EM Review Cards Flashcards
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What is the name of the rash associated with Lyme disease?
Erythema Migrans
Rapid Review
Lyme Disease
- Most commonly caused by Borrelia burgdorferi carried by Ixodes tick
- History of being in the woods, hiking, or camping
**Sx
* Stage 1: erythema migrans (pathognomonic), viral-like syndrome (fever, fatigue, malaise, myalgia, headache)
* Stage 2: myocarditis, bilateral facial nerve palsy (pathognomonic for Lyme disease)
* Stage 3: chronic arthritis, chronic encephalopathy
* PE: slightly raised red lesion with central clearing, erythema migrans (bull’s-eye) rash
**Tx: doxycycline
* Children: amoxicillin or doxycycline (if used for < 21 days)
* Pregnant: amoxicillin
**Prevention after tick bite - doxycycline 200 mg in a single dose if:
* tick identified as Ixodes
* attached for ≥ 36 hours based on engorgement
* prophylaxis begins within 72 hours of tick removal
* doxycycline not contraindicated
Category: Environmental Disorders
Subcategory: Bites & Envenomation
Question: 695476
Rapid Review
Metabolic Abnormalities Associating With Purging Disorder
Metabolic Abnormalities Associating with Purging Disorder
* Metabolic alkalosis
* Hypokalemia
* Hypochloremia
What antidepressant medication should be avoided in patients with eating disorders?
Bupropion because it potentiates weight loss and reduces the seizure threshold in patients with electrolyte abnormalities.
EKG
What are the criteria for left anterior fascicular block (LAFB)?
- Slightly prolonged QRS duration (Not quite 120 msec or < 3 small boxes)
- Left axis deviation
- qR complex in leads I and aVL (Depolarization going towards these leads)
- rS complex in leads II, III, and aVF (Depolarization going away from these leads)
What are the electrolyte abnormalities seen in Addison’s disease?
- Hyponatremia 9most common)
- Hyperkalemia (next most common)
- Hypercalcemia
- Hypomagnesemia
Rivers’ 11th Edition Flash Cards (2024) - Endocrine, Metabolic, and Nutritional Disorders 1
The use of high-dose insulin therapy in diabetics is associated with which emergent complications?
Hypoglycemia, hypokalemia, hypophosphatemia, ARDS, and cerebral edema
Rivers’ 11th Edition Flash Cards (2024) - Endocrine, Metabolic, and Nutritional Disorders 2
Clinical presentation: A patient complaints of sudden onset of shortness of breath while dining out in a restaurant; he was not swallowing food when the symptoms began. Phyusical findings include inspiratory stridor and bilateral expiratory wheezing.
What is the most likely diagnosis?
Acute anaphylactic reaction
Rivers’ 11th Edition Flash Cards (2024) - Endocrine, Metabolic, and Nutritional Disorders 3
What therapy is indicated for the alcoholic who is acutely ill, dehydrated, and has the following laboratory values?
* Glucose 140 mg/dL
* Blood alcohol 0.00 mg/dL
* pH = 7.18
* Serum ketones elevated
This patient has alcoholic ketoacidosis. The treatment consists of fluid restoration and glucose. Some patients may have even modest hyperglycemia, but “refeeding” usually corrects this. Bicarbonate is not indicated.
Rivers’ 11th Edition Flash Cards (2024) - Endocrine, Metabolic, and Nutritional Disorders 4
What is the most common cause of euvolemic hyponatremia?
Syndrome of Inappropriate secretion of AntiDiuretic Hormone (SIADH)
Rivers’ 11th Edition Flash Cards (2024) - Endocrine, Metabolic, and Nutritional Disorders 5
What are common precipitating causes of diabetic ketoacidosis?
Inadequate administration of insulin, undiagnosed/unknown diabetes, infection, pregnancy, or stressors such as myocardial infarction, trauma, surgery, or substance abuse.
Rivers’ 11th Edition Flash Cards (2024) - Endocrine, Metabolic, and Nutritional Disorders 5
Which group of medications should be avoided in the treatment of delirium tremens?
