Emergency Medicine 1b

Definition of acute renal failure

Urine output less than 0.5-1cc/kg/hr (400cc/day in adults)

Most common cause of acute renal failure

No urine output

Prerenal cause of ARF

What can cause dehydration?

Renal origins of ARF

Postrenal origins of ARF

Causes of ureteral or bladder obstruction

Urethral obstructions

What lab are you looking at to determine ARF?

Treatment for prerenal ARF

Treatment for renal ARF

Treatment for postrenal ARF

Signs and symptoms of UTI

Most common UTI pathogen

Safe UTI treatments during pregnancy

Duration of treatment for uncomplicated UTI’s

Duration of treatment of pyelonephritis, pregnant patients with utis, complicated/frequent utis/prior treatment failure

Treatment for GC

Treatment for Chlamydia

Treatment for trichomonas

Presentation of acute prostatitis

Source of acute prostatitis in males<35 yo

Source of acute prostatitis in males>35

Treatments for acute prostatitis

Presentation of urolithiasis

What are some deadly diseases that can mimic presentation for kidney stones?

Any female of childbearing age with abdominal pain gets a work up for what

Modality of choice for evaluation of urolithiasis in pregnant females

Presentation of testicular torsion

Testicular torsion must be detorsed within __ for salvage

Blue dot sign on translumination of testes is pathognomonic for what

What is Prehn’s sign and what is it a sign of

Treatment for priapism

Inability to retract the foreskin due to fibrous constriction or scar

Inability to reduce retracted foreskin over the glans

What is essential in the immediate treatment of chemical burns to the eye?

When should treatment of a chemical burn to the eye begin?

If a patient has a chemical burn to the eye with an acidic substance should an attempt be made to neutralized it by adding an alkaline substance

What should be done after 30 min of irrigation of an eye with a chemical burn?

Bleeding in the anterior chamber of the eye

What are some of the general guidelines in the treatment of hyphema?

What are some signs and symptoms of a corneal abrasion?

When considering a corneal abrasion what should be in your differential?

What do you include in the work-up of a corneal abrasion?

What is the treatment for a corneal abrasion in a non-contact lens wearer?

What is the treatment for a corneal abrasion in a contact lens wearer?

When should a corneal abrasion be referred to an ophthalmologist?

Focal loss of corneal stroma with overlying epithelial defect

What is the number one risk factor for corneal infection?

What is the #2 risk factor for corneal infection?

What should you do if you suspect infectious keratitis?

What is the treatment for infectious keratitis?

What should be included in the workup for central retinal artery occlusion?

What is the treatment for central retinal artery occlusion?

The immediate treatment for angle closure glaucoma is to lower eye pressure, how is this done?

What is endophthalmitis?

What are the symptoms of endophthalmitis?

What is the treatment of endophthalmitis?

What is the most common etiologic agent of viral conjunctivitis?

What is the treatment for viral conjunctivitis?

For how long is viral conjunctivitis contagious?

Conjunctivitis in an infant, assume what organisms?

Gonococcal conjunctivitis requires __ treatment

Acute, often red, infection of the sebaceous glands at the base of the eyelashes

Chronic, often fibrotic, infection of the sebaceous glands at the base of the eyelashes

Treatment for hordeolum/chalazion

Inflammation along the eyelashes/meibomian glands (gritty burning eyes)

Treatment of blepharitis

Blepharitis with ulceration or lash loss consider __

What are risk factors for retinal detachment?

What will happen to the pressure in an eye affected with a retinal detachment?

What is significant in the history of a retinal detachment?

What is the treatment for periorbital cellulitis?

Elderly man with history of monocular vision loss, jaw pain, and recent weight loss, what are you suspicious for?

29 year old woman with multiple sclerosis presents with acute loss of central vision in one eye, and pain with eye movements. What are you suspicious for?

