Emergency Flashcards
1
Q
��”Q001. ACEIs Toxicity
A
A001. Cough; rash; proteinuria; angioedema; taste changes; teratogenic effects
2
Q
Q002. Amantadine; Toxicity
A
A002. Ataxia; livedo reticularis
3
Q
Q003. Aminoglycosides; Toxicity
A
A003. Ototoxicity; nephrotoxicity ATN
4
Q
Q004. Amiodarone; Toxicity
A
A004. Pulmonary fibrosis; peripheral deposition => bluish discoloration,; arrhythmias,; hypo /hyperthyroidism,; corneal deposition
5
Q
Q005. Amphotericin; Toxicity
A
A005. Fever/chills; nephrotoxicity; bone marrow suppression; anemia
6
Q
Q006. Antipsychotics; Toxicity
A
A006. Sedation; acute dystonic reaction; akathisia; parkinsonism; tardive dyskinesia; neuroleptic malignant syndrome
7
Q
Q007. Azoles (e.g., fluconazole); Toxicity
A
A007. Inhibition of P 450 enzymes
8
Q
Q008. AZT; Toxicity
A
A008. Thrombocytopenia; megaloblastic anemia
9
Q
Q009. � blockers; Toxicity
A
A009. Asthma exacerbation; masking of hypoglycemia; impotence
10
Q
Q010. Benzodiazepines; Toxicity
A
A010. Sedation; dependence; respiratory depression
11
Q
Q011. Bile acid resins; Toxicity
A
A011. GI upset; malabsorption of vitamins; and medications
12
Q
Q012. Calcium channel blockers; Toxicity
A
A012. Peripheral edema; constipation; cardiac depression
13
Q
Q013. Carbamazepine; Toxicity
A
A013. Induction of P 450 enzymes; agranulocytosis; aplastic anemia
14
Q
Q014. Chloramphenicol; Toxicity
A
A014. Gray baby syndrome; aplastic anemia
15
Q
Q015. Cisplatin; Toxicity
A
A015. Nephrotoxicity; acoustic nerve damage
16
Q
Q016. Clonidine; Toxicity
A
A016. Dry mouth; severe rebound headache; hypertension
17
Q
Q017. Clozapine
A
A017. Agranulocytosis
18
Q
Q018. Corticosteroids; Toxicity
A
A018. Mania (acute) immunosuppression; bone mineral loss; thinning of skin; easy bruising; myopathy (chronic); cataracts
19
Q
Q019. Cyclophosphamide; Toxicity
A
A019. Myelosuppression; hemorrhagic cystitis
20
Q
Q020. Digoxin ; Toxicity
A
A020. GI disturbance; yellow green visual changes; arrhythmias junctional tachycardia or SVT,; varying amounts of AV node blocks
21
Q
Q021. Doxorubicin ; Toxicity
A
A021. Cardiotoxicity; (dilated cardiomyopathy)
22
Q
Q022. Ethyl alcohol ; Toxicity
A
A022. Renal dysfunction
23
Q
Q023. Fluoroquinolones; Toxicity
A
A023. Cartilage damage in children Achilles tendon rupture
24
Q
Q024. Furosemide; Toxicity
A
A024. Ototoxicity; hypokalemia; nephritis
25
Q025. Gemfibrozil; Toxicity
A025. Myositis; reversible �! in LFTs
26
Q026. Halothane; Toxicity
A026. Hepatotoxicity; malignant hyperthermia
27
Q027. HCTZ; Toxicity
A027. Hypokalemia; hyperuricemia; hyperglycemia
28
Q028. HMG CoA reductase inhibitors; Toxicity
A028. Myositis; reversible �! in LFTs
29
Q029. Hydralazine; Toxicity
A029. Drug induced SLE
30
Q030. Hydroxychloroquine; Toxicity
A030. Retinopathy
31
Q031. INH ; Toxicity
A031. Peripheral neuropathy prevent with vitamin B6; hepatotoxicity; inhibition of P 450 enzymes; seizures with overdose
32
Q032. MAOIs ; Toxicity
A032. Hypertensive tyramine reaction; serotonin syndrome with meperidine
33
Q033. Methanol; Toxicity
A033. Blindness
34
Q034. Methotrexate; Toxicity
A034. Hepatic fibrosis; pneumonitis; anemia
35
Q035. Methyldopa; Toxicity
A035. Pos. Coombs test; drug induced SLE
36
Q036. Metronidazole; Toxicity
A036. Disulfiram reaction; vestibular dysfunction; metallic taste
37
Q037. Niacin; Toxicity
A037. Cutaneous flushing
38
Q038. Nitroglycerin; Toxicity
A038. Hypotension; tachycardia; headache; tolerance
39
Q039. Penicillin/� lactams ; Toxicity
A039. Hypersensitivity reactions
40
Q040. Penicillamine; Toxicity
A040. Drug induced SLE
41
Q041. Phenytoin; Toxicity
A041. Nystagmus; diplopia; ataxia; gingival hyperplasia; hirsutism
42
Q042. Prazosin ; Toxicity
A042. First dose hypotension
43
Q043. Procainamide; Toxicity
A043. Drug induced SLE
44
Q044. Propylthiouracil; Toxicity
A044. Agranulocytosis
45
Q045. Quinidine; Toxicity
A045. Cinchonism ; (headache, tinnitus); thrombocytopenia; arrhythmias torsades de pointes
46
Q046. Reserpine; Toxicity
A046. Depression
47
Q047. Rifampin; Toxicity
A047. Induction of P 450 enzymes; orange red body secretions
48
Q048. Salicylates; Toxicity
A048. Fever; hyperventilation with; respiratory alkalosis; and metabolic acidosis; dehydration; diaphoresis; hemorrhagic gastritis
49
Q049. SSRIs; Toxicity
A049. Anxiety; sexual dysfunction
50
Q050. Succinylcholine; Toxicity
A050. Malignant hyperthermia
51
Q051. Tetracyclines; Toxicity
A051. Tooth discoloration; photosensitivity; Fanconi s syndrome
52
Q052. TCAs; Toxicity
A052. Sedation; coma; anticholinergic effects; seizures; wide QRS; in severe cases prolonged QT => torsade
53
Q053. Valproic acid; Toxicity
A053. Teratogenicity => neural tube defects
54
Q054. Vancomycin; Toxicity
A054. Nephrotoxicity; ototoxicity; red man syndrome histamine release, not an allergy
55
Q055. Vinblastine; Toxicity
A055. Severe myelosuppression
56
Q056. Vincristine; Toxicity
A056. Peripheral neuropathy
57
Q057. Acetaminophen; What is the Antidote
A057. N acetylcysteine
58
Q058. Acid/alkali ingestion; What is the Antidote
A058. Upper endoscopy to evaluate for stricture
59
Q059. Anticholinesterases,; organophosphates; What is the Antidote
A059. Atropine; pralidoxime
60
Q060. Antimuscarinic/; anticholinergic agents; What is the Antidote
A060. Physostigmine
61
Q061. Arsenic, mercury, gold; What is the Antidote
A061. Succimer; dimercaprol
62
Q062. � blockers; What is the Antidote
A062. Glucagon
63
Q063. Barbiturates (phenobarbital); What is the Antidote
A063. Urine alkalinization (bicarb); dialysis; activated charcoal
64
Q064. Benzodiazepines; What is the Antidote
A064. Flumazenil
65
Q065. Black widow bite ; What is the Antidote
A065. Calcium gluconate
66
Q066. Carbon monoxide ; What is the Antidote
A066. 100% O2; hyperbaric O2
67
Q067. Copper, arsenic, lead, gold ; What is the Antidote
A067. Penicillamine
68
Q068. Cyanide ; What is the Antidote
A068. Nitrite; sodium thiosulfate
69
Q069. Digitalis ; What is the Antidote
A069. Stop digitalis,; normalize K+,; lidocaine (for torsades), anti digitalis Fab
70
Q070. Heparin ; What is the Antidote
A070. Protamine sulfate
71
Q071. Iron salts ; What is the Antidote
A071. Deferoxamine
72
Q072. Lead ; What is the Antidote
A072. Succimer; CaEDTA; dimercaprol
73
Q073. Methanol, ethylene glycol (antifreeze); What is the Antidote
A073. EtOH; fomepizole; dialysis
74
Q074. Methemoglobin; What is the Antidote
A074. Methylene blue
75
Q075. Opioids; What is the Antidote
A075. Naloxone
76
Q076. Phencyclidine hydrochloride (PCP); What is the Antidote
A076. NG suction
77
Q077. Salicylates ; What is the Antidote
A077. Urine alkalinization; dialysis; activated charcoal
78
Q078. TCAs; What is the Antidote
A078. Na bicarb QRS prolongation; diazepam or lorazepam for Seizures; cardiac monitor for; arrhythmias
79
Q079. Theophylline; What is the Antidote
A079. Activated charcoal
80
Q080. tPA, streptokinase; What is the Antidote
A080. Aminocaproic acid
81
Q081. Warfarin; What is the Antidote
