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2020 EM Boards Rosh learning > 11-1-20 Rosh > Flashcards

11-1-20 Rosh Flashcards

1
Q

Difference in labs between alcoholic and viral hepatitis

A

AST and ALT are only 2-10 times normal in ethos hepatitis

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2
Q

Airborne precautions for what?

A

measles varicella TB SARS ebola smallpox covid

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3
Q

Meningitis abs in Peds?

A

<1 month: amp+cefotax, or amp+gent +vanc >1 month: Vanc, ceftriaxone

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4
Q

Max heart rate formula?

A

220-age

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5
Q

TPA during cardiac arrest, how long to continue CPR?

A

at least 20 min

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6
Q

Thyroid storm meds, order, and mechs

A
  1. beta blocker (propranolol partially blocks T4 to T3) 2. PTU/methimazole– block synthesis of T4 (blocks an enzyme) 3. iodine (after 1h)– blocks release of stored T4 4. prednisone – blocks T4-T3
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7
Q

Dengue fever classic sxs?

A

High fever

retro-orbital HA

severe myalgias (breakback)

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8
Q

umbilical vein cannulation

what does it look like

A

1 big vein (supplies oxygenated blood from placenta)

2 small arteries (deoxy blood back to placenta)

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9
Q

Parental consent

when you don’t need?

A
  • emergent
  • emancipated
  • STD
  • pregnancy
  • drugs
  • abuse
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10
Q

dacryoadenitis vs dacrocystitis

A
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11
Q

Dig FAB dosing:

  1. neither dig level or amount ingested is known
  2. amount dig ingested is known, concentration unknown
  3. steady state dig concentration known
  4. cardiac arrest
A

picture. stead state is 6-8h

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12
Q

When to give Dig FAB in OD?

A

controversial indications, call poison control.

From LIFTL:

cardiac arrest

life-threatening dysrhythmia

K >5mM

>10mg ingested (adult), >4mg ingested (child)

>15 nM level (>12ng/mL)

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13
Q

Measles PEP:

  • explain what is required
  • when does peds get MMR
A
  1. immune and already received MMR: Get MMR vaccine within 72h
  2. immunocompromised, and infant <12mo: Get immunoglobulin AND MMR

infants get MMR typically at 12 mo

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14
Q

jellyfish sting

what to put on it

A

Hot water always works.

Acetic acid helps for inactivation of nematocysts in jellyfish to prevent further injectin of toxin

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15
Q

what tox OD is delayed charcoal still indicated

A

colchicine

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16
Q

Pt with frequent UTIs now with hypoxic respiratory failure, think what

A

Nitrofurantoin, pulmonary toxicity with chronic use

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17
Q

Bupropion OD

what antidote

A

fat emulsion

note–bupropion can look like TCA OD with wide QRS but does not respond to bicarb

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18
Q

Unknown OD, you see wide QRS
Bicarb does not work, think what

A

bupropion OD

needs fat emulsion

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19
Q

Bleach overdose,

pediatric accidental exploratory. do what?

A

Household bleach much safer than industrial

Exploratory peds ingestions are often benign–if pt can tolerate food no need to admit

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20
Q

what is doxepin

A

a TCA

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21
Q

TCA toxicity

when giving bicarb, what to be aware of to stop giving?

A
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22
Q

Isopropyl etoh ingestion

What are the lab findings?

A

“ketosis without acidosis”

Isopropyl etoh –> acetone (which is a ketone but not ketoacid)

Ketoacids are beta hydroxybutarate, and acetacetone

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23
Q

Lithium OD:

Think 3 things that indicate hemodialysis need

A
  1. renal function impaired and Li concentration elevated
  2. Lithium above 5
  3. Dangerous sxs (seizure, AMS, dysrhythmia)
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24
Q

gingkgo biloba

-what danger

A

bleeding, spontaneous hemorrhage

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25
Q

VTach:

when to NOT give amio

A

TCA/tox OD with widened QRS

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26
Q

Classic story for phytophotodermatitis?

A

bartender on beach, using limes, mowing the lawn

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27
Q

Pt with excited delirum, now codes

Give what med?

A

Bicarb.

pt probably extremely acidemic

28
Q

marine envenomation

when to use acetic acid?

A
29
Q

ASA OD

what is goal serum and urine pH?

A

serum: 7.5

urine 8

30
Q

Acute botulism with wounds

-give what in addition to antitoxin

A
31
Q

botulism

3 types

A
  1. infant – spores
  2. adult food borne (canned food)–pre formed toxin
  3. wound
32
Q

Pediatric Opioid OD

how long to observe?

A

If methadone, may need 24h observation

33
Q

ethylene glycol OD

-give what in addition to fomepizole

A

thiamine

pyridoxine

34
Q

Tamiflu

who’s considered high risk to give to?

