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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. V1-V3 - V2-V4 Means LAD (left anterior descending) involved
Stable vs. Unstable Ectopic Pregnancy
Anteroseptal leads and Anterior
STEMI vs Nstemi
Endocarditis
2. 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
Divertriculitis
The vital signs
Cardiac Enzymes
3. LAD - Left Anterior Descending Artery (anterior) - Diagonal branch of LAD (anterior) - Left Circumflex artery (posterior) - Obtuse Marginal Artery
UTI
Supplemental O2
ED Tx of GIB
Other major arteries
4. 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
Additional cardiac Tests
Syphillis
DUKE criteria for endocarditis
Advanced airway techniques
5. 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
Symptoms of Ruptured ovarian cysts
ED treatment for Ectopic Pregnancy
Kidney Stones
Common Presentation of GIB
6. 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
Acute Coronary syndrome
How to assess Airway
Incomplete abortion
What is a large bore IV?
7. Old age - chronic anticoagulation - divertriculosis
Inferior leads
The vital signs
Common risk factors for LGIB
Tachycardia
8. 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
Ranson's criteria
Ectopic Pregnancy
Ovarian Cysts
Additional cardiac Tests
9. Start IVF resuscitaiton - IV access or IO as second option - Thready pulses indicate hypotension and poor perfusion - Check frequent BP to reassess
What to do with weak/thready pulses
ED Tx of GIB
Acute Arterial occlusion - to lower extremities
Common risk factors for LGIB
10. Infection/bacterial overgrowth of particles in divertricula - risk factors: old age - low fiber diet - chronic constipation - - Mostly occurs in sigmoid colon - Dx: CBC - chem 7 - LFT's - Lipase/Amylase - UA - HCG - Abd CT scan - Can do KUb if suspe
Divertriculitis
Types of Infectious diarrhea E coli
What should be done after CDAB's
Abdominal Aortic Aneurysm
11. Abd pain: varies - achy - burning - Melena: dark - tarry stool (UGIB) - Hematemesis - vomiting blood - Hematochezia - BRBPR - Hypotension - tachycardia - Pallor - Guaiac + rectal exam
Common Presentation of GIB
What is a large bore IV?
Ranson's criteria
EKG changes
12. 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
EKG changes
Abdominal Aortic Aneurysm
ED workup of kidney stones
Types of Infectious diarrhea E coli
13. 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
Types of Infectious diarrhea - Salmonella
Define Acute Cholecystitis
Acute Mesenteric Ishemia
UTI
14. 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
Ascending Cholangitis
How to monitor CDAB
EMTALA
ED work up for cholecystitis
15. 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
Pain scale for infants
Emergency Severity Index
Initial steps in stabilizing a patient
Testicular Torsion
16. 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
When to do a pelvic exam
DUKE criteria for endocarditis
Incomplete abortion
Aortic Dissection definition - risks and S/S
17. 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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18. 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
Pericarditis
Incomplete abortion
Placenta Previa
Gonorrhea
19. Especially O157: H7 causes enterohemorrhagic diarrhea. Inundercooked beef - complicated by hemolytic uremic syndrome and TTP
Types of Infectious diarrhea E coli
Placental Abruption
Causes of 3rd trimester bleeding
Appendicitis
20. Incarcerated - means cannot reduce - Strangulated - bowel edema is compromosing blood flow
Dx of Aortic dissection
Additional cardiac Tests
Incarcerated vs strangulated hernias
Stable vs unstable angina`
21. STEMI - due to complete arterial occlusion NSTEMI - ARTERY NOT completely blocked or have collateral vessels
RCA
Divertriculitis
STEMI vs Nstemi
What should be done after CDAB's
22. 'trier' - to separate - sift or select based on priority of condition
Genital Herpes
Triage
Early miscarriage (20 weeks)
Stable vs. Unstable Ectopic Pregnancy
23. 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? -
GIB work up
Testicular Torsion
Lateral Leads
Tx of Unstable Angina
24. CXR - may see cardiomegaly - consolidation or effusions - Echo - look at wall motion - anuersysm - pericardial effusion - LV thrombus - Stress EcHO - CT Angiogram for Pulmonary Embolism!!!! (need good kidneys for dye) - can also do a spiral CT
Triage
Pancreatitis work up
Acute Mesenteric Ishemia
Additional cardiac Tests
25. V1-V2 Right Posterior Descending Artery
UTI
LBO - Large bowel obstruction
Posterior
Types of Infectious diarrhea Campylobacter
26. 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
