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Emergency Medicine > Final > Flashcards

Final Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Syphilis S/S

A
  1. Painless chancre
  2. Maculopapular rash, condyloma lata
  3. Neuro
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2
Q

Chancroid

A

Bubo - painful lesion under skin
LAD

Dx - gram stain neg rods in school of fish
Tx - Azithromycin

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3
Q

Painless lesion on genitals?

A

Syphilis

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4
Q

Lymphogranuloma venereum

A

C trachomatis
Small painless lesion, LAD, groove sign

Dx - clinical & serology
Tx - Doxy

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5
Q

Granuloma inguinale

A

Calymmatobacterium granulomatis
Beefy red, velvety ulcer w/ a rolled border
Painless

Dx - Wright stain
Tx - Doxy

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6
Q

Candidiasis

A

Thick cottage cheese discharge
Pruritis, dysuria
Dx - KOH - pseudohyphae
Tx - Fluconazole

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7
Q

Trichomoniasis

A

Foamy, stinky, greenish white discharge
Can live outside body - toilet seat
Strawberry cervix
Dx- pH >5, flagella on wet mount

Tx - Metronidazole (Flagyl)

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8
Q

Bacterial vaginosis

A

Smelly, fishy vaginal discharge

Dx - leukorrhea, clue cells, pH>5, +whiff test w/ KOH

Tx - Flagyl

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9
Q

Chlamydia

A

Discharge, odor, pelvic pain, bleeding
Fitz-Hugh-Curtis - hepatic

Dx - culture
Tx - Azithromycin + Doxy

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10
Q

N. gonorrhea

A

Discharge, odor, pelvic pain, bleeding

Dx - gram stain - Thayer Martin culture

Tx - Ceftriaxone + Azithromycin

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11
Q

Bartholin’s cyst

A

Infection of glands

Tx - I&D, marupialization of gland

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12
Q

Oligomenorrhea

A

Dec. frequency of menstruation

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13
Q

Menometrorrhagia

A

Excessive irregular vaginal bleeding

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14
Q

MCC post-menopausal bleeding

A

Atrophic endometrium

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15
Q

Abruptio placentae

A 
Often caused by abd trauma
Risk factors:
1. Cocaine
2. HTN
3. Smoking
4. Inc. maternal age 
5. >20wks gestation

Separation & bleeding

  1. Pain
  2. HOTN
  3. DIC
  4. Dark bleeding
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16
Q

Placentae previa

A

Implanted placenta overlaps the cervical os
NO pelvic - do US

  1. Little pain
  2. Bright red vaginal bleeding
  3. > 20 wks
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17
Q

Causes of bleeding in pregnancy

A
  1. Ectopic
  2. Spontaneous abortions
  3. Abruptio placentae
  4. Placentae previa
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18
Q

Uterine atony

A

Baby delivered - uterine doesn’t contract so bleeds

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19
Q

Causes of vaginal bleeding in kids

A
  1. Foreign bodies
  2. Genital trauma/sexual abuse
  3. Severe vulvovaginitis
  4. Submucosal leiomyomas (Fibroid)
  5. Cervical & endometrial polyps
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20
Q

MC genital CA women?

A

Endometrial

MC Sx - vaginal bleeding

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21
Q

When can you use a transvaginal US?

A

35 days

HCG >1500

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22
Q

Molar pregnancy

A

Uterus larger than what is expected for gestational age

US - uterine “snowstorm” appearance

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23
Q

Tx ectopic pregnancy

A
  1. Surgery

2. Methotrexate

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24
Q

Uterine rupture

A

Uterine pain w/o contractions, vaginal bleeding

Risk factors: C-section, cocaine, prostaglandins

Exam - tender, boggy uterine fundus, expanding uterus

Dx - US
Tx - Surgery

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25
Q

Placental accreta

A

Little pain, bright red vaginal bleeding during delivery of placenta
Clinical Dx
Tx - Fisting, surgery

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26
Q

Leimyomas

A

Tumors of muscle origin, MC in blacks
Dx - US
Tx - NSAIDS, progesterone

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27
Q

Polycystic ovary syndrome

A 
Triad
1. Obesity
2. Hirsutism
3. Oligomennorhea
Dx - US, hormones
Tx - OC
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28
Q

When to get C-section?

