SAEM - Emergency Medicine Exam
A thin 18 year old female complains of acute onset of The answer is A. This patient has a large right-sided spontaneous pneumothorax
sharp right-sided chest pain this morning. She has that is not under tension. She needs oxygen and chest tube placement. This can
developed some mild shortness of breath during the be done with proper procedural analgesia and sedation since there is no
morning and thought she should get it checked out. Her immediate threat. Primary spontaneous pneumothorax tends to occur in healthy
chest X-ray is shown in the Figure. The next course of young men (and, less commonly, women) of taller than average height. Other
action should be: risk factors include cigarette smoking, asthma, COPD, interstitial lung disease,
[image] connective tissue diseases, and lung cancers.
A. Chest tube placement
B. Antibiotics
C. Electrocardiogram
D. Needle decompression
A 28 year old patient arrives after helicopter transfer from The answer is C. The patient has a right-mainstem intubation and resultant
an outlying center, where he had been intubated for opacification of the left lung secondary to unilateral lack of ventilation. In an adult
altered mental status after significant alcohol intoxication. male, the ETT should generally be inserted to a depth (to the lip line) of 22-24cm;
There were no reported signs of chest trauma, but the the corresponding depth range for an adult female is 21-23cm
patient now has decreased breath sounds on the left. His
vital signs are stable. Based upon the chest X-ray in the
figure, what is the next step in management of this
patient?
[image]
A. Nasogastric tube placement
B. Chest tube placement
C. Endotracheal tube adjustment
D. Needle decompression
A 25-year old female presents to the ED with dyspnea The answer is B. Helical CT studies of the pulmonary vasculature are
and chest pain. Chest CT, with contrast, is performed increasingly used for detection of pulmonary embolism. Though there are
and some pertinent "slices" are shown in the Figure. questions about CT's ability to detect small (e.g. subsegmental) emboli, CT
What is the diagnosis? scans have high sensitivity for proximal embolism such as that depicted in the
[image] accompanying figure. The patient whose images are shown was found to have
A. Aortic dissection, Type I moderate-severe right ventricular dysfunction and received thrombolytic therapy
in the ED - she had an excellent outcome.
B. Bilateral pulmonary embolism
C. Gas embolism
D. Acute Respiratory Distress Syndrome
The X-ray in the figure indicates: The answer is D. The patient is not intubated. The pathology in the right
[image] hemithorax appears as hyperdensity, rather than air density (not a
pneumothorax), and involves more than the right upper lobe.
A. Need to withdraw the endotracheal tube from the
mainstem
B. A chest radiograph that was taken with the patient
rotated
C. Right upper lobe pneumonia
D. Mediastinal shift due to fluid in the right hemithorax
Regarding the epidemiology of asthma in the United The answer is B. Despite an increase in asthma prevalence in the United States,
States, which of the following is true? Canada, Great Britain and Australia in the 1980s, the 1990s saw a decrease in
A. Etiology is thought to be genetic, not environmental prevalence in these areas. Regarding gender, male children are more likely than
female children to have asthma, however the reverse is true with adults. African-
B. Prevalence increased in the 1980's, and then Americans have a higher prevalence of asthma than Caucasians. Migrants who
decreased in the 1990's relocate from an area of low asthma prevalence to an area of high asthma
C. More common in males than females in adult and prevalence tend to have an increased prevalence of asthma suggesting a role for
pediatric populations environmental factors in the development of asthma.
D. Incidence is comparable for Caucasians and African-
Americans
Regarding pulsus paradoxus and asthma, which of the The answer is A. Pulsus paradoxus is defined as a fall in systolic blood pressure
following statement s is correct of greater than 10mm Hg upon inspiration. It is typically present during acute
A. The presence of pulsus paradoxis in asthma indicates asthma exacerbations in severe asthma; however, its absence does not rule out
severe disease severe disease. Although initially present, a pulsus paradoxus may disappear
B. Pulsus paradoxus is pathognomonic for asthma after only minimal improvement in air flow through the larger airways. Pulsus
C. The absence of pulsus paradoxis in asthma rules out parodoxus may occur in other diseases besides asthma (for example, pericardial
severe disease tamponade).
