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EM Boards > EM5 > Flashcards

EM5 Flashcards

1
Q

Kochers criteria for Peds septic joint? (4)

A

NWB
ESR>40
Fever>38.5
WBC>12

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2
Q

Sodium correction for hyperglycemia

A

Inc sodium by 1.6 for every 100mg inc in glucose (over 100)

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3
Q

Tx trigeminal neuralgia

A

Carbamazepine

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4
Q

Calcium pyrophosphate, positive birefringent.

A

Pseudogout

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5
Q

needle-shaped crystal with negative birefringence

A

Gout

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6
Q

How many vials of digoxin-specific antibody should be administered to someone in cardiac arrest due to digoxin toxicity?

A

20

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7
Q

Bag of grapes appearance on US

A

Molar pregnancy

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8
Q

When pregnancy-induced hypertension is seen before 24 weeks of gestation, the emergency physician must consider the possibility of? Sx? (3)

A

a molar pregnancy or gestational trophoblastic disease. Symptoms of gestational trophoblastic disease include vaginal bleeding and hyperemesis. Laboratory evaluation can reveal abnormally high beta-hCG levels

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9
Q

Staphylococcal scalded skin syndrome (SSSS) ? Tx? (2)

A

Starts with erythroderma around lips, no intraoral involvement, sloughing skin and bullae. To cephalexin or dicloxacillin?

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10
Q

Nikolsky sign? Syndromes (4)

A

slipping of the epidermis away from the underlying dermis when gentle lateral pressure is applied.

SSSS, Stevens-Johnson syndrome, toxic epidermal necrolysis, and pemphigus vulgaris.

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11
Q

LV aneurysm on ECG?

A

STE In anterior leads without reciprocal changes associated with a Q or QS wave >2 weeks after an acute MI

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12
Q

Targetoid rashes? (2)

A

erythema migrans (seen in Lyme disease) and erythema multiforme (caused by herpes simplex virus, mycoplasma, and certain drugs like sulfamethoxazole and antiepileptic drugs).

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13
Q

Gastrocnemius tenderness

A

RMSF

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14
Q

Rocky Mountain spotted fever rash?

A

characteristically begins on the hands, feet, ankles, and wrists and then spreads in a centripetal fashion toward the trunk.

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15
Q

Massive hemoptysis? Tx?

A

Massive hemoptysis: ≥100 mL/hour or ≥500 mL over 24-hours

Massive hemoptysis rx: patient in bleeding side down position, mainstem bronchus intubation

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16
Q

Buckle fracture?

A

Similar to greenstick fracture However, in a buckle fracture, the bony cortex on the side opposite the force is compressed and “buckles” outward without true cortical disruption. (Stable)

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17
Q

Greenstick fracture?

A

disrupt the cortex on the side of the force, but does not penetrate the cortex on the side opposite to the force (stable) peds

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18
Q

Osler-Weber-Rendu syndrome clinical manifestations (4)

A

Telangiectasias on lips/tongue, AVMs of brain/lungs, recurrent nosebleeds, high output heart failure 2/2 AVMs

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19
Q

DIC lab values? (4)

A

Labs will show thrombocytopenia, decreased fibrinogen, increased fibrin split products, and increased BT, PT, and PTT

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20
Q

cloudy cornea and fixed mid-dilated pupil

A

Acute angle closure glaucoma

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21
Q

acute unilateral painful vision loss, vomiting, and seeing halos around lights

A

Acute angle closure glaucoma

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22
Q

Vision loss after entering a dark room or movie theater?

A

Acute angle closure glaucoma

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23
Q

A patient with sciatica and weakness with toe extension likely has compression of what nerve root?

A

L5

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24
Q

Most common cause of lung abscess

A

Aspiration PNA

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25
Q

What non-funduscopic exam finding is classically associated with central retinal artery occlusion?

A

APD

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26
Q

antidote for OD of acetaminophen

A

N-acetylcysteine

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27
Q

antidote for OD of BZD

A

flumazenil

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28
Q

antidote for OD of digoxin?

A

digoxin FAB

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29
Q

antidote for OD of heparin?

A

protamine

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30
Q

antidote for OD of heavy metals? (arsenic, copper, lead, mercury) (4)

A

dimercaprol, EDRA, penicillamine, succimer (DMSA)

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31
Q

antidote for OD of hydrofluoric acid

A

calcium gluconate

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32
Q

antidote for OD of iron?

A

deferoxamine

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33
Q

antidote for OD of isoniazid

A

pyridoxine

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34
Q

antidote for OD of methanol

A

fomepizole, ethanol

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35
Q

antidote for OD of ethylene glycol

A

fomepizole, ethanol

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36
Q

antidote for OD of methemoglobinemia

A

methylene blue

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37
Q

antidote for OD of opioids

A

naloxone

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38
Q

antidote for OD of serotonin reuptake inhibitors

A

cyproheptadine

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39
Q

antidote for OD of sulfonulurea (2)

A

octreotide, glucose

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40
Q

antidote for OD of TCA?

A

sodium bicarb

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41
Q

Functional neurological symptom disorder?

A

(previously known as conversion disorder) Neuro symptom that can’t be explained by a medical condition

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42
Q

Factitious disorder

A

Intentional production of sx NOT motivated by external incentives but rather to assumed “sick role”

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43
Q

behavior in which someone acts with a conscious disregard for the safety of another person despite knowing that injury or harm is likely to result from their actions.

A

willful misconduct

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44
Q

violation of the standard of care and breach of professional duty to care for patients

A

Negligence (but not willfully harming)

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45
Q

behavior that does not obey certain prescribed standards or expectations.

A

Noncompliance

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46
Q

bioethical principle meaning “do no harm.”

A

Nonmaleficience

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47
Q

Children less than 8 years old and pregnant women with Lyme should be treated with ? Why?

A

Amoxicillin. Risk of permanent yellow teeth discoloration with doxycycline

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48
Q

Garlic or metallic taste in mouth after exposure to what toxin

49
Q

Characteristic odor: bitter almonds

50
Q

Characteristic odor: pears

A

Chloral hydrate

51
Q

Characteristic odor: rotten eggs (3)

A

Disulfiram, hydrogen sulfide, NAC

52
Q

Characteristic odor: wintergreen

A

Methyl salicylate

53
Q

Characteristic odor: glue

54
Q

Characteristic odor: carrots

A

Water hemlock

55
Q

Characteristic odor: fruity (3)

A

Ethanol, isopropyl alcohol, acetone

56
Q

Peds epi dosing

A

Epinephrine can be given via IV or IO at 0.01 mg/kg ( 0.1 mL/kg of 1:10 000 concentration)

57
Q

Acid vs alkali ingestion?

A

Acid —> coagulation necrosis

Alkali —> liquefaction necrosis (worse)

58
Q

muscle spasms, stiffness,oculogyriccrisis? Tx? :

A

Acutedystonia

Tx: benztropine,dyphenhydramine

59
Q

restlessness. Tx?

A

Akathisia

. Tx: benztropine

60
Q

Parkinsonism reaction? Tx?

A

Bradykinesia. Benztropine

61
Q

orofacial involuntary movements? Tx?

A

Tardive dyskinesia. Stop offending med

62
Q

What is Murphy’s sign?

A

Sudden inspiratory cessation upon palpation of the right upper quadrant.

63
Q

Vertigo during descent

64
Q

Pain, parasthesias, paralysis min-hours after ascent

A

Decompression sickness (“bends”)

65
Q

Stroke like sx during or immediately after ascent

A

Arterial gas emboli

66
Q

Altered coordination after 100ft deep

A

Nitrogen narcosis

67
Q

Electrolyte abnormality in pyloric stenosis? (4)

A

Hypochloremic metabolic alkalosis + Patients will have low chloride, low potassium, and elevated bicarbonate.

68
Q

Target sign on US

A

Pyloric stenosis

69
Q

Projectile nonbillous vomitting

A

Pyloric stenosis

70
Q

Intubation parameters for myasthenic crisis ? (2)

A

Forced vital capacity < 10-15 mL/kg OR

negative inspiratory force > 20 mm H2O

71
Q

Aortic dissection management ? (2)

A

Type A- ascending. Beta blockers (esmolol) and Surgical emergency.
Type B- descending. Medical only

72
Q

What is “Brodie’s sign”?

A

“Brodie’s sign” is the appearance of a black spot on external affected tissue; it signals the beginning of very rapid propagation of necrosis and is accompanied by clinical deterioration.

73
Q

Osmolarity can be calculated using the formula

A

2[Na+] + [BUN]/2.8 + [glucose]/18 + [ethanol]/4.6.

74
Q

When doing a PTA, carotid artery is located where

A

carotid artery is located approximately 2.5 cm posterolateral to the palatine tonsil. (approach should be performed as medially as possible to avoid the carotid artery)

75
Q

Cyanide toxicity is associated with what common Med?

A

Nitroprusside

76
Q

GB wall thickening ass with cholecystitis?

77
Q

most common nerve injury seen after humeral shaft fractures

A

Radial nerve —> wrist drop (loss of extension of fingers, thumb and wrist)

78
Q

Tx humeral shaft fx?

A

Sugartong + sling. Outpatient Ortho follow up

79
Q

most common nerve injury seen after shoulder dislocation

A

Axillary nerve —> loss of sensation over deltoid

80
Q

most common nerve injury seen after posterior elbow dislocation

A

Median nerve

81
Q

most common nerve injury seen after anterior elbow dislocation

A

Ulnar nerve

82
Q

most common vascular injury seen after humeral shaft fractures

A

Brachial artery

83
Q

Lyme prophylaxis?

A

single dose of doxycycline 200 mg administered to individuals over 8 years old. Amoxicillin if <8

84
Q

Features of WPW on ECG? (5)

A
  1. irregular (pattern like atrial fibrillation)
  2. wide bizarre changing QRS (impulses conducted through accessory pathway)
  3. extremely fast tachycardia(200-300 bpm).
  4. Short PR
  5. Upstroking QRS (wide)
85
Q

What is hydrocarbon cardiac desensitization? Tx?

A
  1. “Sniffing/huffing” paint/glue/gas —> sensitized myocardium
  2. Excitable event (cops on scene) —> catecholamine release
  3. —> fatal ventricular dysrhythmias

Tx = beta blocker

86
Q

Common cause of worsening hepatic encephalopathy

A

Constipation (2/2 inc intestinal ammonia production)

87
Q

Cause of asterixis?

A

Inc ammonia —> inc metabolism to glutamine —> CNS —> asterixis

88
Q

3 meds that tx hepatic encephalopathy?

A

Lactulose, rifampin, neomycin

89
Q

Presentation of multiple myeloma? (4)

A

CRAB: hyperCalcemia, Renal insufficiency, Anemia, lytic Bone lesions/Back pain

90
Q

Tx thrombosed hemorrhoid?

A

Elliptical incision

91
Q

What is the first-line treatment for infectious diarrhea in the United States?

A

Ciprofloxacin 500 mg twice a day for three days.

92
Q

How to manage hypoxia in a ventilated Patient? (5)

A 
D- displacement (check tube)
O- obstruction (suction)
P- PTX (XRay)
E- equipment (try BVM)
S- breath stacking (disconnect vent)
93
Q

Transducer vs exudate? Light’s criteria? (3)

A

Transudate: CHF
Exudate: infection > malignancy, PE

Exudative:
LDH > 2/3 of the upper limit of the normal serum LDH level
fluid:blood LDH ratio >0.6
fluid:blood protein ratio >0.5.

94
Q

mycotic aneurysm?

A

an aneurysmal formation as result of seeding of infection in an arterial wall most commonly 2/2 endocarditis

95
Q

Sandpaper rash

A

Scarlet fever

96
Q

Strawberry tongue

A

Scarlet fever

97
Q

Tx scarlet fever?

A

Penicillin (azithro if pen allergic)

98
Q

Circumoral pallor

A

Scarlet fever

99
Q

Scarlet fever caused by

A

group A beta-hemolytic streptococci.

100
Q

decreased level of consciousness followed by a “lucid” interval.

A

Epidural hematoma

101
Q

What is the maximum dose of 0.5% bupivacaine with epinephrine for an average adult?

A

About 42 mL for a 70 kg adult, using 5 mg/mL and a maximum dose of 3 mg/kg with epinephrine. (1.5 mg/kg is the maximum dose for bupivacaine without epinephrine).

102
Q

Cx of Kawasaki? When?

A
  1. Myocarditis with Dec EF when sick

2. Coronary aneurysms 2-4 weeks later

103
Q

Which rotator cuff muscle is MC injured?

A

Supraspinatus

104
Q

Hawkins-kennedy rest?

A

Supraspinatus tendinitis (Pain with internal rotation of shoulder)

105
Q

2 ways to perform percutabeous jet ventilation?

A
  1. Attach 16G angiocath to 3.5mm ETT cap and BVM

2. Attach 16G angiocath to a syringe with plunger out to 7.0mm ETT cap and BVM

106
Q

Next step if free air under diaphragm?

107
Q

In pts at high risk for SBP- what px antibiotics are used?

A

Fluoroquinolone or bactrim

108
Q

Few day old baby with constipation and distension. Barium study shows transition zone

A

Hirschprungs disease

109
Q

Lack of anal sphincter relaxation on anal mannometry

A

Hirschprungs Disease

110
Q

What type of ectopic tissue causes ulcers and bleeding in meckels diverticulum?

A

Ectopic gastric tissue

111
Q

Delayed meconium passing

A

Hirschprungs Disease

112
Q

Shortened PR with normal QRS? Usu F in 30s?

A

Lown-Ganong-Levine syndrome

113
Q

Resp distress after spine injury?

A

Brachial plexopthy (get diaphragm paralysis)

114
Q

What hyperkalemia Med is CI in ppl with GI intestinal motility issues?

A

Kayexelate (—> intestinal necrosis)

115
Q

URI followed by severe persistent vertigo, hearing loss? Tx?

A

Labyrhinthitis.

116
Q

2 viral causes of prenatal hearing loss?

A

Rubella, CMV

117
Q

Tx omphalitis? (3)

A

MRSA- vanc
Staph- aminoglycoside (gent)
Anaerobes- MNZ

118
Q

High riding patella on XR? Tx?

A

Patellar tendon rupture. Immobilization and ortho follow up

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