CV

Saturday, June 9, 2018 9:48 AM

1. Serum troponin is more sensitive than CK-MB

a. More sensitive and more specific

2. The role of beta blockers in MI are to reduce risk of ventricular dysrhythmias

3. Alcohol can set off A fib

4. If stuck between SVT and A fib….LOOK FOR regular VS irregular

5. Carotid massage is not recommended for children (less effective)

a. Don’t' do ocular pressure (globe rupture)

6. SVT vagal maneuver

a. Ice pack to face
b. Blow through straw
c. Gag reflex
d. Verapamil is CI in
i. Infants < 1
ii. Children with heart failure
iii. WPW
iv. Wide QRS

7. WPW

a.

8. Mobitz Type II or worse necessitates treatment with pacing

9. CAD is the MC pathologic condition in pt who die from V fib

10. Classic EKG findings in HOCM

a. LVH with deep narrow Q waves (esp in precordial leads)

11. Aortic dissection triad

a. Hypotension + back pain + pulsatile abdominal mass

12. Shortened QT interval are seen in hypercalcemia

a. Malignancy is the MC inpt cause

13. DVT
a. Tx: IV heparin and switch to warfarin

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14. Phlegmasia cerulean dolens
a. Massive thrombosis causing venous insufficiency (painful blue legs)

15. PDE-5 Inhibitors SE

a. "Hot and heavy; but then headache, heartburn, hypotension"

16. Defibrillation is indicated for WIDE COMPLEX W/O PULSE

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

19. The MC sx of cardiac ischemia in pt older than 85 y/o is dyspnea

20. Pt with aspirin allergies in CP

a. Should receive clopidogrel instead

21. Monomorphic vtach = synchronized cardioversion

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

24. S3 is the most specific for acute decompensated heart failure

25. AAA pts often present with sx consistent with renal colic

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Resp
Saturday, June 9, 2018 9:49 AM

1. PCP pneumonia
a. Increased LDH, CD4 < 200
b. Tx
i. Steroid for PaO2 < 70 or A-a gradient > 35

c.

2. Westermark sign is rare but specific finding on CXR

a. What: oligemia of pulmonary vasculature visualized distal to site of embolism

b.

c. Also Hampton's hump

3. Tachypnea is the MC vital sign abnormality in acute PE

a. Tachycardia is the most common EKG finding

4. X-ray findings in PE

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 a.

b.

5. Malignancy is in majority of SVC syndrome

6. Pt on heparin for PE needs to be bridged to Warfarin for 3-6 months

7. Primary TB is airborne precaution

a. Varied appearance on X-ray

8. Asthma vs COPD workup….only routine CXR required d/t comorbidities

a. CHF
b. PNA etc.

9. S pneumo is the most likely cause of bullous myringitis in pna

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 a.

10. S aureus post influenza PNA

a.

b.

11. Hypoxemia

a.

12. Klebsiella
a. Can present as right upper lobe infiltrate with air-fluid level

13. Moderate persistent asthma is using an inhaler everyday

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13. Moderate persistent asthma is using an inhaler everyday

14. Bullae on CXR in COPD-ers are signs of increased risk of pneumothorax

15. Flail chest is associated with significant blunt thoracic trauma and underlying pulmonary
contusion

16. CXR findings and signs

a.

17.

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GI
Saturday, June 9, 2018 9:48 AM

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

3. Most children intussusception have no pathologic causes

4. Meckel's Diverticulum
a. MC congenital malformation of GI tract
b. Painless rectal bleeding
c. Technetium-99m scan

5.

6. Any FBO longer than 5 cm should be removed unlikely to pass duodenum

7.

8. Gallstone panc > EtOH panc

9. The reintroduction of ischemic necrotic bowel back into peritoneal cavity --> subsequent
perforation and sepsis

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 perforation and sepsis

10. Ogilvie

a.

