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First Aid for the USMLE Step 2 CK (8th Ed.)/
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First Aid for the USMLE Step 2 CK (8th Ed.) | Medicine (MD/DO) School Study Aid
17 - Selected Topics for Emergency Medicine - Page 487
57 Picmonics to Learn | 1 hr 53 mins
Vitamin B12 (Cobalamin) Deficiency Causes
- Causes
- Vegans
- Pernicious Anemia
- Gastric Bypass Surgery
- Malabsorption
- Sprue
- Enteritis
- Crohn's Disease
- Diphyllobothrium latum
4 mins
Vitamin B6 (Pyridoxine)
- Pyridoxal Phosphate
- Mechanism
- Transamination
- Decarboxylation
- Glycogen Phosphorylase
- Cystathionine Synthase
- Functions
- Heme Synthesis
- Niacin Synthesis
- Neurotransmitter Synthesis
2 mins
Subdural Hematoma
- Mechanism
- Tear of Bridging Veins
- Slow Bleeding, Over Time
- Imaging
- Subdural Space
- Crescent-shaped on CT
- Crosses Suture Lines
- Midline Shift
- Causes
- Elderly
- Whiplash
- Abusive Head Trauma (Shaken Baby Syndrome)
2 mins
Phenytoin
- Indications
- Status Epilepticus
- Tonic-Clonic Seizures
- Mechanism of Action
- Blocks Na+ Channel Activation
- Inhibition of Glutamate Release
- Class IB Antiarrhythmic
- Side Effects
- Teratogenic
- Macrocytic Megaloblastic Anemia
- Induce Cytochrome P450
- Drug-induced Lupus
- Neuropathy
- Hirsutism
- Gingival Hyperplasia
1 min
Tetracycline Drug Names and Indications
- Drug Names
- Demeclocycline
- Minocycline
- Doxycycline
- Fecally Eliminated
- Can be Used in Renal Failure
- Indications
- Antidiuretic Hormone Antagonist
- Chlamydia
- Rickettsia
- Borrelia burgdorferi
- Helicobacter Pylori
- Mycoplasma Pneumonia
3 mins
Tetracycline Mechanism
- Binds to 30 S to Prevent Attachment of Aminoacyl tRNA
- Limited CNS Penetration
- Divalent Cations Inhibit Absorption
- Must Not Take with Milk, Antacids, Iron
1 min
Tetracycline Toxicities
- Inhibition of Bone Growth in Children
- Teratogen
- Discoloration of Teeth
- Photosensitivity
- GI Distress
2 mins
Vitamin B3 (Niacin)
- Derived from Tryptophan
- Synthesis Requires Vitamin B6
- Constituent of NAD+
- Deficiency Causes
- Hartnup Disease
- Carcinoid Syndrome
- Deficiency Symptoms
- Pellagra
- Diarrhea
- Dermatitis
- Dementia
- Glossitis
- Excess Symptoms
- Flushing
2 mins
Glasgow Coma Scale
- LOC Assessment
- Score of 3 to 15
- 8 or Less = Coma
- Eye Opening
- Verbal Response
- Motor Response
1 min
Epidural Hematoma
- Mechanism
- Middle Meningeal Artery Rupture
- Temporal Bone Fracture
- Hematoma Between Skull And Dura Mater
- Transtentorial Herniation
- Lucid Interval
- Imaging
- Lens-shaped on CT
- Does Not Cross Suture Lines
- Treatment
- Craniotomy
1 min
Pelvic Bones
- Ilium
- Iliac Crest
- ASIS (Anterior Superior Iliac Spine)
- AIIS (Anterior Inferior Iliac Spine)
- Acetabulum
- Pubis
- Pubic Symphysis
- Obturator Foramen
- Ischium
- Sacrum
- Coccyx
1 min
Appendicitis
- Mechanism and Characteristics
- Fecalith leading to obstruction and infection
- Most commonly affects teenagers
- Presentation
- Initial peri-umbilical visceral pain
- Subsequent somatic right lower quadrant pain
- Diagnosis
- Rebound tenderness
- Positive psoas sign
- Pain at McBurney's point
- Leukocytosis
- Fever
- Treatment
- Appendectomy
1 min
Burns Assessment
- Stage and Extent of Burn
- Dyspnea
- Singed Nasal Hairs
- Pain
- Initial Decrease Urinary Output
- Paralytic Ileus
- Signs of Inadequate Hydration
- Shock
- Hypothermia
- Hyperkalemia
2 mins
Burns Interventions
- Ensure Airway Patency
- O2
- IV Fluid Replacement
- Dry Sterile Dressing
- Debridement