A
  1. Fetal distress & vaginal delivery not imminent
  2. Severe abruption w/ viable fetus
  3. Life-threatening hemorrhage
  4. Pt has failed trial of labor
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29
Q

When to get urgent hysterectomy?

A
  1. After delivery of fetus if indistinct placental cleavage plane
  2. Excessive hemorrhage
  3. Placental accreta
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30
Q

Chadwick’s sign

A

Blue-violet cervix from inc. vascularization

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31
Q

Hegar’s sign

A

Soft & boggy cervical isthmus

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32
Q

What marks the start of the first stage of labor?

A

Bloody show

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33
Q

When does the first stage of labor end?

A

When the cervix is fully dilated & effaced

Latent phase - slow cervical dilation to 4cm

Active phase - rapid cervical dilation 4cm to completion

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34
Q

What is effacement?

A

The process of cervical thinning

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35
Q

How do you determine the position of a fetus?

A

Leopold maneuvers

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36
Q

Fetal HR decelerations

A

Early - represent head compression
Variable - indicates cord compression
Late - indicates uterine placental insufficiency - bad!

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37
Q

Sinusoidal tracing (Fetal HR)

A

Ominous sign indicating erythroblastosis fetalis, placental abruption, fetal hemorrhage & amnionitis w/ high mortality

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38
Q

What maneuver do you use to facilitate delivery?

A

Ritgen maneuver

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39
Q

Indications for episiotomy

A
  1. Shoulder dystocia

2. Breech delivery

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40
Q

Examination of placenta (after delivery)

A
  1. Clots - placental abruption

2. Missing cotyledones - incomplete separation

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41
Q

Interrupt labor

A

Can’t do if >4cm dilated

  1. Tocolytics (Mag sulfate/beta-mimetics)
  2. Fetal maturation therapy
  3. Bed rest & hydration
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42
Q

Dx premature labor

A
  1. Nitrazine paper testing pH 7.1-7.3 - yellow paper
  2. Ferning on a slide
  3. Smear combustion
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43
Q

Chorioamnionitis

A

Infection around membranes
Mom - uterine tenderness, fever, tachycardia, smelly d/c, leukocytosis
Baby - Dec. activity, tachycardia, dec. viability

Dx - vaginal fault fluid, cultures, amniocentesis studies

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44
Q

What is dystocia?

A

Abnormal labor progression

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45
Q

Maneuver to deliver breech baby?

A

Mauriceaux

Flex knees, sweep out legs, flex neck

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46
Q

Risk factor to uterine rupture?

A

Vaginal birth after C-section

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47
Q

How much blood volume?

A

7% body wt in kg of adults ~5L

Kids 8-9%

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48
Q

Subfalcial herniation

A

1 cerebral hemisphere protrudes beneath the falx into opposite tentorial space

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49
Q

Uncal herniation

A

Uncus of temporal lobe protrudes through opening of tentorium
Compression on CNIII, corticospinal tract & Brain stem

Ipsilat fixed dilated pupil, contralat hemiparesis, dec. LOC
Neuro emergency

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50
Q

Cerebellar tonsillar herniation

A

Compression of medulla

Bradycardia, bradypnea, death

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51
Q

S/S postconcussive syndrome

A
  1. HA
  2. Dec. memory & attention
  3. Insomnia
  4. Dizziness
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52
Q

MC site of bleeding after TBI?

A

Subarachnoid hemorrhage

  1. HA
  2. Photophobia
  3. Meningeal signs

Inc. mortality compared to nontraumatic SAH

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53
Q

Talk & die?

A

Lucid then rapid deterioration

Epidural hematoma - tear of middle meningeal artery

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54
Q

Who is most susceptible to subdural hematomas?

A

Tear of bridging veins

Old people & drunks

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55
Q

At what GCS do you intubate?

