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ER Shelf Flashcards

(173 cards)

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1
Q

Most common cause of sudden cardiac death in adults is

A

Ventricular fibrillation

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2
Q

Medications that can be given through endotracheal tube

A

ALE

Atropine
Lidocaine
Epinephrine

(Also Naloxone)

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3
Q

Give with suspected torsades de pointes

A

Magnesium sulfate

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4
Q

Atrial fibrillation tx if stable

A

CCB (Diltiazem)

Then Beta blocker
Metoprolol
Esmolol
Atenolol

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5
Q

Afib/ A Flutter if unstable

A

Cardioversion

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6
Q

Paroxysmal supraventricular tachycardia (PSVT)

SVT

A

Vagal maneuvers
Adenosine

—> CCB

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7
Q

Suspected meningitis what test to get

A

CT scan of brain before lumbar puncture

Especially if papilledema

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8
Q

Seizure for 6 minutes what to give

A

Benzo (Lorazepam)

Status epilepticus

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9
Q

Hypotension without tachycardia

A

Neurogenic shock

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10
Q

Imaging for ACL tear

A

MRI for soft tissue

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11
Q

32 y.o with chest pain. Pain is sharp and left sided. Worse with inspiration and when laying down. SOB.

Tachycardic regular heart rhythm.

ST segment elevations
Troponin less than 0.01

What other history

A

Acute pericarditis

Preceding upper respiratory infection

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12
Q

What do you see preceding large pulmonary embolism

A

Hemoptysis

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13
Q

Pulmonary emboli EKG

A

Tachycardia

S1Q3T3 elevations

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14
Q

Hepatitis infection acute from fecal oral

A

Hepatitis A virus

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15
Q

What do you see with epididymitis

A

Increased epididymal blood flow

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16
Q

Simple anechoic fluid collection in testicle

A

Hydrocele

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17
Q

Symptomatic bradycardia Tx

A

Atropine

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18
Q

Substituted judgement

A

Surrogate decision maker should try to imagine what the patient would want if they were competent

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19
Q

Prolonged erection what imaging to get

A

Doppler ultrasound

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20
Q

Hypertensive emergency with blood pressure above 180 affects what

Elevates what lab

A

Kidneys
Heart
Arteries
Brain

Creatinine

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21
Q

D-dimer

A

Elevated with elevated fibrin degradation

Thrombosis

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22
Q

Localized temporal abnormalities on MRI

Confusion, HA, lethargic, speaking incomprehensibly
Fever

Tx

A

Herpes Simplex encephalitis

Acyclovir

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23
Q

Vaccination for meningitis

A

11 years to 18 years old

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24
Q

Child in garage

Breathing irregular
Hypotensive
Rapid breathing
Low Bicarb

Give what

A

Ethylene glycol poisoning (antifreeze)