D. Pulsus paradoxus is a fall in systolic blood pressure
during inspiration
, SAEM - Emergency Medicine Exam
Which of the following is correct regarding the use of The answer is B. Oral and intravenous steroids are equally efficacious in treating
corticosteroids in acute asthma exacerbation? an asthma exacerbation. Yet, in the setting of a severe asthma exacerbation, a
A. Beneficial effects occur within the first hour of patient may have difficulty taking oral medications and the intravenous route is
administration. preferred
B. Inhaled steroids should be avoided
C. Intravenous steroids are superior to the oral route
D. Tapering is needed with all corticosteroid regimens
Which of the following is true regarding the treatment of The answer is C. Salmeterol is a long-acting beta2-selective adrenergic agonist
acute asthma exacerbation in the Emergency that has no role in the treatment of an acute asthma exacerbation, but it is
Department? frequently preferred for outpatient asthma management due to its BID dosing
A. Intramuscular terbutaline is preferred over intravenous schedule.
B. Heliox should only be used in the intubated patient.
C. Anticholinergics by inhalation may be beneficial
D. Intravenous albuterol may be indicated
Which of the following drugs is MOST beneficial in an The answer is C. Mucokinetic agents should not be used acutely in treatment of
acute COPD exacerbation? COPD exacerbation. These agents act to mobilize secretions, and this increases
A. Methylxanthines such as theophylline the work of the patient's breathing.
B. Steroids such as solumedrol
C. Beta adrenergic agonists such as albuterol
D. Mucokinetic agents such as acetylcysteine
Regarding the pathogens involved in community- The answer is A. Co-infection with multiple bacteria, such as Chlamydia and S.
acquired pneumonia, which of the pneumoniae, is a well-recognized occurrence and should be sought out to
following is true? ensure appropriate antibiotic coverage.
A. Co-infection with multiple bacteria, such as Chlamydia
and Strep pneumoniae commonly occur
B. Etiologic agents for patients admitted to the ICU with
pneumonia most commonly include Neisseria
meningitidis and Strep pneumoniae
C. Milder cases of community acquired pneumonia are
frequently caused by Chlamydia
D. Q fever, caused by Coxiella burnetii, may present as
pneumonia, particularly in patients exposed to rabbits
Which of the following patients is the most likely to The answer is D. Otitis media has not been associated with the development of
develop S. pneumoniae pneumonia? S. pneumoniae pneumonia. The most common pathogen in community-acquired
pneumonia, S. pneumoniae, is found in the nasopharynx of 40% of adults.
A. 59 year old woman who is a cigarette smoker. Persons at risk for developing S. pneumoniae pneumonia include the elderly
B. 61 year old man with hypertension (>65), and those with a history of alcoholism, diabetes, cardiovascular disease,
C. 65 year old woman with no past medical history splenectomy, sickle cell disease, malignancy, and immunosuppressive disorders.
D. 64 year old man with type 2 diabetes Vaccination is recommended for all people at increased risk.
Regarding the etiology of viral pneumonia, which of the The answer is B. Varicella zoster virus (VZV), the etiologic agent of chicken pox,
following is true? more commonly presents as pneumonia in adults, especially smokers or
A. Influenza virus is the most common cause of viral pregnant women. Influenza outbreaks, which occur in winter months, may cause
pneumonia in children up to 40,000 deaths annually in the United States with elderly people making up
more than 90% of the victims.
B. Cytomegalovirus does not usually cause pneumonia
in immunocompetent adults
C. Parainfluenza virus is the most common cause of viral
pneumonia in adults
D. Varicella zoster causes pneumonia more frequently in
children than in adults
Regarding mycobacterium tuberculosis (TB), which of The answer is B. TB causes more deaths worldwide than any other infectious
the following is TRUE? agent. Approximately one-third of the world's population is infected with TB. In
A. Worldwide, approximately 45-50% of the population is the United States, only about 4-6% of the population is infected with TB. The
infected with TB incidence of TB infection in the United States began decreasing in the 1950s as
B. Worldwide, TB causes more deaths than any other a result of advancements in public health and pharmacologic treatments. Yet, the
infectious agent incidence has been rising since the 1980s, especially in poor, homeless, minority,
C. In the United States, approximately 12-15% of the and prison populations. The incidence of multi-drug resistant TB has been
population is infected with TB. gradually increasing, especially among AIDS patients.
