Rosh Nugz Flashcards

Question

Acute chole treatment

Answer 1

NPO ABx Fluids Cholecystectomy within 3 days

Answer 2

HAS BLED score

Answer 3

BB and CCB * blocks AV node and further exacerbates the re-entreant pathways leading to v fib

Answer 4

Inject 200 cc of saline into joint space away from laceration + test if you see fluid coming out of laceration

Answer 5

Sickle Cell stroke- not embolic or thrombotic- it is vasooccuslive or sticky 1. CT 2. baseline labs 3. Exchange transfusion of blood to get Hgb above 10 and reduce HgbS under 20%

Answer 6

1. R inf STEMI- contractility is dependence on diastolic pressure bc RV is low volume pressure pump 2. Phosphodiesterase inhibitors like sildenafil 3. hypotension

Answer 7

supportive Oxygen, nasal suction positive pressure, humidified air thru NC *day 2-3 is the worst

Answer 8

1. less than 3 mo old 2. 34 week GA 3. RR >70 4. Ill appearing 5. PO intake down 6. Comorbids

Answer 9

snuff box area

Answer 10

FIEEE | flex, internal rotate, extend, external rotate, expulsion

Answer 11

Bactrim 5 days Cover for staph dont sew it up

Answer 12

think sarcoid

Answer 13

``` LOC Vomiting AMS headache mechanism ```

Answer 14

Bactrim Doxy Clinda

Answer 15

None. | -clinical recognition of the presence of inadequate tissue perfusion and oxygenation

Answer 16

1. ulsatile bleeding 2. bruit 3. palpable thrill 4. distal ischemia 5. expanding hematoma - look for neuro and pulse difference too

Answer 17

1. keep them still 2. Set up DL and needle cric at bedside just in case 3. call ENT for them to come remove it - Back blows are used for chkoing infant less than 1 year old

Answer 18

1. orbital pain 2. Proptosis 3. EOM disability 4. recent infection/clotting disorder

Answer 19

hyperacusis (sensitivity to certain pitch) | retroauriclar pain

Answer 20

Electricity | seizures

Answer 21

arm above head and external rotation swimming pool with arm forward collision Pull up and lateral to reduce

Answer 22

indentation of deltoid (squared off) and abducted/external rotation - from fall backwards onto outstretched hand

Answer 23

pericarditis

Answer 24

Acute dystonia reactions- mimics stroke! Give Iv benadryl to cure this *usually medication related, could be pesudoseizure

Answer 25

Supportive | -hepatic failure and cerebral edema

Answer 26

Somatization: they believe it is real Hypochondriac: Symptoms blown out of proportion an doctor shop out of fear

Answer 27

Dermoid- 1 under 3 years old and 2 does NOT move with tongue protrusion 3 above hyoid usually Thyroglossal- under hyoid and DOES move with tongue

Answer 28

Give optiates to treat pain! | check for bladder retention and other causes of delirium

Answer 29

1. pain qith passive extension 2. tenderness of flexor sheath into the palm 3. sausage finger 4. held in slight flexion -local compartment syndrome with sheath fluids, abx, surgery quickly

Answer 30

1. sonogrpahic murphys 2. pericholecystic fluid 3. wall thickening 4. stones/ slduge 5. CBD dilation

Answer 31

eczema herpticum - superimposed infection | acyclovir

Answer 32

1. check eyes before tx or vision loss | 2. albendazole +/- praziquantel

Answer 33

Acute dystonic reactions Give Iv benadryl to cure this *usually medication related, could be pesudoseizure

Answer 34

1. PTX, pneumomediastinum (trauma to chest) - If it is tension pneumomediastinum incision at suprasternal notch 2. Pericarditis 3. PE 4. PNA 5. Conginental heart- HOCM, coronary artery abnromalities

Answer 35

1. NV intact 2. digital block 3. longitnudianl traction and hyyper extend 4. XR and assess for stability 5. pslint in extension

Answer 36

- hypotension or impaired gas exchange or - 100/hr or 500/25 hr Tx: Mainstem intubate the good lung and have them lie on the bleeding lung in decubtitus to not bleed into the good lung

Answer 37

VQ mismatch- aiwarys opened up to non ventilated lungs

Answer 38

Hypotension Dehydration from increased RR- give them fluids

Answer 39

erosion into a vessel coagulaopthy pulm HTN

Answer 40

needle gives immediate improvement then put in chest tube

Answer 41

``` Duonebs Abx steroids non invasive vemtialtion -avoid intubations as mortalrity increases ```

Answer 42

No Retinal detachement- flashes of light with floaters

Answer 43

ocular massage and co2 retention breathe into paper bag

Answer 44

Fluids remove foreign body if possible Clindamycin- blocks exotoxins and kills bacteria

Answer 45

1. Less than 3 weeks 2. VS normal 3. Absence of Lung disease 4. Asbcence of PNA PE findings

Answer 46

possible eye involvement | give topical trifluridine/acyclovir

Answer 47

1-8% Cross reactivity with the beta-lactam ring similiarty structure. First/second gen cephs are more likely Cefoxitin and cefazolin

Answer 48

2 hours | retina ischemia when central retinal artery occluded

Answer 49

GBS, Staph, E coli- Amp and Gent or cefotaxime for both <7 and >7 days presentation +/- Acyclovir

Answer 50

if patient will be >90 minutes to balloon time

Answer 51

1. High impact trauma- check skull, lungs etc | 2. Check clavicle for scpaular dissocation=emergency surger

Answer 52

- duration of pain for greater than 48 hour - previous episodes of similar pain - lack of migration and right lower quadrant pain - vomiting before the onset of pain *obturator sign- keep knee stable and bring the foot out towards you and wall

Answer 53

Fluids!. severe dehyradtion, hyperosmolar, electryltie abnormlaities leads to this

Answer 54

Give benadryl or benztropine -This reaction is caused by disruption in the balance between dopaminergic and cholinergic pathways in the basal ganglia. They tend to occur within 48 hours of administration of a neuroleptic agent. Patients often experience tongue protrusion, acute torticollis, sustained eye deviation (usually upwards) and arching of the back. Laryngospasm is rare but potentially life threatening. Because dystonic reactions occur as a result of cholinergic dominance, they should be treated with anticholinergic agents including benztropine and diphenhydramine. These agents typically reverse symptoms immediately.

Answer 55

Supportive care, dont increase pulm pressures, pain management * alveolar leak * complications= tension pnuemopericardium , PTX

Answer 56

Goodpastures

Answer 57

1. pulmonary capillaritis- inflammaotry (lupus) 2. Bland alveolaer hemorrhage- back up from heart, bleeding disorder, no inflammation 3. Diffuse alveolar damage- edema + hylaine mebranes of alvoleoli that leads to ARDS

Answer 58

blood coming from mouth or nose

Answer 59

``` AMS lethargy minimal breath sounds acidosis worsenign hypoxia/hypercapnia ```

Answer 60

impending respiratory fatigue/failure

Answer 61

1. CXR 2. BNP 3. PE for volume overload

Answer 62

1. Clay shovelers- C6,C7 transverse process 2. unilateral facet 3. Type 1 (tip) odontoid fracture

Answer 63

Jefferson bit off a hangmans thumb 1. jefferson burst fracture 2. bilateral facet (dislocation i think) 3. Odontoid 2, 3 4. Hangman 5. Teardrop

Answer 64

``` No focal neurologic deficits, normal alertness, no evidence of intoxication, no distracting injuries no posterior midline cervical tenderness. ```

Answer 65

supportive- pain, resp support, do not wrap the chest Intubate if it is big enough *negtive insirpaotry pressure causes the segment to move inward

Answer 66

methemoglobinemia pulse ox right at 85%ish and not moving if mild just oxygen, if above 25% give methylene blue normal paO2

Answer 67

bupivicaine

Answer 68

esters > PABA metbaolite

Answer 69

Hyperoxia test- need ABG give 100% oxygen and if paO2 is <150 then cardiac congitnal disease- give prostaglandins- cyanosis wont improve if it is greater than 150 then pulmonary- cyanosis will improve. Oxygen is able to get into the lungs not shutned away

Answer 70

Erythema multiforme, supportive vs steroids | HSV, medications, pregnency, mlaignancy, X rays

Answer 71

Retinal detachment | *between inner neruonal outer pigment layer- Get US!

Answer 72

``` torsion appendage torsion, itis orchitis epididymitis abscess hernia nephrolithiasis gangrene ```

Answer 73

``` Altered or obtunded patient, hemodynamic instability inability to tolerate oral secretions recent trauma or injury to the face poor mask fit. ```

Answer 74

1. reduce obstruction with albuterol 2. increase oxygen [] with supplemental 3. reduce inflmmation with steorids 4. tx infection

