Emergency Medicine Flashcards
(173 cards)
1
Q
Bilious emesis younger than one year is what until proven otherwise?
A
Malrotation with midgut volvulus
2
Q
Number of umbilical arteries and veins
A
One vein and two arteries
3
Q
How long is the umbilical vein patent after birth?
A
Approximately 1 week
4
Q
Charcots triad
A
Fever, RUQ pain, Jaundice (ascending cholangitis). Only present in 50 percent of patients however
5
Q
Reynolds Pentad
A
Charcots triad (fever, RUQ pain, jaundice) plus signs of sepsis (hypotension, AMS). Indicates bad ascending cholangitis. Initiate broad spectrum abx immediately
6
Q
Lines of management in ascending cholangitis
A
1st - broad spectrum antibiotics. Perform RUQ ultrasound or CT if US nondiagnostic. 2nd - ERCP. 3rd - Surgical drainage (eg perc chole tube)
7
Q
Upper limit of normal common bile duct diameter in a patient who still has their gallbladder?
A
8 mm
8
Q
Rash of Kawasaki disease
A
Generalized non-bullous, non-vesicular
9
Q
Kawasaki Criteria
A
CRASH and BURN. Conjunctivitis, Rash, Adenopathy, Strawberry tongue, Hand swelling or erythema, and fever (5 days)
10
Q
Percentage of untreated Kawasaki patients who develop coronary artery aneurysms
A
15-25 percent
11
Q
Number of joules for an unstable VT patient using a biphasic machine
A
200
12
Q
Aplastic crisis and ED management
A
An aplastic event (eg Parvo B19 infection) in a high risk pt (eg sickle cell). Droplet precautions, RBC transfusion, heme consult, admit for IVIG
13
Q
Most common organism causing osteomyelitis in sickle cell patients
A
Staph (same as general pop). However, higher risk of salmonella osteo than general pop.
14
Q
Why are antibioitics and antidiarrheals relatively contraindicated in children with bloody diarrhea and no confirmed infection on stool culture?
A
They may increase risk of developing HUS. Test the stool for E Coli O157H7 (the shiga toxin from this is most common cause of HUS).
15
Q
Characteristic components of HUS and TTP
A
HUS - ART. Autoimmune hemolysis, Renal failure, Thrombocytopenia and bloody diarrhea. TTP - FAT RN. Fever, Autoimmune hemolysis, Thrombocytopenia, Renal failure, Neuro symptoms
16
Q
Formula for cuffed and uncuffed ET tube sizing by age
A
Cuffed is (Age/4) + 3.5, Uncuffed is (Age/4) + 4
17
Q
Contraindications to Dix-Hallpike testing
A
Unstable heart disease, ongoing stroke or TIA, severe neck disease, high grade carotid stenosis
18
Q
Target INR for mechanical mitral and aortic valves
A
Mitral is 3-3.5, Aortic is 2.5-3
19
Q
Which types of valve repairs need anticoagulation?
A
Mechanical but not biologic
20
Q
Most common atypical complaint of elderly patients diagnosed with ACS
A
Dyspnea
21
Q
Most commonly injured cardiac chamber in stab wounds
A
RV
22
Q
Volume of blood that can acquire acutely in the pericardial sac before tampondade occurs
A
60-100 ccs
23
Q
EKG findings in TCA overdose that you get before you reach unstable VT
A
Rightward axis, tall R waves in AVR. Then you get wide QRS and tachycardia. Right axis and tachycardia should make you think PE vs Sodium Channel Blocker (eg TCA) overdose
24
Q
VT causes a wide complex tachycardia. Is a very wide tachycardia consistent with VT?
A
Not generally. If QRS width approaches 200 ms (1 big box), consider other causes like hyperK, metabolic acidosis, or TCA overdose. Consider giving calcium and bicarb early.
