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ABEM Recert Exam 2015 > ABEM Recert Exam pt. 1 > Flashcards

ABEM Recert Exam pt. 1 Flashcards

1
Q

Mechanism of hypovolemic hyponatremia

A

Loss of Na in excess of loss of H2O

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2
Q

Rx for hypovolemic hyponatremia

A

Saline

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3
Q

Mechanism of euvolemic hyponatremia

A

Dilutional from slight water retention

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4
Q

Types of euvolemic hyponatremia

A
  1. Hypothyroidism
  2. Arsenal insufficiency
  3. Psychogenic polydipsia
  4. SIADH

HAPS

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5
Q

Rx for euvolemic hyponatremia

A

Fluid restrition

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6
Q

Mechanism of hypervolemic hyponatremia

A

Severe water retention

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7
Q

Types of hypervolemic hyponatremia

A
  1. Acute renal failure
  2. Hyperglycemia
  3. Severe edema
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8
Q

Rx for hypervolemic hyponatremia

A

Fluid restriction

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9
Q

Maximum rate of correction of Na in hyponatremia

A

0.5 meq/L/hr in chronic

1 meq/L/h in acute

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10
Q

Usual cause of hypernatremia

A

Decreased total body water

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11
Q

Mechanism of diabetes insipidus

A

Lack of ADH; causes hypernatremia

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12
Q

Hypercalcemia: MCC

A

Malignancy

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13
Q

Hypercalemia: Si/sx based on levels

A

<12: asymptomatic or mild N/V and anorexia
12-14: weakness & fatigue
15+: altered MS

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14
Q

Hypercalcemia: Rx

A

Lasix

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15
Q

Hypocalcemia: Usual causes

A

parathyroidism or thyroid surgery

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16
Q

Chvostek sign:

A

Seen with hypocalcemia

Twitching of mouth with tapping on facial nerve

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17
Q

Trousseau sign

A

Seen with hypocalcemia

Carpal spasm with inflation of BP cuff

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18
Q

Hypocalcemia: si/sx

A

Anorexia, N/V, fatigue

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19
Q

Hypomagnesiumemia: si/sx

A

Anoerxia, N/V, fatigue

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20
Q

Malempatti: how is it scored?

A 
1 = best view
4 = horrible view
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21
Q

ETT: Where to secure in adult males and females

A

21cm at lip in females

23cm at lip in males

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22
Q

When to perform needle cricothyroidotomy?

A

Infants and small children, can’t do typical open crich because membrane is too small

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23
Q

When to use uncuffed ET tubes?

A

Age <2

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24
Q

Where is narrowest part of airway?

A 
Adults = vocal cords
Pediatrics = criccoid rings
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25
Q

ET tube: How to calculate size

A

(Age / 4) + 4

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26
Q

ET tube: How far to insert in peds

A

3 x ETT size

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27
Q

Blade to use for intubation with term infants

A

Miller 1

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28
Q

Blade to use for intubation with preterm infants

A

Miller 0

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29
Q

Benzocaine: What toxicity is seen with excess use of?

A

Methemoglobinemia

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30
Q

How to tell amides and esters apart?

A

Amides have “i” prior to caine in name

Esters don’t

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31
Q

Lidocaine: Maximal dose for local infiltration

A

5 mg/kg

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32
Q

Orbital wall fracture: What is most common?

A

Inferomedial wall

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33
Q

Hypopeon: Disposition

A

Immediate ophtho consult in ED

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34
Q

Thyroid hormone: Mechanism of production

A
  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
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35
Q

Graves dz: Pathophysiology

A

Inappropriate stimulation of thyroid gland by autoantibodies against TSH receptor.
Causes hyperthyroidism

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36
Q

Thyroid storm: MCC

A

Infection

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37
Q

Thyroid storm: Rx

A
  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
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38
Q

Hypoglycemia: Defintion

A

<70 mg/dL

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39
Q

Malignant otitis externa: MCC

A

Pseudomonas is almost always cause

Surgical consult is mandatory

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40
Q

Isolated scapula fx: Rx

A

Sling

Often secondary to significant MOI, so must consider further w/u

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41
Q

Bankart lesion: Definition

A

Labral detachment in shoulder

May or may not be visible on xray

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42
Q

Radial nerve: Anatomic path

A

Inside of upper arm along humerus

Often injured with humeral fracture

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43
Q

Montaggia fracture: Definition

A

Ulnar fracture with radial head dislocation

GRUM

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44
Q

Galeazzi fracture: Definition

A

Radius fracture with radioulnar dislocation.

