ABEM Recert Exam pt. 1 Flashcards
1
Q
Mechanism of hypovolemic hyponatremia
A
Loss of Na in excess of loss of H2O
2
Q
Rx for hypovolemic hyponatremia
A
Saline
3
Q
Mechanism of euvolemic hyponatremia
A
Dilutional from slight water retention
4
Q
Types of euvolemic hyponatremia
A
- Hypothyroidism
- Arsenal insufficiency
- Psychogenic polydipsia
- SIADH
HAPS
5
Q
Rx for euvolemic hyponatremia
A
Fluid restrition
6
Q
Mechanism of hypervolemic hyponatremia
A
Severe water retention
7
Q
Types of hypervolemic hyponatremia
A
- Acute renal failure
- Hyperglycemia
- Severe edema
8
Q
Rx for hypervolemic hyponatremia
A
Fluid restriction
9
Q
Maximum rate of correction of Na in hyponatremia
A
0.5 meq/L/hr in chronic
1 meq/L/h in acute
10
Q
Usual cause of hypernatremia
A
Decreased total body water
11
Q
Mechanism of diabetes insipidus
A
Lack of ADH; causes hypernatremia
12
Q
Hypercalcemia: MCC
A
Malignancy
13
Q
Hypercalemia: Si/sx based on levels
A
<12: asymptomatic or mild N/V and anorexia
12-14: weakness & fatigue
15+: altered MS
14
Q
Hypercalcemia: Rx
A
Lasix
15
Q
Hypocalcemia: Usual causes
A
parathyroidism or thyroid surgery
16
Q
Chvostek sign:
A
Seen with hypocalcemia
Twitching of mouth with tapping on facial nerve
17
Q
Trousseau sign
A
Seen with hypocalcemia
Carpal spasm with inflation of BP cuff
18
Q
Hypocalcemia: si/sx
A
Anorexia, N/V, fatigue
19
Q
Hypomagnesiumemia: si/sx
A
Anoerxia, N/V, fatigue
20
Q
Malempatti: how is it scored?
A
1 = best view 4 = horrible view
21
Q
ETT: Where to secure in adult males and females
A
21cm at lip in females
23cm at lip in males
22
Q
When to perform needle cricothyroidotomy?
A
Infants and small children, can’t do typical open crich because membrane is too small
23
Q
When to use uncuffed ET tubes?
A
Age <2
24
Q
Where is narrowest part of airway?
A
Adults = vocal cords Pediatrics = criccoid rings
25
ET tube: How to calculate size
(Age / 4) + 4
26
ET tube: How far to insert in peds
3 x ETT size
27
Blade to use for intubation with term infants
Miller 1
28
Blade to use for intubation with preterm infants
Miller 0
29
Benzocaine: What toxicity is seen with excess use of?
Methemoglobinemia
30
How to tell amides and esters apart?
Amides have "i" prior to caine in name
| Esters don't
31
Lidocaine: Maximal dose for local infiltration
5 mg/kg
32
Orbital wall fracture: What is most common?
Inferomedial wall
33
Hypopeon: Disposition
Immediate ophtho consult in ED
34
Thyroid hormone: Mechanism of production
1. Hypothalamus makes Thyroid releasing hormone
2. TRH stimulates Anterior Pituitary to release TSH.
3. TSH stimulates Thyroid Gland to release T4
4. Liver & kidneys convert T4 into T3
35
Graves dz: Pathophysiology
Inappropriate stimulation of thyroid gland by autoantibodies against TSH receptor.
Causes hyperthyroidism
36
Thyroid storm: MCC
Infection
37
Thyroid storm: Rx
1. Supportive care
2. Beta blockers
3. PTU (reduces conversion of T4 into T3)
4. SSKI - 1 hour after PTU (decreases synthesis of new T4)
5. Dexamethasone or hydrocortisone
6. Identify and treat cause
38
Hypoglycemia: Defintion
<70 mg/dL
39
Malignant otitis externa: MCC
Pseudomonas is almost always cause
| Surgical consult is mandatory
40
Isolated scapula fx: Rx
Sling
| Often secondary to significant MOI, so must consider further w/u
41
Bankart lesion: Definition
Labral detachment in shoulder
| May or may not be visible on xray
42
Radial nerve: Anatomic path
Inside of upper arm along humerus
| Often injured with humeral fracture
43
Montaggia fracture: Definition
Ulnar fracture with radial head dislocation
| GRUM
44
Galeazzi fracture: Definition
Radius fracture with radioulnar dislocation.
| GRUM
45
Carpal bone: Most common fractured
Scaphoid
| Triquetrium is 2nd most common but most commonly missed
46
Median nerve: Motor and sensory functions
Motor: Make OK with thumb and finger
Sensory: Palm of thumb, index, middle and 1/2 of ring finger
47
Median nerve: Where is it injured?
Anecubital fossa
48
Radial nerve: Where is it injured?
Humerus fractures
49
Ulnar nerve: Motor and sensory functions
Motor: Spread fingers against resistance
Sensory: Palm and dorsal aspect of 1/2 of ring and entire small finger
50
Ulnar nerve: Where is it injured?
