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Medical School > Emergency Medicine > Flashcards

Emergency Medicine Flashcards

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USMLE® Step 1 flashcards
1
Q

DDx Chest Pain (Urgent)

A
  1. MI
  2. Pericarditis
  3. Aortic Dissection
  4. PE
  5. Pneumothorax (hyperresonance, decreased air entry, tracheal deviation)
  6. Esophageal Perforation (vomit, trauma, subcutaneous emphysema)
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2
Q

Wells Criteria

A

(/15)

  • Clinically suspected DVT — 3.0 points
  • Alternative diagnosis is less likely than PE — 3.0 points
  • Tachycardia (heart rate > 100) — 1.5 points
  • Immobilization (≥ 3d)/surgery in last 4 weeks — 1.5 points
  • Hx DVT or PE — 1.5 points
  • Hemoptysis — 1.0 points
  • Malignancy (Tx w/in 6 months) or palliative — 1.0 points

Traditional interpretation

  • Score >6.0 — High (probability 59%)
  • Score 2.0 to 6.0 — Moderate (probability 29%)
  • Score <2.0 — Low (probability 15%)

Alternative interpretation[10][13]

  • Score > 4 — PE likely & image
  • Score 4 or less — PE unlikely & consider D-dimer to rule out PE
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3
Q

Signs of Basal Skull Fracture

A
  • Battle’s Sign (bruised amstoid process)
  • Hemotympanum
  • Racoon eyes (periorbital bruising)
  • CSF rhinorrhea/otorrhea
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4
Q

Best Immaging for Intracranial Injury

A

Non-contrast CT

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5
Q

GCS Eyes

A

Eyes Open

  1. Nothing
  2. To Pain
  3. To Voice
  4. Spontaneously
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6
Q

GCS: Motor

A

Best Motor Response

  1. Nothing
  2. Decerebrate = extension
  3. Decorticate = flexion
  4. Withdraws from pain
  5. Localizes pain
  6. Obeys commands
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7
Q

GCS: Verbal

A

Best Verbal Response

  1. None
  2. Sounds
  3. Inappropriate words (wrong topic)
  4. Confused, disoriented (wrong answer)
  5. Appropriate answer
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8
Q

Fluid Maintenance Rule

A

4:2:1

4mL/kg/hr for first 10 kg

2mL/kg/hr for next 10 kg

1mL/kg/hr after 20 kg

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9
Q

3:1 Crystalloid Rule

A

Since crystalloids move to extravascular space, need to give 3 x estimated bloods loss, versus colloids

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10
Q

3 DDx for unilateral, dilated, non-reactive pupil (aka blown pupil)

A

Cranial nerve III (occulomotor) is damaged, so…

  1. Epidural hamtoma (lens shape)
  2. Subdural hematoma
  3. Focal mass lesion
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11
Q

3 Contraindications to Foley Insertion

A
  1. Blood at urethral meatus
  2. Scrotal hematoma
  3. High-riding prostate on DRE
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12
Q

Trauma Tests and Investigations

A
  • Vital signs q5-15min
  • ECG, BP, O2
  • Foley catheter + NG tube
  • CBC, lytes, BUN, Cr, glucose, amylase, INR/PTT, beta-HCG, toxicology screen, cross and type
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13
Q

7 Signs of ICP

A
  1. Deteriotating LOC (hallmark)
  2. Deterioating respiratory pattern
  3. Cushing reflex (high BP, low HR, irregular resp)
  4. Lateralizing CNS signs (cranial nerve palsies, hemiparesis)
  5. Seizures
  6. Papilledema
  7. N/V and headache
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14
Q

Cushing’s Reflex

A

A sign of ICP

  1. Increased BP
  2. Decreased HR
  3. Irregular Resps
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15
Q

What is the Cranial Vault

A

The cranial vault is formed by the frontal, parietal, occipital, and temporal bones, and the greater wings of the sphenoid bone.

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16
Q
A
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17
Q

Formula for Cerebral Perfusion Pressure (CPP)

A

CPP = MAP - ICP

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18
Q
A
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19
Q

What is MAP and how is it calculated?

