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16 Cards in this Set

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15 y/o M is found unresponsive at a party. No history of trauma. BP 100/60, HR 40, RR 12, Temp 98.6. Physical exam is remarkable for the absences of a gag reflex with some vomit present in his mouth, normal sized reactive pupils, bradycardia, and GCS 3. Cardiac monitor reveals narrow complex sinus bradycardia; BG is nl, no response to naloxone. Pt is intubated for airway protection. CT brain is normal. Ethanol is 20 mg/dl on arrival. He remains comatose for the next 5 hours but then suddenly awakens, pulls his ET tube out and attempts to leave. Which of the following agents induces toxicity that is most consistent with this presentation?

A. Carisoprodol
B. Flunitrazepam
C. GHB
D. MDMA
E. Oxycodone, sustained release
C. GHB

-Leads to ataxia, sedation, respiratory depression, coma, apnea, death
-Used for date rape d/t rapid coma induction
-Non-hemodynamically compromising sinus bradycardia and mild hypothermia are common
-Rapid recovery of consciousness from deep CNS sedation
A 40 y/o M passed out while using a gas-powered cement cutter in his garage with the doors closed. His wife called 911; paramedics placed him on oxygen with a non rebreather mask and transported him to the emergency department. On arrival he says he has only nausea and a mild headache. A venous blood COHb of 20% confirms carbon monoxide poisoning; detailed neurologic examination is normal. The hospital’s hyperbaric oxygen chamber is available. What is the rationale for using the hyperbaric chamber to treat this patient?

A. To correct presumed associated metabolic alkalosis more rapidly
B. To decrease the COHb level more rapidly
C. To decrease the likelihood of death
D. To decrease the likelihood of delayed neurologic sequelae
E. To prevent the development of cardiac dysrhythmias
D. Decrease neurologic sequelae

Hyperbaric oxygen:
-May prevent lipid peroxidation
-Decrease risk of developing neurologic sequelae
-No evidence that it reduces mortality or decreases risk of ventricular dysrhythmias
-More rapidly decrease COHb levels
-More rapidly corrects metabolic acidosis associated with CO poisoning
In which of the following situations of known methanol ingestion are both administration of fomepizole and performance of hemodialysis indicated?

A. pH/PCO2 7.10/10, methanol 0 mg/dl, ethanol 0 mg/dl
B. pH/PCO2 7.10/10, methanol 10 mg/dl, ethanol 300 mg/dl
C. pH/PCO2 7.10/10, methanol 30 mg/dl, ethanol 30 mg/dl
D. pH/PCO2 7.40/40, methanol 50 mg/dl, ethanol 10 mg/dl
E. pH/PCO2 7.40/40, methanol 200 mg/dl, ethanol 300mg/dl
C. pH/PCO2 7.10/10, methanol 30 mg/dl, ethanol 30 mg/dl
A 47 y/o M with bipolar disorder presents with confusion, tremulousness, and hyperreflexia. Regarding the agent that the patient is most likely poisoned from, which of the following is correct?

A. Activated charcoal is effective at decreasing the serum half-life
B. Chronic toxicity is usually the result of renal failure or intravascular volume depletion
C. CNS symptoms correlate well with serum levels
D. DM is a complication of long term therapy
E. It is associated with neuroleptic malignant syndrome
B. Chronic toxicity is the result of renal failure and intravascular volume depletion

Lithium poisoning:
-Confusion, tremor, hyperreflexia
-Narrow therapeutic window
-Causes hypothyroidism and DI (not DM)
-An adverse drug interaction precipitates serotonin syndrome (not neuroleptic malignant syndrome)
With regard to salicylate poisoning, which of the following is correct?

