Eye, Hematology, Psych, Toxicity Emergencies

Question 1

Treatment of chemical ocular injury

Answer 1

Topical anesthetic (Proparicaine)
Irrigation (NS/LR via Morgan Lens until pH of 7)
Erythromycin Ointment
Atropine Eye drops

Question 2

History of sudden, painless, complete monocular vision loss. dx?

Answer 2

Central retinal artery occlusion

Question 3

What is seen on eye exam of Central retinal artery occlusion?

Answer 3

cherry red spot with disc pallor

boxcarring

Question 4

“steamy” or hazy cornea
perilimbal conjunctival injection
fixed mid-dilated pupil

Answer 4

Acute angle closure glaucoma

Question 5

Treatment of Central retinal artery occlusion

Answer 5

Ocular massage

Acetazolamide 500mg IV or Timolol drop to reduce IOP

Question 6

Flashes of light and floater then “curtain/shadow” over visual field =

Answer 6

Retinal detachment

Question 7

Retinal detachment treatment

Answer 7

Rest head on pillow with side of detachment down (side opposite deficit)

Question 8

First line tx for Acute Angle Closure Glaucoma

Answer 8

Timolol 0.5% 1 drop

Question 9

Treatment of orbital cellulitis

Answer 9

IV Ampicillin/sulbactam (Unasyn)

Question 10

Periorbital vs orbital cellulits

Answer 10

orbital has vision changes and in older children

periorbital usually just erythema and edema and in infants and toddlers

Question 11

What is Nikolsky sign? What derm condition is it seen in?

Answer 11

Bullae spread and skin sloughs with lateral pressure

Seen in Stevens-Johnsons Syndrome and Toxic Epidermal Necrolysis (SJS = BSA30%)

Question 12

Treatment of minor and major Erythema Multiforme

Answer 12

Minor: Topical steroids, oral antihistamines, oral antivirals

Major: IV fluids, Prophylactic Abx, Analgesics, Antihistamines, IVIG, Corticosteriods, (may require transfer to burn center)

Question 13

When should anemic patient get transfusion with PRBCs?

Answer 13

Hgb less than 7g/dl
End organ ischemia
Blood loss of 1500mL

Question 14

When is platelet or FFP indicated in Thrombocytopenia?

Answer 14

less than 50,000mcL and actively bleeding

less than 10,000mcL prophylactically

Question 15

Pathophysiology of DIC

Answer 15

clot everywhere and then severe bleeding everywhere

systemic activation of coagulation and fibrinolysis by some pathology

Question 16

Dx studies of DIC

Answer 16

low platelets, prolonged PT/PTT, elevated BUN/Cr

Question 17

2 labs elevated in Rhabdo

Answer 17

CPK (5-10x nml)

Myoglobin in urine

Question 18

Common cause of neutropenic fever

Answer 18

chemotherapy

Question 19

Poisoning that causes dilated pupils and increased HR

Answer 19

anti-cholinergics, sympathomimetics (cocaines, amphetamines), hallucinogenics

Question 20

Poisoning that causes pin point pupils

Answer 20

cholinergics and opioids

Question 21

Poisoning that causes hypotension

Answer 21

opioids and sedatives (Benzos, Barbs, antihistamines), anti-depressants

Question 22

Toxidrome that causes asterixis

Answer 22

Tylenol

Question 23

Toxidrome that causes seizures

Answer 23

TCA

Question 24

Signs of cholinergic toxicity

Answer 24

“SLUDGE” = salivation, lacrimation, urination, defecation, GI cramping, emesis

Question 25

Signs of serotonin syndrome

Answer 25

hyperreflexia, clonus, diaphoresis, dilated pupils

Question 26

How to treat Tylenol overdose?

Answer 26

Acetylcysteine (Mucomyst)

Question 27

How to treat Benzo overdose?

Answer 27

Flumazenil

Question 28

How to treat carbon monoxide toxicity?

Answer 28

100% oxygen

Question 29

How to treat alcohol overdose?

Answer 29

Ethanol

Question 30

How to treat Narcotics overdose?

Answer 30

Naloxone

Question 31

Symptoms of opiate withdrawal

Answer 31

sweating, vomiting, tachycardia, abdominal cramps

*can’t die from this

Question 32

Symptoms of alcohol or benzo withdrawal

Answer 32

seizures, hallucinations, delirium tremors, confusion, N/V, hallucinations

Wernicke’s Encephalopathy

• can die from this

Question 33

Treatment for alcohol or benzo withdrawal

Answer 33

IM Thiamine

Lorazepam or Diazepam