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207 Cards in this Set
- Front
- Back
What is EMTALA?
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The initial intent of EMTALA was to address the allegation that some hospitals were transferring, discharging, or refusing to treat patients who did not have insurance.
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What is by far the most commonly abused opiate?
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Heroin
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Name the various forms of opiates:
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Heroin, methadone, morphine, codeine, oxycodone, fentanyl (China white), and black tar (a potent form of heroin)
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When is an alcoholic most likely to develop delirium tremens?
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Often occurs 3-5 days after the last drink
DT is characterized by disorientation, fever, and visual hallucinations. |
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Signs of opiate withdrawal:
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Strong craving for the drug, yawning, tears, diarrhea, abdominal cramping, piloerection, and rhinorrhea.
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What airway securing maneuver should be used in a patient with a cervical spine injury?
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Jaw Thrust
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What is asystole?
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Cardiac standstill with no cardiac output and no ventricular depolarization; it eventually occurs in all dying patients.
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Name conditions that can cause asystole:
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MI complicated by VF or VT that deteriorates to asystole
Near drowning Suffocation Hyperkalemia Hypothermia Sedative-hypnotic overdoses (secondary to respiratory depression) |
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Work-up of asystole: |
ABG, potassium level |
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What are the 3 drugs approved by the AHA for the treatment of asystole in adults?
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Epinephrine, vasopressin, and atropine
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The goal in using these agents is to enhance sinoatrial activity and to improve conduction through the SA or AV node by reducing vagal tone via muscarinic receptor blockade.
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Anticholinergic drugs
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Parasympatholytic agent used to eliminate vagal influence on SA and AV nodes. Not effective for infranodal third-degree heart block.
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Atropine
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Considered the single most useful drug in cardiac arrest:
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Epineprine
Used to increase coronary and cerebral blood flow during CPR. May enhance automaticity during asystole. Can be used for bradycardia in adult and pediatric patients. |
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Has vasopressor and ADH activity.
Increases water resorption at distal renal tubular epithelium (ADH effect) and promotes smooth muscle contraction throughout vascular bed via stimulation of V1 receptors, thus the vasopressor effect. |
Vasopressin
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TRUE or FALSE: There is no benefit to defibrillation or pacing in asystolic arrest
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TRUE
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What is the management for asystole?
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ACLS drugs and CPR
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During CPR, what is the ratio of compressions to breaths that should be given?
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30 compressions followed by 2 breaths;
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During CPR (ACLS guidelines), how may chest compressions should be delivered each minutue?
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100
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When should CPR be stopped on a patient?
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Time down > 20 minutes
3 Rounds of epinephrine given 3 Rounds of atropine given Signs of rigor |
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Name some clinical signs/sx's of acute upper airway obstruction
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Stridor
Hot Potato or muffled voice Drooling Use of accessory muscles Retractions Hypoxia (late finding) Agitation/Anxiety/AMS |
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DDX of acute upper airway obstruction
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Angioedema
Anaphylaxis Foreign Body Trauma Inhalation/Ingestion injury Retropharyngeal abscess Epiglottitis Peritonsillar Abscess Ludwig's Angina |
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What deficiency is assoc'd with the hereditary form of angioedema?
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C1 inhibitor deficiency
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What is the tx for the hereditary form of angioedema?
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Give C1 inhibitor concentrate or FFP
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Treatment of non-hereditary angioedema
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Tx is similar to that for allergic reactions:
-H1 (Benadryl) or H2 blockers -SubQ epinephrine -Removal of the triggering agent |
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TRUE or FALSE:
Most patients w/ angioedema will require intubation. |
FALSE!
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What is the most common age for young children to ingest foreign bodies?
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6 months - 4 years old
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What is the GOLD STANDARD for the diagnosis/treatment of foreign object ingestion in a small child?
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Bronchoscopy
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What is a complication of foreign body aspiration in small children seen on CXR?
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Hyperinflation of one lung -
If the object lodges in the mainstream bronchus, it can create a ball-valve --> resulting in hyperinflation of one lung |
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The cornerstone of acute asthma management
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Beta-agonists
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A patient arrives to the ER complaining of SUDDEN ONSET dyspnea. What is on your differential?
