HIGHYIELD/REDFLAG Flashcards

Question 1

Q

DSM 5 criteria
(schizophrenia)

Answer

A

Disturbance of at least 6mos
1mo of active phase symptoms (2 or more, 1 has to be positive) [7]
- positive symptoms (1 of)
* Hallucination OR
* Delusions
- disorganized speech
- disorganized / catatonic behavior
- negative symptoms
* Social withdrawal
* Blunt effect
* Poor rapport w ppl
* Difficulty with abstract thinking
* Loss of spontaneous conversation
- impact on level of function
- not due to substance
- no mood symptoms

Question 2

Q

DSM5 criteria
(MDD)

Answer

A

> 2WEEKS
5 SYMPTOMS (SIGECAPS)
at least 1: 1) depressed mood OR 2) loss of interest
* Sleep
* Interests - decrease
* Guilt / worthlessness
* Energy - low
* Concentration
* Appetite change (incr / decr) / weight change
* Psychomotor agitation / retardation
* SI / plan / thoughts consumed with death

Question 3

Q

DSM5 criteria
(BIPOLAR D/O)

Answer

A

BIPOLAR 1
* 1 manic episode
* (MDE not needed)

BIPOLAR 2
* Hypomanic episode
* at least 1 MDE

Question 4

Q

DSM5
(MANIA)

1-2-3

Answer

A

1 WEEK daily symptoms
2 symptoms of mania: incr energy + mood
at least 3 of DIGFAST
* Disorganized
* Increased pleasure / risk taking
* Grandiose
* Flight of ideas
* Activity incr / goal directed
* Sleep (decreased)
* Talkative (pressured)

decline in function (needs hospitalization)
not due to drugs / organic reason (i.e. trauma)

Question 5

Q

DSM5
(panic attack)

Answer

A

Acute sense of fear reaches peak within minutes PLUS 4
palpitations
sweating
trembling
SOB / smothered feeling
choking feeling
chest pain / discomfort
nausea / abdominal distress
dizzy / light headed
chills / heat sensation
paresthesias
derealization
fear of losing control / going crazy
fear of dying

Question 6

Q

DX CRITERIA
(somatic symptom d/o)

Answer

A

more than 1 somatic symptom
- disrupting daily life
<6mos

more than 1 of:
1. disproportionate +persistent thoughts about seriousness of symptoms
2. high level of anxiety about health /symptoms
3. excessive time + energy devoted to theses symptoms / health concerns

Question 7

Q

DX CRITERIA
(functional d/o)

Answer

A

Factitious d/o - Primary gain
* Falsify psychological / physical signs
* present themselves (a child) as ill
* deceptive behavior apparent
* not explained by another psych dx

Malingering d/o - Secondary gain
* Medicolegal context of presentation
* discrepancy btwn person’s stress+ objective sx
* poor cooperation to evaluation
* hx of antisocial evaluation

Question 8

Q

List risk factors for suicide

SADPERSONS

Answer

A

Sex
Age (<19 / >45)
Depression / hopelessness
Previous attempts / psychiatric care
Excessive ETOH/drug use
Rational thinking loss
Separated, divorced, widowed
Organized / serious attempt
No social supports
Stated future death intent

<5 - outpt vs PLN
>6 - psych consult

Question 9

Q

Indications for MAID

Answer

A

> 18yrs
Valid health card /ID
Voluntary
informed consent
suffer from grievous + irremediable medical conditions

Question 10

Q

Define consent

VICS

Answer

A

Voluntary
Informed
Capable person (patient / SDM) - patient has capacity
Specific (procedure specific risks)

Question 11

Q

Define capacity

KAC

Answer

A

Knowledge of options
Awareness of consequences + personal cost benefit
Consistency of choice / values in relation to previous values + preferences

Question 12

Q

Digoxin containing plants

Answer

A

Oleander
milkweed
lily of the valley
fox glove
Dogbane

Question 13

Q

Anticholinergics containing plants

Answer

A

Deadly night shade (atropine)
jimson weed (scopolamine)
hyoscyamine
angels trumpet
mandrake

Question 14

Q

Indications for WBI vs gastric lavage

Answer

A

WBI - 2L PEG/hr until rectal effluent is clear
* Drug packers
* sustained / delayed release formulas
* potential bezoar (think ASA)
* Metals: iron, lithium
* high lethal: BB, CCB, TCA

Gastric Lavage - Intubate, LLD
GL w 200cc warm saline + suck until no fragments
* Within 1hr ingestion => CHAMP
* life threatening poison
* no antidote
* AC won’t work (not lithium)

Question 15

Q

Indications for GI decontamination

CHAMP

Answer

A

Camphor - neurotox, seizures
Halogenated HC
Aromatic HC - BM suppress + leukemia (toulene, benzene)
Metals - arsenic, Hg, Pb (neurotox)
Pesticides - cholinergic crosis, seizure, resp depression

Question 16

Q

Indications for methylene blue

Answer

A

MetHgB >30%
symptomatic

Question 17

Q

What is CAGE

Answer

A

Cut down?
Annoyed when ppl bring up bleeding
Guilt around actions with drinking
Eye opener - drink first in AM

0-1: low risk
2-3: high suspect of alcoholism
4: diagnostic

Question 18

Q

Components of CIWA

SONATA HHHH

Answer

A

Sweating
Orientation
N/V
Agitation
Tremor
Anxiety

Hallucinations: 1) auditory 2) visual 3) tactile
HA

>20 severe
<8 - no tx needed

Question 19

Q

Criteria for WERNIKE encephalopathy

Answer

A

2’ thiamine dependent enzyme deficiency => thiamine B1 deficient

2 signs:
- CB signs (wide based gait)
- oculomotor signs (nystagmus)
- known thiamine deficiency
- AMS/mild memory impairment

Question 20

Q

What is the COW scale

STOP TRYING Joints

Answer

A

Sweating
Tremor
O-mydriasis
Piloerection
Tachy
Rhinorrhea
Yawning
Irritation
Nausea/vomiting
Got to go (restless)
joint pain

>13= for suboxone start
(>12 per CAEP 2020 statement)

Question 21

Q

Indications for admission / discharge post hydrocarbon overdose

Answer

A

Admission
* Any CHAMP HCs
* SI attempt
* mild CNS depression
* tachypnea, hypoxia
* CXR - not improved in 6H

ICU admission
* Mod-severe CNS depression
* sig resp distress + hypoxia
* hypercapnia
* ++ resp support (PPV / intubation)
* hc of cardiac dysrhythmias
* HD instability

Discharge
* Observe for 6hrs
* asymptomatic
* no CXR findings post 6H

Question 22

Q

Stages of ETHYLENE GLYCOL

Question 23

Q

Indications for fomepizole / HD in toxic ETOH ingestion

Answer

A

Fomepizole
* Methanol: 6.6
* Ethylene glycol: 3.2
* Hx of ingestion + OG >10
* suspected ingestion PLUS (2):
pH <7.3
OG >10
bicarb <20
calcium oxalate crystals

HD
* Methanol: 16
* Ethylene glycol: 8
* pH <7.3
* anion gap >20
* evidence of EOD: seizure, coma, vision
* can’t eliminate parent / toxic compounds
* deteriorates despite aggressive tx

Question 24

Q

What is the dx criteria for SILENT syndrom

Answer

A

Neuro (CB) dysfunction 2’ lithium PLUS
* no prior neuro illness
* at least 2mos no lithium

symptoms: CB, EPS, brainstem dysfxn, hyperT = predictor of severity

Question 25

Q

List indications for dialysis

(lithium)

Answer

A

Acute >4mEq/L / Chronic >2.5mEq/L
CNS - seizures, decr LOC
Renal insuff - can’t excrete
unable to tolerate vol expansion

Question 26

Q

What meds are associated with serotonin syndrome

Answer

A

Antidepressants: SSRI, SNRI, TCA, lithium
Street drugs: MDMA, cocaine, LSD
opioids: dextromethorphan, methadone, tramadol, meperidine
St John’s wart

Question 27

Q

What is HUNTER’S CRITERIA

Answer

A

On serotonergic agent / washout
PLUS 1:
1) spontaneous clonus
2) inducible clonus + diaphoresis OR agitation
3) ocular clonus + diaphoresis OR agitation
4) inducible clonus + hyperTHERMIA + hyperTONIA
5) ocular clonus + hyperTHERMIA + hyperTONIA
6) hyperreflexia + tremor

treatment: stop drug, cool, benzos, crytohepatadine 12mg

Question 28

Q

List diagnostic criteria for NMS

HERACS

Answer

A

Hyperthermia (>38, oral)
Exposure <72hrs - dopamine antagonist (antipsych) OR withdrawal from dopamine agonist
Rigidity
AMS
CK elevation (x4 ULN)
Sympathetic NS lability (at least 2):
- BP >25% from baseline
- BP fluctuates DBP >20% or SBP >25% in 24H
- sweaty, pee yourself
- hypermetabolic - HR >25% / RR >50%
- negative w/o for other tox

Question 29

Q

Define acetaminophen overdose

Answer

A

TOXIC 150mg/kg
MASSIVE 1g/kg
(7.5mg - adult 4mg malnourished, ETOH, P450 inducer)

Question 30

Q

Define the stages of acetaminophen toxicity

Answer

A

Stage 1 - pre injury
0-12H (<1D)
* GI symptoms
* APAP level

Stage 2 - liver injury
8-72h (2D)
* RUQ pain
* AST up

Stage 3 - fulminant hepatic failure
2-4d (3D)
* Liver failure
* encephalopathy, DIC
* ARDS, MOF

Stage 4 - recovery
>4d (4D)
* Complete hepatic histologic recovery
* OR
* death

Question 31

Q

Indications to start NAC

Answer

A

ACUTE
* APAP 4H on / above nomogram line
* present >8H post ingestion
* time of ingest unknown => AST up / APAP detectable
* Toxic dose (150mg/kkg) + no APAP + <8hrs

CHRONIC
* Elevated AST >50 / X2N
* APAP higher than expected (66)

Question 32

Q

List the KING’S COLLAGE criteria

Answer

A

Cr >300 umol/L
Hepatic encephalopathy grade 3/4
INR >6.5
PH <7.3
(other strong predictors: lactate >3.5 / phosphate >3.75mg/dL)

Question 33

Q

Indications for dialysis in acetaminophen
(massive OD)

Answer

A

(think of KING’S criteria)
++APAP level (>1000mg/dL @4H)
Cr >300umol/L
Lactate >3.5
pH <7.3
encephalopathy

Question 34

Q

TOXIC DOSE of salicylates

Answer

A

200-300mg/kg
>500mg/kg (death)
level: >2.2mmol/L

Question 35

Q

List the stages of ASA toxicity

Answer

A

Early - 0-4H (4)
* Resp alkalosis
* met alklaosis
* Tinnitus
* tachypnea

Moderate - 2-12H (8)
* Resp alkalosis
* Met acidosis
* Hyperthermia
* low CNS glucose

Late - 10-24H (16)
* Resp acidosis
* met acidosis
* Acidemia
* organ failure

Question 36

Q

List risk factors for pulm edema in salicylate toxicity

Answer

A

Adults
* >40mg/dL
* Smoker
* neuro sx
* chronic ASA use

Kids
* >80mg/dL
* high anion gap
* low CO2
* low K

Question 37

Q

Indications for Urinary alkalnization in salicylate toxicity

Answer

A

SALICYLATE LEVEL >2.2
rapidly rising levels
sig acid -base disturbances
proven / suspected toxicity w symptoms of salicylate OD (tinnitus)

Question 38

Q

Indications for dialysis in salicylate toxicity

Answer

A

SALICYLATE LEVEL: ACUTE >7mmol/L / CHRONIC >2.9mmol/L
rapidly rising levels
deteriorating condition
CNS: AMS, coma, seizure
RS: pulm edema, intubated (can’t keep up w RR)
hepatic, renal failure
Other dialysis indications: severe acid /base
- unable to tolerate volume

Question 39

Q

Indications for HD in metformin OD

Answer

A

Lactate >20
severe acidosis <7.0
failure of supportive care + NaHCO3 within 2-4H of ingestion

Question 40

Q

List indications for DIGIFAB

Answer

A

HD unstable + bradyarrythmias (unresponsive to atropine)
HD unstable + cardiac ingestant
Dysrhythmias, ventricular
Dysrhythmias + plant ingestions
progressive rhythm disturbances
K >5
rising K level
Acute ingestion of >10mg + any of above
Level > 6ng/mL + any of above

CHILDREN
0.1mg/mL / >5ng/mL level PLUS
Symptoms
K>6
Co-ingestion of drugs (no need for unstable)
Co-ingestion of cardiac glycoside plant + dysrhythmia

Question 41

Q

Stages of inhalational injury

Answer

A

Immediate chem irritation + edema
necrotic lining + pseudomembrane casts forms
ciliary damage + decr mucous clearance
pulmonary edema + decr compliance (ARDS)

Question 42

Q

Indications for HBOT in CO toxicity

Answer

A

> 25% Co-HgB (adult) / >15% Co-HgB (preg)
any level PLUS
- neuro - syncope, coma, seizures, AMS (GCS <15)
- abnormal CB dysfunction
- prolonged CO exposure w minor clinical findings

Question 43

Q

Phases of caustic injury

Answer

A

Necrosis: invasion of PMN + bacteria
Vascular thrombosis
Tissue slough => 1-5H post, tensile strength low = perforation risk high
Granulation: 1wks - mos
Strictures => contraction of scar tissue (wks -yrs)

