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25 Cards in this Set
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Pt w/ 1day localized small swelling along margin upper eyelid, feels pain, not on conjunctiva.
ML Dx? Cause? TMT? Does not resolve after 48hr, next step? |
External hordeolum or stye
-staphylococcus abscess eyelid -Warm compresses -after 48hr, I & D |
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5yo pt to ED w/ cat bite in arm, vitals WNL.
Steps? |
1. clean wound w/ betadine and lavage w/ saline
2. prescribe amoxicillin/clavulonate for 5 days (ppx against pasteurella multocida) |
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5yo pt bitten by cat 2 days ago. Now has considerable pain, erythema, swelling at bite site w/ fever and lymphadenopathy.
ML Dx? TMT? |
Pasteurella infxn
-amoxicillin/clavulonate |
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Pt took 20 acetominophen, now in ED.
Steps! Sx of ingestion |
1. w/in 4 hrs, give activated charcoal (decrease absorption)
2. at 4hrs, take acetaminophen blood level (since that is time used to predict hepatoxiticity) 3. If level hi, give N-Acetylcystein (effective w/in 8hrs of ingestion) -nonspecific: naus/vom/anorexia -->hepatotxicity |
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Pt to ED in suicide attempt w/ confusion, appeared to suffer seizure, BP 70/40, pulse 40, RR 12, diffuse wheezing, cold/clammy extrems, AV block on EKG. No response to IV fluids and atropine.
ML Dx? TMT Step? |
Beta-blocker overdose (AV block, hypotension, wheezing, bradycardia)
Steps: 1. IV fluids and Atropine (to reverse effects) 2. if fails, give glucagon (increase cAMP to increase intracellular Ca augmenting cardiac contractility) |
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Pt to ED in suicide attempt w/ RR 12, BP 120/70, blurred vision, fatigue, HA, abd pain, seeing "odd colors of world"
ML Dx? TMT? |
Digoxin toxicity
-Dig specific antibody (Dig Fab) (Stop Dig and KLAM=normalize K, lidocaine, anti-dig fab fragments, Magnesium) |
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What drugs can cause Hyperkalemia?
What are signs hi K? TMT to acutely reduce a hi K? What to do after tmt? |
-ACEI, ARB, spironolactone, trimethoprim, pentamidine
-weakness (1st), flaccid paralysis, respiratory insufficiency, cardiac tox, sine wave on EKG, vfib -Sodium polystyren sulfonate -Review all current medications |
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Pt to ED w/ vomiting and abd pain. Given fluids and metoclopramide. Now has neck pain and stiff tender neck muscles.
ML dx? TMT? |
Metoclopramide-induced dystonic rxn (dopamine receptor antagonist for naus/vom/gastroperesis)-->can cause all symptoms of typical antipsychotics (EPS, tardive dysk, acute dystonia, NMS)
-Benztropine, trihexyphenidyl, diphenhydramine |
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Depressed pt overdosed in suicide attempt, has febrile, low BP, seizures, EKG wide QRS (0.18sec), dry mouth, urinary retention
ML Dx? TMT? What tmt does? |
TCA overdose (has anticholinergic effects: dry mouth, hyperthermia, dilated pupils, ileus, QRS prolonged, ventr arrhythmia, seizure, hypOtension)
Sodium Bicarbonate -alleviates cardio-depressant tca action by acting on sodium channels to narrow QRS complex |
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Boy w/ multiple vomiting, abd pain for 2hrs, coffee ground emesis, irritable, BP 80/50, extrem cold to touch, bicarb 18, abd imaging shows radioopaque tablets in stomach. IV fluids given.
ML Dx? TMT? |
Iron poisoning (in prenatal vitamins)
-fluid resuscitation and IV deferoxamine (binds Fe allowing urinary excretion) |
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Sx of Iron intoxication?
Dx test |
5 phases:
GI phase: 30min-6hr, direct mucosal damage->naus/vom/hematemesis/melena/abd pain Latent Phase: 6-24hrs, nothing Shock and met acidosis: 6-72hrs after Hepatotoxicity: 12-96hr Bowel obstruction 2/2 mucosal scarring: weeks after -Dx w/ serum iron concentration |
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Farmer attempts suicide, has emesis over body, lacrimation, rhinorrhea, abd pain, polyuria, diarrhea, RR 12 w/ SOB
ML Dx? TMT steps? |
1. Atropine
2. decontaminate patient (remove clothing since absorbed through skin) -Pralidoxime (acetylcholinesterase agonist) is antidote -Physostigmine (acetylcholinesterase antagonist) is contraindicated |
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Findings in methanol poisoning?
TMT? |
Vision loss (optic disc hyperemia), anion gap met acidosis, osmolar gap
-fomepizole, dialysis if insufficient |
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What is best indicator severity of TCA intox?
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Duration of QRS complex (tmt w/ sodium bicarb)
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Difference opiate intox from benzo intox?
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opiate intox has miosis and severe resp depression whereas benzo has neither (mild resp depression), but lots drowsy
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Findings in phenytoin toxicity?
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horizontal nystagmus, ataxia, confusion
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Pt w/ hx schizophrenia managed, found outside asleep in winter morning w/ temp 34C (90F).
ML Dx? Pathophys? |
Fluphenazine (injectible hi potency typical antipsychotic for poor compliance patient)
-causes hypothermia by disrupting thermoregulation and inhibiting body shivering mechanism. Tell pts avoid extreme temps |
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TMT for opioid withdrawal?
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methadone replacement in emergency setting
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Opiate intox has hypo or hypertension?
Cause? |
HypOtension
-from histamine release |
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Pt w/ bitter almond breath.
ML Dx? Burning what? |
Cyanide inhalation (sx similar to CO poisoning)
-burning rubber or plastic (not wood as in CO) |
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What conditions predispose to Torsades?
What is pathophys? TMT? |
familial long QT syndrome, malnourished (from low mg) as in alcoholics, TCAs, amiodarone (class 3 antiarrythmic), sotalol (class III antiarrythmic), anti-infectives (moxifloxacin, fluconazole)
-Path due to increasing long QT from low mg -give Mag Sulfate |
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Patient ingested Lye caustic agent.
Alkali or Acid? TMT steps? |
Alkali (NaOH)
1. vigorous IV hydration 2. endoscopy to assess for perforation 3. if perf suspected->gastrografin study |
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rotatory nystagmus=?
TMT? |
PCP intox
-benzo to treat agitation |
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Pt overdoses, confused, drowsy, ataxic, blurred vision, dry skin, dilated pupils, urinary retention, hx asthma, insomnia.
ML dx? TMT? |
diphenhydramine intox (has antihistamine and anticholinergic effect)
-Physostigmine (cholinesterase inhibitor) |
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1yr old boy moved into old house, fingerstick w/ lead level 12 (normal <10).
Next step? What if 50 |
Re-check w/ serum Lead level (since capillary fingerstick can have false positive)
-if confirmed, remove child from house -if >45, chelation therapy w/ dimercaprol or succimer or EDTA -if <20, recheck in 1 month after thorough hx and counseling. |
