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MO AED > Stuff > Flashcards

Stuff Flashcards

1
Q

Lisfranc

A

Tarsometatarsal joint (TMTJ) complex injury

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2
Q

Causes of Lisfranc injuries

Classification

A

RTA
Fall from height
Field sports like rugby

Classification: Myerson classification

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3
Q

TMTJ complex contents

A
  • 5 MTs
  • 3 Cuneiforms
  • Cuboid
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4
Q

Lisfranc ligament
x3

A
  1. Dorsal ligament (weakest)
  2. Interosseus ligament (aka Lisfranc ligament; strongest)
  3. Plantar ligament

All run obliquely from medial border of 2nd MT to lateral aspect of medial cuneiform

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5
Q

Lisfranc injury mechanisms

A

axial load on plantar-flexed foot then forcibly rotates / bends / compressed

e.g. miss a step downstairs
lands on heel of a plantar flexed foot

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6
Q

Pathognomonic sign for Lisfranc

A

Plantar ecchymosis
(24-48h after)

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7
Q

Special tests for Lisfranc

A
  1. Pronation-abduction test
  2. TMT squeeze test
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8
Q

Fleck sign for Lisfranc injury

A

Pathognomonic

Avulsion fracture of medial cuneiform or 2nd MT

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9
Q

Cx of Lisfranc injuries

A

Acute
- Vascular compromise
- Nerve injury
- Compartment syndrome

Chronic
- OA
- Chronic midfoot pain

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10
Q

Normal Foot XR findings

A

Normal AP
- medial border of 2nd MT colinear with medial border of middle cuneiform

Normal oblique
- medial border of 4th MT colinear with medial border of cuboid

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11
Q

Carpal bones

A

Trapezium Trapezoid Capitate Hamate
Scaphoid Lunate Triquetral Pisiform

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12
Q

Anatomical snuffbox

A

Medial: EPL
Lateral: EPB, APL
Proximal: Radius styloid Floor: Scaphoid, Trapezium

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13
Q

Jefferson #

A

anterior and posterior arches of C1

from axial load on back of head or hyperextension of neck

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14
Q

Hangman #

A

both pedicles or pars of C2

forcible hyperextension of neck

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15
Q

Jefferson bit off a hangman’s thumb

A
  • Jefferson #
  • Bilateral facet dislocation
  • Odontoid #
  • Atlanto-axial and Atlanto-occipital dislocation
  • Hangman # (hyperextension)
  • Teardrop #
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16
Q

Central cord syndrome

A

Hyperextension injuries
Cervical spondylosis
UL > LL neurological deficit
Bladder dysfunction
Variable sensory loss

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17
Q

Anterior cord syndrome

A

Paralysis
Loss of pain / temp
Preserved propioception / vibration / 2-point

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18
Q

Posterior cord syndrome
(less common)

A

Loss of proprioception / vibration
Ataxic gait
Hypotonia
Loss of deep tendon reflexes
Romberg +ve

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19
Q

NEXUS criteria full name

A

National emergency X-radiography utilization study

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20
Q

NEXUS criteria
(x5)

A
  1. No focal neurology
  2. No midline C-spine tenderness
  3. Conscious
  4. No intoxication
  5. No distracting injury
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21
Q

ABCD2 score for TIA

A

Age >=60

BP >= 140/90

Clinical features of TIA (Unilateral weakness = 2; speech disturbance = 1)

Duration of symptoms (<10 mins = 0; <1h = 1; >- 1h = 2)

DM

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22
Q

Dengue fever symptoms

A

Headache, retro-orbital pain, joint pain
MP rash
Biphasic fever course (saddle back)
Thrombocytopenia
Dengue hemorrhagic fever

WHO 2009 classification
- Dengue without warning signs
- Dengue with warning signs
- Severe dengue

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23
Q

Segond fracture

A

Avulsion # of lateral surface of lateral tibial condyle

Excessive internal rotation + varus stress -> increased tenson on lateral capsular ligament of knee joint

Asso w/ detachment of capsular portion of lateral collateral ligament + ACL tear, +/- medial/lateral meniscal tear

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24
Q

Arcuate sign

A

Avulsion fracture of fibular head (at site of insertion of arcuate ligament complex)
asso w/ cruciate ligament injury

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25
Q

Reverse Segond #

A

Avulsion of deep fibers of MCL
Valgus stress + External rotation

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26
Q

Chauffeur’s # / Hutchinson #

A

Oblique # of radial styloid
FOOSH, compression of scaphoid against radial styloid

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27
Q

Purple glove syndrome

A

IV Dilantin (Phenytoin)

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28
Q

Tillaux fracture

A

occurs when medial aspect of the distal tibial growth plate has started to fuse

from abduction-external rotation mechanism
anterior tibiofibular ligament avulses the anterolateral corner of the distal tibial epiphysis

Vertical fracture through the distal tibial epiphysis (Salter-Harris III) with a horizontal extension through the lateral aspect of the physis.
The lack of a metaphyseal fracture component in the coronal plane (evaluated with lateral x-ray or CT) distinguishes a Tillaux fracture from a triplanar fracture.

