Rosh Flashcards
1
Q
Difference in strep vs mono on exam
A
B/l posterior lymphadenopathy (atypical WBCs, rash after abx)
Strep is anterior
2
Q
PPH first two steps
A
1.Massage
2. Oxytoxcin 5 Unit bolus
Rule out retained prodcuts, vaginal trauma, DIC, uterine rupture
3
Q
Ehrlichia LAbs
A
leukopenia, thrombocytopenia, Transmainits
Gram neg bacilli
4
Q
Spinal epidural abscess Lab test highly sensitive
A
ESR
Not white count or Fever
5
Q
Presentation MC in Giant biopsy
A
Jaw claudication
6
Q
ALL
AML
CLL
CML
A
ALL- KIDS MC
AML- normo/normo anemia, leukocytosis, thrombocyopenia Auer rods, older
CLL- older, anemia, thrombocytopenia, lymphadenopahthy, splenomegaly
CML-PMNs leukocytosis
7
Q
visceral bias
availabitly bias
confirmation bias
diagnosis momentum
A
Bad case then you miss easy info on next patient
recent memory of diagnosis
looking to confirm your own reconcetions
acecting another docotrs handoff and framing of the case
omissions bias- looking at actions as worse than equally bad omssions or inactions
8
Q
what is the one idncation to use sodium bicarb in acidosis >7.1 (not severe)
A
AKI- reduces need for dialysis at 30 days
9
Q
give 3% to Na levesl of…
A
Less than 110
or
Less than 120 with symptoms
10
Q
is placental abruption painful
A
yes
11
Q
Constipation, weakness in baby tx
A
<1 baby big form human for Ig
>1 is equine anti-toxin
12
Q
acute alcohlic hepatiits with liver failure charactersitics tx
A
supportive care
13
Q
MC type of hernia
A
Inguinal for men AND women!
femoral more common in womean but not as common as inguinal
14
Q
Ketosis without acidosis…
A
isopropyl alcohol
normal pH, ketosis
tx is supportive
breaks down to acetone
elevated osmol gap ONLY!
15
Q
anion gap acidosis with resp alkosliss
A
ASA OD
Sodium Bicarb
16
Q
BUN >60 with chest pain tx
A
Hemodilaysis for percarditis
17
Q
When do you ID perianal abscess, when do you gvie Abx after?
A
If simple perianal, does NOT involve rectum
DM, comorbids, assocaited cellulits
if rectum then OR drainage (dont need OR for bad diabetcis and perianal abscess)
18
Q
Wide complex arrythmia after cocaine, tx?
A
Sodium Bicarb
19
Q
Mlaignnat otits externa dx and tx
A
CT
Cipro +/- cefepime
20
Q
Looks like SJS, but over multiple months- what is it?
A
Pemhisgus vulgaris
IgG deposition
bullous pemhogoid is nikolsky negative
21
Q
post partum dizziness, elecytorlye deficienes =
A
PPH> pituitary apoplexy
22
Q
what are the two long acting insulins,
A
detemir and glargine
detemir can peak and needs observation
23
Q
ubicial cord prolapse treatment
A
raise fetal part
downward dog
trendelnburg
c section
24
Q
UV keratits tx
A
Cycloplegics
Abx
optho follow up
25
prakland forumla
4XTBSAXKg
26
What do you need to make needle cric
5 3 16
5ml syringe w/ al ittle water in there
3 ETT adapter
16 guage needle
27
MC bug otitis externa
pseudmonas
then staph aureus and epidermidis
28
Highest predictor of HEart failure on physical exam
S3 sound
29
lead level for chelation therapy?
70
30
toxo vs cns lyphoma
RING + lots= toxo
solid 1 OR 2= CNS lymphoma
31
when to give steroids in PCP PNA for Pa gradient Less than
70
or >35 AA
32
kid, racoon eyes, abd distention and mass, twitching/eye movements =
Neruoblastoma
opsoclonus, myoclonus
33
Drinking collegeu always do this
Report to the state health program - dont confromnt him
34
ASA OD HD indications
lvl 100
AMS
Acidemia
Kidney or liver failure
pulm edema
35
AIDS, purple coalsecing rash - Tx
HSV KAposia sarcoma
Radiation and chemo!
36
Kid with recent sinusitis, no Ataxia, FND but no signs of meningitis
CT head for brain Empyema
37
MC cause of gross hematuria in alll ages and kids
UTI
Bladder cancer for adults #2
Or post infectious neprbtiis for kids
38
Level where things get stuck in kids
C6
Cricopharygenous muscle
39
Epistaxis on warfarin, stopped, no
Posterior, next step if INR is 5.2?
