Emergency Medicine Flashcards
1
Q
Pregnant woman with dysuria, frequency, urgency and hydronephrosis. What is the best initial step?
A
turn on left side, ultrasound, stent or induce labor
2
Q
Show of EKG of “going, going, gone”
A
2nd degree type I
3
Q
What is diagnostic maneuver of BPV?
A
Dix-Hallpike
4
Q
Patient has right flank pain radiating to testicles with dysuria, frequency, urgency, nitrates, leuks, and CVAT. What is dx?
A
nephrolithiasis or pyelonephritis
5
Q
Patient has acute asthma attack. Which ABG would have a worse prognosis?
A
pH 7.27, CO2 46
-it’s the most acidic answer, shows patient getting tired (respiratory acidosis…breathing slowing down)
6
Q
Patient with HIV has consolidation on CXR. What do you use to tx?
A
Bactrim
7
Q
Patient with optic neuritis has MRI showing white lesions, what is the dx?
A
MS
8
Q
65 year old patient with symptoms of pneumonia. What vaccine should they have gotten?
A
pneumococcal vaccine
9
Q
What risk factor increases chance of aortic dissection?
A
hypertension
10
Q
What cervical spine injury can cause respiratory distress?
A
above C5
11
Q
Midshaft fracture of ulna, what splint?
A
sugar tong
12
Q
Murmur associated with aortic dissection?
A
aortic regurgitation
13
Q
Patient is hypotensive that is not responding to fluids. What should you add?
A
norepi or dopamine
14
Q
65 year old man goes out drinking and then complains of a hot, swollen, and tender knee. Knee tap shows negatively birefringent crystals, what is the dx?
A
gout
15
Q
Patient is diagnosed with a. fib, other than an anticoagulant, what else should you start?
A
diltiazem
16
Q
Patient is complaining of pain with chewing but has erythema and induration anterior and inferior to the ears. What is the dx?
A
parotitis or giant cell arteritis
17
Q
Patient is taking clindamycin and now has diarrhea, what is the cause?
A
pseudomembranous colitis
18
Q
Patient hit his head and now has blood in anterior chamber of eye, what is the dx?
A
hyphema
19
Q
PE finding of malignant hypertension?
A
papilledema
20
Q
Patient gets corneal ulcer patch, what complications might happen?
A
pseudomonas
21
Q
Patient is having a stroke, what do you want to do?
A
tPA
22
Q
MC bug in pyelonephritis?
A
E coli
23
Q
What do you worry about in a knee dislocation?
A
arterial bleed
24
Q
Patient has a cast and now is developing pain, what is the dx?
A
compartment syndrome
25
Open fracture of fibular, in addition to stabilization, what do you want to do?
antibiotics
26
What is in the pheochromocytoma triad other than HTN and diaphoresis?
headache
27
Patient brought to ED with acute onset dyspnea, alcoholic, history of MVA, crackles auscultated. CXR shows bilateral infiltrates spare costovertebral angles, no cardiomegaly or pleural effusion. O2 sat 70%. What is initial tx?
intubation
28
Patient was bit by a cat. What medication?
augmentin
29
LP finding of Guillain Barre?
elevated protein with normal glucose
30
OB question about threatened abortion, what is initial step?
type and screen and Rh status
31
Patient is acting needy and saying they will "do anything" to get help. What is the dx?
histrionic
32
Kid having trouble in school, tearing, and sad for several weeks after parents got divorced. What is the dx?
adjustment
33
Kid with URI presenting with altered mental status, funky liver labs, vomiting. What is the dx?
Reye's syndrome
34
Patient can't see, can't pee, can't climb a tree. What is the dx?
reactive arthritis
35
Patient with non-infected olecranon bursitis, what is the best tx?
naproxen
36
Patient is having acute asthma attack, what is the initial tx?
albuterol nebs
37
Patient has suspected pneumonia. What would you see on PE?
"ee" sounds like "ay"
38
Patient has suspected pneumonia. What would you see on PE?
"ee" sounds like "ay"
39
What is the best intervention for osteopenia?
weight lifting
40
Girl is fatigued with period, lab values show anemia. What is causing her anemia?
menorrhagia
41
IVDA with endocarditis MC valve?
tricuspid
42
Patient with endocarditis what is the MC valve?
mitral
43
8 year old girl with bleeding gums. thrombocytopenia. what is the dx?
