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Emergency Medicine
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Subjects
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health-sciences
,
emergency-medicine
Instructions:
Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.
This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.
1. Placenta previa - vaginal/cervical trauma - polyps - genital infections - hemorrhoids - onset of labor (no fetal distress) - placental abruption (have fetal distress)
Chlamydia
EKG changes
Causes of 3rd trimester bleeding
ED treatment for Ectopic Pregnancy
2. Chronic anticoagulation - Coumadin - Pradaxa/Dabigatran (no meds to reverse it) - Lovenox - ESLD / alcoholism (lack clotting factors) - NSAIDS (increase risk PUD and blood thinning) - Smoking
How to monitor CDAB
Common risk factors for UGIB
When is Rho GAM used
Supplemental O2
3. Obstruction of appendiceal lumen (fecalith) - leads to edema - ischemia - infection - necrosis - ? perf and peritonitis - +Rosvig's sign (push and feel on opposite side)
ED work up for cholecystitis
Types of Infectious diarrhea Yersinia
Ovarian Torsion
Appendicitis
4. Gram negative - bad eggs - dairy - poultry. - S/S: bloody diarrhea - fever - abd pain - Resolves in 10-14 days.
Aortic Dissection definition - risks and S/S
When is Rho GAM used
Types of Infectious diarrhea - Salmonella
How to assess Airway
5. Emergency Medical Treatment and Active Labor Act - hospitals are obligated to screen/treat a patient in the ER regardless of insurance - if a emergency medical condition exists - they must stabilize the patient before transferring or d/c the patient
Incomplete abortion
EMTALA
Defibrillation
Dx of Aortic dissection
6. On ANY FEMALE WITH ABDOMINAL PAIN- including bimanual vagino-rectal exam
The vital signs
Define Biliary colic
LCA
When to do a pelvic exam
7. V1-V2 Right Posterior Descending Artery
Placenta Previa
Common risk factors for LGIB
When are Beta Blockers contraindicated
Posterior
8. ABC's - IV - O2 - cardiac monitor - Diuretics - Lasix - Lasix naive patients start at 20 mg IV - chronic users start at 40 mg IV - Morphine - Nitro if pain - Pressors prn
ED work up for cholecystitis
STEMI vs Nstemi
Tx of CHF
Common Presentation of GIB
9. O2 - 2 large bore IV's: IVF with crystalloid (NS or LR) - type and screen crossmatch - transfuse prn - OB GYN cx ASAP
ED treatment for Ectopic Pregnancy
Types of Infectious diarrhea - Salmonella
Tachycardia
ED Tx of GIB
10. Premature separation of the implanted placenta - S/S: abdominal pain - dark vaginal bleeding -hypertonic and tender uterus - fetal distress - may see signs of shock without visible bleeding if intrauterine bleeding Risk factors: HTN - pelvic trauma -
Placental Abruption
Ascending Cholangitis
Ectopic Pregnancy
Contraindications for thrombolytics
11. HR/pulse: 60-100 - Bp: 120/80 - Resp rate: 16-20 - Temp 97-99 - O2 sat > 94% - Pain!!! - 6th vital sign
The vital signs
Triage
Pancreatitis work up
Types of Infectious diarrhea - Salmonella
12. Def: Defect in the intimal layer of the aorta allows for blood to enter space between vascular layers - Risk actors: age - HTN - Connective tissue dz (marphans) - bicuspid aortic valve - coarctation of the aorta - inflam dz of aorta - atherosclerosi
