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393 Cards in this Set

  • Front
  • Back

What is the most common cause of sudden cardiac death in adults?


Survival rates are highest when BLS is initiated within ____ minutes and ACLS is initiated within ___ minutes

4, 8

What is the most common cause of airway obstruction in an unconscious victim?

The tongue

When an advanced airway is in place, during 2 person CPR, give 1 breath every ___ to ____ seconds without attempting to synchronize with chest compressions.

6 to 8 seconds

How much tidal volume normally causes visible chest rise during resuscitation breathing?

500-600 mL

What is the most common cause of foreign body airway obstruction in adults?

Poorly chewed meat

If a patient with a foreign body airway obstruction is able to cough and speak, what is the next best step?

- DO NOT interfere

- Coughing is the most effective way to clear the obstruction

- Speaking indicates adequate ventilation is still occuring

Which cardiac medications can be administered through an ET tube?





(Also, naloxone)

What is the fluid of choice in a resuscitation setting?

Normal Saline

Return to Spontaneous Circulation is characterized by a PCO2 > ___?

40mm Hg

Markers of compromised quality CPR:

PETCO2 < _____

Diastolic Pressure < ______

PETCO2 < 10mm Hg

Diastolic BP < 20 mm Hg

What drug can be used in the V-fib/Pulseless V-tach algorithm if Amiodarone is not available?

Lidocaine 1-1.5mg/kg

DOC for Torsades de pointes?

Magnesium Sulfate

DOC for hypomagnesemia?

Magnesium sulfate

What are the 10 causes of PEA?


Hypovolemia (normal saline infusion)

HypOxemia (O2, intubation, ventilation)

HypoThermia (warmed normal saline infusion)

Massive Pulmonary Embolism (thrombolytics)

Acidosis (sodium bicarbonate)

Tension pneumothorax (needle decompression)

Myocardial Infarction

Drug Overdose with TCAs, digoxin, beta-blockers, calcium channel blockers

What is the most common cause of a "flatline" tracing on ECG?

Detached lead or equipment malfunction

Why is atropine not preferred in Type II second-degree heart block?

Atropine may convert Type II second-degree heart block into complete heart block.

Transcutaneous Pacing is indicated

Contraindications to carotid massage and ice baths in an attempt to convert stable Paroxysmal Supraventricular Tachycardia?

Carotid Massage --> bruits present

Ice Bath --> previous MI

ECG strip shows a narrow, regular QRS and a rate greater than 160bpm


What is the biggest mistake when using adenosine to try to convert PSVT?

Not pushed rapidly enough


Adenosine 6mg rapid IV push

(Important: Wait 1-2 minutes)

Adenosine 12mg rapid IV push

This drug feels like a "mule kick to the chest"

Warn patients before giving it...


Adenosine is contraindicated in patients with what airway disease?


Before giving adenosine to patients with heart transplants, or patients taking dipyramidole or carbamazapine, you should _____ the dose

Decrease the dose

Patients with tachyarrhythmias that are unstable should receive ___________________

Synchronized cardioversion

Ventricular Tachycardia may readily convert to _________


Shock is defined as inadequate _______ perfusion

inadequate tissue perfusion

Ventricular Tachycardia = wide QRS + rate > ____

> 100msec

Rapid Sequence Intubation:

Children should be pretreated with _____


Rapid Sequence Intubation:

Patients with head injuries should be pretreated with ______________

Lidocaine (to ↓ Intracranial Pressure)

Rapid Sequence Intubation:

Agent used for sedation in children?


Rapid Sequence Intubation:

Succinylcholine should not be used in patients with _____________ (3 things)

Crush Injuries


History of Neuromuscular Dz

Rapid Sequence Intubation:

Name 4 agents used for sedation

Etomidate (doesn't cause hypotension)

Ketamine (doesn't cause hypotension)


Propofol (can cause hypotension)

Rapid Sequence Intubation:

Which agent used for paralysis has the shortest onset?


Rapid Sequence Intubation:

Name the 3 agents used for paralysis




Rapid Sequence Intubation:

Steps to take before, during and after RSI?

Prepare = equipment

Pretreat = drugs

Position = sniffing position

Preoxygenate = pulse oximetry of 100%

Paralyze = drugs

Placement of tube

Position of tube = confirm by 2 methods

Needle vs. Surgical Cricothyroidotomy

Which one allows for both oxygen delivery and ventilation for elimination of CO2?

Surgical Cricothyroidotomy

Equation to calculate a patient's accurate calcium level?

4 - serum albumin (g/dL) x 0.8 + serum Calcium

Rough correction for total body calcium in hypoalbuminemia:

Add 1 mg/dL to serum Calcium for every 1 mg/dL in albumin below _____ mg/dL

Add 1 mg/dL to serum Calcium for every 1 mg/dL in albumin below 4 mg/dL

How are calcium levels affected by acidosis?

Acidosis ↑ Calcium levels


Alkalosis ↓ Calcium levels

What changes will hypercalcemia cause on ECG?

Shortened QT interval

(Hypercalcemia also potentiates digoxin toxicity)

A patient's bloodwork reveals hypercalcemia.

Bloodwork also shows ↑ serum Cl and low bicarbonate in a ratio > 33:1

This is suggestive of _____________

Primary Hypothyroidism

A patient's bloodwork reveals hypercalcemia.

Bloodwork also shows a high serum protein with a reversed albumin-to-globulin (A/G) ratio.

This is suggestive of _____________

Multiple Myeloma

How does hypocalcemia affect ECG?

Prolonged QT Intervals

Type of diuretic used to help correct Hypercalcemia?

Loop Diuretic

(Loops LOOSE Calcium)

Giving _____ in the setting of digitalis toxicity mya cause tetany and "stone heart"



(Consider this when using Calcium Gluconate to treat patients with hyperkalemia)

A woman presents because her home blood sugar monitor readings at home have been "high"

Bloodwork reveals a serum glucose of 900 mg/dL, and a sodium level of 124 mg/dL.

