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First Aid Step 2 > Emergency Medicine > Flashcards

Emergency Medicine Flashcards

1
Q

Class of drugs that may cause syndrome of muscle rigidity, hyperthermia, autonomic instability, EPS

A

Antipsychotics- neuroleptic malingnant syndrome

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2
Q

Side effect of corticosteroids

A

Acute mania, immunosuppression, thin skin, easy bruising, myopathies

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3
Q

Tx DTs

A

BDZ

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4
Q

Tx acetaminophen OD

A

N-acetylcystein

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5
Q

Tx opiod overdose

A

Naloxone

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6
Q

Tx BDZ OD

A

Flumazenil

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7
Q

Tx NMS and hyperthermia

A

Dantrolene

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8
Q

Tx malignant HTN

A

Nitroprusside

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9
Q

Tx afib

A

Rate control, rhythm conversion, anticoagulation

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10
Q

Tx SVT

A

Stable: rate control with carotid massage or other vagal stimulation
Unsuccessful: adenosine

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11
Q

Causes drug induced SLE

A 
INH
Penicillamine
Hydralazine
Procainamide
Chlorpromazine
Methyldopa
Quinidine
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12
Q

Macrocytic megaloblastic anemia with neuro Sx

A

B12 def

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13
Q

Macrocytic megaloblastic anemia w/o neuro Sx

A

Folate def

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14
Q

Burn pt with cherry red, flushed skin and coma. SaO2 normal but carboxyhemoglobin elevated. Tx

A

CO poisoning- 100% O2 or hyperbaric O2 if poisoning severe or pt pregnant

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15
Q

Blood in urethral meatus or high riding prostate or perineal ecchymosis or blood in scrotum or pelvic fx

A

Bladder rupture or urethral injury

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16
Q

Test to r/o urethral injury

A

Retrograde cystourethrogram

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17
Q

Radiographic evidence of aortic disruption or dissection

A

Widened mediastinum (>8 cm), loss of aortic knob, pleural cap, tracheal dev to right, depression L main stem bronchus

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18
Q

Radiographic indications for surgery of acute abdomen

A

Free air under diaphragm, extravasation of contrast, severe bowel distention, space occupying lesion on CT, mesenteric occlusion on angiography

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19
Q

Most common organism in burn related infection

A

Pseudomonas- look for fruity smell or blue green color

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20
Q

Method of calculating fluid replacement in burn pts

A

Parkland formula: 24 hr fluid = 4 x kg x % BSA

50% over first 8 hrs and rest over 16 hrs

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21
Q

Acceptable urine output in trauma pt

A

50 cc/hr

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22
Q

Acceptable urine output in stable pt

A

30 cc/hr

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23
Q

Signs neurogenic shock

A

Hypotension and bradycardia

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24
Q

Signs of increased ICP (Cushing’s triad)

A

HTN
Bradycardia
abnormal respirations

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25
Q

Dec CO, Dec PCWP, inc PVR

A

Hypovolemic shock

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26
Q

Dec CO, Inc PCWP, Inc PVR

A

Cardiogenic or obstructive shock

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27
Q

Inc CO, Dec PCWP, Dec PVR

A

Septic or anaphylactic shock

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28
Q

Tx septic shock

A

Fluids and broad spectrum abx
Give fluid until CVP=8
Pressors- NE or DA
Cultures before abc

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29
Q

Tx cardiogenic shock

A

Identify cause, pressors like dopamine if hypotensive or dobutamine if not hypotensive

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30
Q

Tx hypovolemic shock

A

Identify cause, isotonic (LR or NS) fluid and blood repletion in 3:1 ratio
NO PRESSORS

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31
Q

Tx anaphylactic shock

A

Diphenhydramine or epi 1:1000

Consider steroids

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32
Q

Supportive Tx ARDS

A

CPAP

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33
Q

Signs of air embolism

A

Pt with chest trauma who was previously stable suddenly dies

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34
Q

Sign of cardiac tamponade

A

Distended neck veins
Hypotension
Diminished heart sound (Beck’s triad)
Pulsus paradoxus

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35
Q

Absent breath sounds, dullness to percussion, shock, flat neck veins

A

Massive hemothorax

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36
Q

Absent breath sounds tracheal deviation, shock, distended neck veins, hyperresonance

A

Tension pneumothorax

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37
Q

Tx for blunt or penetrating ABD trauma in hemodynamically unstable pts

A

Immediate exploratory laparotomy

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38
Q

Inc ICP in alcoholics or elderly following head trauma. Can be acute or chronic, crescent shape in CT

