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Emergency Medicine > EM Exam 3 - Enoch > Flashcards

EM Exam 3 - Enoch Flashcards

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1
Q

Erysipelas MC organism is…

A

GAS

Upper dermis only

The GAS tank is Empty

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2
Q

Cellulitis MC organism is…

A

Staph

Skin and SQ tissue

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3
Q

Cellulitis has () borders, while erysipelas has () borders.

A
  • Cellulitis = Ill-defined borders
  • Erysipelas = Well-defined/Demarcated borders
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4
Q

Cellulitis & Erysipelas

  • Concerned for abscess? Order a ()
  • Concerned for DVT? Order a ()
  • Concerned for osteomyelitis? () or ()
  • Concerned for systemic infection/bite? order a set of ()
A
  • Abscess: US
  • DVT: Venous Doppler US
  • Osteomyelitis: XR or CT
  • Systemic: Serologies (CBC, CMP, cultures)
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5
Q

Cellulitis & Erysipelas

Outpatient management of NO MRSA RISK

A

Keflex or Clinda

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6
Q

Cellulitis & Erysipelas

Outpatient management of MRSA RISK

A

Bactrim, Doxy, Clinda

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7
Q

Cellulitis & Erysipelas

You should follow up after starting outpatient abx in () to () hours

A

48-72 hours

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8
Q

Cellulitis & Erysipelas

Inpatient admit + IV ABX via Rocephin, Ancef, or Clinda +/- Vanco/daptomycin are indicated if you meet at least 2 of these sepsis criteria:

  • Temp > ()
  • HR > ()
  • RR > ()
  • WBC < () or > ()
  • SBP < ()
  • AMS
  • Lactic acid > 2
  • Immunocompromised
A
  • Temp > 100.4F/38C
  • HR > 90
  • RR > 20
  • WBC < 4k or > 12k
  • SBP < 100

Pretty much SIRS criteria

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9
Q

MC pathogen for a cutaneous abscess

A

Staph

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10
Q

T/F: Cutaneous abscesses can spontaneously drain

A

True

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11
Q

T/F: You need diagnostics to evaluate a cutaneous abscess

A

False.

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12
Q

Prior to doing an I&D on an abscess, you need…

A

Informed consent

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13
Q

After I&D and packing a cutaneous abscess, you should follow up in ()

A

2-3 days

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14
Q

ABX prophylaxis is indicated prior to I&D of a cutaneous abscess if the patient is at high risk for what cardiac condition? What is the ABX?

A
  • High risk for endocarditis
  • Must use IV clinda or vanco 30-60 mins prior.
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15
Q

ABX prophylaxis is indicated in severe cutaneous abscess presentations, such as immunocompromised or septic patients. The ABX used primarily are (), and if they show signs of sepsis, you must add on () or ().

A
  • IV vanco, linezolid, or clinda
  • Add on Zosyn or meropenem
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16
Q

A moderate to severe cutaneous abscess is indicated by this criteria:

  • Lesion > () cm
  • Multiple abscesses
  • Surrounding ()
  • immunosuppression
  • Signs of ()
A
  • Lesion > 2cm
  • Surrounding cellulitis
  • Signs of systemic infection
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17
Q

Oral therapy using (3 options) can be used for abscesses with risk of MRSA as long as it is a moderate presentation and the patient is ()

A
  • Bactrim, doxy, clinda
  • Patient must be immunocompetent
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18
Q

Patient education for a cutaneous abscess discharge include:

  • Keeping the wound (wet/dry)
  • Removing the dressing after 2-3 days
A
  • Keep wound dry
  • DO NOT REMOVE dressing (come back to ED/PCP to remove)
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19
Q

Most useless physical exam test for DVT

A

Homan’s sign

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20
Q

You should suspect DVT in someone with ()lateral extremity swelling that is greater than () cm in difference when measured 10 cm below the tibial tubercle.

A

Unilateral swelling >= 2 cm in diff.

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21
Q
  • Phlegmasia alba dolens describes a large DVT that is (color).
  • Phlegmasia cerulea dolens describes a large DVT that is (color)
A
  • Alba dolens = white/pale
  • Cerulea dolens = dusky blue
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22
Q

Well’s DVT scores of 2 or less = ()

A

D-dimer

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23
Q

High bleeding risk in a DVT is the presence of () or more risk factors.

A

2

I wrote that you just need to know # of RFs, not the actual RFs

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24
Q

A proximal DVT with NO limb ischemia can be treated with () if high bleeding risk, or () if mod-low bleeding risk.

A
  • High bleed risk = IVC filter
  • Mod-low bleed risk = DOAC or LMWH
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25
Q

A proximal DVT + limb ischemia with high bleeding risk is treated via (), whereas a mod-low bleeding risk is treated via ()

A
  • High risk = thrombectomy + IVC filter
  • Mod-low = Catheter thrombolysis + AC
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26
Q

A distal-only DVT with high bleeding risk is treated via ()

A distal-only symptomatic DVT with mod-low bleeding risk is treated via ()

A
  • High risk distal = IVC filter
  • Symptomatic low-mid distal = DOAC (preferred) or LMWH
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27
Q

In a distal-only asymptomatic DVT, you should treat it with () if there is concern for proximal extension, but if not, you should treat it via ()

A
  • Risk of proximal spread = DOAC (preferred) or LMWH
  • No risk = Serial proximal compressive US Qweekly for 2-4 weeks
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28
Q

T/F: A proximal DVT should always be admitted.

A

Trueee

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29
Q

Chronic PAD is characterized by:

  • (classic symptom)
  • Atypical leg pain (ischemic rest)
  • () healing wounds
  • () skin changes
A
  • Claudication
  • Non-healing wounds
  • Hyperpigmented skin changes
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30
Q

The 6 Ps of acute arterial occlusions are:

A
  • Pain
  • Pallor
  • Poikilothermia
  • Paresthesias
  • Paralysis
  • Pulselessness

At least one will be present

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31
Q

ABI < () is indicative of PAD

A

0.9

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32
Q

The initial imaging modality for arterial limb ischemia is…

A

Duplex US

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33
Q

Venous doppler can no longer pick up pulses starting at what Rutherford acute limb ischemia classification? (I, IIa, IIb, III)

A

III - nonviable

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34
Q

At what rutherford stage(s) can you just do diagnostic vascular imaging before treating?

A

Stage I and IIa

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35
Q

The initial pharm tx once rutherford classification is determined for acute limb ischemia is…

A

UFH bolus followed by maintenance

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36
Q

Testicular torsion MC occurs as a () or during ()

A

Neonate or puberty

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37
Q

The affected testicle in testicular torsion is (), (), and (), lying ()

A

Firm, tender, elevated, and lying transverse (Bell Clapper)

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38
Q

You would expect a () cremasteric reflex with testicular torsion

A

Negative reflex

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39
Q

The initial imaging modality of choice for Testicular Torsion

A

Duplex US showing diminished blood flow to affected testis.

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40
Q

The goal to detorsion for testicular torsion is within () hours of onset

A

6 hours after

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41
Q

Manual detorsion is done via a () to () direction, and you still need to do surgical detorsion afterwards!!

A

Medial to lateral direction

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42
Q

The MC torsed testicular appendage is…

A

Appendix epididymis

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43
Q

The pathognomonic sign of a testicular appendage torsion is…

A

Blue dot sign

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44
Q

Doppler US of a testicular appendage torsion shows () blood flow to the testis.

A

Confirms blood flow to testis.

