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Emergency Medicine > Extra notes from slides Exam #1 > Flashcards

Extra notes from slides Exam #1 Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

if photophobia, pain or tearing interferes with exam, what should you add

A

topical ophthalmic anesthetics

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2
Q

If corrective lenses are unavailable, what should you do for VA?

A

pinhole testing

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3
Q

what does a slit lamp allow

A

3d view of ocular structure

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4
Q

what structures are infected with periorbital vs orbital cellulitis?

A

peri = anterior to orbital septum and benign

orbital = extends BEHIND orbital septum

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5
Q

difference in timing of hordeolum vs chalazion

A

both can infect the meibomian gland, but hordelolum is always an acute infection, while chalazion can be subacute and can be a progression of an internal hordeolum

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6
Q

if you are under this age and have HZV opthalmicus, you should get a work up

A

40 yo

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7
Q

what test can you use for a FB?

A

seidel test

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8
Q

what is the f/u for corneal foreign bodies if rust rings, central line, or deep? What if symptoms persist?

A

1st one = 24 hours
2nd one = 48 hours

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9
Q

what specifically is put over the eye for globe fracture?

A

Eye shield

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10
Q

when do you typically up date tetanus for eye?

A

If there is trauma

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11
Q

when do you f/o for chemical eye injury?

A

24 hours

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12
Q

for optic neuritits, what would some1 perceive a red object as?

A

Desaturated - almost pink

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13
Q

apart from veil going over eye, what do people with retinal detachment see?

A

floaters

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14
Q

what is bullous myringitis an extension of?

A

OM

just has a intact blood filled TM (shows red instead of purulent discharge)

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15
Q

how to make a hands-free tongue-depressor for pinching nose

A

tape 2/3 the way up

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16
Q

What is used to cauterize and when is it done?

A

silver nitrate, only after 2 attempts of direct pressure and bleeding is visualized (meaning it is anterior epistaxis)

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17
Q

Order of anterior epistaxis management

A
  1. pinch for 10-15 mintes two attempts
  2. silver nitrate
  3. thrombogenic foams/ gels
  4. nasal packing
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18
Q

when do you f/u for food impaction

A

12-24 hours

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19
Q

if passage does not occur w/in ____ days for a sharp object, consult surgery

A

3 days

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20
Q

if a battery passes through the esophagus, when is/are repeat exam(s) needed?

A

24 hours and 48 hours

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21
Q

When is hyperthermia common and what clues you into this?

A

Environmental exposure
Warm skin
Do not respond to antipyretics

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22
Q

What drugs can cause fever?

A

serotonin

New meds or dose changes

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22
Q

What is the length of FUO?

A

38.3 = 100.9 F for 3 weeks w/out diagnosis

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23
Q

What history question should you ask for all patients with fever?

A

Ill contacts
Travel
IV drug use (EVER)

endocarditis
spinal epidural abscess

once in the system, it can be there for ever

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24
Q

contitutional symptoms is worrying for

A

TB

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25
Q

what two things should you default to if a patient comes in with weird vitals but no symptoms?

A

PNA (CXR is sometimes normal - get a CT if not a clear)
UTI (UA is not always positive)

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26
Q

When do you use tylenol over ibruoprofen?

A

Tylenol is for younger

Ibuprofen for > 6 months (stronger)

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27
Q

If you have pain + fever, what is used?

A

Toradol IV/IM which is ibuprofen

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28
Q

Why are pediatric fever worrisome?

A

Lack of mature immune system leads to VAGUE symptoms + risk of spread of infection from system to system (from GU to another tract)

Hard to do a good PE in these patients

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29
Q

If there is a fever + rash, what likely is it?

A

MMR
unvaccinated

30
Q

Roseala vs measels

A

rosealo starts at bottom and goes up (like a rose grows)

measles starts at top and goes down (like a weasle digs down)

31
Q

Why is birth history important for infants?

A

if a patient is 1 week early, then they are considered minus 1 week to be their true age

for risk stratifying

32
Q

what makes a seizure provoked (within this time window)?

A

A seizure within 7 days of an insult

33
Q

what is refractory status epilepticus?

A

persistent seizure activity despite IV administration of 2 antiepileptic drugs

34
Q

What can you use to verify psedoseizure?

A

Use a saline flush and if they move, then it is not a seizure

35
Q

when would you get an LP for seizure?

A

Only if fever or worried of meningitis

36
Q

If 1st and 2nd line methods do not work for seizure control what do you do?

A

Induce COMA
EEG

37
Q

When can hyponatremia lead to seizure?

A

<120

give NaCl but titrate slow

38
Q

discharge for a that patient is doing fine but has no history of seizure

A

normal imaging = discharge but NEED to have someone to drive them back. NO DRIVING!

39
Q

How should you give antipyretics to adults? Should you stop after they do not have a fever?

A

Administer so that they always have a dose in their body instead of intermittently to avoid period chills/sweats

40
Q

when specifically do you give AB for adults with fever?

A

ONLY if
neutropenia or soon to be
asplenia
immunocompromised
hemodynamically unstable

41
Q

when do you order a CXR for a pediatric patient with fever?

A

tachypnea, cough, or hypoxemia

42
Q

why do you only get a cath for UA in females < 24 m, uncircumcised boys < 12 m, circumcised boys < 6 m?

A

Low chance of UTI outside this window

girls are more likely to get UTI, which is why they get it later

43
Q

why does chemo lead to neutropenic fever?

A

chemotherapy affects myelopoiesis and the integrity of GI mucosa allowing bacterial colonization and transposition across mucosa

44
Q

is fosphenytoin or phenytoin preferred 2nd line for status epilepticus?

A

fosphenytoin d/t less SE

phenytoin can cause cardiac arrhythmia

45
Q

what is hypocalcemia?

A

< 7

cause of seizures

calcium has 7 letters

46
Q

what is hypomagnesemia?

A

< 1.5

cause of seizures

magnus has 150iq

47
Q

syncope and presyncope

A

Syncope = LOC and tone for < 1min

Presyncope = prodomal symptom feeling like you are about to faint

BOTH WORKED UP THE SAME

48
Q

syncope w/ multiple events with new onset should r/o

A

AV block

49
Q

syncope w/ multiple events over years

A

vasovagal syncope

50
Q

syncope w/ multiple events lasting multiple minutes

A

psychogenic

51
Q

supine vs upright syncope

A

supine = cardiac
upright = reflex syncope (vasodilation +/- bradycardia)

52
Q

how long does post event of syncope (N, pallor, diaphoresis) last and why?

A

when you pass out, you lie supine allowing blood to reprofuse the brain

53
Q

DM are at risk for this type of syncope

A

Orthostatic hypotension d/t autonomic neuropathy and hypoglycemia

54
Q

what typically causes vasovagal syncope?

A

emotions, vigorous exercise, etc followed by reflex parasympathetic response leading to drop in BP really fast

55
Q

treatment of carotid sinus syncope in ER and disposition

A

ER = no treatment
Disposition = consider midodrine (vasoconstrictive drug)

56
Q

worrying HINTS exam

A

bi-directional nystagmus

uni-directional (only to the right or left) is not concerning

57
Q

management of HZV with ocular involvement

A

erythromycin ointment, cycloplegics, opioids, cool compresses

+ acyclovir of course

58
Q

do you do ABX for UV keratitis?

A

yes

59
Q

when do you use ketorolac drops?

A

corneal abrasions

also do prophylaxis ABX

60
Q

what ABX do you use for lid laceration?

A

Keflex + erythromycin

think of erythro = blood and keflex = impetigo on eye

61
Q

when do you get CT/US of abd w/ con if you have a fever?

A

abdominal pain
kinda common sense

62
Q

what is the opening pressure for idiopathic hypotension?

A

< 6 H2O

63
Q

what med should you avoid with idiopathic hypotension?

A

Opioids

instead use tylenol for pain!

64
Q

what aortic stenosis LVEF do you need for surgery (if already severe)?

A

< 50 LVEF

65
Q

eye finding to differentiate temporal arteritis from idiopathic intracranial hypertension

A

BOth have 6th CN palsy, but temporal arteritis also has Afferent pupillary defect (eye constricts with consensual but NOT direct light) and Flame hemorrhages from vasculature inflammation

ICH might have increased IOP

66
Q

MC organism of spinal epidural abscess

A

Staph aureus

67
Q

when do you use UFH vs LMWH?

A

BOTH for unstable angina and NSTEMI management

UFH if you choose to do sUrgery
LMWH if you choose to approach conservatively

68
Q

aortic dissection detection risk score (ADD-RS) purpose and values

A

whether or not to order a d-dimer or CTA when sus of an aortic dissection

0-1 = Order D-dimer. If d-dimer >500, order CTA (if < 500, there is a 97% chance there is no dissection)

2-3 = SKIP d-dimer and straight to CTA

69
Q

indications for admitting pericarditis

A

temperature >38°C (100.4°F)
subacute onset over weeks
immunosuppression
history of oral anticoagulant use
associated myocarditis (elevated cardiac biomarkers, symptoms of heart failure)
failure to respond to therapy with NSAIDs after 1 week of therapy,
a large pericardial effusion (an echo-free space >20 mm)
cardiac tamponade
uremic pericarditis (renal failure)
hemodynamic compromise

most are common sense, mainly know if there is still a fever, no response to treatment for 1+ week, or a large, 20+ mm effusion

70
Q

two reasons to keep acyclovir after getting cultures back for CSF

A

herpes!

HSV HZV

71
Q

which HA complaint is concerning of stroke if it is untreated?

A

temporal arteritis (giant cell), because the blood can back up and lodge

72
Q

preferred cycloplegic

A

homatropine (hom on cycle)

Emergency Medicine (14 decks)

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