EMED Phase 2 Flashcards

1
Q

ACS includes ? three Dxs

What is the MC Sx for ACS

What are the atypical Sxs

A

N/STEMI, UA

Angina

Diaphoresis Dizzy Palpitations Nausea SOB Back/Ab pain

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2
Q

? type of MI doesn’t produce Q-waves and is Dx by ?

Repeat troponins in ? time frame if Dx is uncertain

What are the 3 characteristics of UA

A

Posterior- tall R-wave in V1-2

3hrs

Began <2mon,
Inc frequency, intensity, duration
Occurs at rest

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3
Q

Vessel involvement of MIs

A
Inferior- RCA > RCX
Lateral- LCX
Septal- LAD septal branch
Anterior- LAD
RV- RCA
Posterior- LCX
Atrial- RCA
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4
Q

What are the absolute c/i for fibrinolytic therapy when Tx STEMIs

A
Any prior intracranical hemorrhage
Structural cerebral vascular lesion
Intracranial neoplasm
Ischemic stroke <3mon
Actively bleeding 
Suspected dissection/pericarditis
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5
Q

Define Cardiogenic Shock

This is MCC by ?

What causes coronary artery hypoperfusion

A

NSTEMI reduction of output leading to dec perfusion despite normal volume available for circulation

AMI dec contractility= pump failure w/ dec CO and hypoperfusion

Dec DBP d/t lack of systemic resistance

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6
Q

Define Situational Syncope

Define Carotid Sinus Hypersensitivity

When does this DDx become a likely Dx

A

Autonomic reflex response from urination, defecation or coughing

Syncope w/ head turning/wearing tight neck clothes

Recurrent syncope w/ neg cardiac workup

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7
Q

What are S/Sxs of brain stem ischemia/vertebrobasilar insufficiency

What structure is occluded if syncope was induced by overhead physical activity

What is the MC Dx mistaken as syncope and what makes this more likely

A

Posterior circulation deficits-
Diplopia Vertigo Focal neuro deficit Nausea

Brachiocephalic, Subclavian artery

Seizures- Postictal state, Epileptic aura, Tongue bite, Incontinence

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8
Q

What are the 3 most important parts of a syncope work up

What PE results suggests Subclavian Steal Syndrome

Per San Francisco Syncope Rules, ? Pts are at increased risk for adverse events from their syncope

A

Hx, PE, EKG

> 20mmHg difference between extremities

Abnormal EKG, SOB, SBP <90, Hct <30%, Age >45, MedHx of ventricular dyshythmia/CHF

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9
Q

What are the MC precipitating factors to acute HF

What are the 6 classifications of HF

A

Afib, MI, D/c meds, Inc Na, Overexertion

HTN: SBP 140 w/ S/Sx of CHF, +CXR and Sxs <48hrs
Pulm edema
Cardiogenic shock: hypoperfusion and SBP <90
Acute on Chronic- SBP <140 but >90 w/ edema
High output: Tachy, Warm w/ pulmonary congestion
Right HF: low output w/ JVD, hepatomegaly, HOTN

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10
Q

What is the most useful part for Dx acute HF

What Sxs have the highest sensitivity for this Dx

What Sxs have the highest sensitivity for this Dx in order

A

Hx of acute HF

Dyspnea

Paroxysmal nocturnal dyspnea
Orthopnea
Edema

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11
Q

What are the most specific CXR findings for Dx of Acute HF

How can the Sxs of HF be reduced

? is the primary indication for cardiac transplant in the US

A

Venous congestion, Megaly, Interstitial edema

Dec after load w/ vasodilators

Idiopathic dilated cardiomyopathy

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12
Q

How are cardiomyopathies Dx

How are complex ventricular ectopy Tx in the setting of cardiomyopathy

What meds are used for the chronic therapy

A

Echo

Amiodarone

ACEI, BB (carvedilol)- improve survival
Diuretics Digoxin- improve Sxs

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13
Q

What are the MC Sxs of HOCM in order

What should be prescribed to Pts once Dx is made

What is an uncommon Sx of Restrictive Cardiomyopathy

A

Dyspnea > Angina, Palpitations Syncope

Atenolol

Chest pain

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14
Q

Define Kussmaul Sign and when is it seen

How are Pts w/ Restrictive Myopathy Tx

What is the MC Sx of pericarditis

A

Inspiratory JVD w/ restrictive myopathy

ACEi w/ diuretics
CCS- Sarcoidosis
Chelation- Hemachromatosis

Sharp/stabbing chest pain worse w/ supine, relieved w/ sitting and leaning fwd

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15
Q

What c/c is unique and specific to pericarditis

What is the best location to hear the friction rub

What are the 4 stages of EKG findings

A

Pain radiating to left trap muscle ridge

LLSB, Apex

1: ST elevation w/ PR depression
2: ST normalizes, dec T-wave amplitude
3: T-wave inversions
4: resolution, returns to normal EKG

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16
Q

How is Pericarditis Dx when sequential EKGs are not available

When should pericarditis Pts be admitted

A

Early repolarization:
ST/T-wave amplitude ratio > 0.25 in leads 1, V5-6= pericarditis

Myocarditis
Enlarged silhouette on CXR
Effusion
Uremic pericarditis
Hemodynamic compromise
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17
Q

What is a classic but rare EKG finding of cardiac tamponades

How are these Dx

Gold standard for Dx myocarditis

A

Electrical alternans

Bedside US or Echo w/ RA/RV collapse

Biopsy

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18
Q

What are two rare but significant findings for DVT

What are the two MC Sxs of PEs

A

Phlegmasia Cerulea Dolens- swollen, cyanotic limb d/t obstruction and inc compartment pressure

Phlegmasia alba dolens- pale limb d/t arterial spasm

Dyspnea, Pleuritic chest pain

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19
Q

What cardiac d/os can present w/ Sxs similar to PE

What 3 PE findings also aid w/ a Dx of PE

Well’s Score for PE

A

CHF Angina MI Pericarditis Tachydysrhythmia

Clear lungs w/ hypoxemia/dyspnea and clear CXR

Suspected DVT/PE, Alternative Dx less likely- 3
HR >100, Prior VTE, Immobile <4wks- 1.5
Active malignancy, Hemoptysis- 1
>6: high 2-6: mod <2: low

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20
Q

What can cause an elevated D-dime w/out DVT presence

A
Age
Pregnancy
Malignancy
Surgery
Liver/Rheum dz
Infection
Trauma
Sicle cell dz
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21
Q

Image of choice to Dx PE

Only medication approved for fibrinolysis Tx of PE

Indications for this type of Tx

A

Pulmonary angiography

Alteplase w/ UFH/LMWH started after

SBP <90
Dec in SBP >40mm
Right heart strain on EKG
Inc troponin/BNP
Hypoxemia/Respiratory distress
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22
Q

Pts w/ PE are admitted to ? ward

Define HTN Emergency

What are examples of end organ damage

A

Telemetry monitoring

Organ dysfunction d/t persistent wall stress/endothelial injury leading to inc permeability and fibrinoid necrosis

Chest pain, SOB, Neuro Sxs, Peripheral edema

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23
Q

JNC-7 HTN Classifications

What are the secondary precipitants of acute HTN

A

Norm: <120 and <80
Pre: 120-30 or 80-90
1: 140-59 or 90-99
2: ≥160 or ≥100

Pregnancy 
Sympathomimetic toxicity
Adverse drug reaction
Drug interactions
Withdrawal
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24
Q

What lab results suggest renal injury from HTN

How are Aortic Dissections Tx

What are the VS goals

A

Hema/Protein-uria and Red cell casts
Inc BUN, Cr, K

B-antagonists before vasodilators:
Esmolol/Labetalol or Diltiazem/Nicardipine

HR <60, SBP 100-140 w/ ideal target <120

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25
S/e of using Enalaprilat for HTN Pulmonary Edema How are HTN Emergencies in Peds Tx Define P-HTN and how is this Dx
First dose HOTN, Pregnancy Cat-D Lower MAP by 25% in 1st hr w/ Labetolol or Nicardipine Pulm artery pressure >25mm at rest/>30 w/ exertion; Dx w/ Right heart cath
26
What adverse outcome can occur when intubating Pts w/ severe P-HTN What two meds are used to augment RV function How is coronary artery perfusion maintained during P-HTN
Cardiovascular collapse d/t inc throacic pressure Dobutamine, Milrinone NorEpi
27
How can RV after load be dec during P-HTN Abdominal aorta is considered aneurysm at ? size and surgical repair is needed when? Pts w/ aortic grafting after AAA repair are at increased risk for fistula development located ?
Prostanoids- Epoprostenol PD-5 inhibitors- Sildenafil ≥3cm= aneurysm Sxs/≥5 cm- repair Duodenum
28
How do Pts present if this fistula develops What outcome are these Pts at risk for What is the MC incorrect Dx given to AAA
Hematemesis, Melena, Hematochezia High output HF w/ dec flow distal to fistula Renal colic
29
BP goal during fluid resuscitation ? is the MC peripheral aneurysm Aortic dissections occur when blood separates ? layers
SBP >90 Popliteal Intimal and Adentitia
30
How can the location of pain indicate the area of dissection Most Pts w/ dissection have ? RFs Stanford dissection classifications
Anterior- ascending Abdominal/back- descending Male, >50, HTN, Cocaine, Cardiac surgery Ascending- A, Descending- B
31
DeBakey classifications What are the MC CXR findings What is the imaging modality of choice for aortic dissections
1: ascending and descending 2: ascending only 3: descending only Abnormal aortic contour Widened mediastinum CT w/ contrast
32
What are the HR/BP goals during dissection Tx Define Dyspnea What can cause an artificially elevated pulse-ox reading
HR 60-70 bpm, SBP 100-120 Subjective feeling of difficult/uncomfortable breathing Methemoglobinemia
33
What findings may suggest a cardiologic etiology to a Pts dyspnea complaint What use do ABGs have during dyspnea What test is used for reactive airway dzs
``` S3 Edema JVD Orthopnea Inc BNP/Troponin CXR w/ edema and megaly ``` Detects hypoxia and hypercarbia IDs metabolic causes Peak expiratory flow rate
34
What test suggests neurological cause of dyspnea What are the goals of O2 therapy for Pts being Tx for dyspnea When would these goal ranges be ignored
Negative inspiratory force PaO2 >60 or O2 sat above 90% COPD
35
# Define Hypoxia and Hypoxemia ? PE finding is not a sensitive or specific indicator of hypoxemia How are these conditions Dx
- xia: Insufficient O2 delivery to tissues - mia: PaO2 <60mmHg Cyanosis ABG
36
What are the 5 mechanisms that cause hypoxemia What physiological responses occur d/t this
``` Hypoventilation R-L shunt bypassing lungs Vent/Perfusion mismatch Impaired diffusion Low inspired O2 (altitude) ``` Pulm arterial constriction Inc minute ventilation Inc sympathetic tone- tachy/tachy
37
STEMI O2 goal Acute HF O2 goal P-HTN O2 goal Dyspnea O2 goal Asthma/COPD O2 goal Sepsis O2 goal Cyanide poisoning Tx
>95% >95% >90% >90% >90% >90% 100%
38
# Define Hypercapnia What factors affect and can create this condition Hypercapnia causes HA and confusion d/t ?
Alveolar hypoventilation w/ PaCO2 >45mmHg RR, Tidal/Dead space volume Inc ICP
39
What are the risks when hypercapnia rise above 80mmHG Define Wheeze This is usually present d/t ?
Coma Encephalopathy Seizure Musical lung sounds through central airways during exhalation Lower airway dz- asthma, COPD, Pulmonary edema, Foreign body, Bronchiolitis
40
MCC of coughs lasting >6wks Cough d/t ACEI/ARB can take up to ? to develop and ? to stop after d/c meds What two types of meds can be used to Tx cough Sxs
Smoking 12mon, 1-4wks Antitussive- block cough reflex Demulcents- soothe pharynx w/ mild cough suppression
41
How can intractable coughing paroxysms in the ED be Tx ? is the only drug FDA approved for Tx hiccups Why does cyanosis develop
Nebulized lidocaine Chlorpromazine Deoxyhemoglobin (reduced Hb) >5mg/dL
42
Central cyanosis is most reliably visualized in ? locations How is this Dx Pleural effusions will create ? PE findings
Under tongue, Buccal mucosa ABG w/ co-oximetry Dullness w/ percussion, Dec breath sounds
43
How much fluid is removed during thoracentesis of pleural effusions Why is removal stopped at this amount ? is the MC bacterial infection of the alveolar lung
1-1.5L Re-expansion pulmonary edema Pneumonia, MC d/t Strep pneumo
44
Pts w/ pneumonia typically present w/ ? What will be seen on PE HCAP is d/t ? and is applicable Dx to ? Pts
Productive cough, Fatigue, Fever, Dyspnea, Pleuritic pain Tachy, Tachy, low pulse ox, Wheeze ``` MRSA, Pseudomonas; Admitted >48hrs in past 90days Residents of nursing facility Chemotherapy Home IV ABX Outpatient dialysis Wound care ```
45
Aspiration pneumonia is most likely to be found ? Untreated/Incompletely Tx aspiration pneumonia can develop into ? Uncomplicated pneumonia are usually Dx by ?
Right lower lobe Empyema- Tx w/ Piper/Tazo (add Vanc if MRSA suspected) CXR
46
How is uncomplicated CAP Tx outpatient How is this Tx outpatient in Pts w/ comorbidities How is pneumonitis that progresses into pnemonia prior to or shortly after ER presentation Tx
Azithromycin, Doxy then Fluroquinolones for Tx failures Levoflox or Augmentin w/ Azithromycin Levofloxacin w/ Clindamycin
47
How are lung abscesses Tx ? is the MC RF for Spot Pneumos What are the MC presenting Sxs
Clinda w/ Ceftriaxone Smoking Sudden, ipsilateral, pleuritic chest pain and dyspnea
48
What is the MC PE finding of Spot Pneumos What will be found on PE ? is the primary image obtained for stable Pts
Sinus tachycardia Dec sound/expansion w/ hyper resonance Erect PA CXR
49
