Exam 3 - Study guide (MC) Flashcards Preview

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Flashcards in Exam 3 - Study guide (MC) Deck (89):
1

Opiate toxidrome antidote

Naloxone (Narcan)

2

Valproate antidote (2)

Charcoal
L-carnitine

3

Methanol antidotes (3)

Fomepizole
Etoh
HD

4

Visine antidote

Atropine

5

Camphor antidotes (2)

Charcoal
Benzos

6

Cocaine antidote

Benzos

7

Iron poisoning tx (4)

Gastric lavage
Whole bowel irrigation
MOM
Deferoxamine

8

Cyanide toxicity tx (5)

100% O2
Amyl nitrite
Sodium nitrite
Sodium thiosulfate
Hydroxocobalamin

9

Digoxin antidote? How often should you check levels? What should you avoid?

- Digibind
- Check level at least 6 hrs after last dose
- Avoid Ca --> increased arrhythmias ("stone heart")

10

CCB antidotes (4)

CaCl
Glucagon
Epi
Insulin

11

Acetaminophen antidote? At what time is it no longer beneficial? What are side effects of the antidote?

N-acetylcystine
*No benefit if > 8hrs
*N/V/D

12

Barbiturates antidotes (3)

Glucose
Narcan
Charcoal

13

Lithium antidote

Benzos for seizures

14

Isopropanol tx (2)

IVF
Ventilation

15

Ethylene glycol tx

Similar to methanol:
Fomepizole
Etoh
HD

16

Bath salts antidotes (4)

Cooling
IVF
Bicarb
Benzos

17

Amphetamines antidotes (3)

Benzos
Haldol
Cooling

18

MDMA (ecstacy) antidote

Benzos

19

Phenycyclidine (PCP) antidote

Benzos

20

Hydrofluoric acid antidote

Ca gluconate

21

Dystonic reactions antidotes (2)

Benadryl
Benzos

22

TCAs antidotes (2 categories)

For hypotension: fluids, bicarb, alpha agonists
For seizures: benzos, barbituates

23

TCAs + ________ = DEATH

Procainamide

24

BB antidote

Glucagon

25

What increases osmolar gap?

ME DIE
- Methanol
- Ethylene glycol
- Diuretics
- Isopropyl alcohol
- Etoh

26

What causes 1/4 of all trauma related deaths?

Blunt trauma

27

When should you provide ventilatory support to a trauma pt? (6)

- Upper airway obstruction
- Flail chest
- Multiple injuries
- Comatose
- Elderly
- O2 < 50% on RA or < 80% on >40% O2

28

How do you dx sternal fx?

Serial EKGs q 8hrs for 24-36hrs
Echo

29

How do you tx scapular fx?

Sling
Ice
Analgesics
Early ROM

30

When does a scapular fx require surgery?

If it involves glenoid &/or coracoid

31

When is mechanical ventilation required for flail chest?

- Shock
- 3+ injuries
- Head injury
- Prior pulm disease
- 8+ rib fractures
- > 65yo

32

What occurs during pulmonary contusion?

Direct injury w/ no laceration --> hemorrhage & edema --> interstitial & intra-alveolar fluid collection

33

How do you dx pulmonary contusion?

pulmonary opacity within 6hrs of blunt trauma

34

How do you tx pulmonary contusion?

Ventilation
Pain & chest physiotherapy

35

When is mechanical ventilation for pulmonary contusion required?

When 1/4 lung volume involved or pre-existing pulmonary disease
*May need to have uninjured lung down!

36

What is the clinical presentation of a basilar skull fx? (3)

- Raccoon eyes
- Battle sign
- Hemotympanum

37

What is the clinical presentation of transtentorial/uncal herniation?

- Oculomotor n compression --> ipsilateral dilated pupil
- Cerebral peduncle compression --> contralateral hemiparesis

38

What are warning signs of an orbital blow-out fx? (3)

- Infraorbital numbness
- Enophthalmos
- limited upward gaze w/ diplopia

39

How do you tx orbital blow-out fx?

Augmentin
Tetanus prophylaxis

40

What do you see w/ splenic rupture?

Kher's sign (L shoulder pain)

41

What is the MC blunt trauma of the abd? What is the MC penetrating?

Blunt = splenic
Penetrating = liver

42

How do you dx renal injuries?

CT
IVP
Angiography

43

What causes renal injuries?

Direct impact or decelerating force

44

How is the pancreas injured? How do you dx?

Compression against spine

CT
*Amylase & DPL are NOT reliable

45

How do you dx bladder injuries?

Cystogram
CT w/ contrast

46

What are S/S of pneumomediastinum?

- Hamman's crunch
- SubQ emphysema in neck

47

What are S/S of cardiac tamponade? What is the triad?

- Becks triad: JVD, muffled heart sounds, hypotension
- Pulsus paradox (10-15 drop in SBP during inspiration)
- Kussmaul sign (increase in JVD & pressure during inspiration)
- Electrical alternans

48

How do you tx cardiac tamponade?

Pericardiocentesis via paraxyphoid approach w/ 18 gauge & 20cc syringe, directed toward L scapular tip

49

What are characteristics of an aortic rupture? What is seen on CXR?

- Most commonly involves aortic isthmus
- Retrosternal or interscapular pain (worse w/ increased BP)
- CXR: mediastinal widening (MC), deviation of esophagus (most accurate sign), L pleural effusion, blurred aortic knob

50

What imaging do you use to dx aortic rupture?