Normal torsion has decreased blood flow

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45
Q

The management for a testicular appendage torsion is…

A

Discharge and take some pain meds

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46
Q

Viral Orchitis is MC due to…

A

Mumps

Mumps is all the -itis

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47
Q

Epididymitis is MC due to…

A

Bacteria

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48
Q

Epididymitis shows a () cremasteric reflex and () prehn sign

A

Positive for both

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49
Q

The affected testis in epididymitis is be (higher/lower) in the scrotum

A

Lower

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50
Q

Generally, the initial lab you want to get in epididymitis/orchitis is…

A

UA w/ C&S

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51
Q

Outpatient tx of epididymitis that you suspect is NOT due to Gono/Chla is () or ()

If you think its due to G/C, then the tx is () + ()

Anal: () + ()

A
  • UTI: Levofloxacin or Bactrim
  • G/C: Rocephin + Doxy/azithro
  • Anal: Rocephin + Levo

Admit tx is essentially the same, just IV

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52
Q

A superficial scrotal abscess occurs due infection of a (), while the other form is an extension of intrascrotal infections

A

Infection of a hair follicle

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53
Q

The preferred imaging study for a scrotal abscess is a ()

A

US

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54
Q

For intrascrotal abscesses, you must do ()

A

Surgical drainage.

Do not just I&D if its intrascrotal

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55
Q

A necrotizing fasciitis of the perineal, genital, or perianal anatomy that originated as a benign infection/simple infection is known as…

A

Fournier’s Gangrene

Microthrombosis of small SC vessels.

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56
Q

You suspect fournier’s gangrene but you’re not super sure. You should order a () showing air along fascial planes or deep tissue involvement.

A

CT w/ IV con

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57
Q

The broad spectrum ABX for Fournier’s Gangrene is..

A

Zosyn

Also do resuscitation tx

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58
Q

If you have a high clinical suspicion of Fournier’s Gangrene, your immediate next action should be…

A

Getting an urgent urology consult before more imaging.

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59
Q

Inflammation of both the glans and foreskin is..

A

Balanoposthitis

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60
Q

The usual tx for balanoposthitis is topical…, but severe presentations require oral…

A
  • Topical nystatin/clotrimazole
  • Oral fluconazole

If bacterial, use bacitracin or mupirocin in children

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61
Q

You have a balanoposthitis patient that stays symptomatic despite proper tx. Your next step in management is to…

A

Obtain fungal/bacterial specimen swabs

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62
Q

Paraphimosis has a () sign and is an ()

A

Donut sign = emergency

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63
Q

Initial management of paraphimosis is to..

A

Reduce the glans via anesthesia and compression

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64
Q

Your manual reduction of paraphimosis fails. You should now use…

A

Make small punctures into the glans so it leaks fluid

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65
Q

Paraphimosis

You attempt reduction which fails. Puncturing the glans also failed. There is now arterial compromise and urology is unavailable for consultation. Your next step is to…

A

Dorsal incision of foreskin, reduction, suture

Follow up in 3 days

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66
Q

Phimosis can interefere with urine retention. The temporary tx for it is… but the definitive treatment is…

A

Temporary: hemostatic dilation
Definitive: Circumcision

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67
Q

Your patient with phimosis does not want to get circumcised. You recommended () with daily manual () to reduce the need.

A
  • Topical steroid therapy
  • Daily manual retraction
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68
Q

Priaprism lasts longer than () hours, and causes irreversible damage after () hours.

A

> 4 hours, irreversible damage after 24hrs.

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69
Q

Ischemic priaprism is () flow and MC in (). A coagulopathy () is the MCC if it occurs in children.

A
  • Low flow.
  • MC in adults
  • Sickle cell disease for children
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70
Q

ABG from low-flow/ischemic priapism will show…

A

Hypoxemia

Black blood when aspirating.

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71
Q

ABG of non-ischemic/high flow priapism will show ()

A

Normal blood.

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72
Q

The MCC of non-ischemic/high flow priapism is…

A

Traumatic fistula

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73
Q

Ischemic/low-flow priapism is treated via () block, () aspiration, instillation of ().

A
  1. Dorsal block
  2. Coporal aspiration
  3. Phenylephrine
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74
Q

The first step in treating a trapped penis due to ring/hair/wire is…

A

Compression and cooling

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75
Q

A penile fracture refers to rupture of the () of 1 or both corpus cavernosa due to direct trauma

A

Tunica albuginea

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76
Q

MCC of penile fracture

A

Sex

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77
Q

You hear an audible snap when having sex. Your penis becomes discolored and swollen. This describes a…

A

Penile fracture

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78
Q

First step in penile fracture management is…

A

Consult urology + do a pre-op retrograde urethrogram

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79
Q

Fibrotic plaques within the () of the penis that make it curved describe Peyronie’s

A

Tunica albuginia

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80
Q

The following are seen in clinical presentation of peyronie’s:

  • Hx of () dysfunction
  • () pain
  • ()
  • ()
  • () deformity during erection
A
  • Hx of sex dysfunction
  • Penile pain
  • Indentation
  • Curvature
  • Shortening deformity during erection
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81
Q

The two patient populations with the highest risk for urethral foreign bodies are…

A

Children and mentally unstable

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82
Q

T/F: After Pelvis XR you can remove a urethral foreign body

A

No consult urology

is what i have written down

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83
Q

Initial management of urethral strictures is via…

A

14 or 16 Fr foley straight tip catheter

After, try a 12 Fr Coude with lubricant

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84
Q

You should consult urology regarding urethral strictures after () failed attempts to cath.

A

3 failed attempts

3 strikes

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85
Q

You failed to cath a urethral stricture 3 times and urology is unavailable. You perform an emergent ()

A

Suprapubic cystostomy with catheter placement.

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86
Q

The MC patient to complain of urinary retention is…

A

Old guy with BPH

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87
Q

Your first diagnostic test in evaluating urinary retention is…

A

Post void residual US showing more than 50 cc

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88
Q

Management of urinary retention with hematuria is..

A

3-way foley

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89
Q

Just like for urethral strictures, if urology is unavailable and you need them, you have to do an emergent ()

A

Suprapubic catheter

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90
Q

Bladder spasms can be treated with ()

A

Oxybutynin

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91
Q

Most urinary retention pts can go home with a catheter in place for 3-7 days. However, you should admit them if they demonstrate post-obstructive () or post-obstructive ()

A
  • Renal failure
  • Diuresis
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92
Q

() is the MC presenting symptom to the ED

A

PAIN

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93
Q

The two ways we rate pain are via the () scale or () faces

A
  • 1-10 scale
  • Wong-baker faces
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94
Q

Systemic opioids are used when pain is severe and ()

A

Severe nociceptive pain

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95
Q

Almost all NSAIDs should be used with caution in () dysfunction

A

Renal dysfunction

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96
Q

Almost all NSAIDs cause:
* () upset
* () dysfunction
* Cannot be used in () dysfunction
* ()spasm

A
  • GI upset
  • Platelet dysfunction
  • Cannot be used in renal dysfunction
  • Bronchospasms

Exception: ASA has no bronchospasm

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97
Q

Once you give an initial dose of an opioid, you should then () it to effect

A

Titrate to effect

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98
Q

Fentanyl is especially useful in opioid-tolerant breakthrough pain in () patients

A

Cancer

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99
Q

Tramadol is risky because it can contribute to () syndrome

A

Serotonin syndrome

It is a weak NE and 5-HT reuptake inhibitor

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100
Q

() describes misuse of a medication to the detriment of a patient’s well being.

() describes that abrupt cessation of a medication with cause acute withdrawal symptoms.

A
  • Addiction
  • Dependence
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101
Q

Generally, never take tylenol or advil within () hrs of an opioid combined with tylenol or advil.

A

6 hours

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102
Q

The MC source of misused Rx opioids in adolescents comes from…

A

Parent’s medicine cabinet

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103
Q

Epinephrine injections are avoided in patients with () vascular injuries

A

Digital

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104
Q

Topical anesthestics can be applied in 3 major situations:

  • On () skin prior to dermal instrumentation
  • On () mucosa
  • On () skin for pain control or prior to wound repair.
A
  • Intact skin
  • Intact mucosa
  • Open skin
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105
Q

Nerve blocks are used in place of subdermal injections of large volumes because they do not () the wound.

A

Distort

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106
Q

Peripheral nerve blocks take about () minutes for a lido injection and () minutes for a bupivacaine injection.

A
  • 10-20 for lido
  • 15-30 for bupi
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107
Q

T/F: A flexor tendon sheath will fully anesthetize the distal fingertip

A

False

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108
Q

Chronic pain lasts either () months or more, beyond reasonable time for an injury to heal, or () months beyond the usual course of an acute disease.

A
  • 3 months
  • More than 1 month past the usual healing time for an acute disease
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109
Q

T/F: Opioids are highly recommended for ED treatment of chronic pain.

A

False

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110
Q

Should you write drug-seeking behavior in a chart?

A

No. List actual facts not opinions

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111
Q

Lower back pain in the ED is managed primarily with (drug) and (lifestyle) and a 3-day supply of (drug)

A
  • NSAIDs, like naproxen or advil
  • Restriction of activity
  • 3 day supply of opioid (Not first-line)
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112
Q

Wounds greater than () cm and located in () vascular areas are more likely to be infected.

A

Longer than 5 cm and in LESS vascular areas are more likely to be infected.

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113
Q

Nonabsorbale sutures retain strength for () days and must be removed. (name some of the non-absorbable ones)

A
  • 60 days.
  • Silk, nylon, prolene

You should use these on the Outermost layer!!!

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114
Q

Generally, the scalp should use () or () -0 sutures, while the face uses ()-0

A
  • 3 or 4 for scalp
  • 6-0 for face
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115
Q

In simple interrupted sutures, you should aim to do () ties relative to suture size

A

Same ties as suture size (i.e. 4 ties for a 4-0)

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116
Q

Running stitches are specifically not used in (shaped) wounds

A

Irregular wounds

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117
Q

Buried dermal sutures should not be placed in what layer of skin?

A

Adipose tissue

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118
Q

Vertical mattress sutures are good in () skin, such as over the shin.

A

Thin/lax skin

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119
Q

Horizontal sutures require less stitching, but the main DISadvantage is that they are ()

A

Very difficult to do

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120
Q

What wound closure device is the LEAST reactive and most cost-effective?

A

Adhesive tape

Aka steristrips

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121
Q

T/F: A patient needs to come back to get dermabond removed.

A

False. Sloughs off on its own after 5-10 days.

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122
Q

Why is debridement generally avoided on the face/scalp?

A

Because it is so vascularized, it generally heals itself well.

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123
Q

Forehead wounds that fall () to the lines of skin tension, () to muscle fibers yield the best cosmetic results.

A

Parallel to skin tension, perpendicular to muscle fibers

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124
Q

Forehead muscle fascia should be closed via ()-0 suture, whereas the epidermal layer should be closed via ()-0 suture.

A

5-0 for muscle, 6-0 for epidermal

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125
Q

These 5 kinds of eye injuries should be referred to ophtho instead:

  • Involves the () surface of the eyelid
  • Wounds that go across () margins
  • Injuries to the lacrimal ()
  • Wounds with associated ()
  • Injuries that extend into the () plate
A
  • Inner surface of eyelid
  • Wounds going across lid margins
  • Injuries to the lacrimal duct
  • Wounds with associated PTOSIS
  • Injuries extending into the TARSAL plate
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126
Q

Eyelid injuries within 6-8mm of the () are at risk of canalicular laceration.

A

Medial canthus

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127
Q

The most important assessment of nasal lacerations is to determine their () and involvement of ()

A
  • Depth
  • Deeper tissue layers and septum
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128
Q

A septal hematoma of the nose can produce 3 major complications:

  • Permanent () of the septum
  • Necrosis and () of the septum
  • Septal erosion leading to a () deformity
A
  • Permanent thickening
  • Erosion
  • Saddle Nose Deformity
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129
Q

Besides checking the nose in direct blunt trauma, you must check the cribiform plate to see if there is any () rhinorrhea

A

CSF rhinorrhea

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130
Q

For superficial lacerations to the nasal skin, you should use a (size) (abs/non-abs) monofilament simple interrupted stitch.

For anything deeper, you use (size)

A
  • 6-0 Non-absorbable
  • 5-0 absorbable for deeper

Since its at the skin surface.

Same for ears pretty much, just use 6-0 non-absorbable

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131
Q

Mucosal lip lacerations do NOT need sutures if they are () and the wound edges sponatenously ()

A

Isolated with spontaneous approximation

Otherwise, big gaping wounds need absorbable 5-0.

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132
Q

Lip laceration suture techniques are decided by the () border.

A

Vermilion border

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133
Q

Lip lacs that do NOT include the vermilion border should be closed in ().

A

Layers

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134
Q

The order in which you close a lip lac WITHOUT vermilion border inclusion:

  1. Mucosal layer: (size) (abs/non-abs)
  2. Orbicularis oris muscle fascia with (size) (abs/non-abs) via simple int or horizontal mat
  3. Skin with (size) (abs/non-abs)
A
  • Mucosal: 5-0 absorbable
  • Muscle fascia: 4-0 or 5-0 absorbable
  • Skin 6-0 NON-absorbable
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135
Q

The process in which you suture lip lacs WITH vermilion border involvement:

  1. First stitch must repair vermilion border via (size) (abs/non-abs) suture to align edges precisely
  2. Repair vermilion + skin with (size) (abs/non-abs)
  3. Repair mucosa + muscle with (size) (abs/non-abs)
A
  1. 6-0 nonabsorbable for first stitch
  2. Vermilion + skin with 6-0 nonabsorbable
  3. Mucosa + muscle with 5-0 absorbable
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136
Q

Intraoral lacerations only need closure if they are large enough to () or have a tissue flap that interferes with ()

A
  • Trap food
  • Interferes with chewing
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137
Q

An intraoral suture uses (size) (abs/non-abs)

A

4-0 absorbable

Drip some 1% lido in their wound first

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138
Q

Most cheek/facial lacs can be repaired via 6-0 non-abs or dermabond and stuff. However, if the () duct is injured, operative repair is indicated.

A

Parotid duct

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139
Q

In a full-thickness cheek lac, you want to repair the wound in ()

A

Layers

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140
Q

Scalp sutures/staples should be removed after () days

A

14 days

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141
Q

Forehead, external ear, or lip sutures should be removed after () days

A

5 days

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142
Q

Eyelid, nose, or face sutures should be removed after () days

A

3-5 days

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143
Q

Intranasal packing should be removed after () days

A

1-2 days

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144
Q

Generally, the wrist, forearm, and hand should use (size) sutures, while the arm should use (size) sutures.

A
  • Wrist/forearm/hand: 5-0
  • Arm: 4-0
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145
Q

An upper extremity wound is generally more prone to infection if it is sutured more than () hours after the injury occurred.

A

> 12 hrs post injury

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146
Q

The mainstay of treating a subungal hematoma is via…

A

Trephination of the nail plate

Stabbing a hole in the nail via scalpel or cautery

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147
Q

You should only remove a nail if there is associated partial () or surrounding () disruption

A
  • Associated partial nail avulsion
  • Surrounding nail bed disruption
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148
Q

Generally, foot and leg wounds use (size) sutures and are removed after (0 days.

