Ow my foot
Gin and Chronic
"Don't you know you're toxic"
Night Night
Mixed Bag
100
These set of rules help determine whether radiography should be obtained in a foot or ankle injury in pts >6 yo
Ottawa Foot and Ankle Rules
100
What is the blood glucose goal while hospitalized? (Give a range)
140-180mg/dL
100
Antidote for benzodiazepine toxicity
Flumazenil IV
100
first line nonpharmacologic tx for insomnia is
CBT-I
cognitive behavioral therapy for insomnia
5-elements
-cognitive restructuring
-stimulus control
-sleep hygiene
-relaxation therapy
-sleep restriction
100
Most patients with levonorgestrel IUDs will experience a reduction in bleeding within ______ months
Most patients with levonorgestrel IUDs will experience a reduction in bleeding within:
TWELVE (12) months
200
If you suspect a great toe fracture, what specific type of imaging would you order? (Name the method and views)
AP, Lateral, & oblique toe radiography
200
Name at least 4 conditions that results in transient BP elevation
pain
anxiety
fluid overload
transient kidney dysfunction
agitation
nausea
poor sleep hygiene
urinary retention
withdrawal(nicotine/alcohol)
200
Name at least 2 classes of medication with increased risk of QTc prolongation
Antidepressant (SSRIs, TCAs)
antihistamines (diphenhydramine, loratadine)
antimicrobials (fluoroquinolone, macrolide, fluconazole)
antipsychotics (haloperidol, droperidol, chlorpromazine)
cardiac (amiodarone, procainamide, sotalol)
Other (methadone)
200
True or False:
Long term use of medications for insomnia (i.e. more than 6 months) is discouraged.
FALSE
-more than 3 months
(SOR A)
200
True or False:
A urine culture with susceptibility testing should always be performed in men with suspicion for UTI.
True:
A urine culture with susceptibility testing should always be performed in men to confirm the diagnosis and adjust the choice of antibiotic once results become available
300
Name the 3 possible indications for referral to ortho in a toe fracture
1. neurovascular compromise
2. contaminated wounds
3. open fractures
300
True or False: Acute management of severe asymptomatic HTN in hospitalized patients should be avoided
True
It increases risk of adverse composite outcomes, AKI, MI. (SOR B)
300
Treatment of choice in salicylate overdose?
What additional tx is given if pt exhibits AMS?
Alkalization with sodium bicarbonate
If AMS: Dextrose (D5 in water) - salicylate can cause neuroglycopenia despite possible normal serum BG
300
Which 2 types of insomnia are Dual Orexin Receptor antagonists FDA approved for?
Examples include: daridorexant (Quviviq), lemborexant (Dayvigo), and suvorexant (Belsomra)
sleep maintenance insomnia or difficulty with sleep onset
Orexins: neuropeptides that bind to orexinergic neurons, promoting arousal in areas of the brain.
Dual orexin receptor antagonists: reversibly bind to orexin receptors, inhibits activation of the arousal system.
300
Give at least 4 of 9 causes of abnormal uterine bleeding
400
Which two zones of proximal 5th metatarsal fracture requires consideration of surgical management (provide the name of the 2 zones)
400
What is the management of blood glucose in a TIIDM not on insulin but poorly controlled on admission (A1c >10 or BG >180) AND is eating
Start weight based basal, prandial and correction insulin dosing
(Initial Insulin basal dosing 0.2-0.5units/kg daily)
400
What are the symptoms of anticholinergic (scopolamine, oxybutynin, etc) toxicity?
Include: mental status, Vitals, pupils, derm findings
Mental status: agitation, hallucination
Vitals: hypertensive, tachycardic, febrile
Eyes: Mydriasis
Derm: hot and dry
400
What are the Z-drugs (name all 3)
Name at least 2 side effects and/or safety concerns associated with Z-drugs
zaleplon, zolpidem, and eszopiclone (Lunesta)
motor vehicle crashes, falls, and fractures.
Complex sleep-related behaviors such as sleepwalking and sleep eating (more likely w/ a hx of sleepwalking.)
400
What medication can be prescribed as first line tx to reduce abnormal uterine bleeding related to levonorgestrel IUD and what is the recommended dosing and duration?
Naproxen
500mg BID x5 Days
500
Name at least 2 of the 3 Ottawa Foot and Ankle Rules
Ankle radiograph: bone tenderness at posterior edge or tip of malleolus (laterl or medial)
Foot radiograph: bone tenderness at base of 5th metatarsal or navicular bone
ankle and foot radiograph if: unable to bear weight on affected leg/foot for at least 4 steps after injury
500
What symptoms are exhibited in Stage 4 of Alcohol Withdrawal Syndrome?
&
How many hours since last drink does stage 4 typically appear? (time range)
1. Delirium Tremens - agitation, diaphoresis, disorientation, hallucination, hyperactivity, HTN, hyperthermia, tachycardia, tachypnea
2. typically: 72-96hrs since last drink; sxs may last up to 7 days
TX: IV benzo and phenobarbital
500
Name at least 5 medications and/or substances associated with elevated anion gap
Acetaminophen
acetylsalicylic acid or other salicylates
colchicine
generalized seizure producing toxins
ibuprofen
iron
isoniazide
medications with propylene glycol
metformin
methanol
paraldehyde
500
Name at least 1 medication indicated for pt experiencing sleep onset insomnia
Doxepin
Ramelteon (Rozerem)
Lemborexant (Dayvigo)
Suvorexant (Belsomra)
Eszopiclone (Lunesta)
500
Nitrofurantoin should not be prescribed in which trimester(s) of pregnancy for UTI
AND
TMP/SMX (Bactrim) should be avoided in which trimester(s) of pregnancy
Nitrofurantoin: Avoid in 1st and 3rd trimester
TMP/SMX: Avoid in 1st trimester