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Final Flashcards

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1
Q

Syphilis S/S

A
  1. Painless chancre
  2. Maculopapular rash, condyloma lata
  3. Neuro
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2
Q

Chancroid

A

Bubo - painful lesion under skin
LAD

Dx - gram stain neg rods in school of fish
Tx - Azithromycin

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3
Q

Painless lesion on genitals?

A

Syphilis

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4
Q

Lymphogranuloma venereum

A

C trachomatis
Small painless lesion, LAD, groove sign

Dx - clinical & serology
Tx - Doxy

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5
Q

Granuloma inguinale

A

Calymmatobacterium granulomatis
Beefy red, velvety ulcer w/ a rolled border
Painless

Dx - Wright stain
Tx - Doxy

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6
Q

Candidiasis

A

Thick cottage cheese discharge
Pruritis, dysuria
Dx - KOH - pseudohyphae
Tx - Fluconazole

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7
Q

Trichomoniasis

A

Foamy, stinky, greenish white discharge
Can live outside body - toilet seat
Strawberry cervix
Dx- pH >5, flagella on wet mount

Tx - Metronidazole (Flagyl)

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8
Q

Bacterial vaginosis

A

Smelly, fishy vaginal discharge

Dx - leukorrhea, clue cells, pH>5, +whiff test w/ KOH

Tx - Flagyl

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9
Q

Chlamydia

A

Discharge, odor, pelvic pain, bleeding
Fitz-Hugh-Curtis - hepatic

Dx - culture
Tx - Azithromycin + Doxy

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10
Q

N. gonorrhea

A

Discharge, odor, pelvic pain, bleeding

Dx - gram stain - Thayer Martin culture

Tx - Ceftriaxone + Azithromycin

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11
Q

Bartholin’s cyst

A

Infection of glands

Tx - I&D, marupialization of gland

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12
Q

Oligomenorrhea

A

Dec. frequency of menstruation

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13
Q

Menometrorrhagia

A

Excessive irregular vaginal bleeding

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14
Q

MCC post-menopausal bleeding

A

Atrophic endometrium

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15
Q

Abruptio placentae

A 
Often caused by abd trauma
Risk factors:
1. Cocaine
2. HTN
3. Smoking
4. Inc. maternal age 
5. >20wks gestation

Separation & bleeding

  1. Pain
  2. HOTN
  3. DIC
  4. Dark bleeding
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16
Q

Placentae previa

A

Implanted placenta overlaps the cervical os
NO pelvic - do US

  1. Little pain
  2. Bright red vaginal bleeding
  3. > 20 wks
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17
Q

Causes of bleeding in pregnancy

A
  1. Ectopic
  2. Spontaneous abortions
  3. Abruptio placentae
  4. Placentae previa
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18
Q

Uterine atony

A

Baby delivered - uterine doesn’t contract so bleeds

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19
Q

Causes of vaginal bleeding in kids

A
  1. Foreign bodies
  2. Genital trauma/sexual abuse
  3. Severe vulvovaginitis
  4. Submucosal leiomyomas (Fibroid)
  5. Cervical & endometrial polyps
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20
Q

MC genital CA women?

A

Endometrial

MC Sx - vaginal bleeding

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21
Q

When can you use a transvaginal US?

