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1
Q

Unidentified pills ingested within 1hr w/ no changing MS, next best step

A

Gastric lavage

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2
Q

When is gastric lavage dangerous

A

Altered MS
Caustic injestion
Acetaminophen OD

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3
Q

How much does gastric lavage remove

A

50% at 1 hr

15% at 2hrs

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4
Q

What is always the wrong answer w/ response to poisoning

A

Ipecac
Cathartics
Forced diuresis
Whole bowel irrigation

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5
Q

Cause of OD is unclear

A

Acetaminophen

Aspirin

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6
Q

MCC death by OD

A

Acetaminophen

Aspirin

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7
Q

Best initial management of OD >1hr w/ Altered MS

A

Naloxone
Dextrose
Thiamine

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8
Q

Is benzo OD fatal

A

No, but acute withdrawal causes seizures

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9
Q

When is charcoal given

A

Anyone w/ pill OD

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10
Q

How much acetaminophen is toxic

A

8-10 grams

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11
Q

How much acetaminophen is fatal

A

12-15 grams

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12
Q

Lab changes in acetaminophen OD

A

Elevated AST, Bili

Abd pain and vomitting

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13
Q

Clearly toxic amount of acetaminophen ingested, next best step

A

NAC

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14
Q

Acetaminophen OD >24hrs, what now

A

Nothing

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15
Q

Can’t tell how much acetaminophen was ingested

A

Get level

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16
Q

Charcoal in acetaminophen OD

A

Give it w/ NAC even if vomitting

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17
Q

Features of Aspirin OD

A

Resp alk → Tinnitus
Metab acid → Hyperventilation
Renal tox and altered MS
Increased anion gap