In addition to correcting her blood glucose, should you also correct her hyponatremia?

No. This is pseudohyponatremia, caused by increased blood glucose.

Sodium "falls" by approximately 1.6 mEq/L for every 100 mg/dL of glucose over 200.

Her actual sodium level is 124 + (7x1.6) = 135

What is the most common cause of hypernatremia?


Hypothalamus does not make ADH

Central Diabetes Insipidus

Kidneys do not respond to SIADH

Nephrogenic Diabetes Insipidus

Most common cardiac axis seen in asthma and COPD?

Right axis

A new LBBB is considered an ________ until proven otherwise

Acute MI

A normal PR interval is _______ms

200 ms

Risk of torsades de pointes is increased in patients with a prolonged ___________

QT Interval


Seen with hypokalemia, hypomagnesemia, hypocalcemia and certain medications (TCAs)

Normal QRS duration is _____ ms

120 ms

Diffuse ST elevations and PR depression are seen in ____________


U waves may indicate _____ or _____

hypokalemia or hypocalcemia

A loss of costophrenic angle on a CXR indicates approximately _____ cc of fluid accumulation


What is the most sensitive film to order to check for intrabdominal free-air?

Upright Chest X-ray

Views obtained in an Abdominal X-ray series?

Upright chest, Supine and lateral decubitus abdominal

Cervical Spine X-ray series consists of which views?

Lateral, AP and Open mouth

One abdomen/Pelvis CT exposes a patient to as much radiation as _____ X-rays

250 x-rays!

Acute ischemic strokes may initially present with a _____ CT scan

negative CT scan

What study should be done before a lumbar puncture to r/o increased ICP?

Head CT w/o contrast

Best study to order for an HIV positive patient with a suspected intracranial infection?

CT with contrast

Intrauterine pregnancy on ______ ultrasound is seen at beta-HCG 1000-1500 IU/L

Transvaginal US


Intrauterine pregnancy on transabdominal US may not be seen until beta-HCG is around 6000 IU/L

The HIDA scan loses sensitivity when _____ levels rise above 5 mg


You suspect a PE in a pregnant patient. Which test is preferred, A V/Q scan, or CT scan?

CT scan with abdominal shielding.


V/Q scan exposes the mother to less radiation, but radioisotope collects in the bladder near the fetus which exposes the fetus to more radiation.

"Low probability V/Q scans" miss ___% of pulmonary emboli



PIOPED study

In the trauma room, life-threatening hemorrhage should be controlled with __________ __________

Direct pressure

How much of body water is intravascular? How much is extravascular?

1/4 Intravascular

3/4 Extravacular

How much of body water is intracellular? How much is extracellular?

2/3 Intracellular

1/3 Extracellular

What is the most common cxause of shock in an injured patient?



Pressors will not help!

Adequate urinary output for an adult in trauma situation?

0.5 cc/kg per hour


Child less than 1 = 2.0 cc/kg/hr

Child over 1 = 1.0 cc/kg/hr

What is the AVPU scale used in trauma assessment?




What studies are included in a Trauma Series of x-rays?

C-spine, chest and pelvis

The normal adult blood volume is ____ % of body weight



So, a 70kg adult has 4.9L of blood

(70x.07 = 4.9)

The scalp consists of 5 layers... Name them



Connective Tissue

Aponeurosis (galea)

Loose areolar tissue


Occular deformity caused by uncal herniation?

"Blown pupil" --> CN III compression

CN III runs along the edge of the tentorium cerebelli, which is the most common site of herniation

________ reflex: Hypertension, bradycardia and respiratory depression in the setting of ↑ ICP

Cushing reflex


This is the brain's attempt to maintain Cerebral perfusion pressure (CPP)


Racoon eyes, Battle sign (mastoid bruising), blood in auricular canal, Blood/CSF in nares and hemotympanum all suggest _________________

Basilar Skull Fracture

A severe head injury has a GCS less than or equal to ______



Moderate Head injury = GCS 9-13

Mild Head injury = GCS 14-15

Name 2 noxious stimuli used to assess Glascow Coma Scale

Nail bed pressure

Sternal rub

What has the highest sensitivity and specificity for identifying a fluid as CSF in a patient with a head injury?

𝞫 2- transferrin

Describe how the ring test identifies CSF rhinorrhea in the presence of epistaxis in a patient with a head injury

Sample of blood from the nose is placed on filter paper to test for presence of CSF.

If CSF is present, a large transparent ring will surround a blood clot on the paper

This type of skull fracture carries a much greater risk of underlying brain injury and complications such as meningitis and post-traumatic seizures

Depressed Skull Fracture

How does a head CT look in a patient with a concussion?

With concussions, head CTs are most often unremarkable

Biconcave/Lenticular shape seen on head CT

Epidural Hematoma

Mortality rate range for subdural hematomas?



Vessel damaged in a patient with an Epidural Hematoma?

Middle Meningeal Artery

Vessels damaged in a patient with a subdural hematoma?

Bridging Veins

Crescent shape seen on head CT that may cross suture lines

Subdural Hematoma


Alcoholics and Elderly have ↑ brain atrophy and have a higher risk for subdurals

Name 5 measures that can be used to ↓ ICP in patients with head trauma.




Ventriculostomy (burr hole)

Elevate the head of bed

Diuretics (Mannitol, Furosemide)

Where do the majority of vital structures lie in the neck?

The anterior triangle

What types of neck injuries are most likely to produce C-spine fractures?

Blunt neck injury

Injury to which neck zone buys the patient a trip to the OR for surgical exploration?




Patients on a backboard for long periods of time are at risk for formation of ____________

Pressure Ulcers

Cardiac Arrest unresponsive to fluid resuscitation in penetrating neck trauma may be ___________________

Keep the patient in head down, left lateral decubitus position

Venous Air Embolism

What is the first sign of resolution of spinal shock in a patient with a spine injury?

Return of the bulbocavernous reflex

A 70 yo male presents to the ED after a whiplash injury. He ambulates well but has an extremely weak handshake.

