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CLINICAL YR: Emergency Med EOR Exam_JD > EM EOR Topic List_Other > Flashcards

EM EOR Topic List_Other Flashcards

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1
Q

(RR)

what is the difference in presenting symptoms for upper UTI vs lower UTI?

A

Lower UTI s/s are limited to GU system (dysuria, urgency, frequency, hematuria)

Upper UTI (pyelonephritis) also develop constitutional symptoms (fever, vomiting, malaise, back and flank pain)

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2
Q

(RR)

what is the duration of treatment for upper UTI infections?

A

10 to 14 days

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3
Q

(RR)
what is first line parenteral treatment of mild to moderate uncomplicated pyelonephritis?

what is a second option for treatment of mild to moderate uncomplicated pyelonephritis?

A

Ceftriaxone (it has excellent coverage of E. coli)

FQ’s are another option

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4
Q

(RR)

three common presenting s/s of nephrolithiasis

A

CVA tenderness
hematuria
Colicky unilateral back/flank pain radiating to the groin

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5
Q

(SmartyPance)

what size kidney stone is likely to pass on it’s own?

A

<5mm

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6
Q

(SmartyPance)

what size stone is likely to have complications?

A

> 10mm

treat as IP with fluid, fluid, fluid

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7
Q

(SmartyPance)

what is the treatment for uncomplicated cystitis?

A

nitrofurantoin
TMP-SMX for 3-5 days
(FQ’s only for people with no alternative options)

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8
Q

(SmartyPance)

common features of lower UTI/cystitis?

A

frequency, urgency, DYSURIA, suprapubic tenderness
Often appears following sexual intercourse in women
The exam usually unremarkable – sometimes SUPRAPUBIC TENDERNESS

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9
Q

(RR)

what is the initial treatment for acute prostatitis?

A

fluoroquinolone (like CIPROFLOXACIN)
for FOUR WEEKS

(or TMP-SMX)

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10
Q

(RR) BUZZWORDS

warm, exquisitely tender prostate

A

acute prostatitis

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11
Q

(RR)

what is the most important complication of sickle cell disease?

A

aplastic crisis

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12
Q

(RR) BUZZWORDS

body is unable to make enough RETICULOCYTES TO COMPENSATE FOR HEMOLYSIS

A

aplastic crisis of sickle cell disease

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13
Q

(RR)

what is the most common cause of aplastic crisis?

A

infection

human parvovirus B19 is most frequently implicated

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14
Q

(RR)

what is most common presentation of aplastic crisis?

A

INCREASING FATIGUE

SIGNS OF INFECTION, including fever, tachycardia

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15
Q

(RR)

what is the sequelae of aplastic crisis?

A

it is SELF-LIMITED, resolves in about 7-10 days

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16
Q

(RR)

what is the treatment for aplastic crisis of sickle cell disease?

A

care is supportive, TRANSFUSIONS given as needed

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17
Q

(RR)

how is diagnosis of BPH made?

A

by digital rectal exam

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18
Q

(RR)

what is the treatment of BPH?

A

alpha-blockers
5-reductase inhibitors
surgery (TURP)

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19
Q

(RR)
in terms of heart failure and pulmonary edema, venous distention, hepatomegaly or peripheral edema, what is happening to capillary pressures to cause these symptoms?

A

capillary pressures are increased

(heart failure –> “this results in increased capillary pressures that cause pulm edema, venous distention, hepatomegaly or peripheral edema”)

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20
Q

(RR)

two cardinal symptoms of PID

A

lower tract inflammation (cervicitis or friable cervix)

pelvic tenderness or mass

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21
Q

(RR)

treatment for PID

A

ceftriaxone IM and doxycycline PO x 14 days

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22
Q

(RR)

What is the treatment for adrenal crisis?

A

hydrocortisone

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23
Q

(RR)

what is impaired during primary adrenal insufficiency (Addison Disease)?

A

CORTISOL

ALDOSTERONE

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24
Q

(RR)

two predominating s/s of adrenal crisis

A

HYPOTENSION

hypovolemia

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25
Q

(RR)

how long does a single manic episode last to be used for diagnosis of bipolar I disorder?

A

AT LEAST ONE WEEK of PROFOUND MOOD DISTURBANCE

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26
Q

(RR)

initial treatment for bipolar

A

antipsychotics

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27
Q

(RR)

what is the difference between oppositional defiant disorder and conduct disorder?

A

oppositional defiant disorder: DOES NOT HAVE BEHAVIORS THAT VIOLATE THE BASIC RIGHTS OF OTHERS OR THE LAW

conduct disorder: does all those things (behaviors are typically a major violation of social expectations of pt’s age group…can include cruelty to animals and people, destruction of property, etc.)

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28
Q

(RR)
how long should s/s be present before suspecting oppositional defiant disorder in a child?

what is a key characteristic of ODD?

A

6 months

VINDICTIVENESS

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29
Q

(RR)

what is the most common, NON-pharmacologic cause of Stevens Johnson Syndrome?

A

Mycoplasma infection

Mycoplasma pneumoniae, to be exact

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30
Q

(RR) BUZZWORDS

“pus on tonsils”

A

think about MONO!

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31
Q

(RR)
infectious mono - where do the lymph nodes swell?

nearly half of all patients will show what s/s?

A

POSTERIOR CERVICAL CHAINS

SPLENOMEGALY

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32
Q

(UpToDate)

what is the first line alternative agent for treating syphilis in nonpregnant adults?

A

doxycycline

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33
Q

(RR)

how do we diagnose infectious mono?

A

MONONUCLEAR SPOT TEST

“diagnosis is made by heterophile antibody test (mononuclear spot test) or a generalized maculopapular rash following administration of amoxicilin”

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34
Q

(RR)

the most common risk factor for the development of placental abruption is __________

A

HYPERTENSION

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35
Q

(RR)

common s/s of placental abruption

A

SUDDEN ONSET, constant ABDOMINAL PAIN
and
VAGINAL BLEEDING generally DARKER IN COLOR

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36
Q

(RR)
“A 9-year-old boy with no past medical history presents to the emergency department with facial swelling. He states that his symptoms started 1 day ago. He also notes that his urine has been more foamy than it usually is. His mom reports that he recently recovered from a sore throat and fever 2 weeks ago, which was treated with antibiotics. Urinalysis shows red blood cells and proteinuria. What is the pathophysiology of this disease process?”

A

IMMUNE COMPLEX DEPOSITION

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37
Q

(RR)

physical exam findings of hyphema

A

unequal pupils
injected conjunctiva or sclera
blood in anterior chamber

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38
Q

(RR)

what is the treatment of hyphema?

A

eye protection
limitation of activity
head elevation of 30-45 degrees

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39
Q

(RR)

presentation of placenta previa

A

painless
BRIGHT RED
vaginal bleeding, usually in
THIRD TRIMESTER

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40
Q

(RR)

how do we diagnose placenta previa?

A

U/S

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41
Q

(RR)

what is placenta previa?

A

placenta overlaps and implants on the cervix, covering the internal os to varying degrees

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42
Q

(RR)

“what is the most common risk factor of placenta previa?”

A

multiparity

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43
Q

(RR)

what do we NOT do with suspected placenta previa?

A

DO NOT DO A DIGITAL VAGINAL EXAM

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44
Q 
(RR)
A pt with 20-40 minute episodes of dizziness ("room-spinning") with ringing sounds, worse w/ head movement and positional changes.  What would be expected on physical exam?
a) conductive hearing loss
b) middle ear effusion
c) sensorineural hearing loss
d) vertical nystagmus
A

C) SENSORINEURAL HEARING LOSS

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45
Q

(RR)

triad of Meniere Disease

A

episodic vertigo (a true spinning sensation)

sensorineural hearing loss

tinnitus

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46
Q

(RR)

what’s another name for Meniere Disease?

A

endolymphatic hydrops

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47
Q

(RR)

treatment for Meniere Disease?

A 
management - 
reduce salt
antihistamines (meclizine)
benzodiazepines
diuretics
prednisone
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48
Q

(RR)

“Benign paroxysmal positional vertigo is thought to be caused by what?”

A

“BPPV is most commonly attributed to calcium debris w/in the post semicircular canal but may also occur in the lateral and anterior semicircular canals.”

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49
Q

(RR)
blood transfusions -
a single PRBCs unit will raise hemoglobin _____ and hematocrit _____

A

“A Single PRBCs unit will raise hemoglobin by 1g/dL and hematocrit by 3%.”

