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PANCE prep JQ > Emergency Medicine > Flashcards

Emergency Medicine Flashcards

1
Q

Shockable cardiac arrest rhythms

A

Ventricular fibrillation and pulseless ventricular tachycardia

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2
Q

How to treat unstable tachycardia

A

Synchronized cardioversion cardioversion

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3
Q

How to treat stable tachycardia

A

If wide QRS(>.12) maybe adenosine and consult cardiology

If narrow QRS vagaries maneuvers, are Dione, BB, CBB, then consult

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4
Q

What indicates that a patient is unstable?

A

SBP <90
Chest pain
CHF
AMS

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5
Q

How to treat unstable bradycardia?

A

Atropine, then transcutaneous pacing if needed

Dopamine and epi are back up treatments in

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6
Q

Lateral leads

A

I aVL V5 V6

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7
Q

Septal leads

A

V1 V2

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8
Q

Anterior leads

A

V3 V4

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9
Q

Inferior leads

A

II III aVF

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10
Q

Samter’s triad

A

Asthma, nasal polyps, ASA/NSAID allergy

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11
Q

Pulmonary exam on asthma

A

Prolonged expiration with wheezing hyperesonance

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12
Q

Side effects of beta agonist

A

Tachycardia/arrhythmia, muscle tremor, CNS stimulation, hypokalemia

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13
Q

Lab abnormalities with chronic bronchitis

A

Respiratory acidosis and increased hct/RBC

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14
Q

Most common cause of transudative pulmonary effusion

A

CHF

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15
Q

Pulmonary exam with pleural effusion

A

Decreased tactile Fremont is, decreased breath sounds, dullness to percussion, pleural friction rub

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16
Q

How do you know if a effusion is exudative?

A

Pleural protein:serum protein >0.5

Pleural LDH:serum LDH >0.6

Pleural LDH>2/3 UNL

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17
Q

Physical exam with tension pneumothorax

A

Elevated JVP, pulsus paradoxus, hypotension

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18
Q

Pulmonary exam with pneumothorax

A

Hyperresonance, decreased fremitus, decreased breath sounds

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19
Q

Tx for pneumothorax

A

Observation if <20% with fu cxr in 24-48 hr

Chest tube/thoracotomy if large or severe sx

Needle aspiration if tension

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20
Q

Characteristics of benign pulmonary nodules

A

Round, smooth, slow growing, calcified, cavitary

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21
Q

Characteristics of malignant pulmonary nodules

A

Irregular speculated, rapid growth

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22
Q

Where does lung cancer usually metastasize to? (5)

A

Brain, bone, liver, lymph nodes, adrenals

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23
Q

MC lung cancer arises peripherally and metastasizes to distant areas

A

Non small cell adenocarcinoma

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24
Q

Centrally located lung cancer that may cause hemoptysis. Associated with cavitary lesions, hyper lace is, and pa cost syndrome.

A

Non small cell squamous cell carcinoma

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25
Q

Pancoast syndrome

A

Shoulder pain

Hornets syndrome(miosis , ptosis, anhydrosis)

Atrophy or arm/hand muscles

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26
Q

Very aggressive pulmonary non small cell carcinoma

A

Large cell (anaplastic) carcinoma

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27
Q

Lung cancer that metatasizes early. Associated with SVC syndrome, SIADH/hyponatremia, Cushings syndrome, and lambert-Eaton.

A

Small cell (oat cell) carcinoma

  • surgery usually not tx of choice
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28
Q

Antidote for heparin

A

Protamine sulfate

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29
Q

MOA heparin

A

Potentiates antithrombin III

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30
Q

Morphology of strep pneumo

A

Gram positive cocci in pairs

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31
Q

Morphology of staph aureus

A

Gram positive cocci in clusters

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32
Q

Pneumonia caused by gram negative rod should make you think of these organisms

A

H flu, klebsiella, pseudomonas

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33
Q

MC cause of CAP

A

Strep pneumo

Followed by H flu

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34
Q

Pneumonia associated with GI symptoms, elevated LFTs and hyponatremia

A

Legionella

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35
Q

History suspicious for histoplasmosis

A

Exposure to bat droppings in Mississippi & Ohio River valley

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36
Q

Rusty blood tinged sputum

A

Strep pneumo

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37
Q

Green sputum

A

H flu and pseudomonas

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38
Q

Currant jelly sputum

A

Klebsiella

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39
Q

Foul smelling sputum

A

Anaerobes

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40
Q

First line therapy for CAP

A

Doxycycline or macrolides/mycin

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41
Q

Inpatient pneumonia tx

A

Beta lactam with macrolide or FQ

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42
Q

Tx for legionella

A

Levo or azithromycin

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43
Q

Tx for pseudomonas

A

Pipracillin/taxobactam, cefepime, amikacin, gentamicin, tobramycin, FQ

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44
Q

Caseating granumonas in apecies of lung

A

Tb

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45
Q

What is a positive PPD?

