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1
Q

mcc visceral perforation

A

PUD

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2
Q

RUQ AIR

A

mesenteric ischemia or emphesymatous cholecystisi

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3
Q

extraintestinal manifestations IBD

A

uveitis, arthritis, erytema nodosum, pyoderma ganernosm, vasculitis - tx sulfasalzine, emsalamine, prednisone

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4
Q

which IBD involes the entire colonic wall

A

crohns

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5
Q

which IBD is assn with kidney stones

A

crohns- inc abs oxylate

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6
Q

complicaiton of UC

A

toxic megacolon

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7
Q

thumbprint sign on CT

A

mesnetic ischemi

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8
Q

higher cancer risk of IBD

A

UC

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9
Q

causes of mesenteric ischemia

A

arr, clot, low flow states like CHF post MI or pressors, b blockers, digoxin

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10
Q

mcc diarrhea is viral or bacterial? mcc kids? leading cause GE?

A

viral, rotavirus mcc children, norovirus GE, cruise ships, viral diarrhea has no blood or WBC

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11
Q

invasive diarrhea characteristics

A

takes a few days to onset, blood and WBC

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12
Q

causes HUS in kids, TTP in elderly, abx can increase risk of HUS- under cooked hamburger, peeting zoos

A

EHEC - gross bloos, wbcs, 0157h7

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13
Q

invasive diarrhea, high fever, febrile, seizures

A

shigella- tx cipro

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14
Q

invasive diarrhea, common, cafeteruai food, turtles, amphbiains, osteomyelitis in SCA

A

salmonellla - tx cipro

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15
Q

mcc bacterial diarrhea, can cause GBS

A

campylobacter- fecal oral- backpackers diarrhea- contiaminated food and water

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16
Q

diarrhea that comes fomr oysters, shellfish, can cause terrible wounds, inc morbidity in pt with liver disease

A

vibrio - paraheomlyitics an dvulnificus (worse)

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17
Q

invasive diarrhea that mimics appendicitis

A

yersinia entercolitica- wright stain positive fecal, tx bactrim

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18
Q

diarrhea that is wattery, immediate, no wbc or rbc, no sepsis

A

toxigenic

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19
Q

travellers diarrhea

A

E coli - fecal oral

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20
Q

bacillus cereus

A

fried rice, toxigenic, chinese, violent vomiting 2-3 hours post ingestion

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21
Q

histamine toxin, not regrid depp sea fish- peppery- facial flushign and diarrhea-

A

scromboid- multiple pt with allergic rx - heat stable toxin

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22
Q

diarrhea, muscle weakness, paresthesia, temperature iversion , neuro sxs worse with etoh

A

ciguateria - dinoflagellates, tx mannitol, amutyptyline, benadryl - sxs can last for years, avoid fisha nd etoh

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23
Q

pseudomenbranous enterocoitis

A

c diff

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24
Q

mcc water born diarrhea outbreak in US, backpackers diarrhea

A

giardia- fecal oral - stool w cysts, trophozoites tx metronuudazole

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25
Q

amebiasis- entomeba histolytica

A

fecal oral, between partners and family- cyst passers- can cause liver cysts or other cysts

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26
Q

mcc chronic diarrhea, wasting in AIDS

A

cryptosporidium- ingestion of oocytes, trophozites attack intestinal membraine- 1 week inculbation- severe diarrhea -

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27
Q

tx hemrroids

A

WASH - warm water, anelgesics, stool softer, high fiber diet

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28
Q

non mindline anal fissue (6,12))

A

IBD, Ca, sexual assault

29
Q

nexus criteria

A

no midline tenderness, no neuro, no distracting injury, no AMS or intox

30
Q

NTI is CI in what kind of trauma

A

maxiollofacial trauma, basilar skull fx, apnea

31
Q

hemothorax with >1500 mL out

A

thoracotomy

32
Q

blood loss from femur fx, pelvic fx?

A

1L, 1.5-2L

33
Q

class 1 shock

A

< 15% normal vitals

34
Q

class 2 shoc

A

15-30, decc cap refill, inc HR, narrow pulse pressure

35
Q

class 3 shock

A

30-40%, shock- BP drops, AMS

36
Q

class IV

A

> 40%, HR 130-140s

37
Q

GCS 15

A

eyes open, command, pain, no rxn, verbal oritented, confused, inappropr, uninteligable, no sound, motor obeys, lozalies withdrawls flexion extension no reaction

38
Q

Ed thoracotomy indication

A

penetrating chest and signs of life prehospital or ED or cardiac activity in ED, liberal indication abdominal trauma and cardiac activity requiring aortic cross clamp aorta, blunt chest trauma with loss of VS in ED