Give membrane receptor blockade
Fomepizole

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25
Concerned for what in chemo patients with fever
Neutropenic fever
26
Overdose of lithium causes
Nephropathy | - Elevated serum osmolality
27
Venom works how
Destructive enzymatic proteins Antivenom is antibodies or antibody fragments that bind to venom protein and inactivate them
28
Colon cancer see what on blood smear
Microcytosis= Low MCV Iron deficiency anemia
29
Bacterial thrombophlebitis of the internal jugular vein
Lemierre syndrome Complication of peritonsillar abscess Fusobacterium necrophorum= gram negative rod
30
Tx Vibrio vulnificus
Doxycycline and ceftrazidime
31
Clams | Curved gram negative pathogen
Vibrio vulnificus Tx Doxycycline and ceftrazidine
32
TMP SMX good for
Cellulitis w/ MRSA
33
Tx hemolytic transfusion reaction
Stop transfusion | IV fluids in a large bolus
34
Wrist extension Finger extension Thumb abduction What nerve
Radial nerve
35
Loss of abduction of the arm 15 to 90 degrees
Axillary nerve
36
Weakness in flexion of wrist, hand, thumb, and lateral fingers
Median nerve
37
Weakness of elbow flexion and forearm supination
Musculocutaneous nerve
38
Injury to medial epicondyle
Ulnar nerve
39
Weakness in flexion of the wrist, hand and medial fingers
Ulnar nerve
40
Supracondylar fractures
Median nerve
41
Associated with ulcerative colitis and Crohns
Erythema nodosum Red or violaceous subcutaneous nodules on anterior surface of both legs.
42
Dermatitis herpetiformis
itchy and painful papulovesicular rash associated with celiac disease
43
Wound on hip with desquamation and black eschar
Pressure ulcer due to bony prominences
44
Ipsilateral ptosis associated with
Cluster headache
45
Malignant pleural effusions
Bloody Total protein 4 LDH 120 Exudative
46
Exudative pleural effusion
Pleural fluid protein to serum protein is greater than 0.5 The ratio of pleural fluid LDH to serum LDH is greater than 0.6 Pleural fluid LDH is greater than 0.6 times the upper limit of normal for serum LDH
47
Initial step for HHS
Normal saline
48
Decreased breathe sounds on one side | Hyperresonance
Tension penumothorax Inadequate venous return from increase in intrathoracic pressure increases and results in vena cava compression.
49
Salicylate poisoning | Aspirin
Respiratory alkalosis Elevated pH Decreased PaCo2
50
Anterior cord syndrome
Anterior spinal artery Loss of motor function and sensation of pain and temp Retention of touch, proprioception, and vibratory sensation
51
Brown Sequard syndrome
One half of the spinal cord Penetrating injury Loss of ipslateral motor function and touch, proprioception and vibratory sensation CL loss of sensation of pain and temp
52
Central cord syndrome
Trauma to cervical spine Decreased motor function and sensation in both upper extremities.
53
Hypothermia at risk for
Cardiac arrhythmias
54
HR 50 Tx
Bradycardia Atropine
55
Risk factor for placental abruption
HTN Trauma Substance use (cigarettes, alcohol, cocaine) Maternal age younger than 20 and older than 35 Low socioeconomic status
56
TX PEA Has P, QRS and T waves
Epinephrine
57
Next step in patients who survive out of hospital sudden cardiac arrest
Therapeutic hypothermia Improves neurologic outcomes
58
Alcohol withdrawal scoring evaluation system
Clinical institute withdrawal assessment for alcohol (CIWA)
59
CHA2DS2-VASc
Predict stroke in patients with atrial fibrillation
60
Ranson criteria
evaluate severity of pancreatitis
61
Suspected TCA overdose get what
EKG
62
Haemophilius influenza | Epiglottitis
Polysaccharide-protein conjugate vaccine
63
``` Watery diarrhea Now has fever and abdominal pain Meckels diverticulum TEmp Yellow drainage on rectal exam ```
Pneumaturia Fistulas common w/ crohns disease Enterovesical fistula between bowel and bladder. Pneumaturia is air in bladder
64
birefringent crystals
Calcium pyrophosphate crystals Pseudogout Rhomboid shaped
65
Dont give what antibiotic with acute intermittent porphyria
Sulfa drugs | TMP-SMX
66
Myasthenia gravis
Anti-acetylcholine receptor antibodies
67
What to initial do for incarcerated inguinal hernia
Trendelenburg position
