Emergency Medicine SHELF
Which headache meds should never be combined? ergotamine and triptans should never be combined because they both have
vasoconstrictive effects, which can lead to complications such as stroke or
myocardial infarction.
What is the first line med for migraine with auro + vomiting first line abortive med for migraine with auro (esp repeated vomiting) - IV
prochlorperazine
What type of fractures are common low-impact injuries and Femoral neck fractures and intertrochanteric fractures are common injuries on a
which are high-impact in elderly? low-impact fall to the hip in the elderly. Intertrochanteric fractures typically result in
- femoral neck bruising because the fracture site is extra-capsular
- femoral head
- intertrochanteric fractures Posterior hip dislocation and femoral head fractures commonly occur in high-impact
falls (dashboard injuries)
Define: rupture of small penetrating artery = intracerebral hemorrhage
rupture of small penetrating artery rupture of a saccular aneurysm = berry aneurysm = subarachnoid hemorrhage
rupture of a saccular aneurysm
What is the best diagnostic test for boorehave syndrome? hemodynamically stable, contrast esophagography with gastrografin is the preferred
confirmatory test.
NOT hemodynamically stable, CT scan of the chest is the best test
What tests do you order for a patient with concerns of a Hemodynamically stable - colonoscopy requires bowel prep and will be unreliable in
lower GI bleed? (hemodynamically stable vs unstable) an urgent situation
Hemodynamically unstable - angiography because it can be done quickly without
the need for bowel prep ( you could do a CT angiography first before proceeding
with invasive catheter angiography)
When should you be conscerned for bowel perf vs SBO? This patient presents with diffuse abdominal pain, nausea, vomiting, high-pitched
bowel sounds, and a distended and diffusely tender abdomen, all of which suggest
bowel obstruction. If the patient develops guarding or rebound tenderness and
bowel sounds are absent, be concerned for a perf
What complication after cardiac catheterization can lead to cholesterol embolization is a potential complication that can lead to ischemia in
livedo reticularis?- many organs, often including the kidney
How do nitrates work to reduce myocardial oxygen Nitrates, such as nitroglycerin, cause arterial and venous vasodilation by inducing
demand? smooth muscle relaxation. Anginal pain relief is mainly achieved by venous dilation
(venous pooling), which leads to decreased end-diastolic pressure (i.e., decreased
preload), reduced myocardial wall tension, and improved myocardial perfusion. The
decreased preload results in reduced heart size and decreased myocardial oxygen
demand.
What is the management for patient with HELLP at 35 HELLP - Hemolysis, elevated liver enzymes, low platelets. If a patient is over 34
weeks pregnant weeks pregnant, then immediate delivery
Mag sulfate is indicated in all patients with HELLP for seizure prophylaxis
What is the diagnostic test for central retinal vein Fluorescein angiography (FA) is indicated as a next step to confirm the diagnosis of
occlusion? central retinal vein occlusion (CRVO), evaluate the severity of CRVO, and decide
whether laser photocoagulation should be performed.
What is TB adrenalitis - This is adrenal insufficiency caused by TB, which can occur in patietns in a coutnry
with high burden of tb
, Emergency Medicine SHELF
What type of ulcers are you concerned for in burn Curling ulcers are a subtype of stress gastritis seen in patients with extensive burns
patients? and occur due to hypovolemia and subsequent hypoperfusion of the stomach. The
resultant ischemic tissue injury to the stomach epithelium results in an interruption
in the normal mucosal barrier of the stomach, and ulcer formation
What is the difference between superficial second degree Superficial partial thickness burn (superficial second degree burn) is known for
burns, deep second degree burns, and third degree blanching and blistering and being extremely tender
burns? Deep partial thickness burn (deep second degree burn) is known for blistering as
well but as less tender and do not blanch
Third degree burns are painless with no blanching that appear black, gray or white
and leathery
How can you tell the difference between infective Conduction abnormalities on ECG (e.g., AV block) occur when the abscess extends
endocarditis and a perivalvular abscess? to cardiac conduction tissues, which signals that the disease is not just infective
endocarditis but also a perivalvular abscess
What are the causes of vasovagal syncope? Causes can include pain, fear, the sight of blood, or emotional stress. Patients
usually experience a presyncopal prodrome, as seen here. Patients with syncope
may also experience myoclonic jerks that last for less than 15 seconds
evidence of bronchial wall fibrosis (tram-track opacities) is bronchiectasis
code for which disease?
