Tres Flashcards
(97 cards)
1
Q
Hypsarrthymia, infant seizures on waking, delay=
A
infantile spasms
give ACTH, predinsose and AEDs
tuberous sclerosis
2
Q
what is LEMON
when to give suggammadex
Sux raises K by…?
A
Look -beard/facial trauma. Eval 332. Mallampati. Obstruction (neck cancer, obesity, hematoma,infllmmation in airway) Neck mobility
Rocurionium (just put LMA in)
0.5
3
Q
vWF minro bleeding tx
severe
A
Desmopressin
Cryoprecipitate (hase vWF in it) or Factor 8 concentrate
PTT prolonged if 8 very low
4
Q
Termination criteria
A
CO2<10
K >12
ph <6.9 i thiknk/????
hypothermia of body temp less than 57- not dead until warm and dead
5
Q
fluticason or cetirizine?
A
fluticasone
6
Q
rash dista then central, hypoNA, thrombocytopenia, lfts?
A
Rocky moutnain
dermacentor tick
7
Q
how many mcg of ep i are you giving in anaphgylaxis?
A
300 (1:1000) giving 0.3 ml
8
Q
Tachy, red skin, LARGE WGMA kactic acidosis, AMS, headache
A
CN toxicity
Hydroxycobaliamine- binds and is excreted thru kidneys
stops oxidative phsophirlyation
9
Q
SCIWROA prognosis?
A
Full recovery
spianl cord injury wihtout radiographic evidence
10
Q
Basilar skull fracture stuff
A
gtemproal bone fractrue
Tx: just pain meds, observation- surgery not needed
Look above the eye lid
Cranial nerve deficits
11
Q
BB Txs in ODs
A
GLucagon clackum fluids IV insulin (increase contractiliy with carb utilization) an dglucose lipid emulsions vasioressrs
Bradycardia, HypoTN, hyperK, AMS
12
Q
Next move, massve PE- heparin or tpa/
A
tpa
heparin for submassive or less severe
13
Q
hypoNA, hypoGlucose, hypoTN, not getting better with fluids?
A
Adrenal -100 mg hydrocortisone (or 4 Dex)
COPDers nto tkaing meds anymore
14
Q
Dsiposition of electical injury
A
Get UA, EKG, BMP looking for arrythmia, mygolbin, mucle damage
if skin burn - observe for severql hours then go , if nto can g hoem i f all negative
figure out if AC current- more severe, an dhwo much volts was used.
15
Q
What score od you use for nec fasc to help you out? US?
A
LRINEC
US can help too
16
Q
Positive Hiv quick test needs hat next to confirm?
A
blood test with Blot or immnunoassay
Post exp ppx cna be given within 72 hours of tripple therapy
17
Q
What do you need to have ready in the back of yoru mind for lots of fentanyl doses?
A
Rigid chest syndrome
Naloxone and BVM and then parlaysis if needed
18
Q
bloody diarrhea in kid
THrmobocytopenia, hemolytic anemia, Renal filure? Tx?
A
HUS
Supportivem NO Abx
19
Q
RBBBLead 1 and V1
LBBB lead 1 and V1
A
Downward deflection, Up
Up, Down
20
Q
Thumb cannot resis abduction force, no pincer grip- what ijnury/
A
UCL
Game keepter skiier thumb
21
Q
fever, tahcycardia, chest pain, dysnpea, oxygen sats OK after blood transfusion you need to
A
stop and make sure its nto hemolytic
msot likely your antiboides against donro leukocytes
22
Q
Weigh tloss, painless jaindice, palpable gall baldder-
A
COurverier sign for choangiocarcinoma
23
Q
Fever, exteeme rigidity, AMS from what OD?
A
Anti Dopamine pills for NMS
Icludes anti emetics liek phenergan and metocprlmaide
24
Q
ARDS diangosis
A
emonstration of diffuse bilateral pulmonary infiltrates on imaging, (2) exclusion of a cardiac etiology (through normal echocardiography, BNP, or right heart catheterization), and (3) a PaO2:FiO2 of less than 200
25
Looks ike retinal detahcment on US but it moves aroudn liek a wave on US with EOM...
POster vitreous detahcment- emegrent for risk of retinal detahcment
vitreous is an avascular layer of the eye attached anteriorly to the ora serrata, and posteriorly to the optic disc head. Symptoms include the sudden onset of monocular flashes and floaters that appear particularly with eye movement
26
VBG on COPD exacerbation
CO2 retention with bicarb comepensation - but hten the compensationdoens tmake sense and they are more acidoditc
27
what is eryothema nodosum
tender looking bruises in the shins- delayed hypersenistivty inflammoatry reaction between demis and adipose
after bactrim, infection or AI dz like lupus or sarcoid
self limited for 6 weeks
arthralgias
28
SAH Tx
```
nimodopine
BP/ head control
sz ppx
neuro checks
reverse cogaluaopthy
```
29
AIDS weight loss bowel obstrcuion picture
SMA syndrome
| The duaodenum is pinned beteween aorta and SMA- the fat pad lessens
30
Define neutropenic fever
100.9 once or 100.4 for an hour with ANC of 500 or less
usually worst 6-10 days after chemo - cver psudomonas
31
FLu like prodrome + mice + single papule eschar?
Rickettsial Pox from a mite
32
6 weeks post parrtum + HTN + HA + abd Pain + blurry vision = TX?
IV Mag and HTN Meds
| this is pre ecmaplmpsia- risk for stroke
33
What do you do with an avulsed tooth?
carry it in milk
put it back in after your rinse it within 60 mintues
call oral surgeon if after 60 mintues
34
ear pain + vesicels + facial droop=
Ramsay hunt syndrome - Zoster otiticus
Watch out for menintigits and givr acyclovir
35
you give zofran or anatheor antiemeitc and then all of a sudden they want to leave - why/
Akasthesia- offer them benztropine or benadryl
36
COPD Tx?
Duonebs
Abx
Steorids
Bipap if encessayr
37
Asthma exacerbation on all the treatments getting wrose- what med?
Vent settings?
IM epi- repeat every 30 mins to 60 mins
| Intubaitons is not that scary- 6 cc/kg, low PEEP at 5 to vercome tube resistance, I:E ratio 1:4/5, rate 10-12
38
5 complications from brown reculse bite?
```
Hemolysis
DIC
AKI
Rhabdo
Arthalgias
```
Supportive, ABCs, Hct lvl, avoid ointments, ice
39
What is Kohler disease?
```
Navicluar bone AVNecrosis
BOYS, 4-5 years old
can be bilateral
X ray shows necrosis , sclrosis of navicualr
Walking boto and gets better in 6 months
```
Think of the foot as Hind foot talus/calcanoues
mid foot navicualr, cuenifroms
and forefoot is metatarasl and digits
Freiberg is adolescent females - at the metatarsal - PIP joint AVN.
40
open vs closed mandibular fx tx?
how to test for occult fx?
admit op. and iv abx vs dc home to dentist w/ abx
bite on tongue blade and try to break it
41
pulmonary contusion complications
edema, hemorrhage, cardiovascular compromise
possible pulmonary laceration
occurs 6-8 hours after blunt chest trauma
bad lung toward ceiling
42
A fib ddx
OUtside in
1. Systemic- Infection, Thyroid, Drugs, Caffeine, hypovolemia
2. Lungs- PE, PNA, COPD, hypoxia
3. Pericardium- Itis aor effusion
4. Myocardium- MI, itis
5. Endo- itis, mitral stenosis!!
43
Diffuse ST elevation DDx:
1. Proixmal LAD
2. Pericarditis
3. Myocarditis
4. Benign eary repole
5. POst MI anysursym
44
Seizure vs syncope?
1. Tongue/pissy pants
2. POst ictal
3. Amnesia
4. No prodrome
5. epilepsy
Trauma to head?
45
Why Seizure? Sz antidotes?
AMS workup
| HTS, Oxygen, flucose, B6 for INH, Mg for Eclampsia
46
UA +, flank pain, N/V Fever Tx- appears well
Pyelo, DC with augmenton, fluroquinolone, bactrim or third gen.
no sepsis, appears well= go home
47
Bleeding fistula site, pressure and it stops, what next?
Vascualr surgeon consult
| make sure htere is a thrill and that there isnt a thrombosis
48
THrombosed hemorrhoid - when do you not take it out?
Immunocompromised patients, pregnant women, those with coagulopathies, >72 hours old
If not - elliptical incision and tkae it out
49
Tx for PCKD?
ACE and BP control
watch out for cerebral anyrusms
50
First step you ALWASY need to do when thinking baouthyponatremia?
If seizing what do you do?
is is hypovolemia, euvolemia, hypervolemia?!
then Mental status
Like amarhton runner is hypovolemic and will need hypertonic and volume
give 100-150 cc bolus of HTS, rpeat 3 times as needed. D onot raise 8–12 mEq/L during the first 24 hours for fear of osmotic demyelination syndrome.
51
Painful ulcers
| pailness
Painful is chancroid, HSV
CLamydia granuloma, klebsiella beefy ulcer granuomae, syphilis
52
Assymetircal motor neurons?
Assymetircla distal motor and sensory/
ALS
Mononeuropahty multiplex
53
difference in transverse myelits and GBS? Tx of TM/
Definitive line of changes. IV steroids vs plasma exhange - inflammoatyr condiiton of spinal cord which can occur after an illness like GBS
GBS is moleclar mimcyr for myelination of the nerves
54
What FVC do you need to tinubate and ventilate for them?
<20 cc/kg FVC
55
one eye Central scotoma, roetroorbital eye pain, affernt pupillary defect?
MS and optic neuritis
Central scotoma= Optic neuroitis or macular degeneration
56
FOOSH- TX and things you need to chekc for?
Scpahiod, snuffbox, thumb spica
57
CXR lung mass with weird nuro symptoms and lab abnromalities?
Think squamos cell, paraneoplastic syndrome . HYpercalcemia
58
AMS, hyponatremia, hyperK, hypoglyemia, HEadache with globe and pupil abnromalmities, CT with sellar mass-
pituitary apoplplexy- sudden hemorrhage into the pituitary- think hydrocoritcsone for glucocorticoids and minieralocorticoids for adrenal insufficiency
59
What do glucocorticoids do vs minerlaocorticoids
Min- all kidneys. H and K secretion (aldosteorne/fludricotrisone)
Gluc- responsiveness to catecholmines, gluconeogeneis, proten catabloism, immunosuppresion and slowed healing, weak minerlaocorticoids (everything else)
60
10 year old kid with viral illness, given RX then has AMS, N/V and LFTs high?
Aspirin- reyes syndrome
61
HSP labs
normal plateltes
get UA for kidney invovlement
arthritis
watchout for intussicpetion
62
bug bite with rigid abdomen tx?
Lorazepam form black widow muscle spasms- Autonomic instbaility
Antivenin for severe cases
63
```
What is rsi dosing for
Ketamine bronchorrhea-larygnsoapsm-HTN
Prop
Etomidate
Fentanyl hypotension
```
Sux
Rock long
1.5 mg
1.5 mg
.3 mg
2 mcg
1. 5
1. 0-1.2
64
WHat is Brash syndrome?
```
Bradycardia
Renal failure
AV nodal blockers
Shock
HyperK
a cycling downward spiral
```
65
kid rash with multiple stages ofhealing complciaiton?
chicken pox zoster
bacterial superinfection
(penimonitis, encepjlaitis)
66
diverticulitis complication s you need to care about
perforaiton, obsturction, abscess, fistula
constipation is more common than diarrhea
67
recent MI coming in wirth SOB, resp distress - you need ot think about what?
mitral regurg, papillarty rupture.
listen for new murmur, may come in as shock.
can also happen after trauma, rheamtic, or endocarditis
68
Dx and tx for...
Ellis 1
ellis 2
ellis 3
Enamel- file it and sne dhome dental
+dentin- yellowish white, cover with calcium hydroxide
+ pulp- wipe with white cloth to look for pink/red, immediate dentla consult
69
Cause, Tx, DX for
DIC
TTP
ITP
DIC- supportive, they look sick, thrombin excess
TTP- endolthelin defect, Pentad FAT RN, PLEX, IVIG
ITP- Ab against PLatlets, Kids/illness, IVIG/steroids/steroids
70
PNA + low sodium?
legionella - cover atypicals
71
Difference between TRALI and TACO?
Lung injury= hypotension- aburptly or within 6 hours- usually with FFP or platelets
Taco= HTN
TRALI- endolthelial damage and then leaking, fever, tachy, hypoxic, hypotension. Stop an surrpotive care
ABO- fever, chills, chest restriction, joint pain, hemolysis
allergic can be anaphylaxis!
72
Recent MI 2 weeks ago with a cough, SOB. no chest pain, PErsistent STEMI in V3-V6? Dx and complications form it
Ventircular anysrusm
Poor perfusion to mycoardial scar
CHF, thrombus, rupture, dysrhytmia
73
chronic UTI despite mutliple Abx given- what is your next ABx of choice Oral outpatient?
Fosomycic- good againt E coli and E facelis- and MDRs. check a culture.
Side effect- vagnitis, HEadache, NV, diarrhea
bacteriocidal against cell walll- high [ ] in bladder
74
```
RSI dosing
KEtamine
Prop
fentanyl
etomidate
```
Sux
Roxk
1.5 mg- bronchorrhea, larynospma, HTN
1.5 mg
fent 2 mcg- hypotension
.3
1. 5
1. 2
75
first 4 steps for TE fistula
1. Hyerinflate
2. secure airway from above
3. Take tube out
4. compress
76
what does worsenign hpercpania mean on vbg?
Going ot icu
77
indiciations for tpa in PE?
Shock or CPR
if more stable0 hypoxemia, RH enlargement, excessive clot burden
78
TLS labs
High everything
| low Ca
79
Dispo for iron ingestion?
```
Get IRON level 4-6 hours after ingestion (500 is seriours)
need 40-60 mg/kg for symptoms/toxicity
GI phase happens witin 6 hrs
then latent pahse fr 24 hours
then dsitrbituiv shock after that
```
80
what lab do you look at for biliary pancreatitis etiology?
ALT 3x upper limit
| 95% spec sendfor gallstone panc
81
What two things are bad to do in PAH patients?
Fluids (interventirclar septum bowing)
| Intubation - increases pulmonary pressures and could cause them to code
82
Duodenal hematoma Pathphys
Pinned against vertebral body, hematoma forms, obstrucitons and hematemsis happens
Chilaiditi syndrome refers to the presence of right upper abdominal pain plus the overlying position of the right colon relative to the liver underneath the right hemidiaphragm. This may be misinterpreted on radiography as pneumoperitoneum.
A Dieulafoy lesion refers to a large gastric vessel that can result in a significant amount of upper gastrointestinal bleeding.
83
How do you reverse dabigatran?
| How do you reverse Xarelto
Idarucizumab or PCC
| Adexenat
84
Why do you give HSV meds in bells palsy?
Bc ramsay hunt syrnome
85
pnuemomedisasinum TX?
Supplmentla O2
86
What is ARVD
Fibrofaty replacement in RV causing ventricular dysrhytmias
PSOITIVE deflection at the end of QRS
aneyrusm is QS waves or deep QRS complex into a st elevation
87
Bloo dtransfusion urticaria, do you need to stop?
no
if you think hemolysis: positive antiglobulin, look out for ARF and DIC
88
leukemia stuff
super old, very high white count
kid. bone pain, LA
Older but still kids, higher complication/death risk, thrombocytopenia, neuropenia, fevr, fatigue
CLL
ALL
AML\
Similar presntation for CML
89
Dose for organophospahe poisning?
1-2 mg every 5 minutes until secretions dry
| 2pam
90
accuminata vs lata
lata is huge and syphylis
| accuminata is small and hpv 6 o4
91
hypotension with necorsis and bullae in the setting of infection should be...
nec fasc
92
How do you define enutropenic fever?
| Dotn do what phys exam move/
100.9 once or 100.4 1 hr - ANC <1500
DRE!
93
ddx rhabdo
| 3 main things you want to avoid?
Drugs and alcohol, falls, trauma, exercise, heat
| DIC, ARF (aim for at least 200 cc hr uop), Lytes bad (Calcium)
94
Hyperemeis gravidarum 1 2 3 line tx?
D5 NS , clear ketones and doxyalmine + b6 (Class A)
then meclizine/benadryl or reglan zofran (ClassB)
95
big ol painful scrotum- gotta think about
incarcerated hernia
96
hydrocarbon- gasoline ingestion Tx and things to look out for
What do you need to look out for hydrogen peroxide ingestion?
It is not well absorbed- systemic toxicity is rare
very volatile from stomach- Pneumoniitis risk! watch for 6 hour evaluating for pneumonitis and need for ventilation hypercarbia, severe respiratory distress, CNS depression, and hypoxia.
or asyhpxiant if inhaled- displaces oxygen
hhydorgen peroxide ingestion? Gas emboli in brain! hyperbarics
97
Blue/hemorrhgae, outside, crpeitus, bullae lesion?
C perfringens causing myonecrosis
