Title: The Long
1The Long
2And the Short of It
3A patient with acute adrenal insufficiency is
best treated with hydrocortisone and
- A. NS
- B. D5 NS
- C. NS Ca
- D. NS K
- E. Makes no difference
4A 45 year old WF with history of breast CA
presents with constipation and abdominal pain.
ED evaluation and treatment include
- A. Positive Chvosteks sign
- B. Increase fluid and dietary fiber
- C. IVF and lasix
- D. Referral to oncologist
- E. Obtain Barium enema
5Treatment of acute asthma attack in patients in
2nd trimester pregnancy includes all except
- A. Prednisone
- B. Beta agonists
- C. SQ epinephrine
- D. IV fluids
6A mom that delivered her baby yesterday develops
chicken pox. Who must receive VZIG?
- A. Mom
- B. Mom and infant
- C. Mom, infant and 2 year old sibling
- D. Infant and 2 year old sibling
- E. Infant alone
7Post Exposure Treatment- VZIG
- Pts on high dose steroids
- Immunocompromised without a history of CP
- Pregnant women
- Newborns exposed 5 days prior to birth and 2
days after delivery - Neonates born to nonimmune mothers
- Hospitalized premature infants lt 28 weeks
gestation
8A pt on chronic dialysis has been taking
magnesium containing antacids. He presents with
hypotension and areflexia. ED treatment includes
- A. Bicarb
- B. Pacing
- C. IV Calcium
- D. Terbutaline
- E. IV fluids
9An elderly patient c/o bilateral buttock and
posterior upper thigh pain on ambulation.
Diagnostic modality
- A. LS spine x-rays
- B. CT of L- spine
- C. MRI of back
- D. MRA of back
- E. Angiography of BLE
Leriches Syndrome
10A 55 yo male presents with facial swelling over
one week in conjunction with SOB, ?JVD and
dilated thoracic veins. Most likely diagnosis is
- A. Ascites with anasarca
- B. Mediastinitis
- C. Pulmonary embolism
- D. Bronchogenic CA
- E. Pneumonia
11Most common cause of sudden death in athletes
- Hypertrophic Cardiomyopathy
12Earliest complaint of a patient with tetanus
13A patient 2 wks post anterior MI presents with
stroke. ED workup should include
- A. Carotid doppler
- B. Brain MRA
- C. Echocardiogram
- D. Cardiac enzymes
- E. Four vessel angiogram
14Kids with cyanotic heart disease presenting with
syncope should be placed in
- A. Trendelenberg position
- B. Reverse Trendelenberg position
- C. Knee-chest position
- D. Upside down position
- E. Left decubitus position
15- 22-year-old man presents with a one day history
of increasing bilateral leg weakness and
paresthesias. He has not been ill otherwise and
his vital signs are normal. Physical exam is
normal except for symmetric lower extremity
weakness and decreased deep tendon reflexes.
Sensation is normal. What is the most likely
diagnosis? - Guillain-Barré syndrome
- poliomyelitis
- tick paralysis
- transverse myelitis
- viral hepatitis
16Guillain-Barré syndrome
- Autoimmune etiology
- Distal weakness is more common
- The ascending paralysis is characteristically
symmetric or nearly symmetric - The facial and other cranial nerves are involved
in 25-50 of the patients. - Motor deficits predominate
- DTRs are almost always absent in the affected
extremities - Recent bacterial infection, preceding
Campylobacter jejuni infection, and influenza
vaccination have all been associated
17Guillain-Barré syndrome
- Diagnosis is based on the patients clinical
presentation - Analysis of CSF Albuminocytologic dissociation,
in which the CSF has a protein content of greater
than 400 mg/L and a cell count of less than 10/ml - Heavy metal poisoning, volatile hydrocarbon
abuse, acute intermittent porphyria are all on
the diff dx
1835 year old female with hx of multifocal neuro
deficit. The best way to make the diagnosis is
- A comprehensive psychiatric evaluation
- CT of the head
- Lumbar puncture
- MRI of the head
- EMG and NCS
19A 2 year old male presents after being struck by
a car
20Assuming the patient is stable, the next step
would be to
- A) obtain a CT of the abdomen and pelvis
- B) insert a foley catheter
- C) perform a retrograde urethrogram
- D) perform a diagnostic peritoneal lavage
- E) obtain an intravenous pyelogram
2159 yom with acute chest pain and weakness to left
arm. ECG shows ST elevation in anterior leads.
Treatment should include all of the above, except
- Nitrates
- Beta blockers
- Thrombolytics
- ASA
- Ca channel blockers
22- Where is the most common site of bursitis in
the body?