Answer 75

``` altered mental status severe hypoxia hypotension hypercarbia * Altered mental status may suggest worsening hypercarbia as well as an inability to tolerate noninvasive positive pressure ventilation. ```

Answer 76

Serotinin syndrome NMS=antipsychotics, muslce rigidity MAOI + tyramine= sweaty, hyperthermic, flduhing

Answer 77

Hyphema | Acetazolamide- Lowers pH and exacerbates sickling and increases IOP

Answer 78

HTN Bradycardia Bradypnea

Answer 79

supportive parotitis- aggreisve infection | broad spectrum abx

Answer 80

Grade 1 2 3 sling and follow up (it can still look pretty displaced and it is still follow up)- 456 get srugery for massive displacement

Answer 81

NAVEL, naloxone, atropine, vasopressin, epi, lido no access, in arrest, no IO 2x IV dose Transient hypoxia from liquid in lungs

Answer 82

brain abscess, CN, mastoiditis, menginitis, sinus thrombosis, osteo -itching, foul discharge

Answer 83

Zanamivir Oselatmvir- GI -mantadines: Neuropsyh

Answer 84

macrolide or doxy | Add a 3rd gen ceph or just a flruoquinolone

Answer 85

Lung abscess

Answer 86

lay on side

Answer 87

2 interspaces below dullness inthe midscapular line

Answer 88

Place Ng tube and get x ray to see it coiled

Answer 89

Cardiac contusion- dysrhtmias and heart failure can ensure- heart muscle is stunned needs telemetry montoring

Answer 90

- use electrocautery. If acrylic nail polish use 18 G needle to manually drill - posterior nail edge disruption is a ocntraindication- need ot remove nail and repair laceration - just trpehination is enough for most, dontneed ot rpeair lacertion - repair lac with 6-0 absorbale gut, or glue, cover with nail or other cover and give abx - check for fracture

Answer 91

intubation and they have their last catecholamine surge and you take it away with paralytics they might code right then

Answer 92

5 cm or greater DM2/immunocompromised pilondial abscess

Answer 93

reassurance and f/u

Answer 94

amiodarone chemical induced

Answer 95

bacterial tracheitis - OR airway management

Answer 96

corwing rooster- both arms up like signlaing for a field goal- then i pull thier elbows bakc and up!

Answer 97

idiopathic= prednisone for 7-14 days (60 mg) Sudden sensorineural hearing loss has numerous causes, including idiopathic, infectious, autoimmune disease, neoplasms, cerebrovascular disease, and ototoxic medications. Could be conductive too

Answer 98

Low Ca Mg K

Answer 99

Abuse- yanking on arms

Answer 100

hyperrelfexia spastic muscles Babinski response Spinal cord lesion* LMN- hyporeflexia, low muscle tone, negative babinski

Answer 101

ASA- give sodium bicarb

Answer 102

Dantrolene or bromocruptine for dopamine agonsit mainly just stop the offending agent

Answer 103

transeint synosvitis- after URi usually- dx of excusion- give steroids (between 3 and 10 yo) rule out septic arthritis remeber slipped cap and legg calfe perthes

Answer 104

1. amox-clav 2. secondary closure Clinda/metro + Doxy or bactrim or cefuroxime no doxy in kids

Answer 105

ethylene glycol- give fomepizole | watch out for kidney function

Answer 106

fluids pain x ray to see if perf endoiscopy

Answer 107

clomtrizole nystatin oral refracotr is fluconsazole or Amphortericin B

Answer 108

warm, circulating water. gentle rewarming Pathophys*As the temperature drops below 10°C, cutaneous sensation is compromised. With microvascular vasoconstriction, plasma begins to leak into the interstitial space. Ice crystals begin to form once the temperature approaches 0°C. Once crystals begin forming, intracellular osmolarity rises and cells begin to collapse and die. - once that cold, hyperkalmiec, acidotic blood return s to system then it is termed core temp after drop

Answer 109

mole with trophopblastic disease and possible mets

Answer 110

>18 CHF renal failure neuro symptoms

Answer 111

venous thrombosis! aska bout clots and pregnancy MRV and Heparin

Answer 112

Think early parkinsons- bradykinesia. - speed, amplitude, and rhythm of skills such as finger tapping and rapid hand movements - refer to outpatient neurology

Answer 113

3 point US of compressible vein | If non cimopressible- start LMWH and Warfarin outpatient

Answer 114

Outpatient US for DVT in 1 week

Answer 115

Iritis - get slit lamp and look for cells

Answer 116

Optic neuritis | Orbital cellulitis

Answer 117

Augmenton | irrigiation

Answer 118

The wound is clinically not infected, less than 12 hours old (24 hours for facial wounds) is not located on the hands or feet is not a crush injury or a puncture wound is not heavily contaminated the patient is not immunocompromised.

Answer 119

Like bradycardia- Atropine and then transcutaneous pacing _ it orignates in AV noe, HIS, or Ventricle. No p waves! Slow and narrow. If fast, narrow no p waves= Accelerated juncitona lrhtynm

Answer 120

Stable- Get echo (+/-), anticoagulate, cardiovert Unstable (150-200J) sync cardiovert Medical cardiovert- Dilt 15-20 mg bolus over 2 minutes and then go to 5-10 mg/hr. if that fails then give 25 mg in 15 minutes. * verapamil, metorpolol, procainamide, amio

Answer 121

lytes distrubances/underlying trigger | Mag Sulfate 2 g IV over 1 minute

Answer 122

Amox- clav | + x ray

Answer 123

PVCs most common and Heart block -Block Na K atpase- HYPERKALEMIA - Extra Na in cell leads to more Ca in cell bc of Na/Ca pump= ionotropy Dont give IV calcium to this! stone heart

Answer 124

1. asymptomatic usually but : CP, palps, SOB 2. INcrease Preload=later in systole click 3. look for mitral regurg

Answer 125

Age >55 years, glucose >200, WBC >16,000, AST>250, LDH>350 causes: 1. Steroids 2. Hyperlipiedmia 4-7% mortality for acute pancreatitis lipase: 4-8 hours of symptom onset and peak at 24 hours. If biliary cause then LFTs/alk phos/bilirubin=biliary >now need an ERCP to reduce mortality!

Answer 126

NO. false negative is very high. Give ceftriaxone (E coli and klebsiella) afterwards unless very sick and risk factors for it

Answer 127

intravenous drug use, rheumatoid arthritis, diabetes mellitus, recent joint surgery, or a prosthetic joint

Answer 128

PSVT- Ice to face(15 seconds)/modified valsalva, TOngue dperessor back of mouth>ednosine poor feeding, tachypnea, and irritability

Answer 129

adrenal crisis Hydrocortisone 100 mg bolus then q6 hour Drop in crit, back pain, AMS etc. Can happen in MI, trauma, clots etc!

Answer 130

can occur up to 6 months old can occur in term babies vomting and distention- Xray

Answer 131

elevated ICP- long QT | Stoke with edema, brain bleed

Answer 132

precordial catch

Answer 133

B6 pyridoxune 5g IV push slow INH interferes with GABA and metbaolism of b6

Answer 134

20% or less

Answer 135

cribiform plate

Answer 136

lyte distrubances? tolerate PO? playful? if so then discharge home with reassruance this takes a week *non bloody, non bilious, watery diarrhea others at school have it

Answer 137

``` ITP >50k observe <50k prednisone < 20 k not bleeding= iv methylpred <20 bleeding= IVIG + steroids -petechia, ecchymosis, mennorhagia, epistaxis ``` HepSplenmgaly, LA, pallor, bilirubin= leukemia, lymphoma

Answer 138

ELISA testing with Western Blot and PCR

Answer 139

pr depression

Answer 140

BB or CCB overdose

Answer 141

Tumor lysis syndrome- can have seziures, cardiac arrythemia and cardiac arrest watch out for hyperK, hyperPO4, hypoCa, give rasburicase/allopurinol and fluids

Answer 142

Needle aspirate>abx>observe 6 hours> imporvement and tolerate PO=CYAAAAA -Mono

Answer 143

1. DVT 2. Palps and a fib or ECHO needed 3. Endocarditits

Answer 144

Can they tolerate PO and be safe at home for discahrge

Answer 145

1. stop 2. fluids (prssors if need be) 3. diruetics to maintian UOP and sto renal damage - hemolysis so send for LDH and hapto to be high and low respectively

Answer 146

14-FLUIDS | 18

Answer 147

atigue, weakness, confusion, hypertension, bradycardia, polyuria, polydipsia, dehydration, nausea, vomiting, constipation, ataxia, and coma

Answer 148

you can but it will take a while to work, hydration and fluids is the Tx mainstay

Answer 149

Shortening of the QTc interval, PR prolongation, and QRS widening.

Answer 150

Klebsiella Rocpehin and gentamycin (aminoglycoside) Strep pneumo is lower lobe and lobar consildation

Answer 151

G6PD no NADPH=no glutathione= cant handle oxidative stress and nothing to clean up free radicals Aspirin, Bactrim, Macrobid etc

Answer 152

Perforated PUD and pain in lower quadrants bc of paracolic gutter leak pain can be referred to here lower Quads bc leakage into the area

Answer 153

1. fluids 2. blood/FFP? 3. Octreotide 4. ceftriaxone 5. BB - SB tube? surgery?

Answer 154

Group A strep- needle aspirate Strep viridans

Answer 155

1. evidence of step throat w/ titer or swab 2. Joints, cardiac murmur, painless Nodes over bones/tendons,rash sparing the face (erythema marginatium), syndeham chorea 3. CRP/ESR, prolonged PR itnerval, arthralgia, fever

Answer 156

ST segment depression new T wave inversions hyperacute T waves.

Answer 157

TIcagrelor | shown to be better and reverisbel than ADP inhibtors

Answer 158

methemoglinemia | topical anesthetics

Answer 159

Diatolic of 115

Answer 160

hordelum hurts, bottom eyelid, infectious, acute | chalazion blocked meiboam gland, chronic, top eyelid

Answer 161

angio embolization

Answer 162

1. tylenol doesnt prevent reoccurence 2. A seizure puts them at increase risk for epilepsy from 1% to 2-3% 3. the younger the mor elikley for epilepsy 4. antioncvulsatns dont help long term

Answer 163

1. post herp neurlagia | 2. bacterial infection

Answer 164

1. allopurinol, rasburicase IV | 2. Hemodilaysis if severe

Answer 165

C collar and follow up outpatient | other facet makes it stable

Answer 166

- clomtrizole/nystatin | - fluconazole

Answer 167

1. US 2. down syndrome + large dense and painless 3. AFP, LDH, BHcg DDx: hemotcele, rupture

Answer 168

dysrthmias | seizures

Answer 169

1. benzos 2. cooling 3. physostigmine 4. WBI bc of slowed gastric emptying

Answer 170

1-2 mins | post ictal for hours

Answer 171

stable or unstable? | start resuscitiation quickly and if still tachy then surgery

Answer 172

Think MS! give steroids

Answer 173

Dextromethoprhan PCP/opiate ingestion from cough syrup

Answer 174

1. sutures 2. irriagtaion 3. abx - primary vs secondary closure no diff in infection

Answer 175

US- check for placenta previa! dont do cervical or speculum exam until this is ruled out

Answer 176

COPD!! /hypoxia irregular, different p waves, tachycardic Treat COPD, oxygen & rate control

Answer 177

Organ disfunction lactic acidoss hypotension

Answer 178

ID & catheter drainage ongoing like a tube or Word catheter

Answer 179

.1-.3 every hour with a max of 0.7 total in a day alpha 2 agonist to give hypotension and decrease sympatethci tone

Answer 180

stimualtes release of factor 8 by stimualting the release of vWF from endothelial cells

Answer 181

1. Fever 2. Renal failure 3. Neuro complaints 4. anemia 5. thrombocytopenia * dont give plateltes it gets worse

Answer 182

High PT PTT low platelts and fibrinogen high D dimers and fibrin

Answer 183

plateletes | collagen vascular disease leading to destruction of plateltes

Answer 184

Uremia 1. Pericardititis 2. AMS 3. plateltet dysfunction and bleeding 4. N/V

Answer 185

- Ig or complement on RBCs in for autoimmuniehemolytic anemia, coombs negative in aplasitc anemia - low, aplstic anemia is no hemolysis

Answer 186

``` mechanical tearing or shearing of the vasculature of the iris or ciliary body. over 33% or 30 IOP Acetazolamide or timolol ASA, ibuprofen atropine/scoplamine ```

Answer 187

amoxicillin 90mg/kg divided into BID or TID for 10 days

Answer 188

RMSF- no rash can happen especially early! also petiechiea after BP cuff inflation! doxy

Answer 189

Rumpele leede phenomena- rupture dermal capillaries with vascular pathology underlying like DM2 or HTN, or HTN emergency!

Answer 190

HTS 3%: 100 cc over 10 min and then 100 cc over 50 minutes

Answer 191

