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Emergency Medicine Midterm flashcards
Emergency Med. Midterm
126
Anatomy
Graduate
01/16/2012

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Term
presentation of bronchiolitis:
Definition
- clear profuse rhinorrhea and congestion
- wheezing
- cough
- low grade fever
- tachypnea
Term
Bronchiolitis is acute inflammatin of the bronchioles usually from a ___. It usually affects children from __ to age __ years and is most common in the __ months.
Definition
- virus
- birth to age 2 years
- winter months (november-march)
Term
60-90% of Bronchiolitis is caused by ___. Other causes include:
Definition
- 60-90%= RSV
- parainfluenza
- rhinovirus
- adenovirus
- influenza
- human Bocavirus
Term
what you may hear on lung exam of pt with bronchiolitis:
Definition
inspiratory wheezes and crackles
Term
standard for dx of bronchiolitis:
Definition
nasopharyngeal aspirate for rapid dx of RSV and influenza

these patients should also get a chest xray
Term
standard CXR findings of bronchiolitis:
Definition
- hyperinflation
- atelectasis
- peribronchial thickening
- diffuse interstitial infiltrates
Term
Bronchiolitis treatment:
Definition
- oxygen
- trial of bronchodilators
- Ribavirin- synthetic nucleoside analoge that has virostatic activity against RSV
Term
What patients with bronchiolitis should Ribavirin be given to?
Definition
- hx of congenital heart disease
- hx of chronic lung disease
- preterm infants
- infants younger than 6 weeks
- infants ventilated for RSV infection
Term
Criteria suggestive of severe bronchilitis:
Definition
- toxic appearing
- O2 saturation less than 95%
- gestational age less than 34 weeks
- respiratory rate > 70 bpm
- atelectasis on CXR
- age less than 3 months
Term
Single best objective measure of severe bronchiolitis:
Definition
infants o2 saturation while feeding
Term
Tmt for viral pneumonia:
Definition
supportive, unless severe RSV> Ribavirin
- hydration
- antitussives
- bronchodilators
Term
neonatal pneumonia tmt:
Definition
- Ampicillin OR Nafcillin _+ Gentamycin

OR

Vancomycin + Cefotaxime
Term
1-3 month old pneumonia tmt;
Definition
Erythromycin OR Amoxicillin OR Cefuroxime
Term
2 options to treat chlamydia pneumonia:
Definition
Erythromycin or Cefuroxime or Ceftriaxone
Term
2 tmt options for S. pneumoniae:
Definition
Amoxicillin or Cefuroxime
Term
STD with ulcer and firm rubbery non-tender lymph nodes:
Definition
Syphilis
Term
STD with ulcers and bilateral, firm, tender lymph nodes:
Definition
Herpes simplex
Term
STD with ulcer and unilateral, firm, erythematous, tender suppurative lymph nodes:
Definition
Chancroid
Term
STD with ulcer and unilater firm tender matted and fixed lymph nodes:
Definition
LGV
Term
name 3 stds with ulcers but no lymphadenopathy:
Definition
- Genital warts
- Pediculosis
- Scabies
Term
define massive hemoptysis:
Definition
> 200 ml blood in 24 hours
Term
hemoptysis, weight loss, fever, night sweats:
Definition
TB
Term
Good test to measure response to treatment with asthma and COPD:
Definition
- peak expiratory flow rate
Term
Drugs that may exacerbate asthma:
Definition
- ASA
- NSAIDs
- Beta blockeres
- Food coloring
Term
Tmt of asthma and COPD:
Definition
- Oxygen
- Beta-adrenergic agonists
- Anticholinergics
- Corticosteroids
Term
Specifics about beta adrenergic agonists for asthma COPD treatments:
Definition
- Nebulized Albuterol: 0.05-0.15mg/kg, up to 1.25 mg per treatment
- 20-30 min apart
- up to 3 treatments
Term
Specifics about anticholinergics used to treat asthma/COPD:
Definition
Nebulized Ipatroprium Bromide 0.5 mg per neb, up to 3 doses
Term
Specifics about corticosteroids used to treat asthma/COPD:
Definition
- Methylprednisone 125 mg IV
OR
- Prednisone 60 mg po
OR
- oral dose pack of choice
Term
Treatment for life threatening bronchospasm refractory to other tmts of asthma and COPD:
Definition
- Magnesium Sulfate 2-3 grams IV infused at 1 gm/min