Central Cord Syndrome

What are the NEXUS criteria for ordering C-spine films?

C-spine films should be ordered in patients with:

-Posterior midline cervical tenderness


-Altered Mental Status

- Distracting Injuries

The most common level of cervical vertebral fracture is at ___________


Most common level of cervical subluxation is between ____ and ______

C5 and C6

You have ordered a C-spine x-ray series and noticed that C7-T1 are not visualized on the films.

What additional view should you order

Swimmer's view


C-spine Series:

  1. Cross table grid Lateral view
  2. AP view - with 20 degree cephalad angle
  3. Swimmer's View if C7-T1 aren't visualized
  4. Open mouth Odontoid view

Oblique Views are optional

Basion Axis Interval (BAI) > 12mm or ↓ < 4mm

Basion Dental Axis Interval (BDI) >12mm

Atlanto-Occipital Dislocation

What do you call a C1 (atlas) burst fracture?

Jefferson Fracture


Most common C1 fracture

Occurs when patient lands directly on head or heavy object is dropped on head

Beck's triad seen in cardiac tamponade?

  1. Hypotension
  2. JVD
  3. Muffled Heart Sounds


ECG Findings = Electrical Alternans

Procedure of choice for a patient with laryngotracheal separation?


What percentage of hemothoraxes have an associated pneumothorax?

25% (1/4)

What percentage of hemothoraxes are associated with extrathoracic injuries?

75% (3/4)

- CVP line or chest tube placement

- Intra-aortic balloon pump placement

- Use of non-vascular clamp during ED thoracotomy

-Over-inflation of Swan- Ganz balloon

**These are all Iatrogenic causes of what?**

Great Vessel Injury

The most frequently injured solid organ associated with penetrating trauma is ______ followed by ____________

the liver, followed by small bowel

The most frequently injured solid organ associated with blunt trauma is _________ followed by ____________

the spleen, followed by the liver

In a stable patient with suspected abdominal trauma and a negative FAST exam, _______ is the next best step

CT scan

Next best step for a patient with a positive FAST scan?

Send to the OR


Negative FAST: look for other sites of bleeding

What do you fall a FAST exam that also checks for a pneumothorax?


What is the most sensitive test for retroperitoneal injury?

CT scan

Name some past medical history that can make passage of a foley catheter difficult in a trauma patient and can be confused for urethral disruption.

- Enlarged prostate

- Prostate cancer

-Urethral Stricture

- Self catheterization

- Previous urological surgery

________ relase during rhabdomyolysis can cause renal failure



In order to reduce precipitation of myoglobin in the kidney:

1) Maintain a high urine output

2) Alkalize the urine

ET tube size is based on the size of the ______ rather than the glottic opening because the narrowest part of a child's airway is beyond the glotic opening

cricoid ring

What are the 3 symptoms that are assessed during the Pre-Hospital Cinicinnati Stroke Scale?

  1. Facial Droop
  2. Slurred Speech
  3. Arm drift/Pronator drift

Why is identification of strokes involving the cerebellum important?

Increased risk of edema and ↑ pressure to brainstem

Steps for optimization of a patient experiencing an ischemic stroke:

- Supplemental O2

- BP: MAP should be greater than _____, SBP should be greater than or equal to _______

-Serum Glucose < _______

-Normal temperature

- Screen for thrombolytics

- For HTN, do not treat until MAP < 130

- Supplemental O2

- BP: MAP should be greater than 60, SBP should be greater than or equal to 90

-Serum Glucose < 150

-Normal temperature

- Screen for thrombolytics

- For HTN, do not treat until MAP < 130

Which diagnosis should be considered in a young patient with stroke and in patients with headaches and neck pain with acute stroke?

Carotid or Vertebral Artery Dissection

Up to ____% of patients with hemorrhagic stroke will seize within 72 hours.



Control seizures with lorazepam acutely, followed by phenytoin.

Seizure prophylaxis is achieved with phenytoin

Use the PAC3T mnemonic to recall conditions where a headache is not a benign symptom.

Pseudotumor Cerebri

Acute Angle Closure Glaucoma

Cervical Artery dissection

Cerebral Venous Thrombosis

Carbon Monoxide poisoning

Temporal areritis

Sub-arachnoid hemorrhage

A patient presents during a cold winter month with headache, nausea and vomiting. Several other family members have the same complaint.

Consider Carbon Monoxide Poisoning

You suspect a patient has a sub-arachnoid hemorrhage. However, the CT is negative. What next step is required?

Lumbar puncture

Tests to order for a patient with "the worst headache of my life"

Suspect SAH:

CT w/o contrast

Lumbar Puncture

Hunt and Hess classification for SAH:

Which grade begins to show confusion or mild focal neurological deficit?

Grade III


Grade I: Asymptomatic, mild headache, mild nuchal rigidity

Grade II: Moderate to severe headache, nuchal rigidity, cranial nerve palsy may be present

Grade III: Drowsiness, confusion, or mild focal neurological deficit

Grade IV: Stupor, hemiparesis, early decerebration or vegetative state

Grade V: Coma, decerebrate, moribund

ECG findings possibly seen in a patient with SAH?

Deep, inverted T-waves

Clinical Diagnosis:

-New headache

-Temporal artery deformity/abnormality

- Jaw claudication

Temporal Arteritis


These clinical findings have 94% specificity and 100% sensitivity for temporal arteritis

This neurological condition has a triad of:

  1. Deafness
  2. Vertigo
  3. Tinnitus

(DVT mnemonic)

Meniere's Disease


The _____ sign is considered positive with pain or resistance with passive extension of the knee with the hip flexed 90 degrees

Kernig Sign


The _______ sign is considered positive when passive flexion of the neck causes flexion of the hips

Brudzinski Sign

The causes of encephalitis are usually viral in origin. What are the most common causes (4)?



Epstein- Barr



You suspect meningitis in a patient with fever, nuchal rigidity, photophobia and altered mental status.

