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EM5 Flashcards

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1
Q

Kochers criteria for Peds septic joint? (4)

A

NWB
ESR>40
Fever>38.5
WBC>12

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2
Q

Sodium correction for hyperglycemia

A

Inc sodium by 1.6 for every 100mg inc in glucose (over 100)

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3
Q

Tx trigeminal neuralgia

A

Carbamazepine

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4
Q

Calcium pyrophosphate, positive birefringent.

A

Pseudogout

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5
Q

needle-shaped crystal with negative birefringence

A

Gout

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6
Q

How many vials of digoxin-specific antibody should be administered to someone in cardiac arrest due to digoxin toxicity?

A

20

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7
Q

Bag of grapes appearance on US

A

Molar pregnancy

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8
Q

When pregnancy-induced hypertension is seen before 24 weeks of gestation, the emergency physician must consider the possibility of? Sx? (3)

A

a molar pregnancy or gestational trophoblastic disease. Symptoms of gestational trophoblastic disease include vaginal bleeding and hyperemesis. Laboratory evaluation can reveal abnormally high beta-hCG levels

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9
Q

Staphylococcal scalded skin syndrome (SSSS) ? Tx? (2)

A

Starts with erythroderma around lips, no intraoral involvement, sloughing skin and bullae. To cephalexin or dicloxacillin?

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10
Q

Nikolsky sign? Syndromes (4)

A

slipping of the epidermis away from the underlying dermis when gentle lateral pressure is applied.

SSSS, Stevens-Johnson syndrome, toxic epidermal necrolysis, and pemphigus vulgaris.

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11
Q

LV aneurysm on ECG?

A

STE In anterior leads without reciprocal changes associated with a Q or QS wave >2 weeks after an acute MI

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12
Q

Targetoid rashes? (2)

A

erythema migrans (seen in Lyme disease) and erythema multiforme (caused by herpes simplex virus, mycoplasma, and certain drugs like sulfamethoxazole and antiepileptic drugs).

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13
Q

Gastrocnemius tenderness

A

RMSF

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14
Q

Rocky Mountain spotted fever rash?

A

characteristically begins on the hands, feet, ankles, and wrists and then spreads in a centripetal fashion toward the trunk.

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15
Q

Massive hemoptysis? Tx?

A

Massive hemoptysis: ≥100 mL/hour or ≥500 mL over 24-hours

Massive hemoptysis rx: patient in bleeding side down position, mainstem bronchus intubation

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16
Q

Buckle fracture?

A

Similar to greenstick fracture However, in a buckle fracture, the bony cortex on the side opposite the force is compressed and “buckles” outward without true cortical disruption. (Stable)

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17
Q

Greenstick fracture?

A

disrupt the cortex on the side of the force, but does not penetrate the cortex on the side opposite to the force (stable) peds

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18
Q

Osler-Weber-Rendu syndrome clinical manifestations (4)

A

Telangiectasias on lips/tongue, AVMs of brain/lungs, recurrent nosebleeds, high output heart failure 2/2 AVMs

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19
Q

DIC lab values? (4)

A

Labs will show thrombocytopenia, decreased fibrinogen, increased fibrin split products, and increased BT, PT, and PTT

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20
Q

cloudy cornea and fixed mid-dilated pupil

A

Acute angle closure glaucoma

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21
Q

acute unilateral painful vision loss, vomiting, and seeing halos around lights

A

Acute angle closure glaucoma

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22
Q

Vision loss after entering a dark room or movie theater?

A

Acute angle closure glaucoma

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23
Q

A patient with sciatica and weakness with toe extension likely has compression of what nerve root?

