Em - 300-400

Front 1

What labs tro draw for suspected CO poisoning?

Back 1

COHb levels - Co-oximetry, electrolytes, renal function, lactate, ECG and cardiac enzynes, CPK - maybe CXR and Head CT if AMS

Front 2

Indications for hyperbaric O2?

Back 2

pregnant women , MI, seizure, AMS, syncope

Front 3

Half life of CO? with 100% O2? with hyperbaric chamber?

Back 3

4-6 hrs; 90 mins; 23 mins

Front 4

When can you discharge CO poisoned pt

Back 4

no endorgan failure and CO level <5%

Front 5

Why might pregnant women need hyperbaric O2 with CO expsure even if her levels are low?

Back 5

HgF has much more affinity for CO and may be CO poisened

Front 6

Milks, moderate and severe hypothermia defined as?

Back 6

35-32; 32-30; <30

Front 7

At what point do hypothermic pts stop shivering?

Back 7

below 32, mod hypothermia

Front 8

Pathognomonic EKG findgin for med-sever hypothermia?

Back 8

Osborn J wave; wide upward deflection at end of QRS; looks lik WPW syndrome with delta on the other side of QRS complex

Front 9

When to admit hypothermic pt?

Back 9

serious comorbid, med-severe hypothermia, any with MI or undergo active internal warming.

Front 10

Final stages of severe hypothermia involve what physiologic changes?

Back 10

fatal increase in blood viscosity.

Front 11

How does the body respond to heat stress?

Back 11

increased sweating, decreased internal heat production, removal from hot environment; mainly evaporation of sweat being the best cooling mechanism

Front 12

Heat exhaustion vs heat stroke?

Back 12

exhaustion can have normal - T104, malaise, nv, but with NO AMS; stroke means you are above 103 with AMS

Front 13

Psych pt with signs of heat stroke; what to rule out?

Back 13

NMS or serotonin syndrome

Front 14

Lab studies important to heat stroke workup? imaging?

Back 14

DIC, coags, CPK, liver enzymes, renal function, lytes; CT head and EKG

Front 15

what to expect on CT with heat stroke? CO poisoning?

Back 15

normal; increased globus pallidus densities

Front 16

treatment of heat exhaustion and stroke?

Back 16

rehydrate; replete lytes, SPRAY AND FAN; pyrolytics are ineffective because hypothalamus is OK

Front 17

Na correction for hyperglycemia?

Back 17

add 1.6 per 100 over 100 mg/dL

Front 18

Why would urine ketones be positive despite good DKA tx?

Back 18

it also detects acetone and acetoacetate ; B-hydroxybuterate shifts to that...

Front 19

Fluid replacement in DKA?

Back 19

fluids (.9NS 1L; then D5; .45NS; then .45NS w d5W after glucose is <250

insulin drip until pH 7.3 and anion gap closed, potassium, Mg

Front 20

Fluid replacement in HHS DM?

Back 20

.9NS for 1L, then .45NS at 200-500ml/hr with goal of 3-4L over 4 hrs.
insulin drop and potassium/Mg repletion

Front 21

Dispo for hyperglycemic patients?

Back 21

admit if DKA and HHS; ICU if HHS or ph<7 in DKA or AMS...
dc if hyperglycemia uncontrolled withoug HHS or DKA

Front 22

Treatment of yperkalemia?

Back 22

cardiac monitor, calcium, insulin, albuterol neb, NaHCO3, furosemide;; MAYBe kexlate

Front 23

most feared complication of hperkalemia?

Back 23

cardiac arrythmia

Front 24

Diagnosis of thyroid storm and myxedema coma?

Back 24

CLINICA

Front 25

Tx thyrotoxicosis?

Back 25

PTU then iodine; B-blocker

Front 26

throid storem bs throtoxicosis?

Back 26

storm means you ahve tach and probs febrile... acute on chronic throtoxicosis

Front 27

Tx thyroid storm?

Back 27

PTU, iodine 1 hr after, dexamethasone, B-blocker, supportive care.

Front 28

Tx of myxedema coma?

Back 28

levo, IV, rewarm, dexamethasone, tx precipitating factor.

Front 29

Dispo for thyroid dz pts?

Back 29

ICU if myxedematous or thyroid storm.; admission with comorbids

Front 30

Tx of hypercalcemia?

Back 30

IVfluids and furosemide

Front 31

Tx of tumor lysis syndrome?

Back 31

IV, loop diuretics, allopurinol +/- hemodialysis

Front 32

Tx of neutropenic fever?

Back 32

ceftazidime 2g IV; possibly vancomycin

Front 33

Tx of SVC syndrome?

Back 33

IV steroids and furosemide to reduce venous pressure

Front 34

Pts with sickling crisis, how to manage?

Back 34

IV, pain, imaging as necessary to determine ACS, stroke, etc priapism

Front 35

Onset of HIT is at what day?

Back 35

5-12 days after onset of therapy; same w coumadin skin necrosis; 3-10 days after

Front 36

How to treat suprapublic warfarin?

Back 36

hold if <9 and recheck INR in 24 hrs; INR>9 Vitamin K PO; if BLEEDING, vitamin K and FFP

Front 37

How to treat bleeding from heparin?

Back 37

protamine

Front 38

What is Seidel's sign?

Back 38

fluorescien seen draining from site of injury; sugggesting full thickness corenal injury with aqueous leakage

Front 39

How to distinguish between corenal abraision and uveitis?

Back 39

lack of relief with tetracaine

Front 40

MCC of corneal ulcer?

Back 40

HSV

Front 41

gritty foreign body sensation and discharge in eye?

Back 41

conjunctivitis

Front 42

photophobia, tearing?

