EM3 M4

Question 1

hypertensive emergency aka aka
define
9 examples

Answer 1

hypertensive emergency aka malignant hypertension aka hypertensive crisis

defined as hypertension with end-organ damage
eg hypertensive encephalopathy, intracerebral hemorrhage, hypertensive retinopathy, heart failure and pulmonary edema, acute coronary syndrome, acute renal failure, aortic dissection, eclampsia

Question 2

5 ocular signs of hypertension

Answer 2

5 ocular signs of hypertension

• arterio-venous nicking
• linear or flame-shaped hemorrhages and cotton wool patches (infarction of nerve layer from arteriolar occlusion)
• copper or silver arteriole discoloration from sclerotic changes
• lipid (hard) exudates from htn permeability changes
• optic disc edema from infarction of optic disk is hallmark of malignant hypertension

Question 3

treat htn in aortic dissection

sublingual nifedipine?

Answer 3

propanolol (bb) and nitroprusside (vasodilator)
with SBP goal 120, or if htn emergency goal 20-25% reduction in 30-60 minutes, or if htn urgency goal reduce over hours to days

NOT sublingual nifedipine – dangerous overshoot BP reduction

Question 4

selectiveness of labetalol propranolol metoprolol atenolol esmolol
which has elimination half life of minutes

Answer 4

labetolol - nonselective beta also alpha blocking
propanolol - nonselective beta block
metoprolol atenolol esmolol - beta 1 selective
esmolol has elimination half-life of minutes

Question 5

treat htn from pheochromocytoma with ___ not ___
why
alternatives

Answer 5

treat htn from pheochromocytoma with Alpha blockade NOT beta blockade… contraindicated till after alpha blockade to avoid paradoxical increase in blood pressure due to antagonism of skeletal muscle vasodilation

nitroprusside CCBs ACEIs alternatives to alpha blockade

Question 6

what is the goal for malignant htn after reducing SBP 25-30% in the first hour

Answer 6

SBP reduction 25-30% in first 30-60min

then 160/100 in 2-6 hours of treatment

Question 7

preferred initial agent for treating hypertensive emergency

Answer 7

esmolol IV

100-500 mic/kg load

Question 8

TF
shingles can present after mechanical trauma
treat in ED

Answer 8

T
shingles can present after mechanical trauma
discharge home with analgesics and acyclovir

Question 9

etiology of stasis dermatitis

Answer 9

impaired oxygen delivery to skin and subcutaneous tissue… gradual and chronic

Question 10

Smallpox incubation period __ weeks.
__ day prodromal phase characterized by ____.
temperature subsides over __ days.
____ precedes skin rash by a day.
Skin rash begins as ____ which become ____ then ____ then ____ then ____ over the course of ____.
lesions occur first ____ then spread to ____.
Distribution is ___ and lesions are all at ____ stage of development.
Death from smallpox is from ____

Answer 10

Smallpox incubation period 1.5-2 weeks.
2-3 day prodromal phase characterized by fever headache backache.
temperature subsides over 2-3 days.
Enanthem over tongue mouth and oropharynx precedes skin rash by a day.
Skin rash begins as small reddish Macule which become Papules then Vesicles then Pustules then Umbilication and Crusting over the course of ~2 weeks.
lesions occur first on Face and Extremities then spread to Cover the Body.
Distribution is Peripheral and Centrifugal and lesions are all at The Same stage of development.
Death from smallpox is from Toxemia from immune complex deposition and HypOtension.

Question 11

Diagnosis:
incubation period 1.5-2 weeks.
2-3 day prodromal phase characterized by fever headache backache.
temperature subsides over 2-3 days.
Enanthem over tongue mouth and oropharynx precedes skin rash by a day.
Skin rash begins as small reddish Macule which become Papules then Vesicles then Pustules then Umbilication and Crusting over the course of ~2 weeks.
lesions occur first on Face and Extremities then spread to Cover the Body.
Distribution is Peripheral and Centrifugal and lesions are all at The Same stage of development.
Death is from Toxemia from immune complex deposition and HypOtension.

