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Emergency Medicine > Extra notes from slides Exam #1 > Flashcards

Extra notes from slides Exam #1 Flashcards

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1
Q

if photophobia, pain or tearing interferes with exam, what should you add

A

topical ophthalmic anesthetics

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2
Q

If corrective lenses are unavailable, what should you do for VA?

A

pinhole testing

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3
Q

what does a slit lamp allow

A

3d view of ocular structure

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4
Q

what structures are infected with periorbital vs orbital cellulitis?

A

peri = anterior to orbital septum and benign

orbital = extends BEHIND orbital septum

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5
Q

difference in timing of hordeolum vs chalazion

A

both can infect the meibomian gland, but hordelolum is always an acute infection, while chalazion can be subacute and can be a progression of an internal hordeolum

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6
Q

if you are under this age and have HZV opthalmicus, you should get a work up

A

40 yo

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7
Q

what test can you use for a FB?

A

seidel test

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8
Q

what is the f/u for corneal foreign bodies if rust rings, central line, or deep? What if symptoms persist?

A

1st one = 24 hours
2nd one = 48 hours

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9
Q

what specifically is put over the eye for globe fracture?

A

Eye shield

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10
Q

when do you typically up date tetanus for eye?

A

If there is trauma

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11
Q

when do you f/o for chemical eye injury?

A

24 hours

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12
Q

for optic neuritits, what would some1 perceive a red object as?

A

Desaturated - almost pink

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13
Q

apart from veil going over eye, what do people with retinal detachment see?

A

floaters

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14
Q

what is bullous myringitis an extension of?

A

OM

just has a intact blood filled TM (shows red instead of purulent discharge)

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15
Q

how to make a hands-free tongue-depressor for pinching nose

A

tape 2/3 the way up

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16
Q

What is used to cauterize and when is it done?

A

silver nitrate, only after 2 attempts of direct pressure and bleeding is visualized (meaning it is anterior epistaxis)

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17
Q

Order of anterior epistaxis management

A
  1. pinch for 10-15 mintes two attempts
  2. silver nitrate
  3. thrombogenic foams/ gels
  4. nasal packing
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18
Q

when do you f/u for food impaction

A

12-24 hours

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19
Q

if passage does not occur w/in ____ days for a sharp object, consult surgery

A

3 days

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20
Q

if a battery passes through the esophagus, when is/are repeat exam(s) needed?

A

24 hours and 48 hours

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21
Q

When is hyperthermia common and what clues you into this?

A

Environmental exposure
Warm skin
Do not respond to antipyretics

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22
Q

What drugs can cause fever?

A

serotonin

New meds or dose changes

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22
Q

What is the length of FUO?

A

38.3 = 100.9 F for 3 weeks w/out diagnosis

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23
Q

What history question should you ask for all patients with fever?

A

Ill contacts
Travel
IV drug use (EVER)

