Rosh
Rosh
7. WPW
a.
13. DVT
a. Tx: IV heparin and switch to warfarin
17. Right atrial diastolic collapse is the EARLIEST sonographic finding of cardiac tamponade
18. Chest pain is the most common presenting sx reported in pts with acute aortic dissection…not
back pain
22. Give low molecular weight heparin and warfarin to pt with superficial femoral vein thrombus (3
months?)
23. Holiday Heart can be observed since it converts back into sinus within 24-48 hrs
25. AAA pts often present with sx consistent with renal colic
1. PCP pneumonia
a. Increased LDH, CD4 < 200
b. Tx
i. Steroid for PaO2 < 70 or A-a gradient > 35
c.
b.
4. X-ray findings in PE
b.
a.
b.
11. Hypoxemia
a.
12. Klebsiella
a. Can present as right upper lobe infiltrate with air-fluid level
15. Flail chest is associated with significant blunt thoracic trauma and underlying pulmonary
contusion
a.
17.
1. Complicated Diverticulitis
a. Abscess, obstruction, perforation, fistula
b. Drain abscess at 5 cm
c. If no complications….7-10 days oral abx
2. Adult intussusception
a. Rare
b. Small bowel 80% of case
4. Meckel's Diverticulum
a. MC congenital malformation of GI tract
b. Painless rectal bleeding
c. Technetium-99m scan
5.
7.
9. The reintroduction of ischemic necrotic bowel back into peritoneal cavity --> subsequent
perforation and sepsis
10. Ogilvie
a.
15. Hemorrhoids
a. Initial rx:
i. WASH
1) Water (sitz bath)
2) Analgesic
3) Stool softeners
4) High fiber
18.
1. Acute mastoiditis
a.
4. Oral acetic acid otic washes are just as good as topical antibiotics
a.
b.
8. Coin sign
10. Tinnitus
a. Acoustic neuroma: CN VIII, hearing loss + tinnitus + disequilibrium
b. Ménière disease: recurrent vertigo + tinnitus + hearing loss
c. Ramsay Hunt syndrome: facial paralysis, zoster lesions, tinnitus
d. Labyrinthitis: sudden severe vertigo, hearing loss, tinnitus, not recurrent
e. Ototoxic agents:
i. Salicylates: respiratory alkalosis + anion gap metabolic acidosis + tinnitus
ii. NSAIDs
iii. Quinine
iv. ABX (aminoglycosides, erythromycin, vancomycin)
v. Chemotherapeutic agents
11. Epiglottitis
a. Can elicit pain by moving thyroid cartilage
12. UV keratitis
a.
b.
15.
16. Pterygium
a. Fibrovascular proliferation triggered by UV light exposure
b. Young male in hot dry climate
c. Surgical removal necessary once vision is impaired
d.
a.
1. Epididymitis
a. Prehn's sign
i. Relief with testicular elevation
b. MCC
i. <35: C trachomatis/gonorrhea
ii. >35 e coli, pseudomonas
c. Treatment
i. <35: ceftriaxone
ii. >35: ciprofloxacin
f.
a.
5.
4. Osteosarcoma
a. Can be associated with use of ionizing radiation in childhood solid cancers
5. Maisonneuve fracture
a. Spiral fracture of proximal 1/3 fibula associated with distal tib-fib syndesmosis and
interosseous membrane
6. Lisfranc
a. Fx/dislocation of tarsometatarsal joint
b. Pain on dorsum of midfoot
c. Easily misdiagnosed as ankle sprain
d.
8.
9.
2. Pelvic fracture
a. 3 types
i. Lateral compression (T-bone MVC)
ii. AP fx (head on MVC)
iii. Vertical shear (fall)
b. Destot's sign: hematoma above inguinal ligament
c. Hemorrhagic shock
d. Urethra/bladder injury
e. Tx: pelvic binder over greater trochanters, external fixation, embolization
f. Preform bimanual exam on females
g. Urethrogram before Foley
c.
a.
6. NEXUS criteria
a. NSAID
i. Neuro deficit
ii. Spinal tenderness (nuchal ridge to T1)
iii. AMS (GCS 14 or less, inability to remember 3 objects at 5 mins, delayed, inappropriate
7. Canadian C spine
a. NEXUS +
i. Age
ii. Mechanism
iii. Neck rotation
9. Jones Fracture
a. Transverse fx through base of 5th MT
b.
c. Risk of malunion
d. Tx: cast/splint, crutches for non-weight bearing
i. Can displace further
a.
c.
d.
a.
a.
