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Emergency Med > Final review > Flashcards

Final review Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Abx you can and cannot give for OM with perforation or tympanostomy tube

A

Avoid eardrops containing aminoglycosides
-Avoid gentamicin, neomycin sulfate, or tobramycin in the presence of TM perf
-Results in sensorineural hearing loss
If pt has a perf
-PO abx: amoxicillin, bactrim, cefixime, augmentin
-Topical: Ofloxacin gtts

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2
Q

What object inserted into the nose would be concerning?

A

Button batteries, magnets anywhere in the body are of particular concern
Electrical current has the potential to necrose tissue
Unilateral rhinorrhea usually indicates mechanical nasal obstruction

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3
Q

Most common site for anterior nosebleed

A

Kiesselbach’s plexus

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4
Q

DDx for exudate on surface of tonsils

A

Strep and mono
-Mono: posterior lymph nodes and splenomegaly
Most cases of pharyngitis are viral in origin but MC bacterial: GABHS (strep pyogenes)
-Tx for GABS: PCN
-If allergic: erythromycin or 1st gen cephalosporin

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5
Q

Modified Centor criteria: age

A

+1: 3-14

0: 15-44
- 1: >45

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6
Q

Modified Centor criteria: exudates/tonsillar swelling

A

+1: positive

0: none

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7
Q

Modified Centor criteria: temp >38 (100.4)

A

+1: yes

0: no

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8
Q

Modified Centor criteria: cough

A

+1: absent

0: present

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9
Q

Modified Centor criteria: total score

A

-1 to 1: no Cx or abx
2-3: Cx and tx
+4-5: no cx needed, tx

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10
Q

DDx for pseudomembrane on tonsils

A

Diphtheria
High propensity to obstruct airway
Sx: high fever, dysphagia, drooling, respiratory distress
Tx: diphtheria antitoxin. Abx: 1st line erythomycin 2nd line: Pen G

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11
Q

What to do in epiglottitis in peds

A

O2
Keep child calm
Ensure an adequate airway (immediate airway management)
Not stable or has signs of resp distress or pending respiratory arrest: first attempt ventilation with BVM, with correct positioning, correct size face mask, and adequate ventilation with use of end-tidal CO2

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12
Q

What not to do with a child with epiglottitis

A

Oral airway should NOT be placed
Unnecessary blood tests, IV access, and tongue depression with a tongue blade should be avoided
Visualization of the epiglottis should not be performed unless staff members capable of securing an airway are present

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13
Q

What is the best abx to use for facial swelling

A

Clindamycin

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14
Q

How to calculate body surface area

A

Total head 9% (back or front of head: 4.5% each)
Front side of each arm: 4.5%, back side of each arm: 4.5% (ENTIRE arm 9%)
Each half of torso: 18% each
Front of each leg: 9%, back side of each leg 9%
Genitals/perineum: 1%

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15
Q

Parkland formula for fluid resuscitation in adult burn pts

A

4 mL lactated ringers x weight (kg) x TBSA (%) over initial 24 hrs

  • 50% in 1st 8 hrs from time of burn
  • 50% over remaining 16 hrs
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16
Q

First-degree burn

A

Epidermis only
Erythema; blanches with pressure
Sensation: intact; mild to moderate pain
Healing: 3-6 days without scarring

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17
Q

Superficial second degree burn

A

Epidermis and superficial dermis; skin appendages intact
Erythema, blisters, moist, elastic; blanches with pressure
Sensation: intact; severe pain
Healing: 1-3 wks; scarring unusual

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18
Q

Deep second degree burn

A

Epidermis and most dermis; most skin appendages destroyed
White appearing with erythematous areas, dry, waxy, less elastic; reduced blanching to pressure
Sensation decreased; may be less painful
Healing > 3 weeks; often with scarring and contractures

