EM Flashcards
Bidirectional VT
Digoxin toxicity
First biomarker positive in STEMI
Myoglobin
Order of ECG changes in STEMI (5)
- Hyperactive T waves
- J point elevation
- STE
- Q wave/loss of R
- TWI
R sided STEMI ECG changes
STE of V4R and V5R
Posterior STEMI ECG changes
ST depressions in V1, V2, large R waves (R/S ratio > 1)
What clinical findings represent right ventricular infarction in the setting of an inferior MI? (2)
JVD + Hypotension
MC SE IV amiodarone
Hypotension
pregnancy and t-PA
Relative contraindication
SE of procainamide (2)
Hypotension, prolonged QT
Drugs that can be given via ETT? (5)
Adults: NAVEL Naloxone Atropine Vasopressin Epi Lidocaine
PEDS: LANE
Successful placement of transvenous pacer in right ventricle? (2)
left bundle-branch block with left axis deviation
Tachycardia disproportionate to fever
Myocarditis
MCC myocarditis worldwide? In US?
World-Chagas disease caused by the protozoan Trypanosoma cruzi.
US-enterovirus (coxsackie group B)
Most specific PE finding in CHF
S3
Overmedication with nitroglycerin can cause what toxic effect?
Methemoglobinemia
High-quality chest compressions are associated with what CO2 values
> 10 mm Hg
Serum ß-hCG pattern in pregnancy?
doubles every 2 days in early pregnancy
Vital sign changes in pregnancy (2)
HR: ↑ 10-15 bpm
BP: ↓ in 2nd trimester, normalizes in 3rd
Fundal height: (3)
12 weeks: pubic symphysis
20 weeks: umbilicus
20-32 weeks: height (cm) above symphysis = gestational age (weeks)
Transvaginal vs transabdominal ultrasound: IUP visualized when ß-hCG
Transvaginal ultrasound: IUP visualized when ß-hCG > 1500
Transabdominal ultrasound: IUP visualized when ß-hCG > 4000
Which therapy for COPD is associated with a reduction in mortality?
O2
What must you remember to do in a patient with salicylate toxicity who requires intubation?
Set the respiratory rate to match their pre-intubation rate to allow continued compensatory expiration of CO2.
What correlates with severity of hepatic encephalopathy?
CSF glutamine
Ranson’s criteria? (5)
age >55 Wbc> 16k Glucose>200 LDH>350 AST>250
Charcot’s triad?
Fever, abd pain, jaundice (CHOLANGITIS)
Reynold’s pentad?
Fever, abd pain, jaundice AND +Hypotension, AMS
CHOLANGITIS
Which lab marker elevation has the highest positive predictive value for a biliary etiology in patients diagnosed with acute pancreatitis?
Alanine aminotransferase (ALT) is the best single marker for a biliary etiology. Levels three times greater than baseline support the diagnosis of biliary pancreatitis.
What is the target temperature for postarrest therapeutic hypothermia?
32-36°C
Preferred anticoagulation in cancer pt with DVT?
LMWH SC and DC to follow up with PMD
MC mediastinal tumor?
Thymoma (ass w/ MG 50%)
Triad fat embolism?
Hypoxemia, neuro abnormality, petechial rash
Treatment of latent TB? (2)
INH for 9 months OR Rifampin for 4 months
Tx for active TB?
rifampin, INH, pyrazinamide, ethambutol (RIPE)
Positive PPD Criteria:
- 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
SE of INH (3)? tx?
Peripheral neuropathy + hepatitis + seizures
Tx- pyridoxine B6
Pulmonary Capillary Wedge Pressure (PCWP) in noncardiogenic Pulm edema?
PCWP<18
Tx of primary TB in preggo? OK to breastfeed?
rifampin, INH, ethambutol (RIE). Yes
SE of ethambutol? (2)
red-green vision loss, optic neuritis
Above what serum salicylate level should you consider hemodialysis in acute and chronic aspirin toxicity?
Acute toxicity > 100 mg/dL and chronic toxicity > 60 mg/dL.
Anthrax finding on CXR
Widened mediastinum
Inc risk of what type of PNA in alcoholics
Klebsiella
SE of Rifampin
Turns body fluids orange
MC injured site of heart in penetrating injury
RV
What nerve can be injured during thoracotomy?
Phrenic –> diaphragm paralysis
What defines a positive diagnostic peritoneal aspiration? (2)
DPL positive if > 10 ml gross blood or > 100,000 RBCs/mL
MC injured organ in GSW?
