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Flashcards in EM Surg Uworld Deck (78):
1

eschar causes compartment syndrome

do escharotomy
if Sx don't improve then fasciotomy

2

lithium in pregnancy

ebstein anomaly
malformed inferiorly attached tricuspid valve
causes right ventrilce to become part of right atrium

3

lithium in second or third trimester

goiter
transient neonatal Neuromuscular dysfunction

4

Tx tourette

risperidone

5

Sx iron poisoning

abdominal pain, comiting, diarrhea, hypotensive shock with reflex tachycardia
metabolic acidosis

6

Dx findings for iron poisoning

anion gap metabolic acidosis and radiopaque pills

7

Tx iron poisoning

whole bowel irrigaiton
deferoxamine
supportive ABC

8

aspiritn OD

tinnitus, fever, hyperapnea (respiratory alkalosis) and metabolic acidosis

9

acute OD of vitamin A

nausea vomiting and blurry vision
can lead to pseudotumor cerebri (ICP)

10

vit D toxicity

hypercalcemia: n/v confusion, polyuria and polydipsia

11

vit K toxicity

hemolytic anemia and hyperbilirubinemia in infants

12

when to kids have imaginary friends

2-6 years old

13

how does NaHCO3 help with TCA OD

sodium alleviated depressant action on myocardial Na channels

14

signs of TCA OD

mental status changes
seizures and resp depression
sinus tachy, hypotension
prolonged PR QRS QT
arrhythmias
dry mouth, blurred vision, dilated pupils
urinary retention, flushing, hyperthermia

15

Tx TCA OD

O2
IV
activated charcoal if within 2 hours
IV NaHCO3 for QRS widening or arrhythmia

16

methanol toxicity

nausea, HA vomiting, epigastric pain
can cause vision loss and coma

17

what ingestion causes extremely low bicarb and metabolic acidosis

methanol ingestion and ethylene glycol ingestion

18

hyperemic optic disc

methanol ingestion

19

what causes heat stroke

inadequate/failure of thermoregulation

20

screening serum lead is elevated in child, next step

measure venous lead

21

when is chelation Tx given for lead poisoning

>45 ug/dL

22

Tx trichotillomania

CBT

23

target rate for rewarming patient with hypothermia

1-2 C/hr

24

benzo OD signs

slurred speech
ataxia
drowsiness

25

what to use of neuroleptic malignant syndrome

dantrolene
then bromocriptine and amantadine

26

what drugs cause neuroleptic malignant syndrome

haloperidol
and aytpicals like risperidone

27

PCP intoxication

hallucinations, dissociative feelings, agitaiton, confusion, pupillary dilation tachy and nystagmus

28

patient beginint to have alcohol withdrawl

give chlordiazepoxide (librium) its a benzo and used for this

29

next step after caustic ingestion

upper GI endoscopy within first 12-24 hours in hemodynamically stable patients

30

if suspect perforation after ingestion caustic material

abcominal XR with water soluble contrast

31

smoke inhalation at risk for

cyanide poisoning and carbon monoxide poisoning

32

Tx cyanide poisoning from inhalation

hydroxocobalamin
Na thiosulfate

33

what induce methemoglobinemia

nitrites

34

acute toxicity cyanide

HA, vertigo, dizziness, hyperventilation,t achy nausea and vomiting
Cv and resp depression
coma, seizures, brady, hypotension and cardioresp arrest

35

how do nitrites induce methemoglobinemia

increase ferric iron Fe3+ in circulating Hb and cyanide binds this

36

how does cyanide cause lactic acidosis

inhibit ETC in mitochondria blocking production ATP from ox phos
forces anaerobic metabolism
causes tachypnea and fall in arterial PaCO2

37

effects of heroin and methadone on fetus

IUGR, macrocephaly, SIDS, neonatal abstinence syndrome

38

neonatal abstinence syndrome

first few days of life with irritability, high pitch cry, poor sleeping, tremors, seizures, sweating, sneezing, tachypnea, poor feeding, vomiting and diarrhea

