Treatment for constipation causing pain with stooling, anal fissure?
What defines UTI in sprapubic aspiration?
Abrupt onset unilateral neck pain and HA around eye or frontal area in pt < 45 y/o with partial Horner syndrome has what?
Carotid a. Dissection
Heparin followed by warfarin
What kind of fish can cause scombroid (histamine) reaction?
Tuna Mahi Mackerel Marlin Sardine Herring
What is the Auspitz sign?
Seen in what common condition?
Punctate bleeding when scales scraped off
Patient with sickle cell coming in with reticulocyte count < 0.5% has what?
Parvo B19 aplastic crisis
What bacteria are MC in acute chest syndrome in adults?
Which cells are infected by Mono?
Treatment for SBP d/t peritoneal dialysis?
What medication can reduce mortality?
Vancomycin + Cefepime
Superficial laceration in hemophilia A patient, treat how?
HSP is also called what?
What type HS?
Associated with GI pathology?
Treat traumatic iritis how?
Cycloplegic —> homatropine drops
What is the strongest RF for postpartum endometritis?
PROM > 24 hours, stage 2 labor > 12 hours, lots of pelvic
What sign on CXR to see with coarctation of the aorta?
Figure 3 sign on the right side of the mediastinum
Orbital blowout fracture what muscle gets entrapped?
What Benzo is better to give to EtOH withdrawal?
Oropharynx eval tumors involving the base of the tongue/tonsils, MC assoc with what infection?
What is the MC cause of pulmonary HTN?
What can cause mitral valve regurgitation in a young patient with murmur?
Murmur for MR sounds like what?
Holosystolic, high-pitched blooming murmur loudest at apex, radiates to carotid
What hernia carries highest risk of strangulation?
Best way to diagnose esophageal atresia/rupture in kids?
Patient getting blood that gets fever, chills, back pain, pain at site of transfusion and tachycardia has what?
Acute intramuscular hemolytic reaction
IVF after stopping blood
Stridor in young baby (< 1 y/o) that gets worse supine, agitation, infection is what?
What is 2nd line med in pediatric status epilepticus?
Prolongs refractor period of VG Na channels
Patient that gets lots of IV BENZOs is at risk for becoming acidotic from what?
Used to dilute BENZOs
MS presents with what murmur?
loud S1 with opening snap and low pitched rumbling diastolic apical murmur
1st line drug to treat pheochromctyoma?
MOA of dabigatran?
Reversal agent called?
Direct thrombin inhibitor
Posterior vitreous detachment presents how?
Where to look on ocular US?
Intermittent flashes and floaters w/eye movement
Center, look for line
How to treat foreign body aspiration in crashing patient when abdominal thrusts do not work?
DL w/Magill forceps to remove it
What enzyme causes necrosis by brown recluse?
What med can help sx?
Pt that gets hives and itching when getting a blood transfusion is having what?
Give Benadryl and CONTINUE transfusing
What is the MC extraintestinal manifestation in pts with Crohn’s disease?
Peripheral arthritis (knee effusion/pain)
SE of thiazides for BP?
What lab can tell you if pt had true seizure?
Prolactin (will be high)
What is a normal CSF of wbc?
How does oseltamivir work?
Prevents release of virus from infected cells
What describes apical displacement of the tricuspid valve with dilation of the right atrium?
Assoc with what arrhythmia?
Unstable pt with high suspicion for Aortic dissection, image how?
TEE at bedside
Middle ear barotrauma is the result of what?
Patient with HIT reaction, do what next?
Stop heparin, give bivalirudin (direct thrombin inhibitor)
What is the IM Epinephrine dose for Peds in analyphylaxis?
.01 mL/kg of 1:1,000
MC extra-articular manifestation of ankylosing spondylitis?
What test has the highest specificity for herniated disc?
Crossed straight leg raise test
Give the order of things that happen in an EKG in a patient with HyperK
- Peak T waves
- P wave widening and flattening, PR interval prolongation, dropped P waves
- QRS prolongation
- Sinus Brady, slow AFib —> Sine waves
What nerve runs along the lateral aspect of the LV pericardium?