A

35 days

HCG >1500

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22
Q

Molar pregnancy

A

Uterus larger than what is expected for gestational age

US - uterine “snowstorm” appearance

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23
Q

Tx ectopic pregnancy

A
  1. Surgery

2. Methotrexate

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24
Q

Uterine rupture

A

Uterine pain w/o contractions, vaginal bleeding

Risk factors: C-section, cocaine, prostaglandins

Exam - tender, boggy uterine fundus, expanding uterus

Dx - US
Tx - Surgery

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25
Placental accreta
Little pain, bright red vaginal bleeding during delivery of placenta Clinical Dx Tx - Fisting, surgery
26
Leimyomas
Tumors of muscle origin, MC in blacks Dx - US Tx - NSAIDS, progesterone
27
Polycystic ovary syndrome
``` Triad 1. Obesity 2. Hirsutism 3. Oligomennorhea Dx - US, hormones Tx - OC ```
28
When to get C-section?
1. Fetal distress & vaginal delivery not imminent 2. Severe abruption w/ viable fetus 3. Life-threatening hemorrhage 4. Pt has failed trial of labor
29
When to get urgent hysterectomy?
1. After delivery of fetus if indistinct placental cleavage plane 2. Excessive hemorrhage 3. Placental accreta
30
Chadwick's sign
Blue-violet cervix from inc. vascularization
31
Hegar's sign
Soft & boggy cervical isthmus
32
What marks the start of the first stage of labor?
Bloody show
33
When does the first stage of labor end?
When the cervix is fully dilated & effaced Latent phase - slow cervical dilation to 4cm Active phase - rapid cervical dilation 4cm to completion
34
What is effacement?
The process of cervical thinning
35
How do you determine the position of a fetus?
Leopold maneuvers
36
Fetal HR decelerations
Early - represent head compression Variable - indicates cord compression Late - indicates uterine placental insufficiency - bad!
37
Sinusoidal tracing (Fetal HR)
Ominous sign indicating erythroblastosis fetalis, placental abruption, fetal hemorrhage & amnionitis w/ high mortality
38
What maneuver do you use to facilitate delivery?
Ritgen maneuver
39
Indications for episiotomy
1. Shoulder dystocia | 2. Breech delivery
40
Examination of placenta (after delivery)
1. Clots - placental abruption | 2. Missing cotyledones - incomplete separation
41
Interrupt labor
Can't do if >4cm dilated 1. Tocolytics (Mag sulfate/beta-mimetics) 2. Fetal maturation therapy 3. Bed rest & hydration
42
Dx premature labor
1. Nitrazine paper testing pH 7.1-7.3 - yellow paper 2. Ferning on a slide 3. Smear combustion
43
Chorioamnionitis
Infection around membranes Mom - uterine tenderness, fever, tachycardia, smelly d/c, leukocytosis Baby - Dec. activity, tachycardia, dec. viability Dx - vaginal fault fluid, cultures, amniocentesis studies
44
What is dystocia?
Abnormal labor progression
45
Maneuver to deliver breech baby?
Mauriceaux | Flex knees, sweep out legs, flex neck
46
Risk factor to uterine rupture?
Vaginal birth after C-section
47
How much blood volume?
7% body wt in kg of adults ~5L Kids 8-9%
48
Subfalcial herniation
1 cerebral hemisphere protrudes beneath the falx into opposite tentorial space
49
Uncal herniation
Uncus of temporal lobe protrudes through opening of tentorium Compression on CNIII, corticospinal tract & Brain stem Ipsilat fixed dilated pupil, contralat hemiparesis, dec. LOC Neuro emergency
50
Cerebellar tonsillar herniation
Compression of medulla Bradycardia, bradypnea, death
51
S/S postconcussive syndrome
1. HA 2. Dec. memory & attention 3. Insomnia 4. Dizziness
52
MC site of bleeding after TBI?
Subarachnoid hemorrhage 1. HA 2. Photophobia 3. Meningeal signs Inc. mortality compared to nontraumatic SAH
53
Talk & die?
Lucid then rapid deterioration Epidural hematoma - tear of middle meningeal artery
54
Who is most susceptible to subdural hematomas?
Tear of bridging veins Old people & drunks
55
At what GCS do you intubate?
<8
56
Cushing's phenomenon