2.5 mg K hold next dose
Of warfarin
40
Just got up to altitude with acute mountain sickness - first line tx
Acetazolamode! Even for run in the mill
Of severe or cerebral edema then Dex
41
Which bacteria causes HUS stuff?
EHEC
42
Dental abscess ABx first line and second line
Augmentin plus flagyl
Or clinda plus levo
43
MC skull fracture bone in kids
Parietal bone
44
8 yr old GIRL, pushes herself to get up, lower extremity weakenss, nail changes, rash near eyes... Dx Tx
juvenile dermatomyositis
steroids
45
Very common for IUDs to be out of place and cause pain
thats it
46
neonatal lip smaxking for hours...
give phenobarb
then full work up and admit - not EEG first
47
Tx of preseptal cellulitis
CLinda
Augmentin
staph and strep coverage
48
severe malaria tx?
artusenate
49
Red flag that needs urgent follow up for patella fx
Extensor mechanism for straigth legraise
50
HYpermag tx
Fluids, diuretics, Calcium
If AMS, Renal failure, paralysis= HD
Dysrhtmia, paralysis, respiratory failure (RR low) and death
51
MC ankle lig sprain
ATFL
52
MC bactermia bug in old ppl?
E coli- from UTI
53
Supr unstable vitals but awake, tamponade- THoracotomy or consult surgery?
Consult surgeyr
54
Chillblains is damp an dnon frezzig temp
Frost bit needs to be frezzing - supprotive care for threse
55
Carcinoid syndrome Tx
Octreatoide to sto psomatostatin receptors
56
If there is a cremsasteric reflex that is the most sensitve to rule out torsion
57
looks like zoster but no rash..
pain precedes the rash- still can be it
58
MC bug in SBP?
Klebsiella or E coli
250 PMNs on fluids
59
Does a TIA have a time frame or show up on MRI
NO
NO
FND that resolves and no sign on MRI
60
Reactivation TB Tx
RIPE
61
ear hematoma tx
ID, pressure, follow up in 1 week- usualy for big ones
if small maybe needle but generally wrong answerr on test
62
hyphema tx
what do you do with sicklers
timolo first
avoid acetazolamide!
63
vWF vs hemophila
vWF is all platelt bleeding so epistaxis and ginigival - n ohemarthrosis
64
Down out an dblown pupil on one side get...
CTA - anwuyrm for oculmotoer nerve palsy - PCA
65
hypermeesis gravidaru
first is b6 and doxyalmine
then benadryl, meclizine, dimenhydrante
third line is zofran d and reglan
5% eight loss or ketonuria/hypoK is big deal
66
pseydomembranous colitis tx
oral vanc for c diff
67
first line for IIH
Acetazlomaide
68
orbital blow ou tfx w/ entrapment treatment-
abx
outpatient optho in 2 days
onyl surgery if visioj changes or retrobulbar hemaatoma
69
sux copntraindications
spina cord damage up to 3 months
burns greater than 5 days
muscle stuff
GBS
70
when to prophylaxis against N menignitis
Hoiusehold contacts
healthcare workers with direct mucoasl contact and thats it
rifampin
71
BRUE send home for low risk
>32 weeks gest
> 609 days old
less than a minmute
+++
72
psgn tx
Loops- mostly if resp symptoms!
anti-htn
HD
if nrphtic syndrome with protein in urine then prednisone!
73
seizure and then bradycardia an dhypotension after yuou givew what AED?
phenytoin-- propylene glycol if too pushed too fast
74
mononuclear predominance on CSF is for what infection
fungal
75
Diarrhea pearls
osmotic, infectious or infalmmatory
oral rehdyration first, it promost coloncytes to function properly and gut integrity
IV only if cant tolerate PO
antidirrheals are avoided
antiboics in severe cases, old, immunocompromosed with cipro
idf fatty or foul smelling then add flagyl for giardia
76
Bad ekg, better symtpoms now - how do you tx wellens
Cath now
or heparin, trops, admit and early cath tomorrow
cath tomorrow , treated as NSTEMI
77
cant see bleed on epistaxis- ant or post packing
post
78
quicke or whitacre needle better for post lp headaches?
whitacre
79
lightning stuff
MC is TM ruptrue and Cataracts!
rare rhabdo and deep burns
asystole most common not VF
80
trigeminal meurlagaia tx
carbamazapine - yes we give that not prednisone here
81
cirrhosis MC complication GIB or asictes
ascites
82
neutropenic fever cut off reg and severe
1500
500
83
spontaneous pneumomediastinum Dispo
DC home if stable?!
