Treebeard
Baby Blues
Inside Out
Guts & Glory
Moonshine
Pushing Past the Limit
100
Name two physical exam tests to help distinguish between conductive and sensorineural hearing loss.
Weber’s test
Rinne’s test
100
What is the neonatal compression to ventilation ratio?
3 compressions to 1 ventilation
100
List 4 general medical conditions that can cause mood disorders
Parkinson’s, thyroid disease, malignancy, T2DM, MI, ESRD, stroke, substance use disorder... (many)
100
1) What is the most common cause of SBO in children aged 6-36 months?
2)Treatment?
Intussusception. Enema reduction. If limited to small bowel more likely to require surgery.
100
A patient presents intoxicated and toxic alcohols are on the DDx. Calculate an anion gap and osm gap.
Measured Osmolarity = 355
Calcualted Osmolarity = (2 x 140) + 4.8 + 5.2 + (24 x 1.25) = 320
Osmolar GAP = 355-320 = 35
Anion Gap = 140-100-15 = 25
100
Main mechanism of ketamine (i.e. receptor)
N-methyl-D-aspartate (NMDA) receptor antagonist
200
Vascular area where most epistaxis occurs
Kiesselbach's Plexus
200
What FiO2 percentage is indicated for most neonatal resuscitations?
21% FiO2
200
A patient presents to your ED fitting criteria for major depression, which has a temporal relationship to winters. She is completely symptom free in between intervals. What is one therapy you would suggest for this patient?
Light therapy – most effective + safe.
200
What are the indications to place an NG tube in a patient with a small bowel obstruction?
ALOC with risk of aspiration, refractory N/V to antiemetics, requiring surgery
(?Because GenSx says so)
200
Name 4 causes of a double gap (AG+OsmGap)
Methanol
Ethylene glycol
Diabetic ketoacidosis
Alcoholic ketoacidosis
Uremia
Septic shock
Multiorgan failure
200
You are discharging a patient who has struggled with anxiety and pain chronically. She asks if there is any benefit to using cannabis for these purposes. What do you tell her?
Very low evidence for both THC and CBD to help with anxiety, pain, or insomnia. THC generally discouraged as higher risk. CBD generally low-risk, non-toxic, but hard to regulate with regard to dose/concentration – if other options exhausted, may warrant further discussion with PCP to determine if safe and worth trying. Overall takeaway – watch the literature on CBD, it may end up being a viable, low-evidence alternative which patients have an interest in using.
300
List 3 intratemporal and 3 intracranial complications of acute otitis media:
Intracranial complications
- Meningitis
- Epidural abscess
- Brain abscess
- Lateral sinus thrombosis
- Subdural empyema
- Otitic hydrocephalus
Intratemporal complications
- Hearing loss
- TM perforation
- Chronic suppurative otitis media
- Cholesteatoma
- Mastoiditis
- Labrynthitis
- Ossicular erosions
- Retraction pocket formation
- Petrositis
- Facial Nerve paralysis
- Tympanosclerosis
- Cholesterol granuloma
- Infectious eczematoid dermatitis
300
Numerically define neonatal hypoglycemia
< 2.2 mmol/L or 40 mg/dL
300
A patient presents to ED with 6 months of low mood. They endorse that they have been sleeping more than usual, and have been suffering from brain fog. They deny any other symptoms. Please explain if they meet the criteria for major depressive episode or not, with a clear justification for your answer.
No – only fitting 3/9 criteria, more in keeping with dysthymia. (Need 5/9)
Depressed mood, loss of interest/pleasure, weight change, sleep, psychomotor agitation/retardation, fatigue, worthless/guilt, concentration, thoughts of death/SI.
300
What are the 4 types of acute mesenteric ischemia?
1) Mesenteric arterial embolus (most common)
2) Mesenteric arterial thrombosis (think MI of gut)
3) Non occlusive mesenteric ischemia (vasospasm; low flow state)
4) Mesenteric venous thrombosis (hypercoagulable state)
300
A patient presents with suspected toxic alcohol poisoning and is being treated with fomepizole. Name 2 co-factors that can be given as adjunct treatments for ethylene glycol and 1 for methanol.