What is the next immediate step?

Begin antibiotic therapy!

Do not delay antibiotics for LP or CT

Posterior shoulder dislocations are common with what 2 conditions?


Electrical Shock

This is a focal neurological deficit persisting from seizure which usually resolves within 48 hours

Todd's Paralysis

Continuous Seizures can cause _______ injury

CNS Injury

Eclampsia usually occurs in patients > _____ weeks of gestation

20 weeks

Approximately 70% of patients with HIV will develop _______ caused by opportunistic bacteria, viruses, or fungi


Most patients with sinusitis can be treated __________


Anterior epistaxis commonly origninates from which confluence of arteries on the posterior nasal septum?

Keisselbach's Plexus

(located in the "picking zone")

In this type of epistaxis, the bleeding is unilateral and the patient denies the sensation of blood in the back of the throat.

Anterior Epistaxis

What percentage of properly placed nasal-packs fail to control bleeding?


-ENT consult is indicated

Approximately ___% of patients with posterior epistaxis have a systolic BP >/= 180mm Hg or a diastolic BP > 110mm Hg


A 16 yo swim-team captain presents with a greenish discharge from his ear and complains that his ear feels "full".

He withdraws as you tug on his ear to examine it.

Most likely diagnosis?

Otitis Externa ("Swimmer's Ear")

How long should patients diagnosed with otitis externa ovoid getting into water after treatment?

2-3 weeks

Treating Group-A, 𝞫 -hemolytic strep pharyngitis prevents Rheumatic fever, but does not prevent ________________

Post-streptococcal Glomerulonephritis

Does epiglottitis occur more in adults or children?


A "thumbprint sign" is seen on lateral neck radiograph.


A 29 year-year old female who had been treated for strep throat the previous week presents with progressive difficulty swallowing. Physical exam reveals a fluctuant mass on the right side of the soft palate and deviation of the uvula to the right


Peritonsilar abscess

How does a patient with epiglottitis prefer to sit?

How does a patient with retropharyngeal abscess prefer sit?

Epiglottitis: leaning forward with neck flexed

RPA: recumbency with hyperextension of neck

You see currant jelly sputum on physical exam and bulging fissure on chest x-ray.


Klebsiella pneumonia

Name 5 pulmonary pathogens found in the oropharynx that commonly cause penumonia

S. pneumoniae

M. pneumoniae

H. influenzae

Strep. pyogenes

M. catarrhalis

Which area of the lungs is aspiration pneumonia most commonly seen?

Lower Right Lobe

Acute Pulmonary Edema may be a presentation of ______

acute MI

Treatment for Acute Pulmonary Edema?








What are the criteria for the PERC score to determine the need for diagnostic testing for a low risk of PE?

PERC Score:

- Age >/= 50

- HR >/= 100

- O2 Sat on room air < 95%

- Prior DVT or PE

- Recent trauma or surgery

- Hemoptysis

- Exogenous estrogen use

- Unilateral leg swelling

Name the 3 most common causes of pleaural effusion

  1. CHF
  2. Bacterial Pneumonia
  3. Malignancy

Why are steroids given in asthma?

to decrease the late inflammatory response

What 2 drugs are commonly associated with acute asthma exacerbations?



Early asthmatic response may last for a few hours. A late asthmatic response hyperresponsiveness can persist for _______

days to months


This is why we give steroids

How do we treat Asthma in the ED?

(BIOMES mnemonic)

Beta agonists (albuterol)

Ipratroprium (anti-muscarinic)


Magnesium Sulfate



Patients with __________ are sometimes referred to as "blue bloaters"

Chronic bronchitis

Patients with ______ are sometimes referred to as "pink puffers"


What is the most important treatment in patients with COPD?

Smoking Cessation

Tuberculosis adenitis is known as _________


A _____ complex is a calcified lesion of primary pulmonary TB

Gohn Complex

This form of tuberculosis results from hematogenous spread

Miliary TB

Tuberculosis of the spine is known as _______

Pott's Disease

What is the cause of death in patients with massive hemoptysis:

Asphyxiation or Exanguination?


___________ is persistent and progressive dilation of the bronchi or bronchioles.

It as seen as a consequence of chronic infections, tumor or cystic fibrosis.

Hallmark findings are coughing, fetid breath, and expectoration of mucopurulent matter


What ventilatory rate is usually set for patients on mechanical ventilation?

14-16 bpm

What is the tidal volume set for in patients on mechanical ventilation?

What if there is concern for development of ARDS?

Tidal volume is initially set to 6-10mL/kg

If ARDS is a concern, set tidal volume to 6mL/kg

__________ improves oxygenation by keeping alveoli open during inspiration


What ventilator setting is useful for patients with no spontaneous respiration, heavily sedated patients, or paralyzed patients?

Controlled Mechanical Ventilation (CMV)


The patient is ventilated at a preset rate; the patient cannot breathe between the delivered breaths

What is the Levine Sign?

Patient puts a clenched fist to his chest to describe pain of a myocardial infarction

Patient puts a clenched fist to his chest to describe pain of a myocardial infarction

What are 2 contraindications for the administration of NTG in patients with acute chest pain?

  1. Patients who have taken PDE inhibitors such as sildanafil, vardenafil, or tadalafil in the past 24 hours

2. Patients with an inferior wall MI

SEVERE hypotension may result in these cases

Name some contraindications to the administration of beta-blockers in a patient experiencing Acute Coronary Syndrome.

Heart Rate < 60 bpm

Systolic BP < 100 mm Hg

2nd or 3rd degree Heart Block

Moderate to severe LV dysfunction

Signs of peripheral hypoperfusion

PR interval > 0.24 ms

Acute MI due to Cocaine

What are the Sgarbossa Criteria for impending MI in Left Bundle Branch Block?