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19
Q

Third degree burn

A

Epidermis and all of dermis; destruction of all skin appendages
White, charred, tan, thrombosed vessels; dry and leathery; does not blanch
Sensation: anesthetic; not painful (although surrounding areas of second-degree burns are painful)
Healing: does not heal, severe scarring and contractures

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20
Q

Burn unit referral criteria

A

Partial-thickness burns >10% TBSA
Burns that involve face, hands, feet, genitalia, perineum or major joints
Third-degree burns in any age group
Electrical burns, including lightning injury
Chemical burns
Inhalation injury
Burn injury in pts with preexisting medical d/os that could complicate management, prolong recovery or affect mortality
Any pts with burns and concomitant trauma (such as fxs) in which the burn injury poses the greatest risk of morbidity and mortality
Burned children in hospitals without qualified personnel or equipment for the care of children
Burn injury in pts who will require special social, emotional, or long-term rehabilitative intervention

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21
Q

Erlichiosis

A

Caused by erlichia species- amblyomma americanum (Lone Star tick)
Found in southeast, south central, and mid-Atlantic US, 1-21 day incubation

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22
Q

Sx of erlichiosis

A 
High fever
HA
N/V
Malaise
Abd pain
Anorexia
Myalgias
Occasional rash
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23
Q

Erlichiosis triad

A

WBC: low
Platelets: low
LFTs elevated: (2-3x nl)

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24
Q

Tx of erlichiosis

A

7-14 day doxycycline in adults and children

Rifampin in pregnancy

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25
Q

Appendicitis

A

Periumbilical pain that radiates of RLQ
MCC: fecalith
For kids they can have pain anywhere on the abdomen

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26
Q

PE findings for appendicitis

A

Pos McBurney’s, Rovsing’s, Psoas, obturator, bump sign
Early: vague periumbilical pain, anorexia, n/v
Later: classic presentation- pain migrates to RLQ, fever if late finding
-If sudden decrease in pain, consider perforation

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27
Q

Labs for appendicitis

A

CBC
UA
Urine hcG
Nl WBC does not r/o appendicitis

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28
Q

Imaging for appendicitis

A

CT with IV and oral contrast is study of choice, u/s

-Pericecal inflammation, abscess, periappendicular phlegm or fluid collections

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29
Q

Tx for appendicitis

A

Surgery

Abx- Pip-TZ, ampicillin/sulbactam

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30
Q

Diverticulitis sx

A 
LLQ abdominal pain
Steady discomfort 
Tenesmus- the urgency equivalent of poop
Change in BM
N/V
Low-grade fever
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31
Q

Labs for diverticulitis

A

CBC
CMP
UA
Hemoccult may be pos

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32
Q

Imaging for diverticulitis

A

CT abd/pelvis with IV and oral contrast

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33
Q

Tx for diverticulitis

A

IV fluids
Abx- cipro + metronidazole
Clear liquid diet
Surgery if complicated

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34
Q

Acute cholecystitis

A 
RUQ or epigastric pain >5 hrs
Fat
Female
Forty
Fertile
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35
Q

Sx of acute cholecystitis

A

Colicky pain that becomes steady and increases in intensity
N/V
Low fever
Anorexia

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36
Q

PE of acute cholecystitis

A

Pos Murphys. Pain radiation to R shoulder or subscapula

Pain worse after eating, esp high fat meal

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37
Q

Labs of acute cholecystitis

A

CBC
CMP
UA
Increased WBCs, LFTs, bilirubin (BR increases after 24 hrs)

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38
Q

Imaging of acute cholecystitis

A

U/s is study of choice, CT
Pos sonographic Murphy’s sign
Other indicators on u/s- thickened GB wall, gallstones, GB distention, pericholecystic fluid

