1. heuristics for optimal decision-making

2. patient throughput heuristics

3. heuristics for minimizing errors

4. errors influencing clinical decisionmaking

5. endogenous substance that generates a fever / 4 ways it makes a fever

6. the physiologic definition of fever / the normal range of body temperature / definition of hyperthermia

7. ancillary tests to consider in a patient who presents with fever

8. unique historical features to elicit in the patient who presents with fever / ddx fever + bradycardia

9. temperature at which aggressive cooling should be instituted / expected increase in HR to increased Temp

10. noninfectious causes of fever (nonemergent)

11. 7 emergent noninfectious causes of fever

12. 10 critical noninfectious causes of fever

13. nonemergent infectious causes of fever

14. 18 emergent infectious causes of fever

15. 5 critical infectious causes of fever

16. 2 RFs for high morbidity in fever / 3 body systems responsible for >80% of febrile infections

17. 12 emergent causes of generalized, symmetric weakness

18. Common causes of neuromuscular weakness by level [4 UMN, 6 LMN, 6 myoneural junction or muscle fiber]

19. 3 key assessments in the algorithmic approach to generalized weakness / 6 indications for intubation in patients with weakness and ventilatory insufficiency

20. Nonemergent causes of generalized/symmetric weakness

21. 6 structures a lesion of which could cause vertigo / How does nystagmus localize to the side of the lesion in a vertiginous patient?

22. 11 causes of central vertigo

23. 11 causes of peripheral vertigo

24. 6 characteristics of peripheral vertigo, vs. central / nystagmus in central vertigo, vs. peripheral

25. 4 major symptoms the complaint of "dizzy" can refer to / what is the only cause of peripheral vertigo that requires urgent intervention?

26. Characteristics of vertebrobasilar migraine & temporal lobe epilepsy / what % of MS patients first present with vertigo?

27. Characteristics of head trauma-associated vertigo & neck trauma-associated vertigo

28. Characteristics of 4 vascular disorders that cause vertigo

29. Characteristics of acoustic neuroma

30. Characteristics of vestibular neuronitis

31. Characterisics of Meniere's disease

32. Characteristics of serous labyrinthitis and toxic labrynthitis

33. Characteristics of acute suppurative labyrinthitis

34. Characteristics of benign paroxysmal positional vertigo

35. 6 vestibulotoxic medications / Tx peripheral vertigo

36. Initial approach to confusion / 4 major categories in ddx of confusion

37. 7 critical causes of confusion

38. 16 emergent causes of confusion

39. 3 key questions to answer in the assessment of the confused patient

40. Characteristics of functional confusion

41. Characteristics of organic confusion

42. Quick Confusional Scale (QCS)

43. 11 categories in the ddx of coma

44. 4 limitations of the Glascow Coma Scale (GCS) / Initial approach to coma

45. Describe the oculovestibular response / What is the diagnostic value of physostigmine?

46. Approach to coma / Unique H&P features in coma

47. 2 neuroanatomic locations responsible for consciousness / Glascow Coma Scale (GCS)

48. 13 elements in the seizure ddx

49. Initial approach to the seizing patient

50. Management of status epilepticus (4 tiers)

51. Key historical elements in the patient with seizure

52. 6 properties of ictal events / 6 investigations to consider in seizure patient

53. 7 elements of critical ddx for headache with key characteristics

54. Noncritical causes of headache

55. Interventions to consider after ABCs in patient with headache

56. What % SAH are missed on first presentation? / Which cranial nerve mediates pain in most headaches? / Cephalalgia should always trigger consideration of which region, and vice-versa?

57. 7 causes of evolving brain injury to be addressed in cerebral resuscitation

58. Approach to respiratory distress

59. Dyspnea ddx

60. Chest pain ddx

61. Chest pain history mnemonic

62. Esophageal rupture RFs / Pain pattern in Boerhaave's / CXR findings

63. 9 RFs for pericarditis & myocarditis / significant discrepancy in upper extremity BP suggests / Narrow pulse pressure suggests / Describe Hamman's sign

64. 12 critical syncope etiologies

65. Less critical causes of syncope

66. Syncope workup

67. Drugs that may induce syncope

68. Dangerous causes of nausea & vomiting

69. Sequelae of vomiting

70. 4 neurotransmitters active at the chemoreceptor trigger zone / 2 key historical features to elicit in the vomiting patient

71. Pain patterns in bowel obstruction / 3 most common causes of bowel obstruction / other causes

72. Clinical characteristics of gastroenteritis / gastritis / PUD

73. Clinical characteristics of hyperemesis gravidarum vs. nausea & vomiting of pregnancy (NVP)

74. Pediatric vomiting: ddx for newborn, infant, child

75. 6 dangerous causes of abdominal pain / 7 Common causes of abdominal pain

76. Important extra-abdominopelvic causes of abdominal pain

77. diffuse abdominal pain ddx / key historical elements in abdominal pain

78. Specific LLQ pain ddx / High risk historical features in abdo pain

79. Specific LUQ pain ddx / empiric management options in abdo pain

80. Specific RUQ pain ddx

81. Specific RLQ pain ddx

82. Bilateral lower quadrant pain ddx

83. Studies to consider in the evaluation of abdominal pain

84. 3 types of abdominal pain

85. Causes of UGI bleeding in adults / LGIB

86. Causes of upper / lower GI bleeding in children

87. Interventions to consider in GI bleed / low risk criteria to send home GI bleed

88. Rx bleeding patient who has clinical & ECG evidence of myocardial ischemia / one unit of pRBCs should increase H&H by how much? / ddx GI bleeding (what else could it be?)

89. Low risk criteria for GI bleed (prescope) / high risk criteria

90. Limitations of NGT placement in GI bleed / % patients with hematochezia with UGIB

91. Complications of placing an NGT / Proper technique for gastric lavage (for tox) / NAC protocol

92. Marker between upper and lower GI tract / Reason blood turns to coffee grounds / Amount of blood required to produce melena

93. Stool occult blood false positives / false negatives

94. Proportion of LGIB that present with melena / Dx to exclude in hematochezia / % of patients who bleed from same site as previous GIB

95. Dangerous causes of diarrhea

96. Options for Rx diarrhea

97. Tests to consider in the management of diarrhea

98. Epidemiological features to assess in patient with diarrhea

99. Characteristics of O157:H7 / e. histolytica / strongyloides

100. Characteristics of the top five causes of invasive dystenteric colitis

101. Describe the four types of diarrhea

102. Causes of constipation

103. Test to consider in constipation / Key historical features to elicit / Complications

104. Options for symptomatic Rx constipation

105. Jaundice: critical ddx

106. Jaundice: emergent ddx

107. 3 diagnostic categories of jaundice / Conditions that favor neurotoxicity in hyperbilirubinemia / Progression of hepatic encephalopathy

108. Ancillary testing in jaundice

109. Dangerous causes of pelvic pain in nonpregnant or 1st trimester

110. Nonemergent causes of pelvic pain / Ancillary tests to consider

111. Early pregnancy vaginal bleeding ddx / 5 stages of TVUS / ?hCG

112. Late pregnancy vaginal bleeding ddx / Postpartum vaginal bleeding ddx

113. Extrauterine vaginal bleeding ddx

114. Nonpregnant vaginal bleeding ddx

115. Back pain: dangerous ddx

116. High risk features in back pain / Cancers that commonly metastasize to bone

117. L5 nerve root findings /Referred sources of back pain / S1 nerve root findings

118. Three categories of cyanosis by appearance / Causes of methemaglobinemia

119. Cyanosis ddx

120. Pulse ox in methemaglobinemia / Tests in the cyanotic patient

121. Cyanosis unresponsive to oxygen in the nondistressed patient: ddx / Criteria to discharge methemaglobinemia patient

122. When is cyanosis visible? / What causes a left shift in the hemoglobin-oxygen dissociation curve?

123. Describe airway-preserving posture positioning / List upper airway signs

124. Centor criteria for strep throat / Tests to consider in sore throat

125. Sore throat ddx (2 cards)

126. Stabilization of the massive hemoptysis patient / definitive care options

127. hemoptysis ddx

128. tests to consider in red eye / dangerous ddx

129. elements of complete eye exam

130. Increased IOP management / neonatal conjunctivitis etiologies and Rx

131. diphtheria risk factors / What % adults >40 lack protective antibodies? / Two major kinds of infection

132. Characteristics of the diphtheritic membrane / Which organs are primarily affected?

133. Complications of diphtheria / ddx / Rx

134. 3 phases of pertussis infection / Treatment

135. Pertussis complications / ddx / Supramaximal Inspiration for Hiccups Hiccoughs

136. Conditions necessary for tetanus bacteria to cause invasive disease / Pathophys / Age cutoff for DTaP

137. Causes of mortality in tetanus / ddx

138. 4 types of tetanus

139. Treatment of tetanus

140. Tetanus prophylaxis in routine wound management / Wounds at high risk for tetanus

141. Pathophysiology of botulism / Key findings

142. 5 types of botulism

143. Confirmation of Botulism dx / ddx / Tx

144. % pneumococcal pneumonia with pneumococcemia / Indications for 23 valent vaccine / Indications for 7 valent vaccine

145. Meningococcemia RF / Pathophysiology of meningococcal septicemia

146. Meningococcemia: where do petechiae first appear? / Complications / ddx

147. Meningococcemia Tx

148. Kawasaki's epidemiology / Case definition

149. 3 Phases of Kawasaki's / KD workup

150. Kawasaki's ddx / Tx

151. Case definition of toxic shock syndrome / most common cause of TSS

Toxic shock syndrome RFs / staph vs. strep TSS

153. Toxic shock syndrome ddx / TSS Tx

154. Use of amantadine / Use of neuraminidase inhibitors / Mortality rate of variola major

Smallpox vs. chicken pox / Pre-event vaccination contraindications / Description of Molluscum Contagiosum

156. 8 herpes viruses / Features of herpetic gingivostomatitis

157. Herpes genitalis presentation / Features of neonatal herpes / Features of herpes encephalitis

158. Herpes gingivostomatitis ddx / Genital warts ddx / Antiviral treatment for herpes infections

159. Features of varicella / Tx chicken pox / Manifestations of CMV

160. Infectious mononucleosis s/sx / ddx

161. Features of HHV-6 / Herpes B virus / Why should genital warts be removed?

162. S/sx parvovirus B19 / Features of Colorado tick fever, ddx

163. Rotavirus characteristics / Encephalitis ddx

164. Six classic exanthems of childhood / Yellow fever features

165. Characteristics of dengue / Tx of dengue, west nile, st. louis / etiology of the common cold

166. Mumps features / S/sx measles

167. African hemorrhagic fevers features / S/sx influenza / Most common serious complication of flu / CDC isolation precautions for communicable diseases / MMC Isolation Precautions

168. Lassa fever features / Polio clinical course

169. Coxsackie infections / Indications for IV acyclovir in zoster

170. Most rabid animals in US / When are infected animals capable of transmitting rabies?

171. Rabies incubation period / Pathophys & clinical course

172. Rabies PEP after bite from dog/cat/ferret / skunk/raccoon/fox/other carnivores/bats / livestock/lagomorphs/rodents/other mammals

173. 3 steps in rabies prophylaxis

174. Case definition of AIDS / HIV RF / Proven modes of HIV transmission

175. Causes of false negative HIV test / False positive

176. Test to order if query acute HIV / Interpretation of POC HIV tests / S/sx acute HIV

177. Most common pneumonia in AIDS / findings suggestive of PCP / Tx

178. Pathogens responsible for systemic symptoms in HIV patients

179. Oral candidiasis Tx / Approach to HIV patient with esophageal complaints

180. Approach to AIDS + AMS/new seizure/severe HA/focal neuro deficit / AIDS diarrhea workup

181. 3 most common sites of KS in HIV patients / Infestation to consider in HIV patients with dermatitis / Relative risk of zoster vs. general population / 3 most common causes of acute RF in HIV patients

182. How to dx syphilis in immunosuppressed patient / 3 most important HIV medication side effects / Antimicrobial prophylaxis for which AIDS-related infections?

183. Reported # cases of seroconversion following health care worker exposure to a suture needle / Estimated efficacy of transmission for percutaneous exposure – hollow needle / Mucocutaneous exposure

184. HIV postexposure prophylaxis (PEP) for health care workers: high risk source RFs / low risk source / high risk exposure / low risk exposure

185. HIV PEP process / High risk factors in sexual HIV exposure / NYC DOH HIV PEP Bulletin / BBFE checklist

186. Etiology of pericarditis [6 categories]

187. Presentation of pericarditis

188. ECG changes in pericarditis

189. ECG features to distinguish pericarditis from ACS / Pericarditis + ventricular dysrhythmias or positive troponin = / Rx acute idiopathic pericarditis

190. Which nerve is at risk when the pericardial sac is opened? / How much fluid is normally in the pericardial sac? / What sort of infiltrate is typical in pericarditis?

191. If a uremic patient presents with pericarditis, what category of etiologies must be ruled out? / Rx uremic pericarditis

192. Describe two types of post-MI pericarditis / 4 most common causes of malignant pericarditis

193. Features of RA-related pericarditis / Common consequences of SLE-related pericarditis / Pericarditis vs. CHF on CXR

194. Complications of pericardiocentesis / Most common causes of tamponade / Pathophysiology of tamponade

195. Strategies for diagnosing tamponade / Tx / Features of purulent pericarditis

196. Features of pneumopericardium or pyopneumopericardium

197. Features of constrictive pericarditis

198. Most common cause of myocarditis in North America / In the world / Myocarditis prognosis / Natural history of myocarditis

199. S/sx myocarditis / Diagnostic strategies

200. Myocarditis ddx / Tx / Complications

201. Nonviral causes of myocarditis / Most important factor in most cardiomyopathies

202. Pathophysiology of Chagas' disease / Cardiac manifestations / Who to suspect, test, treat

203. Cause of trichinosis / S/sx / Dx / Tx / Prevalence of cardiac involvement in diphtheria

204. How long after erythema migrans does lyme carditis occur? / In whom should lyme carditis be suspected? / Etiologies of myocardial disease in AIDS patients

205. Dilated cardiomyopathy RFs / Clinical features / Management

206. Monikers & pathophysiology of hypertrophic cardiomyopathy / When to suspect HCM / Investigations to perform if suspicious

207. Management of HCM / Etiologies of restrictive cardiomyopathy / Tx RCM

208. Who gets peripartum cardiomyopathy? / Clinical features / Describe cardiac amyloidosis

209. Cardiac manifestations of sarcoidosis / Etiologies of sudden death in young people

210. What is a vegetation? / Infective endocarditis microbiology

211. S/sx endocarditis / Diagnostic tests to perform if suspected

212. Duke criteria for infectious endocarditis / Initial Rx

213. What is cotton fever? / Endocarditis RF

214. Procedures where endocarditis prophylaxis is indicated / Key procedures where it is not indicated

215. Age group most at risk for developing rheumatic fever / Latent period between pharyngitis and RF / Jones criteria

216. Management of acute rheumatic fever / Prevalence of mitral valve prolapse / Important complications of MVP

217. Cardiovascular symptoms assoc with MVP / Noncardiovascular symptoms / MVP Tx

218. Pathophysiology of mitral stenosis / most common cause / ECG abnormalities

219. Two types of mitral regurgitation with causes / Management

220. Top causes of aortic stenosis / Pathophysiology / Tx

221. Causes of acute and chronic aortic regurgitation / Dx & Tx

222. Causes of tricuspid valve disease / Physical exam clues that a prosthetic valve isn't working / Complications of prosthetic valves

223. Hypertension definition / Secondary causes of hypertension

224. Names of MAOIs and foods/drugs that cause hypertensive crisis in patients taking them / Hypertensive emergencies

225. Cerebral autoregulation is impaired above MAP of / S/sx hypertensive encephalopathy / Ddx & Goal of treatment

226. Features of malignant hypertension (microangiopathic hemolytic anemia) / What percentage of strokes are hemorrhagic? / General recommendation for BP management in thrombotic stroke

227. Antihypertensives of choice in cardiac ischema / BP in pregnancy that = hypertensive emergency / Starting nitroprusside dose / Problems with Nipride

228. Indications for NTG in hypertensive emergency / Dose and problems with hydralazine / Action of labetolol / Labetolol dose

229. Does labetolol provide sufficient alpha blockade to use in high catechol states? / Dose and use of esmolol / Contraindications to esmolol / Dose of phentolamine

230. Nicardipine effect, dose, indications / Enalaprilat effect / 2 tests to consider in severe asymptomatic hypertension

231. Aortic dissection risk factors / Histology / Factors favoring continued dissection

232. Stanford classification of aortic dissection / Historical features

233. Dissection: physical exam and other findings

CXR findings in dissection / Usefulness of TTE / Key clinical syndromes suggestive of dissection

235. Management of aortic dissection

236. What kind of aneurysm is an abdominal aortic aneurysm? / Max diameter of normal aorta / AAA risk factors / Most important predictor of rupture

237. AAA complications / S/sx unruptured AAA

238. S/sx ruptured AAA / GI bleed + h/o AAA repair =

239. Features of aortovenous fistula / Role of plain films in dx AAA

240. Misdiagnoses in patients with AAA / How aggressively should a ruptured AAA be reuscitated preoperatively?

241. Surgical mortality of AAA repair / Late complications of AAA repair

242. Consequences of atherosclerosis / Distribution of atherosclerotic plaques / True aneurysm vs. pseudoaneurysm

243. How do aneurysms cause clinical symptoms? / What % arterial emboli originate from a cardiac thrombus? / What is the most frequent site of arterial embolism?

244. Labs to watch in revascularization injury / What is atheroembolism? / Types of atypical emboli

245. Causes of arterial thrombosis / Symptoms of expanding hematoma / Define vasospastic disorder

246. Causes of arteriovenous fistulae / Consequences / S/sx peripheral arterial disease

247. Management of acute arterial occlusion / Symptoms of chronic arterial insufficiency

248. What is Leriche's syndrome? / S/sx acute arterial occlusion / Distinguishing between thrombotic vs. embolic acute arterial occulusion

249. Physical exam findings in chronic arterial insufficiency / What % of the population does not have one palpable dorsalis pedis pulse? / Describe the three top vasospastic disorders

250. Features of AV fistulae (including Branham's sign) / Advanced diagnostic modalities for advanced arterial occlusive disease / Dose of unfractionated heparin

251. Can patients with limb-threatening ischemia be treated with thrombolysis? / Why isn't the Fogarty catheter used in veins? / Two complications of prosthetic vein grafts

252. Ddx claudication / Features of lower extremity ulcers caused by arterial insufficiency / Venous insufficiency

253. Management of arteriosclerosis obliterans / Features of thromboangiitis obliterans

254. Phlegmasia cerulea dolens vs. phlegmasia alba dolens / Ddx acute arterial embolism

255. Ddx atheroembolism/blue toe syndrome / Describe the broad categorization of arterial aneurysms / Causes of subclavian artery aneursym

256. Key cause of axillary artery aneurysm / Describe hypothenar hammer syndrome / Features of splenic artery aneurysm

257. Key cause of SMA aneurysm / What is a mycotic aneurysm? / Clinical presenation of post-traumatic pseudoaneurysm

258. Criteria for Raynaud's disease / Triphasic Raynaud's attack / Abnormal structures that can lead to thoracic outlet syndrome / Sx & pathophysiology of TOS

259. How to test for thoracic outlet syndrome on physical exam / Ancillary studies

260. Ddx thoracic outlet syndrome / 5 Causes of peripheral A-V fistulae

261. Vascular problems a/w intravenous drug use / Ddx occluded chronic indwelling catheter

262. Approach to occluded indwelling catheter / Remove line if local infection? / Why no circumferential bandage or tourniquet or BP cuff on arm with Cimino prosthetic bridge fistula?

Complications of Cimino fistulae

264. Virchow's Triad / Superficial & deep leg veins

265. Wells score for DVT

266. DVT ddx / Best d-dimer techniques (3)

267. Testing schema for DVT / Cutoff for negative d-dimer / What is d-dimer? / Conditions that elevate d-dimer

268. Treatment of superficial thrombophlebitis / Tx of saphenous vein thrombosis / Tx phlegmasia cerulea dolens

269. Upper extremity DVT RFs / Complications of DVT / PE RF

270. PE symptoms / Trivial risk criteria / Cardiac arrest from massive PE usually presents with what rhythm?

271. What % of patients with PE describe their CP/SOB as sudden onset? / Two rare but classic CXR findings / ECG findings

272. What % of patients with PE have no identifiable RF? / What pretest prob marks the workup harm-benefit line? / PE workup based on pretest prob

273. How to manage "isolated subsegmental findings" on CT for PE / Indirect CT venography vs. ultrasound / Alternative diagnoses to PE revealed by CT

274. Anticoagulate pending imaging in rule-out PE? / If PE diagnosed, management of patients with anticoagulation contraindication? / Factors that predict severe PE

275. Management options for PE / Management of pt with diagnosed PE who returns with persistent symptoms / How to R/O PE in pregnant patient

276. Error-prone areas in EM / Shift work strategies

277. Tick-borne illnesses

278. What are the two major hosts for the Ixodes tick? / What % of patients with Lyme disease do not recall a tick bite? / How long after attachment does a tick transmit the Lyme disease spirochete? / Common places on the body to find a tick

279. Stages and clinical features of Lyme disease

280. Dx Lyme disease / Ddx

281. Lyme disease vaccine efficacy / Prophylaxis (if tick found on body) / Treatment

282. Describe the Jarisch-Herxheimer reaction / Clinical features, Dx, Rx, Ddx of relapsing fever

283. Clinical features of tularemia

284. Area of the US most endemic for Rocky Mountain Spotted Fever (RMSF) / Rickettsia rickettsii like to invade which cellular structures? / What % patients have no exposure history? / Incubation period? / What % have no rash?

