PREP:EM Notes

Question 1

IV Meds to Tx HTN Emergency (4)

Answer 1

1. labetalol 0.2-1mg/kg
2. nitroprusside gtt
3. nicardipine gtt
4. fenoldapam

Question 2

HOCM murmur

Answer 2

systolic murmur that gets louder with valsalva or standing from squatting

Question 3

hCG levels at which you should see a pregnancy on US (transabd vs transvag)

Answer 3

transabd > 6500

transvag > 1000

Question 4

DDx of Late Pregnancy Bleeding? (3)

What do you do?

Answer 4

DDx: placenta previa, placental abruption, preterm labor
Actions: get OB STAT and don’t do a pelvic

Question 5

Management Options for Laryngospasm (5)

Answer 5

• reposition airway
• give sustained BVM pressure/PEEP
• stimulate “laryngospasm notch” (behind the earlobe, the soft area between the skull base, mastoid bone, and mandible)
• sux 0.1-0.2mg/kg
• propofol 0.5-1mg/kg

Question 6

If you see metabolic acidosis + respiratory alkalosis, you should think of this poisoning

Answer 6

salicylate poisoning

Question 7

classic blood gas abnml with salicylate poisoning

Answer 7

metabolic acidosis + respiratory alkalosis

Question 8

key difference in presentation between ethylene glycol and methanol poisonings

Answer 8

ethylene glycol: results in oxalic crystals in the urine and hurts the kidneys
methanol: results in formic acid and causes blindness

Question 9

toxic alcohol resulting in blindness

Answer 9

methanol

Question 10

toxic alcohol resulting in renal failure

Answer 10

ethylene glycol

Question 11

J-waves/Osborn waves are seen in:

Answer 11

hypothermia

Question 12

characteristic EKG finding of hypothermia

Answer 12

J-waves/Osborn waves

Question 13

In treating hypothermia, at what temperature should you initiate resuscitation meds and defibrillation attempts?

Answer 13

T > 30C

Question 14

characteristics of organic etiologies to psychosis (7)

Answer 14

1. abrupt onset
2. <12yo
3. abnml VS
4. abnml physical exam
5. mental status changes
6. abnml neuro exam findings
7. visual hallucinations

Question 15

treatment of adrenal crisis

Answer 15

1-2mg/kg of hydrocortisone

Question 16

meds to acutely treat thyroid storm (4)

Answer 16

1. propanolol
2. iodide/lugols
3. methimazole
4. steroids

Question 17

Patient comes in with occipital HA associated with ataxia/vertigo, dysarthria with short period of LOC. Symptoms resolve after emesis. What less scary dx should you think of?

Answer 17

basilar artery migraine

Question 18

zones of the neck

Answer 18

3. angle of mandible to base of skull
4. cricoid to angle of mandible
5. cricoid to clavicles/thoracic inlet

Question 19

Patient with alkaline serum but aciduria - what is this???

Answer 19

paradoxical aciduria secondary to potassium depletion

Question 20

Malaria mimic seen in New England?
Transmission?
How do you diagnose it?
Treatment?

Answer 20

Babesiosis
Ixodes tick
dx with thick and thin smears (like malaria); may see the Maltese cross
atovaquone + azithromycin OR clinda + quinine

Question 21

Cutaneous ulcer OR purulent conjunctivitis with preauricular lymph nodes should make you think of this disease:

Answer 21

tularemia

Question 22

radiopaque toxins (5)

Answer 22

COINS
1. chloral hydrate
2. opiate packets
3. iron and Hg, As, Li
4. neuroleptics
SR/enteric coated meds

Question 23

poisonings that activated charcoal won’t work for (3)

Answer 23

ions/metals
acids/bases
alcohols

Question 24

this common household object can be 17% EtOH

Answer 24

mouthwash

Question 25

toxin that smells like rotten eggs

Answer 25

hydrogen sulfide

Question 26

toxin that smells like almonds

Answer 26

cyanide

Question 27

toxin that smells like garlic

Answer 27

arsenic