1. ST Elevation > 1mm in leads with dominant R waves (concordant with QRS complex)

2. ST Elevation > 5 mm in leads with dominant S waves (discordant with QRS complex)

3. ST Depression > 1mm in V1, V2, or V3

What are the absolute contraindications for thrombolytic therapy? (8)

- History of intracranial hemorrhage

- History of ischemic stroke > 3 hours but < 3 months

- Cerebral Vascular Malformation

- Intracranial malignancy

- Symptoms or signs of an aortic dissection

- Bleeding diathesis

- Active bleeding

- Significant closed-head or facial trauma < 3 months

What are some relative contraindications to thrombolytic therapy? (7)

- History of chronic, severe, poorly controlled hypertension

- Severe, uncontrolled hypertension on presentation > 180/110 mm Hg

- Recent (within 2-4 weeks) internal bleeding

- Traumatic or prolonged (>10min) CPR

- Major Surgery within 3 weeks

-Current use of anticoagulant (warfarin) with INR 1.7

- Pregnancy

Which has a worse prognosis:

Type I or Type II heart block?

Type II

Name some causes of AV Heart Blocks







Valvular Disease


Name 2 causes of sudden cardiac death in young people


Prolonged QT

What is the heart rate commonly seen in patients who have experienced an inferior wall MI?

Sinus Bradycardia

(resolves in 1-2 days)

Atrial fibrillation increases the risk of acute ischemic stroke ___-fold. It is responsible for 15-20% of all acute ischemic stroke.


What is the most common pediatric dysrhythmia?


This heart condition has the following ECG findings:

-Short PR interval

-Widened QRS

-Delta-wave slurring QRS upswing

Wolff-Parkinson White

Why are adenosine, beta blockers, calcium channel blockers and digoxin contraindicated in patients with WPW?

They preferentially block at the AV node, allowing unopposed conduction down the accessory bypass tract.

What is considered the most significant risk factor for sudden death for patients with hypertrophic cardiomyopathy?

Symptoms prior to age 30

(Severity of symptoms does not do not increase risk)

A young patient has a systolic murmur that decreases with valsalva


Name 3 causes of paradoxical splitting of S2

1. HCM

2. Aortic stenosis


List , in order, the valves affected by acute bacterial endocarditis

1. Aortic

2. Mitral

3. Tricuspid

Which is most sensitive for the diagnosis of acute bacterial endocarditis:

Transesophageal or transthoracic echocardiography?

Transesophageal = 90-100% sensitive

Transthoracic = 28-63% sensitive

A 29 yo male presents with fever and retrosternal chest pain. He had the "flu" two weeks ago.

Most Likely diagnosis?


In new diagnosis of refractory asthma in a young adult, consider this diagnosis:


ECG shows diffuse PR depression and ST elevations



Always rule out ACS in a patient presenting with the classical signs of pericarditis

What is the mean survival for patients with Aortic stenosis and:

- Angina = _______ years

- Syncope = _______ years

- Heart failure = _________ years

- Angina = 5 years

- Syncope = 2-3 years

- Heart failure = 1-2 years


Abdominal aortic aneurysms __________, thoracic aneurysms ___________________

Abdominal aortic aneurysms rupture

Thoracic aortic aneurysms dissect

AAA is most commonly misdiagnosed as _______

renal colic

What is the mortality rate for patients with a ruptured AAA that get to the OR?

50% mortality

Aortic dissections are most commonly misdiagnosed as _________

Acute MI's

You should always get a Chest film in patients that you suspect are having an MI. Some patients will have __________ and thrombolytics will kill them

aortic dissection

How do you calculate MAP?

(2DBP x SBP)/3

Nitroprusside, given for hypertensive emergencies, can cause _______ toxicity

cyanide toxicity

This region of the GI system has a higher rate of morbidity and mortality than any other source of upper GI bleed


How should you treat ingestion of a button battery that has:

A) Passed into the stomach

B) Is lodged in the esophagus

A) Expectant management

B) Immediate removal --> alkaline ingestion is highly corrosive and can lead to liquefactive necrosis

A majority of patients with asthma have associated ________


Barrett's esophagus carries a ___ to ____ risk of development of esophageal adenocarcinoma, which carries a <5% chance of 5-year survival

2-5% risk

____________ is a transmural perforation of the esophagus.

___________ is a non-transmural tear of the esophagus associated with vomiting

Boerhaave syndrome = transmural tear

Mallory-Weiss Syndrome = non-transmural

What is the most common cause of gastritis?

Chronic NSAID use

Crossmatching blood takes 40-60 mins. Use _________ blood if type-specific blood is not readily available and the patient is unstable

O negative blood

_______ is associated with ____% of gastric ulcers and ________% of Duodenal ulcers

80% of GUs

95% of DUs

What is triple therapy for H. pylori?

PPI + Amoxicillin + Clarithromycin

Name 4 adverse affects of cimetidine when used to treat Peptic Ulcer Disease

1) P450 system inhibitor (inhibits clearance of warfarin, phenytoin, diazepam, propanolol, lidocaine, theophylline, TCAs)

2) CNS dysfunction in the elderly

3) Thrombocytopenia

4) Painful gynecomastia

This form of inflammatory bowel disease has:

-lower incidence

-lower risk of cancer

-more common in women

Crohn's Disease

When used to treat inflammatory bowel disease, which component of sulfasalazine is active



The 5-ASA component is not effective in treating IBD. It is effective in rheumatoid arthritis, however.

Drugs that only have a ________ component are not effective in treating Inflammatory bowel disease


What is the definition of pneumatosis intestinalis as described on an abdominal x-ray?

Gas in the bowel wall

What is the most common cause of small bowel obstruction?


What is the second most common cause of small bowel obstruction behind adhesions?

Incarcerated hernias

What is the most common cause of bowel obstruction in children ages 2 months to 5 years?


What is the most common blood-borne cause of viral hepatitis in the U.S.?

Hepatitis C

In alcoholic hepatitis, the ____ is greater than ______ by a factor of 2


___________ : acute hepatic encephalopathy associated with ASA use in children

Reye Syndrome

What is the mortality rate for hepatorenal syndrome?

