Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 3 > COMBANK EM COMAT > Flashcards

COMBANK EM COMAT Flashcards

1
Q

Tx of symptomatic LBBB

A
  • LBBB considered a STEMI-equivalent

- reuires thrombolysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

consent for minor if parents not present

A
  • after appropriate attempts have been made to contact parent, an adult who presents with the child may give consent for tx
  • if child old enough to understand medical condition and tx plan, tey may give consent themselves
  • this only applies to tx necessary for stabilization and emergency medical conditions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

at what age is child old enough to understand medical condition and tx plan

A

have to assess. But recc is over 14yo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

sx of iritis

A

ciliary flush (redness/irritation around the iris itself) and miosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

acetaminophen dosing for kids

A

10-15mg/kg q6h

not to exceed 75mg/kg in a day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

ibuprofen dosing for kids

A

10mg/kg q6h
(not to exceed 40 mg/kg in a day)

  • can only use in kids >6mo
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

buckle fx

A
  • aka torus fx
  • seen in kids
  • bulging of bony cortex or periosteum, usually involving metaphysis, following compressive forces
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

buckle fx tx

A

splinting in a position of function with ortho f/u in 1w

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

vent settings:

I:E ratio for COPD/asthmatics

A

1:4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

vent settings:

PEEP normal

A
  • should be 5 mmHg PEEP

- important in drownings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

vent settings:

FIO2 normal

A
  • start at 100%

- once PaO2 comes back, decrease to 40-60%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Cushing’s triad

A
  • HTN, bradyC, irregular respirations

- indicates SAH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

mechanism of SAH vs epidural hematoma

A
  • SAH can form spontaneously (Ex/ from uncontrolled HTN), while epidural need trauma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

prolactin and SZ’s

A

prolactin is a very acute phase reactant. Will be elevated for a short time following SZ.

  • time sensitive test, has to be drawn w/in 15-30min after SZ activity
  • can help r/o or r/i pseudoSZ
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

posterior Chapman’s points for adrenal gland

A

between spinous and transvers processes of T11 and T12 posteriorly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

pancreas ant and post CP’s

A
  • ant: lateral to the costal cartilage between the 7th and 8th ribs on the R
  • post: transverse process of T7 and T8 on the R
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

sympathetic viscerosomatic reflex at C4-C5

A

reflexes of the phrenic nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

timeline for primary closure of wound

A

6hr deadline for suturing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

spasmodic croup vs viral laryngotracheobronchitis

A

spasmodic croup has same path but is short interval of spasm without associated fever or retractions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what does low O2 sat on pulse ox but normal PaO2 on ABG mean?

A

methemoglobinemia

— tx is methylene blue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

anterior wall MI, ST elevation seen in leads …

A

V1-V4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

lateral wall MI, ST elevation seen in leads …

A

V5, V6, I, and AVL

when anterolateral or inferolateral this changes to V5-V6, and I and/or AVL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

inferior wall MI, ST elevation seen in leads …

A

II, III, AVF

with reciprocal ST flattening in anterior leads (V1-V3)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

nosebleed management steps

A
  1. Direct pressure (regardless of severity)
  2. Spray alpha-adrenergic agonist (oxymetazoline, aka Afrin) to vasoconstrict blood vessels
  3. cautery (silver nitrate or electric)
  4. nasal packing (gauze, balloon, thrombogenic foam)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

uveitis sx and exam

A
  • ocular pain, blurred vision, injected sclera

- slit lamp shows cells and flare in anterior chamber

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

corneal abrasion sx and exam

A
  • pain, FB sensation, eye redness, can have decreased visual acuity
  • fluorescein stain slit lamp exam showing epithelial defect/FB
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

conjunctivitis sx (viral, allergic, bacterial)

