Term
| Pt presents with N/V, abdominal pain, tachycardia, poor skin turgor, and hyperventilation as well as altered mental status and fruity breath, what condition do you suspect? |
|
Definition
|
|
Term
| What is the level of blood glucose in DKA? |
|
Definition
|
|
Term
| What type of DM does DKA usually occur in? |
|
Definition
|
|
Term
| What events can trigger DKA? |
|
Definition
Infection
MI
Stroke
Trauma
Pregnancy
Hyperthyroidism
Pancreatitis
PE
Surgery
Steroid Use |
|
|
Term
| What is the BIGGEST risk factor for DKA development? |
|
Definition
| Uncontrolled DM Type 1 - Not using insulin |
|
|
Term
| What lab (besides glucose) is elevated in DKA? |
|
Definition
|
|
Term
| What type of metabolic imbalance is caused by DKA? |
|
Definition
| high-anion gap metabolic acidosis |
|
|
Term
| What is the INITIAL treatment for DKA (before labs return)? |
|
Definition
| aggressive fluid therapy prior to receiving lab results - High volumes of isotonic saline (1-3 L) in the first hr |
|
|
Term
| What are the complications of aggressive fluid therapy in the tx of DKA? |
|
Definition
Hypoglycemia, Hypokalemia, hypophosphatemia
ARDS - due to shift of fluid across the pulmonary capillary membrane
Cerebral Edema - Usually 6 - 12 hrs after start of therapy |
|
|
Term
| What are the LATE complications of aggressive fluid therapy in the tx of DKA? |
|
Definition
Hyperchloremic non-anion-gap metabolic acidosis
Late Vascular Thrombosis - Usually cerebral |
|
|
Term
| What is mortality from DKA treatment complications caused by? |
|
Definition
Sepsis
Pulmonary and CV complications
Fatal Cerebral Edema |
|
|
Term
| What anion imbalance is MOST serious and MC in DKA? |
|
Definition
| Hypokalemia (due to the shift from K inside cells to serum - they shift due to exchange of H+ into the cells) |
|
|
Term
| What condition presents yellow (can be green or white) penile discharge, burning with urination and painful, swollen testes? |
|
Definition
|
|
Term
| What is the tx for Chlamydia? |
|
Definition
| azithromycin or doxycycline |
|
|
Term
| What is the tx for Gonorrhea? |
|
Definition
|
|
Term
| What condition presents with mild symptoms in women including painful or burning symptoms when urinating, increased vaginal discharge, and vaginal bleeding between periods? |
|
Definition
|
|
Term
| Which disease is characterized mostly by no symptoms at all, but in women can have symptoms including abnormal vaginal discharge, a burning sensation with urination, abdominal pain, low back pain, nausea and fever, dysparaunia and bleeding between menstrual periods? |
|
Definition
|
|
Term
| What disease condition presents in men with urethral discharge, burning sensation with urination, itching around urethra, but unlike a similar disease it rarely causes swelling or pain in the testes? |
|
Definition
|
|
Term
| What are the non-gonococcal cause of urethritis, cervicitis and/or discharge? |
|
Definition
C. Trachomatis (aka Chlamydia)
Ureaplasma urealyticum (aka Mycoplasma genitalum) |
|
|
Term
| What disease produces a frothy-green vaginal discharge with a strong odor in women, accompanied by a 'strawberry' cervix, discomfort during intercourse and urination as well as irritation and itching of the genitalia? |
|
Definition
|
|
Term
| How is trichomonas treated? What must be avoided with this treatment? |
|
Definition
| Metronidazole; Avoid alcohol |
|
|
Term
| What disease has symptoms including a painless genital ulcer that is indurated? What organism causes it? |
|
Definition
|
|
Term
| Which STI has symptoms including a rash on the palms and soles of the feet? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| What disease presents with painful ulcers on the genitalia, enlarged lymphnodes, fever (especially during the first episode), and a burning or tingling sensation prior to the ulcers appearance? |
|
Definition
|
|
Term
| How is herpes simplex diagnosed? How is it treated? |
|
Definition
|
|
Term
| What disease has symptoms including a painful genital ulcer that is described as soft instead of indurated? What organism causes it? |
|
Definition
| Chancroid - Haemophilus ducreyi |
|
|
Term
| How is a chancroid treated? |
|
Definition
| Azithromycin, Ceftriaxone, Ciprofloxacin, Erythromycin |
|
|
Term
| Which disease presents with a small painless ulcer on the genitalia, swelling and redness of the skin in the groin area, swollen groin lymphnodes unilaterally or bilaterally? |
|
Definition
|
|
Term
| What is the treatment for Lymphogranuloma venereum? |
|
Definition
| Doxycycline, Erythromycin |
|
|
Term
| What disease condition has symptoms that begin as a nodular lesion that evolve into ulcerations, which expand and are locally destructive? |
|
Definition
