Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

01 Family Medicine > Emergency Medicine > Flashcards

Emergency Medicine Flashcards

AAFP Board Review lecture: Emergency Medicine Parts 1 & 2

1
Q

What are the two Nonshockable rhythms?

A

  1. Asystole
  2. Pulseless Electrial Activity (PEA)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Per ACLS protocol what are the steps of managment for nonshockable heart rhythms?

A
  1. Continue CPR for 2 minutes, establish an airway and provide oxygen
  2. Give Epinephrine 1 mg IV/IO every 3-5 minutes
  3. Evaluate heart rhythm
  4. If no VT or VF, evaluate and treat reversible causes (5Ts and 6Hs); still continue CPR and epinephrine
  5. If no return of circulation, repeat all steps
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the 5 T’s and 6 H’s to consider with nonshockable rhythms?

A
  1. Toxins
  2. Tamponade
  3. Tension pneumothorax
  4. Thrombosis (cardiac)
  5. Thrombosis (PE)
  6. H+ (acidosis)
  7. Hypothermia
  8. Hypokalemia
  9. Hyperkalemia
  10. Hypovolemia
  11. Hypoxia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the Shockable Rhythms?

A

Ventricular fibrillation

Ventricular Tachycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Per ACLS, What are the mangement steps for a shockable rhythm?

A
  1. CPR for 2 minutes
  2. Epinephrine 1 mg IV/IO every 3-5 minutes
  3. Evaluate rhythm, If VT/VF, Defibrillate 200J x1
  4. CPR for 2 minutes, 5 times
  5. Evaluate rhythm, If VT/VF, Defibrillate again and give epinephrine 1mg
  6. CPR for 2 minutes, 5 times
  7. Evaluate rhythm, if VT/VF defibrillate agian and give amiodarone or lidocaine
  8. If no ROSC, repeat all steps
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Which 3 unstable rhythms are treated with synchronized cardioversion?

A

SVT

Atrial flutter/fibrillation

Monomorphic VT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the general principles of the Good Samartian Law?

A
  1. No legal obligation to provide aid (outside of hospital/clinical setting)
  2. Immunity from malpractive suit*

*except if actions were willful negligence or lack of good faith

*Immunity removed if payment is accepted for aid provided

3.Recipient of aid must not object to aid rendered

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Where does the Good Samaritan law apply?

A

In all 50 states and on airlines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the definition of SIRS?

A

2 or more of the following:

Temperature < 36 C (96.8 F) or >38 C (100.4 F)

Respiratory Rate >20

Pulse >90

WBC < 4,000 or >12,000 or >10% immature cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Define sepsis, severe sepsis and 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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How is septic shock managed and within what time frame?

A

All steps should be completed within 3 hours of presentation

  • Measure Lactate
  • Obtain cultures
  • Administer antibiotics (within 1 hour of presentation)
  • Administer 30 mL/kg of cystalloid for hypotension or lactate >4
  • If hypotensive (MAP <65) after fluids, start norepinephrine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the #1 and #2 causes of trauma deaths in adults?

A
  1. Firearms
  2. Motor vehicle accident
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the #1 and #2 causes of trauma deaths in kids?

A
  1. Motor vehicle accident
  2. Firearms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

At what age can children safely sit in the front seat of a car?

A

13 and older

12 and under always in the backseat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Are car seats based off of age or weight/height recommendations?

A

Weight and height

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which is associated with the poorest outcome in drowning cases?

A) Below freezing water

B) Saltwater aspiration

C) >6 minute submersion

A

C) >6 minute submersion

Water temperatue has no correlation with outcome

No difference in fresh water v. salt water aspiration

*4 sided fencing is the best prevention measure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the most common cause of unintentional death in infants and how can it be prevented?

A

Suffocation

  • remove soft bedding and toys from sleeping area
  • have newborns sleep on their back
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Name 4 types of head trauma

A

Intracerebral hemorrhage

Epidural hematoma

Subdural hematoma

Concussion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What causes epidural hematomas?

A

Usually due to middle meningeal artery rupture

  • associated with skull fracture
  • can present during a “lucid interval” then deteriorate
  • Convex bleed on CT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Which type of head trauma may not be seen on initial CT?

A

Intracerebral hemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What causes subdural hematomas?

A

Tearing of bridging veins between dura and arachnoid

  • Common in elderly and alcoholics
  • Concave, crescent shape bleed on CT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Name and Rank the order of INR reversal agents from longest to fastest

A

Vitamin K (12-24 hours)

FFP (13-48 hours)

Prothrombin Complex Concentrate (3-15 minutes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the ideal treatment for life threatening bleeding in a patient on warfarin?

A

Vitamin K 10mg IV

and

prothrombin complex concentrate (dose based on INR)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Why is FFP used more but less ideal?

A

Cheaper, available in more hospitals

Requires ABO testing

Takes 30-45 minutes to thaw

Takes 12-48 hours to have effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What is the treatment for corneal abrasion?
Topical NSAIDs Topical antibiotics (Grade C) If wearing contacts remove and add pseudomonas abx coverage
26
What treatments are not proven to be beneficial in corneal abrasion?
Topical cycloplegics and mydriatics (no pain relief or benefit) Eye patch (may delay healing)
27
“I got punched in the eye” What are three eye injuries to look out for?
Orbital fracture, Traumatic iritis, Hyphema
28
What common physical exam findings can be found with orbital fractures?
Restricted upward gaze numbness of lower eyelid, lateral side of nose, anterior cheek, upper lip (infraorbital nerve)
29
What is traumatic iritis and how to treat it?
Inflammation of iris and ciliary muscle Analgesia: mydriatics (help with ciliary spasm and light sensitivity)
30
What is this? How to treat?
Hyphema-blood in anterior chamber Elevate bed to 30 degrees, call ophtho Avoid NSAIDs/ASA [https://en.wikipedia.org/wiki/Hyphema]
31
What is the diagnosis and treatment?
Not an emergency, provide reassurance Avoid straining [https://en.wikipedia.org/wiki/Subconjunctival\_bleeding]
32
Differential for Non-traumatic painful eye problem? What intervention can help narrow your differential?
Relieved by proparacaine: conjunctivitis, keratitis, corneal ulcer Not relieved by proparacaine: iritis, uveitis, acute glaucoma
33
Differential for Non-traumatic painless eye problem with vision changes?
Posterior vitreous detachment Rretinal detachment Retinal artery/vein occlusion Ischemic optic neuropathy (temporal arteritis)
34
Differential for blunt chest trauma?
Rib fractures, flail chest hemothorax, pneumothorax pulmonary contusion aortic tear cardiac tamponade
35
What is commotio cordis?
Blunt chest trauma just as the T wave begins before the peak -\> Causes Vfib Classic example: kid hit in chest during baseball game
36
What is Kehr’s sign? In what common situation is it seen?
Left shoulder pain due to blood irritating the diaphragm. Seen with spleen hemorrhage, abdominal trauma
37
What vaccines are needed post splenectomy?
Pneumococcal, HIB, meningococcal
38
What are some causes of Rhabdomylolysis?
Trauma, seizures, burns, drug overdose, exertion, toxins
39
What labs results are seen in rhabdomylolysis?
Urine dipstick (+) blood, UA RBCs 0-2 CPK (2-3x above upper limit of normal) elevated Cr
40
What is the treatment of rhabdomyolysis?
Fluids- crystalloid 500 cc/hour goal urine output 200-300 cc/hour
41
When does compartment syndrome occur?
When perfusion pressure falls below tissue pressure in any anatomic space Pressure \>30 mm Hg
42
What are the signs of Compartment Syndrome?
Pain (first sign) parenthesia poikilothermia (affected limb is colder) Paralysis Pallor Pulselessness
43
When irrigating wounds should sterile or tap water be used?
Irrigation with tap water has been shown to have comparable (or lower) rates of infection compared to sterile water
44
When should tetanus prophylaxis be given in the setting of a new wound?
Give if clean wound and greater than 10 years since last dose Give if dirty wound and greater than 5 years since last dose
45
Can non sterile gloves be used in wound care?
Yes, does not increase infection rate
46
Up to how many hours after the incident can non infected wounds caused by clean objects be closed up?
Up to 18 hours If on face/scalp 24 hours
47
Can lidocaine with epinephrine be used on digits?
Yes if no concern for vascular compromise
48
What is the next step in management if you are concerned about glass in a wound?
X-ray Can identify any glass 2mm or greater
49
Which wounds need prophylactic antibiotics?
High risk site- hand, foot High risk mechanism- bites High risk patient-immunocompromised, prosthetic valve
50
4 month old with diffuse cerebral injury with edema +/- intracerebral bleed and retinal hemorrhages, diagnosis?
Shaken baby syndrome
51
What are 3 principles to remember about child abuse?
1. If they don’t cruise they don’t bruise 2. 82% of rib fractures in kids less than 3 years old are abuse 3. Undiagnosed abuse had a 25% mortality in 2 years
52
20 month old with spiral fracture of the distal tibia, diagnosis? Treatment?
Toddler’s fracture Below knee walking cast for 3 weeks
53
What age range is toddler’s fracture seen most commonly?
9 months to 3 years
54
Radial nerve sensory and motor function?
Sensory- posterior hand thumb to radial half of ring finger Motor-wrist and finger extension
55
Median nerve sensory and motor function?
Sensory- palmer surface thumb to radial half of ring finger Motor- flexion of wrist and fingers Test with OK sign
56
Ulnar nerve sensory and motor function?
Sensory- Anterior and posterior sides of little finger and ulnar half of ring finger Motor- interossesous muscles intrinsically- abduction Test with star trek sign
57
Diagnosis?
Community acquired MRSA
58
What bugs cause non purulent cellulitis?
Strep pyogenes MSSA
59
Common treatments for non purulent cellulitis?
Dicloxacillin, Cephalexin, Doxycycline, Clindamycin
60
Common treatment for purulent cellulitis?
TMP-SMX, Doxycycline, Clindamycin
61
Why do face injuries rarely get infected?
Due to high vascularization
62
What type of bite has the highest risk on infection?
Cat bites Puncture wound that is hard to wash out Higher risk of bone/joint infection
63
Human bite or closed fist injury treatment?
Polymicrobial Copious irrigation, avoid closure, Augmentin x5 days
64
What is the rate of infection in dog bites?
About 5% Higher if bite is on the hands or a deep puncture or an elderly patient
65
Treatment of dog bites?
+/- Augmentin Ok to close
66
Most common bacteria and treatment for Cat bite?
Pasteurella multocida Amoxicillin- Clavulanate
67
Most common bacteria and treatment for Dog bite?
Pasteurella multocida, Capnocytophaga sp, Fuscobacterium, S. aureus, eikenella, EF-4 Amoxicillin- Clavulanate
68
Most common bacteria and treatment for Human bite?
Viridans Streptococci, Bacteroides Amoxicillin- Clavulanate
69
Most common bacteria and treatment for Animal hides, carcasses?
Bacillus anthracis (Anthrax) - skin and lung infection Ciprofloxacin, doxycycline, PCN
70
Most common bacteria and treatment for Fresh water injury?
Aeromonas sp TMP-SMX, Fluroquinolones
71
Most common bacteria and treatment for Salt water injury?
Vibrio fulnificus- skin and GI infection 3rd gen cephalosporin + minocycline/doxycycline or fluoroquinolone
72
Most common bacteria and treatment for Fish tank exposure?
Mycobacterium marinum Hot compresses, minocycline, clarithromycin
73
Most common bacteria and treatment for Hot tube exposure?
Pesudomonas aeruginosa Self limiting, acetic acid compresses, ciprofloxacin
74
What is the characteristic finding in Cat Scratch Disease?
Regional lymphadenopathy: Axillary/epitrochlear, Cervical, inguinal 10% suppurative
75
How is Cat Scratch Disease diagnosed?
Serologic IgG antibodies to bartonella henselae
76
What is the treatment of Cat Scratch Disease?
Self limiting (1-2 months) Do NOT I&D No antibiotics needed Unless immocompromised, use azithromycin
77
Name the rash and associated illness: A flat, oval, large rash with central clearing, no fluctuance, non tender Hx of travel to the NE
Erythema Migrans Lyme disease
78
How is Lyme disease transmitted?
Deer tick Bacteria: borrelia burgdorferi
79
What are the early stages of Lyme disease?
Erythema migrans Cranial nerve 7 neuropathy, radiculopathy, lymphocytic meningitis A-V block
80
What are the late stages of Lyme disease?
Lyme arthritis (mainly large joints like knees) Encephalopathy, peripheral neuropathy
81