Answer 11

Smallpox
incubation period 1.5-2 weeks.
2-3 day prodromal phase characterized by fever headache backache.
temperature subsides over 2-3 days.
Enanthem over tongue mouth and oropharynx precedes skin rash by a day.
Skin rash begins as small reddish Macule which become Papules then Vesicles then Pustules then Umbilication and Crusting over the course of ~2 weeks.
lesions occur first on Face and Extremities then spread to Cover the Body.
Distribution is Peripheral and Centrifugal and lesions are all at The Same stage of development.
Death from smallpox is from Toxemia from immune complex deposition and HypOtension.

Question 12

Erythema Multiforme exists on a spectrum with ___ and ___ and causes include…. such as…

Answer 12

Erythema Multiform/Stevens-Johnson/Toxic Epidermal Necrolysis exist on a spectrum

causes include drugs (sulfa antibiotics, penicillins, barbiturates), viral or mycoplasma infections, recent immunization

Question 13

treat cellulitis vs recurrent cellulitis in diabetic

Answer 13

cellulitis - cover GPCs staph and strep… penicillinase-resistant penicillins (dicloxacillin nafcillin oxacillin)… or 1st generation cephalosporins (cephalexin cefazolin)

recurrent cellulitis in diabetic- cover GPCs and GNRs… broader spectrum… Unsayn (Ampicillin-Sulbactam)

Question 14

when (ages) is seborrheic dermatitis common vs uncommon

treat seborrheic dermititis
topical steroids?

Answer 14

common in infants and elderly
uncommon between infancy and puberty

treat with anti-dandruff shampoo
NOT steroids

Question 15

what rash is associated with an anterior and posterior thorax Christmas-tree pattern distribution

Answer 15

pityriasis rosacea

is associated with an anterior and posterior thorax Christmas-tree pattern rash distribution

Question 16

what color under Woods Lamp UV light?
erythrasma
tinea versicolor
pseudomonas
porphyria cutanea

Answer 16

what color under Woods Lamp UV light?
erythrasma - red/pink
tinea versicolor - green/yellow
pseudomonas - yellow/green
porphyria cutanea - urine orange/yellow

Question 17

to achieve large differences in potency of topical steroid, is it more effective to switch agents or vary the dose of the same agent?

Answer 17

it is more effective to switch agents to achieve large differences in potency of topical steroid… changing dose does not affect potency much

Question 18

how is potency of topical steroid measured

Answer 18

potency of topical steroid is measured by the ability to induce vasoconstriction

Question 19

why are interrupted application schedules of topical steroid use preferred

Answer 19

because tachyphylaxis (vasoconstriction in response to corticosteroid use decreases over time), so on 2 weeks off 1 week preferred

Question 20

____ steroids are to be avoided in pregnant women

Answer 20

Fluorinated steroids are to be avoided in pregnant women

Question 21

is topical Hydrocortisone preferred for thick or thin skin?

Answer 21

topical Hydrocortisone preferred for Thin skin… relatively low potency steroid

Question 22

Treat diffuse pruritus of most of the body
First gen second gen antihistamine?
Topical PO IV?
Anything else?

Answer 22

First gen ok second gen antihistamine lower dose frequency requirement and less sedation but more costly

PO ok can also do IV if necessary, not topical becuase can overdose when spreading over large area hard to estimate total dosing

Baths and soaks too

Question 23

____ are white in color, greasy in texture and can be applied to any body surface area. These characteristics make them the most versatile vehicle. ____ are for acute use only; chronic use leads to drying of the skin. ____ are composed of greases such as petroleum jelly with little water added. ____ can help lubricate skin lesions that are particularly dry. ____ are greaseless mixtures of propylene glycol with water and may or may not contain alcohol. ____ are drying and are best for exudative lesions such as poison ivy but will cause discomfort in denuded areas. ____ are used for dry scaly conditions.

