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PEM Board Review > All Cards > Flashcards

All Cards Flashcards

1
Q

Hangman vs Jefferson fracture

A

Jefferson - C1 burst fracture, usually from axial loading (like a diving injury)
Hangman - posterior C2 fracture, usually from hyperextension

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2
Q

symptoms and management of hydrofluoric acid burns?

A

used in glass etching, metal cleaning, and electronics manufacturing
hypocalcemia, hypomag, and hyperkalemia
treat with topical, intra-arterial, IV calcium gluconate

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3
Q

mild vs moderate vs severe hypothermia

definitions and treatment

A

mild 32-35: active external warming
moderate 28-32: +active core (bladder, gastric lavage)
severe < 28: ECMO, pleural lavage

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4
Q

treatment of shivering

A

BDZs

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5
Q

atropine dose

A

0.02mg/kg (minimum dose of 0.1mg)

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6
Q

What’s a normal ankle-brachial index?

A

> 0.9

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7
Q

disorder with mousy/musty odor

A

PKU

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8
Q

fishy odor

A

trimethylaminuria

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9
Q

sweaty feet smell

A

isovaleric acidemia

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10
Q

SIRS criteria

A

Core temp < 36 or >38.5
tachycardia or bradycardia
tachypnea
leukocytosis, lymphopenia, or 10%+ bandemia

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11
Q

Septic shock definition

A

sepsis + SIRS + continued cardiovascular dysfxn after 40ml/kg fluids

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12
Q

refractory septic shock definitions

A

fluid refractory: after 60ml/kg fluidscatecholamine refractory: after 10 mcg/kg/min of dopa, epi, or norepi

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13
Q

severe sepsis definition

A

when associated with:
ARDS
cardiovascular dysfxn
dysfxn of 2 or more organ systems

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14
Q

what is hydrogen sulfide

A

mustard gas

causes superficial skin burns, eye irritation, and resp tract irritation

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15
Q

What are the classifications of neutropenia

A

severe < 500
moderate 500-1000
mild 1000-1500

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16
Q

What is the discriminatory zone with HCG?

A

transvaginal US- 1,500 mIU/mL

transabdominal US- 6,000 mIU/mL

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17
Q

symptoms of carbemazepine toxicity

A

can cause resp compromise, altered mental status, vomiting, drowsiness, slurred speech, nystagmus, hallucinations, hypotension, coma, dystonic reactions, seizures has some anticholinergic properties false positive for TCAs on UDS

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18
Q

expected compensation for acute resp acidosis

A

increase in serum bicarb 0.1 meq for each 1 mmHg PCO2

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19
Q

expected compensation for acute metabolic acidosis

A

decrease in PCO2 1.2 mmHgfor each 1 meq of bicarb

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20
Q

expected compensation for acute resp alkalosis

A

decrease in serum bicarb 0.2 meq for each 1mmHg PCO2

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21
Q

expected compensation for acute metabolic alkalosis

A

increase in PCO2 0.6 mmHg for each 1meq of bicarb

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22
Q

how frequently can you repeat epi in anaphylaxis?

A

3-4 times every 5-15 minutes

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23
Q

what is the pathophys of staph scalded skin syndrome?

A

hematogenous spread of epidermolytic or exfoliative toxin; children are more affected that adults due to inefficient renal clearance

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24
Q

most common nerve injury in supracondylar fracture

A

median nerve

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25
Q

most common artery injury in supracondylar fracture

A

brachial artery

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26
Q

treatment of DUB

A

combo pills or progestin only pill taper

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27
Q

sites for IO access

A 
proximal tibia
distal tibia
distal femur
proximal humerus
sternum in adults
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28
Q

MUDPILES

A 
methanol/metabolic defects
uremia
DKA, alcoholic ketoacidosis, starvation
paraldehyde
iron and INH
lactic acidosis
ethylene glycol
salicylates
* also CO, cyanid, hydrogen sulfide, metformin, phenformin, sulfur, theophyllin, and toulene!
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29
Q

normal CSF opening pressure

A

< 20 cm H2O

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30
Q

LR +

A

= (positive test/presence of disease) / (positive test/absence of disease)
= sensitivity / (1 - specificity)

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31
Q

LR -

A

= (negative test/presence of disease) / (negative test/absence of disease)
= (1 - sensitivity) / specificity

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32
Q

How do you use LRs?

