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Test your basic knowledge |
Emergency Medicine
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Subjects
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health-sciences
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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. 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
Cardiac Tamponade
Types of Infectious diarrhea E coli
GIB work up
What is a large bore IV?
2. Gram negative - bad eggs - dairy - poultry. - S/S: bloody diarrhea - fever - abd pain - Resolves in 10-14 days.
Lateral Leads
Types of Infectious diarrhea - Salmonella
Types of Infectious diarrhea Shigella
Incarcerated vs strangulated hernias
3. 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
Stable vs unstable angina`
Acute Mesenteric Ishemia
ED work up for cholecystitis
Hypertensive Emergency
4. LAD - Left Anterior Descending Artery (anterior) - Diagonal branch of LAD (anterior) - Left Circumflex artery (posterior) - Obtuse Marginal Artery
GIB work up
Posterior
Other major arteries
What is a large bore IV?
5. 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
Tx of Unstable Angina
Chlamydia
Where to check pulses
Hypertensive Emergency
6. Most due to E coli - Lower UTI - bladder and /or urethra - Upper UTI: bladder - urethra and kidneys (so ureters to) S/S: dysuria - urgency and frequency - may be asymptomatic in prego - elderly and immunosuppressed - may see confusion or AMS Tx: Uri
Early miscarriage (20 weeks)
Cardiac Enzymes
UTI
Miscarriage
7. 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
Incomplete abortion
Gonorrhea
Chlamydia
8. 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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9. Gram negative - contaminated salads (mayo) - dairy - mean. Severe Dysentery (bloody diarrhea)'
LCA
Types of Infectious diarrhea Shigella
Other major arteries
Initial steps in stabilizing a patient
10. 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
Bradycardia
Abdominal Aortic Aneurysm
Common risk factors for LGIB
Missed Abortion
11. Obstruction of appendiceal lumen (fecalith) - leads to edema - ischemia - infection - necrosis - ? perf and peritonitis - +Rosvig's sign (push and feel on opposite side)
How to assess Airway
Appendicitis
Defibrillation
Ascending Cholangitis
12. For any chest pain due to COCAINE USE!!! (because cocaine makes the arteries spasm)
Endocarditis
Contraindications for thrombolytics
When are Beta Blockers contraindicated
Missed Abortion
13. Fluid filled sacs within the ovary - Common in infancy and teens - Causes: ovarian stimulation (in vitro fertilization) - hypothyroid - prego - PCOS
EKG changes
SBO
Defibrillation
Ovarian Cysts
14. Spontaneous abortion - Never CALL IT ABORTION IN FRONT OF PATIENT
Acute Mesenteric Ishemia
Miscarriage
Appendicitis
Types of GI bleeds
15. 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
LBO - Large bowel obstruction
LCA
ED work up for cholecystitis
16. Chronic anticoagulation - Coumadin - Pradaxa/Dabigatran (no meds to reverse it) - Lovenox - ESLD / alcoholism (lack clotting factors) - NSAIDS (increase risk PUD and blood thinning) - Smoking
Tachycardia
Common risk factors for UGIB
Additional cardiac Tests
Breathing
17. 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
SBO
Urosepsis
RCA
ED treatment for Ectopic Pregnancy
18. S/S - PAIN OUT OF PROPORTION TO ABDOMINAL EXAM - benign compared to pain - At risk patients: elderly - vasculopaths - patients with afib - patients in cardiogenic shock/cardiopulm bypass or on high dose pressors - most occur in SMA (ie intracardiac e
Dx of Aortic dissection
Emergency Severity Index
Acute Mesenteric Ishemia
Symptoms of Ruptured ovarian cysts
19. 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 -
Placenta Previa
Acute Arterial occlusion - to lower extremities
ED work up for cholecystitis
Placental Abruption
20. 'trier' - to separate - sift or select based on priority of condition
Triage
Kidney Stones
Posterior
What to do with weak/thready pulses
21. 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
Placental Abruption
Symptoms of Ruptured ovarian cysts
Breathing
Dx of Aortic dissection
22. 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
LBO - Large bowel obstruction
Breathing
Define Acute Cholecystitis
Stable vs unstable angina`
23. 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
Acute Arterial occlusion - to lower extremities
UTI
LCA
Emergency Severity Index
24. Common STI- S/S: skin pustules - fever - monarticular septic arthritis. - may be asymptomatic in females - or cervicitis - PID Males: epididimytis - urethritis - prostatitis Dx: cervical or urethral culture swab Tx: Ceftriaxone IM x 1or Cefixime 4
