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Final review Flashcards

1
Q

Abx you can and cannot give for OM with perforation or tympanostomy tube

A

Avoid eardrops containing aminoglycosides
-Avoid gentamicin, neomycin sulfate, or tobramycin in the presence of TM perf
-Results in sensorineural hearing loss
If pt has a perf
-PO abx: amoxicillin, bactrim, cefixime, augmentin
-Topical: Ofloxacin gtts

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2
Q

What object inserted into the nose would be concerning?

A

Button batteries, magnets anywhere in the body are of particular concern
Electrical current has the potential to necrose tissue
Unilateral rhinorrhea usually indicates mechanical nasal obstruction

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3
Q

Most common site for anterior nosebleed

A

Kiesselbach’s plexus

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4
Q

DDx for exudate on surface of tonsils

A

Strep and mono
-Mono: posterior lymph nodes and splenomegaly
Most cases of pharyngitis are viral in origin but MC bacterial: GABHS (strep pyogenes)
-Tx for GABS: PCN
-If allergic: erythromycin or 1st gen cephalosporin

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5
Q

Modified Centor criteria: age

A

+1: 3-14

0: 15-44
- 1: >45

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6
Q

Modified Centor criteria: exudates/tonsillar swelling

A

+1: positive

0: none

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7
Q

Modified Centor criteria: temp >38 (100.4)

A

+1: yes

0: no

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8
Q

Modified Centor criteria: cough

A

+1: absent

0: present

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9
Q

Modified Centor criteria: total score

A

-1 to 1: no Cx or abx
2-3: Cx and tx
+4-5: no cx needed, tx

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10
Q

DDx for pseudomembrane on tonsils

A

Diphtheria
High propensity to obstruct airway
Sx: high fever, dysphagia, drooling, respiratory distress
Tx: diphtheria antitoxin. Abx: 1st line erythomycin 2nd line: Pen G

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11
Q

What to do in epiglottitis in peds

A

O2
Keep child calm
Ensure an adequate airway (immediate airway management)
Not stable or has signs of resp distress or pending respiratory arrest: first attempt ventilation with BVM, with correct positioning, correct size face mask, and adequate ventilation with use of end-tidal CO2

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12
Q

What not to do with a child with epiglottitis

A

Oral airway should NOT be placed
Unnecessary blood tests, IV access, and tongue depression with a tongue blade should be avoided
Visualization of the epiglottis should not be performed unless staff members capable of securing an airway are present

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13
Q

What is the best abx to use for facial swelling

A

Clindamycin

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14
Q

How to calculate body surface area

A

Total head 9% (back or front of head: 4.5% each)
Front side of each arm: 4.5%, back side of each arm: 4.5% (ENTIRE arm 9%)
Each half of torso: 18% each
Front of each leg: 9%, back side of each leg 9%
Genitals/perineum: 1%

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15
Q

Parkland formula for fluid resuscitation in adult burn pts

A

4 mL lactated ringers x weight (kg) x TBSA (%) over initial 24 hrs

  • 50% in 1st 8 hrs from time of burn
  • 50% over remaining 16 hrs
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16
Q

First-degree burn

A

Epidermis only
Erythema; blanches with pressure
Sensation: intact; mild to moderate pain
Healing: 3-6 days without scarring

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17
Q

Superficial second degree burn

A

Epidermis and superficial dermis; skin appendages intact
Erythema, blisters, moist, elastic; blanches with pressure
Sensation: intact; severe pain
Healing: 1-3 wks; scarring unusual

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18
Q

Deep second degree burn

A

Epidermis and most dermis; most skin appendages destroyed
White appearing with erythematous areas, dry, waxy, less elastic; reduced blanching to pressure
Sensation decreased; may be less painful
Healing > 3 weeks; often with scarring and contractures

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19
Q

Third degree burn

A

Epidermis and all of dermis; destruction of all skin appendages
White, charred, tan, thrombosed vessels; dry and leathery; does not blanch
Sensation: anesthetic; not painful (although surrounding areas of second-degree burns are painful)
Healing: does not heal, severe scarring and contractures

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20
Q

Burn unit referral criteria

A

Partial-thickness burns >10% TBSA
Burns that involve face, hands, feet, genitalia, perineum or major joints
Third-degree burns in any age group
Electrical burns, including lightning injury
Chemical burns
Inhalation injury
Burn injury in pts with preexisting medical d/os that could complicate management, prolong recovery or affect mortality
Any pts with burns and concomitant trauma (such as fxs) in which the burn injury poses the greatest risk of morbidity and mortality
Burned children in hospitals without qualified personnel or equipment for the care of children
Burn injury in pts who will require special social, emotional, or long-term rehabilitative intervention

