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Flashcards in Emergency Medicine Deck (118):
1

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Stress fracture - metatarsals

Can occur from running or significant walking

can be hairline fracture with no displacement.

 

tx. review 7-10 days. analgesia and << activity. Possibly x-ray.

2

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peri-orbital cellulitis

painful, unilateral red swollen eyelids

px often systemically unwell

 

3

managment for sprains

Ice 20 mins every two hours. elevate << swelling.

Increase in pain 48 hours after injury. Takes 6-8 weeks to heal.

4

What is diagnosis of DKA based on?

 

Diabetic ketoacidosis is a serious complication of Type I DM.

Diagnosis based on

diabetes (blood glucose >11 mmol/L)

ketones (urine or blood)

acidosis (pH <7.30 venous blood)

5

Which part of the orbit do the cranial nerves IV, III, VI pass?

Superior orbital fissure

6

What is the cause of most URTI?

common cold virus

7

What is Kussmaul breathing?

Deep and labored breathing pattern often associated with severe metabolic acidosis, particularly diabetic ketoacidosis (DKA) but also kidney failure.

8

Scaphoid fracture management

Cast if suspected (scaphoid backslab)

Refer to review clinic in 10-12 days

 

9

What passes through the optic canal?

optic nerve

ophthalmic artery

ophthalmic vein

10

Le Fort Fractures

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11

Signs/ symptoms fractured mandible

pain/ restricted movement

missing teeth, numbness, teeth not meeting properly

Sublingual haematoma; often indicative of fractures.

12

When to use Equinus cast

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Ruptured achilles tendon

13

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It transmits the infraorbital artery and vein, and the infraorbital nerve, a branch of the maxillary nerve

Can be palpated during an examination.

14

foot bones 1

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15

When would you use a collar and Cuff sling?

  • gravity assist
  • eg. impacted head of humerus (refer if impacted head)

16

Foot bones 4

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17

management of corneal abrasion

remove FB with damp cotton bud/ bevel of needle (with slit lamp)

antibiotic ointment

review 2-3 if not improving.

18

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Acute-angle closure glaucoma

acutely painful red eye. 

Px usually > 60, other symptoms; headache, nausea, blurred vision and haloes around lights.

19

EM tx of hypoglycaemia

50ml of glucose 50% if IV access available.

otherwise 1 mg glucagon

(as PAs 10% glucose IV okay)

non-emergency; dextrose, then more complex carbohydrates.

20

Two main types of conjunctiva based anatomically

  • palpebral conjunctiva lines the lids
  • bulbar conjunctiva is over the eyeball

21

Types of wrist fracture

Smith's - surgery

Colle's (often due to FOOSH). Tx in A & E

22

Symptoms of hypoglycaemia

confusion, sweating, fatigue and feeling dizzy.

maybe pale, weak, blurred vision, tachycardia, unconsciousness

 

 

23

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 an injury to the spine in which the vertebral body is severely compressed.

- severe trauma, such as a motor vehicle accident or a fall from a height.

24

foramen and fissures of the orbit

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25

organism; bacterial tonsilitis

group A beta haemolytic streptococcus

 

'Strep throat'

 

 

26

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27

elbow fracture - what will you find on x-ray?

The sail sign.

Never a posterior fat pad unless there is a fracture.

28

hyphaema

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Hyphaema

refer.

29

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Battle's sign, also mastoid ecchymosis, is an indication of fracture of middle cranial fossa of the skull, and may suggest underlying brain trauma.

30

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Anterior compression/ Open book

Look at SI joint and pubic symphysis

31

Common causes of hypotension (6)

  • sepsis
  • acidosis
  • medications
  • nitrates (GTN)
  • CCBs
  • many anaesthetic agents

32

What's a common symptom of a fractured orbit?

Diplopia

due to obstruction of rectus muscles, or suspensory ligament is not fixed.

33

Foot bones 3

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34

Diagnositic symptoms of DKA?

polydipsia

weight loss

dehydration

+ Kussmaul breathing

35

What drug can be used for emergency treatment of acute-angle closure glaucoma

pilocarpine

NB. causes miosis

36

Emmetropia

Good vision 20/20

37

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bilateral - basilar skull fracture

Bilateral hemorrhage occurs when damage at the time of a facial fracture tears the meninges and causes the venous sinuses to bleed into the arachnoid villi and the cranial sinuses

38

What can cause mydriasis?

anticholinergic drugs

MDMA

cocaine

amphetamines

some hallucinogens

39

When?