A

You have to convert the pretest probability to odds
This is pretest probability / (1 - pretest probability)
Then you multiply by the LR
Finally, you convert the odds BACK to the probability!

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33
Q

What are clinically significant LRs?

A

LR + > 10

LR - < 0.1

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34
Q

Amanita phalloides ingestion

A

white mushroom that can kill. classically:
stage I: 6-24hrs of no sxs
II: V/D 12-24hrs
III: seeming recovery
IV: 2-4d later with liver and renal failure

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35
Q

loss of contralateral pain and temperature

loss of ipsilateral motor

A

Brown Sequard syndrome

hemisection of the spinal cord

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36
Q

loss of motor and pain sensation

preserved temp and proprioception

A

Anterior cord syndrome

disruption of the anterior spinal artery

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37
Q

upper extremities affected more than lower extremities

A

central cord syndrome

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38
Q

Posterior cord syndrome

A

loss of proprioception and pain sensation

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39
Q

loss of proprioception and pain sensation

A

posterior cord syndrome

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40
Q

ectasy/MDMA intoxication

A

hyponatremia, concentrated urine, altered mental statusmay see serotonin syndrome

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41
Q

lab abnormality in hereditary angioedema

A

low C4

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42
Q

reasons to use VariZig

A

only for post-exposure ppx, but NOT once there is varicella infection

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43
Q

lab abnormalities in strep glomerulonephritis

A

low C3, nml C4. if levels are normal, consider something else

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44
Q

non-ketotic hypoglycemia with metabolic acidosis should make you think of…

A

fatty acid oxidation disorder

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45
Q

classic lab findings in fatty acid oxidation disorder

A

non-ketotic hypoglycemia

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46
Q

anion gap formula

A

AG = Na - Cl - HCO3

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47
Q

calculated osmolarity

A

= 2 x Na + glucose/18 + BUN/2.8

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48
Q

Multi-casualty vs mass casualty event

A

multi-casualty = 5+ victims

mass casualty = strains the existing EMS system

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49
Q 
What can different levels of responders do:
first responders?
EMT-B?
EMT-I?
EMT-P?
A

1st responders: airway clearance, control blood loss, AED, CPR
EMT-B: assessment, spinal immobilization, BVM, defibrillation
EMT-I: pacing, cardioversion, IO, EKG, needle thoracostomy, advanced airway management
EMT-P: arrhythmias, advanced airway management, intubation, cricothyrotomy, meds, fluids

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50
Q

Best pressors for shock that is:

  1. cold
  2. warm
  3. normal BP
A
  1. epi
  2. norepi
  3. dopa
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51
Q

CXR findings (measurements) for RPA

A

prevertebral soft tissue swelling >7mm at C2 or 14mm at C6

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52
Q

Lab findings concerning for a pulmonary EXUDATE

A 
WBC >10K
glucose < 50% of serum
protein > 50% of serum
amylase > 200
LDH > 60% of serum
pH < 7.0 (v. suggestive of empyema)
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53
Q

EKG findings in pericarditis

A

widespread ST elevation
PR depression
ST elevation in limb and precordial leads with concave elevations

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54
Q

Location for ____ nerve block at wrist:

1) ulnar
2) median
3) radial

A

1) ulnar - proximal ventral crease at ulnar styloid
2) median - medial tendon of flexor carpi radialis
3) radial - dorsal crease @ radial styloid

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55
Q

pressure readings associated with compartment syndrome

A

> 30 mmHg

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56
Q

Components of the pediatric trauma score

A
  1. size
  2. airway
  3. consciousness
  4. SBP
  5. fractures
  6. cutaneous
    ranges from -6 to 12
    lower the score, the higher the chance of mortality
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57
Q

How do you determine size for:

  1. ET tube
  2. ET tube depth of insertion
  3. NG tube size
  4. chest tube size
A
  1. ET tube = age/4 + 4
  2. ET tube depth of insertion = ETT x 3
  3. NG tube size = ETT x2
  4. chest tube size = ETT x 4
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58
Q

low plasma alanine levels are associated with what IEM?

A

ketotic hypoglycemia

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59
Q

what are treatments for hyperammonemia?

A

IV arginine
sodium benzoate
phenylacetate
hemodialysis

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60
Q

what disease is associated with +reducing substances in the urine, cloudy cornea, and HSM?

