emergency medicine rosh mock exam Questions And Answers Complete Study Solutions

A 14-year-old girl presents to the ED with agitation, hallucinations, and myalgias. Her father notes she has been sick recently with a viral upper respiratory illness. Upon attempting to drink water, she begins to choke and retch violently. To which of the following was she likely exposed? - *Skunk bite* not bat feces DX: rabies -Postexposure prophylaxis involves three steps, including wound care, passive immunization with human rabies immunoglobulin (HRIG) infiltrated around the wound and intramuscularly at a distant site, and active immunization with human diploid cell vaccine at day 0, 3, 7, and 14 A 20-year-old woman presents to the emergency department for chest pain. The pain started two days ago and worsens with breathing. It is associated with a dry cough, rhinorrhea, and sore throat. She has no medical or surgical history. She does not take any medications and has never had these symptoms before. Her vital signs include pulse 98 bpm, blood pressure 122/78 mm Hg, respiratory rate 14 breaths per minute, and oxygen saturation 96% on room air. Her physical exam is notable for mild diffuse chest tenderness to palpation, normal heart sounds, and a friction rub with inspiration and expiration. Her ECG is shown above. Her labs are notable for a troponin 0.03 ng/mL and ESR 6 mm/hr. What is the most likely diagnosis? - *Viral pleurisy* -most commonly occurs due to influenza, parainfluenza, coxsackievirus, and respiratory syncytial virus. Diagnosis is clinical and one of exclusion. 8pleural friction rubs can be heard w/inspiration & expiration*. TX NSAIDs -Costochondritis may cause pleuritic chest pain and tenderness on exam. However, it is not associated with a viral syndrome and primarily causes pain over the costochondral junctions, not diffusely as seen in this patient. A 22-year-old man presents to the ED with cyanosis after general anesthesia. The triage nurse checks his pulse oximetry and finds it to be 85% despite supplemental oxygen. Which of the following is the most likely diagnosis? - *Methemoglobinemia* -Methemoglobin cannot bind oxygen - impairs oxygen release from normal hemoglobin causing a leftward shift of the oxyhemoglobin dissociation curve -*caused by medications including amyl nitrite, benzocaine, dapsone, nitroglycerin, nitroprusside, phenazopyridine, quinines, and sulfonamide*-should always be considered in fire victims due to inhalation of nitrogen oxide in smoke or due to heatinduced denaturation of hemoglobin -sx: *cyanosis that doesn't improve w/o2* due to impaired oxygen delivery to the tissues -blood is chocolate brown *oxygen saturation measured by the pulse oximeter is often 85% while the blood gas demonstrates a normal oxygen saturation* A 22-year-old man presents to the emergency department with foot pain after landing on his foot improperly while playing basketball last night. Using the image, what is the diagnosis in this patient? - *jones fracture* transverse Fractures of the proximal fifth metatarsal or acute proximal diaphyseal fracture -*increased risk for malunion* -TX: immobilization in posterior splint & orthopedist referral within 3-5 days A 22-year-old man presents with pain, erythema and localized edema of the right thigh. An ultrasound of the area is shown w/ hyperechoic fat lobules in a cobblestone pattern w/hypoechoic edema. What is the next best step in management? - *outpatient abx* DX: cellulitis -most common organisms involved: Staphylococcus aureus (both methicillin sensitive and methicillin resistant) and streptococci species. -If nonpurulent cellulitis who are nontoxic and have no evidence of disease progression or underlying comorbidities can be treated with an outpatient course of cephalexin -Clindamycin or trimethoprim-sulfamethoxazole are appropriate options for patients with evidence of purulent cellulitis or risk factors for infection with MRSA. A 22-year-old man with no known past medical history presents with dyspnea and chest discomfort while playing soccer. He is currently asymptomatic. On examination, he is afebrile with a heart rate of 82 beats per minute, blood pressure 139/76 mm Hg and oxygen saturation 99% on room air. His lungs are clear to auscultation and he has a harsh midsystolic murmur that is worse with valsalva maneuver. Which of the following best describes his likely electrocardiogram findings? - *deep, narrow Q waves in the lateral and inferior leads w/tall R waves in V1-V2, large amplitude QRS complexes. * DX: HOCM - left ventricular hypertrophy which is often asymmetrical and more likely to involve the septum than the free ventricular wallA 22-year-old woman presents with dyspnea. She has a history of asthma and noted increased difficulty breathing starting yesterday. She says she has been using her albuterol inhaler every 15 minutes for the last four hours without relief. What laboratory abnormality is likely to be found in this patient? - *HYPOkalemia* Albuterol most common side effects include tremor and tachycardia. A 24-year-old mechanic presents to the Emergency Department with severe pain and swelling of his left middle finger. He thinks he may have injured it while removing a nail from a tire a few days ago. Which of the following is consistent with the diagnosis of infectious flexor tenosynovitis? - *Digit flexed at rest* to minimize pain -tenderness along course of flexor tendon -uniform(fusiform) or symmetrical swelling of finger -pain w/passive *ROM*, and actually w/passive extension rather than w/flexion -Because infection can spread rapidly into the deep hand spaces, *early intravenous antibiotics *(including coverage for methicillin-resistant S. aureus) are indicated along with consultation from a hand surgeon.