First Aid For The Emergency Medicine Clerkship

Front 1

What is the most common cause of sudden cardiac death in adults?

Back 1

V-Fib

Front 2

Survival rates are highest when BLS is initiated within ____ minutes and ACLS is initiated within ___ minutes

Back 2

4, 8

Front 3

What is the most common cause of airway obstruction in an unconscious victim?

Back 3

The tongue

Front 4

When an advanced airway is in place, during 2 person CPR, give 1 breath every ___ to ____ seconds without attempting to synchronize with chest compressions.

Back 4

6 to 8 seconds

Front 5

How much tidal volume normally causes visible chest rise during resuscitation breathing?

Back 5

500-600 mL

Front 6

What is the most common cause of foreign body airway obstruction in adults?

Back 6

Poorly chewed meat

Front 7

If a patient with a foreign body airway obstruction is able to cough and speak, what is the next best step?

Back 7

- DO NOT interfere

- Coughing is the most effective way to clear the obstruction

- Speaking indicates adequate ventilation is still occuring

Front 8

Which cardiac medications can be administered through an ET tube?

Back 8

"ALE"

Atropine

Lidocaine

Epinepherine

(Also, naloxone)

Front 9

What is the fluid of choice in a resuscitation setting?

Back 9

Normal Saline

Front 10

Return to Spontaneous Circulation is characterized by a PCO2 > ___?

Back 10

40mm Hg

Front 11

Markers of compromised quality CPR:

PETCO2 < _____

Diastolic Pressure < ______

Back 11

PETCO2 < 10mm Hg

Diastolic BP < 20 mm Hg

Front 12

What drug can be used in the V-fib/Pulseless V-tach algorithm if Amiodarone is not available?

Back 12

Lidocaine 1-1.5mg/kg

Front 13

DOC for Torsades de pointes?

Back 13

Magnesium Sulfate

Front 14

DOC for hypomagnesemia?

Back 14

Magnesium sulfate

Front 15

What are the 10 causes of PEA?

Back 15

"HOT MATCH MD"

Hypovolemia (normal saline infusion)

HypOxemia (O2, intubation, ventilation)

HypoThermia (warmed normal saline infusion)

Massive Pulmonary Embolism (thrombolytics)

Acidosis (sodium bicarbonate)

Tension pneumothorax (needle decompression)

Myocardial Infarction

Drug Overdose with TCAs, digoxin, beta-blockers, calcium channel blockers

Front 16

What is the most common cause of a "flatline" tracing on ECG?

Back 16

Detached lead or equipment malfunction

Front 17

Why is atropine not preferred in Type II second-degree heart block?

Back 17

Atropine may convert Type II second-degree heart block into complete heart block.

Transcutaneous Pacing is indicated

Front 18

Contraindications to carotid massage and ice baths in an attempt to convert stable Paroxysmal Supraventricular Tachycardia?

Back 18

Carotid Massage --> bruits present

Ice Bath --> previous MI

Front 19

ECG strip shows a narrow, regular QRS and a rate greater than 160bpm

Back 19

PSVT

Front 20

What is the biggest mistake when using adenosine to try to convert PSVT?

Back 20

Not pushed rapidly enough

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Adenosine 6mg rapid IV push

(Important: Wait 1-2 minutes)

↓

Adenosine 12mg rapid IV push

Front 21

This drug feels like a "mule kick to the chest"

Warn patients before giving it...

Back 21

Adenosine

Front 22

Adenosine is contraindicated in patients with what airway disease?

Back 22

Asthma

Front 23

Before giving adenosine to patients with heart transplants, or patients taking dipyramidole or carbamazapine, you should _____ the dose

Back 23

Decrease the dose

Front 24

Patients with tachyarrhythmias that are unstable should receive ___________________

Back 24

Synchronized cardioversion

Front 25

Ventricular Tachycardia may readily convert to _________

Back 25

V-fib

Front 26

Shock is defined as inadequate _______ perfusion

Back 26

inadequate tissue perfusion

Front 27

Ventricular Tachycardia = wide QRS + rate > ____

Back 27

> 100msec

Front 28

Rapid Sequence Intubation:

Children should be pretreated with _____

Back 28

Atropine

Front 29

Rapid Sequence Intubation:

Patients with head injuries should be pretreated with ______________

Back 29

Lidocaine (to ↓ Intracranial Pressure)

Front 30

Rapid Sequence Intubation:

Agent used for sedation in children?

Back 30

Ketamine

Front 31

Rapid Sequence Intubation:

Succinylcholine should not be used in patients with _____________ (3 things)

Back 31

Crush Injuries

Hyperkalemia

History of Neuromuscular Dz

Front 32

Rapid Sequence Intubation:

Name 4 agents used for sedation

Back 32

Etomidate (doesn't cause hypotension)

Ketamine (doesn't cause hypotension)

Midazolam

Propofol (can cause hypotension)

Front 33

Rapid Sequence Intubation:

Which agent used for paralysis has the shortest onset?

Back 33

Succinylcholine

Front 34

Rapid Sequence Intubation:

Name the 3 agents used for paralysis

Back 34

Succinylcholine

Rocuronium

Vecuronium

Front 35

Rapid Sequence Intubation:

Steps to take before, during and after RSI?

Back 35

Prepare = equipment

Pretreat = drugs

Position = sniffing position

Preoxygenate = pulse oximetry of 100%

Paralyze = drugs

Placement of tube

Position of tube = confirm by 2 methods

Front 36

Needle vs. Surgical Cricothyroidotomy

Which one allows for both oxygen delivery and ventilation for elimination of CO2?

Back 36

Surgical Cricothyroidotomy

Front 37

Equation to calculate a patient's accurate calcium level?

Back 37

4 - serum albumin (g/dL) x 0.8 + serum Calcium

Front 38

Rough correction for total body calcium in hypoalbuminemia:

Add 1 mg/dL to serum Calcium for every 1 mg/dL in albumin below _____ mg/dL

Back 38

Add 1 mg/dL to serum Calcium for every 1 mg/dL in albumin below 4 mg/dL

Front 39

How are calcium levels affected by acidosis?

Back 39

Acidosis ↑ Calcium levels

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Alkalosis ↓ Calcium levels

Front 40

What changes will hypercalcemia cause on ECG?

Back 40

Shortened QT interval

(Hypercalcemia also potentiates digoxin toxicity)

Front 41

A patient's bloodwork reveals hypercalcemia.

Bloodwork also shows ↑ serum Cl and low bicarbonate in a ratio > 33:1

This is suggestive of _____________

Back 41

Primary Hypothyroidism

Front 42

A patient's bloodwork reveals hypercalcemia.

Bloodwork also shows a high serum protein with a reversed albumin-to-globulin (A/G) ratio.

This is suggestive of _____________

Back 42

Multiple Myeloma

Front 43

How does hypocalcemia affect ECG?

Back 43

Prolonged QT Intervals

Front 44

Type of diuretic used to help correct Hypercalcemia?

Back 44

Loop Diuretic

(Loops LOOSE Calcium)

Front 45

Giving _____ in the setting of digitalis toxicity mya cause tetany and "stone heart"

Back 45

calcium

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(Consider this when using Calcium Gluconate to treat patients with hyperkalemia)

Front 46

A woman presents because her home blood sugar monitor readings at home have been "high"

Bloodwork reveals a serum glucose of 900 mg/dL, and a sodium level of 124 mg/dL.

In addition to correcting her blood glucose, should you also correct her hyponatremia?

Back 46

No. This is pseudohyponatremia, caused by increased blood glucose.

Sodium "falls" by approximately 1.6 mEq/L for every 100 mg/dL of glucose over 200.

Her actual sodium level is 124 + (7x1.6) = 135

Front 47

What is the most common cause of hypernatremia?

Back 47

dehydration

Front 48

Hypothalamus does not make ADH

Back 48

Central Diabetes Insipidus

Front 49

Kidneys do not respond to SIADH

Back 49

Nephrogenic Diabetes Insipidus

Front 50

Most common cardiac axis seen in asthma and COPD?

Back 50

Right axis

Front 51

A new LBBB is considered an ________ until proven otherwise

Back 51

Acute MI

Front 52

A normal PR interval is _______ms

Back 52

200 ms

Front 53

Risk of torsades de pointes is increased in patients with a prolonged ___________

Back 53

QT Interval

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Seen with hypokalemia, hypomagnesemia, hypocalcemia and certain medications (TCAs)

Front 54

Normal QRS duration is _____ ms

Back 54

120 ms

Front 55

Diffuse ST elevations and PR depression are seen in ____________

Back 55

pericarditis

Front 56

U waves may indicate _____ or _____

Back 56

hypokalemia or hypocalcemia

Front 57

A loss of costophrenic angle on a CXR indicates approximately _____ cc of fluid accumulation

Back 57

250cc

Front 58

What is the most sensitive film to order to check for intrabdominal free-air?

Back 58

Upright Chest X-ray

Front 59

Views obtained in an Abdominal X-ray series?

Back 59

Upright chest, Supine and lateral decubitus abdominal

Front 60

Cervical Spine X-ray series consists of which views?

Back 60

Lateral, AP and Open mouth

Front 61

One abdomen/Pelvis CT exposes a patient to as much radiation as _____ X-rays

Back 61

250 x-rays!

Front 62

Acute ischemic strokes may initially present with a _____ CT scan

Back 62

negative CT scan

Front 63

What study should be done before a lumbar puncture to r/o increased ICP?

Back 63

Head CT w/o contrast

Front 64

Best study to order for an HIV positive patient with a suspected intracranial infection?

Back 64

CT with contrast

Front 65

Intrauterine pregnancy on ______ ultrasound is seen at beta-HCG 1000-1500 IU/L

Back 65

Transvaginal US

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Intrauterine pregnancy on transabdominal US may not be seen until beta-HCG is around 6000 IU/L

Front 66

The HIDA scan loses sensitivity when _____ levels rise above 5 mg

Back 66

bilirubin

Front 67

You suspect a PE in a pregnant patient. Which test is preferred, A V/Q scan, or CT scan?

Back 67

CT scan with abdominal shielding.

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V/Q scan exposes the mother to less radiation, but radioisotope collects in the bladder near the fetus which exposes the fetus to more radiation.

Front 68

"Low probability V/Q scans" miss ___% of pulmonary emboli

Back 68

16%

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PIOPED study

Front 69

In the trauma room, life-threatening hemorrhage should be controlled with __________ __________

Back 69

Direct pressure

Front 70

How much of body water is intravascular? How much is extravascular?

Back 70

1/4 Intravascular

3/4 Extravacular

Front 71

How much of body water is intracellular? How much is extracellular?

Back 71

2/3 Intracellular

1/3 Extracellular

Front 72

What is the most common cxause of shock in an injured patient?

Back 72

Hemorrhage

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Pressors will not help!

Front 73

Adequate urinary output for an adult in trauma situation?

Back 73

0.5 cc/kg per hour

---------------------------------------------------------------

Child less than 1 = 2.0 cc/kg/hr

Child over 1 = 1.0 cc/kg/hr

Front 74

What is the AVPU scale used in trauma assessment?

Back 74

Alert

Verbal
Pain

Unresponsive

Front 75

What studies are included in a Trauma Series of x-rays?

Back 75

C-spine, chest and pelvis

Front 76

The normal adult blood volume is ____ % of body weight

Back 76

7%

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So, a 70kg adult has 4.9L of blood

(70x.07 = 4.9)

Front 77

The scalp consists of 5 layers... Name them

Back 77

"SCALP"

Skin

Connective Tissue

Aponeurosis (galea)

Loose areolar tissue

Pericranium

Front 78

Occular deformity caused by uncal herniation?

Back 78

"Blown pupil" --> CN III compression

CN III runs along the edge of the tentorium cerebelli, which is the most common site of herniation

Front 79

________ reflex: Hypertension, bradycardia and respiratory depression in the setting of ↑ ICP

Back 79

Cushing reflex

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This is the brain's attempt to maintain Cerebral perfusion pressure (CPP)

CPP= MAP - ICP

Front 80

Racoon eyes, Battle sign (mastoid bruising), blood in auricular canal, Blood/CSF in nares and hemotympanum all suggest _________________

Back 80

Basilar Skull Fracture

Front 81

A severe head injury has a GCS less than or equal to ______

Back 81

8

------------------------------------------------------------

Moderate Head injury = GCS 9-13

Mild Head injury = GCS 14-15

Front 82

Back 82

Front 83

Name 2 noxious stimuli used to assess Glascow Coma Scale

Back 83

Nail bed pressure

Sternal rub

Front 84

What has the highest sensitivity and specificity for identifying a fluid as CSF in a patient with a head injury?

Back 84

𝞫 2- transferrin

Front 85

Describe how the ring test identifies CSF rhinorrhea in the presence of epistaxis in a patient with a head injury

Back 85

Sample of blood from the nose is placed on filter paper to test for presence of CSF.

If CSF is present, a large transparent ring will surround a blood clot on the paper

Front 86

This type of skull fracture carries a much greater risk of underlying brain injury and complications such as meningitis and post-traumatic seizures

Back 86

Depressed Skull Fracture

Front 87

How does a head CT look in a patient with a concussion?

Back 87

With concussions, head CTs are most often unremarkable

Front 88

Biconcave/Lenticular shape seen on head CT

Back 88

Epidural Hematoma

Front 89

Mortality rate range for subdural hematomas?

Back 89

1/3-2/3

(33-66%)

Front 90

Vessel damaged in a patient with an Epidural Hematoma?

Back 90

Middle Meningeal Artery

Front 91

Vessels damaged in a patient with a subdural hematoma?

Back 91

Bridging Veins

Front 92

Crescent shape seen on head CT that may cross suture lines

Back 92

Subdural Hematoma

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Alcoholics and Elderly have ↑ brain atrophy and have a higher risk for subdurals

Front 93

Name 5 measures that can be used to ↓ ICP in patients with head trauma.

Back 93

"HIVED"

Hyperventilation

Intubation

Ventriculostomy (burr hole)

Elevate the head of bed

Diuretics (Mannitol, Furosemide)

Front 94

Where do the majority of vital structures lie in the neck?

Back 94

The anterior triangle

Front 95

What types of neck injuries are most likely to produce C-spine fractures?

Back 95

Blunt neck injury

Front 96

Injury to which neck zone buys the patient a trip to the OR for surgical exploration?

Back 96

ZONE II

Front 97

Patients on a backboard for long periods of time are at risk for formation of ____________

Back 97

Pressure Ulcers

Front 98

Cardiac Arrest unresponsive to fluid resuscitation in penetrating neck trauma may be ___________________

Keep the patient in head down, left lateral decubitus position

Back 98

Venous Air Embolism

Front 99

What is the first sign of resolution of spinal shock in a patient with a spine injury?

Back 99

Return of the bulbocavernous reflex

Front 100

A 70 yo male presents to the ED after a whiplash injury. He ambulates well but has an extremely weak handshake.

Back 100

Central Cord Syndrome

Front 101

What are the NEXUS criteria for ordering C-spine films?

Back 101

C-spine films should be ordered in patients with:

-Posterior midline cervical tenderness

-Intoxication

-Altered Mental Status

- Distracting Injuries

Front 102

The most common level of cervical vertebral fracture is at ___________

Back 102

C5

Front 103

Most common level of cervical subluxation is between ____ and ______

Back 103

C5 and C6

Front 104

You have ordered a C-spine x-ray series and noticed that C7-T1 are not visualized on the films.

What additional view should you order

Back 104

Swimmer's view

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C-spine Series:

1. Cross table grid Lateral view
2. AP view - with 20 degree cephalad angle
3. Swimmer's View if C7-T1 aren't visualized
4. Open mouth Odontoid view

Oblique Views are optional

Front 105

Basion Axis Interval (BAI) > 12mm or ↓ < 4mm

Basion Dental Axis Interval (BDI) >12mm

Back 105

Atlanto-Occipital Dislocation

Front 106

What do you call a C1 (atlas) burst fracture?

Back 106

Jefferson Fracture

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Most common C1 fracture

Occurs when patient lands directly on head or heavy object is dropped on head

Front 107

Beck's triad seen in cardiac tamponade?

Back 107

1. Hypotension
2. JVD
3. Muffled Heart Sounds

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ECG Findings = Electrical Alternans

Front 108

Procedure of choice for a patient with laryngotracheal separation?

Back 108

Tracheostomy

Front 109

What percentage of hemothoraxes have an associated pneumothorax?

Back 109

25% (1/4)

Front 110

What percentage of hemothoraxes are associated with extrathoracic injuries?

Back 110

75% (3/4)

Front 111

- CVP line or chest tube placement

- Intra-aortic balloon pump placement

- Use of non-vascular clamp during ED thoracotomy

-Over-inflation of Swan- Ganz balloon

**These are all Iatrogenic causes of what?**

Back 111

Great Vessel Injury

Front 112

The most frequently injured solid organ associated with penetrating trauma is ______ followed by ____________

Back 112

the liver, followed by small bowel

Front 113

The most frequently injured solid organ associated with blunt trauma is _________ followed by ____________

Back 113

the spleen, followed by the liver

Front 114

In a stable patient with suspected abdominal trauma and a negative FAST exam, _______ is the next best step

Back 114

CT scan

Front 115

Next best step for a patient with a positive FAST scan?

Back 115

Send to the OR

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Negative FAST: look for other sites of bleeding

Front 116

What do you fall a FAST exam that also checks for a pneumothorax?

Back 116

eFAST

Front 117

What is the most sensitive test for retroperitoneal injury?

Back 117

CT scan

Front 118

Name some past medical history that can make passage of a foley catheter difficult in a trauma patient and can be confused for urethral disruption.

Back 118

- Enlarged prostate

- Prostate cancer

-Urethral Stricture

- Self catheterization

- Previous urological surgery

Front 119

________ relase during rhabdomyolysis can cause renal failure

Back 119

Myoglobin

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In order to reduce precipitation of myoglobin in the kidney:

1) Maintain a high urine output

2) Alkalize the urine

Front 120

ET tube size is based on the size of the ______ rather than the glottic opening because the narrowest part of a child's airway is beyond the glotic opening

Back 120

cricoid ring

Front 121

What are the 3 symptoms that are assessed during the Pre-Hospital Cinicinnati Stroke Scale?

Back 121

1. Facial Droop
2. Slurred Speech
3. Arm drift/Pronator drift

Front 122

Why is identification of strokes involving the cerebellum important?

Back 122

Increased risk of edema and ↑ pressure to brainstem

Front 123

Steps for optimization of a patient experiencing an ischemic stroke:

- Supplemental O2

- BP: MAP should be greater than _____, SBP should be greater than or equal to _______

-Serum Glucose < _______

-Normal temperature

- Screen for thrombolytics

- For HTN, do not treat until MAP < 130

Back 123

- Supplemental O2

- BP: MAP should be greater than 60, SBP should be greater than or equal to 90

-Serum Glucose < 150

-Normal temperature

- Screen for thrombolytics

- For HTN, do not treat until MAP < 130

Front 124

Which diagnosis should be considered in a young patient with stroke and in patients with headaches and neck pain with acute stroke?

Back 124

Carotid or Vertebral Artery Dissection

Front 125

Up to ____% of patients with hemorrhagic stroke will seize within 72 hours.

Back 125

25%

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Control seizures with lorazepam acutely, followed by phenytoin.

Seizure prophylaxis is achieved with phenytoin

Front 126

Use the PAC3T mnemonic to recall conditions where a headache is not a benign symptom.

Back 126

Pseudotumor Cerebri

Acute Angle Closure Glaucoma

Cervical Artery dissection

Cerebral Venous Thrombosis

Carbon Monoxide poisoning

Temporal areritis

Sub-arachnoid hemorrhage

Front 127

A patient presents during a cold winter month with headache, nausea and vomiting. Several other family members have the same complaint.

Back 127

Consider Carbon Monoxide Poisoning

Front 128

You suspect a patient has a sub-arachnoid hemorrhage. However, the CT is negative. What next step is required?

Back 128

Lumbar puncture

Front 129

Tests to order for a patient with "the worst headache of my life"

Back 129

Suspect SAH:

CT w/o contrast

Lumbar Puncture

Front 130

Hunt and Hess classification for SAH:

Which grade begins to show confusion or mild focal neurological deficit?

Back 130

Grade III

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Grade I: Asymptomatic, mild headache, mild nuchal rigidity

Grade II: Moderate to severe headache, nuchal rigidity, cranial nerve palsy may be present

Grade III: Drowsiness, confusion, or mild focal neurological deficit

Grade IV: Stupor, hemiparesis, early decerebration or vegetative state

Grade V: Coma, decerebrate, moribund

Front 131

ECG findings possibly seen in a patient with SAH?

Back 131

Deep, inverted T-waves

Front 132

Clinical Diagnosis:

-New headache

-Temporal artery deformity/abnormality

- Jaw claudication

Back 132

Temporal Arteritis

--------------------------------------------------------------

These clinical findings have 94% specificity and 100% sensitivity for temporal arteritis

Front 133

This neurological condition has a triad of:

1. Deafness
2. Vertigo
3. Tinnitus

(DVT mnemonic)

Back 133

Meniere's Disease

Front 134

Meningitis:

The _____ sign is considered positive with pain or resistance with passive extension of the knee with the hip flexed 90 degrees

Back 134

Kernig Sign

Front 135

Meningitis:

The _______ sign is considered positive when passive flexion of the neck causes flexion of the hips

Back 135

Brudzinski Sign

Front 136

The causes of encephalitis are usually viral in origin. What are the most common causes (4)?

Back 136

"HEAR"

Herpes

Epstein- Barr

Arboviruses

Rabies

Front 137

You suspect meningitis in a patient with fever, nuchal rigidity, photophobia and altered mental status.

What is the next immediate step?

Back 137

Begin antibiotic therapy!

Do not delay antibiotics for LP or CT

Front 138

Posterior shoulder dislocations are common with what 2 conditions?

Back 138

Seizure

Electrical Shock

Front 139

This is a focal neurological deficit persisting from seizure which usually resolves within 48 hours

Back 139

Todd's Paralysis

Front 140

Continuous Seizures can cause _______ injury

Back 140

CNS Injury

Front 141

Eclampsia usually occurs in patients > _____ weeks of gestation

Back 141

20 weeks

Front 142

Approximately 70% of patients with HIV will develop _______ caused by opportunistic bacteria, viruses, or fungi

Back 142

sinusitis

Front 143

Most patients with sinusitis can be treated __________

Back 143

Symptomatically

Front 144

Anterior epistaxis commonly origninates from which confluence of arteries on the posterior nasal septum?

Back 144

Keisselbach's Plexus

(located in the "picking zone")

Front 145

In this type of epistaxis, the bleeding is unilateral and the patient denies the sensation of blood in the back of the throat.

Back 145

Anterior Epistaxis

Front 146

What percentage of properly placed nasal-packs fail to control bleeding?

Back 146

25%

-ENT consult is indicated

Front 147

Approximately ___% of patients with posterior epistaxis have a systolic BP >/= 180mm Hg or a diastolic BP > 110mm Hg

Back 147

50%

Front 148

A 16 yo swim-team captain presents with a greenish discharge from his ear and complains that his ear feels "full".

He withdraws as you tug on his ear to examine it.

Most likely diagnosis?

Back 148

Otitis Externa ("Swimmer's Ear")

Front 149

How long should patients diagnosed with otitis externa ovoid getting into water after treatment?

Back 149

2-3 weeks

Front 150

Treating Group-A, 𝞫 -hemolytic strep pharyngitis prevents Rheumatic fever, but does not prevent ________________

Back 150

Post-streptococcal Glomerulonephritis

Front 151

Does epiglottitis occur more in adults or children?

Back 151

Adults

Front 152

A "thumbprint sign" is seen on lateral neck radiograph.

Back 152

Epiglottitis

Front 153

A 29 year-year old female who had been treated for strep throat the previous week presents with progressive difficulty swallowing. Physical exam reveals a fluctuant mass on the right side of the soft palate and deviation of the uvula to the right

Diagnosis?

Back 153

Peritonsilar abscess

Front 154

How does a patient with epiglottitis prefer to sit?

How does a patient with retropharyngeal abscess prefer sit?

Back 154

Epiglottitis: leaning forward with neck flexed

RPA: recumbency with hyperextension of neck

Front 155

You see currant jelly sputum on physical exam and bulging fissure on chest x-ray.

diagnosis?

Back 155

Klebsiella pneumonia

Front 156

Name 5 pulmonary pathogens found in the oropharynx that commonly cause penumonia

Back 156

S. pneumoniae

M. pneumoniae

H. influenzae

Strep. pyogenes

M. catarrhalis

Front 157

Which area of the lungs is aspiration pneumonia most commonly seen?

Back 157

Lower Right Lobe

Front 158

Acute Pulmonary Edema may be a presentation of ______

Back 158

acute MI

Front 159

Treatment for Acute Pulmonary Edema?

"NOt BAD"

Back 159

Nitroglycerin

Oxygen

t

BiPAP (or CPAP)

Aspirin

Diuretics

Front 160

What are the criteria for the PERC score to determine the need for diagnostic testing for a low risk of PE?

Back 160

PERC Score:

- Age >/= 50

- HR >/= 100

- O2 Sat on room air < 95%

- Prior DVT or PE

- Recent trauma or surgery

- Hemoptysis

- Exogenous estrogen use

- Unilateral leg swelling

Front 161

Name the 3 most common causes of pleaural effusion

Back 161

1. CHF
2. Bacterial Pneumonia
3. Malignancy

Front 162

Why are steroids given in asthma?

Back 162

to decrease the late inflammatory response

Front 163

What 2 drugs are commonly associated with acute asthma exacerbations?

Back 163

Beta-blockers

Aspirin

Front 164

Early asthmatic response may last for a few hours. A late asthmatic response hyperresponsiveness can persist for _______

Back 164

days to months

----------------------------------------------------------------------

This is why we give steroids

Front 165

How do we treat Asthma in the ED?

(BIOMES mnemonic)

Back 165

Beta agonists (albuterol)

Ipratroprium (anti-muscarinic)

Oxygen

Magnesium Sulfate

Epinepherine

Steroids

Front 166

Patients with __________ are sometimes referred to as "blue bloaters"

Back 166

Chronic bronchitis

Front 167

Patients with ______ are sometimes referred to as "pink puffers"

Back 167

Emphysema

Front 168

What is the most important treatment in patients with COPD?

Back 168

Smoking Cessation

Front 169

Tuberculosis adenitis is known as _________

Back 169

scrofula

Front 170

A _____ complex is a calcified lesion of primary pulmonary TB

Back 170

Gohn Complex

Front 171

This form of tuberculosis results from hematogenous spread

Back 171

Miliary TB

Front 172

Tuberculosis of the spine is known as _______

Back 172

Pott's Disease

Front 173

What is the cause of death in patients with massive hemoptysis:

Asphyxiation or Exanguination?

Back 173

Asphyxiation

Front 174

___________ is persistent and progressive dilation of the bronchi or bronchioles.

It as seen as a consequence of chronic infections, tumor or cystic fibrosis.

Hallmark findings are coughing, fetid breath, and expectoration of mucopurulent matter

Back 174

Bronchiectasis

Front 175

What ventilatory rate is usually set for patients on mechanical ventilation?

Back 175

14-16 bpm

Front 176

What is the tidal volume set for in patients on mechanical ventilation?

What if there is concern for development of ARDS?

Back 176

Tidal volume is initially set to 6-10mL/kg

If ARDS is a concern, set tidal volume to 6mL/kg

Front 177

__________ improves oxygenation by keeping alveoli open during inspiration

Back 177

PEEP

Front 178

What ventilator setting is useful for patients with no spontaneous respiration, heavily sedated patients, or paralyzed patients?

Back 178

Controlled Mechanical Ventilation (CMV)

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The patient is ventilated at a preset rate; the patient cannot breathe between the delivered breaths

Front 179

What is the Levine Sign?

Back 179

Patient puts a clenched fist to his chest to describe pain of a myocardial infarction

Front 180

What are 2 contraindications for the administration of NTG in patients with acute chest pain?

Back 180

1. Patients who have taken PDE inhibitors such as sildanafil, vardenafil, or tadalafil in the past 24 hours

2. Patients with an inferior wall MI

SEVERE hypotension may result in these cases

Front 181

Name some contraindications to the administration of beta-blockers in a patient experiencing Acute Coronary Syndrome.

Back 181

Heart Rate < 60 bpm

Systolic BP < 100 mm Hg

2nd or 3rd degree Heart Block

Moderate to severe LV dysfunction

Signs of peripheral hypoperfusion

PR interval > 0.24 ms

Acute MI due to Cocaine

Front 182

What are the Sgarbossa Criteria for impending MI in Left Bundle Branch Block?

Back 182

1. ST Elevation > 1mm in leads with dominant R waves (concordant with QRS complex)

2. ST Elevation > 5 mm in leads with dominant S waves (discordant with QRS complex)

3. ST Depression > 1mm in V1, V2, or V3

Front 183

What are the absolute contraindications for thrombolytic therapy? (8)

Back 183

- History of intracranial hemorrhage

- History of ischemic stroke > 3 hours but < 3 months

- Cerebral Vascular Malformation

- Intracranial malignancy

- Symptoms or signs of an aortic dissection

- Bleeding diathesis

- Active bleeding

- Significant closed-head or facial trauma < 3 months

Front 184

What are some relative contraindications to thrombolytic therapy? (7)

Back 184

- History of chronic, severe, poorly controlled hypertension

- Severe, uncontrolled hypertension on presentation > 180/110 mm Hg

- Recent (within 2-4 weeks) internal bleeding

- Traumatic or prolonged (>10min) CPR

- Major Surgery within 3 weeks

-Current use of anticoagulant (warfarin) with INR 1.7

- Pregnancy

Front 185

Which has a worse prognosis:

Type I or Type II heart block?

Back 185

Type II

Front 186

Name some causes of AV Heart Blocks

Back 186

Age

Ischemia

Cardiomyopathies

Myocarditis

Congenital

Surgery

Valvular Disease

Drugs

Front 187

Name 2 causes of sudden cardiac death in young people

Back 187

HCOM

Prolonged QT

Front 188

What is the heart rate commonly seen in patients who have experienced an inferior wall MI?

Back 188

Sinus Bradycardia

(resolves in 1-2 days)

Front 189

Atrial fibrillation increases the risk of acute ischemic stroke ___-fold. It is responsible for 15-20% of all acute ischemic stroke.

Back 189

five-fold

Front 190

What is the most common pediatric dysrhythmia?

Back 190

SVT

Front 191

This heart condition has the following ECG findings:

-Short PR interval

-Widened QRS

-Delta-wave slurring QRS upswing

Back 191

Wolff-Parkinson White

Front 192

Why are adenosine, beta blockers, calcium channel blockers and digoxin contraindicated in patients with WPW?

Back 192

They preferentially block at the AV node, allowing unopposed conduction down the accessory bypass tract.

Front 193

What is considered the most significant risk factor for sudden death for patients with hypertrophic cardiomyopathy?

Back 193

Symptoms prior to age 30

(Severity of symptoms does not do not increase risk)

Front 194

A young patient has a systolic murmur that decreases with valsalva

Back 194

HCM

Front 195

Name 3 causes of paradoxical splitting of S2

Back 195

1. HCM

2. Aortic stenosis

3. LBBB

Front 196

List , in order, the valves affected by acute bacterial endocarditis

Back 196

1. Aortic

2. Mitral

3. Tricuspid

Front 197

Which is most sensitive for the diagnosis of acute bacterial endocarditis:

Transesophageal or transthoracic echocardiography?

Back 197

Transesophageal = 90-100% sensitive

Transthoracic = 28-63% sensitive

Front 198

A 29 yo male presents with fever and retrosternal chest pain. He had the "flu" two weeks ago.

Most Likely diagnosis?

Back 198

Myocarditis

Front 199

In new diagnosis of refractory asthma in a young adult, consider this diagnosis:

Back 199

Myocarditis

Front 200

ECG shows diffuse PR depression and ST elevations

Back 200

Pericarditis

------------------------------------------------------------

Always rule out ACS in a patient presenting with the classical signs of pericarditis

Front 201

What is the mean survival for patients with Aortic stenosis and:

- Angina = _______ years

- Syncope = _______ years

- Heart failure = _________ years

Back 201

- Angina = 5 years

- Syncope = 2-3 years

- Heart failure = 1-2 years

Front 202

Mechanisms:

Abdominal aortic aneurysms __________, thoracic aneurysms ___________________

Back 202

Abdominal aortic aneurysms rupture

Thoracic aortic aneurysms dissect

Front 203

AAA is most commonly misdiagnosed as _______

Back 203

renal colic

Front 204

What is the mortality rate for patients with a ruptured AAA that get to the OR?

Back 204

50% mortality

Front 205

Aortic dissections are most commonly misdiagnosed as _________

Back 205

Acute MI's

Front 206

You should always get a Chest film in patients that you suspect are having an MI. Some patients will have __________ and thrombolytics will kill them

Back 206

aortic dissection

Front 207

How do you calculate MAP?

Back 207

(2DBP x SBP)/3

Front 208

Nitroprusside, given for hypertensive emergencies, can cause _______ toxicity

Back 208

cyanide toxicity

Front 209

This region of the GI system has a higher rate of morbidity and mortality than any other source of upper GI bleed

Back 209

Esophagus

Front 210

How should you treat ingestion of a button battery that has:

A) Passed into the stomach

B) Is lodged in the esophagus

Back 210

A) Expectant management

B) Immediate removal --> alkaline ingestion is highly corrosive and can lead to liquefactive necrosis

Front 211

A majority of patients with asthma have associated ________

Back 211

GERD

Front 212

Barrett's esophagus carries a ___ to ____ risk of development of esophageal adenocarcinoma, which carries a <5% chance of 5-year survival

Back 212

2-5% risk

Front 213

____________ is a transmural perforation of the esophagus.

___________ is a non-transmural tear of the esophagus associated with vomiting

Back 213

Boerhaave syndrome = transmural tear

Mallory-Weiss Syndrome = non-transmural

Front 214

What is the most common cause of gastritis?

Back 214

Chronic NSAID use

Front 215

Crossmatching blood takes 40-60 mins. Use _________ blood if type-specific blood is not readily available and the patient is unstable

Back 215

O negative blood

Front 216

_______ is associated with ____% of gastric ulcers and ________% of Duodenal ulcers

Back 216

80% of GUs

95% of DUs

Front 217

What is triple therapy for H. pylori?

Back 217

PPI + Amoxicillin + Clarithromycin

Front 218

Name 4 adverse affects of cimetidine when used to treat Peptic Ulcer Disease

Back 218

1) P450 system inhibitor (inhibits clearance of warfarin, phenytoin, diazepam, propanolol, lidocaine, theophylline, TCAs)

2) CNS dysfunction in the elderly

3) Thrombocytopenia

4) Painful gynecomastia

Front 219

This form of inflammatory bowel disease has:

-lower incidence

-lower risk of cancer

-more common in women

Back 219

Crohn's Disease

Front 220

When used to treat inflammatory bowel disease, which component of sulfasalazine is active

Back 220

sulfapyridine

------------------------------------------------------------------

The 5-ASA component is not effective in treating IBD. It is effective in rheumatoid arthritis, however.

Front 221

Drugs that only have a ________ component are not effective in treating Inflammatory bowel disease

Back 221

5-ASA

Front 222

What is the definition of pneumatosis intestinalis as described on an abdominal x-ray?

Back 222

Gas in the bowel wall

Front 223

What is the most common cause of small bowel obstruction?

Back 223

Adhesions

Front 224

What is the second most common cause of small bowel obstruction behind adhesions?

Back 224

Incarcerated hernias

Front 225

What is the most common cause of bowel obstruction in children ages 2 months to 5 years?

Back 225

Intussusception

Front 226

What is the most common blood-borne cause of viral hepatitis in the U.S.?

Back 226

Hepatitis C

Front 227

In alcoholic hepatitis, the ____ is greater than ______ by a factor of 2

Back 227

SGOT (AST) > SGPT (ALT)

Front 228

___________ : acute hepatic encephalopathy associated with ASA use in children

Back 228

Reye Syndrome

Front 229

What is the mortality rate for hepatorenal syndrome?

Back 229

Almost 100%

Front 230

__________ is an obstruction of the biliary tract leading to stasis → bacterial overgrowth and infection.

This is a surgical emergency

Back 230

Cholangitis

Front 231

What is the most common cause of hepatic abscess?

Back 231

Ascending cholangitis

Front 232

_________'s sign: The arrest of inspiration while palpating the RUQ. This testis more than 95% sensitive for acute cholecytsitis, less sensitive in the elderly.

Back 232

Murphy's Sign

Front 233

What is the sonographic Murphy's sign?

Back 233

Arrest of inspiration when the U/S probe is placed in the RUQ

Front 234

Most gallstones are composed of _____ and are radiolucent.

Back 234

Cholesterol (70%)

-------------------------------------------------------------------

Pigment (20%) → Radiodense

Mixed (10%)

Front 235

What metabolic derrangement can be caused pancreatitis?

Back 235

Hypercalcemia

---------------------------------------------------------------------

Hypercalcemia can also cause pancreatitis

Front 236

This abdominal diagnosis has the following abdominal X-ray findings:

Sentinel Loop

Colon cutt-off sign (distended colon to midtransverse colon with no air distally)

Back 236

Pancreatitis

Front 237

Suspect a ______ when patients with pacreatitis fail to resolve

Back 237

pancreatic pseudocyst

Front 238

Criteria used to assess prognosis in pancreatitis

Back 238

Ranson's Criteria

Front 239

What is the most common surgical emergency?

Back 239

Appendicitis

Front 240

_________ in late pregnancy presents with RUQ pain due to displacement by gravid uterus

Back 240

appendicitis

Front 241

What is the most common cause of pancreatitis?

Back 241

Fecalith

Front 242

Due to its small radius, the ______ is normally the site of highest pressure in the GI tract

Back 242

cecum

Front 243

What is the most common cause of painless lower GI bleeding in older adults?

Back 243

Diverticulosis

Front 244

__________ is a common cause of large bowel obstruction

Back 244

Diverticulitis

Front 245

What 2 modalities should be avoided in cases of acute diverticulitis due to risk of perforation?

Back 245

Barium enema

Colonoscopy

Front 246

What is the most common cause of GI bleeding in younder patients?

Older patients?

Back 246

Younger = Angiodysplasia

Older = diverticulosis

Front 247

What is usually the most common cause of an apparent lower GI bleed?

Back 247

An upper GI bleed

Front 248

What is the most common cause of anorectal pain (especially in children)?

Back 248

Anal fissure

Front 249

________ is the production of less than 400mL of urine in 24 hours

Back 249

oliguria

Front 250

What is the most common cause of community-acquired Acute renal failure (40-80% of cases)

Back 250

Pre-renal Acute Renal Failure

----------------------------------------------------------------------

BUN:Cr ratio > 20:1

Urine sodium excretion is < 10

Fractional excretion of sodium < 1%

Front 251

What is the most common cause of postrenal failure?

Back 251

BPH

Front 252

What is the most common reason to initiate dialysis in a patient with end stage renal disease?

Back 252

Pulmonary Edema

Front 253

List the most common causes of non-traumatic hematuria in order of frequency (6)

Back 253

1. Nephrolithiasis

2. Carcinoma of GU tract

3. Urethritis

4. UTI

5. BPH

5. Glomerulonephritis

Front 254

Granular casts in urine are seen in __________

Back 254

acute tubular necrosis

Front 255

WBC casts in urine are seen in _____________

Back 255

pyelonephritis/interstitial nephritis

Front 256

RBC casts in urine are seen in _____ and ______

Back 256

Glomerulonephritis and Malignant HTN

Front 257

Renal stones formed from ______ may appear as coffin-lid crystals in urine

Back 257

Struvite

Front 258

Many OTC medications contain ________, which can cause prostatic obstruction

Back 258

pseudoephederine

Front 259

Buzzwords for stages of this disease include:

Phase 1 : Painless chancre

Phase 2: condyloma lata

Phase 3: Gummas, Argyll Robertson pupil, tabes dorsales

Back 259

Syphilis

Front 260

______________ is an acute reaction that occurs ~24 hours after treatment of early syphilis.

It presents with headache, and severe myalgias. It can cause early labor and fetal distress during pregnancy.

Back 260

Jarisch-Herxheimer reaction

Front 261

Drug of choice for syphilis infection?

Back 261

Penicillin G

Front 262

Both _____ and ______ have a positive Whiff test after KOH is mixed with discharge and heated on a slide.

Back 262

Trichomonas and Bacterial Vaginosis

Front 263

The effectiveness of the intrinsic clotting pathway can be measured with ______________

Back 263

PTT

Front 264

The effectiveness of the extrinsic clotting pathway can be measured with ___________

Back 264

PT

Front 265

Heparin is associated with the intrinsic or extrinsic clotting pathway?

Back 265

Intrinsic

Front 266

Warfarin primarily affects the PT or PTT?

Back 266

PT

Front 267

Ingestion of what can cause subtherapeutic INR levels in patients taking warfarin?

Back 267

Green Leafy Vegetables --> ↑ Vit. K

Front 268

What is the most common inherited bleeding disorder?

Back 268

Von-willebrand disease

Front 269

Bleeding time in Von-willebrand disease Vs. Hemophilia A?

Back 269

vWD = ↑ Bleeding time

Hemophilia A: No change in BT (platelets are not affected)

Front 270

What is the lifespan of RBCs in patients with sickle cell anemia?

Back 270

17 days as compared to 120 in patients without sickle cell

Front 271

Most cases of spinal cord compression are in which area of the spine?

Back 271

Thoracic (68%)

----------------------------------------------------------------

Lumbar (19%)

Cervical (15%)

Front 272

Which gynecologic disorder presents with the triad of:

1. Hirsutism

2. Obesity

3. Oligomenorrhea

Back 272

Polycystic Ovarian Syndrome

Front 273

What is the most common ovarian tumor?

Back 273

Benign Cystic teratoma (dermoid cyst)

Front 274

Yoplait contains which type of bacteria which are shown to be decreased in patients with bacterial vaginosis?

Back 274

Lactobacilli

Front 275

Bacterial vaginosis during pregnancy can cause ______________, so it should always be treated even if the patient is asymptomatic

Back 275

preterm labor

Front 276

A woman presents with recurrent vaginal candidiasis. What is the next best test to order?

Back 276

Blood glucose ---> Diabetes

Front 277

There is a high rate of recurrence of Bartholin's abscess due to ___________ formation

Back 277

fistulous tract formation

Front 278

What is the leading cause of female infertility?

Back 278

PID

Front 279

______ is a risk factor for infertility, chronic pelvic pain, and ectopic pregnancy

Back 279

PID

Front 280

__________ is uncommon during pregnancy due to the plug formed by the fusion of the chorion and decidua providing an extra natural barrier to infection

Back 280

PID

Front 281

What is the most common organism to cause a tubo-ovarian abscess?

Back 281

Bacteroides

Front 282

Should you treat asymptomatic bacteriuria in pregnant women?

Back 282

Yes... use nitrofurantoin

Front 283

𝞫 -hCG levels double every _____to_____ days in normal early pregnancy

Back 283

2-3 days

Front 284

What test can be used to determine the amount of fetal-maternal blood mixing in Rh (-) patients?

Back 284

Kleihauer-Betke tets

Front 285

First-trimester bleeding occurs in approximately ____% of all pregnancies, one-half of patients will eventually experience a miscarriage

Back 285

25%

Front 286

What is the most common risk factor for abruptio placentae?

Back 286

Hypertension

Front 287

Eclampsia and Seizures:

____% of seizures are before labor

___% are during labor

____% are up to 10 days postpartum

Back 287

25% of seizures are before labor

50% are during labor

25% are up to 10 days postpartum

Front 288

_______ syndrome complicates about 10% of preeclampsia:

Hemolysis, Elevated liver enzympes, Low platelets

Back 288

HELLP Syndrome

Front 289

Why should rapid BP reduction be cautioned against during eclampsia/preeclampsia?

Back 289

Decrease in uterine blood flow --> fetal distress

Front 290

Drug of choice for a patient with Eclampsia?

Back 290

Magnesium Sulfate

---------------------------------------------------------------------

-Terminates seizure

-Prevents recurrence of seizure

- ↓ risk of placental absorption

- Associated with ↓ NICU admissions

- Better than phenytoin or placebo

Front 291

Patients with PROM are at higher risk for what complication?

Back 291

chorioamnionitis

Front 292

What is the leading cause of neonatal death?

Back 292

Preterm labor

Front 293

What is the most common organism to cause septic arthritis in all age groups?

Back 293

Staph. aureus

Front 294

Most common joints involved in septic arthritis?

Back 294

The knee, followed by the hip, shoulder and wrist

Front 295

Most common cause of osteomyelitis?

Back 295

Staph. aureus

Front 296

Most common cause of osteomyelitis in patients with asplenia or sickle-cell disease?

Back 296

Salmonella

Front 297

What is the most common entrapment neuropathy?

Back 297

Carpal Tunnel Syndrome

Front 298

What percentage of the population normally has a positive Phalen or Tinel's sign?

Back 298

20-50%

Front 299

Most common malignancies causing spinal cord compression?

Back 299

Prostate, breast, lung

Front 300

Which has longer morning stiffness, OA or Rheumatoid arthritis?

Back 300

Rheumatoid arthritis

Front 301

OA vs RA:

Which affects the Distal Interphalangeal joints (DIPs)?

Back 301

OA

Front 302

This disorder affects small joints and aspiration shows needles with negative biferingence

Back 302

Gout ---> Uric acid crystals

---------------------------------------------------------------------

Pseudogout --> large joints (shoulder,knee,wrist), positive biferingence --> calcium pyrophosphate crystals

Front 303

What is the most common and frequent manifestation of gout?

Back 303

Podagra

Front 304

Polymyositis and dermatomyositis are both more common in men or women?

Back 304

women

Front 305

Patients with dermatomyositis or polymyositis are often given azathioprine or methotrexate.

Both can cause what side effect?

Back 305

Bone marrow suppression

----------------------------------------------------------------

Azathioprine may also cause hepatotoxicity

Front 306

Posterior shoulder dislocations account for only __% of all dislocations

Back 306

2%

Front 307

Posterior shoulder dislocations are frequently missed. Surgical fixation is necessary when diagnosis is delayed more than ____ weeks

Back 307

2 weeks

Front 308

A fracture of the humerous at this location is associated with radial nerve injury and wrist drop

Back 308

Mid-shaft humerus

Front 309

This is a distal radius fracture with dorsal angulation.

-FOOSH

- "Dinner fork deformity" is classic

Back 309

Colle's Fracture

Front 310

Anterior shoulder dislocations may damage which nerve?

Back 310

Axillary Nerve

Front 311

________ is commonly associated with ski-pole injury

Back 311

Gamekeeper's thumb

---------------------------------------------------------

-Avulsion of ulnar collateral ligament of first MCP joint

Front 312

A patient complains or arm pain after a fall on outstretched hand. X-ray shows a posterior fat pad.

Back 312

Radial head/neck fracture

Front 313

If left untreated, a mallet finger may result in a permanent ________ deformity.

Back 313

Boutonniere deformity

----------------------------------------------------------------

-Mallet finger --> rupture of extensor tendon at insertion of distal phalanx

Front 314

Fracture/dislocation at the base of the thumb

Back 314

Bennett fracture

Front 315

Fracture at neck of 5th metacarpal following a closed-fist injury

Back 315

Boxer's Fracture

Front 316

Fracture of the ulnar shaft

Back 316

Nightstick fracture

Front 317

What is the percentage of patients that die within 1 year of hip fracture?

Back 317

30%

Front 318

What is the most frequently injured foot bone?

Back 318

Calcaneous

Front 319

Describe an antalgic gait

Back 319

Pain on weight bearing in which the stance phase of the gait is shortened on the affected side

Front 320

Is compartment syndrome most common in the upper or lower extremity?

Back 320

Lower extremity

Front 321

What is the most common cause of adrenal crisis?

Back 321

Abrupt withdrawal of steroid therapy

Front 322

Patients with CHF and DKA will require ________

Back 322

agressive fluid resuscitation

-------------------------------------------------

This also holds true for patients with CHF and HHS

Front 323

Which anti-thyroid drug does NOT block conversion of T3 to T4

Back 323

Methimazole

Front 324

What antiparasitic drug can cause seizure if overused?

Back 324

Lindane

Front 325

More potent steroids are needed for rashes/diseases involving ______ skin

Back 325

thicker

Front 326

_______ agents are first-line for the treament of acne

Back 326

Topical Agents

-benzoyl peroxide

-Clindamycin

-Trenitoin

-Erythromycin

Front 327

Exposure to sun while on ________ or ________ can cause a rash in patients being treated for acne

Back 327

tetracycline or doxycycline

Front 328

Lyme disease can cause which nerve palsy?

Back 328

Bell's palsy (CN VII)

Front 329

Many patients with Rocky Mountain Spotted Fever have exquisite tenderness of the ________ muscle

Back 329

gastrocnemius

Front 330

Varicella-zoster infection of CN VIII is called _______________ syndrome.

-Hearing loss

-Vertigo

-Tinnitus

Back 330

Ramsay Hunt Syndrome

Front 331

Bullous Pemphigoid vs. Pemphigus Vulgaris:

Which is Nikolsky (+) ?

Back 331

Pemphigus Vulgaris

Front 332

Bullous Pemphigoid vs. Pemphigus Vulgaris:

intraepidermal involvement

Back 332

Pemphigus Vulgaris

Front 333

Bullous Pemphigoid vs. Pemphigus Vulgaris:

subepidermal involvement

Back 333

Bullous Pemphigoid

Front 334

Psoriasis is worse during which season?

Back 334

Winter

Front 335

What accounts for most recurrent cases of erythema multiforme?

Back 335

HSV

Front 336

Describe the stages of decubitus ulcers (I-IV)

Back 336

I - nonblanching erythema of intact skin

II - partial-thickness skin loss involving epidermis and/or dermis

III- full thickness skin loss involving epidermis and dermis. May involve damage to subcutaneous tissues, extending down to fascia

IV- full thickness skin loss with extensive damage to muscle, bone or supporting structures

Front 337

Early Kaposi's sarcoma is often mistaken for ____________

Back 337

Bruising

Front 338

What is the emergent treatment of choice if a chest tube can't be immediately placed for a patient with a tension pneumothorax?

Back 338

Needle decompression with a 14g needle at the 2nd intercostal space, mid-clavicular line

Front 339

Neurovascular bundles run along the ______ rib margin

Back 339

inferior

Front 340

An emergence reaction is the occurrence of hallucinations and nightmares during the wearing off of ________ after procedural sedation

Back 340

Ketamine

----------------------------------------------------------------

Not common in children, occurs in 10-20% of adults. Allow emergence in a dark, calm room to decrease this phenomenon

Front 341

DOC for procedural sedation in children?

Back 341

Ketamine

Front 342

Which drugs are preferred in hypotensive patients needing procedural sedation?

Back 342

Ketamine or Etomidate

--------------------------------------------------------------------

These do not decrease BP

Front 343

How should the patient be positioned for a central venous cannulation?

Back 343

Trendelenburg position

-----------------------------------------------------------------

Thought to prevent air embolism

Front 344

Is central venous cannulation preferred on the right or left side? Why?

Back 344

Right side!

Avoids thoracic duct (on left) and dome of right lung is lower leaving a decreased chance of pulmonary injury

Front 345

Antibiotic of choice for an abscess in an otherwise healthy individual?

Back 345

None.. Incision and drainage is the treatment of choice...

---------------------------------------------------------------------

Antibiotics should be considered in immunocompromised patients or those with valvular disease.

Front 346

A farmer presents after spraying insecticide on crops all day. He has increased salivation, lacrimation, anxiety and bradycardia.

Treatment of choice?

Back 346

This is Cholinergic toxicity from organophosphate poisoning. Treat with atropine +/- pralidoxine

Front 347

A patient presents mad as a hatter, blind as a bat, hot as a hare, and dry as a bone.

What's going on?

Back 347

Anticholinergic Toxicity

Treat with Benzos +/- Physostigmine (↑s ACh)

-----------------------------------------------------------------

Mad as a Hatter: AMS

Blind as a bat: Mydriasis

Hot as a Hare: Hyperthermia (can't sweat)

Dry as a bone: Dry mucous membranes

Front 348

Toxidrome:

Decreased level of consciousness, respiratory depression, pinpoint pupils

Back 348

Opioid Toxicity

Treat with Naloxone

Front 349

Toxidrome:

Treatment for benzodiazepine overdose?

Back 349

Supportive +/- flumazenil

Front 350

What's in the "coma cocktail"?

Back 350

(DON'T)

Dextrose

Oxygen

Naloxone

Thiamine

[Give thiamine before dextrose]

Front 351

name a classic example for a "spot" test for a toxidrome

Back 351

Ferric Chloride ---> Salicylate Poisoning

Front 352

What are two factors that accelerate acetameniphen toxicity

Back 352

1) Prior induction of P450 (smokers, EtOH, drugs)

2) Malnutrition (↓ glutathione stores)

Front 353

What is the potential toxic dose of acetameniphen?

Back 353

140 mg/kg

Front 354

What is the initial dose for NAC in acetameniphen toxicity?

Back 354

140 mg/kg

Front 355

At what 4-hour level of acetameniphen will hepatic toxicity become induced?

Back 355

140 ug/kg

------------------------

micrograms

Front 356

A 67 yo female presents with 6 days of headache and 2 days of "ringing in ears" and fever. She is breathing deeply at a rate of 22/min.

Diagnosis?

Back 356

Aspirin toxicity

Front 357

What ECG finding is pathognomic for digoxin toxicity?

Back 357

Bidirectional ventricular tachycardia

Front 358

Without digibind therapy, Digoxin toxicity mortality is:

___% for K+ levels > 5.5

____% for K+ levels 5.0-5.5

____% for K+ levels < 5.0

Back 358

100% for K+ levels > 5.5

50% for K+ levels 5.0-5.5

0% for K+ levels < 5.0

Front 359

First-line drug for treatment of dysrhythmias in patients with a TCA overdose?

Back 359

Sodium Bicarbonate

-----------------------------------------------------------------

Sodium in sodium bicarb alters the interaction between the drug and sodium channels in the heart.

Front 360

Does lithium bind to charcoal?

Back 360

No... Activated charcoal is useless in the presence of lithium overdose

Front 361

Toxicity from antipsychotic medications can occur with ______ or _______

Back 361

therapeutic dose or overdose

-------------------------------------------------------------------

-Extra Pyramidal Symptoms --> Tx = Benadryl

-Sedation

-Orthostatic hypotension

Front 362

A patient with newly diagnosed schizophrenia presents with hyperthermia, AMS, autonomic instability and muscular rigidity...

Diagnosis?

Back 362

Neuroleptic Malignant Syndrome

---------------------------------------------------

Treat with supportive care, benzo's and dantrolene

Front 363

In alcoholic ketoacidosis, most ketones are ______ and are poorly detected by the lab

Back 363

𝞫 -hydroxybutyrate

Front 364

In patients who ingest Methanol, toxicity is contributed to formation of ___________

Back 364

formic acid

Front 365

Which opiod causes dilated pupils (mydriasis)?

Back 365

Meperidine

----------------------------------------------------------------

Can also precipitate Serotonin syndrome in patients using MAOIs

Front 366

Although flumazenil is the DOC for benzodiazepine reversal by IV drug sedation, why should it not be used in an overdose setting?

Back 366

It may precipitate seizures

Also, which drug is first line for seizures --> Lorazepam... Wouldn't make sense to give a competitive inhibitor of benzodiazepines if seizure is a risk!

Front 367

What is the most common household caustic exposure?

Back 367

Bleach

Front 368

Type of necrosis caused by acid exposure?

Back 368

Coagulation necrosis

Front 369

Type of necrosis caused by alkali exposure

Back 369

Liquefactive necrosis

Front 370

Dermal exposure to hydrofluoric acid, found in rust removers, may result in systemic absorption causing hypocalcemia, hypomagnesemia and death.

How would you treat?

Back 370

Calcium gluconate paste for dermal burn

IV/IA Calcium

Front 371

How do organophosphates cause cholinergic crisis?

Back 371

Deactivation of acetylcholinesterase

Front 372

3 unique symptoms associated with high-altitude sickness?

Back 372

-Snow blindness (ultraviolet keratitis)

-Pharyngitis

-Retinopathy

Front 373

The definitive treatment for high-altitude syndromes is ____________

Back 373

descent

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When not possible, descent may be simulated by a Gamow bag (portable hyperbaric O2 chamber)

Front 374

According to Boyle's Law, as Pressure increases, Volume _______

Back 374

decreases

Front 375

What is a risk factor for "reverse ear squeeze" (ascent barotrauma)?

Back 375

Respiratory tract infection/congestion

Front 376

Decompression Sickness occurs at a dive/depth of at least ______ feet

Back 376

30 ft

Front 377

Treatment of choice for Decompression Sickness ("The bends")?

Back 377

Immediate hyperbaric O2

Front 378

What is "secondary drowning"?

Back 378

Death after initial stabilization

Front 379

Name 3 risk factors for near drowning:

Back 379

-Hypoglycemia

-Seizures

-Head trauma

Front 380

Name 4 subsets of patients at high risk for drowning:

Back 380

- Children < age 4

- Teens (poor judgment)

- Elderly (tubs)

-Alcohol and Drug Users

Front 381

A 24 yo male diver syncopizes upon ascent tot he surface.

Diagnosis?

Back 381

Dysbaric Air Embolism

Front 382

When do you NOT close wounds caused by human bites?

Back 382

Closed fist injuries ("Fight Bite")

Front 383

What is the Parkland formula for burn victims?

Back 383

4 x weight(kg) x %BSA = mL fluid resuscitation

Give 1/2 over first 8 hours

Give remaining half over a 16 hr period

Front 384

Fluid of choice for burn victims?

Back 384

Ringer's Lactate

Front 385

Rule of 9's for burn victims

Back 385

Front 386

Name some criteria for patient transfer to a burn unit

Back 386

-Electrical or chemical burns

-Inhalation injury

-Children

- >10% TBSA in ages < 10 or >50

- >20% TBSA in ages 10-50

- >5% TBSA Third degree burn

- Significant burns to face, eyes, ears, hands, feet, genitalia, perineum or major joints

Front 387

Name some products that contain Hydroflouric acid and can cause burns/toxicity

Back 387

Glass etching dyes

High-octane gas

Germicides

Front 388

Name some products containing Phenol, which can cause a chemical burn after exposure to skin

Back 388

Dyes

Deodorants

Agriculture

Disinfectants

Front 389

When should ocular pH be tested when irrigating an eye exposed to a chemical?

Back 389

Before AND After irrigation!

Front 390

What is Frostnip?

Back 390

Mild, reversible, superficial frost bite

Front 391

Best way to get a core temperature in a patient with hypothermia?

Back 391

Rectal or bladder temperature

Front 392

ECG finding in hypothermia?

Back 392

Osborn ( J ) wave

Front 393

"Duty to warn" was established by the _________ case

Back 393

Tarasoff Case