D. In the United States, the incidence of TB has been
steadily increasing since the 1950s.
Which finding is commonly associated with pneumonia The answer is D. Klebsiella pneumoniae can cause severe pneumonia,
caused by Klebsiella pneumoniae? especially in the elderly or debilitated host. The mechanism of Klebsiella
A. Absence of sputum pneumoniae infection leads to a necrotizing, hemorrhagic process responsible
B. Encephalitis for the classic "currant-jelly" sputum. Abscess formation, empyema and
C. Low mortality bacteremia are frequent complications, and the mortality rate is high.
D. Empyema
, SAEM - Emergency Medicine Exam
Which of the following patients presenting to the The answer is D. The most common pathogens to generate cavitary lesions
emergency department with a chief complaint of include tuberculosis, anaerobic bacteria (common pathogens in aspiration
"shortness of breath" is most likely to have cavitary pneumonia), aerobic gram-negative bacilli, S. Aureus, and fungal disease. The
lesion with air-fluid levels on CXR? patient described in C has multiple risk factors for developing a cavitary
A. 64 year old female with history of congestive heart pneumonia, including a higher risk of tuberculosis from being homeless and a
failure higher risk of aspiration pneumonia due to alcoholism. Congestive heart failure
B. 54 year old male with history of recent myocardial would cause a diffuse pattern of edema on CXR
infarction
C. 32 year old female who is 36 weeks pregnant
D. 43 year old homeless male with history of alcohol
abuse
In the emergency department, regarding the disposition The answer is C. The decision whether to admit or discharge patients diagnosed
of patients diagnosed with pneumonia: with pneumonia in the emergency department is not straightforward. Despite
A. Patients over 50 years of age should be admitted numerous guidelines including those recommending admission for patients with
B. Patients under 2 years of age should be admitted co-morbid disease such as HIV, CHF, malignancy, renal disease, liver disease
C. Patients with co-morbidities should be admitted and others, the decision ultimately resides in the clinical judgment of the
D. Patients with normal vital signs should be discharged emergency department physician. Likewise, though most patients with normal
home vital signs are typically well enough to be treated as outpatients, circumstances
may exist in which this choice is not optimal, such as an elderly patient who lives
alone and has poor follow-up.
A 28 year old man is shot in the right chest. His vital The answer is A. The patient has a gunshot wound to the right chest near the
signs are: T 97.9, HR 120, BP 70/50, RR 12, SPO2 84%. sternum. His hypotension and JVD suggest an obstructive shock. Given the
He has significant JVD, his trachea is deviated to the left, tracheal deviation to the left and absent breath sound on the right, he most likely
and he has decreased breath sounds on the right. The has a tension pneumothorax. His emergent treatment includes needle
patient's diagnosis is: decompression followed by chest tube placement.
A. Tension pneumothorax
B. Spinal cord injury
C. Hypovolemic shock
D. Lung laceration
E. Cardiac tamponade
Which of the following are associated with a higher risk The answer is A. Physical exertion has not been associated with an increased
of spontaneous pneumothorax? risk of spontaneous pneumothorax.
