Emergency Medicine

Front 1

Q001. ACEIs; Toxicity

Back 1

A001. Cough; rash; proteinuria; angioedema; taste changes; teratogenic effects

Front 2

Q002. Amantadine; Toxicity

Back 2

A002. Ataxia; livedo reticularis

Front 3

Q003. Aminoglycosides; Toxicity

Back 3

A003. Ototoxicity; nephrotoxicity - ATN

Front 4

Q004. Amiodarone; Toxicity

Back 4

A004. Pulmonary fibrosis; peripheral deposition => bluish discoloration,; arrhythmias,; hypo-/hyperthyroidism,; corneal deposition

Front 5

Q005. Amphotericin; Toxicity

Back 5

A005. Fever/chills; nephrotoxicity; bone marrow suppression; anemia

Front 6

Q006. Antipsychotics; Toxicity

Back 6

A006. Sedation; acute dystonic reaction; akathisia; parkinsonism; tardive dyskinesia; neuroleptic malignant syndrome

Front 7

Q007. Azoles (e.g., fluconazole); Toxicity

Back 7

A007. Inhibition of P-450 enzymes

Front 8

Q008. AZT; Toxicity

Back 8

A008. Thrombocytopenia; megaloblastic anemia

Front 9

Q009. β-blockers; Toxicity

Back 9

A009. Asthma exacerbation; masking of hypoglycemia; impotence

Front 10

Q010. Benzodiazepines; Toxicity

Back 10

A010. Sedation; dependence; respiratory depression

Front 11

Q011. Bile acid resins; Toxicity

Back 11

A011. GI upset; malabsorption of vitamins; and medications

Front 12

Q012. Calcium channel blockers; Toxicity

Back 12

A012. Peripheral edema; constipation; cardiac depression

Front 13

Q013. Carbamazepine; Toxicity

Back 13

A013. Induction of P-450 enzymes; agranulocytosis; aplastic anemia

Front 14

Q014. Chloramphenicol; Toxicity

Back 14

A014. Gray baby syndrome; aplastic anemia

Front 15

Q015. Cisplatin; Toxicity

Back 15

A015. Nephrotoxicity; acoustic nerve damage

Front 16

Q016. Clonidine; Toxicity

Back 16

A016. Dry mouth; severe rebound headache; hypertension

Front 17

Q017. Clozapine

Back 17

A017. Agranulocytosis

Front 18

Q018. Corticosteroids; Toxicity

Back 18

A018. Mania (acute) immunosuppression; bone mineral loss; thinning of skin; easy bruising; myopathy (chronic); cataracts

Front 19

Q019. Cyclophosphamide; Toxicity

Back 19

A019. Myelosuppression; hemorrhagic cystitis

Front 20

Q020. Digoxin -; Toxicity

Back 20

A020. GI disturbance; yellow-green visual changes; arrhythmias - junctional tachycardia or SVT,; varying amounts of AV node blocks

Front 21

Q021. Doxorubicin -; Toxicity

Back 21

A021. Cardiotoxicity; (dilated cardiomyopathy)

Front 22

Q022. Ethyl alcohol -; Toxicity

Back 22

A022. Renal dysfunction

Front 23

Q023. Fluoroquinolones; Toxicity

Back 23

A023. Cartilage damage in children Achilles tendon rupture

Front 24

Q024. Furosemide; Toxicity

Back 24

A024. Ototoxicity; hypokalemia; nephritis

Front 25

Q025. Gemfibrozil; Toxicity

Back 25

A025. Myositis; reversible ↑ in LFTs

Front 26

Q026. Halothane; Toxicity

Back 26

A026. Hepatotoxicity; malignant hyperthermia

Front 27

Q027. HCTZ; Toxicity

Back 27

A027. Hypokalemia; hyperuricemia; hyperglycemia

Front 28

Q028. HMG-CoA reductase inhibitors; Toxicity

Back 28

A028. Myositis; reversible ↑ in LFTs

Front 29

Q029. Hydralazine; Toxicity

Back 29

A029. Drug-induced SLE

Front 30

Q030. Hydroxychloroquine; Toxicity

Back 30

A030. Retinopathy

Front 31

Q031. INH -; Toxicity

Back 31

A031. Peripheral neuropathy - prevent with vitamin B6; hepatotoxicity; inhibition of P-450 enzymes; seizures with overdose

Front 32

Q032. MAOIs -; Toxicity

Back 32

A032. Hypertensive tyramine reaction; serotonin syndrome - with meperidine

Front 33

Q033. Methanol; Toxicity

Back 33

A033. Blindness

Front 34

Q034. Methotrexate; Toxicity

Back 34

A034. Hepatic fibrosis; pneumonitis; anemia

Front 35

Q035. Methyldopa; Toxicity

Back 35

A035. Pos. Coombs’ test; drug-induced SLE

Front 36

Q036. Metronidazole; Toxicity

Back 36

A036. Disulfiram reaction; vestibular dysfunction; metallic taste

Front 37

Q037. Niacin; Toxicity

Back 37

A037. Cutaneous flushing

Front 38

Q038. Nitroglycerin; Toxicity

Back 38

A038. Hypotension; tachycardia; headache; tolerance

Front 39

Q039. Penicillin/β-lactams ; Toxicity

Back 39

A039. Hypersensitivity reactions

Front 40

Q040. Penicillamine; Toxicity

Back 40

A040. Drug-induced SLE

Front 41

Q041. Phenytoin; Toxicity

Back 41

A041. Nystagmus; diplopia; ataxia; gingival hyperplasia; hirsutism

Front 42

Q042. Prazosin -; Toxicity

Back 42

A042. First-dose hypotension

Front 43

Q043. Procainamide; Toxicity

Back 43

A043. Drug-induced SLE

Front 44

Q044. Propylthiouracil; Toxicity

Back 44

A044. Agranulocytosis

Front 45

Q045. Quinidine; Toxicity

Back 45

A045. Cinchonism -; (headache, tinnitus); thrombocytopenia; arrhythmias - torsades de pointes

Front 46

Q046. Reserpine; Toxicity

Back 46

A046. Depression

Front 47

Q047. Rifampin; Toxicity

Back 47

A047. Induction of P-450 enzymes; orange-red body secretions

Front 48

Q048. Salicylates; Toxicity

Back 48

A048. Fever; hyperventilation with; respiratory alkalosis; and metabolic acidosis; dehydration; diaphoresis; hemorrhagic gastritis

Front 49

Q049. SSRIs; Toxicity

Back 49

A049. Anxiety; sexual dysfunction

Front 50

Q050. Succinylcholine; Toxicity

Back 50

A050. Malignant hyperthermia

Front 51

Q051. Tetracyclines; Toxicity

Back 51

A051. Tooth discoloration; photosensitivity; Fanconi’s syndrome

Front 52

Q052. TCAs; Toxicity

Back 52

A052. Sedation; coma; anticholinergic effects; seizures; wide QRS; in severe cases - prolonged QT => torsade

Front 53

Q053. Valproic acid; Toxicity

Back 53

A053. Teratogenicity => neural tube defects

Front 54

Q054. Vancomycin; Toxicity

Back 54

A054. Nephrotoxicity; ototoxicity; “red man syndrome” - histamine release, not an allergy

Front 55

Q055. Vinblastine; Toxicity

Back 55

A055. Severe myelosuppression

Front 56

Q056. Vincristine; Toxicity

Back 56

A056. Peripheral neuropathy

Front 57

Patient presents within one hour of acute single acetaminophen overdose. What is the Antidote?

Back 57

- Activated charcoal up to one hour after ingestion
- draw a 4-hour serum APAP concentration
- treat with N-acetylcysteine (NAC) according to the Rumack-Matthew nomogram

Front 58

Q058. Acid/alkali ingestion; What is the Antidote

Back 58

A058. Upper endoscopy to evaluate for stricture

Front 59

Q059. Anticholinesterases,; organophosphates; What is the Antidote

Back 59

A059. Atropine; pralidoxime

Front 60

Q060. Antimuscarinic/; anticholinergic agents; What is the Antidote

Back 60

A060. Physostigmine

Front 61

Q061. Arsenic, mercury, gold; What is the Antidote

Back 61

A061. Succimer; dimercaprol

Front 62

Q062. β-blockers; What is the Antidote

Back 62

A062. Glucagon

Front 63

Q063. Barbiturates (phenobarbital); What is the Antidote

Back 63

A063. Urine alkalinization (bicarb); dialysis; activated charcoal

Front 64

Q064. Benzodiazepines; What is the Antidote

Back 64

A064. Flumazenil

Front 65

Q066. Carbon monoxide -; What is the Antidote

Back 65

A066. 100% O2; hyperbaric O2

Front 66

Q067. Copper, arsenic, lead, gold -; What is the Antidote

Back 66

A067. Penicillamine

Front 67

Q068. Cyanide -; What is the Antidote

Back 67

A068. Nitrite; sodium thiosulfate

Front 68

Q069. Digitalis -; What is the Antidote

Back 68

A069. Stop digitalis,; normalize K+,; lidocaine (for torsades), anti-digitalis Fab

Front 69

Q070. Heparin -; What is the Antidote

Back 69

A070. Protamine sulfate

Front 70

Q071. Iron salts -; What is the Antidote

Back 70

A071. Deferoxamine

Front 71

Q072. Lead -; What is the Antidote

Back 71

A072. Succimer; CaEDTA; dimercaprol

Front 72

Q073. Methanol, ethylene glycol (antifreeze); What is the Antidote

Back 72

A073. EtOH; fomepizole; dialysis

Front 73

Q074. Methemoglobin; What is the Antidote

Back 73

A074. Methylene blue

Front 74

Q075. Opioids; What is the Antidote

Back 74

A075. Naloxone

Front 75

Q076. Phencyclidine hydrochloride (PCP); What is the Antidote

Back 75

A076. NG suction

Front 76

Q077. Salicylates -; What is the Antidote

Back 76

A077. Urine alkalinization; dialysis; activated charcoal

Front 77

Q078. TCAs; What is the Antidote

Back 77

A078. Na bicarb - QRS prolongation; diazepam or lorazepam for Seizures; cardiac monitor for; arrhythmias

Front 78

Q079. Theophylline; What is the Antidote

Back 78

A079. Activated charcoal

Front 79

Q080. tPA, streptokinase; What is the Antidote

Back 79

A080. Aminocaproic acid

Front 80

Q081. Warfarin; What is the Antidote

Back 80

A081. Vitamin K, FFP

Front 81

Q082. Cardiac Life Support; What are the Basic Principles

Back 81

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

Front 82

Q083. Burns; Hx/PE

Back 82

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

Front 83

Q084. Burns; Dx; Rule of 9's

Back 83

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%

Front 84

Q085. Burns; Categories

Back 84

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

Front 85

Q086. Burns; Tx

Back 85

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

Front 86

Q087. Burns; Complications

Back 86

A087. Shock; superinfection - esp. Pseudomonas

Front 87

Q088. CO Poisoning; What is it

Back 87

A088. Hypoxemic poisoning syn causes; car exhaust; smoke inhalation; barbeque in poor ventilation; old appliances

Front 88

Q089. CO Poisoning; HX/PE

Back 88

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

Front 89

Q090. CO Poisoning; Dx

Back 89

A090. ABG; normal serum carboxyHb level - < 5% in nonsmokers, < 10% in smokers; laryngoscopy; bronchoscopy; EKG - elderly; history of cardiac dis.

Front 90

Q091. CO Poisoning; Tx

Back 90

A091. 100 O2 hyperbaric O2:; pregnant; neuro Sxs; severely ↑ carboxyHb; smoke inhalation - may need early intubation (before edema sets in)

Front 91

Q092. Aortic Disruption; What is it

Back 91

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

Front 92

Q093. Aortic Disruption; Dx

Back 92

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

Front 93

Q094. Aortic Disruption; Tx

Back 93

A094. OR emergently

Front 94

Q095. Aortic Dissection; What is it; Risk Factors

Back 94

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

Front 95

Q096. Aortic Dissection; Hx/PE

Back 95

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

Front 96

Q097. Aortic Dissection; Dx

Back 96

A097. CXR; CT with IV contrast; transesoph echo or; MRI/MRA or; angiography - gold standard; EKG

Front 97

Q098. Aortic Dissection; Tx

Back 97

A098. Stabilize HBP or low HBP; IV nitrates; B blockers; goal - systolic < 120, HR < 70; type A - emergent surgery; type B - med management

Front 98

Q099. Aortic Dissection; Complications

Back 98

A099. MI; CHF; cardiac tamponade; postop hemorrhage; future dissection; future aneurysm; death

Front 99

Q100. Postop Fever; What is it Caused By; (What are the 6 W's)

Back 99

A100. Wind - atelectasis, pneumonia; Water - UTI; Wound - abscess; Walk- DVT; Wonderdrug - drug reaction; Wire - catheter

Front 100

Q101. Postop Fever; How to Decrease Risk

Back 100

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

Front 101

Q102. Acute Abdomen; What is it

Back 101

A102. Abdom Sxs so severe; surgery should be considered; primary Sx - acute abdom pain

Front 102

Q103. Acute Abdomen; Hx/PE

Back 102

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

Front 103

Q104. Acute Abdomen; Character of Pain

Back 103

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

Front 104

symptoms of corneal abrasion

Back 104

pain out of proportion with exam, foreign-body sensation, photophobia

Front 105

Q105. Acute Abdomen; Dx

Back 105

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

Front 106

diagnostics for corneal abrasion

Back 106

fluorescein staining (cobalt blue light source via slit-lamp or Wood's lamp examination) reveals abraded area

Front 107

Q106. Acute Abdomen; Tx

Back 107

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

Front 108

treatment of corneal abration

Back 108

topical broad-spectrum antibiotics (genta, sulfacetamide, bacitracin) tetanus prophylaxis, oral analgesics

Front 109

Q107. Appendicitis; What is it

Back 109

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

Front 110

laterality of viral vs bacterial conjunctivitis

Back 110

viral is usually bilateral, bacterial is usually unilateral

Front 111

Q108. Appendicitis; Hx/PE

Back 111

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

Front 112

organisms causing bacterial conjunctivitis

Back 112

staph, strep, neisseria gonorrhea, chlamydia trachomatis (newborns and sexually active)

Front 113

Q109. Appendicitis; Dx

Back 113

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

Front 114

treatment of bacterial conjunctivitis

Back 114

staph and strep - topical 10% sulfacetamide or AG; N gonorrhea with IV ceftri and topical erythromycin or tetracycline; chlamydia - IV and topical erythromycin

Front 115

Q110. Appendicitis; Tx

Back 115

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

Front 116

PE findings in allergic conjunctivitis

Back 116

diffuse conjunctival injection with normal visual acuity, lid edema, cobblestone papillae under upper lid

Front 117

Q111. Appendicitis; Complications

Back 117

A111. Risk of perforation & mortality increased with amt of time have appendicitis; (at 48 hrs - 75% risk)

Front 118

treatment of allergic conjunctivitis

Back 118

topical antihistamine / vasoconstrictor preparations (naphazoline / pheniramine) or mast cell stabilizers (cromolyn or olopatadine); cool compresses

Front 119

Q112. Acute Management of Trauma Patient; "ABCDE"; What is "A"

Back 119

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

Front 120

how to differentiate alkali from acid chemical conjunctivitis

Back 120

litmus paper - coag necrosis with acid burns; liquefaction in alkali burns

Front 121

Q113. Acute Management of Trauma Patient; "ABCDE"; What is "B"

Back 121

A113. Breathing 5 thoracic causes of immed. death must not be missed:; tension pneumothorax; cardiac tamponade; open pneumothorax; massive hemothorax; airway obstruction

Front 122

treatment of chemical conjunctivitis

Back 122

copious irrigation with Morgan lens until pH neutral; tetanus prophylaxis

Front 123

Q114. Acute Management of Trauma Patient; "ABCDE"; What is "C"

Back 123

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)

Front 124

Q115. Acute Management of Trauma Patient; "ABCDE"; What is "D"

Back 124

A115. Disability; evaluate CNS dysfunction via Glasgow Coma Scale

Front 125

Q116. Acute Management of Trauma Patient; "ABCDE"; What is "E"

Back 125

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

Front 126

Q117. Pelvic Fractures; What are they

Back 126

A117. MC after trauma such as a MVA; needs immediate attention by orthopedist; potentially life-threatening

Front 127

Q118. Pelvic Fractures; Hx/PE

Back 127

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

Front 128

Q119. Pelvic Fractures; Tx

Back 128

A119. Embolize bleeding vessels; emergent external pelvic fixation; internal fixation if hemodynamically stable

Front 129

Q120. acute dystonia

Back 129

A120. involuntary muscle cont/spasm - torticollis, oculogyric crisis; Rx: anticholinergic (benztropine) or diphenhydramine; Prevent: prophylatic benztropine

Front 130

Q121. akathisia

Back 130

A121. subjective/objective restlessness; Rx: reduce neuroleptic, βblocker (propranolol), +/- benzos, anticholinergics

Front 131

Q122. dyskinesia

Back 131

A122. pseudoparkinsonism Rx:; anticholinergic (benztropine); or DA agonist (amantidine); reduce/stop neuroleptic or d/c

Front 132

Q123. tardive dyskinesia

Back 132

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

Front 133

Q124. Neuroleptic Malignant syndrome

Back 133

A124. fever; muscle rigidity; autonomic instability; clouded consciousness; ↑CPK, WBCs Rx:; stop neuroleptic; dantrolene/bromocriptine; IV fluids

Front 134

Q125. Evolution of EPS

Back 134

A125. 4 hours: acute dystonia; 4 days: akathisia; 4 weeks: akathisia; 4 months: tardive dyskinesia

Front 135

Q126. EtOH withdrawal syndrome

Back 135

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%

Front 136

Q127. EtOH withdrawal Rx including DTs

Back 136

A127. benzos* (DOC); haloperidol for hallucinations; clonidine, BBs for hyperadrenergic state; thiamine, folate, vitamens; replace lytes; IV fluids

Front 137

Q128. Barbituate withdrawal

Back 137

A128. anxiety; seizures; delerium; tremor; cardiac & respiratory depression; Rx: benzos

Front 138

Q129. Benzodiazepine withdrawal

Back 138

A129. rebound anxiety; seizures; tremor; instability; Rx: benzos

Front 139

Q130. Cocaine/amphetamine withdrawal

Back 139

A130. depression; hyperphagia; hypersomnolence; Rx: supportive, avoid BBs (results in excess uninhibited cardiac activation)

Front 140

Q131. Opioid withdrawal

Back 140

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

Front 141

Q132. Aortic disruption CXR

Back 141

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

Front 142

Q133. Arrhythmia Rx:; asystole

Back 142

A133. epi; atropine

Front 143

Q134. Arrhythmia Rx:; Vfib

Back 143

A134. desynchronized shock --> epi or vasopressin --> shock --> lido or amio --> shock --> procainamide or Mg

Front 144

Q135. Arrhythmia Rx:; VTach

Back 144

A135. if unstable/pulseless - desynchronized shock; if stable - lido or amio

Front 145

Q136. Arrhythmia Rx:; PEA

Back 145

A136. identify & Rx underlying; +/- epi +/or atropine

Front 146

Q137. Arrhythmia Rx:; Afib/flutter

Back 146

A137. if unstable shock at 100J; If stable, control rate (CCB, dig, BB); +/- rhythm conversion; anticoagulate

Front 147

Q138. Arrhythmia Rx:; SVT

Back 147

A138. Control rate; valsalva, carotid sinus massage, cold stimulation; adenosine (procainamide)

Front 148

Q139. Arrhythmia Rx:; bradycardia

Back 148

A139. if symptomatic consider atropine; if Mobitz II/AVB pace; Acutely, unstable - atropine/dopamine/dobutamine or transvenous pacing

Front 149

Q140. hypovolemic shock

Back 149

A140. ↓CO; ↓PCWP; ↑PVR

Front 150

Q141. cardiogenic shock

Back 150

A141. Causes:; tension PTX; cardiac tamponade; arrhythmia; structural hrt dz; MI; ↓CO; ↑PCWP; ↑PVR

Front 151

Q142. Septic shock

Back 151

A142. ↑CO; ↓PCWP; ↓PVR

Front 152

Q143. anaphylactic shock

Back 152

A143. ↑CO; ↓PCWP; ↓PVR

Front 153

Q144. Rx for malignant HTN

Back 153

A144. nitroprusside

Front 154

Q145. test to rule out urethral injury

Back 154

A145. retrograde cystourethrogram

Front 155

Q146. Radiographic indications for Sx in pts with acute abd

Back 155

A146. free air under diaphragm; extravasation of contrast; severe bowel distension; SOL; mesenteric occlusion (angiography)

Front 156

Q147. Cannon a waves

Back 156

A147. complete AVB

Front 157

Q148. signs of neurogenic shock

Back 157

A148. hypotension; bradycardia

Front 158

Q149. Cushing's triad

Back 158

A149. Signs of ↑ICP; HTN; bradycardia; abnormal respirations

Front 159

Q150. Signs of air embolism

Back 159

A150. pt with chest truma previously stable suddenly dies

Front 160

Q151. Organims/Rx of strep pharyngitis

Back 160

A151. Org: GAS, S. pneumo Rx:; Pen V; Amoxicillin; erythromycin

Front 161

Q152. Organisms causing sinusitis

Back 161

A152. S. pneumo; H. flu; M. catarrhalis; GAS; anaerobes; S. aureus

Front 162

Q153. Rx for sinusitis

Back 162

A153. 1st line – Amoxicillin (TMP-SMX if pen allergic); 2nd line - Amox/clav; 3rd line clarithromycin

Front 163

Q154. Acute OM pathogens

Back 163

A154. Viral; S. pneumo; H. flu; M. catarrhalis

Front 164

Q155. The nasopharyngeal airway can be used in which types of patients?