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39
Q

Tx of acute cholecystitis

A

Cholecystectomy

Abx- ceftriaxone + metronidazole

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40
Q

Ascending cholangitis

A

EMERGENCY

Complete biliary obstruction + bacterial superinfection

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41
Q

Presentation of ascending cholangitis

A

Charcot’s triad: fever + jaundice + RUQ abdominal pain

Reynold’s pentad: Charcot’s + hypotension + AMS (indicated sepsis)

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42
Q

Labs for ascending cholangitis

A

Leukocytosis and elevated bili

Alk phos increased

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43
Q

Imaging for ascending cholangitis

A

U/s, ERCP is optimal (diagnostic and therapeutic)

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44
Q

Tx of ascending cholangitis

A

Triple coverage
-Ampicillin, gentamicin, clinda
IMMEDIATE surgical consult

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45
Q

Spontaneous bacterial peritonitis presentation

A

Ascites + fever= SBP until proven otherwise
Abd pain, ascites, fever, usually confusion/AMS
MC in pts with portal HTN (EtOH)

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46
Q

Diagnosis of spontaneous bacterial peritonitis

A

Diagnostic paracentesis

250+ neutrophil count of ascitic fluid OR if <250, positive ascitic fluid cultures (do not delay abx)

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47
Q

Tx of spontaneous bacterial peritonitis

A

3rd gen cephalosporin (i.e., cefotaxime) is preferred

48
Q

MC organisms of spontaneous bacterial peritonitis

A

E. coli + Klebsiella

49
Q

Presentation of intestinal obstruction

A

Result of mechanical blockage or loss of nl peristalsis
Crampy, intermittent progressive abdominal pain with inability to have a BM or pass flatus
Vomiting
Bilious in proximal obstructions, feculent in distal obstructions
Abd distention
May have surgical scars, hernia or masses on exam that can provide clues to site of obstruction
Localized to generalized tenderness
Active, high pitched BS that later become absent
Tympany with percussion

50
Q

Workup for intestinal obstruction

A

Rectal exam and hemoccult: stool in rectum does not exclude obstruction
CBC and CMP

51
Q

Imaging of intestinal obstruction

A 
Abd series (plain films) may show air fluid levels and multiple dilated loops of bowel 
CT scan abd/pelvis (with IV contrast) is diagnostic
52
Q

Tx of intestinal obstruction

A 
Hospitalize
IV fluids
Nasogastric decompression
NPO
Surgery
53
Q

Criteria for dx of PID

A

Laparoscopy is the criterion standard, but the dx of PID in EDs is often based on clinical criteria

54
Q

Minimal criteria needed to diagnose PID

A

Pelvic or lower abd pain
No other cause other than PID can be identified
One or more of the following:
-Cervical motion tenderness (chandelier test)
-Uterine tenderness
-Adnexal tenderness

55
Q

Additional criteria that improve diagnostic specificity include:

A

Oral temp > 38.3 (101)
Abundant cervical or vaginal mucopurulent d/c
Abundant WBCs on saline microscopy of vaginal secretions
Elevated ESR
Elevated CRP
Lab evidence of cervical infection with N. gonorrhoeae or C. trachomatis (via culture or DNA probe)

56
Q

MC organisms responsible for bronchitis in adults

A

Viruses (60%)-MC: influenza A + B or parainfluenza

Mycoplasma species, Chlamydia pneumoniae, S. pneumoniae, M. catarrhalis, H. flu

57
Q

Intermittent asthma

A

Nighttime awakenings less than or equal to 2/mo
Less than or equal to 2 days/wk SABA use for symptom control
No interference with nl activity
Nl FEV1 during exacerbations; FEV1 >80% predicted; FEV1/FVC nl

58
Q

Mild persistent asthma

A 
Sx >2 days/wk
Nighttime awakenings 3-4/mo
>2 days/wk but not daily; not >1x on any day SABA use for symptom control
Minor limitation with nl activity
FEV1>80% predicted; FEV1/FVC nl
59
Q

Moderate persistent asthma

A

Daily sx
>1x/wk but not nightly nighttime awakenings
Daily SABA use for symptom control
Some limitation with nl activity
FEV1 60-80% predicted; FEV1/FVC reduced 5%

60
Q

Severe persistent asthma

A

Sx throughout the day
Nightly nighttime awakenings
Several times/day SABA use for symptom control
Extreme limitation with nl activity
FEV1 <60% predicted; FEV1/FVC reduced >5%

61
Q

Clinical presentation of respiratory failure

A

Tachypnea and dyspnea; crackles upon auscultation

62
Q

Clinical setting of resp failure

A

Direct insult (aspiration) or systemic process causing lung injury (sepsis)

63
Q

Radiologic appearance and lung mechanics of resp failuare

A

Radiologic: 3-quadrant or 4-quadrant alveolar flooding- “white out”
Lung mechanics- diminished compliance

64
Q

MC pathogen with cat bites

A

Pasturella multocida
Infection <24 hrs: P. multocida, 10-14 days amox-clav, cefuroxime axetil, doxycycline
If >24 hrs: strep- irrigate all penetrating wounds
-LAD- Bactrim (TMP-SMX), Rifampin

65
Q

S/sx of cat bites

A

Progressively growing red, swollen area. Hand is MC location. Will see puncture wound and lacerations

66
Q

What is P. multocida resistant to?

A

Dicloxacillin
Cephalexin
Clindamycin
Some to erythromycin

67
Q

NSTEMI characteristic findings on EKG

A

ST depression
Transient ST elevation (absence of persistent ST elevation)
New T-wave inversion
Positive troponins

68
Q

What is the MCC of syncope

A

Vasovagal

69
Q

Potential causes of syncope

A 
Sick sinus syndrome
PE
Anaphylaxis
Severe aortic stenosis
MVP
Pulm HTN
Sudden cardiac arrest
HCM
Cor pulmonale
Orthostatic hypotension
Hypoglycemia
QT prolongation
70
Q

What are meds that can cause QT prolongation?

A

Azithromycin
TCAs
Zofran
Others

71
Q

BV typical organism

A

Gardnerella vaginalis

72
Q

BV presentation

A

Fishy smell on KOH prep and increased pH

73
Q

D/c in BV

A

Fishy, watery, and grayish

74
Q

Microscopy in BV

A

Clue cells

75
Q

Tx of BV

A

Metronidazole or clindamycin

Tx of male partner not indicated

76
Q

Typical organism for trich

A

Trichomonas vaginalis

77
Q

Presentation of trich

A

Severe itching and increased pH

Strawberry cervix and petechiae

78
Q

D/c of trich

A

Yellow and green

79
Q

Microscopy of trich

A

Motile trichomonads

80
Q

Tx of trich

A

Metronidazole for pt and partner

81
Q

Typical organism of yeast

A

Candida albicans

82
Q

Presentation of yeast

A

Itching, burning, erythema, and decreased pH

83
Q

D/c of yeast

A

Cottage cheese

84
Q

Microscopy of yeast

A

Pseudohyphae- more pronounced with KOH prep

85
Q

Tx of yeast

A

Fluconazole or nystatin
Tx of male partner not indicated
In pregnancy, treat with topical miconazole

86
Q

Abortive treatment for migraine

A

NSAIDs
Acetaminophen
Triptans and ergot alkaloids

87
Q

Prophylactic tx for migraine

A

BBs
TCAs
Divalproex
CCBs

88
Q

Lyme dz is usually diganosed through what?

