Emergency Medicine EOR Exam Cards Flashcards

Question

5 tests to order for chest pain

Answer 1

EKG Troponin I BNP CXR CBC/CMP

Answer 2

Three or more consecutive VPBs, displaying a broad QRS complex tachyarrhythmia

Answer 3

Bunny ears in V4-6 On side of block

Answer 4

Bunny ears in V1-3 On side of block

Answer 5

Elevated troponins WITHOUT ST elevation or Q waves Subendocardial infarct without complete blockage

Answer 6

Most sensitive and specific, appears at 2-4 hours, peaks at 12-24 hours, and lasts for 7-10 days

Answer 7

Appears at 4-6 hours, peaks at 12-24 hours, and returns to normal within 48-72 hours

Answer 8

Less commonly used appears at 1-4 hours. The peak is 12 hours and returns to baseline levels within 24 hours

Answer 9

Beta Blockers + NTG + aspirin and clopidogrel + heparin + ACEI + statins + reperfusion NO thrombolysis Less time sensitive than a STEMI

Answer 10

Full thickness infarct with ST elevation/q waves along with biomarker elevation

Answer 11

Q waves and ST elevation in leads I, AVL, and V2 to V6

Answer 12

Q waves and ST elevation in leads II, III, and AVF

Answer 13

ST elevation in the lateral leads (I, aVL, V5-6). Reciprocal ST depression in the inferior leads (III and aVF)

Answer 14

ST depressions in V1 to V3

Answer 15

Give ASA and Plavix immediately PCI - 90 minutes THrombolytics - 30 minutesif PCI not available

Answer 16

Prior intracranial hemorrhage (ICH) Known structural cerebral vascular lesion. Known malignant intracranial neoplasm. Ischemic stroke within 3 months. Suspected aortic dissection. Active bleeding or bleeding diathesis (excluding menses)

Answer 17

Coronary heart disease Heart failure Myocarditis Pericarditis MI ACS

Answer 18

Asthma COPD Pneumonia Pulmonary Hypertension Obesity, kyphosis, scoliosis (restrictive lung disease) Interstitial lung disease Drugs (e.g., methotrexate, amiodarone) or radiation therapy, cancer Psychogenic causes

Answer 19

CHF Kidney disease Liver disease Chronic venous disease Pregnancy Drugs Travel

Answer 20

Reduce salt intake Lasix HTCZ Compression stockings Body position (elevate legs)

Answer 21

CCB Alpha 1 blockers -zosin (ie. doxazosin, prazosin...)

Answer 22

DOE and then with rest Chronic non-productive cough after lying down Fatigue Orthopnea Nocturnal dyspnea Nocturia

Answer 23

Cheyenne stokes breathing (cyclic) Edema Rales S3/S4 JVD Cyanosis/coolness Ascites

Answer 24

Elevated BNP (lower in obese) Kerley B lines on CXR Echo is BEST TEST

Answer 25

I - No limitation II - Slight limitation III - Marked limitation IV - Dyspnea at rest

Answer 26

HFrEF ACEI BB LOOP DIURETIC

Answer 27

HfpEF NO LOOP DIURETIC ACEI and BB/CCB

Answer 28

BP 180/120+ Without end organ damage Immediate reduction not needed - start on 2 drug regimen with outpatient follow up

Answer 29

Retinal hemorrhages Papilledema, Encephalopathy, Acute and subacute kidney injury, Intracranial hemorrhage, Aortic dissection, Pulmonary edema, Unstable angina or MI

Answer 30

Reduce BP in first hour by 10-20% and then and additional 5-15% over the next 23 hours Targets are Under 180/120 in first hour and under 160/110 in the next 24 hours

Answer 31

Sodium nitroprusside

Answer 32

severe preeclampsia, eclampsia, or pheochromocytoma crisis

Answer 33

Aortic DIssection

Answer 34

Clevidipine or Sodium Nitroprusside

Answer 35

Altered mental status, SBP under 90 Capillary wedge pressure over 15 Fluid and pressors

Answer 36

A drop of > 20 mm Hg systolic, 10 mmHg diastolic, 15 BPM increase in pulse 2-5 minutes after a change from supine to standing

Answer 37

Associated with HR increase >15 BPM

Answer 38

Cardiac causes: CHF MI Arrhythmias (atrial fibrillation) Pulmonary causes:` COPD and cor pulmonale Pulmonary hypertension Kidney/Liver failure Obesity

Answer 39

Atrial fibrillation Wolff-Parkinson-White (WPW) syndrome Paroxysmal supraventricular tachycardia

Answer 40

Sick sinus syndrome MVP MI

Answer 41

Hypokalemia or Hypomagensemia Hyperthyroid Pheochromocytoma T1DM Hypoglycemia

Answer 42

Cocaine Amphetamines Caffeine (digoxin, beta-blockers, calcium channel antagonists, hydralazines, diuretics, minoxidil)

Answer 43

Similar to paricarditis with low voltage EKG, electrical alternans, and distant heart sounds Relieved when sitting forward Worsens with inspiration Fluid on Echo Treat with pericardiocentesis if large

Answer 44

Hair loss, pallor, cyanosis, brittle nails, black dray ulcers. Hx of atherosclerosis

Answer 45

ABI <0.9 Angiography is GOLD STANDARD

Answer 46

Arterial bypass

Answer 47

Cilostazol Aspirin Plavix Statins

Answer 48

Not enough blood to brain Out for seconds with no resuscitation Loss of postural tone and consciousness

Answer 49

SAME WORKUP

Answer 50

Cardiac - Start with this Neuro - Consider after Ask to describe dizziness for vertigo vs. lightheadedness

Answer 51

Seizure has a post-ictal phase, true syncope does not

Answer 52

Fainting after seeing blood, etc., w/ prodrome (pallor, nausea, warmth, diaphoresis, blurred vision) 60% of patients with a heart condition

Answer 53

No prodrome and w/ exercise Syncope while supine

Answer 54

After exercise with a drop in HR and BP

Answer 55

Long lasting, no post ictal phase - suspect

Answer 56

HA - SAH Chest Pain - MI, PE Fever - Sepsis

Answer 57

Check for meds - Zophran, Psych, Macrolides, FQ, Antipsychotics, Diuretics, nDHP-CCB May have gone into torsades EKG of 450+ is concerning

Answer 58

Head and Neck Trauma Skin Turgor Abdomen for AAA Rectal exam for bleed

Answer 59

Neuro deficit Trauma to head - Canadian CT rules

Answer 60

Less than a minute

Answer 61

Change in position causes BP to drop causing a reflexive tachycardic response

Answer 62

Tight collar, Head turn, Shaving - leading to push on artery Hx of atherosclerosis Use carotid massage to dx Midodrine

Answer 63

Decrease of SBP by 50+ upon carotid sinus massage

Answer 64

Avoid: Nitro, BB, CCB Admit for TAVR

Answer 65

Systolic ejection crescendo-decrescendo at the right upper sternal border 1st post with radiation to the neck Split S2

Answer 66

Murmur is worse with squatting and expiration Murmur decreases with valsalva Syncope and LVH

Answer 67

Early diastolic, soft-blowing decrescendo murmur with a high-pitch quality, especially when the patient is sitting and leaning forward heard at the left lower sternal border

Answer 68

Increases with squatting, decreases with valsalva History of congenital heart defect or rheumatic fever

Answer 69

Rumbling diastolic murmur with a split s1 that occurs following an opening snap. The rumbling is loudest at the start of diastole and is heard best at the left sternal border and apex

Answer 70

Opening snap and murmur at LLSB/Apex Left atrial hypertrophy - golden arches P wave on EKG lead II SOB and CHF from fluid backup Increase with squatting, decreases with valsalva

Answer 71

Blowing HOLOSYSTOLIC murmur at APEX with a SPLIT S2, radiates to the axilla

Answer 72

Previous STEMI Low BP with tachycardia Lung crackles

Answer 73

Pulsatile abdominal mass Flank pain Hypotension

Answer 74

Surgical repair if > 5.5 cm or expands > 0.6 cm per year Monitor annually if > 3 cm. Monitor every 6 months if > 4 cm Beta-blockers

Answer 75

Tearing chest pain radiating to the back Widened mediastinum on CXR

Answer 76

Ascending aorta- Surgical emergency Descending aorta- Medical therapy (beta-blockers) unless complications are present

Answer 77

Pain, Pallor, Pulselessness, Paresthesia, Paralysis, Poikilothermia

Answer 78

A-fib Mitral Stenosis

Answer 79

Angiography is gold standard Treat with IV heparin if not limb-threatening then call the vascular surgeon for angioplasty, graft, or endarterectomy

Answer 80

Spontaneous or following IV/PICC line trauma Pain, erythema, induration, palpable cord

Answer 81

Duplex ultrasound Gold Standard for diagnosis Treatment: Symptomatic: NSAIDs, warm compress

Answer 82

Stiffness/pain in the neck; presents with paraspinal muscle tenderness and spasm and + Spurling test

Answer 83

Passive cervical extension, Ipsilateral rotation, and Axial compression with pain down the ipsilateral side

Answer 84

Soft cervical collar (2-3 days), application of ice /heat, analgesics, gentle active ROM soon after injury

Answer 85

Axial back pain with difficulty bending No radicular symptoms - pain below the knees

Answer 86

Bed rest < 2 days + NSAIDs ± muscle relaxants if no red flag symptoms

Answer 87

You've Been in Pain for Over a Week Your Pain Extends to Other Body Parts You Have Numbness, Tingling or Weakness You Have Pain After an Accident Your Pain is Worse at Certain Times or in Certain Positions You're Having Problems with Your Bowels or Urination

Answer 88

Involves muscles/ligaments

Answer 89

Involves tendons

Answer 90

Scholar's elbow Pain or fever may suggest septic bursitis Gout also possible etiology

Answer 91

NSAIDs, Rest, Abx, steroid injection, surgery

Answer 92

Housemaid's knee Pain with direct knee pressure (ie. kneeling) Often septic in wrestlers

Answer 93

Compression, NSAID, aspiration, immobilization

Answer 94

Often not associated with trauma Pain with motion and rest Similar to rotator cuff impingement

Answer 95

Fever Diabetes Immune compromise

Answer 96

Anterior knee pain Basset's sign - tenderness to palpation at the distal pole of the patella in full extension and no tenderness to palpation at the distal pole of the patella in full flexion

Answer 97

Ice, Rest, NSAID Steroids - CONTRAINDICATED tendon rupture

Answer 98

Pain in the bicipital groove Anterior shoulder pain and pain with resisted supination of the elbow Popeye deformity = rupture

Answer 99

NSAID, PT, Steroids, surgery if refractory

Answer 100

Speed test: Pain elicited in the bicipital groove when the patient attempts to forward elevate shoulder against examiner resistance while the elbow extended, and forearm supinated. Positive if the pain is reproduced. May also be positive in patients with SLAP lesions. Yergason’s test: Elbow flexed 90 degrees, wrist supination against resistance. Positive if the pain is reproduced.

Answer 101

Large midline disk herniation compressing several nerves Saddle anesthesia, incontinence, paralysis

Answer 102

MRI SUrgical emergency

Answer 103

Pain and tenderness on the breastbone, pain in more than one rib, or pain that gets worse with deep breaths or coughing MC unilateral with pain on movement Reproducible with palpation

Answer 104

CRX, Biopsy, EKG, VItamin D to rule out other causes

Answer 105

NSAIDS, Heat, Compression, potentially PT or steroids

Answer 106

Inflammatory process causing visible enlargement of the costochondral area “slipping rib syndrome”

Answer 107

Ice and NSAIDs Bruising on an extremity is a fracture until proven otherwise

Answer 108

Erythema is smoke not fire (needs to find underlying cause) Often indicates that infection needs to be rules out

Answer 109

MC site of radial nerve injury; posterior fat pad/sail sign, treat with sugar tong splint (distal) and coaptation splint (shaft) with ortho follow up in 24-48 hours

Answer 110

MC pediatric elbow fracture; usually from fall to outstretched hand; XR shows anterior fat pad (dark area on either side of the bone), check neurologic/vascular involvement (median nerve / brachial artery injury), long arm posterior splint followed by long arm casting (ORIF for displaced)

Answer 111

Lateral elbow pain, hold the elbow in slight flexion and forearm pronated; pain and tenderness localized to the lateral aspect of the elbow; usually from pulling upward motion; the supination-flexion technique is classically used

Answer 112

Pain and tenderness along the lateral aspect of the elbow, limited elbow/forearm ROM, particularly pronation/supination; MC cause is falling on an outstretched arm; treat with a sling, long arm splint at 90 degrees, ORIF

Answer 113

Usually from a blow; functional brace with good interosseous mold for isolated nondisplaced or distal 2/3 ulna shaft fx; ORIF if displaced

Answer 114

Proximal ulnar shaft fracture with radial head dislocation. elbow pain and swelling, tenderness to palpation along the elbow, decreased elbow ROM, the radial head may be palpable if dislocated. FOOSH, radial nerve injury, treat with ORIF

Answer 115

Distal radial shaft fracture, dislocation of ulna. Wrist pain, swelling, pain with flexion/extension; FOOSH, falling on pronated hand, unstable fracture = ORIF, long arm splint

Answer 116

Dorsally angulated extra-articular distal radius fracture; “fragility fracture”; FOOSH; causes dinner fork deformity; need lateral XR to make the diagnosis; treat with sugar tong splint/cast

Answer 117

Extra-articular metaphysis fracture of the radius with volar angulation and displacement – garden spade deformity; from fall with palm closed, hands flexed, blow to the back of wrist; median nerve injury = common (can develop carpal tunnel over time); reduction/surgery or casting, PT for ROM and strengthening

Answer 118

Thumb spica splint for 10-12 weeks

Answer 119

Fracture of neck of 5th/4th metacarpal; usually from s punch with a clenched fist; treat with ulnar gutter splint with joints at 60-degree flexions

Answer 120

Common in elderly, complication = adhesive capsulitis/rotator cuff tear; MRI to r/o rotator cuff tear; scapular fractures often missed after MVA; tx = immobilize 2-3 weeks the begin with gentle passive ROM and modalities; progress to light strengthening after 6 weeks

Answer 121

Arm is abducted and externally rotated (FOOSH)

Answer 122

Anterior: MC (arm = anterior) ⇒ arm is abducted and externally rotated (FOOSH) Posterior: the arm is adducted and internally rotated

Answer 123

AP, axillary, and scapular view Reduce, post-reduction films, sling, and swath, PT

Answer 124

Axillary nerve

Answer 125

Injury of the anterior (inferior) glenoid labrum following a dislocated shoulder

Answer 126

Dent in the humeral head due to dislocation Compression chondral injury of the posterior superior humeral head following impaction against the glenoid

Answer 127

Usually middle third of clavicle Swelling, erythema, tenderness to palpation, tenting of overlying skin, MC injured rotator cuff muscle = supraspinatus X-ray: anteroposterior and clavicle view Tx: simple arm sling or figure of eight sling: 4-6 weeks adults, ortho consult if proximal 1/3; begin PT after 4 weeks with light strengthening after 6 weeks

Answer 128

Severe hip or groin pain after a fall Positive Log Roll maneuver Pain with active and passive ROM

Answer 129

Medial circumflex femoral artery

Answer 130

AP X-ray of the pelvis Look for Avascular necrosis

Answer 131

Manage with ORIF; hip arthroplasty, DVT prophylaxis until ambulatory

Answer 132

adducted, flexed, internally rotated

Answer 133

abducted, flexed, externally rotated

Answer 134

Sciatic nerve injury DVT - prevent

Answer 135

Anterior - Femoral head below acetabulum Posterior - Femoral head above acetabulum

Answer 136

Closed reduction, open if failure XR and neurovascular check after reduction

Answer 137

SENSITIVE (rule out) Age > 55 Tenderness to the head of the fibula Isolated tenderness to the patella Inability to flex the knee to 90 degrees Inability to bear weight for 4 steps both immediately and in examination room regardless of limp

Answer 138

SPECIFIC - Rule in Recent fall or blunt trauma Age < 12 y/o or > 50 y/o Unable to take 4 unaided steps

Answer 139

Usually after high impact trauma Concern for popliteal artery injury CT angiogram to dx Pre and post XR and MRI

Answer 140

Usually peds in MVA Lateral oblique XR Peroneal nerve check (foot drop) Nondisplaced - 6-8 weeks cast Displaced - ORIF

Answer 141

Patella Alta (pulled quad muscles cause fracture displacement; tx = 6-8 weeks immobilization, may bear partial eight; displaced need ORIF

Answer 142

Space narrowing and osteophytes Weight reduction, moderate activity, NSAIDs, intra-articular steroid injection, bracing, canes, muscle strengthening, PT; acetaminophen = first line, NSAIDs = second line; total joint replacement indicated in advanced cases

Answer 143

Pain along lateral malleolus, medial malleolus Midfoot pain, 5’th metatarsal or navicular pain Unable to walk more than four steps in the ER or exam room

Answer 144

5th metatarsal diaphysis fracture Lateral foot pain Due to poor blood supply AP, Lat, Oblique XR NWB for 6 weeks RICE +boot

Answer 145

3rd metatarsal - athlete, military May not show up on XR, may need MRI

Answer 146

High force impact (falling/snowboarding), X-ray demonstrates talus fracture, non-weight bearing cast for non-displaced, surgery for displaced

