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Clin Med > Emergency Med > Flashcards

Emergency Med Flashcards

1
Q

NS vs LR: high Cl

A

LR

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2
Q

NS vs LR: non-anion gap metabolic acidosis

A

LR

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3
Q

NS vs LR: lactic acidosis

A

NS

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4
Q

NS vs LR: AKI

A

NS

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5
Q

NS vs LR: hypovolemic hyponatremia

A

NS

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6
Q

dropping the serum Na level >10-12 mEq/<24 hr can lead to ____

A

Osmotic demyelination syndrome
Central pontine myelinolysis (CPM) is a component of osmotic demyelination syndrome (ODS). It is characterized by damage to regions of the brain, most commonly pontine white matter tracts, after rapid correction of metabolic disturbances such as hyponatremia.

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7
Q

to reduce intracerebral pressure, use ____ fluid

A

hypertonic, like mannitol

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8
Q

resuscitation fluid bolus amount

A

30mL/kg

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9
Q

avoid what mask in COPD pts

A

NRB

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10
Q

which induction agent for intubation also provides analgesia?

A

ketamine

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11
Q

which induction agent commonly causes hypotension?

A

propofol

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12
Q

2 main risky SEs of succinylcholine

A

hyperK, malignant hyperthermia

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13
Q

most reliable way to tell if intubation is working

A

Wave form capnography/end tidal capnography

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14
Q

get CXR to confirm that ET tube is _____ above carina

A

5cm

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15
Q

narrow vs wide complex PEA: which is d/t metabolic problems?

A

wide

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16
Q

narrow vs wide complex PEA: which is d/t mechanical problems?

A

narrow

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17
Q

for pt that will need blood transfusion, place __ ______ IVs

A

2 large bore

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18
Q

reverse warfarin w/ ____

A

vitamin K

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19
Q

reverse dabigatran w/ _____

A

idarucizumab (Praxbind)

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20
Q

Tranexamic acid (TXA) can be given w/in first ___ hrs of presentation of hemorrhage

A

3

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21
Q

High Risk Features Spinal Cord Injury:

High speed MVA (>___mph)
* ____ at scene of MVA
* Fall from height (>__ ft)
* Significant closed head injury or ___ on CT
* Neuro S&S
* _____ or multiple extremity fx

A

High speed MVA (>35mph)
* Death at scene of MVA
* Fall from height (>10 ft)
* Significant closed head injury or ICH on CT
* Neuro S&S
* Pelvic or multiple extremity fx

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22
Q

initial test for all pts w/ blunt thoracic trauma

A

CXR

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23
Q

sensitive finding for aortic injury on CXR

A

widened mediastinum

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24
Q

pt w/ blunt thoracic trauma: if 1st test shows widened mediastinum, order ____ if stable, _____ if unstable

A

chest CTA
TEE

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25
Q

BP goal for management of aortic injury

A

100

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26
Q

for aortic injury, emergent consult w/ _____ or _____

A

trauma surgeon
vascular surgeon

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27
Q

definitive imaging for diaphragmatic rupture

A

CT

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28
Q

definitive dx for esophageal rupture

A

Endoscopy or esophagography w/ contrast

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29
Q

best loc for needle thoracostomy

A

5th intercostal space (nipple) in the midaxillary or midclavicular line

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30
Q

in abd trauma, be sure to ask about ______ pain

A

referred

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31
Q

initial imaging for unstable trauma pt

A

eFAST

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32
Q

initial imaging for stable trauma pt

A

eFAST

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33
Q

initial imaging for stable trauma pt is neg. now order ______ (3 options)

A

serial eFAST exams, CT, or observation

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34
Q

initial imaging for stable trauma pt is +. now order ______

A

CT scan

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35
Q

initial imaging for unstable trauma pt is +. next step?

A

OR

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36
Q

initial imaging for unstable trauma pt is neg. now order ______

A

CT

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37
Q

2 MC injured abd organs in abd trauma

A

spleen, liver

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38
Q

fx of sacrum. risk of bladder/GU injury level?

A

low

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39
Q

2 CI for placing foley catheter in presence of pelvic trauma

A

Sign of ureteral injury: blood at urethral meatus, hematuria.
or high risk pelvic fx

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40
Q

initial imaging for unstable pt w/ suspected pelvic fx

A

pelvic xray

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41
Q

main concern in pelvic fx

A

vascular injury / hemorrhage

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42
Q

pt w/ confirmed pelvic fx: immediate consultation w/ _____

A

ortho

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43
Q

dose of fentanyl to start w/ for trauma pt in pain per kg

A

0.5-1mcg/kg

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44
Q

are kids at higher or lower risk of hypoglycemia than adults?

A

higher

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45
Q

preg pt w/ minor abd trauma. do continuous fetal HR mohnitoring if >__________________

A

22-24 wks

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46
Q

ped abd injury. imaging?

A

CT w/ IV contrast

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47
Q

sexual assault pt: you have suspicion of neck/throat injury. order what imagint?

A

CTA of neck

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48
Q

pt in shock can have what acid/base problem?