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Pulmonary embolus
Pneumothorax |
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TRUE or FALSE:
An acute MI can present with SOB without chest pain. |
TRUE
This is common in elderly and diabetic patients. You can still have a heart attack without experiencing chest pain. |
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Name the likely condition based on the presenting sx:
1. Dyspnea on exertion 2. Orthopnea/PND |
1. CHF, COPD
2. CHF |
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Other than asthma, what other conditions can present with wheezing on lung exam?
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Foreign body
Pulmonary edema (cardiac wheezing) Pulmonary infection PE Anaphylaxis |
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TRUE or FALSE:
A CXR is always indicated in pts with asthma exacerbations. |
FALSE
Only get a CXR if you suspect a complication(s) during this exacerbation or if you suspect an alternative dx other than asthma |
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What labs/studies/imaging should you order in a pt presenting with dyspnea?
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EKG (acute MI)
CBC (anemia) CMP/BMP Cardiac markers (MI) BNP (CHF, pulmonary edema) ABG (metabolic abnormalities) - but not generally necessary |
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The 3 Hallmarks of Asthma
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1. Airway constriction
2. Airway inflammation 3. Increased secretions |
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Treatment of Asthma exacerbation
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1. Beta-agonists (albuterol 5 mg nebs x3 or continuous neb) - to treat bronchoconstriction
2. Corticosteroids (systemic, pednisone 40-60mg/day) to treat airway inflammation 3. Ipratroprium (atrovent) - to decrease airway secretions and smooth muscle tone |
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Are leukotrienes effective in the treatment of acute asthma exacrerbations or in chronic asthma?
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Chronic asthma
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TRUE or FALSE:
Antibiotics are useful in the treatment of acute asthma exacerbations. |
FALSE!
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If an asthma patient should have to be intubated, what is the induction agent of choice?
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Ketamine
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TRUE or FALSE:
Intubating an asthma patient helps to decrease mortality by 50%. |
FALSE!!!! Intubating asthma pts INCREASES mortality by 50%!
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Name some risk factors for severe exacerbation/death from asthma?
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Prior intubation
Prior ICU admission Multiple hospital/ER visits for asthma Current use of systemic steroids Frequent use of rescue inhalders (MDI) Comorbidity |
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Treatment of CHF exacerbation:
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Nitrates - to reduce preload
Furosemide - for diuresis Morphine - reduce preload ACE-I - Captopril Nesiritide (recombinant B-type natriuretic peptide) - causes arterial & venous vasodilation & natriuresis Dialysis (in renal failure pts) CPAP/BiPAP |
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TRUE or FALSE:
In a pt with CHF exacerbation and elevated blood pressure, the pt should receive BP meds to decrease BP |
FALSE b/c most of the other therapies to treat CHF will subsequently reduce bp.
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TRUE or FALSE:
Anorexia will always be present in pts who present with appendicitis. |
FALSE.
1/3 of all pts presenting with appendicitis do no report loss of appetite. |
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What is obstipation?
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The inability to pass stool or flatus for more than 8 hours despite a perceived need.
This is usually indicative of intestinal obstruction. |
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What are the 2 most commonly missed surgical causes of abdominal pain?
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1. Appendicitis
2. Intestinal obstruction |
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Name some common diseases that can mimic an acute abdomen:
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Pneumonia
DKA Food Poisioning PID |
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TRUE of FALSE:
Plain radiographs (xrays) are always indicated in pts who present with abdm pain. |
FALSE.
Abdominal xrays produce the highest yield in pts with ileus, obstruction, free air under the diaphragm due to perforated viscus, and intussusception. |
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What is the most common diagnosis in a pt who presents to the ER with abdominal pain?
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Abdominal pain of UNKNOWN cause!
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A pt presents with SUDDEN onset of abdm pain. What are the likely causes?
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Perforated viscus
Vascular catastrophe Uteral stone Ruptured ectopic pregnancy Ovarian torsion Ruptured ovarian cyst |
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Common indications for obtaining plain radiographs of the abdomen in a pt with abdm pain
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Foreign body
Intestinal obstruction |
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What test is required of EVERY woman of reproductive age who comes to the ER c/o abdominal pain?
