Emergency Med NBME Form 1 EXAM Questions AND Correct Answers
13 yo - 30 min after fell off sailboat into freshwater lake
> underwater for about 2 min
> rescued - cyanotic and unresponsive
> began coughing/breathing again after mouth2mouth
ED: awake/alert; mild SOB and cough
98.6F
108/min
20/min
93/45 mmhg
POx: 94% RA
PE: mild wheezes; no signs of ext trauma
CXR: mild diffuse int markings
most app next step in mgnt? - ✔✔admission to the hospital for
observation
I guess you don't give assisted ventilation until O2 really drops - UTD
suggests maintaining SpO2 > 94%
> if needs oxygen - give noninvasive positive-pressure ventilation via
BLPAP or CPAP
def needs hospital admission bc CXR looks junky and currently has
SOB/cough
> make sure she doesn't develop ARDS
~ can develop insidiously over next 72 hrs
,~ monitor closely for dyspnea, cough, crackles, and cyanosis
15 yo girl - prolonged extrication from car involved in roll-over MVA
at scene: 130/min, sys BP 70 mmHg; intubated; 2L crystalloid fluid
ED: unresponsive to voice stimulation; L.femur fx; winces to abd palp
> 2L crystalloid fluid given
98.6F
130/min
25/min
BP: 75/50 mmHg
labs: Hct 15%
w/ cont crystalloid resuscitation - most app next step in mgnt? -
✔✔transfuse type O, Rh-negative, packed red blood cells
you don't have time to type and crossmatch bc homegirl is
hemodynamically unstable (esp w/ Hct 15% aka Hgb 5 !!!)
> in most instances, prep of fully typed and cross-matched blood
requires at least 20 min (more likely 30 to 45 min)
need to transfuse RBCs when Hgb < 7
O neg blood = universal dOnor
another option is dopamine - this is never given in hemorrhagic shock,
give it in cardiogenic or septic shock
17 yo female - 2 days of inc severe abd pain
,> initially around navel > now in RLQ
> no fever, nausea/vomiting, diarrhea, dysuria, vag d/c/bleeding
> menses reg, last 5 days, LMP - 10 days ago
vitals stable
PE: abd - RLQ tenderness to palp w/ voluntary guarding; pelvic -
R.adnexal tenderness
labs: WBC 15,400
UA: WNL
urine preg: neg
pelvic US: gucci
most app next step in mgnt? - ✔✔consultation with surgery for
appendectomy
literally the classic picture for appendicitis
MC surg emergency
MC cause: fecalith
begins w/ vague periumbilical pain > migrates to RLQ (McBurney's
point)
> rebound tenderness and guarding
random signs: Rovsing's, iliopsoas, obturator
Ob-Gyn stuff can mimic appendicitis - don't forget to r/o
> ovarian cyst (esp if ruptured), ectopic prog, PID, pyelo, etc.
17 yo girl - 2 days of gen weakness/fatigue
, > light-headed upon standing; almost fainted earlier today
> very thirsty recently
no meds, NKDA
ED: sleepy, easily aroused
BMI: 17
99.1F
118/min
28/min
102/54 mmHg
POx: 99% RA
PE: dry mucous membranes; lungs clear; abd - soft, nontender
serum studies will most likely show what abnormality? -
✔✔decreased bicarbonate
she's in DKA - aka metabolic acidosis, dec bicarb
homegirl has T1DM - skinny (low BMI), thirsty, dry, fatigued
can also have inc potassium - bc K shifting out in exchange for H (to
dec the acidosis that is occurring)
> pseudo hyperK
18 yo male - 1 hr of severe L.testicular pain
> began when walking his dog
> similar episode 1 wk ago while jogging - resolved spontaneously
w/in 30 min
13 yo - 30 min after fell off sailboat into freshwater lake
> underwater for about 2 min
> rescued - cyanotic and unresponsive
> began coughing/breathing again after mouth2mouth
ED: awake/alert; mild SOB and cough
98.6F
108/min
20/min
93/45 mmhg
POx: 94% RA
PE: mild wheezes; no signs of ext trauma
CXR: mild diffuse int markings
most app next step in mgnt? - ✔✔admission to the hospital for
observation
I guess you don't give assisted ventilation until O2 really drops - UTD
suggests maintaining SpO2 > 94%
> if needs oxygen - give noninvasive positive-pressure ventilation via
BLPAP or CPAP
def needs hospital admission bc CXR looks junky and currently has
SOB/cough
> make sure she doesn't develop ARDS
~ can develop insidiously over next 72 hrs
,~ monitor closely for dyspnea, cough, crackles, and cyanosis
15 yo girl - prolonged extrication from car involved in roll-over MVA
at scene: 130/min, sys BP 70 mmHg; intubated; 2L crystalloid fluid
ED: unresponsive to voice stimulation; L.femur fx; winces to abd palp
> 2L crystalloid fluid given
98.6F
130/min
25/min
BP: 75/50 mmHg
labs: Hct 15%
w/ cont crystalloid resuscitation - most app next step in mgnt? -
✔✔transfuse type O, Rh-negative, packed red blood cells
you don't have time to type and crossmatch bc homegirl is
hemodynamically unstable (esp w/ Hct 15% aka Hgb 5 !!!)
> in most instances, prep of fully typed and cross-matched blood
requires at least 20 min (more likely 30 to 45 min)
need to transfuse RBCs when Hgb < 7
O neg blood = universal dOnor
another option is dopamine - this is never given in hemorrhagic shock,
give it in cardiogenic or septic shock
17 yo female - 2 days of inc severe abd pain
,> initially around navel > now in RLQ
> no fever, nausea/vomiting, diarrhea, dysuria, vag d/c/bleeding
> menses reg, last 5 days, LMP - 10 days ago
vitals stable
PE: abd - RLQ tenderness to palp w/ voluntary guarding; pelvic -
R.adnexal tenderness
labs: WBC 15,400
UA: WNL
urine preg: neg
pelvic US: gucci
most app next step in mgnt? - ✔✔consultation with surgery for
appendectomy
literally the classic picture for appendicitis
MC surg emergency
MC cause: fecalith
begins w/ vague periumbilical pain > migrates to RLQ (McBurney's
point)
> rebound tenderness and guarding
random signs: Rovsing's, iliopsoas, obturator
Ob-Gyn stuff can mimic appendicitis - don't forget to r/o
> ovarian cyst (esp if ruptured), ectopic prog, PID, pyelo, etc.
17 yo girl - 2 days of gen weakness/fatigue
, > light-headed upon standing; almost fainted earlier today
> very thirsty recently
no meds, NKDA
ED: sleepy, easily aroused
BMI: 17
99.1F
118/min
28/min
102/54 mmHg
POx: 99% RA
PE: dry mucous membranes; lungs clear; abd - soft, nontender
serum studies will most likely show what abnormality? -
✔✔decreased bicarbonate
she's in DKA - aka metabolic acidosis, dec bicarb
homegirl has T1DM - skinny (low BMI), thirsty, dry, fatigued
can also have inc potassium - bc K shifting out in exchange for H (to
dec the acidosis that is occurring)
> pseudo hyperK
18 yo male - 1 hr of severe L.testicular pain
> began when walking his dog
> similar episode 1 wk ago while jogging - resolved spontaneously
w/in 30 min