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29
Q

Common medical causes of blindness (x4)

A

Cataract
Glaucoma
Age related macular degeneration
Diabetic retinopathy

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30
Q

Takotsubo cardiomyopathy

A

aka stress cardiomyopathy, “broken heart syndrome”

  1. Transient hypokinesis, dyskinesis, or akinesis of the LV midsegments, with or without apical involvement; the regional wall-motion abnormalities extend beyond a single epicardial vascular distribution, and a stressful trigger is often, but not always, present
  2. Absence of obstructive coronary disease or angiographic evidence of acute plaque rupture
  3. New ECG abnormalities (either ST-segment elevation and/or T-wave inversion) or modest elevation in the cardiac troponin level
  4. Absence of pheochromocytoma or myocarditis
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31
Q

SDH chronicity

A

hyperacute <12h - isodense
acute 12h-2d - hyperdense
subacute 2d-1 month - isodense
chronic > 1month - hypodense

anemia / if on NOAC -> will affect density, hyperdensity will become isodense

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32
Q

Fluid level in knee XR
post trauma

A

Lipohemarthrosis
results from an intra-articular fracture with escape of fat and blood from the bone marrow into the joint
asso w/ tibial plateau fracture or distal femoral fracture

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33
Q

Common causes of primary PPH
4Ts

A
  1. Tone
  2. Tissue
  3. Trauma
  4. Thrombin
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34
Q

Common causes of primary PPH
4Ts

A
  1. Tone
    - Uterine atony, tx: Syntocinon infusion, bimanual uterine massage, other: Ergometrine, Prostaglandin F2alpha analog (Hemabate)
  2. Tissue
    - Retained tissue of conception, may need surgical removal
  3. Trauma
    - Perineal, vulva, vaginal or lower uterine segment laceration
  4. Thrombin
    - Clotting abnormality - primary or secondary due to DIC
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35
Q

Cord prolapse initial Mx

A
  1. O2 by mask
  2. Head down position (Sims or Knee-chest) to avoid compression of cord by presenting part
  3. Do not handle cord excessively to avoid vasospasm
  4. Elevate presenting part to ensure umbilical flow until delivery
  5. If prolonged transfer -> Instillation of bladder by Foley (500-750ml NS), may help pushing the present part up and ease pressure on prolapsed cord
  6. Monitor fetal HR
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36
Q

Bells palsy description
x4

A

Lack of wrinkling of forehead
Impaired closure of eye
Flattened nasolabial fold
Drooping of mouth corner

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37
Q

Other symptoms of facial nerve palsy

A

Postauricular pain
Eye pain / tearing
Hyperacusis (n. to stapedius)
Loss of sensation of anterior 2/3 of tongue

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38
Q

Causes of facial n. palsy
x6

A
  1. Bell’s palsy
  2. Ramsay Hunt syndrome aka Herpes zoster oticus (Herpes zoster infection of geniculate ganglion)
  3. Middle ear infection / pathology (OM, cholesteatoma)
  4. Temporal bone #
  5. Parotid tumor
  6. Cerebellopontine angle tumor - Acoustic neuroma
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39
Q

Ramsay Hunt syndrome triad

A

Ipsilateral facial paralysis
Otalgia
Vesicles in auditory canal / on auricle

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40
Q

Acyclovir renal adjustment

A

Increase interval but keep same dose (poor oral bioavailability)
CrCl 10-50: 800mg BD-TDS
CrCl <10: 200mg BD

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41
Q

Life threatening cause of chest pain
x5

A
  1. ACS
  2. PE
  3. Aortic dissection
  4. Cardiac tamponade
  5. Esophageal rupture
    Tension PTX
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42
Q

Boerhaave syndrome

A

aka Effort rupture of esophagus

Spontaneous perforation of eso caused by sudden increase in intraeso pressure + negative intrathoracic pressure (vomit, severe straining)

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43
Q

Mackler’s triad

A

of Boerhaave syndrome
1. vomiting
2. chest pain
3. subcutaneous emphysema

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44
Q

Hamman’s sign / crunch

A

pneumomediastinum
heard over precordium in spontaneous mediastinal emphysema

Mediastinal crackling sound synchronus with heart beat

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45
Q

Cx of Boerhaave syndrome
x6

A
  1. Pneumomediastinum
  2. Mediastinitis
  3. Hydropneumothorax
  4. Empyema
  5. Sepsis
  6. Multiorgan dysfunction syndrome
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46
Q

Ix for Boerhaave syndrome

A

Gastrografin swallow
(cannot use barium as perforation, will cause mediastinitis)

CT thorax

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47
Q

RV STEMI ECG features
(when have inferior STEMI)

A
  1. STE in V1
  2. STE in V1 and STD in V2 (highly specific for RV infarction)
  3. Isoelectric ST segment in V1 with marked STD in V2
  4. STE in III > II
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48
Q

Clinical significance of RV infarction

A

Isolated RV infarction is rare
Most with inferior STEMI
Most useful V4R (5th ICS, Rt MCL)

  • Nitrates contraindicated
  • treat with IVF when hypotension

Very preload sensitive (due to poor RV contractility) and can develop severe hypotension in response to nitrates or other preload-reducing agents

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49
Q

STEMI meds

A

Aspirin
Clopidogrel
Fibrinolytics
- Tenecteplase (TNK) - IV bolus x1
- Alteplase (rt-PA) - IV bolus then 2 infusions
- Reteplase (r-PA) - IV bolus x2
similar effect, TNK easier as one dose no need infusion

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50
Q

CI of Fibrinolytic for STEMI

A

Absolute
1 Any prior ICH
2 Known structural cerebral vascular lesion (e.g. AVM)
3. Known malignant intracranial neoplasm (primary or met)
4. Ischemic stroke within 3 months (except within 4.5h)
5. Suspected aortic dissection
6. Active bleeding (excluse menses) or bleeding diathesis
7. Significant closed-head or facial trauma within 3 months

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51
Q

Cx of fibrinolytics

A
  1. ICH (~1%)
  2. Bleeding risk, most common GIB
  3. Hypersitivity reaction, hypotension, reperfusion arrhythmias
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52
Q

Early Cx of AMI

A
  1. Lethal arrhythmias (VT, VF, heart blocks)
    2.
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53
Q

Steps for transcutaneous pacing

A

Explain procedure, consent
Sedation, analgesics
Electrodes placement (anterolateral or anteroposterior)
Set cardiac monitor to pacing mode / demand mode
Set pacing rate 10-30bpm higher than patient’s HR (~60-70)
Increase current output until electrical capture
Check for mechanical capture by feeling femoral pulse (cuz upper body is twitching)

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54
Q

Causes of 3rd n. palsy

A

DM neuropathy
Demyelineating disease (MS, Miller Fisher)
Brain tumor, Trauma
Cerebral aneurysm (Berry aneurysm)

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55
Q

5 causes of headache

A
  1. Acute SAH
  2. CNS infection
  3. Cerebral venous thrombosis
  4. Temporal arteritis
  5. Acute angle closure glaucoma
  6. Carotid / vertebral artery dissection
  7. Brain tumor
  8. HT encephalopathy
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56
Q

CTB finding of basal cistern SAH

A
  1. Hyperdensity over subarachnoid space and basal cistern
  2. Dilated temporal horn of lateral ventricles, suggestive of obstructive hydrocephalus
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57
Q

Common cause of primary SAH

A

Rupture of berry aneurysm
AVM
Coagulopathy
Brain tumor
Arterial dissection
Arteritis
Cocaine use

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58
Q

2 classifications / grading of SAH

A
  1. Hunt and Hess scale
  2. World Federation of Neurological Surgeons grading system
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59
Q

Immediate Tx of SAH on warfarin (meds)

A
  1. PCC Prothrombin complex concentrate
    (Beriplex: 4-factor PCC)
  2. Vitamin K1
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60
Q

Cx of SAH

A
  1. Cerebral vasospasm
  2. Obstructive hydrocephalus
  3. Seizure
  4. Recurrent SAH
  5. Cerebral salt wasting syndrome
  6. Neurogenic pul edema
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61
Q

Wellens syndrome

A

Critical stenosis of proximal LAD
Recent chest pain now resolved

Do not perform stress test e.g. treadmill

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62
Q

ECG features of Wellens syndrome

A

Type A (25%): Biphasic T waves in V2,3
Type B (75%): Deeply symmetrically TWI in V2,3

Pseudo-normalization when LAD occlude again
(T waves become upright, signifies hyperacute STEMI)

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63
Q

ECG V7-9 placement

A

for posterior MI
same horizontal plane as V6

V7: left posterior axillary line
V8: tip of left scapula
V9: left paraspinal region

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64
Q

Sgarbossa criteria

A
  1. Concordant STE >= 1mm any lead
  2. Concordant STD >= 1mm V1, V2, V3
  3. Discordant STE >= 5mm in leads with negative QRS

Modified:
3. Proportionally excessive discordant STE in ≥ 1 lead anywhere with ≥ 1 mm STE, as defined by ≥ 25% of the depth of the preceding S-wave

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65
Q

STEMI equivalents

A
  1. Posterior MI (STD V1-3, do posterior leads)
  2. new LBBB Sgarbossa criteria
  3. De Winter T waves (complete LAD occlusion)
  4. Hyperacute T waves (early anterior STEMI)
  5. Wellens syndrome (proximal LAD critical stenosis)
  6. STE in aVR - Left main coronary artery (LMCA) occlusion, Proximal LAD stenosis, severe TVD
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66
Q

DDx for hyperthermia, tachycarida, agitation

A

CNS
1. CNS infection
2. Stroke, tumor (involve thermoregulatory pathway)
3. Status epilepticus

  1. Sepsis

Endocrine
5. Thyroid storm
6. Pheochromocytoma

  1. Heat stroke

Toxicological
8. Sympathomimetic toxidrome
9. Anticholinergic toxidrome
10. Salicylate poisoning
11. Serotonin syndrome
12. Neuroleptic malignant syndrome
13. Benzodiazepine / alcohol withdrawal
14. Malignant hyperthermia

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67
Q

Tx for sympathomimetic toxidrome

A
  1. Physical restraint followed by chemical restraint
  2. Rapid and aggressive cooling for hyperthermia
  3. Aggressive fluid resuscitation
  4. Benzodiazepine
    - can treat agitation, hyperthermia, HT, tachycardia
    - antidote of cocaine and other stimulants
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68
Q

ECG findings of Na channel blocker overdose (e.g. cocaine)

A

Wide complex tachycardia
Right axis deviation
“R” in aVR

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69
Q

Na channel blockers
TCA-PP-DV

Toxi book

A

T - Tricyclic antidepressants
C - Carbamazepine, Cocaine, Citalopram
A - Antiarrhythmic 1A (Procainamide) / 1C (Flecainide), Amantadine

P - Propranolol
P - Phenothiazine (Thioridazine)

D - Diphenhydramine (Benadryl)
V - Venlafaxine

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70
Q

Mx of Na channel blockers overdose

A

Antidote: NaHCO3 50-100ml IV bolus
Indication
1. QRS >100ms
2. Ventricular arrhythmias
3. Hypotension
CI
1. Serum pH >7.5-7.55
2. Intolerable to fluid / Na overload

Endpoint
- QRS <100ms
- No more ventricular arrhythmias
- BP stabilize

GI decon: gastric lavage, activated charcoal within 1-2h

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71
Q

Mx of hyperthermia (cooling method)

A
  1. Remove clothing
  2. Water mist spray and fanning
  3. Ice packs at neck, axillae, groin
  4. Bladder irrigation with ice water
  5. Peritoneal lavage with cold dialysate

aim: reduce core temp to <40 in 30 mins

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72
Q

Serotonin syndrome
3 As

A

Antidepressants (SSRI)
Analgesics (Tramadol, Pethidine, Fentanyl)
Abusive drugs (cocaine, ectasy, “ice”)

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73
Q

Features of Serotonin syndrome

A

usually clonus over LL

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74
Q

Antidote of Serotonin syndrome

A

Cyproheptadine (antihistamine + antiserotonergic)
8-12mg PO x1
2mg Q2H till symptom resolve
Up to 32mg / day

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75
Q

Cocaine intoxication drug CI

A

Beta blockers - unoppposed alpha effect -> paradoxical HT

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76
Q

Tx of HT in cocaine intoxication

A
  1. Benzodiazepine
  2. Phentolamine
  3. Nitroglycerin, Nitroprusside
  4. CCB
  5. Labetalol (controversial)
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77
Q

Phlegmasia cerulea dolens

A

uncommon DVT
congestion and cyanosis of a limb due to massive venous thrombosis

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78
Q

Massive blood transfusion definition

A

10 units packed red cells within 24h

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79
Q

Beck’s triad

A

Cardiac tamponade

  1. Hypotension, narrow pulse pressure
  2. Distended neck veins (jugular veins)
  3. Muffled heart sounds
80
Q

Colistin

A

Polymyxin E
Last resort for Gram neg infections
SE: Nephotoxicity, neurotoxicity

81
Q

HBOT indications currently

A

Life-threatening
1. Severe decompression sickness
2. Cerebral arterial gas embolism

Emergency
3. CO poisoning
4. Necrotizing soft tissue infection
5. CRAO

82
Q

Absolute CI for HBOT

A
  1. Unresolved PTX
  2. Pneumocephalus
  3. Hollow orbital prosthesis
  4. Currently on Bleomycin / Adriamycin (Doxorubicin)
83
Q

AACG Glaucoma Mx
STAMP

ATM PBL

A

Supine

Timolol eye drops (Topical BB - decrease production aqueous humor)

Acetazolamide IV (Systemic carbonic anhydrase inhibitor - decrease production aqueous humor)

Mannitol IV (Systemic osmotic diuretic - decrease volume of vitreous humor)

Pilocarpine eye drops (Topical muscarinic agonist - constrict pupil, facilitate drainage from ant chamber)

Latanoprost (Topical prostaglandin)

Brimonidine (Alpha 2 agonist - decrease production aqueous humor)

84
Q

Osborn wave

A

Positive deflection seen at the J point in precordial and true limb leads.

Most commonly associated with hypothermia

Reciprocal, negative deflection in aVR and V1

85
Q

Causes of Osborn wave

A

Hypothermia

HyperCa
AMI
Takotsubo cardiomyopathy
LV hypertrophy due to hypertension
Normal variant and early repolarization
Neurological insults such as intracranial hypertension, severe head injury and SAH
Severe myocarditis
Brugada syndrome
Le syndrome d’Haïssaguerre (idiopathic VF)

86
Q

Brudzinski’s sign

A

Passive neck flexion -> Flexion of hips and knees

specific but not sensitive

87
Q

Kernig’s sign

A

Supine, hip and knee flex to 90 deg
Resistant / Pain during passive extension of leg

specific but not sensitive

88
Q

Echo
Parasternal short axis view

A

look for RWMA

89
Q

PE classification

A
  1. Massive (hemo unstable)
  2. Submassive (RV strain)
  3. Non-massive (no RV strain)
90
Q

ECG low voltage

A

QRS all limb leads <5mm or all precordial leads <10mm

91
Q

Posterior MI ECG changes

A

Look at V1-3
Horizontal STD, tall & broad R waves, upright T wave, dominant R wave in V2 (R/S >1)

-> do V7-9 (posterior leads)

92
Q

Posterior MI
litfl

A
  • usu w/ inferior or lateral STEMI
  • implies a much larger area of myocardial damage, with an increased risk of LV dysfunction and death

Isolated posterior MI is less common (3-11% of infarcts)

-> needs urgent PCI

93
Q

RV infarction

A

usu with inferior STEMI (in 40% of inferior MI)
-> preload sensitive, nitrates contraindicated

STE in V1
STE in V1 + STD in V2
Isoelectric V1 + marked STD in V2
STE Lead 3 > 2

94
Q

Right side ECG

A

V1-2 same position
V3-6 to V3R - V6R

Most useful = V4R (R 5th ICS, MCL)

95
Q

De Winter T waves
STEMI equivalent

A

Tall, prominent, symmetrical T waves in precordial leads
Upsloping STD > 1mm at the J point in precordial leads
Absence of STE in precordial leads
Reciprocal STE (0.5mm – 1mm) in aVR

Signifies LAD occlusion

96
Q

STE in aVR, diffuse STD in other leads

A

LMCA occlusion
or pLAD stenosis, severe TVD…

cause by diffuse subendocardial ischemia / infarction of basal septum

97
Q

5 types of MI
(EM book)

A

Type 1: related to atherosclerotic plaque rupture with thrombosis

2: related to ischemia due to imbalance btn oxygen demand and supply

3: cardiac death with S/S of coronary ischemia but death before blood samples taken