A

galactosemia

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61
Q

What is the BP treatment for pheochromocytoma?

A

phenotalamine 2nd line is CCBs

NO beta-blockers!!!

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62
Q

Patient with a PAINFUL Horner’s syndrome should make you think of…

A

carotid artery dissection

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63
Q

treatment for HOCM emergency?

A

B-blockers and CCBs

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64
Q

what is the treatment for lichen sclerosis?

A

topical steroids

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65
Q

treatment of prolapsed urethra

A

topical estrogen

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66
Q

treatment for tet spells

A

morphine (decreases pulmonary venous return, relaxes the infundibulum)
phenylephrine (increases SVR)
sodium bicarb (reduces acidosis)
beta-blockers (relaxes infundibular spasm, decreases inotropic effect)

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67
Q

treatment of HOCM?

what should you avoid?

A

beta-blockers
CCBs
avoid - diuretics and digoxin

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68
Q

Criteria for Acute Rheumatic Fever

A 
JONES (major) PEACE (minor)
Joints - arthritis
O - heart - pancarditis
Nodules (subcutaneous
Eythema marginatum
Sydenham chorea
PR prolonged
ESR elevated
Arthralgias (rather than arthritis)
CRP/WBC elevated
Elevated temp >39C
(previous rheumatic fever too)

*Polyarthritis is the most frequently found major criteria
*Dx if 2 major or 1 major + 2 minor
Tx: PCN

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69
Q

med to rapidly inhibit release of thyroid hormone in pediatrics

A

potassium iodide (PTU is contraindicated in kids; methimazole doesn’t work acutely)

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70
Q

Symptoms of autonomic dysfxn syndrome

A

tachycardia, tachypnea, diffuse diaphoresis, hyperthermia, hypertension, mydriasis, and dystonia

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71
Q

Treatment of autonomic dysfxn/sympathetic storm

A

bromocriptine, dantrolene, benzodiazepines, clonidine, and narcotics

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72
Q

What are the components of Cushing’s triad?

What is the earliest and most sensitive indicator?

A

bradycardia, hypertension, irregular respirations

most sensitive/earliest: bradycardia

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73
Q

What are the impt landmarks for IJ venous access?

A

The medial approach uses the apex of the triangle formed by the sternal and clavicular heads of the SCM.
Best localized with mild hyperextension of the neck.

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74
Q

Location for a distal ulnar nerve block?

A

just proximal to the ulnar styloid process

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75
Q

Location for a distal median nerve block?

A

between the palmaris longus and flexor carpi radialis tendons

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76
Q

Nerve block achieved at: between the palmaris longus and flexor carpi radialis tendons

A

median nerve block

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77
Q

Reasons to refer a patient to a burn center (4)

A

1) partial thickness depth >10% if 20% BSA > 11 years)
2) full thickness depth > 2% BSA
3) high risk for disability or poor cosmetic outcome (e.g., hands, feet, face, circumferential burns and those overlying joints)
4) associated inhalation injury or trauma

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78
Q

Parkland Formula

A 
4 x BSA x wt (kg)
Give half in first 8 hours
Give second half in subsequent 16 hours
Does NOT account for maintenance fluids
Should only include partial and full thickness burns in BSA calculation
Only apply if 15% BSA is involved
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79
Q

Max dose of bupivicaine

A

2mg/kg without epi

3mg/kg with epi

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80
Q

1% lidocaine is how many mg/ml

0.25% bupivicaine is…

A

10mg/ml

2.5mg/ml

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81
Q

Things that can cause false positive guaiac stools

A

Horseradish
Turnips
Cherries
Tomatoes

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82
Q

Things that can cause red stool that isn’t bloody

A 
cefdinir/omnicef
red food dye
licorice
blueberries
spinach
beets
bismuth
iron preparations
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83
Q

Most common reason for child to have hypoglycemia?What’s low/wrong?

A

ketotic hypoglycemia

low alanine stores in muscles

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84
Q

Distinction between organic acidemias and urea cycles defects?

A

OA: elevated ammonia and acidotic
UC: VERY high ammonia (1000s) and usually NOT acidotic; low BUN, nml lactate, encephalopathy

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85
Q

IEM mimic of child abuse with macrocephaly, chronic subdural effusions?
How to diagnose?

A

glutaric acidemia type I
dx with urine organic acidsdx usually made during crises (intercurrent illnesses) with metabolic acidosis, hyperammonemia and encephalopathy.

