Emergency Medicine Flashcards
What is the 1st line treatment for minor bleeding in a patient with von Willebrand disease?
Desmopressin
What are the 3 types of definitive airways?
Orotracheal tube
Nasotracheal tube
Surgical airway (cricothyrotomy/tracheostomy)
Which nerve is most likely to be injured when the arm is hyperextended?
T1 of the brachial plexus
What is the T1 nerve root motor function?
Finger abduction
Finger adduction
Thumb opposition
Wrist flexion
What is the T1 nerve root sensory function?
Sensation to the ulnar aspect of the forearm
What are the 4 causes of postpartum hemorrhage?
4 T’s
Uterine atony (most common)
Trauma to birth canal
Retention of fetal or placental tissue
Coagulopathy or thrombin disorder
What is 1st line treatment for a patient that presents with symptoms of alcohol withdrawal?
Benzos or phenobarbital
Generally speaking, what is the 1st line PO treatment of uncomplicated pyelonephritis?
Ceftriaxone
What are the signs/symptoms of serotonin syndrome?
History of taking multiple meds that increase serotonin (SSRI, SNRI, TCA)
Mental status changes
Autonomic instability (tachy, diaphoresis, diarrhea)
Neuromuscular abnormalities (clonus, tremor, seizure)
What is the treatment for serotonin syndrome?
Benzos
Cyproheptadine
Remove the offending agent
What is a greenstick fracture and how do you manage it?
A bone that is bent with a fracture line that does not extend completely through the width of the bone
Immobilization and casting
What are the Ottawa foot and ankle rules?
Rules to x-ray a foot/ankle if:
Pt cannot bear weight for 4 steps
Distal 6 cm of tibia or fibula is tender
Medial or lateral malleolus is tender
5th metatarsal is tender
Navicular bone is tender
What are signs/symptoms of a lisfranc injury?
Hx of MVC, fall, playing sports
Severe foot pain & inability to bear weight
Tenderness of the tarsometatarsal joint
What is the most common cause of osteomyelitis in children?
Staphylococcus aureus
What organisms commonly lead to sepsis in asplenic patients?
Strep pneumo
N. meningitidis
H. flu
What is the treatment for a cat bite?
Irrigate the wound
Leave the wound open
Treat w/Augmentin
What are the signs/symptoms of mitral valve prolapse?
Palpitations
Dyspnea
Non-exertional chest pain
Fatigue
Midsystolic click & late systolic murmur
What maneuvers increase preload or afterload that move a midsystolic click to a later systolic click?
Squatting (increase preload)
Afterload (hand grip)
Which nerve root is most commonly affected when a pt presents with pain that radiates down the posterior arm to the dorsum of the forearm & 3rd digit (cervical radiculopathy)?
C7
What are the signs/symptoms of osteoarthritis?
Joint pain & stiffness (knees, hips, DIP)
Pain that is worse with activity & better with rest
Swelling, deformity, crepitus, decreased ROM
Joint space narrowing and osteophytes (on x-ray)
What is considered a hypertensive emergency?
Elevated BP (systolic > 180 or > 120 diastolic) with concomitant end-organ damage
What is the treatment for hypertensive emergency?
IV antihypertensives (labetalol or nicardipine)
If with pulmonary edema, vasodilators (nitrates)
What are the signs/symptoms of transient aplastic crisis?
May have sickle cell, iron deficiency anemia, or hereditary spherocytosis
Pallor, fatigue, lethargy, SOB
Low or undetectable reticulocyte count
What is the most common cause of transient aplastic crisis and what is the treatment?
Parovirus B19
Self-limited, transfusion support
What is the most common post-partum infection?
Endometritis
What are the signs/symptoms and the treatment for endometritis?
Sxs: may have hx of c-section, abdominal pain, fever, foul smelling lochia
Tx: clindamycin + gentamicin (add ampicillin if GBS)
What is the most common ankle injury and how does it occur?
Lateral ankle sprain
Occurs when plantar flexed foot is inverted
ST elevations on EKG based on occlusion site
Anterior: V1 thru V4
Inferior: II, III, aVF
Lateral: I, aVL, V5, V6
Posterior: depressions in V1 thru V3 & elevations in V8 & V9
What presents with dyspnea on exertion, syncope, and chest pain and also has a harsh crescendo-decrescendo systolic murmur that increases in intensity with Valsalva maneuver and decreases with squatting?