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Urine pregnancy test (B-hCG)
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What is the risk of developing cancer secondary to being exposed to radiation from a CT scan in the following women:
1. Age 70 2. Age 30 3. Age 15 |
1. 1 in 3,330 CT scans will cause cancer
2. 1 in 1,000 CT's 3. 1 in 500 CT's (The younger the pt who is exposed to radiation, the higher the risk of developing cancer) |
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What labs tests should you order in pts presenting with abdominal pain?
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CBC
CMP/BMP Lipase Hepatic function |
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What 2 symptoms are most likely to be seen in a pt with gastroenteritis?
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Nausea AND vomiting
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Name a metabolic etiology that can cause abdominal pain
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DKA
Uremia Hypercalcemia Porphyria |
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Name a toxicology etiology that can cause abdominal pain
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Lead or iron poisoning
Black widow spider bite |
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Name an ENT etiology that can cause abdominal pain
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Streptococcal pharyngitis
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Name a genitourinary etiology that can cause abdominal pain
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Testicular torsion, ovarian torsion
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Name a cardiovascular etiology that can cause abdominal pain
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Acute MI
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Name a pulmonary etiology that can cause abdominal pain
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Pneumonia (especially basilar pna's)
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Common causes of abdominal pain in the elderly
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AAA
Diverticulitis Ischemic Bowel Biliary tract disease |
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Name the condition:
Abdominal pain out of proportion to physical exam |
Mesenteric Ischemia
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TRUE or FALSE:
Research studies have shown that giving pain medication to pts w/ abdominal pain does not alter the diagnostic accuracy of tests/studies. |
TRUE
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TRUE or FALSE:
Pts seen in the ER with c/o abdm pain who are discharged should not be sent home on narcotics for pain control. |
TRUE
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Common causes of abdominal pain in the elderly
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AAA
Diverticulitis Ischemic Bowel Biliary tract disease |
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Name the condition:
Abdominal pain out of proportion to physical exam |
Mesenteric Ischemia
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TRUE or FALSE:
Research studies have shown that giving pain medication to pts w/ abdominal pain does not alter the diagnostic accuracy of tests/studies. |
TRUE
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TRUE or FALSE:
Pts seen in the ER with c/o abdm pain who are discharged should not be sent home on narcotics for pain control. |
TRUE
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Minimum diagnostic criteria for Pelvic Inflammatory Disease
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Cervical motion tenderness
Bilateral adnexal tenderness Lower abdominal tenderness |
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Are most cases of PID mono- or polymicrobial?
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Polymicrobial (N. Gonorrhea, Chlamydia, E.Coli, Peptostreptococcus, Gardinerlla)
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When should a woman with PID be admitted to the hospital for further treatment?
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-If the pt is pregnant
-Pt appears toxic -Dx is uncertain Suspected pelvic abscess, IUD, or recent instumentation -Immunocompromised (HIV, chemo, etc) -Pt is not compliant to do further f/u as outpatient |
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Outpatient tx of PID
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Ceftriaxone (Rocefin) 250 mg IM x1 dose
plus. . . Doxycycline 100 mg PO BID x14 days OR . . . Levofloxacin 500 mg PO BID x 14 days, plus Clindamycin or Metronidazole to improve anerobic coverage |
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Management of Eclampsia/Severe Preeclampsia:
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Delivery of the baby (definitive tx)
Magnesium: 2-6 gm IV bolus, then 2 gm ABC's Fetal Monitor OB/Gyn consultation |
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If a woman who has eclampsia continues to have elevated blood pressure (especially if the DBP remains > 110 mmHg), what other drugs can you give to lower bp?
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Hydralazine
Labetolol |
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In a woman whom you suspect has PID, you are going to obtain a UA to r/o UTI. How should you obtain the urine sample?
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You should get a in/out catheter-obtained sample.
Clean catch urine samples are not acceptable because the urine can easily be contaminated from vaginal secretions |
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In a patient who has overdosed on Tylenol, when should you check a Tylenol level?
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4 hours after the last ingestion
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What labs/studies should you check in a pt who has overdosed on prescription medication?
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Check a Tylenol level 4 hours after the last ingestion (normal is < 30 mcg/mL)
Check a salicylate (aspirin) level Check a total CK level (to check for rhabdomyolyisis) Check a EKG (arrhythmias, QT prolongation, etc.) Urine drug/tox screen Call the Poison Center |
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What are the top 3 complications from overdosing on prescription medications that lead to the most morbidity and mortality?