Question 44

Q

Describe GRADES of caustic injury

Answer

A

Grade 1
* Edema

Grade 2
* White membrane exudate
* ulcers
* Friable tissue + hemorrhage
* non circ / nearly circ

Grade 3
* Full thickness
* deep tissue
* necrotic mucosa
* high risk for perforation

Question 45

Q

Indications for emergent sx with caustic ingestions

Answer

A

Free air / perforation on imaging
peritonitis / mediastinitis
incr / severe chest pain / abdo pain
persistent hypotension (source control)

Question 46

Q

Indications to intubate in caustic ingestions

Answer

A

Signs + symptoms
intentional OD

Question 47

Q

Indications to give 2PAM

Answer

A

ORGANOPHOSPHATE TOXICITY PLUS:
Resp depression / apnea
fasciculations
seizures
arrhythmias
CV instability
Using >4mg atropine

Question 48

Q

Indications to stop atropine

Answer

A

Resp secretions drying out
Breathing better
RR normal

Question 49

Q

Contraindications to physostigmine

Answer

A

TCA OD + CV instability (QRS)
widened QRS (>100msec)
bradycardia (AV block)
seizures
relative: reactive airway dz, intestinal obstruction
acute closed angle glaucoma (ACE inhibitor = ACH = muscarinic (miosis) + nicotinic (mydriasis) effect)
(could be okay for open angle glaucoma => miosis overall)

Question 50

Q

Indications for treatment anticholinergic (charcoal, physostigmine)

Answer

A

Charcoal
* Only for symptomatic pts
* high toxic quantity of anti-muscarinic plant
* seed ingested (<2H from ingestion)

Physostigmine
* Control symptoms of agitation / delirium
* no seizures
* normal QRS

Question 51

Q

Describe the stages of FE OD

Question 52

Q

Indication for treatment
in Fe OD

Answer

A

WBI indications - 2L /hr NG until effluent clear
* >20mg/kg ingestion
* see tabs on AXR

Deferoxamine = 100mg:10mg Fe (15mg/kg/hr (24H))
* Systemic illness
* level >90umol/L
* ingested >60mg/kg

Question 53

Q

Contraindications to WBI

Answer

A

Perforation
bowel obstruction, ileus
HD instability

Question 54

Q

What are the complications of deferoxamine

Answer

A

Anaphylactoid reaction
pink pee (vin rose)
hypotension
ototoxic
yersinia infection
ARDS
Visual toxicity

Question 55

Q

End points for deferoxamine

Answer

A

Patient stable
appears well
acidosis is gone
urine not pink

Question 56

Q

List the grades for HTN retinopathy

Answer

A

Gr 0 - normal
Gr 1 - arterial narrowing
Gr 2 - arterial narrowing + irregularity
Gr 3 - arterial narrowing + hemorrhage / exudate
Gr 4 - grade 3 + papilledema

Question 57

Q

List 2 types of classifications of AD

Answer

A

STANDFORD
* A - ascending (surgery +/- AV replacement)
* B - descending (med mgmt +/- TEVAR)

DEBAKEY
* 1 - ascending arch + distal aorta
* 2 - isolated ascending OR arch
* 3A - descending thoracic
* 3B - thoracic + abdominal

Question 58

Q

What is the WELL’S SCORE for DVT

C3P2OTR2D2

Answer

A

Calf swelling >3cm
Collateral veins present
Pitting edema
Prev DVT documented
Oedema of entire leg
Tenderness to calf
Recent paralysis / plaster / paresis of lower extremity
Recent surgery 12wks or immobilization 3days
Diff dx at least as likely (-2)

0-2: D dimer
>3 = D dimer + US
+dimer -US => rpt 1wk

Question 59

Q

What is the PERC score

HADCLOTS

Answer

A

Hormone use
age >50
DVT/PE hx
Coughing blood
Leg swelling
O2 <95%
Tachycardia >100
surgery / trauma <28days

PERC NEG <2% chance

Question 60

Q

What is the WELLS SCORE (PE)

LASTPCH

Answer

A

Leg swelling +3
Alternative dx unlikely +3
Surgery (4wks) / Immobilization (3d) 1.5+
Tachycardia >100 +1.5
Prev DVT / PE +1.5
Cancer (6mos) +1
Hemoptysis +1

0-4 unlikely - dimer alone

>5 - likely - CTPE

Question 61

Q

Explain the YEARs score

Answer

A

YEARS criteria
* Clinical signs of DVT
* Hemoptysis
* PE most likely

Question 62

Q

What are the PESI score components

80/90/100/110

Answer

A

age >80
SpO2 <90
SBP <100
HR <110
Hx of CA
Hx of cardiopulmonary dz

0 points - low risk = outpatient
>1 point - high risk, 9% risk for death

pulmonary embolism severity index

Question 63

Q

What is the modified HESTIA score

PACATSSRO

Answer

A

NO:
Pain >2dose IV narcotics
active bleed
co-morbidities (preg, severe liver dz, HIT)
anti-coagulation
Thrombolytics needed

Social reasons for admission
SBP <100
Renal - CrCl <30
O2 <94

Question 64

Q

What is the LIGHT’S CRITERIA

Answer

A

Protein pleural / serum >0.5
LDH pleural / serum >0.6
2/3 ULN of LDH

TRANSUDATIVE- low protein 2’ hydrostatic pressure
* CHF
* Cirrhosis
* nephrotic syndrome, GN
* hypoalbuminemia
* myxedema
* Peritoneal dialysis
* atelectasis
* CSF leak into pleural space
* VP shunt dysfunction

EXUDATIVE - high protein
* Bacterial pneumonia
* parapneumonic effusion
* lung abscess
* TB, viral
* primary lung Ca, mesothelioma, pulmonary / pleural mets
* carcinoma
* asbestosis, sarcoid
* uremia
* RA, SLE, Wegeners
* pancreatitis, hypothyroidism
* chylothorax

Answer 63

A

Acute <1wk
bilateral opacities
PF ratio
mild <300 (PEEP5)
mod <200 (PEEP5)
severe 100 w PEEP

Answer 64

A

Asthma
nasal polyps
eosinophilic rhinitis
sensitivity to NSAIDs / aspirin

Tx- steroids

Answer 65

A

STEP1 - (yes to any, no D/C // no to all - step 2)
prior ACS
abn ECG (STE/STD, q waves, LVHH, LBBB, paced)
Nitrate needs
+ trop @ 2hrs

STEP 2 (yes - DC home)
Pain on palpation

STEP 3 (yes to any - no DC)
>50
radiating to neck

low risk ACS screen

Answer 66

A

History (highly, mod, slightly suspicious)
ECG (STD, non specific repol, normal)
Age (65, 45-65, <45)
Risk factors (>3, 1-2, 0): DM, HTN, Obesity, + fm history, DLD, CAD
Troponin (3xN, 1-3Xn, <1)

0-3: D/C home
4-6: adm to hospital
>7: early invasive measures

Risk of MACE @ 6wks; (mace: AMI, PCI/CABG, death)

Answer 67

A

CLASS 1: no signs of HF (3%)
CLASS 2: crackles, S3, incr JVP (10%)
CLASS 3: acute pulmonary edema (15%)
CLASS 4: cardiogenic shock (>30%)

30d mortality with acute MI

Answer 68

A

Bleeding history
Liver disease
Age>65
Meds - antiplatelets, NSAIDs
ETOH
Kidney disease
INR labile
SBP >160
Stroke history

0-2 = anticoag
>3 = high risk of bleed
risk of sig bleeding on anticoa

Answer 69

A

CHF
HTN
Age >75 (CHADS=65 >65)
DM
Stroke / tia

Annual stroke risk

0 = 0.8% risk for stroke
1-2 = 2.7
3-6 = 5.3

Answer 70

A

Faint hx (-1)
Abnormal HEART (CHF, CAD, ICD) (+1)
Increased SBP (>180 / <90) (+2)
Non narrow QRS (<130) (+1)
Troponin >90th percentile (+2)
Rotated axis <30/>100 (+1)
Increased QTC >480 (+2)
Syncope hx - vasovagal (-2)
kardiac syncope (+2)

30d serious adverse risk

<0 - low risk (2hrs monitor)
1-3 - med risk

Answer 71

A

INCLUSION
* ED patient
* >16 yrs
* present to ED within 24H of syncope

EXCLUSION
* Prolonged LOC (>5min)
* obvious witnessed seizure
* mental status - changes from baseline
* head trauma = LOC
* Major trauma
* unable to obtain hx (language barrier, ETOH, drug)
* underlying condition

Answer 72

A

CHF
HCT <30%
ECG abnormal: changed, not sinus, new arrythmia
SOB
SBP <90

7D serious outcomes risk
if yes to any - not low risk

Answer 73

A

1 - pain with strenuous activity
2- pain with moderate activity (>2 stairs)
3 - pain with mild activity (1-2 stairs ) => 60%
4 - pain at rest (95% stenosis)

Answer 74

A

Nitrate responsive angina
transient ischemic - ECG changes
angiographic evidence of coronary artery spasm

Answer 75

A

Concordant STE >1mm + QRS (any lead)
Concordant STD >1mm - QRS (V1-V3)
Discordance >25% STE / STD than main vector QRS

Answer 76

A

No reciprocal changes
No isolated STE (inferior / limb leads)
max seen in V2-V5
Fish-hook => notching of terminal portion of QRS @ J point
J point elevation <3.5mm
STE <2mm in precordial leads / <0.5mm limb leads
temporal stability

Answer 77

A

1 - no symptoms with normal activity
2 - symptoms with normal activity
3 - symptoms with limitation of activity
4 - symptoms at rest

Answer 78

A

Transient LV systolic function, regional
No obstructive coronary disease /angiographic evidence of acute plaque rupture
New ECG abnormalities (STE / TWI) or modest cardiac TNT elevation
Absence of pheochromocytoma / myocarditis

extra:
ECHO - apical ballooning
ECG - transient anterior MI (q waves transient, STE)

Answer 79

A

PERICARDITIS
2 OF:
* typical chest pain
* ECG changes
* pericardial friction rub
* PCE (new / worsening)

MYOCARDITIS
@ least 1 of clinical:
* Pericarditis
* new SOB w/o HF
* unexplained Cardiogenic shock
* palpitations +/- arrythmia +/- syncope

1 diagnostic
* trop /CK +
* ECG - AVB, BBB, VF/VT
* ECHO/angio - evidence of LV depression

Answer 80

A

STAGE 1- Immediate (1wk)
* Diffuse STE, PR depression
* spodick sign - downslope TP
* reciprocal STD (AVR V1)

STAGE 2 - Days - 3wks (2wks
* Normalization ST/PR
* T wave flatten

STAGE 3 - 3wks
* TWI (deep)

STAGE 4 - >4wks
* Normalization of ECG
* Can have permanent TWI

Answer 81

A

Sinus node dysfunction
* Symptomatic bradycardia
* Chronotropic incompetence

AV node dysfunction
* Complete 3rd deg
* High grade 2nd deg => >2 blocked Ps
* symptomatic 2nd deg, type 1/2
* 2nd deg, type 2 PLUS 1) wide QRS or 2) chronic bi-fasicular block
* exercise = 2nd/3rd deg block w/o ischemia

Answer 82

A

Primary
MI + EF <30%
CM + EF <35% + NYHA 2/3
high risk for VT/VF:
Brugada
ARVC
Congenital long QTC
HOCM

Secondary
VT/VF arrest
unstable sustained VT + no underlying cause
sustained VT + heart dz
- CAD, dilated, channelopathy, valvular

Answer 83

A

Ventricular rate >200
undulating baseline of QRS axis
paroxysms last <90seconds

Answer 84

A

Absence of RS complex
RS >100msec
evidence of AV dissociation *
VT LBBB / RBBB morphology (think of LAFB / LPFB) =>
LBBB V6 qR / V1 rS
RBBB V6 rS / V1 qR

Answer 85

A

LBBB /RBBB (in V1+V6)
neither present
= Look for AV dissociation
if not present = SVT

Answer 86

A

RR
SpO2
Air vs O2
SBP
HR
LOC
Temp

Answer 87

A

Eye response

Motor response

Brainstem reflexes

Respiration

Answer 88

A

Phase 1: animal only
Phase 2: animal => human (isolated)
Phase 3: animal => human (sporadic)
Phase 4: human => human (local community)
Phase 5:human => human (x1 WHO region (6 total), x2 countries)
Phase 6: human => human (x2 WHO regions)

Answer 89

A

Phase 1: animal only
Phase 2: animal => human (isolated)
Phase 3: animal => human (sporadic)
Phase 4: human => human (local community)
Phase 5:human => human (x1 WHO region (6 total), x2 countries)
Phase 6: human => human (x2 WHO regions)

Answer 90

A

PHYSIOLOGIC(3)
* GCS <13
* SBP <90
* RR >30 / <10

MECHANISM (4)
* Fall (A >20ft / C >10ft)
* MVC vs pedestrian
* motorcycle
* MVC high risk (intrusion, pt death, ejection)

AGE / CO-MORBIDITIES (5)
* Old >75 (>50)
* children
* pregnant
* NOAC
* burns

ANATOMY(6)
* Open / depressed skull #
* paralysis
* flail chest
* open pelvis
* penetrating injury 1) head 2) neck 3) torso 4) prox extremity
* crushed / mangled extremities
* >2 prox long bone #

Answer 91

A

> 70 PLUS any of the following:

injury >2 body regions
GCS <15 + known /suspect TBI
SBP <100
fracture >1 prox long bone 2’ MVC
pedestrian vs MVC
falls from height (including standing) + suspect TBI

