Cause of chillblain? - Exposure to damp and non-freezing temperature
What are the indications for starting antibiotics for acute rhinosinusitis? - 1. Af... [Show More] ter 10 days of non-improvement
2. Fever and severe symptoms > 39 degrees
3. Purulent discharge or facial pain for 3-4 days at least
Tx with amoxicillin and clavaunic acid
Management of shingles? - Pain control
Steroid has mixed efficacy
Bacterial labyrinthitis puts patient at risk for? - Meningitis
A 6-year-old boy presents to the emergency department with his father for an earache and fever. A week ago, he began complaining of ear pain and he has had no relief with acetaminophen and ibuprofen. This morning, the patient began to describe room-spinning episodes and difficulty hearing out of his right ear. His vital signs include temperature 38.4oC, pulse 126 bpm, blood pressure 110/70 mm Hg, respiratory rate 26 bpm, and oxygen saturation 98% on room air. Physical exam is notable for a bulging, erythematous right tympanic membrane. Neurological testing elicits near complete hearing loss in his right ear and is otherwise normal. Given the most likely diagnosis, what complication is this patient most at risk for? - This is bacterial labrinythitis
A 57-year-old woman with multiple myeloma presents with myalgias, abdominal pain, generalized weakness, and confusion. Laboratory testing demonstrates a calcium of 15.5 mg/dL. Aggressive hydration with normal saline is initiated. Which of the following medications is also indicated? - Fluids first then
Alendronate
NEVER Alendronate before fluids
Also only give bisphonate for calcium breakdown due to cancer
Which of the following is the most common cause of a small bowel obstruction in a 18-month-old previously healthy child? - Intussusception is the most common cause of small bowel obstruction in children less than 2 years of age.
A 78-year-old man is brought to the ED from his nursing home for confusion. His vital signs are within normal limits for his age. He is thin but unshaven and malodorous. He is awake, alert, and oriented only to person and place. His blood glucose is 89 mg/dL. After completely undressing the patient and performing a head-to-toe examination, which of the following is the next most appropriate step in management? - Get more info before doing labs according to Rosh Reivew
A 3-year-old boy presents to the ED with a rash. He has had a fever and sore throat for the past three days. Yesterday, his mother noticed a fine rash with a rough texture. It started on his neck but has now spread to the rest of his body. Vital signs are BP 100/60 mm Hg, HR 100 beats per minute, RR 20 breaths per minute, oxygen saturation of 98% on room air, and T 100.8F. Physical exam reveals a bright red tongue, red spots on the soft palate, and tonsillar exudates. Which of the following is the most likely diagnosis? - Scarlet fever
LGL syndrome? - Lown-Ganong-Levine syndrome is a cardiac preexcitation syndrome similar in category to Wolff-Parkinson-White syndrome. It causes paroxysms of tachycardia. The exact underlying cause is unknown. Diagnostic criteria include a PR interval less than or equal to 0.12 seconds (120 milliseconds), a normal QRS duration of less than 120 milliseconds, and clinical tachycardia.
30 year female presenting with palpitation, clinical tachycardia, PR interval < 120 mseconds consider? - Lown-Ganong-Levine syndrome
If think a patient has IIH, next step? - Confirm with LP and opening pressure > 25 mmHg
Signs of deep sedation? - Cannot be aroused, but respond to painful or purpose stimulation
Ventilatory funciton may be impaired
Cardipulmonary function is normal
What is dissociative sedation? - Trance-like cataleptic state with profound analgesia and amnesia
Retention of airway reflexes
What are the methods of extracorporal warming? - Dialysis
Bypass
ECMO
What are the methods of active internal warming? - Warm, humididfied air
Warm IV fluids
pleural/bladder lavage
Peritoneal dialysis
What are the methods of active external warmning? - Forced air
warm blanket
warm water immersion
What is the method passive external warming - blanks
How do smallpox progress? - The prodrome consists of a few days of fever, myalgias, nausea, vomiting, headache, and back pain. Approximately one week later, the patient develops an oral enanthem, typified by small erythematous spots on the tongue, palate, and pharynx. The characteristic rash follows one to two days later, initially with macules on the forehead, then trunk, and finally distal extremities
If you see spots in the mouth, what should you consider and what should you do? - Consider:
-herpangina
-small pox
-measles
measles = white spots
herpangina = vesicles
Small pox = erythematous spots on the tongue, palate, and pharynx
Consider putting patient in AIRBORNE PRECAUTION for small pox and measles
Treatment of corneal abrasion? - This patient presents with a traumatic corneal abrasion requiring topical antibiotics and follow up.