What is your first thought if someone is intubated and then Absent or decreased breath sounds on the left suggest inadvertent right mainstem
has assymetrical chest rise and decreased breath sounds bronchus intubation, which is more common than inadvertent left mainstem
on the left bronchus intubation because the right mainstem bronchus is more vertically
oriented than the left mainstem bronchus at the bifurcation of the trachea.
A CT scan of the head shows a hyperdense fluid collection oculomotor - CNIII
in the right medial temporal lobal and uncal herniation of
the hippocampa gyrus. Which cranial nerve is likely
affected?
What is the first line treatment for symptomatic Atropine is an anticholinergic agent that is used to increase heart rate. Intravenous
bradycardia? atropine is the first-line treatment in patients who present with symptomatic
bradycardia when there are no reversible causes that can be immediately identified
How does pulmonary contusion appear on chest xray? Pulmonary contusion shows up as patchy infiltrates on chest xray
How does AS lead to increased myocardial oxygen In AS, blood flow from the left ventricle to the aorta is obstructed by the narrowed
demand? aortic valve opening (increased afterload), which, over time, results in left ventricular
hypertrophy (LVH). LVH leads to increased left ventricular oxygen demand, resulting
in myocardial ischemia (angina) during periods of strenuous exercise or stress.
What is amebiasis? This is caused by protozoan entamoeba histolytica. Patients present with liver
abscesses and bloody diarrhea. It can take several weeks to years for
extraintestinal amebiasis to manifest
What is the test to diagnose intestinal malrotation in Intestinal malrotation often presents with acute bilious vomiting in a 3-4 week infant.
infants? On xray you will see no gas in the distal small intestine. You must order an upper GI
contrast series to diagnose
What is the pathophys for cholelithiasis? This condition is caused by increased intraluminal gallbladder pressure as a result
of gallbladder contraction against an occluded cystic duct, most commonly due to
gallstones?
Which headache meds should never be combined? ergotamine and triptans should never be combined because they both have
vasoconstrictive effects, which can lead to complications such as stroke or
myocardial infarction.
What is the first line med for migraine with auro + vomiting first line abortive med for migraine with auro (esp repeated vomiting) - IV
prochlorperazine
What type of fractures are common low-impact injuries and Femoral neck fractures and intertrochanteric fractures are common injuries on a
which are high-impact in elderly? low-impact fall to the hip in the elderly. Intertrochanteric fractures typically result in
- femoral neck bruising because the fracture site is extra-capsular
- femoral head
- intertrochanteric fractures Posterior hip dislocation and femoral head fractures commonly occur in high-impact
falls (dashboard injuries)
Define: rupture of small penetrating artery = intracerebral hemorrhage
rupture of small penetrating artery rupture of a saccular aneurysm = berry aneurysm = subarachnoid hemorrhage
rupture of a saccular aneurysm
What is the best diagnostic test for boorehave syndrome? hemodynamically stable, contrast esophagography with gastrografin is the preferred
confirmatory test.
NOT hemodynamically stable, CT scan of the chest is the best test
What tests do you order for a patient with concerns of a Hemodynamically stable - colonoscopy requires bowel prep and will be unreliable in
lower GI bleed? (hemodynamically stable vs unstable) an urgent situation
Hemodynamically unstable - angiography because it can be done quickly without
the need for bowel prep ( you could do a CT angiography first before proceeding
with invasive catheter angiography)
When should you be conscerned for bowel perf vs SBO? This patient presents with diffuse abdominal pain, nausea, vomiting, high-pitched
bowel sounds, and a distended and diffusely tender abdomen, all of which suggest
bowel obstruction. If the patient develops guarding or rebound tenderness and
bowel sounds are absent, be concerned for a perf
What complication after cardiac catheterization can lead to cholesterol embolization is a potential complication that can lead to ischemia in
livedo reticularis?- many organs, often including the kidney
How do nitrates work to reduce myocardial oxygen Nitrates, such as nitroglycerin, cause arterial and venous vasodilation by inducing
demand? smooth muscle relaxation. Anginal pain relief is mainly achieved by venous dilation
(venous pooling), which leads to decreased end-diastolic pressure (i.e., decreased
preload), reduced myocardial wall tension, and improved myocardial perfusion. The
decreased preload results in reduced heart size and decreased myocardial oxygen
demand.
