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EM Boards > EM6 > Flashcards

EM6 Flashcards

1
Q

BL putamen hemorrhages?

A

Methanol poisoning

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2
Q

Snow storm vision

A

Methanol poisoning

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3
Q

Methanol metabolism? Tx? (2)

A

Methanol —> formaldehyde —> Formic acid.
Can use folate to help Formic acid —> co2 and water
+ HD

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4
Q

Toxic alcohol found in coolants, polishes, and detergents

A

Ethylene glycol

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5
Q

Toxic alcohol found in paint products, windshield washer fluid, and antifreeze

A

Methanol

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6
Q

Metabolism of ethylene glycol? Tx? (2)

A

Ethylene glycol —> oxalic acid —> calcium oxalate

Thiamine and pyridoxine help remove toxic metabolites
+ HD

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7
Q

Toxic alcohol found in rubbing alcohol, solvents, paint thinners, skin and hair products, and antifreeze

A

Isopropyl alcohol

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8
Q

osmolal gap without an elevated anion gap.

A

Isopropyl alcohol

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9
Q

Toxic alcohol causing Hemorrhagic gastritis

A

Isopropyl alcohol

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10
Q

Torsades de pointes may be caused by? (2)

A

electrolyte disturbances (hypokalemia, hypomagnesemia, hypocalcemia), antiarrhythmic drugs that prolong the QT interval (procainamide, quinidine, disopyramide)

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11
Q

Tx torsades?

A

Stable: Mg, isoproterenol (overdrive pacing)
Unstable: cardioversion
Pulseless: defibrillation

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12
Q

Seizure tx?

A

1st: Benzodiazepines (lorazepam etc.)
2nd: Phenytoin or fosphenytoin
3rd: Pentobarbital

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13
Q

deeply and symmetrically inverted T waves in the anterior precordial leads? Tx?

A

Wellens. Urgent cath for likely critical stenosis of LAD

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14
Q

What is a de Winter ECG pattern?

A

Considered a STEMI equivalent seen with acute LAD occlusion, it is ST depression with peaked T waves in the precordial leads

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15
Q

Two types of Wellens syndrome?

A

Biphasic T waves (type A)

deeply and symmetrically inverted T waves in the anterior precordial leads (type B)

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16
Q

Hydrophobia

A

Rabies

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17
Q

What is CREST syndrome?

A

Calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasias.

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18
Q

What is the definitive management for patients with Brugada syndrome?

A

Implantable cardiac defibrillator.

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19
Q

Common lab abnormality heat stroke

A

Elevated LFTs

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20
Q

What is the mainstay of treatment for hypertrophic cardiomyopathy?

A

Long-term beta-blocker therapy.

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21
Q

Late pregnancy vaginal bleeding differential? (3)

A

Late pregnancy vaginal bleeding is never normal and raises suspicion for placental abruption, placenta previa and vasa previa; all potentially life threatening disorders to both the mother and fetus

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22
Q

What arterial blood gas finding is concerning for impending respiratory failure in an asthmatic?

A

A normal, elevated or rising carbon dioxide.

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23
Q

The optimal rate for chest compressions?

A

rate of 100-120/minute.

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24
Q

Diffuse maculopapular rash with white spots on the buccal mucosa

A

Measles (Rubeola)

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25
Q

A prodrome of fever, lymphadenopathy, and conjunctivitis followed by a maculopapular rash that starts on the face and spreads to the trunk and limbs

A

Rubella

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26
Q

rash typically starts on the face and spreads to the extremities.

A

Measles (Rubeola)

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27
Q

High fever for 3 days followed by the appearance of a pink maculopapular rash after defervescence

A

Roseola

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28
Q

“Blueberry muffin” spots.

A

Rubella

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29
Q

What are the electrocardiogram findings that suggest underlying Wolff-Parkinson-White syndrome? (3)

A

A short PR interval (< 0.12 seconds), a prolonged QRS complex (> 0.12 seconds), and a “delta wave” or slurred upstroke of the QRS complex.

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30
Q

AV and SA node receives blood flow from what vessel in most people?