How to manage entrapped urethral catheter?
Cut head of balloon inflation valve off and try to place flexible guidewire
Max dose of lido? W/Epi?
5 mg/kg, 7
2 mg/kg, 3
What is the most serious transfusion reaction?
Lab shows what?
Hemolytic transfusion reaction
+ direct antiglobulin testing
Stop transfusion, give fluids
What blood pressure to give in pts with Aortic Stenosis?
What meds to avoid?
What is erythema nodosum caused by?
Delayed type HS rxn, IBD, infection, drug, sarcoidosis
What can underestimate IOP on tonometry?
What can over-estimate?
IOP > 30
Supine, off-center measurement
Patient that presents with new-onset weakness and HA after hydrogen peroxide ingestion needs what treatment?
What is the pathology?
Hyperbaric O2 therapy
Cerebral gas emboli
What causes high flow priapism?
Arterial-cavernosal shunt formation usually d/t groin or STRADDLE injury, high SC injury
Observation, not emergent and usually painless
US that shows systolic flattening of the interventricular septum indicates what pathology?
What makes this worse?
Fluids and intubation patient will decompensated
What is seen only in Le Fort II and III fractures?
MC location for pediatric pseudosubluxation?
What features seen in orbital blow out fracture?
Diplopia on upward gaze d/t inferior rectus m. Entrapment
Patient has a pacemaker and essential tremor. Comes in with syncope episode, what is the pacer malfunction?
Oversensing - thinks the tremor or noncardiac activity is the beat and interprets them as adequate cardiac beats. Therefore it will not pace
Pt w/GBS what is an indication for intubation?
FVC falls below 20 mL/kg
What are inflammatory lesions due to exposures to cold, damp environments called?
What patients predisposed to it?
Chilblains aka perniones
SLE, anti-phos lipid, Raynaud
What nerve is MC effected in cavernous sinus thrombosis?
CN 6 abducens
When to stop insulin pump in pt w/T1D?
What predisposes pt to umbilical cord prolapse?
Also multiple gestation, polyhydramnios, PROM, IGUR, preterm delivery
How to tell rubella from rubeola?
Rubella infection is mild, no significant conditions
What is a common presentation of newborn seizures?
Rhythmic beating of 1 arm or leg
When should you remove a rust ring from the eye?
24-48 hours after it develops
What level of dysfunction defines ARF in transplant patients?
20% compared to 50% in gen pop
Patient has hypoNa and is given Hypertonic saline to stop seizures. What fluid needs to be started once the seizures have stopped?
How much Na does 3% hypertonic saline have?
513 mEq of Na
How fast can serum Na be corrected to prevent osmotic demyelination syndrome?
4-6 mEq/day with MAX of 12
What is the max BP for tPA in stroke?
MC presentation of ASD?
What diabetic drugs do not cause Hypoglycemia?
Thiazolidinediones, DDP4-I’s (Gliptins) and Biguanides (Metformin)
3 Ottawa Ankle rules?
- Can’t walk 4 steps immediately after injury AND at time of eval
- TTP posterior edge of distal 6cm or tip of medial Malleolus
- TTP post edge of distal 6cm or tip of lateral Malleolus
What drug withdrawal can cause delirium?
When does food borne botulism (A and B) develop in adults?
Is the toxin heat labile or stable?
Where does intestinal colonization occur?
Only in infantile
What are the electrolyte derangements in rhabdomyolysis?
UO goal is what?
HyperK, hyperPO4, HypoCa early in the disease
Patient with juvenile dermatomyositis is at risk for what complications?
Atelectasis —> pneumonia
How to treat Toddler fracture?
Place in controlled ankle movement boot
MC symptoms of heat exhaustion?
What sx indicate heat stroke?
T > 40C
Describe the pediatric airway in infants compared to adults
Epiglottis is proportionally longer, narrower and omega-shaped in infants
What causes artificial widening of the retropharyngeal space on Xray?
What nerve is MC injured in supracondylar fractures?
Anterior interosseous —> OK sign
CRITOE is for what?
Elbow ossification center 1 - capitellum 3 - radial head 5 - internal epicondyle 7 - trochlea 9 - olecranon 11 - external epicondyle
What is the triple therapy tx for h. Pylori?
Clarithromycin 500mg bid
Amoxicillin 1g bid
What is the 1st line inpatient treatment of cap in a child?
What are the MC complications of ileostomy?
Hyponatremia and dehydration
What is high volume stoma output defined as?
How much Na excreted?
> 2L day
60 mEq/day which is 3x more than normal
At what age of gestation does the CNS develop while mom is pregnant?
What kind of metabolic derangement does isopropyl (rubbing) alcohol cause?
Elevated osmolar gap and serum ketones
It does NOT cause metabolic acidosis
What substance causes the most damage when pressure injected?
Pt with sulfonylurea overdose, what medication to give other than glucose?
Inhibits insulin release via closing VG Ca channels
Valproic acid toxicity causes what?
HyperK one is
What eye symptoms are present in Wernicke encephalopathy?
Lateral rectus palsy
Where to put a chest tube?
This procedure is called what?
Anterior axillary line
What site is the preferred spot for CVC in hypotension pt?
It is compressible, subclavian is not
What is the most sensitive finding for UTI?
What drug to use to treat pediatric pt under 8 with erythema migrants from Lyme?
Doxycycline as long as treatment period is < 21 days
What is the lethal triad in trauma?
Coagulopathy, metabolic acidosis, hypothermia
What lab abnormalities in hyperemesis gravidarum?
Hypokalemia Ketonuria Low TSH Elevated LFTs Weight loss > 5% pre-pregnancy weight
Where does the carotid artery lie in relation to the tonsils?
How deep can you insert a needle for peritonislar drainage of an abscess?
No more than 8-10mm
What is the MC immunoglobulin in multiple myeloma?
What lab changes indicate severe digoxin toxicity?
Hyperkalemia above 5.0
What is the max dose of factor replacement that should ever be given?
What is the MC blunt thoracic trauma injury?
What is variola?
What is a spiral fracture of the prox 1/3 fibula and tear of the distal tib/fib syndesmosis and interosseous membrane called?
What does the nadir of neutropenia occur in pts receiving chemotherapy?
What is the normal width of the retropharyngeal space on lateral neck xray?
7mm at C2
What is the MC location for blunt aortic injury?
Left subclavian artery origin where the ligamentum flavum is fixed
Describe how adverse effects of antipsychotics occur (pathophys)?
Anti-dopaminergic effects cause increased ACh available due to imbalance in the basal ganglia
What Tb drug may be teratogenic?
All cross placenta barrier
Treatment for pt with chest pain after cocaine use?
ASA + Benzo
What is an indication for CT head in a pediatric pt that had a fall?
Slowed response = decreased GCS
Criteria for nail trephination?
Painful subungual hematoma < 48 hours old, not spontaneously draining, intact nail folds
Patient intubated and receiving compressions, how often to deliver the breath?
1 ventilation q 6-8 seconds
Where to perform paracentesis? (Landmark)
4cm superior and 1cm medial to ASIS
What is the treatment for Bullous pemphigoid?
Dapsone, tetracycline, steroids
MOA of physostigmine?
AChE-i —> increases amount of ACh available
MSM pts with proctitis, treat how?
250 Rocehpin IM + 100 Doxycycline bid x 7 days
What is the MC cause of splenic infarction?
Cardiogenic emboli —> pt may have abnormal echo
Compression To ventilation ratio in newborn child?
Total of 90:30 per minute
Where to perform elbow arthrocentesis?
In the middle of the triangle bw radial head, lateral epicondyle, and tip of olecranon process
What is a risk factor for developing kidney stones?
Peptic ulcer disease bc these people eat lots of calcium containing foods
What kind of snake is poisonous?
Elapidae - coral, cobra, kraits, mambas
What is a Smith fracture?
What nerve at risk for injury?
Flexion injury of the hand aka Reverse Colles
What causes death in cold water exposure and give time frames
Dysrhythmia in first 3-5 minutes
Muscle fatigue 3-30 minutes
Hypothermia > 30 minutes
Cavernous sinus thrombosis effects what first?
Abducens nerve (CN 6) —> pt has lateral rectus gaze palsy
Ceftriaxone, Metro, Nafcillin
What is the MC cause of death in people with AD poly cystic kidney disease?
Describe physiologic changes in pregnancy in regards to pulmonary stuff?
What should ABG look like?
Progesterone causes Inc in minute ventilation
Respiratory alkalosis that gets partial compensation by renal Bicarb excretion
What is the finding on CXR of people with vaping associated lung injury?
Diffuse hazy opacities
Fever + bradycardia is called what?
Due to what?
Faget sign (sphygomthermic dissociation)
Yellow fever, typhoid, tularemia, brucellosis, CO tick fever, legionella, myco pna
What is the most sensitive indicator of effectiveness of resuscitation of newborn with PPV?
Treatment for iritis?
Cycloplegics like homatropine and topical steroids
Epinephrine has what beta-2 agonist effect?
Bronchodilation and stabilizes mast cells and basophils to limit further release of inflammatory mediators
What is the goal MAP in pts with neurogenic shock?
85-90 due to higher risk of SC ischemia
What is the MC serious SE that can result from IV NAC treatment for OD on Tylenol?
Common SE of oral NAC tx?
Anaphylactoid reaction (20%)
Usually do nothing, it is non-IgE mediated
What are the only situations in which the “BAD” lung should be positioned downwards?
Large pulmonary abscess
What is the earliest finding of cardiac tamponade?
What does the EKG look like if TVP is against the RV wall (desired location)?
ST elevation in V1
Normal QRS and P wave
P wave invert and QRS amplitude will decrease
What can cause hypermagnesemia?
Laxative abuse, renal insufficiency with meds high on Mag
60% stool, 40% renal
IVF, Lasix, Cal Gluc
Pt with presenting cancer, what is the initial imaging study if they have jaundice present?
What can you use to treat Methanol poisoning with?
How does it work?
50mg Folinic acid q4
Cofactors that breaks town formic acid to CO2 + aqua
What is the MC corneal lesion in herpes zoster ophthalmicus?
Caused by what?
Lies dormant where?
Punctuate epithelial keratitis
Trigeminal (V) ganglion
What is the empiric treatment of acute angle closure glaucoma?
Pilocarpine (Miocic, use after IOP decreased)
Max dose of lido?
Lido with Epi?
Max dose of bupivicaine?
MC location of spontaneous bleeding in kids?
When to transfuse platelets in someone with NO bleeding?
Plts < 10,000
Inc risk of spontaneous ICH
What is the MC bowel site of bleeding for Aortoenteric fistula?
What brain lesion in HIV patients is usually found around the basal ganglia?
Can Cryptococcous infection be seen on Brain CT?
What causes a blowing diastolic murmur after S2?
Can cause what acutely?
2nd or 3rd ICS left sternal border
Describe the murmur of MS
Mid-diastolic rumbling murmur best heard in axilla
What is Reynaud’s Pentad?
Fever, jaundice, RUQ pain, HoTN, AMS
How to treat Carbamazepine OD?
Family member that comes in close contact with TB patient and has 7mm of induration, what is the course of action?
Treatment for latent TB, > 5mm is cutoff for close contact
What is the timeframe to excise acutely thrombosis hemorrhoids?
Less than 72 hours
What are the symptoms of tracheomalacia?
Brassy, barking cough after TEF repair, collapse during expiration causing stridor and wheezing
At what vertebral level does the carina sit?
What drug can cause aplastic anemia and thus pancytopenia?
What abnormality is also associated with molar pregnancy?
New onset HTN < 20 weeks
What is a Mantoux test?
tuberculin skin test
Where should a pelvic binder be placed?
Across the greater trochanter
What does a retinal detachment with vitreous hemorrhage look like on US?
Swirling effect, called washing machine sign as they look side to side
What is in the assessment of blood consumption score for MTP?
BP < 90
HR > 120
What has the highest PPV for biliary etiology of pancreatitis?
How to treat otitis media in child with PCN allergy that is a rash?
2nd or 3rd gen cephalosporin
Cefuroxime (2nd) or cefpodoxime/cefdinir
What cohort of peds patients should have urine sent in fever > 102.2F?
F < 2 y/o
Uncircumcised male < 1 y/o
Circumcised male < 6 months
How to treat seborrheic dermatitis that is on parts of the body other than head of a child that is healthy?
What is the distinguishing feature?
Ketoconazole 2% cream w/low potency topical corticosteroid (1% hydrocortisone)
Diaper rash SINCE BIRTH
What is a tripod fracture?
What bone is fractured in the presence of CSF rhinorrhea?
What is the antidote dose for intralipid?
1.5 mg/kg over 2-3 minutes then .25 mg/kg/min infusion
What does an absence of respiratory fluctuation or decrease in drainage imply for chest tube insertion?
System is blocked, usually in drainage tube
What does bubbling in the 3rd chamber of chest tube suction set indicate?
Air leak present
What indicates successful placement of TVP in RV?
Left BBB with LAD
What is the formula to calculate systolic HoTN in children?
70 + (age x 2) for ages 1-10
What signs indicate cardiopulmonary compromise in pediatrics?
When to start CPR?
HR < 60
.01 mg/kg IV
What is the max size of normal GB wall?
What is the classic skin finding in pts with sarcoidosis?
How to treat?
Lupus pernio, presents w/papules along the nasal ala
Infliximab and methotrexate
What malaria species is dominant outside of Africa?
Pts present how?
Get better, then symptoms can return weeks/months later
What atypical drugs cause Serotonin syndrome?
Tramadol Li Triptans Mepiridine Dextromethorphan Linezolid
What defines a candidal rash in newborn?
Well-demarcated erythematous lesions w/smaller satellite lesions separate from larger areas of dermatitis
What is an indication for IVC filter placement in presence of DVT?
Neurosurgery in last 10 days
Plt < 20,000
What causes thick purulent vaginal discharge and itching in a pre-puberty female with no concerns for STD?
What spider bite presents with intense pain at the site, diaphoresis, and priapism, located in South America?
Armed banana spider
IT CRIES mnemonic?
Infection Trauma Tourniquet Cardiac Reflux, rectal fissure Intussusception Eye stuff Strangulation, hernat
Pt with COPD and acidosis on ABG after intubation, what is the first step to correct?
Decreases chance of air-trapping and auto-PEEP if you do this 1st instead of increasing RR
What is the initial treatment for a seizure due to HoNa?
100-150 mL of 3% hypertonic saline over 15-20 minutes
When do you inflate the balloon in TVP?
Do what next?
How do you know in right place?
Advance until tip is at wall of RV
STE on EKG, capture evidenced by pacer spike followed by wide QRS
Pt with HUS symptoms with NO diarrhea is due to what?
What TB drug is contraindicated in pregnancy?
Causes congenital deafness
What are the MC findings of a scorpion sting?
Heightened sensitivity to touch in area of sting, local numbness and weakness
What is the 1st line treatment for Asx bacteruria in pregnant pts?
Amoxicillin or Cephalexin
What is the lowest level to perform thoracentesis?
What can occur after corrective surgery for scoliosis?
Acute or insidiously with bilious vomiting
What med reduces hospital length of stay in mod-severe croup?
MC complication of systemic sclerosis (scleroderma)?
Acute kidney crisis
What can decrease levels of BNP?
What type HS is contact dermatitis?
What PCWP indicates a non-cardiac etiology?
What are the possible consequences of lightning strike?
MC cause of death?
Keraunoparalysis - temporary LE paralysis
What is the most specific marker for pheochromacytoma?
What is the first line treatment in neonatal seizures?
Can present how?
What causes AKI in hepatorenal syndrome?
This causes what?
Arterial vasodilation in the splanchnic system activates the RAAS system
What toxicity presents with coma or CNS depression, normal VS and midposition pupils?
What injury occurs with direct injury to perineum in men?
What PE finding is characteristic?
Anterior urethral injury (straddle MOA)
Hematoma (ecchymosis) in the perineal area
How to distinguish TRALI from TACO (transfusion-associated circulatory overload)?
