Emergency Medicine EOR Flashcards
(431 cards)
1
Q
Shoulder impingement syndrome is caused by compression of the tendon of what muscle?
A
Supraspinatus
2
Q
What physical exam special test finding is most consistent with shoulder impingement syndrome?
A
A positive hawkins-kennedy test
3
Q
How is the Hawkins-Kennedy test preformed?
What is a positive test?
A
- Stabilize shoulder
- Flex elbow 90 degrees
- Internally rotate shoulder
Positive test = pain with internal rotation
4
Q
What is the most common risk factor for shoulder impingement syndrome?
A
Repetitive overhead activity
5
Q
Treatment for shoulder impingement syndrome?
A
Rest, ice, NSAIDs, physical therapy
6
Q
A positive O’Brien test indicates an injury where?
A
Superior labrum anterior and posterior tear
7
Q
What indicates a positive O’Brien test?
A
While shoulder is flexed to 90 degrees, pain with downward pressure while internally rotated, and relief of pain with downward pressure while externally rotated.
8
Q
A Speed test is used to evaluate for what injury?
A
Bicipital tendinitis
9
Q
What is a Homans test used to evaluate?
A
For DVT
10
Q
Which rotator cuff muscle is most commonly injured, inflamed, or torn?
A
The supraspinatus muscle.
11
Q
What is the classic triad of symptoms for bacterial meningitis?
A
Fever, confusion, neck stiffness.
12
Q
What are the most common causative agents of bacterial meningitis in adults?
A
Strep pneumo and Neisseria meningitidis
13
Q
What are the typical CSF analysis results in bacterial meningitis?
A
Cloudy/purulent fluid CSF glucose <40% of serum glucose WBC count >1000, predominantly polymorphonucleocytes (PMNs) Elevated opening pressure Increased protein level
14
Q
What is a normal opening pressure for a lumbar puncture?
A
6-20
15
Q
How would you expect CSF analysis results to differ in mycobacterium tuberculosis meningitis or fungal meningitis when compared to strep pneumo meningitis?
A
TB meningitis and fungal meningitis should have similar results, but cell count is typically lower, between 10-1000 cells/microL, with a predominance of lymphocytes rather than PMNs
16
Q
What CSF analysis results would you expect in viral meningitis?
A
Clear fluid appearance
Normal-slightly elevated opening pressure
WBC count 25-2000 with lymphocyte predominance
Elevated protein
CSF glucose >60% serum glucose
17
Q
Why is dexamethasone administered with antibiotics for suspected meningitis?
A
Decrease in mortality and long-term morbidity (e.g. hearing loss).
18
Q
What two physical exam findings would you expect to be positive in a patient with meningitis?
A
Brudzinski's sign (neck) Kernig sign (Knee)
19
Q
What causative agent of meningitis should you have concern for in HIV patients?
A
Cryptococcus
20
Q
What is the empiric treatment for bacterial meningitis in a 18-50 year old patient?
A
Ceftriaxone + vancomycin
21
Q
What is the empiric treatment for bacterial meningitis in a >50 year old patient?
A
Ceftriaxone + vancomycin + ampicillin (to cover Listeria)
22
Q
Which are painful, internal or external hemorrhoids?
A
External (below dentate line)
23
Q
What patients with thrombosed external hemorrhoids are good candidates for hemorrhoid excision?
A
Patient with acute (less than 48 hours) sever symptoms in otherwise healthy patients?
24
Q
What patients should not have thrombosed hemorrhoids excised in the ED?
A
Immunocompromised patients, pregnant patients, patients with coagulopathies, and patients with symptoms >48 hours.
25
What type of excision should be made to remove a thrombosed hemorrhoid?
Elliptical incision
26
If a patient is not a good candidate for excision of a thrombosed hemorrhoid, what is the recommended treatment?
Stool softeners, sitz baths, PCP follow up.
27
How is rectal bleeding associated with hemorrhoids typically described?
Limited, at the end of defecation, either dripping into the bowl or on tissue paper.
28
What is the most consistent finding in patients with cauda equina syndrome?
Urinary retention
29
What imaging should you order emergently for patients you suspect cauda equina syndrome?
MRI
30
What is the treatment for cauda equina syndrome?
emergency surgery
31
What is the treatment for cauda equina syndrome secondary to a malignancy?
Emergent radiation therapy.
32
What is the reversal agent for warfarin?
Vitamin K
33
What is the INR goal for DVT prevention?
2-3
34
For a patient with an INR of 12, with no bleeding, what is the treatment?
Oral vitamin K, hold next warfarin dose, repeat labs in 24-48 hours.
35
What is the treatment for a patient with an INR of 8, with no bleeding?
Hold warfarin, no vitamin K necessary.
36
What is the pharmacologic treatment for a patient on warfarin with any INR, who has serious bleeding?
Four-factor prothrombin complex concentrate (4-factor PCC)
IV vitamin K
Hold warfarin
37
What blood product may be used to reverse warfarin?
Fresh frozen plasma.
38
A patient suspected of acute coronary syndrome has an elevated troponin without ST segment changes or T wave abnormalities. They have been given nitroglycerin, aspirin, an IV, and are being prepared for PCI. What other medication do they still need?
Ticagrelor (which is a P2Y12 adenosine diphosphate platelet receptor antagonist (P2Y12 antagonist))
39
Why is ticagrelor preferred over other P2Y12 anatagnoists such as clopidogrel or prasugrel in patients with ACS?
Studies have shown that it provides faster, greater, and more consistent ADP receptor inhibition
40
What is the dose of Ticagrelor that should be given for ACS?
180mg by mouth
41
What type of medication is tenecteplase?
A tissue plasminogen activator variant
42
When should Tenecteplase be given for ACS?
If PCI is thought to be longer than 120 minutes from first medical contact.
43
What are two modalities to evaluate for low-probability (patients with normal cardiac serum biomarkers and no acute ischemic ECG changes) ACS?
CT coronary angiography and nuclear medicine testing
44
What antiplatelet agent should be given to patients with ACS who have a true aspirin allergy?
Clopidogrel.
45
What is the pathophysiological of the disease process causing PSGN?
Immune complex deposition
46
How long after a strep infection does PSGN usually present?
2 weeks
47
What are the classic symptoms of PSGN?
HTN, edema, tea-colored urine or foamy urine
48
Urinalysis often shows what in PSGN?
Red blood cell casts and proteinuria
49
Do antibiotics help lower the incidence of poststreptococcal glomerulonephritis?
No.
50
What is the treatment for PSGN?