- Elevate Burned Limbs
- Analgesics
- Silver Sulfadiazine
- Escharotomy
2 mins
Burns Considerations
- Maintain Body Temperature
- Increased Risk of Infection
- Venous Thromboembolism (VTE) Prophylaxis
- Curling's Ulcer
- Excision and Grafting
- Adequate Nutrition
- Contractures
2 mins
Rule of 9's for Burns
- Total Body Surface Area (TBSA)
- Head
- Anterior Torso (18%)
- Chest
- Abdomen
- Posterior Torso (18%)
- Upper Back
- Lower Back
- Extremities
- Posterior Leg (each)
- Anterior Leg (each)
- Each Arm
- Genitalia 1%
2 mins
Parkland Formula
- Burn victims
- 24 hours
- TBSA% x Weight x 4 = Fluids
- TBSA %
- x Weight (kg)
- x 4
- = Fluid Requirement (in first 24 hrs)
- Fluids in first 8 hours
- 1/2 of fluid given in first 8 hours
1 min
Stages of Hypothermia
- Mild
- 32 to 35°C (90 to 95°F)
- Shivering
- Moderate
- 28 to 32°C (82 to 90°F)
- Obvious Motor Impairment
- Slowed Thinking
- Severe
- < 28°C (< 82°F)
- Shivering Stops
- Paradoxical Undressing
- Arrhythmias
3 mins
Hypothermia Interventions
- Remove From Environment
- Remove Wet Clothing
- Passive Rewarming
- Warm Clothing
- Active Rewarming
- Heated Blankets
- Warm IV Solutions
- Heated Oxygen
- Warm Gastric Lavage
- Considerations
- Warm Trunk BEFORE Extremities
2 mins
Postoperative Fever
- 5 W's
- Wind (Days 1-3)
- Atelectasis
- Pneumonia
- Water (Days 3-5)
- Urinary Tract Infection from Catheter
- Walking (Days 4-6)
- Deep Vein Thrombosis (DVT)
- Pulmonary Embolism
- Wound (Days 5-7)
- Infection
- Wonder Drugs (Days 7+)
- Drugs
2 mins
Types of Shock
- Hypovolemic
- Depleted Volume
- Cardiogenic
- Pump Failure
- Obstructive
- Indirect Pump Failure
- Distributive
- Lost Vascular Tone
- Neurogenic
- Anaphylactic
- Septic
2 mins
Rabies Virus
- Characteristics
- Enveloped
- RNA Virus
- SS Negative Linear
- Helical
- Bullet-Shaped Envelope
- Binds to Acetylcholine Receptor
- Retrograde Fashion
- Migrates to Saliva
- Diagnosis
- Negri Bodies
- Cytoplasmic Inclusions in Neurons
- Purkinje Cells of Cerebellum
2 mins
Rabies Symptoms and Animals
- Characteristics
- Bats, Skunks, and Raccoons (Inside United States)
- Dog Bites (Outside United States)
- Fever
- Agitation
- Paralysis
- Hydrophobia
- Photophobia
- Considerations
- Fatal If Not Treated
1 min
P450 Inducer
- Griseofulvin
- Phenytoin
- Carbamazepine
- Rifampin
- Barbiturates
- Chronic Alcohol Use
- St. John's Wort
51 secs
P450 Inhibitors
- Quinidine
- Ciprofloxacin
- Isoniazid
- Grapefruit Juice
- Acute Alcohol Use
- Erythromycin (Macrolide)
- Indinavir
- Cimetidine
- Sulfonamides
- Ketoconazole
- Amiodarone
2 mins
Antimuscarinic Antidote
- Antidote
- Physostigmine Salicylate
44 secs
Atropine
- Indications
- Blocks DUMBBeLSS
- Bradycardia
- Side Effects
- Skin Flushing
- Increased Temperature
- Dry Mouth
- Cycloplegia
- Disorientation
- Mydriasis
1 min
Beta Blocker Antidote
- Antidote
- Glucagon
29 secs
ACE Inhibitor Toxicity
- CAPTOPRIL Mnemonic
- Cough
- Angioedema
- Potassium Changes (Hyperkalemia)
- Taste Change
- Hypotension
- Pregnancy Changes
- Rash
- Increased Renin
- Lower Angiotensin II
2 mins
Chloramphenicol
- Mechanism
- Bacteriostatic
- Inhibits 50S Peptidyltransferase Activity
- Indications
- Meningitis
- Rocky Mountain Spotted Fever in Pregnant Women
- Side Effects
- Anemia
- Aplastic Anemia
- Gray Baby Syndrome due to Decreased UDP-Glucuronyl Transferase
- Resistance Caused by Plasmid Encoded Acetyltransferase
2 mins
Cisplatin
- Indications
- Carcinomas
- Ovarian
- Bladder
- Lung
- Testicular
- Mechanism
- Cross-Links DNA
- Side Effects