A

Subdural

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39
Q

Head trauma with immediate loss of consciousness followed by lucid interval then rapid deterioration, Convex on CT

A

Epidural

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40
Q

ABCDE

A 
Airway
Breathing
Circulation
Disability
Exposure
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41
Q

4 reasons to intubate

A

GCS <8
Apnea
Significantly depressed mental status
Impending airway compromise- maxillofacial trauma, inhalation injury

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42
Q

Tx tension pneumothorax

A

Immediate needle decompression w/ thoracostomy tube

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43
Q

CXR tension pneumo

A

Hyperlucent on affected side, flattening and inferior displacement of diaphragm on that side, shift of mediastinum away

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44
Q

Amount of blood for massive hemothorax

A

> 1500 cc

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45
Q

Replacement of fluids

A 
3:1 ratio of fluid to blood loss
Use 16 gauge IV in both arms
Isotonic-LR or NS
Fluid bolus 1-2 L first, recheck vitals, continue repletion
Consider PRBC if hypotension
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46
Q

Triad cardiac tamponade

A

JVD
Hypotension
Muffled heart sound

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47
Q

Tx cardiac tamponade

A

Immediate pericardiocentesis

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48
Q

FAST scan

A

Focused abdominal sonography for trauma

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49
Q

New murmur 2/2 chest trauma

A

Aortic dissection

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50
Q

Rapid deceleration injury can cause…

A 
Coup contrecoup (bleeds where 2 impacts)
Diffuse axonal injury
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51
Q

Punctate hemorrhage at gray white matter junction

A

Diffuse axonal injury

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52
Q

Lucid interval

A

Epidural hematoma

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53
Q

Crosses suture lines

A

Subdural

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54
Q

Does not cross suture lines

A

Epidural

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55
Q

Middle meningeal artery

A

Epudural

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56
Q

Dural bridging veins

A

Subdural

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57
Q

Most common cause aortic disruption

A

decel injury

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58
Q

CXR shows wide mediastinum, loss of aortic knob, pleural cap, deviated esophagus and trachea to R, depression L main stem bronchus

A

Aortic disruption

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59
Q

Gold standard for evaluation of aortic disruption

A

Aortography

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60
Q

Define flail chest

A

3+ adjacent ribs fx at 2 places

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61
Q 
Fever
Tachypnea
Tachycardia
Conjuctival hemorrhage
UE petechiae
Trauma
A

Fat emoblism

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62
Q

Kehr’s sign

A

Referred shoulder pain due to diaphragmatic irritation (usu on left due to spleen rupture)

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63
Q

Possible causes of pulseless electrical activity

A 
Hypovolemia
Hypoxia
Hydrogen ions - acidosis
Hyper/Hypo K+ and others
Hypothermia
Tablets: Drug OD
Tamponade: Cardiac
Tension pneumo
Thrombosis: coronary
Thrombosis: PE
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64
Q

Peritoneal lavage

A

Saline infused by catheter into ABD and removed and examined- find blood or fecal matter

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65
Q

When to do exparatory lap

A

Penetrating abd trauma
Intra-abd bleeding or visceral damage
Retroperitoneal hematoms in upper abdomen

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66
Q

SVT

A

Unstable: synchronized electrical cardioversion
Stable: control rate (Valsalva, carotid sinus massage, cold stimulus)
Resistant to maneuvers: adenosine followed by other AV nodal blocking agents - CCB or Beta blockers

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67
Q

Afib/aflutter

A

Unstable: synchronized electrical cardioversion 120-200J
Stable: control rate with diltiazem or Beta blockers and anticoagulate if >48 hrs duration
Elective cardioversion if <48 hrs; otherwise must anticoagulate or do TEE
NO NODAL BLOCKERS- WPW; procainamide is better

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68
Q

Bradycardia

A

Sx: atropine
Ineffective: transcutaneous pacing, dopamine, epi

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69
Q

Abdominal pain that is sharp and focal with tenderness and guarding
Pts do not want to move

A

Parietal/peritoneal

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70
Q

Abdominal pain that is dully, crampy, achy, midline or diffuse
Pt unable to lie still

A

Visceral/organ

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71
Q

Abrupt, excruciating pain

A 
Biliary colic- RUQ
MI: substrnal
Perforated ulcer: epigastric
Ureteral colic: LQ
Ruptured aneurysm: umbilical
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72
Q

Rapid onset of severe, constant pain

A

Acute pancreatitis: epigastric
Mesenteric thrombosis, strangulated bowel- umbilical
Ectopic pregnancy- deep LQ