Define Biliary colic
Aortic Dissection definition - risks and S/S
SBO
Advanced airway techniques
13. Gallbladder inflammation - often from prolonged obstruction of stones - Pain more severe than biliary coli - assoc w/ fever and lasts 6+ hours - Common bacteria: gram - - strep - anaerobes
Define Acute Cholecystitis
Contraindications for thrombolytics
Placental Abruption
Common risk factors for LGIB
14. Charcot's Triad - Fever - Jaundice - RUQ pain - bacteria enters the biliary tract thru Sphincter of Oddi - Increase risk after sphincterotomy - cholecochal surgery or biliary stent Dx: with ERCP - endoscopic retrograde cholangiopancreatography
Ascending Cholangitis
When is Rho GAM used
Stable vs. Unstable Ectopic Pregnancy
EMTALA
15. Troponin T or I - mores specific for heart. Tropoinin I stays elevated for 7-10 days - Troponin T stays elevated for 10-14 days - CK - MB: - peaks 20 hours after AMI (specific to cardiac muscle) - CPK - measures muscle breakdown so nonspecific
Cardiac Tamponade
CHF
Cardiac Enzymes
Abdominal Aortic Aneurysm
16. Bilateral carotid and femoral pulses = most reliable - No pulse - start CPR immediately (2 minutes fast and hard and then swhich out)- Never stop doing CPR until pulse is present (CPR while defibrillator is charging - stop for electric discharge - an
Appendicitis
Where to check pulses
UTI
SBO
17. Elevated Bp with signs of end organ damage to brain - eyes - heart or kidney. - Organ damage risk increases when diastolic Bp > 115-130 - HTN urgency if see high Bp but no signs of organ damage yet - Get a head CT ASAP!! Symptoms: Head: HA - confusio
Anteroseptal leads and Anterior
Breathing
RCA
Hypertensive Emergency
18. Main cause - hernias and adhesions. Other causes: CA - IBD - bezoar - gallstones - intussusception - Ascaris worm if travel - - Diagnostic Tests = KUB --> look or air/ fluid - levels and dilated loops of bowel - also CT scan Labs: CBC - chem 7 - LF
Triage
What to do with weak/thready pulses
SBO
Ovarian Torsion
19. Left coronary artery (short and branches quickly)
LCA
Types of Infectious diarrhea - Salmonella
Other major arteries
Testicular Torsion
20. Common STI - similar presentation as Gonorrhea - may have pus when milking urethra - Common caUse of infertility - Dx: PCR of urine - fluorescent antibody testing - cervical or urethral culture swab - Tx: Asithromycin 1 g po x 1 or Doxy x 7 days (at
Appendicitis
Placenta Previa
Miscarriage
Chlamydia
21. LAD - Left Anterior Descending Artery (anterior) - Diagonal branch of LAD (anterior) - Left Circumflex artery (posterior) - Obtuse Marginal Artery
Incomplete abortion
Posterior
Other major arteries
Contraindications for thrombolytics
22. Often a complicaiton of a patient with ACS (often s/p AMI) - HR > 100 BPM - Dx: Look for P waves to see a fib vs a flutter - Tx: Adenosine to slow heart for diagnostic purposes - always check TSH - classifications: narrow complex vs wide complex - re
Initial steps in stabilizing a patient
ED work up for cholecystitis
Tachycardia
What is a large bore IV?
