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Emergency and Surgical Medicine > Week 2 > Flashcards

Week 2 Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Treatment for the bends:

A
  • O2, analgesics, crystalloid fluids

- Immediately put in hyperbaric chamber

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2
Q

What should you do with asymptomatic near-drowning patients?

A

Observe for 8 hours and admit if deterioration

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3
Q

Mgmt of altitude sickness:

A
  • Immediate descent to below 5000 ft
  • Analgesics and antiemetics
  • Dexamethasone, acetazolamide, nifedipine or mannitol for HAPE/HACE
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4
Q

True or false: anything that increases metabolism also increases fluid need.

A

True. Fever, tachypnea, burns, etc. all increase fluid needs.

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5
Q

What does a subdural hematoma look like on CT?

A

Crescent shaped

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6
Q

What does an epidural hematoma look like on CT?

A

Football or lens shaped

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7
Q

How should you manage a patient with a basilar skull fracture?

A

Admit and possibly prophylax for meningitis (cefazolin)

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8
Q

Treatment options for severe chillblains:

A

Nifedipine and steroids

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9
Q

Beck’s Triad:

A
  • Classic finding in cardiac tamponade

- Hypotension, muffled heart sounds, and JVD

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10
Q

What lab finding distinguishes alcoholic pancreatitis from gall stone pancreatitis?

A

Lipase and amylase: very elevated in gall stone pancreatitis, only moderately with alcoholic.

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11
Q

Treatment for cholangitis:

A

Abx and ERCP to remove obstruction

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12
Q

What IV fluid would you use for DKA or a hyperosmolar hyperglycemic state?

A
  • 1/2 NS for hyperosmolar hyperglycemic state

- NS or 1/2 NS for DKA, depending on whether you want to treat low volume or shift fluid into intracellular compartment

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13
Q

What IV fluid should you use to treat hypernatremia?

A

D5W

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14
Q

What should you do before closing a laceration on the eyelid, nose, mandible, or around the orbit?

A

Get an x-ray

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15
Q

What should you get before closing a scalp laceration in which the pt suffered a loss of consciousness?

A

CT

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16
Q

Possible complications of septal hematoma if it isn’t drained immediately:

A

Saddle deformity and/or necrosis

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17
Q

What should antibiotic therapy be directed towards in a patient with a nasal fracture or septal hematoma?

A

Staph (augmentin, cephalexin, erythromycin, etc.)

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18
Q

Management of posterior epistaxis:

A
  • Nasal balloon (Nasostat, Epistat)

- ENT consult

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19
Q

Most common bone fractured in an orbital blow out fracture:

A

Maxillary bone

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20
Q

S/S of orbital blowout fracture:

A
  • Diplopia (upward gaze)
  • Enophthalmos
  • Ipsilateral anesthesia (V2)
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21
Q

What do you want your patients to avoid if they have an orbital blowout fx?

A
  • Valsalva
  • Prophylax for vomiting
  • Don’t blow nose
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22
Q

How should you manage an avulsed tooth?

A
  • Chest x-ray if it can’t be found
  • Hanks Balanced Salt Solution for transport
  • Re-implant directly in socket and splint
  • Get dental consult
  • Abx X 5d
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23
Q

Medical treatments for central retinal artery occlusion:

A

Timolol, acetazolamide or inhaled carbogen

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24
Q

Important risk factor for general anesthesia:

A

Malignant hyperthermia

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25
Q

Drugs used for general anesthesia:

A
  • Propofol
  • Inhaled ethers or propofol drip for maintenance
  • Others: ketamine, etomidate
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26
Q

How should you treat someone with a hemolytic transfusion reaction?

A

Fluids, mannitol and/or furosemide (Lasix), vasopressors for shock

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27
Q

How would you treat someone with an anaphylactic transfusion reaction?

A
  • Antihistamines if mild

- Epi injection in thigh or brochodilators if severe

28
Q

Fluid of choice for resuscitation and maintenance:

A
  • NS

- Can also give LR for resuscitation

29
Q

Good fluid to give for GI loss, fistula drainage, and burns/trauma patients:

A

LR

30
Q

Fluid to use for maintaining daily body fluid requirements:

A

D5 1/2NS

31
Q

Good option for someone with a history of transfusion reactions:

A

Leukocyte poor blood

32
Q

Used to transfuse patients with liver disease or who are over-anticoagulated and need clotting factors:

A

Fresh frozen plasma

33
Q

Fresh vs frozen packed red blood cells:

A
  • Both used to treat anemia due to blood loss

- Frozen is better for rare blood types.

