Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clerkship > Emergency Medicine > Flashcards

Emergency Medicine Flashcards

1
Q

Chest pain with neurologic symptoms is what until proven otherwise?

A

aortic dissection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the main purpose of CT head with suspected stroke?

A

rule out hemorrhagic stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Headache red flags?

A

meningismus, fever, n/v - meningitis
thundercap onset - SAH
… many

Elderly
Fever or immunocompromised (HIV/AIDS, Cancer)
Trauma
New onset, sudden onset, worst at onset
Neurological findings
Progressive headache
Jaw claudication, muscle aches, temporal artery pain (PMR/GCA)
Multiple patients with headache (CO toxicity)
Eye pain (acute angle closure glaucoma)
Pregnancy or post pregnancy (eclampsia)
Clotting disorder (primary or acquired)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Acute onset severe headache is what until proven otherwise?

Timeline: do what imaging or what test depending on time from headache onset…

A
  • subarachnoid hemorrhage
  • head CT if <6h from headache onset
  • if greater than 6h, do LP
  • or if CT head negative and you are still suspicious, do LP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Young person with syncope is what until proven otherwise?

Other thing you should always think about? hint.. young female

A

Cardiac cause - HCM, arrythmia..
- Always ask about history of sudden cardiac death in the family

Pulmonary embolism, ruptured ectopic (they’d probably have abdo pain though)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Every female between age 8-80 is _____ until proven otherwise

A

pregnant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Every pregnancy is _______ until proven otherwise

A

ectopic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

A new LBBB is what until proven otherwise

A

Acute MI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the FiO2 delivered with non-rebreather mask?

A

near 100%

Good seal and running 10-15L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Threshold for transfusion in the absence of acute bleeding?

A

70 g/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Important info you get with ABG/VBG - gases just counts for one, name 4 others

A

pH
lactate
hgb
lytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What physical exam do you do for all patients with headache?

bonus: run through the exam

A

Full neuro

CN
strength and sensation x4
gait and coordination
tone and reflexes
rhomberg and pronator drift
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Typical treatment for a headache in ER?

A

Rule out dangerous causes, red flags

Consider fluid bolus
Analgesic - tylenol, NSAIDs (maybe toradol IM/IV)
Dopamine antagonists
- prochlorperazine (Compazine), metoclopramide, haloperidol (Haldol)
- maybe diphenhydramine or benztropine for EPS
Steroids to prevent rebound headache
- dexamethasome

Advise GP for abortive strategies or possible neuro consult for ++ frequency migraines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the purpose of the Wells and PERC scores?

A

When you suspect PE
Use Wells PE criteria to estimate pretest probability
- if low PTP, use PERC to “rule out” VTE in patients with low pretest probability
- if moderate PTP, get D-dimer, if pos, CTPE
- if high PTP, straight to CTPE b/c just a negative d-dimer would no be sensitive enough to rule OUT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

ECG findings of PE

Hint: think through approach - rate, rhythm, axis, intervals, ischemia/infarct…

A
  1. Sinus tachycardia – the most common abnormality (seen in 44% of patients with PE)

Right ventricular strain pattern – T wave inversions in the right precordial leads (V1-4) ± the inferior leads (II, III, aVF). - This pattern is associated with high pulmonary artery pressures (34%)… so pretty massive PE

SI QIII TIII pattern – deep S wave in lead I, Q wave in III, inverted T wave in III (20%)

Non-specific ST segment and T wave changes, including ST elevation and depression (50%)

Right axis deviation (16%) - look at I, II, aVF

RBBB (18%) - bunny ears in V1/2

Dominant R wave in V1 – a manifestation of acute right ventricular dilatation

Peaked P wave in lead II > 2.5 mm in height (9%) - sign of right atrial enlargement (P pulmonale)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

60 yo male with history of renal colic with right flank pain. He thinks he passed a stone. Pain has resolved. What ddx should you think about before letting him go?

A

AAA +/- rupture
- mortality about 50%

Consult vascular surgery for OR or an ICU

17
Q

What tendon attaches to the base of the 5th metatarsal?

A

peronius brevis

18
Q

You want to give morphine to your patient. Nurse asks if there is any dose adjustment for IM vs SC vs IV?