Hypertrophic cardiomyopathy
What is the Parkland formula?
Calculation for fluid resuscitation for burn patients
4mL x total body surface area of burns (%) x body weight (kg)
1st half given over 8 hrs, 2nd half given over 16 hours
What is the rule of 9’s?
Burn % based on body part
Head: 9%
Torso front: 18%
Torso back: 18%
Each arm: 9%
Each leg: 18%
Genitals: 1%
Palm: 0.5%
All fingers: 1%
What is a common presentation/signs of an epidural hematoma?
Head injury with loss of consciousness followed by lucid interval and then rapid cognitive decline
Biconvex opacity on CT (lens shaped)
Usually from middle meningeal artery
What are the EKG findings in a pt suspected of having pericarditis?
PR depression
PR elevation in aVR
Diffuse ST segment elevation
What is the treatment for pericarditis?
NSAIDs
Colchicine
What sound is heard in a pt with aortic regurgitation?
Diastolic blowing murmur best heard at the left sternal border
What are the signs/symptoms of a subarachnoid hemorrhage?
Worst headache of their life or thunderclap headache
Blood in Circle of Willis and/or fissures on CT
What is the most commonly affected vessel in an ischemic stroke?
Middle cerebral artery (MCA)
What are the signs/symptoms of a middle cerebral artery ischemic stroke?
Contralateral paralysis
Aphasia
What is a P2Y12 inhibitor?
Antiplatelet (clopidogrel)
Commonly used in acute coronary syndrome management
What are the signs/symptoms of mitral stenosis?
Hx of rheumatic heart disease
Exertional dyspnea, hemoptysis
Mid-diastolic rumbling best heard at apex (does not radiate)
What are the signs/symptoms of hyperthyroidism?
Heat intolerance, anxiety, weight loss
Exophthalmos, pretibial edema
Low TSH, high free T4
Treat with methimazole or PTU
*PTU in the 1st trimester of pregnancy
If a pt presents with hypotension and you suspect septic shock due to a plethoric IVC on ultrasound, what is the best management?
Start vasopressors (norepinephrine)
What EKG changes are seen in a pt with a pulmonary embolism?
S1, Q3, T3
S wave in lead I
Q wave in lead III
Flipped T wave in lead III
What EKG changes are seen in a left bundle branch block?
Wide QRS complex
Large R wave in lead I
Negative wave in lead V1
What lab values would you see in a patient with disseminated intravascular coagulation (DIC)?
Thrombocytopenia
Decreased fibrinogen
Increased fibrin split products
Increased bleeding time
Increased PT & PTT
What are the characteristics of pheochromocytoma?
Catecholamine-secreting tumor of adrenal gland
Sx: diaphoresis, tremors, vision changes
PE: hypertension
Dx: increased 24hr urinary catecholamines & metanephrines or increased serum metanephrines
Tx: alpha blocker (phentolamine, phenoxybenzamine)
What is a Trousseau sign?
Carpal spasm produced when the examiner applies a blood pressure cuff to the upper arm and maintains a pressure above systolic for 2–3 minutes
Commonly seen in hypocalcemia
What are the signs/symptoms of a migraine and what is the treatment?
Gradual onset, unilateral, throbbing
Abortive tx: triptans, DHE, NSAIDs, antiemetics
Prophylaxis: TCAs, beta blockers, anticonvulsants (topiramate), CCBs
Avoid triptans with uncontrolled HTN
What is anterior cord syndrome?
An incomplete spinal cord syndrome caused by hyperflexion of the spine or thrombosis of the anterior spinal artery
What are the signs/symptoms of anterior cord syndrome?
Direct or indirect injury
Loss of motor function below lesion
Loss of pain & temp below lesion
Does NOT lose proprioception (position) or vibration
What is the first-line pharmacotherapy for treating a patient with bulimia nervosa?
Fluoxetine
What are the signs/symptoms of bacterial endocarditis?
FROM JANE
Fever
Roth spots
Osler nodes
Murmur
Janeway lesions
Anemia
Nail bed hemorrhages
Emboli
What valve is most commonly affected by bacterial endocarditis in IV drug users?
Tricuspid
What would you see on a chest x-ray in a pt with reactivation of latent pulmonary tuberculosis?
Apical-posterior upper lobe infiltrate
What are the characteristics of Myasthenia Gravis?
