1
Q
When do you give K in DKA
A
Hold insulin until 3.3
Supplement 3.3-5.2
2
Q
Courvosier sign
A
Nontender palpable gallbladder in pancreatic cancer
3
Q
Virchow node
A
Palpable left supraclavicular lymph node in abdominal cancers
4
Q
Medication contraindicated in thyroid storm
A
Aspirin; displaces T4 from binding proteins
5
Q
NS causes hyperchloremic metabolic acidosis
A
Preferred in TBI
6
Q
Best XR to see free air
A
Upright lateral > upright chest
7
Q
Order to give meds in thyroid storm
A
BB, PTU, iodine, steroid
8
Q
First line for ETOH use disorder
A
Naltrexone
9
Q
Epi dosing
A
1: 1000 anaphylaxis
1: 10,000 cardiac arrest
10
Q
How much blood can be missed on supine XR?
A
1L
11
Q
Primary adrenal insufficiency
A
HypoNa, HyperK
12
Q
1 surgical emergency in elderly
A
Cholecystitis
13
Q
Best suture for poor perfusion
A
Horizontal mattress
14
Q
Metabolic causes of hiccups
A
Hyponatremia and hypocalcemia
15
Q
Ranson score
A
WBC >16 Age >55 Glucose >200 AST >250 LDH >350
16
Q
Paralytic in myasthenia gravis
A
Higher dose of succ (2.5)
Lower dose of roc (0.5)
17
Q
Beta thalassemia
A
Mild microcytic anemia
More common in Mediterranean/Middle East/African
Target cells
18
Q
Reed Sternburg cells
A
Hodgkin lymphoma
B-symptoms
19
Q
HELLP
A
Don’t forget about it
Mg and induction
20
Q
Most common cause of death in SCD?
A
Acute chest syndrome
21
Q
Predicting severity of acute pancreatitis
A
SIRS > RANSON
22
Q
What is legally determined?
A
Competency
23
Q
Sequela of lightening strike
A
TM rupture
Cataracts within days
Asystole
24
Q
Blocks telease of stored thyroid
A
Iodine
25
Risk factors for ectopic pregnancy
Tobacco, PID, previous ectopic, tubal surgery
26
Target temp for induced hypothermia
32-36 C
27
Cardinal movements of delivery
Every day fine infants exit eager and excited
28
Indications for dialysis in hyperCa
>18
Neuro sx
CHF
ARF
29
Persistent, painless peripheral lymphadenopathy
Lymphoma - B symptoms
Increased risk with HIV+
30
Peak for neutropenic fever
6-10 after last chemo
31
Addison changes
Hypotension, hypoglycemia, high potassium, low sodium
32
Thalassemia iron counts
MCV low
Iron high
Everything else normal
33
Methylergonovine
Post partum bleeding
Vasospasm - avoid in htn/preeclampsia
34
Carboprost
Uterotonic- avoid in asthma
35
Platelet transfusion cut offs
50k: LP, surgery, active bleeding
20K: central line
10k: always
36
Contraindicated with danteolene
CCB
37
G6PD lab and smear
Normocytic
Bite cells, Heinz bodies
38
Alpha Thalassemia labs and smear
Microcytic, nml ferritin
hypochromic RBCs, target cells
39
Complications of targeted temp management
Bleeding - coagulopathy
Hypovolemia
Hyperglycemia
Infection
Long QT
40
PPROM
Rupture before 37 weeks
No pain or bleeding
41
Most commonly injured ligament lateral ankle sprain
Anterior talofibular
42
Transverse myelitis
Can look like MS - but more abrupt (days to weeks)
Weakness and sensory loss with autonomic dysfunction
Steroids
43
US in early pregnancy order
Gestational sac, double decision sac
Yolk sac, fetal pole
44
Gilbert Syndrome
Unconjugated hyperbilirubinemia
45
Euglycemic DKA seen with what meds?