- monitor for hypotension, respiratory depression, and decreased DTRs
Term
What should you monitor for if you give Magnesium Sulfate to an asthma or COPD patient with bronchrospasm resistant to other treatments?
Definition
- hypotension
- respiratory depression
- decreased DTRs
Term
Examples of Methylxanthines:
Definition
Theophylline
Aminophylline
Term
What should be used to help intubate patients with status asthmasticus
Definition
Ketamine 1-2 gm/kg IV or 4 mg/kg IM
Term
Asthmatics with greater than __% PEF can be sent home.
Definition
70%
Term
3rd most common cardiovascular disease:
Definition
pulmonary embolism
Term
most common symptom of PE:
Definition
dyspnea
Term
Signs of RV failure with PE:
Definition
JVD, gallop, edema
Term
__ and __ in general suggest a massive PE.
Definition
hypotension and symptoms in general
Term
early on in PE, would you see respiratory alkalosis or acidosis?
Definition
alkalosis b/c hyperventiliating so blowing off lots of CO2
Term
CXR of a PE:
Definition
- atelectasis
- infiltrates
- effusions
- Westermark's sign: dilated proximal to embolus, oligemia distal
- Hamptom's hump: pleural based density with a rounded border facing the hilum
Term
When is a VQ scan most helpufl?
Definition
- when the CXR was normal and the patient does not have chronic lung disease
Term
High probability VQ scan:
Definition
2 or more areas with perfusion defects with normal ventilation
Term
current Gold standard for PE dx:
Definition
Pulmonary Artery Arteriogram
Term
what 3 tests will confirm or exclude acute PE in most cases:
Definition
- D-dimer
- Doppler ultrasound
- VQ scan
Term
A normal chest x-ray with hypoxia with no other cuase is highly suggestive of a __ __.
Definition
pulmonary embolus
Term
anticoagulatns are a form of __ prevention for recurrent PEs.
Definition
secondary
Term
Anticoag tmt for PE:
Definition
- Heaparin or low molecular weight heparin initially (Enoxaparin or Dalteparin)

- Heparin 80 u/kg bolus> then 18/u/kg/hr drip, PTT goal 1.5-2.5of norm

- Warfarin (coumadin)- add orally after starting heparin product
- initial dose of 2.5-10 mg
- overlap with heparinoid for at least 5 days
- INR: 2.5
- check monthly once therapeutic
Term
Acute aspiration of gastric contents:
Definition
Mendleson Syndrome
Term
CXR findings with pulmonary aspiration syndrome:
Definition
- initially normal
- later RLL consoliation
Term
normal WBC:
Definition
5-10
Term
normal triponin:
Definition
around 0.4
Term
when is BNP most helpful?
Definition
when its low, best used to rule out. If its low> no fluid exacerbation. If its high> could be due to fliud, PE, or other causes.
Term
Parkland formula:
Definition
4 x kg x % burn
- give half of this fluid over first 8 hours
- give the rest over the next 16 hours
Term
Urine output goal for adults and children who have suffered from burns:
Definition
- adults: 0.5ml/kg/hr
- children: 1ml/kg/hr
Term
Review all notes from Environmental disasters ppt up to urine output for burn victims
Definition
Term
Hypothermia is a core temperature less than:
Definition
35 degrees Celsius or 95 degrees Farenheit
Term
first degree frost bite:
Definition
freezing without blistering, peeling occasionally present
Term
second degree frost bite:
Definition
freezing with clear blistering
Term
third degree frost bite:
Definition
freezing with death of skin, hemorrhagic blisteres, and subcutaneous involvement
Term
fourth degree frost bite:
Definition
freezing with full thickness involvement, including bone, ultimate loss or deformity of body part
Term
full thickness frostbite manaagement:
Definition
Rapid rewarming is the most important aspect of management. It should not be attempted, however, if the potential for refreezing exists. Rewarming should be performed with a water bath or whirlpool containing an antimicrobial agent such as iodine or chlorhexidine. Water temperature of 40–42°C (104–107.6°F) is necessary. However, The State of Alaska Cold-injury Guidelines recommend a lower temperature of 37–39°C (98.6–102.2°F). This temperature causes less pain for the patient and only slightly prolongs rewarming. Rewarming should continue until a red-purple color appears and the skin becomes pliable. Recommended rewarming time is anywhere from 15 inutes up to 1 hour.
Term
Severe cases of frostbite have led to subsequent rhabdomyolysis with renal failure, which then requires aggressive hydration. Intravenous narcotics are almost always necessary secondary to the severe pain associated with rewarming.
Definition
Term
frostbite once in the hospital:
Definition
Debride clear blisters because prostaglandins and thromboxane are present in the exudate. Leave hemorrhagic blisters intact. Administer antitetanus prophylaxis. Apply aloe vera cream every 6 hours. Administer ibuprofen, 400–600 mg every 8–12 hours for 72 hours.
Term
with frost bite tmt what abx should be given prophylactically?
Definition
penicillin
Term
mcc of death with lighting injuries:
Definition
respiratory arrest
Term
triage of lightning struck is diff in that dead appearing are attended to first
Definition
Term
Linear lightning strike burns:
Definition
Linear burns are first- and second-degree burns that begin at the head and neck and course in a branching pattern down the chest and legs. They tend to follow areas with a heavy concentration of sweat.
Term
Punctate lightning burns:
Definition
clusters of discrete circular partial or full thickness burns in star burst shape
Term
Feathering burns are not true burns but rather cutaneous imprints from electron showers that track through the skin. They create a fernlike pattern with delicate branching. These patterns are also called ferning, keraunographic markings, and Lichtenberg flowers or figures
Definition
Term
Thermal burns

