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Clinical Rotations > Emergency Medicine > Flashcards

Emergency Medicine Flashcards

1
Q

What is the 1st line treatment for minor bleeding in a patient with von Willebrand disease?

A

Desmopressin

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2
Q

What are the 3 types of definitive airways?

A

Orotracheal tube
Nasotracheal tube
Surgical airway (cricothyrotomy/tracheostomy)

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3
Q

Which nerve is most likely to be injured when the arm is hyperextended?

A

T1 of the brachial plexus

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4
Q

What is the T1 nerve root motor function?

A

Finger abduction
Finger adduction
Thumb opposition
Wrist flexion

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5
Q

What is the T1 nerve root sensory function?

A

Sensation to the ulnar aspect of the forearm

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6
Q

What are the 4 causes of postpartum hemorrhage?

A

4 T’s
Uterine atony (most common)
Trauma to birth canal
Retention of fetal or placental tissue
Coagulopathy or thrombin disorder

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7
Q

What is 1st line treatment for a patient that presents with symptoms of alcohol withdrawal?

A

Benzos or phenobarbital

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8
Q

Generally speaking, what is the 1st line PO treatment of uncomplicated pyelonephritis?

A

Ceftriaxone

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9
Q

What are the signs/symptoms of serotonin syndrome?

A

History of taking multiple meds that increase serotonin (SSRI, SNRI, TCA)
Mental status changes
Autonomic instability (tachy, diaphoresis, diarrhea)
Neuromuscular abnormalities (clonus, tremor, seizure)

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10
Q

What is the treatment for serotonin syndrome?

A

Benzos
Cyproheptadine
Remove the offending agent

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11
Q

What is a greenstick fracture and how do you manage it?

A

A bone that is bent with a fracture line that does not extend completely through the width of the bone
Immobilization and casting

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12
Q

What are the Ottawa foot and ankle rules?

A

Rules to x-ray a foot/ankle if:
Pt cannot bear weight for 4 steps
Distal 6 cm of tibia or fibula is tender
Medial or lateral malleolus is tender
5th metatarsal is tender
Navicular bone is tender

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13
Q

What are signs/symptoms of a lisfranc injury?

A

Hx of MVC, fall, playing sports
Severe foot pain & inability to bear weight
Tenderness of the tarsometatarsal joint

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14
Q

What is the most common cause of osteomyelitis in children?

A

Staphylococcus aureus

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15
Q

What organisms commonly lead to sepsis in asplenic patients?

A

Strep pneumo
N. meningitidis
H. flu

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16
Q

What is the treatment for a cat bite?

A

Irrigate the wound
Leave the wound open
Treat w/Augmentin

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17
Q

What are the signs/symptoms of mitral valve prolapse?

A

Palpitations
Dyspnea
Non-exertional chest pain
Fatigue
Midsystolic click & late systolic murmur

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18
Q

What maneuvers increase preload or afterload that move a midsystolic click to a later systolic click?

A

Squatting (increase preload)
Afterload (hand grip)

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19
Q

Which nerve root is most commonly affected when a pt presents with pain that radiates down the posterior arm to the dorsum of the forearm & 3rd digit (cervical radiculopathy)?

A

C7

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20
Q

What are the signs/symptoms of osteoarthritis?

A

Joint pain & stiffness (knees, hips, DIP)
Pain that is worse with activity & better with rest
Swelling, deformity, crepitus, decreased ROM
Joint space narrowing and osteophytes (on x-ray)

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21
Q

What is considered a hypertensive emergency?

A

Elevated BP (systolic > 180 or > 120 diastolic) with concomitant end-organ damage

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22
Q

What is the treatment for hypertensive emergency?

A

IV antihypertensives (labetalol or nicardipine)
If with pulmonary edema, vasodilators (nitrates)

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23
Q

What are the signs/symptoms of transient aplastic crisis?

