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Final Exam Flashcards

1
Q

Do not treat ___________ children with STI prophylaxis. However, _____ prophylaxis should be considered.

A

prepubertal

HIV

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2
Q

Prophylactic treatment of STIs for adolescents

A

Ceftriaxone PLUS
Azithromycin PLUS
Metronidazole OR
Tinidazole

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3
Q

Diagnostic of sexual abuse: ________, _________, _________, _________

A

Gonorrhea
Syphilis
HIV
Chlamydia

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4
Q

High suspicion of sexual abuse: ________, _______ _______

A

Trichomonas

Genital herpes

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5
Q

Suspicious of sexual abuse: _________ ________

A

Anogenital warts

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6
Q

Inconclusive of sexual abuse: ________ _________

A

Bacterial vaginosis

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7
Q

When a pediatric patient is well appearing:

A

5 vital signs

S, O, A, P

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8
Q

When a pediatric patient is sick appearing (5 things):

A
  1. Oxygen (assist ventilation if needed)
  2. Pulse ox
  3. Cardiorespiratory monitor
  4. IV access
  5. CXR/EKG
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9
Q

Normal blood pressure is maintained up over _____% of a child’s circulating volume is lost. Therefore hypotension is a late finding in ______

A

30%

Shock

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10
Q

Signs of shock/poor tissue perfusion in a pediatric patient (3):

A
  1. Cool or mottled skin
  2. Tachycardia
  3. AMS
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11
Q

Fluid resuscitation for the pediatric patient in shock

A

20 ml/kg boluses NS or LR until signs of improved perfusion and resolution of tachycardia

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12
Q

Fluid resuscitation for the pediatric patient in shock due to hemorrhage

A

2 boluses of NS/LR 20 ml/kg

After, PRBC 10 ml/kg

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13
Q

Treatment if signs of increased ICP with herniation in pediatric patient

A
  1. Elevate HOB 30 degree
  2. Hypertonic saline (3%)
  3. Mannitol
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14
Q

Seatbelt sign

A

High probability of abdominal injury; CT of abdomen warranted

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15
Q

Pain before vomiting in children is typical of ____________

A

Appendicitis

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16
Q

Abnormal rotation of mesentery during embryonic development

A

Intestinal malrotation

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17
Q

Management/treatment of intestinal malrotation

A
  1. IV fluid resuscitation
  2. NG tube w/ intermittent suction
  3. Call your surgeon
  4. Upper GI series
  5. Laparotomy
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18
Q

Preferred imaging and classic image of intussusception

A

Ultrasound

Coiled spring or bullseye

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19
Q

Management of intussusception

A
  1. ABCs, resuscitate with IVF
  2. NGT if frequent vomiting
  3. IV abx if concern for perforation
  4. Notify surgery early, abdominal x rays to exclude perforation with free air
  5. Air enema reduction
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20
Q

Contraindications to air enema for intussusception

A
  1. > 3 days
  2. Signs of peritonitis
  3. Evidence of free air on plain X Ray
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21
Q

A WBC count of less than _______ and an absolute neutrophil count of less than _______ makes appendicitis much less likely

A

9,000

7,000

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22
Q

Management for appendicitis

A
  1. IV Fluids
  2. IV pain meds and antiemetics
  3. IV ABX (ancef or zosyn if concern for perforation)
  4. Call surgeon
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23
Q

Classic presentation of sudden unilateral lower abdominal pain, nausea and vomiting with a palpable mass

A

Ovarian Torsion

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24
Q

In ovarian torsion, the ______ side is more commonly affected than the _______ side

A

Right

Left

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25
Q

Management of ovarian torsion

A
  1. Pain control
  2. IV Fluids
  3. US with doppler
  4. Emergent operative intervention
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26
Q

What to do when patient is having a seizure:

A
  1. Assess ABCs
  2. Place patient on his/her side
  3. O2, pulse ox, IV access, bedside glucose
  4. If longer than 3 minutes: lorazepam, diazepam, midazolam
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27
Q