A

L5

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24
Q

Most common cause of lung abscess

A

Aspiration PNA

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25
What non-funduscopic exam finding is classically associated with central retinal artery occlusion?
APD
26
antidote for OD of acetaminophen
N-acetylcysteine
27
antidote for OD of BZD
flumazenil
28
antidote for OD of digoxin?
digoxin FAB
29
antidote for OD of heparin?
protamine
30
antidote for OD of heavy metals? (arsenic, copper, lead, mercury) (4)
dimercaprol, EDRA, penicillamine, succimer (DMSA)
31
antidote for OD of hydrofluoric acid
calcium gluconate
32
antidote for OD of iron?
deferoxamine
33
antidote for OD of isoniazid
pyridoxine
34
antidote for OD of methanol
fomepizole, ethanol
35
antidote for OD of ethylene glycol
fomepizole, ethanol
36
antidote for OD of methemoglobinemia
methylene blue
37
antidote for OD of opioids
naloxone
38
antidote for OD of serotonin reuptake inhibitors
cyproheptadine
39
antidote for OD of sulfonulurea (2)
octreotide, glucose
40
antidote for OD of TCA?
sodium bicarb
41
Functional neurological symptom disorder?
(previously known as conversion disorder) Neuro symptom that can’t be explained by a medical condition
42
Factitious disorder
Intentional production of sx NOT motivated by external incentives but rather to assumed “sick role”
43
behavior in which someone acts with a conscious disregard for the safety of another person despite knowing that injury or harm is likely to result from their actions.
willful misconduct
44
violation of the standard of care and breach of professional duty to care for patients
Negligence (but not willfully harming)
45
behavior that does not obey certain prescribed standards or expectations.
Noncompliance
46
bioethical principle meaning “do no harm.”
Nonmaleficience
47
Children less than 8 years old and pregnant women with Lyme should be treated with ? Why?
Amoxicillin. Risk of permanent yellow teeth discoloration with doxycycline
48
Garlic or metallic taste in mouth after exposure to what toxin
Arsenic
49
Characteristic odor: bitter almonds
Cyanide
50
Characteristic odor: pears
Chloral hydrate
51
Characteristic odor: rotten eggs (3)
Disulfiram, hydrogen sulfide, NAC
52
Characteristic odor: wintergreen
Methyl salicylate
53
Characteristic odor: glue
Toluene
54
Characteristic odor: carrots
Water hemlock
55
Characteristic odor: fruity (3)
Ethanol, isopropyl alcohol, acetone
56
Peds epi dosing
Epinephrine can be given via IV or IO at 0.01 mg/kg ( 0.1 mL/kg of 1:10 000 concentration)
57
Acid vs alkali ingestion?
Acid —> coagulation necrosis | Alkali —> liquefaction necrosis (worse)
58
muscle spasms, stiffness,oculogyriccrisis? Tx? :
Acutedystonia | Tx: benztropine,dyphenhydramine
59
restlessness. Tx?
Akathisia | . Tx: benztropine
60
Parkinsonism reaction? Tx?
Bradykinesia. Benztropine
61
orofacial involuntary movements? Tx?
Tardive dyskinesia. Stop offending med
62
What is Murphy’s sign?
Sudden inspiratory cessation upon palpation of the right upper quadrant.
63
Vertigo during descent
Barotitis
64
Pain, parasthesias, paralysis min-hours after ascent
Decompression sickness (“bends”)
65
Stroke like sx during or immediately after ascent
Arterial gas emboli
66
Altered coordination after 100ft deep
Nitrogen narcosis
67
Electrolyte abnormality in pyloric stenosis? (4)
Hypochloremic metabolic alkalosis + Patients will have low chloride, low potassium, and elevated bicarbonate.
68
Target sign on US
Pyloric stenosis
69
Projectile nonbillous vomitting
Pyloric stenosis
70
Intubation parameters for myasthenic crisis ? (2)
Forced vital capacity < 10-15 mL/kg OR | negative inspiratory force > 20 mm H2O
71
Aortic dissection management ? (2)
Type A- ascending. Beta blockers (esmolol) and Surgical emergency. Type B- descending. Medical only
72
What is “Brodie’s sign”?
“Brodie’s sign” is the appearance of a black spot on external affected tissue; it signals the beginning of very rapid propagation of necrosis and is accompanied by clinical deterioration.
73
Osmolarity can be calculated using the formula
2[Na+] + [BUN]/2.8 + [glucose]/18 + [ethanol]/4.6.
74
When doing a PTA, carotid artery is located where
carotid artery is located approximately 2.5 cm posterolateral to the palatine tonsil. (approach should be performed as medially as possible to avoid the carotid artery)
75
Cyanide toxicity is associated with what common Med?
Nitroprusside
76
GB wall thickening ass with cholecystitis?
>4-5mm
77
most common nerve injury seen after humeral shaft fractures
Radial nerve —> wrist drop (loss of extension of fingers, thumb and wrist)
78
Tx humeral shaft fx?
Sugartong + sling. Outpatient Ortho follow up
79
most common nerve injury seen after shoulder dislocation
Axillary nerve —> loss of sensation over deltoid
80
most common nerve injury seen after posterior elbow dislocation
Median nerve
81
most common nerve injury seen after anterior elbow dislocation
Ulnar nerve
82
most common vascular injury seen after humeral shaft fractures
Brachial artery
83
Lyme prophylaxis?
single dose of doxycycline 200 mg administered to individuals over 8 years old. Amoxicillin if <8
84
Features of WPW on ECG? (5)
1. irregular (pattern like atrial fibrillation) 2. wide bizarre changing QRS (impulses conducted through accessory pathway) 3. extremely fast tachycardia(200-300 bpm). 4. Short PR 5. Upstroking QRS (wide)
85
What is hydrocarbon cardiac desensitization? Tx?
1. “Sniffing/huffing” paint/glue/gas —> sensitized myocardium 2. Excitable event (cops on scene) —> catecholamine release 3. —> fatal ventricular dysrhythmias Tx = beta blocker
86
Common cause of worsening hepatic encephalopathy
Constipation (2/2 inc intestinal ammonia production)
87
Cause of asterixis?
Inc ammonia —> inc metabolism to glutamine —> CNS —> asterixis
88
3 meds that tx hepatic encephalopathy?
Lactulose, rifampin, neomycin
89
Presentation of multiple myeloma? (4)
CRAB: hyperCalcemia, Renal insufficiency, Anemia, lytic Bone lesions/Back pain
90
Tx thrombosed hemorrhoid?
Elliptical incision
91
What is the first-line treatment for infectious diarrhea in the United States?
Ciprofloxacin 500 mg twice a day for three days.
92
How to manage hypoxia in a ventilated Patient? (5)
``` D- displacement (check tube) O- obstruction (suction) P- PTX (XRay) E- equipment (try BVM) S- breath stacking (disconnect vent) ```
93
Transducer vs exudate? Light’s criteria? (3)
Transudate: CHF Exudate: infection > malignancy, PE Exudative: LDH > 2/3 of the upper limit of the normal serum LDH level fluid:blood LDH ratio >0.6 fluid:blood protein ratio >0.5.
94
mycotic aneurysm?
an aneurysmal formation as result of seeding of infection in an arterial wall most commonly 2/2 endocarditis
95
Sandpaper rash
Scarlet fever
96
Strawberry tongue
Scarlet fever
97
Tx scarlet fever?
Penicillin (azithro if pen allergic)
98
Circumoral pallor
Scarlet fever
99
Scarlet fever caused by
group A beta-hemolytic streptococci.
100
decreased level of consciousness followed by a “lucid” interval.
Epidural hematoma
101
What is the maximum dose of 0.5% bupivacaine with epinephrine for an average adult?
About 42 mL for a 70 kg adult, using 5 mg/mL and a maximum dose of 3 mg/kg with epinephrine. (1.5 mg/kg is the maximum dose for bupivacaine without epinephrine).
102
Cx of Kawasaki? When?
1. Myocarditis with Dec EF when sick | 2. Coronary aneurysms 2-4 weeks later
103
Which rotator cuff muscle is MC injured?
Supraspinatus
104
Hawkins-kennedy rest?
Supraspinatus tendinitis (Pain with internal rotation of shoulder)
105
2 ways to perform percutabeous jet ventilation?
1. Attach 16G angiocath to 3.5mm ETT cap and BVM | 2. Attach 16G angiocath to a syringe with plunger out to 7.0mm ETT cap and BVM
106
Next step if free air under diaphragm?
Ex lap
107
In pts at high risk for SBP- what px antibiotics are used?
Fluoroquinolone or bactrim
108
Few day old baby with constipation and distension. Barium study shows transition zone
Hirschprungs disease
109
Lack of anal sphincter relaxation on anal mannometry
Hirschprungs Disease
110
What type of ectopic tissue causes ulcers and bleeding in meckels diverticulum?
Ectopic gastric tissue
111
Delayed meconium passing
Hirschprungs Disease
112
Shortened PR with normal QRS? Usu F in 30s?
Lown-Ganong-Levine syndrome
113
Resp distress after spine injury?
Brachial plexopthy (get diaphragm paralysis)
114
What hyperkalemia Med is CI in ppl with GI intestinal motility issues?
Kayexelate (—> intestinal necrosis)
115
URI followed by severe persistent vertigo, hearing loss? Tx?
Labyrhinthitis.
116
2 viral causes of prenatal hearing loss?
Rubella, CMV
117
Tx omphalitis? (3)
MRSA- vanc Staph- aminoglycoside (gent) Anaerobes- MNZ
118
High riding patella on XR? Tx?
Patellar tendon rupture. Immobilization and ortho follow up

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