Brainscape's Knowledge GenomeTM

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


See full index

CCFP(EM) Omar > Common ER Presentations > Flashcards

Common ER Presentations Flashcards

1
Q

<div>Indications for admission in syncope</div>

A

“<div><span>Absolute</span>:(must admit)</div> <ol> <li>Chest pain</li> <li>Hx of CHF or valvular lesions</li> <li>Unexplained SOB</li> <li>Serious ECG findings:</li> <ol> <li>VT</li> <li>QT prolongation</li> <li>Ischemia or new BBB</li> </ol> </ol> <div></div> <div><span>Relative</span>:(consider admit)</div> <ol> <li>Age > 45</li> <li>Pre-existing CV or congenital heart disease</li> <li>FHx of sudden death (Brugada)</li> <li>Exertional syncope (HOCM, critical AS)</li> <li>Serious comorbidities (DM)</li></ol>”

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

Ix for syncope

A

ECG<div>Preg test</div><div>HCT</div><div>Electrolytes</div><div>Glucose</div>

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

D/C instructions for pt with syncope

A

No driving<div>No operating heavy machinary</div><div>Avoid working in heights</div>

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

<div>Describe the San Francisco Syncope Rule:</div>

A

“<div>5 points: (<span>CHESS</span>) </div> <div></div> <div>1. History <span>CHF </span></div> <div>2. <span>Hematocrit</span> <30% </div> <div>3. Abnormal <span>ECG </span></div> <div>4. <span>SOB</span> on history </div> <div>5. <span>SBP</span> <90 at triage</div>”

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

Life threatening causes of abd pain

A

Ruptured EP<div>Ruptured AAA</div><div>Mesenteric ischemia</div><div>Intestinal obstruction</div><div>Perforated viscus</div><div>Acute appendicitis</div><div>Ascending cholangitis</div><div>Complicated diverticulitis</div>

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

List 6 life threatening causes of acute pelvic pain in women

A

PID<div>Tubo-ovarian abscess <br></br>Ectopic pregnancy <br></br>Hemorrhagic ovarian cyst (ruptured) <br></br>Appendicitis <br></br>Bowel/uterine perforation</div>

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Red flags for Back pain

A

“<b><u>History</u></b>:<div>Trauma</div><div>Sudden</div><div>Acute</div><div>Children</div><div>Syncope</div><div>Sweating</div><div>Fever</div><div>Neurological deficit</div><div>Immune compromised</div><div>IVDU</div><div><br></br></div><div><b><u>PMH</u></b>:</div><div>Cancer</div><div>Steroid use</div><div><br></br></div><div><b><u>Examination</u></b>:</div><div>Unstable vitals</div><div>Unequal BP in extremities</div><div><br></br></div><div>Diastolic murmur in aortic ares (AI)</div><div>LL pulse deficit</div><div>Pulsatile abd mass</div><div>Focal bone tenderness</div><div>ROU</div><div>Loss of rectal sphincter</div><div>Focal LL weakness</div>”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

6 emergent causes of back pain:

A

Aortic dissection <br></br>Cauda equina syndrome <br></br>Epidural abscess / HEMATOMA <br></br>Meningitis <br></br>Ruptured or expanding abdominal aortic aneurysm <br></br>Spinal fracture with subluxation causing CORD or ROOT impingement

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

Back pain and involved disc space

A

“<b>L5</b>:<div>Decrease sensation of 1st webspace in foot<div>Weak extension of the great toe and NORMAL reflexes</div></div><div><br></br></div><div><b>S1:</b></div><div>Decreased sensation to lateral foot and small toe <br></br>Weak plantar flexion +/- ankle jerk reflex loss<br></br></div>”

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

Major categories can impact and disrupt normal cortical function

A

<b>I. Substrate deficiency</b> <br></br> a. Hypoxia <br></br> b. Hypoglycemia<div><br></br><b>II. Neurotransmitter dysfunction</b> <br></br> a. Endocrine disease <br></br> b. Hepatic failure <br></br> c. CNS sedatives <br></br> d. EtOH <br></br> e. Poisons <br></br><br></br></div><div><b>III. Circulatory dysfunction</b> <br></br> a. Shock</div>