1. Inc. ICP 2. HTN 3. Bradycardia
57
Tx inc. ICP
1. Mild hyperventilation 2. Elevate head of bed 3. Sedation 4. Mannitol IV
58
Which type of facet dislocation has neuro defecits?
Bilateral - displaced >50% of its width
59
Anterior cord syndrome
Cervical flexion injury Compresses ant. cord - corticospinal & spinothalamaic pathways Loss of motor function & pain & temp sensation distally Vibration, position & crude touch preserved
60
Central cord syndrome
Old people w/ hyperextension injury Central fibers of corticospinal & spinothalamic tracts Dec. strength & slightly dec. pain & temp sensation More in upper than lower extremities
61
Brown-Sequard syndrome
Hemisection of the cord Ipsilat loss of motor function, proprioception & vibratory sensation w/ contralat loss of pain & temp Best prognosis
62
NEXUS criteria for spinal imaging
1. Absence of midline cervical tenderness 2. NL level of alertness & consciousness 3. No evidence of intoxication 4. No focal neuro deficit 5. No painful distracting injury
63
When is MRI better than CT for spinal injuries?
Describing anatomy of nerve injury, herniated disks or spinal cord contusions
64
Neck zones
I - clavicles to cricoid II - cricoid to mandible III - mandible to base of skull
65
Dx hemothorax
CT - need chest tube
66
Prostate not palpable or high up?
Urethral disruption
67
Which GU traumas might not cause hematuria?
1. Pedicle injuries 2. Arterial thrombosis Amount of blood does not correlate to extent of injuries
68
Dx bladder rupture?
Retrograde cystogram
69
Dx testicular injury
Color doppler US
70
What is the Kleihauer-Betke test?
Measures amount of fetomaternal hemorrhage - counts maternal & fetal RBCs in maternal blood
71
Drop in BP in kids, what % blood loss?
25-30%
72
S/S epidural hematoma kids
Uncommon Period of lucency
73
S/S subdural hematoma in kids
1. Irritable 2. Vomiting 3. Seizures MC in infants
74
When to give anticonvulsants to kids?
Seizure lasting more than a few mins of kid w/ >2 seizures Phenytoin/Fosphenytoin
75
SCIWORA
Spinal cord injury w/o radiographic abnormality Seen in kids ``` Sx delayed for days 1. Paresthesias 2. Numbness 3. Weakness Leads to paralysis - get MRI ```
76
Tx hydrofluoric acid burns
1. Water irrigation 2. IV Ca2+ & Mg2+ 3. Topical calcium gluconate gel to bind fluoride 4. SQ & Intradermal injection of calcium gluconate DOES NOT cause coagulation necrosis
77
Parkland formula for burns
LR 4 mL X wt X BSA burned over initial 24h 1/2 over 1st 8h from time of burn, other 1/2 over next 16h For 2nd/3rd degree burns only
78
Tx sprains
1&2 - RICE 3rd degree - Ortho consult
79
Shoulder dislocation but no pulse, what do you do?
Reduce it before Xray
80
Compartment syndrome Dx
Clinical | >30-50 pressure
81
Leading cause of death by poison?
Carbon monoxide
82
DONT protocol for poisoning
Dextrose Oxygen Narcan Thiamine
83
Poison - causes of HTN?
``` Cocaine Thyroid supplements Sympathomimetics Caffeine Anticholinergics, amphetamines Nicotine ```
84
Poison - causes of HOTN?
``` Clonidine, Ca channel blockers Reserpine or other BP meds Antidepressants, aminophylline Sedative-hypnotics Heroin/other opiates ```
85
Poison - causes of tachycardia
Free base/other forms of cocaine Anticholinergics, antihistamines, amphetamines Sympathomimetics, solvent abuse Theophylline
86
Poison - causes of bradycardia
``` Propranolol/other beta-blockers, poppies (opiates), phenylpropanolamine Anticholinesterase drugs Clonidine, Ca channel blockers Ethanol/other alcohols Digoxin ```
87
Poison - causes of rapid respiration
PCP, pneumonitis (chemical) ASA/other salicylates Noncardiogenic pulm edema Toxin-induced met. acidosis
88
Poison - causes of slow respiration
Sedative hypnotics Liquor Opiates Weed
89
Poison - causes of hyperthermia
NMS, nicotine Antihistamines Salicylates, sympathomimetics Anticholinergics, antidepressants
90
Poison - causes of hypothermia
``` Carbon monoxide Opiates Oral hypoglycemics, insulin Liquor Sedative hypnotics ```