25
Ergotism
Miosis, burning sensation in extremities, CVA symptoms, GI disturbances, seizures, bradycardia, hypertension. Due to overdose of ergot derivatives (migraine med) which cause serotonin syndrome and alpha agonism
26
Treatment for ergotism
Activated charcoal if within 1-2 hours of ingestion and airway secure. IVF, antiemetics, analgesia. If ischemic changes, give vasodilators (nitroprusside, nitroglycerin, or phentolamine). Consider steroids and heparin
27
Lab abnormality in valproic acid toxicity
Hyperammonemia. Also look for abnormal LFTs, amlyase and lipase, and pancytopenia
28
Common side effects of NNRTIs such as efavirenz
Vivid dreams, headache, severe rash, dizziness, lightheadedness
29
Common side effects of protease inhibitors such as Indinavir
Kidney stones (not seen on dry CTs), hyperbilirubinemia, hepatitis
30
Common side effects of combination protease inhibitors such as Lopinavir
Nausea, vomiting, diarrhea, hepatitis
31
Common side effects of NRTIs such as Zidovudine
Bone marrow suppression, anemia, macrocytosis
32
Common side effects of Didanosine (nucleoside analog RTI)
Pancreatitis
33
Common side effect of NRTIs
Lactic acidosis
34
Common side effect of Ritonavir (protease inhibitor)
Parasthesias
35
Dosing of magnesium sulfate in eclampsia
4 to 6 grams IV followed by a drip
36
How long postpartum can eclampsia occur?
Up to 4 weeks
37
Two main side effects of hypomagnesemia
Hyporeflexia and hypoventilation
38
Most common fracture leading to compartment syndrome
Closed long bone fractures of the tibia
39
Most consistent physical exam finding in compartment syndrome
Loss of two point discrimination
40
Dacroadenititis vs Dacrocystitis
Adenitis is inflammation of the tear gland (upper outer eye), Cystitis is of the tear duct (inner lower eye)
41
Trench mouth
Acute Necrotizing Ulcerative Gingivitis (ANUG). Warm saline irrigate mouth, give antibiotics with oral coverage, and refer to dentistry or oral surgery.
42
Most common populations to get Acute Necrotizing Ulcerative Gingivitis (ANUG)
HIV, malnourished children, young adults under stress, polysubstance abusers
43
Complication of excessive phazopyridine (OTC tx for UTIs) use
Methemoglobinemia
44
Treatment for High Altitude Cerebral Edema (HACE)
Supplemental oxygen, descent, dexamethasone. Eventually hyperbaric therapy as well.
45
Dental pain with pain on percussion, gingival swelling but no signs of buccal or submandibular soft tissue swelling is usually a PERIAPICAL ABSCESS. What is the ED management?
Antibiotics (penicillin), analgesia, dental follow up within 48 hours
46
Parulis gumboil (also called intraoral dental sinus)
Oral soft erythematous papule on the alveolar process in association with a dental (typically periapical) abscess
47
Most common medication causes of erythema nodosum
Sulfas, OCPs, PCNs, Phenytoin
48
Most common systemic disorders causing erythema nodosum
Sarcoid, IBD, SLE, Lymphoma, Leukemia
49
Characteristics of erythema nodosum
Tender, erythematous subcutaneous nodules that have a blue hue as they resolve. Typically symmetrical and pretibial
50
Duration of symptoms in erythema nodosum
Rash up to 6 weeks, arthralgias up to 2 years. Condition is self-limited with no treatment. Identify underlying condition or drug cause and treat or stop.