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Aspiration pneumonia
Rhabdomyolysis Anoxia |
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What lab will help you identify rhabdomyolysis in a pt with drug overdose?
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Presence of RBC's on urine dipstick, despite not seeing microscopic blood
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First line agents in the treatment of toxin-induced seizures
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Benzodiazepines
Barbituates |
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What is the antidote for the following drug overdose:
Tylenol (Acetaminophen) |
N-acetylcystiene
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What is the antidote for the following drug overdose:
Beta blockers |
Glucagon
|
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What is the antidote for the following drug overdose:
Cyanide |
Amyl nitrate, sodium nitrite, sodium thiosulfate
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What is the antidote for the following drug overdose:
Ethylene glycol |
Ethanol, fomepizole
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What is the antidote for the following drug overdose:
Lead |
EDTA
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What is the antidote for the following drug overdose:
Opioids |
Naloxone (Narcan)
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What is the antidote for the following drug overdose:
ASA |
sodium bicarbonate
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What is the antidote for the following drug overdose:
organophosphates |
atropine, pralidoxime
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What is the minimum dose of acetaminophen that can cause toxic liver injury?
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7.5 gm (150 mg/kg body wt) in adults
200 mg/kg in children |
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During what phase of acetaminophen toxicity does the pt experience RUQ pain and a rise in hepatic enzymes?
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Phase II (24-72 hrs post ingestion)
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During what phase of acetaminophen toxicity is a pt most likely to die from their overdose?
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Phase III (72-96 hrs post ingestion)
Hepatic necrosis, encephalopathy, and jaunduce |
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How does N-acteylcystiene work in the detox of acetaminophen overdose?
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NAC is a precursor of glutathione and as such, increases glutathione conjugation of NAPQI.
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What area of the liver is the most susceptible to injury from acetaminophen overdose and why?
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Centrilobular - b/c this area contains the most p450 but the least gluathione
|
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What toxins can be removed via dialysis?
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Alcohols
Lithium Theophylline Salicylates (aspirin) |
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What are the Centor criteria for dx of Group A Strep pharyngitis (GAS)?
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1. Fever
2. NO cough! 3. Tonsillar exudates 4. Anterior cervical lymphadenopathy pts scoring 0-1 unlikely to have GAS infection, and pts w/ a score of 4 are more likely to have GAS |
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Most cases of pharyngitis are caused by viruses. What are the most common viral etiologies?
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Adenovirus (commonly assoc'd with conjunctivitis)
CMV EBV Cocksackie virus |
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You have a pt who presents with pharyngitis and is now developing difficulty breathing. You think his airway might become compromised. After assessing ABC's, you decide to do further testing with imaging. What imaging should you order?
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Lateral neck film should be taken in patients with suspected epiglottitis or airway compromise.
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What is the main reason abx are given to treat GAS pharyngitis?
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The main reason they are given is for prevention of acute rheumatic fever.
Abx have been shown to only shorten the duration of illness by 1 day! |
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A 23 yo old male presents to the ER with c/o breathlessness, wheezing, chest tightness, and coughing that began after exposure to some household cats (which he is severely allergic to). What is the most likely dx?
|
Acute asthma exacerbation
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DDX of wheezing
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Asthma
COPD Foreign body aspiration CHF Anaphylaxis Epiglottitis Reactive airway dz Viral respiratory infection Vocal cord dysfunction |
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What are the important questions to ask a pt who presents with asthma exacerbation?
|
-Previous hospitalizations for asthma
-Previous need for intubation -Increase in the number of ER visits for asthma -Exposure to triggers (allergens, cold air, exercise) -Increased use of inhaler |
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At what temperature is fever defined?
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38.0 C = 100.4 F
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Name the gold standard method for taking a child's temperature
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Rectal temperature
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Name some serious bacterial infections (SBI) commonly seen in infants/children
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Meningitis
Septicemia Bone and Joint infections UTI Pneumonia Bacterial gastroenteritis |
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Infants 0 - 28 days with a fever w/o a source require what type of work up?
