EM Flashcards
Vessels most likely to be injured during cricothyrotomy
Superior cricothyroid vessels
Which insulins require a prolonged observation period?
Detemir, NPH, NPL
Estimate of total body potassium deficit
each 0.3 drop = 100 mE1 total body deficit
Lumbar disc herniations typically affect which nerve root
the one below
L4-L5 herniation affects L5, L5-S1 herniation affects S1, etc.
Frontotemporal dementia
behavioral disturbances, including disinhibition with socially inappropriate behaviors, hyperorality, and compulsive behaviors
Lewy Body Dementia
cognitive fluctuations, parkinsonism, and, most classically, visual hallucinations
Zone of Neck
Zone 1 - clavicle to cricoid (highest mortality)
Zone 2 - cricoid to mandible
Zone 3 - mandible to skull base
Difference between toxoplasmosis and primary CNS lymphoma on CT
toxo = RING enhancing lesions
CNS lymphoma = hypderdense/isodense SOLIDLY enhancing round lesions
Abnormal movements with eyes open =
cerebellar disease
Abnormal movements with eyes closed =
posterior column disorders
Rule of 80 for adult and pediatric neck masses
80% in peds = benign
80% in adults = malignant (non-thyroid)
Insecticide exposure associated with what toxidrome
cholinergic crisis DUMBBELLS
Central cord syndrome
Upper extremity weakness > lower
Associated with EXTENSION injuries
Corticospinal and spinothalamic tracts are most affected within the CENTRAL portion of the cord
Anterior cord syndrome
loss of motor and sensory below the level of injury
preservation of position, touch, vibration
Bankart fracture
inferior glenoid rim
Hill-Sachs fracture
compression fracture of the posterolateral humeral head
Wernicke encephalopathy
nystagmus, ophthalmoplegia, ataxia
Mechanism of magnesium deficiency leading to hypocalcemia
produces parathyroid hormone resistance
magnesium supplementation can improve symptoms of hypocalcemia
Croup virus
parainfluenza virus type 1
Lab findings in Erlichiosis and Anaplasmosis
leukopenia, thrombocytopenia, transaminitis
Typical rash spread pattern in RMSF
centripetal = distal extremities to the trunk
Toxic metabolite of ethylene glycol
oxalic acid
Bark scorpion physical exam findings
motor restlessness and hypersalivation
neonatal conjunctivitis <5 days old
Neisseria
IV or IM ceftriaxone
neonatal conjunctivitis > 5 days
Chlamydia
oral erythromycin
What dermatologic condition is most commonly associated with celiac disease
dermatitis herpetiformis
Coronary occlusion that can cause complete heart block
RCA
Painless abdominal mass + hematuria in a 3ish year old child
Wilms Tumor
Renal US
Nephrectomy
Elapidae
Coral snake, Cobra, Kraits, Mambas
Marked systemic neurotoxicity
Irreversibly binds acetylcholine receptors
Crotalidae
Pit vipers
Coagulopathy
Systemic symptoms uncommon
Loxosceles
Brown spiders
Brown recluse
Necrotic eschar
Centruroides
Bark scorpion
muscle spasms, oculomotor abnormalities
Aspiration location for priapism
2 OR 10 o’clock
followed by phenylephrine injection
Max dose of lido w/epi
w/o epi
7mg/kg or max of 500mg regardless of weight
5mg/kg
Phenobarbital mechanism of action
increases GABA receptor opening duration
Allergic compound of poison ivy/oak/sumac
Urushiol
Nitrazine positive
Blue coloration with pH > vaginal pH, usually around 7.2-7.4
Silo fillers disease
Nitrogen dioxide
Musty hay or newly mown grass smell
Phosgene
Dextrose rule for peds
5-10mL/kg of D10
2-4 mL/kg of D25
1-2 mL/kg of D50
Small positive deflection buried in the end of the QRS complex
Epsilon wave
ARVD
two most common causes of SJS or TEN
Mcyoplasma or Herpes simplex
Bullous pemphigoid
> 60 years
Nikolsky negative
Does not involve mucous membranes
Pemphigus vulgaris
Younger 40-60
Involves mucous membranes
Nikolsky positive
4 cluster B personality types
Antisocial
Borderline
Histrionic
Narcissistic
Cytoplasmic inclusions found in Parkinsons
Lewy bodies
Tx for hereditary angioedema
C1 esterase inhibitor replacement OR
FFP
First line tx for pregnancy related nausea/vomiting
Pyridoxine alone or in combination with doxylamine
apical displacement of the tricuspid valve with dilation of the right atrium
Ebstein anomaly
atrialization of the proximal right ventricle
Bitter almond smell
Cyanide
Rotten eggs smell
Hydrogen sulfide
Garlic odor toxidrome
organophosphate poisoning
Foodborne diarrhea that can cause liver abscess
Entamoeba histolytica
Most common cause of erysipelas
beta-hemolytic Strep pyogenes
Syphilis tx regimens ( primary, secondary, tertiary, etc.)