Small bowel
MC injured organ in Stab wounds?
Liver
beta2-transferrin test?
is used to detect CSF presence in suspected CSF otorrhea or CSF rhinorrhea.
Kleihauer-Betke test ?
concern for significant maternal-fetal hemorrhage (need extra rhogam)
nitrazine test?
used to evaluate vaginal fluid for amniotic fluid leak and potential premature rupture of membranes.
MC injured organ in peds blunt trauma?
Spleen
Indication for perimortem c-section? (2)
gestation ≥ 24 weeks + loss of maternal vital signs
Hemorrhagic shock 4 classes
Class II: HR >100, decreased pulse pressure
Class III: SBP <90
Class IV: negligible urine output, confusion
O- for women
Jefferson fracture? Caused by? (2)
C1 burst fracture.
axial loading or vertical compression force
Hangman’s fracture? Caused by?
fractures of the bilateral pedicles of C2. . extreme hyperextension
Odontoid fx? Caused by? (2)
high cervical pain radiating to the occiput. shearing force or extreme flexion
Teardrop fracture? Caused by?
Any level. extreme flexion
Anterior cord syndrome caused by what mechanism? (2
Extreme neck flexion or vascular
Anterior cord syndrome - neuro findings? Prognosis?
Complete loss of motor + pain/temp below the lesion.
Preserved propioception/vibration
Prognosis is poor
Central cord syndrome - neuro findings? Prognosis?
Sensory and motor deficit in UE>LE. Prognosis is average
Central cord syndrome caused by what mechanism?
Forced hyperextension of neck
Brown-sequard syndrome caused by what mechanism
Penetrating trauma
Brown-Sequard syndrome - neuro findings? Prognosis?
IL loss of motor + proprioception/vibration
CL loss of pain/temp
Prognosis good
Most common incomplete spinal cord syndrome?
Central cord syndrome
3 types of pelvic fractures and their mechanisms?
lateral compression (T-bone MVC/pedestrian hit from side) AP fracture (head on MVC) vertical shear (fall)
5 categories of blast injuries
(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)
MC blast injury
Ruptured TM
Antidote to magnesium OD
Calcium gluconate
Preeclampsia? (3)
Hypertension > 140/90
>20 weeks pregnant
edema or proteinuria (>300mg/24hrs)
Tx for preeclampsia (3)
Mg + hydralizine/labetolol
Obese 13 year old with limp and knee pain holding leg in external rotation
SCFE
MCC Peds limp or hip pain
Transient synovitis
What is Legg-Calve-Perthes disease?
avascular necrosis of the femoral head
Boy aged 4-10 with intermittent limp and flatted femoral head on XR?
Legg-calve-perthes
What causes Osgood-Schlatter disease?
Repeated microtrauma occurs at the apophyseal cartilage between the anterior tibial tubercle and the secondary ossification center of the patellar tendon.
Teen or athlete with anteroinferior knee or superior shin pain and tender tibial tuberosities.
Osgood schlatter
blood on dipstick with the absence or only minimal amount of RBCs on microscopy
Rhabdomyolysis
MC type of hernia in M? F?
Indirect inguinal hernia are MC in both
Indirect vs direct hernia?
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)
MC hernia in peds?
Umbilical
projectile, non-bilious vomiting that occurs immediately after feeding age 2 weeks-2 years
Pyloric stenosis
Peds olive shaped mass in the right upper abdomen
Pyloric stenosis
Peds hypochloremic metabolic alkalosis
Pyloric stenosis
bilious vomiting in infants? (2)
Malrotation and volvulus
Prednisone safe in pregnancy ?
associated with fetal cleft lips and palates and should generally be avoided if possible in the first trimester of pregnancy
Dx Kawasaki’s disease? (5)
fever for more than 5 days, strawberry tongue, cervical adenopathy, conjunctivitis, desquamation
MCC mortality in SCD in adults? Peds?
Acute chest syndrome in adults. Strep pneumo sepsis in peds
Most common presentation of SCD in infants
Dactylitis (swelling of hands)
Dx septic arthritis?
Synovial fluid with WBC > 50,000 with > 75% PMNs
What dose of acetaminophen is typically required to cause significant liver damage?
> 150mg/kg @ 4 hours post ingestion
What organism is most commonly associated with croup?
Parainfluenza
MC skin CA
basal cell CA
pearly papule with well-defined borders and telangiectasias
Basal cell CA
Irregular growth with erythema, induration, inflammation, crusting, or oozing
SCC
hyperattenuation of the temporal lobes and insular cortex on CT
HSV encephalitis
What three viral causes of encephalitis travel in a retrograde fashion from a distal site to the central nervous system?