23. V1-V3 - V2-V4 Means LAD (left anterior descending) involved
Kidney Stones
Common Presentation of GIB
SBO
Anteroseptal leads and Anterior
24. Active internal bleeding - hx hemorrhagic stroke/TIA in the past year - Intracranial tumor - AV malformation or aneurysm - suspected aortic dissection or tamponade - Severe bleeding disorder - Head trauma - Intracranial procedure
Acute Arterial occlusion - to lower extremities
Abdominal Aortic Aneurysm
Contraindications for thrombolytics
Appendicitis
25. IVF - fill the tank - CBC - chem 7 - LFT's - Lipase - UA - HCG for females - surgery cx - Abd CT scan for adults - ultrasound for kids or to r/o ovarian pathology in females - NPO - Pain control - Pre op Antibiotics (Levo - Flagyl or Unasyn)
Types of Infectious diarrhea Campylobacter
Appendicitis work up
Chlamydia
Types of Infectious diarrhea - Salmonella
26. BRADYCARDIA - due to depressed SA node act or delayed conduction - excessive beta blockers - HR < 50 BPM - Tx: Atropine - Pacing ready / defibrillator prn - treat underlying cause (electrolyte imbalance - drugs - hypothermia)
RCA
Acute Arterial occlusion - to lower extremities
Bradycardia
Endocarditis
27. Right Coronary artery - SA node branch (anterior) - Acute marginal artery (anterior) - AV node branch (posterior) - Posterior descending artery (posterior)
Testicular Torsion
Pericarditis
RCA
Acute Coronary syndrome
28. Due to chromosomal abnormalities - check Rubella a) Threatened abortion if - 1st trimester vag bleed - < 20 weeks GA - os closed - membranes intact - some cramping. Tx - pelvic rest - bed rest - close OB GYN f/you b) Inevitable abortion - if < 20 wee
How to assess Airway
Emergency Severity Index
Early miscarriage (20 weeks)
Placental Abruption
29. Pay attention to resp rate - breathing pattern (normal vs. agonic breaths) - O2 sats - goal is > 94% - Chest rise/tidal volume - Waveform Capnography: measures CO2 input and output. Best measure for assessing ventilation - Bag-valve-mask helps patie
Stable vs unstable angina`
Abdominal Aortic Aneurysm
Breathing
Lateral Leads
30. Inflammation of the pericardial sac with or without effusion - S/S: sharp - pleuritic chest pain that's worse when laying down - pericardial friction rub on exam - ST elevations in ALL leads!!! - depressed PR intervals
Incidence of AMI
Contraindications for thrombolytics
Lateral Leads
Pericarditis
31. HEAD TILT-CHIN LIFT: assess if airway is obstructed vs. open - look for foreign body - vomit - blood. - JAW THRUST - if C-spine injury suspected - 30 compressions for every 2 breaths - Give one breath every 5-6 sections (don't over-ventilate the pat
What should be done after CDAB's
How to assess Airway
ED Tx of GIB
Acute Arterial occlusion - to lower extremities
32. RUQ/epigastric pain - lasts 30 min to 6 hours - once gallbladder contracts and it relieves the obstruction - pain resolves - NO Fever
Endocarditis
Pericarditis
Triage
Define Biliary colic
33. Reassess circulation: compression - check cardiac rhythm - pulse - give meds to help Bp or rhythm prn - Monitor Oxygen and IV - DDx -goalis to find and treat reversible causes
How to monitor CDAB
Gonorrhea
Cardiac Tamponade
Aortic Dissection definition - risks and S/S
34. Often embolic phenomenon triggered by afib or endocarditis - 6 P's: Pain - pallor - paralysis - paresthesias - poikilothermia - pulselessness - DX: dopplers with ABI - ankle brachial index
Tx of Unstable Angina
Ranson's criteria
Acute Arterial occlusion - to lower extremities
Lateral Leads
35. leading caUse of death inUS - Includes angina (stable and unstable) and MI (STEMI vs NSTEMI) - risk factors: HTN - Hyperlipidemia - smoking - DM - fam hx under age 55 - advanced age - males and postmenopausal females - Patho: atherosclerosis of arter
Define Biliary colic
Acute Coronary syndrome
Other major arteries
Viral Gastroenteritis
36. Explosive - frothy and foul smellng diarrhea - Entamoeba hystlytica - crypto - isospora (HIV)
Common risk factors for LGIB
