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True or False: gastric distension due to excessive volume or rate of ventilation impairing ventilatory function is a reason to intubate a neonate - ✔✔False management for nursemaid elbow injury - ✔✔apply pressure to the radial head while flexing and supinating elbow A 17 year old boy injured his right shoulder playing football. He tried to arm-tackle a player when his right arm was pulled away from his body and back (abducted and extended). He felt a sudden pain in his shoulder. He presents to the emergency department holding his arm in slight abduction and external rotation by his good arm. He has severe pain with adduction or internal rotation. What is the most common fracture associated with this injury? - ✔✔compression fracture of the posteriolateral aspect of the humeral head (Hill-Sachs deformity) What are most common heart rhythms seen in pediatric arrest? - ✔✔bradycardia or asystole risk factors for neonatal resuscitation - ✔✔ prematurity IUGR multiple gestation thick meconium In the post-arrest setting, which of the following is the drug of choice in treating hypotension in a child: - ✔✔epi Low body temperatures in newborns can lead to severe physiologic consequences, which include all EXCEPT: Answers:
- metabolic acidosis
- increased oxygen consumption
- hypoglycemia
- apnea
- hyperglycemia - ✔✔ 3. hypoglycemia In a newborn, bradycardia is most commonly an indicator of: - ✔✔hypoxemia All the following are signs of hypoxemia in a newborn, EXCEPT: Answers: 1 .cyanosis 2 .lethargy 3 .tachycardia 4 .unresponsiveness 5 .bradycardia - ✔✔ 3. tachycardia A newborn presents to the emergency department a few days after hospital discharge. The infant has been noted to be drooling, choking, and coughing, and the mother reports seeing bubbles at the baby's mouth. Which is the most likely explanation? Answers: 1 .osteogenesis imperfecta 2 .inborn error of metabolism 3 .congenital diaphragmatic hernia 4 .foreign body 5 .tracheoesophageal fistula - ✔✔ 5. tracheoesophageal fistula Which of the following pairs of maneuvers are consistent with current recommendations for emergency care for a choking 5 - month-old infant?
A mother brings in her 4 year old child who was happily eating "blackberries" from weeds in the garden and is now acting strangely. She has identified them as Belladonna from a quick internet search. Which physical examination finding might you also expect to find in this child? Answers: 1 .Diaphoresis 2 .Flushed skin 3 .Miosis 4 .Urinary incontinence - ✔✔ 2. flushed skin For which of the following cases is activated charcoal therapy most appropriate? Answers: 1 .Acetaminophen overdose 2 .Drain cleaner ingestion 3 .Iron supplement overdose 4 .Lithium overdose - ✔✔ 1. Acetaminophen overdose A 45 year-old is brought in 8 hours after a large overdose of his lithium. What is the best treatment method for this overdose? Answers: 1 .Activated charcoal 2 .Gastric lavage 3 .Hemodialysis 4 .Whole bowel irrigation - ✔✔ 3 .Hemodialysis A 42 year-old woman presents with an overdose of her Xanax (alprazolam) that her family indicates she has been taking for years to help with her anxiety. The bottle indicates that the prescription was filled
yesterday with 90 pills and is now empty. The patient is minimally responsive to painful stimuli and does not react when you suction secretions out of her posterior pharynx. What is your next management step? Answers: 1 .Administration of flumazenil 2 .Administration of narcan 3 .Close observation 4 .Intubation for airway support - ✔✔ 4 .Intubation for airway support A 72 year-old presents with an intentional overdose of a bottle of aspirin about 3 hours prior to presentation in the ED. Which of the following arterial blood gas results would you expect to come from this patient? Answers: 1 .pH 7. 14 pCO 2 68 pO 2 102 HCO3 23 2 .pH 7. 33 pCO 2 48 pO 2 58 HCO3 29 3 .pH 7. 45 pCO 2 21 pO 2 124 HCO3 14 4 .pH 7. 47 pCO 2 31 pO 2 96 HCO3 25 - ✔✔ 3 .pH 7. 45 pCO2 21 pO2 124 HCO 3 14 A teenager presents one hour after ingesting a "handful" of acetaminophen tablets. Which of the following statements is TRUE? Answers: 1 .An acetaminophen level drawn at hour four dictates need for antidotal therapy. 2 .Serial liver function tests are indicated in all acetaminophen ingestions. 3 .Renal sequelae are expected. 4 .The intravenous formulation of N-acetylcysteine is safer than oral N-acetylcysteine. - ✔✔ 1 .An acetaminophen level drawn at hour four dictates need for antidotal therapy.
