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