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EM COMAT > EM COMAT > Flashcards

EM COMAT Flashcards

1
Q

What is the mnemonic for remembering the 5 types of Salter-Harris fractures?

A 
I - S = Slip
II - A = Above
III - L = Lower
IV = TE = Through Everything
V = R = Rammed
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2
Q

Describe a type I Salter-Harris fracture

A

I - S = Slip, Straight across the cartilage of the growth plate

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3
Q

Describe a type II Salter-Harris fracture

A

II - A = Above, a fracture of the growth plate and metaphysis, Above and Away from the physis

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4
Q

Describe a type III Salter-Harris fracture

A

III - L = Lower, a fracture of the growth plate and epiphysis, below the physis

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5
Q

Describe a type IV Salter-Harris fracture

A

IV - TE = Through Everything, a fracture of the growth plate, the metaphysis and the epiphysis

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6
Q

Describe a type V Salter-Harris fracture

A

V - R = Rammed, a crush fracture of the physis

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7
Q

What is the most common cause of traveler’s diarrhea?

A

enterotoxigenic E. coli (caused by heat labile enterotoxin and heat-stable enterotoxin

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8
Q

Slipped capital femoral epiphysis

patient, pathology, sx,

A

obese males age 10-16

femoral head remains within the acetabulum but is displaced posteriorly and inferiorly in relation to the femoral neck

gradually worsening pain and gait abnormalities but patient remains able to ambulate

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9
Q

drug of choice for ICP secondary to brain neoplasm

A

dexamethasone

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10
Q

blood gas in salicylate poisoning (3 Phases)

A

Phase 1 (up to 24 hours) - primary respiratory alkalosis with elevated pH and decreased PaCO2 due to hyperventilation from direct respiratory center stimulation

Phase 2 - compensation for phase 1 leads to KHCO3 and NaHCO3 leaving in urine. When enough K+ has been lost, you get paradoxical aciduria

Phase 3 - lactic acidosis due to inhibition of citric acid cycle and uncoupling oxidative phosphorylation

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11
Q

ABG pH 7.24, PaCO2 48, HCO3- 22 - disorder?

A

acute primary respiratory acidosis - can occur in respiratory depression due to opioid intoxication

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12
Q

ABG pH 7.39, PaCO2 48, HCO3- 30 - disorder?

A

primary metabolic alkalosis (because HCO3- is increased) with compensatory respiratory acidosis (because PaCO2 is increased and pH is normal) - this can occur with patients taking thiazide diuretics

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13
Q

ABG pH 7.41, PaCO2 41, HCO3- 23 - disorder?

A

none, this is normal. learn your normal values, Mik

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14
Q

ABG pH 7.50, PaCO2 44, HCO3- 30 - disorder?

A

uncompensated metabolic alkalosis - copious vomiting can cause this picture

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15
Q

prinzmetal angina sx and tx

A

sx - cardiac chest pain that occurs at rest due to coronary artery vasospasm
tx - CCB (amlodipine) for prevention

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16
Q

ANC calculation and cut off for neutropenia

A 
ANC = WBC x (% neutrophils + % bands)
neutropenia = ANC <1500, high risk = ANC <500
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17
Q

What is recommended with ANC < 100?

A

broad spectrum Abx therapy with piperacillin-tazobactam, cefepime, meropenem, or imimpenem-cilastatin

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18
Q

Where is a tube thoracotomy placed?

A

fifth intercostal space at mid-axillary line

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19
Q

What test diagnoses acute Hep A?

A

Hepatitis A IgM antibody

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20
Q

What medications are known to cause Stephens-Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN)?

A

sulfonamide antibiotics, allopurinol, carbamazepine, lamotrigine, phenobarbital, and piroxicam

(mycoplasma pneumonia and viral infections can also cause these, and HIV infection is a risk factor)

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21
Q

What is the treatment for SJS/TEN?

A

discontinuing offending medication, IV fluids, electrolyte management, pain management, and wound care

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22
Q

Contrast the crystals found in gout vs. pseudogout

A

gout - negatively birefringent urate crystals (needle-shaped)

pseudo gout - positively birefringent calcium pyrophosphate crystals (rhomboid shaped)

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23
Q

Tx of PEA?

A

epinephrine (inotrope) 1 mg q3-5 minutes. The first or second dose of epinephrine can be replaced by vasopressin 40 units

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24
Q

What are the reversible causes of cardiac arrest?

A

H’s:
Hypovolemia, Hypoxia, Hydrogen ions (acidosis), Hypo/Hyperkalemia, Hypoglycemia, and Hypothermia) and T’s: Toxins, cardiac Tamponade, Tension pneumothorax, and Thrombosis (MI or PE)

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25
Q

When can atropine be used in PEA?

