PaEasy Emergency Medicine, Emergency
Medicine EOR Practice, Exam Questions
and Answers (Solved Papers)
A 59-year-old woman presents to the accident and emergency department
by ambulance with second- and third-degree burns to her head and neck,
and the anterior surfaces of her upper extremities, right leg, and trunk
including her genital area.
Question
Which of the following represents a reasonable estimation of the extent of
her burns?
Answer Choices
1 36%
2 37%
3 46%
4 45%
5 55% - Correct Answers ✅The correct answer is 55%. This estimation is
based on the "rule of 9s". Body surface area is estimated at 9% for each arm,
the head and neck, anterior surface of upper torso, anterior surface of lower
torso, posterior surface of upper torso, posterior surface of lower torso,
anterior surfaces of each leg, posterior 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 her anterior lower torso,
and 1% for the genital area for a total of 55%.
The other answers are incorrect using the estimation by the "rule of 9s".
A 45-year-old man presents with hematemesis. He has had 2 episodes of
vomiting 'coffee-ground'-appearing material; the vomiting began 45 minutes
prior to presentation. Additionally, he reports passing black, sticky stools for
the past 3 or 4 days. Past medical history is positive for occasional
headaches; they have been coming more frequenly lately. Social history
,PaEasy Emergency Medicine, Emergency
Medicine EOR Practice, Exam Questions
and Answers (Solved Papers)
reveals alcohol use (1 case of beer each weekend) and tobacco (1 pack per
day). Medications include ibuprofen as needed for headaches; he has been
taking 800 mg 3 times a day for the past week. You place a nasogastric tube
and find bright red blood that fails to clear with saline irrigation. Hemoglobin
is 8.9 g/dL. Evaluation of his blood pressure and pulse reveals orthostatic
changes that resolve with an intravenous fluid bolus of 500 cc of Lactated
Ringer's solution. What should you do next?
Answer Choices
1 Transfuse 2 units of packed red blood cells an - Correct Answers ✅refer
for emergency endoscopy
He should be referred for an emergency upper endoscopy.
This patient is most likely bleeding from a gastric ulcer. His recent NSAID use,
as well as his alcohol and tobacco habits, make him at risk for peptic ulcer
disease. His symptoms of melena and hematemesis, along with his anemia,
make the diagnosis quite straightforward.
It appears that this patient is still actively bleeding based on the results of
the nasogastric tube irrigation; therefore, the priority should be getting the
ulcer to stop bleeding. Upper endoscopy should be performed so that the
bleeding site can be identified and treated with electrocautery, coagulation,
or injection of epinephrine or a sclerosing agent. If the bleeding cannot be
stopped with endoscopic interventions, angiographic embolization should
also be tried. If these interventions do not succeed, the patient has rapid
deterioration, or if he requires more than 6 units of blood in a 24-hour period,
then emergency surgery may be indicated.
The other choices are not the best options for immediate management. This
individual cannot be followed simply with transfusions and serial CBC's
because he appears to still be actively bleeding.
,PaEasy Emergency Medicine, Emergency
Medicine EOR Practice, Exam Questions
and Answers (Solved Papers)
Helicobacter pylori infection may very well be playing a part in the etiology
of this man's ulcer, but evaluation for H. pylori can be done with a biopsy at
the time of his endoscopy; it will not help in his immediate management.
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.
A 16-year-old male was hit on the left side of his face by a line drive baseball.
Marked swelling is noted externally to the left eye. There was no loss of
consciousness. Upon physical exam, he complains of diplopia during
extraocular motion testing. Enophthalmos is noted, as well as decreased
sensation of the left cheek. Plain x-rays of the face demonstrate an air-fluid
level in the left maxillary sinus, and a fracture of the orbit. Based on this
information, what is the most likely diagnosis?
A Zygomatic arch fracture
B Orbital blowout fracture
C Le Fort I fracture
D Le Fort II fracture
E Le Fort III fracture - Correct Answers ✅orbital blow out fracture
B Diplopia is common in an orbital blow out fracture, due to entrapment of
the inferior rectus and inferior oblique muscles. Loss of infraorbital sensation
occurs from disruption or swelling of the infraorbital nerve. A Le Fort I
fracture describes a transverse fracture separating the body of the maxilla
from the pterygoid plate and nasal septum. A Le Fort II fracture describes a
pyramidal through the central maxilla and hard palate. Movement of the
hard palate and nose occurs, but not the eyes. A Le Fort III fracture describes
, PaEasy Emergency Medicine, Emergency
Medicine EOR Practice, Exam Questions
and Answers (Solved Papers)
a craniofacial disjunction, wherein the entire face is separated from the skull
due to fractures of the frontozygomatic suture line, across the orbit and
through the base of the nose, and ethmoids. The entire face shifts, with the
globes held in place only by the optic nerve.
What is the most common ECG abnormality in patients with a pulmonary
embolism (PE)?
A Atrial fibrillation
B Sinus tachycardia
C Ventricular ectopy
D Sinus bradycardia - Correct Answers ✅sinus tachycardia
B In most cases, sinus tachycardia is the only abnormality in patients with a
PE. You may also find some ECGs that will have non-specific ST-T wave
changes. Sinus bradycardia and AV blocks are not common findings that are
associated with PE.
In the emergency department, you are asked to evaluate a 77-year-old man
with a history of HTN who had a syncopal episode while chasing after his
dog. He admits to recent episodes of chest discomfort, also associated with
activity, as well as dyspnea at lower levels of activity including walking up
one flight of stairs. On physical exam, a grade III/IV crescendo-decrescendo
systolic ejection murmur can be heard best over the right upper sternal
border. His EKG demonstrates NSR @ 80 bpm, with evidence of left
ventricular hypertrophy. His troponin levels are negative for ischemia. What
is the next most appropriate test or procedure?
A Echocardiography
B VQ scan
C CT scan of the head
Medicine EOR Practice, Exam Questions
and Answers (Solved Papers)
A 59-year-old woman presents to the accident and emergency department
by ambulance with second- and third-degree burns to her head and neck,
and the anterior surfaces of her upper extremities, right leg, and trunk
including her genital area.
Question
Which of the following represents a reasonable estimation of the extent of
her burns?
Answer Choices
1 36%
2 37%
3 46%
4 45%
5 55% - Correct Answers ✅The correct answer is 55%. This estimation is
based on the "rule of 9s". Body surface area is estimated at 9% for each arm,
the head and neck, anterior surface of upper torso, anterior surface of lower
torso, posterior surface of upper torso, posterior surface of lower torso,
anterior surfaces of each leg, posterior 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 her anterior lower torso,
and 1% for the genital area for a total of 55%.
The other answers are incorrect using the estimation by the "rule of 9s".
A 45-year-old man presents with hematemesis. He has had 2 episodes of
vomiting 'coffee-ground'-appearing material; the vomiting began 45 minutes
prior to presentation. Additionally, he reports passing black, sticky stools for
the past 3 or 4 days. Past medical history is positive for occasional
headaches; they have been coming more frequenly lately. Social history
,PaEasy Emergency Medicine, Emergency
Medicine EOR Practice, Exam Questions
and Answers (Solved Papers)
reveals alcohol use (1 case of beer each weekend) and tobacco (1 pack per
day). Medications include ibuprofen as needed for headaches; he has been
taking 800 mg 3 times a day for the past week. You place a nasogastric tube
and find bright red blood that fails to clear with saline irrigation. Hemoglobin
is 8.9 g/dL. Evaluation of his blood pressure and pulse reveals orthostatic
changes that resolve with an intravenous fluid bolus of 500 cc of Lactated
Ringer's solution. What should you do next?
Answer Choices
1 Transfuse 2 units of packed red blood cells an - Correct Answers ✅refer
for emergency endoscopy
He should be referred for an emergency upper endoscopy.
This patient is most likely bleeding from a gastric ulcer. His recent NSAID use,
as well as his alcohol and tobacco habits, make him at risk for peptic ulcer
disease. His symptoms of melena and hematemesis, along with his anemia,
make the diagnosis quite straightforward.
It appears that this patient is still actively bleeding based on the results of
the nasogastric tube irrigation; therefore, the priority should be getting the
ulcer to stop bleeding. Upper endoscopy should be performed so that the
bleeding site can be identified and treated with electrocautery, coagulation,
or injection of epinephrine or a sclerosing agent. If the bleeding cannot be
stopped with endoscopic interventions, angiographic embolization should
also be tried. If these interventions do not succeed, the patient has rapid
deterioration, or if he requires more than 6 units of blood in a 24-hour period,
then emergency surgery may be indicated.
The other choices are not the best options for immediate management. This
individual cannot be followed simply with transfusions and serial CBC's
because he appears to still be actively bleeding.
,PaEasy Emergency Medicine, Emergency
Medicine EOR Practice, Exam Questions
and Answers (Solved Papers)
Helicobacter pylori infection may very well be playing a part in the etiology
of this man's ulcer, but evaluation for H. pylori can be done with a biopsy at
the time of his endoscopy; it will not help in his immediate management.
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.
A 16-year-old male was hit on the left side of his face by a line drive baseball.
Marked swelling is noted externally to the left eye. There was no loss of
consciousness. Upon physical exam, he complains of diplopia during
extraocular motion testing. Enophthalmos is noted, as well as decreased
sensation of the left cheek. Plain x-rays of the face demonstrate an air-fluid
level in the left maxillary sinus, and a fracture of the orbit. Based on this
information, what is the most likely diagnosis?
A Zygomatic arch fracture
B Orbital blowout fracture
C Le Fort I fracture
D Le Fort II fracture
E Le Fort III fracture - Correct Answers ✅orbital blow out fracture
B Diplopia is common in an orbital blow out fracture, due to entrapment of
the inferior rectus and inferior oblique muscles. Loss of infraorbital sensation
occurs from disruption or swelling of the infraorbital nerve. A Le Fort I
fracture describes a transverse fracture separating the body of the maxilla
from the pterygoid plate and nasal septum. A Le Fort II fracture describes a
pyramidal through the central maxilla and hard palate. Movement of the
hard palate and nose occurs, but not the eyes. A Le Fort III fracture describes
, PaEasy Emergency Medicine, Emergency
Medicine EOR Practice, Exam Questions
and Answers (Solved Papers)
a craniofacial disjunction, wherein the entire face is separated from the skull
due to fractures of the frontozygomatic suture line, across the orbit and
through the base of the nose, and ethmoids. The entire face shifts, with the
globes held in place only by the optic nerve.
What is the most common ECG abnormality in patients with a pulmonary
embolism (PE)?
A Atrial fibrillation
B Sinus tachycardia
C Ventricular ectopy
D Sinus bradycardia - Correct Answers ✅sinus tachycardia
B In most cases, sinus tachycardia is the only abnormality in patients with a
PE. You may also find some ECGs that will have non-specific ST-T wave
changes. Sinus bradycardia and AV blocks are not common findings that are
associated with PE.
In the emergency department, you are asked to evaluate a 77-year-old man
with a history of HTN who had a syncopal episode while chasing after his
dog. He admits to recent episodes of chest discomfort, also associated with
activity, as well as dyspnea at lower levels of activity including walking up
one flight of stairs. On physical exam, a grade III/IV crescendo-decrescendo
systolic ejection murmur can be heard best over the right upper sternal
border. His EKG demonstrates NSR @ 80 bpm, with evidence of left
ventricular hypertrophy. His troponin levels are negative for ischemia. What
is the next most appropriate test or procedure?
A Echocardiography
B VQ scan
C CT scan of the head
