Over My Head
A 25M came in to your ED with severe headache. He notes that he does not really have episodes of headache. He is screaming in pain and tells you - Doc, this is the worst headache I felt in my entire life.
A rule you can use to evaluate this headache?
Ottawa SAH rule
The most commonly used scale and is the easiest to administer.
Verbal quantitative scale
A 33M alcoholic came in to the ED due to agitation. According to his family he has been having a daily alcohol session because he recently broke up with his girlfriend.
According to the protocol for treatment of agitation what will you give the patient.
Avoid BZN if possible
1. Oral 1st-generation
Antipsychotics
haloperidol 2–10 mg
2. Parenteral 1st-generation
Antipsychotics
haloperidol 2–10 mg IM
A patient comes to you because he recently had a graft 3 months ago.
Name the most widely used acute graft versus host prophylaxis.
Combination of calcineurin inhibitor (cyclosporine, tacrolimus) with methotrexate
A 18/F came in to your ED complaining that she was drugged during a drinking session.
Name 1 date rape drug and up to what hours it can be detected in the urine.
Ketamine, flunitrazepam (72 hours) and y-hydroxybutyric acid (12 hours)
A 77/M came in to the ED with severe slurring of speech. The prehospital screening tool uses a blood glucose level.
Los Angeles Pre hospital stroke screen
Name the 2 preferred opioids for patients with renal failure.
Differentiate delirium, dementia and psychiatric disorder based on their delusions.
Delirium: Transient, Poorly organized
Dementia: Usually absent
Psychiatric disorders: Sustained
Name a masculinizing hormone therapy related complication
Erythrocytosis
Levonorgestrel (Plan B)
1.5 milligrams once or 0.75 milligram at 1 and 12h
Combined estrogen- progestin (Yuzpe®)
100 micrograms ethinyl estradiol plus 0.50 milligram levonorgestrel, at 1 and 12 h
Mifepristone 25–50 milligrams PO as a single dose
Ulipristal acetate (Ella®/Fibristal®)30 milligrams PO as a single dose
A 28/F came in with unilateral headache described as throbbing. This mnemonic is beneficial if 4/5 is seen in the patient.
POUND mnemonic
This block is relatively easy to perform but requires a specialized pneumatic tourniquet.
Intravenous regional anesthesia (Bier Block)
A 32/F came in for behavioral change. According to her mother, she has been having low mood for the past unknown weeks.
Give 5/9 symptoms in order to diagnose MDD and how many weeks should it be present?
2 weeks or more
SIGECAPS
In military medicine, there is a 3 tier prioritization. Name the 3 things that you will tell your patients to do in order to triage them.
Try to wave or make a purposeful movement
If they do not move at all
Name a group of people who have a substantial higher rates of intimate partner physical violence overall
Another hospital endorsed a patient with alleged bacterial meningitis. Name all the 4 signs or symptoms that will alert you to think of bacterial meningitis.
Fever, headache, neck stiffness, and altered mental status
A 45/F with a height of 5'2" obese came in to your ED due to trauma. She told you that she weighs 100kgs. You need to perform procedural sedation to the patient. You prefer to use ketamine, how much ketamine will you give her?
IBW: 52.1 kgs
Ketamine: 1 - 1.5 mgs/kg
Answer: 52 - 78mgs
A 20/F comes to you with vomiting. She has been inducing vomiting for fear of gaining weight.
Name the parts of the SCOFF questionnaire.
Sick
Control
One stone
Fat
Food
A patient comes to you morbidly obese. Name the 4 diagnostic criteria for pickwickian syndrome.
Body mass index 30 kg/m2
Daytime Paco2 >45 mm Hg
Associated sleep-related breathing disorder (obstructive sleep apnea–hypopnea syndrome or sleep hypoventilation or both)
Absence of other known causes of hypoventilation
Name 3 clues that may suggest elder abuse
The patient appears fearful of his or her companion.
There are conflicting accounts of an injury or illness from the patient and caregiver.
The caregiver displays an attitude of indifference or anger toward the patient.
The caregiver is overly concerned with the costs of treatment needed by the patient.
The caregiver denies the patient the chance to interact privately with the physician.
The caregiver appears overly concerned and attentive.
A 28/F came runner started to feel muscle weakness. She noted this would worsen after repetitive use of her voluntary muscles. Name 5 drugs contraindicated in this disease.
Rocuronium Succinylcholine, Morphine, Codeine, Propranolol, Clindamycin, Metronidazole, Magnesium sulfate, Lidocaine, Timolol etc
A 57/F came in to your ED with facial pain. She describes it as short bursts of sharp, electric like pain.
Name the acute and chronic pain management for this and its consequent dosing.
Acute and Chronic: Carbamazepine and Oxcarbazepine
Carbamazepine: 100mgs PO BID
Oxcarbazepine: 300mgs PO BID for 3 days
A 23/F came in due to behavioral change. Upon interviewing the relatives, she has been having suicidal ideations.
Name 5 physical examination features suggestive of organic causes of psychiatric complaints.
Abnormal vital signs
Fluctuating level of consciousness/alertness (e.g., clouded sensorium)
Significantly decreased level of consciousness (Glasgow Coma Scale score <8)
Focal neurologic findings (e.g., new-onset seizures, inability to walk unassisted)
Ophthalmologic abnormalities (e.g., rotary nystagmus)
Evidence of trauma (e.g., raccoon eyes, Battle’s sign, septal hematoma, abrasions, lacerations)
Abnormal dermatologic manifestations (e.g., rashes, purpura, jaundice, uremic frost, cool, mottled extremities)
Abnormal mental examination or Quick Confusion Scale
Presence of visual hallucinations
A 30M lieutenant is brought to your campsite for a gunshot injury.
Name the MARCH mnemonic used in military medicine.
Massive hemorrhage
Airway
Respiratory
Circulation
Hypothermia prevention/head injury