A

if the underlying electrical rhythm is slower than 60 bpm (dose = 1 mg q5 minutes up to 3 doses)

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26
Q

Acute phenytoin toxicity sx

A

nystagmus and ataxia, uncommonly cardiac arrhythmia can occur with rapid IV administration of phenytoin

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27
Q

What does chronic phenytoin use cause?

A

decreased folate -> megaloblastic anemia, gingival hyperplasia

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28
Q

What drug-drug interactions should you remember with phenytoin?

A

isoniazid, fluconazole, sulfonamides, and trimethoprim

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29
Q

What are the most common causes of methemoglobinemia?

A

exposure to oxidizing agents, most commonly local anesthetic agents (prilocaine and benzocaine) and dapsone (can also be caused by congenital enzyme deficiencies)

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30
Q

What are the symptoms of decreased serum pyridoxine (Vitamin B6) levels?

A

dermatitis, glossitis, AMS, peripheral neuropathy, sideroblastic anemia

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31
Q

What changes can you see in blood cells in lead poisoning? What are the symptoms?

A

blood cells - basophilic stippling and ringed sideroblasts (RBC precursors with nuclei surrounded by mitochondria containing iron granules)

Sx - anemia, neurotoxicity, and GI toxicity; in acute poisoning, CNS symptoms may predominant, esp visual disturbances

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32
Q

What are the two shockable rhythms?

A

V tach and V fib

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33
Q

What are the most common causes of v tach?

A

Hx of acute or chronic infarction, ischemia, myocardial scar, ventricular hypertrophy, cardiac conduction abnormalities, or QT interval prolongation

Electrical abnormalities (hypokalemia, hypocalcemia, and hypomagnesemia)

Medications (digoxin, methamphetamine, and cocaine)

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34
Q

Class I Hemorrhage

A

involves up to 15% of blood volume. These patients typically do not have detectable hemodynamic changes

35
Q

Class II Hemorrhage

A

involves 15-30% of blood volume. These patients typically have tachycardia (100-120 bpm) and narrowed pulse pressure

36
Q

Class III Hemorrhage

A

Involves 30-40% of blood volume. These patients typically have tachycardia (120-140 bpm), hypotension with decreased pulse pressure, and tachypnea. They exhibit signs of end-organ hypo perfusion (AMS and oliguria)

37
Q

Class IV Hemorrhage

A

involves over 40% of blood volume. These patients have tachycardia (>140 bpm), significant hypotension, and tachypnea above 35 breaths per minute. They exhibit end-organ hypo perfusion with confusion/stupor and negligible urine output

38
Q

TRALI cause and sx

A

caused by donor antibodies targeted against recipient WBCs

Sx - occurs in the first 6 hours (usually within 2 hours), picture similar to ARDS with dyspnea, hypotension, and hypoxemia

TRALI will NOT show signs of circulatory volume overload and will be unresponsive to diuretics

39
Q

Tx for snake bites?

A

Snake venoms cause injury due to destructive enzymatic proteins.

Tx = antivenom (or antivenin), which consists of antibodies (or antibody fragments) against snake venom that are derived from the serum of the host animal, typically horse or sheep

40
Q

Empiric tx of CAP for those at risk of multi-drug resistant infections

A

cover for pseudomonas

w/o requiring hospitalization = respiratory fluoroquinolone, such as levofloxacin or moxifloxacin

requiring hospitalization = respiratory fluoroquinolone or pip-tazo plus a macrolide (commonly azithromycin or clarithromycin)

41
Q

What bleeding parameter does warfarin affect?

A

prothrombin time (PT) and INR (WEPT = Warfarin Extrinsic PT)

drugs that can affect warfarin levels: amiodarone, simvastatin, fluconazole, macrolides, fluoroquinolones, Bactrim, mirtazapine, metronidazole, St Johns Wort, SSRIs (and tamoxifen is contraindicated)

42
Q

What bleeding parameter does heparin affect?

A

partial thromboplastin time (PTT)

43
Q

mechanism of botulinum toxin?

A

prevents the release of acetylcholine from axons at the neuromuscular junction, leading to flaccid paralysis

44
Q

mechanism of organophosphate poisoning?

