Step 2 Dit: Er, Icu, Surg (Combined)

Front 1

lab changes seen in a patient with hyperaldosteronemia

Back 1

metabolic alkalosis

hypokalemia

mild hypernatremia

incr'd 24-hr urine aldosterone

Front 2

lab findings a/w hashimotos thyroiditis

Back 2

high TSH

Low T4

anti-thyroid peroxidase (TPO) AB's

anti-thyroglobulin AB's

anti-microsomal AB's

Front 3

5 criteria for metabolic syndrome

Back 3

ABDOMINAL OBESITY:
waist circumference > 40" (M) & > 35" (F)

"PRE-HTN":
BP > 130/85

"PRE-DM":
FSBG 100+ mg/dl (2-hr post-oral 140+)

DYSLIPIDEMIA:
TG's 150+
HDL < 40 (M) & < 50 (F)

Front 4

complications a/w electrical burns

Back 4

cardiac disarrhythmia

various neurological disturbances

rhabdomyolysis --> myoglobinuria --> renal failure

bony injuries --> compartment syndrome

acidosis

Front 5

what are some life threatening complications of a px with substantial burns

Back 5

inhalation injury

cardiac dysrhythmias

renal failure

sepsis (pneumonia & pseudomonas wound infection)

hypovolemia/shock

Front 6

what is the parkland burn formula

Back 6

Lactated Ringer:
4ml x body wt in kg x % BSA

1/2 in first 8 hours + maintenance fluids
1/2 in following 16 hours + maintenance fluids

Front 7

how can you prevent renal failure from electrical burns

Back 7

aggressive IVF's

urine output goal: > 1.5 - 2 cc / min

Front 8

pulmonary pathology seen in a px with salt water near-drowning experience

Back 8

pulmonary edema

Front 9

where would an aspirated object most likely end up

Back 9

right mainstem bronchus

Front 10

next step in a px who aspirated an object that cannot be dislodged and is having difficulty breathing

Back 10

emergent tracheotomy

Front 11

degree of burn:
epidermis only

Back 11

1st degree

Front 12

degree of burn:
epidermis & partial dermis

Back 12

2nd degree

Front 13

degree of burn:
epidermis & full dermis without muscle/bone involvement

Back 13

3rd degree

Front 14

degree of burn:
epidermis & full dermis with muscle/bone involvement

Back 14

4th degree

Front 15

degree of burn:
no blisters

Back 15

1st degree

Front 16

what differentiates the two 2nd degree classifications

Back 16

SUPERFICIAL PARTIAL-THICKNESS:
capillary refill intact
(i.e. does blanch with pressure)

DEEP PARTIAL-THICKNESS:
capillary refill NOT intact
(i.e. does not blanch with pressure)

Front 17

degree of burn:
painless

Back 17

3rd or 4th degree

Front 18

degree & depth of burn:
epidermis only;
painful, erythema, no blisters

Back 18

1st degree - superficial

Front 19

degree of burn:
epidermis & partial dermis;
painful, erythema, blisters
capillary refill intact

Back 19

2nd degree - superficial partial-thickness

Front 20

degree of burn:
epidermis & partial dermis;
painful, erythema, blisters
capillary refill not intact

Back 20

2nd degree - deep partial-thickness

Front 21

degree of burn:
epidermis & full dermis + no muscle/bone
white &/or charred, painless
capillary refill not intact

Back 21

3rd degree - full thickness

Front 22

degree of burn:
epidermis & full dermis + muscle/bone
white &/or charred, painless
capillary refill not intact

Back 22

4th degree

Front 23

degree of burn:
burns 2nd/2 electrical shock

Back 23

4th degree
(b/c they may involve muscles, bones, & other structures)

Front 24

Extent of burns: Rule of 9's

Back 24

9% head
9% chest; 9% upper back
9% stomach; 9% lower back (down to gluteal folds)
9% left arm; 9% right arm
9% left anterior leg; 9% left posterior leg
9% right anterior leg; 9% right posterior leg
1% genitalia

Front 25

Dx & initial w/u
obese patient with dirty, velvety patch on back of neck

Back 25

dx: DM (pathology = acanthosis nigricans)

w/u: glucose & H&P (r/o malignancy)

Front 26

what is the appropriate tx fo HTN in cases of pheochromacytoma

Back 26

FIRST: a-Blocker (e.g. pheoxybenzamine, phentolamine)

THEN: B-Blocker

Front 27

What is the classic presentation of a pt with hyperprolactinemia

Back 27

galactorrhea/gynecomastia

amenorrhea/decr'd libido

infertility (low sperm count)/decr'd libido/impotence

Front 28

Tx of heat stroke

Back 28

ABC's

O2 (4L/min)

