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EM COMAT > Questions > Flashcards

Questions Flashcards

1
Q

Patient with AIDS presents with PJP pneumonia. You start appropriate antibiotics as well as _____ which is essential to reduce inflammatory reaction that occurs as bacteria are killed

A

corticosteroids

[Pts at highest risk for this reaction include those with PaO2 < 70 mmHg and/or Alveolar-arterial (A-a) gradient > 35 mm Hg]

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2
Q

ECG shows ST elevations in leads I, aVL, V5-6.

Where is the infarct?

a. anterior
b. anterolateral
c. inferior
d. inferolateral
e. lateral

A

e. lateral

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3
Q

Which of the following is a contraindication to succinylcholine

a. cataracts
b. cirrhosis
c. hypokalemia
d. myopathy
e. renal insufficiency

A

d. myopathy

contraindications to succinylcholine include HYPERkalemia, hx of malignant hyperthermia, myopathies associated with elevated CK, trauma that may result in rhabdo, and ocular surgery/closed-angle glaucoma/penetrating eye injury (bc it increases intraocular pressure)

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4
Q

57 y/o woman with hx of ESRD on dialysis presents with fever and SOB. On exam she has rales in right mid-lung. CXR confirms right middle lobe PNA. Most appropriate abx choice?

a. moxifloxacin
b. ceftriaxone and azithromycin
c. azithromycin
d. vancomycin, cefepime, and azithromycin
e. ampicillin/sulbactam and ciprofloxacin

A

d. vancomycin, cefepime, and azithromycin

Assume hospital-acquired PNA in pts on hemodialysis; must specifically cover for pseudomonas (cefepime), MRSA (vancomycin), and atypicals (azithromycin)

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5
Q

14 day old with 4-hours of fever and history of increased nasal secretions while feeding. Rectal temp at home was 102.3. Appears lethargic and has mottled extremities. Vitals include BP 74/48, HR 170 bpm, RR 40, temperature 102.9. Which pair of abx is most appropriate to empirically administer?

a. ceftriaxone and azithromycin
b. ampicillin and doxycycline
c. cefotaxime and ampicillin
d. piperacillin-tazobactam
e. ceftriaxone and vancomycin

A

c. cefotaxime and ampicillin

[bacteria of concern in neonates with fever = L.monocytogenes, group B streptococcus, E.coli]

Can’t use ceftriaxone in neonates d/t hepatic and biliary immaturity, don’t generally use doxy in kids, pip/tazo and vans are the combo used in adults with this presentation

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6
Q

What heart condition presents as either deep symmetrical T wave inversions or biphasic T wave changes in the anterior precordial leads?

A

Wellens syndrome

[critical stenosis of LAD – represents a pre-infarction stage of CAD]

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7
Q

Which of the following will not cover influenza B?

a. influenza vaccine
b. oseltamavir
c. peramivir
d. rimantadine
e. zanamivir

A

d. rimantadine

[rimantadine and amantadine only cover flu A]

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8
Q

Pt presents 6 hours after a suspected sulfonylurea overdose. You give an amp of D50 when you see a glucose level of 45 mg/dL. What do you give her next?

a. activated charcoal
b. glucagon
c. octreotide
d. another amp of D50
e. whole bowel irrigation

A

c. octreotide

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9
Q

management of radial head subluxation (nursemaids elbow)

a. attempt to flex and supinate forearm with slight pressure at radial head
b. apply traction to wrist while pronating the arm and extending elbow
c. consult ortho
d. apply sling and refer for outpatient ortho
e. order x-rays of contralateral elbow for comparison

A

a. attempt to flex and supinate forearm with slight pressure at radial head

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10
Q

ECG shows ST elevations in V1-4.

Where is the infarct?

a. anterior
b. anterolateral
c. inferior
d. inferolateral
e. lateral

A

a. anterior

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11
Q

An inferior wall STEMI displays elevation in leads II, III, and aVF. With inferior MIs, anticipate a right ventricular or posterior infarct. To determine if there is a right-sided infarct, lead _____ can be switched to the right side of the chest and the ECG repeated. If there is elevation in that lead, then there is likely to be a right ventricular infarct and the pt is therefore _____ dependent and requires IV fluids to maintain CO – also nitro should be cautioned against.

A

V4

preload

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12
Q

Pts eyes are closed but he opens them to verbal command, he moves all extremities on command, and when you ask him questions he is able to converse but he is disoriented. What is his GCS?

A

13

Eye opening to command = 3 (gets 4 if spontaneous)

Moves extremities on command = 6 (best)

Disoriented but able to converse = 4 (gets 5 if oriented)

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13
Q

In pt with PE, which of the following is an indication for giving thrombolytic?

a. bilateral proximal clot
b. hypotension
c. persistent tachycardia
d. right atrial dilation
e. elevated BNP

A

b. hypotension

[fibinolytic therapy generally reserved for pts with massive PE which is defined as PE with sustained hypotension or right ventricular strain]

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14
Q

best monotherapy for ascending cholangitis

a. vancomycin
b. ciprofloxacin
c. gentamicin
d. metronidazole
e. piperacillin-tazobactam

A

e. piperacillin-tazobactam

[others include meropenem, imipenem, doripenem]

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15
Q

ECG shows ST elevations in leads II, III, aVF, and V5-6.

Where is the infarct?

a. anterior
b. anterolateral
c. inferior
d. inferolateral
e. lateral

A

d. inferolateral

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16
Q

treatment of choice for Bartonella henselae (cat scratch) disease

a. ampicillin-sulbactam
b. TMP-SMX
c. penicillin G
d. metronidazole
e. azithromycin

A

e. azithromycin

17
Q

Management of sub-massive, stable PE is LMWH with bridge to warfarin. Management of massive PE (characterized by cardiac arrest, hypotension, and/or right heart strain) is with _____

A

tPA

18
Q

Antibiotic tx of choice for inhalational anthrax

a. ceftriaxone
b. ciprofloxacin
c. azithromycin
d. clindamycin
e. cefazolin

A

b. ciprofloxacin

[doxycycline is also first line]

19
Q

45 y/o male with severe left eye pain and photophobia after eye was hit with a broom. Exam shows ciliary flush and mitosis. Dx?

a. acute angle closure glaucoma
b. acute iritis
c. conjunctivitis
d. corneal abrasion
e. hyphema

A

b. acute iritis

20
Q

ECG shows ST elevations in leads I, aVL, and V3-6.

Where is the infarct?

a. anterior
b. anterolateral
c. inferior
d. inferolateral
e. lateral

A

b. anterolateral

21
Q

Next step in management for pt with peritonsillar abscess that is in no acute distress

a. perform needle aspiration, prescribe clindamycin, have pt return in 24 hrs
b. give IV morphine and IV ceftriaxone, observe in ED for 6 hrs
c. admit for I&D in OR under general anesthesia
d. prescribe clindamycin and have pt return in 24 hrs
e. order CT of neck

A

a. perform needle aspiration, prescribe clindamycin, have pt return in 24 hrs

22
Q

Cushing’s reflex indicates potentially lethal increase in intracranial pressure

What is the triad

A

Hypertension

Bradycardia

Respiratory depression

23
Q

TIMI risk score is used as prognostic tool in pts with unstable angina or NSTEMI. It categorizes a pts risk of death and ischemic events and helps clinicians with therapeutic decision making. What are the 7 components?

A

ASA use in last 7 days

ST changes of at least ).5 mm on EKG

elevated cardiac biomarkers

age > 65

known CAD

2+ angina episodes in last 24 hrs

3+ risk factors for CAD

24
Q

When calculating GCS, what is the best score in each category?

A

Eye opening response = 4 points (spontaneous)

Verbal response = 5 points (oriented/spontaneous)

Motor response = 6 points (obeys command for movement)

25
Q

55 y/o farmer presents with SOB. He is mildly tachycardia and appears cyanotic. His O2 is 85% on RA and does not change with supplemental O2. CXR is normal. ABG shows measured O2 sat of 100%. Tx?

a. enoxaparin
b. hyperbaric oxygen
c. hydroxycobalamin
d. methylene blue
e. sodium bicarbonate

A

d. methylene blue

[this is methemoglobinemia]

26
Q

A pt with suspected malignancy comes in with pleural effusion. How would you expect to characterize the pleural effusion?

a. transudative
b. exudative
c. transudative and exudative
d. fluid-to-blood LDH ratio < 0.6
e. fluid-to-blood protein ratio < 0.5

A

b. exudative

[causes of exudative effusion include malignancy, infection, connective tissue disease, neoplasm, pulmonary emboli, uremia, pancreatitis, and esophageal rupture. Exudative effusions have fluid to blood LDH ratio > 0.6 and fluid to blood protein ratio > 0.5, OR a pleural fluid LDH greater than 2/3 the serum LDH upper limit of normal]

27
Q

80 y/o pt with symptomatic bradycardia with HR 34 bpm and BP of 80/60. The most appropriate pharmacologic management is:

a. adenosine
b. amiodarone
c. atropine
d. diltiazem
e. metoprolol

A

c. atropine

[if that fails, use dopamine, isoproterenol, epinephrine, or pacing]

28
Q

rattlesnake bite pt comes in with DIC - do you give antivenin first, or administer blood platelets, cryoprecipitate, and FFP to address DIC first?

A

antivenin first – any blood products administered prior to this step would just be consumed in coagulopathy

29
Q

If all PERC criteria are negative, this effectively rules out PE. If any criteria are positive, consider d-dimer vs. CT angio. What are the 8 PERC criteria?

A

Age > 50

HR > 100 bpm

O2 sat < 95%

Prior hx of DVT/PE

Recent trauma or surgery

Hemoptysis

Exogenous estrogen use

Unilateral leg swelling

30
Q

7 components of Wells Score

A

Clinically suspected DVT (+3)

Alternative dx is less likely than PE (+3)

Tachycardia (+1.5)

Immobilization >3 days OR surgery in past 4 weeks (+1.5)

History of DVT or PE (+1.5)

Hemoptysis (+1)

Malignancy with treatment within 6 months (+1)

[score >6 has high probability of PE (proceed direct to CT angio), 2-6 is moderate probability (consider d-dimer in clinical context), score <2 is low probability (consider d-dimer)]

31
Q

tx for pertussis

A

azithromycin (TMP-SMX if allergic)

32
Q

what is the most common complication associated with succinylcholine?

a. hypercalcemia
b. hypokalemia
c. hypotension
d. increased secretions
e. rhabdomyolysis

A

e. rhabdomyolysis

33
Q

Centor criteria

A

presence of tonsillar exudates +1

tender anterior cervical LAD +1

fever +1

absence of cough +1

age <15 yrs +1

age >45 years -1

[0-1 points no testing/no abs; 2-3 points rapid antigen test; 4+ points gets abx and no further testing]

34
Q

treatment for corneal abrasion

a. ophtho consult
b. tobramycin drops
c. erythromycin drops
d. eye patch
e. proparacaine drops

A

b. tobramycin drops

[pseudomonal protection]

35
Q

22 y/o brought in after bystander noticed he was wandering and agitated. Vitals are HR 130 bpm, RR 30/min, BP 180/95 mm Hg, and temp 102 F. Exam reveals dilated pupils, coughing with black sputum, and reactive mydriasis. Causative agent?

a. alcohol
b. cocaine
c. marijuana
d. opiates
e. phencyclidine

A

b. cocaine

36
Q

Which of the following is appropriate tx for spontaneous bacterial peritonitis?

a. metronidazole
b. vancomycin
c. TMP-SMX
d. neomycin and lactulose
e. cefotaxime

A

e. cefotaxime

[covers gram negative rods like e.coli and klebsiella as well as strep species]

37
Q

If a patient on a vent has an ABG done that shows respiratory acidosis, what should you do to their respiratory rate setting?

A

Increase it

[A low respiratory rate setting causes hypoventilation, so pt with retain CO2 causing a respiratory acidosis]

EM COMAT (1 decks)

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