Medicine (Acute Care/Preventive) Flashcards
causative agent of chancroid, painful papule or pustule with irregular, deep, and demarcated borders
Haemophilus ducreyi
Syphilis is caused by
Treponema pallidum (spirochete)
presents with painless ulcer called chancre
Syphilis
maculopapular rash + condylomata lata + low grade fever + malaise + headache + generalized lymphadenopathy
Syphilis - Secondary stage (4-8 wks after chancre)
presents with multiple painful vesicles accompanied by vulvar pain and pruritus
Herpes simplex
most common bacterial STD
Chlamydia trachomatis
STD often asymptomatic, but may present with urethritis, mucopurulent cervicitis, or PID
Chlamydia trachomatis
causes granuloma inguinale (donovanosis)
Klebsiella granulomatis
lesion characterized by beefy red ulcer with a rolled edge of granulation tissue
granuloma inguinale / donovanosis
seizure treatment or prophylaxis for head trauma px at ER
phenytoin or levetiracetam
signs of increased ICP
deteriorating LOC
deteriorating resp pattern
cushing reflex
lateralizing CNS signs (cranial nerve palsies, hemiparesis)
seizures
papilledema (occurs late)
n/v and h/a
response to increased ICP presenting as high BP, low HR and irregular respirations
Cushing reflex
signs of basal skull fracture
raccoon’s eyes
hemotympanum
battle’s sign
csf rhinorrhea or otorrhea
meds to administer at least 2 mins prior to RSI in suspected raised ICP
fentanyl or lidocaine
goals for head trauma cases in ED
avoid secondary injuries:
ischemia
dec CPP
hypoxia
seizures
vitamin K-dependent clotting factors
factors 279,10
receptor proteins C&S
When may gastric lavage be useful?
Gastric lavage may occasionally be useful in the first hour of ingestion.
In what situations is gastric lavage dangerous?
Gastric lavage is dangerous in:
1. Caustic ingestion
2. Altered mental status
Why is gastric lavage dangerous in caustic ingestion?
It causes burning of the esophagus and oropharynx.
Why is gastric lavage dangerous in altered mental status?
It may cause aspiration.
What are the most common causes of death by overdose?
Acetaminophen and Aspirin
They are, by far, the most common cause of death by overdose.
benign and should be given to anyone with a pill overdose; superior to lavage and ipecac
Activated charcoal (SDAC / MDAC)
acetaminophen ingestion causes toxicity at how many grams (and # of 500mg tabs)?
> 8g or > 16 tabs
acetaminophen ingestion causes fatality at how many grams (and # of 500mg tabs)?
> 12 g or > 24 tabs
aspirin overdose treatment
urinary alkalinization with sodium bicarbonate
What condition is characterized by crushing, substernal chest pain with ST elevations in V1, V2, V3, short breath, crackles, and LE edema?
STEMI
What condition is indicated by an unrestrained passenger in a motor vehicle accident presenting with unilateral diminished breath sounds and dullness to percussion?
Hemothorax
What condition is seen in a young person with unilateral upper extremity swelling, pain, and erythema following vigorous exercise?
Deep venous thrombosis
What condition is presented by an older man with a recent history of abdominal surgery, severe abdominal pain, constipation, and an irreducible mass in the left lower quadrant?
Incarcerated inguinal hernia
What condition occurs immediately after completing a marathon when a runner collapses without loss of consciousness and has minimally elevated temperature?
Exercise-associated postural hypotension
What condition is indicated by a young patient with moderate chest pain worsened by palpation?
Costochondritis
Miner present with Ataxia, irritability, gingival inflammation, and excess salivation
Mercury poisoning
What condition is suggested by a sudden-onset, severe headache in an elderly patient?
Subarachnoid hemorrhage
What type of headache is characterized by sudden-onset, severe, unilateral, periorbital headache with tearing and conjunctival injection?
Cluster headache
What condition is indicated by an elderly patient with an extensive smoking history presenting with fatigue, malaise, bilateral upper extremity edema, and headache worse with supine positioning?
SVC syndrome (Pancoast tumor)
What injury is indicated by a fall onto an outstretched hand with arm in adduction and internal rotation, showing widening of the glenohumeral joint space?
Posterior shoulder dislocation
What condition is characterized by repeated bilateral lower extremity pain and swelling after strenuous exercise with spontaneous resolution?
Chronic exertional compartment syndrome
What condition presents in a young patient with no past medical history, showing encephalopathy, anion gap metabolic acidosis, and hyperglycemia?
Diabetic ketoacidosis
What injury is indicated by a fall from a roof with spinal tenderness and spinal X-ray showing decreased vertebral body height at T8?
Vertebral compression fracture
What injury is associated with a recent bar fight and severe tenderness of the medial hand at the 5th metacarpal?
Boxer’s fracture
associated injury in head-on collision
head/facial, thoracic (aortic), lower extremity
associated injuries in lateral/T-bone collision
head, c-spine, thoracic, abdominal, pelvic, and LE
associated injuries in rear-end collision
hyperextension of C-spine (whiplash injury)
head trauma with a gcs score of 8 or less, + cushing’s response
A: intubate
B: hyperventilate (100% O2)
C: maintain adequate bp (sBP >90)
administer fentanyl or lidocaine (2mins prior to RSI)
sedate
elevate head to 20 °
seizure prophylaxis
mannitol 1g/kg rapidly infused or 3% saline 3ml/kg
remove cervical collar if possible
treatment of TCA overdose
sodium bicarbonate
most accurate test for carbon monoxide poisoning
level of carboxyhemoglobin
very high carbon monoxide will lead to ph?, pCO2?, HCO3?
low ph
low pCO2
low HCO3
decreases the half life of methemoglobin
methylene blue
shortens half life of carboxyhemoglobin
hyperbaric oxygen
first step in managing organophosphate poisoning / nerve gas at ER
administer Atropine
dangerous mechanisms requiring c-spine radiography (Canadian C-Spine Rule)
Fall from 1m or more / 5 stairs
axial load to head (e.g. diving)
MVC high speed (>100km/hr), rollover, ejection
motorized recreational vehicles
bicycle collision
GCS15, alert and stable trauma patients requiring c-spine radiograph
age 65 or older, OR
dangerous mechanism
paresthesias in extremities
next step after confirming there is no high-risk factor that mandates c-spine radiography for gcs15, alert and stable patient? (Canadian C-Spine Rule)
assess any low-risk factor that allows safe assessment of ROM
- Simple rear-end MCV , OR
- Sitting position in ED, OR
- Ambulatory at anytime, OR
- Delayed (not immediate) onset of neck pain, OR
- absence of midline C-spine tenderness
mechanisms excluded in simple rear-end MVC
hit by truck/bus
hit by high-speed vehicle
rollover
pushed into oncoming traffic
mgmt for patient with SCI and in shock
IVF
vasopressors
maintain normothermia
maintain euglycemia
High urine pH increases the risk of developing this stone
struvite stones (magnesium ammonium phosphate)
