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Specialty Care > Adult EM > Flashcards

Adult EM Flashcards

1
Q

Differential for Lower Quadrant Pain

A
  • Pregnancy
  • Appendicitis
  • UTI
  • Nephrolithiasis
  • Bowel obstruction
  • Ovarian torsion
  • PID or TOA
  • Ectopic
  • Cecal volvulus
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2
Q

3 Appendicitis Signs

A
  • Rovsing - RLQ pain with LLQ palpation
  • Psoas - RLQ pain with hip extension in lateral decubitus position
  • Obturator - RLQ pain with internal rotation of hip
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3
Q

What imaging should you choose if you suspect appendicitis?

A
  • US in young females or if pregnant

* CT if older adult or male

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4
Q

Tx of Appendicitis

A

NPO, IV abx, IVF, zofran or reglan and pain meds; SURGICAL

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5
Q

Differential for SOB and Chest Pain

A
  • Coronary
  • A fib
  • CHF
  • Pericarditis
  • Anxiety
  • Cardiomyopathy
  • Pleural effusion
  • Pneumonia
  • COPD
  • Restrictive Lung Disease
  • Cor pulmonale
  • Pneumothorax
  • PE
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6
Q

Pathophysiology of PE

A
  • Causes increase in pulmonary vascular resistance –> less LV preload –> R heart failure
  • Inc in dead space (blood not reaching alveoli)
  • Improves with administration of O2 unlike a shunt
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7
Q

Classic PE EKG Finding

A

S1Q3T3 (inverted t wave in lead III)

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8
Q

Imaging Choices for PE

A

CT pulmonary angio - unless pregnant or allergic to contrast

If pregnant use US of lower extremities

If allergic use VQ scan

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9
Q

PE Tx

A
  • If stable … heparin bridge to coumadin

* If unstable … embolectomy or TPA

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10
Q

UFH v. LMWH

A
  • Unfractionated (IV) - must monitor PTT q 6 hr

* LMWH (subQ) - no monitoring but must have good renal function

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11
Q

Tx of Spontaneous v. Tension Pneumothorax

A
  • Spontaneous …
    • If >15% of lung field then place chest tube (b/n 4th and 5th rain in nipple line) + observe
    • If < 15% of lung field and stable then dispo home
  • Tension …
    • Usually traumatic and unstable
    • Use needle decompression at 2nd intercostal space in mid-clavicular line
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12
Q

Causes of A Fib

A
  • Cardiac - MV regurgitation, MI, WPW, conduction problem, pericardial pathology
  • Hyperthyroid
  • Hypothermia
  • Pulmonary - PE, pneumonia, hypoxia, COPD
  • Alcohol
  • Infection
  • Renal failure
  • DM
  • Obesity
  • Digoxin
  • Electrolytes abnormalities
  • Cardiac or pulmonary surgery
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13
Q

Tx of A fib

A

If stable … Ca ++ channel blocker (diltiazem) and usually convert on own

If unstable (hypotension and altered) … immediate cardio version and IV heparin –> Coumadin

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14
Q

CHADS2 Score

A
  • **0 is low, 1 moderate, 2 high so give med
    • C - CHF
    • H - HTN
    • A - age > 75
    • D - DM
    • S - stroke (prior TIA or thromboembolism)
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15
Q

Has-Bled Score

A
  • **if greater than CHADS2 score then do not give med
    • H - HTN
    • A - abnormal liver or renal function (1 pt ea)
    • S - stroke
    • B - bleed hx or predisposition
    • L - labile INRs
    • E - elderly (> 65)
    • D - drugs or alcohol (1 pt ea)
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16
Q

Testicular Torsion v Epididymitis

A

Torsion

  • neg cremasteric reflex
  • high lie or horizontal lie
  • no flow on US
  • bimodal distribution (childhood and pre-adolescence)
  • EMERGENT urology consult + detorsion (rotate medial to lateral “open the book”)

Epididymitis
-point tenderness at head of epididymis and at superior
pole
-most commonly secondary to STDs in adolescence
-Tx = IM ceftriaxone and oral doxy

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17
Q

What is the #1 sign of a torsed appendage testis?

A
  • blue dot sign; self-resolving
18
Q

What are possible etiologies of a R sided varicocele?

A

retroperitoneal tumor, RCC, renal vein thrombosis

19
Q

Differential for Flank Pain

A
  • AAA
  • PE
  • Appendicitis
  • Renal vein thrombosis
  • Renal tumor
  • Ectopic
  • Bowel obstruction
  • Pancreatitis
  • Cholecystitis
  • MSK
  • Zoster
  • Renal cyst
  • Pyelonephritis
  • Nephrolithiasis
  • Hepatitis
  • Peptic ulcer
  • Diverticulitis
20
Q

3 Most Common Locations of Kidney Stones

A

ureteropelvic junction

iliac vessels

ureterovesicular junction

21
Q

Mgt of Kidney Stones

A
  • CBC, CMP, UA
  • pain meds, zofran, Flomax, IVF
  • Imaging = US in pregnant women or kids; non-enhanced CT in adults
  • Dispo - > 7 mm need surgical correction
22
Q

Differential for Sore Throat

A
  • Strep throat (GBS) - treat w/ PCN; only steroids to lessen tonsil swelling
  • EBV
  • PTA/retropharyngeal abscess
  • Epiglossitis
  • Lemieres
23
Q

