Shift Flashcards
1
Q
Atropine dosing
A
1mg IV q5min
2
Q
peds atropine dosing
A
.01-.03mg/kg
3
Q
Diltiazem dosing
A
.25 mg/kg IV over 2 min
repeat q15 mins at .35mg/kg IV
4
Q
Diltiazem infusion
A
5mg/hr -> 10 -> 15
5
Q
ACAT MUDPILES
A
alc ketoacidosis, carbon monoxide, ASA, Toluene
Methanol, uremia, DKA
Paraldehyde, iron/INH, lactic acidosis, ethylene glycol, starvation/sepsis
6
Q
When do you give insulin with K+ levels in HHS
A
> 5 = nothing
4-5 = 20-30 mEq in 1st liter then 20 mEq/hr
3-4 = 40 mEq
<3 = hold insulin & give 10-20 mEq until >3.3
7
Q
Tx for hypoglycemia
A
1.D5W
2. Octreotide
3. glucagon
***if adrenal insuff then give hydrocortisone
8
Q
glucagon dosing
A
0.5-2mg IV/IM/SC
9
Q
peds glucagon dosing
A
.03-.1
10
Q
Hydrocortisone dosing
A
100mg IV
11
Q
Dx HHS
A
- pH > 7.3
- BG >600
- HCO3 >15
- Serum osm >320
12
Q
purpura description
A
non-blanchable, palpable
13
Q
Venous stasis MC s/sx
A
pruritus
14
Q
MC location of venous stasis ulcers
A
proximal to medial malleolus
15
Q
DX osteomyelitis
A
MRI
16
Q
Dx venous air embolism
A
bubble study
17
Q
churning sound on auscultation of heart
A
air embolism
18
Q
position for arterial air embolism
A
supine
19
Q
position for venous air embolism
A
left lateral decubitus or trendelenburg
20
Q
Pancreatitis abx
A
fluoroquinolone + metronidazole
21
Q
Abx covering gram neg
A
Aminoglycosides, Monobactams, Ciprofloxacin, Cephalosporins, Carbapenems, Fluoroquinolones, Polymyxins, and Fosfomycin
22
Q
abx covering anaerobes
A
Augmentin, Unasyn, Zosyn, Cefoxitin, carbapenems, moxifloxacin, clindamycin
23
Q
abx covering MRSA
A
doxycycline, vancomycin, daptomycin, TMP SMX, clindamycin, linezolid, 5th gen cephalosporin
24
Q
abx covering pseudomonas
A
Zosyn, ceftazidime, Rocephin, carbapenems, quinolones, amnioglycoside
25
Ranson Criteria on admission
Age >55 yr
WBC count >16,000 mm3
Blood glucose >200 mg/dL
Serum lactate dehydrogenase >350 IU/L
AST >250 IU/L
26
triad of Salicylate toxicity
1. respiratory alkalosis (earliest sign)
2. AG metabolic acidosis
3. metabolic (contraction) alkalosis
27
Tx of Salicylate toxicity
1. airway - avoid intubation
2.decontamination - charcoal vs irrigation
3. D5W - impairs glucose metab
4. Bicarb - NaHCO3 1-2mEq/kg IV bolus; then 3amp bicarb in 1L D5W at 2-3mL/kg/hr
5. dialysis
28
pathophys of Salicylate tox
Uncouples oxidative phosphorylation → increased metabolic rate and hyperthermia
29
s/sx of salicylate tox
1. N/V
2. resp alkalosis
3. AG metab acidosis
4. hyperthermia
5. AMS
6.pul edema - increased pul vascularity
30
anaphylaxis epi dosing
.3-.5mg IM
31
epi cardiac arrest
1mg
32
push dose epi
10mg syringe with NS --> remove 1cc -> add 1cc epi
33
management of transient global amnesia
1. Rule out CVA (clinically or with further workup)
2. Neurology referral
3. Once diagnosed, no specific treatment needed
34
s/sx of transient global amnesia
Anterograde amnesia
Unaware of their memory loss
Normal attention and social skills
Struggle with delayed recall
Periods of time typically less than 24 hrs, but typically lasts 4-6 hrs
No localizing symptoms
35
isopropyl metabs to
acetone
36
isopropyl alcohol
- AG metab acidosis
+osmolar gap
+ketones
- ca ox stones
+ reduced vision
37
Work up for toxic alcohols
Fingerstick glucose
Complete metabolic panel
Serum ketones
Serum Osmolality
Urinalysis
VBG
Aspirin/Tylenol levels
ECG
Serum alc level
Total CK
38
tx isopropyl toxicity
supportive
39
ethylene glycol
+AG metab
+osmolar gap
-ketones
+ca ox stones
- reduced vision
40
tx ethylene glycol toxicity
Fomepizole, thiamine, B6, dialysis
41
Methanol
+AG metab
-ketones
-ca ox
+ reduced vision
42
tx methanol toxicity
fomepizole, etoh, folinic acid
43
Clinical features of CRAO
sudden, painless, monocular vision loss
44
Work up for CRAO
ESR & CRP, carotid US, EKG, echocardiogram
45
Managment of CRAO
