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Rosh 2 Flashcards

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1
Q

Treatment for pt with Von willebrand dz with bleeding?

A

Desmopressin

-If severe, factor8 concentrate

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2
Q

What are some indications for emergent HD in aspirin/salicylate toxicity?

A
  • Salicylate level > 100 mg/dL
  • rapidly rising levels
  • AMS (cerebral edema)
  • Seizures
  • kidney or liver failure
  • pulm edema
  • severe acid base abnormality
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3
Q

For every ___ mL of sodium bicarb given, serum pH rises by 0.1

A

50

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4
Q

Initial screening test for Lyme?

A

ELISA testing with western blot and PCR

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5
Q

What drug might you want ready for RSI in kids <2 yo?

A
  • Atropine

* tought to attenuate reflex bradycardia from succynylcholine administration

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6
Q

A boutonniere deformity is caused by _____ and looks like ______.

To fix it, splint should____

A
  • Central slip injury (inserts at base of middle phalanx and lateral edges of distal phalanx), aids in extension
  • PIP in flexion, DIP in hyperextension

-Splint: PIP in extension. DIPand MCP full ROM

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7
Q

What are some signs of cor pulmonale on EKG?

A
  • RAD
  • prominent R in V1
  • inverted T waves in V1-v3 or 4
  • Large S wave in I, II, III
  • Large Q wave in III
  • Tall P waves in II, III, AvF
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8
Q

What level are ICPs in patients with IIH (aka pseudotumor cerebri)?

A

> 20 in non-obese

>25 in obese

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9
Q

Tx for cryptococcal meningitis?

A
  • Amphotericin B + Flucytosine x2 weeks

- Fluconazole for 8 weeks after that

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10
Q

Diagnostic criteria for Kawasaki disease?

A

Fever for 5 days plus 4/5 of the following:

  • Cervical LAD
  • oropharyngeal changes
  • b/l conjunctivitis
  • Rash on torso
  • Erythema or desquamation on hands or feet
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11
Q

Formulas for determining whether CO2 retention/acidosis is acute vs chronic?

A
  • Acute: delta pH 0.008 x (40 - CO2)

- Chronic: same but with 0.003

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12
Q

What drugs can cause drug-induced Lupus syndrome?

A
  • Hydralazine
  • Isoniazid
  • Procainamide
  • Phenytoin

also..methlydopa, chlorpromazine, quinidine, minocyclin

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13
Q

Triple therapy meds for H pylori?

A
  • Clarithromycin
  • Amoxicillin (or Flagyl)
  • PPI

10-14 days**

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14
Q

What is the treatment for TCA overdose? (other than supportive stuff)

A

-NA-Bicarb.

50 meq IV at a time until QRS normalizes and bicarb drip

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15
Q

How do you calculate Shock index? What does it tell you?

A
  • HR / SBP

- 0.5 -0.7 = normal, >0.7 = more sensitive than VS alone in diagnosis occult shock/need for transfusion

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16
Q

What is the Amsel criteria for diagnosing bacterial vaginosis?

A
  • Thin, white homogenous discharge,
  • clue cells,
  • pH > 4.5,
  • positive whiff test.
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17
Q

Tx for Bacterial vaginosis?

A

_Flagyl 500 mg po BID x7 days

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18
Q

On Lateral elbow Xray…no visible fracture but post + anterior fat pads visible….

  • Diagnosis in adults?
  • Diagnosis in kids?
A
  • Adults: Radial head fracture

- Kids: Supracondylar fracture

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19
Q

What should be immediate treatment in Digoxin toxicity?

A
  • Digoxin immune Fab
  • It also improves hyperkalemia. DON’T give Calcium, as it can cause “stone heart” since calcium is already high with digoxin use
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20
Q

What type of cardioversion should be used when needed for SVT?

A

-Synchronized

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21
Q

What’s a good drug to start for Pt w/ ascending aortic dissection?

  • Why?
  • What dose?
A
  • Esmolol
  • Decreases HR too. Dropping just BP can lead to reflex tachy. Easily titratable
  • Blous of 500 mcg/kg then infusion 50-200 mcg/kg/min
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22
Q

Main derrangement clinically and metabolically in Cyanide poisoning?

treatment?

A
  • Severe met. acidosis. Severe dyspnea, LOC, seizures, dysrythmias
  • Nitrites or Thiosulfate
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23
Q

Tx of choice for sinus Brady 2/2 Beta Blocker Overdose?

A

Glucagon

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24
Q

What surgery is often complicated by complete heart block?