What CXR findings of a supine AP CXR suggest pneumothorax Why are CT images needed prior to placing chest tubes for tension pneumos What image can be used for young, healthy Pts w/out lung dz
Cardiophrenic recess hyperlucency, Deep sulcus sign (angle enlargement) R/o emphsematous bullae as etiology Beside US- comet tails, ants on a log
50
How much air is give to Pts one tension pneumothorax is ID'd When can Pts be d/c ? size needles are used for decompression
>28% or 2-4L by cannula Supplemental O2 x 4hrs, repeat CXR; Improvement- d/c w/ 24hr f/u and weekly until resolution Adult: 14g Peds: 18g at least 2"/5cm long; Anterior to 2nd ICS at MCL Lateral in 5th ICS at AAL
51
Chest tube procedure name Preferred size and location What are the four Tx complications that can occur
Thoracostamy 10-14F for non-trauma 14-22F for traumatic ``` Vessel hemorrhage Parenchymal injury Empyema Tube malfunction Re-expansion injury- collapse >72hrs ```
52
Half of iatrogenic pneumothoraxes are caused by ? Define Massive Hemoptysis ? is an ominous sign in these Pts
Transthoracic needle procedures: biopsy, thorecentesis 100-1000ml/24hrs HOTN
53
Pts w/ ongoing, massive hemoptysis may benefit/have Sx relief in ? position Intubate these Pts w/ ? size tube ? is the MC chronic Dz of childhood
Decubitus w/ bleeding lung in dependent position 8mm- facilitates bronchoscopy Asthma
54
? is the only major cause of death that is increasing in frequency Asthma exacerbations are d/t ? while COPD exacerbations are d/t ? How are severe asthmatic exacerbations categorized
COPD d/t tobacco abuse A: expiratory flow limitations C: ventilation-perfusion mismatch FEV1 or PEFR <40%= severe
55
? is a severe and ominous lab finding during an asthmatic exacerbation Asthma and COPD co-existance/mistakenly Dx more often in ? gender How are these exacerbations Tx
Normal/Elevated PaCO2 Females 1st: Albuterol sulfate (SABA) 2nd: Terbutaline/Epi 3rd: Ipratropium added to SABA 4th: 40-60mg Pred or IV Methylpred
56
COPD exacerbations d/t bacterial infections are Tx w/ ? ? air adjunct is used during asthma/COPD exacerbations and lowers intubation rates Refractory asthma may benefit from intubation w/ ? med
Azithromycin, Doxy, Amoxicillin/Augmentin Non0invasive Partial Pressure Ventilation Ketamine
57
What is the most important part of the PE for abdominal pain ? finding is the clinical criterion standard for peritonitis What sign is a test that is reliable for Dx of abdominal wall pain
Palpation Rebound tenderness (Pt wants to lie still) Carnett Sign- sit up test w/ finger on tender area; same/increased pain= Pos for dx of abdominal wall syndrome
58
What are the 4 MCC of abdominal pain in Pts >50y/o ? type of pregnancy test do all post-puberty Pts need ? is the MC ordered lab test in Pts w/ abdominal pain
Biliary dz, Obstruction, Diverticulitis, Ca, Hernia Qual CBC
59
CT imaging is the preferred imaging modality for ? etiologies of abdominal pain ? is the MC resuscitation needed in Pts w/ abdominal pain Only use NSAIDs/Ketrolac for ? conditions of pain
``` Urolithiasis Appendicitis Mesenteric ischemia Aortic aneurysm Pancreatitis ``` NS/LR Renal colic
60
ED Pts w/ vomiting can have an outlet obstruction r/o be the presence of ? Vomit induced HOTN is Tx w/ ? Avoidance of ? products can aid in reducing vomiting episodes
Bile in emesis NS 20mL/kg Raw fruit, Caffeine, Lactose, Sorbitol
61
? anti-vomiting agents are used for persistent vomiting
Metoclopramide- catebory B Ondansetron- category B Promethazine Prochlorperazine Meclizine- vomiting d/t vertigo
62
Criteria for diarrhea What are the 4 mechanisms behind it's development Most cases are d/t ? etiology
3 or more per day (chronic: >3wks, acute: <3wks) ``` Inc intestinal secretion (cholera) Dec absorption (toxin, inflammation, ischemia) Inc osmotic load (laxative, lactose intolerance) Abnormal motility (IBS) ``` Infectious
63
? diarrhea illnesses can cause neuro Sxs What illness can cause paresthesia and reverse temp sensations Diarrhea after eating ? products suggest ? microbe
Shigellosis, HypoNa Ciguatoxin ``` Lake/stream water- Giardia Oyster- Vibrio Rice- Bacillus cereus Eggs: Salmonella Meats: Campylobacter, Staph, Yersinia, EColi, Clostridium ```
64
Most specific test for diarrheal illnesses is ? What microbes are tested for Diarrhea >7d need to be tested for ?
Stool study in lab Salmonella/Shigella Campylobacter Shiga toxin from EColi Amoebic infections Giardia, Crypto
65
How does HUS present Diarrhea induced HOTN is best Tx w/ ? fluid ? is the MC/majority etiology of infectious diarrhea in the US
Hemolytic anemia Acute renal failure Thrombocytopenia NS Norovirus
66
Most infectious diarrhea are Tx w/ ? C Diff Tx Cyclospora diarrhea Tx
Cipro Metronidazole preferred TMP-SMX
67
Giardia diarrhea Tx Vibrio cholerae diarrhea Tx Entabmoeba histolytics diarrhea Tx
Tinidazole Doxy or Azith Metronidazole and Paromomycin
68
? meds are used to reduce/slow diarrhea ? ABX can cause C Diff infections ? MC stat does this own
Loperamide Bismuth subsalicylate Diphenoxylate and Atropine Clinda, Cephalosporins Am/Amox-icillin, Fluroquinolones w/ onset 7-10 days after start MCC of infectious diarrhea in admitted Pts
69
? type of hand hygiene is needed for C Diff Pts How is C Diff Tx if outpatient w/ Metronidazole is not an option Pseudomembranous colitis d/t toxic megacolon are Tx w/ ?
Soap and water w/ contact isolation- alcohol bases are ineffective Vanc Metronidazole and Vanc
70
Nearly 1/3 of C Diff Pts will relapse and have recurrent episodes which are Tx w/ ? Most useful Dx test for Crohns Dx What meds are used for Tx
1st: Metronidazole 2nd: Vanc w/ 4wk taper Abdominal CT Sulfasalazine/Mesalamine Hydrocortisone/Pred 6-Mercaptopurine/Azaioprine- steroid sparing and surgical c/is Cipro, Metronidazole and Rifaximin
71
Crohns Dz w/ fulminant colitis is Tx w/ ? How are medically resistant cases Tx How can diarrhea d/t the Dz be Tx
Piper-Tazo Infliximab, Adalimumab Loperamide, Diphenolxylate, Cholestryamine
72
? is the MC digestive complaint in the USA What differs functional from organic causes
Constipation Functional: Medication/diet, Dec fluid/fiber, Change in activity Organic: Acute onset, Weight loss, Bleeding, N/V/F, Change in caliber
73
? is the most important Rx for functional constipation ? fiber can be used to improve Sxs ? defines an Upper GI bleed
Diet, Fluids, Exercise Bran, Psyllium, Docusate sodium Source above Ligament of Trietz
74
MCC of upper and lower GI bleeds Melena suggests a bleeding source located ? All Pts w/ significant GI bleeds need ? lab order