A081. Vitamin K, FFP
82
Q082. Cardiac Life Support; What are the Basic Principles
A082. Check if responsive; call for help; Patient on firm, flat surface ABCs; Airway open?; Breathing?; CPR; IV meds before intubate; CPR if alone 2 breaths, check pulse carotid or femoral, 15 compressions; CPR if have help 2 breaths, 5 compressions
83
Q083. Burns; Hx/PE
A083. 2nd leading cause of death in kids; don't underestimate degree of nonvisible deep destruction esp. with electrical burns thorough airway & lung exam; respiratory burn patient may need early intubation before edema sets in
84
Q084. Burns; Dx; Rule of 9's
A084. ABCs; aware of possible shock, inhalation injury, CO poisoning; evaluate % of BSA involved rule of 9's; BSA (Body Surface Area); head = 18%; front = 18%; back = 18%; each arm = 9%; each leg = 18%
85
Q085. Burns; Categories
A085. 1st degree epidermis involved, area painful, no blisters, capillary refill intact; 2nd degree epidermis & superficial dermis, area painful, blisters; 3rd degree epidermis & dermis, area painless, white & charred
86
Q086. Burns; Tx
A086. Treatment supportive; freq. dressing changes; rehydrate; topical silver sulfadiazine and mafenide; circumferential burns at risk for compartment syn, need early escharotomy; early skin graft prevent contractures; fluid req. in 1st 24 hrs. BSA x wt(kg) x 4cc, give 1/2 in 1st 8 hrs, 1/4 in next 8 hrs, 1/4 in last 8 hrs; 1st choice lactate ringers; 2nd choice NS (0.9%); hydrate enough to maintain urine output at least 1cc/kg/hr
87
Q087. Burns; Complications
A087. Shock; superinfection esp. Pseudomonas
88
Q088. CO Poisoning; What is it
A088. Hypoxemic poisoning syn causes; car exhaust; smoke inhalation; barbeque in poor ventilation; old appliances
89
Q089. CO Poisoning; HX/PE
A089. Cherry red skin; confusion; headaches; if severe coma, seizures chronic low level exposure; flu like Sxs; suspect smoke inhalation in singed nose hairs; facial burns; hoarseness; wheezing; carbonaceous sputum
90
Q090. CO Poisoning; Dx
A090. ABG; normal serum carboxyHb level < 5% in nonsmokers, < 10% in smokers; laryngoscopy; bronchoscopy; EKG elderly; history of cardiac dis.
91
Q091. CO Poisoning; Tx
A091. 100 O2 hyperbaric O2:; pregnant; neuro Sxs; severely �! carboxyHb; smoke inhalation may need early intubation (before edema sets in)
92
Q092. Aortic Disruption; What is it
A092. Rapid deceleration injury most common causes; high speed MVAs; fall from great heights; ejection from vehicles complete; rapidly fatal; usually have contained hematoma within adventitia; laceration usually at lig. arteriosum
93
Q093. Aortic Disruption; Dx
A093. CXR immediately; wide mediastinum; loss of aortic knob; pleural cap; trachea deviation to right; left main stem bronchus depressed; aortography gold standard; transesoph echo before OR; always suspect if sternal fractures or 1st & 2nd rib fractures
94
Q094. Aortic Disruption; Tx
A094. OR emergently
95
Q095. Aortic Dissection; What is it; Risk Factors
A095. Surging of blood through tear in aortic intima; seperation of intima & media => false lumen; Stanford type A: ascending aorta; type B: desc. thoracic aorta (distal to lt. subclavian) risk factors:; HTN; trauma; coarctation of aorta; syphilis; pregnancy; Ehlers Danlos; Marfan's
96
Q096. Aortic Dissection; Hx/PE
A096. Acute onset; severe tearing chest pain radiates to back => syncope, stroke, MI; asymm or decreased periph pulses; paraplegia; shock as worsens; type A aortic regurgitation with diastolic murmur
97
Q097. Aortic Dissection; Dx
A097. CXR; CT with IV contrast; transesoph echo or; MRI/MRA or; angiography gold standard; EKG
98
Q098. Aortic Dissection; Tx
A098. Stabilize HBP or low HBP; IV nitrates; B blockers; goal systolic < 120, HR < 70; type A emergent surgery; type B med management
99
Q099. Aortic Dissection; Complications
A099. MI; CHF; cardiac tamponade; postop hemorrhage; future dissection; future aneurysm; death
100
Q100. Postop Fever; What is it Caused By; (What are the 6 W's)
A100. Wind atelectasis, pneumonia; Water UTI; Wound abscess; Walk DVT; Wonderdrug drug reaction; Wire catheter
101
Q101. Postop Fever; How to Decrease Risk
A101. Incentive spirometry; short term foley use; early ambulation; DVT prophylaxis; pre & post op ABx; fevers before POD3: probably not infectious unless Clostridium or B hemolytic strep
102
Q102. Acute Abdomen; What is it
A102. Abdom Sxs so severe; surgery should be considered; primary Sx acute abdom pain
103
Q103. Acute Abdomen; Hx/PE
A103. OPQRST: Onset, Precip factors, Quality, Radiation, Sxs, Temporal quality; Treatment modalities; full GYN Hx; LMP; STD Sxs; pelvic exam; pregnancy test rule out PID, ectopic pregnancy,; ovarian torsion
104
Q104. Acute Abdomen; Character of Pain
A104. Sharp parietal (peritoneal); dull, diffuse visceral (organ); perforation sudden onset of diffuse, severe pain; obstruction acute onset of colicky; inflammation gradual onset over 10 12 hrs, constant, ill defined
105
Q105. Acute Abdomen; Dx
A105. Assess stability; emergent surgery & exploratory lap peritoneal signs, impending shock, shock; if stable PE, pelvic exam (women), CBC with diff, electrolytes, LFTs, amylase, lipase, urine B hCG, UA, KUB, US; no contrast studies if suspect complete LBO
106
Q106. Acute Abdomen; Tx
A106. Hemodynamically unstable emergent exploratory lap; stable expectant management; vitals; NPO; NG tube; IV fluids; serial abdom exams; serial labs; type & cross; Foley monitor urine output; monitor fluid status
107
Q107. Appendicitis; What is it
A107. Always consider in patient with acute abdomen; MC teens & 20's; causes no. 1 lumen obstructed by lymphoid tissue hyperplasia; no. 2 fecalith, foreign body, tumor (carcinoid), parasite; obstruction => overdistention, increased pressure, ischemia & necrosis
108
Q108. Appendicitis; Hx/PE
A108. Dull, vague pain orig. at umbilicus, lasts 1 12 hrs. pain then followed by n/v, anorexia, ("hamburger sign"); may have mild fever; sharper pain => RLQ at McBurney's point, psoas sign, obturator sign, rovsing's sign; if perforated pain decreased, peritoneal sigs will dev. atypical elderly, kids, pregnant, retrocecal appendices
109
Q109. Appendicitis; Dx
A109. Clinical if classic signs & Sxs, mild leukocytosis & left shift; UA a few RBCs or WBCs; KUB fecalith, loss of psoas shadow; US rule out gyn abnorm; abdom CT rule out abscesses
110
Q110. Appendicitis; Tx
A110. strong suspicion immed open or lap appendectomy; 15 20% false pos. acceptable; if no appendicitis found complete exploration of abdo; before surgery NPO, IV fluids, ABx for anaerobes 24 hrs. if perforation cont. ABx until afebrile & WBC count normalizes, close wound by delayed primary closure on POD5; if abscess broad spectrum ABx, abscess percutaneously drained, elective appendectomy 6 8 wks
111
Q111. Appendicitis; Complications
A111. Risk of perforation & mortality increased with amt of time have appendicitis; (at 48 hrs 75% risk)