15.
c.
a.
a.
a.
b.
c.
b.
a.
b. Rx:
i. Type I-III: sling, orthopedic referral
ii. Type IV-VI: sling, orthopedic referral, surgery likely necessary
26.
27. The shoulder is most vulnerable when abducted and externally rotated
b.
a.
33. The return of the bulbocavernosus reflex demonstrates end of spinal shock
a. One finger in rectum
b. Squeeze glans of penis or clit = rectal sphincter contraction
a.
37.
38.
39.
a.
5. Hyperkalemia
a.
6. Hypoglycemia
a. Observe glucose level
b. May need dextrose drip
c. Octreotide: somatostatin analogue
i. Limit effect of native insulin
ii. Inhibit glucose stimulated insulin release
d. Consider activated charcoal in severe overdose
8. Hyperparathyroidism
a. Malignancy (most common inpatient)
b. Primary hyperparathyroidism (most common outpatient cause)
1. Pityriasis Rosea
a. Treat with anti-histamines and is self limiting
1. Frostbite
a. Place injured extremity in warm water 98.6-102.2 for about 15-30 minutes until pliable and
erythematous
b.
a.
b. Mgmt
i. Empiric
1) Timolol (topical beta blocker)
2) Apraclonidine (topical alpha agonist)
3) Pilocarpine (topical miotic)
ii. Systemic
1) Acetazolamide (carbonic anhydrase inhibitor)
2) Mannitol (osmotic diuretic)
a.
7.
8. Hypothermia
a. Osborn J waves
b. Temp less than 31 C
c.
9. Heat Stroke
10. Which adult patients with burns should be transferred to a burn center?
a. Partial thickness burn > 10%
b. Face, hands, feet, genitals, perinuem, joints
c. Full thickness burn
d. Chemical/inhalation
b.
12. Lightning
a. Lichtenberg sign: ferning pattern
b. Tympanic membrane rupture
1. Hyperviscosity Syndrome
○ Causes
▪ Waldenstrom
▪ MM
▪ Leukemias with blast transformation
▪ PCV
○ Clinical
▪ Blurry vision
▪ Headace, fatigue
▪ Stroke
▪ Ischemia
○ Mgmt
▪ Phlebotomy with IV fluid replacement
▪ Plasmapheresis for dysproteinemia
▪ Leukapheresis for BLAST TRANSFORMATION
a.
b.
1. Vasculitis
a. Temporal arteritis: PMR, carotid artery branches affected, vision loss, Rx: immediate steroids
b. Takayasu’s arteritis: Asian, decreased pulses
c. PAN: generalized without lung involvement, HBV
d. Buerger's disease: smokers, claudication of hands/feet
e. Granulomatosis with polyangiitis (GPA): Upper and lower respiratory sx + renal sx, c-anca
f. Microscopic polyangitis: similar to GPA but without nasopharyngeal involvement, p-ANCA
g. Churg-Strauss syndrome: vasculitis + eosinophilia + asthma
h. Cryoglobulinemia: HCV, malaise, skin lesions, joint pain
i. Behçet's disease: oral and genital ulcers, hyperreactivity to needle sticks
2. GVHD
a. Nonspecific rash
b. Mucositis
c. Diarrhea
d. Tx: steroids
e. 1-12 weeks after transplant
3. Angioedema
a. C1 esterase inhibitor concentrate is treatment of choice
b.
4. Anaphylaxis treatment
a. Corticosteroids: prevents rebound
b. H1/H2 blocker: antihistamine effect
c. Albuterol: bronchospasm
d. Epinephrine: vasoconstriction
a.
9. ITP
a. Plt count > 50K = no treat
b. 20k-50k = prednisone taper
c. Lower = IV IG , steroids, anti-D ab
11. Angioedema
a.
2. Myasthenic crisis
a. Respiratory failure leading to mechanical ventilation
6.
9. Putamen Hemorrhage
a. Homonymous hemianopia
b. Contra sensory loss
c. Contra hemiparesis/plegia
11. TIA
a. ASA alone or ASA + dipyridamole
b. Admitted for assessment of stroke risk factor
1. Shoulder dystocia
a. Mgmt
i. Episiotomy
ii. Empty bladder
iii. McRoberts
iv. Wood screw maneuver
v. Clavicle fx
vi. Zavenelli
2. Vaginal Infection
a.
