Emergency Medicine2 Flashcards
Q200. bilateral facet dislocation…? stable?
A200. flexion injury; subluxation of the dislocated vertebra; very unstable
Q201. Cullen’s sign? Gray-Turner’s sign?
A201. ecchymosis of the abdomen signifies late retroperitoneal hemorrhage; Gray-Turner’s: same, but of the flanks
Q202. 12% of patients with hyperthyroidism will suffer…?
A202. Pathologic fracture
Q203. serious associated injuries are present in up to 95% of patients with a dislocated…?
A203. hip
Q204. a pt with a posterior hip dislocation holds the hip how?
A204. flexed, adducted, and internally rotated
Q205. most common ortho injury seen in the ED?
A205. knee - in particular, MCL (medial collateral ligament)
Q206. 50% of patients with ACL injury have a concomitant…?
A206. Meniscal tear
Q207. lachman’s test?
A207. flex the knee to 30 degrees and pull anteriorly on the tibia
Q208. donahue’s unhappy triad?
A208. ACL, MCL, and medial meniscus tear
Q209. Injury to the ________ occurs in 50% of knee dislocations…
A209. popliteal artery
Q210. injury to the tibial nerve causes…?
A210. inability to stand on tiptoes
Q211. which ankle fracture warrants a careful radiologic examination? of what specifically?
A211. medial malleolar fracture; proximal shaft of the fibula (Maisoneuve fracture)
Q212. 10% of calcaneal fractures are associated with…?
A212. lumbar fractures
Q213. when do you call for an ortho consult?
A213. compartment syndrome; irreducible fractures; circulatory compromise; open fracture; anything that requires surgery
Q214. what is the most frequent complication of orotracheal intubation?
A214. Right main stem bronchus intubation
Q215. Patients with COPD, asthma, or CHF that are awake but cannot remain in the supine position may be intubated how…?
A215. Nasotracheal intubation
Q216. Most serious complication of nasotracheal intubation?
A216. Intracranial passage of the tube
Q217. advance airway adjuncts?
A217. fiberoptic intubation; retrograde intubation; combitube; laryngeal mask airway
Q218. What is the preferred surgical airway for kids? Adults?
A218. Kids - needle cricothyroidotomy; Adults - surgical cricothyroidotomy
Q219. if an airway will be needed for greater than 2-3 days, a surgical cricothyoidotomy should be converted to…?
A219. a tracheostomy
Q220. slit lamp exam consists of…?
A220. evaluate the integrity of the cornea, conjunctiva, and the anterior chamber; fluorescein to light up corneal defects
Q221. central retinal artery occlusion occurs in which people?
A221. men in their 60s
Q222. fundoscopic exam in central retinal artery occlusion?
A222. pale retina with cherry red fovea
Q223. what is amaurosis fugax?
A223. type of TIA - sudden vision loss (Shade over eye), transient, due to carotid-origin embolic shower
Q224. classic triad of optic neuritis?
A224. marcus gunn pupil; central vision loss; red vision desaturation
Q225. flashing lights, spider webs, or floaters that interfere with vision may be a sign of…? what meds should NOT be given?
A225. retinal detachment; DON’T anticoagulate
Q226. painful red eye - most often due to which things?
A226. conjunctivitis, corneal abrasion, or foreign body
Q227. which conjunctivitis produces copious DC?
A227. gonorrhea
Q228. punctuate lesions in conjunctivitis?
A228. viral cause
Q229. treatment of conjunctivitis?
A229. broad spectrum antibiotics, pain meds
Q230. soft contact wearers are especially prone to infection by.?
A230. pseudomonas
Q231. severe unilateral eye pain, decreased visual acuity and photophobia…?
A231. iritis
Q232. treatment of iritis?
A232. cycloplegic such as homatropine(not a mydratic)
Q233. severe unilateral HA, eye pain, N/V assoc with loss of vision….?
A233. narrow angle glaucoma
Q234. which drugs decrease aqueous production?
A234. acetazolomide and topical b blockers
Q235. which chemicals causes coag necrosis? liquefaction necrosis?
A235. acids; alkali
Q236. treatment of chemical burn…
A236. IRRIGATE
Q237. what’s hyphema?
A237. blurred vision after blunt trauma (dull eye pain)… bleeding
Q238. basic approach to all toxicity patients in the ED?
A238. ABCs; Decontamination; Elimination; Antidotes
Q239. key things on physical exam for toxicity exposures….?