Answers: 1 .Cancer 2 .Diverticulosis 3 .Inflammatory bowel disease 4 .Polyps - ✔✔ 2 .Diverticulosis Which of the following bacteria does NOT produce bloody diarrhea? Answers: 1 .Campylobacter enteritis 2 .Clostridium perfringens 3 .Escherichia coli 0157 4 .Yersinia enterocolitica - ✔✔ 2 .Clostridium perfringens With respect to laboratory findings in diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar nonketotic coma (HHNC), all of the following guidelines are generally true EXCEPT: Answers: 1 .Patients with HHNC typically have blood glucose > 700 mg/dL, whereas patients with DKA have blood glucose > 350 mg/dL. 2 .Serum ketones are present in patients with DKA but not usually in patients with HHNC. 3 .Serum bicarbonate is typically severely low (< 10 mEq) in patients with either DKA or HHNC. 4 .Serum osmolality in patients with HHNC is typically > 350 mOsm/L. 5 .BUN is elevated more in patients with HHNC (> 50 mg/dL) than in patients with DKA ( 25 - 50 mg/dL). - ✔✔ 3 .Serum bicarbonate is typically severely low (< 10 mEq) in patients with either DKA or HHNC. Regarding the treatment of hyperosmolar hypertonic nonketotic coma (HHNC) and its associated symptoms, which of the following is correct: Answers:
1 .Half of the fluid deficit should be corrected over the first hour and the remainder over the following 8 hours. 2 .Since patients are not acidotic, close monitoring of glucose is not necessary. 3 .Hyperosmolarity should be corrected within the first few hours in the emergency department. 4 .Phenytoin (Dilantin) is often ineffective for seizures associated with HHNC. 5 .In HHNC patients with severe dehydration, bleeding diathesis is a major clinical concern. - ✔✔ 4 .Phenytoin (Dilantin) is often ineffective for seizures associated with HHNC. Regarding the development of cerebral edema in patients being treated for DKA, all of the following are true EXCEPT: Answers: 1 .Cerebral edema typically occurs six to ten hours following onset of treatment. 2 .Children have a higher incidence of cerebral edema. 3 .Mannitol and steroids should be administered immediately to any patient suspected of developing cerebral edema. 4 .Mortality of patients developing cerebral edema is 90 %. 5 .Patients with serum glucose below 250 mg/dL still being treated with insulin are most likely to develop clinically evident cerebral edema. - ✔✔ 3 .Mannitol and steroids should be administered immediately to any patient suspected of developing cerebral edema. Metabolic abnormalities often seen with hypothyroidism include all of thefollowing EXCEPT: Answers: 1 .hyponatremia 2 .hyperglycemia 3 .hypercholesterolemia 4 .respiratory acidosis from hypoventilation 5 .anemia - ✔✔ 2 .hyperglycemia Laboratory abnormalities typically seen with adrenal insufficiency include all of the following EXCEPT:
Answers: 1 .untreated pneumothorax 2 .COPD with air trapping 3 .otitis media 4 .pregnancy - ✔✔ 4 .pregnancy Which of the following is not a common sign or symptom of thyrotoxicosis? Answers: 1 .hypothermia 2 .cogestive heart failure 3 .tachycardia 4 .hyperhidrosis 5 .nervousness - ✔✔ 1 .hypothermia Which of the following is true regarding the use of iodine in the treatment of thyroid storm? Answers: 1 .Iodine should be the first drug administered in the treatment of thyroid storm. 2 .Iodine should be administered only after treatment with propranolol. 3 .Iodine should be administered at least one hour after propylthiouracil (PTU) has been given. 4 .Dexamethasone must be given 30 minutes prior to iodine administration. 5 .Iodine should be administered even in patients with known iodine allergy. - ✔✔ 3 .Iodine should be administered at least one hour after propylthiouracil (PTU) has been given. A 4 year old girl is brought to the ED two hours after being stung by a scorpion while on a camping trip in Arizona. She has periods of agitation and restlessness alternating with calmness. Her vital signs are: blood pressure 106 / 61 , pulse 120 , respiratory rate 24 , temperature 37. 0 C, and oxygen saturations of 99 % on room air. On physical examination you note drooling, a disconjugate gaze, and occasional jerking
movements of the extremities.Which of the following is the most correct regarding the treatment of a scorpion sting in this child? Answers: 1 .Treatment with antivemon is not indicated becase these symptoms will be self-limiting. 2 .Complications of treatment with antivenom include delayed serum sickness 3 .Analgesics have a minimal role in controlling symptoms 4 .The patient should be intubated because respiratory failure is expected - ✔✔ 2 .Complications of treatment with antivenom include delayed serum sickness A 24 year old female gardener presents to the emergency department with foot pain 30 minutes after working barefoot in her garden. She saw a scorpion in the area. Which of the following signs or symptoms are most expected? Answers: 1 .Puncture mark 2 .Local erythema and swelling 3 .Pain and paresthesias 4 .Cranial nerve abnormalities - ✔✔ 3 .Pain and paresthesias A 48 year old farmer is plowing his field when a thunderstorm rapidly overcomes him. Drivers on a nearby highway see him struck by lightening. You respond to the scene with EMS. What is the least likely finding on physical exam? Answers: 1 .respiratory arrest 2 .cardiac asystole 3 .extensive skin burns 4 .Glascow Coma Score of 3 - ✔✔ 3 .extensive skin burns Which of the following anti-hypertensive medications is associated with a lupus-like syndrome?