| Granuloma inguinale, or Calymmatobacterium granulomatis |
|
|
Term
| Which types of HPV cause genital warts? |
|
Definition
|
|
Term
| What is the treatment for HPV? |
|
Definition
| podofilox, imiquimod cream, cryotherapy or trichloroacetic acid (TCA) in a physician's office |
|
|
Term
| What disease causes small or large bumps, groups of bumps, that can be flat, raised, or shaped like a cauliflower? |
|
Definition
|
|
Term
| What is the MC cause of environmentally related death in the US in the past decade? |
|
Definition
|
|
Term
| What puts you at greater risk for developing heat related illnesses? |
|
Definition
The elderly or the very young
Limited Mobility
Alcoholics
Medications (Anti-psychotics, B-blockers)
Obesity
Dehydration
Vigorous exertion |
|
|
Term
| What condition is described as Postural hypotension from vasodilation, volume depletion, & decreased vascular tone? |
|
Definition
|
|
Term
| What is the treatment for heat syncope? |
|
Definition
| Rehydrate, remove from heat, & evaluate for serious Dz |
|
|
Term
| What condition is described as painful, contractions of calves, thigh, or shoulders in pt sweating liberally & drinking hypotonic soln (H2O)? |
|
Definition
|
|
Term
| What is the treatment for heat cramps? |
|
Definition
Replace fluids: 0.1-0.2% oral soln or IV NS
Do NOT use salt tablets |
|
|
Term
| What condition is described as salt & H2O depletion causing orthostasis & hyperthermia? |
|
Definition
|
|
Term
| What labs are indicative of heat exhaustion? |
|
Definition
| high hematocrit, high Na or high BUN |
|
|
Term
| What is the treatment for heat exhaustion? |
|
Definition
|
|
Term
| What is the difference btwn heat stroke and heat exhaustion? |
|
Definition
| heat exhaustion has a normal neuro and mental status exam and temp is below 104F |
|
|
Term
| What condition is characterized by cerebral dysfunction with impaired consciousness, high fever and absence of sweating? |
|
Definition
|
|
Term
| Which is a life threatening medical emergency, heat exhaustion, heat syncope or heat stroke? |
|
Definition
|
|
Term
| At what temp does heat stroke become imminent? |
|
Definition
| when core (rectal) temp 41C, 105.8F |
|
|
Term
| What are the two forms of heat stroke? |
|
Definition
Classic: pts with compromised homeostatic system
Exertional: healthy pts over do it in hot environment |
|
|
Term
| Pt was in the middle of a basketball game and began to become disoriented, dropped to the ground and said he was very dizzy and was feeling nauseated. His skin initially was wet and hot, but then become dry later. What condition do you suspect? How do you treat it? |
|
Definition
| Heat Stroke; MEDICAL EMERGENCY |
|
|
Term
| What drugs increase the risk of heat stroke? |
|
Definition
Amphetamines
Anticholinergics
Antihypertensives
Sympathomimetics (cocaine)
Phenothiazines |
|
|
Term
| What are the complications of heatstroke? |
|
Definition
CNS dysfunction: seizures, altered mentation, plantar response, hemiplegia, ataxia
Rhabdomyolysis |
|
|
Term
| How is heatstroke managed? |
|
Definition
ABCs
Immediate Cooling:
- Evaporation (spay with water and fan)
- Shivering (Lorazepam)
- Ice Water (tub immersion - controversial) |
|
|
Term
| What electrolyte imbalances are caused by heat stroke? |
|
Definition
Hypo - natremia, calcemia, and phosphatemia
Potassium may be increased or decreased |
|
|
Term
| What type of fracture is described as an incomplete fracture that occurs with an axial loading force and happens when the bone essentially "buckles" on itself? |
|
Definition
| Torus Fracture aka buckle fracture |
|
|
Term
| What common childhood fracture is described as the bone cracks but doesn't break all the way through? |
|
Definition
|
|
Term
| If there is shortening of a bone with fracture, what tx may be required? |
|
Definition
|
|
Term
| What fraction description is caused by the extent to which the distal fracture fragment is twisted on its own axis? |
|
Definition
|
|
Term
| Which type of SALTER harris fracture is described as is a transverse fracture through the hypertrophic zone of the physis. In this injury, the width of the physis is increased? |
|
Definition
| Type 1 - Sliding (Separation) |
|
|
Term
| Which type of SALTER harris fracture is described as occurs through the physis and metaphysis; the epiphysis is not involved in the injury? |
|
Definition
|
|
Term
| Which type of SALTER Harris fracture is described as a fracture through the physis and epiphysis, this fracture passes through the hypertrophic layer of the physis and extends to split the epiphysis, inevitably damaging the reproductive layer of the physis? |
|
Definition
|
|
Term
| Which type of SALTER Harris fracture is described as nvolves all 3 elements of the bone, passing through the epiphysis, physis, and metaphysis? |