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50
Q

(RR)
“A 66 y/o woman presents for acute HA. She has a hx of HTN and migraines. She states the HA started suddenly after walking into a movie theater. She has associated n/v and states she has never had anything like this in the past. Phys exam is remarkable for the finding noted above (picture was included). What is the best first step in treatment of pt?”

A

apraclonidine

the picture was of a glaucoma eye - conjunctival injection, mid-sized fixed pupil, hazy cornea

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51
Q

(RR)

glaucoma treatment

A

topical BB and alpha-agonist
such as TIMOLOL and APRACLONIDINE (respectively)
along with ACETAZOLAMIDE

EMERGENCY CONSULT WITH OPTHAMOLOGY!!

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52
Q

(RR)

what is glaucoma?

A

GLAUCOMA is a group of disorders characterized by increased intraocular pressure that causes optic neuropathy and vision loss

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53
Q

(RR)

how is glaucoma diagnosed?

A 
with the clinical features of 
CONJUNCTIVAL INJECTION
MID-SIZED AND FIXED PUPIL
HAZY CORNEA
GLOBE THAT IS ROCK HARD TO TOUCH
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54
Q

(RR)

“what is the mechanism by which acute angle-closure glaucoma happens?”

A

“In acute angle-closure glaucoma or crisis, the lens or the peripheral iris blocks the trabecular meshwork, obstructing the outflow of aqueous humor and resulting in a rapid increase in intraocular pressure”

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55
Q

(RR)

what is the preferred treatment for Pneumocystis jirovecii pneumonia?

A

TMP SMX

this is the most common opportunistic infection seen in HIV patients, esp w/ CD4 count <200 cells/microL

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56
Q

(RR)

how does urticaria present?

A

pruritus and an ERYTHEMATOUS PLAQUE WITH CENTRAL PALLOR (possibly with deeper dermal swelling)

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57
Q

(RR)

treatment of urticaria

A

antihistamines

a short course of oral steroids can be given for more severe symptoms

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58
Q

(RR)

“What type of hypersensitivity reaction is contact dermatitis?”

A

type IV

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59
Q

(RR)

what is urticaria most commonly caused by (in terms of the body’s reaction)?

A

IgE-mediated reaction to an allergen

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60
Q

(RR)

what is the main distinction between mastitis and breast abscess?

A

fluctuance

“On exam, pts with mastitis will have erythema, tenderness to palpation and warmth to affected area. The presence of fluctuance is suggestive of a breast abscess.”

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61
Q

(RR)

what are the most common causes of puerperal mastitis?

A

Staph aureus

may also be caused by E. coli and Strep

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62
Q

(RR)

what antibiotics cover for mastitis pathogens?

A

DICLOXACILLIN
cephalexin
clindamycin

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63
Q

(RR)

management of mastitis

A

cool compresses
analgesics b/w feedings

CONTINUE BREAST FEEDING!

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64
Q

(SmartyPance)

how do we diagnose DKA?

A

BS > 250 mg/dL

anion gap acidosis
pH < 7.3
bicarb < 18

pts may be hyperkalemic

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65
Q

(SmartyPance)

s/s for DKA

A 
ABD PAIN
thirst
polyuria
polydypsia
nocturia
weakness 
fatigue
convusion
n/v
fatigue
chest pain
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66
Q

(SmartyPance)

treatment of DKA

A

IVF = 1st CRITICAL STEP!
(lowers serum glucose, switches body from catabolic to anabolic state)

if severe acidosis,
K
bicarb

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67
Q

(SmartyPance)

diagnosis of BV

A 
milky vaginal discharge +
pH.4.5 +
amine "whiff" test of fishy odor
CLUE CELLS (gram negative)

AMSEL criteria

68
Q

(SmartyPance)

treatment for BV

A

metonidazole (PO or intravag)

or

clindamycin

may need prolonged treatment (6 months)

69
Q

(SmartyPance)

dx of trichomonas

A

saline wet mount to see dancing parasites

PE may show strawberry cervix

70
Q

(SmartyPance)

treatment of trich

A

metonidazole (PO only)

partner treatment -

retest in 2 weeks to 3 months (“test of cure”

71
Q

(SmartyPance)

dx of candidiasis

A

wet mount –> KOH

72
Q

(SmartyPance)

treatment for candidiasis

A

fluconazole 150 mg PO x1

if bad, redose 72 hrs later

7-day course works better

73
Q

(RR)

s/s of thyroid storm

A

hyperthermia
HTN
tachycardia

74
Q

(RR)

how do we treat thyroid storm?