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

List the Major Categories for the differential diagnosis of Confusion/Coma

A

“<b>DIMES</b><div><br></br></div><div><b>Drugs (OBs and 5Cs):</b></div><div> Opiates</div><div> BB</div><div> CO poisoning</div><div> Cyanide</div><div> Cyclic antidepressants</div><div> Cardiac glycosides</div><div><br></br></div><div><b>Infections</b></div><div> Meningitis, encephalitis</div><div> Sepsis and septic shock</div><div><br></br></div><div><b>Metabolic</b></div><div> Hypoglycemia</div><div> DKS,HONK</div><div> Hyper or hypo T4</div><div> Kidney failure</div><div> Liver failure</div><div><br></br></div><div><b>Environmental</b></div><div> High altitude</div><div> Heat stroke</div><div> Hypothermia</div><div></div><div><b>Structural</b></div><div> ICH</div><div> Stroke</div><div> ACS</div><div> Shocks</div><div> PE</div><div> Hypertensive encephalopathy</div><div> Trauma, head injuries</div>”

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

Organic vs Psychological Confusion

A

“<img></img>”

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

Critical causes of Confusion

A

Shock and hypoxia<div>Hypoglycemia</div><div>CNS infections</div><div>Htsive encephalopathy</div><div>Raised ICP (medical, surgical)</div>

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Miosis (pin point pupil) causes:

A

Pontine hge<div>Intoxication:</div><div> Opioids</div><div> Clonidine</div><div> Cholinergic toxidrome</div>

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

<div>Important questions to ask in ALOC</div>

A

<ul> <li>When were they last seen normal? </li> <li>How was their health prior to being altered? </li> <li>Had they any specific cardiovascular, respiratory, urinary, or neurologic complaints of note? </li> <li>How did they become altered? Was it a sudden or gradual event?</li></ul>

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

Best pain stimulus to evaluate GCS

A

“Interphalangeal pressure<div>(Apply pressure with a pen/pencil to the lateral outer aspect of the proximal or distal</div>interphalangeal joint (lateral aspect of the patient’s finger or toe) for 10 to15 seconds to <br></br>elicit a response.)”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What simple tests can you use to assess concentration at the bedside?

A

Repeat digits forward and backward<div>Listing the months in reverse order OR spell a commonly used backward<br></br></div>

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

<div>List 5 emergent and 4 critical diagnoses that cause confusion</div>

A

<div>Critical </div>

<div>● Failure to oxygenate </div>

<div>● Failure to ventilate </div>

<div>● Hypoglycemia </div>

<div>● Elevated ICP with impending herniation </div>

<div></div>

<div>Emergent </div>

<div>● Toxic ingestion/Substance withdrawal </div>

<div>● Infection (esp. meningitis/encephalitis) </div>

<div>● Hypo/hyper calcemia, hepatic encephalopathy, uremia, etc. </div>

<div>● Endocrine disease (thyroid/adrenal) </div>

<div>● Structural brain lesion (stroke/bleed/mass) </div>

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

<div>Non-neurologic Weakness</div>

A

<ul> <li>Alterations in plasma volume (dehydration)</li> <li>Alterations in plasma composition (glucose, electrolytes)</li> <li>Derangement in circulating red blood cells (anemia or polycythemia)</li> <li>Decrease in cardiac pump function (myocardial ischemia)</li> <li>Decrease in systemic vascular resistance (vasodilatory shock from any cause)</li> <li>Increased metabolic demand (local or systemic infection, endocrinopathy, toxin)</li> <li>Mitochondrial dysfunction (severe sepsis or toxin-mediated)</li> <li>Global depression of the central nervous system (sedatives, stimulant withdrawal)</li></ul>

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

<div>List 5 non-emergent causes of peripheral neuropathy</div>

A

<div>1. Connective tissue disorder </div>

<div>2. External compression (entrapment syndrome, compressive plexopathy) </div>

