Cardiology
What medication is contra-indicated in cocaine induced chest pain? How would you treat it?
Beta blockers are contra-indicated.
Treat with benzodiazepines
What is the diagnosis: fat protruding through an eyelid laceration
Globe injury
Eyelids do not contain fat, so you need to look for globe injury underneath
A 73 year old man presents with chest tightness after eating a sandwich. He is unable to tolerate any liquids by mouth. An EKG is normal. What is the most effective management for this condition?
EGD
You can use Glucagon but this is not the MOST effective
What EtCO2 indicates adequate chest compressions?
10-20 mmHg
Maintaining a level >15 is associated with better outcomes
What is the most common cause of bacterial diarrhea in the US?
Salmonella
Second most common is Campylobacter
What drug can cause bidirectional ventricular tachycardia or slow atrial fibrillation? How do you treat toxicity?
Digoxin
Digoxin antibody
What is the most appropriate transfusion strategy for patients with severe hemorrhage on board questions?
1:1:1; pRBC:FFP:platelets
A 35 yo man presents with agitation, confusion, dilated pupils, and dry, flushed skin. BP 160/90, T 40 C, P 140. Administration of which medication would be detrimental to the patient?
Midazolam, Physostigmine, Ketamine, Diphenhydramine
Diphenhydramine
Anticholinergic toxicity; Benadryl is an antihistamine that has anticholinergic properties
Contraindication to the use of Ketamine
Schizophrenia (may increase psychosis)
Leading infectious cause of infertility?
Chlamydia trachomatis
What is the diagnosis for pleuritic chest pain 4 weeks after an MI?
How do you treat it?
Dressler's syndrome: autoimmune pericarditis, typically occurs 2-6 weeks post MI
Treatment: NSAIDS
A patient comes in after MVC. He has motor paralysis below the level of T6 on both sides when tested. He cannot feel any painful stimuli. He can feel a vibratory sensation however. What spinal cord disorder is described?
Anterior cord syndrome
2/2 to hyper flexion; bilateral motor paralysis, loss of pain and temperature, intact vibration and proprioception
What medication for maternal hemorrhage is contraindicated in patients with asthma?
TXA
Methylergonovine
Carboprost
Oxytoxin
Carboprost: synthetic prostaglandin analogue; known to cause broncho-constriction and should be avoided in asthma
What complication of Fentanyl cannot be reversed with Narcan?
Chest wall rigidity or "wooden chest syndrome"
Diagnosis and treatment: "Gunmetal gray" pustules to hands and skin, septic arthritis +/- tenosynovitis
Disseminated gonococcus
Arthritis-dermatitis syndrome
Tx IV ceftriaxone
In cardiac arrest, which drugs can be given to adult and pediatric patients via ET tube?
Adults: NAVEL- Narcan, Atropine, Vasopressin, Epinephrine, Lidocaine
Peds: LANE- all above except vasopressin
Review types of blast injury:
Primary
Secondary
Tertiary
Quaternary
Primary: blast shock wave (hollow viscus injury, TM rupture)
Secondary: projectiles from explosion
Tertiary: individual thrown by explosion
Quaternary: Environmental contamination (burn, inhalation)
A 22 yo man presents with non-bloody, watery diarrhea of 3 days duration associated with cramping abdominal pain and nausea. He recently returned from a 2 week trip in Mexico. What is the most appropriate management?
Azithromycin, Metronidazole, Ciprofloxacin, or TMP/SMX
Azithromycin; either a single 1000 mg dose or 3 days course of 500 mg daily
List 4 indications for obtaining a CT prior to doing an LP
Altered mental status, immunocompromised state, focal neuro deficit, increased ICP, history of CNS lesion, new onset seizure in previous week, suspected SAH
A 4 year old boy presents with a limp and a fever. His right hip is warm to touch and erythematous. He has elevated WBC, CRP, and ESR. X ray shows periosteal thickening. What is the bacterial cause?
Staph aureus
Staph is the most common cause of osteomyelitis in children
What is the difference between orthodromic and antidromic AVRT? Describe what they look like on EKG.
Orthodromic: travels anterograde down AV node and back up accessory pathway resulting in regular, narrow QRS complex (looks like SVT)
Antidromic: travels anterograde down accessory pathway and back up AV node resulting in regular, wide QRS (looks like VT)
A patient comes in as L1 trauma. He opens his eyes when the nurse pokes him with an IV. He makes incomprehensible sounds when asked questions. His extremities are in a decorticate position. What is his GCS?
Eyes: 2 (opens eyes to pain)
Verbal: 2 (sounds)
Motor: 3 (Decorticate/flexed)
GCS: 7
55 yo man collapses and is pulseless. Receives two shocks and 20 min of CPR. ROSC is achieved. Which of the following should be maintained in post-resus period?
Core temp 38 C
MAP 50 mmHg
Glucose 80-100 mg/dL
Target pCO2 of 40 mmHg
pCO2 of 40
Target pCO2 of 35-45 mmHg
MAP >65
Temp 32-37.5 C for TTM
Glucose should be 140-180
Signs, symptoms, diagnosis and treatment of re-expansion pulmonary edema after chest tube placement
Sx: worsening dyspnea, hypoxia
Dx: CXR with pulmonary edema
Tx: Supportive. Turn off suction and keep chest tube to water seal only. Treat like you would any non-cardiogenic pulmonary edema
Man presents with worsened rash and toxicity shortly after he began treatment for syphilis. What is the diagnosis and treatment?
Jarisch-Herxheimer reaction
Due to endotoxin release from dying spirochetes
Treatment is supportive