primary/secondary - single dose IM pen G
Tertiary or Late latent - weekly IM pen G for 3 weeks
Factor replacement doses for Hemophilia A and B
50IU to get 80-100% replacement with Factor VIII
100IU to get 80-100% replacement with factor IX
Initial bullous pemphigoid management
wound care, steroids, doxycycline
Tx for RMSF even in children
Doxycycline
Findings associated with oligoarticular juvenile arthritis
Chronic uveitis
ANA positive
TMJ arthritis
Bacterial infection predisposing to PSGN
Group A beta-hemolytic strep
Strep throat, Impetigo
timing of arterial gas embolism
on ascent or within minutes
timing of decompression syndromes
minutes to hours after ascent
Depth related diving syndromes
Barotitis occurs at shallower depths compared to nitrogen narcosis
Nitrogen narcosis occurs are deep depths (at least 100 ft below sea level)
Electrolyte abnormality often seen with myxedema coma
hyponatremia (50% of patients)
most common site of pediatric linear skull fractures
parietal bone
Tympanic membrane rupture, blast lung, ocular injury, concussion - type of blast injury
primary
Secondary blast injuries
impact of fragments
penetrating trauma, amputation
tertiary blast injuries
crush injuries, blunt trauma
body propelled into objects
Quaternary blast injuries
environmental contamination
burns, inhalation, toxic substances
quinary blast injury
bodily absorption of device additives
Tripod fracture
lateral orbit, zygoma, maxilla
ACA stroke symptoms
contralateral weakness and sensory loss,
LEG > ARM
Loud single heart sound with harsh systolic murmur
Tetralogy of Fallot
GVHD in BMT patient most common presenting symptoms
rash (maculopapular)
diarrhea (bloody)
benzos MOA
binds to GABA a receptors, increasing frequency of chloride channel opening, reducing the resting potential and producing inhibitory effects
serum osmolality equation
2x Na + BUN/2.8 + glucose/18 + ethanol/3.7
Tx for cyanide toxicity
Hydroxycobalamin (preferred if concomitant CO exposure)
OR
Amyl nitrite + Sodium thiosulfate
Most frequently isolated organism with acute suppurative parotitis
Staph aureus
A-a gradient and Pao2 for steroids in PJP
PaO2 < 70
A-a gradient >35
Most common basilar skull fracture location
temporal bone
MCC of ischemic stroke in children
sickle cell
DeWinter wave associated with what lesion
LAD
What infection is associated with adult onset asthma
Chlamydia pneumonia
Foxglove toxidrome
dig toxicity
Jimson weed toxidrome
anticholinergic
What US finding is nearly 100% sensitive for cardiac tamponade
plethoric IVC
What is indicative of benign physiologic cause of neonatal jaundice
jaundice on day 3 of life
levels peak at day 3 then return to normal by two weeks of life
Hypsarrhythmia on EEG
Infantile spasms
Arsine gas exposure
- work?
tx?
Semi-conductor industry
Alkalinization of urine
Exchange transfusion
Most common location for intussusception
Ileocecal colon
Stages of iron toxicity
1 - GI symptoms, nausea/vomiting/diarrhea
2- period of improvement
3 - Systemic - GI symptoms return, hypotension, severe AGMA, AMS
2 to 5 days after
4- Elevated LFT’s
5 - Bowel obstruction (often pyloric outlet obstruction)
Coronary lesion with Wellens waves
Left Anterior Descending
Confirmatory test for neurosyphilis
CSF VDRL
Tx for acute mountain sickness vs HACE
acetazolamide
dexamethasone for HACE
Most sensitive test for active TB infection
Mantoux skin test
Most sensitive test for spinal epidural abscess
ESR
What meds should be avoided in hydrocarbon ingestion
Dopamine, Epi, Norepi
Procainamide
Amiodarone, Sotalol
Tx for travellers diarrhea in pregnant patients
Azithromycin
Most common neurovascular injury in knee dislocation
Peroneal nerve
Popliteal artery
Most common lung cancer in smokers
adenocarcinoma
Examples of type I hypersensitivity reaction
Anaphylaxis
Angioedema
Urticaria
Most common cause of gross hematuria in children
UTI
Abx of choice in toxic shock syndrome
Clindamycin
most effective emergency contraception up to 120 hrs
Ulipristal acetate
Most common site of cervical spine injury in children < 8 yrs old
C1-C3
Paralytics for intubation with myasthenia gravis
Higher dose of depolarizing (2.25 /kg of sux)
Lower dose of non-depolarizing
Do patients with Lambert-Eaton require higher or lower doses of paralytics for intubation?
Lower
What characteristic differentiates TRALI from TACO?
High fever
Pattern of paralysis in botulism
Descending symmetric
CD4 count associated with CMV infection
< 50
What type of lesion is cauda equina?
lower motor neuron
composed of peripheral spinal nerves being compress
Nikolsky positive diseases
Staphylococcal scalded skin
SJS/TEN
Pemphigus vulgaris
Condyloma acuminata vs Condyloma lata
Acuminata - > HPV
Lata - > Syphilis
Most common bacteria from dog bites
Pasteurella
narcan drip dosing
2/3rds of reversal dose
0.3 bolus - > 0.2mg/hr drip rate
Lupus pernio commonly associated with
sarcoidosis
Chancroid (bug and tx)
Haemophilus ducreyi
Ceftriaxone 250IM, Azithro 1g oral
Test for evidence of maternal-fetal hemorrhage
Kleihauer-Betke
Thyroid storm order of tx
beta blocker
PTU
Methimazole
Iodine
Steroids
PTU preferred in pregnancy
Abx for strep throat if anaphylactic to penicillins
Clarithomycin, Azithromycin, Clindamycin
Rubella
German measles
maculopapular rash start on face and spread downward
associated with fever
most common congenital CYANOTIC heart disease
Tetralogy of Fallot
US location most sensitive for free fluid in the setting of trauma
hepatorenal window
QS waves in V2-V4 without reciprocal changes
Ventricular aneurysm
ECHO
Tx for epiploic appendagitis
NSAID’s
Abx for cavernous sinus thrombosis as a complication of acute sinusitis
vanco, ceftriaxone, metronidazole