question

Sgarbossa Criteria for AMI with old LBBB

answer

1. ST-segment elevation measuring ≥ 1mm concordant with the QRS in any lead. 2. ST-segment depression measuring ≥ 1mm in any of the V1-V3 leads. 3. Discordant ST-segment elevation measuring ≥ 5mm

question

Electrolyte-Induced QT Prolongation

answer

Hypokalemia Hypocalcemia Hypomagnesemia Hyperphosphatemia

question

Calculate Anion Gap

answer

Na - (Cl + HCO3) ≦ 12 MUDPILES: Methanol/Metformin, Uremia, DKA, Paraldehyde, Iron/INH, Lactic acidosis, Ethylene glycol, Salicylates. In all cases, you're adding acid. No-gap acidosis - you are losing bicarb, e.g. diarrhea.

question

Calculate Osmolar Gap (Measured vs. calculated)

answer

2Na + BUN/2.8 + Glu/18 + EtOH/4.6 = 285-295 Measured should not exceed calculated by >10. Increased by: acetone, all alcohols, ketoacidosis (any)

question

Calculate Parkland Burn Fluids

answer

4ml x kg x %BSA = per day LR Give 1/2 over 1st 8 hrs

question

Calculate Pediatric ET Tube Size (mm)

answer

Age+16/4 Depth = 3x size

question

Calculate A-a Gradient Measured vs. Calculated PaO2

answer

Increased by VQ mismatch (PE, COPD, pneumonia) or shunt 140 - (PaO2 + PaCO2) Normal = 10-15 or (age+10)/4

question

Anticholinergic poisoning

answer

Antidepressants, phenothiazines, antihistamines, antiparkinsonians, Jimsonweed HOT/DRY/RED/BLIND (huge pupils)/MAD Can't see, can't pee. Tx: Benzos. VTach: lido/amio; Torsades: Mg++ 2gm slam Physostigmine (but don't give unless life-threatening); never in TCA OD or heart block. TCA with wide complex tachy: Bicarb

question

Sympathomimetic poisoning

answer

Amphetamines, cocaine, PCP Very similar but sweating!!! More hypertensive and tachycardic. Nasty (vs. pleasant).

question

Cholinergic poisoning

answer

Insecticides, mushrooms, chemical warfare SLUDGE syndrome (ie, salivation, lacrimation, urinary incontinence, diarrhea, gastrointestinal [GI] upset and hypermotility, emesis); Killer Bs (bradycardia, bronchospasm, bronchorrhea) Miosis (pinpoint) Treatment: Inhibit cholinesterases (massive atropine); Increase acetylcholine (2-PAM = pralidoxime)

question

Salicylate poisoning

answer

Presentation: anxiety with tachypnea, difficulty concentrating, and hallucinations; agitated delirium. Physio: Anion gap metabolic acidosis + resp alkalosis, hypoglycemia Fluids, alkalinize urine, gluc, K+, Hemo if severe Oil of wintergreen = salicylates

question

Miosis

answer

COPS = Cholinergics/clonidine, Opiods/organophosphates, Phenothiazines/pontine bleed, Sedatives/hypnotics

question

Mydriasis (in poisoning)

answer

AAAS Antihistamines, Antidepressants, Anticholinergics(Atropine), Sympathomimetics

question

Kawasaki Disease

answer

Age 2-5, Males, Asian. Mucocutaneous Lymph node syndrome. A vasculitis. Criteria: Fever >5d + Conj injection, Strawberry tongue/cracked lips, Swelling or desquamation of fingers & toes, erythematous rash (starts palms & soles), Enlarged cervical nodes. >WBC, platelets & ESR Complications: coronary artery aneurysms. Tx: ASA, IVIG (therefore admit!)

