Emergency Medicine2 Flashcards
(200 cards)
1
Q
Q200. bilateral facet dislocation…? stable?
A
A200. flexion injury; subluxation of the dislocated vertebra; very unstable
2
Q
Q201. Cullen’s sign? Gray-Turner’s sign?
A
A201. ecchymosis of the abdomen signifies late retroperitoneal hemorrhage; Gray-Turner’s: same, but of the flanks
3
Q
Q202. 12% of patients with hyperthyroidism will suffer…?
A
A202. Pathologic fracture
4
Q
Q203. serious associated injuries are present in up to 95% of patients with a dislocated…?
A
A203. hip
5
Q
Q204. a pt with a posterior hip dislocation holds the hip how?
A
A204. flexed, adducted, and internally rotated
6
Q
Q205. most common ortho injury seen in the ED?
A
A205. knee - in particular, MCL (medial collateral ligament)
7
Q
Q206. 50% of patients with ACL injury have a concomitant…?
A
A206. Meniscal tear
8
Q
Q207. lachman’s test?
A
A207. flex the knee to 30 degrees and pull anteriorly on the tibia
9
Q
Q208. donahue’s unhappy triad?
A
A208. ACL, MCL, and medial meniscus tear
10
Q
Q209. Injury to the ________ occurs in 50% of knee dislocations…
A
A209. popliteal artery
11
Q
Q210. injury to the tibial nerve causes…?
A
A210. inability to stand on tiptoes
12
Q
Q211. which ankle fracture warrants a careful radiologic examination? of what specifically?
A
A211. medial malleolar fracture; proximal shaft of the fibula (Maisoneuve fracture)
13
Q
Q212. 10% of calcaneal fractures are associated with…?
A
A212. lumbar fractures
14
Q
Q213. when do you call for an ortho consult?
A
A213. compartment syndrome; irreducible fractures; circulatory compromise; open fracture; anything that requires surgery
15
Q
Q214. what is the most frequent complication of orotracheal intubation?
A
A214. Right main stem bronchus intubation
16
Q
Q215. Patients with COPD, asthma, or CHF that are awake but cannot remain in the supine position may be intubated how…?
A
A215. Nasotracheal intubation
17
Q
Q216. Most serious complication of nasotracheal intubation?
A
A216. Intracranial passage of the tube
18
Q
Q217. advance airway adjuncts?
A
A217. fiberoptic intubation; retrograde intubation; combitube; laryngeal mask airway
19
Q
Q218. What is the preferred surgical airway for kids? Adults?
A
A218. Kids - needle cricothyroidotomy; Adults - surgical cricothyroidotomy
20
Q
Q219. if an airway will be needed for greater than 2-3 days, a surgical cricothyoidotomy should be converted to…?
A
A219. a tracheostomy
21
Q
Q220. slit lamp exam consists of…?
A
A220. evaluate the integrity of the cornea, conjunctiva, and the anterior chamber; fluorescein to light up corneal defects
22
Q
Q221. central retinal artery occlusion occurs in which people?
A
A221. men in their 60s
23
Q
Q222. fundoscopic exam in central retinal artery occlusion?
A
A222. pale retina with cherry red fovea
24
Q
Q223. what is amaurosis fugax?
A
A223. type of TIA - sudden vision loss (Shade over eye), transient, due to carotid-origin embolic shower
25
Q224. classic triad of optic neuritis?
A224. marcus gunn pupil; central vision loss; red vision desaturation
26
Q225. flashing lights, spider webs, or floaters that interfere with vision may be a sign of...? what meds should NOT be given?
A225. retinal detachment; DON'T anticoagulate
27
Q226. painful red eye - most often due to which things?
A226. conjunctivitis, corneal abrasion, or foreign body
28
Q227. which conjunctivitis produces copious DC?
A227. gonorrhea
29
Q228. punctuate lesions in conjunctivitis?
A228. viral cause
30
Q229. treatment of conjunctivitis?
A229. broad spectrum antibiotics, pain meds
31
Q230. soft contact wearers are especially prone to infection by.?
A230. pseudomonas
32
Q231. severe unilateral eye pain, decreased visual acuity and photophobia...?
