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EOR - Emergency Medicine > Rosh Material > Flashcards

Rosh Material Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

what is this showing

A

fluid behind the retina
discrete hyperechoic retina line

retinal detachment

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2
Q

4 sx of retinal detachment

A

floaters - cobweb appearance
photopsia (flashes of light
visual field defect
hazy retina w. white folds

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3
Q

what is this visual field defect

A

retinal detachment

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4
Q

US finding: mixed granular and linear echogenicities in the posterior eye

A

posterior vitreous hemorrhage

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5
Q

US finding: granular echogenic debris in the posterior eye that swirls and settles w. eye movement

A

washing machine sign -> vitreous hemorrhage

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6
Q

tx for retinal detachment

A

stat ortho consult

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7
Q

what is this showing

A

patela alta -> patella tendon rupture

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8
Q

forced hyperflexion of DIP -> unable to extend the DIP

A

mallet finger

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9
Q

tx and complication of mallet finger

A

tx: volar splint of DIP in extension x 6-8 weeks

complication: swan neck deformity

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10
Q

branches of the common peroneal n

A

deep peroneal n
superficial peroneal n

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11
Q

damage to the common peroneal nerve happens with injury at the

A

proximal fibula (fibular head)

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12
Q

2 PE findings of damage to the common peroneal nerve

A

foot drop
numbness in web space btw 1st/2nd toes

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13
Q

sensory and motor fxn of the deep peroneal n

A

sensory: first and second toe
motor: tibialis anterior -> foot dorsiflexion/inversion, great toe extension

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14
Q

sensory and motor fxn of the superficial peroneal n

A

motor: ankle eversion
sensory: dorsum of foot

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15
Q

what nerve controls plantar flexion of the ankle

A

tibial

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16
Q

2 rf for common peroneal n injury

A

leg cast
prolonged lying

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17
Q

describe pain w. OA:
describe pain w. RA:

A

OA: worse with activity
RA: better w. activity

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18
Q

what is pathognomonic for OA

A

heberden’s nodes -> bony hard swelling of DIP

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19
Q

joints mc affected by OA

A

DIP
CMC
knees
hips

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20
Q

XR finding of periarticular bone loss

A

RA

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21
Q

2 joints mc affected w. RA

A

MCP
PIP

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22
Q

2 mc presenting sx of autoimmune hemolytic anemia

A

fatigue
pallor

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23
Q

drug mc associated w. drug induced immune hemolytic anemia

A

cephalosporins

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24
Q

two types of autoimmune hemolytic anemia, including abs type

A

warm: IgG
cold: IgM

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25
Q

tx for warm autoimmune hemolytic anemia (3)

A

steroids
immunosuppression
splenectomy

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26
Q

tx for cold autoimmune hemolytic anemia (3)

A

warm pt
immunosuppression
plasmapharesis

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27
Q

“sniffing position” (jaw thurst forward)
sore throat
fever
stridor

A

epiglottitis

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28
Q

order of tx for thyroid storm

A
  1. bb
  2. methimazole
  3. 1 month later: radioiodine vs surgery
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29
Q

characteristics of histrionic pd

A

praise me:
provocative behavior
relationsips considered more intimate
attention
influenced easily
speech - impressionistic
emotions - rapidly shifting
make up
exaggerated emotions

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30
Q

unstable mood/relationships
impulsivity
self harm/suicidality
splitting

A

borderline pd

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31
Q

primary immune thrombocytopenia is same same

A

idiopathic thrombocytopenic purpura

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32
Q

sx of primary immune thrombocytopenia (aka ITP)