A239. Vital signs; pupils; toxidromes; autonomic signs; motor signs; mental status; skin
Q240. describe anticholinergic toxidrome?
A240. “mad as a hatter, dry as a bone, red as a beet, hot as a stove.” Also - decreased GI motility, urinary retention, mydriasis.
Q241. describe muscarinic toxidrome?
A241. DUMBELLS
Q242. narcotic toxidrome?
A242. respiratory depression,; hypotension,; depressed sensorium, miosis
Q243. sympathomimetic toxidrome? compare with anticholinergic toxidrome?
A243. very similar except sympathomimetic involves diaphoresis
Q244. withdrawal toxidrome?
A244. agitation,; hallucination,; mydriasis,; diarrhea,; cramps,; lacrimation,; tachycardia,; insomnia,; seizures
Q245. major toxic effect of acetaminophen?
A245. metabolite NAPQI causes centrilobular hepatocellular damage
Q246. treatment of acetaminophen toxicity?
A246. 4 hour level on rumack-matthew nomogram,; activated charcoal,; N-acetyl-cysteine (to regenerate glutathione)
Q247. methanol toxicity?
A247. formic acid metabolite - causing a gap acidosis and direct optic nerve toxicity
Q248. treatment of ethylene glycol toxicity?
A248. 4MP or EtOH
Q249. which drugs can cause anticholinergic syndromes? tx?
A249. antihistamines, antipsychotics, TCAs… treatment - physostigmine
Q250. symptoms of calcium channel blocker toxicity? tx?
A250. bradycardia and hypotension; treatment - CaCl2, glucagon, epinephrine, DA
Q251. CO toxicity symptoms
A251. HA,; N/V,; flu-like symptoms,; CNS depression,; tachy,; hypotension
Q252. treatment of CO toxicity?
A252. 100% O2
Q253. GHB?
A253. date rape drug - euphoric and amnestic effects
Q254. refractory seizures could be caused by what toxicity?
A254. INH
Q255. Organophosphates can cause which toxidrome?
A255. muscarinic
Q256. naloxone?
A256. opioid antagonist
Q257. standard of care for salicylate poisoning?
A257. activated charcoal; also consider alkalinization of urine and blood with bicarb
Q258. benzo receptor antagonist that can rapidly reverse coma from benzo OD…? what’s the problem with this drug/
A258. flumazenil; can lower the seizure threshold in pts with TCA OD and induce benzo withdrawal
Q259. loxosceles bites can be treated with…?
A259. dapsone
Q260. signs and symptoms of TCA OD?
A260. anticholinergic sx,; cardiac dysfunction,; intractable seizures,; and hyperthermia
Q261. treatment of TCA toxicity?
A261. decontamination with MDAC; Sodium bicarb administration; Benzos for seizure management; Alpha agonists for hypotension
Q262. prerenal failure due to..?
A262. decreased renal perfusion; (volume depletion, low CO, abnormal renal hemodynamics)
Q263. most common cause of intrinsic renal failure?
A263. longstanding HTN
Q264. majority of hospital-assoc episodes of ARF are caused by…?
A264. ATN
Q265. postrenal failure caused by?
A265. obstructive uropathy
Q266. FENA <1 in which condition?
A266. Prerenal failure
Q267. Urine Na <20 in which condition?
A267. Prerenal failure
Q268. treatment of prerenal failure?
A268. volume replacement, d/c offending meds
Q269. intrinsic RF treatment?
A269. monitor fluid status,; restrict protein,; correct electrolyte abnormalities
Q270. dispo for patients with ARF?
A270. admit
Q271. what drugs can cause ARF in pts with renal artery stenosis?
A271. ACE inhibitors
Q272. #1 cause of death in 1-44 year olds?
A272. Trauma (specifically, MVCs)
Q273. Preparation for a trauma case includes?
A273. History from EMTs; Prep the trauma bay; Airway box; O2 and suction; IVF and supplies
Q274. Indications for intubation?
A274. GCS <8; Inadequate breathing; Unable to protect airway
Q275. Chin lift is contraindicated if…?
A275. A C-spine injury is suspected
Q276. Radial pulse should have a BP of at least…? Femoral?
A276. 80 mmHg; 70
Q277. what % of ECF is plasma?
A277. 40181
Q278. which drug is an ineffective pressor in hypovolemic patients?
A278. dopamine
Q279. GCS consists of which 3 categories?
A279. eye opening,; verbal response,; moto response