- Ototoxicity
- Nephrotoxicity
- Treat with Amifostine and Chloride Diuresis
2 mins
Cyclophosphamide
- Mechanism
- Requires Bioactivation by Liver
- Cross-links DNA
- Guanine N7 Position
- Indications
- Autoimmune Disorders
- Leukemia
- Lymphoma
- Solid Tumors
- Side Effects
- Myelosuppression
- Hemorrhagic Cystitis
- Prevent with Mesna
3 mins
Fluoroquinolones Antibiotics
- -floxacin
- Mechanism of Action
- Inhibits Topoisomerase II & IV
- Bactericidal
- Indications
- Gram-negative Rods
- Pneumonia
- Gastrointestinal Infections
- Urinary Tract Infection
- Genital Infections
- Drugs
- Levofloxacin
- Ciprofloxacin
- Has Pseudomonas Coverage
- Considerations
- Avoid Polyvalent Cations
3 mins
Fluoroquinolones Toxicities
- Diarrhea
- Skin Rash
- Headache
- Tendon Rupture in Adults
- Myalgias in Kids
- Damage to Cartilage
- Teratogen
- QT Prolongation
1 min
Penicillin
- Gram Positive
- Spirochetes
- Bind PBPs
- Block Transpeptidase Cross-linking of Cell Wall
- Activate Autolytic Enzymes
- Bactericidal
- Hypersensitivity Reactions
- Hemolytic Anemia
- Beta-lactamase Sensitive
2 mins
Aspirin
- Indications
- Fever
- Pain and Headache
- Cardiovascular Disease (CAD)
- Mechanism of Action
- Irreversible inhibition of COX-1 and COX-2
- Suppress Thromboxanes and Prostaglandins
- NSAID
- Side Effects
- Reye's Syndrome
- Tinnitus
- Peptic Ulceration
- Mixed Acidosis/Alkalosis
- Nephropathy
2 mins
Aspirin Poisoning (Salicylism) Assessment
- Early Symptoms
- Nausea and Vomiting
- Tinnitus
- Confusion
- Hyperventilation
- Respiratory Alkalosis
- Late Symptoms
- Metabolic Acidosis
- Coma
- Hyperthermia
1 min
Succinylcholine
- Indications
- Inducing Paralysis
- Mechanism of Action
- Neuromuscular Blocking Drugs
- Motor Nicotinic Receptor
- ACh Receptor Agonist
- Depolarization
- Phases of Action
- Phase I (Paralysis Non-reversible)
- Phase II (Paralysis Reversible)
- Neostigmine (Reversal Agent)
2 mins
Vancomycin Mechanism
- Bacteriostatic and Bactericidal
- Gram-Positive
- Inhibits Cell Wall Mucopeptide
- Binds to D-ala D-ala
- Resistance with Change to D-ala D-lac
- Staphylococcus aureus
- Orally for Clostridium difficile
- Enterococci
2 mins
Vancomycin Side Effects & Toxicity
- Side Effects
- Thrombophlebitis
- Nephrotoxicity
- Ototoxicity
- Diffuse Flushing Called Red Man Syndrome
- Prevent with Antihistamine
- Prevent with Slow Infusion
2 mins
Ergocalciferol (Vitamin D2)
- Mechanism
- Vitamin D2
- Indications
- Hypoparathyroidism
- Rickets
- Hypophosphatemia
- Side Effects
- Fatigue
- Constipation
- Hypercalcemia
- Kidney Stones
2 mins
Riboflavin (Vitamin B2)
- Classification
- Vitamin B2
- Biochemistry
- FAD
- FAD Makes 1.5 ATP
- Succinate to Fumarate
- DEFICIENCY
- Glossitis
- Cheilosis
- Corneal Vascularization
2 mins
Vitamin B1 (Thiamine)
- Mechanism
- Branched-chain Ketoacid Dehydrogenase
- Pyruvate Dehydrogenase
- Alpha-ketoglutarate Dehydrogenase
- Transketolase
- DEFICIENCY EFFECTS
- Wernicke-Korsakoff Syndrome
- Beriberi
- ATP Depletion
- Aerobic Tissues Like Brain and Heart Affected First
- Considerations
- Deficiency Can Worsen with Glucose Infusion
2 mins
Vitamin A (Retinol) Function and Deficiency
- Mechanism
- Retinol
- Constituent of Visual Pigments
- Differentiation of Epithelial Cells into Specialized Tissue
- Signs and Symptoms
- Night Blindness
- Dry Skin
- Considerations
- Used to Treat Measles
- Antioxidant
2 mins
Vitamin A (Retinol) Toxicity
- Signs and Symptoms
- Alopecia
- Vision Changes
- Headache
- Skin Changes
- Hyperlipidemia
- Hepatotoxicity
- Arthralgias