PMH details to watch for in pediatric seizures

A
  1. Neurosurgical procedures (shunt for hydrocephalus)
  2. Prematurity or developmental delays
  3. History of meningitis, CNS infections
  4. Hx of head trauma
  5. Hypercoagulable state (sickle cell)
  6. Immunosuppression
  7. TB exposures/access to INH
  8. Formula mixing
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28
Q

Signs of increased ICP in pediatric patients

A
  1. Bulging fontanelle

2. Papilledema

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29
Q

2 important questions to always ask after a pediatric seizure:

A
  1. Vaccination status (DTP/MMR)

2. Recent ABX (can be masking signs/symptoms of meningitis)

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30
Q

Lumbar puncture is an option in a post-seizure child that is:

A
  1. Deficient in immunizations OR

2. Pretreated with ABX

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31
Q

Lumbar puncture is clearly indicated in a post-seizure child that has:

A
  1. Status epilepticus
    AND
  2. Fever
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32
Q

____% of children will experience recurrent febrile seizures

A

33

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33
Q

Preferred imaging modalities for children in epilepsy evaluation

A

EEG

MRI

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34
Q

2 tests that should be ordered right away for a child in suspected DKA

A
  1. Accucheck

2. Urinalysis

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35
Q

Definition of DKA

A 
Hyperglycemia > 200 mg/dL 
AND
Venous pH < 7.30
OR
Bicarbonate < 15 mmol/L
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36
Q

Physical exam findings of a child in DKA

A
  1. Kussmaul respirations
  2. Tachycardia
  3. Dehydration (sunken eyes, dry mucous membranes)
  4. Delayed capillary refill
  5. Abdominal tenderness
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37
Q

Electrolyte imbalances in kids with DKA

A

Hyponatremia

Hypokalemia

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38
Q

The 4 I’s of DKA

A
  1. Insulin lack
  2. Indiscretion
  3. Infection
  4. Impregnation
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39
Q

Management of pediatric DKA

A
  1. ABCs, cardiac monitor, vital signs, accucheck
  2. IV access
  3. BMP, VBG, +/- CBC, +/- EKG
  4. Accucheck every hour
  5. VBG every 1-2 hours
  6. BMP every 4 hours
  7. Neurological checks every hour
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40
Q

Treatment of DKA: Step 1

A

NS/LR bolus 20 ml/kg over 1 hour

Next: LR at 2x MIVF rate

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41
Q

Treatment of DKA: Step 2

A

Insulin infusion -.05-0.1 U/kg/hr
No insulin bolus in children
Switch to D5NS when glucose is < 300 mg/dL

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42
Q

Treatment of DKA: Step 3

A

Next 4-6 hours, NS with 40 mEq/L K+

After, switch to 0.45% saline with electrolytes

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43
Q

Most serious complication of DKA and its treatment

A 
Cerebral Edema
Treatment:
1. Reduce rate of IVF
2. Mannitol 0.5-1 g/kg over 20 minutes
3. Hypertonic saline (3%)
4. Consider intubation
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44
Q

In the event of spinal cord injury, ___________ should be given if within ____ hours

A

High dose steroids

8 hours

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45
Q

Most commonly injured organ in blunt trauma

A

Spleen

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46
Q

Second most commonly injured organ in blunt trauma

A

Liver

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47
Q

Glasgow Scale for mild TBI

A

13-15

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48
Q

Glasgow Scale for moderate TBI

A

9-12

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49
Q

Glasgow Scale for severe TBI

A

8 or less

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50
Q

Canadian CT Head Rules for mild TBI

A
  1. GCS score < 15 at 2 hours after injury
  2. Suspected open or depressed skull fracture
  3. Any sign of basal skull fracture
  4. Vomiting > 2 episodes
  5. Age > 65 y/o

Medium Risk

  1. Amnesia before impact > 30 minutes
  2. Dangerous mechanism
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51
Q

Cushing’s Reflex

A

Triad of intracranial hypertension
Systolic BP increase
Bradycardia
Irregular respirations

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52
Q

Fastidious gram-negative rod. Can cause bacteremia and fatal sepsis after animal bites, especially in asplenic patients, chronic alcohol abusers or those with underlying hepatic disease