high ESR/CRP -> start steroids & ophthalmology consult
46
Ativan dose for seizures
2mg
47
CIWA score to start benzos
8-10
48
management of type I AC joint injury
rest, ice, sling
ROM and strengthening exercises
49
management of type II AC joint injury
rest, ice, sling 3-7 days
ROM and strengthening exercises
50
management of Type III AC injury
rest, ice, sling 2-3 weeks
ROM and strengthening exercises
return to sport/work 6-12 weeks after injury
ortho consult within one week
51
Type IV & V AC joint injury
surgery; ortho consult
52
RSI induction agents
Etomidate
Versed
Propofol
Ketamine
53
etomidate dosing
0.2-0.4mg/kg
54
etomidate onset and duration
onset: 1 min
duration 30-60 mins
55
Versed dosing
0.2-0.3mg/kg
56
Versed onset and duration
onset: 1-2 mins
duration: 30-60 mins
57
propofol dosing
1-3mg/kg
58
propofol duration
10-15 mins
59
Ketamine dosing
1-2 mg/kg
60
ketamine duration
30 mins
61
RSI paralytics
succinylcholine, rocuronium, vecuronium
62
succinylcholine dosing
1.5mg/kg
63
succinylcholine onset and duration
onset: 45 seconds
duration: 4-6 mins
64
Rocuronium dosing
1.2mg/kg
65
Rocuronium onset and duration
onset: 60 seconds
duration: 25-60 mins
66
Vecuronium dosing
0.1mg/kg
67
vecuronium onset and duration
onset 60-90 seconds
duration: 65 mins
68
COPD exacerbation tx
CPAP/BiPAP, Duonebs (albuterol/ipratropium), steroids, magnesium, +/- abx
69
Tx for outpatient CAP with no comorbidities
amoxicillin or doxycycline
70
Tx for outpatient CAP with comorbidities (chronic heart, liver, lung, and renal disease; DM, alcoholism, malignancy, or asplenia)
Augmentin or cephalosporin + macrolide or doxycycline
71
Tx for inpatient CAP (non-severe)
beta lactam + macrolide OR fluoroquinolone
72
TX for inpatient CAP (severe)
beta lactam + macrolide OR beta lactam + fluoroquinolone
73
Causes of proctitis
radiation, autoimmune, vasculitis, ischemia, infectious (STI)
74
causes of epididymitis
STI ; e.coli, pseudomonas, TB, syphillis
75
tx epididymitis
STI: rocephin and doxy
STi and enteric: rocpehin and levofloxacin
only enteric: Levofloxacin
Peds: Bactrim or augmentin
76
Bacteria that causes cellulitis
staph and strep
77
COVID 19 tx outpatient
Paxlovid, remdesivir,
78
COVID tx outpatient or inpatient requiring new or increased oxygen
Dexamethasone
79
Normal vent settings
TV: 8
RR: 10-12
PEEP: 5
80
lung protective vent settings
TV: 6
RR:12-20
PEEP: 2-15
81
obstructive vent settings
TV: 6
RR: 5-8
PEEP: 0-5
82
Hypovol vent settings
TV: 8
RR: 10-12
PEEP: 0-5
83
SCAPE (sympathetic crashing acute pul edema) s/sx
rales/crackles
SBP >180
Tachycardia
Tachypnea
84
Tx SCAPE
GOAL: vasodilate arterial side and maintain oxygenation
BiPAP
Nitroglycerin
if dehydrated: IVF
captopril
85
acute post infectious cerebellar ataxia
sudden ataxia after viral infection
can be seen on MRI
onset 5-10 days after
86
psychogenic non-epileptic seizures tx
if new: EEG
lorazepam 1-2mg or hydroxyzine 50-100mg
87
psychogenic non-epileptic seizures eval
same as seizure
88
transient synovitis s/sx
unilat hip pain; children <10 yo; recent URI
89
transient synovitis eval
XR, ESR, CBC, CRP
90
transient synovitis tx
NSAIDs
91
Retropharyngeal abscess s/sx
early: sore throat, fever, dysphagia, torticollis
Late: stridor, resp distress, chest pain, drooling, neck stiffness
92
Retropharyngeal abscess dx
CT with IV contrast or XR soft tissues
93
Retropharyngeal abscess tx
ENT for I&D
clindamycin or cefoxitin or zosyn
94
types of supracondylar fx that needs ortho and surgery
type II & III
95
splint for supracondylar
double sugar tong or long arm posterior
96
XR findings of supracondylar fracture
anterior fat pad, posterior fat pad, and anterior humeral line
97
tx refractory vfib
ap pad placement
98
refractory vfib definition
continues after three successful shocks from a defib
99
Miller fisher syndrome