Answer 147

INVERT Fibular fracture below mortise, tibiofibular syndesmosis intact, usually unstable

Answer 148

EVERT Fibular fx at the level of the mortise, tibiofibular syndesmosis intact or mild tear, deltoid ligament intact or may be torn, stable or unstable

Answer 149

LATERAL PUSH Fibular fx above Mortise, tibiofibular syndesmosis torn with a widening of talofibular joint, deltoid ligament damage or medial malleolar fracture, unstable = ORIF

Answer 150

Men over 30 (more common in women poste menopause) Assymmetric tophi - great toe Pain, swelling redness, tenderness

Answer 151

Sudden gout attack

Answer 152

Rod shaped negatively birefringent crystals Serume uric acid over 8 Punched out lesions on XR

Answer 153

Elevation, rest, decrease purines (meats, beer, seafood, alcohol), weight loss, increase protein, limit alcohol

Answer 154

Indomethacin is best Colcicine (bad GI s/e) or steroids if not tolerated

Answer 155

Thiazide diuretics Aspirin No allopurinol while acute

Answer 156

Allopurinol Colchicine

Answer 157

Over 60, Large joint involvement without LE tophi Rhomboid, birefringent, calcium pyrophosphate crystals Linear calcifications of XR

Answer 158

NSAIDs, colchicine, intra-articular steroid injections Colchicine = prophylaxis, NSAIDs = acute attacks

Answer 159

May affect the levator scapular and trapezius muscles, resulting in weakness in shoulder elevation. There is no reliable associated reflex.

Answer 160

Weakness of the rhomboid, deltoid, bicep, and infraspinatus muscles. Patients may have weakness of shoulder abduction and external rotation. The bicep reflex may be diminished.

Answer 161

Produces pain at the shoulder tip and trapezius with radiation to the anterior upper arm, radial forearm, and thumb, and sensory impairment in these areas. Weakness can overlap with the C5 or C7 muscles. Muscles affected include infraspinatus, bicep, brachioradialis, pronator teres, and triceps. Weakness involves flexion at the elbow, or shoulder external rotation. The bicep or brachioradialis reflex may be diminished.

Answer 162

Weakness can be present in the opponens pollicis, flexor digitorum profundus, flexor pollicis longus, and hand intrinsic muscles. Clinically, patients present with symptoms similar to an ulnar or median motor neuropathy and can have weakness of finger abductors and grip strength; they may also have findings suggesting median motor neuropathy. No reliable reflex test is available.

Answer 163

Back pain radiating through thigh/buttocks (lower leg below the knee down L5-S1) – Do straight leg raise, crossover test; dx = non-contrast MRI; Tx: NSAIDs, rest, steroids, PT, epidural steroid injection, surgery if warranted

Answer 164

Rare, causes inguinal pain

Answer 165

Older patients with spinal stenosis Anterior aspect of thigh and knee affected

Answer 166

Most common herniation Posterior aspect of the leg into the foot from the back. On examination, strength may be reduced in leg extension (gluteus maximus) and plantar flexion. Sensation is generally reduced on the posterior aspect of the leg and the lateral foot. Ankle reflex loss is typical.

Answer 167

Patients can present with sacral or buttock pain that radiates down the posterior aspect of the leg or into the perineum. Weakness may be minimal, with urinary and fecal incontinence as well as sexual dysfunction.

Answer 168

Prolapsed intervertebral disk and low back strain. Usually occurs within 24 hours of injury/overuse

Answer 169

Sciatica/Pain radiating down a leg MSK injury creates localized point tenderness SI joint involvement gets worse with standing Spinal Stenosis improves with leaning forward

Answer 170

CT, MRI, XR if persistent Leg lift test

Answer 171

Short term rest (max 2 days), with support under knees and neck + NSAIDs Imaging if lasting over 6 weeks PT

Answer 172

Fever, restriction of movement and non-weight bearing May be due to contiguous spread or due to trauma/surgery

Answer 173

MC - S. Aureus CAT/Dog - Pasturella Sickle cell - salmonella Vertebrae - TB\Prosthtic - S. epidermitis

Answer 174

Bone aspiration - GOLD STANDARD Demineralization, periosteal reaction, bone destruction (MRI showes before XR) Elevated ESR/CRP Blood culture

Answer 175

Remove ALL hardware IV ABX 4-6 weeks acute; 8+ weeks chronic

Answer 176

Over 2cmx2cm foot ulcer

Answer 177

Acute - determine if nociceptive or neuropathic Chronic - Consult with regular provider

Answer 178

Naproxen: 500 mg (1000 mg/day) Ibuprofen: 400 mg (1200 mg/day) Diclofenac: 50 mg (150 mg/day)

Answer 179

Not absolutely CI Weight risk/benefit

Answer 180

History of a previously complicated ulcer Age >65 High dose NSAID therapy Concurrent use of aspirin/corticosteroids/anticoagulants Use PPI

Answer 181

Consider topical analgesic patches (lidocaine 5%) Consider Cymbalta for a combination of pain and depression Consider COX 2 inhibitors such as Celebrex or Mobic Consider muscle relaxants such as baclofen, cyclobenzaprine (Flexeril), tizanidine (Zanaflex), etc. Consider gabapentin or TCAs (nortriptyline) for neuropathic pain

Answer 182

Discuss goals of tx Short, low dose course Combine with NSAID or TYlenol Oral preferred over IV

Answer 183

Single swollen warm and painful joint with fever and systemic symptoms Knee and hip are MC places

Answer 184

Staph Aureus in normal Gonorrhea more common if sexually active Pseudomonas in IVDU

Answer 185

50,000+ WBCs in joint aspirate Or 1,000+ in prostetic joints

Answer 186

Treatment is based on gram stain- 2–4-week course of antibiotics + arthrotomy with joint drainage Staph aureus = Vanco/nafcillin (Vanco or Clindamycin if PCN allergic) Gonorrhea = ceftriaxone IVDU = Cipro/Levaquin

Answer 187

Golfer/Pitcher elbow pain with resisted wrist flexion and pronation, pain at the medial elbow may radiate to the wrist; tx: activity modification, PT, steroid injection, surgery for a patient who failed PT for 4-6 mo

Answer 188

Tennis elbow Pain with wrist extension and forearm supination; tx: activity modification, counterforce bracing, PT, steroid injection, surgery for failed PT 4-6mo

Answer 189

Phalen (only CT) and Tinnell (both)

Answer 190

NSAIDs Splinting Steroid injection Decompression if severe

Answer 191

Positive finklestein test (thumb in fist) Swelling in thumb radiates to radial forearm Thumb spica splint x 3 weeks, NSAIDs 10-14 days, steroid injections, PT

Answer 192

Ulnar collateral ligament injury from fall on an abducted thumb Gamekeeper = chronic; skier = acute Laxity and pain with valgus stretch; XR to evaluate for avulsion injury Tx: thumb spica splint 4-6 weeks

Answer 193

MC in digits 4&5 Contracture of palms and palmar nodules – associated with alcoholic cirrhosis – painless nodules on palms, may limit function; tabletop test positive (lie flat on the tabletop)

Answer 194

Dx - Clinical; Tx: injected collagenase or steroid, fasciotomy or fasciectomy if pt is refractory to 1st line therapy

Answer 195

(baseball – tear at DIP joint): avulsion of extensor tendon ⇒ forced flexion; can’t straighten distal finger

Answer 196

XR = bony avulsion of the distal phalanx; tx: splint DIP uninterrupted extension x6 weeks or surgical pinning

Answer 197

Tear at PIP joint – jammed finger): PIP flexion and DIP hyperextension, usually from jammed finger; Elson test = bend PIP 90 degrees over the edge of the table and extend middle phalanx against resistance ⇒ weak PIP extension and DIP will be rigid

Answer 198

XR not required; tx: splint PIP in extension x4-6 weeks

Answer 199

Infection of the pulp space of the fingertip, usually with staphylococci and streptococci

Answer 200

Herpes virus infection around the fingernail (thumb sucking)

Answer 201

Allen's test to ensure radial and ulnar artery flow; U/S can differentiate a cyst from a vascular aneurysm; most ganglia don’t require treatment - observe. Aspirate (avoid on the volar aspect of wrist d/t radial artery – effective on only 50% of pt. Excision (severe sx or neurovascular manifestations)

Answer 202

From FOOSH or direct shoulder trauma Step up deformity and pain with cross chest testing

Answer 203

XR with patient holding weight to assess severity Sling and analgesia, surgery if more severe

Answer 204

Popey deformity Pain at bicipital groove NSAIDs, PT, steroid injection; surgical release for refractory cases

Answer 205

Speed's: patient attempts to forward elevate shoulder against examiner resistance while the elbow extended and forearm supinated; positive with pain (SLAP lesion) Yergason's elbow flexed at 90, wrist supination against resistance

Answer 206

XR = initial imaging (loss of subacromial space due to upward migration of humeral head), MRI = most accurate; Tx = NSAIDs, steroid injection and surgical repair if you fail 3-6mo of conservative

Answer 207

Supraspinatus: empty can test, full can test, arm drop Subscapularis: lift-off test (elbow at 90, rotate medially against resistance) Teres minor/infraspinatus: elbow at 90, rotate laterally against resistance

Answer 208

Apley scratch test; tx = NSAIDs, PT, steroid injection

Answer 209

Neer test: arm fully protonated with pain during forward flexion while shoulder is being held Hawkins: elbow/shoulder flexed at 90 with sharp anterior shoulder pain with internal rotation Drop arm: pain with inability to lift the arm above shoulder or hold it

Answer 210

XR may show a subacromial spur Tx: rest, ice, activity modification, NSAIDs, steroid injection, arthroscopic surgery if refractory to conservative

Answer 211

Activity-related, “jumper’s knee”, swelling over tendon and tenderness at the inferior border of the patella

Answer 212

XR may show inferior traction spur in chronic cases (enthesophyte), U/S = thickening tendon and hypoechoic areas; MRI shows tendon thickening;

Answer 213

Ice, rest, activity modification, PT; surgical excision and suture repair as needed; Steroid injection = CI d/t risk of tendon rupture!!!!!

Answer 214

Pop with knee giving out Positive lachman's test (most sensative) MRI to confirm with PT and surgery for young active patients

Answer 215

MCL: valgus stress injury (hit in football); “pop” along with medial joint line pain, MRI = definitive; conservative tx with bracing and therapy = effective; surgery for chronic instability; Valgus stress test LCL: trauma to the inside of the knee; rare; MRI = definitive study; conservative treatment with bracing and therapy usually effective; surgery for grade III injury; Varus stress test

Answer 216

Blow to the knee while flexed or bend like landing hard during sports fall Posterior drawer sign or sag sign

Answer 217

MRI = confirms; protected weight-bearing and rehab for isolated grade I and II; surgical repair for PCL + ACL or PCL and PCL + grade III MCL or LCL

Answer 218

After twisting injury with locking, feeling of the knee giving away, a triad of joint line pain, effusion, locking; effusion usually 6-24 hours after injury; McMurray test/Apley test

Answer 219

anterior talofibular ligament (ATFL) - MC injury calcaneofibular ligament (CFL), and posterior talofibular ligament (PTFL)

Answer 220

THompson test (calf squeeze)

Answer 221

Surgical repair for early ROM, splint with the ankle in some plantar flexion

Answer 222

Pain on the plantar surface, usually at calcaneal insertion of plantar fascia upon weight bearing especially in the morning/initiation of walking after prolonged rest (dancers, runners); tx: stretching, ice, calf strengthening, shoe inserts, NSAIDs

Answer 223

Posterior tibial nerve compression from overuse, restrictive footwear, + Tinel's sign, dx: nerve conduction test/electromyography; tx: avoid exacerbating activities, NSAIDs, steroid injection if no improvement, surgery

Answer 224

Deformity of the bursa over 1st metatarsal; hx of poorly fitted shoes / flat feet (pes planus); or RA; pain over prominence at MTP joint / pain with shoes, dx = XR, tx = comfortable wide toed shoes; surgical when sx present despite shoe modification

Answer 225

Painful mass near tarsal heads; MC in women with tight-fitting shoes, high heels; sharp pain with ambulation at 3rd metatarsal head; associated with numbness/paresthesia; MRI may be needed for diagnosis; tx = wide shoes, steroid injections, surgical resection if conservative management fails

Answer 226

1 - Stretched but intact 2 - 1/3 to complete tear 3 - Complete rupture with avulsion potentially

Answer 227

10–15 minutes at a time, 3-4 times a day.

Answer 228

Hamstring muscle and the lower back

Answer 229

First degree (mildest) – little tissue tearing; mild tenderness; pain with a full range of motion. Second degree – torn muscle or tendon tissues; painful, limited motion; possibly some swelling or depression at the spot of the injury. Third-degree (most severe) – limited or no movement; severe acute pain, though sometimes painless straight after the initial injury

Answer 230

Acute hepatitis RUQ pain with fatigue, malaise, nausea, vomiting, and anorexia. Patients may also have jaundice, dark urine, and light-colored stools Perihepatitis (Fitz-Hugh-Curtis syndrome) RUQ pain with a pleuritic component, pain is sometimes referred to the right shoulder Liver abscess Fever and abdominal pain are the most common symptoms Budd-Chiari syndrome Symptoms include fever, abdominal pain, abdominal distention (from ascites), lower extremity edema, jaundice, gastrointestinal bleeding, and/or hepatic encephalopathy Portal vein thrombosis Symptoms include abdominal pain, dyspepsia, or gastrointestinal bleeding

Answer 231

Splenomegaly Pain or discomfort in LUQ, left shoulder pain, and/or early satiety Splenic infarct Severe LUQ pain Splenic abscess Associated with fever and LUQ tenderness Splenic rupture May complain of LUQ, left chest wall, or left shoulder pain that is worse with inspiration

Answer 232

MCC - Fecalith The first symptom is crampy or "colicky" pain around the navel (periumbilical) → then pain over McBurney’s point (RLQ) N/V and anorexia

Answer 233

Rovsing – RLQ pain with palpation of LLQ Obturator sign – RLQ pain with internal rotation of the hip Psoas sign - RLQ pain with hip extension while laying on the left side

Answer 234

Imaging if atypical presentation - appy ultrasound or abdominal CT scan CBC - neutrophilia supports the diagnosis TX: surgical appendectomy

Answer 235

Cholelithiasis: Gallstones within the gallbladder sac Cholangitis: Inflammation of the common bile duct, often caused by infection or choledocholithiasis Cholecystitis: Inflammation of the gallbladder Choledocholithiasis: Gallstones that have migrated from the gallbladder sac into the common bile duct.

Answer 236

Stones in the gallbladder, Asymptomatic (most), symptoms only last few hours Biliary colic—RUQ pain or epigastric Pain after eating and at night Boas sign—referred right subscapular pain

Answer 237

RUQ ultrasound - high sensitivity and specificity if >2 mm. CT scan and MRI TX: Asymptomatic—no treatment necessary Elective cholecystectomy for recurrent bouts

Answer 238

Gallstones with inflammation 5 Fs: Female, Fat, Forty, Fertile, Fair (+) Murphy's sign (RUQ pain with GB palpation on inspiration) RUQ pain after a high-fat meal Low-grade fever, leukocytosis, jaundice

Answer 239

Ultrasound is the preferred initial imaging - gallbladder wall >3 mm, pericholecystic fluid, gallstones HIDA is the best test (Gold Standard) - when ultrasound is inconclusive CT scan - alternative, more sensitive for perforation, abscess, pancreatitis Labs: ↑ Alk-P and ↑ GGT, ↑ conjugated bilirubin Porcelain gallbladder = chronic cholecystitis Cholecystectomy to treat

Answer 240

ERCP = gold standard

Answer 241

Recent travel with sudden jaundice, RUQ pain, scleral icterus, fever HAV, Parasites, Alcohol can cause it

Answer 242

Hepatomegaly and GB thickening on US Hyperbilirubinemia with elevated AST and ALT

Answer 243

Early HBV disease

Answer 244

Resolve acute hepatitis

Answer 245

Vaccinated and resistant

Answer 246

Chronic HBV

Answer 247

Fluids Manage clotting issues Manage encephalopathy THiamine/Folate supplementation

Answer 248

Entacavir for severe HBV Pentoxifylline or steroids for severe alcoholic hepatitis

Answer 249

Abdominal CT is the diagnostic test of choice - required to differentiate from necrotic pancreatitis ERCP is the most sensitive for chronic pancreatitis

Answer 250

Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune disease, Scorpion sting, Hypercalcemia, Hyperlipidemia, ERCP and Drugs.

Answer 251

Age > 55 Leukocyte: >16,000 Glucose: >200 LDH: >350 AST: >250

Answer 252

Arterial PO2: <60 HCO3: <20 Calcium: <8.0 BUN: Increase by 1.8+ Hematocrit: decrease by >10% Fluid sequestration >6L

Answer 253

Painful defectation with swelling and fluctuance at the anus. Fever is not common Treat with drainage and surgery if needed. Abx in at-risk patients

Answer 254

Tearing rectal pain with bright red bleeding after Superficial cut Sitz bath - heals in 6 weeks Botox if failing conservative tx

Answer 255

1. Periumbilical pain (intermittent and crampy) 2. Nausea/vomiting 3. Anorexia 4. Pain migrates to RLQ (constant and intense pain), usually in 24 hours

Answer 256

Appendicitis

Answer 257

Weight loss, Emesis, Anorexia, Pain/epigastric discomfort, Obstruction, Nausea

Answer 258

sedatives, digoxin, laxatives, thiazide diuretics, narcotics, antibiotics

Answer 259

Colorectal cancer (always consider if over 50) Bowel obstruction - Air fluid levels and dilated loops on XR Volvulus - XR with colonic distension Ileus - Absent bowel sounds Gastroparesis - (diabetes) vomiting, abdominal pain, fullness after eating small amounts

Answer 260

Infection of billiary tract Charcot's triad - Pain, Fever, Jaundice Reynauds pentad - Charcot + Altered mental status and hypotension

Answer 261

US - Initial ERCP - Best

Answer 262

Cipro and Flagyl ERCP to remove stones Cholecystectomy post-acute

Answer 263

Jaundice and pruritus Associated with IBD, cholangiocarcinoma, pancreatic cancer, colorectal cancer

Answer 264

Hepatic vein thrombosis Triad of abdominal pain, ascites, and hepatomegaly

Answer 265

Ammonia accumulates and reaches the brain causing ↓ mental function, confusion, poor concentration Asterixis (flapping tremor) - have patient flex hands Dysarthria, delirium, and coma

Answer 266

Dilated submucosal veins, retching or dyspepsia, hypovolemia, hypotension, and tachycardia

Answer 267

Salt restriction and diuretics (furosemide and spironolactone) Paracentesis if tense ascites, SOB, or early satiety

Answer 268

Straining Lumpy hard stools A sensation of incomplete evacuation Use of digital maneuvers A sensation of anorectal obstruction or blockage with 25 percent of bowel movements A decrease in stool frequency (less than three bowel movements per week) For three months starting six months ago

Answer 269

Colorectal cancer

Answer 270

CHeck for opioid use CBC, CMP, TSH Increase fiber Laxatives Metamucil (Bulk forming)>Polyethylene glycol (Osmotic)>Stimulant/Suppository/Stool softeners

Answer 271

Rotavirus, Cryptosporidium, Giardia, Shigella

Answer 272

Staph aureus

Answer 273

Cholera (rice water stools), V. Parahemolyticus

Answer 274

Salmonella

Answer 275

C. perfringens C Botulinum

Answer 276

Cryptosporidium

Answer 277

Left sided appendicitis Fever/chills/Nausea/vomiting/left-sided abdominal pain

Answer 278

CT with oral, rectal, and IV contrast; do colonoscopy 1 to 3 months after the episode to look for cancer. CT revealing fat stranding and bowel wall thickening

Answer 279

Pain control and liquid diet May us abx Metamucil and HIgh fiber diet to prevent

Answer 280

NSAIDs or Bisphosphonates

Answer 281

Fluconazole 100 mg PO Daily

Answer 282

HSV - Punch lesions use acyclovir CMV - Large solitary ulcers use gancyclovir

Answer 283

Allergen elimination Steroid topical of inhaled

Answer 284

Take with water avoid reclining for 30-45 minutes

Answer 285

Dyspepsia (belching, bloating, distension, and heartburn) and abdominal pain are common indicators of gastritis

Answer 286

LOcated in the antrum and body of the stomach Breath or fecal antigen test CAP (Clarithromycin, Amoxicillin, PPI0 4-8 weeks OR quad therapy (PPI, Pepto, 2 ABX

Answer 287

Ligament of trietz

Answer 288

Peptic ulcer: upper abdominal pain Esophageal ulcer: odynophagia, gastroesophageal reflux, dysphagia Mallory-Weiss tear: emesis, retching, or coughing prior to hematemesis Esophageal varices with hemorrhage or portal hypertension: jaundice, abdominal distention (ascites) Malignancy (gastric cancer and right-sided colon cancer): dysphagia, early satiety, involuntary weight loss, cachexia Severe erosive esophagitis: odynophagia (painful swallowing), dysphagia and retrosternal chest pain

Answer 289

NPO Fluids Oxygen IV PPI until cause determined

Answer 290

Under 9 in high risk pts (ie. elderly, CAD) Under 7 in everybody else

Answer 291

Hemorrhoids: painless bleeding with wiping Anal fissures: severe rectal pain with defecation Proctitis: rectal bleeding and abdominal pain Polyps: painless rectal bleeding, no red flag signs Colorectal cancer: Painless rectal bleeding and a change in bowel habits in a patient 50-80 years of age Diverticulosis is generally an incidental finding since diverticular bleeding is usually of greater volume

Answer 292

Drinking stream water hx Bulky foul smelling stool without blood DX: Stool sample cyst or trophozoites TX with tinidazole (first line) Flagyl (Metronidazole) 250-750 mg PO TID Symptoms resolve within 5-7 days

Answer 293

Pinworm Perianal pruritis worse at night Peds Scotch tape test with egg visualization under microscopy TX with mebendazole or pyrantel pamoate

Answer 294

GI sx and weight loss B12 defdiciency with hx of undercooked meat consumption Tape test for D. latum, stool for eggs Tx: Praziquantel

Answer 295

Cough, weight loss, anemia, recent travel, anemia Hx of serpigionous rash (foot to lungs to GI) Stool for adult worms TX: mebendazole or pyrantel

Answer 296

Pancreatic duct, common bile duct, and bowel obstruction, myalgia Ate bear meat MC helminth worldwide Stool sample for eggs and adult worms TX: albendazole, mebendazole, pyrantel pamoate

Answer 297

Bloody diarrhea and tenesmus, liver abcess, Stool for trophozooites Iodoquinol or paromomycin Flagyl for liver abscess

Answer 298

Contaminated fresh water - penetrate the skin and spread through the body Rash, abdominal pain, diarrhea, bloody stool, or blood in the urine DX: Eggs in urine or feces TX: Praziquantel

Answer 299

Mild/Self limiting symptoms do not require further workup unless long standing or resistant to PPI therapy Standard workup: Endoscopy with biopsy is the gold standard for diagnosis Manometry 24-hour ambulatory pH probe testing Barium esophagography Step up therapy H2 blockers to PPI

Answer 300

Gastrin secreting tumor - resect and PPI

Answer 301

Esophagus - Progressive dysphagia to solids with weight loss, hematemesis GI - Abdominal pain and unexplained weight loss, Dyspepsia, N/V, early satiety

Answer 302

Hx of hematochezia, straining, constipation Below dentate line Anoscopy Purple with extreme pain, may not bleed iif thrombosed Thrombosed = Excise Non-thrombosed = Conservative therapy (sitz bath, anesthetic, fiber)

Answer 303

Above dentate line Bright red blood per rectum, pruritus and rectal discomfort Tx: Fiber, sitz bath, ice packs, bed rest, stool softeners, topical steroids Rubber band ligation If protrudes with defecation, enlargement, or intermittent bleeding Closed hemorrhoidectomy if permanently prolapsed

Answer 304

WHen it continues beyond two years

Answer 305

Indirect through the internal inguinal canal - may enter scrotum, more likely to than direct Direct through external canal at hesselbach's triangle

Answer 306

Strangulated hernia: A hernia becomes strangulated when the blood supply of its contents is seriously impaired Obstructed hernia: This is an irreducible hernia containing intestine that is obstructed from without or within, but there is no interference to the blood supply to the bowel Incarcerated hernia: A hernia so occluded that it cannot be returned by manipulation, it may or may not become strangulated

Answer 307

Most common in the rectum Shallow - mucosa only Hematochezia and pus-filled diarrhea, fever, tenesmus, anorexia, weight loss Barium enema: Lead pipe appearance (loss of haustral markings) -> may lead to toxic megacolon P-ANCA on serology Colonoscopy: continuous lesions in the mucosa/submucosa of rectum and colon Colectomy is curative Medications: Prednisone and mesalamine

Answer 308

Mouth to anus- most common in the terminal ileum Deep skip lesions Fistulas common, abscess Abdominal pain, aphthous ulcers, weight loss, nonbloody diarrhea, and cramping Barium enema: Cobblestone appearance Colonoscopy: focal ulcerations alternating with normal mucosa Flares: Prednisone +/- Mesalamine +/- Metronidazole or Ciprofloxacin Maintenance: Mesalamine NO SUrgery

Answer 309

Septic and febrile with abdominal pain Distended colon, more common with UC than Crohns Decompression and potential colon resection

Answer 310

MC site - SMA History of coronary artery disease experiencing recurrent cramping with postprandial abdominal pain Pain 10-30 mins after eating, relieved by lying or squatting Few PE findings

Answer 311

Mesenteric angiography is considered the gold standard Abdominal X-ray shows “thumb-printing” of small bowel or right colon due to submucosal bleeding