68
Suspected appendicitis what test
Ultrasound abdomen
69
Scale used to traumatic brain injury
Glasgow Coma Scale (GCS)
70
ST elevations in Inferior leads II, III, aVF
Right coronary artery
71
ST elevations in V2, V3, V4 and lateral V5, V6, I, aVL
Left anterior descending artery LAD Anterior
72
ST elevations RV4, RV5, RV6
Right anterior leads Right marginal artery
73
Getting stitches | Patient becomes numb and dizzy and has seizure
Intravascular injection of local anesthetics Causes central nervous system or cardiovascular toxicity Numbness, metallic taste, lightheadedness, dizziness, disorientation before progressing to nconsciousness or seizure
74
Dont give TPA
if previous bleed therapeutic anticoagulation - heparin - warfarin - direct thrombin inhibitors - Factor Xa inhibitors
75
Genital pain Pain and erythema over left inguinal region Fever Perineal tenderness Skin overlying scrotum, perineum, and left inguinal region is dusky with crepitance and a feculent odor
Fournier gangrene Necrotizing soft tissue infection of the perineum, genitals and surrounding areas Associated with compromised immunity from any cause - Diabetes mellitus
76
``` Fever Fluid wave Abdominal pain Abdominal swelling Emesis nonbloddy Loose stool Elevated WBC ``` Testing to get
Spontaneous bacterial peritonitis (SBP) Paracentesis
77
What lab to get for blunt chest injury with sternal fracture
Troponin Concerned for myocardial contusion
78
IV drug use to bacteremia spreads by
Hematogenous seeding Spinal epidural abscesses
79
Acute limb ischemia Lack of blood flow and pulses What medication to give
Heparin
80
Receives unit of packed red blood cells During transfusion reports shortness of breath Bilateral rales Drop in blood pressure Drop in oxygen saturation Most likely cause?
Donor antibodies Transfusion related acute lung injury (TRALI)
81
Febrile nonhemolytic transfusion reaction
Donor leukocytes attacked by the recipients preformed antibodies Fever w/o hypotension
82
Acute hemolytic transfusion reaction
Recipient antibodies against donor RBC Severe intravascular hemolysis with error in cross-matching Incompatibility Fever, chills, and severe intravascular hemolysis
83
Sickle cell with chest pain What to do
Acute chest syndrome IF doesnt improve with oxygen, morphine, albuterol, maintenance IV fluids, antibiotics Next: Exchange transfusion
84
Tx Bell palsy
Oral steroids within first three days of paresis
85
Medication for chest pain with no atherosclerotic coronary artery disease
Prinzmetal angina Coronary artery vasospasm CCB - Amlodipine
86
PCP MOA
NMDA receptor antagonist
87
Cocaine MOA
blocking of DA, NE, 5HT (serotonin) reuptake
88
Marijuana MOA
CB1/CB2 recptors
89
Benzo MOA
Increased firing of GABAa
90
MOA of opiates
Mu receptor agonist
91
Class III hemorrhage
30-40% Hypovolemic shock manifesting with tachycardia (120-140 beats per min) Hypotension Decreased pulse pressure Tachypnea Mental status changes Oliguria
92
Class I hemorrhage
up to 15% DO not have hemodynamic changes No altered mental status
93
Class II hemorrhage
15-30% Tachycardia Narrowed pulse pressure
94
Rhinosinusitis treatment
Intranasal fluticasone propionate for 15 days | 15-21 day course of intranasal steroids
95
Emergency thoracotomy location
Left fifth intercostal space from the border of the sternum to the mid-axillary line
96
Rhabdomyolysis has a decrease in what lab
Calcium Calcium deposition occurs in areas of necrotic muscle can result in hypocalcemia
97
HIV and headache Meningeal enhancement No mass lesion CD4 97 Increased opening pressure on lumbar puncture What test
Cryptococcal meningitis Cryptococcus neoformans India ink preparation
98
Abdominal pain Diabetes, HTN, CKD Began with carrying groceries Diaphoresis N/V SOB
Acute coronary syndrome Get EKG
99
Pain reproduced by leg straightened and passively flexed at the hip
Sciatica intervertebral disc herniation
100
Medication to give if mass effect and edema with brain neoplasm Increased intracranial pressure
Dexamethasone IV
101
Epilepsy controlled with antiepiletpci Latent TB found and started on medications Blurry vision now with nystagmus