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73
Q

Intermittent colicky pain crescendo with free intervals

A

Early pancreatitis-epigastric
SBO-umbilical
IBS-suprapubic and middle of LQ

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74
Q

Gradual steady pain

A

Acute cholecystitis, acute cholangitis, acute hepatitis: RUQ
Appendicitis, acute salpignitis: RLQ
Diverticulitis: LLQ

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75
Q

Positive beta hCG with shock

A

ruptured ectopic until prove otherwise

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76
Q

Abdominal pain + syncope or shock in older pt

A

AAA until proven otherwise

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77
Q

Cervical motion tenderness

A

Consider PID

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78
Q

Sudden onset of diffuse, severe abdominal pain w/ abdominal rigidity

A

Perforation

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79
Q

Acute onset of severe radiating colicky pain
Obstipation (not pass stool or gas)
Bilious emesis

A

Obstruction

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80
Q

Constant, ill-defined pain with gradual onset over 10-12 hrs

A

Inflammation

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81
Q

Associated Sx of anorexia, N/V, changes in bowel habits, hematochezia, melena suggest what etiology?

A

GI

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82
Q

Fever and cough suggest what etiology

A

Pneumonia

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83
Q

Hematuria, pyuria, CVA tenderness suggest what etiology?

A

GU

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84
Q

Assocaited with meals

A 
Mesenteric ischemia-elderly or w/ CAD or PAD
PUD
Biliary disease
Pancreatitis
Bowel pathology
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85
Q

FH of abdominal pain

A

Familial Mediterranean fever

Acute intermittent porphyria

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86
Q

Hx AF or recent AAA repair, bloody stool,sudden onset abdominal pain out of proportion to physical findings

A

Ischemic colitis

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87
Q

Psoas sign

A

Passive extension of hip leads to RLQ pain

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88
Q

Obturator sign

A

Passive IR of flexed hip leads to RLQ pain

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89
Q

Rosving’s sign

A

Deep palpation of LLQ leads to RLQ pain

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90
Q

Hamburger sign

A

Pt wants to eat- consider something other than appendicitis

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91
Q

Pt populations with atypical S/S during acute appendicitis

A

Children
Elderly
Pregnant
Retrocecal appendices

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92
Q

Dx tests for appendicitis

A

CT with IV and PO contrast- highly sensitive for periappendiceal stranding or fluid
US: enlarged noncompressible- kids and preggers

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93
Q

How to estimate BSA in burn patients

Adults vs kid

A 
Rule of 9's
Adult:
Head and each arm = 9%
Back and chest each: 18%
Each leg = 18%
Perineum =1%
Kids: 
Head 18%
Arm- 9% each
legs-14% each
trunk and back: 18% each
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94
Q

Second leading cause of death in kids

A

Burns

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95
Q

First degree burn

A

Epidermis only
Painful, erythematous
NO BLISTERS,
Good cap refill

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96
Q

Second degree burn

A

Epi and partial dermis

Painful w/ blisters

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97
Q

Third degree

A

Epi and full dermis, potentially deeper

Painless, white, cleared

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98
Q

Major complications of burns

A 
Shock
Compartment syndrome
Superinfection- Pseudomonas or Gram P cocci
Stress ulcer-Curling
Aspiration
Dehydration
Ileus
Renal insufficiency- 2/2 rhabdomyolsysis
Epithelial contractions
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99
Q

6 W of Postop fever

A 
Wind: atelectasis, pneumonia
Water: UTI
Wounds: infection/abscess
Walking: DVT
Wonder drug
Womb: endometritis
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100
Q

Fevers before postop day? usually not infectious

Exception?

A

Post day 3

Clostridium or Beta hemolytic strep

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101
Q

Cause malignant hyperthermia

A

Halothane

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102
Q

CAuse NMS

S/S, labs

A

Neuroleptic agents

Mental status change, inc creatinine phosphokinase

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103
Q

What measure is not beneficial in CO poisoning?

