Phase 2 Emergency Medicine

Question 1

Which is INCORRECT regarding anaphylactic reactions?

Answer 1

You should begin management when 3 or more body systems are involved

Question 2

71 year old with sudden onset of left sided weakness and facial droop at 1035. Negative CT and LP negative at 1310. How much time remains to administer TPA?

Answer 2

25 minutes

Question 3

Disorders other than heat stroke can present with neurological changes, hyperthermia, and dry, hot skin. The best approach in such patients is?

Answer 3

Refine the diagnosis while lowering body temp

Question 4

You have been called in by triage nurse to evaluate a 2 month old child w/ altered mental status and hyperthermia. As you begin evaluation, how much risk does this child have for serious bacterial infection?

Answer 4

intermediate

Question 5

Pt suspected of perforated esophagus. Pt appears toxic but stable. What is the correct disposition?

Answer 5

Consult General Surgery

Question 6

28 year old male w/ sudden-onset abd pain while playing football. Fire fighter friend believes he ruptured spleen. Vitals nml, exquisite tenderness in periumbilical region with guarding but no rebound. Flexion of ant abd wall musculature shows increased tenderness. What is most likely dx?

Answer 6

Rectus sheath hematoma

Question 7

45 yo homeless male found unresponsive. Core temp of 80F w/ A. fib and RR of 2 without pulse or BP. Which of the following is true of this pt?

Answer 7

Peritoneal lavage is a rapid, safe and effective rewarming technique

Question 8

75 yo female from nursing home. Mental status acutely changed: confused & disoriented w/ visual and auditory hallucinations. How would you best describe her presentation?

Answer 8

Delirium

Question 9

Admit pt w/ DVT in RLE. What regimen is most appropriate?

Answer 9

Concomitant heparin and warfarin therapy

Question 10

27 yo female w/ acute onset chest pain and SOB. Pn is sharp and associated w/ hemoptysis. Of the above, which ones are most clinically useful for dx of PE?

Answer 10

Chest pain and dyspnea

Question 11

Which of the following labs are helpful in diagnosing a spontaneous pneumothorax?

Answer 11

No labs are helpful

Question 12

Pink eye complaint w/ frequent contact lens wear. Inflamed conjunctiva w/ mucopurulent discharge. Which of the following would NOT be considered appropriate management?

Answer 12

Gentamicin topical ointment

Question 13

Pt w/ peripheral vertigo. What is the MOST appropriate medication to help w/ her condition?

Answer 13

Meclizine

Question 14

Which of the following is the best imaging modality for determining the location of a pregnancy?

Answer 14

Ultrasound

Question 15

24 yo female w/ worsening acute onset RLQ and right flank pain that started 24 hrs ago. + N/V. UhCG positive. Which of the following would be the next most appropriate study?

Answer 15

Pelvic US

Question 16

A frantic mother brings her 2 y/o boy into the Emergency Department stating that her baby is having really bad abdominal pain and that he has not had a bowel movement in 2 days. On physical exam you find an inconsolable male child that intermittently pulls his legs up to his chest. His abdomen appears distended and tender and you note that there are no bowel sounds present but there is a scant amount reddish stool in his diaper. With the information available what is the most likely diagnosis in this case?

Answer 16

Intussusception

Question 17

The physical finding seen here is called:

Answer 17

Positive Seidel test

Question 18

You begin the evaluation of a patient that presents with acute onset chest pain. The pain has been present for approximately 1 hour. The patient has a history of a myocardial infarction 2 years ago. Which of the following questions is most important first question when gathering your history?

Answer 18

Is the pn equivalent to your attack pain?

Question 19

A 22-year-old man arrives to the Emergency Department with a history of multiple bee stings 30 minutes ago. He is light-headed, with a history of nausea, vomiting and diarrhea just prior to arrival. There is no generalized itching or dyspnea. Physical examination reveals diffuse involuntary muscle spasms and extremity edema. V/S: P-102, B/P-110/69, R-18, Temp 100.4. What is the MOST likely diagnosis?

Answer 19

Toxic Reaction

Question 20

Complications of colonic diverticular disease include all of the following EXCEPT:

Answer 20

Carcinoma

Question 21

EMS has just brought in a 73 y/o African-American man who reports an abrupt onset of exquisite pain and loss of vision in his left eye. He was nauseated and the EMS crew states that he had been vomiting in the ambulance. Your patient’s upper lid is edematous. You notice that he has circumcorneal injection and lacrimation. He is able to cooperate for a slit lamp exam and you see that the cornea is also edematous and hazy with a shallow anterior chamber; the pupil is fixed and dilated. Tonometry readings are 20mmHg right eye and 60mmHg left eye. What is your next action?

