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Emergency Medicine > More Misc > Flashcards

More Misc Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Definition of AKI:

A
  • Serum creatinine increase of 0.3+ in 48 hours
  • Serume creatinine increase of 150% of baseline in 7 days
  • Urine volume <0.5 mL/kg/hr
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2
Q

RBC casts

A

acute glomerulonephritis

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3
Q

Muddy brown or epithelial casts

A

ATN

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4
Q

WBC casts

A

AIN or pyelonephritis

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5
Q

Narrow waxy casts

A

chronic ATN/glomerulonephritis

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6
Q

Broad waxy casts

A

ESRD

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7
Q

Fatty casts “maltese crosses”, oval fat bodies

A

nephrotic

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8
Q

eospinophils

A

ATN

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9
Q

MC form of AKI

A

Prerenal

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10
Q

Define acute tubular necrosis:

A

prolonged or severe ischemia caused by a prerenal condition, it eventually leads to an intrarenal processes

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11
Q

Define tubulointerstitial nephritis

A

inflammatory of allergic response in interstitium with sparing of the glomeruli and blood vessels

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12
Q

MCC of tubulointerstitial nephritis

A

drug hypersensitivity

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13
Q

Tx tubulointerstitial nephritis

A

prednisolone x 1-2 weeks

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14
Q

TINU syndrome

A

interstitial nephritis + uveitis

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15
Q

BUN/Cr ratio: prerenal

A

> 20:1

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16
Q

BUN/Cr ratio: intrarenal

A

<10:1

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17
Q

BUN/Cr ratio: post-renal

A

early >20:1 and late <10:1

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18
Q

MCC of ESRD?

A

DM

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19
Q

CKD Stage 1

A

> 90

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20
Q

CKD Stage 2

A

60-89

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21
Q

CKD Stage 3

A

30-59

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22
Q

CKD Stage 4

A

15-29

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23
Q

CKD Stage 5

A

<15 or dialysis

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24
Q

Glomerulonephritis AKA

A

nephritic syndrome

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25
Q

What kidney disease is associated with cola colored urine?

A

nephritic

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26
Q

MCC AGN worldwide?

A

IgA neuropathy (Berger’s)

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27
Q

Young male presents within 24-48 hours after URI or GI infection with symptoms of nephritic syndrome?

A

IgA nephropathy (Berger’s)

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28
Q

Dx of IgA nephropathy (Berger’s)

A

+ IgA mesangial deposits on immunostaining

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29
Q

Tx Berger’s

A

ACE +/- corticosteroid

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30
Q

Post-infectious glomerulonephritis MC after?

A

GABHS

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31
Q

2-14 year old boy with facial edema 3 weeks after strep with scanty, cola-colored/dark urine?

A

Post-infectious glomerulonephritis

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32
Q

Dx of post-infectious glomerulonephritis

A

increased ASO, low serum complement

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33
Q

kidney failure + hemoptysis

A

Good pasture’s disease

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34
Q

nephritic syndrome gold standard

A

renal biopsy

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35
Q

Nephrotic CM

A

heavy protienuria (>3 g/d), hypoalbuminemia, hyperlipidemia, edema

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36
Q

MCC of nephrotic syndrome in kids

A

minimal change disease

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37
Q

MCC overall of nephrotic syndrome in adults?

A

DM

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38
Q

gold standard for nephrotic syndrome

A

24 hour urine protein collection

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39
Q

Tx nephrotic syndrome

A

ACE/ARB, loop for edema, statins for hyperlipidemia

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40
Q

Others in house have head cold?

A

bronchiolitis

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41
Q

CXR bronchiolitis

A

hyperinflation, patchy atelectasis

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42
Q

Bronchiolitis tx

A

no tx

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43
Q

Barky cough

A

croup

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44
Q

MC infection of middle respiratory tract in kids

A

croup

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45
Q

Laryngitis in older kids

A

croup

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46
Q

viral or bacterial? croup

A

viral

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47
Q

When are symptoms worse with croup?

A

night

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48
Q

Westley croup severity score?

A

Level of consciousness, cyanosis, stridor, air entry, retractions

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49
Q

Steeple sign

A

Croup

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50
Q

Tx mild croup

A

observe –> antipyretics, vaprizer, fluids

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51
Q

Tx croup with stridor at rest or signficant discomfort

A

oral dexamethasone x 1 dose OR

racemic epinephrine for resp. distress

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52
Q

Whoop coughing

A

pertussis

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53
Q

Dx pertussis

A

Pertussis PCR

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54
Q

tx pertussis

A

Azithromycin

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55
Q

Extrinsic causes of pleural effusion are called?

