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Shelf Exams > ER Shelf > Flashcards

ER Shelf Flashcards

1
Q

Most common cause of sudden cardiac death in adults is

A

Ventricular fibrillation

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2
Q

Medications that can be given through endotracheal tube

A

ALE

Atropine
Lidocaine
Epinephrine

(Also Naloxone)

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3
Q

Give with suspected torsades de pointes

A

Magnesium sulfate

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4
Q

Atrial fibrillation tx if stable

A

CCB (Diltiazem)

Then Beta blocker
Metoprolol
Esmolol
Atenolol

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5
Q

Afib/ A Flutter if unstable

A

Cardioversion

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6
Q

Paroxysmal supraventricular tachycardia (PSVT)

SVT

A

Vagal maneuvers
Adenosine

—> CCB

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7
Q

Suspected meningitis what test to get

A

CT scan of brain before lumbar puncture

Especially if papilledema

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8
Q

Seizure for 6 minutes what to give

A

Benzo (Lorazepam)

Status epilepticus

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9
Q

Hypotension without tachycardia

A

Neurogenic shock

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10
Q

Imaging for ACL tear

A

MRI for soft tissue

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11
Q

32 y.o with chest pain. Pain is sharp and left sided. Worse with inspiration and when laying down. SOB.

Tachycardic regular heart rhythm.

ST segment elevations
Troponin less than 0.01

What other history

A

Acute pericarditis

Preceding upper respiratory infection

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12
Q

What do you see preceding large pulmonary embolism

A

Hemoptysis

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13
Q

Pulmonary emboli EKG

A

Tachycardia

S1Q3T3 elevations

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14
Q

Hepatitis infection acute from fecal oral

A

Hepatitis A virus

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15
Q

What do you see with epididymitis

A

Increased epididymal blood flow

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16
Q

Simple anechoic fluid collection in testicle

A

Hydrocele

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17
Q

Symptomatic bradycardia Tx

A

Atropine

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18
Q

Substituted judgement

A

Surrogate decision maker should try to imagine what the patient would want if they were competent

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19
Q

Prolonged erection what imaging to get

A

Doppler ultrasound

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20
Q

Hypertensive emergency with blood pressure above 180 affects what

Elevates what lab

A

Kidneys
Heart
Arteries
Brain

Creatinine

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21
Q

D-dimer

A

Elevated with elevated fibrin degradation

Thrombosis

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22
Q

Localized temporal abnormalities on MRI

Confusion, HA, lethargic, speaking incomprehensibly
Fever

Tx

A

Herpes Simplex encephalitis

Acyclovir

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23
Q

Vaccination for meningitis

A

11 years to 18 years old

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24
Q

Child in garage

Breathing irregular
Hypotensive
Rapid breathing
Low Bicarb

Give what

A

Ethylene glycol poisoning (antifreeze)

Give membrane receptor blockade
Fomepizole

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25
Q

Concerned for what in chemo patients with fever

A

Neutropenic fever

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26
Q

Overdose of lithium causes

A

Nephropathy

- Elevated serum osmolality

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27
Q

Venom works how

A

Destructive enzymatic proteins

Antivenom is antibodies or antibody fragments that bind to venom protein and inactivate them

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28
Q

Colon cancer see what on blood smear

A

Microcytosis= Low MCV

Iron deficiency anemia

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29
Q

Bacterial thrombophlebitis of the internal jugular vein

A

Lemierre syndrome

Complication of peritonsillar abscess

Fusobacterium necrophorum= gram negative rod

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30
Q

Tx Vibrio vulnificus

A

Doxycycline and ceftrazidime

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31
Q

Clams

Curved gram negative pathogen

A

Vibrio vulnificus

Tx Doxycycline and ceftrazidine

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32
Q

TMP SMX good for

A

Cellulitis w/ MRSA

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33
Q

Tx hemolytic transfusion reaction

A

Stop transfusion

IV fluids in a large bolus

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34
Q

Wrist extension
Finger extension
Thumb abduction

What nerve

A

Radial nerve

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35
Q

Loss of abduction of the arm 15 to 90 degrees

A

Axillary nerve

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36
Q

Weakness in flexion of wrist, hand, thumb, and lateral fingers

A

Median nerve

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37
Q

Weakness of elbow flexion and forearm supination

A

Musculocutaneous nerve

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38
Q

Injury to medial epicondyle

A

Ulnar nerve

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39
Q

Weakness in flexion of the wrist, hand and medial fingers

A

Ulnar nerve

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40
Q

Supracondylar fractures

A

Median nerve

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41
Q

Associated with ulcerative colitis and Crohns

A

Erythema nodosum

Red or violaceous subcutaneous nodules on anterior surface of both legs.