A

Capnocytophaga canimorsus

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53
Q

Organism responsible for cat scratch disease

A

Bartonella henselae

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54
Q

Diagnostic testing for animal bites

A

Blood cultures prior to abx

X Rays AP and lateral (if deep or markedly infected wounds)

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55
Q

Criteria for closure of dog bite wound

A
  1. Clinically uninfected
  2. Less than 12 hours old (24 hours on the face)
  3. NOT located on the hand or foot
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56
Q

Kanavel sign

A

Flexor Tenosynovitis

  1. Finger held in slight flexion
  2. Fusiform swelling
  3. Tenderness along the flexor tendon sheath
  4. Pain with passive extension of the digit
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57
Q

Treatment of flexor tenosynovitis (infectious)

A

Surgical drainage

Consult hand surgeon

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58
Q

Rabies postexposure prophylaxis

A
  1. Wound cleansing (soap/water or povidone/iodine solution)
  2. RIG infiltrated around wounds
  3. Vaccine - IM in deltoid area
    Days 0, 3, 7, and 14
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59
Q

All ______ bites require antibiotic prophylaxis

A

Human

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60
Q

Bacteria commonly found in human bites

A

Streptococci, staph aureus, eikenella, fusobacterium, peptostreptococcus, prevotella, and porphyromonas species

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61
Q

Treatment for human bites

A 
Amoxicillin clavulanate (Augmentin) and Moxifloxacin
Cellulitis 10-14 days
3 weeks for tenosynovitis
4 weeks for septic arthritis
6 weeks for osteomyelitis
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62
Q

Medications for insect bite rxns

A
  1. Epinephrine (DOC)
  2. Antihistamines (H1 blocker - diphenhydramine; H2 blocker - Ranitidine)
  3. Corticosteroids (methylprednisolone)
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63
Q

Diagnostic testing for snake bites

A
  1. CBC, electrolytes, creatinine, blood urea nitrogen
  2. Serum creatinine kinase - indicative of rhabdo
  3. PT and PTT/INR, fibrinogen, UA (rhabdo), EKG
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64
Q

_______ prophylaxis should be given for all snake bites

A

Tetanus

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65
Q

Dosing for CroFab

A

Not weight-based
Initial dose is 4-6 vials
After 1 hour, determine is initial control has been reached. If yes, 2 vials every 6 hours for 18 hours
If no, repeat initial dosing of 4-6 vials

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66
Q

Complications of snake bites

A

Coagulopathy

Compartment Syndrome

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67
Q

Indications for intubation in post-drowned patients

A
  1. Inability to protect airway
  2. PaO2 < 60 mmHg or O2 saturation < 90% on high-flow O2
  3. PaCO2 > 50 mmHg
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68
Q

Water-borne pathogens that commonly cause pneumonia in post-drowning survivors

A 
Pseudomonas
Proteus
Pseudallescheria boydii (fungus)
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69
Q

Pseudallescheria boydii

A

Fungus found in contaminated water such as floods

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70
Q

How does cold diuresis work in a post-drowning survivor?

A
  1. Pt is hypothermic, so blood is shunted to the core
  2. Central volume receptors sense fluid overload
  3. ADH is decreased
  4. Diuresis and hypovolemia occur
  5. Body goes into hypotension and shock
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71
Q

Symptoms of heat exhaustion

A

Moist and clammy skin, dilated pupils, normal or subnormal body temperature

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72
Q

Symptoms of heat stroke

A

Dry hot skin, constricted pupils, very high body temperature (>104)

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73
Q

Vital signs of a pt undergoing heat stroke

A 
Elevated core body temp
Tachycardia
Tachypnea
Widened pulse pressure
Hypotension
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74
Q

Physical exam signs of a patient undergoing heat stroke

A 
Flushing
Crackles
Excessive bleeding
Altered mentation
Slurred speech
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75
Q

Management of heat stroke patient

A
  1. ABCs
  2. Rapid cooling
  3. Intubation often necessary
  4. Fluid resuscitation for hypotension
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76
Q

Cooling methods for heat stroke patients

A

Evaporative cooling methods are best (moistened skin with fans across patient)
Immersion in ice water is rapid and effective in young patients with exertional heat stroke

