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A2 > ER rotation booklet > Flashcards

ER rotation booklet Flashcards

1
Q

What are the two things that should be covered when signing out patients?

A
  • Complete all pt-related duties

- Inform attending

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2
Q

What is the Hypothetico Deductive decision making?

A

Working dx is tested as new data is collected (clues in a detective case)

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3
Q

What is the algorithmic decision making model?

A

Series of steps followed via algorithm

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4
Q

What is pattern recognition decision making model?

A

Series of s/sx are clumped together into a known grouping

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5
Q

Which decision making model has a risk of premature closure?

A

Pattern recognition (mostly)

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6
Q

What is the exhaustive decision making model?

A

Shotgun and figure out later

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7
Q

What is the event-driven decision making model?

A

Clinician treats symptoms without seeking underlying diagnosis

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8
Q

For each degree F rise in temp, how much faster does the HR go?

A

10 beats per minute

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9
Q

What is the formula for calculating the normal BP in children?

A

BP = 80+ 2*(age in years)

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10
Q

What is the 5th vital sign?

A

Pulse ox

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11
Q

What is the downfall of pulse ox readings?

A

-Does not reflect ventilatory status

-

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12
Q

What happens to the pulse ox with carboxyhemoglobinemia?

A

False rise

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13
Q

What happens to the pulse ox with methemoglobinemia?

A

Will appear as 85% d/t wavelength of light emitted from methHb

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14
Q

What is the definition of an emergency medical condition?

A

A medical condition manifesting itself by acute symptoms of sufficient severity, such that

  • the health of the pt is in serious jeopardy
  • Impairment in bodily functions
  • Serious dysfunction of any bodily organ or part
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15
Q

What is the grade level at which medical instructions should be written?

A

6th grade level

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16
Q

What do most pts rescued from fires die of?

A

Inhalation injuries

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17
Q

How hot should hot water heaters allow water to get?

A

120 F

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18
Q

What are the six core competencies?

A
  1. Pt care
  2. Medical knowledge
  3. Professionalism
  4. System-based practices
  5. Practice-based learning environment
  6. Interpersonal and communication skills
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19
Q

What are the two treatments and their dosages for acute dystonic rxn 2/2 neuroleptic use?

A

1-2 mg IV/IM or benztropine

25-50 mg IV/IM of diphenhydramine

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20
Q

What EKG finding may appear with Haldol use?

A

Prolonged QT

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21
Q

What life threatening complication can arise from restraint use?

A

Metabolic acidosis from struggling.

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22
Q

What sort of acidosis does isopropyl alcohol cause? Why?

A

Non-anion gap, since it is metabolized by alcohol dehydrogenase to ketones. So causes ketosis without anion gap

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23
Q

What electrolyte abnormality usually exist with alcoholics, and should be treated empirically?

A

Mg

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24
Q

What is the definition of delirium?

A

Global inability to relate to environment and process sensory input

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25
Q

What happens to psychomotor activity with delirium?

A

Increased

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26
Q

What the the most common metabolic abnormality that leads to confusion? Which metabolic abnormality, by itself, will not cause confusion?

A

Most common is hypernatremia

Hypokalemia will not, of itself, cause confusion

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27
Q

When is rapid lowering of BP indicated for eclamptic pts?

A

If diastolic remains above 110 after seizures are controlled

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28
Q

What are the indications for an ED thoracotomy? (6)

A
  • Hemorrhage control
  • Release of cardiac tamp
  • prevent air embolism
  • Cardiac massage
  • Repair cardiac injury
  • Expose the aorta for clamping
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29
Q

How will the leg appear with a femoral neck fracture?

A

Abducted and externally rotated

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30
Q

How will the leg appear with a posterior hip dislocation?

A

internally rotated thigh

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31
Q

What physical exam finding is found with high voltage injuries from electrical wiring vs lightning?

A

Deep burns will be present on high voltage wiring injury

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32
Q

Review rule of 9s.

A

Review

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33
Q

What is the major side effect of Etomidate?

A

Adrenal suppression

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34
Q

What sort of ingestions is gastric lavage contraindicated for? (2)

A

caustic ingestions, or hydrocarbons.

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35
Q

What ingestions are charcoal contraindicated? (2)

A

Caustic substances since interferes with visualizing with endoscopy

Heavy metals, as will do nothing

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36
Q

How well does Li levels correlate with prognosis in cases of an overdose?

A

Not well–use clinical appearance to guide decision making

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37
Q

What is the treatment for Li overdose?

A

Dialysis

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38
Q

What OTC drug commonly interacts with Li?

A

NSAIDs 2/2 renal vasculature effects

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39
Q

What is the toxic dose of acetaminophen (mg/kg)?

A

140

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40
Q

What is the nomogram used for acetaminophen overdose? What type of acetaminophen is this used for?

A
  • Rumack-Matthew

- This is for the non-sustained release form of the drug

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41
Q

When are serum levels drawn for the Rumack-Matthew nomogram?

A

4 hours post ingestion

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42
Q

What is NAC given?