285. RMSF clinical features

286. RMSF diagnostic strategies / Ddx / Complications

287. RMSF treatment / Features of Q fever

288. Ehrlichiosis features

289. Babesiosis features / Colorado tick fever features

290. Tick paralysis ddx & features / How to remove a tick

291. How long after initiating multidrug antituberculous therapy must pt be isolated, if AFB negative and no extensive disease? / How long if AFB positive or extensive disease?

292. Describe the four stages of tuberculosis infection

293. What is the rate of development of clinically active TB in healthy PPD converters and HIV patients? / TB RFs

294. TB symptoms / RFs for TB to progress

295. TB pulmonary complications / Most important study if considering active TB / PPD false-negative rate in patients with active TB

296. CXR findings in TB / Role of CXR in discerning active TB vs. inactive disease

297. Relative usefulness of variably-acquired sputum samples for TB / Usefulness of microscopy / Limitation of TB culture

298. How long does it take for a PPD to become positive? / Tuberculin skin test procedure / How to read a PPD / Criteria for positive PPD

299. PPD false positives / False negatives

300. Pulmonary TB vs. bacterial pneumonia / Ddx cavitary lesion / Ddx upper lobe infiltrate

301. Ddx mediastinal lymphadenopathy / Top 3 extrapulmonary TB sites

302. Less common extrapulmonary TB sites

303. Most emergent presentation of pulmonary TB / Side effects of INH and other antituberculous meds / After primary infection, when does latent period begin?

304. Rx latent TB / If dx active TB / What % ED workers convert their PPD?

305. 3 high-risk ED presentations for TB / Preventative therapy after inadvertant exposure / Who gets BCG vaccine?

306. RFs for developing bone& joint infections / Microbiologic etiology of bone & join infections

307. Age distribution of bone&joint infections / List of orthopedic infections

308. Signs, symptoms, labs in osteomyelitis / Radiologic dx of osteo

309. What is reactive arthritis? / Bone segment terminology

310. Unique features of pediatric osteomyelitis / Features of advanced osteomyelitis / Mechanism of osteomyelitis in children and adults

311. Treatement of open fractures / Treatment of osteomyelitis / Epidemiology of septic arthritis

312. Microbiologic dx osteomyelitis / Features of pediatric osteomyelitis

313. Vertebral osteomyelitis pathophys, presentation, complications

314. Features of diabetic foot osteomyelitis / Features of HbSS osteomyelitis

315. Complications of acute osteomyelitis / Ddx osteomyelitis

316. S/sx septic arthritis / Can septic arthritis be ruled out by absence of effusion on ultrasound?

317. Causes of false negative culture in septic arthritis / Glucose value in joint fluid analysis suggestive of septic arthritis / Value of joint fluid analysis in ruling out septic arthritis

318. S/sx gonococcal arthritis / How to dx

319. Relationship between existing joint disease and development of septic arthritis / Prosthetic joint infection vs. loosening / Ddx septic arthritis

320. Priorities for synovial fluid analysis / Other tests for dx septic arthritis / Epidemiology of gonococcal arthritis

321. Management of septic arthritis / Features of reactive arthritis

322. S/sx cellulitis / Cellulitis bugs / RFs

323. Clinical features of Ludwig's angina / Cellulitis ddx

324. Diagnostic strategies in cellulitis / Management / Causes

325. Features of preseptal cellulitis / Management / When to suspect orbital cellulitis / Management

326. What is streptococcal cellulitis? / S/Sx erysipelas / Erysipelas bug, RF

327. Features of staphylococcal scalded skin syndrome (SSSS) / Ddx / Dx strategies

328. Features of h. flu cellulitis / Who gets staphylococcal toxic shock syndrome? / TSS dx criteria / TSS ddx

329. Management of TSS / Strep TSS vs. gram negative sepsis / Cause of impetigo / Features of two kinds of impetigo

330. Treatment of impetigo / Pathophysiology of abscesses (extremity, head, neck, perineum, perirectal) / Considerations when presented with recurrent abscess

331. Abscess management / What is a furuncle? Carbuncle?

332. Clinical features of hidradenitis suppurativa / Management of Bartholin cyst abscess

333. 4 types of perirectal abscesses and their management / Management of pilonidal abscess

334. Fasciitis RFs / S/sx fasciitis

335. Necrotizing fasciitis pathophysiology / Signs & symptoms

336. What is Meleney's synergistic gangrene? / Fournier's syndrome? / What causes myonecrosis?

337. Sepsis epidemiology / What % of patients with sepsis have positive blood cultures? / Sepsis pathophys with key mediators

338. Sepsis definitions (bacteremia, SIRS, sepsis, severe sepsis, septic shock)

339. Define ARDS / Sepsis effects on target organs / Skin findings in sepsis progression

340. RFs for sepsis / Sources to check for sepsis / Tests to exclude these sources

341. Cultures to consider in sepsis workup / Ddx sepsis

342. Management of sepsis

343. Dosing of vasopressors and inotropes

344. Characteristics of stable angina / Canadian cardiovascular society classification of angina / Define unstable angina

345. Define Prinzmetal's angina / Define AMI

346. Pathophysiology of AMI / Determinants of myocardial oxygen demand

347. Traditional CAD risk factors / Ischemic chest pain classically radiates to / If pain extends down arm, which side of arm? / Classic exacerbating factors

348. Classic symptoms associated with angina pectoris / Key anginal equivalent / Chest pain features more likely to be anginal

349. What proportion of AMI patients do not have chest pain on presentation? / Risk factors for atypical presentation of ACS / Pain in which body parts should prompt consideration of ACS?

350. Chest pain ddx / Which patient group is most often inappropriately discharged having missed the diagnosis of AMI? / Sinai Newman Low Risk Chest Pain Algorithm

351. Early complications of AMI

352. Describe the earliest ECG finding in AMI and its ddx / What is the baseline used for measuring the ST segment? / ddx ST elevation

353. Features of benign ST elevation / ddx ST depression / In inferior MI, which lead most reliably shows reciprocal ST depression?

354. In which leads are T waves normally upright? / Inverted? / What do ACS-related T wave inversions look like? / Deep symmetric or biphasic T wave inversions in anterior precordial leads suggest

355. What is pseudonormalization of T waves? / How early can Q waves appear? / Anterior wall territory on ECG / Lateral wall

356. Inferior territory on ECG / RV territory / Posterior territory

357. Ddx JVD+hypotension or NTG-induced hypotension / Characteristics of benign early repolarization / Where are ST segments not elevated in pericarditis?

358. In pericarditis, where is PR depression best seen? / Distinguishing LV aneurysm from AMI / ECG predictors of MI in the presence of LBBB

359. Classic findings of LBBB / 3 additional leads for 15 lead ECG / Features of LVH with repolarization abnormality on ECG

360. Indications for 15 lead ECG / Ways to increase ECG sensitivity for ACS / Reasons to get a CXR in ACS

361. Time course of troponin rise / Troponin T vs. I / Time course of CK-MB

362. Time course of myoglobin in ACS / Novel cardiac injury markers / Usefulness of echo in chest pain patient

363. Role of stress echo / Describe myocardial scintigraphy / Contraindications to exercise stress testing

364. Key benefits of ED-based chest pain unit / General principles of ACS management / Mechanisms of late reperfusion benefit

365. Points of time delay in myocardial reperfusion / If the patient is a candidate for lysis, how long can reperfusion be delayed for transfer for PCI? / Mechanism by which NTG benefits ACS patients

366. NTG administration protocol and cautions / When should morphine be given in ACS?

367. Beta blockers in ACS – indications, contraindications, mechanism / When should ACE inhibitors be started in ACS? Contraindications? / Why are calcium channel blockers not indicated in ACS?

368. ASA dose and mechanism of action in ACS / Mechanism and indication for glycoprotein IIb/IIIa inhibitors in ACS / Why is clopidogrel favored vs. ticlopidine?

369. Plavix mechanism and indication in ACS / Heparin mechanism and indication in ACS

370. Advantages of LMWH over unfractionated heparin / Advantages and use of direct thrombin inhibitors vs. heparin

371. Indications for fibrinolysis in AMI

372. Which AMI patients are eligible for thrombolysis after 12 hours of symptoms? / Hypertension considerations for lysis in AMI / Retinopathy considerations / CPR and CVA considerations

373. Prior CABG considerations in lysis for AMI / Absolute contraindications for lysis of AMI / Relative

374. Advantages of PCI vs. lysis / Who should get lysis if both PCI and lysis are possible?

375. Indications for transfer of a lysis patient to higher level of care / NSTEMI management

376. Describe the flow of ions across the myocardial cell membrane (oh yes)

377. How do pacemaker cells differ from non-impulse generating cells? / What are afterdepolarizations? / The SA node is supplied by what artery?

378. Which artery supplies the AV node? / Pacemaker rates at three different sites / Describe the conduction pathway / Which conduction defects are associated with RCA and LAD occlusion?

379. What is the Ashman phenomenon? / Define pre-excitation / Describe 3 mechanisms for dysrhythmia formation

380. Vaughan Williams Class IA / Class IB

381. Vaughan Williams class IC / II

382. Vaughan Williams class III / Describe amiodarone toxicity

383. Vaughan Williams class IV / How do you mitigate CCB-induced hypotension? / Effects of digoxin

384. Conditions that enhance digoxin toxicity / Can you electrically cardiovert a digitalized patient? / Dig adverse effects

385. Mg as an antidysrhythmic / Half-life and pediatric dose of adenosine / Adenosine antagonists and potentiators

386. Signs, symptoms that mark unstable rhythms / Signs of AV dissociation on physical exam / Ways to increase accuracy of ECG for defining an arrhythmia

387. Causes of pseudodysrhythmias / Pathophysiologic causes of bradycardia / Basic treatments for bradycardia

388. Causes of sinus bradycardia / Definition and causes of sinoatrial block

389. Describe sick sinus syndrome / Define 1st degree AV block / Define conduction ratio as used to describe 2nd degree AV block

390. Compare type I and type II second degree AV block / Causes of grouped impulses

391. What determines QRS width in 3rd degree AV block? / Congenital vs. acquired 3rd degree AV block / Most common cause of a pause on ECG

392. Features of PACs vs. PVCs

393. What does the ECG show for a PJC? Causes of PVCs and ventricular tachycardia / When does a PVC appear narrow?

394. An RV source for a PVC results in what morphology QRS? / What is a fusion beat? / What is an interpolated PVC? / What is the treatment for PVCs? / What is the Lown classification of PVCs?

395. What is parasystole? / What is pseudotachycardia? / Ddx irregularly irregular rhythm

396. Describe the P waves in sinus tachycardia / When a beta blocker is indicated in sinus tach / Ddx sinus tach

397. Describe atrial tachycardia / Paroxysmal atrial tachycardia / Multifocal atrial tachycardia (etiologies, treatment)

398. Characteristics of atrial flutter / Treatment / A. flutter with VR>200 suggests

399. Causes of atrial fibrillation / When can atrial clot develop? / Options for chemical cardioversion

400. When are beta blockers favored in atrial fibrillation rate control? / Special considerations for electrical cardioversion of afib besides clot, anticoagulation issues / Most common PSVT / Classic features of WPW syndrome

401. Name of most common accessory pathway / Compare orthodromic and antidromic tachycardias / Various WPW rhythms and treatment

402. Structural causes of SVT with aberrancy / Features of v. tach compared to SVT with aberrancy

403. Likelihood of v. fib following electrical cardioversion of v. tach / Pharmacological agent of choice to convert wide complex tachycardia of unknown origin / How many PVCs = v. tach? / 2 kinds of polymorphic v. tach / 4 drugs to treat v. tach

404. Features of torsades de pointes / QT interval clearly at risk for TdP / Classification of long QT syndromes

405. General indications for pacemaker placement / Indication for AICD / Difference between new generation pacemaker batteries and older batteries / 5-letter pacemaker code

406. Which chambers are paced with a pacemaker? / Advantages & disadvantages of VVI pacemaker / DDD pacer

407. Advantages and disadvantages of unipolar vs. bipolar leads / How to differentiate unipolar vs. bipolar lead on ECG / What is the relationship between P waves and QRS complexes in VVI pacing? / Pacemaker complications

408. Management of query pacemaker infection / How does pacemaker syndrome present? / Pathophysiology of pacemaker syndrome

409. What does a VVI pacer look like on CXR? / DDD or DVI pacer? / Must DDD or DVI pacer provide 2 spikes on ECG? / What is the effect of a magnet on a pacemaker?

410. Management of ?pacemaker syndrome / 4 types of pacemaker malfunction and their causes

411. What is the first sign of battery voltage depletion? / Most common cause of failure to capture / Where do leads commonly displace? / Where do lead fractures occur?

412. What is exit block and what are its causes? / Most common cause of undersensing / What does undersensing look like on ECG?

413. What does oversensing look like on ECG? / What is runaway pacemaker and endless loop tachycardia? / What therapy may interrupt pacemaker-mediated tachycardia?

414. Pain in arm ipsilateral to pacemaker insertion suggests / Defibrillation with pacemaker in situ? / Why failure to capture post-defibrillation?

415. 3 types of AICD malfunction and their causes / What does a magnet do to an AICD? / Chest compressions with AICD? What if it shocks the rescuer?

416. Define heart failure / Heart failure prognosis and cause of death / Normal cardiac index & physiologic parameters determining cardiac output and CI / Describe the Frank-Starling relation

417. Preload describes what measurable parameter? Key values for pulmonary artery occlusion pressure / 2 major components of SVR / Components of MAP

418. How does an arterial dilator cause an increase in cardiac output? / Who does a venodilator relieve pulmonary congestion? / Causes of decreased contractility / Pathophysiology and etiologies of noncardiogenic pulmonary edema

419. IVF for cardiogenic shock? / Physiologic compensatory mechanisms for declining cardiac function

420. Disease processes resulting in heart failure / Causes of high-output heart failure

421. Relationship between R heart failure and L heart failure / Give fluid to hypotension with increased JVD? / Systolic vs. diastolic dysfunction / NYHA heart failure classification

422. Acute heart failure precipitants / Interpretation of BNP level

423. Mechanistic strategies for managing heart failure / What proportion of patients with acute pulmonary edema have JVD? Peripheral edema? / How does CPAP, BIPAP work in APE? How does NTG help?

424. Hypertensive acute pulmonary edema therapy / Hypotensive APE therapy / Long term management of CHF

425. Name three kinds of joints / Normal components of joint fluid / Basic mechanism of DJD and inflammatory arthropathies

426. Arthritis ddx (3 categories)

427. Key categorical determinations to make when presented with arthralgia

428. Two nonroutine regions to check on exam of arthralgia patient / 6 elements of joint exam / Position of patient with hip effusion / Labs of potential interest in the evaluation of arthritis

429. Systematic approach to joint radiographs / Indications for imaging modalities in arthritis

430. Common plain film findings in acute arthritis, late septic arthritis, pseudogout, OA, RA / Indications and contraindications for arthrocentesis

431. Complications of arthrocentesis / Send joint fluid for _ / Limitations of joint fluid analysis

432. Difference between gout and pseudogout on microscopy / When to consider an ECG in the arthralgia patient / 3 ways pathogens reach the joint space / RFs for septic arthritis

433. Microbiology of joint infections / Top joints involved in septic arthritis / Rx septic arthritis

434. Who was Podagra? / Pathophysiology and risk factors for gout

435. Commonly involved joints in gout / Long term sequelae / Management of acute gout / Rx chronic gout

436. Pseudogout: Crystal / Joints / Age range / Associated conditions / Treatment // Consequence of cartilege degratation in osteoarthritis / 4 OA signs

437. Usual presentation of gonococcal arthritis / How often does pt present with genital complaints? / Utility of various cultures in GC arthritis / Two most common viral arthritides

438. When does Lyme arthritis occur? Which joints? What does joint fluid show? Serology peaks when? / Features common to all seronegative spondyloarthropathies / Most common examples

439. Features of ankylosing spondylitis / Features of Reiter's syndrome

440. Mechanism of acute rheumatic fever / Clinical presentation / Diagnostic criteria / Workup / Treatment

441. Rheumatoid arthritis pathophys / Clinical presentation, signs / Extraarticular symptoms / Treatment

442. Basic strategies in the treatment of tendinopathy / Major precipitating factors in tendinopathy / Intrinsic and extrinsic modifying factors that lead to tendinopathy

443. Historical features pertinent to the evaluation of tendinopathy / Classic historical progression of tendinopathy (4 stages) / Tendinopathy physical exam

444. Differentiating arthritis vs. tendinopathy / Causes of atraumatic shoulder pain / Muscles of the rotator cuff

445. Shoulder impingement syndrome – Which 3 structures can be caught between which 2 structures? / Aside from isolated trauma, what % rotator cuff tears are the result of impingement? / Describe 3 stages of impingement syndrome

446. Shoulder impingement syndrome – Supraspinatus tendon test / 2 tests for mechanical impingement in the subacromial space / Sign indicative of attempt to adduct arm without using rotator cuff muscles

447. Symptoms of bicipital tendinopathy / Test to elicit it / What is calcific tendinopathy?

448. What condition commonly causes pain in the lateral elbow? / Who gets it? / Test? / Rx? / What is the counterpart on the medial elbow?

449. Pain over the radial styloid suggests which syndrome? Describe the pathophys, test, ddx, Rx / Pain over the inferior pole of the patella suggests which syndrome? Describe test, ddx, Rx

450. Causes of achilles tendinopathy / Clinical manifestations / Rx / Achilles tendon rupture: clinical presentation, test, Rx

451. Maximum duration of shoulder immobilization / Cryotherapy regimen / Steroid injection in tendinopathy? / What are bursae and what is their purpose? / Key causes of bursitis

452. What is the key entity to exclude when considering bursitis? / Factors that favor septic bursitis (hx, exam) / Bursitis ddx

453. Options for the management of bursitis / Features of various types of bursitis

454. Demography most likely to develop SLE / Pathophys (modifying factors, mechanisms of disease) / The lupus triad

455. Rheumatologic manifestations of SLE / Dermatologic / Renal progression of disease

456. Neurologic manifestations of SLE / Ddx for AMS in SLE / Cardiac manifestations of SLE

457. SLE pulmonary manifestations / GI / Hematologic / Serum diagnostic considerations / Studies to order in SLE flare

458. American college of rheumatology revised criteria for the classification of SLE

459. Treatment of SLE (and key adverse effects of treatment) / Drugs implicated in lupus-like syndrome

460. Which two antibodies comprise the antiphospholipid antibody syndrome? / What is their effect? / Clinical manifestations of AAS / Target INR in AAS

461. Most important element of neonatal lupus syndrome / Long term considerations of corticosteroid therapy / Key problems to look for in SLE patient with chest pain-SOB, abdo pain, weakness or bleeding

462. Large vessel vasculitides / Medium vessel / Small vessel / Mechanism of vasculitis

463. Who gets temporal arteritis? Which vessels are primarily affected? Sx? Temporal arteritis is a/w what condition? Management & diagnostic approach

464. Takayasu's arteritis: mechanism / vessels affected / who gets it? / sx / dx / Rx

465. Polyarteritis nodosa: pathology / associated conditions / sx / dx / Rx // Wegener's granulomatosis: sx / labs / Rx

466. Behcet's triad / dx / Rx // Precipitants of hypersensitivity vasculitis / Hallmark lesions / Peak incidence of HSP

467. Henoch Schonlein Purpura precipitants / Sx / Rx

468. Mixed cryoglobulinemia sx / associated diseases / Rx // When does serum sickness occur?

469. What is Goodpasture's syndrome? Sx / Dx / Rx // Who gets erythema nodosum? Sx / Associated problems

470. Anaphylaxis pathophysiology in the most basic terms / Triggers / Negative and positive RFs

471. Components of two broad immune system divisions / Gell & Coombs hypersensitivity classification

472. Mediators of activated mast cells and basophils / Effects of H1 H2 H3 receptor stimulation

473. Pathways that lead to anaphylaxis / Pathophysiologic mechanisms that underlie signs & symptoms

474. Anaphylaxis signs & symptoms by organ system

475. Rate of penicillin-related allergic reactions, anaphylactic reactions, fatality / Risk of reaction to cephalosporins in patients who have urticaria or anaphylatic reactions to penicillin / Heterologous sera that cause allergic reactions / Allergy and classification of local anesthetics

476. Who is more susceptible to transfusion reactions? / Opioids cause allergic symptoms because / Who is more susceptible to ASA allergy? / Time course of anaphylaxis / Which organ system is usually first affected?