A

petechiae
gingival bleeding
epistaxis
menorrhagia
GI bleed
ICH

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33
Q

mc rf for immune thrombocytopenia

A

viral infxn

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34
Q

what is this showing

A

bent inner tube: sigmoid volvulus

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35
Q

tx for for sigmoid volvulus

A

sigmoidoscopy -> decompress
+/- surgery

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36
Q

3 rf for sigmoid volvulus

A

advanced age
bedbound
chronic constipation

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37
Q

what type of volvulus is more common in young people

A

colonic volvulus

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38
Q

holosystolic murmur w. radiation to the axilla
loud/blowing

A

chronic mitral regurgitation

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39
Q

mid-systolic click followed by mid-late dystolic murmur

A

MVP

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40
Q

harsh midsystolic murmur best heard at apex
radiates to the base

A

acute mitral regurgitation

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41
Q

acute mitral regurg radiates to the:
chronic mitral regurg radiates to the:

A

acute: base
chronic: axilla

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42
Q

8 drugs that cause serotonin syndrome

A

SSRIs/SNRIs
MAOIs
TCAs
tramadol
lithium
linezolid
triptans
dextromethorphan

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43
Q

triad of serotonin syndrome

A

cognitive: AMS
autonomic: htn, tachy
neuromuscular: hyperreflexia, myoclonus

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44
Q

tx for serotonin syndrome (3)

A

supportive: hydration/coolin
benzos
cyprohepatadine

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45
Q

2 relative contraindications for triptans

A

uncontrolled HTN
CVD

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46
Q

what is this showing

A

a flutter

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47
Q

tx for rate control of rapid a flutter in stable pt (2)

A

non dihydropyridine CCB
bb

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48
Q

5 rf for a flutter

A

COPD
PE
thyrotoxicosis
mitral valve dz
etoh

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49
Q

two types of priaprism
which is associated w. pain

A

low flow: painful
high flow: painless

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50
Q

tx for low flow vs high flow priaprism

A

low flow: emergency -> aspiration, intracavernous phenylephrine

high flow: obs vs arterial embolization

+/- aspiration at 2 or 10 o’clock

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51
Q

2 rf for low flow priaprism

A

SSA
ED meds, CCB, trazodone

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52
Q

what is this showing
what is the tx

A

afib w. RVR

bb vs ccb

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53
Q

tx for afib w. rvr if sx persist past 48 hr

A
  1. anticoagulate x 21 days
  2. cardioversion
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54
Q

order of tx for acute gout

A
  1. naproxen and ice
  2. prednisone
  3. triamcinolone injxn
  4. arthrocentesis
  5. colchicine
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55
Q

3 urate lower drugs used for gout prevention

A

allopurinol
probenecid
pegloticase

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56
Q

order of management for anterior epistaxis (5)

A
  1. direct pressure leaning forward
  2. oxymetazoline vs phenylephrine
  3. silver nitrate only if vessel is visualized
  4. silver nitrate cautery
  5. packing w. 48 hr f/u
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57
Q

what is this showing

A

2nd degree type 1 - wenckebach/mobitz 1

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58
Q

how might wenckebach be described in words

A

grouped beating

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59
Q

notched p wave

A

left atrial enlargement

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60
Q

classic presentation of hyperosmolar hyperglycemic state (HHS) (2)

A

critical signs of dehydration
decreased consciousness

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61
Q

pathway of HHS

A
  1. decreased renal clearance
  2. hyperglycemia/decreased insulin sensitivity
  3. hyperosmolar state
  4. fluid shifts intracellular -> extracellular

+/- ketosis

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62
Q

3 hallmark findings of HHS

A

BG > 600
pH < 7.3
negative ketones (can be mildly elevated)