Almost 100%

__________ is an obstruction of the biliary tract leading to stasis → bacterial overgrowth and infection.

This is a surgical emergency


What is the most common cause of hepatic abscess?

Ascending cholangitis

_________'s sign: The arrest of inspiration while palpating the RUQ. This testis more than 95% sensitive for acute cholecytsitis, less sensitive in the elderly.

Murphy's Sign

What is the sonographic Murphy's sign?

Arrest of inspiration when the U/S probe is placed in the RUQ

Most gallstones are composed of _____ and are radiolucent.

Cholesterol (70%)


Pigment (20%) → Radiodense

Mixed (10%)

What metabolic derrangement can be caused pancreatitis?



Hypercalcemia can also cause pancreatitis

This abdominal diagnosis has the following abdominal X-ray findings:

Sentinel Loop

Colon cutt-off sign (distended colon to midtransverse colon with no air distally)


Suspect a ______ when patients with pacreatitis fail to resolve

pancreatic pseudocyst

Criteria used to assess prognosis in pancreatitis

Ranson's Criteria

Ranson's Criteria

What is the most common surgical emergency?


_________ in late pregnancy presents with RUQ pain due to displacement by gravid uterus


What is the most common cause of pancreatitis?


Due to its small radius, the ______ is normally the site of highest pressure in the GI tract


What is the most common cause of painless lower GI bleeding in older adults?


__________ is a common cause of large bowel obstruction


What 2 modalities should be avoided in cases of acute diverticulitis due to risk of perforation?

Barium enema


What is the most common cause of GI bleeding in younder patients?

Older patients?

Younger = Angiodysplasia

Older = diverticulosis

What is usually the most common cause of an apparent lower GI bleed?

An upper GI bleed

What is the most common cause of anorectal pain (especially in children)?

Anal fissure

________ is the production of less than 400mL of urine in 24 hours


What is the most common cause of community-acquired Acute renal failure (40-80% of cases)

Pre-renal Acute Renal Failure


BUN:Cr ratio > 20:1

Urine sodium excretion is < 10

Fractional excretion of sodium < 1%

What is the most common cause of postrenal failure?


What is the most common reason to initiate dialysis in a patient with end stage renal disease?

Pulmonary Edema

List the most common causes of non-traumatic hematuria in order of frequency (6)

1. Nephrolithiasis

2. Carcinoma of GU tract

3. Urethritis

4. UTI

5. BPH

5. Glomerulonephritis

Granular casts in urine are seen in __________

acute tubular necrosis

WBC casts in urine are seen in _____________

pyelonephritis/interstitial nephritis

RBC casts in urine are seen in _____ and ______

Glomerulonephritis and Malignant HTN

Renal stones formed from ______ may appear as coffin-lid crystals in urine


Many OTC medications contain ________, which can cause prostatic obstruction


Buzzwords for stages of this disease include:

Phase 1 : Painless chancre

Phase 2: condyloma lata

Phase 3: Gummas, Argyll Robertson pupil, tabes dorsales


______________ is an acute reaction that occurs ~24 hours after treatment of early syphilis.

It presents with headache, and severe myalgias. It can cause early labor and fetal distress during pregnancy.

Jarisch-Herxheimer reaction

Drug of choice for syphilis infection?

Penicillin G

Both _____ and ______ have a positive Whiff test after KOH is mixed with discharge and heated on a slide.

Trichomonas and Bacterial Vaginosis

The effectiveness of the intrinsic clotting pathway can be measured with ______________


The effectiveness of the extrinsic clotting pathway can be measured with ___________


Heparin is associated with the intrinsic or extrinsic clotting pathway?


Warfarin primarily affects the PT or PTT?


Ingestion of what can cause subtherapeutic INR levels in patients taking warfarin?

Green Leafy Vegetables --> ↑ Vit. K

What is the most common inherited bleeding disorder?

Von-willebrand disease

Bleeding time in Von-willebrand disease Vs. Hemophilia A?

vWD = ↑ Bleeding time

Hemophilia A: No change in BT (platelets are not affected)

What is the lifespan of RBCs in patients with sickle cell anemia?

17 days as compared to 120 in patients without sickle cell

Most cases of spinal cord compression are in which area of the spine?

Thoracic (68%)


Lumbar (19%)

Cervical (15%)

Which gynecologic disorder presents with the triad of:

1. Hirsutism

2. Obesity

3. Oligomenorrhea

Polycystic Ovarian Syndrome

What is the most common ovarian tumor?

Benign Cystic teratoma (dermoid cyst)

Yoplait contains which type of bacteria which are shown to be decreased in patients with bacterial vaginosis?


Bacterial vaginosis during pregnancy can cause ______________, so it should always be treated even if the patient is asymptomatic

preterm labor

A woman presents with recurrent vaginal candidiasis. What is the next best test to order?

Blood glucose ---> Diabetes

There is a high rate of recurrence of Bartholin's abscess due to ___________ formation

fistulous tract formation

What is the leading cause of female infertility?


______ is a risk factor for infertility, chronic pelvic pain, and ectopic pregnancy


__________ is uncommon during pregnancy due to the plug formed by the fusion of the chorion and decidua providing an extra natural barrier to infection


What is the most common organism to cause a tubo-ovarian abscess?


Should you treat asymptomatic bacteriuria in pregnant women?

Yes... use nitrofurantoin

𝞫 -hCG levels double every _____to_____ days in normal early pregnancy

2-3 days

What test can be used to determine the amount of fetal-maternal blood mixing in Rh (-) patients?

Kleihauer-Betke tets

First-trimester bleeding occurs in approximately ____% of all pregnancies, one-half of patients will eventually experience a miscarriage


What is the most common risk factor for abruptio placentae?


Eclampsia and Seizures:

____% of seizures are before labor

___% are during labor

____% are up to 10 days postpartum

25% of seizures are before labor

50% are during labor

25% are up to 10 days postpartum

_______ syndrome complicates about 10% of preeclampsia:

Hemolysis, Elevated liver enzympes, Low platelets

HELLP Syndrome

Why should rapid BP reduction be cautioned against during eclampsia/preeclampsia?

Decrease in uterine blood flow --> fetal distress

Drug of choice for a patient with Eclampsia?

Magnesium Sulfate


-Terminates seizure

-Prevents recurrence of seizure

- ↓ risk of placental absorption

- Associated with ↓ NICU admissions

- Better than phenytoin or placebo

Patients with PROM are at higher risk for what complication?


What is the leading cause of neonatal death?

Preterm labor

What is the most common organism to cause septic arthritis in all age groups?

Staph. aureus

Most common joints involved in septic arthritis?

The knee, followed by the hip, shoulder and wrist

Most common cause of osteomyelitis?

Staph. aureus

Most common cause of osteomyelitis in patients with asplenia or sickle-cell disease?


What is the most common entrapment neuropathy?

Carpal Tunnel Syndrome

What percentage of the population normally has a positive Phalen or Tinel's sign?


Most common malignancies causing spinal cord compression?

Prostate, breast, lung

Which has longer morning stiffness, OA or Rheumatoid arthritis?

Rheumatoid arthritis

OA vs RA:

Which affects the Distal Interphalangeal joints (DIPs)?


This disorder affects small joints and aspiration shows needles with negative biferingence

Gout ---> Uric acid crystals


Pseudogout --> large joints (shoulder,knee,wrist), positive biferingence --> calcium pyrophosphate crystals

What is the most common and frequent manifestation of gout?


Polymyositis and dermatomyositis are both more common in men or women?


Patients with dermatomyositis or polymyositis are often given azathioprine or methotrexate.

Both can cause what side effect?

Bone marrow suppression


Azathioprine may also cause hepatotoxicity

Posterior shoulder dislocations account for only __% of all dislocations


Posterior shoulder dislocations are frequently missed. Surgical fixation is necessary when diagnosis is delayed more than ____ weeks

2 weeks

A fracture of the humerous at this location is associated with radial nerve injury and wrist drop

Mid-shaft humerus

This is a distal radius fracture with dorsal angulation.


- "Dinner fork deformity" is classic

Colle's Fracture

Anterior shoulder dislocations may damage which nerve?

Axillary Nerve

________ is commonly associated with ski-pole injury

Gamekeeper's thumb


-Avulsion of ulnar collateral ligament of first MCP joint

A patient complains or arm pain after a fall on outstretched hand. X-ray shows a posterior fat pad.

Radial head/neck fracture

If left untreated, a mallet finger may result in a permanent ________ deformity.

Boutonniere deformity


-Mallet finger --> rupture of extensor tendon at insertion of distal phalanx

Fracture/dislocation at the base of the thumb

Bennett fracture

Fracture at neck of 5th metacarpal following a closed-fist injury

Boxer's Fracture

Fracture of the ulnar shaft

Nightstick fracture

What is the percentage of patients that die within 1 year of hip fracture?


What is the most frequently injured foot bone?


Describe an antalgic gait

Pain on weight bearing in which the stance phase of the gait is shortened on the affected side

Is compartment syndrome most common in the upper or lower extremity?

Lower extremity

What is the most common cause of adrenal crisis?

Abrupt withdrawal of steroid therapy

Patients with CHF and DKA will require ________

agressive fluid resuscitation


This also holds true for patients with CHF and HHS

Which anti-thyroid drug does NOT block conversion of T3 to T4


What antiparasitic drug can cause seizure if overused?


More potent steroids are needed for rashes/diseases involving ______ skin


_______ agents are first-line for the treament of acne

Topical Agents

-benzoyl peroxide




Exposure to sun while on ________ or ________ can cause a rash in patients being treated for acne

tetracycline or doxycycline

Lyme disease can cause which nerve palsy?

Bell's palsy (CN VII)

Many patients with Rocky Mountain Spotted Fever have exquisite tenderness of the ________ muscle


Varicella-zoster infection of CN VIII is called _______________ syndrome.

-Hearing loss



Ramsay Hunt Syndrome

Bullous Pemphigoid vs. Pemphigus Vulgaris:

Which is Nikolsky (+) ?

Pemphigus Vulgaris

Bullous Pemphigoid vs. Pemphigus Vulgaris:

intraepidermal involvement

Pemphigus Vulgaris

Bullous Pemphigoid vs. Pemphigus Vulgaris:

subepidermal involvement

Bullous Pemphigoid

Psoriasis is worse during which season?


What accounts for most recurrent cases of erythema multiforme?


Describe the stages of decubitus ulcers (I-IV)

I - nonblanching erythema of intact skin

II - partial-thickness skin loss involving epidermis and/or dermis

III- full thickness skin loss involving epidermis and dermis. May involve damage to subcutaneous tissues, extending down to fascia

IV- full thickness skin loss with extensive damage to muscle, bone or supporting structures

Early Kaposi's sarcoma is often mistaken for ____________


What is the emergent treatment of choice if a chest tube can't be immediately placed for a patient with a tension pneumothorax?

Needle decompression with a 14g needle at the 2nd intercostal space, mid-clavicular line

Neurovascular bundles run along the ______ rib margin


An emergence reaction is the occurrence of hallucinations and nightmares during the wearing off of ________ after procedural sedation



Not common in children, occurs in 10-20% of adults. Allow emergence in a dark, calm room to decrease this phenomenon

DOC for procedural sedation in children?


Which drugs are preferred in hypotensive patients needing procedural sedation?

Ketamine or Etomidate


These do not decrease BP

How should the patient be positioned for a central venous cannulation?

Trendelenburg position


Thought to prevent air embolism

Is central venous cannulation preferred on the right or left side? Why?

Right side!

Avoids thoracic duct (on left) and dome of right lung is lower leaving a decreased chance of pulmonary injury

Antibiotic of choice for an abscess in an otherwise healthy individual?

None.. Incision and drainage is the treatment of choice...


Antibiotics should be considered in immunocompromised patients or those with valvular disease.

A farmer presents after spraying insecticide on crops all day. He has increased salivation, lacrimation, anxiety and bradycardia.

Treatment of choice?

This is Cholinergic toxicity from organophosphate poisoning. Treat with atropine +/- pralidoxine

A patient presents mad as a hatter, blind as a bat, hot as a hare, and dry as a bone.

What's going on?

Anticholinergic Toxicity

Treat with Benzos +/- Physostigmine (↑s ACh)


Mad as a Hatter: AMS

Blind as a bat: Mydriasis

Hot as a Hare: Hyperthermia (can't sweat)

Dry as a bone: Dry mucous membranes


Decreased level of consciousness, respiratory depression, pinpoint pupils

Opioid Toxicity

Treat with Naloxone


Treatment for benzodiazepine overdose?

Supportive +/- flumazenil

What's in the "coma cocktail"?






[Give thiamine before dextrose]

name a classic example for a "spot" test for a toxidrome

Ferric Chloride ---> Salicylate Poisoning

What are two factors that accelerate acetameniphen toxicity

1) Prior induction of P450 (smokers, EtOH, drugs)

2) Malnutrition (↓ glutathione stores)

What is the potential toxic dose of acetameniphen?

140 mg/kg

What is the initial dose for NAC in acetameniphen toxicity?

140 mg/kg

At what 4-hour level of acetameniphen will hepatic toxicity become induced?

140 ug/kg



A 67 yo female presents with 6 days of headache and 2 days of "ringing in ears" and fever. She is breathing deeply at a rate of 22/min.


Aspirin toxicity

What ECG finding is pathognomic for digoxin toxicity?

Bidirectional ventricular tachycardia

Without digibind therapy, Digoxin toxicity mortality is:

___% for K+ levels > 5.5

____% for K+ levels 5.0-5.5

____% for K+ levels < 5.0

100% for K+ levels > 5.5

50% for K+ levels 5.0-5.5

0% for K+ levels < 5.0

First-line drug for treatment of dysrhythmias in patients with a TCA overdose?

Sodium Bicarbonate


Sodium in sodium bicarb alters the interaction between the drug and sodium channels in the heart.

Does lithium bind to charcoal?

No... Activated charcoal is useless in the presence of lithium overdose

Toxicity from antipsychotic medications can occur with ______ or _______

therapeutic dose or overdose


-Extra Pyramidal Symptoms --> Tx = Benadryl


-Orthostatic hypotension

A patient with newly diagnosed schizophrenia presents with hyperthermia, AMS, autonomic instability and muscular rigidity...


Neuroleptic Malignant Syndrome


Treat with supportive care, benzo's and dantrolene

In alcoholic ketoacidosis, most ketones are ______ and are poorly detected by the lab

𝞫 -hydroxybutyrate

In patients who ingest Methanol, toxicity is contributed to formation of ___________

formic acid

Which opiod causes dilated pupils (mydriasis)?



Can also precipitate Serotonin syndrome in patients using MAOIs

Although flumazenil is the DOC for benzodiazepine reversal by IV drug sedation, why should it not be used in an overdose setting?

It may precipitate seizures

Also, which drug is first line for seizures --> Lorazepam... Wouldn't make sense to give a competitive inhibitor of benzodiazepines if seizure is a risk!

What is the most common household caustic exposure?


Type of necrosis caused by acid exposure?

Coagulation necrosis

Type of necrosis caused by alkali exposure

Liquefactive necrosis

Dermal exposure to hydrofluoric acid, found in rust removers, may result in systemic absorption causing hypocalcemia, hypomagnesemia and death.

How would you treat?

Calcium gluconate paste for dermal burn

IV/IA Calcium

How do organophosphates cause cholinergic crisis?

Deactivation of acetylcholinesterase

3 unique symptoms associated with high-altitude sickness?

-Snow blindness (ultraviolet keratitis)



The definitive treatment for high-altitude syndromes is ____________



When not possible, descent may be simulated by a Gamow bag (portable hyperbaric O2 chamber)

According to Boyle's Law, as Pressure increases, Volume _______


What is a risk factor for "reverse ear squeeze" (ascent barotrauma)?

Respiratory tract infection/congestion

Decompression Sickness occurs at a dive/depth of at least ______ feet

30 ft

Treatment of choice for Decompression Sickness ("The bends")?

Immediate hyperbaric O2

What is "secondary drowning"?

Death after initial stabilization

Name 3 risk factors for near drowning:



-Head trauma

Name 4 subsets of patients at high risk for drowning:

- Children < age 4

- Teens (poor judgment)

- Elderly (tubs)

-Alcohol and Drug Users

A 24 yo male diver syncopizes upon ascent tot he surface.


Dysbaric Air Embolism

When do you NOT close wounds caused by human bites?

Closed fist injuries ("Fight Bite")

What is the Parkland formula for burn victims?

4 x weight(kg) x %BSA = mL fluid resuscitation

Give 1/2 over first 8 hours

Give remaining half over a 16 hr period

Fluid of choice for burn victims?

Ringer's Lactate

Rule of 9's for burn victims

Name some criteria for patient transfer to a burn unit

-Electrical or chemical burns

-Inhalation injury


- >10% TBSA in ages < 10 or >50

- >20% TBSA in ages 10-50

- >5% TBSA Third degree burn

- Significant burns to face, eyes, ears, hands, feet, genitalia, perineum or major joints

Name some products that contain Hydroflouric acid and can cause burns/toxicity

Glass etching dyes

High-octane gas


Name some products containing Phenol, which can cause a chemical burn after exposure to skin





When should ocular pH be tested when irrigating an eye exposed to a chemical?

Before AND After irrigation!

What is Frostnip?

Mild, reversible, superficial frost bite

Best way to get a core temperature in a patient with hypothermia?

Rectal or bladder temperature

ECG finding in hypothermia?

Osborn ( J ) wave

"Duty to warn" was established by the _________ case

Tarasoff Case