Answer 23

Creams are white in color, greasy in texture and can be applied to any body surface area. These characteristics make them the most versatile vehicle. Creams are for acute use only; chronic use leads to drying of the skin. Ointments are composed of greases such as petroleum jelly with little water added. Ointments can help lubricate skin lesions that are particularly dry. Gels are greaseless mixtures of propylene glycol with water and may or may not contain alcohol. Alcohol-containing gels are drying and are best for exudative lesions such as poison ivy but will cause discomfort in denuded areas. Alcohol-free gels are used for dry scaly conditions.

Question 24

Tzanck preparation can identify the ____ but cannot distinguish among them

Answer 24

Tzanck preparation can identify the herpes viruses but cannot distinguish among them

Question 25

What is the mortality rate of eczema herpeticum What is the presentation and diagnosis of eczema herpeticum

Answer 25

10% mortality with eczema herpeticum (eczema with positive tzank smear for a herpes virus HSV OR VZV)... constitutional symptoms, adenopathy in addition to rash... — so consult dermatology immediately

Question 26

Rocky mountain spotted fever Prodrome of ___ ___ ___ Symtpoms of ___ ___ ___ and rash that is ____ begins ____ and spreads to ____ within __ to __ hours Caused by ____ 95% of patients develop symptoms between ___ and ___ dates A skin biopsy shows ____

Answer 26

Rocky mountain spotted fever Prodrome of fever chills anorexia Symtpoms of headache photophobia myalgias and rash that is non-blanching papular, begins wrists forearms ankles and spreads centripitally up legs and arms to trunk neck face within 6 to 18 hours Caused by Rickettsia Rickettsi 95% of patients develop symptoms between April 1st and September 30th dates A skin biopsy shows necrotizing vasculitis

Question 27

Scabies Treatment is ____. Often this condition occurs in young adults by ____ or in the elderly ____ population. The organism involved does not penetrate the ____ for it relies on ____ for survival. ____ therapy may be needed if ____ develops, suggested by ____. The parasite is a ____ known as ____.

Answer 27

Scabies Treatment is permethrin 5% cream applied to skin for 8-12 hours. Often this condition occurs in young adults by sexual contact or in the elderly hospitalized population. The organism involved does not penetrate the dermis for it relies on oxygen for survival. Antibiotic therapy may be needed if bacterial superinfection develops, suggested by surrounding erythema. The parasite is a mite known as Sarcopetes scabii.

Question 28

Poison ivy/oak is classified as a ____. Although the rash can be expected to resolve on its own (i.e. without medical intervention) in ___ weeks, relief can be facilitated with ____ therapy and/or ____ treatment. The bullae can be drained for ____ purposes, but the tops should not be removed to avoid risk for ____. This condition is due to exposure to ____, which may remain on ____ until it is ____. The allergen ____ present in the bullae of vesicles and so, after the initial washing of the involved site, contact with the rash ____ cause it to spread.

Answer 28

Poison ivy/oak is classified as a allergic contact dermatitis, a type-IV hypersensitivity reaction. Although the rash can be expected to resolve on its own (i.e. without medical intervention) in 1-2 weeks, relief can be facilitated with antihistamine therapy and/or oral steroid treatment. The bullae can be drained for cosmetic purposes, but the tops should not be removed to avoid risk for bacterial superinfection. This condition is due to exposure to allergenic plant oleresins, which may remain on the clothing that the patient was wearing at the time of contact until it is washed. The allergen is not present in the bullae of vesicles and so, after the initial washing of the involved site, contact with the rash does not cause it to spread.

