EM Review + Quizzes

button battery sharp objects

2 types of esophageal foreign bodies that should be removed immediatly

GCA

Blood vessel inflammation; suspect in pts >50 yo complaining of new onset HA, temporal pain, visual sx, or jaw claudication Associated w/ polymyalgia rheumatica

Hamman's crunch

CXRAY shows air in the chest; What PE finding would you expect to find?

1

GCS eye opening response - no repsonse

4

GCS eye opening response - open spontaneously

2

GCS eye opening response - open to pain

3

GCS eye opening response - open to speech

2

GCS motor response - extension; abnormal, decerebrate posturing

3

GCS motor response - flexion; abnormal, decorticate

5

GCS motor response - localizes pain

1

GCS motor response - no response

4

GCS motor response - nonpurposeful movement

6

GCS motor response - obeys verbal command

4

GCS verbal response - confused

3

GCS verbal response - inappropriate

2

GCS verbal response - makes incomprehensible sounds

1

GCS verbal response - no response

5

GCS verbal response - oriented to person, place, and time

cervical artery dissection

HA after MVC where the pt got whiplash

spontaneous intracranial hypotension

HA after an LP

cerebral venous thrombosis

HA with sinusitis extension

BB then Nitropusside

How do you manage HTN in someone w/ aortic dissection?

only touch the crown keep it most if primary then leave it out, if permanent then put it back in

How do you treat and avulsed tooth?

CT w/out contrast for kidney stone CT w/ contrast for diverticulitis

How does imaging differ for nephrolithiasis and diverticulitis?

fluids for rhabdo cold bath for heat stroke

How is the treatment different for pt with Rhabdo and pt with heat stroke?

Epi

Only drug that can help with upper and lower respiratory obstruction/resp distress

Are associated with a high risk of bacterial meningitis

Open fractures of the cranial vault: Often need a burr hole created to relieve intracranial pressure Are uncommonly associated with multisystem trauma Most commonly cause death due to increased intracranial pressure Do not have Galea involvement Are associated with a high risk of bacterial meningitis

distributive, obstructive, cardiogenic, hypovolemic

4 classifications of shock

ectopic pregnancy

A 26-year-old gravida 0 sexually active female presents to the emergency room complaining of colicky pain in her lower right abdomen for the past 12 hours. She passed out earlier in the day while trying to have a bowel movement. Her last menstrual period was 6 weeks ago. She has noted vaginal spotting over the last 24 hours. Vital signs show Temp 37 degrees C, BP 96/60mmHg, P 110, R 16, Oxygen Sat. 98%. Abdominal exam is positive for distension and tenderness. Bowel sounds are decreased. Pelvic exam shows no cervical motion tenderness but positive right adnexal tenderness. Which of the following is the most likely diagnosis?

T4

A 28 year old man presents to the ED with a back injury following an all-terrain vehicle (ATV) crash. The examination reveals a sensory deficit at the nipples. The spinal cord injury level is most likely at which of the following levels?

endoscopic removal

A 3-year-old girl swallows a button battery. Plain radiographs demonstrate that the battery is lodged in the esophagus. Which of the following is the most appropriate next step in management?

LP

A 41 year old woman presents to the ER complaining of a sudden onset of the "worst headache of my life." A stat non-contrast head CT is normal. The next appropriate step in the diagnosis of this patient would be

pulmonary angio

A 45 year old man returns from an 18 hour long air flight. He presents with shortness of breath and stabbing chest pain for the past hour. On examination, he is afebrile, respiratory rate is 33 and pulse is 110. Pulse oximetry is 89% on room air and EKG reveals sinus tachycardia. Which of the following is the gold standard to establish a definitive diagnosis?

PUD

A 50 year old male patient presents to the ER with a burning sensation in the mid-chest that worsens after meals. He presents with blood-tinged emesis and denies difficulty breathing. His PCP advised him to avoid aspirin, caffeine and alcohol. What is the most likely diagnosis of this patient's symptoms?

