Random Flashcards by Julia Bonanno

Sail sign is associated with ____ in children and _____ in adults

Sail sign is most commonly associated with a supracondylar fracture in children and a radial head fracture in adults.

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Risk factors for development of apnea in children with bronchiolitis

prematurity
age <2 months
underlying pulmonary and cardiac disease
hypoxemia at triage (<91% on room air)
dehydration.

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Sepsis medication for neonates < 30 days

Gentamicin & Ampicillin

Neonates <30 days old are at increased risk for Listeria monocytogenes, so require ampicillin, which has excellent CNS penetration and a strong sensitivity profile. An additional CNS-penetrating broad-spectrum antibiotic is further required for other potential bacterial meningitis causes such as S. agalactiae and E. coli. The 3rd-generation cephalosporin cefotaxime or an aminoglycoside such as gentamicin is recommended.

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Maximum dose of lidocaine with epinephrine

7 mg/kg

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Maximum dose of lidocaine without epinephrine

5 mg/kg

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What’s the bug?

RLQ abdominal pain
Watery diarrhea

Yersinia enterocolitica

From untreated water and pork
Treat with ciprofloxacin or TMP-SMX

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What’s the bug?

Diarrhea
Gillian barre

Campylobacter

Undercooked poultry / unpasteurized milk
Treatment - azithromycin or ciprofloxacin

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Pressor for neurogenic shock

Norepinephrine

Has both alpha (vasoconstriction) and beta (helps treat the bradycardia from unopposed vagal tone) properties

Start at 0.1 mg/kg/min
Titrate for MAP 85-90

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Most common viral cause of diarrhea

Norwalk virus

Associated with cruise ships

Fluids / supportive care

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Treatment of primary syphilis

Benzathine penicillin 2.4 million units IM

Doxycycline 100mg BID x 14 days if penicillin allergic

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Treatment for anaphylaxis refractory to epinephrine

Glucagon

Produces inotropic and chronitropic effects not mediated by beta receptors

Repeat this and epinephrine every 5-10 minutes and can then do IV infusions

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Treatment for aplastic crisis

RBC transfusion if hemoglobin <6

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Mushroom with sympathomimetic symptoms

Amanita muscaria

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Mushroom with cholinergic symptoms

Clitocybe, inocybe

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Mushroom with hallucinations

Psilocybe

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Mushroom with disulfiram like reaction with alcohol ingestion

Coprinus

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Mushroom with delayed GI symptoms then seizures

Gyromitra

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Mushroom with delayed GI symptoms followed by kidney failure

Cortinarius orellanus

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Mushroom with delayed GI symptoms followed by hepatotoxicity

Amanita phalloides

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Treatment of erysipelas

Elevation

Ceftriaxone / cefazolin or flucloxacilln if severe infections with systemic compromise

Penicillin VK, amoxicillin, cephalexin if mild

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Recommended medication for blood pressure control associated with intracerebral hemorrhage

Nicardipine

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Leading cause of epiglottis in adults

Streptococcus pneumoniae

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Recommended antibiotic regimen for patient with suspected epiglottis

Ceftriaxone plus vancomycin

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Cholinergic toxidrome symptoms

SLUDGE
Salivation
Lacrimation
Urination
Diarrhea
Gastrointestinal cramps
Emesis

Also have diaphoresis, meiosis, bradycardia, muscular fasciculations, paralysis, agitation, seizures, coma

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Management of cholinergic toxidrome

Decontomination Atropine - titrate to drying of bronchial secretions Pralidoxime (2-PAM) is the definitive antidote

Calcium channel blocker toxicity symptoms

Bradycardia, hypotension, hyperglycemia (due to inhibition of calcium-mediated insulin release)

Treatment of calcium channel blocker toxicity

High dose insulin and glucose

Symptoms of digitalis toxicity

GI symptoms and cardiac toxicity Slow a fib with high degree AV block or bidirectional ventricular tachycardia

Anticholinergic toxicity symptoms

Dry skin and mouth Mydriasis Tachycardia Bronchoconstriction Constipation Urinary retention

Treatment of anticholinergic toxicity

Physostigmine

Triad for meniere disease

Episodic vertigo Sensorineural hearing loss Tinnitus Treatment - low salt diet, diuretics (HCTZ + triamterene)

Most common cause for bacterial tracheitis

Staphylococcus aureus Looks like croup but sicker Kids often get after croup, but influenza A is most common associated viral infection Steeple sign on X-ray (subglottic narrowing) Treatment - airway management in the OR, broad spectrum antibiotics, IV fluids, bronchoscopy

Treatment of acute closed-angle glaucoma

Topical timolol & acetazolamide Also topical apraclonidine, topical prednisolone, mannitol, iridotomy