Phenothiazines (they lower the seizure threshold, which can be a concern in patients with DTs who are already at risk of seizures
Rivers’ 11th Edition Flash Cards (2024) - Endocrine, Metabolic, and Nutritional Disorders 6
The use of high-dose insulin therapy in diabetics is associated with which emergent complications?
Hypoglycemia, hypokalemia, hypophosphatemia, ARDS, and cerebral edema
Rivers’ 11th Edition Flash Cards (2024) - Endocrine, Metabolic, and Nutritional Disorders 7
Beers Criteria
- American Geriatrics Society
- Medications to avoid or use with caution in older population
- At risk for drug-drug interactions
- Monitor for polypharmacy
- Deprescribe as necessary
Category: Other Components & Core Competencies
Subcategory: Practice Based Learning & Improvement
Question: 154345
In addition to the Beers Criteria, what is another tool for identifying inappropriate prescribing in older patients?
Screening Tool of Older Person’s Prescriptions (STOPP) also considers drug-drug interactions and duplication of medications within a class.
Category: Other Components & Core Competencies
Subcategory: Practice Based Learning & Improvement
Question: 154345
Which pathogen is associated with conjunctivitis and corneal ulceration in patients who wear contact lenses?
Pseudomonas aeruginosa
Neisseria gonorrhoeae Conjunctivitis
- Newborns ≤ 5 days old, sexually active adults
- Hyperpurulent discharge
- Corneal ulceration or perforation
- Admission
- Topical + IV antibiotics
Subcategory: Eye
Question: 166081
Category: HEENT Disorders
Transient Aplastic Crisis
Transient Aplastic Crisis
***** Risk factors: sickle cell anemia, iron deficiency anemia, or hereditary spherocytosis
* Sx: pallor, fatigue, lethargy, and shortness of breath
* Labs will show low or undetectable reticulocyte count and a drop in hemoglobin concentration of > 30%
* Most commonly caused by recent parvovirus B19 infection
* Tx: self-limited, transfusion support
Subcategory: Eye
Question: 166081
Subcategory: Red Blood Cell Disorders
Question: 142923
What bacteria are most commonly implicated in acute chest crisis?
Chlamydia pneumoniae in adults and Mycoplasma pneumoniae in children.
Category: Hematologic Disorders
Question: 142923
Chlamydial Conjunctivitis
Clinical presentation: A 1-year-old presents with intermittent abdominal discomfort and a palpable sausage-shaped mass in the right mid-abdomen.
What is the most appropriate therapeutic course of action?
Air insufflation or barium enema (BE)
These studies are useful both diagnostically and therapeutically since 90% of intussusception cases may be corrected if it is performed within the first 12-24 hours.
Note: Ultrasound should be the first diagnostic tool if the diagnosis is ambiguous.
Rivers’ 11th Edition Flash Cards (2024) - Pediatric Emergencies 10
What are the most common **signs/symptoms **of hypothermia in infants?
- Lethargy
- Decreased feeding
Remember, very young infants do not have the ability to shiver. They rely on non-shivering thermogenesis.
Rivers’ 11th Edition Flash Cards (2024) - Pediatric Emergencies 11
In addition to the rash, what are the characteristic physical findings of rubella (German measles)?
Lymphadenopathy involving the postauricular, posterior cervical, and suboccipital nodes. Conjunctivitis Imild nonexudative) and an exanthem on the soft palate may be observed in some cases. Forchheimer spots are pinpoint petechiae involving the soft palate that coalesce.
Rivers’ 11th Edition Flash Cards (2024) - Pediatric Emergencies 12
Brown Recluse Spider
- Brown violin shape on cephalothorax
- Southern midwestern United States
- Cytotoxin → local tissue destruction
- Antivenin (antivenom) unavailable
- Rx: supportive care
What North American crotaluine is notable for having a neurotoxic venom?
The Mojave rattlesnake
Category: Environmental Disorders
Subcategory: Bites & Envenomation
Question: 155149
Slipped Capital Femoral Epiphysis (SCFE)`
- Patient will be a boy 12–16 years old with obesity
- Progressive limp and hip or knee pain
- PE will show loss of hip internal rotation
- X-ray will show scoop of ice cream slipping off cone
- Diagnosis is made by AP and frog-leg lateral X-rays
- Treatment is non-weight-bearing and urgent orthopedic consultation
Category: Musculoskeletal Disorders (Nontraumatic)
Subcategory: Joint Abnormalities
Question: 103080
What is the most feared complication seen following acute slipped capital femoral epiphysis?
Osteonecrosis (avascular necrosis) due to disruption of the blood supply to the epiphysis occurs in 15% of patients and will often result in long-term degenerative hip joint changes, necessitating future total hip arthroplasty.
Category: Musculoskeletal Disorders (Nontraumatic)
Subcategory: Joint Abnormalities
Question: 103080
Rheumatic fever
- History of GAS infection
- Clinical: fever, arthritis, red skin lesions on the trunk and proximal extremities, and small, nontender lumps located over the joints, murmur
* J.O.N.E.S. criteria: joints, oh no—carditis!, nodules, erythema marginatum, Sydenham chorea - Labs: antistreptolysin O, anti-DNase B, positive throat culture, or positive rapid antigen test
- Tx: antibiotics, NSAIDs
Category: Immune System Disorders
Subcategory: Immune Complex Disorders
Question: 168727
True or false: treating group A Streptococcyus pharyngitis prevents subsequent acute rheumatic fever.
True. Adequate treatment of a documented streptococcal pharyngitis reduces the incidence of subsequent ARF by nearly 70 percent.
Perichondritis
- Infection of connective tissue of the ear
- Risk factors include trauma, burns, skin breakdown, piercing
- Consider I&D, obtain wound culture
- Antipseudomonal antibiotics
- ENT follow-up
Hearing Loss
Conductive
* Limitation of external sound in gaining access to the inner ear
* Weber: localizes to affected ear
* Rinne: abnormal (BC > AC)
* Most commonly caused by otitis media, serous otitis, and cerumen impaction
* Rarer causes: otosclerosis
Sensorineural
* Involvement of the inner ear, cochlea, or auditory nerve
* Weber: localizes to unaffected ear
* Rinne: normal (AC > BC)
* Most commonly caused by excessive noise exposure, drugs, and normal aging
Lateral Epicondylitis
- Tennis elbow
- Occupational overuse syndrome of wrist extensor tendons
- Tenderness at lateral epicondyle or 1–2 cm distal to epicondyle
- Pain with resisted wrist extension
- Weakened resisted grip
- Dx: clinical
- Tx: bracing, NSAIDs, avoid overuse activities
What cause of corneal ulcers typically shows dendritic lesions on fluorescein staining or slit lamp examination?
Herpes simplex virus?
Corneal Ulcer
Corneal Ulcer
Patient will have a history of trauma, incomplete closure, or extended contact lens use
PE will show oval ulcer with ragged edges, severe conjunctival inflammation
Most commonly caused by Staphylococcus, Pseudomonas( contact lens wearers), Streptococcus pneumoniae
Treatment is emergent ophthalmology consult
Alcohol Withdrawal Syndrome
Alcohol Withdrawal Syndrome
Early symptoms: anxiety, nausea, restlessness
Risk of seizure
Delirium tremens may start after 48 hours
Treat with benzodiazepines
Correct nutritional deficiencies
Offer alcohol cessation support and resources
What acid-base derangement can occur from abrupt cessation of alcohol after chronic use?
