#7 -- 2014-09-12 SAEM Tests Practice Questions 2013

Question 1

A 26 year old woman presents to the ED with right lower quadrant pain. She is afebrile, with a pulse of 118 and a blood pressure of 92/50. On exam, she has significant tenderness to palpation of the right lower quadrant, and right adnexal tenderness. Her urine pregnancy test is positive, and quantitative beta-hCG level is 4125. A pelvic ultrasound is negative with the exception of moderate pelvic free fluid. The most appropriate management for this patient is:
A. Consult general surgery for surgical management of suspected appendicitis
B. Consult Ob-Gyn for medical management of suspected ectopic pregnancy
C. Discharge home with 48 hour follow up for repeat quantitative hCG and ultrasound to further evaluate suspected ectopic pregnancy
D. Consult Ob-Gyn for surgical management of suspected ectopic pregnancy

Answer 1

D. Consult Ob-Gyn for surgical management of suspected ectopic pregnancy

Question 2

A 58 year old male with a past medical history significant for more than 30 pack years of tobacco use and recently diagnosed COPD presents to the emergency department with an episode of shortness of breath and increased sputum production for the last several days, which became acutely worse overnight. Which of the following findings would make the patient a good candidate for initiation of noninvasive positive pressure ventilation?
A. hemodynamic instability
B. noncompliant with face mask for oxygen supplementation
C. markedly increased airway secretions
D. hypoxia refractory to initial management

Answer 2

D. hypoxia refractory to initial management

Question 3

A 62 year-old female with a history of congestive heart failure presents after a family picnic with worsening shortness of breath. This is exacerbated by walking or lying in the recumbant position. Her blood pressure is 150/80, heart rate 90, respiratory rate is 24, temperature is 98oF and pulse oximetry reads 88%. She speaks in broken sentences. She has JVD to the angle of the mandible and her trachea is midline. Her lungs have symmetrically decreased air movement with crackles halfway up. What is the best way to support her breathing while waiting for medications to take effect?
A. Oxygen delivered by nasal cannula
B. Bilevel positive pressure ventilation
C. Needle thoracostomy
D. Intubation and mechanical ventilation

Answer 3

B. Bilevel positive pressure ventilation

Question 4

A 65 year old male with a history of COPD presents to the emergency department with increasing dyspnea, rhinorrhea, cough, and sputum production over the last three days. He denies fever or chest pain. His last acute health visit was 6 months ago. His vital signs are as follows: BP 135/75, HR 85, RR 19, SpO2 95%, Oral temp 98.0 °F. His exam is significant for a diffuse expiratory wheeze and prolonged expiratory time. His chest X-ray and EKG are unchanged from baseline and your patient responds to your ED medical therapy. In addition to an inhaled beta agonist your patient’s recommended outpatient pharmacotherapy includes:
A. A methylxanthine such as theophyline
B. A high-dose oral corticosteroid such as prednisone
C. An antibiotic such as doxycycline
D. A mucokinetic such as guaifenesin

Answer 4

C. An antibiotic such as doxycycline

Question 5

A 39-year-old diabetic man with hypertension and cirrhosis, presents to the ED with an infected tattoo resulting in cellulitis encompassing his entire left arm and forearm. His vital signs are 40.0 C, pulse 140, respirations 28, blood pressure 120/50. His last admission reveals his usual blood pressures to be systolic values of 180-190. To which level of care should he be admitted?
A. General medical/surgical ward with IV antibiotics
B. Observation unit until vital signs normalize and can tolerate oral antibiotics
C. Intensive care unit with IV antibiotics
D. Discharge home with daily ED wound checks and oral antibiotics

Answer 5

C. Intensive care unit with IV antibiotics

Question 6

A 17 year old male presents to the emergency department complaining of excruciating groin pain that woke him from sleep. This pain is associated with nausea and radiation into the abdomen. On examination his right testicle is firm, exquisitely tender, and there is unilateral absence of the cremasteric reflex. A bedside diagnostic and therapeutic maneuver would be to:
A. Elevate the left testicle
B. Rotate his right testicle in a medial to lateral rotation (540 degrees)
C. Perform a bedside scrotal ultrasound
D. Transilluminate the right testicle

Answer 6

B. Rotate his right testicle in a medial to lateral rotation (540 degrees)