Radiology / Emergency Flashcards Preview

Step 3 > Radiology / Emergency > Flashcards

Flashcards in Radiology / Emergency Deck (56):
1

when is contrast head CT the best answer?

AV malformations
primary or metastatic tumors

2

when is abdominal pelvic CT the best answer

to evaluate retroperitoneal structures (pancreas, colon, prostate, testicular or renal)

3

when is high resolution CT scan of chest the best answer?

evaluate parenchymal lung disease and bony structures

4

who should NOT get a CT scan w/ contrast?

pt with renal dz (Cr > 1.5)
pt with multiple myeloma

5

what drug should be discontinued prior to doing a CT scan w/ contrast?

metformin
- do not resume until 48 hours after scan

6

test of choice for evaluating demyelinating dz

MRI

7

when is HIDA scan the answer?

1. biliary obstruction vs. acute cholecystitis
2. biliary leaks post-op
3. congenital biliary atresia

8

when is a bone scan the answer?

1. metastatic bone lesions (NOT Lytic)
2. delayed fractures
3. osteomyelitis
4. avascular necrosis of femoral head

9

when is adrenal scan the answer?

test of choice to localize pheochromocytoma when MRI/CT scan is not diagnostic

10

initial test of choice to evaluate pulmonary embolism

V/Q scan

11

who should not get a V/Q scan

pts with COPD or extensive lung dz

12

when is a gallium scan the answer?

localizing abscesses
staging lymphomas and melanomas

13

pt presents to ED with acute mental status change - what do you do?

1. give naloxone, thiamine and dextrose
2. give O2 and saline
3. check toxicology screen
4. CBC, chemistry, urinalysis
5. psych consult - if suicide attempt
6. charcoal

14

when can gastric emptying be used

only within first hour of overdose

15

antidote - acetaminophena

N acetyl cysteine
- can give charcoal too
- prevents liver toxicity for up to 24 hours after ingestion

16

antidote - aspirin

bicarb to alkalinize the urine

17

antidote - BDZs

do NOT give flumazenil; may precipitate a seizure

18

antidote - carbon monoxide

100% Oxygen

19

antidote - digoxin

digoxin binding antibodies
- use if CNS or cardiac abnormalities

20

antidote - ethylene glycol/ methanol

fomepizole or ethanol

21

antidote - methemoglobinemia

methylene blue
- also give 100% oxygen

22

antidote - neuroleptic malignant syndrome

bromocriptine, dantrolene

23

antidote - TCAs

bicarb (protects the heart)

24

features of ASA o/d

1. metabolic acidosis, increase AG
2. respiratory alkalosis (hyperventilation)
3. tinnitus
4. renal insufficiency
5. elevated prothrombin time
6. CNS symptoms
7. fever

25

what should you order on CCS if suspected ASA o/d?

CBC
chem panel
ABG
PT/INR/PTT
ASA (salicylate) level

26

how do you alkalinize the urine in ASA o/d

D5W with 3 amps bicarbonate

27

what drug o/d is alkalinization of the urine useful for?

ASA
TCAs
phenobarbital
chlorpropamide

28

what three things should be ordered on all overdose patients

ASA, acetaminophen and alcohol levels

29

management of BDZ overdose in ED

move the clock forward on CCS - o/d is not fatal and will resolve with time.

30

routine tx. of CO poisoning

100% supp O2 via non rebreathing mask

31

when do you use hyperbaric O2 for management of CO poisoning?

carboxy Hb > 25%
LOC
ph < 7.1

32

what drug can result in cyanide toxicity?

nitroprusside - esp. if pt has CRF or is receiving a high dose/prolonged infusion of nitroprusside

33

pt presents with N/V/D, blurred vision with yellow halos around objects and an arrhythmia with PR prolongation. Labs show hyperkalemia - what did he o/d on?

digoxin

34

meds/things that can cause digoxin toxicity

CCB (verapamil)
quinidine
amiodarone
spironolactone
hypokalemia

35

unique findings with ethylene glycol toxicity

1. renal insufficiency
2. kidney stones - calcium oxalate stones
3. hypocalcemia - from precipitate of oxalic acid with calcium

36

unique findings with methanol toxicity

1. visual disturbance
2. retinal hyperemia - toxicity of formic acid

37

what things in the pts history will make you consider methemoglobinemia?

history of nitrate, anesthetics, dapsone or other oxidants and any drug ending in caine

38

diagnosis of methemoglobinemia

normal pO2 on ABG with chocolate-brownish blood; methemoglobin level

39

pt is cyanotic with normal pO2 - what do you think of?

methemoglobinemia

40

Tx. heat exhaustion (sweating, NV)

normal saline IV
remove from hot environment

41

Tx. heat stroke (dry skin, altered mental status)

cooling measures - ice baths/packs

42

cardiotoxic effects of TCAs

QRS prolongation
re-entrant arrhythmias --> VT, Vfib, Torsades

43

Tx. TCAs toxicity

NaHCO3
lidocaine - for arrhythmias

44

next step in pt with TCA toxicity and wide QRS prolongation

give bicarb and transfer to ICU

45

CF: black widow spider bite

abdominal pain w/o tenderness, rigidity and hypocalcemia

46

Tx. black widow bite

antivenin

47

CF: brown recluse spider bite

local necrosis, bullae and dark lesions

48

Tx. brown recluse spider bite

debridement

49

most important step for any pt who has been in a fire

100% supp O2

50

in a pt who was in a fire - who should be intubated?

hoarseness, wheezing or stridor
burns inside the nose or mouth

51

which agents should be avoided in burn patients for sedation?

succinylcholine and other depolarizing agents
- increase K+ can be lethal

52

what pain/sedative meds do you give a burn pt?

morphine - 10 mg/hr
diazepam

53

Parkland formula for fluids in burn pt

4 ml x kg x %BSA
- give over 24 hours; first half in first 8 hours

54

first step to perform in hypothermic pt

EKG - J waves of osborn

55

best initial therapy for acute angle closure glaucoma

pilocarpine drops

56

management: unknown dry chemical powder on skin

always brush off powder first - once the visible powder is removed, then the area should be irrigated with copious amounts of low pressure water