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Residency > Emergency Medicine > Flashcards

Emergency Medicine Flashcards

1
Q

Bilious emesis younger than one year is what until proven otherwise?

A

Malrotation with midgut volvulus

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2
Q

Number of umbilical arteries and veins

A

One vein and two arteries

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3
Q

How long is the umbilical vein patent after birth?

A

Approximately 1 week

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4
Q

Charcots triad

A

Fever, RUQ pain, Jaundice (ascending cholangitis). Only present in 50 percent of patients however

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5
Q

Reynolds Pentad

A

Charcots triad (fever, RUQ pain, jaundice) plus signs of sepsis (hypotension, AMS). Indicates bad ascending cholangitis. Initiate broad spectrum abx immediately

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6
Q

Lines of management in ascending cholangitis

A

1st - broad spectrum antibiotics. Perform RUQ ultrasound or CT if US nondiagnostic. 2nd - ERCP. 3rd - Surgical drainage (eg perc chole tube)

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7
Q

Upper limit of normal common bile duct diameter in a patient who still has their gallbladder?

A

8 mm

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8
Q

Rash of Kawasaki disease

A

Generalized non-bullous, non-vesicular

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9
Q

Kawasaki Criteria

A

CRASH and BURN. Conjunctivitis, Rash, Adenopathy, Strawberry tongue, Hand swelling or erythema, and fever (5 days)

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10
Q

Percentage of untreated Kawasaki patients who develop coronary artery aneurysms

A

15-25 percent

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11
Q

Number of joules for an unstable VT patient using a biphasic machine

A

200

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12
Q

Aplastic crisis and ED management

A

An aplastic event (eg Parvo B19 infection) in a high risk pt (eg sickle cell). Droplet precautions, RBC transfusion, heme consult, admit for IVIG

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13
Q

Most common organism causing osteomyelitis in sickle cell patients

A

Staph (same as general pop). However, higher risk of salmonella osteo than general pop.

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14
Q

Why are antibioitics and antidiarrheals relatively contraindicated in children with bloody diarrhea and no confirmed infection on stool culture?

A

They may increase risk of developing HUS. Test the stool for E Coli O157H7 (the shiga toxin from this is most common cause of HUS).

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15
Q

Characteristic components of HUS and TTP

A

HUS - ART. Autoimmune hemolysis, Renal failure, Thrombocytopenia and bloody diarrhea. TTP - FAT RN. Fever, Autoimmune hemolysis, Thrombocytopenia, Renal failure, Neuro symptoms

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16
Q

Formula for cuffed and uncuffed ET tube sizing by age

A

Cuffed is (Age/4) + 3.5, Uncuffed is (Age/4) + 4

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17
Q

Contraindications to Dix-Hallpike testing

A

Unstable heart disease, ongoing stroke or TIA, severe neck disease, high grade carotid stenosis

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18
Q

Target INR for mechanical mitral and aortic valves

A

Mitral is 3-3.5, Aortic is 2.5-3

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19
Q

Which types of valve repairs need anticoagulation?

A

Mechanical but not biologic

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20
Q

Most common atypical complaint of elderly patients diagnosed with ACS

A

Dyspnea

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21
Q

Most commonly injured cardiac chamber in stab wounds

A

RV

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22
Q

Volume of blood that can acquire acutely in the pericardial sac before tampondade occurs

A

60-100 ccs

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23
Q

EKG findings in TCA overdose that you get before you reach unstable VT

A

Rightward axis, tall R waves in AVR. Then you get wide QRS and tachycardia. Right axis and tachycardia should make you think PE vs Sodium Channel Blocker (eg TCA) overdose

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24
Q

VT causes a wide complex tachycardia. Is a very wide tachycardia consistent with VT?

A

Not generally. If QRS width approaches 200 ms (1 big box), consider other causes like hyperK, metabolic acidosis, or TCA overdose. Consider giving calcium and bicarb early.

