Third Year Saveables

Question 1

TRALI

Answer 1

More common in FFP and platelets
Mortality rate 5-8%!
Supportive and maybe Intubate
Hypoxia fever ARDS CXR

Question 2

How do you decide inpatient vs outpatient CAP tx?

Answer 2

PSI score!

Question 3

CAP outpatient therapy healthy and comorbids

Answer 3

Healthy Doxy

Co morbids: Augmentin + doxy OR Levo

Question 4

Sudden onset

Question 5

2 labs to order in a septic mimic?

Answer 5

VBg and sailicylate. ASA toxicity
Acidosis with CO2 lower than it should be (resp alk. + met acidosis) co2 should match pH levels

They can intislly be alkalemic with vomiting and resp. Alk

Question 6

Always get what test in Preg VB

Answer 6

Type and screen for Rhogam

Question 7

ASA tox treatment

Answer 7

Avoid HypoG
Put oxygen on with good sats
Replenish K
Hydrate
sodium bicarbonate in D5w 7.4-7.5 pH
Dialysis 

What kills is pulm edema and cerebral edema and renal failure

Question 8

4 causes hypoxia

Answer 8

VQ mismatch (the common lung diseases): PNA, Asthma, COPD, Atalectasis, PE, pulmonary edema, ARDS. Corrects with supplemental O2.
Shunt: deadspace (alveoli filled with pus, fluid, or blood); or cardiac defect with RL shunt. Will NOT improve with supplemental O2.
Diffusion defect: interstitial lung disease or interstitial edema.
Hypoventilation: resp depression, CNS injury, peripheral neuromuscular dz, chest wall rigidity
Low Fi02: altitude, SCUBA system malfunction

Question 9

Absolutely lymphocyte count less than 1600 should make you think about…

Answer 9

HIV

Question 10

Saline load vs CT

Answer 10

CT is 100/100% ,vs 92/92% for knee saline load good p but lower power
ppx abx
rosh says ct scan is best vs saline load

40 cc is needed for elbow- not sure of CT here.

Question 11

Codes things you actually shoudlnt do:

Answer 11

1. Calcium (harmful, worse outocmes- JAMA 2021 articles)
2. bicarb (harmful, worse outcomes)
3. Intubate (really just need oxygenation)
4. atropine

Question 12

when do you shock asystole

Answer 12

US shows a quivering heart (asystole is dead heart) and it is fine v fib - shock it

Question 13

tourniquet on finger which is too tight?

Answer 13

Digital block

use a cutting needle (look to see if conventional or reverse cutting)

Question 14

Food impaction tx

Answer 14

Don’t use glucagon for vomiting against a closed tube
Nitro paste works!
Secretions a lot of them is a sign, if it stops then there is partial passage. Then GI scope maybe

Question 15

CHF risk factors for poor prognosis

Answer 15

hyponatremia, poor renal function, hypoalbuminemia, and congestive hepatopathy or elevated liver enzymes.

Question 16

why low plt in liver disease?

Answer 16

Portal hypertension leads to splenomegaly, which causes platelet sequestration and is the largest contributor to thrombocytopenia.

Question 17

ptosis ddx

Answer 17

bells
stroke
MG
brain aneyrusm
horners

Question 18

thyroid dz with eye pain

Answer 18

watch out for conreal ulcer

Question 19

dacroadenitis is

Answer 19

inflammation of lacrimal gland above the eye- usually viral

Question 20

2 month old with purpleish outpouching above eye

Answer 20

think a deep hemangioma (treat with BB)

Question 21

BP necessary for pre-E PP

Answer 21

150-160 or 110 DBP
usually with headache
then get labs and urine and think mag and admit

Question 22

What clinical tool should you use for liver stuff?

Answer 22

Meld for chronic

Kings college for transfer in acute liver failure for transplant eval

Question 23

Headache, CTA neg within 6 hours, small aneurysm tho…

Answer 23

Have to do LP

Question 24

Do do eacharatoty unless you have electrocautery

Answer 24

Unless on the chest and HD unstable - transfer for it or only do if loss Doppler pulses

Question 25

Bowel Obstructions 3 6 9 rule (Small, larhe, cecal on CT) SBO usually resolve on own, valvuale (stair step and pearls on a string) LBO (diverticuli can cause it)- surgery usually, half way haustra on KUB Cant miss volvulus, closed loop obstructions Admit, hydtae (not all routine NG and abx, case by case for bad casses)

Question 26

isolated elevated AST and abd pain, net CT...