Elevated phenytoin level Due to decreased folate Leads to megaloblastic anemia and gingival hyperplasia
102
Overuse of local anesthetic agents Prilocaine Benzocaine Dapsone
Methemoglobinemia Methemoglobin oxidized form of hemoglobin unable to bind oxygen Hypoxia Tx Methylene blue
103
Area colon most likely to perforate
Cecum
104
Heroin overdose given naloxone Stats drop in 30 minutes
Naloxone pharmacodynamics Duration of action 30 minutes
105
Haloperidol Sweating Fever Elevated blood pressure Tachycardia Resting tremor Pale Rigidity What would be elevated
Neuroleptic malignant syndrome Creatine kinase due to muscle injury
106
Allopurinol
Can cause stevens-johnson syndrome/toxic epidermal necrolysis Skin rash Difficulty swallowing
107
Rubeola virus
Measles Koplik spots Conjunctivitis Rhinitis
108
MOA of MRSA
Penicillin binding protein Mutation of the pencillin binding protein which no longer bind the beta-lactam antibiotics
109
Widening and flattening of the femoral head
Legg-Calve Perthes disease is avascular necrosis
110
HIV lung infection Silver staining crushed ping pong balls
Pneumocystis pneumonia (PCP) TMP-SMX
111
Salter-Harris fracture
Involves epiphyseal plate Can lead to limb length discrepancy Angular deformity
112
TX Scabies
Ivermectin
113
Acetaminophen overdose scale
Rumack-Matthew nomogram Likelihood of hepatotoxicity can be predicted based on a plot of the serum acetaminophen level against time starting four hours post ingestion
114
Acute Physiology and Chronic Health Evaluation (APACHE)
Validated severity of disease score that predicts mortality in patients upon admission to intensive care units
115
Milan criteria
Used to select patients with hepatocellular carcinoma associated with cirrhosis for liver transplantation
116
Model for End-Stage LIver disease (MELD) score
is used to objectively assess the severity of chronic liver disease
117
Bright red blood per rectom of 11 month old Bleeding past ileocecal valve on colonoscopy
Meckel diverticulum Get Nuclear imaging to confirm
118
Medication put you at risk for latent TB reactivation
TNF inhibitors for autoimmune conditions Adalimumab Etanercept Infliximab
119
Tx Benzo withdrawal
Diazepam Chlordiazepoxide Taper off
120
Needle aspiration of peritonsillar abscesses at risk for
Hitting Carotid artery
121
Fall on outstretch hand and fracture
Distal radius Wrist in dorsiflexion Colles fracture With posterior and radial displacement of wrist
122
Community acquired pneumonia that is drug resistant
Pseudomonas aeruginosa
123
Prolonged QT interval
Delayed cardiac repolarization Increases risk fo torsades de pointes Cause syncope Avoid antibiotics, antidepressants, and antipsychotics
124
Malignant otitis externa | Left mastoid process tender
IV Ciprofloxacin
125
Tx Digoxin toxicity
Hydration Correction of electrolyte abnormalities Digoxin specific antibody fragments (Fab)
126
``` Diarrhea Urination Bradycardia Pinpoint pupils Drainage from eyes ``` Overdose
Organophosphate poisoning MOA enzyme inhibition
127
What to do for boerhaave syndrome esophagus rupture
NPO status IV proton pump inhibitor IV broad-spectrum antibiotics
128
MI medication that causes hypotension
Nitroglycerin
129
Complete heart block/ Third degree heart block tx
Transcutaneous cardiac pacing
130
Abdominal pain Fever Scleral icterus RUQ tenderness Tx
Cholangitis RUQ pain, jaundice, fevers Tx: Piperacillin- tazobactam
131
Aspiration pneumonia bacteria
Polymicrobial Gram positive Gram negative Anaerobic
132
MOA to Toxic shock syndrome Tx
Immune activation Toxin-producing staph aureus Which allows non-specific binding of T cell receptor MHC II resulting in massive immune activation Tx IV antibiotics
133
Risk factor for hemorrhagic stroke Bright area of blood on CT
Hypertension Causes leakage form intracerebral arteries
134
Elevated lab with necrotizing fasciitis
Elevated C-reactive protein Elevated WBC Elevated Creatinine Elevated Glucose Decreased hemoglobin Decreased sodium
135
Temporal arteritis give what
Corticosteroids
136
What to do with a human bite
Wound debridement You don't need prophylactic antibiotics unless primary closure
137
