Final Flashcards
Which of the following are complications of blood cultures? (DI)
A. Hematoma
B. Local skin infection
C. Inappropriate use of antibiotics due to sample contamination.
D. All of the above
D ATB
A 19-year-old male comes to the ER with left-hand pain after punching a wall. On physical exam, swelling over the dorsum of his left hand is noted, and pain is elicited upon palpation of the fifth metacarpal. What of the following is the most likely diagnosis? (DI) A. Boxer’s fracture B. Colles fracture C. Greenstick fracture D. Stress fracture
A Boxers fx
Which of the following is not a potential complication from obtaining blood cultures? (CB)
a. Hematoma
b. Phlebitis
c. Sepsis
d. Contaminated samples
C sepsis
Which of the following are contraindications for lumbar puncture? (CB)
a. Patient is a minor, facial trauma or choanal atresia
b. Increased ICP, spinal column structural abnormalities or medical instability
c. Coma, nerve damage or infection
d. Intubated patient, history of psychosis, or GCS of 8
B
Before a live insect is removed from the ear, it should be killed with: A. 2% lidocaine B. Alcohol C. Olive oil D. Any of the above may be used
D any of the above
A contraindication to irrigation of the external auditory canal is:
A. Impacted ear wax is causing hearing loss
B. Tympanic membrane is not visible due to impacted ear wax
C. History of perforation of the tympanic membrane
D. Impacted ear wax is causing pain
C hx of perforation of tm
Which of the following is a contraindication to NG tube? A) Severe facial trauma B) Sampling gastric contents C) Sinusitis D) Pt needs nutritional support
A severe facial trauma
Which of the following methods assists in inserting the NG tube?
A) Having the pt flex their neck
B) Applying lubricant to the first 2-3ins of the tube
C) Having the pt sip water as the provider inserts the tube
D) All of the above
D ATB
True or False: Blood culture requires 2 samples from 2 different locations.
T
What is true regarding NG tube placement?
a. Used in patients with esophageal varices, stricture, or atresia
b. Utilized as gastric decompression
c. You do not need radiographic confirmation
d. Placement should be in the nostril that is less patent
B utilized as gastric decompression
True or False: Cerumen impaction is a common cause of hearing loss in young children
False
What should you always do when a foreign body is visualized in one ear/nostril of a child?
Use lidocaine to extract the foreign body
Always check the opposite ear/nostril
Always irrigate if perforation is suspected
Pre-treat ear canal with normal saline
always check the opposite ear/nostril
Which of the following is NOT an indication for NG tube placement?
Sampling of gastric content
Removing gastric content
Providing nutritional support
Reducing esophageal stricture
reducing esophageal stricture
What angle should a patient be positioned for NG tube placement?
180
90
45
15
45
Reverse sugar tong is a possible indication for:
5th metacarpal fracture
Elbow sprains
Ulnar collateral ligament sprains
Colles fracture
colles
All the below are complications of tube thoracostomy, except:
Hemorrhage (usually from intercostal artery injury)
Neurovascular bundle injury
Endocarditis
Death
endocarditis
During a needle decompression, where should the large bore angiocatheter be placed? -
Midclavicular line at the 2nd or 3rd intercostal space
Midaxillary line at the 6th intercostal space
Midclavicular line at the 7th intercostal space
Midsternal line at the 4th intercostal space
midclavicular line at the 2nd or 3rd ICS
How should the site be prepared during a tube thoracostomy?
Flush the site with sterile water
Scrub the site with povidone-iodine
Locally anesthetize the site with lidocaine
Both b and c
both b and c
- scrub the site with povidione-iodine
- locally anesthetize the site with lidocaine
When draining a subungual hematoma, you should avoid using the heat method if the patient has ________ , as they may be flammable
A. Onychomycosis
B. Finger tattoos
C. Nail pitting
D. Acrylic Nails
D acrylic nails
- In immunocompromised patients, nonspecific CSF abnormalities may indicate which of the following?
