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FP board review > General EM > Flashcards

General EM Flashcards

0
Q

What is the prevalence of patients with a mild head injury, not requiring an MRI, in the ER who later develop a measureable decrement in mental function at 1 month due to postconcussion syndrome? J Emerg Med 2011: 40, 262

A

Two-thirds

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1
Q

What is the best way to transport an ambulated tooth?

A

In a glass of milk

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2
Q

Which type of acute nasal trauma is an emergency?

A

Septal Hematoma

“septal cartilage can necrose leading to a perforated septum. Septal hematomas should be drained acutely and the nose packed to keep the perichondrium in contact with the septal cartilage”

Excerpt From: Mark Graber & Jason Wilbur. “Family Practice Examination and Board Review, Third Edition.” McGraw-Hill Medical, 2013. iBooks.
This material may be protected by copyright.

Check out this book on the iBooks Store: https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewBook?id=582642389

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3
Q

What kind of Trauma to the eye results in loss of unilateral upward gaze, and why?

A

“The force of a blow to the globe is transmitted to the inferior orbital wall, which is the weakest point in the orbit. This can cause entrapment of the contents of the inferior orbit, including the inferior rectus”

Excerpt From: Mark Graber & Jason Wilbur. “Family Practice Examination and Board Review, Third Edition.” McGraw-Hill Medical, 2013. iBooks.
This material may be protected by copyright.

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4
Q

Fluid seen upon facial x-ray in the maxillary sinus after facial trauma is indicative of what dx?

A

Blowout fracture

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5
Q

A blowout fracture with entrapment must be addressed within 24 hours. True or False

A

False

“a decision to operate may be delayed for up to 14 days. If the entrapment spontaneously resolves when the swelling goes down (not uncommon) and there is no diplopia or other complicating symptoms, surgery is not needed”

Excerpt From: Mark Graber & Jason Wilbur. “Family Practice Examination and Board Review, Third Edition.” McGraw-Hill Medical, 2013. iBooks.
This material may be protected by copyright.

Check out this book on the iBooks Store: https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewBook?id=582642389

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6
Q

Is a blowout fracture in a pediatric pt any different from an adult?

A

Yes. It is an emergent situation. Fibrosis of the muscle may occur if not addressed surgically within 24 hours.

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7
Q

A patient falls asleep with their contacts in. Upon staining her eye it is evident that she has a corneal ulcer. What is the appropriate management?

A

“This is an ophthalmologic emergency that requires topical antibiotics, cycloplegia (for pain control), and referral to an ophthalmologist. These ulcers can become quite deep and result in a ruptured globe”

Excerpt From: Mark Graber & Jason Wilbur. “Family Practice Examination and Board Review, Third Edition.” McGraw-Hill Medical, 2013. iBooks.
This material may be protected by copyright.

Check out this book on the iBooks Store: https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewBook?id=582642389

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8
Q

What are some cycloplegic eye drops?

A

Cyclopentolate, homoatropine & atropine.

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9
Q

How do you treat corneal abrasions?

A

Avoid contacts for 1 week. Anesthetic, antibiotics & eye patches are not indicated.

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10
Q

What are the five p’s of compartment syndrome?

A

“pulselessness, paresthesia, pallor, pain, and paralysis.

Pain out of proportion to the injury is the hallmark

“factors that cause compartment syndrome including electrical injury, excessive muscle use, tetany, reperfusion after ischemia, etc”

Excerpt From: Mark Graber & Jason Wilbur. “Family Practice Examination and Board Review, Third Edition.” McGraw-Hill Medical, 2013. iBooks.
This material may be protected by copyright.

Check out this book on the iBooks Store: https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewBook?id=582642389

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11
Q

How might you monitor for SEs of compartment syndrome?

A

“One of the major complications of compartment syndrome is rhabdomyolysis. This will manifest itself as a urine which is dipstick positive for blood but with a negative microscopic exam for red blood cells”

Excerpt From: Mark Graber & Jason Wilbur. “Family Practice Examination and Board Review, Third Edition.” McGraw-Hill Medical, 2013. iBooks.
This material may be protected by copyright.

Check out this book on the iBooks Store: https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewBook?id=582642389

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12
Q

What is the treatment for rhabdomyolysis?

