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Emergency Medicine Pearls > EM EOR > Flashcards

EM EOR Flashcards

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1
Q

Which ligaments are injured in an inversion injury of the ankle?

A

anterior talofibular is most frequently damaged.

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2
Q

Which ligaments are injured in an eversion injury of the foot?

A

Deltoid ligaments- they are so strong they often cause an avulsion fracture of the medial maleolus.

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3
Q

Sx of hypercalcemia (or high PTH)?

A

Bones, stones (renal), groans (abdominal), moans (psychiatric).

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4
Q

ST elevations in II, III, AvF

A

Inferior MI

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5
Q

ST elevations in I, AvL

A

Lateral MI

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6
Q

ST elevations in V1, V2, V3, V4

A

Anterior MI (V1-V2 could be septal)

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7
Q

ST elevations in V5, V6

A

Low lateral MI.

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8
Q

When are cardiac enzymes elevated? For how long? When will they peak?

A

Troponin- 3-12 hours to become elevated, remain 4 -7 days. Peak is 12 hours.

CK- Elevated 3-12 hours after insult, remains for 48-72 hours. Peak is 24 hours.

Myoglobin elevates in 1-4 hours.

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9
Q

When is IV thrombolytic therapy indicated in MI?

A

MI 1 mm in 2+ contiguous leads
New LBBB
Chest pain that does not resolve with nitroglycerin

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10
Q

causes of pinpoint pupils

A

Pontine hemorrhage, cholinergics, opioids, clonidine

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11
Q

Antidote for Benzodiazapine overdose:

A

Flumazenil (anexate)

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12
Q

What factors are most important for survival of an out of hospital cardiac arrest?

A

Defibrillation and CPR

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13
Q

RhoGAM dose

A

50 micrograms if

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14
Q

Most common cause of acidosis in nonhospitalized, nondiabetic patients…

A

lactic acidosis

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15
Q

most reliable clinical technique for confirming ET tube placement

A

Direct visualization of passing vocal cords (1), then CO2 detection device.

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16
Q

What factors increase risk for MAT (multifocal atrial tachycardia)?

A

COPD, theophylline, beta adrenergic agonists.

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17
Q

ST elevations (>1mm) mean…

A

acute myocardial injury

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18
Q

Abnormal Q waves - definition and interpretation

A

Def >2mm wide or >25% of the height of QRS.

Interpretation dead tissue (infarction).

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19
Q

ST elevations in I, AvL, V5, V6

A

High lateral MI

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20
Q

ST depressions in V1-V4

A

Posterior MI (mirror of anterior MI).

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21
Q

Temporal arteritis- management

A

steroids. Consult optho if vision change.

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22
Q

Pregnancy-induced hypertension- definition and treatment

A

PIH is BP>140/90 without proteinuria (preeclampsia) or seizures (eclampsia). Treat with hydralazine.

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23
Q

How to treat pneumocystis pneumonia? What are the side effects?

A

SMP-TSX (mild) or Pentamidine if severe. Pentamidine hypoglycemia, renal impairment, leukopenia, hepatotoxicity…monitor GLUCOSE, BUN, Cr, CBC, platelets, LFTs, calcium

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24
Q

Top priorities in sepsis:

A

1 - Airway and ventilation

2- Fluids

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25
common pathogen from cat bite
P multocida
26
Addison disease (adrenal insufficiency) sx:
hyperkalemia, hyponatremia, hypoglycemia, prerenal (BUN/Cr ratio (high)), anemia. Can cause pneumonia hypotension, tachycardia. Secondary to cancer, autoimmune destruction of adrenals post infection.
27
What is the most common cause of non-traumatic cardiac tamponade?
Metastatic malignancy.
28
Hampdon hump
focal area of hemorrhage or an actual pulmonary infarction- wedge shaped, dense, consolidation on pleural surface (PE)
29
Westermark sign
regional decreased vascularity.
30
Best choices for hypertensive emergency:
1. Sodium nitroprusside (unless renal) | 2. Labetolol
31
Plegmasia alba dolens
"milk leg" is an uncommon presentation of DVT where there is massive ileofemoral thrombosis. The leg is white or pale with loss of PT and DP pulses.
32
Most common cause of LBO in adults?
Carcinoma
33
Nipple line corresponds with which dermatome?
T4
34
Pseudomonas pneumonia presentation:
hypoxic, confused, fever, sepsis, systemic illness, lower lobe infiltrates on CXR.
35
CURB65 - do it
1 point each: - Confusion - BUN>19 - RR>30 - SBP
36
extrapulmonary symptoms of mycoplasma pneumonia
bullous myringitis (serous or hemorrhagic blebs on the TM), rash (erythema multiforme), neurologic sx, arthritis, and arthralgia.
37
Most reliable MI symptom
Retrosternal chest discomfort that is described as pressure or squeezing as opposed to frank "pain"
38
ED management of acute asthma
SABA (albuterol) plus steroid
39
Window for tPA?
4.5 hours. 6 hours is the true max but there are major diminishing returns after 3 hours.
40
Most common etiologies of esophagitis (2):
1) GERD | 2) Pills
41
Antibiotics for CAP?
Outpatient: Azithromycin (Macrolide) 500 mg PO 1 day, then 250 mg for days 2-5. OR Clarithromycin, or doxycycline Inaptient: Ceftriaxone 1g plus Azithromycin 500 mg PO/IV OR Cef + Levoquin
42
Antibiotics for HCAP?
HCAP or VCAP: Cefepime (or ceftazidime or pip/tazo/ or if PCN allergy Aztreonam 2g IV tid) + Azithro/cipro/levo/gent PLUS vanc or linezolid
43
How to treat thyroid storm
Hyperthyroidism under stress (infection, surgery, DKA, MI) 1. Beta blockers (propanolol) 2. Propylthiouracil (PTU)- inhibits synthesis of thyroid hormones. MUST BE GIVEN > 1 hour before iodide to prevent oxidation of iodide. 3. Iodide- inhibits the release of pre-formed thyroid hormone.
44
Pulmonay Embolism on EKG
S1Q3T3- Prominant S wave in lead I, Q and T waves INVERTED in lead 3. This will correlate with the clinical picture (sinus tach).
45
Primary trauma survey
``` Airway Breathing Circulation Disability/Neuro (spinal cord injury, GCS) Environmental ```
46
How much fluids do you give for a paediatric patient at risk of circultory collapse after trauma (tachy, BP 80/40)
20mL/kg of crystaloid is where to start.
47
Which metabolic disorder can cause hemiplegia?
Hypoglycemia.
48
Epidemiology: Who gets epidural hematomas
Young adults.
49
Most common mechanism of SDH:
Acceleration-deceleration injuries (MVC)
50
Best medical intervention to lower intracranial pressure after SDH?
nimodipine
51
Thompson-doherty test
Squeeze calf and watch for plantar-flexion of ankle. Diagnostic for achilles rupture.
52
LeFort facial fracture types
Type 1- (floating palate) Horiizontal maxillary fracture separating teeth from upper fade. Passing through inferior wall of maxillary sinus. Type 2- (floating maxilla) Pyramidal maxillary fracture passing through lateral walls of maxillary sinus Type 3- (floating face) cranio-facial dyslocation. Fx passes through nasofrontal suture, maxillo-frontal suture, orbital wall
53
Henoch-Schonlein purpura
Immune-mediated disease of children presenting with triad of abdominal pain, bloody diarrhea, arthralgias, and nonthrombocytopenic rash, esp on lower extremities.
54
What is a torus fracture?
an incomplete fracture of a long bone commonly seen in children. on XR you will see buckling or bulging of the cortex
55
"wrist drop" suggests damage to which nerve?
Radial. usually at the level of the humerus.
56
Fever, sore throat, neck pain, "duck voice" suggests
retropharyngeal abscess.
57
acetaminophen overdose antidote:
N-acetylcysteine (NAC).
58
Differentiate orbital from periorbital cellulitis:
Both have erythema, lid edema. Pain with extraocular movements suggests orbital.
59
Methanol posioning
Ocular toxicity, anion gap, Lactic acidosis, without ketosis
60
Isopropanol poisoning
Mild acidosis, high urine ketones, NO anion gap
61
Ethylene glycol (antifreze) poisoning
High K, wide anion gap acidosis, calcium oxilate crystals in urine
62
Insect bite with pinprick, spreading pain to large area within 1 hour, erythema, a target shaped lesion, muscle-cramp-like spasms
Black widow
63
Estimate body surface area of burn
``` A rule of 9's Head/neck - 9% (note, half anterior, half posterior) Trunk- 36 % (18% each) Arms- 9% each (4.5% a or p) Legs- 18% each Genetalia- 1% ```
64
Most common cause of death in hemophelia A?
ICH- heme A is the most common type BTW.
65
AV block types:
1- just a long pR interval (0.2 sec). Still a QRS for every P. 2. Wenckebach/Mobitz I- long, longer, drop OR Mobitz II- arbitrarily non conducted p waves 3. Ventricles and atria are pumping separately.
66
How to treat digoxin toxicity (note- hypotension, A-V block, high K)
Digoxin immune Fab fragments
67
Chronic B6 deficiency presents as...
Agitation, tremors, hallucinations, fever, tachycardia, nystagmus and CN 6 palsy. What is it called? Wernicke encephalopathy.
68
Dental abscess ER management
Oral penicillin, oral analgesics, dental referral.
69
Who gets TB primarily to the CNS?
Kids
70
You suspect intussiception in a kid...what imaging? Sensitivity?
air-contrast enema. About 70% sensitive.
71
When to hospitalize for RSV?
Confirmed RSV and hypoxia
72
What happens when a person with mono is given amoxicillin?
They get the pettichial rash of the palate that can occur with mono. Except this group will get it 100% of the time.
73
complication of a snake bite?
compartment syndrome.

Emergency Medicine Pearls (1 decks)

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