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86
Q

Lab that is usually diagnostic for CAH

A

17-hydroxyprogesterone (17-OHP)

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87
Q

IEM associated with reducing substances in urine?

A

galactosemia

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88
Q

Management of Kawasaki when acute?

When convalescent?

A

Acute: IVIG, high dose ASA
Conv: low dose ASA (3-5mg/kg/day)

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89
Q

Management of dry gangrene in scleroderma

A

tx with systemic or topical nitro; or CCBs

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90
Q

How do you calculate sodium deficit?

A

Figure out the volume deficitNa/1000 x 0.6 x volume deficit

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91
Q

Labs in RTA type IV

A

hyperkalemic, hyperchloremic, metabolic acidosis with normal AG

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92
Q

Winter’s Formula

A

PCO2 = 1.5 x HCO3 + 8 +/- 2

explains what the appropriate CO2 response should be to metabolic acidosis

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93
Q

Symptoms of scorpion sting

A

local pain, restlessness, hyperactivity, roving eye movements, and respiratory distress. More severe signs include seizures, drooling, wheezing, hyperthermia, cyanosis, GI hemorrhage, respiratory distress and death from shock or respiratory paralysis

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94
Q

Envenomation associated with metallic taste

A

rattlesnake

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95
Q

systemic symptoms of brown recluse spider bite

A

fever, chills, malaise, weakness, nausea, vomiting, joint pain, petechial morbilliform rash, intravascular hemolysis, hematuria, and renal failure

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96
Q

what do you need to avoid when treating a patient with ciguatera poisoning?

A

opioids - may interact with toxin and cause hypotension

97
Q

order of tissues with resistance to electricity

A

Bone > fat > tendon > skin > muscle > nerve.

98
Q

when should you consider active rewarming measures

A

cardiovascular instability, T < 32ºC, or inadequate response to passive re-warming methods

99
Q

how do you grade frostbite injuries?

A

1st degree- numbness and erythema with no tissue loss
2nd - superficial blistering, with clear to milky fluid, surrounded by edema and erythema
3rd - deeper blisters with blood containing fluid (leave blisters alone)
4th - affects muscle and bone.

100
Q

in hypothermia, resuscitate to at least what temperature

A

The patient should be resuscitated until a body temperature of 32 – 34ºC

101
Q

Symptoms of lithium toxicity

A

coarse tremor, ataxia, dysarthria, vomiting, diarrhea, cardiovascular changes and renal dysfunction. Later signs: impaired consciousness, muscle fasciculations, myoclonus, seizures, coma and death.

102
Q

Best med for an agitated (possibly delirious) child?

A 
haldol
NOT BDZs (could loosen inhibitions or worsen delirium)
103
Q

What are the different levels of sedation?

A

Minimal - respond normally to verbal commands and not asleep.
Moderate - does not need repeated painful stimulation to be aroused and should not require intervention to maintain a patent airway.
Deep sedation - patient cannot be easily aroused but respond purposefully after repeated verbal or painful stimulation; ability to independently maintain ventilatory function may be impaired.
General anesthesia is not arousable, even by painful stimulation.

104
Q

What are the ASA classifications?

A

I - normal, healthy patient
II - mild systemic illness without functional limitation
III - severe systemic disease with definite functional limitation
IV - severe systemic disease that is a constant threat to life
V - moribund patient who is not expected to survive without the procedure

105
Q

Epi dose for bradycardia in neonatal resuscitation

A

0.01 mg/kg of 1:10,000

106
Q

How do you differentiate between main types of neonatal conjunctivitis?

A

Gonococcal - 3-5 days after birth.
Chlamydial - 5- 14 days after birth.
Negative gram stain (obligate intracellular parasite) Non-gonococcal, non-chlamydial bacterial - after the first 2 weeks of life.
Chemical (due to silver nitrate prophylaxis) - first day of life and resolves in 2-4 days.

107
Q

Symptoms of morning glory intoxication?

A

mydriasis, hyper or hypothermia, perspiration, bronchorrhea and increased salivation

108
Q

What’s the difference between:
boutonniere deformity
swan neck deformity
hammer/mallet finger

A

boutonniere - flexed PIP, extended DIP
swan neck - extended PIP, flexed DIP
hammer - flexed DIP due to rupture of extensor digitorum tendon

109
Q

Fruity odor, ingestion with no acidosis, but +osmolar gap?