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77
Q

Rules for collecting urine culture via bladder catheterization in a child

A

All males < 6 mo and all uncircumcised males < 12 mo

All females < 24 mo and older female children if symptoms of UTI

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78
Q

Fever workup in the toxic child (labs)

A

Rapid testing for viruses
CBC (looking for bandemia)
Blood cultures, CXR, obtain stool for WBCs and guaiac if diarrhea is present
Lumbar puncture

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79
Q

4 types of shock

A
  1. Cardiogenic
  2. Obstructive
  3. Distributive
  4. Hypovolemic
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80
Q

Clinical manifestations of shock

A 
Hypotension
Tachycardia
Oliguria
Mental status changes
Cool, clammy, cyanotic, mottled skin
Metabolic acidosis
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81
Q

Shock patients may need as much as ______ L of fluid for resuscitation

A

4-6

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82
Q

Inadequate blood volume to maintain supply of oxygen and nutrients to tissue

A

Hypovolemic

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83
Q

Hypotension unresponsive to fluid resuscitation, metabolic acidosis, encephalopathy, oliguria and coagulation disorders

A

Distributive or Septic Shock

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84
Q

Clinical signs of septic shock

A 
Hyperthermia or hypothermia
Tachycardia
Wide pulse pressure
Low blood pressure (SBP < 90)
Mental status changes
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85
Q

Treatment of septic shock

A

2 large bore IVs - NS bolus 1-2 L wide open
Supplemental oxygen
Empiric antibiotics: Zosyn and ceftriaxone OR imipenem

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86
Q

Treatment for hypotension if no response after 2-3 L IVF

A

Start a vasopressor (norepinephrine, dopamine)

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87
Q

Anaphylactic Shock Treatment

A
  1. ABCs
  2. IV, cardiac monitor, pulse ox
  3. IVFs, oxygen
  4. Epinephrine
  5. Second line: corticosteroids, H1/H2 blockers
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88
Q

Epi pen dosage

A

0.3 mg IM of 1:1000 in the thigh

Repeat every 5-10 minutes as needed

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89
Q

Occurs after acute spinal cord injury, results in hypotension and bradycardia

A

Neurogenic shock

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90
Q

Neurogenic Shock Treatment

A
  1. ABCs (c-spine precautions)
  2. Fluid resuscitation - keep MAP at 85-90 mmHg for first 7 days. If crystalloid is insufficient, use vasopressors
  3. For bradycardia, atropine or pacemaker
  4. Methylprednisolone - high dose therapy for 23 hours, must be started within 8 hours
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91
Q

Treatment for cardiogenic shock due to MI

A 
Aspirin
Beta blocker
Morphine
Heparin
IV fluids if no pulmonary edema
If pulmonary edema: dopamine, dobutamine
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92
Q

Tx for tension pneumothorax

A

Needle decompression, chest tube

93
Q

Beck’s Triad

A

Cardiac Tamponade
Hypotension
Muffled heart sounds
JVD

94
Q

Treatment for cardiac tamponade

A

Pericardiocentesis

95
Q

Imaging for cardiac tamponade

96
Q

Treatment for pulmonary embolism

A

Heparin, consider thrombolytics

97
Q

Signs of pulmonary embolism

A

Tachypnea, tachycardia, hypoxia

98
Q

Drug intoxication associated with tachypnea and hyperpnea

A

Salicylates

99
Q

Drug intoxication associated with large pupils

A

Anticholinergic or sympathomimetic

100
Q

Drug intoxication associated with small pupils

A

Cholinergic or opioids (pinpoint)

101
Q

Drug intoxication associated with physiologic stimulation (everything is up)

A

Sympathomimetics
Anticholinergics
Stimulants
Hallucinogens

102
Q

Drug intoxication associated with physiologic depression

A

Cholinergic, opioids, sedatives-hypnotics

103
Q

Coma cocktail

A

Oxygen
Thiamine
Dextrose
Naloxone

104
Q

Toxic dose of acetaminophen

105
Q

First NAC dose for APAP overdose

A

150 mg/kg

If given within 8 hours, hepatotoxicity is uncommon and death is rare

106
Q

Maintenance NAC dose for APAP overdose

A

50 mg/kg over 4 hours

107
Q

Toxic dose of aspirin (salicylates)