``` Serum Osms Urine Osms Thyroid Cortisol for adrenal insuffiecny calculate FeNa ```

Answer 192

1. N/V hemolycitc reaction clincially | 2. VOlume overload w/ legs, lungs and AMS

Answer 193

1. Observe for hours 2. tylenol to drive fever down 3. PO challenge them - education

Answer 194

hypo: K Mg Ca

Answer 195

- acute renal failure - neuromuscular disease like multiple sclerosis, amyotrophic lateral sclerosis, and muscular dystrophy. - spinal cord injuries 1 week to 3months after - burns 5 days after

Answer 196

1. cardiac arrest 2. Bradypena/resp failure 3. respiratory exhaustion (somnolence, eyes closed, subcostal retractions) 4. AMS - before you get there is Heliox, Bipap, Mag and terbutaline

Answer 197

1. Suasage finer 2. tender along the entire flexor tendon 3. Flexed 4. pain with passive extnesion

Answer 198

1. symptoms start at 50 2. Long actign and sulonureas need 24 hour obs 3. Catcho,aine surge leads to the sympmtoms when brains dont get their food

Answer 199

1.liver or cholestatic, if really high chlestatic 2. GGT + Alk = cholestatic GGT + Alk+ High Conj bilirubin = Obstructive jaundice

Answer 200

1. supportive 2. Benadryl, supportive 3. Tylenol 4. Lots of immediate fluids and some diuretics

Answer 201

1. Non rebreather at 15L *resrobes 4x faster than observation resrobes at 2% oer day and admit for obs

Answer 202

Large volume off in tap or a VP shunt

Answer 203

B12 deficneicy

Answer 204

HFM is anterior mouth | herpangina is still coxsackie A but it is posteoir soft palate

Answer 205

blocks aldehyde dehydorgenase

Answer 206

endometritis + fould smelling lochia | -c section is high risk

Answer 207

1. epiglottitis 2. croup 3. foreign body 4. retroprhagnrala abscess 5. tracheitits * give oxygen and racemic epi to help befor ientubation

Answer 208

1. DONT give albuterol or solumedrol 2. Fever maanagement/pulse ox/suction/hydration/02 if needed 3. Discharge criteria 90% sats reliable care taker Day 5 vs day2-3 mild work of breathing 4 wet diapers in 24 hours

Answer 209

Posterior edge of medial and lateral malleolus 2) Base of 5th metatarsal 3) Navicular 4) Midfoot (for Lisfranc injury) 5) Proximal fibula (for Maisonneuve fracture)

Answer 210

proximal base of 5th is dancer and no surgery and Jones is distal and is surgery

Answer 211

ectopic gastric mucosa caugin gastric acid an dlbeeding and T99 scan

Answer 212

Meralgia paresthetica is the clinical syndrome of pain or dysesthesias, or both in the anterolateral, proximal thigh, due to a compressive neuropathy of the lateral femoral cutaneous nerve. Entrapment of this nerve under the inguinal ligament is common. - COnfirmed by relfief of pain with lidociane

Answer 213

>5 min seizure or not fully recovered siezure and then gets another one

Answer 214

lots of symtpoms but no caus sympathy external gain

Answer 215

Isopropyl alcohol Alcohol dehydo will make it into acetone and is read a s a ketone on the lab. Is is not charged so no acidosis but high OSm

Answer 216

``` 3% will commit suicide very severe previously nromal psych histry within 5 days equivalent of 40 mg prednisone ```

Answer 217

1. 5 WBCs abnromal with no suqames | 2. E coli/enterobacter/Klebsiella- convert nitrates to nitrites

Answer 218

Massive PE=dont give fluids to hypotension and give TPA | Hypotension

Answer 219

AMS stridor (@rest= epi, give them 3 hours to return to baseline) cyanosis retractions(@rest= epi, give them 3 hours to return to baseline) air entry

Answer 220

to avoid Tension PTX

Answer 221

4 X Kg x % IN NUMBER of full thickness not partial thickness

Answer 222

THiazide diuretics Symptoms of lithium toxicity include bradycardia, ataxia, tremor, hypothyroidism, eczema, edema, nephrogenic diabetes insipidus, and Ebstein's anomaly in pregnancy.

Answer 223

1. abive 20 K plateltes observe 2. <10k= IVIG and steroids 3. 10-20 + bleeding = IViG steroids 4. Life threatneing bleeding = give platelts - Ab directed against plateltes, no bone marrow invovlement

Answer 224

1. Give benzos, not Haldol (seizures and arythmias) 2. Rhabdo (check CK + fluids), Renal failure from CK, Traumatic injuries - NMDA antagonist

Answer 225

Factitious | Somatic symptoms

Answer 226

Admission- if perirectal and supericial can be follow up | if deep and digit rectal exam feels the abscess then admit.

Answer 227

Dopamine drugs - NMS!! rigidity is the key here | If no rigidity then clonidine

Answer 228

preseptal= NO orbital invovlement. No pain with EOM, No visual distrubances, no pupillary defect. Eye looks univolved. If orbital- then get a CT

Answer 229

topical steorids !

Answer 230

Dont repair: 1. through and throughs 2. Nasolacrimal ducts (use flurosceine) or lid margins 3. ptosis, tarsal plate or levator plapebrae If <1 mm near margin it hels on its own *look for corneal abrasian and ruptures here too

Answer 231

entrapment subQ emphysema infraorbital paesthesia

Answer 232

clincal penetrating injury to eye | It could have sealed up and siedels could be negative. Still give eye patch, antibitoics, anti emietics

Answer 233

it block aquehous humor production | BUT! wouldnti this dialte the eye and cuase decreased outflow?

Answer 234

OPtic neuritis MS (also sarcoid and syhpilis) Steorids if MS

Answer 235

make it more acidic- Hydrogen peroxide or acetic acid/hydrocrotisone tpoical antibitoics Look out for malgnant otitis externa into the skull

Answer 236

1. conducitve hearing loss (Self limited) 2. TM perf (SL) 3. Labrytinhitis 4. cholesteatoma 5. facial nerve paralysis - ENT emegrency 6. Masotiditis 7. Sinus thrombosis

Answer 237

1. insect 2% lidocaine 2. wax= mineral oil, hydorgen eroioxde, sodium bicarb 3. Heals spontaneously- antibtioics +/-

Answer 238

1. Abx, Nsaids, ASA 2. Vascualr 3. Mechanical 4. Menireres

Answer 239

Lidocaine withou epi and drain it! dont want septum necrosis

Answer 240

-phenylephrine 4x per day for 3 days -meningitis -thombosis cavernous sinus - intrcrainal abscess, robital cellutlites, osetmyeltiies

Answer 241

best to wait 36 hours! | Tamsulosin is not a contraidinctation (alpha 1 blcoker for BPH)

Answer 242

1. hypoxia 2. Thrombus (PE and MI) may need to give thrombolytics if suspected!! 3. Hypothermia 4. Acidosis 5. Tnesion penumo 6. TOx 7. hyperK 8. hypovolemia

Answer 243

Transverse myelitis | GIve high dose steroids- reoslves over weeks usually

Answer 244

Aortic dissection, caortid artery, opthalmic artery give steroids

Answer 245

diaphragm invovlement, intubate this patient | need plasmapheresis or IVIG

Answer 246

anterior = motor/pain gone but DCML good Central= sensory and motor in upper>Lower Hemi- ipsi motor and DCML &opposite pain

Answer 247

thombolytivcs srugery embolectomy

Answer 248

1. takes 4 hours to start damage 2. minimum requirement is 7.5 grams (150 mg/kg for peds) to do damage - Induced emesis- not proven to clincially benefit + complicaitons - Orogaatric laavge if <2 hours old- but complciations arise - charcoal reserved for spsecifc drugs- carbamazepine, dapsone, phenobarbital, quinine, or theophylline

Answer 249

1. Hypoxia 2. HTN encephalopathy 3. Hypoglycemia 4. CNSinfection 5. high ICP

Answer 250

1. L carnitiine!. ocnsider charcoal and Dialysis too if severe 2. it blocks Carbomyl phos synthestase and makes high AMMONIA levels

Answer 251

AV node bockers | BB CCB Adensoine Amiodarone

Answer 252

``` 1. dementia Alzherimers parkinsons with rigidity, pyramidal symptoms NPH- CT big ventricles Vascualr dementia if FND depressed ``` CT head, CXR, LP CBC BMP B12 Thyroid ESR UA HIV folate syph

Answer 253

1. dex 10 mg 2. Mannitol .5-1.0 mg/kg 3. hyperventilate

Answer 254

1. Peripheral is sudden and severe, positional, no FND, w/ N/V/Sweating , hearing loss 2. Ill dfined spinning , can be sudden or gradual

Answer 255

1. BPPV 2. Menieres 3. Labryinthitis 4. Otototxicity drugs 5. Vestibualr neuoniitis- Viral unilateral tinnitus + heairn gloss - No Rx 6. Vestibular ganglionitis- Zoster- Ramsay Hunt- Acyclovir 7. perilyhym fistula - vertigot with pressure liek flying, diving, coughing 8. Labrytihnitis- Sudden vertigo + middle ear fidnings Mcelinzine and benadryl Zofran and benzos 2nd line

Answer 256

Vertigo: 1. BPPV 2. Menieres 3. Labryinthitis 4. Otototxicity drugs 5. Vestibualr neuoniitis- Viral unilateral tinnitus + heairn gloss 6. Vestibular ganglionitis- Zoster- Ramsay Hunt 7. perilyhym fistula - vertigot with pressure liek flying, diving, coughing 8. Labrytihnitis- Sudden vertigo + middle ear fidnings - can also cocur with tumors, bleeds, post concussive Central: Cerebellar- HA, Truncal ataxia, ROmberg +, ataxia tandem gait Lateral meduallry - dyspahgua, dysphonia, facial numbenss, corneal reflex out Diplopia, dyspahiga, dysartrhia, drop attacks, dizzinies= vertebobasilar Vertebal artery- truama, chiropracter, Neck pain, vertigo MS Vestibualr Migraine