34
Q

Other colloids sometimes given intravenously:

A
  • Synthetics: Dextran and Hespan (hetastarch)

- Plamanate (plasma protein fraction)

35
Q

What drugs are most commonly used in epidural or spinal anesthesia?

A
  • Bupivacaine, lidocaine, ropivacaine and chloroprocaine are commonly used, along with narcotics, in epidurals
  • Bupivacaine (mostly), lidocain, ropivacaine and sometimes epinephrine in spinal blocks
36
Q

Two potential uses for a penrose drain:

A
  • Large abscesses

- Peritoneal space

37
Q

Medical and surgical treatment for ectopic pregnancy:

A
  • Medical = methotrexate

- Surgical = laparoscopic surgery and salpingectomy if tube isn’t salvageable

38
Q

Medical and surgical treatment for leiomyoma:

A
  • Medical = Mifepristone

- Surgical = myomectomy or hysterectomy

39
Q

Workup for endometrial cancer:

A

Biopsy, then hysterectomy + pelvic and aortic lymphadenectomy

40
Q

Labs suggestive of testicular carcinoma:

A
  • Hcg, alpha fetoprotein, lactate dehydrogenase
41
Q

Workup for suspected testicular cancer:

A

Abdominal CT + chest x ray or chest CT for mets, scrotal ultrasound

42
Q

Do you biopsy a suspected testicular carcinoma?

A

No

43
Q

Features of a solitary pulmonary nodule (coin lesion):

A
  • Less than 1 cm, stable for 2 years

- Target/popcorn appearance

44
Q

Workup for coin lesion:

A
  • CT
  • Fine needle aspiration
  • PET scan
  • Sputum culture
  • Bronchoscopy
45
Q

Indications for wedge resection:

A
  • Secondary lung cancers except solitary SCC or adenocarcinoma
  • Benign neoplasms such as hamartomas and fibromas
46
Q

Treatment for non small cell lung cancer:

A

Lobectomy, radiation and chemo

47
Q

Mnemonic for acute coronary syndrome treatment:

A

MONA = morphine, O2, Nitroglycerin, ASA

48
Q

Presurgical medical interventions for aortic dissection:

A

Esmolol (beta blocker) and nitroprusside

49
Q

Surgical management of ruptured spleen:

A

Splenectomy

50
Q

Imaging for suspected splenic rupture:

A

FAST or CT if stable

51
Q

Workup for perforated bowel:

A
  • 3 view x ray or CT for suspected duodenal perf

- Blood and urine cultures

52
Q

Surgical mgmt of cholecystitis, cholangitis

A
  • Laparoscopic cholecystectomy then abx

- Cholangitis is surgical emergency with ERCP

53
Q

Imaging for diverticulosis/diverticulitis:

A
  • Barium enema x ray for diverticulosis

- CT for diverticulitis

54
Q

Management of diverticulitis:

A
  • IV abx, surgical resection, drainage of abscesses
55
Q

Evisceration:

A
  • Usually occurs 5 - 8 days post op
  • Return to OR, rinse peritoneal cavity with LR
  • Abx
56
Q

Time frame for fat embolism:

A

12 - 72 hours post op

57
Q

Time frame for ileus:

A
  • Peristalsis usually returns after about 72 hours

- During this time fecal impaction likely

58
Q

Time frame for urinary retention:

A

4 - 5 days post op

59
Q

Most common cause of fever after third day post op:

A

Phlebitis

60
Q

Timeline for post surgical wound infection:

A

5 - 10 days

61
Q

Most common pathogen in furuncle/carbuncle:

A

Staph

62
Q

Most common pathogen in cellulitis:

A

Group A strep

63
Q

Drugs to use for cellulitis:

A

Dicloxicillin (Bactrim if staph), IV PCN for strep, Nafcillin or Vanco for staph.

64
Q

Treatment for gas gangrene:

A

IV PCN, clindamycin may be useful to reduce production of toxins

65
Q

Timeline for post op pneumonia:

A

24 - 96 hours

Emergency and Surgical Medicine (2 decks)

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