A

Saline iv

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13
Q

What is acute chest syndrome

A

It is associated with sickle cell anemia and may be indistinguishable from pneumonia. Acute chest syndrome is characterized by pleuritic chest pain, fever, cough, chills, dyspnea, rales, and rhonchi. The etiology is unknown, but it may be secondary to infarction of the lung and/or fat emboli”

Excerpt From: Mark Graber & Jason Wilbur. “Family Practice Examination and Board Review, Third Edition.” McGraw-Hill Medical, 2013. iBooks.
This material may be protected by copyright.

Check out this book on the iBooks Store: https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewBook?id=582642389

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14
Q

What is the treatment for two chest syndrome in patients who remain hypoxic?

A

“exchange transfusion to bring the level of HbS to <30% of the total. Simply administering blood (“C”) will not resolve the problem”

Excerpt From: Mark Graber & Jason Wilbur. “Family Practice Examination and Board Review, Third Edition.” McGraw-Hill Medical, 2013. iBooks.
This material may be protected by copyright.

Check out this book on the iBooks Store: https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewBook?id=582642389

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15
Q

Which infection is a common cause of aplastic anemia in patients with sickle cell disease?

A

Parvovirus B 19

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16
Q

Which Organ in sickle cell disease infarcts at around five years of age?

A

Spleen

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17
Q

What is a cute sequestration syndrome?

A

“Acute sequestration syndrome occurs when the spleen sequesters red blood cells, leading to a drop in hemoglobin. The presentation can be quite dramatic with severe left upper quadrant pain, splenomegaly, and profound anemia, sometimes resulting in hypovolemic shock and death”

Excerpt From: Mark Graber & Jason Wilbur. “Family Practice Examination and Board Review, Third Edition.” McGraw-Hill Medical, 2013. iBooks.
This material may be protected by copyright.

Check out this book on the iBooks Store: https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewBook?id=582642389

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18
Q

What is the best method to rewarm frostbitten body parts?

A

Rapidly warming in as hot water as the patient can stand.

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19
Q

Is oral steroids as effective as IVs steroids in the treatment of acute cases of asthma?

A

Yes

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20
Q

What are the treatments for an acute anaphylaxis reaction to a bee sting?

A

IV or IM diphenhydramine, IV cimetidine or ranitidine, subcutaneous epinephrine

21
Q

The presence of the cremasteric reflex effectively rules out epididymitis or testicular torsion. T or T

A

False

22
Q

“What is the most common agent causing epididymitis in a 21 yo male?

A

“epididymitis is usually the result of sexually transmitted diseases. Of these, C. trachomatis is currently the most common etiologic agent. N. gonorrhoeae is second most common in this age group”

Excerpt From: Mark Graber & Jason Wilbur. “Family Practice Examination and Board Review, Third Edition.” McGraw-Hill Medical, 2013. iBooks.
This material may be protected by copyright.

Check out this book on the iBooks Store: https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewBook?id=582642389

23
Q

What are the categories of urinary retention in a male and some common causes associated?

A

“The categories of acute urinary retention may be divided into neurogenic (spinal cord injuries, cauda equina syndrome, diabetes, syringomyelia, herpes, etc.), obstructive (BPH, phimosis, paraphimosis, calculi, urethral stricture, etc.), pharmacologic (anticholinergics, antihistamines, narcotics, antipsychotics, tricyclics, etc.), and psychogenic, which is a diagnosis of exclusion.”

Excerpt From: Mark Graber & Jason Wilbur. “Family Practice Examination and Board Review, Third Edition.” McGraw-Hill Medical, 2013. iBooks.
This material may be protected by copyright.

Check out this book on the iBooks Store: https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewBook?id=582642389

24
Q

Name a condition in which the foreskin is swollen painful and cannot be reduced into its normal position

A

Paraphimosis

25
Q

What is the typical presentation of a patient with an ovarian torsion?

A

“Patients with ovarian torsion present with sudden onset of severe lower abdominal pain. The pain is frequently colicky. Since only one ovary is involved, the pain is located in one side or the other”

Excerpt From: Mark Graber & Jason Wilbur. “Family Practice Examination and Board Review, Third Edition.” McGraw-Hill Medical, 2013. iBooks.
This material may be protected by copyright.