A. A negative plain x-ray excludes the presence of enteric coated or sustained release ASA in the GIT
B. Ensuring hypoventilation after intubation is critical in management
C. Reversible sensorineuronal hearing loss correlates with serum salicylate levels
D. The Done nomogram is essential in guiding therapy
E. Urinary pH is a determinant of mortality
C. Reversible sensorineuronal hearing loss correlates with serum salicylate levels

-ASA is hydrolyzed to salicylic acid
-Activated charcoal is effective
-Plain X-ray can potentially identify enteric coated or sustained release
-Primary respiratory alkalosis is common
-Must hyperventilate if you intubated. If not leads to respiratory acidosis and serve acidemia
Which of the following statements regarding drugs of abuse panels are correct?

A. A positive amphetamine screen is specific for methamphetamine
B. A positive test confirms intoxication
C. Generally more helpful clinically in adults than in children
D. Medically indicated for most patients who present to the ER with suicidal ideation
E. Rarely contributes significantly to the evaluation, management, or outcome of emergency department patients
E. Rarely contributes significantly to the evaluation, management, or outcome of emergency department patients

For psych only
A 33 y/o F presents 7 hours after ingesting, according to her boyfriend, “about 30” Extra Strength Tylenol. She is asymptomatic. Acetaminophen level testing is ordered, but results will not be available for 2 hours. Which of the following treatment strategies is most appropriate?

A. Administer activated charcoal
B. Administer the initial dose of N-acetyl-L-cysteine
C. Cancel the test and get psych consult
D. Perform gastric lavage and administer activate charcoal
E. Take no action pending test results
B. Administer the initial dose of N-acetyl-L-cysteine

-Decontamination with charcoal not effective after 2 hours
-APAP rapidly absorbed
Peak serum levels within 2 hours
-Therapy based on serum levels
-100% effective in preventing hepatotoxicity if given within 8 hours
A 28 y/o M presents complaining of withdrawal symptoms. He is yawning and sneezing; PE reveals mydriasis and piloerection. Which of the following statements regarding withdrawal symptoms is correct?

A. Altered level of consciousness is typical
B. Clonidine is an effective treatment
C. Convulsions occasionally occur
D. Inpatient therapy is required
E. Buprenorphine administration is contraindicated
B. Clonidine is an effective treatment

Clonidine – nonopioid
Effective at decrease noradrenergic activity
Both neuroleptic syndrome and serotonin syndrome:

A. Are characterized by hyperreflexia and clonus
B. Have specific test to confirm diagnosis
C. Occur soon after initiating drug administration
D. Typically occur after overdose
E. Are characterized by autoimmune instability and neuromuscular abnormalities
E. Are characterized by autoimmune instability and neuromuscular abnormalities

-NMS – occurs after the administration of dopamine antagonists or from abrupt withdrawal of dopamine agonists
-Can occur at any time
-Not typically due to
overdose
-Serotonin syndrome – from stimulation of serotonin receptors
-Typically soon after
initiation of drug or 2nd
serotonergic agent
-Not typically due to
overdose
A 2 y/o boy is brought to the ED by his parents immediately after he was discovered “eating a few of his grandmother’s pills”. The grandmother, who is visiting from out of town, keeps her pills in an unlabeled, multi-compartment plastic container that organizes her medication by the day of the week. The parents think the boy ingested 1 day’s worth of pills. He is asymptomatic. Which of the following is the next best step?

A. Administer activated charcoal along with flavoring agent
B. Feed the child syrup of ipecac to induce emesis
C. Have the child ingest sorbitol to induce osmotic catharsis
D. Initiate whole bowel irrigation with polyethylene gylcol
E. Perform gastric lavage with room temperature isotonic saline
A. Administer activated charcoal along with flavoring agent

Activated charcoal has the best effect for unknown recent ingestion
Absorbs 75% of toxin within 1 hour
Not effective for – alcohols, hydrocarbons, metals, and minerals
Paramedics covering a marathon event call in for medical direction in their care of a runner who collapsed halfway through a race. He is disoriented and slightly diaphoretic and has a rectal temp of 105.8. Rapid diagnostic testing reveals normal serum sodium and blood glucose. They are 1 hour away from the nearest emergency department. What is the most effective immediate treatment?