GRUM

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45
Q

Carpal bone: Most common fractured

A

Scaphoid

Triquetrium is 2nd most common but most commonly missed

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46
Q

Median nerve: Motor and sensory functions

A

Motor: Make OK with thumb and finger
Sensory: Palm of thumb, index, middle and 1/2 of ring finger

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47
Q

Median nerve: Where is it injured?

A

Anecubital fossa

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48
Q

Radial nerve: Where is it injured?

A

Humerus fractures

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49
Q

Ulnar nerve: Motor and sensory functions

A

Motor: Spread fingers against resistance
Sensory: Palm and dorsal aspect of 1/2 of ring and entire small finger

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50
Q

Ulnar nerve: Where is it injured?

A

Passes by ulnar styloid at elbow

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51
Q

Radial nerve: Motor and sensory functions

A

Motor: Wrist & finger extension
Sensory: Back of thumb, index, middle, and 1/2 of ring fingers

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52
Q

Mallet finger: Definition

A

Damage to extensor tendon, so DIP is flexed and cannot fully extend

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53
Q

Mallet finger: Rx

A

Splint DIP in extension for 6 weeks

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54
Q

Jersey finger: Definition

A

Disruption of FDP on volar (palmar) aspect of distal phalynx

Causes inability to flex DIP

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55
Q

Jerser finger: Rx

A

Referral for prompt surgical repair

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56
Q

Hip dislocations: Types

A

90% are posterior (e.g. hitting flexed knee/hip on dashboard)
10% are anterior

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57
Q

Tibial plateau fracture: What nerve is injured?

A

Deep peroneal nerve

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58
Q

Knee dislocation: Possible associated injury

A

Popliteal artery

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59
Q

Ankle sprains: What is injured in most?

A

ATFL (found laterally on ankle)

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60
Q

Deltoid ligament: Where is it on ankle?

A

Medial

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61
Q

Jones fracture: Defintion

A

Transverse proximal 5th metatarsal fx

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62
Q

Jones fracture: Rx

A

Non-weight bearing and ortho f/u

63
Q

Terry Thomas sign: Definition

A

Gap >3mm between scaphoid and lunate

Seen with scapholunate dissocation

64
Q

Spilled teacup sign: Definition

A

Seen with lunate dislocation

65
Q

Posterior fat pad: Causes

A

Children: Supracondylar fracture
Adults: Radial head fracture

66
Q

Lisfranc injury: Definition

A

Disruption of tarsal - metatarsal joint

Look for fracture at base of 2nd metatarsal

67
Q

Coles fracture: Associated injury

A

Must evaluate for possible median nerve injury

68
Q

Hip fracture: Most common type

A

Intertrochanteric

Presents as shortened and externally rotated

69
Q

What presents as shortened and internally rotated leg?

A

Posterior hip dislocation

70
Q

What presents as shortened and externally rotated leg?

A

Intertrochanteric hip fx

71
Q

Acetaminophen: What is toxic metabolite?

A

NAPQI

72
Q

Acetaminopehn OD: When to rx if time of ingestion unknown?

A
  1. If suspect toxic ingestion based on amount ingested

2. If level normal but AST elevated, should also rx

73
Q

Chronic aspirin OD: si/sx

A

Dehydration
Metabolic acidosis
Level >60

74
Q

Acute aspirin OD: si/sx

A 
N/V
Tinnitis
Hypoglycemia
Tachycardia
MS changes
Pulmonary edema
Respiratory acidosis
Level > 100
75
Q

Aspirin OD: Rx

A

Sodium bicarb to alkinilize urine
Keep serum pH >= 7.4; urine pH 7.5-8.5
If intubate, must increase respiratory rate

76
Q

Carbemazepime OD: si/sx

A 
Anticholinergic si/sx
Blind as a bat
Red as a beet
Hot as a hare
Mad as a hatter
77
Q