Globe rupture due to projectile get what imaging
CT for foreign body
138
DM affects what to cause wounds
Microvascular circulation [Not venous insufficiency]
139
Chest pain Dyspnea Congestive Heart failure "Suffocating" Mottled skin Thready pulses JVD Distant heart sounds Intra-aortic balloon pump placed to reduce afterload What next
Dobutamine [Beta-1 receptor agonist with some beta 2 activity] Cardiogenic shock Positive inotropic effect Decreases afterload
140
Side effect Etomidate
Short acting IV anesthetic agent used for intubation Acute adrenal insufficiency due to the suppression of the adrenal synthesis of cortisol
141
Candidiasis of the mouth caused by what medications
Inhaled corticosteriods [Fluticasone] Not albuterol
142
Wolff-parkinson white drug to give to prevent SVT tx
Propafenone [Dont give CCB, beta blocker or adenosine]
143
Infections in immunosuppressed patients causing left sided facial swelling and vision loss
Mucormycosis Mucor Rhizopus Absidia Cunninghamella
144
First Treatment hyperthermia
Electric fan and tepid water from spray bottles
145
Spinal metastases can progress to
spine or cauda equina compression Paraplegia [Quadriplegia if metastasis in cervical spine]
146
Tx for hip fracture pain if pain not improved with morphine
Regional anesthesia Femoral nerve block
147
How to catch preeclampsia early
Blood pressure checks [Not urine dipstick protein]
148
Reduce mortality and morbidity in COPD
Continuous oxygen
149
``` 13 y.o with left hip and groin pain. Past month No trauma Limping Obese No deformity or change in length Limited internal rotation ```
Physeal fracture Slipped capital femoral epiphysis (SCFE) Physeal fracture of the growth plate of the femur
150
Rash from drug reaction
Leukocytoclastic vasculitis Small vessel inflammation with a neutrophilic infiltrate and necrosis with nuclear debris
151
Henoch- Schonlein purpura
IgA antibody deposition Skin lesions Lower extremity palpable purpura, abdominal pain, gastrointestinal bleeding Joint pain
152
CML related to
Increased activity of tyrosine kinase (bcr-abl) which is encoded by the philoadelphia chromosome Mutant tyrosine kinase causes inhibition of apoptosis and increased mitosis, leading to unregulated proliferation of granulocytes
153
Person might go into septic shock what to do
Urinary catheterization Provides ongoing assessment of urine output, a surrogate for end organ (specifically kidney) perfusion
154
Chest compression rate
At least 100 per minute
155
Subdural bleed caused by
Age [Not acetaminophen]
156
Lead poisoning cells
Basophilic stippling
157
Howell jolly bodies
Sickle cell disease
158
Macroovalocytes
enlarged oval shaped red blood cells Megalblastic anemia Folate or vitamin B12 deficiency
159
What to give to continuous nose bleed
Alpha receptor agonist [Epinephrine, oxymetazoline, or phenylephrine] Vasoconstricting agent
160
Traumatic injury in pregnancy get what test
Kleihauer Betke test Maternal exposure to fetal blood anti-rH antibodies to negative month KB: blood test performed on pregnant woman to measure the amount of fetal hemoglobin transferred from the fetus to the mothers bloodstream
161
Serum Elisa negative for HIV
Get nucleic acid testing HIV RNA
162
Second intercostal space at the midclavicular line
Decompressive needle thoracostomy
163
Subxiphoid space
Used to perform pericardiocentesis
164
Non bloody vomiting and diarrhea
Norovirus
165
Heart pain referred into epigastrium
Inferior wall myocardial infarction Inferior leads: II, III, avF
166
Most common myocardial infarction location
Anterior wall MI
167
ST depression in V1, V2, V3 and V4
Posterior wall MI
168
ST segment elevation in leads I, II, III, aVF, aVL, V2, V3, V4, V5 and V6
Pericarditis
169
ST segment elevations in leads V2, V3, and V4
Left anterior wall infarct
170
St segment elevation in leads V4, V5, and V6
lateral wall MI
171
On warfarin and blood in stool. What lab to check
Prothrombin time (PT)
172
Convulsive epileptic seizures with open eyes
PNES Pseudoseizure
173
Botulism MOA
Neurotransmitter release inhibition Wound botulism Black tar heroin

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