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Rosh > Rosh PGY-2 > Flashcards

Rosh PGY-2 Flashcards

1
Q

What do you want to avoid cutting in ED thoracotomy?

A

Phrenic nerve

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2
Q

What approach do you use in ED throacotomy and how can you help distinguish the aorta?

A

Left anterior-lateral: incision is made along the fifth rib from the sternum to the posterior axillary line

NG tube in the E. You want to cross clamp the aorta to help perfuse the coronaries and the brain

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3
Q

What would you be treating with a ED throacotomy? 5 reasons

A

1- relieve cardiac tamponade,
2- support cardiac function with open massage
3- aortic cross-clamping
4- internal cardiac defibrillation
5-control cardiac, pulmonary, or great vessel hemorrhage.

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4
Q

What is the indications for ED thoracotomy?

A

Penetrating: cardiac arrest after initially good vital signs in the field OR SBP <50 after fluids OR ED arrest

Blunt: ED arrest

OR air embolism

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5
Q

Scalp hematoma on the side or back of childs head- you should suspect…

A

underlying skull fracture

NOT predictive on frontal bone

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6
Q

Tx for flail chest?

A

Intubation or Non invasive ventilation

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7
Q

Output from CT to go to OR?

A

> 1,500 mL of blood immediately or > 200 mL/hour for 3 hours

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8
Q

Isolated sternal Fx disposition?

A

Pain control and DC home

Mortaliy rate is <1%

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9
Q

Most Common finding in basilar skull Fx?

A

Hemotympanum?

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10
Q

+ FAST, when do you go to the scanner?

A

when stable

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11
Q

What are the reverisble causes of hemorrhagic shock in trauma?

A

HemoPTX
Long bone deofrmity
Pelvic bleeding
pericardial tamponade

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12
Q

Where do you put the Chest tube in preggos?

A

Same spot but 3rd rib and not 4-5th. diaphragm is up 4 cm

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13
Q

Testicualr trauma DDx

A 
hemaotcele
hematoma
fracture
avulsion
dislocation into inguinal canal or abomdinal wall
trauamtic epipdidymitis
scrotal lacs or contusion
truamtic torision
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14
Q

Which bad c spine fx has rare neuro deficts?

A

Hangmans (bilateral pars inter. fx from extension)

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15
Q

Axial load fx?

A

Jefferson fx, disruption of ant and post ring of C1

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16
Q

5 NEXUS criteria

A
  1. Injury
  2. GCS
  3. Intoxication
  4. Neuro deficits
  5. Midline tender
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17
Q 
Hemorrhagic shock criteria
HR goes up
Pulse pressure narrows
RR increases
UOP starts to drop slightly 
BP drops
Confused and Lethargic
A 
2
2
2
2
3
4
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18
Q

unilateral facet dislocation dispo

A

Home and follow up in c collar

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19
Q

MC blunt injury to peds?

to adults

A

Both spleen

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20
Q

When do you go to IR for pelvic traumatic injury?

A

Negative fast, positive Pelvic X ray ro exam

If positive FAST its OR

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21
Q

What type of extrmemities do you have in neuro shock?

A

Warm and Dry

T5 or above, possible bradycardia

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22
Q

S/p Heart transplant Basal Heart rate?

A

90-110 (loss of vagus nerve!)

acute rejection leads to shock- give pressors

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23
Q

How do you use the PERC

A

If they are low risk pre test, then go thru the criteria. if you have any 1 + then get a d dimer. if not then no test needed

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24
Q

3 things to do in late decels?

A

oxygen
bolus
lateral recumebtn positiion

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25
Q 
what OD?
Hyperpyrexia
acidosis
gypolcyemia
pulm edema/septic picutre
hypoK
A

Aspirin
get uRine Alkoltic w/ bicarb
Give D5W Bicarb + K

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26
Q

Stable V tach- Sync shock or Procainamide?

A

Procainamide

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27
Q 
What is the evolution of STEMI on EKG between these?
STEMI
Q wave
Hypercute T waves
J point elevation 
TWI
A 
Hyperacute Ts- minutes after
J point elevation 
STEMI - flat to convex
Q Wave 
TWI
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28
Q

MC Amiodoarone Side effect

A

Hypotension (25%) Bradycardia (5%)

class 1 2 3 4
Blocks K and slows AP mechanism of aciton
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29
Q

Deep inverted Ts or Biphasic T=?

A

Wellens LAD- urgent cath

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30
Q

MC ACS complaint from old ppl?

A

SOB

weak andd dizzy too

atypicals from Dm2 patient

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31
Q

ETT meds?

A 
Naloxe
Atropine
!!Vasporessin
Epi
Lido
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32
Q

Dont give what imed in WPW and why?