Cholinergic OD: si/sx

A

SLUDGE

78
Q

Anticholinergic OD: si/sx

A

Blind as a bat
Red as a beet
Hot as a hare
Mad as hatter

79
Q

Carbemazepime OD: Rx

A

Sodium bicarb if wide QRS

80
Q

Serotonin syndrome: Rx

A

Cyprohepatidine
BZD
Supportive care

81
Q

TCA OD: Si/sx

A 
Anticholinergic
Blind as a bat
Red as a beet
Hot as a hare
Mad as a hatter
82
Q

TCA OD: Rx

A

Supportive care

Sodium bicarb if QRS >100 ms, ventricular dysrhythmias, or hypotension unresponsive to fluids

83
Q

Calcium channel blocker vs beta blocker OD: How to diff?

A

CCB has hyperglycemia

B-blocker has hypoglycemia

84
Q

Clonidine OD: si/sx

A

Mimics opiate OD

85
Q

Clonidine OD: Rx

A

Supportive

High-dose naloxone has been effective

86
Q

Lithium OD: Indications for dialysis

A

Acute ingestion with level >4 or chronic level >2.5

Acute renal failure

87
Q

Tripod midface fx: Definition

A

Maxilla, Zygoma & Lateral orbit

Operative repair to prevent cosmetic deformity

88
Q

Lefort I fx: Definition

A

Maxilla only

89
Q

Lefort II fx: Definition

A

Extends from ptyregoid plate through maxilla
Involves orbit
AKA pyramidal fx

90
Q

Lefort III fx: Definition

A

Begins at nasal bridge, involves maxilla, orbital wall & zygomatic arch
AKA craniofacial disruption

91
Q

Open mandible fx: Rx

A

Antibiotics

Admission

92
Q

Closed mandible fx: Rx

A

No antibiotics

d/c with outpatient f/u

93
Q

Neck zones

A
  1. Sternal notch to criccoid cartilidge
  2. Criccoid cartilidge to angle of mandible
  3. Angle of mandible to base of skull
94
Q

Stuctures in neck zone 1

A 
Subclavian artery
Lung apex
Esophagus and trachea
Carotid and verterbal arteries
(Sternal notch to criccoid cartilidge)
95
Q

Structures in neck zone 2

A 
Larynx
Pharynx
Vagus nerve
Esophagus and trachea
Carotid and vertebral arteries
(criccoid cartilidge to angle of mandible)
96
Q

Structures in neck zone 3

A

Salivary and parotid glands
Cranial nerves
Carotid and vertebral arteries
(Angle of mandible to base of skull)

97
Q

Work up of neck zone 1 injuries

A

Imaging

98
Q

Work up of neck zone 2 injuries

A 
Operative exploration if hard signs present:
Expanding hematoma
Bruit
Pulse deficit
Subcutaneous emphysema
Stridor
Respiratory distress
Horseness
Hemiparesis
99
Q

Work up of neck zone 3 injuries

A

Imaging

100
Q

Most commonly injured vascular structure in neck

A

Jugular vein

101
Q

Retinal detachment: Common risk factor for

A

Myopia

102
Q

Ellis dental fracture classification

A
  1. Enamel only
  2. Enamel and dentition
  3. Pulp exposed (immediate dental consult)
103
Q

Osteomyelitis: Most common pathogen

A

S. aureus (Salmonella is most common in sickle cell dz)

104
Q

Primary tumors which most commonly met to bone

A

Breast
Prostate
Lung

105
Q

Most common level of cervical radiculopathy

A

C5

106
Q

Most common level of lumbar degerative disc disease

A

L4/5

L5/S1

107
Q

Septic arthritis: Most common pathogens

A

S. aureus

Strep

108
Q

Is joint fluid culture positive in septic arthritis

A

Only (+) 50% of time

109
Q

Pseudogout: New term for

A

Calcium pyrophosphate deposition (CPPD)

110
Q

Gout crystals: Microscopic appearance

A

Negatively bifringent needle crystals

111
Q

Gout: Joints most commonly affected

A

1st MTP > Knee > Ankle

112
Q

Pseudogout: Microscopic appearane

A

Positively bifringent rhomboid crystals

113
Q

Gangrene: Types

A

Dry: no pain, no pus
Wet: Painful, pus, prone to sepsis

114
Q

Head injuries: MCC

A
  1. Falls

2. MVCs

115
Q

SDH: Appearance on CT

A

Crescent shaped

Associated with skull fx

116
Q

Epidural hematoma: Appearance on CT

A

Lenticular

Associated with cerebral contusion / damage

117
Q

Isolated skull fx: Rx

A

None, unless it is depressed greater than thickness of skull

118
Q

Penetrating neck trauma: What immobilization is required?

A

None if neurovascularly intact

119
Q

Denque fever: Vector

A

Mosquito borne (most common mosquito borne illness world-wide)

120
Q

Mosquito borne illness: Most common

A

Dengue fever

121
Q

Dengue fever: si/sx

A

N/V
Severe myalgias/arthralgias (breakbone fever)
Maculopapular rash

122
Q

Dengue fever: Rx

A

Supportive

123
Q

West Nile virus: Incubation period

A

2-15 days

124
Q

West Nile virus: Rx

A

Supportive

125
Q

Rabies: Geographic distribution in US

A

Everywhere but Hawaii

126
Q

Rabies: Animals that are not carriers

A

Rabbits (lagomorphs)

Small rodents, mice, hampsters, gerbils, etc.

127
Q

Rabies: Rx

A

RIG + vaccine at day 0, 3, 7, 14

128
Q

Small pox vs Chicken pox rash: How to diff?

A

Small pox rash is all in same morphology

Chicken pox rash is in different phases

129
Q

Malaria: Which type is worst?

A

Falciprum

130
Q

Toxoplasmosis: Appearance on head CT

A

Multiple, subcortical lesions with ring enhancement on contrast head CT

131
Q

Cryptococcal meningitis: How to dx

A

Send CSF for India Ink test

132
Q

Cryptococcal meningitis: Rx

A

Antifungals

133
Q

Renal failure: MCC in community

A

Prerenal (decreased flow to kidneys)

134
Q

Prerenal failure: Pathophysiology

A

Decreased flow to kidneys

135
Q

Intrinsic renal failure: Rx

A

Remove offending agent

136
Q

Indications for emergent dialysis

A 
AEIOU
Acidosis
Electrolytes
Ingestions (poisoning with a dialyzable drug)
Overload (pulmonary edema)
Uremia
137
Q

Uremic patient who’s bleeding: Rx

A

DDAVP (desmopressin)

138
Q

Hypotensive dialysis patient: What must you r/o?

A

Pericardial tamponade (uremic pericarditis & effusion is common in dialysis)

139
Q

Hyperkalemia in patient on digoxin: Rx to avoid

A

No calcium (can cause stone heart phenomenon)

140
Q

Peritoneal dialysis peritonitis: Common causes

A

S aureus

S epidermis

141
Q

Peritoneal dialysis peritonitis: Dx

A

> 100 WBC in peritoneal dialysis fluid = infection

142
Q

Nephrotic syndrome: MCC in kids

A

Minimal change disease

143
Q

Nephritic syndrome: How to diff from ureteral stones based on UA

A

Red cell casts seen with nephritic syndrome but not with stones

144
Q

Phimosis: Def

A

Unretractable foreskin

145
Q

Paraphimosis: Def

A

Foreskin is stuck down (like a turtleneck)

146
Q

Child with priapism: Common caues

A

Sickle cell dz (need emergent exchange transfusion)

Thalessemia

147
Q

Testicular torsion: When is most common age to occur

A

Bimodal: infants then again in young adolescents

148
Q

What causes blue dot sign?

A

Torsion of testicular appendage

149
Q

How long to rx asymptomatic bacturia in pregnancy?

A

10-14 days

150
Q

UTI: Microscopic definition

A

5+ WBC/hpf

151
Q

Prostatitis: How long to rx

A

4-6 weeks

152
Q

Prostatitis: How to dx

A

Clinical (prostate tenderness +/- LBP)

UA may be negative

153
Q

Kidney stones: Most common type

A

Calcium

ABEM Recert Exam 2015 (7 decks)

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