Answer 92

A

GCS <8
SBP <90 plus 1) GSW to prox extremities 2) neck 3) chest 4) abdo
2) intubated on scene
Penetrating GSW - neck, abdo, chest
resp compromise airway

Answer 93

A

Severity
* 3rd deg - any age
* partial thickness - >10% TBSA

Location
* Face
* hands
* genitalia, perineum
* major joints

Type
* Electrical
* chemical burns
* inhalational

PT characteristics
* BURN PLUS
- pre-existing med d/o
- co-comittant trauma
- peds in non peds hospital
- social / emotional / rehab intervention

Answer 94

A

HARD
* Airway compromise
* Bubbling air (wound)
* Bruit
* Blood ++
* Cerebral ischemia
* Decreased / absent radial pulse
* Stridor
* Subcut air ++
* Shock (no response to tx)
* Hemoptysis (massive)

SOFT
* Minor hemoptysis
* Neurologic findings
* Non expanding hematoma
* Oropharyngeal wound
* Proximity wound
* subQ air
* Hematemsis
* Dysphonia / dysphagia

Answer 95

A

HARD - AB2C-M
* Airway obstruction
* Bubbling
* Bony crepitus / subcutaneous empysema
* Clothesline mechanism
* Massive subcut air

SOFT
* Pain w tongue mov’t
* dysphonia
* SOB
* stridor
* hematoma = loss of thyroid prominence
* visible neck wound
* palpable cartilage fracture

Complications: 1) tracheal stenosis 2) hoarseness 3) vocal cord paralysis 4) laryngeal nerve

Answer 96

A

HARD
* Mottled / cool
* Arterial popliteal hemorrhage
* Rapid expanding popliteal hematoma
* Distal pulse deficit

SOFT
* Paresthesia

Answer 97

A

Basal cistern (normal, compressed, absent)
Epidural mass (present - 0, absent 1)
Intraventricular blood/SAH (absent 0, present 1)
Midline shift (<5mm 0 / >5mm 1)

pred 6mos mortality post TBI

Answer 98

A

0 – unruptured
1 – asymptomatic, minimal HA, no nuchal rigidity
2 – mod – severe HA, nuchal rigidity, no neuro deficits (excpt CN palsies)
3 – decr LOC, confusion, mild focal deficits
4 – stupor, mod-severe hemiparesis
5 – deep coma, decerebrate posturing

Answer 99

A

Age 40
Neck pain / stiffness
Thunderclap
LOC
Exertion - onset
Flexion - pain with flexion

if no to all - R/O SAH

Answer 100

A

INCLUSION
* >16
* atraumatic
* pain peaks in 1hr
* presents within 2wks
* GCS 15

EXCLUSION
* Focal neuro deficits
* papilledema
* Known aneurysm, tumor, hydrocephalus
* prior SAH / SAH dx made
* recurrent similar headaches
* rpt visit

Answer 101

A

GCS (3-4 +2 / 5-12 +1 / 13-15 0)
ICH vol >30mL
Intraventricular hemorrhage
Infratentorial hemorrhage
age >80

CT estimated mortality of ICH

Answer 102

A

A => complete, no sensation / motor, preserved in S4-S5
B => incomplete, sensation, no motor
C => incomplete, sensation, partial motor <3/5
D => incomplete, sensation partial, motor >3/5
E => normal, sensation, motor both intact

Answer 103

A

GRADE 1
* Intimal irregularity
* <25% narrowed

LMWH
rpt CT 7-10d => 3-6mos / endovascular stenting

GRADE 2
* Dissection / intramural hematoma
* >25% luminal narrowing, intraluminal clot
* visible intimal flap

Surgical accessible - operative repair
if not accessible - then grade 1

GRADE 3
* Pseudoaneurysm
* HD insignificant AV fistula

GRADE 4
Complete occlusion

GRADE 5
* Active extrav (hemorrhage)
* HD significant AV fistula

Operative repair
endovascular tx

Answer 104

A

ABCDEF
* Arterial hemorrhage
* (nose, mouth, neck)
* Bruit (cervical, <50)
* Cervical expanding,hematoma
* Deficit =/= findings on CT
* E(I)maging = stroke on CT
* Focal deficits:
1) TIA
2) hemiparesis
3) horners
4) vertebrobasilar

RISK FACTORS
* High energy transfer mech
* near hanging + anoxic brain injury

FRACTURES (5)
* Le fort 2/3
* Mandibular #
* occipital condyle #
* complex skull / basilar
* c spine # - any level

OTHERS:
* TBI + GCS <6
* TBI + thoracic inj
* degloved scalp
* upper rib #
* blunt cardiac injury
* thoracic vascular injury

Answer 105

A

LeFort 1
* Maxilla mobile
* transverse through maxilla - above roots of teeth

LeFort 2
* Maxilla + nasal complex
* maxilla => lacrimal bones, orbital floor + rim

LeFort 3
* Craniofacial disjunction
* maxilla => medial wall of orbit to include zygomatic arch

Answer 106

A

Class 1
* Enamel
* minimal pain

Dentist out of hospital

Class 2
* Enamel, dentin
* pain

Dressing w aluminum foil, CaOH2
Dentist in clinic

Class 3
* Pulp exposed
* v painful

Dentist on call

Answer 107

A

Distracting painful injury
Abnormal CXR
Rapid decel 1) fall >20ft 2) MVC >40ft
Tenderness 1) sternum 2) spine 3) scapula 4) chest wall

Answer 108

A

EAST
* >1500cc initial drainage
* >200cc/hr over 3hrs

ATLS
* >1500cc initial
* >200cc/hr / 3hrs
* persistent transfusion req’t

ROSENS
* Initial drainage >20cc/kg (peds 15)
* persistent bleeding >7cc/kg /hr (peds 2) (>200cc/hr) x3
* increasing HTX on CXR
* still hypotensive despite blood
* decompensation after initial resus

Answer 109

A

ROSENS
Cardiac arrest + SOL in field
SBP <50 post fluid
severe shock + clinical tamponade

EAST
Pulseless, SOL
- penetrating thoracic trauma
- no SOL, penetrating
- SOL, penetrating, extraT
- no SOL, penetrating, extrT

WEST
<15min pre hospital CPR
<5min pre hospital CPR (neck extremity)
profound refractory shock

Answer 110

A

Cardiac arrest in ED

EAST
Pulseless:
- SOL, blunt
AGAINST: no SOL, blunt (no pulse)

WEST
<10min pre-hospital CPR

Answer 111

A

(think HEAD-TOE) GT DAAVS
GCS 14 + blunt abdo trauma
Thoracic wall trauma
Decreased BREATH sounds
ABDO (4)
Abdo wall trauma
Abdominal tenderness
Vomiting
Seatbelt sign

other indications:
positive fast
hematuria
liver enzyme elevation
persistent hypotension NYD

high risk if yes to any = CT

Answer 112

A

Inclusion
* <18yo
* blunt abdo trauma
* within 24H

Exclusion
* Penetrating
* pre-existing neuro
* pregnancy
* CT already done

Answer 113

A

Type 1
Tendon rupture
closed
+/- dorsal avulsion

Type 2
Tendon laceration
open
skin tissue loss

Type 3
Tendon injury
open
skin + tissue loss

Type 4
Mallet fracture
A - transepiphyseal plate #
B - # of 25-50% of articular surface
C - # fragment >50% of articular surface

Answer 114

A

Scapholunate dissociation
* Terry Thomas sign => 2mm
* Signet ring sign (subluxed scaphoid)

Peri-lunate dislocation
* DORSAL d/c of capitate (radius - lunate intact)
* scaphoid, radial styloid, capitate #

Peri-lunate + Triquetrum d/c
* Capitate d/c, triquetrum d/c +/- #
* volar triquetral #

Lunate dislocation
* VOLAR d/c of lunate (Spilled Tea Cup sign)
* AP view: Piece of Pie sign (rotated lunate)

Answer 115

A

scaphoid
radial styloid
capitate
volar triquetral

Answer 116

A

(supracondylar fractures)

Answer 117

A

Type 1 no displacement
* Posterior splint, in flexion

Type 2 Displaced, stable
* <2mm - as above
* >2mm - ED ortho

Type 3 Displaced, unstable
* ED ortho

Answer 118

A

Type 1 no displacement
* Sling, early ROM

Type 2 <30% articular surface, >2mm displaced
* Sling, early ROM

Type 3 Comminuted
* Ortho +/- radial head excision

Type 4 Any of above PLUS elbow d/c
* Reduction
* Ortho

(radial head #)

Answer 119

A

Fragment parts => anatomical neck, surgical neck, greater tuberosity, less tuberosity

part 1 => no frag meets displacement criteria
* (<45deg angle / <1cm separation)

2 part => 1 segment displaced (2 total parts)
3 part => 2 parts, placed
4 part => 3 segments displaced

(prox humerus #)

Answer 120

A

Type 1 No/min displacement, lateral CC ligaments
* Conservative mgmt

Type 2
A - unstable - medial to CC ligament (medial portion d/p)
B - stable - fracture btwn CC ligaments (medial portion d/p)
* 2A= ORTHO
* 2B = conservative

Type 3 Intra-articular distal clavicle (AC joint)
* Conservative mgmt

Type 4 Peds only => SH1

Type 5 Comminuted, medial clavicle displaced, inferior frag attached to CC ligament
* ORTHO

(lateral clavicular #)

Answer 121

A

Immediate ortho
* Neurovascular compromise
* 100% displacement
* skin tenting
* open fracture
* soft tissue - Interpositioning

Delayed ortho (next day)
* Lateral: Type 2, type 5
* Middle: 100% displacement
* >2cm shortening
* severely comminuted
* Medial: >2cm overlap
* posterior displacement

Conservative mgmt
* Lateral: Type 1/3, stable
* Middle: non displaced
* Medial: non displaced
* peds - distal

Answer 122

A

Grade 1 Strain AC
* Sling

Grade 2 AC disrupted (widened AC)
* Sling

Grade 3 AC + CC disrupted (widened AC+CC)
* Sling
* ortho f/u

Grade 4 Posterior clavicular displacement
* Ortho

Grade 5 Superior clavicular displacement
* Ortho

Grade 6 Inferior clavicular displacement
* ortho

Answer 123

A

Type 1
Acromion process
scapular spine
coracoid process

Type 2
Scapular neck

Type 3
Intra-articular # of glenoid fossa

Type 4
Scapular body (common)

Answer 124

A

FOOT
* Pain in midfoot AND
* 1) tender @ 5th MT base
* 2) tender @ navicular region
* 3) no wt bear (4 steps)

ANKLE
Pain in malleolar zone AND
1) pain post. 6cm lat mal
2) pain post. 6cm med mal
3) no wt bear (4 steps)

Exclusion
<18yrs (now valid >2)
pregnancy
2nd presentation
isolated skin / soft tissue
10d post injury
not traumatic
sent from outside hospital w XR
intoxicated / unreliable

KNEE
If only 1:
>55yrs
can’t wt bear (4steps)
can’t flex knee (90deg)
isolated patellar pain
pain to fibular head

Exclusion
<18yrs (now valid >2)
pregnancy
2nd presentation
isolated skin / soft tissue
7d post injury
poly trauma / distracting

Answer 125

A

Grade 1 Ligamentous stretching
No joint instability

Grade 2 Partial ligamentous tear
Mod joint instability

Grade 3 Complete tear
Marked joint instability

Answer 126

A

Palpable gap
angle of declination
+ thompson test (squeeze = no plantar flexion)

incomplete - plantar flexion weakness

(Achilles rupture)

Answer 127

A

Type 1 Non displaced #
Type 2 # and subtalar subluxation
Type 3 As above + tibiotalar subluxation
Type 4 As above AND talonavicular

(talar fracture)

Answer 128

A

A Below tibio-talar joint
deltoid ligament disruption

B @ level of tibiotalar joint
50% disruption syndesmosis

C Above/prox to tibiotalar joint
disruption syndesmosis

(fibular #)

Answer 129

A

Type 1 Lateral tibial plateau
Type 2 Type 1 + depressed component
Type 3 Pure depression of lat tibial plateau
Type 4 Medial tibial plateau +/- depression
Type 5 Bicondylar fracture
Type 6 Dissociation of tibial metaphysis + diaphysis

(tibial plateau#)

Answer 130

A

Type 1 => incomplete avulsion (cast in extension)
Type 2 => complete avulsion (extra-articular)
Type 3 => complete avulsion (intra-articular)

(tibial tuberosity #)

Answer 131

A

TYPE A Intact posterior arch
* Stable Avulsion
* iliac spine#
* ischial tuberosity

TYPE B Incomplete disruption of posterior arch
rotation instability / vertical intact
* Lateral compression
* open book

TYPE C Complete disruption of posterior arch
unstable (rot + vertical instability)
* Iliac, sacroiliac + vertical sacral injury

Answer 132

A

Sartorius - Anterior superior iliac spine
Rectus femoris - Anterior inferior iliac spine
Iliopsoas -Lesser trochanter
Adductors - Inferior pubic rami
Hamstrings - Ischial tuberosity
Abdo muscles - Iliac crest

Answer 133

A

Penetrating injury
positive FAST
Shock index >1.0 (SBP/HR)
Pelvic fracture
>2 = MTP

