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1
Q

mcc visceral perforation

A

PUD

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2
Q

RUQ AIR

A

mesenteric ischemia or emphesymatous cholecystisi

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3
Q

extraintestinal manifestations IBD

A

uveitis, arthritis, erytema nodosum, pyoderma ganernosm, vasculitis - tx sulfasalzine, emsalamine, prednisone

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4
Q

which IBD involes the entire colonic wall

A

crohns

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5
Q

which IBD is assn with kidney stones

A

crohns- inc abs oxylate

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6
Q

complicaiton of UC

A

toxic megacolon

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7
Q

thumbprint sign on CT

A

mesnetic ischemi

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8
Q

higher cancer risk of IBD

A

UC

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9
Q

causes of mesenteric ischemia

A

arr, clot, low flow states like CHF post MI or pressors, b blockers, digoxin

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10
Q

mcc diarrhea is viral or bacterial? mcc kids? leading cause GE?

A

viral, rotavirus mcc children, norovirus GE, cruise ships, viral diarrhea has no blood or WBC

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11
Q

invasive diarrhea characteristics

A

takes a few days to onset, blood and WBC

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12
Q

causes HUS in kids, TTP in elderly, abx can increase risk of HUS- under cooked hamburger, peeting zoos

A

EHEC - gross bloos, wbcs, 0157h7

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13
Q

invasive diarrhea, high fever, febrile, seizures

A

shigella- tx cipro

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14
Q

invasive diarrhea, common, cafeteruai food, turtles, amphbiains, osteomyelitis in SCA

A

salmonellla - tx cipro

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15
Q

mcc bacterial diarrhea, can cause GBS

A

campylobacter- fecal oral- backpackers diarrhea- contiaminated food and water

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16
Q

diarrhea that comes fomr oysters, shellfish, can cause terrible wounds, inc morbidity in pt with liver disease

A

vibrio - paraheomlyitics an dvulnificus (worse)

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17
Q

invasive diarrhea that mimics appendicitis

A

yersinia entercolitica- wright stain positive fecal, tx bactrim

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18
Q

diarrhea that is wattery, immediate, no wbc or rbc, no sepsis

A

toxigenic

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19
Q

travellers diarrhea

A

E coli - fecal oral

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20
Q

bacillus cereus

A

fried rice, toxigenic, chinese, violent vomiting 2-3 hours post ingestion

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21
Q

histamine toxin, not regrid depp sea fish- peppery- facial flushign and diarrhea-

A

scromboid- multiple pt with allergic rx - heat stable toxin

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22
Q

diarrhea, muscle weakness, paresthesia, temperature iversion , neuro sxs worse with etoh

A

ciguateria - dinoflagellates, tx mannitol, amutyptyline, benadryl - sxs can last for years, avoid fisha nd etoh

