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351 Cards in this Set
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The nasopharyngeal airway can be used in which types of patients?
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breathing semiconscious patients and when an oropharyngeal airway is technically challenging
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Prolonged use of a bag valve can lead to..?
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Distention of the stomach increasing the chance of an aspiration event
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What are the steps of successful intubation?
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5P's Preparation, preoxygenation, pretreatment, paralysis, and placement
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How do you prepare for successful intubation?
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IV access, monitors, suction, appropriate sized ET tube, and meds for rapid sequence intubation
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What pretreatment may be necessary in small children prior to intubation and why?
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Atropine, to blunt the bradycardia induced by succinocholine
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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?
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Reactive airway disease - lidocaine 1.5mg/kg
Pancuronium 0.01mg/kg |
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What sedative agent is used prior to paralysis for intubation?
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Etomidate 0.3mg/kg
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volar =?
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palmar
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Physical Exam of emergency ortho...?
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ROM
Palpation for subtle deformities well beyond the area of subjective pain Neurovascular assessment |
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Ulnar nerve palsy causes..?
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Claw hand
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Inability to extend the knee could be caused by paralysis of which nerve?
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Femoral nerve
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Early treatment of ortho emergencies?
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NSAIDs
RICE (rest ice compression elevation) NPO Reduction of long bone deformities |
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Don't forget to give _____ for open fractures?
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Tetanus
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In children with trauma to a joint, what is important to consider on imaging?
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Comparison to the opposite extremity - difficult to tell the difference between a fracture and an epiphyseal growth plate
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Compartment syndrome defined?
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When the pressure in a compartment exceeds the arterial perfusion pressure
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Most reliable sign of compartment syndrome?
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Paresthesia
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ARDS, neuro involvement, and thrombocytopenia post- closed fractures in leg..?
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Fat embolism
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If you land directly on your shoulder, and hit hurts to reach across your body, what is the injury?
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Acromioclavicular joint separation
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when does Acromioclavicular joint separation require surgery?
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type iv or higher (when the clavicle is displaced into surrounding areas)
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96% of shoulder dislocations are...?
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Aneterior shoulder dislocations
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how does the patient with an Anterior shoulder dislocation appear?
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holding arm in slight abduction and external rotation
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What is the most common fracture in Aneterior shoulder dislocations? what nerve should be tested?
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Hill-Sachs deformity - fracture of the posterolateral aspect of the humeral head
Test the axillary nerve |
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Posterior disloactions are caused by...? always associated with...?
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fall on outstretched hand, convulsive seizure.
Assoc. with Hill Sachs deformity |
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Most common mechanism of acute rotator cuff tear? Thisinjury impairs which movement?
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Forced abduction.
Impairs arm abduction to 30 degrees |
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What important structures travel with the humerus?
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The deep brachial artery and the radial nerve
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Who gets supracondylar fractures? how?
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Kids < 15.
Falling backwards on an outstrertched hand |
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Posterior fat pad sign indicates?
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In adults - radial head fracture
In kids - supracondylar fracture |
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What is fracture of the proximal 1/3 of the ulna with radial head dislocation called?
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Monteggia fracture
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What is fracture of the distal 1/3 of radius with dislocation of the distal radioulnar joint called?
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Galeazzi
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Causes of carpal tunnel?
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RA, hypothyroid, DM, collagen vascular diseases
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Phalen's test?
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Fully flex the wrists for 60 seconds
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Tinel's sign?
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Light tapping over the median nerve produces pain or paresthesias
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Most common carpal injury..?
High risk of..? |
Fracture of the scaphoid. AVN
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Smith's fracture?
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Like colles, but distal fragment is displaced in the volar direction
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neurogenic shock?
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state of vasomotor instability resulting from impairment of the descending symp. pathways in the spinal cord, or just a loss of symp. tone
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does spinal shock signify permanent spinal cord damage?
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often times no
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anterior cord syndrome results in loss of which tracts?
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spinothalamic and corticospinal tract
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Central cord syndrome can be caused by? Affects?
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Hyper-extension injuries.
Nerves that cross over at that level |
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if a penetrating spinal injury is diagnosed, begin treatment with..?
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High dose methylprednisolone
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if suspecting a c-spine fracture, what xrays should be ordered?
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lateral, AP, and odontoid view
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C1 burst fracture is called? Caused by...?
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Jefferson fracture. Caused by axial loading - someone falls on their head, or something falls on their head
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Odontoid fractures are caused by..?
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Flexion
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Hangman's fracture?
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Fracture of both pedicles of C2 - hyperextension mechanism
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Stable or unstable?
atlanto-occipital dislocation burst fracture of C5 with intact ligaments... simple wedge fracture odontoid fracture flexion teardrop fracture extension teardrop fracture |
atl - unstable
burst c5 - stable simple wedge - stable odontoid - unstable flexion teardrop - unstable extension teardrop - stable |
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flexion teardrop fracture is associated with...?
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tearing of the posterior complex
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bilateral facet dislocation...? stable?
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flexion injury
subluxation of the dislocated vertebra very unstable |
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Cullen's sign? Gray-Turner's sign?
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ecchymosis of the abdomen signifies late retroperitoneal hemorrhage
Gray-Turner's: same, but of the flanks |
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12% of patients with hyperthyroidism will suffer...?
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Pathologic fracture
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serious associated injuries are present in up to 95% of patients with a dislocated...?
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hip
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a pt with a posterior hip dislocation holds the hip how?
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flexed, adducted, and internally rotated
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most common ortho injury seen in the ED?
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knee - in particular, MCL (medial collateral ligament)
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50% of patients with ACL injury have a concomitant...?
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Meniscal tear
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lachman's test?
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flex the knee to 30 degrees and pull anteriorly on the tibia
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donahue's unhappy triad?
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ACL, MCL, and medial meniscus tear
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Injury to the ________ occurs in 50% of knee dislocations...
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popliteal artery
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injury to the tibial nerve causes...?
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inability to stand on tiptoes
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which ankle fracture warrants a careful radiologic examination? of what specifically?
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medial malleolar fracture
proximal shaft of the fibula (Maisoneuve fracture) |
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10% of calcaneal fractures are associated with...?
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lumbar fractures
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when do you call for an ortho consult?
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compartment syndrome
irreducible fractures circulatory compromise open fracture anything that requires surgery |
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what is the most frequent complication of orotracheal intubation?
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Right main stem bronchus intubation
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Patients with COPD, asthma, or CHF that are awake but cannot remain in the supine position may be intubated how...?
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Nasotracheal intubation
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Most serious complication of nasotracheal intubation?
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Intracranial passage of the tube
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advance airway adjuncts?
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fiberoptic intubation
retrograde intubation combitube laryngeal mask airway |
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What is the preferred surgical airway for kids? Adults?
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Kids - needle cricothyroidotomy
Adults - surgical cricothyroidotomy |
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if an airway will be needed for greater than 2-3 days, a surgical cricothyoidotomy should be converted to...?
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a tracheostomy
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slit lamp exam consists of...?
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eval the integrity of the cornea, conjunctiva, and the anterior chamber
fluorescein to light up corneal defects |
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central retinal artery occlusion occurs in which people?
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men in their 60s
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fundoscopic exam in central retinal artery occlusion?
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pale retina with cherry red fovea
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what is amaurosis fugax?
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type of TIA - sudden vision loss (Shade over eye), transient, due to carotid-origin embolic shower
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classic triad of optic neuritis?
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marcus gunn pupil
central vision loss red vision desaturation |
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flashing lights, spider webs, or floaters that interfere with vision may be a sign of...? what meds should NOT be given?
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retinal detachment
DON'T anticoagulate |
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painful red eye - most often due to which things?
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conjunctivitis, corneal abrasion, or foreign body
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which conjunctivitis produces copious DC?
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gonorrhea
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punctate lesions in conjunctivitis?
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viral cause
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tx of conjunctivitis?
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broad spectrum antibx, pain meds
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soft contact wearers are especially prone to infection by.?
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pseudomonas
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severe unilateral eye pain, decreased visual acuity and photophobia...?
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iritis
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tx of iritis?
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cycloplegic such as homatropine(not a mydratic)
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severe unilateral HA, eye pain, N/V assoc with loss of vision....?
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narrow angle glaucoma
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which drugs decrease aqueous production?
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acetazolomide and topical b blockers
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which chemicals causes coag necrosis? liquefaction necrosis?
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acids
alkali |
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tx of chemical burn...
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IRRIGATE
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what's hyphema?
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blurred vision after blunt trauma (dull eye pain)... bleeding
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basic approach to all tox patients in the ED?
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ABCs
Decontamination Elimination Antidotes |
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key things on physical exam for tox exposures....?
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Vital signs
pupils toxidromes autonomic signs motor signs mental status skin |
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describe anticholinergic toxidrome?
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"mad as a hatter, dry as a bone, red as a beet, hot as a stove." Also - decreased GI motility, urinary retention, mydriasis.
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describe muscarinic toxidrome?
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DUMBELLS
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narcotic toxidrome?
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resp depression, hypotension, depressed sensorium, miosis
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sympathomimetic toxidrome? compare with anticholinergic toxidrome?
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very similar except sympathomimetic involves diaphoresis
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withdrawal toxidrome?
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agitation, hallucination, mydriasis, diarrhea, cramps, lacrimation, tachycardia, insomnia, seizures
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major toxic effect of acetaminophen?
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metabolite NAPQI causes centrilobular hepatocellular damage
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tx of acetaminophen tox...?
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4 hour level on rumack-matthew nomogram, activated charcoal, N-acetyl-cysteine (to regenerate glutathione)
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methanol tox?
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formic acid metabolite - causing a gap acidosis and direct optic nerve toxicity
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treatment of ethylene glycol tox?
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4MP or EtOH
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which drugs can cause anticholinergic syndromes? tx?
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antihistamines, antipsychotics, TCAs...
tx - physostigmine |
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symptoms of calcium channel blocker tox? tx?
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brady and hypotension
tx - CaCl2, glucagon, epinephrine, DA |
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CO tox symptoms
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HA, N/V, flu-like syx, CNS dep, tachy, hypotension
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tx of CO tox?
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100% O2
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GHB?
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date rape drug - euphoric and amnestic effects
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refractory seizures could be caused by what toxicity?
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INH
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Organophosphates can cause which toxidrome?
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muscarinic
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naloxone?
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opioid antagonist
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standard of care for salicylate poisoning?
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activated charcoal
- also consider alkalinization of urine and blood with bicarb |
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benzo receptor antagonist that can rapidly reverse coma from benzo OD...? what's the problem with this drug/
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flumazenil
can lower the sz threshold in pts with TCA OD and induce benzo withdrawal |
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loxosceles bites can be treated with...?
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dapsone
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signs and symptoms of TCA OD?
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anticholinergic sx, cardiac dysfunction, intractible szs, and hyperthermia
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treatment of TCA tox?
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decontamination with MDAC
Sodium bicarb administration Benzos for sz management Alpha agonists for hypotension |
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prerenal failure due to..?
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decreased renal perfusion (volume depletion, low CO, abnormal renal hemodynamics)
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most common cause of intrinsic renal failure?
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longstanding HTN
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majority of hospital-assoc episodes of ARF are caused by...?
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ATN
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postrenal failure caused by?
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obstructive uropathy
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FENA <1 in which condition?
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Prerenal failure
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Urine Na <20 in which condition?
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Prerenal failure
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tx of prerenal failure?
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volume replacement, d/c offending meds
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intrinsic RF treatment?
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monitor fluid status,restrict protein, correct eletrolyte abnormalities
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dispo for patients with ARF?
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admit
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what drugs can cause ARF in pts with renal artery stenosis?
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ACE inhibitors
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#1 cause of death in 1-44 year olds?
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Trauma (specificallly, MVCs)
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Preparation for a trauma case includes?
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History from EMTs
Prep the trauma bay Airway box O2 and suction IVF and supplies |
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Indications for intubation?
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GCS <8
Inadequate breathing Unable to protect airway |
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Chin lift is contraindicated if...?
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A C-spine injury is suspected
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Radial pulse should have a BP of at least...? Femoral?
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80 mmHg
70 |
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what % of ECF is plasma?
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1/3
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which drug is an ineffective pressor in hypovolemic patients?
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dopamine
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GCS consists of which 3 categories?
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eye opening, verbal response, moto response
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most rapid means to lower ICP?
what other method? |
Hyperventilation
mannitol |
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volume of blood in an adult?
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5 L (7% of ideal body weight)
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physiologic response to acute hypovolemia?
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In order:
Tachycardia narrowed pulse pressure (increased diastolic press) slowing of cap refill decreased systolic pressure |
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raccon eyes, and battle sign?
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late findings in basilar skull fractures
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assessment of C-spine in trauma?
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posterior midline - any tenderness?
focal neuro deficit? A&O? evidence of intox? any painful injury that may distract the pt? |
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FAST?
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quick, non-invasive method of examining the abdomen and pericardium for blood
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how to check for pelvic frx?
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press down and in on both iliac crests simultaneously
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urine myoglobin can be elevated secondary to...?
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massive muscle breakdown (rhabdo)
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tx of rhabdo?
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IVF, sodium bicarb, and mannitol
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calculate cerebral perfusion pressure?
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MAP - ICP
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Cushing's reflex? sign of?
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HTN, brady, hypopnea
sign of increased ICP |
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in traumatic head injury, what is the target MAP?
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90mmHg
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intubation considerations for elevated ICP?
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intubate early but WITHOUT ketamine
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seizure prophy with head bleeds?
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dilantin
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how does cardiac tamponade present? findings?
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hypotension, muffled heart sounds, JVD, and pulsus paradoxus
electrical alternans on ECG may present with pulseless electrical activity |
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which condition can lead to hypotension, absent breath sounds, hyperresonance, distended neck veins, and high airway pressures?
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tnesion pneumothorax
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hypoxia occurs if an open pneumothorax is greater than?
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2/3 trachea diameter
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flail chest?
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3 or more rib fractures in 2 or more sites with paradoxical motion of chest wall with inspiration
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how to demonstrate fluid in the pericardium in tamponade?
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echocardiogram, or ED U/S
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tx of tension pneumothorax?
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angiocath in the 2nd intercostals space in the mid-clavicular line
chest tube if hemo or simple pneumothorax suspected |
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tx of cardiac tamponade?
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subxyphoid pericardiocentesis
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splenic injury can cause pain referred to...? eponym?
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left shoulder...Kehr's sign
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which chief complaints warrant a stat EKG?
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chest pain/presure/discomfort
SOB hypotension weakness/dizziness syncope abdominal pain esp in elderly palpitations N/V esp in elderly, diabetics |
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shortened PR interval suggests?
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alternate, abnormal conduction pathway like WPW syndrome
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elongated PR interval suggests?
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some form of AV block
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quick and dirty way of determining the axis of the heart?
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leads I and aVF...
both up - normal aVF down - LAD I down - RAD both down - RAD |
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DDx of U waves?
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hypokalemia
hypercalcemia meds (digoxin, quinidine) thyrotoxicosis |
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Describe possible characteristics of an unstable cardiac patient?
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Pulseless
Hypotension AMS Ischemic chest pain CHF |
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tx basics for unstable cardiac patients?
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cardioversion (synch or un-synch) per ACLS protocol, then IV meds or other therapy
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tx of sinus tachy?
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tx the UNDERLYING CAUSE
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how can you tell there's paroxysmal supraventricular tachy? tx?
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abnormal/absent P waves
Tx: unstable --> synch cardioversion stable --> AV node blockade via adenosis, calcium channel blockers (diltiazem, verapamil), b-blockers, manuevers |
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tx of a fib?
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unstable --> synch cardioversion
stable w/ rapid vent. response --> AV blockade: calcium channel blockers, b blockers, digoxin anticoagulation |
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pts with pre-excitation syndromes - be careful not to...?
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block the AV node by conventional meds
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premature ventricular contractions, etiology?
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4 H's - hypokalemia, hypomagnesemia, hypoxia, hyperthyroidism
drugs heart disease |
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what is trigeminy?
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every 3rd beat is a PVC
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tx of PVCs?
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iv lidocaine or amiodarone
iv magnesium sulfate procainamide |
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tx of pulseless v tach?
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immediate UNSYCNHED cardioversion
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tx for unstable v tach?
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synchronized cardioversion, then amiodarone or lidocaine drip
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tx for stable v tach?
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medical cardioversion with lidocaine, amiodarone, adenosine, or procainamide
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etiology of torsades?
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ischemic heart disease
MI hypo-electrolyte states |
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tx of stable torsades?
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electrical overdrive pacing
also consider Mg sulfate |
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tx of Vfib?
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unsynchronized cardioversion, ACLS protocols, and correction of lytes abnormalities
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pulseless electrical activity etiology?
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MATCH4ED
MI Acidosis Tension pneumo Cardiac tamponade H4- hypothermia, hyperkalemia, hypoxia, hypovolemia Embolism (pulm) Drug OD |
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tx of ventricular asystole?
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IVF, epinephrine, atropine
Transvenous pacing |
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for Mobitz II 2nd degree AV block, what tx? What won't work?
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transcutaneous or transvenous pacing
Admit for implantable pacemakers Atropine won't work |
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tx for 3rd degree AV block?
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immediate temporary pacemaker
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you should consider a new LBBB to be _______ until proven otherwise?
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acute MI
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Indications for temporary cardiac pacing?
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hemodynamically unstable bradycardia
brady that fails to respond to tx refractory tachydysrhythmias early bradyasystolic arrest |
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how does digoxin cause toxicity?
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blockade of the NaKATPase
increased vagal tone and increased AV nodal blockade |
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EKG signs of WPW?
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short PR interval
Delta wave wide QRS adult tachycardia |
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EKG signs of hypokalemia?
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more prominent U waves
flattened t waves |
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EKG signs of hyperkalemia?
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hyperacute T waves
wide QRS that eventually blends with the T wave to form a sine wave appearance |
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ekg signs of hypocalcemia?
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prolonged QT
terminal T wave inversion |
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ekg signs of hypercalcemia?
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shortened QT interval
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associated symptoms of ACS?
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dyspnea, diaphoresis, nausea, lightheadedness, or sense of weakness
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define stable angina?
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symptoms precipitated by exertion and relieved by rest or nitroglycerin
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define unstable angina?
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exertional angina of recent onset
angina of worsening character angina at rest |
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describe myoglobin as a cardiac marker?