SGLT2 inhibitors (flozins)
46
Abx for preseptal cellulitis
Augmentin
47
Ehrlichiosis
Gram -, intracellular, ricketssia like coccobacilli
48
Borrelia hermsii
Tick borne relapsing fever
West coast
Giemsa stained blood smears
Doxy or erythromycin
49
Linezolid mechanism
MAOI
50
Cric tubes
6mm tracheostomy
5 or 6 ET
Needle 12-16 gauge
51
Mortality risk in hemoptysis
Hypoxia > hypotension > total blood loss
52
Graves’ disease
Hyperthyroid
53
Travelers diarrhea tx
Azithro or flouroquinolone
54
Fetal heart tracing
Nml: early decels, moderate variability, accelerations
55
Max amount of fluid for thoracentesis
1.5L
56
Cause of HACE
Pulmonary artery vasoconstriction
Patchy alveolar infiltrate (rt middle)
57
Treat scleroderma renal crisis
Captioril and nitroprusside
No steroids
58
Factor 8 replacement
50% (hemarthrosis): 25 u/kg
100% (life threatening bleed): 50 u/kg
59
Warm and dead temp
>32C/89.6F
60
Fibrocystic breast lesion
Noncancerous - excess fibrous tissue
Nodular, mobile, smooth
61
Nitrogen dioxide
Silo gas - Farms and military
Pneumonitis
1. Sob
2. Resolution
3. Pulm edema and resp failure
62
Cultured from aspiration pna
H influenza
63
Reverse Coumadin
Ffp if not life threatening
PCC if life threatening or chance of fluid overload
64
Abx associated with NCSE
Beta lactams and fluoroquinolones
65
Abx that cause myasthenia crisis
Aminoglycosides, macrolides, fluoroquinolones
66
Distal intestinal obstruction syndrome
Inspissated intestinal contents, usually ileocecal junction
Happens in CF
67
Treat symptomatic inhalation of bleach
Bronchodilators
Sodium bicarb nebulized
68
Abx for empyema
Recephin, flagyl or unasyn
69
Most common GI issues in CF
Pancreatic insufficiency
70
Steroids in PJP
PaO2<70, A-a >35
71
Heart valve most commonly injured in blunt trauma
Aortic
72
Intubation in GBS
FVC <20 ml/kg
Negative insp force <30cm
Max ins pressure <40cm
73
Chest XR traumatic rupture of aorta
Displacement of esophagus 1-2cm to right
Blurred aortic knob
Downward displacement of left main stem 40 degrees from horizontal
74
HOCM on echo
LVOT obstruction:
ant leaf of mitral valve moving ant in systole
Asymmetric hypertrophy of septum
Small left ventricular cavity
Premature closure of aortic valve
75
Failed hyperoxia test
Congenital heart disease
76
Treatment of myasthenic crisis
Airway, IVIG, plasmapharesis
77
Hydrogen sulfide
Rotten egg smell
Edema bronchitis
LA, AKI, cns sx
78
Strychine
Looks like tetnus -glycine receptors
Supportive treatment
79
Cyanide
Apnea, very high lactic acidosis, coma, cherry red skin, no improvement with O2
High venous oxygen sats (cells not using oxygen)
Hydroxycobalamin
80
Contraindicated w/ dantrolene
CCB
81
PEP for HIV time frame
Within 72 hours
82
Tetnus mechanism
Decreases gaba and glycine at anterior horn in spinal cord (decreases inhibition)
83
Botulism mechanism
Decreases NT at NMJ
84
Increased risk with downs
Seizure, celiac, aa instability
85
Electrolyte abnormality in degeorge
Hypocalcemia
86
Early complication in trachs
Hemorrhage
87
Cancers with Mets to bone
Breast, lung, prostate
88
Liver most likely to metastasize where?