A. Cigarette smoking
B. Female gender
C. Physical exertion
D. Trisomy 21
A radiographic finding that may be seen in an elderly The answer is D. Due to its wider diameter and the fact it forms a more obtuse
patient who aspirated food is: take-off angle with the trachea, the right mainstem bronchus is a more likely site
A. Visualization of the food bolus in the right mainstem of aspiration than the left mainstem bronchus in adults. On chest X-ray,
bronchus aspiration is more likely to be detected because of secondary signs, such as
B. An opacity in the right middle lobe bronchus hyperinflation or atelectasis of the involved lung, rather than direct visualization
C. Tension pneumothorax on the right, with leftward of the aspirated contents. In this clinical scenario, the adult patient may have
mediastinal shift aspirated food into the right mainstem bronchus. One would therefore expect
D. Hyperinflation of the left lung either atelectasis (collapse) or hyperinflation on the right side. The lobar
bronchus to the right middle lobe has an acute take-off angle and poor collateral
ventilation, which make it prone to atelectasis. Thus, it is the part of the right lung
most likely to exhibit atelectasis after an aspiration event.
A 7 year old girl is brought in by her father complaining of The answer is D. Antibiotics are not indicated for allergic reactions. Inhaled
difficulty breathing after being stung by a bee. She is racemic epinephrine decreases inflammation of the airways and promotes
otherwise in good health. Neither she nor her father bronchodilation. Heliox decreases turbulence of air flow to facilitate air movement
recall whether she has been stung previously, but state into the airways. Albuterol nebulizer is a beta-agonist that causes
she has never before had a reaction like this. Which of bronchodilation, and intravenous cimetidine is an antihistamine that helps
the following treatments would be inappropriate? mitigate the allergic response.
A. inhaled racemic epinephrine
B. albuterol nebulizer
C. heliox by face mask
D. intravenous antibiotics
Regarding the diagnosis of pulmonary embolism (PE), The answer is D. Up to two-thirds of patients with PE have no symptoms of DVT.
which is correct. PE is also found in about half of patients who have DVT but who do not have
A. Autospsy studies indicate that approximately 30% of symptoms of PE. Thus, the presence or absence of DVT or symptoms of DVT
patients who die in the hospital have undiagnosed PE does not correlate well with the finding of PE.
B. By 80 years of age, one out of four people will develop
deep venous thrombosis
C. One-year mortality of PE is 25% even with early
diagnosis and treatment
D. Pulseless electrical activity in Emergency Department
cardiac arrest victims is associated with PE in 33%
A thin 18 year old female complains of acute onset of The answer is A. This patient has a large right-sided spontaneous pneumothorax
sharp right-sided chest pain this morning. She has that is not under tension. She needs oxygen and chest tube placement. This can
developed some mild shortness of breath during the be done with proper procedural analgesia and sedation since there is no
morning and thought she should get it checked out. Her immediate threat. Primary spontaneous pneumothorax tends to occur in healthy
chest X-ray is shown in the Figure. The next course of young men (and, less commonly, women) of taller than average height. Other
action should be: risk factors include cigarette smoking, asthma, COPD, interstitial lung disease,
[image] connective tissue diseases, and lung cancers.
A. Chest tube placement
B. Antibiotics
C. Electrocardiogram
D. Needle decompression
A 28 year old patient arrives after helicopter transfer from The answer is C. The patient has a right-mainstem intubation and resultant
an outlying center, where he had been intubated for opacification of the left lung secondary to unilateral lack of ventilation. In an adult
altered mental status after significant alcohol intoxication. male, the ETT should generally be inserted to a depth (to the lip line) of 22-24cm;
There were no reported signs of chest trauma, but the the corresponding depth range for an adult female is 21-23cm
patient now has decreased breath sounds on the left. His
vital signs are stable. Based upon the chest X-ray in the
figure, what is the next step in management of this
patient?
[image]
A. Nasogastric tube placement
B. Chest tube placement
C. Endotracheal tube adjustment
D. Needle decompression
A 25-year old female presents to the ED with dyspnea The answer is B. Helical CT studies of the pulmonary vasculature are
and chest pain. Chest CT, with contrast, is performed increasingly used for detection of pulmonary embolism. Though there are
and some pertinent "slices" are shown in the Figure. questions about CT's ability to detect small (e.g. subsegmental) emboli, CT
What is the diagnosis? scans have high sensitivity for proximal embolism such as that depicted in the
[image] accompanying figure. The patient whose images are shown was found to have
A. Aortic dissection, Type I moderate-severe right ventricular dysfunction and received thrombolytic therapy
in the ED - she had an excellent outcome.