Answer 312

Supportive: Bowel rest, fluids, antibiotics Laparotomy with bowel resection for bowel infarction Revascularization is the gold standard

Answer 313

Scleral icterus

Answer 314

Serum bilirubin > 2.5 mg/dl

Answer 315

Hemolytic Increased indirect/unconjugated bilirubin, mild hyperbilirubinemia Dark urine due to hemoglobinuria; dark stool

Answer 316

Increased indirect and direct bilirubin; ALT and AST markedly elevated Dark urine = increased direct bilirubin ETOH hepatitis: AST > ALT 2:1 Acute hepatitis: increased ALT and AST > 1000; ALT >AST usually Chronic hepatitis: increased ALT: AST but <500

Answer 317

Obstructive Cholestasis = bile duct blockage ⇒ increased conjugated bilirubin Cholestasis / pancreatic CA Increased direct/ conjugated hyperbilirubinemia GGT and ALP elevated Dark urine = increase direct bilirubin Acholic stools = biliary obstruction (white)

Answer 318

Caused by forceful vomiting. Associated with alcohol use, upper Endoscopy showing superficial longitudinal mucosal erosions. Hematemesis. Treatment: Supportive. May cauterize or inject epinephrine if needed

Answer 319

Gastric cancer, Duodenal ulcers, Right-sided colon cancer, Portal hypertension with esophageal varices, Severe erosive esophagitis, Mallory-Weiss syndrome.

Answer 320

Hemorrhoids, Anal fissures, Polyps, Proctitis, Rectal ulcers, and Colorectal cancer. Diverticulosis is generally an incidental finding since diverticular bleeding is usually of greater volume

Answer 321

Gastroenteritis: nausea, vomiting, diarrhea, stomach cramps Migraine headache: nausea, vomiting, headache Food poisoning: nausea, vomiting, malaise Influenza virus: nausea, vomiting, cough with phlegm Pyloric Stenosis: Infant with projectile vomiting Peptic ulcer disease: upper abdominal pain, may have nausea or vomiting Hiatal hernia: symptoms of GERD Common cold: nausea, vomiting, runny nose

Answer 322

Standard nausea meds: Scopolamine patch, Dexamethasone (4mg), Ondansetron (4mg) Rescue anti nausea: Prochlorperazine, Droperidol

Answer 323

Maalox, viscous lidocaine, droperidol PO challenge in ED – eat something before going home ⇒ can be performed with GI cocktail

Answer 324

Postoperative adhesions - adults Intussussception - Peds

Answer 325

Typically in ileum or jejunum (hint that most of the small bowel) Symptoms include colicky abdominal pain, nausea, bilious vomiting, abdominal distention, and diarrhea High-pitched hyperactive bowel sounds (early) progressing to silent bowel sounds (hypoactive bowel sounds -late) Dehydration + electrolyte imbalances

Answer 326

KUB shows dilated small bowel loops (< 3 cm), air-fluid levels in the small bowel with valvulae conniventes visible across the full width of the bowel, string of pearls (multiple air-fluid levels), and paucity of gas in the colon CT for follow up

Answer 327

Treat with decompression with an NGT, surgery if a mechanical obstruction is suspected

Answer 328

Cancer - COlon or rectum

Answer 329

Gradually increasing abdominal pain with longer intervals between episodes of pain, abdominal distention, constipation, less nausea and vomiting (may be delayed) - late-onset feculent vomiting, blood in stool, more common in the elderly May be febrile/tachycardic/dehydrated/electrolyte imbalanced

Answer 330

KUB shows dilated colon (> 5 cm), air-fluid levels in the colon, haustra (small pouches caused by sacculation, which give the colon its segmented appearance) that do not transverse bowel, bird beak sign: narrowing of the lumen at the site of obstruction CT after

Answer 331

Bowel rest, NG tube placement, surgery as directed by the underlying cause

Answer 332

More common in SBO

Answer 333

SBO - Shorter and more frequent cramps LBO - Longer and less frequent cramps

Answer 334

Duodenal - Pain decreases with eating, 90% of ulcers, 95% are H. Pylori Gastric - Pain increases with eating, 10% of ulcers, often H pylori, Gnawing or burning pain Bleeding is MC complication of both

Answer 335

Upper endoscopy with ulcer biopsy for H pylori and neoplasia

Answer 336

PPI for 4-8 weeks CAP therapy for H. pylori In active bleeding, a negative bipsy does not exclude H. pylori - a breath test or stool test may be needed Eradication confirmation 4+ weeks after therapy completion.

Answer 337

RSV = MCC Wintermonths Infants and young children Tachypnea, respiratory distress, wheezing

Answer 338

DX: Nasal washing for RSV culture and antigen assay; CXR = normal

Answer 339

Oxygen is only therapy shown to improve Hospitalization if O2 saturation < 95-96%, Age <3 months, RR > 70, Nasal flaring, Retractions, or Atelectasis on CXR Steroids, Bronchodilators, Ribavirin, Monoclonal Ab's may help if severe or immune compromised

Answer 340

Cough for > 5 days lasting 1-3 weeks total Cough, fever (unusual), constitutional symptoms Typically, it is less severe than pneumonia, with normal vital signs, no rales, no egophony

Answer 341

Most common - viral (95%) Common bacterial = M. catarrhalis Chronic lung patients: H. influenzae, S. pneumoniae, M. catarrhalis

Answer 342

DX: Obtain CXR if the diagnosis is uncertain or symptoms persist despite conservative treatment

Answer 343

Supportive tx, steroids in those with preexisting lung disease - hydration, expectorant, analgesic, B2 agonist, cough suppressant Hospitalize if O2 under 96% Antibiotics are indicated in the elderly, underlying cardiopulmonary disease, cough >7-10 days, or immunocompromised - Azithromycin/Clarithromycin

Answer 344

Haemophilus influenzae type B (Hib) Usually in unvaccinated children Tripod with dysphagia, drooling, and respiratory distress

Answer 345

Thumbprint sign on Lateral XR Culture for H. flu CT scan shows narrow airway Definitive = laryngoscopy with cherry red epiglottis

Answer 346

Intubation, supportive care Rocephin May treat outpatient if stable

Answer 347

⇑ Permeability of alveolar-capillary membranes ⇒ development of protein-rich pulmonary edema (non-cardiogenic pulmonary edema) ARDS can occur in those who are critically ill or who have significant injuries ⇒ sepsis (most common), severe trauma, aspiration of gastric contents, near-drowning

Answer 348

Rapid onset of profound dyspnea occurring 12-24 hours after the precipitating event Tachypnea, pink frothy sputum, crackles

Answer 349

CXR shows air bronchogram and bilateral fluffy infiltrate

Answer 350

Tracheal intubation with the lowest level PEEP to maintain PaO2 >60 mmHg or SaO2 >90 ARDS is often fatal. The risk increases with age and the severity of illness

Answer 351

REVERSIBILITY!! Spirometry with pre and post-therapy (albuterol inhalation) readings Decreased FEV1/FVC (75-80%) > 10% increase of FEV1 with bronchodilator therapy

Answer 352

Oxygen, Nebulized SABA (albuterol, etc.) Ipratropium bromide, and Oral steroids

Answer 353

Infection of the upper airway, which obstructs breathing and causes a characteristic barking cough and stridor Caused by the parainfluenza virus

Answer 354

Steeple sign on CXR

Answer 355

Supportive (air humidifier), antipyretics Severe: IV fluids and nebulized racemic epinephrine, steroids

Answer 356

Inspiratory stridor (high) or wheezing (low) Elevated temp and pulse, some decreased breath sounds (lobar) Choking/Gagging Hx of institutionalization, sedation, alcohol

Answer 357

Mediastinal shift and hyperinflation shown on CXR - may also see FB ABG to assess ventilation

Answer 358

Right main stem bronchus over left

Answer 359

Treatment: Remove foreign body with a bronchoscope Rigid bronchoscopy is preferred in children, while flexible is diagnostic and therapeutic in adults

Answer 360

Bronchitis (50%): hemoptysis, dry cough, cough with phlegm Tumor mass (20%): hemoptysis, chest pain, rib pain, tobacco history, weight loss, clubbing Tuberculosis (8%): hemoptysis, chest pain, sweating

Answer 361

Cytology (especially when worried about lung cancer) Fiberoptic bronchoscopy is preferred for CA tissue biopsy, bronchial lavage, or brushing Rigid bronchoscopy for cases of massive bleeding because of its greater suctioning and airway maintenance capabilities High-resolution CT gives a greater positive yield of pathology - can't r/o cancer with an XR

Answer 362

Rapid antigen test to dx BIlateral diffuse infiltrates on CXR Zanamivir or Oseltamivir within 48 hours of symptoms Antivirals reduce illness by 1 day

Answer 363

15% of lung cancer cases with 99% being smokers Recurrent pneumonia with anorexia, weight loss, and weakness

Answer 364

Superior vena cava syndrome Laryngeal nerve palsy Horner syndrome Malignant pleural effusion Digital clubbing Eaton lambert syndrome

Answer 365

MC in SCLC Similar to myasthenia gravis (proximal muscle weakness/fatigue, diminished DTRs, paresthesias (lower extremity)

Answer 366

CXR is most important for DX CT chest with IV contrast for staging Definitive - Tissue biopsy—determine the histologic type Cytologic examination of sputum if central tumor

Answer 367

Combination chemotherapy with 10-13% survival rate CANNOT be treated with surgery

Answer 368

Squamous cell 25-35% Large cell - 5% Adenocarcinoma - 35-40%

Answer 369

Central May cause hemoptysis Hypercalcemia with elevated PTH

Answer 370

Rapid growth with response to surgery 60% are peripheral Gynecomastia

Answer 371

Peripheral - associated with smoking and asbestos Peripheral with thrombophlebitis

Answer 372

Stage 1-2 surgery Stage 3 Chemo then surgery Stage 4 palliative

Answer 373

If suspicious (depending on radiographic findings below) will need a biopsy Ill-defined lobular or spiculated suggests cancer If not suspicious < 1 cm, it should be monitored at 3 mo, 6 mo, and then yearly for 2 yr Calcification, smooth, well-defined edges, suggest benign disease

Answer 374

Severe hacking cough followed by a high-pitched intake of breath that sounds like a whoop. Consider in adults with 2+ week cough and peds under 2 y/o

Answer 375

Nasopharyngeal swab Treat with a macrolide (gram negative) and b2 agonsit

Answer 376

Presents with dyspnea and a vague discomfort or sharp pain that worsens during inspiration

Answer 377

Determine if the pleural fluid is exudative by meeting at least one of Light’s Criteria (increased protein, increased LDH) Pleural fluid protein / Serum protein >0.5 Pleural fluid LDH / Serum LDH >0.6 Pleural fluid LDH > 2/3

Answer 378

Trans - Hydrostatic pressure, liver, etc. Ex - Infection, cancer

Answer 379

Lateral decubitus XR Thoracocentesis = gold standard to treat PLeurodesis for recurrent or drains

Answer 380

Characterized by sudden and intensely sharp, stabbing, or burning pain in the chest when inhaling and exhaling Pneumonia Pericarditis Pericardial effusion Pancreatitis

Answer 381

Kids - RSV Adults - Flu

Answer 382

fever, dyspnea, tachycardia, tachypnea, cough, +/- sputum Dx: patchy, segmental, lobar, multilobar consolidation; blood cultures x2, sputum gram stain Tx: outpatient = doxy, macrolides; inpatient = ceftriaxone + azithromycin/respiratory FQs

Answer 383

Non-remitting cough/bronchitis non-responsive to conventional tx Fungal inhalation in western states; test with EIA for IgM and IgG Tx: fluconazole / itraconazole

Answer 384

Usually those with healthy immune systems Tx: fluconazole / itraconazole

Answer 385

Found in soil; can disseminate and à meningitis Lumbar puncture for meningitis Tx: amphotericin B

Answer 386

Pulmonary lesions that are apical and resemble cavitary TB; worsening cough and dyspnea, progression to disabling respiratory dysfunction; no dissemination Bird or bat droppings (caves, zoo, bird); Mississippi Ohio river valley Signs: mediastinal or hilar LAD (looks like sarcoid) Tx: amphotericin B

Answer 387

CXR: diffuse interstitial or bilateral perihilar infiltrates Dx: bronchoalveolar lavage PCR, labs, HIV test; low O2 sat despite supplemental oxygen Tx: Bactrim and steroids; pentamidine for allergy Prophylaxis for high risk pt with CD4 <200 = daily Bactrim

Answer 388

Confusion, Urea >7, RR >30, Systolic BP < 90 mmHg or Diastolic BP ≤ 60 mmHg, Age >65

Answer 389

0-1 = low risk, consider home tx 2 = probable admission vs close outpatient management 3-5 admission, manage as severe

Answer 390

Acute onset ipsilateral chest pain and dyspnea with decreased tactile fremitus, deviated trachea, hyperresonance, diminished breath sounds

Answer 391

Those who are unstable should have rapid bedside imaging with pleural ultrasonography (highly sensitive and specific) Those with a stable presentation can wait for confirmation by chest radiography - expiratory chest film reveals pleural air CT scan if uncertain, hypoxemia on ABG

Answer 392

Under 15% Will resolve spontaneously

Answer 393

Chest tube placement

Answer 394

Large bore needle decompression

Answer 395

CXR every 24 hours until resolved

Answer 396

TACHYCARDIA (most common), S1Q3T3 (rare), Non-specific ST wave changes

Answer 397

Spiral CT - Initial Pulmonary angiography - Definitive CXR: Westermark sign or Hampton hump (triangular or rounded pleural base infiltrate adjacent to hilum)

Answer 398

Heparin followed by DOAC

Answer 399

COPD Asthma CHF

Answer 400

Respiratory rate<10 or >25 Weak respiratory effort Oxygen saturation<92% on room air or <95% on high concentration oxygen Hypercapnia (elevated CO2 in ABG) Decrease level of consciousness Exhaustion

Answer 401

Oxygen (high flow nasal canal or rebreathing mask) Albuterol for asthma and COPD Lasix for CHF BIPAP for respiratory difficulty and low O2 saturations Intubation for severe cases

Answer 402

At high risk, fibrotic changes on CXR, immunocompromised HIV/drugs, steroids/TNF antagonists daily, or close contact with pt with infectious TB

Answer 403

In patients age < 4 or some risk factors = hospitals and other healthcare facilities, IVDU, recent immigrants from high prevalence area, renal insufficiency, prison, homeless shelter, diabetes, head/neck cancer, gastrectomy/jejunoileal bypass surgery

Answer 404

Need 3 negative AFB smears to be considered negative BBiopsy shows caseating granulomas

Answer 405

Positive PPD with negative CXR Three months of once-weekly isoniazid plus rifapentine (3HP) Four months of daily rifampin (4R) Three months of daily isoniazid plus rifampin (3HR)

Answer 406

Active High-dose daily rifapentine (RPT) with Moxifloxacin (MOX): QT-prolonging agent and has been associated with cardiac arrhythmias, which may be fatal Isoniazid (INH) and Pyrazinamide (PZA)

Answer 407

Rifampin (RIF): Orange body fluids, hepatitis - "remember R = red/orange body fluids" Isoniazid (INH): peripheral neuropathy (give with B6 - pyridoxine 25 to 50 mg/day) Pyrazinamide (PZA): Hyperuricemia (Gout) Ethambutol (EMB): Optic neuritis, red-green blindness - "remember E = eyes"

Answer 408

Naloxone is opiate OD suspected ABC's Thiamine and dextrose

Answer 409

Eye-opening: 4- spontaneous 3- voice 2-pain 1-none

Answer 410

Verbal: 5-oriented 4-confused 3-inappropriate words 2-incomprehensible 1-none

Answer 411

3. Motor: 6-obeys commands 5-localizes pain 4-withdraws 3-abnormal flexion (decorticate) 2-abnormal extension (decerebrate) 1-none

Answer 412

Diabetes (very common due to the destruction of the nerves due to the elevated glucose) Nerve root pathology ( impingement and compression of the nerves) Central pathology (Brain causes such as Multiple Sclerosis, CVAs, etc.) CT/MRI

Answer 413

Unilateral facial nerve paralysis with no other findings Peak in 48 hours with viral prodrome NOT FORHEAD SPARING Keratitis from inability to close eyes

Answer 414

Treatment is prednisone, artificial tears, tape eyelid shut Comments: Bilateral: Lyme disease, infectious mononucleosis

Answer 415

Clinically differentiated from meningitis due to altered brain functioning HSV MC, with CMV MC in immunecompromised Flu-like illness folloed by fever, headahce , seizure, and AMS

Answer 416

lumbar puncture and MRI PCR for viruses Kernig's and Brudzinski’s usually absent

Answer 417

Supportive care and acyclovir 10 mg/kg IV q8hr started promptly Empiric antibiotics are often given until bacterial meningitis is excluded

Answer 418

> or equal to 5 min continuous seizure activity or more than one seizure without recovery from the postictal state in between episodes

Answer 419

Place in left lateral decubitus position Benzo - 1st line Phenytoin - 2nd line Phenobarbitol or lacosamide - 3rd line Watch for resolution of acidosis post

Answer 420

Phenytoin or Carbamazepime May or may not loose consciousness (simple v. complex)

Answer 421

EEG ⇒ brief 3-Hz, spike, and wave discharge Tx: ethosuximide

Answer 422

Tonic-clonic: convulsive (grand mal) – bilaterally symmetric and without focal onset, begins with LOC Tonic phase: very stiff and rigid 10-60 seconds, clonic phase = convulsions, post-ictal phase= confused state Atonic = drop attack ⇒ like syncope; loss of muscle tone Clonic: loss of control of bodily function, jerking, may temporarily lose consciousness Tonic: extreme rigidity then LOC Myoclonic: muscle jerking, no tonic phase, occurs in the morning Febrile: temp >38 C, >6mo, <5 years, absence of CNS infection / inflammation Infantile spasm: type of epilepsy seizure Psychogenic non-epileptic seizure: not due to epilepsy but look similar to an epileptic seizure

Answer 423

Transient loss of consciousness following injury LUCID with headache and one sided weakness MC - Middle meningeal artery bleed

Answer 424

Non-contrast CT showing a lens shape May also see a skull fracture Surgical craniotomy / medical management of increased intracerebral pressure (mannitol, hyperventilate, steroids/ventricular shunt)

Answer 425

Head injury followed by neurological symptoms - often seen in the elderly or in alcoholics with hx of falls

Answer 426

Non-contrast CT scan showing crescent shaped bleed Observe if small Surgery ⇒ burr hole trephination, craniotomy, craniectomy

Answer 427

Loss of pain/temperature below the level of the lesion preserved joint position/vibration

Answer 428

Loss of pain and temperature sensation at the level of the lesion, where spinothalamic fibers cross the cord with other modalities preserved (dissociated sensory loss)

Answer 429

Rostral zone of spared sensory levels (reduced sensation caudally, no sensation in levels below injury); urinary retention and bladder distension

Answer 430

Loss of joint position and vibration sense on the same side as the lesion and pain/temperature on the opposite side a few levels below the lesion

Answer 431

Ascending paralysis after immunization or infection (C. jejune, CMV, EBV)

Answer 432

Lumbar puncture ⇒ elevated CSF protein with normal CSF WBC Tx: plasma exchange (remove circulating antibodies) and IVIG Monitor PFTs for paralysis of chest muscle/diaphragm (respiratory failure) Good prognosis

Answer 433

Mild TBI with potential loss of consciousness less than 30 minutes GCS 13-15 Amnesia, HA, Nausea, vomiting

Answer 434

Use validated clinical decision rules to determine if imaging is warranted - No routine imaging of pediatric patients with mTBI Usually a clinical diagnosis

Answer 435

Step 1: back to regular activities Step 2: light aerobic exercises – walking stationary cycling no resistance training Step 3: sports specific exercise – running or skating drills Step 4: non-contact training drills Step 5: Full contact practice Step 6: Return to sports – normal gameplay

Answer 436

Ischemic: 85% - 2/3 thrombotic, 1/3 embolic Hemorrhagic - 15%

Answer 437

Hemiparesis opposite of side of stroke, Hemisenory deficit,

Answer 438

Associated with hemispheric s/s (aphasia, apraxia, hemiparesis, hemisensory loss, visual field defect)

Answer 439

Coma, drop attack, vertigo, n/v, ataxia

Answer 440

amaurosis fugax

Answer 441

Aphasia, neglect, hemiparesis, gaze preference, homonymous hemianopsia

Answer 442

Leg paresis, hemiplegia, urinary incontinence

Answer 443

Homonymous hemianopsia

Answer 444

Coma, cranial nerve palsies, apnea, drop attack, vertigo

Answer 445

Silent, pure motor or sensory

Answer 446

Non-contrast CT Transcranial doppler US, echo for ischemic stroke

Answer 447

Thrombolysis, IV admin for rtPA for occlusive disease treat with IV tPA within 3-4.5 hours onset Admit to ICU or stroke unit with neuro exams every 15 minutes during infusion, every 60 minutes for the next 6 hours then hours 24 hours after tx/get serial blood pressures

Answer 448

BP closely monitored in first 24 hours; hold antihypertensives until systolic >220 or diastolic >120 with a goal to lower BP by 15% in first 24 hours if tx is indicated BP has to be <185/110 for thrombolytics ⇒ give labetalol 10-20 mg IV over 1-2 min

Answer 449

SAH, Head trauma / prior stroke within 3 mo, MI within 3 mo, GI / gastric ulcer within 3 weeks, Major surgery in 14 days, Hx of intracranial hemorrhage, Elevated BP >185 systolic / 110 diastolic, Active bleeding / acute trauma, INR >1.7 with anticoagulation, Glucose <50, Seizure with postictal state, Multilobar infarction on CT

Answer 450

Excruciating periorbital pain, lateral/temporal Ptosis, miosis, lacrimation, conjunctival injection, rhinorrhea, nasal congestion Occur in clusters 100% oxygen, sumatriptan (prophylaxis: CCBs)

Answer 451

Nausea, photo/phonophobia, aura Pulsating HA Abortive tx – triptans, Dihydroergotamine (DHE), antiemetics, NSAIDs Prophylaxis – beta-blockers, CCBs, TCAs

Answer 452

Worst HA of my life with potential sudden LOC Ruptured berry (saccular) aneurysm accounts for 75% nontraumatic

Answer 453

non-contrast head CT, LP (elevated opening pressure / grossly blood fluid in all 4 tubes May do cerebral angiography

Answer 454

Manage BP Surgical clipping/wrapping of the aneurysm Anticonvulsants for seizure prevention

Answer 455

Usually d/t HTN abrupt onset of a focal neurologic deficit that worsens steadily over 30 to 90 minutes, altered LOC, stupor, coma, HA, vomiting, and signs of increased ICP Dx: CT / MRI Tx: neurosurgery

Answer 456

Saccular aneurysms are almost always the result of hereditary weakness in blood vessels and typically occur within the arteries of the circle of Willis Diagnosis: Magnetic resonance angiography (MRA) or CT angiography (CTA) Treatment: Surgical clipping or endovascular coil

Answer 457

Syncope during exertion, Multiple recurrences in short time, Heart murmur, Old age, Significant injury during syncope, Family history sudden unexpected death

Answer 458

Drugs (ETOH) and toxins Tumors CVAs Genetics B12 deficiency

Answer 459

Sudden onset of neurologic deficit, lasting minutes to <1 h (15-30 min on average), a reversal of symptoms within 24 h 10% will have a stroke within 90 days

Answer 460

CT (without contrast), MRI more sensitive, carotid doppler ultrasound to look for stenosis, CT angiography, MR angiography of neck Carotid endarterectomy if internal or common carotid artery stenosis is > 70%

Answer 461

Aspirin + dipyridamole or clopidogrel monotherapy (antiplatelet therapy) ABCD2score: predicts the likelihood of subsequent stroke within 2 days 30% of those with CVA had TIA; the risk is highest 24 hours after the initial event

Answer 462

Dementia (Alzheimer's) Delirium (withdrawal or infection) Amnesia (head injury, CVA, etc.)

Answer 463

Irreversible causes: vascular dementia, Creutzfeldt-Jakob Reversible: depression, B12 deficiency, syphilis, hypothyroidism, NPH, drug use, intracranial mass

Answer 464

Tx: cholinesterase inhibitors (donepezil); NMDA antagonists (memantine) à don’t cure, just slow progression

Answer 465

Positional, no hearing loss, tinnitus, ataxia, dx: Dix-Hallpike test; tx: Epley maneuvers, meclizine

Answer 466

Not positional, no hearing loss/tinnitus, tx: meclizine

Answer 467

Acute, self-resolving episode; vertigo, hearing loss tinnitus, tx: meclizine + steroids

Answer 468

Chronic, relapsing, remitting; vertigo + hearing loss + tinnitus; tx: diuretics, salt restriction, CN VIII ablation for severe cases

Answer 469

A history of trauma; vertigo from trauma; tx: fix damage surgically

Answer 470

Ataxia, neurofibromatosis type II, MRI findings: vertigo, hearing loss, tinnitus, and ataxia; tx = surgery

Answer 471

fever > 38 C, nuchal rigidity (stiff neck), headache NO AMS

Answer 472

Aseptic: usually viral; negative blood cultures Bacterial: community-acquired, usually s. pneumonia (gram + cocci)/n. meningitidis (gram - diplococci) – likely if pt has a rash Neonates = e. coli / s. agalactiae >50-60 = listeria / cryptococcus neoformans Hospital-acquired: staph / aerobic gram-negative

Answer 473

LP AFTER checking for increased intercranial pressure via CT scan (papilledema is clue for increased ICP)

Answer 474

Aseptic: symptomatic or IV acyclovir for HSV Bacterial: dexamethasone + empiric IV antibiotics (cephalosporin, Vanco, penicillins) Household contacts: treat with rifampin, Cipro, Levaquin, azithromycin, ceftriaxone

Emergency Medicine EOR Exam Cards Flashcards

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