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EM Flashcards

1
Q

Bidirectional VT

A

Digoxin toxicity

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2
Q

First biomarker positive in STEMI

A

Myoglobin

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3
Q

Order of ECG changes in STEMI (5)

A
  1. Hyperactive T waves
  2. J point elevation
  3. STE
  4. Q wave/loss of R
  5. TWI
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4
Q

R sided STEMI ECG changes

A

STE of V4R and V5R

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5
Q

Posterior STEMI ECG changes

A

ST depressions in V1, V2, large R waves (R/S ratio > 1)

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6
Q

What clinical findings represent right ventricular infarction in the setting of an inferior MI? (2)

A

JVD + Hypotension

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7
Q

MC SE IV amiodarone

A

Hypotension

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8
Q

pregnancy and t-PA

A

Relative contraindication

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9
Q

SE of procainamide (2)

A

Hypotension, prolonged QT

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10
Q

Drugs that can be given via ETT? (5)

A 
Adults: NAVEL
Naloxone
Atropine 
Vasopressin 
Epi 
Lidocaine

PEDS: LANE

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11
Q

Successful placement of transvenous pacer in right ventricle? (2)

A

left bundle-branch block with left axis deviation

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12
Q

Tachycardia disproportionate to fever

A

Myocarditis

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13
Q

MCC myocarditis worldwide? In US?

A

World-Chagas disease caused by the protozoan Trypanosoma cruzi.
US-enterovirus (coxsackie group B)

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14
Q

Most specific PE finding in CHF

A

S3

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15
Q

Overmedication with nitroglycerin can cause what toxic effect?

A

Methemoglobinemia

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16
Q

High-quality chest compressions are associated with what CO2 values

A

> 10 mm Hg

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17
Q

Serum ß-hCG pattern in pregnancy?

A

doubles every 2 days in early pregnancy

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18
Q

Vital sign changes in pregnancy (2)

A

HR: ↑ 10-15 bpm
BP: ↓ in 2nd trimester, normalizes in 3rd

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19
Q

Fundal height: (3)

A

12 weeks: pubic symphysis
20 weeks: umbilicus
20-32 weeks: height (cm) above symphysis = gestational age (weeks)

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20
Q

Transvaginal vs transabdominal ultrasound: IUP visualized when ß-hCG

A

Transvaginal ultrasound: IUP visualized when ß-hCG > 1500

Transabdominal ultrasound: IUP visualized when ß-hCG > 4000

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21
Q

Which therapy for COPD is associated with a reduction in mortality?

A

O2

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22
Q

What must you remember to do in a patient with salicylate toxicity who requires intubation?

A

Set the respiratory rate to match their pre-intubation rate to allow continued compensatory expiration of CO2.

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23
Q

What correlates with severity of hepatic encephalopathy?

A

CSF glutamine

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24
Q

Ranson’s criteria? (5)

A 
age >55
Wbc> 16k
Glucose>200
LDH>350
AST>250
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25
Q

Charcot’s triad?

A

Fever, abd pain, jaundice (CHOLANGITIS)

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26
Q

Reynold’s pentad?

A

Fever, abd pain, jaundice AND +Hypotension, AMS

CHOLANGITIS

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27
Q

Which lab marker elevation has the highest positive predictive value for a biliary etiology in patients diagnosed with acute pancreatitis?

A

Alanine aminotransferase (ALT) is the best single marker for a biliary etiology. Levels three times greater than baseline support the diagnosis of biliary pancreatitis.

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28
Q

What is the target temperature for postarrest therapeutic hypothermia?

A

32-36°C

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29
Q

Preferred anticoagulation in cancer pt with DVT?

A

LMWH SC and DC to follow up with PMD

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30
Q

MC mediastinal tumor?

A

Thymoma (ass w/ MG 50%)

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31
Q

Triad fat embolism?

A

Hypoxemia, neuro abnormality, petechial rash

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32
Q

Treatment of latent TB? (2)

A

INH for 9 months OR Rifampin for 4 months

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33
Q

Tx for active TB?

A

rifampin, INH, pyrazinamide, ethambutol (RIPE)

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34
Q

Positive PPD Criteria:

A
  • 15 mm: no ↑ risk
  • 10 mm: high-risk, homeless, health-care workers, IVDU, foreign-born
  • 5 mm: immunosuppressed, recent TB contact, abnormal CXR, steroid use
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35
Q

SE of INH (3)? tx?

A

Peripheral neuropathy + hepatitis + seizures

Tx- pyridoxine B6

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36
Q

Pulmonary Capillary Wedge Pressure (PCWP) in noncardiogenic Pulm edema?

A

PCWP<18

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37
Q

Tx of primary TB in preggo? OK to breastfeed?

A

rifampin, INH, ethambutol (RIE). Yes

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38
Q

SE of ethambutol? (2)

A

red-green vision loss, optic neuritis

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39
Q

Above what serum salicylate level should you consider hemodialysis in acute and chronic aspirin toxicity?

A

Acute toxicity > 100 mg/dL and chronic toxicity > 60 mg/dL.

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40
Q

Anthrax finding on CXR

A

Widened mediastinum

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41
Q

Inc risk of what type of PNA in alcoholics

A

Klebsiella

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42
Q

SE of Rifampin

A

Turns body fluids orange

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43
Q

MC injured site of heart in penetrating injury

A

RV

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44
Q

What nerve can be injured during thoracotomy?

A

Phrenic –> diaphragm paralysis

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45
Q

What defines a positive diagnostic peritoneal aspiration? (2)

A

DPL positive if > 10 ml gross blood or > 100,000 RBCs/mL

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46
Q

MC injured organ in GSW?

A

Small bowel

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47
Q

MC injured organ in Stab wounds?

A

Liver

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48
Q

beta2-transferrin test?

A

is used to detect CSF presence in suspected CSF otorrhea or CSF rhinorrhea.

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49
Q

Kleihauer-Betke test ?

A

concern for significant maternal-fetal hemorrhage (need extra rhogam)

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50
Q

nitrazine test?

A

used to evaluate vaginal fluid for amniotic fluid leak and potential premature rupture of membranes.

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51
Q

MC injured organ in peds blunt trauma?

A

Spleen

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52
Q

Indication for perimortem c-section? (2)

A

gestation ≥ 24 weeks + loss of maternal vital signs

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53
Q

Hemorrhagic shock 4 classes

A

Class II: HR >100, decreased pulse pressure
Class III: SBP <90
Class IV: negligible urine output, confusion
O- for women

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54
Q

Jefferson fracture? Caused by? (2)

A

C1 burst fracture.

axial loading or vertical compression force

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55
Q

Hangman’s fracture? Caused by?

A

fractures of the bilateral pedicles of C2. . extreme hyperextension

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56
Q

Odontoid fx? Caused by? (2)

A

high cervical pain radiating to the occiput. shearing force or extreme flexion

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57
Q

Teardrop fracture? Caused by?

A

Any level. extreme flexion

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58
Q

Anterior cord syndrome caused by what mechanism? (2

A

Extreme neck flexion or vascular

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59
Q

Anterior cord syndrome - neuro findings? Prognosis?

A

Complete loss of motor + pain/temp below the lesion.
Preserved propioception/vibration
Prognosis is poor

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60
Q

Central cord syndrome - neuro findings? Prognosis?

A

Sensory and motor deficit in UE>LE. Prognosis is average

61
Q

Central cord syndrome caused by what mechanism?

A

Forced hyperextension of neck

62
Q

Brown-sequard syndrome caused by what mechanism

A

Penetrating trauma

63
Q

Brown-Sequard syndrome - neuro findings? Prognosis?

A

IL loss of motor + proprioception/vibration
CL loss of pain/temp
Prognosis good

64
Q

Most common incomplete spinal cord syndrome?

A

Central cord syndrome

65
Q

3 types of pelvic fractures and their mechanisms?

A 
lateral compression (T-bone MVC/pedestrian hit from side)
AP fracture (head on MVC)
vertical shear (fall)
66
Q

5 categories of blast injuries

A

(Blast Fragments ride the Wave to C.A.)
B- blast. Direct effect from blast shockwave (ruptured TM, hollow organ injury, concussion)
F- fragments/projectiles from blast (penetrating trauma/lacs)
W-wave from blast throwing your body (crush injuries/Blunt trauma)
C- contamination (burns/inhalation/toxic exposure)
A- absorption (hypermetabolism state)

67
Q

MC blast injury

A

Ruptured TM

68
Q

Antidote to magnesium OD

A

Calcium gluconate

69
Q

Preeclampsia? (3)

A

Hypertension > 140/90
>20 weeks pregnant
edema or proteinuria (>300mg/24hrs)

70
Q

Tx for preeclampsia (3)

A

Mg + hydralizine/labetolol

71
Q

Obese 13 year old with limp and knee pain holding leg in external rotation

72
Q

MCC Peds limp or hip pain

A

Transient synovitis

73
Q

What is Legg-Calve-Perthes disease?

A

avascular necrosis of the femoral head

74
Q

Boy aged 4-10 with intermittent limp and flatted femoral head on XR?

A

Legg-calve-perthes

75
Q

What causes Osgood-Schlatter disease?

A

Repeated microtrauma occurs at the apophyseal cartilage between the anterior tibial tubercle and the secondary ossification center of the patellar tendon.

76
Q

Teen or athlete with anteroinferior knee or superior shin pain and tender tibial tuberosities.

A

Osgood schlatter

77
Q

blood on dipstick with the absence or only minimal amount of RBCs on microscopy

A

Rhabdomyolysis

78
Q

MC type of hernia in M? F?

A

Indirect inguinal hernia are MC in both

79
Q

Indirect vs direct hernia?

A

Indirect pass THROUGH inguinal canal into scrotum/labia (lateral to epigastric artery)
Direct passes BEHIND inguinal ring and does NOT go into scrotum (MEDIAL to epigastric artery)

80
Q

MC hernia in peds?

81
Q

projectile, non-bilious vomiting that occurs immediately after feeding age 2 weeks-2 years

A

Pyloric stenosis

82
Q

Peds olive shaped mass in the right upper abdomen

A

Pyloric stenosis

83
Q

Peds hypochloremic metabolic alkalosis

A

Pyloric stenosis

84
Q

bilious vomiting in infants? (2)

A

Malrotation and volvulus

85
Q

Prednisone safe in pregnancy ?

A

associated with fetal cleft lips and palates and should generally be avoided if possible in the first trimester of pregnancy

86
Q

Dx Kawasaki’s disease? (5)

A

fever for more than 5 days, strawberry tongue, cervical adenopathy, conjunctivitis, desquamation

87
Q

MCC mortality in SCD in adults? Peds?

A

Acute chest syndrome in adults. Strep pneumo sepsis in peds

88
Q

Most common presentation of SCD in infants

A

Dactylitis (swelling of hands)

89
Q

Dx septic arthritis?

A

Synovial fluid with WBC > 50,000 with > 75% PMNs

90
Q

What dose of acetaminophen is typically required to cause significant liver damage?

A

> 150mg/kg @ 4 hours post ingestion

91
Q

What organism is most commonly associated with croup?

A

Parainfluenza

92
Q

MC skin CA

A

basal cell CA

93
Q

pearly papule with well-defined borders and telangiectasias

A

Basal cell CA

94
Q

Irregular growth with erythema, induration, inflammation, crusting, or oozing

95
Q

hyperattenuation of the temporal lobes and insular cortex on CT

A

HSV encephalitis

96
Q

What three viral causes of encephalitis travel in a retrograde fashion from a distal site to the central nervous system?

A

HSV, HZV, Rabies

97
Q

tx for MS flare?

A

Methylprednisolone

98
Q

Low flow vs high flow priapism?

A

Low flow - ischemic, painful, Dec venous outflow, shaft rigid/glans soft, (2/2 SCD, Med SE) urologic emergency

High flow- not ischemic, painless, inc arterial flow, shaft partial rigid/glans hard, (2/2 shunt or SC lesion) obs

99
Q

An overdose of which antihypertensive mimics opiate intoxication?

100
Q

Loss of red color vision

A

Optic neuritis

101
Q

Cardioversion pads go where? (2)

A

R upper chest and L midaxillary line OR

L anterior chest and L upper back

102
Q

Cardioversion pads go where? (2)

A

R upper chest and L midaxillary line OR

L anterior chest and L upper back

103
Q

Tx Preseptal cellulitis?

104
Q

Tx seizing kid with Na<120?

A

correct the serum sodium to greater than 120 mmol/L with a sodium chloride 3% bolus. The dose is 4 to 6 mL/kg over 20 minutes.

105
Q

Most sensitive test for carpal tunnel?

A

Median nerve compression —> + if reproduces numbness of thumb to half ring finger

106
Q

Phalens sign:

A

reproduction of symptoms with wrist hyperflexion

107
Q

Tinels sign:

A

reproduction of symptoms with percussion over the carpal tunnel

108
Q

1st sx of aortic stenosis?

109
Q

Infant needle placement for LP:

A

L4–L5 or L5–S1

110
Q

Testicular torsion maneuver?

A

Medial to later rotation of testes 540* (1.5 rotation)

111
Q

The “blue dot” sign, a blue spot noted through the scrotum of the affected testis, is pathognomonic of what urologic condition?