A

isopropyl alcohol (odor is from acetone metabolic byproduct)

110
Q

How often do physically restrained patients need their restraints renewed according to JACHO?

A

< 9 years - every hour
9-17 years - every 2 hours
adults - every 4 hours.
Patients must be evaluated, face-to-face, by the physician ordering the restraints within 1 hour of placing the order.

111
Q

Findings in cardiac tamponade

A

Beck’s triad: hypotension, muffled heart sounds, and distended neck veins
Low QRS voltages in all leads
Electrical alternans in precordial leads

112
Q

What is the dose for naloxone?

A

0.1mg/kg

113
Q

x-ray findings in RPA

A

> 7mm at C2

>14mm at C6

114
Q

EKG findings in pericarditis

A

An ECG will demonstrate changes of epicardial inflammation with widespread ST elevation, PR depression, ST elevation in limb and precordial leads. The elevations are concave.

115
Q

treatment of malignant hyperthermia

A

dantrolene

116
Q

Treatment of labial adhesions?
Treatment of urethral prolapse?
Treatment of lichen sclerosis?

A

1st line: topical estrogen cream; 2nd line: topical steroids
topical estrogen
topical steroids

117
Q

medical treatment of phimosis

A

topical steroids

118
Q

epi dosing for anaphylaxis

A

1: 1000 epi
0. 01 mg/kg
0. 01 ml/kg

119
Q

epi dosing for codes

A

1: 10,000
0. 01 mg/kg
0. 1 ml/kg

120
Q

management of frenulum lacerations

A

expectant - do not suture as they heal spontaneously

121
Q

With regards to hemothorax, what amount of bloody output should trigger operative management?

A

Immediate return of 1500mL or 10-15ml/kg

>200ml/hr or 2-4ml/kg/hr of bloody drainage

122
Q

Immediate treatment of commotio cordis?

A

defibrillation

123
Q

What qualifies for a positive DPL?

A

free aspiration of gross blood, gastrointestinal contents, vegetable fibers or bile through the lavage catheter upon entering the abdominal cavity
presence of ≥100,000 RBC/mm3
≥500 WBC/mm3
bacteria on Gram stain of the lavage fluid.

124
Q

Malaria mimic seen in New England?
Transmission?
How do you diagnose it?
Treatment?

A

Babesiosis
Ixodes tick
dx with thick and thin smears (like malaria); may see the Maltese cross
atovaquone + azithromycin OR clinda + quinine

125
Q

Cutaneous ulcer OR purulent conjunctivitis with preauricular lymph nodes should make you think of this disease:

A

tularemia

126
Q

Bloody diarrhea infectious agent associated with vaginitis?

A

Shigella

127
Q

Bloody diarrhea infectious agent associated with bandemia on CBC?

A

Shigella

128
Q

treatment of Shigella dysentery?

A

5d of azithro; can also do bactrim, 3rd gen cephalosporin, fluoroquinolones

129
Q

infectious diarrhea agent to treat with antibiotics?

A

Shigella

130
Q

tx for tularemia

A

streptomycin, gentamicin, doxycycline, cipro

131
Q

responsible organism in Lemierre’s disease?

treatment?

A

Fusobactermium necrophorum

unasyn

132
Q

Pt with fever, PNA, endocarditis, flu-like symptoms.
Dx?
Tx?

A

Q-fever (Coxiella burnetti, rickettsial organism)

tx with doxy, fluoroquinolone

133
Q

Treatment for cat scratch dz

A

Can usually observe, but if abx desired, try azithromycin to reduce duration of lymphadenopathy
Can also try rifampin, bactrim, and cipro

134
Q

formula for NNT

A 
NNT = 1/ARR
ARR = absolute risk reduction
135
Q

type I error

A

rejecting the null hypothesis when it’s actually correct
false positive study
alpha

136
Q

type II error

A

failure to reject the null hypothesis appropriately
false negative study
beta

137
Q

failure to reject the null hypothesis appropriately

A

type II error

138
Q

rejecting the null hypothesis when it’s actually correct

A

type I error

139
Q

What 3 factors do you need to look at to determine the appropriate type of statistical test to perform?