COOLING:
ice packs to neck, axilla, & groin
continuous fanning & spraying with lukewarm water
+/- cold gastric lavage, cooling blankets, cold IVF's

IVF's

Benzo's (if seizures)

Front 29

why are acetomenophen and NSAIDs ineffective against heat stroke

Back 29

hypothalamus is not underlying problem

Front 30

after an animal bite when should rabies prophylaxis be used

Back 30

if animal cannot be observed for 10 days

or if highly suspected of having rabies

Front 31

EKG finding in hypothermia

Back 31

j wave

Front 32

What is the tx for black widow spider bite

Back 32

antivenin within 30 minutes

benzo's to prevent lactodectism (i.e. muscle spasm)

observe pt for 24 hrs

consider oral antibiotics if secondary infection

Front 33

underlying problem for hyperthermia that must be corrected

Back 33

dehydration

Front 34

after appropriate wash out should a dog bite wound be closed

Back 34

no

except facial bites (due to low rate of infection b/c well perfused), which should be sutured close

Front 35

Mgmt of skin laceration from human bite

Back 35

copious irrigation

leave wound open

prophylactic antibiotics

Front 36

which antibiotics are given after human bites

Back 36

amoxicillin + clavulanic acid
or
clindamycin + levofloxacin
or
clindamycin + TMP/SMX

Front 37

what rx should be given to a pt with muscle spasms, abdominal stiffness, AMS, & tachycardia due to spider bite

Back 37

dx aka "lactodectism"

tx: antivenin (within 30 minutes) & benzo's

Front 38

Rx for hyperparathyroidism due to parathyroid hyperplasia

Back 38

remove 3.5 glands

mark remaining 1/2 gland with surgical clip

Front 39

what is the LDL goal in a px with diabetes

Back 39

LDL < 100

Front 40

how is fluid repletion calculated after a burn

Back 40

PARKLAND FORMULA:
Lactated ringer: 4mL x weight in kg x % BSA

1/2 in first 8 hrs
1/2 in following 16 hrs

Front 41

tx for bradycardia due to B-blocker overdose

Back 41

IVF's (bolus)

atropine

GI decontamination (activated charcoal, gastric lavage, or whole bowel irrigation)

Front 42

symptoms of anticholinergic toxicity

Back 42

hyperpyrexia (hot as a hare)
decr'd secretions (dry as a bone)
cutaneous flushing (red as a beet)
cycloplegia & mydriasis (blind as a bat)
disorientation (mad as a hatter)
constipation & urinary retention (bloated as a toad)
+
tachycardia
QRS widening
+
decreased or absent bowel sounds

Front 43

antidote for anticholinergics

Back 43

physostigmine

Front 44

a/w almond-scented breathe

Back 44

cyanide poisoning

Front 45

early & late findings of cyanide poisoning

Back 45

EARLY (everything is incr'd):
tachycardia, HTN, tachypnea, flushing
--> obtundation --> coma --> death

LATE (everything is decr'd):
bradycardia, hypotension, bradypnea, cyanosis, hepatic necrosis, renal failure

Front 46

what is a long term neurological effect in survivors of severe cyanide poisoning

Back 46

delayed-onset parkinsonism

Front 47

Rx for cyanide poisoning

Back 47

ABC's

high-flow O2 (regardless of pulse-ox readings)

sodium thiosulfate

hydroxocobalamin

nitrates (e.g. amyl nitrate and sodium nitrate)

Front 48

cradiac meds that are safe to treat tachycardia and HTN in cocaine overdose

Back 48

CCB's

a-Blockers

Benzos

AVOID B-BLOCKERS (unopposed alpha --> incr'd BP)

Front 49

what is given to tx acetaminophen overdose; what other uses does this medication have

Back 49

TX: N-Acetylcysteine

OTHER USES:
CF pt's (for mucous plugs)
pre-IV contrast

Front 50

what lab abnormality is classically seen in digoxin toxicity

Back 50

hyperkalemia

elevated digoxin levels

Front 51

what are some non-specific sx's of digoxin toxicity

Back 51

fatigue
blurred vision, change in color (e.g. "yellow vision")
anorexia, n/v/d, abd'l pain
HA, dizziness, confusion, delirium

Front 52

what characteristic cardiac changes may be seen with digoxin toxicity

Back 52

DYSRHYTHMIAS:
bradycardia
atrial tachycardia
bidirectionl V-tach (digioxin toxicity until proven o/w)

EKG CHANGES:
prolonged PR interval
ST segment "scooping" (seen at therapeutic levels)

Front 53

what should be avoided in digoxin overdose because it could worsen intracellular hyperkalemia

Back 53

Ca2+ (can worsen intracellular hyperkalemia)

Front 54

what is the MC sign of digoxin toxicity

Back 54

bradycardia

Front 55

what indicates the severity of digoxin toxicity

Back 55

hyperkalemia (inhibits the Na-K-ATPase)

Front 56

what is rx for digioxin toxicity

Back 56

activated charcoal (in repeated doses)

digoxin antibody fragments, if necessary

Atropine, if bradycardia

ACLS medications as needed (except calcium)

Front 57

when is digoxin antibody fragments necessary in digoxin toxicity

Back 57

hemodynamic instability

life-threatening arrhythmias/severe bradycardia

"digoxin-toxic" rhythm (e.g. bidirectional V-tach) in setting of elevated [digoxin]

[K+] > 5 mEq/L

[digoxin] > 10 ng/mL

ingestion of > 10 mg (adults) or > 4 mg (children)

Front 58

Rx for methanol or ethylene glycol (antifreeze) poisoning

Back 58

Na bicarb
(to correct acidosis & limit penetration of toxic metabolites into tissues such as retina)

dialysis if severe or evidence of organ damage
(e.g. vision changes or renal failure)

fomepizole/ethanol
(to inhibit the alcohol dehydrogenase enzyme)

thiamine (B1), pyridoxine (B6), & folic acid (B9) supplementation (to optimize elimination pathways)

Front 59

diagnostic features of salicylate overdose

Back 59

n/v, dehydration

AMS

tinnitus

hyperthermia
(ASA uncouples mt'l oxidative phosphorylation)

resp alk --> mixed resp alk + met acid with incr'd AG

Front 60

what is the electrolyte abnormalities seen in ASA overdose & what is the pathophysiology of these abnormalities

Back 60

resp alk --> mixed resp alk + met acid with incr'd AG

RESPIRATORY ALKALOSIS is due to hyperventilation 2nd/2 ASA stimulation of medullary respiratory center

METABOLIC ACIDOSIS is 2nd/2 accumulation of lactic acid & ketoacids

Front 61

antidote for:
aspirin

Back 61

charcoal

Na+ bicarb

dialysis

Front 62

what is rx used to tx warfarin overdose & at what point would you consider tx'ing the warfarin overdose

Back 62

Administer Vitamin K

Consider if INR b/w 5 - 9

Administer if INR > 9 or any serious bleed

Front 63

what can be used in place of FFP in warfarin overdose

Back 63

prothrombin complex concentrate

recombinant human CF VIIa

Front 64

antidote for:
acetaminophen

Back 64

N-acetylcysteine

Front 65

antidote for:
opioids

Back 65

naloxone

Front 66

antidote for:
benzos

Back 66

flumazenil

Front 67

antidote for:
TCA

Back 67

Na+ bicarb (if QRS > 100 msec's)

Benzo's (for seizures)

Front 68

antidote for:
atropine

Back 68

physostigmine

Front 69

antidote for:
propanolol

Back 69

glucogon

Ca2+ gluconate

insulin

dextrose

Front 70

antidote for:
digoxin

Back 70

Digoxin AB's

atropine (if bradycardic)

Front 71

antidote for:
cyanide

Back 71

Na+ thiosulfate

nitrates (e.g. amyl nitrate & Na+ nitrate)

hydroxocobalamine

Front 72

antidote for:
methemoglobin

Back 72

methylene blue

Front 73

antidote for:
methanol

Back 73

fomepizole

ethanol

Front 74

antidote for:
isoniazid

Back 74

Vit B6

Front 75

antidote for:
heparin

Back 75

protamine sulfate

Front 76

most sensitive test for multiple sclerosis

Back 76

MRI brain & orbits
(asymmetric white matter lesions of different ages)

Front 77

what type of bite/sting can cause acute pancreatitis

Back 77

scorpion sting

Front 78

in which endocrine disorder might weight loss completely eliminate the need for medication

Back 78

DM2

PCOS

Front 79

what is the next step in mgmt of a sx'c pt who has ingested alkali plumbing liquid

Back 79

ABC's:
resp distress --> laryngoscopy +/- tracheostomy

emergent surgery if perforation, mediastinitis, or peritonitis

AVOID: emetics (e.g. ipecac), neutralizing agent, & NG tube

Front 80

What classic toxic ingestion mgmt. options should NOT be chosen in pt's with alkaline fluid ingestion

Back 80

emetic agent (ipecac)

neutralizing agent

NG tube

Front 81

what are the determining factors for out-pt vs in-pt care in a pt who has ingested alkali plumbing liquid

Back 81

OUTPATIENT TX if: reliable h/o low-vol, accidental ingestion

INPATIENT TX if : unreliable hx, high-vol ingestion, or intentional ingestion

Front 82

what is the proper in-pt care of an asx'c pt who has ingested alkali plumbing liquid

Back 82

EGD ASAP

ICU care to manage life-threatening complications (mediastinitis, peritonitis, respiratory distress, shock)

esophageal dilations
(3-6 weeks after injury if necessary for strictures)

SURVEILLANCE EGD's:
starting 15-20 yrs after ingestion
q1-3 yr intervals

Front 83

for what is a px who ingests alkali plumbing liquid at long-term risk

Back 83

esophageal squamous carcinoma

Front 84

what happens within 6 hours of iron ingestion

Back 84

abdominal pain

vomiting/hematemesis

diarrhea/hematochezia/melena

lethargy

shock

Front 85

what happens within 6-72 hours of iron ingestion

Back 85

wide-spread cellular dysfunction

multisystem organ failure

Front 86

what happens within 12-96 hours of iron ingestion

Back 86

heptotoxicity

Front 87

what happens withig 2-8 weeks of iron ingestion

Back 87

bowel obstruction (2nd/2 GI scarring, classically at the gastric outlet)

Front 88

antidotes for:
iron toxicity

Back 88

deferoxamine

Front 89

Rx for lead poisoning in adults

Back 89

EDTA or succimer

Front 90

Rx for lead poisoning in children

Back 90

EDTA or succimer

SEVERE toxicity: succimer + dimercaprol

Front 91

symptoms of theophylline overdose

Back 91

seizures

hypotension

tachyarrhythmias

Front 92

antidote for:
arsenic

Back 92

dimercaprol

succimer

penicillamine

Front 93

Tx for theophylline overdose

Back 93

supportive care (IVF's + maintain nl [K+])

ACLS protocols for arrhythmias (SVT or V-Tach)

benzo's for seizures (avoid phenytoin)

GI decontamination (activated charcoal)

hemodialysis in severe cases

Front 94

signs/sx's of cholinergic toxicity (e.g. organophosphates)

Back 94

"DUMBBELSS"
Diarrhea
Urination
Miosis
Bronchospasm
Bradycardia
Emesis & Excitation of skeletal muscle
Lacrimation
Sweating
Salivation

Front 95

antidote for:
anticholinesterases, organophosphates

Back 95

atropine + pralidoxime

Front 96

antidotes for:
carbon monoxide

Back 96

100% O2 (hyperbaric O2 therapy)

Front 97

antidote for:
copper

Back 97

penicillamine

Front 98

antidotes for:
mercury

Back 98

dimercaprol

Front 99

antidote for:
tPA, streptokinase

Back 99

aminocaproic acid

Front 100

if you suspect an MI and are waiting for an EKG, what treatments should be initiated immediately

Back 100

"MONA"

morphine
O2
Nitrates
Aspirin

Front 101

antidote for:
opioids

Back 101

naloxone or Naltrexone

Front 102

antidote for:
heparin

Back 102

protamine sulfate

Front 103

antidote for:
benzo

Back 103

flumazenil

Front 104

antidote for:
barb

Back 104

bicarb (to alkalinize the urine)

dialysis

activated charcoal

Front 105

antidote for:
carbon monoxide

Back 105

100% O2 (hyperbaric O2)

Front 106

Dx & Rx
patient presents with new skin pigementation, hyponatremia and hyperkalemia

Back 106

Dx: Addison's

Tx: glucocorticoids & mineralcorticoids (e.g. fludracortisone)

Front 107

what drugs are used in treating stable, asymptomatic ventricular tachycardia

Back 107

amiodarone (1st line)

procainamide

sotalol

synchronized cardioversion if pt fails to respond to pharmacological measures

Front 108

Rx for supraventricular tachycardia

Back 108

vagal maneuvers/carotid massage

adenosine (IV push: 6mg --> 12mg --> 6mg)

ventricular rate control (CCB or B-blocker)

Front 109

what adverse SE's should you be expecting with adenosine IV push

Back 109

intense, transient flushing
chest pain
hypotension
"flat line" on monitor (turn volume down)

NOTE:
SE's are UNCOMFORTABLE
but only last a few seconds

Front 110

initial Rx for new atrial fib with RVR of unknown duration

Back 110

RATE CONTROL:
B-blocker
Non-DHP CCB (e.g. diltiazem or verapamil)
Digoxin
Amiodarone

ANTICOAGULATE:
Heparin (initially)
Warfarin (later)

Front 111

ACLS protocol for PEA or asystole

Back 111

CPR (30:2)**

epinephrine 1mg q 3-5 mins
(OR vasopressin 40 U's in place of 1st or 2nd epi)

Evaluate & Tx causes ("H's" & "T's")

**NOTE: PEA & asystole are NOT shockable rhythms

Front 112

causes of PEA

Back 112

hypothermia
hypovolemia
hypoxia
hypoglycemia
hyper acidosis
hyper/hypokalemia

tamponade
thrombosis (MI)
thrombosis (PE)
tension pneumothorax
trauma
toxins

Front 113

ACLS protocol for V-Fib & pulseless V-tach

Back 113

Shock 360 J + CPR (30:2)

Check rhythm
Shock 360 J + CPR (30:2)

Check rhythm
Epi 1 mg
OR vasopressin 40 units (in place of 1st or 2nd epi)

Check rhythm
Shock + CPR (30:2)

Check rhythm
Consider Antiarrhythmics
(i.e. amiodarone 300 mg or lidocaine 150 mg or lidocaine 1 - 1.5 mg/kg (max 3 mg/kg)

CONTINUE:
q2 minutes: check rhythm --> shock 360 J + cpr (30:2)
q3 - 5 mins: check rhythm --> epinephrine 1mg IV

Front 114

What is max number of epinephrine doses that can be given when treating cardiac arrest

Back 114

There is no max:

Epinephrine 1 mg IV q3-5 minutes

Front 115

antidote for:
antimuscarinics, anticholinergic agents

Back 115

physostigmine

Front 116

antidote for:
benzo's

Back 116

flumazenil

Front 117

antidote for:
TCA

Back 117

Na+ bicarb

Front 118

antidote for:
warfarin

Back 118

Vit K

FFP

Front 119

antidote for:
ethylene glycol

Back 119

fomepizole

EtOH

Front 120

antidote for:
arsenic

Back 120

dimercaprol

succimer

penicillimine

Front 121

Dx
systolic murmur at apex and LLSB increases in intensity while standing after squatting

Back 121

hypertrophic cardiomyopathy

Front 122

clinical definition of HTN

Back 122

>140/90

on 3 separate occasions

at least 2 wks apart

Front 123

blood product most appropriate for:
severe anemia due to autoimmune hemolytic anemia

Back 123

PRBC's

Front 124

blood product most appropriate for:
hemophilia

Back 124

Hemophilia A: CF VIII

Hemophilia B: CF IX

Front 125

blood product most appropriate for:
DIC

Back 125

FFP +/- plt's

Front 126

blood product most appropriate for:
shock due to trauma or postpartum hemorrhage

Back 126

PRBC's

whole blood (rarely)

Front 127

blood product most appropriate for:
to maintain blood pressure during large volume paracentesis

Back 127

colloid (e.g. albumin)

Front 128

blood product most appropriate for:
hemorrhage due to warfarin overdose

Back 128

Vitamin K

FFP

Front 129

blood product most appropriate for:
need for vWF-rich blood product

Back 129

cryoprecipitate

Front 130

blood product most appropriate for:
thrombocytopenia

Back 130

platelets

Front 131

which blood product replaces clotting factors

Back 131

FFP

cryoprecipitate

whole blood

Front 132

vasopressor a/w:
theoretically causes renal vasodilation

Back 132

dopamine

Front 133

vasopressor a/w:
high doses optimize the a1 vasoconstriction

Back 133

epinephrine

Front 134

vasopressor a/w:
ADH analogue

Back 134

vasopressin

Front 135

vasopressor a/w:
best choice for anaphylactic shock

Back 135

epinephrine

Front 136

vasopressor a/w:
septic shock

Back 136

NE

Front 137

vasopressor a/w:
best choice for cardiogenic shock

Back 137

dobutamine

Front 138

vasopressor a/w:
causes vasoconstriction but with bradycardia

Back 138

phenylephrine

Front 139

a swanz catheter is a good estimate of what pressure

Back 139

LA of heart

Front 140

what are the preferred vessels in the placement of swan ganz catheter

Back 140

R jugular

L subclavian

Front 141

what is seen on ECG of atrial flutter

Back 141

sawtooth pattern of p wave

Front 142

side effects of theophylline

Back 142

seizures with hyperthermia

hypotension

tachyarrhythmias

Front 143

Rx for kawasaki disease in acute phase

Back 143

IVIG + high-dose ASA

Front 144

what are common findings of basilar skull fracture

Back 144

racoon eyes (i.e. bruising around the eyes)

battle sign (i.e. bruising over mastoid)

hemotympanum (i.e. blood behind the TM's)

CSF rhinorrhea or otorrhea

Front 145

when is cushings triad seen and what are the components

Back 145

Triad seen with elevated ICP

HTN

Bradycardia

bradypnea

Front 146

how is elevated intracranial pressure managed

Back 146

elevate head of bed to 30 degrees

IV mannitol

intubate (pre-tx with lidocaine) & hyperventilate

decompressive craniectomy

other: ventriculostomy, barbiturate coma, paralysis

Front 147

what are the 3 categories of the Glasgow Coma Scale & the components/points for each

Back 147

EYE OPENING:
spontaneous (4)
to voice (3)
to pain (2)
none (1)

VERBAL RESPONSE
oriented (5)
confused (4)
inappropriate words (3)
incomprehensible (2)
none (1)

MOTOR RESPONSE
obeys command (6)
localizes pain (5)
withdraws from pain (4)
flexion with pain (3)
extension with pain (2)
none (1)

Front 148

heart disease a/w:
ST segment elevation in leads corresponding to the perfusion of multiple arteries (i.e. "diffuse")

Back 148

acute pericarditis

Front 149

heart disease a/w:
hypotension, distant heart sounds, distended neck veins

Back 149

cardicac tamponade

Front 150

heart disease a/w:
cardiac cath shows equal pressures in all heart chambers

Back 150

constrictive pericarditis

Front 151

heart disease a/w:
chest pain that is relieved by leaning forward

Back 151

acute pericarditis

Front 152

what is the next step in evaluating a pulsitile abdominal mass and bruit

Back 152

abdominal US

Front 153

what is the treatment for ventricular fibrillation

Back 153

immediate cardioversion --> ACLS protocol

Front 154

what are the different zones of the neck & structures contained in each zone

Back 154

ZONE I: clavicle --> cricoid cartilage
great vessels, aortic arch
cervical spine, spinal cord, cervical nerve roots
lung apices, trachea, esophagus

ZONE 2: cricoid cartilage --> angle of mandible
carotid & vertebral arteries, jugular veins
cervical spine, spinal cord
pharynx, larynx, trachea, esophagus

ZONE 3: angle of mandible --> base of skull
carotid arteries, jugular veins
cervical spine, major cranial nerves
salivary & parotid glands, trachea, esophagus

Front 155

what is initial w/u to penetrating injury to the neck when platysma has been violated

Back 155

IMMEDIATE:
ABC's, O2, 2 large bore IV's, type & cross blood

IF UNSTABLE:
OR STAT if unstable, obvious bleeding, or rapidly expanding hematoma

IF STABLE:
prophylactic AB's (incr'd risk of contamination from oropharyngeal flora)

follow protocol for each zone

Front 156

protocol tx:
stable pt with Zone I neck injury where platysma has been breached

Back 156

prophylactic AB's

ASSESS:
4-vessel arteriogram (CTA)
triple endoscopy

Front 157

protocol tx:
stable pt with Zone II neck injury where platysma has been breached

Back 157

prophylactic AB's

surgical exploration

Front 158

protocol tx:
stable pt with Zone III neck injury where platysma has been breached

Back 158

prophylactic AB's

Assess w/ 4-vessel arteriogram (CTA)

Front 159

what is included in a triple endoscopy

Back 159

broncoscopy

laryngoscopy

esophagoscopy

Front 160

what CXR findings might indicate a ruptured thoracic aorta

Back 160

widened mediastinum

loss of aortic knob

pleural cap

deviation of trachea & esophagus to the right

depression of the left main stem bronchus

Front 161

what is the next step in a patient with chest trauma, hypotension, JVD, and distant heart sounds

Back 161

dx = cardiac tamponade

pericardiocentesis

pericardial window

Front 162

what are the signs of tension pneumothorax (PTX)