<div>3. Endocrinopathy (diabetes) </div>

<div>4. Paraneoplastic syndromes </div>

<div>5. Toxins (alcohol) </div>

<div>6. Trauma </div>

<div>7. Vitamin deficiency</div>

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

<div>List four factors that blunt the febrile response:</div>

A

<div>1. Advanced Age </div>

<div>2. Immunosuppression </div>

<div>3. Malnutrition </div>

<div>4. Chronic Disease</div>

22
Q

<div>Benefits of the febrile response include:</div>

A

<div>● Increased chemotaxis </div>

<div>● Decreased microbial replication </div>

<div>● Improved lymphocyte functioning </div>

<div>● Direct inhibition of bacterial or viral growth</div>

23
Q

<div>Pitfalls of the febrile response include:</div>

A

<div>● Increased oxygen consumption </div>

<div>● Increased metabolic demands </div>

<div>● Protein breakdown </div>

<div>● Increased gluconeogenesis </div>

<div>These are problematic in patients with poor physiologic reserve.</div>

24
Q

What is the most accurate measure of core body temperature

A

the thermistor of a pulmonary artery catheter, <br></br>rectal temperature measurements<div>bladder thermistors</div>

25
Q

Features ofBasilar Artery Thrombosis

A

Vertigo, dysarthria,<div>other cranial nerve involvement; <br></br>risk factors for stroke</div>

26
Q

Orbital Apex Syndrome, <br></br>Cavernous Sinus Process

A

Combination of palsies of the <br></br>CN III, IV, VI, with retro-<br></br>orbital pain, conjunctival <br></br>injection, possible <br></br>periorbital/facial numbness

27
Q

Diabetic microIschemic Neuropathy

A

Isolated CN palsy<div>(pupil-sparing if CN III)</div>

28
Q

List 6 causes of false positive stool guaic

A

ingestions of:<div>red meat</div><div>turnips</div><div>horseradish</div><div>vitamin C<br></br>methylene blue</div><div>bromide preparations</div>

29
Q

<div>The differential diagnosis of sudden severe headache includes:</div>

A

<ul> <li>subarachnoid or intracranial hemorrhage (ICH), </li> <li>cerebral venous thrombosis </li> <li>cervical artery dissection.</li></ul>

30
Q

“Features of ““BAD”” headache”

A

<div>Abdormal VSs</div>

Focal findings<div>ALOC</div><div>S/S of systemic illness</div>

31
Q

Specific features of Cluster Headache

A

Ipsilateral autonomic features (facial sweating, conjunctival injection, nasal <div>congestion, rhinorrhea, ptosis, miosis) <div><br></br></div><div>Sense of restlessness or agitation<br></br></div></div>

32
Q

<div>Emergency Rx of Migraine:</div>

A

“<img></img>”

33
Q

<div>Criteria suggesting SAH:</div>

A

<div>Thunderclap headache </div>

<div>Headache + loss of consciousness </div>

<div>Severe headache with neck stiffness/pain </div>

<div>Onset of headache during exertion </div>

<div>Age >/40 years </div>

<div>Limited neck flexion on ROM</div>

34
Q

Which diagnostic test is best to establish the diagnosis of cerebral <br></br>venous thrombosis?

A

MR Venography

35
Q

<div>Classes of antiemetics:</div>

A

<div>Dopamine D2 antagonists (metoclopramide / Maxeran) </div>

<div>Serotonin receptor antagonists (ondansetron / Zofran) </div>

<div>Cholinergic & histamine receptors antagonists are in the lateral vestibular nucleus (diphenhydramine, scopolamine, dimenhydrinate) </div>

<div>Cannabinoid receptors also inhibit reflex</div>

36
Q

CTZ - chemoreceptor trigger zone

A

i. Floor of the 4th ventricle <br></br>ii. Part of this area is OUTSIDE the blood brain barrier <br></br>iii. Activated by: <br></br> 1. Hormones <br></br> 2. Peptides <br></br> 3. Medications <br></br> 4. Toxins (opiates, digitalis, chemotherapy agents, salicylate, dopamine)

37
Q

Types of Generalized Seizure

A

Tonic-Clinic<div>Absence</div><div>Atonic</div><div>Myoclonic</div>

38
Q

Syncope vs Seizure

A

“<img></img>”

39
Q

Indications for Emergent CT Scan

A
  • New focal deficit <br></br>- Persistent altered mental status <br></br>- Fever <br></br>- Recent trauma <br></br>- Persistent headache <br></br>- History of cancer <br></br>- Anticoagulant use <br></br>- Suspicion or known history of AIDS <br></br>- Age > 40 years <br></br>- Presence of partial complex seizure
40
Q