Answer 257

Cross reacivity of Antibodies to heart, joints skin etc | JONES criteria

Answer 258

``` papilledema AMS FNDs immunocompromised -to avoid a mass or herniation or ICP high if blunted sulci ```

Answer 259

Can be lined with mucuous Stress induced can be, crhonic pressure, better when poop HYdration, exercise, fiber

Answer 260

Faical paralysis, needs amyringotomy

Answer 261

US= 98% and 98% | Air or liquid enema

Answer 262

COver and NSAIDs 3-4 weeks | give acylovir if immunocomprmised

Answer 263

1. Hydration 2. Check electrolytes, B12,Iron and rpeleace- also they are ADEK vitmain down as well 3. metronidazole and cipro

Answer 264

Malignant otitis externa- broad psecturm Abx (pseudo and staph)+ CT scan Trismus=measseter invovled CN invvlement= extenive

Answer 265

Surgery - repair tunica albuginea and evCUATE HEMAOTMA

Answer 266

MI!, endocarditis, trauma | All about pulm edema- Nitrates, lasix, oxygen and positive pressure venitlation

Answer 267

Charcoal, GI absorption takes awhile

Answer 268

Calcium mediates inuslin release

Answer 269

Quinidine and doxy

Answer 270

2 hours clears, 4 hours milk, 6 hours solids | NOT based on outcome studies but expert opinion only

Answer 271

DCML crosses at brain stem- ipsi loss when spinal cord take out Corticospinal already crossed above so ipsi loss below Pain and temp crossed in spinal canal so contra loss

Answer 272

NO! not intil after the next round of comrpessions

Answer 273

Borhaave- Give fluids, abx and do X ray or soluble water x ray

Answer 274

5 mg/kg without 7 mg/kg with If you use ep becareful in ares iwht poor wound healing because pei decreases it and cuases poor healing It lasts for up to 60 minutes, comes in seconds

Answer 275

1. Octreotide drip 50mcg bolus, 50 mcg/hr. Somatotatin anaolg to shunt splancnic blood away - Reduce transfusions not mortality 2. 1 g Ceftriaxone- reduce rebleed and mortality - ---------- 3. PPI-no benefits with varcies 4. NG tube little useo ther than lowers aspiration risk 5. SB tube if unstable

Answer 276

1. Flagyl and Cipro 2. Amox/clav - sepsis, perforation, uncontrolled pain, high fever, advanced age, significant comorbidities - fistual or obstruction

Answer 277

70% have leukocytosis | MOst ocmmonly caused by fecolith or LN enlargement

Answer 278

Self limited | steorids for itching

Answer 279

FFP or c1 esterase inhibnitor rpelacement | GI an dupper resp invovlvemnt

Answer 280

3 on x ray

Answer 281

1- low levels = give desompressin | 2- faulty vWF

Answer 282

Menieres tinnititus, intermittent vertigo attacks an dheairn gloss neuritis- one long attack, no hearing issues, after a virla infection

Answer 283

1. LFTs and Tylenol level | 2. Give 140 mg/kg of NAC

Answer 284

1. Physiologic is days after birth bc fetla Hgb breakdown 2. >7 days w/ jaundice but good feeds and weight= guconuryl transferse def. and high unconj. bili 3. Low brith weight, low feeds, dehydrated= failure kernicterus is the brian damage as a result of high bili

Answer 285

GLucagon 1 mg slowly Nitro sublingual can be used Papin protelytic enzyme but esophigitis

Answer 286

HSP, igA vasulitis get UA for neprhotic syndrome watch out for GI intussicpetion and perf DC on +/- Steroids if invivlement of organs is low

Answer 287

primary- Dark field micro Secondard- RPR Tertiary - fluroescent treponemal Ab test Pupils will accomodate but not react to light

Answer 288

1-12 weeks | Reverisible - fever, pain over the site , failure

Answer 289

Posteori hip dislocation If cant dorsifle or plantflex and decresaed sensation loss with leg deformity it is surgical emergency for avacualr necrosis

Answer 290

1300 acute ammonia encpehalopathy pH <7.1 Coma, shock give L Carnitine to stop urea cycle and build up of ammonia

Answer 291

Retrograde urtehrogram,if negative pass a foley

Answer 292

USualy asymptomatic and not severe if over 100mg/kg then in 4 hours they should be symptomatic. 1. Gete Tylenol level 2. watch out for eizure, hypotension, coma, acute renal failure, metabolic acidosis and upper gastrointestinal tract bleeding

Answer 293

4/5 criteria 1. Mucous mebranes -even cracked lips 2. Cervical LA 3. Rash 4. palms soles rash 5. COnjucitivitis IVIG and High dose apsirin within 10 days of fever. Coronary aneyrusm complications

Answer 294

If it is in fragments, near a nerve, vessel, palms/soles ror joint If unco,plicated, in soft tissue and no infection jsut give pain meds and DC

Answer 295

serial physical exams, ankle-brachial indices (ABI), CT angiography, conventional angiography, or duplex ultrasonography

Answer 296

PEricardio | if it doesnt imprvoe then go to thoracotomy

Answer 297

C- lots of carriers, 20% chronic infection rate | B-5 % chronic infection

Answer 298

Sling (not figure 8)and send home with follw up | Vascular injuries are rare, malunion is the most common complication

Answer 299

PJP pneumonia with Hypoxia of 92% sats~ or pao2 of 70= steroids!!!! would help + Bactrim

Answer 300

1. No, CPP can lower 2. YES! 3. Mannitol, varying success 4. Pheynotin- seizure snot a bad outcome 5. No benefit

Answer 301

FOmepizole first | Clincial symptoms and ocntinued acidosis for HD

Answer 302

when you ssupect gall bladder disease-cholesstais

Answer 303

1= Ciguatera- IVF, antiemeitcs, atropine 2= Scromboid- antihistamines

Answer 304

NItraes, aspirin, possible hydralazine and benzos | Think about PTX< pnumomediastinum and Dissection

Answer 305

Scleroderma crisis Treat hyperK and lytes THEN give CAPTOPRIL for HTN and renal protection Give Abx if Diarrhea bc of bacterial overgorwth

Answer 306

Brachial artery

Answer 307

Pheo MEtanpehrines Phenoxybenzaprine HYdral and phentolamine in acute crisis

Answer 308

LVH and DEEP NARROW Qs (inferoir and lateral)

Answer 309

Subacromial bursititis- NSAIDs, PT Steroid injections

Answer 310

Myocardial contusion EKG trops watch out for arrythemias

Answer 311

Aortic stenosis, baloon valvuloplasty

Answer 312

1. should be done within 5 minutes of arrest, conitnue CPR 1a. baby needs to have doppler heart tones 2. Only if the fundus is above the belly button 3. From pubic sympgysis to 5 cm below the Xiphphoid 4. push bladder out fo the way and then do vertical incision on uterus 5. it is htoguht to relive aortocaval pcmpresisonand return blood to heart 6. dont do a bedside US, it dealys it

Answer 313

PArvo! no reticulocyts are in aplastic retics will be high in splenic sequestration

Answer 314

Low TV (<8ml.kg), Low minute vent (<115 ml.kg), Low RR (permisseve hypercpania is OK to avoid barotrauma), long expiraotry time Pleateu: end-inspiration pressure when flow is zero, and it correlates to small airway and alveoli pressures.

Answer 315

MOrbillofrm rash on the body and spares mucous membranes at first Fever Internal organ ovlvoement (cna lead ot death) mailasie, LA, pharyngitis, IVIG/steroids Anticonvuslants, Bactrim, Antivirals, dapsone etc

Answer 316

Succimer/dimercaprol | NEVER give dimercaprol, give sucimer i think

Answer 317

Admit with IV abx. Source of infection only seen in 20% of patients w. neutorpenic fever and infection

Answer 318

Equinus splint | Posterior mold + stirrups plsint is for tib fibs stability

Answer 319

>3K but less than 50 K (septic arhtitis)

Answer 320

Heartblock, Hyper K, HypoG, bronchospasms 1. Glucagon and fluids 2. Pressor sif need be if bad and LIPID EMULSION IF real bad 3. Calcium 3. High dose insulin 1 unit/kg?

Answer 321

Cyclopegics- atorpine, cyclopentalte ABx Optho follow up

Answer 322

Malrotation + volvulus NG tube, Abx, fluids upper GI sereis if stable (corskscrew) Surgery NOW

Answer 323

A transverse level of sensory impairment, paraplegia, and sphincter disturbance.

Answer 324

lay supine 100% oxygen fluids

Answer 325

``` Age 55 WBC 16 GLucose >200 LDH 350 ASt 250 ```

Answer 326

Wernickes- give 100 mg thiamine anterograde amnseis is korsakoff!

Answer 327

Super high mortality The nerve has now died, and they are getting close to bowel necrosis. Still need to get CTA abdomen! Put abx on board and give fluids use dobutmaine if you need pressors, vessels avoided Always think about Veni thrombosis or clot in Celic or SMA or IMA! may need heparni!

Answer 328

AAA! Look for risk factors, look for femoral pulses (usually intact and perfusoin distal is uslaly OK) GIVE fluids, better to maintain BP between 80-100 than possibly disrupt clot formation

Answer 329

CPR, this is not a shockabel rhythm if V fib or pulselss vtach hen both have shown good results epi has not shwon to reduce mortlaity butgets ROSC Cooling helps with post enuro sypmtoms

Answer 330

7.1 acidosis 25 or 15 if preggo LOC end organ ischemia 6 months old, preggo, older than 60, CAD risk factors

Answer 331

Put Naso airway in

Answer 332

Conreal ulceration | Its ifnected, Abx and optho

Answer 333

2.5 cm and <50% collapse on inspiration

Answer 334

1. Forensic evidence first 2. cops only if the ywant it 3. offer STD empiric treatment but not necessary to test for it bc postive STD could be used against them if it is positive

Answer 335

fluids they third space and vomit, pain control ``` Gall stones Ethanol trauma Steroids Mumps Autoimmune Scropion Hyperlipidemia ERCP Drugs ```

Answer 336

serial CTs if small, and supportive care emergent if >5 mm midline shift or FNDs between dura and subarachnoid

Answer 337

Sync cardiovert if nto try ice bag and then adensoine

Answer 338

``` Hydoxycoablimine (binds cyandie tight) or Nitrites (makes methemogbloin to bind to cyandie) ``` Look out for for sevfer acidosis

Answer 339

Mild Acetic acid - avoid!! if you cant see the TM to rule out perf Moderate - cipro and hydrocotrionse Severe- Ear is completely cursted over = ""+ear wick Psueomonas is top offedner

Answer 340

not proporthional to ammonia level! but it is becasu eliver cant metabolize ammonia an dincresased glutmate in braine GIVE lactulose

Answer 341

Bureelia antibody

Answer 342

Thrombosed ext hemorrhois: 48-72 hours= Elliptical incison and removal. If longer then DC with sitz, pain, topical steroids Perianal abscess- get a CT scan to see the extent of it. Makue sure its not perirectal. If simple then drain. If DM2 or cellutlitis then add Abx to it.

Answer 343

<15 mintues, no more than 1 in 24 hours, gernealized menigisumus, complex, on abx, not immunized get an LP

Answer 344

100 level AMS Kidney liver failure

Answer 345

7.1 acidosis 25 or 15 if preggo LOC end organ ischemia

Answer 346

Linear, closed- DC to home i think Linear, open- Admit obs open depressed- Admit Abx HemoTM, battle, raccon, basilar

Answer 347

Dilt 0.25 mg/kg or usually 10-15 mg max 25 bolus to rate control and leave them in A fib target 100 bpm

Answer 348

10 mg midazolam | 2-4 mg IV

Answer 349

4 mg/kg bolus | 1 mg/kg/hr infusion (up to mg/kg/hr)

Answer 350

Fiberoptic nasally

Answer 351

You can give anaphylaxis Rx but it wont help much C1 or FFP if that is it Supportive and Airway care is the other- ask them to say EEEEE

Answer 352

Methylnaltrexone

Answer 353

Not if it is suspected to be clean

Answer 354

``` <70= Succimer outpatient >70= Dimercaprol + EDTA ```

Answer 355

Aortoenteric fistula- always need outthink about this with syphilis and TB infections or a herald bleed picture!