What does TCA look like on EKG - The term R> 3mm and R/S > 0.7 in aVR
How does the QRS interval predict toxicity in patients with TCA intoxication? - QRS < 100 - no significant toxicity
QRS > 100 - 33% has seizures
QRS > 160 - 50% of patients has ventricular dysrhymia
What is normal pupil size? - 2-4 mm
A 56-year-old man presents to an urgent care facility complaining of nausea and vomiting. He has a history of hypertension. His antihypertensive medication was recently adjusted. A screening ECG reveals flattened P waves and a wide QRS complex. The evaluating physician arranges for EMS transport to an Emergency Department for definitive care. Which of the following treatments available at the urgent care is most appropriate to administer while waiting for transport? - Give albuterol 10 mg in 4mL NS, neb over 20 minutes
Change in blood pressure medications and findings on EKG consistent with flattened P waves and widened QRS? - Consider hyperkalemia
How do breast abscess present? - A breast abscess may occur as a complication of mastitis and presents with a tender, fluctuant mass and possible discharge of pus from the nipple.
how does mastitis present? - Patients present with erythema, warmth, and tenderness localized to one area of the breast.
You can systemic symptoms
How do galactocele present? - galactocele, or milk retention cyst, is caused by an obstructed milk duct. It presents as a nontender, soft, cystic mass.
How do a plugged duct present? - A plugged duct results in a localized, palpable lump in the breast, which may be tender. Systemic symptoms are absent.
Treatment of mastitis? - Continue breast feeding
Compression
Dicloxacillin, amoxicillin, cephalexin
How sensitive is the heterophile spot test? - The diagnosis can be confirmed via heterophile antibody test (monospot test) which has a false negative rate of 25% in the first week
Slapped cheeks is caused by? - Fifth disease,
Erythema infectiosum
Management of PTSD? - Psychotherapy therapy (especially cognitive therapy, exposure therapy, cognitive behavior therapy, and eye movement and desensitization and reprocessing)
BEFORE SSRI
Why is listeria bad for pregnant ladies? - It increase risks of PPROM
How does listeria present? - Presentation includes fever, myalgias, vomiting, and nonbloody diarrhea. Disseminated infection may lead to sepsis or meningitis in the elderly or immunocompromised.
In children less than the age of 2, which type of scalp hematoma predicts intracranial injury? - In children under the age of two, with a GCS score of 14 or higher, the presence of parietal, occipital or temporal scalp hematomas is predictive of intracranial injury. Frontal or forehead hematomas were not predictive of intracranial injury.
What is Hill sachs lesion? - Posteriolateral humoral head compression fracture
What is bankart lesion? - Detachment of the anterior inferior labrum form the underlying glenoid
Which nerve injury is most commonly seen with a shoulder dislocation? - Axillary nerve, test by sensation over the deltoid
Relative contraindication for shoulder reduction in the ED? - Associated fracture of humeral neck
Associated nerve injury/deficit
Suspected major vascular injury
Chronic Dislocation
> 48 hours
Success rate exceedingly low
Refer to orthopedics for surgical evaluation if initial attempts fail
3 techniques for shoulder reduction? - 1. Cunningham technique
2. Stimson
3. Traction/counter traction
How does anterior shoulder dislocation look? -
How does posterior shoulder dislocation look? -
V tach, think about? - Shock,
amiodarone [Show Less]