Back 164

A155. breathing semiconscious patients and when an oropharyngeal airway is technically challenging

Front 165

Q156. Prolonged use of a bag valve can lead to..?

Back 165

A156. Distention of the stomach increasing the chance of an aspiration event

Front 166

Q157. What are the steps of successful intubation?

Back 166

A157. 5P's Preparation, preoxygenation, pretreatment, paralysis, and placement

Front 167

Q158. How do you prepare for successful intubation?

Back 167

A158. IV access, monitors, suction, appropriate sized ET tube, and meds for rapid sequence intubation

Front 168

Q159. What pretreatment may be necessary in small children prior to intubation and why?

Back 168

A159. Atropine, to blunt the bradycardia induced by succinocholine

Front 169

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?

Back 169

A160. Reactive airway disease - lidocaine 1.5mg/kg; Pancuronium 0.01mg/kg

Front 170

Q161. What sedative agent is used prior to paralysis for intubation?

Back 170

A161. Etomidate 0.3mg/kg

Front 171

Q162. volar =?

Back 171

A162. palmar

Front 172

Q163. Physical Exam of emergency ortho...?

Back 172

A163. ROM; Palpation for subtle deformities well beyond the area of subjective pain; Neurovascular assessment

Front 173

Q164. Ulnar nerve palsy causes..?

Back 173

A164. Claw hand

Front 174

Q165. Inability to extend the knee could be caused by paralysis of which nerve?

Back 174

A165. Femoral nerve

Front 175

Q166. Early treatment of ortho emergencies?

Back 175

A166. NSAIDs; RICE (rest ice compression elevation); NPO; Reduction of long bone deformities

Front 176

Q167. Don't forget to give _____ for open fractures?

Back 176

A167. Tetanus

Front 177

Q168. In children with trauma to a joint, what is important to consider on imaging?

Back 177

A168. Comparison to the opposite extremity - difficult to tell the difference between a fracture and an epiphyseal growth plate

Front 178

Q169. Compartment syndrome defined?

Back 178

A169. When the pressure in a compartment exceeds the arterial perfusion pressure

Front 179

Q170. Most reliable sign of compartment syndrome?

Back 179

A170. Paresthesia

Front 180

Q171. ARDS, neuro involvement, and thrombocytopenia post- closed fractures in leg..?

Back 180

A171. Fat embolism

Front 181

Q172. If you land directly on your shoulder, and hit hurts to reach across your body, what is the injury?

Back 181

A172. Acromioclavicular joint separation

Front 182

Q173. when does Acromioclavicular joint separation require surgery?

Back 182

A173. type iv or higher (when the clavicle is displaced into surrounding areas)

Front 183

Q174. 96% of shoulder dislocations are...?

Back 183

A174. Anterior shoulder dislocations

Front 184

Q175. how does the patient with an Anterior shoulder dislocation appear?

Back 184

A175. holding arm in slight abduction and external rotation

Front 185

Q176. What is the most common fracture in Aneterior shoulder dislocations? what nerve should be tested?

Back 185

A176. Hill-Sachs deformity - fracture of the posterolateral aspect of the humeral head; Test the axillary nerve

Front 186

Q177. Posterior dislocations are caused by...? always associated with...?

Back 186

A177. fall on outstretched hand, convulsive seizure. Associated with Hill Sachs deformity

Front 187

Q178. Most common mechanism of acute rotator cuff tear? This injury impairs which movement?

Back 187

A178. Forced abduction. Impairs arm abduction to 30 degrees

Front 188

Q179. What important structures travel with the humerus?

Back 188

A179. The deep brachial artery and the radial nerve

Front 189

Q180. Who gets supracondylar fractures? how?

Back 189

A180. Kids < 15. Falling backwards on an outstretched hand

Front 190

Q181. Posterior fat pad sign indicates?

Back 190

A181. In adults - radial head fracture; In kids - supracondylar fracture

Front 191

Q182. What is fracture of the proximal 1/3 of the ulna with radial head dislocation called?

Back 191

A182. Monteggia fracture

Front 192

Q183. What is fracture of the distal 1/3 of radius with dislocation of the distal radioulnar joint called?

Back 192

A183. Galeazzi

Front 193

Q184. Causes of carpal tunnel?

Back 193

A184. RA, hypothyroid, DM, collagen vascular diseases

Front 194

Q185. Phalen's test?

Back 194

A185. Fully flex the wrists for 60 seconds

Front 195

Q186. Tinel's sign?

Back 195

A186. Light tapping over the median nerve produces pain or paresthesias

Front 196

Q187. Most common carpal injury..?; High risk of..?

Back 196

A187. Fracture of the scaphoid. AVN

Front 197

Q188. Smith's fracture?

Back 197

A188. Like colles, but distal fragment is displaced in the volar direction

Front 198

Q189. neurogenic shock?

Back 198

A189. state of vasomotor instability resulting from impairment of the descending sympathetic pathways in the spinal cord, or just a loss of sympathetic tone

Front 199

Q190. does spinal shock signify permanent spinal cord damage?

Back 199

A190. often times no

Front 200

Q191. anterior cord syndrome results in loss of which tracts?

Back 200

A191. spinothalamic and corticospinal tract

Front 201

Q192. Central cord syndrome can be caused by? Affects?

Back 201

A192. Hyper-extension injuries. Nerves that cross over at that level

Front 202

Q193. if a penetrating spinal injury is diagnosed, begin treatment with..?

Back 202

A193. High dose methylprednisolone

Front 203

Q194. if suspecting a c-spine fracture, what xrays should be ordered?

Back 203

A194. lateral, AP, and odontoid view

Front 204

Q195. C1 burst fracture is called? Caused by...?

Back 204

A195. Jefferson fracture. Caused by axial loading - someone falls on their head, or something falls on their head

Front 205

Q196. Odontoid fractures are caused by..?

Back 205

A196. Flexion

Front 206

Q197. Hangman's fracture?

Back 206

A197. Fracture of both pedicles of C2 - hyperextension mechanism

Front 207

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

Back 207

A198. atl - unstable; burst c5 - stable; simple wedge - stable; odontoid - unstable; flexion teardrop - unstable; extension teardrop - stable

Front 208

Q199. flexion teardrop fracture is associated with...?

Back 208

A199. tearing of the posterior complex

Front 209

Q200. bilateral facet dislocation...? stable?

Back 209

A200. flexion injury; subluxation of the dislocated vertebra; very unstable

Front 210

Q201. Cullen's sign? Gray-Turner's sign?

Back 210

A201. ecchymosis of the abdomen signifies late retroperitoneal hemorrhage; Gray-Turner's: same, but of the flanks

Front 211

Q202. 12% of patients with hyperthyroidism will suffer...?

Back 211

A202. Pathologic fracture

Front 212

Q203. serious associated injuries are present in up to 95% of patients with a dislocated...?

Back 212

A203. hip

Front 213

Q204. a pt with a posterior hip dislocation holds the hip how?

Back 213

A204. flexed, adducted, and internally rotated

Front 214

Q205. most common ortho injury seen in the ED?

Back 214

A205. knee - in particular, MCL (medial collateral ligament)

Front 215

Q206. 50% of patients with ACL injury have a concomitant...?

Back 215

A206. Meniscal tear

Front 216

Q207. lachman's test?

Back 216

A207. flex the knee to 30 degrees and pull anteriorly on the tibia

Front 217

Q208. donahue's unhappy triad?

Back 217

A208. ACL, MCL, and medial meniscus tear

Front 218

Q209. Injury to the ________ occurs in 50% of knee dislocations...

Back 218

A209. popliteal artery

Front 219

Q210. injury to the tibial nerve causes...?

Back 219

A210. inability to stand on tiptoes

Front 220

Q211. which ankle fracture warrants a careful radiologic examination? of what specifically?

Back 220

A211. medial malleolar fracture; proximal shaft of the fibula (Maisoneuve fracture)

Front 221

Q212. 10% of calcaneal fractures are associated with...?

Back 221

A212. lumbar fractures

Front 222

Q213. when do you call for an ortho consult?

Back 222

A213. compartment syndrome; irreducible fractures; circulatory compromise; open fracture; anything that requires surgery

Front 223

Q214. what is the most frequent complication of orotracheal intubation?

Back 223

A214. Right main stem bronchus intubation

Front 224

Q215. Patients with COPD, asthma, or CHF that are awake but cannot remain in the supine position may be intubated how...?

Back 224

A215. Nasotracheal intubation

Front 225

Q216. Most serious complication of nasotracheal intubation?

Back 225

A216. Intracranial passage of the tube

Front 226

Q217. advance airway adjuncts?

Back 226

A217. fiberoptic intubation; retrograde intubation; combitube; laryngeal mask airway

Front 227

Q218. What is the preferred surgical airway for kids? Adults?

Back 227

A218. Kids - needle cricothyroidotomy; Adults - surgical cricothyroidotomy

Front 228

Q219. if an airway will be needed for greater than 2-3 days, a surgical cricothyoidotomy should be converted to...?

Back 228

A219. a tracheostomy

Front 229

Q220. slit lamp exam consists of...?

Back 229

A220. evaluate the integrity of the cornea, conjunctiva, and the anterior chamber; fluorescein to light up corneal defects

Front 230

Q221. central retinal artery occlusion occurs in which people?

Back 230

A221. men in their 60s

Front 231

Q222. fundoscopic exam in central retinal artery occlusion?

Back 231

A222. pale retina with cherry red fovea

Front 232

Q223. what is amaurosis fugax?

Back 232

A223. type of TIA - sudden vision loss (Shade over eye), transient, due to carotid-origin embolic shower

Front 233

Q224. classic triad of optic neuritis?

Back 233

A224. marcus gunn pupil; central vision loss; red vision desaturation

Front 234

Q225. flashing lights, spider webs, or floaters that interfere with vision may be a sign of...? what meds should NOT be given?

Back 234

A225. retinal detachment; DON'T anticoagulate

Front 235

Q226. painful red eye - most often due to which things?

Back 235

A226. conjunctivitis, corneal abrasion, or foreign body

Front 236

Q227. which conjunctivitis produces copious DC?

Back 236

A227. gonorrhea

Front 237

Q228. punctuate lesions in conjunctivitis?

Back 237

A228. viral cause

Front 238

Q229. treatment of conjunctivitis?

Back 238

A229. broad spectrum antibiotics, pain meds

Front 239

Q230. soft contact wearers are especially prone to infection by.?

Back 239

A230. pseudomonas

Front 240

Q231. severe unilateral eye pain, decreased visual acuity and photophobia...?

Back 240

A231. iritis

Front 241

Q232. treatment of iritis?

Back 241

A232. cycloplegic such as homatropine(not a mydratic)

Front 242

Q233. severe unilateral HA, eye pain, N/V assoc with loss of vision....?