Answer 356

Joint capsule- inject 150 ml + in joint to see if it comes out the laceration = Abx and surgery

Answer 357

Etomidate to not suppress the adrenals

Answer 358

50-100 mcg

Answer 359

DC! delayed bleeding 5-21 days later but can go home without escahromtoy

Answer 360

get x rays and peronal nerve testing after it knee imbolizer and f/up ortho just push on it medially

Answer 361

Cefixime Augmenton Bactrim Cipro

Answer 362

Flexion of nck and shooting pain down neck/back Heat temp changes ysmptoms=uthoffs MRI and LP

Answer 363

Glsaco-bltachford to see if they need scope or transfusions

Answer 364

WGMA- Dehydration, low gluyconeogensis, and high gluconaon/lowinsulin leads to ketones normal pH bc Alkalosis usually too Flduids and glucose

Answer 365

Streptomycin

Answer 366

It indirectly Activates catcehomlaines NE. Since it cantbe broken down by MAOIs it does this rapidly

Answer 367

Getting betterna dthen worse with sinusitis. Viral>bacterial=give abx

Answer 368

R IJ or L Subclavian is best Cardiac Pacing Transcutaneous: 40 to 60 mA to capture Transvenous: capture at 5 mA then decrease Electrical capture without a palpable pulse = PEA

Answer 369

HUS- damages little vessels leading ot shearing RBCs and plaeltes UA- poreitnuria, RBCs high haptoglobin, LDH high too. Hydration an dpaincontorl and transfuions if need be

Answer 370

1. Flush it 2. still clogged? replace it and then have them follow up **within the last 4 weeksplaced? leave it be! immature tract.

Answer 371

Plaque thrombosis

Answer 372

Mstitis is unilateral infection, ocntinue to breastfeed, give Kelfex, usually fevers fatigue Bilateral = engorement, non breastfeeding, cold compresses Abscess, pocket, drain

Answer 373

Dacrocystitis- Dont ID it! give Oral clinda

Answer 374

IVF and O2, nothing else shown to wokr

Answer 375

1. Vagal tone 2. sick Sinus syndromee (SA node disease, fast/slow HR w/ syncope) 3. BB 4. Hypothyroid 5. Hypothermia 6. Hypoglycemia

Answer 376

albumin to see if you are in ALF

Answer 377

DOxy and still doxy! starts outside and spreads in labs hypoNA, thrombocytopenia, neutropenia, LFTs

Answer 378

first born male, premature,, erythmycin use

Answer 379

15% symptomatics | 30% asymptomatics

Answer 380

Pace them in ED if symtpomatic and get cards for pacemaker placement

Answer 381

descent, oxygen, steorids

Answer 382

Yes, it takes 5-10 rads to damage fetus and CT abd is 2.5-4.5 rads worse when weeks 2-9 in pregnnayc

Answer 383

Omphalitis of Nec Fasc, Broad specturm

Answer 384

NAAT testing not HIV ab testing if you suspect acute viral illness HIV (more prevlaent than asymtpomatic infection)

Answer 385

Peripheral | COntinuous is more central, not episodic

Answer 386

Caffeine | surfactant if under 1 hour

Answer 387

expectant manegment- heals on its own

Answer 388

1. PR long 2. QT long 3. ST depressed 4. Shallow T 5. U wave Braydcardia and AV block

Answer 389

Until symptome resolve, you dont need to stop at 1.5L

Answer 390

Mepiridine

Answer 391

Albendoazole or mebendizole 1x time dose

Answer 392

Diverticular disease, angiodysplasia, and neoplasms

Answer 393

R mainstem bronchus UP, left is down Trachea Right, E tothe RIght Wide mediastinum

Answer 394

Closer to 1% but techinically 1-10% for first and second gens. Neglgible for 3rd and fourth

Answer 395

Wegners, polyarteritis

Answer 396

Goodpasture

Answer 397

Churg strauss

Answer 398

No, only when at rest. Give dex

Answer 399

will not have proptosis, ophthalmoplegia, visual changes, afferent pupillary defect, or decreased visual acuity.

Answer 400

Endopthlamitis- needs and optho right away plus Abx

Answer 401

Fluid bolus- preload dependent

Answer 402

Shigellosis- Ceftriaxone

Answer 403

tibial- rotational fall

Answer 404

Closed | Still in uterus

Answer 405

EBV-HIV | NO

Answer 406

Wellnes Warning for LAD- Cath urgently

Answer 407

12-24 horus but def not after 24 for perforation | dont use charcoal

Answer 408

Staph The patient should be placed on topical and oral antibiotics, advised to use warm compresses and given analgesic medications. They should be provided with ophthalmologic referral for outpatient follow-up.

Answer 409

Intraneural nutrient artery to CN3- seen in DiBEETS THe artery is is still giving blood to parasymp peripherally but core is nto working for motor If Refelx is out then thing bleed, tumor, stroke

Answer 410

Sling and go home- watch out for Capsulitis and AVN | DONT need to sedate and reduce if minimal

Answer 411

Chronhs- mmore oxalata, less Ca and fat absorption

Answer 412

Bc blood gets absorbed in GI tract and BLOOD urea nitrogen is aborbed

Answer 413

IV fluids, analgesics, 5-aminosalicylates, systemic steroids, and antibiotics if there is concern for infection or perforation.

Answer 414

pyrimethamine and sulfadiazine

Answer 415

COnfusion BUN >19 RR>30 90/60 65 0-1 go home 2+ come in

Answer 416

NO, wait and see after intubation n

Answer 417

Obsturction and infection (hydro?) Cant sotp pain or vomiting One kidney, transplant

Answer 418

Supportive

Answer 419

INterventricular hypertrophy- resolves on its own usually

Answer 420

BB Alcohol ablatoin Low EF, sudden cardiadc death risk is ICD placement

Answer 421

AMiodarone- wait for a couple months a redraw

Answer 422

HbBarts or 4 gamma is alpha thal Beta thelmessemia- is hbF and HbA2 is high HbSC less evere sickle variant, nromocytic

Answer 423

Get CT scan for metastic meduallry cancer bc Calcitoni levels are still high

Answer 424

SIADH- absorba all water and pisss out salt

Answer 425

Hemoglobin > 13.0 g/dL (men) or > 12.0 g/dL (women); BUN < 18.2 mg/dL; initial systolic blood pressure > 109 mm Hg; HR < 100/min; no melena or syncope at presentation and absence of hepatic disease or heart failure history.

Answer 426

irrigate tiwth 2 liters fluid | then check make sure pH is 7.0-7.2

Answer 427

Anteriootalor fibular Calcaneal fib and posterior talo fib is rare needs a lot of force Grade 3 is joitn instability

Answer 428

Macrocytic from folate Pancreaititrs and PUD elevated ammonia, estrogen, and progesterone level - -decreased albumin level. Because the majority of calcium is bound to albumin, a decreased serum calcium will be noted but the free or ionized calcium level is typically normal.

Answer 429

Ab cross reactivity with the valve tissues- leads topulm HTN leads to RHF

Answer 430

Pre renal azotemia or pre renal AKI bc tubes still work to retain Na ATN from infection, drugs or toxnis would be elevated

Answer 431

Warm and fresh water

Answer 432

Perilunate dislocation is actually capitate dorsal dislocation. Teacup is up. Emergent ortho surgery. check median nerve, avoid AVN Lunate is dislocated and curve facing down

Answer 433

primary- shcokwave secodnayr- fragments tertiary- propel into obejcts

Answer 434

How to Tx Primary/secondary syph Late syph Neruosyph

Answer 435

Labetalol and dleivery Hepatic hematoma! DICHemolysis, LFTs, emolysis, LFTs, Low plateltes usually with HTN like preecamlsia