A
  • allergic/viral: clear watery DC, stringy white mucus
  • bacterial: yellow purulent DC
  • viral: additional reauricular adenopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

central retinal vein occlusion sx and exam

A
  • GRADUAL PAINLESS monocular vision loss
  • see optic disc edema, numerous retinal hemorrhages, cotton wool spots in macular edema, and dilated congested veins (blood and thunder appearance of retina)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

central retinal vein occlusion sx vs central retinal ARTERY occlusion

A
  • vein sx occur gradually,

artery sx sudden-onset

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

central retinal artery occlusion sx and exam

A
  • SUDDEN PAINLESS unilateral vision loss

- exam shows cherry red macula and pale spot between macula and optic disc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

risk factors for central retinal artery occlusion

A

temporal arteritis, trauma with fat embolus, sickle-cell dz, diabetes, hyperviscosity syndrome (multiple myeloma), atherosclerotic plaque embolization to retinal a (usually from internal carotid a)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

acute angle closure glaucoma sx and exam

A
  • SUDDEN onset PAINFUL unilateral vision loss, blurry vision with halos around lights, HA, n/v
  • exam shows fixed and dilated pupil nonreactive to light (or sluggish), injected conjunctiva, steamy/hazy cornea, elevated IOP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

succinylcholine SEs and Contraindications

A
  • SE: malignant hyperthermia, increased IOP, hyperK, rhabdo
  • contraindications: ocular surgery, penetrating eye injurys, closed-angle glaucoma, hx acute malignant hyperthermia, myopathies associated with elevated serum CK, truamas that may result in rhabdo (burns, crush)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Bell’s palsy tx

A
  • corticosteroids alone or with antivirals

- no scan needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

activated charcoal doesn’t work for:

A
  • ionic compounds (Li, Ca, K, Na, Mg, Fluoride, I)
  • heavy metals: (Arsenic, Pb, Mercury, Fe, zine cadmium)
  • acids/bases
  • hydrocarbons (alkenes, alkanes, alkly halides, aromatics)
  • essential oils
  • alcohols (acetone, ethanol, ethylene glycol, methanol, isopropanol)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

lithium tox sx

A

AMS, n/v, defecation, urination, tachyP, sweating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

epinephrine antidote

A

phentolamine (alpha-1 adrenergic blocker)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

signs of prerenal cause of kidney dysfunction

A

BUN:CR>20
UNa <10
FENa <1%
FEUrea <35%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

regions affected by C1-C2 level parasympathetic dysfunction

A 
(via vagus n) 
kidney
upper ureter
ovaries, testes
ascending colon, transverse colon
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

regions affected by S2-S4 level parasympathetic dysfunction

A 
(via pelvic splanchnic nn)
lower ureter
bladder
urethra
prostate
uterus, proximal fallopian tubes
descending colon, sigmoid colon, rectum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

how to test for CO poisoning

A

ABG to measure carboxyhemoglobin levels (>15% in smokers, >3% in non-smokers)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

sx of CO poisoning

A

HA, n/v, AMS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

subarachnoid hemorrhage on CT

A

high-attenuating, amorphous substance that fills in the normally dark, CSF-filled subarachnoid spaces around the brain. Normally black subarachnoid cisterns and sulci appear white in acute hemorrhage.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

subarachnoid hemorrhage sx

A

sudden HA with maximal intensity at onset (thunderclap, worst HA of life)
nv, meningismus, or LOC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

subdural hematoma on CT

A

“cresecent”-shaped area of hemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

epidural hematoma on CT

A

“lens”-shaped area of hemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

s/sx opioid overdose

A
  • classic triad: depressed or altered mentation, decreased RR, pin point (miotic) pupils
  • decreased bowel sounds,
    hemodynamic instability, bradyC, hypoT, apnea, hypothermia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

review other overdose s/sx and tx

A

(maybe in psych cards)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Tx of esophageal variceal bleeding

A
  • airway management
  • hemodynamic stabilization
  • emergent upper endoscopy
  • resuscitation with IV fluids or blood produces for massive hemorrhage
  • continual octreotide or somatostatin
  • treatment of coagulopathy (ex/ anticoagulant reversal)
  • abx prophylaxis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

GCS components & score range

A

eye opening
motor response
verbal response

3-15

51
Q

GCS: eye opening scoring

A

4 - opens eyes spontaneously
3 - opens eyes in response to speech
2 - opens eyes in response to painful stimulus
1 - doesn’t open eyes

52
Q

GCS: motor response scoring

A

6 - follows commands
5 - makes localized movement in response to painful stimulation
4 - makes nonpurposeful movement in response to noxious stimulation
3 - flexes upper extremities/extends lower extremities in response to pain
2 - extends all extremities in response to pain
1 - makes no response to noxious stimuli

53
Q

GCS: Verbal response scoring

A 
5 - oriented x 3
4 - converses, may be confused
3 - replies with inappropriate words
2 - incomprehensible sounds
1 - no response
54
Q

“J” or Osborne waves associated with…

A

hypothermia
(not pathognomonic though)
— can also see T wave inversions, interval prolongation (PR, QRS, QT), and dysrhythmias

55
Q

signs of hypothermia

A
  • core temp <95F
  • decreasing metabolic activity: bradyC, hypoT, dysrhythmias
  • “J” or Osborne waves
56
Q

acute psoas spasm presentation

A

torso flexion
low back pain radiating to the pelvic area
increased pain with standing

57
Q

tx of B blocker OD

A

Obs or Glucagon (competitive inhibition)

58
Q

warfarin reversal for INR 3.5-5 (w/o major bleeding)

A

lower warfarin dose or omit a dose

59
Q

warfarin reversal for INR 5-9 (w/o major bleeding)

A

skip next 1-2 doses

+ administer 1-2.5mg Vit K orally

60
Q

warfarin reversal for INR >10 (w/o major bleeding)

A

skip next 1-2 doses

+ administer 2.5-5mg Vit K orally

61
Q

warfarin reversal for elevated INR w/ major bleeding

A

10mg Vit K IV

3-4u FFP

62
Q

splint for

  1. ulnar fx
  2. scaphoid fx
  3. DeQuervain’s dz
  4. spiral fx of ulna and radius
A
  1. ulnar gutter splint for ulnar fx
    2-3. radial gutter splint for Scaphoid fx and DeQuervain’s dz
  2. Sugar Tong splint for spiral fx of ulna and radius
63
Q

w/u for fever of unknown origin in kid less than 3yo

A

blood cultures
urine
CSF
chest radiograph

64
Q

age where you can’t give ceftriaxone

A

less than 30 days old

— displaces bilirubin resulting in jaundice, kernicterus, and brain damage

65
Q

tx of tension PTX vs simple PTX

A

Tension PTX needs immediate decompression with needle thoracostomy followed by chest tube placement.
Simple PTX treated with chest tube.

66
Q

what’s urushiol

A

causative agent in Rhus dermatitis or poison ivy dermatitis

67
Q

pancreatitis s/sx

A

fever, epiG pain rad back, n/v, shock, Cullen’s sign, Grey Turner sign

68
Q

Cullen’s sign

A

periumbilical discoloration

seen in pancreatitis

69
Q

Grey Turner Sign

A

flank discoloration
- due to pancreatic retroperitoneal hemorrhage
(seen in pancreatitis)

70
Q

Boorhaave syndrome

A

complete esophageal rupture

most often from extremely foreceful emesis or sudden ride in intraesophageal pressure

71
Q

posterior wall MI ECG findings

A

tall R waves in V1-V3
ST depression in leads V1-V3

(sometimes aka inferolateral)

72
Q

Todd’s paralysis

A

transient post-ictal paralysis

  • may occur for up to 36h post-seizure
  • typically disappears fairly quickly
  • focal deficit (usually unilateral)
73
Q

status epilepticus

A

sz activity lasting longer than 5 continuous minutes or that is refractory to anti-epileptics
- tx: IV/IM benzos

74
Q

cocaine intox

A

sympathomimetic toxidrome: tachyC, hyperT, tachyP, hyperthermia, mydriasis

  • can see nasal perforation, or “crack lung” (black sputum production and hypersensitivity pneumonitis)
75
Q

PCP intox

A

AMS (comatose to profound psychomotor agitation), hallucinations, HTN, tachyC, multi-directional nystagmus

76
Q

anticholinergic toxicity sx

A 
hot as a hare (hyperthermia)
blind as a bat (mydriasis)
dry as a bone (dry skin/mucous membranes)
red as a beet (flushed)
mad as a hatter (AMS)
  • also tachyC, U retention
77
Q

anticholinergic toxicity tx

A

Suportive: IV fluids, Benzos prn

  • Physostigmine if severe
78
Q

cholinergic toxicity tx

A

atropine

pralidoxime

79
Q

influenza tx for only A not A and B

A

rimantadine

amantadine

80
Q

SIADH lab findings

A

elevated urine osmolality
elevated urine sodium
euvolemic hyponatremia

81
Q

acid-base of salicylate toxicity

A
  • initally presents with respiratory alkalosis due to increased RR
  • then metabolic acidosis
82
Q

salicylate toxicity sx

A 
abdominal pain (epigastric)
n/v
irritability (poss anxiety or acutepsychoses)
tinnitus
tachyC and tachyP
83
Q

salicylate toxicity tx

A

activated charcoal if within first hour

also sodium bicarb (to cause alkalinization of urine)

84
Q

acetaminophen toxicity sx

A

n/v, abdominal pain (RUQ)
pallor, diaphoresis
signs of acute liver failure (scleral icterus, jaundice, AMS)

85
Q

acetaminophen toxicity tx

A

N-acetylcysteine

86
Q

benzo toxicity sx

A

decreased RR

somnolent

87
Q

tx for barbiturate toxicity

A

none (supportive)

88
Q

imaging for suspected appy

A

abd US first.

If doesn’t r/o appy, then CT

89
Q

SIRS criteria

A
  • temp >38C (100.4F) or <36C (96.8F)
  • HR > 90
  • RR > 20 or PaCO2 <32mmHg
  • WBC > 12,000/mm3, < 4,000/mm3, or > 10% bands

(NO source or suspected source of infection b.c otherwise that would be sepsis not SIRS)

90
Q

severe sepsis

A

sepsis + organ dysfunction

lactate up, U output down, acute lung injury, creatinine up, bili up, platelets down, INR up

91
Q

septic shock

A

sepsis-induced hypotension persisting despite adequate fluid resuscitation

92
Q

fluids to use in initial resuscitation after trauma

A

crystalloids (normal saline or lactated ringers)

  • if this fails, then can do blood products (RBC, FFP)
93
Q

when to use 1/2 normal saline (0.45%)

A

maintenance fluid in pts with water loss

ex/ DKA, gastric losses

94
Q

when can you NOT use 1/2 (0.45%) NS

A

LIVER DZ
TRAUMA
BURNS

95
Q

med tx for stable symptomatic bradyC

A

atropine

96
Q

med tx for stable Vfib / Vtach

A

amiodarone

  • can use for wide SVT sometimes too
97
Q

med tx for stable SVT

A

(vagal maneuvers first)

adenosine

98
Q

med tx for Afib/flutter

A

rate control (verapamil/diltiazem, metoprolol)

99
Q

abx tx of human bit wound

A 
Ampicillin/Sulbactam
Pipercillin/Tazobactam
Cefoxitin
Ceftriaxone and Metro
Clinda and Cipro
  • has to cover aerobic and anaerobic bacterial
100
Q

foods that expose to E coli O157:H7

A

undercooked beef, unpasteurized milk, juices, raw fruits/veggies

101
Q

OMM tx of colonic sympathetics (viscerosomatic reflexes) helps with …

A

ileus or constipation

102
Q

OMM tx of colonic PARAsympathetics (viscerosomatic reflexes) helps with …

A

diarrhea

103
Q

contraindications to Nitro use in ACS

A
  • Development of hypotension in pts with volume depletion
  • R ventricular infarction (inferior)
  • recent use of PDEi for ED
104
Q

