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503 Cards in this Set

  • Front
  • Back
Q001. ACEIs; Toxicity
A001. Cough; rash; proteinuria; angioedema; taste changes; teratogenic effects
Q002. Amantadine; Toxicity
A002. Ataxia; livedo reticularis
Q003. Aminoglycosides; Toxicity
A003. Ototoxicity; nephrotoxicity - ATN
Q004. Amiodarone; Toxicity
A004. Pulmonary fibrosis; peripheral deposition => bluish discoloration,; arrhythmias,; hypo-/hyperthyroidism,; corneal deposition
Q005. Amphotericin; Toxicity
A005. Fever/chills; nephrotoxicity; bone marrow suppression; anemia
Q006. Antipsychotics; Toxicity
A006. Sedation; acute dystonic reaction; akathisia; parkinsonism; tardive dyskinesia; neuroleptic malignant syndrome
Q007. Azoles (e.g., fluconazole); Toxicity
A007. Inhibition of P-450 enzymes
Q008. AZT; Toxicity
A008. Thrombocytopenia; megaloblastic anemia
Q009. β-blockers; Toxicity
A009. Asthma exacerbation; masking of hypoglycemia; impotence
Q010. Benzodiazepines; Toxicity
A010. Sedation; dependence; respiratory depression
Q011. Bile acid resins; Toxicity
A011. GI upset; malabsorption of vitamins; and medications
Q012. Calcium channel blockers; Toxicity
A012. Peripheral edema; constipation; cardiac depression
Q013. Carbamazepine; Toxicity
A013. Induction of P-450 enzymes; agranulocytosis; aplastic anemia
Q014. Chloramphenicol; Toxicity
A014. Gray baby syndrome; aplastic anemia
Q015. Cisplatin; Toxicity
A015. Nephrotoxicity; acoustic nerve damage
Q016. Clonidine; Toxicity
A016. Dry mouth; severe rebound headache; hypertension
Q017. Clozapine
A017. Agranulocytosis
Q018. Corticosteroids; Toxicity
A018. Mania (acute) immunosuppression; bone mineral loss; thinning of skin; easy bruising; myopathy (chronic); cataracts
Q019. Cyclophosphamide; Toxicity
A019. Myelosuppression; hemorrhagic cystitis
Q020. Digoxin -; Toxicity
A020. GI disturbance; yellow-green visual changes; arrhythmias - junctional tachycardia or SVT,; varying amounts of AV node blocks
Q021. Doxorubicin -; Toxicity
A021. Cardiotoxicity; (dilated cardiomyopathy)
Q022. Ethyl alcohol -; Toxicity
A022. Renal dysfunction
Q023. Fluoroquinolones; Toxicity
A023. Cartilage damage in children Achilles tendon rupture
Q024. Furosemide; Toxicity
A024. Ototoxicity; hypokalemia; nephritis
Q025. Gemfibrozil; Toxicity
A025. Myositis; reversible ↑ in LFTs
Q026. Halothane; Toxicity
A026. Hepatotoxicity; malignant hyperthermia
Q027. HCTZ; Toxicity
A027. Hypokalemia; hyperuricemia; hyperglycemia
Q028. HMG-CoA reductase inhibitors; Toxicity
A028. Myositis; reversible ↑ in LFTs
Q029. Hydralazine; Toxicity
A029. Drug-induced SLE
Q030. Hydroxychloroquine; Toxicity
A030. Retinopathy
Q031. INH -; Toxicity
A031. Peripheral neuropathy - prevent with vitamin B6; hepatotoxicity; inhibition of P-450 enzymes; seizures with overdose
Q032. MAOIs -; Toxicity
A032. Hypertensive tyramine reaction; serotonin syndrome - with meperidine
Q033. Methanol; Toxicity
A033. Blindness
Q034. Methotrexate; Toxicity
A034. Hepatic fibrosis; pneumonitis; anemia
Q035. Methyldopa; Toxicity
A035. Pos. Coombs’ test; drug-induced SLE
Q036. Metronidazole; Toxicity
A036. Disulfiram reaction; vestibular dysfunction; metallic taste
Q037. Niacin; Toxicity
A037. Cutaneous flushing
Q038. Nitroglycerin; Toxicity
A038. Hypotension; tachycardia; headache; tolerance
Q039. Penicillin/β-lactams ; Toxicity
A039. Hypersensitivity reactions
Q040. Penicillamine; Toxicity
A040. Drug-induced SLE
Q041. Phenytoin; Toxicity
A041. Nystagmus; diplopia; ataxia; gingival hyperplasia; hirsutism
Q042. Prazosin -; Toxicity
A042. First-dose hypotension
Q043. Procainamide; Toxicity
A043. Drug-induced SLE
Q044. Propylthiouracil; Toxicity
A044. Agranulocytosis
Q045. Quinidine; Toxicity
A045. Cinchonism -; (headache, tinnitus); thrombocytopenia; arrhythmias - torsades de pointes
Q046. Reserpine; Toxicity
A046. Depression
Q047. Rifampin; Toxicity
A047. Induction of P-450 enzymes; orange-red body secretions
Q048. Salicylates; Toxicity
A048. Fever; hyperventilation with; respiratory alkalosis; and metabolic acidosis; dehydration; diaphoresis; hemorrhagic gastritis
Q049. SSRIs; Toxicity
A049. Anxiety; sexual dysfunction
Q050. Succinylcholine; Toxicity
A050. Malignant hyperthermia
Q051. Tetracyclines; Toxicity
A051. Tooth discoloration; photosensitivity; Fanconi’s syndrome
Q052. TCAs; Toxicity
A052. Sedation; coma; anticholinergic effects; seizures; wide QRS; in severe cases - prolonged QT => torsade
Q053. Valproic acid; Toxicity
A053. Teratogenicity => neural tube defects
Q054. Vancomycin; Toxicity
A054. Nephrotoxicity; ototoxicity; “red man syndrome” - histamine release, not an allergy
Q055. Vinblastine; Toxicity
A055. Severe myelosuppression
Q056. Vincristine; Toxicity
A056. Peripheral neuropathy
Q057. Acetaminophen; What is the Antidote
A057. N-acetylcysteine
Q058. Acid/alkali ingestion; What is the Antidote
A058. Upper endoscopy to evaluate for stricture
Q059. Anticholinesterases,; organophosphates; What is the Antidote
A059. Atropine; pralidoxime
Q060. Antimuscarinic/; anticholinergic agents; What is the Antidote
A060. Physostigmine
Q061. Arsenic, mercury, gold; What is the Antidote
A061. Succimer; dimercaprol
Q062. β-blockers; What is the Antidote
A062. Glucagon
Q063. Barbiturates (phenobarbital); What is the Antidote
A063. Urine alkalinization (bicarb); dialysis; activated charcoal
Q064. Benzodiazepines; What is the Antidote
A064. Flumazenil
Q065. Black widow bite -; What is the Antidote
A065. Calcium gluconate
Q066. Carbon monoxide -; What is the Antidote
A066. 100% O2; hyperbaric O2
Q067. Copper, arsenic, lead, gold -; What is the Antidote
A067. Penicillamine
Q068. Cyanide -; What is the Antidote
A068. Nitrite; sodium thiosulfate
Q069. Digitalis -; What is the Antidote
A069. Stop digitalis,; normalize K+,; lidocaine (for torsades), anti-digitalis Fab
Q070. Heparin -; What is the Antidote
A070. Protamine sulfate
Q071. Iron salts -; What is the Antidote
A071. Deferoxamine
Q072. Lead -; What is the Antidote
A072. Succimer; CaEDTA; dimercaprol
Q073. Methanol, ethylene glycol (antifreeze); What is the Antidote
A073. EtOH; fomepizole; dialysis
Q074. Methemoglobin; What is the Antidote
A074. Methylene blue
Q075. Opioids; What is the Antidote
A075. Naloxone
Q076. Phencyclidine hydrochloride (PCP); What is the Antidote
A076. NG suction
Q077. Salicylates -; What is the Antidote
A077. Urine alkalinization; dialysis; activated charcoal
Q078. TCAs; What is the Antidote
A078. Na bicarb - QRS prolongation; diazepam or lorazepam for Seizures; cardiac monitor for; arrhythmias
Q079. Theophylline; What is the Antidote
A079. Activated charcoal
Q080. tPA, streptokinase; What is the Antidote
A080. Aminocaproic acid
Q081. Warfarin; What is the Antidote
A081. Vitamin K, FFP
Q082. Cardiac Life Support; What are the Basic Principles