A

Hx

Most are unaware of bite, late spring-early fall, outdoor activity

89
Q

Organism of Lyme dz

A

Borrelia burgdorferi

90
Q

Stage I Lyme dz

A

Target lesion/erythema migrans 2-20 days after bite

91
Q

Stage II Lyme dz

A 
Multiple lesions
Fever
LAD
Arthralgias
Splenomegaly
Cardiac abnormalities
Flu-like sx
May develop into neurologic dz
92
Q

Stage III Lyme dz

A 
Chronic arthritis
Myocarditis
Subacute encephalopathy
Axonal polyneuropathy
Leukoencephalopathy
93
Q

Tx of Lyme dz

A

21 days of doxycycline, amoxicillin, cefuroxime, clarithromycin, azithromycine or ceftriaxone

94
Q

Classic findings of Rocky Mountain Spotted Fever

A

Rickettsia rickettsii bacteria

Sx: HA and high fever, rash on wrist/ankles then spreads (little red spots of over)

95
Q

Tx of Rocky Mountain Spotted Fever

A

Doxy x7-14 days BID

Alternative: Chloramphenical QID x 7-14 days

96
Q

Post-streptococcal glomerulonephritis

A

Seen most commonly following GABHS infection and occurring on average 7-10 days after initial infection
Abrupt onset of nephritic symptoms and AKI

97
Q

Post-streptococcal glomerulonephritis

A 
HTN
Dark-reddish brown urine
Decreased urine output
Facial swelling
Protein in urine
RBC casts
98
Q

Lab findings in post-streptococcal glomerulonephritis

A

UA: hematuria, proteinuria, RBCs, RBC casts

99
Q

Tx of post-streptococcal glomerulonephritis

A

Supportive

High-dose steroids

100
Q

Hand foot mouth dz

A

Coxsackie A16 virus

Common in kids during summer and fall

101
Q

S/sx and tx hand foot mouth dz

A

Low-grade fever
Painful mouth ulcers
Flat-reddish-gray vesicles on hands and feet
Tx: supportive

102
Q

Rabies vaccine schedule

A

For immunocompetent: 0, 3, 7, 14 days following injury

Immunocompromised: 0, 3, 7, 14, and 21 days following injury

103
Q

Ovarian cysts

A

MC ovarian mass in women of reproductive age
Tx:
Large (>5 cm) or symptomatic may undergo surgical resection
Small asymptomatic cysts managed conservatively

104
Q

Ovarian torsion

A

An emergency
Colicky pain and N/V more likely to be torsion, pain that radiates to groin
Worse with menstrual cycle is more likely to be cysts
If a cyst ruptures, emergency
Get an u/s with doppler

105
Q

Ectopic pregnancy

A

Should be suspected in any woman in reproductive age with:
Abd/pelvic pain (referred shoulder pain may be present)
Irregular bleeding
Amenorrhea
Temp >38 C is unusual (look for infectious cause)

106
Q

PE of ectopic pregnancy

A

Cervical motion tenderness

Adnexal mass

107
Q

Presentation of ruptured ectopic pregnancy

A

Hypotension

Signs of shock

108
Q

Workup for ectopic pregnancy

A

Pelvic u/s

Elevate b-hcG with no signs of uterine gestational sac by u/s is highly suspicious

109
Q

Tx of ectopic pregnancy

A

Methotrexate or surgery

110
Q

How does tooth numbering work?

A

Starts at upper right, goes to upper left
Then lower left to lower right
Wisdom teeth are 1, 16, 17, 32

111
Q

Tooth numbering types from “inside out”

A 
Medial incisors
Lateral incisors
Canines
1st and 2nd premolars
1st and 2nd molars
8 incisors, 4 canines, 8 premolars, 12 molars (including wisdom teeth)
112
Q

Ludwig’s angina

A

MC presentation is elderly debilitated man

Most disease spread from infected mandibular teeth

113
Q

PE of retropharyngeal abscess

A

Woody induration

TTP on submandibular space

114
Q

S/sx of retropharyngeal abscess

A

Difficulty speaking
Muffled voice
Constitutional sx
Open mouth

115
Q

Tx for retropharyngeal abscess

A

I and D STAT- Unasyn or Pen G + metro or clinda

Imunnocompromised: Cefepime, Zosyn

Emergency Med (11 decks)

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