Answer 436

Least infection (half as much as internal jugular), PTX

Answer 437

``` NAVEL (no V for kids) Naloxone atropine Vaso Epi lidocain ```

Answer 438

120 110 Always think are they low, eu or hypervolemic? if hypovolemic aim for 0.5 meq an hour

Answer 439

Wellenes or tight stenosis of LAD

Answer 440

Brain MRI! most liekly a Viral cause but rule our brainstem strone, pontine angle mass Air>bone conduction maybe give sterdois and acylcovir

Answer 441

Para (paramedics)- urologic emergency- foreksin is stuck up and cant reduce. reduce with frim pressure 5-10 minutes. No uroglogy? Lidociane plus dorsal slit Phimosis- cant retract foreskin

Answer 442

Ach Dopamine Benztropine block ACH receptors and blocks reuptake of Dopamine

Answer 443

Echo evidence of valve regurg Blood cx new murmur the rest you would think woudl be minor criteria

Answer 444

Klebsiella

Answer 445

Defib! Mg for a pulse

Answer 446

Hopelessness/depressio previos attmept intent rational thinking loss

Answer 447

Sodium bicarbonate is the antidote of choice and works via overcoming the sodium channel blockade by providing a sodium load and via inducing an alkalosis to decrease drug binding to sodium channels. Indications for sodium bicarbonate include a QRS duration > 100 ms, ventricular dysrhythmias, and hypotension. Look for Terminal R wave in in AVR

Answer 448

Lots of stress on the inside of your thumb, like you ginfers didn the splits. And then the UCL ulnar ligmenat is torn and has laxity >35 degress. Thumb spica and urgent surigcal follow up

Answer 449

IVF, acetazolamide and nof urhter ascent progresso n to descent and dex if that doesnt wokr

Answer 450

Acut einfection

Answer 451

Decresae afterload and pre load by increased intrahtoac pressure

Answer 452

any UMN is conus, very sudden, bilateral, Ankles gone w/ preserved Knees

Answer 453

Posterior Cerv LA (Ant is strep throat) with exudated in post OP Almost always rash after pen/amox splenomgaly dont play sports for 4 weeks after heterophile Ab test and atypica llymphocuytes

Answer 454

GN coccobacilli- H Ducreyi

Answer 455

Mannitol! begins 6-10 hours after therpay for unknown reason- 90% mortality, usually kids

Answer 456

B6 and B1 to shunt the pathway Ehtlyene glycol 50 glyciolic acid 8

Answer 457

Iburpfoen and Tylenol - dysmenorrhea - prostaglandins mediated

Answer 458

systolic blood pressure < 90 mm Hg for > 15 minutes, a systolic blood pressure of < 100 mm Hg with a history of hypertension, or a > 40% reduction in baseline systolic blood pressure. Tachy. RV dialtion hypokinesis. Hypoixc and hypoTN think lytics

Answer 459

BIpap IV Nitro furoesmide

Answer 460

Hypoxia- intubate | Hypotension - SBP 90

Answer 461

Adenosine this is PSVT or valsalva | If it is wide or irregular then think procainamide

Answer 462

Arsenic- urinay alkinalization

Answer 463

Homatotropine

Answer 464

You can do itin IIH but make sure this no mass ocupying lesion and CN abnromalities! it is diagnositic if you have papilledmea INR <1.5 and platletes 50K are the cut offs

Answer 465

Cushing disease is pituriaty tumor, syndrome is steroids | - Keotconazole and metyrapone to stop steroigensis or take out hte tumor

Answer 466

Nothing, it is from the ventricles and usally after a reprufion to myocaridum. wide complex and regular, 40-100 beats

Answer 467

Ecchymosis and DIC and ganrene of extmeities | Waterson F

Answer 468

100 vs 92%

Answer 469

Kelfex, augmenton, Macrobid NOT cipro or bactrim Uterus is big and porgesterone relaxes smoth muscle so risk of Pyelo is 30%, preterm labor, IUGR, sepsis, UTI, neonatal death

Answer 470

Deep ST depression in V1 and V2 Either from Right coroanry or Left circumflex artery get posterior ekg

Answer 471

Apsirin Slopidrgrel heparain Nitro to vasodialte coraonry arteries (not right sided) 90 minutes from door to balloon time or else thromblytics 120 if transferred

Answer 472

5 6 lead 1 and AVL STEMI

Answer 473

ST depression in anteriro leads Same look if it was right sided, 2 3 F

Answer 474

Proetien hydorylsatye AMnio acid formula if weight loss and esophigitis and ill appearing them do histamine or ppi therpay

Answer 475

CFTX for + and - coverage and metornidazole for anaerobes and E. hisolytica infection

Answer 476

GRam stain with bacteria 7.1 pH 50k WBC glucose <60 usualy a parapenumonic effusion

Answer 477

Clinical findings may include subcutaneous emphysema or crepitus, dysphonia, stridor, hemoptysis, laryngeal tenderness, anterior neck pain with tongue movement, or anterior neck pain with head rotation.

Answer 478

FLuconazole, itraconazole for occicodio

Answer 479

narrow complex 3rd degree AV block + inferoir wall MI is transeiint and good prognosis Right bundle, left bundle, posterieor ehmi block have increased rsk of shock, v fib, big infarct size and poor mortality

Answer 480

IRON OD | deferoximine

Answer 481

Calcium gluconate- if you suspect deep invovlement may need to push it IV bc it binds to those ions watch out arrythmias

Answer 482

DC microscopic without gross heamturia | if gross then CT

Answer 483

<1500 lymphoytes

Answer 484

MIcorangiopathic thrombosis Patients with HELLP syndrome are at risk for bleeding complications, including disseminated vascular coagulation (DIC), intracranial hemorrhage, placental abruption, and spontaneous hepatic or splenic hemorrhage. Hepatic hemorrhage can progress to hepatic rupture

Answer 485

Lung cancer | rarely

Answer 486

Dextromehtorphan

Answer 487

ADAMST13 ab cleaving vWF into smaller thigns to glom up vessels Plasma exchnage

Answer 488

MEsenteric ishcamia- need abx

Answer 489

Sitz bath and steroids | <72 = cut it out

Answer 490

Soft signs= CT angio +/- EGD and bronch HArd= OR ZOne 1= SC to cricoid HArd= Non reposnsive shock, no radial pulses, FND, massive hmoptysis

Answer 491

``` Erysieplas of superficial dermis- systemic so give IV CFTX if not then give amoxicillin Strep pyo (B) ```

Answer 492

DSypena on exertion diasotlic rumble hoarseness bc L atrium onto recurrent larygeal nerve

Answer 493

``` 100 if less than discharge home You would need 28 g or 140 pills in 70 kg person Common:GI and CNS Rare: hypoTN seizure coma ```

Answer 494

Hemolysis | Diuretics and fludis

Answer 495

1. Stop, could be non hemolytic or hemolytic 2. repeat cross match, haptoglobin, LDH, direct antigen test 3. Blood cultures 4. once hmeoysis is ruled out- restart and give tlyenol. can use leuokcyte recude blood

Answer 496

Weak pincer grasp bc ulnar colateral lig on medial side . valgus stress

Answer 497

cardiac dysrhytmia bc catecholamine release and senstize myocaridum - give BB

Answer 498

100% O2 and reshoot xray in 6 hours, DC after

Answer 499

needs flex sig and then opertion to prevent recurrence

Answer 500

Digoxin "Dig" that slope

Answer 501

E coli | bactirm or flkuoruinoline

Answer 502

Doesnt have ot be just at rest, it can be new or worsenign anginal pain

Answer 503

need lateral chest x ray restrained drivers low mortality, doesnt alwya smean underying injury

Answer 504

Etomidate- ressur eneutral and quick sux- quick to reassess mental status afterwards avoid hypoxia and hypoTN

Answer 505

P. malariae is every third day --- vivax, faciparum, ovale is every other day - recurrence after months of exporusre is vivax or ovale dormant= needs primaquine

Answer 506

posterior displacement of the globe - truama

Answer 507

Trigeminal neurlagia

Answer 508

decomrpession sickenss

Answer 509

Reexpansion pulmonary edema. happens when you turn on suction from a PTX that has usually been there for a few days and repaid expansion of the lung causes fluid shifts. Dont turn on suction right away. Supportive and self limited, PPV if need be

Answer 510

Calcum gluconate and try to get K down first

Answer 511

Repeat if below 1000 in 48 hours Can be an empty gestastional sac AND a actopic pregnancy it does nto rule it out Rhogam to Rh neg patients an bleeding MTX 85-93% medical therpay in early ectopic

Answer 512

``` Tetanis Ig Metronidzaole Benzos and ROcuronium! opiods ```

Answer 513

L-R shint progresses to R to left shunt! bc overload into the lungs an dpulm HTN Oxygen wont increase the sats!

Answer 514

60 minutes=rinse and reimplant >60 minute= soak in citric acid and emergent dental follow up (1% per minute) kid under 6 years- dont put it back in

Answer 515

grade 2 in decreased ROM but still can wlak on it. Partial tear. immobilize Grade 1 is full ROM with pain and can walk. microscopic tears 3= no walk, full tear. surgery

Answer 516

Supportive if no PTX

Answer 517

hyperkalemic, hypokalemic, thyrtoxic types. happens after heavy exercise and high carbs! PAralysis + BMP give carbonic anydrahes and K sparing siruetics in hypokalemic which is common ion channel problem. famimlial

Answer 518

>240 V even if they are asymptomatic - lytes, CK, cardiaac arrtyhmias

Answer 519

old copd ummunocompormised

Answer 520

trifluridiine

Answer 521

pulmonary effusion

Answer 522

dengue fever

Answer 523

160/110 | plus AMS, labs, pulm edema ect

Answer 524

WASH Warm water, analgesics, st MC anorectal disorder- if it isnot midline think crohns, orinfectoius

Answer 525

internal carotid is 2-3 cm inferior lateral

Answer 526

Interventions start with rales in pulm fields- low flow oxygen in the ED- if none then go home Rales in all field sis high flow oxygen and ICU and if Abnromal BP then conisder intubate and ICU- 3&4 needs hgi flow oxygne

Answer 527

neurgenic pulm edema obsturvive pulm edema ARDS

Answer 528

intubate and positive pressure ventilation | if 8 ribs, old, shock, resp fail, comorbids then do this early to reduce mortality

Answer 529

Tarasal-metatarsal dislocation- cuneifrom and cuboid keep calc stabel and twist foot. Xray Nondisplaced= walking boot. Displaced is surgical

Answer 530

CHeck IOP- eye hsield, rest- f/up | it is a bleeding oiris or ciliary body -

Answer 531

When Diastolic - compartment pressure is >30

Answer 532

VP shunt with intermittent headaches around exercise and stress Overdrainage and the ventirlces collapse and now obstruct the shunt altogether an dimproves with rest. Needs nuerusurg consults and lay supine/treneldumburg

Answer 533

Discharge and KEep dry

Answer 534

HYPO all the way (even hypochloremia) | met alkalosis

Answer 535

NOT naloxone | needs paralytic

Answer 536

Supportive not fomepizole

Answer 537

neutrophils causing enodthelial injruy and vascualr leakege in the lungs

Answer 538

Burn treatment including fluid repletion to replace insensible losses, wound care, and prophylactic antibiotics as indicated. Patients with severe oral or airway involvement may require intubation for airway protection as well as transfer to a burn center, depending on the degree of involvement Mycopalsma can cause this

Answer 539

glass etching White figners directly after--- GIve clacium gluconate bc QT and arrtynmais can happen 24 hours later even for 1-5% of surface area

Answer 540

IO if can tbe accessed in 1 mintue

Answer 541

If ischemic then penile block, and Ab oitnment and dorsal slit IF non ischemoc soak a sauzein mannitol ro sugar and osmosis to reduce swelling

Answer 542

Over 4, even if metal valve | K and PCC

Answer 543

Patients not in a “shockable” rhythm should receive high-quality CPR, epinephrine, and a diligent search for potentially correctable causes of arrest should be undertaken. Therefore, because the patient is in cardiac arrest with a rhythm on the monitor but no pulse, chest compressions is the next most appropriate step. Causes include hypothermia, hypoxemia, hypovolemia, hemorrhage, hyperkalemia, hypokalemia, severe acidosis, tension pneumothorax, pericardial tamponade, pulmonary embolism, myocardial infarction, traumatic injury, and toxic ingestion or overdose. Chest compressions should continue with minimal pauses during bag ventilation, definitive airway establishment, or defibrillation (if indicated). Compression depth is 5 to 6 cm (maximum 6 cm), and the compression-to-breath ratio is 30:2 (30 compressions followed by 2 breaths delivered by 100% FiO2 through a bag-valve mask). Once a definitive airway is established, the ventilation rate is 10 breaths per minute or one breath every 6 seconds. Once return of spontaneous circulation (ROSC) is achieved, post-cardiac arrest care may include percutaneous coronary intervention, early goal-directed therapy, targeted temperature management, or aggressive glycemic control.

Answer 544

NO- IVF ABx and surgery

Answer 545

2 hours to PCI | apsirin too nless allerguc

Answer 546

Pseudomonas coverage plus think staph and strep | cartilage receives its blood supply from the surroungin perichondrium - disrupt htese layres and worse blood flow

Answer 547

Yes | Ant mid and posterior columns keep this in line. need to knokc out 2 columns for instbaility

Answer 548

it is embryogenic where ileum, cecum and ascedning colon did not adheere to posterior wall. LUQ will shwo the trnasition point young 30-50

Answer 549

UP The CAPITATE is what is actually displaced here and the lunate will be up and over the radius lunate idlsocation is spilled and off the radius

Answer 550

diffuse hypokinesis with multichamber dilation

Answer 551

erythcytosis from erythpoeitnin PTH, low phosphae HTN from Renin Hyperglycmeria from ACTH

Answer 552

Upper GI series (or abd ultrasound) for midgut volvulus

Answer 553

1=33% 2=50% chance of PNA HR, RR 30, febrile, no wheezing, leukocytosis, crackles, confusion

Answer 554

3 ml NS with suction

Answer 555

contorl it bc poor neuro outcomes

Answer 556

CREST syndrome are Calcinosis, Raynaud phenomenon, Esophageal dysmotility, Sclerodactyly and Telangiectasias. Most treatment is aimed at symptomatic relief although there is some evidence for the use of methotrexate as an immunosuppressive agent

Answer 557

CK >5X the upper limits | Get an EKG - renal failure> hypoCa- HyperK-hyperP

Answer 558

severe pain, is febrile, or has a leukocytosis, then an emergency surgical consultation Vitals too, Phys exam

Answer 559

These can be remembered by the mnemonic “ABCD”-- adenosine, beta-blockers, calcium channel blockers, and digoxin. Atenolol is a beta blocker and is therefore contraindicated. AV nodal blockers

Answer 560

PSGN- weeks plus throat or skin IgA=URI and then 2 days you get hematuria

Answer 561

Carbamazapine/Oxcarb Anitdepressenats Antipsychotics HCTZ and Loops

Answer 562

6 months-5 years

Answer 563

The treatment of myocarditis is supportive and aimed at maintaining cardiac output. This includes management of associated rhythm disturbances and congestive heart failure to hemodynamic support with vasopressors, ventricular assist devices, aortic balloon pumps, and even cardiac transplantation in fulminant cases. Endomyocardial biopsy is the historical “gold standard” for diagnosis of myocarditis, confirming microscopic features of myocardial inflammation and necrosis. However, some studies have questioned the sensitivity and specificity of endomyocardial biopsy, and in the future cardiac MRI may supplant endomyocardial biopsy as the test of choice for myocarditis.

Answer 564

doxycycline. In pregnant women or children under the age of 8 years, amoxicillin should be substituted. Patients with neurologic or cardiac manifestations should be admitted and treated with IV ceftriaxone CNS and AV block is 4 weeks later.

Answer 565

yes Studies have shown that patients with renal failure and metabolic acidosis have a reduced need for dialysis and reduced mortality at 28 days when treated with sodium bicarbonate. DKA no shown benefit

Answer 566

Propranolol, PTU, Idodide, Dex Propylthiouracil is then administered to block synthesis of thyroid hormone and also block peripheral conversion of T4 to T3. Approximately one hour after administration of propylthiouracil, you would then administer potassium iodide to prevent release of stored thyroid hormone. This is done with a one-hour delay to prevent the utilization of the iodide by the hyperactive thyroid to make new thyroid hormone. Dexamethasone is then administered due to concern for adrenal insufficiency in association with severe hyperthyroidism, as well as its ability to decrease peripheral conversion of T4 to T3.

Answer 567

Urethreal innjury | gross hematuria

Answer 568

Glimpiridie- sulfonurea 24 hours of half life and peak activitiy glargine is lng acting but never has peak activity

Answer 569

dont hold yor breath | hyperbarics

Answer 570

if CT negaitve and you stil suspect it

Answer 571

US and then prtozoan in stool | IV metornidazole- drain only if refractory

Answer 572

Klebsiella Mycoplasma pneumo Anthrax

Answer 573

AIN acute renal failure resulting from immune-mediated tubulointerstitial injury. The presence of eosinophiluria in a patient with acute kidney injury suggests acute interstitial nephritis, which is typically an allergic reaction to medications such as penicillins, sulfa-containing antibiotics and diuretics, NSAIDs and proton pump inhibitors. Patients with acute interstitial nephritis may also present with a rash, fever, eosinophilia, and other constitutional symptoms

Answer 574

``` DiGeorge Cardiac abnromal face Thymic Cleft platate hypocalcemia 22 chorme ```

Answer 575

Trendelmburg or knees and elbowes to c section immedietely or if you cant try tp put it back in the uterue

Answer 576

flat | Flat

Answer 577

Postive and wide in 1 negative QS in V1 RBBB is negative and thenin V1 it is triphasic

Answer 578

blocks acethcolinesterase- 2PAM regerneates it Wach out for brady cardia, bronchsopsms and bronchorrhea - All muscarinic effecgts nicotninic is fascilautions and paralysis

Answer 579

augmenton oral hygiene rinsies follow up with dentist for debirdement

Answer 580

Aspirin CO CN Caffeine Acetominophen Theophyliine

Answer 581

Wellens warning

Answer 582

Steorid enemas stool softenres DC to home

Answer 583

To perform a needle cricothyrotomy a 12 or 14-gauge angiocatheter is inserted into the cricothyroid membrane. If the commercial kit is available, the oxygen delivery tubing with an on/off valve is attached and periodically insufflated for breaths. However, two alternatives exist when the commercial kit is not available. The end of a 3-5 endotracheal tube can be directly attached to the angiocatheter and a subsequent bag valve mask to the endotracheal tube tip. This circuit will have significant resistance although the patient can ultimately be ventilated. An additional option is to attach a 3 mL syringe with the plunger removed to the angiocatheter. The adapter of a 7-0 endotracheal tube can then be attached to the open end of the syringe.

Answer 584

Retro urethrogram

Answer 585

looks like ascending cholangitis a little bit but no stone noted and fatty/cirrhotic liver

Answer 586

K PO Uric Acid high low Ca

Answer 587

``` Primary low cortisol and aldosterone Hyper K, hypoNa low glucose hypotn and shock Pigmentation ``` hydrocortiosne

Answer 588

HD 5, 4+kidneys or 2.5 and symptomatic (especially siezures) If low and mild then NS at 2x main rate

Answer 589

go get | repeat x ray 48 hours

Answer 590

gastric outlet syndrome

Answer 591

c6 Cricpharygenal

Answer 592

BAD SHIT: Biliary, Alcohol, Drugs, Scorpion, Hyperlipidemia, Iatrogenic (ERCP), Trauma

Answer 593

Hemorrhagic: Cullen sign (ecchymosis around umbilicus), Grey Turner (ecchymosis around flanks)

Answer 594

``` 16 WBC 55 Age 200 GLucose 250 AST 350 LDH ```

Answer 595

1000 | 250

Answer 596

emphysematous cholecystitis (higher risk of perforation 🡪 emergent surgical consult 'Acalculous: elderly, diabetes, trauma, burns: high risk of perforation and death Gallstone ileus: stone goes into small bowel with obstruction at ileocecal valve

Answer 597

increased risk fo cancer

Answer 598

emergent decomrpession

Answer 599

``` fever RUQ jaunidce hypoTN AMS ```

Answer 600

angiogngraphy for emsneteric ischemia

Answer 601

#1 cause is adhesions Hernia is #2 cause Treatment: NG tube, IVF

Answer 602

#1 cause is tumor X-ray show distended large bowel with no stool in the vault Treatment: NG tube, IVF

Answer 603

signmoidopscopy or rectal tube and then surgery to takc it down cecal volvuslus is striaght to tsrugery i think

Answer 604

Indirect Inguinal Most Common Passage through persistent processus vaginalis deep ingeuinal ring baove/lateral the inferior epigastric Direct Inguinal Passage through transversalis fascia and external inguinal canal beoow/medial the epigastric Femoral Passage below inguinal ligament (more common in females) and medial to femoral artery Spigelian Passage lateral to rectus muscle (difficult to diagnose Incarcerated = irreducible Strangulated = irreducible with vascular compromise Treatment: manual reduction. If strangulated or time of incarceration unknown, do not try to reduce

Answer 605

psoas abscess Extraintestinal manifestation: arthritis, uveitis, sclerosing cholangitis, erythema nodosum

Answer 606

May cause urinary symptoms because of irritation of underlying GU structures Do not miss colon cancer Outpatient Treatment: Cipro + Flagyl for 7-10 days Inpatient Treatment: obstruction, peritonitis, immunocompromised, abscess

Answer 607

4= percutaneous drianage

Answer 608

sitz, stool softener, high fiber

Answer 609

Dull, aching rectal pain, erythema, induration, +/- fever, +/- fluctuance Rectal exam to rule out intersphincteric abscess Ischiorectal abscess – lateral Simple perianal abscess maybe drained in the ED, all others in the OR Abx not routinely recommended Think of STDs if they have proctitis

Answer 610

Smooth edged body: remove in the ED (awaiting spontaneous passage can lead to infection and perforation Signs of perforation: consult surgery

Answer 611

Platelets: <50,000 give one per 6 pack of RBC Liver Failure + GI bleed: octreotide, PPI (reduces rebleeding and transfusion requirement but no mortality benefit), Antibiotics: mortality benefit

Answer 612

``` Toxogenic diarrhea Abrupt: <24 hours; +/- abd pain No systemic symptoms Invasive diarrhea Slower onset: > 24 hours Fevers, abd pain, blood/mucous/pus in stool (dysentery) ``` Testing: Helps to distinguish between invasive vs toxogenic Usually not done through ER Stool cultures important for: HIV, food handlers, healthcare workers, C.diff for recent hospitalizations or antibiotic use O&P – not routinely done but important in men who have sex with men, AIDS, foreign travel

Answer 613

Dehydration: oral preferred, IV otherwise Pt’s fed earlier do better Antidiarrheals: Loperamide: anti-motility agent, recommended for patient that is afebrile or low grade fever Bismuth: less effective than Loperamide but can be used with fever and dysentry Antibiotics: moderate to severe diarrhea with signs of invasive bacterial infection, elderly, immunocompromised Oral Flagyl and Vancomycin for C.diff Fluorquinolone: 3-5 days unless proven E.coli 0157:H7 Azithromycin if resistance/allergy suspected

Answer 614

Symptoms within 6 hrs: preformed toxin (B. cereus) Symptoms within 6-18 hrs: C. perfringens Pregnant women eating unpasteurized products: 20 times increase of Listerosis Shigella can cause seizures in infants Yersenia – may present like appendicitis Campylobacter jejuni #1 cause of infectious diarrhea in United States Amoeba histolytica causes liver abscess

Answer 615

hypercoagable bc it is unable to stop the cascade | hypercoagable bc it is unable to accept the effects of protein C so cant sotp the cascade

Answer 616

Consequences of decreased platelets <50,000: excess bruising with minor trauma <30,000: spontaneous petechiae and bruising <10,000: spontaneous visceral hemorrhage 1 unit considered to raise recipient’s count by 10,000

Answer 617

Non palpable purpura: think low or dysfunctional platelets | Palpable purpura: think angiopathy/vasculitis

Answer 618

Decreased production: Aplastic anemia, malignancy, meylofibrosis, radiation, viral infections, drugs (ethanol, thiazides, estrogens, chemotherapeutics, heparin) Increased destruction: ITP/TTP/HUS/DIC/viruses/drugs (heparin) Splenic sequestration Enlarged spleen can hold half of blood volume and 90% of platelets Malaria, rheumatoid arthritis, TB… Platelet loss Bleeding, hemodialysis

Answer 619

50K bleeding 20 K non bleeding Kids resovle, adults dont steorids and IVIG if less than 5

Answer 620

Steroids, FFPPlex 80% mrtality if untreated Schixotcytes

Answer 621

Consumptive coagulopathy Extrinsic pathway problem Liberation of tissue activating factor 🡪small fibrin and blood clots deposit in microcirculation 🡪 consume clotting factors and causes hypoxemia🡪fibrinolysis🡪elevated fibrin split products Etiologies: trauma, sepsis (meningococcemia), transfusion reaction, envenomation, retained products of conception Labs: Increased fibrin split products and d-dimer, thrombin time, PTT Decreased platelets, fibrinogen (may be normal) ``` TX Treat the underlying cause If primarily bleeding follow the PT (best single test in this setting) PCCs FFP (10-15 mL/kg) Vitamin K Folate If primarily thrombosis consider low dose heparin infusion ```

Answer 622

HIT 1. stop heparin 2. reverse warfarin (warfarin necorsis risk) 3. give Ruidn or Agrotroban (direct 2a thrombin inhibuor bc they are high risk of thromobosis) 1. Dont give warfarin or 2. plateltes

Answer 623

Dialysis need, rneally excreted Bleeding and on drugs: Consider tranexamic acid (fibrinolytic inhibitor), desmopressin (transports VIII and stimulates release of von Willebrand factor PCC maybe too

Answer 624

ACS- pulm vasculature from infection, infarction ``` Oxygen Antibiotics (include a macrolide) Incentive spriometry Pain control Bronchodilator therapy Transfusion (especially if high risk)- for al tyes of crisis if bad enough ``` Renal, brian, hand and foot, priapism (echange and asiration) Watch out for splenic sequestration and aplasitc crissis- low theshold for Abx

Answer 625

Desmopressin | Factor 8 trnsfuion rare

Answer 626

MAP-ICP Ideal CPP >60 80-15 is great head trauama: Elevate head of bed Maintain adequate oxygenation, ventilation, systemic perfusion Mannitol 1 g / kg Hyperventilation (temporizing) to Pco2 of 30-35 mmHg Emergency decompressive craniotomy

Answer 627

Jefferson= C burst from axial load Type 2 and 3 odotoid fractures form flexion (body of dens invovlenmnt) Hangbmans' C2 displaced anteriorly bilateral pedicle Fx Teardrop- flexion or extension but spinal cord injury - frnt of vertbal body is brokena nd pushed the body into th epsinal cord

Answer 628

Anteori cord form spinal artery injury | DCML is still intact

Answer 629

avoid hypotension

Answer 630

``` HypoTN Art bleed rapid expangin hematoma Deficit neuro Buit ```

Answer 631

spinal cord injury with out rads evidence Kids>adults C sine>TL

Answer 632

Chest x ray can lag hours and get worse Sucking chest wound= 3 sided not Chest tube through it Tension= needle nto x ray

Answer 633

1500 1 for 6 hours 200 for 3 hours air leak cant get a hole of

Answer 634

Penetrating trauma and lose vital suddenly NOT blunt trauma If you do it, go anteroiro to avoid phrenic nerve

Answer 635

Diahrgam injury - CT can miss it Hollow viscus small bowle injury, CT can miss it Pancreas easily missed to

Answer 636

Spleen Liver

Answer 637

Grey turner retorperitonnal bleed

Answer 638

Retorgrade cystogram? Intrapertineoal is surgery, extra just sticka foley in retrograde urethrogram- urethral injury- dont put a foley

Answer 639

Fall from heigh ti si latreal comrpession and vertical shear MVC is AP and urethral tears Sacral fracture can have cauda equina

Answer 640

dont inject into it | hand surgeon iedialtely

Answer 641

>20 >30 for sure pulse goes last, pain and paresthsia first

Answer 642

Unvaccinated + bad injury = Ig! lidocaine 4mgkg and 7 mg kg epi

Answer 643

Same thing but extra 9 to head | legs are 14 a piece instead of 18

Answer 644

acid is coagulative burns 3rd degree, 2nd 10% and up, face, hands genitals, inuhaltion, electrical, acid== ALL need burn center!

Answer 645

``` MCC of pediatric death > 1 year Follows same ATLS protocol Airway: Large occiput tends to flex neck ETT size : (age/4) + 4 ETT depth: 3 x tube size No cricothyroidotomy if < 8 years old Temporize with Transtracheal jet ventilation: oxygenation but poor ventilation Circulation: pRBC: 10 cc/kg Disability: C-spine fractures less likely than adults SCIWORA: dx by MRI- if still complaining of neuro injury ```

Answer 646

Uterine rupture, baby is usually dead, way worse, no uterine contour, maternal shock minor fall but no bleeding- placenta abruption - concelaed bleeding MOre bleeding with preggo pelvic fractures

Answer 647

1. pressure (lungs, TM, small bowel ) -air filled organs 2. debris hitting you 3. throws you 4. burn injury, anything else

Answer 648

needed if unstable, dont go to CT scanner | GO straight to OR if postivr fast

Answer 649

Transfer- if you can get to the center within the 120 minute hten transfer him you can give tpa within 12 ours of sympomts, 30 minutes form symptom onset

Answer 650

surgery ocnuslt the other 2 come after

Answer 651

Cefotetan or ceofixitn 2nd gen for gram neg and anerboes keflex is fist gen

Answer 652

Trephination is indicated for subungual hematomas that are less than 48 hours old, are not spontaneously draining, and are painful hematoma involves the nail fold or there is a fingertip avulsion that requires subungual sutures for repair, then the entire nail should be removed instead of trephination large hematoma and tuft fracture DOES NOT need anything more thn trephination bad fracture or nailbed exporsure is surgery

Answer 653

<4cm stable no liver disease not ruptured

Answer 654

uncuffed is 4s | cuffed is age/4+3.5

Answer 655

BRADYCARDIA

Answer 656

ehrichia | give doxy

Answer 657

dont cause paint in AMS, asthma and eczema hx, CAD and V fib most ocmmon not hyperK

Answer 658

Amp and sulbactam not pip tazo and vanc

Answer 659

malbaosroption, poor diet and pth resistance

Answer 660

Viscous lidocaine 2%, 30 mL aluminum hydroxide and 150 mg ranitidine

Answer 661

nikolsky negative, old ppl, basement membrane antibodies, oral steorid s

Answer 662

Historical elements indicating cardiac causes of syncope, as opposed to orthostatic or neurocardiogenic episodes, include syncope during exertion, palpitations at the time of syncope, ECG findings of dysrhythmogenesis (e.g., bifascicular block, intraventricular conduction delay, QT interval abnormalities, Brugada pattern findings), and lack of postdrome. Prolonged prodrome and postdrome symptoms are common with vasovagal etiologies, with fatigue and nausea lingering well beyond the event itself, whereas true cardiac etiologies typically have no harbingers or postepisode symptomatology.

Answer 663

weight loss thats it | MC liver disease herer

Answer 664

resp distress | GLucaogon X2 20 min apart and observation if not

Answer 665

Klebsiella, Donovanosis Granuloma Inguniale. Klebsiella Ingunale DOxy or azithro Lymopgranuloa venereum is Chlamydia chancroid can have LA too

Answer 666

LMWH and Warfarin

Answer 667

Meidal, pain with resisted flexion lateral, pain with resised extension medial elbow pain in kids compression of posterior interossius nerve

Answer 668

Radius fx and ulna dislocation watch out for compartment syndrome OK sign to test for ant interosseos smedian nerve!!!

Answer 669

Ulna fx radial head dislocation

Answer 670

Each 0.3 meq drop needs about 100 mew replaced

Answer 671

HypoK on diuretics, long QT St depression with shallo T right into a U wave possible dig overdose

Answer 672

hustmaine release, not true allergy

Answer 673

supportive

Answer 674

full spine for skip lesions

Answer 675

R sight sided problem like RBBB or RI MI

Answer 676

AvR for roximal LAD or left mian one of the two

Answer 677

Magnet over it will shock them | and emporary stop to recongize dysrhtmyia

Answer 678

tachy and brady trading off needs both pacemaker and for slow and dysrthymics for fast long term It is usually kn older ppl atropine is tough to use bc then you get tachy

Answer 679

slcerititis- neocrtiing vascultitis of slcera- optho and steroids epislceritits

Answer 680

Ant uveitis or iritis | uvea= chorid, iris and cilairy body so need same day optho

Answer 681

strep pneunmo staph mycoplasma mycoplasma

Answer 682

PE hmaptons hump: infarct wedge | westermark: not as much blood vessels distal

Answer 683

steroids | PLEX

Answer 684

Transfer- first 2 seconds of swallowng MG, ALS and stroke Trnasport dysphgia- obstrucive (schzatkis ring vs achlaisa)

Answer 685

Button battery to be removed immediately in the E & the nose. If it is in the stomach youc an repeat x ray is asymptomatic.

Answer 686

turtle= slamonella Ciguatera- hot and cold discpernacy Peppry fish and histmaine- scromboid Aids- cryptosporidium

Answer 687

LUQ usually

Answer 688

Clean and no known is TDAP, or clean an dknow is less 10 years tdap Dirty and no nown is iG and tdap and dirty with known is give TDAP if under5 yers

Answer 689

Intubate and plex | 2x sux and half of roc

Rosh Nugz Flashcards

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