AEM - Shock and Sepsis, Environment and
Endocrine, Pulm Emergencies questions with correct
answers
A 32 year old woman walks into the emergency department two weeks
after a fall from a bus. She tripped stepping off the bus and landed with
her right hip on the last stair. The fall was only a few feet in distance.
She noted very little immediate pain, and there was no pain at all by the
next day. However, the next week her right hip began to "burn." After a
day's burning sensation she developed a rash involving the hip region
(see Figure). She denies any chest pain, shortness of breath, nausea or
vomiting. Physical examination shows a unilateral, erythematous,
maculopapular rash extending from below her umbilicus to her back in a
band-like pattern. There are no open lesions or cuts. What is the
appropriate management of this patient?
[image]
Figure courtesy of eMedicine.com
A. Obtain an X-ray for fat emboli.
B. Discharge home with a first-generation cephalosporin for a bacterial
process.
C. Discharge home for res Correct Answer-analgesics and antiviral;
herpes zoster can be brought on by minor trauma
A 58 year old construction worker who has no primary care doctor
comes to the emergency department because of a non-pruritic rash above
his ankles (see Figure). Physical examination reveals bilateral
erythematous and swollen ankles that are mildly warm but non-tender to
touch. His overlying skin of both legs show mild scaling and thickened
skin. There is no puncture site or visible opening in the skin, although he
,has prominent varicose veins bilaterally (see Figure). His temperature is
37C (98.6F). He appears to be in no acute distress. What is the most
likely diagnosis?
[image]
Figure courtesy of eMedicine.com
A. eczema
B. cellulitis
C. psoriasis
D. necrotizing fasciitis
E. stasis dermatitis Correct Answer-e; The syndrome described is the
spectrum of erythema multiforme/Stevens-Johnson syndrome/toxic
epidermal necrolysis. Although the etiology is not always clear, many
drugs (including sulfa antibiotics, penicillins, and barbiturates), viral or
Mycoplasma infections, and recent immunization have been implicated.
Corticosteroids are a controversial adjunct in treatment, but have not
been implicated as a cause of the disease.
A patient with no medical history presents to the emergency department
for a second opinion. Nearly a week ago, there was a rapid onset of
malaise, headache, backache, and fever. A rash began to appear on the
leg a few days after the initial symptoms and the patient presented to a
hospital-affiliated walk-in clinic for assessment. The patient had no
respiratory symptoms but was noted to have some lesions on the tongue.
At the time of his assessment at the walk-in clinic, the fever had
resolved and the patient was diagnosed as having a viral syndrome. At
the walk-in clinic, a digital photograph of the rash was taken and
inserted into his computer records (see top of Figure). It is now 3 days
,after the initial walk-in clinic visit. You are working in the emergency
department where the patient presents complaining of a recurrence of
high fevers and a spread of the rash which now involves the face,
extremities, and torso Correct Answer-e;
A patient develops a rash that starts as multiple bilateral target-like
macules and papules on the palms and soles. It progresses to widespread
sloughing of the skin requiring admission to the burn unit. Which of the
following etiologic agents has NOT been implicated in this syndrome?
A. penicillins
B. sulfa antibiotics
C. barbiturates
D. recent immunization
E. corticosteroids Correct Answer-e;
A 53 year old man with non-insulin dependent diabetes mellitus presents
with pain, redness, and swelling of the right foot and lower leg,
accompanied by a temperature of 102. X-rays reveal no subcutaneous
gas and show no evidence of osteomyelitis. The patient has been
admitted on three previous occasions for cellulitis of the right foot and
notes that this episode is identical. Which of the following antibiotics is
the most appropriate initial therapy for a presumed diagnosis of
cellulitis?
A. intravenous nafcillin
B. intravenous cefazolin
, C. oral dicloxacillin
D. intravenous ampicillin-sulbactam
E. intravenous gentamicin Correct Answer-d; Gram-positive bacteria
(Streptococcus species and S. aureus) most commonly cause cellulitis in
non-diabetic hosts. Penicillinase-resistant penicillins (e.g. dicloxacillin,
nafcillin, oxacillin) or 1st-generation cephalosporins (cephalexin,
cefazolin) can effectively treat cellulitis. However, in diabetics with
recurrent cellulitis, the infection is more likely to be polymicrobial and
involve gram-negative organisms. A broader-spectrum antibiotic (e.g.
ampicillin-sulbactam) with coverage of gram-positive and gram-
negative bacteria is recommended
Which of the following is FALSE regarding the common skin disorder,
seborrheic dermatitis?
A. differential diagnosis includes Tinea capitis, psoriasis of scalp,
cutaneous lupus erythematosus
B. uncommon between infancy and puberty
C. found in skin folds and hair-bearing of face scalp, chest and groin
D. characterized by erythema and waxy scaling
E. initial therapy often consists of high dose topical steroids Correct
Answer-E; Initial therapy for seborrheic dermatitis is application of anti-
dandruff shampoo lathered onto the area and left on for 5-10 minutes.
