March on

Question 1

HHS vs dka

Answer 1

HHS usually non acidotic w/ a bicarb > 15

Question 2

DKA is typically severely dehydrated with a total body water deficit ~70-80 mL/kg, and being total body depleted of ___________

Answer 2

potassium, magnesium, and phosphorous

*despite initially normal serum levels of these electrolytes.

Question 3

Regarding the development of cerebral edema in patients being treated for DKA, all of the following are true EXCEPT:
A. Mannitol and steroids should be administered immediately to any patient suspected of developing cerebral edema.
B. Patients with serum glucose below 250 mg/dL still being treated with insulin are most likely to develop clinically evident cerebral edema.
C. Cerebral edema typically occurs six to ten hours following onset of treatment.
D. Children have a higher incidence of cerebral edema.
E. Mortality of patients developing cerebral edema is 90%.

Answer 3

FALSE
Mannitol and steroids should be administered immediately to any patient suspected of developing cerebral edema.

Steroids are not indicated for treatment of cerebral edema and may actually worsen DKA.

Question 4

__________ should be administered upon any change in mental status of children being treated for DKA as they are at high risk for developing cerebral edema especially when being treated with insulin and serum glucose is below 250 mg/dL

Answer 4

Mannitol 0.25-2.0 mg/kg

Question 5

the best treatment of the patient with hyperkalemia and EKG changes is

Answer 5

calcium to stabilize cardiac membranes- works quickly and is relatively safe unless patients are digitalized.

Other treatments for acute hyperkalemia include sodium bicarbonate and insulin/glucose.

Question 6

Immediate antagonism of K+ at the cardiac membrane is achieved with IV administration of?

Answer 6

calcium chloride or gluconate

Question 7

Symptoms should not be attributed to hypoglycemia unless the level falls below ____

Answer 7

40-50 mg/dL.

Question 8

atients who overdose on oral hypoglycemic agents such as sulfonylureas must have their serum glucose monitored for a minimum of ___________ before emergency department discharge.

Answer 8

24-hour observation (at minimum)

Question 9

Hypoglycemia can present with ___________ (cns)

Answer 9

virtually any neurological deficit.

Question 10

Moderate hypothermia is associated with temperatures of _________ and s/s are

Answer 10

28-32 C.

Shivering ceases at about 32 degrees Celsius.
altered mental status
 absence of shivering
bradycardia
bradypnea

Question 11

_____________ is the mainstay of treatment for patients with frostbite.

Answer 11

Immersion of the affected extremity

Question 12

With regard to laboratory findings in hypothyroidism, which of the following is false?

• Serum thyroid-stimulating hormone (TSH) is the most sensitive test to diagnose primary hypothyroidism.
• Free thyroxine (T4) is always depressed in hypothyroid states.

Answer 12

FALSE: -Free thyroxine (T4) is always depressed in hypothyroid states.

Question 13

Metabolic abnormalities often seen with hypothyroidism include all of thefollowing EXCEPT:
A. hyperglycemia
B. respiratory acidosis from hypoventilation
C. anemia
D. hyponatremia
E. hypercholesterolemia

Answer 13

Hyperglycemia- NOT typically associated with hypothyroidism.

Hypoglycemia may be present, but is unusual, and may suggest hypothalamic-pituitary involvement.

Hyponatremia is common and corrects with thyroid replacement.

Hypercholesterolemia to over 250 mg/dL is typical.

A mild normochromic, normocytic anemia may be present, in addition to respiratory acidosis from hypoventilation.

Question 14

treatment of suspected but not confirmed adrenal insufficiency

Answer 14

dexamthasone 4mg IV every 6 hours

Question 15

Hyperpigmentation is present in 90% of _______ adrenal insufficiency

Answer 15

primary

Question 16

Symptoms of secondary adrenal insufficiency include all of the following EXCEPT:
A. nausea and vomiting
B. weight loss
C. weakness
D. anorexia
E. hyperpigmentation

Answer 16

E. hyperpigmentation

Question 17

Hyperbaric oxygen can treat?

Answer 17

nec fash 
CO poisining 
decompression sickness
air embolous
crush injury 
compartnemt syndrome 

*NEVER PTX

Question 18

Hyperbaric oxygen contraindications

Answer 18

NEVER PTX

others +/- to avoid it in
COPD
URI
otitis media

Question 19

underlying conditions asc w/ a fib

Answer 19

ishemia

hyperthyroid

Question 20

Thyrpoid storm s/s

Answer 20

tachycardia> 140 
atrial fibrillation.
high fever.
persistent sweating.
shaking.
agitation.
restlessness.
confusion.
diarrhea

*if needed treat before confirming

Question 21

Iodine in thyroid storm

Answer 21

give at least 1 hour after ptu

Question 22

Drugs to AVOID in thyroid storm

Answer 22

amiodarone and aspirin- both have effects on thyroid

Question 23

Body temp in heat stroke

Answer 23

> 40.5
skin is dry and hot

ex: 80 yo f w/ AMS last seen normal 4 days ago, she is agitated and confused. RR of 20, HR of 100, BP of 90/50, and temperature of 40.6 Celsius. move all extremities. Mucous membranes are dry and skin is dry / hot.

Question 24

Atrial dysrhythmias in hypothermia are common below ________ and are associated with a slow ventricular response.

Answer 24

32o C

It usually converts spontaneously with rewarming.

Question 25

RX for someone with severe hypothermia with mental status change and cardiac dysrhythmias is probably ____________.

Answer 25

active core rewarming

ex: warm IV fluid

Question 26

A 5 year old male is bitten by a snake while playing along a ditch. The child is brought to the ED by his parents with complaint of fang marks to the right index finger. On physical exam, you note absence of swelling to the right hand or fingers. He does appear to have 2 small superficial fang marks, but no bleeding or oozing is present. Vital signs are normal. What is the next most appropriate step in the management of this patient?

Answer 26

Discharge home in 8 hours if patient’s exam remains unchanged

The patient is unlikely to suffer envenomation if he does not have any local or systemic symptoms in 8 hours. Prophylactic antibiotics are NOT recommended

Question 27

A 24 year old female gardener presents to the emergency department with foot pain 30 minutes after working barefoot in her garden. She saw a scorpion in the area. Which of the following signs or symptoms are most expected?

Answer 27

Pain and paresthesias–>

can progress to involve the entire body.
Systemic s/s unusual in adults, but more common in children.
puncture wound is almost never seen.
RX= analgesia.

Question 28

Most scorpion envenomations are mild, limited to_______________ at the site of envenomation.

Answer 28

pain and paresthesias

Question 29

CHILDREN AND SCQOURPIAN BITYE

Answer 29

s/s restlessness, jerking movements of the limbs, roving eye movements, and drooling

Anaphylaxis can also occur.

Intubation is required rarely.

Most require analgesics only

antivenom for severe reactions/anaphylaxis. s/e – serum sickness, immediate and delayed hypersensitivity

Without antivenom treatment, symptoms usually last for 1-2 days.

Question 30

Without antivenom treatment for scorpion envenomations , symptoms usually last for____________

Answer 30

1-2 days.

Question 31

Which of the following is true regarding the use of iodine in the treatment of thyroid storm?
A. Iodine should be administered even in patients with known iodine allergy.
B. Iodine should be the first drug administered in the treatment of thyroid storm.
C. Iodine should be administered at least one hour after propylthiouracil (PTU) has been given.
D. Iodine should be administered only after treatment with propranolol.
E. Dexamethasone must be given 30 minutes prior to iodine administration.

Answer 31

C. Iodine should be administered at least one hour after propylthiouracil (PTU) has been given.

Question 32

Which of the following is NOT a common sign or symptom of thyrotoxicosis?

• congestive heart failure
• hypothermia
• hyperhidrosis
• nervousness
• tachycardia

Answer 32

-hypothermia, usually HAS a fever

Question 33

Regarding the diagnosis and treatment of thyroid storm in the emergency department, ____- is important

Answer 33

Patients suspected of having thyroid storm should undergo treatment prior to a definitive diagnosis due to the potentially life-threatening nature of this disease.

Question 34

_____________ is an absolute contraindication to HBO therapy

Answer 34

Untreated pneumothorax

Question 35

Treatment with hyperbaric oxygen (HBO) is associated with contraindications. Which of the following is not a relative or absolute contraindication to HBO?

• pregnancy
• untreated pneumothorax
• COPD with air trapping
• otitis media

Answer 35

-pregnancy

Question 36

Symptoms of secondary adrenal insufficiency include all of the following EXCEPT:

• anorexia
• hyperpigmentation
• nausea and vomiting
• weakness

Answer 36

-hyperpigmentation

Question 37

___________ is the treatment of choice in suspected but not confirmed adrenal insufficiency.

Answer 37

Dexamthasone- will not affect the serum cortisol level; therefore, it will not interfere with the diagnosis of adrenal insufficiency using the ACTH stimulation test.

Question 38

Shivering ceases at about _______ degrees Celsius.

Answer 38

32