51
Order of actions when patient presents with suspected meningitis with AMS or other abnormal neuro findings (eg focal deficits, seizures, etc)
Dexamethasone, empiric antibiotics, CTH (to avoid herniation during LP), then LP
52
How can time course be used to differentiate causes of meningitis
Acute (less than 24 hrs) is usually bacterial, Subacute (1-7 days) typically lymphocytic or viral, and Chronic is usually insidious fungal (eg cryptococcus in HIV patients)
53
What are the typical cutoffs for adding ampicillin when empirically covering for meningitis
Add it if patient is less than 3 months or older than 50 years
54
Most common age of incidence in testicular torsion
Bimodal. Less than 1 year old and another peak in puberty
55
5 principle causes of hypoxemia
Hypoventilation, Right to Left Shunting, VQ mismatching, Diffusion impairment, and Low Inspired FiO2
56
Maximum acceptable INR for an ED pericardiocentesis in an unstable patient
None. A pericardiocentesis should be performed for any unstable patient with tamponade (although thoracotomy is strongly preferred if the tamponade is traumatic in origin)
57
Most common age and complication of SCFE
11-13. Avascular necrosis
58
What is Legg-Calve-Perth and what is the most common age of diagnosis?
Idiopathic Avascular Osteonecrosis of the Capital Femoral Epiphysis (disruption of femoral head blood vessels due to unknown cause). Age 6-8
59
Bloombergs Sign and Kleins Line
Indicative of SCFE. Bloombergs Sign - Widening or blurring of the growth plate. Kleins Line - Tangential to superior aspect of femoral neck, normally intersects the epiphysis
60
Most common cause of aortoenteric fistula after AAA graft repair
Graft infection. Prodrome of low grade fever and back pain leads to GI bleeding and hypovolemic shock.
61
Absolute contraindications to IO insertion
Fracture of the bone and vascular disruption
62
Signs and symptoms of putamen hemorrhage
Hemiplegia, nausea, vomiting, headache progressing (over about 30 minutes) to ipsilateral eye deviation, stupor, coma, and blown pupils
63
Of the sites where you most commonly see hypertensive intracranial hemorrhages, which is most associated with anticoagulation
Lobar hemorrhage (ie in the white matter of one of the cerebral lobes)
64
Signs and symptoms of western diamondback envenomnation
Pain, edema, ecchymosis, bleb formation, and necrosis extending proximally from bite site. Also thrombocytopenia.
65
Imaging test of choice for hepatic abscess
Ultrasound. CT can be used adjunctively if US is nondiagnostic
66
Empiric antibiotics for hepatic abscesses and typical causative organisms
Ampicillin, Ceftriaxone, and Metronidazole. Pyogenic caused by aerobes (e coli, klebsiella, pseudomonas) or anaerobes (enterococcus, bacteroides, anaerobic strep), Amebic caused by entemoeba histolytica
67
Red raised bump that grows over several weeks into a purple nodule in a pet shop owner
Fish tank granuloma (mycobacterium marinum infection)
68
Mycobacterial infection with skin lesions and neuropathy
Leprosy
69
Most common human enzyme deficiency
G6PD
70
Incidence of recurrent peritonsillar abscess (PTA)
About 10 percent
71
What lab value is used as a cutoff for determining futility of CPR in accidental hypothermia and what is the cutoff?
Serum potassium. Above 12 it is generally considered that resuscitative efforts for accidental hypothermia are futile.
72
Classic EKG finding in accidental hypothermia
Osborne waves (slurring of the terminal portion of the QRS)
73
US animals considered high risk for rabies upon bite injuries
Raccoons, skunks, foxes, bats, coyotes, AND DOGS found along the US-Mexico border
74
Mnemonic for Salter Harris Fractures
SALTER. I - Slipped (or separation), goes transversely through physis, II - Above (metaphyseal side), III - Lower (epiphyseal side), IV - Through (both sides), V - ERasure (crushing of physis)
75
Typically, which Salter Harris fractures are managed operatively, and which non-operatively?
I and II are usually managed non-op. III, IV, and V are typically managed with ORIF
76
Definitive treatment for lithium toxicity and cutoff at which it should be given
Hemodialysis. If lithium level greater than 4
77
EKG manifestations of lithium toxicity
Bradycardia, T wave flattening, QTc prolongation
78
A viral prodrome followed by respiratory decompensation in a 3-4 year old child is suggestive of what condition, and what other conditions should be considered?