B. Bilateral pulmonary embolism
C. Gas embolism
D. Acute Respiratory Distress Syndrome
The X-ray in the figure indicates: The answer is D. The patient is not intubated. The pathology in the right
[image] hemithorax appears as hyperdensity, rather than air density (not a
pneumothorax), and involves more than the right upper lobe.
A. Need to withdraw the endotracheal tube from the
mainstem
B. A chest radiograph that was taken with the patient
rotated
C. Right upper lobe pneumonia
D. Mediastinal shift due to fluid in the right hemithorax
Regarding the epidemiology of asthma in the United The answer is B. Despite an increase in asthma prevalence in the United States,
States, which of the following is true? Canada, Great Britain and Australia in the 1980s, the 1990s saw a decrease in
A. Etiology is thought to be genetic, not environmental prevalence in these areas. Regarding gender, male children are more likely than
female children to have asthma, however the reverse is true with adults. African-
B. Prevalence increased in the 1980's, and then Americans have a higher prevalence of asthma than Caucasians. Migrants who
decreased in the 1990's relocate from an area of low asthma prevalence to an area of high asthma
C. More common in males than females in adult and prevalence tend to have an increased prevalence of asthma suggesting a role for
pediatric populations environmental factors in the development of asthma.
D. Incidence is comparable for Caucasians and African-
Americans
Regarding pulsus paradoxus and asthma, which of the The answer is A. Pulsus paradoxus is defined as a fall in systolic blood pressure
following statement s is correct of greater than 10mm Hg upon inspiration. It is typically present during acute
A. The presence of pulsus paradoxis in asthma indicates asthma exacerbations in severe asthma; however, its absence does not rule out
severe disease severe disease. Although initially present, a pulsus paradoxus may disappear
B. Pulsus paradoxus is pathognomonic for asthma after only minimal improvement in air flow through the larger airways. Pulsus
C. The absence of pulsus paradoxis in asthma rules out parodoxus may occur in other diseases besides asthma (for example, pericardial
severe disease tamponade).
D. Pulsus paradoxus is a fall in systolic blood pressure
during inspiration
, SAEM - Emergency Medicine Exam
Which of the following is correct regarding the use of The answer is B. Oral and intravenous steroids are equally efficacious in treating
corticosteroids in acute asthma exacerbation? an asthma exacerbation. Yet, in the setting of a severe asthma exacerbation, a
A. Beneficial effects occur within the first hour of patient may have difficulty taking oral medications and the intravenous route is
administration. preferred
B. Inhaled steroids should be avoided
C. Intravenous steroids are superior to the oral route
D. Tapering is needed with all corticosteroid regimens
Which of the following is true regarding the treatment of The answer is C. Salmeterol is a long-acting beta2-selective adrenergic agonist
acute asthma exacerbation in the Emergency that has no role in the treatment of an acute asthma exacerbation, but it is
Department? frequently preferred for outpatient asthma management due to its BID dosing
A. Intramuscular terbutaline is preferred over intravenous schedule.
B. Heliox should only be used in the intubated patient.
C. Anticholinergics by inhalation may be beneficial
D. Intravenous albuterol may be indicated
Which of the following drugs is MOST beneficial in an The answer is C. Mucokinetic agents should not be used acutely in treatment of
acute COPD exacerbation? COPD exacerbation. These agents act to mobilize secretions, and this increases
A. Methylxanthines such as theophylline the work of the patient's breathing.
B. Steroids such as solumedrol
C. Beta adrenergic agonists such as albuterol
D. Mucokinetic agents such as acetylcysteine
Regarding the pathogens involved in community- The answer is A. Co-infection with multiple bacteria, such as Chlamydia and S.
acquired pneumonia, which of the pneumoniae, is a well-recognized occurrence and should be sought out to
following is true? ensure appropriate antibiotic coverage.