A

Orally

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43
Q

How does clonidine OD present? How does this med work?

A

Like opioids

Alpha-2 agonist

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44
Q

What are the EKG manifestations of TCA overdose?

A

Marked RAD

QRS prolongation

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45
Q

How is deferoxamine given, and what is the classic side effect?

A

IV/IM

Urine turns pink/red

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46
Q

What are the neurologic symptoms of Pb toxicity?

A

Paresthesias
Wrist drop
Memory issues

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47
Q

What is the antidote for methemoglobinemia?

A

Methylene blue

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48
Q

Chocolate brown blood = which toxidrome?

A

Methemoglobinemia (Fe3+)

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49
Q

What are the drugs that can cause methemoglobinemia? (4)

A
  • Nitrates/nitrites
  • Local anesthetics
  • Dapsone
  • Phenazopyridine
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50
Q

How fast does ASA toxicity present?

A

Within 30 minutes

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51
Q

What is the role of inhaled steroids in the treatment of an asthma exacerbation?

A

Give IV or PO, NOT inhaled

52
Q

True or false: tapering is needed with all corticosteroid regimens

A

False

53
Q

True or false: Heliox should only be used in the intubated pt

A

False

54
Q

What type of medication is the MOST beneficial in the treatment of COPD exacerbations?

A

Beta- agonists

55
Q

True or false: CMV does not usually cause pneumonia in immunocompetent adults

A

True

56
Q

What is the most common infectious cause of death world-wide?

A

TB

57
Q

What is the most common findings on CXR of food aspiration?

A

Hyperinflation of the left lung

58
Q

True or false: 25% of patients who have a PE w/o identifiable risk factors will be diagnosed with CA in 2 years

A

True

59
Q

Pneumonia + bullous myringitis = which bacteria?

A

mycoplasma

60
Q

What is the #1 cause of drowning in children aged 1-4?

A

Unsupervised at the pool

61
Q

What percent of fire deaths occur at home? What percent of these are the result of not having a smoke detector?

A

4/5

1/2

62
Q

Which local anesthetic is known for average potency, low toxicity, and rapid onset of action?

A

Lidocaine

63
Q

What is the classic presentation of a spinal epidural hematoma?

A

Acute lower back pain worse with coughing after and epidural

64
Q

How does an anterior spinal artery thrombus present?

A

painless paraplegia

65
Q

True or false: a posterior tibial nerve block will provide anesthesia to the entirety of the sole of the foot

A

False

66
Q

Under what age is a surgical cricothyrotomy absolutely contraindicated? Why?

A

5 years
Anatomic differences, including a smaller cricothyroid membrane, and the rostral funnal shaped more compliant pediatric larynx

67
Q

What is the only absolute contraindication to a cricothyroidotomy?

A

Age under 5 years

68
Q

True or false: lidocaine with epi can be safely used in the eyebrow region

A

True

69
Q

Is a large wound occurs with large amounts of fatty tissues protruding, what should be done to reduce post closure skin tension?

A

Undermining of SQ tissue

70
Q

What is the first symptom of lidocaine toxicity? What general symptoms follow?

A
  • Lightheadedness and dizziness

- CNS excitatory effects

71
Q

What is the maximum acceptable dose of lidocaine with and without epi for local wound anesthesia?

A

7 mg/kg with epi

5 mg/kg without

72
Q

What is the role of prophylactic abx in the treatment of clean wounds?

A

Unstudied

73
Q

What is the preferred method of anesthesia for palmar lacerations?

A

Local nerve block (ulnar, medial)

74
Q

Why is a vertical mattress not used to close lacerations to the palm?

A

Risks deep structures

75
Q

What is the rare, but classic side effect of using high dose fentanyl rapidly? Treatment?

A
  • Chest wall rigidity and glottic spasm

- RSI with paralytic if cannot bag properly

76
Q

Does lying supine prevent the development of post LP headaches?

A

No

77
Q

What is the role of needle size in the formation of a post LP headache?

A

Smaller size = less likely to develop

78
Q

Where are LP HAs located?

A

Bitemporal worse with sitting up

79
Q

What is the normal ratio between CSF and serum glucose in adults and children respectively? Pts with systemic hyperglycemia?

A
  1. 6:1 = adult
  2. 4:1 = kids
  3. 4:1 if hyperglycemia
80
Q

What is the appropriate management for a paronychia that has spread significantly into the surrounding tissue?

A

Drainage, abx.

81
Q

What is the difference between a hypopyon and hyphema?

A

Hypopyon is a collection of purulent material in the eye, as opposed to blood in hyphema

82
Q

What is the treatment/workup for suspected hyperextension neck injury causing neurologic s/sx?

A

Steroids and MRI

83
Q

How reliable is the physical exam with neck injuries?

A

Not very- get imaging and admit for obs

84
Q

Can beside US image the retroperitoneum?

A

No

85
Q

What psych disorder increases the chance of suicide the most?

A

Panic disorder

86
Q

Why is phenytoin avoided in pts with seizures 2/2 hyperglycemic cerebral edema?

