Emergency Medicine Flashcards
(136 cards)
1
Q
Shockable cardiac arrest rhythms
A
Ventricular fibrillation and pulseless ventricular tachycardia
2
Q
How to treat unstable tachycardia
A
Synchronized cardioversion cardioversion
3
Q
How to treat stable tachycardia
A
If wide QRS(>.12) maybe adenosine and consult cardiology
If narrow QRS vagaries maneuvers, are Dione, BB, CBB, then consult
4
Q
What indicates that a patient is unstable?
A
SBP <90
Chest pain
CHF
AMS
5
Q
How to treat unstable bradycardia?
A
Atropine, then transcutaneous pacing if needed
Dopamine and epi are back up treatments in
6
Q
Lateral leads
A
I aVL V5 V6
7
Q
Septal leads
A
V1 V2
8
Q
Anterior leads
A
V3 V4
9
Q
Inferior leads
A
II III aVF
10
Q
Samter’s triad
A
Asthma, nasal polyps, ASA/NSAID allergy
11
Q
Pulmonary exam on asthma
A
Prolonged expiration with wheezing hyperesonance
12
Q
Side effects of beta agonist
A
Tachycardia/arrhythmia, muscle tremor, CNS stimulation, hypokalemia
13
Q
Lab abnormalities with chronic bronchitis
A
Respiratory acidosis and increased hct/RBC
14
Q
Most common cause of transudative pulmonary effusion
A
CHF
15
Q
Pulmonary exam with pleural effusion
A
Decreased tactile Fremont is, decreased breath sounds, dullness to percussion, pleural friction rub
16
Q
How do you know if a effusion is exudative?
A
Pleural protein:serum protein >0.5
Pleural LDH:serum LDH >0.6
Pleural LDH>2/3 UNL
17
Q
Physical exam with tension pneumothorax
A
Elevated JVP, pulsus paradoxus, hypotension
18
Q
Pulmonary exam with pneumothorax
A
Hyperresonance, decreased fremitus, decreased breath sounds
19
Q
Tx for pneumothorax
A
Observation if <20% with fu cxr in 24-48 hr
Chest tube/thoracotomy if large or severe sx
Needle aspiration if tension
20
Q
Characteristics of benign pulmonary nodules
A
Round, smooth, slow growing, calcified, cavitary
21
Q
Characteristics of malignant pulmonary nodules
A
Irregular speculated, rapid growth
22
Q
Where does lung cancer usually metastasize to? (5)
A
Brain, bone, liver, lymph nodes, adrenals
23
Q
MC lung cancer arises peripherally and metastasizes to distant areas
A
Non small cell adenocarcinoma
24
Q
Centrally located lung cancer that may cause hemoptysis. Associated with cavitary lesions, hyper lace is, and pa cost syndrome.
A
Non small cell squamous cell carcinoma
25
Pancoast syndrome
Shoulder pain
Hornets syndrome(miosis , ptosis, anhydrosis)
Atrophy or arm/hand muscles
26
Very aggressive pulmonary non small cell carcinoma
Large cell (anaplastic) carcinoma
27
Lung cancer that metatasizes early. Associated with SVC syndrome, SIADH/hyponatremia, Cushings syndrome, and lambert-Eaton.
Small cell (oat cell) carcinoma
* surgery usually not tx of choice
28
Antidote for heparin
Protamine sulfate
29
MOA heparin
Potentiates antithrombin III
30
Morphology of strep pneumo
Gram positive cocci in pairs
31
Morphology of staph aureus
Gram positive cocci in clusters
32
Pneumonia caused by gram negative rod should make you think of these organisms
H flu, klebsiella, pseudomonas
33
MC cause of CAP
Strep pneumo
Followed by H flu
34
Pneumonia associated with GI symptoms, elevated LFTs and hyponatremia
Legionella
35
History suspicious for histoplasmosis
Exposure to bat droppings in Mississippi & Ohio River valley
36
Rusty blood tinged sputum
Strep pneumo
37
Green sputum
H flu and pseudomonas
38
Currant jelly sputum
Klebsiella
39
Foul smelling sputum
Anaerobes
40
First line therapy for CAP
Doxycycline or macrolides/mycin
41
Inpatient pneumonia tx
Beta lactam with macrolide or FQ
42
Tx for legionella
Levo or azithromycin
43
Tx for pseudomonas
Pipracillin/taxobactam, cefepime, amikacin, gentamicin, tobramycin, FQ
44
Caseating granumonas in apecies of lung
Tb
45
What is a positive PPD?