Answer 134

A

Persistent hypovol in major pelvic # (despite hemorrhage control)
patient w evidence of arterial contrast extrav in pelvis by CT
angiography +/- embolization w ongoing bleeding after non pelvic sources of blood loss is r/o’d
>60 w major pelvic fracture (open book, butterfly, vertical)

Answer 135

A

Bacterial invasion - Primary
* Alveoli macrophages eat bacilli
* 1) infection stops (host wins)
* 2) infection continues (bacilli beats host immune system)

Tubercle formation - Primary
* Bacilli replicate and lyse macrophage, releases TB
* Tubercle formation
* lymphatic + hematologic spread => LD, kidneys, bones, VBs, lung

Granuloma - 2-3wks
(1) latent (2) progressive primary
* T cell mediated
* caseating necrotic granulomas
* 1) host response sufficient => latent TB
* 2) host response insufficient => progressive primary

Reactivation / Liquefaction - mos
Dormant foci reactivated =>
* 1) liquefication of tubercle + cavitation
* OR 2) re-infection

Answer 136

A

@ least 10days
persistent + not improving

Plus 1/3:
3-4D severe symptoms (T >39)
nasal discharge, facial pain => no improvement
onset of progressive symptoms with worsening symptoms after initial improvement

Answer 137

A

Painful anterior lymphadenopathy
Exudative tonsils
No cough
Fever
(all worth 1 point)
age 3-15 (+1) / age 15-45 (0) / age >45 (-1)

Answer 138

A

Joints - migratory polyarthritis
Carditis
Nodules, subcutaneous
Erythema marginatum
Sydenham chorea
CRP +
Arthralgias
Fever
ESR +
Prolonged PR

Answer 139

A

Soaring fever
Sore throat
Sandpaper rash (12-48H post fever)
Strawberry tongue
Streptococcal - Group A
Small <10

Pastia lines => in skin creases - then desquamates once rash is gone
Forcheimer spots - spots on palate

SIX S’S

Answer 140

A

Confusion
Urea >7
RR >30
BP <90
Age >65

0- 1 = outpatient
2 = admission / hospitalize
3-5 = ICU

Answer 141

A

Systolic BP low (2)
Multilobar (1)
Albumin (1)
RR high (1)
Tachycardia (1)
Confusion (1)
O2 poor (2)
PH acidotic (2)

>3pts = need for invasive resp + vasopressor requirements in >50

Answer 142

A

Age, sex
Vitals: RR, SBP, HR, Temp
bloodwork: BUN, Na, Glc, HCT
pAO2 <60 / pH <7.35
Pleural effusion on XR
Nursing home resident
altered
Comorbid - neoplastic dz, CHF, liver / renal dz

estimates mortality for adult patients w CAP
Class 4 / 5 = admit

Answer 143

A

Blood culture + (typical bacteria)
ECHO findings: 1) paravalvular abscess 2) new regurgitation 3) new dehesicance of valve 4) vegetation on valve
Fever
Vascular findings:
Immunologic findings:
Evidence - single positive C+S
Risk factors (see above)

x2 major / x1 major - 3min / 5maj

Answer 144

A

Vegetation OR peri-annular extension
Heart failure
Bacteremia (persistent)
Emboli, recurrent
Fungal

Answer 145

A

MUST FULFILL ALL:

<60D
Appears well
no evidence focal infection

No prior illness
* Term >37wks
* no perinatal abx
* no unexplained hyperbilirubinemia
* no prev hospitalizations
* no chronic / underlying illness
* not hospitalized longer than mother after delivery

Lab values
* WBC 5-15
* Band neutrophils <1.5
* urine WBC <5WBC/hpf
* CRP <20
* no diarrhea - if present (fecal leuks <5WBC/hpf)

febrile infants at low risk for SBI

Answer 146

A

4/5 CRASH + 5days of fever
Conjunctivitis => non exudative, bilateral
Rash => generalized (trunk => face + extremities)
Adenopathy, 1.5cm
Strawberry tongue / mouth change (cracked lips, pharyngeal erythema)
Hands/feet erythema - peeling => swelling of hands / feet

Cardiac findings => Prolonged PR, non specific ST/T wave changes

Answer 147

A

<6mos

2/5 CRASH + 5days of fever
CRP >30 / ESR >40
3 of PAAAWS
PLT >450
Anemia
Albumin <30
ALT elevated
WBC >15
Sterile urine >10WBC/hpf

Answer 148

A

24h of fever
<21
multisystem
Inflammatory markers [CRP >50, ferritin, procalcitonin, albumin, WBC (neutrophils, lymphocytes), PLT]
Sever symptoms => needing hospitalization
COVID +

Answer 149

A

Leukocytosis
Renal failure / AKI
I - hyperglycemia (>10)
Na - sodium low
Erythocyte (HgB <11)
CRP >150

>8 - high risk
<3 - low risk

Answer 150

A

Incubation -1-3mos
Prodrome - Days - wks
* ILI, non specific
* paresthesia around the wound
Acute Neuro 2 types
* FURIOUS/encephalopathic (80%)
* DUMB/paralysis (20%)
Coma
Death

Answer 151

A

GRADE 0 Minimal
* <1inch surrounding erythema + edeama
* no systemic symptoms >12H

GRADE 1 Minimal
* 1-5inches, erythema + edema
* pain + throbbing
* no systemic symptoms >12H

GRADE 2 Moderate
* Edema towards trunk
* petechiae + bruising to area of edema
* temp elevated, NV

GRADE 3 Severe
* <12h - edema to extrem + trunk
* petechiae, gen bruising
* HR, hypoptensive
* labs: elevated CK, AKI, decr PLT, fibrinogen
* elevated d dimer, PTT, WBC

GRADE 4 Very severe
* Ecchymosis, bleb formation, necrosis
* incontinence, seizures / coma
* cardiopulm arrest

Answer 152

A

Hematogenous (RF: extremes of age, vertebral OM, metaphysis OM, synovial involvement)
Contiguous - vascular source
Chronic (>6wks)

(OM)

Answer 153

A

STAGES
A - non infected
B - infected
C- ischemic
D - infected + ischemic

TEXAS GRADING
0 - pre ulcer
1 - FULL thickness ulcer
2 - tendon involved
3 - bone involved

Answer 154

A

What is KOCHER’S criteria
NEWT
>2 = 40% chance of septic hip
>3 = 93%

Non weight bear
ESR >40
WBC >12
Temp >38.5

*helps identify if effusion in peds is septic arthritis vs transient synovitis (US- b/l effusion)

>3 = 93% for septic arthritis

Answer 155

A

Recurrent episodes of UNILATERAL FACIAL PAIN => V2/V3 distribution
PLUS
Pain: 1) 1sec - 2min 2) severe 3) sharp electric, shooting
precipitated by innocuous stimuli (trigeminal distribution)
not explained by alternative dx

[other symptoms: Facial muscle spasms – tick douloureux, autonomic symptoms: lacrimation, conjunctival injection, rhinorrhea]

Answer 156

A

Grade 1: normal
Grade 2: mild - complete eye closure, normal symmetry @ rest
Grade 3: moderate - complete eye closure + noticeable asymmetry @ rest
Grade 4: mod-severe - incomplete eye closure + obvious asymmetry
Grade 5: severe - incomplete eye closure + muscle twitch
Grade 6: total paralysis

Answer 157

A

> 24H
Acute onset
persistent vertigo / dizziness
PLUS 1) nystagmus
2) N/V
3) head motion intolerance
4) gait unsteady

Answer 158

A

AP
* Fleck sign (# of metatarsal base)
* widening of MT 1+2 >2mm
* medial edge 2nd MT + medial cuneiform

OBLIQUE
* Medial edge 4th MT + medial cuboid
* base of 5th MT subluxed >3mm lateral edge of cuboid

LATERAL
* Dorsal alignment metatarsal + tarsals
* line btwn plantar aspect of 5th MT + medial coneiform

Answer 159

A

Large artery atherosclerosis (embolus / thrombosis)
Cardio-embolism
Small vessel occlusion
Stroke of other determined etiology
Stroke of undetermined etiology

Classification of ischemic strokes

Answer 160

A

Age >60
Blood pressure: >140/ >90
Clinical: a) unilateral weakness (2) b) speech only (1)
Duration of symptoms: a) >60min (2) b) 10-59min (1)
Diabetes

Predicts 7 day risk of stroke in patients w TIA

0-3 low risk
>4: high risk (mod 4-5 / severe >6)
- consider DAPT [ASA 325LD => 100mg daily / CLOPIDOGREL 300-600mg LD => 75mg daily] x3wks
- consider admission, neuro consult, MRI

Answer 161

A

Clinical
* 1st TIA
* >10min
* Initial DBP >110
* on an anticoagulant

hx:
weakness
gait disturbance
dysarthria / dysphagia
vertigo (-3)

Labs
* EKG - AFIB
* CT - old / new infarct
* glc >15
* plt >400

-3 to 3: low risk => non infused CT, outpatient follow up
4-8: moderate risk => non infused CT/CTA, emergent follow up
>9: high risk, non infused CT / CTA + neuro in ED

Answer 162

A

WEAKNESS (pronator driftt) PLUS
Vision
Aphasia
Neglect

identifies large vessel occlusion

Answer 163

A

a) aLOC
b) questions
c) follow commands

Best language
Dysarthria

Eyes:
Best gaze
Visual fields

Extinction of neglect
Sensory

Facial palsy
Motor (arms)
Motor (legs)
Limb ataxia

quantifies stroke severity

0-4 = minor ischemic stroke

Answer 164

A

0 – no symptoms
1 – symptoms, no disability
2 – mild disability, independent of all ALDs
3 – mod disability, independent of walking
4 – mod – severe disability, walk w assistance
5 – bedridden
6 – death

Quantifies degree of disability on daily life post stroke

Answer 165

A

Without aura (5 4-3 2 1)
>5 attacks
4h-3d
2 of (DUMP - disabling, unilateral, mod-severe pain, pulsatile)
+ 1 of (N/V or photophobia / photophobia)

Answer 166

A

With aura
>2 attacks
>1 aura (retinal, visual, sensory, speech, motor, brainstem)
+ >3 of following
>2 succession,
w or within 6hrs of HA
unilateral
5-60min
positive sx (scintillating scotomas, photopsia, blurred vision, teichopsia, fortification spectrum)

Answer 167

A

> 5 attacks:
Unilateral
orbital / temporal pain
1.5-3 hr (lots in 24H)
either / both:
1) restlessness / agitation
2) at least 1:
conjunctival injection
nasal congestion
eyelid edema
miosis/ptosis
face sweating

Answer 168

A

> 5 attacks:
Unilateral
orbital / temporal pain
1.5-3 hr (lots in 24H)
either / both: 1) restlessness / agitation
2) at least 1: conjunctival injection, nasal congestion, eyelid edema, miosis/ptosis, face sweating

Answer 169

A

HA better with LP
Increased ICP signs: papilledema / vomiting
LP negative
Opening pressure >280 (peds) / >250 (adults)
CT normal

*VISUAL SYMPTOMS => transient photopsia, diplopia, pulsatile tinnitus

Answer 170

A

minimum
1) Lower abdomen pain OR
2) adnexal pain OR
3) CMT

Additional criteria
1) Fever >38.3
2) ESR/CRP
3) WBC on wet mount
4) G+C positive
5) cervix is friable / mucopurulent vag d/c

Definitive Dx Criteria
1) Endometrial bx w histopathologic evidence of endometritis
2) TV US - thickened fluid filled tubules +/- free pelvic fluid
3) gold standard- laparoscopy => abnormalities consistent w PID

Answer 171

A

Need 3/4
1. thin, white, homogenous discharge - coats vaginal walls
2. clue cells on microscopy
3. vaginal fluid ph >4.5
4. fishy odor to discharge pre/post addition of 10% KOH

(bacterial vaginosis)

Answer 172

A

crying no reason
>3hrs a day
>3d /week
in an infant <3mos old

different from normal: episodes of hypertonia, louder / higher / more variable, paroxysmal, non consolable

(infantile colic)

Answer 173

A

<1yr)
Brief (<1min)
Resolved (normal vitals / physical exam)
Unexplained
Event >1 of ABCT: aLOC / breathing - irregular, apnea / cyanosis, pallor / tone (hyper-hypotonia)

Answer 174

A

Retractions (0-3)
Air entry (0-2)
Stridor (0-2)
Cyanosis (0/4 w agitation / 5 at rest)
LOC (0 normal / 5 altered)

Mild 0-2 / Mod 3-5 / Severe 6-11 / failure >12

Answer 175

A

Suprasternal indrawing: 0 (absent) 2 (present)
Scalene retractions: 0 (absent) 2 (present)
O2 on RA: 0 (>93%) / 1 (90-93%)/ 2 <90%
Wheezing0(absent)/1(exp only)/2(exp+insp)/3(silent chest)
Air entry0(normal)/1(decr @base)/2(+decr)/3(minimal)

MILD0-3 / MOD4-7 / SEVERE8-12

Answer 176

A

General appearance
Eyes (sunken)
Tears
Mucous membranes
Breathing (i.e. kusmall)
Quality of pulses
Skin turgor
HR
Urine output
Cap refill

Answer 177

A

Suspect open / depr’d skull #
Irritable on exam
GCS <15 @ 2H post
History of worsening HA
Basilar skull # signs
Boggy hematoma large
Dangerous mechanism

(vomit x4 => CATCH2)

Mechanisms
* fall >3ft / 5 stairs
* MVC
* Bike + no helmet

YES TO ANY - CT

Answer 178

A

INCLUSION
* within 24h
* GCS 13-15
* <16yrs
* (Minor head injury):
* confused
* amnesia
* LOC - witnessed
* emesis >1 episode
* persistent irritability

