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Clinical Medicine > Emergency > Flashcards

Emergency Flashcards

1
Q

��”Q001. ACEIs Toxicity

A

A001. Cough; rash; proteinuria; angioedema; taste changes; teratogenic effects

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2
Q

Q002. Amantadine; Toxicity

A

A002. Ataxia; livedo reticularis

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3
Q

Q003. Aminoglycosides; Toxicity

A

A003. Ototoxicity; nephrotoxicity ATN

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4
Q

Q004. Amiodarone; Toxicity

A

A004. Pulmonary fibrosis; peripheral deposition => bluish discoloration,; arrhythmias,; hypo /hyperthyroidism,; corneal deposition

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5
Q

Q005. Amphotericin; Toxicity

A

A005. Fever/chills; nephrotoxicity; bone marrow suppression; anemia

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6
Q

Q006. Antipsychotics; Toxicity

A

A006. Sedation; acute dystonic reaction; akathisia; parkinsonism; tardive dyskinesia; neuroleptic malignant syndrome

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7
Q

Q007. Azoles (e.g., fluconazole); Toxicity

A

A007. Inhibition of P 450 enzymes

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8
Q

Q008. AZT; Toxicity

A

A008. Thrombocytopenia; megaloblastic anemia

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9
Q

Q009. � blockers; Toxicity

A

A009. Asthma exacerbation; masking of hypoglycemia; impotence

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10
Q

Q010. Benzodiazepines; Toxicity

A

A010. Sedation; dependence; respiratory depression

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11
Q

Q011. Bile acid resins; Toxicity

A

A011. GI upset; malabsorption of vitamins; and medications

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12
Q

Q012. Calcium channel blockers; Toxicity

A

A012. Peripheral edema; constipation; cardiac depression

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13
Q

Q013. Carbamazepine; Toxicity

A

A013. Induction of P 450 enzymes; agranulocytosis; aplastic anemia

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14
Q

Q014. Chloramphenicol; Toxicity

A

A014. Gray baby syndrome; aplastic anemia

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15
Q

Q015. Cisplatin; Toxicity

A

A015. Nephrotoxicity; acoustic nerve damage

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16
Q

Q016. Clonidine; Toxicity

A

A016. Dry mouth; severe rebound headache; hypertension

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17
Q

Q017. Clozapine

A

A017. Agranulocytosis

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18
Q

Q018. Corticosteroids; Toxicity

A

A018. Mania (acute) immunosuppression; bone mineral loss; thinning of skin; easy bruising; myopathy (chronic); cataracts

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19
Q

Q019. Cyclophosphamide; Toxicity

A

A019. Myelosuppression; hemorrhagic cystitis

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20
Q

Q020. Digoxin ; Toxicity

A

A020. GI disturbance; yellow green visual changes; arrhythmias junctional tachycardia or SVT,; varying amounts of AV node blocks

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21
Q

Q021. Doxorubicin ; Toxicity

A

A021. Cardiotoxicity; (dilated cardiomyopathy)

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22
Q

Q022. Ethyl alcohol ; Toxicity

A

A022. Renal dysfunction

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23
Q

Q023. Fluoroquinolones; Toxicity

A

A023. Cartilage damage in children Achilles tendon rupture

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24
Q

Q024. Furosemide; Toxicity

A

A024. Ototoxicity; hypokalemia; nephritis

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25
Q

Q025. Gemfibrozil; Toxicity

A

A025. Myositis; reversible �! in LFTs

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26
Q

Q026. Halothane; Toxicity

A

A026. Hepatotoxicity; malignant hyperthermia

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27
Q

Q027. HCTZ; Toxicity

A

A027. Hypokalemia; hyperuricemia; hyperglycemia

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28
Q

Q028. HMG CoA reductase inhibitors; Toxicity

A

A028. Myositis; reversible �! in LFTs

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29
Q

Q029. Hydralazine; Toxicity

A

A029. Drug induced SLE

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30
Q

Q030. Hydroxychloroquine; Toxicity

A

A030. Retinopathy

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31
Q

Q031. INH ; Toxicity

A

A031. Peripheral neuropathy prevent with vitamin B6; hepatotoxicity; inhibition of P 450 enzymes; seizures with overdose

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32
Q

Q032. MAOIs ; Toxicity

A

A032. Hypertensive tyramine reaction; serotonin syndrome with meperidine

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33
Q

Q033. Methanol; Toxicity

A

A033. Blindness

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34
Q

Q034. Methotrexate; Toxicity

A

A034. Hepatic fibrosis; pneumonitis; anemia

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35
Q

Q035. Methyldopa; Toxicity

A

A035. Pos. Coombs test; drug induced SLE

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36
Q

Q036. Metronidazole; Toxicity

A

A036. Disulfiram reaction; vestibular dysfunction; metallic taste

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37
Q

Q037. Niacin; Toxicity

A

A037. Cutaneous flushing

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38
Q

Q038. Nitroglycerin; Toxicity

A

A038. Hypotension; tachycardia; headache; tolerance

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39
Q

Q039. Penicillin/� lactams ; Toxicity

A

A039. Hypersensitivity reactions

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40
Q

Q040. Penicillamine; Toxicity

A

A040. Drug induced SLE

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41
Q

Q041. Phenytoin; Toxicity

A

A041. Nystagmus; diplopia; ataxia; gingival hyperplasia; hirsutism

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42
Q

Q042. Prazosin ; Toxicity

A

A042. First dose hypotension

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43
Q

Q043. Procainamide; Toxicity

A

A043. Drug induced SLE

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44
Q

Q044. Propylthiouracil; Toxicity

A

A044. Agranulocytosis

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45
Q

Q045. Quinidine; Toxicity

A

A045. Cinchonism ; (headache, tinnitus); thrombocytopenia; arrhythmias torsades de pointes

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46
Q

Q046. Reserpine; Toxicity

A

A046. Depression

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47
Q

Q047. Rifampin; Toxicity

A

A047. Induction of P 450 enzymes; orange red body secretions

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48
Q

Q048. Salicylates; Toxicity

A

A048. Fever; hyperventilation with; respiratory alkalosis; and metabolic acidosis; dehydration; diaphoresis; hemorrhagic gastritis

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49
Q

Q049. SSRIs; Toxicity

A

A049. Anxiety; sexual dysfunction

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50
Q

Q050. Succinylcholine; Toxicity

A

A050. Malignant hyperthermia

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51
Q

Q051. Tetracyclines; Toxicity

A

A051. Tooth discoloration; photosensitivity; Fanconi s syndrome

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52
Q

Q052. TCAs; Toxicity

A

A052. Sedation; coma; anticholinergic effects; seizures; wide QRS; in severe cases prolonged QT => torsade

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53
Q

Q053. Valproic acid; Toxicity

A

A053. Teratogenicity => neural tube defects

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54
Q

Q054. Vancomycin; Toxicity

A

A054. Nephrotoxicity; ototoxicity; red man syndrome histamine release, not an allergy

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55
Q

Q055. Vinblastine; Toxicity

A

A055. Severe myelosuppression

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56
Q

Q056. Vincristine; Toxicity

A

A056. Peripheral neuropathy

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57
Q

Q057. Acetaminophen; What is the Antidote

A

A057. N acetylcysteine

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58
Q

Q058. Acid/alkali ingestion; What is the Antidote

A

A058. Upper endoscopy to evaluate for stricture

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59
Q

Q059. Anticholinesterases,; organophosphates; What is the Antidote

A

A059. Atropine; pralidoxime

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60
Q

Q060. Antimuscarinic/; anticholinergic agents; What is the Antidote

A

A060. Physostigmine

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61
Q

Q061. Arsenic, mercury, gold; What is the Antidote

A

A061. Succimer; dimercaprol

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62
Q

Q062. � blockers; What is the Antidote

A

A062. Glucagon

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63
Q

Q063. Barbiturates (phenobarbital); What is the Antidote

A

A063. Urine alkalinization (bicarb); dialysis; activated charcoal

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64
Q

Q064. Benzodiazepines; What is the Antidote

A

A064. Flumazenil

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65
Q

Q065. Black widow bite ; What is the Antidote

A

A065. Calcium gluconate

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66
Q

Q066. Carbon monoxide ; What is the Antidote

A

A066. 100% O2; hyperbaric O2

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67
Q

Q067. Copper, arsenic, lead, gold ; What is the Antidote

A

A067. Penicillamine

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68
Q

Q068. Cyanide ; What is the Antidote

A

A068. Nitrite; sodium thiosulfate

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69
Q

Q069. Digitalis ; What is the Antidote

A

A069. Stop digitalis,; normalize K+,; lidocaine (for torsades), anti digitalis Fab