question

Thyroid Storm

answer

Freq. precipitated by pneumonia. Requires the presence of fever. Ordered approach: 1. General - fluids, steroids (decreases conversion of T4 to T3), no ASA 2. Block hormone effects: Propranolol. 3. Block synthesis: PTU 4. Block release: Iodone, 1 hour after PTU. SPPI

question

Pediatric Burns: Rule of "10s"

answer

Head & Neck = 20% Trunk = 20 + 20 Extremities = 10 each (arms & legs equal)

question

Bacterial Meningitis

answer

S. pneumo most common >1 mo. Neisseria next. Don't delay treatment for CT or difficult LP! Steroids first, then ABx! All > 1mo: 3rd generation cephalosporin + Vanco 500 WBCs, OP >200 Prot >150 Aseptic: <100 WBCs predominantly monocytes Note: Also add ampcillin for older alcoholics, debilitated, or any possible Listeria cases.

question

Guillian-Barre vs. Botulism

answer

GB is progressive ascending weakness; loss of DTRs. Caused by autoimmune demyelination Associated with Campylobacter and Mycoplasma. Tx: Supportive + plasmapheresis. Botulism (very rapid onset) typically presents with cranial nerve weakness (EOM palsy). Can be very severe. Peds: Floppy baby, feeble cry, canning (honey, etc.) Tx: supportive. Cause C. botulinum toxin. Abx not helpful.

question

LGV vs. Chancroid

answer

Chylamydia, incubation 1-3 weeks, painless vesicles or papules (noted by only 10%), painful unilateral buboes weeks-months later, "groove sign", Tx: doxy or erythro 3 weeks. vs. Chancroid: Painful, Hemophilus ducreyi

question

Bacterial Vaginosis vs. Trich

answer

BV: Fishy odor, Clue cells, not an STD, Tx Flagyl oral or topical Trich: Strawbery cervix, is an STD, Tx Flagyl, but not topical, treat partner

question

HELLP Syndrome

answer

Hemolysis, Elevated Liver enzymes, Low Platelets A variant of preeclampsia Multigravida, RUQ pain Tx: Same as eclampsia: Bedrest, delivery, Mg++. No diuretics or ACE inhibitors because of fetal side effects

question

Salter Fractures

answer

Slip, Above, Lower, Through, Ram I-V, worsening prognosis for affecting growth

question

Ottawa Ankle Rules

answer

X-ray if: Inability to bear weight, Bony tenderness to either malleolus, Point tenderness over 5th MT or navicular

question

Maisonneuve Fx

answer

Combination of medial ankle ligament tear + proximal fibula Fx. Mortise disrupted, may be missed on ankle x-ray alone, may require surgery.

question

Dancer's Fx vs. Jones Fx of 5th MT

answer

Dancer's is base of MT only - cast shoe. Jones is transverse Fx through proximal diaphysis - increased incidence of nonunion, needs case or ORIF

question

Leg spinal motor nerves

answer

L4, knee extension L5, foot dorsiflexion S1, foot plantar flexion

question

NEXUS C-Spine Rules

answer

No x-ray if: No posteior midline neck tenderness, no intoxication, no distracting injury, normal level of alertness, no focal neurologic deficits

question

Pediatric Hip Syndromes

answer

Toxic synovitis (gen benign): Generally preschool up to 6. Afebrile and non-toxic appearing. CBC & ESR WNL Aseptic necrosis of femoral head (Legg Calve-Perthes): Males, 5-9 (median age 7; elementary school) SCFE: 11-15 (the fat bully); middle school Septic Arthritis: Any age: >WBC, > CRP

question

Petechiae/Purpura

answer

Deposits of blood under the skin. Non-blanching. 3mm = purpura. Non-palpable = platelet disorder. Palpable = vasculitis.

question

HSP

answer

A vasculitis. Winter, white, males; 2-11 Palpable purpura, abdominal pain, migratory large joint arthritis. Hematura, proteinuria. Normal platelets. No hemolysis. No diarrhea. Usually resolves 4-6w, steroids if symptomatic. Internal lesions cause complications (like intussusception).

