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Emergency Medicine > ROSH missed > Flashcards

ROSH missed Flashcards

1
Q

________ is the most common lymphoma in children between 2-12 years of age

A

Non-Hodgkin lymphoma

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2
Q

Patient in house fire + coma + anion gap metabolic acidosis + increased lactate = poisoning? Tx?

A

Cyanide; hydroxocobalamin

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3
Q

Bacterial infection of the lacrimal sac and duct of eye?

A

Dacryocystitis

Tx = oral antibiotics i.e. augmentin

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4
Q

Which hernia carries the highest risk of developing strangulation?

A

Femoral hernia

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5
Q

1st line tx for mild bleeding in von willebrand disease?

A

Desmopressin

Promotes release of VWF from endothelial cells

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6
Q

Tx of acute intravascular hemolytic rxn

A

IV hydration

Pt will develop tachycardia, fever, chills, back pain and pain at site of transfusion

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7
Q

A 1-day-old boy presents to the ED with hypotonia, diminished responsiveness, and no interest in feeding. Patient was born without significant complications and had normal labs after birth. On physical exam, you note jaundice. A total bilirubin returns with a level of 28 mg/dL. The child’s blood type is B negative. Which of the following maternal blood types would result in this child’s presentation?

A

Type O, Rh negative

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8
Q

What happens to the PT(INR)/PTT in patients with primary immune thrombocytopenia?

A

Normal

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9
Q

You are transfusing the tenth unit of packed red blood cells to a bleeding patient. Her current vital signs are BP 115/85 mm Hg, HR 110 bpm, RR 24/min, and T 35.8°C. Laboratory results reveal hemoglobin 10.1 g/dL, platelets 105,000/microliter, international normalized ratio 2.2, fibrinogen 250 mg/dL, and calcium 8.3 mg/dL. Which of the following is the most appropriate to administer?

a) citrate b) cryo c) FFP
d) platelets

A

FFP

Administer platelets if count is < 100,000/microliter

Administer fresh frozen plasma for international normalized ratio > 1.5

Administer cryoprecipitate if fibrinogen level is < 150–200 mg/dL

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10
Q

Which of the following animal envenomations is associated with heightened sensitivity to touch in the affected area, along with local numbness and weakness?

A

Scorpion

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11
Q

Hallmark sx’s of amanita phalloides ingestion? (death cap)

A
  • Fulminant liver failure
  • DIC, elevated LFT’s, hyperbili
  • Renal failure
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12
Q

Antibiotic tx for children <1mo with meningitis? MCC

A

Cefotaxime + AMP
or
Gent + AMP

E. coli, GBS, L. mono, gram negs

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13
Q

Which pressor used if tachydysrhythmia precludes use of levo?

A

Phenylephrine

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14
Q

3 components of Ottawa Foot Rule?

A
  • TTP navicular
  • TTP of 5th metatarsal
    -Inability to bear weight
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15
Q

Tx of TB in pregnancy?

A

Rifampin + isoniazid + ethambutol

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16
Q

Female recently began hormone-based assisted reproductive therapy and presents with nausea + abdominal pain + distension; her vitals are unstable

What should be done?

A

Ovarian hyper stimulation syndrome; bimanual exam contraindicated

Start ppx AC + replete volume and correct electrolytes + consult OB

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17
Q

Absolute contraindications to IO placement

A
  • Fracture
  • Vascular interruption
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18
Q

Infection associated with unilateral periorbital swelling, cardiomyopathy and mega colon

A

Chagas’ disease caused by Trypanosoma Cruzi

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19
Q

Flu-like prodrome with cyclical episodes of chills followed by fever

A

Malaria

Causes hemolytic anemia

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20
Q

Imaging modality of choice for unstable patient with suspected traumatic aortic rupture?

A

Unstable = TEE
Stable = CTA

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21
Q

What is the HR and BP goal for aortic rupture?

A

BP <120 and HR 60-80

Use esmolol (titratable) and nitroprusside

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22
Q

Which medication given for seizures may cause cardiovascular collapse, leading to hypotension and bradycardia?

A

Phenytoin as it is diluted with propelyne glycol

Phenytoin blocks voltage gated sodium channels

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23
Q

What is Wellen’s syndrome and ECG pattern seen?

A

Critical occlusion of the LAD

Deeply inverted or biphasic T waves in anterior precordial leads (V2-V3)

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24
Q

A patient with hemophilia A presents to the ED after falling from a ladder. He has a hematoma on the posterior occiput.

How to manage?

A

Give factor VIII immediately —> CT brain

50 IU/KG

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25
Q

Normal optic nerve sheath diameter

A

<5mm; measured 3mm posterior to globe

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26
Q

Triad of Ménière disease

A

Tinnitus, vertigo and unilateral hearing loss

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27
Q

4 way to prevent postdural HA

A
  • Use small caliber needle
  • Use blunt needle
  • Stylet replacement before needle removal
  • Direction of bevel parallel to dural fibers
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28
Q

Which meds should be given immediately if angle-closure glaucoma is suspected?

A

Topical beta-blocker (timolol) + alpha-agonist (apraclonidine) + acetazolamide

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29
Q
A
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30
Q

Myoclonus is a side effect of which agent used for procedural sedation?

A

Etomidate

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31
Q

Most common cardio complication of anorexia?

A

Mitral Valve Prolapse

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32
Q

How do you calculate shock index? Relevance?

A

= HR/systolic BP

SI >0.7 = presence of occult shock and beef for transfusion

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33
Q

Hyphema vs hypopyon

A

Hyphema: blood in the anterior chamber usually caused by trauma

Hypopyon: pus in the anterior chamber

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34
Q

Mcc of erythema nodosum?

A

Streptococcus pyrogenes

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35
Q

In younger patients, SMA syndrome is most common following what procedure?

A

Corrective surgery for scoliosis

Lengthens spine and decreases angle between the SMA and aorta

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36
Q

What is tx for rapid reversal of warfarin?

A

PCC + Vit K

PCC contains factors II, VII, IX and X; can reverse the INR within minutes

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37
Q

What infection has been associated with the development of adult onset asthma?

A

Chlamydia pneumoniae

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38
Q

What is the primary mechanism of mortality from coral snake bites?

A

Temporary respiratory paralysis

*any patient who develops respiratory or neuro sx’s should be treated with anti-venom and intubation considered

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39
Q

What is the most common symptom of acute rheumatic fever.

When does acute rheumatic fever occur?

A

Migratory polyarthritis

Occurs 2-6 weeks after initial group A beta-hemolytic strep infection

JONES criteria

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40
Q

What is the Jones criteria for acute rheumatic fever?

A

J: joints; migratory polyarthritis
O: cardiac involvement
N: subcutaneous nodules
E: erythema marginatum (serpiginous rash)
S: sydenham chorea (involuntary jerking movements)

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41
Q

Peri-limbal flush is most suggestive of what eye problem?

A

Iritis (anterior uveitis)

*injection greatest around the limbus

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42
Q

What lab finding favors a pure beta-blocker overdose vs ccb?

A

Hypoglycemia

43
Q

Which beta blocker also has sodium channel blockade?

A

Propranolol

*increases QRS interval and may present with wide complex bradycardia

44
Q

During neonatal resuscitation, below what heart rate should epinephrine be administered?

A

HR <60

45
Q

An employee of a fish store develops a granulomatous lesion w/ ulceration and serosanguinous drainage. What is the culprit organism?

A

Mycobacterium marinum

*Tx with clarithromycin, minocycline, or TMP/SMX

46
Q

Most common cause of erysipelas

A

Beta-hemolytic strep (S. pyogenes)

47
Q

What is the dose of factor VIII replacement for major or life-threatening bleed in patient with hemophilia A?

A

50 IU/kg

48
Q

What is the reversal agent for enoxaparin?

A

Protamine sulfate

49
Q

Which anti-arrhythmic drug may enhance the anticoagulation effect of warfarin?

A

Amiodarone

*increased risk of bleeding

50
Q
A
51
Q

Which antibodies are most specific for SLE?

A

Anti-smith antibodies

52
Q

Treatment of giardias?

A

Metronidazole 250mg TID x7 days

53
Q

CSF findings in Guillain-Barré syndrome?

A

Albuminocytologic dissociation

High protein with low cell count

54
Q

What is the lowest possible space to be considered to perform thoracentesis?

A

Between the eighth and ninth rib

55
Q

What is the MAP goal in neurogenic shock?

What are the recommended pressors?

A

> 85-90 mmHg

1) NE and if necessary 2) Phenyephrine

56
Q

Which lab abnormality is closely associated with breath holding spells?

A

Iron deficiency

57
Q

Tx of anticholinergic toxidrome?

A

Physostigmine

58
Q

Why is it important to avoid hypoxia and hypercapnia in patient with massive PE?

A

Can lead to pulmonary vasoconstriction

59
Q

Why is positive pressure ventilation dangerous in patient with massive PE?

A

↑ intrathoracic pressure –> ↑ RV afterload –> ↓ RV output –> ↓ LV preload –> ↓ RV O2 delivery –> biventricular failure and circulatory collapse

60
Q

Findings in central cord syndrome?

A

Weakness+ loss of pain + temperature > in the UE vs. LE

61
Q

Findings in anterior cord syndrome?

A

Complete loss of motor, pain and temp below the injury

Retains proprioception and vibratory sensation

61
Q

What is a Galeazzi fx?

A

Fracture of distal 1/3rd of radial shaft

Disruption of radioulnar joint

61
Q

What is a Monteggia fracture?

A

Proximal to mid ulnA fx

Radial head dislocation

62
Q

Classic features of acute graft-versus-host disease?

Tc?

A

Macular or papular rash

N/V/D

Direct hypebilirubinemia

Tx: Steroids

63
Q

HR and BP goals in dissection?

