Things

Question 1

Mechanisms of injury from lightening

Answer 1

• Direct hit (usually fatal)
• Splash (from ground to person)
• Conduction Ground Current

Question 2

Lightening Injury Management

Answer 2

• Reverse Triage (pulseless gets most attention)
• Monitor for:
  
  • ventricular dysrhythmias,
  • rep depression, s
  • seizure

Question 3

Lightening Injuries

Answer 3

VT/VF, asystole, apnea, seizures Keranuparalysis – vasospastic paralysis of LE, resolves spontaneously Lichtenburg sign – arboreal pattern Cataracts

Question 4

Liver Abscess

Answer 4

• Usually R lobe of liver, can be associated with R pleural effusion
• Pyogenic – caused by ascending infection from biliary tract (i.e. obstruction, cholangitis) and other belly infx (appy) (klebsiella, e coli)
  
  • These need admission for IV abx, drainage (perc)
• Amebic – entamoeba histolytica, history of camping in midwest, can trial PO Flagyl x 7 days

Question 5

Otitis Externa management

Answer 5

Mild - acetic acid/hydrocortisone

Moderate - ciproodex (not with perforation) (cipro alone OK)

Severe - ciprodex and wicks

MOE –> diabetics, chemo, immusupressed etc… -failure to respond to conservative tx

• -fever -elevated inflammatory markers, CT/MRI for osteomyelitis, CN involvement, trismus -needs ENT, maybe IV abx, sx.

Question 6

Rectal Prolapse

Answer 6

• If prolonged can lead to edema, ischemia
• May need sedation for reduction
• Can use regular sugar to reduce edema before reduction

Question 7

Parkland

Answer 7

Question 8

Hydrocarbon Inhalation

Answer 8

Need at least 6hr obs

CXR with patchy infiltrates

Avoid catecholiminergic meds –> sensitizes myocardium and can lead to TdP VT VF etc…

Question 9

Febrile Seizure –> complex vs simple

Answer 9

Simple = <15 minutes, non-focal, no more than 1 in 24h

Complex = anything not simple

If complex, need labs, +/- LP

Question 10

Pediatric Hypoglycemia Treatment By Age

Answer 10

<2 mo –> D10w 5 mL/kg

2mo-8 years –> D25 2 mL/kg

>8 D50 1 mL/kg

D10W for maintenance

Question 11

Push Dose Epi

Answer 11

9 mL NS + 1 mL of code dose epi (1:10,000)

There are 1000 mcg in 10 mL code dose epi (100 mcg/mL) so –>

push dose has 10 mcg/mL

Giving 1-2mL/min push dose = epi gtt at ~ 0.1-0.2 mcg/kg/min

1:1000 injection anaphylaxis = 1 mg/mL, while epinephrine 1:10,000 = 0.1 mg/mL.

Question 12

Tooth Avulsion Management

Answer 12

Handle by CROWN only

Rinse in saline

Re-implant and splint

24-48h dental follow up

Liquid DIET

Question 13

Guillane Barre W/u and Tx

Answer 13

Ascending weakness, symmetric, sensation preserved.

Can see autonomic dysfunction

CSF with increased protein, but normal WBC counts

Tx plasmapheresis and or IVIG

Check NIF!

Question 14

Physiologic changes during pregnancy

Answer 14

Question 15

Duration of calcium gluconate

Answer 15

30-60 minutes

Can redose after an hour

Question 16

Classic ECG Finding in Tricyclin OD

Answer 16

Wide QRS AND terminal R wave in aVR

Question 17

Sigmoid vs Cecal Volvulus

Answer 17

Sigmoid = coffee bean sign on XR, if not s/s perforation/ischemia can have sigmoidoscopy to decompress and sx is definitive managaement

Cecal volvulus ALWAYS needs sx.

Question 18

Indications for Thoracotomy after Chest Tube

Answer 18

Question 19

Other non biliary causes of RUQ pain

Answer 19

RLL PNA

PE

Fitz-Hugh Curtis

Think of in pleuritic RUQ pain.

Question 20

Ethylene Glycol Characteristics

Answer 20

Nonspecific presentation initially – i.e. intoxication.

Later leads to cardiopulmonary, metabolic derangement (hypocalcemia), ARDS

Renal failure after 1-3 days with stones

HAGMA

Osm Gap from PARENT Alcohol, not metabolites

Fluoresces under Woods Lamp (though this is neither specific nor sensitive)

Rx Fomepizole (better tolerated than etoh)

Question 21

Indications for HD in salisylate toxicity

Answer 21

AMS (cerebral edema)

Pulmonary Edema

Level > 100 mg/dL or rapidly rising level

Renal failure

Severe acid base d/o

Otherwise, rx = NaHCO3

Question 22

Salicylate toxicity management

Answer 22

HD if severe

Bicarb –> ~2 amp IVP and then gtt

Give bicarb push prior to tube (but don’t tube)

Can given charcoal if close to ingestion

D50 regardless of glucose

IVF

Question 23

Medications that can be removed with dialysis

Answer 23

1. Salicylates
2. Methanol
3. Ethylene glycol
4. Lithium
5. Theophylline
6. Carbamazepine
7. Amanita mushrooms

Question 24

Activated Charcoal Indications

Answer 24

• Overall, short time since ingestion (1-2), or drug delays gastric empyting, or is controlled release
• Meds
  
  • colchicine
  • CCBs
  • Cardiglycosides (DIG)
  • Cyclis (TCAs)
  • Salicylate