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Royal College: Emergency Medicine > Cardinal Presentations > Flashcards

Cardinal Presentations Flashcards

This deck covers Chapters 9-32 in Rosens, compromising all of the cardinal presentations. (104 cards)

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1
Q

List 2 outpatient and 2 inpatient antibiotic regimens for PID

A

Outpatient

  • Doxycycline + Ceftriaxone + Flagyl
  • Levofloxacin + Flagyl

Inpatient

  • Clindamycin + Gentamycin
  • Cefoxitin + Doxycycline
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2
Q

List 4 risk factors for C. difficile

A
  1. Recent hospitalization
  2. Recent antibiotics
  3. LTC facility
  4. Antacid use
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3
Q

List 5 reasons why you may not be able to visualize the optic fundus on fundoscopy

A
  1. Hyphemia
  2. Cornea scar
  3. Cataract
  4. Miotic pupil
  5. Vitreous hemorrhage
  6. Retinal detachment
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4
Q

What is the definition of massive hemoptysis? What is the usual source?

A

>500 cc/24h or >100 cc/hr

  • Bronchial artery (90%)
  • Pulmonary artery
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5
Q

List 6 risk factors for renal colic

A
  1. Male
  2. FHx
  3. Previous stone
  4. Dehydrated
  5. Hot climates
  6. Metabolic disturbance
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6
Q

List 8 causes of neuromuscular weakness that are life-threatening

A
  1. Stroke
  2. GBS
  3. MG
  4. LES
  5. Tick
  6. Botulism
  7. Tetanus
  8. Organophosphates
  9. ALS
  10. Pufferfish
  11. SEH
  12. SEA
  13. Transverse myelitis
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7
Q

What enzyme reduces met-HgB?

A

NADH MetHgB reductase

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8
Q

List 5 risk factors for serious abdominal pathology

A
  1. Age >60
  2. Previous OR
  3. Recent OR
  4. Fever/Rigors
  5. IBD
  6. Cancer
  7. Chemotherapy
  8. Immunocompromised
  9. Child-bearing age
  10. Recent immigrants
  11. Language barrier
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9
Q

List 5 causes of cervical motion tenderness

A
  1. PID
  2. Ovarian torsion
  3. Ovarian cyst
  4. TOA
  5. Ectopic
  6. Endometriosis
  7. Appendicitis
  8. Peritonitis
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10
Q

List 3 BPPV variants and their provocative and curative maneuver

A
  1. Posterior (MCC)
    * Dx: Dix-Hallpike
    * Tx: Epley
  2. Horizontal
    * Dx: Supine roll
    * Tx: BBQ roll
  3. Anterior
    * Dx: Dix-Hallpike
    * Tx: Deep Head Hanging
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11
Q

List 5 risk factors for PUD/Gastritis

A
  1. H. pylori
  2. NSAIDs
  3. Alcohol
  4. Steroids
  5. Smoking
  6. Critical Illness
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12
Q

List 6 complications of vomiting

A
  1. UGIB (Mallory-Weiss)
  2. Aspiration
  3. Esophageal perforation (Boerhaave’s)
  4. Electrolyte abnormalities (HypoCl-/K+)
  5. Metabolic Alkalosis
  6. Dehdyration
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13
Q

List the 5 common causes of any ocular nerve palsy

A
  1. Aneurysm
  2. Diabetes
  3. CVST
  4. Tumour
  5. Trauma

  • MS = CN3
  • MG = CN4 (longest/thinnest and most prone to trauma)
  • ICP = CN6
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14
Q

Describe 6 classic findings when performing the Dix-Hallpike maneuver in someone with posterior canal BPPV

A
  1. Symptomatic when head down
  2. Latency of nystagmus
  3. Geotropic nystagmus (up/rotatory ground)
  4. Nystagmus resolves within 30s
  5. Fatiguable on repeated testing
  6. Direction-changing when sitting up
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15
Q

List 10 causes of hemoptysis

A

Airway

  • FB
  • Bronchitis
  • Bronchiectasis
  • Cancer
  • Trauma

Parenchymal

  • Pneumonia
  • TB
  • Cancer

Vascular

  • PE
  • AVM
  • Pulmonary HTN
  • Vasculitis

Hematologic

  • OAC
  • Coagulopathy
  • DIC
  • Thrombocytopenia

Cardiac

  • Endocarditis
  • Valvular heart disease
  • CHD

Miscellaneous

  • Cocaine
  • SLE
  • Tracheal-arterial fistula (trach)
  • Post-procedural
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16
Q

List 5 red flags with headache

A
  1. Sudden onset
  2. Syncope
  3. Focal deficits
  4. Trauma
  5. Fever
  6. Immunocompromised
  7. Weight loss
  8. Cancer history
  9. Elderly
  10. No history of headaches
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17
Q

List 6 causes of methemoglobinemia

A
  1. Nitrites
  2. Nitrates
  3. Topical anesthetics (lidocaine, benzocaine)
  4. Antibiotics (dapsone, sulfa)
  5. Anti-malarials (quinones)
  6. Antineoplastics (cyclophosphamide)
  7. NADH Met-HgB reductase deficiency
  8. G6PD deficiency
  9. Mothballs
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18
Q

Give 6 categories for causes of central cyanosis

A
  1. Shunt
  2. V/Q mismatch
  3. Diffusion
  4. Low FiO2
  5. Hypoventilation
  6. Hemoglobinopathy
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19
Q

Define orthostatic hypotension

A

5 min supine, stand, measure BP within 2-5 min

>20 mmHg drop in sBP

>10 mmHg drop in dBP

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20
Q

List 3 antibiotics that are 1st line for GAS sore throat and 2 if PCN-allergic.

A

No allergies

  • Pen G IM
  • Pen V PO
  • Amoxicillin PO

PCN Allergic

  • Azithromycin
  • Clindamycin
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21
Q

Give a DDx of 8 items that cause hyperthermia (not fever)

A
  1. Stroke
  2. Seizure
  3. DVT
  4. CHF
  5. MI
  6. Pulmonary edema
  7. Pancreatitis
  8. Crohn’s/UC
  9. Gout
  10. Cancer
  11. Hyperthyroidism
  12. SS/NMS/MH
  13. Transfusion reaction
  14. Drugs
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22
Q

List 4 admission criteria for PID

A
  1. Unable to tolerate PO antibiotics
  2. Failure of PO antibiotics
  3. Pregnant
  4. Toxic
  5. TOA
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23
Q

List 5 critical diagnoses that cause pelvic pain in women

A
  1. Ovarian torsion
  2. PID
  3. Ectopic pregnancy
  4. Placental abruption
  5. Uterine rupture
  6. TOA
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24
Q

List 7 critical diagnoses that present with vomiting

A
  1. ICH/Stroke
  2. ACS
  3. Boerhaave’s
  4. Bowel Ischemia
  5. Ovarian/Testicular torsion
  6. DKA
  7. Sepsis
  8. Pregnancy
  9. Organophosphate
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25
Define weakness
Lacking physical strength, energy, or vigor (feeble)
26
List 4 things that shift the oxy-HgB curve to the left (higher affinity for oxygen)
1. Decreased temp 2. Decreased H+ 3. Decreased 2,3-DPG 4. Carboxy-HgB 5. Met-HgB 6. Fetal-HgB
27
List 8 causes of binocular diplopia
**Orbital** * Grave's, Hematoma, Abscess, Entrapment **Oculomotor** * CN3/4/6 palsy **Neuro-muscular** * GBS, Tick, LES, MG **Brain** * MS, Migraine, Tumour **Vascular** * Aneurysm, Dissection, CVST
28
List the 4 components of the MacIsaac-Centor score
* Fever * Exudative tonsils * No cough * Anterior lymphadenopathy * Age
29
What are 6 requirements for the use of methotrexate for therapeutic abortion?
1. Small (\<3.5cm) 2. BhCG \<5000 3. No fetal heart beat 4. Hemodynamically stable 5. Not ruptured 6. Good follow-up
30
After what week in pregnancy is a pelvic exam contraindicated without an ultrasound to rule out previa?
20 weeks
31
List 6 factors that increase mortality in LGIB
1. Age \>70 2. Male 3. Transfused 4. Intestinal ischemia 5. OAC use 6. Comorbid
32
What are the three main categories for causes of jaundice? Give a DDx for 5 for each.
**Overproduction** 1. Hemolysis 1. Hemoglobinopathy 2. Membranopathy 3. Enzymopathy 2. Sepsis 3. ABO incompatibility 4. Breast milk jaundice 5. Breastfeeding jaundice 6. HEELP syndrome **Hepatocellular** 1. Infectious (Hepatitis) 2. Ischemic 3. Drugs (Tylenol, EtOH, etc.) 4. Autoimmune 5. Metabolic (Gilbert, Wilson) 6. Budd-Chiari **Obstructive** 1. Cholangitis 2. Choledocholithiasis 3. Choledochal cyst 4. Biliary atresia 5. Biliary stricture 6. Cancer 7. CF 8. Sepsis
33
List 4 treatment options for stable abnormal uterine bleeding
1. OCP 2. Progestin-only OCP 3. Estrogen IV 4. NSAIDs 5. TXA 6. Lupron
34
How much do HR and RR increase with fever?
HR = 10 bpm/degree RR = 5 bpm/degree
35
List 6 'can't miss' diagnoses for sore throat
1. PTA w/ airway compromise 2. RPA w/ airway compromise 3. Epiglottitis w/ airway compromise 4. Croup w/ stridor at rest 5. Lemierre's 6. Ludwig's 7. Angioedema 8. Anaphylaxis 9. ACS with referred pain
36
Give a DDx of 8 for altered mental status
**DIMES** * **D**rugs (BZD, opiates, sedatives, EtOH, toxin) * **I**nfection (sepsis, CNS infection) * **M**etabolic (hypoglycemia, hypoxia, hepatic/renal failure) * **E**ndocrine (adrenal insufficiency, hypo/hyperthyroid) * **S**tructural (mass, bleed, stroke)
37
List 5 critical causes of hemoptysis
1. PE 2. Tracheoinominate fistula 3. Aortotracheal fistula 4. DIC 5. Post-procedural
38
List 4 inclusion criteria for the Ottawa SAH Rule.
**Inclusion** * Age \>15 * Max intensity with 1hr * Non-traumatic * GCS 15 **Rule:** ANT LEaF * **A**ge \>40 * **N**eck stiffness * **T**hunderclap * **L**OC * **E**xertional * **F**lexion limited
39
List 5 categories of Type 1 and Type 2 respiratory failure
**Type 1 (Hypoxemic)** 1. V/Q mismatch 2. Shunt 3. Low FiO2 4. Diffusion 5. Hypoventilation 6. Hemoglobinopathy **Type 2 (Hypercarbic)** 1. Hypoventilation 2. Neuromuscular 3. Obstructive 4. Chest wall disorder 5. Decreased gas exchange area
40
List 4 indications for OR with a GI bleed
1. Hemorrhage despite endoscopic therapy 2. 4 units pRBCs within 1 hr 3. Indication for surgery as the cause of bleed (perf) 4. Life-threatening hemorrhage despite resuscitation
41
List 5 indications to get a CT scan after a seizure
1. First seizure 2. Age \>65 3. \>15 minutes 4. Focal neuro deficits 5. Persistently altered 6. Immunocompromised 7. Trauma history 8. Cancer history
42
Give 4 causes of invasive and non-invasive infectious diarrhea
**Invasive** 1. E. coli H157:07 2. Yersinia 3. Campylobacter 4. Shigella 5. Salmonella **Non-Invasive** 1. ETEC 2. Vibrio vulnificus 3. Vibrio cholera 4. C. diff 5. C. perfringes
43
List 6 red flag symptoms for constipation
1. Fever 2. Anorexia 3. Weight loss 4. Blood in stool 5. Anemia 6. Nausea/Vomiting 7. Onset \>50yo 8. FHx of colon cancer
44
List 5 causes of persistent altered mental status after seizure
1. NCSE 2. Bleed 3. Meningitis 4. Hypoglycemia 5. Drug toxicity 6. Psychogenic 7. Migraine 8. Transient global amnesia 9. Metabolic encephalopathy
45
List 8 risk factors for short term risk of serious adverse outcome following syncope
1. No prodrome 2. Palpitations 3. Long duration 4. Exertional 5. Seated at onset 6. Age \>65 7. Male 8. Hx of arrhythmia 9. Hx of structural heart disease 10. FHx of sudden cardiac death **San Francisco Rule (CHESS)** 1. **C**HF 2. **H**CT \<30% 3. **E**CG changes 4. **S**OB 5. **S**BP \<90 mmHg
46
What is the triad of fulminant hepatic failure?
1. Jaundice 2. Encephalopathy 3. Coagulopathy
47
List 3 causes of seizure in a patient with HIV
1. Toxoplasmosis 2. Cryptococcus 3. CNS Lymphoma 4. PML 5. HIV Encephalopathy 6. CMV Encephalitis 7. Brain abscess 8. TB
48
Provide the DSM-5 criteria for delirium (5)
* Acute and fluctuating * Alterations in attention/awareness * Alterations in cognition * Due to GMC or substance * Not due to dementia
49
What is the San Francisco Syncope rule?
**CHESS** * **C**HF * **H**CT \<30% * **E**CG changes * **S**OB * **S**BP \<90 Any of the above predicts adverse outcome at 7 days Sensitivity in derivation = 96%; in validation = 90%
50
List 5 first-line agents for migraine treatment
1. Triptans 2. NSAIDs 3. Metoclopramide 4. Prochlorperazine 5. Dexamethasone
51
List 5 causes of non-neurologic weakness
1. Dehydration 2. Electrolyte/Glucose abnormalities 3. Anemia 4. MI 5. Shock 6. Infection 7. Mitochondrial dysfunction (sepsis/toxin) 8. Sedation (toxins)
52
When would you consider starting someone on an anticonvulsant after their first seizure?
High likelihood of recurrence: * Todd's paralysis * Partial seizures * Status epilepticus * HIV * Previous CNS surgery Keppra 250 mg PO BID
53
What is the Canadian Syncope Risk Score?
**Clinical** * Vasovagal predisposition * sBP \<90 or \>180 (2) * Heart disease **Investigations** * QRS \>130 ms * Axis deviation * QTc \>480 ms * Troponin AbN (2) **Diagnosis** * Vasovagal (-2) * Cardiac (2)
54
Define syncope
A sudden, transient LOC with spontaneous recovery
55
What are 2 indications to treat Met-Hgb? How do you treat Met-HgB? What is the mechanism of action of methylene blue?
**Indications:** * Symptomatic * \>30% **Dose & Mechanism:** * Methylene Blue 1-2 mg/kg * via NADPH to leukomethylene blue (LMB) * LMB reduces MetHgB to HgB
56
List 5 ototoxic drugs
1. Aminoglycosides 2. Lasix 3. Alcohol 4. ASA 5. Deferoxamine 6. Anticonvulsants 7. Quinine 8. Chemotherapy
57
List 4 suppurative and 4 non-suppurative complications of GAS sore throat
**Suppurative** * PTA * RPA * Lemierre's * Mastoiditis * Cervical lymphadenitis **Non-suppurative** * Scarlet fever * Rheumatic fever * Glomerulonephritis * PANDAS
58
What is a normal A-a gradient?
\< 15 mmHg
59
List 4 indications to admit someone following syncope
1. Chest pain 2. Dyspnea 3. CHF 4. Valvular disease 5. AbN ECG
60
List 7 critical diagnoses that present with back pain
1. Aortic dissection 2. ACS 3. Pneumothorax 4. AAA 5. Spinal fracture with cord involvement 6. Cauda equina 7. SEA 8. SEH
61
List 5 causes of an adnexal mass
1. Ovarian tumour 2. Ovarian cyst 3. Ovarian torsion 4. TOA 5. Ectopic pregnancy
62
List 3 ways to stop bleeding in a tracheoinominate fistula
1. Trach balloon 2. Foley 3. Finger
63
Give 8 critical diagnoses causing coma
**DIMES** **Drugs** 1. Opioids 2. Hypoglycemic agents **Infection** 1. Sepsis **Metabolic** 1. CO 2. MetHgB 3. Asphyxiants **Endocrine** 1. Hypoglycemia 2. Hyperglycemia 3. Adrenal insufficiency **Structural** 1. Stroke 2. Bleed
64
List 7 precipitants of hepatic encephalopathy
**BEDRAIL-C** 1. **B**leeding 2. **E**lectrolyte AbN 3. **D**rugs (Opiates/Sedation) 4. **R**enal failure 5. **A**lcohol withdrawal 6. **I**nfection 7. **L**arge protein meals 8. **C**onstipation
65
List 5 critical diagnoses for infectious fever
1. Pneumosepsis 2. Peritonitis 3. Meningitis 4. Lemierre's syndrome 5. CVST 6. Septic shock
66
List 5 triggers for migraine
1. Caffeine 2. Chocolate 3. Stress 4. Lack of sleep 5. Menses 6. Weather changes 7. Alcohol
67
List 5 causes of peripheral neuropathy
1. Diabetes 2. Compression 3. Heavy metals 4. Trauma 5. Malignancy 6. Vasculitis 7. B12 deficiency 8. Alcohol 9. HIV 10. Critical illness
68
List the components of triple therapy for H. pylori
1. Amoxicillin 2. Clarithromycin 3. PPI
69
List 6 principles of neuroprotective resuscitation
1. HOB 30 2. Remove constricting items from neck 3. Avoid hypoxia/hyperoxia 4. Avoid hypo/hypercarbia 5. Avoid hypo/hyperglycemia 6. Avoid hyperthermia 7. Avoid hypotension 8. Prevent and treat seizure
70
List 6 indications for intubating a patient with weakness and ventilatory insufficiency
1. Hypoxia 2. Decreased LOC 3. Unable to handle secretions 4. Increasing CO2 5. FVC \<20 cc/kg 6. MIP \<30 cmH2O 7. MEP \<40 cmH2O
71
What are the components of the CAM score for delirium?
Acute/Fluctuating **AND** Inattentive **AND** Disorganized **OR** Altered
72
List 7 tests to order in pediatric jaundice
1. CBC 2. Smear 3. Bilirubin 4. Coombs 5. G6PD 6. TSH 7. Ultrasound 8. +/- septic workup
73
List 7 risk factors for a 'high-risk' GI bleed
1. Advanced age 2. ASA, NSAIDs, Steroid, OAC use 3. EtOH abuse 4. Smoker 5. Cirrhosis 6. PUD 7. AAA repair 8. Comorbid
74
List 6 syncope mimics
1. Seizure 2. Hypoxia 3. Hypoglycemia 4. Narcolepsy 5. Toxin 6. Psychogenic
75
List 4 conditions that increase the risk of neurotoxicity from unconjugated bilirubinemia
1. Hemolysis 2. Hypoalbuminemia 3. Acidosis 4. Drugs that compete for albumin binding
76
What is the definition of status epilepticus? Refractory status? Super-refractory status?
**Status Epilepticus** * \>5 min or 2 seizures without full recovery between **Refractory Status** * Seizing despite BZD + 1 AED (often Dilantin) **Super-refractory Status** * Seizing 24h+ despite anesthetic therapy * Propofol, Midaz, Barbituates
77
What is a contraindication to methylene blue? How would you treat someone with the contraindication?
Contraindicated in G6PD If Met-HgB + G6PD: ascorbic acid, exchange transfusion/HBO
78
What are the components of the MMSE?
**ORArLL 23 RWD** * **O**rientation * **R**egistration * **A**ttention * Recal**L** * **L**anguage * Identify **2** objects * Follow **3**-step command * **R**eading * **W**riting * **D**rawing
79
List 4 treatment strategies for hepatic encephalopathy
1. Fix reversible causes 2. Lactulose 3. Flagyl 4. Rifaxamin 5. Low protein diet
80
List the 4 stages of hepatic encephalopathy
1. MCI/Tremor 2. Confusion/Asterixis 3. Stuporous/Clonus 4. Coma/Posturing
81
Provide a DDx of 6 for seizure
1. Syncope 2. PNES 3. Panic attack 4. Cataplexy 5. Tics 6. Migraine 7. Rigors 8. Hypoglycemia 9. Intoxication 10. Thyrotoxicosis 11. Delirium Tremens 12. Tetanus 13. CNS infection
82
List 4 complications of PUD.
1. Perforation 2. Penetration 3. Hemorrhage 4. Obstruction
83
For detecting an IUP, what is the discriminatory BhCG for TAUS and TVUS? What are the U/S findings that confirm an IUP?
**Discriminatory Zone** * TAUS = 6,000 * TVUS = 1,500 **U/S Findings** 1. Gestational sac 2. Yolk sac/fetal pole 3. \>8mm myometrial mantle 4. Bladder juxtaposition
84
List the top 3 causes of post-menopausal bleeding
1. Endometrial cancer/hyperplasia 2. Exogenous hormone use 3. Atrophic vaginitis
85
List 6 findings that are associated with serious eye diagnoses
1. Severe pain 2. Loss of vision 3. Contact lenses 4. Unreactive pupil 5. Corneal opacification 6. Ciliary flush 7. Exophthalmos 8. Immunocompromised 9. Neonate 10. Worsening on treatment
86
What defines a negative LP for SAH?
* No xanthochromia * RBCs \< 2000
87
List 4 mechanisms that can explain diarrhea
1. Osmotic 2. Secretory 3. Inflammatory 4. Motility
88
List 4 characteristics that differentiate peripheral from central nystagmus
**Central** * Vertical * Direction changing * Non-fatiguable * Spontaneous * Downbeating (toward nose)
89
List 4 causes of cauda equina syndrome
1. Trauma 2. Herniation 3. Tumour 4. Hematoma 5. Abscess
90
List 5 types of seizure with special treatment
* Eclampsia * Hypoglycemia * Hyponatremia * Drugs (INH, TCA, ASA) * ICP
91
List 4 cytokines involved in fever production.
1. IL-1 2. IL-6 3. TNF-a 4. Interferon
92
List 8 risk factors for ectopic pregnancy
1. IVF 2. PID 3. IUD 4. Previous ectopic 5. Previous Tubal surgery 6. Previous D&C 7. Smoking 8. Age
93
List 8 critical diagnoses to consider in a patient with syncope.
1. Stroke 2. SAH 3. Arrhythmia 4. MI 5. Severe AS 6. HOCM 7. Tamponade 8. Dissection 9. AAA 10. PE 11. Ectopic 12. Hemorrhage
94
List 5 causes of peripheral vertigo and 5 causes of central vertigo
**Peripheral** 1. BPPV 2. Labyrinthitis 3. Vestibular neuritis 4. Meniere's 5. AOM 6. Acoustic neuroma **Central** 1. Stroke 2. Tumour 3. Vestibular migraine 4. MS 5. Meningitis 6. Toxin (EtOH, Ketamine)
95
List 5 contraindications to OCP
1. Smoking 2. Age \>35 3. Migraine with focal symptoms 4. VTE 5. HTN 6. Ischemic heart disease 7. Stroke 8. Liver disease 9. Breast cancer 10. Pregnancy
96
List 5 reasons to get stool cultures in someone with diarrhea
1. Symptoms \>2 weeks 2. Fever 3. Severe symptoms 4. Immunocompromised 5. Recent antibiotics 6. Recent hospitalization 7. Bloody stool
97
What are the minimum criteria to diagnose PID?
**Minimum** * Sexually active female * Pelvic pain * Adnexal tenderness/CMT **Additional Criteria** * Mucopurulent cervical discharge * Gonorrhea/Chlamydia cultured * WBCs on microscopy * Fever * Elevated ESR/CRP
98
List 3 populations who should receive Thiamine 100 mg IV on spec
1. Malnourished 2. Alcohol dependence 3. Hyperemesis
99
List 8 critical diagnoses causing dyspnea
1. Anaphylaxis 2. Obstruction 3. Epiglottis 4. Tension PTX 5. Pulmonary edema 6. PE 7. Pneumosepsis 8. ACS 9. Tamponade 10. DKA 11. Toxin (CO, ASA)
100
List 5 causes of monocular diplopia
1. Iridodialysis 2. Refractive error 3. Lens dislocation 4. Cataracts 5. Corneal scar 6. Conversion disorder
101
List the results from the HINTS exam that would point to peripheral cause
* HI - catch up saccade * N - unilateral, non-direction changing * TS - no skew deviation
102
What is the PALM-COINE in relation to abnormal uterine bleeding?
**PALM - Structural Causes** * Polyp * Adenomyosis * Leiomyoma * Malignancy **COINE - Non-Structural Causes** * Coagulopathy * Ovulatory dysfunction * Iatrogenic * Not yet classified * Endometrial
103
Give 5 categories for causes of peripheral cyanosis
1. Low CO 2. Cold environment 3. Venous occlusion 4. Arterial occlusion 5. Flow redistribution
104
List the 6 components of a slit-lamp exam
1. Lashes/Lacrimals 2. Sclera/Conjunctiva 3. Cornea 4. Iris 5. AC 6. Lens

Royal College: Emergency Medicine (25 decks)

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