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Meniscus tear

40

What nerve supplies the lateral rectus muscle?

abducens (VI)

long nerve makes it prone to injury. 

41

which extraoccular muscle attaches nasally?

Inferior Oblique

42

Foot bones 2

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43

Bones of skull

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44

What is a Salter-Harris Fracture?

A fracture that involves the epiphyseal plate.

45

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Compression fracture.

collapse of a vertebra.

Trauma or a weakening of the vertebra (compare with burst fracture). This weakening is seen in patients with osteoporosis 

Wedge deformities, with greater loss of height anteriorly than posteriorly

46

Tender points for knee - ottawa

other factors

> 55 yrs

can't weight bear

can't flex 90 o

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47

sudden foot inversion can cause....

avulsion fracture of the base of the 5th metatarsal.

(tightening of peroneus brevis tendon)

tx. support bandage if can weight-bear

backslab is unable to weight-bear

48

Conjunctivitis characteristics

  • red, watery eye, often bilateral.
  • VA is usually normal.
  • bacterial or viral

 

Infectious, topical treatment,

 

NB> check for FB, abrasion before diagnosing conjunctivitis

49

What is the signifance of a lack of consensual pupillary response?

  • problem with motor connection
  • could be; oculomotor nerve or Edinger-Westphal nucleus

50

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Vertical shearing

51

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dentritic ulcer - not common

presents as red eye with FB sensation.

seen with fluoroscein , caused by herpes-simplex virus

52

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Orbital cellulitis; an emergency and requires intravenous (IV) antibiotics.

In contrast to orbital cellulitis, patients with periorbital cellulitis do not have bulging of the eye (proptosis), limited eye movement (ophthalmoplegia), pain on eye movement, or loss of vision. 

53

Bones of the hand

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54

Tests for diabetes

Blood glucose

urine or blood test for ketones

pH (venous fine)

55

What can cause sudden loss of vision?

retinal detachment

central retinal artery occlusion

vitreous detachment/ haemorrhage

+ full neurological examination for cv event

56

what could be triggers for hypoglycaemia attacks?

infections; UTI, pneumonia

physiological stressors including cold, status epilepticus.

57

What's the function of the choroid?

Dark pigmentation to prevent internal light reflection, supplies blood to the retina

58

Bones of the wrist 

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59

orthostatic hypotension values

20 mmHg drop of systolic pressure

20 beats per minute increase in HR

(remember two min delay between position changes)

60

What is the most common cause of hypotension?

+ what drugs commonly cause hypotension

hypovolaemia

>>> diuretics

alpha/ beta blockers

61

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Giant cell arteritis

painless visual loss, px usually >60.

Scalp tenderness, jaw claudication, headache.

Blindness if not prompt treatment.

refer.

62

allergic conjunctivitis

bilateral, often related to hay-fever.

Chemosis (oedema of the conjunctiva) is a classic sign.

tx. antihistamines

63

PPPP

stop bleeding

Pressure

Posture

Patient - time

Pray

64

Weber fractures

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65

Rhonchi

Continuous low pitched, rattling lung sounds that often resemble snoring.

Obstruction or secretions in larger airways.

Chronic obstructive pulmonary disease (COPD), bronchiectasis, pneumonia, chronic bronchitis, or cystic fibrosis.

Rhonchi usually clear after coughing. 

66

Common cause of metatarsal fractures?

stress fractures; don't need trauma history

67

drainage of aqueous humour

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Formed in the anterior portion of the ciliary process in the posterior chamber of the eye.

 

Drains into the scleral venous sinus (Schlemm's canal)

Blockage = glaucoma

68

General advice for facial fractures

no nose blowing

no sneezing

knocked out teeth; keep in saline or milk. 1-4 hour window to reimplant.

Bites; Augmentin antibiotic

69

White-Eyed Blowout

Greenstick fracture of the orbital floor or medial orbital wall resulting in ischemic entrapment of an extraocular muscle.

• Typically children

Minimal external signs of trauma mask the severity of the orbital injury.

Commonly due to sports injuries.

70

What is the anatomical signifiance of the central artery of the retina?

It runs WITHIN the optic nerve.