TCA overdose sx

A
  • anticholinergic effects (dry, hot, red, blind)

- cardiac effects (prolonged QRS)

105
Q

when to give tetanus prophylaxis

A

MINOR wounds:

  • if last vacc was >10y ago
  • if <3 doses tetanus toxoid vacc previously

MAJOR wounds:

  • if last vacc was >5y ago
  • if <3 doses tetanus toxoid vacc previously (then would also need to give human tetanus immune globulin as well)
106
Q

at what hCG level can you see IUP on US

A

1,000-2,000 mIU/mL

107
Q

dx of ectopic pregnancy

A

vag bleed + pain
elevated hCG
NO IUP
risk factors (previous ectopic, tubal lig, IUD, smoking, PID, multiple partners, early age of intercourse)

NO CT needed. Go to surgery.

108
Q

What is TIMI risk score used for?

A

prognostication tool in pts with unstable angina or NSTEMI
- categorizes pt’s risk of death and ischemic events

  • higher score = higher risk at 14d of all-cause mortality, enw or recurrent MI, or severe recurrent ischemia requiring urgent revascularization
109
Q

How to scale TIMI risk score:

A 
One point for each (AMERICA):
Age greater than 65
Markers (elevated cardiac biomarkers)
EKG (ST changes of at least 0.5mm)
Risk factors (at least 3 of CAD risk factors)
Ischemia (at least 2 angina episodes w/in past 24h)
CAD (stenosis at least 50%)
Aspirin use w/in 7d
110
Q

Tx of sulfonylurea overdose

A
  • D50
  • octreotide (to inhibit additional insulin release)
  • continued monitoring (12-24h effects)
111
Q

human bite infectious organisms

A

most commonly Eikenella corrodens

  • also staph and strep bacteria
112
Q

s/sx of appendix testis torsion

A
  • classic “blue dot sign”: small palpable tender nodule on the superior testis that reflects blue with light through scrotum
  • usually in kids
113
Q

s/sx of epididymitis

A
  • unilateral testicular pain
  • ttp
  • fever
  • get US to r/o testicular torsion
114
Q

What can cause false positive gFOBT?

A
  • elevated concentration of heme from recent diet of red meet
  • elevated peroxidase found in some fruits and vegetables including beets
115
Q

tx of Vtach with pulse vs without

A
  • with pulse: cardiovert

- without pulse: defib

116
Q

what does secondary closure mean

A

let wound heal on own

117
Q

Sx of class I hemorrhagic shock

A

normal BP
HR <100
RR normal
U output normal (30 or more)

Overall normal ranges (anything above normal range moves into Class II)

blood loss of < 750 mL

118
Q

Sx of class IV hemorrhagic shock

A

hypoT
HR >140
RR > 35
U output neglifible

pt confused, lethargic

blood loss of 2000 mL or more

119
Q

heat stroke vs heat exhaustion

A
  • heat exhaustion has no change in mental status, stroke does
  • normal LFTs in heat exhaustion but not heat stroke
120
Q

pericardial tamponade sx

A

SOB
distended neck veins
signs of shock

esp with hx trauma

121
Q

opiate withdrawal sx

A 
muscle cramps
rhinorrhea
sneezing
yawning
lacrimation (tearing)
leg cramping
piloerection (goose bumps)
dilated pupils
122
Q

treatment of PE in stable pt

A
  • immediate anticoagulation with either unfractionated heparin or LMWH (ex/ enoxaparin)
123
Q

when to use tPA in PE tx

A

massive PE with signs of cardaic arrest, hypoT, and R heart strain

124
Q

contraindications to TPA use

A 
suspected aortic dissection or pericarditis
active internal bleeding
known intracranial neoplasm
ischemic CVA in the past yr
previous hemorrhagic stroke ever

Year 3 (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions