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EOR Exams > Emergency Medicine EOR Exam Cards > Flashcards

Emergency Medicine EOR Exam Cards Flashcards

1
Q

Presentation of Acute bacterial endocarditis

A

Fever
Often IVDU
New systolic heart murmur (regurg)

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2
Q

Causitive agents of bacterial endocarditis

A

Acute - S. aureus
Subacute - S. viridans

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3
Q

3 Major Dukes criteria for bacterial endocarditis

A

Vegetation on Echo
2 blood cultures 12 hours apart
New regurg murmur

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4
Q

Difference of causitive agent and vegetated valve for IVDU v. non-IVDU in bacterial endocarditis

A

Drug users: Staphylococcus w/ tricuspid veggies
Non-drug users: Streptococcus w/ mitral veggies

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5
Q

4 Minor DUke criteria

A

Risk factor,
Fever 100.5,
Vascular phenomena (splinter hemorrhages, Janeway lesions: painless, palms and soles), Immunologic phenomena (Osler node: raised painful tender; Roth spots: exudative lesions on the retina)

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6
Q

Management for bacterial endocarditis including prosthetic valve and prophylaxis for procedures

A

IV vancomycin or ampicillin/sulbactam PLUS aminoglycoside
Prosthetic valve: Add rifampin
High-Risk patients prophylaxis for procedures: Amoxicillin

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7
Q

Presentation and management of stable angina

A

Predictable pain relieved by rest or NTG
ST depression of 1mm+ on stress test
Agiography for Ddx
Beta blockers and NTG to treat, angioplasty if severe

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8
Q

Presentation of unstable angina

A

Previously stable and predictable symptoms of angina that are now more frequent, increasing, or present at rest

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9
Q

Diagnosis and mangement of unstable angina

A

Admit for continuous cardiac monitoring
Stress test if symptoms resolve
MONA
Antiplatelet, BB, LMWH

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10
Q

Presentation and management of prinzmetal angina

A

Smoking is #1 risk factor, cocaine abuse also risk factor
May see U waves
No reduction in exercise capacity
Transient ST elevation

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11
Q

Management for prinzmetal angina

A

Stress test or heart cath (no clot found)
IV nitrates
Propranolol = Contrindicated
CCB and long acting nitrates to treat

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12
Q

Common complaints for heart arrhythmias

A

SOB and Chest Pain

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13
Q

Premature atrial contractions

A

Early P waves - may not have a QRS

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14
Q

Atrial fibrillation

A

Irregular heart rate with many foci leading to irregular P waves

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15
Q

Atrial flutter

A

One foci, sawtoothed P waves between QRS complexes. More regular than A fib

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16
Q

Paroxysmal supraventricular tachycardia

A

Regular, fast (160 to 220 beats per minute) heart rate that begins and ends suddenly and originates in atria

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17
Q

Accessory pathway tachycardia

A

An accessory pathway is an additional electrical conduction pathway between two parts of the heart most common is WPW. The impulse from the SA node takes an accessory pathway to the AV node and can result in tachycardia. Shorten PR interval <.20

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18
Q

AV nodal reentrant tachycardia

A

Most common type of supraventricular tachycardia.
Heart rates 100-250 bpm regular rhythm Late P waves - may be hidden within the QRS

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19
Q

Management of narrow tachycardic arrhythmias

A

Slowed up with either calcium channel blockers or beta-blockers, adenosine, procainamide, or cardioversion

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20
Q

Management for Wide tachycardic arrhythmias

A

Cardioversion or amiodarone

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21
Q

Becks triad for cardiac tamponade

A

Hypotension
Muffled heart sounds
JVD

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22
Q

Other signs of cardiac tamponadeq

A

Pulsus alternans
Pulsus paradoxus (large drop in BP ~10mmHg with inspiration)

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23
Q

Dx and management of cardiac tamponade

A

Echo showing diastolic collapse of the right ventricle (an effusion will NOT show collapse)
Pericardiocentesis to treat

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24
Q

5 emergent causes of chest pain

A

Pericarditis
ACS/MI
PE
Pneumothorax
Aortic Aneurism/Dissection

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25
Q

5 tests to order for chest pain

A

EKG
Troponin I
BNP
CXR
CBC/CMP

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26
Q

Definition of ventricular tachycardia

A

Three or more consecutive VPBs, displaying a broad QRS complex tachyarrhythmia

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27
Q

EKG of a LBBB

A

Bunny ears in V4-6
On side of block

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28
Q

EKG of RBBB

A

Bunny ears in V1-3
On side of block

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29
Q

Presentation of an NSTEMI

A

Elevated troponins WITHOUT ST elevation or Q waves
Subendocardial infarct without complete blockage

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30
Q

Troponin as a cardiac biomarker

A

Most sensitive and specific, appears at 2-4 hours, peaks at 12-24 hours, and lasts for 7-10 days

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31
Q

CK-MB as a cardiac biomarker

A

Appears at 4-6 hours, peaks at 12-24 hours, and returns to normal within 48-72 hours

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32
Q

Myoglobin as a cardiac biomarker

A

Less commonly used appears at 1-4 hours. The peak is 12 hours and returns to baseline levels within 24 hours

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33
Q

Management for NSTEMI

A

Beta Blockers + NTG + aspirin and clopidogrel + heparin + ACEI + statins + reperfusion
NO thrombolysis
Less time sensitive than a STEMI

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34
Q

How a STEMI is different from an NSTEMI

A

Full thickness infarct with ST elevation/q waves along with biomarker elevation

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35
Q

EKG finding for anterior MI

A

Q waves and ST elevation in leads I, AVL, and V2 to V6

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36
Q

EKG finding for inferior MI

A

Q waves and ST elevation in leads II, III, and AVF

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37
Q

EKG finding for lateral MI

A

ST elevation in the lateral leads (I, aVL, V5-6). Reciprocal ST depression in the inferior leads (III and aVF)

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38
Q

EKG findings for posterior MI

A

ST depressions in V1 to V3

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39
Q

Time windows for STEMI PCI and Thrombolytics

A

Give ASA and Plavix immediately
PCI - 90 minutes
THrombolytics - 30 minutesif PCI not available

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40
Q

6 Absolute contraindications to thrombolytic use for an MI

A

Prior intracranial hemorrhage (ICH)
Known structural cerebral vascular lesion.
Known malignant intracranial neoplasm.
Ischemic stroke within 3 months.
Suspected aortic dissection.
Active bleeding or bleeding diathesis (excluding menses)

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41
Q

6 Cardiac Causes of DOE

A

Coronary heart disease
Heart failure
Myocarditis
Pericarditis
MI
ACS

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42
Q

8 Pulmonary causes of DOE

A

Asthma
COPD
Pneumonia
Pulmonary Hypertension
Obesity, kyphosis, scoliosis (restrictive lung disease)
Interstitial lung disease
Drugs (e.g., methotrexate, amiodarone) or radiation therapy, cancer
Psychogenic causes

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43
Q

6 potential causes of edema

A

CHF
Kidney disease
Liver disease
Chronic venous disease
Pregnancy
Drugs
Travel

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44
Q

Four treatments for edema

A

Reduce salt intake
Lasix HTCZ
Compression stockings
Body position (elevate legs)

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45
Q

2 medications that may cause edema

A

CCB
Alpha 1 blockers -zosin (ie. doxazosin, prazosin…)

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46
Q

Presentation of heart failure

A

DOE and then with rest
Chronic non-productive cough after lying down
Fatigue
Orthopnea
Nocturnal dyspnea
Nocturia

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47
Q

SIgns of heart failure

A

Cheyenne stokes breathing (cyclic)
Edema
Rales
S3/S4
JVD
Cyanosis/coolness
Ascites