4a: related to PCI
4b: related to stent thrombosis

5: related to CABG

98
Q

ECG mimics of STEMI

A
  1. Acute pericarditis
  2. LV aneurysm
  3. Benign early repolarization (BER)
  4. Prinzmetal’s angina (coronary vasospasm)
  5. Brugada syndrome
  6. LVH
  7. HOCM
  8. SAH (raised ICP)
  9. HyperK
  10. LBBB
99
Q

BER (Benign early repolarization) vs Pericarditis
ECG

A

ST segment / T wave ratio in V6
>0.25 = Pericarditis
<0.25 = BER

100
Q

Acute epiglottitis most common microbe

A

Haemophilus influenzae type B (historically)
Now: Streptococcus pneumoniae, Streptococcus pyogenes, Staphylococcus aureus

101
Q

Chest pain life threatening causes (x6)

EM book

A
  1. Acute coronary syndrome
  2. Acute aortic syndrome
  3. PE
  4. Tension PTX
  5. Cardiac tamponade
  6. Eso rupture (Boerhaave’s syndrome)
102
Q

Hamman’s sign

A

For pneumo-mediastinum

a crunching, rasping sound, synchronous with the heartbeat, heard over the precordium in spontaneous mediastinal emphysema

result from heart beating against air-filled tissues

103
Q

Westermark sign

A

PE
sign seen on CXR

  • focal peripheral hyperlucency secondary to oligemia resulting in a collapsed appearance of vessels distal to the occlusion
  • central pulmonary vessels may also be dilated
104
Q

Echo findings of cardiac tamponade

A
  1. Pericardial effusion
  2. Diastolic RV collapse (highly specific)
  3. Systolic RA collapse (earliest sign)
  4. Dilated IVC w/o insp collapse (highly sensitive)
105
Q

SVT vs VT features

EM book

A
  1. QRS >0.14s in RBBB / >0.16s in LBBB
  2. AV dissociation
  3. Capture or fusion beats
  4. Precordial QRS complex concordance
  5. Axis -90 to +180
  6. QRS configuration…
106
Q

Causes of VT

A
  1. Coronary artery disease
  2. Hypertrophic cardiomyopathy
  3. MV prolapse
  4. Drug toxicity
  5. Electrolyte disturbance
107
Q

Torsades de pointes
Tx

A

MgSO4 1-2g over 60-90 seconds
Isoproterenol 1-8 mcg/min

108
Q

Score for unsalvageable limb
MESS

A

Mangled Extremity Severity Score

> = 7 amputation!

109
Q

CXR PE findings

A
  1. Westermark sign (focal oligemia)
  2. Hampton’s hump (peripheral wedge shaped opacity)
  3. Palla’s sign (enlarged right dsc pul a)
110
Q

Echo findings acute PE

A
  1. RV dilatation
  2. RV hypokinesis (w/ sparing of apex) “McConnell’s sign”
  3. D shaped LV
  4. TR
  5. IV septal flattening

increased insp collapse of IVC
D shaped septum

111
Q

TCA poisoning clinical features
PIC

A

Toxicity within 6h; 1-2h if sig poisoning (>10-20mg/kg adult / >5mg/kg pedi)
Cardiac toxicity (hypotension, tachyarrhythmia)
CNS toxicity (lethargy, confusion, coma, seizure)
Anticholinergic toxidrome

112
Q

Radio-opaque meds

COINS
/ CHIPS

A

Chloral hydrate / Cocaine packets
Opiate packets
Iron and heavy metal
Neuroleptic agents (e.g. TCA)
Sustained release medications

C Chlorinated hydrocarbons (eg, chloral hydrate, carbon tetrachloride)
Calcium salts (eg, calcium carbonate)
Crack vials
H Heavy metals (eg, iron, arsenic, mercury, thallium, lead)
I Iodinated compounds (eg, thyroxine)
P Psychotropics (eg, phenothiazines, lithium, cyclic antidepressants)
Packets of drugs (eg, cocaine and heroin “body packers”)
Play-Doh
Potassium salts
E Enteric-coated tablets (eg, aspirin)
S Salicylates
Sodium salts
Sustained-release preparations

113
Q

Blast injury 1/2/3/4

A

Primary
- caused by the blast wave moving through the body

Secondary
- caused by debris that is displaced by the blast wind of the explosion

Tertiary
- caused when the person in displaced through the air and impacts on another object by the blast wind, or when a structure collapses and causes injury to the person

Quaternary
- comprised of all injuries that are not included in primary, secondary, or tertiary blast injury categories.
- can be caused by exposure to resulting, fire, fumes, radiation, biological agents, smoke, dust, toxins, environmental exposure, and the psychological impact of the event

114
Q

Pedi BP

A

SBP: (Age x2) + 90
Hypotension SBP: (Age x2) + 70

115
Q

Pediatric Endotracheal Tube Size / Depth

A

Uncuffed = (age/4) + 4
Cuffed = (age/4) + 3

Depth = ETT size x3

116
Q

Tibial plateau # classification

A

Schatzker (type 1-6)

117
Q

Pedi maintenance IVF formula
(4-2-1)

A

First 10kg = 4ml/kg/hr = 40ml/hr
Next 10kg = 2ml/kg/hr = 20ml/hr
Then 1ml/kg/hr

Shock: 20ml/kg bolus

118
Q

Eclampsia Mx

A

Loading: MgSO4 4-6g IV over 15-20 mins
Maintenance MgSO4 1-3g/hr (for 24h after last seizure)

119
Q

MgSO4 toxicity monitoring

A
  • Loss of deep tendon reflex (patella reflex)
  • Resp depression (RR >12)
  • Foley to BSB for u/o monitoring (>100ml/4h)

Reverse with Calcium gluconate 10% 10ml over 10 mins

CI of MgSO4: Myasthenia gravis

120
Q

Radio-opaque meds

COINS

A

Cloral hydrate / Cocaine packets
Opiate packets
Iron and heavy metal
Neuroleptic agents (TCA)
Sustained release medications

121
Q

Delayed cord clamping pros and cons

A

Pros
1. Increase Hb at birth, improves iron store in first few months
2. Better for preterm
- improved transitional circulation
- better establishment of red blood cell volume
- decreased need for blood transfusion
- lower incidence of necrotizing enterocolitis and intraventricular hemorrhage

Cons
- Increase neonatal jaundice

122
Q

BRASH syndrome

A

Bradycardia
Renal Failure
AV blockade
Shock
HyperK

123
Q

SCORTEN score

A
  1. Age (>40)
  2. Associated malignancy
  3. HR (>120)
  4. Detacted or compromised body surface (>10%)
  5. Serum urea (>10)
  6. Serum HCO3 (<20)
  7. Serum glucose (>14)
124
Q

Etiology of SJS/TEN

A
  1. Drugs (allupurinol, AED carbamazepine, lamotrigine, NSAIDs)
  2. Infection (Mycoplasma pneumoniae)
125
Q

WPW ECG features

A
  1. Short PR interval < 120ms
  2. Delta wave: slurring slow rise of initial portion of the QRS
  3. Prolong QRS 110ms
  4. Discordant ST/T changes
  5. Pseudo-infarction pattern in up to 70% of patients — due to negatively deflected delta waves in inferior/anterior leads (“pseudo-Q waves”), or prominent R waves in V1-3 (mimicking posterior infarction)
126
Q

Drug Tx for thyroid storm

A

Antithyroid: Propylthiouracil
Iodide (inhibit rlease of stored thyroid hormone): Lugol’s solution
BB: Propranolol

127
Q

Risk factor of testicular torsion

A
  1. Bell-clapper deformity
  2. Cryptorchidism
  3. Testicular tumor
128
Q

NMS Tx

A
  1. Dantrolene (also use in malig hyperthermia)
  2. Bromocriptine (dopamine agonist)
  3. Amantadine
  4. Benzo: Lorazepam, Diazepam
129
Q

Score for TEN/SJS mortality

A

SCORTEN score

130
Q

Etiology of SJS/TEN

A
  1. Drugs (allupurinol, AED Lamotrigine, NSAIDs)
  2. Infection (Mycoplasma pneumoniae)
131
Q

WPW ECG features

A
  1. Short PR interval < 120ms
  2. Delta wave: slurring slow rise of initial portion of the QRS
  3. Prolong QRS 110ms
  4. Discordant ST-segment and T-wave changes
  5. Pseudo-infarction pattern in up to 70% of patients — due to negatively deflected delta waves in inferior/anterior leads (“pseudo-Q waves”), or prominent R waves in V1-3 (mimicking posterior infarction)
132
Q

Panadol overdose values

A

Toxic: >7.5g or >150mg/kg
Massive: 0.5-1g/kg

133
Q

Panadol overdose types

A
  1. Acute single overdose
    (single ingestion)
  2. Staggered overdose
    (multiple ingestions in 1-24 hrs; <4h interval treat as acute)
    NAC indicated if >150mg/kg
  3. Chronic supratherapeutic overdose
    (multiple ingestions in >2 days with dose >4g/day adult or 90mg/kg/day pedi)
    NAC indicated if S/S of hepatitis, dLFT, Panadol level suggesting delayed clearance
  4. Massive overdose
    (acute ingestion >1g/kg)
    early onset coma, met (lactic) acidosis, early coagulopathy
    acute tubular necrosis, ARDS, myocardial injury, thrombocytopenia, high amylase, pyroglutamic acidosis
134
Q

GI decontamination for panadol overdose

A

Activated charcoal 1g/kg within 1-2h of ingestion

if significant co-ingestion / massive overdose >1g/kg, consider gastric lavage

135
Q

Panadol nomogram name

A

Rumack-Matthew nomogram

136
Q

Poor prognostic marker for liver/death from panadol overdose

A
  1. pH < 7.30 after fluid and hemodynamic resuscitation.
  2. Coexistence of PT>100s, Cr >300 and grade III/IV hepatic encephalopathy
  3. Serum lactate >3.0 to 3.5
  4. Serum phosphate > 1.2 at 40-92 hr
  5. Serum AFP > 3.9 on day+1 after peak ALT identifies patients with favourable outcome
  6. Coagulation factor VIII/V ratio > 30; factor VIII is produced by endothelial cells while Factor V is
    made by hepatocytes
137
Q

Burn care classification
3 levels

A

Level 1. Gen sur / Ortho

Level 2. Burn facility (KWH/QEH/TMH)
- 5-20% TBSA
- Cosmetic
- Full thickness burn
- Electrical / Chemical burn
- Circumferential burn

Level 3. Burn unit (QMH/PWH)
- 20% TBSA for adults / 10% for children <= 12

138
Q

Methods of GI decontamination

Book

A
  1. Single dose Activated Charcoal (AC)
  2. Gastric lavage (GL)
  3. Multiple dose Activated Charcoal (MDAC)
  4. Whole bowel irrigation (WBI)
  5. Surgical intervention
139
Q

AC dose
Book

A

adult 50-100g
children 1g/kg

140
Q

Indication of AC
Book

A

A potential toxic ingestion within 1-2h
up to few hours

141
Q

CI of AC
Book

A
  1. Corrosive
  2. Rapidly absorbed e.g. ethanol
  3. Small molecular size e.g. lithium
  4. Unprotected airway
  5. GIT injury (e.g. corrosive injury)
  6. Non-functioning GIT (e.g. absent gut motility)
    GI endoscopic visualization considered essential
142
Q

MDAC dose
Book

A

Initial single dose AC
then 0.5g/kg Q2-4h x4

143
Q

Cx of MDAC
Book

A
  1. Fatal aspiration
  2. Pneumonitis
  3. SB obstruction
  4. Appendicitis
144
Q

Indication of GL
Book

A
  • A life threatening posion ingestion where poison likely still in stomach
  • Preferred within 1h
145
Q

CI of GL
Book

A
  1. Caustic ingestion
  2. Large FB or sharp objects
  3. Inability to protect airway
146
Q

Cx of GL
Book

A
  1. Aspiration pneumonia
  2. Eso / Gastric perforation
  3. Tension PTX and empyema
  4. Decreased oxygentation during procedure
147
Q

Indication of WBI
Book

A
  1. Potentially toxic ingestions of sustained release / enteric coated drugs, particially >2h
  2. Toxic ingestion of iron, lithium, potassium
  3. Removal of ingested packets of illicit drugs in body packers
148
Q

CI of WBI
Book

A
  1. Absent bowel sound
  2. Bowel obstruction / perforation
149
Q

Hydroxocobalamin indication

A

Cyanide poisoning

150
Q

Hydroxocobalamin SE

A
  1. Reversible pink discoloration of skin, mucous membrane, urine
  2. Muscle spasm and twitching
  3. Hypertension
151
Q

Sodium nitrite indication

A

Cyanide poisoning (prefer to use hydroxocobalamin)

152
Q

Sodium nitrite SE

A
  1. Hypotension
  2. Methemoglobinemia
153
Q

ABCD2 score for TIA

A

A: Age >60

B: BP >= 140/90

C: Clinical features of TIA
Unilateral weakness +2
Speech disturbance +1
Others 0

D (1). Duration of symptoms
<10mins 0
10 mins-1h +1
>=1h +2

D (2). DM

154
Q

High AG acidosis (HAGMA)

CAT MUD PILES

KULT

A

CAT MUD PILES
Cyanide, CO, colchicine
Alcoholic ketoacidosis, acetaminophen (in large doses)
Toluene
Methanol, metformin
Uremia
DKA
Paraldehyde
Isoniazid, iron
Lactic acidosis
Ethylene glycol
Salicylates

KULT
- Ketones (DM/Alcohol/Starvation)
- Uremia
- Lactate (Metformin, Poisons causing convulsion or shock)
- Toxin (methanol, ethylene glycol, salicylate)

155
Q

Substances not binding to AC

PHAILS

A

Pesticides
Heavy metals
Acid / Alkali / Alcohol
Iron
Lithium
Solvents

156
Q

Maisonneuve fracture

A

spiral # of the proximal third of fibula
associated with a tear of the distal tibiofibular syndesmosis and the interosseous membrane

157
Q

Sign of basal skull #

A
  1. Battle’s sign (bruising of mastoid process of temporal bone)
  2. Raccoon eyes (periorbital ecchymosis)
  3. CSF rhinorrhea
  4. Hemotympanum
158
Q

Croup score

A

Westley Croup Severity Score

159
Q

Dog / Cat bite micro-organisms

A

Pasteurella (G-ve coccobacilli)
- canis, multocida, septica

Capnocytophaga canimorsus

160
Q

Rolando #

A

comminuted intra-articular # base of 1st MC

161
Q

Bennett #

A

intra-articular, simple, oblique fracture at base of 1st MC

reverse Bennett #
- fracture-dislocation of base of 5th MC

162
Q

Digoxin toxicity
when to expect

A
  1. Unexplained bradycardia
  2. Non-specific GI/ Neuro complaints
  3. ECG changes
  4. Unexplained hyperK
  5. RF for chronic digoxin toxicity
    - increase sensitivity: hypoK/ hyperCa / hypoMg, hypoxia, underlying cardiomyopathy, ischemia, conduction problems
    - increase serum digoxin levels: CKD, CCB use, recent macrolide, dehydration
163
Q

Digoxin toxicity ECG changes

A

Scooped ST segments (reverse tick appearance)
Prolong PR
ventricular arrhythmias
sinus bradycardia, impaired AVN conduction

164
Q

Digoxin toxicity specific treatment

A

Digoxin-specific antibody fragments (Fab)
K>5.0 = indication for acute single overdose

other
1. GI decontam - AC / MDAC / GL
2. Atropine / pacing for bradyarrhythmias
3. Replace K / Mg, amiodarone, lignocaine when tachyarrhythmias

165
Q

4 types of shock

COHD

A
  1. Cardiogenic (AMI, CHF)
  2. Obstructive (3Ps - Tension PTX, cardiac tamponade, PE)
  3. Hypovolemic
  4. Distributive (septic, anaphylactic, neurogenic)
166
Q

Anion gap calculation

A

Na - (Cl + HCO3)

> 10 = high anion gap

adjust for albumin 0.25 x (40-alb)

167
Q

Osmolar gap calculation

A

Na x2 + Glucose + Urea

168
Q

Score for NF

A

LRINEC Score
Laboratory Risk Indicator for Necrotizing Fasciitis score

169
Q

Hypertropic cardiomyopathy (HCM) ECG features

A

LVH with increased precordial voltages and non-specific ST/T abnormalities
Deep, narrow (“dagger-like”) Q waves in lateral (I, aVL, V5-6) +/- inferior (II, III, aVF) leads

170
Q

Classification of mid face fracture

A

Le Fort

171
Q

Lemierre’s syndrome

A

infectious thrombophlebitis of IJV

172
Q

C1/2 subluxation classification
(atlantoaxial rotatory subluxation)

A

Fielding and Hawkins classification

173
Q

CRITOE (1-11y)

A

Appearance of ossification centers

Capitellum 1y
Radial head 3y
Internal epicondyle 5y
Trochlea 7y
Olecranon 9y
External epicondyle 11y

174
Q

3 common elbow injuries in children

A
  1. Supracondylar fracture
  2. Radial head subluxation
  3. Lateral condyle fracture
175
Q

Human bite micro-organism

A

Eikenella corrodens

176
Q

CRAO management

A
  1. Ocular massage
  2. Breathe into a paper bag
  3. IV Acetazolamide, Timolol eye drops
  4. HBOT
177
Q

ACLS modifications for pregnant women

A
  1. Manual displacement of uterus to left
  2. IV set above diaphragm
  3. Airway / ventilation priority (expect laryngeal edema)
178
Q

6P for Compartment syndrome

A
  1. Pain
  2. Poikilothermia (Perishing cold)
  3. Paresthesia
  4. Paralysis
  5. Pulselessness
  6. Pallor
179
Q

Pott puffy tumor

A

Subperiosteal abscess due to associated frontal skull osteomyelitis

180
Q

MR SOPA for NRP

A

Mask adjustment
Reposition airway

Suction mouth then nose
Open mouth

Pressure increase (up to 40)

Alternate airway

181
Q

Neck zones 1-3

A

Zone 1: Clavicle to Cricoid cartilage

Zone 2: Cricoid cartilage to angle of mandible

Zone 3: Angle of mandible to base of skull

2 most common, easier exploration
1 most dangerous

182
Q

LEMON rule

A

Look externally
- Facial trauma
- Large incisors
- Beard / moustache
- Large tongue

Evaluate 3-3-2 rule
- Inter-incisor distance 3 finger breadths
- Hyoid-mental distance 3 finger breadths
- Hyoid-thyrioid distance 2 finger breadths

Mallampati (>=3 is difficult)

Obstruction (epiglottitis, quinsy, trauma)

Neck mobility

183
Q

Ramp position for obesity intubation

A

head and torso are elevated such that the external auditory meatus and the sternal notch are horizontally aligned
CI if neck injury

184
Q

Lethal triad of trauma

A

Hypothermia
Acidosis
Coagulopathy

185
Q

Cushing triad for raised ICP

A
  1. Widened pulse pressure
  2. Bradycardia
  3. Irregular respiration (Cheyne–Stokes respirations)
186
Q

Quetiapine overdose effects

A

Dose-dependent CNS depression

Peripheral alpha blockade -> parodixcal hypotension if given adrenaline (beta 2 mediated vasodilatation)

Clinical features
-Sedation
-Tachycardia, common to be 120 bpm
-Hypotension
-Mild to moderate anticholinergic syndrome

187
Q

Magnesium sulphate for Asthma dose

A

MgSO4 2g over 20 mins IV

CI: renal failure, hyperMg

188
Q

Chance fracture

A

Unstable
Flexion-distraction injury
Seatbelt sign
typical in TL junction
asso w/ intra-abd injury e.g. duodenum

189
Q

Zopiclone overdose

A

Methemoglobinemia
Hemolytic anemia

190
Q

Tuna Fish for LBP red flags

A

Trauma
Unexplained weight loss
Neurological symptoms / signs
Age > 50
Fever
Intravenous drug use
Steroid use
History of cancer

191
Q

CXR signs for aortic dissection
x7

EM handbook

A
  1. Widened mediastinum
  2. Left pleural effusion
  3. R sided tracheal deviation
  4. Calcium sign (separation of calcification at aortic arch)
  5. Double aortic knob sign
  6. Pericardial effusion
  7. Displacement of NG tube
192
Q

Echo signs for aortic dissection

EM handbook

A
  1. Aortic root dilatation
  2. Aortic regurgitation (AR)
  3. Pericardial effusion
  4. Ventricular wall regional wall abnormalities implying coronary ostial occlusion
193
Q

Echo probe manipulation

POCUS

A
  1. Sliding
  2. Rocking (towards and away indicator)
  3. Tiliting (Fanning)
  4. Rotation
194
Q

McConnell’s sign for PE

A

RV free wall akinesis with sparing of the apex

195
Q

Echo findings of PE

A

RV dilatation
RV free wall hypokinesis
McConnell’s sign
IV septum flattening -> D shaped LV
Tricuspid regurgitation
60/60 sign

196
Q

Drug cause of prolonged QTc
5A + CLAM

Toxi book

A

5A + CLAM

  1. Anti-arrhythmic
  2. Anti-depressants
  3. Anti-psychotic
  4. Anti-histamine
  5. Anti-microbial (Macrolide, FQ, Amantadine, Antifungal)
  6. CLAM (Cisapride, Cesium, Lithium, Arsenic, Methadone)
197
Q

HyperK ECG changes

A
  1. Peaked T waves
  2. P wave widening/flattening, PR prolongation
  3. Bradyarrhythmias: sinus bradycardia, high-grade AV block with slow junctional and ventricular escape rhythms, slow AF
  4. Conduction blocks (bundle branch block, fascicular blocks)
  5. QRS widening with bizarre QRS morphology

MO AED (8 decks)

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