Check out this book on the iBooks Store: https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewBook?id=582642389

26
Q

And an unresponsive patient what does the mnemonic DONT refer to?

A

Dextrose, oxygen, naloxone, and Thiamin.

27
Q

At what Glasgow coma score should you intubate?

A

I Glasgow of 8, time to intubate.

GCS
Eyes mnemonic “4 eyes”
Verbal response mnemonic “Jackson 5”
Motor response mnemonic “6 cylinders”

28
Q

What is the primary survey of a trauma patient?

A

A is for airway, B is for breathing, C is for circulation, D is for disability which means neurologic examination, E is for exposure which means disrobing the patient.

29
Q

“If a trauma patient arrives hypotensive with no signs of external bleeding, what is the appropriate emergent tx?

A

“2 L of crystalloid (normal saline) should be given immediately. If the patient continues to be hypotensive, packed red blood cells should be started along with additional normal saline”

Excerpt From: Mark Graber & Jason Wilbur. “Family Practice Examination and Board Review, Third Edition.” McGraw-Hill Medical, 2013. iBooks.
This material may be protected by copyright.

Check out this book on the iBooks Store: https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewBook?id=582642389

30
Q

What are the contraindications to a urethral catheter to be placed in a male patient?

A

“high riding, soft boggy prostate; blood at the urethral meatus; and perineal hematoma”

Excerpt From: Mark Graber & Jason Wilbur. “Family Practice Examination and Board Review, Third Edition.” McGraw-Hill Medical, 2013. iBooks.
This material may be protected by copyright.

Check out this book on the iBooks Store: https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewBook?id=582642389

31
Q

“In aortic dissection, the BP is different between the extremities in only 15% of cases.
What limb should you use to guide treatment?

Excerpt From: Mark Graber & Jason Wilbur. “Family Practice Examination and Board Review, Third Edition.” McGraw-Hill Medical, 2013. iBooks.
This material may be protected by copyright.

Check out this book on the iBooks Store: https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewBook?id=582642389

A

The limb with the highest BP. Tx should include a beta blocker and an IV vasodilator, like nitroprusside.

32
Q

After ingestion of a possibly toxic amount of iron when can the serum levels be drawn to best help the diagnosis and treatment course?

A

Two to four hours in regular iron supplements and 6 to 8 hours after ingestion with extended release. However, you can’t treat based solely on Serum levels because the iron is taken up by the cells. You have to treat based on clinical findings.

33
Q

What are the symptoms of iron overdose?

A

“The first stage is characterized by nausea, vomiting, diarrhea, and abdominal pain. There may be hematemesis and hematochezia as the GI mucosa becomes irritated. The second phase is a relatively asymptomatic period as the GI symptoms resolve. During this quiet phase, iron is absorbed and transported to the periphery where it causes the interruption of aerobic metabolism. In the “next (third) phase, patients become hypotensive, acidotic, and can develop multisystem organ failure and coma. It is this shock that is the usual cause of death in iron toxicity. The fourth phase is heralded by hepatic necrosis. Liver failure, which does not occur in all patients, is the second most frequent cause of death in cases of iron toxicity. Finally, the patient may develop bowel obstructions 2–4 weeks or longer after the ingestion due to stricture at the site of mucosal irritation”

Excerpt From: Mark Graber & Jason Wilbur. “Family Practice Examination and Board Review, Third Edition.” McGraw-Hill Medical, 2013. iBooks.
This material may be protected by copyright.

Check out this book on the iBooks Store: https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewBook?id=582642389

34
Q

What is the treatment for iron overdose?

A

“whole bowel irrigation with polyethylene glycol solution to flush the iron out of the GI tract

“10–15 mL/kg/hr, up to 2000 cc/hr, seems to be a reasonable place to start”
“The irrigation should continue until the rectal effluent is clear and there are no visible pill fragments. If follow-up radiographs demonstrate persistent iron tablets in the stomach, consider the possibility of a bezoar having formed, which may require endoscopic or surgical intervention for removal.”

“Deferoxamine is used to chelate iron, while EDTA is a chelation treatment for lead poisoning. Fastidious supportive care, with correction of the patient’s volume and “acid-base disturbances, is imperative. Ensuring that the patient is euvolemic is especially important when using chelation therapy, given that the major side effect of deferoxamine is hypotension”

Excerpt From: Mark Graber & Jason Wilbur. “Family Practice Examination and Board Review, Third Edition.” McGraw-Hill Medical, 2013. iBooks.
This material may be protected by copyright.