A

RCA

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31
Q

The classic triad of aortic stenosis is

A

chest pain, dyspnea, and syncope.

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32
Q

Hernias relationship with inferior epigastric artery?

A

Medial to IEA: Direct;

Lateral to IEA: Indirect

(MDs dont LIe)

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33
Q

What mathematical formula is recommended to determine serum osmolarity (mOsm/kg)

A

2(Na) + (BUN/2.8) + (glucose/18).

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34
Q

Sciatic nerve palsy? Tx?

A

buttock injury, hip dislocation, ↓ knee flexion, foot drop

rx: analgelsics, physical therapy

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35
Q

Common peroneal nerve palsy? Tx?

A

proximal fibula injury, footdrop

rx: ankle splint

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36
Q

Radial nerve palsy? Tx?

A

crutches, sleeping drunk, wrist/finger drop

rx: wrist splint

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37
Q

Ulnar nerve palsy?

A

elbow injury, ↓ finger adduction/thumb grasp, 4th/5th digit paresthesias

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38
Q

Lateral femoral cutaneous nerve palsy?

A

inguinal ligament entrapment, upper thigh dysesthesia/numbness

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39
Q

Concerning PVR in cauda equina?

A

Volumes greater than 100–200 mL without a history of voiding difficulties suggests a neurologic etiology.

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40
Q

Tx hereditary Angioedema? (2)

A

C1 esterase inhibitor replacement or FFP

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41
Q

At what heart rate should CPR be initiated for a pediatric patient with bradycardia and poor perfusion despite adequate oxygenation?

A

60 bpm

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42
Q

Indications for urgent endoscopy for stomach foreign bodies ?

A

ingestion of sharp or long objects (e.g., toothpicks, needles), co-ingestion of a button battery and magnet, objects wider than 2 cm, objects longer than 6 cm, and localization proximal to the pylorus over 24 hours after ingestion.

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43
Q

Polycythemia Vera is Hb>

A

greater than 16 g/dL in women or greater than 16.5 g/dL in men.

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44
Q

NSAID toxicity occurs with ingestions of >

A

100 mg/kg

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45
Q

normal PaO2 despite cyanosis

A

Methemoglobinemia

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46
Q

Chocolate brown blood

A

Methemoglobinemia

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47
Q

Hypoxia that does not improve with supplemental o2

A

Methemoglobinemia

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48
Q

What is a quick way to decide whether a tachycardic rhythm is supraventricular or ventricular in origin?

A

Supraventricular has narrow QRS complexes and ventricular has wide QRS complexes.

49
Q

Maltese cross sign

A

Nephrotic syndrome

50
Q

HBsAg:

A

Active infection

51
Q

HBsAb:

A

recovered or immunized

52
Q

HBcAb IgM vs IgG

A

Anti-HBc IgM: early marker of infection, positive in window period
Anti-HBc IgG: best marker for prior HBV

53
Q

HBeAg:

A

high infectivity

54
Q

Anti-HBeAb:

A

low infectivity

55
Q

HCV transmission?

A

IVDA, chronic, cirrhosis, carcinoma, carrier

56
Q

HDV transmission?

A

Dependent on HBV coinfection

57
Q

HEV transmission?

A

fecal-oral (enteric) high mortality rate among pregnant (expectant) patients, epidemics,

58
Q

Which hepatitis transmitted fecal oral?

A

HAV and HEV are fecal-oral: “The vowels hit your bowels”

59
Q

Which hepatitis has vaccines?

A

HAV and HBV have preventative vaccine available

60
Q

Alcoholic hepatitis LFTs?

A

moderate transaminase elevation, AST > ALT (2:1)

61
Q

What type of animal bite wounds require immediate postexposure prophylaxis for rabies?

A

Bite wounds sustained from a bat, raccoon, skunk, or fox.

62
Q

most common pathogen in cat wounds

A

Pasteurella multocida

63
Q

Tx cat bites? (2)

A

Abx for all cat wounds (amoxicillin-clavulanate)

Most cat wounds left open

64
Q

Capnocytophaga canimorsus

A

Sepsis or gangrenous wound after dog bite

65
Q

Dix hallpike vs epley maneuvers?

A

Dix-Hallpike maneuver can be used to support the diagnosis of BPPV. After performing a Dix-Hallpike, an Epley maneuver can be performed to expel the otolith from the labyrinth.

66
Q

Levels of Sedation

A 
Minimal
Responsiveness: Normal
Airway: Unaffected
Ventilation: Unaffected
Cardiovascular function: Unaffected

Moderate
Responsiveness: responds purposefully to verbal/tactile stimulation
Airway: No intervention required
Ventilation: adequate
Cardiovascular function” usually maintained

Deep
Responsiveness: Purposeful response after repeated/painful stimulation
Airway: Intervention may be required
Ventilation: may be inadequate
Cardiovascular function: usually maintained

General Anesthesia
Responsiveness: unarousable
Airway: requires intervention
Ventilation: usually inadequate
Cardiovascular function: may be impaired
67
Q

Most common cause of hip pain in young child? Dx?

A

Transient synovitits. Dx-US with effusion

68
Q

ST segment elevation in aVR greater than 1 mm or greater than the ST elevation seen in V1 is most concerning for occlusion of ?

A

the left main coronary artery (STEMI equivalent)

69
Q

Chest tube placement where?

A

Chest tube placement should occur at the 4th or 5th intercostal space in the midaxillary line. The tube should placed over the superior aspect of the rib in order to avoid injuring the neurovascular bundle that runs under each rib.

70
Q

What are the current recommendations for hospital admission for patients with hyphemas (independent of other injuries or conditions)?

A

Patients with 50% or greater hyphema volume or other risk factors as outlined above should be admitted.

71
Q

Frostbite stages

A

1st degree - white plaques
2nd degree - clear blisters
3rd degree- hemorrhagic blisters
4th degree- full-thickness involvement of underlying muscle and bone

72
Q

Chilblains vs immersion foot?

A

Chilblains- exposure to damp non freezing temps

AKA Trench foot- exposure to wet non freezing temps

73
Q

What is the appropriate rewarming method for frostbite?

A

Rapid rewarming with immersion in 37–39°C circulating water until tissue feels pliable.

74
Q

What is the most serious complication of impetigo?

A

Acute glomerulonephritis.

75
Q

Esophagitis Treatment:
Candida:
CMV:
HSV:

A

Candida: fluconazole
CMV: Ganciclovir
HSV: acyclovir

76
Q

When should you use flumazenil in BZD OD?

A

in benzodiazepine naive patients only bc can cause acute withdrawal in chronic users

77
Q

Tx endometritis?

A

Clindamycin + gentamicin

78
Q

DKA Management summary?

A
  1. Start insulin gtt at 0.1mg/kg when serum K+>3.3
  2. Switch from NS to D5 1/2NS when BG 200-250
  3. Taper insulin gtt (0.02-0.05) and start SC insulin when BG < 200 AND at least two of the following goals are met:
    ———-serum anion gap < 12 mEq/L
    ———-serum bicarbonate ≥ 15 mEq/L
    ———-venous pH > 7.30.
79
Q

Wells criteria for PE? (7)

A 
Sign/Sx-3
No other dx more likely-3
HR>100 - 1.5
Immobilization- 1.5
Previous PE/DVT- 1.5
Hemoptysis is- 1
Malignancy- 1
80
Q

Bence-Jones proteins

A

Multiple myeloma

81
Q

Rouloux formation

A

Multiple myeloma

82
Q

What plants are known to cause an anticholinergic toxidrome? (2)

A

Jimson weed and belladonna

83
Q

eating reheated rice - diarrhea

A

Bacillus cereus

84
Q

canned food - diarrhea

A

C. botulinum

85
Q

reheated meat or canned foods within 24 hours - watery diarrhea and epigastric pain

A

Clostridium perfringens

86
Q

sea bass, grouper, red snapper - diarrhea

A

Ciguatera

87
Q

undercooked meat - diarrhea, HUS

A

E. coli O157:H7

88
Q

poultry, meat, eggs - diarrhea

A

Salmonella

89
Q

peppery tasting fish - diarrhea

A

Scombroid

90
Q

eating meats, mayonnaise, custard 1 - 6 hours ago - nausea, vomiting, abdominal pain and diarrhea

A

Staphylococcus aureus

91
Q

shellfish and seafood - diarrhea

A

V. parahaemolyticus, V. vulnificus

92
Q

undercooked pork - pseudoappendicitis, bloody diarrhea

A

Yersinia

93
Q

Chvostek sign?

