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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.
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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. 'trier' - to separate - sift or select based on priority of condition
Triage
Syphillis
EKG changes
The vital signs
2. 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
The vital signs
Missed Abortion
Placental Abruption
Endocarditis
3. On ANY FEMALE WITH ABDOMINAL PAIN- including bimanual vagino-rectal exam
Types of Infectious diarrhea Campylobacter
Types of Infectious diarrhea - Salmonella
When to do a pelvic exam
Cardiac Enzymes
4. 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)
STEMI vs Nstemi
EKG changes
Early miscarriage (20 weeks)
Genital Herpes
5. V1-V3 - V2-V4 Means LAD (left anterior descending) involved
Pain scale for infants
Stable vs unstable angina`
ED treatment of a Miscarriage
Anteroseptal leads and Anterior
6. 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
Appendicitis work up
Miscarriage
Kidney Stones
Acute Mesenteric Ishemia
7. Chinese food bug - Fever - abdo pain - blood diarrhea - lasts x 1 week.Get from dirty wateror poultry - may cause/trigger Guillan Barre
Missed Abortion
Acute Coronary syndrome
Types of Infectious diarrhea Campylobacter
Gonorrhea
8. 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
Common Presentation of GIB
Ovarian Torsion
GIB work up
9. 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
Types of Infectious diarrhea Yersinia
Pain scale for infants
Emergency Severity Index
Syphillis
10. O2 - 2 large bore IV's: IVF with crystalloid (NS or LR) - type and screen crossmatch - transfuse prn - OB GYN cx ASAP
ED treatment for Ectopic Pregnancy
Common risk factors for UGIB
Additional cardiac Tests
Chlamydia
11. 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)
Additional cardiac Tests
Defibrillation
What to do with weak/thready pulses
Tx of Unstable Angina
12. 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
Incidence of AMI
UTI
Emergency Severity Index
CHF
13. Often embolic phenomenon triggered by afib or endocarditis - 6 P's: Pain - pallor - paralysis - paresthesias - poikilothermia - pulselessness - DX: dopplers with ABI - ankle brachial index
LCA
ED treatment of a Miscarriage
Acute Arterial occlusion - to lower extremities
ED Tx of GIB
14. For any chest pain due to COCAINE USE!!! (because cocaine makes the arteries spasm)
UTI
Miscarriage
When are Beta Blockers contraindicated
Defibrillation
15. 16-18 Gauge
When is Rho GAM used
Early miscarriage (20 weeks)
What is a large bore IV?
Viral Gastroenteritis
16. 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
How to assess Airway
LBO - Large bowel obstruction
UTI
Bradycardia
17. Directly invades the intestine - s/s abd pain - watery or bloody diarrhea - vomiting
EKG changes
Define Biliary colic
Anteroseptal leads and Anterior
Types of Infectious diarrhea Yersinia
18. 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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19. 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)
Types of GI bleeds
LBO - Large bowel obstruction
Bradycardia
Appendicitis
20. 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
Hypertensive Emergency
Missed Abortion
Stable vs unstable angina`
LBO - Large bowel obstruction
21. 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
STEMI vs Nstemi
Acute Mesenteric Ishemia
Incomplete abortion
Placenta Previa
22. 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
Define Biliary colic
Acute Coronary syndrome
Early miscarriage (20 weeks)
23. Obstruction of appendiceal lumen (fecalith) - leads to edema - ischemia - infection - necrosis - ? perf and peritonitis - +Rosvig's sign (push and feel on opposite side)
Miscarriage
When are Beta Blockers contraindicated
What is a large bore IV?
Appendicitis
24. Sepsis due to urologic infection - common in elderly - 2 large bore IV - crystalloid IVF - Blood cultures - IV antibiotics - hosptial admission
Chlamydia
What to do with weak/thready pulses
Urosepsis
Stable vs unstable angina`
25. life threatening pericardial effusion -S/S: muffled heart sounds - JVD - hypotension - pulsus paradoxus - Water bottle heart on CXR - ellarged heart Tx: peicardiocentesis
Gonorrhea
Cardiac Tamponade
Common risk factors for UGIB
Ranson's criteria
26. Placenta previa - vaginal/cervical trauma - polyps - genital infections - hemorrhoids - onset of labor (no fetal distress) - placental abruption (have fetal distress)
Causes of 3rd trimester bleeding
GIB work up
Divertriculitis
Incarcerated vs strangulated hernias
27. 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
EMTALA
Tx of CHF
Advanced airway techniques
Define Acute Cholecystitis
28. 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
Stable vs. Unstable Ectopic Pregnancy
Bradycardia
Acute Mesenteric Ishemia
Pancreatitis work up
29. 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
Acute Arterial occlusion - to lower extremities
Other major arteries
Chlamydia
ED treatment for Ectopic Pregnancy
30. 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
Endocarditis
The vital signs
Missed Abortion
Ovarian Cysts
31. 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
Pancreatitis work up
Ectopic Pregnancy
GIB work up
Initial steps in stabilizing a patient
32. Spontaneous abortion - Never CALL IT ABORTION IN FRONT OF PATIENT
Acute Coronary syndrome
Miscarriage
LCA
Emergency Severity Index
33. Common complication after an AMI - S/S: edema - elevated JVP - hepatojugular reflux - pulm rales - rhochi - decrease BS - +/- cardiac murmurs - low O2 sat - elevated BNP
CHF
How to monitor CDAB
When is Rho GAM used
Aortic Dissection definition - risks and S/S
34. 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
RCA
Abdominal Aortic Aneurysm
Cardiac Enzymes
35. 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
Anteroseptal leads and Anterior
Aortic Dissection definition - risks and S/S
Testicular Torsion
36. 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
Common Presentation of GIB
Anteroseptal leads and Anterior
Testicular Torsion
EMTALA
37. Bp diffrence between R and L arms: > 20 difference in systolic or > 15 mm Hg difference in diastolic - Aortography - gold standard - CT scan with contrast - EKG - CXR - widended mediastinum - obliteraiton of aortic knowb - tracheal deviation - L hemo
Dx of Aortic dissection
Appendicitis
What to do with weak/thready pulses
Bradycardia
38. 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
Where to check pulses
Acute Arterial occlusion - to lower extremities
Aortic Dissection definition - risks and S/S
How to monitor CDAB
39. Especially O157: H7 causes enterohemorrhagic diarrhea. Inundercooked beef - complicated by hemolytic uremic syndrome and TTP
Lateral Leads
Types of Infectious diarrhea E coli
Incidence of AMI
Acute Arterial occlusion - to lower extremities
40. 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
Causes of 3rd trimester bleeding
Inferior leads
Incidence of AMI
Cardiac Enzymes
41. V1-V2 Right Posterior Descending Artery
Tx of CHF
Gonorrhea
Posterior
Common risk factors for UGIB
42. 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
Breathing
ED work up for cholecystitis
When is Rho GAM used
DUKE criteria for endocarditis
43. Check Vital Signs
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44. Chronic anticoagulation - Coumadin - Pradaxa/Dabigatran (no meds to reverse it) - Lovenox - ESLD / alcoholism (lack clotting factors) - NSAIDS (increase risk PUD and blood thinning) - Smoking
Common risk factors for UGIB
Defibrillation
LCA
Types of Infectious diarrhea Yersinia
45. STEMI - due to complete arterial occlusion NSTEMI - ARTERY NOT completely blocked or have collateral vessels
When to do a pelvic exam
STEMI vs Nstemi
Acute Arterial occlusion - to lower extremities
Common risk factors for UGIB
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
Ectopic Pregnancy
DUKE criteria for endocarditis
Common risk factors for LGIB
Acute Mesenteric Ishemia
47. Gram negative - contaminated salads (mayo) - dairy - mean. Severe Dysentery (bloody diarrhea)'
Types of Infectious diarrhea Shigella
Cardiac Enzymes
Types of Infectious diarrhea Yersinia
Miscarriage
48. Explosive - frothy and foul smellng diarrhea - Entamoeba hystlytica - crypto - isospora (HIV)
Types of Infectious diarrhea Protozo -Giardia (dirty water sources)
Abdominal Aortic Aneurysm
Types of Infectious diarrhea Shigella
Volvulus
49. II - III - aVF - Means RCA involved
Inferior leads
Common Presentation of GIB
STEMI vs Nstemi
Appendicitis work up
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
Divertriculitis
Contraindications for thrombolytics
Inferior leads
What to do with weak/thready pulses
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