Lung and lymph nodes
89
Falsely elevated procal
Malignancy
90
Kid with fever, bleeding and vague sx
Leukemia
91
Treat acute angle closure glaucoma
Timilol
Acetazamide, apraclonide
92
Acute aortic valve regurg
Aortic insufficiency
Treat: nitroprusside and dobutamine
C/I: balloon pump, beta blockers
93
Droplet precautions
Meningitis, pertussis, flu, rsv
94
Hyperventilation acid base change
Decreased CO2 -> cerebral vasoconstriction
95
Order appearance on US of pregnancy
Gestational sac, double decidual sac, yolk sac, fetal pole
96
Hyperbilirubinemia in kids
Conjugated always pathologic
Biliary atresia, alpha 1 antitripsin, sepsis
97
SBO on XR
Dilated bowel with prominent folds (plicae circularis), air fluid levels, bowel dilation >3cm
98
PRES
Immunosuppressants, HtN, autoimmune, ESRD predisposing factors
Parietal-occipital lobes
99
Acute cholangitis on US
Cholecystits plus dilated CBD 0.6 + 1 cm for each decade over 60
100
Sensitivity
TP/(all positive actual dz)
Ability to detect disease
101
Specificity
TN/(all actual negatives)
Detects absence of disease
102
Positive likelihood ratio
How likely a pt with dz will test + for dz
103
Positive predictive value
Likelihood a positive test is truly positive for disease
Dependent on prevalence in population
104
Amlodipone OD sx
Hypotension, TACHY (Brady with massive OD)
105
Diltiazem OD
Hypotension, brady, hyperglycemia
106
Clonidine OD
Brady and hypotensive
107
Huffing
Halogenated hydrocarbons
Wife complex arrhythmia
Catechole surg- no epi
108
Popper use
Methemoglobinemia
109
Imaging for hip dysplasia
US
110
Treat celiac
Prednisone
111
Dental prophylaxis
Prosthetic valves, hx of endocarditis, heart transplant, congenital heart disease unrepaired or with ongoing defects
112
Pneumoconiosis
Restrictive lung dz - fibrosis
Slow onset sob
113
Treatment for pelvic pain in endometriosis
OCP, nsaids
114
Tamponade
Preload dependent
115
Treat DIC
Underlying cause! (Abx for sepsis and etc)
116
Eye exam in acute angle closure glaucoma
Mid size pupil, minimally reactive
117
Give charcoal
Tylenol, aspirin, most antihypertensives
(Don’t absorb metal well)
118
Volkman contracture seen with what injury
Supracondylar fx of distal humerus
(Compartment syndrome and ischemia in forearm)
Brachial artery
119
Complications of targeted temp management
Bleeding, hypovolemia, hyperglycemia, infection, long qt
120
Risk factors for celiac
T1DM, autoimmune thyroiditis, hemosiderosis, Down syndrome, Turner
121
Complication of Blakemore tube
Esophageal perforation (gastric balloon placed above the diaphragm)
122
vWD abnormality
Decreased vwf -> decreased VIII -> abnormal PTT
123
qSOFA
GCS <= 14
RR >= 22
SBP <= 100
124
Carpal tunnel on US
Cross sectional >10 abmnl
Notched on long view
Waistline with compression under flexor retinaculum
Higher intraneural vascularity
125
Rumack Mathew nomogram
Only for single OD ingestion
126
First line for pain in fibromyalgia
Cyclobenzaprine and TCAs
2nd: duloxetine or pregabalin
127
Juvenile laryngeal papillomatosis
Papillomas on cords
Presents in infancy hoarse cry and stridor
Likely caused by HPV
128
Infantile hemangioma
Soft vascular tumor with blue color
Cervicofacial, mandibular or beard distribution
Can also have airway hemangiomas (in the subglottic region)
129
Pain med that can precipitate SS
Fentanyl, methadone, tramadol
130
Spigelian hernia
Anterior wall, adjacent to semilunar line
Develops between the fascia
131
Methylene chloride toxicity
In paint remover
Metabolizes to CO
132
Airway disruption with blunt neck trauma
At the level of cricoid cartilage
133
