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Emergency Medicine > EOR Topics to Review > Flashcards

EOR Topics to Review Flashcards

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1
Q

What are contraindications to using thrombolytics for stroke treatment?

A
  • TCP < 100,000
  • Active bleed
  • GI ulcer or bleeding within the last 3 weeks
  • Ischemic stroke or MI within the last 3 months
  • Known bleeding disorder
  • Major surgery (intracranial or intraspinal) within the last 3 months
  • History of ischemic stroke
  • INR > 1.7, PT > 15 s, aPTT > 40 s while on ACT
  • Evidence of hemorrhage on imaging
  • SBP must be < 185, DBP must be < 110
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2
Q

Description of subdural vs epidural hematoma on imaging

A

Epidural: lens/lemon shaped hyperdensity, does NOT cross suture lines
Subdural: crescent shaped hyperdensity, CAN cross suture lines

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3
Q

What is a situation in which you should start empiric therapy for meningitis before doing the lumbar puncture?

A

Always start empiric therapy after performing a lumbar puncture UNLESS the pt is showing signs of ICP and warrants a head CT –> waiting to start abx post CT delays care too long

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4
Q

What are clinical signs of ICP?

A

Papilledema (swelling of optic disc on fundoscopic exam)
AMS
Lethargy
Seizures
HA
Peds: high pitched cry, bulging fontanelle

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5
Q

What signals ICP on imaging?

A

Mass effect (cerebral shifting to one side)

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6
Q

MOI for anterior cord, central cord, and Brown Sequard injuries

A

Anterior: flexion or ischemia
Central: hyperextension
Brown Sequard: penetrative trauma

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7
Q

Clinical manifestations of spinal cord injuries

A

Anterior: loss of sensation, pain/temp and motor ability below injury/lesion level, preserved proprioception and vibration
Central: sensory and motor deficits in UE > LE
Brown Sequard: ipsilateral loss of motor, vibration and proprioception at the level of the injury with contralateral loss of pain and temp 2-3 levels below the lesion

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8
Q

MG versus LE pathophys

A

MG = autoimmune destruction of postsynaptic membrane ACh receptors (WORSE with movement)
LE = destruction of presynaptic membrane ACh receptors (BETTER with movement)

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9
Q

C4/C5 radiculopathy (C5 root) manifestations

A

Pain - medial scapula, lateral upper arm
Weakness - deltoid, supra/infraspinatus
Sensory loss - lateral upper arm
Reflex loss - brachioradialis, “supinator” reflex

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10
Q

C5/C6 radiculopathy (C6 root) manifestations

musculocutaneous n. involvement

A

Pain - lateral forearm, thumb, index finger
Weakness - biceps, brachioradialis, wrist extensors
Sensory loss - lateral forearm and thumb
Reflex loss - biceps reflex

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11
Q

C6/C7 radiculopathy (C7 root) manifestations

A

Pain - medial scapula, posterior arm, dorsum of forearm, third finger
Weakness - triceps, wrist flexors, finger extensors
Sensory loss - posterior forearm, middle finger
Reflex loss - triceps reflex

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12
Q

C7/T1 radiculopathy (C8 root) manifestations

A

Pain - shoulder, ulnar side of forearm, fifth finger
Weakness - thumb flexors, abductors, intrinsic hand muscles
Sensory loss - fifth finger
Reflex loss - N/A

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13
Q

First line gout treatments

A

Acute management:
NSAIDs (naproxen, indomethacin) + ice
Colchicine (CI if severe kidney disease)
Steroids (PO or IV prednisone depending on severity, caution in pts with DM)

Chronic management:
Allopurinol
Probenecid (uricosuric, helps increase renal excretion of uric acid)

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14
Q

Kanavel criteria for flexor tenosynovitis

A

1) Tenderness along the course of the flexor tendon
2) Fusiform or symmetrical swelling of the finger
3) Pain with passive extension
4) Flexed posture of the finger

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15
Q

Flexor tenosynovitis treatment

A

IV abx (vanco and broad spectrum penicillins)

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16
Q

Olecranon bursitis vs septic arthritis of elbow

A

Olecranon bursitis – localized swelling of olecranon bursa, not associated with nearly as much erythema, systemic signs of infection or warmth to palpation –> DOES NOT REQUIRE JOINT TAP, treat with NSAIDs
Septic arthritis – swelling, warmth, fever, tenderness to palpation, SIRSy –> REQUIRES JOINT TAP, traet with abx

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17
Q

Muscle sprain treatment of choice

A

NSAIDs + rest

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18
Q

What physical exam finding is consistent with supraspinatus tendonitis?

A

Hawkins-Kennedy test – assess impingement
Jobes (empty can) test – best assesses supraspinatus function in isolation

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18
Q

Physical exam findings of AC joint separation versus anterior shoulder dislocation

A

Anterior shoulder dislocation – loss of rounded aspect of shoulder, externally rotated and slightly abducted, prominent acromion

AC joint separation – tenderness to palpation over AC joint

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19
Q

Which murmur is most associated with rheumatic heart disease/fever?

A

Mitral stenosis

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20
Q

Describe the findings of mitral stenosis

A

Mid diastolic, rumbling murmur with an opening snap

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21
Q

How can you distinguish afib with RVR versus SVT on EKG?

A

Afib with RVR = irregular rhythm
SVT = regular rhythm

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22
Q

First line pharmaceutical mgmt for SVT vs afib with RVR

A

SVT = adenosine 6 mg IV
Afib with RVR = metoprolol or diltiazem IV (get rate control)

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23
Q

Are murmurs that occur after S2 diastolic or systolic?

A

Diastolic

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24
Q

Aortic regurg description

A

Soft, high pitched blowing diastolic murmur best heard at LUSB in 3rd intercostal space, louder/better auscultated when pt is sitting up and leaning forward

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25
Q

What is the #1 risk factor for aortic dissection?