What is a stye

Treatment for stye (external hordeolum)

Acute or chronic noninfectious inflammation of the eyelid secondary to meibomian gland blockage in the tarsal plate

Why has gentamicin fallen out of favor for the treatment of bacterial conjunctivitis?

Presents as monocular or binocular eyelash matting, mild to moderate mucopurulent discharge, and conjunctival inflammation

Presents as a monocular or binocular watery discharge, chemosis, and conjunctival inflammation

Treatment of viral conjunctivitis

Endophthalmos is a true __

How do patients with endophthalmos present?

What is the initial empiric treatment for endophthalmos?

Periorbital cellulitis (preseptal cellulitis)

Orbital cellulitis (postseptal cellulitis)

How should superficial conjunctival abrasions be treated?

What is the preferred topical ocular anesthetic used when assessing a corneal abrasion?

How will a corneal abrasion appear during fluorescein stain when using cobalt blue light on slit lamp?

What is the treatment for a simple corneal abrasion?

What is the antibiotic treatment for a corneal abrasion for a person with contact lenses?

How are superficial corneal foreign bodies removed?

Who should remove a corneal foreign body deep within the corneal stroma, or in the central visual axis?

What do you do for a high risk lid laceration if an ophthalmologist is not immediately available to evaluate and treat?

A hyphema should be dilated with __ to prevent pupillary movement from tearing damaged blood vessels

What orbital walls do blowout fractures commonly involve?

Which muscle is usually entrapped in a blowout fracture, and what does it cause?

What must be avoided once a globe injury is suspected?

Severe subconjunctival hemorrhage, shallow or deep anterior chamber, hyphema, teardrop-shaped pupil, limited extraocular motility, extrusion of globe contents, reduction in visual acuity can all mean what?

A bright green streaming appearance to fluorescein instilled into the tear layer (Seidel test) is pathognomonic for what?

Treatment for ruptured globe

How long after the first 2L of irrigation fluid should you wait to check the ph in an eye that has suffered a chemical burn?

What should you do for an eye that has been chemically burned and continues to have an abnormal ph despite being irrigated with 8-10 L of fluid?

What ocular condition classically presents with eye pain or headache, cloudy vision, colored halos around lights, conjunctival injection, a fixed mid-dilated pupil and increased IOP of 40-70 mmhg?

What is a normal range for IOP?

What can precipitate an attack of acute angle closure glaucoma in a patient with narrow anterior chamber angles?

What are some treatments used to reduce IOP?

What can you use to decrease pressure if the IOP is greater than 50 mmhg?

What can you use to decrease IOP if it does not do so with first line agents after 1 hour?

Once IOP is below 40 mmhg in acute angle closure glaucoma, what can be given as long as the patient has an intact lens in place?

Presents with acute vision loss with a particular reduction in color vision (red desaturation test), often painful especially with eoms

What can often be detected in Optic Neuritis?

Presents as a sudden painless, severe monocular loss of vision, often associated with a history of amaurosis fugax

Causes acute, painless monocular vision loss. Examination shows optic disc edema, cotton wool spots, and retinal hemorrhages in all quadrants (blood and thunder fundus)

A systemic vasculitis that can cause a painless ischemic optic neuropathy?

Who is the typical patient with giant cell arteritis?

What are associated symptoms of giant cell arteritis?

What is may be seen on funduscopic exam with giant cell arteritis?

What labs should be ordered when giant cell arteritis is suspected?

What should be done if there is a strong suspicion of giant cell arteritis?

What may be done if there is a low suspicion for giant cell arteritis?

Hyphema work-up

What is the most life threatening gynecologic cause of acute abdomen in the female patient?

Amylase is elevated in __

ALT/AST is elevated in __

Bilirubin/Alk Phosphatase is elevated in __

Never place __ above an obstruction

Indications for barium studies

Barium studies are not only useless for evaluation of __ they are dangerous

For what disease process are the five F’s used for

Five F’s of acute cholecystis

Murphy’s sign is used to help diagnose __

Periumbilical pain that migrates to RLQ, anorexia is a possible history of __

Obturator sign/psoas sign is used to help diagnose __

__ hours after acute appendicitis symptom onset there is a >95% perforation rate

What is the rule of 2’s for Meckel’s diverticulitis?