EXCLUSION
* penetrating
* depressed skull #
* focal neuro
* developmental delay
* child abuse
* re-evaluate
* pregnancy

Answer 179

A

HIGH RISK vs CT
* GCS <15
* Altered LOC
* Skull # <2: palpable depressed / >2: basilar skull #

MEDIUM RISK - OBS vs CT
* H: <2 hematoma />2 HA
* Acting: <2 weird />2 emesis
* LOC: <2 >5seconds />2 any LOC
* Mechanism*

Mechanisms
* pedestrian
* ejection
* MVC death
* rollover
* fall >3ft (<2y) / >5ft (>2y)
* axial load

Answer 180

A

INCLUSION
* within 24H
* GCS 14
* <18yrs

EXCLUSION
* penetrating
* pre-existing neuro
* pre-hospital imaging
* no signs of trauma
* trivial injury
=> ground level fall
=> ran into things

Answer 181

A

HIGH RISK
* >65
* 2 fractures - basilar skull
* - open /dep
* 2 emesis
* 2HRS post injury; GCS <15

MEDIUM RISK
* Amnesia pre impact
* Dangerous mech

Mechanisms
* Pedestrian
* ejection
* fall >3ft / 5 stairs

Answer 182

A

INCLUSION
* within 24H
* GCS 13-15
* (Minor TBI):
* BLUNT +
* confused
* amnesia
* LOC - witnessed

EXCLUSION
* pregnancy
* Penetrating
* pediatrics >16
* presenting twice
* prolonged >24H
* anticoagulated
* neuro def focal
* trauma unstable
* seizure pre ED

Answer 183

A

HIGH RISK: DAP
* Dangerous mech
* Age >65
* Paresthesia

Low risk (5)
* simple rear ended
* sitting in ED
* ambulatory
* no midline neck pain
* delayed onset of neck pain

Mechanisms
* fall >3ft
* axial load
* ATV
* MVC high speed
* ejection
* roll over
* bike struck

Answer 184

A

INCLUSION
* <48H + neck pain OR
* dangerous mech
* not ambulatory
* Injury > clavicle
* GCS 15
* >16
* blunt

EXCLUSION
* pregnancy
* penetrating
* pediatric <16
* presenting twice
* previous VB injury / pathology
* pev spin surgery
* paralysis
* no trauma
* unstable

Answer 185

A

Neurologic deficit
Spinal tenderness (midline)
Altered LOC
Intoxication
Distracting injury

Answer 186

A

0.01mg/kg
allergy: 1mg/mL
cardiac: 0.1mg/mL
Infusion: 0.1-1mcg/kg/min

Answer 187

A

PE (TPA)
cardiac arrest (50mg)
non arrest (10mg LD => 90mg / 2hrs => total 100mg Q24H)

STROKE
0.9mg/kg (max 90mg)
1.10% of dose (bolus), 90% of remainder of dose /1hr

STEMI
NON ARREST: 15mg / 2min then 0.75mg/kg (max 50mg) over 30min THEN 0.5mg/kg (max 35mg) over 60min
CARDIAC ARREST: 50mg IV

Answer 188

A

absolute
* ICH imaging
* active bleeding

relative:
* Any ICH
* CVA <3mos >4.5H
* ICH malignancy
* known intracranial AVM
* face/head trauma <3mos
* aortic dissection
* intra-cranial/spinal surgery <2mos
* HTN unresponsive to treatment (SBP >185 / DBP >110)

Hx of ischemic CVA >3mos
pregnancy
recent internal bleeding 2-4wks
major surgery <3wks
active PUD
sig HTN on presentation

stroke specific:
* SAH specific sx + normal CT
* PLT <100
* currently anticoagulated
* hypo/hyperglycemia
* minor symptoms / improving
* GI hemorrhage <21d
* GI malignancy

Answer 189

A

Absolute:
* Any ICH
* Active bleeding
*
* CVA 3mos 4.5H
* ICH malignancy
* known intracranial AVM
* face/head trauma 3mos
* aortic dissection
* intra-cranial/spinal surgery 2mos
* HTN unresponsive to treatment
* (SBP >185 / DBP >110)

relative
* Hx of ischemic CVA >3mos
* pregnancy
* recent internal bleeding 2-4wks
* major surgery <3wks
* active PUD
* sig HTN on presentation

Cardiac arrest / PE specific:
* Traumatic (PTX, flail, pulm contusion, hemorrhage) or prolonged CPR >10min
* dementia

Answer 190

A

SSRI
Ibuprofen, opiates
Anti-epileptic drugs; carbamazepine, VPA, SSRIs (i.e. sertraline), barbiturates
Diuretics - thiazide
Haldol

OTHERS:
Cancer drugs - anti-neoplastics, vincristine
Antipsychotics- haldol, thioridazine, amitriptyline, MOIs, SSRIs
Pain; opiates, NSAIDs
Exogenous hormone administration; vasopressin, desmopressin (dDAVP) or oxytocin
Thiazide diuretics
Cyclophosphamide

Answer 191

A

OCPs
Sulfa drugs (septra, dapsone)
Allopurinol
Tetracycline - doxycycline. Other abx: levo, cipro, amoxicillin, ampicillin
Tb - rifampin (associated)
Antiseizure(PD-LC): phenobarb, dilantin, lamotrigine, carbamazepine
NSAIDs

viruses: mycoplasma, HSV

Answer 192

A

Antiseizures (PD-LC)- Phenobarb, dilantin, lamotrigine, carbamazepine
Sulfa - dapsone, septra
Allopurinol

DRESS specific:
Vanco
All of RIPE

Answer 193

A

SITOP
Sulfonamides
Iodides
TNF alpha inhibitors
OCPs
Penicillins

Answer 194

A

Chloropromazine
Hydralazine
INH
Methyldopa
Procainamide

Answer 195

A

Propofol
Acetaminophen
NSAIDs/nitrofurantoin
Cannabis
Rifampin
Estrogen
ASA
Steroids / sulfa

Answer 196

A

Cocaine
Chemo - cisplatin, cycospirin
Ibuprofen, IVIG
Heparin, LMWH, clopidogrel
Antiepileptics - phenytoin, VPA
Tylenol
Ethambutol
Penicillin
Lasix
TMP/SMX
Statins / Salicylates

Answer 197

A

Antipsychotic - haldol, olanzapine
anti-depressants - TCA, citalopram, lithium
anti-arrhythmic - procainamide, amiodarone
antibiotics - azithromycin, macrolides
anti-emetics - ondansetron, gravol
anti-malarial - quinine
Anti-histamine - benadryl

Increased ICP
hypothermia
hypoK/Ca/Mg
Hydrofluoric acid, ethylene glycol (2’ oxalate byproduct)
methadone
congenital - MVP, Romano-ward, Jarvell-Lange-Neilson

Answer 198

A

Antipsychotic - Quetiapine
Drugs of abuse: cocaine, oxycodone ER
Antibiotics - septra, flagyl, penicillin
Quinine
Immunosuppressive - cyclosporin, IVIG, interferon alpha/beta

Answer 199

A

Acute ETOH
antifungals (ketoconazole, fluconazole)
antiarrythmics (amiodarone, verapamil)
antidepressants (SSRI’s)
antiviral HAART
antibiotics - Sulfa, macrolides, fluoroquinolones, flagyl, erythromycin, clarithromycin
INH
PPI’s
NSAIDS, ASA
Tylenol, tramadol

INCR INR

Answer 200

A

Chronic ETOH
CRAPS
Carbamazepine
rifampin
alcohol (chronic)
Phenobarbital, phenytoin
sulfonylureas, St johns wart
dexamethasone

Answer 201

A

Age
parity
tobacco, ETOH, drugs
infection
trauma
fibroids
Hx of miscarriage

Answer 202

A

smoking, advanced age
PID
IUD
Tubal surgery (for tubal sterilization
hx: prior spontaneous abortion, medically induced abortion
Hx of ectopic
hx of infertility

Answer 203

A

Indications
* Stable (hemodynamic)
* reliable
* BHCG <5000
* US:
- tubal mass <3.5cm
- no cardiac activity
- no evidence of rupture

Contraindications
* Bone marrow d/o: leukopenia, thrombocytopenia
* Hepatic disease
* renal disease
* heterotopic preg
* breastfeeding

Answer 204

A

Previous
extremes of age (mostly >35)
spontaneous abortion
infertility

Answer 205

A

Extremes of age (<20 / >40)
Obesity, smoker, black
Parity: primigravida, nulliparity
twin / molar pregnancy
HTN hx: 1) chronic HTN
2) renal dz
3) Hx of pre-eclampsia
4) gestational HTN
5) vascular disease
Autoimmune: SLE, antiphospholipid, hyperthyroid
sleep disordered breathing
Invitro fertilization

Answer 206

A

> 20wks
140/90
no proteinuria
no EOD

Answer 207

A

<20wks PLUS
>140/90 (x2) or >160/110 (x1)
PLUS
proteinuria - dip / >0.3mg/dL
OR
EOD: CEELLP
Cr >1.5
Eyes - disturbances
Encephalopathy
LFTs x2ULN
Lung edema
Plt <100

Answer 208

A

Hemolysis: @ least 2
- peripheral smear (schistocytes + burr cells)
- LDH x2 ULN OR haptoglobin down
- bili up
Elevated Liver enzymes: AST/ALT x2 ULN
Plts <100

Answer 209

A

microinfarcts
edema
hemorrhage - punctate
hemorrhage- cerebral

Answer 210

A

Trauma
HTN
Twins
Tobacco
thrombophilia

age
parity
prev abruption
cocaine use
pre-eclampsia

Answer 211

A

Polyps
Adenomyosis
Leimyoma
Malignancy
Coagulopathy => vWF, hemophilia, low plts, ITP
Ovulatory dysfxn
Endometrial
Iatrogenic
Not yet classified
Endocrine: weight related (anorexia/obesity, pregnancy, exercise, PCOS), hyperprolactinemia, Cushing’s, adrenal hyperplasia, hypothyroidism

Answer 212

A

Obesity
later menopause
nulliparity
estrogen - 1) exogenous (tamoxifen) 2) unopposed (PCOS)
>35
DM

Answer 213

A

VTE risk
smoker
<35
pregnancy
HTN >160/100
IHD
CVA, migraines
breast CA
Liver cirrhosis
DM

Answer 214

A

Tumors
cysts >5cm - increases risk significantly
PCOS
IVF, hyperstimulation
pregnancy, reproductive age
hx of tubal ligation

Answer 215

A

General
* Enlarged ovary
* Ovarian mass
* Ovarian edema
* Pelvic free fluid

US
* No venous flow
* No arterial flow
* loss of enhancement
* whirpool sign

CT
* FT thick
* hemorrhage
* uterus deviated to affected side

Answer 216

A

Higher fulcrum (C2-C3: 2y => C5-C6: 8y)
pseudo-subluxation (C2-C3 in children <8-12y)
large head => greater flex / ex injuries
large occiput => head in flexion
Ligamentous injury > fractures
incomplete ossification = hard to read XR
spinal processes epiphysis = fractures
SCIWORA
pre-vertebral space (changes w inspiration)

Answer 217

A

High ammonia + acidosis
- fatty acid defect
- carb storage defect
- organic acidemia

High ammonia only
- urea cycle

No acidosis / No ammonia
- amino acid (= NO AA)

Answer 218

A

Activity
Pulse
Grimace
Appearance
Respiration

Answer 219

A

> 60days
premature: >32wks, post conception age >45wks
only one BRUE (no hx of previous)
duration <1min
no CPR needed by trained medical provider

no concerning history
- including risk for child abuse
- resp illness
- recent injury
- symptoms in days preceding event
- medication
- vomiting / lethargy
- developmental dealy
- hx of sudden unexplained death in a sibling

normal physical exam / normal vitals

Answer 220

A

Narrowed subglottic space
ragged edge of usually smooth tracheal air column
hazy density within tracheal lumen

Answer 221

A

Bronchiolitis
Croup
Pneumonia
TB
Bronchiolitis obliterans
GERD
Cystic fibrosis
CHF
Tracheo-esophageal fistula
Mediastinal mass
Vascular ring
Foreign body aspiration
Anaphylaxis

Answer 222

A

atelectasis
diaphragmatic flattening
bronchial wall thickening
peri-bronchial cuffing

Answer 223

A

Peyer’s patches (inflamed lymphoid tissue)
HSP vasculitis
Meckel’s diverticulum
Lymphoma
Polyps
post surgical scars
celiac disease
cystic fibrosis

Answer 224

A

Target sign
crescent sign
meniscus sign
free air (if perf)
dilated small bowel
lack of air in cecum / large bowel

Answer 225

A

Anesthetic complications
Bleeding
Cardiovascular - takutsubos, PPMS
Drugs
Embolic (PE, amniotic)
Fever
General non obstetric causes of CA (H+Ts)
HTN (eclampsia)

Answer 226

A

Hormone causes Ca release (PTHrP, prostaglandin, peptides)
Metastatic disease (osteoclasts = release Ca / PO4)
Lymphomas (secrete 1,25 OH)
Ectopic hyperparathyroidism

Answer 227

A

LAB DX: 2 BW (25% incr / decr)
3d before / 7 d post chemo
* Uric acid (high)
* K >6
* phosphate (high)
* Calcium (low)

CLINICAL DX: Lab TLS+ 1 clinical
* AKI 1.5 xULN
* cardiac - arrythmia, sudden death
* neuro - seizures