A. Fungal meningitis
B. CNS tuberculosis
C. Neurosyphilis
D. All of the Above
D ATB
- One of first things you should do for a suspected scaphoid fracture is to place the wrist in a:
Thumb spica splint
Ulnar gutter splint
Posterior ankle splint
Reverse sugar tong splint
thumb spica splint
An ankle stirrup splint can be used for which of the following? -BD Ankle sprain/strain Shin splints Hairline fractures All of the above
ATB
True/false: Anesthesia can be used when draining a subungual hematoma as it can help relieve the pain. -
false
The most common complication to look for after performing a lumbar puncture is:
Disk herniation
Seizure
Headache
Asterixis
HA
What size catheter should you use and how should you hold it during an emergency needle decompression procedure?
At least 3 cm ; hold it perpendicular to the chest wall
At least 7 cm ; hold it at a 45 degree angle to chest wall
At least 5 cm ; hold it perpendicular to the chest wall
At least 5 cm ; hold it at a 45 degrees angle to the chest wall
At least 5 cm, hold it perpendicular to the chest wall
What type of acid is as dangerous as alkaline solutions in eye injuries?
Hydrochloric acid
Hydrofluoric acid
Sulfuric acid
Hydrobromic acid
hydrofluoric acid
Which of the following is a contraindication for a cast?
During the acute injury phase (3-4 days), when acute swelling of the extremity is expected
When the cast would cover or conceal a known skin or soft tissue infection
When the cast would cover or conceal an open wound, where infection may occur
All of the following are contraindications
all of the following are contraindications
When is it appropriate for a patient in a splint to return for replacement of a cast? BF 1-2 days 3-7 days 7-14 days 14-16 days
3-7 days
Using a stepwise approach, what is the next step in managing an anterior epistaxis when the anterior source has been identified?
Electric cauterization
Mechanical packing
Silver nitrate cauterization
Nasal tampon
silver nitrate cauterization
What is the gold standard test to confirm correct placement of an NG tube when there are no contraindications?
Ultrasound
X-ray
Listen with a stethoscope in the LUQ
Percuss over the LUQ for a dullness sound
X-ray
- In what patients is impacted cerumen MORE commonly seen in?
Elderly or handicapped patients
Infants
Children or adolescents
Patients with frequent ear infections
Elderly or handicaped patietns
- If you have a young child in the ED who cannot be adequately restrained how should you proceed with the removal of a foreign body in the ear?
Prepare for removal.
Have the patient go home and return when they are more relaxed.
Refer to a specialist.
Wait for the patient to calm down.
refer to a specialist
- When casting a patient’s leg for a fracture, you want to explain to the patient what neurovascular symptoms they should be checking for such as pain, pallor, paresthesia, pulselessness, and paralysis. What are these symptoms indicative of? -(A. DVT
B. Cellulitis
C. Compartment Syndrome
D. Rhabdomyolysis
C–comp syndrmoe
- What are the two primary materials used to make casts and splints?
A. plaster and thermoplastic
B. plaster and fiberglass
C. thermoplastic and carbon fiber synthetic materials
D. fiberglass and carbon fiber synthetic materials
B–plaster and fiberglass
Which of the following is false regarding lumbar puncture complications:
Potential infectious complications range from localized cellulitis to meningitis to spinal abscesses in the epidural or subdural space.
Postdural puncture headaches are relieved by standing up.
Nerve damage may occur, causing electric shocks and transient pain.
Postdural puncture headaches are bilateral.
postural puncture HA are relieved by standing up
Which of the following is not a cause of epistaxis:
Digital manipulation.
Inhalation of illicit substances.
Exposure to warm, humid air.
Liver failure.
Exposure to warm, humid air
All of the following are used when draining a subungual hematoma, except:
Conventional hand-held microcautery device
Anesthesia
18 gauge large bore needle
No. 11 scalpel
Anesthesia
What type of acid is as dangerous as alkaline solutions in eye injuries?
Hydrochloric acid
Hydrofluoric acid
Sulfuric acid
Hydrobromic acid
hydrofluoric acid
What is the only scenario that’s okay to skip visual acuity as first line management?