<div>Criteria for D/C of syncope patient:</div>

A

<div>Age: Men < 45, women < 55</div>

<div>Absence of worrisome S/S</div>

<div>Absence of worrisome ECG findings</div>

<div>No concomitant serious co-morbidities</div>

41
Q

<div>Red flags for serious syncope:</div>

A

<div> <div>History</div> <div>Sudden onset without prodrome</div> <div></div> <div>Chest pain</div> <div></div> <div>Exertional</div> <div></div> <div>Dyspnea/hemoptysis</div> <div></div> <div>Ass with any bleeding</div> <div></div> <div>Fever, chills</div> <div></div> <div>Ass with risk factors: VTE, CVS, Drugs</div> <div>Examination</div> <div>Abnormal VS</div> <div></div> <div>Generally unwell</div> <div></div> <div>Neuro: ALOC, Focal signs, meningeal signs</div> <div></div> <div>CVS: murmurs, JVP, unequal pulses</div> <div></div> <div>Abdo: RT, bleeding PR/PV</div> </div>

42
Q

What are 5 ECG findings to look for in the syncopal patient?

A
  1. Dysrhythmias <br></br>2. Pre-excitation <br></br>3. Shortened PR <br></br>4. Prolonged QTc <br></br>5. ST Elevation (regional and diffuse)<div>6. Brugada pattern (RBBB in association with ST elevation in V1-V3) <br></br>7. Right ventricular strain pattern <br></br>8. Electrical alternans<br></br></div>
43
Q

What are markers of increased short-term risk in syncope patients?

A
  1. Age >65 years <br></br>2. Male gender <br></br>3. History of CHF <br></br>4. History of CVD or serious dysrhythmia <br></br>5. History of structural heart disease <br></br>6. Family history of early (<50 years) sudden death <br></br>7. Syncope without prodrome <br></br>8. Exertional syncope <br></br>9. Dyspnea or shortness of breath <br></br>10. Syncope during supine position <br></br>11. Hypotension - systolic BP <90 mmHg <br></br>12. Abnormal EKG <br></br>13. Anemia with HCT <30% or hemoglobin <90 g/L
44
Q

Potentially consider prolonged monitoring for patients with syncope who have:

A
  1. Age > 65 years <br></br>2. Pre-existing cardiovascular or congenital heart disease <br></br>3. Family history of sudden death <br></br>4. Serious comorbidities (e.g., diabetes mellitus) <br></br>5. Exertional syncope
45
Q

Typical causes of central cyanosis:

A

• Presence of pathologic or abnormal hemoglobin <br></br>• Shunting of venous unsaturated hemoglobin into arterial circulation <br></br>• Decreased arterial oxygen saturation

46
Q

At what concentration of de oxyhemoglobin does cyanosis present?

A

Deoxyhemoglobin of 50 g/L.

47
Q

Causes of no improvement in cyanosis after O2 therapy:

A

Methemoglobinemia<div>Sulfhemoglobinemia</div><div>Cyanide toxicity</div>

48
Q

Factors that shift the oxyhemoglobin dissociation curve to the left:

A

● Decreased temperature <br></br>● Increased pH <br></br>● Decreased 2,3 DPG <br></br>● Increased methemoglobin <br></br>● Presence of sulfhemoglobin

49
Q

Factors that shift the oxyhemoglobin dissociation curve to the right:

A

● Increased temperature <br></br>● Decreased pH <br></br>● Increased 2,3 DPG

50
Q

These patients are typically exposed to sulfur -­containing substances, including:

A

● Hydrogen sulfide gas <br></br>● Sulfonamide derivatives <br></br>● Gastrointestinal sources (seen in cases of bacterial overgrowth)

51
Q

What is the colour of the blood in a patient with methemoglobinemia?

A

chocolate brown or dark purple -­brown

52
Q

Work up for cavernous sinus thrombosis

A

MTR is the imaging of choice<div>AB (3rd gen cephalo, consider MRSA or anaerobic coverage)</div><div>Steroids</div><div>Heparin</div><div>Consult (ophth, neuro, ID)</div><div>May require surgical drainage</div>

CCFP(EM) Omar (27 decks)

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