A

HTN

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26
Q

Aortic regurg most common presentation

A

Dyspnea, pulmonary edema (bibasilar rales)

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27
Q

What is the BP med of choice in pts with aortic dissection and hypertension?

A

Esmolol (goal is SBP < 120)

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28
Q

First line antihypertensives in hypertensive emerency for pts with:
- Eclampsia
- Hypertensive encephalopathy
- Pulmonary edema
- Aortic dissection

A

Eclampsia = magnesium sulfate +/- labetalol, hydralazine
Hypertensive encephalopathy = nicardipine
Pulmonary edema = vasodilators FIRST (nitroglycerin, sodium nitroprusside), can f/u with diuretics after
Aortic dissection = esmolol

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29
Q

What historical factors point more towards cardiogenic etiologies of syncope?

A

Absence of pre/postdromal symptoms
Syncope with exertion
Murmur on physical exam

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30
Q

Treatment for acute decompensated heart failure

A

LMNOP
L: lasix (or another diuretic if contraindicated)
M: morphine
N: nitroglycerin drip
O: oxygen if O2 sat < 92% (non rebreather, noninvasive positive pressure ventilation)
P: position head of bed to 30 degrees

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31
Q

NSTEMI/STEMI treatment

A

Acute mgmt: MOAN + DAPT + anticoagulate + reperfuse

MOAN = morphine for irretractable pain, oxygen if O2 < 92%, aspirin 325 mg crushed, nitroglycerine

DAPT = aspirin + tocagrelor prior to PCI, continue indefinitely (can use clopidogrel in pts with true aspirin allergy)

Anticoagulate = eliquis, xarelto

Reperfusion = PCI

Discharge/long term mgmt: BASH + continuation of DAPT

BASH = beta blocker, ace inhibitor, statin, and heparin

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32
Q

When do you initiate transcutaneous pacing and/or atropine for AV blocks?

A

If patient is hemodynamically unstable

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33
Q

What is the appropriate chronic treatment for Mobitz II or 3rd degree AV block?

A

Permanent pacemaker (can admit for observation in asymptomatic Mobitz II patients)

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34
Q

What is the most common cause of acute arterial occlusion?

A

Thrombus/atrial fibrillation

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35
Q

Hallmarks of thyroid storm

A

Tachycardia, hyperthermia, hypertension, exophthalmos

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36
Q

6 D’s of dilated cardiomyopathy etiology

A

Dunno (idiopathic)
Drugs (cocaine, antivirals such as HIV meds)
Disease (viral infection)
Doxorubicin
Deficiency (B12)
Drinking alcohol

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37
Q

V fib treatment algorithm

A

Early defibrillation + CPR (queue up 1 mg epi IV while machine is getting ready) –> can administer epi q3-5 min

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38
Q

Which of the following is most consistent with reflex syncope/vasovagal response?

A) Absence of a postdrome
B) Postevent confusion
C) Prodrome with dizziness
D) Provocation with prolonged standing

A

D

A – c/w cardiogenic syncope
B – c/w seizure
C – c/w cardiogenic syncope or seizure

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39
Q

What are the 2 big stroke mimics?

A

Hypoglycemia –> ALWAYS GET A POC GLUCOSE IN SUSPECTED STROKE

Aortic dissection –> check distal pulses and BP in both arms

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40
Q

Multifocal atrial tachycardia treatment

A

Supportive care
+/- oxygenation

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41
Q

Characteristics of LBBB on EKG

A

W in V1, M in V6, large wide R wave in lead I

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42
Q

pSVT management algorithm

A

If HDS: Valsalva –> adenosine 6 mg IV –> adenosine 12 mg IV –> cardiovert

If hemodynamically unstable: start with cardioversion

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43
Q

Acute angle closure glaucoma treatment

A

PO or IV acetazolamide (carbonic anhydrase inhibitor, decreases aqueous humor production), topical timolol or another beta blocker, topical apraclonidine (alpha agonist) + immediate ophtho consult for potential iridotomy

Consider mannitol if refractory to initial medical management

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44
Q

MC pulmonary complication of influenza

A

Pneumonia secondary to superimposed bacterial infection (MRSA, strep pneumo MC)

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45
Q

Anterior vs posterior epistaxis

A

Anterior (MC, often seen in kids) = comes from the kiesselbach plexus, less severe bleeding, treat with direct pressure, topical vasoconstrictors (i.e. Afrin aka ozymetazoline), silver nitrate cautery, packing and d/c with orders to follow up for packing removal in 24-48 hours

Posterior = comes from the sphenopalantine artery, report bleeding from b/l nostrils, treat with packing (balloon or foley nasal catheter)

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46
Q

What meds should be avoided in R sided MI?

A

Vasodilators (i.e. nitro) b/c patients are preload dependent

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47
Q

R sided MI treatment

A

IV fluids (fluid resuscitation helps avoid hypotension)

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48
Q

Spinal epidural abscess big 5

A

Etiology: common in immunocompromised (DM) pts, pts with alcohol use disorder or misuse of IV drugs
S/sx: low back pain, fever, loss of bladder/bowel function+/- presence of focal neurologic deficits
Dx: emergent MRI of lumbar spine
Tx: emergent NSGY consultation for drainage and decompression + broad spectrum abx

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49
Q

What calcium level warrants dialysis?

A

> 18 mg/dL

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50
Q

Cholangitis vs acute hepatitis

A

Cholangitis = RUQ pain, jaundice, fever, AMS, hypotension (Reynold’s pentad or Charcot’s triad), markedly elevated ALP

Acute hepatitis = history of alcohol use, AST:ALT is 2:1, tender hepatomegaly!!!

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51
Q

Painful versus painless vision loss

A

PAINFUL = optic neuritis, GCA, acute angle closure glaucoma
PAINLESS = central retinal artery or vein occlusion, retinal detachment

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52
Q

Patellar dislocation treatment

A

Closed reduction + follow up XR to r/o fractures, then knee immobilization and rest with orthopedic follow up

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53
Q

Respiratory distress treatment algorithm

A

Start with nasal cannula 6 L –> venturi mask –> nonrebreather –> high flow nasal cannula –> noninvasvie positive pressure ventilation –> endotracheal intubation

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54
Q

What meds provide mortality benefit in ACS?

A

BASH + DAPT + anticoagulants + beta blockers + statins

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55
Q

Treatment of stroke 2/2 sickle cell in kids

A

Exchange transfusion (tPA not indicated in kids)

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56
Q

Is bowel/bladder retention or incontinence more specific for cauda equina?

A

Retention – incontinence only develops later in disease as a result of overflow

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57
Q

Which is more sensitive for cauda equina – bowel/bladder retention or saddle anesthesia?

A

Bowel/bladder retention

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58
Q

ADRs of ace inhibitors

A

Cough
Hyperuricemia/hyperkalemia
Angioedema
Dose 1 hypotension

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59
Q

ADR of amiodarone

A

Pulmonary toxicity with chronic use – lead to pulmonary fibrosis

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60
Q

ADR of heparin

A

Thombocytopenia leading to bleeding and microthrombi formation (tx of HIT = d/c heparin, start a direct thrombin inhibitor i.e. dabigatraban)

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61
Q

ADR of metoprolol

A

Hypotension, erectile dysfunction, lightheadedness

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62
Q

ADRs of tPA

A

Hemorrhage/bleeding, anaphylaxis/allergic reaction/angioedema

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63
Q

Top 2 diagnoses for flank pain

A

Nephrolithiasis
AAA –> get a CT AP with contrast!

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64
Q

Which is more reliable for ruling out testicular torsion: presence of Prehn or cremasteric reflex?

A

Presence of cremasteric reflex

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65
Q

What structure is most commonly injured in ski accidents?

A

Ulnar collateral ligament d/t forced radial abduction

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66
Q

Skier thumb presentation and treatment

A

TTP on ulnar side of MCP joint, weak pincer grasp

Thumb spica splint, ortho referral

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67
Q

MC location of mesenteric ischemia

A

Superior mesenteric artery (d/t emboli, uncoagulated afib = high risk), jejunum most affected

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68
Q

Myocarditis diagnostic tool gold standard

A

Myocardial biopsy (though rarely performed, often a clinical diagnosis – echo can show hypokinesis and decreased ventricular ejection fraction)

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69
Q

Protein and LDH ratios in transudative vs exudative pleural effusion

A

Transudative = low protein ( < 0.5) , low LDH ( < 0.6) with respect to the pleural fluid

Exudative = high protein ( > 0.5), high LDH ( > 0.6) with respect to the pleural fluid

*** ratio is pleural serum:fluid

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70
Q

What kind of events are most likely to cause PTSD?

A

Sexual trauma

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71
Q

Treatment for asymptomatic first degree AV block

A

Reassurance, no intervention necessary

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72
Q

When should you start with ordering a D dimer for suspected DVT?

A

If suspicion is low/moderate after doing Wells and you are unable to PERC them out, b/c a negative D dimer will r/o DVT without any imaging

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73
Q

What tests are required to make a diagnosis of pyelonephritis?

A

Only a UA, (+) for WBCs, leuks, nitrates if E. coli is causative organism (non con CT AP would help look for potential obstruction but not inflammation associated with pyelo)

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74
Q

What are drusen spots associated with?

A

Macular degeneration

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75
Q

Classic physical exam finding a/w PCP toxicity + treatment?

A

Rotary nystagmus (like a diagonal nystagmus) + feeling of superhuman strength, combative

Treatment = benzodiazepines

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76
Q

1st line gout treatment in pts with kidney disease

A

Prednisone (colchicine and NSAIDs CI in CKD)

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77
Q

Hematuria work up

A

MCC of hematuria: UTI, trauma, stone

Initial workup: UA, full H&P, assess kidney function with Cr

If initial workup does not yield cause: renal US or CT AP w/ contrast to look for structural disease or mass (now have concern for malignancy)

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78
Q

Renal ADR of chronic lithium toxicity

A

Nephrogenic DI d/t arginine vasopressin resistance
Interstitial nephritis
Kidney failure

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79
Q

What is the specific finding on echo for cardiac tamponade?

A

Diastolic collapse of RV

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80
Q

Risk factors for depression mnemonic

A

SADPERSONS
Sex (MC in M than F)
Age (increased risk in M > 45 y/o) and adolescents)
Depression
Previous attempt
Ethanol or drug use
Rational thinking loss
Social supports lacking
Organized plan
No spouse
Sickness (mental health disorder or general medical issue)

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81
Q

What are the 8 PERC criteria?

A

Age greater than or equal to 50
History of PE or DVT
Recent surgery or trauma
Taking oral contraceptives
Unilateral leg swelling
HR greater than or equal to 100
O2 sat < 95% on RA
Hemoptysis

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82
Q

Pharmacologic treatment of Meniere’s

A

Thiazide diuretics (and salt restriction)

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83
Q

What is a felon and what is the best treatment?

A

Felon = pyogenic infection of digital subQ tissue usually d/t staph aureus (gram positive cocci in clusters)

Tx = I&D + antibiotics if overlying cellulitis present

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84
Q

Which form of vaginitis has a pH < 4.5?

A

Candidiasis

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85
Q

Ottawa ankle rules

A

Get an ankle XR if:
- Unable to bear weight for more than 4 steps
- Bony tenderness at medial or lateral malleolus
- Bony tenderness in mid foot

Get a foot XR if:
Pain in midfoot PLUS…
- Navicular tenderness
- Pain at base of fifth metatarsal
- Unable to bear weight

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86
Q

Saturday night palsy nerve involvement + presentation

A

Radial nerve damage

S/sx: weakness of brachioradialis, wrist drop (manifestation of weak wrist extensors), weakness of finger extensors

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87
Q

Distinguishing tension pneumo and pericardial effusion/tamponade on physical exam

A

Tamponade: JVD, hypotension, decreased CARDIAC sounds on auscultation (bilateral), breath sounds usually present

Tension pneumo: JVD, hypotension, decreased BREATH sounds on auscultation (unilateral to side of injury)

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88
Q

Where do you perform decompression in a pneumothorax?

A

2nd ICS in midclavicular line OR 4th/5th ICS in anterior axillary line

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89
Q

Treatment of stable vs unstable sinus bradycardia

A

Stable = observation

Unstable = start with atropine, consider epi/norepi if unresponsive, consider transcutaneous pacing

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90
Q

TTP manifestations and best treatment

A

FATRN: fever, anemia (likely d/t hemolysis), thrombocytopenia, renal dysfunction, neurologic deficits/dysfunction

Treatment: plasmapharesis to address both anemia and TCP (avoid platelet transfusion if possible bc additional platelets will be destroyed given microvascular circulation)

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91
Q

PDA treatment

A

Indomethacin within first 10-14 days of life

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92
Q

Umbilical prolapse presentation and treatment

A

Fetal heart decels, pulsating mass protruding from cervical os

Tx: immediate/emergent C section, elevate presenting part (maternal knee to chest positioning, Trendelenburg) in time prior to delivery

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93
Q

MC valve involved in endocarditis leading to embolic events?

A

Tricuspid (mitral regularly)

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94
Q

Treatment of choice for lice?

A

Permethrin (ok in pregnant, lactating women, kids)

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95
Q

Strangulated hernia presentation and treatment

A

Mass near or in scrotum, toxic appearing, s/sx of SBO (N/V – bilious, abdominal pain, hyperactive BS early on to absent BS later on)

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96
Q

Alcohol related hepatitis tx

A

Supportive care

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97
Q

Which bursa does the knee joint communicate with?

A

Suprapatellar – this is why you can “milk” knee joint effusions

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98
Q

What finding indicates pneumothorax on CXR?

A

Ability to see pleural edge indicating buildup of air in pleural space

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99
Q

What is Nikolsky sign?

A

Sliding of epidermis away from underlying dermis

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100
Q

Which has a negative Nikolsky sign, bullous pemphigoid or pemphigus vulgaris?

A

Bullous pemphigoid (THINK: this is BULL, NO way I have a Nikolsky sign)

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101
Q

How can you tell if acidosis/alkalosis is acute vs acute on chronic?

A

Acute = no signs of compensation
Acute on chronic = signs of compensation (i.e. ROME is present but the other respiratory/metabolic process is also abnormal in an effort to compensate)

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102
Q

Which of the MOAN meds in MOAN and BASH for ACS has a proven mortality benefit?

A

Aspirin

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103
Q

What are the 2 instances where you DONT do a CT AP with contrast?

A

If pt has CKD, if solely looking for nephrolithiasis

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104
Q

Treatment of corneal ulcer

A

Topical ciprofloxacin (for contact wearers)

105
Q

Causative agent of bronchiolitis and presentation

A

Pathogen = RSV

Pres = SOB, viral prodrome (cough, runny nose, fussiness), accessory muscle use on PE, wheezing, UNRESPONSIVE to nebulizer treatment

106
Q

Paraphimosis vs phimosis

A

Para = worse, unable to replace foreskin distally back to its anatomic position
Phimosis = unable to expose glans penis b/c cant retract foreskin proximally

107
Q

Erysipelas presentation

A

Abrupt onset of erythema and swelling of the skin + infectious symptoms (fever, chills)

Often follows a malar distribution but will not have systemic symptoms like Lupus, infectious sx + no acne like lesions help differentiate from rosacea

108
Q

Erysipelas treatment

A

Amoxicillin or cephalexin (inf often caused by strep pyogenes)

109
Q

Pertussis treatment

A

Azithromycin (1st line), or bactrim (if PCN allergic)

110
Q

What kind of event has the highest likelihood of causing PTSD?

A

Sexual violence

111
Q

Volvulus presentation, dx, and tx

A

Pres = insidious onset/slowly progressive abdominal pain, chronic constipation
Dx = xray shows (+) bent inner tube sign for sigmoid volvulus, which shows colonic dilation pointing to the LUQ, (+) bird’s beak on contrast enema
Tx = flexible sigmoidoscopy to reduce volvulus followed by surg to reduce recurrence

112
Q

What is volvulus

A

Redundant loop of sigmoid colon twists and obstructs the lumen

113
Q

MC chest injury in children with severe blunt trauma

A

Pulmonary contusion

114
Q

At what point do you administer D5W when treating DKA?

A

When glucose becomes < 200

115
Q

When do you stop DKA treatment?

A

When anion gap is closed

116
Q

DKA treatment mainstay

A

1st = IV fluids!!!
Then = potassium repletion FOLLOWED BY insulin drip, eventually need to transition to SQ insulin before d/c IV insulin

117
Q

What pathogen causes abscesses to form?

A

MRSA

118
Q

what antibiotics do we use to treat purulent/more severe cellulitis?

A

Clindamycin – has MRSA coverage (can also do bactrim, doxy)

119
Q

Osteopenia and osteoporosis T scores

A

Osteopenia: -1.5 to -2.5
Osteoporosis: less than -2.5

120
Q

Parotitis treatment

A

Outpatient: clindamycin or augmentin
Inpatient: IV unasyn (amp-sulbactam) or a cephalosporin + metronidazole – indications for admission include fever, which shows severe disease that wont respond to PO treatment

121
Q

What is a SLAP tear and how does it present?

A

Superior labrum anterior posterior tear

Pres = baseball player with history of shoulder/glenohumeral issues, hears clicking and popping while throwing, pain at its worst while in the cocked position getting ready to throw

122
Q

CAP outpatient treatment

A

F’ing MAD

Fluoroquinolones (prolong QT, tendonitis – not used as often d/t ADRs)
Macrolides – azithromycin (atypical coverage)
Amoxicillin – good gram positive cvg
Doxycycline – gram pos, good gram neg, and atypical coverage

123
Q

What is the JAK2 mutation responsible for?