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Full sepsis workup
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What tests comprise a full sepsis workup (done on febrile children age 0-28 days)?
|
CBC
Blood Cx U/A Urine cx LP Empiric Abx Admit to hospital Also get CXR if respiratory sx are present, and stool analysis for WBC if diarrhea is present |
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Name some common causes of pediatric fever due to viruses:
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Varicella
Measles Mumps Adenovirus Coxsackievirus (Herpangina, Hand-Foot-Mouth dz) Croup Influenzae Brochiolitis |
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Name some common causes of pediatric fever due to bacterial infections:
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Pneumonia
Meningitis Septic Arthritis Osteomyelitis Lymphadenitis Cellulitis Bacterial enteritis |
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What criteria are used to risk stratify low-risk pediatric patients who present with fever?
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Rochester criteria
Philadelphia criteria |
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What are the Rochester Criteria for Pediatric pts with fever?
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Clinical Criteria:
--Term infant, previously healthy, uncomplicated nursery stay --Non-toxic appearing --No signs of bacteria infection on exam Lab Criteria: --WBC count 5-15,000/mm3, <1,500 bands/mm3, band:neutrophil ratio <0.2 --Urine showing <5 WBC/hpf, neg Gram stain, or neg leukocyte esterase and nitrites --If diarrhea +, <5 WBC/hpf in stool --CSF <8 WBC/mm3, and neg Gram stain |
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What antibiotic treatment option should you start in a pediatric patient who meets all of the Rochester criteria?
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Outpatient management with Ceftriaxone 50 mg/kg IV/IM and have the pt reevaluated in 24 hrs
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What are the top 3 causes of occult bacteremia in children ages 3-36 months?
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#1 Streptococcus pneumoniae (85% of occult bacteremia in this age group)
#2 Haemophilus influenzae #3 N. meningitidis |
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You are evaluating a 12 month old child who is well-appearing and has a fever without a source. Should you obtain a CBC and blood cultures?
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No! It is not necessary in this case.
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You are evaluating a child who is 24 months old with fever. They appear toxic. What should your management of this pt be?
Would your management change if the same pt was non-toxic? |
Admit the pt, perform a full workup!
If the pt is non-toxic, you should only begin a thorough workup when their fever is 39 C (102.2 F) |
|
TRUE or FALSE:
UTI's are almost always occult in children < 2 yrs of age. |
TRUE
|
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You have a child who is 18 months old who you suspect has a UTI. How should you obtain a urine sample for testing?
|
Get a cath specimen (suprapubic or trans-urethral) b/c getting a clean catch sample is impossible!
Always get a urine cx if you are able to get a urine sample. |
|
TRUE or FALSE:
The majority of pneumonias in infants and young children are bacterial in origin. |
FALSE!
Most etiologies are viral (RSV, parainfluenza, Chlamydia) But, children with high fever and leukocytosis are more likely to have a occult bacterial pneumonia |
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When should a pt receive a tetanus shot?
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If it has been more than 5 years since their last tetanus shot.
|
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What patients should receive tetanus immune globulin (TIG) as opposed to tetanus toxoid?
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Pts who have incomplete tetanus immunization (< 3 injections)
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Risk factors for venous thomboembolism
|
Previous hx of DVT
Malignancy Advanced age (>60 yrs) Recent operation during past 4 weeks Bed rest > 3 days Immobilzation |
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What is the most frequent EKG finding in persons with suspected pulmonary embolus?
|
Sinus tachycardia
|
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What is the importance of getting a CXR in pts who are suspected to have an pulmonary embolus?
|
To rule out other causes of dyspnea such as pneumonia, pneumothorax, CHF
|
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If you have a patient with a DVT who cannot receive anticoagulation therapy, what other option do you have to prevent blood clots from reaching the lungs?
|
IVC filter
|
|
Name this condition:
Sudden onset of cough and dyspnea w/ exertion, blood-tinged sputum, tachycardia, rales/crackles, and low-grade fever. |
Pulmonary embolus
|
|
In the diagnosis of PE, does the d-dimer test have greater positive predictive value or negative predictive value?
|
Negative predictive value (meaning, if the d-dimer level is low/normal in a person suspected to have PE,it is not likely they have a PE)
|
|
Treatment for pulmonary embolism
|
Start with IV heparin followed by bridging to warfarin
|
|
What is syncope?