Second line for cluster headache
Subq sumatriptan
134
Avoid in pheochromocytoma
Steroids (catechol surge)
Glucagon, TCAs, BB, dopamine antagonist
135
Organophosphate tox sx
Bradycardia, vomiting, cough
Sludge + BBB
136
Risk for poor outcome in stroke
Elevated trop, fever, HtN, hyperglycemia, old, high NHS, black, dehydrated, hypoxia
137
Dermoid cyst
Congenital subq nodule in peds
Anterior fontanelle, submental region, lateral forehead
138
Epidermoid cyst
Central punctum, capsule filled with keratin debris
139
Pilar cyst
Hair follicle
140
Lipoma
Rubbery, round, fat cells on the subq tissue
Benign
141
Thyroid storm and sx of CHF
Avoid bb
142
Lisfeanc injury
Midfoot
Axial load to plantar flexed foot
Weight bearing XRs b/l
143
Cipro
Not good for respiratory
144
Risk factor for SSSS and treatment
Age <3
Kidney disease
Sumner and fall
Abx-pen
145
CD4 cut offs for opportunistics
<50 crypt and MAC
<100 toxo
<150 histo
<200 PJP
<250 coccidio
146
Shock in takotsubo
Phenyephrine
If confirmed no LVOT obstruction: doubutamine
ECMO, balloon pump, LVAD
147
Dialysis in aspirin overdose
Pulmonary edema, severe acidosis <7.2, ams, hypoxemia
Initial level >90-100 or >80-90 after treatment
148
Labs in Kawasaki
WBCs in UA
Low albumin
High plt
Elevated ALT
149
Treat travelers diarrhea
Single dose azithro
150
PERC components
Age, HR, O2, hx DVT/PE, hemoptysis, LEE, hormones, surgery or trauma <= 4 weeks
151
TMJ dislocation more common in which direction?
Anterior
152
Hernia most likely to be strangulated
Femoral
More common in women
153
Direct hernia
Medial to inferior epigastric vessels through Hesselbach triangle
154
HINTS
Head impulse: central cause - NO corrective saccade (normal)
Nystagmus: central - bi, vertical, rotational
Skew: central - +skew and abnormal correction
155
Midbrain stroke
Thalamus - pure sensory
156
Internal capsule stroke
Pure motor
157
ACA stroke
Frontal and parietal
LE sx
158
PCA stroke
Occipital
Posterior sx
159
LVAD suction event
Cannula sucked down against LV wall due to increased LV pressure: decreases flow and output
-hypovolemia or arrhythmia
-increase preload
160
LVAD mechanical failure
Thrombosis (high power alarm)
Part failure (low power alarm)
161
Obs time for snake bite
12-24 hours
162
Keratitis
Infection of cornea (contacts)
163
Hyper acute bacterial conjunctivitis
N. Gonaorrhea
Purulent drainage, lid swelling, periorbital edema
Optho consult - corneal perf
164
White plaques in mouth with odynophagia and retrosternal CP
Esophageal candadisis
Systemic fluconazole
165
HSP also called and labs
IgA vasulitis
Normal coags
Low serum complement
Hematuria and proteinuria
166
Myositis
Usually viral
Influenza
Calves
167
Drugs most commonly associated with SJS
Phenytoin and carbamazepine
Oxicam nsaids
Allopurinol
168
Course of abx for Lyme arthritis
28 days - doxy, amox, cefuroxime
<8 yo: no doxy
Pregnant: amox
169
Obtain MAP in LVAD
Manual cuff, Doppler over brachial or radial, inflate cuff to 120
MAP is when constant Doppler is heard
170
McConnell sign on US
Right ventricular dysfunction with hypokinesis of the free wall but normal apex
PE
171
Dialysis for lithium
Lithium >4 with kidney dysfunction
AMS, seizure, arrhythmias
>5
CHF
172
Abx for infected stone
Carbapenem plus vanc
173
Time for levothyroxine OD
Delayed - 7 to 10 days
174
LGV
Doxy for 21 days
175
Macrophage activation syndrome
Drop in platelets in juvenile idiopathic arthritis - consumptive coagulopathy
Cytopenia, liver dysfunction, high ferritin
Low ESR and fibrinogen
High dose steroids
176
Whippets abuse
Nitrous oxide
B12 deficiency
177
Medication gout triggers