A

May have sickle cell, iron deficiency anemia, or hereditary spherocytosis
Pallor, fatigue, lethargy, SOB
Low or undetectable reticulocyte count

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24
Q

What is the most common cause of transient aplastic crisis and what is the treatment?

A

Parovirus B19
Self-limited, transfusion support

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25
Q

What is the most common post-partum infection?

A

Endometritis

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26
Q

What are the signs/symptoms and the treatment for endometritis?

A

Sxs: may have hx of c-section, abdominal pain, fever, foul smelling lochia
Tx: clindamycin + gentamicin (add ampicillin if GBS)

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27
Q

What is the most common ankle injury and how does it occur?

A

Lateral ankle sprain
Occurs when plantar flexed foot is inverted

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28
Q

ST elevations on EKG based on occlusion site

A

Anterior: V1 thru V4
Inferior: II, III, aVF
Lateral: I, aVL, V5, V6
Posterior: depressions in V1 thru V3 & elevations in V8 & V9

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29
Q

What presents with dyspnea on exertion, syncope, and chest pain and also has a harsh crescendo-decrescendo systolic murmur that increases in intensity with Valsalva maneuver and decreases with squatting?

A

Hypertrophic cardiomyopathy

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30
Q

What is the Parkland formula?

A

Calculation for fluid resuscitation for burn patients
4mL x total body surface area of burns (%) x body weight (kg)
1st half given over 8 hrs, 2nd half given over 16 hours

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31
Q

What is the rule of 9’s?

A

Burn % based on body part
Head: 9%
Torso front: 18%
Torso back: 18%
Each arm: 9%
Each leg: 18%
Genitals: 1%
Palm: 0.5%
All fingers: 1%

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32
Q

What is a common presentation/signs of an epidural hematoma?

A

Head injury with loss of consciousness followed by lucid interval and then rapid cognitive decline
Biconvex opacity on CT (lens shaped)
Usually from middle meningeal artery

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33
Q

What are the EKG findings in a pt suspected of having pericarditis?

A

PR depression
PR elevation in aVR
Diffuse ST segment elevation

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34
Q

What is the treatment for pericarditis?

A

NSAIDs
Colchicine

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35
Q

What sound is heard in a pt with aortic regurgitation?

A

Diastolic blowing murmur best heard at the left sternal border

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36
Q

What are the signs/symptoms of a subarachnoid hemorrhage?

A

Worst headache of their life or thunderclap headache
Blood in Circle of Willis and/or fissures on CT

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37
Q

What is the most commonly affected vessel in an ischemic stroke?

A

Middle cerebral artery (MCA)

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38
Q

What are the signs/symptoms of a middle cerebral artery ischemic stroke?

A

Contralateral paralysis
Aphasia

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39
Q

What is a P2Y12 inhibitor?

A

Antiplatelet (clopidogrel)
Commonly used in acute coronary syndrome management

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40
Q

What are the signs/symptoms of mitral stenosis?

A

Hx of rheumatic heart disease
Exertional dyspnea, hemoptysis
Mid-diastolic rumbling best heard at apex (does not radiate)

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41
Q

What are the signs/symptoms of hyperthyroidism?

A

Heat intolerance, anxiety, weight loss
Exophthalmos, pretibial edema
Low TSH, high free T4
Treat with methimazole or PTU
*PTU in the 1st trimester of pregnancy

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42
Q

If a pt presents with hypotension and you suspect septic shock due to a plethoric IVC on ultrasound, what is the best management?

A

Start vasopressors (norepinephrine)

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43
Q

What EKG changes are seen in a pt with a pulmonary embolism?

A

S1, Q3, T3
S wave in lead I
Q wave in lead III
Flipped T wave in lead III

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44
Q

What EKG changes are seen in a left bundle branch block?

A

Wide QRS complex
Large R wave in lead I
Negative wave in lead V1

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45
Q

What lab values would you see in a patient with disseminated intravascular coagulation (DIC)?

A

Thrombocytopenia
Decreased fibrinogen
Increased fibrin split products
Increased bleeding time
Increased PT & PTT

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46
Q

What are the characteristics of pheochromocytoma?

A

Catecholamine-secreting tumor of adrenal gland
Sx: diaphoresis, tremors, vision changes
PE: hypertension
Dx: increased 24hr urinary catecholamines & metanephrines or increased serum metanephrines
Tx: alpha blocker (phentolamine, phenoxybenzamine)

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47
Q

What is a Trousseau sign?

A

Carpal spasm produced when the examiner applies a blood pressure cuff to the upper arm and maintains a pressure above systolic for 2–3 minutes
Commonly seen in hypocalcemia

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48
Q

What are the signs/symptoms of a migraine and what is the treatment?

A

Gradual onset, unilateral, throbbing
Abortive tx: triptans, DHE, NSAIDs, antiemetics
Prophylaxis: TCAs, beta blockers, anticonvulsants (topiramate), CCBs
Avoid triptans with uncontrolled HTN

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49
Q

What is anterior cord syndrome?

A

An incomplete spinal cord syndrome caused by hyperflexion of the spine or thrombosis of the anterior spinal artery

50
Q

What are the signs/symptoms of anterior cord syndrome?

A

Direct or indirect injury
Loss of motor function below lesion
Loss of pain & temp below lesion
Does NOT lose proprioception (position) or vibration

51
Q

What is the first-line pharmacotherapy for treating a patient with bulimia nervosa?

A

Fluoxetine

52
Q

What are the signs/symptoms of bacterial endocarditis?

A

FROM JANE
Fever
Roth spots
Osler nodes
Murmur
Janeway lesions
Anemia
Nail bed hemorrhages
Emboli

53
Q

What valve is most commonly affected by bacterial endocarditis in IV drug users?

A

Tricuspid

54
Q

What would you see on a chest x-ray in a pt with reactivation of latent pulmonary tuberculosis?

A

Apical-posterior upper lobe infiltrate

55
Q

What are the characteristics of Myasthenia Gravis?

A

Autoantibodies to nicotinic acetylcholine receptors resulting in impaired transmission at the neuromuscular junction
Ocular or generalized weakness that is worse at the end of the day or after exertion, ptosis & diplopia
Ice to eyelids improves diplopia
Treat with pyridostigmine

56
Q

What is the treatment for balanitis?

A

Topical clotrimazole cream

57
Q

What is responsible for most cases of embolic occlusion?

A

A fib

58
Q

What is the initial therapy for acute uncomplicated cystitis?

A

Bactrim or
Nitrofurantoin

59
Q

What are the signs/symptoms of primary immune thrombocytopenia (formerly ITP)?

A

Can present for 1st time in kids age 2-6
Hx of recent viral illness
Non-blanching petechiae/purpura, gingival bleeding
Platelets < 100,000/µL, normal WBC, normal hematocrit

60
Q

What are the signs/symptoms of acute angle-closure glaucoma?

A

Acute unilateral pain and vision loss, headache, vomiting, and seeing halos around lights
Cloudy cornea and fixed mid-dilated pupil

61
Q

What is the treatment for acute angle-closure glaucoma?

A

Emergent ophthalmology evaluation
Topical beta-blockers (timolol), topical alpha-agonists (apraclonidine), carbonic anhydrase inhibitors (acetazolamide)
Iridotomy (definitive tx)

62
Q

What EKG changes are seen in Wellen’s syndrome?

A

Deeply inverted or biphasic T waves in V2-3, which is highly specific for critical stenosis of the left anterior descending artery

63
Q

What is Charcot’s triad?

A

Symptoms of acute cholangitis
Pain in the RUQ, fever, & jaundice

64
Q

What are the signs/symptoms of anticholinergic toxidrome?

A

Hot as a hare (hyperthermia)
Blind as a bat (mydriasis)
Red as a beet (flushed skin)
Mad as a hatter (altered mental status/agitation)

65
Q

How do you treat anticholinergic toxidrome?