84
spontaneous cartoid artery dissection tx
TPA?! if FND present
usualy after some sort of weird movement or exertion
85
allen test bullshit
ulnar artery needs to be released and show perfusion
if you relesease radial artery and it perfuses that does no good bc youneed collaterall flow from ulnar
86
superior vena cava syndrome either fro mclot or malignancy
malignancy
87
4 things on tet fallot
RVH not left!
RVOFTO
VSD
overriding aorata
88
climber with elbow pain
over use syndromem like meidal epicondultitis for tenonopathy
not bursitis
89
TTP- is INR elevated?
NO!
FAT RN
no coagulopathy - plateltes
90
took a new abx then you get an oval, violacieous, itchy spot (used to be a birth mark there)- what is it/.
fixed drug reation - supportive care
91
MC site of oral cancer
tngue
92
what is pellagra
niacin - Derm diarrha dementia
93
B1 def
B2
beri beri
angular stomatiies/mouth stuff for riboflavin
niacin is b3
b6 i smouth stuff but with neruo
b5 is burning feet
94
MC phys exam finding in endocarditis
murmur
95
confirmatory test for botulism
fecal toxin
96
chest pain after MVC- X ray look at
sternum- EKG and chest CT
97
Dog bite abx no PCN
CLinda
Cipro
tetanus + x ray
98
wound care for pressure ulcers
hydrogel for the ound but dry around the wound
ABx only if acitvely infected
surgery consultation if signs of necrosis such as sliugh or escar present >needs debridement
99
freshly cut hay posion and tx
phosgene
admit for obs for supporitve care
100
does a cabg or fake aortic valve need ppx before dental procedures/
aortic valve
101
pre-pubertal female with vulvovaginitis tx
amoxacillin
augmenitn or clinda
from poor hygiene
102
droplet vs airborne
meales
varicella
TB
influenza
airborne
airborne
airborne
droplet (bigger particles)
103
is SSSS nikolsky +?
does it go in mouth?
yes
No
104
WHat is scerlodermic crisis
collagen everyhere- especially in kidneys
ACE -i is tx - HD if it meets crtieria for any other kidney injury
CREST Ca, Raynauds, E dys, scleordactly, telganectasia
105
corneal abrasion abx for contact lens wearers
fluro
or
tobramycin
106
this is it, CT or load the joint for joint invovlement?
CT!
107
FDA approved fibromyalgia drugs
SSRI, SNRI, Pregabalin
108
hirschprung disease Dx test
barium enema - biopsy to confirm
109
need head ct before LP
FND
immunocmpromised
papilledema
New seziure
AMS
110
knee dislcoation gets wha nerve`
peroneal nerve
Foot drop and 1/2 web space gone
111
Acute chest management
Abx
supprotive
excahneg transfusaion (not blood transfusion)
give blood in splenic sequestration, aplastic crisis
usually below 9 hgb
112
outpatient PNA tx
healthy
Risk facotrs
Aug, Doxy, Azithro
Aug + Doxy or azitrho OR moxifloxacin
113
pressure injection injuries are determined most by pressure ot the chemical
chemical
114
admit or discharge a nroma looking hisotry for aspiration?
admit if old
115
lithium HD
and acut elithium OD tx
WBI!!!
lithium level is greater than 5 mEq/L, when the lithium level is greater than 4 mEq/L in the setting of renal insufficiency, and in patients who present with altered mental status, seizures or life-threatening complications regardless of their lithium level
116
is atropine recomended in RSI for kids?
not anymore
Sux or roc can be used
117
first imagaing study to get whenn suspecting a wilms tumir on a kid
US then CT
118
cleans fish tanks with papules then shallow ulcers
mycobacertium marinae
119
ocular chlamydia tx for neonate at days
oral erythmycin
IV CFTX if Gonorrhea
120
INR <10
INR >10
no bleeding
hold next dose
hold and give po vit K
121
sweling on side of face just below the ear, us goes into the mout hthru stensons duct
inpateint tx
outpatient
unasyn
augmentin
upproitve parotitis
122
lefort fxs
speak no evil - teeth
see- up to nasal brindge/eyes
hear- all they way across
123
Neonate gonorrhea Tx
Admit for IV Ceph
124
oral candidiaiasis
HIV
normal patients
FLuconazole
nystatin
125
HACE tx
steroids
126
most accurate way to confirm ett placement
Coloiemter!
127
stable PTX tx, DC or rpeat x ray in 6 hours
repeat x rays
128
can anticholinergic OD happen with benadryl?
yes
129
looks liek meningitis- do you give abx or ct hen lumabr first
Abx first
130
straight p opoiod OD, RR 14 do you give narcan
no, ETCO2 an domnitor and give it if rsp depression!
