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Master the Boards > Radiology / Emergency > Flashcards

Radiology / Emergency Flashcards

1
Q

when is contrast head CT the best answer?

A

AV malformations

primary or metastatic tumors

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2
Q

when is abdominal pelvic CT the best answer

A

to evaluate retroperitoneal structures (pancreas, colon, prostate, testicular or renal)

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3
Q

when is high resolution CT scan of chest the best answer?

A

evaluate parenchymal lung disease and bony structures

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4
Q

who should NOT get a CT scan w/ contrast?

A

pt with renal dz (Cr > 1.5)

pt with multiple myeloma

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5
Q

what drug should be discontinued prior to doing a CT scan w/ contrast?

A

metformin

- do not resume until 48 hours after scan

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6
Q

test of choice for evaluating demyelinating dz

A

MRI

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7
Q

when is HIDA scan the answer?

A
  1. biliary obstruction vs. acute cholecystitis
  2. biliary leaks post-op
  3. congenital biliary atresia
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8
Q

when is a bone scan the answer?

A
  1. metastatic bone lesions (NOT Lytic)
  2. delayed fractures
  3. osteomyelitis
  4. avascular necrosis of femoral head
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9
Q

when is adrenal scan the answer?

A

test of choice to localize pheochromocytoma when MRI/CT scan is not diagnostic

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10
Q

initial test of choice to evaluate pulmonary embolism

A

V/Q scan

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11
Q

who should not get a V/Q scan

A

pts with COPD or extensive lung dz

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12
Q

when is a gallium scan the answer?

A

localizing abscesses

staging lymphomas and melanomas

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13
Q

pt presents to ED with acute mental status change - what do you do?

A
  1. give naloxone, thiamine and dextrose
  2. give O2 and saline
  3. check toxicology screen
  4. CBC, chemistry, urinalysis
  5. psych consult - if suicide attempt
  6. charcoal
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14
Q

when can gastric emptying be used

A

only within first hour of overdose

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15
Q

antidote - acetaminophena

A

N acetyl cysteine

  • can give charcoal too
  • prevents liver toxicity for up to 24 hours after ingestion
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16
Q

antidote - aspirin

A

bicarb to alkalinize the urine

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17
Q

antidote - BDZs

A

do NOT give flumazenil; may precipitate a seizure

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18
Q

antidote - carbon monoxide

A

100% Oxygen

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19
Q

antidote - digoxin

A

digoxin binding antibodies

- use if CNS or cardiac abnormalities

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20
Q

antidote - ethylene glycol/ methanol

A

fomepizole or ethanol

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21
Q

antidote - methemoglobinemia

A

methylene blue

- also give 100% oxygen

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22
Q

antidote - neuroleptic malignant syndrome

A

bromocriptine, dantrolene

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23
Q

antidote - TCAs

A

bicarb (protects the heart)

24
Q

features of ASA o/d

A
  1. metabolic acidosis, increase AG
  2. respiratory alkalosis (hyperventilation)
  3. tinnitus
  4. renal insufficiency
  5. elevated prothrombin time
  6. CNS symptoms
  7. fever
25
Q

what should you order on CCS if suspected ASA o/d?

A 
CBC
chem panel
ABG
PT/INR/PTT
ASA (salicylate) level
26
Q

how do you alkalinize the urine in ASA o/d

A

D5W with 3 amps bicarbonate

27
Q

what drug o/d is alkalinization of the urine useful for?

A

ASA
TCAs
phenobarbital
chlorpropamide

28
Q

what three things should be ordered on all overdose patients

A

ASA, acetaminophen and alcohol levels

29
Q

management of BDZ overdose in ED

A

move the clock forward on CCS - o/d is not fatal and will resolve with time.

30
Q

routine tx. of CO poisoning

A

100% supp O2 via non rebreathing mask

31
Q

when do you use hyperbaric O2 for management of CO poisoning?

A

carboxy Hb > 25%
LOC
ph < 7.1

32
Q

what drug can result in cyanide toxicity?

A

nitroprusside - esp. if pt has CRF or is receiving a high dose/prolonged infusion of nitroprusside

33
Q

pt presents with N/V/D, blurred vision with yellow halos around objects and an arrhythmia with PR prolongation. Labs show hyperkalemia - what did he o/d on?

A

digoxin

34
Q

meds/things that can cause digoxin toxicity

A 
CCB (verapamil)
quinidine
amiodarone
spironolactone
hypokalemia
35
Q

unique findings with ethylene glycol toxicity

A
  1. renal insufficiency
  2. kidney stones - calcium oxalate stones
  3. hypocalcemia - from precipitate of oxalic acid with calcium
36
Q

unique findings with methanol toxicity

A
  1. visual disturbance

2. retinal hyperemia - toxicity of formic acid

37
Q

what things in the pts history will make you consider methemoglobinemia?

A

history of nitrate, anesthetics, dapsone or other oxidants and any drug ending in caine

38
Q

diagnosis of methemoglobinemia

A

normal pO2 on ABG with chocolate-brownish blood; methemoglobin level

39
Q

pt is cyanotic with normal pO2 - what do you think of?

A

methemoglobinemia

40
Q

Tx. heat exhaustion (sweating, NV)

A

normal saline IV

remove from hot environment

41
Q

Tx. heat stroke (dry skin, altered mental status)

A

cooling measures - ice baths/packs

42
Q

cardiotoxic effects of TCAs

A

QRS prolongation

re-entrant arrhythmias –> VT, Vfib, Torsades

43
Q

Tx. TCAs toxicity

A

NaHCO3

lidocaine - for arrhythmias

44
Q

next step in pt with TCA toxicity and wide QRS prolongation

A

give bicarb and transfer to ICU

45
Q

CF: black widow spider bite

A

abdominal pain w/o tenderness, rigidity and hypocalcemia

46
Q

Tx. black widow bite

A

antivenin

47
Q

CF: brown recluse spider bite

A

local necrosis, bullae and dark lesions

48
Q

Tx. brown recluse spider bite

A

debridement

49
Q

most important step for any pt who has been in a fire

A

100% supp O2

50
Q

in a pt who was in a fire - who should be intubated?

A

hoarseness, wheezing or stridor

burns inside the nose or mouth

51
Q

which agents should be avoided in burn patients for sedation?

A

succinylcholine and other depolarizing agents

- increase K+ can be lethal

52
Q

what pain/sedative meds do you give a burn pt?

A

morphine - 10 mg/hr

diazepam

53
Q

Parkland formula for fluids in burn pt

A

4 ml x kg x %BSA

- give over 24 hours; first half in first 8 hours

54
Q

first step to perform in hypothermic pt

A

EKG - J waves of osborn

55
Q

best initial therapy for acute angle closure glaucoma

A

pilocarpine drops

56
Q

management: unknown dry chemical powder on skin

A

always brush off powder first - once the visible powder is removed, then the area should be irrigated with copious amounts of low pressure water

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