ITP
44
How do you diagnose hemophilia B?
factor IX
45
Lab finding in DKA?
low bicarb, I think it was 12.2
46
What is best given to patient to prevent MI?
aspirin
47
Patient has symptoms of SJS. What is cause?
ampicillin
48
Kid had arm pulled out of traffic, now has pain at elbow, what is the dx?
radial head subluxation
49
Little girl going downstairs and knee clicks, some lateral deformity and flattened anterior, she keeps it flexed at 30 degrees and pain with passive motion. What is the dx?
patella dislocation
50
Why do patient with inferior MI have sinus bradycardia and vomiting?
increased vagal tone
51
Pt with SBO, with PMH of abdominal surgery in the past, what is the cause?
adhesions
52
Patient stabbed in chest with electrical alternans and echo showing collapsed right ventricle. What else is associated?
JVD
53
Baseball player injured his shoulder, what is the dx?
labrum tear
54
Patient has positive empty can test, this is rotator cuff injury, what is the tx?
NSAIDs
55
What is the best XR view to see position of shoulder dislocation?
axillary
56
Risk factor for pancreatitis?
hypertriglyceridemia
57
What will cause a rash because of cross reactivity with PCN?
cephalosporin
58
EKG showing V-tach but patient is comfortable and responding to questions, what is the next best step?
synchronized cardioversion
59
Yellow tissue at TM after untreated otitis media?
cholesteatoma
60
Patient has 4 hours of left leg pain with pallor, cool, and no pulses, what is the dx?
arterial insufficiency or DVT
61
Patient has leg pain on the anterolateral leg (not calf), what is this?
compartment syndrome
62
Patient with several months of nonhealing ulcers on toe, leg is cool with pallor and decreased pulses, what is the dx?
arterial insufficiency
63
Patient has intracranial bleed with HTN with systolic in 200s, what is the tx?
clonidine
64
What do you tell a patient with CHF to do daily?
weigh themselves
65
Patient coughs, cough, cough some more and then vomits. What is the dx?
pertussis
66
Most likely pathogen of endocarditis?
staph aureus (acute) or strep viridians (subacute)
67
Patient is alcoholic with yellow sputum and pneumonia symptoms. Most likely etiology?
Klebsiella
68
Patient had total knee replacement in the past. Now presenting with swollen tender knee after dental surgery, what is the dx?
periprosthetic infection
69
Patient has symptoms of mycoplasma pneumonia with bullous myringitis, what is the tx?
azithromycin
70
Patient recently had a C-section and now presenting with SOB and sinus tach on EKG, what is the dx?
pulmonary embolism
71
Patient has rigid abdomen, rebound tenderness and guarding, what would you see on abdominal x-ray?
free air
72
Patient gets abdominal pain that is relieved with eating, what is the dx?
duodenal ulcer
73
Patient went camping and now has foul smelling stool, what is the cause?
giardia
74
What would confirm successful immunization against hep B?
hepatitis surface antibody
75
Patient has periorbital headache with unilateral lacrimation, what is the tx?
oxygen
76
Patient has cluster headache symptoms, what is the acute treatment at home?
NSAIDs
77
What kind of injury would cause binocular double vision in maxillofacial trauma?
EOM dysfunction, rental injury, lens dislocation
78
Patient had cataract surgery removal and now presenting with floaters in vision, what is the dx?
retinal detachment
79
Patient has a sore throat with exudates but has splenomegaly, negative strep and positive heterophile test, this is mono, what is the tx?
acetaminophen
80
Patient has SBO, what do you wanna give IV?
normal saline
81
Patient has hypopigmented maculopapular that are more easily visualized when he is tan. KOH prep shows hyphae, what is the dx?
tinea versicolor
82
Patient was bit by something and now has symptoms of local pain, burning, nausea, vomiting, tearing, etc. what bit him?
black widow spider
83
What is a symptom due to electrolyte changes with SIADH?
sluggishness and confusion
84
What is the treatment of a patient that had sinus surgery through the nose and now presents with symptoms of diabetes insipidus?
desmopressin
85
Patient has vaginal bleeding, what is the definitive treatment?
hysterectomy
86
Patient has been acting weird for past 8 days with a lot of shopping and being disorganized and then also bouts of depression, what is the dx?
bipolar I
87
Patient depressed for year but does not affect work life, what is the dx?
dysthymic disorder
88
Patient coombs positive, what is the dx?
autoimmune hemolytic anemia
89
Patient with fever, night sweats, what would you see on CXR?
upper lobe/apical lesions
90
What is the reversal agent of tylenol?
n-acetylcysteine
91
What is the reversal agent of benzos?
flumazenil
92
Penis foreskin has white discharge with KOH showing hyphae, what is the tx?
Monistat cream
93
Post measles complication in 10 month old
encephalitis
94
What medication interacts with coumadin?
clarithromycin
95
What is a risk factor for placental abruption?
hypertension
96
Patient has bulimia nervosa, what is a symptom?
misuse of laxatives
97
Patient has bulimia nervosa, what is the tx?
fluoxetine (Prozac)
98
What symptom is associated with diabetic ketoacidosis?
deep, slow breathing
99
Patient who is an alcoholic presents with sx of pneumonia, what is the tx?
azithromycin or doxy
100
Patient has red, swollen finger with pain on passive extension, what is the dx?
flexor tenosynovitis
101
What is the best way to diagnose pheochromocytoma?
24 hour urine catecholamines
102
Patient presents with a hematocrit of 59%, what is the dx?
secondary polycythemia vera
103
Female patient comes in 24 hours after vaginal delivery that was uncomplicated, is now bleeding a lot, along with IV resuscitation and blood, what other intervention do you do?
Pitocin or hysterectomy
104
Presentation of patient with COPD, but is a nonsmoker, what is the etiology of this?
antitrypsin deficiency
105
Presents with a whole bunch of labs - all the blood values are low, what is this?
aplastic anemia
106
Patient presents with stroke symptoms - gait ataxia, diplopia, nystagmus with occipital pain, what type of stroke?
posterior cerebral artery
107
Stroke with symptoms that are mac in the face and upper extremity
middle cerebral artery
108
Low back pain, has + straight leg test, what testing do you want to do on this patient?
MRI
109
Why does S3 sound occur?
because of LV becoming stiff and interfering with blood entering LV during filling
110
Patient with hypertensive with AMS, what is the tx of hypertensive emergency?
nicardipine
111
Facial weakness, eyebrow dropped, dysphagia, and upper extremity weakness that goes away, what is the dx?
myasthenia gravis
112
CT scan of bleed and vignette will say it is an alcoholic, what kind of bleed?
subdural bleed
113
Patient has a cast on, and now has swelling of all fingers, what is the finding?
decreased two point discrimination
114
What is charcot's triad for cholangitis?
fever, jaundice, and abdominal pain
115
What is reynold's pentad for cholangitis?
fever, jaundice, abdominal pain, altered mental status, hypotension
116
X-ray and symptoms of patient presenting with epiglottis. What other symptom would this patient have?
drooling, dysphagia, tripod position
117
Basketball ball injury to finger, now cannot extend DIP. What is the treatment?
splint DIP for 8 weeks
118
Lumbar puncture showing atraumatic RBC. What is this?
subarachnoid hemorrhage
119
Patient is afraid to give presentations at work, what do you dx this as?
social panic disorder
120
What is the tx of Reiter's?
indomethacin (NSAIDs)
121
How do you treat priapism?
IV Phenylephrine
122
What reflex is Achilles tendon reflex?
S1
123
What reflex is biceps?
C5
124
What reflex is knee?
L4
125
What is the worst prognostic factor of cauda equina?
decreased sphincter tone
126
What is the tx of parotitis?
augmentin
127
What is the dx when you hear a click with shoulder movement?
labrum
128
What is the MCC of pyelonephritis?