A

Contraction of facial muscles after tapping facial nerve (hypocalcemia)

94
Q

What is the most accurate test in the diagnosis of adrenal insufficiency?

A

A cortisol level.

95
Q

Hypoparathroidism labs? (3)

A

Labs will show low PTH, low calcium, high phosphorus

96
Q

extremity and perioral paresthesias, tetany, and lethargy

A

Hypocalcemia (consider hypoparathyroidism)

97
Q

MAP goal for LVAD pt?

A

goal MAP is between 70 and 90 mm Hg.

98
Q

What dialysis-related complication presents with altered mental status, headache, and vomiting?

A

Dialysis disequilibrium syndrome.

99
Q

What are the indications for dialysis in a patient with tumor lysis syndrome?

A

Potassium >6 mEq/L, uric acid >20 mg/dL, creatinine >10 mg/dL, phosphorus >10 mg/dL, volume overload, or symptomatic hypocalcemia.

100
Q

4 stages of labor

A

1-dilate to 10cm
2- deliver baby
3-deliver placenta
4-postpartum

101
Q

hematuria, proteinuria, RBC casts

A

acute glomerulonephritis

102
Q

edema, proteinuria but NO hematuria

A

nephrotic syndrome

103
Q

dose of factor VIII for bleeding hemophiliac

A

50 IU/kg

104
Q

target UOP in rhabdo

A

200-300cc/hr

105
Q

gastroenteritis + febrile sz

A

shigella

106
Q

which tineas need PO antifungals

A

capitis + unguium

107
Q

What is an appropriate inspiratory:expiratory ratio for a pediatric patient with a percutaneous needle cricothyrotomy?

A

1:4 to 1:5.

108
Q

The straight leg raise test is considered positive if

A

A positive test results in radicular pain below the knee of the affected leg.

109
Q

L3 radiculopathy?

A

weakness with hip flexion with decreased sensation of the anterior thigh

110
Q

L4 radiculopathy?

A

weakness with knee extension, and decreased sensation of medial leg.

111
Q

L5 radiculopathy?

A

MC. back pain that radiates down the lateral leg with weakness with dorsiflexion of the foot. Sensation will be decreased in dorsum of the foot and and webspace between the first and second toe

112
Q

S1 radiculopathy?

A

decreased plantar flexion at the ankle and numbness of the lateral foot/posterior leg

113
Q

Hyperosmolar hyperglycemic state differs from diabetic ketoacidosis primarily because of

A

because of the lack of or very low levels of ketoacidosis.

Labs will show Glc > 600 and negative ketones

114
Q

HHS management? 3

A

Immediate 15–20 mL/kg intravenous isotonic fluid bolus, start intravenous regular insulin drip (0.05–0.1 unit/kg/hr) if or when blood glucose does not fall by 50–70 mg/dL per hour, replace potassium when level is less than 5.3 mEq/L

115
Q

dermatomyositis? 3

A

gottrans papules on extensor surfaces and heliotrope rash on eyelids w/ proximal muscle weakness

116
Q

What is the most common cause of meningitis in adult patients?

A

Streptococcus pneumoniae

117
Q

dacroadenitis vs dacrocystitis?

A

dacroAdenitis- Above (upper eyelid)

dacrocystitis- lower eyelid

118
Q

On plain film, what is the best image on which to see free air

A

the lateral chest X-ray

119
Q

strain vs sprain

A

strain- muscle belly or tendons

sprain- ligaments to bone

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