A

BB (e.g. propranolol)

propylthiouracil or methimazole (antithyroid medications)

then, iodine

“The hyperadrenergic effects of thyroid storm (i.e. tachycardia, HTN) should be treated with a beta-blocker.”

75
Q

(RR)
what do we give to block peripheral conversation of thyroxine (T4) to triiodothyronine (T3) after the first steps of treating thyroid storm are completed?

A

glucocorticoids

76
Q

(RR)

what lab results are indicative of thyroid storm?

A

low TSH

high free T4 or T3

77
Q

(RR)

“When should hypertension be treated in the setting of an acute ischemic stroke?”

A

“if the systolic is greater than 220mm Hg, the diastolic is greater than 110mm Hg, or if the pt has another condition that would benefit from bp control”

78
Q

(RR)

what s/s indicate anterior cerebral artery ischemic stroke?

A 
frontal lobe dysfunction
apraxia
contralateral paralysis (lower > upper)
79
Q

(RR)

what s/s indicate middle cerebral artery ischemic stroke?

A 
contralateral paralysis (upper > lower)
aphasia
80
Q

(RR)

what s/s indicate posterior cerebral artery and VBI?

A 
LOC
nausea or vomiting
CN dysfunction
ataxia
visual agnosia
81
Q

(RR)

what do we see on CT of ischemic stroke?

A

“CT reveals loss of gray-white interface, acute hypodensity”

82
Q

(RR)

what is the equation for calculating appropriate fluid resuscitation for burn patients (the Parkland formula)?

A

4 x pt wt (kg) x % TBSA of burns (not the superficial ones) = # of mL of LR to given in first 24 hrs

*half in first 8 hours, other half over following 16 hours

83
Q 
(RR)
Rule of Nines for burns:
torso
head
arms
legs
A

torso: front = 18%, back = 18%
head: 9%
each arm: 9%
each leg: 18%

84
Q

(RR)

what do we use for first-line treatment for minor bleeding in patients with von Willebrand disease?

A

DESMOPRESSIN (DDAVP)

85
Q

(RR)
what do you do if desmopressin does not work or if the patient presents with life-threatening bleeding for von Willebrand Disease?

A

give von Willebrand factor (recombinant or cryoprecipitate)

86
Q

(RR)

what is the most common inherited bleeding disorder, autosomal dominant?

A

von Willebrand Disease

87
Q

(RR)

what do labs show for von Willebrand Disease?

A

decreased factor VIII

prolonged bleeding time

88
Q

(RR)

what is the treatment for most cases of subacute thyroiditis?

A

NSAIDs

89
Q

(RR)

common s/s of subacute thyroiditis

A 
FEVER
MYALGIAS
FATIGUE
malaise
ANTERIOR NECK PAIN
90
Q

(RR)

what is the hallmark physical exam finding for subacute thyroiditis?

A

TENDERNESS OVER THE THYROID GLAND

91
Q

(RR) BUZZWORDS

tenderness over the thyroid gland

A

subacute thyroiditis

92
Q

(RR)

how do we diagnose subacute thyroiditis?

A

clinically

…“but thyroid studies will reveal a suppressed TSH w/ elevated T3 and T4 in early phases in illness”

93
Q

(RR)

another name for subacute thyroiditis

A

de Quervain thyroiditis

94
Q

(RR)

how do we treat reactive arthritis?

A

first - treat underlying infections

then - treat symptoms with PT, anti-inflammatories, potentially short course of steroids

95
Q

(RR) BUZZWORDS

“can’t pee, can’t see, can’t climb a tree”

A

reactive arthritis

urethritis, conjunctivitis, uveitis, arthritis

96
Q

(RR)

what do labs show for reactive arthritis?

A

HLA-B27

97
Q

(RR)

what is central vertigo?

A

vertigo from a central cause such as a cerebellar or brainstem hemorrhage or infarction.