E. coli
129
What should conjunctivitis, urethritis, arthritis make you think of?
reiter's
130
What is the organism for endocarditis?
staph wasn't there, pick strep viridians
131
What is the MCC of endocarditis (mentions IVDA)?
staph
132
What is the best tool to see valves?
transesophageal echocardiogram
133
45 year old comes in with a change in her bowel habits, has FH of breast cancer and colon cancer, what is the next step for her?
send her for a colonoscopy and genetic testing
134
Football player collapses when he gets off field, what do you do?
don't let him practice until cleared by cardiologist
135
What is aortic stenosis?
harsh systolic ejection crescendo-decrescendo murmur at the right upper sternal border (aortic area) with radiation to the neck and apex heard best by leaning forward with expiration
136
What is aortic regurgitation?
soft, early diastolic blowing murmur along the left sternal border with the patient sitting leaning forward after exhaling
137
What is mitral stenosis?
diastolic low pitched decrescendo rumbling murmur with opening snap heard best at the apex (mitral area) with the patient in the lateral decubitus position
138
What is mitral regurgitation?
holosystolic high-pitched blowing murmur at the apex (mitral area) that radiates to axilla with a split S2
139
What is a direct inguinal hernia?
passage of intestine through the external inguinal ring at Hesselbach triangle, rarely enters the scrotum
140
What is the treatment for stable SVT?
Adenosine
141
75 yo lady who found to have LVH leading to CHF. She comes in for something else however, what would you expect her to admit for?
Dyspnea on Excertion
142
Pt with PMH of HLD and 40 pack/year smoker. Recently dx with glioblastoma. Just had surgery and developed 6hrs of crushing CP. Stable VS. ECG shows ST elevations in precordial leads. What is the treatment option?
PCI (Percutaneous Coronary Intervention)
143
Patient with signs of PAD (atrophic changes, hair loss, pain with ambulation not rest). What lifestyle modifications would you give her?
Decrease caffeine consumption
144
After recent bone reduction, you no longer feel distal pulses. Next step?
Consult vascular surgery
145
Patient comes in with polygonal, pruritic papules with scales. Dx?
Lichen Planus
146
Patient comes in with truncal rash. We think it’s either HHV 6 (Roseola) or 7 (Pityriasis rosea). Describe the rash?
Salmon colored, oval, scales -- Herald patch
147
Patient has signs of SJS. What drug likely caused it?
Unasyn (Ampicillin-sulbactam)
148
Unvaccinated teen comes in testicular pain. What vaccine would have prevented his current condition?
MMR (Mumps)
149
Patient noticed hypopigmentation on chest and pack after tanning. Doesn’t tell you KOH. Dx?
Tinea versicolor
150
Patient has had trauma to ear and now the TM is chalky white and hard, what is the likely dx?
Tympanosclerosis
151
Treatment of parotitis?
Ampicillin-sulbactam
OR
Cefuroxime + metronidazole
OR
Nafcilli + Ceftriaxone or levofloxacin + Metronidazole or clindamycin
152
Symptoms seen in SIADH?
Hyperreflexia, fasculitions, convulsions, stupor
153
Old guy with PMH of DM and dementia comes in with 1 wk of N/V “can’t keep anything down”. VS are not great and he’s disoriented. What lab do you want to do initially?
Blood glucose, ABG, CBC
154
Middle age guy recently went out drinking and now having severe stomach pain. Has been taking 5 ASA QD for back pain. What treatment would you give?
Protonix
155
What would you see on titers for someone who had the Hep B vaccination?
HB surface AB
156
45 yo F with FHx of colorectal CA and endometritis. Comes in bc of change in bowel habits. She meets some fancy criteria. What would you do next?
Outpatient colonoscopy and follow-up with GI
157
HIV + male who just got off clindamycin for a lung infection comes in with constant diarrhea and +LLQ pain on exam. What do you want to order next?
Stool culture to observe for C.diff
158
Patient has diagnosed anal fissure. It stopped bleeding but he’s still experiencing a lot of pain. Next step?
Topical analgesics and stool softeners
159
What medication class do you want to give to BPH pts?
5 alpha reductase inhibitors (ie finasteride)
160
What do you want to inhibit the conversion of in BPH?
Dihydrotestosterone
161
MCC of posterior shoulder dislocation?
Seizure
162
Patient has signs of rotator cuff tear. Mentions he’s a crossfit trainer. First line tx?
NSAIDs
163
Patient has FOOSH injury on a flexed wrist. Ventral angulation. Dx?
Smith Fx - distal radius fracture
164
Patient with lower back strain. First tx?
NSAIDs
165
Spinal level which you worry about respiratory dysfunction?
C5
166
Treatment of essential tremor?
Propanolol
167
Tx of TIA?
Anticoagulation and close outpatient follow up
168
Patient in MVA and had neck hyperextension injury. Upper extremities have ⅗ strength, lower ⅘ strength, lower ⅘ strength. +Proprioception and vibratory sensation. No bowel and bladder incontinence. What cord is injured?
Central cord (upper extremities/shawl distribution)
169
2 yo having SOB. No other URI sx. Wheezes auscultated on RUL. Dx?
Foreign body aspiration
170
Pt had stroke and now is having trouble swallowing. The soft palate is not rising. Tongue midline. Sensory intact. What cranial nerve is damaged?
Vagus
171
Patient who is on psych meds for bipolar comes in with AMS (hinting at NMS I believe). What is the first thing you want to do?
Discontinue the medication
172
When/to whom is the proper time to administer the gardasil vaccine?
10-24
173
Medication that causes achilles tendon rupture?
Cephalosporin
174
SE of colchicine?
fever, diarrhea, nausea, vomiting
175
Etiology of SVT?
Reentry pathway
176
Na 152, Chloride 100, BUN 28, urine H20 osmolality. Patient presents with polyuria, polydipsia, and nocturia. What is dx?
Diabetes insipidus
177
Treatment for Scabies?
permethrin
178
Pain in the back of the neck radiates down the arm and into the first finger & index finger. What cervical level?
C6 or C7
179
Pt on clinda, now has diarrhea. How to dx?
Stool assay
180
Patient has compartment syndrome on the hand. What is the first presentation?
Loss of 2 point discrimination
181
Pt presents with Sciatica what is the treatment?
Naproxen
182
You auscultate the pts abdomen and the patient’s rectus abdominis contracts. What physical exam finding?
Guarding
183
Patient PMHx conists of colon cancer & gets a DVT. What is the tx?
Anticoagulant
184
Woman presents with uterine atony. How do you treat?
Uterine massage and IV pitocin
185
Upon fundoscopy, you see blurred disc margins what would you diagnose?
Papilledema
186
Anterior shoulder dislocation. What nerve is involved?
Axillary
187
Patient has perioral and extremity paresthesias. What is also seen on PE?
Chvostek sign
188
Patient in nursing home, has an NG tube and now has rales and decreased breath sounds in the right lower lobe. What dx?
Misplacement of NG tube causing atelectasis
189
Patient has mild persistent asthma. On albuterol. What do you want to add?
ICS
190
Pt with crohns and is having an acute flare up with diarrhea and dehydration. What medication do you want to give pt?
Prednisone
191
Patient is having blood in bowel and signs of a GI bleed. What is initial dx?
Endoscopy and/or Colonoscopy
192
Pt with diabetic nephropathy what HTN med should be started?
ACE-I
193
Pregnant pt comes in with lab values of pancreatitis. What is the cause?
Gallstones
194
Pt with A fib + Hyperthyroid how do you treat?
PTU
195
What medication is used for Nephrolithiasis?
Tamsulosin (alpha blocker)
196
20 year old with severe scrotal swelling, and pain so severe he vomited. Absent cremasteric reflex. What do you want to do?
Urology Consult
197
1st sign of a brain abscess?
Headache
198
How to treat hepatic encephalopathy?
Lactulose
199
What medications can cause SJS?
Ampicillin, ASA, HCTZ, Prednisone
200
Causative organism in chronic paronychia?
Candida albicans
201
Painless ulcer on vagina, fatigue and lymphadenopathy, likely dx?
Lymphogranuloma venereum
202
In an MI, n/v weakness and bradycardia are due to what?
Increased vagal tone
203
Pt presents with cat bite, how do you treat?
Augmentin
204
Blood in anterior chamber of eye is what diagnosis?
Hyphema
205
Risk Factors for pancreatitis?
High Triglycerides
206
Tx of bulimia?
Fluoxetine - Prozac
207
Girl is anemia is likely due to what?
menorrhagia
208
What Murmur is heard in aortic dissection?
Aortic Regurgitation
209
Lab finding in DKA?
Decreased bicarb
210
Pt presents with hypotension what medication do you administer?
Norepinephrine
211
Pneumothorax on XR shows what?
