In Service 2015 Flashcards
(127 cards)
1
Q
Shock in drowning
A
Shock is rare in drowning
R/o trauma
C spine precautions
2
Q
Spinal shock
A
spinal cord shock
the loss of muscle tone and reflexes with complete cord syndrome during the acute phase of injury
typically lasts <24hrs
2
Q
Drowning survival factors
A
Primary factor, duration of drowning
Low core temp correlates with bad outcome
3
Q
Neurogenic shock
A
loss of autonomic tone
warm/hypotension 2/2 peripheral vasodilation
4
Q
Nitrogen narcosis
A
X
5
Q
Decompression sickness
A
type I - the bends
-severe arthalgias and pruritis
type ii - more serious
nitrogen bubble formation in high-fat-containing tissues like white matter
significant spinal cord damage can occur
6
Q
Squeeze syndromes
A
x
7
Q
Endometriosis
A
Most commonly involves ovary
8
Q
Boerhaaves
A
Everything happens on left
9
Q
Sigmoid volvulus
A
Bent inner tube
10
Q
Cecal volvulus
A
Coffee bean
11
Q
Midgut volvulus
A
Newborn
12
Q
Indication for antibiotic ppx in endocarditis
A
x
13
Q
Absolute contraindications to thromombolysis in ACS
A
x
14
Q
Ventricular aneurysm
A
Ekg ***
15
Q
heart block in inferior MI
A
Wenckebach
2nd degree Type I
16
Q
heat block in anterior MI
A
2nd degree type II
High grade AV block
Get pacer ready
17
Q
how to manage HTN in pheochromocytoma or MAOI
A
phentolamine then BB
no BB 1st due to unopposed alpha
18
Q
HTN and cocaine
A
IV fluids
benzos
19
Q
1 electrolyte abnormality in AICD dysrhythmias
A
hypoMag
20
Q
cardiac pacemaker
A
pace sense trigger program shock
21
Q
most specific troponin
A
Troponin I
22
Q
tx of stable afib/flutter
A
CCB/BB
amiodarone
ibutilide - class III antidysrhythmic
anticoagulate
24
Q
hypertrophic CM: tx
A
beta blocker
25
restrictive CM: tx
diuretics
| dig
25
pericarditis: tx
nsaids, colchicine
26
idiopathic dilated CM: tx
diuretics
dig
vasodilators
27
penetrating chest trauma, pulseless
ed thoracotomy
28
atypical PNAs
legionella (macrolide)
mycoplasma (macrolide)
chlamydia (tetracycline/macrolide)
29
legionella
```
non productive cough
elevated ast/alt
hyponatremia
gram stain w/ PMNs but no organsims
diarrhea
relative bradycardia
```
30
Contraindications to arthroscentesis
Overlying cellulitis
| Bacteremia
31
EKG findings in HOCM
high QRS voltage
early R wave transition
TWI in anterior leads
deep narrow Q waves in lateral leads
diagnostic test of choice, echo
32
Intraosseous line peds
x
proximal tibia is the preferred site, followed by
distal tibia, and
distal femur
humerus, clavicle and calcaneous held in less regard
33
Conscious sedation
| Benzodiazepine/opioid
give pain control first
Fentanyl 1.5-2 mcg/kg
Versed 0.05-0.1 mg/kg
34
causes of increased anion gap metabolic acidosis
ketones, uremia, lactic acidosis, toxic alcohols, salicylates
35
peripheral cyanosis w/o associ central cyanosis
low cardiac output states including dilated cardiomyopathy
environmental exposure to cold w/ vasoconstriction
arterial or venous occlusion
redistribution of blood flow
36
Midazolam:
Intubating dose
Conscious sedation dose
Intubating dose - 0.2 mg/kg
| Conscious sedation dose - versed 0.05-0.1 mg/kg
37
kleb pneumo
alcoholic, cough, black/maroon sputum
abscess/empyema
gram neg rods in pairs
rx: cephalosporin + macrolide (eg gentamycin)
38
PCP pna tx
bactrim
pentamine
IV steroids if paO2 <70
39
peritonsillar abscess
sore throat, drooling, muffled voice
aspiration
rx penicillin, clindamycin
polymicrobial (GABHS)
40
ludwig's angina
sore throat, drooling, muffled voice
organism
polymicrobial (aerobes, anerobes)
rx unasyn, clinda
airway!