131
vertical and verticla incisions for perimortem c section
132
first step with treacho innominate fistula
overinflate cuff then!
then ETT and digial compression if that doesnt work
133
any mention of steroids and hypotension think adrenals and hydcort
134
another word for ideal body weight is
predicited body weight
135
Workng in a silo, hypoxic, chest pain- why?
nitrogen dioxide
136
hypo mag hyper or hypo reflexia
hyper
137
hypotonia with high ro low calcium
high
138
perio oral paresthesia with hihg or low calcium
low
139
curtain coming down, flashers, floaters, usually anchored to optic disk
ret detach
140
medial examiner for...
laws broken or unexplained reason
141
candidia ph < or > 4.5
<4 - topical or oral azole (fluc PO)
142
recent MI with deep Q or QS waves and STEMI in v1/V2 =
Vent anyrieusm
143
jelly fish stings (even box)
acetic acid
hot water
144
autrailain box jelly fish or stone fish need
antivenin
145
defib- when is your next pulse check
after another round of comrpessions
146
RAD + TWI and STD in V1-V4 =
cor pulmonale or right side heart fialure form th elungs
147
Pen allergic strep throat tx
pcn
cephalos
clinda
macrolides
148
adult onset astha by what bug?
chlamydia pna
149
Which bugs ot what
bullous myringitis
Rusty sputum
stoacco cough
diarrhea
Mycoplasma
strep pneumo
chlamydia
legionella
150
preseptal cellulitis tx
auhgmentin
151
MC cause hypo Mg
nutrition
152
HypoG dosing
<1
1-8
>8 yrs old
2-5 D10
2 ml/kg D25
1 mlkg d50
153
Acute bronchiits tx
Dextropemthrophan
mucoltics
expectorants
anithistmaines
Prednisone if asthma or COPD
154
if it looks like pericarditis but has big vital sign changes and signs of HF then ithink
myocarditis
MC compliciton is cardiomyopathy
155
young person, severe chest pain for 30 minutes every morning, ST evleations during it and then itgoes away =
prinzmental or vasospastic anigna
CCB or nitrates
156
severe MG crisis
plasmapheres or IVIG
157
when to do lytics for STEMIs
When contact to balloon is > 2 hours
cant give asa to allergy to asa
158
Painless VB in 24 weeks preggo- best next step? n contractions and everything else nromal
US
(rhogam needs mention of their blood type)
this is placenta previa
159
METH ABUSE make sure you check thier
core temp
160
heat stroke- start cooling at scene or transfer
cool at scene and then transfer
161
scelral icterus RUQ pain, tick borne...
ehrlichia
anaplasmosis
162
small RCT with blinding or well excuecuted observational study with large effect?
Obs study
Small RCTs only give moderate effect
163
Gold silver bronze
Meta abalysis/Systemeitc review
RCT
Cohort study
In order
Gold
Silver
bronze
statisical power provides a that a value is acutally true
164
peds septic joint kocher criteria
ESR 40
WBC 12
Fever 38.5
NWB
165
hyperleukocysosits is MC in which malignancy?
AMLeukemia
166
Unstable MAT tx first step, second step
Oxygen
Rate control
NOT sync cardiovert!
167
omphalitis need surgery or iv abx?
IV abx
168
autoimmune off their immuniologics with new eye pain and redness think...
scleritis (bleu hue) give steroid - pain worse with mvoement
OR UC with eye pain think iritis or ant uvetis
169
Lymes disease pearls
Upper midwest can be a place for it too if they say midwest!
Doxy can be used in kids under 8 yrs old if given for less than 3 weeks
preggos get amoxacllin
tx is for 2-3 weeks!
PPx is 200 mg PO doxy one time
170
how to tx outpatient atypical PNA?
Doxy!
Of note, the rate of macrolide-resistant Streptococcus pneumoniae in the USA exceeds 40% and azithromycin alone is no longer recommended in the treatment of pneumonia as a sole agent.
171
kawasakis cirteria
fever 5 days
eyes
mouth
hands/feet
polymorphous rash
neck LA
172
when to go immediately to OR for penentrating neck wound?
symptomatic patient or hard signs
173
lsiteria coverage in menigitis criteria?
50 yrs
alcohol
immunospruressed
infants
174
echange tranfusions oor hydorxyura reducies sickling?
hydorxurea
175
newly pregnant RLQ pain - best next test is MRI, CT or TVUS...