question

Hemolytic Uremic Syndrome

answer

Acute renal failure assoc with hemolytic anemia and thrombocytopenia. Presents as acute bloody diarrhea, uremia, hematuria, proteinuria. Caused by E.Coli 0157:H toxin. TTP is similar but in adults (with fever, AMS; high mortality)

question

PALS

answer

Start CPR if hypoperfusion and HR <60. Cardioversion = 0.5J/Kg Uncuffed tube up to age 8 (some disagreement on this) No surgical crich <10 (TT jet instead). Sinus tach up to 220 intants, 180 children

question

CPR

answer

C-A-B (no longer ABC) Compression rate ≥ 100 all age groups Depth ≥ 2 inches adults Allow complete recoil Minimize interruptions. Rotate compessors q2 min. If 2 HCPs, 15:2 (otherwise 30:2) If advanced airway only, 8-10 breath/min & asynchronous.

question

ACLS

answer

AED: Resume compressions immediately after each shock. Dopamine infusion: 2-10 mcg/kg/min. Epi infusion 2-10 mcg/min. ETCO2 during CPR should be >10, and >40 with ROSC

question

Adult Tachycardia (>150) with pulse

answer

If hypotension, AMS, shock, chest pain, acute CHF: Cardiovert. None of the above: Narrow complex: Adenosine Wide complex: Adenosine if regular & monomorphic, otherwise treat as VTach with Procainamde, Amio or Sotalol infusion. On boards, regular WCT is always VT. Irregular is always WPW.

question

Cyanosis

answer

Only seen if >5g/dl desat Hgb. Cannot have simultaneous anemia and cyanosis

question

Serotonin Syndrome

answer

SSRI usually with another drug CNS, Hyperthermia, tachy, hypertension, myclonus and rigidity (lower > upper), hyperkinesia Tx: Cooling, Periactin (cyproheptadine) Similar to sympathomimetcis with hyperthermia & rigidity being the hallmarks.

question

Central retinal artery occlusion

answer

Box car vessels. Cherry red spot. Sudden painless vision loss. Dilates the pupil.

question

Pediatric exanthems (6)

answer

Measles (Rubeola): Begins @ head & goes down Cough, Coryza & Conjunctivitis; Koplik spots are prodromal. Varicella. Rubella ("3-day measles") Scarlet Fever: (one of the "6") Strep, Strawberry tongue, sandpaper truncal rash. Only non-viral. Tx. Penicillin Erythema Infectiosum (5th Disease) slapped cheeks- eyelids & chin spared. Parvovirus. By the time the rash appears, pt. is no longer infectious. No Tx. Roseola Infantum (6th disease): Fever, then truncal rash when fever is gone

question

RV Infarction

answer

Hypotension, JVD and clear lungs. Use Ntg with caution. Augment preload with fluids

question

Dressler's syndrome

answer

Pericarditis 2-8 weeks post MI. Fever, leukocytosis, friction rub, pericardial and pleural eff. Tx: NSAIDS & steroids.

question

Infective endocarditis

answer

Osler nodes (tender tips fingers & toes); Janeway lesions (nontender hemorrhagic plaques on palms & soles); Roth spots: retinal hemorrhages; Petechiae & splinter hemorrages

question

Aortic stenosis

answer

Exertional dyspnea, chest pain and SYNCOPE. Systolic murmur radiating to neck.

question

Hypertrophic cardiomyopathy

answer

Hypertrophic cardiomyopathy also exertional syncope + sudden death. Causes outflow obstruction with exertion. Often familial autosomal dominant.

question

Pericarditis

answer

ST elevations are concave upwards, like a cup holding water or smiley face. AMI is the opposite (like a tombstone or frowny face).

question

Myocarditis

answer

Looks like MI in an otherwise healthy young person.

question

Hypertensive emergency

answer

Reduce by 30% over 30 min, except in aortic dissection & eclampsia -- reduce much faster.