It's an end artery, a branch of the ophthalmic artery.

71

Why avoid amoxicilin with tonsillitis?

in case causative organism is Epstein-Barr virus (glandular fever); rash

72

What are the EM physiological side effects of NO insulin causing hypoglycaemia? (3) 

>>> sugar in blood, none in cells.

Breakdown of fats and proteins; ketones and acidosis

leads to dehydration, Potassium loss and acidosis.

Dehydration because water follows excretion of sugar (osmotic diuresis)

73

What's the risk if injury close to bone?

osteomyelitis

74

sling for elbow fracture?

Broad arm sling,

and backslab up to the shoulder.

75

Management of Otitis media

analgesia. 80% improve spontaneously. 

>48hrs require antibiotics

76

Hamstring injury management

crutches and refer to fracture clinic

77

Toes - x-ray or not?

If associated wound present, or injury is with the great toe.

78

Signs of scaphoid fracture?

  • tenderness at anatomical snuff box.
  • pain when pressing thumb proximally

 

IMP. Danger of avascular necrosis

79

Eye conditions not to miss

  • acute-angle closure glaucoma
  • peri-orbital cellulitis
  • giant cell arteritis
  • keratitis
  • uveitis

80

Which bone is boxer's fracture?

5th metacaral

81

What is a haematoma block?

Analgesic technique used to allow painless manipulation of fractures while avoiding the need for full anesthesia.

This procedure is normally only appropriate for fractures of the radius and ulna.

82

Clavicle management

Broad arm sling and let heal.

83

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Jones fracture is a break between the base and middle part of the fifth metatarsal of the foot.

tx. cast, 6 weeks rest.

84

Signs/ symptoms of fractured zygomatic arch

swelling/ bruising - periorbital

pain, numbness, diplopia, reduced eye movements

altered pupillary reflexes, facial flattening/ symmetry

- look at jaw from behind and put fingers on zygomatic arches. Compare for differences.

85

Why rehydrate gradually with DKA?

to avoid rapid intracellular osmotic/ sodium shifts that may cause fatal CNS oedema.

Remember: with DKA and polydipsia, rapid fluid shift from intracellular compartments.

86

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usually bilateral. 

Refer to orthopaedics ; other injuries likely.

87

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Dacryoadenitis

  • Swelling of the outer portion of the upper lid, with possible redness and tenderness
  • Pain in the area of swelling
  • Excess tearing or discharge
  • Swelling of lymph nodes in front of the ear

Common causes include mumps, Epstein-Barr virus, staphylococcus, and gonococcus.

 

 

88

What is Argyll Robertson (AR) pupil and what's the most important cause (and very specific)?

bilateral small pupils that reduce in size on a near object (i.e., they accommodate), but do not constrict when exposed to bright light

 

Syphilis

+ diabetic neuropathy

89

What is a big danger of px with long-standing diabetes and neuropathy?

MI or abdominal conditions such as infection or pancreatitis may be painless. Maybe osteomyelitis in the feet.. 

90

Tx for DKA

 

(Sickness and vomiting, abdominal pain, muscular weakness)

500ml then another 500ml then another 500ml (saline).  MUST ensure patient is rehydrated before giving insulin. 0.1units per kilo per hour.  

As sugar moves into cells (insulin taking effect) potassium follows therefore px becomes hypokalaemic. Normal potassium 3.5 to 5. 

Watch urine output to check hydration. 

 

Red flag; peds until 22-23 yr old. Can die from cerebral oedema; therefore don’t give insulin until properly hydrated.  

91

What factors cause cause a hypoglycaemic attack?

Too high a dose of medication (insulin or hypo causing tablets)

Delayed meals

Exercise

Alcohol

92

Otitis media bugs

haemophilus influenzae

streptococcus pneumoniae

moraxella catarrhalis

 

93

Cauda Equina - signs and symptoms

  • altered sensation perineal area, bowel/ urine/ sexual dysfunction
  • PR - loss of tone and sensation

94

What can cause miosis?

 

NB> latency of pupillary responses increases with age

Light

opiates/ opioids

anti-hypertension medication

95

What could blood clotting abnormalities and platelet consumption indicate with a septic px?

development of disseminated intravascular coagulation (DIC); clotting factors and platelets are consumed by clot formation in the peripheral circulation.