Bacterial tracheitis. Also consider croup, epiglottits, and foreign body aspiration
79
Flu-like symptoms followed by pulmonary decompensation after exposure to mouse droppings or rodent bite
Hantavirus. Especially if in southwestern US
80
Most common CBC abnormality in Hantavirus infection
Thrombocytopenia
81
Average age for discitis
7 years old
82
Which of the 5 Ps of arterial occlusion warrants immediate surgical intervention
Paralysis
83
What finding typically differentiates pyogenic from amebic hepatic abscess?
Jaundice. Present in pyogenic, typically not present in amebic hepatic abscess
84
Test characteristics of Nitrite and Leuk Esterase for UTI
Nitrite - Not sensitive (19-48), but very specific (92-100). LE - Very sensitive (72-97) but not specific (41-86)
85
3 causes of false positive nitrites in urine samples
Contamination, exposure of dipstick to air, phenazopyridine
86
In a patient who has been massively transfused (more than 10u RBCs in 24 hrs), what lab markers are used to determine that they may need more FFP, cryo, or platelets?
Platelets less than 50K (give platelets), INR over 1.5 (give FFP), Fibrinogen less than 100 (give cryo)
87
What complication of acute hepatitis occurs in about 2 percent of patients and occurs around 6-12 weeks after the infection?
Pancytopenia. Can be fatal if unrecognized.
88
What rule of thumb can be used on x-ray to determine if a swallowed coin is in the esophagus or trachea?
Esophageal coins appear face on (ie looking at the coins full width) whereas coins in the trachea appear as a sliver (ie looking at the narrow edge)
89
Major complications of button batteries located in the esophagus
Liquifaction necrosis (can occur within 4-6 hours)
90
What percentage of ALTEs have a determined cause, and what are the three most common of these causes?
50 percent. GERD, Seizure, Lower Respiratory Tract Infection
91
What groups of kids with OM may be observed with NO ANTIBIOTICS?
6 months to 2 years with unilateral OM and no otorrhea, Over 2 years with bilateral or unilateral OM and no otorrhea. Note, all otorrhea and all kids with severe symptoms rec is still abx
92
Tissue adhesives have a strength equal to what thickness of sutures?
4-0
93
How long do tissue adhesives typically remain on the wound?
5-10 days
94
Indications for operative fixation of flail chest
Inability to wean from vent, severe chest wall instability, persistent pain, progessive pulm function decline
95
Common complication of basilar skull fractures
Cranial nerve entrapment
96
What is the most commonly injured cranial nerve from a basilar skull fracture?
CN 7
97
Dosing of vitamin K in patients with active hemorrhage and activated INR on coumadin
10 mg IV
98
Treatment for Henoch Schonlein Purpura (HSP)
NSAIDs, Dapsone, or Prednisone can be used for symptomatic relief. The disease iteself is self-limiting (6-8 weeks)
99
What GI disorder is associated with Henoch Schonlein Purpura (HSP)?
Intussuception
100
The only treatment that significantly alters the course of croup
Steroids. Racemic epi is a temporizing measure. Heliox and humidified air have not been shown to have benefit
101
Extraintestinal manifestations of invasive shigella gastroenteritis
Reactive arthritis, seizures, hallucinations
102
Most common cause of dysentery in the US
Shigella Sonnei
103
NAC administration should ideally be in what time window after acetaminophen ingestion?
4-8 hours
104
Target urine output in burn patients
Adults - 0.5 to 1 cc per kg per hr, Children - 1 to 2 cc per kg per hr
105
Ottawa ankle rule is positive if pain in malleolar zone plus certain findings OR pain in midfoot region plus certain findings. What are the certain findings?