108
Q

Lethal dose of aspirin (salicylates)

109
Q

Stimulates respiratory drive causing hyperventilation, but limits ATP production, causing metabolic acidosis

A

Aspirin

Salicylates

110
Q

Treatment for salicylate overdose

A

No antidote
Empiric dextrose, activated charcoal, urinary alkalinization
Possible hemodialysis

111
Q

Presents with N/V, tinnitus, diaphoresis, confusion, deafness, tachypnea, vertigo, respiratory alkalosis

A

Salicylate overdose

112
Q

Fruity breath, ketosis without acidosis, osmolar gap

A

Alcohol overdose (isopropanol)

113
Q

Causes permanent retinal injury, blindness parkinsonian syndrome

114
Q

Treatment for methanol/ethylene glycol overdose

A 
Supportive, bicarb for acidosis
Benzos for seizures
Folic acid, thiamine, magnesium
Ca gluconate to correct hypocalcemia
Fomepizole 15 mg/kg
10% ethanol in 5% DW IV
Hemodialysis
115
Q

May cause urine to fluoresce

A

Ethylene Glycol (Antifreeze)

116
Q

Examples of amphetamines

A

Ephedrine, bath salts, Ritalin (ADHD treatment)

117
Q

Amphetamine OD Tx

A

Charcoal
Benzos
External cooling
Monitoring for cerebral edema

118
Q

Opioid Toxicity Tx

A

Naloxone 0.4-2 mg IV/IM/SC

119
Q

Most common cause of abdominal pain requiring surgery

A

Acute appendicitis

120
Q

Most common cause of abdominal pain requiring surgery in the elderly patient

A

Cholecystitis

121
Q

Periumbilical migrating to the RLQ with N/V after onset of pain, anorexia

A

Appendicitis

122
Q

Preferred imaging for appendicitis

123
Q

Preferred imaging for biliary tract disease

A

Ultrasound

124
Q

Preferred imaging for biliary tract disease

A

Abdominal X Ray

CT Scan with IV

125
Q

Preferred lab for pancreatitis

A

Lipase (increased speed and accuracy over amylase)

126
Q

Preferred imaging for pancreatitis

127
Q

Treatment for pancreatitis

A

Symptom control
Bowel rest
Admit vs obs vs D/C

128
Q

Preferred imaging of diverticulitis

129
Q

Treatment for diverticulitis

A

Uncomplicated: ABX and D/C

Septic, co-morbid conditions, abscess, perforation: consult for admission and IV ABX

130
Q

Main causes of ulcer disease

A

Helicobacter pylori and NSAIDs

131
Q

Treatment for ulcer disease if no concern for perforation

A

Treatment of symptoms

GI cocktail: PPI, H2 blocker

132
Q

Preferred imaging for ulcer disease (hemorrhage)

A

Acute abdominal X Ray

133
Q

Management of ulcer disease with hemorrhage

A
  1. Type and cross screen
  2. Fluid resuscitation
  3. IV PPI bolus and drip
  4. NG tube
  5. Consultation for admission
  6. Broad spectrum antibiotics if concern for perforation
134
Q

Inadequate fixation of testis to tunica vaginalis

A

Testicular torsion

135
Q

Bell Clapper deformity

A

Testicular torsion

136
Q

Testicular torsion most commonly occurs after ______________ or ______________

A

Vigorous activity or

Trauma

137
Q

In testicular torsion, will see a negative __________ reflex and a negative __________ sign on physical exam