477. Unusual tests to consider in anaphylaxis / Ddx flush syndromes + rash / Ddx stridor

478. Ddx bronchospasm / Anaphylaxis vs. vasovagal syncope / vs. other types of shock / Concentration of 1:1000 epinephrine in mg/ml

479. Treatment options for anaphylaxis

480. Why epi works in anaphylaxis / Epi adverse effects / Indications for IV epi

482. Discharge considerations for anaphylaxis (when, with what Rx, other advice) / Ways to avoid anaphylaxis

482. Relationship between angioedema and urticaria / Mechanisms underlying them / Ddx

483. Hereditary angioedema: pathophys, precipitants, Sx, Rx / Outpatient management of urticaria & angioedema / Clinical features and dx of mastocytosis

484. 3 key historical points in the assessment of a rash / What is a dermatophytosis? / List of dermatophytoses / Diagnostic test of choice for dermatophytoses

485. Tinea capitis demography / Underlying organism / Appearance / Complications / Ddx

486. Treatment of tinea capitis / What is a kerion? How is it managed?

487. Define macule / patch / papule / plaque / nodule / cyst / vesicle / bullae / pustule / lichenification / erythema / purpura

488. Tinea corporis is better known as / Rx / Describe tinea pedis / Rx

489. Describe tinea versicolor / What is the responsible organism? / Management / Why do patients present to attention? // What is tinea unguium? / Rx

490. Who gets candidiasis? // Thrush: usual setting, appearance, ddx / Rx thrush in kids & adults

491. Where on body do we see cutaneous candidiasis? Describe the lesions, ddx, and Rx

492. Who gets pityriasis rosea? Describe the lesions, unique feature, and Rx / Is atopic dermatits an allergic disorder?

493. Describe the appearance of atopic dermatitis, distribution, hallmark symptom, consequences, ddx, and Rx

494. Who gets impetigo? Etiology, description, complications, Rx

495. What is folliculitis? Etiology, Rx? / Describe hidradenitis suppurativa / Where do carbuncles and furuncles occur? / Carbuncle vs. furuncle

496. Arthritis + dermatitis suggests / Describe the dermatitis / Rx // Most common two types of drug eruptions, typical time course / Two types of photosensitive drug reactions / Rx drug rash

497. Main feature of toxic epidermal necrolysis (TEN), preciptants, signs/symptoms, Rx

498. Specific Rx for cold urticaria / Define exanthem / 2 most common viruses that cause exanthems / Clinical features / Hand foot mouth disease occurs where? / Contagious period for measles

499. Measles sx, complications / Roseola infantum etiology, age range, clinical course

500. Rubella s&sx, complications / Fifth disease etiology s&sx, complications

501. Scarlet fever etiology, s&sx, Rx / Contact dermatitis precipitants, description, Rx

502. Cause of diaper dermatitis, common secondary infection, Rx / Erythema multiforme precipitants, description

503. More severe form of erythema multiforme, distinguishing characteristics, complications / EM Rx / How to diagnose pediculosis, Sx

504. Do body lice live on the body? Rx / S&sx scabies, norweigan scabies

505. Scabies Rx / Time course of cutaneous syphilis

506. Underlying conditions that produce erythema nodosum, management / Describe pemphigus vulgaris lesions

507. Management of pemphigus vulgaris / Hallmark of HSV skin infection / Clinical features of herpes gingivostomatitis / Who is at risk for HSV skin infection?

508. Genital HSV Sx, Rx / Who gets admitted for genital herpes? / Usefulness of Rx

509. Varicella clinical course, rash description / Chicken pox complications, Rx, isolation period / Who gets VZIG?

510. Clinical course of zoster, complications, Rx / Smallpox vs. chicken pox

511. Clinical course of cutaneous anthrax / Describe acanthosis nigricans, where does it occur? / What conditions are associated with acanthosis nigricans? / Generalized erythroderma suggests

512. Causes of purpura / Diffuse pruritis in the absence of rash suggests

513. Define clinical guideline, potential benefits of guidelines / Patient-oriented outcomes

514. Potential drawbacks of guidelines

515. Define clinical decision rule, clinical pathway / What is the difference between a pathway and a protocol? / List different types of clinical studies

516. What is the purpose of randomization? What is stratified randomization, and its purpose? What is a confounding factor? What is publication bias? What is type I error, type II error, alpha, beta?

517. Implementation of an RCT (9 steps) with associated potential weaknesses

518. What is the p value / Define trial power / What is the Bonferonni correction?

519. Why perform a multivariate analysis over a univariate analysis? / What is intention to treat? / What is a funnel plot? / Define sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), negative likelihood ratio (-LR) and positive likelihood ratio (+LR)

520. What is the purpose of observation units or clinical decision units? / What kinds of conditions are appropriate for observation?

521. Contrast impairment and disability / Specific occupational health questions to ask when managing a possible worker's compensation case / Key differences between worker's comp patient and usual patient, from EM management perspective

522. What is listed on a material safety data sheet / Potential therapies for blood or body fluid exposure / Variables to assess in management of Hep B postexposure prophylaxis

523. Hepatitis B PEP: Exposed is known vaccine responder & source is HBsAg negative / Other combinations for unvaccinated exposed / Known nonresponder // Hep C PEP // Hep B Serology Graphic

524. Variables to assess in work-related HIV exposure / Measures for any HIV-exposed worker

525. Estimated risk of HIV infection from all types of percutaneous exposures to HIV positive blood / Risk from mucous membrane exposure / Skin exposure // HIV PEP: source is known HIV negative, unknown source, source status unknown, source positive (several combinations)

526. Situations for which consultation for HIV PEP is advised / Is there a delay after which PEP is ineffective? / How long is PEP? / Usual 2 drug regimen / PEP followup

527. Reasons to intubate / Signs of airway reflex compromise / Reasons we should not test gag reflex when assessing airway reflex integrity

528. Signs of upper airway obstruction / Causes of upper airway obstruction / Preliminary airway opening measures

529. Causes of airway reflex compromise / Most important consideration when assessing need for intubation secondary to failure to ventilate/oxygenate / Intubation failure rate in the ED for medical and trauma cases / Rate of failure to intubate and failure to ventilate in anesthesia

530. 5 step approach to the evaluation of the potentially difficult airway

531. How to assess for difficult BVM / Difficult cricothyrotomy / Cormack-Lehane grading system

532. Ways to confirm endotracheal tube placement

533. Summarize the main Walls airway management algorithm / Crash airway algorithm / 2 criteria for administering RSI agents

534. Describe the awake technique of intubation / Summarize the difficult airway algorithm / Summarize the failed airway algorithm

535. Maneuvers that facilitate effective BVM ventilation

536. What is RSI? What is the purpose of RSI? What are the six Ps of RSI?

537. RSI pretreatment options (drugs, dosages, indications) / Adverse events associated with blind nasotracheal intubation

538. Problems with sux / Why was rapacuronium withdrawn from the market? / Postintubation prn vec & midaz boluses

539. What is succinylcholine? How is it degraded? What affects the degradation rate? / Contraindications to sux / Management of sux-induced masseter spasm

540. How do induction agents improve intubating conditions? / Dose, indications, contraindications of induction agents / C-spine precautions in penetrating neck trauma?

541. Pediatric airway considerations, anatomic differences / Alternatives to direct laryngoscopy & endotracheal intubation

542. Three surgical airway techniques / Indications for cricothyrotomy / Absolute contraindication / Why the cricothyroid membrane over a tracheostomy? / Levitan Cric Sequence

543. How to find the cricothyroid membrane / How to perform open cric

544. Complications of surgical airway management / Percutaneous cricothrotomy technique / Transtracheal jet ventilation (TTJV) technique

545. Management of airway foreign body – incomplete and complete obstruction

546. STD ddx (includes non STDs): ulcerative vs. nonulcerative

547. Specific historical and physical exam elements to elicit when evaluating a potential STD / Other considerations specific to STD management

548. Herpes genitalis: incubation, description of lesions/syndrome, clinical course, dx, Rx and reasons to Rx // Neonatal herpes considerations

549. Where are the bartholin glands? / Cyst vs. abscess / Rx

550. Clinical features of syphilis in its various stages

551. Diagnostic choices in syphilis, Rx // Lymphogranuloma venereum: etiology, demography, sx, rx

552. Chancroid: sx, dx, rx // Donovanosis: aka, epidemiology, etiology, s/sx, natural history, rx

553. Condyloma acuminata: etiology, ddx, rx // Rule for distinguishing between chlamydia and gonorrhea

554. Genital chlamydia: organs affected, s/sx, dx, rx // Nongonoccocal urethritis – what is it?

555. Gonorrhea: organs affected, sx (at each organ), dx, rx

556. Trichomonas: etiology, sx, physical exam, dx, rx // Vulvar candidiasis: s/sx, dx, rx

557. Bacterial vaginosis: pathogenesis, s/sx, dx, rx // Other causes of vaginal discomfort

558. Pelvic inflammatory disease (PID): various infections, etiologies, consequences, risk factors, symptoms

559. CDC criteria for treatment of PID / Supporting criteria / Imaging? / ddx

560. CDC criteria for hospitalization of PID / Inpatient Rx / Outpatient Rx

Describe the GxPy nomenclature for pregnant patients / Define gestational age, preterm, postterm, embryo, fetus, abortus / What hormone does the corpus luteum secrete?

562. Origin of HCG / What is a pseudoerosion? / What is chadwick's sign

563. Skin changes in pregnancy / Breast changes / Average weight gain / Key metabolic change

564. Change in blood volume during pregnancy / What is anemia in pregnancy? / Change in WBC count, implications of this / Cardiovascular changes in pregnancy

565. Respiratory system changes during pregnancy / Urinary system / GI tract / Endocrine / MSK / Ophthalmologic

566. Early s/sx of normal pregnancy / How to estimate the date of confinement / What is pathologic hypertension in pregnancy? / What is the 5th vital sign in pregnancy and how is it measured?

567. What are Braxton Hicks contractions? / Where the fundus can be found at various points in gestation / Sensitivity of the ELISA hCG assay / What causes false positives and negatives? / How early can pregnancy be detected with usual urine test?

569. What is muscle contraction headache? / Headache considerations in pregnancy / Reasons pregnancy predisposes to DVT / Obstetric causes of abdomincal pain in early pregnancy

570. Obstetric causes of abdominal pain in late pregnancy / Where does appendix migrate in pregnancy? / Management of pregnancy-related hand pain / Conservative management of pregnancy-related back pain / What is meralgia paresthetica?

568. Early pregnancy ddx / What is a pseudosac? / What is spurious pregnancy?

571. Risk factors for pregnancy-associated domestic violence / Seat belts for pregnant women? / Sex during pregnancy? / Fly during pregnancy? / Recommended vitamin supplementation / Average weight gain

572. What is the overall fetal loss rate in detectable pregnancies? / Risk factors for fetal loss / What % of women bleed? Of these, what % will miscarry? / 2 major causes of miscarriage

573. When does most fetal demise occur? / In symptomatic pregnant women with threatened abortion, what is the fetal loss rate if cardiac activity is verified at 8 weeks? / Define threatened miscarriage, inevitable, incomplete, complete (with caviat), missed abortion

574. Landmarks for gestational age by hCG and transvaginal sonography / What is the discriminatory zone? / What is an endometrial cast? / Sonographic criteria for abnormal pregnancy by TVUS

575. First trimester bleeding ddx / Management of threatened miscarriage / Options for management of inevitable miscarriage / Advice to patients with threatened or inevitable miscarriage

576. What % of pregnancies are ectopic at large and in the ED? / % heterotopic pregnancy in patients taking fertility drugs / Ectopic pregnancy risk factors / 3 possible outcomes of ectopic pregnancy / Most dangerous location of ectopic pregnancy

577. What % patients with ectopic pregnancy have a risk factor? / What % have not missed their menstrual period? / Shoulder pain in rule-out ectopic / HR in rule-out ectopic / In what % of patients with ectopic and beta

578. Beta hCG trend in normal pregnancy / Use of beta trend / Value of single, low beta / Value of serum progesterone / Role for culdocentesis

579. Value of D&C in the dx of ectopic / Ectopic ddx / Hypotension without significant vaginal bleeding suggests / Management of ectopic / Outline management of stable first trimester bleed

580. Indications for methotrexate in ectopic, contraindications / What is a molar pregnancy? What are the two types? Long term consequences?

581. Molar pregnancy sx, dx, complications / What is aburptio placentae and where does the blood go?

582. Abruption risk factors, usual precipitant, sx, features of severe abruption, utility of ultrasound in dx

583. Consequences of placental abruption, ddx / Placenta previa presentation, definition, risk factors, warnings for physicians

584. How to dx placenta previa / What is vasa previa? / Management of 3rd trimester bleeding / 3 types of pregnancy induced hypertension with descriptions

585. Preeclampsia risk factors, pathophysiology, symptoms

586. What is HELLP? / Gestational time course of eclampsia / What is severe preeclampsia / Diagnostic and therapeutic workup of eclampsia & severe preeclampsia

587. If symptomatic hypermagnesemia, what is the Rx? / Circumstances where amniotic fluid embolism is seen, pathophys, clinical features, ddx

588. Circumstances that may result in Rh sensitization and indicates Rhogam, dose / Problem with the kleihauer-betke test, indication / Ddx seizure in pregnancy

589. Ddx abdominal pain in pregnancy, dyspnea, jaundice

590. Approach to diagnosing appendicitis in pregnancy and the risk:benefit of laparoscopy / Distinguishing appe vs. pyelo in pregnancy / How to dx appe / Most common liver disease in pregnancy

591. Acute fatty liver of pregnancy: RFs, when in gestation, consequences, sx, dx, ddx, rx

592. Intrahepatic cholestasis of pregnancy: when in gestation, sx, ddx, rx

593. Definition of hyperemesis gravidarum, when in pregnancy, management / What is the leading cause of death in pregnancy? How to diagnose it? Rx?

594. Diagnostic consideration if severe flank pain in pregnant patient / What is exertnal dysuria and what does it suggest? / Management of pregnancy-related pyelonephritis / BV in pregnancy consequences / Rx of yeast infections / Consequences of chlamydia infection / Features of chorioamnionitis (sx, dx, rx)

595. Describe respiratory physiology and acid-base response during pregnancy / Treatment of asthma in pregnancy with caviat / Management of hypertension in pregnancy (nonpreeclamptic) – which class of antihypertensives is contraindicated?

596. Causes of chest pain more common than myocardial ischemia in pregnancy / Most common cause of MI in postpartum period / Use of tPA in pregnancy / Most important valvulopathy in pregnancy

597. Why are regurgitant lesions well tolerated in pregnancy? / Most common medical complication of pregnancy / What is the usual reason for megaloblastic anemia in pregnany and who is most at risk? / Why doesn't the Apt test or the KB test work in moms with HbSS? / Considerations in the pregnant patient with spinal cord injury

598. Considerations in the pregnant patient with myasthenia gravis / BUN, Cr in pregnancy / Glycemic considerations in pregnancy / Major consequences of materanal DM on fetus

599. Value of HIV testing in neonates / Key clinical features of congenital syphilis / Considerations for Hep B positive pregnant woman, vs. Hepatitis C

600. Proteinuria in SLE pregnant mom generates what key ddx? / Steroids in pregnancy? / ASA or NSAIDs in pregnancy? / What year was the thalidomide amelia epidemic?

601. Drugs known to be teratogenic / FDA teratogen risk classification

602. Why is aspirin's toxicity enhanced in the fetus? When in development is the fetus most susceptible to toxic insults? What is the safety of ASA/NSAIDs in pregnancy? What are considerations for opioid administration during pregnancy? When should chloramphenicol be avoided in pregnancy?

603. Which macrolide is a problem in pregnancy? When are sulfa drugs to be avoided? When are tetracyclines and fluoroquinolones to be avoided? Flagyl? What is the antifungal of choice in pregnancy? What neonatal diseases are associated with dilantin? What antidysrhythmics have a long safety record in pregnancy?

604. Beta blockers considered safe in pregnancy, CCBs / EtOH intake during pregnancy assoc with 40% risk of fetal malformation / Features of fetal alcohol syndrome / HOw late can neonatal abstinence syndrome appear?

605. Advantages of having your baby on L&D rather than in the ED / High risk obstetric conditions that are overrepresented in the ED

606. What is the bottom line of the consolidated omnibus reconciliation budget act? / At what point is a preterm infant high risk by definition and what are the consequences in terms of delivery preparations? / When is delivery imminent?

607. What is the viability threshold for fetal monitoring? / Symptoms that represent the onset of labor / Features of false labor

608. Characteristics of true labor / When does the first stage of labor start and end? / What are the phases of the first stage of labor and how long do they last?

609. Characteristics of bloody show / Elements of the cervical exam of the woman in labor / Most common position and presentation

610. How to distinguish between occiput anterior and occiput posterior / How may the lie of the fetus be determined on physical exam? / How is gestational age determined on physical exam?

611. When does stage two of labor start and end? What is its duration? / Options for ancillary monitoring in labor / Indications for third trimester ultrasonography

612. Components of fetal heart tracings to be assessed / Define baseline heart rate / Two types of variability / Significance of variability

613. Types of decelerations and their significance / How to distinguish them on a tracing

614. What is a sinusoidal tracing of fetal heart rate? What is its significance? / What is a reactive or reassuring nonstress test? / Elements of biophysical profile

615. Equipment needed for delivery / Acceptable maternal positions for delivery / Goal of delivery / What is the modified Ritgen maneuver?

616. What to do after the fetal head is delivered / What to do when fetus clears the perineum

617. When to perform an episiotomy / What is the third stage of labor? How long should it take? What to do? What not to do? / Signs of placental separation

618. What is the fourth stage of labor? What do you do? / Adjuncts to normal delivery: yes or no: NPO/IVF, enema, shaving, nitrous oxide, narcotics, regional anesthesia, electronic fetal monitoring, ultrasound, amniotomy, episiotomy, Ritgen

619. Define preterm or premature labor / Premature labor risk factors / Studies to get in preterm labor / Indications and contraindications to tocolysis

620. Agents used for tocolysis / What is the success rate of tocolysis? / Adverse effects associated with magnesium / Treatment of mag toxicity / Define premature rupture of membranes (PROM)

621. What symptoms can be confused with premature rupture of membranes? / Usual PROM symptom / The incidence of ascending infections is proportional to / Bedside tests to confirm fluid is amniotic fluid

622. Factors to consider in the management of PROM / How to determine fetal lung maturity / If lungs are immature, can rx with

623. Sx chorioamnionitis / Studies to rule out chorioamnionitis / How to rule out placenta previa

624. Management of placenta previa / In what % of placental abruptions is bleeding concealed? / Diagnoses that should be made with caution if abruption is in the ddx / Ability of ultrasound to rule out abruption

625. Complications of placental abruption / Management / Circumvellate placenta: define, complications, dx, rx

626. Vasa previa: define, risk factors, complications, rx / 2 ways to test for fetal blood

627. Management of untreated HIV in woman who presents with labor / Potential reduction of HIV vertical transmission if appropriate interventions are performed / 3 etiologic caegories of dystocia, complications / Incidence of breech presentation and shoulder dystocia

Describe 3 types of breech presentation and their key features / Why should breech presenations be imaged with either ultrasound or plain film?

629. What to do if you have the misfortune to deliver a breech baby in the ED, and what not to do / What is the Mauriceau maneuver?

630. Major risk factor for shoulder dystocia / Complications of shoulder dystocia and complication rate / How to dx, manage / Why does dystocia occur? // Precipitous Delivery in the ED Algorithm

631. What is a compound presentation? / Management of face, brow, compound presentations / Differences in the duration of labor stages with multiple gestations / Can twins be delivered vaginally?

632. What condition must be ruled out after all ED deliveries? / List umbilical cord emergencies / What is cord prolapse? Risk factors? Management?

633. mangement of cord entaglement (knot) / Management of nuchal cord / List maternal complications of L&D / Define postpartum hemorrhage (PPH)

634. Differential for postpartum hemorrhage and their management / 5 general management techniques for PPH

635. Uterine inversion: how to dx, rx

636. Most important RF for uterine rupture, complications, dx, sx, rx / Sx amniotic fluid embolism / Postpartum endometritis RFs

637. Postpartum endometritis: sx, when it occurs, management / Postpartum cardiomyopathy: onset, sx, mangement, prognosis / Key dx to consider in postpartum woman who presents with fatigue or vague sx

638. Stoke is the _ leading cause of death in the US and the _ leading cause of disability / What % of stroke survivors return to functional independence? / What % are permenantly disabled? / Define stroke / What % strokes are ischemic? / Discuss cerebral blood flow numbers and define the penumbra in terms of CBF

639. Pathophysiologic mechanisms of cell injury in hemorrhagic stroke / The anterior carotid system perfuses what % of the brain? / What is the first branch of the internal carotid artery, and how to the internal carotids termininate? / What are the main structures supplied by the posterior vertebral artery system? / Trace the basic path of the vertebral arteries

640. Where does vessel occlusion most commonly occur in thrombotic stroke? / What % of ischemic strokes are thrombotic? / Lacunae or small vessel strokes: RFs, common locations, common syndromes / What clinical features are not present with lacunes?

641. Sources of emboli in stroke / Causes of stroke in young people / What % of patients with TIA develop a stroke within 3 months?

642. ICH comprises what % of acute strokes? / Causes of ICH / What % of anterior CVAs and posterior CVAs progress after presentation? / Signs of anterior cerebral artery occlusion / Middle cerebral artery (MCA)

643. Nondominent hemisphere stroke findings / Posterior circulation stroke findings and structures possibly involved

644. Reasons to calculate an NIHSS score / Classic presentation of a hemorrhagic stroke / What proportion of ICH patients have expansion of the hematoma in the first hours? / Bilateral pinpoint pupils suggest lesion of the _ / Bilateral dilated pupils?

645. Poor prognostic indicators for patients with ICH / How do you calculate ICH volume? / Stroke ddx

646. Tests to perform on all stroke patients / Other tests to consider / "Ultra-early" stroke findings on CT / Potential echocardiography findings in acute ischemic stroke

647. NINDS recommended evaluation targets for thrombolytic candidates / What type of IV fluid should be avoided in stroke care? / 3 nonpharmacologic keys to stroke management / Which ischemic stroke patients require blood pressure lowering? / BP-lowering agents of choice

648. tPA dose in AIS / Inclusion & exclusion criteria

649. Role of ASA and heparin in AIS / Studied neuroprotective agents and their role in AIS / Blood pressure above which you should treat in ICH / Disadvantages to using nipride in AIS / Role of steriods in AIS

650. Increased ICP options / Drug to add to ICH management / Stroke patients that need ICU / Recommended studies for TIA

651. What is a seizure? What is epilepsy? Seizures that occur as a result of a predictable insult are called _ / Describe the categorization of seizures / What is a generalized seizure?

652. Are secondary seizures usually generalized or focal? / Define status epilepticus / Describe the pathophysiology of seizures / Features of simple partial seizures

653. Features of complex partial seizures / Specific injuries associated with generalized seizures

654. Features of typical absence ictus / Features of myoclonic and tonic seizures / Atonic seizures / ACEP indications for head CT in 1st time seizure

655. Causes of status epilepticus (5 categories)

656. Key intoxicants that cause status or look like status epilepticus / Can acute alcohol intoxication cause seizures? / What is kindling / Pseudoseizure RFs

657. Key steps in the management of the postictal patient / Describe two main postictal complications

658. Consideration before giving an anticonvulsant / Seizure mimics (things that look like a seizure but are not) / Intial management of seizing patient

659. Doses of agens used for seizure abortive therapy

660. Decision to treat seizures long term is based on three factors / Risk of a second seizure in one year in first time seizure patients without reversible cause / RFs for another seizure / Two last considerations before discharging a seizure patient

661. Three types of uncomplicated migraines / What is status migrainosis? / Common migraine precipitants / Dose and contraindications to DHE

662. Dose and side effects of triptans / Anti-migrainous neuroleptics / Steroids / Narcotics / Options for migraine prophylaxis

663. Cluster headache RFs, clinical features, ddx, Rx

664. Features of tension headache / Causes of subarachnoid hemorrhage / What % of the population has a berry aneurysm? / Diseases associated with berry aneurysm

665. What % headache patients have SAH? / S&Sx SAH / Hunt & Hess Classfication

666. Sensitivity of CT in SAH / When does xanthochromia occur? / If persistently bloody LP but no xanthochromia with high suspicion for SAH, what to do? / Ancillary test commonly positive in SAH / Treatment of SAH / Cancers most likely to metastasize to brain

667. Features of increased ICP headache / ED treatment of increased ICP associated with brain tumor / Temporal arteritis RFs, symptoms

668. Dx temporal arteritis, Rx / Most common cause of stroke in persons

669. Triad of symptoms classic for carotid dissection / Vertebral artery dissection / Duplex ultrasound to diagnose? / Idiopathic intracranial hypertension RFs, pathophysiology

670. Idiopathic intracranial hypertension symptoms, dx, Rx / Post-traumatic headache symptoms

671. Acute angle closure glaucoma: precipitants, s/sx, Rx, vs. cluster headache / Incidence of post dural puncture headache, cause, ways to decrease incidence

672. Symptoms of post LP headache, Rx / What is a hypertensive headache? / When to suspect a cervicogenic headache / What is a medication-induced headache?

673. Trigeminal neuralgia symptoms, workup, Rx / Cough & exertional headache workup / Postcoital headache symptoms

674. Pathophysiology of migraines, clinical features, describe "classic" migraine

675. Key features to distinguish delerium from dementia / Diagnostic criteria for delerium / Basic pathophysiology of delerium

676. Swadron approach to altered mentation

677. Swadron's AMS diagnoses to watch out for (may not be picked up on algorithm)

678. Most common etiology of delerium in the elderly / Extracranial infections associated with delerium / Factors that predispose elders to delerium / Areas of Folstein MMSE

679. CAM confusional assessment method for determining the presence of delerium / Features of acute psychosis that distinguish it from delerium / Treatment of Wernicke's encephalopathy / Supportive care for the delerious patient

680. Options for pharmacologic management of delerium / Define dementia / Dementia diagnostic criteria / List key types of primary dementia

681. Define mild, moderate, and severe dementia / Define dementia pugilistica / Pathophysiology of Alzheimer's / Alzheimer's RFs

682. Hallmark of Lewy Body dementia / List the slow virus infections that cause dementia / Features that distinguish subcortical from cortical dementia

683. Reversible dementias / Mechanism of action of donepezil (Aricept) / Role of dexamethasone suppression test in dementia workup

684. Characteristics that distinguish pseudodementia from dementia / Demential ddx

685. Who gets trigeminal neuralgia? Pathophys, s&sx, ddx, Rx

686. Signs of CN 4 palsy / Causes of CN 6 palsy / Function of CN 9 and causes of CN 9 dysfunction / S&sx CN 10 dysfunction

687. Signs of CN 11 palsy / CN 12 palsy / Motor functions of CN 7 (sensory, somatic) / Causes of CN 7 dysfunction

688. Symptoms associated with Bell's palsy / Medical Rx / Discharge instructions / S&sx Ramsay Hunt Syndrome

689. Most common cause of bilateral CN 7 palsy / Most commonly injured cranial nerve in head trauma / S&sx suggesting neoplasm as cause of CN 7 palsy / Workup of CN 7 palsy

690. Acoustic neuroma s&sx, ddx, dx, rx, sequella / Most common CN involved with diabetic cranial mononeuropathy

691. S&sx diabetic CN 3 palsy / Diabetic vs. compressive CN 3 palsy / Ddx diabetic mononeuropathy, Rx

692. When to suspect cerebral sinus thrombosis, dx, Rx / Epidemiology of multiple sclerosis, pathophys

693. Clinical features of multiple sclerosis

694. Clinical feature unique to MS / Diagnostic criterion, tests, ddx, Rx

695. Where does the spinal cord end in adults, and what is distal? / Anterior vs. posterior horn / Vascular supply of the cord/ The three main spinal cord tracts, where they cross, and their function

696. S&sx complete spinal cord syndrome / Significance of and how to test for sacral sparing / Describe spinal shock and the significance of the bulbocavernosis reflex

697. Central cord syndrome: s&sx, mechanism, RFs / Brown-Sequard syndrome: mechanism, s&sx

698. Anterior cord syndrome s&sx, causes / Differentiation of conus medullaris and cauda equina syndromes / Most common cause of cauda equina syndrome, s&sx, most sensitive sign

699. Three cardinal s&sx of spinal cord dysfunction / 0-5 motor function grading scale / Five localizations of neuromuscular weakness and their respective features

700. Diagnostic modalities for query spinal cord dysfunction / Atraumatic causes of spinal cord dysfunction / Three basic treatment modalities for spinal cord disease

701. Transverse myelitis s/sx, etiology, management, prognosis / Spinal SAH: usual cause, s/sx, management

702. What is syringomyelia? S/sx, management // What is idiopathic spastic paraparesis? / Common causes of spinal cord infarction

703. Who gets spinal epidural hematoma? S/sx, dx, Rx // Spinal epidural abscess: RFs, cause, s/sx, dx, Rx

704. Diskitis pathophysiology, s/sx, dx, Rx / Most common mets to spine / S/sx spine mets

705. Three clinical features to assess when confronted with a suspected neuropathy / The anterior spinal cord gives rise to what nervous system structure, and what is its function? / How many pairs of spinal nerves are there? / Two components of the peripheral autonomic system

706. What answers can alectrophysiologic nerve testing (EMG and nerve conduction studies) provide? / Causes of acute, emergent weakness

707. Seven patterns of peripheral neuropathy and their respective prototype diseases

708. Describe the clinical presentation of Guillain-Barr? syndrome / What is the Miller-Fisher variant? / What % GBS patients have autonomic involvment? / What % have long-term consequences? / Mortality% / Recurrence %

709. Ancillary tests for GBS / CSF findings / Classic precedent infection / Mangement / How can the respiratory status of a GBS patient be easily followed?

710. What is the most common peripheral neuropathy seen in the ED? What is its clinical course, management? // Options for treating neuropathic pain

711. Most common cause of plexopathy / Most common cause of isolated mononeuropathy / Radial neuropathy etiologies, sx, rx

712. The ulnar nerve is transmitted through which canal at the wrist? / Which intrinsic hand muscles are all innvervated by the ulnar nerve? / Appearance of hand in ulnar nerve palsy / Carpal tunnel symptoms

713. Which muscles are affected in carpel tunnel syndrome? / Conditions asociated with CTS / Management & treatment options

714. Causes of sciatic mononeuropathy / Function of the sciatic nerve / Lateral femoral cutaneous mononeuropathy

715. Common peroneal nerve is vulnerable where? Palsy signs, causes, Rx // Ancillary studies to consider in mononeuropathies / Diagnosis to rule out if mononeuropathy multiplex is considered / Diagnostic procedure for mononeuropathy multiplex

716. Findings suggestive of ALS / If Lyme is suspected as a cause of neuropathy, what investigations must be performed? / Sensory neuropathy symptoms, causes

717. What is a radiculopathy? Main symptom? / Characterize strength, sensation, DTRs, and wasting in myelopathy / motor neuron disease (ALS) / neuropathy / NMJ disease / myopathy

718. Methods and key numbers in the assessment of respiratory function in neuromuscular disease / Poliomyelitis: Where is the lesion? What sort of deficit? Clinical scenario

719. Five characteristics to distinguish UMN from LMN lesions / Which autonomic syndrome is associated with NMJ disease? / Myopathy s/sx // Nonroutine tests to consider in weakness

720. Myasthenia gravis: age of onset, pathophys, s/sx, dx

721. What is Lambert-Eaton myasthenic syndrome? s/sx? / How do you perform the tensilon test? / Cautions with tensilon test

722. Types of drugs that may exacerbate MG / Modifications that must be made in dosing of depolarizing and nondepolarizing neuromuscular blockers in MG

723. Causes of myasthenic crisis / Management of myasthenic crisis / Causes of botulism / Which three of the eight botulism toxins cause human disease? /

724. Botulism pathophysiology, infant botulism pathophysiology, s/sx, distinguishing feature vs. MG, Rx

725. Tick paralysis: name of toxin, supposed mechanism, s/sx, ddx, Rx // Two most common inflammatory myopathies, s/sx, Rx

726. Familial periodic paralysis: clinical syndrome, RFs, s/sx, Rx // vs. thyrotoxic periodic paralysis

727. Risk factors for CNS abscess / Etiology of meningitis & encephalitis (6 categories)

728. Most common cause of endemic and sporadic encephalitis / Microbiology of CNS abscesses / Meningitis pathophysiology / Sources of CNS abscesses (contiguous/local and remote/seeding)

729. Meningitis RFs, classic s/sx // The absence of these three s/sx excludes meningitis in immunocompetent adults

730. Meningitis-specific physical exam signs / If meningitis is suspected, physical exam should hunt for / Classic s/sx encephalitis / Complications of meningitis (immediate, delayed)

731. Mild and severe viral encephalitides / Clinical presentation of CNS abscess / Consequence specific to cryptococcal meningitis / Indications for CT scan before LP in suspected meningitis

732. Priority of CSF studies in query meningitis / When does CSF turbidity occur? / Normal CSF pressure, cell count, turbidity, xanthochromia, CSF:serum glucose ratio, protein, lactate

733. Usual cell count in bacterial meningitis / Viral meningitis cell count rule-in // Gram stain report for staph, strep, neisseria, listeria, h. flu, e. coli, pseudomonas

734. Lumbar puncture in coagulopathy? / WBC correction in traumatic tap / What type of patient ought to receive specialized CSF antigen testing? / Additional tests to consider in CNS infx workup

735. Threshold for LP in the elderly / Chronic meningitis is generally caused by / Rx meningitis

736. Empiric Rx bacterial meningitis in PCN-allergic / Who needs chemoprophylaxis for meningitis? / Options for chemoprophylaxis

737. Define cardiac arrest / Trick to making a pocket mask fit a small child / Where should the chest be compressed in infants and children / Intraosseous (IO) access sites

738. Where should IO needles NOT be placed? / Major receptor effect of epinephrine at cardiac arrest doses / Dose of epinephrine in cardiac arrest with relevant concentrations / Mechanism of action of vasopressin / Write the equation by which sodium bicarbonate buffers acidosis

739. Reasons not to give bicarb to fix acidosis / Dose of HCO3 / Indications for bicarb / Adenosine dose / Albuterol dose

740. Resus atropine dose, calcium chloride (CaCl2), dextrose, dobutamine, dopamine

741. Racemic epinephrine dose / flumazenil / glucagon / labetolol / lidocaine / How many mg/cc are in 1% lidocaine? / Narcan dose

742. Nipride dose / Should fixed & dilated pupils postarrest be attributed to atropine? / Indications for IV calcium / Magnesium dose / Mechanism of action of adenosine

743. Receptor effects of amiodarone, dose in arrest, dose in VT or SVT with poor perfusion / Procainamide dose / Lidocaine infusion dose / Cause of arrest in adults vs. pediatrics

744. How to know if the laryngeal and tracheal axes are aligned / Intervention to align these axes in infant, small child, large child/adult // ETT cuff pressure is OK when air leak is heard at how many cm H20 pressure? / Rule for estimating depth of ETT / Mnemonic for deterioration post-intubation

745. Alternatives for failed or difficult pediatric intubation / Trick to assist you in finding the tracheal inlet, when laryngoscope is properly positioned / PIP to stay below / What to do with high pressure alarm on a pressure-limited ventilator setting

746. Drug of choice in most pediatric bradycardias / When should adult paddle be used on kids' chest? / Postarrest drug of choice in hypotensive patient and normotensive patient / Caveat in starting vasoactive drip on initiation / Three provisions for having family present for resus

747. Two major cardiorespiratory changes required to transition from fetal to the extrauterine environment / Newborn HR, RR, systolic BP / Three conditions to correct if necessary in every newborn / The major cause of bradycardia in a newborn / Why is the newborn so susceptible to hypothermia?

748. Neonatal hypoglycemia RFs / Management of meconium stained amniotic fluid / Indications to NOT resuscitate a newborn i.e. DNR // Describe the levels of the pyrimid of neonatal resuscitation

749. Indications to perform suctioning on newborn / Tracheal suctioning technique / Management of diaphragmatic hernia

750. Perinatal management of meningomyelocele, bilateral choanal atresia, Pierre Robin syndrome // Equipment needed for neonatal resus

751. Elements of the Apgar score / 3 parameters to assess when resuscitating a newborne / First five steps to neonatal resus (top level of pyrimid) / Indications for BVM in neonatal resus

752. When to start chest compressions in newborn resus / Meds and indications in newborn resus / Venous site of choice in newborn

753. Criteria for acute respiratory failure / Potential adverse effects of positive pressure ventilation / Define pressure-cycled ventilation

754. Define volume-cycled ventilation / Why volume-cycled ventilation is generally superior in the ED / Define controlled mechanical ventilation / Define assist-control ventilation and list disadvantages

755. Define IMV ventilation (intermittent mandatory), reasons to use // Define SIMV (synchronized mandatory ventilation) // Define PSV (pressure support ventilation)

756. PEEP vs. CPAP, physiologic effect of PEEP // What is intrinsic PEEP, causes, effects // Key consideration when ventilating patients with auto-PEEP

757. Contraindications to NIPPV / Selecting Vt in healthy lungs vs. primary lung disease / I:E ratio / Starting dose of PEEP / FiO2 setting

758. Causes of low PIP / Causes of high PIP // Initial settings for BiPAP

759. How often should an intubated patient be suctioned? / Ddx fighting the ventilator / Things ventilated patients need

760. How quickly should respiratory acidosis be corrected in a COPD patient? / What to do about dynamic hyperinflation / Vent settings in asthma / Vent considerations in ARDS

761. Vent strategy in cardiogenic shock with pulmonary edema / Hypovolemic shock / ED weaning parameters / Initial RR in normal lungs

762. How do most NIBP devices work? / When NIBP readings may be inaccurate / Indications for an arterial line

763. How does pulse oximetry work? / Conditions that may falsify pulse oximetry / Pulse oximetry in CO and MetHB / 3 levels of response of the colorimetric capnometer

764. Usefulness of sublingual capnography / ACOG fetal monitoring recommendation post-trauma / Normal fetal HR range / Fetal monitoring signs that mandate obstetrics referral

765. Shock pathophysiology from mitochondrial perspective / Neurohormonal stress response to shock / Inflammatory cascade mediators in shock

766. Role of base deficit in pathophysiology of shock / Define base deficit, normal value, when to be concerned value / Resuscitation injury primarily affects which organs?

767. Shock ddx (8 categories)

768. Empiric criteria for diagnosis of circulatory shock / 3 major effects of septic shock that must be addressed in resuscitation / What % of normal myocardium must be affected (by ischemia, inflammation, toxins) to produce cardiogenic shock? / Specific gravity in UA suggestive of dehydration

769. Define the continuum of septic shock according to ACCP/SCCM consensus guidelines / 3 goals and interventions to reach those goals in EGDT

770. What is the preservative used in most stored blood? What is the shelf life of stored blood? What is the hematocrit of a unit of pRBCs? Who is at risk for pRBC-transfusion hyperkalemia? Define massive transfusion.

771. What is the blood volume of a humanoid? / Problems to anticipate in massive transfusion and what to do about them / How long does it take to get type-specific blood, incompletely cross-matched blood, completely cross-matched blood

772. When infusing blood, hemolysis is a risk when small guage needles are used and if the infusion rate exceeds what? / Indications for FFP / Indications for platelets and contraindication / One unit of pRBCs is expected to raise the Hb/HCT by how much in an average adult? / What is the volume of one unit of pRBCs?

773. What fluid is compatible with pRBC transfusion? / How can oen speed the infusion without risking hemolysis? / Usual time required to give 1 unit pRBCs / What is in 1 u FFP? / Dose of FFP to reverse warfarin / Cross-match FFP?

774. Crossmatch platelets? How much volume is one unit of platelets? One unit raises platelets by how much? Usual platelet dose in kids and adults / List 4 main acute immune-mediated transfusion-related adverse effects / What is the cause of the most serious type of transfusion reaction?

775. S/sx acute intravascular transfusion reaction, Rx / Most common transfusion reaction / S/sx, Rx, what to do if it occurs in first transfusion

776. Treatment of transfusion urticaria / When does TRALI appear? What does it look like? Rx? / Risk of tranfusion-acquired viruses

777. Two delayed immune-mediated transfusion reactions and their treatment / List non-immune mediated adverse effects of transfusion

778. At what cerebral perfusion pressure does cerebral blood flow start to fail? What happens at CBF of 35% of baseline? 20%? // Basic pathophysiology of neuronal cell death / What happens to CBF after reperfusion?

779. When does peak ICP occur after a global CNS ischemic event? // Cerebral resuscitation: strategies to maximize cerebral outcome postarrest

780. Therapeutic hypothermia postarrest recommendation, two general techniques, how to prevent shivering / Which postarrest patients should receive therapeutic hypothermia? Wht is the chance of neuro recovery in ROSC without return of neuro function? / Experimental and potential specific therapies for brain resuscitation postarrest

Interventions of proven benefit in cardiac arrest / The most susceptible organ to ischemic injury in cardiac arrest / Restoration of neurologic function is unlikely if untreated cardiac arrest persists beyond how long? / Chest compressions can generate at most what % baseline cardiac output?

782. Disadvantages of using epi in cardiac arrest / Two models of how chest compressions work / What is postresuscitation syndrome, and what causes it?

783. What is myocardial stunning? / Most common rhythm associated with cardiac arrest of primary cardiac etiology / Cascade of vital signs and rhythms in primary respiratory and primary obstructive or hypovolemic cardiac arrest / Most common metabolic cause of cardiac arrest

784. Duration of consciousness after sudden circulatory arrest (eg VF) / Signs of prolonged cardiac arrest / Define coronary perfusion pressure / Minimum coronary perfusion pressure required to achieve ROSC if initial defibrillation attempts have failed / Modalities available to assess effetiveness of CPR

785. Uses of an arterial line in CPR / Three key variables that make up end-tidal CO2 / Uses of PetCO2 in CPR / Normal ScvO2 value

786. Goal for ScvO2 in CPR / Uses of echocardiography in CPR / Ideal sequence of interventions and monitoring in CPR

787. What to do if patient develops VF or pulseless VT on the monitor, is still conscious, and defibrillator isn't yet available / When to wait, how long to wait before defibrillating / Classic causes of EMD and pseudo-EMD / When to confirm asystole

788. Immediate post ROSC management / Exclusion criteria for thrombolytics pertaining to post arrest patient / Monitoring postarrest patient with postarrest goals

789. Contraindications to therapeutic hypothermia / Optimal duration of compression in CPR / Complications of CPR / Alternatives to standard chest compressions

790. Proposed benefits of interposed abdominal compression CPR / How does compression-decompression CPR work? / Indications for open chest cardiac message / Advantage of biphasic defibrillation

791. Indications for precordial thump / General guideline for ETT administration of resus drugs / Desirability of central line locations in resus / Dose of vasopressin in CPR / Antidysrhythmics to consider / Atropine dosing in asystole

792. Pediatric differences to keep in mind when assessing the injured child / Maneuver to consider when managing a small child with dyspnea

793. Key physical exam maneuver when differentiating between shock and benign tachycardia / Normal RR and HR at under 1 year, 1-2, 2-5, 6-12, > 12 // Lower limit of SBP at 0-28 days, 1-12 months, 1-10 years

794. How to use the pulse ox to take a BP / Describe normal periodic breathing in infants / Adjustment of RR for fever in infants / Define infant toddler preschool school-age adolescent

795. Developmental milestones – 2, 4, 6, 8, 12, 18, 24 months // When should an infant interact? When should an infant have separation anxiety?

796. Three sides of the pediatric assessment triangle & features to look for in each side // Usual progression of AMS in hypoperfused pediatric brain

797. What does grunting represent physiologically in an infant? / Torticollis or refusal to extend neck with loss of upward gaze may result from what dx? / Effortless tachypnea suggests / Progression of respiratory failure / What is mottling? / Ddx mottling

798. Historical indications of child abuse / Bruises suggestive of child abuse

799. What is Cheyne-Stokes breathing? / How should cap refill be meaured? / Four key organs to assess in shock / Elements of croup score

800. How is fever defined in pediatrics? / What is the classic incidence of bacteremia in children under 36 months with fever and no clear source? / What pathogens are primarily responsible? / Why does this figure overestimate the rate of serious bacterial infection today? / Does response to antipyretic therapy reduce the chance of a child having an SBI?

801. What are the indications for a chest radiograph during the workup of pediatric fever? / What are the indications for ruling out UTI in the workup of pediatric fever? / Value of a positive UA by bag specimen

802. When is a negative UA sufficient to rule out UTI? / Value of urine nitrite and leukocyte esterase / Commonly accepted definition of positive urine culture & microscopy / What is occult bacteremia? What are the possible consequences?

803. What % children 3-36 months previously well who have fever without source will have an SBI? / what % will have meningitis or sepsis? / When should antibiotics be considered in well children aged 3-36 months? / Is the likelihood of bacteremia proportional to temperature and WBC count?

804. What is hyperpyrexia? / At what temperature does end-organ damage occur? / 5 causes of high fever (infectious) / Noninfectious causes of hyperpyrexia / Pharmacologic management of fever / Empiric abx for pediatric fever

805. Key causes of prolonged fever of unknown origin (> 14 days) // Ddx fever + petechiae

806. Common febrile illnesses in children / Value of TM and axillary temp

807. WBC differential in viral vs. bacterial disease / Causes of fever and altered sensorium

808. Is gram's stain of urine a good test for UTI? / When to send a stool culture and what to send culture for / Principle diagnostic criteria for Kawasaki syndrome

809. Maternal vaginal flora (ie what makes neonates sick) / Inpatient abx for fever in the first 4 weeks / Rectal exam in neutropenic patient? / Fever + indwelling vascular catheter

810. Leading cause of death of sickle cell patients / Bugs that HbSS patients are susceptible to / Key ddx in HbSS patient with bone pain / Investigations in pt with fever and VP shunt / Most common pathogen in VP shunt patients

811. Contraindication to ceftriaxone in first 60 days of life / Most common diseases that cause fever without source in infants

812. Management of the febrile infant less than 30 days old / Is a caretaker's report of a fever, if only by touch, to be believed? / Most common cause of acute gastroenteritis in children / Why should blood culture be drawn from a site spearate from the IV insertion site? When can you start to use bag urine specimens?

813. Pediatric risk factors for UTI / What is the key difference between the Philadelphia, Brown criteria and the Rochester criteria for ruling out SBI in 31-60 day olds? / Criteria for simple febrile seizure

814. Rochester criteria low risk historical, physical exam, laboratory factors

815. Criteria for doing an LP in 31-60 days if ruling out by Rochester / What to do with febrile 31-60 day olds who fail to be low risk by Rochester / What to do if they satisfy Rochester

816. Clincally identifiable viral infections / Clinically identifiable bacterial infections / Presumably viral infectious syndromes

817. What % of well-appearing children with petechiae have bacteremia? / Initial three questions to answer in the evaluation of febrile 2 month to 2 year old

818. Selective testing for 2 month-2 year febrile child who is well and witout evident bacterial or viral source: options & indications // What happens when you press a slide down on petechiae or purpura?

819. Pediatric airway features (vs. adults) // Until what age may uncuffed ET tubes be used? / What sounds are clasically associated with, and anatomic structures involved with: supraglottic, glottic, and subglottic lesions?

820. Causes of pediatric supraglottic, glottic, subglottic stenosis

821. Tests to consider in the management of pediatric upper airway obstruction / What is the most common congenital anomaly of the nose? / Conditions associated with macroglossia / Conditions associated with micrognathia

822. Age group and risk factor for retropharyngeal abscess / S/sx retropharyngeal abscess / Complications / Maximum allowable width of the retropharyngeal space on a soft tissue lateral neck film / The other major xray finding in retropharyngeal abscess

823. Management of retropharyngeal abscess (RPA) / Typical age group for pediatric classic epiglottitis / S/sx acute epiglottitis

824. Criteria for examining the pharynx in a child with suspected epiglottitis / Findings on soft tissue lateral that suggest the dx / Management / What to do if airway decompensates

825. What is laryngomalacia? What is its natural history? // Most common cause of vocal cord paralysis, s/sx // Croup: peak age, microbiology

826. S/sx croup, criteria for mild/mod/severe classification of croup, management of croup

827. Admission and discharge criteria for croup / What is spasmodic croup? / What is tracheomalacia? / What is tracheal stenosis?

828. What is a vascular ring? / Suggestive symptoms / Diagnostic test // Bacterial tracheitis: peak age, pathophys, s/sx, findings on plain film, Rx // Most frequently aspirated objects / Most deadly aspirated object

829. Define asthma / RFs for development of asthma / Asthma pathophys

830. Precipitants of asthma exacerbations / Asthma triad of symptoms / Define status asthmatics

831. Symptoms and signs to assess in asthma, and how to classify them into mild/mod/severe exacerbation

832. Risk factors for death from asthma / Complications of asthma / How to estimate predicted peak flow in kids

833. Indications for CXR in asthma exac / Causes of electrolyte disturbances in asthma / Asthma ddx

834. The issue other than resp status to pay particular attention to in a small child suffering an asthma exacerbation / How to deliver nebuized Rx / Dose of albuterol/ventolin / Advantage of nebulizer over MDI / At what age can MDI with spacer be considered as an alternative to MDI Rx?

835. Albuterol MDI dose in asthma exac / How much drug is in each pump? / Terbutaline dose / Ipratropium bromide dose / Approach to management of mod/severe non-extremis asthma / ICU indications

836. Criteria for discharge of asthma exac / Steriod dose, onset, peak effect / Alternative to prednisone for discharged patients / Adverse effects assoc with short-term systemic corticosteroid Rx

837. Dose of magnesium (MgSO4) in asthma, side effects / How to use heliox to deliver albuterol / Intubation-sparing dose of ketamine / Medications used to manage chronic asthma

838. Bronchiolitis pathophys, peak incidence (age and season), RFs, microbiology, usual clinical presentation

839. Bronchiolitis complications / Infants at risk for severe disease / Best predictor of severe bronchiolitis on exam / Ominous result of blood gas / Indications

840. Bronchiolitis ddx / 2 most important interventions in bronchiolitis / Other potential therapies / Øymar algorithm

841. Admission criteria for bronchiolitis / Top 5 anaphylaxis triggers / What is an anaphylactoid reaction, and what are common anaphylactoid triggers?

842. Pitfall in diagnosing anaphylaxis in patients taking antihistamines / Anaphylaxis ddx: acute respiratory compromise ddx, cutaneous symptoms ddx // Epi dose in anaphylaxis

843. H2 blocker dose in anaphylaxis / Anaphylaxis treatment in patients on beta blockers / Who gets discharged with epipen junior? / Most common age to aspirate a FB / Most commonly aspirated food / 3 clinical stages to FB aspiration

844. Usual history of foreign body aspiration / If history is strongly suggestive, how to manage child with normal exam? / Physical exam finding in FB aspiration / FB aspiration complications

845. FB aspiration: Findings on inspiratory/expiratory CXR / How to image kids too young to cooperate with insp/exp film / L lung vs R lung FB prevalence in < 15 years old / Presentations that should prompt consideration of FB aspiration / Management of diagnosed FB aspiration

846. Risk factors to have a recurrent febrile seizure in subsequent illness after having febrile seizure / RFs to develop epilepsy after febrile seizure / Epilepsy risk in general population and in simple febrile seizures

847. Viruses are estimated to cause 60-90% of pediatric pneumonias except in what age group? / When is the heptavalent pneumococcal conjugate vaccine given? / Aspiration pneumonia: microbiology, distribution, RFs, Rx / Pneumonia RFs

848. WHO clinical indicators of lower respiratory tract disease / WHO definition of tachypnea, age-stratified / Complications of bacterial pneumonia / Features of viral pneumonia vs. bacterial

849. Bugs and treatment of pediatric pneumonia at 0-12 weeks, 4 months-4 years, 5-15 years

850. Pediatric pneumonia admission indications // Distinguish two etiologies of chlamydia pneumonia

851. What age group most often gets whooping cough? / 3 stages / Effectiveness of immunization / Population that acts as a reservoir / Laboratory finding / Abx?

852. Management options for pleural effusion / Assume bacterial pneumonia if / Noninfectious pneumonia ddx

853. What is the most common systemic complication of pediatric pneumonia? / Symptoms assoc with mycoplasma pneumonia / Intervention to consider in pneumonia patients with increased work of breathing / How cystic fibrosis affects the lung

854. By 18 years of age, 80% of CF patients are colonized with what? / Adjunctive therapies to consider in CF pneumonia / Bronchopulmonary dysplasia: Who gets it, complication, key intervention

855. Ways that cardiac disease may present in infants and children / Name 3 fetal circulation structures and their function

856. Describe the path of blood through the fetus, starting with oxygenated blood in the placenta / When does the ductus arteriosis close?

857. Major causes of decreased stroke volume in infants & children / Formula for cardiac output and blood pressure / When is cyanosis visible? Who becomes cyanotic first, the anemic or non-anemic patient?

858. Three clinical parameters that allow the differentiation of cardiac and pulmonary etiology of cyanosis / Common causes of pediatric chest pain

859. Three distributions of cyanosis / Causes of the less important two types / Causes of the important two types (4 categories)

860. Pediatric vital signs: HR and RR in four pediatric age categories / Minimum acceptable SBP in four different age categories / Infant with bounding pulse suggests / Child with strong upper extremity pulses and weak lower extremity pulses suggests / Widely split, fixed S2

861. Features associated with pathologic murmurs / Describe two common innocent pediatric murmurs

862. How to do the hyperoxia test / Potential danger of the hyperoxia test / ABG and CBC findings in compensated cyanotic CHD / Thymus can be seen on CXR until what age? / Three classic CHD cardiac silhouettes

863. When does the right ventricle cease to be the dominant ventricle? / In which CHD can an infant present with myocardial ischemia? / Top acyanotic CHDs / Top cyanotic CHDs / All cyanotic CHDs present within 2-3 weeks except

864. A cyanotic infant with increased pulmonary vascularity on CXR most likely has / Decreased pulmonary vascularity likely has / Bolus volume in suspected or confirmed CHD / When to start PGE1, dose, side effects

865. When does the murmur of VSD appear? / Complications of VSD / Usual clinical course of ASD / Describe Eisenmenger's syndrome / Structural cardiac anomaly present in 50% of patients with coarctation

866. Complications of coarctation of the aorta / Blood pressure differential suggestive of coarctation / 2 reasons congenital heart disease can cause cyanosis / Anatomic defects present in tetrology of fallot

867. Tet spells: triggers, pathophys, s/sx, Rx

868. Staged surgical procedure for tetrology of fallot / Complications of postoperative CHD patients that may be seen in the ED / CHD and RSV issues

869. Pediatric causes of CHF / What kind of cardiac lesions are more likely to develop endocarditis?

870. Clinical conditions that should raise the spectre of endocarditis in child with anatomic cardiac defect / S/sx myocarditis, Dx, Rx

871. Kawasaki age group / What % untreated Kawasaki patients develop coronary artery abnormalities? / Diagnositic criteria / Lab findings / Kawasaki vs. measles

872. Children with suspected Kawasaki require what test? / 2 phases of Kawasaki-related heart disease / Rx / Side effects of Rx // Cardiac manifestations of rheumatic fever

873. Causes of sudden death in young athletes / Why HCM is often not picked up on pre-sports physicals / Two congenital long QT syndromes / Safest medication to use for long QT associated vtach/vfib

874. Basic life cycle of bilirubin / At what level does jaundice become apparent? / Definition of conjugated hyperbilirubinemia / Causes of unconjugated hyperbilirubinemia

875. Causes of direct hyperbilirubinemia / Toxic bili level in infant – risk for kernicterus / Kernicterus pathophys, s/sx

876. Breast milk jaundice vs. breast feeding jaundice vs. physiologic jaundice / What % of newborns have jaundice? / Indications for immediate exchange transfusion

877. Approach to the jaundiced infant / Indications for workup (usually admit)

878. Infant vomiting ddx / Other diagnoses to consider in child and adolescent

879. Hypertrophic pyloric stenosis: Prevalence, male vs. female, acid-base disturbance, usual age, s/sx, signs on imaging, ddx, Rx

880. Malrotation with midgut valvulus: Age of onset, male to female ratio, pathophys, s/sx, imaging findings, Rx // Three different double-bubble signs

881. Necrotizing enterocolitis: what % full term? When does it present? RFs? Three clinical stages? Rx?

882. Pediatric GERD: pathophys, consequences, s/sx, Rx // Intussusception: when it presents, pathophys, top four causes

883. Intussusception: s/sx, dx, rx

884. Hirschsprung's disease: RFs, pathophys, s/sx, ddx, dx, Rx

885. Meckel's diverticulum: rule of 2s, pathophys, s/sx, dx

886. GI Bleeding ddx in infancy and childhood/adolescence // Managment of Meckel's

887. Henoch-Schonlein Purpura: age, precipitants, pathophys, s/sx, dx, ddx, Rx

888. Most common GI foreign body in kids / 3 areas of physiologic narrowing where FBs get stuck / 4 clincal scenarios a/w GI FB / Management of button battery ingestion / Other GI FBs managment

889. Indications for surgical removal of gastric FB / Causes of pancreatitis in kids / Peak age incidence of appendicitis / Mesenteric adenitis: pathophys and s/sx

890. Factors a/w likely viral cause of diarrhea / Factors that increase chance that diarrhea has bacterial or parasitic cause / Factors that increase the chance that diarrhea is cuased by Shiga toxin producing e. coli O157:H7

891. Noninfectious causes of diarrhea

892. Management of acute diarrhea

893. Most common diarrhea etiology in children / Causes of acidosis in diarrheal illness / Rotavirus syndrome, s/sx, Rotavirus vaccine? / Most common bacterial etiologies of diarrhea

894. Clinical assesment of degree of dehydration: levels, signs, labs

895. Thick, doughy skin in the context of dehydration suggests / How to do oral rehydration therapy / Adequate urine output at home

896. Strayer approach to IV rehydration, including hypo/hypernatremic dehydration / Rate to correct hypo and hypernatremia / Dose and fluid to use in hyponatremic seizure

897. Causes of priapism / Etiology of two kinds of priapism / Management priorities in priapism other than detumescence

898. Treatment of low flow priapism, high flow // Symptoms and consequences of phimosis / What % of newborns, 1 year olds and 4 year olds have a retractable foreskin? / Other causes of phimosis

899. Management of phimosis / Paraphimosis: causes, consequences, treatment

900. Balanitis vs. balanoposthitis / Causes of balanoposthitis, Rx // Conditions prevented by circumcision

901. Key diagnoses to rule out in penile entrapment and tourniquet injuries and how to rule them out // How to manage penile zipper entrapment // Where is the epididymis located on the testicle? / Describe the microbiology and symptomatology of epididymitis

902. Value of pain relief with scotal elevation in distinguishing epididymitis from torsion / What % epididymitis has pyuria? / Tests in epididymitis / Rx / Who to admit

903. Orchitis: s/sx, most common etiology, Rx // Testicular torsion: when does necrosis begin? What is the salvage rate if Rx delayed >24h? Peak incidence (age)? Predisposing anatomic deformity? S/sx? Value of cremasteric reflex?

904. Does pyuria rule out testicular torsion? What is the sens/specificity of doppler for torsion? Who needs to be ruled out? What is the prevalence of the bell clapper deformity on the contralateral testicle, in torsion patients? How do you manually detorse? // Torsion of the testicular appendage: What is it? S/sx? Diagnostic finding? Rx?

905. Which patients with varicocele require imaging to rule out compressive mass in abdomen? / What is idiopathic scrotal edema? / What is a hydrocele? Who needs imaging? / Direct vs. indirect inguinal hernia

906. Irreducible hernia s/sx, management // Key risk factors for teticular carcinoma, s/sx, diagnostic tests

907. Only period when males are more likely to have a UTI than females / UTI sequelae / At what age can UA alone rule out UTI? / Definition of UTI based on culture results // Ddx dysuria in kids

908. Duration of Rx for UTI in 3 month to 2 year age group / Which children need follow-up imaging and to rule out what? / Definition of microscopic hematuria / Positive hemoglobin with negative RBCs means what? / Urine casts suggest lesion is where? / Most common renal stones in kids

909. Pediatric hematuria ddx

910. Most common symptom for renal tumor / Why get urine catecholamines when renal tumor is suspected? / Causes of proteinuria / Proteinuria workup / Does treating strep throat reduce likelihood of PSGN? / Poststreptococcal glomerulonephritis pathophys

911. PSGN: Age, clinical course, s/sx, studies, Rx // Most common cause of primary nephrotic syndrome

912. Nephrotic syndrome patients are at special risk for what? / What is positive 24 hour urine for proteinuria? / Management priorities in nephrotic syndrome // Complications the EP is concerned about in acute renal failure

913. Acute renal failure: Causes

914. Define hypertension in the pediatric patient / Correct cuff size / Causes of nonessential hypertension

915. Tests to consider in diagnostic evaluation of hypertension / In what % HSP patients is a cutaneous symptom the presenting complaint? / Usual abdominal complaint / Frequency of HSP glomerulonephritis, % of these patients who develop ARF

916. Hemolytic-uremic syndrome (HUS): usual age, pathophys, s/sx, dx, Rx

917. Acute bacterial meningitis: long-term sequelae, neonatal bugs, bugs in other kids, risk factors

918. Meningitis pathophys / What % of kids have fulminant disease? / Acute hearing loss with history of trauma suggests / CSF WBC findings in infants

919. Dexamethasone for pediatric meningitis? / When to administer acyclovir empirically / Special neonatal causes of seizures

920. Infantile spasms: s/sx, common misdiagnosis, prognosis // Juvenile absence epilepsy: age, EEG, GTCS?, trigger, Rx, prognosis

921. What % kids have at least one febrile seizure before age 5? What % have a recurrence? // Pediatric seizure mimics // Breath holding spells: age, %, trigger, s/sx

922. What is the proper name for sleep talking? // Bug that causes diarrhea and seizures / Significance of impact seizures / Significance of early post-traumatic seizures / RFs for pediatric ischemic stroke

923. Dose for seizures: lorazepam IV, diazepam IV, diazeam RP, midazolam IM, phenytoin IV, phenobarbital IV // Risk factors for having a recurrent seizure in an unprovoked first seizure

924. Anticonvulsant side effects (dose related, idiosyncratic) / Usual pediatric causes of headache / Classic symptoms of increased ICH

925. Signs of increased ICP in idiopathic intracranial hypertension (pseudotumor cerebri, benign intracrania hypertension) / IIH RFs, neuroimaging findings, opening CSF pressure // Childhood ataxia ddx

926. Acute cerebellar ataxia: age, pathophys, s/sx, prognosis / Friedrich's ataxia: pathophys, prognosis / Ataxia telangiectasia: pathophys, prognosis

927. Factors that distinguish the pediatric musculoskeletal system from the adult / Fractures unique to pediatrics

928. Risk for growth arrest is small in which types of Salter-Harris injuries? / Most common S-H fracture / Most common childhood fracture, complications of that fracture, indications for surgery, figure of eight?

929. Clavicle # treatment / Most common obstetric #, complication / Most common type of supracondylar # / Gartland classification / Supracondylar # complications

930. Elbow ossification centers by age / Two lines to draw to determine the presence of a supracondylar # / Is an anterior fat pad normal?

931. What to do with supracondylar fracture presenting with cold hand / Management of Gartland I vs. II&III

932. Proximal third ulna # = what until proven otherwise, Rx / Nursemaid's elbow: pathophys, age, mechanism, Rx (two options)

933. If two attempts to reduce nursemaid's elbow fail, what next? / Toddler's fracture: age, description, s/sx, management // Fractures suspicious for abuse

934. Fracture patterns suspicious for abuse / Most common injury pattern associated with abuse / Diseases that present like child abuse

935. Osteogenesis imperfecta: pathophys, skeletal s/sx, extraorthopedic manifestations // Rickets: cause, manifestations

936. Developmental dysplasia of the hip: diagnosis, 3 eponyms // Radiographs of the hip?

937. Pediatric hip pain ddx // Transient synovitis pathophysiology, age, s/sx, dx

938. Indications for ultrasound-guided hip arthrocentesis in child with hip pain // What % transient synovitis patients have effusion? / Rx transient synovitis // Septic hip is generally held in what position? / ESR vs. CRP / What is the mucin clot test?

939. Legg Calve Perthes disease: definition, age, RFs, s/sx, dx, Rx

940. Slipped capital femoral epiphysis: define, RFs, bilateral? / Two types of SCFE, s/sx

941. SCFE dx, 2 xray eponyms, Rx

942. Management of SCFE / complications // What is an apophysis? Name three apophyseal injuries // Osgood-Schlatter syndrome: age, s/sx, Rx

943. Structure to examine in kids with knee pain that is not in the knee / In Colles #, cast in supination or pronation? Smith's #? // If radius and ulna broken, cast extends to where? / Cast for nondisplaced radial head # / 1st MC # / 2nd or 3rd MC# / 4th or 5th MC #

944. Management of phalynx buckle # / Phalynx displacement allowed / Tibia shaft diaphyseal # cast / Medial malleolus / Lateral mal / Fibula / Metatarsal # / Toes

945. Define SIDS / What has reduced SIDS rate by 40%? / Peak incidence of SIDS / Define pathologic apnea

946. Define periodic breathing / Define ALTE / RFs for SIDS including modifiable RFs

947. Define breath-holding spell, potential sequelae / OK for infant to sleep on side? / Etiology of SIDS / When to involve CPS

948. Helpful interventions in managing an unexpected infant death / Pathophysiology of ALTE, relationship to SIDS // How often is a causal diagnosis reached in ALTE workups? / Disposition of ALTE?

949. Etiologies of ALTEs / ED workup

950. Which agent has a role in managing apnea of prematurity and in periodic breathing in infants at risk for SIDS? / Candidates for home monitoring of chest wall movement and HR

951. Three phases of schizophrenia, DSM IV criteria

952. Medical disorders that may cause acute psychosis, medications that may cause acute psychosis

953. Features of organic psychosis vs. functional psychosis

954. Psychiatric ddx for psychosis / Components of mental status exam

955. Main side effects of low/high potency antipsychotics, members of these classes, members of atypicals // Rx dystonia

956. Mood vs. affect / Symptoms of depression / DSM IV major depressive episode

957. DSM IV manic episode

958. Psychiatric ddx for depression / Criteria for hospitalization of a patient with an acute psychiatric episode

959. General emergency priorities when managing suspected psychiatric presentation: 5 steps // Somatic symptoms of anxiety

960. Anxiety psychiatric ddx / How to distinguish functional vs. organic hyperventilation

961. What is somatization? / Criteria for somatization disorder / Varieties of somatoform disorders

962. Most common somatization complaints / What is conversion disorder? / Most common ED presentations / Hallmark feature of conversion

963. Characteristics of hypochondriasis / Organic diseases that may be mistaken for somatoform disorder

964. Strategies in the management of somatoform disorders / What is a factitious disorder?

965. Reasons for malingering / Malingering is associated with what personality disorder? / Characteristics of malingering

966. What is the therapeutic double bind? / Problems with confronting factitious patients / Strategies to uncover Munchausen's by proxy

967. Define parasuicide, occult suicide, silent suicide // Suicide risk factors

968. What % suicide attemptors ultimately complete suicide? / What % suicide completers are successful on 1st attempt? / Describe association of suicide and starting antidepressant Rx / Most common attempted suicide method / Tool for discharging suicidal patient / Factors to discharge such a patient

969. What is cotton fever? / Consequence of prolonged use of IV methylphenidate / Define rhabdomyolysis / Who abuses solvents? / Different mechanisms to abuse solvents

970. Effect of toluene abuse – 3 syndromes / Why one should avoid startling a solvent abuser / Effect of carbon tetrachloride / What is in paint stripper that is really bad / How to spot a solvent abuser

971. Sequelae of nitrites / Cause of death in helium or nitrous oxide abuse / Management of solvent abuse in the ED / Symptoms of methemoglobinemia – correlated to two leves, pulse ox / Key messages in carbon monoxide poisoning

972. Who needs Tx for MetHb? / Rx / How it works / Other treatments / Signs of PCP intoxication

973. Complications of PCP intox / UOP to acheive with IVF in rhabdo / Herbals: khat and ma huang are analgous to what?

974. Define disability / Define mental retardation / Complications of VP shunts / How may shunt infections present? / How reliable is shunt-pumping as a way to assess shunt function? / Complications of shunt migration

975. Down Syndrome complications / Turner's / Marfan's / What is legal blindness? / Spinal roots nomenclature vs. vertebrae

976. Complications of spinal cord injury / What is SMA syndrome? / Treatment of autonomic dysreflexia

977. Baclofen pump complications / What is autonomic dysreflexia? / Precipitants of autonomic dysreflexia

978. Most common sites of decubitus ulcers / Distinguishing infectious bacteruria from colonization / Post-traumatic syrinx: what is it? s/sx, dx, Rx

979. Elements of fracture description / How to determine if a fracture is open

980. Valgus vs. varus / How to describe the direction of angulation / Causes of pathologic fractures / Nutrient artery vs. fracture

981. Management of open fractures / Complications of fractures

982. Nerve injury associated with elbow fracture, shoulder dislocation, sacral #, acetabulum #, hip dislocation, femoral shaft #, knee dislocation, lateral tibial plateau # // Complications of vascular injuries /// safety of nerve blocks in various fractures

983. Normal compartment pressure & key pressure numbers in compartment syndrome / Elevate extremity? / What % compartment syndrome patients have soft tissue injury without fracture?

985. Complications of compartment syndrome / Bones at special risk for avascular necrosis // What is complex regional pain syndrome? / What can precipitate it?

984. Causes of compartment syndrome / Signs & symptoms

986. RSD s/sx, Rx // Fat embolism syndrome: what is it? S/sx, Rx

987. What is a fracture blister? Locations? What might it fortell? // Complications of immobility / Where do walking heels go on a walking cast?

988. Safest approach to a patient presenting with pain about a cast / If relieving pressure does not improve pain, consider what? / Classic recommendation for ice application duration / Contraindications to cryotherapy (ice)

989. Swelling about the dorsum of the hand may indicate infection where? Why does the eccentric shape of the metacarpal head alter how we immobilize the hand? The physis is located at which end of the metacarpal and which end of the phalanx? What do lumbricles do?

990. What do the seven interossei muscles do? innervation? / Which is more commonly lacerated, the FDP or the FDS? / Nerve root testing: C5 C6 C7 C8 / Which intrinsic muscles of the hand are innervated by the radial nerve? / Radial nerve palsy causes what clinical syndrome?

991. Ulnar nerve palsy causes what clinical syndrome? / Late appearance of hand with median nerve palsy / Best place to check sensation of median, ulnar, radial nerves / Maximum allowable distance of two point discrimination at fingertip, base of palm, dorsum of hand

992. Determinants of fracture stability / Injuries associated with distal phalanx fracture / Treatment of distal phalanx fractures / Implications of fibrous septations in distal finger

993. Middle and proximal phalanx fractures: complication to rule out in the ED, how to rule it out, who to refer, Rx // MC shaft fracture: maximum allowable angulation in D1-D5, who to refer

994. Injury to rule out in metacarpal head fracture / Treatment of MC head # / Allowable angulation of MC neck # / Name of common MC neck #, Rx

995. Management of thumb MC # / Bennett's fracture: define, Rx / Vs. Rolando's / Assessment and management of ligamentous injuries

996. How to reduce DIP/PIP dislocations / If avulsion #? / Rx // Which looks worse on presentation: an MCP subluxation or dislocation?

997. Complex/complete dislocation of MCP Rx // Forced radial deviation (abduction) of thumb causes what injury? How do you test for it?

998. What is positive valgus stress testing for UCL injury? Get radiographs? Rx // Why is hand position important in tendon injury? // What is mallet finger?

999. Mallet finger Rx / Who needs surgery? / Prognosis / Name of associated deformity and opposite deformity / Extensor tendon injury over MCP is what until proven otherwise? / Rx

1000. Most important closed flexor tendon injury, Rx // Significance of palmaris longus lacerations // Rx flexor tendon lacerations if surgeon not available

1001. Management of fingertip amputation if wound < 1 cm // Radiographs in nailbed injury? // When to trephinate / If subungual hematoma & fracture, pull of nail?

1002. If nailbed repaired, what to do with nail? // Management of fight bite

1003. Amputation rate associated with high pressure finger injuries / Most important prognostic factor in pressure injuries / Rx // Management of finger avulsion or amputation

1004. Treatment of partial amputation with vascular compromise / Warm ischemia time? Cold ischemia time? / Indications and contraindications to replantation // Management of exsanguinating limb hemorrhage if direct pressure ineffective

1005. Paronychia: define, Rx // Felon: define, key diagnosis to rule out, Rx

1006. Herpetic whitlow: Risk factors, s/sx, vs. felon, Rx

1007. Flexor tenosynovitis: S/sx, complication, Rx // Common cause of subfascial web space infection, Rx // Septic arthritis vs flexor tenosynovitis

1008. Management of stenosing tenosynovitis / Signs of occult foreign body

1010. Most commonly fractured carpal bone / Usual mechanism / Value of xray? / Refer? // If lunate fracture is suspected, but xray normal, mangement? / Complication of lunate #

1009. Which carpal bones are a particular risk for avascular necrosis after fracture and why? / How far distally should the radial styloid extend beyond the articular surface of the ulna? / What is the normal ulnar slant of the distal radius? / What is the normal anterio-posterior tilt of the distal radius? What bones line up on a lateral view of the wrist?

1011. Which carpal bone is a sesamoid bone? What is a sesamoid bone? // Injury associated with pisiform # / Mechanism associated with hook of hamate fracture / Scapholunate dislocation xray findings / How to accentuate findings

1012. Perilunate dislocation xray findings / Lunate dislocation xray findings / Treatment of carpal ligamentous injury

1013. What is colles' fracture? / Associated with what injuries? / Goals of reduction / Complications / Cast in what position?

1014. Smith's fracture: Define, mechanism, Rx // Barton's fracture: define, Rx // Hutchison's fracture: mechanism, Rx

1017. Complication associated with radius & ulna # / Treatment of both bones fracture // Acceptable angulation & displacement in ulna # / When ulna # is seen, what must be ruled out? Define this entity, how to r/o radiographically, nerve injury associated with it, Rx

1018. Galeazzi's fracture: define, how to diagnose, Rx // In pediatric fractures, features that portend greater remodeling potential / Treatment of radius ulna plastic deformation

1019. Midshaft humerus fractures are associated with injury to which structure? / Fractures near medial epicondyle put what structure at risk? / Describe the anterior humeral line and its significance / An abnormal elbow effusion suggests what in adults and children? / When is the fat pad sign falsely negative?

1020. Describe Baumann's angle and its significance / Mangement of humeral shaft # / What % humerus fractures are complicated by radal nerve injury?

1021. Why are supracondylar fractures unusual in adults? / What % supracondylar fractures are extension-type? / Mechanism? / Where does the distal fragment displace? / Treatment of type I supracondylar # / Management of child with localized tenderness but negative xray findings for supracondylar #

1022. When does post fracture swelling peak and what are the risks? / ED reduction of supracondylar fracture? / Supracondylar # complications / Rx supracondylar # types I,II / Position children with extension type supracondylar fractures present in

1023. Flexion-type supracondylar fracture: mechanism, presenting posture, structure at risk, Rx // Transcondylar fractures: define, population

1024. Intercondylar fractures: define, population, mechanism // Two most common elbow fractures in kids / Features of medial condyle fracture that makes it more serious than lateral / Treatment of medial and lateral condyle fracture

1025. Usual cause of capitellum #, associated injury, Rx // Usual cause of trochlea # // Causes of medial epicondyle #, hallmark sign, Rx

1026. Typical history for little leaguer's elbow, Rx // Olecranon #: two mechanisms, associated deficit, structure at risk, indication for surgery // Radial head/neck fracture: mechanism, common radiograph findings, Rx

1027. Two most commonly dislocated joints // Most common direction of elbow dislocation, signs & symptoms, structures at risk, management

1028. Anterior elbow dislocation: appearance, Rx // Radial head subluxation: recurrence rate, indications for xray // Lateral epicondylitis: cause s/sx, Rx // Elbow Reduction Technique

1029. Olecranon bursitis: cause, s/sx, Rx // Biceps tendon rupture: two types with two causes, two s/sx, treatment // Tendinosis RFs

1030. Four joints that make up the shoulder girldle / Rotator cuff muscles / Pain that may refer to the shoulder

1031. Most common type of clavicle fracture / Indications for immediate ortho & urgent ortho / Treatment in other (vast majority of) cases / Consideration with medial one-third fracture / Complications

1032. Most important management principle in scapular fractures / Rx / Who most often gets proximal humerus fractures? Usual mechanism? Qualitatively describe the classification system

1033. Proximal humerus fracture treatment, complications / Sternoclavicular dislocation: mechanism, usual direction, key management issue

1034. Sternoclavicular dislocation: S/sx, Dx, Rx

1035. Acromioclavicular AC joint separation: Usual mechanism, s/sx of three grades of injury, normal coracoclavicular distance

1036. Stress views of the AC joint? / Treatment of AC joint separation / Complications & associated injuries // Glenohumeral dislocation: bimodal peak incidence / % anterior / 99% of anterior dislocations are in which two locations? / How to test the axillary nerve

1037. Anterior shoulder dislocation: Associated fractures / Methods of reduction

1038. Anterior shoulder dislocation: Postreduction care / Who to refer? // Anterior shoulder subluxation: s/sx, dx, rx

1039. Mechanisms that cause posterior shoulder dislocation, s/sx, common misdx, AP xray signs

1040. Inferior glenohumeral dislocation: presentation, Rx, complications // What is the subacromial space? What is in the subacromial space? Impingement is centered on what? What is the subacromial syndrome cycle?

1041. Impingment syndrome stages, ddx / Describe the impingement injection test / AAOS Rotator Cuff Exercises

1042. Management of impingement syndrome / Action of infraspinatus, teres minor, subscapularis, supraspinatus / Two kinds of rotator cuff tears, s/sx, Rx

1043. Xrays in impingement syndrome and rotator cuff tear // Bicipital tenosynovitis: s/sx, test, Rx

1044. Most biceps tendon ruptures are which type? S/sx, Rx // Calcific tendinitis: age, pathophys, three phases of s/sx, dx, Rx // Adhesive capsulitis: age, s/sx, Rx

1045. What % patients with mechanical low back pain have complete resolution of symptoms within 6 weeks? / 95% lumbar disk herniations occur at which two disks, which correspond to which two nerve roots? / Which direction do disks usually bulge? / Where does the spinal cord end? / Causes of nerve root impingement / What is sciatics?

1046. 85% Low back pain patients have what diagnosis? / The other 15% have pain that is found to localize where? / Typical age for disc herniation and why / Spinal stenosis pathophysiology / Testing for compromise of a lumbar nerve root diagram

1047. Spondylolisthesis: define, usual direction, when patients become symptomatic, associated anatomic defect // Cancers most likely to metastasize to bone / Relative incidence of back pain caused by primary neoplasm vs. metastasis

1048. Four diagnoses of non-referred back pain that must be excluded in ED / What is a positive straight leg raise? / What is the value of a crossed SLR? / What does a reverse SLR test?

1049. How to test L3, L4, L5, S1 nerve roots (strength & sensation) / Signs and symptoms of spinal stenosis / Cause of spondylolisthesis in adults and kids

1050. Classic s/sx ankylosing spondylitis / Causes of cauda equina syndrome / Most sensitive sign of CES / Spinal infection RFs

1051. Key s/sx spinal infection / Malignancy back pain RFs / Test for malingering sciatica / Blood test of interest in back pain

1052. Where vertebral osteomyelitis is usually found / Dangerous etiologies of referred back pain / Approach to the low back pain workup

1053. Management of lumbar disk herniation / Spinal stenosis / Spondylolisthesis // Role of xrays in detecting vertebral metastases

1054. Thoracic back pain ddx / Management of thoracic disk herniation / Most metastatic spine disease occurs at what part of the spine?

1055. Sources of pelvic bleeding in trauma / Possible fates of an enlarging pelvic hematoma / Physical exam maneuvers to perform if positive pelvic fracture

1056. Pelvic trauma + blood at the meatus = what? / Gross hematuria = what? // S2-S5 nerve root injury signs and symptoms // AP compression fractures of the pelvis are strongly associated with what thoracic injury?

1057. Value of inlet/outlet pelvic radiographs / Normal width of symphysis pubis & SI joint / If doing DPL in context of pelvic fracture, why do a fully open technique? / Unstable blunt trauma patient with pelvic # and DPL positive by cell count only: OR or angio?

1058. Tile's classification of pelvic fractures

1059. Priorities in management of high energy pelvic ring injury + hypotension / Pelvic avulsion fractures: who gets them? 4 kinds // Straddle #: define, associated with what injury?

1060. Coccyx fractures: 2 causes, ?xray, Rx // Two kinds of sacral fractures that are more serious // Open book pelvic #: usual mechanism, hallmark on xray

1061. Radiographic clues to posterior arch injuries / Two mechanisms for acetabular fracture, physical exam findings & signs, xray view

1062. Predictors of large transfusion based on AP pelvis / Angiographic embolization: arterial vs. venous, indications

1063. Epidemiology of femoral neck fractures vs. intertrochanteric fractures // Avascular necrosis of the femoral head: s/sx, mean age, atraumatic causes & traumatic causes

1064. Importance of hip dislocation / Myositis ossificans: what is it? Cause? Location? Natural history? Rx? // Etiologies of referred hip and groin pain

1065. Hip fracture: occult management issues / How much blood can be lost into a femur #? / Presenting leg position in displaced femoral neck #, intertrochanteric # // Three techniques to find hip fractures on plain film // Femoral Nerve Block Fascia Iliaca Block by landmark

1066. Occult hip # incidence, indications for further testing, and test of choice // Traction for femoral #s? / Contraindications to traction / What attaches to the small concavity in the center of the femoral head?

1067. Classification of open fractures and how it affects treatment / Analgesic option in hip and femoral shaft fractures / Complications of prosthetic hips / Garden classification of femoral neck fractures

1068. Orthopedic management of femoral neck fractures / How are intertroch fractures classified? What is the optimal timing of surgery? Complications of subtrochanteric fractures / Injuries associated with femoral shaft fracture

1069. Orthopedic management of femoral shaft # / Two periods postoperative refracture most likey / Ddx painful hip without #

1070. What % patients with hip dislocation have other serious injuries? / What % hip dislocations are posterior? What is the usual mechanism? / Mechanism of anterior dislocation? / Fractures assoc with hip dislocation / Presenting posture of posterior hip dislocation

1071. Three xray findings in hip dislocation / Contraindication to closed reduction of dislocated hip / Two techniques for reduction / Describe Allis method

1072. Urgency of displaced prosthetic hip / S/sx complete muscle tear, Rx / Iliopsoas strain: unusual and misleading symptom, why xray?

1073. Femoral neuropathy & sciatic neuropathy: motor and sensory deficit // What is Klein's line?

1074. Two knee articulations / Common peroneal nerve becomes what? May be injured when? When injured, causes what motor deficit? // Pain that refers to the knee // High energy knee injury without swelling suggests what? Early hemarthrosis suggests what? Late hemarthrosis?

1075. Physical exam maneuvers to uncover knee effusion (3) / Palpation tenderness of the knee: etiologies at various locations / Describe McMurray's test

1076. Describe the pivot shift test / Collateral ligament stress test: laxity in full extension vs. laxity only with 30 degrees of flexion // Ottawa knee rules / Pittsburgh knee rules

1077. Most effective intra-articular knee analgesia // Management of distal femur # / Tibial plateau fracture: mechanism, associated injuries, xray finding // What is a Segond fracture?

1078. Tibial spine #: Who gets them? What do they represent? Best radiographic view? Rx? // What is the fabella? // What is osteochondritis dissecans? Location? S/sx?

1079. Where does AVN occur in the knee? Patella in quadriceps tendon rupture vs. patellar tendon rupture / Treatment of extensor mechanism injuries / What is the largest sesamoid bone in the body? / Most common fracture pattern of this bone, two types

1080. Patella # diagnosis, xray view, pitfall, Rx // Risk factors for patellar dislocation / Usual direction, mechanism

1081. Patella dislocation s/sx, diagnostic tool if patella dislocation-relocation suspected, Rx // Patellafemoral pain syndrome: s/sx

1082. Patellofemoral pain syndrom Rx // Peroneal nerve & posterior tibial nerve: sensory and motor testing / Alternative to arteriography in evaluating knee dislocation, how to immobilize, complications

1083. Orthopedic management of knee ligament injuries / Which meniscus is more vulnerable to injury? Which part of the meniscus heals? // Iliotibial band syndrome: who gets it, s/sx, Rx

1084. Peripatellar tendinitis s/sx // Lateral patella compression syndrome: define // Plica syndrome: define, s/sx

1085. Popliteus tendinitis causes pain where? // Prepatellar bursitis: s/sx, ddx // Pes anserine bursitis: who gets it? s/sx? // Knee injuries that predispose to osteoarthritis

1086. Xray findings in osteoarthritis // Popliteal cyst: define, Rx // Four lower leg compartments

1087. Contents of the four lower leg compartments

1088. Tibial tubercle fractures: Population, mechanism, class and treatment, vs. Osgood-Schlatter // Tibial shaft fracture: complications, treatment

1089. What is a Maisonneuve fracture? // Treatment of fibula fracture // Usual history of stress fractures and the performance of plain films

1090. Treatment of incomplete gastrocnemius rupture // Shin splints signs, symptoms // Most common knee injury

1091. Describe the ankle stability structure / Maximum allowable medial clear space / Ottawa ankle rules

1092. Management of chip avulsion fractures of the ankle / Which ankle fractures require ortho in the ED? / Weber classification

1093. Pilon fracture mechanism and associated injuries // Most commonly injured ankle ligament and how to test it // Test to reveal fibular and syndasmotic injury

1094. Ankle sprain ddx // Management of uncomplicated ankle fracture // Is plantarflexion possible in complete achilles tendon rupture?

1095. Peroneal tendon dislocation: mechanism, s/sx, Rx // Tibialis posterior tendon rupture: population, s/sx // What is snowboarder's fracture?

1096. Management of diagnosed or suspected talar dome # // What is subtalar dislocation? Mechanism? S/sx? Rx?

1097. Calcaneous fracture: Assoc injuries, special xray view, describe radiographic test to r/o compression # // Complication of navicular fracture

1098. What is a Lisfranc injury? What is the most important element in the Lisfranc joint? Mechanisms? Associated injuries? Injury that should especially raise concern for Lisfranc?

1099. Three types of Lisfranc injuries, what to look for on xray, Rx // Most commonly fractured metatarsal, treatment of undisplaced metatarsal #

1100. Which displaced MT shaft fractures need reduction? What is the treatment? / Management of MT head and neck fractures / Two kinds of base of 5th MT fractures / Injury associated with base of MT #s 1-4

1101. Management of base of MT #1-4 // Management of 5th MT tuberosity # // Jones # treatment // Hallux phalynx fracture management

1102. Sesamoid fracture: clinical sign, xray pitfall, Rx // MT dislocation postreduction Rx // Three key diagnostic considerations in all foot pain without obvious etiology

1103. Hindfoot pain ddx // Forefoot pain & metatarsalgia ddx

1104. Morton's Neuroma: features, s/sx, Rx // Causes of pedal compartment syndrome and time frame

1105. Leading cause of death in 1-37 year old age group / Prehospital variables to assess when deciding whether or not to transport to a trauma center (four categories) / 50% of those who jump from how high die? 90%?

1106. Low-velocity bullet injury mechanisms vs. high-velocity // Injuries associated with broken windshield and broken steering wheel

1107. Injuries associated with: knees to dashboard, improper lap belt, 3-point belt, rear-end collision, fall with supine impact and upright impact, periorbital penetrating injury

1108. Injuries associated with: buttocks penetrating injury, strangulation, handlebar impact // Trauma labs to consider

1109. Massive transfusion: FFP rule of thumb, fibrinogen target level, platelet level to transfuse // Problems with transfusing non-warmed IVF/pRBCs // ED thoractomy priorities // NHS Massive Transfusion Pathway

1110. C-spine injury in penetrating neck trauma? // Signs of spinal cord injury in altered patient / What procedures must be performed prior to DPL / Injuries that become symptomatic late

1111. Oral contrast: merits and demerits // Hemodynamically unstable patient with decreased level of consciousness and need for laparotomy > delay lap for brain CT?

1112. What is the leading cause of maternal death? / List the pregnancy changes that can mimic shock, hide shock, exacerbate bleeding, complicate intubation

1113. Hemodynamic changes in pregnancy (3 trimesters): HR, SBP, DBP, CO, CVP, blood volume, HCT, WBC

1114. Where to put a chest tube in the third trimester // Term values of ESR, fibrinogen, pCO2, HCO3-

1115. Most sensitive indicator of placental abruption / Maximum allowable frequency of contractions if concerned about abruption / Gestational age to intervene if abruption / Etiology of DIC in abruption / Most common problem assoc with maternal tauma and usual outcome of this problem

1116. Dose of millirads at which teratogenicity readily occurs // Amount of naturally occurring radiation fetus is exposed to over nine month gestation // Studies that expose fetus to

1117. DPL in pregnancy? / Complications of fetomaternal hemorrhage / When to use Kleihauer-Betke test

1118. Cutoff of fetal viability and approach to mom vs. baby in trauma // When are FHT's appreciable?

1119. Purpose of pelvic exam in obstetric trauma / Fetal monitoring in situation with stable mom / Indications to extend fetal monitoring

1120. If mom released, what are indications for return to the ER or OB? // C-section in unstable mom? // Assessment of uterine penetrating injury // Perimortem c-section: indications, procedure

1121. Elements of San Francisco syncope rule // Pediatric anatomy features that affect trauma management

1122. Pediatric airway anatomic differences and consequences

1123. GCS modification for pediatrics // What is an impact seizure? What is its significance?

1124. Signs and symptoms of increased ICP in infants / Pediatric c-spine differences and consequences / Normal pre-odontoid space

1125. Skull film indications // Approach to pediatric minor head injury

1126. How to verify that subluxation on C2 on C3 is pseudosubluxation / Maximum allowable predental space in kids < 10 years old // Rule of thumb for chest tube size // Management of open pneumothorax

1127. Blood from chest tube: indications for thoracotomy in kids // Traumatic diaphragmatic hernia: usual mechanism and management // Lap belt injury complex with hallmark sign

1128. Geriatric trauma considerations / Mortality in burns by age

1129. Define mild, moderate, severe head injury // Tissue layers of the scalp // Autoregulation works within what range? // Effect of decreased PaO2 on cerebral vasculature

1130. Reversible causes of cerebral secondary injury // Define increased ICP // Cushing's reflex is seen in what % of life-threatening elevated ICP? // Describe uncal herniation

1131. What is Kernohan's notch syndrome? // Describe central transtentorial herniation syndrome // Describe cerebellotonsillar herniation syndrome

1132. Limitations of the Glasgow Coma Scale GCS in the ED // Describe the oculovestibular response

1133. Intervention to consider in the polytrauma hypotensive head-injured patient // Managment options for elevated ICP // Indications for prophylactic abx in head injury

1134. Indications for seizure prophylaxis in head injury // Canadian CT head rule

1135. New Orleans head CT criteria // Management of concussion // What is postconcussive blindness? // Signs of shaken baby syndrome

1136. Mannitol Rx in kids // What is a leptomeningeal cyst? // Characteristics of self-inflicted GSW

1137. Post head injury complications // Most common head injury-associated dysrhythmia // Why must large galea lacs be closed?

1138. Clinically significant skull fractures // Complications of basilar skull fractures // Prognosis in diffuse axonal injury (DAI)

1139. Which two structures, when disrupted, may cause an epidural hematoma? // Acute vs. subacute vs. chronic SDH // What is a subdural hygroma? // Most common CT abnormality followign head trauma and its significance // Traumatic contusion vs. intracerebral hematoma

1140. Pediatric facial injuries that suggest abuse // Bony borders of the orbit // Describe the anatomy of the salivary system

1141. Describe LaFort fracturs // How to rule out a mandibular fracture clinically

1142. Injury to rule out if injury occurs near parotid gland // Three things to test before sending nasal injury home with followup // Management intervention in acute exsanguination from facial wound // Complication to rule out in shotgun injuries to face // Lip and mucosa should be closed with what type of suture?

1143. Pediatric perioral electrical burns: managment and complications // Managment of septal hematoma // Management of nasal # or possible nasal # in kids

1144. Management of subperichondral hematoma of the ear // Evaluation of the lacrimal apparatus // Antibiotics in facial bone fractures?

1145. Complications of blowout fracture // Most important ED complication of orbit injury

1146. Management of patient with TMJ trauma, no fracture but pain and decreased ROM of jaw // Managment of jaw dislocation

1147. What is a tripod fracture? // Posterior nasopharyngeal bleeding in facial trauma managment // Issues around mandible fracture in kids

1148. Tooth fractures: classification & managment // Managment of avulsed, subluxed, intruded tooth pending dentistry evaluation

1149. Nine flexion spinal injuries-stable or unstable

1150. One flexion-rotation spinal injury, four extension injuries, and three vertical compression injuries?stable or unstable

1151. Features of unstable spinal fractures // Contents of anterior and posterior spinal columns

1152. Odontoid fracture: classification, stability, mechanism // How to distinguish unilateral vs. bilateral faced dislocation // Hangman's fracture: mechanism, description

1153. Differentiating burst vs. compression # // Jefferson # mechanism, description, sign on lateral film // Abdominal breathing in context of spinal cord injury

1154. Horner's + spinal cord trauma means lesion is where? // Concern regarding spinal cord trauma with Down syndrome or RA // Motor exam: C4/5/6/7, C8-T1, T1-T12, L3/4/5, S1-S2, S2-S4

1155. Spinal reflexes: C6 C7 L4 S1 // Sensory: C2,3,4,5,6,7,8 T4,10 L1,2-3,4,5 S1,2-4

1156. Usefulness of DTRs in assessing flaccid paralysis // How to assess sensation

1157. Signs of sacral sparing and its significance // How to test for spinal shock and its significance

1158. Central cord syndrome: population, mechanism, deficit // Brown-Sequard: mechanism, deficit // Anerior cord syndrome: mechanisms, deficit

1159. 3 Questions to answer for Canadian C Spine Rule // What is the retropharyngeal space? Acceptable width?

1160. Flex-ex criterion // Dose of methylprednisolone for traumatic spinal cord injury

1161. Three types of neck injuries by mechanism // High vs. low velocity GSW and its clinical significance // Three zones of the neck

1162. Two neck triangles and their importance // Structures at risk in penetrating neck trauma and top three most injured // Structures uniquely at risk in zones I and III

1163. Marker for need for investigations, surgery, or observation in penetrating neck injury // Hard signs for penetrating neck injury // Soft signs

1164. Is the physical exam reliable to detect significant neck injury in a stable patient? // Dangers of BVM neck injured patient // Profound shock unresponsive to IVF or arrest in a neck-injured patient raises what diagnosis? Rx?

1165. Signs and symptoms of arterial air embolism // Problem with NGT placement in neck trauma // RSI with neck trauma? Contraindicaitons, approach to urgent and potentially difficult airway

1166. Complications assoc with blind nasotracheal intubation // Contraindications // BiPAP in pulmonary edema starting settings // Disposition of neck trauma patients

1167. Most frequently missed neck injury // Primary signs of esophageal injury // Secondary signs // Diagnostic approach to esophageal injury // Initial management

1168. Significance of the cricoid cartilege // Laryngotracheal injury: primary, secondary signs, dx // Optimal management of tracheal transection

1169. Most common mechanism of vertebrobasilar artery injury // Approach to possible vessel injury in stable, minimally symptomatic neck trauma patient // Trauma patient with neuro deficit and normal CT scan should suggest // Management options in blunt neck trauma

1170. Potential sources of neuro deficit in neck trauma // Complete vs. incomplete hanging // How does hanging cause injury? Judicial vs. incomplete vs. in-hospital

1171. Traumatic rib injury: Where do ribs generally break? Which ribs are most commonly fractured? Why? What are complications of rib fractures? // Indications for rib view plain film

1172. Issue with displaced rib fracture // Management of rib fracture – who to be concerned about and analgesic adjunct // Sternal fracture: mechanism, major injury association, diagnosis

1173. Diagnosis to rule out in sternal # // Management of isolated sternal # // Costochondral separation: signs, sx, Rx // Main cause of respiratory insufficiency with flail chest and diagnostic pitfall

1174. Management of flail chest, indications for ETT // Nonpenetrating ballistic injury: 2 mechanisms, key principle

1175. Traumatic asphyxia: mechanism, s/sx, Rx // Causes of subcutaneous emphysema

1176. Localized chest wall subcutaneous air suggests what? At supraclavicular region or anterior neck? // Important complication of pneumomediastinum and usual precipitant of this complication // Physical exam sign of pneumomediastinum or pneumopericardium // Pulmonary contusion: pathophys, sx, Dx – when visible on chest xray?

1177. Pulmonary contusion vs. ARDS // Most accurate way to follow pulmonary contusion and most common complication // Three types of pneumothorax // Three grades of pneumothorax by size / BTS guidelines for spontaneous pneumothorax

1178. Tension pneumo: pathophys, signs, Rx // Earliest sign of tension pneumo in intubated patient

1179. Management of penetrating chest trauma with asymptomatic patient and normal chest xray // Indications for chest tube // Placement and direction of chest tube // Indications for suction; how much suction?

1180. Complications of chest tube placement (8) // Management of subacute PTX // Amount of blood needed to blunt costophrenic angle in upright CXR // If hemothorax, what size chest tube? // Indications for OR thoracotomy

1181. Indications for ER thoracotomy // Should all hemothoraces be drained?

1182. Presentation of tracheobronchial injury, treatment

1183. Complications of blunt myocardial injury // Spectrum of injury // Most sensitive sign, dx // Indications for echo in BMI

1184. Management of BMI // Traumatic myocardial rupture: presentation, characteristic finding // DDx hypotension and increased CVP

1185. Myocardial rupture management // Penetrating cardiac injury presentations // Tamponade: hallmark hemodynamic parameters // What is pulsus paradoxus?

1186. Sonographic signs of tamponade / Electrical alternans in pericardial effusion / Pericardiocentesis complications // Where do most traumatic aortic tears occur?

1187. Traumatic aortic rupture: symptoms, signs, CXR findings

1188. Traumatic aortic rupture: dx, Rx // Importance of early diagnosis of esophageal rupture

1189. Causes of esophageal perforation // Places of esophageal narrowing / Rx caustic burn of the esophagus

1190. Classic symptoms of Boerhaave's, ddx // Most specific sign of esophageal injury, other signs // Radiograph findings // Rx

1191. Most likely organs to be injured in GSW to abdomen, stab, and blunt injury // Potential upper margin of the abdomen

1192. Problems associated with high velocity missiles // Classification of shotgun wounds

1193. Proposed pathophys mechanisms in blunt abdominal trauama / Ped-MVC injury triad / Significance of abdominal lap belt sign / Auscultation of bowel sounds in the thorax suggests / Usefulness of serum amylase and lipase in trauma

1194. Concerning base deficit // Value of LFTs in trauma // Disadvantages of CT in abdominal trauma // DPL contraindications

1195. DPL site, method in standard adult, kid, late pregnancy, midline scarring, pelvic # // DPL RBC criteria: blunt, GSW, stab

1196. Guidelines for local wound exploration

1197. Major use for laparoscopy in trauma // Severe complications of laparoscopy // What procedures can be performed in ED thoracotomy in blunt trauma patient

1198. Three key clinical questions in penetrating wound to abdomen / Indications for laparotomy in penetrating abdominal injury

1199. Management of thoracoabdominal (low chest) stab wound // Management of impalement instrument in situ // How to assess peritoneal violation in GSW // WEST 2018 Abdominal Stab Wound Algorithm

1200. Management of shotgun wounds by category // Problem with DPL for determining hemoperitoneum / How DPL can be used to r/o hollow viscous injury / Free fluid on CT without solid organ injury suggests / Indications for laparotomy in blunt trauma

1201. Pitfalls in expectant management of blunt abdominal injury // Unstable patient with pelvic fracture and abdominal free fluid destination [controversial] // Unstable patient with intraperitoneal hemorrhage and closed head injury // Unstable patient with intraperitoneal hemorrhage and wide mediastinum

1202. What is the order in which the urinary tract is evaluated for injury? / When to suspect urethral injury, and what to do if it's suspected

1203. Urethragraphy in females? // When to suspect urethral injury in females // Important evaluation at foley placement

1204. Main cause of posterior & anterior urethra injury // Physical exam findings that support integrity of urethra and allow placement of foley // What to do if foley is in place but partial urethra disruption is suspected

1205. Retrograde urethrogram procedure // Interpretation of RUG // Two types of bladder injury and their supposed mechanisms

1206. How to dx bladder injury: procedure and interpretation

1207. Management of bladder injury // Where is the kidney in cephalo-caudal axis? // Relationship of degree of hematuria to degree of renal injury

1208. When to suspect renal injury in adults and kids / What to do if renal injury suspected / Managment of microscopic hematuria

1209. Dx kidney pedicle injuries (artery, vein) / Rx renal lac / Penetrating renal trauma – key emergency issue

1210. S/sx blunt ureteral injury // Penile # pathophysiology, s/sx // Traumatic lymphangitis of penis: pathophys, s/sx, Rx

1211. Peyronie's disease: pathophys, s/sx, Rx // Management of testicular trauma // Dog bite to scrotum management

1212. Warm ischemia time // Types of vascular injury // Three classes of vascular injury based on history and physical

1213. Hard signs for vascular injury // Soft signs

1214. What is a proximity wound? // Other wounds at high risk for vascular injury // Value of angiography in obvious arterial injury // Value of xray in query vascular trauma // Reassuring ABI or API ratio

1215. Approach to possible peripheral vascular injury in ABI/API is .9-.99 // Other modalities to rule out vascular injury // Management of bleeding if direct pressure fails // Goal BP in resuscitation of patient with uncorrected arterial injury // What is a PTFE shunt?

1216. How to deal with risk of compartment syndrome after reperfusion of limb // Late reperfusion complications // Repair venous injuries? // Criterial for expectant management of minor vascular injuries – can this be done in kids?

1217. Strategies for managing possible popliteal artery injury after knee dislocation // Likelihood of true vascular injury with hard signs in penetrating vs. blunt injury // Should angio be performed at peripheral hospital in proximity wounds?

1218. Common wound-related lawsuits brought against EPs // Simplified chronology of wound healing // Steps in wound management

1219. Risk factors for wound infection (three categories) // How thick must glass be to be visible on xray as a foreign body? // How to remove a fish hook

1220. How many mg lidocaine in 1 cc of 1% solution? // Toxic dose of lidocaine // How long must you wait between lidocaine doses if near toxicity dose? // Antidote for epinephrine-induced digital artery vasospasm (probably unnecessary) // Toxic dose of bupivicaine // How to decrease pain assoc with lidocaine injection // Intralipid, high dose insulin, hydroxocobalamin B12, NAC, CroFab dosing

1221. Dose of bicarb to add to lidocaine // When to avoid TAC // What is methylparaben? // What skin disinfectant can be used in a wound?

1222. Clip vs. razor hair around wounds // Most important step to decrease wound infections // Best PSI to irrigate and how to achieve that // Three wound closure options and when to choose each // Delayed primary closure technique

1223. Techniques to reduce wound tension // When to use chromic, silk, monofilament // Which types of wounds rouinely require abx? // Main pathogen in cat bite, human bite

1224. Features of an optimal wound dressing // Dressing a lac closed primarily // Wounds near joints // How many days for suture removal?

1225. Tetanus prophylaxis grid

1226. Radial keratotomy with ocular foreign body sensation concern // Tool for removing non-corneal ocular foreign bodies // What type of eye patient shouldn't be instrumented? How to manage corneal FB with and without rust ring // Contraindication to irrigation technique in ear FB

1227. S/sx nasal foreign body and management techniques // Airway FB: peak incidence, site of obstruction in adults vs. kids // Cafe coronary: MI vs. food airway FB

1228. Airway FB "penetration syndrome" // Signs & symptoms of airway foreign body // Orientation of esophageal FB vs. tracheal FB // Xray findings in bronchial FB

1229. Management of stable airway FB / Patient in extremis / Postremoval management // GI foreign body – when to consider early endoscopy

1230. Complications of esophageal FB // Signs & symptoms of esophageal FB // If a patient with prior esophageal stenting p/w esophageal FB symptoms, what is likely dx? // Sensitivity of plain films for impacted fish bone, next imaging modality

1231. Management options in esophageal FB // Management of button battery ingestion // Which objects need early removal based on size i.e. maximum allowable dimensions

1232. Why should extra care be taken if removing a rectal FB in place for more than a few hours? How can a rectal FB be pulled proximally during removal attempt? // Most common urinary tract bezoar // Most common places an esophageal FB gets stuck

1233. Important pathogen in cat bites and usual effect of infection with said pathogen // Most dangerous pathogen in cats and dogs, disease it causes, risk factors // Rodent bites: infections that result

1234. Dangerous pathogen in monkeys, what kind of monkey, mode of transmission, s/sx // The Problem With Ferrets

1235. High risk mammalian bites by species, location, wound type, and patient characteristics

1236. Wound care for bites vs. other wounds // Issue regarding dog bite to hand of small child // Suture or phrophylactic abx of bites from dog, cat, rodent, monkey, human

1237. Antibiotic choice for dog/cat/human bite prophylaxis, if pen allergic, duration of Rx // Most important preventative action vs. herpes B virus, basic management of possible herpes B exposure // Management of infected bite wound

1238. Complications of clenched fist injury // Management of non-CFI human bites // Infectious complications aside rom wound infection

1239. CFI management, indications for admission

1240. Members of the crotalidae family // The other important north american venomous snake and how to distinguish it from its non-venomous look-alike // Features of venomous vs. non-venomous snakes // Pathophysiology of snake venom toxin

1241. % dry snakebites // S/sx crotalid envenomation // S/sx coral snake envenomation

1242. Prophylactic abx for snakebites? // How to slow spread of venom prehospital // How to follow progression vs. resolution of symptoms // Dosing of CroFAB

1243. Snake bite classification // Antivenin indication, relative dose in kids, precautions when administering, pregnancy managment

1244. Time limit for constricting band post snakebite // Other snakebite management issues // Rx serum sickness // Common biting insects, two types of reactions, managment

1245. Black widow identification, toxin/effect, s/sx, Rx

1246. Brown recluse identification, s/sx, Rx

1247. Tarantula danger // Scorpion bite: s/sx, Rx // Effects of octopus toxin

1248. Most toxic coelenterate // Most common cause of death in marine envenomations // Rx nematocyst injury

1249. Six types of burns by mechanism // Thermodynamic variables that determine burn severity // What is heat capacity? What is the heat transfer coefficient?

1250. Three methods of heat transfer?describe // Zones of burn injury // At what % total body surface area are patients at risk for SIRS

1251. Burn complications // Classification of burns by depth, describe

1252. Rule of nines, modification for infants // Signs of inhalation injury

1253. Cool a burn? // Usefulness of fiberoptic bronchoscopy in possible inhalation injury // Neck eschar: effects, Rx // Constricting eschar of the anterior thorax: effects, Rx

1254. Airway casts treatment // Assessment and management of possible CO intoxication with inhalation injury // When to consider cyanide intoxication // What parameter to follow in burned patient requiring fluid resus who has cardiopulmonary disease // What % TBSA correlates with need for fluid resus // Acceptable UOP // Hydroxycobolamine B12 dose in Cyanide Toxicity

1255. Parkland formula // Consideration for fluid resus of inhalation injury patient // What to give severe burn patient after 24 hours // Type of patient that cannot survive large burn // Pediatric considerations

1256. Burns: Td? Prophylactic abx? // Risk period for constrictive eschars // Most common cause of decreased pulses // Burn wound management if immediate transfer to burn center, if delayed transfer // Minor burns: topical abx? po abx? Td?

1257. Management of minor burns

1258. Transfer criteria for patients with severe burns // Admission criteria for moderate burns // Removing hot tar

1259. Priorities in dealing with HAZMAT incidents // Common acids and alkali

1260. Neutralize acids/alkali? // High pressure or low pressure hydrotherapy? // How long to continue hydrotherapy for acids and alkali? // Most dangerous ocular caustic // Rx ocular caustic: at the scene, in the ED

1261. Inhalational HF exposure: s/sx, Rx // Skin HF exposure: systemic toxicity and Rx

1262. S/sx formic acid exposure, anhydrous ammonia // Phenol: s/sx, medicinal use, Rx // White phosphorous: s/sx, Rx

1263. Nitrate toxicity symptom // Gasoline/hydrocarbon toxicity // Management issue with elemental sodium or potassium exposure // Chemical terrorism agents

1264. Sulfur mustard gas: toxicity, Rx // Phosgene: diagnostic clue, s/sx, Rx

1265. Mandible anatomy // Deciduous dentition: how many, timeline to appearance // Permanent teeth: name them, when they start to come in, when they finish coming in

1266. Define these surfaces: labial, lingual, medial, distal, occlusal, apical, coronal // Evolution of dental caries // Dental pain can refer to where?

1267. Management of dental abscess // Which ones require admission // Trismus: define, caution for EPs

1268. Ludwig's angina: Describe, complication of interest, management // Periodontal abscess management

1269. Acute necrotizing ulcerative gingivitis: describe, s/sx, complication, Rx // Pain post root canal: Rx

1270. Postextraction pain: when it requires specific treatment, and what treatment? // Temporomandibular myofascial pain dysfunction syndrome: s/sx, RFs, Rx

1271. Predisposing factor for periodontal lesions // Pyogenic granuloma: describe, RF, Rx // Massive gingival hyperplasia: diagnostic considerations // Gingival bleeding diagnostic considerations // Aphthous stomatitis: ddx, Rx

1272. Managment of Ellis I II III fractures

1273. Minimally subluxed tooth: Rx // Significantly subluxed: Rx // Management priority in all tooth avulsions // Primary tooth avulsion Rx // Adult tooth avulsion Rx

1274. Desirability of various media for transporting avulsed tooth if cannot be replanted at scene // Closing intraoral wounds // Tongue lac: closing criterion // Rx through-and-through // In unilateral jaw dislocation, which direction does the jaw dislocate?

1275. Jaw dislocation Rx // Management of oral hemorrhage

1276. Consequences of orbital blowout / Xray findings / Activities patients should avoid // Why alkali burns are worse than acid burns // Ultraviolet keratitis: s/sx, Rx

1277. Easiest way to differentiate corneal injury from other causes of acute eye pain // How to remove corneal FB // Scrape off rust ring? // Subconjunctival hemorrhage: symptoms that should be absent and Rx // Hyphema Rx and rebleeding time course

1278. Hyphema: indications for surgery, considerations with HbSS // Ciliary flush: what is it, what it suggests // Traumatic iridocyclitis: Describe, Rx

1279. Complication of traumatic cataract // Lens subluxation & dislocation: RFs, s/sx // Scleral rupture: diagnostic finding, IOP value // ED management of globe rupture

1280. Vitreous hemorrhage: s/sx, Rx // Retinal hemorrhage: 3 types, 3 patterns on fundoscopy, Sx, R/o with funduscope? // Rx traumatic optic neuropathy

1281. Eyelid laceration should prompt search for what? // Indications for OR repair // Complications of ocular trauma

1282. Keratoconjunctivitis is what? // Acute bacterial conjunctivitis: s/sx, Rx, complications // Gonococcal conjunctivitis: s/sx, Rx

1283. Viral conjunctivitis: s/sx, Rx // Ophthalmia neonatorum: ddx, feaures, Rx

1284. Allergic conjunctivitis: s/sx, Rx // Rx pingueculum, pterygium // Rx herpes simplex vs. herpes zoster // Management of contact lens associated symptoms

1285. Management of hordeolum and chalazion // Dacryocystitis pathophys and Rx // Preseptal vs. postseptal cellulitis: s/sx and Rx

1286. Open angle glaucoma: pathophys, s/sx // Closed angle glaucoma: pathophys, s/sx, Rx

1287. Acute visual loss ddx // CRAO & CRVO s/sx, Rx

1288. Retinal detachment pathophys, s/sx, Rx // Vitreous hemorrhage s/sx // Macular disease s/sx

1289. Neuroophthalmologic visual loss: prechiasmal ddx // Optic neuritis: pathophys, s/sx, association, Rx // Toxic-metabolic optic neuropathy causes

1290. Temporal arteritis: s/sx, management, ESR value, upper limit, Rx // Visual loss + other CN deficits suggests

1291. Chiasmal visual loss ddx, s/sx // Postchiasmal visual loss ddx, s/sx // How to uncover functional visual loss // Anisocoria ddx

1292. Adie's tonic pupil: feature, Rx // How to verify pharmacologic mydriasis // CN III lesion s/sx // Horner's syndrome ddx

1293. Nystagmus ddx // CN 4 palsy s/sx // CN 6 palsy

1294. Physiologic response to cold stress // What is the hunting response? // Frostbite pathophysiology // Assessing prognosis in frostbite

1295. Describe frostnip, chilblains // Trench foot: pathophys, s/sx, prevention

1296. Frostbite classes by s/sx // Prehospital Rx frostbite // Warm frostbite prehospital? // Name three phases of ED rewarming management

1297. Elements of ED frostbite management: prethaw, thaw, postthaw

1298. Disposition of frostbite // Sequelae

1299. Define hypothermia: mild, moderate, severe // Primary mechanism of heat loss // Physiologic response to mild hypothermia and clinical presentation

1300. Cardiac effects of hypothermia, CNS, renal, heme & metabolic

1301. S/sx moderate hypothermia, severe hypothermia // Prehospital Rx

1302. Management of arrhythmias in hypothermia / Temperature monitoring in hypothermic patient / Does intubation induce arrhthmias in hypothermia? / Passive rewarming: what is it, use

1303. Methods of active external rewarming // What is afterdrop?

1304. Active internal rewarming methods

1305. Indications for active rewarming // Causes of secondary hypothermia and predisposing factors to hypothermia // Poor prognostic factors in hypothermia – when to consider calling a patient cold and dead // Severe Hypothermia Protocol

1306. Most important physiologic cooling mechanism in hot person // Role of convection // Enemy of evaporation // 2 physiologic mechanisms by which heat loss is accellerated // Why are saunas and hot tubs dangerous to cardiopaths?

1307. Mechanisms of heat acclimitization // Heat stroke prevention // Heat illness risk factors

1308. What is wet bulb globe thermometer index? // Types of minor heat illness // Heat cramps, heat edema s/sx, pathophys, Rx

1309. Heat syncope, prickly heat, heat exhaustion s/sx, pathophys, Rx

1310. Heat stroke: pathophys, s/sx // Exertional vs. classic heat stroke

1311. Relationship between sweating and heat stroke // Head stroke ddx // Cooling methods: 3 good methods and 3 lesser methods

1312. When to stop cooling heat stroke // Airway issues, IVF, ACLS meds, antipyretics, prevention of rhabdo // Management of hypotensive heat stroke

1313. Lightning mortality // Factors determining the severity of electrical injury // AC vs. DC current – which one is more dangerous? // Danger with current > 6-9 milliamps // Significance of tissue resistance, high medium and low resistance tissues // Most important resistor to current entering the body

1314. Low resistance skin, high resistance skin // Implication of low and high resistance skin variation // Dividing line between high and low volatge injuries // Electric current complications

1315. Is lightning AC or DC? // Usual lightning injuries // Characteristic lightning burns

1316. General clinical presentation of low voltage injury vs. high voltage injury vs. lightning injury // Significance of fixed/dilated pupils in lightning injury // Where are skin burns usually most severe? // How to predict extent of internal tissue damage from cutaneous involvement

1317. Key emergency department consequences of extremity electrical injury // Lightning and neurovascular deficit // Managment of taser exposure // Electrically isulated gloves? // Triage of lightning mass casualty

1318. Electrical injury: like a crush or a burn? // Rx electrical injury // Who can be discharged, who must be admitted for ECG monitoring // Late trimester pregnancy electrical injury complication to rule out

1319. One atm = how many mm Hg? // Each foot of seawater exerts an additional how many mm Hg? // Boyle's Law and its practical consequences // Charles' Law // Dalton's Law

1320. Henry's law // Dysbaric injuries (12 injuries in 3 categories)

1321. Middle ear barotrauma: pathophys, s/sx, Rx // External ear baratrauma pathophys // Inner ear barotrauma: s/sx, consequence, Rx

1322. Facial barotrauma: pathophys, s/sx, Rx // Nitrogen narcosis: depth of risk, s/sx, complications // O2 toxicity: pathophys, s/sx

1323. How does compressed air get contaminated? // Decompression sickness pathphys, RFs // Type I vs. Type II

1324. Type I DCS s/sx // Type II DCS: 4 types, s/sx

1325. Pulmonary barotrauma pathophys, may present as what? // Arterial gas embolism (AGE): pathophys, s/sx, when to suspect

1326. Alternobaric vertigo: pathophys, s/sx, ddx // Diving disorders that mandate recompression // What to do while awaiting recompression // Trendelenberg for AGE?

1327. Otitis media RFs // Define AOM and OME // Eustachian tube anatomy in kids vs. adults // AOM pathophys

1328. Most common etiologies of otitis media // Bullous myringitis organisms // Clinical differentiator AOM vs. OME // Complications of AOM

1329. Otitis media ddx // Diagnostic criteria for AOM // Management strategy based on age // Definition of severe AOM

1330. Antibiotic choices in AOM Rx // Describe observation strategy // Approach to AOM abx failure // OME Rx // Otitis externa RF, pathophys, 3 bugs

1331. AOE ddx // Describe Ramsay-Hunt syndrome // Rx otitis externa

1332. Necrotizing external otitis (malignant otitis externa): pathogen, RF, progression & pathophys, signs & symptoms, Rx

1333. Causes of mastoiditis, s/sx, Rx // Sudden hearing loss ddx

1334. 90% epistaxis is localized to where? / Arteries involved / Etiologies of epistaxis / Management options

1335. Management of nasal anterior packing / Posterior epistaxis identification, Rx, complications / Sialolithiasis: most common gland, ddx, s/sx, Rx

1336. Neck masses: rule of 80 // What is the globus symptom? // Neck mass ddx

1337. Relative position of the two kidneys // Does hydrocele exclude dangerous pathology? // Relationship between size of prostate on exam and BPH-related urinary obstruction // Define complicated UTI and why it matters // Most important pathophysiologic predisposition to UTI // How do bacteria usually enter urinary tract?

1338. UTI RFs // UTI bugs // Collecting urine from adolescent or adult male // Usefulness of bacteria on microscopy // 2011 IDSA UTI Algorithm

1339. How to do urine micro – 3 steps // Definition of positive urine culture // UTI high risk groups and what that means

1340. Who needs imaging in UTI? / Pregnancy: UTI predisposing features, complications of untreated bactiuria in pregnancy

1341. Abx in pregnancy UTI // Admit which cases? // Diabetic patients with UTI have increased risk of what? // Managment of UTI + indwelling catheter

1342. Dysuria ddx // Urinary analgesic // UTI prevention

1343. More UTI RFs // Acute bacterial prostatitis s/sx, Rx, if retention? // Hallmark of chronic prostatitis

1344. Urolithiasis RFs // Types of kidney stones // Infectious complications of kidney stones // Stone size threshold for usual passage

1345. Where do kidney stones usually get stuck? // How frequently do patients with a stone not have hematuria? // Sterile pyuria with stone? // Dx stone on IVP // Problem with plain film diagnosis of stone

1346. Nephrolithiasis ddx // Indications for admission // Vesical calculus – who gets them? S/sx // Renal Colic SDM Graphic

1347. Where is the epididymis? // Acute scrotum Ddx // In torsion, salvage is very good if fixed within // Suggestive historical clue in torsion // Looking for bell-clapper deformity

1348. Classic epididymitis bugs // Epididymitis vs. torsion // Rx // Most common testicular tumor misdiagnosis

1349. Testicular tumors RF, most common type // Sudden pain as presenting complaint? // Management // Urinary retention ddx

1350. Urinary obstruction s/sx // Suprapubic aspiration technique // Bladder decompression complication // ?Gradual emptying of bladder to decrease complications? // Most common causes of hematuria by age

1351. Hematuria of glomerular origin shows what on microscopy? // Hematuria ddx // Pseudohematuria

1352. Kidney cannot correct for alkalosis until // Normal anion gap // Causes of low anion gap // Delta gap

1353. Respiratory alkalosis etiologies // Anion gap acidosis etiologies

1354. Normal anion gap acidosis etiologies // AKA: presentation, acid-base disturbance // Ketone physiology vs. measurement

1355. Four causes of lactic acidosis // Two types of RTA // Physiologic responses to acidemia

1356. Complications of NaHCO3- (bicarbonate) administration // Causes of metabolic alkalosis: 2 types and how to verify which type, how to Rx each type

1357. Etiologies of hyponatremia

1358. Causes of SIADH // Hyponatremia s/sx // Urinary Na in SIADH, CHF/cirrhosis // Managment of hyponatremia // S/sx central pontine myelinolysis

1359. Causes of hypokalemia // Mechanism of hypoK in vomiting

1360. S/sx hypokalemia, ECG changes, Rx // Hyperkalemia: ECG changes and other symptoms

1361. Causes of hypernatremia // Causes of diabetes insipidus (DI) // S/sx hyperNa, Rx

1362. Causes of hyperkalemia

1363. Treatment of hyperkalemia

1364. Causes of hypocalcemia // Effect of calcitonin and PTH

1365. Effects of hypocalcemia // Rx of hypoCa // How much calcium in the two preparations? // 90% cases of hypercalcemia are secondary to which two causes? // Bryan Hayes Electrolyte Replacement

1366. Causes of hypercalcemia // Signs & symptoms // Treatment

1367. Interpretation of serum magnesium level // Releationship between Mg K Ca // Causes of hypomagnesemia

1368. Hypomagnesemia: s/sx and Rx // Etiologies and s/sx of hyperMg

1369. Rx hyperMg // Causes of hypophosphatemia, s/sx, Rx // Caveat in treating hypoPO4

1370. Hyperphosphatemia causes, s/sx, Rx

1371. Normal HbA1c // Treatment of hypoglycemia in adults, kids, neonates // If no IV access?

1372. Diagnosis of factitious hypoglycemia // Management of DKA

1373. Hyperglycemic hyperosmolor nonketotic coma vs. DKA // Correction for pseudohyponatremia // Insulin comparison chart

1374. Variables that deterimine the incidence and severity of altitude illness // Levels of altitude // Most important feature of acclimatization // Limiting step in acclimatization

1375. Other aspects of acclimatization // 3 Types of altitude illness and their relative time course

1376. Altitude illness pathophysiology // S/sx acute mountain sickness

1377. Red flags in assessment of acute mountain sickness // Acute mountain sickness treatment

1378. High altitude pulmonary edema s/sx, Rx // High altitude cerebral edema s/sx, Rx // HbSS precautions at altitude

1379. Drowning terminology: near-drowning, drowning, submersion injury // What is immersion syndrome? // Drowning RFs, pathophys // Salt vs. freshwater

1380. Ingestion vs. aspiration in submersion injury // Management of submersion injury // Indications for admission

1381. Types of injury in a nuclear explosion // Radon toxicity affects what organ primarily? // Ionizing vs. nonionizing radiation

1382. What is a radioactive substance? // Irradiated vs. contaminated // Alpha particles, beta, gamma rays, neutrons, kryptonite

1383. Effects of various radiation doses, LD50, nonsurvivable dose // Early organs affected in acute radiation syndrome // Most sensitive early indicator

1384. Managment of radiation exposure

1385. Acute anemia ddx // Lifespan of an RBC // Body cavities where blood can accumulate // Causes of rapid hemolysis // 3 broad diagnostic classifications of anemia

1386. Anemia resulting from decreased RBC production ddx // Results of iron studies in iron deficiency anemia // Normal MCV

1387. What is thalassemia? 3 types with clinical manifestations // What is the defect in sideroblastic anemia? // Iron studies in anemia of chronic disease // Causes of folate deficiency

1388. Causes of B12 deficiency with associated clinical finding // Normal corrected reticulocyte count // Normocytic anemia ddx

1389. Intravascular vs. extravascular hemolysis // Hemolysis labs

1390. Direct vs. indirect Coombs // Causes of hemolysis / hemolytic anemia

1391. Sickle Cell complications with their clinical features

1392. Disease and drugs a/w autoimmune hemolytic anemia // Polycythemia causes, features and treatment // Leukopenia ddx // Leukemoid reaction – what is it?

1393. Major site of heparin activity // Platelet functions // Features of platelet disorder vs. coagulation disorder

1394. Conditions that increase and decrease fibrinogen // Bleeding diathesis ddx (3 types)

1395. Why does dilutional thrombocytopenia occur? Rx // Most common platelet adhesion defect // PT (prothrombin time) dependent defects // PTT dependent defects

1396. ITP: two types, s/sx, Rx // TTP thrombotic thrombocytopenic purpura: pathophys vs. HUS, pentad, Rx

1397. Hemophilia A: pathophys, classification, baseline info to collect, Rx

1398. Initial factor 8 dose if significant concern in hemopheliac // How to monitor response to therapy in hemophilia // vWB disease Rx // Hemophilia B vs. A // DIC pathophys

1399. Signs, symptoms of DIC // Ddx // Lab values // Rx

1400. Oncologic emergencies // Define "significant fever" in a cancer patient // Vancomycin indications //// Palliative Care Resources

1401. Causes of SVC syndrome // Structures bordering the SVC // Signs, symptoms, treatment

1402. Acute tumor lysis syndrome: most common associated malignancies, RFs, biochemical hallmarks, s/sx, Rx

1403. Hyperviscosity syndrome: causes, s/sx, Rx // Hyperuricemia presenting syndromes, Rx

1404. Rhabdomyolysis pathophys, clinical consequences // ATN definition, urine characteristics

1405. Causes of rhabdo, s/sx, dx (lab abnormalities)

1406. Pigmenturia ddx (and how to differentiate among them)

1407. Problems with mannitol, HCO3- in Rx rhabdo, dose

1408. S/sx thyrotoxicosis // Hallmark signs & symptoms of thyroid storm // Thyroid storm ddx

1409. Thyroid storm Rx

1410. Myxedema coma: 2 key precipitants // Hypothyroidism s/sx // Treatment of severe hypothyroidism

1411. Causes of adrenal hemorrhage // Causes of adrenal insufficiency

1412. S/sx adrenal insufficiency // ACTH stim test // Adrenal replacement Rx