A

mean arterial pressure

MAP = Diastolic Pressure + 1/3 (Systolic - diastolic pressure)

It represents an average of blood pressure, but the formula reflects the body is in diastole longer than systole

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20
Q

Treatment of Suspected ICP

A
  • Raise stretcher head 20o (if hemodynamically stable)
  • Intubate and hyperventilate (aim: pCO2 30-35mmHg)
  • Mannitol 1g/kg infused rapidly
  • GOAL: maintain CPP (=MAP - ICP)
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21
Q

Indications for C-Spine Collar

A
  • Midline tenderness
  • Neurological symptoms or signs
  • Significant distracting injuries
  • Head injury
  • Intoxication
  • Dangerous Mechanism
  • History of altered LOC
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22
Q

What to palpate for along the spine?

A
  1. Tenderness
  2. Bony deformities
  3. Spinous process malalignment
  4. stop off
  5. spasms
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23
Q

5 Lines of contour ona lateral C-Spine XRay

A
  1. Anterior vertebral line
  2. Posterior Vertebral line (anterior margin of spinal canal)
  3. Posterior border of facets
  4. Laminar fusion line (posterior margin of spinal canal)
  5. Posterior spinous ine

NOTE: also check prevertebral soft tissue swelling (49% sensitivity for spinal injury)

24
Q

Dangerous Mechanism for C-Spine

A
  1. Fall from _>_1m
  2. Axial load to head (i.e. driving)
  3. MVC high speed (>100km/h), rollover, ejection
  4. Motoriesd recreational vehicles
  5. Bicycle collision
25
Q

High Risk C-Spine Criteria as per Canadian C-Spine Rule

A

(proceed to radiograph)

  1. Age _>_65
  2. Dangerous mechanism
  3. Paresthesias in extremities
26
Q

Low Risk C-Spine Criteria as per Canadian C-Spine Rule

A

(Exclude radiography if can roate head >45o)

  1. Simple rear-end MVC
  2. Sitting position in ER
  3. Ambulatory at any time
  4. Delayed onset of neck pain
  5. Absence of midline C-spine tenderness
27
Q

Can clear C-Spine if…

A
  1. Oriented to person, place, time, & event
  2. No evidence of intoxication
  3. No posterior midline cervical tenderness
  4. No focal neurlogical deficits
  5. No distracting injury (i.e. long bone fracture)
28
Q

Spinal shock vs neurogenic shock

A

Both are acute phases of spinal cord injury

  • Spinal: Absence of all voluntary and reflexes below injury level
  • Neurogenic: loss of vasomotor tone, SNS tone (i.e. hpotension, bradycardia from unopposed SNS, poilkothermia)
29
Q

Chronic phase of Spinal Cord Injury (T6 or above)

A
  • Autonomic dysreflexia
    • Pounding headache
    • Nasal congestion
    • Apprehension/anxiety
    • Visual changes
    • Dangerously high sBP and dBP
      • From bladder distension, infection, kidney stones, fecal impaction, or bowel distension
30
Q
A

Pneumoperitoneum (air under the diaphragm)

  • perforrate abdominal viscus (from ulcer to trauma)
  • created artificially during laproscopic surgery
  • mimics include subphrenic abscess, linear actelectasis, and bowel interposed between liver and diaphragm
31
Q

What is testicular torsion?

A
  • Spermatic cord (from which the testicle is suspended) twists, cutting off the testicle’s blood supply
    *
32
Q

What is Bell-Clapper Deformity?

A
  • congenital deformity predisposing to testicular torsion
  • testes is inadequately fixed to the scrotum and can move freely within
33
Q

Testicular Torsion

A
  • absence of cremasteric reflex (sometimes)
  • fast onset testicular pain
  • swollen, high riding, tender testicle
  • doppler U/S or straight to OR
34
Q

AST

A
  • Transaminase with ALT, markers of hepatocyte integrity
  • Aspartate aminotransferase
  • Leaks from injured liver, heart, or skeletal muscle cells or erythrocytes (less often kidney
  • AST > ALT: alcohol related
  • AST < ALT: viral, drug, toxin
35
Q

