EM E2 random questions

what are the physical findings due to neglect seen in infants?

diaper rash

alopecia

ribs showing

sunken

not meeting milestones

dirty

injuries

what are the physical findings due to neglect seen in school aged children?

stealing food

absent

emotionally withdrawn

poor eye contact

aggressive

poor dental health

fall asleep during school

dirty and unkempt

what are the findings of sexual abuse seen in children?

STDs

warts

ulcers

vesicles

store all evidence in paper bags !

what are the signs of physical abuse seen in children?

adult bite → 3 cm

cig burn → 5 mm

scald burns

skeletal injuries

abd/head injuries

what is mandatory in evaluation for Munchausen by proxy?

social services and psych eval

what are the s/sx of Munchausen by proxy?

bleeding

seizures

AMS

apnea

D/V

fever

rash

multiple organ involvement

MC biological mothers

what is the MC injured organ in blunt trauma?

liver then spleen***

what is the MC injured organ in penetrating trauma?

liver then small bowel

what is the gold standard tx for intra-abd injuries?

laparotomy

what is the etio of herpangina?

coxsackie virus

which Le Fort fracture involves only the maxilla at the level of the nasal fossa?***

1 → speak no evil

which Le Fort fracture involves the maxilla, nasal bones, and medial aspects of orbits?

2 → see no evil

which Le Fort fracture involves the maxilla, zygomatic, nasal, ethmoid, and vomer and the lesser bones of the cranial base?

3 → hear no evil

what is posterior displacement of the eye within the orbit? what other sx are seen?

enophthalmos*** → impaired ocular motility, diplopia, infraorbital hypesthesia

clouding of the maxillary sinus on the side of trauma is ____________ ___________ until proven otherwise***

orbital fracture

emphysema of orbit is a sx of which dx?

orbital blowout fracture

what is the MC ligamentous injury of the hand?

PIP → via axial load and hyperextension

which elbow dislocation is MC?

posterior

what does a fat pad sign indicate?

bleeding into soft tissue or pathological fracture

which shoulder dislocation is MC?

anterior

which odontoid fracture: fracture of the upper part of the odontoid peg?

1

which odontoid fracture: fx of the base?

2

which odontoid fracture: through the odontoid and into the lateral masses of c2?

3 → best prognosis

what is the MC hip dislocation?

posterior → force applied to flexed knee

what are the complications of a posterior hip dislocation?

sciatic nerve injury

AVN

which hip fx: abducted, externally rotated, flexed?***

anterior

which hip fx: adducted, internally rotated, shortened?***

posterior

what are the precipitating factors for DKA?

- T1DM

- poor insulin compliance

- stress

- infection/UTI → klebsiella

what are the s/sx of DKA?

dehydration

hypotension

AMS

N/V

kussmaul breaths

fruity breath

what are the complications related to tx of DKA?

1. hypoglycemia, hypokalemia, hypophosphatemia (gradually correct to avoid this)

2. cerebral/pulm edema

3. ARDS (from aggressive fluid tx, shift of fluid across pulm capillary membrane)

what do labs look like in DKA?

serum ketones > 5

blood glucose > 250

bicarb < 18

pH < 7.2 (HAGMA)

HYPOkalemia

ketonuria

glucosuria

what is the treatment for DKA in ORDER?

1. fluids → 1-3 L of NS in the first hr

2. insulin and/or potassium (after labs)

3. phosphate, magnesium, bicarb

what NIHSS score indicates a severe stroke?***

REALLY HIGH = REALLY BAD

dont need to know numbers

what are the sx of cluster HA?***

severe unilateral orbital/supraorbital/temporal pain lasting 15-180 mins with at least one of the following:

- ipsilateral conjunctival injection

- lacrimation

- nasal congestion

- rhinorrhea

- facial swelling

- miosis

- ptosis

peripheral or central vertigo: sudden onset, horizontal nystagmus, hearing loss, fatigue of s/sx?***

peripheral →paroxysmal, intense spinning, rotary vertical or horizontal nystagmus, frequent nausea/sweating, aggravated by movement, hearing loss/tinnitus, ABSENT CNS s/sx

peripheral or central vertigo: constant, vertical nystagmus, CNS symptoms?***

central → sudden/slow onset, less intense vertigo, constant pattern, vertical nystagmus, no fatiguing of symptoms, no hearing loss/tinnitus, no abnormal TM, CNS sx present

what is the MC etio of toxic shock syndrome (TSS) in women aged 15-24?

staph

what is the MC etio of TSS in women aged 20-50?

strep

what are the s/sx of TSS?