What characterizes Lewy Body Dementia?
EPS and recurrent visual hallucinations
What part of the duodenum is the ascending part?
What artery lies over it?
What clavicle fractures are prone to nonunion?
Superior displaced or type II distal clavical fxs
How much output from a chest tube mandates exploratory thoracotomy?
MC cause of septic arthritis in Sickle cell pts?
Staph aureus, salmonella is MC for osteomyelitis
What is the optimal needle size for diagnostic paracentesis?
Pt lies in left lateral recumbent, 3cm superior/inferior to ASIS
Ascitic fluid leak
MC organ injured in blunt trauma?
What personality disorder has magical thinking and metaphoric speech?
What personality disorder prefers few friends and is a loner?
What is the approximate strength of tissue adhesive (glue)
5-0 nylon suture
Sickle cell patients at inc risk of what more rare bacteria?
encapsulated —> SHiNE SKiS
What is the MC atypical complaint in elderly complaining of generalized weakness that have ACS?
Young child that has a (+) direct antiglobulin test (Coombs) after viral infection has what?
Autoimmune hemolytic anemia
What is a special feature of SJS/TEN?
+ Nikolsky sign
How to treat anticholinergic toxicity?
What MOA does it work by?
It is an ACh-I —> gets rid of ACh faster
How does PSGN present?
Dark urine, puffy eyes, pericardial effusion
What organ is MC injured in stab wounds?
Pregnant patients with flu should be treated with what medicine?
What time frame?
Up to 4 days from symptom onset
What labs are abnormal with RMSF?
What causes loss of red perception on exam?
What is a contraindication for flu anti-viral treatment?
Kid < 12 y/o but older than 2 (maybe up to 5)
MOA of pralidoxime?
Regenerates ACh-E thus decreasing amount of ACh around
MOA of physostigmine?
Reversible AChE-i, this will increase ACh levels
Anti-cholinergic poisoning (Jimson weed/belladonna ingestion)
What pH level indicates SBP?
Or pH gradient > what?
pH < 7.34
What bacterial gastroenteritis is associated with febrile seizures?
What ASA level is indication for HD?
What is the MC infection post transplant in the 1st month?
1st - 6th months?
After 6 months?
Staph a, pseudomonas, strep
Viruses and fungi
How does thalassemia present on lab values?
How to obtain lateral xray to r/o Retropharyngeal abscess?
On inspiration with next extension
I to E
What causes an invasive mass of the left atrium?
Primary cardiac sarcoma
Adverse effects of chronic isoniazid ingestion?
Where is B12 absorbed?
Where is folate absorbed?
Where is iron absorbed?
How to prevent falsely elevated intra-abdominal pressure?
Describe the lab values found in sarcoidosis
Hypercalcemia thus causing Low PTH
elevated Vitamin D
Antidote for CN toxicity after house fire?
5g IV hydroxocobalamin
What is the MC Cause of arterial thromboembolism?
LV thrombus formation resulting from MI
DDH, what is the test called?
How to reduce?
Barlow - stabilize pelvis, adduct and flex hip, apply downward pressure
Ortolani - abduct hip and apply upward (ant) pressure
Femoral head relocates anteriorly into the acetabulum
What categorizes subjects into unranked groups?
Pts with biliary colic complain of what kind of pain?
Steady RUQ/epigastric pain
What is the pathology of recipient antibodies against donor leukocytes?
Febrile nonhemolytic reactions
MC cause of pain in pt with testicular pain and a tumor?
What is type 3 HS?
What are the 3 stages of ARDS?
Infection from what can cause adult onset asthma?
What defines severe acute OM?
Pain > 48H
Temp > 39C (102.2F)
What is associated with oligoarticular juvenile arthritis?
What is the MC site of infection in LVAD?
What Abx to use?
Cover staph a and pseudomonas
What is a Segund fracture?
Associated w/what additional injury?
Avulsion injury of the lateral tibial plateau
What tx can prevent coronary aneurysm in Kawasaki disease?
Describe Le Fort II fracture
Pyramid shaped, involves the Lacrimal bone and nasal bridge
What is the treatment of CCB?
If that doesn’t work then do what?
2g CaCl through Central Line
Pt presenting with placenta previa in the ED, what is the best next step?
Pelvic US (unless Trans-abdominal is an option?)
MC organism associated with mastoiditis?
MC physical exam finding?
MC complication of anterior shoulder dislocation?
What to change fluids and what do you change them to in management of pediatric DKA?
bG < 200 change to .45% NS w/5% dextrose
Avoid hypoglycemia and cerebral edema
What is the difference between perinatal and perirectal abscess?
What is the management for them?
perirectal found lateral to anal verge
Perianal palpable at anal verge only
Perirectal get CT
Pt that has SCFE and presents weeks after surgery with weight-bearing groin pain is due to what?
AVN due to injury to the lateral epiphysis artery injury
What are the physiologic effects of NIPPV in a patient with COPD?
Pt with HF?
Inc TV, inc MV
Dec dead space
Dec Venous return, Dec afterload
Inc Left Heart Output
Greatest risk of placing suprapubic catheter in ED?
Pt with prior lower abdominal surgery —> can lead to bowel perf
How to decrease air trapping (auto-PEEP) in COPD/asthma pts?
Max I:E (1:4)
Inc inspiratory flow rate
Pt presenting with meningitis, what med to order 1st?
When you should order a CT before doing LP in cases of meningitis?
FAILS FND AMS Immunosuppressed Lesions on spine Seizure
Describe erythema nodusm
TENDER erythematous subQ nodules that have a blue hue as they spontaneously resolve
How does Valsalva effect preload?
What muscle is located in the deep volar compartment of forearm?
Flexor digitorum profundus
Flexor pollicus longish
Pronator quadratus muscles
What kind of transfusion reaction is caused by causes respiratory distress, severe angioedema, and hives?
IgA deficiency —> anaphylactic transfusion reaction
Stops transfusion, give IM Epi
What type of transfusion reaction causes fever, flank pain, hemoglobinuria?
Hemolytic reaction which causes rapid destruction of donor rbcs
Stop transfusion, give lots of IVF
What is the gold standard to test for DVT?
What are the main patient populations for treating patients with oseltamivir?
< 2 and > 65 Pregnant Immunocompromised (on methotrexate) Chronic Renal failure Cancer DM / Obesity with BMI > 40
MC cause of acute arterial occlusion?
What causes afferent pupillary defect and acute monocular loss of vision?
Optic neuritis —> M.S.
What is a potential cause of hepatic encephalopathy? What else?
Occult GI Bleed, high protein large meal
Inc nitrogen supply
What is a Zone I finger amputation?
Pulp and distal nail
Involve the eponychium (nail fold)
What presents with RUQ pain, jaundice, boggy gall bladder on ABD US in peds?
Hydrops of the gall bladder
What are the 2 types of Nec Fasc?
1 - polymicrobial
2 - GrpA strep
How to cut off rings made of hard metal like titanium or steel?
How to treat hypernatremia that is acute?
What is the correction factor for chronic hyperNa?
Goal of Na < 140 within 24 hours
10 mmol/24 hours
What does tick paralysis cause?
Ascending weakness, begins days 4-7
What is the Miller Fisher variant of GBS?
Ocular and cerebellar features
Ophthalmologist, ataxia, areflexia
What is a symptom concerning for decompression sickness?
Joint pain that begins after ascent from diving
What anti-seizure med can acutely cause cardiovascular collapse?
What is max recommended infusion rate?
Due to diligent of propylene glycol
How to tell difference between IDA and thalassemia?
RDW increased in IDA
What drugs requires less adenosine?
Which ones require you to use more bc they cause antagonistic effects?
Carbamazepine, dipyridamole, cardiac transplant
Methylxanthines, theophylline, caffiene
What does phosgene cause?
Need to treat how?
Delayed pulmonary edema or acute lung injury
24 hour cardiopulmonary monitoring
What presents as floaters in 1 eye with cloudy areas in the visual field that blocks vision?