question

Aortic dissection

answer

B Blockers, then nitroprusside

question

ST segment elevation

answer

STEMI, Prinzemetal's, Pericarditis, Ventricular wall aneurysm, Benign early repol, BBB. Of these, only STEMI has reciprocal changes and only lateral and inferior MIs have these (anterior doesn't - well it does, but there's no posterior lead to see them).

question

WPW

answer

WPW + Afib with 1:1 conduction -- Death. Delta wave is seen in NSR, but not in tachyarrhythmias Only acceptable antiarrhymic is procainamide. Afib (i.e. irregular) with known WPW: Procainamde, cardioversion. No other antiarrhythmics in this circumstance. Afib going 250 = AF + WPW. Any irregularly irregular rhythm >200 is Afib with WPW. VTach is regular. For boards, any irregular wide complex tach - treat as WPW. Shock or procainamide.

question

Brugada syndrome

answer

Pseudo RBBB. Familial autosomal dominant. Causes syncope and/or sudden death in young males with a structurally normal heart. ST elevation in V1 and V2.

question

Infantile eczema

answer

Blisters, crusts, exfoliation, esp. scalp & face. Esp. first few months. Resolves by 2 y/o.

question

Exfoliative dermatitis

answer

DDx: SSSS (peds only), EM (target lesions), SJS (mucous membanes, up to 30% BSA), TEN maximal severity - Nicolsky's sign. High mortality older age group. A response to drugs, chemicals, systemic disease or malignancy. SSSS: Toxin. + Nicolsky. Fever, rash, exfoliation.

question

Pityriasis Rosea

answer

No known etiology. Children & young adults. Spring & fall. Herald patch, then Christmas tree pattern. If no herald patch, think of secondary syphillis.

question

Erysipelas

answer

Red. Face. Well-demarcated edge. Young children & elderly. Strep. Penicillin.

question

E. Nodosum

answer

Painful red subctuaneous nodules. A marker for systemic disease. Women 30-50. Resolves 3-6. Look for and treat underlying disease. Typical in sarcoid, ulcerative colitis.

question

Pemphigus Vulgaris

answer

The bad pemphigus. Like a bullous TEN. Big flaccid bullae. + Nicolsky sign. An autoimmune disease. Usually 50-60 y/o. Can be drug induced. 50-70% have oral lesions. Almost all have mucosal lesions, usually before skin. Tx: steroids & immunosupressive drugs.

question

Basal cell carcinoma

answer

Most common. Most benign. Do not metastasize. Only where there are hair follicles.

question

RMSF

answer

Tick transmitted: Rickettisa - a bacterium, causes a vasculitis. April -Sept. Children <15. SE USA. Fever, HA, myalgias, petechiae/purpura spread from peripheral to central & spare face. Frequently have low Na. Can be severe. Tx empirically with doxy (serologies take too long).

question

Erlichiosis

answer

Tick transmitted. Spotless RMSF (has maculopapular rash; not spots). HA, fever, myalgias. Can be severe. Same Tx.

question

Gonococcemia

answer

Gm neg dips. Fever, mono or polyarthritis - knees, ankles. Rash: erythematous base with necrotic pustules or hemorrhagic vessicles (usually 10-12) on extremities.

question

Zoster

answer

CN V: Hutchinson's sign (tip of nose) = opthalmic involvement CN VII: Ramsay Hunt = Zoster presenting with facial n. palsy & ear pain.

question

Hand Foot and Mouth vs. Herpangina

answer

Box are coxsackieviruses. HFM: involves anterior mouth Herpangina: anterior mouth is spared

question

Ultrasound Pearls: Pregnancy I

answer

I Gestational sac appears at approx. 5 weeks, BHCG 1000-2000. "Discriminatory zone" = 1200-1500. II. Yolk sac is the first evidence of a definite IUP. Gen 5.5 weeks. Round echogenic ring with central anechoic area. Outside the amniotic cavity. III. Should see an embryo within the amniotic cavity at 6 weeks. Once an embryo is 5mm, you should see cardiac activity. (Can't see in stills; only in M-Mode) IV. Cul-de-sac fluid: Large amt. extends beyond the posterior wall of the uterus. If present with no IUP = ruptured ectopic. Also, echogenic material (speckles or thicker) within the cul-de-sac is concerning for hemorrhage or infection.