When a patient has a blow out fracture
When you suspect a corneal abrasion
When the eye has been splashed with an alkaline solution
When there is a foreign body in the eye.
when he eye has been splashed with an alkaline soln
What is the correct water temperature for irrigation of the ear? 80* F 97* F 105* F 75* F
97
What is the first step in removal of a nasal foreign body?
Using alligator forceps, gently grasp the object and slowly remove from nare.
Have the patient occlude one nostril and forcibly exhale through the nose in attempt to dislodge it.
Insert a balloon catheter into the nostril passed the foreign body, inflate the balloon, then gently remove the catheter with the balloon still inflated.
Refer to ENT
have the patient occlude one nostril and forcibly exhale thru the nose in attempt to dislodge it
Which of the following is false regarding removal of a foreign body from the ear?
Water should be very cold in order to provide pain relief for the patient.
If the foreign body is a battery, do not irrigate.
Sudden onset of pain and dizziness during the procedure indicates that the tympanic membrane may be ruptured, and is cause for referral to ENT.
Foreign bodies such as nuts, seeds or anything made of wood will swell when in contact with water and thus should not be irrigated.
water should be very cold in order to provide pain relief for the pt
When molding a cast one should never use their fingertips because:
This can cause nerve damage to the patient
It will ruin the cast and it will be more difficult to remove
It can create pressure ulcers
Your fingers will get tired while molding the cast
it can create pressure ulcers
All are contraindications to removing cerumen from the ear EXCEPT:
Perforated tympanic membrane
Recent surgery to the ear
Recent scuba diving trip
Sudden onset of dizziness
recent scuba diving tirp
What is an advantage of applying a non circumferential splint rather than a circumferential cast?
It provides more mechanical support than a cast
It allows for soft tissue swelling during the acute phase of the injury
It provides more protection than a cast
a and b
allows for soft tissue swelling during acute phase
What is a disadvantage of cotton padding?
It is difficult to roll onto an extremity without wrinkling
It is bulkier than synthetic padding
Wet plaster adheres to cotton padding
None of the above
it is difficult to roll onto an extremitiy without wrinkling
Which of the following are contraindications for nasal packing for epistaxis?
Nasal bone fractures
Shock/Altered Mental Status
A & B
None of the above
a and b
After removing the foreign body, what should you do?
Recheck ear to make sure foreign body is completely removed
Prescribe antibiotic drops if there is inflammation
Document if tympanic membrane is intact
All of the above
all the above
Which of the following would warrant a blood culture?
Suspected bacteremia
Suspected septicemia
A & B
None of the above
a and b
If specimens for multiple lab tests are required, which should you do?
Collect the blood culture specimen tubes before other tubes.
Aerobic tubes should be collected first
Anaerobic tubes should be collected second.
All of the above
al the above
Which of the following patients are at higher risk for burns due to the exothermic reaction generated by plaster cast material?
Patients that are unable to communicate due to immaturity or cognitive impairment
Patients with sensory deficits
Patients that have visual impairment
Both A and B
a and b
Which of the following is a potential complication of casts? (Oneeka) Gouty arthritis Target shaped rash Compartment syndrome Anaphylaxis
comp syndr
When confirming NG tube placement, one must inject ____ mL of air through the tube, and listen over the ____ of the abdomen. RK
5; RUQ
10; LUQ
7; RLQ
5; LLQ
10, LUQ
While performing an irrigation of the ear, the PA must use water that is body temperature to avoid: RK Vertigo Itching Reflux cough Hiccups
vertigo
Compartment syndrome is a potentially dangerous complication of circumferential casting of an injured extremity. Which of the following is the most predictiver symptom of the compartment syndrome?
Pain that increase over time that is out of proportion to the severity of the injury
Numbness and tingling distall to the site of the injury
Soft tissue compartment resting pressures of 20 -30 mm Hg
Intense pain that radiates proximally
pain that increases over time that is out of proportion to the severity of the injury
Long arm posterior splints and double sugar-tong splints are used with fractures to the olecranon process. The olecranon process is a bony prominence located at the top of the \_\_\_\_\_. ulna radius humerus acromion
ulna
