Toxicology
Heme/Onc
Medications
Diagnosis
Miscellanous
100
Ingestion of which of these is associated with delayed GI symptoms and hepatic failure?
A) Amanita mushroom
B) Poison hemlock
C) Oleander
D) Water hemlock
A
100
66 year old male presents with severe left-sided flank pain and urinary retention 2 days after starting chemotherapy for non-Hodgkin lymphoma. Workup shows a new acute renal failure along with hyperkalemia. Given the most concerning condition causing this clinical picture, what additional abnormal laboratory finding is most likely?
Hyperuricemia, hypocalcemia, hyperphosphatemia
100
Rising Second year:
How do we calculate dosages for Etomidate and Succinylcholine? What would be the correct dose for a 70kg patient
Etomidate 0.2-0.4 mg/kg , 14-28mg
Succinylcholine 1.5mg/kg , 105 mg
100
In what leads would you see ST changes that would indicate a Septal infarct?
V1 - V2
200
An overdose of what pharmaceutical can cause an opioid like toxidrome?
Clonidine
200
A 55 yo 70kg Patient comes in with Afib RVR that was confirmed by initial triage EKG:
BP is stable but the patient is uncomfortable.
What is your first line agent, and what is the initial dosage
PER 2023 ACA/AHA guides
Diltiazem aka Cardizem , is superior for rate control in acute onset Afib rvr, due to its acute onset.
Initial Bolus: 0.25mg/kg so 17.5mg
15 mins later if unsuccessful you can readminister with a bolus dosed at 0.35mg/kg
200
6 year old boy presents with fever of 3 days duration. Complained of back and abdominal pain for the past 2 weeks. Examination reveals adenopathy on the posterior cervical chain with normal appearing pharynx and scattered petechia on the boy’s trunk. Spleen tip is palpable and liver edge is palpated 2 cm below the costal margin. Most likely diagnosis?
A) Leukemia
B) ITP
C) Anemia
D) Infectious mononucelosis
A, Leukemia
200
What are the diagnostic criteria for HHS? (n=3)
Hyperglycemia = extremes usually greater than 600
Hyperosmolar state > 320mOSM/kg. (normal 275-295mOSm/kg)
PH = >7.30
Bonus = Residual insulin production inhibits ketone formation
300
When considering physostigmine for the treatment of anticholinergic toxidrome, what is an absolute contraindication?
QRS widening
300
You have a patient brought in by family for AMS. What is the Agorithem for Status epilepticus
Benzo: 10mg IM Midazolem, 4 mg IV Lorazepam
redose Benzo
Keppra 60mg/kg max 4500mg
Propafol: 2mg/kg then titrate to effect
300
In what leads would you expect to see reciprocal changes in a Posterior MI?
ST depressions would be present in the Anterior Leads V3-V4
PAILS
Posterior MI ; Anterior changes
Anterior MI ; Inferior changes
Inferior MI ; Lateral changes
Septal MI ; Posterior changes
400
You have successfully intubated a COPDer. RT asks what ventilator settings you would like the patient to be started on?
Low Tidal volumes ; 6-8ml per Kg typically 400ml
RR= 10-12 , Low Respiratory Rate to prolong expiratory phase
PEEP start at 5 cmH20 usually does not need to be higher than 10
Later:
Titrate FIO2 to maintain SpO2 88-92%
500
How do you make a dirty Epi drip
Inject the full 1 mg into a 1,000 mL normal saline bag (final concentration 1 mcg/mL).
wide open this will give you an equivalent drip of 20mcg per min
https://www.aliem.com/dirtyepi/
500
At what Beta HCG level should a Intrauterine Pregnancy be able to be visualized on US? (n=2)
Transvaginal: 1,500-2000
Transabdominal: 5,500-6,000