Thermal burns from clothing or heated metal are typical second- and third-degree burns. Cranial burns (direct or indirect head strike) and leg burns (ground current) are associated with increased death rates.
Definition
Term
Electric shock and burns essentials of dx:
Definition
Direct current is less dangerous than alternating current (AC)
AC (most house current) can cause ventricular fibrillation and respiratory arrest
Burns can result from the electrical current and, although they may look mild, can indicate significant internal damage
Treatment includes CPR, wound care, and possibly fasciotomy
Term
poisoning that would cause miosis:
Definition
Narcotics
Organophosphates
Term
poisoning that would cause mydriasis:
Definition
- anticholinergics
- stimulants
Term
substances that could cause nystagmus:
Definition
EtOH, sedatives
Term
Anticholinergic toxidrome:
Definition
- eyes dilated
- delirium
- mumbling speech
- tachycardia
- dry flushed skin
- myoclonus
- urinary retention
- decreased bowel sounds
- seizures
- dysrhythmias
Term
Opiod/sedative/ethanol toxidrome:
Definition
- coma
- respiratory depression
- miosis
- hypotension
- bradycardia
- hypothermia
- pulmonary edema
- decrease bowel sounds
- hyporeflexia
- needle marks
Term
Cholinergic toxidrome:
Definition
- confusion
- CNS depression
- weakness
- salivation
- lacrimation
- urinary/fecal incontinence
- GI cramping
- emesis
- diaphoresis
- muscle fasiculations
- miosis
- brady/tachycardia
- seizures

causes: Organophosphates, carbamate, insecticeides, nicotine, pliocarpine, some mushrooms
Term
tmt of acetaminophen poisoning:
Definition
N-acetyl-cysteine
Term
Anticholinergic overdose tmt:
Definition
Physostigmine
Term
BZD overdose tmt:
Definition
Flumazenil
Term
TCA overdose tmt:
Definition
Sodium bicarbonate
Term
Organophosphate and other cholinesterase inhibitors overdose tmt:
Definition
Atropine, Pralidoxime
Term
Treatment of beta blocker overdose;
Definition
Glucagon
Term
Tmt of calcium channel blocker overdose:
Definition
calcium
Term
Tmt of cyanide poisoning:
Definition
- Sodium nitrite
- Sodium thiosulfate
Term
Tmt of Isoniazid overdose:
Definition
Pyridoxine (vitamin B6)
Term
Tmt of methanol/ethylene glycol ingestion:
Definition
Ethanol, folate
Term
Tmt of Narcotics overdose:
Definition
Naloxone
Term
DDx of Hypoglycemia:
Definition
SAD-LIFE

- Sepsis
- Addison's
- Drugs
- Liver
- Insulin
- Fasting
- ETOH
Term
Hypoglycemia tmt:
Definition
IV dextrose as a 50% solution- 1g/kg; continuous 10% dextrose solution to keep blood sugar above 100
Term
Hypoglycemia treatment if there is NO IV access or if pt is critical:
Definition
Glucagon 1 mg IM or SC
Term
Refractory Hypoglycemia tmt:
Definition
- glucagon IV or hydrocortisone 100 mg IV
- D-stick every hour