A

Torsion of the appendix testis.

112
Q

3 injuries that are highly suggestive of nonaccidental trauma

A

Posterior rib fractures, metaphyseal corner fractures, and retinal hemorrhages

113
Q

Tx intussusception in adult?

A

Surgical (ex lap)

114
Q

Pituitary tumor gives you what visual sx?

A

Bitemporal hemianopsia

115
Q

what fetal heart tracings are bad? (2)

A
  1. LATE decelerations
  2. LACK of accelerations

(early decels are benign + accels are good)

116
Q

coral snake bite?

A

neurotoxin w/ minimal local toxicity- not much pain, but get bad neuro sx w/ diplopia first, resp depression, sz, coma

117
Q

how to confirm tracheal intubation? (2)

A

direct visualization or end tidal CO2

118
Q

“bird’s beak” appearance of contrast on barium enema

A

sigmoid volvulus

119
Q

delayed SE 4-6 weeks after iron ingestion?

A

pyloric stenosis/gastric outlet obstruction

120
Q

painless LAD in peds w/ violaceous discoloration of the overlying skin? tx?

A

nontuberculous Mycobacterium. long term Abx and surgical excision

121
Q

tx of “cold” shock or shock refractory to IVF?

122
Q

what needs airborne precautions? (4)

A

TB, measles, VZV (chicken pox), VZV (shingles until it crusts over)

123
Q

precautions for neisseria meningitis?

124
Q

what needs contact precautions? (3)

A

C diff, herpes simplex, rotavirus

125
Q

test of choice to confirm chlamydia?

A

nucleic acid amplification test that uses polymerase chain reaction (most sensitive and specific)

126
Q

autoimmune against TSH receptor

A

grave’s disease (hyperthyroidism)

127
Q

how to tell if vitreous vs retinal detachment?

A

Vitreous detachment can cross over the optic nerve, while retinal detachment will never cross the optic nerve since it is made of nerve fibers, which converge into the optic nerve

128
Q

molloscum contagiousum caused by? takes how long to heal?

A

poxvirus. 6-9 months

129
Q

tx iritis?

A

steroids, cycloplegics (cyclopentolate, atropine)

130
Q

in peds<2, which hematomas were not predictive of intracranial injury?

A

frontal bone/forehead

131
Q

MCC myocarditis in cardiac transplant pts?

132
Q

MC cx bacterial labrynthitis?

A

meningitis

133
Q

triad of scleroderma renal crisis? tx?

A

acute onset oliguric renal failure, marked HTN, normal UA.

tx= ACE-I and monitor renal fxn

134
Q

CSF studies?

A

bacterial: >1000WBCs
viral: <1000WBC, high protein <200
fungal/TB: <1000WBCs, low glucose

135
Q

albuinocytologic dissosciation?

A

CSF w/ normal WBC <5, but high protein >50. c/f GBS

136
Q

tx for holiday heart?

A

(afib/flutter after heavy EtOH use) observation- usu convert back to NSR in 24-48 hrs

chem cardiovert if still in rhythm after 48 hours

sync cardiovert if unstable

137
Q

50% ppl develop this 2 weeks after myocardial contusion 2/2 trauma

A

pericardial effusion

138
Q

what tx is CI for frostbite?

A

massaging the limb (–> inc tissue losses cuz of crystal damage)

139
Q

tx of ACUTE lithium ingestion, level<5

A

whole bowel irrigation w/ polyethylene glycol

140
Q

probability of detecting a disease in a patient with the disease (true positives / disease positives)

A

sensitivity

141
Q

having a negative test result in a patient without the disease (true negatives / disease negatives)

A

specificity

142
Q

the probability of having a disease given a positive test result (true positives / test positives)

143
Q

the negative predictive value is defined as the probability of not having a disease given a negative test result (true negatives / test negatives).

144
Q

positive likelihood ratio

A

sensitivity / (1 – specificity)

145
Q

posttest probability of a given patient having a disease determined by

A

positive likelihood ratio

146
Q

sensitivity

A

probability of detecting a disease in a patient with the disease (true positives / disease positives). It is a measure of the false negative rate, i.e., highly sensitive tests miss few patients with the disease process. Highly sensitive tests are therefore used as screenings tests

147
Q

specificity

A

the probability of having a negative test result in a patient without the disease (true negatives / disease negatives). Specificity is a measure of the false positive rate and is independent of disease prevalence (as is sensitivity)

148
Q

severe hyperthermia

A

> 40.5* (considered heat stroke)

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