Shampoos can contain zinc pyrethrin (Head and Shoulders), selenium
sulfide (Selsun Blue), salicylic acid (Neutrogena T-Sal) or tar (Polytar or
Neutrogena T-Gel).e
Endocrine, Pulm Emergencies questions with correct
answers
A 32 year old woman walks into the emergency department two weeks
after a fall from a bus. She tripped stepping off the bus and landed with
her right hip on the last stair. The fall was only a few feet in distance.
She noted very little immediate pain, and there was no pain at all by the
next day. However, the next week her right hip began to "burn." After a
day's burning sensation she developed a rash involving the hip region
(see Figure). She denies any chest pain, shortness of breath, nausea or
vomiting. Physical examination shows a unilateral, erythematous,
maculopapular rash extending from below her umbilicus to her back in a
band-like pattern. There are no open lesions or cuts. What is the
appropriate management of this patient?
[image]
Figure courtesy of eMedicine.com
A. Obtain an X-ray for fat emboli.
B. Discharge home with a first-generation cephalosporin for a bacterial
process.
C. Discharge home for res Correct Answer-analgesics and antiviral;
herpes zoster can be brought on by minor trauma
A 58 year old construction worker who has no primary care doctor
comes to the emergency department because of a non-pruritic rash above
his ankles (see Figure). Physical examination reveals bilateral
erythematous and swollen ankles that are mildly warm but non-tender to
touch. His overlying skin of both legs show mild scaling and thickened
skin. There is no puncture site or visible opening in the skin, although he
,has prominent varicose veins bilaterally (see Figure). His temperature is
37C (98.6F). He appears to be in no acute distress. What is the most
likely diagnosis?
[image]
Figure courtesy of eMedicine.com
A. eczema
B. cellulitis
C. psoriasis
D. necrotizing fasciitis
E. stasis dermatitis Correct Answer-e; The syndrome described is the
spectrum of erythema multiforme/Stevens-Johnson syndrome/toxic
epidermal necrolysis. Although the etiology is not always clear, many
drugs (including sulfa antibiotics, penicillins, and barbiturates), viral or
Mycoplasma infections, and recent immunization have been implicated.
Corticosteroids are a controversial adjunct in treatment, but have not
been implicated as a cause of the disease.
A patient with no medical history presents to the emergency department
for a second opinion. Nearly a week ago, there was a rapid onset of
malaise, headache, backache, and fever. A rash began to appear on the
leg a few days after the initial symptoms and the patient presented to a
hospital-affiliated walk-in clinic for assessment. The patient had no
respiratory symptoms but was noted to have some lesions on the tongue.
At the time of his assessment at the walk-in clinic, the fever had
resolved and the patient was diagnosed as having a viral syndrome. At
the walk-in clinic, a digital photograph of the rash was taken and
inserted into his computer records (see top of Figure). It is now 3 days
,after the initial walk-in clinic visit. You are working in the emergency
department where the patient presents complaining of a recurrence of
high fevers and a spread of the rash which now involves the face,
extremities, and torso Correct Answer-e;
A patient develops a rash that starts as multiple bilateral target-like
macules and papules on the palms and soles. It progresses to widespread
sloughing of the skin requiring admission to the burn unit. Which of the
following etiologic agents has NOT been implicated in this syndrome?
A. penicillins
B. sulfa antibiotics
C. barbiturates
D. recent immunization
E. corticosteroids Correct Answer-e;
A 53 year old man with non-insulin dependent diabetes mellitus presents
with pain, redness, and swelling of the right foot and lower leg,
accompanied by a temperature of 102. X-rays reveal no subcutaneous
gas and show no evidence of osteomyelitis. The patient has been
admitted on three previous occasions for cellulitis of the right foot and
notes that this episode is identical. Which of the following antibiotics is
the most appropriate initial therapy for a presumed diagnosis of
cellulitis?
A. intravenous nafcillin
B. intravenous cefazolin
, C. oral dicloxacillin
D. intravenous ampicillin-sulbactam
E. intravenous gentamicin Correct Answer-d; Gram-positive bacteria
(Streptococcus species and S. aureus) most commonly cause cellulitis in
non-diabetic hosts. Penicillinase-resistant penicillins (e.g. dicloxacillin,
nafcillin, oxacillin) or 1st-generation cephalosporins (cephalexin,
cefazolin) can effectively treat cellulitis. However, in diabetics with
recurrent cellulitis, the infection is more likely to be polymicrobial and
involve gram-negative organisms. A broader-spectrum antibiotic (e.g.
ampicillin-sulbactam) with coverage of gram-positive and gram-
negative bacteria is recommended
Which of the following is FALSE regarding the common skin disorder,
seborrheic dermatitis?
A. differential diagnosis includes Tinea capitis, psoriasis of scalp,
cutaneous lupus erythematosus
B. uncommon between infancy and puberty
C. found in skin folds and hair-bearing of face scalp, chest and groin
D. characterized by erythema and waxy scaling
E. initial therapy often consists of high dose topical steroids Correct
Answer-E; Initial therapy for seborrheic dermatitis is application of anti-
dandruff shampoo lathered onto the area and left on for 5-10 minutes.
Shampoos can contain zinc pyrethrin (Head and Shoulders), selenium
sulfide (Selsun Blue), salicylic acid (Neutrogena T-Sal) or tar (Polytar or
Neutrogena T-Gel).e