A

BB

Urges accessory pathway usage

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33
Q

compression rate for newborn?

A

The optimal ratio is 3 compressions to 1 ventilation for a total of 90 compressions per minute and 30 breaths per minute

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34
Q

Trop
earliest?
Peak?
Return to baseline?

A

3 hours
24-48
5-14 days
Most sensitve and speciifc than others

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35
Q

Vtach Ddx?

A

Ischemic/Non ischemic cardiomyopathy
CAD
Lytes
Meds

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36
Q

what is a J point?

A

end of the QRS complex and the beginning of the ST segment. A positive deflection of the J point is termed an Osborn wave and can be seen in hypothermia. Notching of the J point can be seen in benign early repolarization.

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37
Q

why procainamide in VT and WPW?

A

blocks accessory pathway too

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38
Q

difference on x ray between AICD and pacemaker?

A

Thick distal leads (big shock) for AICD
Thin for pacemaker

Implant for brugagada, HOCM, HEart failure, Dysthrmias etc

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39
Q

What is pacemaker syndrome (20%) and how do you treat it surgically?

A

loss of atrioventricular synchrony and the presence of retrograde ventriculoatrial conduction
syncope or near-syncope, heart failure, fatigue, exercise intolerance, dizziness

Get a dual chamber and nto a VVI pacemekaer

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40
Q

First 3 letters of PAcemaker means what?

VVI?

A

chamber paced ventricle (atrial, dual, none O)
chamber sensed ventricle “”
pacing response inhibited (triggered, dual, none 0)

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41
Q

etoligies for A flutter and Tx

A

Still BB/CCB/ or electicity

HTN, ischemic, Rheumatic, Cardiomyopathy

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42
Q

Etiologies for A fib

A 
Ischemic
valvular heart disease
thyrotoxicosis
cardiomyopathies
myocaridtis
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43
Q

DDx for Sinus Tahc?

A 
Poor HEart function
PE
Hypovolemia (fluids or hemorrhage)
Hypoxia
DKA
HyperTSH
fever
drugs
withdrawal
Pain/anxiety
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44
Q

use mroe adenosine in? less in?

A

More ceffeine

less carbamazpeine, dipryamdole, heart transplant

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45
Q

tx unstable torsades?

ddx torsades?

A

shock- it is polymorphic v tach that can turn into v fib

thyroid, drugs, lytes, nutrition, intracranial, congenital, cards problems

46
Q

high risk syncope needs admit?

A

abnormal ECG, a history of structural heart disease or heart failure, persistent hypotension, shortness of breath, hematocrit less than 30%, family history of sudden cardiac death, and older age or presence of multiple comorbidities

47
Q

what to do in torsades if mag doesnt work?

A 
tv PACING (OVER DRIVE PACING 90-120 BPM)
which has the effect of reducing the QT interval and preventing a recurrence of torsade. Unstable patients should undergo unsyncronized cardioversion.
48
Q

3 things seen ekg in wpw

tx?

A

slurred up
short pr
wide qrs

100 mg procaine

49
Q

syncope stats

A

cause of syncope remains unknown in nearly 40% of patients.-vasovagal (21%), followed by cardiac (9.5%), orthostatic (9%), medication related (7%) and neurologic (4%). Patients with vasovagal syncope had no increased risk of death compared to the general population.

50
Q

DDx for bilateral lower edema

A

Think oncotic or hydrostatic

Nephrotic syndrome (SLE)
Pulm HTN!!!
CHF
Liver disease 
Lymph Edema or lymphatic congestion
Venous insufficiency 
Lytes
Medications
51
Q

Blood transfusions. Stable. Itching urticaria. Continue or stop?

A

Benadryl and continue

Be aware of Iga def

52
Q

how old can you get NEC

A

up to 6 months

53
Q

NRP stuff

A

Warm dry stimulate- MR SOPA
If apneic or <100 PPV @ 40-60 RR
if still then intubat and THEN CPR 3:1

54
Q

RSV or flu + but looks good lso get…

A

UA

55
Q

which bugs in peds fever in neonte?

A

e coli amp and GBS = AMP and Gent

56
Q

no risk factors, a fitting URI fever- what lab do you get and if they are nromal can you send them home to follow up

A

Bloo Cx
UA
CRP CBC

57
Q

acrocyanosis lasts for…

A

up to 48 hours and Os2 sat is normal

58
Q

Seizure meds for neonatates

A

phenobarb

lip smacking in kid

59
Q

worse whens tanding and better when laying down headached with VP shunt

A

slit shunt syndrome

60
Q

DX and Tx?
clusters of myoclonic seizures on awakening
hypsarrhythmia EEG
developmental delay.
4-8 months old
Infants will demonstrate brief contractions of the neck, trunk, and extremities lasting five to ten seconds each, occurring in clusters.

A

INfantile spasms or WEST syndrome

ACTH
prednsione
AEDs

61
Q

2 month old menignits bugs

A

Neisseria, strep, H flu

CFTX????? vanc

62
Q 
5-9 yrs old
morning headaches, lethargy , ataxia 
chornic ysmptoms
Dx and tx
CN 6
A

meduloblastome— MC
MRI
Surgery and aggressive tx

63
Q

What do you need to do a needle cric?

A

12-14 gauge needle
Use the angiocath
3.5 or 3.0 endotrach tube end
a 3 or 5 ml syringe with no plunger

Adapter with 7-0 tube can be attached to the syringe

Age<8

64
Q

Peds dose anaphylaxis Epi

A

.01 mg/kg max .3

65
Q

Difference in epiglottis and bacterial tracheitis

A

Teach- ins and exp stridor with UTI prodrome. Subglottic narrowing. Staph. 3-8 years

Epi- drooling stridor, thumbprint, dame age group

66
Q

When can you use adult pads on kids?

A

Above 10 kg

67
Q

Kids IO

A

Pink in kids less Th an 40kg

Distal femur: 2 cm proximal to end of femur in midline

68
Q

lots of URIs
stridor on expiratoin and in supine
feeding difficutlies

A

tracheomalacia

goes away by 1

69
Q

risk facotrs and when to admit in croup

A

Admit: stridor after rac epi (given to kids with stridor at rest), repepat rac epi doses or stirodr returns

look sout for stridor, AMS, cyanosis, air entry and retractions

70
Q

amio
lido
epi
doses in acls of rkids

A

5 mg/kg
1 mg/kg
.01 1:10k

71
Q

what is your first step for foreign body in airway with hypoxia/resp distress?

A

Direct Laryngoscopy - with magill forceps (not VL)- and if it is below the cords then mainstem it and push it down
then cric

72
Q

eye lid lac with fat protrusion needs…

A

CT and optho- concern for orbtial septum injury with damage to msucle and globe

73
Q

one abx needed in nec fasc

A

CLinda for the toxins

74
Q

recurrent pancreatitis with cholecystitis but no stones or cause found…=?

A

sphincter of oddi spasm/dusfunction
HIDA > Scinitgripahy >ERCP Oddi testing

Use ROME 4 to help diagnose

75
Q

What is endopathlamitis

A

Hypopyn + conjucitvitis from inflammation of post/ant and vitreous part of eye
trauma or inefection

76
Q

EVALI

A

bilateral hazy opacties - hemppytsis - not infectious

fibrinous pneumonitis, diffuse alveolar hemorrhage, and eosinophilic or lipoid pneumonia

77
Q

When to transfer for a burn?

A 
Face/Genitals/Eye/Hands
>10%
Comorbids!!!
Type 3
Inhalational
electrical
Chemical
  • If they are young you can debride and refer
78
Q

priapism in trauma?

A

Spinal cord injruy

79
Q

What is your post sedation doses?

A

20-30 mcg/kg/min propofol
1 mcg/kg fentanyl or 100 mcg bolus and 100 mcg/hr
Versed 2 mg boluses (Not dialyzable for CKD)

Terrible liver- avoid versed and give ativan (for the metaoblite than can be cleared)

80
Q

Airway Burn

A
  1. Blast less likely to be worse than chronic inhalational fire
  2. Do a burn a lert if there is airway
  3. Hoarseness, fullness big physicla exam- more likely to intubate
  4. you can try albuterol
  5. think of thier traijectory
  6. on your own? you may need ot be safe and pull the tirgger if the burn center is a long ways away
  7. NP scope it!
81
Q

where do you look when you think rash cleiacs?

A

elbows- itchy little vesicle - dermaitis herpitiformis

82
Q

Men UTI stuff

A

Even 1 WBC in the righ setting is enough

UTI like symptoms gotta think STD

83
Q

post paetum headache and blurry vision?

A

Venous thormbosis
Delta sign or trianlge and the posterior part of head CR is white

look for tinnitus and other focal findings (CN, motor, sezireus)

84
Q

Most sensitive symptom for Cauda equina?

A 
Urinary retention (100 ml)  and then urinary incontinence 
all the regualr stuff plus flaccid parlaysis

Etiologies are most commonly herniated discs, bone fragments, hematomas, epidural abscesses, tumors, or vascular insufficiency.

85
Q

post paetum headache and blurry vision?

A

Venous thormbosis

Delta sign or trianlge and the posterior part of head CR is white

86
Q

What is wellens warning

A

Biphasic T or deep inverted T
Can be painless at first and trop negative
Prox LAD

can cause sudden cardiac arrest- urgent cath needed

87
Q

what is De Winters? EKG

A

AVR: 1/2 mm elevation and then inverted T (looks like wellens)
Precoridal: deep depresison into tall T waves

STEMI - LAD

88
Q

patient is aysynchronius on the vent- change the setting to ?
2 other things ot do here?

A

Pressure support

Paralyze/Sedate

89
Q

What is a segond fracture and why is it improtant?

A

Lateral avulsion fraction of the knee - possible ACL tear

90
Q

patient is aysynchronius on the vent- change the setting to

A

Pressure support

91
Q

spotnaneous PTX in young helathy kid- when do you put a CT in?

A

> 20%

92
Q

Go to vent srttings?

A 
Volume control
TV 6 cc/kg
FiO2 over 60% at first
PEEP 5
Rate 12-16

If hypoxic then creep up Fio2- get ABG and make sure nto too high and abvoe 60 for sure
If still hypoxi then give more PEEP (14 is too high, stay below)
Keep plateau pressures below 35 (parlayze if need be)

93
Q

What is plateau pressure?

A

alevoli pressure. there will be a peak and then a plateau this is the resistance int he smal airways

once the alevoli empty then the pressure goes back to baseline

94
Q

kid comes in with umbilicated papules- tx?

A

None- moluscum contagiousum

adults get it too

95
Q

Isopropyl acohol gap stuff an docm plications

A

Osmol- no anion gap (ketosis without acidosis)

Hemorrhaigc gastritis and tracheobronchitis

96
Q

epidiymitis tx

A

> 35 yrs old = Levoflox! or bactrim
<35 yrs old is STD = CFTX and doxy
-posterior lateral and releif with elevation

if anal= its CFTX and levo for enteric bacteria

97
Q 
young
fever
night sweats
weight loss
gotta check for...
A

Lymphadenopathy (non tender)! Hodgkin lymphoma or leukoemias

get CXR for wide mediastinum

98
Q

200/110 symptomatic tx

A

go home if good follow up

if not, check BMP

99
Q

candidiaissi tx

A

fluconoazole

100
Q 
tick
LFTs
thrombocytopenia
leukopenia
Fever sypmtoms
A

Erlichiosis

101
Q

how long tx for moderate to severe posion ivy tx

A

prednisone taper for 3 weeks!

if mild is clamine and benadryl

102
Q

SCFE tx and complciations

A

Operative

avbascular nescoriss

103
Q

Juvenile arthritis stuff

A

Systemic: rash/Fever/liver/spleen ANA - RF - Tx: Steroids, Tx MTX/Steroids/Nsaids

Oligo: no fever or rash 3 years old female, 1-4 joints, ANA + RF - ESR -

poly: mild ysystmiec, uveitis, 5 joints, ANA + RF + ESR +

all similar tx

104
Q

MC fx leading to compartment syndorme?

A

TIbia

foreamrs get it too!

105
Q

what 3 complications can happen with Massive transfusions?

A
  1. Coagulopathy (thats why you give platelts and ffp)
    INR >1.5 - give FFP
    Plates > 50 - give plates
    fibinogen <100 - give cryo
  2. Hypothermia- warm the fludis and patient
  3. Hypocalcemia

1 unit of reds should raise hgb hct 1/3

106
Q

pulse ox right at 85% and doesnt get better withO2?

A

Methemoglobinemia Fe3+

107
Q

first tests for syph?

A

RPR or VDRL

then darkfield

108
Q

ESRD new fistula, what are the complications you need to think of?

A

Thrombosis of graft- US
bleeding- topical TXA, figure of 8, pressure, gelatin spognes or oturniquet before and after site
Steal syndorme- arterila blood shunted to venous (poor helaing and ischemia
Hypotension right after session- voleume down before
still think sepsis, MI, PE shock
HA, AMS, HTN!, right after dialysis = disequilbirium syndrome High solute removal during dialysis will cause lower osmolality in the blood compared to the brain, resulting in fluid shifting and subsequent cerebral edema… give mannitol (also look at ICH and lytes)

109
Q

recurrent anpahylaxis, Dx and TX

A

C1 esterase FFP (contasins C1 inhibtior)
lips toungue (spiekd on the side) but nonpurutis edema
if ACE, supportive care
cryo has no role here

110
Q

dashboard injruy to knee think

A

PCL, dislocaiotn

111
Q

infant macrocephaly, nausea, lehtargy

A

TUmor

112
Q

rewarm the body to 35 core first before extremites

A

that sall

Rosh (14 decks)

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