The most sensitive bedside test for nerve injury in a finger after trauma is: Select all that apply 1 .light touch 2 .O'Riain wrinkle test 3 .pain 4 .temperature sensation 5 .two-point discrimination - ✔✔ 5 .two-point discrimination In a patient with a suspected ruptured globe from penetrating trauma to the eye, all of the following should be performed EXCEPT: Answers: 1 .administration of broad spectrum antibiotic therapy 2 .ascertainment of intraocular pressure via tonometry 3 .ascertainment of tetanus status 4 .ophthalmology consultation 5 .visual acuity assessment - ✔✔ 2 .ascertainment of intraocular pressure via tonometry Following a motor vehicle crash, a 25 year old man presents complaining of a painful right eye. Visual acuity is 20 / 200 in the right eye and 20 / 25 in the left eye. The right eye protrudes from the orbit and the patient has right eye pain with extraocular movement. What is the most likely cause of his symptoms? Answers: 1 .chemosis 2 .hyphema 3 .orbital blow-out fracture 4 .retrobulbar hematoma 5 .ruptured globe - ✔✔ 4 .retrobulbar hematoma
Following a brawl at a local bar, a gentleman presents with an impressive right-sided periorbital ecchymosis. All of the following physical examination findings would suggest an orbital blowout fracture EXCEPT: Answers: 1 .anesthesia of the right infraorbital region 2 .diplopia with upward gaze 3 .proptosis 4 .right-sided epistaxis 5 .right-sided infraorbital subcutaneous emphysema - ✔✔ 3 .proptosis Which of the following cervical spine fractures is considered stable? Answers: 1 .Flexion teardrop fracture 2 .Bilateral facet dislocation 3 .Transverse process fracture 4 .Jefferson fracture of C 5 .Hangman's fracture of C 2 - ✔✔ 3 .Transverse process fracture A 23 year old man is stabbed in the anterior neck with a 3 - inch knife during a street fight. At the scene, there is some bleeding, which is controlled with direct pressure. He presents to the emergency department breathing comfortably and in no distress. His pulse is 88 , blood pressure 126 / 76 , and oxygen saturation 99 % on room air. There is a 1 cm laceration 2 cm above the right sternoclavicular junction, lateral to the trachea. There is mild oozing and no obvious underlying hematoma. There is no obvious subcutaneous air, and he has clear lung sounds. What is the most appropriate management for this patient? Answers: 1 .Immediate operative exploration 2 .Local wound exploration and discharge home if no significant injury identified
1 .Loss of consciousness 2 .Cardiac arrest 3 .Fractures or dislocations 4 .Deep burns - ✔✔ 4 .Deep burns Regarding the epidemiology of asthma in the United States, which of the following is true? Answers: 1 .Etiology is thought to be genetic, not environmental 2 .Incidence is comparable for Caucasians and African-Americans 3 .More common in males than females in adult and pediatric populations 4 .Prevalence increased in the 1980 's, and then decreased in the 1990 's - ✔✔ 4 .Prevalence increased in the 1980 's, and then decreased in the 1990 's Which of the following patients is the most likely to develop S. pneumoniae pneumonia? Answers: 1 .59 year old woman who is a cigarette smoker. 2 .61 year old man with hypertension 3 .64 year old man with type 2 diabetes 4 .65 year old woman with no past medical history - ✔✔ 3. 64 year old man with type 2 diabetes A 28 year old man is shot in the right chest. His vital signs are: T 97. 9 , HR 120 , BP 70 / 50 , RR 12 , SPO 2 84 %. He has significant JVD, his trachea is deviated to the left, and he has decreased breath sounds on the right. The patient's diagnosis is: Answers: 1 .Hypovolemic shock 2 .Tension pneumothorax 3 .Cardiac tamponade
4 .Lung laceration 5 .Spinal cord injury - ✔✔ 2 .Tension pneumothorax Regarding the diagnosis of pulmonary embolism (PE), which is correct. Answers: 1 .Autospsy studies indicate that approximately 30 % of patients who die in the hospital have undiagnosed PE 2 .By 80 years of age, one out of four people will develop deep venous thrombosis 3 .One-year mortality of PE is 25 % even with early diagnosis and treatment 4 .Pulseless electrical activity in Emergency Department cardiac arrest victims is associated with PE in 33 % - ✔✔ 4 .Pulseless electrical activity in Emergency Department cardiac arrest victims is associated with PE in 33 % Regarding the role of malignancy in the diagnosis of pulmonary embolism (PE): Answers: 1 .Hematologic malignancies such as leukemia and have the highest incidence of venous thromboembolism 2 .2 5 % of PE patients without identifiable risk factors are diagnosed with cancer within 2 years. 3 .The risk of PE is decreased in patients on chemotherapy 4 .Autopsy studies indicate that greater than 60 % of patients who die of ovarian cancer have PE. - ✔✔ 2. 25 % of PE patients without identifiable risk factors are diagnosed with cancer within 2 years. A 25 year old female presents with fever, productive cough, and shortness of breath. Physical exam reveals T 101 , RR 24 and SpO2 of 94 %. Her left tympanic membrane is inflamed and there are TM bullae. The chest X-ray reveals a large right middle lobe pneumonia. The organism most commonly associated with this type of presentation is: Answers: 1 .Legionella pneumoniae
1 .CXR
2 .d-dimer 3 .Echocardiogram 4 .EKG with right-sided leads - ✔✔ 4 .EKG with right-sided leads A patient with nontraumatic chest pain is administered nitroglycerin in the field and has subsequent drop in blood pressure. An EKG reveals ST-segment elevation in lead V 4 R. What is the diagnosis? Answers: 1 .anteroseptal MI 2 .pericarditis 3 .pulmonary embolism 4 .unstable angina 5 .right-ventricular MI - ✔✔ 5 .right-ventricular MI A 7 1 - year-old male presents after a syncopal episode. He reports 12 hours of recurrent substernal chest pressure. A report from the patient's primary care physician's office states that an EKG performed four days ago was completely normal. Repeat EKG in the ED reveals no ST-segment elevation, but you do note a right bundle-branch block, and a left anterior fascicle block. Troponin I is elevated above normal at 1 .6. What intervention would be indicated to provide definitive management for the findings seen on EKG in this patient? Answers: 1 .Continuous cardiac monitoring for 24 - 48 hours 2 .Emergent revascularization with thrombolytics or percutaneous coronary intervention (PCI) 3 .Radiofrequency ablation 4 .Urgent placement of a cardiac pacemaker - ✔✔ 4 .Urgent placement of a cardiac pacemaker Which coronary vessel is usually the cause of the myocardial infarction in a patient with ST elevation in V1, V 2 , and V 3?
Answers: 1 .left anterior descending (LAD) 2 .left circumflex artery 3 .posterior descending branch of the right coronary artery 4 .right coronary artery (RCA) 5 .right ventricular branch of the right coronary artery - ✔✔ 1 .left anterior descending (LAD) A 6 5 - year-old female presents 2 weeks after an MI complaining of chest pain, fever, and shortness of breath. She has a new friction rub on exam and a leukocytosis. She most likely has: Answers: 1 .congestive heart failure 2 .Dressler's syndrome 3 .new myocardial infarction 4 .pneumonia 5 .pulmonary embolism - ✔✔ 2 .Dressler's syndrome A 25 year old man returns to the ED, 24 hours after being released from the hospital with a new diagnosis of schizophrenia. He has recently started to take haloperidal for his psychotic symptoms. In the ED he is noted to have involuntary contractions of the muscles of the face, a protruding tongue, deviation of the head to one side, and sustained upward deviation of the eyes. Vital signs are stable, and initial labs show no electrolyte or hematological abnormalities. Of the following choices, the preferred medication for this condition is: Answers: 1 .diphenhydramine 2 .lorazepam 3 .phenobarbital 4 .metoprolol - ✔✔ 2 .lorazepam