Answer 228

A

Calcium up
Renal dysfunction
Anemia
Bone disease

Answer 229

A

HgB >185 (M) >165 (F)
Not hypoxic (O2 >92%)
splenomegaly

Answer 230

A

Apparent - dehydration
Primary - myelodysplasia (myeloproliferative D/O)
Secondary - CHF + shunt, COPD, sleep apnea, high altitude, COHgB

Answer 231

A

Blood pressure (>90 = +5 / <90 = 0)
Burden of disease (5+ / 3+ / Severe = 0)
COPD (4+ not active / active = 0)
Cancer type (solid, hematologic, no prior fungal 4+ / prior fungal infxn + heme = 0)
Fluid (no dehydration = 3 / need fluids = 0)
Fever (temp outpatient =3 / temp in hospital = 0)

<21 = high risk

Answer 232

A

no comorbid
no source of infection (PNA, line)
no acute leukemia
hemodynamically stable
MASCC >21

Obs 4hrs
onc doc agrees
compliant patient
access to phone / transport back to hospital

cipro 750mg PO BID + amox/clav

Answer 233

A

comorbid
evidence of infection => PNA, SSTI, line, AMS, end organ damage
acute leukemia
HD unstable, organ failure
MASCC <21

uncontrolled cancer
expected neutropenia >10d

Piptaz/vanco +/- gentamicin if sick
peds - cefepime/ piptaz/ meropenem

Answer 234

A

FFP: 4U (10cc/kg)
* F8
* fibrinogen
* clotting factors

CRYOPRECIPITATE: 10U = 4g fibrinogen (1U/10kg)
* F8
* F13, vWF
* fibrinogen (150mg/unit)

PCC: 30U/kg (max 3000)
* F2,7,9,10
* Protein C+S
* heparin

Adjuncts
* TXA 1g
* Vit K 10mg
* DDAVP 20mcg (incr F8, vWF release)

Answer 235

A

BAL (dimercaprol)
Amyl nitrite, all nitrites
Rasburicase - can cause metHb
Fluroquinolone - ciprofloxacin, moxifloxacin
Nitrofurantoin, nitroprusside
Methylene blue
EMLA (prilocaine)
Dapsone
Sulfonylureas - glipizide, glyburide

Answer 236

A

extrinsic: 7
intrinsic: 8, 9, 11, 12
common pathways: 10, 5, 2 (prothrombin), 1
vitamin K dependent factors: 2, 7, 9, 10

Answer 237

A

Heparin (Protamine 1mg / 100U UFH)
Thrombin (2a)
* aPTT

LMWH (Protamine 1mg /1mg LMWH)
Xa
* Anti-Xa

Warfarin (Vit K, PCC(octaplex) / FPP)
Vit K antagonist
* INR

Dabigatran (Praxbind 5mg)
Thrombin (2a)
* TT

Apixaban/Rivaroxaban (Andexanet alfa, octaplex )
F10a
* anti Xa

Answer 238

A

DKA
* Glc >11.1
* AG >12
* Bicarb <15
* pH <7.3
* BUN 25-50
* + ketones

HHS
* Glc >33 mmol/L
* AG variable
* Bicarb >15
* pH >7.3
* BUN >50
* no ketones
* osmoles >330 mOsm/L

Answer 239

A

Tachycardia
Precipitating event (ACS, MI, PE)
Mental status
Fever
GI/hepatic symptoms
CHF

> 45: thyroid storm / 25-44: impending storm / <25: unlikely

Answer 240

A

Pregnancy
Trauma - penetrating / blunt to gland, burns
Sugar - DKA, HSS, hypoglycemia
Surgery
Stress
Drugs - thyroid hormone, lithium
Infection, sepsis
Ischemia - MI, PE, CVA
Iodine - amiodarone, contrast

Answer 241

A

> 20mg/day
700mg total
30days duration

Answer 242

A

Allergic
i. IgE mediated
ii. Mast cell mediated
* Anaphylaxis

Cytotoxic (Antibody / IgG/IgM)
* Blood transfusion (ABO incompatibility)
* RH reaction

Immune (Immune complexes)
* Serum sickness
* reactive arthritis

Delayed hypersensitivity (T cell)
* Contact dermatitis
* DRESS /erythema multiforme, SJS/TENS

Answer 243

A

Known exposure PLUS hypotension
Likely exposure PLUS (2 of):
1. Mucosal / skin involvement (hives)
2. Resp involvement (wheezes, SOB etc)
3. GI involvement - N/V
4. Hypotension
Unknown exposure/allergy PLUS skin/mucosal involvement AND (1 of)
1. Resp involvement
2. Hypotension

Answer 244

A

Allergy - histamine mediated

Hereditary - bradykinin (C1 inhibitor deficiency)

Acquired - bradykinin (C1 inhibitor deficiency)

ACEi induced - aCEi induced (ACE activates bradykinin)

Idiopathic - bradykinin (unknown)

Answer 245

A

Serositis [pleuritis, effusion, pericardial effusion / pericarditis]
Oral ulcers [palate, buccal, nasal, tongue]
Arthritis [>2 joint, >30min AM]
Photosensitivity
Blood d/o => pancytopenia
Renal d/o [++protein, red blood casts]
ANA
Immuno criteria
Neuro d/o [seizures, psychosis, CN neuropathies, confusion state]
Malar rash
Discoid rash

Answer 246

A

Large
* GCA
* Takayasu’s

Medium
* Pan Nodosa Arthritis
* Buerger’s disease
* Kawasaki’s disease

Small
* Bechet’s disease
* Goodpasture’s disease
* Wegner’s granulomatosis
* Microscopic polyangiitis
* Churg-Strauss dz
* HSP
* ANCA associated

Answer 247

A

> 3 oral aphthous ulcers / year PLUS 2 or more:
* recurrent genital lesions
* recurrent eye lesions (uveitis cells, retinal vasculitis)
* recurrent skin lesions (erythema nodosum)
* pathergy test (non specific hypersensitivity test)

Answer 248

A

Monoarticular
* Osteoarthritis
* Septic arthritis
* Gout / pseudogout
* Trauma

Polyarticular - Symmetric (PAPER)
* Polymyalgia rheumatica
* Ankylosing spondylitis
* Psoriatic arthritis
* Enteric arthritis
* RA

Polyarticular - Asymmetric
* Disseminated gonococcal
* ARF - post GAS
* Lyme
* Reactive
* Viral - dengue, chikungunya
* rat bite fever

Answer 249

A

Subchondral bone destruction
periosteal new bone
joint space narrowed / lost
osteoporosis
joint effusion

Answer 250

A

Asymmetrical joint space narrowing
sclerosis of juxta-articular bone
bone spurs (subchondral)
subchondral cysts
sclerosis
no osteoarthritis

Answer 251

A

Yersinia
E coli
Shigella
Salmonella
Campylobacter
Vibrio
Gonorrhea, chlamydia

Answer 252

A

Osteoporosis (peri-articular bone)
symmetrical joint space narrowing
marginal erosions
little reactive bone formation

Answer 253

A

Age >50
ESR >40
Bilateral hip/shoulder pain x 30 days

Answer 254

A

SSRIs
Ibuprofen
Anti-epileptics: carbamazepine, VPA, phenobarb
Diuretics - thiazide
Haldol
Pain meds: opiates, NSAIDs
Oxytocin
Cyclophosphamide

Answer 255

A

ALCOHOL
* Methanol
* ethylene glycol
* propylene glycol
* isopropanol (no AG)
* ethanol
* Acetone

SUGAR
* Mannitol
* sorbitol

FAT
* Hyperlipidemia

PROTEIN
* MM
* gamma globulins

Answer 256

A

Renal failure
alcohol ketoacidosis
Methanol
multiorgan dysfunction
Ethylene glycol
DKA

Answer 257

A

Methanol
urea
DKA
Paraldehyde / APAP
Iron / isoniazid
Lactic acidosis
Ethanol
Salicylate / ASA /aspirin

Answer 258

A

HyperCl
HyperPTH
Addisons
Acetazolamide
RTA
Diarrhea
Uretero-enteric fistula
Pancreato-enteric fistula

Answer 259

A

Contraction alkalosis (diuretics)
Licorice
Endo - Conn’s, Cushings
Vomit
Excess alkali (bicarb)
Refeeding

Answer 260

A

phenytoin, penicillin
Iron, Ibuprofen
L-arginine
Lincomycin
Steroids

Answer 261

A

Recurrent abdo pain
>1mo
Pain present >25%
no organic disease

Answer 262

A

14d PO

Bismuth therapy (PF - TB)
* PPI
* Flagyl
* Tetracycline
* Bismuth

Non Bismuth therapy (PF - AC)
* PPI
* Flagyl
* Amoxicillin
* Clarithromycin

Answer 263

A

A - acetaminophen, Hep A, amanita phalloides
B - Budd Chiari, Hep B
C - Hep C, cancer
D - drugs, toxins
E - ETOH, EBV
F - fatty liver
G - genetic => Wilson’s
H - HSV, HELLP
I - Ischemia, sepsis, shock

Answer 264

A

PRIMARY
* >250mm PMNs
* + ascites fluid culture

SECONDARY: RUYON’S CRITERIA (need 2):
* glc <2.8mmol/L
* protein >10g/L
* LDH > upper limit of normal

PD
+ dialysate fluid culture
OR >2 of:
* dialysate PMN >100
* +effluent fluid
* cloudy fluid/abdo pain

Answer 265

A

Chronic / acute hepatic disease with advanced hepatic failure + portal HTN
AKI (Cr >150)
* absence of other apparent cause of AKI
* no parenchymal disease: protein >500mg/day, microhematuria >50cells/hpf
* Failure to improve despite fluid replacement, stopping diuretics, albumin

Answer 266

A

False positive
* Bismuth
* iron
* red meat
* NSAIDs

False negative
* Pepto bismol
* Beets
* Magnesium.
* Spinach

Answer 267

A

Lab
1. BUN
2. HgB
3. SBP <110
4. HR >100
Clinical
1. Melena
2. Syncope
3. CHF
4. Hepatic disease

0 = low risk / >0 = high risk

Assesses need for intervention in UGIB

Answer 268

A

Age <60
BP / HR - evidnece of shock
Comorbidities (liver dz, CHF)
Diagnosis (mallory weiss = no lesion = 0)
Endoscopic findings of recent bleed

<3 = low risk / >8 = high risk

Assesses risk for bad outcomes (recurrent bleeds/death)

Answer 269

A

Preterm
Hemolysis - G6PD, hereditary spherocytosis
Acidosis
Temperature instability
Lethargy
Albumin - low
Asphyxia
Sepsis

Answer 270

A

Idiopathic
Ischemia
Gallstones
ETOH
Tumors - ampullary tumor, pancreatic carcinoma, neuroendocrine tumor
Trauma - penetrating, blunt
Vascular - hypoperfusion, embolism, ischemia, hypercoagulopathy, vasculitis
Steroids
Mumps - viral: coxsackie, HIV, CMV, EBV, varicella, bacteria: TB
Autoimmune
Scorpion bites
Hyperlipidemia, hypercalcemia, hyperuremia, hereditary
ERCP - post
Drugs**

Answer 271

A

Propofol
Acetaminophen
NSAIDs
Cannabis, cancer meds: cisplatin, cyclosporine
ETOH
ASA
Sulpha drugs, steroids

Answer 272

A

No organ failure, no systemic complications
No organ failure <48H, some systemic complications
Organ failure >48H

Answer 273

A

Pancreatitis
Pancreatic tumor
Pancreatic stone
T2DM
DKA
PUD
peritonitis
bowel obstruction / infarction
Celiac disease
IBD
post ERCP
cholecystitis
renal failure
Ectopic pregnancy

Answer 274

A

Ranson’s
APACHE II
BISIP
CTSI score

Answer 275

A

@ admission
* Glc >11.1
* Age >55
* LDH >350
* AST >250
* WBC >16

@48H
* Ca < 2mmol/L
* Hct 10% drop
* paO2 <60
* BUN <2 (1.8mmol/L)
* Base deficit 4
* Sequestration of fluid >6L

Answer 276

A

SIGNS
* RLQ +
* Fever
* rebound tenderness

SYMPTOMS
* Migration of pain to RLQ
* nausea
* anorexia

LABS
* WBC >10
* leuk L shift

<4 = low risk
>6 = high risk

Answer 277

A

Apthous ulcers, anemia of chronic disease
Pyoderma gangrenosum, psoriasis
Iritis, uveitis, scleritis, episcleritis
Erythema nodosum
Sacrolitis, sclerosing cholangitis (GI?)
Arthritis (crohns), ankylosing spondylitis
Clubbing of fingers
Kidney stones

Answer 278

A

Spinal cord injury, CVA, seizure d/o
Toxic – black widow spiders
Illicit drugs – ETOH, cocaine, marijuana
Leukocytosis – leukemia, MM, SCD
Hypertensives – labetalol, hydralazine, prazosin
Anticoagulation – warfarin / heparin stopped
Ritalin
Depression – SSRI, trazadone, antipsych (risperidone)
other: cancers - bladder, prostate Ca, RCC mets

Answer 279

A

Labetalol, hydralazine, prazosin
IV heparin, stop warfarin
Methylphenidate
PDE-5 inhibitor
Drugs of abuse: ETOH, cocaine, marijuana
Depression: trazodone, risperidone

Answer 280

A

Drugs
* Antihistamines
* Anticholinergics
* Antidepressants
* Antispasmodics
* Amphetamines