11. Risk factor for hepatic encephalopathy

a. Infection
b. GI bleeding
c. Constipation
d. High protein diet
e. Zinc deficiency
f. Benzodiazepine
g. Diuretics

12. 3/6/9 rule for bowel diameter

a. Small bowel = 3 cm
b. Colon = 6 cm
c. Cecum = 9 cm

13. Schatzki ring

a. Most common esophageal structural abnormality
b. Fibrous esophageal ring --> esophageal stenosis
c. "piece of steak" stuck in throat

14. Sigmoid volvulus

a. Two population
i. Elderly bed-ridden patients with debilitating comorbid disease
ii. Patient of any age with profound neuro/psych illness
b. Cecal volvulus is the MCC of bowel obstruction in pregnancy

15. Hemorrhoids
a. Initial rx:
i. WASH
1) Water (sitz bath)
2) Analgesic
3) Stool softeners
4) High fiber

16. Mackler's triad in Boerhaave

a. Chest pain
b. Vomiting
c. subQ emphysema

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17. Anal Fissure
a. Rx: sitz bath, topical anesthetic (lidocaine) and vasodialtor (nitroglycerin ointment) and stool
softner

18.

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HEENT
Saturday, June 9, 2018 9:49 AM

1. Acute mastoiditis

a.

b. CT scan temporal bone + IV abx

2. Lightning strikes are associated with TM perf

3. Three complications of bacterial sinusitis

a. Meningitis
b. Orbital cellulitis
c. Sinus bone osteitis

4. Oral acetic acid otic washes are just as good as topical antibiotics

5. Orbital Cellulitis vs Pre-septal Cellulitis

a.

b.

6. Facial paralysis with otitis media is indication for myringotomy

7. Esophageal foreign body

a. C6 > T4 > T11
b. Look for signs of obstruction
i. i.e. drooling

8. Coin sign

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 a.

9. Septal hematoma shows no relief following administration of oxymetazoline

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.

13. Corneal Abrasion

a. Hallmark is complete or near complete relief of pain with topical anesthetic drop

b.

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14. Globe rupture
a. Placing pressure on the eye is contraindicated…i.e. don't put tonopen on eye

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.

17. Peripheral Vertigo

a.

18. Triad in Meniere disease

a. Fluctuating hearing loss
b. Tinnitus

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b. Tinnitus
c. Vertigo
d. Vestibular neuronitis (no hearing loss, severe vertigo)

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Renal/Urogenital
Saturday, June 9, 2018 9:49 AM

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

2. Male Genital Lesions

a. Herpes: painful, shallow, cluster of vesicles
b. Syphilis: painless chancre
c. LGV: C. trachomatis, painless ulcer, inguinal lymphadenopathy
d. Chancroid: H. ducreyi, painful chancres, inguinal bubo
e. Granuloma inguinale: K. granulomatis, beefy red ulcer

f.

3. 3 mL/kg/hr is the goal in fluid therapy for rhabdomyolysis

4. Indication for admission

a.

5.

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MSK
Saturday, June 9, 2018 9:49 AM

1. Low risk laceration from dog bites can be primarily closed

a. Do not require antibiotic prophylaxis

2. Management of wound closure

a. Primary
i. Clinically uninfected
ii. Less than 12 hrs old (24 hours on face)
iii. Not located on hand or feet
b. Abx ppx
i. Moderate to severe crush wounds
ii. Wounds on hands, genitalia, face, joint
iii. Immunocompromise
iv. Underlying venous or lymphatic compromise

3. Septic arthritis needs to be differentiated from gout

a. Need to tap knee with clinical suspicion
b. Pain (especially passive ROM) is concerning

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.

e. Severe plantar flexion

f. Sports related, MVC, fall from height
g. Rx: immobilization or surgical repair

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7.

8.

9.

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Trauma
Saturday, June 9, 2018 9:50 AM

1. Isolated Pubic Ramus Fracture

a. MC pelvic fracture encountered
b. Tx: conservative with wt bearing and PT

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

3. Ottawa Ankle Rules

a. Acute injuries within 48 hrs
b. Get films if
i. Inability to bear wt with 4 steps both immediately after injury and at time of eval

c.