A

Nope, same same

19
Q

Patient has abdo pain and fever, what test should you think of? You’ll probably start abx.

A

blood cultures

20
Q

Patient has air under the diaphragm. You’re going to start abx. Thinking pip-tazo.

?normal and renal dosing for pip-tazo

A
  1. 5 g

3. 375 g renal dose

21
Q

Person with lots of vascular risk factors with acute onset diffuse abdo pain. Benign abdo on palpation. What dx must be on your ddx?

A

mesenteric ischemia

22
Q

Patient with lots of vascular risk factors (DLD, HTN, DM, afib) with acute onset 8/10 but diffuse abdo pain. Benign abdo on palpation.
What dx must be on your ddx?
RF?
Gold standard test?

A

Mesenteric ischemia

RF: afib, recent MI (for the most common mes. art. embolism 50% of cases)

Bloody diarrhea is a late finding after bowel has infarcted

CTA abdo/pelvis (Labs consider lactate and d-dimer but generally labs not sens or spec.; late findings on AXR - pneumatosis)

23
Q

What are the four causes of mesenteric ischemia

bonus: common pathophys for each

A
  1. mesenteric artery embolism (commonly due to atrial fibrillation)
  2. mesenteric artery thrombosis (commonly due to atherosclerosis)
  3. mesenteric vein thrombosis (commonly due to hypercoagulability)
  4. non-occlusive mesenteric ischemia, aka abdominal angina, (commonly due to low flow states, eg low CO, sepsis)
24
Q

Two genetic hypercoagulable states?

A

Factor V Leiden, Protein C deficiency

25
Q

Classic presentation of appendicitis?

Hx, exam, vitals, labs

A 
Vague epigastric or periumbilical pain. 
Nausea, vomiting and anorexia.
Abdominal tenderness, migrating and then localizing to the right lower quadrant.
Fever
Leukocytosis
26
Q

Initial managment for an appendicitis patient?

A

consider fluids, antiemetic, pain management

27
Q

What 3 patient groups would be more likely to have atypical presentation of appendicitis?

A

Atypical presentations can occur in any patient, but more are more likely in:

  1. extremes of age (immunosupr - subtle signs, no WBC)
  2. pregnant patients
  3. children (<4yo perforation rates can be as high as 90%)
28
Q

Abdominal pain in female vs male, should always think about?

Name 3 of these urgent ddx for female.

A

male - torsion

female - gyne or obstetrical issues (ovarian torsion, tubo-ovarian abcesses, ectopic)

29
Q

What ballpark % of patients with appendicitis will have a normal WBC count?

Use in conjunction with what other marker?

A

10-20%

CRP - Both an elevated CRP and WBC have a combined sensitivity of 98%, and if both labs are within normal limits the diagnosis is less likely

30
Q

Your patient with abdo pain (appendicitis high on the ddx), also has pyuria (from your appropriate and complete initial testing in which you included a UA, good job).
Why might this be?
Should you chalk it up to UTI and discharge them?

A

No.

Pyuria without bacteria present can be cause by inflamed appendix in close proximity to the ureter or bladder.

31
Q

empiric abx for uncomplicated appendicitis?

why is this a trick question…

A

Empiric therapy (ie. treating the organisms) not indicated. Surgical prophylaxis however IS indicated if getting surgery.. cefazolin 2g IV

32
Q

what makes someone a complicated appendicitis (3)?

empiric abx for complicated appendicitis?

A

perforation, abscess, truly immunocompromised

mild-moderate: ceftr + metro
severe: pip-tazo (4.5g or 3.375 renal dosing)

33
Q

Consider US as first line for appendicitis for what two patient populations? Plus probably one more.

A

children
pregnant
young people generally..

34
Q

Give 3 reasons why CT is the gold standard for appendicitis?

A
  1. more sens/spec than US
  2. evaluating alternative diagnoses
  3. diagnosing complications of appendicitis (perforation, abscess, etc.)
35
Q

What type of CT is gold standard for appendicitis:
location?
contrast?

A

CT abdo/pelvis

CT with contrast is best
CT without contrast still used (still excellent specificity, accommodate renal issues, allergy, and just faster than with contrast)

Clerkship (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions