EM2 Flashcards
What medications constitute triple therapy for Helicobacter pylori?
Clarithromycin, Amoxicillin (or metronidazole) and a proton pump inhibitor
Kanavel’s signs? (4) -
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.
Epi cardiac vs anaphylactic dosing?
Cardiac- 1:10,000 IV, 1 mg (10ml)
Anaphylactic- 1:1000 IM, 300mcg (0.3ml)
Try this medicine for refractory hypotension in patient with known HTN
Glucagon
Beck’s triad for cardiac tamponade
hypotension, JVD, muffled heart sounds
Which bacteria is associated with many variants of Guillain-Barré syndrome that are preceded by diarrhea?
Campylobacter jejuni
What is Fitz-Hugh-Curtis?
Perihepatitis associated with PID
Most sensitive exam finding for cauda Equina?
Urinary retention (Post void residual> 100ml) followed by urinary incontinence
What is the Parkland formula for fluid resuscitation in burns?
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)
MCC neonatal Meningitis? Tx?
GBS. Amp/gent or amp/cefotaxime
Tx of meningitis in <18 vs >18?
(Cefotaxime)/ceftriaxone + vanc
Tx of meningitis in >50 or alcoholic?
CTX + vanc + amp
MCC meningitis in adults?
Strep pneumo
Difference between placenta previa and placenta abruptio? (3)
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
Tx Kawasaki disease (2)
ASA + IVIG
Ketosis without AG acidosis
Isopropyl alcohol toxicity
Tx of primary adrenal insufficiency?
100mg hydrocortisone IV (bc both glucocorticoid and mineralocorticoid)
What is the most common worldwide cause of primary adrenal insufficiency?
TB
What special population has an increased risk of cecal volvulus?
Marathon runners
Tx for intussusception
air enema
Tx for midgut volvulus or malrotation? (3)
IVF, NGT, Surgery
Tx for HAPE?
Descent
What treatments may prevent the development of acute mountain sickness? (3)
Acetazolamide, dexamethasone, slow ascent
Classic pentad for TTP?
1- microangiopathic hemolytic anemia 2- thrombocytopenia 3- fever 4- renal pathology 5- CNS abnormality
What bacterial diarrheal organism can lead to TTP?
Shiga toxin producing E Coli
What is the first sign of magnesium toxicity?
Loss of patellar tendon reflexes.
Epididymitis tx <35 vs >35?
<35: ceftriaxone + doctor
> 35: levoflox/cipro or bactrim
Prehn’s sign?
Relief of pain when the scrotum is lifted (indicates inflammation of the epididymis.)
Patients with sickle cell disease are at higher risk of bacteremia and osteomyelitis from which organism?
Salmonella
What is the most rapid method of rewarming?
Cardiopulmonary bypass circuit.
MC age for quad tendon rupture vs patellar Tendon Rupture?
<40 : PTR
> 40: QTR
Differential for AG metabolic acidosis?
MUDPILES: Methanol, uremia, diabetic ketoacidosis (as well as alcoholic and starvation ketoacidosis), propylene glycol/paracetamol (acetaminophen), iron/isoniazid, lactate, ethylene glycol, salicylates.
Tx beta-blocker OD? (3)
Glucagon, vasopressor, high dose insulin
TCA OD tx? until?
Sodium bicarb 50mEq until QRS narrows
AAA triad?
Abdominal/back pain, hypotension and a pulsatile abdominal mass.
Radiation injuries prognosis?
Lymphocyte count in 48 hours
organophosphate poisoning tx?
Atropine + pralidoxime
Diltiazem OD Tx? (3)
calcium chloride, high dose insulin and glucose, and, in severe cases, intralipid
Anticholinergics toxicity tx? (3)
Physostigmine, BZDs, cooling
At how many weeks gestation should one expect fetal cardiac activity?
6 weeks
Tx UTI in pregnancy?
Macrobid, keflex
Spontaneous pneumothorax tx?
<20% observe
>20% chest tube
How to dx intestinal malrotation?
Upper GI series with oral contrast
Virchow’s node?