LESS PRONOUNCED SYMPTOMS SUGGEST A CENTRAL CAUSE RATHER THAN A PERIPHERAL CAUSE

98
Q

(RR)

common PE findings for central vertigo

A

BS SYMPTOMS

severe gait impairment w/ inability to walk, or limb dysmetria

99
Q

(RR)

in a hemothorax, what should be done after airway is secure and packed RBCs are being infused?

A

chest thoracostomy tube

can be both diagnostic and guide further management, and should be done before sending pt to OR

100
Q

(RR)

“what is the most common cause of DIC?”

A

infection

101
Q

(RR)

first line treatment of status epilepticus

A

benzos (LORAZEPAM)

102
Q

(RR)

second line treatment of status epilepticus

A

phenytoin or fosphenytoin
valproic acid
levetiracetam

103
Q

(RR)

what is third line treatment for status epilepticus?

A

pentobarbital
propofol
phenobarbital

104
Q

(RR)

“what is the best benzo for treatment of status epilpeticus in a pt w/o intravenous access?”

A

IM Midazolam

105
Q

(RR)

what is the most common complication from a midshaft humerus fracture?

A

radial nerve injury

“clinically, pts may exhibit radial nerve palsy with wrist drop” …“loss of extension of fingers, thumb, and wrist”

106
Q

(RR)

osteomyelitis - most common pathogen and treatment

A

S. aureus

“long term abx”

107
Q

(RR)

“what bacteria may cause osteomyelitis in patients who have a history of sickle cell disease?”

A

Salmonella

108
Q

(RR)
nephrolithiasis -
once pyelonephritis, cystitis, biliary colic or aortic aneurysm are ruled out, what is the next step for pt treatment?

A

“Once these etiologies are ruled out, a pt with recurrent nephroliathiasis and adequate pain control can be DISCHARGED W/O FURTHER WORKUP.”

109
Q

(RR)

five clinical signs of nephrolithiasis

A 
hematuria (1/3 of pts)
abd/flank pain
urinary frequency
dysuria
fever (sometimes)
110
Q

(RR)

what imaging is used for nephrolithiasis workup?

A

plain xray
u/s
CT scan (w/o contrast)

111
Q

(RR)

what is the management of nephrolithiasis?

A

supportive
IV hydration
tamsulosin
renal/urology consult

112
Q

(RR)

papilledema is the hallmark funduscopic finding of _____?

A

IDIOPATHIC INTRACRANIAL HYPERTENSION

113
Q

(RR)

“what is an alternative to fundoscopy when evaluating for papilledema?

A

ocular u/s

114
Q

(RR)

what is the PE finding of papilledema?

A

OPTIC DISK SWELLING

115
Q

(RR)

what is the treatment of papilledema?

A

“TREATMENT IS THE TREATMENT OF THE UNDERLYING DISORDER”

116
Q

(RR) BUZZWORDS

Philadelphia chromosome

A

chronic myelogenous leukemia

117
Q

(RR) BUZZWORDS

auer rods

A

acute myelogenous leukemia

118
Q

(RR) BUZZWORDS

clue cells

A

bacterial vaginosis

119
Q

(RR) BUZZWORDS

smudge cells

A

chronic lymphocytic leukemia

120
Q

(RR)

what is first line treatment for scabies mites?

A

“permethrin 5% cream on day 1, then reapply in 1 week”

“oral ivermectin is also an option.”

121
Q

(RR)

what type of hypersensitivity reaction takes place with scabies mites?

A

type IV hypersensitivity reaction causing intense pruritus

122
Q

(RR)

MC presentation of Hodgkin lymphoma in a 17 year old boy?

A

painless cervical lymphadenopathy

“Most adolescents present with painless lymphadenopathy in the cervical or supraclavicular region.”

123
Q

(RR) BUZZWORDS

Reed Sternberg Cell (Owl’s eye)

A

Hodgkin lymphoma

124
Q

(RR)

what is Reye syndrome?

A

progressive encephalopathy with hepatic dysfunction

125
Q

(RR) BUZZWORDS

aspirin exposure in the setting of a viral illness

A

think Reye syndrome (progressive encephalopathy with hepatic dysfunction)

126
Q

(RR)

how do we treat/manage Reye syndrome?

A

“There is no specific cure, and MANAGEMENT IS SUPPORTIVE”

127
Q

(RR)

“what is the most common acid-base disturbance in Reye syndrome?”

