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Emergency Med/Surgery > General > Flashcards

General Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

A patient comes in with a foreign body to the finger. What is your first step?

A

Evaluate for sensation and circulation

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2
Q

What is the number one cause of FB sensation?

A

Glass

If it is small, asymptomatic, no need to remove.

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3
Q

Which materials pose the highest risk of infection when it comes to foreign bodies?

A

Organic splinters

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4
Q

A patient comes in with a horizontal splinter. How do you treat?

A

Incise/deroof and remove.

Irrigate with NS.

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5
Q

A patient comes in with a vertical splinter. How do you treat?

A

Elliptical incision, lift cone and undercut.

Irrigate with NS.

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6
Q

A patient comes in with a subungual splinter. How do you treat?

A

V section, shave, or trephination.

Remove splinter and irrigate with NS.

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7
Q

A patient comes in with sweaty tennis shoe syndrome following a nail puncture to the foot. What criteria must they meet in order to be considered for this dx?

A

> 4 days of persistent symptoms post puncture.

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8
Q

A patient comes in with a nail puncture. What sequelae are we most concerned about?

A

Osteomyelitis

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9
Q

What is the causative agent of sweaty tennis shoe syndrome?

Tx?

A

Pseudomonas aeruginosa

16+: ciprofloxacin
<16: ceftazidime

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10
Q

Define cellulitis

A

Diffuse skin infection that presents with warmth, edema, and erythema

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11
Q

Define abscess

A

localized skin infection that contains pus within the dermis or subcutaneous space

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12
Q

Define a furuncle

A

Boil

Single infection that develops around a hair follicle

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13
Q

Define a carbuncle

A

a coalescence of several furuncles

Deeper than furuncles and can cause scarring

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14
Q

What are some common areas abscesses tend to grow in?

A

Back of neck, face, axillae, and buttocks - coarse haired areas

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15
Q

What is the number one infective agent in superficial purulent skin infections?

A

Stah. aureus

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16
Q

What must you NOT do when working on an abscess that is located on the finger/toe, penis or nose?

A

DO NOT use epinephrine

17
Q

A patient presents with an abscess. Are antibiotics needed? How do you treat?

A

Tx: I&D

PO antibiotics are not needed unless there is surrounding cellulitis. Topical antibiotics are not effective.

18
Q

A patient presents with an abscess. What criteria must be met for it to be packed?

A

abscess >5 cm

Pilonidal cyst - on gluteal cleft.

DM patient

Immunocompromised

19
Q

A patient presents with a pilonidal cyst and cellulitis. Is antibiotic treatment recommended?

A

Yes - cellulitis and the pilonidal cyst

20
Q

A patient comes in with a history of recurrent and multiple abscesses. Is antibiotic treatment recommended?

A

Yes - recurrent and multiple abscesses

21
Q

A 2 month old patient comes in with an abscess. Is antibiotic treatment recommended?

A

yes - extremes of age (young infants and elderly)

22
Q

A patient comes in with purulent cellulitis without signs of systemic infection. What tx is called for?

A

TMP-Sulfa BID x 7 days

23
Q

A patient comes in with purulent cellulitis with signs of systemic infection. What tx is called for?

A

IV vancomycin q 12 hrs - this covers MRSA

24
Q

A patient comes in for a perirectal abscess. What tx is not recommended?

A

I&D

25
Q

When is I&D contraindicated?

A
  • Anterior/lateral neck abscesses that came from congenital cysts - thyroglossal duct cyst, cystic hygroma
  • hand abscesses - not paronychias/felons
  • abscesses adjacent to vital nerves/blood vessels
  • abscesses in the central triangle of the face - tx with warm compresses, broad spectrum antibiotics, referral to otolaryngology
  • breast abscesses - especially if near nipple
26
Q

A patient comes in with a visible, painful subungual hematoma. The nail is fractured as is the distal phalanx. How do you treat?

A

NOT WITH a nail bed trephination.

Contraindications to a trephination:

  • crushed/fractured nails
  • finger fx - especially distal phalanx
  • subungual melanoma
  • acrylic nail
  • hematomas >50%+ of nail
27
Q

What are the indications for a nail avulsion?

A

Onychomycosis
Onychocryptosis - ingrown toenail
Chronic, recurrent paronychia - infection of skin surrounding the nail
Trauma

28
Q

You have a patient with a suspected abrasion to the eye. After stabilizing the patient, what must you do?

A

Emergent referral to ophtho

29
Q

Under what conditions is a slit lamp contraindicated?

A
  • ruptured globe
  • intraocular foreign body
  • eyelid laceration unless superficial and horizontal/paraellel to eyelid
  • caustic splash exposure - IRRIGATE!!
30
Q

What is a positive Seidel sign?

A

It’s done post-FB removal.

Positive sign: aqueous humor oozing at penetration site through the cornea
- “dark waterfall”” under UV light

31
Q

A patient presents with a painless, chronic granulomatous inflammation of a Meibomian gland that produces a nodule. What is this?

A

Chalazion

32
Q

A patient presents with a staph. infection of a superficial accessory gland in the eyelid margins. What is it?

A

Hordeolum - stye

33
Q

A patient comes in with a penetrating foreign body to the eye. What do you do?

A

Leave it in place

Place a fox shield

NO MRI

STAT ophtho referral

34
Q

What are the indications for a cerumen impaction/FB removal?

A
  • foreign body
  • ceruen impaction & associated symptoms
  • can visualize the TM
35
Q

What are the contraindications for a cerumen impaction/FB removal?

A
  • current/past TM perforation
  • PSH ear/TM
  • sudden onset severe dizziness/hearing loss
  • <4 yo/uncooperative
  • can’t visualize the FB
  • large hard round objects
36
Q

What are the complications of a cerumen impaction/FB removal?

A

Minor
- pain, vertigo, N, trauma

Major

  • trauma induced Otitis Externa
  • TM perforation
  • Alkaline necrosis of auditory canal (batteries)
  • Hearing loss
37
Q

Where do most epistaxis occur?

A

Kiesselbach plexus

Emergency Med/Surgery (8 decks)

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