A

Aortic valve repair or replacement

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25
EKG findings in pericarditis?
- PR depression | - diffuse STE
26
Target SBP for ruptured/leaking AAA patient with hypotension?
80 - 100. Give NS or blood
27
With traumatic hyphema rebreeding tends to occur within ______days/hours.
72 hours. Treatment is supportive. Just stop anti platelets, AC, etc, eye shield to avoid repeat trauma
28
What is the management for traumatic iritis?
- Cycloplegics such as homatropine. This paralyzes the ciliary body - Maybe topical steroids (discuss with ophtho)
29
Treatment for UV keratitis (aka superficial punctate keratitis)
topical NSAIDs
30
When is surgery indicated for orbital floor fracture?
> 50% of floor, extra ocular must. entrapment, exophthalmos, diplopia
31
Target ocular pH when flushing/irrigating a chemical burn of the eye?
7 - 7.2
32
What is the goal PaO2/SpO2% for an intubated ARDS patient?
55-80 PaO2 or 88-95% SpO2
33
How should octreotide be dosed in upper GI bleed?
bolus of 50 mcg followed by an infusion of 50 mcg/hour.
34
What is initial treatment of mild IBD?
Mesalamine
35
Which lab marker elevation has the highest positive predictive value for a biliary etiology in patients diagnosed with acute pancreatitis?
ALT | -ALT levels more than 150 IU/L have 96% specificity and 95% positive predictive value for gallstone pancreatitis.
36
Treatment for Peds shigellosis (when required, i.e sick patient)?
-Ceftriaxone 50 mg/Kg IV daily can also do copra
37
What serologies will be positive in acute hep B infection?
- HBsAg | - Anti hep B core antigen IgM
38
what is the best marker of HBV immunity?
Anti-Hepatitis B surface antibody (anti-HBsAb)
39
What organism is likely responsible for a cavitary lesion on CXR in alcoholic patient with fever/chills/cough?
Klebsiella | -Tx: 3rd gen cephalosporin and aminoglycoside
40
What are adverse effects of Zanamivir? In which patients is it contraindicated?
- Wheezing, severe bronchospasm, resp distress - Asthma, COPD, other structural lung disease *Zanamivir is an inhaled version of Tamil essentially
41
What is the lowest you should enter for a thoracentesis?
-8th intercostal space (posterior)
42
Diagnosis in a patient who handles fish/works at aquarium....develops skin lesion over course of weeks after an abrasion/laceration, gets red, tracks up lymphatics? treatment?
- fish tank granuloma - Mycobacterium marinum -Tx: Minocycline or Clarithromycin
43
What findings/lab values would you expect to see with an exudative pleural effusion?
- pH < 7.2 - Glucose < 60 - WBC > 50K - pleural fluid protein to serum protein is greater than 0.5 - pleural fluid LDH to serum LDH is greater than 0.6
44
Pyridoxine needs to be administered in conjunction with ______ (medication) to prevent ______
- Isoniazid | - neuropathy, seizures, etc
45
The "blush sign" on CT around the Spleen is an indication for ________
Angioembolization via IR | *Only if HD stable
46
What deficits do you expect with anterior cord syndrome?
- Complete loss of Moto, pain, and temperature sensation below injury - Intact proprioception/vibratory sensation
47
What deficits do you expect with central cord syndrome? What is the usual mechanism?
- Sensory and motor deficits upper > lower | - Forced hyperextension
48
What is normal intra-occular pressure?
10 - 21 mm Hg
49
What vascular structure is at risk of injury with a proximal fibular fracture?
Anterior tibial artery.
50
What nerve/nerves provides sensation to lateral aspect of dorm of the foot?
Sural nerve and lateral dorsal cutaneous nerve
51
What nerve(s) provide sensation to the medial malleolus area?
Saphenous nerve and Medial sural cutaneous nerve
52
What nerve provides sensation to posterior calf?
Saphenous and rural nerves
53
Most common nerve injury with distill radius fracture?
-Median nerve
54
Indications for emergent surgery in a patient with a subdural hematoma include _________
neurologic deterioration or midline shift > 5 mm on CT
55
How do you calculate MAP?
DBP + 1/3(SBP-DBP)
56
Management of pt with orbital blowout fracture with entrapment?
- Ice - elev HOB during sleep - nasal decongestants - no blowing nose - NSAIDs - Antibiotics (augmentin) **OK to discharge!
57
EKG features of WPW?
- Slurred upstroke of QRS complex (delta wave) - Widened QRS - Shortened PR
58
Most common organism for pediatric PNA in the following age groups: - 0-3 weeks? - 3 wk - 3 mo? - 3 mo - 5 y? - 6-8 y?
- GBS - Chlamydia trach. - RSV - Mycoplasma
59
Which statistical values are influenced by prevalence?
- PPV | - NPV
60
Treatment of Sporothrichosis?
- Itraconazole | * Amphotericin for severe, systemic disease
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