DKA

A 68 year old obese, insulin dependent diabetic woman, presents with a markedly decreased level of consciousness. She was found in bed by her husband. Your initial assessment reveals that her respirations are deep and labored. Her pulse is fast and she is hypotensive. According to the patient's husband, she has had a recent infection but he cannot remember what the doctor called it. You should be most suspicious that this patient is experiencing

A pale or milky retina with a cherry-red fovea

A 75 year old man presents with painless, sudden loss of vision in one eye. A careful history reveals previous episodes of vision loss that resolved spontaneously. A workup for these previous episode included a carotid ultrasound which confirmed a diagnosis of bilateral carotid stenosis. Given this patient's current symptoms and medical history, which of the following findings would be expected on funduscopic examination?

intestinal obstruction

A 79 year old female patient presents with nausea, vomiting and abdominal distention. She complains of generalized, intermittent and cramping abdominal pain. She states she has been constipated for 7 days. You should suspect:

Will result in permanent loss of all cord-mediated functions below the level of injury

A complete spinal cord injury to the upper cervical spine: Will result in breathing secondary to diaphracmatic innervation only Results in neurological dysfunction that is considered permanent if it lasts longer than 24 hours Will result in permanent loss of all cord-mediated functions below the level of injury It is not compatible with life and results in immediate death due to cardiopulmonary failure Results in paraplegia but the patient usually retains the ability to breathe spontaneously

A free-floating segment of fractured ribs

A flail chest is BEST characterized by

Hangman's fx

A patient is involved in a motor vehicle accident and suffered a fractured neck. The fracture lines extend through the pedicles of C2. Which of the following describes this unstable hyperextension fracture to the cervical spine?

Rovsing's sign

A patient presents with abdominal pain in the right lower quadrant, examination reveals increased pain in the right lower quadrant on deep palpation of the left lower quadrant. This is commonly known as which of the following?

decerebrate lesion at brainstem

A pt presents in this position; what positioning is this and where is the lesion?

1. tetanus 2. rabies testing or immunoglobulin 3. Augmentin

A pt presents with multiple puncture wounds to their hand; how do you treat them?

liver or spleen

Fractures of the lower rib cage should make you MOST suspicious for injuries to the

long, slender fingers

Among the patients presenting to the ED with chest pain, which of the following physical examination findings is the biggest risk factor for aortic dissection? Severe obesity (BMI >40) A systolic blood pressure difference of 15 mm Hg between the upper extremities A very muscular physique Long, slender fingers

it is safe to release the student back to sports since he is continually improving

In your family medicine clinic you are taking care of a 16 y.o. male who was instructed to follow up in 4 weeks with his PCP after a football injury. He was diagnosed with a concussion in the ER at the time of injury. Since the initial injury he states he is still tired, but his headaches are improving. He only has 2-3 per week. He is doing well in school since the incident and states his memory is much better, he has a little bit of difficulty with concentration in math and science. His vital signs are blood pressure: 120/80, pulse: 60, respiratory rate: 16 bpm, O2Sats: 99% on room air, Pupils are PERRL with EOMI, Cranial Nerve Exam is normal, no neurological deficits on physical exam. At this visit

orbital blow out fx

On physical exam, your patient has unequal extra ocular movements. You should be MOST concerned for:

anterior cord syndrome

Loss of motor function below the injury w/ perservation of position, vibration, and temp; what cord syndrome?

chance fx

Male present post MVC. He reports that he feels fine but has some lower back pain. On XR you note a horizontal fx through L1; what is your diagnosis?

Tissues are penetrated by single or multiple objects

Penetrating trauma occurs when?

retroperitoneal bleed

Pt comes in with this; which is commonly seen in acute pancreatitis and?

maxillary/facial CT

Pt is hit in the head with a baseball bat, their eye is fixed. You suspect an orbital blowout fx; what imaging should you do?

acute pancreatitis, burns, and trauma

Pt meets SIRS criteria, but has NO signs of proven infection. What other dz states can cause this?

Clay-Shoveler fracture

Which of the following spinal fractures is considered to be a stable fracture? Flexion teardrop fracture Burst fracture Clay-Shoveler fracture Hangman's fracture Jefferson fracture

CHF Hct <30% EKG abnormalities SOB SBP <90

San Franciso Syncope Rule includes?

Boerhaave syndrome

Spontaneous esophageal rupture following forceful vomiting after overindulging in food and alcohol is known as

Temperature > 38.3 degrees C or <36 degrees C, pulse >90/min; RR >20/minute, elevated WBC >12,000, <4,000 or >10% bands

Systemic inflammatory response syndrome (SIRS) includes the presence of 2 or more of the following:

MVC

The leading cause of traumatic injuries in the United States is caused by:

Peritonitis caused by rupture and spillage of toxins

The major complication associated with hollow organ injury is

subdural hematoma

The traumatic tearing of blood vessels resulting in a slow bleed in the area in the attached image will result in a/an:

LeFort III

This patient has what type of injury?

Acute mesenteric ischemia MC in old people; make sure you get an angiogram

Top Ddx for abd pain that is out of proportion to what you find on PE

- BG in HHNC >600 - DKA will have an anion gap - No acidosis or serum ketones in HHNC - high serum osm in HHNC (>350)

What are some criteria that differentiate DKA and HHNC?

septal hematoma

What do you want to monitor for in nasal fx?

subdural hematoma MC in elderly

What is this and what population is it MC in?

CTA for normal pt VQ scan for pregnant pt

What radiographic test would you do for a regular pt vs a pt who is pregnant?

Brown-Sequard syndrome

What spinal cord injury is characterized by motor, vibration, and position loss on the same side as the injury and loss of pain and temperature sensation on the contralateral side?

US, CBC, cross and screen, etc.

What work up would you do for a pregnant pt who presents with vaginal bleeding?

unilateral horizontal gaze nystagmus correct saccade no deviation skew

What would the HINTS exam result in a pt with peripheral vertigo?

w/in 4.5 hours neg head CT, no recent surgery or hx of bleeding

When is TPA given?

Hbg <10

When should you consider transfusing an elderly patient who has sustained a head trauma?

Hampton's hump

Which of the following best defines the peripheral wedge-shaped consolidation on the pleural surface observed in a patient with a pulmonary embolism?

tension ptx

Which of the following conditions would result in obstructive shock? Tension pneumothorax Severe head injury Profound hypovolemia Severe overwhelming infection

Waters

Which of the following conventional or plain radiographic views of the face is most beneficial for evaluating trauma of the midface?

anticoagulation

Which of the following factors would have the MOST dangerous effect on the body's process of hemostasis?

pressure wave caused by a bomb blast

Which of the following injury mechanisms would MOST likely result in blunt trauma? Small-caliber gunshot wound The pressure wave caused by a bomb blast Explosion involving shards of glass Falling from a tree and onto a picket fence post Stabbing injury to the abdomen by a knife

Kidney/Hydronephrosis

Which of the following is NOT a typical view of the Focused assessment with sonography in trauma (FAST) exam? Bladder/View of the pelvis Subxyphoid LUQ/View of the spleno-renal junction Kidney/Hydronephrosis RUQ/Morrison's pouch

It is a result of damage from the cervical sympathetic chain resulting in Ptosis, Miosis, Anhydrosis

Which of the following is correct regarding Horner's Syndrome? It's is a result of spinal cord injury below T3 It is a result of cervical parasympathetic chain damage resulting in Ptosis, Miosis, and hyperhidrosis It is a result of damage from the cervical sympathetic chain resulting in Ptosis, Miosis, Anhydrosis It is a result of complete spinal cord transection resulting in Ptosis, Midriasis, and anhydrosis It is a result of head trauma with damage to cranial nerves II, III, V, VI

size of stone

Which of the following is the most important factor in determining the chance of a spontaneous passage of a kidney stone?

