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Emergency
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Emergency Medicine EOR Practice
Emergency
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ER FinalEOR
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Emergency
Guide Exam
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Medicine
ER Final
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2026.pdf
Exam
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ER Final
and Answers
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Terms in this set (1044)
A 59-year-old woman presents to the accident and The correct answer is 55%. This estimation is based on the "rule of 9s". Body
emergency department by ambulance with second- and surface area is estimated at 9% for each arm, the head and neck, anterior surface
third-degree burns to her head and neck, and the of upper torso, anterior surface of lower torso, posterior surface of upper torso,
anterior surfaces of her upper extremities, right leg, and posterior surface of lower torso, anterior surfaces of each leg, posterior
trunk including her genital area. surfaces of each leg and an additional 1% for the groin area for a total of 100%. In
this case, 9% for her head and neck, 9% for the anterior surface of each arm, 9%
for the anterior surface of her right leg, 9% for her anterior upper torso, 9% for
Question her anterior lower torso, and 1% for the genital area for a total of 55%.
Which of the following represents a reasonable
estimation of the extent of her burns? The other answers are incorrect using the estimation by the "rule of 9s".
Answer Choices
1 36%
2 37%
3 46%
4 45%
5 55%
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A 45-year-old man presents with hematemesis. He has refer for emergency endoscopy
had 2 episodes of vomiting 'coffee-ground'-appearing He should be referred for an emergency upper endoscopy.
material; the vomiting began 45 minutes prior to
presentation. Additionally, he reports passing black, This patient is most likely bleeding from a gastric ulcer. His recent NSAID use, as
sticky stools for the past 3 or 4 days. Past medical well as his alcohol and tobacco habits, make him at risk for peptic ulcer disease.
history is positive for occasional headaches; they have His symptoms of melena and hematemesis, along with his anemia, make the
been coming more frequenly lately. Social history diagnosis quite straightforward.
reveals alcohol use (1 case of beer each weekend) and
tobacco (1 pack per day). Medications include ibuprofen It appears that this patient is still actively bleeding based on the results of the
as needed for headaches; he has been taking 800 mg 3 nasogastric tube irrigation; therefore, the priority should be getting the ulcer to
times a day for the past week. You place a nasogastric stop bleeding. Upper endoscopy should be performed so that the bleeding site
tube and find bright red blood that fails to clear with can be identified and treated with electrocautery, coagulation, or injection of
saline irrigation. Hemoglobin is 8.9 g/dL. Evaluation of epinephrine or a sclerosing agent. If the bleeding cannot be stopped with
his blood pressure and pulse reveals orthostatic endoscopic interventions, angiographic embolization should also be tried. If
changes that resolve with an intravenous fluid bolus of these interventions do not succeed, the patient has rapid deterioration, or if he
500 cc of Lactated Ringer's solution. What should you requires more than 6 units of blood in a 24-hour period, then emergency surgery
do next? may be indicated.
Answer Choices The other choices are not the best options for immediate management. This
1 Transfuse 2 units of packed red blood cells and individual cannot be followed simply with transfusions and serial CBC's because
recheck CBC in 8 hours he appears to still be actively bleeding.
2 Check serum for Helicobacter pylori antibody
3 Order a double contrast barium swallow to evaluate Helicobacter pylori infection may very well be playing a part in the etiology of
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for a gastric ulcer this man's ulcer, but evaluation for H. pylori can be done with a biopsy at the
4 Refer for emergency upper endoscopy time of his endoscopy; it will not help in his immediate management.
5 Discontinue his ibuprofen use and encourage
cessation of alcohol and tobacco A barium esophagram will not identify actively bleeding ulcers and cannot treat
active bleeding.
While NSAID, alcohol, and tobacco use may have precipitated this man's GI
bleed, counseling about his use of these substances will not sufficiently treat his
immediate bleed.
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