question

Ultrasound Pearls: Pregnancy II

answer

Failed pregnancy: 1. Embryo >5mm with no cardiac activity. 2. Gestational sac >8mm with no yolk sac. 3. Gestational sac >16mm with no embryo. 4. Large subchorionic hemorrhage (abruption of placental margin) = worse prognosis (small may be OK).

question

Ultrasound Pearls: Gallbladder

answer

1. GB wall must be <3mm. 2. Lumen should be anechoic. 3. Gallstones are echogenic and have posterior shadowing. 4. CBD should be <7mm.

question

Ultrasound Pearls: Renal

answer

Hydronephrosis: Calyceal dilatation, anechoic (unless you happen to see a bright white stone). Hydro does not always mean renal disease. The ureter can be compressed by external sources such as a pregnant uterus or an aortic aneurysm.

question

Ultrasound Pearls: DVT

answer

Inside of vein is anechoic and compressible. The SFV is a deep vein! (a misnomer) Baker's cyst: large anechoic structure that narrows to a point. (Pain is acute onset vs. slow for DVT.)

question

Ultrasound Pearls: Aorta

answer

100% for aneurysm, but not for rupture. Normal aorta 5cm should warrant emergent surgery. (unless stable and known prior Hx) You may also see echogenic clot within the aorta. Dissection: You will see an intimal flap within the vessel. Don't be fooled by flank pain & hydro!

question

Ultrasound Pearls: FAST

answer

Goal: To detect hemoperitoneum, hemopericardium and hemothorax. 4 views (3 abdominal, 1 subxiphoid) Hepatorenal (or splenorenal views) Blood in Morrison's pouch. Free fluid is anechoic, black, has sharp edges and surrounds the structure that it's in. You can also see the diaphram in these views and may see hemothorax too. (Best view for hemothorax.) When you see sharp edges (of fluid), it is free fluid. If it's round, you were born with it. Hemopericardium is usually obvious. Pelvic view: Pouch of Douglas is retrouterine peritonal reflexion - should be empty.

question

Digitalis Toxicity

answer

Worsened by hypokalemia (digoxin normally competes with K+ ions for the same binding site on the Na+/K+ ATPase pump). Therefore treating for low K very important in this setting. If hyperK, treat, but not with Ca++ Significant arrhythmia, Tx with Mg++ while waiting for Fab fragment Tx.

question

Dialyzable ODs

answer

Salicylates, alcohols, lithium, theophylline, phenobarb. Non-dialyzable: Benzos, dig, Ca++ channel blockers, B-blockers.

question

GI Foreign Bodies

answer

Coins on AP view: Vertical lie - in trachea (because of vocal cord orientation). Horizontal lie - in esophagus. Button batteries have characteristic double ring. If button battery is esophageal, need to be removed immediately. If stomach, can watch closely.

question

Bleeding varices

answer

Octreotide. Vasopressin if severe. Sengsten Blakemore tube - dual balloon, 3 lumens.

question

Elevated Bilirubin in adult

answer

Indirect: Hemolysis, Gilbert's. Direct: Liver disease, biliary obstruction from any cause.

question

Hypokalemia and Mg++

answer

They move together. When K+ is very low, always give Mg++ as well. Flaccid paralysis = low K or low Mg

question

Contraindications to succinylcholine

answer

Hyperkalemia, allergy, history of malignant hyperthermia, denervation syndromes, and patients who are 24-48 h post burn or crush injury.

question

Newborn antibiotics

answer

No ceftriaxone first month. Cefotaxime instead. Several reasons (precipitates with Ca++, causes kernicterus).

question

Bioterrorism

answer

Doxycycline.