A

Impairs insulin release

87
Q

At what temperature does shivering cease?

A

32 C

88
Q

What is the most appropriate first step in treating frostbite?

A

Immerse in warm water

89
Q

What is the drug of choice for suspected but not confirmed hypoadrenalism?

A

Dexamethasone

90
Q

True or false: pregnancy is a contraindication to hyperbaric oxygen treatment

A

False

91
Q

True or false: OM is a contraindication to hyperbaric oxygen treatment

A

True–relative contraindication

92
Q

Why is a ptx a contraindication to hyperbaric oxygen?

A

May precipitate a tension ptx

93
Q

True or false: necrotizing fasciitis is an indication for hyperbaric oxygen treatment

A

True

94
Q

True or false: necrotizing enterocolitis is an indication for hyperbaric oxygen treatment

A

False

95
Q

What is the treatment for most scorpion envenomations? How often is intubation needed?

A

supportive care for mild-moderate, antivenom for severe–intubation not usually needed despite apparently terrible s/sx

96
Q

What is a complication with the use of anti-venom?

A

Serum sickness

97
Q

What is the most common s/sx of scorpion stings?

A

Pain and paresthesias–more than local inflammation

98
Q

How long may snake venom take to have an effect, and thus how long should you observe pts?

A

8 hours

99
Q

What is the major differentiating factor between heat stroke and heat exhaustion?

A

AMS in heat stroke

100
Q

What is a major differentiator on PE between electrical shocks from lightning vs wiring?

A

Burns go with wiring, not common with lightning

101
Q

True or false: seizures that occur in kids immediately after trauma are unlikely to be associated with intraparenchymal insults

A

True

102
Q

What is the appropriate treatment for supracondylar humeral fracture in children? Why?

A
  • Ortho consult for possible ORIF

- Risk of injury to median and ulnar nerves

103
Q

What are the salter-harris classification for fractures?

A
  • Type I = fracture through the physeal plate (often not detected radiographically)
  • Type II = fracture through the metaphysis and physis
  • Type III = fracture through the epiphysis and physis
  • Type IV = fracture through the metaphysis, physis and epiphysis
  • Type V = crush injury involving part or all of the physis
104
Q

True or false: there is no need for imaging for a radial head subluxation if pain resolves after injury

A

True

105
Q

What injury to the shoulder is usually held in slight abduction and external rotation, with pain with attempts to reverse this?

A

Hill-sachs deformity

106
Q

What is a Hill-Sachs deformity?

A

It is a cortical depression in the posterolateral head of the humerus. It results from forceful impaction of the humeral head against the anteroinferior glenoid rim when the shoulder is dislocated anteriorly

107
Q

What is the most common rhythm to see in a pediatric arrest?

A

Bradycardia

108
Q

Which is associated with an increased risk of neonatal resuscitation: fetal acidosis or alkalosis?

A

Acidosis

Alkalosis is NOT

109
Q

When should chest compression begin for an infant with bradycardia?

A
  • at 60 bpm or lower AND

- Oxygen and adequate ventilation have not resolved

110
Q

What is the rate of compressions for an infant for CPR?

A

90 cpm

111
Q

What are the ACLS drugs that can be given via endotracheal tube?

A

Lidocaine
Epi
Atropine
Naloxone

(“LEAN”)

112
Q

What is the most common rhythm in the setting of pediatric cardiopulmonary arrest?

A

Asystole

113
Q

In the post-arrest setting, what is the presser of choice to treat hypotension?

A

Epi infusion

114
Q

Low body temperatures in the neonate can cause hyper or hypoglycemia?

A

Hypoglycemia

115
Q

True or false: long bone fracture is a contraindication to the use of an IO?

A

True

116
Q

What is the equation for ET tube size in children?

A

16 + age /4

117
Q

What is the appropriate order of maneuvers for a choking child?

A
  • Back thrust then 4 chest thrust

- Jaw thrust to look for FBs

118
Q

What is the role of the Heimlich maneuver in children?

A

Not performed due to risk of abdominal organ damage

119
Q

What APGAR scores coincide with perinatal asphyxia?

A

0-3

120
Q

The pediatric airway is more (posterior/anterior) than in an adult?

A

Anterior

121
Q

What should be given prior to use of succinylcholine in the pediatric intubation, and why?

A

Atropine to prevent bradycardia

122
Q

Why is lidocaine used in pretreating the pediatric patient for intubation?

A

Prevents further increases in intracranial pressure

123
Q

What are the four ways of approximating ET tube size in kids over 1 year?

A
  • Age +16 /4
  • Approximation with nares
  • Age in months /3
  • approx with child’s 5th finger
124
Q

What is the most likely CXR findings of a radiolucent FB aspiration?

A

Atelectasis of the affected lung

125
Q

What sort of FBs carry the worst prognosis in kids that aspirated them?

A

Large objects in the proximal airway

126
Q

What is the most common form of shock in kids?

A

hypovolemic

A2 (26 decks)

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