Admit: oral agent, recurrent dips, associated disease
Home: insulin error and ok post 6 hours
Term
Whipple's Triad is a collection of 3 criteria that suggest that a patient's symptoms are due to ___.
Definition
hypoglycemia
Term
Whipple's Triad is 3 criteria that suggest that their symptoms are due to hypoglycemia:
Definition
1. Symptoms known or likely to be caused by hypoglycemia
2. A low plasma glucose measured at the time of symptoms
3. Relief of symptoms when the glucose is raised to normal
Term
Ketoacidosis is a type of metabolic acidosis caused by high concentrations of __ bodies formed from the breakdown of __ __ and __ of __ __.
Definition
- ketone bodies
- fatty
- amino acids
Term
In Ketoacidosis the body fails to regulate ketone production b/c the body is not making enough ___ to decrease production, thus the pH of blood ___.
Definition
- insulin
- decreases
Term
Ketoacidosis is most commonly seen in __ __ _ ___ b/c the liver breaks down __ and __ in perceived need for respiratory substrate. This is also seen in ___.
Definition
- untreated Type 1 Diabetics
- fat and protein
- alcoholics
Term
3 main characteristics of Diabetic Ketoacidosis (DKA):
Definition
- insulin deficiency
- hyperglycemia
- dehydration

(starvation in the face of plenty)
Term
DDx of Diabetic Ketoacidosis:
Definition
MUDPILES:
- Methanol
- Uremia
- DKA
- Paraldehyde
- INH
- Iron inhalants
- Lactate
- ETOH
- Salicylate

also consider hypoglycemia and HHS
Term
Thyroid storm treatment:
Definition
1. Decrease synthesis with propylthiouracil or methimazole
2. Prevent release with Iodine or Lithium carbonate
3. Beta blocker (propanolol or esmolol)
Term
causes of Hyperkalemia:
Definition
- Renal failure
- ACE-I
- Acidosis
Term
hyperkalemia:
Definition
K>5
Term
Hyperkalemia tmt:
Definition
- Calcium gluconate- decrease K effects on heart
- Sodium Bicarbonate
- Glucose and Insulin may be used to drive K back into cells
- Kayexelate PO- removes K from body
Term
clinical features of hyperkalemia:
Definition
- arrhythmia
- cardiac arrest
- numbness
- weakness
- flaccid paralysis
Term
causes of hypokalemia:
Definition
- diuretic use
- renal-tubular acidosis
- GI loss
Term
EKG findings of hyperkalemia:
Definition
peaked T waves
Term
Clinical features of Hypokalemia:
Definition
- ventricular arrhythmias
- hypotension
- cardiac arrest
- musce weakness/cramps
- hyperglycemia
Term
hypokalemia:
Definition
K<3.5
Term
EKG findings of hypokalemia:
Definition
- flat or inverted T- waves
- U waves
Term
tmt of hypokalemia:
Definition
PO K if not emergent
IV K if K< 2.5
Term
Hypernatremia:
Definition
sodium > 150
Term
clinical features of hypernatremia:
Definition
- thirst
- restlessness
- irritability
- delirium
- convulsions
- dry mouth
- anuria
Term
Hypernatremia tmt:
Definition
- free water PO OR
- IV 5% dextrose solution
- Dialysis if sodium > 200

CAUTION- TOO RAPID> CEREBRAL/PULMONARY EDEMA
Term
MC electrolyte disorder in the hospital:
Definition
hyponatremia, sodium less than 135
Term
Labs for hyponatremia:
Definition
- urine sodium
- if SIADH suspected get GT of head and CXR to r/o lung mass and CNS disorder
Term
Hyponatremia tmt:
Definition
- usually fluid restriction
- IV hypertonic solution possibly

check sodium hourly and closley monitor neuro
Term
Hypercalcemia clinical features:
Definition
- nausea, anorexia, AMS, tachycardia

Bones, Mones, Stones, Groans, Psychiatric overtones
Term
Labs to order with hypercalcemia:
Definition
- phosphorous
- CXR
- UA
- ESR
- Vitamin D
Term
Hypercalcemia tmt:
Definition
normal saline and manage cause
Term
Diverticulitis abx:
Definition
Cipro + Metronidazole/Clindamycin
Term
Appendicitis abx before sx:
Definition
CAS:
- Cefoxitine
- Ampicllin/Sulbactam
Term
Cholecystitis abx:
Definition
- Ampicillin/sulbactam
- Clindamycin
- Levaquin
- Metronidazole
- Zosyn
Term
AST:ALT ration < 1:
Definition
acute and chronic viral hepatitis
Term
AST:ALT ratio > 2:
Definition
ETOH induced hepatitis b/c ETOH stimulates AST
Term
If alkaline phosphate is 4 times normal suspect:
Definition
cholestasis
Term
what test do you run to LOCATE intestinal perforation:
Definition
Ct scan
Term
classic AAA triad:
Definition
- pain
- hypotension
- pulsatile mass
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