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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. RUQ/epigastric pain - lasts 30 min to 6 hours - once gallbladder contracts and it relieves the obstruction - pain resolves - NO Fever






2. 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






3. 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)






4. 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






5. 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






6. 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)






7. 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






8. Spontaneous abortion - Never CALL IT ABORTION IN FRONT OF PATIENT






9. 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






10. Placenta previa - vaginal/cervical trauma - polyps - genital infections - hemorrhoids - onset of labor (no fetal distress) - placental abruption (have fetal distress)






11. Obstruction of appendiceal lumen (fecalith) - leads to edema - ischemia - infection - necrosis - ? perf and peritonitis - +Rosvig's sign (push and feel on opposite side)






12. 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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13. LAD - Left Anterior Descending Artery (anterior) - Diagonal branch of LAD (anterior) - Left Circumflex artery (posterior) - Obtuse Marginal Artery






14. Gram negative - contaminated salads (mayo) - dairy - mean. Severe Dysentery (bloody diarrhea)'






15. V1-V3 - V2-V4 Means LAD (left anterior descending) involved






16. O2 - 2 large bore IV's: IVF with crystalloid (NS or LR) - type and screen crossmatch - transfuse prn - OB GYN cx ASAP






17. 'trier' - to separate - sift or select based on priority of condition






18. 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






19. 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






20. 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 -






21. 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






22. Abd pain: varies - achy - burning - Melena: dark - tarry stool (UGIB) - Hematemesis - vomiting blood - Hematochezia - BRBPR - Hypotension - tachycardia - Pallor - Guaiac + rectal exam






23. Coffee bean signs on KUB for sigmoid volvulus - can also have cecal volvulus - 10% of LBO are sigmoid volvulus






24. 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






25. 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






26. 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






27. 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)






28. 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)






29. CDAB - Circulation (rapid CPR to reestablish circulation) - Defibrillaiton - Airway - Breathing - the main goal is to restore effective oxygenation -ventilation and circulation until return of spontaneous circulation or ACLS






30. 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






31. 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






32. On ANY FEMALE WITH ABDOMINAL PAIN- including bimanual vagino-rectal exam






33. Chronic anticoagulation - Coumadin - Pradaxa/Dabigatran (no meds to reverse it) - Lovenox - ESLD / alcoholism (lack clotting factors) - NSAIDS (increase risk PUD and blood thinning) - Smoking






34. 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






35. 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






36. FLACC Face - legs - activity - cry - consolability (0 - 1 - 2)






37. 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:






38. Gram negative - bad eggs - dairy - poultry. - S/S: bloody diarrhea - fever - abd pain - Resolves in 10-14 days.






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






40. 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






41. 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






42. For any chest pain due to COCAINE USE!!! (because cocaine makes the arteries spasm)






43. Right Coronary artery - SA node branch (anterior) - Acute marginal artery (anterior) - AV node branch (posterior) - Posterior descending artery (posterior)






44. 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






45. 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






46. 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






47. 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






48. 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






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






50. 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






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