Er Med-Test

Front 1

The acute intervention necessary for successful outcome requires a close cooperative team effort involving the emergency physician, gastroenterologist, interventional radiologist and the surgeon
T or F

Back 1

T

Front 2

Medications such as _________ and certain _________ can blunt the normal physiologic tachacardic response to the hypovolemia that occurs with bleeding

Back 2

beta blockers
calcium channel blockers

Front 3

Hematemesis is when blood is lost from the _______ tract accumulating in the stomach RAPIDLY the associated emesis is red blood

Back 3

upper GI

Front 4

coffee ground emisis is the result of SLOWER _______ bleeding or stagnation of blood secondary to the presence of partially digested blood

Back 4

upper GI

Front 5

Hematochezia is the passage of bright red blood in the patients stool or per rectum without stool. This represents the presence of _______ GI Hemorrhage in 90% of cases.

Back 5

lower

Front 6

Melena is black tarry stool, which results from bacterial degradation of hemoglobin to various hemochromes during its transit time through the small and large intestines is in most cases a sign of ______ GI hemorrhage.

Back 6

upper

Front 7

The presence of only approximately ________ of blood is necessary to cause melena[test]

Back 7

50-100cc

Front 8

Upper GI Hemorrhage(75%) is bleeding occurring proximal to the _______. In the nonvariceal category peptic ulcer disease represents the most frequent etiology.

Back 8

ligament of Trietz

Front 9

Lower GI Hemorrhage(25%) is bleeding occurring _____ to the ligament of Trietz (distsl duodenum)

Back 9

distal

Front 10

Three major questions have to be answered regarding the patient presenting to the Emergency Department with GI Hemorrhage.

Back 10

Has the patient actually had a GI Hemorrhage?
Does it originate from the upper or lower tract?
If it is an upper GI Hemorrhage, is it variceal or nonvariceal?

Front 11

If there is doubt about the origin of blood passed per rectum check the ______ GI tract first, this is more likely to be catastrophic

Back 11

upper

Front 12

Esophageal varices are almost always associated with the clinical features of underlying________

Back 12

liver disease

Front 13

________ and ________are more common in the older population

Back 13

Diverticular hemorrhage ischemic colitis

Front 14

_________ and _______ occur more frequently in younger patients

Back 14

Peptic ulcer disease esophagitis

Front 15

Bleeding from a Meckel’s diverticuli occur more frequently in patients under ___ years of age

Back 15

30

Front 16

History of epigastric pain for some time that is transiently relieved by food ingestion would strongly suggest __________

Back 16

duodenal peptic ulcer disease

Front 17

If the patient has a history of prior AAA repair suspicion of __________ should be present

Back 17

aortoenteric fistula

Front 18

If there is a history of previous retching episodes followed by subsequent upper GI bleeding think _________ tear

Back 18

Mallory-Weiss

Front 19

The most frequent etiologies in these renal patients are _________ and angiodysplasia

Back 19

peptic ulcer disease

Front 20

History of decrease in appetite with weight loss and change in bowel habits should arouse suspicion of underlying gastrointestinal ___________

Back 20

malignancy

Front 21

In the Catastrophic GI Hemorrhage, even if the pulse oximeter reading is normal you should do this

Back 21

place pt on supplemental oxygen to maximize tissue oxygenation

Front 22

Intravenous volume In the Catastrophic GI Hemorrhage, resuscitation should be initiated immediately with ____________

Back 22

crystalloids(NS or LR)-no dextrose

Front 23

The patient who continues to demonstrate hemodynamic instability after receiving an infusion of 2-3 liters of crystalloid should be considered for ________

Back 23

transfusion

Front 24

__________ blood should be used when transfusion is immediately indicated and type specific or type and crossmatched blood is not available

Back 24

O negative

Front 25

In the Catastrophic GI Hemorrhage, __________ should be performed after each fluid bolus

Back 25

vital signs and clinical status

Front 26

In the Catastrophic GI Hemorrhage, Foley catheter to monitor urinary output and therefore indirectly __________

Back 26

renal perfusion

Front 27

Remember that the initial _____ obtained maybe normal even in the face of severe hypovolemic shock

Back 27

Hgb

Front 28

More severe shock =

Back 28

higher mortality rate

Front 29

In many patients _______ is a late manifestation of shock and may not manifest until 30% of blood volume is lost

Back 29

hypotension

Front 30

The earliest detectable sign of shock is the presence of ________

Back 30

tachycardia

Front 31

Esophageal varicies (is or is not) a contraindication to use of an NG tube

Back 31

is not

Front 32

A BUN-creatinine ratio found to be equal to or greater than 36 in the absence of renal failure is highly suggestive of an _______ GI Bleed

Back 32

upper

Front 33

For the Catastrophic GI Hemorrhage, _________ have recently been shown in two well designed randomized double blind placebo controlled studies to produce improvement of outcome

Back 33

Continuous infusion of Proton Pump Inhibitors(PPI)

Front 34

_________ can be used in the catastrophic GI bleed as an adjunct to reduce bleeding in nonvariceal bleeds

Back 34

Octreotide

Front 35

Commonly used endoscopic treatment of esophageal verices

Back 35

– variceal ligation – elastic band strangulation of varix

Front 36

Pharmacologic therapy of Esophageal Varicies

Back 36

Octreotide

Front 37

Temporizing device to control hemorrhage in the face of a failure of octreotide and no immediate access to endoscopy or failure of endoscopy

Back 37

Gastroesophageal Balloon Tamponade Devices

Front 38

a. Stab wounds of the abdomen occur most commonly in the ___________

Back 38

upper quadrants
with the left > right.(TEST)

Front 39

Anterior stab wounds penetrate the peritoneum ____ of the time but inflect a visceral injury less than ____ of the time.(TEST

Back 39

70%
30%

Front 40

Abdominal entries from the flank and back penetrate the peritoneum up to ___ and ____ respectively.

Back 40

44%
14%

Front 41

The most commonly injured organs are the ____ and ____.

Back 41

liver
spleen

Front 42

_______ is most important factor in tissue injury

Back 42

velocity

Front 43

Shotgun Wound Classification:
Type 1 wounds

Back 43

tissue and deep fascia only

Front 44

_________ occurs 65% of the time in documented visceral injuries.

Back 44

Decreased or absent bowel sounds

Front 45

radiologic technique useful for detecting free fluid-hemoperitoneum.

Back 45

Ultrasound