112
Q112. Acute Management of Trauma Patient; "ABCDE - What is "A""
A112. Airway airway patency & adeq ventilation; take precedence over other Tx; conscious nasal cannula or face mask; unconscious chin lift or jaw thrust to reposition tongue; early intubation apnea, decreased mental status, impending airway compromise, severe closed head injuries, failed bag mask ventilation; cricothyroidectomy can't be intubated, signif maxillofacial trauma, keep cervical spine stable, never let this concern delay airway management
113
Q113. Acute Management of Trauma Patient; "ABCDE - What is "B""
A113. Breathing 5 thoracic causes of immed. death must not be missed:; tension pneumothorax; cardiac tamponade; open pneumothorax; massive hemothorax; airway obstruction
114
Q114. Acute Management of Trauma Patient; "ABCDE - What is "C""
A114. Circulation; 2 16 gauge IVs; fluid bolus of 1 2L (adults); vitals rechecked; replete fluid per fluid status; LR or NS isotonic; replete 3:1 (fluid to blood)
115
Q115. Acute Management of Trauma Patient; "ABCDE - What is "D""
A115. Disability; evaluate CNS dysfunction via Glasgow Coma Scale
116
Q116. Acute Management of Trauma Patient; "ABCDE - What is "E""
A116. Extra; check temperature status; foley catheter after rule out urethral injury; secondary survey full exam; additional XRs trauma series: AP chest, AP pelvis, AP/lat C spine, T1
117
Q117. Pelvic Fractures; What are they
A117. MC after trauma such as a MVA; needs immediate attention by orthopedist; potentially life threatening
118
Q118. Pelvic Fractures; Hx/PE
A118. ABCDE trauma survey; secondary survey may reveal unstable pelvis; AP pelvic XR; when stable CT; if hypotension & shock hemorrhage likely; can be assoc with urethral injury check for blood at urethral meatus; check high riding, "ballotable" prostate; check for lack of prostate; retrograde urethrogram, rule out injury before Foley; serial H&H; never explore pelvic or retroperitoneal hematoma
119
Q119. Pelvic Fractures; Tx
A119. Embolize bleeding vessels; emergent external pelvic fixation; internal fixation if hemodynamically stable
120
Q120. acute dystonia
A120. involuntary muscle cont/spasm torticollis, oculogyric crisis; Rx: anticholinergic (benztropine) or diphenhydramine; Prevent: prophylatic benztropine
121
Q121. akathisia
A121. subjective/objective restlessness; Rx: reduce neuroleptic, �blocker (propranolol), +/ benzos, anticholinergics
122
Q122. dyskinesia
A122. pseudoparkinsonism Rx:; anticholinergic (benztropine); or DA agonist (amantidine); reduce/stop neuroleptic or d/c
123
Q123. tardive dyskinesia
A123. stereotypic oral facial movements; likely d/t DA receptor sensitization; 50% irreversible Rx:; reduce/stop neuroleptic or d/c or change drugs; giving anticholinergics or �!neuroleptic may initially WORSEN TD
124
Q124. Neuroleptic Malignant syndrome
A124. fever; muscle rigidity; autonomic instability; clouded consciousness; �!CPK, WBCs Rx:; stop neuroleptic; dantrolene/bromocriptine; IV fluids
125
Q125. Evolution of EPS
A125. 4 hours: acute dystonia; 4 days: akathisia; 4 weeks: akathisia; 4 months: tardive dyskinesia
126
Q126. EtOH withdrawal syndrome
A126. Mild withdrawal (6 24h from last drink): tremor, anxiety, N/V, insomnia; Major Withdrawal (10 72h): visual/auditory hallucinations, whole body tremor, vomiting, diaphoresis,�!BP; Withdrawl seizures 6 48hrs; DTs 2 7d, severe autonomic instability/hyperactivity (�!HR, BP), delerium, confusion, agitation, hallucinations, fever, positional nystagmus, death mortality 15 20%
127
Q127. EtOH withdrawal Rx including DTs
A127. benzos* (DOC); haloperidol for hallucinations; clonidine, BBs for hyperadrenergic state; thiamine, folate, vitamens; replace lytes; IV fluids
128
Q128. Barbituate withdrawal
A128. anxiety; seizures; delerium; tremor; cardiac & respiratory depression; Rx: benzos
129
Q129. Benzodiazepine withdrawal
A129. rebound anxiety; seizures; tremor; instability; Rx: benzos
130
Q130. Cocaine/amphetamine withdrawal
A130. depression; hyperphagia; hypersomnolence; Rx: supportive, avoid BBs (results in excess uninhibited cardiac activation)
131
Q131. Opioid withdrawal
A131. anxiety; insomnina; flu like symptoms*; sweating; piloerection; fever; rhinorrhea; stomach cramps; diarrhea; mydriasis; Rx: clonidine +/or buprenorphine for mod withdrawal, methadone for severe, naltrexone in pts drug free for 7 10d
132
Q132. Aortic disruption CXR
A132. widened mediastinum; pleural cap; loss of aortic knob; deviation of trachea to R; depression of L main stem bronchus; Always suspect with R1 2#s; aortography gold standard
133
Q133. Arrhythmia Rx:; asystole
A133. epi; atropine
134
Q134. Arrhythmia Rx:; Vfib
A134. desynchronized shock > epi or vasopressin > shock > lido or amio > shock > procainamide or Mg
135
Q135. Arrhythmia Rx:; VTach
A135. if unstable/pulseless desynchronized shock; if stable lido or amio
136
Q136. Arrhythmia Rx:; PEA
A136. identify & Rx underlying; +/ epi +/or atropine
137
Q137. Arrhythmia Rx:; Afib/flutter
A137. if unstable shock at 100J; If stable, control rate (CCB, dig, BB); +/ rhythm conversion; anticoagulate
138
Q138. Arrhythmia Rx:; SVT
A138. Control rate; valsalva, carotid sinus massage, cold stimulation; adenosine (procainamide)
139
Q139. Arrhythmia Rx:; bradycardia
A139. if symptomatic consider atropine; if Mobitz II/AVB pace; Acutely, unstable atropine/dopamine/dobutamine or transvenous pacing
140
Q140. hypovolemic shock
A140. �!CO; �!PCWP; �!PVR
141
Q141. cardiogenic shock
A141. Causes:; tension PTX; cardiac tamponade; arrhythmia; structural hrt dz; MI; �!CO; �!PCWP; �!PVR
142
Q142. Septic shock
A142. �!CO; �!PCWP; �!PVR
143
Q143. anaphylactic shock
A143. �!CO; �!PCWP; �!PVR
144
Q144. Rx for malignant HTN
A144. nitroprusside
145
Q145. test to rule out urethral injury
A145. retrograde cystourethrogram
146
Q146. Radiographic indications for Sx in pts with acute abd
A146. free air under diaphragm; extravasation of contrast; severe bowel distension; SOL; mesenteric occlusion (angiography)
147
Q147. Cannon a waves
A147. complete AVB
148
Q148. signs of neurogenic shock
A148. hypotension; bradycardia
149
Q149. Cushing's triad
A149. Signs of �!ICP; HTN; bradycardia; abnormal respirations
150
Q150. Signs of air embolism
A150. pt with chest truma previously stable suddenly dies
151
Q151. Organims/Rx of strep pharyngitis
A151. Org: GAS, S. pneumo Rx:; Pen V; Amoxicillin; erythromycin
152
Q152. Organisms causing sinusitis
A152. S. pneumo; H. flu; M. catarrhalis; GAS; anaerobes; S. aureus
153
Q153. Rx for sinusitis
A153. 1st line Amoxicillin (TMP SMX if pen allergic); 2nd line Amox/clav; 3rd line clarithromycin
154
Q154. Acute OM pathogens
A154. Viral; S. pneumo; H. flu; M. catarrhalis
155
Q155. The nasopharyngeal airway can be used in which types of patients?
A155. breathing semiconscious patients and when an oropharyngeal airway is technically challenging
156
Q156. Prolonged use of a bag valve can lead to..?
