EMed Exam Flashcards
1
Q
What is considered chronic otitis externa?
A
> 6wks
2
Q
What is another name for acute otitis externa?
A
Swimmer’s ear
3
Q
other than the ear exam, what is an essential part of the PE for an ear complaint?
A
full cranial nerve assessment
4
Q
which of the following is NOT a sensorineural cause of hearing loss? presbycusis, meinere’s, ototoxic medications, otosclerosis
A
otosclerosis
5
Q
where exactly is a hematoma of the pinna located?
A
between the perichondrium and cartilage
6
Q
how long is a chronic OE?
A
> 6 weeks
7
Q
what is the concern with OE untreated?
A
progression to malignant OE or mastoiditis
8
Q
what are the results of an acute trauma to the middle ear?
A
perforation of TM
ossicular damage
hematoma of the middle ear
9
Q
toward which side does Weber lateralize with a TM perforation?
A
perforated side
10
Q
what is abrupt onset of ear pain consistent with?
A
barotrauma
11
Q
how long does it take hearing to return with a middle ear hematoma?
A
6-8 wks
12
Q
what is the most common symptom in adults with AOM?
A
tinnitus
13
Q
another name for labyrinthitis
A
vestibular neuronitis
14
Q
what is the triad of meniere’s disease?
A
unilateral hearing loss
tinnitus
vertigo
15
Q
where do most nose bleeds originate from?
A
anterior septum (Kiessellbach’s plexus)
16
Q
what is the most common source of posterior nose bleeds?
A
sphenopalatine artery
17
Q
what are the mL used to fill the balloons in the posterior balloon packing?
A
posterior balloon = 5ml
anterior balloon = 30 ml
18
Q
what is epiphora?
A
blockage of lacrimal duct
19
Q
complications of posterior packing
A
necrosis of nasal ala
infection
dysphagia
ET dysfunction
20
Q
another name for allergic rhinitis
A
hay fever
21
Q
name 3 differences (in sx) between sinusitis and rhinitis
A
purulent rhinorrhea in sinusitis - clear in rhinitis
postnasal drip in sinusitis - runny nose in rhinitis
facial pain in sinusitis - itchy red eyes in rhinitis
22
Q
acute vs chronic sinusitis in terms of duration
A
acute: < 4wks
chronic: >12 wks
23
Q
what are complications of a septal hematoma?
A
septal abscess
septal perforation
cartilage destruction with saddle nose deformity
24
Q
timeframe within which a septal hematoma can develop
A
within 72 hrs after injury
25
ellis classification of tooth fracture
```
I = enamel alone
II = dentin
III = pulp
```
26
what is pharyngitis
infection or irritation of the pharynx and/or tonsils
27
which disease gives a hot potato voice?
peritonsillar abscess
28
what is the dx test for peritonsillar abscess?
neck CT
29
what is the gold standard dx test for peritonsillar abscess
aspiration of pus from abscess
30
how much of the needle should be exposed when aspirating a peritonsillar abscess?
0.5cm
31
where on the abscess should you aspirate?
superior pole first
(if negative) then middle
(if negative) then lower
32
why should the lateral aspect of the abscess be avoided?
carotid artery is 2.5cm posterolateral to tonsil
33
where do irregular foreign bodies usually lodge in adults?
lingual or palatine tonsils
valleculae
piriform sinuses
34
where do smooth foreign bodies usually lodge in adults?
opening to the esophagus
| cricopharynxgeus muscle
35
how are XR and US for foreign bodies used differently?
XR: inorganic things
US: more sensitive for organic matter
36
when does collagen reformation occur during the wound healing process?
5-7 days into healing
37
how long does it take for proliferation of bacteria to cause an infection?
3-5 hrs
38
within what timeframe should a face wound be closed?
24 hrs
39
within what timeframe should a UE wound be closed?
12 hrs
40
within what timeframe should a LE wound be closed?
8 hrs
41
what is done in the interim when delayed primary wound healing is employed?