Left supraclavicular LAD usu from gastric malignancy
HIV post-exposure prophylaxis
(if mucous membrane exposure or skin compromise) Tenofovir + emtricitabine plus raltegravir
HBV post-exposure prophylaxis
Prior vaccination: PEP not needed
No prior immunization: HBIG + HBV vaccine
HCV post-exposure prophylaxis
No PEP available
What is the most common viral cause of cirrhosis in the United States?
HCV
How to calculate maintenance fluids rate
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.
Hypersensitivity reactions? (4)
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)
3 types of pelvic fractures + mech?
1- lateral compression (T-bone MVC/pedestrian hit from side)
2- AP fracture (head on MVC)
3- vertical shear (fall)
Where do most esophageal Foreign body’s get stuck?
C6 cricopharyngeus muscle
What size FB needs to be removed from stomach
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.
Dx compartment syndrome? (2) Tx?
compartment pressure >30 mmHg or delta pressure (DBP - compartment pressure) <30 mmHg indicates significant CS.
tx= fasciotomy
SIRS criteria? 2 or more of the following:
T >38° or <36°
HR > 90 bpm
RR > 20 bpm or PCO2 < 32 mmHg
WBC >12000/mm3 or <4000/mm3
What is the immediate ED management of a patient with polycythemia vera and altered mental status?
Phlebotomy of 500cc of blood
3 neck injury zones + prognosis ?
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
Tx for achilles tendon rupture
posterior splint in plantarflexion, orthopedic consult
Cushing reflex: (3)
Hypertension + bradycardia + respiratory depression
Decorticate posturing:
upper extremity flexion, lower extremity extension
Decerebrate posturing:
upper/lower extremity extension
Oculocephalic response:
eyes moving in opposite direction of head turning = intact brainstem function
Oculovestibular response:
irrigation of saline into the ear; no eye movement = brainstem injury
Which two maneuvers should be attempted first in a patient with shoulder dystocia
Suprapubic pressure and McRoberts maneuver
When should an asymptomatic AAA be referred for repair?
> 5cm
Tx for jellyfish sting
Immersion in acetic acid (vinegar)
tx for cholinergic poisoning? until?
Atropine and 2-PAM (pralidoxime) until sessation of secretions
Symmetric descending paralysis
Botulism
At what ages should infants begin to roll over and walk?
5 months and 12-15 months, respectively.
Difference between phimosis and paraphimosis? Which more dangerous?
Paraphimosis- needs PARAmedics (more dangerous)- cannot retract foreskin over exposed edematous glans
Phimosis- can’t pull back foreskin
Diff between breast feeding failure and breast milk jaundice
BFF- presents within first week. Dec bilirubin excretion bc poor feeding
BMJ- benign. Well appearing just delay in gut flora
Colicky abd pain, sausage shaped mass, current jelly stool
Intussception
Bullous pemphigoid vs pemphigus vulgaris?
BP- Old, tense, neg Nikolsky, benign, topical steroids
PV- 40-60, flaccid, pos Nikolsky, life threatening, mucosal involvement
RIJ placement depth
13 +/- 2 cm
Nerve injury associated with shoulder dislocation
Axillary nerve (sensation over deltoid)
Hill-Sachs lesion
2/2 shoulder dislocation, posterolateral humeral head compression fx
Bankhart lesion
2/2 shoulder dislocation, injury to labrum of glenoid
Thompson test?
Lack of plantar flexion with calf squeeze= Achilles tendon rupture
Diff between uterine rupture and placental rupture?
UR- No palpable fetus, loss of contractions, heavy bleeding
pseudo-obstruction seen in elderly debilitated patients with chronic constipation?
Ogilvie syndrome
Which organisms cause bloody diarrhea (6)
Salmonella, Shigella, Campylobacter, Yersinia, enterohemorrhagic Escherichia coli, enteroinvasive E. coli, and Entamoeba histolytica.
Organism most related to reactive Arthritis
Chlamydia
Hypothermia, hypotension, bradycardia
Myxedema coma
MCC Tricuspid Regurg
RA And RV dilatation
Cold calories, expected nystagmus?
COWS. Cold water causes opposite side nystagmus , warm water causes same side nystagmus
Double bubble sign
Duodenal atresia
Sx of hypercalcemia
Patient will be complaining of bone pain (Bones), kidney stones (Stones), abdominal pain (Groans), lethargy, psychosis (Psychiatric overtones)
Saltar Harris Classification? Tx?
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
Hypoproteinemia, proteinuria, edema
Nephrotic syndrome
Tx malaria?
Uncomplicated, no resistance areas Rx: chloroquine
Complicated, P. falciparum Rx: quinidine + doxycycline
Target pH for Morgan lens irrigation
7-7.2
Diff between acid vs alkali burns (ocular)
Acid- protein coagulation.
Alkali- liquefactive necrosis. Worse
Tx of wernicke-korsakoff syndrome?
thiamine then glucose
Tx of serotonin syndrome
Supportive then cyproheptadine
Diff between serotonin syndrome and neuroleptic malignant syndrome
Both can cause hyperthermia, automatic instability, AMS but hyperreflexia and clonus are more specific to SS
MC location of anal fissure
posterior midline (6pm)
Diff between internal and external hemorrhoids
Internal bleed
External hurt
At what level does the spinal cord end in adults?
L1-L2
What medications do you use to treat hypertension caused by cocaine toxicity? (2)
Benzodiazepines and phentolamine.
Terminal R wave in aVR
TCA poisioning
VP shunt reservoir interpretations?
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)
Common cause of food bolus?
Shiatzki rings
TX SJS?
Supportive + refer to burn center
Sea urchin tx
Hot water immersion
Peds coiled NG tube
Tracheoesophagel fistula
What labs are unreliable from IO line?
CBC (only HB is reliable) + K + pO2
Tx preseptal cellulitis?
Oral augmentin or clindamycin
Dosing for rhogam?
<12 weeks: 50mcg
>12 weeks: 300 mcg antiD immunoglobulin IM
but no harm in giving 300 so might as well
Toluidine blue:
Wood’s lamp:
Toluidine blue: detects vulvar tears
Wood’s lamp: detects semen stains
triad nephrotic syndrome?
hypoproteinemia, edema, proteinuria (greater than 3.5 gm per day or 3+ to 4+ on dipstick)
nephrotic syndrome in children, preceded by URI. rx?
Minimal change disease
rx= steroids
nephrotic syndrome in African-Americans, HIV/IVDA
Focal segmental glomerulosclerosis
nephrotic syndrome in Caucasians, HBV, HCV, SLE, gold, penicillamine, malignancy
Membranous nephropathy
maculopapular rash with lesions in the same stage of development? tx?
smallpox (variola)
tx= supportive
vague flu-like symptoms and fever that can progress to hemorrhagic mediastinitis? tx?
anthrax. cipro or doxy
sudden onset febrile flu-like illness that can progress to pleuropneumonitis? tx?
tularemia. streptomycin.
gram-negative sepsis with or without flu-like symptoms or bobo lesions? tx?
Yersinia pestis, or the plague. streptomycin or gentamicin
PERC out? (8)
age>50 HR>100 O2<95% prior hx recent trauma/surgery hemoptysis OCP UL leg swelling
all must be neg to PERC out
What are the three components of Horner’s syndrome caused by disruption of the sympathetic chain?
Ptosis, miosis and anhidrosis.
ptosis, diplopia and blurred vision
myasthenia gravis
Improvement of muscle strength with repeated stimulation
Lambert-Eaton syndrome
antibodies target the calcium channels which results in a reduction of acetylcholine release
Lambert-Eaton syndrome
autoimmune destruction of the nicotinic acetylcholine receptors on the postsynaptic membrane –> less total receptors
myasthenia gravis
ice bag test
lid lag in MG improves w/ ice
because improved neuromuscular transmission at lower muscle temperatures
tx of TM rupture 2/2 AOM?
amox + otic drops
What delivery method is preferable in cases of placental abruption involving a term pregnancy when the mother and fetus are stable?
oxytocin assisted vag delivery
pseudomembranes w/ mucopurulent sputum or cough
bacterial tracheitis