What is the management for patient with HELLP at 35 HELLP - Hemolysis, elevated liver enzymes, low platelets. If a patient is over 34
weeks pregnant weeks pregnant, then immediate delivery
Mag sulfate is indicated in all patients with HELLP for seizure prophylaxis
What is the diagnostic test for central retinal vein Fluorescein angiography (FA) is indicated as a next step to confirm the diagnosis of
occlusion? central retinal vein occlusion (CRVO), evaluate the severity of CRVO, and decide
whether laser photocoagulation should be performed.
What is TB adrenalitis - This is adrenal insufficiency caused by TB, which can occur in patietns in a coutnry
with high burden of tb
, Emergency Medicine SHELF
What type of ulcers are you concerned for in burn Curling ulcers are a subtype of stress gastritis seen in patients with extensive burns
patients? and occur due to hypovolemia and subsequent hypoperfusion of the stomach. The
resultant ischemic tissue injury to the stomach epithelium results in an interruption
in the normal mucosal barrier of the stomach, and ulcer formation
What is the difference between superficial second degree Superficial partial thickness burn (superficial second degree burn) is known for
burns, deep second degree burns, and third degree blanching and blistering and being extremely tender
burns? Deep partial thickness burn (deep second degree burn) is known for blistering as
well but as less tender and do not blanch
Third degree burns are painless with no blanching that appear black, gray or white
and leathery
How can you tell the difference between infective Conduction abnormalities on ECG (e.g., AV block) occur when the abscess extends
endocarditis and a perivalvular abscess? to cardiac conduction tissues, which signals that the disease is not just infective
endocarditis but also a perivalvular abscess
What are the causes of vasovagal syncope? Causes can include pain, fear, the sight of blood, or emotional stress. Patients
usually experience a presyncopal prodrome, as seen here. Patients with syncope
may also experience myoclonic jerks that last for less than 15 seconds
evidence of bronchial wall fibrosis (tram-track opacities) is bronchiectasis
code for which disease?
What is your first thought if someone is intubated and then Absent or decreased breath sounds on the left suggest inadvertent right mainstem
has assymetrical chest rise and decreased breath sounds bronchus intubation, which is more common than inadvertent left mainstem
on the left bronchus intubation because the right mainstem bronchus is more vertically
oriented than the left mainstem bronchus at the bifurcation of the trachea.
A CT scan of the head shows a hyperdense fluid collection oculomotor - CNIII
in the right medial temporal lobal and uncal herniation of
the hippocampa gyrus. Which cranial nerve is likely
affected?
What is the first line treatment for symptomatic Atropine is an anticholinergic agent that is used to increase heart rate. Intravenous
bradycardia? atropine is the first-line treatment in patients who present with symptomatic
bradycardia when there are no reversible causes that can be immediately identified
How does pulmonary contusion appear on chest xray? Pulmonary contusion shows up as patchy infiltrates on chest xray
How does AS lead to increased myocardial oxygen In AS, blood flow from the left ventricle to the aorta is obstructed by the narrowed
demand? aortic valve opening (increased afterload), which, over time, results in left ventricular
hypertrophy (LVH). LVH leads to increased left ventricular oxygen demand, resulting
in myocardial ischemia (angina) during periods of strenuous exercise or stress.
What is amebiasis? This is caused by protozoan entamoeba histolytica. Patients present with liver
abscesses and bloody diarrhea. It can take several weeks to years for
extraintestinal amebiasis to manifest
What is the test to diagnose intestinal malrotation in Intestinal malrotation often presents with acute bilious vomiting in a 3-4 week infant.
infants? On xray you will see no gas in the distal small intestine. You must order an upper GI
contrast series to diagnose
What is the pathophys for cholelithiasis? This condition is caused by increased intraluminal gallbladder pressure as a result
of gallbladder contraction against an occluded cystic duct, most commonly due to
gallstones?