Supportive measures including salt and water restriction, furosemide if edema and HTN are present
51
What are the two most common risk factors for small bowel obstructions?
Adhesions from previous surgery
Cancer
52
What is the preferred imaging modality to diagnose a SBO?
CT
53
What is the most common cause of large bowel obstruction?
Neoplasm.
54
What is common to see on abd x-ray in a SBO?
Dilated bowel, air fluid levels, stack of coins or string of pearls sign.
55
Treatment for SBO?
NGT, surgery
56
What is the cause of a bowing fracture?
| What is the treatment?
Cause: Longitudinal compression
Tx: Ortho consult
57
What is the cause of a greenstick fracture?
| What is the treatment?
Cause: Axial compression with twisting
Tx: Casting and reduction
58
What is the cause of a Torus (Buckle) fracture?
| What is the treatment?
Cause: axial compression
Tx: casting
59
What are two treatment options for acute uncomplicated cystitis?
TMP-SMX or nitrofurantoin x 3-5 days
60
What are the treatment options and duration for acute uncomplicated cystitis with comorbid conditions?
TMP-SMX or nitrofurantoin or a fluoroquinolone x 7 days
61
What is the treatment for acute cysitis in men?
TMP-SMX or nitrofurantoin x 7 days or a fluoroquinolone x 5 days
62
Why is asymptomatic bacteriuria treated in pregnant women?
It has been linked to increased risk of low birth weight infants as well as pyelonephritis in mothers.
63
What is the outpatient treatment for acute uncomplicated pyelonephritis?
Fluoroquinolone (I dont really know if someone does LMK)
64
The diagnosis of DKA can be made with the presence of what three findings?
Hyperglycemia, ketosis, and acidemia.
65
What are the three aims of treatment for DKA?
Insulin therapy, fluid resuscitation, and electrolyte replacement.
66
What electrolyte abnormality is typically found in DKA?
Hyperkalemia
67
Why should you give potassium to patients being treated for DKA?
Potassium levels decrease significantly as acidemia is corrected
68
What is the term for deep and labored breathing seen in patients with diabetic ketoacidosis?
Kussmaul respirations.
69
What are the 5 I's that can cause DKA?
Infection, Ischemia (cardiac, mesenteric), Infarction, Insulin deficit (poor control), Intoxication.
70
What are the symptoms of DKA?
Abd pain, vomiting, fatigue.
71
What is temporal arteritis associated with?
polymyalgia rheumatica
72
What are the symptoms of polymyalgia rheumatica?
Anorexia, headache, jaw claudication, and fever.
73
What is the gold standard for dx of temporal arteritis?
Temporal artery biopsy
74
What is the treatment for temporal arteritis?
Corticosteroid treatment
75
What is another large-vessel vasculitis aside from giant cell (or temporal) arteritis?
Takayasu arteritis.
76
What lab finding is common in temporal arteritis?
Elevated ESR
77
What are the 6 different types of abortion?
Threatened, inevitable, incomplete, compete, missed, and septic.
78
The cervical os is open during what types of spontaneous abortion?
Inevitable, incomplete, and septic.
79
What is the most common pathogen responsible for septic abortion?
Staph aureus
80
What is the treatment for septic abortion?
evacuation of uterine contents as well as antibiotics (ampicillin-sulbactam or clindamycin + gentamicin)
81
Carpospasm while checking blood pressure is known as what sign?
Trousseau sign
82
What does Trousseau sign indicate?
Hypocalcemia
83
What sign other than Trousseau sign indicates hypocalcemia?
Chvostek sign
84
Describe a positive Chvostek sign.
Contraction of the ipsilateral facial muscles elicited by tapping the facial nerve just anterior to the ear.
85
What electrolyte abnormality can cause hemodynamic instability during massive transfusion protocol?
Hypocalcemia. Calcium levels can drop precipitously during transfusion secondary to the citrate present in packed red blood cells.
86
What ECG findings are associated with pericarditis?
Diffuse ST elevation with reciprocal ST depression in leads aVR and V1.
87
Describe the pain associated with pericarditis.
Sharp, pleuritic chest pain that is relieved by sitting up and leaning forward.
88
What is the treatment for pericarditis?
NSAIDs, cholchicine, and steroids for refractory cases.
89
What viruses commonly cause pericarditis?
Coxsackie viruses A and B, echovirus, adenovirus, HIV, Epstein-Barr virus, influenza, and hepatitis B.
90
What is the initial monotherapy for a low back strain?
NSAIDs or acetaminophen
91
What is the second line combination therapy for low back strains?
NSAIDs and muscle relaxants.
92
How does the back pain of a herniated disc present?
Electrical pain that radiates down the back of the leg.
93
What is the most common type of mesenteric ischemia?
Arterial embolism
94
What is the gold standard imaging for diagnosis of mesenteric ichemia?
Mesenteric CT angiography
95
How long after the onset of bowel ischemia does complete transmural necrosis complete?
Six hours.
96
What physical exam findings would give you concern for mesenteric ischemia?
Pain out of proportion to exam
97
What history findings with abdominal pain point towards mesenteric ischemia?
History of dysrhythmias, recent MI, CAD, valvular heart disease, prior thromboembolic events, hypercoagulable states, heart failure.
98
What lab finding is common in mesenteric ischemia?
Lactic acidosis
99
What is the difference between relative and absolute polycythemia?
Relative polycythemia is due to a decrease in plasma volume, commonly caused by dehydration or excessive diuresis.
Absolute polycythemia is an increase in RBC mass.
100
What is the difference between primary and secondary absolute polycythemia?
Primary is due to mutation in erythroid cell lines or EPO receptors.
Secondary is due to increased levels of circulating EPO.
101
How is polycythemia vera classified?
Polycythemia vera is an absolute primary polycythemia.
102
What gene mutation is associated with polycythemia vera?
JAK2 gene mutation
103
What are the classic symptoms of polycythemia vera?
Pruritis, particularly when exposed to hot water, and early satiety.
104
What is the name of the most life threatening complication of polycythemia vera?
Hyperviscosity syndrome
105
What is the triad of symptoms associated with hyperviscosity syndrome?
Vision changes, bleeding, and focal neurologic deficits.
106
Name some physical exam findings consistent with polycythemia vera.
Splenomegaly, plethoric facies, flushed skin, nail clubbing, and distal cyanosis.
107
What is the treatment for polycythemia vera?
low-dose aspirin and therapeutic phlebotomy.
Other treatments include ruxolitinib (a JAK1 and JAK2 inhibitor.)