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48
Q

Diagnostics for CHF

A

Elevated BNP (lower in obese)
Kerley B lines on CXR
Echo is BEST TEST

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49
Q

NYHA heart classes

A

I - No limitation
II - Slight limitation
III - Marked limitation
IV - Dyspnea at rest

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50
Q

Management for systolic CHF

A

HFrEF
ACEI
BB
LOOP DIURETIC

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51
Q

Management for diastolic HF

A

HfpEF
NO LOOP DIURETIC
ACEI and BB/CCB

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52
Q

Definition and management of hypertensive urgency

A

BP 180/120+ Without end organ damage
Immediate reduction not needed - start on 2 drug regimen with outpatient follow up

53
Q

8 Indications of end organ damage (meaning hypertensive emergency)

A

Retinal hemorrhages
Papilledema,
Encephalopathy,
Acute and subacute kidney injury,
Intracranial hemorrhage,
Aortic dissection,
Pulmonary edema,
Unstable angina or MI

54
Q

General management of hypertensive emergency

A

Reduce BP in first hour by 10-20% and then and additional 5-15% over the next 23 hours
Targets are Under 180/120 in first hour
and under 160/110 in the next 24 hours

55
Q

Drug of choice for hypertensive urgency

A

Clonidine

56
Q

Drug of choice for hypertensive emergency

A

Sodium nitroprusside

57
Q

Indication to reduce BP to 140 in the first hour

A

severe preeclampsia, eclampsia, or pheochromocytoma crisis

58
Q

Indication to reduce BP to 120 in first hour

A

Aortic DIssection

59
Q

Drug of choice for hypertensive retinopathy

A

Clevidipine or Sodium Nitroprusside

60
Q

Presentation and management of hypotension

A

Altered mental status, SBP under 90
Capillary wedge pressure over 15
Fluid and pressors

61
Q

Definition and management of orthostatic hypotension

A

A drop of > 20 mm Hg systolic, 10 mmHg diastolic, 15 BPM increase in pulse 2-5 minutes after a change from supine to standing

62
Q

Indication the orthostatic hypotension is due to low blood volume

A

Associated with HR increase >15 BPM

63
Q

7 causes of orthopnea:
3 Cardiac
2 Pulm
2 Other

A

Cardiac causes:
CHF
MI
Arrhythmias (atrial fibrillation)

Pulmonary causes:`
COPD and cor pulmonale
Pulmonary hypertension

Kidney/Liver failure
Obesity

64
Q

Arrhythmias causing palpitations - 3

A

Atrial fibrillation
Wolff-Parkinson-White (WPW) syndrome
Paroxysmal supraventricular tachycardia

65
Q

Other cardiac conditions causing palpitations - 3

A

Sick sinus syndrome
MVP
MI

66
Q

Endocrine and metabolic causes of palpitations - 4

A

Hypokalemia or Hypomagensemia
Hyperthyroid
Pheochromocytoma
T1DM Hypoglycemia

67
Q

Drugs causing palpitations - 3+6

A

Cocaine
Amphetamines
Caffeine
(digoxin, beta-blockers, calcium channel antagonists, hydralazines, diuretics, minoxidil)

68
Q

Pericardial effusion presentation

A

Similar to paricarditis with low voltage EKG, electrical alternans, and distant heart sounds
Relieved when sitting forward
Worsens with inspiration
Fluid on Echo
Treat with pericardiocentesis if large

69
Q

Presentation of peripheral vascular disease

A

Hair loss, pallor, cyanosis, brittle nails, black dray ulcers. Hx of atherosclerosis

70
Q

Diagnostics of peripheral vascular disease

A

ABI <0.9
Angiography is GOLD STANDARD

71
Q

Definitive treatment for peripheral vascular disease

A

Arterial bypass

72
Q

Medication for peripheral vascular disease

A

Cilostazol
Aspirin
Plavix
Statins

73
Q
A
74
Q

Syncope - primary cause and technical definition

A

Not enough blood to brain
Out for seconds with no resuscitation
Loss of postural tone and consciousness

75
Q

Workup for syncope vs. presyncope

A

SAME WORKUP

76
Q

Differential and workup for syncope

A

Cardiac - Start with this
Neuro - Consider after
Ask to describe dizziness for vertigo vs. lightheadedness

77
Q

Seizure vs. True Syncope

A

Seizure has a post-ictal phase, true syncope does not

78
Q

Presentation of vasovagal syncope

A

Fainting after seeing blood, etc., w/ prodrome (pallor, nausea, warmth, diaphoresis, blurred vision)
60% of patients with a heart condition

79
Q

Presentation of cardiac syncope

A

No prodrome and w/ exercise
Syncope while supine

80
Q

Presentation of reflex syncope

A

After exercise with a drop in HR and BP

81
Q

Presentation of psychogenic syncope

A

Long lasting, no post ictal phase - suspect

82
Q

3 potential associated signs of syncope

A

HA - SAH
Chest Pain - MI, PE
Fever - Sepsis

83
Q

QT and syncope

A

Check for meds - Zophran, Psych, Macrolides, FQ, Antipsychotics, Diuretics, nDHP-CCB
May have gone into torsades
EKG of 450+ is concerning

84
Q

Physical exam for syncope

A

Head and Neck Trauma
Skin Turgor
Abdomen for AAA
Rectal exam for bleed

85
Q

Who gets a CT for syncope

A

Neuro deficit
Trauma to head - Canadian CT rules

86
Q

How long should syncope last

A

Less than a minute

87
Q

Orthostatic syncope presentation

A

Change in position causes BP to drop causing a reflexive tachycardic response

88
Q

Carotid sinus syncope

A

Tight collar, Head turn, Shaving - leading to push on artery
Hx of atherosclerosis
Use carotid massage to dx
Midodrine

89
Q

Positive dx for carotid sinus syncope

A

Decrease of SBP by 50+ upon carotid sinus massage

90
Q

ED care for aortic stenosis

A

Avoid: Nitro, BB, CCB
Admit for TAVR

91
Q

Murmur of aortic stenosis

A

Systolic ejection crescendo-decrescendo at the right upper sternal border
1st post with radiation to the neck
Split S2

92
Q

Presentation of Aortic stenosis

A

Murmur is worse with squatting and expiration
Murmur decreases with valsalva
Syncope and LVH

93
Q

Murmur of Aortic regurg

A

Early diastolic, soft-blowing decrescendo murmur with a high-pitch quality, especially when the patient is sitting and leaning forward heard at the left lower sternal border

94
Q

Presentation of aortic regurg

A

Increases with squatting, decreases with valsalva
History of congenital heart defect or rheumatic fever

95
Q

Murmur of mitral stenosis

A

Rumbling diastolic murmur with a split s1 that occurs following an opening snap. The rumbling is loudest at the start of diastole and is heard best at the left sternal border and apex

96
Q

Presentation of mitral stenosis

A

Opening snap and murmur at LLSB/Apex
Left atrial hypertrophy - golden arches P wave on EKG lead II
SOB and CHF from fluid backup
Increase with squatting, decreases with valsalva

97
Q

Murmur of mitral regurg

A

Blowing HOLOSYSTOLIC murmur at APEX with a SPLIT S2, radiates to the axilla

98
Q

Presentation of mitral regurg

A

Previous STEMI
Low BP with tachycardia
Lung crackles

99
Q

Presentation of AAA

A

Pulsatile abdominal mass
Flank pain
Hypotension

100
Q

Management of AAA

A

Surgical repair if > 5.5 cm or expands > 0.6 cm per year
Monitor annually if > 3 cm.
Monitor every 6 months if > 4 cm
Beta-blockers

101
Q

Presentation and Diagnostics for Aortic Dissection

A

Tearing chest pain radiating to the back
Widened mediastinum on CXR

102
Q

Management for ascending and descending aortic dissections

A

Ascending aorta- Surgical emergency
Descending aorta- Medical therapy (beta-blockers) unless complications are present

