

When is TIG needed for tetanus wound ppx?

If it's a dirty wound and the pt has less than 3 doses of tetanus vaccine

220

What should you ask the laboring mother in the ED before delivery of her baby?

1. due date
2. number of babies in utero
3. meconium stained fluid?
4. PNC/STIs

221

How do you treat tetanus after development of symptoms?

flagyl, wound care, TIG

222

DDx of non-anion gap metabolic acidosis

Hyperalimentation
Acetazolamide
RTA
Diarrhea
Ureteroenteric fistula
Pancreaticoduodenal fistula
* also spironolactone

223

ehrlichiosis - presentation and tx

presents like RMFS
get treated the same with doxy!

224

toxins causing miosis

COPS
cholinergics/clonidine
opiates
phenothiazines
sedatives

225

treatment for anthrax, plague, and tularemia?

cipro or doxy

226

WMD with non-specific flu like illness without rhinorrhea

anthrax

227

WMD with significantly tender regional LAD

plague (buboes)

228

WMD with classic clinical finding of blood-streaked sputum

plague

229

WMD gram negative coccobacillus

Tularemia

230

WMD with rapid onset (3-12hrs) fever, HA, chills, myalgias, and cough

Staph enterotoxin B

231

nerve agents

sarin and venom x (VX)
act as organophosphates

232

when are you most likely to see the most severe effects of acute radiation syndrome?

~30 days after exposure

233

what is the first cell line to decrease in response to radiation?

lymphocyte count
good prognosticator for severity of acute radiation syndrome

234

BLS vs ALS ambulances

BLS: BVM, OP, NP, bulb suction, regular suction, immobilization (backboard and c-spine), splints, bandages, obstetric kits, extrication materials

ALS: defibrillator, EKG, intubation equipment, NG, IV/IO, meds

235

pt has low calcium, high phos
dx?

primary hypoparathyroidism

236

pt has low calcium, low phos
dx?

vitamin D deficiency

237

differentiation between torticollis and rotary subluxation?

torticollis - muscles spasm of SCM OPPOSITE the side the chin points to
rotary subluxation - muscle spasm of SCM on the SAME side the chin points to; seen with trauma, URIs, or spontaneous

238

Neonatal ETT sizes

2.5 = < 1000g, 3000g, >38wks