108
What is the treatment for hyperviscosity syndrome?
IV fluid hydration and hematology consult.
109
What is the term for pruritis following a warm bath of shower?
Aquagenic pruritis
110
What is a leukemoid reaction?
Significant leukocytosis (50,000/μL) in the absence of hematologic malignancy.
111
How can you differentiate an ischemic priapism from a nonischemic priapism?
A nonischemic priapism is painless, and the glans is hard.
An ischemic priapism is painful, and the glans is soft. The blood gas has a pH <7.25, pCO2>60 and pO2<40.
112
What is the treatment for an ischemic priapism?
Corporal aspiration with intracavernosal phenylephrine
113
What is the initial treatment of ischemic priapism in patients with sickle cell disease?
Initial treatment is the same with aspiration and intracavernosal phenylephrine.
114
What type of leukemia are the following cells found in:
Auer rods
Smudge cells
Philidelphia chromosome
Auer rods = AML (ask me later, in an auer)
Smudge cells = CLL (the sound it would make if you rolled the car window down with your face pressed against it, and it would leave a smudge)
Philidelphia chromosome = CML (Check My Location)
115
What is a risk factor for development of CML?
Exposure to ionizing radiation.
116
Is a spontaneous pneumothorax more common in males or females?
Males:Females = 3:1
117
What sign seen on supine chest XR is indicative of pneumothorax?
Deep sulcus sign (profound lateral costophrenic angle)
118
Where should a tube thoracostomy be inserted?
Fourth or fifth intercostal space, above the rib, midaxillary line (usually coincides with nipple line).
119
What physical exam findings may be present in a spontaneous pneumothorax?
Decreased breath sounds, decreased fremitus, and hyperresonance to percussion
120
What antibiotic is first line treatment for mastitis?
Dicloxacillin
121
What is the treatment for a breast abscess?
Antibiotics and ultrasound-guided needle aspiration.
122
Should patients with mastitis continue breast feeding?
Yes, it helps avoid progression to abscess.
123
What are the symptoms of autoimmune hemolytic anemia?
Most often just fatigue and pallor after exposure to a medication or viral infection.
124
What is the treatment for autoimmune hemolytic anemia?
Glucocorticoids
125
Which class of medications is the most common cause of drug-induced immune hemolytic anemia?
Cephalosporins.
126
What condition is Lhermitte sign seen in?
Multiple sclerosis
127
What are the symptoms of optic neuritis?
Painful vision loss
128
What is the treatment for an acute exacerbation of multiple sclerosis?
High dose steroid such as methylprednisolone
129
In what condition can ophthalmoplegia be seen in an alcoholic?
Wernicke encephalopathy.
130
CSF analysis showing oligoclonal IgG bands supports what diagnosis?
Multiple sclerosis
131
What brain MRI findings support a diagnosis of MS?
Periventricular white matter lesions
132
Each unit of packed red blood cells raises hemoglobin by ____ and hematocrit by _____.
Each unit of packed red blood cells raises hemoglobin by 1g/dL and hematocrit by 3%.
133
For most patients, transfusion should be initiated for hemoglobin less than ___.
7g/dL
134
A unit of platelets will increase a patients platelet count by approximately how much?
50,000/microL
135
What is the appropriate ratio of red cells, platelets, and plasma in a massive transfusion protocol?
1:1:1.
136
Relief of pain associated with elevation of the affected testicle is known as what sign?
Phren sign
137
What is Phren sign associated with?
epididymitis
138
Where is pain typically located in epididymitis?
The posterolateral aspect of the testicle
139
What is the treatment for epididymitis in patients who do not have high risk sexual behavior?
A fluoroquinolone such as levofloxacin.
140
What is the treatment for epididymitis in patients with high risk sexual behavior?
Ceftriaxone and doxycycline
141
What is the first line medication for septic shock with hypotension?
Norepinephrine is the first line vasopressor
142
What does a plethoric inferior vena cava on ultrasound indicate in the setting of septic shock?
It means that the patient would not benefit from additional fluids
143
What is the first-line vasopressor or inotropic agent of choice for cardiogenic shock?
Norepinephrine. Although norepinephrine acts primarily on the vasculature to increase vascular tone, it is still the first recommended agent for cardiogenic shock.
144
What type of cord injury is characterized by complete loss of motor, pain, and temperature below injury, but retained proprioception and vibratory sensation?
Anterior cord syndrome
145
What are the most common mechanisms of injury for anterior cord syndrome?
Hyperflexion or vascular injuries
146
What cord syndrome is characterized by sensory and motor deficits greater in the upper extremities than the lower extremities?
Central cord syndrome
147
What is the most common mechanism of injury to cause central cord syndrome?
Forced hyperextension
148
What cord syndrome is characterized by ipsilateral loss of motor, vibratory sensation, and proprioception with contralateral loss of pain and temperature sensation?
Brown-Sequard syndrome
149
What is the most common mechanism of injury causing Brown-Sequard syndrome?
Penetrating trauma
150
What are the National Emergency X-Radiography Utilization Study (NEXUS) criteria for not obtaining imaging of the cervical spine in blunt trauma?
Imaging may be avoided if the patient does not have cervical midline tenderness, focal neurologic deficit, altered mental status, intoxication, or a distracting injury.
151
What is clicking rib syndrome?
A lower rib pain syndrome characterized by lower rib pain at the costal margin that is reproducible with palpation.
152
What signs and symptoms associated with chest pain are positive likelihood ratios for chostochondritis?
Pain worsens with breathing, movement, and horizontal arm flexion (crowing rooster maneuver).
Pain reproducible with palpation over the costochondral junctions
153
Papillary muscle rupture is associated with what type of MI?
Inferior MI
154
How long after MI do symptoms of papillary muscle rupture present?
3-5 days after infarction
155
What valvular disease occurs secondary to papillary muscle rupture?
Mitral regurgitation
156
What are the symptoms of mitral regurgitation?
Pulmonary edema, dyspnea, heart failure, and even cardiogenic shock.
157
What is the name of the tendinous structures that connect the mitral valve leaflets to the papillary muscle?
Chordae tendinae.
158
What shoulder injury presents with a "squared off" shoulder, slight shoulder abduction, and external rotation?
Anterior shoulder dislocation
159
What is a Hill-Sachs Lesion?
Posterolateral humeral head compression fracture
160
What is a Bankart lesion?
An avulsion of the glenoid labrum
161
Which nerve is most commonly injured in shoulder dislocations?
Axillary nerve.
162
What is the first line treatment for acute bacterial sinusitis?
