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2020 EM Boards Rosh learning > 11-1-20 Rosh > Flashcards

11-1-20 Rosh Flashcards

(65 cards)

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1
Q

Difference in labs between alcoholic and viral hepatitis

A

AST and ALT are only 2-10 times normal in ethos hepatitis

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2
Q

Airborne precautions for what?

A

measles varicella TB SARS ebola smallpox covid

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3
Q

Meningitis abs in Peds?

A

<1 month: amp+cefotax, or amp+gent +vanc >1 month: Vanc, ceftriaxone

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4
Q

Max heart rate formula?

A

220-age

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5
Q

TPA during cardiac arrest, how long to continue CPR?

A

at least 20 min

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6
Q

Thyroid storm meds, order, and mechs

A
  1. beta blocker (propranolol partially blocks T4 to T3) 2. PTU/methimazole– block synthesis of T4 (blocks an enzyme) 3. iodine (after 1h)– blocks release of stored T4 4. prednisone – blocks T4-T3
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7
Q

Dengue fever classic sxs?

A

High fever

retro-orbital HA

severe myalgias (breakback)

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8
Q

umbilical vein cannulation

what does it look like

A

1 big vein (supplies oxygenated blood from placenta)

2 small arteries (deoxy blood back to placenta)

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9
Q

Parental consent

when you don’t need?

A
  • emergent
  • emancipated
  • STD
  • pregnancy
  • drugs
  • abuse
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10
Q

dacryoadenitis vs dacrocystitis

A
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11
Q

Dig FAB dosing:

  1. neither dig level or amount ingested is known
  2. amount dig ingested is known, concentration unknown
  3. steady state dig concentration known
  4. cardiac arrest
A

picture. stead state is 6-8h

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12
Q

When to give Dig FAB in OD?

A

controversial indications, call poison control.

From LIFTL:

cardiac arrest

life-threatening dysrhythmia

K >5mM

>10mg ingested (adult), >4mg ingested (child)

>15 nM level (>12ng/mL)

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13
Q

Measles PEP:

  • explain what is required
  • when does peds get MMR
A
  1. immune and already received MMR: Get MMR vaccine within 72h
  2. immunocompromised, and infant <12mo: Get immunoglobulin AND MMR

infants get MMR typically at 12 mo

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14
Q

jellyfish sting

what to put on it

A

Hot water always works.

Acetic acid helps for inactivation of nematocysts in jellyfish to prevent further injectin of toxin

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15
Q

what tox OD is delayed charcoal still indicated

A

colchicine

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16
Q

Pt with frequent UTIs now with hypoxic respiratory failure, think what

A

Nitrofurantoin, pulmonary toxicity with chronic use

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17
Q

Bupropion OD

what antidote

A

fat emulsion

note–bupropion can look like TCA OD with wide QRS but does not respond to bicarb

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18
Q

Unknown OD, you see wide QRS
Bicarb does not work, think what

A

bupropion OD

needs fat emulsion

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19
Q

Bleach overdose,

pediatric accidental exploratory. do what?

A

Household bleach much safer than industrial

Exploratory peds ingestions are often benign–if pt can tolerate food no need to admit

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20
Q

what is doxepin

A

a TCA

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21
Q

TCA toxicity

when giving bicarb, what to be aware of to stop giving?

A
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22
Q

Isopropyl etoh ingestion

What are the lab findings?

A

“ketosis without acidosis”

Isopropyl etoh –> acetone (which is a ketone but not ketoacid)

Ketoacids are beta hydroxybutarate, and acetacetone

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23
Q

Lithium OD:

Think 3 things that indicate hemodialysis need

A
  1. renal function impaired and Li concentration elevated
  2. Lithium above 5
  3. Dangerous sxs (seizure, AMS, dysrhythmia)
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24
Q