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23
Q

pseudomenbranous enterocoitis

A

c diff

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24
Q

mcc water born diarrhea outbreak in US, backpackers diarrhea

A

giardia- fecal oral - stool w cysts, trophozoites tx metronuudazole

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25
amebiasis- entomeba histolytica
fecal oral, between partners and family- cyst passers- can cause liver cysts or other cysts
26
mcc chronic diarrhea, wasting in AIDS
cryptosporidium- ingestion of oocytes, trophozites attack intestinal membraine- 1 week inculbation- severe diarrhea -
27
tx hemrroids
WASH - warm water, anelgesics, stool softer, high fiber diet
28
non mindline anal fissue (6,12))
IBD, Ca, sexual assault
29
nexus criteria
no midline tenderness, no neuro, no distracting injury, no AMS or intox
30
NTI is CI in what kind of trauma
maxiollofacial trauma, basilar skull fx, apnea
31
hemothorax with >1500 mL out
thoracotomy
32
blood loss from femur fx, pelvic fx?
1L, 1.5-2L
33
class 1 shock
< 15% normal vitals
34
class 2 shoc
15-30, decc cap refill, inc HR, narrow pulse pressure
35
class 3 shock
30-40%, shock- BP drops, AMS
36
class IV
> 40%, HR 130-140s
37
GCS 15
eyes open, command, pain, no rxn, verbal oritented, confused, inappropr, uninteligable, no sound, motor obeys, lozalies withdrawls flexion extension no reaction
38
Ed thoracotomy indication
penetrating chest and signs of life prehospital or ED or cardiac activity in ED, liberal indication abdominal trauma and cardiac activity requiring aortic cross clamp aorta, blunt chest trauma with loss of VS in ED
39
trauma in pediatrics
half of deaths, head injury most common lethaal, large occiput, obligate nose breather <6 mo, inc tongue, anterior larynx, narrow sublogittc area
40
age for pediatric cric
not less than 8
41
ETT size determination
age +16 / 4
42
Ped EET depth of insertion
3x tube size
43
plan if ET intubation impossibl ein peds
transtracheal jet ventilation LMA
44
location of broken neckin kids and elderly
c1-c2, in kids cord injuries are more common
45
2nd mcc death in kids < 5
burns, inhalation
46
shaken baby syndrome
diffuse cerebral injury w edema, retinal hemorrhage,,
47
suspcious findings for child abuse -
stocking glove burns, immersion, contusions on buttocks genetalia, neck bface low back, fractures < 1 yr, posterior rib, nonlinear skull fx, long bone fx, various stages of bruises
48
trauma and pregnancy - signs of demise, leading cause of mother death?>
injuries to spleen, RP, uterus from seat belt, uterus rises out of pelvis at 12 weeks, signs of demise - loss of mvmt, absent heart stones, extended extremities, blunt trauma leading cause of maternal death
49
leading cause of fetal death
abruptio placentae- minor fall, airbag, bump onto counter, can have neg vaginal bleeding (conceleaed abruption) get abdominal pain and uterine tetany
50
kleihaue betke
fetal nucleated RBC in maternal circulation
51
common complication of abruptio placentae
DIC
52
recommendation for all blunt trauma paitnes > 20 weeks
external fetal monitoring, fetal tocodynatomary, > 8 contractions per hour for first 4 hours- concern for delivery - abruption , if 3-7 contractions, admit, <3 discharge
53
signs of fetal distress >23 weeks
tachycardia, brady, decelerations, - C section
54
nexus head ct
no intox, gcs 15, no skull fx, nonfoca exam, no anticoag, normal Mental status
55
complications of temporal skull fx
middle meningeal artery- epidurla hematoma
56
type of skull fx that can dc
linear, non depressed
57
difference between moderate and deep sedation
purpuseful repsonse to verbal or tactile vs repeated or painful
58
ASA classes
1- healthy 2 - mild systemic like asthma or DM 3- pneumonia, seizure - severe systemic 4- high risk, threat to life- renal failure, chf, sepsis - may require consult anesthesia
59
JC restraint requireiemtns
evaluate within hour of restraints, monitor for injuyr, only orderd by practitioner, suffocation mcc death, restraint can be ordered 4 hours at a time, kids is 2 hours, reasses and document restartins eveyr 15 mins, readidiness or d/c, continous obs by sitter
60
true positive rate
sensitivity- will find everyone who has it
61
true negative rate
specificity - will find everyone who doesnt have it
62
disaster triate- START techinique
simple triage, rapid treatment - quick asses RPM - respiration, perfusion, mentla status green- walking wounded black - morgue, red- life thratening- yellow- serious but stable
63
emergenecy medicial conditoin - emtala
1- could place health of indivudual in jeopary, cause impairemnt or dysfunx- done by a qualified personall- not just ED doc - with minors- emtala applies , once determind must be stabiized or transfered
64
mandatory reporting example
child abuse, NAT - report any suspicioun, consider FTT and psychological truma, usaly < 5 yo, seen wih delays of care, frequent vague complaints, also COMMUNICABLE DISEASE, highly contageous TB measels anthrax, violent acts child buse, elder abuse, domestic/exual abuse, firearms, deaths
65
decision making capaity -
complehension of options, awaarenes of ocnsequences, comprenshioon os risk and benefits - patient with this has right to refuse treatment , not the saame as COMPETENCE - legal term requiring court ruling
66
5 elements of informed consnet
intention, hamrs and benefits, alterenative, harms na benefits of laternative, harms and benefits of doing nothing - must have DMC to give IC
67
emergency exception to IC
need to alleviate severe pain, risk of D and D, find or document abscence of surrogate and why not enough time to find one
68
leaving AMA
establsuh capaicyt, risks and benefits, try to contacat family, signs AMA documents - provide any possible treatment
69
malpractice fundamentals
1- duty to treat, standard of care, proximate cause/causation, damages , medical malpractice doesnt cover EMTALA

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