Augmentin 875/125 BID
163
What is the first line pharmacotherapy and dose for SVT?
Adenosine 6mg rapid bolus, followed by 12mg if first dose is unsuccessful
164
What is the most common cause of a pleural effusion in a patient residing in a developing nation?
Tuberculosis.
165
Does pleural effusion cause increased or decreased tactile fremitus?
Decreased
166
What is the classic EKG finding of pericardial effusion?
Electrical alternans
167
What is the definitive therapy for pericardial effusion with tamponade?
Pericardiocentesis
168
What is the triad of symptoms associated with pericardial effusion?
Becks triad - hypotension, JVD< and muffled heart sounds
169
What is the most common cause of atraumatic pericardial effusion with tamponade?
Malignancy.
170
What is the most common cause of atypical pneumonia?
Mycoplasma pneumonia
171
What are the expected chest XR findings in atypical pneumonia?
Patchy infiltrates
172
What is the first line therapy for atypical pneumonia?
Macrolides of respiratory fluoroquinolones
173
Which electrolyte abnormality is seen in Legionella pneumonia?
Hyponatremia
174
What rash presents with golden crusted lesions?
Impetigo
175
What is the first line treatment for impetigo?
Mupirocin (or retapamulin)
176
What is the causative agent of impetigo?
Staph aureus (most common)
Can also be caused by strep
177
What renal complication may occur following impetigo?
Poststreptococcal glomerulonephritis.
178
Why would a patient with a medication-induced dystonic reaction develop airway compromise?
Laryngeal dystonia leading to airway obstruction.
179
What clinical feature is MOST suggestive of appedicitis?
Periumbilical pain that migrates to the right lower quadrant.
180
What is the treatment for acute appendicitis?
Appendectomy
181
What special tests would you preform on a patient in whom you expect appendicitis?
Check for McBurney point tenderness, Rovsing sign, Psoas sign, and Obturator sign.
182
Is appendicitis more common in men or women?
Appendicitis is more common in men and boys.
183
What is the most common cause of appendicitis?
Fecolith
184
What are the expected ultrasound findings in acute cholecysitis?
Pericholecystic fluid and gallbladder wall thickening greater than 4-5mm
185
What is a positive murphy sign?
Inspiratory pause or arrest with deep palpation of the right upper quadrant.
186
Where does acute cholecystitis cause referred pain?
The right shoulder
187
Fever, right upper quadrant pain, and jaundice suggest what pathology?
Ascending cholangitis.
188
What is the most likely diagnosis for asymmetric oligoarthritis 1-4 weeks following urethritis or enteric infection?
Reactive arthritis
189
What is the preferred imaging modality for aortic disection?
CTA of the aorta
190
What is the initial treatment for aortic dissection?
Aggressive BP control with a BB such as esmolol.
191
When might an aortic dissection cause stroke symptoms?
Dissection near the carotid artery
192
What are the systolic BP and HR goals for a patient with an aortic dissection?
SBP 120-100
| HR <60
193
Why is lowering the heart rate, not only the blood pressure, also an important step in the management of aortic dissection?
Lowering the heart rate in aortic dissection decreases the potential propagation of the dissection flap by decreasing the shearing forces.
194
In patients with nephrolithiasis, when has medical expulsive therapy with tamsulosin been shown to be most effective?
When the stone size is less than 10 mm.
195
What are most kidney stones made of?I
Calcium oxalate
196
What would you be concerned about if a patient was found to have a struvite stone?
Infection - struvite is produced by urease-producing bacteria
197
Describe the typical patient in which you would find a kidney stone made of cystine.
A child with metabolic disease(s)
198
What is the most common cause of croup?
Parainfluenza virus
199
What is the treatment for croup?
Oral or IM dexamethasone, plus nebulized racemic epi for mod-severe cases.
200
What x-ray finding would likely be found in a croup patient?
Steeple sign
201
What is the oseltamivir dose for prophylaxis of influenza?
75mg PO QD X 7 days
202
What is the oseltamivir dose for treatment of influenze?
75mg PO BID x 5 days
203
T/F? Oseltamivir should only be started in patients with symptoms <2 days
False, high-risk outpatients should be treated with oseltamivir regardless of symptom duration.
204
Which antiviral medication is recommended for the treatment of influenza patients who are unable to tolerate oral oseltamivir?
Intravenous peramivir.
205
What is the most common bacteria causing infection after cat bites?
Pasturella multocida
206
What antibiotic should be prescribed for cat bites?
Augmentin
207
What characteristics of mammal bite wounds indicate that they should be closed primarily?
Injury to the face or scalp, presentation within six hours, and no host immunosuppressive conditions.
208
What technique may improve the chance of diagnosing a Lisfranc injury on plain radiograph?
Including weight-bearing (stress) views.
209
What medication can be given to non-pregnant patients with abnormal uterine bleeding to slow the bleeding?
IV estrogen
210
What are the 4 structural causes of abnormal uterine bleeding?
Polyp
Adenomyosis
Leiomyoma
Malignancy/hyperplasia
211
What are the 5 non-structural causes of abnormal uterine bleeing?
```
Coagulopathy
Ovulatory dysfunction
Endometrial
Iatrogenic
Not yet classified
```
212
What medication is used to treat postpartum hemorrhage due to atony?
Misoprostol
213
Oral contraceptives are absolutely contraindicated in smokers over what age?
35 years.
214
A holosystolic murmur with radiation to the axilla describes what type of murmur?
Chronic mitral regurg
215
Name two diastolic murmurs.
Mitral stenosis and aortic insufficiency.
216
A patient has epigastric pain radiating to the back. A chest XR shows free air under the diaphragm. What is the most likely diagnosis?
Perforated peptic ulcer
217
What is the first and second most common cause of peptic ulcer disease?
First - H. pylori
| Second - Aspirin or NSAID use
218
How long after acute injury is compartment syndrome typically seen?
Between two hours and 6 days post injury
219
What is the classic physical exam finding in compartment syndrome?
Pain out of proportion to physical exam findings
220
What is normal compartment pressure?
10-12mmHg
221
What is the delta pressure when using a tonometer?
| Delta pressure greater than ___ should get a fasciotomy.
Delta pressure is diastolic blood pressure - intracompartmental pressure.
Delta pressure >/= 30 probably needs a fasciotomy
222
What are the 6 P's of compartment syndrome?
```
Paresthesia
Pallor
Pulselessness
Poikilothermia
Paralysis
Pain out of proportion
```
223
Compartment syndrome of the deep posterior compartment of the lower leg will lead to which passive movement producing intense pain?