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elevated as early as one hour and peaks at 4-12 hours
nonspecific |
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describe CKMB as a cardiac marker?
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rises in 3-4 hours, peaks at 12-24 hours
can be elevated in skeletal muscle injury |
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describe troponin as a cardiac marker?
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rises in 3-6 hours, peaks 12-24 hours
most specific and sensitive |
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acute MI tx?
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MOAN B H
morphine oxygen aspirin nitroglycerin beta blockade heparin |
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in pump failure.. which pressors for hypotension in a volume unresponsive pt...?
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sbp 80-100 - dobutamine
sbp 70-80 - dopamine sbp <70 - levophed |
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pericarditis - presentation?
pain is worsened by..? |
sharp stabbing precordial or retrosternal chest pain...
pain worsened by inspiration or lying flat |
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assoc symptoms of pericarditis?
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low grade fever
dyspnea dysphagia tachycardia |
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test of choice for detection and f/u of pericarditis?
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echo
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tx for pericarditis
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NSAIDs for 1-3 weeks
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aortic dissections typically occur in what group?
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uncontrolled hypertensive males ages 50-70
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physical findings in aortic dissection?
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asymmetric pulses with BP differences between extremities
very hypertensive severe distress JVD palpable pulsatile mass or tenderness |
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chest tube required for what size pneumothorax?
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>15%
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Nitro's relief of cardiac vs esophageal pain?
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Cardiac w/in 5 minutes, esophageal w/in 10 minutes
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life threatening etiologies of abdominal pain...?
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ruptured AAA, perforated viscous, intestinal obstruction, ectopic pregnancy, mesenteric ischemia, appendicitis, and MI
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INITIAL TEST OF CHOICE FOR BILIARY TRACT DISEASE, AAA, ectopic, or free peritoneal fluid?
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US
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Plain films can rule out which abdominal emergencies?
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Perforation or obstruction
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Colicky pain usually responds to which drugs? Specifically...?
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NSAIDs, esp IV Ketorolac
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Triad of pain, hypotension, and a pulsatile abdominal mass...?
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AAA
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_______ is virtually 100% sensitive in detecting AAAs?
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US
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What is usually the primary inciting factor of appendicitis?
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Obstruction of the appendix usually by an appendicolith
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CBC in approx 75% of appy pts reveals?
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leukocytosis above 10,000
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Antibx for appy?
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amp/gent/flagyl
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risk factors for cholecystitis?
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fat, forty, and female
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radiation of pain in acute cholecystitis?
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tip of the right scapula
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most useful test if suspicious of cholecystitis?
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US of RUQ
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which agents should not be used in acute gastroenteritis?
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anti-motility agents (Imodium) because it diminishes diarrheal excretion of organisms
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Presentation of patients with acute hepatitis?
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Jaundice, dark urine/light stools, hepatomegaly, fatigue, malaise, RUQ pain, N/V, and fever
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coagulation should be normalized with FFP in which condition?
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hepatitis
|
|
|
presentation of acute mesenteric ischemia?
|
severe, poorly localized colicky abdominal pain associated with recurrent forceful bowel movements
classic - abdominal pain out of proportion to the minimal physical exam findings |
|
|
Most useful test to diagnose acute mesenteric ischemia?
|
Angiography
|
|
|
Midepigastric abdominal pain usually assoc. with N/V?
|
Acute pancreatitis
|
|
|
An amylase raised _______ times the upper limit of normal is 98% specific to acute pancreatitis...
|
1.5
|
|
|
All patients with acute pancreatitis should be....
|
admitted and made NPO
|
|
|
good narcotic choice for pain in acute pancreatitis
|
Meperidine (better than morphine)
|
|
|
fever, abdominal pain, and rebound tenderness...?
|
Peritonitis
|
|
|
Small bowel obstruction is caused by ________ more than 50% of the time...?
|
postoperative adhesions
|
|
|
Most significant complications of small bowel obstruction?
|
Strangulation and bowel infarction
|
|
|
etiology of bronchitis?
|
viruses (influenza, adenovirus, etc.)
Mycoplasma Chlamydia Bordetella pertussis |
|
|
Virchow's triad of the pathophysiology behind PE?
|
Venostasis
Hypercoagulability Vessel wall damage/inflammation |
|
|
Classic triad of PE presentation?
|
Hemoptysis
Dyspnea chest pain |
|
|
EKG findings in PE?
|
S1
Q3 inverted T3 |
|
|
golden standard for diagnosing PE?
|
pulmonary angiography
|
|
|
ED treatment of CHF?
|
diuretics
nitrates anlgesics intubation or CPAP if no improvement |
|
|
treatment of COPD in the ED?
|
ABCs monitoring
albuterol neb glucocorticoids MgSO4 in severe exacerbations antibiotics (empiric broad spectrum) |
|
|
ED eval of asthma?
|
Monitors, O2, pulse ox
Peak expiratory flow rate CXR - to rule out pneumonia |
|
|
signs of hyperventilation syndrome?
|
tachypnea, chest wall tenderness, carpopedal spasm, Chvostek's/Trousseau's sign (hypocalcemia)
|
|
|
this condition likely results from inflammation of CN VII as it courses through the styloid foramen?
|
Bell's palsy
|
|
|
tx of bell's palsy?
|
acyclovir AND prednisone
eye patching to prevent keratitis and corneal ulceration |
|
|
work up of CVA?
|
STAT head CT - esp if < 3 hrs
standard labs STAT Accu-check |
|
|
in hemorrhagic stroke, you want to decrease SBP by no more than _____ to limit hypoperfusion...?
|
20-25%
|
|
|
Peripheral vertigo is caused by.?
|
viral etiology (labyrinthitis)
decaying or "lost" otoliths |
|
|
peripheral vertigo presentation?
|
acute onset
intense spinning sensation, N/V unidirectional nystagmus that can be inhibited by fixation |
|
|
work-up of peripheral vertigo?
|
hallpike maneuver
epley manuevers anti-emetics, anti-cholinergics |
|
|
most szs in the ED are due to...?
|
Medical non-compliance in known seizure patients
|
|
|
workup of szs in the ED...
|
ABCs
IV check glucose head CT anti-epileptic level LP if any possibility of intracranial hemorrhage or meningitis |
|
|
LOC occurs in ____ % of patients with SAH?
|
50%
|
|
|
75% of SAH is due to...?
|
ruptured congenital arterial aneurysm
|
|
|
diagnostic test for SAH?
|
noncontrast head CT
|
|
|
if there is suspicion for SAH and it's not seen on CT, ____ must be performed?
|
LP
|
|
|
What other condition besides SAH could cause blood in the CSF?
|
Herpes encephalitis
|
|
|
goal of ICP management is to maintain the cerebral perfusion pressure greater than ______?
|
60
|
|
|
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...?
|
intracranial tumor / mass
|
|
|
85% of people experiencing malignant hypertension complain of _____?
|
Headache
|
|
|
Temporal arteritis affects women ______ than men, and is uncommon before the age of _____? ESR is usually ____?
|
Women more than men
50 ESR 50-100 |
|
|
Jaw claudication is strongly suggestive of...?
|
temporal arteritis
|
|
|
tx of temporal arteritis?
|
prednisone 60mg po, arrange a biopsy to confirm diagnosis
|
|
|
Often compression of ______________ can improve the pain of migraine?
|
the ipsilateral superficial temporal or carotid artery
|
|
|
ergotamine is contraindicated in... ? Should be used w/ caution in ....?
|
Pregnancy
Caution in HTN or CAD |
|
|
Patients should avoid _____ while in the midst of cluster headaches?
|
Alcohol
|
|
|
This causes HAs often in overweight women in their 30s...
|
Pseudotumor Cerebri (benign intracranial HTN)
|
|
|
90% of patients with Pseudotumor Cerebri have ....?
|
papilledema
|
|
|
in Pseudotumor Cerebri, head CT will show...? LP will show...?
|
CT - slit-like ventricles
LP - increased opening pressure |
|
|
treatment of Pseudotumor Cerebri..?
|
Acetazolamide 250 mg pid
|
|
|
tx of post LP HA?
|
caffeine sodium benzoate
|
|
|
cherry-red coloration of skin/mucous membranes, retinal hemorrhages, AMS?
|
CO poisoning
|
|
|
sudden onset of head/eye pain, decreased visual acuity?
|
Acute angle closure glaucoma
|
|
|
tx of acute uncomplicated UTI?
|
Bactrim for 3 days
|
|
|
Pyelo w/ systemic sx tx?
|
admit for IV antibx
|
|
|
pregnant women with UTI tx?
|
macrobid for 7 days
|
|
|
What % of pts presenting with classic UTI sx show minimal to no bacteria on UA?
|
30-40%
|
|
|
Sudden onset of testicular pain in children and young men?
|
Testicular torsion
|
|
|
most common cause of urinary retention?
|
BPH
|
|
|
>100 ml postvoid residual urine volume is diagnostic of...?
|
urinary retention
|
|
|
what is fournier's gangrene?
|
agressive fasciitis of the perineum in a toxic appearing pt likely with history of DM, urethral trauma, surgery, or obstruction
|
|
|
tx of fournier's gangrene??
|
immediate surgery - complete debridement of necrotic tissue
|
|
|
tender, swollen, painful epididymis and testis usually accompanied by fever?
|
Epididymitis
|
|
|
testicular US can distinguish...?
|
torsion from epididymitis
|
|
|
the cremasteric reflex is present in _____ but not in ___________?
|
epididymitis
torsion |
|
|
nonspecific infection of the glans penis is called...?
|
balanitis
|
|
|
abnormally small opening in the foreskin?
|
phimosis
|
|
|
abnormal painful swelling of the glans penis occurring after aggressive retraction of a phimotic foreskin?
|
paraphimosis
|
|
|
flank/abdominal pain, does not change with position or remaining still, radiation to groin...
|
stones
|
|
|
work up of stones?
|
IVF
IV narcotics UA - will generally show hematuria BMP |
|
|
test of choice for kidney stones?
|
noncontrast CT
|
|
|
stone <3mm probability of passing spontaneously?
|
80%
|
|
|
Indications for urology consults or admission in kidney stones...?
|
Associated UTI
uncontrolled pain/emesis extravasation of contrast renal failure single kidney hydronephrosis + hydroureter stone > 6mm |
|
|
in a patient >60, first time renal colic is _________ until proven otherwise...
|
AAA
|
|
|
of those women who experience bleeding in the first trimester, ______________ will undergo spontaneous abortion
|
1/2
|
|
|
threatened abortion...?
|
vaginal bleeding with a pre-viable fetus and closed cervix
|
|
|
inevitable abortion?
|
vaginal bleeding with cervical dilatation
i |
|
|
incomplete abortion
|
vaginal bleeding with partial passage of products of conception and dilated cervix
|
|
|
complete abortion
|
passage of all products of conception and closed cervix
|
|
|
missed abortion
|
fetal demise and retention of products of conception, cervix closed
|
|
|
6-8 weeks gestation with amenorrhea, spotting, and cramping lower abdominal pain....concerning for...?
|
ectopic
|
|
|
gold standard in diagnosing an ectopic?
|
US
|
|
|
any patient who presents with vaginal bleeding and is _____ should be given RhoGAM?
|
Rh -
|
|
|
2 most common pregnancy related causes of vaginal bleeding in the second trimester?
|
miscarriage
hydatidiform mole |
|
|
pre-eclampsia that occurs prior to 20 weeks gestation is pathognomonic for...?
|
trophoblastic disease
|
|
|
most common presentation of placenta previa?
|
late 2nd to early 3rd trimester painless bleeding
|
|
|
____________- may occur in up to 1/3 of placental abruptions?
|
DIC
|
|
|
pre-eclampsia?
|
triad of HTN, edema, and proteinuria of >100 mg/dl
|
|
|
HELLP syndrome?
|
subset of pre-eclamptic pts:
Hemolysis, Elevated Liver enzymes, and Low Platelets |
|
|
In preeclampsia and eclampsia, the most important part of the CBC is...?
|
the platelet count
|
|
|
seizure prophylaxis in pre, eclampsia?
|
MgSO4
|
|
|
preterm labor is defined as occuring...?
|
before 37 weeks gestation
|
|
|
Strawberry cervix?
|
trichomonas
|
|
|
avg blood loss in normal menses/
|
30-60cc
|
|
|
benign leiomyomas that develop in the uterues and often result in menometrorraghia?
|
fibroids
|
|
|
dysfunctional uterine bleeding tx..?
|
NSAIDs, and OCPs
rule out endometrial carcinoma |
|
|
Chlamydia can cause....?
|
Asymptomatic infection
Urethritis Cervicitis PID |
|
|
PID?
|
Lower abdom. tenderness, cervical motion tenderness, and adnexal tenderness
+ fever or inc. WBC or ESR etc.. |
|
|
most common cause of infectious arthritis in young sexually active adults?
|
Gonorrhea
|
|
|
green-gray discharge?
|
trichomonas
|
|
|
thin-gray malodorous discharge, non sexually transmitted
|
bacterial vaginosis
|
|
|
most common cause of pelvic pain in women not associated with infection is...?
|
Rupture of an ovarian cyst
|
|
|
50% of cases of ovarian torsion are caused by..?
|
Benign dermoids that cause the ovary to twist
|
|
|
A major cause of pelvic pain, dyspareunia, and dysmenorrhea
|
Endometriosis
|
|
|
postcoital contraception?
|
norgestrel
|
|
|
first, second, etc degree frostbite?
|
1st - warm, hyperemic, sensate
2nd - clear vesicles 3rd - purple bullae 4th - mummification |
|
|
ED management of frostbite?
|
tx hypothermia
IVF remove nonadherent wet apparel rapid thawing thawing in 42C water bath unroofing clear blisters aloe vera tetanus prophy ibuprofen, ascorbic acid, nifedipine |
|
|
How to estimate total body surface area for burns..?
|
9's - LUE - 9%, LLE - 18%, posterior torso - 18%, head - 9%
|
|
|
burn degrees?
|
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) |
|
|
How do you determine IVF needs in a burn victim?
|
If TBSA >15%....
4ml x kg weight x tbsa% = total volume of replacement needed in first 24 hrs |
|
|
don't forget _________ in frostbite, burns, and a variety of other injuries....?
|
tetanus prophy
|
|
|
hypothermia defined?
|
core temp < 35 C
|
|
|
presentation of mild hypothermia?
|
confusion, lethargy, fatigue, shivering, tachy, resp alkalosis
|
|
|
resuscitation in severe hypothermia should include _________ in order to treat cardiac dysrhythmias...?
|
Warming until core temp > 32 C
|
|
|
severe dehydration, thermoregulaory failure, temp >40C, tachy, hypotension, confusion, rhabdo...?
|
Heat stroke
|
|
|
tx of heat stroke..?
|
rapid cooling, monitoring, seizure prophy
|
|
|
voltage > _____________ is considered high tension..?
|
1000 V
|
|
|
the _________ the resistance, the more the current and damage
|
less
|
|
|
AC current is ___________ dangerous than DC, because?
|
more
increased duration of exposure increased likelihood of Vfib |
|
|
barotrauma of ascent?
|
when a diver fails to exhale when ascending, exacerbating the overexpansion of the airspaces
|
|
|
type 1 decompression sickness? type 2?
tx if severe? |
1 - joint, skin, bone problems
2 - neuro, lung, CV problems Hyperbaric oxygen chamber |
|
|
what agent can mimic acclimatized state in the tx of altitude sickness?
|
Acetazolamide - causes a compensatory respiratory alkalosis
|
|
|
most infection prone bite injury?
|
human bite to the hand
|
|
|
___________ is implicated in 50% of infected cat bites and 30% of infected dog bites?
|
Pasteurella
|
|
|
complications of this infection include encephalitis, Painaud's, osteolytic bone lesions, purpura, and erythema nodosum
|
Bartonella
|
|
|
describe phases of rabies briefly?
|
Incubation period - couple months
Prodrome - 1 week of localized pain, malaise, N/V Acute neuro phase - 1 week Coma - up to 2 weeks |
|
|
Loxosceles spider bite tx?
|
wound care
antibx if superinfected antihistamines and analgesics dapsone to prevent ulceration IV steroids in viscerocutaneous loxoscelism to prevent hemolysis |
|
|
sudden onset fever, centripetal rash spread, severe HA, myalgia, N/V, and abdominal pain
|
Rocky mountain spotted fever
|
|
|
tx of rocky mountain?
|
teracycline or chloramphenicol
supportive care for shock, DIC, ARDS, CHF |
|
|
complications of auricular hematoma?
|
cauliflower ear, cartilage necrosis
|
|
|
pathogens of otitis externa?
|
pseudomonas and staph
|
|
|
treatment of anterior bleeding epistaxis?
|
pinching pressure, decongestion, silver nitrate, packing, abx to prevent sinusitis
|
|
|
problem with posterior bleeding epistaxis?
|
pharyngeally stimulated hypoxia and stopped breathing
|
|
|
____________ cures >95% of peritonsillar abscesses?
|
I and D
|
|
|
Ludwig's angina? big concern?
|
trenchmouth - dental origin infection of submandibular space due to horrible hygiene
Concern - airway compromise |
|
|
duck quack cry is characteristic of...?
|
Retropharyngeal deep space infection
|
|
|
swallowed coins appear ____________ in trachea, _____________ in esophagus?
|
side on
face on |
|
|
diagnosis and tx. of esophageal foreign body?
|
EGD for visualization
glucagon for esophageal relaxation |
|
|
epiglottitis has traditionally been associated with which infection?
|
Hemophillus B
|
|
|
diagnosis of epiglottitis?
|
loss of V-shaped dip in neck plain film (valecula sign)
|
|
|
if suspecting epiglottitis in kids....what next?
|
call ENT or anesthesia - no IV's, oral exam, nothing that stimulates/agitates the child
|
|
|
croup? what type of cough?
|
laryngotracheobronchitis - viral infection
seal-like barking cough |
|
|
difference in presentation in kids with croup vs. epiglottitis?
|
in croup, kids generally appear well
|
|
|
tx of croup?
|
racemic epi, humidified air, steroids
|
|
|
angioedema? tx
|
inflammatory autoimmune reaction, increased capillary permeability
tx - H1 blocker, steroids, H2 blocker, epi for severe cases |
|
|
causes of pharyngitis?
|
group A strep
Mono with lymphadenopathy, splenomegaly adenovirus |