Aspirin, thiazides, alcohol
178
ITP
In kids
Preceded by virus
Symptomatic treatment
179
Old, fall, negative xr
MRI
180
Gastroparesis risk factors
CCB, TCAs, alpha agonists, dopamine agonist, cholinergics
181
Sx of ibuprofen od
Metabolic acidosis with normal vitals
(Oil of wintergreen can look the same)
182
HF in an alcoholic patient
Wet beriberi - mag and thiamine
183
Malignant hyperthermia
Hyper metabolic state
Hyperthermia, tachycardia, tachypnea and elevated CO2
184
Flat tire sign on CT
Flat anterior chamber
Globe rupture - intraocular foreign body
(Also Seidel sign and tear drop pupil)
185
First line for giardia
Tinidazole
186
Risk of stroke after TIA
Highest in first 48 hours
187
Leukocyte reduced packed rbcs
Use in patients with febrile transfusion reactions (likely due to recipient antileukocyte antibodies
188
Most common location of osteoporotic fx
Spine
189
Most rapid rewarming
Cardiac bypass
190
TCA OD
Can have anti HAMs side affects
191
Acute lupus pneumonitis
High mortality
Can be first sx of lupus erythematousus
192
Cavernous sinus thrombosis
Complication of orbital cellulitis
HA and papilledema
193
Aortic stenosis murmur
High pitched cresc-decresc, midsystolic with radiation to carotids best at right upper sternum
194
Heyde syndrome
Aortic stenosis, iron deficiency anemia, vwb
GIB 2/2 angiodysplasia
195
Complications of LVAD
#1 bleeding
#2 infection
196
Spondylolysis
Unilateral fx of pars
Back hyperextension
197
Most common cause of traumatic ureter injury
GSW
198
Fastest sedation
Ketamine
Midazolam=droperidol>olanzapine>haldol
199
Peds high flow rate
1-2 L/kg/min
200
Organic FB
MRI
201
Splint open in nail avulsion
Eponychium
202
OA vs RA hand sx
OA distal
RA proximal
203
Drug induced myasthenic crisis
Abx: aminoglycosides, macrolides, fluoroquinolones
204
Choreoathetosis
Seen in Parkinson’s
Not drug induced
205
Diagnose dissection in unstable patient
TEE
206
Pain and temp are on which spinal tract
Spinothalamic
207
Posterior column carries which sensations
Vibration, proprioception, fine touch
208
Early complication of cric
Damage to cartilaginous structures
209
Imaging with highest sens and spec for osteo
MRI
210
Delayed post partum hemorrhage
Retained placenta
211
Overdrive pacing
Terminate hemodynamically stable torsadea
212
Treat hyperviscosity syndrome in polycythemia
Asa, IVF
Phlebotomy - 500c at a time
Goal Hct <45%
213
Second gen antipsychotic most likely to prolong qt
Ziprasidone
214
Olanzapine side effects
Weight gain, hyperglycemia
215
Treatment for SSSS
Pens or cephalosporins
Clarithromycin if pen allergic
216
Vessel injured in blunt oral trauma (toothbrush)
Internal carotid -> middle cerebral
217
Laceration within 7mm of medial canthus
Lacrimal duct injury
Fluorescein streaming through lac
Oculoplastics
218
Causes of vitreous hemorrhage
Diabetes, old, shaken baby
219
Posterior communicating artery aneurysm
CN 3 palsy with same side pupillary dilation
220
Lisfranc joint & dislocation
Distal tarsal bones, cuniform, cuboid and metatarsal bones: tarsometatarsal dislocation
Fx base second metatarsal
Rotational force with axial loading
221
Elbow fat pad
Adults: radial head fx
Peds: supracondylar humerus fx
222
Preferred incision side for felon I&D
Ulnar
223
Bennett/Rolando
Base of thumb
ORIF
224
Barton’s fx
Distal radius at the intrarticular surface
225
Legg-Calve-Perth
Idiopathic avascular necrosis
226
Most common compartment in compartment syndrome
Anterior tibial
Earliest symptom is pain
227
Madisonneuve fx
External rotation of ankle
Rupture of medial collateral ligament
Prox fib maybe fx
228
Low impact fx