Toe extension.
224
Blood in the anterior chamber of the eye is known as a?
Hyphema
225
What can you do for a patient with a hyphema while waiting for ophthalmology consult?
Elevate the head of the bed to 45 degrees to promote settling of blood and prevent occlusion of the trabecular meshwork
226
Explain the grading system for hyphema.
Grade I = <1/3 anterior chamber volume
Grade II = 1/3-1/2 anterior chamber volume
Grade III = >1/2 anterior chamber volume
Grace IV = Total anterior chamber volume
227
What disease are spontaneous hyphemas commonly associated with?
Sickle cell disease.
228
C5 radiculopathy would effect what finger(s)?
None
229
C6 radiculopathy would effect what finger(s)?
Thumb
230
C7 radiculopathy would effect what finger(s)?
2nd and 3rd digits
231
C8 radiculopathy would effect what finger(s)
4th and 5th digits
232
What is Lhermitte phenomenon?
Shock-like paresthesias that occur with neck flexion. This can be a sign of compression of the spinal cord from a midline disk herniation or spondylosis.
233
What rhythm is characterized by a sawtooth pattern?
A flutter
234
What is the treatment for rate control of rapid atrial flutter in a stable patient?
A non-dihydropyridine calcium channel blocker or a beta-blocker.
235
What are some risk factors for the development of plantar fasciitis?
Obesity, prolonged standing or jumping, and flat feet.
236
A westermark sign seen on chest XR is specific for what?
Pulmonary embolism
237
What are some abnormalities that may be seen on chest XR in a patient with CHF?
Kerley B lines
Increased cardiac silhouette
Increased interstitial and alveolar edema
Peribronchial cuffing
238
What causes Kerley B lines on chest X-ray?
Engorgement of lymphatic vessels.
239
What tests can be used to diagnose mononucleosis?
Mono-spot or herterophile antibody test
240
Between strep and mono, which classically has anterior cervical LAD and which has posterior cervical LAD?
Strep - anterior
| Mono - posterior
241
What organomegaly is concerning during mononucleosis?
Splenomegaly
242
What medications will cause a rash if given to a patient with mononucleosis?
Amoxicillin or ampicillin
243
When is the false-negative rate highest for the heterophile antibody test?
During the first week of symptoms.
244
What CBC and blood smear findings are common in mononucelosis?
Left shift and atypical lymphocytes.
245
What is the mechanism of action of lactulose and rifaximin in treating hepatic encephalopathy?
Lactulose acidifies gut contents and causes a loss of NH4+ in the stool, and rifaximin is an antibiotic against colonic flora that produce ammonia.
246
What is the most common valve affected by infectious endocarditis?
Mitral valve
247
What is the most common valve involved in infective endocarditis in IV drug users?
Tricuspid valve
248
What is the most common pathogen causing infective endocarditis in all populatuions?
Staph aureus
249
What is a reasonable empiric therapy for suspected infective endocarditis?
Vancomycin plus gentamycin
250
What variant of endocarditis is found in patients with systemic lupus erythematosus?
Libman-Sacks endocarditis, a noninfectious (sterile) thrombotic form of endocarditis.
251
What physical exam findings are suggestive of infective endocarditis?
FROM JANE
Fever
Roth spots
Osler nodes
Murmur
Janeway Lesions
Anemia
Nailbed hemorrhages (splinter hemorrhages)
Emboli
252
What neurovascular structure is most frequently injured with a tibiofemoral dislocation?
Peroneal nerve
| Popliteal artery is the most common artery injury
253
What is the ankle-brachial index?
The ratio of the systolic blood pressure at the ankle compared to the systolic brachial pressure. An ABI of < 0.9 is considered abnormal.
254
What is the most common type of knee dislocation?
Anterior knee dislocation (tibia is displaced anteriorly relative to the femoral condyle)
255
What is the primary treatment intervention for a patient with sickle cell anemia who presents to the emergency department with an acute ischemic stroke?
Transfusion therapy.
256
What is the most common cause of SJS and TEN?
Drugs - PEC SLAPP
Penicillin
Ethosuximide
Carbamazepine
```
Sulfa
Lamotrigine
Allopurinol
Phenytoin
Phenobarbital
```
257
What is the second most common cause of SJS and TEN?
Mycoplasma pneumoniae infections
258
Name two disorders other than SJS/TEN that have a positive Nikolsky sign.
Pemphigus vulgaris and staphylococcal scaleded skin syndrome
259
Why is ipratropium bromide not used while hospitalized?
It is shown to reduce hospitalization rate but not hospitalization duration.
260
What is the blood supply to anterior nosebleeds?
| Posterior?
Anterior - Kiesselbach Plexus
| Posterior - Sphenopalatine artery
261
What is included in the initial management of an anterior nosebleed?
Vasoconstrictive medications such as oxymetazoline or phenylephrine, and pressure.
262
How long should packing remain for the treatment of an anterior nosebleed?
48 hours
263
How can you tell the difference between an incarcerated hernia from a strangulated hernia?
Strangulated hernias have necrosis and overlying skin changes.
Patients with strangulated hernias also often have elevated white count and/or lactate.
264
What is the treatment for a strangulated hernia?
IV cefoxitin and emergent surgery consult
265
What is the difference between a direct and an indirect inguinal hernia?
Direct passes directly through a defect in the transversalis fascia, whereas indirect passes through a patent processus vaginalis in the inguinal ring.
266
How much water should a patient with a detected kidney stone drink within the first 24 hours?
2 L.
267
What is quadruple therapy for H pylori consist of?
Bismuth
Metronidazole
Tetracycline
Omeprazole
268
What is triple therapy for H pylori?
Omeprazole, clairithromycin, and amoxicillin
269
How many patients infected with H. pylori will develop an ulcer?
5–10%.
270
Are gastric ulcers or duodenal ulcers more common?
duodenal
271
What lead are R and R' waves seen in in a left bundle branch block?
Right bundle branch block?
R and R' (bunny ears) are seen in V6 in a left BBB.
| They are seen in V1 in a right BBB
272
What are causes of left bundle branch block?
Myocardial ischemia, myocardial infarction or myocarditis, but most often is caused by the degeneration of the conduction system with age.
273
What is the most common cause of osteomyelitis in children?
Staph aureus
274
What bacteria may cause osteomyelitis in patients who have a history of sickle cell disease?
Salmonella.
275
A pregnant patients pelvic ultrasound shows a psuedosac with surrounding free fluid. What is this concerning for?
