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EM > In Service 2015 > Flashcards

In Service 2015 Flashcards

1
Q

Shock in drowning

A

Shock is rare in drowning

R/o trauma
C spine precautions

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2
Q

Spinal shock

A

spinal cord shock

the loss of muscle tone and reflexes with complete cord syndrome during the acute phase of injury

typically lasts <24hrs

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2
Q

Drowning survival factors

A

Primary factor, duration of drowning

Low core temp correlates with bad outcome

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3
Q

Neurogenic shock

A

loss of autonomic tone

warm/hypotension 2/2 peripheral vasodilation

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4
Q

Nitrogen narcosis

A

X

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5
Q

Decompression sickness

A

type I - the bends
-severe arthalgias and pruritis

type ii - more serious
nitrogen bubble formation in high-fat-containing tissues like white matter
significant spinal cord damage can occur

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6
Q

Squeeze syndromes

A

x

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7
Q

Endometriosis

A

Most commonly involves ovary

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8
Q

Boerhaaves

A

Everything happens on left

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9
Q

Sigmoid volvulus

A

Bent inner tube

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10
Q

Cecal volvulus

A

Coffee bean

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11
Q

Midgut volvulus

A

Newborn

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12
Q

Indication for antibiotic ppx in endocarditis

A

x

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13
Q

Absolute contraindications to thromombolysis in ACS

A

x

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14
Q

Ventricular aneurysm

A

Ekg ***

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15
Q

heart block in inferior MI

A

Wenckebach

2nd degree Type I

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16
Q

heat block in anterior MI

A

2nd degree type II
High grade AV block
Get pacer ready

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17
Q

how to manage HTN in pheochromocytoma or MAOI

A

phentolamine then BB

no BB 1st due to unopposed alpha

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18
Q

HTN and cocaine

A

IV fluids

benzos

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19
Q

1 electrolyte abnormality in AICD dysrhythmias

A

hypoMag

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20
Q

cardiac pacemaker

A

pace sense trigger program shock

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21
Q

most specific troponin

A

Troponin I

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22
Q

tx of stable afib/flutter

A

CCB/BB
amiodarone
ibutilide - class III antidysrhythmic
anticoagulate

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24
Q

hypertrophic CM: tx

A

beta blocker

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25
Q

restrictive CM: tx

A

diuretics

dig

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25
Q

pericarditis: tx

A

nsaids, colchicine

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26
Q

idiopathic dilated CM: tx

A

diuretics
dig
vasodilators

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27
Q

penetrating chest trauma, pulseless

A

ed thoracotomy

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28
Q

atypical PNAs

A

legionella (macrolide)
mycoplasma (macrolide)
chlamydia (tetracycline/macrolide)

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29
Q

legionella

A 
non productive cough
elevated ast/alt
hyponatremia
gram stain w/ PMNs but no organsims
diarrhea
relative bradycardia
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30
Q

Contraindications to arthroscentesis

A

Overlying cellulitis

Bacteremia

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31
Q

EKG findings in HOCM

A

high QRS voltage
early R wave transition
TWI in anterior leads
deep narrow Q waves in lateral leads

diagnostic test of choice, echo

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32
Q

Intraosseous line peds

A

x
proximal tibia is the preferred site, followed by
distal tibia, and
distal femur

humerus, clavicle and calcaneous held in less regard

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33
Q

Conscious sedation

Benzodiazepine/opioid

A

give pain control first

Fentanyl 1.5-2 mcg/kg
Versed 0.05-0.1 mg/kg

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34
Q

causes of increased anion gap metabolic acidosis

A

ketones, uremia, lactic acidosis, toxic alcohols, salicylates

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35
Q

peripheral cyanosis w/o associ central cyanosis

A

low cardiac output states including dilated cardiomyopathy
environmental exposure to cold w/ vasoconstriction
arterial or venous occlusion
redistribution of blood flow

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36
Q

Midazolam:
Intubating dose
Conscious sedation dose

A

Intubating dose - 0.2 mg/kg

Conscious sedation dose - versed 0.05-0.1 mg/kg

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37
Q

kleb pneumo

A

alcoholic, cough, black/maroon sputum

abscess/empyema

gram neg rods in pairs

rx: cephalosporin + macrolide (eg gentamycin)

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38
Q

PCP pna tx

A

bactrim
pentamine
IV steroids if paO2 <70

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39
Q

peritonsillar abscess

A

sore throat, drooling, muffled voice

aspiration
rx penicillin, clindamycin

polymicrobial (GABHS)

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40
Q

ludwig’s angina

A

sore throat, drooling, muffled voice

organism
polymicrobial (aerobes, anerobes)

rx unasyn, clinda

airway!