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42
Q

Dermatitis herpetiformis

A

itchy and painful papulovesicular rash associated with celiac disease

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43
Q

Wound on hip with desquamation and black eschar

A

Pressure ulcer due to bony prominences

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44
Q

Ipsilateral ptosis associated with

A

Cluster headache

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45
Q

Malignant pleural effusions

A

Bloody
Total protein 4
LDH 120

Exudative

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46
Q

Exudative pleural effusion

A

Pleural fluid protein to serum protein is greater than 0.5

The ratio of pleural fluid LDH to serum LDH is greater than 0.6

Pleural fluid LDH is greater than 0.6 times the upper limit of normal for serum LDH

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47
Q

Initial step for HHS

A

Normal saline

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48
Q

Decreased breathe sounds on one side

Hyperresonance

A

Tension penumothorax

Inadequate venous return from increase in intrathoracic pressure increases and results in vena cava compression.

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49
Q

Salicylate poisoning

Aspirin

A

Respiratory alkalosis
Elevated pH

Decreased PaCo2

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50
Q

Anterior cord syndrome

A

Anterior spinal artery

Loss of motor function and sensation of pain and temp

Retention of touch, proprioception, and vibratory sensation

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51
Q

Brown Sequard syndrome

A

One half of the spinal cord

Penetrating injury

Loss of ipslateral motor function and touch, proprioception and vibratory sensation

CL loss of sensation of pain and temp

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52
Q

Central cord syndrome

A

Trauma to cervical spine

Decreased motor function and sensation in both upper extremities.

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53
Q

Hypothermia at risk for

A

Cardiac arrhythmias

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54
Q

HR 50

Tx

A

Bradycardia

Atropine

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55
Q

Risk factor for placental abruption

A

HTN
Trauma
Substance use (cigarettes, alcohol, cocaine)
Maternal age younger than 20 and older than 35
Low socioeconomic status

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56
Q

TX PEA

Has P, QRS and T waves

A

Epinephrine

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57
Q

Next step in patients who survive out of hospital sudden cardiac arrest

A

Therapeutic hypothermia

Improves neurologic outcomes

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58
Q

Alcohol withdrawal scoring evaluation system

A

Clinical institute withdrawal assessment for alcohol (CIWA)

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59
Q

CHA2DS2-VASc

A

Predict stroke in patients with atrial fibrillation

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60
Q

Ranson criteria

A

evaluate severity of pancreatitis

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61
Q

Suspected TCA overdose get what

A

EKG

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62
Q

Haemophilius influenza

Epiglottitis

A

Polysaccharide-protein conjugate vaccine

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63
Q 
Watery diarrhea
Now has fever and abdominal pain
Meckels diverticulum
TEmp
Yellow drainage on rectal exam
A

Pneumaturia

Fistulas common w/ crohns disease

Enterovesical fistula between bowel and bladder. Pneumaturia is air in bladder

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64
Q

birefringent crystals

A

Calcium pyrophosphate crystals

Pseudogout
Rhomboid shaped

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65
Q

Dont give what antibiotic with acute intermittent porphyria

A

Sulfa drugs

TMP-SMX

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66
Q

Myasthenia gravis

A

Anti-acetylcholine receptor antibodies

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67
Q

What to initial do for incarcerated inguinal hernia

A

Trendelenburg position

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68
Q

Suspected appendicitis what test

A

Ultrasound abdomen

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69
Q

Scale used to traumatic brain injury

A

Glasgow Coma Scale (GCS)

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70
Q

ST elevations in Inferior leads

II, III, aVF

A

Right coronary artery

71
Q

ST elevations in V2, V3, V4 and lateral V5, V6, I, aVL

A

Left anterior descending artery

LAD

Anterior

72
Q

ST elevations RV4, RV5, RV6

A

Right anterior leads

Right marginal artery

73
Q

Getting stitches

Patient becomes numb and dizzy and has seizure

A

Intravascular injection of local anesthetics

Causes central nervous system or cardiovascular toxicity

Numbness, metallic taste, lightheadedness, dizziness, disorientation before progressing to nconsciousness or seizure

74
Q

Dont give TPA

A

if previous bleed

therapeutic anticoagulation

  • heparin
  • warfarin
  • direct thrombin inhibitors
  • Factor Xa inhibitors
75
Q

Genital pain
Pain and erythema over left inguinal region
Fever

Perineal tenderness
Skin overlying scrotum, perineum, and left inguinal region is dusky with crepitance and a feculent odor

A

Fournier gangrene

Necrotizing soft tissue infection of the perineum, genitals and surrounding areas

Associated with compromised immunity from any cause
- Diabetes mellitus

76
Q 
Fever
Fluid wave
Abdominal pain
Abdominal swelling
Emesis nonbloddy
Loose stool
Elevated WBC

Testing to get

A

Spontaneous bacterial peritonitis (SBP)

Paracentesis

77
Q

What lab to get for blunt chest injury with sternal fracture

A

Troponin

Concerned for myocardial contusion

78
Q

IV drug use to bacteremia spreads by

A

Hematogenous seeding

Spinal epidural abscesses

79
Q

Acute limb ischemia
Lack of blood flow and pulses

What medication to give

A

Heparin

80
Q

Receives unit of packed red blood cells

During transfusion reports shortness of breath

Bilateral rales
Drop in blood pressure
Drop in oxygen saturation

Most likely cause?

A

Donor antibodies

Transfusion related acute lung injury (TRALI)

81
Q

Febrile nonhemolytic transfusion reaction

A

Donor leukocytes attacked by the recipients preformed antibodies

Fever w/o hypotension

82
Q

Acute hemolytic transfusion reaction

A

Recipient antibodies against donor RBC

Severe intravascular hemolysis with error in cross-matching

Incompatibility

Fever, chills, and severe intravascular hemolysis

83
Q

Sickle cell with chest pain

What to do

A

Acute chest syndrome

IF doesnt improve with oxygen, morphine, albuterol, maintenance IV fluids, antibiotics

Next: Exchange transfusion

84
Q

Tx Bell palsy

A

Oral steroids within first three days of paresis

85
Q

Medication for chest pain with no atherosclerotic coronary artery disease

A

Prinzmetal angina

Coronary artery vasospasm

CCB
- Amlodipine

86
Q

PCP MOA

A

NMDA receptor antagonist

87
Q

Cocaine MOA

A

blocking of DA, NE, 5HT (serotonin) reuptake

88
Q

Marijuana MOA

A

CB1/CB2 recptors

89
Q

Benzo MOA

A

Increased firing of GABAa

90
Q

MOA of opiates

A

Mu receptor agonist

91
Q

Class III hemorrhage

A

30-40%

Hypovolemic shock manifesting with tachycardia (120-140 beats per min)

Hypotension
Decreased pulse pressure
Tachypnea

Mental status changes
Oliguria

92
Q

Class I hemorrhage

A

up to 15%

DO not have hemodynamic changes
No altered mental status

93
Q

Class II hemorrhage

A

15-30%

Tachycardia
Narrowed pulse pressure

94
Q

Rhinosinusitis treatment

A

Intranasal fluticasone propionate for 15 days

15-21 day course of intranasal steroids

95
Q

Emergency thoracotomy location

A

Left fifth intercostal space from the border of the sternum to the mid-axillary line

96
Q

Rhabdomyolysis has a decrease in what lab

A

Calcium

Calcium deposition occurs in areas of necrotic muscle can result in hypocalcemia

97
Q

HIV and headache

Meningeal enhancement
No mass lesion

CD4 97

Increased opening pressure on lumbar puncture

What test

A

Cryptococcal meningitis

Cryptococcus neoformans

India ink preparation

98
Q

Abdominal pain
Diabetes, HTN, CKD
Began with carrying groceries

Diaphoresis
N/V
SOB

A

Acute coronary syndrome

Get EKG

99
Q

Pain reproduced by leg straightened and passively flexed at the hip

A

Sciatica

intervertebral disc herniation

100
Q

Medication to give if mass effect and edema with brain neoplasm

Increased intracranial pressure

A

Dexamethasone IV

101
Q

Epilepsy controlled with antiepiletpci

Latent TB found and started on medications

Blurry vision now with nystagmus

A

Elevated phenytoin level

Due to decreased folate

Leads to megaloblastic anemia and gingival hyperplasia

102
Q

Overuse of local anesthetic agents

Prilocaine
Benzocaine

Dapsone

A

Methemoglobinemia

Methemoglobin oxidized form of hemoglobin unable to bind oxygen

Hypoxia

Tx Methylene blue

103
Q

Area colon most likely to perforate

A

Cecum

104
Q

Heroin overdose given naloxone

Stats drop in 30 minutes

A

Naloxone pharmacodynamics

Duration of action 30 minutes

105
Q

Haloperidol

Sweating
Fever
Elevated blood pressure
Tachycardia

Resting tremor
Pale
Rigidity

What would be elevated

A

Neuroleptic malignant syndrome

Creatine kinase due to muscle injury

106
Q

Allopurinol

A

Can cause stevens-johnson syndrome/toxic epidermal necrolysis

Skin rash
Difficulty swallowing

107
Q

Rubeola virus

A

Measles

Koplik spots
Conjunctivitis
Rhinitis

108
Q

MOA of MRSA

A

Penicillin binding protein

Mutation of the pencillin binding protein which no longer bind the beta-lactam antibiotics