A
  1. is the distribution parametric or not?
  2. is your data continuous, nominal/ordinal, or categorical?
  3. are your tested populations dependent or independent?
140
Q

Sensitivity =

A

TP / TP+FN

141
Q

Specificity =

A

TN / TN+FP

142
Q

Power

A

1 - beta

beta = type II error rate

143
Q

PPV =

A

TP / TP+FP

144
Q

NPV =

A

TN / TN+FN

145
Q

Incidence vs Prevalence

A 
Incidence = RATE of new diseases over a period of time
Prevalence = number of existing disease cases at a specific POINT in time
146
Q

What do you need to calculate the sample size for a study?

A
  1. the effect size
  2. the type I error rate
  3. the type II error rate
147
Q

what is the reciprocal of the rate difference?

A

the NNT

148
Q

What is the other name for the Mann-Whitney U test?

A

Wilcoxon rank-sum test

149
Q

What is another name for the Wilcoxon rank-sum test?

A

Mann-Whitney U test

150
Q

What is the t-test?

A

statistical test for parametric, continuous data that is independent

151
Q

what is the paired t-test?

A

statistical test for parametric, continuous data that is paired

152
Q

what is the ANOVA?

A

statistical test for parametric, continuous data with 3 or more independent groups

153
Q

what is the wilcoxon signed-rank sum test?

A

statistical test for non-parametric, continuous data that is paired
non-parametric corollary to paired t-test

154
Q

what is the wilcoxon ranked-sum test?

A

statistical test for non-parametric, continuous data that is independentnonparametric corollary to t-testalso called the mann-whitney u test

155
Q

what is the kruskal-wallis?

A

statistical test for non-parametric, continuous data with 3 or more independent groupsnonparametric corollary to ANOVA

156
Q

what is the Chi-square test?

A

statistical test for parametric, categorical data with independent groups

157
Q

what is the Fisher’s exact test?

A

statistical test for parametric, categorical data with independent groups if there are <5 measurements/group

158
Q

what is logistic regression?

A

statistical test to predict the relationship between a DICHOTOMOUS outcome vs a set of variables while controlling for other variables in the analysis

159
Q

what is Bonferroni’s correction

A

a method to correct for multiple repeated testing on the same data set

160
Q

what is Kolmogorov-Smirnov?

A

test to determine if data is parametric or not

161
Q

what is Shaprio-Wilk?

A

test to determine if the data is parametric or not

162
Q

formula for odds ratio

A

(AxD)/(BxC) in standard 2x2 table

163
Q

what’s the difference between odds ratio and relative risk?

A

relative risk is used when patients are followed over time.

odds ratio is used when patients already have the outcome and you look back retrospectively at an exposure of interest

164
Q

In treating hypothermia, at what temperature should you initiate resuscitation meds and defibrillation attempts?

A

T > 30C

165
Q

What are treatments for high altitude pulmonary edema? (4)

A

descent
acetazolamide
dexamethasone
nifedipine

166
Q

pressor to use in heat stroke

A

dobutamine - supports BP and HR while keeping vessels dilated for heat dissipation

167
Q

radiopaque toxins (5)

A
  • COINS*
    1. chloral hydrate
    2. opiate packets
    3. iron and Hg, As, Li
    4. neuroleptics
    5. SR/enteric coated meds
168
Q

poisonings that activated charcoal won’t work for (3)

A

ions/metals
acids/bases
alcohols

169
Q

toxin that smells like rotten eggs

A

hydrogen sulfide

170
Q

Morning Glory poisoning symptoms

A

hallucinations, mydriasis, perspiration, bronchorrhea, salivation, hyper or hypothermia, diarrhea

171
Q

Treatment to reduce thyroid uptake of radioactive iodine?

A

Potassium iodine

172
Q

Fish associated with scombroid poisoning?

A

tuna, mackerel, bonito, mahi-mahi, bluefish, sardines, anchovies

173
Q

Fish associated with cigautera poisoning?

A

barracuda, snapper, grouper, amberjack, moray eels, triggerfish, parrotfish

174
Q

bidirectional v tach is pathognomic for what toxicity?

A

digoxin toxicity

175
Q

what is unique about digoxin toxicity related hyperkalemia?

A

do NOT give calcium - it can cause a “stone heart” from excessive intracellular calcium and cardiac tetany

176
Q

what is the treatment for digoxin toxicity?