A

metabolic acidosis and respiratory alkalosis

128
Q

(RR)

what do labs show in Reye Syndrome?

A

hypoglycemia
elevated liver enzymes
hyperammonemia
metabolic acidosis

129
Q 
(RR)
"which of the following conditions has a negative Nikolsky sign?"
a) bullous pemphigoid
b) pemphigus vulgaris
c) Staphylococcal scalded skin syndrome
d) toxic epidermal necrolysis
A

A) BULLOUS PEMPHIGOID

130
Q

(RR)

In a pt with low-to-moderate risk for DVT, the appropriate workup includes…..what? and in what order?

A

“…AT LEAST A NEGATIVE HIGH-SENSITIVITY D-DIMER TEST IN ORDER TO COMPLETE THE WORKUP W/O IMAGING”

(If duplex ultrasonography is performed in a moderate risk pt and is negative, either a high-sensitivity D-dimer test should be sent and should be negative or the pt should seek serial duplex ultrasonography.)

131
Q

(RR)

Lithium toxicity is associated w/ several different forms of renal injury, but which is the most common?

A

“NEPHROGENIC DIABETES INSIPIDUS is by far the most common”

132
Q

(RR)

what is the PO treatment of pyelonephritis?

A

FQ’s CIPROFLOXACIN or LEVOFLOXACIN

or

TMP-SMX

133
Q

(RR)

MC causes of acute prostatitis, for pts <35 yrs old and pts >35 yrs old

A

<35yrs: N. gonorrhoeae, C. trachomatis
(treat w/ ceftriaxone IM and doxy)

> 35 yrs: E. coli
(treat w/ TMP-SMX or FQ for 4 weeks)

134
Q

(RR)
what do we use for first-line treatment for corneal ulceration to cover against eyeball Pseudomonas aeruginosa infection?

A

TOPICAL CIPROFLOXACIN

and emergent ophthalmologic consultation

135
Q

(RR)

what is the most common injury in children w/ severe blunt chest trauma?

A

PULMONARY CONTUSION,

occurring in nearly half of such victims (even w/ no external signs or even rib fractures…cuz kids are spongy)

136
Q

(RR)

Bell Palsy physical exam will show CN VII palsy that _________ spare the forehead?

A

DOES NOT

“PE will show CN VII palsy that does NOT spare the forehead”

137
Q

(RR)

if a pt presents with signs of Bell palsy and stroke, what do the eyebrows tell us?

A

“preserved ability to raise the eyebrows suggests a central process. This is because the forehead receives bilateral upper motor neuron innervation, so a central stroke will SPARE THE FOREHEAD AND ALLOW THE PT TO RAISE THE EYEBROWS”

138
Q

(RR)

what is first line treatment for trigeminal neuralgia?

A

carbamazepine

139
Q

(RR)
after DKA has been managed with aggressive IVF and insulin drip, what do we do after the glucose is <200 mg/dL and the anion gap is closed?

A

“glucose-containing fluids should be initiated to prevent hypoglycemia”

140
Q

(RR) BUZZWORDS

drusen spots on the macula

A

macular degeneration

141
Q

(RR) BUZZWORDS

bilateral gradual central field vision loss

A

macular degneration

142
Q

(RR)

what is the treatment for an ill-appearing female with vomiting and high fever with signs of PID?

A

admit, she’s sick!

inpatient management with IV cefotetan and doxycyline

143
Q

(RR)

what findings in the synovial fluid analysis of an arthrocentesis indicate septic arthritis?

A

WBC > 50,000 w/ more than 75% neutrophils
fluid would look cloudy and yellow
(no crystals present, that’s gout)

144
Q

(RR)

what are the empiric antibiotics of choice for septic arthritis?

A

vanc and ceftriaxone

145
Q

(RR)

missed abortion =

A

intrauterine fetal death prior to 20 weeks gestation
closed cervical os
retention of the pregnancy

146
Q

(RR)
the antibiotics for Mastitis -
what are the two anti-staph abx?
what is the antibiotic for beta-lactam allergic pts?

A

anti-staph abx = DICLOXACILIN, cephalexin

beta-lactam sensitive pts = clindamycin

147
Q

(RR)
antibiotics for MASTITIS -
what is the abx when concerned for MRSA?

what abx if given in an in-patient setting?