Autoantibodies to nicotinic acetylcholine receptors resulting in impaired transmission at the neuromuscular junction
Ocular or generalized weakness that is worse at the end of the day or after exertion, ptosis & diplopia
Ice to eyelids improves diplopia
Treat with pyridostigmine
What is the treatment for balanitis?
Topical clotrimazole cream
What is responsible for most cases of embolic occlusion?
A fib
What is the initial therapy for acute uncomplicated cystitis?
Bactrim or
Nitrofurantoin
What are the signs/symptoms of primary immune thrombocytopenia (formerly ITP)?
Can present for 1st time in kids age 2-6
Hx of recent viral illness
Non-blanching petechiae/purpura, gingival bleeding
Platelets < 100,000/µL, normal WBC, normal hematocrit
What are the signs/symptoms of acute angle-closure glaucoma?
Acute unilateral pain and vision loss, headache, vomiting, and seeing halos around lights
Cloudy cornea and fixed mid-dilated pupil
What is the treatment for acute angle-closure glaucoma?
Emergent ophthalmology evaluation
Topical beta-blockers (timolol), topical alpha-agonists (apraclonidine), carbonic anhydrase inhibitors (acetazolamide)
Iridotomy (definitive tx)
What EKG changes are seen in Wellen’s syndrome?
Deeply inverted or biphasic T waves in V2-3, which is highly specific for critical stenosis of the left anterior descending artery
What is Charcot’s triad?
Symptoms of acute cholangitis
Pain in the RUQ, fever, & jaundice
What are the signs/symptoms of anticholinergic toxidrome?
Hot as a hare (hyperthermia)
Blind as a bat (mydriasis)
Red as a beet (flushed skin)
Mad as a hatter (altered mental status/agitation)
How do you treat anticholinergic toxidrome?
Physostigmine (antidote)
Benzos
Supportive care
What presents with the classic triad of palpable purpura, abdominal pain, and arthritis and usually a preceding upper respiratory tract infection?
HSP
What are decreased cortisol and increased ACTH levels following administration of ACTH indicative of?
Primary adrenal insufficiency (ex Addison’s)
What are the signs/symptoms of tumor lysis syndrome (TLS)?
3-7 days post starting chemo
Hyperuricemia
Hyperkalemia
Hyperphosphatemia
Hypocalcemia
What is the cornerstone of treatment/prevention of tumor lysis syndrome?
Aggressive IV hydration
Guillain-Barré syndrome (GBS) is commonly associated with what bacteria?
Campylobacter jejuni
What are the signs/symptoms of Guillain-Barre syndrome?
Symmetric ascending paralysis
Areflexia
1-6 weeks after illness (or flu vaccine)
Elevated levels of creatinine kinase are often associated with what?
Rhabdo
What is the initial management of a pt with hypertrophic cardiomyopathy?
Avoid exertion
Beta blocker (metoprolol)
What is the treatment for severe Lyme carditis?
IV ceftriaxone
What is both diagnostic and therapeutic in a suspected ectopic pregnancy?
Laparoscopy
What is the definitive test for a pt suspected of having orbital cellulitis?
CT scan of the orbits
What are the most common causes of hypercalcemia?
Primary hyperparathyroidism
Malignancy
What EKG changes are seen in a pt with hypercalcemia?
Shortened QT interval
If there is suspicion for SAH despite a negative CT scan or if the time frame suggests a CT may not be as accurate, what is the test of choice?
Lumbar puncture
What is the initial treatment for an acute asthma exacerbation?
Short-acting beta-agonist nebulizers
Corticosteroids
What is the cause and treatment of histoplasmosis?
Cause: endemic areas, bird or bat droppings
Tx: itraconazole and amphotericin for severe disease
Along with a surgical consultation, what medication should be started in a pt with acute limb aschemia?
Unfractionated heparin
What is the initial treatment for a hemodynamically stable patient with a pulmonary contusion?
Pain control and pulmonary hygiene
Stable pts who are found to have a viral meningitis and are neurologically intact are treated with what?
Supportive care
What is a result of repeated hyperextension injury that is common in athletes who play soccer?
Spondylolysis
Physical examination that shows purulent conjunctivitis, blisters and ulcerations on the lips and in the mouth, and an erythematous, blistering rash on the trunk with recent exposure to a sulfa medication should make you suspect what diagnosis?