The Cushing reflex is a physiological nervous system response to acute elevations of intracranial pressure (ICP) resulting in Cushing's triad of widened pulse pressure, bradycardia, and irregular respirations

Which of the following is true about Head Injury An MRI is the diagnostic study of choice in acute head injury The Cushing reflex is a physiological nervous system response to acute elevations of intracranial pressure (ICP) resulting in Cushing's triad of widened pulse pressure, bradycardia, and irregular respirations In Decerebrete Posturing, the patient will have upper extremities flexed with extension/internal rotation of the lower extremities. The presence of Racoon eyes indicates pooling of blood in the anterior chamber of the eye In severe TBI, patient's will have a GCS of 13-15

To lower blood pressure in a patient with an aortic dissection, it is important to initiate beta blocker (i.e. esmolol) therapy prior to giving a direct vasodilator (i.e. nicardipine)

Which of the following is true regarding HTN emergencies? Nicardipine is the drug of choice for treating a Hypertensive emergency in an OB patient To lower blood pressure in a patient with an aortic dissection, it is important to initiate beta blocker (i.e. esmolol) therapy prior to giving a direct vasodilator (i.e. nicardipine) Evaluation for target organ damage does not include a urinalysis Malignant Hypertension is defined as a blood pressure >180/120 with or without target organ damage The blood pressure goal for patient's with Malignant Hypertension is <140/90 and should be achieved within 2 hours of arrival in the ER

Patients with open mandibular fractures should be admitted and given IV antibiotics and operative fixation

Which of the following is true regarding Maxillofacial Trauma? Patients with open mandibular fractures should be admitted and given IV antibiotics and operative fixation The majority of posterior nose bleeds occur from bleeding at Kieselbach's plexus Mandibular fractures are best identified on Waters View plain film Septal hematomas can be seen in nasal fracture. They generally resolve on their own and do not require additional management. The airway of a patient with a maxillary fracture should be secured via a nasal intubation

Trauma to Zone I of the neck has the highest mortality due to the presence of the great vessels and the difficult surgical approach

Which of the following is true regarding Neck Trauma? The best way to manage an airway in a laryngotracheal injury is through oral intubation Zone III of the neck is the most exposed region of the neck allowing for direct visualization should a trauma result in a carotid dissection Trauma to Zone I of the neck has the highest mortality due to the presence of the great vessels and the difficult surgical approach A CT scan of the neck is the gold standard for identifying vascular injury Esophageal perforation is most commonly associated with hangings or strangulation injuries

Alcocolic ketoacidosis is treated with dextrose containing IV fluids, thiamine and correction of electrolytes

Which of the following is true regarding glycemic emergencies? Alcocolic ketoacidosis is treated with dextrose containing IV fluids, thiamine and correction of electrolytes A patient with diabetic ketoacidosis (DKA) generally presents with blood sugars >600 mg/dl whereas a patient with hyperosmolar hyperglycemic nonketoacidosis (HHNK) generally presents with blood glucose levels of approx 300 mg/dl Kussmaul respirations are seen in patients with severe metabolic acidosis and characterized by slow deep breathing with respirations generally < 10 per minute Similarities between diabetic ketoacisosis (DKA), hyperosmolar hyperglycemic nonketoacidosis (HHNK) and alcoholic ketoacidosis (AKA) include a presenting pH of >7.3 and an anion gap

Seizures are a common mechanism of injury

Which of the following is true regarding posterior shoulder dislocations? Seizures are a common mechanism of injury Neurovascular injury is more common than in anterior dislocations External rotation is usually intact Recurrent injury is more common than in anterior dislocations The absence of pain excludes the diagnosis

The NEXUS criteria cannot be used in a patient who is intoxicated

Which of the following is true regarding spinal trauma? The Odontoid view is not part of the full c-spine series for trauma patients A Jefferson fracture is considered a stable fracture High dose Methylprednisolone should be administered to all patients with spinal trauma The NEXUS criteria cannot be used in a patient who is intoxicated Complete paraplegia occurs due to an injury to the cervical spine