Upper: PUDz, Lower: diverticular dz Proximal to right colon Type and Cross
75
PUD induced bleeding can be Tx w/ ? ? other med can be used for upper GI bleeds ? balloon can be used as a tamponade
Pantoprazole- PPI Octreotide Sengstaken Blakemore
76
What are the two types of dysphagia MC type of structural dysphagia MC type of motor lesion leading to dysphagia is from ?
Transfer: oropharyngeal Transport: esophageal SCC CVA
77
? is the classic Sx of GERD How are mild Dzs Tx ? are the prokinetics used for Tx
Heart burn Ranitidine, Omeprazole Metoclopramide
78
MCC of infectious esophagitis in ImmSupp Pts MCC of perforations ? syndrome can lead to esophageal perfs
Candidiasis Iatrogenic Boerhaave- inc intraesophageal pressure
79
? PE findings can help aid Dx of esophageal rupture from dissection ? are these Dx ? ABX are used to cover Pts w/ esophageal perfs
Pain w/ swallowing, Hammon crunch CXR then esophagram/endoscopy Piper-Tazo, Cefotaxime/Ceftriax w/ Clinda or Metronidazole
80
MC location for swallowed foreign bodies to become lodged Once the object passes ? landmark, it's considered to be passing What images are used for identifying objects
Peds: Prox esophagus, Adult: distal Transverses the pylorus X-ray and CT scans
81
MCC of food impactions ? med is c/i in Tx What can be attempted but w/ poor results
Meat Proteolytic enzymes containing papain Glucagon
82
X-ray results for coins in trachea vs esophagus How are these removed from the trachea How quickly can button batteries lead to perfs
Trach: narrow to anterior, Eso: enface w/ anterior Foley balloon catheter <6hrs
83
What time frame for ingested button battery removal vs allowing them to pass How are sharp ingested objects managed ? procedure is c/i in drug mules
Foley balloon if ≤2hrs since ingestion, Passed esophagus- repeat x-ray at 24 and 48hrs Distal to duodenum: monitor passage Consider removal on day 3 if not passed Endoscopy
84
PUD ulcers affects ? part of the GI system What two factors create these ulcers ? medical conditions contribute to their production
Stomach, Proximal duodenum Acid, Pepsin, NSAIDs, H Pylori Behcet's Dz Zollinger Ellison syndrome Helicobacter heilmannii CMV, Crohns Dz, Cirrohsis w/ P-HTN
85
? are the protective factors of the stomach against PUDz ? Tx method has shown to increase ulcer healing time and decrease relapse/re-bleeding Lab result of H Pylori
Prostaglandins- enhance mucus, bicarb production and increase blood flow H Pylori eradication Gram-neg spiral flagellated bacteria that produces urea
86
How does H Pylori's presence induce ulcer formation ? is an almost universal finding in Pts w/ H Pylori H pylori has been found to be associated w/ the development of ? lymphoma
Urease, Cytotoxins, Proteases, Inc gastrin Chronic active but ASx gastritis Mucosa associated lymphoid tissue- Tx H Pylori can help induce remission
87
H Pylori places Pts at risk for developing ? Ca H Pylori has shown to induce ? Heme issue w/ Tx helping ? other Heme Dx Why do concurrent use of NSAIDs increase the risk for ulcer development
Gastric adenocarcinoma Causes FeDAnemia, Improves ITP Inhibit prostaglandin synthesis= dec mucus/Bicarb production and blood flow
88
What causes acute gastritis ? is the MC classic Sx of PUD ? may be the only positive PE finding of uncomplicated PUD
Severe illness- Shock Trauma Burn Organ failure Toxic effects- NSAID Steroid Bile acids Burning epigastric pain Epigastric tenderness- neither sensitive or specific
89
? is the MC presentation of acute gastritis Older Pts >65y/o are more likely to present w/ ? atypical Sxs of PUDz What is the gold standard for Dx PUDz
GI bleeds, occult to massive N/V, anorexia, weight loss, bleeds Upper GI endoscopy
90
What are the "alarm features" that warrant endoscopy for suspected PUDz
``` IDAnemia/bleeds FamHx of upper GI malignancy >50y/o w/ new onset of Sxs Dys/Odyno-phagia Mass/adenopathy Vomiting Weight loss ```
91
How is a Urea Breath test of H Pylori conducted What is this test better used for What is also a useful test of cure
Urea w/ Carbon-13/14 (instead of 12) is ingested and will be reduced to Co2 and Ammonia by H Pylori Presence of infection after therapy Stool Ag testing ≥4wks after therapy completion
92
What medications need to be stopped prior to H Pylori testing How is PUDz Tx Pt education or taking Tx meds
D/c PPIs Bismuth ABX H2 antagonist 2-4wks prior to testing PPI- first (-azole), heal ulcers faster Irreversibly bind w/ proton pump in parietal cells blocking H+ secretions Take 30-60min prior to food w/ s/e of HA, GI upset
93
What are the long term risks of taking PPI therapy for PUDz/H Pylori What occurs when abrupt medication d/c occurs Risk of using H2 antagonists (-tidine) for Tx
C Diff, Fxs, Pneumonia, CKDz, HypoMg Rebound hyper-acid and dyspepsia Sxs Renal dosing adjustments, especially Cimetidine d/t medication interactions
94
? medication is used PRN for pain from PUDz What are the s/e of using this medication class ? medication can be used for Pts that must continue taking NSAIDs w/ ulcers
Antacids Inc Aluminum- osteoporosis, encephalopathy HyperMg Misoprostol- prostaglandin analogue that inc bicarb and mucus (abortant- don't use in possible pregnancy)
95
? is Triple Therapy for H Pylori eradication ? is the MCC of GI-related admissions If endoscopy is ordered, ? two meds are given prior
PPR Clarithromycin and Amoxicillin or Metronidazole x 10-14days Upper GI bleeds d/t PUDz Bolus PPI and Erythromycin
96
PUDz lesions are described using ? classification to predict risk for re-bleeds ? are three groups of meds that can cause pancreatitis ? medication can cause potentially fatal pancreatitis
Forrest Chemo: Dideoxyinosine ImmSuppressant- Azathioprine Antiretrovirals
97
Pancreatitis etiology may be d/t ? This pain is worse w/ ? and better w/ ? What are 3 late but severe PE findings
Activation of trypsin in the pancreatic acinar cells Worse laying supine, better sitting w/ knees flexed Cullins, Grey-Turner, Erythematous skin nodules d/t fat necrosis
98
? lab results are used for Dx pancreatitis ? rapid test may be used but not used often ? lab result predicts a positive gallstone pancreatitis
Amylase 2x normal, Lipase 3x normal Urine trypsinogen-2 dipstick test Alanine Aminotransferase >150 w/in first 48hrs of Sxs
99
? image is used to evaluate for pancreatitis ? medication intervention lowers morbidity and mortality When can Pts be d/c home
Abdominal CT w/ contrast, MRI if RF, pregnant or contrast allergy Aggressive fluid therapy w/ crystalloids LR > NS Non-biliary pancreatitis and able to tolerate PO feeding/pain control