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70
Q

Q070. Heparin ; What is the Antidote

A

A070. Protamine sulfate

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71
Q

Q071. Iron salts ; What is the Antidote

A

A071. Deferoxamine

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72
Q

Q072. Lead ; What is the Antidote

A

A072. Succimer; CaEDTA; dimercaprol

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73
Q

Q073. Methanol, ethylene glycol (antifreeze); What is the Antidote

A

A073. EtOH; fomepizole; dialysis

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74
Q

Q074. Methemoglobin; What is the Antidote

A

A074. Methylene blue

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75
Q

Q075. Opioids; What is the Antidote

A

A075. Naloxone

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76
Q

Q076. Phencyclidine hydrochloride (PCP); What is the Antidote

A

A076. NG suction

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77
Q

Q077. Salicylates ; What is the Antidote

A

A077. Urine alkalinization; dialysis; activated charcoal

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78
Q

Q078. TCAs; What is the Antidote

A

A078. Na bicarb QRS prolongation; diazepam or lorazepam for Seizures; cardiac monitor for; arrhythmias

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79
Q

Q079. Theophylline; What is the Antidote

A

A079. Activated charcoal

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80
Q

Q080. tPA, streptokinase; What is the Antidote

A

A080. Aminocaproic acid

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81
Q

Q081. Warfarin; What is the Antidote

A

A081. Vitamin K, FFP

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82
Q

Q082. Cardiac Life Support; What are the Basic Principles

A

A082. Check if responsive; call for help; Patient on firm, flat surface ABCs; Airway open?; Breathing?; CPR; IV meds before intubate; CPR if alone 2 breaths, check pulse carotid or femoral, 15 compressions; CPR if have help 2 breaths, 5 compressions

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83
Q

Q083. Burns; Hx/PE

A

A083. 2nd leading cause of death in kids; don’t underestimate degree of nonvisible deep destruction esp. with electrical burns thorough airway & lung exam; respiratory burn patient may need early intubation before edema sets in

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84
Q

Q084. Burns; Dx; Rule of 9’s

A

A084. ABCs; aware of possible shock, inhalation injury, CO poisoning; evaluate % of BSA involved rule of 9’s; BSA (Body Surface Area); head = 18%; front = 18%; back = 18%; each arm = 9%; each leg = 18%

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85
Q

Q085. Burns; Categories

A

A085. 1st degree epidermis involved, area painful, no blisters, capillary refill intact; 2nd degree epidermis & superficial dermis, area painful, blisters; 3rd degree epidermis & dermis, area painless, white & charred

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86
Q

Q086. Burns; Tx

A

A086. Treatment supportive; freq. dressing changes; rehydrate; topical silver sulfadiazine and mafenide; circumferential burns at risk for compartment syn, need early escharotomy; early skin graft prevent contractures; fluid req. in 1st 24 hrs. BSA x wt(kg) x 4cc, give 1/2 in 1st 8 hrs, 1/4 in next 8 hrs, 1/4 in last 8 hrs; 1st choice lactate ringers; 2nd choice NS (0.9%); hydrate enough to maintain urine output at least 1cc/kg/hr

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87
Q

Q087. Burns; Complications

A

A087. Shock; superinfection esp. Pseudomonas

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88
Q

Q088. CO Poisoning; What is it

A

A088. Hypoxemic poisoning syn causes; car exhaust; smoke inhalation; barbeque in poor ventilation; old appliances

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89
Q

Q089. CO Poisoning; HX/PE

A

A089. Cherry red skin; confusion; headaches; if severe coma, seizures chronic low level exposure; flu like Sxs; suspect smoke inhalation in singed nose hairs; facial burns; hoarseness; wheezing; carbonaceous sputum

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90
Q

Q090. CO Poisoning; Dx

A

A090. ABG; normal serum carboxyHb level < 5% in nonsmokers, < 10% in smokers; laryngoscopy; bronchoscopy; EKG elderly; history of cardiac dis.

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91
Q

Q091. CO Poisoning; Tx

A

A091. 100 O2 hyperbaric O2:; pregnant; neuro Sxs; severely �! carboxyHb; smoke inhalation may need early intubation (before edema sets in)

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92
Q

Q092. Aortic Disruption; What is it

A

A092. Rapid deceleration injury most common causes; high speed MVAs; fall from great heights; ejection from vehicles complete; rapidly fatal; usually have contained hematoma within adventitia; laceration usually at lig. arteriosum

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93
Q

Q093. Aortic Disruption; Dx

A

A093. CXR immediately; wide mediastinum; loss of aortic knob; pleural cap; trachea deviation to right; left main stem bronchus depressed; aortography gold standard; transesoph echo before OR; always suspect if sternal fractures or 1st & 2nd rib fractures

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94
Q

Q094. Aortic Disruption; Tx

A

A094. OR emergently

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95
Q

Q095. Aortic Dissection; What is it; Risk Factors

A

A095. Surging of blood through tear in aortic intima; seperation of intima & media => false lumen; Stanford type A: ascending aorta; type B: desc. thoracic aorta (distal to lt. subclavian) risk factors:; HTN; trauma; coarctation of aorta; syphilis; pregnancy; Ehlers Danlos; Marfan’s

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96
Q

Q096. Aortic Dissection; Hx/PE

A

A096. Acute onset; severe tearing chest pain radiates to back => syncope, stroke, MI; asymm or decreased periph pulses; paraplegia; shock as worsens; type A aortic regurgitation with diastolic murmur

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97
Q

Q097. Aortic Dissection; Dx

A

A097. CXR; CT with IV contrast; transesoph echo or; MRI/MRA or; angiography gold standard; EKG

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98
Q

Q098. Aortic Dissection; Tx

A

A098. Stabilize HBP or low HBP; IV nitrates; B blockers; goal systolic < 120, HR < 70; type A emergent surgery; type B med management

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99
Q

Q099. Aortic Dissection; Complications

A

A099. MI; CHF; cardiac tamponade; postop hemorrhage; future dissection; future aneurysm; death

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100
Q

Q100. Postop Fever; What is it Caused By; (What are the 6 W’s)

A

A100. Wind atelectasis, pneumonia; Water UTI; Wound abscess; Walk DVT; Wonderdrug drug reaction; Wire catheter

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101
Q

Q101. Postop Fever; How to Decrease Risk

A

A101. Incentive spirometry; short term foley use; early ambulation; DVT prophylaxis; pre & post op ABx; fevers before POD3: probably not infectious unless Clostridium or B hemolytic strep

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102
Q

Q102. Acute Abdomen; What is it

A

A102. Abdom Sxs so severe; surgery should be considered; primary Sx acute abdom pain

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103
Q

Q103. Acute Abdomen; Hx/PE

A

A103. OPQRST: Onset, Precip factors, Quality, Radiation, Sxs, Temporal quality; Treatment modalities; full GYN Hx; LMP; STD Sxs; pelvic exam; pregnancy test rule out PID, ectopic pregnancy,; ovarian torsion

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104
Q

Q104. Acute Abdomen; Character of Pain

A

A104. Sharp parietal (peritoneal); dull, diffuse visceral (organ); perforation sudden onset of diffuse, severe pain; obstruction acute onset of colicky; inflammation gradual onset over 10 12 hrs, constant, ill defined

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105
Q

Q105. Acute Abdomen; Dx

A

A105. Assess stability; emergent surgery & exploratory lap peritoneal signs, impending shock, shock; if stable PE, pelvic exam (women), CBC with diff, electrolytes, LFTs, amylase, lipase, urine B hCG, UA, KUB, US; no contrast studies if suspect complete LBO

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106
Q

Q106. Acute Abdomen; Tx

A

A106. Hemodynamically unstable emergent exploratory lap; stable expectant management; vitals; NPO; NG tube; IV fluids; serial abdom exams; serial labs; type & cross; Foley monitor urine output; monitor fluid status

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107
Q

Q107. Appendicitis; What is it

A

A107. Always consider in patient with acute abdomen; MC teens & 20’s; causes no. 1 lumen obstructed by lymphoid tissue hyperplasia; no. 2 fecalith, foreign body, tumor (carcinoid), parasite; obstruction => overdistention, increased pressure, ischemia & necrosis

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108
Q

Q108. Appendicitis; Hx/PE

A

A108. Dull, vague pain orig. at umbilicus, lasts 1 12 hrs. pain then followed by n/v, anorexia, (“hamburger sign”); may have mild fever; sharper pain => RLQ at McBurney’s point, psoas sign, obturator sign, rovsing’s sign; if perforated pain decreased, peritoneal sigs will dev. atypical elderly, kids, pregnant, retrocecal appendices

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109
Q

Q109. Appendicitis; Dx

A

A109. Clinical if classic signs & Sxs, mild leukocytosis & left shift; UA a few RBCs or WBCs; KUB fecalith, loss of psoas shadow; US rule out gyn abnorm; abdom CT rule out abscesses

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110
Q

Q110. Appendicitis; Tx

A

A110. strong suspicion immed open or lap appendectomy; 15 20% false pos. acceptable; if no appendicitis found complete exploration of abdo; before surgery NPO, IV fluids, ABx for anaerobes 24 hrs. if perforation cont. ABx until afebrile & WBC count normalizes, close wound by delayed primary closure on POD5; if abscess broad spectrum ABx, abscess percutaneously drained, elective appendectomy 6 8 wks

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111
Q

Q111. Appendicitis; Complications

A

A111. Risk of perforation & mortality increased with amt of time have appendicitis; (at 48 hrs 75% risk)