A156. Distention of the stomach increasing the chance of an aspiration event
157
Q157. What are the steps of successful intubation?
A157. 5P's Preparation, preoxygenation, pretreatment, paralysis, and placement
158
Q158. How do you prepare for successful intubation?
A158. IV access, monitors, suction, appropriate sized ET tube, and meds for rapid sequence intubation
159
Q159. What pretreatment may be necessary in small children prior to intubation and why?
A159. Atropine, to blunt the bradycardia induced by succinocholine
160
Q160. What pretreatment prior to intubation may be used in adults with reactive airway disease? What about in adults where there is a concern about increased ICP?
A160. Reactive airway disease lidocaine 1.5mg/kg; Pancuronium 0.01mg/kg
161
Q161. What sedative agent is used prior to paralysis for intubation?
A161. Etomidate 0.3mg/kg
162
Q162. volar =?
A162. palmar
163
Q163. Physical Exam of emergency ortho...?
A163. ROM; Palpation for subtle deformities well beyond the area of subjective pain; Neurovascular assessment
164
Q164. Ulnar nerve palsy causes..?
A164. Claw hand
165
Q165. Inability to extend the knee could be caused by paralysis of which nerve?
A165. Femoral nerve
166
Q166. Early treatment of ortho emergencies?
A166. NSAIDs; RICE (rest ice compression elevation); NPO; Reduction of long bone deformities
167
Q167. Don't forget to give _____ for open fractures?
A167. Tetanus
168
Q168. In children with trauma to a joint, what is important to consider on imaging?
A168. Comparison to the opposite extremity difficult to tell the difference between a fracture and an epiphyseal growth plate
169
Q169. Compartment syndrome defined?
A169. When the pressure in a compartment exceeds the arterial perfusion pressure
170
Q170. Most reliable sign of compartment syndrome?
A170. Paresthesia
171
Q171. ARDS, neuro involvement, and thrombocytopenia post closed fractures in leg..?
A171. Fat embolism
172
Q172. If you land directly on your shoulder, and hit hurts to reach across your body, what is the injury?
A172. Acromioclavicular joint separation
173
Q173. when does Acromioclavicular joint separation require surgery?
A173. type iv or higher (when the clavicle is displaced into surrounding areas)
174
Q174. 96% of shoulder dislocations are...?
A174. Anterior shoulder dislocations
175
Q175. how does the patient with an Anterior shoulder dislocation appear?
A175. holding arm in slight abduction and external rotation
176
Q176. What is the most common fracture in Aneterior shoulder dislocations? what nerve should be tested?
A176. Hill Sachs deformity fracture of the posterolateral aspect of the humeral head; Test the axillary nerve
177
Q177. Posterior dislocations are caused by...? always associated with...?
A177. fall on outstretched hand, convulsive seizure. Associated with Hill Sachs deformity
178
Q178. Most common mechanism of acute rotator cuff tear? This injury impairs which movement?
A178. Forced abduction. Impairs arm abduction to 30 degrees
179
Q179. What important structures travel with the humerus?
A179. The deep brachial artery and the radial nerve
180
Q180. Who gets supracondylar fractures? how?
A180. Kids < 15. Falling backwards on an outstretched hand
181
Q181. Posterior fat pad sign indicates?
A181. In adults radial head fracture; In kids supracondylar fracture
182
Q182. What is fracture of the proximal 1/3 of the ulna with radial head dislocation called?
A182. Monteggia fracture
183
Q183. What is fracture of the distal 1/3 of radius with dislocation of the distal radioulnar joint called?
A183. Galeazzi
184
Q184. Causes of carpal tunnel?
A184. RA, hypothyroid, DM, collagen vascular diseases
185
Q185. Phalen's test?
A185. Fully flex the wrists for 60 seconds
186
Q186. Tinel's sign?
A186. Light tapping over the median nerve produces pain or paresthesias
187
Q187. Most common carpal injury..?; High risk of..?
A187. Fracture of the scaphoid. AVN
188
Q188. Smith's fracture?
A188. Like colles, but distal fragment is displaced in the volar direction
189
Q189. neurogenic shock?
A189. state of vasomotor instability resulting from impairment of the descending sympathetic pathways in the spinal cord, or just a loss of sympathetic tone
190
Q190. does spinal shock signify permanent spinal cord damage?
A190. often times no
191
Q191. anterior cord syndrome results in loss of which tracts?
A191. spinothalamic and corticospinal tract
192
Q192. Central cord syndrome can be caused by? Affects?
A192. Hyper extension injuries. Nerves that cross over at that level
193
Q193. if a penetrating spinal injury is diagnosed, begin treatment with..?
A193. High dose methylprednisolone
194
Q194. if suspecting a c spine fracture, what xrays should be ordered?
A194. lateral, AP, and odontoid view
195
Q195. C1 burst fracture is called? Caused by...?
A195. Jefferson fracture. Caused by axial loading someone falls on their head, or something falls on their head
196
Q196. Odontoid fractures are caused by..?
A196. Flexion
197
Q197. Hangman's fracture?
A197. Fracture of both pedicles of C2 hyperextension mechanism
198
Q198. Stable or unstable?; atlanto occipital dislocation; burst fracture of C5 with intact ligaments... simple wedge fracture; odontoid fracture; flexion teardrop fracture; extension teardrop fracture
A198. atl unstable; burst c5 stable; simple wedge stable; odontoid unstable; flexion teardrop unstable; extension teardrop stable
199
Q199. flexion teardrop fracture is associated with...?
A199. tearing of the posterior complex
200
Q200. bilateral facet dislocation...? stable?
A200. flexion injury; subluxation of the dislocated vertebra; very unstable
201
Q201. Cullen's sign? Gray Turner's sign?
A201. ecchymosis of the abdomen signifies late retroperitoneal hemorrhage; Gray Turner's: same, but of the flanks
202
Q202. 12% of patients with hyperthyroidism will suffer...?
A202. Pathologic fracture
203
Q203. serious associated injuries are present in up to 95% of patients with a dislocated...?
A203. hip
204
Q204. a pt with a posterior hip dislocation holds the hip how?
A204. flexed, adducted, and internally rotated
205
Q205. most common ortho injury seen in the ED?
A205. knee in particular, MCL (medial collateral ligament)
206
Q206. 50% of patients with ACL injury have a concomitant...?
A206. Meniscal tear
207
Q207. lachman's test?
A207. flex the knee to 30 degrees and pull anteriorly on the tibia
208
Q208. donahue's unhappy triad?
A208. ACL, MCL, and medial meniscus tear
209
Q209. Injury to the ________ occurs in 50% of knee dislocations...
A209. popliteal artery
210
Q210. injury to the tibial nerve causes...?
A210. inability to stand on tiptoes
211
Q211. which ankle fracture warrants a careful radiologic examination? of what specifically?
A211. medial malleolar fracture; proximal shaft of the fibula (Maisoneuve fracture)
212
Q212. 10% of calcaneal fractures are associated with...?
A212. lumbar fractures
213
Q213. when do you call for an ortho consult?
A213. compartment syndrome; irreducible fractures; circulatory compromise; open fracture; anything that requires surgery
214
Q214. what is the most frequent complication of orotracheal intubation?
A214. Right main stem bronchus intubation
215
Q215. Patients with COPD, asthma, or CHF that are awake but cannot remain in the supine position may be intubated how...?
A215. Nasotracheal intubation
216
Q216. Most serious complication of nasotracheal intubation?
A216. Intracranial passage of the tube
217
Q217. advance airway adjuncts?
A217. fiberoptic intubation; retrograde intubation; combitube; laryngeal mask airway
218
Q218. What is the preferred surgical airway for kids? Adults?
A218. Kids needle cricothyroidotomy; Adults surgical cricothyroidotomy
219
Q219. if an airway will be needed for greater than 2 3 days, a surgical cricothyoidotomy should be converted to...?
A219. a tracheostomy
220
Q220. slit lamp exam consists of...?
A220. evaluate the integrity of the cornea, conjunctiva, and the anterior chamber; fluorescein to light up corneal defects
221
Q221. central retinal artery occlusion occurs in which people?
A221. men in their 60s
222
Q222. fundoscopic exam in central retinal artery occlusion?
A222. pale retina with cherry red fovea
223
Q223. what is amaurosis fugax?
