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Emergency Medicine Pearls > EM EOR > Flashcards

EM EOR Flashcards

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1
Q

Which ligaments are injured in an inversion injury of the ankle?

A

anterior talofibular is most frequently damaged.

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2
Q

Which ligaments are injured in an eversion injury of the foot?

A

Deltoid ligaments- they are so strong they often cause an avulsion fracture of the medial maleolus.

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3
Q

Sx of hypercalcemia (or high PTH)?

A

Bones, stones (renal), groans (abdominal), moans (psychiatric).

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4
Q

ST elevations in II, III, AvF

A

Inferior MI

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5
Q

ST elevations in I, AvL

A

Lateral MI

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6
Q

ST elevations in V1, V2, V3, V4

A

Anterior MI (V1-V2 could be septal)

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7
Q

ST elevations in V5, V6

A

Low lateral MI.

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8
Q

When are cardiac enzymes elevated? For how long? When will they peak?

A

Troponin- 3-12 hours to become elevated, remain 4 -7 days. Peak is 12 hours.

CK- Elevated 3-12 hours after insult, remains for 48-72 hours. Peak is 24 hours.

Myoglobin elevates in 1-4 hours.

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9
Q

When is IV thrombolytic therapy indicated in MI?

A

MI 1 mm in 2+ contiguous leads
New LBBB
Chest pain that does not resolve with nitroglycerin

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10
Q

causes of pinpoint pupils

A

Pontine hemorrhage, cholinergics, opioids, clonidine

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11
Q

Antidote for Benzodiazapine overdose:

A

Flumazenil (anexate)

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12
Q

What factors are most important for survival of an out of hospital cardiac arrest?

A

Defibrillation and CPR

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13
Q

RhoGAM dose

A

50 micrograms if

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14
Q

Most common cause of acidosis in nonhospitalized, nondiabetic patients…

A

lactic acidosis

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15
Q

most reliable clinical technique for confirming ET tube placement

A

Direct visualization of passing vocal cords (1), then CO2 detection device.

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16
Q

What factors increase risk for MAT (multifocal atrial tachycardia)?

A

COPD, theophylline, beta adrenergic agonists.

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17
Q

ST elevations (>1mm) mean…

A

acute myocardial injury

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18
Q

Abnormal Q waves - definition and interpretation

A

Def >2mm wide or >25% of the height of QRS.

Interpretation dead tissue (infarction).

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19
Q

ST elevations in I, AvL, V5, V6

A

High lateral MI

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20
Q

ST depressions in V1-V4

A

Posterior MI (mirror of anterior MI).

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21
Q

Temporal arteritis- management

A

steroids. Consult optho if vision change.

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22
Q

Pregnancy-induced hypertension- definition and treatment

A

PIH is BP>140/90 without proteinuria (preeclampsia) or seizures (eclampsia). Treat with hydralazine.

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23
Q

How to treat pneumocystis pneumonia? What are the side effects?

A

SMP-TSX (mild) or Pentamidine if severe. Pentamidine hypoglycemia, renal impairment, leukopenia, hepatotoxicity…monitor GLUCOSE, BUN, Cr, CBC, platelets, LFTs, calcium

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24
Q

Top priorities in sepsis:

A

1 - Airway and ventilation

2- Fluids

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25
Q

common pathogen from cat bite

A

P multocida

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26
Q

Addison disease (adrenal insufficiency) sx:

A

hyperkalemia, hyponatremia, hypoglycemia, prerenal (BUN/Cr ratio (high)), anemia. Can cause pneumonia hypotension, tachycardia. Secondary to cancer, autoimmune destruction of adrenals post infection.

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27
Q

What is the most common cause of non-traumatic cardiac tamponade?

A

Metastatic malignancy.

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28
Q

Hampdon hump

A

focal area of hemorrhage or an actual pulmonary infarction- wedge shaped, dense, consolidation on pleural surface (PE)

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29
Q

Westermark sign

A

regional decreased vascularity.

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30
Q

Best choices for hypertensive emergency:

A
  1. Sodium nitroprusside (unless renal)

2. Labetolol

31
Q

Plegmasia alba dolens

A

“milk leg” is an uncommon presentation of DVT where there is massive ileofemoral thrombosis. The leg is white or pale with loss of PT and DP pulses.

32
Q

Most common cause of LBO in adults?

A

Carcinoma

33
Q

Nipple line corresponds with which dermatome?

A

T4

34
Q

Pseudomonas pneumonia presentation:

A

hypoxic, confused, fever, sepsis, systemic illness, lower lobe infiltrates on CXR.

35
Q

CURB65 - do it

A

1 point each:

  • Confusion
  • BUN>19
  • RR>30
  • SBP
36
Q

extrapulmonary symptoms of mycoplasma pneumonia

A

bullous myringitis (serous or hemorrhagic blebs on the TM), rash (erythema multiforme), neurologic sx, arthritis, and arthralgia.

37
Q

Most reliable MI symptom

A

Retrosternal chest discomfort that is described as pressure or squeezing as opposed to frank “pain”

38
Q

ED management of acute asthma

A

SABA (albuterol) plus steroid

39
Q

Window for tPA?

A

4.5 hours. 6 hours is the true max but there are major diminishing returns after 3 hours.

40
Q

Most common etiologies of esophagitis (2):

A

1) GERD

2) Pills

41
Q

Antibiotics for CAP?