A
  • 4-0 sutures
  • 10-14 days.
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149
Q

T/F: You should remove all foreign bodies within soft tissue

A

False. Weigh risk vs benefit

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150
Q

Any splinter parallel to skin surface should be removed along its () axis

A

Long

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151
Q

The technique to remove deep fishhooks is…

A

Advance-and-cut

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152
Q

For normal fishhooks, the most successful technique is…

A

Incision technique

Make wound entrance bigger

153
Q

The MC organism seen in puncture wounds

A

Staph aureus

154
Q

The MC organism in plantar puncture wounds that resulted in osteomyelitis

A

Pseudomonas

155
Q

ABX prophylaxis is indicated in puncture wounds that are (location), due to a (), or with heavy ()

A
  • Plantar located
  • Due to a bite
  • Heavy contamination
156
Q

ABX prophylaxis for a established infected puncture wound are (), () or ().

If it is a plantar puncture, you must use ()

A
  • Normal infected wound: First-gen cephalo, augmentin, or FQ.
  • Plantar: Ciprofloxacin (anti-pseudomonal FQ)

F/u in 48 hrs!

157
Q

For needle sticks, you can get Post-exposure prophylaxis for () and (), but not ()

A
  • HIV and Hep B
  • You’re out of luck for Hep C
158
Q

In high pressure wounds, it is recommended to avoid (), which can increase pressure in the finger compartments. Ideally, you should do surgical () within 6 hours to reduce the risk of subsequent ()

A
  • Avoid digital nerve blocks
  • Do surgical debridement
  • Reduces risk of amputation
159
Q

Bites

The current practice is to () primary wound closure in patients with systemic immunodeficiencies and higher-risk wounds

A

AVOID PRIMARY WOUND CLOSURE

Suturing showed higher infection rate. Re-eval in 24-48 hrs!

You just debride and clean

160
Q

The MC organism within dog and cat bites is…

A

Pasteurella Multocida

161
Q

ABX are indicated in bite wounds:

  • all (animal) bites
  • Bites in () hosts
  • (animal) bites that puncture
  • hand wounds
  • Any injury that will undergo surgical repair
A
  • All cat bites
  • Immunocompromised hosts
  • Dog bites that puncture

Use augmentin.

Pen V or ampicillin works for Pasteurella infections too

162
Q

In PCN-allergic pts, the abx for a cat bite is () or ().

For a dog bite, it is () + ()

A
  • Cat bite: doxy or cefuroxime
  • Dog bite: clinda + FQ
163
Q

What is worse, a human bite or a cat/dog bite?

A

A human bite

164
Q

What is one of the MC ways you can get a human bite equivalent injury?

A

Closed-fist injury

Punching their mouth

165
Q

There is a very specific G- rod that is present in human bites known as (E)

A

Eikenella corrodens

166
Q

The initial ABX for a human bite is:

A

Cephalexin

Augmentin alternative.

You should give to every human bite unless its extremely superficial.

167
Q

The only place where you SHOULD do primary wound closure on a human bite is…

A

Face

168
Q

The treatment for a rodent is IV () followed by oral ()

A
  1. IV PCN for 5-7 days
  2. Oral PCN for 7 more days
169
Q

Freshwater fish bites can contain (bacteria), which saltwater can contain (bacteria)

ABX for freshwater bites is:
ABX for saltwater bites is:

A
  • Freshwater = aeromonas = FQ or bactrim
  • Saltwater = Vibrio = FQ or doxy

Salty docks vibrate, Fresh arrows are trimmed

170
Q

Rabies MC comes from () in the US

A

BATS

171
Q

Tetanus guidelines

A
  • No tetanus vaccination or Ig if minor wound with complete vaccination hx.
  • Tdap + Ig is for incomplete hx and contaminated wound
172
Q

After draining an abscess, your patient should follow up in () days

A

2-3 days

173
Q

() is slow in onset and chronic in nature

A

Dementia

174
Q

() is an acute change in attention and mental functioning

A

Delirium

175
Q

If a patient presents with neuro deficits and AMS, the first thing you focus on is…

A

their LOC

176
Q

If you have an AMS patient that is also hypoxic, you should probably order a ()

A

ABG

177
Q

The main restriction to using a simple mask or NRB over NC is (time)

A

NRB and simple mask can only be used for a few hrs.

178
Q

There are 3 things you can administer IV for an AMS patient that are pretty much 0 risk. They are:

A
  • Dextrose
  • Thiamine
  • Naloxone
179
Q

You have treated the pt’s vitals and started 2 large bore IVs. They are currently stable. Your next step is to…

A

Obtain history

180
Q

Very abrupt onset of AMS is most likely () or () or seizures.

A

Ischemia or SAH

181
Q

Associated symptoms in a neuro history

A

Have fun

182
Q

GCS scale (better know this)

A
  • EYES: spontaneous, verbal, pain, none
  • VERBAL: oriented, confused, weird responses, weird SOUNDS, none
  • Motor: Obeys, Goes towards pain, withdraws from pain, Decorticate, Decerebrate, None

Decorticate = protect the core

183
Q

A neuro deficit usually suggests a () abnormality of the brain

A

Structural

184
Q

What lab measure serum ketones?

A

Serum-beta-hydroxybutyrate

185
Q

You suspect SAH but CT non-con was negative. Your next test is a ()

A

LP

186
Q

Delirium generally occurs over ()

A

Hours-days

187
Q

The two agents used for acutely agitated delirious patients are:

A
  • Haldol PO/IM (monitor for EPS and QT prolongation)
  • Ativan PO/IM/IV (monitor for resp depression)

Haldol is an antipsychotic. Ativan is a benzo

Same tx for dementia pts with dangerous behaviors

188
Q

Prior to discharging someone you gave Narcan to, you should observe them for ()

A

1-1.5 hours!

Narcan has a shorter half-life than some opiates.

Also consult psych if it was accidental. Intentional OD = SI attempt

189
Q

Hypoglycemia is < () in symptomatic children and > () in asymptomatic children

A
  • < 45 if symptomatic
  • < 35 if asymptomatic
190
Q

Neonates with hypoglycemia get () over 3-5 minutes, whereas Infants and Older children get () over 3-5 minutes. Maintenance dosing is with ()

All dextrose %s

A
  • Neonates: D10W
  • Infants/older children = D25W
  • Maintenance = D10W

Glucagon if no IV access

191
Q

In adults, hypoglycemia is treated with (dextrose %) over 3-5 minutes and with a continuous infusion of (dextrose %)

A
  • D50W for adults
  • D10W for maintenance to keep > 100

Glucagon for no IV

192
Q

() is used for hypoglycemia that is refractory and related to (diabetic drug) use

A

Octreotide to counter sulfonylurea usage

SC injection

193
Q

T/F: You should remove insulin pumps if a patient is becoming hypoglycemic

A

False. Consult endo to lower tha basal rate.

194
Q

Generally, the only people that need to be admitted for hypoglycemia are those on (drugs)

A

Sulfonylureas for serial glucose monitoring

195
Q

Insulin has 5 main actions:

  • () into cells
  • () into cells
  • () environment
  • Inhibits the breakdown of ()
  • Inhibits the breakdown of ()
A
  • Glucose into cells
  • K+ into cells
  • Anabolic environment
  • Inhibits fat breakdown
  • Inhibits protein breakdown
196
Q

DKA is more common in type (1/2) diabetics

A

Type 1!