A223. type of TIA sudden vision loss (Shade over eye), transient, due to carotid origin embolic shower
224
Q224. classic triad of optic neuritis?
A224. marcus gunn pupil; central vision loss; red vision desaturation
225
Q225. flashing lights, spider webs, or floaters that interfere with vision may be a sign of...? what meds should NOT be given?
A225. retinal detachment; DON'T anticoagulate
226
Q226. painful red eye most often due to which things?
A226. conjunctivitis, corneal abrasion, or foreign body
227
Q227. which conjunctivitis produces copious DC?
A227. gonorrhea
228
Q228. punctuate lesions in conjunctivitis?
A228. viral cause
229
Q229. treatment of conjunctivitis?
A229. broad spectrum antibiotics, pain meds
230
Q230. soft contact wearers are especially prone to infection by.?
A230. pseudomonas
231
Q231. severe unilateral eye pain, decreased visual acuity and photophobia...?
A231. iritis
232
Q232. treatment of iritis?
A232. cycloplegic such as homatropine(not a mydratic)
233
Q233. severe unilateral HA, eye pain, N/V assoc with loss of vision....?
A233. narrow angle glaucoma
234
Q234. which drugs decrease aqueous production?
A234. acetazolomide and topical b blockers
235
Q235. which chemicals causes coag necrosis? liquefaction necrosis?
A235. acids; alkali
236
Q236. treatment of chemical burn...
A236. IRRIGATE
237
Q237. what's hyphema?
A237. blurred vision after blunt trauma (dull eye pain)... bleeding
238
Q238. basic approach to all toxicity patients in the ED?
A238. ABCs; Decontamination; Elimination; Antidotes
239
Q239. key things on physical exam for toxicity exposures....?
A239. Vital signs; pupils; toxidromes; autonomic signs; motor signs; mental status; skin
240
Q240. describe anticholinergic toxidrome?
A240. "mad as a hatter, dry as a bone, red as a beet, hot as a stove." Also decreased GI motility, urinary retention, mydriasis.
241
Q241. describe muscarinic toxidrome?
A241. DUMBELLS
242
Q242. narcotic toxidrome?
A242. respiratory depression,; hypotension,; depressed sensorium, miosis
243
Q243. sympathomimetic toxidrome? compare with anticholinergic toxidrome?
A243. very similar except sympathomimetic involves diaphoresis
244
Q244. withdrawal toxidrome?
A244. agitation,; hallucination,; mydriasis,; diarrhea,; cramps,; lacrimation,; tachycardia,; insomnia,; seizures
245
Q245. major toxic effect of acetaminophen?
A245. metabolite NAPQI causes centrilobular hepatocellular damage
246
Q246. treatment of acetaminophen toxicity?
A246. 4 hour level on rumack matthew nomogram,; activated charcoal,; N acetyl cysteine (to regenerate glutathione)
247
Q247. methanol toxicity?
A247. formic acid metabolite causing a gap acidosis and direct optic nerve toxicity
248
Q248. treatment of ethylene glycol toxicity?
A248. 4MP or EtOH
249
Q249. which drugs can cause anticholinergic syndromes? tx?
A249. antihistamines, antipsychotics, TCAs... treatment physostigmine
250
Q250. symptoms of calcium channel blocker toxicity? tx?
A250. bradycardia and hypotension; treatment CaCl2, glucagon, epinephrine, DA
251
Q251. CO toxicity symptoms
A251. HA,; N/V,; flu like symptoms,; CNS depression,; tachy,; hypotension
252
Q252. treatment of CO toxicity?
A252. 100% O2
253
Q253. GHB?
A253. date rape drug euphoric and amnestic effects
254
Q254. refractory seizures could be caused by what toxicity?
A254. INH
255
Q255. Organophosphates can cause which toxidrome?
A255. muscarinic
256
Q256. naloxone?
A256. opioid antagonist
257
Q257. standard of care for salicylate poisoning?
A257. activated charcoal; also consider alkalinization of urine and blood with bicarb
258
Q258. benzo receptor antagonist that can rapidly reverse coma from benzo OD...? what's the problem with this drug/
A258. flumazenil; can lower the seizure threshold in pts with TCA OD and induce benzo withdrawal
259
Q259. loxosceles bites can be treated with...?
A259. dapsone
260
Q260. signs and symptoms of TCA OD?
A260. anticholinergic sx,; cardiac dysfunction,; intractable seizures,; and hyperthermia
261
Q261. treatment of TCA toxicity?
A261. decontamination with MDAC; Sodium bicarb administration; Benzos for seizure management; Alpha agonists for hypotension
262
Q262. prerenal failure due to..?
A262. decreased renal perfusion; (volume depletion, low CO, abnormal renal hemodynamics)
263
Q263. most common cause of intrinsic renal failure?
A263. longstanding HTN
264
Q264. majority of hospital assoc episodes of ARF are caused by...?
A264. ATN
265
Q265. postrenal failure caused by?
A265. obstructive uropathy
266
Q266. FENA <1 in which condition?
A266. Prerenal failure
267
Q267. Urine Na <20 in which condition?
A267. Prerenal failure
268
Q268. treatment of prerenal failure?
A268. volume replacement, d/c offending meds
269
Q269. intrinsic RF treatment?
A269. monitor fluid status,; restrict protein,; correct electrolyte abnormalities
270
Q270. dispo for patients with ARF?
A270. admit
271
Q271. what drugs can cause ARF in pts with renal artery stenosis?
A271. ACE inhibitors
272
Q272. #1 cause of death in 1 44 year olds?
A272. Trauma (specifically, MVCs)
273
Q273. Preparation for a trauma case includes?
A273. History from EMTs; Prep the trauma bay; Airway box; O2 and suction; IVF and supplies
274
Q274. Indications for intubation?
A274. GCS <8; Inadequate breathing; Unable to protect airway
275
Q275. Chin lift is contraindicated if...?
A275. A C spine injury is suspected
276
Q276. Radial pulse should have a BP of at least...? Femoral?
A276. 80 mmHg; 70
277
Q277. what % of ECF is plasma?
A277. 40181
278
Q278. which drug is an ineffective pressor in hypovolemic patients?
A278. dopamine
279
Q279. GCS consists of which 3 categories?
A279. eye opening,; verbal response,; moto response
280
Q280. most rapid means to lower ICP?; what other method?
A280. Hyperventilation; mannitol
281
Q281. volume of blood in an adult?
A281. 5 L (7% of ideal body weight)
282
Q282. physiologic response to acute hypovolemia?
A282. In order:; Tachycardia; narrowed pulse pressure (increased diastolic press); slowing of cap refill; decreased systolic pressure
283
Q283. raccon eyes, and battle sign?
A283. late findings in basilar skull fractures
284
Q284. assessment of C spine in trauma?
A284. posterior midline any tenderness?; focal neuro deficit?; A&O; evidence of intoxification?; any painful injury that may distract the pt?
285
Q285. FAST?
A285. quick, non invasive method of examining the abdomen and pericardium for blood
286
Q286. how to check for pelvic fracture?
A286. press down and in on both iliac crests simultaneously
287
Q287. urine myoglobin can be elevated secondary to...?
A287. massive muscle breakdown (rhabdo)
288
Q288. treatment of rhabdo?
A288. IVF,; sodium bicarb,; and mannitol
289
Q289. calculate cerebral perfusion pressure?
A289. MAP ICP
290
Q290. Cushing's reflex? sign of?
A290. HTN, bradycardia, hypopnea; sign of increased ICP
291
Q291. in traumatic head injury, what is the target MAP?
A291. 90mmHg
292
Q292. intubation considerations for elevated ICP?
A292. intubate early but WITHOUT ketamine
293
Q293. seizure prophylaxis with head bleeds?
A293. dilantin
294
Q294. how does cardiac tamponade present? findings?
A294. hypotension, muffled heart sounds, JVD, and pulsus paradoxus; electrical alternans on ECG; may present with pulseless electrical activity
295
Q295. which condition can lead to hypotension, absent breath sounds, hyperresonance, distended neck veins, and high airway pressures?
A295. tension pneumothorax
296
Q296. hypoxia occurs if an open pneumothorax is greater than?
A296. 2/3 trachea diameter
297
Q297. flail chest?