109
Q

Widening and flattening of the femoral head

A

Legg-Calve Perthes disease is avascular necrosis

110
Q

HIV lung infection

Silver staining crushed ping pong balls

A

Pneumocystis pneumonia (PCP)

TMP-SMX

111
Q

Salter-Harris fracture

A

Involves epiphyseal plate

Can lead to limb length discrepancy

Angular deformity

112
Q

TX Scabies

A

Ivermectin

113
Q

Acetaminophen overdose scale

A

Rumack-Matthew nomogram

Likelihood of hepatotoxicity can be predicted based on a plot of the serum acetaminophen level against time starting four hours post ingestion

114
Q

Acute Physiology and Chronic Health Evaluation (APACHE)

A

Validated severity of disease score that predicts mortality in patients upon admission to intensive care units

115
Q

Milan criteria

A

Used to select patients with hepatocellular carcinoma associated with cirrhosis for liver transplantation

116
Q

Model for End-Stage LIver disease (MELD) score

A

is used to objectively assess the severity of chronic liver disease

117
Q

Bright red blood per rectom of 11 month old

Bleeding past ileocecal valve on colonoscopy

A

Meckel diverticulum

Get Nuclear imaging to confirm

118
Q

Medication put you at risk for latent TB reactivation

A

TNF inhibitors for autoimmune conditions

Adalimumab
Etanercept
Infliximab

119
Q

Tx Benzo withdrawal

A

Diazepam
Chlordiazepoxide

Taper off

120
Q

Needle aspiration of peritonsillar abscesses at risk for

A

Hitting Carotid artery

121
Q

Fall on outstretch hand and fracture

A

Distal radius

Wrist in dorsiflexion

Colles fracture
With posterior and radial displacement of wrist

122
Q

Community acquired pneumonia that is drug resistant

A

Pseudomonas aeruginosa

123
Q

Prolonged QT interval

A

Delayed cardiac repolarization

Increases risk fo torsades de pointes

Cause syncope

Avoid antibiotics, antidepressants, and antipsychotics

124
Q

Malignant otitis externa

Left mastoid process tender

A

IV Ciprofloxacin

125
Q

Tx Digoxin toxicity

A

Hydration
Correction of electrolyte abnormalities
Digoxin specific antibody fragments (Fab)

126
Q 
Diarrhea
Urination
Bradycardia
Pinpoint pupils
Drainage from eyes

Overdose

A

Organophosphate poisoning

MOA enzyme inhibition

127
Q

What to do for boerhaave syndrome esophagus rupture

A

NPO status
IV proton pump inhibitor
IV broad-spectrum antibiotics

128
Q

MI medication that causes hypotension

A

Nitroglycerin

129
Q

Complete heart block/ Third degree heart block tx

A

Transcutaneous cardiac pacing

130
Q

Abdominal pain
Fever
Scleral icterus
RUQ tenderness

Tx

A

Cholangitis

RUQ pain, jaundice, fevers

Tx: Piperacillin- tazobactam

131
Q

Aspiration pneumonia bacteria

A

Polymicrobial

Gram positive
Gram negative
Anaerobic

132
Q

MOA to Toxic shock syndrome

Tx

A

Immune activation

Toxin-producing staph aureus

Which allows non-specific binding of T cell receptor MHC II resulting in massive immune activation

Tx IV antibiotics

133
Q

Risk factor for hemorrhagic stroke

Bright area of blood on CT

A

Hypertension

Causes leakage form intracerebral arteries

134
Q

Elevated lab with necrotizing fasciitis

A

Elevated C-reactive protein
Elevated WBC
Elevated Creatinine
Elevated Glucose

Decreased hemoglobin
Decreased sodium

135
Q

Temporal arteritis give what

A

Corticosteroids

136
Q

What to do with a human bite

A

Wound debridement

You don’t need prophylactic antibiotics unless primary closure

137
Q

Globe rupture due to projectile get what imaging

A

CT for foreign body

138
Q

DM affects what to cause wounds

A

Microvascular circulation

[Not venous insufficiency]

139
Q

Chest pain
Dyspnea

Congestive Heart failure

“Suffocating”