(GBS variant) ophthalmoplegia, ataxia, areflexia
100
neutropenic enterocolitis s/sx
10-14days after toxic drug (chemo), fever, RLQ pain, N/V
101
neutropenic enterocolitis dx
neutropenia, thrombocytopenia
CT: cecal distention, wall thickening, pneumatosis, perf, fat stranding
102
neutropenic enterocolitis tx
NPO, NG to suction, IVF, TPN, flagyl + cefepime or zosyn or amphotericin B
103
chance fx
unstable; caused by flexion distraction forces (seatbelt from MVC)
104
MC location for chance fx
T12-L2
105
chance fx tx
if no neuro deficits: immobilize
neuro deficits: surgery
106
ITP s/sx
petechiae, epistaxis, gingival bleeding, menorrhagia, GI bleed, intracranial bleed
107
ITP tx
adults: high dose steroids
peds: IVIG and steroids
108
tx mesenteric adenitis
only if ill: ciporfloxacin or TMP/SMX to cover for yersinia
109
Tx HAPE
O2, hyperbarics, nifedipine (30mg ER)
110
Tx of hypercalcemia of malignancy
only if s/sx or >14; fluids, calcitonin, bisphosphonates; dialysis
111
when do you give dialysis for hypercalcemia
Anuric with renal failure
Failing all other therapy
Severe hypervolemia not amenable to diuresis
Serum Calcium level >18mg/dL
Neurologic symptoms
Heart failure with reduced ejection fraction (unable to provide fluids)
112
refeeding syndrome electrolyte abnormalities
hypophos, hypomag, metab acidosis, hypokal, prolonged QT
113
starting BiPAP settings
IPAP of 8-10 cm H2O and an EPAP of 2-4 cm H2O.
114
Traditional initial mechanical vent settings
FiO2: 100%, rate: 8-12, PEEP 0-5, TV: 5-8, I:E: 1:2
115
LVAD complications
pump thrombosis, batteries, suction event (cannula malposition, tamponade, or vascular resistance), arrhythmia, infection, bleeding
116
how to measure BP with LVAD
BP cyff with doppler
117
Elevated LDH >1150 for LVAD patients
pump thrombosis
118
when to start compressions on a LVAD patient
patient is unresponsive with MAP less than 50mmHg, end tidal carbon dioxide level less than 20mmHg, or LVAD cannot be restarted
119
NMS presentation
AMS, hyperthermia, lead pipe rigidity (MC), tachycardia, HTN, diaphoresis
120
Tx NMS
benzos, IVF, cooling; +/- dantrolene and bromocriptine
121
NMS cause
antipsychotics or DA anti nausea
122
How to tell difference between NMS and serotonin syndrome
NMS has elevated CK, LFTs, and WBCs and decreased iron
123
serotonin syndrome presentation
clonus (MC), more acute, hyperreflexia, AMS, tremor
124
tx serotonin sydrome
benzos, cyproheptadine, chlorpromazine
125
malignant hyperthermia causes
anesthesia
126
malignant hyperthermia tx
dantrolene, O2, bicarb
127
malignant hyperthermia presentation
fever, muscle contraction (Masseter), hypercarbia
128
tx of asthma exacerbation
O2, albuterol, ipratropium, steroids (dexamethasone or methylprednisone), magnesium, epi (0.5mg), terbutaline,
129
tx lymphadenitis
abx - cephalexin, augmentin
130
ethylene glycol produces what stones
ca oxalate
131
what toxic alcohols produce reduced vision
methanol an disopropyl
132
what toxic alcohols produce ketones
ethanol and isopropyl
133
lethal triad of trauma
coagulopathy, hypothermia, acidosis
134
what is the shock index
HR/SBP; closer to 1 is bad
135
anterior shoulder dislocation on XR
displaced medially and overalying glenoid
136
posterior shoulder dislocations on XR
light bulb sign, loss of half moon, trough sign
137
ABI formula
SBP ankle/SBP brachial
138
ABI values
<0.4 = severe occlusion
.4-.69 = moderate occlusion
0.7-0.9 = mild occlusion
0.91-1.30 = NORMAL
>1.30 = calcified vessels
139
why use delayed sequence intubation
to help pre-oxygenation; use ketamine 1-2mg/kg
140
PAC
abnormal early p wave; can precipitate Afib, Aflutter, or SVT
141
underlying conditions with PACs
chronic heart disease, chronic lung disease, and drugs: cocaine, amphetamines, caffeine, nicotine, and digoxin
142
PVCs
broad QRS
143
causes of PVCs