A. Co-infection with multiple bacteria, such as Chlamydia
and Strep pneumoniae commonly occur
B. Etiologic agents for patients admitted to the ICU with
pneumonia most commonly include Neisseria
meningitidis and Strep pneumoniae
C. Milder cases of community acquired pneumonia are
frequently caused by Chlamydia
D. Q fever, caused by Coxiella burnetii, may present as
pneumonia, particularly in patients exposed to rabbits
Which of the following patients is the most likely to The answer is D. Otitis media has not been associated with the development of
develop S. pneumoniae pneumonia? S. pneumoniae pneumonia. The most common pathogen in community-acquired
pneumonia, S. pneumoniae, is found in the nasopharynx of 40% of adults.
A. 59 year old woman who is a cigarette smoker. Persons at risk for developing S. pneumoniae pneumonia include the elderly
B. 61 year old man with hypertension (>65), and those with a history of alcoholism, diabetes, cardiovascular disease,
C. 65 year old woman with no past medical history splenectomy, sickle cell disease, malignancy, and immunosuppressive disorders.
D. 64 year old man with type 2 diabetes Vaccination is recommended for all people at increased risk.
Regarding the etiology of viral pneumonia, which of the The answer is B. Varicella zoster virus (VZV), the etiologic agent of chicken pox,
following is true? more commonly presents as pneumonia in adults, especially smokers or
A. Influenza virus is the most common cause of viral pregnant women. Influenza outbreaks, which occur in winter months, may cause
pneumonia in children up to 40,000 deaths annually in the United States with elderly people making up
more than 90% of the victims.
B. Cytomegalovirus does not usually cause pneumonia
in immunocompetent adults
C. Parainfluenza virus is the most common cause of viral
pneumonia in adults
D. Varicella zoster causes pneumonia more frequently in
children than in adults
Regarding mycobacterium tuberculosis (TB), which of The answer is B. TB causes more deaths worldwide than any other infectious
the following is TRUE? agent. Approximately one-third of the world's population is infected with TB. In
A. Worldwide, approximately 45-50% of the population is the United States, only about 4-6% of the population is infected with TB. The
infected with TB incidence of TB infection in the United States began decreasing in the 1950s as
B. Worldwide, TB causes more deaths than any other a result of advancements in public health and pharmacologic treatments. Yet, the
infectious agent incidence has been rising since the 1980s, especially in poor, homeless, minority,
C. In the United States, approximately 12-15% of the and prison populations. The incidence of multi-drug resistant TB has been
population is infected with TB. gradually increasing, especially among AIDS patients.
D. In the United States, the incidence of TB has been
steadily increasing since the 1950s.
Which finding is commonly associated with pneumonia The answer is D. Klebsiella pneumoniae can cause severe pneumonia,
caused by Klebsiella pneumoniae? especially in the elderly or debilitated host. The mechanism of Klebsiella
A. Absence of sputum pneumoniae infection leads to a necrotizing, hemorrhagic process responsible
B. Encephalitis for the classic "currant-jelly" sputum. Abscess formation, empyema and
C. Low mortality bacteremia are frequent complications, and the mortality rate is high.
D. Empyema
, SAEM - Emergency Medicine Exam
Which of the following patients presenting to the The answer is D. The most common pathogens to generate cavitary lesions
emergency department with a chief complaint of include tuberculosis, anaerobic bacteria (common pathogens in aspiration
"shortness of breath" is most likely to have cavitary pneumonia), aerobic gram-negative bacilli, S. Aureus, and fungal disease. The
lesion with air-fluid levels on CXR? patient described in C has multiple risk factors for developing a cavitary
A. 64 year old female with history of congestive heart pneumonia, including a higher risk of tuberculosis from being homeless and a
failure higher risk of aspiration pneumonia due to alcoholism. Congestive heart failure
B. 54 year old male with history of recent myocardial would cause a diffuse pattern of edema on CXR
infarction
C. 32 year old female who is 36 weeks pregnant
D. 43 year old homeless male with history of alcohol
abuse
In the emergency department, regarding the disposition The answer is C. The decision whether to admit or discharge patients diagnosed
of patients diagnosed with pneumonia: with pneumonia in the emergency department is not straightforward. Despite
A. Patients over 50 years of age should be admitted numerous guidelines including those recommending admission for patients with
B. Patients under 2 years of age should be admitted co-morbid disease such as HIV, CHF, malignancy, renal disease, liver disease
C. Patients with co-morbidities should be admitted and others, the decision ultimately resides in the clinical judgment of the
D. Patients with normal vital signs should be discharged emergency department physician. Likewise, though most patients with normal
home vital signs are typically well enough to be treated as outpatients, circumstances
may exist in which this choice is not optimal, such as an elderly patient who lives
alone and has poor follow-up.
