This paralytic should be used when a patient has a neuromuscular disease such as ALS or MS.
What are Rocuronium or Vecuronium.
Succinylcholine is contraindicated in neuromuscular disease states. It should also be avoided in rhabdomyolysis, stroke or spinal injuries.
100
These are 5 antibiotics that cover MRSA
What are Vancomycin, Daptomycin, Linezolid, Trim/Sulfa, Clindamycin, Rifampin, Doxycycline
100
My PCWP is down, CO is up and SVR is up. What type of shock am I.
What is hypovolemic shock.
100
This presser has pure alpha-mediated activity leading to vasoconstriction in all vascular beds with no direct effect on cardiac contractility or rate.
What is Phenylephrine
100
I'm a type 1 diabetic with some poor numbers:
pH: 7.30/PCO2 25/PO2 95
Anion Gap: 24, Delta/Delta=2.
What are anion gap metabolic acidosis and metabolic alkalosis.
This patient has the AG acidosis from ketogenesis from DKA, but also has an alkalosis from recent vomiting.
Once Delta/Delta is calculated you may go by the following rules.
If 2 or greater: there is also a metabolic alkalosis
If 1-2: You just have your primary AG acidosis
If less than 1: you also have a non-AG metabolic acidosis
200
An intubated patient's pH drops from 7.4 to 7.3 overnight. What initial vent changes can help fix this.
What are increase respiratory rate or increase TV.
Both will help blow off excess CO2.
200
I can kill MRSA but may cause thrombocytopenia
What is Linezolid
200
My PCWP is up, CO is down, SVR is Up, JVP is up and JVD to my ears! What is the type of shock and what is causing it.
What is cardiogenic shock due to cardiac tamponade.
200
Explain the difference in PCWP in ARDS and cardiogenic pulmonary edema.
If PCWP is low <18 ARDS is more likely. If PCWP is >18 cardiogenic pulmonary edema is more likely.
200
A pure B1 and B2 presser which leads to tachycardia, increased inotropy, vasodilation and bronchodilation.
What is Isoproterenol
300
Ideal vent adjustments for ARDS.
What are lower tidel volume and increase PEEP.
Recall that with ARDS we have lung tissue injury and the inablity to keep the alveoli open. In order to prevent further injury and help oxygenation lower TV and pump up the PEEP!
TV = 6cc/kg
300
I might be able to kill MRSA but don't use me if it's a pneumonia.
What is Daptomycin. Remember it is inactivated by surfactant in the lungs.
300
This is optimal PCWP.
What is 15-20
300
Three criteria for diagnosing an exudate.
Exudative effusions have at least one of the following:
Pleural Protein/Serum protein > 0.5
Pleural LDH/Serum LDH > 0.6
LDH> two-thirds upper limit of normal serum LDH
300
The CD4 counts when PCP and MAC are a concern in HIV patients.
What are 200 for PCP and 50 for MAC.
PC is treated with TMP-SMX
MAC is treated with azithromycin
400
These are 3/4 induction agents for rapid sequence intubation.
What are etomidate, ketamine, versed and propofol
400
When using Vancomycin this is when you should check trough levels and the appropriate level for a complicated infection.
What is before the 4th dose and 15-20 for complicated infections such as MRSA bacteremia, memingitis, HAP, and osteomyleitis. Otherwise it is 10-15.
400
These are the 5 medications or at least classes of meds that should be administered for anaphylactic shock.
Epinephrine 1:1000 0.3-0.5 mL IM or 0.1 mL 1:10,000 IV
Benadryl 50 mg IV
Ranitidine 50 mg IV
Albuterol Neb 5 mg PRN
Prednisone 60 mg PO or methylprednisolone 125-250 mg IV
400
Empiric treatment of meningitis in a 55 y/o.
What is Ceftriaxone or Cefotaxime + Vancomycin + Ampicillin
Remember in patients over 50 you must cover for Strep, Niesseria and Listeria.
400
Adrenal Insufficency due to meningococcemia infection.
What is Waterhouse–Friderichsen syndrome
The bacterial infection leads to massive hemorrhage into one or usually both adrenal glands.
Can also be caused by Strep, Pseudomonas and TB
500
This potential deadly side effect should make you think twice before using succinylcholine as a paralytic.
What is hyperkalemia
500
I'm preferably used when there is concern for fungal meningitis.
What is fluconazole. 800 mg PO/IV load then 400 mg Qday. Has excellent CSF penetration.
500
What degree of obstruction must a PE cause to lead to shock?
What is 50% of pulmonary circulation.
500
73 y/o with airway hemorrhage 3 weeks after the placement of a tracheostomy. What is likely dx?
What is tracheo-innominate fistula.
Symptoms may be mild and may present months after the procedure. Mortality rate is >75%.
The trach tube should not be manipulated until a thoracic surgeon evaluates the patient in the OR.
500
A 25 y/o woman with confusion in the ED, with no history.
Na = 138
Cl = 98
HCO3 = 12
ABG = pH 7.45/ PCO2 18/ PO2 95
What is her acid base problem and diagnosis?
What are an anion gap metabolic acidosis and respiratory alkalosis due to salicylates.
Recall salicylates overdose will lead to a anion gap metabolic acidosis and oddly enough stimultes the respiratory center of the brain leading to hyperventilation that will overshot the correction of the pH.