ALT

A
  • Transaminase, hepatocyte integrity marker
  • Alanine aminotransferase
  • ALT > AST: think drug, toxin, viral
  • ALT < AST: alcohol-related
36
Q

6 Treatable Causes of an Unstable or Arrested Rhythm

A
  1. Hypovolemia - toxins and tablets
  2. Hypoxia - tamponade
  3. H+ (acidosis) - tension pneumothorax
  4. Hyper/hypokalemia - thrombus MI
  5. Hypothermia - thrombus PE
  6. Hypoglycemia - trauma
37
Q

Unstable Symptomatic Bradycardia Treatment

A

If stable, observe and monitor

  1. Prep transcutaneous pacing
  2. Drugs (consider)
    1. Atropine
    2. Dopamin
    3. Epinephrine
  3. Search for treatable causes
38
Q

Unstable Tachycardia Treatment

A
  1. Synchronized cardioversion
    2.
39
Q

Rate Control agents for Atrial Flutter and Atrial Fibrillation

A
  1. Beta Blockers
  2. Calcium Channel BLockers
  3. Digoxin

+ Cardioversion if <48 hours

40
Q

Checmical Cardioversion Agents

A
  1. Amiodarone
  2. Procainamide
  3. Propafenone
41
Q

WPW Presentationa

A
  1. Wide QRS
  2. HR >220
  3. Delta wave

NOTE: consider avoiding rate control or chemical cardioversion

42
Q
A
43
Q

Three types of ischemic strokes

A
  1. Throbotic (clots, 75%)
  2. Embolic (20%, a clots from seomwhere else, i.e. aorta, cartids, vertebral arteries, valves, a-fib, etc.)
  3. Systemic hypoperfusion (5%, diffuse injury parttern)
44
Q

ACA Infarct Sx

A
  1. Contralateral LEG weakness (+/- minor arm weakness)
  2. Perseverate with speech or motor actions/respond slow
45
Q

MCA Infarct Sx

A
  1. Contralateral ARM and LEG weakness and numbness
  2. Aphasia if dominant hemisphere (left, typically)
  3. Hemi-neglect if nondominant hemisphere (right, typically)
  4. Homonymous hemianopsia + gaze preference to ipsilateral side
46
Q

PCA Infarct Sx’s

A
  1. Visual cortex abnormalities
  2. Light-touch/pin prick sensation may be greatly reduced
47
Q

Vertebrobasilar Syndrome Sx’s

A

Stroke from posterior circulation deficits to brainstem/cerebellum/visual cortex

  1. Dizziness, vertigo, diplopia, dysphagia, ataxia, cranial nerve palsies, and limb weakness
  2. “crossed nuerologic deficits” (ipsilateral cranial nerve + contralateral motor weakness)
48
Q

Basilar Artery Occulsion

A
  1. Quadripelgia/”locked in syndrome”
49
Q

What is “Drop Attack”

A

Froma cerebellar infarct/stroke, patients lose ability to walk/stand.

Symptoms include vertigo, headache, nausea, vomitting, and neck pain.

50
Q

Lacunar Infarct Sx’s

A
  • From small penetrating arteries, associated with hypertension*
    1. Pure motor or pure sensory deficits
51
Q

Are ischemic or hemorrhagic strokes more likely to present with a headache?

A

Hemorrhagic! Only 10-20% of ischemics present with a headache.

52
Q
A
53
Q

Management of “Worst Headache of my life”

A
  1. CBC
  2. INR
  3. Glucose
  4. CT
  5. Lumbar puncture if CT negative
54
Q

Contraindications of Thromboylisis

A
  1. Risk of Bleeds
    1. Previous intracerebral hemorrhage
    2. Previous stroke/HI within 90 days
    3. Anticoagulants or INR > 1.7
    4. Platelets < 100K
    5. GI/GU bleeding within 21 days
    6. Recent MI
    7. Recent Major Surgery within 14 days
  2. Glucose (hyper or hypo)
  3. Hypertension (>185sBP, >110 dBP)
  4. Diabetic Retinopathy, proliferative
55
Q

Dose of rt-PA

A

0.9mg/kg, max 90mg

  • 10% as bolus
  • 90% over 60 minuts

Medical School (12 decks)

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