Pearls

Question 1

Neonatal hypoglycemia, treatment.

Answer 1

5cc/kg of D10

Then D10 drip 6-8 mg/kg/min

Question 2

Lab to trend in toxic alcohol ingestion

Answer 2

Serum bicarb q2-4h for 12h

Question 3

equation for lung compliance

Answer 3

TV / (Pplat - PEEP)

Question 4

pathogen that is the most common cause of infectious foodborne illness?

Answer 4

norovirus

Question 5

Black widow spider bite symptoms and management

Answer 5

Muscle cramps, surg abd mimic.

BZD and supportive care

Question 6

What % carotid stenosis should get endarterectomy?

Answer 6

> 50%

Question 7

Mos common cause of bowel obstruction in peds patients age 3mo to 5yo?

Answer 7

Intussusception

Question 8

After what age should you consider an abnormal lead point for a patient with intussusception?

Answer 8

> 2yo

Question 9

Norepinephrine drip dosing

Answer 9

0.1-0.5 mcg/kg/min (but no true max)

Question 10

Epinephrine drip dosing

Answer 10

0.1-0.5 mcg/kg/min (but no true max)

Question 11

How to make a dirty epinephrine drip

Answer 11

Goal: make 1mcg/mL solution:
Inject 1mg of epinephrine into 1L bag then run wide open to effect.

I.e. make a 1mg/L bag = 1000mcg/L bag = 1mcg/mL

Question 12

What sign/symptom indicates severe iron toxicity after an overdose?

Answer 12

Vomiting more than 4x

Question 13

definition of severe neutropenia, which would require emergent broad spectrum ABX if febrile?

Answer 13

ANC <500

Question 14

at what size should a diverticular abscess be drained/treated surgically?

Answer 14

abscess > 5cm in diameter

Question 15

5 drugs associated with noncardiogenic pulm edema (ARDS)

Answer 15

meprobamate (precursor in most BZD), opioids, naloxone, PCP, aspirin/salicylates

Question 16

what serum salicylate level would be considered indication for hemodialysis in acute vs in chronic salicylate toxicity?

Answer 16

acute: >100 mg/dL
chronic: >60 mg/dL

Question 17

fever+rash+cough, conjunctivitis, coryza (runny nose), + oral mucosal lesions

Answer 17

measles=rubeola

Koplik spots= oral involvement

Question 18

fever + cough + rash that starts on the face and spreads to the trunk, no conjunctivitis, no oral involvement

Answer 18

rubella= german measles

also associated with posterior cervical lymphadenopathy

Question 19

high fever for 3-5 days but otherwise appearing well then fever resolves and truncal rash that spreads to extremities starts, dx?

Answer 19

roseola

occurs in children <2 years old, w/ peak incidence 7-13 months

Question 20

what are the 2 first line treatments for alcohol use disorder?

Answer 20

naltrexone (can cause liver failure) and acamprosate (contraindicated in renal failure)

Question 21

coral snake venom toxicity

Answer 21

irreversibly binds ACh receptors, causeing weakness, blindness, bulbar palsies, respiratory paralysis

Question 22

rattlesnake and/or copperhead snake venom toxicity

Answer 22

burning pain at the bite, hemorrhagic bullae, vomiting, sweating and in severe cases massive pulm edema, coagulopathy, shock, death

Question 23

PGE1 drip dose

Answer 23

0.05 ug/kg/min

Question 24

size of ectopic gestational sac that is acceptable for methotrexate?

Answer 24

4cm and less

Question 25

fluid choice for treatment of hyper emesis gravidarum?

Answer 25

D5LR or D5NS

Question 26

what is the strongest risk factor for endometritis?

Answer 26

c. section

Question 27

age range for necrotizing enterocolitis to occur?

Answer 27

first 3 weeks of life

Question 28

deathcap mushrooms (amanita phalloides) mechanisms of badness and management

Answer 28

hypoglycemia, liver failure then multiorgan system failure (hepatic and renal failure first) penicillin G, silibinin dihemisuccinate to inhibit amatoxin uptake then NAC, cimetidine, vitamin C for antioxidant therapy

Question 29

what are the first manifestations of deathcap mushrooms and when do they typically occur?

Answer 29

abdominal pain, cholera-like diarrhea, vomiting. Occurs 6-24 hours after ingestion

Question 30

in a patient with iron toxicity, how long after ingestion does hepatic failure occur?

Answer 30

24-96 hours (1-4 days)

Question 31

what is the 5th stage/thing you get from iron toxicity (occurs 3-6 weeks after ingestion)?

Answer 31

pyloric stenosis

Question 32

What correlates with severity of bleeding in placental abruption?

Answer 32

Fibrinogen (<200 means severe hemorrhage)

Question 33

Diagnostic test for darcyocystitis?

Answer 33

Fluoroscein stain the eye, if there’s still dye in there after 5-10 mins, it’s confirmed.

Question 34

Treatment for dacryocystitis- mild vs severe

Answer 34

Clindamycin for mild | Vancomycin for severe

Question 35

hypertension + itching after hot showers = what diagnosis?

Answer 35

polycythemia vera

Question 36

antibiotic for prophylaxis after neisseria meningitidis exposure?

Answer 36

rifampin 600 bid x2d

Question 37

how are the kidneys affected by hypothermia?

Answer 37

they have decreased ability to concentrate urine. aka cold diuresis

Question 38

below what core temp do you typically begin to see dysrhythmias?

Answer 38

<30 C

Question 39

how would you rewarm a patient who has severe hypothermia but normal cardiac stability?

Answer 39

active external rewarming | active internal/invasive rewarming reserved for those with cardiac instability

Question 40

`what medication is started when CD4 count drops below 50 and why?

Answer 40

azithromycin CD4 <50 predisposes to MAC so azithromycin is prophylaxis for that

Question 41

where do anal fissures happen in setting of crohns or malignancy or other systemic badness?

Answer 41

laterally

Question 42

where do normal (benign) anal fissures occur?

Answer 42

Posterior midline

Question 43

exposure to damp nonfreezing temps results in...?

Answer 43

chillblains aka pernio

Question 44

exposure to wet nonfreezing temps results in...?

Answer 44

immersion foot aka trenchfoot

Question 45

exposure to dry freezing temps with reversible injury results in...?

Answer 45

early frostbite aka frostnip

Question 46

cryptococcal meningitis occurs at CD4 less than...?

Answer 46

CD4<100

Question 47

what histological effect(s) does hepatorenal syndrome have on the kidneys?

Answer 47

none. it is all mediated by RAAS and has no actual histological/structural effects

Question 48

First cutaneous finding of small pox?

Answer 48

Oral exanthem, occurs approx 1 week after exposure- consists of small erythematous spots on the tongue, palate and pharynx

Question 49

Minimum toxic dose of ibuprofen for an overdose?

Answer 49

100mg/kg

Question 50

Vestibular schwannomas (cerebellopontine angle tumors) present how?

Answer 50

they start with gradual hearing loss followed by gradual and constant mild vertigo.

Question 51

How does vestibular neuronitis present?

Answer 51

Sudden onset vertigo that persists for days to weeks. It is not associated with a preceding or concurrent viral illness. It typically does not recur.