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EM7 Flashcards

1
Q

common causes of APD? 4

A

Common causes include central retinal artery or vein occlusion, optic neuritis, and retrobulbar neuritis.

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2
Q

when can you see IUP on US?

A

This range is referred to as the “discriminatory zone” and is 1000-2000 mIU/mL for transvaginal scans and 6500 mIU/mL for transabdominal scans.

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3
Q

: At what week gestation is cardiac activity usually present?

A

6 weeks

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4
Q

brugada tx?

A

Automatic implantable cardioverter-defibrillator (AICD) placement

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5
Q

most common surgical emergency in patients older than 65 years of age

A

cholecystitis

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6
Q

painful vs painless vision loss (5)

A

painful- AACG, optic neuritis, iritis, temporal artertitis, corneal abrasion

painless- RD, CRAO/CRVO, amaourosis, MD, CVA

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7
Q

Wernicke’s encephalopathy triad?

A

opthalmoplegia, ataxia and confusion

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8
Q

What is diagnostic of appendicitis on ultrasound?

A

Diameter of 7 mm

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9
Q

What is the normal safe dose of 1% lidocaine solution injected subcutaneously?

A

3–5 mg/kg, not to exceed 300 mg per injection. 1% lidocaine contains 10 mg/mL of lidocaine.

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10
Q

Which electrolye abnormality is the predominant cause of refeeding syndrome?

A

hypophosphatemia

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11
Q

The presence of progressive cognitive decline, in addition to two of the following three features - fluctuating cognition, visual hallucinations and parkinsonism

A

Lewy Body Dementia

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12
Q

What is the common side effect of the administration of hydroxycobalamin?

A

Skin turns red

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13
Q

most common cause of nontraumatic hip pain in children.

A

Transient synovitis

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14
Q

proptosis, pain and limitation of extraocular movements

A

Orbital cellulitis

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15
Q

Diff between preseptal and orbital cellulitis?

A

OC- May have proptosis, vision impairment, diplopia, opthalmoplegia, cheimosis

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16
Q

painful, shallow, cluster of vesicles

A

Herpes

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17
Q

painless chancre

A

Syphillis

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18
Q

painless ulcer, inguinal lymphadenopathy

A

Lymphogranuloma venereum (C. Trachomatis)

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19
Q

painful chancres, inguinal bubo

A

Chancroid: H. ducreyi

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20
Q

beefy red genital ulcer

A

Granuloma inguinalea: K. granulomatis

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21
Q

Dermatitis, diarrhea, dementia

A

Niacin (B3) deficiency (pellagra)

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22
Q

Toxidrome- hypoglycemia and then fulminant liver failure

A

Amanita phyllodes

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23
Q

What would a neonate with abdominal pain and bilious vomiting suggest?

A

Bilious vomiting suggests malrotation with midgut volvulus.

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24
Q

Pericardiocentesis procedure

A

spinal needle insertion at the left sternal border between the 5th and 6th ribs.

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25
Q

Patients without vomiting 6 hours after exposure will not have major toxicity

A

Iron toxicity

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26
Q

Deferoxamine indications:

A

systemic illness, serum Fe level >350 mcg/dL + symptoms

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27
Q

Dx SBP? (3)

A

PMNs > 250, WBC > 1,000, pH < 7.34

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28
Q

Tx endometritis?

A

Inpt- clinda, gent

Outpt- augmentin

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29
Q

Epididymitis Treatment is?

A

< 35 y/o ceftriaxone/doxycycline,

> 35 y/o ciprofloxacin

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30
Q

Best location for temperature probe:

A

esophagus

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31
Q

ROSC cooling Target temperature:

A

33 - 36°C

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32
Q

Normal ABI?

A

ABI > 0.9

If less, needs angiography

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33
Q

Lab findings of microangiopathic hemolytic anemia? (4)

A

schistocytes on peripheral blood smear, as well as anemia with decreased haptoglobin, and elevated LDH and unconjugated bilirubin.

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34
Q

Tx TTP?