A

atropine
digiFab
mag, potassium
consider PHYT, lidocaine

177
Q

treatment for cesium radiation poisoning

A

prussian blue

178
Q

EKG findings in TCA OD

A

sinus tach, prolonged PR, QRS, and QT intervals

179
Q

Symptoms of scorpion sting

A

local pain, restlessness, hyperactivity, roving eye movements, and respiratory distress.
More severe signs include seizures, drooling, wheezing, hyperthermia, cyanosis, GI hemorrhage, respiratory distress and death from shock or respiratory paralysis

180
Q

envenomation associated with metallic taste

A

rattlesnake

181
Q

systemic symptoms of brown recluse spider bite

A

fever, chills, malaise, weakness, nausea, vomiting, joint pain, petechial morbilliform rash, intravascular hemolysis, hematuria, and renal failure

182
Q

toxic dose of acetaminophen?

A

150mg/kg in adults

200-250mg/kg in kids

183
Q

toxicity of ethelyne glycol vs methanol?

A

ethylene glycol: metabolized into oxalic acid, will crystals in urine and possible ARF
methanol: metabolized into formic acid, injures the eyes

184
Q

normal serum osmolality

A

285-295

185
Q

treatment of organophosphate poisoning

A

atropine if wet/killer Bs

pralidoxime for for weakness (works at nicotinic skeletal muscle receptors)

186
Q

Coral snake vs king snake?

A

red on black, venom lack;

red on yellow, kill a fellow.

187
Q

ricin poisoning

A

inhalational: sudden onset of fever, chest tightness, cough, dyspnea, nausea, and arthralgias, progressing to cyanosis, pulmonary edema and respiratory failure

188
Q

Tularemia: symptoms and treatment

A

fever, malaise, pneumoniatx: streptomycin

189
Q

aerosolized toxin that smells of “newly mown hay”?

symptoms?

A

phosgene - ocular and nasal irritation, resp symptoms

190
Q

inhalational anthrax - presentation

A

initial mild symptoms followed by abrupt onset resp distress, cyanosis, diaphoresis 1-6 days later. may see widened mediastinum on CXR.

191
Q

inhalational anthrax ppx

A

cipro or doxy

192
Q

staph enterotoxin b symptoms

A

sudden onset of fever, chills, headache, myalgias and nonproductive cough

193
Q

pneumonic plague symptoms

A

The initial presentation includes respiratory symptoms, fever, cough and myalgia. The clinical course is rapidly progressive with bloody sputum, dyspnea, cyanosis, circulatory collapse and a bleeding diathesis.

194
Q

The initial presentation includes respiratory symptoms, fever, cough and myalgia. The clinical course is rapidly progressive with bloody sputum, dyspnea, cyanosis, circulatory collapse and a bleeding diathesis.

A

pneumonic plague

195
Q

toxin with sudden onset of fever, chills, headache, myalgias and nonproductive cough

A

staph enterotoxin b

196
Q

initial mild symptoms followed by abrupt onset resp distress, cyanosis, diaphoresis 1-6 days later. may see widened mediastinum on CXR.

A

inhalational anthrax

197
Q

bitter almond odor is associated with this toxin

A

cyanide

198
Q

treatment of plagueppx?

A

tx: doxy or streptomycinppx: doxycycline

199
Q

ingestions where multidose activated charcoal may be helpful?

A

phenobarbital, carbamazepine, theophylline, and dapsone

200
Q

carbamezepine toxicity

A

can cause resp compromise, altered mental status, vomiting, drowsiness, slurred speech, nystagmus, hallucinations, hypotension, coma, dystonic reactions, seizures has some anticholinergic properties false positive for TCAs on UDS

201
Q

symptoms and management of hydrofluoric acid burns?

A

used in glass etching, metal cleaning, and electronics manufacturinghypocalcemia, hypomag, and hyperkalemiatreat with topical, intra-arterial, IV calcium gluconate

202
Q

IV Meds to Tx HTN Emergency (4)

A
  1. labetalol 0.2-1mg/kg
  2. nitroprusside gtt
  3. nicardipine gtt
  4. fenoldapam
203
Q

HOCM murmur

A

systolic murmur that gets louder with valsalva or standing from squatting

204
Q

DDx of Late Pregnancy Bleeding? (3)

What do you do?