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41
Q

retropharyngeal abscess

A

sore throat, drooling, muffled voice

stiff neck, extention more comfortable

ent
iv abx (clinda, unasyn)
icu admit

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42
Q

ethmoid fx

A

csf rhinorrhea/meningitis

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43
Q

posterior nose bleed

A

pack

admit

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44
Q

most common site of sinusitus

A

maxillary sinusitis

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45
Q

cavernous sinus thrombosis

A

sphenoid/ethmoid sinusitis

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46
Q

potts puffy tumor

A

frontal sinusitis

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47
Q

periorbital/orbital cellulitis

A

ethmoid sinusitis

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48
Q

tripod fx

A

punched in the cheek

zygomaticofrontal suture, sygomatic arch, infraorbital foramen

flat cheek
periorbital sweling
diplopia
anesthesia of the cheek, upper teeth, lip and gums

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49
Q

ellis type iii dental fx

A

broken tooth
blood on tooth, pulp involved

rx calcium hydroxide paste - paste on tooth, protects until they can get to the dentist

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50
Q

seat belt injuries

A

chance fx
rectus sheath hematoma
intestinal perf

51
Q

MC organ injured following blunt abd trauma

A

splenic lac

52
Q

MC organ injured following penetrating abd trauma

A

liver lac

53
Q

chancroid

A

1 g azithro or
250 mg im ctx

painful ulcer, friable, jagged edges, inguinal bubos

etiology H Ducrei

54
Q

pre eclampsia tx

A

hydralazine, labetalol

55
Q

beefy red velvety ulcers, std

A

granuloma inguinale

56
Q

glucagon

A

insulin antagonist

stimulates cAMP synthesis to accelerate hepatic glycogenolysis and gluconeogenesis

relaxes smooth muscle of the gi tract

57
Q

drugs that are radioopaque

A

chipes

chlorohydrate
heavy metals
iron
phenothiazines
enteric coated
solvents
58
Q

rotator cuff tears

involve which muscles

A

subscapularis
supraspinatus
infraspinatus
teres minor

59
Q

rotator cuff tears

most commonly injured

A

supraspinatus

60
Q

assoc nerve injury in humeral shaft fx

A

radial

61
Q

assoc nerve injury in elbow fx

A

median, ulnar

62
Q

assoc nerve injury in colles/smith fx

A

median

63
Q

assoc nerve injury in sacral fx

A

cauda equina

64
Q

assoc nerve injury in acetabular fx

A

sciatic

65
Q

assoc nerve injury in posterior hip dislocation

A

sciatic

66
Q

assoc nerve injury in anterior hip disloc

A

femoral

67
Q

assoc nerve injury in knee dislocation

A

peroneal/tibial

68
Q

assoc nerve injury in lateral tibial plateau fx

A

peroneal

69
Q

supracondylar fx assoc w/

A

volkmanns ischemic contracture

70
Q

compartment pressures

A

normal = 10 mmHg

abnormal >30 mmHg

71
Q

Lisfrac

A

fx dislocation at the base of the 2nd metatarsal

unstable fx
keystone of midfoot
requires ORIF

MC complication is degenerative arthritis

72
Q

Jones fx

A

fx of the 5th metatarsal

high incidence of delayed/nonunion

73
Q

anterior hip dislocations

assoc complications

A

10% of hip dislocations

abducted, flexed, externally rotated

femoral vein/artery thrombosis
w/ pulmonary embolism

74
Q

posterior hip dislocations

assoc complications

A

90% of hip dislocations

flexed knee strikes dashboard
shortened
adducted
internally rotated
flexed at the ?knee]

avascular necrosis of femoral head

75
Q

felon

organism

A

staph aureus

I&D, antibiotic

for I&D incise laterally - divide all the septa when you go in laterally

76
Q

flexor tendon synovitis

organism
tx

A

staph>strep

surgical debridement, iv antibiotics PCN/cephalosporin

77
Q

bells palsy

forehead sparing?

A

no forehead sparing

forehead sparing suggests central lesion

78
Q

hangmans fx

mechanism

A

hyperextension

80
Q

anterior cord syndrome

A

hyperFlexion

motor paralysis distal to lesion
loss of pain/temp

proprioceptions/vibration intact

80
Q

pontine hemorrhage

A 
pinpoint pupils
occipital headache
hyperventilating
coma
decerebrate posturing
81
Q

brown sequard syndrome

A

penetrating injury

ipsilateral loss of motor, position, vibration

contralateral loss of pain and temp

82
Q

brown sequard syndrome

A

penetrating injury

ipsilateral loss of Motor, Position, Vibration

contralateral loss of pain and temp

83
Q

MC vessel involved in stroke

A

mca

84
Q

double vision lateral gaze

A

MS

85
Q

erythema multiforme

pattern?

associ w/?

A

target lesions

associ w/
malignancy
mycoplasma

DRUGS (SOAP)
sulfa
oral hypoglycemic agents
anticonvoulants
pcn
86
Q

Vaccines in pregnancy

A

Live virus vaccines including

MMR, polio, varicella and intranasal influenza should not be administered.

87
Q

Mgmt of hypertension in pregnancy

A

Labetalol
Methyldopa
Add long acting nifedipine if either of above fail to control bp

Contraindicated in pregnancy:
ACEI, ARBs
Toxic effects on fetal scalp, lungs and kidneys

88
Q

Side effects of high or toxic levels of mag

Tx?

A 
Flushing
Diaphoresis
Hypothermia
Hypotension
Flaccid paralysis
Respiratory depression

When levels are approaching toxicity patellar reflexes diminish and respiratory rate slows

Tx: Calcium gluconate

89
Q

Massive hemothorax

A

1500 cc

200cc/hr x 2 hrs

90
Q

Endometriosis

A

Fever

Foul smelling profuse bloody discharge

91
Q

Radial head fx

Sail sign

A

X

92
Q

Ovarian cysts less than —cm can be managed expectantly

A

8

93
Q

Most common skull fx in kids?

A

Parietal

94
Q

Chest tube size for hemothorax

A

36F

95
Q

Mgmt of clenched fist injury

A

X

96
Q

Mgmt of toxic mega colon

A

Antibiotics, steroids, fluids

97
Q

Tracheobronchial

A

MC w/in 2 cm of carina

98
Q

Strawberry cervix

A

Trich

99
Q

Salter Harris II

A

Most common

100
Q

Rolando fx

A

x

101
Q

Bennetts fx

A

X

102
Q

Boxer’s fx

A

X

103
Q

Boutonnière deformity

A

X

104
Q

Mallet finger

A

x

105
Q

Jersey finger

A

X

106
Q

Supra condylar fx

A

Brachial a injury

Volkmann’s contracture

107
Q

Lunate

A

X

108
Q

Perilunate

A

X

109
Q

MCC of lower GI bleed in children?

A

Anal fissure

110
Q

Pins lesion

A

Ipsi lateral facial droop

Contra lateral hemiparesis

111
Q

Treatment of poison ivy

A

may need systemic steroids and long steroid taper for severe cases

112
Q

acute radiation syndrome

A

condition that results from whole-body irradiation from an internal or an external source over a short time period
4 phases:
1 prodromal -

2 latent - symptom free for weeks to hours depending on exposure dose

3 manifest

4 recovery or death

113
Q

severe otitis externa

A

use an ear wick or gauze for antibiotic delivery when the ear canal is swollen shut

114
Q

Raynauds tx

A

gentle rewarming combined

w/ topical or oral calcium channel blocker or nitrates

115
Q

mgmt of PCP intoxication

A

iv benzos

for seizures: benzos or phenobarb, other ageants usually ineffective

116
Q

buprenorphine

A
117
Q

naltrexone

A
118
Q

mgmt of PCP PNA

A

bactrim

?steroids

120
Q

Tibial plateau fx

A

NO WEiGHT BEARING for several weeks

121
Q

mgmt of tetralogy of fallot

A 
1  oxygen
2 fluids
3.  morphine
4  alpha agonist tx
5  prostaglandin E1 may be needed to prevent closure of the ductus arteriosus - can cause apnea and hypotension
122
Q

sodium correction for hyperglycemia

A

Corrected Na = Nacalc + (1.6)(Glucal-100)/100

123
Q

common complications of anterior shoulder dislocation

in order of decreasing frequency

A

axillary n injury
hillman-sacks deformity - humeral head fx
bankart lesion - glenoid rim disruption

124
Q

bedside test for assessing severity of asthma exac

A

peak expiratory flow rate

125
Q

first line tx in children w/ bacterial cystitis

A

bactrim

126
Q

most common cause of large bowel obstruction in adults?

A

1 malignancy
2 volvulus
3 diverticulitis

127
Q

age cutoff for surgical cric

A

> 8yo

needle cric for younger

EM (15 decks)

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