|
Definition
|
|
Term
| Which type of SALTER Harris Fracture is described as a compression or crush injury of the epiphyseal plate, with no associated epiphyseal or metaphyseal fracture? |
|
Definition
|
|
Term
| Which type of SALTER harris fractures can interfere with growth and cause deformities to joints? |
|
Definition
|
|
Term
| What condition is the result of the immune system’s reaction to one or more of a large family of true exotoxins referred to collectively as pyrogenic toxin superantigens? |
|
Definition
|
|
Term
| What bacteria produce the toxins that cause TSS? |
|
Definition
|
|
Term
| What is early goal-directed therapy for TSS aimed at? |
|
Definition
| ADMIT - Initial tx aimed at hemodynamic optimization within first 6 hrs (aggressive fluid resuscitation and cardiac monitoring) |
|
|
Term
| What are some common sites for growth of bacteria causing TSS? |
|
Definition
| Tampons and Wound Packing |
|
|
Term
| What is the medicinal treatment for TSS? |
|
Definition
| Antibiotics that cover both staph and strep (minimum of 7 days of treatment) - Ex Clindamycin |
|
|
Term
| What does streptococcal TSS develop from? What specific bacteria is involved in this infection? |
|
Definition
| Severe soft tissue infection; Streptococcis pyrogenes (Grp A strep) |
|
|
Term
| What is the treatment for Strep TSS? |
|
Definition
Anti-biotic therapy started ASAP in ED (Penicillin G and Clindamycin) - If allergic to PCN give Erythromycin
Prompt and aggressive exploration and debridement of wound |
|
|
Term
| What is the diagnostic study of choice for a sternclavicular dislocation? |
|
Definition
| CT = imaging procedure of choice |
|
|
Term
| What is the initial evaluation of choice for a suspected stroke pt? |
|
Definition
| CT scan - Head (MRI produces the BEST images, but takes too long to be the INITIAL study of choice) |
|
|
Term
| Most common x-ray used in trauma survey? |
|
Definition
|
|
Term
| What are the hallmarks of a brain injury? |
|
Definition
| Alteration in Consciousness |
|
|
Term
| What is the MCC of intra-peritoneal bleeding? |
|
Definition
|
|
Term
| MC COD via envenomation in the US? |
|
Definition
| Hymenoptera Stings (Bees, Wasps and Ants) |
|
|
Term
| Are physicians required to report child abuse? |
|
Definition
| YES, they are required by law |
|
|
Term
| What is the MC reason physicians don't report suspected child abuse? |
|
Definition
| B/c they are NOT 100% sure the abuse exists |
|
|
Term
| If you fail to report child abuse, what is the penalty? |
|
Definition
|
|
Term
| Which type of vertigo is caused by disorders affecting the vestibular apparatus and CN 8? |
|
Definition
|
|
Term
| Which type of vertigo is described as being caused by disorders affecting structures such as brainstem and cerebellum? |
|
Definition
|
|
Term
| Which type of vertigo produces more distressing symptoms, but are seldom life-threatening? |
|
Definition
|
|
Term
| Which type of vertigo produces less distressing sx, but are generally MORE serious? |
|
Definition
|
|
Term
| Pt has a sudden onset of intense spinning feeling, is aggravated by different positions, has vertical and horizontal nystagmus, as well as associated N/V, tinnitus is present but has no neurological deficit. What condition do you suspect? |
|
Definition
|
|
Term
| Pt presents with a slow onset of mild vertigo that is constant, vertical nystagmus is present on exam and some neurological deficits are present. What condition do you suspect? |
|
Definition
|
|
Term
| What is required prior to evidence collection in cases of sexual assault? What is required to maintain after collection of specimen? |
|
Definition
Informed consent is required prior to evidence collection
Maintenance of "chain of evidence" is essential |
|
|
Term
| What are the two evidentiary requirements for a case of sexual assault? |
|
Definition
Proof of RECENT SEXUAL contact
Proof of FORCE |
|
|
Term
| What are some evidence that can be collected proving recent sexual contact? |
|
Definition
Sperm or other seminal products
Examining skin for trace amounts of semen
Identification of assailant - hair, DNA from blood, saliva, or semen |
|
|
Term
| What evidence can be collected to prove force of sexual assault? |
|
Definition
Injuries
Victim's Statement
Clothing (trace evidence)
Urine Specimen (done by law enforcement) |
|
|
Term
| What are the triggers for a myxedema coma? |
|
Definition
Infection
Cold Exposure
Drugs (Sedatives, Lithium, Amiodarone)
Trauma
Stroke or CHF
Not taking thyroid drug |
|
|
Term
| What is the medical treatment for myxedema coma? |
|
Definition
ABCs
IV levothyroxine
Antibiotics if infection was precipitating factor |
|
|
Term
| Herpes affecting CN V is known as? |
|
Definition
| Herpes Zoster ophthalmicus |
|
|
Term
| What CN is affected by herpes zoster ophthalmicus? |
|
Definition
|
|
Term
| Pt presents with vesicles in the ear canal and on the TM. What condition? What CN is affected? |
|
Definition
| Ramsey Hunt Syndrome; CN VII |
|
|
Term
| What is the BEST treatment for post-herpetic neuralgia? |
|
Definition
| anti-viral within 72hours of symptom onset, |
|
|
Term
| What is the difference between shingles and Chicken Pox? |
|
Definition
| Shingles vesicles are limited to a specific dermatome |
|
|
Term
| Pt presents to your ER after spending yesterday at the beach. They have a HA, chills, & malaise. Additionally under their bra and bikini area they have a morbilliform pruritic lesions. What condition is this pt suffering from? What is the causative agent? |
|
Definition
Seabather's Itch or Sea Lice
Caused by larva of the Thimble Jellyfish |
|
|
Term
| What is the treatment for Sea Lice? |
|
Definition
| Papain (in "Accent"), Benadryl, Calamine Lotion or Topical Corticosteroids |
|
|
Term
| What is the Parkland formula used for? |
|
Definition
| Used for calculating the amount of fluids given for fluid resuscitation in burns |
|
|
Term
| What is the Parkland Formula? |
|
Definition
| (4ml x kg x %BSA)/ 1000 = Volume in L of fluid replacement for 1st 24hrs (give 50% in over first 8hrs) |
|
|
Term
| What are the symptoms of Tylenol overdose in Phase 1? (4) |
|
Definition
Diaphoresis
Malaise
Vomiting
Pallor |
|
|
Term
| What are the symptoms of Tylenol overdose in Phase 2? (3) |
|
Definition
RUQ tenderness
Tachycardia
Hypotension |
|
|
Term
| What are the symptoms of Tylenol overdose in Phase 3? (4) |
|
Definition
Tender hepatic edge
Jaundice
Evidence of Hepatic encephalopathy
Evidence of bleeding (GI or coagulopathy) |
|
|
Term
| What is phase 4 of a Tylenol overdose? |
|
Definition
|
|
Term
| What is the toxicity of tylenol increased by? |
|
Definition
| chronic ETOH use, phenytoin, zidovudine, INH |
|
|
Term
| When should the initial level of acetaminophen ingestion be checked? What does this level determine? |
|
Definition
| 4 hrs after ingestion; Probable vs possible toxicity |
|
|
Term
| What is the treatment for acetaminophen toxicity? When is it indicated for use? |
|
Definition
N-acetylcysteine
- Serum level >10mcg/ml if time of ingestion unknown
4 hr level > 150
8 hr level > 70
12 hr level > 40 |
|
|
Term
| What is the treatment for acetaminophen toxicity if pt presents within the first hour of ingestion? |
|
Definition
| Decontamination with activated charcoal; |
|
|
Term
| What is used to measure acetaminophen levels? |
|
Definition
|
|
Term
| Pt presents with vomiting, tachypnea, tinnitus, lethargy and high-anion gap metabolic acidosis? |
|
Definition
|
|
Term
| Pt presents comatosed, hx of seizures prior to coma state, has a fever, and on PE pulmonary edema, hypotension, and tachycardia. What overdose condition do you suspect? |
|
Definition
|
|
Term
| How is ASA acute overdose treated? |
|
Definition
Activated Charcoal (Consider bowel irrigation)
Bicarb to correct acidosis and enhance urinary elimination
Correct fluid deficit (b/c of pulmonary edema risk) |
|
|
Term
| What is the treatment for severe ASA toxicity? |
|
Definition
| Prompt hemodialysis for serious intoxication |
|
|
Term
| Pt presents with confusion, depression, anorexia, N/V, diarrhea and yellow vision. What condition do you suspect? |
|
Definition
|
|
Term
| What toxicity can cause ST-T wave changes, 1st-degree heart block, ventricular premature depolarizations, sinus arrest, accelerated junctional rhythm, paroxysmal atrial tachycardia with AV node block, v tach and v fib on EKG? |
|
Definition
|
|
Term
| What is the treatment for a digitalis overdose? |
|
Definition
Generally Supportive (Fluids, Electrolytes)
CONTROL ARRHYTHMIAS
Digoxin-specific Fab antibody fragments (Digibind) in profound toxicity in the face of life-threatening intoxications |
|
|
Term
| What is the antidote for a Anticholinergic overdose? |
|
Definition
| Physostigmine salicylate is the antidote |
|
|
Term
| Pt presents with flushing, dry skin & mucous membranes, mydriasis w/loss of accommodation, fever, decreased bowel sounds, urinary retention. What overdose condition do you suspect? |
|
Definition
|
|
Term
| What is the treatment for Anticholinergic Overdose? |
|
Definition
| GI decontamination, activated charcoal is recommended; Benzo for seizure control |
|
|
Term
| Pt presents with ataxia, disorientation, short-term memory loss, confusion, hallucinations (visual, auditory), psychosis, agitated delirium, seizures (rare), coma, respiratory failure, and cardiovascular collapse. What overdose condition do you suspect? |
|
Definition