question

Myasthenia questions

answer

Always airway. Headache questions = always LP.

question

Bilateral VII cranial n. palsy

answer

= Lyme. Requires LP for lyme studies.

question

Polycyctic Kidneys:

answer

Very high incidence of aneurysms. (Think SAH)

question

Hyperglycemia and sodium

answer

Serum Na level decreases by 1.6 for every 100mg/dl of glucose over 100. So 600: 1.6 x 500 = 8. Predicted would be 140 - 8 = 132.

question

Sulfonylurea OD

answer

Glucagon effective; should also give octreotide to prevent recurrence.

question

Pulmonary endometriosis

answer

Can cause cyclic hemo-pneumothorax.

question

Legionella infection

answer

Severe pneumonia accompanied by multisystemic disease; prominent neurologic and GI Sx. Tx: Quinolones, macrolides.

question

Bell Palsy

answer

Includes paralysis of the forehead (i.e the entire side of the face). Central 7th nerve lesion spares the forehead.

question

Rhogam dosage:

answer

Give to Rh Neg mother: 12w 300

question

Horner syndrome

answer

Characterized by the classic triad of miosis (ie, constricted pupil), partial ptosis, and loss of hemifacial sweating (ie, anhidrosis). It is a problem with the sympathetic nerves of the face. May see with Pancoast tumor, after chest procedure, sarcoid or TB in cervical lymph nodes. Rarely after botox injection.

question

When not to do procedural sedation in ED

answer

ASA classifications: 1. A normal healthy patient. 2. A patient with mild systemic disease. 3.A patient with severe systemic disease. 4. A patient with severe systemic disease that is a constant threat to life. We should not do procedural sedation for a class III or higher.

question

EXAM:

answer

Every pt. is about to die! There are no benign diagnoses. Always treat the most serious possible syndrome. Flu = endocarditis or anthrax. If TEE is an option, always choose it. Positional chest pain = pericarditis. CP + any neuro Sx = dissection. Thoracic back pain = spinal mets or SEA Severe abd pain = Dissection or Mesenteric ischemia (or other surgical emergency) Hyponatremia: think Nec Fasc, RMSF. Do not keep re-reading the stem. Once you understand it, just eliminate answers. Guessing: B or D.

question

Hepatitis

answer

Hep A now has a vaccine. Hepatitis B: sAg = active infection. sAb = immune. cAb - Appears after sAG and persists for life. Best evidence that someone was infected at some point in the past. E antigen = Pt. is highly contagious. Hep C 50% become cirrhotic. Admit any Hep if encephalitis, elevatged INR, Bili >20.

question

Febrile seizure + diarrhea =

answer

Shigella. Seizure (toxin-induced) occurs before the diarrhea.

question

Diarrhea

answer

Viral: most common overall cause. Campylobacter = most common bacterial diarrhea (all age groups). Assoc. with development of Guillian-Barre syndrome. Yersinia enterocolitica mimics appy (terminal ileitis, pseudoappendicitis, mesenteric lymphadenitis). Pain may last up to 3 wks. Abx not helpful unless immunocompromised. Giardia (protozoa) diarrhea goes on for weeks! Frothy and foul smelling. Shigella and Salmonella: Tx Cipro. Vibrio: raw shellfish, especially in liver disease. Bad one is vulnificus - high mortality rate; also causes skin infections and septicemia. Tx: Doxy, quinolone.

question

Pain out of proportion to exam findings:

answer

Ischemic bowel, nec fasc, compartment syndrome.

question

A "stinger" that involves both arms

answer

Is a spinal cord injury (either fx or SCIWORA).

question

Tension pneumo:

answer

Causes hypotension by decreased venous return. Needle decompression, tube, then x-ray.

question

Pericardial effusion

answer

Most common causes: breast or lung Ca, uremia, bacterial (esp. Tb). Tamponade: Beck's Triad: JVD, hypotension, muffled heart sounds. Aortic dissection kills by tamonade. US: RA, then RV collapse during diastole.