A

<8

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56
Q

Cushing’s phenomenon

A
  1. Inc. ICP
  2. HTN
  3. Bradycardia
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57
Q

Tx inc. ICP

A
  1. Mild hyperventilation
  2. Elevate head of bed
  3. Sedation
  4. Mannitol IV
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58
Q

Which type of facet dislocation has neuro defecits?

A

Bilateral - displaced >50% of its width

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59
Q

Anterior cord syndrome

A

Cervical flexion injury
Compresses ant. cord - corticospinal & spinothalamaic pathways

Loss of motor function & pain & temp sensation distally
Vibration, position & crude touch preserved

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60
Q

Central cord syndrome

A

Old people w/ hyperextension injury
Central fibers of corticospinal & spinothalamic tracts

Dec. strength & slightly dec. pain & temp sensation
More in upper than lower extremities

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61
Q

Brown-Sequard syndrome

A

Hemisection of the cord

Ipsilat loss of motor function, proprioception & vibratory sensation w/ contralat loss of pain & temp

Best prognosis

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62
Q

NEXUS criteria for spinal imaging

A
  1. Absence of midline cervical tenderness
  2. NL level of alertness & consciousness
  3. No evidence of intoxication
  4. No focal neuro deficit
  5. No painful distracting injury
63
Q

When is MRI better than CT for spinal injuries?

A

Describing anatomy of nerve injury, herniated disks or spinal cord contusions

64
Q

Neck zones

A

I - clavicles to cricoid
II - cricoid to mandible
III - mandible to base of skull

65
Q

Dx hemothorax

A

CT - need chest tube

66
Q

Prostate not palpable or high up?

A

Urethral disruption

67
Q

Which GU traumas might not cause hematuria?

A
  1. Pedicle injuries
  2. Arterial thrombosis

Amount of blood does not correlate to extent of injuries

68
Q

Dx bladder rupture?

A

Retrograde cystogram

69
Q

Dx testicular injury

A

Color doppler US

70
Q

What is the Kleihauer-Betke test?

A

Measures amount of fetomaternal hemorrhage - counts maternal & fetal RBCs in maternal blood

71
Q

Drop in BP in kids, what % blood loss?

A

25-30%

72
Q

S/S epidural hematoma kids

A

Uncommon

Period of lucency

73
Q

S/S subdural hematoma in kids

A
  1. Irritable
  2. Vomiting
  3. Seizures

MC in infants

74
Q

When to give anticonvulsants to kids?

A

Seizure lasting more than a few mins of kid w/ >2 seizures

Phenytoin/Fosphenytoin

75
Q

SCIWORA

A

Spinal cord injury w/o radiographic abnormality
Seen in kids

Sx delayed for days
1. Paresthesias
2. Numbness
3. Weakness 
Leads to paralysis - get MRI
76
Q

Tx hydrofluoric acid burns

A
  1. Water irrigation
  2. IV Ca2+ & Mg2+
  3. Topical calcium gluconate gel to bind fluoride
  4. SQ & Intradermal injection of calcium gluconate

DOES NOT cause coagulation necrosis

77
Q

Parkland formula for burns

A

LR 4 mL X wt X BSA burned over initial 24h

1/2 over 1st 8h from time of burn, other 1/2 over next 16h

For 2nd/3rd degree burns only

78
Q

Tx sprains

A

1&2 - RICE

3rd degree - Ortho consult

79
Q

Shoulder dislocation but no pulse, what do you do?

A

Reduce it before Xray

80
Q

Compartment syndrome Dx

A

Clinical

>30-50 pressure

81
Q

Leading cause of death by poison?

A

Carbon monoxide

82
Q

DONT protocol for poisoning

A

Dextrose
Oxygen
Narcan
Thiamine

83
Q

Poison - causes of HTN?

A 
Cocaine
Thyroid supplements
Sympathomimetics
Caffeine
Anticholinergics, amphetamines
Nicotine
84
Q

Poison - causes of HOTN?