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21
Q

Erlichiosis

A

Caused by erlichia species- amblyomma americanum (Lone Star tick)
Found in southeast, south central, and mid-Atlantic US, 1-21 day incubation

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22
Q

Sx of erlichiosis

A 
High fever
HA
N/V
Malaise
Abd pain
Anorexia
Myalgias
Occasional rash
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23
Q

Erlichiosis triad

A

WBC: low
Platelets: low
LFTs elevated: (2-3x nl)

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24
Q

Tx of erlichiosis

A

7-14 day doxycycline in adults and children

Rifampin in pregnancy

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25
Appendicitis
Periumbilical pain that radiates of RLQ MCC: fecalith For kids they can have pain anywhere on the abdomen
26
PE findings for appendicitis
Pos McBurney's, Rovsing's, Psoas, obturator, bump sign Early: vague periumbilical pain, anorexia, n/v Later: classic presentation- pain migrates to RLQ, fever if late finding -If sudden decrease in pain, consider perforation
27
Labs for appendicitis
CBC UA Urine hcG Nl WBC does not r/o appendicitis
28
Imaging for appendicitis
CT with IV and oral contrast is study of choice, u/s | -Pericecal inflammation, abscess, periappendicular phlegm or fluid collections
29
Tx for appendicitis
Surgery | Abx- Pip-TZ, ampicillin/sulbactam
30
Diverticulitis sx
``` LLQ abdominal pain Steady discomfort Tenesmus- the urgency equivalent of poop Change in BM N/V Low-grade fever ```
31
Labs for diverticulitis
CBC CMP UA Hemoccult may be pos
32
Imaging for diverticulitis
CT abd/pelvis with IV and oral contrast
33
Tx for diverticulitis
IV fluids Abx- cipro + metronidazole Clear liquid diet Surgery if complicated
34
Acute cholecystitis
``` RUQ or epigastric pain >5 hrs Fat Female Forty Fertile ```
35
Sx of acute cholecystitis
Colicky pain that becomes steady and increases in intensity N/V Low fever Anorexia
36
PE of acute cholecystitis
Pos Murphys. Pain radiation to R shoulder or subscapula | Pain worse after eating, esp high fat meal
37
Labs of acute cholecystitis
CBC CMP UA Increased WBCs, LFTs, bilirubin (BR increases after 24 hrs)
38
Imaging of acute cholecystitis
U/s is study of choice, CT Pos sonographic Murphy's sign Other indicators on u/s- thickened GB wall, gallstones, GB distention, pericholecystic fluid
39
Tx of acute cholecystitis
Cholecystectomy | Abx- ceftriaxone + metronidazole
40
Ascending cholangitis
EMERGENCY | Complete biliary obstruction + bacterial superinfection
41
Presentation of ascending cholangitis
Charcot's triad: fever + jaundice + RUQ abdominal pain | Reynold's pentad: Charcot's + hypotension + AMS (indicated sepsis)
42
Labs for ascending cholangitis
Leukocytosis and elevated bili | Alk phos increased
43
Imaging for ascending cholangitis
U/s, ERCP is optimal (diagnostic and therapeutic)
44
Tx of ascending cholangitis
Triple coverage -Ampicillin, gentamicin, clinda IMMEDIATE surgical consult
45
Spontaneous bacterial peritonitis presentation
Ascites + fever= SBP until proven otherwise Abd pain, ascites, fever, usually confusion/AMS MC in pts with portal HTN (EtOH)
46
Diagnosis of spontaneous bacterial peritonitis
Diagnostic paracentesis | 250+ neutrophil count of ascitic fluid OR if <250, positive ascitic fluid cultures (do not delay abx)
47
Tx of spontaneous bacterial peritonitis
3rd gen cephalosporin (i.e., cefotaxime) is preferred
48
MC organisms of spontaneous bacterial peritonitis
E. coli + Klebsiella
49
Presentation of intestinal obstruction
Result of mechanical blockage or loss of nl peristalsis Crampy, intermittent progressive abdominal pain with inability to have a BM or pass flatus Vomiting Bilious in proximal obstructions, feculent in distal obstructions Abd distention May have surgical scars, hernia or masses on exam that can provide clues to site of obstruction Localized to generalized tenderness Active, high pitched BS that later become absent Tympany with percussion