TEE
CT
Aortography

51

How do you tx aortic rupture?

Avoid valsalva/vomiting
Maintain SBP <120
Surgery

52

What is most associated w/ myocardial contusion? What is the main cause?

Sternum fx

MVC

53

What indicated increased ICP? What is the triad?

Cushings triad: HTN, depressed respiratory, brady

54

How do you tx salicylate overdose? (5)

- Gastric lavage if within 1hr
- Charcol
- Normal saline
- NaHCO3
- HD (if ESRD, CNS toxicity, serum>100, worsening, failure to alkalinize)

55

How do you tx barbiturate overdose? (4)

Glucose
Narcan
Charcoal
Urinary alkalinization

56

What are sx of acetaminophen overdose? (3)

- Centrolobular necrosis
- Vomiting (esp children)
- Renal failure

57

What are the phases of acetaminophen overdose?

0-24 hrs = N/V, pallor, diaphoresis, malaise

24-48 hrs = RUQ pain, increased LFTs

72-96 hrs = LFTs peak, coagulopathy, encephalopathy

4-14 days = recover or die

58

What is the serotonin syndrome triad?

Myoclonus
MS changes
Shivering

59

What are other sx of sertonin syndrome?

"A2D2H2T"
Agitation, ataxia
Diarrhea, diaphoresis
Hyperreflexia, hyperthermia
Tremor

60

Antifreeze toxicity - what does the urine fluorescence reveal?

Ca oxalate crystals

61

Digoxin overdose - what is seen on EKG?

Atach w/ AV block

62

What is the triad seen w/ hypoglycemia?

Whipple's triad
- Diaphoresis
- Nausea
- AMS

63

Iron toxicity - what is seen on labs?

Basophilic stippling & "vin rose" urine

64

What is the clinical presentation of dystonic rxns?

- Sudden onset abnormal posturing of head, neck, jaw
- Contractures of lips, tongue, face, throat
- Trismus, torticollis, tongue protrusions
- Laryngeal, pharyngeal spasms
- Fear, axiety
- Oculogyric crisis (unable to move eyes in vertical plane, double vision)

65

How do you tx dystonic rxns?

- Benadryl 3-4 days to prevent recurrence
- Benzos

66

What are RFs for dystonic rxns?

Male
Young
Cocaine
Hypocalcemia
Neurodegenerative d/o

67

What is the clinical presentation of diverticulitis? (3)

Abrupt onset LLQ pain
Fever
Leukocytosis w/ left shift

68

How do you tx diverticulitis?

Levaquin
Flagyl
Zosyn
If severe --> add vanco
If abscess --> drain

69

How do you tx mesenteric ischemia?

Heparin
Abx

70

How do you tx H. pylori?

H2 blockers or PPI
Surgery

71

How do you tx urolithiasis?

<5mm = no tx (will pass)

> 5mm:
- Toradol
- Morphine
- Antiemetics
- IVF
- If infection --> abx, drain, admit

72

How do you tx pancreatitis?

"Place bowel at rest"
- NPO
- Fluids
- Demerol
- Antiemetics

73

How do you tx frostbite?

Elevate, splint
Wrap in dry gauze
Debride
Tetanus
Analgesics

74

How do you tx heat stroke? (4)

- IVF
- Ice packs
- Evaporative cooling*
- Diazepam

75

How do you tx jellyfish sting? (3)

Vinegar
Isopropyl alcohol
Anesthetics (topical or oral)

76

How do you tx hymenoptera stings?

Antihistamines
Epi (IM or auto-injector)
Steroids
Beta agonists

77

How do you tx black widow spider bite? (4)

Narcotics
Benzos
Antivenin
Ca gluconate

78

How do you tx scabies?

Lindane (also used for lice)
Elemite
Calamine lotion
Oral antipruritic agents
Analgesics

79

How do you tx snake bites?

Elevate, constriction bands

Antivenins: "polyvalent"

80

How do you tx scorpion sting?

cool compress
anascorp antivenin

81

How do you tx thermal burns?

Tetanus prophylaxis
NG tube
Narcotics
Debride, steril dressings
Ointment

82

What is the MC active enzyme of the brown recluse spider?

Sphingomyelinase D

83

What is the triad of heat stroke?

Hyperthermia >105
CNS dysfunction
Anhydrosis

84

What is the MCC of pancreatitis? (3)

Alcoholism
Cholelithiasis
Hypertriglyeridemia

85

What is the clinical presentation of epididymitis?

- Gradual, bilateral pain
- Fever
- Phren's sign (relief w/ scrotal elevation)
- Swelling
- Worse w/ standing
- 19-35yo

86

What is the clinical presentation of testicular torsion?

- Bell clapper deformity
- Sudden, unilateral pain
- Absent cremaster reflex
- Vomiting common
- Neonates, 12-15yo

87

What are sx of a barbiturate overdose?

CNS depression
Hypothermia, hypoglycemia
Urinary retention
Aspiration pneumo*

88

What are characteristics & dx tests for appendicitis?

- Periumbilical, RLQ pain
- Fever, N/V, anorexia
- Rovsings sign: pain in RLQ w/ palpation of LLQ
- Iliopsoas sign: pt supine, R knee extender & flex right hip
- Obturator sign: pt supine, flex R knee to 90˚, internally/externally rotates hip
- Alvarado score (10 pts total)

89

What are S/S of digoxin?

- N/V, weakness
- Vision changes (yellow halos)
- Syncope
- MS changes
- Hyperkalemia