39

signs of ethylene glycol ingestion

flank pain, hematuria, oliguria cranial nerve palsies and tetany

40

lab results in ethylene glycol ingestion

high osmolar ga
high anion gap metabolic acidosis
Ca oxalate crystals in urine

41

Tx for ethylene glycol ingestion

fomepizole which competetively binds alcohol dehydrogenase
NaHCO3 for acidosis
hemodialysis may be required

42

signs opioid withdrawl

n/v/d cramps dysphoria restlessness rhinorrhea, lacrimation, myalgias and arthralgias
mydriasis, goose bumps, hyperactive bowel sounds

43

Tx withdrawl opioid

methadone

44

bath salt intoxication

severe agitation, combativeness, psychosis, delirium, myoclonus and rarely seizures

45

signs of CO poisoning

HA, n/v abdominal pain, confusion, coma
pink hue to skin color

46

Tx CO poisoning

hyperbaric O2

47

which antipsychotic can contribute to hypothermia

fluphenazine because it inhibits the body's shivering mechanism and autonomic thermoregulation

48

Patient with tourrettes is most likely to develop what at later age

ADHD and OCD

49

patient with normal labs but claims to have taken lots of acetominophen 2 hours ago

give activated charcoad if within 4 hours of ingestion

50

how long can acetominophen intoxication be asymptomatic

24 hours

51

signs of benadryl toxicity
anticholinergic

dry mouth
blurry vision
hyperthermia
urinary retention
decreased bowel sounds

52

serotonin syndrome

tachy hyperthermia, inc bowel sounds, HTN, metnal statu changes, dilated pupils and clonus or hyperreflexia

53

what do people die from in TCA Od

TCA induced hypotension

54

what is buspirone

anti anxiety drug

55

Cyanide poisoning

HA vomiting, abdominal pain and flushed skin
inhalational can cause bitter almond odor

56

thoracic GSW and FAST exam was limited due to body habitus
next step

ex lap

57

US shows blood in peritoneal cavity in hemodynamically unstable patient

urgent laparotomy

58

CT shows ruptured aorta with blood collection in adventitial layer
next step

exploratory abdominal surgery

59

hemodynamically stable patient with US showing blood in spleno renal angle after MVA
next step

CT scan

60

chronic growth on hard palate of mouth

torus palatinus

61

patient had last tetanus shot 12 years ago and has deep laceration from rusty barbed wire fence
next step

administer tetanus diptheria toxoid vaccine only

62

when do you give tetanus Ig

if dirty or severe wound in unimmunizaed, or less than 3 tetanus toxoid doses

63

preferred airway in someone with facial lacerations or temporal skull fracture but no significant facial trauma

orotracheal

64

what intubation is contraindicated with basilar skull fractures

nasotracheal

65

MVA accident and BP not responding to IV fluids
abdominal distention and absent bowel sounds

go to surgery ex lap

66

post MVA
persistent pneumothorax despite chest tube placement
subcutaneous emphysema

tracheobronchial performation

67

components of glascow coma scale

eye opening, verbal response
motor response

68

management penile fracture

retrograde urethrogram followed by surgical exploration of penis

69

next step after seeing pneumoperitoneum (air under diaphragm) on CXR

abdominal CT

70

complicaiton of rhinoplasty that results in whistling noise during rsepiration

septal perforation from a hematoma

71

penetrating injury to abdomen

ex lap

72

how to identify splenic injury

abdominal CT with contrast if patient is stable

73

blunt abdominal trauma, FAST is negative
8 hours later has LUQ pain with left shoulder pain and mild nausea, low BP and tachycardia
fluids help a little

splenic injury

74

what is msot sensitive vital sign for blood loss

heart rate

75

abdominal pain that refers to the shoulder

peritonitis and irritation of diaphramg. kehr sign
'

76

which part of bladder is convered by peritoneum

the dome is the only park

77

bladder area most susceptible to rupture from blunt trauma if bladder is distended

dome

78

nasopharyngeal carcinoma is associated with what

EBV
mediterranean or far eastern descent
smoking
nitrosamine consumption (salted fish)