A

DDx: placenta previa, placental abruption, preterm labor
Actions: get OB STAT and don’t do a pelvic

205
Q

Management Options for Laryngospasm (5)

A
  • reposition airway
  • give sustained BVM pressure/PEEP
  • stimulate “laryngospasm notch” (behind the earlobe, the soft area between the skull base, mastoid bone, and mandible)
  • sux 0.1-0.2mg/kg
  • propofol 0.5-1mg/kg
206
Q

If you see metabolic acidosis + respiratory alkalosis, you should think of this poisoning

A

salicylate poisoning

207
Q

characteristic EKG finding of hypothermia

A

J-waves/Osborn waves

208
Q

treatment of adrenal crisis

A

1-2mg/kg of hydrocortisone

209
Q

meds to acutely treat thyroid storm (4)

A
  1. propanolol
  2. iodide/lugols
  3. methimazole
  4. steroids
210
Q

Patient comes in with occipital HA associated with ataxia/vertigo, dysarthria with short period of LOC. Symptoms resolve after emesis. What less scary dx should you think of?

A

basilar artery migraine

211
Q

zones of the neck

A
  1. angle of mandible to base of skull
  2. cricoid to angle of mandible
  3. cricoid to clavicles/thoracic inlet
212
Q

Patient with alkaline serum but aciduria - what is this???

A

paradoxical aciduria secondary to potassium depletion

213
Q

Cutaneous ulcer OR purulent conjunctivitis with preauricular lymph nodes should make you think of this disease:

A

tularemia

214
Q

toxin that smells like almonds

A

cyanide

215
Q

toxin that smells like garlic

A

arsenic

216
Q

toxic alcohol resulting in large ketosis

A

isopropyl alcohol

217
Q

penile fracture is disruption of what?

A

tunica albuginea/corpus cavernosa

218
Q

presentation of CN III palsy

A

“down and out” eye

b/c parasympathetics ride on CN III, may also see ptosis and mydriasis

219
Q

When is TIG needed for tetanus wound ppx?

A

If it’s a dirty wound and the pt has less than 3 doses of tetanus vaccine

220
Q

What should you ask the laboring mother in the ED before delivery of her baby?

A
  1. due date
  2. number of babies in utero
  3. meconium stained fluid?
  4. PNC/STIs
221
Q

How do you treat tetanus after development of symptoms?

A

flagyl, wound care, TIG

222
Q

DDx of non-anion gap metabolic acidosis

A 
Hyperalimentation
Acetazolamide
RTA
Diarrhea
Ureteroenteric fistula
Pancreaticoduodenal fistula
* also spironolactone
223
Q

ehrlichiosis - presentation and tx

A

presents like RMFS

get treated the same with doxy!

224
Q

toxins causing miosis

A 
COPS
cholinergics/clonidine
opiates
phenothiazines
sedatives
225
Q

treatment for anthrax, plague, and tularemia?

A

cipro or doxy

226
Q

WMD with non-specific flu like illness without rhinorrhea

A

anthrax

227
Q

WMD with significantly tender regional LAD

A

plague (buboes)

228
Q

WMD with classic clinical finding of blood-streaked sputum

A

plague

229
Q

WMD gram negative coccobacillus

A

Tularemia

230
Q

WMD with rapid onset (3-12hrs) fever, HA, chills, myalgias, and cough

A

Staph enterotoxin B

231
Q

nerve agents

A

sarin and venom x (VX)

act as organophosphates

232
Q

when are you most likely to see the most severe effects of acute radiation syndrome?

A

~30 days after exposure

233
Q

what is the first cell line to decrease in response to radiation?

A

lymphocyte count

good prognosticator for severity of acute radiation syndrome

234
Q

BLS vs ALS ambulances

A

BLS: BVM, OP, NP, bulb suction, regular suction, immobilization (backboard and c-spine), splints, bandages, obstetric kits, extrication materials

ALS: defibrillator, EKG, intubation equipment, NG, IV/IO, meds

235
Q

pt has low calcium, high phos

dx?

A

primary hypoparathyroidism

236
Q

pt has low calcium, low phos

dx?

A

vitamin D deficiency

237
Q

differentiation between torticollis and rotary subluxation?

A

torticollis - muscles spasm of SCM OPPOSITE the side the chin points to
rotary subluxation - muscle spasm of SCM on the SAME side the chin points to; seen with trauma, URIs, or spontaneous

238
Q

Neonatal ETT sizes

A

2.5 = < 1000g, 3000g, >38wks

PEM Board Review (8 decks)

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