Approach to scenarios 1

Question 1

Abdominal pain in conjunction with hemodynamic instability should alert the physician to the possibility of what 4 things?

Answer 1

hemorrhage, sepsis, perforated viscus, or necrotic bowel

Question 2

What is often the first sign of hemodynamic instability?

In patients with established hemodynamic instability, what 3 things need to be done immediately?

Answer 2

tachycardia
fluid resuscitation should begin by establishing 2 large bore IVs and rapidly infusing isotonic crystalloid. Supplemental oxygen should be administered, and patients should be placed on a monitor.

Question 3

In the unstable patient with abdominal pain in whom hemorrhage is diagnosed or highly suspected, what must be done immediately?

Answer 3

typed and crossed blood should be immediately ordered. The transfusion of type O blood can be performed in critical situations where there is not enough time to wait for cross matched blood.

Question 4

Women of childbearing age who present with abdominal pain require urgent?

Answer 4

pregnancy test to rule out ectopic pregnancy

Question 5

Portable x-ray and ultrasound can serve as immediate diagnostic tools that can be performed at the bedside when there is concern for what two things?

Answer 5

air or blood in the abdominal cavity

Question 6

What is the diagnostic modality of choice for suspected biliary pathology, ovarian and testicular torsions?

Answer 6

US

Question 7

two imaging choices for kidney stones and which one can see super small stones?

Answer 7

CT and US

CT

Question 8

Diffuse and upper abdominal pain should always warrant what 2 examinations?

Answer 8

heart and lungs

Question 9

All emergency department patients require an initial assessment for immediate threats, what is the standard approach?

Answer 9

ABCDEF

airway, breathing, ciruclation, disability, exposure and finger stick glucose

Question 10

What type of breathing status can lead to AMS and what am I thinking is the cause and treatment?

Answer 10

hypoventilation leading to respiratory acidosis

narcotic overdose, naloxone

Question 11

What are three broad range classifications of AMS?

Answer 11

delirium, dementia and psychosis

Question 12

onset, vital signs, hallucinations and level of consciousness for all 3?

Answer 12

onset: rapid for delirium
VS: abnormal for delirum
visual for del, none for dem, auditory for psychosis
altered for del

Question 13

An important differentiating aspect of psychosis is that?

Answer 13

their orientation is often intact, which can help differentiate from delirium and dementia.

Question 14

Decreased level of consciousness with cranial nerve findings is a what until proven otherwise.

Answer 14

brainstem lesion

Question 15

Lets say you are looking at the QRS with a patient in cardiac arrest and it is wide. What are the two differentials an how to treat each?

Answer 15

hyperkalemia, calcium

sodium channel blocker, bicarb

Question 16

same question but QRS is narrow, what 3?

Answer 16

tamponade, centesis
PE, tpa
tension, needle decompression

Question 17

What is the most important prognostic factor for survival in cardiac arrest?

Answer 17

duration of cardiac arrest

Question 18

how are we going to treat asystole or PEA?

Answer 18

transcutaenous pacing

Question 19

What are my top 3 life threatening differentials for chest pain, and then 4 others not as common life threatening?

Answer 19

ACS, PE, and aortic dissection

tension, esophageal rupture, pericardits, and tamponade

Question 20

Ligament of Trietz separates what two things?

Answer 20

duodenum from jejunum

Question 21

What are the most common etiology in patients presenting with acute upper gastrointestinal bleeding>

Answer 21

Peptic ulcers

Question 22

Hematemesis (red blood in emesis) or coffee ground emesis usually indicates?

Answer 22

upper GI bleed

Question 23

Melena (dark or tarry stools) occurs in about 70% of patients with?

Answer 23

upper GI bleed

Question 24

What is the diagnostic choice for headache if you are thinking bleed and how will it look on the image?

Answer 24

CT without contrast and bright

Question 25

When would I use CT with contrast for a headache patient?

Answer 25

vascular compromise, infection and masses

Question 26

what drug to remember to treat cholinergic poisoning?

Answer 26

atropine

Question 27

two complications of drugs causing too much sympathetic system?

Answer 27

rhabdo and hyperthermia

Question 28

drug for opioid overdose?

Answer 28

naloxone

Question 29

antidote for tylenol?

Answer 29

NAC

Question 30

4 things to do with aspiring toxicity?

Answer 30

manage the airway, stomach decontamination, bicarb and hemodialysis

Question 31

what to give for TCA overdose?

Answer 31

bicarb

Question 32

What are considered the 3 toxic alcohols?

Answer 32

isopropanol, methanol, and etheylene glycol

Question 33

What is the main difference to remember about these three alcohols?

Answer 33

iso will not cause significant high anion gap metabolic acidosis. other tow will

Question 34

a helpful diagnostic step for ethylene glycol?

Answer 34

woods lamp to urine

Question 35

what is given initially to treat methanol or ethylene glycol posioning?

Answer 35

fomepizole

Question 36

What am I always thinking when a patient is drunk?

Answer 36

thiamine

Question 37

what is the first line vasopressor for adults and children?

Answer 37

NE

dobutamine

Question 38

image modality of choice for AAA? What is the size differentirator?

Answer 38

CT

5.5

Question 39

what is the main difference between type a and type b

aortic dissections?

Answer 39

type a involve the ascending aorta and type b do not

Question 40

when would TEE be good to use for dissection?

Answer 40

when the patient is unstable and you need a bedside diagnostic study

Question 41

Main difference initially in treating type a vs type b dissections?

Answer 41

type a surgery right away

type b can begin with medcial managament. get the bp and heart rate down. beta blockers for hr and nicardipine for bp.