- female w retained tampon

- high fever

- chills

- body aches

- erythematous desquamating rash → palms and soles!!

what is the tx for TSS?

inpatient → vanco + clinda

what is the difference between periorbital cellulitis and orbital cellulitis?

EOMs are PRESERVED in PERIorbital and IMPAIRED in orbital

Peri = preserved

what is the tx for periorbital cellulitis?

mild/mod → augmentin

severe → rocephin + vanco IV

what is the tx for orbital cellulitis?

vanco + rocephin

get contrast CT of orbits + paranasal sinus

pt presents with unilateral facial paralysis, peripheral vertigo, and hearing loss with vesicles in their ear canal. what is the dx?

Ramsay hunt → reactivation of VZV → affects CN 7

what formula is used to calculate fluid replacement for burn patients?***

Parkland Bourne

(4ml x body wt (kg) x BSA %) / 1000 = L over 24 hrs

half given in 8 hrs, second half in 16 hrs

pt presents with burns across the abdomen, chest, left arm and left hand. pt weighs 71 kg. what volume of IV fluids should be given in the first 8 hrs of treatment?

(4 x 71 x 28)/1000 = 8 L in 24 hrs

4 L in first 8 hrs

what is the MC fish envenomation cause?

stingrays → tx with hot water soak

what is the MC cause of nonbacterial fish poisoning?

Ciguatera → N/V/D, abd pain, body chills, itching, HA, perspiration, dizziness, muscle pain, weakness/cramps, tingling, numbness

which dx has pathognomonic symptom of reversal of hot and cold tactile perception?

ciguatera → tx with IV mannitol and benadryl

pt presents to the ER from the beach with multiple linear, very painful "whiplike" urticarial lesions. what is the tx?***

portuguese man-of-war attack → sea water, acetic acid (vinegar), remove nematodes

NOT HOT WATER

pt presents with morbilliform pruritic dermatitis after returning from beach vacation. the rash is present in areas covered by her bathing suit and her itching is worse at night. what is the dx?

sea bathers eruption → tx with benadryl, calamine lotion, hydrocortisone

what tis the MCC of death via envenomation?

hymenoptera stings (bees, wasps, ants)

which fracture: distal radial metaphysis fracture that is DORSALLY angulated?***

Colles → the FRAGMENT moves dorsally (back of the hand) (not the shaft) → dinner fork deformity

know imaging

which fracture: volar/VENTRAL angulated fracture of the distal radius?***

smith → fragment moves towards the PALM

know imaging!!!

what should be ordered if SAH is suspected?

lumbar puncture

what should be ordered for CVA/stroke pts?

- CT non contrast

- EKG

- CXR

- 3 Ps → PT, PLT, PTT

- MRI (after CT)

- cerebral angiography

which HA: bilateral, non-pulsating, not worse with exertion, no N/V?

tension

which HA: N/V, photophobia, phonophobia, lightheadedness?

migrane

which HA: worse HA of your life?

SAH

MC caused by berry aneurysm

which dx presents with severe unilateral pain in the trigeminal nerve lasting only seconds?

Tic Douloureux → tx w carbamazepine

what is the imaging of choice for sternoclavicular dislocation?

