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Test your basic knowledge |
Emergency Medicine
Start Test
Study First
Subjects
:
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. STEMI - due to complete arterial occlusion NSTEMI - ARTERY NOT completely blocked or have collateral vessels
Incomplete abortion
Cardiac Enzymes
Where to check pulses
STEMI vs Nstemi
2. Often embolic phenomenon triggered by afib or endocarditis - 6 P's: Pain - pallor - paralysis - paresthesias - poikilothermia - pulselessness - DX: dopplers with ABI - ankle brachial index
Incidence of AMI
Acute Arterial occlusion - to lower extremities
Common risk factors for LGIB
Ovarian Cysts
3. 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
Tx of Unstable Angina
Define Acute Cholecystitis
Posterior
ED treatment for Ectopic Pregnancy
4. 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
RCA
Stable vs. Unstable Ectopic Pregnancy
Tachycardia
What is a large bore IV?
5. No bleeding - no fetal cardiac activity - uterus small - os closed - retained fetal tissue - Tx: D and C - Can have sepsis due to retained tissue/ fetus. Treat with IV abx (ampicillin and gentamycin) - Can give Misoprostol and cytotec (to dilate cerv
Genital Herpes
Pain scale for infants
Missed Abortion
LBO - Large bowel obstruction
6. 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
STEMI vs Nstemi
Inferior leads
Define Biliary colic
ED Tx of GIB
7. 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
Types of Infectious diarrhea E coli
RCA
Cardiac Tamponade
How to monitor CDAB
8. 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
Other major arteries
Ovarian Cysts
Incomplete abortion
Missed Abortion
9. Check Vital Signs
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10. 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
ED Tx of GIB
Ascending Cholangitis
Additional cardiac Tests
Initial steps in stabilizing a patient
11. LAD - Left Anterior Descending Artery (anterior) - Diagonal branch of LAD (anterior) - Left Circumflex artery (posterior) - Obtuse Marginal Artery
DUKE criteria for endocarditis
Where to check pulses
Other major arteries
Contraindications for thrombolytics
12. 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
Supplemental O2
The vital signs
Common risk factors for UGIB
Types of Infectious diarrhea Campylobacter
13. 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
Aortic Dissection definition - risks and S/S
EKG changes
Early miscarriage (20 weeks)
When to do a pelvic exam
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
Acute Arterial occlusion - to lower extremities
GIB work up
Kidney Stones
Supplemental O2
15. Common complication after an AMI - S/S: edema - elevated JVP - hepatojugular reflux - pulm rales - rhochi - decrease BS - +/- cardiac murmurs - low O2 sat - elevated BNP
Volvulus
Contraindications for thrombolytics
Cardiac Enzymes
CHF
16. 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
Placenta Previa
When to do a pelvic exam
Pain scale for infants
17. 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
Pain scale for infants
LBO - Large bowel obstruction
Acute Coronary syndrome
ED workup of kidney stones
18. 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
Viral Gastroenteritis
Cardiac Enzymes
Breathing
What to do with weak/thready pulses
19. 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
Kidney Stones
Additional cardiac Tests
What is a large bore IV?
Lateral Leads
20. Spontaneous abortion - Never CALL IT ABORTION IN FRONT OF PATIENT
Miscarriage
Bradycardia
EKG changes
Types of Infectious diarrhea Protozo -Giardia (dirty water sources)
21. Leads I - aVL - V4-V6 - Left circumflex artery
Supplemental O2
Ascending Cholangitis
How to assess Airway
Lateral Leads
22. Chronic anticoagulation - Coumadin - Pradaxa/Dabigatran (no meds to reverse it) - Lovenox - ESLD / alcoholism (lack clotting factors) - NSAIDS (increase risk PUD and blood thinning) - Smoking
Breathing
UTI
Common risk factors for UGIB
Ascending Cholangitis
23. 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
Additional cardiac Tests
Genital Herpes
Kidney Stones
Pancreatitis work up
24. HR/pulse: 60-100 - Bp: 120/80 - Resp rate: 16-20 - Temp 97-99 - O2 sat > 94% - Pain!!! - 6th vital sign
What should be done after CDAB's
Breathing
The vital signs
Dx of Aortic dissection
25. Abd pain: varies - achy - burning - Melena: dark - tarry stool (UGIB) - Hematemesis - vomiting blood - Hematochezia - BRBPR - Hypotension - tachycardia - Pallor - Guaiac + rectal exam
Posterior
Gonorrhea
Common Presentation of GIB
Initial steps in stabilizing a patient
26. 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
Viral Gastroenteritis
Where to check pulses
CHF
How to monitor CDAB
27. 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
Contraindications for thrombolytics
DUKE criteria for endocarditis
Ascending Cholangitis
Inferior leads
28. 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 Enzymes
Volvulus
Additional cardiac Tests
Ovarian Cysts
29. II - III - aVF - Means RCA involved
Divertriculitis
When is Rho GAM used
Tx of Unstable Angina
Inferior leads
30. Coffee bean signs on KUB for sigmoid volvulus - can also have cecal volvulus - 10% of LBO are sigmoid volvulus
Kidney Stones
LBO - Large bowel obstruction
Causes of 3rd trimester bleeding
Miscarriage
31. 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:
Defibrillation
Types of GI bleeds
Ovarian Torsion
EKG changes
32. 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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33. 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)
Emergency Severity Index
Incomplete abortion
Bradycardia
GIB work up
34. Gram negative - bad eggs - dairy - poultry. - S/S: bloody diarrhea - fever - abd pain - Resolves in 10-14 days.
Pancreatitis work up
Types of Infectious diarrhea - Salmonella
Lateral Leads
Placental Abruption
35. Right Coronary artery - SA node branch (anterior) - Acute marginal artery (anterior) - AV node branch (posterior) - Posterior descending artery (posterior)
DUKE criteria for endocarditis
Triage
Incidence of AMI
RCA
36. On ANY FEMALE WITH ABDOMINAL PAIN- including bimanual vagino-rectal exam
Symptoms of Ruptured ovarian cysts
Stable vs. Unstable Ectopic Pregnancy
When to do a pelvic exam
Hypertensive Emergency
37. V1-V2 Right Posterior Descending Artery
Posterior
Bradycardia
Symptoms of Ruptured ovarian cysts
Emergency Severity Index
38. Sepsis due to urologic infection - common in elderly - 2 large bore IV - crystalloid IVF - Blood cultures - IV antibiotics - hosptial admission
How to monitor CDAB
Urosepsis
Incidence of AMI
Types of Infectious diarrhea Protozo -Giardia (dirty water sources)
39. 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
Gonorrhea
SBO
Chlamydia
Placenta Previa
40. 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
Aortic Dissection definition - risks and S/S
ED workup of kidney stones
Urosepsis
ED Tx of GIB
41. 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? -
Aortic Dissection definition - risks and S/S
Appendicitis work up
Pancreatitis work up
Tx of Unstable Angina
42. 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
Symptoms of Ruptured ovarian cysts
Acute Arterial occlusion - to lower extremities
Aortic Dissection definition - risks and S/S
Types of Infectious diarrhea E coli
43. 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
When to do a pelvic exam
Lateral Leads
ED work up for cholecystitis
Syphillis
44. 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
Symptoms of Ruptured ovarian cysts
Tx of CHF
UTI
Contraindications for thrombolytics
45. 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
Types of GI bleeds
Volvulus
Placenta Previa
Chlamydia
46. 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 -
DUKE criteria for endocarditis
Placental Abruption
Ovarian Torsion
Hypertensive Emergency
47. 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)
ED treatment of a Miscarriage
Tx of Unstable Angina
Emergency Severity Index
EKG changes
48. Sigmoid - volvulus: High risk patients: chronic constipation - elderly and debilitated patients - Dx: plain film - Tx: decompress with rectal tube - Cecal volvulus - see congenital hypermobile cecum. also dx with plain films
What to do with weak/thready pulses
Volvulus
Syphillis
DUKE criteria for endocarditis
49. 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
Acute Mesenteric Ishemia
Ovarian Torsion
Types of Infectious diarrhea - Salmonella
Placenta Previa
50. 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
Endocarditis
Contraindications for thrombolytics
Types of Infectious diarrhea Shigella
What should be done after CDAB's