A

O2 sat- measure carboxyHg as normally saturated = not reflect low arterial PO2 levels

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104
Q

Bees and wasps stings
Complication
Tx

A

Anaphylaxis

Tx: antihistamine, steroid, IM epi for anaphylaxis

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105
Q

Black widow bites
Complication
Tx

A

Mm pain and spasms, localized diaphoresis, ABD pain, inc ANS = ileus, CV collapse, hemolytic anemia, DIC, rhabdo
Tx: antivenin, wound care, BDZ

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106
Q

Scorpions
Complication
Tx

A 
CN dysfcn (severe), excessive motor activity, resp compromise, acute pancreatitis, myocardial toxicity
Tx: Support w/ BDZ/phenobarb and analgesics, atropine for hypersalivation and resp distress, IV ab, Antivenin
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107
Q

Snakes bites
Complications
Tx

A

Progressive dyspnea, DIC 2/2 toxin
Tx: Antivenom
Elevate affected limb

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108
Q

Dogs and cats bites
Complications
Tx

A

Infection, rabies, tetanus= Staph, Pasteurella multocida possible infection
Tx: amoxicillin, clavulanate; saline irrigation, debridement, tetanus and rabies prophy

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109
Q

Humans bites Tx

A

Amoxicillin clavulanate, saline irrigation, debridement

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110
Q

Rodents bite Tx

A

Local wound care- low risk infection

May carry rabies

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111
Q

Rabies
What carries
Prophy

A

BATS
If animal showed signs rabies give 1 dose human rabies Ig and 4 doses rabies vaccine over 14 d; if vaccinated need 2 dose vaccine

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112
Q

Tetanus Tx

A

Previous dose /=3:

  • Clean, minor: vaccine only if last was >/= 10 yrs prior
  • All other: vaccine only if last >/= 10 yrs ago
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113
Q

Normal levels carboxyHg smoker vs non

A

Smoker <5%

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114
Q

Induction of P 450

A 
Queen Barb Steals Phenphen and Refuses Greasy Carbs
Quinidine
Barbs
St Johns Wort
Phenytoin
Rifampin
Griseofulvin
Carbamazepine
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115
Q

Inhibition P450

A 
Cimetidine
Ketoconazole
INH
Grapefruit
Erythromycin
Sulfonamides
116
Q

Metabolism by _ 450

A 
BDZ, barbs
Amide anesthetics
Metoprolo, Propranolol
Nifedipine
Phenytoin
Quinidine
Theophylline
Warfarin
117
Q

Increased risk dig toxicity

A

Quinidine
Cimetidine
Amiodarone
CCB

118
Q

Competition for albumin binding sites

A

Warfarin
ASA
Phenytoin

119
Q

Blood dyscrasias

A

Ibuprofen
Quinidine
Methyldopa
Chemotherapeutic agents

120
Q

Hemolysis in G6PD def

A 
Sulfonamides
INH
ASA
Nitrofurantoin
Primaquine
Pyrimethamine
Chloramphenicol
121
Q

Gynecomastia

A 
Some Excellent Drugs Create Awesome Knockers
Spironolactone
Estrogens
Digitalis
Cimetidine
chronic Alcohol use
Ketoconazole
122
Q

SJS

A

Anticonvulsants
sulfonamides
Penicllins

123
Q

Photosensitiviy

A

Tetracycline
AMiodarone
Sulfonamides

124
Q

Drug induced SLE

A 
Procainamide
Hydralazine
INH
Penicillamine
Methyldopa
Quinidine
125
Q

Antidote acetaminophen

Sx OD

A

N-acetylcysteine

Sx: N, hepatic insufficiency

126
Q

Antidote acid or alkali ingestion

A

Upper endoscopy for stricture

127
Q

Antidote anticholinesterase

SX

A

Physostigmine

Sx: Dry mouth, urinary retention, QRS widening

128
Q

Antidote arsenic, mercury, gold

Sx

A

Succimer
Dimercaprol
Sx: renal insuff, tremor, mental status changes

129
Q

Antidote Beta blockers

Sx

A

Glucagon, calcium, insulin, dextrose

Sx: bradycardia, hypotension, hypoglycemia, pulmonary edema

130
Q

Antidote Barbs (phenobarb)

A

Urine alkalinization
Dialysis
Activated charcoal
Support

131
Q

Antidote BDZ

Sx

A

Flumazenil- can precipitate withdrawal

Sx: Sedation, resp depression

132
Q

Antidote Black widow bite

A

Calcium gluconate, methocarbamol

133
Q

Antidote CO

A

100% O2/hyperbaric

134
Q

Antidote Copper, arsenic, lead, gold

A

Penicillamine

135
Q

Antidote cyanide

A

hydroxycobalamin
Amyl nitrate
Na nitrate
Na thiosulfate

136
Q

Antidote digitalis

Sx

A

Normalize K but avoid giving Ca or Mg or lido (for torsade)
anti-digitalis Fab
Sx: N/V, changes vision, arrhyhtmias