Treatment of early Lyme disease?
Doxycycline 100 mg BID x 10 days Other options: Amoxicillin, Cefuroxime, Azithromycin
82
Who should be tested for Lyme disease?
Bell’s palsy with questionable hx Presenting with large swollen joints
83
How does treatment for Lyme disease change if signs of early neurological disease are present?
7th CN palsy - oral tx for 14-21 days Meningitis, radiculopathy- parenteral tx for 10-28 days
84
Treatment length of Lyme carditis?
Oral or parenteral for 21-28 days
85
Treatment length of Lyme arthritis?
Oral tx for 28 days
86
Patient presents with fever, chills, myalgias, headache after starting antibiotic treatment for Lyme disease, what is the best treatment plan?
Contine same antibiotics and treat symptomatically This is Jarisch-Herxheimer Reaction
87
Who needs antibiotic prophylaxis for Lyme disease?
If all of the following are met: Attached tick reliably identified Estimated that tick was attached for more than 36 hours Prophylaxis can be started within 72 hours of tick removal Local rate of infection in these ticks with B. Burgdorferi is greater than 20% Doxycycline not contraindicated
88
What is the regiment for Lyme disease prophylaxis?
One dose of doxycycline (200 mg)
89
Other than Lyme disease, what other 2 illness are transmitted by deer ticks?
Anaplasmosis Babesiosis
90
What is the presentation of human granulocytic anaplasmosis?
Fever, chills, headache Thrombocytopenia, leukopenia, elevated LFTs Symptoms within 3 weeks of tick bite
91
What is the presentation of Babesiosis?
Malaria-like illness Hemolytic anemia, thrombocytopenia, elevated LFTs Caused by intracellular protozoa
92
What is Rocky Mountain Spotted Fever and how does it present?
Organism: Rickettsia rickettsia Transmitted by American dog tick, Rocky Mountain wood tick Flu-like illness, rash within 5-10 days of tick bite, can progress to multisystem involvement
93
What occurs during a Nonimmunologic (Non- IgE) reaction?
Direct release of granules from mast cells and basophils Not a true allergy- does not require sensitization (1st exposure) (contrast, opioids, ASA/NSAIDs)
94
A patient has used their EPi-pen following an allergic reaction, what should you advise them to do next?
Go to ED for follow up Due to concern for "second wave" biphasic reaction (very rare)
95
How does epinephrine treat allergic reaction?
Causes vasoconstriction (Dose 0.3-0.5 cc of 1:1000 IM)
96
How do H1/H2 antagonists treat allergic reaction?
Antihistamine effects - decreases itch
97
How do steroids treat allergic reaction?
They do NOTHING for an acute episode Unclear benefit in preventing recurrence
98
What causes ACE induced angioedema?
Possibly accumulation of bradykinin Not an allergic reaction Can occur day 1 or year 12 (anytime while on ACEi) More common in African Americans and women more than men
99
What is the treatment of ACE induced angioedema?
Supportive (will likely get EPI and steroids in the ED but not necessary)
100
Patient has facial flushing, diaphoresis, hives, edema, diarrhea and peppery taste about 1-2 hours after eating Tuna and mackerel. Diagnosis?
Scombroid poisoning, "Psuedo" Fish allergy Bacteria in contaminated fish converts histidine to histamine
101
How is Scombroid poisoning treated?
H1/H2 blockers Self limiting illness Lasts about 4- 6 hours
102
Your patient reports that hot water feels cold and cold water feels hot along with GI upset for the past several weeks. He notes that he recently went on a tropical vacation to the Great Barrier reef. Diagnosis?
Ciguatera Poisoning Caused by eating reef fish that have accumulated dinoflagellate (barracuda, amberjack, grouper, snapper, sturgeon, king mackerel) Symptoms start 1-6 hours after consumption Can last weeks to months Mixed GI, neurological symptoms, cold sensation reversal
103
What is chilblains/pernio?
Abnormal vascular response to cold Inflammation of skin with pruritus, painful erythematous or violaceous acral lesions
104
What is the difference between frostnip and frostbite?
Frostnip- no ice crystal formation or tissue loss, Pale, painful tissue Frostbite- ice crystal formation, tissue loss Tx: rapid rewarding in circulating water (104-108 F)
105