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112
Q

Q112. Acute Management of Trauma Patient; “ABCDE - What is “A””

A

A112. Airway airway patency & adeq ventilation; take precedence over other Tx; conscious nasal cannula or face mask; unconscious chin lift or jaw thrust to reposition tongue; early intubation apnea, decreased mental status, impending airway compromise, severe closed head injuries, failed bag mask ventilation; cricothyroidectomy can’t be intubated, signif maxillofacial trauma, keep cervical spine stable, never let this concern delay airway management

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113
Q

Q113. Acute Management of Trauma Patient; “ABCDE - What is “B””

A

A113. Breathing 5 thoracic causes of immed. death must not be missed:; tension pneumothorax; cardiac tamponade; open pneumothorax; massive hemothorax; airway obstruction

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114
Q

Q114. Acute Management of Trauma Patient; “ABCDE - What is “C””

A

A114. Circulation; 2 16 gauge IVs; fluid bolus of 1 2L (adults); vitals rechecked; replete fluid per fluid status; LR or NS isotonic; replete 3:1 (fluid to blood)

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115
Q

Q115. Acute Management of Trauma Patient; “ABCDE - What is “D””

A

A115. Disability; evaluate CNS dysfunction via Glasgow Coma Scale

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116
Q

Q116. Acute Management of Trauma Patient; “ABCDE - What is “E””

A

A116. Extra; check temperature status; foley catheter after rule out urethral injury; secondary survey full exam; additional XRs trauma series: AP chest, AP pelvis, AP/lat C spine, T1

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117
Q

Q117. Pelvic Fractures; What are they

A

A117. MC after trauma such as a MVA; needs immediate attention by orthopedist; potentially life threatening

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118
Q

Q118. Pelvic Fractures; Hx/PE

A

A118. ABCDE trauma survey; secondary survey may reveal unstable pelvis; AP pelvic XR; when stable CT; if hypotension & shock hemorrhage likely; can be assoc with urethral injury check for blood at urethral meatus; check high riding, “ballotable” prostate; check for lack of prostate; retrograde urethrogram, rule out injury before Foley; serial H&H; never explore pelvic or retroperitoneal hematoma

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119
Q

Q119. Pelvic Fractures; Tx

A

A119. Embolize bleeding vessels; emergent external pelvic fixation; internal fixation if hemodynamically stable

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120
Q

Q120. acute dystonia

A

A120. involuntary muscle cont/spasm torticollis, oculogyric crisis; Rx: anticholinergic (benztropine) or diphenhydramine; Prevent: prophylatic benztropine

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121
Q

Q121. akathisia

A

A121. subjective/objective restlessness; Rx: reduce neuroleptic, �blocker (propranolol), +/ benzos, anticholinergics

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122
Q

Q122. dyskinesia

A

A122. pseudoparkinsonism Rx:; anticholinergic (benztropine); or DA agonist (amantidine); reduce/stop neuroleptic or d/c

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123
Q

Q123. tardive dyskinesia

A

A123. stereotypic oral facial movements; likely d/t DA receptor sensitization; 50% irreversible Rx:; reduce/stop neuroleptic or d/c or change drugs; giving anticholinergics or �!neuroleptic may initially WORSEN TD

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124
Q

Q124. Neuroleptic Malignant syndrome

A

A124. fever; muscle rigidity; autonomic instability; clouded consciousness; �!CPK, WBCs Rx:; stop neuroleptic; dantrolene/bromocriptine; IV fluids

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125
Q

Q125. Evolution of EPS

A

A125. 4 hours: acute dystonia; 4 days: akathisia; 4 weeks: akathisia; 4 months: tardive dyskinesia

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126
Q

Q126. EtOH withdrawal syndrome

A

A126. Mild withdrawal (6 24h from last drink): tremor, anxiety, N/V, insomnia; Major Withdrawal (10 72h): visual/auditory hallucinations, whole body tremor, vomiting, diaphoresis,�!BP; Withdrawl seizures 6 48hrs; DTs 2 7d, severe autonomic instability/hyperactivity (�!HR, BP), delerium, confusion, agitation, hallucinations, fever, positional nystagmus, death mortality 15 20%

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127
Q

Q127. EtOH withdrawal Rx including DTs

A

A127. benzos* (DOC); haloperidol for hallucinations; clonidine, BBs for hyperadrenergic state; thiamine, folate, vitamens; replace lytes; IV fluids

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128
Q

Q128. Barbituate withdrawal

A

A128. anxiety; seizures; delerium; tremor; cardiac & respiratory depression; Rx: benzos

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129
Q

Q129. Benzodiazepine withdrawal

A

A129. rebound anxiety; seizures; tremor; instability; Rx: benzos

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130
Q

Q130. Cocaine/amphetamine withdrawal

A

A130. depression; hyperphagia; hypersomnolence; Rx: supportive, avoid BBs (results in excess uninhibited cardiac activation)

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131
Q

Q131. Opioid withdrawal

A

A131. anxiety; insomnina; flu like symptoms*; sweating; piloerection; fever; rhinorrhea; stomach cramps; diarrhea; mydriasis; Rx: clonidine +/or buprenorphine for mod withdrawal, methadone for severe, naltrexone in pts drug free for 7 10d

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132
Q

Q132. Aortic disruption CXR

A

A132. widened mediastinum; pleural cap; loss of aortic knob; deviation of trachea to R; depression of L main stem bronchus; Always suspect with R1 2#s; aortography gold standard

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133
Q

Q133. Arrhythmia Rx:; asystole

A

A133. epi; atropine

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134
Q

Q134. Arrhythmia Rx:; Vfib

A

A134. desynchronized shock > epi or vasopressin > shock > lido or amio > shock > procainamide or Mg

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135
Q

Q135. Arrhythmia Rx:; VTach

A

A135. if unstable/pulseless desynchronized shock; if stable lido or amio

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136
Q

Q136. Arrhythmia Rx:; PEA

A

A136. identify & Rx underlying; +/ epi +/or atropine

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137
Q

Q137. Arrhythmia Rx:; Afib/flutter

A

A137. if unstable shock at 100J; If stable, control rate (CCB, dig, BB); +/ rhythm conversion; anticoagulate

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138
Q

Q138. Arrhythmia Rx:; SVT

A

A138. Control rate; valsalva, carotid sinus massage, cold stimulation; adenosine (procainamide)

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139
Q

Q139. Arrhythmia Rx:; bradycardia

A

A139. if symptomatic consider atropine; if Mobitz II/AVB pace; Acutely, unstable atropine/dopamine/dobutamine or transvenous pacing

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140
Q

Q140. hypovolemic shock

A

A140. �!CO; �!PCWP; �!PVR

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141
Q

Q141. cardiogenic shock

A

A141. Causes:; tension PTX; cardiac tamponade; arrhythmia; structural hrt dz; MI; �!CO; �!PCWP; �!PVR

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142
Q

Q142. Septic shock

A

A142. �!CO; �!PCWP; �!PVR

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143
Q

Q143. anaphylactic shock

A

A143. �!CO; �!PCWP; �!PVR

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144
Q

Q144. Rx for malignant HTN

A

A144. nitroprusside

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145
Q

Q145. test to rule out urethral injury

A

A145. retrograde cystourethrogram

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146
Q

Q146. Radiographic indications for Sx in pts with acute abd

A

A146. free air under diaphragm; extravasation of contrast; severe bowel distension; SOL; mesenteric occlusion (angiography)

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147
Q

Q147. Cannon a waves

A

A147. complete AVB

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148
Q

Q148. signs of neurogenic shock

A

A148. hypotension; bradycardia

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149
Q

Q149. Cushing’s triad

A

A149. Signs of �!ICP; HTN; bradycardia; abnormal respirations

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150
Q

Q150. Signs of air embolism

A

A150. pt with chest truma previously stable suddenly dies

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151
Q

Q151. Organims/Rx of strep pharyngitis

A

A151. Org: GAS, S. pneumo Rx:; Pen V; Amoxicillin; erythromycin

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152
Q

Q152. Organisms causing sinusitis

A

A152. S. pneumo; H. flu; M. catarrhalis; GAS; anaerobes; S. aureus

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153
Q

Q153. Rx for sinusitis

A

A153. 1st line Amoxicillin (TMP SMX if pen allergic); 2nd line Amox/clav; 3rd line clarithromycin

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154
Q

Q154. Acute OM pathogens

A

A154. Viral; S. pneumo; H. flu; M. catarrhalis

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155
Q

Q155. The nasopharyngeal airway can be used in which types of patients?

A

A155. breathing semiconscious patients and when an oropharyngeal airway is technically challenging

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156
Q

Q156. Prolonged use of a bag valve can lead to..?

A

A156. Distention of the stomach increasing the chance of an aspiration event

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157
Q

Q157. What are the steps of successful intubation?

A

A157. 5P’s Preparation, preoxygenation, pretreatment, paralysis, and placement

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158
Q

Q158. How do you prepare for successful intubation?

A

A158. IV access, monitors, suction, appropriate sized ET tube, and meds for rapid sequence intubation

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159
Q

Q159. What pretreatment may be necessary in small children prior to intubation and why?