3. Amsel criteria
a. 3 of 4 must be met
i. Thin white homogenous d/c
ii. Clue cells
iii. pH vaginal fluid > 4.5
iv. Fishy odor before or after 10% KOH "whiff test"
6. Ovarian torsion
a. 15-30 y/o or psotmenopausal
b. Sudden onset of unilateral abdominal/pelvic pain
c. Initial: transvaginal ultrasound
d. Cyst or tumor
e.
1. Reyes
a. Cerebral edema is a major causes of M&M d/t increased intracranial pressure
b. Supportive care
a.
3. Child Abuse
a. Bucket handle fx
b. Posterior rib rx
c. Fx of different ages
d. Cutaneous: bruises, bites, burns
e. Shaken baby: retinal hemorrhages
4. Tarasoff vs Regents
a. Establishes physicians duty to breach patient confidentiality if patients poses significant
threat to 3rd party
5. Febrile Seizures
a.
6. Croup
a. 6 months - 3 y/o
b. Cool humidified air helps
c. Dexamethasone is mainstay of therapy
i. Decrease duration
a.
8. Inconsolable infant
a. Thorough exam before d/c
i. Expose, palpate fontanelle, fluorescein stain, finger, toes, penis for hair tourniquets,
hernia, retinal hemorrhages
b.
a.
14.
22. Clarithromycin and erythromycin are not recommended for infants less than 1months b/c of
23. In asthma, Dexamethasone is just as effective as prednisolone and has no associated emesis
a.
a.
b.
a.
31. Bronchiolitis
a. No bronchodilator or steroids
b. Anticipatory guidance, nasal suctioning, hydration
c. High flow nasal cannula
d. PEEP
32. Botulism
a. Infant botulism is the most common form of botulism in the US
i.
1. Nursemaid's Elbow
a.
2.
3. Retrograde urethrogram
a. Indication: concern for urethral injury
b. Foley can be placed in partial urethral tear
c.
4. Thompson test
a. Patient lies in prone position with knees at 90 degrees flexed
b. Squeeze calf muscle
i. If Achilles intact…should plantar flex ankle
c.
d. RF: deconditioned, FQ
e. Pop or snap
5. The nail should be removed in subungal hematoma if nail is split, avulsed or a laceration
extends to skin
b.
a.
13.
14. Priapism
a. Intracavernous aspiration is on PROXIMAL DORSAL surface of shaft
b. Low flow (venous) should be managed in the ED
15.
16.
1. Depression
a. SADPERSONS - risk of suicide
i. 5 person or fewer = outpatient
ii. >6 = ER psych eval and tx
iii. >9 = psych inpatient
2. Somatoform disorders
a. Genuine sx with no identifiable cause
b. F > M
c. Conversion disorder: sudden loss of sensory or motor function
d. Hypochondriasis: preoccupation with having illness
e. Pain disorder
f. Somatization disorder: many complaints in ≥ 1 organ systems
g. Rx: reassurance, minimize providers
3. Bulimia Nervosa
a.
4.
5.
2. Nec Fasciitis
a.
4. Rabies
a. Small domestic animals (rats, squirrels) are almost never found to have rabies
b. PEP not recommended
5. RPR and VDRL test become positive usually two weeks after appearance of chancre
6. Chicken pox
a. Multiple lesions of various stages on the skin at the same time
b.
8. HAV/HEV
a. Fecal oral transmission
b. "the vowels hit your bowel"
2. Disulfiram reaction
a. Alcohol + metronidazole
i. Acetealdehyde accumulation
b.
5. Bleach ingestion
a. Rarely causes injury
b. Not corrosive to esophagus
c. It is the MOST common ingested household item
6. Serotonin Syndrome
a. CLONUS IS THE MC FINDING IN SEROTONIN SYNDROME
b. Helps separate mimics
c. Muscle rigidity if often noted in LE
8. Amanita phalloides
a.
10. Which commonly prescribed over the counter drug is associated with serotonin syndrome?
a. Answer: Dextromethorphan, the cough suppressant, blocks serotonin reuptake.
12. Phosgene
a.
13. Cyanide is another toxin commonly co-inhaled in fire with carbon monoxide
14. Salicylates
17. GHB
a. Anabolic effect and euphoric
b. Body builder and night clubs
c. Classic presentation
i. Comatose pt intubated who abruptly awakens and self-extubate