A

MRSA: TMP-SMX

In-patient: vancomycin

148
Q

(RR)

erysipelas characteristics

A

abrupt onset of fever, chills, malaise, followed by development of bright red, well-demarcated, indurated area of skin,
and -
you might see peau d’orange!
or malar distribution on the face!

149
Q

(RR)

pathogen most commonly causing erysipelas, and it’s treatment

A

MC caused by beta-hemolytic streptococci (Strep pyogenes)

“Treatment is elevation and antibiotics”

Ceftriaxone, cefazolin (systemic symptoms)
amoxicillin, cephalexin (mild)

150
Q

(RR) BUZZWORDS

no cremaster reflex

A

think testicular torsion

151
Q

(RR)

what test is most sensitive for a UTI on urine dipstick testing?

A

LEUKOCYTE ESTERASE

second - nitrites
(bac converting urinary nitrates to nitrites, but the bac have to act on the urine for 6 hours and an ideal specimen is collected from first void of the day)

152
Q

(RR)

three key features of primary hyperparathyroidism

A

high parathyroid hormone
high calcium
low phosphorous

153
Q

(RR)

what is the fun saying about the results of hypercalcemia?

A

“bones, stones, groans, and psychiatric overtones”

bones - abnormal bone remodeling and fracture risk
stones - increased risk for kidney stones
groan - abdominal cramping, nausea, ileus, constipation
psych - lethargy, depressed mood, psychosis, cognitive dysfunction

154
Q

(RR)

hypercalcemia is a common complication of….

A

….malignancy

155
Q

(RR)
a painful severe diffuse headache with abrupt onset, photophobia, phonophobia, and pain with extraocular movements - what should you be thinking about?

A 
SUBARACHNOID HEMORRHAGE
(they don't all say "thunderclap headache" or "worst headache of life")
156
Q

(RR)

treatment of subarachnoid hermorrhage

A

supportive

NIMODIPINE (decreases vasospasm)

157
Q

(RR)

if patients have rhinorrhea or conjunctivitis with pharyngitis, they are more likely to have which type of etiology?

A

VIRAL

158
Q

(RR)

treatment for pts with aplastic crisis of sickle cell disease

A

transfused with packed red blood cells

(in particular if they are experiencing signs of decrease end-organ perfusion such as demand ischemia (painful!) or exertional dyspnea)

159
Q

(RR)

treatment for alcohol withdrawal syndrome

A

lorazepam

(chronic alcohol use leads to the CNS adapting by upregulating NMDA channels (stimulatory) and downregulating GABA channels (inhibitory). when pt suddenly stops consuming alcohol the pt can have withdrawal seizures….so give a benzo such as lorazepam which stimulates GABA receptors.)

160
Q

(RR)

most commonly affected vessel in ischemic stroke

A

MCA

161
Q

(RR)

typical symptoms of MCA ischemic stroke

A

contralateral hemiparesis
facial weakness
sensory loss

(usually affect upper extremity and face more than lower extremity, which is a distinguishing factor of MCA strokes, and differentiates them from ACA strokes)

162
Q

(RR)

MC drugs that cause serotonin syndrome (LE hyperreflexia, clonus, hypersalivating, mydriasis, etc.)

A 
antidepressants (SSRI, MAOI, SNRI, TCA, atypicals) such as:
TRAMADOL
lithium
linezolid
triptans
meperidine
DEXTROMETHORPHAN
163
Q

(RR)

what organisms most likely cause sepsis in asplenic patients?

A

ENCAPSULATED BACTERIA
Strep pneumo
Neisseria meningitidis
Haemophilus influenza

(these may lead to meningitis, so treat accordingly!)

164
Q

(RR)
what neurotransmitter imballance leads to dystonic reactions with involuntary contractions of muscles to extremities, face, neck, pelvis?

A

dopamine receptor blockade leading to INCREASED CHOLINERGIC ACTIVITY

(most common causative agents: first gen antipsychotics and antiemetic medications)

treat with anticholinergic meds like diphenhydramine or benztropine, relax the pt with a benzo

165
Q

(RR)

three s/s of infectious mono

A

atypical lymphocyte
tonsillar exudate
enlarged spleen

(caused by Epstein-Barr virus)

CLINICAL YR: Emergency Med EOR Exam_JD (5 decks)

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