|
|
Term
| What are the hallmarks of an opioid overdose? |
|
Definition
| coma, respiratory depression and miosis |
|
|
Term
| What is the most important initial treatment for Heroin overdose? |
|
Definition
| AIRWAY - Intubation for comatosed pt |
|
|
Term
| What is a the opioid antagonist used for reversal of heroin and other opioid overdoses? What is the time of onset? |
|
Definition
| Naloxone(Narcan); onset in 1 min (be careful - pt may wake up screaming or aggressive) |
|
|
Term
| What are the 2 most frequently abused opioids in the US? |
|
Definition
|
|
Term
| What are the most commonly overdosed GHB? |
|
Definition
| Barbiturate and Benzodiazepines |
|
|
Term
| What effect does GHB have on the CNS? What are the symptoms? |
|
Definition
| depression of CNS; sedative-hypnotic symptoms |
|
|
Term
| What med is used to competitively and reversible binds benzodiazepine receptors? |
|
Definition
|
|
Term
| How can elimination of GHB, Benzos or barbituates be enhanced? |
|
Definition
| Enhance elimination with alkaline diuresis |
|
|
Term
| What is one of the leading causes of death caused by toxicological agents in children < 6 yrs of age? |
|
Definition
|
|
Term
| At what level of iron ingestion can GI toxicity be evident? At what level does moderate intoxication occur? At what level can a lethal toxicity occur? |
|
Definition
Gi Sx @ 20mg/kg
Moderate Intox = > 40mg/kg
Death Possible = > 60mg/kg |
|
|
Term
| Pt presents with history of vomiting, nausea, diarrhea, and abdominal pain, hemorrhagic gastroenteritis, signs of dehydration, hypovolemic shock and third-spacing present. What type of overdose do you suspect? |
|
Definition
|
|
Term
| What is the treatment for Iron toxicity? |
|
Definition
| Deferoxamine chelation is the mainstay of therapy |
|
|
Term
| Pt presents after a morning at the beach with intense back pain, burning, throbbing with pain radiating from extremities centrally, pruritis and has multiple reddish brown whip-like linear lesions. What condition do you suspect? |
|
Definition
| Portuguese Man-of-War Sting - Mild Envenomation |
|
|
Term
| What will inactivate the venom of a Portuguese Man-of-War? |
|
Definition
|
|
Term
| What are the moderate and severe envenomation symptoms of a Portuguese Man-of-War sting? |
|
Definition
| Neurologic, Cardiovascular, Respiratory, Musculoskeletal, GI and Ocular |
|
|
Term
| What is the treatment for Portuguese Man-of-War? What should you NOT do? |
|
Definition
Rinse with sea water (DO NOT USE hypotonic solution to rinse as it will stimulate nematocyte d/c)
shave area to remove nematocytes
5% Acetic Acid
Topical Lidocaine, Benadryl, or steroids |
|
|
Term
| What med is used to treat muscle spasms caused by portuguese man-of-war stings? |
|
Definition
| Valium or 10% Calcium Gluconate |
|
|
Term
| What med is used to treat anaphylaxis caused by portuguese man-of-war stings? |
|
Definition
|
|
Term
| Pt presents with an erythematous halo around a lesion that has soft tissue destruction in the middle. She explains that it started two days ago as an area that was stinging and then developed into a painful and pruritic lesion and now this. She also has a fever, chills, and N/V. What condition do you suspect? |
|
Definition
| Brown recluse spider bite |
|
|
Term
| What is the treatment of a brown recluse spider bite? |
|
Definition
Monitor Fluid and Electrolytes
Elevation and Immobilization
Cold Compress (slows necrosis of tissue)
Local Wound CAre
Td Prophylaxis, Analgesics, antipuritics, antihistamines |
|
|
Term
| What are the predominant effects of a black widow spider bite? |
|
Definition
| neurological and autonomic |
|
|
Term
| Within what time frame so the systemic effects of a black widow spider bite occur? |
|
Definition
|
|
Term
| Pt presents with muscle cramping in his thighs, abdomen, back and chest, nausea, vomiting, HA, anxiety, diaphoresis and severe pain that waxes and wanes. With further history elicitation, the pt remembers that in the morning while in his car he felt a pinch on the back of his arm. On inspection you not a raised lesion and looking closely you see tiny fang marks in the center of the lesion. What condition do you suspect this pt is suffering from? |
|
Definition
|
|
Term
| What are the SERIOUS effects of a brown-recluse spider bite? |
|
Definition
Renal Failure
Seizures
DIC
Coma
Occasionally Death |
|
|
Term
| What are the SERIOUS complications of a black widow spider bite? |
|
Definition
HTN
Resp. Failure
Shock
Coma |
|
|
Term
| How is the pain and cramping caused by a black widow spider bite treated? |
|
Definition
| Analgesics & Benzodiazepines |
|
|
Term
| In general, when should pts be given anti-venom for a black widow spider bite? |
|
Definition