- Teratogen
- Cleft palate
- Cardiac Abnormalities
3 mins
Vitamin B12 (Cobalamin) Mechanism and Deficiency
- Mechanism
- Cobalamin
- Large reserve pool in the liver
- Homocysteine to methionine
- Methylmalonyl CoA to succinyl CoA
- Deficiency Signs and Symptoms
- Macrocytic Megaloblastic Anemia
- Hypersegmented Neutrophils
- Neurologic defects
- Posterior column
- Lateral corticospinal tract
- Spinocerebellar tract
5 mins
Vitamin B5 (Pantothenate)
- Mechanism
- Pantothenate
- Pyruvate Dehydrogenase
- Coenzyme A
- Fatty Acid Synthase
- Deficiency Signs and Symptoms
- Enteritis
- Dermatitis
- Alopecia
- Adrenal Insufficiency
2 mins
Vitamin B6 (Pyridoxine) Deficiency
- Deficiency From Isoniazid
- Deficiency From Oral Contraceptives
- Seizures
- Hyperirritability
- Peripheral Neuropathy
- Sideroblastic Anemia
3 mins
Vitamin C Mechanism and Deficiency
- Mechanism
- Ascorbic acid
- Antioxidant
- Protects Against Free Radicals
- Keeps Iron in Reduced State
- Hydroxylation of Proline and Lysine
- Necessary for Dopamine B Hydroxylase
- Deficiency Signs and Symptoms
- Scurvy
- Swollen Gums
- Bruising
- Poor Wound Healing
- Hemarthrosis
- Perifollicular Hemorrhages
- Anemia
4 mins
Vitamin D Deficiency
- Signs & Symptoms
- Rickets in children
- Bending bones
- Rachitic rosary
- Breast milk has decreased vitamin D
- Osteomalacia in adults
- Tetany from Hypocalcemia
2 mins
Vitamin D Toxicity
- Kidney Stones
- Metastatic Calcification of the Kidney
- Loss of Appetite
- Abdominal Pain
- Sarcoidosis
1 min
Vitamin E (Alpha-tocopherol)
- Mechanism
- Antioxidant
- Indications
- Fat Malabsorption Syndrome
- Alpha-TTP Deficiency
- Side Effects
- Bleeding
- Considerations
- Increased Risk Hemorrhagic Stroke
- Limit Doses < 200 IU per Day
- Nuts and Whole Grains
- Vegetable Oils
2 mins
Vitamin E Deficiency
- Mechanism
- Antioxidant
- Protects Erythrocytes
- Protects from Free Radical Damage
- Deficiency Signs and Symptoms
- Hemolytic Anemia
- Posterior Column
- Spinocerebellar Tract
2 mins
Vitamin K
- Sources
- Dark Green Leafy Vegetables
- Synthesized by Intestinal Flora
- Mechanism
- Activated by Epoxide Reductase
- Gamma Carboxylation of Glutamate
- Activation of Clotting Factors II, VII, IX, X, Protein C and S
- Considerations
- Deficiency with Broad Spectrum Antibiotics
- Neonatal Hemorrhage with Increased PT and aPTT
- Warfarin is a Vitamin K Antagonist
4 mins
Stevens-Johnson Syndrome
- Etiologies
- Drugs
- Symptoms
- < 10% of Body Surface Area (BSA) Involved
- 10-30% BSA Overlaps with Toxic Epidermal Necrolysis (TEN)
- Fever
- Affects Skin and Mucous Membranes
- Bullae Formation
- Necrosis
- Sloughing of Skin
- High Mortality Rate
- Treatment
- Supportive Care
- IVIG (Intravenous Immunoglobulin)
3 mins
Methemoglobinemia Diagnosis and Management
- Clinical Features
- Cyanosis
- Respiratory Distress
- Headache
- Lethargy
- Diagnosis
- "Chocolate-colored Blood"
- Decreased Oxygen Saturation
- Normal Partial Pressure of Arterial O2 (PaO2)
- Management
- Identify Triggers
- Methylene Blue
- Vitamin C
- Exchange Transfusion
3 mins
Acute Carbon Monoxide Toxicity Characteristics and Presentation
- Characteristics
- Carboxyhemoglobin
- Decreases Hemoglobin's Oxygen Carrying Capacity
- Increases Hemoglobin's Oxygen Affinity
- Anaerobic Metabolism
- Etiologies
- Vehicle Exhaust
- House Fires
- Clinical Features
- Altered Mental Status
- Headache
- Nausea and Vomiting
- Dyspnea
- "Cherry Red" Skin
- Associations
- Cyanide Toxicity
2 mins
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