137
Q

Antidote heparin

A

Protamine sulfate

138
Q

Antidote INH

Sz

A

pyrodoxine (B6)

Sx: neuropathy, hepatoxicity

139
Q

Antidote iron salt

Sx

A

Deferoxamine

Sx: nausea, constipation, hepatotoxicitiy

140
Q

Antidote Lead

Sx

A

Succumer
CaEDTA
Dimercaprol
Sx: peripheral neuropathy, anemia

141
Q

Antidote methanol/ethylene glycol

Sx

A

EtOH
Fomepizole
Dialysis
Ca gluconate for ethylene glycol
Sx: HA, vision changes, dizziness- methanol
Sx: ataxia, hallucinations, seizures, SWEET BREATH- ethylene glycol

142
Q

Antidote methemoglobin

A

Methylene blu

143
Q

Antidote Opiods

Sx

A

Naloxone

Sx: pinpoint pupils, resp depression

144
Q

Antidote Salicylates

Sx

A

urine alkinization, dialysis, activated charcoal

Sx: N/V, tinnitus, hyperventilation, anion gap, metabolic acidosis

145
Q

Antidote TCA

Sx

A

Na bicarb for QRS prolongation
Diazepam or lorazepam for seizures
Cardiac monitor for dysrhythmias
Sx: Tachycardia, dry mouth, urinary retention, QRS widening

146
Q

Antidote Theophylline

A

Activated charcoal

Consider repeat doses

147
Q

Antidote tPA, streptokinase

A

Aminocaproic acid

148
Q

Antidote warfarin

A

Vit K

FFP

149
Q

Side effect ACEI

A 
COUGH
Rash
Proteinuria
Angioedema
Taste changes
TERATOGEN
150
Q

Side effect amantadine

A 
Ataxia
LIVEDO RETICULARIS (lace like purplish discoloration of skin 2/2 venule inflammation)
151
Q

Side effect Amiodarone

A

Acute: AV block, hypotension, bradycardia,
Chronic: pulm fibrosis, peripheral deposits leading to bluish discoloration, arrhythmias, hypo/hyperthyroidism, corneal deposits

152
Q

Side effect Amphotericin

A

Fever/ rigors, nephrotoxic, bone marrow suppression, anemia

153
Q

Side effect antipsychotics

A

SEdation, acute dystonic reaction, akathisia, parkisonism, tardice dyskinesia
NMS

154
Q

Side effect azoles

A

Inhibit P450

155
Q

Side effect AZT

A

thrombocytopenia, megaloblastic anemia

156
Q

Side effect beta blockers

A

AStham exacerbation, masking hypoglycemia, importence, bradycardia, AV block, CHF

157
Q

Side effect BDZ

A

sedation, dependence, respiratory depression

158
Q

Side effect Bile acid resin

A

GI upset, malabsorption vit and minerals

159
Q

Side effect Carbamazepine

A

Induction P450, agranulocytosis, aplastic anemia, liver toxicity

160
Q

Side effect CCB

A

peripheral edema, constipation, cardiac depression

161
Q

Side effect Chloramphenicol

A

GRAY BABY SYNDROME

aplastic anemia

162
Q

Side effect Cisplatin

A

Nephrotoxic, acoustic nerve damage

163
Q

Side effect clonidine

A

dry mouth

SEVRE REBOUND HA AND HTN

164
Q

Side effect clozapine

A

Agranulocytosis

165
Q

Side effect corticosteroids

A

mania, hyperglycemia, immunosuppression, bone mineral loss, thin skin, easy bruising, myopathy, cataract

166
Q

Side effect cyclophosphamide

A

HEMORRHAGIC CYSTITIS

myleosuppression

167
Q

Side effect digoxin

A

YELLOW VISUAL CHANGES
ARRHYTHMIAS
GI

168
Q

Side effect doxorubicin

A

CARDIOTOXIC-CMP

169
Q

Side effect ethyl alcohol

A

Acidosi, renal dysfunction, CNS depression

170
Q

Side effect fluoroquinolones

A

Cartilage damage in kids

Achilles tendon rupture adults

171
Q

Side effect furosemide

A

Ototoxic
Hypokalemia
Nephritis
Gout

172
Q

Side effect gemfibroxzil

A

Myositis, reversible inc LFT

173
Q

Side effect halothane

A

MALIGNANT HYPERTHERMIA

hepatotoxic

174
Q

Side effect HCTZ

A

HypoK, hypoNa, hyperuricemia, hyperglycemia, hypercalcemia

175
Q

Side effect statin

A

Myositis, reversible inc LFT

176
Q

Side effect Hydralazinw

A

Drug induced SLE

177
Q

Side effect hydroxychloroquine

A

Retinopathy

178
Q

Side effect INH

A

Peripheral neuropathy (prevent pyridoxin/B6), hepatotoxic, inhibit P450, seizure in OD, hemolysis in G6PD def