A

> 5mm if immunocompromised, known contact, or suggestive CXR

> 10mm if high risk population

> 15mm if no risk factors

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46
Q

Tb treatment

A

RIPE or RIPS

Rifampin, isoniazid, pyrazinamide, ethambutol or streptomycin

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47
Q

Adverse effects of rifampin

A

Thrombocytopenia, orange secretions

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48
Q

Adverse effects of isoniazid

A

Hepatitis, peripheral neuropathy (B6 supplement), drug induced lupus

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49
Q

Adverse effects of pyrazinamide

A

Hepatitis, photosensitivity, hyperuricemia

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50
Q

Adverse effects of ethambutol

A

Optic neuritis, peripheral neuropathy

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51
Q

Adverse effects of streptomycin

A

Ototoxic and nephrotoxic

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52
Q

Pertussis/whooping cough is caused by

A

Bordetella

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53
Q

RVS is part of this viral family

A

Paramyxovirus

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54
Q

Tx of RVS/acute bronchiolitis

A

Humidified air

Beta agonist and epi if needed

Steroid if hx asthma

Rivavirin if severe or risky pt

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55
Q

Tx of epiglottis

A

Maintain airway

Cephalosporin

56
Q

Croup/laryngotracheitis is caused by

A

Parainfluenza

57
Q

Influenza is part of this viral family

A

Orthomyxovirus

58
Q

Common SE of neuraminidase inhibitors (flu A & B)

A

Nausea and vomiting

59
Q

How does pt with anterior shoulder dislocation hold their arm?

A

Abducted and externally rotated

60
Q

How does pt with posterior shoulder dislocation hold their arm?

A

Addicted and internally rotated

61
Q

Describe hill-sacs lesion

A

Groove on humeral head

62
Q

Describe bankart lesion

A

Inferior glenoid rim fracture

63
Q

Posterior shoulder dislocations are associated with this (3)

A

Seizures, trauma, electric shock

64
Q

The best xray view for shoulder dislocations is

A

Axillary and y view

65
Q

Shoulder impingement tests (3)

A

Hawkins

Drop arm

Neers

66
Q

Shoulder strength test

67
Q

Classifying AC joint dislocations/shoulder separations

A 
Class I: normal
Class II: AC ruptured
Class III: CC also ruptured
Class IV: clavicle displaced
Class V: disruption of clavicular attachment
68
Q

Axillary nerve injury results in

A

Decreased deltoid sensation

69
Q

Proximal humerus fracture can result in damage to this nerve

70
Q

Treat with sugar tong splint

A

Humeral shaft fracture, colles fracture

71
Q

Worry about radial nerve damage with these fractures

A

Humeral shaft, supracondylar humerus, monteggia

72
Q

Humeral shaft fx can result in damage to this nerve

73
Q

MC fx in children, adolescents, and newborns during delivery

74
Q

Volkmanns contracture

A

Median nerve and brachial artery injury lead to clawlike deformity

75
Q

Volkmann ischemic contracture is associated with this fracture

A

Supracondylar humerus

76
Q

Inability to fully extend elbow should make you think of these two fractures

A

Radial head and olecranon

77
Q

Nightstick fracture

A

Ulnar shaft

78
Q

Proximal ulnar shaft dx with anterior radial head dislocation

A

Monteggia fracture

79
Q

Olecranon fxs can result in distinction of this nerve

80
Q

Middistal radial shaft fracture with dislocation of distal radioulnar joint

A

Galeazzi fracture

81
Q

Radial head subluxation

A

Nursemaids elbow

82
Q

Radial styloid fracture

A

Hutchinson fracture

83
Q

Lateral epicondylitis

A

Tennis elbow

84
Q

Medial epicondylitis

A

Golfers elbow

85
Q

Tx for elbow dislocation

A

EMERGENT reduction and posterior splint for 7-10d

Associated with brachial artery, median/ulnar/radial nerve injury

86
Q

Froment’s sign

A

Flexing IP joint to hold paper. Associated with ulnar nerve injury

87
Q

Thumb spica these fractures

A

Scaphoid, navicular, gamekeepers/skiers thumb, Bennett’s, rolandos, de quervains

88
Q

Distal radial fracture with dorsal/posterior dislocation

A

Colles fracture (dinner fork deformity)

89
Q

MOA colles fracture

A

FOOSH with wrist extension

90
Q

Distal radius fracture with central/anterior dislocation

A

Smiths fracture

91
Q

MOA smiths fracture

A

FOOSH with wrist flexion

92
Q

Intra-articular distal radius fracture with carpal displacement

A

Barton fracture

93
Q

Kienbock’s disease

A

Avas ulnar necrosis of lunate bone

94
Q

Inability to straighten distal finger-extensor tendon avulsion

A

Mallet/baseball finger

95
Q

Tx for mallet finger

A

Splint DIP in uninterrupted extension for 6wk

96
Q

Sprain of tear of ulnar collateral ligament of thumb

A

Gamekeepers/skiers thumb

97
Q

Fracture at neck of 5th metacarpal

A

Boxer’s fracture

98
Q

Tx for boxers fracture

A

Ulnar gutter splint

99
Q

Intraarticular fx at base of 1st MCP

A

Bennett’s fracture

100
Q

Comminuted Bennett’s fracture

A

Rolando’s fracture

101
Q

Hip pain with leg shortened and internally rotated

A

Dislocation

102
Q

Hip pain with leg shortened and externally rotated

A

Hip fracture

103
Q

Avas ulnar osteobecrosis of femoral head

A

Legg calve perthes disease

104
Q

How does perthes present?

A

Painless limping

Loss of abduction and internal rotation

105
Q

Femoral head slipped inferior and posterior at growth plate

A

Slipped capital femoral epiphysis (SCFE)

106
Q

How does SCFE present?

A

Painful limp with external rotation

107
Q

Tests for ACL laxity

A

Lachmans

Anterior drawer

108
Q

Avulsion of lateral tibial condyle with varus stress

A

Segond fracture

109
Q

Unhappy/o’donoghue’s triad

A

ACL
Medial collateral ligament
Medial meniscus

110
Q

Test for meniscus tear

A

Mcmurray’s sign

111
Q

Complications of tibial-fermoral dislocations

A

EMERGENT popliteal artery rupture

Peroneal and tibial nerve injury

112
Q

How to you check peroneal nerve?

A

Sensation in first web space and foot drop

113
Q

Worry about peroneal injury in these fractures/dislocations

A

Knee dislocation, femoral condyle fx, tibial plateau fx, posterior ankle dislocation

114
Q

MC ligament in ankle sprain

A

Anterior talofibular

115
Q

Spiral fracture of proximal fibula

A

Maisonneuve

116
Q

3rd metatarsal fracture

A

Stress/March fracture

117
Q

Transverse fracture through diaphysis of 5th metatarsal

A

Jones fracture

118
Q

Transverse avulsion fracture at base of 5th metatarsal

A

Pseudojones fracture

119
Q

Disruption of articulation of medial cuneiform with 2nd metatarsal

A

Lisfranc injury

120
Q

L4 compression presents as

A

Anterior thigh pain
Sensory loss to medial ankle
Weak ankle dorsiflexion
Loss of knee jerk

121
Q

L5 compression presents as

A

Lateral thigh/groin pain
Sensory loss to dorsum of foot
Weak big toe extension

122
Q

S1 compression presents as

A

Posterior leg/calf pain
Sensory loss to plantar surface of foot
Weak plantar flexion
Loss of ankle jerk

123
Q

Anticholinergic toxidrome

A

Increased vitals
Dilated pupils
Dry skin

124
Q

Anticholinergic antidote

A

Pysostigmine

125
Q

Cholinergic toxidrome

A

Decreased vitals
Constructed pupils
Wet skin

*farmers and terrorist attacks

126
Q

Opioid toxidrome

A

Decreased vitals
Constructed pupils
Dry skin

127
Q

Opioid antidote

128
Q

Sedative toxidrome

A

Decreased vitals
Normal pupils
Dry skin

129
Q

Cholinergic antidote

130
Q

Sympathometics (upper) toxidrome

A

Increased vitals
Dilated pupils
Wet skin

131
Q

Sympathometics/upper antidote

132
Q

Systolic ejection crescendo-decresendo murmur at RUSB

133
Q

Diastolic rumble at apex with opening snap

A

Mitral stenosis

134
Q

Diastolic decreaendo blowing at LUSB

A

Aortic regurg

135
Q

Blowing holosystolic murmur at apex

A

Mitral regurg

136
Q

Mid to late systolic ejection click

A

Mitral valve prolapse

PANCE prep JQ (15 decks)

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