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EM8 Flashcards

1
Q

acid base disturbance in ASA tox

A

metabolic acidosis w/ resp alkalosis

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2
Q

spider bite + abd pain

A

black widow

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3
Q

necrotic spider bite after lifting log

A

brown recluse (violin shape)

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4
Q

should you give antivenin in coral snake bite

A

administer antivenin even w/o sx “red on yellow kill a fellow”

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5
Q

machine oil urine

A

hyperthermia

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6
Q

staccato cough

A

neonatal chlamydia (dev @ 4-12 weeks)

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7
Q

type 1 vs II error

A

type 1 = a (null hypothesis incorrectly rejected)

type 2= B (failure to reject null when its wrong)

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8
Q

class iv hemorrhage will present with

A

negligible urine output, confusion

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9
Q

NEXUS Criteria?

A
  • N- Neuro deficit
  • E- EtOH/intoxication
  • X- distracting injury
  • U- Unconsciousness/AMS
  • S- servical tenderness
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10
Q

What injury is likely to be present in a child with a raised elbow fat pad?

A

Supracondylar fracture.

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11
Q

Posterior fat pad sign suggestive of ?

A

radial head fracture

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12
Q

Quincke’s pulse:

A

prominent nail pulsations ass w/ AR

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13
Q

major Duke’s criteria for endocarditis? 3

A

+blood cx, echo findings, new murmur

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14
Q

melena indicates where location of bleed

A

UGIB prox to ligament of treitz

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15
Q

MCC LBO

A

cancer

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16
Q

1st line tx for Crohns

A

5-ASA agents (sulfasalazine or mesalamine)

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17
Q

causes of inc unconjugated bili (2)

A

hemolysis (or inc production) or hepatocellular injury (problem w/ hepatocyte)

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18
Q

causes of inc conjugated bili

A

bile obstruction

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19
Q

vaccines for splenectomy pts?

A

cover encapsulated organisms (s pneumo, h influenza, n meningitiditis)

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20
Q

morbilliform rash after ampicillin

A

EBV

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21
Q

dx SCD sequestration (3)

A

Hb drop by 2 points, thrombocytopenia, reticulocytosis

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22
Q

Displacement of the radiocapitellar line suggestive of?

A

subluxation or dislocation of the radial head

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23
Q

What chemotherapeutic agent is associated with dilated cardiomyopathy?

A

doxorubicin

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24
Q

How long does it take for Gtube to mature?

A

4 weeks (before this g tube displacement should be admitted for IV Abx and monitor for peritonitis)

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25
Q

CI during thyroid storm?

A

Aspirin (because it displaces T4 from binding proteins leading to increased serum levels of T4 and T3 potentiating the thyrotoxicosis.)

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26
Q

Fusion beats ? Suggestive of?

A

occur when impulses from two different locations (one within the ventricle and one in a supraventricular location) activate the ventricle. The result is a QRS complex with morphology resembling a hybrid of a sinus beat and intraventricular beat. These are diagnostic of VT because they represent AV dissociation.

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27
Q

Capture beats?

A

Capture beats occur when a sinus beat is normally conducted and a single beat with the sinus QRS morphology occurs within a wide complex tachycardia.

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28
Q

Tx prinzmetal angina?

A

Nitrates and CACB

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29
Q

What three medications decrease mortality after a myocardial infarction?

A

ABC – Aspirin, beta-blockers, statins (anti-cholesterol)

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30
Q

Which kidney stone patients need admission?

A

Patients who have only one kidney and an obstructing stone need admission with urology consultation

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31
Q

Which kidney stones likely to pass? And not?

A

Treatment is:
< 5 mm: likely to pass spontaneously
> 8 mm: unlikely to pass, lithotripsy

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32
Q

Which finding on lung ultrasound is most specific for a diagnosis of spontaneous pneumothorax?

A

presence of a lung point sign, visualization of the junction of normal lung sliding adjacent to an area with absent lung sliding.

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33
Q

What viral foodborne disease presents with jaundice, dark urine, and diarrhea?

A

Hepatitis A.

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34
Q

Tx GuillianBarre Syndrome?

A

Treatment is supportive, plasmapheresis, or IVIG

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35
Q

MCC osteomyelitis?

A

S aureus

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36
Q

MC spread osteomyelitis?

A

Adults: contiguous spread
Children: hematogenous spread

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37
Q

Tx ketamine laryngospasm?

A

BVM

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38
Q

Best needle position for evacuation of PTX? PLeural effusion?

A

Air evacuation site: 2nd ICS, midclavicular line

Fluid evacuation site: ≥ 1 ICS below top of effusion in the midscapular or posterior axillary line

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39
Q

Standard sexual assault tx?

A

CDC recommends empiric treatment of gonorrhea, chlamydia, and trichomoniasis with ceftriaxone 250 mg IM, azithromycin 1 gm orally, and metronidazole 2 gm orally, respectively. Hep B vaccine only if not previously vaccinated

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40
Q

Best emergency contraception if >72 hours from encounter?

A

Ulipristal 30 mg orally is the preferred choice if it has been 72 hours or longer since the assault and in overweight or obese women. It is a selective progesterone receptor modulator which delays ovulation by as much as five days.

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41
Q

Best emergency contraception if <72 hours from encounter? (2)

A

Ethinyl estradiol 100 mcg and levonorgestrel 0.5 mg x two doses 12 hours apart is 80% effective if given within 72 hours of intercouse but is not well tolerated due to frequently associated nausea and vomiting. Levonorgestrel 1.5 gm is another treatment option for emergency contraception

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42
Q

Two types of local anesthetic classes?

A

Amides: lidocaine, bupivacaine (2 Is)
Esters: tetracaine, benzocaine (1 I)

(If allergic to one try the other class)

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43
Q

Tx local anesthetic OD?

A

Toxicity Rx: lipid emulsion

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44
Q

Sx Benzocaine OD?

A

methemoglobinemia

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45
Q

Sx Lidocaine OD:

A

seizures, hypotension

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46
Q

Sx Bupivicaine OD:

A

cardiotoxicity

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47
Q

Lidocaine Concentration 1% means what

A

1% = 1g/100mL = 10 mg/mL

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48
Q

What local anesthetics can be used subdermally in patients with allergic reactions to both amide and ester anesthetics? (2)

A

Diphenhydramine or benzyl alcohol with epinephrine.

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49
Q

Dx HIV?

A
  • Dx: ELISA followed by HIV-1/HIV-2 differentiation immunoassay or Western blot
  • Dx tests become positive during seroconversion (3-12 weeks after exposure)
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50
Q

HIV * Chronic watery diarrhea:

A

Cryptosporidium

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51
Q

HIV * White cottage cheese lesions:

A

Candida

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52
Q

HIV * Irremovable white lesions on lateral tongue:

A

hairy leukoplakia (EBV)

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53
Q

PCP PNA in HIV when?

A

CD4 < 200

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54
Q

TB in HIV when?

A
  • TB: CD4 < 200, may have negative CXR/PPD
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55
Q

HIV * Ring-enhancing intracranial lesions + focal neurologic deficits:

A

Toxoplasma gondii

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56
Q

HIV * Ring-enhancing intracranial lesions + AMS:

A

primary CNS lymphoma

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57
Q

HIV * Meningitis, CD4 < 100:

A

Cryptococcus

58
Q

HIV * Focal neurologic deficits, non-enhancing white matter lesions, CD4 < 200:

A

PML (JC virus)

59
Q

HIV * Retinitis, cotton-wool spots:

A

CMV

60
Q

HIV * Dark purple skin/mouth nodules:

A

Kaposi’s sarcoma

61
Q

HIV * Cutaneous:

A

HSV, zoster reactivation

62
Q

HIV dz when CD4< 250? (2)

A

Esophageal candidiasis, HSV

63
Q

HIV dz when CD4< 200? (2)

A

PCP PNA, PML

64
Q

HIV dz when CD4< 100? (4)

A

Toxoplasmosis, encephalopathy, crypto, military TB

65
Q

HIV dz when CD4< 50? (2) px?

A

CMV retinitis, MAC

Start azithromycin for Px

66
Q

How to calculate absolute lymphocyte count ?

A

absolute lymphocyte count is calculated by multiplying the percentage of lymphocytes by the total number of white blood cells
(An absolute lymphocyte count < 950 K/ml is predictive of a CD4 count below 200.)

67
Q

Mackler’s triad for Boerhaaves?

A

chest pain, vomiting and subcutaneous emphysema

68
Q

In which portion of the esophagus does rupture typically occur for Boerhaaves?

A

The posterolateral portion is the most common site of rupture.

69
Q

Dx Boerhaaves?

A

esophogram with water-soluble oral contrast

70
Q

massive transfusion cx-3

A

coagulopathy, hypocalcemia, hypothermia

71
Q

transfusion rxn- hemolytic rxn? tx?

A

ABO incompatibility, d/c

72
Q

transfusion rxn- allergic rxn?

A

urticaria or hives

73
Q

transfusion rxn- TRALI? tx?

A

like ARDS. stop transfusion

74
Q

transfusion rxn- delayed rxn? 3

A

3-4 weeks later, dec Hb, inc bilirubin

75
Q

transfusion rxn- GVHD?- 4

prevention?

A

immunocompromised pt, rash, pancytopenia, inc LFTs. prevent w/ irradiated blood products in immunocompromised pt

76
Q

how to open PDA?

A

prostaglandin E1

77
Q

tetrology of fallot?

A

PROVe (pulm stenosis, RVH, overriding aorta, VSD)

78
Q

2 most common infxns that cause Jarisch-herxheimer rxn after starting Abx?

A

lyme + syphillis

Abx —> lysis of spirochete bacteria

79
Q

brudzinski sign

A

flex neck

80
Q

kernig sign

A

extend knees

81
Q

px of close contacts for meningitis

A

rifampin

82
Q

5 indications for emergent HD

A

A-acidosis, E-electrolyte abnl, I-ingestion (lithium, methanol), O-overload, U-uremia

83
Q

erythema multiforme

A

target-like lesions (can be 2/2 infxn, meds, autoimmiune)

84
Q

erythema marginatum

A

rheumatic fever (macule w/ central clearing that spares face)

85
Q

erythema nodosum

A

inflammatory nodules (can be 2/2 autoimmune, infxn, meds, preg)

86
Q

erythema migrans

A

lyme disease (bull’s eye)

87
Q

erythema infectiosum

A

parvo b19 (slapped cheek)

88
Q

what rashes appear on palms-6

A

syphillis, RMSF, hand/foot/mouth, erythema multiforme, drug eruption, scabies

89
Q

back pain in young pt w/ morning stiffness

A

seroneg spondyloarthropathy

90
Q

back pain w/ extension, relief w/ flexion

A

spinal stenosis

91
Q

carbon monoxide indication for hyperbaric tx?

A

if COHb<20% —> 100% O2 tx.

if COHb>25% then hyperbaric (>15% in preggos)

92
Q

thermal burn grades-4?

A

superficial= like sunburn

superficial partial thickness= red + painful + blisters

deep partial thickeness= white + leathery + painless

full thickness= charred + insensate

93
Q

which burns go to burn center? 6

A

any full thickness, partial thickness > 10% TBSA, burns of face/genitalia/hands/feet/major joints, high voltage or electrical, chemical, inhalation injury

94
Q

clonic vs tonic

A

clonic= jerking, tonic= posturing

95
Q

ICH where- homonymous hemianopsia

A

putamen

96
Q

ICH where- sensory loss> motor loss

A

thalamus

97
Q

ICH where- pinpoint pupils, decerebrate posturing, coma

A

pontine

98
Q

finkelstein test dx of? tx?

A

de quervain’s tendinopathy (flex thumb + ulnar deviation). tx= thumb spica

99
Q

tx DVT in preggo

A

LMWH

100
Q

tetanus px for low risk wound? high risk?

A

low risk= dT

high risk= dT and TIG (250 U IM)

101
Q

order of drugs in hyperthyroidism/thyroid storm? 3

A

1- propranolol
2- PTU/methimazole
3-iodine/steroids

102
Q

tx scabies- 2

A

(interdigit burrows) permethrin, ivermectin

103
Q

pinworm tx- 3

A

albendazole or mebendazole. pyrantel pamoate

104
Q

PNA- ohio/mississippi river valley, bird/bat droppings

A

histoplasmosis

105
Q

PNA- southwest, arthritis, erythema nodosum

A

coccidiodomycosis

106
Q

PNA- midwestern, south east, budding yeast, bone lesions

A

blastomycosis

107
Q

weber localizes to affected ear, Rinne abnl (BC>AC)

A

conductive hearing loss (OM, cerumen)

108
Q

weber localized to unaffected ear, Rinne normal (AC>BC)

A

sensorineural hearing loss (noise exposure, drugs, aging)

109
Q

basophilic stipling + microcytic anemia? tx?

A

lead poisioning, tx= succimer (it SUCCs to eat lead)

110
Q

SCD: low Hb, reticolytosis

tx? (3)

A

splenic sequestration crisis. tx= transfuse, supportive, splenectomy

111
Q

SCD: low Hb, no reticolytosis

tx? (2)

A 
aplastic crisis (parvo b18)
tx= transfuse, supportive
112
Q

vent tx breath stacking?

A

dec RR, then inc TV

113
Q

MC bug in resp secretions for CF kids? adults?

A

kids- staph

adults- pseudomonas

114
Q

status epilepticus tx? (3)

A
  1. BZDs
  2. phenytoin/fosphenytoin OR valproic acid OR pheonobarb OR levitiracetam
  3. pentobarb OR propofol
115
Q

anterior nosebleeds from what vessel? posterior?

A

anterior- kiesselbach plexus

posterior- sphenopalatine artery (posterolateral)

116
Q

What is the first maneuver that should be attempted when a patient with a tracheostomy presents with massive bleeding concerning for a tracheoinnominate artery fistula?

A

Hyperinflate the cuff of the trachea to attempt to tamponade the bleeding vessel. If this fails, orotracheal or nasotracheal intubation followed by direct digital pressure should be pursued.

117
Q

how long does it take for a trach site to mature?

A

7 days

118
Q

stages of pertussis?

A
  1. catarrhal: 1-2 weeks of URI
  2. paroxysmal: 2-6 weeks of cough attacks
  3. convalescent: 1-2 weeks of getting better
119
Q

post-exposure px for pertussis?

A

macrolide (erythromycin, azithromycin, clarithromycin). Bactrim if allergic

120
Q

tx toxic shock syndrome?

A

Clindamycin as it suppresses toxin production.

121
Q

if treating aspiration PNA, what antibiotic should you use?

A

ampicillin-sulbactam (for aerobe and anaerobe coverage)

122
Q

What solutions should be used to unclog a gastrostomy tube?

A

Warm water (found to be superior to colas) or pancreatic enzymes dissolved in a bicarbonate solution.

123
Q

MC source of embolization from the heart?

A

atrial appendage (small area in the left lateral wall of the left atrium where clots form)

*esp w/ afib

124
Q

What is the international normalized ratio (INR) target when treating atrial fibrillation with warfarin?

A

2.0 to 3.0.

125
Q

What artery is at risk of injury with a supracondylar fracture?

A

Brachial artery.

126
Q

what meds is associated with anhidrotic hyperthermia in overdose?

A

antihistamines (eg: scopolamine)

127
Q

when do you transfuse FFP?

A

bleeding pt w/ INR > 1.7

128
Q

when do you tranfuse cryo?

A

bleeding pt w/ fibrinogen < 100

129
Q

tx giardia?

A

MNZ

130
Q

marcus gunn pupil?

A

APD

131
Q

bartholin’s cyst tx?

A

NO tx unless sympomatic or >40 (these are diff from bartholin’s abscess)

132
Q

1st-3rd line tx for hypotension in septic shock?

A
  1. levophed
  2. vasopressin or epi
  3. glucocorticoids
133
Q

treatment of choice in bradydysrhythmias in cardiac transplant patients

A

isoproterenol (atropine doesnt work bc denervation during transplant –> no vagal tone)

134
Q

Transplant Rejection
Hyperacute rejection:
Acute rejection:
Chronic rejection:

tx?

A

Hyperacute rejection: minutes-hours post-transplant, irreversible graft destruction, due to preformed antibodies
Acute rejection: weeks-months post-transplant, humoral/T-cell mediated
Chronic rejection: months–years post-transplant

Transplant rejection Rx: steroids

135
Q

MC bug in lung abscess

A

Peptostreptococcus

136
Q

tx of tet spells? (3)

A

knee-to-chest position, morphine to decrease the respiratory rate and improve oxygenation, and phenylephrine, which increases systemic vascular resistance, improving blood flow to the pulmonary artery for proper oxygenation.

137
Q

“painless jaundice.”

A

pancreatic cancer

138
Q

migratory thrombophlebitis

A

pancreatic cancer (Trousseaus syndrome)

139
Q

palpable nontender gallbladder

A

pancreatic cancer (Courvoisier sign)

140
Q

Palpable left supraclavicular lymph node

A

pancreatic cancer (Virchows node)

141
Q

palpable nodule bulging into the umbilicus

A

pancreatic cancer (Sister Mary Joseph sign)

EM Boards (8 decks)

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