When there is severe envenomation
When opiates or sedative hypnotics are not adequate
Certain age groups |
|
|
Term
| What is the treatment if anaphylaxis occurs with the antivenom used with black widow spider bites? |
|
Definition
Epi
Antihistamines
Steroids |
|
|
Term
| What are the complications of anaphylaxis of antivenom used to treat a black widow spider bite? |
|
Definition
Respiratory difficulty
Hypertensive crisis
Rhabdomyolysis
Priaprism |
|
|
Term
| What is the causative agent behind periocular superficial cellulitis? |
|
Definition
|
|
Term
| Pt presents with L eye in which the eyelid is erythematous, warm, and edematous. Vision, pupillary reaction and EOMs are maintained. What condition do you suspect? |
|
Definition
| Preseptal Cellulitis (Periorbital Cellulitis) |
|
|
Term
| If a pt <5y/o, presents with periorbital cellulitis, what does this warrant? |
|
Definition
| warrants complete eval (H. influenzae) |
|
|
Term
| What is the treatment for Preseptal Cellulitis in children > 5 y/o and adults? |
|
Definition
|
|
Term
| What is the treatment for preorbital cellulitis in a child < 5y/o or in SEVERE cases? |
|
Definition
| admit for IV Abx - Ceftriaxone / eval |
|
|
Term
| What is the difference between pre-orbital and orbital cellulitis? How can you confirm orbital vs pre-orbita with imaging? |
|
Definition
On PE orbital cellulitis affects the EOMs, occasionally proptosis occurs, and decreased visual acuity (late finding)
Contrast-Enhanced CT confrims |
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Term
| What is the MOI for maxillary fractures? |
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Definition
| Often secondary to high-speed deceleration |
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Term
| Pt presents with massive facial soft-tissue injury, midface mobility, and malocclusion or CSF rhinorrhea. What condition do you suspect? What imaging should you get to confirm this diagnosis? |
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Definition
| Maxillary Fracture; Water's View and CT scan |
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Term
| Which type of Maxillary fracture is described as involving only maxilla at level of nasal fossa? |
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Definition
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Term
| Which type of Maxillary fracture is described as involving maxilla, nasal bones, and medial aspects of orbits - pyramidal dysfunction? |
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Definition
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Term
| Which type of Maxillary fracture is described as involving maxilla, zygoma, nasal bones, ethmoids, vomer, and all lesses bones of cranial base? |
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Definition
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Term
| Pt presents with mandibular pain, tenderness, and malocclusion with a step off in dentition and an ecchymosis in the floor of the mouth. What condition do you suspect? |
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Definition
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Term
| What are the predisposing factors to oral candidiasis? |
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Definition
extremes of age,
dentures,
malnourished states,
antibiotics,
AIDS, |
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Term
| Pt presents with white curd like plaques on their tongue, what condition do you suspect? |
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Definition
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Term
| What is the treatment for oral candidiasis? |
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Definition
| topical oral antifungal agents |
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Term
| What is the treatment for sialolithiasis? |
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Definition
| analgesics, Abx, massage, sialologues (lemon drops) |
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Term
| Pt presents with unilateral pain and swelling in their submandibular area that is aggravated by meals. What condition do you suspect? |
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Definition
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Term
| What is the diagnostic test of choice for SAH? |
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Definition
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Term
| What is the MCC of a SAH? |
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Definition
| Saccular (berry) aneurysm |
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Term
| Pt presents with neck pain and stiffness that radiates down the spine, HA that is described as a 10/10 (he couldn't even drive here), and a hx of HTN that was uncontrolled. What condition do you suspect? |
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Definition
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Term
| What is the treatment for alcoholic ketoacidosis? |
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Definition
fluid of choice is D5NS for volume repleation
Glucose Administration (halts ketone formation) |
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Term
| What condition is described as A wide-anion-gap acidosis most often associated with acute cessation of alcohol consumption? |
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Definition
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Term
| Pt presents with a fever, SVT, is confused and c/o GI discomfort and diarrhea, and is diaphoretic. EKG show SVT but no signs of MI. What condition do you suspect? |
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Definition
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Term
| Pt presents with severe hypotension, that is resistant to catecholamine and IV fluid administration. What condition do you suspect? |
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Definition
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Term
| If a pt presents with what you believe is adrenal crisis and they have abdominal and flank pain with hypotension, what is the underlying cause of their adrenal crisis? |
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Definition
| Hemorrhage or thrombosis of adrenal glands |
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Term
| If a pt presents with what you believe is adrenal crisis and they have other neurologic deficits, HA, visual field deficits, what is the most likely cause of the adrenal crisis? |
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Definition
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Term
| What is the test used to confirm a diagnosis of adrenal crisis? |
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Definition
| AM cortisol levels = rule in (level <83 nmol/L), or rule out (level >525 nmol/L) AI |
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Term
| Pt presents to the ER with body chills, itching, HA, perspiration, dizziness, muscle pains and weakness, cramps, joint aches and tingling around her mouth and in her hands. What sign would be pathognomonic of a suspected ciguatera poisoning? |
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Definition
Reversal of hot & cold tactile perception
Develops after 3-5 days & may last months |
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Term
| What can be used to reverse symptoms in a CIGUATERA poisoning? |
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Definition
| Mannitol IV, < 48 hrs 60% reverse Sx |
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Term
| Pt presents with intense shivering, lethargy, confusion, pupils are unreactive and respirations and heartrate are slow. On EKG there is a slow Afib rhythm. What condition do you suspect? |
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Definition
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Term
| On EKG what is pathognomonic of hypothermia? |
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Definition
| Pathognomonic J-wave of Osborn prominent in lead II |
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Term
| How is hypothermia diagnosed? |
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Definition
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Term
| What is the 1st priority of treatment in hypothermia? |
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Definition
| Prevent further heat loss by removing wet cloths, wrapping pt in blankets, & covering head |
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Term
| How much should you increase the temperature of a hypothermic pt by? |
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Definition
| increase core temp by 1°C/hr |
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Term
| What is the most obvious predictor of a violent pt in the ED? |
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Definition
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Term
| What is the MC perpetrator of violence in the ED? |
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Definition
| males with a history of substance abuse |
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Term
| What is the MC functional disorder related to violent behavior? |
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Definition
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Term
| What are the 3 prodromes of violence? |
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Definition
Anxiety
Defensiveness
Physical Aggression |
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Term
| What is the purpose of restraints or seclusion? |
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Definition
| to ensure the safety of patients and others |
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Term
| What is the usual route of choice for delivering meds to help restrain a violent pt? |
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Definition
| Intramuscular injection as it is absorbed rapidly |
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Term
| What is the antipsychotic of choice used as a chemical restraint in violent pts? |
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Definition
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Term
| What are some mechanisms to lower violence? |
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Definition
Interviews conducted in a safe, calm environment
Seclusion rooms safe for both the patient
No free-standing objects = potential weapons
Room exit should be clear of obstruction
Panic buttons may be installed
Deterrence |
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Term
| What is the most important factor in curbing violence in the ED? |
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Definition
| The education of ED personnel |
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Term
| Which type of fracture is described as wedge-shaped fragment of anteroinferior vertebral body displaced anteriorly? |
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Definition
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Term
| Where do burst fractures most often occur? |
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Definition
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Term
| What type of fracture is described as vertebral body shattered outward from within? |
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Definition
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Term
| What is a complication of a burst fracture? |
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Definition
| Fragments may impinge on spinal cord |
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Term
| Is there neurological damage with a teardrop fracture? |
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Definition
| Pt may have neurological deficit |
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Term
| Is there neurological damage with a burst fracture? |
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Definition
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Term
| Is there neurological damage with a clay-shoveler's fracture? |
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Definition
| Usually NO neurological involvement |
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Term
| What fracture is described as oblique fx of base of spinous processes of lower cervical vertebrae? |
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Definition
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Term
| What is the most distinguishing clinical feature of Sickle Cell Disease? |
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Definition
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Term
| An AA pt presents with dactylitis and joint pains. What condition do you suspect? |
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Definition
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Term
| What are the complications of sickle cell disease? |
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Definition
spleen infarctions
liver infarctions
papillary necrosis common renal manifestation
Stroke |
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Term
| Pt presents with severe unilateral pain in the cheek area, lasting only seconds. Neuro exam is normal. What condition do you suspect? |
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Definition
| Trigeminal Neuralgia (Tic Douloureux) |
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Term
| What does snuff-box tenderness indicate? |
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Definition
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Term
| Where do 90% of anterior nosebleeds originate? |
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Definition
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Term
| What is the treatment for an anterior nosebleed? |
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Definition
| direct pressure - vasoconstrictive agents |
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