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18
Q

How does aspirin OD affect lungs

A

ARDS

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19
Q

Rx aspirin OD

A

Alkalinize urine w/ bicarb

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20
Q

ABG in aspirin OD

A

↓ pCO2
↓ HCO3
↑ pH

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21
Q

Fatal consequences of TCA OD

A

Seizures

Arrhythmias

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22
Q

What can prevent seizures in TCA OD

A

Benzos

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23
Q

Best initial test in TCA OD

A

EKG

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24
Q

What is seen on EKG in TCA OD

A

Wide QRS

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25
Main sx in TCA OD
Dry mouth Constipation Urinary retention
26
Rx TCA OD
Na bicarb
27
MCC death in fires
CO poisoning
28
Only way to rx caustic ingestion
Water in high volumes to flush out | Endoscopy to assess degree of damage
29
Hx clues for CO poisoning
Gas heaters, wood burning stoves | Automobile exhaust
30
Presentation of CO poisoning
Dyspnea, lightheadedness, confusion, seizures
31
How does CO poisoning kill you
MI
32
ABG picture in CO poisoning
May be normal Lactic acidosis - Low bicarb - Low pH
33
Most accurate test for CO poisoning
Carboxyhemoglobin level
34
Soot around mouth and nose but not inside
Don't intubate
35
Burns inside mouth
Intubate | 4mL NS per % body surface affected
36
Best initial therapy for CO poisoning
Give 100% O2 | Hyperbaric O2 if severe
37
What is severe CO poisoning
CNS sx Cardiac sx Metabolic acidosis
38
MCC death from burns
Infection
39
What is methemoglobinemia
Hb locked in ferric state | Brown, will not carry O2
40
What can cause methemoglobinemia
Benzocaine and other anesthetics Nitrites and nitroglycerin Dapsone
41
Sx methemoglobinemia
Dyspnea and cyanosis HA, confusion, seizures (altered MS) Metab acid
42
Most accurate test for methemoglobinemia
Methemoglomin level
43
Best initial therapy for methemoglobinemia
100% O2
44
Most effective therapy for methemoglobinemia
Methylene blue
45
What predisposes digoxin toxicity
Hypokalemia
46
MC presentation of digoxin toxicity
GI issues (N/V)
47
Other sx of digoxin tox
``` Hyperkalemia Confusion Visual disturbance Rhythm disturbance Gynecomastia (rare) ```
48
What else causes hyperkalemia
ACEIs, ARBs, BBs, Spironolactone
49
Most accurate test for digoxin toxicity
Digoxin levels
50
Best initial test for digoxin tox
K level and EKG
51
EKG finding in dig tox
Downsloping ST
52
Most common arrhythmia in dig tox
Atrial tachy w/ variable AV block
53
Rx Dig tox
Control K | Digoxin Ab
54
Strongest indication for digoxin Ab
CNS and cardiac involvement
55
Presentation of organophosphate/nerve gas poisoning
``` Salivation Lacrimation Polyuria Diarrhea Bronchospasm (resp arrest if severe) ```
56
Rx organophosphate/nerve gas poisoning
Atropine immediately
57
Presentation of Pb poisoning
``` Abd pain ATN Sideroblastic anemia Wrist drop Memory loss, confusion ```
58
Best initial test for Pb poisoning
Increased free erythrocyte protoporphyrin
59
Most accurate test for Pb poisoning
Lead level
60
Most accurate test for sideroblastic anemia
Prussian blue stain
61
Rx Pb poisoning
Succimer (oral) | EDTA, Dimercaprol (IV)
62
Sx in Mercury poisoning
Oral - CNS | Inhaled - Lung fibrosis
63
Specific CNS sx in mercury poisoning
Nervous, jittery, twitchy, hallucinatory
64
Can lung damage in mercury poisoning be reversed
No
65
Rx Mercury poisoning
Dimercaprol, Succimer
66
Effects of methanol and ethylene glycol poisoning
Intoxication Metabolic acidosis Increased anion gap
67
Rx methanol and ethylene glycol poisoning
Fomepizole | Dialysis
68
Source of methanol poisoning
Wood alcohol Cleaning solutions Paint thinner
69
Source of ethylene glycol poisoning
Antifreeze
70
Metabolite in methanol poisoning
Formic acid/ Formaldehyde
71
Metabolite in ethylene glycol poisoning
Oxalic acid/ Oxalate
72
Presentation of methanol poisoning
Ocular toxicity
73
Presentation of ethylene glycol poisoning
Renal toxicity
74
Initial diagnositic abnormality in methanol poisoning
Retinal inflammation
75
Initial diagnositic abnormality in ethylene glycol poisoning
Hypocalcemia | Enveloped shaped crystals in urine
76
Calculation of serum osmolality
2xNa + BUN/2.8 + Glc/18
77
MC injury from snake bite
Local injury
78
What damages local tissue in snake bites
Proteases and lipses
79
How does snake hemolytic toxin kill you
Hemolysis and DIC
80
How does snake neurotoxin kill you
Resp paralysis
81
Ineffective snake bite remedies
Tourniquets Ice Incision and suction
82
Effective snake bite remedies
Pressure Immobilization Antivenom
83
Presentation of black widow bite
Abd pain | Muscle pain
84
Presentation of brown recluse bite
Local skin necrosis Bullae Blebs
85
Lab tests in black widow bite
Hypocalcemia
86
Lab tests in brown recluse bite
None
87
Rx black widow bite
Calcium | Antivenom
88
Rx brown recluse bite
Debridement Steroids Dapsone
89
Management of dog, cat, human bites
Amoxicillin/Clavulanate | Tetanus vaccine booster if >5yrs since last
90
Organisms in dog/cat bites
Pasteurella multocida
91
Organisms in human bites
Eikenella corrodens
92
What's worse dog/cat bites or human
Human
93
When is rabies vaccine given
Animal has altered MS | Attack was unprovoked by stray that cannot be observed
94
Management of any head trauma causing altered MS or LOC
Head CT first
95
Best initial test in head trauma
Head CT without contrast to look for blood
96
Difference between concussion and contusion
Normal CT in concussion | Ecchymoses in contusion
97
Can you differentiate between subdural/epidural hematomas and concussion without a CT
No
98
Which hematoma types have a lucid interval
Epidural | Subdural
99
Rx concussion
Nothing, wait 24hrs before returning to sports | Observe at home for changes in MS
100
Rx contusion
Nothing
101
Rx Subdural/epidural hematoma
Small - nothing | Large - Intubation, hyperventilation, mannitol, drainage
102
What is the benefit of hyperventilation in hematoma management