23- The most frequent cause of fetal death
following blunt abdominal trauma during pregnancy
is
24The antihypertensive most likely responsible for
this finding is a(n)
- ACE inhibitor
- Beta blocker
- Calcium channel blocker
- Diuretic
- Nitrate
25- Abrupt shaking chills, rusty sputum, lobar
consolidation
ETOH abuse, current jelly sputum, lobar
infiltrate with bulging fissure
HA, malaise, nonproductive cough,interstitial
infiltrates
Old smoker, high fever, dry cough, toxic
appearance, patchy infiltrate, pleural effusion
26- 53 year old man involved in an MVA and suffered
a neck injury. The most likely injury is - Dissection of carotid artery
- jugular vein
- Injury to C7-T2
- Epidural hematoma
- C1-C2 fracture
27Horners Syndrome
- Unilateral facial ptosis, miosis, and anhydrosis
- Damage to the cervical sympathetic plexus
- Cluster headaches may show Horners
- Horners syndrome may also result from
- Aortic dissection
- Advanced malignancy
- Occlusion of the PICA (Wallenberg syndrome)
- Posterior pharynx abscesses
28- What is the most common cause of painful hip in
children?
29This 16 year old female who presented with heart
palpitations
30Most likely suffers from
- A) hyperkalemia
- B) hyperthyroidism
- C) supraventricular tachycardia
- D) cocaine abuse
- E) idiopathic palpitations
31Delta waves WPW syndrome
32(No Transcript)
33- True statements about this condition includes
- Often atraumatic or associated with a relatively
minor injury - Most commonly occurs in boys 10 to 17 years of
age with obesity and underdeveloped genitalia - Salter and Harris type I variety
- Internal fixation is the treatment
- All of the above
34Slipped Femoral Capital Epiphysis
- Often atraumatic, boys 10-17 years (obese)
- Left more common than right
- Insidious onset
- Stiffness in the hip
- An abduction and external rotational deformity is
characteristic - CT scan, an MRI scan, or a bone scan should be
considered if a fracture is clinically suggested
but remains radiographically occult after plain
radiographs. - Treatment is Internal fixation
35- Muffled heart tones
- Hypotension
- Increased JVD
366 year old presents with fever, sore throat and a
rash
37The following are true of this disease
- A) Penicillin is the treatment of choice
- B) Its natural history is to resolve
spontaneously without sequelae - C) The most common etiology is Strep pneumoniae
- D) It is contagious only before the rash erupts
- E) It is most common in children less than 3
years of age
38- This 2 year old child presents with drooling. He
is otherwise in no distress. The next step should
be - Rapid intubation
- Ipecac administration
- Barium swallow study
- Call the friendly GI doc
- Meat tenderizer
39Esophageal Foreign Bodies
- Esophagus has three normal anatomic sites of
narrowing where impactions are most common - The cricopharyngeus muscle
- The crossing point of the aorta
- Lower esophageal sphincter
40- What are the most common causes of acute mitral
regurgitation?
- Acute MI
- Bacterial endocarditis
- Trauma
41This childs lesion is a
- Left CN VI palsy
- Right CN VI palsy
- Left CN III palsy
- Right CN III palsy
- A great party trick
42- What are the most common signs of pulmonary
embolism?
What are the most common ECG findings in a
patient with pulmonary embolism?
- Sinus tachycardia
- Non specific ST-T changes
43- 38 year old patient with HIV presents with fever,
shortness of breath and dry cough for 1 week.
ABG shows PO2 of 59. The treatment should include
all except - Oxygen therapy
- Intubation if in distress
- Bactrim IV
- Triple med regimen for TB
- Steroids
44PCP
- PCP is the most common opportunistic infection in
AIDS - Uncommon in patients with CD4 gt200/mm3
- Nonproductive cough, fever, shortness of breath,
diffuse interstitial infiltrates on chest
radiograph, and arterial hypoxemia - Bilateral interstitial infiltrates that begin in
the perihilar region- can vary considerably,
ranging from a normal appearance to dense
consolidation - Prednisone is indicated for moderate-to-severe
PCP who have a PaO2 less than 70 mm Hg or an A-a
gradient greater than 35 mm Hg.
45- 8-week-old boy presents with cough and
low-grade fever and conjunctivitis
46- The following etiologies are associated with the
condition shown on this radiograph, except
- Collagen vascular diseases
- Previous hip dislocation
- Prolonged corticosteroid use
- Sickle cell anemia
- Thallasemia minor
47This 6 year old presents after being treated at
his PCP clinic for 3 days of vomiting
48A reasonable next step would be to
- A) Obtain a CT of the head
- B) Perform a lumbar puncture
- C) Obtain a cervical spine series
- D) Administer diphenhydramine
- E) Sneak up on the childs left side and yell
BOO to see if hes faking this and will turn
his head
49- Testicular torsion has two peaks
50This patient cannot recall how he was injured.