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63
Q

tx for HHS

A

isotonic fluids
IV insulin
lytes monitoring

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64
Q

4 drugs associated w. SJS

A

sulfas
antiepileptics
allopurinol
NSAIDs

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65
Q

pathogen associated w. SJS

A

mycoplasma

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66
Q

3 disorders associated w. positive nikolsky sign

A

SJS/TEN
pemphigus vulgaris
staph scalded skin syndrome

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67
Q

hall mark finding of neisseria gonorrhea conjunctivitis

A

hyperpurulent discharge

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68
Q

management of neisseria gonorrhea in newborn

A

admit
single dose ceftriaxone IV/IM
PLUS
cefotaxime

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69
Q

mc cause of neonatal chemical conjunctivitis

A

erythromycin

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70
Q

what conjunctivitis in newborns is assocaited w. minimal eyelid swelling

A

chlamydia

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71
Q

complication of gonorrhea vs chlamydia conjunctivitis

A

gonorrhea: corneal rupture, vision loss
chlamydia: PNA

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72
Q

management of adrenal crisis (2)

A

crystalloid fluids
hydrocortisone

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73
Q

hallmark lab findings of adrenal crisis (2)

A

hyponatremia
hyperkalemia

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74
Q

postpartum pituitary necrosis

A

sheehan syndrome

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75
Q

management of acute closed angle glaucoma

A
  1. topical timolol
  2. apraclonidine
  3. pilocarpine
  4. acetazolamide
  5. iridotomy
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76
Q

what is this showing

A

fixed, dilated pupil
hazy cornea

acute closed angle glaucoma

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77
Q

anterior cord syndrome symptoms

A

loss of motor fxn below lesion
loss of pain/temp below lesion
preservation of position/vibratory fxn

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78
Q

sx of central cord syndrome

A

loss of senosory AND motor deficit
UE > LE

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79
Q

anterior cord syndrome is mc caused by what type of injury

A

flesion injury

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80
Q

anti-D immuen globulin must be administered w.in _ hr to be effective

A

72

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81
Q

pathway of Rh incompatability: first pregnancy/second pregnancy

A

first pregnancy:
-dad: Rh+
-mom: Rh-
-fetus Rh+

second pregnancy:
-mom: Rh- -> produces Rh abs
-fetus: Rh+ -> hemolytic dz of newborn -> hydrops fetalis

82
Q

5 sensitizing events for Rh incompatability

A

-any type of abortion or intrauterine fetal death
-trauma
-amniocentesis
-delivery of Rh+ baby
-ectopic pregnancy

83
Q

steps in thrombosed external hemorrhoid excision

A
  1. anesthesize
  2. make an elliptical incision
  3. remove
84
Q

management of COPD exacerbation

A
  1. SABA
  2. ipratropium
  3. prednisone
  4. NPPV
  5. macrolide vs doxy
  6. vaccinations
85
Q

2 indications for abx w. COPD exacerbation

A
  1. mechanical ventilation
  2. acute worsening of at least 2 cardinal sx (coughing, sputum, dyspnea etc)
86
Q

SpO2 goal for supplemental O2 in COPD exacerbation

A

88-92%

87
Q

management of von willebrand dz

A
  1. minor bleeding: desmopressin
  2. worse bleeding: desmopressing -> activates release ov von Willebrand factor
  3. severe bleedig: cryoprecipitate (von Willebrand factor recombinant)
88
Q

labs in von Willebrand

A

elevated: aPTT
normal: platelets, PT

89
Q

2 hallmark signs of von Willebrand dz

A

mucosal bleeding
postpartum bleeding

90
Q

painful, inflamed mass in midline superior natal cleft, no surrounding erythema

A

pilonidal cyst/abscess

91
Q

managemet of pilonidial abscess

A
  1. I&D w. outpt surgery f/u
  2. abx if cellulitis

do not pack the incision

92
Q

what malignancy is hashimoto a rf for

A

non-hodgkin lymphoma

93
Q

2 characteristic findings of benzo toxicity

A

coma/CNS dpn w. normal vitals
midposition pupils

94
Q

t/f: benzos affect pupil size

A

f!!

95
Q

management of cellulitis:
simple vs MRSA

A

simple: keflex, amoxicillin, dicloxacillin
MRSA: bactrim, doxy, clinda

96
Q

tx for RSV: nonsevere vs severe

A

nonsevere: nasal suctioning, hydration
severe: SABA, high flow nasal cannula, CPAP, intubation

97
Q

3 hallmark PE findings of RSV

A

tachypnea
polyphonic wheezing
rales

98
Q

what spider bite mimics a surgical abdomen

A

black widow

99
Q

management of black widow bite

A
  1. opioids, benzos
  2. antivenom if severe
100
Q

lab findings of DIC

A

low: platelets, fibrinogen
elevated: aPTT, PT, ddimer, fibrin complexes, thrombin clotting time

101
Q

mc cause of DIC

A

infxn

102
Q

nerve mc injured in shoulder dislocations

A

axillary

103
Q

XR findings of anterior shoulder dislocation

A

humeral head displaced inferiorly and medially

104
Q

diffuse ST elevation w. reciprocal ST depression in aVR and V1

A

acute pericarditis

105
Q

types of thyroiditis and tx for each

A

-hashimoto: levothyroxine
-postpartum: propranolol (hyper) vs levothyroxine (hypo)
-subacute (deQuervain): high dose ASA/NSAID
-infectious: admit, abx, I&D

106
Q

what is this showing
what is the tx

A

multifocal atrial tachy: at least 3 different p wave morphologies, rate 100-180, irregular

tx: supportive, CCB if e/o end organ damage

107
Q

2 rf for multifocal atrial tachy

A

old
COPD

108
Q

first line pressor for septic shock

A

norepinephrine

109
Q

what is this showing

A

large IVC diameter

plethoric inferior vena cava

110
Q

what is this showing

A

HOCM:
left axis deviation
p wave abnmormalities
abnormal q waves in inferior/lateral leads

111
Q

t/f: hypoxia is uncommon w. croup

A

t!

112
Q

tx for severe RSV (2)

A

steroids
racemic epi

113
Q

mcc of acute urinary retention in men

A

bph

114
Q

sx of bph

A

hi fun

hesitancy
intermittence, incontinence
frequency, fullness
urgency
nocturia

115
Q

management of acute urinary retention due to bph

A

urethral catheter

116
Q

brachial plexus

A

C5-T1

C5-C7: musculocutaneous -> BBC (biceps, brachialis, coracobrachialis -> forearm flexion/supination
C5-C6: axillary -> deltoid, teres minor -> shoulder abduction
C5-T1: radial -> triceps, extensor carpi radialis and ulnaris, supinator, extensor pollicis -> arm extension, supination, thumb abduction
C5-T1: median -> flexor carpi radialis, palmaris longus, pronator quadratus, pronator teres, digital flexors -> thumb flexion of digits 2/3, wrist flesion/abduction, forearm pronation
C8-T1: ulnar -> flexor carpi ulnaris, flexor digitorum profundus, abductor policis, small digital muscles -> finger adduction/abduction besides thumb, thuumb abduction, flexion of digits 4/5, wrist flexion and adduction

117
Q

what does abof the law stand for

A

all intrinsic hand muscles are innervated by the ulnar nerve except: abof

median nerve:
abductor pollicis brevis
flexor pollicis brevis
opponens policis
lateral lumbricals

118
Q

what brachial plexus nerve root injury is mc with hyperextension

A

T1

119
Q

tx for balanitis

A

topical clotrimazole

120
Q

what is this showing

A

second degree heart block
type II mobitz

121
Q

what is this showing

A

WPW -> procainamide

122
Q

5 clues to bacterial source of gastroenteritis

A

diarrheal onset
high stool frequency
fever > 40
grossly bloody stools
severe abd pain

123
Q

what is this showing

A

-bases of all metatarsals dislocated laterally
-metatarsal fx

lisfranc fx

124
Q

pathognomonic for lisfranc fx

A

ecchymosis on plantar surface of foot

125
Q

severe pain in midfoot
inability to bear wt

A

lisfranc fx

126
Q

what is this showing

A

lisfranc fx

127
Q

mc GI ulcer

A

duodenal -> mcc of UGI bleeding

128
Q

name 3 P2Y12 inhibitors

A

clopidogrel
prasugrel
ticagrelor

129
Q

where are the majority of anal fissures located

A

posterior midline

130
Q

primary anal fissure location and causes

A

location: posterior midline
causes: trauma, constipation, diarrhea, vaginal deivery, anal intercourse

131
Q

secondary anal fissure location and causes

A

location: lateral
causes: crohn’s, granulomatous dz, malignancy, communicable dz

132
Q

if anal fissure is located _, search for pathologic etiologies

A

laterally

133
Q

first line tx for scabies for all pt’s

A

topical permethrin 5%
nursing home: consider oral ivermectin

134
Q

damage to which nerve is most likely

A

radial

135
Q

complication of mid shaft humerus fx

A

radial n palsy (wrist drop):
loss of finger/wrist/thumb extension

136
Q

acute angle closure glaucoma is caused by

A

obstruction of aqueous humor outflow

137
Q

reactivation TB appears where on CXR (2)

A

apical upper lobe
superior lower lobe

138
Q

gs dx for TB

A

culture for AFB

139
Q

COPD causes respiratory _

A

acidosis

140
Q

hyperventilation causes respiratory _

A

alkalosis

141
Q

mc affected vessel in eschemic stroke

A

MCA

142
Q

typical sx of mca ischemic stroke

A

upper extremity and face
contralateral hemiparesis
facial weakness/sensory loss
aphasia

143
Q

sx of aca stroke

A

lower extremities
apraxia
contralateral paralysis

144
Q

pca/VBI stroke sx

A

loc
n/v
CN dysfxn
ataxia
visual agnosia

145
Q

pathology of myasthenia gravis

A

autoimmune destruction of Ach receptors on the postsynaptic membrane

146
Q

triad of MG

A

ptosis
diplopia
blurred vision

147
Q

initial tx for MG

A

pyridostigmine
later: plasma exchange vs IVIG

148
Q

MG is associated w. what 3 conditions

A

thymoma
thyroid dz
other autoimmune d.o

149
Q

2 first line meds for cardiogenic shock

A

dobutamine -> inotropic
norepinephrine -> vasopressor

150
Q

mcc of cardiogenic shock

A

MI

151
Q

ottawa foot/ankle rules

A

can not bear weight for 4 steps
ttp of distal 6 cm of tib or fib
medial or lateral malleolus ttp
ttp of 5th metatarsal
ttp of navicular bone

152
Q

walking PNA is caused by

A

mycoplasma pneumoniae

153
Q

walking pna is an _ respiratory illness with cough

A

subacute

154
Q

hallmark sx of atypical pna

A

retrosternal cp

155
Q

cxr findings of atypical pna

A

patchy infiltrates

156
Q

tx for atypical pna

A

macrolides vs respiratory fluoroquinolones

157
Q

atypical pna pathogens plus hx clues

A

mycoplasma: young
legionella: smokers, aerolized droplets, GI sx, hyponatremia
chlamydophila: close quarters, young, follows pharyngitis
coxiella burnetti: livestock exposure, elevated LFTs
chlamydophilia psittaci: bird exposure, hyperpyrexia, severe. HA

158
Q

tx for ALL cases of hemophilia a and b regarding the severity

A

repletion of deficient factor

159
Q

which hemophilia is christmas tree dz

A

b

160
Q

hemophilias are _ linked recessive

A

x

161
Q

factors associated w. hemophilia a and b

A

a: VIII
b: IX -> christmas tree dz

162
Q

tx for low risk vs high risk TIA based on ABCD2

A

low risk: score (< 4) -> ASA alone
high risk: (>/=4) -> ASA + clopidogrel

163
Q

which maneuvers move the midsystolic click of MVP later into systolic phase

A

increasing prelead or afterload:
-squatting
-handgrip

164
Q

midsystolic click
late systolic murmur

A

MVP

165
Q

MVP murmur is increased w. _
and decreased w. _

A

increased: decreased preload
decreased: increased preload

166
Q

3 types of definitive airway

A

orotracheal tube
nasotracheal tube
surgical airway

167
Q

3 cardiomyopathie

A

dilated
hypertrophic
restrictive

168
Q

dilation and impaired contraction of one or both ventricles

A

dilated cardiomyopaty

169
Q

walls of ventricles are stiff but not thickened
impaired diastolic filling
preserved dystolic fxn

A

restrictive cardiomyopathy

170
Q

S3 gallop is associated w. which cardiomyopathy

A

dilated

171
Q

mc cardiomyopathy

A

dilated

172
Q

2 mcc of dilated cardiomyopathy

A
  1. idiopathic
  2. AUD
173
Q

mc rf for placental abruption

A

htn

174
Q

lab finding of placental abruption

A

hypofibrinogenemia

175
Q

what is this showing

A

blood in suprasellar cistern
blood in sylvian fissure
blood in COW

subarachnoid hemorrhage

176
Q

2 hallmark LP finding of SAH

A

-first and last tubes have significant amt of RBCs
-xanthochromia

177
Q

very large difference in RBC numbers with much higher amt in first tube

A

traumatic tap

178
Q

papillary muscle rupture mc occurs w. which type of MI

A

inferior

179
Q

hallmark finding of papillary muscle rupture

A

sudden development of mitral regurgitatoin 3-5 days after inferior MI

180
Q

tenderness at posterolateral pole of the testicle

A

epididymitis

181
Q

dx for epididymitis

A

UA -> pyuria
US -> hyperemia

182
Q

tx for epididymitis:
low risk:
high risk:

A

low risk sexual behavior: fluoroquinolone
high risk sexual behavior: ceftriaxone/fluoroquinolone

183
Q

mcc of AOM
tx for AOM

A

mcc: strep pneumo
tx: amoxicillin

184
Q

mc US finding of ovarian torsion

A

ovarian enlargement

185
Q

-abrupt onset of pain that radiates interscapular
-stroke mimic

A

aortic dissection

186
Q

gs dx for aortic dissection

A

CTA

187
Q

two types of aortic dissection

A

stanford a: ascending aorta
stanford b: descending aorta

188
Q

which type of aortic dissection is a surgical emergency

A

stanford a -> ascending

189
Q

management of aortic dissection

A
  1. aggressive bp control -> IV esmolol
  2. reduce HR < 60
  3. nitroprusside
  4. pain control
190
Q

4 rf for aortic dissection

A

old
male
HTN
marfan

191
Q

2 PE finding of aortic dissection

A

asymmetric pulses
SBP difference > 20

192
Q

bounding water hammer peripheral pulse

A

aortic regurgitation

193
Q

what is de musset sign

A

head bobbing w. systole -> aortic regurgitation

194
Q

what is quincke pulse

A

prominent nail pulsations

195
Q

austin flint murmur

A

mid diastolic murmur -> sevre aortic regurgitation

196
Q

what is duroziez sign

A

systolic or diastolic thrill or murmur heard over femoral arteries

197
Q

hyperdynamic apical pulse displaced to the left

A

aortic regurgitation

198
Q

5 PE findings of aortic regurgitation

A

bounding water hammer pulse
de musset sign
quincke pulse
hyperdynamic apical pulse
diastolic blowing murmur along LSB

199
Q

bp management for pt presenting w. acute hypertensive emergency w. acute pulmonary edema

A

nitrates

200
Q

bp control for aortic dissection

A

esmolol

201
Q

bp management for hypertensive encephalopathy, ischemic stroke, AKI

A

nicardipine

EOR - Emergency Medicine (13 decks)

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