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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. 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
Acute Coronary syndrome
Posterior
Symptoms of Ruptured ovarian cysts
DUKE criteria for endocarditis
2. 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
Types of GI bleeds
Types of Infectious diarrhea E coli
Acute Coronary syndrome
Other major arteries
3. 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
Other major arteries
STEMI vs Nstemi
Placenta Previa
Gonorrhea
4. 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
Testicular Torsion
Tx of CHF
Divertriculitis
Define Acute Cholecystitis
5. V1-V2 Right Posterior Descending Artery
Supplemental O2
Common risk factors for LGIB
EMTALA
Posterior
6. Directly invades the intestine - s/s abd pain - watery or bloody diarrhea - vomiting
LBO - Large bowel obstruction
When are Beta Blockers contraindicated
Types of Infectious diarrhea E coli
Types of Infectious diarrhea Yersinia
7. FLACC Face - legs - activity - cry - consolability (0 - 1 - 2)
Pain scale for infants
Additional cardiac Tests
Where to check pulses
Breathing
8. Obstruction of appendiceal lumen (fecalith) - leads to edema - ischemia - infection - necrosis - ? perf and peritonitis - +Rosvig's sign (push and feel on opposite side)
What should be done after CDAB's
Appendicitis
Common risk factors for LGIB
ED work up for cholecystitis
9. 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
Initial steps in stabilizing a patient
CHF
Stable vs. Unstable Ectopic Pregnancy
Posterior
10. Coffee bean signs on KUB for sigmoid volvulus - can also have cecal volvulus - 10% of LBO are sigmoid volvulus
Acute Coronary syndrome
Contraindications for thrombolytics
Stable vs unstable angina`
LBO - Large bowel obstruction
11. 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
ED Tx of GIB
Dx of Aortic dissection
Stable vs. Unstable Ectopic Pregnancy
Symptoms of Ruptured ovarian cysts
12. LAD - Left Anterior Descending Artery (anterior) - Diagonal branch of LAD (anterior) - Left Circumflex artery (posterior) - Obtuse Marginal Artery
What should be done after CDAB's
LBO - Large bowel obstruction
Other major arteries
Types of GI bleeds
13. 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)
ED treatment for Ectopic Pregnancy
Acute Coronary syndrome
Defibrillation
Urosepsis
14. 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
What is a large bore IV?
Pain scale for infants
Aortic Dissection definition - risks and S/S
Missed Abortion
15. Spontaneous abortion - Never CALL IT ABORTION IN FRONT OF PATIENT
What to do with weak/thready pulses
Cardiac Enzymes
Miscarriage
Dx of Aortic dissection
16. 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
Where to check pulses
DUKE criteria for endocarditis
ED work up for cholecystitis
Appendicitis work up
17. 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
UTI
Acute Arterial occlusion - to lower extremities
Other major arteries
Common Presentation of GIB
18. Explosive - frothy and foul smellng diarrhea - Entamoeba hystlytica - crypto - isospora (HIV)
Types of Infectious diarrhea Protozo -Giardia (dirty water sources)
Causes of 3rd trimester bleeding
ED Tx of GIB
Incarcerated vs strangulated hernias
19. 16-18 Gauge
GIB work up
Types of Infectious diarrhea Yersinia
What is a large bore IV?
EMTALA
20. 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
What is a large bore IV?
When are Beta Blockers contraindicated
Tx of Unstable Angina
Testicular Torsion
21. 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
Inferior leads
GIB work up
How to monitor CDAB
Miscarriage
22. 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 Yersinia
Acute Mesenteric Ishemia
Ovarian Torsion
Tx of CHF
23. 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
Contraindications for thrombolytics
Stable vs. Unstable Ectopic Pregnancy
The vital signs
Volvulus
24. 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
Urosepsis
Emergency Severity Index
Bradycardia
UTI
25. 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
What should be done after CDAB's
Types of Infectious diarrhea Campylobacter
Ovarian Torsion
26. Placenta previa - vaginal/cervical trauma - polyps - genital infections - hemorrhoids - onset of labor (no fetal distress) - placental abruption (have fetal distress)
CHF
Tx of CHF
Causes of 3rd trimester bleeding
Endocarditis
27. LMA: Laryngeal Mask Airway - Cricothyroidotomy -surgical airway done as last resort when unable to maintain oxygenation with other methods
Advanced airway techniques
Divertriculitis
Volvulus
Emergency Severity Index
28. 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
Urosepsis
The vital signs
Ascending Cholangitis
ED work up for cholecystitis
29. 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
Types of Infectious diarrhea Yersinia
Aortic Dissection definition - risks and S/S
Hypertensive Emergency
30. 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
Early miscarriage (20 weeks)
Types of Infectious diarrhea - Salmonella
Types of GI bleeds
Acute Coronary syndrome
31. 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
Types of Infectious diarrhea Protozo -Giardia (dirty water sources)
Where to check pulses
RCA
Early miscarriage (20 weeks)
32. 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
Initial steps in stabilizing a patient
Viral Gastroenteritis
Symptoms of Ruptured ovarian cysts
Inferior leads
33. Especially O157: H7 causes enterohemorrhagic diarrhea. Inundercooked beef - complicated by hemolytic uremic syndrome and TTP
Dx of Aortic dissection
Types of Infectious diarrhea E coli
Emergency Severity Index
RCA
34. 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
Incomplete abortion
Gonorrhea
Stable vs unstable angina`
Missed Abortion
35. HR/pulse: 60-100 - Bp: 120/80 - Resp rate: 16-20 - Temp 97-99 - O2 sat > 94% - Pain!!! - 6th vital sign
Posterior
STEMI vs Nstemi
Aortic Dissection definition - risks and S/S
The vital signs
36. 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
Viral Gastroenteritis
GIB work up
Supplemental O2
ED work up for cholecystitis
37. 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
How to monitor CDAB
Syphillis
Kidney Stones
Ovarian Torsion
38. 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
Advanced airway techniques
Endocarditis
Ectopic Pregnancy
Breathing
39. O2 - 2 large bore IV's: IVF with crystalloid (NS or LR) - type and screen crossmatch - transfuse prn - OB GYN cx ASAP
How to monitor CDAB
Initial steps in stabilizing a patient
ED treatment for Ectopic Pregnancy
ED treatment of a Miscarriage
40. 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
Symptoms of Ruptured ovarian cysts
Genital Herpes
Ectopic Pregnancy
Incarcerated vs strangulated hernias
41. 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
Endocarditis
Chlamydia
Appendicitis work up
Pancreatitis work up
42. 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
Placenta Previa
Advanced airway techniques
Causes of 3rd trimester bleeding
43. 'trier' - to separate - sift or select based on priority of condition
Early miscarriage (20 weeks)
SBO
Hypertensive Emergency
Triage
44. Sepsis due to urologic infection - common in elderly - 2 large bore IV - crystalloid IVF - Blood cultures - IV antibiotics - hosptial admission
Urosepsis
Acute Coronary syndrome
GIB work up
Chlamydia
45. Chinese food bug - Fever - abdo pain - blood diarrhea - lasts x 1 week.Get from dirty wateror poultry - may cause/trigger Guillan Barre
RCA
Types of Infectious diarrhea Campylobacter
Incomplete abortion
LCA
46. Incarcerated - means cannot reduce - Strangulated - bowel edema is compromosing blood flow
Gonorrhea
Incarcerated vs strangulated hernias
Aortic Dissection definition - risks and S/S
Contraindications for thrombolytics
47. 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
Common risk factors for UGIB
Inferior leads
Appendicitis
48. Old age - chronic anticoagulation - divertriculosis
Common risk factors for LGIB
Hypertensive Emergency
Posterior
ED workup of kidney stones
49. II - III - aVF - Means RCA involved
When to do a pelvic exam
Pain scale for infants
Placenta Previa
Inferior leads
50. Left coronary artery (short and branches quickly)
Pericarditis
Kidney Stones
Define Acute Cholecystitis
LCA
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