anxiety, sympathomimetics, beta agonists, caffeine, hypokalemia, hypomag, digoxin, MI
144
three or more PVCs with HR >100bpm
non sustained VT
145
premature junctional complex
narrow QRS without preceding p wave or retrograde p wave
146
constipation tx
docusate (emollient), senna/Bisacodyl (stimulant), mag citrate (saline laxative, lactulose (hypersom), enema (fleet vs soap sud)
147
constipation work up
CBC, CMP (hypokalemia and hypercalcemia), LFTS + lipase
TSh if hypothyroid
lactate if stercoral colitis concern
148
stercoral colitis
inflammatory colitis that causing increased intraluminal pressure from impacted feces; can cause ulceration/necrosis/perforation
149
stercoral colitis CT findings
free air
150
stercoral colitis tx
IVF, IV rocephin + Flagyl, surgical consult , can be non-surgical if no bowel perf or ischemia
151
Hard signs of neck trauma
airway compromise, air bubbling, expanding hematoma or pulsatile hematoma, active bleeding, shock , hematemesis, neuro deficits, or absent radial pulses
152
which neck zones will CNs be injured
zone 2&3
153
which neck zone will esophagus be injured
zone 1&2
154
which neck zone will the subclavian artery and vein be injured
zone 1
155
clinical features of PAD
shiny, hyperpigmented skin, hair loss, cap refill >3 seconds
156
PAD eval
ABI, CTA
157
PAD eval
manage outpatient
158
phlegmasia albs vs cerulea
alba: white leg, acute
cerulea: painful, blue, edema -> can progress to gangrene and high risk for PE
159
does hypothyroidism cause anemia
yes: decreased receptors on BM
160
hereditary spherocytosis labs
increased MCHC, spectrin def
161
why does renal failure cause anemia
decreased EPO production
162
lab findings of lead poisoning
basophilic stippling, increased free erythrocyte protoporphyrin
163
adams13 function
cut vWF into smaller units to prevent clotting
164
TTP
decreased adams13; hypercoag
165
vWF disease
increased adams13; destroy vWF
166
anagrelide moa
inhibits megakaryocytes from making platelets
167
bernard soulier disease
defective gp1B; floating large mass of platelets that cannot anchor
168
glanzmans disease
defective gp2B3A; platelets cannot bind together
169
ADP2 receptor inhibitors
clopidogrel; stops the creation of gp2B3A
170
ITP tx
STEROIDS, ig THERAPY
171
ITP presentation
two weeks after URI; increased BT
172
TTP pentad
purpura, fever, renal failure, neuro changes, hemolytic anemia
173
TTP smear
schistocytes
174
autoimmune thrombocytopenia tx (under 40k)
steroids
175
autoimmune thrombocytopenia tx (under 20k)
plasmapheresis or IVIG
176
intrinsic clotting system lab value
PTT
177
Extrinsic clotting system lab value
PT
178
thrombin inhibitors
agatroban, dabigatran, biluvaridin
179
direct xa inhibitors
apixaban
180
tx HIT
24-28 hrs: obs
>5 days: stop heparin, start thrombin inhibitor or xa inhibitor
181
LMWH
enoxaparin aka lovenox
182
heparin metabolism
hepatic
183
LMWH metabolism
renal
184
monitor heparin with
PTT
185
monitor warfarin with
PT/INR
186
vitamin k affects which factors
X,IX, VII, II, proteinC, protein S
187
vWF disease lab values
elevated PTT and BT
188
tx vWF disease
mild: DDAVP
mod: cyroprecipitate (8, 5, vWF, and fibrinogen)
severe: FFP
189
tx hemophilia A
mild: DDAVP
mod: cryoprecipitate
Severe: factor 8
190
tx hemophilia B
FFP
191
tpa reversal
aminocaproic acid
192
tx polycythemia rubra vera
NS+ASA+anegrelide
193
anterior mediastinum cancers
thymus, thyroid, t cell leukemia/lymphomas, teratomas
194
kidney transplant rejection s/sx
HTN + decreased UOP; increased creatinine
195
kidney transplant complications
renal artery stenosis, renal vein thrombosis, fistula, pseudoaneurysm, ureteral obstruction
196
liver transplant rejection s/sx
malaise + ab pain; jaundice + increased LFTs
197
complications of liver transplant