A. Administer acetaminophen
B. Perform ice water immersion
C. Place him in the shade until he recovers
D. Place ice packs to his axillae and groin
E. Transport to the ED, where evaporative cooling can be preformed
B. Perform ice water immersion

-Cooling is the treatment
-Initiate immediately
-Evaporative cooling is preferred
-Military studies show efficacy of ice water immersion (Can be used prehospital)
Regarding submersion injuries, which of the following is correct?

A. Complete recovery in 48 hours is typical if they never require CPR
B. Electrolyte measurements should be routine
C. Prophylactic antibiotics are usually indicated
D. The Heimlich maneuver is of proven efficacy in removing aspirated fluid
E. Prolonged attempts at resuscitation of asystolic pediatric patients after warm water submersion should be pursued
A. Complete recovery in 48 hours is typical if they never require CPR

-Electrolyte abnormality only seen in aspiration of high solute concentrations (Dead Sea)
-Heimlich only useful to clear particulate matter
-Bacterial pneumonia rare
-No prophylactic antibiotics
-Prolonged CPR in asystole after ice water submersion reasonable
-Asystole in warm water submersion is a sign poor prognosis for CNS recovery
A 4 y/o boy presents after sticking a fork into a home electrical outlet with his right hand and getting shocked. His right elbow was on the ground at the time. Although he cried initially, he has remained asymptomatic. Physical examination reveals two extremely small first-degree burns on his right hand and elbow; a 12 lead ECG is normal.

A. Admit to a monitored bed for 24 hours
B. Admit to a non-monitored bed for serial peripheral vascular examinations
C. Discharge home
D. Perform echocardiography in the ED
E. Observe in the ED for 6 hours; if no dysrhythmias occur, discharge home
C. Discharge home

High voltage >600 V
-All these patients should be admitted
-Even if initial ECG is normal

Household range = 110 to 220V
-Asymptomatic and normal ECG can be discharged home
-May admit is transthoracic current exposure
Which of the following statements regarding lightning strikes is correct?

A. Absence of pupil reactivity is a reliable examination finding to help confirm brain death
B. In mass casualty incidents cardiopulmonary arrest victims mandate highest priority
C. Lower extremity paralysis is common
D. Most common cause of death is intracranial injury
E. Vitreous hemorrhage is the most frequent observed ocular sequelae
B. In mass casualty incidents cardiopulmonary arrest victims mandate highest priority

-Resuscitation from cardiac arrest is reversible
-Cardiac arrest is most common cause of death
-Almost all who don’t suffer cardiac arrest will survive
-Respiratory paralysis can outlast cardiac arrest in lightening strike victims
A 56 y/o M is brought in by the police after he was found under a bridge on a winter night. His core temperature is 30°C. Which of the following findings is likely to be seen?

A. Anemia
B. Pinpoint pupils
C. Shivering
D. Tachypnea
E. Urinary diuresis
E. Urinary diuresis

-Diuresis occurs secondary to increased renal flow
-Increased peripheral vascular resistance
-Blood shunted centrally
-Progressive loss of resorptive function electrolytes and water
With regard to mammalian bites, which of the following statements are correct?

A. Antibiotic prophylaxis is indicated in all human bites
B. Considerable evidence supports antibiotic prophylaxis for both dog and cat bites
C. Evidence fails to support prophylactic antibiotics for hand bites
D. Infection rates are higher for dog bites than cat bites
E. Infection rates are higher for bites on the face than on the hand
A. Antibiotic prophylaxis is indicated in all human bites

-Infection rate is higher in bites to hand
-Antibiotics for bites to hand
-Infection rates from human bites are higher than from cat bites
-Antibiotics for human bites
-Infection rate for cat bites are higher than dog bites
-Augmentin is optimal
-ceftriaxone or cefotaxime for pen-allergic for cat and dog bites
clindamycin or bactrim for human bites