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Family Medicine Boards 2020 > Emergency Medicine > Flashcards

Emergency Medicine Flashcards

1
Q

What are the 5Ts and 6Hs of ACLS?

A

5Ts: toxins, tamponade, tension pneumo, cardiac thromus, pulmonary thrombus

6Hs: H+, hypothermia, hypokalemia, hyperkalemia, hypovolemia, hypoxia

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2
Q

ACLS algorithm for Vfib/Vtach

A
  1. Defibrillate (200 J) –> CPR
  2. Defibrillate again, give vasopressor (Epi) –> CPR
  3. Defibrillate again, given antiarrhythmic (amiodarone)
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3
Q

Cardioversion dose in this scenario:

Narrow QRS, regular such as SVT or A flutter

A

50-100 J

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4
Q

Cardioversion dose in this scenario:

Narrow irregular such as a fib

A

120-200 J

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5
Q

Cardioversion dose in this scenario:

wide regular such as monomorphic VT

A

100 J

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6
Q

Cardioversion dose in this scenario:

wide irregular such as polymorphic VT

A

200 J not synchronized

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7
Q

Definition of SIRS

A 
SIRS = 2 or more of following
Temp < 36 or > 38 C
RR > 20
P > 90
WBC < 4000 or > 12,000 or 10% immature cells
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8
Q

Definition of

  • sepsis
  • severe sepsis
  • septic shock
A
  • sepsis: SIRS + source of infection
  • Severe sepsis: sepsis + lactate > 2 or organ dysfunction
  • Septic shock: severe sepsis + lactate > 4 or hypotension despite fluid resuscitation
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9
Q

Septic Shock Management

A
  • obtain lactate level
  • obtain blood cultures before Antibiotics
  • administer broad spectrum Abx before 1 hour
  • administer 30 cc/kg crystalloid for hypotension or lactate > 4 * administer w/in 3 hours
  • if hypotensive (MAP < 65) after fluid challenge, start norephinephrine
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10
Q

Most common cause of trauma related deaths in peds

A

motor vehicle crash

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11
Q

Most common cause of death in children ages 1-4 yo

A

Drowning

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12
Q

Most common cause of unintentional death in newborns

A

suffocation

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13
Q

At what age can children move into the front seat?

A

13

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14
Q

65 yo with a fib on warfarin presents with acute intracerebral hemorrhage. What should you start according to the ACCP and AHA/ASA recommendations?

A

Start a 4 factor prothrombin complex concentrate (K centra) + vitamin K 10 mg IV

Rapidly reverses INR in 2-15 minutes
ABO testing not required
low volume

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15
Q

If pt has life-threatening bleed on warfarin and has history of HIT, what should you use?

A

Profilnine

K centra has heparin in it

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16
Q

Management of Corneal abrasion

A
  • no eye patch (SOR A)
  • topical NSAIDs offer effective pain relief (SOR B)
  • topical cycloplegics and mydriatics do not relieve pain and aren’t recommended (SOR B)
  • topical antibiotics may be prescribed to prevent bacterial superinfection in corneal abrasions (SOR C)
  • if associated with contact lense use antipseudomonal abx
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17
Q

Management of chemical burns of the eye

A

IRRIGATE!!!!! 2L

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18
Q

Management of hyphema

A

blood in anterior chamber

  • elevated HOB 30 degrees during rest
  • avoid aspirin or NSAIDS
  • optho consult
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19
Q

How do you approach evaluation of painful eye trauma

A

does proparacaine relieve pain?

  • if yes –> conjunctivitis, keratitis, corneal ulcer
  • if no –> iritis/uveitis, acute glaucoma
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20
Q

How do you approach evaluation of painless eye trauma?

A

Is there a visual change?
if yes, consider posterior vitreous detachment, retinal detachment, retinal artery/vein occlusion, ischemic opthic neuropathy (including temporal arteritis)

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21
Q

What is kehr’s sign?

A

sign of splenic rupture: blood irritates the diaphragm and leads to referred pain to left shoulder

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22
Q

Diagnosis and management of rhabdo

A

urine dipstick positive 50% (myoglobinuria)
elevated CPK (> 2-3 times reference)
complcation: acute renal failure
Treatment: crystalloid 500 cc/hr => urine output 200-300 cc/hr

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23
Q

In diagnosis of compartment syndrome, what is the pressure at which it is diagnosed?