Alcoholic ketoacidosis, an anion gap metabolic acidosis
Sickle Cell Disease
Sickle Cell Disease
* Sickling → vaso-occlusive ischemia
* Hydroxyurea increases fetal hemoglobin (HbF) production, reduces chance of sickling
* ↓ O2, dehydration, acidosis → sickling
* Crizanlizumab -> to reduce frequency of vaso-occlusive crises
* Newborns: initially asymptomatic (due to ↑ HbF)
* Most common presentation in infants: dactylitis
* Aplastic crisis: ↓ Hgb + reticulocytopenia, parvovirus B19
* Acute chest syndrome
* Most common cause of death in adults
* Fever, CP
* CXR: pulmonary infiltrate
* Splenic sequestration crisis: rapid splenic sequestration of RBCs → splenomegaly + severe anemia
* Stroke
* Aseptic necrosis of the femoral head
* Dysfunctional spleen → ↑ infection risk
* Salmonella osteomyelitis
* S. pneumoniae sepsis: most common cause of death in children
What opioid dosing modifications are typically required for the successful treatment of vaso-occlusive pain in most patients with sickle cell disease?
An increase in both the dose and frequency of opioid administration.
What is the recommended treatment of choice of sudden onset sensorineural hearing loss?
Prednisone 1 mg/kg/day (up to 60 mg) for 10–14 days.
Category: HEENT Disorders
Subcategory: Ear
Question: 30514
Hearing Loss
Conductive
Limitation of external sound in gaining access to the inner ear
Weber: localizes to affected ear
Rinne: abnormal (BC > AC)
Most commonly caused by otitis media, serous otitis, and cerumen impaction
Rarer causes: otosclerosis
Sensorineural
Involvement of the inner ear, cochlea, or auditory nerve
Weber: localizes to unaffected ear
Rinne: normal (AC > BC)
Most commonly caused by excessive noise exposure, drugs, and normal aging
True or false: Black Americans choose hospice less often than other groups.
True.
What patient factors improve survival outcomes in those with Ewing sarcoma?
Being a child and having localized disease.
Ewing Sarcoma
Ewing Sarcoma
Patient presents with fever, weight loss, pain, and foot swelling that awakens them at night
X-ray will show primarily lytic bone lesion with periosteal reaction (onion-skinning)
Most common site is proximal femur
Category: Musculoskeletal Disorders (Nontraumatic)
Subcategory: Bony Abnormalities
Question: 163609
What complication of sickle cell disease, other than aplastic crisis, commonly present with a sudden and significant decrease in hemoglobin?
Splenic sequestration and acute chest syndrome
What initial test should be ordered on a patient presenting with isolated bilateral lower extremity paresthesias?
Point-of-care glucose to screen for diabetes mellitus
Physician Task : Focused H&P, Diagnosis
Age: Adult
Acuity : Lower acuity
Question Type: Second order
What bacteria are most commonly implicated in acute chest crisis?
Chlamydia pneumoniae in adults and Mycoplasma pneumoniae in children.
Transient Aplastic Crisis
- Risk factors: sickle cell anemia, iron deficiency anemia, or hereditary spherocytosis
- Sx: pallor, fatigue, lethargy, and shortness of breath
- Labs will show low or undetectable reticulocyte count and a drop in hemoglobin concentration of > 30%
- Most commonly caused by recent parvovirus B19 infection
Tx: self-limited, transfusion support
Chlamydia Conjunctivitis
- Patient will be a neonate 7–14 days (most common) after delivery
- PE will show mucopurulent ocular discharge, eyelid swelling, and erythematous conjunctiva
- Diagnosis is made by culture
- Most commonly caused by Chlamydia trachomatis
- Treatment of choice is oral erythromycin or azithromycinPatient will be a neonate 7–14 days (most common) after delivery
- PE will show mucopurulent ocular discharge, eyelid swelling, and erythematous conjunctiva
- Diagnosis is made by culture
- Most commonly caused by Chlamydia trachomatis
- Treatment of choice is oral erythromycin or azithromycin
What are considered to be poor prognostic markers in patients with oligoarticular juvenile arthritis?
Hip, cervical spine, wrist or ankle involvement, prolonged elevation of ESR or CRP, and evidence of joint damage on radiographs
Category: Musculoskeletal Disorders (Nontraumatic)
Subcategory: Joint Abnormalities
Question: 130225