179
Q

Side effect MAOI

A 
HYPERSENSITIVE TYRAMINE REACTION
SEROTONIN SYNDROME (w/ meperidine)
180
Q

Side effect Methanol

A

Blindnes, ion gap metabolic acidosis

181
Q

Side effect Methotrexate

A

Hepatic fibrosis, penumonitis, anemia

182
Q

Side effect Methyldopa

A

+ Coombs, drug induced SLE

183
Q

Side effect metronidazole

A

Disulfuram reaction, vestibular dysfucntion, metallic taste

184
Q

Side effect Niacin

A

FLUSHING

185
Q

Side effect penicillamine

A

Drug induced SLE

186
Q

Side effect penicillins/beta lactam

A

Hypersensitivity

187
Q

Side effect Phenytoin

A

Nystagmus, diplopia, ataxia, arrhythmia, GINGIVAL HYPERPLASIA, hirsutism, teratogen

188
Q

Side effect prazosin

A

First dose hypotension

189
Q

Side effect procainamide

A

drug induced SLE

190
Q

Side effect propylthiouracil

A

Agranulocytosis

Aplastic anemia

191
Q

Side effect quinidine

A

cinchomism (HA, tinnitus), thrombocytopenia, arrhythmia- TORSDAES

192
Q

Side effect Reserpine

A

Depression

193
Q

Side effect rifampin

A

induction P450 enzymes

ORANGE RED BODY SECRETIONS

194
Q

Side effect salicylates

A

Fever, hyperventilation wit RESPIRATORY ALKALOSIS AND METABOLIC ACIDOSIS, dehydration, hemorrhagic gastritis

195
Q

Side effect SSRI

A

Anxiety, 5HT syndrome with MAOI

SEXUAL DYSFUNCTION

196
Q

Side effect succinylcholine

A

MALIGNANT HYPERTHERMIA

HyperK

197
Q

Side effect TCA

A

Sedation, comia, antichol, seizures, arrhythmia

QRS PROLONGATION

198
Q

Side effect Tetracycline

A

Tooth discoloration, photosensitivity, Fanconi’s, GI

199
Q

Side effect Trimethoprim

A

Megaloblastic anemia, leukpenia, granulocytopenia

200
Q

Side effect Valproic acid

A

Teratogen- neural tube defect

Rare fatal hepatotoxicity

201
Q

Side effect Vancomycin

A

Nephrotoxic, ototoxic

RED MAN SYNDROME- histamine release

202
Q

Side effect Vinblastine

A

Severe myelosuppresion

203
Q

Side effect Vincristine

A

Peripheral neuropathy, paralytic ileus

204
Q

Tremor (6-12 hrs)
Tachycardia, HTN, agitation, seizure (48hrs)
Hallucinations

A

Alcohol withdrawal

205
Q

Severe autonomic instability leading to tachycardia, HTN, delirium and possibly death within 2-7 d

A

DT

206
Q

Tx Etoh withdrawal

A

BDZ
Haloperidol hallucinations
Thiamine, folate, multivitamin

207
Q

Anxiety, seizures, delirium, tremor, tachycardia, HTN

A

barbs withdrawal

208
Q

Tx barb withdrawal

A

BDZ

209
Q

Rebound anxiety, seizures, tremor, insomnia

A

BDZ withdrawal

210
Q

Tx BDZ withdrawal

A

BDZ taper

211
Q

Depression, hyperphagia, hypersomnolence

A

Cocaine/amphetamine withdrawal

212
Q

Tx cocaine or amphetamine withdrawal

A

Supportive

Avoid pure beta blockers which can lead to unopposed alpha activity = HTN

213
Q

Anxiety, insomnia, flu like Sx, piloerection, fever, rhinorrhea, lacrimation, yawning, nausea, stomach cramps, diarrhea, mydriasis

A

Opiod withdrawal

214
Q

Tx opiod withdrawal

A

Antiemetics
MM relaxers
NSAID
Clonidine, buprenorphine, or metadone if severe to mod Sx

215
Q

Vit def: night blindness and dry skin, Bitot spots (debris on conjunctiva)

A

Vit A

216
Q

Vit def: beriberi (polyneuritis, dilated CMP, high output CHF, edema), Wernicke Korsakoff

A

VIt B1 thiamine

Wet beriberi: high output cardiac failure
dry beriberi: peripheral neuropathy

217
Q

Vit def: Angular stomatitis, chelitis, corneal vascularization, dermatitis

A

Vit B2 riboflavin

218
Q

Vit def: Pellagra- diarrhea, dermatitis, dementia

A

Vit B3 niacin

219
Q

Vit def: Dermatitis, enteritis, alopecia, adrenal insuff

A

Vit B5 pantothenate

220
Q

Vit def: Convulsions, hyperirritability, microcytic anemia, seborrheic dermatitis, stomatitis, cheilosis; required w/ INH

A

Vit B6 pyridoxine

221
Q

Vit def: Macrocytic megaloblastic anemia, neuro Sx (optic neuropathy, subacute combined degneration, paresthesias), glossitis

A

Vit B12 cobalmin

222
Q

Vit def: Scurvy, poor wound healing, hyperkeratotic hair follicles, bone pain (2/2 periosteal hemorrhages)

A

Vit C

223
Q

Vit def: Rickets in kids, osteomalacia in adults, hypocalcemic tetany

A

Vit D

224
Q

IVit def: increased RBC fragility, anemia

A

Vit E

225
Q

Neonatal hemorrhage, Inc PT and aPTT, Vit def: normal BT

A

VIt K

226
Q

Vit def: Dermatitis, enteritis; can be caused by ingestion of raw eggs or antibiotic use

A

Biotin

227
Q

Vit def: MOST COMMON VIT DEF, sprue, macrocytic megaloblastic anemia without neuro

A

Folate

228
Q

Vit def: Weakness, mm cramps, exacerbation hypocalcemic tetany, CNS hyperirritability lead ing to tremors, choreoarthertoid movement

A

Magnesium

229
Q

Vit def: Keshan disease -CMP

A

Selenium

230
Q

“4th degree burn”

A

electrical burns - may injure bone, mm, other internal structures
May have cardiac (vfib) or neuro Sx (seizure, loss of vision)

231
Q

When inpatient for burns

A

2nd degree over >10% body
3rd degree >2% body
2nd or 3rd-face, gentile, hands, major flexion creases

232
Q

When to intubate 3rd and 2nd degree burns

A

> 25% BSA or face

233
Q

Risk factors mortality in burns

A

> 60 yrs
40% BSA
Inhalation
more factors - more risk = 0.3% (0 risk), 3% (1), 33%(2), 90%(3)

234
Q

Salt water vs fresh water drowning

A

Fresh: hypotonic fluid absorbed into vasculature = DECREASED electrolyte conc and RBC lysis
Salt: hypertonic fluid creates osmotic gradient draws fluid from pulm capillaries into alveoli and causes PULMONARY EDEMA and INCREASED electrolyte conc

235
Q

Most common location aspirated items that pass beyond trachea

A

Right main stem bronchus = greater vertical orientation

236
Q

Hypothermia
Temperature?
Risks
EKG

A

<95/35
old, intoxication
EKG: J waves (end of QRS complex), Vtach or Vfib

237
Q

Brown recluse bite
Complication
Tx

A

Possible ulceration and necrosis = ileus, CV collapse, hemolytic anemia, DIC, rhabdo
TX: wound care, dapsone to prevent tissue necrosis

238
Q

When to not use charcoal

A

Metals

Alcohols

239
Q

Antidote CCB

Sx

A

Glucagon, insulin, dextrose (like Beta blockers)

Sx: bradycardia, hypotension

240
Q

Antidote cocaine

Sx

A

Support

Sx: tachycardia, agitation

241
Q

Antidote isopropyl alcohol

Sx

A

Ethanol, fomepizole, dialysis

Sx: decreased consciousness, N, abd pain

242
Q

Antidote sulfonylureas

Sx

A

Octreotide, dextrose

Sx: hypoglycemia

243
Q

Antidote organophosphates

Sx

A

Atropine, pralidoxime, support
Sx: DUMBBELSS
Diarrhea, urination, miosis, bronchospasm, bradycardia, excitation of skeletal mm, lacrimation, sweating, salivation
CAN ABSORB THROUGH SKIN- REMOVE CLOTHING

244
Q

Cardiac arrest lasting longer than ? = brain death

A

10 minutes

245
Q

Low retroperitoneal bleeding - tx

A

Angiography and emoblization if blunt

Lap if penetrating

246
Q

12 Ps neuro exam

A 
Paired ocular movement
Papilledema
Patellar and other reflexes
Paralysis
Paresthesias
Pee (incontinence)
Pressure (blood and intracranial)
Psych (mental status)
Ptosis
Pulse rate
Pupils
Pyramidal signs
247
Q