A

Outpatient: Azithromycin (Macrolide) 500 mg PO 1 day, then 250 mg for days 2-5.
OR Clarithromycin, or doxycycline

Inaptient: Ceftriaxone 1g plus Azithromycin 500 mg PO/IV OR Cef + Levoquin

42
Q

Antibiotics for HCAP?

A

HCAP or VCAP: Cefepime (or ceftazidime or pip/tazo/ or if PCN allergy Aztreonam 2g IV tid) + Azithro/cipro/levo/gent PLUS vanc or linezolid

43
Q

How to treat thyroid storm

A

Hyperthyroidism under stress (infection, surgery, DKA, MI)

  1. Beta blockers (propanolol)
  2. Propylthiouracil (PTU)- inhibits synthesis of thyroid hormones. MUST BE GIVEN > 1 hour before iodide to prevent oxidation of iodide.
  3. Iodide- inhibits the release of pre-formed thyroid hormone.
44
Q

Pulmonay Embolism on EKG

A

S1Q3T3- Prominant S wave in lead I, Q and T waves INVERTED in lead 3. This will correlate with the clinical picture (sinus tach).

45
Q

Primary trauma survey

A 
Airway
Breathing
Circulation
Disability/Neuro  (spinal cord injury, GCS)
Environmental
46
Q

How much fluids do you give for a paediatric patient at risk of circultory collapse after trauma (tachy, BP 80/40)

A

20mL/kg of crystaloid is where to start.

47
Q

Which metabolic disorder can cause hemiplegia?

A

Hypoglycemia.

48
Q

Epidemiology: Who gets epidural hematomas

A

Young adults.

49
Q

Most common mechanism of SDH:

A

Acceleration-deceleration injuries (MVC)

50
Q

Best medical intervention to lower intracranial pressure after SDH?

A

nimodipine

51
Q

Thompson-doherty test

A

Squeeze calf and watch for plantar-flexion of ankle. Diagnostic for achilles rupture.

52
Q

LeFort facial fracture types

A

Type 1- (floating palate) Horiizontal maxillary fracture separating teeth from upper fade. Passing through inferior wall of maxillary sinus.
Type 2- (floating maxilla) Pyramidal maxillary fracture passing through lateral walls of maxillary sinus
Type 3- (floating face) cranio-facial dyslocation. Fx passes through nasofrontal suture, maxillo-frontal suture, orbital wall

53
Q

Henoch-Schonlein purpura

A

Immune-mediated disease of children presenting with triad of abdominal pain, bloody diarrhea, arthralgias, and nonthrombocytopenic rash, esp on lower extremities.

54
Q

What is a torus fracture?

A

an incomplete fracture of a long bone commonly seen in children. on XR you will see buckling or bulging of the cortex

55
Q

“wrist drop” suggests damage to which nerve?

A

Radial. usually at the level of the humerus.

56
Q

Fever, sore throat, neck pain, “duck voice” suggests

A

retropharyngeal abscess.

57
Q

acetaminophen overdose antidote:

A

N-acetylcysteine (NAC).

58
Q

Differentiate orbital from periorbital cellulitis:

A

Both have erythema, lid edema. Pain with extraocular movements suggests orbital.

59
Q

Methanol posioning

A

Ocular toxicity, anion gap, Lactic acidosis, without ketosis

60
Q

Isopropanol poisoning

A

Mild acidosis, high urine ketones, NO anion gap

61
Q

Ethylene glycol (antifreze) poisoning

A

High K, wide anion gap acidosis, calcium oxilate crystals in urine

62
Q

Insect bite with pinprick, spreading pain to large area within 1 hour, erythema, a target shaped lesion, muscle-cramp-like spasms

A

Black widow

63
Q

Estimate body surface area of burn

A 
A rule of 9's
Head/neck  - 9% (note, half anterior, half posterior)
Trunk- 36 % (18% each)
Arms- 9% each (4.5% a or p)
Legs- 18% each
Genetalia- 1%
64
Q

Most common cause of death in hemophelia A?

A

ICH- heme A is the most common type BTW.

65
Q

AV block types:

A

1- just a long pR interval (0.2 sec). Still a QRS for every P.
2. Wenckebach/Mobitz I- long, longer, drop
OR
Mobitz II- arbitrarily non conducted p waves
3. Ventricles and atria are pumping separately.

66
Q

How to treat digoxin toxicity (note- hypotension, A-V block, high K)

A

Digoxin immune Fab fragments

67
Q

Chronic B6 deficiency presents as…

A

Agitation, tremors, hallucinations, fever, tachycardia, nystagmus and CN 6 palsy. What is it called? Wernicke encephalopathy.

68
Q

Dental abscess ER management

A

Oral penicillin, oral analgesics, dental referral.

69
Q

Who gets TB primarily to the CNS?

A

Kids

70
Q

You suspect intussiception in a kid…what imaging? Sensitivity?

A

air-contrast enema. About 70% sensitive.

71
Q

When to hospitalize for RSV?

A

Confirmed RSV and hypoxia

72
Q

What happens when a person with mono is given amoxicillin?

A

They get the pettichial rash of the palate that can occur with mono. Except this group will get it 100% of the time.

73
Q

complication of a snake bite?

A

compartment syndrome.

Emergency Medicine Pearls (1 decks)

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