A297. 3 or more rib fractures in 2 or more sites with paradoxical motion of chest wall with inspiration
298
Q298. how to demonstrate fluid in the pericardium in tamponade?
A298. echocardiogram, or ED U/S
299
Q299. treatment of tension pneumothorax?
A299. angiocath in the 2nd intercostals space in the mid clavicular line; chest tube if hemorrhagic or simple pneumothorax suspected
300
Q300. treatment of cardiac tamponade?
A300. subxyphoid pericardiocentesis
301
Q301. splenic injury can cause pain referred to...? eponym?
A301. left shoulder...Kehr's sign
302
Q302. which chief complaints warrant a stat EKG?
A302. chest pain/pressure/discomfort; SOB; hypotension; weakness/dizziness; syncope; abdominal pain especially in elderly; palpitations; N/V especially in elderly, diabetics
303
Q303. shortened PR interval suggests?
A303. alternate, abnormal conduction pathway like WPW syndrome
304
Q304. elongated PR interval suggests?
A304. some form of AV block
305
Q305. quick and dirty way of determining the axis of the heart?
A305. leads I and aVF... both up normal; aVF down LAD; I down RAD; both down RAD
306
Q306. DDx of U waves?
A306. hypokalemia; hypercalcemia; meds (digoxin, quinidine); thyrotoxicosis
307
Q307. Describe possible characteristics of an unstable cardiac patient?
A307. Pulseless; Hypotension; AMS; Ischemic chest pain; CHF
308
Q308. treatment basics for unstable cardiac patients?
A308. cardioversion (synch or un synch) per ACLS protocol, then IV meds or other therapy
309
Q309. treatment of sinus tachycardia?
A309. treatment the UNDERLYING CAUSE
310
Q310. how can you tell there's paroxysmal supraventricular tachycardia? tx?
A310. abnormal/absent P waves; Tx: unstable > synch cardioversion; stable > AV node blockade via adenosis, calcium channel blockers (diltiazem, verapamil), b blockers, manuevers
311
Q311. treatment of a fib?
A311. unstable > synch cardioversion; stable w/ rapid vent. response > AV blockade: calcium channel blockers, b blockers, digoxin; anticoagulation
312
Q312. pts with pre excitation syndromes be careful not to...?
A312. block the AV node by conventional meds
313
Q313. premature ventricular contractions, etiology?
A313. 4 H's hypokalemia, hypomagnesemia, hypoxia, hyperthyroidism; drugs; heart disease
314
Q314. what is trigeminy?
A314. every 3rd beat is a PVC
315
Q315. treatment of PVCs?
A315. iv lidocaine or amiodarone; iv magnesium sulfate; procainamide
316
Q316. treatment of pulseless v tach?
A316. immediate UNSYCNHED cardioversion
317
Q317. treatment for unstable v tach?
A317. synchronized cardioversion, then amiodarone or lidocaine drip
318
Q318. treatment for stable v tach?
A318. medical cardioversion with lidocaine, amiodarone, adenosine, or procainamide
319
Q319. etiology of torsades?
A319. ischemic heart disease; MI; hypo electrolyte states
320
Q320. treatment of stable torsades?
A320. electrical overdrive pacing; also consider Mg sulfate
321
Q321. treatment of Vfib?
A321. unsynchronized cardioversion,; ACLS protocols,; and correction of lytes abnormalities
322
Q322. pulseless electrical activity etiology?
A322. MATCH4ED; MI; Acidosis; Tension pneumo; Cardiac tamponade; H4 hypothermia, hyperkalemia, hypoxia, hypovolemia; Embolism (pulm); Drug OD
323
Q323. treatment of ventricular asystole?
A323. IVF, epinephrine, atropine; Transvenous pacing
324
Q324. for Mobitz II 2nd degree AV block, what tx? What won't work?
A324. transcutaneous or transvenous pacing; Admit for implantable pacemakers; Atropine won't work
325
Q325. treatment for 3rd degree AV block?
A325. immediate temporary pacemaker
326
Q326. you should consider a new LBBB to be _______ until proven otherwise?
A326. acute MI
327
Q327. Indications for temporary cardiac pacing?
A327. hemodynamically unstable bradycardia; bradycardia that fails to respond to tx; refractory tachycardia dysrhythmias; early bradyasystolic arrest
328
Q328. how does digoxin cause toxicity?
A328. blockade of the NaKATPase; increased vagal tone and increased AV nodal blockade
329
Q329. EKG signs of WPW?
A329. short PR interval; Delta wave; wide QRS; adult tachycardia
330
Q330. EKG signs of hypokalemia?
A330. more prominent U waves; flattened t waves
331
Q331. EKG signs of hyperkalemia?
A331. hyperacute T waves; wide QRS that eventually blends with the T wave to form a sine wave appearance
332
Q332. EKG signs of hypocalcemia?
A332. prolonged QT; terminal T wave inversion
333
Q333. EKG signs of hypercalcemia?
A333. shortened QT interval
334
Q334. associated symptoms of ACS?
A334. dyspnea, diaphoresis, nausea, lightheadedness, or sense of weakness
335
Q335. define stable angina?
A335. symptoms precipitated by exertion and relieved by rest or nitroglycerin
336
Q336. define unstable angina?
A336. Exertional angina of recent onset; angina of worsening character; angina at rest
337
Q337. describe myoglobin as a cardiac marker?
A337. elevated as early as one hour and peaks at 4 12 hours; nonspecific
338
Q338. describe CKMB as a cardiac marker?
A338. rises in 3 4 hours, peaks at 12 24 hours; can be elevated in skeletal muscle injury
339
Q339. describe troponin as a cardiac marker?
A339. rises in 3 6 hours, peaks 12 24 hours; most specific and sensitive
340
Q340. acute MI tx?
A340. MOAN B H; morphine; oxygen; aspirin; nitroglycerin; beta blockade; heparin
341
Q341. in pump failure.. which pressors for hypotension in a volume unresponsive patient..?
A341. sbp 80 100 dobutamine; sbp 70 80 dopamine; sbp <70 levophed
342
Q342. pericarditis presentation?; pain is worsened by..?
A342. sharp stabbing precordial or retrosternal chest pain... pain worsened by inspiration or lying flat
343
Q343. associated symptoms of pericarditis?
A343. low grade fever; dyspnea; dysphagia; tachycardia
344
Q344. test of choice for detection and f/u of pericarditis?
A344. echo
345
Q345. treatment for pericarditis
A345. NSAIDs for 1 3 weeks
346
Q346. aortic dissections typically occur in what group?
A346. uncontrolled hypertensive males ages 50 70
347
Q347. physical findings in aortic dissection?
A347. asymmetric pulses with BP differences between extremities; very hypertensive; severe distress; JVD; palpable pulsatile mass or tenderness
348
Q348. chest tube required for what size pneumothorax?
A348. >15%
349
Q349. Nitro's relief of cardiac vs esophageal pain?
A349. Cardiac w/in 5 minutes, esophageal w/in 10 minutes
350
Q350. life threatening etiologies of abdominal pain...?
A350. ruptured AAA,; perforated viscous,; intestinal obstruction,; ectopic pregnancy,; mesenteric ischemia,; appendicitis,; and MI
351
Q351. INITIAL TEST OF CHOICE FOR BILIARY TRACT DISEASE, AAA, ectopic, or free peritoneal fluid?
A351. US
352
Q352. Plain films can rule out which abdominal emergencies?
A352. Perforation or obstruction
353
Q353. Colicky pain usually responds to which drugs? Specifically...?
A353. NSAIDs,; esp IV Ketorolac
354
Q354. Triad of pain, hypotension, and a pulsatile abdominal mass...?
A354. AAA
355
Q355. _______ is virtually 100% sensitive in detecting AAAs?
A355. US
356
Q356. What is usually the primary inciting factor of appendicitis?
A356. Obstruction of the appendix usually by an appendicolith
357
Q357. risk factors for cholecystitis?
A357. fat, forty, and female
358
Q358. radiation of pain in acute cholecystitis?
A358. tip of the right scapula
359
Q359. most useful test if suspicious of cholecystitis?
A359. US of RUQ
360
Q360. which agents should not be used in acute gastroenteritis?
A360. anti motility agents (Imodium) because it diminishes diarrheal excretion of organisms
361
Q361. Presentation of patients with acute hepatitis?