91
Poison - causes of miosis
1. Cholinergics 2. Clonidine 3. Organophosphates 4. Sedative hypnotics
92
Poison - causes of mydriasis
1. Antihistamines 2. Antidepressants 3. Anticholinergics 4. Sympathomimetics
93
Poison - causes of nystagmus
Horizontal - lithium, barbiturates, phenytoin, carbamazepine, alcohol Vertical/rotary - PCP
94
Poison - causes of seizures
``` Organophosphates TCAs INH, insulin Sympathomimetics Camphor, cocaine Amphetamines, anticholinergics Methylxanthines (Theophylline, caffeine) PCP Benzo withdrawal Ethanol withdrawal Lithium, lidocaine Lead, lindane ```
95
Cholinergic toxidrome
Organophostphates - insecticides ``` Diarrhea, diaphoresis Urinary +/- fecal incontinence Miosis Bradycardia, bronchosecretions, bronchospasm Emesis Lacrimation Salivation ```
96
Anticholinergic toxidrome
Antihistamines, TCA Hot as a hare, red as a beet, dry as a bone, blind as a bad, mad as a hatter
97
Sympathomimetic toxidrome
Cocaine, amphetamines, decongestants, caffeine, theophylline 1. Diaphoresis 2. Mydriasis 3. Tachycardia 4. HTN 5. Hyperthermia 6. Seizures, agitation, hallucinations
98
Narcotic/sedative/alcohol toxidrome
1. Miosis 2. Hypoventilation 3. Coma 4. Bradycardia 5. HOTN
99
Methods of GI decontamination
1. Emesis 2. Gastric lavage 3. Activated charcoal 4. Multiple dose activated charcoal
100
What is used for whole body irrigation?
Golytely
101
Poison - when to use dialysis?
1. Salicylates 2. Lithium 3. Theophylline 4. Toxic alcohols
102
Antidotes
``` Acetaminophen - N-acetylcysteine Carbon monoxide - O2/HBO Coumadin - Vit K/FFP Digoxin - Digibind Narcotics - Naloxone Beta-blockers - Glucagon Methanol/ethylene glycol - Ethanol/4-MP TCAs - Sodium bicarbonate ```
103
Benzoyl ecgonine in urine, what did Pt take?
Cocaine - present for 3 days
104
Tx cocaine OD
1. IV diazepam 2. IVF 3. Rapid cooling if high temp NO beta-blockers
105
Tx barbiturate withdrawal
Phenobarbital
106
Tx benzo OD
Supportive
107
Tx GHB OD
Supportive
108
Tx digoxin OD
1. Correct hypokalemia in chronic, hyperkalemia in acute 2. Digibind Bradycardia/AV blocks? Atropine/pacing Tachyarrhythemias - phenytoin/lidocaine
109
What is the most lethal beta-blocker OD?
Propranolol
110
Toxic dose of acetaminophen?
150 mg/kg If 4h level above nomogram, give antidote or AST>50 If started w/in 8h, Pt will do fine
111
NAC indications
1. Serum acetaminopehn level over Tx line 2. Any detectable level >24h post ingestion 3. Level won't be avail. 8h post ingestion 4. Preggers 5. Time of ingestion can't be determined 6. Fulminant hepatic failure 7. Repeated supratherapeutic level - serum level exceeds 20, AST/ALT elevated
112
S/S salicylate OD
1. Resp. alkalosis & met. acidosis 2. Hypoglycemia, low Na/K/Ca 3. Pulm. & cerebral edema - dialysis
113
Pt says vision is like 'stepping out into a snow storm'
Methanol poisoning
114
Dx methanol poisoning
1. Severe AG met. acidosis from formic acid 2. Elevated osm gap >10 3. Serum methanol & ethylene glycol level
115
Stages of ethylene glycol poisoning
1. Acute neuro stage 2. Cardiopulm. stage 3. Renal stage 4. Delayed neuro sequelae stage
116
Dx ethylene glycol poisoning
1. Ethylene glycol level 2. +/- crystalluria 3. QT prolongation 4. AG met. acidosis 5. Elevated osm. gap
117
Tx ethylene glycol & methanol poisoning
1. Bicarb 2. ADH enzyme blockade 3. Dialysis 4. Ethanol/Fomepizole 5. Methanol? Folinic acid 6. Ethylene glycol - Thiamine & pyridoxine
118
Tx isopropyl alcohol
1. Supportive | 2. Hemodialysis for severe HOTN
119
Tx carbon monoxide poisoning
<10% nonsmokers 1. 100% O2 2. Hyperbaric O2
120
Phases of frostbite
1. Prefreeze - vasospasm & plasma leakage 2. Freeze-thaw phase - tissue ice crystals form 3. Vascular stasis phase - blood vessels damaged & plasma leakage, coagulation & shunting 4. Late ischemic phase - AV shunting, thrombosis, ischemia lead to gangrene & autonomic dysfunction
121
Degrees of frostbite burns