Answer 26

Think cardiac, AST also released in cardiac damage

Question 27

Lactate sensitivity in mesenteric ishcmeia

Answer 27

48% of Mes Ischemia normal - does not rule out

Question 28

CT findings: thickened/edema bowel wall, new ascites

Answer 28

Think possible mesenteric ischemia, early findings (reg CT w/ contrast sensitivity is 70-90%) Now htink Surgery consult or CTA

Question 29

Smart trial/salted, LR vs NS

Answer 29

Basic balanced crystallioids nnt 94, 5 percent mortality ARR for 90 day mortality especially beneficial in sepsis, much better than NS Remember: LR more hypotonic than plasmalyte- don’t give it in head injuries but otherwise pretty equal. No trial looking at the two of them

Question 30

Valvular emergency

Answer 30

Don’t expect to hear a murmur, pressure between LV aorta the same - keep on ddx for SOB CP- From dissection, endocarditis, trauma Don’t use BB Reduce aftelad nitropussy Hypotensive= dobutamine Surgery consult * Avoid intubation, bipap (increased Intra thoracic pressure) Avoid levo (up after road) avoid nitro (decrease preload) More ways to screw it up than go right

Question 31

Kids sedations adjuncts to decrease slaivation

Answer 31

atropine, glucorpyrralte | can sedate for an exam if needed

Question 32

Refractory migraine/headache in Female <40 yo, some neck pain, partial hroner, HA

Answer 32

Cartoid artery dissection - repeat imaging if not imrpovong - it is more common than you think

Question 33

Post T&A bleed

Answer 33

TXA, epi soaked gauze, sedate the kid if needed, once you stabilize, intubate (secondary hemorrhage adter herald dbleed), mcgill foreceps with gauze and hold pressure and leave tail outside the mouth. be prepared for needle cric

Question 34

BRB in diaper for kid…

Answer 34

Think omnicef, looks like tomato sauce, if neg bedside test can go home

Question 35

What do you do if you want a cath and cardiologist doesn’t?

Answer 35

Heparinize them, admit for serial ekgs/trop

Question 36

5 deadly withdrawals

Answer 36

``` Alcohol Bacolfen Benzo Barb Clonidine ```

Question 37

UAs

Answer 37

1. look at Antibiogram 2. In order E coli, Enterobacter, Proteus, 3. MAcrobid good for E coli, bad for everything else, Keflex good, Augmentin good 4. Cefdinir For outpatient pyelo 5. Realize what rules in and rules out on UA (Nitrite IN, if no WBC helps rule out, 8 squames cut off (a urine culture still good)

Question 38

evidence behind bicarp for renal dysfunction acidosis

Answer 38

No mrotlaity benefit but does help (ICU septic patient mostly) - Good to go for it

Question 39

AKI + edema

Answer 39

Pulm inovlvement: 1 mg/kg lasix | if not, think albumin possibly vs Give fluids fo rkidneys

Question 40

Who do you scan with AKI?

Answer 40

``` UA normal PVR normal AKI doesnt get better with fluids Hydronephrosis b/l =badness within belly ```

Question 41

Do you need to wake up nephrologist voernight for AKI patient needing CRRT?

Answer 41

STARRT - AKI trial: Ealry vs late CRRT no difference in outcomes (6 hours vs 18 or so hours) *you can wait

Question 42

AEIOU for dilausis | What is the dilayzable ingestion?

Answer 42

``` I STUMBLED INZD, iso alcohol salicyaltes theophylliine URea Methaniol BArbs lithium Ethylene glycil Depakote, dabitgratran ```

Question 43

bleeding fistual steps

Answer 43

direct pressure 5-10 mins> Surgicell, combat gause with it Protamine 10-20 mg or DDAVP Last line is figure of 8 If life threatening: toruiquet and vascular consult- graft is done tho DASS or steal syndrome is poor flow and inschemic limb- vasc consult

Question 44

Fisutla problems

Answer 44

thinks thrombosis or stneosis needs fisutlagram and vasc surgery consult

Question 45

Type 4 rash DDX | usually days to weeks later

Answer 45

Morbilliform drug eruoptions (95%) (many diff presentations) SJS AGEP (single drug, 24 hours later, can have mucous membranes) DRESS Photosensitivity allergic reaction after a drug (PMLE is similar but unknown trigger after light exposure)

Question 46

rash emergencies DDX

Answer 46

``` Morbilliform drug eruoptions SJS AGEP DRESS Photosensitivity allergic reaction HIV MONO RMSF 2nd syphilis SCAR Subacute cutaenous Lupus Erythema (upperchest/arms and up) acute cutaneous lupus (systmic lupus flares) ```

Question 47

rash red flags

Answer 47

``` pain mcuousa hgih fever blisters ertyehderma immunosuppressed purpura ``` Infection, drugs, autoimmune stuff

Question 48

AKA

Answer 48

Does not need ketones in urine (measures acetoen not beta hydoybtyrate) order beta hyroxybutyrate to confirm if needed if not gettign better think toxic alcohols Think in an older person, hihg ethnaol [ ] , and HIGH anion

Question 49

osmol gap and anion gap graph

Answer 49

``` know the graph, understand the time frame and that you may not see the osmol gap if they ave had tiem to metabolize and turn it into an anion gap ongoing acidosis (lactate will continue to rise too!) and you cant explain thin ktoxic alcohol SI attempt and call tox and think fomepizole ```