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USMLE Step 2 CK > Emergency Medicine > Flashcards

Emergency Medicine Flashcards

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USMLE® Step 1 flashcards
1
Q

when can gastric lavage be done for OD

A

if within 2 hrs and it is NOT caustic, acetaminophen, or altered mental status

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2
Q

what is whole bowel irrigation good for

A

iron, Li, drug smuggling - usually WRONG answer

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3
Q

is charcoal dangerous

A

no

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4
Q

next best step in altered mental status of unclear etiology

A

naloxone and glucose

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5
Q

alcoholism increases/decreases the amount of aceaminophen to cause toxicity

A

decreases

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6
Q

next step, >8-10g of aceteminophen injested

A

N-acetylcystein

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7
Q

next step, acetaminophen OD >24 hrs ago

A

no tx

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8
Q

next step, unknown amount of acetaminophen injested

A

drug level

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9
Q

N-acteylcysteine given for acetaminophen OD, can you give charcoal

A

yes, not contraindicated, does not make N-acetylcysteine ineffective

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10
Q

Tinnitus, hyperventilation, Renal toxicity and altered mental status

A

aspirin OD

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11
Q

blood gasses in aspirin OD

A

respiratory alkalosis (low pCO2) → metabolic acidosis (low bicarb). metabolic acidosis from lactate

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12
Q

tx of aspirin OD

A

alkalinize urine (sodium bicarb) to increase rate of aspirin excretion

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13
Q

drug that can prevent seizures from TCA toxicity

A

Benzos, so if coinjested dont give flumazenil!

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14
Q

next step, suspected TCA OD

A

EKG (widening of QRS –> torsades)

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15
Q

tx of TCA OD

A

sodium bicarb (protects heart against arrhythmia does not increase urinary excretion)

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16
Q

most common cause of death in fires

A

carbon monoxide poisoning

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17
Q

Dyspnea, lightheaded, confused, seizures → death from MI

A

carbon monoxide poisoning

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18
Q

blood gases in CO poisoning

A

Normal pO2, lactic acidosis (low bicarb, low pH)

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19
Q

most accurate test for CO poisoning

A

level of carboxyhemoglobin

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20
Q

best initial tx for CO poisoning

A

remove from exposure, give 100% O2, hyperbaric O2 if severe

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21
Q

drugs that can cause methemoglobinemia

A

benzocaine, other anesthetics, nitrites, nitroglycerin, dapsone

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22
Q

cyanosis + normal pO2

A

methemoglobinemia

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23
Q

blood gases in methemoglobinemia

A

Normal pO2, Metabolic acidosis

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24
Q

most accurate test for methemoglobinemia

A

methemoglobin level

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25
Q

best initial tx for methemoglobinemia

A

100% O2

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26
Q

most effective tx for methemoglobinemia

A

methylene blue

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27
Q

MOA of nerve gas

A

increase level of acetylcholine by inhibiting its metabolism

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28
Q

MOA of atropine

A

blocks effects of acetylcholine that is already increased in body

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29
Q

tx of organophosphate toxicity

A

atropine

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30
Q

MOA of pralidoxime

A

reactives acetylcholinesterase, takes longer than atropine to work

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31
Q

what predisposes to digoxin toxicity

A

hypokalemia

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32
Q

GI (N/V, abdominal pain), hyperkalemia, confusion, yellow halos, rhythm disturbances

A

digoxin toxicity

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33
Q

most accurate test for digoxin toxicity

A

digoxin level

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34
Q

best initial test for digoxin toxicity

A

K level and EKG (downsloping of ST in all leads)

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35
Q

tx for digoxin toxicity

A

control K and digoxin specific antibodies

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36
Q

Abdominal pain, acute tubular necrosis, sideroblastic anemia, peripheral neuropathies (wrist drop), CNS (memory loss, confusion)

A

lead poisoning

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37
Q

most accurate test for lead poisoning

A

lead level

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38
Q

best initial test for lead poisoning

A

increased level of free erythrocyte protoporphyrin

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39
Q

tx of lead poisoning

A

chelators (succimer is oral, EDTA and BAL are parenteral)

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40
Q

mercury ingestion causes

A

neurologic problems (nervous, twitchy, jittery, hallucinations)

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41
Q

mercury inhalation causes

A

lung toxicity → pulmonary fibrosis

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42
Q

tx of mercury exposure

A

chelators (dimercaprol and succimer)