Passes by ulnar styloid at elbow
51
Radial nerve: Motor and sensory functions
Motor: Wrist & finger extension
Sensory: Back of thumb, index, middle, and 1/2 of ring fingers
52
Mallet finger: Definition
Damage to extensor tendon, so DIP is flexed and cannot fully extend
53
Mallet finger: Rx
Splint DIP in extension for 6 weeks
54
Jersey finger: Definition
Disruption of FDP on volar (palmar) aspect of distal phalynx
| Causes inability to flex DIP
55
Jerser finger: Rx
Referral for prompt surgical repair
56
Hip dislocations: Types
90% are posterior (e.g. hitting flexed knee/hip on dashboard)
10% are anterior
57
Tibial plateau fracture: What nerve is injured?
Deep peroneal nerve
58
Knee dislocation: Possible associated injury
Popliteal artery
59
Ankle sprains: What is injured in most?
ATFL (found laterally on ankle)
60
Deltoid ligament: Where is it on ankle?
Medial
61
Jones fracture: Defintion
Transverse proximal 5th metatarsal fx
62
Jones fracture: Rx
Non-weight bearing and ortho f/u
63
Terry Thomas sign: Definition
Gap >3mm between scaphoid and lunate
| Seen with scapholunate dissocation
64
Spilled teacup sign: Definition
Seen with lunate dislocation
65
Posterior fat pad: Causes
Children: Supracondylar fracture
Adults: Radial head fracture
66
Lisfranc injury: Definition
Disruption of tarsal - metatarsal joint
| Look for fracture at base of 2nd metatarsal
67
Coles fracture: Associated injury
Must evaluate for possible median nerve injury
68
Hip fracture: Most common type
Intertrochanteric
| Presents as shortened and externally rotated
69
What presents as shortened and internally rotated leg?
Posterior hip dislocation
70
What presents as shortened and externally rotated leg?
Intertrochanteric hip fx
71
Acetaminophen: What is toxic metabolite?
NAPQI
72
Acetaminopehn OD: When to rx if time of ingestion unknown?
1. If suspect toxic ingestion based on amount ingested
| 2. If level normal but AST elevated, should also rx
73
Chronic aspirin OD: si/sx
Dehydration
Metabolic acidosis
Level >60
74
Acute aspirin OD: si/sx
```
N/V
Tinnitis
Hypoglycemia
Tachycardia
MS changes
Pulmonary edema
Respiratory acidosis
Level > 100
```
75
Aspirin OD: Rx
Sodium bicarb to alkinilize urine
Keep serum pH >= 7.4; urine pH 7.5-8.5
If intubate, must increase respiratory rate
76
Carbemazepime OD: si/sx
```
Anticholinergic si/sx
Blind as a bat
Red as a beet
Hot as a hare
Mad as a hatter
```
77
Cholinergic OD: si/sx
SLUDGE
78
Anticholinergic OD: si/sx
Blind as a bat
Red as a beet
Hot as a hare
Mad as hatter
79
Carbemazepime OD: Rx
Sodium bicarb if wide QRS
80
Serotonin syndrome: Rx
Cyprohepatidine
BZD
Supportive care
81
TCA OD: Si/sx
```
Anticholinergic
Blind as a bat
Red as a beet
Hot as a hare
Mad as a hatter
```
82
TCA OD: Rx
Supportive care
| Sodium bicarb if QRS >100 ms, ventricular dysrhythmias, or hypotension unresponsive to fluids
83
Calcium channel blocker vs beta blocker OD: How to diff?