197
Q

The 6 Is of DKA are:

A
  • Infection
  • Infarction
  • Insult (to the body)
  • Infant (pregnancy)
  • Indiscretion (lack of care)
  • Insulin (absence
198
Q

Of hyperglycemia, volume depletion, and acidosis, the first symptoms will be from…

A

Hyperglycemia

199
Q

DKA

The diagnostic criteria:

  • BG > () mg/dL
  • Anion Gap > () to ()
  • Bicarb < ()
  • pH < () with moderate ketonuria or ketonemia
A
  • BG > 250
  • AG > 10-12
  • Bicarb < 15
  • pH < 7.3
200
Q

You shoulder order an EKG in a DKA patient in in order to check if they are having a () or if they have ()

A
  • MI
  • Hyperkalemia
201
Q

RFs for DKA with initial BG of < 250

A
202
Q

The very first step of DKA management is…

A

Fluid resuscitation!!!!

203
Q

Potassium correction in DKA is divided into 3 sections:

  1. If K > 5.2, you use ()
  2. If K is 3.3-5.2, you use () with ()
  3. If K is < 3.3, you use ()
A
  • > 5.2 = only need insulin.
  • 3.3-5.2 = 20-30 mEq of K to each LITER of NS + insulin
  • < 3.3 = only need K
204
Q

Once volume status is corrected and potassium is being corrected, your next step in management of DKA is…

A

Insulin therapy

0.1 and 0.1 units per kg if you bolus, otherwise 0.14 units per kg

205
Q

The first infusion of insulin you give in DKA is primarily to treat what?

A

Potassium levels

206
Q

The goal glucose reduction rate per hour in DKA is… ()

A

75 mg/dl/hr

207
Q

Your patient in DKA needs glucose reduction. They started at 250, but after one hour, they’re at 240 even with an insulin drip. They weigh 70 kg. You should give (amt) of insulin via (bolus/drip)

A

9.8 units of insulin BOLUS

70 kg * 0.14 Units/kg

208
Q

Your patient in DKA needs glucose reduction. They started at 450, but after one hour, they’re at 350 with an insulin drip. They weigh 70 kg. You should do what next???

A

Halve their insulin drip

209
Q

Your patient in DKA is being glucose monitored. They started at 275, and after one hour, they’re now at 200 with an insulin drip. They weigh 70 kg. You should switch their fluids to () and decrease their insulin dose to ()

A
  • Switch fluids to D5W
  • Decrease insulin to 1.4-3.5 Units/hr
210
Q

Electrolytes, AG, and ABG/VBG should be rechecked every () hours in DKA.

A

Every 2 hours

211
Q

In a pH of less than 6.9 in DKA, you can consider giving () in water with K+ until pH is at least 7.

A

Bicarb

But just consider.

212
Q

The MC type of CVA is a…

A

Ischemic CVA

213
Q

The most important thing to know in history for a CVA is…

A

Last known normal time

214
Q

The goal time for a NON-con head CT to be done for a CVA is… () minutes of arrival. It is most sensitive within () hours.

A
  • 25 minutes upon arrival
  • 6 hours is highest sens
215
Q

The normal position for a stroke patient is…

A

Supine

216
Q

Antipyretics are only indicated in CVA if temperature is greater than…

A

100.4F/38C

217
Q

In an ICH with an SBP of 150-220, you should lower their SBP to () within () hours

A

Goal of 140 SBP in 1 hour

218
Q

In an ICH with an SBP > 220, you want to get their SBP down to ()

A

140-160 SBP

219
Q

The 3 first-line antiHTNs for lowering BP in a CVA are…

A
  • Labetalol
  • Nicardipine
  • Clevidipine
220
Q

In order for tPA to be administered for an ischemic stroke, SBP must be below () and DBP must be below ()

A
  • SBP <= 185
  • DBP <= 110

Labetalol, nicardipine, clevidipine

221
Q

In an ischemic stroke that is not eligible for tPA, the goal SBP and DBP are

A

Only treat if > 220/120 or signs of end-organ damage.

Labetalol, nicardipine, clevidipine

222
Q

tPA can only be used in a () stroke, within () hours of symptom onset, and a patient older than () years

A
  • Ischemic stroke
  • 4.5 hours of onset
  • 18 years or older

Also get informed consent and do exclusion criteria

223
Q

tPA is administered to your ischemic CVA patient. You need to perform neuro checks every () minutes for 3 hours and then every () for 6 hours. You also need to make sure their BP is under ()/()

A
  • Q15 mins x 3 hours
  • Q30 mins x 6 hours
  • 185/105
224
Q

Thrombectomy can be done if tPA is contraindicated or if a patient has a NIHSS of (less than ). It is specifically for a () artery occlusion in the () circulation with a small infarct core and non-hemorrhagic. It must occur within () hours of onset.

I feel like elkins meant to write less than for NIHSS?

A
  • NIHSS >= 6
  • Large artery occlusion in anterior circulation
  • Must be done within 24 hrs of symptom onset.
225
Q

T/F: You should workup a TIA like a stroke

A

True

226
Q

(Auditory/Visual) hallucinations are more suggestive of a medical etiology, whereas (Auditory/Visual) hallucinations are more suggestive of a psychiatric etiology.

A
  • Visual = medical
  • Auditory = psychiatric

Lewy Dementia = Visual hallucinations, which is a medical etiology.

227
Q

T/F: UDS and BAC are necessary for awake, alert, and cooperative patients.

A

FALSE

228
Q

You should be at least () arms lengths from a violent patient and () access to the door

A
  • 2 arms length distance
  • At least equal access to door
229
Q

SAFEST approach stands for…

A
  • Spacing
  • Appearance
  • Focus
  • Exchange
  • Stabilization (Ativan to sedate)
  • Treatment
230
Q

Sedation is achieved using (), whereas chemical restraint is achieved using ()

A
  • Sedation is via ativan
  • Chemical restraint is via Haldol Q30minutes
231
Q

You should only use physical restraints on a patient when they pose an () or () evaluation/treatment

A
  • IMMEDIATE threat
  • Obstruct eval/treatment

Also document why

232
Q

The two sets of symptoms you should monitor when administering Haldol are…

A
  • EPS (extrapyramidal symptoms)
  • QT Prolongation
233
Q

Overall, the best screening approach to a suicidal patient is asking () questions

A

General questions about emotional state

234
Q

A high risk of suicide via Assessment of Suicide risk is greater than () pts.

A
235
Q

T/F: Males are at higher risk for suicide.

A

True

we r on the assessment thing

236
Q

A high SI risk patient must be admitted. Involuntary admission consists of () performing an evaluation while the ED provider issues a temporary hold lasting () hours.

A
  • Mental hygiene commissioner writes longer holds
  • ED provider can write a 24-hour temporary hold.
237
Q

Generally, a moderate SI risk patient is treated outpatient if:

  • No () needed
  • Therapy is established ()
  • Development of a ()
A
  • No medical intervention needed
  • Therapy is established immediately with close follow-up
  • Development of a safety plan
238
Q

T/F: A “no harm/suicide prevention” contract is useful in preventing suicidal behavior

A

False.

239
Q

() describes an agreement to treatment and proper follow-up.

A

Joint safety plan

240
Q

T/F: Any adult can apply to have an individual involuntarily committed for homicidal ideation.

A

True.

241
Q

The first thing you do with a patient that rolls into the ED with poison on her is..

A

Gross decontamination prior to assessment

242
Q

T/F: Most toxidromes will respond to IVF.

A

False.

243
Q

What do you give first, thiamine or dextrose?

A

THIAMINE

GLucose first => worse wernicke’s encephalopathy

244
Q

A new onset seizure that needs pharm tx should first be managed with IV (), but if it persists, you should () the dose. If it really persists, you should give IV () and intubate.

A
  1. Start with IV ativan
  2. Double ativan
  3. Phenobarbital and intubate
245
Q

The treatment for isoniazid-induced seizures is…

The I in RIPE therapy for TB tx :)

A

Vit B6 pyridoxine

246
Q

() is highly ineffective for tx of seizures due to poisonings.

A

Phenytoin

247
Q

Anticholinergics will cause your pupils to (), whereas cholinergics cause them to ()

A
  • Anticholinergic = mydriasis/dilation
  • Cholinergic = miosis
248
Q

You suspect your poisoned patient was a drug mule for cocaine. You should order what imaging to confirm your suspicion?

A

Abd XRAY

249
Q

T/F: A tox screen is indicated in patients with accidental ingestion and are asymptomatic with a consistent history.

A

FALSEEE

250
Q

Ethlyene glycol poisoning/antifreeze poisoning can present with what kind of crystals in the urine?

A

Calcium oxalate

251
Q

The preferred method of decontaminating gastic contents is () if the ingestion was less than () hours prior to arrival. It is CONTRAINDICATED if the patient cannot maintain their own ()

A
  • Activated charcoal
  • Ingestion must be within 1 hour prior to arrival
  • Cannot use if airway cannot be protected

Also if the toxin doesn’t have an antidote already.

252
Q

T/F: Activated charcoal can bind tylenol, alcohol, metals, and corrosives.

A

FALSE

Cannot bind alcohol, metals, or corrosives

253
Q

Activated charcoal is best delivered via (NG/OG) tube.

A

OG tube

254
Q

Whole bowel irrigation is indicated in:

  • Ingestion of chemicals that () with charcoal
  • Ingestion of () packets
A
  • Poor binding chemicals with charcoal
  • Drug-filled packets
255
Q

T/F: Gastric irrigation does not require bowel sounds or normal peristalsis.

A

False.

256
Q

Multi-dose activated charcoal is using at least () doses of oral activated charcoal.

A

At least 2 doses

257
Q

Urinary alkalinization is primarily indicated in () poisonings

A

Moderate-severe salicylate poisonings

258
Q
A
259
Q

You must monitor (electrolyte) levels because hypo() will reduce urine alkalinity in salicylate poisoning tx.

A

Potassium levels, because HypoK will cause more H+ secretion instead

Goal: 4-4.5

Nephrooooo

260
Q

Hemodialysis can remove highly () bound drugs and highly () soluble drugs.

Hemoperfusion can remove () soluble low molecular wt substances.

A
  • Hemodialysis = protein bound and lipid solubles
  • Hemoperfusion = water-soluble low molecular weight substances

Very invasive, very expensive!

261
Q

In an inhaled poisoning patient, should you administer oxygen?

A

Yes silly

262
Q

You can irrigate eyes with either () or ()

A

Water or NS

263
Q

T/F: You should discard contaminated clothes.

A

Truee

Throw it out

264
Q

What is the poison control hotline???????

A

1-800-222-1222

265
Q

There are 3 Questions that must be addressed to determine if an exposure was NON-toxic:

  1. Was the exposure () and is there a clearly identified single substance?
  2. () of the agent was ingested
  3. Can the () confirm the substance is nontoxic at that dose?
A
  • Unintentional
  • How much was ingested
  • Can the CDC confirm?
266
Q

Overall, the mainstay of treatment for any poisoning is…

A

Treat the patient, not the poison!

267
Q

In a poisoned pt who is HTN and agitated, the drug of choice is…

A

BZDs

268
Q

Bicarb can be useful for ()-QRS tachyarrhythmias

A

Wide-QRS

269
Q

Naloxone can be administered 3 ways

A
  • IV
  • IM
  • IN
270
Q

The supportive care tx for cardiac arrhythmias is just correction of (), (), and administration of an antidote

A
  • Correct hypoxia
  • Correct any acid-base abnormalities
271
Q

You should consider aggressive cooling in a poisoned patient once their temperature reaches…

A

39C or 102.2F

272
Q

Re-warming is indicated once core temperature reaches…

A

< 32C or 90F

273
Q

AG Gap is calculated from:

A

Na - (Cl + HCO3)

Normal AG is 10-15

274
Q

AG Metabolic acidosis causes is memorized by the mnemonic CAT MUDPILES.

A
275
Q

In AG Metabolic acidosis, the first management step involves addressing any lack of () first.

A

Any lack of respiratory compromise is the first thing to check!!!!!

276
Q

The presentation of narcotic/opioid toxidrome is memorized with the mnemonic CPR-3H

A
  • Coma
  • Pinpoint Pupils
  • Respiratory Depression
  • HypoTN
  • Hypothermia
  • Hyporeflexia
277
Q

MATHS is the mnemonic for sympathomimetic

A
  • Mydriasis/muscle cell death
  • Agitation/Arrhythmia/Angina
  • Tachycardia
  • HTN/hyperthermia/Hyperactive bowel sounds
  • Seizure/sweating
278
Q

The drug of choice for sympathomimetics toxicity is (). () is CONTRAINDICATED.

A
  • BZDs for sympathomimetic toxicity.
  • DO NOT USE BBs
279
Q

The two drugs that cause CHOLINERGIC toxicity are:

A
  • Organophosphate insectides
  • Carbamate insecticides

AKA insecticides

280
Q

The presentation of Cholinergic toxicity can be summed up in 3 words. () all over.

A

Crying all over

281
Q

There are two drugs given for cholinergic toxicity.

A
  • Atropine (Blocks muscaricin receptors)
  • Pralidoxime (reacttivates acetylcholinesterase)
282
Q

What very common medication used for motion sickness is also an anticholinergic like atropine :)

A

Scopolamine!

283
Q
  • Dry as a bone
  • Mad as a hatter
  • Full as a tick
  • Blind as a bat
  • Red as a beet
A

ANTIcholinergic toxicity

284
Q

You can differe anticholinergic toxicity from sympathomimetic toxicity via (skin) and (bowel sounds)

A
  • Dry skin
  • Decreased bowel sounds

This is anticholinergic

285
Q

The antidote for anticholinergic poisoning is…

A

Physostigmine

Cholinesterase inhibitor to increase Ach concentration

Used once convential fails.

286
Q

You can discharge someone home with anticholinergic toxicity after they have been asymptomatic for () hours

A

6 hours

287
Q

() and () are the MC drug classes + non-BZDs that can cause sedation/hypnosis

A
  • BZDs
  • Barbiturates
288
Q

For barbiturate poisoning that does NOT respond to supportive care, you should use enhanced excretion methods, such as () or ()

A
  • Repeated charcoal
  • Extracorporal removal (hemodialysis/perfusion)
289
Q

BZD ODs can be confirmed by the presence of (), and the reversal agent is (), but it can precipitate seizures!!

A
  • Respiratory depression
  • Flumazenil
290
Q

Same as for anticholinergic toxicity, you can discharge after () hours of no symptoms for sedative/hypnotic OD.

A

6 hours later

291
Q

Some of the biggest drugs that can cause serotonin syndrome are:

  • () inhibitors
  • () reuptake inhibitors
  • () in cough syrup
  • () antidepressants
  • L-(amino acid)
A
  • MAO inhibitors
  • SSRIs
  • DXM
  • TCAs
  • L-tryptophan
292
Q

The mnemonic for serotonin syndrome is HATS or SHAT which stands for

A
  • Hyperthermia, HTN
  • AMS, agitation
  • Tremor, tone (rhabdo), Tachycardia/pnea
  • Seizures
293
Q

Initially, you should treat serotonin syndrome with (), but if that + supportive care fails, you should use a serotonin receptor antagonist called ()

A
  • BZDs for agitation, tremors, and seizures
  • Cyproheptadine is a serotonin receptor antagonist
294
Q

T/F: All patients with serotonin syndrome get admitted.

A

TRUE

295
Q

A common ingredient found in cough syrup can be used as a hallucinogenic and it is ()

A

DXM

Dextromethorphan

Other hallucinogenics are like LSD, PCP, psilocybin/shrooms, ecstasy, ketamine

296
Q

For the agitation, hyperthermia, seizures, tachycardia and HTN in hallucinogenic OD, you should use ()

A

BZDs

297
Q

In refractory hallucinogenic OD, once BZDs fail, you should consider () or () for refractory HTN. Otherwise, you should consider inducing a ()

A
  • Nitroprusside or phentolamine for refractory HTN in hallucinogenic OD.
  • Induce a medical coma if refractory.
298
Q

Summary of all the toxidromes

A

Another simplified picture of the toxidromes

299
Q

About 1/4 of the 450 deaths due to tylenol/APAP toxicity are unintentional, because in child, () occurs

A

Supratherapeutic dosing

AKA too much tylenol by accident :(

300
Q

There are 4 demographics that are at an increased risk for APAP toxicity:

  • Chronic () use
  • AIDS
  • () use
  • anti-() therapy users
A
  • Chronic alcohol use
  • AIDS
  • Anticonvulsant use
  • anti-TB therapy user
301
Q

In a patient 6 years or YOUNGER, > 10g of tylenol or 200mg/kg as a single ingestion in a () time period is a toxic exposure. Once you are older than 6, the time period changes to over ().

A
  • 24 hours at first
  • Older is over 8 hours
302
Q

Tylenol toxicity presents with 4 stages of toxicity.

  • Stage 1 is characterized by: (symptoms) and (lab change)
  • Stage 2 is characterized by improvement, but (lab changes)
  • Stage 3 is characterized by ()itis and recurrent GI symptoms.
  • Stage 4 is characterized by either () or ()
A
  • Stage 1 = N/V + hypoK
  • Stage 2 = ELEVATED LFTs
  • Stage 3 = Pancreatitis + coagulopathy
  • Stage 4 = improvement or multi-organ failure/death.

Every day is about 1 stage.

303
Q

T/F: Even in an asymptomatic APAP OD patient, you should get serum APAP levels.

A

True

Can take 30-120 minutes to reach peak concentration!

304
Q

A rumack-matthew monogram is used in () toxicity. It is for clinical outcome determination and can only be used after acute ingestion between () to () hours

A
  • APAP toxicity
  • 4-24 hours

Just know tx above the line!

305
Q

The main drug of choice to counter APAP toxicity is.., and its MOA is to prevent metabolites from binding to () cells and diminishing hepatic ()

Within 8 hours of exposure.

A
  • Acetylcysteine PO/IV
  • Hepatic cell binding inhibitor
  • Diminishes hepatic necrosis
306
Q

Past the 8 hour window to use acetylcysteine for APAP toxicity, your last resort is (), and it is also used in patient demonstrating signs of ()pathy

A
  • Last resort: Extra-corporal excretion
  • Used in signs of hepatic encephalopathy, such as AMS/neuro deficits.
307
Q

You should request an serum APAP level if APAP ingestion occurred between () hours.

A

4-24 hours

Less or more = consider GI decontamination!

Gastric lavage/activated charcoal

308
Q

T/F: All patients undergoing acetylcysteine therapy for APAP toxicity must be admitted.

A

TRUEEE

309
Q

You should not expect LFTs to be elevated in APAP toxicity until how long?

A

Give it like a day or 2 at least

2-3 days is stage 2!

310
Q

The MC lab finding you would prob see in ETOH toxicity is…

A

Hypoglycemia

ETOH inhibits gluconeogenesis

311
Q

You only really need a BAC if you don’t know…

A

How much they ingested!

312
Q

Generally, a BAC of () or more is when you see reflexes/gross motor control start to take a hit in ETOH toxicity.

A

0.1 or higher

313
Q

At a BAC of (), you would probably see noticeable changes in breathing and pulse.

A

0.3 or higher

314
Q

IV thiamine is primarily used in ETOH toxicity if there is a ()

A

Hx of chronic ETOH use.

315
Q

Pt presents to the ED. Was binge drinking and vomited a little. No hx of chronic ETOH abuse. No SI/HI. Pretty solid health history. His glucose is about 40. Your dispo for this patient is to….

A

Give some IV dextrose and observe in ED until sober and then d/c

316
Q

Ingestion of () is ethylene glycol poisoning.

A

Antifreeze

100 mL or a 1/2 cup is a LETHAL DOSE

317
Q

Ethylene glycol is processed in the liver and makes a (acid/base), eventually leading to metabolic (acid/base) and end-organ damage.

A

Oxalic acid, leading to metabolic acidosis

318
Q

Generally, the first set of symptoms you would see in a patient presenting with antifreeze/ethylene glycol toxicity is…

A

CNS depression after 1 hr

In just 12 hours, you will show end-organ signs

319
Q

ABG for ethylene glycol toxicity should show a wide AG metabolic () and a UA can be fluoresced to show () crystals.

A
  • High AG metabolic acidosis
  • Calcium oxalate crystals

Oxalic acid

320
Q

BEcause serum ethlyene glycol levels take 2 days to come back, we prefer to determine exposure amount based on serum (). A () > 50 is highly suggestive of ethylene glycol poisoning.

A

Serum Osmolality gap

321
Q

You should only use Bicab for alcohol toxicity if the pH is less than …

A

7.2

322
Q

Specifically in ethylene glycol, you use two drugs for the metabolic blockade.

The first drug is (), which inhibits alcohol dehydrogenase and prevents breakdown of EG into its toxic metabolites.

The 2nd drug is (), which is used because it has a higher affinity for alcohol dehydrogenase than EG.

A
  1. Fomepizole IV
  2. Ethanol
323
Q

Besides metabolic blockade for ethylene glycol toxicity, you can do () in more severe symptoms.

A

Hemodialysis

324
Q

T/F: B vitamin therapy for EG toxicity is very helpful.

A

False

325
Q

If you are uncertain about if someone actually ingested EG, you shoudl watch them for () hours, making sure they have a negative ethanol, no symptoms, no osmolar gap, and no presence of metabolic acidosis

A

6 hours

I think its 6 hours for everything =

326
Q

Besides aspirin, a common OTC drug that contains salicylate is…

A

Pepto Bismol

327
Q

Salicylate is converted to (), which can impair gastric emptying, leading to () formation

A

Salicylic acid, leading to bezoar formation

328
Q

Acute salicylate poisoning is DOSE Dependent:

  • < 150mg/kg = (ear) + N/V
  • 150-300 mg/kg = Tachy(), Hyperprexia, sweating, ataxia, anxiety
  • 300mg/kg + = (neuro) + ()failure

Note: these are not salicylate serum levels

A
  • < 150 = tinnitus, hearing loss
  • 150-300 = tachypnea
  • 300+ = AMS, seizures, heart/lung/renal failure
329
Q

A salicylate level measured greater than () mg/dL is considered toxic.

A

30 mg/dL or more

Note that it takes 4-6 hours to peak and you check hourly until peak.

330
Q

The first acid-base disorder in salicylate poisoning is (), but then it becomes ()

A

Respiratory alkalosis, followed by metabolic acidosis

I think of it as you start hyperventilating first, but as you convert it to salicylic acid, you get metabolic acidosis.

331
Q

You need to get () imaging if you suspect bezoar formation in salicylate poisoning.

A

Abdominal imaging

You would suspect if level rises despite gastric lavage/charcoal

332
Q

Your patient’s salicylate level is rising steadily every hour despite adequate gastric lavage and activated charcoal. Your next step in management should be…

A

Order abdominal imaging to check for bezoar formation

333
Q

The two ways to reduce salicylate burden in salicylate toxicity is by () urine with (), or in more severe cases, doing ()

A
  • Mod-severe: Urinary alkalinization via bicarb (FIRST-LINE)
  • Severe: hemodialysis (also if renally impaired)
334
Q

Bezoars can be removed…

A

Surgically

335
Q

The MCC of abnormal vaginal bleeding in a PRE-menarcheal girl is…

A

Trauma/abuse :(

336
Q

The MCC of abnormal vaginal bleeding once you hit reproductive age is…

A

Coagulopathies

It was first on her slide so im guessing MC

337
Q

The MCC of abnormal vaginal bleeding in a POST-menopausal woman is…

A

Exogenous hormones

That OCP MHT

338
Q

An unstable abnormal vaginal bleed can be treated with IV (), but a stable abnormal vaginal bleed can be treated with oral ()

A
  • IV Estrogen
  • Oral short-term MHT or TXA
339
Q

The 5 RFs for an ectopic pregnancy are:

  • Prior () pregnancy
  • Prior () surgery
  • () infections
  • () disease
  • (-osis)
A
  • Prior ectopic
  • Prior abd/pelvic/fallopian tube surgery
  • STIs
  • PID
  • Endometriosis

Also smoking + older with fertility issues

340
Q

The classic triad of ectopic pregnancy is:

  • () pain
  • () bleeding
  • ()rrhea
A
  • Abdominal pain
  • Vaginal bleeding
  • Amenorrhea
341
Q

Which hCG lab test is preferred and WHY

A

Quantitative is preferred, aka it gives you an actual number like 30.

342
Q

The first US you would get of a suspect ectopic pregnancy is…

A

TransABDOMINAL (bladder full)

TVUS is empty bladder

343
Q

A typical home pregnancy test is the equivalent of hCG being ()

A

20

344
Q

T/F: An unstable vaginal bleed in early pregnancy (< 20 weeks) with an Rh+ mother and Rh- fetus requires Rhogam and emergent OB consult.

A

False. It is for Rh- mothers with an Rh+ fetus

345
Q

() describes the implantation of the placenta over the cervical os

A

Placenta previa

346
Q

A pool of fluid in the posterior fornix is diagnostic of …

A

PROM

347
Q

() describes vaginal bleeding in the first 20 weeks of pregnancy with a closed cervical os, benign exam, and no passage of tissue.

A

Threatened abortion

348
Q

() describes partial passage of conceptus, usually between 6-14 weeks.

A

Incomplete abortion

349
Q

() describes fetal death at less than 20 weeks without passage of any fetal tissue for 4+ weeks after fetal death

A

Missed abortion

350
Q

The only two abortion types that require a D&C are…

A
  • Incomplete: partial passage of products of conception
  • Missed: fetus died 4 weeks ago
351
Q

The empiric ABX for septic abortion are () or (), along with ()

A
  • Unasyn or clinda
  • Gentamicin
352
Q

The timeframe for chronic HTN is beginning before () gestation or lasting () weeks after delivery

A

Started before 20 weeks or lasting 12+ weeks after delivery

AKA it already existed or it existed way beyond pregnancy

353
Q

The time frame for gestational HTN is after () weeks gestation or in the immediate () period.

A

After 20 weeks gestation or with immediate postpartum period.

354
Q

Elevated BP in pregnancy is SBP greater than () OR DBP > 90 on () occasions more than () hours apart.

A
  • > 140
  • > 90
  • 2 occasions more than 4 hours apart
355
Q

You should treat gestational HTN via ()

A

Lifestyle modifications

356
Q

The presence of () turns gestational HTN into pre-eclampsia.

A

Proteinuria >= 300mg in 24 hrs

Alternative criteria linked

357
Q

Besides proteinuria, HELLP syndrome is basically the equivalent to pre-eclampsia. It stands for…

A
  • Hemolysis
  • Elevated LFTs
  • Low Platelets

HELLP!!!!!!

358
Q

Severe pre-eclampsia is pre-eclampsia + ()

A

End-organ involvement

359
Q

Pre-eclampsia becomes eclampsia once () occurs.

A

Seizures

360
Q

In HELLP syndrome, () may not be present, which is always present in pre-eclampsia

A

HELLP does not always have elevated BP!!!

But it is a clinical variant of pre-eclampsia

361
Q

Besides focused US for pre-eclampsia evaluation, you can also order a…

A

CT Abdomen

362
Q

The DOC for both severe pre-eclampsia and eclampsia is…

A

IV MgSO4 4-6g

363
Q

Severe HTN in pregnancy (with a goal to reduce by (%)), is either using () or ()

A
  • 10% reduction in BP is goal
  • IV Labetalol
  • IV Hydralazine
364
Q

Overall, the definitive way to solve severe pre-eclampsia/eclampsia is…

A

Delivering the fetus!

365
Q

Pelvic pain is usually due to gynecologic pathology, but you must always get a ()

A

ALWAYS GET A PREGNANCY TEST N REPRODUCTIVE AGED WOMEN

366
Q

Primary dysmenorrhea is essentially () pain that comes () period

A

Crampy abdominal pain before or after prior

NOT DURING

367
Q

Mittelschmerz is pelvic pain that occurs () period

A

DURING period (ovulation)

Mittel like Middle

368
Q

Ovarian cyst rupture causes (side) pain

A

Unilateral

369
Q

You should be concerned about an ovarian cyst if it is greater than () cm, multi(), or (consistency)

A
  • Greater than 8cm
  • Multiloculated
  • Solid

Normally just fluid filled

370
Q

() describes sudden onset of unilateral, severe adnexal pain with N/V and fever. They have a hx of chemical ovulation.

A

Ovarian torsion

371
Q

() describes chronic inflammation within the pelvis resulting from ()tissue implanting outside the uterus

A
  • Endometriosis
  • Endometrium-like tissue
372
Q

T/F: Leiomyomas are benign smooth muscle tumors in the uterus and/or GI tract.

A

Trueeee

Uterine fibroids, the big single ones

373
Q

PID encompasses 4 diseases:

  • ()itis
  • ()itis
  • () abscess
  • Pelvic ()itis
A
  • Endometritis
  • Salpingitis
  • Tubo-ovarian abscess
  • Pelvic Peritonitis
374
Q

PID has 3 groups of diagnostic criteria:

  • Group 1 (minimum criteria): () tenderness and () motion tenderness
  • Group 2 (increased specificity): (systemic), Secretions elevated ESR/CRP, positive ()
  • Group 3 (procedures based): lappy, Pelvic US/MRI, () biopsy
A
  • Group 1: Uterine/adnexal tenderness and cervical motion tenderness
  • Group 2: Fever, positive pelvic cultures
  • Group 3: Endometrial biopsy
375
Q

T/F: PID is a risk factor for ectopic pregnancy and infertility

A

TRUEEE

376
Q

Pelvic pain is initially evaluated via a (imaging)

A

TVUS

377
Q

T/F: A tubo-ovarian abscess causing pelvic pain is an indication to admit.

A

Trueee

378
Q

2 ways to treat PID via IVs:

  • () or (), with ()
  • (), plus ()
A
  • Cefotetan or cefoxitin, plus doxy
  • Clinda plus gentamicin
  • alternate: unasyn + doxy

Tin tan goes the dock, clint is a gentleman to women

379
Q

If FQ resistance is high

Oral/OP tx of PID:

  • () IM once, or () IM once with probenecid ORRRR
  • another 3rd gen cephalo with () +/- Metronidazole

I wrote more important slide?

A
  • Rocephin or Cefoxitin + probenecid
  • 3rd gen + doxy +/- metro

Emergency Medicine (4 decks)

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