39
Q

trauma in pediatrics

A

half of deaths, head injury most common lethaal, large occiput, obligate nose breather <6 mo, inc tongue, anterior larynx, narrow sublogittc area

40
Q

age for pediatric cric

A

not less than 8

41
Q

ETT size determination

A

age +16 / 4

42
Q

Ped EET depth of insertion

A

3x tube size

43
Q

plan if ET intubation impossibl ein peds

A

transtracheal jet ventilation LMA

44
Q

location of broken neckin kids and elderly

A

c1-c2, in kids cord injuries are more common

45
Q

2nd mcc death in kids < 5

A

burns, inhalation

46
Q

shaken baby syndrome

A

diffuse cerebral injury w edema, retinal hemorrhage,,

47
Q

suspcious findings for child abuse -

A

stocking glove burns, immersion, contusions on buttocks genetalia, neck bface low back, fractures < 1 yr, posterior rib, nonlinear skull fx, long bone fx, various stages of bruises

48
Q

trauma and pregnancy - signs of demise, leading cause of mother death?>

A

injuries to spleen, RP, uterus from seat belt, uterus rises out of pelvis at 12 weeks, signs of demise - loss of mvmt, absent heart stones, extended extremities, blunt trauma leading cause of maternal death

49
Q

leading cause of fetal death

A

abruptio placentae- minor fall, airbag, bump onto counter, can have neg vaginal bleeding (conceleaed abruption) get abdominal pain and uterine tetany

50
Q

kleihaue betke

A

fetal nucleated RBC in maternal circulation

51
Q

common complication of abruptio placentae

A

DIC

52
Q

recommendation for all blunt trauma paitnes > 20 weeks

A

external fetal monitoring, fetal tocodynatomary, > 8 contractions per hour for first 4 hours- concern for delivery - abruption , if 3-7 contractions, admit, <3 discharge

53
Q

signs of fetal distress >23 weeks

A

tachycardia, brady, decelerations, - C section

54
Q

nexus head ct

A

no intox, gcs 15, no skull fx, nonfoca exam, no anticoag, normal Mental status

55
Q

complications of temporal skull fx

A

middle meningeal artery- epidurla hematoma

56
Q

type of skull fx that can dc

A

linear, non depressed

57
Q

difference between moderate and deep sedation

A

purpuseful repsonse to verbal or tactile vs repeated or painful

58
Q

ASA classes

A

1- healthy 2 - mild systemic like asthma or DM 3- pneumonia, seizure - severe systemic 4- high risk, threat to life- renal failure, chf, sepsis - may require consult anesthesia

59
Q

JC restraint requireiemtns

A

evaluate within hour of restraints, monitor for injuyr, only orderd by practitioner, suffocation mcc death, restraint can be ordered 4 hours at a time, kids is 2 hours, reasses and document restartins eveyr 15 mins, readidiness or d/c, continous obs by sitter

60
Q

true positive rate

A

sensitivity- will find everyone who has it

61
Q

true negative rate

A

specificity - will find everyone who doesnt have it

62
Q

disaster triate- START techinique

A

simple triage, rapid treatment - quick asses RPM - respiration, perfusion, mentla status
green- walking wounded black - morgue, red- life thratening- yellow- serious but stable

63
Q

emergenecy medicial conditoin - emtala

A

1- could place health of indivudual in jeopary, cause impairemnt or dysfunx- done by a qualified personall- not just ED doc - with minors- emtala applies , once determind must be stabiized or transfered

64
Q

mandatory reporting example

A

child abuse, NAT - report any suspicioun, consider FTT and psychological truma, usaly < 5 yo, seen wih delays of care, frequent vague complaints, also COMMUNICABLE DISEASE, highly contageous TB measels anthrax, violent acts child buse, elder abuse, domestic/exual abuse, firearms, deaths

65
Q

decision making capaity -

A

complehension of options, awaarenes of ocnsequences, comprenshioon os risk and benefits - patient with this has right to refuse treatment , not the saame as COMPETENCE - legal term requiring court ruling

66
Q

5 elements of informed consnet

A

intention, hamrs and benefits, alterenative, harms na benefits of laternative, harms and benefits of doing nothing - must have DMC to give IC

67
Q

emergency exception to IC

A

need to alleviate severe pain, risk of D and D, find or document abscence of surrogate and why not enough time to find one

68
Q

leaving AMA

A

establsuh capaicyt, risks and benefits, try to contacat family, signs AMA documents - provide any possible treatment

69
Q

malpractice fundamentals

A

1- duty to treat, standard of care, proximate cause/causation, damages , medical malpractice doesnt cover EMTALA

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