A

A159. Atropine, to blunt the bradycardia induced by succinocholine

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160
Q

Q160. What pretreatment prior to intubation may be used in adults with reactive airway disease? What about in adults where there is a concern about increased ICP?

A

A160. Reactive airway disease lidocaine 1.5mg/kg; Pancuronium 0.01mg/kg

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161
Q

Q161. What sedative agent is used prior to paralysis for intubation?

A

A161. Etomidate 0.3mg/kg

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162
Q

Q162. volar =?

A

A162. palmar

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163
Q

Q163. Physical Exam of emergency ortho…?

A

A163. ROM; Palpation for subtle deformities well beyond the area of subjective pain; Neurovascular assessment

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164
Q

Q164. Ulnar nerve palsy causes..?

A

A164. Claw hand

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165
Q

Q165. Inability to extend the knee could be caused by paralysis of which nerve?

A

A165. Femoral nerve

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166
Q

Q166. Early treatment of ortho emergencies?

A

A166. NSAIDs; RICE (rest ice compression elevation); NPO; Reduction of long bone deformities

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167
Q

Q167. Don’t forget to give _____ for open fractures?

A

A167. Tetanus

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168
Q

Q168. In children with trauma to a joint, what is important to consider on imaging?

A

A168. Comparison to the opposite extremity difficult to tell the difference between a fracture and an epiphyseal growth plate

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169
Q

Q169. Compartment syndrome defined?

A

A169. When the pressure in a compartment exceeds the arterial perfusion pressure

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170
Q

Q170. Most reliable sign of compartment syndrome?

A

A170. Paresthesia

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171
Q

Q171. ARDS, neuro involvement, and thrombocytopenia post closed fractures in leg..?

A

A171. Fat embolism

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172
Q

Q172. If you land directly on your shoulder, and hit hurts to reach across your body, what is the injury?

A

A172. Acromioclavicular joint separation

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173
Q

Q173. when does Acromioclavicular joint separation require surgery?

A

A173. type iv or higher (when the clavicle is displaced into surrounding areas)

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174
Q

Q174. 96% of shoulder dislocations are…?

A

A174. Anterior shoulder dislocations

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175
Q

Q175. how does the patient with an Anterior shoulder dislocation appear?

A

A175. holding arm in slight abduction and external rotation

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176
Q

Q176. What is the most common fracture in Aneterior shoulder dislocations? what nerve should be tested?

A

A176. Hill Sachs deformity fracture of the posterolateral aspect of the humeral head; Test the axillary nerve

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177
Q

Q177. Posterior dislocations are caused by…? always associated with…?

A

A177. fall on outstretched hand, convulsive seizure. Associated with Hill Sachs deformity

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178
Q

Q178. Most common mechanism of acute rotator cuff tear? This injury impairs which movement?

A

A178. Forced abduction. Impairs arm abduction to 30 degrees

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179
Q

Q179. What important structures travel with the humerus?

A

A179. The deep brachial artery and the radial nerve

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180
Q

Q180. Who gets supracondylar fractures? how?

A

A180. Kids < 15. Falling backwards on an outstretched hand

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181
Q

Q181. Posterior fat pad sign indicates?

A

A181. In adults radial head fracture; In kids supracondylar fracture

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182
Q

Q182. What is fracture of the proximal 1/3 of the ulna with radial head dislocation called?

A

A182. Monteggia fracture

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183
Q

Q183. What is fracture of the distal 1/3 of radius with dislocation of the distal radioulnar joint called?

A

A183. Galeazzi

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184
Q

Q184. Causes of carpal tunnel?

A

A184. RA, hypothyroid, DM, collagen vascular diseases

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185
Q

Q185. Phalen’s test?

A

A185. Fully flex the wrists for 60 seconds

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186
Q

Q186. Tinel’s sign?

A

A186. Light tapping over the median nerve produces pain or paresthesias

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187
Q

Q187. Most common carpal injury..?; High risk of..?

A

A187. Fracture of the scaphoid. AVN

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188
Q

Q188. Smith’s fracture?

A

A188. Like colles, but distal fragment is displaced in the volar direction

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189
Q

Q189. neurogenic shock?

A

A189. state of vasomotor instability resulting from impairment of the descending sympathetic pathways in the spinal cord, or just a loss of sympathetic tone

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190
Q

Q190. does spinal shock signify permanent spinal cord damage?

A

A190. often times no

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191
Q

Q191. anterior cord syndrome results in loss of which tracts?

A

A191. spinothalamic and corticospinal tract

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192
Q

Q192. Central cord syndrome can be caused by? Affects?

A

A192. Hyper extension injuries. Nerves that cross over at that level

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193
Q

Q193. if a penetrating spinal injury is diagnosed, begin treatment with..?

A

A193. High dose methylprednisolone

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194
Q

Q194. if suspecting a c spine fracture, what xrays should be ordered?

A

A194. lateral, AP, and odontoid view

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195
Q

Q195. C1 burst fracture is called? Caused by…?

A

A195. Jefferson fracture. Caused by axial loading someone falls on their head, or something falls on their head

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196
Q

Q196. Odontoid fractures are caused by..?

A

A196. Flexion

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197
Q

Q197. Hangman’s fracture?

A

A197. Fracture of both pedicles of C2 hyperextension mechanism

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198
Q

Q198. Stable or unstable?; atlanto occipital dislocation; burst fracture of C5 with intact ligaments… simple wedge fracture; odontoid fracture; flexion teardrop fracture; extension teardrop fracture

A

A198. atl unstable; burst c5 stable; simple wedge stable; odontoid unstable; flexion teardrop unstable; extension teardrop stable

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199
Q

Q199. flexion teardrop fracture is associated with…?

A

A199. tearing of the posterior complex

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200
Q

Q200. bilateral facet dislocation…? stable?

A

A200. flexion injury; subluxation of the dislocated vertebra; very unstable

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201
Q

Q201. Cullen’s sign? Gray Turner’s sign?

A

A201. ecchymosis of the abdomen signifies late retroperitoneal hemorrhage; Gray Turner’s: same, but of the flanks

202
Q

Q202. 12% of patients with hyperthyroidism will suffer…?

A

A202. Pathologic fracture

203
Q

Q203. serious associated injuries are present in up to 95% of patients with a dislocated…?

A

A203. hip

204
Q

Q204. a pt with a posterior hip dislocation holds the hip how?

A

A204. flexed, adducted, and internally rotated

205
Q

Q205. most common ortho injury seen in the ED?

A

A205. knee in particular, MCL (medial collateral ligament)

206
Q

Q206. 50% of patients with ACL injury have a concomitant…?

A

A206. Meniscal tear

207
Q

Q207. lachman’s test?

A

A207. flex the knee to 30 degrees and pull anteriorly on the tibia

208
Q

Q208. donahue’s unhappy triad?

A

A208. ACL, MCL, and medial meniscus tear

209
Q

Q209. Injury to the ________ occurs in 50% of knee dislocations…

A

A209. popliteal artery

210
Q

Q210. injury to the tibial nerve causes…?

A

A210. inability to stand on tiptoes

211
Q

Q211. which ankle fracture warrants a careful radiologic examination? of what specifically?

A

A211. medial malleolar fracture; proximal shaft of the fibula (Maisoneuve fracture)

212
Q

Q212. 10% of calcaneal fractures are associated with…?

A

A212. lumbar fractures

213
Q

Q213. when do you call for an ortho consult?

A

A213. compartment syndrome; irreducible fractures; circulatory compromise; open fracture; anything that requires surgery

214
Q

Q214. what is the most frequent complication of orotracheal intubation?

A

A214. Right main stem bronchus intubation

215
Q

Q215. Patients with COPD, asthma, or CHF that are awake but cannot remain in the supine position may be intubated how…?

A

A215. Nasotracheal intubation

216
Q

Q216. Most serious complication of nasotracheal intubation?

A

A216. Intracranial passage of the tube

217
Q

Q217. advance airway adjuncts?

A

A217. fiberoptic intubation; retrograde intubation; combitube; laryngeal mask airway

218
Q

Q218. What is the preferred surgical airway for kids? Adults?

A

A218. Kids needle cricothyroidotomy; Adults surgical cricothyroidotomy

219
Q

Q219. if an airway will be needed for greater than 2 3 days, a surgical cricothyoidotomy should be converted to…?

A

A219. a tracheostomy

220
Q

Q220. slit lamp exam consists of…?

A

A220. evaluate the integrity of the cornea, conjunctiva, and the anterior chamber; fluorescein to light up corneal defects

221
Q

Q221. central retinal artery occlusion occurs in which people?

A

A221. men in their 60s

222
Q

Q222. fundoscopic exam in central retinal artery occlusion?

A

A222. pale retina with cherry red fovea

223
Q

Q223. what is amaurosis fugax?

A

A223. type of TIA sudden vision loss (Shade over eye), transient, due to carotid origin embolic shower

224
Q

Q224. classic triad of optic neuritis?