Obstructive
* BPH, Prostatitis
* Tumor
* Phimosis meatal stenosis
* Foreign body
* Stricture

Other
* Trauma - rupture
* UTI
* prostatitis
* urethritis
* Lazy bladder syndrome

Neurologic
* Spinal shock
* spinal cord injury
* MS
* Herpes zoster
* DM

Answer 281

A

Renal infarct, hemorrhage
renal tumor, urothelial tumors, metastatic tumors (of upper + lower urinary tract, ureter)
pyelonephritis
previous surgery (stricture)
urinary retention
papillary necrosis

Answer 282

A

hyaline casts => dehydration, exercise, glomerular proteinuria
RBC => GN, vasculitis
WBC => pyelonephritis, papillary necrosis, renal parenchymal inflammatino
Muddy => ATN
Eosinophilic => AIN

Answer 283

A

HYPOproteinemia (serum albumin low)
Proteinuria
A) >3g/day OR
B) single spot urine collection
PR/CR >3mg/dL
Edema
HYPERlipidemia

Answer 284

A

Rise of Cr >25% from baseline
24-48H within exposure
AND
1. non oliguria
2. usually ATN
3. absence of other causes

Answer 285

A

MAOi
Anti-psychotics (NMS)
Statins
Steroids
Sympathomimetics
SSRIs (Serotonin syndrome)

Volatile anesthetics, SCh (MH)

Answer 286

A

SJS / TENS
Strep TSS
Staph TSS
Staph SSS
erythroderma
burns (thermal, radiation)
pemphigus vulgaris
bullous pemphigus
kawasaki

Answer 287

A

Penicillins
OCPs
Sulfonamides
Iodides
TNF alpha inhibitors

Answer 288

A

Yersinia, salmonella, campy
EBV (mono) + other viruses: HSV, HIV, HEP
Strep (GAS MCC)
Drugs
OCP + preg
Sarcoidosis, SLE, Bechet’s
Ulcerative colitis, crohn’s disease
Malignancy

Answer 289

A

Phenobarb
Dilantin
Lamotrigine
Carbamazepine

Answer 290

A

Itchy skin PLUS (3 or more)
1. hx of skin crease involvement
2. generalized dry skin
3. hx of hay fever / asthma
4. rash onset <2yrs flexural surfaces involved

Answer 291

A

Indicates spontaneous esophageal rupture
1. subcutaneous emphysema
2. chest pain
3. vomiting

Answer 292

A

Grade 1
* corneal epithelial damage
* no limbal ischemia (good prog)

Grade 2
* corneal haze, iris details visible
* <1/3 limbal ischemia (good prog)

Grade 3
* total epithelial loss, stromal haze, iris details visible
* 1/3-1/2 limbal ischemia (guarded prognosis)

Grade 4
* cornea opaque, iris + pupil obscured
* >1/2 limbal ischemia (poor px)

Answer 293

A

Grade 1
* 0 o’clock limbus involvement
* 0% conjunctival involvement

Grade 2
* <3 o’clock
* <30%

Grade 3
* 3-6 o’clock
* <30-50%

Grade 4
* 6-9 o’clock
* 50-75%

Grade 5
* 9-12 o’clock
* 75-100%

Grade 6
* whole limbus
* 100% conjunctival involvement

Answer 294

A

Gr. 1: up to 1/3
Gr. 2: up to ½
Gr. 3: >1/2 but not full
Gr. 4: full

Answer 295

A

PO clindamycin, septra, doxycycline (>8yr), rifampin
IV: linezolid, vanco, daptomycin
Mupirocin

Answer 296

A

Piptaz
gentamycin, tobramycin
ceftazidime, cefepime, ciprofloxacin
imipenem, meropenem

Answer 297

A

Dental procedure plus
* hx of endocarditis
* prosthetic valve
* cardiac valvopathy (transplanted heart)
* unrepaired cyanotic CHD
* repaired CHD => 1) w prosthesis: 6mos 2) residual defect

Answer 298

A

TAUS: HCG 6000
TVUS : HCG 1500 - 3000 (upper)
gestational sac 1000
yolk sac 2500
fetal pole 5000
FHR 7000

Answer 299

A

No FHR + 1) 10wks OR 2) 5mm CRL
BHCG >3000 + no gestational sac
Gestational sac >25mm + no fetus
Gestational sac >13mm + no yolk sac

Answer 300

A

Naphthalene
Methylene blue

nitRITES
* amyl nitrite
* Na nitrite
* nitroprusside
* nitric oxide

nitRATES
* well water

anti-biotics
* sulfa
* dapsone

anti-malarial
* quinones
* chloroquine

anti-neoplastic
* cyclophosphamide

topical anesthesia
* benzocaine
* lidocaine
* prilocaine

congenital causes:
* NADH metHb reductase (can’t reduce Fe=> Fe2+)
* G6PD deficiency (can’t make NADH)

NNAAAT

Answer 301

A

Organic
* Acute onset
* any age
* fluctuating LOC
* Disorientated
* attention disturbances
* poor recent hx
* hallucinations
* cognitive changes
* abnormal vital signs
* nystagmus
* focal neuro signs
* signs of trauma

Functional (PSYCH)
* Onset over wks - months
* age onset 12-40yrs
* alert
* orientated
* agitated, anxious
* poor immediate memory
* hallucinations (auditory)
* delusions, illusions
* normal vitals
* no nystagmus
* purposeful movement
* no trauma

Answer 302

A

Vegetation OR peri-annular extension
Heart failure
Bacteremia (persistent)
Emboli, recurrent
Fungal

Answer 303

A

Ischemic (no TPA) <220 /120
20% reduction /24H
Ischemic (TPA) <185/110
Post TPA / during <180/105

ICH <140-160 / MAP <130
* CSBP + UTD

SAH <140-160 / MAP <130

Answer 304

A

BB – labetalol, metoprolol, propranolol
class 1 anti-arrythmics - procainamide, quinidine
NMB
Bolulinum toxin (don’t get botox)
Mg
Antibiotics:
- Aminoglycosides – gentamicin, tobramycin
- Fluoroquinolones – ciprofloxacin, levofloxacin
- Macrolides – azithro, clarithro

Lithium
Steroids
Phenytoin, phenobarb, carbamazepine

Answer 305

A

P - propranolol (b-blockers), poppies (opioids), physostigmine
A - anticholinesterase drugs, anti-arrythmias
C - clonidine, CCB
E - ethanol / other alcohols
D - digoxin, digitalis
(others - organophosphates, barbiturates)

Answer 306

A

Non infectious
* Bronchitis
* Congenital - cystic fibrosis
* trauma
* foreign body
* Vasculitis - SLE, goodpastures, Wegners
* PE
* pulm HTN
* AVM
* cancer

Infectious
* TB
* fungal - aspergilliousis, blasto, cocciodio
* bacteria - S aures, legionella, klebsiella
* Ebola
* Hanta
* parasites

Bioterrorism
* Anthrax
* tularemia
* plague
* hemorrhagic fevers (Dengue, malaria, chikugunga)
* mustard gas

P4 yellow

Answer 307

A

Early

Bleed
infection
pneumothorax
Pneumomediastinum
air embolism
accidental decannulation
Obstruction

Late

Stenosis - trachea, stoma, tracheomalacia
fistula - tracheo-arterial, tracheo-esophageal
trach tube dislodged
Dysphonia
Dysphagia
obstruction
aspiration
Nosocomial PNA

Answer 308

A

normal A-a gradient
1. hypoventilation
* central (opioids, sedatives)
* chest wall
* NM: GBS, MG, botulism, ALS
* lung disease

low inspired O2

Decreased A-a gradient
1. Improves w O2
* pneumonia, PE, COPDE
* interstitial lung dz
2. does not improve w O2 (SHUNT)
* cardiac shunt
* severe pneumonia / edema

Answer 309

A

HAPE
ARDS
TRALI

Inhalational injury
Aspiration - gastric contents
Submersion / drowning
near hanging / strangulation

Re-expansion pulmonary edema
ICH / bleed
Ovarian hyperstimulation syndrome
Envenomation

Drugs: ASA, Narcotics, cholinergics, TCA, bleomycin, amiodarone, barbiturates, fentanyl

vent setting:
FiO2 88-95%
RR20
VT6cc/kg
PEEP 5-10cmH20
Pplat <30 cmH20
pH 7.3-7.45

Answer 310

A

Airway inflammation
Bronchial hyperreactivity
Edema, mucous, hypertrophy of airway
Remodeling

Answer 311

A

VIRUS
* Rhinovirus
* RSV
* Influenza
* coronavirus

BACTERIA
* S pneumo
* H flu
* Moraxella catarrhalis (classic)
* pseudomonas

NON INFECTIOUS
* med non compliance
* CHF
* PTX
* Allergies
* MI
* PE

Answer 312

A

BLOODGAS:
* PH <7.35
* CO2 >45

RESP DISTRESS:
* RR>25
* Mod - severe dyspnea
* accessory muscle use
* paradoxical breathing

Answer 313

A

Hypothermia
ICH /SAH
sepsis
HyperCa

Answer 314

A

Hypoxia, acidosis
hypoK, hypoMg
Digoxin
ETOH
Na channel blockade
MI, blunt cardiac injury

Answer 315

A

hypoK/hypoMg
barium
beta agonists
caffeine
sepsis

Answer 316

A

CLASS 1: no signs of HF (3%)
CLASS 2: crackles, S3, incr JVP (10%)
CLASS 3: acute pulmonary edema (15%)
CLASS 4: cardiogenic shock (>30%)

Answer 317

A

Myopathies
hemolysis
Fibrin
ALP elevated
lab error
heterophile antibodies

Answer 318

A

Plaque ruptures (endothelium damaged)
Plts aggregate
Thrombosis forms
Coronary vasoconstriction
Reperfusion injury

Answer 319

A

Refractory NSTEMI pain
Ischemia causing:
- flash pulm edema
- cardiogenic shock
- refractory arrythmia
STEMI
- deWinter T wave
- Wellens
failure of lytics or re-stenosis

Answer 320

A

no contraindications to lytics
ischemic symptoms <12H
ongoing ischemia (12-24H) after symptom onset
long delays more than 120min

Answer 321

A

WCT >100msec
no p waves
rate 50-110

Answer 322

A

All inferior STEMI
STE or STD in V1-V3
Equivocal STE in inferior or lateral leads
Hypotension + ACS

Answer 323

A

> 1mm wide
2mm deep
25% of QRS

Answer 324

A

Nitro responsive
ECG - transient ischemic changes
Angio - shows coronary artery spasm

Answer 325

A

Post partum, multiparity
Hormone therapy
F>M
Fibromuscular dysplasia
Connective tissue disorder
Systemic inflammatory conditions

Answer 326

A

No reciprocal changes
No isolated STE (inferior / limb leads)
J point elevation <3.5mm, max seen in V2-V5
STE <2mm in precordial leads / <0.5mm limb leads
Fish-hook => notching of terminal portion of QRS @ J point

Answer 327

A

Heart function is fine => can’t keep up with increased demand
- increased CO
- low SVR (peripheral vasodilation / AV shunt)
- low arterial - venous O2 content diff

Answer 328

A

AV fistula
Pregnancy
severe anemia
thyrotoxicosis
morbid obesity
liver failure / cirrhosis
carcinoid syndrome
sepsis

Answer 329

A

ARVC
RV infarction
sarcoid
infiltrative disease

Answer 330

A

Known myocarditis
use of tocolytics
cocaine use
Pre-eclampsia
genetic pre-disposition
advanced age
twins, multipariety
obesity

Answer 331

A

Amyloidosis
sarcoidosis
Gaucher’s disease
neoplastic infiltrative
hemochromatosis
Fabry’s disease

Answer 332

A

Idiopathic
post-infectious
viral
trauma
Cancer
Post radiation therapy
Drug induced
post cardiac surgery
systemic rheumatic dz
asbestosis
sarcoidosis
Uremic pericarditis

Answer 333

A

Pericardial effusion
RV collapse during diastole (most specific)
RA collapse during systole
Ventricular interdependence (RV collapse + LV fills)
IVC distension

Answer 334

A

idiopathic, valsalva
iatrogenic - endoscope, ETT, thoracentesis
asthma
Infection w gas forming organisms
trauma / barotrauma - PEEP
labor
cocaine inhalation

Answer 335

A

Cardiac syncope:
* No prodrome / palpitations
* long duration
* exertional onset
* seated at onset

others:
* +SF
* >65
* Male
* HX of 1) fam sudden death 2) structural heart dz 3) arrythmia

Answer 336

A

Paced: Atria / Ventricle / Dual / O - none
Sensed: Atria / Ventricle / Dual / O - none
Response: Triggered / Inhibited / Dual / O - none
Programmability: P - simple / M - multiprogrammable / R - rate adaptive / C-communicating / O- none
Anti-tachycardia function: pacing / Shock / Dual

Answer 337

A

Rate 80
Output 5mA
Sensitivity 3mV

Answer 338

A

Primary
* MI + EF <30%
* CM + EF <35% + nyha 2/3
* high risk for VT/VF:
- brugada
- congenital long QTC
- ARVC
- HOCM

Secondary
VF/VT (arrest, unstable) with no reversible cause
Sustained VT + underlying disease
* dilated CM
* CAD
* channelopathy
* valvular

Answer 339

A

Change in shock freq
* Oversensing
* lead displacement
* incr in VT/VF
* trying to shock SVT

Syncope / lightheaded
* Not pacing brady
* low battery = trying to shock VT
* SVT w HD compromise