|
A sudden and brief LOC with loss of postural tone (arrhythmic, no movement!) with spontaneous AND complete recovery (unlike seizures where there is a post-ictal state)
The pt must wake up WITHOUT any intervention. |
|
Name some conditions that are often mistaken for syncope:
|
AMS
Intoxication (alcohol, drugs) Stroke Seizure |
|
Common prodrome of syncope
|
Nausea
Diaphoresis Lightheadedness |
|
What are the two most dangerous accompanying conditions with syncope that you should be worried about?
|
Syncope with chest pain (cardiac) or with dyspnea (pulmonary)
|
|
TRUE or FALSE: Most pts with syncope do not require a head CT
|
TRUE
Get a head CT if the pt has syncope with other neurological symptoms |
|
Most common cause of syncope
|
Neurocardiogenic
|
|
What are the 2 causes of isolated syncope?
|
Cardiac and neurocardiogenic
|
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What are some distinguishing factors in identifying cardiac vs neurocardiogenic forms of syncope
|
Cardiac
|
|
Risk factors for bad outcomes at 1 year post-syncopal episode in pts who presented to the ED with syncope
|
Abnormal EKG
Age > 45 Hx of CHF Hx of ventricular arrhythmia |
|
What type of hallucinations are assoc'd with delerium? With psychosis?
|
Delerium - visual
Psychosis - auditory |
|
What are the components of a Coma cocktail
|
Glucose - start D50 fluids
Naloxone (Narcan) - pts with narcotic overdose Thiamine - alcoholics *This cocktail is not often used |
|
TRUE or FALSE:
Polypharmacy is not a common cause of altered mental status. |
FALSE!
|
|
A unilateral, dilated pupil in a comatose pt is concerning for what type of brain abnormality?
|
Uncal herniation
|
|
A bilateral, fixed, and dilated pupils in a comatose pt is concerning for what type of brain abnormality?
|
Anoxic brain injury
|
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Non-reactive pinpoint pupils in a comatose pt even after administration of Narcan is concerning for what type of brain abnormality?
|
Pontine insult
|
|
You are evaluating a pt in the ED who just suffered a seizure. What oral physical exam findings are consistent with a dx of seizure?
|
Bilateral lateral tongue lacerations (from biting down on the tongue during the seizure)
|
|
Diagnostic workup for acute stroke
|
EKG - to establish the rhythm
Glucose - to assess for hypoglycemia Head CT - to determine the presence of intracranial hemorrhage, old CVA, or acute changes assoc'd w/ stoke |
|
Acute therapy for stroke
|
IV TPA
Intraarterial TPA Tight glucose control Decompressive Hemicraniotomy |
|
What are the inclusion criteria for administering thrombolytics in pts with acute stoke?
|
Age >18
Clinical dx of acute ishemic strokestroke based on measureable neurological deficits Symptom onset is less than 180 minutes from the time of administration of thrombolytics |
|
Absolute contraindications for the administration of thrombolytics in pts with acute stroke
|
--Minor or rapidly improving stroke symptoms
--SBP > 180 or DBP > 110 mmHg --Any hx of prior ICH --Head CT that shows intracranial bleeding or areas of hypodensity (suggestive of hemorrhage) |
|
What preventative therapy should be started in pts who have previously suffered a stroke?