A361. Jaundice,; dark urine/light stools,; hepatomegaly,; fatigue, malaise,; RUQ pain,; N/V,; and fever
362
Q362. coagulation should be normalized with FFP in which condition?
A362. hepatitis
363
Q363. presentation of acute mesenteric ischemia?
A363. severe, poorly localized colicky abdominal pain associated with recurrent forceful bowel movements; classic abdominal pain out of proportion to the minimal physical exam findings
364
Q364. Most useful test to diagnose acute mesenteric ischemia?
A364. Angiography
365
Q365. Midepigastric abdominal pain usually associated with N/V?
A365. Acute pancreatitis
366
Q366. An amylase raised _______ times the upper limit of normal is 98% specific to acute pancreatitis...
A366. 1.5
367
Q367. All patients with acute pancreatitis should be....
A367. admitted and made NPO
368
Q368. good narcotic choice for pain in acute pancreatitis
A368. Meperidine (better than morphine)
369
Q369. fever, abdominal pain, and rebound tenderness...?
A369. Peritonitis
370
Q370. Small bowel obstruction is caused by ________ more than 50% of the time...?
A370. postoperative adhesions
371
Q371. Most significant complications of small bowel obstruction?
A371. Strangulation and bowel infarction
372
Q372. etiology of bronchitis?
A372. viruses (influenza, adenovirus, etc.); Mycoplasma; Chlamydia; Bordetella pertussis
373
Q373. Virchow's triad of the pathophysiology behind PE?
A373. Venostasis; Hypercoagulability; Vessel wall damage/inflammation
374
Q374. Classic triad of PE presentation?
A374. Hemoptysis; Dyspnea; chest pain
375
Q375. EKG findings in PE?
A375. S1; Q3; inverted T3
376
Q376. golden standard for diagnosing PE?
A376. pulmonary angiography
377
Q377. ED treatment of CHF?
A377. diuretics; nitrates; anlgesics; intubation or CPAP if no improvement
378
Q378. treatment of COPD in the ED?
A378. ABCs monitoring; albuterol neb; glucocorticoids; MgSO4 in severe exacerbations; antibiotics (empiric broad spectrum)
379
Q379. ED eval of asthma?
A379. Monitors, O2, pulse ox; Peak expiratory flow rate; CXR to rule out pneumonia
380
Q380. signs of hyperventilation syndrome?
A380. tachypnea, chest wall tenderness, carpopedal spasm, Chvostek's/Trousseau's sign (hypocalcemia)
381
Q381. this condition likely results from inflammation of CN VII as it courses through the styloid foramen?
A381. Bell's palsy
382
Q382. treatment of bell's palsy?
A382. acyclovir AND prednisone; eye patching to prevent keratitis and corneal ulceration
383
Q383. work up of CVA?
A383. STAT head CT esp if < 3 hrs; standard labs; STAT Accu check
384
Q384. in hemorrhagic stroke, you want to decrease SBP by no more than _____ to limit hypoperfusion...?
A384. 20 25%
385
Q385. Peripheral vertigo is caused by.?
A385. viral etiology (labyrinthitis); decaying or "lost" otoliths
386
Q386. peripheral vertigo presentation?
A386. acute onset; intense spinning sensation, N/V; unidirectional nystagmus that can be inhibited by fixation
387
Q387. work up of peripheral vertigo?
A387. hallpike maneuver; epley manuevers; anti emetics, anti cholinergics
388
Q388. most seizures in the ED are due to...?
A388. Medical non compliance in known seizure patients
389
Q389. workup of seizures in the ED...
A389. ABCs; IV; check glucose; head CT; anti epileptic level; LP if any possibility of intracranial hemorrhage or meningitis
390
Q390. LOC occurs in ____ % of patients with SAH?
A390. 0.5
391
Q391. 75% of SAH is due to...?
A391. ruptured congenital arterial aneurysm
392
Q392. diagnostic test for SAH?
A392. noncontrast head CT
393
Q393. if there is suspicion for SAH and it's not seen on CT, ____ must be performed?
A393. LP
394
Q394. What other condition besides SAH could cause blood in the CSF?
A394. Herpes encephalitis
395
Q395. goal of ICP management is to maintain the cerebral perfusion pressure greater than ______?
A395. 60
396
Q396. A chronic headache that started out mild to moderate in severity and intermittent in nature, described as a deep, aching pain and worsened by coughing, and often maximal upon awakening...?
A396. intracranial tumor / mass
397
Q397. 85% of people experiencing malignant hypertension complain of _____?
A397. Headache
398
Q398. Temporal arteritis affects women ______ than men, and is uncommon before the age of _____? ESR is usually ____?
A398. Women more than men; 50; ESR 50 100
399
Q399. Jaw claudication is strongly suggestive of...?
A399. temporal arteritis
400
Q400. treatment of temporal arteritis?
A400. prednisone 60mg po, arrange a biopsy to confirm diagnosis
401
Q401. Often compression of ______________ can improve the pain of migraine?
A401. the ipsilateral superficial temporal or carotid artery
402
Q402. ergotamine is contraindicated in... ? Should be used w/ caution in ....?
A402. Pregnancy; Caution in HTN or CAD
403
Q403. Patients should avoid _____ while in the midst of cluster headaches?
A403. Alcohol
404
Q404. This causes headaches often in overweight women in their 30s...
A404. Pseudotumor Cerebri (benign intracranial HTN)
405
Q405. 90% of patients with Pseudotumor Cerebri have ....?
A405. papilledema
406
Q406. in Pseudotumor Cerebri, head CT will show...? LP will show...?
A406. CT slit like ventricles; LP increased opening pressure
407
Q407. treatment of Pseudotumor Cerebri..?
A407. Acetazolamide 250 mg pid
408
Q408. treatment of post LP HA?
A408. caffeine sodium benzoate
409
Q409. cherry red coloration of skin/mucous membranes, retinal hemorrhages, AMS?
A409. CO poisoning
410
Q410. sudden onset of head/eye pain, decreased visual acuity?
A410. Acute angle closure glaucoma
411
Q411. treatment of acute uncomplicated UTI?
A411. Bactrim for 3 days
412
Q412. Pyelonephritis w/ systemic sx tx?
A412. admit for IV antibiotics
413
Q413. pregnant women with UTI tx?
A413. macrobid for 7 days
414
Q414. What % of pts presenting with classic UTI sx show minimal to no bacteria on UA?
A414. 30 40%
415
Q415. Sudden onset of testicular pain in children and young men?
A415. Testicular torsion
416
Q416. most common cause of urinary retention?
A416. BPH
417
Q417. >100 ml postvoid residual urine volume is diagnostic of...?
A417. urinary retention
418
Q418. what is fournier's gangrene?
A418. aggressive fasciitis of the perineum in a toxic appearing pt likely with history of DM, urethral trauma, surgery, or obstruction
419
Q419. treatment of fournier's gangrene??
A419. immediate surgery complete debridement of necrotic tissue
420
Q420. tender, swollen, painful epididymis and testis usually accompanied by fever?
A420. Epididymitis
421
Q421. testicular US can distinguish...?
A421. torsion from epididymitis
422
Q422. the cremasteric reflex is present in _____ but not in ___________?
A422. epididymitis; torsion
423
Q423. nonspecific infection of the glans penis is called...?
A423. balanitis
424
Q424. abnormally small opening in the foreskin?
A424. phimosis
425
Q425. abnormal painful swelling of the glans penis occurring after aggressive retraction of a phimotic foreskin?
A425. paraphimosis
426
Q426. flank/abdominal pain, does not change with position or remaining still, radiation to groin...
A426. stones
427
Q427. work up of stones?
A427. IVF; IV narcotics; UA will generally show hematuria; BMP
428
Q428. test of choice for kidney stones?
A428. noncontrast CT
429
Q429. stone <3mm probability of passing spontaneously?
A429. 0.8
430
Q430. Indications for urology consults or admission in kidney stones...?
A430. Associated UTI; uncontrolled pain/emesis; extravasation of contrast; renal failure; single kidney; hydronephrosis + hydroureter; stone > 6mm
431
Q431. in a patient >60, first time renal colic is _________ until proven otherwise...