Ethylene glycol- Thiamine, Pyridoxine
Methanol- Folate
300
A patient is brought to your ED by her friends. She is very agitated, violent, hyperthermic, and has horizontal and vertical nystagmus. No clonus. They are unsure of what she may have taken as it was unwitnessed. What ingestion do you suspect and what should be your next steps?
PCP intoxication (horizontal + vertical nystagmus) Investigations focused on rhabdo w/u +/- imaging of head based on history and exam, ensure safety of personal, control agitation chemically (haldol/benzos/ketamine), cool/consider intubation
400
65M, Hx of poorly controlled DM; re-presents with worsening right sided ear pain, purulence, and new unilateral facial paralysis despite topical abx drops. 1) Diagnosis 2) Most common pathogen 3) Treatment?
Necrotizing (Malignant) Otitis Externa
Pseudomonas
IV Ciprofloxacin 400 mg IV q12h
+/- antipseudomonal β-lactam (Ex.Pip-Taz 4.5gIV)
400
What is the dose of narcan in a typical neonate experiencing opioid toxicity?
Narcan is not indicated as it precipitates seizures, support airway and ventilation instead
400
You see a patient who has cyclothymia on their SCM past medical history. What is this disorder characterized by?
Chronic mood swings not meeting hypomania or depression. Needs to be present persistently – rule of 2s (2 years, HALF the time, and cannot be symptom free for more than 2 months).
400
What is your vasopressor of choice in acute mesenteric ischemia?
Dobutamine, low dose dopamine or milrinone.
Alpha constriction limits mesenteric blood flow exacerbating the underlying condition.
400
A patient presents with ethylene glycol ingestion. Their VBG demonstrates a lactate of 20. Explain this elevation.
Glycolic acid is structurally similar to lactate
Causes false elevations in point of care tests such as VBG analyzer
Formal serum lactate is much lower (lactate gap)
400
A patient ingested a mushroom and shows you a picture. Name this ingestion.
Amanita muscaria: Isoxazole-containing mushrooms
Glutamate and GABA analogues: Excitatory phase followed by deep sleep
500
Describe the CPS criteria for 'watchful waiting' in children with AOM
Healthy children >6 months; Mildly ill, Alert/responsive, no rigors, mild otalgia, responding to antipyretics, TMax <39°C, <48h illness, no perf
500
What is the dose of prostaglandin E1 for ductal dependent cardiac lesions in a neonate?
0.1 ug/kg/min
500
What treatment is contraindicated in adjustment disorders and PTSD
Benzodiazepines – increases risk of AD turning into PTSD – definitely don’t initiate for outpatient in emerg
500
What are 3 risk factors for non-occlusive mesenteric ischemia?
Hypoperfusion: sepsis, severe dehydration, pancreatitis, or hemorrhagic shock
Excessive sympathetic: CHF, vasopressors, cocaine, digoxin
500
List 5 indications for dialysis in toxic alcohol poisoning
Rosens:
- acidosis (pH < 7.3)
- renal failure
- vision abnormalities with methanol exposure
- electrolyte imbalances unresponsive to conventional therapy (ie, hyperkalemia)
- hemodynamic instability
- methanol or EG concentration more than 50 md/dL.
EXTRIP: EG concentration is >50mmol/L, osm gap is >50, anion gap is >27mmol/L, glycolate concentration is >12 mmol/L, Coma, seizures, CKD, AKI stage 2 or 3
500
You are discharging a patient presenting to emerg for anxiety. Before leaving, he wants to ask you about “spice” and if it’s safe to use. What is spice, and what would you tell this patient? HINT: it’s not the stuff from Dune
Numerous synthetic test drugs exist. Spice or K2 is man-made, synthetic cannabinoid that is structurally similar to THC, often associated with ++ stronger effects, and significant side effects. Compared to natural cannibinoids which have no known episodes of death, spice has been associated with deaths.
Tell them that no amount of spice is safe as above – but if the patient is going to use, advise on principles of harm-reduction – namely, should start slow and low, use with a group of friends, test their substances, and call 911 if concerned