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25
Q

Ergotism

A

Miosis, burning sensation in extremities, CVA symptoms, GI disturbances, seizures, bradycardia, hypertension. Due to overdose of ergot derivatives (migraine med) which cause serotonin syndrome and alpha agonism

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26
Q

Treatment for ergotism

A

Activated charcoal if within 1-2 hours of ingestion and airway secure. IVF, antiemetics, analgesia. If ischemic changes, give vasodilators (nitroprusside, nitroglycerin, or phentolamine). Consider steroids and heparin

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27
Q

Lab abnormality in valproic acid toxicity

A

Hyperammonemia. Also look for abnormal LFTs, amlyase and lipase, and pancytopenia

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28
Q

Common side effects of NNRTIs such as efavirenz

A

Vivid dreams, headache, severe rash, dizziness, lightheadedness

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29
Q

Common side effects of protease inhibitors such as Indinavir

A

Kidney stones (not seen on dry CTs), hyperbilirubinemia, hepatitis

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30
Q

Common side effects of combination protease inhibitors such as Lopinavir

A

Nausea, vomiting, diarrhea, hepatitis

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31
Q

Common side effects of NRTIs such as Zidovudine

A

Bone marrow suppression, anemia, macrocytosis

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32
Q

Common side effects of Didanosine (nucleoside analog RTI)

A

Pancreatitis

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33
Q

Common side effect of NRTIs

A

Lactic acidosis

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34
Q

Common side effect of Ritonavir (protease inhibitor)

A

Parasthesias

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35
Q

Dosing of magnesium sulfate in eclampsia

A

4 to 6 grams IV followed by a drip

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36
Q

How long postpartum can eclampsia occur?

A

Up to 4 weeks

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37
Q

Two main side effects of hypomagnesemia

A

Hyporeflexia and hypoventilation

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38
Q

Most common fracture leading to compartment syndrome

A

Closed long bone fractures of the tibia

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39
Q

Most consistent physical exam finding in compartment syndrome

A

Loss of two point discrimination

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40
Q

Dacroadenititis vs Dacrocystitis

A

Adenitis is inflammation of the tear gland (upper outer eye), Cystitis is of the tear duct (inner lower eye)

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41
Q

Trench mouth

A

Acute Necrotizing Ulcerative Gingivitis (ANUG). Warm saline irrigate mouth, give antibiotics with oral coverage, and refer to dentistry or oral surgery.

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42
Q

Most common populations to get Acute Necrotizing Ulcerative Gingivitis (ANUG)

A

HIV, malnourished children, young adults under stress, polysubstance abusers

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43
Q

Complication of excessive phazopyridine (OTC tx for UTIs) use

A

Methemoglobinemia

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44
Q

Treatment for High Altitude Cerebral Edema (HACE)

A

Supplemental oxygen, descent, dexamethasone. Eventually hyperbaric therapy as well.

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45
Q

Dental pain with pain on percussion, gingival swelling but no signs of buccal or submandibular soft tissue swelling is usually a PERIAPICAL ABSCESS. What is the ED management?

A

Antibiotics (penicillin), analgesia, dental follow up within 48 hours

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46
Q

Parulis gumboil (also called intraoral dental sinus)

A

Oral soft erythematous papule on the alveolar process in association with a dental (typically periapical) abscess

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47
Q

Most common medication causes of erythema nodosum

A

Sulfas, OCPs, PCNs, Phenytoin

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48
Q

Most common systemic disorders causing erythema nodosum

A

Sarcoid, IBD, SLE, Lymphoma, Leukemia

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49
Q

Characteristics of erythema nodosum

A

Tender, erythematous subcutaneous nodules that have a blue hue as they resolve. Typically symmetrical and pretibial

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50
Q

Duration of symptoms in erythema nodosum

A

Rash up to 6 weeks, arthralgias up to 2 years. Condition is self-limited with no treatment. Identify underlying condition or drug cause and treat or stop.

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51
Q

Order of actions when patient presents with suspected meningitis with AMS or other abnormal neuro findings (eg focal deficits, seizures, etc)

A

Dexamethasone, empiric antibiotics, CTH (to avoid herniation during LP), then LP

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52
Q

How can time course be used to differentiate causes of meningitis

A

Acute (less than 24 hrs) is usually bacterial, Subacute (1-7 days) typically lymphocytic or viral, and Chronic is usually insidious fungal (eg cryptococcus in HIV patients)

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53
Q

What are the typical cutoffs for adding ampicillin when empirically covering for meningitis

A

Add it if patient is less than 3 months or older than 50 years

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54
Q

Most common age of incidence in testicular torsion

A

Bimodal. Less than 1 year old and another peak in puberty

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55
Q

5 principle causes of hypoxemia

A

Hypoventilation, Right to Left Shunting, VQ mismatching, Diffusion impairment, and Low Inspired FiO2

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56
Q

Maximum acceptable INR for an ED pericardiocentesis in an unstable patient

A

None. A pericardiocentesis should be performed for any unstable patient with tamponade (although thoracotomy is strongly preferred if the tamponade is traumatic in origin)

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57
Q

Most common age and complication of SCFE

A

11-13. Avascular necrosis

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58
Q

What is Legg-Calve-Perth and what is the most common age of diagnosis?

A

Idiopathic Avascular Osteonecrosis of the Capital Femoral Epiphysis (disruption of femoral head blood vessels due to unknown cause). Age 6-8

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59
Q

Bloombergs Sign and Kleins Line

A

Indicative of SCFE. Bloombergs Sign - Widening or blurring of the growth plate. Kleins Line - Tangential to superior aspect of femoral neck, normally intersects the epiphysis

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60
Q

Most common cause of aortoenteric fistula after AAA graft repair

A

Graft infection. Prodrome of low grade fever and back pain leads to GI bleeding and hypovolemic shock.

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61
Q

Absolute contraindications to IO insertion

A

Fracture of the bone and vascular disruption

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62
Q

Signs and symptoms of putamen hemorrhage

A

Hemiplegia, nausea, vomiting, headache progressing (over about 30 minutes) to ipsilateral eye deviation, stupor, coma, and blown pupils

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63
Q

Of the sites where you most commonly see hypertensive intracranial hemorrhages, which is most associated with anticoagulation

A

Lobar hemorrhage (ie in the white matter of one of the cerebral lobes)

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64
Q

Signs and symptoms of western diamondback envenomnation

A

Pain, edema, ecchymosis, bleb formation, and necrosis extending proximally from bite site. Also thrombocytopenia.

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65
Q

Imaging test of choice for hepatic abscess

A

Ultrasound. CT can be used adjunctively if US is nondiagnostic

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66
Q

Empiric antibiotics for hepatic abscesses and typical causative organisms

A

Ampicillin, Ceftriaxone, and Metronidazole. Pyogenic caused by aerobes (e coli, klebsiella, pseudomonas) or anaerobes (enterococcus, bacteroides, anaerobic strep), Amebic caused by entemoeba histolytica

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67
Q

Red raised bump that grows over several weeks into a purple nodule in a pet shop owner

A

Fish tank granuloma (mycobacterium marinum infection)

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68
Q

Mycobacterial infection with skin lesions and neuropathy

A

Leprosy

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69
Q

Most common human enzyme deficiency

A

G6PD

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70
Q

Incidence of recurrent peritonsillar abscess (PTA)

A

About 10 percent

71
Q

What lab value is used as a cutoff for determining futility of CPR in accidental hypothermia and what is the cutoff?

A

Serum potassium. Above 12 it is generally considered that resuscitative efforts for accidental hypothermia are futile.

72
Q

Classic EKG finding in accidental hypothermia

A

Osborne waves (slurring of the terminal portion of the QRS)

73
Q

US animals considered high risk for rabies upon bite injuries

A

Raccoons, skunks, foxes, bats, coyotes, AND DOGS found along the US-Mexico border

74
Q

Mnemonic for Salter Harris Fractures

A

SALTER. I - Slipped (or separation), goes transversely through physis, II - Above (metaphyseal side), III - Lower (epiphyseal side), IV - Through (both sides), V - ERasure (crushing of physis)

75
Q

Typically, which Salter Harris fractures are managed operatively, and which non-operatively?

A

I and II are usually managed non-op. III, IV, and V are typically managed with ORIF

76
Q

Definitive treatment for lithium toxicity and cutoff at which it should be given

A

Hemodialysis. If lithium level greater than 4

77
Q

EKG manifestations of lithium toxicity

A

Bradycardia, T wave flattening, QTc prolongation

78
Q

A viral prodrome followed by respiratory decompensation in a 3-4 year old child is suggestive of what condition, and what other conditions should be considered?

A

Bacterial tracheitis. Also consider croup, epiglottits, and foreign body aspiration

79
Q

Flu-like symptoms followed by pulmonary decompensation after exposure to mouse droppings or rodent bite

A

Hantavirus. Especially if in southwestern US

80
Q

Most common CBC abnormality in Hantavirus infection

A

Thrombocytopenia

81
Q

Average age for discitis

A

7 years old

82
Q

Which of the 5 Ps of arterial occlusion warrants immediate surgical intervention

A

Paralysis

83
Q

What finding typically differentiates pyogenic from amebic hepatic abscess?

A

Jaundice. Present in pyogenic, typically not present in amebic hepatic abscess

84
Q

Test characteristics of Nitrite and Leuk Esterase for UTI

A

Nitrite - Not sensitive (19-48), but very specific (92-100). LE - Very sensitive (72-97) but not specific (41-86)

85
Q

3 causes of false positive nitrites in urine samples

A

Contamination, exposure of dipstick to air, phenazopyridine

86
Q

In a patient who has been massively transfused (more than 10u RBCs in 24 hrs), what lab markers are used to determine that they may need more FFP, cryo, or platelets?

A

Platelets less than 50K (give platelets), INR over 1.5 (give FFP), Fibrinogen less than 100 (give cryo)

87
Q

What complication of acute hepatitis occurs in about 2 percent of patients and occurs around 6-12 weeks after the infection?

A

Pancytopenia. Can be fatal if unrecognized.

88
Q

What rule of thumb can be used on x-ray to determine if a swallowed coin is in the esophagus or trachea?

A

Esophageal coins appear face on (ie looking at the coins full width) whereas coins in the trachea appear as a sliver (ie looking at the narrow edge)

89
Q

Major complications of button batteries located in the esophagus

A

Liquifaction necrosis (can occur within 4-6 hours)

90
Q

What percentage of ALTEs have a determined cause, and what are the three most common of these causes?

A

50 percent. GERD, Seizure, Lower Respiratory Tract Infection

91
Q

What groups of kids with OM may be observed with NO ANTIBIOTICS?

A

6 months to 2 years with unilateral OM and no otorrhea, Over 2 years with bilateral or unilateral OM and no otorrhea. Note, all otorrhea and all kids with severe symptoms rec is still abx

92
Q

Tissue adhesives have a strength equal to what thickness of sutures?

A

4-0

93
Q

How long do tissue adhesives typically remain on the wound?

A

5-10 days

94
Q

Indications for operative fixation of flail chest

A

Inability to wean from vent, severe chest wall instability, persistent pain, progessive pulm function decline

95
Q

Common complication of basilar skull fractures

A

Cranial nerve entrapment

96
Q

What is the most commonly injured cranial nerve from a basilar skull fracture?

A

CN 7

97
Q

Dosing of vitamin K in patients with active hemorrhage and activated INR on coumadin

A

10 mg IV

98
Q

Treatment for Henoch Schonlein Purpura (HSP)

A

NSAIDs, Dapsone, or Prednisone can be used for symptomatic relief. The disease iteself is self-limiting (6-8 weeks)

99
Q

What GI disorder is associated with Henoch Schonlein Purpura (HSP)?

A

Intussuception

100
Q

The only treatment that significantly alters the course of croup

A

Steroids. Racemic epi is a temporizing measure. Heliox and humidified air have not been shown to have benefit

101
Q

Extraintestinal manifestations of invasive shigella gastroenteritis

A

Reactive arthritis, seizures, hallucinations

102
Q

Most common cause of dysentery in the US

A

Shigella Sonnei

103
Q

NAC administration should ideally be in what time window after acetaminophen ingestion?

A

4-8 hours

104
Q

Target urine output in burn patients

A

Adults - 0.5 to 1 cc per kg per hr, Children - 1 to 2 cc per kg per hr

105
Q

Ottawa ankle rule is positive if pain in malleolar zone plus certain findings OR pain in midfoot region plus certain findings. What are the certain findings?

A

Mallolar - tenderness at posterior edge of either lat or med malleolus, OR inability to bear weight, Midfoot - Tenderness at navicular or base of 5th metatarsal, OR inability to bear weight

106
Q

Maisonneuve fracture

A

Spiral fracture of PROXIMAL third of the fibula plus a tear of the DISTAL tibiofibular syndesmosis and interosseus membrane

107
Q

Treatment of choice for suspected cyanide and carbon monoxide poisoning (as in bad house fire)

A

Hydroxocobalamin 5 grams IV over short infusion. The amyl nitrate and sodium nitrate of the traditional cyanide kit can be harmful as they produce methemoglobinemia

108
Q

Odor associated with cyanide toxicity

A

Almond

109
Q

About 90 percent of patients with a cerebral venous sinus thrombosis (CVST) will have an elevation of what lab value?

A

D-dimer

110
Q

Which tick borne illness is associated with hyponatremia and what is the treatment for this illness?

A

Tularemia. Streptomycin

111
Q

Lab test of choice and treatment for serotonin syndrome

A

No lab test, clinical diagnosis. Cyproheptadine

112
Q

Labs that are not reliable when drawn from an IO

A

WBC, Platelets, AST, ALT, Ionized Calcium. Hg and Hct are considered reliable from an IO

113
Q

Can succinylcholine be given through an IO and if so what caveats are there?

A

Yes. It will take 20-30 seconds longer than normal to take effect.

114
Q

Empiric abx for CAP

A

Ceftriaxone and azithromycin

115
Q

Empiric abx for HCAP

A

Zosyn, vanco, tobra

116
Q

Empiric abx for urosepsis

A

Amp and gent

117
Q

Empiric abx for intra-abdominal sepsis

A

Ampicillin, gentamycin and flagyl

118
Q

Empiric abx for biliary sepsis

A

Zosyn

119
Q

Empiric abx for device related sepsis

A

Vanc and gent

120
Q

Empiric abx for skin and soft tissue sepsis

A

Vanc

121
Q

What is a quick test for suspected neurogenic shock

A

Check DTRs. They will be diminished or absent in neurogenic shock

122
Q

Proper site for needle insertion in paracentesis

A

4 to 5 cm superior and medial to ASIS

123
Q

What can the base deficit be roughly interpreted as?

A

The physiologic marker separating trivial blood loss from clinically significant hemorrhage

124
Q

What nerve may be injured with midshaft humeral fractures?

A

Radial nerve

125
Q

Most sensitive finding in cauda equina

A

Urinary retention

126
Q

Most sensitive imaging modality for HSV encephalitis

A

MRI

127
Q

Nursemaids elbow

A

Radial head subluxation. Kids 2-3 years old, typically girls. Due to displacement of radial annular ligament into the radiocapitellar articulation. Will not move arm but in no distress, no exam findings

128
Q

Treatment for nursemaids elbow

A

Supinate forearm then flex arm at the elbow

129
Q

Typical presentation of Hodgkins Lymphoma

A

Neck mass in a teenager with B symptoms

130
Q

Most common age of presentation for Non-Hodgkins Lymphoma

A

2 to 12 years old

131
Q

Virus associated with Burkitts

A

EBV

132
Q

What nerve is at risk of compression in perilunate dislocation?

A

The median nerve

133
Q

Risk factors for nephrolithiasis

A

PUD, Crohns, milk-alkali syndrome, hyperpara, hyperuricosuria, sarcoid, recurrent UTI, RTAs, gout, laxatives, family history, dehydration, hypervitaminosis D, and previous kidney stone

134
Q

Why are patients with Crohns at risk for nephrolithiasis?

A

Fat malabsorption and accumulation in the gut binds calcium and leaves oxalate free to accumulate

135
Q

Objective monitoring system for depth of sedation

A

Bispectral Index (BIS), an EEG signal

136
Q

Most common bacteria causing endocarditis

A

Staph aureus

137
Q

When bridging enoxaparin to warfarin, when can the patient stop the enoxaparin?

A

When INR is greater than 2.0 for 2 consecutive days

138
Q

Classic side effect of ethambutol (anti-TB med)

A

Optic neuritis resulting in painful vision loss, or red-green color blindness

139
Q

How does triage of patients in the field differ in lighting strikes versus other situations?

A

Patients in cardiopulmonary arrest (ie absent vital signs) should be addressed first, instead of being black tagged

140
Q

Initial management of PPROM

A

Analyze fluid for nitrizine or ferning. Avoid serial cervical exams if possible (increases risk of infection)

141
Q

Animals with the highest incidence of rabies

A

Racoons (38 percent) more than bats more than skunks

142
Q

Cholesteatoma

A

Mass in the middle ear or mastoid process of a teenager presenting with conductive hearing impairment

143
Q

Treatment of choice for subungual hematomas

A

Trephination, refer to hand surgeon.

144
Q

Rotator cuff muscles

A

Supraspinatus, infraspinatus, teres minor (all insert at greater tuberosity) and subscapularis

145
Q

Most common concerning complication of bronchiolitis

A

Apnea (especially premature infants)

146
Q

Test of choice in swallow injury mediastinitis

A

CT chest and neck

147
Q

Risk factors for retinal detachment

A

Advanced age, DM, previous cataract surgery, severe myopia, uveitis, connective tissue d/o, trauma, FH of retinal detachment

148
Q

Three types of retinal detachment

A

Rhegmatogenous, tractional, exudative

149
Q

Puncture wounds of the foot through a shoe require coverage for what resistant organism?

A

Pseudomonas

150
Q

What is contraindicated during thyroid storm and why?

A

Aspirin. Displaces T4 from binding proteins leading to increased T3 and T4 concentrations

151
Q

Presentation of prolactinemia in men

A

Infertility, decreased libido, occasionally galactorrhea

152
Q

What viral coinfection is common in patients with a peritonsillar abscess?

A

Mononucleosis

153
Q

What signs favor torsion over epididymitis?

A

Acute severe pain, high-riding testicle, pain worsens with testicle elevation, absent cremasteric reflex, normal testicle but decreased blood flow on color Doppler ultrasonography.

154
Q

At what serum level after an acute salicylate ingestion is hemodialysis indicated?

A

100 mg/dL

155
Q

Clay Shoveler’s Fracture and is it stable or unstable?

A

Avlusion of spinous process of C6 or C7 from abrupt next flexion. Stable

156
Q

Mnemonic for unstable c-spine fractures

A

Jefferson bit off a hangman’s thumb (Jefferson, Bilateral facet, Ondontoid II and III, Any dislocated fracture, Hangman, Teardrop)

157
Q

Jefferson fracture and stable or unstable

A

Axial loading of C1 causing bilateral mass fracture. Unstable

158
Q

Most unstable odontoid fracture

A

Type II (at the base of the odontoid process)

159
Q

Hangman’s fracture and stable or unstable

A

Extreme hyperflexion where cervical posterior processes are fractured and protrude into the canal. Unstable

160
Q

Teardrop fracture and stable or unstable

A

Hyperextension of the ALL causing avulsion of the anteroinferior or flexion causing a fracture fragment from anterior compression. Unstable

161
Q

Most common cause of bleeding in patient’s with LVADs

A

AV malformations

162
Q

What electrolyte abnormality exacerbates chronic digoxin toxicity?

A

Hypokalemia

163
Q

Physical exam sign associated with torsion of the testicular appendage

A

Blue dot sign

164
Q

Amsel criteria for BV

A

Thin, homogenous discharge, clue cells, positive whiff test, pH > 4.5. 3 of 4 must be present

165
Q

3 genetic conditions associated with aortic dissection

A

Marfan (fibrillin), Polycystic kidney disease (polycystin), Ehlers-Danlos IV (type 3 procollagen)

166
Q

Pterygia

A

fibrovascular proliferations triggered by ultraviolet light exposure

167
Q

Phlegmasia cerulean dolens

A

Massive thrombosis causing venous insufficiency (painful blue leg)

168
Q

Infections that do not tend to raise the heart rate in proportion to the temperature

A

Typhoid, malaria, legionella, mycoplasma, yellow fever, tularemia, brucellosis, colorado tick fever

169
Q

Faget sign

A

Sphygmothermic dissociation (i.e. relatively bradycardic heart rate given degree of fever)

170
Q

Treatment of choice for typhoid

A

Rehydration therapy and a fluoroquinolone

171
Q

Pain 3-5 days after dental extraction. What is the diagnosis and management?

A

Alveolar osteitis (dry socket). Clot dislodges after a few days and leads to recurrent pain. Treatment is packing with iodoform gauze moistened with oil of clove. Provide analgesia, ?nerve block, and reassurance

172
Q
A
173
Q
A

Residency (3 decks)

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