A431. AAA
432
Q432. of those women who experience bleeding in the first trimester, ______________ will undergo spontaneous abortion
A432. 40180
433
Q433. threatened abortion...?
A433. vaginal bleeding with a pre viable fetus and closed cervix
434
Q434. inevitable abortion?
A434. vaginal bleeding with cervical dilatation
435
Q435. incomplete abortion
A435. vaginal bleeding with partial passage of products of conception and dilated cervix
436
Q436. complete abortion
A436. passage of all products of conception and closed cervix
437
Q437. missed abortion
A437. fetal demise and retention of products of conception, cervix closed
438
Q438. 6 8 weeks gestation with amenorrhea, spotting, and cramping lower abdominal pain....concerning for...?
A438. ectopic
439
Q439. gold standard in diagnosing an ectopic?
A439. US
440
Q440. any patient who presents with vaginal bleeding and is _____ should be given RhoGAM?
A440. Rh
441
Q441. 2 most common pregnancy related causes of vaginal bleeding in the second trimester?
A441. miscarriage; hydatidiform mole
442
Q442. pre eclampsia that occurs prior to 20 weeks gestation is pathognomonic for...?
A442. trophoblastic disease
443
Q443. most common presentation of placenta previa?
A443. late 2nd to early 3rd trimester painless bleeding
444
Q444. ____________ may occur in up to 1/3 of placental abruptions?
A444. DIC
445
Q445. pre eclampsia?
A445. triad of HTN, edema, and proteinuria of >100 mg/dl
446
Q446. HELLP syndrome?
A446. subset of pre eclamptic pts:; Hemolysis, Elevated Liver enzymes, and Low Platelets
447
Q447. In preeclampsia and eclampsia, the most important part of the CBC is...?
A447. the platelet count
448
Q448. seizure prophylaxis in pre, eclampsia?
A448. MgSO4
449
Q449. preterm labor is defined as occurring...?
A449. before 37 weeks gestation
450
Q450. Strawberry cervix?
A450. trichomonas
451
Q451. average blood loss in normal menses/
A451. 30 60cc
452
Q452. benign leiomyomas that develop in the uterus and often result in menometrorraghia?
A452. fibroids
453
Q453. dysfunctional uterine bleeding tx..?
A453. NSAIDs, and OCPs; rule out endometrial carcinoma
454
Q454. Chlamydia can cause....?
A454. Asymptomatic infection; Urethritis; Cervicitis; PID
455
Q455. PID?
A455. Lower abdomen. tenderness, cervical motion tenderness, and adnexal tenderness; + fever or increased WBC or ESR etc..
456
Q456. most common cause of infectious arthritis in young sexually active adults?
A456. Gonorrhea
457
Q457. green gray discharge?
A457. trichomonas
458
Q458. thin gray malodorous discharge, non sexually transmitted
A458. bacterial vaginosis
459
Q459. most common cause of pelvic pain in women not associated with infection is...?
A459. Rupture of an ovarian cyst
460
Q460. 50% of cases of ovarian torsion are caused by..?
A460. Benign dermoids that cause the ovary to twist
461
Q461. A major cause of pelvic pain, dyspareunia, and dysmenorrhea
A461. Endometriosis
462
Q462. postcoital contraception?
A462. norgestrel
463
Q463. first, second, etc degree frostbite?
A463. 1st warm, hyperemic, sensate; 2nd clear vesicles; 3rd purple bullae; 4th mummification
464
Q464. ED management of frostbite?
A464. treatment hypothermia; IVF; remove nonadherent wet apparel; rapid thawing thawing in 42C water bath; unroofing clear blisters; aloe vera; tetanus prophy; ibuprofen, ascorbic acid, nifedipine
465
Q465. How to estimate total body surface area for burns..?
A465. 9's; LUE 9%,; LLE 18%,; posterior torso 18%,; head 9%
466
Q466. burn degrees?
A466. 1st superficial epidermis (no blisters, heals w/out scar); 2nd superficial dermis (blisters, scarring in 3 wks...); 3rd all of dermis (charred, painless, scars with contractures)
467
Q467. How do you determine IVF needs in a burn victim?
A467. If TBSA >15%.... 4ml x kg weight x tbsa% = total volume of replacement needed in first 24 hrs
468
Q468. don't forget _________ in frostbite, burns, and a variety of other injuries....?
A468. tetanus prophylaxis
469
Q469. hypothermia defined?
A469. core temp < 35 C
470
Q470. presentation of mild hypothermia?
A470. confusion, lethargy, fatigue, shivering, tachycardia, respiratory alkalosis
471
Q471. resuscitation in severe hypothermia should include _________ in order to treat cardiac dysrhythmias...?
A471. Warming until core temp > 32 C
472
Q472. severe dehydration, thermoregulaory failure, temp >40C, tachycardia, hypotension, confusion, rhabdo...?
A472. Heat stroke
473
Q473. treatment of heat stroke..?
A473. rapid cooling, monitoring, seizure prophylaxis
474
Q474. voltage > _____________ is considered high tension..?
A474. 1000 V
475
Q475. the _________ the resistance, the more the current and damage
A475. less
476
Q476. AC current is ___________ dangerous than DC, because?
A476. more; increased duration of exposure; increased likelihood of Vfib
477
Q477. barotrauma of ascent?
A477. when a diver fails to exhale when ascending, exacerbating the overexpansion of the airspaces
478
Q478. type 1 decompression sickness? type 2?; treatment if severe?
A478. 1 joint, skin, bone problems; 2 neuro, lung, CV problems; Hyperbaric oxygen chamber
479
Q479. what agent can mimic acclimatized state in the treatment of altitude sickness?
A479. Acetazolamide causes a compensatory respiratory alkalosis
480
Q480. most infection prone bite injury?
A480. human bite to the hand
481
Q481. ___________ is implicated in 50% of infected cat bites and 30% of infected dog bites?
A481. Pasteurella
482
Q482. complications of this infection include encephalitis, Painaud's, osteolytic bone lesions, purpura, and erythema nodosum
A482. Bartonella
483
Q483. describe phases of rabies briefly?
A483. Incubation period couple months; Prodrome 1 week of localized pain, malaise, N/V; Acute neuro phase 1 week; Coma up to 2 weeks
484
Q484. Loxosceles spider bite tx?
A484. wound care; antibiotics if superinfected; antihistamines and analgesics; dapsone to prevent ulceration; IV steroids in viscerocutaneous loxoscelism to prevent hemolysis
485
Q485. sudden onset fever, centripetal rash spread, severe HA, myalgia, N/V, and abdominal pain
A485. Rocky mountain spotted fever
486
Q486. treatment of rocky mountain?
A486. teracycline or chloramphenicol; supportive care for shock, DIC, ARDS, CHF
487
Q487. complications of auricular hematoma?
A487. cauliflower ear, cartilage necrosis
488
Q488. pathogens of otitis externa?
A488. pseudomonas and staph
489
Q489. treatment of anterior bleeding epistaxis?
A489. pinching pressure, decongestion, silver nitrate, packing, abx to prevent sinusitis
490
Q490. problem with posterior bleeding epistaxis?
A490. pharyngeally stimulated hypoxia and stopped breathing
491
Q491. ____________ cures >95% of peritonsillar abscesses?
A491. I and D
492
Q492. Ludwig's angina? big concern?
A492. Trench mouth dental origin infection of submandibular space due to horrible hygiene; Concern airway compromise
493
Q493. duck quack cry is characteristic of...?
A493. Retropharyngeal deep space infection
494
Q494. swallowed coins appear ____________ in trachea, _____________ in esophagus?
A494. side on; face on
495
Q495. diagnosis and treatment of esophageal foreign body?
A495. EGD for visualization; glucagon for esophageal relaxation
496
Q496. epiglotitis has traditionally been associated with which infection?
A496. Hemophillus B
497
Q497. diagnosis of epiglotitis?
A497. loss of V shaped dip in neck plain film (valecula sign)
498
Q498. if suspecting epiglotitis in kids....what next?
A498. call ENT or anesthesia no IV's, oral exam, nothing that stimulates/agitates the child
499
Q499. croup? what type of cough?
A499. laryngotracheobronchitis viral infection; seal like barking cough
500
Q500. difference in presentation in kids with croup vs. epiglotitis?
A500. in croup, kids generally appear well