A 
Clonidine, Ca channel blockers
Reserpine or other BP meds
Antidepressants, aminophylline
Sedative-hypnotics
Heroin/other opiates
85
Q

Poison - causes of tachycardia

A

Free base/other forms of cocaine
Anticholinergics, antihistamines, amphetamines
Sympathomimetics, solvent abuse
Theophylline

86
Q

Poison - causes of bradycardia

A 
Propranolol/other beta-blockers, poppies (opiates), phenylpropanolamine
Anticholinesterase drugs
Clonidine, Ca channel blockers
Ethanol/other alcohols
Digoxin
87
Q

Poison - causes of rapid respiration

A

PCP, pneumonitis (chemical)
ASA/other salicylates
Noncardiogenic pulm edema
Toxin-induced met. acidosis

88
Q

Poison - causes of slow respiration

A

Sedative hypnotics
Liquor
Opiates
Weed

89
Q

Poison - causes of hyperthermia

A

NMS, nicotine
Antihistamines
Salicylates, sympathomimetics
Anticholinergics, antidepressants

90
Q

Poison - causes of hypothermia

A 
Carbon monoxide
Opiates
Oral hypoglycemics, insulin
Liquor
Sedative hypnotics
91
Q

Poison - causes of miosis

A
  1. Cholinergics
  2. Clonidine
  3. Organophosphates
  4. Sedative hypnotics
92
Q

Poison - causes of mydriasis

A
  1. Antihistamines
  2. Antidepressants
  3. Anticholinergics
  4. Sympathomimetics
93
Q

Poison - causes of nystagmus

A

Horizontal - lithium, barbiturates, phenytoin, carbamazepine, alcohol

Vertical/rotary - PCP

94
Q

Poison - causes of seizures

A 
Organophosphates
TCAs
INH, insulin
Sympathomimetics
Camphor, cocaine
Amphetamines, anticholinergics
Methylxanthines (Theophylline, caffeine)
PCP
Benzo withdrawal
Ethanol withdrawal
Lithium, lidocaine
Lead, lindane
95
Q

Cholinergic toxidrome

A

Organophostphates - insecticides

Diarrhea, diaphoresis
Urinary +/- fecal incontinence
Miosis
Bradycardia, bronchosecretions, bronchospasm
Emesis
Lacrimation
Salivation
96
Q

Anticholinergic toxidrome

A

Antihistamines, TCA

Hot as a hare, red as a beet, dry as a bone, blind as a bad, mad as a hatter

97
Q

Sympathomimetic toxidrome

A

Cocaine, amphetamines, decongestants, caffeine, theophylline

  1. Diaphoresis
  2. Mydriasis
  3. Tachycardia
  4. HTN
  5. Hyperthermia
  6. Seizures, agitation, hallucinations
98
Q

Narcotic/sedative/alcohol toxidrome

A
  1. Miosis
  2. Hypoventilation
  3. Coma
  4. Bradycardia
  5. HOTN
99
Q

Methods of GI decontamination

A
  1. Emesis
  2. Gastric lavage
  3. Activated charcoal
  4. Multiple dose activated charcoal
100
Q

What is used for whole body irrigation?

A

Golytely

101
Q

Poison - when to use dialysis?

A
  1. Salicylates
  2. Lithium
  3. Theophylline
  4. Toxic alcohols
102
Q

Antidotes

A 
Acetaminophen - N-acetylcysteine
Carbon monoxide - O2/HBO
Coumadin - Vit K/FFP
Digoxin - Digibind
Narcotics - Naloxone
Beta-blockers - Glucagon
Methanol/ethylene glycol - Ethanol/4-MP
TCAs - Sodium bicarbonate
103
Q

Benzoyl ecgonine in urine, what did Pt take?

A

Cocaine - present for 3 days

104
Q

Tx cocaine OD

A
  1. IV diazepam
  2. IVF
  3. Rapid cooling if high temp

NO beta-blockers

105
Q

Tx barbiturate withdrawal

A

Phenobarbital

106
Q

Tx benzo OD

A

Supportive

107
Q

Tx GHB OD

A

Supportive

108
Q

Tx digoxin OD

A
  1. Correct hypokalemia in chronic, hyperkalemia in acute
  2. Digibind

Bradycardia/AV blocks? Atropine/pacing
Tachyarrhythemias - phenytoin/lidocaine

109
Q

What is the most lethal beta-blocker OD?