A

Primarty polycythemia vera, causes increased RBC production

124
Q

XR showing dilated loops of bowel with air fluid levels indicates what?

A

SBO

125
Q

How do you DEFINITIVELY diagnose Meniere’s?

A

Post mortem dx

In real-life – exclude other causes of vertigo with an MRI, audiometry to confirm SNHL, etc.

Meniere’s presentation = episodic vertigo, HL, tinnitus

Tx = lifestyle mods (decreased salt intake), thiazide diuretics, vestibular rehab, etc.

126
Q

Meniere’s likely etiology

A

Excess of endolymph

127
Q

What vascular structure is most likely to be damaged with tibiofemoral (knee) dislocation?

A

Popliteal artery

128
Q

Which physical exam finding indicates popliteal artery damage and warrants urgent ortho f/u?

A) ABI of 0.95
B) Asymmetric distal pulses
C) Dusky skin of involved extremity
D) Significant hemarthrosis

A

C – this indicates compromised popliteal artery flow

A – ABI < 0.9 is when you start to get worried about arterial disease
B – warrants urgent arteriogram to determine likelihood of arterial damage
D – primary finding of knee dislocation

129
Q

Risk factors for bone fracture

A
  • Low BMI
  • Osteoporosis (MC in older F patients)
  • Untreated hyperthyroidism
  • Glucocorticoid therapy (d/t increased bone resorption)
  • Current cigarette smoking
130
Q

T or F: OA is a protective factor against bone fractures

A

True

131
Q

Orbital blowout fracture presentation

A

Diplopia
Pain with EOM d/t inferior rectus entrapment
Enophthalmos (globe sunken into orbit)
Limited upward gaze
Decreased sensation to cheek, upper lip, and/or gingiva (d/t infraorbital nerve damage)
+/- intractable vomiting 2/2 pain

132
Q

MOI of orbital blowout fractures

A

Direct force to the globe by small round object (ball, fist, etc.)

133
Q

Orbital blowout fracture dx and treatment

A

Dx: CT – (+) teardrop sign, aka herniated tissue and muscle

Tx: surgery, cold packs and oral steroids to decrease swelling while waiting, +/- antiemetics, prophylactic abx if fracture extends into the sinuses

134
Q

Hep B active infection (HBsAg positive) PEP for healthcare workers

A

With UTD hep B vaccines: none
With unknown or out of date hep B vaccines: one dose of hep B vaccine and one dose of hep B immunoglobulin
If contact is HBsAg negative: one dose of hepatitis B vaccine only

135
Q

How do you CONFIRM hyperaldosteronism?

A

Oral sodium loading test – 2 weeks of high sodium diet and removing certain meds followed by drawing plasma renin activity or a direct renin assay

DIAGNOSTIC = plasma renin activity < 0.65 OR direct renin assay < 0.36

Pres: young person with refractory hypertension, hypokalemia and elevated bicarb on labs

136
Q

Presentation of DKA vs HHS

A

DKA: more likely to have ABDOMINAL PAIN, Kussmaul respirations, weakness, neurologic symptoms in moderate to severe cases, signs of dehydration – tachycardia, dry mucus membranes, orthostatic hypotension, decreased skin turgor, fruity breath odor

HHS: focal neurologic deficits much more common (d/t higher glucose), obtundation/stupor/coma

137
Q

Etiology of central DI versus nephrogenic DI

A

Central = decreased ADH secretion
Nephrogenic = decreased sensitivity to ADH

138
Q

Best test to distinguish central versus nephrogenic DI

A

Water deprivation and ADH administration

139
Q

Water deprivation test results for nephrogenic vs central DI

A

Central DI = exogenous ADH stimulation causes an increase in bodily H20 uptake, urine becomes more concentrated and osmolality INCREASES as a result

Nephrogenic DI = exogenous ADH administration does nothing b/c kidneys are unable to respond, urine osmolality UNCHANGED

140
Q

What does urine osmolality measure?

A

The amount of DISSOLVED PARTICLES

high osmolality = lots of dissolved particles = little water = highly concentrated

low osmolality = few dissolved particles = lots of water = low concentration

141
Q

Which of the following requires empiric antibiotic therapy?

A) Clostridium perfringens
B) Salmonella
C) Shiga-toxin-producing E. coli
D) Shigella

A

Shigella (with quinolones, macrolides, or beta lactams)

142
Q

Post partum hemorrhage presentation and treatment

A

Etiology = 4 T’s (tone – uterine atony, trauma, tissue – retained palcenta, thrombin – coagulation)

Pres = boggy uterus!!!, hypotension, tachycardia, pallor, hypothermia, and LOC

Tx = uterine massage, bimanual compression if atony is suspected, oxytocin infusion, tranexamic acid if bleeding continues, intrauterine balloon catheter if atony and hemorrhage persist after tranexamic acid, final option = hysterectomy

143
Q

Hepatic encephalopathy and hepatic insufficiency health maintenance (pharmacologic)?

A

Encourage probiotic use (i.e. lactobacillus) – helps with ammonia elimination

144
Q

Preferred method of imaging potential nephrolithiasis in pregnant patients

A

Renal ultrasound

145
Q

What is a Bankart lesion?

A

Avulsion of glenoid labrum from inferior glenoid, often occurs with anterior shoulder dislocations

146
Q

Direct vs indirect inguinal hernia

A

Direct = goes through defective abdominal wall (Hesselbach triangle) and passes directly through the external ring, medial to the IEA. does not descend into the scrotum

Indirect = more common, goes through internal ring and passes lateral to the IEA. DOES descend into the scrotum , higher risk of strangulation

THINK: MDs dont lie –> Medial to IEA = direct, Lateral to IEA = indirect

147
Q

Treatment for nonreducible hernias

A

emergent surgery consultation

148
Q

Ectopic pregnancy hCG levels

A

Serum hCG ~3600 (hCG of 900 non detectable on TVUS, c/w absence of IUP)

149
Q

TVUS finding c/w incomplete miscarriage

A

Endometrial thickening (occurs b/c there was initial implantation)

150
Q

Placental abruption risk factors

A

Previous abruption (biggest RF)
HTN
Cocaine
Trauma
Multiparity
Smoking

151
Q

Placental abruption presentation

A

PAINFUL vaginal bleeding (+/- bleeding visualization, can be internal)
Contractions
Abdominal tenderness
Decreased fetal movement

152
Q

Placental abruption diagnostics and tx

A

TVUS – want to avoid doing a bimanual on suspected abruption d/t risk of hemorrhage

Tx: hospital admit for C section +/- hysterectomy if bleeding cannot be controlled

153
Q

MCC of cardiac tamponade?

A

Malignancy

154
Q

Osteomyelitis empiric abx in a fracture

A

Type 1 or type 2 fracture – cefazolin (for gram positive coverage)
Type 3 fracture – cefoxitin or cefotetan (additional gram negative coverage)

Add vanco if MRSA risk

155
Q

Best test for diagnosing pancreatic insufficiency?

A

Fecal elastase – will show decreased levels which is c/w chronic pancreatitis causing pancreatic insufficiency

156
Q

Complications of sinusitis

A

Brain abscess in frontal lobe (vs temporal lobe c/w mastoiditis)

157
Q

Treatment of choice for unequivocal disc herniation and pts with muscular weakness?

A

Discectomy with limited laminotomy

158
Q

Classic SBO findings on imaging

A

Abdominal XR: dilated loops of bowel, air fluid levels, string of pearls

Abdominal CT (BEST imagining modality): pneumoperitoneum – appears as air under the diaphragm and indicates rupture

159
Q

SBO management

A

Initially: volume resuscitation d/t vomiting, correct electrolyte abnormalities, bowel rest, GI decompression with NG tube

If no improvement over 3-5 days –> surgical management/correction

160
Q

Balanitis treatment

A

Uncomplicated: clotrimazole
Complicated or severe s/sx (intense pruritus or pain): fluconazole

161
Q

Currant jelly sputum

A

Klebsiella (gram negative rod)

162
Q

Foul smelling sputum

A

Fusobacterium nucleatum

163
Q

Strep pneumo sputum appearance

A

Blood tinged

164
Q

Peak flow parameters for asthma exacerbations

A

Mild: 25-39%
Moderate: 40-69%
Severe: > 70%

165
Q

diagnostic tool of choice when working up a pt < 45 y/o w new cardiac symptoms

A

TEE

166
Q

Best method to prevent osteomyelitis after a fracture?

A) Administer IV abx
B) High pressure irrigation with antibiotic solution
C) Obtain wound cultures in ED
D) Perform surgical stabilization within 6 hours of injury

A

A

B – want to do LOW pressure, high volume to avoid pushing debris further into the wound
C – not helpful in determining antibiotic choice
D – not shown to lower complications

167
Q

How do you treat mycoplasma pneumoniae?

A

Same as CAP

Fing MAD for outpt
Fing BAD for in pt or immunocompromised out pt

168
Q

What physical exam finding is most sensitive for acute compartment syndrome?

A

Pain is most sensitive

(pallor and pulselessness are rare)

169
Q

What medication is the best treatment for bulimia?

A

Fluoxetine

170
Q

What joint is involved in the motion responsible for ankle sprain?

A

Subtalar

171
Q

Cystic fibrosis increases the risk of what respiratory infection

A

Pseudomonal pneumonia

172
Q

How do you treat CAP in a patient with cystic fibrosis?

A

Zosyn (pip tazo) and ciprofloxacin

173
Q

What diseases put patients at increased risk of developing tenosynovitis?

A

DM, RA, deposition disorders (i.e. sarcoidosis)

174
Q

What is trigger finger?

A

Stenosing flexor tenosynovitis causing the finger to be locked in flexion

175
Q

How do you treat hydronephrosis accompanied with palpable bladder and new onset kidney failure/disease?

A

Bladder catheterization

176
Q

How do you treat hydronephrosis in the setting of an intrinsic cause such as PKD or a renal mass?

A

First try ureteral stent placement, percutaneous nephrostomy if that fails

177
Q

Cough description in pertussis

A

Develops after a cold
Present throughout the day and night but worsens in the evening

178
Q

Asthma exacerbation treatment (4 things)

A

O2
Duo-neb (albuterol, SABA + ipratropium, ICS)
Magnesium (vasodilator)

179
Q

Best test to CONFIRM diagnosis of TB?

A

NAAT – only way to confirm TB, others are more sensitive but less specific

180
Q

How often do you do DEXA scanning if the T score is normal?

A

Every 10 years

Every 3 years if T score is -1.5 to -1.99, every 1-2 years if being treated for low bone density

181
Q

Which risk factor is the most important to decrease to lower risk of developing ACS?

A

Atherosclerotic plaque level – get LDLs under control with a statin

182
Q

Treatment of purulent vs non purulent cellulitis

A

Purulent = clindamycin (or bactrim, doxy)
Non purulent = cephalexin or dicloxacillin (cover staph and strep)

183
Q

DKA lab findings

A

Acidic blood pH on VBG/ABG
Pseudo hyperkalemia
Pseudo hyponatremia d/t elevated glucose
Decreased serum bicarb

184
Q

Release of NO and endothelin from subarachnoid blood clots causes what?

A

Vasospasm

185
Q

Brown recluse spider bite appearance

A

Red plaque that has dusky red eschar

186
Q

Best initial diagnostic study for peptic ulcer disease

A

Upright CXR

187
Q

Bicuspid aortic valve causes what kind of murmur?

A

Aortic stenosis

188
Q

Presentation of aortic stenosis

A

Syncope
Angina
Dyspnea

THINK: SAD

189
Q

Electrolyte abnormalities with SIADH

A

Hyponatremia
Serum hypo-osmolality
Urine hyperosmolality (> 100)

190
Q

Elevated oligoclonal bands on LP

A

Multiple sclerosis

191
Q

MCA stroke manifestations

A

Contralateral weakness of face, arm, leg
Contralateral sensory impairment
Aphasia, dysarthria
Hemineglect on nondominant side

192
Q

Infective endocarditis prophylaxis treatment of choice in pts with cardiac hsitory (cardiac transplant, rheumatic heart disease, etc.) penicillin alg

A

Azithro (first choice is amoxicillin if non PCN allergic)

193
Q

Priapism tx

A

Low flow (ischemic): venous, painful, emergency – treat with corpus cavernosa aspiration and intracavernous phenylephrine

High flow (non-ischemic): arterial, semierect, painless – treat with observation or arterial embolization

194
Q

Mid dilated pupil should make you think what?

A

Acute angle closure glaucoma

195
Q

How long does a manic episode have to last to make a diagnosis of bipolar I?

A

One week

196
Q

Risk factors for developing tamponade other than malignancy

A

SLE
Infectious processes (viral, bacterial, TB)
Post MI

197
Q

What vessels are damaged in:
- Epidural hematoma
- Subdural hematoma
- Subarachnoid hemorrhage
- Intracerebral hemorrhage

A
  • Epidural: middle meningeal artery
  • Subdural: bridging veins
  • Subarachnoid: ruptured berry aneurysm MCC
  • Intracerebral: penetrator arteries
198
Q

Disease that is a risk factor for subarachnoid hemorrhage

A

Polycystic kidney disease (younger patients, + fam hx, palpable kidneys, multiple cysts noted on renal US/CT)

199
Q

EKG findings of a R sided MI

A

ST elevations in V3R and V4R

(Clinical manifestations: Kussmaul breathing, JDV, signs of R sided HF)

200
Q

Which is better at detecting vegetations, TEE or TTE?

A

TEE

201
Q

Which endocrine disorder is pretibial edema associated with?

A

Thyroid storm/hyperthyroidism

202
Q

Treatment of choice for fungal infections of the scalp?

A

Selenium sulfide shampoo

203
Q

Ranson criteria usage

A

Predicts mortality in cases of acute pancreatitis

204
Q

Ranson criteria components

A

at admission:
- age > 55
- WBC > 16
- Glucose > 200
- LDH > 350
- AST > 250
48 hours after admission:
- hematocrit falls > 10%
- BUN rises > 5
- Calcium < 8
- PaO2 < 60
- Base deficit > 4
- Fluid sequestration > 6

Each criteria is worth one point, score of 0-2 = 1% mortality, 3-4 = 15%, 5-6 = 40%, >7 = 100%

205
Q

Top 3 MCC of acute pancreatitis

A
  1. Gallstones
  2. Alcohol
  3. Hypertriglyceridemia
206
Q

Giardia transmission

A

Fecal oral transmission by ingesting cysts in contaminated water

207
Q

Giardia presentation

A

Abrupt onset of colicky abdominal pain, pale, loose/foul smelling stools, explosive diarrhea

208
Q

Giardia treatment

A

Metronidazole 250 mg TID x7 days

209
Q

What kind of GI infections is cipro good to treat?

A

Bacterial

210
Q

Rifaximin is first line treatment for…

A

Traveler’s diarrhea and hepatic encephalopathy

211
Q

Acute and chronic hypocalcemia treatment

A

Acute: IV calcium gluconate
Chronic: oral calcium and vit D supplements

212
Q

What is Murphy’s sign specific to?

A

Cholecystitis (inspiratory arrest with palpation of RUQ)

213
Q

COPD exacerbation mgmt

A

Anticholinergics (ipratropium)
SABA (albuterol)
Steroids (prednisone)
Noninvasive positive pressure ventilation (indicated if acidotic, hypercapnic, hypoxic, or resp fatigue)
Abx if signs of bacterial inf or if ventilation is required

214
Q

Thyroid storm treatment

A

Adrenergic blockade with propranolol FIRST, then PTU (pref) or methimazole and steroids

215
Q

Red flags of back pain (require imaging for further workup)

A

Back pain plus…
- Fever (c/f abscess)
- Acute onset (c/f fracture)
- Unintentional weight loss (c/f malignancy)
- Morning stiffness > 30 min in young adult (c/f spondyloarthropathy)
- Urinary/bowel retention or incontinence, saddle anesthesia (c/f cauda equina)
- Coagulopathy
- Immunocompromised
- Recent surgical instrumentation

216
Q

Bullous pemphigoid big 5

A

Etiology: autoimmune
S/sx: large, tense blisters or bullae
Dx: clinical, negtive Nikolsky sign
Tx: steroids, doxy, +/- immunosuppression

217
Q

Erythema infectiosum is caused by

A

Parvovirus B19

218
Q

What should you be concerned about if a patient is hypotensive and has renal colic?

A

Early AAA

219
Q

MC respiratory infection in patients < 2 y/o

A

Bronchiolitis (caused by RSV)

220
Q

Physical exam findings concerning for mesenteric ischemia

A

Diffuse abdominal pain out of proportion to physical exam findings – eventually progresses to signs of peritonitis

221
Q

Which area of the bowel is most likely to have ischemic changes?

A

Jejunum b/c it has least collateral blood flow from the SMA (most likely area to clot)

222
Q

Epiglottitis big 5

A

Etiology: Hib
Pres: tripod, drooling, wheezing, increased work of breathing
Dx: Lateral CXR shows thumbprint sign
Tx: close airway monitoring, ENT and anesthesia c/s, IV vanco and 3rd gen cephalosporin after securing airway

223
Q

Myocarditis presentation

A

Excessive fatigue, exercise intolerance
Chest pain
Unexplained sinus tach
S3, S4 gallop
Abnormal EKG
Elevated troponin

224
Q

Pertussis treatment

A

Azithro or bactrim if macrolides are CI (avoid bactrim in pts with G6PD b/c it causes hemolysis)

225
Q

Mastitis tx

A

Out pt: dicloxacillin or cephalexin
In pt: vanco

226
Q

Hyphema vs subconjunctival hemorrhage

A

Hyphema = blood in anterior chamber, infiltrates iris
Subconjunctival hemorrhage = blood in sclera ONLY, does not infiltrate iris

227
Q

Ultrasound findings for ovarian torsion

A

MC = ovarian enlargement
90% of the time = whirlpool sign

228
Q

What hormone can help slow vaginal bleeding?