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43
Q

Wood alcohol, cleaning solutions, paint thinner toxicant

A

methanol

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44
Q

antifreeze intoxicant

A

ethylene glycol

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45
Q

methanol toxic byproduct

A

formic acid

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46
Q

ethylene glycol toxic byproduct

A

oxalic acid

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47
Q

toxicity of methanol

A

ototoxicity

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48
Q

toxicity of ethylene glycol

A

renal toxicity

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49
Q

envelope shaped crystals in urine indicate

A

ethylene glycol intoxication

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50
Q

best initial therapy for methanol intoxication

A

fomepizole + dialysis

51
Q

best initial therapy for ethylene glycol intoxication

A

fomepizole + dialysis

52
Q

osmolar gap is seen in

A

alcohol intoxication

53
Q

Serum osmolality =

A

2xNa + BUN/2.8 + glucose/18

54
Q

hemolytic toxin in snake venom causes

A

hemolysis and DIC

55
Q

neurotoxin in snake venom causes

A

respiratory paralysis

56
Q

most common injury in snake bite

A

local injury from proteases and lipases in venom

57
Q

Sudden sharp pain, Abdominal pain, muscle pain, Hypocalcemia

A

black widow bite

58
Q

tx for black widow bite

A

calcium and antivenom

59
Q

sudden sharp pain, local skin necrosis, bullae, blebs

A

brown recluse bite

60
Q

tx for brown recluse bite

A

debridement, steroids, dapsone

61
Q

antiobiotic tx for animal bites

A

amoxicillin/clavulanate

62
Q

venous, crescent shaped bleed on CT

A

subdural hematoma

63
Q

arterial, biconvex bleed on CT

A

epidural hematoma

64
Q

which hematoma is more likely d/t skull fracture

A

epidural hematoma

65
Q

tx for large brain hematomas

A

intubation, hyperventilation, mannitol, drainage

66
Q

MOA of hyperventilation for head trauma

A

decreases pCO2

67
Q

MOA for mannitol in head trauma

A

decreases intravascular volume

68
Q

stress ulcer prophylaxis is indicated in

A

Head trauma, burns, endotracheal intubation, coagulopathy with respiratory failure

69
Q

prevents stroke after subarachnoid hemorrhage

A

nimodipine

70
Q

is there a benefit of steroids in intracranial bleeding

A

no

71
Q

best initial tx for burns

A

100% O2

72
Q

intubate after burn if

A

stridor, hoarseness, wheezing, burns inside nasopharynx or mouth

73
Q

fluid replacement after burn

A

Ringers lactate
Replacement = 4ml * %BSA * weight (kg)
Give ½ in 1st 8 hrs, ¼ in next 8 hrs, then ¼ in 3rd 8 hrs

74
Q

prophylactic topical antibiotic for burns

A

silver sulfdiazine

75
Q

From exertion in heat. Normal body temp, CPK, and K

A

heat exhaustion

76
Q

tx of heat exhaustion

A

oral fluids and electrolytes

77
Q

From exertion in heat. Elevated temp, CPK and K

A

heat stroke

78
Q

tx for heat stroke

A

IV fluids and evaporation cooling

79
Q

From antipsychotic meds. Elevated temp, CPK and K

A

NMS

80
Q

tx for NMS

A

dantrolene or dopamine agonists (bromocriptine, cabergoline)

81
Q

From anesthetics administed systemiccaly. Elevated temp, CPK and K

A

malignant hyperthermia

82
Q

tx for malignant hyperthermia

A

dantrolene

83
Q

most common cause of death from hypothermia

A

cardiac arrhythmia

84
Q

best initial step in hypothermia

A

EKG (J pt elevation)

85
Q

tx of near drowning

A

airway with positive pressure ventilation

86
Q

what type of drowning causes wet lungs (CHF like)

A

salt water

87
Q

what type of drowning causes hemolysis

A

fresh water

88
Q

when is precordial thump indicated

A

if witnessed (<10 mins) and no defibrillator

89
Q

best initial management in pulselessness

A

CPR

90
Q

tx of asystole

A

CPR< epinephrine, vasopressin

91
Q

unsynchronized cardioversion is only used for

A

V fib and T tach

92
Q

tx for V fib

A

unsynchronized cardioversion, amiodarone (then lidocaine)

93
Q

bretyllium is right when

A

NEVER

94
Q

tx of V tach and hemodynamically stable

A

amiodarone → lidocaine → procainamide → cardioversion

95
Q

tx of V tach and hemodynamically unstable

A

cardioversion → meds

96
Q

direct intracardiac meds are used

A

NEVER

97
Q

normal EKG but no pulse

A

PEA

98
Q

sawtooth pattern on EKG

A

A flutter

99
Q

tx of A flutter and hemodynamically unstable

A

synchronized cardioversion

100
Q

tx of atrial fib/flutter

A

control rate (beta blocker, CCB, digoxin) to <100, then anticoagulate (warfarin, dabigatran, rivaroxaban)

101
Q

what should be done before cardioversion in chronic a fib

A

anticoagulate

102
Q

anticoagulant that does not need INR monitoring

A

dabigatran

103
Q

atrial rhythm problems cause

A

acute pulmonary edema

104
Q

CHADS stands for

A

CHF or cardiomyopathy, HTN, Age >75, DM, Stroke or TIA (=2 pts)

105
Q

if CHADS <1

A

give aspirin

106
Q

if CHADS 2+

A

warfarin, dabigatran, rivaroxaban

107
Q

best initial tx for SVT

A

vagal maneuvers, adenosine, BB (metoprolol), CCB (diltiazem) or digoxin

108
Q

SVT alternating with V tach

A

WPW

109
Q

SVT worsens after diltiazem or digoxin

A

WPW

110
Q

delta wave on EKG

A

WPW

111
Q

acute tx for WPW

A

procainamide or amiodarone

112
Q

most accurate test for WPW

A

cardiac electrophysiology (EP) studies

113
Q

chronic tx for WPW

A

radiofrequency catheter ablation (curative). EP tells you where anatomic defect is

114
Q

avoid what drug in MAT

A

beta blockers

115
Q

what drugs are dangerous in WPW

A

digoxin and CCB

116
Q

MAT is associated with what condition

A

lung disease (COPD)

117
Q

Isoproterenol is right when

A

NEVER

118
Q

asymptomatic bradycardia tx

A

none, but don’t forget to do EKG

119
Q

best initial tx for symptomatic bradycardia

A

atropine

120
Q

most effective tx for symptomatic bradycardia

A

pacemaker

121
Q

which type of AV block is a sign of normal aging

A

Mobitz I (wenckeback)

122
Q

tx for asymptomatic mobitz I

A

none

123
Q

tx for mobitz II

A

pacemaker

124
Q

progressively lengthening PR on EKG then dropped beat

A

mobitz I (wenckeback)

USMLE Step 2 CK (11 decks)

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