Ectopic Pregnancy
Advanced airway techniques
Define Acute Cholecystitis
Types of Infectious diarrhea Campylobacter
27. Explosive - frothy and foul smellng diarrhea - Entamoeba hystlytica - crypto - isospora (HIV)
Where to check pulses
ED work up for cholecystitis
How to monitor CDAB
Types of Infectious diarrhea Protozo -Giardia (dirty water sources)
28. RUQ/epigastric pain - lasts 30 min to 6 hours - once gallbladder contracts and it relieves the obstruction - pain resolves - NO Fever
GIB work up
Ranson's criteria
DUKE criteria for endocarditis
Define Biliary colic
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
Other major arteries
Supplemental O2
The vital signs
STEMI vs Nstemi
30. 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
GIB work up
Other major arteries
Chlamydia
What should be done after CDAB's
31. 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)
Incomplete abortion
Types of Infectious diarrhea Shigella
What to do with weak/thready pulses
When is Rho GAM used
32. Coffee bean signs on KUB for sigmoid volvulus - can also have cecal volvulus - 10% of LBO are sigmoid volvulus
Supplemental O2
LBO - Large bowel obstruction
Common risk factors for LGIB
Volvulus
33. Right Coronary artery - SA node branch (anterior) - Acute marginal artery (anterior) - AV node branch (posterior) - Posterior descending artery (posterior)
RCA
Define Biliary colic
Volvulus
LBO - Large bowel obstruction
34. 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
What to do with weak/thready pulses
When to do a pelvic exam
ED work up for cholecystitis
Types of Infectious diarrhea Campylobacter
35. LMA: Laryngeal Mask Airway - Cricothyroidotomy -surgical airway done as last resort when unable to maintain oxygenation with other methods
Advanced airway techniques
Pain scale for infants
Contraindications for thrombolytics
How to assess Airway
36. Due to HSV-1 S/S: painful vesicles after 1-2 weeks of exposure - HA - fever - dysuria - myalgias. First outbreak lasts 2-3 weeks - likely to recur DxL PCR from vesicular fluid Tx: Acyclovir 400 mg po TID x 2 weeks or Valacyclovir x 10 days. Most pat
SBO
Genital Herpes
UTI
Types of GI bleeds
37. Chinese food bug - Fever - abdo pain - blood diarrhea - lasts x 1 week.Get from dirty wateror poultry - may cause/trigger Guillan Barre
Types of Infectious diarrhea Campylobacter
Endocarditis
Bradycardia
ED work up for cholecystitis
38. Gram negative - bad eggs - dairy - poultry. - S/S: bloody diarrhea - fever - abd pain - Resolves in 10-14 days.
Kidney Stones
ED work up for cholecystitis
Early miscarriage (20 weeks)
Types of Infectious diarrhea - Salmonella
39. 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
Viral Gastroenteritis
How to monitor CDAB
DUKE criteria for endocarditis
Ovarian Torsion
40. 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
Tachycardia
CHF
Cardiac Tamponade
Missed Abortion
41. 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
Types of GI bleeds
UTI
DUKE criteria for endocarditis
What to do with weak/thready pulses
42. 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
Tx of CHF
Kidney Stones
What should be done after CDAB's
Posterior
43. 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:
Ectopic Pregnancy
Ovarian Torsion
Dx of Aortic dissection
Incidence of AMI
44. life threatening pericardial effusion -S/S: muffled heart sounds - JVD - hypotension - pulsus paradoxus - Water bottle heart on CXR - ellarged heart Tx: peicardiocentesis
Pancreatitis work up
RCA
Cardiac Tamponade
Missed Abortion
45. O2 - 2 large bore IV's: IVF with crystalloid (NS or LR) - type and screen crossmatch - transfuse prn - OB GYN cx ASAP
Common risk factors for LGIB
Ovarian Torsion
ED treatment for Ectopic Pregnancy
SBO
46. Chronic anticoagulation - Coumadin - Pradaxa/Dabigatran (no meds to reverse it) - Lovenox - ESLD / alcoholism (lack clotting factors) - NSAIDS (increase risk PUD and blood thinning) - Smoking
Missed Abortion
Causes of 3rd trimester bleeding
Common risk factors for UGIB
Types of GI bleeds
47. 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
Types of Infectious diarrhea - Salmonella
EMTALA
Ascending Cholangitis
Dx of Aortic dissection
48. 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
Initial steps in stabilizing a patient
Testicular Torsion
Common Presentation of GIB
How to monitor CDAB
49. 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
Ovarian Torsion
Ectopic Pregnancy
GIB work up
How to monitor CDAB
50. 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)
Appendicitis work up
DUKE criteria for endocarditis
Hypertensive Emergency
Placental Abruption
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