Residency

Emergency Medical
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Review Study Session

12/12/07

 

The following topics were stressed: (I added the links to emedicine, for a quick jump to more info, also, be sure to look at the photos at the bottom of the emedicine article for visual stim questions)

 

  1. In frostbite, what is the temperature of rewarming water?    42 C / 108 F [More]
  2. Hemorrhagic blisters Dont debride; only debride clear blisters
  3. Know rule of 9s

  1. Might be asked to calculate Parkland Formula. KEY=Dont forget the maintenance thats added with peds. Dont add the maintenance with adults, youll be tricked. Also, the time element is based on the time of burn, not presentation to ED. [More]

                        Fluid Requirements = TBSA burned(%) x Wt (kg) x 4mL
                                Give 1/2 of total requirements in 1st 8 hours, then give 2nd half over next 16 hours.

  1. AC Current house. Causes Explosive exit wound and V-fib [More]
  2. DC Current welding, industrial, lightening. Causes Asystole, dilated NR pupils
  3. Know how to do SMART triage of mass casualty victims [More]
  4. Know how lightening victims are approached in mass casualty. [More]
  5. In heat stroke, cool to 39 C (102.2) [More]
  6. Hypothermia dxd as <35 C (<95 F). At 30-32, stop shivering. Pt has Bradycardia Slow A. Fib V Fib Asystole [More]
  7. Tetanus is a Gm + Rod [More]
  8. Pathogens in human bite? Staph / Strep [More] Rx: Bobmentin
  9. Dogs? Pasturella [More] Rx: Dogmentin
  10. Cats? Pasturella, Bartonella Rx: Catmentin
  11. Rocky Mountain Spotted Fever:  female tick, palms & soles, Hyponatremia [More]
  12. Lyme Disease: Ixodes tick, Serpentine spirochete. In peds or preggoAmox; all else, doxy. [More]
  13. Black Widow Bite:  dull muscle cramping. CP with bites to upper body. Rectal spasm with bites to lower body. Can give Ca++. Use nitroprusside for HTN. Use antivenin in <16 or >65. [More]
  14. Brown Recluse Bite: Use dapsone [More]

  15. Trantulas:  hairs used as defense mechanism can become corneal foreign bodies.
  16. Acute Mountain Sickness:  Onset few hours. Treat by going down. Diamox and Dexamethasone speeds acclimatization. [More]
  17. HAPE seen in 1-4 days. Non-cardiac Pulm edema. Use BiPAP and Nifedipine (to reduce pulm art pressure)
  18. If ataxic: HACE, treat with O2, dexamethasone & hyperbarics
  19. Dysbarism: descent barotraumas have bloody ears, tinnitus, vertigo. Ascent barotraumas have pneumothorax, emboli (usually 10 minutes after surfacing). Nitrogen narcosis has bends & chokes. [More] [More]
  20. Inhalation anthrax: Hemorrhagic mediastinitis, lymphadenitis. Its a Gm + Rod. [More]
  21. Cutaneous anthrax: seen after 5 days. Painless papules then eschar
  22. GI anthrax: diarrhea, sepsis
  23. Smallpox: only contagious with rash. >102 temp. [More]
  24. Conjunctival GC: 1st 3 days of life. Treat w/frequent irrigation. IV or IM. Also treat for chladymia (topical and oral ERY) [More]
  25. Orbital Cellulitis in diabetic: mucomycosis & ethmoidal sinusitis [More]
  26. Eaton Lambert: Oat cell lung cancer (memory aid: eatin' oats makes you stronger!) Weakness, fatigue, pelvic girdle & thigh weakness that gets stronger with repeated movement. [More]
  27. Botulism: pre-formed toxin that prevents Ach from nerve endings. Blurred vision (diplopia). [More]
  28. Myasthenia gravis: Ptosis, dysphagia. Destroys Ach Receptor. Proximal muscle weakness, then ptosis & diplopia. Gets weaker with repeated movement.  [More]

Myasthenic Crisis

Cholinergic Crisis

Due to Ach deficiency

Due to overtreatment (think SLUDGE)

Edrophonium improves sxs

Edrophonium worsens sxs

  1. Epidural abscess [More]

  2. GCS: will be asked to calculate
  3. Hep B core Ag only in liver cells
  4. Know Hep A, B, C [More]
  5. Middle Cerebral Stroke (MCA) upper ext weakness > lower ext weakness. Gaze to lesion [More]
  6. Anterior Cerebral Stroke (ACA) lower ext weakness > upper ext weakness

The following were visual stim topics:

  1. Foreign Body on cxr giving hyperlucency to affected side
  2. Pneumocystis carini [More]
  3. Pneumonia w/bulging fissure=klebsiella [More]
  4. Epiglotitis on lat xray [More]
  5. TEN sloughing in sheets [More]
  6. Know the Debakey classification of AAAs [More]
  7. Body Packers
  8. Pneumotosis intestinalis [More]
  9. SVC syndrome [More]
  10. Thoracic outlet: typical scenarioreach up to top shelf and have syncopal episode [More]
  11. Tinea vs. erythema multiforme [More] [More]
  12. Given CXR, whats wrong? Remember: 6@2, 22@6. (6mm @ C2, 22mm @ C6)
  13. Hydroflouric Acid burns: wont affect nail, but fingertip otherwise is burned. Rx w/calcium gluconate through art line [More]
  14. Thrombosed hemorrhoid elliptical incision [More]
  15. Volvulus on X-ray (bird beak) [More]
  16. Rectus sheath hematoma (cullens sign) [More]
  17. HSP [More]
  18. Felon: know where to incise [More]
  19. Paronychia [More]
  20. Herpetic whitlow: dont incise [More]
  21. Leishmaniasis [More]
  22. Erythema migrans lyme Borrelia Burgdorferi ixodes tick [More]
  23. #1 manifestation of tramatic head bleed SAH [More]
  24. Chalazion [More]
  25. Hordeoleum (Or, as Rob says: Stye) [More]
  26. Endopthalmitis [More]
  27. Optho questions will be related to:

      Retinal Vein, Retinal Artery, Retinal Detachment, UV Keratitis

  1. Reaction to hurricaine oral spraychocolate blood (Methemoglobinemia) Rx w/methelene blue. [More]
  2. Silicosis in X-ray [More]
  3. Asbestosis [More]
  4. Plague [More]
  5. Smallpox DDx: Molluscum [More]
  6. Volar plate if cant reduce PIP dislocation
  7. Lunate dislocation on X-ray [More]
  8. Perilunate dislocation on X-ray
  9. C-1 Burst (Jefferson Fx) Key is <9 mm on Dens film. Will be in an axial load scenario. [More]
  10. Hangmans C-2. Will be in a hyperextension scenario.
  11. Angioedema: C-1 esterase deficiency. Give FFP or cryo [More]
  12. Urticaria [More]
  13. Zone 1 Neck Injury [More]
  14. Fingertip injury w/o bone involvement, treat? Wrap it. [More]
  15. Rheumatoid Arthritis. Swan neck vs. Butoniere deformity [More]
  16. Keloid [More]
  17. Ductal carcinomapagets dz.peau-de-orange [More]
  18. Melanoma [More]
  19. Pancreatic Pseudocyst [More]
  20. Thyroglossal duct cyst (midline) [More]
  21. Branchial cleft (lateral to midline)
  22. Gas in bladder vesiculocolic fistula (i.e., good party trick)
  23. Achalasia on Barium swallow [More]
  24. Testicular hernia [More]
  25. Basal cell carcinoma [More]
  26. Hairy Leukoplasia (Know what things are AIDS defining)  [More]
  27. Mononucleosis [More]
  28. Osler-Rendu-Weber petechiae throughout GI [More]
  29. Cauliflower ear [More]
  30. Pyogenic granuloma [More]
  31. Parvo B-19 badness for sicklers and preggos [More]
  32. Hand-Foot-Mouth [More]
  33. Measles w/Koplik spots [More]
  34. Kawasaki s [More]
  35. Bells Palsy Rx: Acyclovir. (DDx from stroke:  remember: upper spares upper) [More]