Back 162

absent breathe sounds

hyperresonance on side of PTX

distended neck veins

hypotension

deviation of trachea away from side with PTX

Front 163

how is a tension pneumothorax Rx

Back 163

immediate chest tube placement

if delay in chest tube, needle decompression

Front 164

what is proper location to place needle for tension pneumothorax

Back 164

2nd or 3rd midclavicular IC space

5th midaxillary IC space

Front 165

what is a flail chest

Back 165

area of chest wall that moves paradoxically (i.e. inward motion with inspiration) to the rest of the chest wall

results from 3 or more sequential rib fractures

Front 166

what is tx for flail chest

Back 166

O2 supplementation

close monitoring for early signs of respiratory compromise

BiPAP by mask
(or by endotracheal intubation w/mech vent)

analgesia

Front 167

initial w/u:
abdominal stab wound

Back 167

ABC's

ABDOMINAL EXAM

Front 168

next step:
abdominal stab wound
ABC'S --> hypotensive

Back 168

emergent laparotomy/surgical exploration

Front 169

next step:
abdominal stab wound
ABDOMINAL EXAM --> signs of peritonitis

Back 169

emergent laparotomy/surgical expoloration

Front 170

next step:
abdominal stab wound
normotensive
no signs of peritonitis

Back 170

EXPLORE STAB WOUND UNDER LOCAL ANESTHESIA:
if anterior fascia is penetrated -->
dx'c laparoscopy

if anterior fascia is not penetrated or unable to assess --> admit for serial 24 hr exams

Front 171

initial w/u:
blunt abdominal trauma
stable vitals

Back 171

ABC's, 2 large bore IV's

CT of abdomen/pelvis

Front 172

initial w/u:
blunt abdominal trauma
unstable vitals

Back 172

ABC's, 2 large bore IV's

assess for & manage pelvic fracture

FAST Ultrasound
(Focused Assessment with Sonography for Trauma)

Front 173

next step:
blunt abdominal trauma
unstable vitals
FAST shows no fluid/blood in pelvis

Back 173

angiography with possible embolization
(possible retroperitoneal hemorrhage)

Front 174

next step:
blunt abdominal trauma
unstable vitals
FAST shows no fluid/blood in pelvis
angiography normal

Back 174

CT abd/pelvis

observation

+/- admission

Front 175

next step:
blunt abdominal trauma
unstable vitals
FAST shows fluid/blood in pelvis

Back 175

emergent laparotomy

Front 176

next step:
blunt abdominal trauma
unstable vitals
FAST is inconclusive

Back 176

Dx'c peritoneal lavage (DPL)

Front 177

next step:
blunt abdominal trauma
unstable vitals
FAST shows fluid/blood in pelvis

Back 177

emergent laporotomy

Front 178

initial w/u:
pelvic fracture

Back 178

ABC's, primary/secondary survey, with thorough neurovascular exam

IVF's +/- blood

FAST

pelvic binder (until external fixator is placed)

Front 179

next step:
pelvic fracture
FAST inconclusive or shows no fluid in pelvis

Back 179

Dx'c peritoneal lavage (DPL)

Front 180

next step:
pelvic fracture
FAST inconclusive or shows no fluid in pelvis
dx'c peritoneal lavage (DPL) shows nothing hemodynamic instability

Back 180

angiography with possible embolization

Front 181

next step:
pelvic fracture
FAST inconclusive or shows no fluid in pelvis
dx'c peritoneal lavage (DPL) shows urine in pelvis

Back 181

urgent laporotomy

Front 182

next step:
pelvic fracture
FAST inconclusive or shows no fluid in pelvis
dx'c peritoneal lavage (DPL) shows blood in pelvis

Back 182

emergent laporotomy

Front 183

what are some common signs of urethral injury

Back 183

blood in urethral meatus

high riding "ballotable" or nonpalpable prostate

scrotal or penile hematoma

Front 184

what study can help diagnose injury to the urethra

Back 184

retrograde cystourethrogram

Front 185

how can a bladder injury be diagnosed

Back 185

CT cystogram or cystography

Front 186

what are the 2 classifications of bladder injury determined by CT cystogram

Back 186

EXTRAPERITONEAL:
below dome of bladder
usually 2nd/2 pelvic fxr or penetrating trauma
CT: variable path of extavasated contrast material
(i.e. urine in the pelvis only)

INTRAPERITONEAL:
involving dome of bladder
CT: intraperitoneal contrast material around bowel loops, b/w mesenteric folds, & in the paracolic gutters (i.e. urine in the pelvis AND peritoneum)

Front 187

what is tx for bladder rupture

Back 187

EXTRAPERITONEAL:
foley catheter x 10 - 14 days
(will resolve on its own)

INTRAPERITONEAL:
urgent (not emergent) laparotomy for definitive bladder repair

Front 188

what type of immunodifeiciency increases the risk of anaphylactic transfusion reaction

Back 188

IgA deficiency

Front 189

what would you find on physical exam of a pt with pericardial effusion

Back 189

diminished heart sounds

apical impulse is difficult to palpate

Front 190

A pt comes to the ER with chronic A-fib with RVR. What study must be performed prior to cardioversion