What is the difference between heat exhaustion and heat stroke?
Heat exhaustion- Temp normal to 104 F, normal Neuro exam, non specific dizzy, headache, weakness, N/V, diaphoresis Heat stroke- Temp \> 105 F with CNS dysfunction, delirium, seizures, looking septic, elderly may have anhydrosis and a more gradual presentation
106
Treatment for heat stroke?
Evaporative cooling, immersion cooling Antipyretics do not work
107
What are the risk factors for heat exhuastion/stroke?
Exogenous heat gain Increased heat production Decreased heat dispersion-dehydration: CVD, very young or old, obesity, improper clothing, skin disease, drugs, anticholinergics
108
For toxic ingestion, what is the best option for gastric decontamination?
Charcoal- decreases absorption by 70% if taken less than 30 minutes from ingestion Decreases by 30 % if taken 30-60 min after ingestion
109
For toxic ingestion what should NOT be used?
Syrup of ipecac Gastric lavage
110
What is the max daily dosing of acetaminophen?
4 grams (toxic dose 150 mg/kg)
111
What are the 4 clinical phases of acetaminophen toxicity?
Stage 1: 0-24 hours, asymptomatic or N/V Stage 2: 18-72 hours, RUQ pain, N/V, LFTs elevated Stage 3: 72-96 hours, Abdominal pain, N/V, jaundice, encephalopathy, renal failure, death Stage 4: 4-14 days, resolution
112
How to diagnose and treat acetaminophen toxicity?
Draw level 4 hours after ingestion Rumack-Matthew nomogram
113
Name the antidote: Acetaminophen
N-acetylcysteine
114
Name the antidote: Aspirin
Alkaline diuresis
115
Name the antidote: Beta blocker
Glucagon
116
Name the antidote: Calcium channel blocker
Glucagon
117
Name the antidote: Digitalis
Fab antibodies
118
Name the antidote: Heparin
Protamine Sulfate
119
Name the antidote: Isoniazid (INH)
Pyridoxine (Vit B6)
120
Name the antidote: Opiates
Naloxone (Narcan)
121
Name the antidote: Organophosphates
Atropine
122
Name the antidote: TCA
Sodium bicarb
123
Describe the toxidrome of anticholinergic overdose
Hot as a hare- hyperthermia Blind as a bat- Mydriasis Dry as a bone- thirsty, decreased salivation Red as a beet- flushing, vasodilation Mad as a hatter- delirium, agitation, confusion
124
What medications have anticholinergic effects?
Antihistamines Antiparkinson Antipsychotics Antiemetics (phenothiazines) Antidepressants (TCAs) Antispasmodics
125
Describe the toxidrome of serotonin syndrome
Cognitive- agitation, anxiety, drowsy, delirium, headache, seizures Autonomic dysfunction- tachycardia, arrhythmia, HTN, hyperthermia, diaphoresis, diarrhea, nausea Neuromuscular- restless, tremor, hyperreflexia, dysarthria, ataxia, myoclonic jerk/twitching
126
What medications have serotonergic effects?
SSRIs, MAOIs Higher risk of serotinin syndrome if combined with meperidine, cocaine, dextromethorphan, venlafaxine, amphetamine, linezolid
127
What is the treatment of serotonin syndrome?
Cyproheptadine
128
Compare serotonin syndrome, anticholinergic toxicity, neuroleptic malignant syndrome: _Skin exam_
SS- diaphoretic AC- dry NMS- diaphoretic, pallor
129
Compare serotonin syndrome, anticholinergic toxicity, neuroleptic malignant syndrome: _muscular tone_
SS- increased tone AC- normal tone NMS- lead pipe rigidity
130
Compare serotonin syndrome, anticholinergic toxicity, neuroleptic malignant syndrome: _reflexes_
SS- hyperreflexia AC- normal NMS- bradyreflexia
131
Describe Type I hypersensitivity reactions
Immediate hypersensitivity IgE mediated Effects within hours Ex: anaphylaxis Antigen binds to IgE on mast cells and basophils -\> degranulation -\> increased vascular permeability, smooth muscle constriction
132
Describe Type II hypersensitivity reactions
IgG, IgM, cytotoxic mediated Effects from hours to days IgG and IgM antibodies react to antigens on cells surfaces Ex: blood transfusion reactions, ITP, hemolytic anemias
133
Describe Type III hypersensitivity reactions
Immune complex mediated Effects days to weeks antigen-antibody complex triggers complement system Ex: post streptococcal glomerulonephritis, serum sickness
134
Describe Type IV hypersensitivity reactions
T cell mediated Effects days to weeks Ex: PPD, poison ivy

01 Family Medicine (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions