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Test your basic knowledge |
Emergency Medicine
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Subjects
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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. Often embolic phenomenon triggered by afib or endocarditis - 6 P's: Pain - pallor - paralysis - paresthesias - poikilothermia - pulselessness - DX: dopplers with ABI - ankle brachial index
ED treatment of a Miscarriage
Define Acute Cholecystitis
Ovarian Cysts
Acute Arterial occlusion - to lower extremities
2. 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
Anteroseptal leads and Anterior
Tx of Unstable Angina
Ovarian Torsion
Stable vs. Unstable Ectopic Pregnancy
3. 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
EMTALA
Gonorrhea
Chlamydia
Ovarian Torsion
4. 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
Types of Infectious diarrhea Protozo -Giardia (dirty water sources)
Cardiac Enzymes
Initial steps in stabilizing a patient
Stable vs unstable angina`
5. V1-V3 - V2-V4 Means LAD (left anterior descending) involved
Cardiac Tamponade
Testicular Torsion
Gonorrhea
Anteroseptal leads and Anterior
6. Obstruction of appendiceal lumen (fecalith) - leads to edema - ischemia - infection - necrosis - ? perf and peritonitis - +Rosvig's sign (push and feel on opposite side)
Appendicitis
Incarcerated vs strangulated hernias
Tx of CHF
Pain scale for infants
7. RUQ/epigastric pain - lasts 30 min to 6 hours - once gallbladder contracts and it relieves the obstruction - pain resolves - NO Fever
When is Rho GAM used
Define Biliary colic
Divertriculitis
Where to check pulses
8. 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
Tx of Unstable Angina
Incidence of AMI
Divertriculitis
ED work up for cholecystitis
9. 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 -
Advanced airway techniques
Placental Abruption
Types of Infectious diarrhea E coli
The vital signs
10. 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)
Cardiac Tamponade
Symptoms of Ruptured ovarian cysts
Define Biliary colic
EKG changes
11. 16-18 Gauge
Gonorrhea
Incidence of AMI
What is a large bore IV?
Divertriculitis
12. 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
RCA
Appendicitis work up
Contraindications for thrombolytics
Incomplete abortion
13. Start IVF resuscitaiton - IV access or IO as second option - Thready pulses indicate hypotension and poor perfusion - Check frequent BP to reassess
Breathing
What to do with weak/thready pulses
EKG changes
Common risk factors for LGIB
14. 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
Urosepsis
Incomplete abortion
Symptoms of Ruptured ovarian cysts
GIB work up
15. 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)
Testicular Torsion
Anteroseptal leads and Anterior
Other major arteries
Defibrillation
16. Especially O157: H7 causes enterohemorrhagic diarrhea. Inundercooked beef - complicated by hemolytic uremic syndrome and TTP
What to do with weak/thready pulses
Types of Infectious diarrhea E coli
ED treatment for Ectopic Pregnancy
ED treatment of a Miscarriage
17. 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
DUKE criteria for endocarditis
Types of GI bleeds
Supplemental O2
18. Left coronary artery (short and branches quickly)
Placenta Previa
Acute Arterial occlusion - to lower extremities
Ascending Cholangitis
LCA
19. Coffee bean signs on KUB for sigmoid volvulus - can also have cecal volvulus - 10% of LBO are sigmoid volvulus
Contraindications for thrombolytics
LBO - Large bowel obstruction
When to do a pelvic exam
Syphillis
20. 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
Defibrillation
Posterior
Stable vs unstable angina`
Types of Infectious diarrhea Shigella
21. 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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22. 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
Triage
Defibrillation
Breathing
Divertriculitis
23. 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
Types of Infectious diarrhea - Salmonella
How to monitor CDAB
ED Tx of GIB
Dx of Aortic dissection
24. 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
Chlamydia
SBO
Acute Arterial occlusion - to lower extremities
25. LMA: Laryngeal Mask Airway - Cricothyroidotomy -surgical airway done as last resort when unable to maintain oxygenation with other methods
Ranson's criteria
Abdominal Aortic Aneurysm
Define Biliary colic
Advanced airway techniques
26. Common complication after an AMI - S/S: edema - elevated JVP - hepatojugular reflux - pulm rales - rhochi - decrease BS - +/- cardiac murmurs - low O2 sat - elevated BNP
LBO - Large bowel obstruction
Appendicitis
CHF
What to do with weak/thready pulses
27. 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
Urosepsis
Hypertensive Emergency
EMTALA
ED work up for cholecystitis
28. 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
Genital Herpes
Cardiac Enzymes
UTI
Bradycardia
29. 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
Ranson's criteria
Types of Infectious diarrhea E coli
Common Presentation of GIB
Hypertensive Emergency
30. 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
Stable vs. Unstable Ectopic Pregnancy
Additional cardiac Tests
When are Beta Blockers contraindicated
Supplemental O2
31. 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
Lateral Leads
Common risk factors for UGIB
Aortic Dissection definition - risks and S/S
Kidney Stones
32. 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
Types of Infectious diarrhea E coli
Contraindications for thrombolytics
How to assess Airway
The vital signs
33. 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
Stable vs. Unstable Ectopic Pregnancy
Kidney Stones
The vital signs
Incarcerated vs strangulated hernias
34. 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
Anteroseptal leads and Anterior
Pericarditis
Ascending Cholangitis
Incomplete abortion
35. 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
How to assess Airway
Contraindications for thrombolytics
Pericarditis
Ovarian Torsion
36. 'trier' - to separate - sift or select based on priority of condition
Acute Mesenteric Ishemia
Cardiac Tamponade
Triage
STEMI vs Nstemi
37. Accounts for 20% o all 3rd trimester bleeding - Placenta overlaps with the cervix near the os (complete - partial - vaginal -low lying) - S/s: bright red vaginal bleeding - painless - NO NOT PERFORM VAGINAL DIGITAL EXAM - risk factors: prior c sect
Dx of Aortic dissection
Placenta Previa
Emergency Severity Index
Incidence of AMI
38. 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
GIB work up
Endocarditis
Acute Coronary syndrome
Incidence of AMI
39. 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
UTI
Symptoms of Ruptured ovarian cysts
Volvulus
LCA
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
Ovarian Cysts
CHF
Testicular Torsion
Common risk factors for LGIB
41. Incarcerated - means cannot reduce - Strangulated - bowel edema is compromosing blood flow
Incarcerated vs strangulated hernias
Common Presentation of GIB
Additional cardiac Tests
Incomplete abortion
42. 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
Incarcerated vs strangulated hernias
EMTALA
ED treatment of a Miscarriage
Early miscarriage (20 weeks)
43. 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)
Bradycardia
Pancreatitis work up
ED treatment for Ectopic Pregnancy
CHF
44. Sepsis due to urologic infection - common in elderly - 2 large bore IV - crystalloid IVF - Blood cultures - IV antibiotics - hosptial admission
Ectopic Pregnancy
Kidney Stones
Types of Infectious diarrhea Protozo -Giardia (dirty water sources)
Urosepsis
45. Chronic anticoagulation - Coumadin - Pradaxa/Dabigatran (no meds to reverse it) - Lovenox - ESLD / alcoholism (lack clotting factors) - NSAIDS (increase risk PUD and blood thinning) - Smoking
Define Acute Cholecystitis
Common risk factors for UGIB
How to monitor CDAB
Tx of Unstable Angina
46. 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
Lateral Leads
When are Beta Blockers contraindicated
Early miscarriage (20 weeks)
Ectopic Pregnancy
47. 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
Chlamydia
Define Biliary colic
Testicular Torsion
48. 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
Where to check pulses
Types of Infectious diarrhea - Salmonella
Other major arteries
Abdominal Aortic Aneurysm
49. LAD - Left Anterior Descending Artery (anterior) - Diagonal branch of LAD (anterior) - Left Circumflex artery (posterior) - Obtuse Marginal Artery
Other major arteries
CHF
Bradycardia
EKG changes
50. Check Vital Signs
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