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MTBs Step 3 > EM & Radiology > Flashcards

EM & Radiology Flashcards

1
Q

What test would you order to r/o cranial hemorrhage?

A

Noncontrast head CT

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2
Q

What test would you order to assess AV malformations or metastatic cranial tumors?

A

head CT with contrast

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3
Q

When is an abdominal pelvic CT most useful?

A

to look at retroperitoneal structures

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4
Q

When is MRI the best test to order?

A

evaluating: demyelinating diseases, posterior fossa, base of skull, orbit, acoustic neuromas, pituitary tumors, intraparenchymal brain tumors, bone tumors, soft tissue infections, joint spaces, aseptic necrosis of the femoral head, disease of the spinal cord and spinal column.

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5
Q

What patients can not get CT or MRI with contrast?

A
  1. Cr >/= 1.5
  2. those with multiple myeloma
  3. those on metformin(must d/c before IV contrast and continue 48 post after r/o kidney dmg)
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6
Q

Patient comes in to the ER with AMS. You have no idea wtf is wrong. Whats the first thing you can order to help them knowing nothing?

A
  1. Naloxone, Thiamine & dextrose

2. Oxygen & Saline

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7
Q

When can you use Ipecac/induce vomiting? when is there a clear C/I?

A

withing the first hour of an OD.

C/I with AMS & children

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8
Q

When can you give charcoal?

A

always. it will never hurt anyone.

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9
Q

Whats the antidote: Acetaminophen

A

N-acetylcysteine

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10
Q

Whats the antidote: ASA

A

Bicarb to alkalinize the urine and help with clearance

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11
Q

Whats the antidote: Benzos

A

NOTHING! do not give anything! let them sleep it off. it will not kill them. giving flumazenil may induce a seizure and is not worth it

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12
Q

Whats the antidote: CO

A

100% oxygen *someone comes in after fire? give them 100% oxygen

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13
Q

Whats the antidote: Digoxin

A

Digoxin-Abs

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14
Q

Whats the antidote: Ethylene Glycol

A

Fomepizole or Ethanol (same as meth)

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15
Q

Whats the antidote: Methanol

A

Fomepizole or Ethanol (same as EG)

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16
Q

Whats the antidote: Methemoglobinemia

A

100% O2 and Methylene blue (look for hx of anethetics or nitrate use!)

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17
Q

Whats the antidote: Neuroleptic Malignant Syndrome

A

Bromocriptine & Dantrolene

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18
Q

Whats the antidote: Opiates

A

Naloxone

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19
Q

Whats the antidote: Organophosphates

A
  1. Atropine 2. Pralidoxime
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20
Q

Whats the antidote: TCAs

A

Bicarbonate to protect the heart

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21
Q

Clinical course of Acetaminophen OD?

A

First 24hrs: N+V which resolves

48-72hrs: hepatic failure

22
Q

Treatment for acetaminophen OD?

A

charcoal & N-acetylcysteine(NAC)

*NAC can only prevent liver tox if given within 24 hrs

23
Q

Which dose of acetaminophen is toxic? which dose is deadly?

A 
Toxic = 10g
Deadly = 15g
24
Q

What symptom will always be present with ASA OD? Other symptoms?

A

Hyperventilating = ASA diretly stimulates the brainstem

  • Lung toxicity = RDS
  • CNS stim = fever, confusion, seizures, coma
  • toxic to kidney tubule = renal insufficiency
  • blocks VitaK = elevated PT
  • RESPIRATORY ALKALOSIS PRECEDES METABOLIC ACIDOSIS
25
Q

Which dx test should you order if you suspect ASA OD?

A

CBC, CMP, ABG, PT/INR/PTT, ASA level

26
Q

What is the tx for ASA OD?

A
  1. Charcoal = block further absorption
  2. Alkalize the urine = increase excretion
  3. Dialysis in severe cases
27
Q

Sx of CO poisoning?

A

SOB, lightheadedness, HA, disorientation, metabolic acidosis(severe cases)

*hx of fire

28
Q

Tx for CO poisoning?

A

100% O2

29
Q

Sx of Digoxin toxicity? tx?

A

GI Stuff(NV, Diarrhea, Pain), Yellow “halos”, blurred vision, Arrhythmias(PR prolongation), encephalopathy, HYPERkalemia

tx: digoxin-ab’s

30
Q

Ethylene glycol poisoning vs methanol poisoning symptoms?