True statement concerning this injury include all
except
- Associated with high incidence of infectious
complications - The most common aerobic organisms include
Strep/Staph - Eikenella corrodens is found in about one third
of anaerobic cultures - ED management includes copious wash out and
closure - Complications could include amputation of the
fingers-hand
51Clinched Fist Injury
- High incidence of infectious complications
- septic arthritis
- Tenosynovitis
- Osteomyelitis
- Surgical amputation
- Most infected wounds are polymicrobial
52- The drugs most commonly associated with Torsades
- Class IA (Quinidine and Procainamide)
- Class IC agents
53A 30 year old male presents complaining of severe
foot pain
54This patient requires prompt consultation by
- A) a dermatologist
- B) an orthopedic surgeon
- C) an infectious disease specialist
- D) an oncologist
- E) a rheumatologist
55Fracture Blister
566 year old boy presents with URI symptoms for a
week, as well as abdominal pain and swollen
tender joints and the rash shown here. True
statements regarding evaluation and treatment for
this patient include all of the above except
57- This is a vasculitis affecting
arterioles and capillaries - Insect stings and drugs could be inciting agents
- Frank arthritis is usually absent
- Hematuria is hallmark of renal failure
- Patient with GI bleeding should be admitted and
receive IV corticosteroids
58Henoch-Schönlein purpura
- Purpuric, petechial rash appears from buttocks to
feet can be seen on extensor surface of arms,
periauricular area - Beware of gastrointestinal bleed or nephritis.
Leg arthralgias common, edema of genitalia seen - Admission not mandatory, steroids used only with
GI bleeding
59- Chronic Lithium (as well as salicylates and
theophylline) is worse than acute toxicity- True
or false
60The findings on this x-ray in a 2 year old struck
by a car suggest
- A) Positional artifact
- B) Subluxation of C-2 on C-3
- C) Fracture of a cervical vertebra
- D) A fatal lesion
61A 1 year old presents with fever and decreased
oral intake
62Your disposition should be
- A) Observe in the ED for p.o. challenge
- B) Discharge home on oral antibiotics
- C) Admit for overnight observation
- D) Prompt surgical consultation for definitive
treatment - E) Emergent ID in the ED
63- These tender lesions are associated with all
underlying infections below, except - Sarcoidosis
- TB
- Yersinia
- Salmonella
- All of the above
64Erythema Nodosum
- Result of a hypersensitivity vasculitis from
infections, drugs, or a systemic disease- viral
URI, streptococcal infections, sarcoidosis, TB,
and drug exposure. - Much rarer causes include IBD, histoplasmosis,
Yersinia, Salmonella, Chlamydia,
coccidioidomycosis, psittacosis, and autoimmune
diseases such as SLE. - Drugs implicated include penicillins, sulfa
drugs, dilantin, and oral contraceptives
65- Visual symptoms, acidosis, an elevated osmolar gap
66A 4 month old is triaged for fever
67This x-ray suggests you should
- A) Intubate the patient emergently
- B) Treat with oral antibiotics
- C) Admit for IV antibiotics
- D) Place the patient in respiratory isolation
- E) Look for another source of the fever
68A diabetic patient presents with fever and this
skin lesion of 1 day duration.All statements
concerning ED treatment are true,except
- Aggressive fluid resuscitation
- Gram /-, anaerobic antibiotic coverage should be
initiated immediately - Emergent wide surgical debridement
- Tetanus prophylaxis
- All of the above
69Fourniers Gangrene
- Polymicrobial, synergistic infection ofthe
subcutaneous tissues that originates from one of
three sites skin, urethra, or rectum - Begins as a benign infection or simple abscess
that quickly becomes virulent,and leads to
end-artery thrombosis in the subcutaneous tissue
that promotes widespread necrosis of previously
healthy tissue
70This patient is brought to the ED under police
custody
71The major complication to be expected with this
patient is
- A) hypoxia
- B) hypercarbia
- C) renal failure
- D) arrhythmia
- E) blindness
72Hydrocarbon Poisoning
Pulmonary Cough, wheeze, tachypnea, pneumonitis
Ingestion N/V, hemorrhagic gastroenteritis
Systemic Confusion, H/A, ataxia, lethargy, coma, death
Local Irritation, burn, corneal injury
73 74 35 year old with positional chest pain.
Diagnosis
Acute pericarditis
75- This 35 year old mentally retarded man with 3
days of swelling to his face and neck. His temp
is 101, P 76 RR 20, Pulse OX 98. The
treatment regimen for this patient includes all
of the above except - Admission to floor
- Set up for possible intubation
- IVF replacement, keep NPO
- High dose PCN and Flagyl
- Immediate OMFS/ENT consultation
76Ludwigs Angina
- Cellulitis of bilateral submandibular spaces and
the lingual space - Brawny induration of the suprahyoid region and
elevation of the tongue - The primary focus of initial management is
maintenance of a patent airway
77- What is Kienbocks disease?