What is the treatment for Meckel’s diverticulitis?

Severe epigastric pain radiating to the back, often associated with ETOH, usually elevated amylase/lipase

Distended abdomen, surgical scars, high pitched bowel sounds, tympanic to percussion, nausea w/ bilious vomiting, constipation, often severely dehydrated

Non-operative treatment for small bowel obstruction

Most common causes of large bowel obstruction

LLQ pain, fever

Sudden onset of sharp ab pain, N/V, diarrhea, GI bleeding, pain out of proportion to physical exam, may have history of angina, atherosclerosis, smoking

Midline ab pain with tearing sensation to the back, patients often present in shock, exam reveals pulsatile mass

>__ cm AAA has an increased risk of rupture 20-30% within 5 years

Patients with __ pain tend to lie still

Patients with __ pain tend to move about

__ should be considered in any patient older than 50 with ab pain out of proportion to physical findings

CT is the preferred imaging modality for what emergencies

__ in appropriate doses may decrease guarding and improve localization of abdominal pain

Antiemetics such as __ increase patients comfort and facilitate assessment of S/S

What is the most reliable symptom of appendicitis?

Palpation of the LLQ quadrant with pain referred to the RLQ is referred to as the __ and is indicative of __

The diagnosis of acute appendicitis is generally __

The most significant predictors of acute appendicitis in the elderly are __

What are the main features of intestinal obstruction?

What causes the pseudoobstruction that commonly occurs in the low colonic region?

In the case of pseudoobstruction what is diagnostic as well as therapeutic

Predominant means of diagnosis for hernias

Should you attempt hernia reduction if there is a question about the duration of the incarceration?

__ hernias in children are common

When should a child with an umbilical hernia be referred for surgical evaluation?

R/LLQ pain, purulent cervical dc, CMT, adnexal tenderness =

AAA risk factors

S/S in abd trauma

Chance fx

Grey Turner sx

Cullen sx

Mesenteric ischemia: cause

Pancreatitis s/s

Pancreatitis tx

SBO tx

SBO s/s

Tx for diarrhea 2/2 Shigella, Yersinia, ETEC, V cholerae

Infxs diarrhea: no abx for:

Ranson's criteria predict M&M for:

What is the suspensory ligament of the duodenum?

What is the most common cause of lower GI bleeding?

Common, painless and can be massive, caused from an erosion into penetrating artery from the diverticulum

What is the most common cause of upper GI bleed?

Cause of esophageal and gastric varices

Longitudinal mucosal tear in the cardioesophageal region, caused by repeated retching

Common cause of lower GI bleeding, seen in people with hypertension and aortic stenosis

Spider angiomata, palmer erythema, jaundice, and gynecomastia are seen in __

Petechiae and purpura seen in __

Why would you do a careful ENT exam on a patient suspected of GI bleed?

Can be diagnostic and therapeutic but requires a brisk bleed at .5-2ml/min

Can only be diagnostic but are more sensitive than angiography and require a bleeding rate of only .1ml/min

Is diagnostic and therapeutic and more accurate than bleeding scans and angiography

Class __ bleed replace volume with crystalloid

Class __ bleed replace volume with crystalloid and blood

Hemorrhaging is broken down into how many categories by the ACS

Class __ hemorrhage involves up to 15% of blood volume. There is typically no change in vital signs and fluid resuscitation is not usually necessary

Class _ hemorrhage involves 15-30% of total blood volume. A patient is often tachy, narrowed pulse pressure. Peripheral vasoconstriction, pale cool skin, slight changes in behavior, volume resuscitation with crystalloids

