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Emergency Medicine > Emergency Medicine Exam 3 > Flashcards

Emergency Medicine Exam 3 Flashcards

1
Q

Erysipelas organism

A

Strep

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2
Q

Cellculitis organism

A

Staph

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3
Q

Erysipelas v. Cellulitis presentation

A

Both warm to touch - erysipelas has more well defined borders

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4
Q

Eval for Cellulitis or erysipelas

A

Only need labs if there are systemic symptoms, immune suppressed, failed outpatient therapy

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5
Q

Workup with concern for abcess

A

Use a bedside US

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6
Q

Outpatient management for erysipelas/cellulitis

A

No RF for MRSA keflex, ALT: clinda
MRSA risk: Bactrim, Doxy, Clinda

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7
Q

When to return for cellulitis/erysipelas

A

Follow up with PCP in 2-3 days
ED if expands, or septic, abcess

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8
Q

Inpatient management for cellulitis/erysipelas

A

If meets sepsis criteria or systemic toxicity
Rocephin, Cefzolin, or Clinda IV for MSSA
MRSA risk -Vanc or Daptomycin

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9
Q

3 MRSA risk factor groups

A

Recent major or invasive healthcare interaction (surgery, hospitalization, dialysis, nursing home)
IV drug or Abx use
Close quarters - military, prison, sports

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10
Q

Presentation of cutaneous abcess

A

Fluctuant, tender, painful nodule - softens over time
May start draining on its own - rupture
Systemic symptoms are rare

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11
Q

Dx for abcess

A

US for pus
XR for foreign body

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12
Q

Management of abcess

A

I&D with anesthesia around the wound lidocaine with epi
Culture of pus
Irrigate and pack with iodoform packing - one long piece

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13
Q

Abx prophylaxis for abcess

A

Clinda or Vanc 30-60 minutes before

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14
Q

4 Risk factors for endocarditis to consider before I&D of abcess

A

Prosthetic valves
Previous endocarditis
Congenital heart isease
Cardiac transplant with regurg

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15
Q

Abx management for abcess tx

A

Mild may not need abx
Bactrim, doxy, or clinda PO for moderate
IV Vanc, linezolid, or clinda for severe

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16
Q

5 Indications for abcess abx (usually we just give anyways)

A

Lesion over 2cm
Multiple abcesses
Extensive surrounding cellulitis
Immune suppression
Signs of systemic illness

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17
Q

Abx we add for severe abcess tx if septic

A

Meropenem OR Zosyn (pip and taz)

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18
Q

Presentation of DVT

A

Unilateral swelling, pain, cramping, red, warmth
Homans sign

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19
Q

Measuring for DVT

A

Diffierence over 2cm in diameter in indicative

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20
Q

Phlegmasia alba/cerula dolens

A

Large proximal DVT extending proximally - emergent

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21
Q

8 Wells criteria

A

Active cancer
Paralysis
Bedridden
Localized tenderness
Swollen leg
Calf swelling unilateral
Pitting edema Unilateral
Collateral superficial veins
Prev hx
1 point each!

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22
Q

Wells interpretation

A

0 or less - D dimer
1-2 high sensitivity d dimer
3+ US

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23
Q

Management of DVT

A

Step 1 - Determine distal or proximal (larger than distal)
Step 2 - Determine risk of bleeding
Step 3 - Determine a treatment plan

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24
Q

of risk factors for moderate risk of bleeding

A

1 risk factor

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25
Q

Management of proximal DVT without limb ischemia and with high bleeding risk

A

IVC filter

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26
Q

Management for proximal DVT without ischemia with mild/moderate bleed risk

A

DOAC - preferred
LMHW - ALT

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27
Q

Management of DVT with ischemia and high bleed risk

A

Surgical thrombectomy with IVC filter

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28
Q

Management for proximal DVT with ischemia and moderate/low risk

A

Catheter directed thrombolysis - followed by anticoagulant

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29
Q

Management for distal DVT patient with high bleed risk

A

IVC filter placement

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30
Q

Management for symptomatic distal DVT with Low/Moderate bleed risk

A

DOAC - preferred
LMWH - ALT

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31
Q

Management for asymptomatic distal DVT with Low/moderate bleed risk

A

Treat as symptomatic if extension suspected
Serial US for 2-4 weeks if extension not suspected

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32
Q

Admission criteria for DVT - 4

A

Proximal DVT
PE symptoms
High risk of bleeding
Comirbidities

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33
Q

Discharge criteria for a DVT - 3

A

Hemodynamically stable
Non renal insufficiency
No social concerns

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34
Q

Presentation of arterial limb ischemia - chronic

A

Classic claudication - only in 30% of patients
Atypical leg pain (at rest
Chronic non-healing wounds
Hair loss and muscle atrophy

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35
Q

Presentation of acute arterial oclusion

A

Sudden onset of severe constant pain
6 Ps. -Pallor, Pulseless, Paresthesia, Poikilothermia, Paralysis, Pain

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36
Q

Progession of arterial limb ischemia skin changes

A

Skin Pallor then Mottling/Cyanosis then Petechiae/Blisters then Necrosis

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37
Q

Diagnostics for arterial limb ischemia

A

Bedside doppler followed by ABI if flow is present
Doppler US for extent of occlusion
CTA/MRA may also be ordered

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38
Q

Management for rutherford I or IIa arterial limb ischemia

A

Get CT or MRA or US to determine level of severity

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39
Q

Management for rutherford stage IIb arterial limb ischemia

A

Immediate surgical consult for attempted revascularization

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40
Q

Management for stage III arterial limb ischemia

A

Amputation usually indicated

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41
Q

Pharm for arterial limb ischemia

A

Use UFH while waiting for surgery
Pain medication

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42
Q

6 things that go into rutherford score

A

Pain
Cap refill
Motor deficit
Sensory deficit
Venous doppler
Arterial doppler

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43
Q

Presentation of testicular torsion

A

Consider in abdominal pain complaints
Sudden onset - exercise, etc.
Severe and unilateral pain
N/V
Position has no effect

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44
Q

PE for testicular torsion

A

Transvere testicle
Absent cremasteric reflex
Anterior Epididymis
Firm and tender testicle

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45
Q

Bell clapper deformity

A

Positional deformity of testicle - RF for torsion

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46
Q

Dx for testicular torsion

A

Color flow duplex US of scrotum
May see pyuria on UA

47
Q

Treatment for testicular torsion

A

Refer to urology
Goal to detorse in 6 hours - amputate after
Medial to lateral detorsion manually - 360 degree rotation

48
Q

Testicular appendage torsion

A

Pain with blue dot sign - non emergent
US to r/o TT
Pain medicine and rest

49
Q

Epididymitis and Orchitis pathogenesis

A

Think mumps with orchitis if unvaccinated
Think syphillis if vaccinated
Think STI under 35, Think E coli/Klebsiella over 35

50
Q

Presentation of epididymitis and orchitis

A

Gradual onset of unilateral testicular pain
Affected testes hangs lower
Normal cremasteric reflex
Pain relieved by elevation (Prehn’s +)

51
Q

Dx for Epididymitis/Orchitis

A

UA with C&S
Catch very first bit of urine
PCR or DNA for GC or chlamydia

52
Q

Tx for orchitis/epididymitis - 4 cases

A

Levaquin for E coli
Rocephin - GC
Doxy - for chlamydia
Rocephin and levofloxacin for anal intercourse

53
Q

Presentation of scrotal abcess

A

Superficial and intrascrotal are possible
Unilateral scrotal pain and swelling
Penile discharge

54
Q

Dx for scrotal abcess

A

US to determine superficial or deep

55
Q

Management for superficial scrotal abcess

A

I&D at bedside and discharge
Sitz bath

56
Q

Management for intrascrotal (deep) abcess

A

Don’t I&D
Urology consult for surgery
Zosyn for immune compromised

57
Q

Fourniers gangrene

A

Necrotizing fasciitis of perineal genital or perianal anatomy
MC in females
Polymicrobial
Deadly

58
Q

Presentation/Progression of fournier’s gangrene

A

Pain out of proportion followed by
Prodromal fever and lethargy
Intense genital edema and erythema
Dusky appearance gangrene then frank necrosis

59
Q

Dx for fournier’s gangrene

A

Look for air on a CT scan with contrast

60
Q

Management of fournier’s gangrene

A

Aggressive IV fluids
NPO
IV Zosyn
Opiate
Septic workup

61
Q

Presentation of balanoposthitis

A

Hx of lack of hygeine
Purulent glans with foul odor
Satellite lesions for candida

62
Q

Management of fungal balanoposthitis

A

Clinical dx
Topical nystatin/clotrimazole
PO fluconazole for severe

63
Q

Management of bacterial balanoposthitis

A

Bacitracin or Mupirocin for mild - topical
PO Clinda or Flagyl for severe

64
Q

When to swab for balanoposthitis

A

Recurrent - may consider circumcision

65
Q

Management for paraphimosis - 3 options

A

Dorsal block of the penis
Compress the glans for 5-10 minutes to reduce
Needle aspiration via small puncture wounds if that fails
Dorsal slit last restort

66
Q

Management of phimosis

A

Emergency if can’t pee
Topical lidocaine with stretching to releive urinary retention
May do dorsal slit if needed

67
Q

Presentation of priapism

A

Painful erection lasting over 4 hours at which point tissue damage occures
Irreversible damage after 24 hours

68
Q

Ischemic priapism

A

Low flow - blood can’t get out
Often an underlying condition
Low O2 high CO2

69
Q

Non-ischmic priapism

A

Fistula from artery to vein
Non-painful
Normal ABG

70
Q

Management of priapism

A

Dorsal block of penis
Two needles to aspirate corpora cavernosa - saline then pull
Phenylephrine ONLY in ischemic to cause vasoconstriction

71
Q

2 diseases to think about for priapsim in a preadolescent

A

Sickle cell
ALL

72
Q

Management of penile entrapment

A

Cooling/Compression followed by string technique or 18G needle aspiration
May also cut or surgically remove
Retrograde urethrogram afterwards and doppler US for blood supply