A

Propranolol

110
Q

Toxic dose of acetaminophen?

A

150 mg/kg

If 4h level above nomogram, give antidote or AST>50
If started w/in 8h, Pt will do fine

111
Q

NAC indications

A
  1. Serum acetaminopehn level over Tx line
  2. Any detectable level >24h post ingestion
  3. Level won’t be avail. 8h post ingestion
  4. Preggers
  5. Time of ingestion can’t be determined
  6. Fulminant hepatic failure
  7. Repeated supratherapeutic level - serum level exceeds 20, AST/ALT elevated
112
Q

S/S salicylate OD

A
  1. Resp. alkalosis & met. acidosis
  2. Hypoglycemia, low Na/K/Ca
  3. Pulm. & cerebral edema - dialysis
113
Q

Pt says vision is like ‘stepping out into a snow storm’

A

Methanol poisoning

114
Q

Dx methanol poisoning

A
  1. Severe AG met. acidosis from formic acid
  2. Elevated osm gap >10
  3. Serum methanol & ethylene glycol level
115
Q

Stages of ethylene glycol poisoning

A
  1. Acute neuro stage
  2. Cardiopulm. stage
  3. Renal stage
  4. Delayed neuro sequelae stage
116
Q

Dx ethylene glycol poisoning

A
  1. Ethylene glycol level
  2. +/- crystalluria
  3. QT prolongation
  4. AG met. acidosis
  5. Elevated osm. gap
117
Q

Tx ethylene glycol & methanol poisoning

A
  1. Bicarb
  2. ADH enzyme blockade
  3. Dialysis
  4. Ethanol/Fomepizole
  5. Methanol? Folinic acid
  6. Ethylene glycol - Thiamine & pyridoxine
118
Q

Tx isopropyl alcohol

A
  1. Supportive

2. Hemodialysis for severe HOTN

119
Q

Tx carbon monoxide poisoning

A

<10% nonsmokers

  1. 100% O2
  2. Hyperbaric O2
120
Q

Phases of frostbite

A
  1. Prefreeze - vasospasm & plasma leakage
  2. Freeze-thaw phase - tissue ice crystals form
  3. Vascular stasis phase - blood vessels damaged & plasma leakage, coagulation & shunting
  4. Late ischemic phase - AV shunting, thrombosis, ischemia lead to gangrene & autonomic dysfunction
121
Q

Degrees of frostbite burns

A
  1. Numb, erythema, swelling, desquamation
  2. Blisters w/ surrounding edema & erythema
  3. Deeper blisters w/ purple bloody fluid, tissue loss of entire thickness of skin
  4. Involves tissue below the dermis w/ muscle & bone involvement
122
Q

Tx frostbite

A
  1. Correct hypothermia
  2. Rapid rewarming - warm water bath 104-108 F until skin is soft, pliable & erythematous
  3. Analgesics
  4. Tetanus prophylaxis
  5. Aloe vera cream
  6. Ibuprofen
123
Q

What is Chilbain?

A

aka pernia
Long-term intermittent exposure to dry/damp nonfreezing temps

Small, erythematous superficial ulcerations, plaques, nodules & vesicles appear 12h after cold exposure
Pruritis & burning

Tx

  1. Supportive w/ gentle rewarming
  2. Skin moisturizers
124
Q

Trench foot

A

aka immersion foot
Several days of exposure to wet, cold conditions, temp above freezing

Tingling & numbness, foot becomes pale, mottled, pulseless, immobile then hyperemic hours after rewarming w/ pain
+/- bullae

Tx - elevation, rest, avoid cold & wet

125
Q

Primary vs. secondary hypothermia

A

<95F - need rectal temp

1 - accidental - not wearing enough clothes

2 - complication of systemic disease that compromises thermoregulatory mechanism

126
Q

When do you get Osborn J waves?