Pleural visceral line
212
MC endocarditis valve?
Mitral Valve
213
MC endocarditis valve in IVDU?
Tricuspid
214
Allergy to PCN cross reaction what do you give instead?
Keflex (cephalexin)
215
Child has bruising, gingival bleeding, platelets 50, likely diagnosis?
Idiopathic Thrombocytopenia Purpura
216
Penis foreskin cracking with white discharge. Stain shows hyphae. How do you treat?
Miconazole (Monistat cream)
217
In a pt with CHF what should be done daily?
Daily body weight
218
Most specific enzyme for cardiac injury?
Troponin
219
Reversal agent for benzos?
Flumazenil
220
What is the pheochromocytoma triad?
Episodic headache, sweating, and tachycardia.
221
Pts mom was murdered and now she has physical symptoms what is the likely dx?
Conversion disorder
222
What is the mechanism of an angiotensin inhibitor?
Vasodilation by inhibiting the formation of angiotensin II.
223
Man had an MI 2 weeks ago and now comes in with 3 days of chest pain, new ST elevations and enlarged heart on chest x-ray. What is the likely dx?
Pericardial tamponade
224
Women is 49 y/o with metromenorrhagia, abnormal uterus, what is the definitive treatment?
Hysterectomy
225
Picture of a splinter hemorrhages is shown and, stem describing endocarditis, what is another physical exam finding?
Heart murmur
226
Man with HIV comes in with diarrhea, how do you determine the organism?
Ova and parasite stool test
227
Alcoholic with pneumonia and yellow sputum has gram negative rods, likely diagnosis?
Klebsiella
228
Red, swollen knee with negative birefringent crystals, likely dx?
Gout
229
Pt with diarrhea after medications use, what is the diagnosis?
Pseudomembranous colitis
230
Symptoms of arterial insufficiency?
Leg pain while walking that is relieved by rest
231
Hepatic encephalopathy diet restrictions?
No proteins
232
Bradycardia tx?
Atropine, if ineffective then transcutaneous pacing
233
What is a sign of chronic pancreatitis?
Pancreatic calcifications
234
Infectious diarrhea tx?
Azithromycin or Cipro
235
Von Willebrand factor tx
Desmopressin
236
Pt is an unstable patient who needs medication to reduce his dislocation, what is the safest option?
Ketamine
237
Best diagnostic study for an aortic dissection?
CT scan
238
RBBB treatment?
Usually none is needed but if needed pacemaker.
239
SIADH causes hyponatremia what symptom findings do you see?
Disorientation
240
25 yo 3 days of sob with exertion, no history of lung disease, denies meds, travel, vital tachy no fever everything else normal but peak flow is 70% what physical exam symptom
Prolonged expiration
241
ESRD with third fracture this year, what are you suspicious of?
Multiple Myloma
242
Why are ACE-inhibitors used for patients with CHF?
Suppresses sympathetic nervous system
243
Imaging used to observe for Osteoprosis?
dual-energy x-ray absorption (DEXA)
244
What type of foot fracture is seen in a pt that occurs in the middle of the foot, affecting ligaments and metatarsals?
Lisfranc fracture
245
Pt with a productive cough, SOB, chills fever 103.7, increase resp effort no retractions decreased breath sounds on right side, likely diagnosis?
Lobar consolidation
246
Pt with hx of bipolar, ran out of med, hearing voices to harm himself, what do you do?
Mood stabilizing medication and admit
247
What is the best initial test for an AAA?
Abdominal US
248
What is the Meniere's disease triad?
Episodic vertigo, tinnitus, and hearing loss
249
Patient has chest pain and gets aggravated when leaning forward, what will you see on EKG?
S1Q3T3 (sign of PE)
250
Patient had radial head fx, which nerve would be affected?
Ulnar nerve
251
Pt with IVDA what is the likely causative organism for endocarditis?
S. aureus
252
Woman with abd pain, shows snowstorm on pelvic US, positive BHCG, likely diagnosis?
Hydatidiform mole
253
Lateral ankle sprain, what will be affected?
Anterior talofibular ligament
254
What physical exam is heard with pneumonia?
Egophony (“Ee” is heard as “ay”)
255
Contraindication for TPA?
Intracranial hemorrhage