A082. Check if responsive; call for help; Patient on firm, flat surface ABCs; Airway open?; Breathing?; CPR; IV meds before intubate; CPR if alone - 2 breaths, check pulse - carotid or femoral, 15 compressions; CPR if have help - 2 breaths, 5 compressions
Q083. Burns; Hx/PE
A083. 2nd leading cause of death in kids; don't underestimate degree of nonvisible deep destruction- esp. with electrical burns thorough airway & lung exam; respiratory burn - patient may need early intubation before edema sets in
Q084. Burns; Dx; Rule of 9's
A084. ABCs; aware of possible – shock, inhalation injury, CO poisoning; evaluate % of BSA involved rule of 9's; BSA (Body Surface Area); head = 18%; front = 18%; back = 18%; each arm = 9%; each leg = 18%
Q085. Burns; Categories
A085. 1st degree - epidermis involved, area painful, no blisters, capillary refill intact; 2nd degree - epidermis & superficial dermis, area painful, blisters; 3rd degree - epidermis & dermis, area painless, white & charred
Q086. Burns; Tx
A086. Treatment supportive; freq. dressing changes; rehydrate; topical silver sulfadiazine and mafenide; circumferential burns - at risk for compartment syn, need early escharotomy; early skin graft - prevent contractures; fluid req. - in 1st 24 hrs. - BSA x wt(kg) x 4cc, give 1/2 in 1st 8 hrs, 1/4 in next 8 hrs, 1/4 in last 8 hrs; 1st choice - lactate ringers; 2nd choice - NS (0.9%); hydrate enough to maintain urine output at least 1cc/kg/hr
Q087. Burns; Complications
A087. Shock; superinfection - esp. Pseudomonas
Q088. CO Poisoning; What is it
A088. Hypoxemic poisoning syn causes; car exhaust; smoke inhalation; barbeque in poor ventilation; old appliances
Q089. CO Poisoning; HX/PE
A089. Cherry-red skin; confusion; headaches; if severe – coma, seizures chronic low-level exposure; flu-like Sxs; suspect smoke inhalation in - singed nose hairs; facial burns; hoarseness; wheezing; carbonaceous sputum
Q090. CO Poisoning; Dx
A090. ABG; normal serum carboxyHb level - < 5% in nonsmokers, < 10% in smokers; laryngoscopy; bronchoscopy; EKG - elderly; history of cardiac dis.
Q091. CO Poisoning; Tx
A091. 100 O2 hyperbaric O2:; pregnant; neuro Sxs; severely ↑ carboxyHb; smoke inhalation - may need early intubation (before edema sets in)
Q092. Aortic Disruption; What is it
A092. Rapid deceleration injury most common causes; high speed MVAs; fall from great heights; ejection from vehicles complete; rapidly fatal; usually have contained hematoma within adventitia; laceration usually at lig. arteriosum
Q093. Aortic Disruption; Dx
A093. CXR immediately; wide mediastinum; loss of aortic knob; pleural cap; trachea deviation to right; left main stem bronchus depressed; aortography - gold standard; transesoph echo before OR; always suspect if sternal fractures or 1st & 2nd rib fractures
Q094. Aortic Disruption; Tx
A094. OR emergently
Q095. Aortic Dissection; What is it; Risk Factors
A095. Surging of blood through tear in aortic intima; seperation of intima & media => false lumen; Stanford type A: ascending aorta; type B: - desc. thoracic aorta (distal to lt. subclavian) risk factors:; HTN; trauma; coarctation of aorta; syphilis; pregnancy; Ehlers-Danlos; Marfan's
Q096. Aortic Dissection; Hx/PE
A096. Acute onset; severe tearing chest pain radiates to back => syncope, stroke, MI; asymm or decreased periph pulses; paraplegia; shock - as worsens; type A - aortic regurgitation with diastolic murmur
Q097. Aortic Dissection; Dx
A097. CXR; CT with IV contrast; transesoph echo or; MRI/MRA or; angiography - gold standard; EKG
Q098. Aortic Dissection; Tx
A098. Stabilize HBP or low HBP; IV nitrates; B blockers; goal - systolic < 120, HR < 70; type A - emergent surgery; type B - med management
Q099. Aortic Dissection; Complications
A099. MI; CHF; cardiac tamponade; postop hemorrhage; future dissection; future aneurysm; death
Q100. Postop Fever; What is it Caused By; (What are the 6 W's)
A100. Wind - atelectasis, pneumonia; Water - UTI; Wound - abscess; Walk- DVT; Wonderdrug - drug reaction; Wire - catheter
Q101. Postop Fever; How to Decrease Risk
A101. Incentive spirometry; short-term foley use; early ambulation; DVT prophylaxis; pre- & post-op ABx; fevers before POD3: probably not infectious unless Clostridium or B-hemolytic strep
Q102. Acute Abdomen; What is it
A102. Abdom Sxs so severe; surgery should be considered; primary Sx - acute abdom pain
Q103. Acute Abdomen; Hx/PE
A103. OPQRST: Onset, Precip factors, Quality, Radiation, Sxs, Temporal quality; Treatment modalities; full GYN Hx; LMP; STD Sxs; pelvic exam; pregnancy test - rule out PID, ectopic pregnancy,; ovarian torsion
Q104. Acute Abdomen; Character of Pain
A104. Sharp - parietal (peritoneal); dull, diffuse - visceral (organ); perforation - sudden onset of diffuse, severe pain; obstruction - acute onset of colicky; inflammation - gradual onset over 10-12 hrs, constant, ill- defined
Q105. Acute Abdomen; Dx
A105. Assess stability; emergent surgery & exploratory lap - peritoneal signs, impending shock, shock; if stable – PE, pelvic exam (women), CBC with diff, electrolytes, LFTs, amylase, lipase, urine B-hCG, UA, KUB, US; no contrast studies - if suspect complete LBO
Q106. Acute Abdomen; Tx
A106. Hemodynamically unstable - emergent exploratory lap; stable - expectant management; vitals; NPO; NG tube; IV fluids; serial abdom exams; serial labs; type & cross; Foley - monitor urine output; monitor fluid status
Q107. Appendicitis; What is it
A107. Always consider in patient with acute abdomen; MC - teens & 20's; causes - no. 1 - lumen obstructed by lymphoid tissue hyperplasia; no. 2 – fecalith, foreign body, tumor (carcinoid), parasite; obstruction => overdistention, increased pressure, ischemia & necrosis
Q108. Appendicitis; Hx/PE
A108. Dull, vague pain orig. at umbilicus, lasts 1-12 hrs. pain then followed by n/v, anorexia, ("hamburger sign"); may have mild fever; sharper pain => RLQ at McBurney's point, psoas sign, obturator sign, rovsing's sign; if perforated - pain decreased, peritoneal sigs will dev. atypical – elderly, kids, pregnant, retrocecal appendices
Q109. Appendicitis; Dx
A109. Clinical - if classic signs & Sxs, mild leukocytosis & left shift; UA - a few RBCs or WBCs; KUB – fecalith, loss of psoas shadow; US - rule out gyn abnorm; abdom CT - rule out abscesses
Q110. Appendicitis; Tx
A110. strong suspicion - immed open or lap appendectomy; 15-20% false pos. acceptable; if no appendicitis found - complete exploration of abdo; before surgery – NPO, IV fluids, ABx for anaerobes - 24 hrs. if perforation - cont. ABx until afebrile & WBC count normalizes, close wound by delayed primary closure on POD5; if abscess - broad-spectrum ABx, abscess percutaneously drained, elective appendectomy 6-8 wks
Q111. Appendicitis; Complications
A111. Risk of perforation & mortality increased with amt of time have appendicitis; (at 48 hrs - 75% risk)
Q112. Acute Management of Trauma Patient; "ABCDE"; What is "A"
A112. Airway - airway patency & adeq ventilation; take precedence over other Tx; conscious - nasal cannula or face mask; unconscious - chin lift or jaw thrust to reposition tongue; early intubation – apnea, decreased mental status, impending airway compromise, severe closed head injuries, failed bag mask ventilation; cricothyroidectomy - can't be intubated, signif maxillofacial trauma, keep cervical spine stable, never let this concern delay airway management
Q113. Acute Management of Trauma Patient; "ABCDE"; What is "B"
A113. Breathing 5 thoracic causes of immed. death must not be missed:; tension pneumothorax; cardiac tamponade; open pneumothorax; massive hemothorax; airway obstruction
Q114. Acute Management of Trauma Patient; "ABCDE"; What is "C"
A114. Circulation; 2 16-gauge IVs; fluid bolus of 1-2L (adults); vitals rechecked; replete fluid per fluid status; LR or NS - isotonic; replete 3:1 (fluid to blood)
Q115. Acute Management of Trauma Patient; "ABCDE"; What is "D"
A115. Disability; evaluate CNS dysfunction via Glasgow Coma Scale
Q116. Acute Management of Trauma Patient; "ABCDE"; What is "E"
A116. Extra; check temperature status; foley catheter - after rule out urethral injury; secondary survey - full exam; additional XRs - trauma series: AP chest, AP pelvis, AP/lat C-spine, T1
Q117. Pelvic Fractures; What are they
A117. MC after trauma such as a MVA; needs immediate attention by orthopedist; potentially life-threatening
Q118. Pelvic Fractures; Hx/PE
A118. ABCDE trauma survey; secondary survey - may reveal unstable pelvis; AP pelvic XR; when stable - CT; if hypotension & shock - hemorrhage likely; can be assoc with urethral injury - check for blood at urethral meatus; check high-riding, "ballotable" prostate; check for lack of prostate; retrograde urethrogram, rule out injury before Foley; serial H&H; never explore pelvic or retroperitoneal hematoma
Q119. Pelvic Fractures; Tx
A119. Embolize bleeding vessels; emergent external pelvic fixation; internal fixation if hemodynamically stable
Q120. acute dystonia
A120. involuntary muscle cont/spasm - torticollis, oculogyric crisis; Rx: anticholinergic (benztropine) or diphenhydramine; Prevent: prophylatic benztropine
Q121. akathisia
A121. subjective/objective restlessness; Rx: reduce neuroleptic, βblocker (propranolol), +/- benzos, anticholinergics
Q122. dyskinesia
A122. pseudoparkinsonism Rx:; anticholinergic (benztropine); or DA agonist (amantidine); reduce/stop neuroleptic or d/c
Q123. tardive dyskinesia
A123. stereotypic oral-facial movements; likely d/t DA receptor sensitization; 50% irreversible Rx:; reduce/stop neuroleptic or d/c or change drugs; giving anticholinergics or ↓neuroleptic may initially WORSEN TD
Q124. Neuroleptic Malignant syndrome
A124. fever; muscle rigidity; autonomic instability; clouded consciousness; ↑CPK, WBCs Rx:; stop neuroleptic; dantrolene/bromocriptine; IV fluids
Q125. Evolution of EPS
A125. 4 hours: acute dystonia; 4 days: akathisia; 4 weeks: akathisia; 4 months: tardive dyskinesia
Q126. EtOH withdrawal syndrome
A126. Mild withdrawal (6-24h from last drink): tremor, anxiety, N/V, insomnia; Major Withdrawal (10-72h): visual/auditory hallucinations, whole body tremor, vomiting, diaphoresis,↑BP; Withdrawl seizures - 6-48hrs; DTs - 2-7d, severe autonomic instability/hyperactivity (↑HR, BP), delerium, confusion, agitation, hallucinations, fever, positional nystagmus, death - mortality 15-20%
Q127. EtOH withdrawal Rx including DTs
A127. benzos* (DOC); haloperidol for hallucinations; clonidine, BBs for hyperadrenergic state; thiamine, folate, vitamens; replace lytes; IV fluids
Q128. Barbituate withdrawal
A128. anxiety; seizures; delerium; tremor; cardiac & respiratory depression; Rx: benzos
Q129. Benzodiazepine withdrawal
A129. rebound anxiety; seizures; tremor; instability; Rx: benzos
Q130. Cocaine/amphetamine withdrawal
A130. depression; hyperphagia; hypersomnolence; Rx: supportive, avoid BBs (results in excess uninhibited cardiac activation)
Q131. Opioid withdrawal
A131. anxiety; insomnina; flu-like symptoms*; sweating; piloerection; fever; rhinorrhea; stomach cramps; diarrhea; mydriasis; Rx: clonidine +/or buprenorphine for mod withdrawal, methadone for severe, naltrexone in pts drug-free for 7-10d
Q132. Aortic disruption CXR
A132. widened mediastinum; pleural cap; loss of aortic knob; deviation of trachea to R; depression of L main stem bronchus; Always suspect with R1-2#s; aortography - gold standard
Q133. Arrhythmia Rx:; asystole
A133. epi; atropine
Q134. Arrhythmia Rx:; Vfib
A134. desynchronized shock --> epi or vasopressin --> shock --> lido or amio --> shock --> procainamide or Mg
Q135. Arrhythmia Rx:; VTach
A135. if unstable/pulseless - desynchronized shock; if stable - lido or amio
Q136. Arrhythmia Rx:; PEA
A136. identify & Rx underlying; +/- epi +/or atropine
Q137. Arrhythmia Rx:; Afib/flutter
A137. if unstable shock at 100J; If stable, control rate (CCB, dig, BB); +/- rhythm conversion; anticoagulate
Q138. Arrhythmia Rx:; SVT
A138. Control rate; valsalva, carotid sinus massage, cold stimulation; adenosine (procainamide)
Q139. Arrhythmia Rx:; bradycardia
A139. if symptomatic consider atropine; if Mobitz II/AVB pace; Acutely, unstable - atropine/dopamine/dobutamine or transvenous pacing
Q140. hypovolemic shock
A140. ↓CO; ↓PCWP; ↑PVR
Q141. cardiogenic shock
A141. Causes:; tension PTX; cardiac tamponade; arrhythmia; structural hrt dz; MI; ↓CO; ↑PCWP; ↑PVR
Q142. Septic shock
A142. ↑CO; ↓PCWP; ↓PVR
Q143. anaphylactic shock
A143. ↑CO; ↓PCWP; ↓PVR
Q144. Rx for malignant HTN
A144. nitroprusside
Q145. test to rule out urethral injury
A145. retrograde cystourethrogram
Q146. Radiographic indications for Sx in pts with acute abd
A146. free air under diaphragm; extravasation of contrast; severe bowel distension; SOL; mesenteric occlusion (angiography)
Q147. Cannon a waves
A147. complete AVB
Q148. signs of neurogenic shock
A148. hypotension; bradycardia
Q149. Cushing's triad
A149. Signs of ↑ICP; HTN; bradycardia; abnormal respirations
Q150. Signs of air embolism
A150. pt with chest truma previously stable suddenly dies
Q151. Organims/Rx of strep pharyngitis
A151. Org: GAS, S. pneumo Rx:; Pen V; Amoxicillin; erythromycin
Q152. Organisms causing sinusitis
A152. S. pneumo; H. flu; M. catarrhalis; GAS; anaerobes; S. aureus
Q153. Rx for sinusitis
A153. 1st line – Amoxicillin (TMP-SMX if pen allergic); 2nd line - Amox/clav; 3rd line clarithromycin
Q154. Acute OM pathogens
A154. Viral; S. pneumo; H. flu; M. catarrhalis
Q155. The nasopharyngeal airway can be used in which types of patients?
A155. breathing semiconscious patients and when an oropharyngeal airway is technically challenging
Q156. Prolonged use of a bag valve can lead to..?
A156. Distention of the stomach increasing the chance of an aspiration event
Q157. What are the steps of successful intubation?
A157. 5P's Preparation, preoxygenation, pretreatment, paralysis, and placement
Q158. How do you prepare for successful intubation?
A158. IV access, monitors, suction, appropriate sized ET tube, and meds for rapid sequence intubation
Q159. What pretreatment may be necessary in small children prior to intubation and why?
A159. Atropine, to blunt the bradycardia induced by succinocholine
Q160. What pretreatment prior to intubation may be used in adults with reactive airway disease? What about in adults where there is a concern about increased ICP?
A160. Reactive airway disease - lidocaine 1.5mg/kg; Pancuronium 0.01mg/kg
Q161. What sedative agent is used prior to paralysis for intubation?
A161. Etomidate 0.3mg/kg
Q162. volar =?
A162. palmar
Q163. Physical Exam of emergency ortho...?
A163. ROM; Palpation for subtle deformities well beyond the area of subjective pain; Neurovascular assessment
Q164. Ulnar nerve palsy causes..?
A164. Claw hand
Q165. Inability to extend the knee could be caused by paralysis of which nerve?
A165. Femoral nerve
Q166. Early treatment of ortho emergencies?
A166. NSAIDs; RICE (rest ice compression elevation); NPO; Reduction of long bone deformities
Q167. Don't forget to give _____ for open fractures?
A167. Tetanus
Q168. In children with trauma to a joint, what is important to consider on imaging?
A168. Comparison to the opposite extremity - difficult to tell the difference between a fracture and an epiphyseal growth plate
Q169. Compartment syndrome defined?
A169. When the pressure in a compartment exceeds the arterial perfusion pressure
Q170. Most reliable sign of compartment syndrome?
A170. Paresthesia
Q171. ARDS, neuro involvement, and thrombocytopenia post- closed fractures in leg..?
A171. Fat embolism
Q172. If you land directly on your shoulder, and hit hurts to reach across your body, what is the injury?
A172. Acromioclavicular joint separation
Q173. when does Acromioclavicular joint separation require surgery?
A173. type iv or higher (when the clavicle is displaced into surrounding areas)
Q174. 96% of shoulder dislocations are...?
A174. Anterior shoulder dislocations
Q175. how does the patient with an Anterior shoulder dislocation appear?
A175. holding arm in slight abduction and external rotation
Q176. What is the most common fracture in Aneterior shoulder dislocations? what nerve should be tested?
A176. Hill-Sachs deformity - fracture of the posterolateral aspect of the humeral head; Test the axillary nerve
Q177. Posterior dislocations are caused by...? always associated with...?
A177. fall on outstretched hand, convulsive seizure. Associated with Hill Sachs deformity
Q178. Most common mechanism of acute rotator cuff tear? This injury impairs which movement?
A178. Forced abduction. Impairs arm abduction to 30 degrees
Q179. What important structures travel with the humerus?
A179. The deep brachial artery and the radial nerve
Q180. Who gets supracondylar fractures? how?
A180. Kids < 15. Falling backwards on an outstretched hand
Q181. Posterior fat pad sign indicates?
A181. In adults - radial head fracture; In kids - supracondylar fracture
Q182. What is fracture of the proximal 1/3 of the ulna with radial head dislocation called?
A182. Monteggia fracture
Q183. What is fracture of the distal 1/3 of radius with dislocation of the distal radioulnar joint called?
A183. Galeazzi
Q184. Causes of carpal tunnel?
A184. RA, hypothyroid, DM, collagen vascular diseases
Q185. Phalen's test?
A185. Fully flex the wrists for 60 seconds
Q186. Tinel's sign?
A186. Light tapping over the median nerve produces pain or paresthesias
Q187. Most common carpal injury..?; High risk of..?
A187. Fracture of the scaphoid. AVN
Q188. Smith's fracture?
A188. Like colles, but distal fragment is displaced in the volar direction
Q189. neurogenic shock?
A189. state of vasomotor instability resulting from impairment of the descending sympathetic pathways in the spinal cord, or just a loss of sympathetic tone
Q190. does spinal shock signify permanent spinal cord damage?
A190. often times no
Q191. anterior cord syndrome results in loss of which tracts?
A191. spinothalamic and corticospinal tract
Q192. Central cord syndrome can be caused by? Affects?
A192. Hyper-extension injuries. Nerves that cross over at that level
Q193. if a penetrating spinal injury is diagnosed, begin treatment with..?
A193. High dose methylprednisolone
Q194. if suspecting a c-spine fracture, what xrays should be ordered?
A194. lateral, AP, and odontoid view
Q195. C1 burst fracture is called? Caused by...?
A195. Jefferson fracture. Caused by axial loading - someone falls on their head, or something falls on their head
Q196. Odontoid fractures are caused by..?
A196. Flexion
Q197. Hangman's fracture?
A197. Fracture of both pedicles of C2 - hyperextension mechanism
Q198. Stable or unstable?; atlanto-occipital dislocation; burst fracture of C5 with intact ligaments... simple wedge fracture; odontoid fracture; flexion teardrop fracture; extension teardrop fracture
A198. atl - unstable; burst c5 - stable; simple wedge - stable; odontoid - unstable; flexion teardrop - unstable; extension teardrop - stable
Q199. flexion teardrop fracture is associated with...?
A199. tearing of the posterior complex
Q200. bilateral facet dislocation...? stable?
A200. flexion injury; subluxation of the dislocated vertebra; very unstable
Q201. Cullen's sign? Gray-Turner's sign?
A201. ecchymosis of the abdomen signifies late retroperitoneal hemorrhage; Gray-Turner's: same, but of the flanks
Q202. 12% of patients with hyperthyroidism will suffer...?
A202. Pathologic fracture
Q203. serious associated injuries are present in up to 95% of patients with a dislocated...?
A203. hip
Q204. a pt with a posterior hip dislocation holds the hip how?
A204. flexed, adducted, and internally rotated
Q205. most common ortho injury seen in the ED?
A205. knee - in particular, MCL (medial collateral ligament)
Q206. 50% of patients with ACL injury have a concomitant...?
A206. Meniscal tear
Q207. lachman's test?
A207. flex the knee to 30 degrees and pull anteriorly on the tibia
Q208. donahue's unhappy triad?
A208. ACL, MCL, and medial meniscus tear
Q209. Injury to the ________ occurs in 50% of knee dislocations...
A209. popliteal artery
Q210. injury to the tibial nerve causes...?
A210. inability to stand on tiptoes
Q211. which ankle fracture warrants a careful radiologic examination? of what specifically?
A211. medial malleolar fracture; proximal shaft of the fibula (Maisoneuve fracture)
Q212. 10% of calcaneal fractures are associated with...?
A212. lumbar fractures
Q213. when do you call for an ortho consult?
A213. compartment syndrome; irreducible fractures; circulatory compromise; open fracture; anything that requires surgery
Q214. what is the most frequent complication of orotracheal intubation?
A214. Right main stem bronchus intubation
Q215. Patients with COPD, asthma, or CHF that are awake but cannot remain in the supine position may be intubated how...?
A215. Nasotracheal intubation
Q216. Most serious complication of nasotracheal intubation?
A216. Intracranial passage of the tube
Q217. advance airway adjuncts?
A217. fiberoptic intubation; retrograde intubation; combitube; laryngeal mask airway
Q218. What is the preferred surgical airway for kids? Adults?
A218. Kids - needle cricothyroidotomy; Adults - surgical cricothyroidotomy
Q219. if an airway will be needed for greater than 2-3 days, a surgical cricothyoidotomy should be converted to...?
A219. a tracheostomy
Q220. slit lamp exam consists of...?
A220. evaluate the integrity of the cornea, conjunctiva, and the anterior chamber; fluorescein to light up corneal defects
Q221. central retinal artery occlusion occurs in which people?
A221. men in their 60s
Q222. fundoscopic exam in central retinal artery occlusion?
A222. pale retina with cherry red fovea
Q223. what is amaurosis fugax?
A223. type of TIA - sudden vision loss (Shade over eye), transient, due to carotid-origin embolic shower
Q224. classic triad of optic neuritis?
A224. marcus gunn pupil; central vision loss; red vision desaturation
Q225. flashing lights, spider webs, or floaters that interfere with vision may be a sign of...? what meds should NOT be given?
A225. retinal detachment; DON'T anticoagulate
Q226. painful red eye - most often due to which things?
A226. conjunctivitis, corneal abrasion, or foreign body
Q227. which conjunctivitis produces copious DC?
A227. gonorrhea
Q228. punctuate lesions in conjunctivitis?
A228. viral cause
Q229. treatment of conjunctivitis?
A229. broad spectrum antibiotics, pain meds
Q230. soft contact wearers are especially prone to infection by.?
A230. pseudomonas
Q231. severe unilateral eye pain, decreased visual acuity and photophobia...?
A231. iritis
Q232. treatment of iritis?
A232. cycloplegic such as homatropine(not a mydratic)
Q233. severe unilateral HA, eye pain, N/V assoc with loss of vision....?
A233. narrow angle glaucoma
Q234. which drugs decrease aqueous production?
A234. acetazolomide and topical b blockers
Q235. which chemicals causes coag necrosis? liquefaction necrosis?
A235. acids; alkali
Q236. treatment of chemical burn...
A236. IRRIGATE
Q237. what's hyphema?
A237. blurred vision after blunt trauma (dull eye pain)... bleeding
Q238. basic approach to all toxicity patients in the ED?
A238. ABCs; Decontamination; Elimination; Antidotes
Q239. key things on physical exam for toxicity exposures....?
A239. Vital signs; pupils; toxidromes; autonomic signs; motor signs; mental status; skin
Q240. describe anticholinergic toxidrome?
A240. "mad as a hatter, dry as a bone, red as a beet, hot as a stove." Also - decreased GI motility, urinary retention, mydriasis.
Q241. describe muscarinic toxidrome?
A241. DUMBELLS
Q242. narcotic toxidrome?
A242. respiratory depression,; hypotension,; depressed sensorium, miosis
Q243. sympathomimetic toxidrome? compare with anticholinergic toxidrome?
A243. very similar except sympathomimetic involves diaphoresis
Q244. withdrawal toxidrome?
A244. agitation,; hallucination,; mydriasis,; diarrhea,; cramps,; lacrimation,; tachycardia,; insomnia,; seizures
Q245. major toxic effect of acetaminophen?
A245. metabolite NAPQI causes centrilobular hepatocellular damage
Q246. treatment of acetaminophen toxicity?
A246. 4 hour level on rumack-matthew nomogram,; activated charcoal,; N-acetyl-cysteine (to regenerate glutathione)
Q247. methanol toxicity?
A247. formic acid metabolite - causing a gap acidosis and direct optic nerve toxicity
Q248. treatment of ethylene glycol toxicity?
A248. 4MP or EtOH
Q249. which drugs can cause anticholinergic syndromes? tx?
A249. antihistamines, antipsychotics, TCAs... treatment - physostigmine
Q250. symptoms of calcium channel blocker toxicity? tx?
A250. bradycardia and hypotension; treatment - CaCl2, glucagon, epinephrine, DA
Q251. CO toxicity symptoms
A251. HA,; N/V,; flu-like symptoms,; CNS depression,; tachy,; hypotension
Q252. treatment of CO toxicity?
A252. 100% O2
Q253. GHB?
A253. date rape drug - euphoric and amnestic effects
Q254. refractory seizures could be caused by what toxicity?
A254. INH
Q255. Organophosphates can cause which toxidrome?
A255. muscarinic
Q256. naloxone?
A256. opioid antagonist
Q257. standard of care for salicylate poisoning?
A257. activated charcoal; also consider alkalinization of urine and blood with bicarb
Q258. benzo receptor antagonist that can rapidly reverse coma from benzo OD...? what's the problem with this drug/
A258. flumazenil; can lower the seizure threshold in pts with TCA OD and induce benzo withdrawal
Q259. loxosceles bites can be treated with...?
A259. dapsone
Q260. signs and symptoms of TCA OD?
A260. anticholinergic sx,; cardiac dysfunction,; intractable seizures,; and hyperthermia
Q261. treatment of TCA toxicity?
A261. decontamination with MDAC; Sodium bicarb administration; Benzos for seizure management; Alpha agonists for hypotension
Q262. prerenal failure due to..?
A262. decreased renal perfusion; (volume depletion, low CO, abnormal renal hemodynamics)
Q263. most common cause of intrinsic renal failure?
A263. longstanding HTN
Q264. majority of hospital-assoc episodes of ARF are caused by...?
A264. ATN
Q265. postrenal failure caused by?
A265. obstructive uropathy
Q266. FENA <1 in which condition?
A266. Prerenal failure
Q267. Urine Na <20 in which condition?
A267. Prerenal failure
Q268. treatment of prerenal failure?
A268. volume replacement, d/c offending meds
Q269. intrinsic RF treatment?
A269. monitor fluid status,; restrict protein,; correct electrolyte abnormalities
Q270. dispo for patients with ARF?
A270. admit
Q271. what drugs can cause ARF in pts with renal artery stenosis?
A271. ACE inhibitors
Q272. #1 cause of death in 1-44 year olds?
A272. Trauma (specifically, MVCs)
Q273. Preparation for a trauma case includes?
A273. History from EMTs; Prep the trauma bay; Airway box; O2 and suction; IVF and supplies
Q274. Indications for intubation?
A274. GCS <8; Inadequate breathing; Unable to protect airway
Q275. Chin lift is contraindicated if...?
A275. A C-spine injury is suspected
Q276. Radial pulse should have a BP of at least...? Femoral?
A276. 80 mmHg; 70
Q277. what % of ECF is plasma?
A277. 40181
Q278. which drug is an ineffective pressor in hypovolemic patients?
A278. dopamine
Q279. GCS consists of which 3 categories?
A279. eye opening,; verbal response,; moto response
Q280. most rapid means to lower ICP?; what other method?
A280. Hyperventilation; mannitol
Q281. volume of blood in an adult?
A281. 5 L (7% of ideal body weight)
Q282. physiologic response to acute hypovolemia?
A282. In order:; Tachycardia; narrowed pulse pressure (increased diastolic press); slowing of cap refill; decreased systolic pressure
Q283. raccon eyes, and battle sign?
A283. late findings in basilar skull fractures
Q284. assessment of C-spine in trauma?
A284. posterior midline - any tenderness?; focal neuro deficit?; A&O; evidence of intoxification?; any painful injury that may distract the pt?
Q285. FAST?
A285. quick, non-invasive method of examining the abdomen and pericardium for blood
Q286. how to check for pelvic fracture?
A286. press down and in on both iliac crests simultaneously
Q287. urine myoglobin can be elevated secondary to...?
A287. massive muscle breakdown (rhabdo)
Q288. treatment of rhabdo?
A288. IVF,; sodium bicarb,; and mannitol
Q289. calculate cerebral perfusion pressure?
A289. MAP - ICP
Q290. Cushing's reflex? sign of?
A290. HTN, bradycardia, hypopnea; sign of increased ICP
Q291. in traumatic head injury, what is the target MAP?
A291. 90mmHg
Q292. intubation considerations for elevated ICP?
A292. intubate early but WITHOUT ketamine
Q293. seizure prophylaxis with head bleeds?
A293. dilantin
Q294. how does cardiac tamponade present? findings?
A294. hypotension, muffled heart sounds, JVD, and pulsus paradoxus; electrical alternans on ECG; may present with pulseless electrical activity
Q295. which condition can lead to hypotension, absent breath sounds, hyperresonance, distended neck veins, and high airway pressures?
A295. tension pneumothorax
Q296. hypoxia occurs if an open pneumothorax is greater than?
A296. 2/3 trachea diameter
Q297. flail chest?
A297. 3 or more rib fractures in 2 or more sites with paradoxical motion of chest wall with inspiration
Q298. how to demonstrate fluid in the pericardium in tamponade?
A298. echocardiogram, or ED U/S
Q299. treatment of tension pneumothorax?
A299. angiocath in the 2nd intercostals space in the mid-clavicular line; chest tube if hemorrhagic or simple pneumothorax suspected
Q300. treatment of cardiac tamponade?
A300. subxyphoid pericardiocentesis
Q301. splenic injury can cause pain referred to...? eponym?
A301. left shoulder...Kehr's sign
Q302. which chief complaints warrant a stat EKG?
A302. chest pain/pressure/discomfort; SOB; hypotension; weakness/dizziness; syncope; abdominal pain especially in elderly; palpitations; N/V especially in elderly, diabetics
Q303. shortened PR interval suggests?
A303. alternate, abnormal conduction pathway like WPW syndrome
Q304. elongated PR interval suggests?
A304. some form of AV block
Q305. quick and dirty way of determining the axis of the heart?
A305. leads I and aVF... both up - normal; aVF down - LAD; I down - RAD; both down - RAD
Q306. DDx of U waves?
A306. hypokalemia; hypercalcemia; meds (digoxin, quinidine); thyrotoxicosis
Q307. Describe possible characteristics of an unstable cardiac patient?
A307. Pulseless; Hypotension; AMS; Ischemic chest pain; CHF
Q308. treatment basics for unstable cardiac patients?
A308. cardioversion (synch or un-synch) per ACLS protocol, then IV meds or other therapy
Q309. treatment of sinus tachycardia?
A309. treatment the UNDERLYING CAUSE
Q310. how can you tell there's paroxysmal supraventricular tachycardia? tx?
A310. abnormal/absent P waves; Tx: unstable --> synch cardioversion; stable --> AV node blockade via adenosis, calcium channel blockers (diltiazem, verapamil), b-blockers, manuevers
Q311. treatment of a fib?
A311. unstable --> synch cardioversion; stable w/ rapid vent. response --> AV blockade: calcium channel blockers, b blockers, digoxin; anticoagulation
Q312. pts with pre-excitation syndromes - be careful not to...?
A312. block the AV node by conventional meds
Q313. premature ventricular contractions, etiology?
A313. 4 H's - hypokalemia, hypomagnesemia, hypoxia, hyperthyroidism; drugs; heart disease
Q314. what is trigeminy?
A314. every 3rd beat is a PVC
Q315. treatment of PVCs?
A315. iv lidocaine or amiodarone; iv magnesium sulfate; procainamide
Q316. treatment of pulseless v tach?
A316. immediate UNSYCNHED cardioversion
Q317. treatment for unstable v tach?
A317. synchronized cardioversion, then amiodarone or lidocaine drip
Q318. treatment for stable v tach?
A318. medical cardioversion with lidocaine, amiodarone, adenosine, or procainamide
Q319. etiology of torsades?
A319. ischemic heart disease; MI; hypo-electrolyte states
Q320. treatment of stable torsades?
A320. electrical overdrive pacing; also consider Mg sulfate
Q321. treatment of Vfib?
A321. unsynchronized cardioversion,; ACLS protocols,; and correction of lytes abnormalities
Q322. pulseless electrical activity etiology?
A322. MATCH4ED; MI; Acidosis; Tension pneumo; Cardiac tamponade; H4- hypothermia, hyperkalemia, hypoxia, hypovolemia; Embolism (pulm); Drug OD
Q323. treatment of ventricular asystole?
A323. IVF, epinephrine, atropine; Transvenous pacing
Q324. for Mobitz II 2nd degree AV block, what tx? What won't work?
A324. transcutaneous or transvenous pacing; Admit for implantable pacemakers; Atropine won't work
Q325. treatment for 3rd degree AV block?
A325. immediate temporary pacemaker
Q326. you should consider a new LBBB to be _______ until proven otherwise?
A326. acute MI
Q327. Indications for temporary cardiac pacing?
A327. hemodynamically unstable bradycardia; bradycardia that fails to respond to tx; refractory tachycardia dysrhythmias; early bradyasystolic arrest
Q328. how does digoxin cause toxicity?
A328. blockade of the NaKATPase; increased vagal tone and increased AV nodal blockade
Q329. EKG signs of WPW?
A329. short PR interval; Delta wave; wide QRS; adult tachycardia
Q330. EKG signs of hypokalemia?
A330. more prominent U waves; flattened t waves
Q331. EKG signs of hyperkalemia?
A331. hyperacute T waves; wide QRS that eventually blends with the T wave to form a sine wave appearance
Q332. EKG signs of hypocalcemia?
A332. prolonged QT; terminal T wave inversion
Q333. EKG signs of hypercalcemia?
A333. shortened QT interval
Q334. associated symptoms of ACS?
A334. dyspnea, diaphoresis, nausea, lightheadedness, or sense of weakness
Q335. define stable angina?
A335. symptoms precipitated by exertion and relieved by rest or nitroglycerin
Q336. define unstable angina?
A336. Exertional angina of recent onset; angina of worsening character; angina at rest
Q337. describe myoglobin as a cardiac marker?
A337. elevated as early as one hour and peaks at 4-12 hours; nonspecific
Q338. describe CKMB as a cardiac marker?
A338. rises in 3-4 hours, peaks at 12-24 hours; can be elevated in skeletal muscle injury
Q339. describe troponin as a cardiac marker?
A339. rises in 3-6 hours, peaks 12-24 hours; most specific and sensitive
Q340. acute MI tx?
A340. MOAN B H; morphine; oxygen; aspirin; nitroglycerin; beta blockade; heparin
Q341. in pump failure.. which pressors for hypotension in a volume unresponsive patient..?
A341. sbp 80-100 - dobutamine; sbp 70-80 - dopamine; sbp <70 - levophed
Q342. pericarditis - presentation?; pain is worsened by..?
A342. sharp stabbing precordial or retrosternal chest pain... pain worsened by inspiration or lying flat
Q343. associated symptoms of pericarditis?
A343. low grade fever; dyspnea; dysphagia; tachycardia
Q344. test of choice for detection and f/u of pericarditis?
A344. echo
Q345. treatment for pericarditis
A345. NSAIDs for 1-3 weeks
Q346. aortic dissections typically occur in what group?
A346. uncontrolled hypertensive males ages 50-70
Q347. physical findings in aortic dissection?
A347. asymmetric pulses with BP differences between extremities; very hypertensive; severe distress; JVD; palpable pulsatile mass or tenderness
Q348. chest tube required for what size pneumothorax?
A348. >15%
Q349. Nitro's relief of cardiac vs esophageal pain?
A349. Cardiac w/in 5 minutes, esophageal w/in 10 minutes
Q350. life threatening etiologies of abdominal pain...?
A350. ruptured AAA,; perforated viscous,; intestinal obstruction,; ectopic pregnancy,; mesenteric ischemia,; appendicitis,; and MI
Q351. INITIAL TEST OF CHOICE FOR BILIARY TRACT DISEASE, AAA, ectopic, or free peritoneal fluid?
A351. US
Q352. Plain films can rule out which abdominal emergencies?
A352. Perforation or obstruction
Q353. Colicky pain usually responds to which drugs? Specifically...?
A353. NSAIDs,; esp IV Ketorolac
Q354. Triad of pain, hypotension, and a pulsatile abdominal mass...?
A354. AAA
Q355. _______ is virtually 100% sensitive in detecting AAAs?
A355. US
Q356. What is usually the primary inciting factor of appendicitis?
A356. Obstruction of the appendix usually by an appendicolith
Q357. risk factors for cholecystitis?
A357. fat, forty, and female
Q358. radiation of pain in acute cholecystitis?
A358. tip of the right scapula
Q359. most useful test if suspicious of cholecystitis?
A359. US of RUQ
Q360. which agents should not be used in acute gastroenteritis?
A360. anti-motility agents (Imodium) because it diminishes diarrheal excretion of organisms
Q361. Presentation of patients with acute hepatitis?
A361. Jaundice,; dark urine/light stools,; hepatomegaly,; fatigue, malaise,; RUQ pain,; N/V,; and fever
Q362. coagulation should be normalized with FFP in which condition?