Question 29

____ can cause periodic muscle paralysis and areflexia. ____ can cause tetany and weakness. Low ____ levels can contribute to myocardial dysfunction, CNS symptoms, muscle weakness and bleeding disorders. ____ can cause a clouded sensorium and other neurological deficiencies. Chronic ____ deficiency leads to dermatologic consequences, including patches and plaques of dry, scaly, sharply marginated and brightly red eczematous dermatitis evolving into vesiculobullous, pustular, erosive, and crusted lesions that initially involve the ____ and ____ areas. Progression can involve the scalp, hands, feet, trunk and flexural regions. There may be diffuse alopecia and graying of remaining hair. Nail manifestations may include ____ or ____. A ____ tongue is common, and the oropharynx may reveal ____. Patients with ____ deficiency tend to be photophobic, irritable, and depressed. Treatment of deficiency consists of ____ for ___ weeks.

Answer 29

Hypokalemia can cause periodic muscle paralysis and areflexia. Hypocalcemia can cause tetany and weakness. Low phosphorus levels can contribute to myocardial dysfunction, CNS symptoms, muscle weakness and bleeding disorders. Hypomagnesemia can cause a clouded sensorium and other neurological deficiencies. Chronic zinc deficiency leads to the dermatologic consequences including patches and plaques of dry, scaly, sharply marginated and brightly red eczematous dermatitis evolving into vesiculobullous, pustular, erosive, and crusted lesions that initially involve the perioral and anogenital areas. Progression can involve the scalp, hands, feet, trunk and flexural regions. There may be diffuse alopecia and graying of remaining hair. Nail manifestations may include loss of nails or paronychia. A red, glossy tongue is common, and the oropharynx may reveal aphthous-like ulcers. Patients with zinc deficiency tend to be photophobic, irritable, and depressed. Treatment of zinc deficiency consists of dietary or intravenous zinc salt supplementation for 2-3 weeks.

Question 30

Name 4 skin conditions that cvan be associated with malignancy

Answer 30

Erythema nodosun Acanthosis nogracans Dermatomyositis Pruritis

Question 31

Dermatological anthrax may occur wherever ____. Antibiotics ____ affect the course of local disease. Characteristic lesion is a ____ preceded by a ____ 1 week prior. The organism most likely to cause dermatological anthrax is ____. Mortality rates are ____ than for pulmonary anthrax. Diagnosis of cutaneous anthrax is usually made ____ often after determining ____ while taking the history. In the future, ____ may become widely available and useful to make definitive diagnoses. Treatment for cutaneous anthrax is aimed at preventing the ____ which is complicated by a significantly higher mortality.

Answer 31

Dermatological anthrax may occur wherever slores contact skin. Antibiotics do not affect the course of local disease. Characteristic lesion is a black eschar preceded by a vesiculopapular lesion 1 week prior. The organism most likely to cause dermatological anthrax is bacillus anthrasis. Mortality rates are over 20-30% lower than for pulmonary anthrax. Diagnosis of cutaneous anthrax is usually made on a clinical basis, often after determining patient exposure while taking the history. In the future, PCR methods may become widely available and useful to make definitive diagnoses. Treatment for cutaneous anthrax is aimed at preventing the dissemination of a disease which is complicated by a significantly higher mortality.

Question 32

Regarding urticaria Association with malignancy ____ strong enough to investigate for possible cancer when urticaria of unknown origin exists. ____ are the most common offenders. Nonimmunological urticaria may be caused by ____. Drug-induced urticaria may be ____ or ____. Precipitants of urticaria include...... Drug-induced urticaria ____ represent anaphylaxis or indicate its impending development so ____ are usually not indicated. Treatment may only include stopping ____ and administering ____. Although ____ and ____ are the most common precipitants, drug-induced urticaria has been demonstrated after use of ____.

