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Emergency Medicine > Misc > Flashcards

Misc Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Most effective drug for allergic rhinitis

A

intranasal steroids

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2
Q

Tx for peritonsillar abscess

A

amp/sulbactam

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3
Q

dacroadenitis:

A

lacrimal gland (above)

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4
Q

dacrocystitis:

A

nasolacrimal gland (below)

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5
Q

RF for retinal detachment

A

myopia, cataracts

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6
Q

+ sign seen with retinal detachment

A

Shafer’s sign

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7
Q

Shafer’s sign

A

clumping of brown colored pigment cells in the anterior vitreous humor resembling tobacco dust

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8
Q

When can you patch a corneal abrasion?

A

if >5 mm, but not more than 24 hours and not in contact wearers

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9
Q

pH of eye?

A

7.0-7.3

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10
Q

Pre-septal cellulitus tx

A

amoxicillin

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11
Q

Orbital cellulitis tx

A

vanco

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12
Q

What drop is ok in a TM perforation?

A

ofloxacin

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13
Q

placenta over os

A

placenta previa

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14
Q

sudden painless bleeding in pregnancy

A

placenta previa

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15
Q

adherent placenta

A

placenta accreta

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16
Q

Premature separation of placenta

A

placental abruption

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17
Q

dark 3rd trimester bleeding; severe pain

A

placental abruption

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18
Q

MCC of placental abruption

A

maternal HTN

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19
Q

fetal vessels transverse the fetal membrane over cervical os

A

vasa previa

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20
Q

abortion: termination <

A

20 weeks

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21
Q

Abortion is MC in the ?

A

7th week

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22
Q

MCC of 1st trimester bleeding

A

threatened abortion

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23
Q

Cervical os closed; bloody vaginal d/c

A

threatened

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24
Q

cervical dilation > 3 cm; bleeding

A

inevitable abortion

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25
Q

some POC expelled, some retained; heavy bleeding/cramping/boggy uterus

A

incomplete abortion

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26
Q

all POC expelled; cervical OS closed

A

complete

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27
Q

fetal demise but remains in uterus >6 weeks

A

missed

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28
Q

Only potentially salvageable abortion?

A

threatened

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29
Q

Dysfunctional uterine bleeding in premenopausal women is likely d/t?

A

anovluation

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30
Q

Dysfunctional uterine bleeding in perimenopausal women is likely d/t ?

A

consider hyperplasia/carcinoma

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31
Q

Acute severe vaginal bleeding?

A

high dose IV estrogen or high dose OCPs; D&C if estrogen fails

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32
Q

Primary dysmenorrhea is due to increase in?

A

prostaglandins

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33
Q

MCC of secondary dysmenorrhea in young

A

endometriosis

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34
Q

MCC of secondary dysmenorrhea in older

A

adenomyosis

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35
Q

Tx of dysmneorrhea

A

NSAIDS; vitamin E

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36
Q

Herniated disc MC @

A

L5-S1

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37
Q

Sciatica:

A

back pain radiating to thigh/buttock –> lower leg (below knee)

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38
Q

Pain: L4

A

anterior thigh

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39
Q

Pain: L5

A

lateral thigh, hip/groin

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40
Q

Pain: S1

A

posterior leg/calf, gluteus

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41
Q

Sensory loss: L4

A

median ankle

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42
Q

Sensory loss: L5

A

dorsum foot (between 1-2 toes)

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43
Q

Sensory loss: S1

A

plantar foot

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44
Q

Weakness: L4

A

ankle dorsiflexion

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45
Q

Weakness: L5

A

big toe extension; walking on heels difficult

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46
Q

Weakness: S1

A

plantar flexion; walking on toes difficult

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47
Q

Reflex diminished: L4

A

knee jerk; weak knee extension

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48
Q

Reflex diminished: L5

A

normal

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49
Q

Reflex diminished: S1

A

loss of ankle jerk

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50
Q

Tx cauda equina:

A

neurosurgery and corticosteroids

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51
Q

Spinal stenosis is worse with?

A

extension (prolonged standing/walking)

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52
Q

Spinal stenosis is better wtih?

A

flexion (sitting/walking uphill)

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53
Q

Spinal stenosis tx:

A

lumbar epidural injection of corticosteroids

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54
Q

Gout is MC d/t

A

under excretion of uric acid

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55
Q

Which ARB does not cause gout?

A

Losartan

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56
Q

What HTN meds increase risk of gout?

A

ARB/diuretics/ACE

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57
Q

CXR gout:

A

mouse-bite or punched out erosions

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58
Q

only drug used in acute and chronic gout?

A

colchicine

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59
Q

MC site of pseudogout

A

knee

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60
Q

Tx of pseudogout

A

intraarticular steroids (1st), NSAIDs, colchicine (chronic: colchicine)

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61
Q

Tietze syndrome

A

localized palpable edema, heat, and erythema –> MC at 2nd and 3rd costochondral junctions

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62
Q

85% of ankle sprains involve?

A

collateral ligaments

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63
Q

MC ligament impacted by ankle sprain?

A

anterior talofibular

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64
Q

Main stabilizer during ankle inversion?

A

ATFL

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65
Q

injured with ankle eversion?

A

deltoid

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66
Q

Bell Palsy is a CN?

A

VII (7)/facial palsy

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67
Q

What virus has a strong association with Bell Palsy?

A

herpes simplex virus

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68
Q

Bell Palsy is MC on which side?

A

right

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69
Q

Bell palsy progression?

A

sudden onset of painless ear pain 24-48 hours –> unilateral facial paralysis (unable to wrinkle forehead), loss of nasolabial fold, decreased lacrimation

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70
Q

Bell phenomenon?

A

eye on affected side moves laterally and superiorly when eye closure attempted

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71
Q

Trigeminal neuralgia tx:

A

carbamazepine (tegretol)

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72
Q

cluster prophylaxis

A

verapamil

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73
Q

essential tremor inheritance

A

AD

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74
Q

What type of tremor is an essential tremor?

A

intentional

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75
Q

Essential tremor MC location?

A

UE and head

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76
Q

What tremor is relieved with alcohol?

A

essential tremor

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77
Q

Parkinson’s is d/t

A

dopamine depletion; failure to inhibit acetylcholine in basal ganglia

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78
Q

What type of tremor is assoc with Parkinson’s?

A

resting tremor (“pill rolling”); worse at rest

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79
Q

Gait associated with Parkinson’s?

A

shuffling gait; festination (increased speeding with walking)

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80
Q

Myerson’s sign

A

tapping bridge of nose repetitively causes sustained blink in Parkinson’s

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81
Q

Tx of Parkinson’s

A

Levodopa/carbidopa

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82
Q

Seizure assoc with bilateral symmetric 3 Hz spike

A

absence

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83
Q

Tx of absence seizures

A

1st line: ethosuximide

2nd line: valproic acid

84
Q

Tonic =

A

rigid

85
Q

clonic =

A

jerking

86
Q

HIV conditions requiring abx, treat with?

A

bactrim

87
Q

HCM treated with?

A

BB

88
Q

“drop attack” seizures

A

atonic

89
Q

Status epilepticus treatment

A

1) BZD (lorazepam, diazepam)
2) add AED if refractory to BZD (phenytoin)
3) Phenobarbitol
+ thiamine, followed by dextore if hypoglycemia

90
Q

amaurosis fugax is associated with TIA of?

A

iCA

91
Q

Initial test for TIA

A

CT

92
Q

Scoring system for TIA?

A

ABCD2

93
Q

ABCD2 for TIA

A 
Age 60+ (+1) 
BP >140/90 (+1) 
Clinical features
    Unilateral weakness (+2) 
     Speech disturbances w/o weakness (+1) 
     Other symptoms (0) 
Duration
    <10 minutes: 0 
    10-59 minutes: +1 
     60+: + 2 
History of DM (+1)
94
Q

ABCD2 for TIA scoring

A

0-3: low risk
4-5: mod risk
6-7: high risk

95
Q

Tx of TIA

A

ASA +/- dipyridamole or clopidogrel

96
Q

Eczema treatment (alt to steroids)

A

calcineurin inhibitors (tacrolimus) is an alternative to steroids (no skin breakdown)

97
Q

Tacrolimus assoc with

A

lymphoma/skin cancer

98
Q

Hypersensitivity reaction: I

A

IgE mediated

99
Q

Hypersensitivity reaction: II

A

cytotoxic, Ab-mediated

100
Q

Hypersensitivity reaction: III

A

immune antibody-antigen complex

101
Q

Hypersensitivity reaction: IV

A

delayed, cell mediated

102
Q

Hypersensitivity reaction: urticaria

A

I

103
Q

Hypersensitivity reaction: angioedema

A

I

104
Q

Hypersensitivity reaction: bullous pemphigoid

A

II

105
Q

Hypersensitivity reaction: drug mediated vasculitis

A

III

106
Q

Hypersensitivity reaction: morbilliform

A

IV

107
Q

Hypersensitivity reaction: EM

A

IV

108
Q

MC drug reaction

A

morbilliform

109
Q

EM is MC associated with

A

herpes simplex

110
Q

Scabies TOC

A

permetherine from neck to soles for 8-14 hours before showering, repeat 1 week

111
Q

Lindane SE

A

seizures, if after shower

112
Q

Alt option for scabies tx for infants and pregnant women

A

sulfur in petroleum jelly

113
Q

Spider bite associated with local burning/erythema/hemorrhagic bullae?

A

brown recluse

114
Q

spider biter associated with muscle pains, spasms, rigidity?

A

black widow

115
Q

Primary Adrenal insufficiency

A

Addison’s, adrenal gland destruction

116
Q

MCC of primary adrenal insufficiency in industralized countries

A

AI

117
Q

MCC of primary adrenal insufficiency worldwide

A

infection

118
Q

Secondary Adrenal Insufficiency

A

primary failure of ACTH secretion

119
Q

MCC of secondary adrenal insufficiency

A

stopping exogenous steroid use

120
Q

Adrenal insufficiency pathway

A

Hypothalamus (CRH) –> anterior pituitary (ACTH) –> adrenal cortex (cortisol)

121
Q

Tertiary adrenal insufficiency

A

hypopituitarisim

122
Q

Labs associated with adrenal insufficiency

A

hyponatremia, hypotension, hypoglycemia

123
Q

High dose acth stimulation test: addisons

A

little or no increase in cortisol (<20)

124
Q

CRH stimulation test: primary

A

increased ACTH, but low cortisol

125
Q

CRH stimulation test: secondary (pituitary)

A

low ACTH, low cortisol

126
Q

CRH stimulation test: tertiary (hypothalamus)

A

exaggerated ACTH response

127
Q

Tx for addrenal insufficiency:

A

Addisons: glucocorticoids (hydrocortisone) and mineralocorticoids (fludrocortisone)
Secondary: only glucocorticoids

128
Q

First line depression tx:

A

psychotherapy

129
Q

second line depression meds

A

1st: SSRI
2nd: bupropion, mirtazipine

130
Q

Name some SSRIs:

A

citalopram, escitalopram, paroxetine, fluoxetine, sertraline, fluoxamine

131
Q

What SSRI is avoided in long QT syndrome?

A

Citalopram

132
Q

SSRIs inhibit?

A

CNS uptake of serotonin

133
Q

Name some SNRIs:

A

venlafaxine, desvenlafaxine, duloxetine

134
Q

SNRIs inhibit?

A

serotonin, norepinephrine, and dopamine uptake

135
Q

AIDS: CD4 count

A

200

136
Q

HIV testing:

A

ELISA + –> confirm with western blot

137
Q

Which type of influenza is most likely to cause a pandemic?

A

Influenza A

138
Q

Antivirals for flu within?

A

48 hours

139
Q

Kernig’s:

A

inability to straighten knee with hip flexion

140
Q

CSF for acute bacterial meningitis:

A

100-10,000 PMN
decreased glucose <45
Increased total protein
Increased CSF pressure

141
Q

Post-exposure for meningitis

A

cipro 500 mg po x 1

142
Q

1 mo -18 yo MC bacterial meningitiis

A

n. meningitidis

143
Q

1 mo -18 yo bacterial meningitiis tx

A

ceftriaxone + vanco

144
Q

18 yo- 50 ys MC bacterial meningitis

A

s. pneumo

145
Q

18 yo -50 ys bacterial meningitis tx

A

ceftriaxone + vanco

146
Q

> 50 bacterial meningitis tx

A

ampicillin + ceftriaxone +/- vanco

147
Q

MC viral meningitis

A

enterovirus (echo, coxsackie)

148
Q

MRI for viral meningitis

A

diffuse enhancement of the meningies

frontal or temporal enhancement with HSV-1

149
Q

MC valvular disease

A

Aortic stenosis

150
Q

MC congenital cause of aortic stenosis

A

bicuspid AoV

151
Q

aortic stenosis becomes symptomatic when AoV

A

1 cm

152
Q

MC symptom of aortic stenosis

A

Dyspnea

153
Q

Aortic stenosis complications

A

Angina, syncope, CHF

154
Q

Where does aortic stenosis radiate to?

A

carotids

155
Q

definitive test for aortic stenosis?

A

cardiac cath

156
Q

Tx for aortic stenosis?

A

replacement

157
Q

Where does aortic regurgitation radiate to?

A

left sternal border

158
Q

What murmur can be associated wtih AR?

A

Austin-Flint: mid-late diastolic rumble at apex secondary to retrograde regurgitant jet competing with antegrade flow from LA into ventricles

159
Q

Wide pulse pressure signs seen in?

A

Chronic AR/AI

160
Q

Sift upstroke and rapid fall of radial pulse accentuated with wrist elevation

A

water hammer

161
Q

Like WHP but specific to cartoid

A

Corrigan’s

162
Q

Popliteal artery systolic > brachial artery by 60 mmHg

A

Hill’s sign

163
Q

Most sensitive sign for chronic AR/AI?

A

Hill’s sign

164
Q

Gradual pressure over femoral –> systolic and diastolic bruits

A

Durozeiz sign

165
Q

Double sound heard at femoral artery with compression of femoral

A

Traube’s sound

166
Q

head bobbing with heart beat

A

De musset

167
Q

Visible systolic pulsations of uvula

A

Muller’s

168
Q

Visible fingerbed pulsations with light compression of nailbed

A

Quinckes

169
Q

Double pulse carotid upstroke

A

Pulses bisferiens (combined AR, AS)

170
Q

Mitral stenosis MC d/t

A

rheumatic heart disease

171
Q

Mitral stenosis AKA

A

fish mouth valve

172
Q

MC symptom of Mitral stenosis

A

dyspnea

173
Q

Valve disorder associated with ruddy (flushed) cheeks with facial pallor

A

mitral stenosis

174
Q

Opening snap with

A

mitral stenosis

175
Q

Tx of mitral stenosis?

A

percuatenous valvuloplasty/valvotomy

176
Q

MCC of mitral regurgitation?

A

MVP

177
Q

MR radiates to?

A

axilla

178
Q

Tx of MR?

A

repair preferred over replacement

179
Q

MVP symptoms?

A

anxiety, atypical chest pain, panic attacks, palpitations, syncope, dizziness, fatigue

180
Q

What valve disorder is closely related to CT disease and is AD?

A

MVP

181
Q

Valvular disorder –> posterior bulging leaflets

A

MVP

182
Q

MVP tx

A

reassurance, BB

183
Q

Valvular disorders that’s almost always congenital and a disease of the young?

A

pulmonic stenosis

184
Q

pulmonic stenosis radiates to?

A

neck or base of heart

185
Q

Tx pulmonic stenosis

A

balloon valvuloplasty

186
Q

Murmur associated with pulmonic regurg?

A

Graham Steel murmur: brief decrescendo early diastolic murmur at LUSB with full inspiration

187
Q

MC primary cause of tricuspid regurg

A

infective endocarditis

188
Q

MC secondary cause of tricuspid regurg

A

pulmonary HTN

189
Q

Sign associated with tricuspid murmur

A

Carvallo’s sign: increased murmur intensity with inspiration

190
Q

Murmur associated with pulsatile liver

A

tricuspid regurgitation

191
Q

Nosocomial UTI treatment

A

cipro or levo 7 -14 d

192
Q

MCC of urethritis

A

gonorrhea

193
Q

MCC of scrotal pain

A

epididymitis

194
Q

MCC of epididymitis if <35

A

chlamydia

195
Q

MCC of epididymitis if >35

A

e.coli

196
Q

If epididiymitis likley d/t G/C –>

A

ceftriaxone 250 mg IM x 1 + Azithromycin 1 gm x 1 (can sub doxy)
-If MSM, ceftriaxone 250 mg IM x 1 + levo 500 mg x 10 days

197
Q

MC complication of mumps

A

orchitis

198
Q

Orchitis viral or bacterial?

A

viral

199
Q

MCC of balanitis in adults

A

DM

200
Q

MCC of obstructive uroopathy in men?

A

BPH

201
Q

Normal urine output

A

800 mL - 2 L/day

202
Q

oliguria:

A

<400 mL

203
Q

MCC of renal artery thrombosis

A

a. fib

204
Q

What lab may be elevated in renal artery thrombosis?

A

LDH (increased in ischemia)

205
Q

Test for renal artery thrombosis

A

non-con CT (renal US NOT useful)

206
Q

tx renal artery thrombosis

A

anticoagulate

Emergency Medicine (7 decks)

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