A

Cremasteric Reflex

Prehn’s Sign

138
Q

Risk factors for ovarian torsion

A

Pregnancy
Ovulation
Ovarian cysts, tumors or masses

139
Q

Preferred imaging for ovarian torsion

A

Color flow doppler transvaginal ultrasonography

140
Q

Signs and symptoms of ectopic pregnancy

A

Severe pain, delayed or missed menses, syncope, signs of shock

141
Q

Diagnostics for ectopic pregnancy

A

Quantitative B-hCG

Pelvic ultrasonography

142
Q

Common diagnoses for dyspnea and wheezing

A

Asthma
COPD
Anaphylaxis

143
Q

Common diagnoses for dyspnea and fever

A

Pneumonia

Pulmonary embolism

144
Q

Common diagnoses for dyspnea and cough

A

Pneumonia
COPD/Asthma
Pulmonary embolism
Heart failure

145
Q

Common diagnoses for dyspnea and leg edema

A

Heart failure
Pulmonary embolism
Acute coronary syndrome

146
Q

Common diagnoses for dyspnea and tachycardia

A

Pulmonary embolism
Tachyarrhythmias
Pneumonia
Heart failure

147
Q

Common diagnoses for dyspnea and chest pain

A

Acute coronary syndrome
Pulmonary embolism
Pneumonia
Trauma

148
Q

Treatment for COPD

A

Supplemental oxygen (90-92%)
Bronchodilators
Antibiotics
Steroids

149
Q

Treatment for asthma (in the ED setting)

A
  1. Supplemental oxygen
  2. B2 agonists (albuterol)
  3. Anticholinergics (Atrovent)
  4. Corticosteroids (within 1 hr of arrival - Prednisone, Solumedrol, Decadron)
  5. Magnesium (shown in help in severe asthma)
150
Q

Discharge for asthma patients (home orders)

A 
Steroids for at least 5 days
All need B2 agonists
Pts with mod to severe should measure daily peak flows
All patients need close follow up
All patients need education about asthma
Smoking cessation counseling
151
Q

Signs/Symptoms of HF

A

Respiratory distress, cool/diaphoretic skin, weight gain, peripheral edema
Elevated JVD, S3, HTN, rales

152
Q

Treatment of CHF

A

NTG by sublingual or IV

Lasix-Diuresis starts in 15-20 minutes

153
Q

Primary spontaneous pneumothorax that is < ____% and does not cause respiratory or cardiac symptoms can be safely observed w/o treatment if chest X Rays done at ___ and ____ hours show no progression

A

20%

6 and 48 hours

154
Q

Presenting symptoms of a pulmonary embolism

A 
Syncope
Abdominal pain
Fever
Cough
Dyspnea
Wheezing
155
Q

Physical exam findings of a pulmonary embolism

A 
Tachypnea
Rales
Accentuated 2nd heart sounds
Tachycardia 
Fever
Potentially S3 or S4
156
Q

Common ECG findings with pulmonary embolism

A 
Tachycardia
Atrial arrhythmias
New RBBB
Interior Q and/or T wave inversion
S1Q3T3
157
Q

Hampton’s Hump on CXR

A

Pulmonary embolism

158
Q

Treatment for hemodynamically stable with pulmonary embolism

A

LMWH
Apixaban, dabigatran, rivaroxaban, edoxaban
Warfarin

159
Q

Where are osborne or notched J waves seen?

A

Hypothermia

160
Q

P waves change shape; <100 beats/min

A

Wandering pacemaker

161
Q

P waves change shape; >100 beats/min

A

Multifocal atrial tachycardia

162
Q

Arrhythmia most commonly associated with COPD

A

Multifocal atrial tachycardia

163
Q

Rapid series of smooth sine waves from a single rapid-firing ventricular focus

A

Ventricular flutter

164
Q

Large diphasic P with tall initial component

A

Right atrial hypertrophy

165
Q

Large diphasic P with wide terminal component

A

Left atrial hypertrophy

166
Q

Large R wave in V1 gets progressively smaller from V2-V3-V4

A

Right ventricular hypertrophy

167
Q

Large S wave V1 + large R wave in V5 is > 35 mm

A

Left ventricular hypertrophy

168
Q

Pathologic Q waves indicate:

169
Q

T wave inversion indicates:

170
Q

Treatment for supraventricular tachycardia

A

Vagal maneuvers
Adenosine 6 mg
Adenosine 12 mg
Defib

171
Q

Treatment for atrial flutter

A

Diltiazem (CCB)