SJS
What is the treatment for SJS?
Stop offending agent
Supportive care (may need burn unit)
Fluid replacement
What is the mainstay of treatment in the emergency department for an acute exacerbation of MS?
IV corticosteroids
What are the signs/symptoms of an acute exacerbation of MS?
Sensory loss
Cerebellar dysfunction
Motor dysfunction
Vision changes
Bladder and bowel dysfunction
Diplopia
A pt presenting with daily headaches which may be more severe in the morning, complaints of transient vision loss, and papilledema on fundoscopic examination likely has what diagnosis and needs what test/treatment?
Idiopathic intracranial hypertension (pseudotumor cerebri)
Dx/Tx: lumbar puncture
What is the most critical intervention in pts presenting with hyperosmolar hyperglycemic state (HHS)?
IV fluids
How is hyperosmolar hyperglycemic state (HHS) distinguished from diabetic ketoacidosis?
HHS usually seen in DM II
Lack of ketones in urine or blood
What lab should be drawn in a pediatric patient suspected of having glomerulonephritis (hematuria, hypertension, edema)?
Antistreptolysin O titer
What medication can be used for a pt suspected of having an aortic dissection who is hypertensive?
Esmolol
If a pt presents with sickle cell and acute pain crisis, what is the 1st line treatment?
Aggressive pain management (hydromorphone)
What is Beck’s triad and what condition is it associated with?
Muffled heart sounds, distended neck veins, hypotension
Cardiac tamponade
What is the nitrazine paper test used for?
Tests for amniotic fluid if preterm premature rupture of membranes is suspected
Paper turns blue if amniotic fluid is present
What is the medication class of choice to suppress premature ventricular contractions?
Beta blockers
What changes on an EKG would indicate a pt is experiencing premature ventricular contractions?
No p waves
Wide QRS complex (may be bizarre looking)
ST segment & T wave are opposite direction of QRS
What bacteria is likely to cause epididymitis in patients > 35 or pts who have low risk for STIs?
E. coli
What is the treatment for epididymitis if the suspected bacteria is E. coli?
Levofloxacin
In pts presenting with stroke like symptoms, what is a test that can be done to determine whether the pt is having a stroke?
Forehead wrinkle test
Bells Palsy: cannot wrinkle forehead
Stroke: can wrinkle forehead
Along with a consult to neuro, what is the treatment for a pt who presents with a vertebral artery dissection?
Anticoagulation (Heparin)
What is the most definitive study in a pt suspected of having an aortic dissection?
CTA
What is the test of choice in pts you are concerned about acute angle-closure glaucoma?
Tonometry
What are the signs/symptoms of acute angle-closure glaucoma?
Eye pain
Blurry vision
Headache
Conjunctival injection
Mid sized fixed pupil
Hazy cornea
What are benzos used to treat symptoms of alcohol withdrawal?
They stimulate GABA receptors
If a pt on anticoagulation presents and is found to have an intracerebral hemorrhage, what treatment should be administered?
Prothrombin complex concentrate to reverse the coagulopathic effects
What is the treatment for a pt with an EKG that shows intermittently non-conducted P waves without progressive prolongation of the PR interval, indicating Mobitz type II block?
Transcutaneous pacing
What is the treatment for phelbitis?
NSAIDs and heat
What is the hallmark finding in a pt with aortic stenosis?
Harsh systolic murmur along the right upper sternal (2nd intercostal space) that radiates to the carotids
What moves the midsystolic click of mitral valve prolapse later into the systolic phase?
Squatting
What is caused by a direct blow to the externally rotated, abducted, and extended arm?
Anterior shoulder dislocation
What nerve courses around the fibular head and is commonly injured with signs of decreased sensation between the first and second toe?
Common peroneal nerve
The murmur associated with hypertrophic obstructive cardiomyopathy is most likely to be louder with what maneuvers?
Standing and valsalva
What is the main cause of acute-angle closure glaucoma?
Obstruction of aqueous humor outflow
HIV and antiretroviral therapies can cause what heart issues?
Dilated cardiomyopathy
What is the 1st line treatment for acute bacterial parotitis?
Ampicillin-sulbactam
What is the most common cause of hyperthyroidism?
Graves disease
What is the treatment for a pt with Graves disease and hyperthyroidism?
Beta blocker
