PREP:EM Questions

Question 1

mild vs moderate vs severe hypothermia

definitions and treatment

Answer 1

mild 32-35: active external warming
moderate 28-32: +active core (bladder, gastric lavage)
severe < 28: ECMO, pleural lavage

Question 2

treatment of shivering

Answer 2

BDZs

Question 3

atropine dose

Answer 3

0.02mg/kg (minimum dose of 0.1mg)

Question 4

What’s a normal ankle-brachial index?

Answer 4

> 0.9

Question 5

disorder with mousy/musty odor

Answer 5

PKU

Question 6

fishy odor

Answer 6

trimethylaminuria

Question 7

sweaty feet smell

Answer 7

isovaleric acidemia

Question 8

SIRS criteria

Answer 8

Core temp < 36 or >38.5
tachycardia or bradycardia
tachypnea
leukocytosis, lymphopenia, or 10%+ bandemia

Question 9

Septic shock definition

Answer 9

sepsis + SIRS + continued cardiovascular dysfxn after 40ml/kg fluids

Question 10

refractory septic shock definitions

Answer 10

fluid refractory: after 60ml/kg fluids

catecholamine refractory: after 10 mcg/kg/min of dopa, epi, or norepi

Question 11

severe sepsis definition

Answer 11

when associated with:
ARDS
cardiovascular dysfxn
dysfxn of 2 or more organ systems

Question 12

what is hydrogen sulfide

Answer 12

mustard gas

causes superficial skin burns, eye irritation, and resp tract irritation

Question 13

What are the classifications of neutropenia

Answer 13

severe < 500
moderate 500-1000
mild 1000-1500

Question 14

What is the discriminatory zone with HCG?

Answer 14

transvaginal US- 1,500 mIU/mL

transabdominal US- 6,000 mIU/mL

Question 15

symptoms of carbemazepine toxicity

Answer 15

can cause resp compromise, altered mental status, vomiting, drowsiness, slurred speech, nystagmus, hallucinations, hypotension, coma, dystonic reactions, seizures
has some anticholinergic properties
false positive for TCAs on UDS

Question 16

expected compensation for acute resp acidosis

Answer 16

increase in serum bicarb 0.1 meq for each 1 mmHg PCO2

Question 17

expected compensation for acute metabolic acidosis

Answer 17

decrease in PCO2 1.2 mmHgfor each 1 meq of bicarb

Question 18

expected compensation for acute resp alkalosis

Answer 18

decrease in serum bicarb 0.2 meq for each 1mmHg PCO2

Question 19

expected compensation for acute metabolic alkalosis

Answer 19

increase in PCO2 0.6 mmHg for each 1meq of bicarb

Question 20

how frequently can you repeat epi in anaphylaxis?

Answer 20

3-4 times every 5-15 minutes

Question 21

what is the pathophys of staph scalded skin syndrome?

Answer 21

hematogenous spread of epidermolytic or exfoliative toxin; children are more affected that adults due to inefficient renal clearance

Question 22

most common nerve injury in supracondylar fracture

Answer 22

median nerve

Question 23

most common artery injury in supracondylar fracture

Answer 23

brachial artery

Question 24

treatment of DUB

Answer 24

combo pills or progestin only pill taper

Question 25

risk factors for patellar dislocation

Answer 25

patella alta
genu valgum
increased femoral anteversion
ligamentous laxity

Question 26

sites for IO access

Answer 26

proximal tibia
distal tibia
distal femur
proximal humerus
sternum in adults

Question 27

MUDPILES

Answer 27

methanol/metabolic defects
uremia
DKA, alcoholic ketoacidosis, starvation
paraldehyde
iron and INH
lactic acidosis
ethylene glycol
salicylates
* also CO, cyanid, hydrogen sulfide, metformin, phenformin, sulfur, theophyllin, and toulene!

Question 28

normal CSF opening pressure

Answer 28

< 20 cm H2O

Question 29

LR +

Answer 29

= (positive test/presence of disease) / (positive test/absence of disease)
= sensitivity / (1 - specificity)

Question 30

LR -

Answer 30

= (negative test/presence of disease) / (negative test/absence of disease)
= (1 - sensitivity) / specificity

Question 31

How do you use LRs?

Answer 31

You have to convert the pretest probability to odds
This is pretest probability / (1 - pretest probability)
Then you multiply by the LR
Finally, you convert the odds BACK to the probability!

Question 32

What are clinically significant LRs?

Answer 32

LR + > 10

LR - < 0.1

Question 33

Amanita phalloides ingestion

Answer 33

white mushroom that can kill. classically:
stage I: 6-24hrs of no sxs
II: V/D 12-24hrs
III: seeming recovery
IV: 2-4d later with liver and renal failure

Question 34

typical murmur for HOCM

Answer 34

midsystolic harsh ejection murmur

Question 35

Brown Sequard syndrome

Answer 35

hemisection of the spinal cord
loss of contralateral pain and temperature
loss of ipsilateral motor

Question 36

loss of contralateral pain and temperature

loss of ipsilateral motor

Answer 36

Brown Sequard syndrome

hemisection of the spinal cord

Question 37

Anterior cord syndrome

Answer 37

disruption of the anterior spinal artery
loss of motor and pain sensation
preserved temp and proprioception

Question 38

loss of motor and pain sensation

preserved temp and proprioception

Answer 38

Anterior cord syndrome

disruption of the anterior spinal artery

Question 39

Central cord syndrome

Answer 39

upper extremities affected more than lower extremities

Question 40

upper extremities affected more than lower extremities

Answer 40

central cord syndrome

Question 41

Posterior cord syndrome

Answer 41

loss of proprioception and pain sensation

Question 42

loss of proprioception and pain sensation

Answer 42

posterior cord syndrome

Question 43

ectasy/MDMA intoxication

Answer 43

hyponatremia, concentrated urine, altered mental status

may see serotonin syndrome

Question 44

formula for odds ratio?

Answer 44

(AxD)/(BxC) in standard 2x2 table

Question 45

what’s the difference between odds ratio and relative risk?

Answer 45

relative risk is used when patients are followed over time.

odds ratio is used when patients already have the outcome and you look back retrospectively at an exposure of interest