COMAT EM Flashcards
Two most common causes of PUD:
H. Pylory
NSAIDs
Classic triad of NPH:
- Urinary incontinence
- Abnormal gait
- Dementia
[“wet, wobbly and wacky”]
What is the next step after heme-positive urine dipstick?
Microscopic urine analysis to differentiate between myoglobinuria (rhabdo) and hemoglobinuria (hemolysis)
What are the steps of management of anterior epistaxis (nose bleed)?
- Compress nasal ala against septum
2. Topical vasoconstrictive agents (alpha receptor agonists: epinephrine, oxymetazoline, phenylephrine)
How is the diagnosis of PID confirmed?
Transvaginal ultrasound which typically shows thickened fluid-filled fallopian tubes, possibly with associated tubo-ovarian abscess and/or free pelvic fluid.
Patients receiving TNF inhibitors (Adalimumab, etanercept, or infliximab) for autoimmune conditions are at risk for:
Reactivation of latent TB
[check for latent TB with T-cell interferon gamma release assay (IGRA) before starting these agents]
Patients with complete heart block who present with hypotension what is the next step?
Immediate pacing with transcutaneous cardiac pacing to prevent cardiovascular collapse.
What kind of edema is noted on extremities in patients with severe hypothyroidism?
Non-pitting edema (myxedema)
How is end-organ perfusion monitored in septic shock?
- HR
- BP
- Urine output (more than 0.5 mL/kg/hr is normal)
- Mental status (brain perf)
What are the first steps in management of patients with septic shock?
- Adequate venous access with two large-bore (16-gauge or larger) IV lines
- Immediate crystalloid bolus of 1 to 2 L over 30-60 minutes
- If patient’s hypotension persists with fluid challenge, then central venous access should be obtained to allow for central administration of vasopressor drugs.
What is the treatment of newly diagnosed Bells Palsy?
Oral steroids
[herpes simplex virus activation is the likely cause of facial nerve palsy in post presentation; however, antiviral agents are not indicated in all cases of bp while steroids are]
What is the first step in management of patient presenting with priapism (prolonged erection lasting more than four hours)?
Doppler ultrasound
[to differentiate between low flow and high flow priapism]
Avascular necrosis of the femoral head that occurs in children, usually without preceding illness. It causes pain and a limp and is evident n radiographs of the hip based on widening and flattening of the femoral head:
Legg-Calve-Parthes disease
What is the duration of action for naloxone?
30 minutes
[vs Heroin is 4-5 hours; therefore, multiple doses of naloxone or a continuous infusion may be needed to treat an episode of an opioid overdose]
What is the most likely complication in hypothermic patients?
Atrial and ventricular arrhythmias
[cardiac monitoring should be used]
Classes of hemorrhage:
Class I: 15% blood volume loss, no HD changes
Class II: 15-50% blood volume loss, tachycardia and narrowed pulse pressure
Class III: 30-40% blood volume loss, hypovolemic shock
Class IV: 40% blood volume, , tachycardia>140 beats/min, hypotension, and tachypnea >35 breaths/minute. End organ hypoperfusion manifesting with confusion or stupor and negligible urine output
What are the initial treatments of hemolytic transfusion reaction?
IV fluids in large bolus
Immediate cessation of the blood transfusion
Blood test performed on a pregnant woman to measure the amount of fetal hemoglobin transferred from the fetus to the mother’s bloodstream:
Kleihauer-Betke test
[The amount of RhoGAM needed to prevent development of maternal anti-Rh antibodies depends on how much fetal blood she is exposed to]
What can be beneficial for bell palsy treatment for patient presenting within the first three days or paresis?
Oral steroids (prednisone)
What is the treatment of scabies?
Oral ivermectin
What is the next step of management of patients who survive out-of-hospital, sudden cardiac arrest?
[after mechanical ventilation and IV vasopressors]
Therapeutic hypothermia
[to improve neurologic outcomes]
What is the treatment of vibrio vulnificus, a curved gram negative rod?
Doxycycline and ceftazidime
What is the first step in management of patient with acute liver failure with severe hepatic encephalopathy?
Endotracheal intubation to protect the airways
Mortality risk from SJS is influenced by what factors?
Age
Comorbidities
What factors make the patient more prone to vulvovaginal candidiasis?
Moist environments created by tight-fitting or occlusive clothing
Diabetes
Immunosuppressed
Increased estrogen level [Oral contraceptives or pregnant]
The presentation of large bowel obstruction depends on what?
Whether or not colon contents can reflux into the small bowel.
[If there is a single point of obstruction and an incompetent ileocecal valve=>colon contents are able to reflux back into the small bowel and the patient may have feculent vomiting.
If there is a closed loop obstruction (as in volvulus) or a competent ileocecal valve, the contents of the colon are unable to exit proximally=>pressure builds up, and wall tension is greatest at the region with the greatest diameter, i.e. cecum, the area of the colon most likely to perforate]
What is the management of human bite wounds?
Wound care with debridement of devitalized tissue that can potentially become nidus for bacterial infection
Red flags for low back pain:
Neurologic deficit Fever Sudden onset of pain with spinal tenderness Trauma Known or suspected malignancy
Management of digoxin toxicity:
Mild to moderate=> treat supportively with hydration and correction of electrolyte abnormalities
Severe digoxin toxicity=>treat with hospital admission and digoxin-specific antibody fragments (Fab) as we;;.
Criteria for using digoxin-specific antibody Fab in digoxin toxicity:
- Life threatening arrhythmia or cardiac arrest
- K>5 mEq/L
Types and management of acute aortic dissection:
Stanford type A=involves s the ascending aorta and requires emergent surgery
Stanford type B=involves only the descending aorta and can be treated non-operatively with blood pressure control to a level of 120/80 mmHg or lower.
What is the rash caused by Amoxicillin allergy called?
Leukocytoclastic vasculitis
[small vessel inflammation with a neutrophilic infiltrate and necrosis with nuclear debris
Causes palpable purpura that are raised, purple areas of skin discoloration that represent blood extravasation from small vessels]
Type of distributive shock in which a lack of sympathetic tone causes decreased systemic vascular resistance, leading to hypotension:
Neurogenic shock = hypotension without tachycardia
[Results from CNS injury above the level of T6, most commonly cervical or high thoracic spinal cord injury
Due to lack of sympathetic activity, there is no compensatory increase in cardiac output
Non-responsive to fluid resuscitation]
