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EM2 Flashcards

1
Q

What medications constitute triple therapy for Helicobacter pylori?

A

Clarithromycin, Amoxicillin (or metronidazole) and a proton pump inhibitor

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2
Q

Kanavel’s signs? (4) -

A

1) symmetrical swelling of the involved finger, 2) finger held in flexion at rest, 3) tenderness along the flexor tendon sheath, and 4) pain with passive extension.

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3
Q

Epi cardiac vs anaphylactic dosing?

A

Cardiac- 1:10,000 IV, 1 mg (10ml)

Anaphylactic- 1:1000 IM, 300mcg (0.3ml)

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4
Q

Try this medicine for refractory hypotension in patient with known HTN

A

Glucagon

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5
Q

Beck’s triad for cardiac tamponade

A

hypotension, JVD, muffled heart sounds

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6
Q

Which bacteria is associated with many variants of Guillain-Barré syndrome that are preceded by diarrhea?

A

Campylobacter jejuni

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7
Q

What is Fitz-Hugh-Curtis?

A

Perihepatitis associated with PID

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8
Q

Most sensitive exam finding for cauda Equina?

A

Urinary retention (Post void residual> 100ml) followed by urinary incontinence

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9
Q

What is the Parkland formula for fluid resuscitation in burns?

A

Total Body Surface Area Burned x Weight (kg) x 4mL. First half is administered in first 8 hours followed by the second half in the next 16. (LR)

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10
Q

MCC neonatal Meningitis? Tx?

A

GBS. Amp/gent or amp/cefotaxime

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11
Q

Tx of meningitis in <18 vs >18?

A

(Cefotaxime)/ceftriaxone + vanc

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12
Q

Tx of meningitis in >50 or alcoholic?

A

CTX + vanc + amp

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13
Q

MCC meningitis in adults?

A

Strep pneumo

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14
Q

Difference between placenta previa and placenta abruptio? (3)

A

PP- Painless third trimester bleeding. Dx with ultrasound. Placenta lying over cervix

PA- Painful third trimester bleeding. Poorly seen with ultrasound. Premature Placenta separation from uterus

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15
Q

Tx Kawasaki disease (2)

A

ASA + IVIG

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16
Q

Ketosis without AG acidosis

A

Isopropyl alcohol toxicity

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17
Q

Tx of primary adrenal insufficiency?

A

100mg hydrocortisone IV (bc both glucocorticoid and mineralocorticoid)

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18
Q

What is the most common worldwide cause of primary adrenal insufficiency?

A

TB

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19
Q

What special population has an increased risk of cecal volvulus?

A

Marathon runners

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20
Q

Tx for intussusception

A

air enema

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21
Q

Tx for midgut volvulus or malrotation? (3)

A

IVF, NGT, Surgery

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22
Q

Tx for HAPE?

A

Descent

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23
Q

What treatments may prevent the development of acute mountain sickness? (3)

A

Acetazolamide, dexamethasone, slow ascent

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24
Q

Classic pentad for TTP?

A 
1- microangiopathic hemolytic anemia
2- thrombocytopenia
3- fever
4- renal pathology
5- CNS abnormality
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25
Q

What bacterial diarrheal organism can lead to TTP?

A

Shiga toxin producing E Coli

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26
Q

What is the first sign of magnesium toxicity?

A

Loss of patellar tendon reflexes.

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27
Q

Epididymitis tx <35 vs >35?

A

<35: ceftriaxone + doctor

> 35: levoflox/cipro or bactrim

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28
Q

Prehn’s sign?

A

Relief of pain when the scrotum is lifted (indicates inflammation of the epididymis.)

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29
Q

Patients with sickle cell disease are at higher risk of bacteremia and osteomyelitis from which organism?

A

Salmonella

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30
Q

What is the most rapid method of rewarming?

A

Cardiopulmonary bypass circuit.

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31
Q

MC age for quad tendon rupture vs patellar Tendon Rupture?

A

<40 : PTR

> 40: QTR

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32
Q

Differential for AG metabolic acidosis?