50
Workup for intestinal obstruction
Rectal exam and hemoccult: stool in rectum does not exclude obstruction CBC and CMP
51
Imaging of intestinal obstruction
``` Abd series (plain films) may show air fluid levels and multiple dilated loops of bowel CT scan abd/pelvis (with IV contrast) is diagnostic ```
52
Tx of intestinal obstruction
``` Hospitalize IV fluids Nasogastric decompression NPO Surgery ```
53
Criteria for dx of PID
Laparoscopy is the criterion standard, but the dx of PID in EDs is often based on clinical criteria
54
Minimal criteria needed to diagnose PID
Pelvic or lower abd pain No other cause other than PID can be identified One or more of the following: -Cervical motion tenderness (chandelier test) -Uterine tenderness -Adnexal tenderness
55
Additional criteria that improve diagnostic specificity include:
Oral temp > 38.3 (101) Abundant cervical or vaginal mucopurulent d/c Abundant WBCs on saline microscopy of vaginal secretions Elevated ESR Elevated CRP Lab evidence of cervical infection with N. gonorrhoeae or C. trachomatis (via culture or DNA probe)
56
MC organisms responsible for bronchitis in adults
Viruses (60%)-MC: influenza A + B or parainfluenza | Mycoplasma species, Chlamydia pneumoniae, S. pneumoniae, M. catarrhalis, H. flu
57
Intermittent asthma
Nighttime awakenings less than or equal to 2/mo Less than or equal to 2 days/wk SABA use for symptom control No interference with nl activity Nl FEV1 during exacerbations; FEV1 >80% predicted; FEV1/FVC nl
58
Mild persistent asthma
``` Sx >2 days/wk Nighttime awakenings 3-4/mo >2 days/wk but not daily; not >1x on any day SABA use for symptom control Minor limitation with nl activity FEV1>80% predicted; FEV1/FVC nl ```
59
Moderate persistent asthma
Daily sx >1x/wk but not nightly nighttime awakenings Daily SABA use for symptom control Some limitation with nl activity FEV1 60-80% predicted; FEV1/FVC reduced 5%
60
Severe persistent asthma
Sx throughout the day Nightly nighttime awakenings Several times/day SABA use for symptom control Extreme limitation with nl activity FEV1 <60% predicted; FEV1/FVC reduced >5%
61
Clinical presentation of respiratory failure
Tachypnea and dyspnea; crackles upon auscultation
62
Clinical setting of resp failure
Direct insult (aspiration) or systemic process causing lung injury (sepsis)
63
Radiologic appearance and lung mechanics of resp failuare
Radiologic: 3-quadrant or 4-quadrant alveolar flooding- "white out" Lung mechanics- diminished compliance
64
MC pathogen with cat bites
Pasturella multocida Infection <24 hrs: P. multocida, 10-14 days amox-clav, cefuroxime axetil, doxycycline If >24 hrs: strep- irrigate all penetrating wounds -LAD- Bactrim (TMP-SMX), Rifampin
65
S/sx of cat bites
Progressively growing red, swollen area. Hand is MC location. Will see puncture wound and lacerations
66
What is P. multocida resistant to?
Dicloxacillin Cephalexin Clindamycin Some to erythromycin
67
NSTEMI characteristic findings on EKG
ST depression Transient ST elevation (absence of persistent ST elevation) New T-wave inversion Positive troponins
68
What is the MCC of syncope
Vasovagal
69
Potential causes of syncope
``` Sick sinus syndrome PE Anaphylaxis Severe aortic stenosis MVP Pulm HTN Sudden cardiac arrest HCM Cor pulmonale Orthostatic hypotension Hypoglycemia QT prolongation ```
70
What are meds that can cause QT prolongation?
Azithromycin TCAs Zofran Others
71
BV typical organism
Gardnerella vaginalis
72
BV presentation
Fishy smell on KOH prep and increased pH
73
D/c in BV
Fishy, watery, and grayish
74
Microscopy in BV
Clue cells
75
Tx of BV
Metronidazole or clindamycin | Tx of male partner not indicated
76
Typical organism for trich
Trichomonas vaginalis
77
Presentation of trich
Severe itching and increased pH | Strawberry cervix and petechiae
78
D/c of trich
Yellow and green
79
Microscopy of trich
Motile trichomonads
80
Tx of trich
Metronidazole for pt and partner
81
Typical organism of yeast