A

prevents neurotransmitter degradation, irreversibly inhibiting acetylcholine esterase resulting in increased concentrations of ACh at synapses and neuromuscular junctions

45
Q

Sx of HIV infection

A

sore throat, myalgias, diarrhea, arthralgias, rash, and mucocutaneous ulcerations

46
Q

Anterior cord syndrome path and Sx

A

path - interruption of the anterior spinal artery
Sx - loss of motor function and sensation of pain and temp below the level of injury (retention of touch, proprioception and vibratory sensation)

47
Q

Brown-Sequard syndrome path and sx

A

path - injury to one half of the spinal cord, typically due to penetrating injury

Sx - ipsilateral upper motor neuron signs below the level of the lesion due to corticospinal tract damage as well as ipsilateral loss of tactile, vibration, proprioception sense below the level of the lesion due to dorsal column damage. And ipsilateral loss of all sensation at the level of the lesion and ipsilateral lower motor neuron signs (flaccid paralysis) at the level of the lesion. Loss of pain and temp occurs on the contralateral side below the level of the lesion due to damage of the spinothalamic tract

48
Q

Central cord syndrome path and sx

A

path - trauma to the cervial spine
Sx - decreased motor function and sensation in both upper extremities with less severe symptoms in both lower extremities

49
Q

coccidioidomycosis path, sx, labs, complication

A

path - inhalation of airborne spores of coccidioides species of soil fungus, most commonly encountered in the southwestern US
Sx - primarily pulmonary symptoms
labs - elevated eosinophils
Complication - cavitary lung disease

50
Q

Fat embolism syndrome path, sx, dx

A

path - release of fat emboli into the systemic circulation, most commonly following long bone fracture
Sx - petechial rash, respiratory decompensation, and change in level of consciousness
Dx - macrophages with lipid inclusions on bronchoalveolar lavage

51
Q

Most common causes of orbital cellulitis

A

staph aureus, strep pneumo, beta-hemolytic strep

52
Q

blunt chest trauma with hypotension and diminished pulses in the lower extremities and possibly left upper extremity - dx?

A

thoracic aortic transection

53
Q

Imaging of nephrolithiasis?

A

U/S or CT scan show the stone and proximal ureteral dilation and/or hydronephrosis in the case of an obstructing stone

54
Q

When does nephrolithiasis require urologic consult and intervention?

A

obstructing renal stones in an infected collecting system, failure of stones to pass spontaneously, and large-sized stones (>10mm)

55
Q

local anesthetic toxicity (injection intravascularly) sx

A

CNS or cardiovascular toxicity

CNS - circumoral or tongue numbness, metallic taste, lightheadedness, dizziness, and disorientation before progressing to unconsciousness or seizures

CV - chest pain, dyspnea, or palpitations that can lead to prolonged PR, QRS, and QT intervals

56
Q

What features of a seizure suggest PNES (pyogenic non-epileptic seizures)?

A

long duration, fluctuating course, closed eyes, ictal crying, and memory recall

57
Q

Tx of suspected rabies

A

wound cleansing and debridement, administration of human rabies immunoglobulin (administered at the site of injury), and inactivated rabies vaccine (administered as a series of four doses over 14 days)

58
Q

Hunter criteria for diagnosis of serotonin syndrome

A

must meet one of the following:

  • spontaneous clonus or
  • inducible clonus plus agitation or diaphoresis or
  • ocular clonus plus agitation or diaphoresis, or
  • tremor plus hyperreflexia or
  • hypertonism plus temp greater than 38 degrees celsius (100.4)
59
Q

ECG and Tx of Wolff-Parkinson-White (WPW)

A

ECG - short PR interval (less than 120 ms), a slurred upstroke of the QRS complex (delta wave), and a widened QRS complex (greater than 120 ms).

Tx - procainamide 1st line, amiodarone and propafenone 2nd line (definitive tx = radiofrequency ablation)

Medications that slow AV node conduction (CCB, beta-blockers, adenosine) may lead to ventricular arrhythmia in WPW

60
Q

characteristics of empyema

A

purulent fluid with a positive gram stain and/or bacterial culture, pH less than 7.2, glucose less than 60 mg/dL

61
Q

Light’s criteria

A

pleural effusion is likely exudative if:

  1. the ratio of pleural fluid protein to serum protein is > 0.5
  2. the ratio of pleural fluid LDH to serum LDH > 0.6
  3. pleural fluid LDH is greater than 0.6 times the upper limit of normal for serum LDH
62
Q

Wernicke encephalopathy triad

A

confusion, ataxia, and ophthalmoplegia

63
Q

mechanism of PCP

A

NMDA receptor antagonist

64
Q

What is a key symptom of inferior wall myocardial infarction, and what leads will be affected?

A

referred pain to the epigastrium. Dx based on ECG changes in leads II, III, aVF

65
Q

Sx of right sided MI, and affected leads?