|
ASA
Platelet aggregation inhibitors (Plavix, Ticlid --> used in pts who cannot take ASA or who have had a stroke while on ASA) |
|
Conditions that can mimic acute stroke
|
Hypoglycemia
Todd's paralysis Complex Migraines Conversion d/o |
|
Treatment of active seizure
|
Benzodiazepines (lorazepam, diazepam) --> when doses of benzos are maxed out, use fosphenytoin or phenobarbital
Oxygen via non-rebreather mask Put bedrails up to protect the patient |
|
Work up of new-onset seizure
|
Electrolytes
Non-contrast head CT Outpatient EEG |
|
TRUE or FALSE:
A pt who has suffered a first time seizure should be discharged on anti-epileptic drugs |
FALSE
Only start anti-epileptic drugs when the pt has had multiple seizures |
|
TRUE or FALSE:
First time seizures provoked by alcohol withdrawal, sleep deprivation, metabolic or drug related causes should be treated with anti-epileptic drugs. |
FALSE
|
|
First line drug therapy for treatment of active seizure that had lasted longer than 2 minutes
|
Benzodiazepines via IV route --> lorazepam (Ativan) is usually the first choice
|
|
Most COMMON cause of first trimester bleeding
Most SERIOUS cause of first trimester bleeding |
Threatened abortion
Ruptured ectopic abortion |
|
Name this type of abortion:
Closed internal cervical os with vaginal bleeding in the 1st trimester |
Threatened abortion
|
|
Name this type of abortion:
Internal cervical os is open on speculum examination |
Inevitable abortion
|
|
Name this type of abortion:
Products of conception present in the cervical os or the vaginal canal |
Incomplete abortion
|
|
Name this type of abortion:
Conceptus dies, but is not passed with retention of the products of conception in utero |
Missed abortion
|
|
The current standard medical treatment of unruptured ectopic pregnancy is?
|
Methotrexate (MTX) therapy
|
|
What are the most likely etiologies for a patient who presents to the ED "found down"?
|
T - trauma, temp
I - infection P - psychiatric S - space occupying lesion, stroke, SAH, shock A - Alcohol E - Endocrine, electrolytes, epilepsy I - Insulin, diabetes O - opiates, oxygen U - uremia, hypertensive encephalopathy |
|
What is the most important question to ask any female of reproductive age who presents to the ED with c/o sharp RLQ pain?
|
Is she pregnant or not!!!
|
|
A positive urine pregnancy test corresponds to what serum concentration of bHCG?
|
10
|
|
What should initial TREATMENT be in a female pt of child bearing age who presents to the ED with c/o RLQ pain and nausea.
|
Hydration with IV fluids
Anti-emetics (Zofran, Phenergan) Pain medication |
|
You have treated a female pt of child bearing age who presented with crampy lower abdm pain and nausea. You have determined that she is well enough to be discharged. When (time frame) should the pt return to the ED if her sx's worsen/don't improve?
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Return if sx's do not improve within 8-12 hours
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Name the most common causes of bleeding in a NON-PREGNANT woman?
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Trauma
Hormonal irregularities (DUB) Fibroids Depo-provera If post-menopausal, always think endometrial cancer until proven otherwise |
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Name the most common causes of bleeding in a PREGNANT woman?
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Ectopic pregnancy
Abortion (Threatened, Spontaneous) Molar pregnancy (if uterus is large for dates) |
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At what beta hCG level should an intrauterine pregnancy be visible on transvaginal ultrasound?
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> 1500
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Early in pregnancy, how often should the beta hCG level double
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Q48-72 hours
If levels are lower, this indicates an abnormal IUP (but cannot distinguish ectopic from failing IUP) |
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TRUE or FALSE:
In early pregnancy, a beta hCG level that is below normal (for expected gestational age) can be used to distinguish an ectopic pregnancy from a failing IUP. |
FALSE!
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TRUE or FALSE:
All pregnant bleeding women and those pregnant women who are involved in a trauma should receive a Rhogam work up. |
TRUE
In early pregnancy, give 50 mcg IM After the 1st trimester, give 300 mg IM |
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What is a spontaneous abortion?
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Termination of pregnancy before 20 week gestation or before the fetus could reach 500 gm.
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TRUE of FALSE:
A woman with a complete abortion will still have vaginal bleeding. |
FALSE! All bleeding has stopped, cervical os is closed, products of conception have been expelled.
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In comparison of the presentation of ectopic pregnancy vs. spontaneous abortion, when does crampy abdominal pain usually occur?
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EP - pain is usually the first and most prominent symptom!
Spontaneous AB - pain usually occurs AFTER onset of bleeding |
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Risk factors for developing an ectopic pregnancy include:
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PID
IUD Previous ectopic Tubal ligation Infertility treatment |
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Which patient is more likely to be having an ectopic pregnancy?
Pt A: Crampy, unilateral lower quadrant pain that occurred before the onset of vag bleeding Pt B: Crampy abdm pain that began after onset of vag bleeding, pt has non-tender adnexa on physical exam |
Patient A
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Management of ectopic pregnancy should include what?