Gonorrhea
Common risk factors for UGIB
Types of Infectious diarrhea E coli
Miscarriage
25. Leads I - aVL - V4-V6 - Left circumflex artery
Tx of Unstable Angina
Dx of Aortic dissection
Stable vs unstable angina`
Lateral Leads
26. 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
Incarcerated vs strangulated hernias
EMTALA
Types of Infectious diarrhea Shigella
27. Chinese food bug - Fever - abdo pain - blood diarrhea - lasts x 1 week.Get from dirty wateror poultry - may cause/trigger Guillan Barre
Bradycardia
Stable vs. Unstable Ectopic Pregnancy
Where to check pulses
Types of Infectious diarrhea Campylobacter
28. 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:
Hypertensive Emergency
Causes of 3rd trimester bleeding
Chlamydia
Ovarian Torsion
29. All cardiac arrest patients get 100% O2 - Room air= 21% - Nasal cannula O2 - raises FiO2 by 2-3% per liter. Normally give 1-6 Liters/minute - Non-rebreather mask --> you are receiving 100% O2
Abdominal Aortic Aneurysm
Supplemental O2
ED Tx of GIB
Ectopic Pregnancy
30. 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
Types of Infectious diarrhea - Salmonella
Ranson's criteria
Define Biliary colic
Tachycardia
31. 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 work up
Chlamydia
When to do a pelvic exam
Incidence of AMI
32. 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
ED workup of kidney stones
Appendicitis
Syphillis
Hypertensive Emergency
33. 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 - Salmonella
Appendicitis work up
Types of Infectious diarrhea E coli
Syphillis
34. 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
Causes of 3rd trimester bleeding
Urosepsis
Types of Infectious diarrhea Campylobacter
35. 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)
Defibrillation
Tachycardia
Cardiac Enzymes
Aortic Dissection definition - risks and S/S
36. On ANY FEMALE WITH ABDOMINAL PAIN- including bimanual vagino-rectal exam
Types of Infectious diarrhea E coli
When to do a pelvic exam
Ranson's criteria
ED treatment of a Miscarriage
37. Left coronary artery (short and branches quickly)
LCA
Bradycardia
Contraindications for thrombolytics
Tx of Unstable Angina
38. 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
Chlamydia
Dx of Aortic dissection
Types of GI bleeds
ED workup of kidney stones
39. 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
Aortic Dissection definition - risks and S/S
Lateral Leads
CHF
Ranson's criteria
40. 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
Types of Infectious diarrhea E coli
Emergency Severity Index
Missed Abortion
Testicular Torsion
41. Same as Early miscarriage - os open - bleeding - but some POC's (prod of conception) expelled. TX: D & C Complete AB: same as miscariage - but OS closed and all POC's expelled
Inferior leads
Incomplete abortion
Symptoms of Ruptured ovarian cysts
Abdominal Aortic Aneurysm
42. 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
How to assess Airway
Symptoms of Ruptured ovarian cysts
Ovarian Torsion
Ovarian Cysts
43. 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
ED work up for cholecystitis
CHF
What to do with weak/thready pulses
44. 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
Pancreatitis work up
Gonorrhea
Inferior leads
Cardiac Tamponade
45. STEMI - due to complete arterial occlusion NSTEMI - ARTERY NOT completely blocked or have collateral vessels
Types of GI bleeds
What should be done after CDAB's
Tachycardia
STEMI vs Nstemi
46. MONA - morphine - oxygen - nitroglycerin (sublingual or IV) -Aspirin 325 mg (consider Integrilin in high risk patients) - Beta Blocker (metoprolol) - decrease streght of heart contractility within first hour - Cardiology cx --> PCI vs surgery prn? -
What to do with weak/thready pulses
STEMI vs Nstemi
Types of Infectious diarrhea Shigella
Tx of Unstable Angina
47. 16-18 Gauge
Common risk factors for UGIB
Tx of CHF
Breathing
What is a large bore IV?
48. 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
Syphillis
Urosepsis
Inferior leads
49. Infection of endocardium and/or heart valves due to Strep bacteria (viridans or aureus) and HACEK species - Risk factors: IVDU - structural heart abomality - prosthetic valve - rheumatic heart dz - HIV Tx: IV antibioticx x 4 weeks
Common risk factors for LGIB
Dx of Aortic dissection
Breathing
Endocarditis
50. O2 and monitor sats - 2 large bore IV's (min 18G) - w/ Normal saline orLR -Blood transfusion prn - give PRBC - 1 unit of PRBC raises Hcrt 3 points - goal is HCRT > 30 - Hold coumadin if INR 5 or less OR reverse with Vit K or Free Frozen plasma if INR
DUKE criteria for endocarditis
ED Tx of GIB
Miscarriage
Pericarditis
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