MSPE Day

Question 1

_________________ can cause a false positive guaiac test.

Answer 1

• methylene blue*
• Red fruits or meats
• chlorophyll, iodide, cupric sulfate and bromide preparations

Question 2

A false negative guaiac test can be caused by ?

Answer 2

bile or ingestion of magnesium-containing antacids or ascorbic acid.

Question 3

Thumbprinting on KUB represents?

Answer 3

local areas of swelling in the bowel mucosa caused by submucosal edema and hemorrhage

may suggest ischemic colitis.

Question 4

Diverticulosis and angiodysplasia account for ______ of lower GI bleeds.

Answer 4

80%

Diverticulosis is the most common cause of lower GI bleeding. Angiodysplasia is the more common in young people.

Question 5

The most common causes of upper GI bleeding are (in descending order of frequency):

Answer 5

PUD
gastric erosions
varices
Mallory-Weiss tears
esophagitis
duodenitis.

Question 6

In general, which mortality: upper gastrointestinal bleeding vs lower gastrointestinal bleeding is higher

Answer 6

In general, however, the mortality of upper gastrointestinal bleeding is higher than lower gastrointestinal bleeding

Question 7

In adults, the most common cause of upper gastrointestinal bleeding is peptic ulcer disease. In children, it is?

Answer 7

esophagitis.

Question 8

The majority of bleeding from diverticula occurs from the________ side of the colon

Answer 8

right

*I question this but it was the answer

Question 9

Sudden sharp pain after defecation along with blood on toilet tissue characterizes _________________

Answer 9

anal fissures.

ex: 49 yo cc 1 day of painful bright red blood per rectum. He has painful bowel movements and streaks of blood appear on the toilet paper. He has had hard stools for two weeks. He has never had these symptoms before.

Question 10

A 36 yo F presents to the ED two hours after sudden onset of a severe occipital headache and nausea. She has a hx of migraines that occur in the right frontal area with an aura. T= 98.8, neck is supple, and her neurological exam is normal. A non-con CT scan of her head is normal. What is the next step in her management?

Answer 10

Perform a lumbar puncture to rule out the possibility of subarachnoid hemorrhage.

Question 11

Which of the following is not a known complication of subarachnoid hemorrhage in the immediate several weeks following the initial bleed?
A. rebleeding
B. seizure
C. cerebral artery vasospasm
D. hypernatremia
E. hydrocephalus

Answer 11

D. hypernatremia

Question 12

TIAs are associated with increased risk for ?

Answer 12

• thrombotic strokes– the result of ulceration of cerebral artery plaque.
• Patients with TIA have a 5 to 6% percent chance per year of having a stroke.
• Antiplatelet therapy reduces risk of stroke in these patients.

Question 13

Epidural hemorrhage is most often associated with skull fracture across the course of the?

Answer 13

middle meningeal artery.

Question 14

Epidural hematomas are least likely in which age group?
A. Children between 8 and 14
B. Elderly
C. Adults excluding elderly
D. Children less than 2 years
E. Prevalence is the same throughout age groups

Answer 14

D. Children less than 2 years

The answer is D. Epidural hematoma (EDH) is less likely in children and elderly because of the close attachment of the dura to the periostium of the skull. This is especially true of children less than 2 years because of the added elasticity of the skull.

Question 15

Which of the following symptoms is not associated with epidural hematomas?
A. Severe headache
B. Sleepiness
C. Nausea
D. Hemotympanum
E. Neurologic deficits

Answer 15

D. Hemotympanum

The answer is D. Although hemotympanum may be found in a patient with an epidural hematoma, it is specifically associated with basilar skull fracture.

Question 16

A 21 yo F presents to the ED with fevers, headache, neck stiffness, and mild confusion over the past several days. T= 38.0 C (100.4 F), pulse 106, bp 116/74. On exam she looks ill, and her neck is stiff. Her neurologic exam is normal. A lumbar puncture reveals 105 WBC and 1240 RBC in tube #1 and in tube #4; all lymphocytes. The CSF protein is 68 and the glucose is 78. This patient most likely has ?

Answer 16

HSV encephalitis

Question 17

Which of the following are potential complications of bacterial meningitis?
A. Seizure disorder
B. Focal paralysis or sensory loss
C. Intellectual impairment
D. Sensorineural hearing loss
E. All of the above

Answer 17

E. All of the above

Question 18

In the adult and older pediatric population, lumbar punctures may be performed as high/low as the ____ level

Answer 18

as high as the L2/L3 interspace and as low as the L5/S1 interspace.

Question 19

ure loss of motor function without disturbances in other neurological modalities, is consistent with an infarct in the ______________

Answer 19

internal capsule- lacunar stroke

Question 20

A 19 year old female college student presents to the emergency department with fever, headache, and confusion. Physical exam reveals T103. She is lethargic. The HEENT exam is normal, she has nuchal rigidity, and her lungs are clear. The next step in her treatment should be

Answer 20

ceftriaxone IV

early antibiotics administration is of the utmost importance but should not delay workup

Ceftriaxone is generally considered an antibiotic of choice in meningitis

Question 21

BPV rx

Answer 21

Diphenhydramine
Meclizine
Diazepam
Promethazine

Benzodiazipines are useful because of their sedative effect on the limbic system, thalamus, and hypothalamus. Vestibular neurons are mediated by acetylcholine; therefore, anticholinergic agents (e.g., meclizine, diphenhydramine, promethazine) are effective to minimize vertigo.

Question 22

_______________ defines hypertensive urgency

Answer 22

A systolic BP of 210 or more, or a diastolic BP of 140 or greater

Question 23

In hypertensive emergencies, the goal is to decrease mean arterial blood pressure by ___________ thereby alleviating symptoms while not compromising cerebral perfusion.

Answer 23

10-25% within the first hour

Question 24

Seizures have a number of secondary causes, which must be identified and corrected before the seizure will end such as

Answer 24

Hypoxemia and hypoglycemia
Toxins-INH, tricyclic antidepressants, and camphor. Trauma 
Sickle cell disease
SLE
leukemia

Question 25

A myasthenic crisis involves ?

Answer 25

an exacerbation of weakness, especially of respiratory muscles, often necessitating intubation

Question 26

Which of the following might suggest central rather than peripheral vertigo?

• Prominent vomiting and diaphoresis
• Sudden onset
• Horizontal nystagmus on extreme lateral gaze
• Diplopia
• Transient and episodically related to head movement

Answer 26

-Diplopia

cranial nerve deficit should raise the suspicion for a central process as an etiology for vertigo. Some horizontal nystagmus (on extreme lateral gaze) can be a normal finding.

Question 27

Even though vestibular neuronitis involves inflammation of CN VIII, it is not associated with ___________

Answer 27

hearing loss.

Question 28

__________ does not facilitate the LP to any great extent and may add to a patient’s discomfort as well as compromise the unconscious patient’s airway.

Answer 28

Flexion of the neck