A

MUDPILES: Methanol, uremia, diabetic ketoacidosis (as well as alcoholic and starvation ketoacidosis), propylene glycol/paracetamol (acetaminophen), iron/isoniazid, lactate, ethylene glycol, salicylates.

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33
Q

Tx beta-blocker OD? (3)

A

Glucagon, vasopressor, high dose insulin

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34
Q

TCA OD tx? until?

A

Sodium bicarb 50mEq until QRS narrows

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35
Q

AAA triad?

A

Abdominal/back pain, hypotension and a pulsatile abdominal mass.

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36
Q

Radiation injuries prognosis?

A

Lymphocyte count in 48 hours

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37
Q

organophosphate poisoning tx?

A

Atropine + pralidoxime

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38
Q

Diltiazem OD Tx? (3)

A

calcium chloride, high dose insulin and glucose, and, in severe cases, intralipid

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39
Q

Anticholinergics toxicity tx? (3)

A

Physostigmine, BZDs, cooling

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40
Q

At how many weeks gestation should one expect fetal cardiac activity?

A

6 weeks

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41
Q

Tx UTI in pregnancy?

A

Macrobid, keflex

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42
Q

Spontaneous pneumothorax tx?

A

<20% observe

>20% chest tube

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43
Q

How to dx intestinal malrotation?

A

Upper GI series with oral contrast

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44
Q

Virchow’s node?

A

Left supraclavicular LAD usu from gastric malignancy

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45
Q

HIV post-exposure prophylaxis

A

(if mucous membrane exposure or skin compromise) Tenofovir + emtricitabine plus raltegravir

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46
Q

HBV post-exposure prophylaxis

A

Prior vaccination: PEP not needed

No prior immunization: HBIG + HBV vaccine

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47
Q

HCV post-exposure prophylaxis

A

No PEP available

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48
Q

What is the most common viral cause of cirrhosis in the United States?

A

HCV

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49
Q

How to calculate maintenance fluids rate

A

100 ml/kg/day for the first 10 kg, 50 ml/kg/day for the next 10 kg, and 20 ml/kg/day for each additional kilogram. The total is then divided by 24 hours.

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50
Q

Hypersensitivity reactions? (4)

A

ACID
1-Anaphylactic/urticarial (igE, needs 2 exposures, immediate)
2-Cytotoxic/Complement (igG/igM, hemolytic anemia, 2 exposures)
3-Immune complex (igG/igM, SLE/RA/serum Sickness)
4-Delayed (T cells, immune mediated, TB/Contact dermatitis/transplant rejection)

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51
Q

3 types of pelvic fractures + mech?

A

1- lateral compression (T-bone MVC/pedestrian hit from side)
2- AP fracture (head on MVC)
3- vertical shear (fall)

52
Q

Where do most esophageal Foreign body’s get stuck?

A

C6 cricopharyngeus muscle

53
Q

What size FB needs to be removed from stomach

A

Any foreign body longer than 5 cm or wider than 2.5 cm diameter should be removed as they are highly unlikely to pass the duodenum.

54
Q

Dx compartment syndrome? (2) Tx?

A

compartment pressure >30 mmHg or delta pressure (DBP - compartment pressure) <30 mmHg indicates significant CS.

tx= fasciotomy

55
Q

SIRS criteria? 2 or more of the following:

A

T >38° or <36°
HR > 90 bpm
RR > 20 bpm or PCO2 < 32 mmHg
WBC >12000/mm3 or <4000/mm3

56
Q

What is the immediate ED management of a patient with polycythemia vera and altered mental status?

A

Phlebotomy of 500cc of blood

57
Q

3 neck injury zones + prognosis ?

A

Zone I: clavicle to cricoid cartilage (highest morbidity and mortality)
Zone II: cricoid cartilage to mandible (best prognosis, most accessible)
Zone III: mandible to skull base

58
Q

Tx for achilles tendon rupture

A

posterior splint in plantarflexion, orthopedic consult

59
Q

Cushing reflex: (3)

A

Hypertension + bradycardia + respiratory depression

60
Q

Decorticate posturing:

A

upper extremity flexion, lower extremity extension

61
Q

Decerebrate posturing:

A

upper/lower extremity extension

62
Q

Oculocephalic response:

A

eyes moving in opposite direction of head turning = intact brainstem function

63
Q

Oculovestibular response:

A

irrigation of saline into the ear; no eye movement = brainstem injury

64
Q

Which two maneuvers should be attempted first in a patient with shoulder dystocia

A

Suprapubic pressure and McRoberts maneuver

65
Q

When should an asymptomatic AAA be referred for repair?

A

> 5cm

66
Q

Tx for jellyfish sting

A

Immersion in acetic acid (vinegar)

67
Q

tx for cholinergic poisoning? until?

A

Atropine and 2-PAM (pralidoxime) until sessation of secretions

68
Q

Symmetric descending paralysis

A

Botulism

69
Q

At what ages should infants begin to roll over and walk?

A

5 months and 12-15 months, respectively.

70
Q

Difference between phimosis and paraphimosis? Which more dangerous?

A

Paraphimosis- needs PARAmedics (more dangerous)- cannot retract foreskin over exposed edematous glans
Phimosis- can’t pull back foreskin

71
Q

Diff between breast feeding failure and breast milk jaundice

A

BFF- presents within first week. Dec bilirubin excretion bc poor feeding
BMJ- benign. Well appearing just delay in gut flora

72
Q

Colicky abd pain, sausage shaped mass, current jelly stool

A

Intussception

73
Q

Bullous pemphigoid vs pemphigus vulgaris?

A

BP- Old, tense, neg Nikolsky, benign, topical steroids

PV- 40-60, flaccid, pos Nikolsky, life threatening, mucosal involvement

74
Q

RIJ placement depth

A

13 +/- 2 cm

75
Q

Nerve injury associated with shoulder dislocation

A

Axillary nerve (sensation over deltoid)

76
Q

Hill-Sachs lesion

A

2/2 shoulder dislocation, posterolateral humeral head compression fx

77
Q

Bankhart lesion

A

2/2 shoulder dislocation, injury to labrum of glenoid

78
Q

Thompson test?

A

Lack of plantar flexion with calf squeeze= Achilles tendon rupture

79
Q

Diff between uterine rupture and placental rupture?

A

UR- No palpable fetus, loss of contractions, heavy bleeding

80
Q

pseudo-obstruction seen in elderly debilitated patients with chronic constipation?

A

Ogilvie syndrome

81
Q

Which organisms cause bloody diarrhea (6)

A

Salmonella, Shigella, Campylobacter, Yersinia, enterohemorrhagic Escherichia coli, enteroinvasive E. coli, and Entamoeba histolytica.

82
Q

Organism most related to reactive Arthritis

A

Chlamydia

83
Q

Hypothermia, hypotension, bradycardia

A

Myxedema coma

84
Q

MCC Tricuspid Regurg

A

RA And RV dilatation

85
Q

Cold calories, expected nystagmus?

A

COWS. Cold water causes opposite side nystagmus , warm water causes same side nystagmus

86
Q

Double bubble sign

A

Duodenal atresia

87
Q

Sx of hypercalcemia

A

Patient will be complaining of bone pain (Bones), kidney stones (Stones), abdominal pain (Groans), lethargy, psychosis (Psychiatric overtones)

88
Q

Saltar Harris Classification? Tx?

A 
I: S (Slipped epiphysis)
II: A (fracture Above physis), most common
III: L (fracture beLow physis)
IV: T (fracture Through physis)
V: ER (ERasure of growth plate)

I/II rx: nonoperative
IV/V rx: surgery required

89
Q

Hypoproteinemia, proteinuria, edema

A

Nephrotic syndrome

90
Q

Tx malaria?

A

Uncomplicated, no resistance areas Rx: chloroquine

Complicated, P. falciparum Rx: quinidine + doxycycline

91
Q

Target pH for Morgan lens irrigation

A

7-7.2

92
Q

Diff between acid vs alkali burns (ocular)

A

Acid- protein coagulation.

Alkali- liquefactive necrosis. Worse

93
Q

Tx of wernicke-korsakoff syndrome?

A

thiamine then glucose

94
Q

Tx of serotonin syndrome

A

Supportive then cyproheptadine

95
Q

Diff between serotonin syndrome and neuroleptic malignant syndrome

A

Both can cause hyperthermia, automatic instability, AMS but hyperreflexia and clonus are more specific to SS

96
Q

MC location of anal fissure

A

posterior midline (6pm)

97
Q

Diff between internal and external hemorrhoids

A

Internal bleed

External hurt

98
Q

At what level does the spinal cord end in adults?

A

L1-L2

99
Q

What medications do you use to treat hypertension caused by cocaine toxicity? (2)

A

Benzodiazepines and phentolamine.

100
Q

Terminal R wave in aVR

A

TCA poisioning

101
Q

VP shunt reservoir interpretations?

A

difficult-to-depress reservoir is suggestive of a distal obstruction (thrombus)

whereas delayed refilling of the reservoir > 3 seconds is suggestive of a proximal obstruction (choroid plexus or inc CSF)

102
Q

Common cause of food bolus?

A

Shiatzki rings

103
Q

TX SJS?

A

Supportive + refer to burn center

104
Q

Sea urchin tx

A

Hot water immersion

105
Q

Peds coiled NG tube

A

Tracheoesophagel fistula

106
Q

What labs are unreliable from IO line?

A

CBC (only HB is reliable) + K + pO2

107
Q

Tx preseptal cellulitis?

A

Oral augmentin or clindamycin

108
Q

Dosing for rhogam?

A

<12 weeks: 50mcg
>12 weeks: 300 mcg antiD immunoglobulin IM

but no harm in giving 300 so might as well

109
Q

Toluidine blue:

Wood’s lamp:

A

Toluidine blue: detects vulvar tears

Wood’s lamp: detects semen stains

110
Q

triad nephrotic syndrome?

A

hypoproteinemia, edema, proteinuria (greater than 3.5 gm per day or 3+ to 4+ on dipstick)

111
Q

nephrotic syndrome in children, preceded by URI. rx?

A

Minimal change disease

rx= steroids

112
Q

nephrotic syndrome in African-Americans, HIV/IVDA

A

Focal segmental glomerulosclerosis

113
Q

nephrotic syndrome in Caucasians, HBV, HCV, SLE, gold, penicillamine, malignancy

A

Membranous nephropathy

114
Q

maculopapular rash with lesions in the same stage of development? tx?

A

smallpox (variola)

tx= supportive

115
Q

vague flu-like symptoms and fever that can progress to hemorrhagic mediastinitis? tx?

A

anthrax. cipro or doxy

116
Q

sudden onset febrile flu-like illness that can progress to pleuropneumonitis? tx?

A

tularemia. streptomycin.

117
Q

gram-negative sepsis with or without flu-like symptoms or bobo lesions? tx?

A

Yersinia pestis, or the plague. streptomycin or gentamicin

118
Q

PERC out? (8)

A 
age>50
HR>100
O2<95%
prior hx
recent trauma/surgery
hemoptysis
OCP
UL leg swelling

all must be neg to PERC out

119
Q

What are the three components of Horner’s syndrome caused by disruption of the sympathetic chain?

A

Ptosis, miosis and anhidrosis.

120
Q

ptosis, diplopia and blurred vision

A

myasthenia gravis

121
Q

Improvement of muscle strength with repeated stimulation

A

Lambert-Eaton syndrome

122
Q

antibodies target the calcium channels which results in a reduction of acetylcholine release

A

Lambert-Eaton syndrome

123
Q

autoimmune destruction of the nicotinic acetylcholine receptors on the postsynaptic membrane –> less total receptors

A

myasthenia gravis

124
Q

ice bag test

A

lid lag in MG improves w/ ice

because improved neuromuscular transmission at lower muscle temperatures

125
Q

tx of TM rupture 2/2 AOM?

A

amox + otic drops

126
Q

What delivery method is preferable in cases of placental abruption involving a term pregnancy when the mother and fetus are stable?

A

oxytocin assisted vag delivery

127
Q

pseudomembranes w/ mucopurulent sputum or cough

A

bacterial tracheitis

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