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EM Boards > EM3 > Flashcards

EM3 Flashcards

1
Q

MC area for mesenteric ischemia lesion?

A

The superior mesenteric artery (SMA) is at highest risk because of its large caliber and small angle of takeoff from the aorta.

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2
Q

Which medication places patients at risk for mesenteric ischemia?

A

Digoxin

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3
Q

Jammed finger and now unable to extend DIP? To?

A

Mallet finger. distal interphalangeal joint should be splinted in slight hyperextension while allowing full range of motion at the proximal interphalangeal joint.

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4
Q

What is a boutonniere (buttonhole) deformity?

A

Extension of the MCP and DIP joints with flexion of the PIP joint. It occurs as a result of central extensor tendon disruption.

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5
Q

Menieres disease triad?

A

Sensorineural hearing loss, episodic vertigo, tinnitus

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6
Q

Tx pseudotumor cerebri (3)

A

acetazolamide, serial LPs, weight loss

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7
Q

Which steroid to use in myxedema coma?

A

Hydrocortisone is typically administered because adrenal crisis occurs frequently along with myxedema coma and lab results are not immediately available.

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8
Q

Type of abdominal incision in perimortem C-section? Must be done within?

A

Midline vertical. Do within 5 minutes of maternal loss of pulses

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9
Q

Indications for perimortem c-section?

A

Loss of maternal pulses and >24 weeks

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10
Q

Tx of TTP?

A

Plasmapheresis

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11
Q

negatively birefringent crystals

A

Gout

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12
Q

Pediatric dextrose administration rule?

A

Neonates and infants should be given 10% dextrose at 5 mL/kg IV bolus, toddlers and children (1-8) should receive 25% dextrose at 2 mL/kg IV bolus, and adolescents (8+) can be given 50% dextrose at 1 mL/kg IV bolus. Maintenance dextrose should the be started with 10% dextrose at 6–8 mL/kg/hr IV. For patients without IV access, glucagon can be given at 0.3 mg/kg intramuscularly.

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13
Q

Sulfonylurea OD Tx? (4)

A

Observe 24 hours, dextrose, charcoal and octreotide if bad

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14
Q

Loss of red color vision? Ass with?

A

Optic neuritis. Multiple sclerosis

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15
Q

acute hemarthroses after a sports-related knee injury

A

ACL tear

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16
Q

Which Med to give if primate bite?

A

Acyclovir (high transmission rate of herpesvirus)

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17
Q

Tx of WPW?

A

Procainamide

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18
Q

PaO2:FiO2 < 300 mm Hg

A

ARDS

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19
Q

Hypoxemia refractory to O2

A

ARDS

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20
Q

PA wedge pressure and A-a gradient in ARDS?

A

PA wedge pressure < 18

↑ A-a gradient

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21
Q

Tx ARDS? (2)

A

Rx: high PEEP, low TVs (6 mL/kg)

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22
Q

Flumazenil only works if?

A

BZD naive patient

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23
Q

First step in tx of NEC?

A

First NGT decompression

THEN IV ABx

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24
Q

child less than two years of age complaining of a rash that started after the fever went away

A

Roseola

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25
Q

Kid <2 PE will show blanching macular or maculopapular rash with a distribution that begins at the neck and trunk region and spreads to the face and extremities

A

Roseola

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26
Q

Hemolytic uremic syndrome? (3)

A

microangiopathic hemolytic anemia, thrombocytopenia, and renal failure

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27
Q

What is the optimal location for placement of a 14-gauge catheter for needle decompression of a pneumothorax?

A

2nd intercostal space in the midclavicular line.

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28
Q

What is the dose and route of administration of epinephrine for anaphylaxis in children?

A

0.01 mg/kg IM (max 0.3-0.5 mg) with an intravenous infusion at 0.1-0.3 mcg/kg/min (max 1 mcg/min) if needed.

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29
Q

Which patients with rib fractures should be admitted? (3)

A

Patients with flail chest, more than three rib fractures and older patients (>50) or those with multiple comorbidities/lung dz . These patients are at increased risk of developing pneumonia after rib fractures.

