A4 Em 4 Heent Emergencies

Front 1

What is the triad of hypertensive encephalopathy?

Back 1

severe HTN
altered mental status
papilledema

Front 2

What confirms the dx of hypertensive encephalopathy?

Back 2

if sx resolve when BP is lowered

Front 3

What is the pathophysiology of hypertensive encephalopathy?

Back 3

htn overwhelms brain's ability to autoregulate; cerebral edema

Front 4

What is treatment of hypertensive encephalopathy?

Back 4

lower MAP 20% in 1-2 hours, similar to hypertensive emergency

Front 5

What is the diagnostic sign of papilledema?

Back 5

enlargement and blurred borders of optic disk; engorged vessels; Paton's lines radiating from optic disk

Front 6

What agents are used to lower BP in hypertensive encephalopathy?

Back 6

nitroprusside or labetalol, but NOT hydralazine or clonidine
(insufficiently predictable and titratable)

Front 7

In what % of TA pts is headache localized to temporal area?

Back 7

50%

Front 8

Normal intraocular pressure

Back 8

10-20 mm hg

Front 9

Meds for glaucoma

Back 9

timolol, acetazolamide - decrease aqeous formation

pilocarpine - increases aqueous outflow

mannitol, isosorbide, glycerin - reduce aqeuous volume

Front 10

Can migraines have focal neurological signs?

Back 10

yes

Front 11

cluster headaches affect ? percent of population

Back 11

0.1 % - uncommon

mostly men, middle aged

Front 12

Cluster headaches usually occur during the [day, night]

Back 12

night

Front 13

what percent of migraines are bilateral?

Back 13

40%

Front 14

Cluster headaches usually occur during what seasons?

Back 14

spring and fall

Front 15

Usual upper limit of duration of cluster headache

Back 15

3 hours

Front 16

What are related symptoms of cluster headaches?

Back 16

lacrimation, nasal congestion, ptosis (30%), miosis (50%)

patients more likely to be agitated, whereas migraine pt will be lying in the dark immobile

seldom any family history with cluster headaches, unlike migraines

Front 17

What meds besides O2 for cluster headaches?

Back 17

imitrex, DHE
verapamil 80 mg TID at discharge, if no contraindications
steroid taper

Front 18

Main three diagnoses not to miss with headache

Back 18

1. Meningitis
2. Subarachnoid hemorrhage

3. CARBON MONOXIDE POISONING

Front 19

What in history / exam is suggestive of carbon monoxide poisoning?

Back 19

Other family members with "flu" and headache, N/V but no URI symptoms on exam
often in fall when heaters come on

Front 20

What is sensitivity of rapid strep?

Back 20

65-80%

Front 21

If patient is allergic to amoxicillin/penicillin, what alternative can be given for strep throat?

Back 21

cephalosporins
azithromycin
clindamycin

Front 22

triad of mono

Back 22

fever
LAD
pharyngitis

Front 23

What does CBC show with mono

Back 23

lymphocytosis (40-75% of pts)

Front 24

How many mono pts test positive with monospot test in first week?

third week?

Back 24

30%

85-90%

but very young and very old may have false negative

Front 25

What is tx of mono?

Back 25

supportive care
steroids if severe;
steroids will not stop splenic rupture

Front 26

Complications with mono (7-8)

Back 26

Bell's palsy
autoimmune hemolytic anemia
thrombocytopenia
GUILLAIN-BARRE
encephalitis
SPLENIC RUPTURE

elevated liver enzymes
airway compromise

Front 27

uvular deviation
unilateral pharyngeal swelling
suggestive of?

Back 27

peritonsillar abscess

Front 28

tx of peritonsillar abscess

Back 28

needle aspiration or I&D
abx: penicillin; clindamycin, unasyn
IV fluids if pt cannot eat or drink

Front 29

What is visible on oral exam in epiglottitis?

Back 29

nothing, usually

Front 30

What is tx for epiglottitis?

Back 30

admission for IV abx and monitoring
Unasyn
Cefotaxime
ceftriaxone
steroids, though little evidence for them