Check out this book on the iBooks Store: https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewBook?id=582642389

35
Q

What is the most common cause of infection in the newborn?

A

“GBS may be the most common cause of bacterial infection in the newborn. The peak incidence of GBS disease is in the first 7days of life, but there may be a delayed presentation during the first 30 days of life.

Excerpt From: Mark Graber & Jason Wilbur. “Family Practice Examination and Board Review, Third Edition.” McGraw-Hill Medical, 2013. iBooks.
This material may be protected by copyright.

Check out this book on the iBooks Store: https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewBook?id=582642389

36
Q

What is the appropriate course of action in a neonate younger than two months of age with an unknown source of infection?

A

It is important that a complete evaluation and septic workup be performed on all children younger than 2 months without a definite source of infection. This includes CBC, blood cultures, catheterized urine specimens for analysis and culture, and a lumbar puncture. A chest x-ray need not be done in the patient without respiratory symptoms but is highly recommended.”

Excerpt From: Mark Graber & Jason Wilbur. “Family Practice Examination and Board Review, Third Edition.” McGraw-Hill Medical, 2013. iBooks.
This material may be protected by copyright.

Check out this book on the iBooks Store: https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewBook?id=582642389

37
Q

“What is the most common cause of respiratory distress in a 6-month-old”

Excerpt From: Mark Graber & Jason Wilbur. “Family Practice Examination and Board Review, Third Edition.” McGraw-Hill Medical, 2013. iBooks.
This material may be protected by copyright.

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A

Bronchiolitis

38
Q

What is the steeple sign?

A

The subglottic narrowing of the trachea as a result of edema associated with croup.

39
Q

True or false: An oxygen saturation of 95% is abnormal in a child.

A

True

40
Q

How can you tell the position in either the esophagus or the trachea for an aspirated coin upon AP X-ray?

A

“The esophagus tends to collapse from anterior to posterior when there is nothing in the lumen. Therefore, a coin in the esophagus should look round on an AP x-ray. By contrast, the trachea is supported by cartilaginous rings around most of its circumference. The anterior part of the trachea, however, abuts the esophagus and has no cartilage. Therefore, coins that fall into the trachea have an end-on appearance in AP films and a disc in lateral films.”

Excerpt From: Mark Graber & Jason Wilbur. “Family Practice Examination and Board Review, Third Edition.” McGraw-Hill Medical, 2013. iBooks.
This material may be protected by copyright.

Check out this book on the iBooks Store: https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewBook?id=582642389

41
Q

Chore false: a button battery consumed by a child is always a surgical emergency.

A

“Batteries lodged in the esophagus need to be removed emergently. However, once a battery transitions to the stomach, it will likely pass without causing any difficulty

“However, it should be removed if it remains in the stomach for more than 48 hours or is ≥15 mm”

Excerpt From: Mark Graber & Jason Wilbur. “Family Practice Examination and Board Review, Third Edition.” McGraw-Hill Medical, 2013. iBooks.
This material may be protected by copyright.

Check out this book on the iBooks Store: https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewBook?id=582642389

42
Q

The patient presents to the ER department with acute mental status changes. They are unresponsive verbally and their eyes are closed, but they respond to the precordial Rub. What would be the appropriate course of action?

A

Administer a coma cocktail:

“dextrose, oxygen, narcan, and thiamine) DONT protocol

Excerpt From: Mark Graber & Jason Wilbur. “Family Practice Examination and Board Review, Third Edition.” McGraw-Hill Medical, 2013. iBooks.
This material may be protected by copyright.

Check out this book on the iBooks Store: https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewBook?id=582642389

43
Q

What are the signs of and treatment for hyperkalemia?

A

“In hyperkalemia with evidence of ECG changes (peaked T waves, wide QRS, sine wave), calcium needs to be administered immediately. The calcium stabilizes cardiac cell membranes within 1 minute”
“Continue administering calcium every 5 minutes until ECG changes resolve. However, in a patient with digitalis toxicity and hyperkalemia, DO NOT give calcium…treat the Dig toxicity with specific antibodies (fab fragments). The Ca increase digoxin binding to myocardial cells.