CCB has hyperglycemia
| B-blocker has hypoglycemia
84
Clonidine OD: si/sx
Mimics opiate OD
85
Clonidine OD: Rx
Supportive
| High-dose naloxone has been effective
86
Lithium OD: Indications for dialysis
Acute ingestion with level >4 or chronic level >2.5
| Acute renal failure
87
Tripod midface fx: Definition
Maxilla, Zygoma & Lateral orbit
| Operative repair to prevent cosmetic deformity
88
Lefort I fx: Definition
Maxilla only
89
Lefort II fx: Definition
Extends from ptyregoid plate through maxilla
Involves orbit
AKA pyramidal fx
90
Lefort III fx: Definition
Begins at nasal bridge, involves maxilla, orbital wall & zygomatic arch
AKA craniofacial disruption
91
Open mandible fx: Rx
Antibiotics
| Admission
92
Closed mandible fx: Rx
No antibiotics
| d/c with outpatient f/u
93
Neck zones
1. Sternal notch to criccoid cartilidge
2. Criccoid cartilidge to angle of mandible
3. Angle of mandible to base of skull
94
Stuctures in neck zone 1
```
Subclavian artery
Lung apex
Esophagus and trachea
Carotid and verterbal arteries
(Sternal notch to criccoid cartilidge)
```
95
Structures in neck zone 2
```
Larynx
Pharynx
Vagus nerve
Esophagus and trachea
Carotid and vertebral arteries
(criccoid cartilidge to angle of mandible)
```
96
Structures in neck zone 3
Salivary and parotid glands
Cranial nerves
Carotid and vertebral arteries
(Angle of mandible to base of skull)
97
Work up of neck zone 1 injuries
Imaging
98
Work up of neck zone 2 injuries
```
Operative exploration if hard signs present:
Expanding hematoma
Bruit
Pulse deficit
Subcutaneous emphysema
Stridor
Respiratory distress
Horseness
Hemiparesis
```
99
Work up of neck zone 3 injuries
Imaging
100
Most commonly injured vascular structure in neck
Jugular vein
101
Retinal detachment: Common risk factor for
Myopia
102
Ellis dental fracture classification
1. Enamel only
2. Enamel and dentition
3. Pulp exposed (immediate dental consult)
103
Osteomyelitis: Most common pathogen
S. aureus (Salmonella is most common in sickle cell dz)
104
Primary tumors which most commonly met to bone
Breast
Prostate
Lung
105
Most common level of cervical radiculopathy
C5
106
Most common level of lumbar degerative disc disease
L4/5
| L5/S1
107
Septic arthritis: Most common pathogens
S. aureus
| Strep
108
Is joint fluid culture positive in septic arthritis
Only (+) 50% of time
109
Pseudogout: New term for
Calcium pyrophosphate deposition (CPPD)
110
Gout crystals: Microscopic appearance
Negatively bifringent needle crystals
111
Gout: Joints most commonly affected
1st MTP > Knee > Ankle
112
Pseudogout: Microscopic appearane
Positively bifringent rhomboid crystals
113
Gangrene: Types
Dry: no pain, no pus
Wet: Painful, pus, prone to sepsis
114
Head injuries: MCC
1. Falls
| 2. MVCs
115
SDH: Appearance on CT
Crescent shaped
| Associated with skull fx
116
Epidural hematoma: Appearance on CT
Lenticular
| Associated with cerebral contusion / damage
117
Isolated skull fx: Rx
None, unless it is depressed greater than thickness of skull
118
Penetrating neck trauma: What immobilization is required?
None if neurovascularly intact
119
Denque fever: Vector
Mosquito borne (most common mosquito borne illness world-wide)
120
Mosquito borne illness: Most common
Dengue fever
121
Dengue fever: si/sx
N/V
Severe myalgias/arthralgias (breakbone fever)
Maculopapular rash
122
Dengue fever: Rx
Supportive
123
West Nile virus: Incubation period
2-15 days
124
West Nile virus: Rx
Supportive
125
Rabies: Geographic distribution in US
Everywhere but Hawaii
126
Rabies: Animals that are not carriers
Rabbits (lagomorphs)
| Small rodents, mice, hampsters, gerbils, etc.
127
Rabies: Rx
RIG + vaccine at day 0, 3, 7, 14
128
Small pox vs Chicken pox rash: How to diff?
Small pox rash is all in same morphology
| Chicken pox rash is in different phases
129
Malaria: Which type is worst?
Falciprum
130
Toxoplasmosis: Appearance on head CT
Multiple, subcortical lesions with ring enhancement on contrast head CT
131
Cryptococcal meningitis: How to dx
Send CSF for India Ink test
132
Cryptococcal meningitis: Rx
Antifungals
133
Renal failure: MCC in community
Prerenal (decreased flow to kidneys)
134
Prerenal failure: Pathophysiology
Decreased flow to kidneys
135
Intrinsic renal failure: Rx
Remove offending agent
136
Indications for emergent dialysis
```
AEIOU
Acidosis
Electrolytes
Ingestions (poisoning with a dialyzable drug)
Overload (pulmonary edema)
Uremia
```
137
Uremic patient who's bleeding: Rx
DDAVP (desmopressin)
138
Hypotensive dialysis patient: What must you r/o?
Pericardial tamponade (uremic pericarditis & effusion is common in dialysis)
139
Hyperkalemia in patient on digoxin: Rx to avoid
No calcium (can cause stone heart phenomenon)
140
Peritoneal dialysis peritonitis: Common causes
S aureus
| S epidermis
141
Peritoneal dialysis peritonitis: Dx
>100 WBC in peritoneal dialysis fluid = infection
142
Nephrotic syndrome: MCC in kids
Minimal change disease
143
Nephritic syndrome: How to diff from ureteral stones based on UA
Red cell casts seen with nephritic syndrome but not with stones
144
Phimosis: Def
Unretractable foreskin
145
Paraphimosis: Def
Foreskin is stuck down (like a turtleneck)
146
Child with priapism: Common caues
Sickle cell dz (need emergent exchange transfusion)
| Thalessemia
147
Testicular torsion: When is most common age to occur
Bimodal: infants then again in young adolescents
148
What causes blue dot sign?
Torsion of testicular appendage
149
How long to rx asymptomatic bacturia in pregnancy?
10-14 days
150
UTI: Microscopic definition
5+ WBC/hpf
151
Prostatitis: How long to rx
4-6 weeks
152
Prostatitis: How to dx
Clinical (prostate tenderness +/- LBP)
| UA may be negative
153
Kidney stones: Most common type
Calcium