A patient with known cardiac disease, a history of CHF, age >60 or an exertional component are at higher risk for a serious etiology for their syncopal event

Which of the following is true regarding syncope? A CBC, BMP, Troponin and D-dimer should be ordered on all patients presenting with syncope A CT scan is recommended in all patients who present with syncope The Denmark syncope rule should be utilized to identify patients at high risk for adverse outcome An EKG is not indicated in otherwise young healthy adults with syncope A patient with known cardiac disease, a history of CHF, age >60 or an exertional component are at higher risk for a serious etiology for their syncopal event

The HEART score can be used to identify patient's with undifferentiated chest pain that are eligible for discharge without additional tests or invasive procedures

Which of the following is true regarding the ED approach to chest pain and shortness of breath? A patient with pericarditis typically feels better laying supine A d-dimer is the initial test of choice for anyone suspected of having a pulmonary embolism The HEART score can be used to identify patient's with undifferentiated chest pain that are eligible for discharge without additional tests or invasive procedures

Using a nasal canula for irrigation may be more tolerable than the Morgan lens and its use can avoid the risk of inducing further trauma to the surface of the eye

Which of the following is true reguarding caustic eye injuries? Fluids should be turned off prior to removing the Morgan's Lens A Morgan's lens is superior to the use of a nasal canula for eye irrigation. If available, the Morgan's lens should always be the method used to irrigate an eye injury Using a nasal canula for irrigation may be more tolerable than the Morgan lens and its use can avoid the risk of inducing further trauma to the surface of the eye Wait to initiate eye irrigation until you have Tetracaine eye drops to provide pain relief Identified the pH of the eye by placing a pH strip at the medial canthus. Eye irrigation can be stopped once a pH of 8 is reached.

Zone 3: From the angle of the mandible to the basement of the skull

Which of the following neck zones have the highest mortality rates associated with injury in that zone?

spleen

Which of the following organs is the most frequently injured organ in blunt abdominal trauma?

58 year old diabetic woman

Which of the following patients would most likely present with atypical signs and symptoms of an acute myocardial infarction? 49 year old obese man 58 year old diabetic woman 71 year old woman with hypertension 60 year old man with anxiety

Abrupt and severe pain in the chest or between the scapula

Which of the following signs and symptoms best describes the presentation of a dissecting thoracic aortic aneurysm? Headache, neck pain, and vomiting accompanied by an inability to walk or stand Abrupt and severe pain in the chest or between the scapula Lower back pain with radiation into the legs Severe quadriplegia and coma Syncope, abdominal pain, back pain, and shock

The patient typically presents with greater loss of function in the upper extremities than in the lower extremities

Which of the following statements regarding central cord syndrome is MOST correct? The patient typically presents with greater loss of function in the upper extremities than in the lower extremities Central cord syndrome causes greater loss of function, pain and temperature perception in the lower extremities Patients with cervical spondylosis or stenosis are at a lower risk for central cord syndrome following an injury in comparison to other cord syndromes Central cord syndrome is almost always associated with a vertebral fracture and has an overall poor prognosis Central cord syndrome typically causes complete paralysis of the lower extremities and decreased proprioception

reduce risk of cerebral hemorhage after TPA but high enough to perfuse

Why are their diff BP requirements in ischemic stroke pts who are TPA candidates?

MI

You are managing a patient presenting with substernal chest discomfort that started while he was watching TV. They describe the pain as "pressure-like". The pain radiates to the jaw and left arm. The discomfort subsides with rest, oxygen and administration of nitroglycerin. What is the most likely working diagnosis?

bilateral facet dislocation

You are treating a patient with a severe hyperflexion injury. Based off the plain film x-ray attached, you note that the anterior and posterior longitudinal ligaments are disrupted, as well as the ligmentum flavum. What is your diagnosis?

zone 3

Zone of the neck associated with carotid diessection

posterior reversible encephalopathy syndrome

clinical syndrome w/ radiographic findings that present w/ HA, seizures, and visual loss often w/ extreme HTN

malignancy and diverticulitis

two MCC of LBO