Answer 21

Prescribe and instill timolol maleate 0.5% solution 1 drop topically to the affected eye twice daily

Question 22

You are called to see an acutely confused or comatose patient who about one hour ago either A) completed hemodialysis, or B) had an infusion of D10 discontinued. What do you most suspect?

Answer 22

Hypoglycemia

Question 23

In the 3-36 month age group, what organism is responsible for the majority of bacteremia, bacterial pneumonia and meningitis?

Answer 23

S. pneumoniae

Question 24

What is considered the imaging study of choice in evaluating pericarditis?

Answer 24

Echo

Question 25

In patients with suspected meningitis or subarachnoid hemorrhage, signs of meningeal irritation include all of the following except:

Answer 25

Babinski's sign

Question 26

You are evaluating a 77 year old female for severe, worsening abdominal pain. Her husband is her caregiver--he states she started complaining of pain 4 days ago. She doesn't want to eat. He feels that is due to nausea. In addition, the husband says she has had some diarrhea the past 2 days. PMHx: ASCVD, PSHx: s/p appy, chole. On presentation, you note a thin elderly woman laying quietly in bed guarding her abdomen. V/S: P-106, B/P-100/60, R-22, T-101.2. O2 sat-98% on 4 L/nc. Your abdominal exam shows mild diffuse tenderness with no distension, masses, guarding or rebound; stool is negative for occult blood. Which of the following labs will be most helpful in "ruling-in" her condition?

Answer 26

ABG/VBG with serum lactate

Question 27

You are treating a patient in your Emergency Department for an acute exacerbation of COPD, which of the following would be considered the most appropriate first-line inhalation treatment?

Answer 27

Albuterol

Question 28

You are in the process of evaluating a 33 year old male with severe left flank pain that radiates to his left testicle. You are considering initiating an evaluation for a urologic stone. Of the following, what is the next most appropriate step?

Answer 28

Provide pain relief

Question 29

Yesterday an inexperienced carpenter used one hammer to strike the head of another hammer in an attempt to pry a nail out of a board. Today he complains of dull pain above the left eye, with blurred vision in the same eye. To decrease the risk of permanent vision loss, which of the following must be ruled out?

Answer 29

Foreign body

Question 30

You are evaluating a patient with several hours of dyspnea. He has a history of COPD. There is no trauma. You note severely decreased lung sounds on the right side, tracheal deviation and JVD. The vital signs are: P-116, B/P-85/50, R-24, T-98.0M SaO2-88% on 2LPM NC. What is the next step?

Answer 30

Needle Decompression

Question 31

Which of the following is not used in the management of acute coronary syndrome?

Answer 31

Hytrin

Question 32

Which of the following is the single MOST important step in managing DKA?

Answer 32

Rapid normal saline IV fluid administration

Question 33

You are evaluating a patient with acute chest pain. You obtain an EKG. Given the following tracing, what is the diagnosis?

Answer 33

Inferior wall MI

Question 34

You are evaluating a 40 year old female with a complaint of nasal congestion and headache for the last 10 days. She states she has had a runny nose. She has been using OTC decongestants with no relief and this is the thrid episode in 2 months. She is unsure if she has had a fever. When she bends down she feels like her her face is about to explode. V/S: P-114, B/P-128/62, R-20, T-102.0. O2 sat-100% on room air. On presentation you note an obviously congested female ill appearing but in NAD, A & O x 3. Your PE is essentially normal. Of the following, what would be most useful in your evaluation?

Answer 34

Head CT w/ sinus cuts

Question 35

All of the following are true with respect to black widow spider bites EXCEPT:

Answer 35

Distinctive red swelling w/ marked local pain quickly develops

Question 36

You obtain an EKG on a chest pain patient. You note S-T elevation in leads V1-V3. Which of the following correlates with your EKG finding?

Answer 36

Anteroseptal Infarct

Question 37

You are working an evening shift at the Emergency Department taking care of a 58 y/o woman complaining of fevers and chills, fatigue and a productive cough with brown-green sputum for the past 3-4 days. The patient also complains of sweating and feeling "cold and shivering" all the time. The patient has a 60 pack year history of smoking and has some difficulty breathing and chest pain on her left side worse with deep breathing. Vital signs are temperature of 104F, HR 120, RR 23; PE reveals crackles in left and right middle lung fields along with the left lower lung field. A sputum gram stain reveals many gram-positive diplococci. Of the following which is the most likely causative agent?