100
When do Pts w/ pancreatitis need to be admitted Define Cholecystitis What are the RFs for this Dx
First time Dx, Biliary pancreatitis, IV meds/PO intolerant Inflammation of gallstone d/t obstructing gallstone Gender F>M, Bariatric surgery
101
? is the MC complication of gallstone dz What can develop if cholecystitis is left untreated/persistently blocked Define Choledocholithiasis
Biliary colic Emphysematous cholecystitis- infected w/ gas producing organisms (Ecoli/Klebsiella) Gallstones in common bile duct, more commonly secondary- form in gallbladder and migrate to duct
102
? condition can further complicate choledocholithiasis ? type of cholecystitis is more likely to result in complications Normally, what causes the gallbladder to contract
Cholangitis- infected biliary tree Acute acalculous cholecystitis Cholecystokinin and Neural stimulation
103
What makes black gall stones What makes brown gall stones What stones are radiopaque vs lucent
Ca bilirubinate d/t liver dz/hemolysis Bacterial/Helminthe infection d/t bile duct stasis/Asian Cholesterol- lucent, Pigemented- paque
104
? microbes are more likely to infect gallstones ? PE test is used for cholecystitis evals Define Mirizzi Syndrome
Gram-neg: EColi, Klebsiella Murphy's Impacted cystic duct/stone w/ adjacent inflammation
105
? is the classic presentation of cholangitis What makes this into a pentad ? is the most sensitive and specific marker for choledocholithiasis Dx
Charcot's Triad: Fever RUQ pain, Jaundice AMS w/ shock Y-glutamyl transpeptidase
106
? is the imaging modality of choice for cholecystitis Definitive evaluation of choledocholithiasis is done by ? When are ellective cholecystectomys recommended
RUQ US ERCP/MRCP, Endoscopic US Sickle Cell, Pre-organ transplants, High risk for gallbladder cancer
107
How is biliary colic managed in the ED What is the risk of using opiates What ABX are used for Tx
NSAIDs- first line Induce Sphincter of Odi spasms 2nd/3rd Gen cephalosporins or Metronidazole and Fluroquinolones combo
108
? is the Tx of choice for cholangitis What is done if this Tx of choice is not available Emphysematous cholecystitis is more common in ? populations
ERCP w/ generous fluids and ABX Percutaneous drainage/decompression Diabetics, Elderly
109
? imaging modality may be used to better visualize Emphysematous cholecystitis ? causes gallstone ileus to form How is this issue more reliable Dx
IV contrasted CT Cholecystitis inflammation causing biliary-enteric fistulas CT
110
? is the classic radiographic appearance of gallstone ileus' In the early post-cholecystectomy period, ? is the primary concern What is a common cause of post-ectomy pain
Rigler Triad: small bowel obstruction, pneumobilia, ectopic stone Bile leak Choledocholithiasis
111
How much of an elevated bili is needed for skin color changes to be seen What causes increase in total and indirect bili What causes increase in total and direct bili
>2.5mg Over production, Hepatocyte injury Obstruction preventing conjugated excretion
112
? liver enzyme is elevated during biliary obstruction and cholestasis Most reliable Sx of appendicitis is ? What is the classic point of max tenderness
ALP Abdominal pain beginning per-umbilical/epigastric RQL below middle line connecting umbilicus and ASIS- AKA McBurney's point
113
# Define Rovsing's Sign Retrocecal appendix may have ? pain What is a late finding during appendicitis
Referred pain to right side w/ palpation of LLQ during appendicitis Flank pain > abdominal pain Fever
114
? scoring system is used for appendicitis ? is the imaging modality of choice for dx How is this modality changes for Peds/Pregnancy
Alvarado's Non-contrast CT Compression US
115
? is the MC surgical emergency in pregnancy ? ABX are used to decrease post-op infections ? is the MC Sx of diverticulitis
Appendicitis Piper-Tazo or Amp-Sulbactam Steady, deep LLQ pain
116
What Pt population may present w/ atypical presentations of diverticulitis What atypical presentation can they have ? imaging modality is used for Dx
Redundant sigmoid, Asian, R-sided dz R-side pain, Suprapubic pain CT w/ IV and PO contrast
117
Pts w/ diverticulitis need to f/u w/ GI in ? long What is the first line ABX regiment What is the alternative ABX regiment
6wks Metronidazole + Cipro or Levo or TMP Augmentin, Moxifloxacin
118
Sigmoid volvulus is more common in ? Cecal volvulus is more common in ? Define Ogilvie Syndrome
Elderly taking anticholinergics Gravid Pts Intestinal pseudo-obstruction- elderly/bedridden taking anticholinergice or TCAs
119
? is the imaging modality of choice for bowel obstructions/volvulus What lab results suggest gangrene, abscess or peritonitis ? is Dx and therapeutic for pseudo-obstructions
CT w/ IV and PO contrast Leukocytosis >20K or L-shift noted Colonoscopy
120
Where are internal hemorrhoids most likely to be found What two DDx need to be considered in Pts >40y/o ? is the MC type of anorectal abscess
2, 5, 9 o'clock w/ Pt prone Rectal, Sigmoid colon tumors Perianal at anal verge
121
Acute/recently thrombosed hemorrhoids w/ pain can be Tx w/ ? AKIs in kids are MCC by ? What are the stigmatas of renal failure
<48hrs= clot excision Hypoxic injury, Nephrotoxins Nausea, Anorexia, HA, Edema, Dec UOP
122
How are AKIs Dx How are pre/post-renal etiologies differed What types of results may be seen w/ pre-renal AKIs
UOP w/ Cr UA w/ microscopy Normal UA w/ high SpecGrav
123
What types of results may be seen w/ interstitial AKI/tubular necrosis How are Pre-Renal AKIs Tx How are Intrinsic AKIs Tx How are post-renal AKIs Tx
Hyaline casts NS crystalloid at 10-20ml/kg w/out K+ added Fluid restrictions despite Dec UOP Foley catheter to remove obstruction
124
What are the 4 hallmarks of nephrotic syndrome What life threatening event can develop d/t this condition How are nephrotic syndromes Tx
Proteinuria Hypoalbumin Hyperlipid Edema Thromboembolic events, Infections NS at 20ml/kg Furosemide for fluid overload PO CCS
125
MCC of Rhabdo in adults ? is the most sensitive indicator of muscle damage ? E+ d/o may be seen early on in Rhabdo
Drug/Alcohol abuse Inc serum creatine kinase 5x above normal HypoCa
126
What needs to be avoided during the Tx of Rhabdo ? are the MC bacterial infections Tx in outpatient setting What are the two types of lower UTIs
NSAIDs UTIs Urethritis d/t STDs, differentiated by + discharge Cystitis- infected bladder
127
# Define Uncomplicated UTI When is it recommended to screen for ASx Bacteriuria MC microbe of UTIs
Young, healthy, nonpregnant woman w/ normal urinary tracts Pregnancy, Men prior to transurethral prostate resection EColi
128
What are the two relevant dipstick results for UTIs What 3 microbes are not detected w/ this test What could cause one of the results to be falsely pos/neg
Nitrate- measurement for bacteriuria Leukocyte esterase- measure of pyuria Enterococcus Pseudomonas Acinetobacter +: Vaginitis/Cervicitis/fecal contamination -: Chlamydia
129
Work ups for UTIs should only have urine cultures ordered on ? Pts First line Tx for uncomplicated UTIs How are Complicated UTIs or Pyelo Tx
Complicated UTIs Relapse/re-infected Peds Septic Nitro > TMP-SMX or Fosfomycin 1st- Cipro, then Levo, Cefpodoxime, TMP, Augmentin
130
How is ASx Bacteriumureia and UTIs during pregnancy Tx What med is used for bladder analgesic ? is the MCC of urinary retention
ASx: Nitro x 3d, Preg: Nitrox 7d Phenazopyridine Outlet obstruction 2/2 BPH
131
? much post-residual volume on US is Dx How are these Pts Tx How are Pts w/ urinary retention from hematuria Tx
50-150cc Cath w/ 2% lidocaine 16F Coudea cath if straight cath fails 3 port foley w/ irrigation until blood fades away
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? med can be used to control bladder spasms from urinary retention Testicular torsion results from abnormal fixation within ? structure ? testicular issue occurs more often than torsions
Oxybutynin Tunica vaginalis Appendage torsion
133
Testicular torsion surgery is best done ? in time frame Torsions typically occur in ? direction so manual manipulation efforts are done in ? direction Where are the majority of kidney stones Dx
<6hrs Lateral to medial= attempt in medial to lateral manner Distal ureter
134
? is the best imaging for Dx kidney stone US can be used for stones smaller than ? How are Pts managed in the ED w/ this condition
Non-contrast helical CT <5mm Ketorolac- prostaglandin inc ureter dilation Crystalloids, Metoclopramide, Tamsulosin/-zosin
135
? ABX are used for kidney stones if infection is also present Criteria for Pts to be d/c from ED Consult urology for stones bigger than ?
Cipro, Levo, Cefpodoxime Stone <5mm, no infection, pain controlled PO w/ f/u in 7days >5mm
136
? is the leading cause of maternal death during the first trimester ? is the MC location for this leading cause to occur What is the classic triad of presentation
Ectopic pregnancy Fallopian tube ampulla Abdominal pain, Vaginal bleeding, Amenorrhea
137
How much Rhogam do Pts w/ ectopic pregnancy receive Threatened abortion Inevitable abortion
50ug Bleeding <20wks EGA, Closed os, No tissue passage Dilated cervix
138
Incomplete abortion Complete abortion Missed abortion
Partial passage of tissue between 6-14wks Complete passage of all tissue <20wks Fetal death <20wks w/out passage of any tissue x 4wks after death
139
? medication can be used for ectopic/miscarriages What ABX are used for septic abortions What meds are used for vomiting d/t pregnancy
Misoprostol Amp-Sulbactam or Clinda+Genta Metoclopramide, Promethazine, Ondansetron, Doxylamine+Pyridoxine
140
Criteria for Pre-E ? is a clinical variant of Pre-E When is this DDx a consideration
>140/90 twice, 4hrs apart w/ proteinuria >300mg in 24hrs in a Pts 20wks EGA through 6wks post-delivery HELLP Syndrome- hemolysis, elevated liver enzymes, low platelets Pregnancy >20wks w/ abdominal pain
141
? steroid is used for pre-term labor <34wks Shoulder dystocia steps Pts w/ PID that are d/c from ED need to f/u in ?
Dexamethasone XXXX 72hrs w/ OB/GYN
142
How are PID Pts Tx w/ IV meds How is this Tx outpatient ? is the rash from TSS described
Genta and Cefotetan/Cefoxiten w/ Doxy or Clinda Ceftriax or Cefoxitin and Probenecid 3rd Gen cephalosporin w/ doxy and/or metro Painless sunburn d/t Staph A exotoxin
143
How is TSS Tx What is the next step if no improvement is seen in 6hrs of starting ABX How is STSS Tx
MRSA: Vanc or Linezolid and Clinda MSSA: Naf/Oxa-cillin w/ Clinda IVIG w/ IDz consult Piper-Tazo or Meropenem w/ Clinda Add Vanc if MRSA suspected
144
# Define Thunderclap HA What are the two DDxs if this occurs during exertion HA w/ seizure, AMS, visual disturbance or focal neuro deficit may be d/t ? syndrome
HA pain reaching 7-10/10 in <1min Subarachnoid hemorrhage, Carotid arterial dissection Posterior Reversible Encephalopathy Syndrome
145
Pts w/ CD4 count less than ? are at increased risk for intracranial pathology Medication use of ? places Pts at increased risk for meningococcal infections Pts w/ ? dz are more likely to have aneurysm ruptures at younger ages
<200 Eculizumab Autosomal dominant PCKDz
146
What is the classic pentad of meningitis If papilledema is seen on PE, ? are the next steps ? PE finding suggests a posterior communicating artery aneurysm
Fever AMS Rigidity + HA CT then LP Asymmetrical/Ptosis pupil- CN3 compression
147
? is the fastest and most appropriate image for HA assessments ? imaging is used if suspected arterial pathology is causing Pts Sxs What is the best position for LPs
CT w/out contrast MRI angiography Lateral decubitus- allows for measuring opening pressure
148
MC etiology of meningitis Negative head CT but strong suspicion for subarrachnoid hemorrhage has ? next step This next step is also done if Pt presents more than ?hrs after Sxs onset
Viral LP >6hrs
149
? antiplatelet med increases risk for acute intracranial bleeds after trauma Pts presenting w/ ? Sxs are considered cerebellar hemorrhage until disproven Image of choice for suspected brain tumors
Clopidogrel Vertigo, Ataxia MRI w/ and w/out contrast
150
# Define Temporal Arteritis MC non-life threatening HA in ED is ? How does this MC present
Inflammatory condition of small/med vessels Migraine Unilateral, pulsating HA w/ photo/phono-phobia and worse w/ exertion
151
What mnemonic is used for Dx migraines Criteria for chronic migraine What are 3 absolute c/i to migraine Tx in pregnancy
POUND ≥5 HA days/mon x 3mon Isometheptene Caffeine Ergotamine
152
# Define Horner's Syndrome Where will the lesion be located to cause this syndrome Presence of ? PE finding mandates CT imaging before LPs
Ipsilateral ptosis, miosis, anhidrosis d/t interrupted sympathetic impulses controlling tarsal muscle (upper lid) and iris dilators Brain stem to plexus near carotid artery Papilledema- edema of optic nerve head d/t ICP
153
What are 4 causes of Papilledema Pentad of Pseudotumor Cerebri What type of vision dysfunction can this cause
Malignant HTN Pseudomotor cerebri Intracranial tumors Hydrocephalus Inc ICP, Papilledema, Normal CSF/Images CN6 paresis= horizontal diplopia (double vision w/ horizontal gaze)
154
Majority of atraumatic subarachnoid hemorrhages are caused by ? Where are these etiologies usually found These bleeds can be r/o w/ 100% certainty using ? rule
Ruptured aneurysm (5-10mm) Bifurcation of Circle of willis Ottawa Subarachnoid Hemorrhage rules: ANT LED Age >40, Neck pain/stiff Thunderclap LoC Extertion Dec flexion
155
? is the initial image ordered for suspected subarrachnoid hemorrhages What is the next step if this initial image is negative Reassess these Pts for ? finding
Non-contrast CT LP w/ RBC count of the 3/4th tube Dec in GCS by 1pt= onset of complications
156
What is the greatest risk after a subarrachnoid hemorrhage How is this risk dec What needs to be avoided in these Pts
Rebleed in first 2-12hrs BP control 120-60 w/ Labetalol/Nicardipine Nitroprusside/Nitro
157
What is a common event to occur 2-21days after subarrachnoid hemorrhage How is this event reduced What post-d/c consideration is given to all Pts
Vasospasms Nimodipine started w/in 96hrs of Sx onset Seizure prophylaxis
158
# Define TIA This condition is considered analogous w/ ? other Dx What two imaging orders do Pts need
Transient neuro dysfunction d/ ischemia w/out infarct Unstable angina EKG for Afib, Non-contrast CT
159
Any positive US test on TIA Pts is f/u w/ ? next step How are TIAs Tx Peripheral Vertigo involves ? structures while Central involves ?
CT/MR angiography Antiplatelets- ASA+Dipyridamole*, Clopidogrel Anticoagulation- Warfarin (r/o Afib first) Endarterectomy P: vestibular apparatus w/ CN* C: brainstem/cerebellum w/out focal deficits
160
? mnemonic of tests are used to test for Central Vertigo ? is the MCC of Vertigo ? is the 2nd MCC of vertigo
HINTS: Head Impulse, Nystagmus, Test of Skew BPPV- otoconia displaced in semicircular canals causing vertigo <2min Vestibular Neuritis- post-viral infection causing vertigo x days w/out HL/tinnitus or pain
161
Labyrinthitis is a complication from ? but will have ? to separate it from other etiologies ? is the most feared cause of vertigo ? reflex prevent blurred vision during head movement
Otitis media; pain, HL and tinnitus Cerebellar stroke Vestibulo-ocular reflex
162
How is BPPV Tx How is Vestibular Neuritis Tx What daily med can be used for Tx
Epley maneuver Anti-cholinergic- Scopalamine H1 antihistamines- Diphenhydramine, Meclizine Ondansetron- 5-HT antagonist Promethazine, Metoclopramide- N/V Betahistine- inc cochlear blood flow to dec peripheral vestibular input
163
How is vertigo during MS Tx Define Status Epilepticus Define Refractory Status Epilepticus
Gabapentin Seizure ≥5min or ≥2 seizures in a row w/out returning to baseline Persistent seizures despite two IV antiepileptics
164
# Define Generalized Seizure Define Todd's Paralysis ? type of seizure allows Pts to recall events of attack
Simultaneous activation of cerebral cortex starting w/ abrupt LoC Transient, unilateral deficit after a focal seizure that resolves <48hrs Simple partial seizure
165
? labs are needed for Pts w/ documented seizure d/o and have single, unprovoked seizure What type of acid-base disturbance can be seen after a first seizure What two lab results will be temporarily elevated and help r/o malingering/pseudoseizure
Glucose, Medication level Wide anion gap metabolic acidosis Lactate, prolactin
166
? image is ordered for first time seizures What meds are used after first time seizures How are HIV Pts w/ seizures worked up
Non-contrast CT Valproate Oxcarbazepine Lamotrigine Levetiracetam Topiramate Non-contrast CT, LP then contrast CT/MRI
167
? is the MCC of secondary seizures How are pregnant Pts w/ seizures Tx What happens to the BBB during Status Epilepticus
Neurocysticercosis d/t T solium larva +HTN after 20wks= eclampsia; Tx: Mg sulfate Compromise allowing K/Albumin entrance (both hyperexcitatory)
168
Drug of choice for Tx Status Epilepticus Define Trench Foot What are the degrees of severity for frostbite
IV Lorazepam Soft tissue injury d/t prolonged non-freezing temp/moisture exposure 1st: partial thickness skin freezing w/out blisters 2nd: full thickness freezing w/ clear bullae 3rd: deep; sking and subdermal plexus freeze w/ hemorrhagic bullae and necrosis 4th: muscle/tendon/bone involvement and black mummified eschar
169
How is frostbite Tx How is Trenchfoot Tx What meds are added to chilblain Tx
Warm water rewarming at 37-39* x 30min until pliable Aloe verz q6hrs Tetanus prophylaxis Dry, elevate, rewarm and bandage Nifedipine, Pentoxifyline LImaprost Fluocinolone cream
170
Criteria for Hypothermia How do Pts die of this What EKG finding can be seen in these PTs
<95*F- tachy, tachy, HTN Afib to Vfib to Asystole Osborn J wave- slow positive deflection at end of QRS
171
Cardinal features of Heat Stroke ? parts of the body are most susceptible to injury Evaporation is the principle mechanism for heat loss but is rednered ineffective when ?
Hyperthermia >104 and end organ injury Nerve, Liver, Kidney, Vessel tissues Humidity >75%
172
# Define Heat Syncope Who does this occur to most often Where are muscle cramps more likely to occur
Dec volume w/ peripheral dilation and dec tone Elderly, Poorly acclimatized Calf, Thigh, Shoulder after water replacement w/out Na
173
Hyperthermic Pts are cooled until ? w/ ? method being most effective How are seizures and excessive shivering managed How are anaphylactic reactions to Hymenaoptera Tx
Core temp 100.4 w/ external cooling Lorazepam/Diazepam Epi, Methyl/Pred, Albuterol H1- diphenydramine H2- famotidine
174
Crotaline snakes Elapidae snakes How are these bites managed
Pit vipers: Rattler, Copper, Moccasin, Massasauga Coral snake- neurotoxin venom Measure area circumference q60min Polyvalent Crotalidae immune Fab
175
Pts that develop Serum Sickness post snake bite Tx are Tx w/ ? Mammal bites located ? are candidates for primary closure Primary closure is avoided in ? populations
Pred Face/scalp w/out devitalized tissue/underlying Fxs ImmDefficient
176
Microbe from cat bites Animal bite prophylactic ABX choice ? dog bite microbe can cause serious systemic infections in ? populations
Pasteurella multocida Augmentin Capnocytophaga carnimorsus- asplenic, alcoholics, ImmSupp
177
Microbe causing Cat Scratch Fever What ABX is used for normal populations What is used in ImmSupp populations
Bartonell henselae Azithromycin TMP-SMX, Cipro, Rifampin
178
Human bite microbe How are these Tx Post-exposure prophylaxis regiment for rabies