gingkgo biloba

-what danger

A

bleeding, spontaneous hemorrhage

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25
VTach: when to NOT give amio
TCA/tox OD with widened QRS
26
Classic story for phytophotodermatitis?
bartender on beach, using limes, mowing the lawn
27
Pt with excited delirum, now codes Give what med?
Bicarb. pt probably extremely acidemic
28
marine envenomation when to use acetic acid?
29
ASA OD what is goal serum and urine pH?
serum: 7.5 urine 8
30
Acute botulism with wounds -give what in addition to antitoxin
31
botulism 3 types
1. infant -- spores 2. adult food borne (canned food)--pre formed toxin 3. wound
32
Pediatric Opioid OD how long to observe?
If methadone, may need 24h observation
33
ethylene glycol OD -give what in addition to fomepizole
thiamine pyridoxine
34
Tamiflu who's considered high risk to give to?
children \<2 age\>65 pregnancy (up to postpartum 2week) immunosuppressed and chronic conditions
35
pertussis stages and timing
1. catarrhal-- lasts 1-2 wks nonspecific cough/fever/rhinorrhea 2. paroxysmal--lasts 2-6 wks whoop 3. convalescent-- lasts 1-2mo
36
trauma level categories
1. full 24h all specialists, has residency 2. SOME specialists 24h 3. Resources for resus/surgery/ICU for most trauma pts. Agreement to transfer to level 1 or 2 4. ED physician only
37
motor and sensory hand testing
motor: median--OK sign ulnar--V sign radial--thumbs up, wrist extension sensory: median--index fingertip ulnar--5th fingertip radial--dorsal first webbed space
38
acute otitis media when do the wait and see abx approach how long to wait?
1. 6 mo - 2y, simple unilateral AOM 2. \>2y unilateral OR b/l AOM 48-72h
39
Classic story for peds vag foreign body
6y girl, just started school, now with bad vaginal smell and small amount of blood specks in underwear she just started toileting by herself and has small piece of toilet paper stuck in vagina. pt may need vaginoscopy under anesthesia if can't cooperate
40
2 types of liability insurance for ED physicians
1. claims-- (claims must be filed during policy period. if claim filed afterwards, then insurance not valid) 2. occurence--AKA tail covers for when the event occurred, not when claimed
41
postpartum endometritis -what abx?
clinda, gent
42
you suspect epiglottitis -what abx
43
you are concerned about RPA lateral neck XR requires what to be proper XR
44
syphillis screening and confirm tests?
RPR/VDRL screening FTA-abs confrm
45
medical malpractice 4 elements
1. duty 2. duty breached 3. harm 4. harm cause by duty breach
46
epistaxis anterior and posterior atery names?
anterior: kesselbach plexus posterior: sphenopalatine
47
HIV PEP what time frame to give
give within 2h improves transmission prevention
48
neutropenia what is the time frame after chemo for Nadir
5-14 days after chemo. (same as HIT timeframe)
49
neutropenia definition
38. 0 for 1h 38. 3 1 time reading with \<500 ANC or expected with nadir
50
transvaginal US, pregnancy findings what order do they appear gestational sac, yolk sac, fetal pole
gestational sac, yolk sac, fetal pole first to last
51
eye irrigation what pH to target
7.0-7.4
52
severe, complicated malaria in the US: what is the drug of choice?
artesunate
53
tetralogy of fallot 4 things
overriding aorta vsd RVH RV outflow tract obstruction
54
male genital lesions think which 3 uncommon ones and their tx?
1. chancroid, hemophylus ducrei.--ceftriaxone 2. LGV lymphogranuloma venereum (certain chylamydia types)--docy 3. granuloma inguinalea "donovanosis" (beefy red ulcer)--azithro
55
Spont peritoneal peritonitis: what criteria -what tx
presence of 2: 1. abd pain or cloudy dialysate 2. WBC \>100 with 50% pmns 3. positive culture tx: vanc and cefepime intraperitoneal preferred, and can be home if wellappearing
56
cpr what Etco2 is good compressions?
\>10 if \<10 then no chance for rosc
57
STEMI what times to know for PCI and tpa
goal 90min door to needle if cannot transfer within 120 min, than do TPA within 30 min
58
what requires medical examiner review?
manner of death is unexpected or unclear, or if law may have been broken eg traumatic death, natural disasters, suicide and homicide suspected, sudden unexplained, most peds deaths
59
kid with laceration give tdap? what is their last tdap scheduled
final dose is age 4-6 years so, any kid less \<9, don't give tdap
60
tylenol OD -when does NAC need to be given, what timeframe?
within 8 hours So, if pt presents \>8h after ingestion, give NC empirically If pt presents within 4h and not massive amount, then wait for th 4h level
61
erlichiosis - describe sxs - tx
62
abnormal uterine bleeding, 1st line tx?
OCPs
63
what IO labs are not acccurate
wbc, K, ionized ca, ast/alt, blood oxygentation
64
SIRS, sepsis, severe sepsis qSOFA
T 36-38 HR \>90 RR \>20 WBC \<4k, \>12k, or \>10% bands sepsis: suspected source severe: lactic acidosis/SBP\<90/SBP drop \>40 from normal/organ dysfunction qSOFA: HAT Hypotension \<100 AMS: gcs\<15 Tachypnea \>22
65

2020 EM Boards Rosh learning (1 decks)

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