A

Ethylene Glycol: intoxication, metabolic acidosis with increased anion gap, renal insufficiency(direct toxicity), hypocalcemia(Ca-oxalic acid stones), Kidney stones

Methanol: intoxication, metabolic acidosis with increased anion gap, visual disturbances, retinal hyperemia

31
Q

Ethylene glycol poisoning vs methanol poisoning treatment?

A

Ethanol or Fomepizole & dialysis

32
Q

Methemoglobinemia sx?

A

Cyanosis, SOB, Dizziness, HA, Confusion, Seizures

**Hx of NITRATE, ANESTHETIC, DAPSONE or other oxidant use

33
Q

What tests should you run if you suspect methemoglobinemia? what do you expect to see?

A

ABG = normal pO2 with chocolate blood, methemoglobin level

34
Q

tx for methemoglobinemia?

A

100% O2 & methylene blue to restore Hg to normal state

35
Q

Heat Stroke VS Heat Exhaustion

sx? tx?

A

Heat stroke = dry skin, AMS
*treat by spraying with water or ice packs/bath

Heat Exhaustion = excessive sweating, NV
*treat with IV NS and move to cool enviroment

36
Q

Opiate OD what kills you?

A

respiratory depression

37
Q

tx for acute opiate OD? tx for addiction?

A

OD: Naloxone
Addiction: buprenorphine

38
Q

wtf is buprenorphine?

A

partial opioid receptor moderator, used to detox pt or maintain those with chronic use

39
Q

Organophospate toxicity sx? What are organophosphates?

A

Organophosphates = inhibitors of acetylcholinesterase

sx: salivation, lacrimation, urination, diarrhea, wheezing from bronchospasm
* look for crop duster or someone exposed to nerve-gas attack

40
Q

Tx for organophosphate tox?

A

1st atropine to relieve sx
2nd pralidoxine
3rd remove clothes and wash

41
Q

TCA OD?

A

Dilated pupils, dry mouth, constipation, urinary retention

42
Q

Tx for TCA OD?

A

EKG to monitor for Vtach & torsades. Bicarb to alkinize

43
Q

Black Widow Spider bite sx & tx

A

Abdominal pain, rigidity, hypocalcemia (patient will look like they have a perforated abdomen but there is NO TENDERNESS)

tx: antivenin

44
Q

Brown Recluse Spider bite sx & tx?

A

local necrosis, bullae and dark lesion

tx: debriding the wound

45
Q

Centruroides Scorpion sx & tx

A

hx of sting, pain on tapping site, abnormal eye movements with normal mental status

tx: managing secretions, pain and airway

46
Q

Calculation for shit to give to burn pplz

A

%of body burnt x 4ml/kg = amount of LR or NS to give.

47
Q

Whats the most important thing to do for someone suffering from hypothermia?

A

EKG! = look for “J-waves of Osborn” = ST segment elevation

48
Q

Acute Altitude Sickness

sx? tx?

A

headache(like an alcohol hangover), malaise, slurred speech, abnormal coordination, sleep disturbance, acute pulmonary edema

tx: decend! *can be prevented by acclimating to 6k feet and taking acetazolamide or others(dexamethasone, nifedipine, tadalafil)

49
Q

Glaucoma

sx? tx?

A

sx: red eye with fixed midpoint pupil - rapid onset
tx: Pilocarpine drops = constricts pupil
others: Acetazolamide(decreases aq humor production), PG analogs(latanoprost, travoprost- increase outflow), BB(timolol), Alpha Ag(apraclonidine, brimonidine -decrease production)

50
Q

Retinal Detachment

sx? tx?

A

sx: “curtain coming down over eye”
tx: tilt head back & reattach retina(surgery, cryotherapy or injecting gas)

51
Q

Uveitis

sx? tx?

A

sx: red eye with photophobia
tx: steroids

52
Q

Retinal Artery vs Retinal Vein Occlusion

sx? tx?

A

BOTH: sudden unilateral loss of vision

Retinal Artery Occlusion: dark pale retina with diministed blood flow
tx: none, attempt thrombolytics, nitrogen, ocular massage

Central Retinal Vein Occlusion: light retina with congested blood in the eye
tx: VEFG inhibitors(ranibizumab or bevacizumab)

MTBs Step 3 (30 decks)

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