A231. iritis
33
Q232. treatment of iritis?
A232. cycloplegic such as homatropine(not a mydratic)
34
Q233. severe unilateral HA, eye pain, N/V assoc with loss of vision....?
A233. narrow angle glaucoma
35
Q234. which drugs decrease aqueous production?
A234. acetazolomide and topical b blockers
36
Q235. which chemicals causes coag necrosis? liquefaction necrosis?
A235. acids; alkali
37
Q236. treatment of chemical burn...
A236. IRRIGATE
38
Q237. what's hyphema?
A237. blurred vision after blunt trauma (dull eye pain)... bleeding
39
Q238. basic approach to all toxicity patients in the ED?
A238. ABCs; Decontamination; Elimination; Antidotes
40
Q239. key things on physical exam for toxicity exposures....?
A239. Vital signs; pupils; toxidromes; autonomic signs; motor signs; mental status; skin
41
Q240. describe anticholinergic toxidrome?
A240. "mad as a hatter, dry as a bone, red as a beet, hot as a stove." Also - decreased GI motility, urinary retention, mydriasis.
42
Q241. describe muscarinic toxidrome?
A241. DUMBELLS
43
Q242. narcotic toxidrome?
A242. respiratory depression,; hypotension,; depressed sensorium, miosis
44
Q243. sympathomimetic toxidrome? compare with anticholinergic toxidrome?
A243. very similar except sympathomimetic involves diaphoresis
45
Q244. withdrawal toxidrome?
A244. agitation,; hallucination,; mydriasis,; diarrhea,; cramps,; lacrimation,; tachycardia,; insomnia,; seizures
46
Q245. major toxic effect of acetaminophen?
A245. metabolite NAPQI causes centrilobular hepatocellular damage
47
Q246. treatment of acetaminophen toxicity?
A246. 4 hour level on rumack-matthew nomogram,; activated charcoal,; N-acetyl-cysteine (to regenerate glutathione)
48
Q247. methanol toxicity?
A247. formic acid metabolite - causing a gap acidosis and direct optic nerve toxicity
49
Q248. treatment of ethylene glycol toxicity?
A248. 4MP or EtOH
50
Q249. which drugs can cause anticholinergic syndromes? tx?
A249. antihistamines, antipsychotics, TCAs... treatment - physostigmine
51
Q250. symptoms of calcium channel blocker toxicity? tx?
A250. bradycardia and hypotension; treatment - CaCl2, glucagon, epinephrine, DA
52
Q251. CO toxicity symptoms
A251. HA,; N/V,; flu-like symptoms,; CNS depression,; tachy,; hypotension
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Q252. treatment of CO toxicity?
A252. 100% O2
54
Q253. GHB?
A253. date rape drug - euphoric and amnestic effects
55
Q254. refractory seizures could be caused by what toxicity?
A254. INH
56
Q255. Organophosphates can cause which toxidrome?
A255. muscarinic
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Q256. naloxone?
A256. opioid antagonist
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Q257. standard of care for salicylate poisoning?
A257. activated charcoal; also consider alkalinization of urine and blood with bicarb
59
Q258. benzo receptor antagonist that can rapidly reverse coma from benzo OD...? what's the problem with this drug/
A258. flumazenil; can lower the seizure threshold in pts with TCA OD and induce benzo withdrawal
60
Q259. loxosceles bites can be treated with...?
A259. dapsone
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Q260. signs and symptoms of TCA OD?
A260. anticholinergic sx,; cardiac dysfunction,; intractable seizures,; and hyperthermia
62
Q261. treatment of TCA toxicity?
A261. decontamination with MDAC; Sodium bicarb administration; Benzos for seizure management; Alpha agonists for hypotension
63
Q262. prerenal failure due to..?
A262. decreased renal perfusion; (volume depletion, low CO, abnormal renal hemodynamics)
64
Q263. most common cause of intrinsic renal failure?
A263. longstanding HTN
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Q264. majority of hospital-assoc episodes of ARF are caused by...?
A264. ATN
66
Q265. postrenal failure caused by?
A265. obstructive uropathy
67
Q266. FENA <1 in which condition?
A266. Prerenal failure
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Q267. Urine Na <20 in which condition?
A267. Prerenal failure
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Q268. treatment of prerenal failure?
A268. volume replacement, d/c offending meds
70
Q269. intrinsic RF treatment?
A269. monitor fluid status,; restrict protein,; correct electrolyte abnormalities
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Q270. dispo for patients with ARF?
A270. admit
72
Q271. what drugs can cause ARF in pts with renal artery stenosis?
A271. ACE inhibitors
73
Q272. #1 cause of death in 1-44 year olds?
A272. Trauma (specifically, MVCs)
74
Q273. Preparation for a trauma case includes?
A273. History from EMTs; Prep the trauma bay; Airway box; O2 and suction; IVF and supplies
75
Q274. Indications for intubation?
A274. GCS <8; Inadequate breathing; Unable to protect airway
76
Q275. Chin lift is contraindicated if...?
A275. A C-spine injury is suspected
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Q276. Radial pulse should have a BP of at least...? Femoral?
A276. 80 mmHg; 70
78
Q277. what % of ECF is plasma?
A277. 40181
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Q278. which drug is an ineffective pressor in hypovolemic patients?
A278. dopamine
80
Q279. GCS consists of which 3 categories?
A279. eye opening,; verbal response,; moto response
81
Q280. most rapid means to lower ICP?; what other method?
A280. Hyperventilation; mannitol
82
Q281. volume of blood in an adult?
A281. 5 L (7% of ideal body weight)
83
Q282. physiologic response to acute hypovolemia?
A282. In order:; Tachycardia; narrowed pulse pressure (increased diastolic press); slowing of cap refill; decreased systolic pressure
84
Q283. raccon eyes, and battle sign?
A283. late findings in basilar skull fractures
85
Q284. assessment of C-spine in trauma?
A284. posterior midline - any tenderness?; focal neuro deficit?; A&O; evidence of intoxification?; any painful injury that may distract the pt?
86
Q285. FAST?
A285. quick, non-invasive method of examining the abdomen and pericardium for blood
87
Q286. how to check for pelvic fracture?
A286. press down and in on both iliac crests simultaneously
88
Q287. urine myoglobin can be elevated secondary to...?
A287. massive muscle breakdown (rhabdo)
89
Q288. treatment of rhabdo?
A288. IVF,; sodium bicarb,; and mannitol
90
Q289. calculate cerebral perfusion pressure?
A289. MAP - ICP
91
Q290. Cushing's reflex? sign of?
A290. HTN, bradycardia, hypopnea; sign of increased ICP
92
Q291. in traumatic head injury, what is the target MAP?
A291. 90mmHg
93
Q292. intubation considerations for elevated ICP?
A292. intubate early but WITHOUT ketamine
94
Q293. seizure prophylaxis with head bleeds?
A293. dilantin
95
Q294. how does cardiac tamponade present? findings?
A294. hypotension, muffled heart sounds, JVD, and pulsus paradoxus; electrical alternans on ECG; may present with pulseless electrical activity
96
Q295. which condition can lead to hypotension, absent breath sounds, hyperresonance, distended neck veins, and high airway pressures?
A295. tension pneumothorax
97
Q296. hypoxia occurs if an open pneumothorax is greater than?
A296. 2/3 trachea diameter
98
Q297. flail chest?
A297. 3 or more rib fractures in 2 or more sites with paradoxical motion of chest wall with inspiration
99
Q298. how to demonstrate fluid in the pericardium in tamponade?
A298. echocardiogram, or ED U/S
100
Q299. treatment of tension pneumothorax?
A299. angiocath in the 2nd intercostals space in the mid-clavicular line; chest tube if hemorrhagic or simple pneumothorax suspected
101
Q300. treatment of cardiac tamponade?
A300. subxyphoid pericardiocentesis
102
Q301. splenic injury can cause pain referred to...? eponym?
A301. left shoulder...Kehr's sign
103
Q302. which chief complaints warrant a stat EKG?
A302. chest pain/pressure/discomfort; SOB; hypotension; weakness/dizziness; syncope; abdominal pain especially in elderly; palpitations; N/V especially in elderly, diabetics
104
Q303. shortened PR interval suggests?
A303. alternate, abnormal conduction pathway like WPW syndrome
105
Q304. elongated PR interval suggests?
A304. some form of AV block
106
Q305. quick and dirty way of determining the axis of the heart?
A305. leads I and aVF... both up - normal; aVF down - LAD; I down - RAD; both down - RAD
107
Q306. DDx of U waves?
A306. hypokalemia; hypercalcemia; meds (digoxin, quinidine); thyrotoxicosis
108
Q307. Describe possible characteristics of an unstable cardiac patient?
A307. Pulseless; Hypotension; AMS; Ischemic chest pain; CHF
109
Q308. treatment basics for unstable cardiac patients?
A308. cardioversion (synch or un-synch) per ACLS protocol, then IV meds or other therapy
110
Q309. treatment of sinus tachycardia?
A309. treatment the UNDERLYING CAUSE
111
Q310. how can you tell there's paroxysmal supraventricular tachycardia? tx?
A310. abnormal/absent P waves; Tx: unstable --> synch cardioversion; stable --> AV node blockade via adenosis, calcium channel blockers (diltiazem, verapamil), b-blockers, manuevers
112
Q311. treatment of a fib?
A311. unstable --> synch cardioversion; stable w/ rapid vent. response --> AV blockade: calcium channel blockers, b blockers, digoxin; anticoagulation
113
Q312. pts with pre-excitation syndromes - be careful not to...?
A312. block the AV node by conventional meds
114
Q313. premature ventricular contractions, etiology?
A313. 4 H's - hypokalemia, hypomagnesemia, hypoxia, hyperthyroidism; drugs; heart disease
115
Q314. what is trigeminy?
A314. every 3rd beat is a PVC
116
Q315. treatment of PVCs?
A315. iv lidocaine or amiodarone; iv magnesium sulfate; procainamide
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Q316. treatment of pulseless v tach?
A316. immediate UNSYCNHED cardioversion
118
Q317. treatment for unstable v tach?
A317. synchronized cardioversion, then amiodarone or lidocaine drip
119
Q318. treatment for stable v tach?
A318. medical cardioversion with lidocaine, amiodarone, adenosine, or procainamide
120
Q319. etiology of torsades?
A319. ischemic heart disease; MI; hypo-electrolyte states
121
Q320. treatment of stable torsades?
A320. electrical overdrive pacing; also consider Mg sulfate
122
Q321. treatment of Vfib?
A321. unsynchronized cardioversion,; ACLS protocols,; and correction of lytes abnormalities
123
Q322. pulseless electrical activity etiology?
A322. MATCH4ED; MI; Acidosis; Tension pneumo; Cardiac tamponade; H4- hypothermia, hyperkalemia, hypoxia, hypovolemia; Embolism (pulm); Drug OD
124
Q323. treatment of ventricular asystole?
A323. IVF, epinephrine, atropine; Transvenous pacing
125
Q324. for Mobitz II 2nd degree AV block, what tx? What won't work?
A324. transcutaneous or transvenous pacing; Admit for implantable pacemakers; Atropine won't work
126
Q325. treatment for 3rd degree AV block?
A325. immediate temporary pacemaker
127
Q326. you should consider a new LBBB to be _______ until proven otherwise?
A326. acute MI
128
Q327. Indications for temporary cardiac pacing?
A327. hemodynamically unstable bradycardia; bradycardia that fails to respond to tx; refractory tachycardia dysrhythmias; early bradyasystolic arrest
129
Q328. how does digoxin cause toxicity?
A328. blockade of the NaKATPase; increased vagal tone and increased AV nodal blockade
130
Q329. EKG signs of WPW?
A329. short PR interval; Delta wave; wide QRS; adult tachycardia
131
Q330. EKG signs of hypokalemia?
A330. more prominent U waves; flattened t waves
132
Q331. EKG signs of hyperkalemia?
A331. hyperacute T waves; wide QRS that eventually blends with the T wave to form a sine wave appearance
133
Q332. EKG signs of hypocalcemia?
A332. prolonged QT; terminal T wave inversion
134
Q333. EKG signs of hypercalcemia?
A333. shortened QT interval
135
Q334. associated symptoms of ACS?
A334. dyspnea, diaphoresis, nausea, lightheadedness, or sense of weakness
136
Q335. define stable angina?
A335. symptoms precipitated by exertion and relieved by rest or nitroglycerin
137
Q336. define unstable angina?
A336. Exertional angina of recent onset; angina of worsening character; angina at rest
138
Q337. describe myoglobin as a cardiac marker?
A337. elevated as early as one hour and peaks at 4-12 hours; nonspecific
139
Q338. describe CKMB as a cardiac marker?
A338. rises in 3-4 hours, peaks at 12-24 hours; can be elevated in skeletal muscle injury
140
Q339. describe troponin as a cardiac marker?
A339. rises in 3-6 hours, peaks 12-24 hours; most specific and sensitive
141
Q340. acute MI tx?
A340. MOAN B H; morphine; oxygen; aspirin; nitroglycerin; beta blockade; heparin
142
Q341. in pump failure.. which pressors for hypotension in a volume unresponsive patient..?
A341. sbp 80-100 - dobutamine; sbp 70-80 - dopamine; sbp <70 - levophed
143
Q342. pericarditis - presentation?; pain is worsened by..?
A342. sharp stabbing precordial or retrosternal chest pain... pain worsened by inspiration or lying flat
144
Q343. associated symptoms of pericarditis?
A343. low grade fever; dyspnea; dysphagia; tachycardia
145
Q344. test of choice for detection and f/u of pericarditis?
A344. echo
146
Q345. treatment for pericarditis
A345. NSAIDs for 1-3 weeks
147
Q346. aortic dissections typically occur in what group?
A346. uncontrolled hypertensive males ages 50-70
148
Q347. physical findings in aortic dissection?
A347. asymmetric pulses with BP differences between extremities; very hypertensive; severe distress; JVD; palpable pulsatile mass or tenderness
149
Q348. chest tube required for what size pneumothorax?
A348. >15%
150
Q349. Nitro's relief of cardiac vs esophageal pain?
A349. Cardiac w/in 5 minutes, esophageal w/in 10 minutes
151
Q350. life threatening etiologies of abdominal pain...?
A350. ruptured AAA,; perforated viscous,; intestinal obstruction,; ectopic pregnancy,; mesenteric ischemia,; appendicitis,; and MI
152
Q351. INITIAL TEST OF CHOICE FOR BILIARY TRACT DISEASE, AAA, ectopic, or free peritoneal fluid?
A351. US
153
Q352. Plain films can rule out which abdominal emergencies?
A352. Perforation or obstruction
154
Q353. Colicky pain usually responds to which drugs? Specifically...?
A353. NSAIDs,; esp IV Ketorolac
155
Q354. Triad of pain, hypotension, and a pulsatile abdominal mass...?
A354. AAA
156
Q355. _______ is virtually 100% sensitive in detecting AAAs?
A355. US
157
Q356. What is usually the primary inciting factor of appendicitis?
A356. Obstruction of the appendix usually by an appendicolith
158
Q357. risk factors for cholecystitis?
A357. fat, forty, and female
159
Q358. radiation of pain in acute cholecystitis?
A358. tip of the right scapula
160
Q359. most useful test if suspicious of cholecystitis?
A359. US of RUQ
161
Q360. which agents should not be used in acute gastroenteritis?
A360. anti-motility agents (Imodium) because it diminishes diarrheal excretion of organisms
162
Q361. Presentation of patients with acute hepatitis?
A361. Jaundice,; dark urine/light stools,; hepatomegaly,; fatigue, malaise,; RUQ pain,; N/V,; and fever
163
Q362. coagulation should be normalized with FFP in which condition?
A362. hepatitis
164
Q363. presentation of acute mesenteric ischemia?
A363. severe, poorly localized colicky abdominal pain associated with recurrent forceful bowel movements; classic - abdominal pain out of proportion to the minimal physical exam findings
165
Q364. Most useful test to diagnose acute mesenteric ischemia?
A364. Angiography
166
Q365. Midepigastric abdominal pain usually associated with N/V?
A365. Acute pancreatitis
167
Q366. An amylase raised _______ times the upper limit of normal is 98% specific to acute pancreatitis...
A366. 1.5
168
Q367. All patients with acute pancreatitis should be....
A367. admitted and made NPO
169
Q368. good narcotic choice for pain in acute pancreatitis
A368. Meperidine (better than morphine)
170
Q369. fever, abdominal pain, and rebound tenderness...?
A369. Peritonitis
171
Q370. Small bowel obstruction is caused by ________ more than 50% of the time...?
A370. postoperative adhesions
172
Q371. Most significant complications of small bowel obstruction?
A371. Strangulation and bowel infarction
173
Q372. etiology of bronchitis?
A372. viruses (influenza, adenovirus, etc.); Mycoplasma; Chlamydia; Bordetella pertussis
174
Q373. Virchow's triad of the pathophysiology behind PE?
A373. Venostasis; Hypercoagulability; Vessel wall damage/inflammation
175
Q374. Classic triad of PE presentation?
A374. Hemoptysis; Dyspnea; chest pain
176
Q375. EKG findings in PE?
A375. S1; Q3; inverted T3
177
Q376. golden standard for diagnosing PE?
A376. pulmonary angiography
178
Q377. ED treatment of CHF?
A377. diuretics; nitrates; anlgesics; intubation or CPAP if no improvement
179
Q378. treatment of COPD in the ED?
A378. ABCs monitoring; albuterol neb; glucocorticoids; MgSO4 in severe exacerbations; antibiotics (empiric broad spectrum)
180
Q379. ED eval of asthma?
A379. Monitors, O2, pulse ox; Peak expiratory flow rate; CXR - to rule out pneumonia
181
Q380. signs of hyperventilation syndrome?
A380. tachypnea, chest wall tenderness, carpopedal spasm, Chvostek's/Trousseau's sign (hypocalcemia)
182
Q381. this condition likely results from inflammation of CN VII as it courses through the styloid foramen?
A381. Bell's palsy
183
Q382. treatment of bell's palsy?
A382. acyclovir AND prednisone; eye patching to prevent keratitis and corneal ulceration
184
Q383. work up of CVA?
A383. STAT head CT - esp if < 3 hrs; standard labs; STAT Accu-check
185
Q384. in hemorrhagic stroke, you want to decrease SBP by no more than _____ to limit hypoperfusion...?
A384. 20-25%
186
Q385. Peripheral vertigo is caused by.?
A385. viral etiology (labyrinthitis); decaying or "lost" otoliths
187
Q386. peripheral vertigo presentation?
A386. acute onset; intense spinning sensation, N/V; unidirectional nystagmus that can be inhibited by fixation
188
Q387. work-up of peripheral vertigo?
A387. hallpike maneuver; epley manuevers; anti-emetics, anti-cholinergics
189
Q388. most seizures in the ED are due to...?
A388. Medical non-compliance in known seizure patients
190
Q389. workup of seizures in the ED...
A389. ABCs; IV; check glucose; head CT; anti-epileptic level; LP if any possibility of intracranial hemorrhage or meningitis
191
Q390. LOC occurs in ____ % of patients with SAH?
A390. 0.5
192
Q391. 75% of SAH is due to...?
A391. ruptured congenital arterial aneurysm
193
Q392. diagnostic test for SAH?
A392. noncontrast head CT
194
Q393. if there is suspicion for SAH and it's not seen on CT, ____ must be performed?
A393. LP
195
Q394. What other condition besides SAH could cause blood in the CSF?
A394. Herpes encephalitis
196
Q395. goal of ICP management is to maintain the cerebral perfusion pressure greater than ______?
A395. 60
197
Q396. A chronic headache that started out mild to moderate in severity and intermittent in nature, described as a deep, aching pain and worsened by coughing, and often maximal upon awakening...?
A396. intracranial tumor / mass
198
Q397. 85% of people experiencing malignant hypertension complain of _____?
A397. Headache
199
Q398. Temporal arteritis affects women ______ than men, and is uncommon before the age of _____? ESR is usually ____?
A398. Women more than men; 50; ESR 50-100
200
Q399. Jaw claudication is strongly suggestive of...?
A399. temporal arteritis