Back 242

A233. narrow angle glaucoma

Front 243

Q234. which drugs decrease aqueous production?

Back 243

A234. acetazolomide and topical b blockers

Front 244

Q235. which chemicals causes coag necrosis? liquefaction necrosis?

Back 244

A235. acids; alkali

Front 245

Q236. treatment of chemical burn...

Back 245

A236. IRRIGATE

Front 246

Q237. what's hyphema?

Back 246

A237. blurred vision after blunt trauma (dull eye pain)... bleeding

Front 247

Q238. basic approach to all toxicity patients in the ED?

Back 247

A238. ABCs; Decontamination; Elimination; Antidotes

Front 248

Q239. key things on physical exam for toxicity exposures....?

Back 248

A239. Vital signs; pupils; toxidromes; autonomic signs; motor signs; mental status; skin

Front 249

Q240. describe anticholinergic toxidrome?

Back 249

A240. "mad as a hatter, dry as a bone, red as a beet, hot as a stove." Also - decreased GI motility, urinary retention, mydriasis.

Front 250

Q241. describe muscarinic toxidrome?

Back 250

A241. DUMBELLS

Front 251

Q242. narcotic toxidrome?

Back 251

A242. respiratory depression,; hypotension,; depressed sensorium, miosis

Front 252

Q243. sympathomimetic toxidrome? compare with anticholinergic toxidrome?

Back 252

A243. very similar except sympathomimetic involves diaphoresis

Front 253

Q244. withdrawal toxidrome?

Back 253

A244. agitation,; hallucination,; mydriasis,; diarrhea,; cramps,; lacrimation,; tachycardia,; insomnia,; seizures

Front 254

Major toxic effect of acetaminophen?

Back 254

Metabolite NAPQI causes centrilobular hepatocellular necrosis (zone III)

Front 255

Patient presents with acetaminophen toxicity more than four hours after ingestion. Treatment?

Back 255

- serum APAP concentration
- administer NAC according to the Rumack-Matthew nomogram
- administer NAC immediately if close to 8 hours after ingestion or if labs will take longer than the 8 hour mark to return

Front 256

Q247. methanol toxicity?

Back 256

A247. formic acid metabolite - causing a gap acidosis and direct optic nerve toxicity

Front 257

Q248. treatment of ethylene glycol toxicity?

Back 257

A248. 4MP or EtOH

Front 258

Q249. which drugs can cause anticholinergic syndromes? tx?

Back 258

A249. antihistamines, antipsychotics, TCAs... treatment - physostigmine

Front 259

Q250. symptoms of calcium channel blocker toxicity? tx?

Back 259

A250. bradycardia and hypotension; treatment - CaCl2, glucagon, epinephrine, DA

Front 260

Q251. CO toxicity symptoms

Back 260

A251. HA,; N/V,; flu-like symptoms,; CNS depression,; tachy,; hypotension

Front 261

Q252. treatment of CO toxicity?

Back 261

A252. 100% O2

Front 262

Q253. GHB?

Back 262

A253. date rape drug - euphoric and amnestic effects

Front 263

Q254. refractory seizures could be caused by what toxicity?

Back 263

A254. INH

Front 264

Q255. Organophosphates can cause which toxidrome?

Back 264

A255. muscarinic

Front 265

Q256. naloxone?

Back 265

A256. opioid antagonist

Front 266

Q257. standard of care for salicylate poisoning?

Back 266

A257. activated charcoal; also consider alkalinization of urine and blood with bicarb

Front 267

Q258. benzo receptor antagonist that can rapidly reverse coma from benzo OD...? what's the problem with this drug/

Back 267

A258. flumazenil; can lower the seizure threshold in pts with TCA OD and induce benzo withdrawal

Front 268

Q259. loxosceles bites can be treated with...?

Back 268

A259. dapsone

Front 269

Q260. signs and symptoms of TCA OD?

Back 269

A260. anticholinergic sx,; cardiac dysfunction,; intractable seizures,; and hyperthermia

Front 270

Q261. treatment of TCA toxicity?

Back 270

A261. decontamination with MDAC; Sodium bicarb administration; Benzos for seizure management; Alpha agonists for hypotension

Front 271

Q262. prerenal failure due to..?

Back 271

A262. decreased renal perfusion; (volume depletion, low CO, abnormal renal hemodynamics)

Front 272

Q263. most common cause of intrinsic renal failure?

Back 272

A263. longstanding HTN

Front 273

Q264. majority of hospital-assoc episodes of ARF are caused by...?

Back 273

A264. ATN

Front 274

Q265. postrenal failure caused by?

Back 274

A265. obstructive uropathy

Front 275

Q266. FENA <1 in which condition?

Back 275

A266. Prerenal failure

Front 276

Q267. Urine Na <20 in which condition?

Back 276

A267. Prerenal failure

Front 277

Q268. treatment of prerenal failure?

Back 277

A268. volume replacement, d/c offending meds

Front 278

Q269. intrinsic RF treatment?

Back 278

A269. monitor fluid status,; restrict protein,; correct electrolyte abnormalities

Front 279

Q270. dispo for patients with ARF?

Back 279

A270. admit

Front 280

Q271. what drugs can cause ARF in pts with renal artery stenosis?

Back 280

A271. ACE inhibitors

Front 281

Q272. #1 cause of death in 1-44 year olds?

Back 281

A272. Trauma (specifically, MVCs)

Front 282

Q273. Preparation for a trauma case includes?

Back 282

A273. History from EMTs; Prep the trauma bay; Airway box; O2 and suction; IVF and supplies

Front 283

Q274. Indications for intubation?

Back 283

A274. GCS <8; Inadequate breathing; Unable to protect airway

Front 284

Q275. Chin lift is contraindicated if...?

Back 284

A275. A C-spine injury is suspected

Front 285

Q276. Radial pulse should have a BP of at least...? Femoral?

Back 285

A276. 80 mmHg; 70

Front 286

Q277. what % of ECF is plasma?

Back 286

A277. 40181

Front 287

Q278. which drug is an ineffective pressor in hypovolemic patients?

Back 287

A278. dopamine

Front 288

Q279. GCS consists of which 3 categories?

Back 288

A279. eye opening,; verbal response,; moto response

Front 289

Q280. most rapid means to lower ICP?; what other method?

Back 289

A280. Hyperventilation; mannitol

Front 290

Q281. volume of blood in an adult?

Back 290

A281. 5 L (7% of ideal body weight)

Front 291

Q282. physiologic response to acute hypovolemia?

Back 291

A282. In order:; Tachycardia; narrowed pulse pressure (increased diastolic press); slowing of cap refill; decreased systolic pressure

Front 292

Q283. raccon eyes, and battle sign?

Back 292

A283. late findings in basilar skull fractures

Front 293

Q284. assessment of C-spine in trauma?

Back 293

A284. posterior midline - any tenderness?; focal neuro deficit?; A&O; evidence of intoxification?; any painful injury that may distract the pt?

Front 294

Q285. FAST?

Back 294

A285. quick, non-invasive method of examining the abdomen and pericardium for blood

Front 295

Q286. how to check for pelvic fracture?

Back 295

A286. press down and in on both iliac crests simultaneously

Front 296

Q287. urine myoglobin can be elevated secondary to...?

Back 296

A287. massive muscle breakdown (rhabdo)

Front 297

Q288. treatment of rhabdo?

Back 297

A288. IVF,; sodium bicarb,; and mannitol

Front 298

Q289. calculate cerebral perfusion pressure?

Back 298

A289. MAP - ICP

Front 299

Q290. Cushing's reflex? sign of?

Back 299

A290. HTN, bradycardia, hypopnea; sign of increased ICP

Front 300

Q291. in traumatic head injury, what is the target MAP?

Back 300

A291. 90mmHg

Front 301

Q292. intubation considerations for elevated ICP?

Back 301

A292. intubate early but WITHOUT ketamine

Front 302

Q293. seizure prophylaxis with head bleeds?

Back 302

A293. dilantin

Front 303

Q294. how does cardiac tamponade present? findings?

Back 303

A294. hypotension, muffled heart sounds, JVD, and pulsus paradoxus; electrical alternans on ECG; may present with pulseless electrical activity

Front 304

Q295. which condition can lead to hypotension, absent breath sounds, hyperresonance, distended neck veins, and high airway pressures?

Back 304

A295. tension pneumothorax

Front 305

Q296. hypoxia occurs if an open pneumothorax is greater than?

Back 305

A296. 2/3 trachea diameter

Front 306

Q297. flail chest?

Back 306

A297. 3 or more rib fractures in 2 or more sites with paradoxical motion of chest wall with inspiration

Front 307

Q298. how to demonstrate fluid in the pericardium in tamponade?

Back 307

A298. echocardiogram, or ED U/S

Front 308

Q299. treatment of tension pneumothorax?

Back 308

A299. angiocath in the 2nd intercostals space in the mid-clavicular line; chest tube if hemorrhagic or simple pneumothorax suspected

Front 309

Q300. treatment of cardiac tamponade?

Back 309

A300. subxyphoid pericardiocentesis

Front 310

Q301. splenic injury can cause pain referred to...? eponym?

Back 310

A301. left shoulder...Kehr's sign

Front 311

Q302. which chief complaints warrant a stat EKG?

Back 311

A302. chest pain/pressure/discomfort; SOB; hypotension; weakness/dizziness; syncope; abdominal pain especially in elderly; palpitations; N/V especially in elderly, diabetics

Front 312

Q303. shortened PR interval suggests?

Back 312

A303. alternate, abnormal conduction pathway like WPW syndrome

Front 313

Q304. elongated PR interval suggests?

Back 313

A304. some form of AV block

Front 314

Q305. quick and dirty way of determining the axis of the heart?

Back 314

A305. leads I and aVF... both up - normal; aVF down - LAD; I down - RAD; both down - RAD

Front 315

Q306. DDx of U waves?

Back 315

A306. hypokalemia; hypercalcemia; meds (digoxin, quinidine); thyrotoxicosis

Front 316

Q307. Describe possible characteristics of an unstable cardiac patient?

Back 316

A307. Pulseless; Hypotension; AMS; Ischemic chest pain; CHF

Front 317

Q308. treatment basics for unstable cardiac patients?

Back 317

A308. cardioversion (synch or un-synch) per ACLS protocol, then IV meds or other therapy

Front 318

Q309. treatment of sinus tachycardia?

Back 318

A309. treatment the UNDERLYING CAUSE

Front 319

Q310. how can you tell there's paroxysmal supraventricular tachycardia? tx?

Back 319

A310. abnormal/absent P waves; Tx: unstable --> synch cardioversion; stable --> AV node blockade via adenosis, calcium channel blockers (diltiazem, verapamil), b-blockers, manuevers

Front 320

Q311. treatment of a fib?

Back 320

A311. unstable --> synch cardioversion; stable w/ rapid vent. response --> AV blockade: calcium channel blockers, b blockers, digoxin; anticoagulation

Front 321

Q312. pts with pre-excitation syndromes - be careful not to...?

Back 321

A312. block the AV node by conventional meds

Front 322

Q313. premature ventricular contractions, etiology?

Back 322

A313. 4 H's - hypokalemia, hypomagnesemia, hypoxia, hyperthyroidism; drugs; heart disease

Front 323

Q314. what is trigeminy?

Back 323

A314. every 3rd beat is a PVC

Front 324

Q315. treatment of PVCs?

Back 324

A315. iv lidocaine or amiodarone; iv magnesium sulfate; procainamide

Front 325

Q316. treatment of pulseless v tach?

Back 325

A316. immediate UNSYCNHED cardioversion

Front 326

Q317. treatment for unstable v tach?

Back 326

A317. synchronized cardioversion, then amiodarone or lidocaine drip

Front 327

Q318. treatment for stable v tach?

Back 327

A318. medical cardioversion with lidocaine, amiodarone, adenosine, or procainamide

Front 328

Q319. etiology of torsades?

Back 328

A319. ischemic heart disease; MI; hypo-electrolyte states

Front 329

Q320. treatment of stable torsades?

Back 329

A320. electrical overdrive pacing; also consider Mg sulfate

Front 330

Q321. treatment of Vfib?

Back 330

A321. unsynchronized cardioversion,; ACLS protocols,; and correction of lytes abnormalities

Front 331

Q322. pulseless electrical activity etiology?

Back 331

A322. MATCH4ED; MI; Acidosis; Tension pneumo; Cardiac tamponade; H4- hypothermia, hyperkalemia, hypoxia, hypovolemia; Embolism (pulm); Drug OD

Front 332

Q323. treatment of ventricular asystole?

Back 332

A323. IVF, epinephrine, atropine; Transvenous pacing

Front 333

Q324. for Mobitz II 2nd degree AV block, what tx? What won't work?

Back 333

A324. transcutaneous or transvenous pacing; Admit for implantable pacemakers; Atropine won't work

Front 334

Q325. treatment for 3rd degree AV block?

Back 334

A325. immediate temporary pacemaker

Front 335

Q326. you should consider a new LBBB to be _______ until proven otherwise?

Back 335

A326. acute MI

Front 336

Q327. Indications for temporary cardiac pacing?

Back 336

A327. hemodynamically unstable bradycardia; bradycardia that fails to respond to tx; refractory tachycardia dysrhythmias; early bradyasystolic arrest

Front 337

Q328. how does digoxin cause toxicity?

Back 337

A328. blockade of the NaKATPase; increased vagal tone and increased AV nodal blockade

Front 338

Q329. EKG signs of WPW?

Back 338

A329. short PR interval; Delta wave; wide QRS; adult tachycardia

Front 339

Q330. EKG signs of hypokalemia?

Back 339

A330. more prominent U waves; flattened t waves

Front 340

Q331. EKG signs of hyperkalemia?

Back 340

A331. hyperacute T waves; wide QRS that eventually blends with the T wave to form a sine wave appearance

Front 341

Q332. EKG signs of hypocalcemia?

Back 341

A332. prolonged QT; terminal T wave inversion

Front 342

Q333. EKG signs of hypercalcemia?

Back 342

A333. shortened QT interval

Front 343

Q334. associated symptoms of ACS?

Back 343

A334. dyspnea, diaphoresis, nausea, lightheadedness, or sense of weakness

Front 344

Q335. define stable angina?

Back 344

A335. symptoms precipitated by exertion and relieved by rest or nitroglycerin

Front 345

Q336. define unstable angina?

Back 345

A336. Exertional angina of recent onset; angina of worsening character; angina at rest

Front 346

Q337. describe myoglobin as a cardiac marker?

Back 346

A337. elevated as early as one hour and peaks at 4-12 hours; nonspecific

Front 347

Q338. describe CKMB as a cardiac marker?

Back 347

A338. rises in 3-4 hours, peaks at 12-24 hours; can be elevated in skeletal muscle injury

Front 348

Q339. describe troponin as a cardiac marker?

Back 348

A339. rises in 3-6 hours, peaks 12-24 hours; most specific and sensitive

Front 349

Q340. acute MI tx?

Back 349

A340. MOAN B H; morphine; oxygen; aspirin; nitroglycerin; beta blockade; heparin

Front 350

Q341. in pump failure.. which pressors for hypotension in a volume unresponsive patient..?

Back 350

A341. sbp 80-100 - dobutamine; sbp 70-80 - dopamine; sbp <70 - levophed

Front 351

Q342. pericarditis - presentation?; pain is worsened by..?

Back 351

A342. sharp stabbing precordial or retrosternal chest pain... pain worsened by inspiration or lying flat

Front 352

Q343. associated symptoms of pericarditis?

Back 352

A343. low grade fever; dyspnea; dysphagia; tachycardia

Front 353

Q344. test of choice for detection and f/u of pericarditis?

Back 353

A344. echo

Front 354

Q345. treatment for pericarditis

Back 354

A345. NSAIDs for 1-3 weeks

Front 355

Q346. aortic dissections typically occur in what group?

Back 355

A346. uncontrolled hypertensive males ages 50-70

Front 356

Q347. physical findings in aortic dissection?

Back 356

A347. asymmetric pulses with BP differences between extremities; very hypertensive; severe distress; JVD; palpable pulsatile mass or tenderness

Front 357

Q348. chest tube required for what size pneumothorax?

Back 357

A348. >15%

Front 358

Q349. Nitro's relief of cardiac vs esophageal pain?

Back 358

A349. Cardiac w/in 5 minutes, esophageal w/in 10 minutes

Front 359

Q350. life threatening etiologies of abdominal pain...?

Back 359

A350. ruptured AAA,; perforated viscous,; intestinal obstruction,; ectopic pregnancy,; mesenteric ischemia,; appendicitis,; and MI

Front 360

Q351. INITIAL TEST OF CHOICE FOR BILIARY TRACT DISEASE, AAA, ectopic, or free peritoneal fluid?

Back 360

A351. US

Front 361

Q352. Plain films can rule out which abdominal emergencies?

Back 361

A352. Perforation or obstruction

Front 362

Q353. Colicky pain usually responds to which drugs? Specifically...?

Back 362

A353. NSAIDs,; esp IV Ketorolac

Front 363

Q354. Triad of pain, hypotension, and a pulsatile abdominal mass...?

Back 363

A354. AAA

Front 364

Q355. _______ is virtually 100% sensitive in detecting AAAs?

Back 364

A355. US

Front 365

Q356. What is usually the primary inciting factor of appendicitis?

Back 365

A356. Obstruction of the appendix usually by an appendicolith

Front 366

Q357. risk factors for cholecystitis?

Back 366

A357. fat, forty, and female

Front 367

Q358. radiation of pain in acute cholecystitis?

Back 367

A358. tip of the right scapula

Front 368

Q359. most useful test if suspicious of cholecystitis?

Back 368

A359. US of RUQ

Front 369

Q360. which agents should not be used in acute gastroenteritis?

Back 369

A360. anti-motility agents (Imodium) because it diminishes diarrheal excretion of organisms

Front 370

Q361. Presentation of patients with acute hepatitis?

Back 370

A361. Jaundice,; dark urine/light stools,; hepatomegaly,; fatigue, malaise,; RUQ pain,; N/V,; and fever

Front 371

Q362. coagulation should be normalized with FFP in which condition?

Back 371

A362. hepatitis

Front 372

Q363. presentation of acute mesenteric ischemia?

Back 372

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

Front 373

Q364. Most useful test to diagnose acute mesenteric ischemia?

Back 373

A364. Angiography

Front 374

Q365. Midepigastric abdominal pain usually associated with N/V?

Back 374

A365. Acute pancreatitis

Front 375

Q366. An amylase raised _______ times the upper limit of normal is 98% specific to acute pancreatitis...

Back 375

A366. 1.5

Front 376

Q367. All patients with acute pancreatitis should be....

Back 376

A367. admitted and made NPO

Front 377

Q368. good narcotic choice for pain in acute pancreatitis

Back 377

A368. Meperidine (better than morphine)

Front 378

Q369. fever, abdominal pain, and rebound tenderness...?

Back 378

A369. Peritonitis

Front 379

Q370. Small bowel obstruction is caused by ________ more than 50% of the time...?

Back 379

A370. postoperative adhesions

Front 380

Q371. Most significant complications of small bowel obstruction?

Back 380

A371. Strangulation and bowel infarction

Front 381

Q372. etiology of bronchitis?

Back 381

A372. viruses (influenza, adenovirus, etc.); Mycoplasma; Chlamydia; Bordetella pertussis

Front 382

Q373. Virchow's triad of the pathophysiology behind PE?

Back 382

A373. Venostasis; Hypercoagulability; Vessel wall damage/inflammation

Front 383

Q374. Classic triad of PE presentation?

Back 383

A374. Hemoptysis; Dyspnea; chest pain

Front 384

Q375. EKG findings in PE?

Back 384

A375. S1; Q3; inverted T3

Front 385

Q376. golden standard for diagnosing PE?

Back 385

A376. pulmonary angiography

Front 386

Q377. ED treatment of CHF?

Back 386

A377. diuretics; nitrates; anlgesics; intubation or CPAP if no improvement

Front 387

Q378. treatment of COPD in the ED?

Back 387

A378. ABCs monitoring; albuterol neb; glucocorticoids; MgSO4 in severe exacerbations; antibiotics (empiric broad spectrum)

Front 388

Q379. ED eval of asthma?

Back 388

A379. Monitors, O2, pulse ox; Peak expiratory flow rate; CXR - to rule out pneumonia

Front 389

Q380. signs of hyperventilation syndrome?

Back 389

A380. tachypnea, chest wall tenderness, carpopedal spasm, Chvostek's/Trousseau's sign (hypocalcemia)

Front 390

Q381. this condition likely results from inflammation of CN VII as it courses through the styloid foramen?

Back 390

A381. Bell's palsy

Front 391

Q382. treatment of bell's palsy?

Back 391

A382. acyclovir AND prednisone; eye patching to prevent keratitis and corneal ulceration

Front 392

Q383. work up of CVA?

Back 392

A383. STAT head CT - esp if < 3 hrs; standard labs; STAT Accu-check

Front 393

Q384. in hemorrhagic stroke, you want to decrease SBP by no more than _____ to limit hypoperfusion...?

Back 393

A384. 20-25%

Front 394

Q385. Peripheral vertigo is caused by.?

Back 394

A385. viral etiology (labyrinthitis); decaying or "lost" otoliths

Front 395

Q386. peripheral vertigo presentation?

Back 395

A386. acute onset; intense spinning sensation, N/V; unidirectional nystagmus that can be inhibited by fixation

Front 396

Q387. work-up of peripheral vertigo?

Back 396

A387. hallpike maneuver; epley manuevers; anti-emetics, anti-cholinergics

Front 397

Q388. most seizures in the ED are due to...?

Back 397

A388. Medical non-compliance in known seizure patients

Front 398

Q389. workup of seizures in the ED...

Back 398

A389. ABCs; IV; check glucose; head CT; anti-epileptic level; LP if any possibility of intracranial hemorrhage or meningitis

Front 399

Q390. LOC occurs in ____ % of patients with SAH?

Back 399

A390. 0.5

Front 400

Q391. 75% of SAH is due to...?

Back 400

A391. ruptured congenital arterial aneurysm

Front 401

Q392. diagnostic test for SAH?

Back 401

A392. noncontrast head CT

Front 402

Q393. if there is suspicion for SAH and it's not seen on CT, ____ must be performed?

Back 402

A393. LP

Front 403

Q394. What other condition besides SAH could cause blood in the CSF?

Back 403

A394. Herpes encephalitis

Front 404

Q395. goal of ICP management is to maintain the cerebral perfusion pressure greater than ______?

Back 404

A395. 60

Front 405

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...?

Back 405

A396. intracranial tumor / mass

Front 406

Q397. 85% of people experiencing malignant hypertension complain of _____?

Back 406

A397. Headache

Front 407

Q398. Temporal arteritis affects women ______ than men, and is uncommon before the age of _____? ESR is usually ____?

Back 407

A398. Women more than men; 50; ESR 50-100

Front 408

Q399. Jaw claudication is strongly suggestive of...?

Back 408

A399. temporal arteritis

Front 409

Q400. treatment of temporal arteritis?

Back 409

A400. prednisone 60mg po, arrange a biopsy to confirm diagnosis

Front 410

Q401. Often compression of ______________ can improve the pain of migraine?

Back 410

A401. the ipsilateral superficial temporal or carotid artery

Front 411

Q402. ergotamine is contraindicated in... ? Should be used w/ caution in ....?

Back 411

A402. Pregnancy; Caution in HTN or CAD

Front 412

Q403. Patients should avoid _____ while in the midst of cluster headaches?

Back 412

A403. Alcohol

Front 413

Q404. This causes headaches often in overweight women in their 30s...

Back 413

A404. Pseudotumor Cerebri (benign intracranial HTN)

Front 414

Q405. 90% of patients with Pseudotumor Cerebri have ....?

Back 414

A405. papilledema

Front 415

Q406. in Pseudotumor Cerebri, head CT will show...? LP will show...?

Back 415

A406. CT - slit-like ventricles; LP - increased opening pressure

Front 416

Q407. treatment of Pseudotumor Cerebri..?

Back 416

A407. Acetazolamide 250 mg pid

Front 417

Q408. treatment of post LP HA?

Back 417

A408. caffeine sodium benzoate

Front 418

Q409. cherry-red coloration of skin/mucous membranes, retinal hemorrhages, AMS?

Back 418

A409. CO poisoning

Front 419

Q410. sudden onset of head/eye pain, decreased visual acuity?

Back 419

A410. Acute angle closure glaucoma

Front 420

Q411. treatment of acute uncomplicated UTI?

Back 420

A411. Bactrim for 3 days

Front 421

Q412. Pyelonephritis w/ systemic sx tx?

Back 421

A412. admit for IV antibiotics

Front 422

Q413. pregnant women with UTI tx?

Back 422

A413. macrobid for 7 days

Front 423

Q414. What % of pts presenting with classic UTI sx show minimal to no bacteria on UA?

Back 423

A414. 30-40%

Front 424

Q415. Sudden onset of testicular pain in children and young men?

Back 424

A415. Testicular torsion

Front 425

Q416. most common cause of urinary retention?

Back 425

A416. BPH

Front 426

Q417. >100 ml postvoid residual urine volume is diagnostic of...?

Back 426

A417. urinary retention

Front 427

Q418. what is fournier's gangrene?

Back 427

A418. aggressive fasciitis of the perineum in a toxic appearing pt likely with history of DM, urethral trauma, surgery, or obstruction

Front 428

Q419. treatment of fournier's gangrene??

Back 428

A419. immediate surgery - complete debridement of necrotic tissue

Front 429

Q420. tender, swollen, painful epididymis and testis usually accompanied by fever?

Back 429

A420. Epididymitis

Front 430

Q421. testicular US can distinguish...?

Back 430

A421. torsion from epididymitis

Front 431

Q422. the cremasteric reflex is present in _____ but not in ___________?

Back 431

A422. epididymitis; torsion

Front 432

Q423. nonspecific infection of the glans penis is called...?

Back 432

A423. balanitis

Front 433

Q424. abnormally small opening in the foreskin?

Back 433

A424. phimosis

Front 434

Q425. abnormal painful swelling of the glans penis occurring after aggressive retraction of a phimotic foreskin?

Back 434

A425. paraphimosis

Front 435

Q426. flank/abdominal pain, does not change with position or remaining still, radiation to groin...

Back 435

A426. stones

Front 436

Q427. work up of stones?

Back 436

A427. IVF; IV narcotics; UA - will generally show hematuria; BMP

Front 437

Q428. test of choice for kidney stones?

Back 437

A428. noncontrast CT

Front 438

Q429. stone <3mm probability of passing spontaneously?

Back 438

A429. 0.8

Front 439

Q430. Indications for urology consults or admission in kidney stones...?

Back 439

A430. Associated UTI; uncontrolled pain/emesis; extravasation of contrast; renal failure; single kidney; hydronephrosis + hydroureter; stone > 6mm

Front 440

Q431. in a patient >60, first time renal colic is _________ until proven otherwise...

Back 440

A431. AAA

Front 441

Q432. of those women who experience bleeding in the first trimester, ______________ will undergo spontaneous abortion

Back 441

A432. 40180

Front 442

Q433. threatened abortion...?

Back 442

A433. vaginal bleeding with a pre-viable fetus and closed cervix

Front 443

Q434. inevitable abortion?

Back 443

A434. vaginal bleeding with cervical dilatation

Front 444

Q435. incomplete abortion

Back 444

A435. vaginal bleeding with partial passage of products of conception and dilated cervix

Front 445

Q436. complete abortion

Back 445

A436. passage of all products of conception and closed cervix

Front 446

Q437. missed abortion

Back 446

A437. fetal demise and retention of products of conception, cervix closed

Front 447

Q438. 6-8 weeks gestation with amenorrhea, spotting, and cramping lower abdominal pain....concerning for...?

Back 447

A438. ectopic

Front 448

Q439. gold standard in diagnosing an ectopic?

Back 448

A439. US

Front 449

Q440. any patient who presents with vaginal bleeding and is _____ should be given RhoGAM?

Back 449

A440. Rh -

Front 450

Q441. 2 most common pregnancy related causes of vaginal bleeding in the second trimester?

Back 450

A441. miscarriage; hydatidiform mole

Front 451

Q442. pre-eclampsia that occurs prior to 20 weeks gestation is pathognomonic for...?

Back 451

A442. trophoblastic disease

Front 452

Q443. most common presentation of placenta previa?

Back 452

A443. late 2nd to early 3rd trimester painless bleeding

Front 453

Q444. ____________- may occur in up to 1/3 of placental abruptions?

Back 453

A444. DIC

Front 454

Q445. pre-eclampsia?

Back 454

A445. triad of HTN, edema, and proteinuria of >100 mg/dl

Front 455

Q446. HELLP syndrome?

Back 455

A446. subset of pre-eclamptic pts:; Hemolysis, Elevated Liver enzymes, and Low Platelets

Front 456

Q447. In preeclampsia and eclampsia, the most important part of the CBC is...?

Back 456

A447. the platelet count

Front 457

Q448. seizure prophylaxis in pre, eclampsia?

Back 457

A448. MgSO4

Front 458

Q449. preterm labor is defined as occurring...?

Back 458

A449. before 37 weeks gestation

Front 459

Q450. Strawberry cervix?

Back 459

A450. trichomonas

Front 460

Q451. average blood loss in normal menses/

Back 460

A451. 30-60cc

Front 461

Q452. benign leiomyomas that develop in the uterus and often result in menometrorraghia?

Back 461

A452. fibroids

Front 462

Q453. dysfunctional uterine bleeding tx..?

Back 462

A453. NSAIDs, and OCPs; rule out endometrial carcinoma

Front 463

Q454. Chlamydia can cause....?

Back 463

A454. Asymptomatic infection; Urethritis; Cervicitis; PID

Front 464

Q455. PID?

Back 464

A455. Lower abdomen. tenderness, cervical motion tenderness, and adnexal tenderness; + fever or increased WBC or ESR etc..

Front 465

Q456. most common cause of infectious arthritis in young sexually active adults?

Back 465

A456. Gonorrhea

Front 466

Q457. green-gray discharge?

Back 466

A457. trichomonas

Front 467

Q458. thin-gray malodorous discharge, non sexually transmitted

Back 467

A458. bacterial vaginosis

Front 468

Q459. most common cause of pelvic pain in women not associated with infection is...?

Back 468

A459. Rupture of an ovarian cyst

Front 469

Q460. 50% of cases of ovarian torsion are caused by..?

Back 469

A460. Benign dermoids that cause the ovary to twist

Front 470

Q461. A major cause of pelvic pain, dyspareunia, and dysmenorrhea

Back 470

A461. Endometriosis

Front 471

Q462. postcoital contraception?

Back 471

A462. norgestrel

Front 472

Q463. first, second, etc degree frostbite?

Back 472

A463. 1st - warm, hyperemic, sensate; 2nd - clear vesicles; 3rd - purple bullae; 4th - mummification

Front 473

Q464. ED management of frostbite?

Back 473

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

Front 474

Q465. How to estimate total body surface area for burns..?

Back 474

A465. 9's; LUE - 9%,; LLE - 18%,; posterior torso - 18%,; head - 9%

Front 475

Q466. burn degrees?

Back 475

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)

Front 476

Q467. How do you determine IVF needs in a burn victim?

Back 476

A467. If TBSA >15%.... 4ml x kg weight x tbsa% = total volume of replacement needed in first 24 hrs

Front 477

Q468. don't forget _________ in frostbite, burns, and a variety of other injuries....?

Back 477

A468. tetanus prophylaxis

Front 478

Q469. hypothermia defined?

Back 478

A469. core temp < 35 C

Front 479

Q470. presentation of mild hypothermia?

Back 479

A470. confusion, lethargy, fatigue, shivering, tachycardia, respiratory alkalosis

Front 480

Q471. resuscitation in severe hypothermia should include _________ in order to treat cardiac dysrhythmias...?

Back 480

A471. Warming until core temp > 32 C

Front 481

Q472. severe dehydration, thermoregulaory failure, temp >40C, tachycardia, hypotension, confusion, rhabdo...?

Back 481

A472. Heat stroke

Front 482

Q473. treatment of heat stroke..?

Back 482

A473. rapid cooling, monitoring, seizure prophylaxis

Front 483

Q474. voltage > _____________ is considered high tension..?

Back 483

A474. 1000 V

Front 484

Q475. the _________ the resistance, the more the current and damage

Back 484

A475. less

Front 485

Q476. AC current is ___________ dangerous than DC, because?

Back 485

A476. more; increased duration of exposure; increased likelihood of Vfib

Front 486

Q477. barotrauma of ascent?

Back 486

A477. when a diver fails to exhale when ascending, exacerbating the overexpansion of the airspaces

Front 487

Q478. type 1 decompression sickness? type 2?; treatment if severe?

Back 487

A478. 1 - joint, skin, bone problems; 2 - neuro, lung, CV problems; Hyperbaric oxygen chamber

Front 488

Q479. what agent can mimic acclimatized state in the treatment of altitude sickness?

Back 488

A479. Acetazolamide - causes a compensatory respiratory alkalosis

Front 489

Q480. most infection prone bite injury?

Back 489

A480. human bite to the hand

Front 490

Q481. ___________ is implicated in 50% of infected cat bites and 30% of infected dog bites?

Back 490

A481. Pasteurella

Front 491

Q482. complications of this infection include encephalitis, Painaud's, osteolytic bone lesions, purpura, and erythema nodosum

Back 491

A482. Bartonella

Front 492

Q483. describe phases of rabies briefly?

Back 492

A483. Incubation period - couple months; Prodrome - 1 week of localized pain, malaise, N/V; Acute neuro phase - 1 week; Coma - up to 2 weeks

Front 493

Q484. Loxosceles spider bite tx?

Back 493

A484. wound care; antibiotics if superinfected; antihistamines and analgesics; dapsone to prevent ulceration; IV steroids in viscerocutaneous loxoscelism to prevent hemolysis

Front 494

Q485. sudden onset fever, centripetal rash spread, severe HA, myalgia, N/V, and abdominal pain

Back 494

A485. Rocky mountain spotted fever

Front 495

Q486. treatment of rocky mountain?

Back 495

A486. teracycline or chloramphenicol; supportive care for shock, DIC, ARDS, CHF

Front 496

Q487. complications of auricular hematoma?

Back 496

A487. cauliflower ear, cartilage necrosis

Front 497

Q488. pathogens of otitis externa?

Back 497

A488. pseudomonas and staph

Front 498

Q489. treatment of anterior bleeding epistaxis?

Back 498

A489. pinching pressure, decongestion, silver nitrate, packing, abx to prevent sinusitis

Front 499

Q490. problem with posterior bleeding epistaxis?

Back 499

A490. pharyngeally stimulated hypoxia and stopped breathing

Front 500

Q491. ____________ cures >95% of peritonsillar abscesses?

Back 500

A491. I and D

Front 501

Q492. Ludwig's angina? big concern?

Back 501

A492. Trench mouth - dental origin infection of submandibular space due to horrible hygiene; Concern - airway compromise

Front 502

Q493. duck quack cry is characteristic of...?

Back 502

A493. Retropharyngeal deep space infection

Front 503

Q494. swallowed coins appear ____________ in trachea, _____________ in esophagus?

Back 503

A494. side on; face on

Front 504

Q495. diagnosis and treatment of esophageal foreign body?

Back 504

A495. EGD for visualization; glucagon for esophageal relaxation

Front 505

Q496. epiglotitis has traditionally been associated with which infection?

Back 505

A496. Hemophillus B

Front 506

Q497. diagnosis of epiglotitis?

Back 506

A497. loss of V-shaped dip in neck plain film (valecula sign)

Front 507

Q498. if suspecting epiglotitis in kids....what next?

Back 507

A498. call ENT or anesthesia - no IV's, oral exam, nothing that stimulates/agitates the child

Front 508

Q499. croup? what type of cough?

Back 508

A499. laryngotracheobronchitis - viral infection; seal-like barking cough

Front 509

Q500. difference in presentation in kids with croup vs. epiglotitis?

Back 509

A500. in croup, kids generally appear well

Front 510

Q501. treatment of croup?

Back 510

A501. racemic epinephrine,; humidified air,; steroids

Front 511

Q502. angioedema? tx

Back 511

A502. inflammatory autoimmune reaction, increased capillary permeability; treatment - H1 blocker, steroids, H2 blocker, epinephrine for severe cases

Front 512

Q503. causes of pharyngitis?

Back 512

A503. group A strep; Mono with lymphadenopathy, splenomegaly; adenovirus

Front 513

Diameter of catheter in mm from French

Back 513

D (mm) = Fr/3

(1 French is 1/3 mm)

Front 514

French catheter system measures which diameter?

Back 514

external diameter

Front 515

Breath odor of bitter almonds

Back 515

cyanide

Front 516

Breath odor of violets

Back 516

turpentine

Front 517

Breath odor of mothballs

Back 517

camphor, naphthalene

Front 518

Breath odor of garlic

Back 518

organophosphates

Front 519

Breath odor of pear

Back 519

chloral hydrate

Front 520

Constricted pupils

Back 520

COPS - clonidine, opiates, pontine bleed, sedative-hypnotics

Front 521

Dilated pupils

Back 521

amphetamines, anticholinergics, cocaine

Front 522

pulmonary edema

Back 522

opioids, salicylates, toxic inhalations, cocaine, organophosphates, ethylene glycol

Front 523

increased bowel sounds

Back 523

sympathomimetics, opiate withdrawal

Front 524

decreased bowel sounds

Back 524

anticholinergics, opiate toxicity

Front 525

needle tracks on skin

Back 525

opioids

Front 526

diaphoresis

Back 526

salicylates, organphosphates, sympathomimetics

Front 527

jaundice

Back 527

acetaminophen, mushroom poisoning

Front 528

alopecia

Back 528

arsenic, thallium, chemotherapeutic agents

Front 529

cyanosis

Back 529

drugs causing methemoglobinemia (nitrates / nitrites, "caine" anesthetics, aniline dyes, chlorates, dapsone, sulfonamides

Front 530

cholinergics toxidrome

Back 530

DUMBBELS - diarrhea, urination, miosis, bradycardia, bronchospasm, emesis, lacrimation, salivation

Front 531

anticholinergics toxidrome

Back 531

hot as stove, red as beet, dry as bone, mad as hatter (fever, skin flushing, dry mucous membrane, psychosis, mydriasis, tachycardia, urinary retention)

Front 532

opioid toxidrom (triad)

Back 532

coma, respiratory depression miosis

Front 533

sedative-hyptonics toxidrome

Back 533

CNS depression, respiratory depression, coma

Front 534

extrapyramidal toxidrome

Back 534

parkinsonian symptoms: tremor, torticollis, trismus, rigidity, oculogyric crysis, opisthotonus, dystonia, dysphagia

Front 535

examples of cholinergics

Back 535

organophosphates, pilocarpine, pyridostigmine, muscarine-containing mushrooms

Front 536

examples of anticholinergics

Back 536

TCAs, atropine, scopolamine, antihistamines, Jimson weed

Front 537

examples of opioids

Back 537

morphine, oxycodone, heroin

Front 538

examples of sedative-hypnotics

Back 538

alcohol, barbiturates, benzodiazepines

Front 539

name the toxidromes

Back 539

cholinergics, anticholinergics, opioids, sedative hypnotics, extrapyramidal

Front 540

Treatment for poisoning / toxin-exposure

Back 540

elimination, removal of unabsorbed toxin, removal of absorbed toxin

Front 541

2 methods of eliminating toxins

Back 541

activated charcoal, whole bowel irrigation

Front 542

two methods of removal of unabsorbed toxin

Back 542

emesis, gastric lavage

Front 543

three methods of removing absorbed toxin

Back 543

alkalization methods, charcoal hemoperfusion, HD

Front 544

polyethylene glycol with electrolytes to wash toxins from GI tract

Back 544

whole bowel irrigation

Front 545

first line treatment of poisoning

Back 545

activated charcoal: 1g/kg BW

Front 546

how to perform emesis

Back 546

ipecac 30cc for adults, 15 cc for children

Front 547

indication for emesis in poisoning

Back 547

patient awake, ingstion recent (30-60 minutes) ingestion moderately or highly toxic

Front 548

contraindications to emesis in poisoning

Back 548

AMS, absent gag reflex, caustic agents, agents that are easily aspirated, nontoxic ingestion

Front 549

indications for gastric lavage

Back 549

ingestion suspected or known to be seroius, ingestion recent, patient awake and cooperative or intubated, patient can be placed in LLD position

Front 550

how is alkalization performed in poisoning

Back 550

mixing D5W with 2-3 amps of NaHCO3

Front 551

when is alkalization done in poisoning

Back 551

TCA poisoning, alkalinzation of urine to ph >8 ionizes weak acids into ionized molecules, increasing excretion of salicylates, phenobarbital adn chlorpropamide

Front 552

procedure that increases absorption of toxic substances in the blood by filtering blood from a shunt through a column of activated charcoal

Back 552

charcoal hemoperfusion

Front 553

when is charcoal hemoperfusion indicated?

Back 553

aminophylline, barbiturates, carbamazepine, digoxin

Front 554

procedure that filter small, ionized molecules in cases of poisoning

Back 554

HD

Front 555

when is HD indicated

Back 555

salicylates, theophylline, methanol, lithium, barbiturates, ethylene glycol

Front 556

treatment for alcohol withdrawal

Back 556

benzodiazepines, haloperidol for hallucinations, thiamine, folate and MV replacement

Front 557

treatment of barbiturates withdrawal

Back 557

BDZ

Front 558

treatment for BDZ withdrawal

Back 558

BDZ

Front 559

treatment of cocaine / amphetamine withdrawal

Back 559

supportive (avoid Beta blockers)

Front 560

why should B blockers be avoided in cocaine use

Back 560

uninhibited alpha-cardiac stimulation with cocaine use

Front 561

treatment of opioid withdrawal

Back 561

symptom management, clonidine / buprenorphine for moderate withdrawal, methadone for severe symptoms

Front 562

symptoms of cocaine or MAP withdrawal

Back 562

depression, hyperphagia, hypersomnolence

Front 563

symptoms of BDZ withdrawal

Back 563

rebound anxiety, seizures, tremor, DTs

Front 564

symptoms of opioid withdrawal

Back 564

anxiety, insomnia, flulike symptoms, sweating piloerection, fever, rhinorrhea, nausea, stomach cramps, diarrhea, mydriasis

Front 565

medically indicated tests after sexual assault

Back 565

HIV, gonorrhea, chlamydia culture, syphilis culture, HBC, HCV testing, pregnancy test

Front 566

evidence to be collected after sexual assault

Back 566

saliva sample, oral, anal, vaginal smears, nasal mucus sample, blood sample, fingernail scraping and clipped fingernails, combed and plucked head and pubic hairs, debris and dried secretions from skin

Front 567

treatment of sexual assault

Back 567

treat infection (plus HBV and HIV prophylaxis) treat injuries, prevent pregnancy, counseling

Front 568

how to prevent pregnancy in sexual assault

Back 568

two Ovral tablets PO stat and in 12 hours

Front 569

What is AVPU?

Back 569

alert, visual stimuli, painful stimuli, unresponsive

Front 570

ABCDE

Back 570

airway maintenance with cervical spine control, breathing with ventilation, circulation with hemorrhage control, disability / brief neuro exam, exposure / environmental control

Front 571

what is the secondary survey?

Back 571

total patient evaluation

Front 572

what is AMPLE

Back 572

inquire about Allergies, Medications, PMH, Last meal eaten, Events / Environment related to the injury (during secondary survey)

Front 573

motor response in Glasgow coma scale

Back 573

obeys commands, localizes, withdraws, abnormal flexion, abnormal extension, NR

Front 574

verbal response in GCS

Back 574

oriented, confused spech, inappropriate speech, incomprehensible, NR

Front 575

eye opening in GCS

Back 575

spontaneous, to voice, to pain, NR

Front 576

most commonly injured solid organ in blunt abdominal trauma

Back 576

spleen

Front 577

when to transfer to OR in abdominal trauma

Back 577

presence of penetrating wound to abdomen deeper than the fascia or with any significant bleeding or bowel injury

Front 578

maximum shock for VF/VT

Back 578

up to 360J if monophasic, 250 J if biphasic

Front 579

other drugs aside from epinephrine that can be used in VF/VT

Back 579

procainamide, amiodarone, lidocaine, magnesium

Front 580

5 Hs of PEA

Back 580

H+ acidosis, hyper or hypokalemia, hypoxia, hypovolemia, hypothermia

Front 581

5 Ts of PEA

Back 581

tablets, tamponade, tension pneumothorax, thrombosis (coronary), thrombosis (pulmonary embolism)

Front 582

treatment of PEA

Back 582

epi q3-5m x 3; atropine q3-5m x 3 if slow PEA rate

Front 583

treatment of asystole

Back 583

epi q3-5m x 3 or vasopressin x 1, atropine q3-5m x 3, consider pacemaker

Front 584

treatment of bradycardia

Back 584

atropine q3-5m x 3; transcutaneous pacemaker, eopa, epi, isoproterenol drip

Front 585

treatment of supraventricular tachycardia

Back 585

vagal stim; adenosine 6mg IV, adenosine 12mg IV, IV diltiazem if no CHF; adenosine 12mg IV

Front 586

treatment of stable monomorphic VT

Back 586

procainamide or sotalol, amiodarone or lidocaine; if with CHF, amiodarone or lidocaine then DC cardioversion

Front 587

treatment of stable wide-complex tachycardia

Back 587

DC cardioversion, procainamide, amiodarone; if with CHF, no procainamide

Front 588

differentiate heat exhaustion from heat stroke

Back 588

heat exhaustion - extreme fatigue with profuse sweating, body temperature is normal or slightly elevated; heat stroke is a true emergency, presents with increased body temperature and altered mental status, no sweating

Front 589

treatment of heat exhaustion

Back 589

IV NS and a cool environment

Front 590

treatment of heat stroke

Back 590

aggressive cooling; undress; atomized tepid water spray; apply ice packs to groin and axillae

Front 591

differentiate superficial and deep frostbite

Back 591

superficial is injury to cutaneous and subcutaneous tissue; skin is soft under frozen surface; deep injury is to deep structures (muscle and bone) and skin is hard under a frozen surface

Front 592

treatment of frostbite

Back 592

rapid rewarming once refreezing can be prevented; circulating water at 40C, wound care, tetanus prophylaxis

Front 593

define hypothermia

Back 593

core body temperature <35C of <95F

Front 594

ECG findings in hypothermia

Back 594

Osborn or J waves

Front 595

treatment of hypothermia (rewarming)

Back 595

passive external (blankets), active external (warmed blankets, hot water bottles; active internal (warm O2, heated IV fluids, colonic bladder or peritoneal lavage, extracorporeal warming)

Front 596

when to pronounce death in hypothermia

Back 596

not until patients have been rewarmed to 35C

Front 597

cardiac complications of hypothermia

Back 597

dysrhythmias esp VF at core temperatures <30C

Front 598

drug of choice for dysrhythmias due to hypothermia

Back 598

bretylium

Front 599

indication for fluid resuscitation in burns

Back 599

if >20% BSA second-degree burns

Front 600

Parkland formula

Back 600

4cc/kg per % total BSA over 24 hours; 1/2 over first 8 hours and second half over next 16 hours

Front 601

what to monitor during fluid resuscitation in burns

Back 601

urine output; 1cc/kg/hr

Front 602

disposition in burns

Back 602

minor burns - discharge with pain meds; moderate burns - hospitalize; major burns - burn center

Front 603

define moderate burns

Back 603

partial thickness 15-25% BSA or full thickness <10%BSA

Front 604

define major burns

Back 604

partial thickness >25% BSA of full thickness >10%; burns to face, hands, joints, feet, perineum; electrical or circumferential burns

Front 605

describe electrical injuries due to AC

Back 605

explosive exit wounds, VF more common

Front 606

describe electrical injuries due to DC (industrial / batteries / lightning)

Back 606

discrete exit wounds, asystole more common

Front 607

what to monitor with IV fluid ersuscitation in electrical burns to prevent myoglobinuria

Back 607

UO 1.5-2 cc/kg/hr

Front 608

which electrical burn patients can be discharged?

Back 608

asymptomatic low-voltage (<1000-V) burn victims

Front 609

antibiotic of choice for tetanus

Back 609

metronidazole

Front 610

Three types of Troponins, which are used for MI screening?

Back 610

TnI, TnT and TnC. Skeletal and isoforms of TnC are identical. Immunoassays exist for distinct subforms of TnI and TnT.

Front 611

Earliest rising cardiac biomarkers?

Back 611

myoglobin and CK isoforms.

Front 612

CKMB timeline

Back 612

elevates within 6 hours 2 - 3 times the ULN, returns to normal range within 2 to 3 days after AMI.

Front 613

Troponin timeline

Back 613

rise 20 to 50 times the ULN in large infarction (small elevations for NSTEMI) about 6 hours after MI, stay elevated for 7 days or more after AMI.

Front 614

Three classes of sutures

Back 614

collagen, synthetic absorbable and nonabsorbable.

Front 615

suture sizing

Back 615

More zeros = smaller strand diameter, (4-0 is larger than 5-0)

Front 616

Patient presents 8 - 24 hours after acute acetaminophen ingestion. Treatment?

Back 616

- initiate NAC
- evaluate for laboratory evidence of hepatotoxicity

Front 617

When should the Rumack-Matthew nomogram be used?

Back 617

- used to predict likelihood of potential hepatotoxicity in acetaminophen overdose 4 or more hours after a single ingestion

Front 618

When should the Rumack-Matthew nomogram NOT be used?

Back 618

- The Rumack-Matthew nomogram is not applicable in cases of multiple ingestions or chronic APAP overuse

Front 619

What could make the Rumack-Matthew nomogram unreliable?

Back 619

- may be less reliable in cases of APAP ingestions associated with anticholinergic agents, opiods or extended release formulations

Front 620

Treatment of black widow bite

Back 620

- pain relief with parenteral opioids or muscle relaxants (eg, methocarbamol 15 mg/kg)
- Calcium gluconate 10% 0.1 - 0.2 mL/kg IV may relieve muscle rigidity
- Antivenin reserved for very young or elderly or pts. who don't respond to above treatments due to hypersensitivity reaction concerns

Front 621

antibiotic treatment for dog bites

Back 621

- Amoxicillin/clavulanate (250-500 mg PO tid)
- or ampicillin/sulbactam (1.5-3.0 g IV q6h)
- penicillin allergy: Clindamycin (150-300 mg PO qid) plus either TMP-SMX (1 DS tablet PO bid) or ciprofloxacin (500 mg PO bid)
+/- tetanus and rabies prophylaxis

Front 622

antibiotic treatment for cat bites

Back 622

- amoxicillin/clavulanate (250-500 mg PO tid)
- or ampicillin/sulbactam (1.5-3.0 g IV q6h)
- penicillin allergic: Clindamycin (150-300 mg PO qid) plus either TMP-SMX (1 DS tablet PO bid) or ciprofloxacin (500 mg PO bid)
+/- tetanus, rabies

Front 623

antibiotic treatment for human bites

Back 623

- Amoxicillin/clavulanate (250-500 mg PO tid)
- or ampicillin/sulbactam (1.5-3.0 g IV q6h)
- penicillin allergic: Erythromycin (500 mg PO qid) or a fluoroquinolone
- HBV vaccine, HBIG and HIV post-exposure prophylaxis (PEP)

Front 624

active immunization for animal bites

Back 624

HDCV human diploid cell vaccine

Front 625

passive immunization for animal bites

Back 625

HRIG human rabies immune globulin

Front 626

likely organism for dog bites

Back 626

- Staph aureus (including MRSA)
- Pasteurella multocida
- anaerobes
- Capnocytophaga canimorsus

Front 627

likely organism for cat bites

Back 627

- P. multocida
- S. aureus
- anaerobes

Front 628

likely organism for human bites

Back 628

polymicrobial;
- occlusional bite; Viridans streptococci (most frequently implicated), S. aureus, Haemophilus influenzae, anaerobes
- clenched fist; above plus Eikenella corrodens

Front 629

NO-1 (nonoxidizer group 1)

Back 629

- bacterium in dog and cat bites
- causes local abscess or cellulitis in healthy persons with no underlying illness

Front 630

Bacterium in dog and cat bites that causes local abscess or cellulitis in healthy persons with no underlying illness

Back 630

- NO-1 (nonoxidizer group 1)
- can progress from localized to systemic illness

Front 631

Brown recluse bite treatment

Back 631

- no universally accepted management
- early excision of bite site vs. oral corticosteroids
- anecdotal reports of success with dapsone and colchicine

Front 632

NEXUS criteria

Back 632

H&P clearance of cervical c-spine if none of the following exist:

1. Tenderness at the posterior midline of the cervical spine
2. Focal neurologic deficit
3. Decreased level of alertness
4. Evidence of intoxication
5. Clinically apparent pain that might distract the patient from the pain of a cervical spine injury

Presence of any one of these requires radiographic evaluation before clearance.

Front 633

American Association for the Surgery of Trauma's Organ Injury Scaling Committee renal injury classification.

Back 633

- About 85%-95% of renal injuries are grade I and include contusions, nonexpanding subcapsular hematomas without parenchymal laceration, minor lacerations that do not involve the collecting system or medulla, and cortical infarcts.
- Grade II injuries are characterized by nonexpanding perirenal hematomas confined to renal retroperitoneum and/or lacerations <1 cm in parenchymal depth of the renal cortex without urinary extravasation.
- Grade III injuries include lacerations >1 cm in parenchymal depth of the renal cortex without rupture of the collecting system or urinary extravasation.
- Grade IV injuries involve parenchymal laceration extending through renal cortex, medulla, and collecting system or vascular injury to the main renal artery or vein with contained hemorrhage.
- Grade V renal injuries result in a completely shattered kidney with vascular avulsion of renal hilum, resulting in devascularization of the kidney and extravasation of urine from the renal hilum.