A

Physostigmine (antidote)
Benzos
Supportive care

66
Q

What presents with the classic triad of palpable purpura, abdominal pain, and arthritis and usually a preceding upper respiratory tract infection?

A

HSP

67
Q

What are decreased cortisol and increased ACTH levels following administration of ACTH indicative of?

A

Primary adrenal insufficiency (ex Addison’s)

68
Q

What are the signs/symptoms of tumor lysis syndrome (TLS)?

A

3-7 days post starting chemo
Hyperuricemia
Hyperkalemia
Hyperphosphatemia
Hypocalcemia

69
Q

What is the cornerstone of treatment/prevention of tumor lysis syndrome?

A

Aggressive IV hydration

70
Q

Guillain-Barré syndrome (GBS) is commonly associated with what bacteria?

A

Campylobacter jejuni

71
Q

What are the signs/symptoms of Guillain-Barre syndrome?

A

Symmetric ascending paralysis
Areflexia
1-6 weeks after illness (or flu vaccine)

72
Q

Elevated levels of creatinine kinase are often associated with what?

A

Rhabdo

73
Q

What is the initial management of a pt with hypertrophic cardiomyopathy?

A

Avoid exertion
Beta blocker (metoprolol)

74
Q

What is the treatment for severe Lyme carditis?

A

IV ceftriaxone

75
Q

What is both diagnostic and therapeutic in a suspected ectopic pregnancy?

A

Laparoscopy

76
Q

What is the definitive test for a pt suspected of having orbital cellulitis?

A

CT scan of the orbits

77
Q

What are the most common causes of hypercalcemia?

A

Primary hyperparathyroidism
Malignancy

78
Q

What EKG changes are seen in a pt with hypercalcemia?

A

Shortened QT interval

79
Q

If there is suspicion for SAH despite a negative CT scan or if the time frame suggests a CT may not be as accurate, what is the test of choice?

A

Lumbar puncture

80
Q

What is the initial treatment for an acute asthma exacerbation?

A

Short-acting beta-agonist nebulizers
Corticosteroids

81
Q

What is the cause and treatment of histoplasmosis?

A

Cause: endemic areas, bird or bat droppings
Tx: itraconazole and amphotericin for severe disease

82
Q

Along with a surgical consultation, what medication should be started in a pt with acute limb aschemia?

A

Unfractionated heparin

83
Q

What is the initial treatment for a hemodynamically stable patient with a pulmonary contusion?

A

Pain control and pulmonary hygiene

84
Q

Stable pts who are found to have a viral meningitis and are neurologically intact are treated with what?

A

Supportive care

85
Q

What is a result of repeated hyperextension injury that is common in athletes who play soccer?

A

Spondylolysis

86
Q

Physical examination that shows purulent conjunctivitis, blisters and ulcerations on the lips and in the mouth, and an erythematous, blistering rash on the trunk with recent exposure to a sulfa medication should make you suspect what diagnosis?

A

SJS

87
Q

What is the treatment for SJS?

A

Stop offending agent
Supportive care (may need burn unit)
Fluid replacement

88
Q

What is the mainstay of treatment in the emergency department for an acute exacerbation of MS?

A

IV corticosteroids

89
Q

What are the signs/symptoms of an acute exacerbation of MS?

A

Sensory loss
Cerebellar dysfunction
Motor dysfunction
Vision changes
Bladder and bowel dysfunction
Diplopia

90
Q

A pt presenting with daily headaches which may be more severe in the morning, complaints of transient vision loss, and papilledema on fundoscopic examination likely has what diagnosis and needs what test/treatment?

A

Idiopathic intracranial hypertension (pseudotumor cerebri)
Dx/Tx: lumbar puncture

91
Q

What is the most critical intervention in pts presenting with hyperosmolar hyperglycemic state (HHS)?

A

IV fluids

92
Q

How is hyperosmolar hyperglycemic state (HHS) distinguished from diabetic ketoacidosis?

A

HHS usually seen in DM II
Lack of ketones in urine or blood

93
Q

What lab should be drawn in a pediatric patient suspected of having glomerulonephritis (hematuria, hypertension, edema)?

A

Antistreptolysin O titer

94
Q

What medication can be used for a pt suspected of having an aortic dissection who is hypertensive?

A

Esmolol

95
Q

If a pt presents with sickle cell and acute pain crisis, what is the 1st line treatment?

A

Aggressive pain management (hydromorphone)

96
Q

What is Beck’s triad and what condition is it associated with?

A

Muffled heart sounds, distended neck veins, hypotension
Cardiac tamponade

97
Q

What is the nitrazine paper test used for?

A

Tests for amniotic fluid if preterm premature rupture of membranes is suspected
Paper turns blue if amniotic fluid is present

98
Q

What is the medication class of choice to suppress premature ventricular contractions?

A

Beta blockers

99
Q

What changes on an EKG would indicate a pt is experiencing premature ventricular contractions?

A

No p waves
Wide QRS complex (may be bizarre looking)
ST segment & T wave are opposite direction of QRS

100
Q

What bacteria is likely to cause epididymitis in patients > 35 or pts who have low risk for STIs?

A

E. coli

101
Q

What is the treatment for epididymitis if the suspected bacteria is E. coli?

A

Levofloxacin

102
Q

In pts presenting with stroke like symptoms, what is a test that can be done to determine whether the pt is having a stroke?

A

Forehead wrinkle test
Bells Palsy: cannot wrinkle forehead
Stroke: can wrinkle forehead

103
Q

Along with a consult to neuro, what is the treatment for a pt who presents with a vertebral artery dissection?

A

Anticoagulation (Heparin)

104
Q

What is the most definitive study in a pt suspected of having an aortic dissection?

A

CTA

105
Q

What is the test of choice in pts you are concerned about acute angle-closure glaucoma?

A

Tonometry

106
Q

What are the signs/symptoms of acute angle-closure glaucoma?

A

Eye pain
Blurry vision
Headache
Conjunctival injection
Mid sized fixed pupil
Hazy cornea

107
Q

What are benzos used to treat symptoms of alcohol withdrawal?

A

They stimulate GABA receptors

108
Q

If a pt on anticoagulation presents and is found to have an intracerebral hemorrhage, what treatment should be administered?

A

Prothrombin complex concentrate to reverse the coagulopathic effects

109
Q

What is the treatment for a pt with an EKG that shows intermittently non-conducted P waves without progressive prolongation of the PR interval, indicating Mobitz type II block?

A

Transcutaneous pacing

110
Q

What is the treatment for phelbitis?

A

NSAIDs and heat

111
Q

What is the hallmark finding in a pt with aortic stenosis?

A

Harsh systolic murmur along the right upper sternal (2nd intercostal space) that radiates to the carotids

112
Q

What moves the midsystolic click of mitral valve prolapse later into the systolic phase?

A

Squatting

113
Q

What is caused by a direct blow to the externally rotated, abducted, and extended arm?

A

Anterior shoulder dislocation

114
Q

What nerve courses around the fibular head and is commonly injured with signs of decreased sensation between the first and second toe?

A

Common peroneal nerve

115
Q

The murmur associated with hypertrophic obstructive cardiomyopathy is most likely to be louder with what maneuvers?

A

Standing and valsalva

116
Q

What is the main cause of acute-angle closure glaucoma?

A

Obstruction of aqueous humor outflow

117
Q

HIV and antiretroviral therapies can cause what heart issues?

A

Dilated cardiomyopathy

118
Q

What is the 1st line treatment for acute bacterial parotitis?

A

Ampicillin-sulbactam

119
Q

What is the most common cause of hyperthyroidism?

A

Graves disease

120
Q

What is the treatment for a pt with Graves disease and hyperthyroidism?

A

Beta blocker

Clinical Rotations (6 decks)

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