172
Q

A premature atrial contraction will have a:

A

Narrow QRS complex

173
Q

A premature ventricular contraction with have a:

A

Wide QRS complex

174
Q

Treatment for monomorphic ventricular tachycardia without a pulse, and stable with a pulse

A

W/o pulse: 200 J biphasic shock

W/ pulse and stable: amiodarone

175
Q

Treatment for ACS in ED

A
  1. ASA and oxygen
  2. NTG
  3. Morphine
  4. Heparin
  5. B Blockers
  6. Statins
176
Q

RRSIDEAD

A 
Resuscitation
Risk Assessment
Supportive Care
Investigations
Decontamination
Enhanced elimination
Antidotes
Disposition
177
Q

5 basic toxidromes

A
  1. Sympathomimetic
  2. Opiate
  3. Anticholinergic
  4. Cholinergic
  5. Sedative hypnotics
178
Q

Examples of sympathomimetics

A

Cocaine, methamphetamine, ecstasy, ADHD meds, ephedrine, caffeine

179
Q

Lethal dose of caffeine

180
Q

Sympathomimetic toxidrome

A

Hyperthermia, diaphoresis, mydriasis, agitation, tachycardia, combativeness, hypertension

181
Q

Caffeine OD Symptoms

A

Tremor, restlessness, N/V, tachycardia, agitation

182
Q

Caffeine withdrawal symptoms

A

HA, yawning, drowsiness, nausea, rhinorrhea, lethargy, irritability, nervousness, depression, decreased motivation

183
Q

Death from cocaine OD usually due to

A 
Ventricular arrhythmia
Status epilepticus
Intracranial hemorrhage
Hyperthermia
Rhabdomyolysis
Renal failure
Coagulopathy
184
Q

Benzoylecgonine, the metabolite of cocaine, is usually present for ______ days

185
Q

Imaging for cocaine OD

A

CT of head if suspected hemorrhage

Abdominal x Ray if packing suspected

186
Q

With MDMA, the electrolyte abnormality likely to show on a BMP is:

A

Hyponatremia

187
Q

Opioid Toxidrome symptoms

A 
Miosis
Respiratory depression (<12 breaths per minute)
CNS depression (coma)
188
Q

Treatment for opioid OD

A

Ventilation - bag valve mask

Naloxone - IV onset 2 min

189
Q

Anticholinergic Toxidrome (7)

A 
Hot as Hades - Fever
Blind as a bat - mydriasis
Full as a tick - urinary retention
Dry as a bone - anhidrosis
Mad as a hatter - delirium
Red as a beet - flushing
Fast as a hare - tachycardia
190
Q

Examples of anticholinergics

A 
Atropine, Pralidoxime
Antihistamines (Benadryl)
Antipsychotics/neuroleptics (Haldol)
Antidepressants (TCA, amitriptyline)
Several plant species
191
Q

Treatment for anticholinergic toxidrome

A

Supportive care
Benzos for agitation
Physostigmine (cholinesterase inhibitor)

192
Q

Differentiation between sympathomimetics and anticholinergics

A

Sym: agitation, diaphoresis, bowel sounds
Anti: dry skin/mucus membranes, flushing, urinary retention, bowel sounds absent

193
Q

Cholinergic Toxidrome (DUMBBBELS)

A 
Diarrhea
Urinary incontinence
Miosis
Bradycardia
Bronchorrhea
Bronchospasm
Emesis
Lacrimation
Sweating, salivation
194
Q

This toxidrome gives off a garlic or hydrocarbon odor

A

Cholinergic (pesticides, etc.)