Answer 32

Regarding urticaria Association with malignancy is not strong enough to investigate for possible cancer when urticaria of unknown origin exists. Panicillins and Opiates are the most common offenders. Nonimmunological urticaria may be caused by degranulation of mast cells. Drug-induced urticaria may be immunologic or nonimmunilogic. Precipitants of urticaria include food allergies, cold induced, malignancy, SLE, familial, exercise, excessive heat, etc. Drug-induced urticaria does not represent anaphylaxis or indicate its impending development so steroids are usually not indicated. Treatment may only include stopping the offending agent and administering antihistamines or other antipruritics as needed. Although penicillins and opiates are the most common precipitants, drug-induced urticaria has been demonstrated after use of an enormous number of medications.

Question 33

Describe the rash lf meningococcemia

Answer 33

palpable petechiae with pale gray centers, usually on the wrists, ankles, flanks, and axilla

Question 34

ITP (immune thrombocytopenic purpura) ____ tranfusion can induce ____ and worsen the patient's condition by increasing ____. ____ is the most feared complication of ITP. ____/mm3 is a commonly cited platelet threshold for ____). The __ is expected to be normal, and intra-articular bleeding ____ a major feature of ITP. ____ are usually indicated for adults

Answer 34

ITP (immune thrombocytopenic purpura) Platelet transfusions can induce inflammatory (autoantibody) response and worsen the patient's condition by increasing platelet destruction. Intracranial hemorrhage is the most feared complication of ITP, (20,000/mm3 is a commonly cited threshold for spontaneous intracranial bleeding). The PT is expected to be normal, and intra-articular bleeding is not a major feature of ITP. Steroids are usually indicated for adults

Question 35

4 classic non-infectious causes of fever | Trauma?

Answer 35

PE CVA thyroid storm neuroleptic malignant syndrome Not trauma... worry more about hypothermia there usually

Question 36

TF | WBC with fever is sensitive and soecific for seriois bacterial infection

Answer 36

F | WBC is a poor discriminatory predictor of serious bacterial infection.

Question 37

``` Strep Most common cause Can viral strep be exudative? What is role of abx Abx of choice ```

Answer 37

Strep The most common bacterial cause is Group A strep. It is very hard to distinguish bacterial versus viral infections based on clinical grounds - viral can be exudative. Antibiotics do not significantly alter clinical course; however, they reduce complications such as rheumatic fever and glomerulonephritis. Penicillin is the treatment of choice.

Question 38

Manage child with stridor Ddx Younger nontoxic appearing is more likely... Manage with... Older high fever ill appearing drooling more likely... Manage with...

Answer 38

A child presenting to the emergency department with stridor most likely has croup, with epiglottitis being a less common – but more serious – etiology. Croup tends to be the etiology in younger, nontoxic-appearing children, who usually have a characteristic barking (“seal”) cough. Treatment of croup includes cool Mist (though the literature supporting this is limited), racemic Epinephrine (which is probably no better than nebulized l-epinephrine), and Steroids. Epiglottitis is a true emergency. It presents in children who are older, with high fever, and who are ill appearing. One of the key clinical features is drooling, which indicates swelling and pain interfering with handling of secretions. Children with epiglottitis are at risk of airway obstruction and need early airway management, preferably while the problem is still urgent (as opposed to during catastrophic deterioration) and preferably in the operating room. Epiglottitis is a bacterial infection treated with antibiotics. A lateral soft tissue X-ray would most likely reveal signs of an inflamed epiglottic region (e.g. thumbprint sign).

Question 39

4 common causes of otitis media

Answer 39

Strep pneumo, h flu, moraxella catarhallis, viral

Question 40

Treat iv drug abuse fever and murmur

Answer 40

Blood cx, iv vanc, admit

Question 41

Treat pregnant uti with

Answer 41

Treat pregnant uti with nitrofurantoin (Macrodantin)

Question 42

Is pyelo managed inpatient or outpatient?

Answer 42

It can be treated as outpatient in uncomplicated adults. Children, pregnant women, elderly and those with co-morbidities need inpatient therapy.

Question 43

16yo M with swollen knee fever rash dx is

Answer 43

Gonococcal arthritis | Arthricentesis to confirm

Question 44

Sperading annular-papular rash from lime is called

Answer 44

Erythema chronicum migrans Sperading annular-papular rash from lime

Question 45

Rocky mountain spotted fever is endemic in ____ and spread by ____

Answer 45

Rocky mountain spotted fever is endemic in the Southeastern United States and spread by ticks.

Question 46

Most common cause of diarrhea in children

Answer 46

Rotavirus and Norwalk virus

Question 47

TF Staph aureus is a common cause of invasive diarrhea Treat diarrheal illness Abx? Antimotility agents?

Answer 47

F Staph is a very common cause of food poisoning due to a toxin but rarely becomes invasive. Most diarrheal illnesses are treated with supportive therapy and rehydration. Antibiotics may worsen the situation depending on the organism. Antimotility agents can also worsen the problem.

Question 48

What is Ludwig’s angina

Answer 48

serious, potentially life-threatening cellulitis or connective tissue infection of the floor of the mouth, usually occurring in adults with concomitant dental infections and if left untreated, may obstruct the airways, necessitating tracheostomy

Question 49

incidence of adult epiglottitis has ___ in recent years, whereas the incidence of pediatric epiglottitis has ___

Answer 49

incidence of adult epiglottitis has Increased in recent years, whereas the incidence of pediatric epiglottitis has Decreased

Question 50

TF | smokers have higher incidence of epiglottitis

Answer 50

T | smokers have higher incidence of epiglottitis

Question 51

diagnostic criteria for Ludwig's angina includes: -spread of cellulitis by ___ not by ___ -___ of glandular tissues -__lateral cellulitis -___ of gangrene large amounts of pus in submandibular space?

Answer 51

diagnostic criteria for Ludwig's angina includes: - spread of cellulitis by Continuity not by lymphatics - Sparing of glandular tissues - Bilateral cellulitis - Presence of gangrene large amounts of pus in submandibular space is typically NOT present

Question 52

Classic symptoms of retropharyngeal abscess include ___.. (looks a lot like ____) In children it is often associated with ___..

Answer 52

Classic symptoms of retropharyngeal abscess include fever neck stiffness drooling toxic appearance (looks a lot like epiglottitis) In children it is often associated with foreign body ingestion leading to perf of the hypopharynx or esophagus

Question 53

infection of the deep space of the fingertip is known as a ___. how is it different from other subcutanous abscesses... treat with ___.

Answer 53

felon, septation, incision procedure - infection of the deep space of the fingertip (subcutaneous abscess) is known as a felon. - different from other subcutaneous abscesses because septa must be divided during incision and drainage - treat with an incision procedure -- avoid pincher surfaces by making incision at ulnar aspect of digits II-IV and radial aspects of digits I and V... incise posterior to digital artery and nerve

Question 54

``` define felon whitlow furuncle carbuncle cellulitis ```

Answer 54

felon - infection (subcutaneous abscess) of deep space of fingertip (pad/pulp of the digit) whitlow - painful lesion of Skin furuncle - skin abscess from staph infection of hair follicle carbuncle - collection of furuncles cellulitis - infection of Skin

Question 55

3 symptoms of digital flexor tenosynovitis | erythema?

Answer 55

tenderness, swelling, pain with passive extension little external evidence other than swelling -- erythema unlikely

Question 56

TF | there is a lyme disease vaccine

Answer 56

T there is a lyme disease vaccine but not widely used

Question 57

which merits urgent ophthalmologic referral in patient with foreign body sensation in the eye, moderate-size linear corneal abrasion or small puncture wound in the globe?