Posterior vitreous detachment
Emergent Ophthalmology consult
Patient with Reiter’s syndrome, what will synovial fluid look like?
Wbc of 2,000 to 64,000
What are the 4 required elements for med mal claim?
Breach caused injury
What labs indicate a hookworm infection?
What are the types of hookworms?
Microcytic anemia and eosinophilia
Necator and ancylostoma
What kind of skin lesion presents with raised pearly margins and visible vessels?
How does SCC of the face present?
Indurated and ulcerated papules
What is the antidote for enoxaparin?
How does 1 IU raise factor level replacement in hemophilia A?
2% so for full factor replacement need 50 IU
1%, need 100 IU
What type of AV block is MC associated with acute inferior MI?
Type I 2nd degree (Wenckebach)
What gastric hormone is hypersecreted in polycythemia Vera?
What is the scientific name for death cap mushroom?
How does death cap mushroom present?
GI toxicity 6-24 hours
Elevated LFTs, hyperbili, DIC, multi organ failure (mostly Liver)
How to test for methemoglobinemia?
Co-oximetry in the lab
Perioral cyanosis that does not improve with oxygen
Describe the dosing and age range for giving dextrose to infants and kids
< 1 y/o give D10
1 to 8 give D25
> 8 give D50
What is a unique feature of cluster HA?
Restlessness or pacing behavior
What presents in HIV pt not on HAART with fever, night sweats, diarrhea, weight loss?
Clarithromycin, ethambutol, rifabutin for 12 mo
What is pulsus paradoxus?
What causes it?
Larger decrease in SBP ( > 10) during inspiration
Inc intrathoracic pressure restricting venous return
Asthma, cardiac tamponade, PE, Vena cava thrombus, const pericard
When to add Abx in abscess after I+D?
Sx of systemic infection
What fish syndrome has peppery taste?
What is the MOA?
Histamine fish toxicity
Treatment for staphylococcal scalded skin syndrome?
MC site of oral cancer?
How to diagnose MS?
MRI of the brain OR spine!
MC source of arterial emboli?
LV thrombus from MI
What back pathology in kids with avg age around 7 and midline vertebral tenderness?
Caused by what?
What is a contraindication to performing I+D of PTA?
Probably of septic arthritis based on # of Kocher criteria?
1 - 3%
2 - 40%
3 - 93%
4 - 99%
Kocher criteria mnemonic
NEWT Non-weight bearing ESR > 40 Wbc > 12,000 Temp > 38.5 C
How to rule out blunt cardiac injury?
Normal troponin x1
Can go home, no need for extended monitoring
What area of the C spine do peds patients usually injure?
What eye disease associated with R.A.?
Ocular erythema and scleral edema w/severe pain on EOM
NSAIDs and glucocorticoids
What determines the degree of pulmonary insult in a drowning patient?
Quantity of liquid aspirated, not length of time
What is a complication of acute hepatitis?
Aplastic anemia —> dec wbc, plt, rbc
6-12 weeks after hepatitis
What is the MOA of CO poisoning?
Direct inhibition of O2 binding to Hgb
MC cause of cavernous sinus thrombosis?
Acute bacterial sinusitis
MC arrhythmia in blunt cardiac injury?
What additional lab value can be deranged with ethylene glycol ingestion?
What is beer potomania?
Hyponatremia in chronic beer drinkers
Describe pupils in GHB ingestion?
What else is characteristic?
Small and minimally responsive to light
Comatose pt requires intubation but then has abrupt awakening
What is Mallet finger?
If untreated then it turns to what?
Forced hyperflexion of DIP
Swan neck deformity
What is Zone 1 of neck?
Cricoid cartilage to sternum
Zone 2 of neck?
Cricoid to angle of mandible
Zone 3 of neck?
Superior to angle of mandible
Injury to what zone of the neck has highest morbidity?
What is the loxosceles genus?
What is the lowest level to perform thoracentesis?
Where to normally perform procedure?
1 interspace below dullness to percussion midscapular or posterior auxiliary line
What is the biggest RF for cellulitis?
What is the only muscle that opens the mandible that can be affected by PTA?
What does Jimson weed cause?