Cardiac arrest
* Missed defibrillation

Answer 340

A

INCR INR = CYP450 INHIBITORS
acute ETOH intoxication
ALSO: garlic, ginko, mango, papya

Answer 341

A

amiodarone
flecainide
propafenone
Ibutilide
Sotalol

Answer 342

A

Idiopathic
Ebsteins anomaly
HOCM
Transposition of the great vessels
endocardial fibroelastosis
MVP
Tricuspid atresia

Answer 343

A

3 diff P waves
varying PR, RR
Irregular
HR >100
mgmt: CCB, BB, electrolytes, TV pacing, ablation

Answer 344

A

ACUTE
* Hypotension
* hyperthyroidism
* prolonged QRS/QTC
* DECR contractility

CHRONIC
* Pulmonary toxicity => fibrosis
* hypothyroidism
* skin photosensitivity
* corneal deposits
* GI tolerance
* Drug toxicity => warfarin, dig, pheny

Answer 345

A

Ventricular rate >200
undulating baseline of QRS axis
paroxysms last <90seconds

Answer 346

A

Bearing down (Valsalva maneuver)
blow into 10cc syringe sitting => supine with legs up

children
* blow into a occluded straw
* baby:
* assuming head down position (15-20sec)
* Bag containing a slurry crushed ice + water to face
* rectal stimulation using a thermometer

Answer 347

A

Griffith
Brugada
Verecki
Wellens

Answer 348

A

No RBBB/LBBB (V1/V6)
no AV dissociation
= SVT

Answer 349

A

Increased QTC syndrome, WPW, HOCM
Torsades
ischemia
CHF
electrolyte - hypoK, hypomg, hypoCa
drugs - hydrocarbons, epinephrine, cocaine

Answer 350

A

Surfactant washout
* Alveolar collapse = bronchospasm / laryngospasm
* Atelectasis
VQ mismatch (aspiration during drown)
Intrapulmonary shunting

aspirated ~1cc/kg = surfactant wash out
intravascular abnormalities 10cc/kg

Answer 351

A

CNS: Hypoxemic ischemic result
RS: incr infxn risk, aspiration of gastric contents, non cardiac ARDS
Temp/hypoxemia/acidosis causes:
- dysrhythmias
- rhabdo
- DIC

Answer 352

A

Increasing age
warm water
duration / degree of hypothermia
Diving reflex (blood shunts to CVS/CNS)
how hard they tried to resuscitate

Answer 353

A

Syncope when you’re in water >5deg colder than body temp
triggers a cardiac arrythmia via
1) vagal stimulation (aystole)
2) sympathetic response (VF 2’ QT prolongation)

Answer 354

A

SpO2 <90%
PaCO2 >50
respiratory distress
loss of airway reflexes
significant head or chest associated trauma (anticipated course)

Answer 355

A

Intact
* Rupture
* Thrombosis
* paralysis
* AE + AV fistula

Repair
* Endoleak
* ischemia (limb, renal, pelvis)
* paralysis
* AE fistula
* device migration
* infection of graft
* bleeding
* pseudoaneurysm

Answer 356

A

Thyroid gland
thymoma
lymphoma
cardiac tamponade
positioning
aortic dissection / aneurysm
venous bleeding (from clavicle / rib #)
mediastinal lymphadenopathy
esophageal rupture

Answer 357

A

Hydralazine
Nifedipine
Nitroprusside (if you give before BB)

due to reflex tachy => minimal chronotropic / inotropic effects

Answer 358

A

Criteria:
triphasic attacks - white / blue /red
1. cold / emotion
2. last 2yrs
3. no other cause (scleroderma, RA, SLE)
4. minimal evidence of ischemia
5. bilateral

Answer 359

A

Criteria
- hx of smoking
- no other atherosclerotic RF
- >50YRS
- upper limb OR phlebitis migrans
- infra-popliteal artery occlusion
- exclusion of autoimmune dz, thrombophilia, DM and prox embolic source

small-med sized vasculitis

Answer 360

A

Positive EAST [3min, symptoms]
20mmHg BP difference (btwn arms)
Bruit
evidence of distal emboli

Answer 361

A

bleeding
thrombosis
infection
aneurysm / pseudoaneurysm
dialysis access steal syndrome (hand ischemia)
neuropathy
high output heart failure

Answer 362

A

(+) DDIMER
Trauma
Burn
crush
rhabdo

preg
inflammation
cancer
DIC
infection
ischemia
age

False negative
* Early clot
* old clot
* small clot burden
* warfarin (d dimer reduc)
* deficient fibrinolysis

Answer 363

A

Chronic venous insufficiency / venous stasis
baker’s cyst
trauma
fracture
compartment syndrome
cellulitis
muscle strain / hematoma
CHF
Vasculitis
superficial thrombophlebitis
claudication / ischemia
intra-abdominal compression (venous)

Answer 364

A

Antiphospholipid antibody
renal impairment
drug interactions
extremes of weight
conditions that impair oral absorption

Answer 365

A

Use of IVC filter
acute bleed
ICH
Bleeding diathesis
major trauma

Answer 366

A

Pregnancy
severe symptoms
risk of extension
unable or unwilling to return for serial studies
progression of DVT on rpt US

Answer 367

A

> 5cm
close to popliteal vein

multiple deep veins
no reversible risk factors
hx of VTE
In patient
active cancer
positive D dimer
**pregnancy

Answer 368

A

PE
Pulm HTN
Recurrent DVT
post thrombotic syndrome - chronic venous insufficiency
- Varicose veins
- Chronic pain, edema
- Infection risk
- Skin changes
Non healing ulcers

Answer 369

A

(high risk features)
Hypotension SBP <90
RV failure
RV dilation (ECHO)
BNP + / troponin +

Answer 370

A

Cardiogenic shock
persistent hypotension (SBP <90)
Circulatory collapse - syncope +/- CPR
Consider: RV strain, persistent hypoxemia, extensive embolic burden
- free floating thrombus (RA/RV)

Answer 371

A

follicular (pathologic when >3cm)
Corpus luteal (>3cm)
Endometrioma (chocolate)
Malignant neoplasms
Non neoplastic
a. Fibroma
b. Cystadenoma
c. teratoma (dermoid cyst)

Answer 372

A

FOLM (avg 28d)
follicular => day 1 (low estrogen + progesterone)
- Estrogen rise
- Endometrium thickens
- Follicle releases ovum
Ovulation - end of follicular phase (day 14)
- LH surge
Luteal
- Progesterone (by corpus luteum) - matures uterine lining
- No implantation - corpus luteum dies
- Death = drop in estrogen + progesterone
Menses

Answer 373

A

Males tend to be of similar age (20-30yr)
known their assailants less often
multiple assailants
more forcible penetration (anal 52%, 15% oral, 33% both)
more anal trauma
more object + digital penetration
more weapons used

Answer 374

A

LOC
no motor control
confused / amnesia
believe they were drugged
<72-96H since assault

Answer 375

A

Age of consent 16
12-13 => <2
14-15 = <5

Answer 376

A

Unconsistent hx
markings / tattos of ownership
delay presentation
no documents/identification
companion won’t leave, answers all questions

Answer 377

A

Uterine rupture
abruption
previa
C section
eclampsia
Amniocentesis

Answer 378

A

Vaginal bleeding PLUS
1. No US showing IUP +/- pelvic pain
2. Near term preg
3. Active labor

Answer 379

A

False +
* Molar pregnancy
* blighted ovum
* ectopic preg
* Post abortion
* post menopause
* IVF
* tumors = choriocarcinoma
* placenta trophoblastic tumor

False -
* Too early <10days
* diluted urine
* lab error

Answer 380

A

Vomit
weight loss (>5% pre preg)
ketones (urine)
[mech]: rapid incr in BHCG occurring in 6-20wks

Answer 381

A

Peak at 8-10weeks (doubles Q48H)
methotrexate d4=>7 (15% drop)

Answer 382

A

Bleeding
HD unstable
pelvic fluid ++

(evidence of rupture)

Answer 383

A

HD unstable
size >3.5cm
pelvic adhesions ++

Answer 384

A

Persistent vomit
intermittent bleed
pelvic pressure / pain
enlarged uterus
US: no FHR
Large size for dates

Answer 385

A

Supportive - IVF
MgSO4 2-4g IV
lower BP: labetolol, hydralazine, nicardipine, nitroglycerin
- GOAL <160/105 post seizure
+/- CT head
Delivery

Answer 386

A

Decreased:
- Reflexes
- Ventilation
UO (<2cc/hr)

Contraindications to MgSO4
* Hypocalcemia
* myasthenia gravis (block on ACH receptor)
* renal failure

Answer 387

A

FHR (most sensitive)
ultrasound (not sensitive for placental abruption)
APT test (pink = fetal blood = abruption)

Answer 388

A

Threatened miscarriage / spontaneous miscarriage
uterine manipulation
amniocentesis
placental abruption
ectopic surgery
trauma

Answer 389

A

APT test: => alkali denaturation test (differentiates fetal vs maternal blood)
vag blood + NaOH = 1) pink = fetus 2) brown = mom

Kleihauer Betke test => can detect 5cc of mixing

Answer 390

A

Neural tube defects
microcephaly
mental deficiency
cardiac abnormalities

Answer 391

A

Extremes of age, low SES
smoking/cocaine
prolonged standing / stress
Infection: UTI/STI

GYNE:
hx preterm
multiple gestations
cervical incompetence
low preg weight gain
first trimester bleed
placental abruption / previa
prior repro organ sx

Answer 392

A

placental abruption (painful)
placenta previa (painless)
vasa previa
premature ROM / labour (bloody show)

Answer 393

A

extremes of age
bad things: smoking, cocaine
Multiple gestations
Infections: UTI, bacterial vaginosis
amniocentesis (not in box)
chorioamniotis (not in box)
- pre-eclampsia (not in box)
- placental abruption
- cervical incompetence
- psychosocial stressors
- prolonged standing

Answer 394

A

Nitrazine – (amniotic fluid pH >6.5 = paper blue / normal yellow)
Ferning – amniotic fluid crystallizes
Smear combustion – amniotic fluid will turn white + crystalize when you light it on fire
Pooling of fluid in posterior fornix
fluid out of cervix w valsalva

Answer 395

A

Stage 1: cervical => onset to full dilation / effacement
Stage 2: fetus => full dilation to fetal delivery
Stage 3: placenta => fetal delivery to placental delivery
Stage 4: uterine => first hour post partum

Answer 396

A

Bleeding
r/o previa, abruption
r/o cord prolapse
measure amniotic fluid
gestational age
fetal heart motion / fetal position
multiples
anatomy

Answer 397

A

MgSO4 4-6g IV
Indomethacin
Nifedipine
Terbutaline 5-10mg PO (0.25mg SC)

meds to delay labor to allow steroid administration

Answer 398

A

Vaginal bleeding
Fetus: anomality, distress
HTN: pre-eclampsia, eclampsia
infection: chorioamnionitis, sepsis
DIC
Relative: cervix >5cm, CVS dz, abruption, stable previa

Answer 399

A

Help - call for help
Episiotomy (indications: shoulder dystocia + breech)
Leg’s up: McRobert’s
Pressure - suprapubic
Enter: 1) Wood’s corkscrew 2) Rubin
Roll onto all 4s
Remove posterior arm
Break clavicle

Answer 400

A

Nerve damage
clavicular fracture
humerus fracture
damage to brachial plexus
death
asphyxia

Answer 401

A

TOCE -M
>500cc / >1L if C section

Answer 402

A

Ischemia
fibrosis
CM
CTD
Drugs: BB, CCB, digitalis, quinine

Answer 403

A

HARD
* Hematoma
* Absent distal pulse
* Arterial hemorrhage (pulsatile)
* Audible bruit (palpable thrill)

SOFT
* non expanding hematoma
* decreased distal pulses / decr ABI
* ++ hemorrhage
* peripheral nerve injury
* bone / penetrating prox wound

Answer 404

A

Chloral hydrate, calcium salts
Heavy metals - Pb, Mg
Iron
Packers
Enteric coated, sustained release salicylates
Solvents - halogenated HC

Answer 405

A

Pesticides
heavy metals
Acids / alkalis
Iron
Lithium
Solvents

Answer 406

A

Anticonvulsants (VPA, phenytoin), amanita phalloides
Barbiturates
Carbamazepine, concretion forming (ASA)
Dapsone, dilantin
Quinine

Answer 407

A

Camphor - neurotox, seizures
Halogenated HC
Aromatic HC - BM suppress + leukemia (toulene, benzene)
Metals - arsenic, Hg, Pb (neurotox)
Pesticides - cholinergic crosis, seizure, resp depression

Answer 408

A

NNAAAT
nitRITES - amyl nitrite, Na nitrite, nitroprusside, nitric oxide
nitRATES - well water
anti-biotics - sulfa, dapsone
anti-malarial - quinones, chloroquine
anti-neoplastic - cyclophosphamide
topical anesthesia - benzocaine, lidocaine, prilocaine
Naphthalene
Methylene blue
NADH metHb reductase (can’t reduce Fe=> Fe2+)
G6PD deficiency (can’t make NADH)

Answer 409

A

METHANOL
* antifreeze
* windshield fluid
* carburator fluid
* glass cleaner
* emblaming fluid

ETHYLENE GLYCOL
* antifreeze
* Brake fluid
* coolant
* de-icing fluid

ISOPROPYL ALCOHOL
* rubbing ETOH
* disinfectants
* hand sani

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