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Test your basic knowledge |
Emergency Medicine
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Study First
Subjects
:
health-sciences
,
emergency-medicine
Instructions:
Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can
study here
.
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. Directly invades the intestine - s/s abd pain - watery or bloody diarrhea - vomiting
Ectopic Pregnancy
Ovarian Cysts
Types of Infectious diarrhea Yersinia
ED workup of kidney stones
2. 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)
EKG changes
ED work up for cholecystitis
LCA
What is a large bore IV?
3. 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
Appendicitis work up
ED treatment of a Miscarriage
What to do with weak/thready pulses
Acute Mesenteric Ishemia
4. 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
When is Rho GAM used
Breathing
Common Presentation of GIB
EMTALA
5. Prolonged/ more severe angina that doens't resolve with rest - 50% triggered by event: stress - exercise - surgery - illness - More common in early am - substernal pain elephant in chest - crushing - heavy +/- radiation to left arm - jaw - neck - may
Incidence of AMI
Aortic Dissection definition - risks and S/S
Defibrillation
When is Rho GAM used
6. Chronic anticoagulation - Coumadin - Pradaxa/Dabigatran (no meds to reverse it) - Lovenox - ESLD / alcoholism (lack clotting factors) - NSAIDS (increase risk PUD and blood thinning) - Smoking
Ascending Cholangitis
ED work up for cholecystitis
Common risk factors for UGIB
ED treatment for Ectopic Pregnancy
7. RUQ/epigastric pain - lasts 30 min to 6 hours - once gallbladder contracts and it relieves the obstruction - pain resolves - NO Fever
Acute Mesenteric Ishemia
Define Biliary colic
Early miscarriage (20 weeks)
Placental Abruption
8. 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
Hypertensive Emergency
Types of Infectious diarrhea Protozo -Giardia (dirty water sources)
Incarcerated vs strangulated hernias
Stable vs. Unstable Ectopic Pregnancy
9. Cysts rupture and cause pelvic bleeding --> peritonitis --> hypotension --> shock S/S: unilateral sharp - lower abd pain - work up: IVF w. crystalloids - - O2 prn - CBC - chem 7 - HCG - UA - ABO/Rh - PT/PTT - Pelvic ultrasound with color doppler fl
How to assess Airway
ED Tx of GIB
Contraindications for thrombolytics
Symptoms of Ruptured ovarian cysts
10. 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
Ranson's criteria
Incomplete abortion
How to monitor CDAB
EMTALA
11. Stable - predictible pattern of chest pain w/ exertion or stress. Relieved by rest or Nitro. Lasts 15 sec to 15 min UNSTABLE - any change in character or time of the angina - ANGINA AT REST - NEW ONSET - ANGINA MORE FREQUENT OR SEVERE. - Unstable a
Types of GI bleeds
Stable vs unstable angina`
When is Rho GAM used
Where to check pulses
12. 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
Endocarditis
When to do a pelvic exam
Hypertensive Emergency
Causes of 3rd trimester bleeding
13. 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 -
What should be done after CDAB's
Define Acute Cholecystitis
When is Rho GAM used
Placental Abruption
14. 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
Syphillis
The vital signs
Abdominal Aortic Aneurysm
Causes of 3rd trimester bleeding
15. 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
Advanced airway techniques
Bradycardia
Ascending Cholangitis
Appendicitis
16. 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
Tx of CHF
Early miscarriage (20 weeks)
Define Biliary colic
Emergency Severity Index
17. Rectal exam for EVERYONE with belly pain - EKG (don't want to r/o MI) - Labs: CBC - chem 7 - PTT - blood type and screen/cross (in case need blood transfusion) - H Pylori: Rapid urease test or IgG / IgM - Endoscopy for UGIB (can be done in ED) - Colo
Emergency Severity Index
Symptoms of Ruptured ovarian cysts
SBO
GIB work up
18. life threatening pericardial effusion -S/S: muffled heart sounds - JVD - hypotension - pulsus paradoxus - Water bottle heart on CXR - ellarged heart Tx: peicardiocentesis
Supplemental O2
When is Rho GAM used
Cardiac Tamponade
Breathing
19. FLACC Face - legs - activity - cry - consolability (0 - 1 - 2)
Posterior
EKG changes
Pain scale for infants
Tachycardia
20. LMA: Laryngeal Mask Airway - Cricothyroidotomy -surgical airway done as last resort when unable to maintain oxygenation with other methods
Advanced airway techniques
EKG changes
STEMI vs Nstemi
Causes of 3rd trimester bleeding
21. IVF w crystalloid CBC - chem 7 - LFT's - lipase - UA - urine cx - HCG - Abdominal/pelvis CT with NO CONTRAST (if suspect a stone) - Ultrasound is an alternative - will show hydronephrosis - Pain control - Dilaudid 1 mg IV - Toradol 30 mg IV (caution
Incidence of AMI
ED treatment of a Miscarriage
ED workup of kidney stones
Appendicitis work up
22. Abnormal dilatation of the arterial wall - most common in abdominal area below renal arteries - risk factors; atherosclerosis - age - HTN - smoking - connective tissue dz - fam hx - hyperlipidemia - DM - S/S : often ASYMPTOMATIC - dull abd or back pa
When is Rho GAM used
LBO - Large bowel obstruction
Acute Coronary syndrome
Abdominal Aortic Aneurysm
23. Fluid filled sacs within the ovary - Common in infancy and teens - Causes: ovarian stimulation (in vitro fertilization) - hypothyroid - prego - PCOS
Ovarian Torsion
UTI
Genital Herpes
Ovarian Cysts
24. Coffee bean signs on KUB for sigmoid volvulus - can also have cecal volvulus - 10% of LBO are sigmoid volvulus
LBO - Large bowel obstruction
ED Tx of GIB
Aortic Dissection definition - risks and S/S
What to do with weak/thready pulses
25. 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
Ranson's criteria
Tx of CHF
What should be done after CDAB's
Miscarriage
26. No bleeding - no fetal cardiac activity - uterus small - os closed - retained fetal tissue - Tx: D and C - Can have sepsis due to retained tissue/ fetus. Treat with IV abx (ampicillin and gentamycin) - Can give Misoprostol and cytotec (to dilate cerv
Tx of Unstable Angina
Missed Abortion
Contraindications for thrombolytics
Other major arteries
27. U GIB - ** DARK STOOLS - above the ligament of Treitz: Esophageal varices - Dieulafoy lesion - PUD - Mallory Weiss Tear - LGIB: ** BRight red blood - below lig of Treitz AVM (Atrio-venous malformation) -Divertriculitis - Meckel's divertriculum - colo
Placenta Previa
Contraindications for thrombolytics
Common risk factors for LGIB
Types of GI bleeds
28. O2 - 2 large bore IV's: IVF with crystalloid (NS or LR) - type and screen crossmatch - transfuse prn - OB GYN cx ASAP
Early miscarriage (20 weeks)
ED treatment for Ectopic Pregnancy
Lateral Leads
Contraindications for thrombolytics
29. 16-18 Gauge
Viral Gastroenteritis
Hypertensive Emergency
What is a large bore IV?