Mallolar - tenderness at posterior edge of either lat or med malleolus, OR inability to bear weight, Midfoot - Tenderness at navicular or base of 5th metatarsal, OR inability to bear weight
106
Maisonneuve fracture
Spiral fracture of PROXIMAL third of the fibula plus a tear of the DISTAL tibiofibular syndesmosis and interosseus membrane
107
Treatment of choice for suspected cyanide and carbon monoxide poisoning (as in bad house fire)
Hydroxocobalamin 5 grams IV over short infusion. The amyl nitrate and sodium nitrate of the traditional cyanide kit can be harmful as they produce methemoglobinemia
108
Odor associated with cyanide toxicity
Almond
109
About 90 percent of patients with a cerebral venous sinus thrombosis (CVST) will have an elevation of what lab value?
D-dimer
110
Which tick borne illness is associated with hyponatremia and what is the treatment for this illness?
Tularemia. Streptomycin
111
Lab test of choice and treatment for serotonin syndrome
No lab test, clinical diagnosis. Cyproheptadine
112
Labs that are not reliable when drawn from an IO
WBC, Platelets, AST, ALT, Ionized Calcium. Hg and Hct are considered reliable from an IO
113
Can succinylcholine be given through an IO and if so what caveats are there?
Yes. It will take 20-30 seconds longer than normal to take effect.
114
Empiric abx for CAP
Ceftriaxone and azithromycin
115
Empiric abx for HCAP
Zosyn, vanco, tobra
116
Empiric abx for urosepsis
Amp and gent
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Empiric abx for intra-abdominal sepsis
Ampicillin, gentamycin and flagyl
118
Empiric abx for biliary sepsis
Zosyn
119
Empiric abx for device related sepsis
Vanc and gent
120
Empiric abx for skin and soft tissue sepsis
Vanc
121
What is a quick test for suspected neurogenic shock
Check DTRs. They will be diminished or absent in neurogenic shock
122
Proper site for needle insertion in paracentesis
4 to 5 cm superior and medial to ASIS
123
What can the base deficit be roughly interpreted as?
The physiologic marker separating trivial blood loss from clinically significant hemorrhage
124
What nerve may be injured with midshaft humeral fractures?
Radial nerve
125
Most sensitive finding in cauda equina
Urinary retention
126
Most sensitive imaging modality for HSV encephalitis
MRI
127
Nursemaids elbow
Radial head subluxation. Kids 2-3 years old, typically girls. Due to displacement of radial annular ligament into the radiocapitellar articulation. Will not move arm but in no distress, no exam findings
128
Treatment for nursemaids elbow
Supinate forearm then flex arm at the elbow
129
Typical presentation of Hodgkins Lymphoma
Neck mass in a teenager with B symptoms
130
Most common age of presentation for Non-Hodgkins Lymphoma
2 to 12 years old
131
Virus associated with Burkitts
EBV
132
What nerve is at risk of compression in perilunate dislocation?
The median nerve
133
Risk factors for nephrolithiasis
PUD, Crohns, milk-alkali syndrome, hyperpara, hyperuricosuria, sarcoid, recurrent UTI, RTAs, gout, laxatives, family history, dehydration, hypervitaminosis D, and previous kidney stone
134
Why are patients with Crohns at risk for nephrolithiasis?
Fat malabsorption and accumulation in the gut binds calcium and leaves oxalate free to accumulate
135
Objective monitoring system for depth of sedation
Bispectral Index (BIS), an EEG signal
136
Most common bacteria causing endocarditis
Staph aureus
137
When bridging enoxaparin to warfarin, when can the patient stop the enoxaparin?
When INR is greater than 2.0 for 2 consecutive days
138
Classic side effect of ethambutol (anti-TB med)
Optic neuritis resulting in painful vision loss, or red-green color blindness
139
How does triage of patients in the field differ in lighting strikes versus other situations?
Patients in cardiopulmonary arrest (ie absent vital signs) should be addressed first, instead of being black tagged
140
Initial management of PPROM
Analyze fluid for nitrizine or ferning. Avoid serial cervical exams if possible (increases risk of infection)
141
Animals with the highest incidence of rabies
Racoons (38 percent) more than bats more than skunks
142
Cholesteatoma
Mass in the middle ear or mastoid process of a teenager presenting with conductive hearing impairment
143
Treatment of choice for subungual hematomas
Trephination, refer to hand surgeon.
144
Rotator cuff muscles
Supraspinatus, infraspinatus, teres minor (all insert at greater tuberosity) and subscapularis
145
Most common concerning complication of bronchiolitis
Apnea (especially premature infants)
146
Test of choice in swallow injury mediastinitis
CT chest and neck
147
Risk factors for retinal detachment
Advanced age, DM, previous cataract surgery, severe myopia, uveitis, connective tissue d/o, trauma, FH of retinal detachment
148
Three types of retinal detachment
Rhegmatogenous, tractional, exudative
149
Puncture wounds of the foot through a shoe require coverage for what resistant organism?
Pseudomonas
150
What is contraindicated during thyroid storm and why?
Aspirin. Displaces T4 from binding proteins leading to increased T3 and T4 concentrations
151
Presentation of prolactinemia in men
Infertility, decreased libido, occasionally galactorrhea
152
What viral coinfection is common in patients with a peritonsillar abscess?
Mononucleosis
153
What signs favor torsion over epididymitis?
Acute severe pain, high-riding testicle, pain worsens with testicle elevation, absent cremasteric reflex, normal testicle but decreased blood flow on color Doppler ultrasonography.
154
At what serum level after an acute salicylate ingestion is hemodialysis indicated?
100 mg/dL
155
Clay Shoveler's Fracture and is it stable or unstable?
Avlusion of spinous process of C6 or C7 from abrupt next flexion. Stable
156
Mnemonic for unstable c-spine fractures
Jefferson bit off a hangman's thumb (Jefferson, Bilateral facet, Ondontoid II and III, Any dislocated fracture, Hangman, Teardrop)
157
Jefferson fracture and stable or unstable
Axial loading of C1 causing bilateral mass fracture. Unstable
158
Most unstable odontoid fracture
Type II (at the base of the odontoid process)
159
Hangman's fracture and stable or unstable
Extreme hyperflexion where cervical posterior processes are fractured and protrude into the canal. Unstable
160
Teardrop fracture and stable or unstable
Hyperextension of the ALL causing avulsion of the anteroinferior or flexion causing a fracture fragment from anterior compression. Unstable
161
Most common cause of bleeding in patient's with LVADs
AV malformations
162
What electrolyte abnormality exacerbates chronic digoxin toxicity?
Hypokalemia
163
Physical exam sign associated with torsion of the testicular appendage
Blue dot sign
164
Amsel criteria for BV
Thin, homogenous discharge, clue cells, positive whiff test, pH \> 4.5. 3 of 4 must be present
165
3 genetic conditions associated with aortic dissection
Marfan (fibrillin), Polycystic kidney disease (polycystin), Ehlers-Danlos IV (type 3 procollagen)
166
Pterygia
fibrovascular proliferations triggered by ultraviolet light exposure
167
Phlegmasia cerulean dolens
Massive thrombosis causing venous insufficiency (painful blue leg)
168
Infections that do not tend to raise the heart rate in proportion to the temperature
Typhoid, malaria, legionella, mycoplasma, yellow fever, tularemia, brucellosis, colorado tick fever
169
Faget sign
Sphygmothermic dissociation (i.e. relatively bradycardic heart rate given degree of fever)
170
Treatment of choice for typhoid
Rehydration therapy and a fluoroquinolone
171
Pain 3-5 days after dental extraction. What is the diagnosis and management?
Alveolar osteitis (dry socket). Clot dislodges after a few days and leads to recurrent pain. Treatment is packing with iodoform gauze moistened with oil of clove. Provide analgesia, ?nerve block, and reassurance
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