Eikenella corrodens Augmentin w/out suture closure unless on face Human Rabies Immunoglobulin x 1 Rabies vaccine x 4 on days 0, 3, 7, 14 ImmSupp- 5th vaccine on day 28
179
Most important means to reduce morbidity and mortality from near/drowning What causes the fruity breath observed during DKA BiCarb is given during Tx if pH is below ?
Prevention Acetone d/t oxidation of ketone bodies ≤6.9
180
What causes Alcoholic Ketoacidosis How is this Tx Diabetics taking ? meds can have hypoglycemia
Dec glycogen stores, Inc lipolysis D5Ns until rehydrated then, D5 .45NS w/out insulin Thiamine before glucose administration- prevents Wernickes Na BiCarb if pH remains <7.0 Insulin, Sufonylureas: Chlorpropramide Glyburide
181
How are Pts w/ Hypoglycemia Tx Thyrotoxicosis is MC in ? Pts What are the cardinal features of a thyroid storm
PO Glucagon IV D50 then D10 Refractory 2/2 sufonylureas- Octreotide Repeat blood glucose levels q30min Antecedent Graves Dz Fever, Tachycardia
182
How is Thyroid Storms Tx All Pts w/ adrenal insufficiency have low levels of ?
``` Acetaminophen PTU > Methimazole to block peripheral T4 to 3 conversion Lugol solution or K iodide or Iopanoic Propranolol or Esmolol Hydrocortisone of Dexamethasone ``` Cortisol
183
Consider Dx of Adrenal Crisis in any Pt presenting w/ ? How are Adrenal Crisis' Tx How does preseptal cellulitis differ it from orbital cellulitis
Unexplained HOTN refractory to pressors 5% dextrose in NS, Hydrocortisone > Dexamethasone No eye involvement= acuity, pupil response, appearance are normal w/out pain during movement
184
Preferred imaging for suspected preseptal cellulits Once Dx, how are Pts w/ preseptal cellulitis Tx How are postseptal cellulitis Pts Tx
CT w/out contrast of orbit Augmentin Cefuroxime or Ceftriax or Augmentin w/ Vanc for MRSA PCN Allergy- =floxacin w/ metro or Clinda
185
# Define Stye Define Hordeolum How are these Tx
Infected oil gland along lid margin Inflammation d/t meibomian gland blockage Warm compress w/ Erythromycin oinment
186
? ABX are used for Peds w/ bacterial conjunctivitis What med is avoided during treatment ? is used for Herpes Simplex Keratitis Tx and ? is avoided
Cipro/O-cloxacin Gentamicin Trifluridine, Topical steroids
187
? two meds can be used for conjunctivitis in Pts wearing contact lenses How is viral conjunctivitis Tx Orbital blowout Fxs involve ? sides of the orbit
Cipro, Tobramycin Naphazoline/Pheniramine w/ tears Inferior and Medial wall entrapping inferior rectus muscle (diplopia w/ upward gaze)
188
? image is used for blowout Fxs What ABX are used ? test is used for suspected high velocity penetrating trauma
CT w/ 1.5mm cuts Cephalexin Seidel test- bright green stream w/ fluorescein
189
Once a globe injury is suspected, ? is the next step What types of eyelid lacerations need to be closed by Eye/Plastics Lacerations less than ? size are able to self resolce
Stop all exam/manipulation and shield eye ``` <8mm medial canthus Duct/sac Inferior lid surface Margin Ptosis Levator palpebrae muscle Tarsal plate ``` <1mm
190
Eyelid lacerations that are not immediately evaluated by Ophtho are managed how How are chemical injuries to the eye managed ? meds are used during Acute angle closure glaucoma
Cephalexin and Erythromycin w/ cool compresses and f/u <24hrs Irrigate w/ 2L NS/LR, check pH (goal 7.4) Cyclopentolate- plegic to aleviate spasms Erythromycin Opioids Timolol Apraclonidine Acetazolamide Pilocarpine
191
What two PE findings may be seen w/ central retinal artery occlusions What three things may be attempted until Ophtho consult arrives What will be seen on PE during central vein occlusion
Cherry red spot, Boxcarring Massage Acetazolamide Timolol Blood and thunder fundus
192
MCC of Facial Cellulitis and Erysipelas What ABX are used for Tx Mumps is MCC by ? virus
Strep pyogenes > Staph A Clinda Diclox Cephalosporin Paramyxo
193
How long are Mumps Pts contagious What PE finding can help distinguish mumps from suppurative parotitis How are Masticator Space Abscesses Dx
9d after onset of swelling Pus expressed from Supp-P CT w/ contrast
194
Why do masticator space abscesses need prompt Tx What is used for Tx of Trigeminal Neuralgia ? is the MC direction of mandibular dislocations
Communicate w/ mediastinum Carbamazepine Anterior d/t extreme mouth opening; Tx w/ down and back pressure w/ padded thumbs
195
How are superficial face lacerations Tx All Pts w/ epistaxis Tx by packing need ? ABX Nasal Fx involving ? structure can lead to CSF rhinorrhea
6-0 nonabsorbent monofilament w/ simple interrupted sutures, remove on day 5-7 Augmentin Cribiform plate
196
How are Malignant Otitis Externa Tx after CT imaging What are the possible complications that can arise from Otitis Media
Tobramycin and Piperacillin or Ceftriax/Cipro ``` Perf CHL Serous labyrinthitis CN7 paralysis Mastoiditis Sinus thrombosis Cholesteatoma Intracranial complications ```
197
What ABX are used to Tx Mastoiditis What are 3 RFs for develops Post-Extraction Alveolar Osteitis How are these Pts managed
Vanc or Ceftriax Carbonated beverage, Smoking, Straws Saline/Chlorhexidine irrigation Eugenol impregnated gause pack PCN VK or Clinda F/u <24hrs
198
How are Periodontal Abscesses Tx How does ANUG present How are these Pts Tx
PCN Vk or Clinda Chlorhexidine mouth wash I&D if large Refer all Pts Punched out papillae w/ bleeding, foul taste, adenopathy and fever Metronidazole and Chlorhexidine mouth wash
199
How are Aphthous Ulcers Tx How are Dental Fxs classified How are these Fxs managed
0.1% traimcinolone acetonide past or Chlorhexidine mouth wash Ellis Classes: 1- enamel only 2- dentin 3- pulp Ca hydroxide over exposed pulp and refer <24hrs
200
How are dental avulsions Tx How are these transported if needed What ABX are used after Tx
Rinse <10sec w/ water Replant immediately if <3hrs Hank's salt solution, Milk, Saliva, Sterile saline Adults: Doxy Kids <12: PCN VK
201
? oral frenulum does and does not need repair ? type of image is used for PTAs ? structure is avoided during aspiration and ? ABX are used after
Maxillary= none, Lingual- 4-0 absorbable CT w/ contrast Internal carotid; PCN+metronidazole Toxic= Piper-Tazo
202
How are adults w/ epiglotitis Tx ? are retropharyngeal abscesses Dx How are these Tx
Cefotax+Vanc and Methylpred CT w/ contrast Clinda or Cefoxitin
203
Glasgow Coma Scale
Eye: Spont Speech Pain None ``` Verbal: A&O Disoriented conversation Speakin, nonsensical Moan/Uninteligible None ``` Motor: Follows Locals Move/Withdraw Decor flex Decere extend None
204
? is the leading cause of death in hospitals of Pts w/ AMI
STEMIs