Ectopic pregnancy
276
What is the most common site of implantation for ectopic pregnancy?
The ampulla of the fallopian tube.
277
What is the most accepted hCG discriminatory zone for visualizing an intrauterine pregnancy on transvaginal ultrasound?
1,500 IU/L.
278
What is the most common cause of bronchiolitis?
RSV
279
What is the first step in management for a child with bronchiolitis?
Nasal suctioning
280
In what age group does bronchiolitis primarily occur in?
Children < 2
281
Bronchiolitis is most common during what time of the year?
In North America, bronchiolitis has a peak occurrence between November and March.
282
What is the preferred treatment for a peritonsillar abscess?
Drainage by needle aspiration and augmentin or clindamycin.
283
What are the CENTOR criteria for streptococcal pharyngitis?
Absence of cough, tonsillar exudates, fever, and tender anterior cervical lymphadenopathy.
284
What are the causes of central diabetes inspididus?
Head trauma, congenital, and genetic disorders
285
What is the most appropriate first line treatment for minor bleeding in patients with von Willebrand disease?
Desmopressin
286
What is the role of von Willebrand factor?
Assists with platelet adhesion and is a carrier for factor VIII
287
What is the treatment for severe bleeding in a patient with von Willebrand disease?
recombinant von Willebrand Factor
| or cryoprecipitate
288
What additional medication can help decrease menorrhagia in patients with von Willebrand disease?
Oral contraceptives.
289
What is the treatment for acute bacterial parotitis?
Ampicillin/sulbactam
or
nafcillin + metronidazole or clindamycin
290
What is the most common pathogen associated with acute bacterial parotitis?
Staph aureus
291
What antibiotic is appropriate for a pediatric patient with bacterial parotitis and a severe penicillin allergy?
Clindamycin.
292
What is the treatment for a-fib with RVR?
Beta blocker or CCB
293
In underdeveloped countries, what underlying disease is most frequently associated with atrial fibrillation?
Rheumatic heart disease.
294
A patient with a lithium level greater than ____ should be considered for dialysis.
>5 mEq/L
| or >4mEq/L in the setting of impaired renal function
295
True or false: activated charcoal is effective in binding lithium.
False, lithium is a metal, therefore, activated charcoal will not be effective, as it does not bind metals.
296
Name 4 special tests to evaluate an ankle injury.
Squeeze test - syndesmotic sprain
Anterior drawer - anterior displacement of talus on tibia
External rotation test -
Talar tilt test -
297
What are the structures injured in lateral ankle sprain?
Anterior talofibular ligament, calcaneofibular ligament, and posterior talofibular ligament.
298
What are the 5 components of management of acute COPD exacerbation?
Beta-adrenergic agonists (albuterol)
Anticholinergic agents (Ipratropium)
Oral glucocorticoid therapy (prednisone)
Noninvasive positive pressure ventilation
Antibiotics (for moderate to severe exacerbations, azithromycin or augmentin are good choices)
299
True or false: intravenous corticosteroids have been shown to be superior to oral corticosteroids in the management of an acute COPD exacerbation.
False.
300
What is the first line medication, concentration, and instructions for a scabies infection?
Permethrin 5% cream on day 1, then reapply in 1 week.
301
In what type of scabies are thousands of mites present?
Crusted or Norwegian scabies.
302
What is the most common risk factor for new-onset childhood immune thrombocytopenia?
Viral infection.
303
Reduced factor VIII activity level is found in what bleeding disorder?
Hemophilia A
304
What is the most likely diagnosis in a patient with painless BRBPR and constipation?
Diverticulosis
305
What electrolyte abnormality is commonly seen in hypothyroidism?
Hyponatremia.
306
List 3 types of definitive airway?
Orotracheal tube, nasotracheal tube, surgical airway
307
What antibiotic is used for infection prophylaxis before surgery?
Cefazolin
308
What is the antibiotic regimen of choice if an open fracture is deemed to be large (> 10 cm) or very contaminated?
First-generation cephalosporin and gentamicin.
309
If a child under one year of age aspirates a foreign body and is choking, what is the appropriate management?
Holding the head lower than the feet, alternate five back blows with five chest thrusts.
310
What imaging should be ordered to detect a foreign body aspiration that is not radiopaque?
lateral decubitus chest XR - it will detect air trapping. If you hear wheezing on right, do a right lateral decubitus, on left, left lateral decubitus.
311
What disease is associated with urinary incontinence, ataxia, and dementia?
Normal pressure hydrocephalus.
312
What special test has the highest sensitivity for sciatica?
| What about specificity?
Sensitivity - straight leg raise
| Specificity - crossed straight leg raise
313
A patient with sciatica and weakness with toe extension likely has compression of what nerve root?
L5.
314
Does unstable angina have any EKG changes or troponin elevation?
Neither
315
How long can an elevated troponin level be detected after acute myocardial infarction?
Up to seven days.
316
What nerve injury is most common with a fibular head fracture?
Common peroneal nerve injury
317
What are the expected BUN:Cr ratios for pre-renal, intrarenal, and post-renal causes of renal failure?
```
Pre-renal = BUN:Cr >20
Intrarenal = BUN:Cr<10:1
Post-Renal = BUN:Cr 10-20:1
```
318
What is an extraintestinal manifestation of celiac disease?
Dermatitis herpetiformis
319
What is an extraintestinal manifestation of inflammatory bowel disease?
Ankylosing spondylosis
320
Pernicious anemia is a type of selective malabsorption leading to a deficiency in what vitamin?
Vitamin B12 (cobalamin).
321
Orthostatic hypotension can be diagnosed by a decrease in SBP by how much when going from sitting to standing?
DBP?
Fall >20 SBP
Fall >10 DBP
322
Which is the more common finding in volume-depleted adults: hypokalemia or hyperkalemia?
Hypokalemia.
323
Is a Wenckebach heart block Mobitz I or Mobitz II?
Mobitz I
324
Describe the PR interval and QRS complexes in a Wenckeback heart block. (Mobitz I)
Progressively longer PR interval until a QRS is dropped.
325
Describe the PR intervals and QRS complexes in a Mobitz II block.
Regular PR interval with random dropped QRS complexes.
326
Describe the P waves and QRS complexes in a complete heart block?
P waves and QRS complexes march out, but QRS complexes have no releation to P waves.
327
What does a notched P wave on ECG potentially indicate?
Left atrial enlargement.
328
What is the characteristic EKG finding of WPW?
Delta waves
329
What is the treatment for a tension pneumothorax?