A

Hypothermia <33C

127
Q

Tx arrhythmia in hypothermia Pt?

A

Rewarm first

128
Q

Heat stroke

A

Heat exhaustion + Temp >40C/104F + AMS

+/- anhidrosis/sweating

129
Q

Tx shivering due to heat stroke

A

Chlorpromazine/diazepam

130
Q

Acute mountain sickness

A

Nonacclimized people who rapidly ascend to 6600ft or +
Caused by hypobaric hypoxia

  1. HA
  2. GI Sx
  3. Dizziness
  4. Sleep disturbance

Tx

  1. Oxygen
  2. Acetazolamide - inc. oxygenation
  3. Aspirin/acetaminophen for HA
  4. Dexamethasone - severe cases
131
Q

Dec. exercise tolerance & dry cough in high altitude?

A

HAPE - high altitude pulm. edema

132
Q

Tx HAPE

A
  1. Immediate descent
  2. Bedrest
  3. Oxygen
  4. Keep Pt warm
  5. CPAP/BiPAP
133
Q

Most lethal altitude illness?

A

HAPE

134
Q

Most severe altitude illness?

A

HACE

135
Q

S/S & Tx HACE

A

High altitude cerebral edema

Confusion, hallucination, ataxia, slurred speech, seizures, focal deficits, coma

Tx
1. Descent 
Can't descend? Steroids, oxygen, hyperbaric (Gamow) bag
2. Oxygen
3. Rest
4. Dexamethasone
136
Q

Snow blindness

A

aka ultraviolet keratitis

Severe pain, gritty sensation, tearing, chemosis, photophobia, eyelid swelling
Heals w/in 24h

137
Q

Barotrauma of descent

A
  1. Barotitis - ear squeeze
  2. External ear squeeze
  3. Sinus barotrauma
  4. Inner ear barotrauma
  5. Face, tooth or dry suit squeeze
138
Q

Barotrauma of ascent

A
  1. Pulm. barotrauma
  2. Decompression sickness (the bends)
  3. Arterial air embolism
139
Q

Barotrauma + neuro Sx?

A

Cerebral arterial gas embolism

140
Q

Decompression sickness

A

Gas bubbles in blood & body tissues
Type I - pain only
II - neuro, vestibular & cardiopum
III - Type II + arterial gas embolism

141
Q

Type barotrauma ascent

A
  1. 100% oxygen
  2. IVF
  3. Hyperbaric oxygen chamber
142
Q

MCC inhalation injury

A

Fire

143
Q

MC toxic cause of death from fire related inhalation

A

Carbon monoxide

144
Q

Tx thermal burns to airway

A

Intubate

145
Q

Lightning strike can cause?

A
  1. Asystole
  2. Burns
  3. Cataracts, ocular trauma, mydriasis/anisocoria
  4. TM rupture
  5. Fx/dislocations
  6. Paralysis transient, coma, AMS
146
Q

Snakebite - pain out or proportion?

A

Pit viper

147
Q

Snakebite - numbness?

A

Coral snakes

Red on yellow kill a fellow, red on black venom lack

148
Q

CK MB elevated w/ electrical injury, what’s injured?

A

Skeletal - not heart

149
Q

How to get bee sting off you?

A

Scrape

150
Q

Tx Black widow bite

A

aka Latrodectus
Woodpiles - black body w/ 2 red spots

  1. Clean
  2. Tetanus
  3. Muscle relaxants/analgesics for spasms
  4. Antivenom
151
Q

Tx brown recluse bite

A

aka Loxosceles
Mainly in S central US

Brown w/ violin shaped mark on back
Bull's eye mark then ulcer 
1. Clean
2. Tetanus
3. Analgesics/abx
152
Q

Fitz-Hugh-Curtis in woman

A

RQ pain, nl LFTs, +Chlamydia

Dx - CT
Tx - same as PID

153
Q

Tx PID

A

Cefotetan + Doxy IV

OutPT? - Ceftriaxone + Doxy +/- Flagyl

Emergency Medicine (5 decks)

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