A

hypotension, distended neck veins, clear lung fields with ECG findings of ST elevation in II, III, and aVR

Pre-load dependent, so avoid nitrates and opioids

66
Q

Most common cause of malignant otitis external? Treatment?

A

Pseudomonas

can use an Abx with pseudomonas coverage, such as IV ciprofloxacin. If this therapy fails to improve symptoms, patient should be treated with a broad spectrum beta-lactam, such as pip-tazo, ceftazidime, and cefepime

67
Q

When can you not use FENa for evaluation of kidney injury? What should be used instead?

A

You cannot use FENa in the case of a patient on diuretics in which case the kidneys’ ability to retain sodium is impaired. You have to use FEUrea instead

FEUrea = 100% * [(Urine urea)(Serum creatinine)]/[(Blood urea nitrogen)(Urine creatinine)]

FEUrea below 35% suggests prerenal acute kidney injury

68
Q

What is the complication of infection with vibrio vulnificus, and what is the treatment?

A

Complication - sepsis or necrotizing fasciitis

Treatment - doxycycline and ceftazidime

69
Q

Definition of a prolonged QT?

A

QTC > 480 ms

QTc = (QT interval)/(square root of RR interval)

70
Q

Sx of Fournier gangrene, what are predisposing conditions?

A

(usually preceded by anorectal, urogenital, or dermatologic infection)
Sx - exquisite pain and tenderness often preceded by a prodrome of fever and lethargy. As tissue necrosis occurs, there is increasing pain and erythema that progresses to a dusky skin appearance. Ultimately, causes crepitus, purulent drainage, and gangrene of the genitals

predisposing conditions - diabetes, morbid obesity, liver disease (alcoholic hepatitis or cirrhosis), and other causes of immune dysfunction (HIV, immunosuppressive meds)

71
Q

What is the treatment for benzo withdrawal?

A

long half-life benzos, typically diazepam or chlordiazepoxide

72
Q

triad of acute cholangitis and tx?

A

fever, RUQ pain, jaundice

Tx = IV zosyn

73
Q

Sx of neuroleptic malignant syndrome (NMS)

A

fever, muscular rigidity, AMS, and autonomic dysfunction

74
Q

Sx of acute cholecystitis?

A

postprandial RUQ pain, fever, leukocytosis, positive Murphy’s sign

75
Q

What is the immediate management of Boerhaave syndrome?

A

NPO status, IV PPI, and IV broad-spectrum Abx

EGD shouldn’t be done if presenting >48 hours after symptoms or if clinical signs of sepsis are present

76
Q

Dx and Tx of acute chest syndrome

A

(pulmonary manifestation of sickle cell disease)
Dx - new infiltrate on CXR in combo with at least one clinical sign or symptom (chest pain, cough, wheezing, tachypnea, fever)
Tx - if patient doesn’t improve with symptomatic treatment, exchange transfusion is indicated

77
Q

Sx of malaria and prophylaxis against

A

Sx - periodic fevers, hepatosplenomegaly, hemolytic anemia, and jaundice

prophylaxis: atovaquone/proguanil, doxycycline, or mefloquine

78
Q

Lemierre syndrome cause, sx, and complication?

A

cause - F. necrophorum bacteria most commonly

Sx - pharyngitis, fever, sepsis

Complication - bacterial thrombophlebitis of the internal jugular vein

79
Q

presentation of a hemolytic transfusion reaction

A

acute onset of fever, flank pain, and red/brown urine that begins soon after a transfusion is initiated

80
Q

Sx of acute intermittent porphyria (AIP)

A

abdominal pain, followed by psychiatric symptoms and peripheral neuropathies (which are predominantly motor). Less common CNS effects are seizures, delirium, cortical blindness, and coma

81
Q

Gamma-hydroxybutyric acid (GHB) drug effects, MOA, complications

A

causes AMS, unconsciousness, and impaired recall

known as a date rape drug

GABAB receptor agonist

Complications include respiratory depression and convulsions

82
Q

3,4-methylenedioxymethamphetamine (MDMA) street name, effects, adverse effects

A

ectasy

causes euphoria and heightened sensations

Adverse effects - hyperthermia and dehydration

83
Q

Lysergic acid diethylamide street name, effects, adverse effects

A

LSD

AMS and hallucinations

Adverse effects - severe anxiety/panic attacks (“bad trip”)

84
Q

CSF analysis in bacterial meningitis?

A

elevated opening pressure, elevated WBC (predominantly neutrophils), elevated protein, and decreased glucose

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