>5mm if immunocompromised, known contact, or suggestive CXR
>10mm if high risk population
>15mm if no risk factors
46
Tb treatment
RIPE or RIPS
Rifampin, isoniazid, pyrazinamide, ethambutol or streptomycin
47
Adverse effects of rifampin
Thrombocytopenia, orange secretions
48
Adverse effects of isoniazid
Hepatitis, peripheral neuropathy (B6 supplement), drug induced lupus
49
Adverse effects of pyrazinamide
Hepatitis, photosensitivity, hyperuricemia
50
Adverse effects of ethambutol
Optic neuritis, peripheral neuropathy
51
Adverse effects of streptomycin
Ototoxic and nephrotoxic
52
Pertussis/whooping cough is caused by
Bordetella
53
RVS is part of this viral family
Paramyxovirus
54
Tx of RVS/acute bronchiolitis
Humidified air
Beta agonist and epi if needed
Steroid if hx asthma
Rivavirin if severe or risky pt
55
Tx of epiglottis
Maintain airway
Cephalosporin
56
Croup/laryngotracheitis is caused by
Parainfluenza
57
Influenza is part of this viral family
Orthomyxovirus
58
Common SE of neuraminidase inhibitors (flu A & B)
Nausea and vomiting
59
How does pt with anterior shoulder dislocation hold their arm?
Abducted and externally rotated
60
How does pt with posterior shoulder dislocation hold their arm?
Addicted and internally rotated
61
Describe hill-sacs lesion
Groove on humeral head
62
Describe bankart lesion
Inferior glenoid rim fracture
63
Posterior shoulder dislocations are associated with this (3)
Seizures, trauma, electric shock
64
The best xray view for shoulder dislocations is
Axillary and y view
65
Shoulder impingement tests (3)
Hawkins
Drop arm
Neers
66
Shoulder strength test
Empty can
67
Classifying AC joint dislocations/shoulder separations
```
Class I: normal
Class II: AC ruptured
Class III: CC also ruptured
Class IV: clavicle displaced
Class V: disruption of clavicular attachment
```
68
Axillary nerve injury results in
Decreased deltoid sensation
69
Proximal humerus fracture can result in damage to this nerve
Axillary
70
Treat with sugar tong splint
Humeral shaft fracture, colles fracture
71
Worry about radial nerve damage with these fractures
Humeral shaft, supracondylar humerus, monteggia
72
Humeral shaft fx can result in damage to this nerve
Radial
73
MC fx in children, adolescents, and newborns during delivery
Clavicle
74
Volkmanns contracture
Median nerve and brachial artery injury lead to clawlike deformity
75
Volkmann ischemic contracture is associated with this fracture
Supracondylar humerus
76
Inability to fully extend elbow should make you think of these two fractures
Radial head and olecranon
77
Nightstick fracture
Ulnar shaft
78
Proximal ulnar shaft dx with anterior radial head dislocation
Monteggia fracture
79
Olecranon fxs can result in distinction of this nerve
Ulnar
80
Middistal radial shaft fracture with dislocation of distal radioulnar joint
Galeazzi fracture
81
Radial head subluxation
Nursemaids elbow
82
Radial styloid fracture
Hutchinson fracture
83
Lateral epicondylitis
Tennis elbow
84
Medial epicondylitis
Golfers elbow
85
Tx for elbow dislocation
EMERGENT reduction and posterior splint for 7-10d
Associated with brachial artery, median/ulnar/radial nerve injury
86
Froment’s sign
Flexing IP joint to hold paper. Associated with ulnar nerve injury
87
Thumb spica these fractures
Scaphoid, navicular, gamekeepers/skiers thumb, Bennett’s, rolandos, de quervains
88
Distal radial fracture with dorsal/posterior dislocation