question

Nadir sepsis

answer

Usually @ 7-10d after chemo.

question

Subdural vs. epidural

answer

Subdural is diffuse. Usually contra-coup. 6x more common than epidural. Epidural is lens shaped, confined (direct blow, lesion on side of "coup") Subdurals have a worse prognosis than epidurals.

question

Post concussion syndrome

answer

Symptoms are all non-focal. Second impact syndrome is very real and can be catastrophic. Minimum 1 week off from sports.

question

Cholecystitis

answer

Acalculous chole is far more serious than calculous. Usually a complication of another process, esp. diabetics and elderly. Chole is most common cause of surgical abdominal pain in the elderly. Gallstone ileus: Stone causing obstruction at ileocecal valve. Ascending cholangitis: Fever, jaundice, RUQ pain

question

Crohn's vs. Ulcerative Colitis

answer

Crohn's: Entire GI tract (mouth to anus) may be involved. Skip lesions. Full thickness of bowel wall. Gross blood uncommon. Ca oxylate renal stones. UC: Colon only. Bloody diarrhea. Toxic megacolon. 30-fold increased incidence of colon cancer.

question

Hemorrhagic shock class

answer

I and IV are the extremes: minor and pre-morbid. II: 15-30% blood loss, pulse, narrowed pulse pressure. III: Shock. 30-40% blood loss, <BP, AMS

question

Abruptio placenta

answer

Leading cause of maternal death during pregnancy. Frequency "concealed" (no vaginal bleeding). Causes DIC in mother (leading cause of DIC).

question

Cerebral perfusion pressure

answer

CPP = MAP - ICP Auto regulation increases BP when ICP>

question

Treatment of air embolus (Machine-like murmur)

answer

Trendelenburg and LL decubitus

question

Electricity dosages for cardioversion

answer

Narrow regular: 75 Wide regular: 100 Narrow irregular: 160 biphasic 200 monophasic Wide irregular = DF: 180 biphasic 360 monophasic (Remember: 75,100 160,180: RR,II NW,NW)

question

Methemoglobinemia

answer

Methemoglobin is incapable of carrying oxygen. Turns Hgb dark-reddish brown - clinically appears as cyanosis. Signs and symptoms at fractions of 25-50% are as follows: Headache, dyspnea, lightheadedness, weakness, confusion, palpitations, chest pain. At 50-70% are as follows: Abnormal cardiac rhythms, Altered mental status; delirium, seizures, coma; profound acidosis Causes: Dapsone, pyridium, local anesthetics, amyl nitrite, sulfonamides. Clinical presentation: cyanosis with low 02 sat (02 sat is unreliable - it is always 85%) and/or cyanosis with normal Pa02. Confirm Dx with methemoblobin level. Tx: methylene blue; hyperbaric 02 if unable to give MB

question

Strawberry tongue

answer

Scarlet Fever, Kawasaki Strawberry cervix: Trichomonas

question

Magnesium therapy

answer

Recognized uses: Torsades, Dig toxicity with arrhythmia (pending Fab), Eclampsia, Asthma.

question

Perilunate vs. lunate dislocations

answer

Perilunate: Lunate is alligned; capitate is displaced. Lunate : Capitate is alligned; lunate is displaced. Complications of either: median n. injury, scaphoid (navicular) Fx. Tx: O.R.

question

Most common ligamentous injury of hand

answer

Scapholunate dislocation: >3mm widening of scapholunate space. Tx: thumb spica splint/cast

question

Digitalis toxicity presentation

answer

"...vomiting, purging, giddiness, confused vision, objects appearing green or yellow; increased secretion of urine, slow pulses, even as low as 35 in a minute, cold sweats, convulsions, syncope, death."

question

Adrenal insufficiency

answer

Hyponatremia + Hyperkalemia + Hypoglycemia

question

Tea colored urine

answer

Rhabdomyolysis

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