A

metabolic acidosis (hyperlactinemia)

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49
Q

septic shock is infx + ______

A

organ dysfunction

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50
Q

5 labs to order for suspected sepsis pt w/in 45 min of presentation

A

CBC, CMP, PT/PTT/INR, Serum lactate, blood cultures x2

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51
Q

must start what 2 tx w/in 1st hour of septic pt?

A

IV fluids and abx

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52
Q

quantity and timeframe for IV fluids in initial septic shock pt

A

30mL/kg (start w/in 1 hr, complete w/in 3 hrs). give in 500mL boluses and recheck pt after each

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53
Q

empiric abx for sepsis

A

(zosyn/ carbapenem/ cefepime) + vanc

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54
Q

1st line tx if septic shock pt is still hypotensive despite fluid resus

A

NE

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55
Q

anaphylaxis epi dose for adult 25-50kg

A

0.3mg

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56
Q

anaphylaxis epi dose for adult >50kg

A

0.5mg

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57
Q

anaphylaxis epi dose for ped 10-25kg

A

0.15mg

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58
Q

anaphylaxis epi dose for infant <10kg

A

0.01mg/kg

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59
Q

IVF to give in anaphylactic shock

A

NS

60
Q

what to do w/ anaphylactic pt who had good response to epinephrine in ED

A

observe 4-6 hr

61
Q

what peptide induces angioedema from ACEi? will epi help?

A

bradykinin, no

62
Q

suspect ________ if pt has mechanism of injury that likely would cause brain/spinal cord injury + bradycardia + hypotension

A

neurogenic shock

63
Q

only tx to improve neuro outcomes in spinal cord injury pts

A

methylprednisolone

64
Q

onset timing of TSS

A

rapid, w/in 48 hrs

65
Q

does TSS rash involve palms/soles?

A

yes

66
Q

empiric abx for TSS

A

Vanc + Clindamycin + Zosyn (pip-taz)/cefepime/meropenem

67
Q

will cardiogenic shock have wide or narrow pulse pressure?

A

narrow

68
Q

how many pts w/ orthostatic hypotension have systolic HTN when seated or supine?

A

half

69
Q

test to differentiate between orthostatic hypotension and relfex syncope/vasovagal

A

table tilt

70
Q

reverse eliquis, xarelto w/ _____

A

andexxa/ andexanet alfa

71
Q

EKG finding specific for PE

A

S1Q3T3

72
Q

PE anticoag for pregnant pt

A

LMWH

73
Q

tx for unstable PE

A

tPA

74
Q

compartment syndrome: more likely from closed or open fx?

A

open

75
Q

abx prophylaxis for mild-moderate contamination open fx

A

cefazolin +/- vanc if indicated

76
Q

abx prophylaxis for severe contamination open fx or periosteal stripping

A

gentamicin/ceftriaxone + vanc

77
Q

abx prophylaxis to add if open fx has soil contamination

A

metronizole

78
Q

abx prophylaxis to add if open fx has freshwater contamination

A

zosyn

79
Q

how to determine whether pt w/ open fx needs tetanus booster

A

dirty wound: give if >5 yrs
clean wound: give if >0 yr

80
Q

nursemaid’s elbow happens in kids < ____

A

4 y/o

81
Q

all ped head injuries should be observed for _____ hours

A

4-6

82
Q

imaging for non-low risk ped head injury

A

head CT

83
Q

2 concerning eye sx after concussion that would req further investigation

A

pupilary abnormality, visual field deficits

84
Q

odontoid fx: stable or unstable?

A

unstable, high risk of nonunion

85
Q

Hangman’s fx (b/l fx of C2 pars interarticularis): stable or unstable?

A

unstable

86
Q

Jeferson fx (C1 burst): stable or unstable?

A

extremely unstable

87
Q

burst fx of vertebral body: stable or unstable?

A

typically stable, but risk of neuro deficits if burst fx involves posterior elements

88
Q

vertebral compression fx: stable or unstable?

A

stable

89
Q

initial imaging for facial trauma (except for isolated nasal bone injuries)

A

facial CT w/o contrast

90
Q

in pt w/ nasal bone trauma, must r/o ____ in PE

A

septal hematoma

91
Q

ideal mgmt of displaced nasal bone fx? ok mgmt if outside of that timeframe or not possible

A

reduce immediately or w/in 6 hrs.
refer to ENT for reduction w/in 3-7 days

92
Q

pt w/ midface fx has clear rhinorrhea. suspect fx of _____ and do what to pt position?

A

cribriform plate fx and CSF leak.
elevate head of bed to 40-60 degrees and allow leak to seal

93
Q

pt w/ Epiphora (excessive tearing), photophobia, reluctance to open eye. what part of eye was probably injured?

A

cornea

94
Q

do superficial burns blanch w/ pressure?

A

yes

95
Q

do superficial partial thickness burns blanch w/ pressure?

A

yes

96
Q

do deep partial thickness burns blanch w/ pressure?

A

no

97
Q

superficial burns heal in ___ to __ days

A

4-6

98
Q

superficial partial thickness burns heal in _____

A

1-3 wks

99
Q

deep partial thickness burns heal in _____

A

2-9 wks

100
Q

deep partial thickness burns have pain w/ ______ only

A

pressure

101
Q

adult pt’s full hand is ____% TBSA. Just palm is ____%TBSA

A

1%, 0.5%

102
Q

burns >___% TBSA need to go to burn center

A

10

103
Q

fluid to use in electrical burns

A

NS

104
Q

fluid to use in thermal burns

A

LR

105
Q

parkland formula for burns and timeframe

A

4ml x TBSA (%) x body weight (kg)
* 50% in first 8 hrs
* 50% in next 16 hrs

106
Q

lab test for suspected CO poisoning

A

carboxyhemoglobin

107
Q

burn pt: you suspect inhalation injuries. order what additional 3 tests?

A

ABG, EKG, CXR

108
Q

if planning to transfer pt to burn center, cover burns w/ ____ gauze

A

dry

109
Q

how long does SJS/TEN last?

A

8-12 days

110
Q

MC meds causing SJS/TEN (2 names, 2 classes)

A

ABOA: allopurinol, bactrim, oxicams, anticonvulsants

111
Q

SJS starts on ___ and ____

A

face, thorax

112
Q

rash suspicious for SJS, ask about/look at ____ and ____ (body areas)

A

eyes ( Most cases, severe conjunctivitis w/ purulent discharge), mouth

113
Q

difference between Erythema multiforme major and minor

A

Erythema multiforme major = severe mucosal involvement
* Erythema multiforme minor = w/o/very mild mucosal involvement

114
Q

expected acid base abnormalities in cyanide poisoning

A

Anion gap metabolic acidosis
o Lactic acidosis

115
Q

tx for cyanide poisoning

A

Antidotal tx = Hydroxocobalamin (Cyanokit)
§ Often in combo w/ sodium thiosulfate

116
Q

tx for a recently hospitalised pt w/ DM back w/ non-purulent cellulitis

A

IV vanc - prob 10-14days

117
Q

tx for pt w/ cellulitis and multiple abscesses who is otherwise healthy

A

PO bactrim

118
Q

tx for pt w/ non-purulent cellulitis near a prosthetic joint. no MRSA RF and otherwise healthy

A

IV cefazolin

119
Q

onset of nec fasc

A

w/in hours

120
Q

abx for nec fasciitis

A

(carbapenem OR zosyn) + vanc + clinda

121
Q

superficial animal bite on hand. close or not? abx or not?

A

don’t close
give augmentin bc on hand

122
Q

small but deep puncture bite on forearm. close or not? abx or not?

A

don’t close
give augmentin bc deep

123
Q

small laceration from cat bite on L cheek that happened 2 hours ago. close or not? abx or not?

A

close loosely bc on face
augmentin bc on face and bc closing

124
Q

superficial bite on middle posterior calf. close or not? abx or not?

A

don’t close
no abx unless close to bone

125
Q

otherwise healthy pt has abrasion on anterior thigh from kayaking in a lake. abx or not?

A

no

126
Q

otherwise healthy pt is bleeding from ripped off toenail while playing in a river. abx?

A

yes bc on foot. keflex + levofloxacin

127
Q

in addition to normal labs, order what 4 for suspected acute toxidrome?

A

acetaminophen, salicylate, and alcohol levels. glucose. UDS can be ordered but isn/t super helpful. preg test if F

128
Q

chemical restraint med for pt intoxicated w/ CNS depressant

A

haldol

129
Q

chemical restraint med for pt w/ known psychosis or psych d/o

A

Olanzapine or Ziprasidone (Haldol if
unavailable)

130
Q

does cocaine cause myosis or mydriasis?

A

mydriasis

131
Q

pt w/ severe acute alcohol intoxication has hypoglycemia. give ____ before giving glucose

A

thiamine

132
Q

key PE finding in serotonin syndrome besides elevated everthing

A

clonus / hyperreflexia

133
Q

dialysis pt w/ hyperK is in arhythmia. give ____ immediately

A

Ca gluconate

134
Q

What classic chest radiograph finding is indicative of pulmonary edema due to CHF?

A

kerley B lines

135
Q

most effective cooling measures for pt w/ heat stroke

A

evaporative (spray w/ cool water and place under fans)

136
Q

should you give antipyretics in heat stroke?

A

no

137
Q

tetrad of neuroleptic malignant syndrome

A

Tetrad: hyperthermia + rigidity + AMS + autonomic instability (tachy, labile BP etc)

138
Q

2 meds for neuroleptic malignant syndrome

A

lorazepam, dantrolene

139
Q

1st sign of malignant hyperthermia

A

1st sign: Hypercarbia
o ↑ end tidal CO2

140
Q

hypothermia = temp of <___

A

35C

141
Q

should you put ice on a snakebite?

A

no

142
Q

should you elevate a snake bite?

A

yes

143
Q

thyroid storm must have _____ for dx

A

AMS

144
Q

adrenal crisis occurs d/t ______ deficiency

A

cortisol

145
Q

what imaging can definitively clear C spine after trauma in pts of all ages?

A

MRI

146
Q

reversal agent for BB toxicity

A

glucagon

Clin Med (14 decks)

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