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Rosh review 1 Flashcards

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1
Q

Whats the dose of propofol for procedural sedation

A

0.5 to 1 mg/kg

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2
Q

Treatment for Corneal abrasion?

A

Topical Abx:

  • Erythromycin ointment
  • Cipro drops
  • Contact lenses = need tx for Psudomonas
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3
Q

Classic phys exam finding associated with Endophthalmitis?

A

Hypopyon

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4
Q

Induction agent of choice for RSI of severe asthma exac

A

Ketamine

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5
Q

Mechnical vent settings for Asthma patient?

A

Objective = maximize expiratory time

  • Low RR
  • High insp flow rate
  • maintain plateau press > 30
  • Permissive hypercapnia to avoid breath stacking
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6
Q

Neonatal fever: what is fluid admin. rate and what is antibiotic choice?

A
  • 20 mL/Kg

- Ampicillin and Cefotxime (consider Acyclovir)

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7
Q

Suspected Meningitis in pt >65 years old, what should antibiotic choice be?

A
  • Ampicillin (Listeria)
  • Ceftriaxone
  • Vancomycin
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8
Q

What is normal Retropharyngeal space width in children on Lateral plain film?

A

-

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9
Q

What is initial therapy for HIV patient with PNA in whom you expect a low CD4 count ?

A

Cover PCP, especially if hypoxic

  • Azithro
  • Ceftriaxone
  • Bactrim
  • +/- Prednisone (PaO2 35 mm/Hg)

*Alternative PCP treatment = Pentamidine

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10
Q

Initial tx of ITP?

A
  • Prednisone + IVIG

* Platelets only if life-threatening hemorrhage

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11
Q

Clinical/lab features of TTP?

A
  • Fever
  • Microangiopathic hemolytic anemia
  • Thrombocytopenia
  • MS changes
  • Renal failure

*Tx = Plasmapheresis

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12
Q

Tx of Thyroid storm 2/2 exogenous thyroid consumption?

A
  • Beta blocker (propanolol)

- Dexamethasone (blocks periph conversion of T4 to T3)

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13
Q

Tx of endogenous thyroid storm?

A
  • BB
  • Dexamethasone
  • PTU or methimazole (blocks thyroid hormone production)
  • Potassium-Iodide (blocks release from gland)

*PTU should be given at least 1 hr prior to K-I, otherwise K-I can cause incr hormone production by gland

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14
Q

Jones criteria for Dx of Acute Rheumatic fever?

A

Major criteria:

  • Carditis (including valve)
  • Polyarthritis
  • Chorea
  • Subq nodules
  • Erythema marginatum

Minor criteria:

  • Fever
  • Arthralgia
  • Elevated ESR or CRP
  • Prolonged PR interval on EKG

*Need 2 major, or 1 major + 2 minor

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15
Q

What can cause exaggerated, super deep inverted T waves on EKG with QT prolongation ?

A

-Cerebral T waves

Casued by incr ICP from ICH, SAH, etc

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16
Q

For WPW pt….Give _____ drug ______ mg IV

A

Procainamide

100 mg

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17
Q

Tx for HF acid exposure?

A
  • Ca-gluconate (topical + IV)

* Fluoride bind calcium and Mg avidly, decr calcium in blood –> Dysrhythmias

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18
Q

What are the 5 major classes of QT prolonging drugs?

A

antidysrhythmics

nonsedating antihistamines, macrolide antibiotics, antidepressants, and antipsychotics.

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19
Q

Management of decompression illness? (4 things)

A
  • 100% O2
  • IV fluids
  • Aspirin
  • hyperbaric chamber
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20
Q

What lab value can be abnormal in HIV pts with PCP PNA?

A

Incr LDH

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21
Q

EKG differentiating factors in TCA overdose vs other anticholinergic overdose?

A

TCA:

  • QRS prolongation
  • Terminal R wave in AvR (big R wave…R:S ration >0.7)
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22
Q

When does Ibuprofen toxicity occur following ingestion?

A

typically within 4 hours, and typically mild stuff. Always check a tylenol level too

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23
Q

Diagnosis in a child 3-6ish, who had recent URI which turned into suddenly worsening High fever, stridor, cough, toxic appearance?

Organism?

Management?

A
  • Bacterial tracheitis (like croup but bacterial, more toxic appearing)
  • Staph Aureus
  • IV Abx, fluids, OR intubation
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24
Q

Tx of Meniere’s dz?

A

Thiazide diuretic

-inhibits Na rab in distal tubule

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25
What vital sign abnormality might you expect in ruptured ectopic, but can be absent? And why?
- Tachycardia. | - Pts can have a reflex Bradycardia 2/2 vagal nerve irritation in peritoneal cavity
26
How is pH affected by cooling in pt's with arrest?
Decreases (falsely)
27
Which factor is deficient in Hemophilia A?
Factor 8 | -use recombinant factor 8, cryoprecipitate, or FFP
28
Serotonin syndrome Clinical presentation:
1. MS changes - Agitation, pressured speech 2. Autonomic instability - Tachy, diarrhea, sweating, mydriasis, shivering 3. Neuromusc. abnormalities: - Clonus, Hyperreflexia (lower>upper), tremor, seizure
29
Serotonin synd tx?
- Benzos - Hydration + cooling - Cyproheptadine
30
Mnemonic and list of unstable C-spine fractures/dislocations?
-Jefferson Bit Off a Hangman's thumb. - Jefferson burst fracture - bilateral facet dislocation - Odontoid type 2 and type 3 fractures - Hangman's fracture (any fracture involving dislocation)
31
What are the five NEXUS criteria for clinically clearing the cervical spine?
- No focal neurologic deficits -normal alertness - no evidence of intoxication --no distracting injuries - no posterior midline cervical tenderness.
32
Dangerous effect of inhaled hydrocarbons? treatment?
Cardiac sensitization --> inciting event causing catecholamin surge --> Incr sensitivity with catechol --> dysrhythmia Tx = Beta blockers
33
In anaphylaxis, what is the Epi dose for mild symptoms in adults vs children? What's the dose for severe symptoms in adults vs children?
Mild: - Adults: 0.3 to 0.5 mL 1:1000 solution IM q15 minutes - Children: 0.01 mL/kg 1:1000 solution IM q15 minutes Severe: - Adults: 1-5 mL 1:10,000 solution IV over 10 minutes - Children: 0.01 mL/kg 1:10,000 solution IV prn
34
What are characteristics of complex febrile seizures?
- multiple seizures during same febrile illness - prolonged seizures (>15 minutes) - Focal component of seizures *simple febrile seizures are generalized
35
Treatment of choice in Acute otitis media?
-Amoxicillin 90 mg/kg per day divided into 2–3 doses for 10 days (high-dose amoxicillin)
36
Treatment (including duration) for bacterial prostatitis?
4-6 week course of oral ciprofloxacin or trimethoprim-sulfamethoxazole If systemic infection, unstable, etc --> admit
37
What is the dosing of alteplase for massive pulmonary embolism?
100 mg IV over 2 hours
38
What are treatment options for stable V-tach?
- Amiodarone - Procainamide - Lidocaine
39
What small bowel diameter on radiographs indicates small bowel dilatation?
3 cm or more.
40
Why do you not want to give NSAIDs to a transplant patient on Cyclosporine?
-It can worsen or precipitate renal failure since cyclosporine already causes renal damage on its own
41
What is the recommended energy level for pediatric cardioversion?
0.5-1 J/kg.
42
What are clinical features of Coarctation of aorta?
- CHF possible - HTN - Bounding pulses in UE, weak in LE - Rib notching on CXR
43
Treatment of Tylenol tox with NAC needs to be initiated within ______ hours of ingestion
8
44
Describe the phases of tylenol toxicity
1 - < 24 hrs. Vague, anorexia, N/V 2- 1 to 3 days. Transaminitis, elev INR, incr Bili, RUQ pain 3 - 3 to 4 days. Fulm hep failure, multiorgan failure
45
Name 2 potential US findings with ovarian torsion (not including decr/absent flow)
- Ovarian enlargement | - Peripherally displaced follicles
46
Which classes of Abx are most commonly assoc with C diff?
Lincosamides (clinda) , Cephalosporins, Fluoroquinolones
47
A bradycardic patient who fails to respond to Atropine can get ______ or _____?
Epinephrine or Dopamine
48
What are some EKG findings assoc. with Hypokalemia?
- QT prolongation - Incr amplitude and widening of P wave - Flattened or inverted T waves - U waves ** (upward deflection following T wave)
49
What are some digitalis effects on EKG?
- Downward sloping ST segments - Flattened, inverted, or biphasic T waves - Shortened QT segment
50
What are the EKG findings assoc with Brugada syndrome?
- Incomplete RBBB | - ST segment elev in leads V1 thru V3
51
What nerve is commonly injured in knee dislocations?
Peroneal nerve (common fibular)
52
When an Rh negative mom miscarries....administer _____ug of rhoGam within _____ hours
- 300 - 72 *this is true even if she's received Rhogam with previous pregnancies
53
What are some drugs you can give to lower IOP?
- topical BB (Timolol) - Topical alpha agonists - Carbonic anhydrase inhibitors (Acetazolamide po, IV, topical) - IV mannitol **In sickle cell pts with hyphema which can cause incr IOP, dont give acetazolamide bc it can incr sickling
54
First line Abx for pts with post-partum endometritis? **2-3 days post c-section, fever, abd/pelv pain, foul smelling discharge, incr WBC
-Clinda + Gentamycin
55
how much pRBC should a child get if they have already been fluid resucitated with NS?
-10 mL/Kg
56
What is the formula for calculating the minimum systolic blood pressure in a child?
Minimum SBP = 70 + (2 x age in years).
57
Which antibiotic should be prescribed to cover marine bacteria in seawater-associated wounds?
A third-generation cephalosporin or fluoroquinolone to cover Vibrio species
58
Patient presenting with the following CVA Sx: - Vertigo - ipsilateral Horner's - ipsilateral facial numbness - contralateral trunk and limb sensory loss - Bulbar symptoms What area is infarcted? What artery? Name of this syndrome?
- Lateral Medulla - Vertebral artery - Wallenberg syndrome
59
Patient presents with stroke symptoms that include coma, quadriplegia, "locked in syndrome" What artery was occluded?
Basilar Artery
60
Patient presents with stroke symptoms that include: - Aphasia or neglect - homonymous hemianopsia contralateral - Contralateral focal deficits to extremities worse in upper What artery is occluded?
MCA

Rosh Review (7 decks)

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