Class __ hemorrhage involves loss of 30-40% of blood volume; pt’s BP drops, HR increases, peripheral perfusion decreases (prolonged cap refill), mental status worsens; crystalloid & blood transfusions usually necessary

Class __ hemorrhage involves loss of >40% of blood volume; limit of body’s compensation is reached and aggressive resuscitation is required to prevent death

__ ulcers do not extend through the muscularis mucosa

Only __ % of patients who are infected with H. Pylori will develop ulcers

Inhibits bicarbonate ion production and increases gastric emptying

Main complaint of gastric ulcer

Physical exam of uncomplicated PUD, there may be a finding of __

Inhibit gastric acid secretion, equally as effective as antacids with better compliance due to decreased frequency of doses

Inhibits gastric acid secretions, heals ulcers faster than H2-antagonists and antacids

Locally binds to the base of the ulcer and therefore protects it from acid

Prostaglandin E1 analogue which acts as natural prostaglandin in the body

Vomiting and diarrhea is most often __

Which is more common: upper or lower GI bleeding?

What is the most common cause of acute lower GI bleeding?

What is the most important lab test for a patient with a significant GI bleed?

When is surgical treatment for hemorrhoids indicated?

Treatment of choice for patients with pseudomembranous colitis

__ should be reserved for patients with pseudomembranous colitis who have not responded to or are intolerant of metronidazole and for children and pregnant patients

For patients with pseudomembranous colitis __ may prolong or worsen symptoms and should be avoided

Mackler triad

Oliguria =

Pre-renal ARF: ineffective circulating volumes; may be due to:

Renal ARF: glomerular causes

Renal ARF: vascular causes

Renal ARF: tx

UTI tx

UTI: cx if:

90% of stones are:

Calcium oxalate or phosphate stones

Magnesium – ammonium – phosphate (struvite) stones

Uric Acid / cystine stones

Stones: ddx

Urolithiasis: dx imaging

Urolithiasis admit criteria

Epididymitis has a _______ onset

Spermatocele

Testicular tumor

Treatment priorities for sepsis

Empiric broad spectrum antibiotics used in sepsis

Recombinant human activated protein C, only FDA approved drug used solely for the treatment of sepsis in the adult patient with high risk of death. Only for use in the ICU

Empiric treatment for bacterial meningitis

What do you add to empiric therapy for meningitis if HSV is suspected?

What do you give concurrently with empiric antibiotics when treating bacterial meningitis?

Supportive care for bacterial meningitis

Outpatient antibiotics for pneumonia

Inpatient regimens for pneumonia

Duration of tx for uncomplicated cystitis in non-pregnant women/men

What is the duration of treatment for uncomplicated cystitis in children, preg women, and complicated infections in everyone else?

Antibiotics for cystitis

Treatment for pyelonephritis

Treatment of impetigo

Outpatient treatment for cellulitis

Inpatient treatment for cellulitis

Treatment of a fresh bite <24 hours old

Prophylactic antibiotics for fresh bite

Incubation of malaria in returning travelers

PID tx

Chancroid tx

Meningitis bugs: neonates

Meningitis bugs: 1 mo - 50 yo

Meningitis bugs: >50 yo / etoh

Meningitis tx: 1 - 3 mos

Meningitis tx: 3 mos - 50 yo

PEP for meningitis

Labs to get in the w/u of sepsis

An important marker of global tissue hypoxia

Additional labs to evaluate source of sepsis

CSF tube 1 is used for what purpose

CSF tube 2 is used for what purpose

CSF tube 3 is used for what purpose

CSF tube 4 is used for what purpose

What patients with cystitis should get a urine culture?

Pneumonia labs

Septic arthritis: Joint fluid analysis

What should be included in the workup for central retinal artery occlusion?

What should be done in the case of orbital cellulitis?

What is the preferred topical ocular anesthetic used when assessing a corneal abrasion

How will a corneal abrasion appear during fluorescein stain when using cobalt blue light on slit lamp

A hyphema should be dilated with __ to prevent pupillary movement from tearing damaged blood vessels

A bright green streaming appearance to fluorescein instilled into the tear layer (Seidel test) is pathognomonic for what

What is a normal range for IOP?