41
retropharyngeal abscess
sore throat, drooling, muffled voice
stiff neck, extention more comfortable
ent
iv abx (clinda, unasyn)
icu admit
42
ethmoid fx
csf rhinorrhea/meningitis
43
posterior nose bleed
pack
| admit
44
most common site of sinusitus
maxillary sinusitis
45
cavernous sinus thrombosis
sphenoid/ethmoid sinusitis
46
potts puffy tumor
frontal sinusitis
47
periorbital/orbital cellulitis
ethmoid sinusitis
48
tripod fx
punched in the cheek
zygomaticofrontal suture, sygomatic arch, infraorbital foramen
flat cheek
periorbital sweling
diplopia
anesthesia of the cheek, upper teeth, lip and gums
49
ellis type iii dental fx
broken tooth
blood on tooth, pulp involved
rx calcium hydroxide paste - paste on tooth, protects until they can get to the dentist
50
seat belt injuries
chance fx
rectus sheath hematoma
intestinal perf
51
MC organ injured following blunt abd trauma
splenic lac
52
MC organ injured following penetrating abd trauma
liver lac
53
chancroid
1 g azithro or
250 mg im ctx
painful ulcer, friable, jagged edges, inguinal bubos
etiology H Ducrei
54
pre eclampsia tx
hydralazine, labetalol
55
beefy red velvety ulcers, std
granuloma inguinale
56
glucagon
insulin antagonist
stimulates cAMP synthesis to accelerate hepatic glycogenolysis and gluconeogenesis
relaxes smooth muscle of the gi tract
57
drugs that are radioopaque
chipes
```
chlorohydrate
heavy metals
iron
phenothiazines
enteric coated
solvents
```
58
rotator cuff tears
| involve which muscles
subscapularis
supraspinatus
infraspinatus
teres minor
59
rotator cuff tears
| most commonly injured
supraspinatus
60
assoc nerve injury in humeral shaft fx
radial
61
assoc nerve injury in elbow fx
median, ulnar
62
assoc nerve injury in colles/smith fx
median
63
assoc nerve injury in sacral fx
cauda equina
64
assoc nerve injury in acetabular fx
sciatic
65
assoc nerve injury in posterior hip dislocation
sciatic
66
assoc nerve injury in anterior hip disloc
femoral
67
assoc nerve injury in knee dislocation
peroneal/tibial
68
assoc nerve injury in lateral tibial plateau fx
peroneal
69
supracondylar fx assoc w/
volkmanns ischemic contracture
70
compartment pressures
normal = 10 mmHg
| abnormal >30 mmHg
71
Lisfrac
fx dislocation at the base of the 2nd metatarsal
unstable fx
keystone of midfoot
requires ORIF
MC complication is degenerative arthritis
72
Jones fx
fx of the 5th metatarsal
| high incidence of delayed/nonunion
73
anterior hip dislocations
assoc complications
10% of hip dislocations
abducted, flexed, externally rotated
femoral vein/artery thrombosis
w/ pulmonary embolism
74
posterior hip dislocations
assoc complications
90% of hip dislocations
```
flexed knee strikes dashboard
shortened
adducted
internally rotated
flexed at the ?knee]
```
avascular necrosis of femoral head
75
felon
organism
staph aureus
I&D, antibiotic
for I&D incise laterally - divide all the septa when you go in laterally
76
flexor tendon synovitis
organism
tx
staph>strep
surgical debridement, iv antibiotics PCN/cephalosporin
77
bells palsy
forehead sparing?
no forehead sparing
forehead sparing suggests central lesion
78
hangmans fx
mechanism
hyperextension
80
anterior cord syndrome
hyperFlexion
motor paralysis distal to lesion
loss of pain/temp
proprioceptions/vibration intact
80
pontine hemorrhage
```
pinpoint pupils
occipital headache
hyperventilating
coma
decerebrate posturing
```
81
brown sequard syndrome
penetrating injury
ipsilateral loss of motor, position, vibration
contralateral loss of pain and temp
82
brown sequard syndrome
penetrating injury
ipsilateral loss of Motor, Position, Vibration
contralateral loss of pain and temp
83
MC vessel involved in stroke
mca
84
double vision lateral gaze
MS
85
erythema multiforme
pattern?
associ w/?
target lesions
associ w/
malignancy
mycoplasma
```
DRUGS (SOAP)
sulfa
oral hypoglycemic agents
anticonvoulants
pcn
```
86
Vaccines in pregnancy
Live virus vaccines including
MMR, polio, varicella and intranasal influenza should not be administered.
87
Mgmt of hypertension in pregnancy
Labetalol
Methyldopa
Add long acting nifedipine if either of above fail to control bp
Contraindicated in pregnancy:
ACEI, ARBs
Toxic effects on fetal scalp, lungs and kidneys
88
Side effects of high or toxic levels of mag
Tx?
```
Flushing
Diaphoresis
Hypothermia
Hypotension
Flaccid paralysis
Respiratory depression
```
When levels are approaching toxicity patellar reflexes diminish and respiratory rate slows
Tx: Calcium gluconate
89
Massive hemothorax
1500 cc
| 200cc/hr x 2 hrs
90
Endometriosis
Fever
| Foul smelling profuse bloody discharge
91
Radial head fx
| Sail sign
X
92
Ovarian cysts less than ---cm can be managed expectantly
8
93
Most common skull fx in kids?
Parietal
94
Chest tube size for hemothorax
36F
95
Mgmt of clenched fist injury
X
96
Mgmt of toxic mega colon
Antibiotics, steroids, fluids
97
Tracheobronchial
MC w/in 2 cm of carina
98
Strawberry cervix
Trich
99
Salter Harris II
Most common
100
Rolando fx
x
101
Bennetts fx
X
102
Boxer's fx
X
103
Boutonnière deformity
X
104
Mallet finger
x
105
Jersey finger
X
106
Supra condylar fx
Brachial a injury
| Volkmann's contracture
107
Lunate
X
108
Perilunate
X
109
MCC of lower GI bleed in children?
Anal fissure
110
Pins lesion
Ipsi lateral facial droop
| Contra lateral hemiparesis
111
Treatment of poison ivy
may need systemic steroids and long steroid taper for severe cases
112
acute radiation syndrome
condition that results from whole-body irradiation from an internal or an external source over a short time period
4 phases:
1 prodromal -
2 latent - symptom free for weeks to hours depending on exposure dose
3 manifest
4 recovery or death
113
severe otitis externa
use an ear wick or gauze for antibiotic delivery when the ear canal is swollen shut
114
Raynauds tx
gentle rewarming combined
w/ topical or oral calcium channel blocker or nitrates
115
mgmt of PCP intoxication
iv benzos
for seizures: benzos or phenobarb, other ageants usually ineffective
116
buprenorphine
***
117
naltrexone
***
118
mgmt of PCP PNA
bactrim
| ?steroids
120
Tibial plateau fx
NO WEiGHT BEARING for several weeks
121
mgmt of tetralogy of fallot
```
1 oxygen
2 fluids
3. morphine
4 alpha agonist tx
5 prostaglandin E1 may be needed to prevent closure of the ductus arteriosus - can cause apnea and hypotension
```
122
sodium correction for hyperglycemia
Corrected Na = Nacalc + (1.6)(Glucal-100)/100
123
common complications of anterior shoulder dislocation
| in order of decreasing frequency
axillary n injury
hillman-sacks deformity - humeral head fx
bankart lesion - glenoid rim disruption
124
bedside test for assessing severity of asthma exac
peak expiratory flow rate
125
first line tx in children w/ bacterial cystitis
bactrim
126
most common cause of large bowel obstruction in adults?
1 malignancy
2 volvulus
3 diverticulitis
127
age cutoff for surgical cric
>8yo
needle cric for younger