Answer 57

small puncture wound in the globe merits urgent ophthalmologic referral -- e.g. risk of intraocular foreign body

Question 58

ultraviolet keratitis aka classic presentation

Answer 58

ultraviolet keratitis aka sunburn of the cornea classic presentation - very injected conjunctiva, eye pain, photophobia

Question 59

``` TF central retinal vein occlusion central retinal artery occlusion retinal detachment vitreous hemorrhage ``` can call cause conjunctival injection

Answer 59

F | they affect structures deep to the conjunctiva and generally do not cause conjunctival injection

Question 60

corneal dendritic lesion suggests

Answer 60

corneal dendritic lesion suggests | herpetic infection

Question 61

OD and OS in ophtho mean

Answer 61

OD - right eye (think dextro-right) OS - left eye O...ophtho...

Question 62

what is the topical ophthalmic anesthetic commonly used in the ED what organic chemistry classification is it and why is that important?

Answer 62

preparacaine - ED topical ophthalmic anesthetic it is an ester -- imprtantn to ask about anesthetic allergy

Question 63

fluorescein strips will stain tears ___

Answer 63

fluorescein strips will stain tears Orange

Question 64

ophthalmic emergency commonly presenting from movie theater is ___ because ___

Answer 64

ophthalmic emergency commonly presenting from movie theater is acute angle closure glaucoma because pupillary dilation in the dark impairs circulation of aqueous humor

Question 65

TF | oral steroids are indicated for optic neuritis

Answer 65

F | if steroids are to be given for optic neuritis,(debatable) they should be given IV

Question 66

Optic neuritis classically presents with ___, often involving ___. ___ are preferentially affected. Optic neuritis may be the initial manifestation of ___ so ....

Answer 66

Optic neuritis classically presents with visual impairment, often involving color vision. Women are preferentially affected. Optic neuritis may be the initial manifestation of MS so follow-up with a relevant provider is indicated

Question 67

manage unilateral temporal headache associated with myalgias and indurated temporal artery and elevated ESR suggestive of temporal arteritis.... potential sequelae

Answer 67

oral steroids and temporal artery biopsy within a week (biopsy will be positive up to a week after steroid initiation) sequelae include visual loss in affected and contralateral eye, TIA, stroke

Question 68

___ are particularly susceptible to temporal arteritis

Answer 68

elderly women, with polymyalgia, are particularly susceptible to temporal arteritis

Question 69

TF | NSAIDS for temporal arteritis

Answer 69

F | Steroids for temporal arteritis... nsaids do nothing

Question 70

sequelae of temporal arteritis

Answer 70

visual loss in affected and contralateral eye, TIA, stroke

Question 71

TF | ipsilateral diminished auditory acuity with bell's palsy

Answer 71

F maybe taste abnormalities with bell's palsy but other cranial nerve involvement suggests an alternative diagnosis -- brainstem tumor, meningioma, brainstem stroke...

Question 72

Monocular papilledema is called ___. Common causes include ___ or ___. True bilateral papilledema is due to ___

Answer 72

Monocular papilledema is called papillitis. Common causes include optic neuritis or optic nerve tumor. True bilateral papilledema is due to increased intracranial pressure

Question 73

painless complete acute unilateral visual loss think

Answer 73

painless complete acute unilateral visual loss think central retinal artery occlusion

Question 74

normal range of intraocular pressure in humans

Answer 74

10-21mmhg normal IOP

Question 75

treatment of corneal ulcer e.g. from soft contact lens or extended wear contact lens in ED

Answer 75

antibiotic like a fluoroquinolone and close ophtho follow-up within 24 hours (treatment of corneal ulcer)

Question 76

TF | cellulitis may be present with any cellulitis

Answer 76

T | cellulitis may be present with any cellulitis

Question 77

with swollen/reddened eyelids and fever suggesting preseptal (periorbital) cellulitis... concern regarding orbital extension should arise when exam shows what 4 things

Answer 77

concern regarding orbital extension should arise when exam shows - proptosis - visual acuity impairment - pain with EOM - impaired EOM

Question 78

TF | preseptal (periorbital cellulitis) is consistent with pain with extraocular motion

Answer 78

F swelling and redness of eyelids and fever is consistent with preseptal/periorbital cellulitis concern regarding orbital extension should arise when exam shows - proptosis - visual acuity impairment - pain with EOM - impaired EOM

Question 79

TF home topical anesthetic is appropriate for corneal abrasion narcotic analgesia?

Answer 79

F home topical anesthetic should not be prescribed for corneal abrasion as can cause corneal toxicity when recurrently dosed Narcotics better than topical... but think more Cycloplegic agents like Homotropine and Cyclopentolate to reduce ciliary spasm and other OTC and prescription analgesics

Question 80

``` young otherwise healthy obese woman with headache nauea vomiting AFVSS WNL, papilledema, normal noncon head CT dx... causes include... sequelae include... next step is... ```

Answer 80

dx... pseudotumor cerebri causes include... pregnancy, medications (OCPs steroids Vit A) sequelae include... visual field cuts next step is... LP

Question 81

4 classic symptoms of horner's syndrome differential diagnosis workup

Answer 81

4 classic symptoms of horner's syndrome - ptosis miosis enopthalmos anhidrosis differential diagnosis - carotid artery dissection, tumors, CVA, pancoast tumor... workup - CXR (pancoast) CT brain/neck (CVA/tumor), carotid angiogram (carotid dissection)

Question 82

5 possible treatments for acute angle closure glaucoma | mydriatic agents?

Answer 82

``` meiotic agents (pilocarpine) carbonic anhydrase inhibitors topical beta blockers (both above decrease aqueous humor production) mannitol (decrease IOP) iridectomy ```

Question 83

``` what do these eye drops do sulfacetamide pilocarpine Pred Forte Proparacaine Tropicamide ```

Answer 83

``` sulfacetamide - topical abx pilocarpine - meiosis Pred Forte - steroid Proparacaine - topical anesthetic Tropicamide - mydriasis ```

Question 84

___ fracture is a fracture of the neck of the fourth or fifth metacarpal. A ___ fracture is an oblique fracture through the base of the first metacarpal with dislocation of the radial portion of the articular surface. A ___ fracture is a fracture of the distal radius with dorsal displacement and volar angulation. ___ fracture is an extra-articular fracture of the distal radius with volar displacement of the distal fragment. ___ fracture is an intra-articular fracture at the base of a metacarpal.

Answer 84

Boxer’s fracture is a fracture of the neck of the fourth or fifth metacarpal. A Bennett’s fracture is an oblique fracture through the base of the first metacarpal with dislocation of the radial portion of the articular surface. A Colles’ fracture is a fracture of the distal radius with dorsal displacement and volar angulation. Smith’s fracture is an extra-articular fracture of the distal radius with volar displacement of the distal fragment. Rolando’s fracture is an intra-articular fracture at the base of a metacarpal.

Question 85

Salter-Harris classification system describes a pediatric fracture and its location relative to the ___. Growth plate injuries are important because injury to them can cause ___. Salter I fractures extend. Salter II fractures extend through the growth plate and the metaphysis of the bone (above the. Salter III fractures extend through the growth plate and the epiphysis (below the growth plate). Salter IV fractures involve both metaphysis and epiphysis and travel through the growth plate. Salter V fractures are those in which epiphysis and metaphysis are pushed onto one another, obscuring the growth plate.

Answer 85

Salter-Harris classification system describes a pediatric fracture and its location relative to the growth plate. Growth plate injuries are important because injury to them can cause arrest of that bone’s growth. Salter I fractures extend through the growth plate only. Salter II fractures extend through the growth plate and the metaphysis of the bone (above the growth plate) as seen in the radiograph. Salter III fractures extend through the growth plate and the epiphysis (below the growth plate). Salter IV fractures involve both metaphysis and epiphysis and travel through the growth plate. Salter V fractures are those in which epiphysis and metaphysis are pushed onto one another, obscuring the growth plate.