endocarditis
spinal epidural abscess

once in the system, it can be there for ever

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24
contitutional symptoms is worrying for
TB
25
what two things should you default to if a patient comes in with weird vitals but no symptoms?
PNA (CXR is sometimes normal - get a CT if not a clear) UTI (UA is not always positive)
26
When do you use tylenol over ibruoprofen?
Tylenol is for younger Ibuprofen for > 6 months (stronger)
27
If you have pain + fever, what is used?
Toradol IV/IM which is ibuprofen
28
Why are pediatric fever worrisome?
Lack of mature immune system leads to VAGUE symptoms + risk of spread of infection from system to system (from GU to another tract) Hard to do a good PE in these patients
29
If there is a fever + rash, what likely is it?
MMR unvaccinated
30
Roseala vs measels
rosealo starts at bottom and goes up (like a rose grows) measles starts at top and goes down (like a weasle digs down)
31
Why is birth history important for infants?
if a patient is 1 week early, then they are considered minus 1 week to be their true age for risk stratifying
32
what makes a seizure provoked (within this time window)?
A seizure within 7 days of an insult
33
what is refractory status epilepticus?
persistent seizure activity despite IV administration of 2 antiepileptic drugs
34
What can you use to verify psedoseizure?
Use a saline flush and if they move, then it is not a seizure
35
when would you get an LP for seizure?
Only if fever or worried of meningitis
36
If 1st and 2nd line methods do not work for seizure control what do you do?
Induce COMA EEG
37
When can hyponatremia lead to seizure?
<120 give NaCl but titrate slow
38
discharge for a that patient is doing fine but has no history of seizure
normal imaging = discharge but NEED to have someone to drive them back. NO DRIVING!
39
How should you give antipyretics to adults? Should you stop after they do not have a fever?
Administer so that they always have a dose in their body instead of intermittently to avoid period chills/sweats
40
when specifically do you give AB for adults with fever?
ONLY if neutropenia or soon to be asplenia immunocompromised hemodynamically unstable
41
when do you order a CXR for a pediatric patient with fever?
tachypnea, cough, or hypoxemia
42
why do you only get a cath for UA in females < 24 m, uncircumcised boys < 12 m, circumcised boys < 6 m?
Low chance of UTI outside this window girls are more likely to get UTI, which is why they get it later
43
why does chemo lead to neutropenic fever?
chemotherapy affects myelopoiesis and the integrity of GI mucosa allowing bacterial colonization and transposition across mucosa
44
is fosphenytoin or phenytoin preferred 2nd line for status epilepticus?
fosphenytoin d/t less SE phenytoin can cause cardiac arrhythmia
45
what is hypocalcemia?
< 7 cause of seizures | calcium has 7 letters
46
what is hypomagnesemia?
< 1.5 cause of seizures | magnus has 150iq
47
syncope and presyncope
Syncope = LOC and tone for < 1min Presyncope = prodomal symptom feeling like you are about to faint BOTH WORKED UP THE SAME
48
syncope w/ multiple events with new onset should r/o
AV block
49
syncope w/ multiple events over years
vasovagal syncope
50
syncope w/ multiple events lasting multiple minutes
psychogenic
51
supine vs upright syncope
supine = cardiac upright = reflex syncope (vasodilation +/- bradycardia)
52
how long does post event of syncope (N, pallor, diaphoresis) last and why?
when you pass out, you lie supine allowing blood to reprofuse the brain
53
DM are at risk for this type of syncope
Orthostatic hypotension d/t autonomic neuropathy and hypoglycemia
54
what typically causes vasovagal syncope?
emotions, vigorous exercise, etc followed by reflex parasympathetic response leading to drop in BP really fast
55
treatment of carotid sinus syncope in ER and disposition
ER = no treatment Disposition = consider midodrine (vasoconstrictive drug)
56
worrying HINTS exam
bi-directional nystagmus uni-directional (only to the right or left) is not concerning
57
management of HZV with ocular involvement
erythromycin ointment, cycloplegics, opioids, cool compresses + acyclovir of course
58
do you do ABX for UV keratitis?
yes
59
when do you use ketorolac drops?
corneal abrasions also do prophylaxis ABX
60
what ABX do you use for lid laceration?
Keflex + erythromycin think of erythro = blood and keflex = impetigo on eye
61
when do you get CT/US of abd w/ con if you have a fever?
abdominal pain kinda common sense
62
what is the opening pressure for idiopathic hypotension?
< 6 H2O
63
what med should you avoid with idiopathic hypotension?
Opioids instead use tylenol for pain!
64
what aortic stenosis LVEF do you need for surgery (if already severe)?
< 50 LVEF
65
eye finding to differentiate temporal arteritis from idiopathic intracranial hypertension
BOth have 6th CN palsy, but temporal arteritis also has Afferent pupillary defect (eye constricts with consensual but NOT direct light) and Flame hemorrhages from vasculature inflammation ICH might have increased IOP
66
MC organism of spinal epidural abscess
Staph aureus
67
when do you use UFH vs LMWH?
BOTH for unstable angina and NSTEMI management UFH if you choose to do sUrgery LMWH if you choose to approach conservatively
68
aortic dissection detection risk score (ADD-RS) purpose and values
whether or not to order a d-dimer or CTA when sus of an aortic dissection 0-1 = Order D-dimer. If d-dimer >500, order CTA (if < 500, there is a 97% chance there is no dissection) 2-3 = SKIP d-dimer and straight to CTA
69
indications for admitting pericarditis
temperature >38°C (100.4°F) subacute onset over weeks immunosuppression history of oral anticoagulant use associated myocarditis (elevated cardiac biomarkers, symptoms of heart failure) failure to respond to therapy with NSAIDs after 1 week of therapy, a large pericardial effusion (an echo-free space >20 mm) cardiac tamponade uremic pericarditis (renal failure) hemodynamic compromise most are common sense, mainly know if there is still a fever, no response to treatment for 1+ week, or a large, 20+ mm effusion
70
two reasons to keep acyclovir after getting cultures back for CSF
herpes! HSV HZV
71
which HA complaint is concerning of stroke if it is untreated?
temporal arteritis (giant cell), because the blood can back up and lodge
72
preferred cycloplegic
homatropine (hom on cycle)

Emergency Medicine (14 decks)

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