Needle thoracostomy
330
What are the physical exam findings of a tension pneumothorax?
Diminished breath sounds, distended neck veins, hypotension, and tracheal deviation.
331
In what other location can needle decompression be performed if unable to reach the pleura from the anterior midclavicular space?
Fourth or fifth intercostal space in the midaxillary plane may also be used (the same location as tube thoracotomies).
332
What is an appropriate treatment plan for a patient with HOCM with a syncopal episode?
Admission and cardiology consult
333
What is an appropriate treatment plan for a patient with HOCM found incidentally who has no symptoms?
Outpatient cardiology follow up
334
Describe the murmur associated with HOCM.
Harsh crescendo-decrescendo systolic murmur that increases intensity with valsalva and decreases with squatting.
335
What is the appropriate dosing of heparin in ST elevation myocardial infarction patients?
A 60 units/kg bolus (up to 4,000 units) followed by a 12 units/kg/hr infusion (up to 1,000 units/hr).
336
What is the initial treatment for acute angle closure glaucoma?
A topical beta blocker and alpha agonist, such as timolol and apraclonidine, along with acetazolamide.
337
You've diagnosed a patient with acute angle closure glaucoma and ophthalmology is on the way. You've treated the patient with timolol, apraclonidine, and acetazolamide, and a recheck of IOP is 50 mmHg. What is the next appropriate treatment?
IV mannitol
338
A FOOSH injury with snuffbox tenderness is concerning for what injury?
Scaphoid fracture
339
What is an appropriate splint for a scaphoid fracture?
Thumb spica splint
340
What is the most concerning complication for scaphoid fractures?
AVN of the proximal pole of the scaphoid.
341
What type of hypersensitivity reaction is contact dermatitis?
Type IV.
342
What is the dose of atropine in symptomatic bradycardia with a pulse?
1 mg IV push.
343
Which three chemicals should not be treated with immediate water irrigation if splashed into the eye because of their harmful exothermic effects?
Dry lime; elemental metals, such as sodium, potassium, magnesium, phosphorus, lithium, cesium, and titanium tetrachloride; and phenol.
344
What is the goal pH of the eye after irrigating a chemical burn?
7.0-7.5
345
What is worse, acid or alkaline chemical burn of the eye?
alkaline - penetrates deeper and faster.
346
What type of chemical burns to the eye cause liquefaction necrosis, and what type cause protein coagulation?
Liquefaction necrosis - alkaline burns
| Protein coagulation - acidic burns
347
What is the normal range of intraocular pressures?
10 to 20 mm Hg.
348
What mechanism is the main cause of acute angle closure glaucoma?
Obstruction of the aqueous humor outflow (trabecular meshwork)
349
What types of hepatitis are transmitted by fecal-oral contamination?
A and E (The vowels hit your bowels)
350
What hepatitis is dependent on hep B coinfection?
Hep D
351
What laboratory value will be decreased (aside from hemoglobin or hematocrit) in an acute episode of hemolytic anemia?
The haptoglobin level as it scavenges free hemoglobin released by lysed red blood cells.
352
When should hypertension be treated in the setting of an acute ischemic stroke?
If the systolic is greater than 220 mmHg, the diastolic is greater than 110 mmHg, or if the patient has another condition that would benefit from blood pressure control.
353
What laboratory test can help differentiate between acute heart failure and an exacerbation of chronic obstructive pulmonary disease in a dyspneic patient?
Brain natriuretic peptide.
354
What is the most common cause of small bowel obstruction?
Adhesions
355
What are the first two steps of treating a small bowel obstruction?
Keeping patient NPO and placing a NG tube
356
What type of hernia is most commonly associated with small bowel obstruction?
Inguinal hernia.
357
What is the best benzodiazepine to give for status epilepticus?
Lorazepam
358
What is the best benzodiazepine for treatment of status epilepticus in a patient without intravenous access?
IM midazolam
359
What is the most oikely diagnosis for a patient in respiratory distress with bilateral rales, tachypnea, tachycardia, and a high pitched blowing murmur occurring after S2 is heard best along the left sternal border in the third intercostal space?
Aortic regurgitation
360
True or false: increases in blood pressure worsen aortic regurgitation.
True. Tachycardia and afterload reduction will reduce regurgitation, whereas slower heart rates and increases in afterload will worsen the regurgitation.
361
What is the innervation of the biceps muscle?
The musculocutaneous nerve. The nerve roots for the musculocutaneous nerve are C5, C6, and C7.
362
What is the classic ECG finding in de Winter syndrome?
J point depression with a sloping ST segment into a peaked, hyperacute T wave in the precordial leads. This suggests a complete LAD occlusion and should be treated as an ST elevation myocardial infarction equivalent.
363
What is Wellens syndrome?
Critical stenosis of the LAD with either biphasic t waves or deeply invereted t waves.
364
What is the appropriate empiric treatment for urethritis in a male with two new sexual partners?
Ceftriaxone 500mg IM and doxycycline 100mg BID x 7 days
365
True or false: Chlamydia trachomatis is identified on Gram stain as gram-negative diplococci.
False. Chlamydia is a small gram-negative bacterium that is an obligate intracellular parasite as it can only replicate within a host cell.
366
What is gonorrhea reported as on a gram stain?
Gram negative diplococci
367
What is the first line treatment of severe hypertension in the setting of an acute MI?
Nitroglycerine
368
What is the first line treatment of severe hypertension in the setting of aortic disection?
Esmolol
369
What is the first line treatment of severe hypertension in the setting of eclampsia?
Magnesium sulfate
370
What is the first line treatment of severe hypertension in the setting of a hypertensive encephalopathy?
Nicardipine
371
True or false: Focal deficits resulting from hypertensive encephalopathy may present on opposite sides of the body.
True. Focal deficits do not follow an anatomic pattern and may be present on opposite sides of the body`
372
An EKG shows a rate of 160, irregularly irregular, with 3 different P wave morphologies. What is the most likely diagnosis?
Multifocal atrial tachycardia.
373
What is the treatment for multifocal atrial tachycardia?
Treat underlying cause, do not give rate-limiting medications.`
374
What is an appropriate treatment for a patient with a fib with RVR?
IV diltiazem
375
What is an appropriate treatment for rhythm control for tachydysrhythmias?
procainamide
376
What is considered a safe time period for cardioversion in new-onset atrial fibrillation or atrial flutter?
48 hours.
377
Describe the murmur of mitral valve prolapse.
Late systolic crescendo murmur
378
What is the most common ultrasound finding in a patient with ovarian torsion?