Centor Criteria

A

(if 2 then do rapid strep - specific so if pos then no culture, if negative but high suspicion get culture)

  • No cough
  • Fever
  • Tonsilar exudate
  • Cervical LN
24
Q

SIRS

Sepsis

Severe Sepsis

Septic Shock

A
  • SIRS (2+)
    • Temp > 38 or < 36
    • HR > 90
    • RR > 20 or PaCO2 < 32
    • WBC > 12,000 or < 4,000 or >10% bands
  • Sepsis
    • SIRS + infection
  • Severe Sepsis
    • Septic + end organ damage
  • Septic Shock
    • Severe sepsis + hypotension
      • Systolic < 90
      • Drop >40 from baseline
      • Refractory to IVF
25
Q

Differential for Acute Abdomen

A
  • Renal Colic
  • Pancreatitis
  • Mesenteric ischemia
  • Diverticulitis
  • Cholecystitis
  • Appendicitis
  • Perforation
  • Bowel obstruction
  • AAA
26
Q

What is the most common AAA location?

A

Infra-renal

27
Q

When do you treat a AAA?

A
  1. 5 cm in males
  2. 0 cm in females

OR if symptomatic

28
Q

AAA Mgt

A
  • US first
  • Then … CBC, BMP, CXR, EKG, type + screen, CT abdomen and pelvis w/ contrast
  • Call vascular surgery
  • 2 large bore IVs for hypotension
29
Q

EKG Findings for STEMI Locations

A
  • Inferior - II, III, aVF
  • Lateral - V5, V6
  • Anterior wall - V2, V3, V4
30
Q

MI Mgt

A
  • First - ASPIRIN
  • Meds - MONA + beta + anti-coagulation
    • Morphine, oxygen, nitrates, aspirin, beta blocker
    • Dual anti-platelet if STEMI
31
Q

Differential for RUQ Pain

A
  • Gallstones / cholecystitis
  • Hepatitis
  • Gastritis / PUD
  • Pancreatitis
  • Pulmonary (RLL pneumonia)
  • Fitz-Hugh-Curtis (PID)
32
Q

Cholelithiasis

Cholecystitis

Choledocholithiasis

Cholangitis

A
  • Cholelithiasis - stones
  • Cholecystitis - stone in cystic duct
  • Choledocholithiasis - stone in common bile duct (jaundice)
  • Cholangitis - stone in biliary tree + bacterial infection (sepsis)
33
Q

Tx of Cholecystitits

A
  • abx, pain and nausea meds +/- GB removal
34
Q

Charcot’s Triad and Reynold’s Pentad

A
  • Charcot’s triad
    • 1- fever
    • 2- RUQ pain
    • 3- jaundice
  • Reynolds Pentad
    • 4- hypotension
    • 5- altered mental status
35
Q

Cholesterol v Pigmented Gallstones

A

Cholesterol

  • Inc cholesterol and dec bile acids
  • Fat, female, fertile, forty
  • CF, family hx
  • do not see on Xray

Pigmented

  • black = hemolysis
  • brown = bacterial or parasite infection
  • sickle cell
  • can be radio-opaque
36
Q

Seizure

A
  • Meningitis
  • Known seizure disorder
  • Anoxic brain injury
  • Hypoglycemia
  • Metabolic disorder
  • Na problem
  • Actually syncope
  • Toxin or withdrawal
  • Pregnancy
  • Intracranial hemorrhage or other intracranial pathology
37
Q

Generalized Sz

Simple Partial Sz

Complex Sz

Status Epilepticus

A
  • Generalized = whole brain
  • Simple partial = no altered mental status
  • Complex = altered mental status
  • Status epilepticus = 5 min continuous sz activity OR 2+ episodes without return to baseline between
38
Q

Important Questions to Ask in Sz History

A
  • ASK FOR WITNESS
  • Any prodrome? Palpitations? Aura?
  • Were they back to baseline immediately after?
  • Movements? Length?
  • Urinary incontinence or tongue biting?
  • Did someone check blood glucose?
39
Q

3 Lines of Tx for Status Epilepticus

A
  • 1 - benzo (ativan) q 2 min X 5
  • 2- phenytoin or phosphenytoin
  • 3- phenobarbital OR levetiracetam OR valproic acid
40
Q

PERC Rules

A

If none present then r/o DVT, pre-test probability < 15%, if any positive then do work-up w/ D dimer or imaging depending on risk

* Age > 50 
* HR > 100 
* SaO2 < 95% on RA
* Unilateral leg swelling 
* Hemoptysis 
* Recent surgery (requiring GA) or trauma in last 4 wks 
* Prior PE or DVT 
* Hormone Use - OCPs, estrogen replacement
41
Q

Well’s Criteria

A
  • Clinical signs and sx DVT - 3 pt
  • PE is #1 diagnosis or equally likely - 3 pt
  • HR > 100 - 1.5 pt
  • Immobilization for 3+ days or surgery in last 4 wks - 1.5 pt
  • Previous DVT or PE - 1.5 pt
  • Hemoptysis - 1 pt
  • Cancer treated in last 6 mo or palliative - 1 pt

POINT SYSTEM

* < 2 pt - low risk (consider D dimer or PERC, if D dimer negative STOP)
* 2-6 pt - moderate risk (high sensitivity D dimer or CTA) 
* > 6 pt - high risk (no D-dimer - right to CTA)

Specialty Care (5 decks)

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