ED treatment of a Miscarriage
30. Right Coronary artery - SA node branch (anterior) - Acute marginal artery (anterior) - AV node branch (posterior) - Posterior descending artery (posterior)
Types of Infectious diarrhea Yersinia
Cardiac Enzymes
RCA
ED treatment of a Miscarriage
31. 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
RCA
EMTALA
Volvulus
CHF
32. At presentation: Age > 55 - WBC > 16 K - Glucose > 200 - LDH > 350 - AST > 250 At 48 hours - fall in HCT > 10 - increase in BUN > 5 - Ca < 8 - PaO2 < 60 - fluid deficit > 6 L
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33. Shock to electrically terminate abnormal heart rate and restart. - The earlier a fibrillating heart is defibrillated - the more successful (survival drops by 10% with each minute)
Common risk factors for LGIB
Defibrillation
Types of Infectious diarrhea Campylobacter
Kidney Stones
34. Start IVF resuscitaiton - IV access or IO as second option - Thready pulses indicate hypotension and poor perfusion - Check frequent BP to reassess
Advanced airway techniques
Common risk factors for UGIB
What to do with weak/thready pulses
Missed Abortion
35. 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
Common risk factors for LGIB
Ovarian Cysts
SBO
36. Placenta previa - vaginal/cervical trauma - polyps - genital infections - hemorrhoids - onset of labor (no fetal distress) - placental abruption (have fetal distress)
Causes of 3rd trimester bleeding
ED treatment of a Miscarriage
Lateral Leads
Acute Mesenteric Ishemia
37. Spontaneous abortion - Never CALL IT ABORTION IN FRONT OF PATIENT
What should be done after CDAB's
Define Acute Cholecystitis
Types of Infectious diarrhea Protozo -Giardia (dirty water sources)
Miscarriage
38. Abd pain: varies - achy - burning - Melena: dark - tarry stool (UGIB) - Hematemesis - vomiting blood - Hematochezia - BRBPR - Hypotension - tachycardia - Pallor - Guaiac + rectal exam
Placenta Previa
How to monitor CDAB
Common Presentation of GIB
Cardiac Tamponade
39. Left coronary artery (short and branches quickly)
LCA
Missed Abortion
ED workup of kidney stones
Ranson's criteria
40. School/work outbreak - Common viruses: rotavirus - norwalk - adenovirus - astrovirus - last 24 to 48 hours - ALWAYS DX as VOMITING AND DIARRHEA - never use the term viral gastroenteritis (CYA medicine) Tx: CBC - chem 7 - LFT's - lIpase - UA - general
When are Beta Blockers contraindicated
LBO - Large bowel obstruction
Viral Gastroenteritis
Abdominal Aortic Aneurysm
41. Ovary torsion causes venous and arterial obstruction leading to ischemia and obstruction - At risk: long fallopian tubes - pregnancy - enlarged ovaries - ovarian tumors - tubal surgery - large ovarian cysts **anything that enlarges the ovary! - S/S:
EKG changes
Ovarian Torsion
Types of Infectious diarrhea Campylobacter
Viral Gastroenteritis
42. Leads I - aVL - V4-V6 - Left circumflex artery
When are Beta Blockers contraindicated
RCA
Lateral Leads
Triage
43. 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 Enzymes
Emergency Severity Index
How to assess Airway
Ranson's criteria
44. STEMI - due to complete arterial occlusion NSTEMI - ARTERY NOT completely blocked or have collateral vessels
Incomplete abortion
STEMI vs Nstemi
Appendicitis
Emergency Severity Index
45. 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
Emergency Severity Index
Advanced airway techniques
Supplemental O2
46. 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
Pericarditis
Types of Infectious diarrhea Yersinia
CHF
Defibrillation
47. Categorize based on severity: 1 to 5 1 - most severe: cyanotic/not breathing - unreseponsive or not talking 2 - MI (life threatening but talking) 3- appendicitis/ abdomino pelvic pain 4- ankle swelling - broken leg 5- suture removal Things you ca
Emergency Severity Index
Define Acute Cholecystitis
Types of Infectious diarrhea Protozo -Giardia (dirty water sources)
Types of Infectious diarrhea Shigella
48. Causes: Alcohol - gallstones - high triglycerides - hypercalcemia - drugs - mumps - trauma Tx: CBC - chem 7 - LFT's - amylase - lipase - EKG Ultrasound CT scan IVF - IVF - IVF!!! NPO Pain control - anti emetics
Posterior
Define Acute Cholecystitis
Pancreatitis work up
Acute Mesenteric Ishemia
49. IV fluids - monitor Bp - EKG prn - CBC - chem 7 - LFT's - Lipase - UA - HCG - Ultrasound of gallbladder - Surgical cx - CCY in 24-48 hours - Broad spectrum Abx (Unasyn or Levaquin) - Pain control (morphine or dilaudid) - don't use Toradol (NSAID) - N
ED work up for cholecystitis
Lateral Leads
Divertriculitis
Types of Infectious diarrhea E coli
50. 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
Defibrillation
Triage
Ovarian Torsion
Tachycardia