A

Estrogen pills

229
Q

Characteristics of R versus L atrial enlargement on EKG

A

R atrial enlargement: peaked P waves in lead II, large positive P wave deflection in lead V1

L atrial enlargement: widened P waves in lead II, large negative P wave deflection in lead V1

230
Q

Risk factors for rhabdo

A

PROLONGED IMMOBILIZATION!!!
Intense exercise leading to muscle breakdown

231
Q

What type of fractures should sugar tong splits be used to immobilize?

A

Elbow, wrist, forearm

232
Q

Short arm gutter splint use

A

Immobilize wrist and ulnar or radial half of hand

233
Q

What is the first step to consider in all burn patients?

A

Tetanus prophylaxis

234
Q

Hyperkalemia EKG changes

A
  • Peaked T waves
  • Prolonged PR interval
  • Prolonged QRS duration (widened)
235
Q

Aspiration PNA treatment

A

Augmentin or Unasyn (ampicillin-sulbactam) for anaerobic coverage

236
Q

Pertussis treatment of choice

A

Azithro (or bactrim in pts intolerant to macrolides)

237
Q

Antibiotics of choice in COPD exacerbation

A

Only give abx in moderate to severe exacerbations (worsening of at least 2 cardinal sx – cough, dyspnea, sputum production)

Azithro (macrolides) or doxy

238
Q

At what O2 sat or PaO2 do you give prednisone in pts with PJP?

A

O2 sat < 93%
Pa O2 < 70

239
Q

Acute mesenteric ischemia presentation and dx

A

Acute onset of poorly localized, severe abdominal pain and vomiting out of proportion to physical exam findings

Dx: elevated serum lactate, CT angiography MC test but mesenteric angiography is gold standard

240
Q

Giardia transmission and treatment

A

Transmission: common in daycare, also contaminated water

Tx: tinidazole 2 g PO for one dose

241
Q

Epiglottitis causative agent

A

Haemophilus influenza type B (HIB)

242
Q

Antitussives that can be used in acute bronchitis?

A

Dextromethorphan

243
Q

What is the timeline for which tamiflu is effective?

A

Given within 48 hours of symptom onset (after that just supportive care – oral rehydration and rest)

244
Q

Crohn vs UC

A

Crohn: gum to bum involvement, skip lesions, but more common in small intestine. More common to have manifestations outside of GI tract and to develop fistulas d/t transmucosal involvement

UC: submucosal involvement, continuous ulcerations in the rectum that extend proximally. More likely to develop malignancy

245
Q

What GI condition is dermatitis herpetiformis (pruritic vesicobullous lesions on elbows, knees and buttocks) consistent with?

A

Celiac

246
Q

Otitis externa causative organisms, pres and treatment

A

Organism: pseduomonas (MC) or staph
Pres: erythema of external auditory canal, tragal tenderness with manipulation, HL
Tx: otic ciprofloxacin or ofloxacin with topical steroids (hydrocortisone, dexamethasone)

247
Q

Peritonsillar abscess treatment

A

Needle drainage (do NOT have to wait for ENT to do it unless this is the first time)

248
Q

Treatment of choice for chemical burns to the eye (acidic or alkaline)

A

Numbing with topical tetracaine anesthetic drops, then begin irrigation

249
Q

Treatment for corneal abrasions

A

Contact wearers – Ciprofloxacin ophthalmic solution (want to cover pseudomonas)

Non-contact wearers – erythromycin

250
Q

What is Reye syndrome

A

Encephalopathy and hepatic issues in the setting of NSAID use after a viral illness

Treat with supportive care

251
Q

Does COPD paint more of a respiratory alkalosis or respiratory acidosis

A

Respiratory acidosis bc it is an OBSTRUCTIVE lung disease so even in its most tachypneic state, Co2 cannot be properly excreted which means CO2 retention leads to acidosis

252
Q

Balanitis tx

A

Mild = topical clotrimazole (covering candida, MC organism)
Severe = oral fluconazole

253
Q

3 types of incontinence:

A

Overflow (think obstructive causes like BPH – c/o difficulty starting stream, incomplete emptying)
Urge (think stroke, Alzheimer’s – c/o urgency and frequency)
Stress (think pregnancy, history of urologic procedures – c/o small volumes of urine loss with coughing or sneezing)

254
Q

MCC of SJS/TEN

A

Drugs: PEC SLAPP

Penicillins
Ethosuximide
Carbamazepine
Sulfa drugs
Lamotrigine
Allopurinol
Phenobarbital
Phenytoin

If not drugs: mycoplasma pneumoniae infection

255
Q

Atopic derm vs psoriasis location

A

Atopic derm = flexor surfaces

Psoriasis = extensor surfaces

256
Q

Deficits in ulnar nerve and median nerve distribution corresponds to a lesion where?

A

T1 nerve root (makes up the medial cord, of which the median nerve and ulnar nerve come off of)

257
Q

Mnemonic for encapsulated organisms iso sepsis w/ asplenia

A

SHNEKSS

Strep pneumo
H influenza
Neisseria meningiditis
E coli
Klebsiella
Strep (group B)
Salmonella typhi

258
Q

EKG findings for PE

A

S1Q3T3 or sinus tachycardia (more commonly)

259
Q

Heparin (prolongs PTT) and warfarin reversal agents (very prolonged PT)

A

Heparin = protamine sulfate
Warfarin = oral vitamin K for INR > 4 but asx patient, four factor prothrombin complex in HDUS pts

Emergency Medicine (1 decks)

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