73
Q

Presentation of penile fracture

A

Blunt trauma, snap and flaccid penis that becomes ecchymotic

74
Q

Management of penile fracture

A

Urgent urologic consult
Preoperative retrograde urethrogram
Analgesics and antipyretics

75
Q

Urethral foreign boies

A

Dx with an XR
Do not try to pull out
Consult Urology
Pain control

76
Q

Urethral stricture presentation

A

Decrease in stream with spraying or unable to peeMa

77
Q

Management of urethral stricture

A

Foley catheter insertion, suprapubic catherter if that does not work

78
Q

Workup for urinary retention

A

Look for signs of stricture
Prostate exam
Neuro exam
GU and Pelvic exam

79
Q

Best dx for urinary retention

A

Post void residual - stuff left over is indicative

80
Q

Management for urinary retention

A

12-14G Foley catheter
Urgent consult if unable to pass
Irrigate with 3 port catheter if hematuria

81
Q

Complications of urinary retention

A

Post obstructive diuresis - will develop electrolyte abnormalities, observe and admit if they have more than 200cc per hour after therapy

82
Q

F/u for urinary retention

A

Admit if renal failure or post obstructive diuresis
All others follow up in 3-7 days

83
Q

Confusion, Delerium, Dementia

A

Confusion - Alters from societal norms
Delerium - Acute change in mental ststus
Dementia - Chronic change in mental status

84
Q

Alertness

A

Reponsive - can maintain arousal independantly

85
Q

Lethargic

A

Fall asleep without verbal stimulus - can stay awake

86
Q

Obtundation

A

Need physical (non painful) stimulus to be aroused

87
Q

Stuporous

A

Need painful stimuli to be aroused

88
Q

Lab to consider for hypoxic patients

A

ABG

89
Q

IV access for AMS patients

A

2 large bore IVs for all patients

90
Q

3 meds safe in all patients

A

Naloxone, Thiamine, Glucose

91
Q

Giving thiamine and glucose

A

Give thiamine before glucose

92
Q

GCS eye responses

A

Open spontaneously - 4
Open to verbal command - 3
Open to pain - 2
Do not open - 1

93
Q

GCS Verbal responses

A

Oriented - 5
Confused conversation - 4
Inapropriate but words - 3
Incomprehensible sounds - 2
No verbal response - 1

94
Q

GCS Motor responses

A

Obeys commands - 6
Purposeful movement to pain - 5
Withdrawal from pain - 4
Decorticate - 3
Decerebrate - 2
No motor response - 1

95
Q

Six item screen for mental status

A

3 item memory
Day of week, Month, Year

96
Q

Indications for a lumbar puncture

A

Suspicion of meningitis

Suspicion of subarachnoid hemorrhage (SAH)

Suspicion of nervous system diseases such as Guillain-Barré syndrome [6] and carcinomatous meningitis

Therapeutic relief of pseudotumor cerebri

97
Q

Absolute CI to lumbar puncture

A

Midline shift - increased ICP

98
Q

Management of delerium

A

Lower doses in older adults
Haldol - QT prolongation and extrapyramidal
Lorazepam - Respiratory depression

99
Q

Observation for narcotic overdose

A

Observe for 1-1.5 hours before discharge - Narcan will wear off

100
Q

Hypoglycemia in children

A

Under 45 with symptoms
Under 35 without symptoms

101
Q

Management of hypoglycemia in children

A

Give oral sugar then IV

102
Q

Neonate dextrose dose

A

D10W over 3-5 minutes

103
Q

Infants and older children dextrose dose

A

D25W over 3-5 minutes

104
Q

Disposition of children given IV dextrose

A

Admit all

105
Q

Management of hypoglycemia in adults

A

D50W over 3-5 minutes
Continuous infusion to maintain over 100mg/dL may be needed
IM glucagon if no IV

106
Q

Management for refractory hypoglycemia due to sulfonylureas

A

Octreotide

107
Q

Hypoglycemia in adults with insulin pump

A

DO NOT remove insulin pump
Refer

108
Q

Adults to admit for hypoglycemia

A

Related to long acting agents: Sulfonylureas, long acting insulin, Meglitinides

109
Q

5 Actions of insulin

A

Glucose into cells
Potassium into cells
Anabolic environment
Inhibits breakdown of fat
Blocks breakdown of proteins

110
Q

6 causes of DKA - 6 I’s

A

Infection
Infarction
Insult
Infant - Pregnant
Indiscretion
Insulin - Not taking

111
Q

Presentation of DKA - 3 main umbrellas

A

Hyperglycemia - Polydipsia, Polyuria
Volume Depletion - Orthostasis, Hypotension
Acidosis - Tachypnea, Fruity breath

112
Q

Diagnostic criteria for DKA

A

Glucose over 250
Anion gap over 10-12
Bicarb under 15
pH under 7.3

113
Q

Management of DKA - Step 1

A

Emergency Medicine (5 decks)

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