CT

what is the tx for trichomonas vaginialis?***

flagyl → avoid alcohol!!***

what are the s/sx of trich?***

strawberry cervix → erythematous with petechial hemorrhages

what are the tx for gonorrhea, chlamydia, syphilis, HSV, granuloma inguinale?

gonorrhea = rocephin

chlamydia = doxy

syphilis = pen G

HSV = antivirals (any)

granuloma inguinale = azithro

which nerve is compressed in colles fracture resulting in paresthesias?

median nerve

pt presents with pain and numbness in thumb and first 2 fingers that is worse at night. what special tests can be used for diangosis?

carpal tunnel → Tinels and phalens

what is an avulsion fracture of FDP from its insertion?

Jersey finger

what is the MC site of tendon injuries?

extensor tendons

mallet finger may develop a _______ _______ deformity?

swan neck → flexed DIP and extended PIP

which deformity is caused by a flexed PIP and extended DIP?

boutonniere

what are the hallmark findings of heat stroke?***

- cerebral dysfunction with impaired consciousness

- high fever

- absence of sweating

SALTER HARRIS FRACTURES!!!!!!!!!!!!!!!!!!!!

........................................... :|

rule of 9s***

Head and neck = 9%

Upper Ex = 9% each

Lower Ex = 18% each

Front trunk = 18%

Back trunk = 18%

Groin, hands = 1%

burns to which body parts warrant admission?

hands

feet

face

perineum

what is the tx for tylenol toxicity?

mucomyst

activated charcoal within 1 hr

what is the tx for aspirin toxicity?

charcoal within 1 hr

bicarb if acidotic

dialysis for severe

what is the tx for anticholinergic toxicity?

Physostigmine

charcoal within 2 hrs

pt presents to the ED with reports of overdose but can't remember which drug. they report yellow vision and EKG shows ST-T changes. what is the antidote?

digoxin toxicity → digibind

what are the sx of BB toxicity?

bronchospasm

bradycardia

hypoglycemia

what are the sx of CCB toxicity?

hypotension

bradyarrhythmia

hyperglycemia

what are the sx of nitrate/nitrite tox?

orthostatic hypotension

lightheaded

syncope

tachy

diaphoresis

tx with methylene blue

toxic levels of which class of drugs can cause prolonged PR, QRS, and QT interval?

TCAs

what is the tx for tox of insecticides?

cholestyramine

what is the mainstay of tx for iron toxicity?

deferoxamine chelation

what does activated charcoal not bind to?

alcohols

what is the tx for seizures?

benzos first

phenytoin for pts who continue to seize despite benzos!!

which findings help confirm that a patient had a seizure prior to presenting to the ED?

tonic clonic movements

urinary/bowel incontinence

post-ictal confusion

tongue biting

bells palsy or stroke: unilateral facial weakness. patient is unable to lift eyebrows

bells palsy!!!! → includes forehead

stroke spares forehead → able to lift brows and have forehead wrinkling

how many ribs are broken to cause flail chest?

2 or more contiguous rib fractures with 2+ breaks PER rib

what is the test of choice for eval of blunt neck trauma?

CT angiogram

what is the tx for carbon monoxide poisoning?

O2

what is the major Duke criteria?***

blood cultures positive

endocardial involvement

what is the minor Duke criteria?***

predisposing factors

temp >38 C

vascular phenomena

immunologic phenomena

microbio evidence

what is the required Duke criteria for dx of IE?

2 major

OR

1 major + 3 minor

OR

5 minor

for tx of infective endocarditis, you should draw ___ blood cultures then begin abx

3***

what are the sx of sickle cell pain crisis?

- pain in abd, bones, joints, soft tissues

- acute chest pain syndrome

- infection (bc of spleen)

- sus stroke

- PAIN is the MC → opioids mainstay of tx***

retic would be elevated***

platelet count of what indicates transfusion therapy?

<5000

low speed acceleration-deceleration MVAs are causes of _________ injury?

C-spine

high speed, high-energy crash cause what type of injury?

structural damage to spine

what are the s/sx of central cord syndrome?

- decreased strength

- milder decreased pain/temp sensation

- spastic paraparesis

- spastic quadriparesis

- loss of fine motor skills