A 28 year old man is shot in the right chest. His vital The answer is A. The patient has a gunshot wound to the right chest near the
signs are: T 97.9, HR 120, BP 70/50, RR 12, SPO2 84%. sternum. His hypotension and JVD suggest an obstructive shock. Given the
He has significant JVD, his trachea is deviated to the left, tracheal deviation to the left and absent breath sound on the right, he most likely
and he has decreased breath sounds on the right. The has a tension pneumothorax. His emergent treatment includes needle
patient's diagnosis is: decompression followed by chest tube placement.
A. Tension pneumothorax
B. Spinal cord injury
C. Hypovolemic shock
D. Lung laceration
E. Cardiac tamponade
Which of the following are associated with a higher risk The answer is A. Physical exertion has not been associated with an increased
of spontaneous pneumothorax? risk of spontaneous pneumothorax.
A. Cigarette smoking
B. Female gender
C. Physical exertion
D. Trisomy 21
A radiographic finding that may be seen in an elderly The answer is D. Due to its wider diameter and the fact it forms a more obtuse
patient who aspirated food is: take-off angle with the trachea, the right mainstem bronchus is a more likely site
A. Visualization of the food bolus in the right mainstem of aspiration than the left mainstem bronchus in adults. On chest X-ray,
bronchus aspiration is more likely to be detected because of secondary signs, such as
B. An opacity in the right middle lobe bronchus hyperinflation or atelectasis of the involved lung, rather than direct visualization
C. Tension pneumothorax on the right, with leftward of the aspirated contents. In this clinical scenario, the adult patient may have
mediastinal shift aspirated food into the right mainstem bronchus. One would therefore expect
D. Hyperinflation of the left lung either atelectasis (collapse) or hyperinflation on the right side. The lobar
bronchus to the right middle lobe has an acute take-off angle and poor collateral
ventilation, which make it prone to atelectasis. Thus, it is the part of the right lung
most likely to exhibit atelectasis after an aspiration event.
A 7 year old girl is brought in by her father complaining of The answer is D. Antibiotics are not indicated for allergic reactions. Inhaled
difficulty breathing after being stung by a bee. She is racemic epinephrine decreases inflammation of the airways and promotes
otherwise in good health. Neither she nor her father bronchodilation. Heliox decreases turbulence of air flow to facilitate air movement
recall whether she has been stung previously, but state into the airways. Albuterol nebulizer is a beta-agonist that causes
she has never before had a reaction like this. Which of bronchodilation, and intravenous cimetidine is an antihistamine that helps
the following treatments would be inappropriate? mitigate the allergic response.
A. inhaled racemic epinephrine
B. albuterol nebulizer
C. heliox by face mask
D. intravenous antibiotics
Regarding the diagnosis of pulmonary embolism (PE), The answer is D. Up to two-thirds of patients with PE have no symptoms of DVT.
which is correct. PE is also found in about half of patients who have DVT but who do not have
A. Autospsy studies indicate that approximately 30% of symptoms of PE. Thus, the presence or absence of DVT or symptoms of DVT
patients who die in the hospital have undiagnosed PE does not correlate well with the finding of PE.
B. By 80 years of age, one out of four people will develop
deep venous thrombosis
C. One-year mortality of PE is 25% even with early
diagnosis and treatment
D. Pulseless electrical activity in Emergency Department
cardiac arrest victims is associated with PE in 33%