1. Numb, erythema, swelling, desquamation 2. Blisters w/ surrounding edema & erythema 3. Deeper blisters w/ purple bloody fluid, tissue loss of entire thickness of skin 4. Involves tissue below the dermis w/ muscle & bone involvement
122
Tx frostbite
1. Correct hypothermia 2. Rapid rewarming - warm water bath 104-108 F until skin is soft, pliable & erythematous 3. Analgesics 4. Tetanus prophylaxis 5. Aloe vera cream 6. Ibuprofen
123
What is Chilbain?
aka pernia Long-term intermittent exposure to dry/damp nonfreezing temps Small, erythematous superficial ulcerations, plaques, nodules & vesicles appear 12h after cold exposure Pruritis & burning Tx 1. Supportive w/ gentle rewarming 2. Skin moisturizers
124
Trench foot
aka immersion foot Several days of exposure to wet, cold conditions, temp above freezing Tingling & numbness, foot becomes pale, mottled, pulseless, immobile then hyperemic hours after rewarming w/ pain +/- bullae Tx - elevation, rest, avoid cold & wet
125
Primary vs. secondary hypothermia
<95F - need rectal temp 1 - accidental - not wearing enough clothes 2 - complication of systemic disease that compromises thermoregulatory mechanism
126
When do you get Osborn J waves?
Hypothermia <33C
127
Tx arrhythmia in hypothermia Pt?
Rewarm first
128
Heat stroke
Heat exhaustion + Temp >40C/104F + AMS | +/- anhidrosis/sweating
129
Tx shivering due to heat stroke
Chlorpromazine/diazepam
130
Acute mountain sickness
Nonacclimized people who rapidly ascend to 6600ft or + Caused by hypobaric hypoxia 1. HA 2. GI Sx 3. Dizziness 4. Sleep disturbance Tx 1. Oxygen 2. Acetazolamide - inc. oxygenation 3. Aspirin/acetaminophen for HA 4. Dexamethasone - severe cases
131
Dec. exercise tolerance & dry cough in high altitude?
HAPE - high altitude pulm. edema
132
Tx HAPE
1. Immediate descent 2. Bedrest 3. Oxygen 4. Keep Pt warm 5. CPAP/BiPAP
133
Most lethal altitude illness?
HAPE
134
Most severe altitude illness?
HACE
135
S/S & Tx HACE
High altitude cerebral edema Confusion, hallucination, ataxia, slurred speech, seizures, focal deficits, coma ``` Tx 1. Descent Can't descend? Steroids, oxygen, hyperbaric (Gamow) bag 2. Oxygen 3. Rest 4. Dexamethasone ```
136
Snow blindness
aka ultraviolet keratitis Severe pain, gritty sensation, tearing, chemosis, photophobia, eyelid swelling Heals w/in 24h
137
Barotrauma of descent
1. Barotitis - ear squeeze 2. External ear squeeze 3. Sinus barotrauma 4. Inner ear barotrauma 5. Face, tooth or dry suit squeeze
138
Barotrauma of ascent
1. Pulm. barotrauma 2. Decompression sickness (the bends) 3. Arterial air embolism
139
Barotrauma + neuro Sx?
Cerebral arterial gas embolism
140
Decompression sickness
Gas bubbles in blood & body tissues Type I - pain only II - neuro, vestibular & cardiopum III - Type II + arterial gas embolism
141
Type barotrauma ascent
1. 100% oxygen 2. IVF 3. Hyperbaric oxygen chamber
142
MCC inhalation injury
Fire
143
MC toxic cause of death from fire related inhalation
Carbon monoxide
144
Tx thermal burns to airway
Intubate
145
Lightning strike can cause?
1. Asystole 2. Burns 3. Cataracts, ocular trauma, mydriasis/anisocoria 4. TM rupture 5. Fx/dislocations 6. Paralysis transient, coma, AMS
146
Snakebite - pain out or proportion?
Pit viper
147
Snakebite - numbness?
Coral snakes Red on yellow kill a fellow, red on black venom lack
148
CK MB elevated w/ electrical injury, what's injured?
Skeletal - not heart
149
How to get bee sting off you?
Scrape
150
Tx Black widow bite
aka Latrodectus Woodpiles - black body w/ 2 red spots 1. Clean 2. Tetanus 3. Muscle relaxants/analgesics for spasms 4. Antivenom
151
Tx brown recluse bite
aka Loxosceles Mainly in S central US ``` Brown w/ violin shaped mark on back Bull's eye mark then ulcer 1. Clean 2. Tetanus 3. Analgesics/abx ```
152
Fitz-Hugh-Curtis in woman
RQ pain, nl LFTs, +Chlamydia Dx - CT Tx - same as PID
153
Tx PID
Cefotetan + Doxy IV OutPT? - Ceftriaxone + Doxy +/- Flagyl

Emergency Medicine (5 decks)

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