Most reliable physical exam finding for bacterial conjunctivitis

Symptoms of campylobacter enteritis

Diarrhea (often bloody) Abdominal pain Fever Dysentery Develop within 2-3 days after ingestion of contaminated food (undercooked poultry, contaminated beef / pork, raw milk)

Treatment of campylobacter enteritis

Supportive (fluids) Antibiotics (fluoroquinolone, azithromycin) only in severe disease - (high fever, significant bloody stools, symptoms > 1 week) or in people at risk of severe disease (pregnant, immunocompromised, older)

Food poisoning cause after ingestion of fried rice

Bacillus cereus

Late onset complications of campylobacter

Reactive arthritis Guillain-Barre

What antidysrhythmic medication is contraindicated in acute phase of myocarditis

Beta blockers Can promote further inflammation and necrosis

What is the preferred choice for treating patients with opioid withdrawal symptoms

Buprenorphine Partial opioid agonist and weak antagonist Typically give 8mg sublingual for acute withdrawal Can be initiated as maintenance therapy Historically alpha 2 agonists (eg clonidine) were used Benzos can also be used

Preferred first line treatment for sympayhomimetic toxidrome

Benzodiazepines

treatment of mastoiditis in children

Vancomycin 15 mg/kg

Criteria for quick sequential organ failure assessment

GCS < 15 Systolic BP /= 22

Fracture of which carpal bone is associated with ulnar nerve injury

Hamate

Electrolyte abnormality seen with pyloric stenosis

Hypochloremic hypokalemic metabolic alkalosis

Name for non bacterial thrombotic endocarditis in patients with malignancy

Marantic endocarditis

Medication given to infants presenting in shock to maintain patency of ductus arteriosus

Alprostadil

Definition of abdominal compartment syndrome

Intra-abdominal pressures > 20 mm ahh with evidence of new organ dysfunction

Medications to decrease aqueous humor production in patients with acute angle closure glaucoma

Topical beta blockers Carbonic anhydrase inhibitors (eg acetazolamide) Systemic osmotic agents (mannitol)

Which pathogens cause diarrhea >/= 7 days after ingestion

Protozoal pathogens like cryptosporidium parvum

How long should a scaphoid fracture be immobilized

6-12 weeks

Treatment for cyanide toxicity

Hydroxocobalamin, sodium nitrite, and sodium thiosulfate

Nausea medication that does not have effect on QTc interval

Tigan

Person with AICD comes in with this EKG, weak, hypotensive. What do you do?

Electrical cardioversion Person in unstable vtach

Gold standard for diagnosing Giant cell / temporal arteritis

Temporal artery biopsy

Indications for hyperbaric oxygen in carbon monoxide exposure

Level > 25% (or 15% if pregnant) Loss of consciousness PH < 7.1 End organ ischemia ECG changes, chest pain, altered mental status Syncope

Pneumonia + Bird exposure Disease and treatment

Psittacosis Supportive care Antibiotics - doxycycline, tetracycline, erythromycin, chloramphenicol Associated with rare cancer - ocular adnexal lymphoma

Anatomic site of central venous access with lowest risk of infection

Subclavian

What is Brodie sign

black spot that shows up on the skin - signals beginning of very rapid propagation of necrosis and clinical deterioration

Lachman test How do you do it and what does it test for

Most sensitive test (98%) for ACL tear Knee in 20-30% flexion. One hand on tibia with thumb on tibial tuberosity. One hand on thigh. Pull tibia anteriorly. Positive test have soft end point.

What is a segued fracture

Avulsion of lateral tibial condyle - associated with ACL injury

McMurray test What does it test for and how do you do it

Meniscal tears Patient supine, flex foot and extend the knee, internally and externally rotate tibia. Clicking = positive test

Thompson test What does it test for and how do you do it

Evaluate integrity of achilles tendon Patient prone, squeeze the calf. Plantar flexion of ankle joint is normal, if ankle doesn't flex then achilles injury

Flexor digitorum superficialis function

Flexion at proximal interphalangeal joint Innervation - median nerve

Flexor digitorum profundus function

Flexion at the DIP joint Helps with flexion at MCP

How do you test motor and sensory function for median nerve

Motor - OK sign Sensory - two point discrimination tip of index finger

How do you test motor and sensory function for ulnar nerve

Motor - abduct index finger (scissors motion) Sensory - two point discrimination over tip of 5th finger

How do you test motor and sensory function for radial nerve

Motor - wrist and finger extension Sensory - dorsal thumb / index finger web space

4 elements that must be proved by plaintiff in medical malpractice case

Professional duty to the patient Breach of this duty Injury caused by the breach Resultant damages

Most common lab abnormality seen in people with ehrlichiosis

Leukopenia

Ketosis without acidosis

Isopropyl alcohol ingestion