Mottled skin
Thready pulses
JVD
Distant heart sounds

Intra-aortic balloon pump placed to reduce afterload

What next

A

Dobutamine
[Beta-1 receptor agonist with some beta 2 activity]

Cardiogenic shock

Positive inotropic effect
Decreases afterload

140
Q

Side effect Etomidate

A

Short acting IV anesthetic agent used for intubation

Acute adrenal insufficiency due to the suppression of the adrenal synthesis of cortisol

141
Q

Candidiasis of the mouth caused by what medications

A

Inhaled corticosteriods
[Fluticasone]

Not albuterol

142
Q

Wolff-parkinson white drug to give to prevent SVT tx

A

Propafenone

[Dont give CCB, beta blocker or adenosine]

143
Q

Infections in immunosuppressed patients causing left sided facial swelling and vision loss

A

Mucormycosis

Mucor
Rhizopus
Absidia
Cunninghamella

144
Q

First Treatment hyperthermia

A

Electric fan and tepid water from spray bottles

145
Q

Spinal metastases can progress to

A

spine or cauda equina compression

Paraplegia

[Quadriplegia if metastasis in cervical spine]

146
Q

Tx for hip fracture pain if pain not improved with morphine

A

Regional anesthesia

Femoral nerve block

147
Q

How to catch preeclampsia early

A

Blood pressure checks

[Not urine dipstick protein]

148
Q

Reduce mortality and morbidity in COPD

A

Continuous oxygen

149
Q 
13 y.o with left hip and groin pain. 
Past month
No trauma
Limping
Obese
No deformity or change in length
Limited internal rotation
A

Physeal fracture

Slipped capital femoral epiphysis (SCFE)

Physeal fracture of the growth plate of the femur

150
Q

Rash from drug reaction

A

Leukocytoclastic vasculitis

Small vessel inflammation with a neutrophilic infiltrate and necrosis with nuclear debris

151
Q

Henoch- Schonlein purpura

A

IgA antibody deposition

Skin lesions
Lower extremity palpable purpura, abdominal pain, gastrointestinal bleeding
Joint pain

152
Q

CML related to

A

Increased activity of tyrosine kinase (bcr-abl) which is encoded by the philoadelphia chromosome

Mutant tyrosine kinase causes inhibition of apoptosis and increased mitosis, leading to unregulated proliferation of granulocytes

153
Q

Person might go into septic shock what to do

A

Urinary catheterization

Provides ongoing assessment of urine output, a surrogate for end organ (specifically kidney) perfusion

154
Q

Chest compression rate

A

At least 100 per minute

155
Q

Subdural bleed caused by

A

Age

[Not acetaminophen]

156
Q

Lead poisoning cells

A

Basophilic stippling

157
Q

Howell jolly bodies

A

Sickle cell disease

158
Q

Macroovalocytes

A

enlarged oval shaped red blood cells

Megalblastic anemia

Folate or vitamin B12 deficiency

159
Q

What to give to continuous nose bleed

A

Alpha receptor agonist
[Epinephrine, oxymetazoline, or phenylephrine]
Vasoconstricting agent

160
Q

Traumatic injury in pregnancy get what test

A

Kleihauer Betke test

Maternal exposure to fetal blood

anti-rH antibodies to negative month

KB: blood test performed on pregnant woman to measure the amount of fetal hemoglobin transferred from the fetus to the mothers bloodstream

161
Q

Serum Elisa negative for HIV

A

Get nucleic acid testing

HIV RNA

162
Q

Second intercostal space at the midclavicular line

A

Decompressive needle thoracostomy

163
Q

Subxiphoid space

A

Used to perform pericardiocentesis

164
Q

Non bloody vomiting and diarrhea

A

Norovirus

165
Q

Heart pain referred into epigastrium

A

Inferior wall myocardial infarction

Inferior leads: II, III, avF

166
Q

Most common myocardial infarction location

A

Anterior wall MI

167
Q

ST depression in V1, V2, V3 and V4

A

Posterior wall MI

168
Q

ST segment elevation in leads I, II, III, aVF, aVL, V2, V3, V4, V5 and V6

A

Pericarditis

169
Q

ST segment elevations in leads V2, V3, and V4

A

Left anterior wall infarct

170
Q

St segment elevation in leads V4, V5, and V6

A

lateral wall MI

171
Q

On warfarin and blood in stool. What lab to check

A

Prothrombin time (PT)

172
Q

Convulsive epileptic seizures with open eyes

A

PNES Pseudoseizure

173
Q

Botulism MOA

A

Neurotransmitter release inhibition

Wound botulism

Black tar heroin

Shelf Exams (2 decks)

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