thrombosis of portal vein or hepatic artery, biliary obstruction, bile leak, biliary stricture, hemorrahge
198
lung transplant rejection s/sx
diff breathing +xr infiltrates
199
cardiac transplant rejection s/sx
dyspnea+ palpitations+ arrhythmia +/- syncope
200
does atropine work for heart transplants
no; no vagus nerve
201
corneal transplant rejection s/sx
pain + injection + decreased visual acuity
202
discriminatory zone of intrauterine sac on US
1500 to 2000 mIU/mL
203
causes of cardio syncope
WPW, long QT, brugada, catecholaminergic polymorphic ventricular tachycardia, sick sinus, arrhythmogenic right ventricular dysplasia
204
catecholaminergic polymorphic ventricular tachycardia
7-9 yo; intracell calcium dysregulation; polymorphic vtach -> syncope/presyncope, palpitations, death
205
what is catecholaminergic polymorphic ventricular tachycardia induced by
exercise, emotional stress, physio stress
206
tx catecholaminergic polymorphic ventricular tachycardia
IV beta blockers; at home nadalol, flecainide, verapamil
207
arrhythmogenic right ventricular dysplasia
fibro-fatty infiltrate of R vent
208
hemolytic anemia labs
low hgb, low hemocrit, reticulocytosis, elevated indirect bilirubin
209
intravascular hemolysis (cold -> IgM)
high LDH, low haptoglobin, hemoglobinuria
210
intravascular hemolysis causes
mycoplasma pneumo, MM, idiopathic
211
extravascular hemolysis (Warm -> IgG)
in spleen -> hemolysis -> unconjugated -> conjugated hyperbili
212
tx warm hemolytic anemia
plasmapheresis if severe
213
tx cold hemolytic anemia
prednisone, plasmapheresis, transfuse RBCs
214
meningitis tx for neonates
ampicillin, gentamicin, vanco
215
meningitis tx for 1 month - 50 yo
Rocephin, vanco, acyclovir
216
meningitis tx for >50 yo
rocephin, vanco, ampicillin
217
meningitis tx for post procedural or penetrating trauma
vanco, cefepime
218
ampicillin covers for
listeria
219
dic tx
tx underlying illness; fibrinogen, platelets, FFP, vit k, folate, heparin
220
vitamin k dosage for warfarin
100mcg
221
lovenox reversal
protamine
222
indication for surgery for acute sdh
hematoma >10mm thick
midline shift >5mm
GCS <9 or 2 point decrease from injury to admission
ICP >20
asym or fixed pupils
lethargy or mental status changes
223
neurogenic shock tx
IVF and NE; may add phenylephrine
224
lab values of tumor lysis syndrome
hyperuricemia, hyperkalemia, hyperphos, hypocal, ARF
225
dialysis criteria for tumor lysis syndrome
Potassium >6
Significant renal insufficiency (Creatinine >10)
Uric Acid >10
Symptomatic hypocalcemia
Serum phosphorus >10
Volume overload
226
CT imaging of typhlitis
cecal distention, wall thickening, pneumatosis intestinalis, intestinal perforation, fat stranding
227
tx typhlitis
bowel rest, NG, IVF, TPN, consider GCSF (for neutropenia)
abx: flagyl + cefepime or zosyn or amphotericin B
228
calcium gluconate dosage for hyperk
1g
229
insulin/dextrose dosage for hyperk
insulin : 10 units
dextrose: 50g
230
albuterol dosage for hyperk
15-20mg
231
furosemide dosage for hyperk
40-80mg
232
Lokelma dosage for hyperk
10mg TID
233
hypokalemic periodic paralysis
muscle weakness (can be painful)
strenuous exercise, high carb meal, high sodium meals, suden change in temp, emotional stress
234
hypokalemic periodic paralysis physical exam
decreased reflexes, shoulder/hips involved most often, no myoclonus or spasticity
235
hypokalemic periodic paralysis tx
replace k, propranolol
236
thyrotoxic periodic paralysis
mc in males and asians
painless weakness, lasts hours to days, proximal muscles > distals, hyporeflexia
237
hemolysis bilirubin levels
total: increased
direct: -
238
liver disease bilirubin levels
total: increased x2
direct: increased x2
239
obstruction bilirubin levels
total: increased x3
direct: increased x3
240
cirrhosis bilirubin levels
total: increased
direct: increased
241
tx crigler nijjar
phenobarbital