Candida albicans
82
Presentation of yeast
Itching, burning, erythema, and decreased pH
83
D/c of yeast
Cottage cheese
84
Microscopy of yeast
Pseudohyphae- more pronounced with KOH prep
85
Tx of yeast
Fluconazole or nystatin Tx of male partner not indicated In pregnancy, treat with topical miconazole
86
Abortive treatment for migraine
NSAIDs Acetaminophen Triptans and ergot alkaloids
87
Prophylactic tx for migraine
BBs TCAs Divalproex CCBs
88
Lyme dz is usually diganosed through what?
Hx | Most are unaware of bite, late spring-early fall, outdoor activity
89
Organism of Lyme dz
Borrelia burgdorferi
90
Stage I Lyme dz
Target lesion/erythema migrans 2-20 days after bite
91
Stage II Lyme dz
``` Multiple lesions Fever LAD Arthralgias Splenomegaly Cardiac abnormalities Flu-like sx May develop into neurologic dz ```
92
Stage III Lyme dz
``` Chronic arthritis Myocarditis Subacute encephalopathy Axonal polyneuropathy Leukoencephalopathy ```
93
Tx of Lyme dz
21 days of doxycycline, amoxicillin, cefuroxime, clarithromycin, azithromycine or ceftriaxone
94
Classic findings of Rocky Mountain Spotted Fever
Rickettsia rickettsii bacteria | Sx: HA and high fever, rash on wrist/ankles then spreads (little red spots of over)
95
Tx of Rocky Mountain Spotted Fever
Doxy x7-14 days BID | Alternative: Chloramphenical QID x 7-14 days
96
Post-streptococcal glomerulonephritis
Seen most commonly following GABHS infection and occurring on average 7-10 days after initial infection Abrupt onset of nephritic symptoms and AKI
97
Post-streptococcal glomerulonephritis
``` HTN Dark-reddish brown urine Decreased urine output Facial swelling Protein in urine RBC casts ```
98
Lab findings in post-streptococcal glomerulonephritis
UA: hematuria, proteinuria, RBCs, RBC casts
99
Tx of post-streptococcal glomerulonephritis
Supportive | High-dose steroids
100
Hand foot mouth dz
Coxsackie A16 virus | Common in kids during summer and fall
101
S/sx and tx hand foot mouth dz
Low-grade fever Painful mouth ulcers Flat-reddish-gray vesicles on hands and feet Tx: supportive
102
Rabies vaccine schedule
For immunocompetent: 0, 3, 7, 14 days following injury | Immunocompromised: 0, 3, 7, 14, and 21 days following injury
103
Ovarian cysts
MC ovarian mass in women of reproductive age Tx: Large (>5 cm) or symptomatic may undergo surgical resection Small asymptomatic cysts managed conservatively
104
Ovarian torsion
An emergency Colicky pain and N/V more likely to be torsion, pain that radiates to groin Worse with menstrual cycle is more likely to be cysts If a cyst ruptures, emergency Get an u/s with doppler
105
Ectopic pregnancy
Should be suspected in any woman in reproductive age with: Abd/pelvic pain (referred shoulder pain may be present) Irregular bleeding Amenorrhea Temp >38 C is unusual (look for infectious cause)
106
PE of ectopic pregnancy
Cervical motion tenderness | Adnexal mass
107
Presentation of ruptured ectopic pregnancy
Hypotension | Signs of shock
108
Workup for ectopic pregnancy
Pelvic u/s | Elevate b-hcG with no signs of uterine gestational sac by u/s is highly suspicious
109
Tx of ectopic pregnancy
Methotrexate or surgery
110
How does tooth numbering work?
Starts at upper right, goes to upper left Then lower left to lower right Wisdom teeth are 1, 16, 17, 32
111
Tooth numbering types from "inside out"
``` Medial incisors Lateral incisors Canines 1st and 2nd premolars 1st and 2nd molars 8 incisors, 4 canines, 8 premolars, 12 molars (including wisdom teeth) ```
112
Ludwig's angina
MC presentation is elderly debilitated man | Most disease spread from infected mandibular teeth
113
PE of retropharyngeal abscess
Woody induration | TTP on submandibular space
114
S/sx of retropharyngeal abscess
Difficulty speaking Muffled voice Constitutional sx Open mouth
115
Tx for retropharyngeal abscess
I and D STAT- Unasyn or Pen G + metro or clinda | Imunnocompromised: Cefepime, Zosyn

Emergency Med (11 decks)

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