Excerpt From: Mark Graber & Jason Wilbur. “Family Practice Examination and Board Review, Third Edition.” McGraw-Hill Medical, 2013. iBooks.
This material may be protected by copyright.

Check out this book on the iBooks Store: https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewBook?id=582642389

Excerpt From: Mark Graber & Jason Wilbur. “Family Practice Examination and Board Review, Third Edition.” McGraw-Hill Medical, 2013. iBooks.
This material may be protected by copyright.

Check out this book on the iBooks Store: https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewBook?id=582642389

44
Q

What are the PE findings associated with acute MI?

A

“hypotension, diaphoresis, and a new S3 gallop”

Excerpt From: Mark Graber & Jason Wilbur. “Family Practice Examination and Board Review, Third Edition.” McGraw-Hill Medical, 2013. iBooks.
This material may be protected by copyright.

Check out this book on the iBooks Store: https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewBook?id=582642389

45
Q

Does chest pain reproduced by chest wall pressure r/o acute MI?

A

No. “15% of patients with cardiac disease and 17% of patients with a pulmonary embolism (PE) will have their pain reproduced by chest wall pressure”

Excerpt From: Mark Graber & Jason Wilbur. “Family Practice Examination and Board Review, Third Edition.” McGraw-Hill Medical, 2013. iBooks.
This material may be protected by copyright.

Check out this book on the iBooks Store: https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewBook?id=582642389

46
Q

What’s the scoop with cardiac enzymes in an MI?

A

“CPK-MB is more sensitive in the first 6 hours than is the troponin (about 84% vs. 74%). However, at least one of them will be positive in 80% of patients within 2–3 hours ED arrival”

“may be due to conditions other than AMI, including CHF, PE, burns, sepsis or other critical illness, stroke, and others”

“The new ultra-sensitive troponin May be positive within 3 hours”

Excerpt From: Mark Graber & Jason Wilbur. “Family Practice Examination and Board Review, Third Edition.” McGraw-Hill Medical, 2013. iBooks.
This material may be protected by copyright.

Check out this book on the iBooks Store: https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewBook?id=582642389

47
Q

When are thrombolytocs indicated in MI?

A

STEMI - ST elevated MI

48
Q

How often do patients with a PE present with pain?

A

About 60% of the time.

49
Q

What is the chest x-ray findings with aortic dissection?

A

”Chest x-ray findings in patients with thoracic aortic dissection may include widened mediastinum, obliterated aortic knob, pleural “capping,” tracheal deviation, depression of left main stem bronchus, esophageal deviation, and loss of the paratracheal stripe”

Excerpt From: Mark Graber & Jason Wilbur. “Family Practice Examination and Board Review, Third Edition.” McGraw-Hill Medical, 2013. iBooks.
This material may be protected by copyright.

Check out this book on the iBooks Store: https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewBook?id=582642389

50
Q

“The patient requires heparin with the thrombolytic that you choose.
What is the dosing regimen best accepted for use in AMIs”

Excerpt From: Mark Graber & Jason Wilbur. “Family Practice Examination and Board Review, Third Edition.” McGraw-Hill Medical, 2013. iBooks.
This material may be protected by copyright.

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A

“For anticoagulation in AMI, the dose of enoxaparin is 1 mg/kg “SQ every 12 hours.

“The correct dose for heparin when given with a thrombolytic is 60 U/kg bolus (maximum of 4000 units) with a drip of 15 units/kg/hr (maximum dose of 1000 units/hr). The bottom line here is that either enoxaparin or heparin can be used in this setting, and they are more or less equivalent”

Excerpt From: Mark Graber & Jason Wilbur. “Family Practice Examination and Board Review, Third Edition.” McGraw-Hill Medical, 2013. iBooks.
This material may be protected by copyright.

Check out this book on the iBooks Store: https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewBook?id=582642389

51
Q

What is the acceptable elevation of liver function tests with the use of the Statin?

A

Three times the normal upper limit. Check the liver enzymes initially at 12 weeks and then yearly. It turns out that liver damage from statins is an idiosyncratic reaction and that monitoring liver enzymes is not help.

FP board review (15 decks)

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