Quiz #4 Flashcards
(218 cards)
1
Q
What must be documented on eye exams?
A
Visual acuity (Snellen chart) and Fundoscopic Exam
2
Q
What is the most common pathogen of bacterial conjunctivitis?
A
viral
3
Q
Txt for conjunctivitis?
A
anti-histamines
lubricants
Abx (bacteria)
4
Q
What are the 3 types pathogens can cause conjunctivitis?
A
viral, bacterial, or allergic
5
Q
Corneal dendrite w/ fluorescein uptake, often involves trigeminal nerve?
A
Herpes Simplex Keratitis
6
Q
Hutchinson Sign
A
Herpes Simplex Keratitis
7
Q
Txt for Herpes Simplex Keratitis?
A
antivirals, optho consult
8
Q
Often common w/ contact lens use, and visible opaque ulcer?
A
Corneal ulcer
9
Q
Txt for corneal ulcer?
A
requires compounded drops, ophtho consult
10
Q
Pupil dilates, tightens contact of lens and iris, stopping outflow of aqueous humor?
A
Acute angle closure glaucoma
11
Q
Deep “boring” pain, rainbow colored rings or halos around bright lights
A
Acute angle closure glaucoma
12
Q
What 3 things can cause acute angle closure glaucoma?
A
mydriatic (dilating) drops, emotional upset, sympathomimetic and anti-cholinergic drugs
13
Q
Txt for acute angle closure glaucoma?
A
drops: timolol, pilocarpine
PO: acetazolamide, osmotic diuretics
14
Q
Consensual photophobia?
A
iritis and uveitis
15
Q
Txt for irits and uveitis?
A
ophtho consult
16
Q
Sector of eye involved w/ pain and FB sensation?
A
Episcleritis
17
Q
Txt for Episcleritis?
A
normally self limiting
18
Q
Med txt for Episcleritis?
A
lubricating drops and optho consult (ocular NSAIDs after consult)
19
Q
Very tender eye w/ pain during EOM use, vasculitis?
A
Scleritis
20
Q
Txt for scleritis?
A
oral NSAIDS and optho f/u after discharge
21
Q
Sudden monocular vision loss, “cherry red spot”
A
Central retinal artery occlusion
22
Q
Txt for central retinal artery occlusion?
A
rebreathe CO2 for arterial dilation, gentle eyeball massage, IOP lowering drugs
23
Q
Drug txt for central retinal artery occlusion
A
Timolol, acetazolamide
24
Q
When should optho be consult in central retinal artery occlusion?
A
EMERGENTLY retina irreversibly damaged in 90 min
25
Rapid progressive vison loss, " blood and thunder fundus"
Central retinal vein occulusion
26
Txt for central retinal vein occlusion?
CONSULT OPTHO EMERGENTLY!
27
Painless bright lights, decreased visual fields (curtain drops), visual floaters?
Retinal detachment
28
Txt for retinal detachment?
Emergent ophtho consult
29
What causes 60-90% of periorbital cellulitis?
sinusitis
30
No vision changes or pain w/ extraocular muscle use?
Periorbital cellulitis
31
Txt for Periorbital celluitis?
Abx and follow closely
32
Painful extraocular muscle use, diplopia, vision loss?
Orbital cellulitis
33
What imaging and labs are done for orbital celluitis?
CT scan, CBC, cultures, consider LP
34
Txt for orbital cellulitis?
IV abx and consult ophtho
35
Pain and foreign body sensation?
corneal abrasion
36
Can recall moment abrasion occurred?
corneal abrasion
37
Txt for corneal abrasion?
antibiotic drops, no contact use
38
What should not be done with a penetration of the globe?
DO NOT REMOVE impaled item!!
39
Seidel's sign?
Penetration of the globe
40
What is the txt for globe penetration?
protect the globe and call ophtho
41
What muscle is entrapped in a blowout fracture?
inferior rectus
42
The eye can't be moved which way in a blowout fracture?
inability to move eyes upwards
43
Txt for blowout fracture?
Ophtho consult (open fx)
44
Most eye complaints should receive follow up in ??
24hrs
45
Persistent otitis externa despite 2-3 wks of topical antimicrobial therapy should be suspected of having?
malignant otitis externa
46
What is the imaging for otitis externa?
CT or MRI
47
What is the txt for otitis externa?
IV abx
48
A otitis media infection that spreads to the mastoid air cells?
Acute mastoiditis
49
Protrusion of the auricle and obliteration of the postauricular crease?
acute mastoiditis
50
What is the imaging for acute mastoiditis?
CT or MRI
51
Txt for acute mastoiditis?
IV abx, myringotomy, and tympanocentesis
52
Caused by trauma to the ear sheering blood vessels from cartilage to skin
auricular hematoma
53
Cauliflower ear
auricular hematoma
54
Txt for auricular hematoma?
remove fluid and maintain pressure in the area for several days to prevent reaccumulating fluid
55
What kills insect in the ears?
lidocaine
56
Txt for insects in the ears?
attempt to remove w/ forceps or flush out
| Abx drops to prevent infection from scratches
57
What are txts for anterior epistaxis?
Afrin
Lido w/ epi covered packing
Chemical cautery w/ silver nitrate
Rhino rocket
58
Blood that comes from both nostrils and mouth?
posterior bleeding
59
Txt for posterior epistaxis?
Rhino rocket or foley catheter to apply posterior pressure
60
When is the Rhino rocket removed for a posterior bleed?
at f/u with ENT
61
Txt for closed nasal fracture?
refer to ENT within 6-10days
| po abx
62
Txt for grossly open fracture?
EMERGENT ENT consult!
63
What must be ruled out in all facial and nasal trauma?
nasal septal hematoma
64
Txt for nasal septal hematoma?
incise and drain the hematoma to avoid ischemic necrosis of the nasal septum
65
Txt for nasal foreign body?
forceps
| parent blows into pt mouth
66
Med txt for nasal foreign body?
abx for infection post removal
67
What is the txt for bacterial sinusitis?
abx
68
How many days of purulent nasal secretions and "double worsening" is considered bacterial sinusitis?
> 7days
69
Txt for dental abscesses?
incision
70
Med txt for dental abscesses?
penicillin VK or amoxicillin
71
Dental pain followed by local swelling that spreads within facial plane?
dental abscesses
72
oral infection that spreads into bilateral submandibular spaces?
Ludwig angina
73
Txt for Ludwig angina?
IV ABX
74
Imaging for Ludwig?
CT face and neck w/ contrast
75
Emergent surgical consult
Ludwig angina
76
Sensitivity to hot and cold stimuli as well as air passing over the exposed surface during breathing?
Enamel Dentin Fracture
77
If the patient cannot follow up with dentist in 2 days what must be done?
dental sealant
78
Txt dental fractures?
abx prophylaxis
79
Txt for crown root fractures?
stablize the fracture
| abx prophylaxis
80
What is the dental f/u period for a crown root fracture?
24-48hrs!
81
How long is splinting required for crown root fracture?
min 4 wks
82
Txt for luxation injuries?
splint in place and f/u w/ dentist
83
Txt for avulsions injuries?
DENTAL EMERGENCY!!!
| Replace tooth and splint in place abx
84
What should be done with the tooth in avulsions?
rinse tooth less 10 sec w/ sterile saline or tap water
85
Collection of purulent material in tonsil?
peritonsillar abscess
86
Muffled "hot potato voice"
peritonsillar abscess
87
What is the biggest s/s seen in peritonsillar abscess?
inferior and medial displacement of the infected tonsils
88
Txt for peritonsillar abscess?
drainage (AVOID CAROTID!!)
89
Med txt for peritonsillar abscess?
IV steroid x 1 dose, Abx x 10dys
90
Post tonsillectomy bleeding is most significant when?
days 5 and 10
91
Txt for Post tonsillectomy bleeding?
Direct pressure to the bleeding tonsillar bed. Moistened w/ either coagulant or lido w/ epinephrine
92
Any respiratory problems gets a ?
Chest X ray
93
Diagnostics for ingestion related esophagitis?
upper endoscopy
94
Txt for battery removal?
endoscopy ASAP
95
What 2 things shouldn't be done in caustic liquid?
induce vomiting
| Use neutrizling agents
96
Treatment for overdose patient who "won't get sick"
stable
benign ingestion
Do well
97
Treatment for overdose patient who "may get sick"
Stable initially
Intervene early or observe
Most do well
98
Treatment for overdose patient who "Sick on presentation"
Stablize
Intubate
Antidotes
Supportive care and ICU admit
99
What are general approach steps?
```
Look
Listen
Touch
Smell*
Dx studies
```
100
What is the most important general approach?
Intervene anytime
101
"DON'T" ?
Dextrose, Oxygen, Naloxone, Thiamine
102
What should be considered for unclear toxidrome?
DON'T
103
What is not always reliable?
History
104
Constricted, pinpoint?
Miosis
105
Dilated
Mydriasis
106
What are two test that can be done immediately?
D-stick and ECG
107
Inhibits the enzyme acetylcholinesterase
Cholinergic Syndrome
108
What is the txt for cholingergic poisoning?
Atropine
Benzodiazepines
Pralidoxime
109
What 4 things make up Sympathomimetic syndrome?
Cocaine
Amphetamine class agents
PCP
Catecholamines
110
Central nervous system excitation
Sympathomimetic Syndrome
111
Symptoms of cholinergic?
```
agitation or seizures
Miosis
increase mouth, lungs, intestine, urine, paralysis
increase/decrease- HR
Fasciculation and paralysis
```
112
Symptoms of sympatho?
```
agitation, combative
Mydriasis (dilated)
decrease mouth, lung, intestine
Intestine urine
hyperthermia
```
113
Sympathomimetic poisoning treatment?
Active cooling
Benzodiazepines
B-blocker
IV fluids
114
Most common cause of antimuscarinic syndrome?
```
Antihistamines
Antipsychotics
Tricyclic antidepressants
Belladonna alkaloids
Antiparkinsonain meds
```
115
Competitively inhibits or antagonizes the binding of neurotransmitter acetylcholine to muscarinic acetylcholine receptors
Antimuscarinic syndrome
116
"Red as a beet"
due to loss of sweat production, skin capillaries dilate
117
"Hot as a hare"
anhydrotic hyperthermia
118
"Bland as a bat"
nonreactive mydriasis
119
"Mad as a hatter"
delirium; hallucinations
120
"Full as a flask"
urinary sphincters constrict
121
Treatment Antimuscarinic poisoning?
supportive
sedation if necessary
Physostigmine
122
Treatment Antimuscarinic poisoning?
supportive
sedation if necessary
Physostigmine
123
The most important general approach?
Smell
124
First thing that should be done in a tox pt?
Call toxicologist
125
Alpha/Beta blocker for sympathomimetic?
Labetolol
126
Why isn't beta blockers used?
Can affect alpha blockers which will cause blood rise through the roof
127
Why isn't beta blockers used?
Can affect alpha blockers which will cause blood rise through the roof
128
Red as a beet, dry as a bone, hot as a hare, blind as a bat, mad as hatter, full as a flask
Antimuscarinic syndrome
129
Antidote for antimuscarnic?
Physostigmine
130
Txt for sedative/hypnotic poisoning tx?
Supportive care
| Flumazenil
131
Txt for Se/hyp withdrawal?
Benzodiazepine
| Thiamine
132
Txt for opioid poisoning?
Naloxone
| Supportive care
133
Supportive Txt for opioid withdrawal?
Clonidine
134
Replacement txt for opioid withdrawal?
methadone
| buprenorphine
135
You should treat the ?? and not the ???
patient, NOT the poison
136
Supportive care?
ABC
Safety net- IV, O2
Temperature control
Electrolyte replacement
137
What is a GI decontamination based on?
Drug, Dose, Patient
138
No longer used for gastric emptying?
Ipecac
139
Why is Ipecac no longer used?
risk of aspiration usually outweighs benefits
140
When is gastric lavage used?
cases w/ high morbidity
141
The most common ED complaint?
Abdominal pain
142
What does the safety Net for abdominal pain include?
```
Vital signs w/ pulse oximetry
O2 supplementation
IV access
NPO status
+/- IV fluid resuscitation, EKG, NG tube
```
143
How does pain being in abdominal pain?
Begins visceral and progresses to somatic pain once the peritoneum is involved
144
What is important in narrowing the ddx in abdominal pain?
Location and OLDCARTS
145
Describe the Acute Abdomen?
sudden, spontaneous, non-traumatic 10/10 pain
146
What does all abdominal pain pts require?
rectal exam w/ stool guaiac and
| GU exam- pelvic or testicular exam
147
What 4 types of imaging are done in abdominal pain?
acute abdominal series
Beside ultrasound
CT scan w/ contrast
MRI
148
What does the FAST exam include?
Beside US
149
What does a Beside US look for?
FREE FLUID in the abdomen or pelvic (blood)
150
What are 4 areas that the beside US views?
Heart
RUQ
LUQ
Pelvic
151
What 2 things does the eFast or extended FAST exam include?
Chest
| Lung viscera
152
How do you determine if a source is a upper or lower GI bleed?
NG tube
153
Hematemesis or blood per NG tube?
UGIB
154
Clear NG tube?
LGIB
155
What two things are used to determine blood loss?
SBP <100 or HR > 100
156
A drop in systolic bp indicates what present of blood loss?
30-40%
157
What is the txt for UGIB/LGIB?
2 large bore IVs- blood products
Igm Ceftriaxone
PPI- IV
158
What is the treatment for esophageal varices?
Octreotide IVP, followed by continuous infusion
159
What is the diposition for UGIB/LGIB?
Consult GI, admit to ICU or floor
160
What is solid organ rupture caused by?
trauma
161
Massive bleeding is seen in?
solid organ rupture
162
What causes hollow organ rupture?
variety of causes (excessive dilation, infection, acid/base erosion, trauma)
163
Bleeding, infection, and sepsis is seen in?
hollow organ rupture
164
What is the flow of hollow organ rupture?
progressive abdominal pain
Period of pain improvement
Worsening abdominal pain w/ fever
Sepsis
165
Txt for hollow organ rupture?
```
(ideally we avoid rupture)
IV fluids
IV abx
Vasoactive meds
Pain meds
Surgery
```
166
Can follow acute embolus, vascular disease, decreased cardiac output?
ischemic bowel disease
167
Disease where pain is out of portion to exam?
ischemic bowel disease
168
Txt for ischemic bowel disease?
Surgery! (re-vascularization or necrotic debridement)
169
What position should pregnant patients be placed in?
semi-left lateral decubitus
170
Why the semi-left lateral decubitus?
to avoid vena cava compression
171
How much volume increase is needed for a pregnant pt?
50%
172
T/F withhold imaging needed for maternal trauma?
FALSE (DON'T WITH HOLD use shielding!)
173
Vaginal bleeding < 20 weeks indicates?
spontaneous abortion
174
Dx of vaginal bleeding?
FAST EXAM
Vaginal US
Quant hCG
175
What med is given for vaginal bleeding in a preggo?
RhO D immunoglobulin (RhoGAM) (Rh - woman)
176
Disposition for a <20wk old bleeding preggo?
d/c safely w/ close OB follow up
177
What should be r/o in a preggo >20wks?
abruptio placentae
placenta previa
vasa previa
178
What should be done before performing a digital or speculum pelvic exam?
Transvaginal US (to locate the placenta)
179
What is done after a US in a traumatic preggo?
Sterile pelvic exam
180
Used to identify injury, bleeding, or amniotic fluid leakage?
Sterile pelvic exam
181
2 things used to determine leakage of amniotic fluid?
Nitrazine paper pH strips
| Ferning
182
Dispostion for trauma in preggo?
>20 wks require observation or admission for fetal monitoring
183
What is preeclampsia?
```
Hypertension > 20 wks +
new proteinuria
sudden increase in proteinuria
OR
development of HELLP syndrome
```
184
What is HELLP syndrome?
hemolysis, elevated liver enzymes, and low platelet count
185
What is considered HTN in preeclampsia?
SBP> 140, DBP >80
186
Mild Preeclampsia txt?
discharge w/ OB fu and after OB consult
187
Severe Preeclampsia txt?
Antihypertensives- Labetalol, hydralazine, nifedipine
| IV magnesium
188
Definitive treatment for preeclampsia?
DELIVERY
189
What is eclampsia?
new onset seizures + preeclampsia
190
When can eclampsia occur?
> 20 wks to 4 wks postpartum
191
Txt for eclampsia?
Antihypertensives- Labetalol, hydralazine, nifedipine
| IV magnesium
192
Definitive txt for eclampsia?
delivery
193
What is imminent delivery?
complete cervical effacement and the fetus is at the vaginal introitus
194
What should be done in a emergency delivery?
```
Call OB to ED
Initiate monitor (if possible)
Obtain IV access and begin IV hydration
Prepare perineum by washing with soap/water and swabbing w/ povidone-iodine
ASSIST IN DELIVERY
```
195
When is gastric lavage used?
high morbidity cases (<30min)
196
When is activated charcoal used?
Sustained release (<1hr)
197
PHAILS stand for?
```
P- Potassium
H- Heavy metals, Hydrocarbon
A- Alcohol, Alkalis, Acid
I- Iron, Inorganic salts
L- Lithium
S- Solvents
```
198
Used for body packers?
Whole bowel irrigation
199
When is hemodialysis used?
lithium, valproic acid, aspirin
200
Specific remedy that stops or controls the effects of a specific poison?
antidotes
201
What is the antidote of Tylenol?
N-acetylcysteine
202
What is used to determine txt for Tylenol?
Rumack-Matthew Treatment nomogram
203
If ingestion is less than ??? plot on Rumack-Matthew
<8hr
204
Antidote for tricyclic antidepressants?
Sodium Bicarbonate
205
Antidote for Beta blocker?
Epi or norepi
Glucagon
High dose insulin w/ glucose
206
Antidote for Calcium Channel blocker?
```
Calcium chloride
(epi or norepi, glucagon, high dose insulin w/ glucose)
```
207
Antidote for iron?
Deferoxamine
208
Antidote for cyanide?
Hydroxocobalamin
209
Antidote for Organophosphates?
Atropine and Pralidoxime
210
Antidote for Sulfonylureas?
Dextrose and Octreotide
211
Antidote for Hydrofluoric Acid?
Calcium
212
Antidote for Anti-freeze?
Ethanol or Fomepizole
213
Antidote for Opiates?
Naloxone
214
Antidote for Benzo?
NOT FLUMAZENIL--- JUST LET IT WEAR OFF- SUPPORT BREATHING!
215
Antidote for Carbon Monoxide?
Oxygen and hyperbaric chamber
216
Antidote for snake bite?
Crofab
217
When should fluids be given?
before vasopressors
218
Poison center number?
1-800-222-1222