Back 190

TEE

Front 191

what antibiotic prophylaxis should be provided for rape victims; what other prophylactic measures should also be given

Back 191

ANTIBIOTIC COVERAGE:
Gonorrhea
Chlamydia
Trichomonas
Hep B vaccine (#1 of 3 if not given) +/- Hep B Ig
HIV prophylaxis

OTHER:
emergency contraception (plan B)
antiemetic (for nausea 2nd/2 HIV meds)

Front 192

Rx for gonorrhea

Back 192

ceftriaxone

Front 193

Rx for chlamydia

Back 193

azithromycin

doxycycline

Front 194

Rx for trichomonas

Back 194

metronidazole

Front 195

what should be done to evaluate an extremity trauma

Back 195

full sensory, motor, & vascular exam

Front 196

Since bleeding b/w the fetus & mother is a concern in trauma, what actions should be taken once the pt & fetus are stabilized

Back 196

administer Rhogam to Rh- mothers

Front 197

what antidepressant causes hypertensive crisis

Back 197

MAOI

Front 198

what substance shouldn't be eaten while taking MAOIs

Back 198

tyramine

Front 199

what is seen on a EKG of hypothermia

Back 199

j wave (small upward deflection after the QRS)

Front 200

physical findings of endocarditis

Back 200

fever
new heart murmur
janeway lesions
osler's nodes
roth spots
splinter hemorrhages
conjunctival hemorrhages

Front 201

when is the greatest risk for post-op MI

Back 201

first 48 hours

Front 202

what is recommended perioperatively to a px with known CAD

Back 202

telemetry monitoring

Front 203

what lab findings suggest hepatic disease during pre-operative work up

Back 203

increase PT/PTT
decreased platelets
increased bilirubin
decreased albumin

Front 204

what interventions help optimize lung function in the post-op period

Back 204

ALL PT'S:
incentive spirometry
pain control
deep breathing
PT

PRE-EXISTING LUNG DS:
+ bronchodilators
+ inhaled steroids

Front 205

what studies are ordered to evaluate the cause of a fever in a post-op pt

Back 205

CXR & sputum culture

UA & culture

blood culture

examine surgical wound +/- wound culture

Front 206

Dx
px with blood in urethral meatus of a high riding prostate

Back 206

bladder rupture
OR
urethral injury

Front 207

what can help measure how severe hypotension is in shock

Back 207

urine output & mental status

Front 208

MCC's of abd'l obstruction

Back 208

"ABC"

adhesion
"bulge" = hernia
cancer

Front 209

what is the typical ER lab w/u for pt with acute abd'l pain

Back 209

"SHOT-GUN" APPROACH:
CBC w/ diff, BMP
UA (UTI's/pyelo), urine B-HCG (if childbearing age)
FOBT
LFT's, amylase, lipase
EKG & cardiac enzymes (if > 45 y/o)

Front 210

signs/sx's of ACUTE mesenteric ischemia

Back 210

sudden severe abdominal pain (periumbilical) that is out-of-proportion to the physical exam

vomiting & diarrhea (usually bloody)

EARLY PE: abd'l distension, +/- occult blood in stool

LATE PE: abd'l distension, absent BS's, peritoneal signs, feculent odor to the breath

Front 211

tx for acute mesenteric ischemia

Back 211

broad spectrum AB's

NG tube decompression

angiogram (dx'c & tx)

heparin anticoag

papaverine infusion

if embolism -->
embolectomy + resection of necrotic bowel

if thrombus -->
thrombectomy + resection of necrotic bowel

Front 212

what does papaverine do when given to a px with mesenteric ischemia

Back 212

decreases arterial vasospasm

Front 213

classic signs/sx's of CHRONIC mesenteric ischemia

Back 213

dull, crampy postprandial epigastric pain within the 1st hour after eating then subsides over 2 hours

"food fear" --> wt loss

possibly n/v & early satiety

abd'l bruit (50%)

Front 214

Rx for chronic mesenteric ischemia

Back 214

SAME AS TX FOR ATHEROSLEROSIS ANYWHERE:
bypass
endarterectomy
angioplasty & stenting

Front 215

what is seen on an xray or CT that indicates a ruptured viscus

Back 215

"viscus" = internal organ

Xray/CT: pneumoperitoneum
(i.e. free air under the diaphragm)

Front 216

which rejection is treatable with immunosuppressives

Back 216

acute rejection

Front 217

what is the mechanism of acute rejection

Back 217

proliferation of antidonor T-cells by recepient

Front 218

what time period does acute rejection occur

Back 218

6 days to 1 year, post-transplant