SAEM 241 – 390 Exam 2024 Questions and Answers

SAEM 241 – 390 Exam 2024 Questions and Answers A 32 year old male, intravenous heroin abuser, presents with a one-day history of mid-back pain, progressive weakness of his legs, and an inability to urinate. He has a temperature of 38.3° C (100.8° F). On exam, absent patellar deep tendon reflexes are noted, he cannot stand or walk, a distended bladder is palpable, and he has tenderness to palpation over his T10 and T11 vertebrae. Which of the following is not an acceptable next step? A. MRI of the spine B. Analgesia C. Foley catheter to drain the bladder D. Hospital admission for neurosurgical consultation in the morning E. Antibiotics to cover a broad spectrum of organism - Answer ️️ -D. Hospital admission for neurosurgical consultation in the morning he answer is D. A spinal epidural abscess is a neurosurgical emergency, with the outcome being dependent on the speed of diagnosis and surgical decompression. Consequently, urgent neurosurgical evaluation is required. Although an uncommon disease, intravenous drug abuse, diabetes mellitus, chronic renal failure, and immunosuppression are risk factors for its development. Antibiotics to cover Staph. aureus, the most common cause, gram negative bacteria, and anaerobes are needed. Bladder decompression for symptomatic relief is important, as is analgesia Which of the following is true about myasthenia gravis? A. It typically presents as an ascending weakness of the peripheral nervous system. B. A myasthenic crisis involves an exacerbation of weakness, especially of respiratory muscles, often necessitating intubation. C. Weakness improves as the involved muscles are used repeatedly. D. The "atropine test" is diagnostic when 0.5 mg of atropine is given intravenously and the patient's symptoms improve within two minutes. E. Cooling exacerbates the symptoms, and heat alleviates them. - Answer ️️ -B. A myasthenic crisis involves an exacerbation of weakness, especially of respiratory muscles, often necessitating intubation. The answer is B. Myasthenia gravis is an autoimmune disease that results from antibodies directed against the acetylcholine receptor (AChR) at the neuromuscular junction. Destruction of the AchR leads to fewer receptors available to bind acetylcholine, with a resulting muscle weakness. Ocular symptoms are usually the first to occur, with diplopia and ptosis being common. The disease typically worsens as the day progresses because of repeated use of the muscles involved. Diagnosis is made with the tensilon test, where edrophonium is given and the patient's symptoms are observed to transiently improve. The administration of atropine is not a diagnostic test. Cooling helps the symptoms and heat exacerbates them. A myasthenic crisis is a feared complication. Patients develop respiratory failure requiring intubation, frequently for prolonged periods. A 36 year old woman on chronic cyclosporine treatment for bilateral lung transplantation visits the emergency department complaining of extreme headache, nausea and vomiting. Her exam is notable for BP 239/165, normal cardiac exam, bibasilar pulmonary rales, and 1+ lower extremity edema. EKG showed asymmetric inverted T-waves in I, aVL, and V4-6. In an effort to acutely control her blood pressure, which of the following is TRUE? A. Hydralazine decreases myocardial oxygen demand by decreasing afterload and would not be useful in this setting B. Nitroprusside would be contraindicated in this patient due to its relatively slow onset of action C. Nitroglycerin decreases BP by decreasing venous re