ED work up for cholecystitis
When is Rho GAM used
Types of Infectious diarrhea Protozo -Giardia (dirty water sources)
37. Abd pain: varies - achy - burning - Melena: dark - tarry stool (UGIB) - Hematemesis - vomiting blood - Hematochezia - BRBPR - Hypotension - tachycardia - Pallor - Guaiac + rectal exam
GIB work up
Anteroseptal leads and Anterior
Common Presentation of GIB
EKG changes
38. Stable - NOT ruptured - vitals stable - no drop in H/H - no pain or tenderness Tx - with Methotrexate per OB GYN - inhibits folate so cells stop multiplying (used in RA and cancers) Don't use Methotrexate if fetal HR identified - Unstable - RUPTURED
Supplemental O2
ED Tx of GIB
Symptoms of Ruptured ovarian cysts
Stable vs. Unstable Ectopic Pregnancy
39. Common complication after an AMI - S/S: edema - elevated JVP - hepatojugular reflux - pulm rales - rhochi - decrease BS - +/- cardiac murmurs - low O2 sat - elevated BNP
Inferior leads
CHF
Miscarriage
Early miscarriage (20 weeks)
40. Risk Factors: PID - Mirena IUD - tubal surgery - pelvic surgery - endometriosis - IVF -DES exposure S/S - R or L adnexal tenderness - R shoulder pain could be referred pain from intraabdominal hemorrhage (gallbladder - liver also) - Workup -CBC - C
Ectopic Pregnancy
ED workup of kidney stones
Chlamydia
Contraindications for thrombolytics
41. Testis twists on a spermatic cord - restore blood flow in 6 hours or may have infertility - common at puberty and in 1 year olds - High risk - Bell Clapper Deformity (tunica vaginalis isterts high on the spermatic cord) - horizontal lie spermatic cor
Testicular Torsion
Common risk factors for UGIB
Triage
UTI
42. Given to any woman that is Rh Negative who is HCG positive and has any vaginal bleeding during pregnancy - to Rh Negative patients (prevent formation of anti Rh antibodies - against baby)
When is Rho GAM used
Stable vs. Unstable Ectopic Pregnancy
Types of Infectious diarrhea Shigella
Supplemental O2
43. 16-18 Gauge
CHF
What is a large bore IV?
Missed Abortion
Ascending Cholangitis
44. Sigmoid - volvulus: High risk patients: chronic constipation - elderly and debilitated patients - Dx: plain film - Tx: decompress with rectal tube - Cecal volvulus - see congenital hypermobile cecum. also dx with plain films
Viral Gastroenteritis
Volvulus
Aortic Dissection definition - risks and S/S
Acute Arterial occlusion - to lower extremities
45. Fluid filled sacs within the ovary - Common in infancy and teens - Causes: ovarian stimulation (in vitro fertilization) - hypothyroid - prego - PCOS
Pancreatitis work up
Genital Herpes
Tx of Unstable Angina
Ovarian Cysts
46. Especially O157: H7 causes enterohemorrhagic diarrhea. Inundercooked beef - complicated by hemolytic uremic syndrome and TTP
Other major arteries
Kidney Stones
Types of Infectious diarrhea E coli
Dx of Aortic dissection
47. IVF with crystalloids - RhoGAM for Rh Negative - Abx if sepsis or suspect retained POC - D and C if retained POC's - F/you with OB GYN in 48 hours - monitor HCG is trending down - Return for worsening sxs
ED treatment of a Miscarriage
ED Tx of GIB
Breathing
Stable vs unstable angina`
48. Look for ST elevation in at least 2 contiguous lead (at least 1mm) - may see a new LBBB - Reciprocal changes - T wave inversion (end of the infarct or old) - Q waves (old infarct)
ED workup of kidney stones
When to do a pelvic exam
EKG changes
Dx of Aortic dissection
49. Rare STI - increaseing now - due to AIDs - S/S - rash or chancre - serologic testing of blood or CSF - TxL Benzathine penicillin or Doxy x 2 weeks
Defibrillation
Syphillis
ED treatment of a Miscarriage
CHF
50. Renal colic - due to passing of a stone thru the ureter (don't cause pain in the kidney - asymptomatic) - pain due to ureteral spasm and obstruction of urine M: F - 3: 1 prevalence - Stones smaller than 5 mm have 90% chance of passing alone
CHF
Early miscarriage (20 weeks)
Ascending Cholangitis
Kidney Stones
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