A

Plasmapheresis

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35
Q

What are three other emergent causes of microangiopathic hemolytic anemia besides TTP?

A

Hemolytic uremic syndrome, HELLP syndrome (hemolysis, elevated liver function tests, low platelets), and disseminated intravascular coagulation.

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36
Q

Trichophyton rubrum

A

Tinea cruris (jock itch)

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37
Q

What correlates with level of severity of placental abruption?

A

Fibrinogen

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38
Q

Tx SAH?

A

Treatment is supportive and nimodipine (decreases vasospasm)

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39
Q

Simple Febrile seizure? (3) tx?

A
  1. Patient will be a child 6 months to 5 years of age
  2. With a history of fever > 38º C
  3. Complaining of a single tonic-clonic seizure lasting < 15 mins

Treatment is supportive care. If lasting > 5 min, a dose of diazepam gel or suppository into the rectum can be used

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40
Q

multinucleated giant cells on Tzanck smear

A

Herpes

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41
Q

most common site of orbital blowout

A

Inferior- the maxillary bone is most commonly fractured.

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42
Q

Eczema on what surfaces?

A

Flexor

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43
Q

Signs of upper motor neuron deficits (3)

A

lower extremity spasticity, hyperreflexia and a positive Babinski sign.

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44
Q

What age is a contraindication for the administration of tPA in the 3-4.5 hour time frame?

A

Greater than 80 years.

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45
Q

Stroke deficit Anterior cerebral artery:

A

frontal lobe dysfct, apraxia, contralat paralysis (lower > upper)

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46
Q

Stroke deficit Middle cerebral artery:

A

contralat paralysis (upper > lower), hemianopsia, aphasia

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47
Q

Stroke deficit Posterior cerebral artery and VBI:

A

LOC, nausea/vomiting, CN dysfct, ataxia, visual agnosia

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48
Q

What are the five NEXUS criteria for clinically clearing the cervical spine? I

A

No focal neurologic deficits, normal alertness, no evidence of intoxication, no distracting injuries, and no posterior midline cervical tenderness.

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49
Q

How to escharotomy?

A

Incise through skin into subcutaneous tissue
Neck: incise from clavicle to mastoid process
Chest wall: incise along anterior axillary line from 2nd to 12th rib
Extremities: incise on medial and lateral aspects 1 cm proximal to 1 cm distal to burn

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50
Q

How can you diagnose papilledema with ultrasound?

A

Optic nerve sheath diameter > 5 mm, measured 3 mm posterior to the globe.

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51
Q

If MRI is not available, what other radiographic modality may identify cord compression?

A

CT Myelography.

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52
Q

most useful marker for severity of radiation injury

A

Absolute lymphocyte count @ 48 hours

Excellent outcomes are expected for normal levels, fair for 500–1000/mm3, and essentially fatal for < 100/mm3

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53
Q

When to give steroids for PCP PNA? (2) tx?

A

PaO2<75 or A-a gradient >35

Give steroids first then Bactrim

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54
Q

Pressure ulcer stages?

A

1- nonblanching erythema - cover w/ transparent film
2- open, erythematous (partial thickness)
3- SC fat (full thickness skin) - hydrogel, Surg debridement if eschar
4- bone, tendon, muscle (full thickness tissue)

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55
Q

Tx of premature rupture of membranes ?

A

If the fetus is immature (24 – 34 weeks of gestation), corticosteroids (+amp/amox) should be considered to accelerate pulmonary maturity. Over 34 weeks of gestation, delivery is preferred.

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56
Q

Nitrazine test?

A

If nitrazine paper turns blue —> premature rupture of membranes

57
Q

Pooling test?

A

Collection of amniotic fluid in vaginal fornixes—> premature rupture of membranes

58
Q

Ferning test?

A

Vaginal fluid on microscope slide will crystallize —> +amniotic fluid —> premature rupture of membranes

59
Q

Terry Thomas sign? Tx ?

A

Scapholunate dislocation . Thumb spica

60
Q

Hand bones?

A

So Long To Pinky, Here Comes The Thumb

61
Q

cephalocaudal spread (2)

A

rubeola (measles), rubella (german measles)

62
Q

boxer fx

A

fx of neck of 5th mcp

63
Q

galeazzi fx

A

fx of distal radius w/ disruption of radioulnar joint (MU/GR)

64
Q

monteggia fx

A

fx of proximal 1/3 ulna w/ dislocation of radial head (MU/GR)

65
Q

TOF-4

A

VSD, overriding aorta, pulmonic stenosis (R–> L shunt), RVH

66
Q

gram stain- s aureus

A

gm+ in clusters

67
Q

gram stain- s pneumo

A

gm+ diplococci

68
Q

tPA reversal (2)

A

amicar (aminocaproic acid) + cryo

69
Q

centrifugal rash

A

smallpox (variola)

70
Q

hot-cold sensation reversal?

71
Q

conjunctivitis, cough, coryza

A

rubeola (measles)

72
Q

vitals in neurogenic shock

A

hypotension, hypothermia, bradycardia

73
Q

positive whiff test? tx?

A

bacterial vaginosis, flagyl

74
Q

clue cells? tx?

A

bacterial vaginosis, flagyl

75
Q

bennett fx

A

fx of base of 1st MCP

76
Q

bohler angle

A

calcaneal fx, angle of 28-40 degrees=normal

77
Q

fat emboli tx? (3)

A

steroids, supportive, NO heparin

78
Q

cough + widened mediastinum on CXR

A

pulm anthrax

79
Q

osmolar gap w/o acidosis

A

isopropyl alcohol

80
Q

opioid w/ dilated pupils or seizures

A

meperidine (demerol)

81
Q

maltese crosses in urine - tox

A

ethylene glycol

82
Q

glass etcher, rust remover, metal cleaners- tox

A

hydrofluoric acid

83
Q

ETT Tube calculation

A

(age/4) + 4
ie: 4 yo= 5 ETT uncuffed
minus 0.5 cuffed (ie: 4.5)
valid age 1-10

84
Q

ETT tube depth

A

ETT size x 3

85
Q

CXR w/ FB- where is it?

A

coin in esophagus- frontal

coin in trachea- sagittal

86
Q

cri de canard (duck cry)

87
Q

thumbprint sign

A

epiglottitis

88
Q

what nerve is blocked- upper lid, lower lid, lower lip

A

upper lid- supraorbital
lower lid-infraorbital
lower lip- mental

89
Q

BL adrenal hemorrhage

A

Waterhouse-friderichsen meningococcemia

90
Q

nail punctures through snearkers

A

pseudomonas

91
Q

rubella aka? sx? 2

A

german measles, (LAD, forscheimer spots)

92
Q

rash spreads on neck/trunk and spreads to face/extremities

93
Q

ALS

A

motor fxn loss (UMN + LMN) but sensation intact

94
Q

port wine stain + seizures

A

sturge-weber syndrome

95
Q

strawberry cervix? tx?

A

tricomoniasis, flagyl

96
Q

thin grey-white vaginal discharge? tx?

A

bacterial vaginosis, flagyl

97
Q

6 unstable cervical spine fxs

A

“Jefferson bit off a hangman’s thumb”

  • jefferson fx
  • BL facet dislocation
  • odontoid type II and type III fx
  • any fx/dislocation
  • hangman fx
  • teardrop fx
98
Q

smith fx

A

reverse colles fx -distal radius fx w/ volar displacement

99
Q

jones fx

A

fx of base of 5th MTP distal to styloid process (surgical)

100
Q

pseudojones fx?

A

styloid process fx of 5th MTP (better prognosis)

101
Q

gamekeeper fx

A

UCL of thumb, lose pincer grasp

102
Q

lisfranc fx

A

fx at base of 2nd MTP

103
Q

bleeding baby after home delivery

A

vit K deficiency

104
Q

perioral burn after biting electrical cord

A

delayed labial artery bleeding in 7-10 days

105
Q

PNA w/ marked lymphocytosis + shaggy R heart border on CXR

106
Q

PNA after air travel

A

legionalla

107
Q

PNA + GI sx

A

legionella

108
Q

PNA + hyponatremia

A

legionella

109
Q

pinpoint pupils- 4

A 
POCO
pontine bleed
opioids
clonidine
organophosphates
110
Q

yellow halos- tox

111
Q

pepto bismol OD - tox

A

salicylates

112
Q

Neers test?

A

Supraspinatus tendinitis

113
Q

B symptoms?

A

fevers, night sweats, and weight loss (Hodgkin’s lymphoma)

114
Q

Reed-Sternberg cells

A

Hodgkin’s lymphoma

115
Q

At what size is an ovarian mass at high risk for torsion?

A

5 cm or greater, although any mass size can cause torsion

116
Q

endolymphatic hydrops

A

Menieres disease (excess fluid buildup in the labrynithe system)

117
Q

tx menieres? (2)

A

low salt diet, diuretics (HCTZ + triamterene)

118
Q

MC organism causing endorcarditis in IVDA? native valve?

A

IVDA: staph (R sided, TV)

non-IVDA: strep (L sided, MV)

119
Q

tx endorcarditis?

A

piperacillin-tazobactam and vancomycin with gentamicin (for double gram-negative coverage) and micafungin (for fungal coverage in severely ill patients or patients being sent to the intensive care unit) + source control

120
Q

retroperitoneal structures?

A

kidneys, adrenal glands, pancreas, and retroperitoneal portions of the duodenum, colon, aorta, and inferior vena cava

121
Q

What physical exam finding can differentiate ethylene glycol ingestion from methanol ingestion?

A

Visual acuity, as methanol leads to blurry vision and blindness rapidly if not treated

122
Q

The historical feature that most increases the likelihood that the patients discomfort is ischemic is ?

A

chest pain that radiates into bilateral arms.

123
Q

cx of nephrotic syndrome?

A

DVT bc they are hypercoaguable

124
Q

what hyperK tx can drive K intracellularly? 3

A

insulin, albuterol, sodium bicarb

125
Q

what hyperK tx can drive eliminate K? 3

A

lasix, kayexelate, HD

126
Q

What is a potential complication of acyclovir administration if administered rapidly or with a high dose?

A

Crystal-induced nephropathy (treated with IV hydration and lowering the dose).

127
Q

tx transverse myeitis in adults? 2

A

high dose steroids, plasmapheresis if refractory

128
Q

tx complete heart block stable vs unstable?

A

Asymptomatic - none
Symptomatic - atropine or isoproterenol
Unstable- transcutaneous vs venous pacing

129
Q

The most sensitive diagnostic maneuvers for meningitis?

most specific exam maneuvers for meningitis?

A

sensitive- jolt accentuation of headache

specific- brudzinski

130
Q

Which infectious agent warrants administration of steroids in the treatment of meningitis?

A

Streptococcus pneumoniae.

131
Q

Etiologies of high-output heart failure include? 5

A

sepsis, hyperthyroidism, beriberi, preg, and arteriovenous fistulas.

132
Q

tx toxic shock syndrome? how do they work?

A

1- clindamycin is bacteriostatic, as it does not actively cause cell death but rather stops protein synthesis and the bacteria’s ability to replicate.
2- Vancomycin is bactericidal by causing cell wall damage.

133
Q

tx RPA

A

Ampicillin-sulbactam is the antibiotic of choice with intravenous dexamethasone

134
Q

spont pneumomediastinum in peds ass with

135
Q

narrow vs wide complex PEA?

A

narrow- RV problem, obstruction

wide- ischemia, metabolic

136
Q

type I DM vs type II? (3)

A

type I- Autoantibodies, low insulin levels, and decreased C-peptide levels

137
Q

tx acute myasthenic crisis?

A

plasmapheresis or IVIG

138
Q

normal CBD size?

139
Q

indications to intubate near-drowning pt? (3)

A
  • neurologic deterioration
  • PCO2 above 50 mm Hg.
  • inability to maintain PO2 above 60 mm Hg despite supplemental oxygen

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