A362. hepatitis
Q363. presentation of acute mesenteric ischemia?
A363. severe, poorly localized colicky abdominal pain associated with recurrent forceful bowel movements; classic - abdominal pain out of proportion to the minimal physical exam findings
Q364. Most useful test to diagnose acute mesenteric ischemia?
A364. Angiography
Q365. Midepigastric abdominal pain usually associated with N/V?
A365. Acute pancreatitis
Q366. An amylase raised _______ times the upper limit of normal is 98% specific to acute pancreatitis...
A366. 1.5
Q367. All patients with acute pancreatitis should be....
A367. admitted and made NPO
Q368. good narcotic choice for pain in acute pancreatitis
A368. Meperidine (better than morphine)
Q369. fever, abdominal pain, and rebound tenderness...?
A369. Peritonitis
Q370. Small bowel obstruction is caused by ________ more than 50% of the time...?
A370. postoperative adhesions
Q371. Most significant complications of small bowel obstruction?
A371. Strangulation and bowel infarction
Q372. etiology of bronchitis?
A372. viruses (influenza, adenovirus, etc.); Mycoplasma; Chlamydia; Bordetella pertussis
Q373. Virchow's triad of the pathophysiology behind PE?
A373. Venostasis; Hypercoagulability; Vessel wall damage/inflammation
Q374. Classic triad of PE presentation?
A374. Hemoptysis; Dyspnea; chest pain
Q375. EKG findings in PE?
A375. S1; Q3; inverted T3
Q376. golden standard for diagnosing PE?
A376. pulmonary angiography
Q377. ED treatment of CHF?
A377. diuretics; nitrates; anlgesics; intubation or CPAP if no improvement
Q378. treatment of COPD in the ED?
A378. ABCs monitoring; albuterol neb; glucocorticoids; MgSO4 in severe exacerbations; antibiotics (empiric broad spectrum)
Q379. ED eval of asthma?
A379. Monitors, O2, pulse ox; Peak expiratory flow rate; CXR - to rule out pneumonia
Q380. signs of hyperventilation syndrome?
A380. tachypnea, chest wall tenderness, carpopedal spasm, Chvostek's/Trousseau's sign (hypocalcemia)
Q381. this condition likely results from inflammation of CN VII as it courses through the styloid foramen?
A381. Bell's palsy
Q382. treatment of bell's palsy?
A382. acyclovir AND prednisone; eye patching to prevent keratitis and corneal ulceration
Q383. work up of CVA?
A383. STAT head CT - esp if < 3 hrs; standard labs; STAT Accu-check
Q384. in hemorrhagic stroke, you want to decrease SBP by no more than _____ to limit hypoperfusion...?
A384. 20-25%
Q385. Peripheral vertigo is caused by.?
A385. viral etiology (labyrinthitis); decaying or "lost" otoliths
Q386. peripheral vertigo presentation?
A386. acute onset; intense spinning sensation, N/V; unidirectional nystagmus that can be inhibited by fixation
Q387. work-up of peripheral vertigo?
A387. hallpike maneuver; epley manuevers; anti-emetics, anti-cholinergics
Q388. most seizures in the ED are due to...?
A388. Medical non-compliance in known seizure patients
Q389. workup of seizures in the ED...
A389. ABCs; IV; check glucose; head CT; anti-epileptic level; LP if any possibility of intracranial hemorrhage or meningitis
Q390. LOC occurs in ____ % of patients with SAH?
A390. 0.5
Q391. 75% of SAH is due to...?
A391. ruptured congenital arterial aneurysm
Q392. diagnostic test for SAH?
A392. noncontrast head CT
Q393. if there is suspicion for SAH and it's not seen on CT, ____ must be performed?
A393. LP
Q394. What other condition besides SAH could cause blood in the CSF?
A394. Herpes encephalitis
Q395. goal of ICP management is to maintain the cerebral perfusion pressure greater than ______?
A395. 60
Q396. A chronic headache that started out mild to moderate in severity and intermittent in nature, described as a deep, aching pain and worsened by coughing, and often maximal upon awakening...?
A396. intracranial tumor / mass
Q397. 85% of people experiencing malignant hypertension complain of _____?
A397. Headache
Q398. Temporal arteritis affects women ______ than men, and is uncommon before the age of _____? ESR is usually ____?
A398. Women more than men; 50; ESR 50-100
Q399. Jaw claudication is strongly suggestive of...?
A399. temporal arteritis
Q400. treatment of temporal arteritis?
A400. prednisone 60mg po, arrange a biopsy to confirm diagnosis
Q401. Often compression of ______________ can improve the pain of migraine?
A401. the ipsilateral superficial temporal or carotid artery
Q402. ergotamine is contraindicated in... ? Should be used w/ caution in ....?
A402. Pregnancy; Caution in HTN or CAD
Q403. Patients should avoid _____ while in the midst of cluster headaches?
A403. Alcohol
Q404. This causes headaches often in overweight women in their 30s...
A404. Pseudotumor Cerebri (benign intracranial HTN)
Q405. 90% of patients with Pseudotumor Cerebri have ....?
A405. papilledema
Q406. in Pseudotumor Cerebri, head CT will show...? LP will show...?
A406. CT - slit-like ventricles; LP - increased opening pressure
Q407. treatment of Pseudotumor Cerebri..?
A407. Acetazolamide 250 mg pid
Q408. treatment of post LP HA?
A408. caffeine sodium benzoate
Q409. cherry-red coloration of skin/mucous membranes, retinal hemorrhages, AMS?
A409. CO poisoning
Q410. sudden onset of head/eye pain, decreased visual acuity?
A410. Acute angle closure glaucoma
Q411. treatment of acute uncomplicated UTI?
A411. Bactrim for 3 days
Q412. Pyelonephritis w/ systemic sx tx?
A412. admit for IV antibiotics
Q413. pregnant women with UTI tx?
A413. macrobid for 7 days
Q414. What % of pts presenting with classic UTI sx show minimal to no bacteria on UA?
A414. 30-40%
Q415. Sudden onset of testicular pain in children and young men?
A415. Testicular torsion
Q416. most common cause of urinary retention?
A416. BPH
Q417. >100 ml postvoid residual urine volume is diagnostic of...?
A417. urinary retention
Q418. what is fournier's gangrene?
A418. aggressive fasciitis of the perineum in a toxic appearing pt likely with history of DM, urethral trauma, surgery, or obstruction
Q419. treatment of fournier's gangrene??
A419. immediate surgery - complete debridement of necrotic tissue
Q420. tender, swollen, painful epididymis and testis usually accompanied by fever?
A420. Epididymitis
Q421. testicular US can distinguish...?
A421. torsion from epididymitis
Q422. the cremasteric reflex is present in _____ but not in ___________?
A422. epididymitis; torsion
Q423. nonspecific infection of the glans penis is called...?
A423. balanitis
Q424. abnormally small opening in the foreskin?
A424. phimosis
Q425. abnormal painful swelling of the glans penis occurring after aggressive retraction of a phimotic foreskin?
A425. paraphimosis
Q426. flank/abdominal pain, does not change with position or remaining still, radiation to groin...
A426. stones
Q427. work up of stones?
A427. IVF; IV narcotics; UA - will generally show hematuria; BMP
Q428. test of choice for kidney stones?
A428. noncontrast CT
Q429. stone <3mm probability of passing spontaneously?
A429. 0.8
Q430. Indications for urology consults or admission in kidney stones...?
A430. Associated UTI; uncontrolled pain/emesis; extravasation of contrast; renal failure; single kidney; hydronephrosis + hydroureter; stone > 6mm
Q431. in a patient >60, first time renal colic is _________ until proven otherwise...
A431. AAA
Q432. of those women who experience bleeding in the first trimester, ______________ will undergo spontaneous abortion
A432. 40180
Q433. threatened abortion...?
A433. vaginal bleeding with a pre-viable fetus and closed cervix
Q434. inevitable abortion?