A

transudative

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56
Q

Intrinsic causes of pleural effusion are called?

A

exudative

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57
Q

Transudative causes of pleural effusion?

A

liver disease/cirrhosis, cardiac disease/CHF, renal disease/chronic renal failure

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58
Q

Exudative causes of pleural effusion?

A

malignancy, pneumonia, TB, PE

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59
Q

Initial test for pleural effusion?

A

x-ray

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60
Q

Tx for pleural effusion?

A

thoracocentesis

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61
Q

Thoracocentesis procedure:

A

insert 1-2 intercostal spaces below height of effusion; not below 9th rib

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62
Q

Do you go above or below rib in thoracocentesis?

A

above

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63
Q

Thoracocentesis: pale yellow

A

usually transudative

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64
Q

Thoracocentesis: yellow-green

A

RA

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65
Q

Thoracocentesis: blood or red

A

malignancy or asbestosis

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66
Q

Thoracocentesis: brown, anchovy psate

A

amebic liver abscess

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67
Q

Thoracocentesis: black

A

aspergillus infection

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68
Q

Thoracocentesis: putrid odor

A

anaerobic abscess

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69
Q

Blunting of costophrenic angles

A

pleural effusion

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70
Q

3 d’s of endometriosis

A

dysmenorrhea, dyschezia, dyspareunia

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71
Q

MC site for endometriosis?

A

ovary

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72
Q

Triad of endometriosis

A

pelvic pain; fixed and firm adnexal mass; tender nodularity in cul-de-sac and uterosacral ligaments

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73
Q

Endometriosis: US

A

ground glass appearance of implants

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74
Q

Tx: endometriosis

A

OCPs, medroxyprogesterone acetate; NSAIDs

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75
Q

MC type of benign ovarian tumor

A

epithelial

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76
Q

MC type of epithelial ovarian tumor

A

Serous

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77
Q

Best modality for assessing ovarian tumors

A

US

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78
Q

PROM definition:

A

at least 1 hour prior to active labor (at or after 37 weeks gestation)

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79
Q

Prolonged PROM:

A

18+ hours before onset of labor

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80
Q

Dx PROM:

A

avoid digital vaginal exam; sterile speculum exam and confirmation via nitrazine test (detects pH –> alkaline if amniotic) and fern test (detects salt crystals in amniotic fluid)

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81
Q

MC site of ectopic

A

Fallopian tube (specifically ampula)

82
Q

Serum HcG should increase by at least

A

66% every 48 hours in the first 6-7 weeks after day 9

83
Q

Progestrone in pregnancy

A

> 25 normal

<5 abnormal

84
Q

Diagnosis of ectopic

A

US

85
Q

When is ectopic suspected on US?

A

suspected if gestational sac is not seen within uterine cavity with serum HcG around 1200

86
Q

Medical tx of ectopic

A

methotrexate (if stable and ectopic <3.5 cm)

87
Q

surgical tx of ectopic

A

lapartomy (unstalbe0, laparoscopy (stable)

88
Q

Define intrauterine fetal demise

A

fetal demise after 20 weeks, but before labor onset

89
Q

Define premature labor

A

Of a viable infant >20 weeks to <37 weeks

uterine contractions: 4 per 20 minutes or 8 per 60 and cervical changes (2 cm dilation or 80% effacement)

90
Q

cause of neonatal morbidity and mortality

A

premature labor

91
Q

Greatest RF of premature labor

A

previous pre-term labor

92
Q

Meds for preterm labor

A

magnesium sulfate

93
Q

MCC of acute pelvic pain

A

ovarian ruptured cyst

94
Q

Pusus paradoxus is seen with ?

A

cardiac tamponade

95
Q

pulsus paradoxus:

A

exaggerated >10 mmHg decease in SBP with inspiration

96
Q

Cardiac tamponade tx:

A

pericardiocentesis

97
Q

ortho hypotension tx

A

fludrocortisone +/- midodrine

98
Q

hypovolemic shock: I

A

15% blood loss –> pulse and SBP normal

99
Q

hypovolemic shock: II

A

15-30% –> tachy (>100) and SBP >100 mmHg

100
Q

hypovolemic shock: III

A

30-40% –> tachy, decrease SBP (<100), confusion, decreased urine output

101
Q

hypovolemic shock: IV

A

> 40% –> tachy, decreased SBP, lethargy, no urine output

102
Q

Only shock where we do NOT give large amounts of fluids

A

cardiogenic

103
Q

Tx for cardiogenic shock

A

dobutamine, epinephrine

104
Q

Warm shock

A

septic

105
Q

MC type of distributive shock

A

septic

106
Q

only shock with increased CO

A

septic shock

107
Q

distributive shock tx

A

zosyn + ceftriaxone or imipenem; vasopressors

108
Q

Analphylactic shock tx

A

Epi 0.3 IM of 1:1000 repeat q 5-10 min
If cardiovascular collapse, give epi 1 mg IV (1:10,000)
-Airway, diphenhydramine 25-50 mg IV, ranitidine, IV lfuids

109
Q

What type of shock is associated with a biphasic phenomenon?

A

anaphylactic

110
Q

Shock: brady and hypotension

A

neurogenic

111
Q

MC route of osteomyelitis in childlren

A

hematogenous

112
Q

MC organism for osteomyelitis

A

s. aureus

113
Q

osteomyelitis organism pathognomonic for SCD

A

salmonella

114
Q

MC site of osteo in kids?

A

hip

115
Q

If x is normal, osteo is unlikely

A

ESR

116
Q

Most sensitive test for osteo?

A

MRI

117
Q

Gold standard for osteo?

A

bone aspiration

118
Q

tx: acute osteo in <4 mo y/o

A

nafcillin or oxacillin + 3rd gen ceph

119
Q

tx: acute osteo in >4 mo old: MSSA

A

nafcillin or oxacillin or cefazolin

120
Q

tx: acute osteo in >4 mo old: MRSA

A

vanco or linezolid

121
Q

Duration of tx for osteo:

A

4-6 weeks; with 2 weeks IV

122
Q

SCD (salmonella) osteo tx

A

3rd gen ceph or FQ

123
Q

MC organism of septic arthritis

A

s. aureus

124
Q

MC site of septic arthritis

A

knee

125
Q

Definitive test for septic arthritis

A

arthrocentesis

126
Q

Arthrocentesis in spetic arthritis

A

WBC >50,000 (primary PMN)S; >2000 in prosthetic joint

Cell count >2000

127
Q

Septic arthritis: gram + cocci

A

nafcillin

128
Q

Septic arthritis: gram - cocci or gonococcus

A

ceftriaxone

129
Q

Septic arthritis: gram - rods

A

ceftriaxone + anti-pseudomonal

130
Q

Septic arthritis: no organism seen

A

nafcillin or vanco + ceftriaxone

131
Q

Compartment syndrome MC after fx of

A

long bone

132
Q

Earliest indicator of compartment syndrome

A

pain on passive stressing

133
Q

Compartment syndrome pressure?

A

> 30-40 mmHg

134
Q

Delta pressure compartment syndrome

A

DBP - measured compartment

<20-30 = compartment syndrome

135
Q

What is chronic mesenteric ischemia?

A

atherosclerosis of GI tract

136
Q

Chronic mesenteric ischemia impacts what site most?

A

splenic flexure

137
Q

CM chronic mesenteric ischemia?

A

chronic dull abdominal pain after meals (“intestinal angina”); weight loss

138
Q

Test for chronic mesenteric sichemia?

A

angiogram

139
Q

Tx chronic mesenteric ischemia?

A

bowel rest; surgical revascularization

140
Q

Acute mesenteric ischemia mc d/t

A

embolus

141
Q

CM acute mesenteric ischemia

A

severe abdominal pain out of proportion to PE; poorly localized pain; N/V/D

142
Q

Test for acute mesenteric ischemia?

A

angiogram

143
Q

Tx acute mesenteric ischemia?

A

surgical revascularization

144
Q

Ischemic coliits is a form of?

A

mesenteric ischemia limited to the colon

145
Q

Ischemic colitis mc d/t

A

hypotension or atherosclerosis involving SMA

146
Q

ISchemic coliits is MC at

A

watershed areas

147
Q

Ischemic colitis CM

A

LLQ pain with TTP, bloody diarrhea

148
Q

Epiglottis MC d/t

A

HIB

149
Q

RF for epiglottis in adults

A

DM

150
Q

3 ds of epiglottis

A

dysphagia, droooling, distress

151
Q

definitive dx of epiglotitis

A

laryngoscopy

152
Q

thumb sign

A

epiglottitis

153
Q

tx: epiglottitis

A

airway, supportive; dexamethasone

Abx: ceftriaxone

154
Q

ARDS is mc d/t

A

sepsis

155
Q

3 components of ARDS

A

1) severe refractory hypoxemia = hallmark
2) bilateral pulmonary infiltrates on CXR (resembles CHF)
3) absence of cardiogenic pulmonary edema/CHF –> PCWP <18 (if >18, cardiogenic pulmonary edema)

156
Q

ARDS: mild hypoxemia ABG

A

PaO2/FIO2 200-300

157
Q

ARDS: mod hypoxemia ABG

A

PaO2/FIO2 100-200

158
Q

ARDS: severe hypoxemia ABG

A

PaO2/FIO2 <100

159
Q

Tx: ARDS

A

CPAP, PEEP

160
Q

MCC of encephalitis

A

hsv-1

161
Q

MC area of brain involved in encephalitis

A

temporal

162
Q

CSF of encephalitis

A

lymphocytes, normal glucose, increased protein

163
Q

Tx encephalitis

A

supportive care, seizure prophylaxis

-Valacyclovir if HSV or unknown

164
Q

Epidural hematoma MC after

A

temporal bone fx –> middle meningeal artery disruption

165
Q

Hematoma associated with brief LOC –> lucid interval –> coma

A

epidural

166
Q

Convex/lens shaped hematoma

A

epidural

167
Q

Hematoma that does NOT cross suture lines

A

epidural

168
Q

Hematoma d/t tearing of cortical bridging veins

A

subdural

169
Q

hematoma d/t temporal bone fx

A

epidural

170
Q

hematoma d/t middle meningeal artery disruption

A

epidural

171
Q

hematoma d/t blunt trauma “contre-coup”

A

subdural

172
Q

Concave (crescent shaped) hematoma

A

subdural

173
Q

hematoma that can cross sturues

A

subdural

174
Q

Tx of subdural hematoma

A

evacuate if massive or 5+ mm midline shift

175
Q

thunderclap headache

A

subarachnoid

176
Q

MC d/t berry aneurysm rupture

A

subarachonid

177
Q

shows xanthochromia on LP

A

subarachnoid

178
Q

intraparenchymal bleed

A

intracerebral

179
Q

hematoma that we do NOT perform LP on

A

intracerebral

180
Q

MC cause of GBS

A

campylobacter jejuni

181
Q

DTR in GBS

A

decreased (LMN lesion)

182
Q

CSF in GBS

A

increased protein with normal WBC

183
Q

Tx GBS

A

plasmapheresis best if done early

184
Q

HA worse with straining; tinnitus; visiual changes

A

pseudotumor cerebri

185
Q

pseudotumor cerebri associated iwth what palsy

A

CN 6 (abducens): lat rectus muscle weakness –> limit of abduction (entropion)

186
Q

Dx pseudotumor cerebri

A

CT scan –> LP

187
Q

tx pseudotumor cerebri

A

acetazolamide

188
Q

NPH

A

dilation of cerebral ventricles with normal opening pressures on LP

189
Q

Classic triad of NPH

A

dementia, gait disturbance, urinary incontinence

190
Q

Gait in NPH

A

shuffling gait “magnentc”

191
Q

MRI/CT of NPH

A

enlarge centricles

192
Q

LP of NPH

A

pressure normal

193
Q

Test that helps confirm NPH

A

lumbar tap test: removal of up to 50 cc of CSF –> improvement 30-60 min after

194
Q

TOC of NPH

A

ventriculoperitoneal shunt

195
Q

Brain changes in AD?

A

cerebral cortex atrophy

196
Q

Meds for alzheimers?

A

donepezil, tarine, rivastigmine, galantamine

-Memantine

197
Q

RF for vascular dementia?

A

HTN

198
Q

Frontotemporal demenita associ with

A

marked personality changes

199
Q

Pick bodies assoc w/

A

frontotemporal demensia

200
Q

visual hallucinations –> type of dementia

A

diffuse lewy body

201
Q

MC type of stroke

A

ISchemic

202
Q

MC type of ischemic stroke

A

middle cerebral

Emergency Medicine (7 decks)

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