Vit D deficiency-> low Ca -> high PTH
229
Pressor for cardiogenic shock
Hypotension: norepi
Normotemsove: dobutamine
230
Torus fx
Buckle fx- incomplete fx of shaft of long bone
Axial loading- FOOSH
231
Structures for femoral nerve block
Iliacus muscle, sartorius muscle, femoral artery
232
Most specific for acute rejection
Proteinuria
233
Acute flaccid myelitis
Viral motor neuron infection
T2 hyper intensities
234
Tube thoracostomy
4th or 5th intercostal space, anterior or mid axillary line
235
Kounis syndrome
ST elevation due to mast cell degranulation (anaphylaxis) causing vasospasm or plaque rupture
236
Polymyositis and inclusion body myositis
Look like dermatomyositis without skin changes
Poly is proximal
Inclusion body is distal
237
Polymyalgia rheumatica
Associated with giant cell arteritis
Elevated ESR and CRP (more reliable)
Proximal muscule weakness that worsens through the day
Steroids
238
Most common fragility fx
Vertebra, Distal radius, hip
239
Patella alta
Predisposes to recurrent dislocations
240
Most common cancer hyperviscsoity
Waldenstrom
241
CLL
Old people
B symptoms
Smudge cells
242
B/L pulmonary opacities with no heart failure
ARDS
243
Peritonsillar needle aspiration
Carotid a: 2.5 cm posterolateral
Max 1cm deep
Clinda or augmentin
244
West Nile virus
Common viral encephalitis
Rash on chest and extremities
Can see asymmetric flacid paralysis
245
Aortoenteric fistula
At duodenum
Abx and surgical repair
246
Appy maneuvers
Rosving: push on LLQ
Psoas: (retrocecal), on side, extend hip
Obturator: flex knee and internally rotate
247
Sciatica testing
Sensitive: same
Specific: crossed
248
Disseminated gonnocoal rash
Pinpoint petechial macules that are hemorrhagic or nectoeic
249
Syphillis rash
Diffuse, symmetric, on the palms and soles
250
neonatal seizures
Hypoxic encephalopathy
Phenobarb
251
Most common source of osteo
Hematogenous spread
252
Toxic Tylenol dose
150 mg/kg
253
Fx from mets
Femur (long bones)
254
Acute vs chronic rejection
Acute < 3m; recipient against donor antigens
Chronic <3m: fibrosis and sclerosis
255
Phenobarb MOA
Inhibits glutamate
256
Give in aneurysms subarachnoid hemhorrage
Nimpodipine
257
Tricuspid stenosis
Rheumatic fever, egotamine, radiation therapy, carcinoid
Right sided HF
258
Greatest heat loss
Radiation
259
Pacemaker code
Paced, sensed, response
260
Life threatening strangulation injury
Cricoid fx -> compression of carotid a
261
Time CT no longer reliable for SAH
6 hours
262
HIV med with psych sx
Efavirenz
263
Mastoiditis bug
Strep pneumo
264
Naloxone drip rate
2/3 wake up dose
265
IgA nephropathy
Hematuria 1-2 days after URI
(vs weeks in PSGN)
266
Acute cerebellar ataxia reassuring findings
Wide gait, truncal weakness, f to n, dysdiad, action tremor, end nystagmus
267
Carcinoid syndrome
5-HIAA
Random flushing
Octreotide
268
Ranula
Fluid collection under tongue
Surgical resection
269
Ewing Sarcoma
Onion skin
Most common bone tumor in 10-20y
270
Osteosarcoma
Sunburst pattern
Soft tissue mass
271
Cyclobenzaprine OD
Like TCA (antimusc)
Tachy, somnolent
272
Uncomplicated pna
Amox, doxy, azithro
273
Hemolytic transfusion reaction
ABO incombat
Low haptoglobin
Elevated LDH
Positive direct antigen
274
Level for chelation of unsystematic lead
45
275
Felty syndrome
RA, neutropenia, splenomegaly
276
Opiate that doesn’t cause miosis
Meperidine
277
Deepest anorectal space
Supralevator
278
Most common ekg with dig tox
PVC
279
Sunburn like erythroderma
TSS
Clinda
280
Malaria
Severe: falciprum
Delayed sx: vivax/ovale
281
Outpatient pna with comborbidites
Aug or ceph AND doxy or azithro
or levaquin