A

children <2

age>65

pregnancy (up to postpartum 2week)

immunosuppressed and chronic conditions

35
Q

pertussis

stages and timing

A
  1. catarrhal– lasts 1-2 wks

nonspecific cough/fever/rhinorrhea

  1. paroxysmal–lasts 2-6 wks

whoop

  1. convalescent– lasts 1-2mo
36
Q

trauma level categories

A
  1. full 24h all specialists, has residency
  2. SOME specialists 24h
  3. Resources for resus/surgery/ICU for most trauma pts. Agreement to transfer to level 1 or 2
  4. ED physician only
37
Q

motor and sensory hand testing

A

motor:

median–OK sign

ulnar–V sign

radial–thumbs up, wrist extension

sensory:

median–index fingertip

ulnar–5th fingertip

radial–dorsal first webbed space

38
Q

acute otitis media

when do the wait and see abx approach

how long to wait?

A
  1. 6 mo - 2y, simple unilateral AOM
  2. >2y unilateral OR b/l AOM

48-72h

39
Q

Classic story for peds vag foreign body

A

6y girl, just started school, now with bad vaginal smell and small amount of blood specks in underwear

she just started toileting by herself and has small piece of toilet paper stuck in vagina. pt may need vaginoscopy under anesthesia if can’t cooperate

40
Q

2 types of liability insurance for ED physicians

A
  1. claims– (claims must be filed during policy period. if claim filed afterwards, then insurance not valid)
  2. occurence–AKA tail

covers for when the event occurred, not when claimed

41
Q

postpartum endometritis

-what abx?

A

clinda, gent

42
Q

you suspect epiglottitis

-what abx

A
43
Q

you are concerned about RPA

lateral neck XR requires what to be proper XR

A
44
Q

syphillis

screening and confirm tests?

A

RPR/VDRL screening

FTA-abs confrm

45
Q

medical malpractice

4 elements

A
  1. duty
  2. duty breached
  3. harm
  4. harm cause by duty breach
46
Q

epistaxis

anterior and posterior atery names?

A

anterior: kesselbach plexus
posterior: sphenopalatine

47
Q

HIV PEP

what time frame to give

A

give within 2h improves transmission prevention

48
Q

neutropenia

what is the time frame after chemo for Nadir

A

5-14 days after chemo.

(same as HIT timeframe)

49
Q

neutropenia definition

A
  1. 0 for 1h
  2. 3 1 time reading

with <500 ANC or expected with nadir

50
Q

transvaginal US, pregnancy findings

what order do they appear

gestational sac, yolk sac, fetal pole

A

gestational sac, yolk sac, fetal pole

first to last

51
Q

eye irrigation

what pH to target

A

7.0-7.4

52
Q

severe, complicated malaria in the US:

what is the drug of choice?

A

artesunate

53
Q

tetralogy of fallot

4 things

A

overriding aorta

vsd

RVH

RV outflow tract obstruction

54
Q

male genital lesions

think which 3 uncommon ones and their tx?

A
  1. chancroid, hemophylus ducrei.–ceftriaxone
  2. LGV lymphogranuloma venereum (certain chylamydia types)–docy
  3. granuloma inguinalea “donovanosis” (beefy red ulcer)–azithro
55
Q

Spont peritoneal peritonitis: what criteria

-what tx

A

presence of 2:

  1. abd pain or cloudy dialysate
  2. WBC >100 with 50% pmns
  3. positive culture
    tx: vanc and cefepime

intraperitoneal preferred, and can be home if wellappearing

56
Q

cpr

what Etco2 is good compressions?

A

>10

if <10 then no chance for rosc

57
Q

STEMI

what times to know for PCI and tpa

A

goal 90min door to needle

if cannot transfer within 120 min, than do TPA within 30 min

58
Q

what requires medical examiner review?

A

manner of death is unexpected or unclear, or if law may have been broken

eg traumatic death, natural disasters, suicide and homicide suspected, sudden unexplained, most peds deaths

59
Q

kid with laceration

give tdap? what is their last tdap scheduled

A

final dose is age 4-6 years

so, any kid less <9, don’t give tdap

60
Q

tylenol OD

-when does NAC need to be given, what timeframe?

A

within 8 hours

So, if pt presents >8h after ingestion, give NC empirically

If pt presents within 4h and not massive amount, then wait for th 4h level

61
Q

erlichiosis

  • describe sxs
  • tx
A
62
Q

abnormal uterine bleeding, 1st line tx?

A

OCPs

63
Q

what IO labs are not acccurate

A

wbc, K, ionized ca, ast/alt, blood oxygentation

64
Q

SIRS, sepsis, severe sepsis

qSOFA

A

T 36-38

HR >90

RR >20

WBC <4k, >12k, or >10% bands

sepsis: suspected source
severe: lactic acidosis/SBP<90/SBP drop >40 from normal/organ dysfunction

qSOFA: HAT

Hypotension <100

AMS: gcs<15

Tachypnea >22

65
Q
A

2020 EM Boards Rosh learning (1 decks)

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