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Hydrate with IV fluids
Pain control OB consult Methotrexate if early in pregnancy and pt is minimally symptomatic Follow serial hCG's if dx is in question |
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Top 3 clinical signs of preeclampsia
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Hypertention > 140/90 or > 30/15 from baseline
Proteinuria Edema (usualy face and hands) |
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Name the 2 classes of drugs that you should use to perform rapid sequence intubation in the EG
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Use a paralytic (succinylcholine) and a sedative (etomidate)
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How long should you assess for breathing in a pt whom you have found down in the field before administering 2 rescue breaths?
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Assess breathing for 10 seconds
An occasional gasp of air does not count! |
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During cardiopulmonary resuscitation, how many breaths should you deliver to the pt per minute?
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8-10 breaths per minute
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What doses of epinephrine and atopine should be used in the treatment of asystole?
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Epi 1 mg IV push
Atropine 1 mg IV push |
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In a pediatric patient who has gone into cardiac arrest, if you cannot establish IV access, what is the next best option to obtain vascular access?
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Intraosseous line
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What distinguishes anaphylaxis from an anaphylactoid reaction?
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In anaphylaxis:
--prior exposure to the allergen is necessary. --Histamine release mediated by IgE --Can be triggered by a SMALL exposre Anaphylactoid rxns: --no prior exposure to the allergen is necessary --Histamine is released directly (no IgE required) --Large systemic exposure is required |
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TRUE or FALSE:
For treatment of MILD forms of anaphylaxis, IV epinephrine should be used/ |
FALSE
Use IM epineprine at 0.3-0.5 mg of 1:1000 dilution Q 3-5 minutes |
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What dilution of epinephinre should be used for SEVERE cases of anaphylaxis?
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0.1 mg of 1:100,000 dilution epinephrine
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Most causes of pulseless electrical activity are a result of what type of disorders?
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Profound metabolic disorders
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In patients presenting with cardiac chest pain, what is their goal pain rating on a pain scale? Why?
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Only pts with cardiac pain should the goal be 0/10 because the presence of any chest pain indicates that myocardial damage is still occurring.
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For patients with non-cardiac pain, what should be their goal for pain relief
?/10 |
0-3/10
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What age child is old enough to begin using the visual analog pain scale (different smiley faces with pain expressions)
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Age 6-7 yrs and up
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What is the difference between pain relief and analgesia?
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Analgesia is COMPLETE absence of pain
Pain management is the reduction of perceived pain, but the pt may still be able to experience/feel some degree of pain |
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The best route of pain medication delivery is what?
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IV because IM injections cannot be titrated, painful injections, and has erratic absorption
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TRUE or FALSE:
How a pt responds to pain medication always depends on their age, weight, and sex. |
FALSE! Factors that affect how a pt responds to pain include:
--number of opioid receptors --Pt's psychological state --Pt's previous attitude/experience toward pain --Extent of neurtotransmitter release |
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TRUE or FALSE:
All people have the same number of opioid pain receptors. |
FALSE! We have different concentrations of mu, delta, kappa, and sigma opioid receptors.
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Name the form of opioid receptor involved with increased respirations and mydriasis
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Sigma
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Name the form of opioid receptor involved with euphoria, urinary retention, dependence, tolerance, and bradycardia
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Mu
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Name the form of opioid receptor involved with diuresis
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Kappa
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What is the generic name for Dilaudid?
How many times stronger is it compared to morphine? |
Hydromorphone
7.5 x as strong as morphine, but has a slower onset than morphine |
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What opioid is assoc'd with the highest incidence of hypotension?
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Hydromorphone (dilaudid)
*Risk of hypotension is due to histamine release |
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What morphine analog is 100x stronger than morphine?
Is this drug assoc'd with hypotention? Why or why not? |
Fentanyl
Not assoc'd with causing hypotension, therefore not assoc'd with a histamine release |
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The most constipating of all the opioids is. . .
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Codiene
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What is the generic name for Demerol?
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Meperidine
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What is the generic name for Darvocet?
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Propoxyphene
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What is the generic name for Toradol?
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Ketorlac
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10 mg of morphine = how many mg of dilaudid?
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1 mg
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10 mg of morphine = how many mg of dilaudid?
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1 mg
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