4. MC sprained ankle ligament?

a. ATL
b. Anterior talofibular ligament

5. Blast injury categories

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

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 iii. AMS (GCS 14 or less, inability to remember 3 objects at 5 mins, delayed, inappropriate
response to external stimuli)
iv. Intoxication
v. Distracting injury

7. Canadian C spine
a. NEXUS +
i. Age
ii. Mechanism
iii. Neck rotation

8. Cervical Spine Fractures

a. Unstable fractures: Jefferson Bit Off a Hangman’s Thumb: Jefferson burst fracture (C1), Bilateral
facet dislocation, Odontoid fractures (C2), Hangman fracture (C2), Teardrop fracture
b. Jefferson burst fracture: C1, axial load
c. Odontoid fracture: high cervical pain radiating to the occiput
d. Hangman fracture: C2, extreme hyperextension
e. Imaging decision: NEXUS criteria or Canadian c-spine rule

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

10. Traumatic iritis (iridocyclitis)

a.

b. s/s: photophobia, decreased visual acuity,

c. Tx:
i. Atropine
1) Cycloplegics - paralyze ciliary body
ii. steroid

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11. Anterior shoulder (glenohumeral dislocation)
a. Abduction and external rotation
b. "squared off"

c.

12. C1 Jefferson Burst Fracture

a. Axial/vertical compression force transmitted through occipital condyle
b. Burst fx of lateral C1
c. Prevertebra hemorrhage and Retropharyngeal swelling

d.

13. Common Peroneal nerve injury

a.

14. Lower Extremity Nerve Deficits

a. Superior gluteal: Trendelenburg sign/gait (lesion is contralateral to the dropped side)
b. Inferior gluteal: ↓ hip extension
c. Obturator: ↓ thigh sensation (medial), •adduction
d. Femoral: ↓ thigh flexion, leg extension

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 d. Femoral: ↓ thigh flexion, leg extension
e. Common peroneal: ↓ foot eversion/dorsiflexion
f. Tibial: ↓ foot inversion/plantarflexion

14. Patella Tendon Rupture

a.

15.

16. Central Cord syndrome

a. MC incomplete spinal cord syndrome

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 b.

c.

17. Posterior hip dislocation

a.

18. Compartment syndrome

a.

19. Radial Head Fx

a. Radial Head Fractures
i. Type I/II: nonoperative
ii. Surgery indications (rule of 3s): >3 mm displacement, >30% of articular surface
involvement, >30% angulation exists

20. Basilar Skull Fracture

a. CN VII and CN VIII entrapment
b. CT scan good for fx, not X-ray
c. Abx are not given prophylactically

21. Stable Cervical Fx

a. Unilateral facet dislocation, type I odontoid fx, clay shoveler's fx

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 b.

22. Jefferson bit off hangman thumb

a.

b.

c.

23. Tooth fracture

a. Exposed dentin needs to be covered with calcium hydroxide paste

b.

24. FOOSH and scaphoid

a. Thumb spica splint + repeat radiographs in 10-14 days

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 a. Thumb spica splint + repeat radiographs in 10-14 days

25. AC joint separation

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

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 a.

28. Clavicular fractures

a. Only angulated or displaced fracture require reduction

b.

29. Hip fracture

a.

b. Severe AP "open book" pelvic fracture

c. DO NOT ROCK THE PELVIS

30. Compartment syndrome

a. Anterior compartment of the leg and volar compartment of the forearm is the most
commonly affected

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31.

32. Rib fracture

a. Posterior angle is the weakest area
b. Elderly or those with multiple rib fx are at the highest risk for pneumonia
c. Also want to watch for pulmonary contusion/pneumothorax

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

34. Guideline for exploratory thoracotomy

a. Initial drainage > 20 mL/kg
b. Output > 200 mL/hr for first 3 hour
c. Persistent bleeding at rate > 7 mL/Kg/hr
d. Increasing hemothorax on CXR
e. Hypotensive despite adequate blood replacement
f. Decompensation after initial response to resuscitation

35. Odontoid fractures

a.

36. Inferior orbital nerve distribution

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 a.

37.

38.

39.

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Endocrine
Saturday, June 9, 2018 9:49 AM

1. Auscultation of enlarged gland/goiter in thyroid may reveal bruit

2. Hyperthyroidism is associated with proximal muscle weakness

3. Hypomagnesemia is the MC electrolyte disorder in ambulatory diabetics

4. Thyroid storm management

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

7. Hyperosmolar hyperglycemic state

a. Because associated with concurrent illness. Higher mortality rate

8. Hyperparathyroidism
a. Malignancy (most common inpatient)
b. Primary hyperparathyroidism (most common outpatient cause)

9. The treatment for alcoholic ketoacidosis is glucose

a. Ketogenesis from poor food intake, stress, dehydration, NADH production
b. Tx: glucose + thiamine + fluid + supportive
c. 12-24 hrs to reverse

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Skin/Derm
Saturday, June 9, 2018 9:48 AM

1. Pityriasis Rosea
a. Treat with anti-histamines and is self limiting

2. What labs should be considered in pityriasis rosea

a. RPR/VDRL to rule out syphilis

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Environmental
Saturday, June 9, 2018 9:49 AM

1. Frostbite
a. Place injured extremity in warm water 98.6-102.2 for about 15-30 minutes until pliable and
erythematous

b.

c. NEVER DRY HEAT…FURTHER INJURY

2. Acute angle closure glaucoma

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)

3. Portuguese man of war

a.

4. Black widow bite

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 a.

b. Opiates and benzo if really severe

c. Acetylcholine and NE release at nerved terminal = muscle cramping

5. High altitude cerebral edema (HACE)

a. Mild altered mental status --> rapid coma in as little as 12 hours
b. Tx: high flow O2, dexamethasone, immediate descent

6. AC exposure is 3x more dangerous than a DC exposure at the same voltage

7.

8. Hypothermia
a. Osborn J waves
b. Temp less than 31 C

c.

9. Heat Stroke

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 a.

b. The most common initial neuro sx is…ataxia

10. Thermal Burns

a. Fire: obtain CO levels

b. Industrial or house fire: suspect CN toxicity
c. Superficial: similar to sunburn
d. Superficial partial: red, painful, blisters
e. Deep partial: white, leathery, relatively painless
f. Full-thickness: charred, insensate
g. Rule of 9s
h. Parkland formula: 4 mL/kg × % total BSA burned (pediatrics give 3 mL/kg); 50% given in first
8 hours, remainder over 16 hours
i. Target urine output: 0.5-1 mL/kg/h in adults; 1-2 mL/kg/h in children
j. Consider escharotomy for circumferential and full-thickness burns

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

11. Coral snake

a. Immobilization and compression technique

b.

12. Lightning
a. Lichtenberg sign: ferning pattern
b. Tympanic membrane rupture

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b. Tympanic membrane rupture
c. Keraunoparalysis
i. Temporary lower extremity paralysis

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Heme
Saturday, June 9, 2018 9:49 AM

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

2. Acute tumor lysis

a.

b.

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Immune
Saturday, June 9, 2018 9:49 AM

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

5. Always look for nephrotoxic drugs in a transplant kidney patient

6. Categories of transplant rejection

a.

7. Transplant related problems

a. Cyclosporine tox:
i. Hyper K, nephrotoxicity
b. Azathioprine:
i. BM suppression, hepatotoxicity, pancreatitis
c. Signs of rejection
i. Increased Cr
ii. Tenderness
iii. Decreased UoP

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 iii. Decreased UoP

8. FFP contains C1 inhibitors used to treat hereditary angioedema

9. ITP
a. Plt count > 50K = no treat
b. 20k-50k = prednisone taper
c. Lower = IV IG , steroids, anti-D ab

10. Henoch Schonlein purpura

a. Often preceded by a viral illness
b. Sx: GI distress, renal issue, lower extremity edema, palpable purpura
c. Blood on UA
d. Cr may be normal or elevated
e. Thrombocytopenia/coagulopathy do not occur

11. Angioedema

a.

b. Edema: GI and resp tract

c. Tongue, face, neck

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Nervous
Saturday, June 9, 2018 9:49 AM

1. Carpel tunnel tests

a. Durkan: reproduction with compression
b. Phalen
c. Tinel
d. Flick sign: shaking hand provides relief
e. Tx: NSAIDS, volar splint in neutral position

2. Myasthenic crisis
a. Respiratory failure leading to mechanical ventilation

3. Patients with syncope SHOULE NOT EXPERIENCE POST ICTAL

a. Can have urination, tongue biting

4. Central vertigo is more gradual vs peripheral

5. Traumatic Brain Injury

a. Cushing reflex: hypertension + bradycardia + respiratory depression
b. Decorticate posturing: upper extremity flexion, lower extremity extension
c. Decerebrate posturing: upper/lower extremity extension
d. Oculocephalic response: eyes moving in opposite direction of head turning = intact
brainstem function
e. Oculovestibular response: irrigation of saline into the ear; no eye movement = brainstem
injury
f. GCS ≤ 8: intubate
g. Prevent hypotension and hypoxia

6.

7. ESR is generally elevated despite normal WBC in epidural abscess

8. Upper age limit for tPA administration up to 4.5 hrs

a. 80 y/o

9. Putamen Hemorrhage
a. Homonymous hemianopia
b. Contra sensory loss
c. Contra hemiparesis/plegia

10. Dystonic reaction

a. Is due to to much acetylcholine…so treatment is with benztropine and diphenhydramine

11. TIA
a. ASA alone or ASA + dipyridamole
b. Admitted for assessment of stroke risk factor

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b. Admitted for assessment of stroke risk factor

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Ob-Gyn
Saturday, June 9, 2018 9:49 AM

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"

4. Cardiac activity is present at 8 weeks

5. ~25% of pregnant pt have bleed in early pregnancy

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.

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Pediatrics
Saturday, June 9, 2018 9:49 AM

1. Reyes
a. Cerebral edema is a major causes of M&M d/t increased intracranial pressure
b. Supportive care

2. Salter Harris fractures

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.

b. General population epilepsy: 0.5-1%

c. Pts with febrile seizures: 1-2%

6. Croup
a. 6 months - 3 y/o
b. Cool humidified air helps
c. Dexamethasone is mainstay of therapy
i. Decrease duration

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 i. Decrease duration
ii. Decrease length of stay
iii. Decrease return
d. If stridor present….racemic epi

7. Lipid soluble drugs that can be delivered via endotracheal tube

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.

9. Peds dosing for IV fluid in hypotensive pt

a. 20 mL/kg

10. Glucocorticoids are the mainstay tx for moderate to severe croup

11. Westley croup severity score for evaluation

12. Paraphimosis vs phimosis

a.

13. Croup severity

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 a.

14.

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15.

16. Holliday Segar Maintenance fluid

a. 4-2-1
b. 10-10-20

17. Neonatal GI bleed

a. MCC swallowed maternal blood
i. Delivery
ii. Crack in nipples during feeding
b. Apt test
i. Fetal blood more resistant to denaturation

18. Classic Viral Exanthems

a. Measles (First disease)
b. Rubella (third)
c. Erythema infectiosum (5th)
d. Roseola (6th)

19. Some dysentery patients can develop extraintestinal manifestation

a. Reactive arthritis
b. Seizures
c. Hallucination

20. Endotracheal tube diameter size (mm) > 2 yrs: 4 + (age/4)

○ May use 5th digit fingernail diameter/Broselow tape

21. Bilious emesis in peds

a. Malrotation until proven otherwise

22. Clarithromycin and erythromycin are not recommended for infants less than 1months b/c of

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22. Clarithromycin and erythromycin are not recommended for infants less than 1months b/c of
increased risk of hypertrophic pyloric stenosis

23. In asthma, Dexamethasone is just as effective as prednisolone and has no associated emesis

24. Major complication of Rubella

a. Arthropathies and arthritis

25. What medications are associated with NEC?

a. Indomethacin and Vitamin E

26. Cat scratch lymphadenopathy

a.