195
Q

Diagnostic tests for cholinesterase OD

A

Labs for RBC AChE activity

196
Q

Treatment for cholinesterase OD

A
  1. Decontamination (removal of clothing, irrigation, charcoal, gastric lavage)
  2. Atropine
  3. 2-PAM
  4. Diazepam for seizures
  5. Supportive care
197
Q

Examples of sedative hypnotics

A

Alcohol, valium, ambien

198
Q

Holiday Heart Syndrome

A

Palpitations, near syncope
May have electrolyte abnormalities
Need ECHO

199
Q

Wernicke Encephalopathy

A

Associated with chronic alcohol abuse
Thiamine deficiency
Treat with high dose IV thiamine, then glucose

200
Q

Four diagnostic criteria for serotonin syndrome

A
  1. Hyperthermia
  2. MS changes
  3. Autonomic instability
  4. Myoclonus, hyperreflexia or rigidity
201
Q

Treatment for serotonin syndrome

A
  1. ABC, supportive care
  2. Cyproheptadine
  3. Antipyretics, benzos
  4. Chlorpromazine
202
Q

Category A Bioterrorism Agents (6)

A
  1. Anthrax
  2. Smallpox
  3. Pneumonia plague
  4. Tularemia
  5. Botulism
  6. Viral hemorrhagic fevers
203
Q

Bacillus anthracis

A

Etiologic agent of anthrax

204
Q

Painless skin lesion evolving from papule to a depressed black eschar with local edema

A

Anthrax (cutaneous exposure)

205
Q

Brief prodrome resembling a viral respiratory illness, followed by development of hypoxia and dyspnea, with mediastinal widening or pleural effusion on CSR

A

Anthrax (inhaled exposure)

206
Q

Inhalational Anthrax Symptoms

A

Fever, chills, chest discomfort, SOB, cough, N/V, dizziness, confusion
Can lead to anthrax meningitis

207
Q

Treatment for anthrax poisoning

A

Ciprofloxacin or levofloxacin or moxifloxacin
PLUS
Clindamycin or linezolid or doxycycline

208
Q

Post exposure prophylaxis for anthrax

A

Doxycycline and Ciprofloxacin first line

209
Q

Yersinia Pestis

A

Etiologic agent for the plague

210
Q

4 versions of the plague

A
  1. Bubonic plague
  2. Septicemic plague
  3. Pneumonic plague
  4. Pharyngeal plague
211
Q

First line treatment for pneumonic plague

A

First line: streptomycin, gentamicin, ciprofloxacin, levofloxacin

212
Q

Variola virus

A

Etiologic agent of smallpox

213
Q

Common symptoms are diplopia, blurred vision, drooping eyelids, slurred speech, dysphagia, dry mouth and muscle weakness

214
Q

Treatment for botulism

A
  1. Skin testing for sensitivity

2. One vial of antitoxin IV

215
Q

Francisella tularensis

A

Etiologic agent for tularemia

216
Q

5 forms of tularemia

A 
Ulceroglandular
Glandular
Oculoglandular
Oropharyngeal
Pneumonic
217
Q

Tularemia Treatment

A

Streptomycin
Gentamicin
Doxycycline
Ciprofloxacin

218
Q

Filoviridae family viruses

A

Etiologic agent for Ebola and Marburg (viral hemorrhagic fever)

219
Q

Treatment of Ebola/Marburg

A

Supportive care

Vaccine currently in clinical trials

220
Q

Treatment of sick sinus syndrome

A

Permanent pacemaker

221
Q

Treatment of premature atrial contractions

A

No specific treatment, treat underlying disorder

222
Q

Treatment of sinus tachycardia

A

Treat underlying disorder

223
Q

Treatment of ventricular fibrillation

A

Electrical defibrillation 360 J monophasic or 120-200 biphasic

224
Q

Outcome is best in cardiac arrest

A

Pulseless ventricular tachycardia

225
Q

Outcome is the 2nd best in cardiac arrest

A

Ventricular fibrillation

226
Q

Most common mechanism for cardiac arrest with most dismal outcome

A

PEA and asystole

227
Q

5 H’s and 5 T’s of cardiac arrest

A 
Hypothermia
Hypovolemia
Hypoxia
Hydrogen ion (acidosis)
Hypo/hyperkalemia
Tension pneumothorax
Tamponade, cardiac
Toxins
Thrombosis, coronary
Thrombosis, pulmonary
228
Q

Atropine First Dose

A

0.5 mg bolus (repeat every 3-5 minutes)

229
Q

Epinephrine Dosing

A

0.1-0.5 mcg/kg per minute

Emergency Medicine (2 decks)

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