What may be seen on funduscopic exam with giant cell arteritis?

What labs should be ordered when giant cell arteritis is suspected?

Hyphema work-up

MI labs

AAA imaging

Imaging modality of choice for acute pancreatitis

Imaging modality of choice for aortic aneurysm

Imaging modality of choice for acute appy

Imaging modality of choice for biliary obstruction

GI bleed labs

GIB: angiography requires bleeding rates of:

Imaging TOC for upper GIB =

GIB IVF resuscitation

GIB rfs

Mesenteric ischemia TOC

Biliary labs

Appendicitis labs

What radiographs should be obtained to assess for intestinal obstruction

Pancreatitis labs

Fever, all peds:

Fever (>38C), <28 days old

Fever (>38C), 28 day - 3 mos

Fever (>39C), 3 mos - 3 yo

Imaging TOC for pyloric stenosis

Imaging TOC for PE

Testing for suspected stroke

Imaging tests for stroke

Meningitis testing

CSF, viral meningitis

CSF, bacterial meningitis

Seizure labs

Seizure tx

Status epilepticus tx

SAH testing

AMI labs: troponin

AMI labs: CK-MB

CHF xray

Imaging for aortic dissection

Feeling of difficult, labored or uncomfortable breathing

Rapid physical exam for respiratory distress

What do you look for in the oropharynx in the setting of respiratory distress?

What do you look for in the neck exam in the setting of respiratory distress?

What do you look for in the cardiac exam in the setting of respiratory distress?

What do you look for in the chest exam in the setting of respiratory distress?

What do you look for in the pulmonary exam in the setting of respiratory distress?

What do you look for in the skin exam in the setting of respiratory distress?

Arbitrarily defined as a Pao2<60mmhg, correlates with O2 sat 90%

Segmental fracture of 3 or more adjacent ribs in two or more places of each individual rib, results in paradoxical respiration

Tall lanky guy who smokes, with sudden onset of dyspnea, what is it?

Chest pain worse on breathing in, leaning forward, and on palpation

Accumulation of fluid in alveoli resulting in impaired gas exchanged and subsequent hypoxia

Characterized by inflamed airway tissue and excessive mucus production

COPD treatment

History: pleuritic chest pain, dyspnea (may be intermittent), cough, hemoptysis, anxiety. Physical findings: tachypnea, tachycardia, fever, hypotension, signs of DVT. What is it

Do you get a d-dimer on patients who you have a high suspicion or low suspicion for pulmonary embolism

Cornerstone of treatment for pulmonary embolism

Biggest reason to perform the Sellick maneuver

Flail chest: indicators for early intubation include

What should be done immediately for the patient with a tension pneumo?

What is the definitive treatment for a tension pneumo?

Who is at risk for aspiration pneumonia?

What are some causes of non-cardiogenic pulmonary edema?

Treatment for pulmonary edema

What are the two phases of asthma?

What are some ominous signs of impending respiratory failure in someone with asthma?

What are red flags in an asthma patient?

Asthma treatment

Characterized by inflamed airway tissue and excessive mucus production. Coughing on most days for 3 month in 2 consecutive years

Alveoli loose ability to stretch and thus become weak, and break resulting in inability of the lung to exchange CO2 and O2

What is the treatment goal of COPD?

What are some hypercoagulable states (in PE)?

Risk factors for pulmonary embolism

Bed rest > __ hours can lead to venous stasis and put the patient at risk for PE

Gold standard for the diagnosis of PE

Causes of cardiogenic pulmonary edema

Pulmonary edema: ancillary tests

Pulmonary embolism: ancillary imaging tests

Pulmonary embolism: tx

Miller laryngoscope blade

Macintosh laryngoscope blade

ET tube sizes

LEMON

BURP