TVUS
176
MC cause PTA
MC cause bug RPA
Strep A
Strep Viridans
177
what does strabismus in a neonate make uyou concerned for>
retinbloastoma
luekocoria
178
looks like transient synovitis, inflammaotry markers low - tap it or DC it?
DC it
179
menintigits tx 1 month to 50 years old=
over 50=
under 1 month
Vnac and CFTX
add amp
amp and gent or cefotax
180
difference between tyhroglossal duct cyst and dermoid cyst in kid?
both midline
thyroglossal duct moves with tongue
brachial cleft is lateral
181
dont do LP in vert fx?
Nope but you can in spinal mets case?? wtf
182
know your GCS
183
Does toa require surgery?
No IV abx
Unless over 9 cm, sepsis, doesnt get better
184
What reducers long term morbidity in anal fissures
Outpatient GI referral
185
Eos in urine is from…
Interstitial cystitis
186
blast
primary
sec
tert
quat
shockwave - hollow
shrapnel
body thrown into objects
environemtnal expisure - burns
187
first line asymptomatic bacturia in preggos
amox or keflex
not nitrofurantoin
188
what is takutusbo?
dialted cardimyopathy after emotions
looks like STEMI
great prognosis
189
infant bilious emesis- best test
X ray
US
Upper GI series
upper GI series
190
MC blunt abd injury in truama in kids
spleen
191
what looks like mulluscom but it isnt?
dissemintated cryptococcus
192
asymptatic HTN- which screenign test has shown utility in this?
serum Cr not EKG
193
most sensitive on UA Leuk est or Bacteria>?
leuks
most specific is nitrite
194
indications for urgent endoscopy for foreign bodies
BUtton +++++ magnet
Long or sharp
2x6 cm
in stomach 24 hrs after ingestion
195
frostbite tx
re-warming bath
196
toxo tx
leucovorin
Sulfadiazine and pyridazinme
197
run in the mill ingrown toenail tx?
Partial nail removal - you are removing the FB!
if paronychia (has to have purluent drainage or abscess) then I and D
if paronychia with uot big abscess can do warm water soaks and abx
198
hyper or hypocalcemia in MM
Hyper
199
stroke stuff
terrible neuro exam with:
Upward gaze= thalamic stroke/hem.
total paralysis with pinpoint pupils=pontine
fixed and dialed, hemiplegia, gzae= putamen
200
looks like bacterial sinusitis but it has been 24 hrs of symtpoms - give..
affrin and supprotive
if no improvement over days then abx
201
pregnangcy induced HTN before 20 weeks=
molar pregnancy
202
rbb
lbbb
R= down and wide S + bunny ears in V1
L= WIDe WRS lead 1, DOwn QRS in V1
203
unstable c spine
Jefferson- C1
Hangman- b/l pars c2
b/l facet
odontoid 2/3
teardrop
A/O
204
NNT
35/50 tx
20/50 control
50/15= NNT
205
hyperpth = PHos? Ca?
Low phos
HIgh ca
alwasy inverse- hight PTH = high Ca
206
recurrent PUD now with cancer symtpoms=
zolliner syndrome or gastrinoma - too much acid
plummer vinsons is IDA w/ Esophogeal webs
207
RMSF can spare the palms and soles
if it looks like it then it is
208
secondary syph- one time Pen G or or for weeks?
One time
209
1 yr old with b/l otitis and erythematous throat=
Abx
210
looks like osler node but polyarhtritis
Goncoccemia
211
what is enopthlamitis
bacterial infection after cataracts or trauma
212
hearing loss, ataxia, faicla nerve involvemnt=
schwannoma
213
FLu coverage with tamiflu [
65 + or under 2 yrs
pregnancy or PPD 2 weeks
ung disease
immunocomprimised
renal disease
heart disease
obese > 40
DM
Cancer
nursing home reisdents
reduces symptoms by 17 hours
214
what is factitious disorder imposed on self?
Munchausen syndrome
DO things to themsleves to be the sick patient without secondary gain
215
pregnent, VB, abd pain, trauma + Hypotension =
emergenct C section for abrutped placenta
216
breath holding spell doesnt have to be intentional
ok
217
superficial thormbosis - when do you AC and when do you not
>5 cm long or < 5 cm from the deep venous system
otherwise supportive care and repeat US
218
mellt vs jersey finger
mallet cant extend- basketball
jersey, cant make a full fist, cant flex DIP
219
do you irriagte or test ph then irrigate in eye chemicals?
irrigate
220
remember in COPD if acutely short of breath then they will be acidodic bc no time to compensate yet with bicarb
thats it
221
refeeding syndrome gotta ewatch out our for what main lyte?
phos