27. Perioral Electrical Burn

a.

28. Elbow supracondylar fracture

a. 3 types
i. Type 1: anterior fat pad (posterior pad is occult fx)
1) Also look for displaced anterior humeral line
ii. Type II/III
1) Hinge mechanism or complete displacement

b.

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 c.

29. Hair tourniquet

a.

30. Pruritic Ani

a. Pinworms are the most common in peds

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

33. Staccato cough is associated with chlamydia trachomatis pneumonia

34. Neonatal Conjunctivitis

a. Rules of 5's

i.

35. Klein's line

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 a.

36. Which endocrinopathies predispose adolescent to SCFE?

a. Hypothyroidism and growth hormone deficiency

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Procedures
Saturday, June 9, 2018 9:49 AM

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.

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 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

6. Peritonsillar abscess age range is 20-30 years

7. SAH vs Traumatic Tap

a. Xanthochromia

b.

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 8.

9. Mental nerve block

a.

10. Facial and Dental Nerve Blocks

a. Supraorbital: ipsilateral forehead and scalp
b. Infraorbital: area between lower eyelid and upper lip
c. Posterior superior alveolar: ipsilateral maxillary molars
d. Inferior alveolar: ipsilateral mandibular teeth, lower lip, chin
e. Mental: ipsilateral lower lip and chin

11. Mean arterial pressure

a. MAP = 1/3 SBP + 2/3 DBP

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12.

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.

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Psychosocial
Saturday, June 9, 2018 9:49 AM

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.

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ID
Saturday, June 9, 2018 9:49 AM

1. Principles of Abx therapy for bacterial meningitis

a. Agent MUST be bactericidal
b. Agent must penetrate blood brain barrier

2. Nec Fasciitis

a.

b. Type 1: polymicrobial (abd and perineum)

c. Type 2: GAS extremity
d. Pain out of proportion
e. Systemic sign + dusky blue and bullae/vesicles

3. High risk tetanus prone wounds

i. >6 hrs old
ii. Greater than 1 cm in depth
iii. Contaminated with dirt or soil
iv. Denervated, ischemic, or obviously infected
a. Should receive immunoglobulin if high risk

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.

7. Amoxicillin for pregnant patient with Lyme Disease

8. HAV/HEV
a. Fecal oral transmission
b. "the vowels hit your bowel"

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Tox
Saturday, June 9, 2018 9:50 AM

1. Maximum dose of lidocaine w/o epi is 5 mg/kg

2. Disulfiram reaction
a. Alcohol + metronidazole
i. Acetealdehyde accumulation

b.

3. Medication that can cause lactic acidosis

a. Metformin
b. Salicylates
c. Propylene glycol

4. Naloxone will reverse opiate effects for 1-2 hours

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

7. What leads to seizures in mushroom toxicity

a. Inhibition of pyridoxine pathway (LIKE INH toxicity)

8. Amanita phalloides

a.

9. MDMA or ectasy can cause serotonin syndrome

10. Which commonly prescribed over the counter drug is associated with serotonin syndrome?
a. Answer: Dextromethorphan, the cough suppressant, blocks serotonin reuptake.

11. Chelating agent for arsenic toxicity

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11. Chelating agent for arsenic toxicity
a. IM dimercaprol or oral DMSA

12. Phosgene

a.

13. Cyanide is another toxin commonly co-inhaled in fire with carbon monoxide

14. Salicylates

15. Methadone can cause prolonged QTc and torsades

16. Tx of organophosphate with atropine continues until respiratory secretions decrease

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

18. Cocaine treatment is usually with benzodiazepines

19. Hydrofluoric acid

a. Hypocalcemia --> dysrhythmia
b. Hypomagnesemia --> hypocalcemia

20. aLkaline burn --> Liquefactie necrosis

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20. aLkaline burn --> Liquefactie necrosis
a. aCidotic burn --> coagulative necrosis

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Ultrasound
Saturday, June 9, 2018 9:50 AM

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