HSV, HZV, Rabies
tx for MS flare?
Methylprednisolone
Low flow vs high flow priapism?
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
An overdose of which antihypertensive mimics opiate intoxication?
Clonidine
Loss of red color vision
Optic neuritis
Cardioversion pads go where? (2)
R upper chest and L midaxillary line OR
L anterior chest and L upper back
Cardioversion pads go where? (2)
R upper chest and L midaxillary line OR
L anterior chest and L upper back
Tx Preseptal cellulitis?
Augmentin
Tx seizing kid with Na<120?
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.
Most sensitive test for carpal tunnel?
Median nerve compression —> + if reproduces numbness of thumb to half ring finger
Phalens sign:
reproduction of symptoms with wrist hyperflexion
Tinels sign:
reproduction of symptoms with percussion over the carpal tunnel
1st sx of aortic stenosis?
Dyspnea
Infant needle placement for LP:
L4–L5 or L5–S1
Testicular torsion maneuver?
Medial to later rotation of testes 540* (1.5 rotation)
The “blue dot” sign, a blue spot noted through the scrotum of the affected testis, is pathognomonic of what urologic condition?
Torsion of the appendix testis.
3 injuries that are highly suggestive of nonaccidental trauma
Posterior rib fractures, metaphyseal corner fractures, and retinal hemorrhages
Tx intussusception in adult?
Surgical (ex lap)
Pituitary tumor gives you what visual sx?
Bitemporal hemianopsia
what fetal heart tracings are bad? (2)
- LATE decelerations
- LACK of accelerations
(early decels are benign + accels are good)
coral snake bite?
neurotoxin w/ minimal local toxicity- not much pain, but get bad neuro sx w/ diplopia first, resp depression, sz, coma
how to confirm tracheal intubation? (2)
direct visualization or end tidal CO2
“bird’s beak” appearance of contrast on barium enema
sigmoid volvulus
delayed SE 4-6 weeks after iron ingestion?
pyloric stenosis/gastric outlet obstruction
painless LAD in peds w/ violaceous discoloration of the overlying skin? tx?
nontuberculous Mycobacterium. long term Abx and surgical excision
tx of “cold” shock or shock refractory to IVF?
epi
what needs airborne precautions? (4)
TB, measles, VZV (chicken pox), VZV (shingles until it crusts over)
precautions for neisseria meningitis?
droplet
what needs contact precautions? (3)
C diff, herpes simplex, rotavirus
test of choice to confirm chlamydia?
nucleic acid amplification test that uses polymerase chain reaction (most sensitive and specific)
autoimmune against TSH receptor
grave’s disease (hyperthyroidism)
how to tell if vitreous vs retinal detachment?
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
molloscum contagiousum caused by? takes how long to heal?
poxvirus. 6-9 months
tx iritis?
steroids, cycloplegics (cyclopentolate, atropine)
in peds<2, which hematomas were not predictive of intracranial injury?
frontal bone/forehead
MCC myocarditis in cardiac transplant pts?
CMV
MC cx bacterial labrynthitis?
meningitis
triad of scleroderma renal crisis? tx?
acute onset oliguric renal failure, marked HTN, normal UA.
tx= ACE-I and monitor renal fxn
CSF studies?
bacterial: >1000WBCs
viral: <1000WBC, high protein <200
fungal/TB: <1000WBCs, low glucose
albuinocytologic dissosciation?
CSF w/ normal WBC <5, but high protein >50. c/f GBS
tx for holiday heart?
(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
50% ppl develop this 2 weeks after myocardial contusion 2/2 trauma
pericardial effusion
what tx is CI for frostbite?
massaging the limb (–> inc tissue losses cuz of crystal damage)
tx of ACUTE lithium ingestion, level<5
whole bowel irrigation w/ polyethylene glycol
probability of detecting a disease in a patient with the disease (true positives / disease positives)
sensitivity
having a negative test result in a patient without the disease (true negatives / disease negatives)
specificity
the probability of having a disease given a positive test result (true positives / test positives)
PPV
the negative predictive value is defined as the probability of not having a disease given a negative test result (true negatives / test negatives).
NPV
positive likelihood ratio
sensitivity / (1 – specificity)
posttest probability of a given patient having a disease determined by
positive likelihood ratio
sensitivity
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
specificity
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)
severe hyperthermia
> 40.5* (considered heat stroke)