96

Fluid challenge and central venous cannula/ measurement of CVP; what's that about?

If CVP doesn't rise or rises transiently and then falls, then px is 'underfilled'.

97

Sign of poor perfusion of the brain?

poor conscious level

98

Sign of poor perfusion of the skin?

poor capillary refill time

99

What could cefuroxime and clarithromycin possibly treat?

CAP

+ may need vasopressor drugs to produce peripheral vasoconstriction if px adequately filled (CVP monitoring). Renal output would be poor.

100

symptoms of septic shock

  • warm peripherae, bounding pulse with low diastolic pressure, low JVP
  • pyrexia (or hypothermia)
  • history and signs of underlying infection

101

Symptoms of hypovolaemic shock (this includes burns)

  • symptoms of fluid loss, eg. melaena, haematemesis
  • cold peripherae; weak, thready pulse, low JVP
  • skin pallor, dry mucous membranes

102

symptoms of cardiogenic shock

  • chest pain, palpitations, history of IHD, AF
  • Cold sweaty peripherae; weak pulse, JVP raised, tachycardia
  • pulmonary oedema

103

What's the difference between hemiparesis and hemiplegia?

Hemiparesis ; unilateral weakness

 

Hemiplegia; complete loss of power on one side

104

What is Todd's paralysis?

A focal appendage transient weakness after a seizure. 

It usually subsides completely within 48 hours.

Todd's paresis may also affect speech, eye position (gaze), or vision.

NB> important to differentiate from ischaemic stroke because seizure is an exclusion criteria for thrombolysis.

105

What % of px presenting to hospital with strokes, fulfill criteria for thrombolytic tx, and what is the drug?

2%

 

Actilyse; recombinant tissue plasminogen activator alteplase

106

What is the risk of thrombolytic tx of ischaemic stroke?

And the incidence?

significant risk of primary intracerebral haemorrhage

1 in 30

107

In the case of ischaemic stroke, what is the window for treatment?

3 hours from onset of symptoms.

(this includes getting a CT scan!)

108

Thrombolysis; remember that...

lots of exclusion criteria!!!

Including:

  • seizures
  • px on warfarin
  • previous stroke within three month
  • BP  >110 diastolic, > 185 systolic
  • hypoglycaemic/ hyperglycaemic

109

Risk factors for CVD?

hypertension

hyperlipidaemia

diabetes mellitus

obesity

family history

smoking

110

What are Charcot-Bouchard aneurysms?

Aneurysms in the small penetrating blood vessels of the brain.

They are associated with hypertension.

The common artery involved is the lenticulostriate branch of the middle cerebral artery.

111

What are the following acronyms?

TACI

 

LACI

TACI: Total Anterior Circulation Infarction

 

LACI: Lacunar Infarction

112

How effective is prophylaxic treatment of AF with warfarin in preventing strokes?

yearly risk of cerebral embolism reduced from 3% to 1%.

 

113

Aspirin, stroke, no CT scan results. What's the story?

No evidence that starting aspirin before CT findings are known adversely affects prognosis. 

114

When is a CT scan URGENT following a stroke?

  • if 3 hour window to start thrombolytics
  • evidence of head injury
  • severe headache at the time of onset of weakness
  • GCS score deteriorating
  • prior anticoagulation treatment

115

Are px with carotid artery stenosis at risk of embolic stroke?

+ exclusions?

Yes, especially if stenosis 70-99% (very high risk). Also: is px well enough to receive tx?

Carotid stenosis diagnosis; doppler

Exclusions?

haemorrhagic strokes - TACI or POCI 

 

116

Stroke tx whilst awaiting CT scan results

Px NBM

Nasogastric tube, IV fluids

Oxygen mask, monitor cardiac rhythm (digoxin if needed)

Possibly catheter to monitor output

Aspirin 75mg

Statins (low dose) even if lipid levels normal

TED (thromboembolic disease) stockings 

 

117

Why don't you treat HT immediately following a stroke?

  1. cerebral autoregulation of blood flow is disturbed and therefore risk of hypoperfusion.
  2. Watershed infarction; there can be an extension of the stroke due to reduced blood supply around area of infarction.

NB. continue with regular BP meds if taken previously.

118

High BP two weeks after stroke. Which meds?

ACE inhibitors (perindopril - take at bedtime because can become dizzy)

thiazide diuretics