Answer 37

S. pneumoniae

Question 38

: A 19-year-old male presents to the ED via EMS actively seizing for the past 15 minutes. There is no history of trauma or prior seizures. Management of this patient includes all of the following EXCEPT:

Answer 38

Immediately load w/ phenytoin or fosphenytoin if seizure is stopped w/ first dose of diazepam

Question 39

Which of the following clinical settings would NOT cause hypothermia?

Answer 39

COPD exacerbation

Question 40

A 40-year-old previously healthy female presents with sudden onset of a severe occipital and nuchal headache following a coughing fit. Vital signs and physical exam are normal. Which of the following is indicated?

Answer 40

Noncontrast head CT; if negative, perform LP

Question 41

When do you acquire an EKG when evaluating an adult patient with acute chest pain?

Answer 41

Within 10 mins of presentation

Question 42

Which of the following is NOT a typical risk factor for Heat Injury/Stroke?

Answer 42

Seizure Disorder

Question 43

Which of the following is NOT true regarding subarachnoid hemorrhage and its treatment?

Answer 43

Stiff neck is virtually always present

Question 44

Deleterious effects of severe ketonemia in diabetic ketoacidosis include all of the following except:

Answer 44

hypoventilation

Question 45

If a patient with suspected meningitis has ________, a head CT should be obtained before the lumbar puncture is done.

Answer 45

Papilledema

Question 46

You are working in an urgent care clinic. A 17 year old hispanic male comes in complaining of pain in his upper abdomen. He appears in acute distress guarding his epigastric region. Vital signs: P-110, B/P-144/90, R-22, T-102.5. Your medics are establishing your safety net and drawing baseline labs. What is your next step?

Answer 46

Assess breathing

Question 47

The most common pathogen of adult meningitis is?

Answer 47

S. pneumoniae

Question 48

Which of the following symptoms support the suspicion of a perforated esophagus?

Answer 48

All of the above

Question 49

In evaluating the patient with a suspected AAA, or in the case of an incidental finding of an AAA, it is important to understand Laplace's Law. Which of the following best describes The Laplace law?

Answer 49

As the aorta dilates, force on the aortic wall decreases, causing more dilatation

Question 50

You obtain an EKG on a chest pain patient. You note S-T elevation in leads II, III, aVF, V5, and V6. Which of the following correlates with your EKG finding?

Answer 50

Inferiolateral MI

Question 51

: 27 y/o AD Sergeant participating in Level 3 Combatives suffers a FOOSH injury and is brought to your Emergency Department. Physical Exam reveals tenderness to palpation over the distal radius and ulna with obvious deformity. Distal neurovascular status is intact and radiographs reveal a both bone distal forearm fracture that is in multiple pieces. From the following what type of fracture is this?

Answer 51

Comminuted

Question 52

Of the following, which represents an example of obstructive lung disease?

Answer 52

Asthma

Question 53

You are evaluating a patient with a history of peptic ulcer disease. What is the most likely cause of this patient's abdominal pain and severe back pain?

Answer 53

Perforated peptic ulcer w/ associated pancreatitis

Question 54

EM Stroke/TIA. You are evaluating a 70 y/o man suspected of having a stroke. You ask him to spell his name on a piece of paper with a pencil. He can say his name without difficulty and he understands what you want him to do, but he is unable to write his name. Of the following, what phenomenon is being described?

Answer 54

Agraphia

Question 55

Complications of status epilepticus include all of the following EXCEPT:

Answer 55

Hyperglycemia

Question 56

Which of the following evaluation modalities is the most useful in evaluating the patient with a suspected asthma exacerbation?

Answer 56

Peak Expiratory Flow Rate

Question 57

Which serum cardiac marker returns to normal levels first after a cardiac injury incident?

Answer 57

Myoglobin

Question 58

You are caring for a hypothermic patient (94 degrees F on rectal temp), he has no cardiovascular compromise. What rewarming technique is most appropriate for this patient?

Answer 58

Passive rewarming

Question 59

Which of the following are the hallmark symptoms of a COPD acute exacerbation?

Answer 59

Exertional Dyspnea, Cough and the pt sittung up and leaning forward

Question 60

Which of the following is a cause of cardiac syncope?

Answer 60

Dysrhythmias, Lyme Disease, Hypomagnesemia