A434. vaginal bleeding with cervical dilatation
Q435. incomplete abortion
A435. vaginal bleeding with partial passage of products of conception and dilated cervix
Q436. complete abortion
A436. passage of all products of conception and closed cervix
Q437. missed abortion
A437. fetal demise and retention of products of conception, cervix closed
Q438. 6-8 weeks gestation with amenorrhea, spotting, and cramping lower abdominal pain....concerning for...?
A438. ectopic
Q439. gold standard in diagnosing an ectopic?
A439. US
Q440. any patient who presents with vaginal bleeding and is _____ should be given RhoGAM?
A440. Rh -
Q441. 2 most common pregnancy related causes of vaginal bleeding in the second trimester?
A441. miscarriage; hydatidiform mole
Q442. pre-eclampsia that occurs prior to 20 weeks gestation is pathognomonic for...?
A442. trophoblastic disease
Q443. most common presentation of placenta previa?
A443. late 2nd to early 3rd trimester painless bleeding
Q444. ____________- may occur in up to 1/3 of placental abruptions?
A444. DIC
Q445. pre-eclampsia?
A445. triad of HTN, edema, and proteinuria of >100 mg/dl
Q446. HELLP syndrome?
A446. subset of pre-eclamptic pts:; Hemolysis, Elevated Liver enzymes, and Low Platelets
Q447. In preeclampsia and eclampsia, the most important part of the CBC is...?
A447. the platelet count
Q448. seizure prophylaxis in pre, eclampsia?
A448. MgSO4
Q449. preterm labor is defined as occurring...?
A449. before 37 weeks gestation
Q450. Strawberry cervix?
A450. trichomonas
Q451. average blood loss in normal menses/
A451. 30-60cc
Q452. benign leiomyomas that develop in the uterus and often result in menometrorraghia?
A452. fibroids
Q453. dysfunctional uterine bleeding tx..?
A453. NSAIDs, and OCPs; rule out endometrial carcinoma
Q454. Chlamydia can cause....?
A454. Asymptomatic infection; Urethritis; Cervicitis; PID
Q455. PID?
A455. Lower abdomen. tenderness, cervical motion tenderness, and adnexal tenderness; + fever or increased WBC or ESR etc..
Q456. most common cause of infectious arthritis in young sexually active adults?
A456. Gonorrhea
Q457. green-gray discharge?
A457. trichomonas
Q458. thin-gray malodorous discharge, non sexually transmitted
A458. bacterial vaginosis
Q459. most common cause of pelvic pain in women not associated with infection is...?
A459. Rupture of an ovarian cyst
Q460. 50% of cases of ovarian torsion are caused by..?
A460. Benign dermoids that cause the ovary to twist
Q461. A major cause of pelvic pain, dyspareunia, and dysmenorrhea
A461. Endometriosis
Q462. postcoital contraception?
A462. norgestrel
Q463. first, second, etc degree frostbite?
A463. 1st - warm, hyperemic, sensate; 2nd - clear vesicles; 3rd - purple bullae; 4th - mummification
Q464. ED management of frostbite?
A464. treatment hypothermia; IVF; remove nonadherent wet apparel; rapid thawing thawing in 42C water bath; unroofing clear blisters; aloe vera; tetanus prophy; ibuprofen, ascorbic acid, nifedipine
Q465. How to estimate total body surface area for burns..?
A465. 9's; LUE - 9%,; LLE - 18%,; posterior torso - 18%,; head - 9%
Q466. burn degrees?
A466. 1st - superficial epidermis (no blisters, heals w/out scar); 2nd - superficial dermis (blisters, scarring in 3 wks...); 3rd - all of dermis (charred, painless, scars with contractures)
Q467. How do you determine IVF needs in a burn victim?
A467. If TBSA >15%.... 4ml x kg weight x tbsa% = total volume of replacement needed in first 24 hrs
Q468. don't forget _________ in frostbite, burns, and a variety of other injuries....?
A468. tetanus prophylaxis
Q469. hypothermia defined?
A469. core temp < 35 C
Q470. presentation of mild hypothermia?
A470. confusion, lethargy, fatigue, shivering, tachycardia, respiratory alkalosis
Q471. resuscitation in severe hypothermia should include _________ in order to treat cardiac dysrhythmias...?
A471. Warming until core temp > 32 C
Q472. severe dehydration, thermoregulaory failure, temp >40C, tachycardia, hypotension, confusion, rhabdo...?
A472. Heat stroke
Q473. treatment of heat stroke..?
A473. rapid cooling, monitoring, seizure prophylaxis
Q474. voltage > _____________ is considered high tension..?
A474. 1000 V
Q475. the _________ the resistance, the more the current and damage
A475. less
Q476. AC current is ___________ dangerous than DC, because?
A476. more; increased duration of exposure; increased likelihood of Vfib
Q477. barotrauma of ascent?
A477. when a diver fails to exhale when ascending, exacerbating the overexpansion of the airspaces
Q478. type 1 decompression sickness? type 2?; treatment if severe?
A478. 1 - joint, skin, bone problems; 2 - neuro, lung, CV problems; Hyperbaric oxygen chamber
Q479. what agent can mimic acclimatized state in the treatment of altitude sickness?
A479. Acetazolamide - causes a compensatory respiratory alkalosis
Q480. most infection prone bite injury?
A480. human bite to the hand
Q481. ___________ is implicated in 50% of infected cat bites and 30% of infected dog bites?
A481. Pasteurella
Q482. complications of this infection include encephalitis, Painaud's, osteolytic bone lesions, purpura, and erythema nodosum
A482. Bartonella
Q483. describe phases of rabies briefly?
A483. Incubation period - couple months; Prodrome - 1 week of localized pain, malaise, N/V; Acute neuro phase - 1 week; Coma - up to 2 weeks
Q484. Loxosceles spider bite tx?
A484. wound care; antibiotics if superinfected; antihistamines and analgesics; dapsone to prevent ulceration; IV steroids in viscerocutaneous loxoscelism to prevent hemolysis
Q485. sudden onset fever, centripetal rash spread, severe HA, myalgia, N/V, and abdominal pain
A485. Rocky mountain spotted fever
Q486. treatment of rocky mountain?
A486. teracycline or chloramphenicol; supportive care for shock, DIC, ARDS, CHF
Q487. complications of auricular hematoma?
A487. cauliflower ear, cartilage necrosis
Q488. pathogens of otitis externa?
A488. pseudomonas and staph
Q489. treatment of anterior bleeding epistaxis?
A489. pinching pressure, decongestion, silver nitrate, packing, abx to prevent sinusitis
Q490. problem with posterior bleeding epistaxis?
A490. pharyngeally stimulated hypoxia and stopped breathing
Q491. ____________ cures >95% of peritonsillar abscesses?
A491. I and D
Q492. Ludwig's angina? big concern?
A492. Trench mouth - dental origin infection of submandibular space due to horrible hygiene; Concern - airway compromise
Q493. duck quack cry is characteristic of...?
A493. Retropharyngeal deep space infection
Q494. swallowed coins appear ____________ in trachea, _____________ in esophagus?
A494. side on; face on
Q495. diagnosis and treatment of esophageal foreign body?
A495. EGD for visualization; glucagon for esophageal relaxation
Q496. epiglotitis has traditionally been associated with which infection?
A496. Hemophillus B
Q497. diagnosis of epiglotitis?
A497. loss of V-shaped dip in neck plain film (valecula sign)
Q498. if suspecting epiglotitis in kids....what next?
A498. call ENT or anesthesia - no IV's, oral exam, nothing that stimulates/agitates the child
Q499. croup? what type of cough?
A499. laryngotracheobronchitis - viral infection; seal-like barking cough
Q500. difference in presentation in kids with croup vs. epiglotitis?
A500. in croup, kids generally appear well
Q501. treatment of croup?
A501. racemic epinephrine,; humidified air,; steroids
Q502. angioedema? tx
A502. inflammatory autoimmune reaction, increased capillary permeability; treatment - H1 blocker, steroids, H2 blocker, epinephrine for severe cases
Q503. causes of pharyngitis?
A503. group A strep; Mono with lymphadenopathy, splenomegaly; adenovirus