A

BP systolic <120
HR: ≤60

64
Q

PSGN is what type of hypersensitivity rxn?

A

Type III: immune complex mediated

65
Q
A
66
Q

What is the cause of encephalopathy associated with Valproic acid?

A

Increased ammonia levels

Tx with L-carnitine

67
Q

Patchy, non-scarring areas of hair loss with peripheral hair breakage and scaling is characteristic of?

A

Tinea Capitis

Tx with oral terbinafine or griseofulvin

68
Q

What risk factor is most strongly associated with cellulitis?

A

Lymphedema

69
Q

What is the dominant risk factor for development of thoracic aortic aneurysm in patient <55 y/o?

A

Genetic predisposition

70
Q

What fracture of the lower extremity has the highest risk of compartment syndrome?

A

Tibial plateau fracture

71
Q

What is the fundoscopic finding seen in central retinal artery occlusion?

A

Pale retina with a hyperemic macula

cherry red macula think red = artery

72
Q

How do you correct acute vs. chronic hypernatremia within 24 hrs?

A

Acute = fast –> 140 mmol/L

Chronic = slow –> ≤10 mmol/L

73
Q

What are the criteria for giving -lytics in patient with MI?

A

Symptom onset within 12 hours and cannot receive primary PCI within 120 minutes

74
Q

Tx for pulseless patient with torsades?

A

Defib

75
Q

Tx of box jellyfish sting?

A

Acetic acid (vinegar) + hot water immersion

76
Q

What is a Pott puffy tumor?

A

Subperiosteal abscess or osteomyelitis of the frontal bone that results from contiguous spread of frontal sinusitis.

77
Q

Which TB drug is associated with retrobulbar neuritis, decreased visual acuity and red-green color blindness?

A

Ethambutol

78
Q

Why does eyelid lac with visible fat protrusion require emergent consult to optho?

A

Suggests violation of orbital septum –> high risk of levator muscle damage + orbital injury

*Obtain CT orbit

79
Q

An abscess in the superior natal cleft represents?

A

Pilonidal abscess

I&D –> surgery f/u

Abx if there surrounding erythema

80
Q

1st line tx for patient with cyanide + suspected CO poisoning?

A

Hydroxycobalamin (5g IV over 15 mins)

*Avoid nitrate meds as there is risk of methemoglobinemia

81
Q

Which symptom is high characteristic of rubella and is not seen in rubeola (measles)?

A

Arthralgias

82
Q

How does tramadol cause seizures?

A

Reuptake of serotonin and NE + opioid agonist

83
Q

Which atypical antipsychotic is associated with agranulocytosis?

A

Clozapine

*Presents as leukopenia

84
Q

Which two periodic table elements are associated with aplastic anemia?

A

Arsenic + Gold

85
Q

Presence of hematuria + proteinuria + RBC casts is suggestive of?

A

Acute glomerulonephritis

86
Q

Earliest sign on U/S suggestive of IUP

A

Gestational sac at hcg 1500

87
Q

What is a key differentiating factor between pulmonary effects of tularemia vs. anthrax?

A

Anthrax = widened mediastinum + hemoptysis

88
Q

How are high-pressure injection injuries treated and injection of what causes the most severe injury?

A

Surgical emergency!

Paint solvents

89
Q

Heparin reversal in bleeding is with?

A

Protamine sulfate

90
Q

What measurements are indicative of compartment syndrome?

A

Compartment pressure: >30 mmHg

Delta pressure: <30 mmHg (DBP - compartment pressure)

91
Q

In addition to fomepizole, a patient with ethylene glycol tox should receive?

A

Thiamine and pyridoxine

92
Q

What antibiotic can be used as an alternative to clindamycin for toxin suppression in toxic shock syndrome?

A

Linezolid

93
Q

When should erythema multiforme be treated with oral corticosteroids?

A

Significant mucous membrane involvement

94
Q

Tx of pituitary apoplexy?

A

Urgent NS decompression or high-dose IV steroids

95
Q

How should steroids be prescribed in acute illness associated with adrenal insufficiency?

A

3x increase in dose x3 days

The 3x3 rule

96
Q

What imaging study has the highest sensitivity and specificity for the diagnosis of acute cholecystitis?

A

HIDA scan

97
Q

Which antibiotic, when used chronically in patients with cystic fibrosis, has an anti-inflammatory effect that decreases the frequency of pulmonary exacerbations?

A

Azithromycin

98
Q

What symptom differentiates Meniere disease from other causes of vertigo?

A

Tinnitus

99
Q

First line for anticholinergic toxidrome?

A

Benzo’s + cooling –> consider physostigmine

100
Q

Which test should be performed in an infant presenting with rectal prolapse?

A

Sweat Chloride

*Cystic Fibrosis is major cause

101
Q

Which finding is most suggestive of chronic hypo-parathyroidism?

A

Chronic mucocutaneous candidiasis

102
Q
A

Emergency Medicine (1 decks)

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