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30
Q

Most commonly fractured:

A

ribs 4-9

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31
Q

Weakest point of ribs

A

posterolateral angle

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32
Q

1st/2nd rib fractures ass with:

A

severe trauma

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33
Q

9-12 rib fractures ass with:

A

liver/spleen injuries

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34
Q

Nurse aids elbow reduction techniques (2)

A

Supination and flexion or hyperpronation

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35
Q

Vesicular lesions on the tip of the nose (Hutchinson’s sign) may indicate herpetic infection involving which nerve?

A

Nasociliary branch of the ophthalmic nerve.

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36
Q

Pericarditis pain pattern?

A

Pain may be improved with sitting forward and exacerbated when supine.

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37
Q

Tx NSAID OD?

A

Activated charcoal if within 2 hours of ingestion, otherwise supportive

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38
Q

Define pulmonary hypertension

A

Mean pulmonary artery pressure > 25mmHg

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39
Q

Tx of umbilical cord prolapse? (5)

A

Treatment is emergent c-section

If cesarean not possible: Trendelenburg position, knee-chest position, bladder filling, manual replacement of the cord

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40
Q

Of the clinical features of generalized tetanus, which usually appears first?

A

Trismus (“lockjaw”).

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41
Q

Magical thoughts and beliefs is characteristic of ?

A

schizotypal personality disorder.

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42
Q

Splitting among providers is typical of ?

A

borderline personality disorder.

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43
Q

Social seclusion and withdrawal is characteristic of ?

A

schizoid personality disorder.

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44
Q

Chlamydia conjunctivitis tx?

A

Oral erythromycin x14 days

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45
Q

Diff between SJS and TEN?

A

SJS <10% BSA

TEN >30% BSA

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46
Q

Perilunate dislocation?

A

dorsal dislocation of the capitate and carpus relative to the lunate

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47
Q

3 C’s on lateral wrist film?

A

The radius (the saucer) holds the lunate (the cup), and this cup contains the capitate (the apple).

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48
Q

Diff between perilunate dislocation and lunate dislocation?

A

In a perilunate dislocation, the radiolunate articulation is maintained, but the capitate is not sitting within the distal articular “cup” of the lunate. In a lunate dislocation, on the other hand, the radiolunate articulation is disrupted and the lunate is tipped towards the palm, which is known as the “spilled teacup” sign.

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49
Q

Perilunate dislocation associated with what other injury? (2)

A

60% also have scaphoid fx. Also medial nerve palsy

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50
Q

Tx of perilunate dislocation

A

Ortho emergency! Immediate closed reduction or OR if cant

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51
Q

TRALI? (5)

A

Within 6 hours of blood transfusion develop:
Hypoxemia
BL pulm infiltrates
Fever, hypotension, tachycardia

52
Q

Above what serum salicylate level should you consider hemodialysis in acute and chronic aspirin toxicity?

A

Acute toxicity > 100 mg/dL and chronic toxicity > 60 mg/dL.

53
Q

Dx of SBP? (3)

A
  1. ascitic neutrophil count (PMN) > 250 cells.
    OR
  2. serum-ascites albumin gradient > 1.1 g/dL
  3. WBC count > 1,000 cells/mm3
54
Q

Anterior knee dislocation ass with what other injuries? (3)

A

Popliteal artery injury, ligamentous injury, common peroneal nerve injury (loss of eversion, dorsiflexion, sensory of medial dorsum of foot)

55
Q

TM rupture tx?

A

D/c with ENT follow up if no infxn. PO amox if infxn.

56
Q

What is the most common cause of minor hemoptysis in the emergency department?

A

Bronchitis

57
Q

What is the classic appearance of the blood in a patient with methemoglobinemia?

A

Chocolate brown

58
Q

Tx of impetigo?

A

Mupurocin or retapamulin x 5 days

59
Q

What post-infectious sequelae are associated with impetigo? (2)

A

Rheumatic fever and poststreptococcal glomerulonephritis (in GAS-associated impetigo).

60
Q

elevated alkaline phosphatase out of proportion to the transaminases

A

cirrhosis

61
Q

Laboratory values that suggest DIC ? (5)

A

PT high, platelet low, PTT high, D-dimer high, and fibrinogen low

62
Q

What laboratory differences will be seen in disseminated intravascular coagulation (DIC) versus thrombotic thrombocytopenic purpura (TTP)?

A

Coagulation studies will be abnormal in DIC and not TTP. PT, PTT, and D-dimer will be elevated and fibrinogen will be low in DIC and normal or near normal in TTP.

63
Q

SC ends where in adults vs infants?

A

Adults - L1

Infants- L3

64
Q

BL Bells Palsy (2)

A

Lyme and infectious mononucleosis

65
Q

Tx epiglottis?

A

Ceftriaxone

66
Q

MC cx of alcohol cirrhosis

A

Ascites

67
Q

Tx sulfonylurea OD?

A

Dextrose, octreotide, 24hr obs for refractory hypoglycemia

68
Q

Glipizide vs glyburide?

A

Both sulfonylureas but glipizide is short acting Vs glyburide is long acting

69
Q

Steps for cric?

A

1) Prepare the skin with antiseptic solution; 2) Locate cricothyroid membrane; 3) Make a vertical incision in the midline through the skin and subcutaneous tissues; 4) Dilate the cricothyroid membrane; 5) Place a 6.0 cuffed endotracheal tube or tracheostomy tube and inflate.

70
Q

Tx Raynaud’s phenomena

A

Rewarming, CaCB

71
Q

Tx neuroleptic malignant syndrome (4)

A

discontinue, supportive, Benzos. Bromocriptine/dantroline if severe

72
Q

What develops first in salicylate toxicity?

A

Resp alkalosis

73
Q

oxygen saturation 85% that does not improve with O2 administration

A

Methemoglobinemia

74
Q

Tx for methemoglobinemia?

A

Methylene blue

75
Q

ITP tx? (2)

A

Steroids, IVIG

76
Q

IgA vasculitis AKA?

A

Henosch Shonlein Purpura

77
Q

HSP + abd pain?

A

Intussusception

78
Q

HSP triad?

A

Arthralgias + palpable purpura + kidney involvement

79
Q

ED Tx hypercalcemia?

A

IVF

80
Q

Tx hyperviscosity syndromes?

A

Temporizing measures for leukemias include leukapheresis, patients with elevated proteins require plasmapheresis, and patients with polycythemia vera require phlebotomy.

81
Q

Hemodialysis is generally indicated for lithium when? (5)

A

When the lithium level is greater than 5 mEq/L, when the lithium level is greater than 4 mEq/L in the setting of renal insufficiency, and in patients who present with altered mental status, seizures or life-threatening complications regardless of their lithium level.

82
Q

Cyanide toxicity tx? (3)

A

Hydroxocobalam, sodium thiosulfate, amyl nitrite

83
Q

2 poisonings from fire?

A

Carbon monoxide and cyanide (burning plastics)

84
Q

Coma + anion gap metabolic acidosis + increased lactate after fire

A

Cyanide toxicity

85
Q

Tx CMV esophagitis?

A

Ganciclovor

86
Q

Tx delirium in elderly

A

Haldol

87
Q

What maneuver is used to attempt to move an otolith within the semicircular canals causing peripheral vertigo?

A

Epley maneuver

88
Q

Which antibiotics are most commonly recommended in patients admitted with fever and severe neutropenia?

A

Cefepime or piperacillin/tazobactam.

89
Q

Hyperoxia test

A

When placed on 100% oxygen, the infant with a congenital heart defect will fail to increase their oxygen saturation, whereas those with respiratory causes will likely respond.

90
Q

Eisenmenger’s syndrome?

A

Eisenmenger’s syndrome is defined by the reversal of a long-standing left-to-right shunt in congenital heart lesions to a right-to-left shunt.

91
Q

Digoxin/digital is toxicity? (3)

Tx? (2)

A

Bradydysrhythmias/AV Blocks acute), VT/VF (chronic), hyperkalemia. Salvador Dalí mustache on ECG

Tx= immediate sodium bicarb, digoxin bonding antibodies

92
Q

Adrenal insufficiency? (2)

A

decreased levels of mineralocorticoids resulting in hyponatremia and hyperkalemia

93
Q

Signs of tumor lysis syndrome? (3)

A

Hyperkalemia, hyperphosphatemia and hypocalcemia

94
Q

What viral illness of early childhood commonly presents with high fever for three to five days and a delayed rash after defervescence?

A

Roseola infantum

95
Q

Carbon monoxide levels indicating hyperbaric oxygen?

A

carboxyhemoglobin level >25% in nonpregnant patients or >15% in pregnant patients

96
Q

Janeway lesions?

A

Nontender macules on palms/soles (endocarditis)

97
Q

Roth spots?

A

Retinal hemorrhages (endocarditis)

98
Q

Osler nodes?

A

Painful palpable nodules on the fingertips

113
Q

Isolated third nerve palsy?

A

PCA aneurism

157
Q

Tetrad of Ménière’s disease?

A

vertigo, tinnitus, hearing loss and aural fullness

158
Q

sudden, often profound, prolonged vertigo without hearing impairment in an otherwise healthy patient

A

Vestibular neuritis

159
Q

Venom of black widow vs brown recluse?

A

black widow- neurotoxin. Muscle cramping + CNS excitation (Ach + NE). +antivenom

Brown recluse- cytotoxin. Local tissue destruction. No antivenom

160
Q

Peds blood transfusion?

A

10cc/kg

161
Q

Trousseau sign?

A

Carpopedal spasm after inflating BP cuff (hypocalcemia)

162
Q

MC presenting sx of hypertrophic CMY?

A

Dyspnea

163
Q

methylene blue is indicated in any symptomatic patient or those with methemoglobin over __%.

A

20%

164
Q

Pruritus After warm shower

A

Polycythemia Vera

165
Q

Risk of having ANOTHER febrile seizure? Epilepsy?

A

Children who have a febrile seizure have a 30% chance of having another febrile seizure at some point in the future.

The prevalence of epilepsy is slightly higher at 1-2% as opposed to the 0.5-1% of the general population.

166
Q

Classic triad of intussusception?

A

Vomiting, colicky abdominal pain, currant jelly stool

167
Q

TCA OD Sx? 3

A
  1. QRS Widening and terminal R wave in aVR
  2. Looks like anticholinergic
  3. Seizures + AMS
168
Q

Normal vs abnl Head Impulse rest suggests?

A

A patient with central vertigo will have a normal head impulse test, characterized by the patient’s eyes remaining on the target. In a patient with a peripheral cause of vertigo, the eyes are dragged off the target followed by a corrective saccade. This is considered an abnormal head impulse test and is reassuring for vestibular neuritis.

169
Q

Interpretation of nystagmus on HINTS exam?

A

Evaluation of nystagmus is the second component of the HINTS exam. A patient with peripheral vertigo will have unidirectional, horizontal nystagmus while a patient with a central cause will have bidirectional nystagmus (i.e., the fast component of nystagmus beats in the same direction as the gaze).

170
Q

Interpretation of test of skew on HINTS exam?

A

Patients with peripheral vertigo will have absent skew deviation with alternate eye covering while vertical ocular misalignment is concerning for brainstem stroke.

171
Q

preferred pressors in cardiogenic shock? (2) if unresponsive?

A

dobutamine/dopa, levophed

if unresponsive- IABP

172
Q

morning stiffness that improves throughout the day?

A

RA

173
Q

affects MCPs + PIPs

A

RA

174
Q

leading cause of poisoning morbidity and mortality in the United States

A

carbon monoxide

175
Q

dry cough with rapid progression to shock, coagulopathy, BL pulmonary edema, dysrhythmia, and death

A

hantavirus from rodent feces exposure

176
Q

hard signs of neck trauma? (7) tx?

A 
airway obs
hematemesis
active heavy bleeding
bubbling
expanding or pulsatile hematoma
bruit/thrill
HDUS

immediate surgical exploration (if soft sign –> further testing)

177
Q

joint pain worse w/ use

A

OA

178
Q

Heberden’s nodes

A

OA

179
Q

hard bony swelling of DIPs

A

OA

180
Q

Is a glucose level of 40 mg/dL atypical in a newborn at two hours old?

A

No, as a newborn transitions from continuous glucose supply from the placenta to intermittent feeding, glucose normally drops to about 40 mg/dL at two hours, before stabilizing at four to six hours of life.

181
Q

ezcema worse w/?

A

cold temps, stress, inc body heat (exercise)

182
Q

3 MC sites of FB obstruction?

A

C6 > T4 > T11

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