- Post traumatic avascular necrosis seen in lunate
fractures
78A 1 week old infant presents with irritability,
tachypnea and poor feeding. O2 sats 82 on room
air.
79The following interventions would be appropriate
EXCEPT
- Supplemental oxygen
- Evaluation for sepsis
- IV antibiotics
- IV indomethacin
- IV prostaglandin E1
8035 year old man was involved in MVC, now C/O LUQ
pain. Vital signs are normal. CT of abdomen shows
the injury. False statements include
81- This is the most commonly injured organ in
pediatric blunt trauma - Treatment may includes exploratory lap if patient
deteriorates - At least 200 cc of fluid in the peritoneum is
required for FAST exam to be positive - FAST exam would be more sensitive for this type
of injury - High level of suspicion should be given to hollow
viscous injuries
82A 1 year old, not moving his right arm after a
fall. He should be
- Placed in a hanging arm splint
- Taken to the OR for internal fixation
- Evaluated for nonaccidental trauma
- Discharged after placement of a long arm cast
83- 76 year old man presents with sudden onset of
painless partial visual loss in left eye. Initial
treatment for this condition includes - Heparin
- Eye massage
- Heliox
- Mannitol
- None of the above
84Central Retinal Artery Occlusion
- Between 50 and 70 years of age- 45 CAD
- Risk factors HTN, CAD, DM, CVD, vasculitis,
cardiac valvular abnormality, and sickle cell
disease. - Reduced visual acuity with an afferent pupillary
defect - Digital global massage immediately in the ED
- Increase P CO2
- Timolol maleate 0.5 topically
- Acetazolamide
85- Patient with tinnitus and shortness of breath,
think.
86A 4 year old presents with high fever for 5 days
and a rash on his trunk
87Treatment should include
- Amoxicillin 80mg/kg divided BID
- 50 mg/kg IM Ceftriaxone x 1
- Supportive care for viral illness
- IV gammaglobulin
- Stopping all over the counter medications
88Kawasakis Disease
- Usually lt 5 years old
- 5 days of fever
- Nonpurulent conjuntivitis, strawberry tongue, red
fissured lips, palmar/solar erythema, rash,
lymphadenopathy
- Treat with IV gamma-globulin, high dose aspirin
- Complications include coronary artery aneurysms
in 25
8965 year old man without prior history presents
with decreased vision in L eye for 2 days. R eye
is normal. L eye is shown here, diagnosis
- Retinal artery occlusion
- Retinal vein occlusion
- Cotton wool spots
- Retinal detachment
- None of the above
90Central Retinal Vein Occlusion
- Painless loss of vision
- Loss of vision can range from minimal to
recognition of hand motion only. - Management is aimed at identifying systemic
disease and monitoring for neovascular glaucoma.
91- Most common ECG abnormality with Digoxin
toxicity is
928 month old with fever for the previous 4 days.
Now afebrile with the rash shown below.
Treatment includes
- Supportive care only
- IV Penicillin
- Diphenhydramine
- Systemic corticosteroids
- Doxycycline
93Viral Exanthums
- Roseola (Erythema Subitum)
- Human herpes 6 virus Rapid temperature
elevation, irritability and often febrile
seizures lasting 3-4 days followed by
defervescence and the a rose colored macular
eruption on the trunk and then spreading to the
extremities. - Tx supportive
- Varicella (Chickenpox)
- Varicella zoster virus Viral prodrome of URI and
fever followed by rapidly appearing crops of
vesicles of differing ages. Lesions start in the
scalp and trunk and spread peripherally. - Tx supportive
94(No Transcript)
95- Erythema Infectiosum (Fifth Disease)
- Human parvovirus B-19 Fever with characteristic
slapped cheek rash later fading and replaced by
a lacy macular eruption on the extremities.
Complications include aplastic anemia in those
with hemoglobinopathies. - Tx supportive
- Hand-Foot-Mouth Disease
- Cocksackie virus Fever, malaise and anorexia
with one/all of the characteristic macular and
vesicular eruption on the palms and/or soles and
shallow oral ulcers of the soft palate and
tonsillar pillars (Herpangina) - Tx supportive
96(No Transcript)
97- Herpes Gingivostomatitis
- Herpes simplex virus Painful white-yellow
friable ulcerations with erythematous halos on
the lips, gums, tongue and anterior oral mucosa.
Fever, halitosis and anorexia are common. May
spread to eyes (conjunctivitis) and extremities
(Whitlow). - Tx supportive
- Rubeola
- Measles virus Fever, malaise, cough, coryza,
conjunctivitis, Kopliks spots (buccal mucosa)
followed by a blotchy macular eruption beginning
at the hairline and spreading caudally.
Complications include pneumonia, otitis,
encephalitis and bacterial secondary infections - Tx supportive
98(No Transcript)
9932 year old obese woman presents with headache
and decreased visual acuity. CT of head is
negative. Further evaluation and or treatment
should include
- MRI of brain
- Carotid doppler
- Lumbar puncture
- Mannitol
- High dose steroids
100Pseudotumor Cerebri
- 20- to 30-year-old obese women
- Complain of N,V,HA, and visual changes
- The headache is typically chronic and the
symptoms can mimic those of a brain tumor. - Pregnancy, oral contraceptives, vitamin A
overuse, tetracycline, nalidixic acid, and
corticosteroid withdrawal or prolonged use have
been associated
101- Child with GI symptoms and anemia
102A 6 year old presents as a restrained passenger
in a car accident
103An appropriate evaluation of this finding would
include
- A) Diagnostic peritoneal lavage
- B) Exploratory laparotomy
- C) Abdominal sonogram
- D) CT scan of the abdomen and x-ray of the lumbar
spine - E) Intravenous pyelogram and barium enema
104- 55 year old woman with acute onset of decreased
visual acuity, described as flashing lights.
Diagnosis
- Retinal hemorrhage
- Acute angle closure glaucoma
- Retinal detachment
- Inter-ocular foreign body
- Retinal artery occlusion
105Retinal Detachment
- Risk factorsHypertension, toxemia of pregnancy,
central retinal venous occlusion,
glomerulonephritis, papilledema, or vasculitis. - Pain is absent
- Retinal detachments diagnosed or suspected in the
ED need emergent consultation.
106- Conjunctivitis in a 4 day old infant
107This patient was found with altered mental status
by her family
108In sorting out the etiology of this finding, it
may be harmful to
- A) Administer 5 mg haloperidol
- B) Administer 2 mg lorazepam
- C) Administer 25 mg diphenhydramine
- D) Administer 1 mg benztropine
- E) Administer 25 gm dextrose
109In sorting out the etiology of this finding.
110One should
- A) Provide emergent dental hygiene
- B) Search diligently for occult rectal foreign
bodies - C) Administer 10 mg IV Ritalin
- D) Withdraw support
11135 year old post partum female presents with
sudden onset of perianal pain. No fever.
Diagnosis is
- Rectal prolapse
- Rectal foreign body
- Thrombosed hemorrhoid
- Perirectal abscess
- Uterine prolapse
112(No Transcript)
113This patient presents with 1 week of worsening
dyspnea
114The exam is unlikely to reveal
- A) Basilar rales
- B) Jugular venous distention
- C) Bounding pulses
- D) Cardiac friction rub
- E) Hypotension
115- 19 year old man felt a pop and had sudden pain to
his penis while trying a new sexual position with
his partner. The injured structures could be all
of the above except - Tunica albuginea
- Bulbous cavernosum
- Urethral tear
- All of the above
116- Patient was stabbed with a kitchen knife. He has
normal vital signs. FAST exam is shown. The next
best step in diagnosis is - Exploratory lap
- Removal of the knife and Repeat FAST in 4 hours
- DPL
- Cut down visualization to see if peritoneum has
been violated - CT of abdomen
-
117- Most common cause of myocarditis in US
Most common cause of myocarditis in Central
America
What is the most characteristic of Lyme disease
associated myocarditis
118You are called to this patients bedside by a
nurse
119(No Transcript)
120His acute respiratory decompensation can likely
be corrected with
- A) Intubation
- B) Left chest tube
- C) Right chest tube
- D) Pericardio-centesis
- E) high flow oxygen
121- 25 year old HIV patient with above rash for 2
days. He has R eye pain and photophobia. He
requires all of the above except - Slit lamp evaluation
- Cycloplegic agents
- IV acylovir
- Steroids if fluorescein is neg and cells and
flare are noted - DC and follow up with an ophthalmologist in 24
hours
122Herpes Zoster Keratoconjunctivitis
- As a result of activation of the virus along
ophthalmic division of the trigeminal nerve - Unilateral, involves the lids, produces
significant pain - Hutchinson sign
- An iritis can occur with photophobia and pain.
Iritis can be treated with topical steroids
prednisolone acetate 1 (Pred Forte) - If HZO is diagnosed, admission and intravenous
acyclovir should be considered. - Ophthalmic zoster mandates emergent
ophthalmologic consultation.
123This assault victim
124Should be examined for this finding
- A) Right lower facial paralysis
- B) Dilated left pupil
- C) Inability to abduct the right eye
- D) Inability to depress the right eye
- E) Inability to elevate the right eye
125(No Transcript)
12635 year old painter accidentally injured himself
while using his high pressure paint gun. All are
true regarding evaluation and treatment of this
injury, except
- Check for tetanus status
- Obtain x-rays of the hand
- DC with follow up in 2 days
- Call a hand surgeon for immediate surgery
- None of the above
127(No Transcript)
128- The signs of tenosynovitis
- Tenderness along the tendon sheath
- Finger held in flexion
- Pain on passive extension of the finger
- Decreased distal sensation
129This patient presents after a fishing accident
130Recommended interventions include all of the
following except
- A) Update tetanus immune status
- B) Document intraocular pressures
- C) Prophylactic antibiotics
- D) Eye shield
- E) Antiemetics
131- 28 year old female with history of IVDU presents
with sudden onset of dyspnea. Her temp is 101, P
130, BP 80/P, and respiratory rate of 36. On
physical exam you see increased JVD and hear
crackles in the lung fields. There is S3 and S4
gallop as well as a harsh apical systolic murmur.
The most likely cause is - Acute MI
- Acute PE
- Acute rupture of papillary muscle
- Severe pneumonia
- Drug seeking behavior
132- The patient shown presents with the above rash
that has been causing him anxiety and pruritus
for the past week. Before discharging him home he
should have - His tetanus updated
- CBC and Hepatitis profile
- GC and chlamydia swab of penis
- VDRL
- None of the above
133Pityriasis Rosea
- Mild inflammatory exanthem of unknown cause,
maybe viral - Occasionally there are prodromal symptoms
including malaise, headache, sore throat,
fatigue, and arthralgia. - Diagnosis is clinical
- It can be confused with viral exanthem,
drugeruptions, syphilis, and seborrheic
dermatitis - A serologic test for syphilis must be done to
exclude that diagnosis.
134- What is the most common presenting complaint for
an aortic dissection?
13520 year old is bitten by a rattlesnake. 1 hour
later, he complains of severe pain to the hand
136Interventions that may be indicated include all
except
- A) Diptheria-Tetanus toxoid
- B) 1 vial crotalid antivenin
- C) Narcotic analgesics
- D) Fresh frozen plasma
- E) Fasciotomy
137What is the name of this fracture?
Bennetts Fracture
138- The most common associated injury with the above
fracture is - Calcaneus fracture
- Tib-fib fracture
- Hip fracture
- Vertebral fracture
- Ankle fracture
139- The most common cause of pneumonia in a
3-week-old infant
The most common cause of meningitis in a
3-week-old infant
The most common cause of sepsis in a 3-week-old
infant
140This patient bit by a spider 3 days ago
141Treatment for this wound includes
- A) Local debridement and physical therapy
- B) Systemic antibiotics
- C) Systemic steroids
- D) Tetanus toxoid
- E) All of the above
142- This patient sustained this injury by falling on
outstretched arm. All statements are true
regarding the possible complications of this
injury except - Early degenerative arthritis
- Delayed union
- Malunion, nonunion, avascular necrosis
- median nerve compression
- All of the above
143- Most common cause of focal encephalitis in AIDS
144The patient with this EKG was found unconscious
in an alley
145Treatment includes
- A) 25 gm Dextrose and 10 units insulin
- B) Rewarming
- C) 200 Joules defibrillation
- D) 1 gm calcium chloride
- E) All of the above
146Osbourne J waves
shivering
147- Common complications of this injury includes all
of the following, except - Complete avulsion of anterior and posterior
cruciate ligaments - Patellar tendon rupture
- Peroneal nerve injury
- Popliteal artery injury
- Posterior joint capsule rupture
148Associated Injuries
- Brachial plexus (BP)
- Subclavian vessels
- Anterior shoulder dislocation
149Associated Injuries
150Associated Injuries
- Brachial artery
- Median nerve
151Associated Injuries
152A 54 y.o. female with Lupus presents with 2 weeks
of worsening dyspnea presentssevere hypotension
153This unstable patient should be treated with
- A) High dose steroids
- B) t-PA
- C) Furosemide
- D) Pericardiocentesis
- E) all of the above
154Electrical Alternans
155- All statements regarding this condition are
true, except - This is the most common type of shoulder
dislocation - Axillary nerve injury is a possible injury
- 80 of these injuries are undiagnosed initially
- Presentation of this patient is with arm in
adducted position and internally rotated with
abduction causing severe pain - All of the above
156A 17 year old male presents with 1 hour of
crushing chest pain after using cocaine
157Which of the following should be avoided in this
patient
- A) Nitrites
- B) Calcium channel antagonists
- C) Beta blockers
- D) Aspirin
- E) Thrombolytics
158- Complication of this injury include
- Radial nerve injury
- Ulnar and median nerve injury
- Compartment syndrome
- Gunstock deformity
- All
159Patellar reflex
160This 80 year old renal dialysis patient presents
with altered mental status
161Your first intervention should be
- A) Calcium
- B) Bicarbonate
- C) Albuterol
- D) Insulin and glucose
- E) TNK
16245 year old El Paso resident presents with
bilateral eye findings shown here for the past
year. Diagnosis
Ptyrigium
163This patient suffered the above injury in a
barroom fight. He lost. True statements regarding
this condition include all except
- Early globe reduction is an important initial
treatment - There are no contraindication to performing globe
reduction - Patients with spontaneous (atraumatic) luxation
and no visual impairment in whom the globe is
easily reduced warrant follow-up within 24 to 48
hours - Patients with traumatic luxation are at greater
risk for underlying ophthalmic injury and warrant
emergent consultation
164This 5 year old who fell on her elbow has a
- Nursemaids elbow
- Radial head fracture
- Ulna fracture
- Supracondylar fracture
- Sprain
165- This patient presents with a red, painful eye for
one day after he fell sleep with his contact lens
on. The organism most likely involved with this
condition is - Staph
- Pseudomonas
- Strep
- Herpes simplex
- Non of the above
166This patient who initially presented with a GCS
of 3 but with a maintained airway and spontaneous
resolution of symptoms likely overdosed on
- A) Ethanol
- B) Amytriptyline
- C) Gamma hydroxybutyrate
- D) Phencyclidine
- E) Jimsonweed
167- False statements regarding this injury include
- More common in children than elderly
- Carries a better prognosis than other cranial
injuries if diagnosed early - 80 occur in temproparietal region
- The lucid interval is pathognomonic for this
injury - All are true
168These patients are poisoned with carbon monoxide.
Which is false?
- A) May have COHgb gt10
- B) Have a normal SaO2
- C) May have a normal PaO2
- D) Should receive oxygen via nasal cannula
16978 year old man presents with sudden onset of
severe abdominal pain that is out of proportion
to his exam. He is in a-fib with ventricular rate
of 140. His guaiac test is positive. Treatment
should include all of the above except
- Securing airway and breathing
- Mesenteric angiography
- Call the surgeons
- Cardioversion to a normal sinus
- IVF therapy
170- 18 year old involved in MVC with head injury was
intubated in route to ED. After viewing this CXR
the next treatment should be - Tube thoracostomy on R
- Tube thoracostomy on L
- CT of the chest
- Reposition the ET tube
- Perform a FAST exam
171(No Transcript)
172- What is the most common cause of endocarditis in
IVDU population?
What is the most common cause of infective
endocarditis?
173A 9 month old is brought to the ED for this
finding. History will reveal
- A) Recent trauma
- B) Febrile seizures
- C) A family history of an inherited disease
- D) Antibiotic use
- E) Congenital anomaly
174Dactylitis
- Earliest manifestation of Sickle Cell Disease.
- Vasoocclusive effects within the bones.
- Hydration and pain control.
175Sickle Cell Disease clinical presentations
- Vasoocclusive Crisis Small vessel occlusion
secondary to noncompliant RBCs leads to distal
hypoxia and pain. - Examples include dactylitis, bony pain crisis,
acute chest crisis, stroke, and avascular
necrosis of the femoral head. - Treatment Aggressive hydration and pain control.
176Sickle Cell Disease clinical presentations
- Hemolytic Crisis Massive destruction of sickled
cells leading to severe anemia and shock. Look
for jaundice. - Aplastic Crisis Shutdown of RBC production
(Parvovirus B-19). - Sequestration Crisis Splenic enlargement can
lead to a functional severe anemia. Priapism.
177Sickle Cell Disease clinical presentations
- Asplenia High risk for infections by
encapsulated organisms (Strep pneumoniae, H. flu,
Salmonella, Klebsiella). Bacteremia, pneumonia,
meningitis and osteomyletitis are more common in
patients with Sickle Cell Disease.
178- 68 year old man with acute anterior MI develops
the following rhythm after receiving tPA.
Treatment includes - Cardioversion
- Lidocaine
- Verapamil
- Permanent pacemaker
- None of the above
179This condition is the third most common cause of
large bowel obstruction. What are the first two
causes
- Cancer
- Diverticulitis
- Volvulus
180One should perform So he does not develop
ID of septal hematoma
A flat nose
181- A 15-year-old boy fractures his right tibia while
playing football. Several hours after the
incident he develops tachycardia, tachypnea and
dyspnea. Soon afterwards he becomes comatose.
Which of the following is most likely?
- A petechial rash may develop on the chest,
axilla, and neck - Chest x-ray will reveal an area of density or
consolidation of the lung - Heparin therapy instituted immediately will
alleviate the symptoms - The presence of fat globules in the urine
sediment is diagnostic
182- What is the bleeding site for most anterior
epistaxis?
183- Lightning strikes a soccer field during a game.
Ten people are injured. An ambulance crew is
present. Which of the following victims should be
treated first? - A fan who is pregnant and complaining of
abdominal pain - A player who is awake, but has an obviously
deformed right thigh - A player who is unconscious, and has no
detectable pulse or visible respiratory effort - An unconscious man with a palpable pulse and
visible respiratory effort
184- A 16-year-old child with sickle cell disease,
presents with left leg pain and a temperature of
38.8C (102F). X-ray is shown here.The most likely
etiologic agent is which of the following? - Bacteroides
- Escherichia coli
- Klebsiella
- Pseudomonas
- Salmonella
185- What is the most common cause of esophageal
perforation?
186- A 25-year-old woman presents with fever and
diffuse, desquamating macular erythematous rash.
She complains of vomiting, diarrhea, myalgias and
a sore throat. Pharyngeal exam shows diffuse
hyperemia. Her vital signs are BP, 90/70 P,
120 R, 24, and T 40C. Which of the following is
the most likely cause? - Erythema multiforme
- Kawasaki's disease
- Scalded skin syndrome
- Toxic shock syndrome
187Toxic Shock Syndrome
- Etiology associated with S aureus (either
infection or colonization), associated with
exotoxin production, TSST-1 - Affected patients
- Menstruating females
- Post-partum females
- Other foreign bodies
- Post-influenza
- Post-surgical
188Toxic Shock Syndrome
- CDC criteria for the diagnosis of TSS
- Temperature gt38.9 C.
- Erythematous macular rash with later
desquamation, particularly of palms and soles - Hypotension
- Negative blood, urine, etc. cultures
- Negative tests for RMSF, leptospirosis, measles,
Hepatitis B, mononucleosis, VDRL
189Toxic Shock Syndrome
- Involves at least 3 of the following organ
systems - GI (vomiting, diarrhea)
- Muscular (myalgias, elevated CPK)
- Renal (pyuria, elevated BUN, creatinine)
- Hepatic (elevation bilirubin, SGOT, SGPT)
- Hematologic (thrombocytopenia)
- CNS (altered mental status)
- Mucosal inflammation (vaginal, conjunctival,
pharyngeal)
190- Most common cause of septic arthritis in
teenagers and young adults
191- Ptosis of the upper eyelid, slight elevation
of the lower lid, constriction of the pupil and
facial anhidrosis all on the ipsilateral side
following penetration injury to the neck suggests
trauma to what anatomical structure? -
- A. Brachial plexus
- B. Lateral spinal cord
- C. Phrenic nerve
- D. Stellate ganglion
- E. Vertebral artery
192- A 26-year-old man presents with a history of
fever, headache and rash. The rash began on the
right wrist and progressed to involve all
extremities. Patient is ill appearing and
physical exam reveals a palpable spleen.
193- Which of the following is the most likely
diagnosis? - Lyme disease
- Meningoccemia
- Mononucleosis
- Rocky Mountain spotted fever
- Rubella
194RMSF
- Etiology Rickettsia rickettsi
- Most common Rickettsial infection in the US
- lt5 occur in Rocky Mountains gt50 occur in south
Atlantic States - Abrupt onset of fever, chills, headache, extreme
muscle tenderness (gastrocnemius), photophobia,
conjunctival infection, 25 of patients have
pulmonary symptoms (Coryza, Dyspnea), rash
(absent in 5-15 of cases)
195RMSF
- Diagnostic Tests
- Fluorescent antibody methods of rickettsial
identification on biopsy - Serologic tests
- Clinical diagnosis and treatment, pending test
results - Treatment doxycycline or tetracycline for 5-7
days - Alternate Chloramphenicol
196- The classic symptoms of aortic stenosis are
- Dyspnea on exertion
- Angina
- Exertional syncope
The most common cause of aortic stenosis in
patientsgt65 years old is
- Calcific degeneration of the valve cusp
197- What are the most frequent causes of
hypercalcemia?
- Malignancies
- Hyperparathyroidism
What is the second leading cause of death in US?
198- A 6-year-old girl is brought to the emergency
department at midnight complaining of rectal
itching. What is the definitive management for
this patient? - Draw CBC looking for eosinophilia
- Obtain stool for culture, gram stain, ova and
parasites - Oral mebendazole or pyrantel pamoate
- Oral metronidazole 15 mg/kg/day TID for ten days
The End