Ovarian enlargement due to venous and lymphatic engorgement.
379
What is the whirlpool sign?
| What is it highly specific for?
Whirlpool sign is the presence of coiled vessels on ultrasound of an ovary which is nearly 90% accurate in diagnosing ovarian torsion.
380
What is the treatment for purulent cellulitis vs non-purulent cellulitis?
Purulent cellulitis should be covered for MRSA, with doxycycline, bactrim, clindamycin, or linezolid.
Non-purulent cellulitis can be treated with cephalexin, amoxicillin, or dicloxacillin
381
What is the most common pathogen implicated in erysipelas?
Beta-hemolytic streptococci.
382
Is diarrheal onset or emesis onset more likely to be a bacterial cause of gastroenteritis?
Diarrheal onset
383
Which pathogen is most responsible for infantile malnutrition from persistent diarrhea in low-resource countries?
Shiga toxin-producing enteropathogenic Escherichia coli.
384
Progressive encephalopathy with hepatic dysfunction is characteristic of what syndrome?
Reye syndrome
385
What is the biggest risk factor for Reye syndrome?
Salicylate use
386
Is WPW with a wide QRS orthodromic or antidromic?
Antidromic
387
What are the only two appropriate treatments for antidromic WPW?
Procainamide or cardioversion
388
What is the triad of EKG changes in WPW?
Slurred upstroke of QRS complex (delta wave)
Wide QRS
Short PR interval
389
What class of antiarrhythmics does procainamide belong to
Class 1a.
390
What type of organisms are asplenic patients high risk for contracting infections from?
encapsulated organisms
391
What are the most common organisms to cause sepsis in asplenic patients?
Strep pneumo, Neisseria meningitidis, and H. influenzae.
| also consider salmonella, although it is not as common
392
Name 7 encapsulated bacteria.
```
SHiNE SKiS
Strep pneumo
H. influenzae (type B)
Neisseria meningitidis
E. coli
```
Salmonella typhi
Klebsiella pneumoniae
Streptococcus (group B)
393
What common viral illness puts a patient at risk for splenic injury and rupture?
Epstein-Barr virus infection.
394
What is the appearance of PJP on chest XR?
Bilateral interstitial infiltrates. (bat wing apperance)
395
What is the treatment for PJP?
TMP-SMX
396
What lab findings are associated with PJP?
CD4 <200
| Increased LDH
397
What is the most common cause of aortic stenosis?
Calcific dengeration
398
Describe the murmur assocaited with aortic stenosis.
systolic Crescendo-decrescendo murmur that radiates to the carotids
399
What is the only cardiac valve that has two cusps instead of three?
Mitral valve.
400
Episodic vertigo, sensorineural hearing loss, and tinnitus is characteristic of?
Meniere disease
401
What is the treatment for meniere disease?
avoidance of alcohol, caffeine, stress, sodium, MSG, and nicotine
402
Benign paroxysmal positional vertigo (BPPV) is thought to be caused by what?
BPPV is most commonly attributed to calcium debris within the posterior semicircular canal but may also occur in the lateral and anterior semicircular canals.
403
What is the most likely diagnosis for a patient presenting with painless visual disturbances, floaters, flashing lights, and a curtain-lowering sensation to his vision?
Retinal detachment.
404
Describe the "classic" pseudotumor cerebri (idiopathic intracranial hypertension) patient.
A young woman with obesity.
405
What are the symptoms of psuedotumor cerebri?
intermittent visual changes, headache, and pulsatile tinnitus.
406
What are the hallmark findings in pseudotumor cerebri?
Papilledemia, elevated opening pressure on lumbar puncture.
407
What is the treatment for pseudotumor cerebri?
Low sodium diet, weight loss, acetazolamide, optic nerve sheath fenestration, shunt.
408
What is an alternative to funduscopy when evaluating for papilledema?
Ocular ultrasound.
409
True or false: positive birefringence on crystal analysis is consistent with gout.
False
410
What is the most common presentation of Hodgkin lymphoma in a 17-year-old boy?
Painless cervical LAD
411
Does hodgkin or non-hodgkin lymphoma have reed-sternberg cells?
Hodgkin
412
What are the two methods of reducing a nursemaids elbow?
Supination and flexion or hyperpronation
413
What is the best initial diagnostic test for a suspected pheochromocytoma?
24-hour urine fractionated metanephrine and catacholamine level or a plasma fractionated metanephrine.
414
What is a pheochromocytoma?
A neoplasm of the chromaffin cells within the adrenal medulla.
415
What is the treatment for hypertension in the setting of pheochromocytoma?
An alpha blocker (phenoxybenzamine is preferred) and then a beta blocker after an alpha blockade has been established.
416
What is the triad of symptoms for pheochromocytoma?
Episodic headache, diaphoresis, and tachycardia with hypertension.
417
What is the most common cause of a transient aplastic crisis in a sickle cell patient?
A recent parvovirus B19 infection
418
What is the most common complication from a midshaft humeral fracture?
Radial nerve injury
419
What neurological findings are consistent with radial nerve injury after a midshaft humeral fracture?
Wrist drop, loss of extension of fingers, thumb, and wrist
420
What is an alternative agent for the treatment of PJP pneumonia?
Pentamidine.
421
What is the most common cause of DIC?
Infection.
422
Which ACL physical exam test provides the best sensitivity and specificity for ACL rupture?
The Lachman test.
423
What is the technique to detorse a testicular torsion?
Medial to lateral rotation
424
What is the most appropriate test to diagnose a bile leak status post cholecystectomy?
Hepatic iminodiacetic acid (HIDA) scan.
425
HIV and antiretroviral therapies can cause what cardiovascular disorder?
Dilated cardiomyopathy
426
What is the cause of Chagas disease, the leading cause of dilated cardiomyopathy in Central and South America?
A protozoan infection with Trypanosoma cruzi.
427
What is the first line treatment for candidal balanitis?
Topical clotrimazole cream
428
What type of medication is chlordiazepoxide?
benzodiazepine
429
Which frequently used benzodiazepine is unaffected by hepatic metabolism status?
Lorazepam. In contrast, diazepam, midazolam, and chlordiazepoxide all undergo significant hepatic metabolism, which can result in accumulation of parent drug and associated prolonged drug effects in those with impaired liver function.
430
A radial/ulnar wrist facture with dorsal displacement is known as a ______ fracture.
Colles (dinner fork deformity)
431
A radial/ulnar wrist facture with ventral displacement is known as a ______ fracture.
Smith (garden spade deformity)