103
Q

6 P’s of arterial occlusion

A

Pain, Pallor, Pulselessness, Paresthesia, Paralysis, Poikilothermia

104
Q

2 MCC of thrombus formation

A

A-fib
Mitral Stenosis

105
Q

Diagnosis and management for arterial occlusion

A

Angiography is gold standard
Treat with IV heparin if not limb-threatening then call the vascular surgeon for angioplasty, graft, or endarterectomy

106
Q

Presentation of thrombophlebitis

A

Spontaneous or following IV/PICC line trauma
Pain, erythema, induration, palpable cord

107
Q

Diagnosis and management of thrombophlebitis

A

Duplex ultrasound Gold Standard for diagnosis
Treatment: Symptomatic: NSAIDs, warm compress

108
Q

Presentation of cervical sprain

A

Stiffness/pain in the neck; presents with paraspinal muscle tenderness and spasm and + Spurling test

109
Q

Spurling test

A

Passive cervical extension, Ipsilateral rotation, and Axial compression with pain down the ipsilateral side

110
Q

Management of a cervical sprain

A

Soft cervical collar (2-3 days), application of ice /heat, analgesics, gentle active ROM soon after injury

111
Q

Presentation of thoracic or lumbar back strain

A

Axial back pain with difficulty bending
No radicular symptoms - pain below the knees

112
Q

Management for a thoracic/lumbar back strain

A

Bed rest < 2 days + NSAIDs ± muscle relaxants if no red flag symptoms

113
Q

6 red flag symptoms of back pain

A

You’ve Been in Pain for Over a Week
Your Pain Extends to Other Body Parts
You Have Numbness, Tingling or Weakness
You Have Pain After an Accident
Your Pain is Worse at Certain Times or in Certain Positions
You’re Having Problems with Your Bowels or Urination

114
Q

Strain

A

Involves muscles/ligaments

115
Q

Sprain

A

Involves tendons

116
Q

Olecranon bursitis

A

Scholar’s elbow
Pain or fever may suggest septic bursitis
Gout also possible etiology

117
Q

Management of olecranon bursitis

A

NSAIDs, Rest, Abx, steroid injection, surgery

118
Q

Prepatellar bursitis

A

Housemaid’s knee
Pain with direct knee pressure (ie. kneeling)
Often septic in wrestlers

119
Q

Management of prepatellar bursitis

A

Compression, NSAID, aspiration, immobilization

120
Q

Presentation of subacromial bursitis

A

Often not associated with trauma
Pain with motion and rest
Similar to rotator cuff impingement

121
Q

3 indications to aspirate subacromial bursitis

A

Fever
Diabetes
Immune compromise

122
Q

Presentation of patellar tendonitis

A

Anterior knee pain
Basset’s sign - tenderness to palpation at the distal pole of the patella in full extension and no tenderness to palpation at the distal pole of the patella in full flexion

123
Q

Management of patellar tendonitis

A

Ice, Rest, NSAID
Steroids - CONTRAINDICATED tendon rupture

124
Q

Presentation of biceps tendonitis

A

Pain in the bicipital groove
Anterior shoulder pain and pain with resisted supination of the elbow
Popeye deformity = rupture

125
Q

Management of biceps tendonitis

A

NSAID, PT, Steroids, surgery if refractory

126
Q

2 special tests for biceps tendonitis

A

Speed test: Pain elicited in the bicipital groove when the patient attempts to forward elevate shoulder against examiner resistance while the elbow extended, and forearm supinated. Positive if the pain is reproduced. May also be positive in patients with SLAP lesions.

Yergason’s test: Elbow flexed 90 degrees, wrist supination against resistance. Positive if the pain is reproduced.

127
Q

Presentation of cauda equina

A

Large midline disk herniation compressing several nerves
Saddle anesthesia, incontinence, paralysis

128
Q

Diagnosis and management of cauda equina

A

MRI
SUrgical emergency

129
Q
A

EOR Exams (5 decks)

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