1) clean and decried devitalized tissue
2) apply saline gauze and cover
3) reirrigate, debride, undermine and close wound after 72-96 hrs
42
name the types of wounds for which epi should not be used
```
finger, nose, penis, toes
decreased blood flow areas
infected wounds
CV disease
propranolol
```
43
how is bacitracin used in wound preparation?
matt down hair around wound
44
why is peroxide bad for wounds?
inhibits wound healing
| hypergranulation
45
when is wound irrigation performed in the preparation phase?
after anesthesia
46
how long is a digital tourniquet applied for?
up to 30min
47
what are the 4 non-absorbable sutures?
ethilon
prolene
silk
nurolon
48
what are the 5 absorbable sutures?
```
vicryl
vicryl rapide
PDS
chromic gut
fast-absorbing gut
```
49
which absorbable suture has the best tensile strength?
PDS
50
which non-absorbable suture has the best tensile strength?
prolene
51
what is a subcuticular running used for?
allows suture to remain for longer period of time
| not used for acute wounds
52
how long should non-facial wounds be covered for in order to foster maximal epithelialization and minimal decontamination post repair?
24-48 hrs
53
which is more likely to get infected - puncture or laceration?
puncture
54
are abx used for uncomplicated wounds?
NO
55
what should be covered with abx in a foot injury?
pseudomonas
56
how long should face sutures remain in for?
3-5 days
57
how long should scalp sutures remain in for?
7 days
58
how long should UE/torso sutures remain in for?
7-10 days
59
how long should LE sutures remain in for?
8-12 days
60
what is the ppx for bite wounds?
Augmentin 3-5 days
61
name the 3 phases of rabies infection?
prodromal phase
neurological phase
paralytic phase
62
what is the bedrock of early ACS tx?
antiplatelet therapy
63
what HTN meds can be used in pregnancy?
labetolol, nifedipine, methyldopa
64
who should not receive clopidogrel?
severe CAD requiring CABG
65
aortic aneurysm measurement for dx
>4cm
66
what valve disorder can present with LVH?
aortic stenosis
67
what is the most common valve disease in the world?
degenerative mitral regurgitation
68
what is secondary mitral regurgitation?
valve is fine
| ventricle or papillary muscles are distorted
69
what are the BIG 3 of aortic dissection?
mediastinal widening
pulse variance or BP differential
abrupt shearing/tearing pain
70
what infection can cause aortic aneurysm?
syphilis
71
other than MI what can cause elevation of cardiac enzymes?
myocarditis
72
what predicts the severity of pericardial tamponade - rate of accumulation or the volume of accumulation?
rate of accumulation
73
what are some causes of subacute (slow accumulation of fluid) pericardial tamponade?
ESRD/uremia
| neoplasm
74
what does an EKG show in pericardial tamponade?
decr voltage
| electrical alternans
75
what is a common initial presentation of hypertensive emergency?
flash pulmonary edema
76
what is another term for neurocardiogenic syncope?
vasovagal syncope
77
what EKG abnormality can be seen in vasovagal syncope?
vagally mediated afib
78
what is cardiogenic syncope associated with in terms of presyncopal episode situation?
physical activity
79
what are 2 important things to assess on the physical exam for someone with a syncopal episode?
murmur and orthostatic vital signs
80
what are the overall tx goals for someone with wet and cold HF sx?
decongestion and inotropic support
81
what treatments are best for inotropic support?
dopamine, dobutamine, milrinone
82
when is the best time to get a US for suspected cholecystitis?
not just after the patient ate (better if gallbladder full)
83
what is the most sensitive hx question for acute appendicitis?
anorexia
84
what can patients eat when they have mesenteric ischemia?
soup - absorbed through the stomach
85
"pain out of proportion of exam"
mesenteric ischemia
86
in SBO, what is a change from crampy to constant pain suggestive of?
intestinal strangulation
87
what do high pitched bowel sounds suggest?
SBO
88
what is the most common cause of acute pancreatitis?
biliary tract disease
89
what improves acute pancreatitis pain?
supine positioning
90
what are the scores used for acute pancreatitis?
Ranson
Apache II
Glasgow
91
what does the Ranson score predict?
mortality
92
what is "coffee ground emesis" most commonly associated with?
upper GI bleed
93
what is black tarry stools associated with?
upper GI bleed
94
what are 4 things that can cause a false positive on hem occult?
PPI, vit C, red meat, jello
95
what is BRBPR (bright red blood per rectum) suggestive of?
lower GI bleed
96
when a patient is spitting up saliva, what does it suggest if you suspect a foreign body?
complete obstruction
97
what is the second MC reason for needing a liver transplant?
acetaminophen OD
98
bag of worms
varicocele
99
which side is a varicocele more likely to happen on?
left
100
what size does a stone need to be in order to pass on your own?
<5mm
101
when does tissue damage begin with priapism?
4 hrs
102
what is typically the cause (organism wise) of Fournier's gangrene?
aerobes and anaerobes
103
name some signs of respiratory distress
```
accessory muscle use
RR>30
pulse ox <90%
cyanosis
can't speak
agitation
lethargy
```
104
what is the classic triad of a PE?
hemoptysis
dyspnea
chest pain
105
what are the top 3 most common sx of a PE?
CP
SOB
anxiety
106
what are the top 3 most common signs of PE?
tachypnea
rales
fever
107
what is the wells criteria used for?
objectifies risk of PE
108
what is the PERC score used for?
to determine if other dx testing is necessary
109
what are the sign of a PE on CXR?
```
westermarks
hampton hump effusion
elevated hemidiaphragm
atelectasis
pleural opacity
```
110
how much VQ scans be interpreted? why?
in conjunction with clinical suspicion
| b/c results are in probabilities no +/-
111
what is the less common PE finding on EKG?
S1Q3T3
112
other than tachycardia and S1Q3T3, what might an EKG show if PE present?
right sided heart strain evidenced by RBBB or incomplete heart block
113
what is a common complication of COPD (think pH)?
respiratory acidosis
114
what should always be ordered for a COPD patient presenting to the ED?
CXR
115
what is the most valuable tool to evaluate medication response or decline in COPD?
PFTs or peak flow
116
what are signs of COPD on CXR?
flat diaphragm
| hyperinflation
117
why is oxygenating a COPD patient tricky?
need to balance need for O2 with producing hypercapnia
| respiratory acidosis - relies on hypoxia for respiratory drive
118
when should intubation be considered in a COPD patient?
respiratory fatigue
respiratory distress
AMS
agitation
119
what is likely the etiology behind a PTX in setting of PNA?
PCP
TB
staph aureus
120
what are the findings with an aspirated foreign body?
```
stridor
wheezing (if in bronchial tree)
```
121
when should you attempt the heimlich maneuver?
no spontaneous breathing
122
what is the last ditch effort when attempting to remove an aspirated foreign body?
push FB into mainstem bronchus with an ambo bag or ET tube
123
what does a silent chest indicate in asthma exacerbation?
severe obstruction
124
T/F: pulse ox is useful in predicting asthma outcomes
false
125
what will ABGs show in an acute asthma exacerbation?
PaCO2 > 40mmHg and/or
| PaO2 < 60mmHg
126
when can a patient with an acute asthma exacerbation go home?
if peak flow >70% of personal best
127
what are the bug that cause atypical PNA?
legionella
chlamydia
mycoplasma
128
which PNA can present with water diarrhea?
legionella
129
where does klebsiella typically cause an infiltrate?
upper lobe
130
what PNA can cause hyponatremia?
legionella
131
what is the most common cause of PNA in CF?
p. aeruginosa
132
which PNA can cause bloody sputum?
klebsiella
133
which bug is usually the cause of PNA in IVDU
staph aureus
134
which bug can cause a patchy infiltrate on CXR in PNA patient?
PCP
135
how long does it take aspiration PNA to develop?
within 1 hour of aspiration
136
where is the most common place for aspiration PNA to develop?
right lower lobe
137
what are the PORT score and PSI?
tools to determine mortality risk and disposition of PNA patients
138
what are the most common causes of pleural effusion?
CHF
bacterial PNA
malignancy
PE
139
4 PE findings that could suggest a pleural effusion
dullness to percussion
egophany
pleural friction rub
diminished/absent BS
140
what 2 things can cause a white out looking CXR?
large pleural effusion
| ARDS
141
urgent vs emergent
urgent: within 24 hrs
emergent: within 1-4 hrs
142
what happens with orbital cellulitis that doesn't happen with periorbital cellulitis?
pain with eye movement
143
what can cause orbital cellulitis?
infectious sinusitis
| dental//facial trauma or infection
144
what are the MC bugs that cause orbital cellulitis?
staph and strep
145
what does a disconjugate gaze suggest?
eye muscle involvement
146
what is the MC cause of viral conjunctivitis?
adenovirus
147
another name for viral conjunctivitis
pink eye
148
what is a common cause of conjunctivitis in contact wearers?
pseudomonas
149
what disease causes a strip of punctate lesions on the cornea? why?
keratitis
| UV light punching little holes
150
what is keratitis?
corneal inflammation (w/ or w/o ulceration)
151
what causes a dendritic appearance on fluorescein stain?
herpes keratitis
152
what are 3 sx of acute angle closure glaucoma?
nausea, HA, photophobia
153
what is a hyphema
pooled blood in the anterior chamber
154
what exact separation does retinal detachment involve?
neurosensory retina from pigmented retina
155
what causes a pale retina and cherry red fovea?
CRA occlusion
156
hypopyon
pus in the anterior chamber
| purulent hyphema
157
other than missing meds, what can cause DKA?
infection
injury/trauma
EtOH, drugs
GI bleed
158
why does Kussmaul breathing occur?
trying to compensate for acidosis
159
what starts of the cascade of events in DKA?
decreased insulin
160
if you get a VBG instead of an ABG what is the difference?
VBG will be lower than ABG
161
why must fluid status not be corrected too quickly?
cerebral edema
162
in what case would you give fluids rapidly in DKA?
shock
163
what does acidosis do to K?
drives it out of the cell
164
what are s/sx of hypokalemia?
cramps
fatigue
fatal arrhythmia
165
what should be checked prior to potassium repletion?
urine output
166
what helps quantify severity in DKA?
anion gap
167
what is the main problem in HHS?
dehydration from gradual diuresis
168
what is the rate at which serum osmolality should decrease when correcting DKA or HHS?
at most 3mOsm/kg/hr (d/t cerebral edema)
169
how is hypoglycemia in alcohol handled differently?
give glucose with thymine
170
what can cause someone to have inappropriate humor?
myxedema wit
171
why should thyroid hormone not be corrected too quickly in myxedema crisis?
risk of MI or atrial arrhythmias
172
what medication should a thyroid storm patient not receive?
aspirin (converts T4 to T3)
173
name the 3 PE signs in Addison's disease
bronzing
hyporeflexia
orthostatic HoTN
174
what is the most common presentation of an addisonian crisis?
shock refractory to fluids and pressors
175
what electrolyte disturbances does an Addisonian crisis cause?
hyponatremia
| hyperkalemia
176
what may an EKG show in an Addisonian crisis?
peaked T waves
| low voltage
177
classic triad of pheo sx
Perspiration
Headache
Tachycardia
178
what will not present on PE for a patient with catecholamine crisis?
flushing
179
what is a common central cause of DI?
trauma
180
what is the most common cause of vaginitis
candida
181
what is the difference in pH between bacterial vaginosis and candida vaginitis?
bacterial: > 4.5
candidal: < 4.5
182
what causes a strawberry cervix on PE?
trichomonas vaginitis
183
what is the MC bacterial cause of genital STD?
chlamydia
184
what is Reiter syndrome?
```
urethritis/cervicitis
conjunctivitis
rash
arthiritis
*can occur after chlamydia*
```
185
are men usually sx or asx with gonorrhea?
80-90% sx
186
besides chlamydia and gonorrhea what are are common causes of PID?
anaerobes
187
what is the hallmark sign of PID?
CMT
188
in terms of partners of patients with PID, who should be treated?
those within 60 days of dx
| if none - tx last partner
189
how long do you expect it to take for sx to get better in PID after tx?
3 days
190
when should you retest for GC/C?
3 mon (12 if not possible)
191
what are the 2 types of functional ovarian cysts?
follicle cysts
| corpus luteal cysts
192
how does a simple cyst differ from a complex cyst?
simple: just fluid
complex: fluid & solid
193
what is a Mittelschmerz?
ovulation pain due to physiological cyst rupture
194
where does ovarian torsion occur more commonly?
right ovary
195
what are causes of AUB?
endometriosis
fibroids
uterine cancer
196
what is postmenopausal bleeding indicative of?
uterine cancer
197
what is the most common GYN cancer?
uterine cancer
198
what 2 complications of pregnancy can cause bleeding after 20 weeks?
abrupto placentae
| placenta previa
199
what causes bleeding during early pregnancy?
ectopic pregnancy
| spontaneous abortions
200
where is the most common place for an ectopic pregnancy?
fallopian tube
201
what is the biggest risk factor for an ectopic?
PID
202
at what point should you see a yolk sac on US?
6 weeks
203
at what point should you see fetal cardiac activity on TV US?
6-6.5 weeks
204
what is the serum bhcg level that you should see a yolk sac?
2000
205
what time frame is considered a spontaneous abortion?
< 20 weeks
206
what does it mean if a woman's bhcg doesn't come down like expected after ectopic management?
trophoblastic tissue remains
207
what is a placental abruption?
partial or complete separation of placenta before delivery
208
T or F: the amount of blood in a placental abruption correlates to the extent of hemorrhage
F
209
what is placenta previa?
implantation of the placenta over the os
210
what is given to a mother 23-34 weeks along with placenta previa? why?
steroids
| to mature fetal lungs
211
how does Plan B act?
stop release of egg from ovary
212
what is the minimum age for emergency contraception?
> 17y/o
213
what are the 2 types of generalized seizures?
tonic-clonic
| non-convulsive (absence)
214
what is the main difference between generalized and partial seizures?
LOC
215
what is the difference between a simple and a complex partial seizure?
simple: isolated motor sx (+/- Jacksonian march)
complex: pt has aura followed by impaired responsiveness
216
what is usually the etiology behind GBS?
infection
217
what are the 2 key features required for GBS?
progressive weakness of limbs
| areflexia
218
why do PCA strokes often go undiagnosed?
do not involve a motor portion of the brain so sx not obvious
219
what is affected with MCA stroke?
face and arm/hand
| +/- aphasia if dominant hemisphere
220
what is affected with ACA stroke?
contralateral leg
221
what is affected with PCA stroke?
vision, light touch and pinprick sensation decr
222
if the left temporal region of the brain is affected, what might a patient have?
aphasia
223
what does a vertebrobasilar artery stroke manifest like?
cranial nerve deficits on one side
| limb weakness on other side of the body
224
what are the 2 types of hemorrhagic stroke?
ICH
| SAH
225
what are the 2 MC causes of a SAH?
ruptured aneurysm
| AVM
226
what is a sentinel bleed?
warning bleed causing headache before SAH
227
"fresh blood on CT, not in a common vascular distribution'
SAH
228
if you do a CT for a suspected SAH and it's normal, what do you do next?
LP - xanthochromia
229
what 3 types of people get a subdural hematoma?
elderly
anticoagulated
alcoholics
230
why are elderly more prone to a subdural hematoma?
cerebral atrophy (stress on bridging veins)
231
hallmark of subdural hematoma on CT
crescent shaped bleed
232
which vessel is implicated in an epidural hematoma?
middle meningeal
233
what is an epidural hematoma usually associated with?
skull fx
234
what is the classic finding on CT for an epidural hematoma?
lens or balloon shaped mass
235
what is the prime cause of mortality in epidural hematoma?
brain herniation from mass effect
236
what are 2 unique signs of an epidural hematoma?
hemotympanum
| CSF otorrhea or rhinorrhea