Colles fracture (dinner fork deformity)
89
MOA colles fracture
FOOSH with wrist extension
90
Distal radius fracture with central/anterior dislocation
Smiths fracture
91
MOA smiths fracture
FOOSH with wrist flexion
92
Intra-articular distal radius fracture with carpal displacement
Barton fracture
93
Kienbock’s disease
Avas ulnar necrosis of lunate bone
94
Inability to straighten distal finger-extensor tendon avulsion
Mallet/baseball finger
95
Tx for mallet finger
Splint DIP in uninterrupted extension for 6wk
96
Sprain of tear of ulnar collateral ligament of thumb
Gamekeepers/skiers thumb
97
Fracture at neck of 5th metacarpal
Boxer’s fracture
98
Tx for boxers fracture
Ulnar gutter splint
99
Intraarticular fx at base of 1st MCP
Bennett’s fracture
100
Comminuted Bennett’s fracture
Rolando’s fracture
101
Hip pain with leg shortened and internally rotated
Dislocation
102
Hip pain with leg shortened and externally rotated
Hip fracture
103
Avas ulnar osteobecrosis of femoral head
Legg calve perthes disease
104
How does perthes present?
Painless limping
Loss of abduction and internal rotation
105
Femoral head slipped inferior and posterior at growth plate
Slipped capital femoral epiphysis (SCFE)
106
How does SCFE present?
Painful limp with external rotation
107
Tests for ACL laxity
Lachmans
| Anterior drawer
108
Avulsion of lateral tibial condyle with varus stress
Segond fracture
109
Unhappy/o’donoghue’s triad
ACL
Medial collateral ligament
Medial meniscus
110
Test for meniscus tear
Mcmurray’s sign
111
Complications of tibial-fermoral dislocations
EMERGENT popliteal artery rupture
Peroneal and tibial nerve injury
112
How to you check peroneal nerve?
Sensation in first web space and foot drop
113
Worry about peroneal injury in these fractures/dislocations
Knee dislocation, femoral condyle fx, tibial plateau fx, posterior ankle dislocation
114
MC ligament in ankle sprain
Anterior talofibular
115
Spiral fracture of proximal fibula
Maisonneuve
116
3rd metatarsal fracture
Stress/March fracture
117
Transverse fracture through diaphysis of 5th metatarsal
Jones fracture
118
Transverse avulsion fracture at base of 5th metatarsal
Pseudojones fracture
119
Disruption of articulation of medial cuneiform with 2nd metatarsal
Lisfranc injury
120
L4 compression presents as
Anterior thigh pain
Sensory loss to medial ankle
Weak ankle dorsiflexion
Loss of knee jerk
121
L5 compression presents as
Lateral thigh/groin pain
Sensory loss to dorsum of foot
Weak big toe extension
122
S1 compression presents as
Posterior leg/calf pain
Sensory loss to plantar surface of foot
Weak plantar flexion
Loss of ankle jerk
123
Anticholinergic toxidrome
Increased vitals
Dilated pupils
Dry skin
124
Anticholinergic antidote
Pysostigmine
125
Cholinergic toxidrome
Decreased vitals
Constructed pupils
Wet skin
*farmers and terrorist attacks
126
Opioid toxidrome
Decreased vitals
Constructed pupils
Dry skin
127
Opioid antidote
Naloxone
128
Sedative toxidrome
Decreased vitals
Normal pupils
Dry skin
129
Cholinergic antidote
Atropine
130
Sympathometics (upper) toxidrome
Increased vitals
Dilated pupils
Wet skin
131
Sympathometics/upper antidote
Benzos
132
Systolic ejection crescendo-decresendo murmur at RUSB
AS
133
Diastolic rumble at apex with opening snap
Mitral stenosis
134
Diastolic decreaendo blowing at LUSB
Aortic regurg
135
Blowing holosystolic murmur at apex
Mitral regurg
136
Mid to late systolic ejection click
Mitral valve prolapse