A

> 30 mm Hg

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24
Q

In the emergency room, when should you given tetanus booster?

A

Clean wound > 10 years since last dose

dirty wound > 5 years since last dose

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25
Q

In wound care, who should be placed on prophylactic antibiotics?

A

high risk site: hand/foot
high risk mechanism: bites
high risk patients: immunocompromised, prosthetic valves

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26
Q

Is epinephrine safe in digits?

A

Yes, if no concern for vascular compromise, epinephrine is safe in digits

SOR B

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27
Q

When can you close non-infected wounds, cause by clean objects?

A

These wounds can be repaired up to 18 hrs later, 24 hours if face/scalp

SOR B

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28
Q

Which lead to higher infection rates?

  • tap water vs sterile water
  • sterile gloves vs clean nonsterile gloves
A
  • tap water as effective or better than saline SOR A

- clean nonsterile gloves do not increase infection rate SOR A

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29
Q

What is a toddlers fracture?

A

Most common fracture in age 9 months - 3 years
presents as limp
spiral fracture of distal tibia best seen on oblique XR
place in below knee walking cast x 3 weeks

NOT ABUSE

30
Q

Management of auricular hematoma

A

I and D, without which will develop cauliflower ear

31
Q

A patient presents with nasal fracture, you find a septal hematoma. What should you do?

A

Incision and drainage? Otherwise will develop saddle nose deformity

32
Q

How should you manage tooth avulsion?

A

immediate replace/reinsert adult tooth
gently cleanse and do not scrub
do not replace/reinsert baby tooth

33
Q

What calculator can you use to identify children at low risk of brain injury after head trauma?

A

PECARN 2009 calculator

34
Q

Innervation with radial nerve:
sensation
motor

A
  • sensation: posterior hand - thumb to radial 1/2 of ring finger
  • motor: wrist and finger extension
  • best test: strenght of extension
35
Q

Innervation with median nerve:
sensation
motor

A
  • sensation: palmar surface, thumb to radial 1/2 of ring finger
  • motor: flexion of wrist and fingers
  • best test: make OK sign
36
Q

Innervation with ulnar nerve:
sensation
motor

A
  • sensation: little finger and ulnar 1/2 of ring finger
  • motor: innervates interosseous muscles (intrinsics)
  • test: ABduction of fingers
37
Q

Treatment of minor burns

A
  • immediately run under cool running water (LOE C)
  • leave blisters alone
  • superficial burns can be treated with topical application of lotion, honey, aloe vera, or antibiotic ointment (LOE B)

Silver sulfadiazine: slows healing and increases infection

38
Q

How do you treat non-purulent cellulitis?

A

Caused most commonly by strep pyogenes and MSSA

  • cephalexin
  • doxycycline
  • clindamycin
  • nafcillin
39
Q

How do you treat purulent cellulitis?

A

CA-MRSA vs HA-MRSA

  • Incision and drainage
  • TMP-SMX
  • doxycycline
  • clindamycin
  • linezolid
40
Q

Which form of bite has highest infection risk

41
Q

Treatment of cat bite?

A
  • puncture wounds
  • most infected with pasteurella
  • watch for bone and joint infection
  • RX: Augmentin
42
Q

How do you treat human bite?

A

polymicrobial infections

  • copious irrigation
  • do not close
  • RX: Augmentin x 5 days
43
Q

How do you treat dog bite?

A

lowest rates of infection

  • primary closure OK
  • irrigate
  • +/- Augmentin
44
Q

What is cat scratch disease and how do you treat it?

A
  • regional lymphadenopathy caused by bartonella henselae
  • diagnosis: serologic testing (immunofixation)
  • Treatment: no incision and drainage as it is self limiting. Always give immunocompromised antibiotics. Up for debate whether immunocompetent need it
45
Q

What are symptoms of early lyme disease?

A
  • erythema migrains: 50-70% of cases
  • neurologic: CN 7 palsy, radiculopathy, meningitis
  • cardiac: AV block
46
Q

What are symptoms of late lyme disease?

A

occurs after weeks

  • lyme arthritis: large joints typically knees
  • neurologic disease: encephalopathy, peripheral neuropathy
47
Q

Treatment of early lyme disease in adults

A

don’t test, just treat

  • doxy x 10 days
  • amoxicillin x 14 days
  • cefuroxime x 14 days
  • azithromycin x 7-10 days
48
Q

Treatment of early lyme disease in children

A
  • doxy if > 8 years old
  • amoxicillin
  • cefuroxime
  • azithromycin
49
Q

A pt is treated for lyme disease with an antibiotic and develops fever, chills, myaglias, HA.

What is happening and what should you do?

A

Jarisch-Herxheimer reaction, similar to treatment of syphilis as both are spirochetes

  • symptomatic treatment, don’t change or discontinue antibiotics
50
Q

When should you give lyme disease prophylaxis

A

single dose doxycycline to adults and children > 8 yo if all of the following are true:

  • tick attached, reliably identified as a I. scapularis tick
  • estimated attachment > 36 hours
  • prophylaxis can be started in 72 hours of time tick was removed
  • local rate of lyme disease is high
  • doxy isn’t contraindicated
51
Q

What is scrumboid poisoning and how to you treat it?

A
  • history of eating a peppery tasting fish
  • poorly preserved fish leads to bacteria the produce histamine
  • histamine directly causes the problem
  • RX: H1 or H2 blockers
52
Q

What is ciguatera poisoning and how do you diagnose it?

A

ingestion of reef fish that have accumulated sufficient amount of dinoflagellate

  • causes GI or neuro symptoms
  • pathognomonic: cold sensation reversal where cold temps are perceived as hot and vv
53
Q

Treatment of frost nip and frost bite

A

rapid rewarming in circulating water 104-108 degrees F (40-42 C)

54
Q

Definition of heat exhaustion

A 
nonspecific symptoms
dizziness, weakness, n/v, HA
DIPHORESIS
NORMAL NEURO EXAM
temp normal to 104F (40 C)
55
Q

Definition of heat stroke

A

T > 105 F + CNS dysfunction
Looks like sepsis
typically with anhidrosis if gradual onset

56
Q

Treatment of heat stroke

A

Evaporative cooling or immersive cooling

57
Q

What is the best option for gastric decontamination after poison ingestion or overdose?

A

Charcoal

  • if given < 30 min, decrease absorption by 70%
  • if given 30-60 min, decrease absorption by 30%
58
Q

Management of acetaminophen toxicity

A
  • acetaminophen level: drawn at 4 hours after ingestion, treatment based on rumack matthew nomogram
  • treatment: N-acetylecysteine
59
Q

Name the antidote:

Acetaminophen

A

N-acetylcysteine

60
Q

Name the antidote:

Aspirin

A

alkaline diuresis

61
Q

Name the antidote:

beta blocker

62
Q

Name the antidote:

Calcium channel blocker

63
Q

Name the antidote:

Digitalis

A

Fab antibodies

64
Q

Name the antidote:

Heparin

A

protamine sulfate

65
Q

Name the antidote:

Isoniazid

A

Pyridoxine (vit B6)

66
Q

Name the antidote:

opiates

A

Naloxone (narcan)

67
Q

Name the antidote:

organophosphates

68
Q

Name the antidote:

Tricyclic antidepressants

A

sodium bicarbonate

The principal mechanism of TCA toxicity is sodium channel blockade resulting in QRS prolongation and life-threatening arrhythmias.

Serum alkalinisation with sodium bicarbonate is the mainstay of treatment of TCA cardiotoxicity.

69
Q

Common toxidromes:

anticholinergic

A

Hot as a hare (hyperthermia)
blind as a bat (mydriasis)
dry as a bone (thirst, decreased salivation)
red as a beet (vasodilation, flushing)
mad as a hatter (delirium, agitation, confusion)

caused by antihistamines, antiparkinson, antipsychotics, antiemetics, antidepressants (TCA), antispasmodics

70
Q

Common toxidrome:

Serotonin syndrome

A
  • cognitive: agitation, anxiety, drowsy, delirium, HA, seizures
  • autonomic: tachycardia, arrhythmia, hyperthermia, HTN, diaphoresis, diarrhea, nausea
  • neuromuscular: restlessness, tremor, hyperreflexia, dysarthria, ataxia, myoclonic jerks/twitching

Watch out for linezolid!!
Treatment: cyproheptadine

Family Medicine Boards 2020 (46 decks)

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