Decreases pCO2 Constricts vessels thereby decreasing pressure Bridge to surgery
103
Definition of large intracranial hemorrhage
Compression Herniation Worsening MS or focal findings
104
Who gets PPX for stress ulcers
Head trauma Burns Intubated Coagulopathy
105
Best initial therapy for anyone trapped in a fire
100% O2 for smoke inhalation and CO poisoning
106
Second most common cause of death from burns
Airway burn
107
When to intubate a pt caught in a fire
Stridor Hoarseness Wheezing Burns inside mouth or nasopharynx
108
2nd MCC of death if no airway burn
Fluid loss
109
Burn fluid replaced with
Ringer lactate (NS if it's not there)
110
Body percentages in burns
``` Head - 9 Arms - 9 each Legs - 18 each Chest/back - 18 each Hand - 1 each ```
111
How much fluid is given to burn pts
4mL*%body*kg | Biggest number in answer choices
112
Routinely given to burn pts
Topical abx for infection PPx
113
Risk factors for heat disorders
Exhaustion - Hot outside temperature, Exertion Heatstroke - Hot outside temperature, Exertion NMS - Antipsychotics Malignant hyperthermia - Anesthetics
114
Difference between heat exhaustion and other heat disorders
Heat exhaustion has normal body temp, CPK, K
115
Rx heat exhaustion
Oral fluids and electrolytes
116
Rx heat stroke
IV fluids | Evaporation
117
Rx NMS
Dantrolene or DA agonists | Bromocriptine, cabergoline
118
Rx malignant hyperthermia
Dantrolene
119
When to suspect hypothermia
Intoxicated person with low body temp
120
MCC death in hypothermia
Cardiac arrhythmia
121
Best initial step in hypothermia
EKG
122
EKG in hypothermia
Elevation at J point
123
Management of drowning
Manage airway and administer positive pressure ventilation
124
What happens in salt water drowning
Acts like CHF with wet heavy lungs
125
What happens in fresh water drowning
Causes hemolysis
126
First step in potential cardiac arrest patient
Make sure they're unresponsive | Call 911, activate EMS
127
Next step after confirming cardiac arrest pt is unresponsive and EMS activated
Open airway Rescue breaths Check pulse and give compressions
128
When is precordial thump the answer
Very recent onset (
129
Cause of sudden loss of pulse
Asystole V-fib V-tach Pulseless electrical activity (PEA)
130
What is the role of CPR
Keep pt alive until cardioversion
131
Best initial management of all forms of pulselessness
CPR
132
Therapy for asystole
CPR | Epi
133
MCC sudden death
V-fib
134
Best initial therapy for V-fib
Unsynchronized cardioversion then resume CPR
135
What is unsynchronized cardioversion
Defibrillation
136
Which cardioversions do not have to be synchronized
V-fib | Pulseless V-tach
137
Complete management of V-fib
``` Shock Shock Epi/vasopressin every 3-5min Shock Amiodarone Shock ```
138
First choice medication for V-fib
Amiodarone
139
Management of pulseless V-tach
Same as V-fib
140
Management of stable V-tach
Amiodarone then lidocaine then procainamide | Cardiovert if fails
141
Management of unstable V-tach
Cardiovert several time then meds
142
Features of V-tach
Rate 160-240 | QRS all look identical
143
Definition of hemodynamic instability
CP SOB Hypotension Confusion
144
What is pulseless electrical activity
Heart electrically normal but no motor contraction | Normal EKG, no pulse
145
Causes of PEA
``` Tamponade Tension PTX Hypovolemia, hypoglycemia Massive PE Hypoxia, hypothermia, metab acid K disorders ```
146
Rx pulseless electrical activity
Fluids | Correct underlying cause
147
Sx atrial arrhythmias
Palpitations, dizziness, lightheadedness Exercise intolerance or dyspnea Embolic stroke
148
Irregularly irregular heartbeat
A-fib
149
MC arrhythmia in USA
A-fib
150
Difference between flutter and fibrillation
Flutter is regular, goes back to sinus or deteriorates to fib
151
Rx unstable atrial arrhythmias
Synchronized cardioversion | - Prevents deterioration into v-tach or v-fi
152
Difference in cardioverting chronic vs acute a-fib
Chronic needs anticoagulation first
153
What is chronic a-fib
Lasting > 2 days
154
Best initial therapy for fib and flutter
Control rate with BBs, CCBs, or digoxin
155
Most appropriate next step in fib and flutter after rate control
Warfarin, digatraban or rivaroxaban
156
Only CCBs that can block the AV node in atrial arrhythmias
Diltiazem | Verapamil
157
What can atrial rhythm problems cause
Acute pulmonary edema
158
Pt w/ CHADS 1 or less management
Aspirin only
159
CHADS
``` CHF/Cardiomyopathy HTN Age >75 DM Stroke or TIA (2pts) ```
160
What does CHADS indicate
What to anticoagulate with 1 or less = aspirin 2 or more = warfarin
161
Presentation of SVT
Palpitations in a pt who is hemodynamically stable
162
Best initial therapy of SVT
Vagal maneuvers Adenosine BBs, CCBs, digoxin
163
Cure for SVT
Radiofrequency catheter ablation
164
When to consider WPW
SVT alternating with V-tach SVT getting worse after diltiaze, or digoxin Delta wave on EKG
165
Most accurate test for WPW
EP studies
166
Acute therapy for WPW
Procainamide or amiodarone only if WPW currently presenting with arrhythmia
167
Chronic therapy for WPW
Radiofrequency ablation is curative
168
What is multifocal atrial tachy associated with
Chronic lung disease like COPD
169
Rx MAT
Treat underlying disease | Treat MAT like A-fib but no BBs
170
Next step in asymptomatic brady
EKG - differentiate from pathologic
171
Rx asymptomatic sinus brady
None
172
Best initial therapy for symptomatic brady
Atropine
173
Most effective therapy for symptomatic brady
Pacemaker
174
Management of first degree AV block
Same as sinus brady
175
Who gets Mobitz I
Sign of normal aging
176
Management of Mobitz I
No Rx if asymptomatic
177
Management of Mobitz II
Pacemaker, just like type III block
178
MCC death 72hrs surrounding acute MI
Ventricular arrhythmia
179
Test for recurrence of ventricular arrhythmia after MI
Echo
180
Pt with multiple syncopal episodes has v-tach, EKG shows v-tach, stress test NL, next step
Pacemaker
181
Best test for detecting source of ventricular arrhythmia
EP studies

Step 2 CK (21 decks)

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