Back 42

corneal abraision or acute uveitis

Front 43

causes of acute uveitis?

Back 43

Reiters, ankylosing spondylitis, IBD, TB/sarcoid

Front 44

What is hypophyon?

Back 44

layer of white cellular debris due to eye infection and accumulation of proteins and shit.

Front 45

ulceration of HSV v herpes zoster opthalmicus?

Back 45

brnaching dendritic ulcer vs spaghetti lesion

Front 46

What is hutchinson's sign?

Back 46

lesions of herpes zoster opthalmicus at tip of nose, indicating V1 involvement

Front 47

Tx of subconjunctival hemorrhage?

Back 47

assurance, 2 weeks it will heal

Front 48

tx of corneal abraision?

Back 48

pain control and antibiotics for infxn prophylaxis

Front 49

tx of anterior eveitis?

Back 49

consult, homatropine for cycloplegia and prednisone to decrease inflamatin

Front 50

When to admit pts w e problems?

Back 50

if bacterial conunctivitis due to gonorrhea

Front 51

how to address vision loss?

Back 51

painful vs painless

Front 52

symptoms of retinal detachment?

Back 52

flashing lights, spider webs, coal dust specks and floater

Front 53

symptoms of acute angle closure glaucoma?

Back 53

cloudy vision w haloed lights

Front 54

Symptoms with optic neuritis?

Back 54

pain with eye movement; red desturation

Front 55

Tx of central retinal artery occlusion?

Back 55

dilate artery and reduce intraocular BP: digital massage for 15 mins, hyperventilation into a bag, acetazolamide and B-blocker ( timolol)

Front 56

Goal of tx of epistasis?

Back 56

anterior vs posterior bleed? kiesselbach's plexus vs sphenopalatine artery bleed.

Front 57

How to test if nosebleed is anterior vs posterior?

Back 57

if trickling down oropharanx occurs with anterior pressure

Front 58

Tx for suspected anterior bleed?

Back 58

holding for 10 mins w pressure, apply bacitracin to anterior nares and dc with followup; may use silvernitrate or cocaine -- abx for prophylaxis

Front 59

How to stop posterior nosebleed?

Back 59

attempt to tamponade with foley or balloon device; consult ENT, \abx and ADMIT. ADMIT ALL POSTERIOR BLEEDS

Front 60

Any patient who requires nasal packing must be given?

Back 60

antibiotics to prevent TSS/sinusitis, 2 days followup to remove packing.

Front 61

Posterior epistasis requires?

Back 61

it is EMERGENCY needing ENT consult and admission

Front 62

What is Ludwig's angina?

Back 62

infection of floor of moth involving sublingual submental and submandibular spaces bilaterally.

Front 63

Pt presenting with trismus. What to consider?

Back 63

aside from tetanus which would be bilat; masticator space abscess; most commonly due to infection of 3rd molar.

Front 64

Canine vs buccal space abscess...

Back 64

Canine is anterior, Buccal more lateral.

Front 65

Ellis teeth fractures classfied by?

Back 65

1,2,3 based upon enamel vs enamel+dentin vs enameldentinpulp exposure. Presenting complaints are jagged edge vs temp sensitivity vs extreme pain

Front 66

Most important hx for tooth evulsion?

Back 66

time out of socket. good prognosis for <20 mins.

Front 67

How to clinically exclude a mandible fracture?

Back 67

tongue blade tests: bite down, try to rotate blade and break it.

Front 68

Tx of odontogenic infection?

Back 68

oral surgeon of drainage + IV antibiotics.

Front 69

Tx for avulsed tooth?

Back 69

rise w saline, replace, bite on gauze; abx, tetanus, and immediate followup for tooth stabilization.

Front 70

Tx for narcatoic overdose?

Back 70

naloxone

Front 71

Tx for narcatoic overdose?

Back 71

naloxone

Front 72

tx for seizures?

Back 72

loraxepam then pheny loading

Front 73

tx for seizures?

Back 73

loraxepam then pheny loading

Front 74

tx fpr hepatic encephalopathy?

Back 74

lactulose

Front 75

tx fpr hepatic encephalopathy?

Back 75

lactulose

Front 76

tx for hypertensive encephalopathy?

Back 76

reduce MAP by 25%

Front 77

Tx for narcatoic overdose?

Back 77

naloxone

Front 78

tx for hypertensive encephalopathy?

Back 78

reduce MAP by 25%

Front 79

tx of SAH?

Back 79

emergent neurosurg consult and nimodipine 60mg PO to prevent vasospasm

Front 80

tx for seizures?

Back 80

loraxepam then pheny loading

Front 81

tx of SAH?

Back 81

emergent neurosurg consult and nimodipine 60mg PO to prevent vasospasm

Front 82

tx fpr hepatic encephalopathy?

Back 82

lactulose

Front 83

tx for hypertensive encephalopathy?

Back 83

reduce MAP by 25%

Front 84

tx of SAH?

Back 84

emergent neurosurg consult and nimodipine 60mg PO to prevent vasospasm

Front 85

tx for benign headache?

Back 85

oral pain meds, IV aniemetics, decreased stimuli.

Front 86

Tx for pseudotumor cerebri?

Back 86

remove 20mL CSF and acetaxolamide/ steroids

Front 87

N/V, horizontal nystagmus, worse with head movement implies what kind of vertigo?

Back 87

peripheral. Central usually with no N/V, with vertical nystag, look for ataxia and focal neuro deficits.

Front 88

What is most emergent when eval a pt with vertigo?

Back 88

cerebellar hemorrhage r/o with central vertigo.

Front 89

Dispo of pt with vertigo?

Back 89

ENT if peripheral with vestibular suppressant therapy, head CT and admission if central.