Sites of significant (1500 mL) blood loss not found on PE

A 
Injury scene
Pleural cavity- See with OCR
Intra-Abd- CT or US
Pelvic-CT
Thighs- X-ray
248
Q

Swan Ganz catheter

Where inserted, where sits, what measures

A

Inserted: left subclvian, right internal jugular
Sits: RA and pulm A
Measures: PCWP = LA P, may measure CO, mixed venous O2 sat, systemic vascular resistance

249
Q

When to use whole blood

A

Severe blood loss- rarely used

250
Q

When to use PRBCS

A

Low HCT 2/2 blood loss or anemia

251
Q

When to use autologous blood?

What is it?

A

Elective surgery or chemo

Blood donated by pt, frozen until needed

252
Q

When to use FFP?

A

Warfarin OD
Clotting factor def
DIC
TTP

253
Q

When to use cryoprecipitate?

What is it?

A

Smaller volume than FFP, preferable to FFP in cases where large transfusion V warranted
-Clotting factor and vWF rich precipitate collected during thawing of FFP

254
Q

When to use platelets

A

Thrombocytopenia not due to rapid platelet destruction

255
Q

When to use clotting factors

A

Specfic deficience - hemophilia

256
Q

Vasopressor anaphylactic shock

A

Epi

257
Q

Vasopressor shcok (Renal sparing)

A

DA

258
Q

Vasopressor CHG

A

Dobutamine

259
Q

Anticholinergic crisis

A 
Blind as a bat- eye mm not focus
Hot as a hare
Mad as a hatter
Dry as a bone
Red as a beet
Dilated pupils and increased HR
(Anti muscarinic and Anti nicotinic meds)
260
Q

Causes disulfiram like reaction

A

Metronidazole

Cephalosporins

261
Q

Aspiration pneumo cause alcoholics

A

Klebsiella

262
Q

Alcoholic: how to not precipitate wernicke

A

Thiamine before glucose- b1 used in glc metabolism

263
Q

Currant jelly sputum

A

Klebsiella

264
Q

Wernicke vs korsakoff

A

AWernicke: acute encephalopatyh - opthalmoplegia, nystagmus, ataxia, or confusion

Korsakoff: chronic psychosis - anterograde amnesia, confabulation, irreversible

265
Q

Area of brain affected by Korsakoff

A

Mamillary bodies and thalamic nuclei

266
Q

Vit def causes wernicke and korsakoff

A

Thiamine/ B1

267
Q

Mineral def: microcytic anemia, koilonychia (spoon shaped fingernails)

A

Iron

268
Q

Mineral def: goiter, cretinism, hypothyroidism

A

Iodine

269
Q

Mineral def: dental caries

A

Fluorine

270
Q

Mineral def: Hypogeusia (dec taste), rash, slow wound healing

A

Zinc

271
Q

Mineral def: menkes disease - Xlinked, kinky hair, mental retardation

A

Copper

272
Q

Mineral def: CMP and mm pain

A

Selenium

273
Q

Mineral def: impaired glc tolerance

A

Chromium

274
Q

Vit toxicity: pseudotumor cerebri, bone thickening, teratogen

A

Vit A

275
Q

Vit toxicity: hypercalcemia, N/V, renal toxicity

A

Vit D

276
Q

Vit toxicity: Necrotizing enterocolitis in infants

A

Vit E

277
Q

Vit toxicity: hemolysis –>kernicterus

A

Vit K

278
Q

Vit toxicity: peripheral neuropathy

A

Vit b6

279
Q

Mineral toxicity: hemochromatosis

A

Iron

280
Q

Mineral toxicity: Myxedema

A

Iodine

281
Q

Mineral toxicity: flurosis with mottling of teeth and bone exostoses

A

Fluorine

282
Q

Mineral toxicity: Wilson

A

Copper

283
Q

Mineral toxicity: Loss of hair and nails

A

Selenium

284
Q

Mineral toxicity: miners ore causes “madness”

A

Manganese

285
Q

Conditions associated with pernicious anemia

What is pernicious anemia

A

What: antiparietal cell Ab destroy ability to secrete IF

DM I, vitiligo, hypothyroidism
Removal of ileum, IBD

286
Q

Tapeworm causes B12 def

A

Diphyllobothrium latum

First Aid Step 2 (22 decks)

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