A

A224. marcus gunn pupil; central vision loss; red vision desaturation

225
Q

Q225. flashing lights, spider webs, or floaters that interfere with vision may be a sign of…? what meds should NOT be given?

A

A225. retinal detachment; DON’T anticoagulate

226
Q

Q226. painful red eye most often due to which things?

A

A226. conjunctivitis, corneal abrasion, or foreign body

227
Q

Q227. which conjunctivitis produces copious DC?

A

A227. gonorrhea

228
Q

Q228. punctuate lesions in conjunctivitis?

A

A228. viral cause

229
Q

Q229. treatment of conjunctivitis?

A

A229. broad spectrum antibiotics, pain meds

230
Q

Q230. soft contact wearers are especially prone to infection by.?

A

A230. pseudomonas

231
Q

Q231. severe unilateral eye pain, decreased visual acuity and photophobia…?

A

A231. iritis

232
Q

Q232. treatment of iritis?

A

A232. cycloplegic such as homatropine(not a mydratic)

233
Q

Q233. severe unilateral HA, eye pain, N/V assoc with loss of vision….?

A

A233. narrow angle glaucoma

234
Q

Q234. which drugs decrease aqueous production?

A

A234. acetazolomide and topical b blockers

235
Q

Q235. which chemicals causes coag necrosis? liquefaction necrosis?

A

A235. acids; alkali

236
Q

Q236. treatment of chemical burn…

A

A236. IRRIGATE

237
Q

Q237. what’s hyphema?

A

A237. blurred vision after blunt trauma (dull eye pain)… bleeding

238
Q

Q238. basic approach to all toxicity patients in the ED?

A

A238. ABCs; Decontamination; Elimination; Antidotes

239
Q

Q239. key things on physical exam for toxicity exposures….?

A

A239. Vital signs; pupils; toxidromes; autonomic signs; motor signs; mental status; skin

240
Q

Q240. describe anticholinergic toxidrome?

A

A240. “mad as a hatter, dry as a bone, red as a beet, hot as a stove.” Also decreased GI motility, urinary retention, mydriasis.

241
Q

Q241. describe muscarinic toxidrome?

A

A241. DUMBELLS

242
Q

Q242. narcotic toxidrome?

A

A242. respiratory depression,; hypotension,; depressed sensorium, miosis

243
Q

Q243. sympathomimetic toxidrome? compare with anticholinergic toxidrome?

A

A243. very similar except sympathomimetic involves diaphoresis

244
Q

Q244. withdrawal toxidrome?

A

A244. agitation,; hallucination,; mydriasis,; diarrhea,; cramps,; lacrimation,; tachycardia,; insomnia,; seizures

245
Q

Q245. major toxic effect of acetaminophen?

A

A245. metabolite NAPQI causes centrilobular hepatocellular damage

246
Q

Q246. treatment of acetaminophen toxicity?

A

A246. 4 hour level on rumack matthew nomogram,; activated charcoal,; N acetyl cysteine (to regenerate glutathione)

247
Q

Q247. methanol toxicity?

A

A247. formic acid metabolite causing a gap acidosis and direct optic nerve toxicity

248
Q

Q248. treatment of ethylene glycol toxicity?

A

A248. 4MP or EtOH

249
Q

Q249. which drugs can cause anticholinergic syndromes? tx?

A

A249. antihistamines, antipsychotics, TCAs… treatment physostigmine

250
Q

Q250. symptoms of calcium channel blocker toxicity? tx?

A

A250. bradycardia and hypotension; treatment CaCl2, glucagon, epinephrine, DA

251
Q

Q251. CO toxicity symptoms

A

A251. HA,; N/V,; flu like symptoms,; CNS depression,; tachy,; hypotension

252
Q

Q252. treatment of CO toxicity?

A

A252. 100% O2

253
Q

Q253. GHB?

A

A253. date rape drug euphoric and amnestic effects

254
Q

Q254. refractory seizures could be caused by what toxicity?

A

A254. INH

255
Q

Q255. Organophosphates can cause which toxidrome?

A

A255. muscarinic

256
Q

Q256. naloxone?

A

A256. opioid antagonist

257
Q

Q257. standard of care for salicylate poisoning?

A

A257. activated charcoal; also consider alkalinization of urine and blood with bicarb

258
Q

Q258. benzo receptor antagonist that can rapidly reverse coma from benzo OD…? what’s the problem with this drug/

A

A258. flumazenil; can lower the seizure threshold in pts with TCA OD and induce benzo withdrawal

259
Q

Q259. loxosceles bites can be treated with…?

A

A259. dapsone

260
Q

Q260. signs and symptoms of TCA OD?

A

A260. anticholinergic sx,; cardiac dysfunction,; intractable seizures,; and hyperthermia

261
Q

Q261. treatment of TCA toxicity?

A

A261. decontamination with MDAC; Sodium bicarb administration; Benzos for seizure management; Alpha agonists for hypotension

262
Q

Q262. prerenal failure due to..?

A

A262. decreased renal perfusion; (volume depletion, low CO, abnormal renal hemodynamics)

263
Q

Q263. most common cause of intrinsic renal failure?

A

A263. longstanding HTN

264
Q

Q264. majority of hospital assoc episodes of ARF are caused by…?

A

A264. ATN

265
Q

Q265. postrenal failure caused by?

A

A265. obstructive uropathy

266
Q

Q266. FENA <1 in which condition?

A

A266. Prerenal failure

267
Q

Q267. Urine Na <20 in which condition?

A

A267. Prerenal failure

268
Q

Q268. treatment of prerenal failure?

A

A268. volume replacement, d/c offending meds

269
Q

Q269. intrinsic RF treatment?

A

A269. monitor fluid status,; restrict protein,; correct electrolyte abnormalities

270
Q

Q270. dispo for patients with ARF?

A

A270. admit

271
Q

Q271. what drugs can cause ARF in pts with renal artery stenosis?

A

A271. ACE inhibitors

272
Q

Q272. #1 cause of death in 1 44 year olds?

A

A272. Trauma (specifically, MVCs)

273
Q

Q273. Preparation for a trauma case includes?

A

A273. History from EMTs; Prep the trauma bay; Airway box; O2 and suction; IVF and supplies

274
Q

Q274. Indications for intubation?

A

A274. GCS <8; Inadequate breathing; Unable to protect airway

275
Q

Q275. Chin lift is contraindicated if…?

A

A275. A C spine injury is suspected

276
Q

Q276. Radial pulse should have a BP of at least…? Femoral?

A

A276. 80 mmHg; 70

277
Q

Q277. what % of ECF is plasma?

A

A277. 40181

278
Q

Q278. which drug is an ineffective pressor in hypovolemic patients?

A

A278. dopamine

279
Q

Q279. GCS consists of which 3 categories?

A

A279. eye opening,; verbal response,; moto response

280
Q

Q280. most rapid means to lower ICP?; what other method?

A

A280. Hyperventilation; mannitol

281
Q

Q281. volume of blood in an adult?

A

A281. 5 L (7% of ideal body weight)

282
Q

Q282. physiologic response to acute hypovolemia?

A

A282. In order:; Tachycardia; narrowed pulse pressure (increased diastolic press); slowing of cap refill; decreased systolic pressure

283
Q

Q283. raccon eyes, and battle sign?

A

A283. late findings in basilar skull fractures

284
Q

Q284. assessment of C spine in trauma?

A

A284. posterior midline any tenderness?; focal neuro deficit?; A&O; evidence of intoxification?; any painful injury that may distract the pt?

285
Q

Q285. FAST?

A

A285. quick, non invasive method of examining the abdomen and pericardium for blood

286
Q

Q286. how to check for pelvic fracture?

A

A286. press down and in on both iliac crests simultaneously

287
Q

Q287. urine myoglobin can be elevated secondary to…?

A

A287. massive muscle breakdown (rhabdo)

288
Q

Q288. treatment of rhabdo?

A

A288. IVF,; sodium bicarb,; and mannitol

289
Q

Q289. calculate cerebral perfusion pressure?

A

A289. MAP ICP

290
Q

Q290. Cushing’s reflex? sign of?

A

A290. HTN, bradycardia, hypopnea; sign of increased ICP

291
Q

Q291. in traumatic head injury, what is the target MAP?

A

A291. 90mmHg

292
Q

Q292. intubation considerations for elevated ICP?

A

A292. intubate early but WITHOUT ketamine

293
Q

Q293. seizure prophylaxis with head bleeds?

A

A293. dilantin

294
Q

Q294. how does cardiac tamponade present? findings?

A

A294. hypotension, muffled heart sounds, JVD, and pulsus paradoxus; electrical alternans on ECG; may present with pulseless electrical activity

295
Q

Q295. which condition can lead to hypotension, absent breath sounds, hyperresonance, distended neck veins, and high airway pressures?

A

A295. tension pneumothorax

296
Q

Q296. hypoxia occurs if an open pneumothorax is greater than?

A

A296. 2/3 trachea diameter

297
Q

Q297. flail chest?

A

A297. 3 or more rib fractures in 2 or more sites with paradoxical motion of chest wall with inspiration

298
Q

Q298. how to demonstrate fluid in the pericardium in tamponade?

A

A298. echocardiogram, or ED U/S

299
Q

Q299. treatment of tension pneumothorax?

A

A299. angiocath in the 2nd intercostals space in the mid clavicular line; chest tube if hemorrhagic or simple pneumothorax suspected

300
Q

Q300. treatment of cardiac tamponade?

A

A300. subxyphoid pericardiocentesis

301
Q

Q301. splenic injury can cause pain referred to…? eponym?

A

A301. left shoulder…Kehr’s sign

302
Q

Q302. which chief complaints warrant a stat EKG?

A

A302. chest pain/pressure/discomfort; SOB; hypotension; weakness/dizziness; syncope; abdominal pain especially in elderly; palpitations; N/V especially in elderly, diabetics

303
Q

Q303. shortened PR interval suggests?

A

A303. alternate, abnormal conduction pathway like WPW syndrome

304
Q

Q304. elongated PR interval suggests?

A

A304. some form of AV block

305
Q

Q305. quick and dirty way of determining the axis of the heart?

A

A305. leads I and aVF… both up normal; aVF down LAD; I down RAD; both down RAD

306
Q

Q306. DDx of U waves?

A

A306. hypokalemia; hypercalcemia; meds (digoxin, quinidine); thyrotoxicosis

307
Q

Q307. Describe possible characteristics of an unstable cardiac patient?

A

A307. Pulseless; Hypotension; AMS; Ischemic chest pain; CHF

308
Q

Q308. treatment basics for unstable cardiac patients?

A

A308. cardioversion (synch or un synch) per ACLS protocol, then IV meds or other therapy

309
Q

Q309. treatment of sinus tachycardia?

A

A309. treatment the UNDERLYING CAUSE

310
Q

Q310. how can you tell there’s paroxysmal supraventricular tachycardia? tx?

A

A310. abnormal/absent P waves; Tx: unstable > synch cardioversion; stable > AV node blockade via adenosis, calcium channel blockers (diltiazem, verapamil), b blockers, manuevers

311
Q

Q311. treatment of a fib?

A

A311. unstable > synch cardioversion; stable w/ rapid vent. response > AV blockade: calcium channel blockers, b blockers, digoxin; anticoagulation

312
Q

Q312. pts with pre excitation syndromes be careful not to…?

A

A312. block the AV node by conventional meds

313
Q

Q313. premature ventricular contractions, etiology?

A

A313. 4 H’s hypokalemia, hypomagnesemia, hypoxia, hyperthyroidism; drugs; heart disease

314
Q

Q314. what is trigeminy?

A

A314. every 3rd beat is a PVC

315
Q

Q315. treatment of PVCs?

A

A315. iv lidocaine or amiodarone; iv magnesium sulfate; procainamide

316
Q

Q316. treatment of pulseless v tach?

A

A316. immediate UNSYCNHED cardioversion

317
Q

Q317. treatment for unstable v tach?

A

A317. synchronized cardioversion, then amiodarone or lidocaine drip

318
Q

Q318. treatment for stable v tach?

A

A318. medical cardioversion with lidocaine, amiodarone, adenosine, or procainamide

319
Q

Q319. etiology of torsades?

A

A319. ischemic heart disease; MI; hypo electrolyte states

320
Q

Q320. treatment of stable torsades?

A

A320. electrical overdrive pacing; also consider Mg sulfate

321
Q

Q321. treatment of Vfib?

A

A321. unsynchronized cardioversion,; ACLS protocols,; and correction of lytes abnormalities

322
Q

Q322. pulseless electrical activity etiology?

A

A322. MATCH4ED; MI; Acidosis; Tension pneumo; Cardiac tamponade; H4 hypothermia, hyperkalemia, hypoxia, hypovolemia; Embolism (pulm); Drug OD

323
Q

Q323. treatment of ventricular asystole?

A

A323. IVF, epinephrine, atropine; Transvenous pacing

324
Q

Q324. for Mobitz II 2nd degree AV block, what tx? What won’t work?

A

A324. transcutaneous or transvenous pacing; Admit for implantable pacemakers; Atropine won’t work

325
Q

Q325. treatment for 3rd degree AV block?

A

A325. immediate temporary pacemaker

326
Q

Q326. you should consider a new LBBB to be _______ until proven otherwise?

A

A326. acute MI

327
Q

Q327. Indications for temporary cardiac pacing?

A

A327. hemodynamically unstable bradycardia; bradycardia that fails to respond to tx; refractory tachycardia dysrhythmias; early bradyasystolic arrest

328
Q

Q328. how does digoxin cause toxicity?

A

A328. blockade of the NaKATPase; increased vagal tone and increased AV nodal blockade

329
Q

Q329. EKG signs of WPW?

A

A329. short PR interval; Delta wave; wide QRS; adult tachycardia

330
Q

Q330. EKG signs of hypokalemia?

A

A330. more prominent U waves; flattened t waves

331
Q

Q331. EKG signs of hyperkalemia?

A

A331. hyperacute T waves; wide QRS that eventually blends with the T wave to form a sine wave appearance

332
Q

Q332. EKG signs of hypocalcemia?

A

A332. prolonged QT; terminal T wave inversion

333
Q

Q333. EKG signs of hypercalcemia?

A

A333. shortened QT interval

334
Q

Q334. associated symptoms of ACS?

A

A334. dyspnea, diaphoresis, nausea, lightheadedness, or sense of weakness

335
Q

Q335. define stable angina?

A

A335. symptoms precipitated by exertion and relieved by rest or nitroglycerin

336
Q

Q336. define unstable angina?

A

A336. Exertional angina of recent onset; angina of worsening character; angina at rest

337
Q

Q337. describe myoglobin as a cardiac marker?

A

A337. elevated as early as one hour and peaks at 4 12 hours; nonspecific

338
Q

Q338. describe CKMB as a cardiac marker?

A

A338. rises in 3 4 hours, peaks at 12 24 hours; can be elevated in skeletal muscle injury

339
Q

Q339. describe troponin as a cardiac marker?

A

A339. rises in 3 6 hours, peaks 12 24 hours; most specific and sensitive

340
Q

Q340. acute MI tx?

A

A340. MOAN B H; morphine; oxygen; aspirin; nitroglycerin; beta blockade; heparin

341
Q

Q341. in pump failure.. which pressors for hypotension in a volume unresponsive patient..?

A

A341. sbp 80 100 dobutamine; sbp 70 80 dopamine; sbp <70 levophed

342
Q

Q342. pericarditis presentation?; pain is worsened by..?

A

A342. sharp stabbing precordial or retrosternal chest pain… pain worsened by inspiration or lying flat

343
Q

Q343. associated symptoms of pericarditis?

A

A343. low grade fever; dyspnea; dysphagia; tachycardia

344
Q

Q344. test of choice for detection and f/u of pericarditis?

A

A344. echo

345
Q

Q345. treatment for pericarditis

A

A345. NSAIDs for 1 3 weeks

346
Q

Q346. aortic dissections typically occur in what group?

A

A346. uncontrolled hypertensive males ages 50 70

347
Q

Q347. physical findings in aortic dissection?

A

A347. asymmetric pulses with BP differences between extremities; very hypertensive; severe distress; JVD; palpable pulsatile mass or tenderness

348
Q

Q348. chest tube required for what size pneumothorax?

A

A348. >15%

349
Q

Q349. Nitro’s relief of cardiac vs esophageal pain?

A

A349. Cardiac w/in 5 minutes, esophageal w/in 10 minutes

350
Q

Q350. life threatening etiologies of abdominal pain…?

A

A350. ruptured AAA,; perforated viscous,; intestinal obstruction,; ectopic pregnancy,; mesenteric ischemia,; appendicitis,; and MI

351
Q

Q351. INITIAL TEST OF CHOICE FOR BILIARY TRACT DISEASE, AAA, ectopic, or free peritoneal fluid?

A

A351. US

352
Q

Q352. Plain films can rule out which abdominal emergencies?

A

A352. Perforation or obstruction

353
Q

Q353. Colicky pain usually responds to which drugs? Specifically…?

A

A353. NSAIDs,; esp IV Ketorolac

354
Q

Q354. Triad of pain, hypotension, and a pulsatile abdominal mass…?

A

A354. AAA

355
Q

Q355. _______ is virtually 100% sensitive in detecting AAAs?

A

A355. US

356
Q

Q356. What is usually the primary inciting factor of appendicitis?

A

A356. Obstruction of the appendix usually by an appendicolith

357
Q

Q357. risk factors for cholecystitis?

A

A357. fat, forty, and female

358
Q

Q358. radiation of pain in acute cholecystitis?

A

A358. tip of the right scapula

359
Q

Q359. most useful test if suspicious of cholecystitis?

A

A359. US of RUQ

360
Q

Q360. which agents should not be used in acute gastroenteritis?

A

A360. anti motility agents (Imodium) because it diminishes diarrheal excretion of organisms

361
Q

Q361. Presentation of patients with acute hepatitis?

A

A361. Jaundice,; dark urine/light stools,; hepatomegaly,; fatigue, malaise,; RUQ pain,; N/V,; and fever

362
Q

Q362. coagulation should be normalized with FFP in which condition?

A

A362. hepatitis

363
Q

Q363. presentation of acute mesenteric ischemia?

A

A363. severe, poorly localized colicky abdominal pain associated with recurrent forceful bowel movements; classic abdominal pain out of proportion to the minimal physical exam findings

364
Q

Q364. Most useful test to diagnose acute mesenteric ischemia?

A

A364. Angiography

365
Q

Q365. Midepigastric abdominal pain usually associated with N/V?

A

A365. Acute pancreatitis

366
Q

Q366. An amylase raised _______ times the upper limit of normal is 98% specific to acute pancreatitis…

A

A366. 1.5

367
Q

Q367. All patients with acute pancreatitis should be….

A

A367. admitted and made NPO

368
Q

Q368. good narcotic choice for pain in acute pancreatitis

A

A368. Meperidine (better than morphine)

369
Q

Q369. fever, abdominal pain, and rebound tenderness…?

A

A369. Peritonitis

370
Q

Q370. Small bowel obstruction is caused by ________ more than 50% of the time…?

A

A370. postoperative adhesions

371
Q

Q371. Most significant complications of small bowel obstruction?

A

A371. Strangulation and bowel infarction

372
Q

Q372. etiology of bronchitis?

A

A372. viruses (influenza, adenovirus, etc.); Mycoplasma; Chlamydia; Bordetella pertussis

373
Q

Q373. Virchow’s triad of the pathophysiology behind PE?

A

A373. Venostasis; Hypercoagulability; Vessel wall damage/inflammation

374
Q

Q374. Classic triad of PE presentation?

A

A374. Hemoptysis; Dyspnea; chest pain

375
Q

Q375. EKG findings in PE?

A

A375. S1; Q3; inverted T3

376
Q

Q376. golden standard for diagnosing PE?

A

A376. pulmonary angiography

377
Q

Q377. ED treatment of CHF?

A

A377. diuretics; nitrates; anlgesics; intubation or CPAP if no improvement

378
Q

Q378. treatment of COPD in the ED?

A

A378. ABCs monitoring; albuterol neb; glucocorticoids; MgSO4 in severe exacerbations; antibiotics (empiric broad spectrum)

379
Q

Q379. ED eval of asthma?

A

A379. Monitors, O2, pulse ox; Peak expiratory flow rate; CXR to rule out pneumonia

380
Q

Q380. signs of hyperventilation syndrome?

A

A380. tachypnea, chest wall tenderness, carpopedal spasm, Chvostek’s/Trousseau’s sign (hypocalcemia)

381
Q

Q381. this condition likely results from inflammation of CN VII as it courses through the styloid foramen?

A

A381. Bell’s palsy

382
Q

Q382. treatment of bell’s palsy?

A

A382. acyclovir AND prednisone; eye patching to prevent keratitis and corneal ulceration

383
Q

Q383. work up of CVA?

A

A383. STAT head CT esp if < 3 hrs; standard labs; STAT Accu check

384
Q

Q384. in hemorrhagic stroke, you want to decrease SBP by no more than _____ to limit hypoperfusion…?

A

A384. 20 25%

385
Q

Q385. Peripheral vertigo is caused by.?

A

A385. viral etiology (labyrinthitis); decaying or “lost” otoliths

386
Q

Q386. peripheral vertigo presentation?

A

A386. acute onset; intense spinning sensation, N/V; unidirectional nystagmus that can be inhibited by fixation

387
Q

Q387. work up of peripheral vertigo?

A

A387. hallpike maneuver; epley manuevers; anti emetics, anti cholinergics

388
Q

Q388. most seizures in the ED are due to…?

A

A388. Medical non compliance in known seizure patients

389
Q

Q389. workup of seizures in the ED…

A

A389. ABCs; IV; check glucose; head CT; anti epileptic level; LP if any possibility of intracranial hemorrhage or meningitis

390
Q

Q390. LOC occurs in ____ % of patients with SAH?

A

A390. 0.5

391
Q

Q391. 75% of SAH is due to…?

A

A391. ruptured congenital arterial aneurysm

392
Q

Q392. diagnostic test for SAH?

A

A392. noncontrast head CT

393
Q

Q393. if there is suspicion for SAH and it’s not seen on CT, ____ must be performed?

A

A393. LP

394
Q

Q394. What other condition besides SAH could cause blood in the CSF?

A

A394. Herpes encephalitis

395
Q

Q395. goal of ICP management is to maintain the cerebral perfusion pressure greater than ______?

A

A395. 60

396
Q

Q396. A chronic headache that started out mild to moderate in severity and intermittent in nature, described as a deep, aching pain and worsened by coughing, and often maximal upon awakening…?

A

A396. intracranial tumor / mass

397
Q

Q397. 85% of people experiencing malignant hypertension complain of _____?

A

A397. Headache

398
Q

Q398. Temporal arteritis affects women ______ than men, and is uncommon before the age of _____? ESR is usually ____?

A

A398. Women more than men; 50; ESR 50 100

399
Q

Q399. Jaw claudication is strongly suggestive of…?

A

A399. temporal arteritis

400
Q

Q400. treatment of temporal arteritis?

A

A400. prednisone 60mg po, arrange a biopsy to confirm diagnosis

401
Q

Q401. Often compression of ______________ can improve the pain of migraine?

A

A401. the ipsilateral superficial temporal or carotid artery

402
Q

Q402. ergotamine is contraindicated in… ? Should be used w/ caution in ….?

A

A402. Pregnancy; Caution in HTN or CAD

403
Q

Q403. Patients should avoid _____ while in the midst of cluster headaches?

A

A403. Alcohol

404
Q

Q404. This causes headaches often in overweight women in their 30s…

A

A404. Pseudotumor Cerebri (benign intracranial HTN)

405
Q

Q405. 90% of patients with Pseudotumor Cerebri have ….?

A

A405. papilledema

406
Q

Q406. in Pseudotumor Cerebri, head CT will show…? LP will show…?

A

A406. CT slit like ventricles; LP increased opening pressure

407
Q

Q407. treatment of Pseudotumor Cerebri..?

A

A407. Acetazolamide 250 mg pid

408
Q

Q408. treatment of post LP HA?

A

A408. caffeine sodium benzoate

409
Q

Q409. cherry red coloration of skin/mucous membranes, retinal hemorrhages, AMS?

A

A409. CO poisoning

410
Q

Q410. sudden onset of head/eye pain, decreased visual acuity?

A

A410. Acute angle closure glaucoma

411
Q

Q411. treatment of acute uncomplicated UTI?

A

A411. Bactrim for 3 days

412
Q

Q412. Pyelonephritis w/ systemic sx tx?

A

A412. admit for IV antibiotics

413
Q

Q413. pregnant women with UTI tx?

A

A413. macrobid for 7 days

414
Q

Q414. What % of pts presenting with classic UTI sx show minimal to no bacteria on UA?

A

A414. 30 40%

415
Q

Q415. Sudden onset of testicular pain in children and young men?

A

A415. Testicular torsion

416
Q

Q416. most common cause of urinary retention?

A

A416. BPH

417
Q

Q417. >100 ml postvoid residual urine volume is diagnostic of…?

A

A417. urinary retention

418
Q

Q418. what is fournier’s gangrene?

A

A418. aggressive fasciitis of the perineum in a toxic appearing pt likely with history of DM, urethral trauma, surgery, or obstruction

419
Q

Q419. treatment of fournier’s gangrene??

A

A419. immediate surgery complete debridement of necrotic tissue

420
Q

Q420. tender, swollen, painful epididymis and testis usually accompanied by fever?

A

A420. Epididymitis

421
Q

Q421. testicular US can distinguish…?

A

A421. torsion from epididymitis

422
Q

Q422. the cremasteric reflex is present in _____ but not in ___________?

A

A422. epididymitis; torsion

423
Q

Q423. nonspecific infection of the glans penis is called…?

A

A423. balanitis

424
Q

Q424. abnormally small opening in the foreskin?

A

A424. phimosis

425
Q

Q425. abnormal painful swelling of the glans penis occurring after aggressive retraction of a phimotic foreskin?

A

A425. paraphimosis

426
Q

Q426. flank/abdominal pain, does not change with position or remaining still, radiation to groin…

A

A426. stones

427
Q

Q427. work up of stones?

A

A427. IVF; IV narcotics; UA will generally show hematuria; BMP

428
Q

Q428. test of choice for kidney stones?

A

A428. noncontrast CT

429
Q

Q429. stone <3mm probability of passing spontaneously?

A

A429. 0.8

430
Q

Q430. Indications for urology consults or admission in kidney stones…?

A

A430. Associated UTI; uncontrolled pain/emesis; extravasation of contrast; renal failure; single kidney; hydronephrosis + hydroureter; stone > 6mm

431
Q

Q431. in a patient >60, first time renal colic is _________ until proven otherwise…

A

A431. AAA

432
Q

Q432. of those women who experience bleeding in the first trimester, ______________ will undergo spontaneous abortion

A

A432. 40180

433
Q

Q433. threatened abortion…?

A

A433. vaginal bleeding with a pre viable fetus and closed cervix

434
Q

Q434. inevitable abortion?

A

A434. vaginal bleeding with cervical dilatation

435
Q

Q435. incomplete abortion

A

A435. vaginal bleeding with partial passage of products of conception and dilated cervix

436
Q

Q436. complete abortion

A

A436. passage of all products of conception and closed cervix

437
Q

Q437. missed abortion

A

A437. fetal demise and retention of products of conception, cervix closed

438
Q

Q438. 6 8 weeks gestation with amenorrhea, spotting, and cramping lower abdominal pain….concerning for…?

A

A438. ectopic

439
Q

Q439. gold standard in diagnosing an ectopic?

A

A439. US

440
Q

Q440. any patient who presents with vaginal bleeding and is _____ should be given RhoGAM?

A

A440. Rh

441
Q

Q441. 2 most common pregnancy related causes of vaginal bleeding in the second trimester?

A

A441. miscarriage; hydatidiform mole

442
Q

Q442. pre eclampsia that occurs prior to 20 weeks gestation is pathognomonic for…?

A

A442. trophoblastic disease

443
Q

Q443. most common presentation of placenta previa?

A

A443. late 2nd to early 3rd trimester painless bleeding

444
Q

Q444. ____________ may occur in up to 1/3 of placental abruptions?

A

A444. DIC

445
Q

Q445. pre eclampsia?

A

A445. triad of HTN, edema, and proteinuria of >100 mg/dl

446
Q

Q446. HELLP syndrome?

A

A446. subset of pre eclamptic pts:; Hemolysis, Elevated Liver enzymes, and Low Platelets

447
Q

Q447. In preeclampsia and eclampsia, the most important part of the CBC is…?

A

A447. the platelet count

448
Q

Q448. seizure prophylaxis in pre, eclampsia?

A

A448. MgSO4

449
Q

Q449. preterm labor is defined as occurring…?

A

A449. before 37 weeks gestation

450
Q

Q450. Strawberry cervix?

A

A450. trichomonas

451
Q

Q451. average blood loss in normal menses/

A

A451. 30 60cc

452
Q

Q452. benign leiomyomas that develop in the uterus and often result in menometrorraghia?

A

A452. fibroids

453
Q

Q453. dysfunctional uterine bleeding tx..?

A

A453. NSAIDs, and OCPs; rule out endometrial carcinoma

454
Q

Q454. Chlamydia can cause….?

A

A454. Asymptomatic infection; Urethritis; Cervicitis; PID

455
Q

Q455. PID?

A

A455. Lower abdomen. tenderness, cervical motion tenderness, and adnexal tenderness; + fever or increased WBC or ESR etc..

456
Q

Q456. most common cause of infectious arthritis in young sexually active adults?

A

A456. Gonorrhea

457
Q

Q457. green gray discharge?

A

A457. trichomonas

458
Q

Q458. thin gray malodorous discharge, non sexually transmitted

A

A458. bacterial vaginosis

459
Q

Q459. most common cause of pelvic pain in women not associated with infection is…?

A

A459. Rupture of an ovarian cyst

460
Q

Q460. 50% of cases of ovarian torsion are caused by..?

A

A460. Benign dermoids that cause the ovary to twist

461
Q

Q461. A major cause of pelvic pain, dyspareunia, and dysmenorrhea

A

A461. Endometriosis

462
Q

Q462. postcoital contraception?

A

A462. norgestrel

463
Q

Q463. first, second, etc degree frostbite?

A

A463. 1st warm, hyperemic, sensate; 2nd clear vesicles; 3rd purple bullae; 4th mummification

464
Q

Q464. ED management of frostbite?

A

A464. treatment hypothermia; IVF; remove nonadherent wet apparel; rapid thawing thawing in 42C water bath; unroofing clear blisters; aloe vera; tetanus prophy; ibuprofen, ascorbic acid, nifedipine

465
Q

Q465. How to estimate total body surface area for burns..?

A

A465. 9’s; LUE 9%,; LLE 18%,; posterior torso 18%,; head 9%

466
Q

Q466. burn degrees?

A

A466. 1st superficial epidermis (no blisters, heals w/out scar); 2nd superficial dermis (blisters, scarring in 3 wks…); 3rd all of dermis (charred, painless, scars with contractures)

467
Q

Q467. How do you determine IVF needs in a burn victim?

A

A467. If TBSA >15%…. 4ml x kg weight x tbsa% = total volume of replacement needed in first 24 hrs

468
Q

Q468. don’t forget _________ in frostbite, burns, and a variety of other injuries….?

A

A468. tetanus prophylaxis

469
Q

Q469. hypothermia defined?

A

A469. core temp < 35 C

470
Q

Q470. presentation of mild hypothermia?

A

A470. confusion, lethargy, fatigue, shivering, tachycardia, respiratory alkalosis

471
Q

Q471. resuscitation in severe hypothermia should include _________ in order to treat cardiac dysrhythmias…?

A

A471. Warming until core temp > 32 C

472
Q

Q472. severe dehydration, thermoregulaory failure, temp >40C, tachycardia, hypotension, confusion, rhabdo…?

A

A472. Heat stroke

473
Q

Q473. treatment of heat stroke..?

A

A473. rapid cooling, monitoring, seizure prophylaxis

474
Q

Q474. voltage > _____________ is considered high tension..?

A

A474. 1000 V

475
Q

Q475. the _________ the resistance, the more the current and damage

A

A475. less

476
Q

Q476. AC current is ___________ dangerous than DC, because?

A

A476. more; increased duration of exposure; increased likelihood of Vfib

477
Q

Q477. barotrauma of ascent?

A

A477. when a diver fails to exhale when ascending, exacerbating the overexpansion of the airspaces

478
Q

Q478. type 1 decompression sickness? type 2?; treatment if severe?

A

A478. 1 joint, skin, bone problems; 2 neuro, lung, CV problems; Hyperbaric oxygen chamber

479
Q

Q479. what agent can mimic acclimatized state in the treatment of altitude sickness?

A

A479. Acetazolamide causes a compensatory respiratory alkalosis

480
Q

Q480. most infection prone bite injury?

A

A480. human bite to the hand

481
Q

Q481. ___________ is implicated in 50% of infected cat bites and 30% of infected dog bites?

A

A481. Pasteurella

482
Q

Q482. complications of this infection include encephalitis, Painaud’s, osteolytic bone lesions, purpura, and erythema nodosum

A

A482. Bartonella

483
Q

Q483. describe phases of rabies briefly?

A

A483. Incubation period couple months; Prodrome 1 week of localized pain, malaise, N/V; Acute neuro phase 1 week; Coma up to 2 weeks

484
Q

Q484. Loxosceles spider bite tx?

A

A484. wound care; antibiotics if superinfected; antihistamines and analgesics; dapsone to prevent ulceration; IV steroids in viscerocutaneous loxoscelism to prevent hemolysis

485
Q

Q485. sudden onset fever, centripetal rash spread, severe HA, myalgia, N/V, and abdominal pain

A

A485. Rocky mountain spotted fever

486
Q

Q486. treatment of rocky mountain?

A

A486. teracycline or chloramphenicol; supportive care for shock, DIC, ARDS, CHF

487
Q

Q487. complications of auricular hematoma?

A

A487. cauliflower ear, cartilage necrosis

488
Q

Q488. pathogens of otitis externa?

A

A488. pseudomonas and staph

489
Q

Q489. treatment of anterior bleeding epistaxis?

A

A489. pinching pressure, decongestion, silver nitrate, packing, abx to prevent sinusitis

490
Q

Q490. problem with posterior bleeding epistaxis?

A

A490. pharyngeally stimulated hypoxia and stopped breathing

491
Q

Q491. ____________ cures >95% of peritonsillar abscesses?

A

A491. I and D

492
Q

Q492. Ludwig’s angina? big concern?

A

A492. Trench mouth dental origin infection of submandibular space due to horrible hygiene; Concern airway compromise

493
Q

Q493. duck quack cry is characteristic of…?

A

A493. Retropharyngeal deep space infection

494
Q

Q494. swallowed coins appear ____________ in trachea, _____________ in esophagus?

A

A494. side on; face on

495
Q

Q495. diagnosis and treatment of esophageal foreign body?

A

A495. EGD for visualization; glucagon for esophageal relaxation

496
Q

Q496. epiglotitis has traditionally been associated with which infection?

A

A496. Hemophillus B

497
Q

Q497. diagnosis of epiglotitis?

A

A497. loss of V shaped dip in neck plain film (valecula sign)

498
Q

Q498. if suspecting epiglotitis in kids….what next?

A

A498. call ENT or anesthesia no IV’s, oral exam, nothing that stimulates/agitates the child

499
Q

Q499. croup? what type of cough?

A

A499. laryngotracheobronchitis viral infection; seal like barking cough

500
Q

Q500. difference in presentation in kids with croup vs. epiglotitis?

A

A500. in croup, kids generally appear well

Clinical Medicine (7 decks)

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